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Dzhalilova D, Makarova O. Differences in Tolerance to Hypoxia: Physiological, Biochemical, and Molecular-Biological Characteristics. Biomedicines 2020; 8:E428. [PMID: 33080959 PMCID: PMC7603118 DOI: 10.3390/biomedicines8100428] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 02/07/2023] Open
Abstract
Hypoxia plays an important role in the development of many infectious, inflammatory, and tumor diseases. The predisposition to such disorders is mostly provided by differences in basic tolerance to oxygen deficiency, which we discuss in this review. Except the direct exposure of different-severity hypoxia in decompression chambers or in highland conditions, there are no alternative methods for determining organism tolerance. Due to the variability of the detection methods, differences in many parameters between tolerant and susceptible organisms are still not well-characterized, but some of them can serve as biomarkers of susceptibility to hypoxia. At the moment, several potential biomarkers in conditions after hypoxic exposure have been identified both in experimental animals and humans. The main potential biomarkers are Hypoxia-Inducible Factor (HIF)-1, Heat-Shock Protein 70 (HSP70), and NO. Due to the different mechanisms of various high-altitude diseases, biomarkers may not be highly specific and universal. Therefore, it is extremely important to conduct research on hypoxia susceptibility biomarkers. Moreover, it is important to develop a method for the evaluation of organisms' basic hypoxia tolerance without the necessity of any oxygen deficiency exposure. This can contribute to new personalized medicine approaches' development for diagnostics and the treatment of inflammatory and tumor diseases, taking into account hypoxia tolerance differences.
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Affiliation(s)
- Dzhuliia Dzhalilova
- Department of Immunomorphology of Inflammation, Federal State Budgetary Institution ‘Research Institute of Human Morphology’, Moscow 117418, Russia;
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Quantitative Assessment of Blood Lactate in Shock: Measure of Hypoxia or Beneficial Energy Source. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2608318. [PMID: 33150168 PMCID: PMC7603544 DOI: 10.1155/2020/2608318] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/18/2020] [Indexed: 12/16/2022]
Abstract
Blood lactate concentration predicts mortality in critically ill patients and is clinically used in the diagnosis, grading of severity, and monitoring response to therapy of septic shock. This paper summarizes available quantitative data to provide the first comprehensive description and critique of the accepted concepts of the physiology of lactate in health and shock, with particular emphasis on the controversy of whether lactate release is simply a manifestation of tissue hypoxia versus a purposeful transfer ("shuttle") of lactate between tissues. Basic issues discussed include (1) effect of nonproductive lactate-pyruvate exchange that artifactually enhances flux measurements obtained with labeled lactate, (2) heterogeneous tissue oxygen partial pressure (Krogh model) and potential for unrecognized hypoxia that exists in all tissues, and (3) pathophysiology that distinguishes septic from other forms of shock. Our analysis suggests that due to exchange artifacts, the turnover rate of lactate and the lactate clearance are only about 60% of the values of 1.05 mmol/min/70 kg and 1.5 L/min/70 kg, respectively, determined from the standard tracer kinetics. Lactate turnover reflects lactate release primarily from muscle, gut, adipose, and erythrocytes and uptake by the liver and kidney, primarily for the purpose of energy production (TCA cycle) while the remainder is used for gluconeogenesis (Cori cycle). The well-studied physiology of exercise-induced hyperlactatemia demonstrates massive release from the contracting muscle accompanied by an increased lactate clearance that may occur in recovering nonexercising muscle as well as the liver. The very limited data on lactate kinetics in shock patients suggests that hyperlactatemia reflects both decreased clearance and increased production, possibly primarily in the gut. Our analysis of available data in health and shock suggests that the conventional concept of tissue hypoxia can account for most blood lactate findings and there is no need to implicate a purposeful production of lactate for export to other organs.
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103
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Mamouei M, Budidha K, Baishya N, Qassem M, Kyriacou P. Comparison of wavelength selection methods for in-vitro estimation of lactate: a new unconstrained, genetic algorithm-based wavelength selection. Sci Rep 2020; 10:16905. [PMID: 33037265 PMCID: PMC7547666 DOI: 10.1038/s41598-020-73406-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 09/08/2020] [Indexed: 12/12/2022] Open
Abstract
Biochemical and medical literature establish lactate as a fundamental biomarker that can shed light on the energy consumption dynamics of the body at cellular and physiological levels. It is therefore, not surprising that it has been linked to many critical conditions ranging from the morbidity and mortality of critically ill patients to the diagnosis and prognosis of acute ischemic stroke, septic shock, lung injuries, insulin resistance in diabetic patients, and cancer. Currently, the gold standard for the measurement of lactate requires blood sampling. The invasive and costly nature of this procedure severely limits its application outside intensive care units. Optical sensors can provide a non-invasive, inexpensive, easy-to-use, continuous alternative to blood sampling. Previous efforts to achieve this have shown significant potential, but have been inconclusive. A measure that has been previously overlooked in this context, is the use of variable selection methods to identify regions of the optical spectrum that are most sensitive to and representative of the concentration of lactate. In this study, several wavelength selection methods are investigated and a new genetic algorithm-based wavelength selection method is proposed. This study shows that the development of more accurate and parsimonious models for optical estimation of lactate is possible. Unlike many existing methods, the proposed method does not impose additional locality constraints on the spectral features and therefore helps provide a much more granular interpretation of wavelength importance.
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Affiliation(s)
- Mohammad Mamouei
- Research Centre for Biomedical Engineering, Department of Electrical and Electronic Engineering, School of Mathematics, Computer Science and Engineering, City, University of London, London, UK.
| | - Karthik Budidha
- Research Centre for Biomedical Engineering, Department of Electrical and Electronic Engineering, School of Mathematics, Computer Science and Engineering, City, University of London, London, UK
| | - Nystha Baishya
- Research Centre for Biomedical Engineering, Department of Electrical and Electronic Engineering, School of Mathematics, Computer Science and Engineering, City, University of London, London, UK
| | - Meha Qassem
- Research Centre for Biomedical Engineering, Department of Electrical and Electronic Engineering, School of Mathematics, Computer Science and Engineering, City, University of London, London, UK
| | - Panayiotis Kyriacou
- Research Centre for Biomedical Engineering, Department of Electrical and Electronic Engineering, School of Mathematics, Computer Science and Engineering, City, University of London, London, UK
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104
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Oh CH, Kim JW, Kim GH, Lee KR, Hong DY, Park SO, Baek KJ, Kim SY. Serum Lactate Could Predict Mortality in Patients With Spontaneous Subarachnoid Hemorrhage in the Emergency Department. Front Neurol 2020; 11:975. [PMID: 33013645 PMCID: PMC7499023 DOI: 10.3389/fneur.2020.00975] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 07/27/2020] [Indexed: 01/28/2023] Open
Abstract
Background: Serum lactate is a useful biomarker for prediction of mortality in critically ill patients. The purpose of this study was to identify if serum lactate could be used as a biomarker for predicting mortality in patients with subarachnoid hemorrhage (SAH) in the emergency department. Methods: This retrospective study enrolled 189 patients. Baseline demographic data and clinical characteristics of patients were obtained from medical record review. Multiple logistic regression analysis was performed to determine predictor variables significantly associated with mortality. Receiver operating characteristic (ROC) curve analysis was used to evaluate the performance of variables for mortality prediction in SAH. Results: Using multivariate logistic regression analysis, age [OR 1.05; 95% confidence interval (CI) 1.00–1.10; p = 0.037], Hunt and Hess scale score (OR 3.29; 95% CI 1.62–6.70; p = 0.001), serum lactate level (OR 1.33; 95% CI 1.03–1.74; p = 0.032), and serum glucose level (OR 1.01; 95% CI 1.00–1.02; p = 0.049) predicted overall mortality in SAH. The area under the ROC curve (AUC) value for the use of serum lactate level to predict mortality in SAH was 0.815 (95% CI 0.753–0.868) (p < 0.001). Conclusion: Serum lactate may be a useful biomarker for the early prediction of mortality in SAH patients in the emergency department.
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Affiliation(s)
- Chang Hwan Oh
- Department of Emergency Medicine, Konkuk University Medical Center, School of Medicine, Konkuk University, Seoul, South Korea
| | - Jong Won Kim
- Department of Emergency Medicine, Konkuk University Medical Center, School of Medicine, Konkuk University, Seoul, South Korea.,Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, South Korea
| | - Geon Ha Kim
- Department of Neurology, College of Medicine, Ewha Womans University Mokdong Hospital, Ewha Womans University, Seoul, South Korea
| | - Kyeong Ryong Lee
- Department of Emergency Medicine, Konkuk University Medical Center, School of Medicine, Konkuk University, Seoul, South Korea
| | - Dae Young Hong
- Department of Emergency Medicine, Konkuk University Medical Center, School of Medicine, Konkuk University, Seoul, South Korea
| | - Sang O Park
- Department of Emergency Medicine, Konkuk University Medical Center, School of Medicine, Konkuk University, Seoul, South Korea
| | - Kwang Je Baek
- Department of Emergency Medicine, Konkuk University Medical Center, School of Medicine, Konkuk University, Seoul, South Korea
| | - Sin Young Kim
- Department of Emergency Medicine, Konkuk University Medical Center, School of Medicine, Konkuk University, Seoul, South Korea
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105
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Lactate Kinetics Reflect Organ Dysfunction and Are Associated with Adverse Outcomes in Intensive Care Unit Patients with COVID-19 Pneumonia: Preliminary Results from a GREEK Single-Centre Study. Metabolites 2020; 10:metabo10100386. [PMID: 32998323 PMCID: PMC7599563 DOI: 10.3390/metabo10100386] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 09/18/2020] [Accepted: 09/26/2020] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease-19 (COVID-19) continues to be a health threat worldwide. Increased blood lactate is common in intensive care unit (ICU) patients; however, its association with outcomes in ICU COVID-19 patients remains currently unexplored. In this retrospective, observational study we assessed whether lactate is associated with outcomes in COVID-19 patients. Blood lactate was measured on ICU admission and thereafter daily up to day 14 in 45 patients with confirmed COVID-19 pneumonia. Acute physiology and chronic health evaluation (APACHE II) was calculated on ICU admission, and sequential organ failure assessment (SOFA) score was assessed on admission and every second day. The cohort was divided into survivors and non-survivors based on 28-day ICU mortality (24.4%). Cox regression analysis revealed that maximum lactate on admission was independently related to 28-day ICU mortality with time in the presence of APACHE II (RR = 2.45, p = 0.008). Lactate’s area under the curve for detecting 28-day ICU mortality was 0.77 (p = 0.008). Mixed model analysis showed that mean daily lactate levels were higher in non-survivors (p < 0.0001); the model applied on SOFA scores showed a similar time pattern. Thus, initial blood lactate was an independent outcome predictor in COVID-19 ICU patients. The time course of lactate mirrors organ dysfunction and is associated with poor clinical outcomes.
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106
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Abstract
Goal-directed therapy couples therapeutic interventions with physiologic and metabolic targets to mitigate a patient's modifiable risks for death and complications. Goal-directed therapy attempts to improve quality-of-care metrics, including length of stay, rate of readmission, and cost per case. Debate persists around specific parameters and goals, the risk profiles that may benefit, and associated therapeutic strategies. Goal-directed therapy has demonstrated reduced complication rates and lengths of stay in noncardiac surgery studies. Establishing goal-directed therapy's early promise and role in cardiac surgery-namely, producing fewer complications and deaths-will require larger studies, including those with greater focus on high-risk patients.
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Affiliation(s)
- Kevin W Lobdell
- Atrium Health Cardiothoracic Surgery, Atrium Health's Carolinas Medical Center, PO Box 32861, Charlotte, NC 28232, USA.
| | - Subhasis Chatterjee
- Department of Surgery, Baylor College of Medicine, One Baylor Plaza, MS: BCM 390, Houston, TX 77030, USA; Division of Cardiovascular Surgery, Texas Heart Institute, Houston, TX, USA. https://twitter.com/SXC71
| | - Michael Sander
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Giessen, Justus-Liebig University Giessen, Rudolf-Buchheim-Strasse 7, Giessen 35392, Germany; Charity Medical University, Berlin, Germany. https://twitter.com/Mich_San_d
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107
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Svedung Wettervik T, Engquist H, Howells T, Rostami E, Hillered L, Enblad P, Lewén A. Arterial lactate in traumatic brain injury - Relation to intracranial pressure dynamics, cerebral energy metabolism and clinical outcome. J Crit Care 2020; 60:218-225. [PMID: 32882604 DOI: 10.1016/j.jcrc.2020.08.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 04/21/2020] [Accepted: 08/13/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE High arterial lactate is associated with disturbed systemic physiology. Lactate can also be used as alternative cerebral fuel and it is involved in regulating cerebral blood flow. This study explored the relation of endogenous arterial lactate to systemic physiology, pressure autoregulation, cerebral energy metabolism, and clinical outcome in traumatic brain injury (TBI). METHOD A retrospective study including 115 patients (consent given) with severe TBI treated in the neurointensive care unit, Uppsala university hospital, Sweden, 2008-2018. Data from cerebral microdialysis, arterial blood gases, hemodynamics and intracranial pressure were analyzed the first ten days post-injury. RESULTS Arterial lactate peaked on day 1 post-injury (mean 1.7 ± 0.7 mM) and gradually decreased. Higher arterial lactate correlated with lower age (p-value < 0.05), higher Marshall score (p-value < 0.05) and higher arterial glucose (p-value < 0.001) in a multiple regression analysis. Higher arterial lactate was associated with poor pressure autoregulation (p-value < 0.01), but not to worse cerebral energy metabolism. Higher arterial lactate was also associated with unfavorable clinical outcome (p-value < 0.05). CONCLUSIONS High endogenous arterial lactate is a biomarker of poor systemic physiology and may disturb cerebral blood flow autoregulation.
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Affiliation(s)
- Teodor Svedung Wettervik
- Department of Neuroscience, Section of Neurosurgery, Uppsala University, Uppsala SE-751 85, Sweden.
| | - Henrik Engquist
- Department of Surgical Sciences/Anesthesia and Intensive Care, Uppsala University, Uppsala SE-751 85, Sweden
| | - Timothy Howells
- Department of Neuroscience, Section of Neurosurgery, Uppsala University, Uppsala SE-751 85, Sweden
| | - Elham Rostami
- Department of Neuroscience, Section of Neurosurgery, Uppsala University, Uppsala SE-751 85, Sweden
| | - Lars Hillered
- Department of Neuroscience, Section of Neurosurgery, Uppsala University, Uppsala SE-751 85, Sweden
| | - Per Enblad
- Department of Neuroscience, Section of Neurosurgery, Uppsala University, Uppsala SE-751 85, Sweden
| | - Anders Lewén
- Department of Neuroscience, Section of Neurosurgery, Uppsala University, Uppsala SE-751 85, Sweden
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108
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Ho KKY, Peng YW, Ye M, Tchouta L, Schneider B, Hayes M, Toomasian J, Cornell M, Rojas-Pena A, Charpie J, Chen H. Evaluation of an Anti-Thrombotic Continuous Lactate and Blood Pressure Monitoring Catheter in an In Vivo Piglet Model undergoing Open-Heart Surgery with Cardiopulmonary Bypass. CHEMOSENSORS (BASEL, SWITZERLAND) 2020; 8:56. [PMID: 35310780 PMCID: PMC8932942 DOI: 10.3390/chemosensors8030056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Blood lactate and blood pressure measurements are important predictors of life-threatening complications after infant open-heart surgeries requiring cardiopulmonary bypass (CPB). We have developed an intravascular nitric oxide (NO)-releasing 5-Fr catheter that contains a lactate sensor for continuous in-blood lactate monitoring and a dedicated lumen for third-party pressure sensor attachment. This device has antimicrobial and antithrombotic properties and can be implanted intravascularly. The importance of this design is its ability to inhibit thrombosis, due to the slow release of NO through the surface of the catheter and around the electrochemical lactate sensors, to allow continuous data acquisition for more than 48 h. An in vivo study was performed using six piglets undergoing open-heart surgery with CPB and cardioplegic arrest, in order to mimic intra-operative conditions for infants undergoing cardiac surgery with CPB. In each study of 3 h, two 5-Fr NO-releasing lactate and blood-pressure monitoring catheters were implanted in the femoral vessels (arteries and veins) and the CPB circuitry to monitor changing lactate levels and blood pressures during and immediately after aortic cross-clamp removal and separation from CBP. Electrical signals continuously acquired through the sensors were processed and displayed on the device's display and via Bluetooth to a computer in real-time with the use of a two-point in vivo calibration against blood gas results. The study results show that lactate levels measured from those sensors implanted in the CPB circuit during CPB were comparable to those acquired by arterial blood gas measurements, whereas lactate levels measured from sensors implanted in the femoral artery were closely correlated with those acquired intermittently by blood gas prior to CPB initiation, but not during CPB. Blood pressure sensors attached to one lumen of the device displayed accurate blood pressure readings compared to those measured using an FDA approved pressure sensor already on the market. We recommend that the sensor be implanted in the CPB's circuit to continuously monitor lactate during CPB, and implanted in the femoral arteries or jugular veins to monitor lactate before and after CPB. Blood pressures dramatically drop during CPB due to lower blood flow into the lower body, and we suspect that the femoral arteries are likely collapsing or constricting on the implanted catheter and disrupting the sensor-to-blood contact. This study shows that the device is able to accurately and continuously monitor lactate levels during CPB and potentially prevent post-surgery complications in infants.
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Affiliation(s)
| | - Yun-Wen Peng
- Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan, Ann Arbor, MI 48109, USA
| | - Minyi Ye
- Biocrede Inc., Plymouth, MI 48170, USA
| | - Lise Tchouta
- Extracorporeal Life Support Laboratory, Department of Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Bailey Schneider
- Extracorporeal Life Support Laboratory, Department of Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - McKenzie Hayes
- Extracorporeal Life Support Laboratory, Department of Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - John Toomasian
- Extracorporeal Life Support Laboratory, Department of Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Marie Cornell
- Extracorporeal Life Support Laboratory, Department of Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Alvaro Rojas-Pena
- Extracorporeal Life Support Laboratory, Department of Surgery, University of Michigan, Ann Arbor, MI 48109, USA
- Section of Transplantation, Department of Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - John Charpie
- Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan, Ann Arbor, MI 48109, USA
| | - Hao Chen
- Biocrede Inc., Plymouth, MI 48170, USA
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Abstract
The basis of all metabolic processes in the human body is the production and metabolism of carriers of energy. Lactate is the end-product of anaerobic glycolysis. Lactate can serve as a substrate for gluconeogenesis and as an oxidation substrate. Hyperlactatemia can be detected as the result of a multitude of acute events (e.g. shock, sepsis, cardiac arrest, trauma, seizure, ischemia, diabetic ketoacidosis, thiamine deficiency, liver failure and intoxication). Hyperlactatemia can be associated with increased mortality, therefore in emergency medicine the search for the cause of hyperlactatemia is just as important as an effective causal treatment. Repetitive measurements of lactate are components of several treatment algorithms as observation of the dynamic development of blood lactate concentrations can help to make a better assessment of the acute medical condition of the patient and to evaluate the effectiveness of the measures undertaken.
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110
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Gao F, Huang XL, Cai MX, Lin MT, Wang BF, Wu W, Huang ZM. Prognostic value of serum lactate kinetics in critically ill patients with cirrhosis and acute-on-chronic liver failure: a multicenter study. Aging (Albany NY) 2020; 11:4446-4462. [PMID: 31259742 PMCID: PMC6660055 DOI: 10.18632/aging.102062] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 06/25/2019] [Indexed: 12/23/2022]
Abstract
Lactate clearance (Δ24Lac) was reported to be inversely associated with mortality in critically ill patients. The aim of our study was to assess the value of Δ24Lac for the prognosis of critically ill patients with cirrhosis and acute-on-chronic liver failure (ACLF). We analysed 954 cirrhotic patients with hyperlactatemia admitted to intensive care units (ICUs) in the United States and eastern China. The patients were followed up for at least 1 year. In the unadjusted model, we observed a 15% decrease in hospital mortality with each 10% increase in Δ24Lac. In the fully adjusted model, the relationship between the risk of death and Δ24Lac remained statistically significant (hospital mortality: odds ratio [OR] 0.84, 95% confidence interval [CI]: 0.78- 0.90, p < 0.001; 90-day mortality: hazard ratio [HR] 0.94, 95%CI 0.92- 0.97, p < 0.001; for Δ24Lac per 10% increase). Similar results were found in patients with ACLF. We developed a Δ24Lac-adjusted score (LiFe-Δ24Lac), which performed significantly better in the area under the receiver operating characteristic curves (AUROCs) than the original LiFe score for predicting mortality. Lactate clearance is an independent predictor of death, and the LiFe-Δ24Lac score is a practical tool for stratifying the risk of death.
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Affiliation(s)
- Feng Gao
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xie-Lin Huang
- Department of Gastroenterology Surgery, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Meng-Xing Cai
- Department of Cardiovascular Medicine, The Heart Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Miao-Tong Lin
- Department of Emergency Medicine, Intensive Care, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Bin-Feng Wang
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wei Wu
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhi-Ming Huang
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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111
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Bouobda GT, Gonzalez CE, Phipps RA, Middleton LP. Value Added Impact of Both Point-of-Care and Laboratory Lactic Acid Analysis When Emergently Evaluating Cancer Patients. Oncol Ther 2020; 8:277-284. [PMID: 32700044 PMCID: PMC7683647 DOI: 10.1007/s40487-020-00118-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Cancer patients are immunosuppressed and may present to an emergency department with atypical symptoms. In the emergency setting, it is important ascertain rapidly if lactic acid levels are high, either due to sepsis or tumor lysis syndrome, to effectively manage symptoms. Therefore, it is critical to determine the blood lactic acid level to timely identify who is at risk of sepsis and provide early intervention. We have compared blood lactic acid concentrations (BLAC) in cancer patients obtained by point-of-care testing (POCT) and those measured by laboratory analysis in blood samples drawn within a short time of each other. METHODS This was a retrospective study in cancer patients whose BLAC had been determined by POCT and laboratory analysis. Only those patients who had blood withdrawn for both testing methods within a 2-h timeframe were included in the study. Regressions were performed together with an analysis categorizing the BLAC from both testing methods. RESULTS A total of 274 patients met the criteria for the study. The BLAC from POCT correlated well with the values from laboratory testing (R = 0.925). Categorization of BLAC showed that 88.32% of the patients had BLAC that directly matched between the two tests; 28 (10.22%) patients had a normal BLAC according to laboratory analysis but a high BLAC on POCT; and four (1.46%) patients had a high BLAC according laboratory analysis but normal BLAC on POCT. CONCLUSIONS There was a high correlation between POCT and laboratory analysis values of BLAC in cancer patients, with the results from both testing methods agreeing 96% of the time. This finding suggests that POCT would suffice in most cases. Importantly, in 2% of the cancer patients who presented emergently, BLAC determined by POCT and laboratory analysis did not agree. Therefore, in subsequent decision-making, we recommend that if sepsis is suspected and BLAC determined by POCT is normal, nucleic acids, proteins, circulating cells, and interleukin-3 levels should also be obtained by POCT to confirm sepsis and/or rule out tumor lysis syndrome in patients with cancer.
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Affiliation(s)
| | | | - Ron A Phipps
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
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112
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Wernly B, Heramvand N, Masyuk M, Rezar R, Bruno RR, Kelm M, Niederseer D, Lichtenauer M, Hoppe UC, Bakker J, Jung C. Acidosis predicts mortality independently from hyperlactatemia in patients with sepsis. Eur J Intern Med 2020; 76:76-81. [PMID: 32143899 DOI: 10.1016/j.ejim.2020.02.027] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 02/15/2020] [Accepted: 02/24/2020] [Indexed: 02/07/2023]
Abstract
RATIONALE AND OBJECTIVES Acidosis and hyperlactatemia predict outcome in critically ill patients. We assessed BE and pH for risk prediction capabilities in a sub-group of septic patients in the MIMIC-III database. METHODS Associations with mortality were assessed by logistic regression analysis in 5586 septic patients. Baseline parameters, lactate concentrations, pH, and BE were analyzed at baseline and after 6 hours. MEASUREMENTS AND MAIN RESULTS We combined acidosis (defined as either BE ≤-6 and/or pH ≤7.3) and hyperlactatemia and split the cohort into three subgroups: low-risk (no acidosis and lactate <2.3 mmol/L; n = 2294), medium-risk (either acidosis or lactate >2.3 mmol/L; n = 2125) and high-risk (both acidosis and lactate >2.3 mmol/L; n = 1167). Mortality was 14%, 20% and 38% (p<0.001) in low-risk, medium-risk and high-risk patients, respectively. The predictiveness of this model (AUC 0.63 95%CI 0.61-0.65) was higher compared to acidosis (AUC 0.59 95%CI 0.57-0.61; p<0.001) and lactate >2.3 mmol/L (AUC 0.60 95%CI 0.58-0.62; p<0.001) alone. Hyperlactatemia alone was only moderately predictive for acidosis (AUC 0.60 95%CI 0.59-0.62). CONCLUSIONS Acidosis and hyperlactatemia can occur independently to a certain degree. Combining acidosis and hyperlactatemia in a model yielded higher predictiveness for ICU-mortality. Septic patients with acidosis should be treated even more aggressively in the future.
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Affiliation(s)
- Bernhard Wernly
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria; Division of Cardiology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Nadia Heramvand
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Maryna Masyuk
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Richard Rezar
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Raphael Romano Bruno
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; CARID, Cardiovascular Research Institute Düsseldorf, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - David Niederseer
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michael Lichtenauer
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Uta C Hoppe
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Jan Bakker
- Department of Intensive Care Adults, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Pulmonology and Critical Care, New York University Medical Center, New York, USA; Department of Pulmonology and Critical Care, Columbia University Medical Center, New York, USA; Department of Intensive Care, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Christian Jung
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.
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A comprehensive analysis of adult patients with secondary hemophagocytic lymphohistiocytosis: a prospective cohort study. Ann Hematol 2020; 99:2095-2104. [PMID: 32440790 DOI: 10.1007/s00277-020-04083-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 05/12/2020] [Indexed: 12/31/2022]
Abstract
Secondary hemophagocytic lymphohistiocytosis (HLH) is a rare but fatal condition with various underlying disorders in adult patients and is diagnosed based on the HLH-2004 criteria, which were established based on experience in pediatric patients. However, few studies have prospectively evaluated the treatment outcomes and diagnostic performance of HLH criteria in adult patients with secondary HLH. Thus, we performed a single-center, prospective cohort study of adult patients with suspected HLH, and we analyzed treatment outcomes of patients enrolled between 2017 and 2019 as an interim analysis ( ClinicalTrials.gov Identifier: NCT03117010). Of the 73 patients with suspected HLH, 70 patients completed the evaluation for ≥ 7 of the HLH-2004 criteria, and 55 patients were diagnosed with HLH (55/73, 75%). Although serum ferritin and fever had a sensitivity of more than 90%, both had exceptionally low specificity, whereas soluble CD25 had a sensitivity of more than 90% and specificity of 80%. Forty patients with malignancy-associated HLH had B cell (n = 19) or T- or NK-cell (n = 21) lymphoid malignancy, whereas 15 patients had non-malignant disorders. Non-malignancy-associated HLH had greater than 90% 1-year overall survival (OS) after diagnosis of HLH, whereas that for malignancy-associated HLH was less than 40%. In conclusion, our study showed promising treatment outcomes for patients enrolled in our prospective cohort study, and prospectively demonstrated the diagnostic performance of the HLH-2004 criteria in adult patients with suspected HLH. Given that lymphoma was the most common cause of HLH in adults, thorough evaluation for lymphoma should be performed in adults with suspected HLH.
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Posma RA, Frøslev T, Jespersen B, van der Horst ICC, Touw DJ, Thomsen RW, Nijsten MW, Christiansen CF. Prognostic impact of elevated lactate levels on mortality in critically ill patients with and without preadmission metformin treatment: a Danish registry-based cohort study. Ann Intensive Care 2020; 10:36. [PMID: 32219580 PMCID: PMC7098407 DOI: 10.1186/s13613-020-00652-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 03/16/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Lactate is a robust prognostic marker for the outcome of critically ill patients. Several small studies reported that metformin users have higher lactate levels at ICU admission without a concomitant increase in mortality. However, this has not been investigated in a larger cohort. We aimed to determine whether the association between lactate levels around ICU admission and mortality is different in metformin users compared to metformin nonusers. METHODS This cohort study included patients admitted to ICUs in northern Denmark between January 2010 and August 2017 with any circulating lactate measured around ICU admission, which was defined as 12 h before until 6 h after admission. The association between the mean of the lactate levels measured during this period and 30-day mortality was determined for metformin users and nonusers by modelling restricted cubic splines obtained from a Cox regression model. RESULTS Of 37,293 included patients, 3183 (9%) used metformin. The median (interquartile range) lactate level was 1.8 (1.2-3.2) in metformin users and 1.6 (1.0-2.7) mmol/L in metformin nonusers. Lactate levels were strongly associated with mortality for both metformin users and nonusers. However, the association of lactate with mortality was different for metformin users, with a lower mortality rate in metformin users than in nonusers when admitted with similar lactate levels. This was observed over the whole range of lactate levels, and consequently, the relation of lactate with mortality was shifted rightwards for metformin users. CONCLUSION In this large observational cohort of critically ill patients, early lactate levels were strongly associated with mortality. Irrespective of the degree of hyperlactataemia, similar lactate levels were associated with a lower mortality rate in metformin users compared with metformin nonusers. Therefore, lactate levels around ICU admission should be interpreted according to metformin use.
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Affiliation(s)
- Rene A Posma
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands. .,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
| | - Trine Frøslev
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Bente Jespersen
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Iwan C C van der Horst
- Department of Intensive Care, Maastricht University Medical Center+, Maastricht University, Maastricht, The Netherlands
| | - Daan J Touw
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Reimar W Thomsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Maarten W Nijsten
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
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Olaetxea I, Lopez E, Valero A, Seifert A. Determination of physiological lactate and pH by Raman spectroscopy. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:475-481. [PMID: 31945941 DOI: 10.1109/embc.2019.8856471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Lactate and pH values in human blood are important physiological parameters that can reflect serious pathological states as sepsis or hypoxia. In this study we demonstrate that we can determine lactate and pH values from blood samples by Raman spectroscopy combined with multivariate analysis at medically relevant resolution and reliability. The method prepares the base for new real-time in vivo analytics for a number of pathological cases and physiological control in competitive sports. We demonstrate the capability to resolve pH variations of 0.04 and lactate concentrations of 0.20 mM ex vivo.
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Shah SB, Bhargava AK, Hariharan U, Jain CR, Kulkarni A, Gupta N. Goal-directed fluid therapy using transoesophageal echocardiographic inferior venacaval index in patients with low left ventricular ejection fraction undergoing major cytoreductive surgery: A clinical trial. Saudi J Anaesth 2020; 14:7-14. [PMID: 31998013 PMCID: PMC6970374 DOI: 10.4103/sja.sja_215_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 05/02/2019] [Indexed: 01/23/2023] Open
Abstract
Background and Aims: This study aims to trans oesophageal echo cardiographically (TOE) measure inferior venacava diameter (IVCD) during inspiration and expiration in poor left ventricular ejection fraction (LVEF) patients undergoing cytoreductive oncosurgery, to ascertain if any correlation exists between, caval index (DeltaIVCD), and stroke volume variation (SVV), and to compare DeltaIVCD-guided versus SVV-guided fluid therapy. Methods: In this prospective, parallel group, interventional study, seventy American Society of Anesthesiologists-III patients, aged 30-75 years, weighing 40-90 kg, with LVEF ≤40% undergoing cytoreductive surgery were included and randomised to group-D (DeltaIVCD-guided fluid therapy) and group-S (SVV-guided fluid therapy). Patients with oesophageal lesions were excluded. After standard endotracheal anaesthesia, arterial and internal jugular vein catheters were placed. A TOE probe was inserted in the interventional group-D. Quantification of IVCD respiratory variations was done. Heart rate (HR), arterial oxygen saturation (SPO2), mean arterial pressure, end tidal carbondioxide (EtCO2), central venous pressure, SVV, IVCD, and urine output (UO) were recorded every 30 min. Post-operative arterial blood gas analysis, lung-ultrasound, chest-radiograph, and serum creatinine were done. Statistical Analysis: Pearson's correlation coefficient as measure of strength of linear relationship, calculation of regression equation, and unpaired t-test for normally distributed continuous variables were used. Results: A positive correlation between DeltaIVCD and SVV (r = 0.751) was observed. A regression equation was obtained for SVV (SVV = [0.317 × DeltaIVCD] + 5.877). Serum lactate, estimated glomerular filtration rate, HR, and UO were within normal limits in group-D. There was no pulmonary oedema. Conclusion: DeltaIVCD-guided intravenous fluid therapy is valuable in low LVEF patients where tight fluid control is essential and any fluid overload may precipitate cardiac failure.
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Affiliation(s)
- Shagun Bhatia Shah
- Department of Anaesthesia, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, Delhi, India
| | - Ajay Kumar Bhargava
- Department of Anaesthesia, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, Delhi, India
| | - Uma Hariharan
- Dr. Ram Manohar Lohia Hospital and PGIMER, CHS, New Delhi, India
| | - Chamound Rai Jain
- Department of Anaesthesia, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, Delhi, India
| | - Anita Kulkarni
- Department of Anaesthesia, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, Delhi, India
| | - Namrata Gupta
- Department of Anaesthesia, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, Delhi, India
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Hashim YM, Lin TL, Wang A, Dhillon NK, Veatch JM, Barmparas G, Singh G, Ley EJ. Quantifying the volume of fluid resuscitation required to normalize lactate in septic patients (Cohort Study). INTERNATIONAL JOURNAL OF SURGERY OPEN 2020. [DOI: 10.1016/j.ijso.2020.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kamel KS, Oh MS, Halperin ML. L-lactic acidosis: pathophysiology, classification, and causes; emphasis on biochemical and metabolic basis. Kidney Int 2020; 97:75-88. [DOI: 10.1016/j.kint.2019.08.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/01/2019] [Accepted: 08/20/2019] [Indexed: 11/30/2022]
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Rational engineering of Aerococcus viridansl-lactate oxidase for the mediator modification to achieve quasi-direct electron transfer type lactate sensor. Biosens Bioelectron 2019; 151:111974. [PMID: 31999581 DOI: 10.1016/j.bios.2019.111974] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 12/15/2019] [Accepted: 12/16/2019] [Indexed: 11/23/2022]
Abstract
The l-lactate oxidase (LOx) based lactate sensors are widely used for clinical diagnostics, sports medicine, and food quality control. However, dissolved oxygen interference and electroactive interferent effects are inherent issues of current lactate sensors. In this paper, a quasi-direct electron transfer (quasi-DET) type lactate sensor was developed using rationally engineered Aerococcus viridans LOx (AvLOx) modified with amine-reactive phenazine ethosulfate (PES). Since the modification of wild type AvLOx by PES did not result quasi-DET, engineered AvLOx with additional Lys residue was designed. The additional Lys residue was introduced by substituting residue locating on the surface of AvLOx, and within 20 Å of the isoalloxazine ring of FMN. Among several constructed mutants, Ala96Leu/Asn212Lys double mutant showed the highest dye-mediated dehydrogenase activity with negligible oxidase activity, showing quasi-DET properties after PES modification, when the enzyme was immobilized on screen printed carbon electrode. The constructed electrode did not show oxygen interference in cyclic voltammetric analysis and distinct catalytic current with 20 mM l-lactate. The sensor performance of a chronoamperometric l-lactate sensor employing PES modified Ala96Leu/Asn212Lys AvLOx, marked with linear range between 0 and 1 mM, with sensitivity of 13 μA/mM∙cm2, and a limit of detection of 25 μM for l-lactate. By applying -200 mV vs. Ag/AgCl, l-lactate could be monitored with negligible interference from 170 μM ascorbic acid, 1.3 mM acetaminophen, 1.4 mM uric acid or 20 mM glucose. These results indicated that a quasi-DET type lactate sensor was developed that did not suffer from the interference of oxygen and representative electroactive ingredient compounds.
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Scolletta S, Franchi F, Damiani E, Cennamo A, Domizi R, Meola A, Scorcella C, Vanoli D, Münch C, Adrario E, Marchetti L, Taccone FS, Donati A. Tissue oxygen saturation changes and postoperative complications in cardiac surgery: a prospective observational study. BMC Anesthesiol 2019; 19:229. [PMID: 31842777 PMCID: PMC6916088 DOI: 10.1186/s12871-019-0905-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 12/06/2019] [Indexed: 11/27/2022] Open
Abstract
Background Cardiac surgery with extracorporeal circulation (ECC) can induce microvascular dysfunction and tissue hypoperfusion. We hypothesized that the alterations in near-infrared spectroscopy (NIRS)-derived parameters would be associated with post-operative complications in cardiac surgery patients. Methods Prospective observational study performed at two University Hospitals. Ninety patients undergoing cardiac surgery with ECC were enrolled. The NIRS sensor was applied on the thenar eminence. A vascular occlusion test (VOT, 3-min ischemia) was performed at baseline (t0), at Intensive Care Unit (ICU) admission (t1), 3 (t2) and 6 (t3) hours later. Baseline tissue oxygen saturation (StO2), oxygen extraction rate and microvascular reactivity indices were calculated. Results In the first hours after cardiac surgery, StO2 tended to increase (86% [80–89] at T3 versus 82% [79–86] at T0, p = ns), while both tissue oxygen extraction and microvascular reactivity tended to decrease, as indicated by increasing occlusion slope (− 8.1%/min [− 11.2 to − 7] at T3 versus − 11.2%/min [− 13.9 to − 7.9] at T0, p = ns) and decreasing recovery slope (1.9%/sec [1.1–2.9] at T3 versus 3.1%/sec [2.3–3.9] at T0, p = ns). No substantial differences were found in NIRS-derived variables and their changes over time between patients with complications and those without complications. Conclusions Peripheral tissue oxygen extraction and microvascular reactivity were reduced during the first hours after cardiac surgery. NIRS-derived parameters were not able to predict complications in this population of cardiac surgery patients.
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Affiliation(s)
- Sabino Scolletta
- Department of Medicine, Surgery and Neuroscience, Anesthesia and Intensive Care Unit, University of Siena, Via Bracci 1, 53100, Siena, Italy.
| | - Federico Franchi
- Department of Medicine, Surgery and Neuroscience, Anesthesia and Intensive Care Unit, University of Siena, Via Bracci 1, 53100, Siena, Italy
| | - Elisa Damiani
- Department of Biomedical Sciences and Public Health, Clinic of Anesthesiology and Intensive Care, AOU Ospedali Riuniti di Ancona, Università Politecnica delle Marche, via Conca 71, 60126 Torrette di Ancona, Ancona, Italy
| | - Armando Cennamo
- Department of Medicine, Surgery and Neuroscience, Anesthesia and Intensive Care Unit, University of Siena, Via Bracci 1, 53100, Siena, Italy
| | - Roberta Domizi
- Department of Biomedical Sciences and Public Health, Clinic of Anesthesiology and Intensive Care, AOU Ospedali Riuniti di Ancona, Università Politecnica delle Marche, via Conca 71, 60126 Torrette di Ancona, Ancona, Italy
| | - Antonio Meola
- Department of Medicine, Surgery and Neuroscience, Anesthesia and Intensive Care Unit, University of Siena, Via Bracci 1, 53100, Siena, Italy
| | - Claudia Scorcella
- Department of Biomedical Sciences and Public Health, Clinic of Anesthesiology and Intensive Care, AOU Ospedali Riuniti di Ancona, Università Politecnica delle Marche, via Conca 71, 60126 Torrette di Ancona, Ancona, Italy
| | - Davide Vanoli
- Department of Medicine, Surgery and Neuroscience, Anesthesia and Intensive Care Unit, University of Siena, Via Bracci 1, 53100, Siena, Italy
| | - Christopher Münch
- Cardiac Anesthesia and Intensive Care Unit, AOU Ospedali Riuniti di Ancona, via Tronto 10/a, 60126 Torrette di Ancona, Ancona, Italy
| | - Erica Adrario
- Department of Biomedical Sciences and Public Health, Clinic of Anesthesiology and Intensive Care, AOU Ospedali Riuniti di Ancona, Università Politecnica delle Marche, via Conca 71, 60126 Torrette di Ancona, Ancona, Italy
| | - Luca Marchetti
- Department of Medicine, Surgery and Neuroscience, Anesthesia and Intensive Care Unit, University of Siena, Via Bracci 1, 53100, Siena, Italy
| | - Fabio Silvio Taccone
- Department of Intensive Care, Université Libre de Bruxelles, Hospital Erasme, Route de Lennik, 808 -, 1070, Brussels, Belgium
| | - Abele Donati
- Department of Biomedical Sciences and Public Health, Clinic of Anesthesiology and Intensive Care, AOU Ospedali Riuniti di Ancona, Università Politecnica delle Marche, via Conca 71, 60126 Torrette di Ancona, Ancona, Italy.
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Koozi H, Lengquist M, Frigyesi A. C-reactive protein as a prognostic factor in intensive care admissions for sepsis: A Swedish multicenter study. J Crit Care 2019; 56:73-79. [PMID: 31855709 DOI: 10.1016/j.jcrc.2019.12.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 11/24/2019] [Accepted: 12/09/2019] [Indexed: 01/08/2023]
Abstract
PURPOSE C-reactive protein (CRP) is not included in the major intensive care unit (ICU) prognostic tools such as the Simplified Acute Physiology Score (SAPS). We assessed CRP on ICU admission as a SAPS-3 independent risk marker for short-term mortality and length of stay (LOS) in ICU patients with sepsis. MATERIALS AND METHODS Adult ICU admissions satisfying the Sepsis-3 criteria to four southern Swedish hospitals were retrospectively identified and divided into a low CRP group (<100 mg/L) and a high CRP group (>100 mg/L) based on the admission CRP level. The standardized mortality ratio (SMR) was calculated. RESULTS A total of 851 admissions were included. The SMR was higher in the high CRP group (0.85 vs. 0.67, P = .001 in the whole sepsis group and 0.85 vs. 0.59, P = .003 in the culture-positive subgroup). The CRP levels also correlated with ICU and hospital LOS in survivors (P < .001 and P = .002), again independent of SAPS-3. CONCLUSION An admission CRP level >100 mg/L is associated with an increased risk of ICU and 30-day mortality as well as prolonged LOS in survivors, irrespective of morbidity measured with SAPS-3. Thus, CRP may be a simple, early marker for prognosis in ICU admissions for sepsis.
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Affiliation(s)
- Hazem Koozi
- Department of Clinical Medicine, Anesthesiology and Intensive Care, Lund University, SE-22185 Lund, Sweden
| | - Maria Lengquist
- Department of Clinical Medicine, Anesthesiology and Intensive Care, Lund University, SE-22185 Lund, Sweden; Skåne University Hospital, Intensive and Perioperative Care, SE-22185 Lund, Sweden
| | - Attila Frigyesi
- Department of Clinical Medicine, Anesthesiology and Intensive Care, Lund University, SE-22185 Lund, Sweden; Skåne University Hospital, Intensive and Perioperative Care, SE-22185 Lund, Sweden.
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McKenna HT, Murray AJ. Reconsidering critical illness as an uncharacterised acquired mitochondrial disorder. J Intensive Care Soc 2019; 21:102-104. [PMID: 32489404 DOI: 10.1177/1751143719892788] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Helen T McKenna
- Division of Surgery and Interventional Science, University College London, Royal Free Hospital, London, UK.,Intensive Care Unit, Royal Free Hospital, London, UK
| | - Andrew J Murray
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
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Hernandez-Avalos I, Mota-Rojas D, Mora-Medina P, Martínez-Burnes J, Casas Alvarado A, Verduzco-Mendoza A, Lezama-García K, Olmos-Hernandez A. Review of different methods used for clinical recognition and assessment of pain in dogs and cats. Int J Vet Sci Med 2019; 7:43-54. [PMID: 31819890 PMCID: PMC6882480 DOI: 10.1080/23144599.2019.1680044] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/07/2019] [Accepted: 10/09/2019] [Indexed: 12/28/2022] Open
Abstract
In light of the need to perform surgical techniques and the importance of animal welfare because of acute pain, the objectives of the veterinary anaesthetists are to manage muscle relaxation and adequate analgesia in order to conserve a balance in the autonomic nervous system, enhance the action of the parasympathetic system in the face of the emerging action of the sympathetic portion provoked by the surgeon, and maintain a balance among them. The aim of the present review is to describe different evaluation criteria for acute pain using unidimensional and multidimensional scales, correlating these findings to parasympathetic tone activity (PTA) and bispectral index (BIS) assessment, to conduct an objective evaluation of pain that patients (dog or cat) perceives, in order to administrate an adequate analgesic treatment in each case. In conclusion, this integral, objective evaluation will allow veterinarians – especially anaesthesiologists – to improve the management of pain in the patients.
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Affiliation(s)
| | - Daniel Mota-Rojas
- Neurophysiology of Pain, Behavior and Assessment of Welfare in Domestic Animals, DPAA, Universidad Autónoma Metropolitana (UAM), Mexico City, Mexico
| | - Patricia Mora-Medina
- Livestock Science Department, Universidad Nacional Autónoma de México (UNAM), FESC, Mexico
| | - Julio Martínez-Burnes
- Graduate and Research Department, Facultad de Medicina Veterinaria y Zootecnia, Universidad Autónoma de Tamaulipas, Victoria City, Tamaulipas, Mexico
| | - Alejandro Casas Alvarado
- Neurophysiology of Pain, Behavior and Assessment of Welfare in Domestic Animals, DPAA, Universidad Autónoma Metropolitana (UAM), Mexico City, Mexico
| | - Antonio Verduzco-Mendoza
- Departamento Bioterio y Cirugía Experimental, Instituto Nacional de Rehabilitación-Luis Guillermo Ibarra Ibarra (INR-LGII), Mexico City, Mexico
| | - Karina Lezama-García
- Neurophysiology of Pain, Behavior and Assessment of Welfare in Domestic Animals, DPAA, Universidad Autónoma Metropolitana (UAM), Mexico City, Mexico
| | - Adriana Olmos-Hernandez
- Departamento Bioterio y Cirugía Experimental, Instituto Nacional de Rehabilitación-Luis Guillermo Ibarra Ibarra (INR-LGII), Mexico City, Mexico
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Durand A, Cartier L, Duburcq T, Onimus T, Favory R, Preau S. [Causes, diagnosis and treatments of circulatory shocks]. Rev Med Interne 2019; 40:799-807. [PMID: 31668884 DOI: 10.1016/j.revmed.2019.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 08/02/2019] [Accepted: 08/14/2019] [Indexed: 12/12/2022]
Abstract
Shock states are the leading causes of intensive care admission and are nowadays associated with high morbidity and mortality. They are driven by a complex physiopathology and most frequently a multifactorial mechanism. They can be separated in whether a decrease of oxygen delivery (quantitative shock) or an abnormal cell distribution of cardiac output (distributive shock). Septic, cardiogenic and hypovolemic shocks represent more than 80% of shock etiologies. Clinical presentation is mostly characterized by frequent arterial hypotension and sign of poor clinical perfusion. Hyperlactatemia occurs in most of shock states. The diagnostic of shock or earlier reversible "pre-shock" states is urgent in order to initiate adequate therapy. Therefore, orientation and therapies must be discussed with intensive care physiologists in a multidisciplinary approach. Etiologic investigation and correction is a primary concern. Hemodynamic and respiratory support reflect another part of initial therapy toward normalization of cell oxygenation. Fluid resuscitation is the corner stone part of initial therapy of any form of shock. Vasoconstrictive drugs or inotropic support still often remain necessary. The primary goal of initial resuscitation should be not only to restore blood arterial pressure but also to improve clinical perfusion markers. On the biological side, decrease of lactate concentration is associated with better outcome.
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Affiliation(s)
- A Durand
- Service de réanimation, hôpital Roger-Salengro, CHU Lille, avenue du Pr.-Emile-Laine, 59000 Lille, France; Inserm, U995 - LIRIC - Lille Inflammation Research International Center, pôle recherche, faculté de médecine de Lille, 5-(e) étage, université Lille, boulevard Pr.-Jules-Leclercq, 59000 Lille, France
| | - L Cartier
- Service de réanimation, hôpital Roger-Salengro, CHU Lille, avenue du Pr.-Emile-Laine, 59000 Lille, France
| | - T Duburcq
- Service de réanimation, hôpital Roger-Salengro, CHU Lille, avenue du Pr.-Emile-Laine, 59000 Lille, France
| | - T Onimus
- Service de réanimation, hôpital Roger-Salengro, CHU Lille, avenue du Pr.-Emile-Laine, 59000 Lille, France
| | - R Favory
- Service de réanimation, hôpital Roger-Salengro, CHU Lille, avenue du Pr.-Emile-Laine, 59000 Lille, France; Inserm, U995 - LIRIC - Lille Inflammation Research International Center, pôle recherche, faculté de médecine de Lille, 5-(e) étage, université Lille, boulevard Pr.-Jules-Leclercq, 59000 Lille, France
| | - S Preau
- Service de réanimation, hôpital Roger-Salengro, CHU Lille, avenue du Pr.-Emile-Laine, 59000 Lille, France; Inserm, U995 - LIRIC - Lille Inflammation Research International Center, pôle recherche, faculté de médecine de Lille, 5-(e) étage, université Lille, boulevard Pr.-Jules-Leclercq, 59000 Lille, France.
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Bisarya R, Shaath D, Pirzad A, Satterwhite L, He J, Simpson SQ. Serum lactate poorly predicts central venous oxygen saturation in critically ill patients: a retrospective cohort study. J Intensive Care 2019; 7:47. [PMID: 31516712 PMCID: PMC6728973 DOI: 10.1186/s40560-019-0401-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 08/27/2019] [Indexed: 02/06/2023] Open
Abstract
Background Serum lactate and central venous oxygen saturation (ScvO2) are commonly used and commonly recommended as markers of tissue oxygenation in shock states. Medical literature has both explicitly stated and implied that the two biomarkers are interchangeable in the management of patients with shock. However, there have been relatively few direct comparisons of these tests in clinical circumstances, and the relationship between them is uncertain. The objective of our study was to evaluate whether simultaneous or near-simultaneous measurements of lactate and ScvO2 reveal a consistent relationship between these two biomarkers. Methods A retrospective cohort study was conducted in an urban, academic US hospital. All adults in ICUs between March 2007 and March 2017 who had a lactate measurement and ScvO2 or mixed venous oxygen saturation (SvO2) measurement made +/− 1 h from the lactate were included. Linear and non-linear correlations of ScvO2 and lactate were assessed in a variety of shock states. Results Two thousand sixty-two patients were included. Lactate and ScvO2 correlated poorly (r2 = 0.0041, p = 0.0019). This was true for patients with ScvO2 ≤ 65% (r2 = 0.0431, p < 0.001), patients with normal kidney and liver function (r2 = 0.0517, p < 0.001), and septic shock patients (r2 = 0.0037, p = 0.17). For patients with an O2 extraction ratio ≥ 50%, lactate and ScvO2 were strongly correlated (r2 = 0.93, p = 0.0019), but these patients represented only 2.8% of patients in whom the ratio could be calculated. Conclusions Lactate can predict ScvO2 when patients are at or below the critical oxygen delivery threshold, but relatively few shock patients meet this criterion. In the overall population of critically ill patients, serum lactate predicts ScvO2 poorly, even after controlling for factors that may affect lactate production. Lactate and ScvO2 should not be assumed to be interchangeable markers of tissue oxygenation/perfusion. Electronic supplementary material The online version of this article (10.1186/s40560-019-0401-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Roshan Bisarya
- 1School of Medicine, University of Kansas, Kansas City, KS USA
| | - Deena Shaath
- 1School of Medicine, University of Kansas, Kansas City, KS USA
| | - Arman Pirzad
- 2Department of Internal Medicine, University of Kansas, Kansas City, KS USA
| | - Lewis Satterwhite
- 3Division of Pulmonary and Critical Care Medicine, University of Kansas, 3901 Rainbow Boulevard, Mail Stop 3047, Kansas City, KS 66160 USA
| | - Jianghua He
- 4Department of Biostatistics, University of Kansas, Kansas City, KS USA
| | - Steven Q Simpson
- 3Division of Pulmonary and Critical Care Medicine, University of Kansas, 3901 Rainbow Boulevard, Mail Stop 3047, Kansas City, KS 66160 USA
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127
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Deelen J, Kettunen J, Fischer K, van der Spek A, Trompet S, Kastenmüller G, Boyd A, Zierer J, van den Akker EB, Ala-Korpela M, Amin N, Demirkan A, Ghanbari M, van Heemst D, Ikram MA, van Klinken JB, Mooijaart SP, Peters A, Salomaa V, Sattar N, Spector TD, Tiemeier H, Verhoeven A, Waldenberger M, Würtz P, Davey Smith G, Metspalu A, Perola M, Menni C, Geleijnse JM, Drenos F, Beekman M, Jukema JW, van Duijn CM, Slagboom PE. A metabolic profile of all-cause mortality risk identified in an observational study of 44,168 individuals. Nat Commun 2019; 10:3346. [PMID: 31431621 PMCID: PMC6702196 DOI: 10.1038/s41467-019-11311-9] [Citation(s) in RCA: 171] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 07/08/2019] [Indexed: 11/09/2022] Open
Abstract
Predicting longer-term mortality risk requires collection of clinical data, which is often cumbersome. Therefore, we use a well-standardized metabolomics platform to identify metabolic predictors of long-term mortality in the circulation of 44,168 individuals (age at baseline 18-109), of whom 5512 died during follow-up. We apply a stepwise (forward-backward) procedure based on meta-analysis results and identify 14 circulating biomarkers independently associating with all-cause mortality. Overall, these associations are similar in men and women and across different age strata. We subsequently show that the prediction accuracy of 5- and 10-year mortality based on a model containing the identified biomarkers and sex (C-statistic = 0.837 and 0.830, respectively) is better than that of a model containing conventional risk factors for mortality (C-statistic = 0.772 and 0.790, respectively). The use of the identified metabolic profile as a predictor of mortality or surrogate endpoint in clinical studies needs further investigation.
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Affiliation(s)
- Joris Deelen
- Molecular Epidemiology, Department of Biomedical Data Sciences, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands. .,Max Planck Institute for Biology of Ageing, PO Box 41 06 23, 50866, Cologne, Germany.
| | - Johannes Kettunen
- National Institute for Health and Welfare, PO Box 30, 00271, Helsinki, Finland.,Computational Medicine, Center for Life Course Health Research and Biocenter Oulu, University of Oulu, PO Box 5000, 90014, Oulu, Finland
| | - Krista Fischer
- The Estonian Genome Center, University of Tartu, Riia 23b, 51010, Tartu, Estonia
| | - Ashley van der Spek
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Stella Trompet
- Department of Internal Medicine, section of Gerontology and Geriatrics, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.,Department of Cardiology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Gabi Kastenmüller
- Institute of Bioinformatics and Systems Biology, Helmholtz Zentrum München, Ingolstaedter Landstraße 1, 85764, Neuherberg, Germany.,German Center for Diabetes Research (DZD), Ingolstaedter Landstraße 1, 85764, Neuherberg, Germany.,Department of Twin Research and Genetic Epidemiology, King's College London, St Thomas' Hospital, Strand, London, WC2R 2LS, UK
| | - Andy Boyd
- ALSPAC, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Jonas Zierer
- Institute of Bioinformatics and Systems Biology, Helmholtz Zentrum München, Ingolstaedter Landstraße 1, 85764, Neuherberg, Germany.,Department of Twin Research and Genetic Epidemiology, King's College London, St Thomas' Hospital, Strand, London, WC2R 2LS, UK.,Novartis Institutes for BioMedical Research, Novartis Campus, Fabrikstrasse 2, 4056, Basel, Switzerland
| | - Erik B van den Akker
- Molecular Epidemiology, Department of Biomedical Data Sciences, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.,The Delft Bioinformatics Lab, Delft University of Technology, PO Box 5031, 2600 GA, Delft, The Netherlands
| | - Mika Ala-Korpela
- Computational Medicine, Center for Life Course Health Research and Biocenter Oulu, University of Oulu, PO Box 5000, 90014, Oulu, Finland.,Systems Epidemiology, Baker Heart and Diabetes Institute, PO Box 6492, Melbourne Victoria, 3004, Australia.,Population Health Science, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK.,MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK.,NMR Metabolomics Laboratory, School of Pharmacy, University of Eastern Finland, Yliopistonranta 1C, Kuopio, 70210, Finland.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, The Alfred Hospital, Monash University, Melbourne, Victoria, 3800, Australia
| | - Najaf Amin
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Ayse Demirkan
- Section of Statistical Multi-omics, Department of Clinical and Experimental research, University of Surrey, Guildford, Surrey, GU2 7XH, UK.,Department of Genetics, University Medical Center Groningen, PO Box 30001, 9700 RB, Groningen, The Netherlands
| | - Mohsen Ghanbari
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Genetics, School of Medicine, Mashhad University of Medical Sciences, PO Box 91735-951, 9133913716, Mashhad, Iran
| | - Diana van Heemst
- Department of Internal Medicine, section of Gerontology and Geriatrics, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Neurology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Jan Bert van Klinken
- Department of Human Genetics, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.,Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Simon P Mooijaart
- Department of Internal Medicine, section of Gerontology and Geriatrics, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Annette Peters
- German Center for Diabetes Research (DZD), Ingolstaedter Landstraße 1, 85764, Neuherberg, Germany.,Institute of Epidemiology II, Helmholtz Zentrum München, Ingolstaedter Landstraße 1, 85764, Neuherberg, Germany
| | - Veikko Salomaa
- National Institute for Health and Welfare, PO Box 30, 00271, Helsinki, Finland
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
| | - Tim D Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, St Thomas' Hospital, Strand, London, WC2R 2LS, UK
| | - Henning Tiemeier
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Psychiatry, Erasmus University Medical Center-Sophia Children's Hospital, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Aswin Verhoeven
- Center for Proteomics and Metabolomics, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Melanie Waldenberger
- Institute of Epidemiology II, Helmholtz Zentrum München, Ingolstaedter Landstraße 1, 85764, Neuherberg, Germany.,Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, Ingolstaedter Landstraße 1, 85764, Neuherberg, Germany
| | - Peter Würtz
- Nightingale Health Ltd., Mannerheimintie 164a, 00300, Helsinki, Finland
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Andres Metspalu
- The Estonian Genome Center, University of Tartu, Riia 23b, 51010, Tartu, Estonia.,Institute of Molecular and Cell Biology, University of Tartu, Riia 23, 23b - 134, 51010, Tartu, Estonia
| | - Markus Perola
- Institute for Molecular Medicine Finland, University of Helsinki, Tukholmankatu 8, 00290, Helsinki, Finland.,Clinical and Molecular Metabolism Research Program, Faculty of Medicine, University of Helsinki, PO Box 63, 00014, Helsinki, Finland
| | - Cristina Menni
- Department of Twin Research and Genetic Epidemiology, King's College London, St Thomas' Hospital, Strand, London, WC2R 2LS, UK
| | - Johanna M Geleijnse
- Division of Human Nutrition, Wageningen University, PO Box 17, 6700 AA, Wageningen, The Netherlands
| | - Fotios Drenos
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK.,Department of Life Sciences, Brunel University London, Uxbridge, UB8 3PH, UK
| | - Marian Beekman
- Molecular Epidemiology, Department of Biomedical Data Sciences, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Cornelia M van Duijn
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Leiden Academic Centre for Drug Research, Leiden University, PO box 9502, 2300 RA, Leiden, The Netherlands
| | - P Eline Slagboom
- Molecular Epidemiology, Department of Biomedical Data Sciences, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.
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128
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Oh TK, Song IA, Bae HJ, Jeon YT. Serum lactate level upon admission to the neuro-intensive care unit and 90-day mortality: A retrospective study. J Clin Neurosci 2019; 70:173-177. [PMID: 31420277 DOI: 10.1016/j.jocn.2019.08.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 08/05/2019] [Indexed: 11/26/2022]
Abstract
The serum lactate level is a useful predictor of mortality in critically ill patients. However, little is known about the association between the serum lactate level and mortality in patients admitted to neuro-intensive care units (NCUs). The present study aimed to investigate the association between the initial lactate level and 90-day mortality in NCU patients. This retrospective observational study was conducted by reviewing the medical records of adult (age ≥18 years) patients admitted to the NCU at a single tertiary care academic hospital during 2013-2017. The initial lactate level (mmol L-1) was defined as the serum lactate level measured within 6 h following NCU admission. The final analysis included 2737 patients, of whom 280 (10.2%) died within 90 days of NCU admission. In a receiver operating characteristic (ROC) analysis, the estimated area under the curve (AUC) for the initial lactate level in predicting overall 90-day mortality was 0.55 [95% confidence interval (CI): 0.52-0.59]. The corresponding values for neurologic and non-neurologic disease-related 90-day mortality were 0.76 (95% CI: 0.71-0.82) and 0.49 (95% CI: 0.45-0.53), respectively. In a multivariable Cox regression analysis, a 1-mmol L-1 increase in the initial lactate level was associated with 1.17- and 1.22-fold increases in overall and neurologic disease-related 90-day mortality, respectively, but not with non-neurological disease-related 90-day mortality (P = 0.422). Elevated lactate levels were related with an increase in overall 90-day mortality among NCU patients. This association was specifically attributed to neurologic disease-related 90-day mortality.
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Affiliation(s)
- Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - In-Ae Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hee-Joon Bae
- Department of Neurology, Stroke Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young-Tae Jeon
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea; Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, Korea.
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129
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Bohne VJB, Bohne Ø. Suggested pathology of systemic exertion intolerance disease: Impairment of the E 3 subunit or crossover of swinging arms of the E 2 subunit of the pyruvate dehydrogenase complex decreases regeneration of cofactor dihydrolipoic acid of the E 2 subunit. Med Hypotheses 2019; 130:109260. [PMID: 31383326 DOI: 10.1016/j.mehy.2019.109260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/22/2019] [Accepted: 06/07/2019] [Indexed: 10/26/2022]
Abstract
Systemic Exertion Intolerance Disease (SEID) or myalgic encephalomyelitis (ME) or chronic fatigue syndrome (CFS) has an unknown aetiology, with no known treatment and a prevalence of approximately 22 million individuals (2%) in Western countries. Although strongly suspected, the role of lactate in pathology is unknown, nor has the nature of the two most central symptoms of the condition - post exertional malaise and fatigue. The proposed mechanism of action of pyruvate dehydrogenase complex (PDC) plays a central role in maintaining energy production with cofactors alpha-lipoic acid (LA) and its counterpart dihydrolipoic acid (DHLA), its regeneration suggested as the new rate limiting factor. Decreased DHLA regeneration due to impairment of the E3 subunit or crossover of the swinging arms of the E2 subunit of PDC have been suggested as a cause of ME/CFS/SEID resulting in instantaneous fluctuations in lactate levels and instantaneous offset of the DHLA/LA ratio and defining the condition as an LA deficiency with chronic instantaneous hyperlactataemia with explicit stratification of symptoms. While instantaneous hyperlactataemia has been suggested to account for the PEM, the fatigue was explained by the downregulated throughput of pyruvate and consequently lower production of ATP with the residual enzymatic efficacy of the E3 subunit or crossover of the E2 as a proposed explanation of the fatigue severity. Functional diagnostics and visualization of instantaneous elevations of lactate and DHLA has been suggested. Novel treatment strategies have been implicated to compensate for chronic PDC impairment and hyperlactataemia. This hypothesis potentially influences the current understanding and treatment methods for any type of hyperlactataemia, fatigue, ME/CFS/SEID, and conditions associated with PDC impairment.
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130
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Loudon KMW, Tarr G, Pethick DW, Lean IJ, Polkinghorne R, Mason M, Dunshea FR, Gardner GE, McGilchrist P. The Use of Biochemical Measurements to Identify Pre-Slaughter Stress in Pasture Finished Beef Cattle. Animals (Basel) 2019; 9:E503. [PMID: 31370255 PMCID: PMC6720208 DOI: 10.3390/ani9080503] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 07/20/2019] [Accepted: 07/22/2019] [Indexed: 01/20/2023] Open
Abstract
This study considered the relationship between pre-slaughter stressors and plasma biomarkers in 488 pasture-raised cattle across two experiments. The design aimed to test groups consisting of steer only, heifer only, and mixed sex cattle under direct kill versus rested (14 days in abattoir holding paddocks) protocols. In Experiment One, cattle were sourced from four farms, and transported by trucks and ships on the same day. In Experiment Two, cattle were sourced from four farms where a comparison was made between marketing via two commercial saleyards or direct farm gate consignment to abattoir. Blood samples were collected at exsanguination for subsequent analyses and relation to meat quality attributes. Muscle damage, as indicated by creatine kinase, is the biomarker most correlated to ultimate pH and muscle glycogen concentrations. A two-week rest period is effective for lowering this enzyme and improving muscle glycogen concentration. Although the cattle was subjected to a range of stress inducing treatments, we found that plasma biomarkers alone appeared insufficient for use as diagnostic stress indicators.
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Affiliation(s)
- Kate M W Loudon
- School of Veterinary and Life Sciences, Murdoch University, Murdoch, WA 6150, Australia.
| | - Garth Tarr
- School of Mathematics and Statistics, The University of Sydney, Sydney, NSW 2006, Australia
| | - David W Pethick
- School of Veterinary and Life Sciences, Murdoch University, Murdoch, WA 6150, Australia
| | | | - Rod Polkinghorne
- Birkenwood Pty. Ltd, 431 Timor Rd, Murrurundi, NSW 2338, Australia
| | - Maddison Mason
- School of Veterinary and Life Sciences, Murdoch University, Murdoch, WA 6150, Australia
| | - Frank R Dunshea
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, VIC 3010, Australia
| | - Graham E Gardner
- School of Veterinary and Life Sciences, Murdoch University, Murdoch, WA 6150, Australia
| | - Peter McGilchrist
- School of Veterinary and Life Sciences, Murdoch University, Murdoch, WA 6150, Australia
- School of Environmental and Rural Science, University of New England, Armidale, NSW 2350, Australia
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131
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Zollo AM, Ayoob AL, Prittie JE, Jepson RD, Lamb KE, Fox PR. Utility of admission lactate concentration, lactate variables, and shock index in outcome assessment in dogs diagnosed with shock. J Vet Emerg Crit Care (San Antonio) 2019; 29:505-513. [PMID: 31290240 DOI: 10.1111/vec.12868] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 05/16/2017] [Accepted: 05/25/2017] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To determine whether admission venous plasma lactate concentration, calculated lactate variables, or shock index (SI) could discriminate hospital survivors from nonsurvivors in dogs admitted with shock. DESIGN Prospective investigation performed over a 19-month period. SETTING Large urban private teaching hospital. ANIMALS Twenty-three dogs consecutively admitted to the ICU from January 2008 to July 2009 with initial peripheral venous plasma lactate concentration >2 mmol/L (18.0 mg/dL) and clinical and hemodynamic parameters consistent with shock. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Heart rate, systolic blood pressure, and venous plasma lactate concentrations were serially recorded at predefined time points and used to calculate SI (SI = heart rate/systolic blood pressure) and lactate variables, including lactime (time lactate > 2.0 mmol/L), lactate clearance ([lactateinitial - lactatedelayed ]/lactateinitial × 100), and LACAREA (area under the lactate concentration versus time curve). Primary outcome was survival to discharge. Overall survival rate was 61%. Admission venous plasma lactate concentration did not differ between groups (P = 0.2). Lactime was shorter in survivors versus nonsurvivors (P = 0.02). Lactate clearance at 1, 10, 16, 24, and 36 hours, and final lactate clearance were greater in survivors versus nonsurvivors (P < 0.05). LACAREA at time intervals 0-1, 1-4, 4-10, 10-16, 16-24, 24-30, and 30-36 hours was larger in nonsurvivors versus survivors (P < 0.05). Total LACAREA did not differ between groups (P = 0.09). Admission SI and time to normalize SI (SI < 0.9) were not different between survivors and nonsurvivors (P > 0.05). CONCLUSIONS While admission venous plasma lactate concentration could not discriminate between hospital survivors and nonsurvivors, lactate variables showed clinical utility to predict outcome in dogs with shock. Further studies are needed to determine SI reference ranges and optimal SI cut-off values to improve its prognostic ability in sick dogs.
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Affiliation(s)
- Ann Marie Zollo
- Department of Emergency and Critical Care, The Animal Medical Center, New York, NY
| | - Ashley L Ayoob
- Departments of Emergency and Critical Care and Internal Medicine, Animal Specialty Hospital of Florida, Naples, FL
| | - Jennifer E Prittie
- Department of Emergency and Critical Care, The Animal Medical Center, New York, NY
| | | | | | - Philip R Fox
- Department of Cardiology, The Animal Medical Center, New York, NY
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132
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Cardoso FS, Abraldes JG, Sy E, Ronco JJ, Bagulho L, Mcphail MJ, Karvellas CJ. Lactate and number of organ failures predict intensive care unit mortality in patients with acute-on-chronic liver failure. Liver Int 2019; 39:1271-1280. [PMID: 30825255 DOI: 10.1111/liv.14083] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 01/20/2019] [Accepted: 02/21/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIMS Patients with acute-on-chronic liver failure (ACLF) have high mortality rates. Most prognostic scores were not developed for the intensive care unit (ICU) setting. We aimed to improve risk stratification for patients with ACLF in the ICU. METHODS A training set with 240 patients with cirrhosis and organ failures (Chronic Liver Failure Sequential Organ Failure Assessment score [CLIF-SOFA]) from Curry Cabral Hospital (Portugal) and University of Alberta Hospital (Canada) in 2010-2016 was used to derive a prognostic model for ICU mortality. A validation set with 237 patients with cirrhosis and organ failures from Vancouver General Hospital (Canada) in 2000-2011 was used to evaluate its performance. RESULTS Amongst patients in the training set, ICU and hospital mortality rates were 39.2% and 54.6% respectively. Median lactate (4.4 vs 2.5 mmol/L) and number of organ failures (3 vs 2) on admission to ICU were associated with higher likelihood of ICU mortality (P < 0.001 for both). The lactate and organ failures predictive model (LacOF) was derived to predict ICU mortality: -2.420 + 0.072 × lactate + 0.569 × number of organ failures (area under-the-curve [AUC], 0.76). In the validation set, the LacOF model discriminative ability (AUC, 0.85) outperformed the CLIF-SOFA (AUC, 0.79), Chronic Liver Failure Consortium Acute-on-Chronic Liver Failure (AUC, 0.73), Model for End-stage Liver Disease score (AUC, 0.78) and Acute Physiology and Chronic Health Evaluation II scores (AUC, 0.74; P < 0.05 for all). The LacOF model calibration was good up to the 25% likelihood of ICU mortality. CONCLUSIONS In patients with ACLF, lactate and number of organ failures on admission to ICU are useful to predict ICU mortality. This early prognostic evaluation may help to better stratify the risk of ICU mortality and thus optimize organ support strategies.
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Affiliation(s)
- Filipe S Cardoso
- Gastroenterology and Intensive Care Divisions, Central Lisbon Hospital Center, Curry Cabral Hospital, Lisbon, Portugal
| | - Juan G Abraldes
- Gastroenterology Division (Liver Unit), University of Alberta Hospital, Edmonton, AB, Canada
| | - Eric Sy
- Critical Care Division, Vancouver General Hospital, Vancouver, BC, Canada
| | - Juan J Ronco
- Critical Care Division, Vancouver General Hospital, Vancouver, BC, Canada
| | - Luís Bagulho
- Intensive Care Division, Central Lisbon Hospital Center, Curry Cabral Hospital, Lisbon, Portugal
| | - Mark J Mcphail
- Liver Intensive Therapy Unit, King's College Hospital, London, UK
| | - Constantine J Karvellas
- Gastroenterology Division (Liver Unit), University of Alberta Hospital, Edmonton, AB, Canada.,Critical Care Department, University of Alberta Hospital, Edmonton, AB, Canada
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133
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Lucas A, Williams AT, Cabrales P. Prediction of Recovery From Severe Hemorrhagic Shock Using Logistic Regression. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2019; 7:1900509. [PMID: 31367491 PMCID: PMC6661015 DOI: 10.1109/jtehm.2019.2924011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 06/13/2019] [Accepted: 06/16/2019] [Indexed: 11/09/2022]
Abstract
This paper implements logistic regression models (LRMs) and feature selection for creating a predictive model for recovery form hemorrhagic shock (HS) with resuscitation using blood in the multiple experimental rat animal protocols. A total of 61 animals were studied across multiple HS experiments, which encompassed two different HS protocols and two resuscitation protocols using blood stored for short periods using five different techniques. Twenty-seven different systemic hemodynamics, cardiac function, and blood gas parameters were measured in each experiment, of which feature selection deemed only 25% of the them as relevant. The reduced feature set was used to train a final logistic regression model. A final test set accuracy is 84% compared to 74% for a baseline classifier using only MAP and HR measurements. Receiver operating characteristics (ROC) curve analysis and Cohens kappa statistics were also used as measures of performance, with the final reduced model outperforming the model, including all parameters. Our results suggest that LRMs trained with a combination of systemic hemodynamics, cardiac function, and blood gas parameters measured at multiple timepoints during HS can successfully classify HS recovery groups. Our results show the predictive ability of traditional and novel hemodynamic and cardiac function features and their combinations, many of which had not previously been taken into consideration, for monitoring HS. Furthermore, we have devised an effective methodology for feature selection and shown ways in which the performance of such predictive models should be assessed in future studies.
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Affiliation(s)
- Alfredo Lucas
- Department of BioengineeringUniversity of California at San DiegoLa JollaCA92092USA
| | | | - Pedro Cabrales
- Department of BioengineeringUniversity of California at San DiegoLa JollaCA92092USA
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134
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Van Nguyen T, Alfaro AC. Targeted metabolomics to investigate antimicrobial activity of itaconic acid in marine molluscs. Metabolomics 2019; 15:97. [PMID: 31230148 DOI: 10.1007/s11306-019-1556-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 06/15/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Itaconic acid (ITA) has recently been identified as an antimicrobial metabolite in mammalian immune cells. The presence of ITA was also reported in different tissues of marine molluscs, indicating its role as an endogenous metabolite of molluscs. In addition, the accumulation of ITA has been observed in different tissues of mussels following pathogen challenges. However, the concentration of ITA in mussel tissues and the possible role of this metabolite in the molluscan innate immune system remain unknown. OBJECTIVES This study aims to quantitatively measure ITA levels in different tissues of marine mussels following an experimental challenge with Vibrio sp. DO1 isolate, and to identify the antimicrobial role of ITA in the innate immune system through the measurement of metabolic and immune alterations in tissues following the challenge. METHODS In this study, adult Perna canaliculus mussels were experimentally challenged with a pathogenic Vibrio sp. DO1 isolate. The metabolite profiles of five different tissues, including mantle, gill, muscle, hepatopancreas and haemolymph were obtained, and levels of ITA in each tissue were characterized using a gas chromatography-mass spectrometry (GC-MS) metabolomics approach. Flow cytometry was also employed to measure cell health parameters, including oxidative stress via reactive oxygen species (ROS) production, apoptosis via changes in mitochondrial membrane potential (MMP) and haemocyte viability. RESULTS The ITA levels in mantle, gill, muscle and hepatopancreas tissues at 18-h post infection (hpi) with Vibrio sp. were 40.31, 41.71, 11.61 and 41.66 ng mg-1, respectively. In haemolymph, the level of ITA was significantly increased from 95.25 ng ml-1 at 6 hpi to 174.36 ng ml-1 at 18 hpi and 572.12 ng ml-1 at 60 hpi. In line with the accumulation of ITA, we observed increased levels of metabolites within the tricarboxylic acid (TCA) cycle, anti-inflammatory metabolites and alterations of other metabolites associated with immune responses of the host. The flow cytometry analyses revealed increases in ROS production, apoptotic cells and decreases in cell viability. CONCLUSIONS We reported on the production of ITA in different tissues of P. canaliculus mussels challenged with a marine pathogen which confirmed ITA as an antimicrobial metabolite. The findings revealed insights into the biosynthesis of ITA and suggests its role in antimicrobial and anti-inflammatory activities in the innate immune system. This study also provided insights into the innate immune system of bivalves and highlighted the potential use of ITA as a biomarker for shellfish health assessment in aquaculture.
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Affiliation(s)
- Thao Van Nguyen
- Aquaculture Biotechnology Research Group, School of Science, Faculty of Health and Environmental Sciences, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand
| | - Andrea C Alfaro
- Aquaculture Biotechnology Research Group, School of Science, Faculty of Health and Environmental Sciences, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand.
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135
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Nazir M, Wani W, Dar SA, Mir IH, Charoo BA, Ahmad QI, Wajid S. Lactate clearance prognosticates outcome in pediatric septic shock during first 24 h of intensive care unit admission. J Intensive Care Soc 2019; 20:290-298. [PMID: 31695733 DOI: 10.1177/1751143719855202] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
This study was undertaken to examine the clinical utility of lactate clearance as an indicator of mortality in pediatric septic shock, and to compare the performance of lactate clearance at 6, 12, and 24 h for predicting in-hospital and 60-day mortality. Pediatric patients with septic shock were prospectively studied. Vital signs, laboratory values, Pediatric Risk of Mortality Score, and pediatric logistic organ dysfunction score were obtained at presentation (hour 0), hour 6, hour 24 and over the first 72 h of hospitalization. Lactate clearance was obtained at 6, 12, and 24 h of hospital admission. Therapy received, outcome parameters of mortality, and duration of hospitalization were recorded. The primary outcome variable of 60-day mortality rate was 31.25%. Only lactate clearance at 6 and 24 h was significantly associated with mortality, with odds of 0.97 (95% CI, 0.951-981; p < 0.001) and 0.975 (95% CI, 0.964-0.986; p < 0.001), respectively. Approximately there was a 24% decrease in likelihood of mortality for each 10% increase in lactate clearance at 24 h. At a threshold value of 10% 6-h lactate clearance had a sensitivity of 0.948 and specificity of 0.571, while at a threshold of 20% 24-h lactate clearance had a sensitivity of 0.922 and specificity of 0.629. The comparison of clearance at 6 and 24 h using receiver operating characteristic showed that former was "fair" (area under the curve = 0.753) and later was "good" (area under the curve = 0.81) in predicting mortality in pediatric septic shock. Conclusion We concluded that optimal lactate clearance in pediatric septic shock both during the early presentation and after the initial "golden hours" is associated with lower in-hospital and 60-day mortality. Further, 24-h lactate clearance appears superior to 6 h lactate clearance in predicting mortality in such patients.
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Affiliation(s)
- Mudasir Nazir
- Department of Pediatrics and Neonatology, Sher-I-Kashmir Institute of Medical Sciences Hospital, Srinagar, India
| | - Wasim Wani
- Department of Pediatrics and Neonatology, Sher-I-Kashmir Institute of Medical Sciences Hospital, Srinagar, India
| | - Sheeraz Ahmad Dar
- Department of Pediatrics and Neonatology, Sher-I-Kashmir Institute of Medical Sciences Hospital, Srinagar, India
| | - Inamul-Haq Mir
- Department of Pediatrics and Neonatology, Sher-I-Kashmir Institute of Medical Sciences Hospital, Srinagar, India
| | - Bashir Ahmad Charoo
- Department of Pediatrics and Neonatology, Sher-I-Kashmir Institute of Medical Sciences Hospital, Srinagar, India
| | - Qazi Iqbal Ahmad
- Department of Pediatrics and Neonatology, Sher-I-Kashmir Institute of Medical Sciences Hospital, Srinagar, India
| | - Syed Wajid
- Department of Pediatrics and Neonatology, Sher-I-Kashmir Institute of Medical Sciences Hospital, Srinagar, India
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136
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Chebl RB, Tamim H, Dagher GA, Sadat M, Enezi FA, Arabi YM. Serum Lactate as an Independent Predictor of In-Hospital Mortality in Intensive Care Patients. J Intensive Care Med 2019; 35:1257-1264. [PMID: 31179840 DOI: 10.1177/0885066619854355] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE The aim of this study was to check if serum lactate was independently associated with mortality among critically ill patients. MATERIALS AND METHODS This was a single-center, retrospective cohort study. All adult patients (>18 years of age) who had at least 1 measurement of lactate within 24 hours of admission to intensive care unit (ICU) between January 2002 and December 2017 were included in the analysis. Patients were stratified into 3 groups: those with a serum lactate of <2 mmol/L (normal level), 2 to 4 mmol/L (intermediate level), and >4 mmol/L (high level). The primary outcome was in-hospital mortality. Secondary outcomes included ICU and hospital lengths of stay and mechanical ventilation duration. To determine the association between lactate level and hospital mortality, bivariate and multivariate logistic regression analyses were performed. RESULTS Of the 16,447 patients admitted to the ICU, 8167 (49.65%) had normal levels, 4648 (28.26%) had an intermediate, and 3632 (22.09%) had high lactate levels. Hospital mortality was the highest in high lactate level, followed by the intermediate and the normal level group (47.4% vs 26.5% vs 19.6%; P < .0001). Intermediate and high lactate levels were independent predictors of hospital mortality (odds ratio [OR], 1.32; 95% confidence interval [CI]: 1.20-1.46, and 1.94; 95% CI, 1.75-2.16, respectively) as well as ICU mortality (OR, 1.47; 95% CI, 1.30-1.66 and 2.56; 95% CI, 2.27-2.88, respectively). CONCLUSIONS Intensive care unit serum lactate is associated with increased ICU and hospital mortality, independent of comorbidities, organ dysfunction, or hemodynamic status.
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Affiliation(s)
- Ralphe Bou Chebl
- Department of Emergency Medicine, 11238American University of Beirut, Beirut, Lebanon
| | - Hani Tamim
- Department of Emergency Medicine, 11238American University of Beirut, Beirut, Lebanon
| | - Gilbert Abou Dagher
- Department of Emergency Medicine, 11238American University of Beirut, Beirut, Lebanon
| | - Musharaf Sadat
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, 48168King Abdullah International Medical Research Center, Intensive Care Department, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Farhan Al Enezi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, 48168King Abdullah International Medical Research Center, Intensive Care Department, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Yaseen M Arabi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, 48168King Abdullah International Medical Research Center, Intensive Care Department, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
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Mahmoodpoor A, Shadvar K, Sanaie S, Golzari SEJ, Parthvi R, Hamishehkar H, Nader ND. Arterial vs venous lactate: Correlation and predictive value of mortality of patients with sepsis during early resuscitation phase. J Crit Care 2019; 58:118-124. [PMID: 31174974 DOI: 10.1016/j.jcrc.2019.05.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/24/2019] [Accepted: 05/27/2019] [Indexed: 12/23/2022]
Abstract
PURPOSE To compare the lactate concentrations obtained from venous to those obtained from arterial blood in predicting hospital mortality of patients with sepsis and septic shock. To also assess lactate clearance as predictor for mortality. METHODS 100 patients with septic shock were prospectively enrolled. Serum was sampled at baseline and after 6 h of resuscitation from arterial and venous lines. Demographic, severity indices, hemodynamic measures as well as lactate clearance levels were noted. Data were analyzed for bias and precision. RESULTS There was correlation between venous and arterial lactate concentrations at the baseline (R = 0.68) and at the 6-hour time point (R = 0.95). Venous concentrations were consistently higher than those obtained from an arterial access by 0.684 mg/dL. Further, arterial lactate level > 3.2 mmol/L and clearance of <20% were considered the cutoff for the mortality risk. While only 8% of the patients with no risk died, all 20 patients who had lactate level > 3.2 mmol/L and clearance of <20% died within the hospital. CONCLUSION Our data suggests a strong correlation between arterial and peripheral venous the lactate levels and in the initial phase of resuscitation in septic shock patients we can use venous lactate level as biomarker instead of arterial lactate level. The study also showed that combining lactate levels and its clearance is a reliable predictor of mortality in sepsis.
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Affiliation(s)
- Ata Mahmoodpoor
- Department of Anesthesiology & Critical Care Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kamran Shadvar
- Department of Anesthesiology & Critical Care Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sarvin Sanaie
- Lung Disease and Tuberculosis Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Samad E J Golzari
- Department of Anesthesiology & Critical Care Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Rukma Parthvi
- Department of Pulmonary, Critical Care and Sleep Medicine, State University of New York at Buffalo, Buffalo, NY, USA.
| | - Hadi Hamishehkar
- Department of Clinical Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nader D Nader
- Department of Anesthesiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
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Peguero A, Parra RA, Carrillo SP, Rojas-Suarez J, Figueras F. Association of plasma lactate concentration at admission of severe preeclampsia to maternal complications. Pregnancy Hypertens 2019; 17:89-93. [PMID: 31487663 DOI: 10.1016/j.preghy.2019.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 04/23/2019] [Accepted: 05/02/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To evaluate in women with severe preeclampsia the association of lactate concentration at admission with maternal complications. METHODS A prospective cohort was created of women with severe preeclampsia consecutively admitted to an Obstetrical High-Dependency Unit. Plasma lactate concentration was measured at admission and its association to maternal complication was evaluated. RESULTS A total of 100 women were included, of which 30 (30%) had a maternal complication. The mean lactate plasma concentration in this group was significantly higher than in those uncomplicated cases (2.38 vs 3.1 mmol/L; p < 0.01). A total of 37 (37%) women had lactate concentrations at >3 mmol/L, which was associated to higher incidence of maternal complications (19% vs. 48.6%; p = 0.002; OR 4.03 [95% CI 1.64-9.9]). This association remained independent of other standard severity criteria (OR 3.89; 95%CI 1.22-12.4; p = 0.022). CONCLUSION Increased plasma lactate concentrations at admission in women with severe preeclampsia are independently associated to maternal complications.
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Affiliation(s)
- Anna Peguero
- BCNatal. Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clínic de Ginecologia, Obstetricia i Neonatologia Fetal i+D Fetal Medicine Research Center, Barcelona, Catalonia, Spain
| | - Rafael Alonso Parra
- Obstetrical High-Dependency Unit; E.S.E. Hospital San Rafael de Facatativa, Colombia
| | - Sara Paola Carrillo
- Obstetrical High-Dependency Unit; E.S.E. Hospital San Rafael de Facatativa, Colombia
| | - Jose Rojas-Suarez
- Obstetrics, Gynecology and Critical Care Departments, Universidad de Cartagena, Colombia
| | - Francesc Figueras
- BCNatal. Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clínic de Ginecologia, Obstetricia i Neonatologia Fetal i+D Fetal Medicine Research Center, Barcelona, Catalonia, Spain.
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González Posada MA, Biarnés Suñe A, Naya Sieiro JM, Salvadores de Arzuaga CI, Colomina Soler MJ. Damage Control Resuscitation in polytrauma patient. ACTA ACUST UNITED AC 2019; 66:394-404. [PMID: 31031044 DOI: 10.1016/j.redar.2019.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/13/2019] [Accepted: 03/18/2019] [Indexed: 11/30/2022]
Abstract
Haemorrhagic shock is one of the main causes of mortality in severe polytrauma patients. To increase the survival rates, a combined strategy of treatment known as Damage Control has been developed. The aims of this article are to analyse the actual concept of Damage Control Resuscitation and its three treatment levels, describe the best transfusion strategy, and approach the acute coagulopathy of the traumatic patient as an entity. The potential changes of this therapeutic strategy over the coming years are also described.
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Affiliation(s)
- M A González Posada
- Servicio de Anestesiología y Reanimación, Hospital Universitario Vall d'Hebron, Barcelona, España; Universidad Autónoma de Barcelona, Barcelona, España.
| | - A Biarnés Suñe
- Servicio de Anestesiología y Reanimación, Hospital Universitario Vall d'Hebron, Barcelona, España; Universidad Autónoma de Barcelona, Barcelona, España
| | - J M Naya Sieiro
- Servicio de Anestesiología y Reanimación, Hospital Universitario Vall d'Hebron, Barcelona, España
| | | | - M J Colomina Soler
- Servicio de Anestesiología y Reanimación, Hospital Universitario de Bellvitge, l'Hospitalet de Llobregat, Barcelona, España; Universidad Barcelona, Barcelona, España
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140
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Alkozai EM, Mahmoodi BK, Decruyenaere J, Porte RJ, Oude Lansink-Hartgring A, Lisman T, Nijsten MW. Systematic comparison of routine laboratory measurements with in-hospital mortality: ICU-Labome, a large cohort study of critically ill patients. Clin Chem Lab Med 2019; 56:1140-1151. [PMID: 29306908 DOI: 10.1515/cclm-2016-1028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 11/23/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND In intensive care unit (ICU) patients, many laboratory measurements can be deranged when compared with the standard reference interval (RI). The assumption that larger derangements are associated with worse outcome may not always be correct. The ICU-Labome study systematically evaluated the univariate association of routine laboratory measurements with outcome. METHODS We studied the 35 most frequent blood-based measurements in adults admitted ≥6 h to our ICU between 1992 and 2013. Measurements were from the first 14 ICU days and before ICU admission. Various metrics, including variability, were related with hospital survival. ICU- based RIs were derived from measurements obtained at ICU discharge in patients who were not readmitted to the ICU and survived for >1 year. RESULTS In 49,464 patients (cardiothoracic surgery 43%), we assessed >20·106 measurements. ICU readmissions, in-hospital and 1-year mortality were 13%, 14% and 19%, respectively. On ICU admission, lactate had the strongest relation with hospital mortality. Variability was independently related with hospital mortality in 30 of 35 measurements, and 16 of 35 measurements displayed a U-shaped outcome-relation. Medians of 14 of 35 ICU-based ranges were outside the standard RI. Remarkably, γ-glutamyltransferase (GGT) had a paradoxical relation with hospital mortality in the second ICU week because more abnormal GGT-levels were observed in hospital survivors. CONCLUSIONS ICU-based RIs for may be more useful than standard RIs in identifying ICU patients at risk. The association of variability with outcome for most of the measurements suggests this is a consequence and not a cause of a worse ICU outcome. Late elevation of GGT may confer protection to ICU patients.
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Affiliation(s)
- Edris M Alkozai
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, TheNetherlands.,Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, TheNetherlands
| | | | - Johan Decruyenaere
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - Robert J Porte
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, TheNetherlands
| | | | - Ton Lisman
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, TheNetherlands
| | - Maarten W Nijsten
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands, Phone: 00-31-50-3616161, Fax: 0031-50-3615644
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Graham CA, Leung LY, Lo RS, Lee KH, Yeung CY, Chan SY, Cattermole GN, Hung KK. Agreement between capillary and venous lactate in emergency department patients: prospective observational study. BMJ Open 2019; 9:e026109. [PMID: 30948594 PMCID: PMC6500234 DOI: 10.1136/bmjopen-2018-026109] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Capillary blood lactate testing with handheld analysers has great advantages to reduce the time needed for clinical decisions, and for extended use in the prehospital setting. We investigated the agreement of capillary lactate measured using handheld analysers (CL-Nova and CL-Scout+ measured by Nova and Lactate Scout+ analyzers) and the reference venous level assessed using a point-of-care testing (POCT) blood gas analyser (VL-Ref). DESIGN A prospective observational study. SETTING A university teaching hospital emergency department in Hong Kong. PARTICIPANTS Patients triaged as 'urgent' (Category 3 of a 5-point scale), aged ≥18 years during 2016 were eligible. 240 patients (mean age 69.9 years) were recruited. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measure was the agreement of the capillary blood lactate level measured by handheld lactate analyser when compared with the reference standard technique, namely venous blood samples obtained by venepuncture and analysed using the blood gas analyser. The secondary outcome measure was the difference in values of venous lactate using blood gas analysers and handheld lactate analysers. RESULTS The results of VL-Ref ranged from 0.70 to 5.38 mmol/L (mean of 1.96 mmol/L). Regarding capillary lactate measurements, the bias (mean difference) between VL-Ref and CL-Scout+ was -0.22 with 95% limits of agreement (LOA) of -2.17 to 1.73 mmol/L and the bias between VL-Ref and CL-Nova was 0.46, with LOA of -1.08 to 2.00 mmol/L. For venous lactate, results showed the bias between VL-Ref and VL-Scout+ was 0.22 with LOA being -0.46 to 0.90 mmol/L, and the bias between VL-Ref and VL-Nova was 0.83 mmol/L with LOA -0.01 to 1.66 mmol/L. CONCLUSION Our study shows poor agreement between capillary lactate and reference values. The study does not support the clinical utility of capillary lactate POCT. However, venous lactate measured by Scout+ handheld analyser may have potential for screening patients who may need further testing. TRIAL REGISTRATION NUMBER NCT02694887.
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Affiliation(s)
- Colin A Graham
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, Hong Kong
- Emergency Department, Prince of Wales Hospital, Shatin, Hong Kong SAR
| | - Ling Yan Leung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ronson Sl Lo
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Kwok Hung Lee
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, Hong Kong
- Emergency Department, Prince of Wales Hospital, Shatin, Hong Kong SAR
| | - Chun Yu Yeung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Suet Yi Chan
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Giles N Cattermole
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Kevin Kc Hung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, Hong Kong
- Emergency Department, Prince of Wales Hospital, Shatin, Hong Kong SAR
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Swan KL, Avard BJ, Keene T. The relationship between elevated prehospital point-of-care lactate measurements, intensive care unit admission, and mortality: A retrospective review of adult patients. Aust Crit Care 2019; 32:100-105. [DOI: 10.1016/j.aucc.2018.02.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 11/23/2017] [Accepted: 02/01/2018] [Indexed: 12/11/2022] Open
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Vreugdenhil S, Freire Jorge PJ, van Driel MF, Nijsten MW. Ischemic priapism as a model of exhausted metabolism. Physiol Rep 2019; 7:e13999. [PMID: 30916476 PMCID: PMC6436141 DOI: 10.14814/phy2.13999] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 01/11/2019] [Accepted: 01/14/2019] [Indexed: 11/24/2022] Open
Abstract
In vivo metabolic studies typically concern complex open systems. However, a closed system allows better assessment of the metabolic limits. Ischemic priapism (IP) constitutes a special model of the compartment syndrome that allows direct sampling from a relatively large blood compartment formed by the corpora cavernosa (CC). The purpose of our study was to measure metabolic changes and the accumulation of end products within the CC during IP. Blood gas and biochemical analyses of aspirates of the CC were analyzed over an 8-year period. Mean ± SD pH, pCO2 , pO2 , O2 -saturation, lactate, and glucose of the aspirated blood were determined with a point-of-care analyzer. Forty-seven initial samples from 21 patients had a pH of 6.91 ± 0.16, pCO2 of 15.3 ± 4.4 kPa, pO2 of 2.4 ± 2.0 kPa, and an O2 -saturation of 19 ± 24% indicating severe hypoxia with severe combined respiratory and metabolic acidosis. Glucose and lactate levels were 1.1 ± 1.5 and 14.6 ± 4.8 mmol/L, respectively. pH and pCO2 were inversely correlated (R2 = 0.86; P < 0.001), glucose and O2 -saturation were positively correlated (R2 = 0.83; P < 0.001), and glucose and lactate were inversely correlated (R2 = 0.72; P < 0.001). The positive correlation of CO2 and lactate (R2 = 0.69; P < 0.001) was similar to that observed in vitro, when blood was titrated with lactic acid. The observed combined acidosis underscores that IP behaves as a closed system where severe hypoxia and glycopenia coexist, indicating that virtually all energy reserves have been consumed.
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Affiliation(s)
- Sanne Vreugdenhil
- Department of UrologyUniversity Medical Center GroningenUniversity of GroningenGroningenNetherlands
| | - Pedro J. Freire Jorge
- Department of Critical CareUniversity Medical Center GroningenUniversity of GroningenGroningenNetherlands
| | - Mels F. van Driel
- Department of UrologyUniversity Medical Center GroningenUniversity of GroningenGroningenNetherlands
| | - Maarten W. Nijsten
- Department of Critical CareUniversity Medical Center GroningenUniversity of GroningenGroningenNetherlands
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Kamo T, Tasaka S, Suzuki T, Asakura T, Suzuki S, Yagi K, Namkoong H, Ishii M, Morisaki H, Betsuyaku T. Prognostic values of the Berlin definition criteria, blood lactate level, and fibroproliferative changes on high-resolution computed tomography in ARDS patients. BMC Pulm Med 2019; 19:37. [PMID: 30744598 PMCID: PMC6371514 DOI: 10.1186/s12890-019-0803-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 02/05/2019] [Indexed: 12/15/2022] Open
Abstract
Background In the Berlin definition, acute respiratory distress syndrome (ARDS) is stratified into three stages according to oxygenation severity at the onset. The relevance between ARDS severity and prognosis varies among published reports and has not been verified, especially in Asian patients. Methods In this study, we examined the associations between the Berlin definition criteria and prognosis and clinical parameters, including high-resolution computed tomography (HRCT) scores of fibroproliferative changes of the lungs. One hundred fifty-three patients (45 females; mean age, 67 y/o), who met the Berlin definition and received treatment in our intensive care unit between January 2012 and December 2015, were enrolled. Results The severity of ARDS was mild in 42 patients, moderate in 71, and severe in 40. The underlying diseases included pneumonia in 56 patients and aspiration in 43. Forty-two (27.5%) patients were deceased within 30 days, and the 30-day mortality was 10% in mild ARDS, 23% in moderate, and 55% in severe, which were significantly different (P < 0.05). In the non-survivors, APACHE II, SOFA, and SAPS II scores were higher than in the survivors (P < 0.001). Multivariate analyses revealed that elevated blood lactate level (≥ 2.0 mmol/L) and increased HRCT scores were significantly associated with weaning failure and 30-day mortality of the patients with ARDS. Conclusions These results suggested that the severity criteria in the Berlin definition might be associated with the prognosis of the patients. Blood lactate levels and HRCT score might be predictive of the outcome of patients with ARDS.
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Affiliation(s)
- Tetsuro Kamo
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Sadatomo Tasaka
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 160-8582, Japan. .,Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki, 036-8562, Japan.
| | - Takeshi Suzuki
- Department of Anesthesiology, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Takanori Asakura
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Shoji Suzuki
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Kazuma Yagi
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Ho Namkoong
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Makoto Ishii
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Hiroshi Morisaki
- Department of Anesthesiology, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Tomoko Betsuyaku
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 160-8582, Japan
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Abstract
PURPOSE OF REVIEW To describe the current understanding and clinical applicability of severity scoring systems in pneumonia management. RECENT FINDINGS Severity scores in community-acquired pneumonia are strong markers of mortality, but are not necessarily clinical decision-aid tools. The use of severity scores to support outpatient care in low-risk patients has moderate-to-strong evidence available in the literature, mainly for the pneumonia severity index, and must be applied together with clinical judgment. It is not clear that severity scores are helpful to guide empiric antibiotic treatment. The inclusion of biomarkers and performance status might improve the predictive performance of the well known severity scores in community-acquired pneumonia. We should improve our methods for score evaluation and move toward the development of decision-aid tools. SUMMARY The application of the available evidence favors the use of severity scoring systems to improve the delivery of care for pneumonia patients. The incorporation of new methodologies and the formulation of different questions other than mortality prediction might help the further development of severity scoring systems, and enhance their support to the clinical decision-making process for the pneumonia-management cascade.
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147
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Kashyap R, Singh TD, Rayes H, O'Horo JC, Wilson G, Bauer P, Gajic O. Association of septic shock definitions and standardized mortality ratio in a contemporary cohort of critically ill patients. J Crit Care 2019; 50:269-274. [PMID: 30660915 DOI: 10.1016/j.jcrc.2019.01.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/07/2019] [Accepted: 01/09/2019] [Indexed: 01/09/2023]
Abstract
PURPOSE The newly proposed septic shock definition has provoked a substantial controversy in the emergency and critical care communities. We aim to compare new (SEPSIS-III) versus old (SEPSIS-II) definitions for septic shock in a contemporary cohort of critically ill patients. MATERIAL AND METHODS Retrospective cohort of consecutive patients, age ≥ 18 years admitted to intensive care units at the Mayo Clinic between January 2009 and October 2015. We compared patients who met old, new, both, or neither definition of sepsis shock. SMR were calculated using APACHE IV predicted mortality. RESULTS The initial cohort consisted of 16,720 patients who had suspicion of infection, 7463 required vasopressor support. The median (IQR) age was 65(54-75) years and 4167(55.8%) were male. Compared to patients with old definition, the patients with new definition had higher APACHE III score (median IQR); (73 (57-92) vs. 70 (56-89), p < .01); SOFA score; (6 (4-10) vs. 6 (4-9), p < .01), were older (70 (59-79) vs. 64 (54-74) years, p = .03). They also had higher hospital mortality, N (%) 71, (19.7%) vs. 40 (12.6%), p < .01) and a higher SMR (0.66 vs. 0.45, p < .01). CONCLUSIONS Compared to SEPSIS-II, SEPSIS-III definition of septic shock identifies patients further along disease trajectory with higher likelihood of poor outcome.
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Affiliation(s)
- Rahul Kashyap
- Department of Anesthesia and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States; Multidisciplinary Epidemiology and Translational Research in Intensive Care- METRIC, Mayo Clinic, Rochester, MN, United States; Anesthesia Clinical Research Unit, Mayo Clinic, Rochester, United States.
| | - Tarun D Singh
- Multidisciplinary Epidemiology and Translational Research in Intensive Care- METRIC, Mayo Clinic, Rochester, MN, United States; Department of Neurology and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
| | - Hamza Rayes
- Multidisciplinary Epidemiology and Translational Research in Intensive Care- METRIC, Mayo Clinic, Rochester, MN, United States; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
| | - John C O'Horo
- Multidisciplinary Epidemiology and Translational Research in Intensive Care- METRIC, Mayo Clinic, Rochester, MN, United States; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States; Division of Infectious Disease, Mayo Clinic, Rochester, MN, United States
| | - Gregory Wilson
- Multidisciplinary Epidemiology and Translational Research in Intensive Care- METRIC, Mayo Clinic, Rochester, MN, United States; Anesthesia Clinical Research Unit, Mayo Clinic, Rochester, United States
| | - Philippe Bauer
- Multidisciplinary Epidemiology and Translational Research in Intensive Care- METRIC, Mayo Clinic, Rochester, MN, United States; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
| | - Ognjen Gajic
- Multidisciplinary Epidemiology and Translational Research in Intensive Care- METRIC, Mayo Clinic, Rochester, MN, United States; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
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Leite-Avalca MCG, Staats FT, Verona D, de Souza P, Almeida MC, Silva-Santos JE, Zampronio AR. Cannabinoid CB1 Receptor Antagonist Rimonabant Decreases Levels of Markers of Organ Dysfunction and Alters Vascular Reactivity in Aortic Vessels in Late Sepsis in Rats. Inflammation 2018; 42:618-627. [DOI: 10.1007/s10753-018-0919-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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149
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Early goal-directed and lactate-guided therapy in adult patients with severe sepsis and septic shock: a meta-analysis of randomized controlled trials. J Transl Med 2018; 16:331. [PMID: 30486885 PMCID: PMC6264603 DOI: 10.1186/s12967-018-1700-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 11/20/2018] [Indexed: 12/29/2022] Open
Abstract
Background The ProCESS, ARISE, and ProMISe trials have failed to show that early goal-directed therapy (EGDT) reduces mortality in patients with severe sepsis and septic shock. Although lactate-guided therapy (LGT) has been shown to result in significantly lower mortality, its use remains controversial. Therefore, we performed a meta-analysis to evaluate EGDT vs. LGT or usual care (UC) in adult patients with severe sepsis and septic shock. Methods Relevant randomized controlled trials published from January 1, 2001 to March 30, 2017 were identified in PubMed, EMBASE, Web of Science, and the Cochrane Library. The primary outcome was mortality; secondary outcomes included red cell transfusions, dobutamine use, vasopressor infusion, and mechanical ventilation support within the first 6 h and Acute Physiology and Chronic Health Evaluation II (APACHE II) score. Results Sixteen studies enrolling 5968 patients with 2956 in EGDT, 2547 in UC, and 465 in LGT were included in this meta-analysis. Compared with UC, EGDT was associated with a lower mortality (10 trials; RR 0.85, 95% CI 0.74–0.97, P = 0.01), and this difference was more pronounced in the subgroup of UC patients with mortality > 30%. In addition, EGDT patients received more red cell transfusions, dobutamine, and vasopressor infusions within the first 6 h. Compared with LGT, EGDT was associated with higher mortality (6 trials; RR 1.42, 95% CI 1.19–1.70, P = 0.0001) with no heterogeneity (P = 0.727, I2 = 0%). Conclusion EGDT seems to reduce mortality in adult patients with severe sepsis and septic shock, and the benefit may primarily be attributed to red cell transfusions, dobutamine administration, and vasopressor infusions within the first 6 h. However, LGT may result in a greater mortality benefit than EGDT. Electronic supplementary material The online version of this article (10.1186/s12967-018-1700-7) contains supplementary material, which is available to authorized users.
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Prognostic relevance of serum lactate kinetics in critically ill patients. Intensive Care Med 2018; 45:55-61. [PMID: 30478622 DOI: 10.1007/s00134-018-5475-3] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 11/19/2018] [Indexed: 12/29/2022]
Abstract
PURPOSE Changes of lactate concentration over time were reported to be associated with survival in septic patients. We aimed to evaluate delta-lactate (ΔLac) 24 h after admission (Δ24Lac) to an intensive care unit (ICU) in critically ill patients for short- and long-term prognostic relevance. METHODS In total, 26,285 lactate measurements of 2191 patients admitted to a German ICU were analyzed. Inclusion criterion was a lactate concentration at admission above 2.0 mmol/L. Maximum lactate concentrations of day 1 and day 2 were used to calculate Δ24Lac. Follow-up of patients was performed retrospectively. Association of Δ24Lac and both in-hospital and long-term mortality were investigated. An optimal cut-off was calculated by means of the Youden index. RESULTS Patients with lower Δ24Lac were of similar age, but clinically sicker. As continuous variable, higher Δ24Lac was associated with decreased in-hospital mortality (per 1% Δ24Lac; HR 0.987 95%CI 0.985-0.990; p < 0.001) and an optimal Δ24Lac cut-off was calculated at 19%. Δ24Lac ≤ 19% was associated with both increased in-hospital (15% vs 43%; OR 4.11; 95%CI 3.23-5.21; p < 0.001) and long-term mortality (HR 1.54 95%CI 1.28-1.87; p < 0.001), even after correction for APACHE II, need for catecholamines and intubation. We matched 256 patients with Δ24Lac ≤ 19% to case-controls > 19% corrected for APACHE II scores, baseline lactate level and sex: Δ24Lac ≤ 19% remained associated with lower in-hospital and long-term survival. CONCLUSIONS Lower Δ24Lac was robustly associated with adverse outcome in critically ill patients, even after correction for confounders. Δ24Lac might constitute an independent, easily available and important parameter for risk stratification in the critically ill.
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