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A Progressive Early Mobilization Program Is Significantly Associated With Clinical and Economic Improvement: A Single-Center Quality Comparison Study. Crit Care Med 2020; 47:e744-e752. [PMID: 31162197 DOI: 10.1097/ccm.0000000000003850] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To determine whether a progressive early mobilization protocol improves patient outcomes, including in-hospital mortality and total hospital costs. DESIGN Retrospective preintervention and postintervention quality comparison study. SETTINGS Single tertiary community hospital with a 12-bed closed-mixed ICU. PATIENTS All consecutive patients 18 years old or older were eligible. Patients who met exclusion criteria or were discharged from the ICU within 48 hours were excluded. Patients from January 2014 to May 2015 were defined as the preintervention group (group A) and from June 2015 to December 2016 was the postintervention group (group B). INTERVENTION Maebashi early mobilization protocol. MEASUREMENTS AND MAIN RESULTS Group A included 204 patients and group B included 187 patients. Baseline characteristics evaluated include age, severity, mechanical ventilation, and extracorporeal membrane oxygenation, and in group B additional comorbidities and use of steroids. Hospital mortality was reduced in group B (adjusted hazard ratio, 0.25; 95% CI, 0.13-0.49; p < 0.01). This early mobilization protocol is significantly associated with decreased mortality, even after adjusting for baseline characteristics such as sedation. Total hospital costs decreased from $29,220 to $22,706. The decrease occurred soon after initiating the intervention and this effect was sustained. The estimated effect was $-5,167 per patient, a 27% reduction. Reductions in ICU and hospital lengths of stay, time on mechanical ventilation, and improvement in physical function at hospital discharge were also seen. The change in Sequential Organ Failure Assessment score and Sequential Organ Failure Assessment score at ICU discharge were significantly reduced after the intervention, despite a similar Sequential Organ Failure Assessment score at admission and at maximum. CONCLUSIONS In-hospital mortality and total hospital costs are reduced after the introduction of a progressive early mobilization program, which is significantly associated with decreased mortality. Cost savings were realized early after the intervention and sustained. Further prospective studies to investigate causality are warranted.
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Qureshi AI, Abd-Allah F, Al-Senani F, Aytac E, Borhani-Haghighi A, Ciccone A, Gomez CR, Gurkas E, Hsu CY, Jani V, Jiao L, Kobayashi A, Lee J, Liaqat J, Mazighi M, Parthasarathy R, Steiner T, Suri MFK, Toyoda K, Ribo M, Gongora-Rivera F, Oliveira-Filho J, Uzun G, Wang Y. Management of acute ischemic stroke in patients with COVID-19 infection: Report of an international panel. Int J Stroke 2020; 15:540-554. [DOI: 10.1177/1747493020923234] [Citation(s) in RCA: 146] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background and purpose On 11 March 2020, World Health Organization (WHO) declared the COVID-19 infection a pandemic. The risk of ischemic stroke may be higher in patients with COVID-19 infection similar to those with other respiratory tract infections. We present a comprehensive set of practice implications in a single document for clinicians caring for adult patients with acute ischemic stroke with confirmed or suspected COVID-19 infection. Methods The practice implications were prepared after review of data to reach the consensus among stroke experts from 18 countries. The writers used systematic literature reviews, reference to previously published stroke guidelines, personal files, and expert opinion to summarize existing evidence, indicate gaps in current knowledge, and when appropriate, formulate practice implications. All members of the writing group had opportunities to comment in writing on the practice implications and approved the final version of this document. Results This document with consensus is divided into 18 sections. A total of 41 conclusions and practice implications have been developed. The document includes practice implications for evaluation of stroke patients with caution for stroke team members to avoid COVID-19 exposure, during clinical evaluation and performance of imaging and laboratory procedures with special considerations of intravenous thrombolysis and mechanical thrombectomy in stroke patients with suspected or confirmed COVID-19 infection. Conclusions These practice implications with consensus based on the currently available evidence aim to guide clinicians caring for adult patients with acute ischemic stroke who are suspected of, or confirmed, with COVID-19 infection. Under certain circumstances, however, only limited evidence is available to support these practice implications, suggesting an urgent need for establishing procedures for the management of stroke patients with suspected or confirmed COVID-19 infection.
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Affiliation(s)
- Adnan I Qureshi
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, MO, USA
| | - Foad Abd-Allah
- Department of Neurology, Kasralainy school of Medicine, Cairo University, Cairo, Egypt
| | - Fahmi Al-Senani
- Neurology Department, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Emrah Aytac
- Department of Neurology, University of FIRAT, Elazig Turkey
| | | | - Alfonso Ciccone
- Department of Neurosciences, Hospital Carlo Poma, ASST di Mantova, Mantua, Italy
| | - Camilo R Gomez
- Department of Neurology, University of Missouri, MO, USA
| | - Erdem Gurkas
- Stroke Center, Department of Neurology, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Chung Y Hsu
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - Vishal Jani
- Department of Neurology, Creighton University Medical Center/CHI Health, Omaha, NE, USA
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Adam Kobayashi
- Department of Neurology and Interventional Stroke Treatment Centre, Kazimierz Pulaski University of Technology and Humanities, Radom, Poland
| | - Jun Lee
- Department of Neurology, Yeungnam University School of Medicine, Daegu, Korea
| | - Jahanzeb Liaqat
- Pakistan Emirates Military Hospital (J.L.), Rawalpindi, Pakistan
| | - Mikael Mazighi
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, University of Paris, Laboratory of Vascular Translational Sciences, Paris, France
| | | | - Thorsten Steiner
- Department of Neurology, Klinikum Frankfurt Höchst, Frankfurt and Heidelberg University Hospital, Heidelberg, Germany
| | | | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Marc Ribo
- Department of Neurology, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Spain
| | - Fernando Gongora-Rivera
- Servicio de Neurología, Hospital Universitario José Eleuterio González de la Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México; Instituto de Neurología y Neurocirugía, Hospital Zambrano Hellion, Tecnológico de Monterrey, San Pedro, Nuevo León, México
| | | | - Guven Uzun
- Beverly Hills Pain Institute and Neurology, Beverly Hills, CA, USA
| | - Yongjun Wang
- Tiantan Comprehensive Stroke Center, Beijing Tiantan Hospital, Capital Medical University Beijing, China
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Sinto R, Suwarto S, Lie KC, Harimurti K, Widodo D, Pohan HT. Prognostic accuracy of the quick Sequential Organ Failure Assessment (qSOFA)-lactate criteria for mortality in adults with suspected bacterial infection in the emergency department of a hospital with limited resources. Emerg Med J 2020; 37:363-369. [PMID: 32317296 DOI: 10.1136/emermed-2018-208361] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 12/20/2019] [Accepted: 12/30/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Routine use of the Sequential Organ Failure Assessment (SOFA) score to prognosticate patients with sepsis is challenged by the requirement to perform numerous laboratory tests. The prognostic accuracy of the quick SOFA (qSOFA) without or with lactate criteria has not been prospectively investigated in low and middle income countries. We assessed the performance of simplified prognosis criteria using qSOFA-lactate criteria in the emergency department of a hospital with limited resources, in comparison with SOFA prognosis criteria and systemic inflammatory response syndrome (SIRS) screening criteria. METHODS This prospective cohort study was conducted between March and December 2017 in adult patients with suspected bacterial infection visiting the emergency department of the Indonesian National Referral Hospital. Variables from sepsis prognosis and screening criteria and venous lactate concentration at enrolment were recorded. Patients were followed up until hospital discharge or death. Prognostic accuracy was measured using area under the receiver operating characteristic curve (AUROC) of each criterion in the prediction of in-hospital mortality. RESULTS Of 3026 patients screened, 1213 met the inclusion criteria. The AUROC of qSOFA-lactate criteria was 0.74 (95% CI 0.71 to 0.77). The AUROC of qSOFA-lactate was not statistically significantly different to the SOFA score (AUROC 0.75, 95% CI 0.72 to 0.78; p=0.462). The qSOFA-lactate was significantly higher than qSOFA (AUROC 0.70, 95% CI0.67 to 0.74; p=0.006) and SIRS criteria (0.57, 95% CI0.54 to 0.60; p<0.001). CONCLUSIONS The prognostic accuracy of the qSOFA-lactate criteria is as good as the SOFA score in the emergency department of a hospital with limited resources. The performance of the qSOFA criteria is significantly lower than the qSOFA-lactate criteria and SOFA score.This abstract has been translated and adapted from the original English-language content. Translated content is provided on an "as is" basis. Translation accuracy or reliability is not guaranteed or implied. BMJ is not responsible for any errors and omissions arising from translation to the fullest extent permitted by law, BMJ shall not incur any liability, including without limitation, liability for damages, arising from the translated text.
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Affiliation(s)
- Robert Sinto
- Division of Tropical and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National Hospital, Jakarta Pusat, DKI Jakarta, Indonesia
| | - Suhendro Suwarto
- Division of Tropical and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National Hospital, Jakarta Pusat, DKI Jakarta, Indonesia
| | - Khie Chen Lie
- Division of Tropical and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National Hospital, Jakarta Pusat, DKI Jakarta, Indonesia
| | - Kuntjoro Harimurti
- Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National Hospital, Jakarta Pusat, DKI Jakarta, Indonesia.,Clinical Epidemiology and Evidence-based Medicine Unit, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National Hospital, Jakarta Pusat, DKI Jakarta, Indonesia
| | - Djoko Widodo
- Division of Tropical and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National Hospital, Jakarta Pusat, DKI Jakarta, Indonesia
| | - Herdiman T Pohan
- Division of Tropical and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National Hospital, Jakarta Pusat, DKI Jakarta, Indonesia
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Loudet CI, Marchena MC, Tumino LI, Cabana ML, Capurro G, Astegiano P, Velásquez MA, Casanova M, Rodríguez Bugueiro MJ, Roth MC, Roda G, Gimbernat R, Balmaceda YDV, Okurzaty P, Perman MI, González AL, Reina R, Estenssoro E. Prognostic capability of the Maximum Acute Gastrointestinal Injury Score and of caloric intake in patients requiring vasopressors: A multicenter prospective cohort study. J Crit Care 2020; 58:41-47. [PMID: 32335494 DOI: 10.1016/j.jcrc.2020.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 04/09/2020] [Accepted: 04/13/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE Our main objective was to use the Maximum Acute Gastrointestinal Injury Score (AGImax) to evaluate the prognostic capability of gastrointestinal dysfunction (GID), on hospital mortality in patients on mechanical ventilation (MV) requiring vasopressors. A secondary goal was to analyze the relationship between AGImax and vasopressor dosage with increasing caloric intake. MATERIALS AND METHODS Prospective multicenter cohort study in ten ICUs across Argentina. Consecutive adult patients on MV, requiring vasopressors and receiving enteral nutrition (EN) were included. AGImax was identified (I-IV) using a modified AGI score. Comparisons of clinical and outcome variables were performed in 3 predetermined EN-groups: <10 kcal/kg/d, ≥10 to <20 kcal/kg/d, or ≥ 20 kcal/kg/d. RESULTS A total of 494 patients met all inclusion criteria. Forty-four percent of patients had severe AGImax and 17% received <10 kcal/kg/day, indicating more severity and higher mortality. Notable independent predictors of mortality were AGImax, vasopressors, and caloric intake. PN was the only factor which had an inverse relationship to mortality. CONCLUSIONS In this population, patients with AGImax III-IV were significantly associated with lower caloric intake and greater hospital mortality, highlighting the importance of AGI as a prognostic tool. As PN was linked with lower mortality, it could be an option to explore in further studies.
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Affiliation(s)
- Cecilia I Loudet
- Servicio de Terapia Intensiva, Hospital Interzonal General de Agudos General San Martín, La Plata, Argentina; Cátedra de Farmacología Aplicada, Universidad Nacional de La Plata, Argentina.
| | - María C Marchena
- Servicio de Terapia Intensiva, Hospital Interzonal General de Agudos General San Martín, La Plata, Argentina
| | - Leandro I Tumino
- Servicio de Terapia Intensiva, Hospital Interzonal General de Agudos General San Martín, La Plata, Argentina
| | - María L Cabana
- Servicio de Terapia Intensiva, Hospital Pablo Soria, Jujuy, Argentina
| | - Gabriela Capurro
- Servicio de Terapia Intensiva, Hospital Interzonal General de Agudos Dr. Oscar Alende, Mar del Plata, Argentina
| | - Paulina Astegiano
- Servicio de Terapia Intensiva, Hospital José María Cullen, Santa Fe, Argentina
| | - Mariela A Velásquez
- Unidad de Terapia Intensiva, Sanatorio Nuestra Señora del Rosario, Jujuy, Argentina
| | - Matías Casanova
- Servicio de Terapia Intensiva, Hospital El Cruce, Florencio Varela, Argentina
| | | | - María C Roth
- Servicio de Terapia Intensiva, Hospital San Juan de Dios, La Plata, Argentina
| | - Gisela Roda
- Servicio de Terapia Intensiva, Hospital Municipal Eva Perón, Merlo, Argentina
| | - Rolando Gimbernat
- Unidad de Terapia Intensiva, Centro de Cuidados Intensivos, San Juan, Argentina
| | | | - Patricia Okurzaty
- Unidad de Terapia Intensiva, Casa Hospital San Juan de Dios, Ramos Mejía, Argentina
| | - Mario I Perman
- Asociación Argentina de Nutrición Enteral y Parenteral (AANEP), Argentina
| | - Ana L González
- Servicio de Terapia Intensiva, Hospital Interzonal General de Agudos General San Martín, La Plata, Argentina
| | - Rosa Reina
- Servicio de Terapia Intensiva, Hospital Interzonal General de Agudos General San Martín, La Plata, Argentina
| | - Elisa Estenssoro
- Servicio de Terapia Intensiva, Hospital Interzonal General de Agudos General San Martín, La Plata, Argentina
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155
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Exploring Incontinence-Associated Dermatitis in a Single Center Intensive Care Unit: A Longitudinal Point Prevalence Survey. J Wound Ostomy Continence Nurs 2020; 46:401-407. [PMID: 31513128 DOI: 10.1097/won.0000000000000571] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE The purpose of this study was to provide longitudinal prevalence rates of incontinence-associated dermatitis (IAD) in patients in an intensive care unit (ICU) and to identify patient characteristics associated with IAD development. DESIGN Prospective observational. SUBJECTS AND SETTING The sample comprised 351 patients aged 18 years and older in a major metropolitan public hospital ICU in Queensland, Australia. METHODS All consenting, eligible participants at risk of developing IAD underwent weekly skin inspections to determine the presence of IAD. Data were collected weekly for 52 consecutive weeks. Descriptive statistics described the study sample and logistic regression analysis was used to identify patient characteristics associated with development of IAD. RESULTS The weekly IAD prevalence ranged between 0% and 70%, with IAD developing in 17% (n = 59/351) of ICU patients. The odds of IAD developing increased statistically significantly with increasing age (odds ratio [OR]: 1.029, 95% confidence interval [CI]: 1.005-1.054, P = .016), time in the ICU (OR = 1.104; 95% CI: 1.063-1.147, P < .001), and Bristol Stool chart score (OR = 4.363, 95% CI: 2.091-9.106, P < .001). Patients with respiratory (OR = 3.657, 95% CI: 1.399-9.563, P = .008) and sepsis (OR = 3.230, 95% CI: 1.281-8.146, P = .013) diagnoses had increased odds of developing IAD. CONCLUSIONS These data show the high variability of IAD prevalence over a 1-year period. Characteristics associated with the development of IAD in patients in the ICU included older age, longer lengths of ICU stay, incontinent of liquid feces, and having respiratory or sepsis diagnoses.
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In-Hospital Post-Operative Infection after Heart Transplantation: Epidemiology, Clinical Management, and Outcome. Surg Infect (Larchmt) 2020; 21:179-191. [DOI: 10.1089/sur.2019.073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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157
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Telles GP, Ferreira IBB, Carvalho de Menezes R, do Carmo TA, David Pugas PL, Marback LF, Arriaga MB, Fukutani KF, Neto LP, Agareno S, Akrami KM, Filgueiras Filho NM, Andrade BB. Comparison of a modified Sequential Organ Failure Assessment Score using RASS and FOUR. PLoS One 2020; 15:e0229199. [PMID: 32084199 PMCID: PMC7034824 DOI: 10.1371/journal.pone.0229199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 02/01/2020] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE ICU severity scores such as the Sequential Organ Failure Assessment (SOFA) determine neurologic dysfunction based on the Glasgow Coma Scale, a tool that may be limited in a critically ill population. It remains unknown whether alternative methods to assess for neurologic dysfunction, such as FOUR and RASS, are superior. This study aimed to determine the predictive performance of a modified SOFA tool in a large Brazilian ICU cohort. DESIGN Prospective cohort single center study. SETTING Mixed surgical and medical ICU in Salvador, Bahia, Brazil between August 2015 and December 2018. PATIENTS All acutely ill ICU admissions, other than postoperative patients or those with insufficient data, were eligible for study inclusion. MEASUREMENTS AND MAIN RESULTS 2147 patients were admitted to the ICU, of which 999 meeting inclusion criteria were included in the final analysis with a median age of 72 years (IQR 58-83) and a female predominance 545 (54%). The SOFA score using GCS, RASS and FOUR for the neurologic component performed marginally in the ability to predict general ICU mortality (SOFAGCS AUC 0.74 vs SOFARASS AUC 0.71 and SOFAFOUR AUC 0.67), with SOFAFOUR performing significantly lower compared to either SOFARASS and SOFAGCS (p<0.04, p<0.004 respectively). All three scores demonstrated decreased discriminate function in the mechanically ventilated population (SOFAGCS AUC 0.70 vs SOFARASS AUC 0.70 and SOFAFOUR AUC 0.55), though SOFAFOUR remained significantly worse when compared to SOFAGCS or SOFARASS (p = 0.034, p = 0.014, respectively).. Furthermore, performance was poor in a subset of patients with sepsis (n = 145) at time of admission (SOFAGCS AUC 0.66 vs SOFARASS AUC 0.55 and SOFAFOUR AUC 0.56). CONCLUSION Modification of the neurologic component in the SOFA score does not appear to improve mortality prediction in the ICU.
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Affiliation(s)
| | | | | | | | | | | | - Maria B. Arriaga
- Instituto Gonçalo Moniz, FIOCRUZ, Salvador, Bahia, Brazil
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
| | | | | | - Sydney Agareno
- Intensive Care Unit, Hospital de Cidade, Salvador, Bahia, Brazil
| | - Kevan M. Akrami
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
- Division of Infectious Diseases and Pulmonary Critical Care and Sleep Medicine, Department of Medicine, University of California, San Diego, California
- * E-mail: (BBA); (KMA)
| | - Nivaldo Menezes Filgueiras Filho
- Universidade do Estado da Bahia (UNEB), Salvador, Bahia, Brazil
- Universidade Salvador (UNIFACS), Salvador, Bahia, Brazil
- Intensive Care Unit, Hospital de Cidade, Salvador, Bahia, Brazil
- Hospital de Cidade, NEPC, Salvador, Bahia, Brazil
| | - Bruno B. Andrade
- Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Bahia, Brazil
- União Metropolitana para o Desenvolvimento da Educação e Cultura (UNIME), Salvador, Bahia, Brazil
- Instituto Gonçalo Moniz, FIOCRUZ, Salvador, Bahia, Brazil
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
- * E-mail: (BBA); (KMA)
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McKeever L, Peterson SJ, Lateef O, Freels S, Fonseca TL, Bocco BMLC, Fernandes GW, Roehl K, Nowak K, Mozer M, Bianco AC, Braunschweig CA. Higher Caloric Exposure in Critically Ill Patients Transiently Accelerates Thyroid Hormone Activation. J Clin Endocrinol Metab 2020; 105:5580691. [PMID: 31581295 PMCID: PMC9633328 DOI: 10.1210/clinem/dgz077] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 09/27/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The inflammatory response of critical illness is accompanied by nonthyroidal illness syndrome (NTIS). Feeding has been shown to attenuate this process, but this has not been explored prospectively over time in critically ill patients. OBJECTIVE To explore the impact of calorie exposure on NTIS over time in critically ill patients. METHODS Mechanically ventilated patients with systemic inflammatory response syndrome (SIRS) were randomized to receive either 100% or 40% of their estimated caloric needs (ECN). Thyroid hormones were measured daily for 7 days or until intensive care unit discharge or death. Mixed level regression modeling was used to explore the effect of randomization group on plasma triiodothyronine (T3), reverse triiodothyronine (rT3), thyroxine (T4), and thyroid stimulating hormone (TSH), as well as the T3/rT3 ratio. RESULTS Thirty-five participants (n=19 in 100% ECN; n=16 in 40% ECN) were recruited. Adjusting for group differences in baseline T3/rT3 ratio, the parameters defining the fitted curves (intercept, linear effect of study day, and quadratic effect of study day) differed by randomization group (P = 0.001, P = 0.01, and P = 0.02 respectively). Plots of the fitted curves revealed that participants in the 100% ECN group had a 54% higher T3/rT3 ratio on postintervention day 1 compared with the 40% ECN group, a difference which attenuated over time. This was driven by a 23% higher plasma T3 and 10% lower plasma rT3 levels on postintervention 1. CONCLUSIONS Higher caloric exposure in NTIS patients transiently attenuates the drop of the plasma T3/rT3 ratio, an effect that is minimized and finally lost over the following 3 days of continued higher caloric exposure.
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Affiliation(s)
| | - Sarah J Peterson
- Rush University Medical Center, Department of Clinical Nutrition, Chicago, Illinois
| | - Omar Lateef
- Rush University Medical Center, Department of Clinical Nutrition, Chicago, Illinois
| | - Sally Freels
- University of Illinois at Chicago, Department of Epidemiology and Biostatistics, Chicago, Illinois
| | - Tatiana L Fonseca
- University of Chicago Medical Center, Section of Adult and Pediatric Endocrinology, Diabetes and Metabolism, Chicago, Illinois
| | - Barbara M L C Bocco
- University of Chicago Medical Center, Section of Adult and Pediatric Endocrinology, Diabetes and Metabolism, Chicago, Illinois
| | - Gustavo W Fernandes
- University of Chicago Medical Center, Section of Adult and Pediatric Endocrinology, Diabetes and Metabolism, Chicago, Illinois
| | - Kelly Roehl
- Rush University Medical Center, Department of Clinical Nutrition, Chicago, Illinois
| | - Kristen Nowak
- Rush University Medical Center, Department of Clinical Nutrition, Chicago, Illinois
| | - Marisa Mozer
- Rush University Medical Center, Department of Clinical Nutrition, Chicago, Illinois
| | - Antonio C Bianco
- University of Chicago Medical Center, Section of Adult and Pediatric Endocrinology, Diabetes and Metabolism, Chicago, Illinois
| | - Carol A Braunschweig
- Correspondence: Carol A. Braunschweig, PhD, RD, Department of Kinesiology and Nutrition, University of Illinois at Chicago, 1919 W Taylor (m/c 517), Room 650, Chicago, IL 60612, USA. E-mail:
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Patel JJ, Baruah D, Sobush D, Koester K, Aase J, Zellner S, Graf J, Durand MJ, Szabo A, Shahir K. Identifying High-Attenuating and Low-Attenuating Muscle Using Computerized Tomography and Exploring Its Impact on Physical Function and Muscle Strength in Obese Critically Ill Patients. Nutr Clin Pract 2020; 35:133-141. [PMID: 31172570 PMCID: PMC10515294 DOI: 10.1002/ncp.10325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Computed tomography (CT) methods to estimate sarcopenia in obesity do not differentiate high-attenuating from low-attenuating muscle. The primary purpose of this study was to determine agreement between a CT method using general workstation-derived total and high-attenuating psoas muscle cross-sectional area (CSA) and a commercially available segmentation software-derived value. Secondary purpose was to explore the relationship between quantity of high-attenuating muscle to physical functioning in a pilot cohort of obese medical intensive care unit (MICU) patients. METHODS We conducted a prospective observational cross-sectional study. CT images of obese MICU patients were reconstructed to calculate total psoas muscle, low-attenuating muscle, and high-attenuating muscle within the third lumbar psoas CSA using a CT method and commercial software. We performed blinded outcome measures of CSA, physical function, and muscle strength in 28 patients. RESULTS Concordance correlation coefficient for identifying total psoas muscle was 0.96 (95% confidence interval: 0.93-0.98, P-value < 0.0001) between CT method and commercial software. There was moderate correlation between modified Medical Research Council muscle strength scores and high-attenuating psoas muscle CSA (r = 0.47, P = 0.01) and lower extremity strength and high-attenuating psoas muscle CSA (r = 0.40, P = 0.04). CONCLUSION There was strong agreement between our CT method and a commercial software method to identify total psoas muscle CSA in obesity. Greater total high-attenuating psoas CSA moderately correlated with muscle strength. Additional studies using more objective markers of muscle strength validating these findings are needed.
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Affiliation(s)
- Jayshil J. Patel
- Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Dhiraj Baruah
- Division of Thoracic Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Dennis Sobush
- Department of Acute Care Rehabilitation, Froedtert and The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Katie Koester
- Department of Acute Care Rehabilitation, Froedtert and The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jacob Aase
- Department of Acute Care Rehabilitation, Froedtert and The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Stephanie Zellner
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jeanette Graf
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Matthew J. Durand
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Aniko Szabo
- Institute for Health and Policy, Milwaukee, Wisconsin, USA
| | - Kaushik Shahir
- Division of Thoracic Radiology, University of South Florida, Tampa, Florida, USA
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Jentzer JC, Wiley B, Bennett C, Murphree DH, Keegan MT, Gajic O, Kashani KB, Barsness GW. Early noncardiovascular organ failure and mortality in the cardiac intensive care unit. Clin Cardiol 2020; 43:516-523. [PMID: 31999370 PMCID: PMC7244298 DOI: 10.1002/clc.23339] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/07/2020] [Accepted: 01/14/2020] [Indexed: 11/07/2022] Open
Abstract
Background Noncardiac organ failure has been associated with worse outcomes among a cardiac intensive care unit (CICU) population. Hypothesis We hypothesized that early organ failure based on the sequential organ failure assessment (SOFA) score would be associated with mortality in CICU patients. Methods Adult CICU patients from 2007 to 2015 were reviewed. Organ failure was defined as any SOFA organ subscore ≥3 on the first CICU day. Organ failure was evaluated as a predictor of hospital mortality and postdischarge survival after adjustment for illness severity and comorbidities. Results We included 10 004 patients with a mean age of 67 ± 15 years (37% female). Admission diagnoses included acute coronary syndrome in 43%, heart failure in 46%, cardiac arrest in 12%, and cardiogenic shock in 11%. Organ failure was present in 31%, including multiorgan failure in 12%. Hospital mortality was higher in patients with organ failure (22% vs 3%, adjusted OR 3.0, 95% CI 2.5‐3.7, P < .001). After adjustment, each failing organ system predicted twofold higher odds of hospital mortality (adjusted OR 1.9, 95% CI 1.1‐2.1, P < .001). Mortality risk was highest with cardiovascular, coagulation and liver failure. Among hospital survivors, organ failure was associated with higher adjusted postdischarge mortality risk (P < .001); multiorgan failure did not confer added long‐term mortality risk. Conclusions Early noncardiovascular organ failure, especially multiorgan failure, is associated with increased hospital mortality in CICU patients, and this risk continues after hospital discharge, emphasizing the need to promote early recognition of organ failure in CICU patients.
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Affiliation(s)
- Jacob C Jentzer
- Department of Cardiovascular Medicine, The Mayo Clinic, Rochester, Minnesota.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, The Mayo Clinic, Rochester, Minnesota
| | - Brandon Wiley
- Department of Cardiovascular Medicine, The Mayo Clinic, Rochester, Minnesota.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, The Mayo Clinic, Rochester, Minnesota
| | - Courtney Bennett
- Department of Cardiovascular Medicine, The Mayo Clinic, Rochester, Minnesota.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, The Mayo Clinic, Rochester, Minnesota
| | - Dennis H Murphree
- Department of Health Sciences Research, The Mayo Clinic, Rochester, Minnesota
| | - Mark T Keegan
- Department of Anesthesiology and Perioperative Medicine, The Mayo Clinic, Rochester, Minnesota
| | - Ognjen Gajic
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, The Mayo Clinic, Rochester, Minnesota
| | - Kianoush B Kashani
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, The Mayo Clinic, Rochester, Minnesota.,Division of Nephrology and Hypertension, Department of Internal Medicine, The Mayo Clinic, Rochester, Minnesota
| | - Gregory W Barsness
- Department of Cardiovascular Medicine, The Mayo Clinic, Rochester, Minnesota
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McKeever L, Peterson SJ, Cienfuegos S, Rizzie J, Lateef O, Freels S, Braunschweig CA. Real-Time Energy Exposure Is Associated With Increased Oxidative Stress Among Feeding-Tolerant Critically Ill Patients: Results From the FEDOX Trial. JPEN J Parenter Enteral Nutr 2020; 44:1484-1491. [PMID: 31995239 PMCID: PMC7754354 DOI: 10.1002/jpen.1776] [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: 10/01/2019] [Revised: 11/19/2019] [Accepted: 12/10/2019] [Indexed: 01/13/2023]
Abstract
Background Prospective randomized controlled trials (PRCTs) that found harm in patients receiving higher levels of energy exposure have been largely ignored, in part because of the lack of a known mechanism of harm. Objective The current 7‐day pilot study is a PRCT and post hoc analysis designed to explore the relationship between energy exposure and oxidative stress (as plasma total F2‐isoprostanes) in mechanically ventilated intensive care unit patients with systemic inflammatory response syndrome. Methods Thirty‐five participants were randomized to receive either 100% or 40% of their estimated energy needs. Our intent‐to‐treat model found no differences in F2‐isoprostanes between groups. A post hoc analysis revealed that on days when participants were in the highest tertile of daily kcal/kg, the real‐time energy flow rate within 2 hours of the blood draw was predictive of increased oxidative stress. On these days, participants in the second or third vs the first tertile of real‐time energy flow rate experienced a 41.8% (P = .006) or 26.5% (P = .001) increase in F2‐isoprostane levels, respectively. This was confirmed through a within‐group subanalysis restricted to participants with measurements on both sides of the median of real‐time energy flow rate that found a 28.2% F2‐isoprostane increase on days in the upper vs lower median of flow rate (P = .002). Conclusion The benefits of feeding may be more nuanced than previously suspected. Our findings imply a potential mechanism of harm in meeting the current recommendations for nutrition support in the critically ill that warrants further investigation.
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Affiliation(s)
- Liam McKeever
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sarah J Peterson
- Department of Clinical Nutrition, Rush University Medical Center, Chicago, Illinois, USA
| | - Sofia Cienfuegos
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jaime Rizzie
- Department of Clinical Nutrition, Rush University Medical Center, Chicago, Illinois, USA
| | - Omar Lateef
- Department of Clinical Nutrition, Rush University Medical Center, Chicago, Illinois, USA
| | - Sally Freels
- Department of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Carol A Braunschweig
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, Illinois, USA
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Ogasawara O, Kojima T, Miyazu M, Sobue K. Impact of the stress ulcer prophylactic protocol on reducing the unnecessary administration of stress ulcer medications and gastrointestinal bleeding: a single-center, retrospective pre-post study. J Intensive Care 2020; 8:10. [PMID: 31988751 PMCID: PMC6966877 DOI: 10.1186/s40560-020-0427-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 01/09/2020] [Indexed: 12/11/2022] Open
Abstract
Background Clinically significant gastrointestinal bleeding from stress ulcers increases patient mortality in intensive care, and histamine type 2 receptor blockers and proton pump inhibitors as stress ulcer prophylaxes were reported to decrease the incidence of that. Although medical checklists are widely used to maintain high compliance with medications and interventions to improve patient outcome in the intensive care field, the efficacy of medical checklists regarding the incidence of gastrointestinal bleeding and the reduction of unnecessary administration of stress ulcer prophylaxis medications has not been sufficiently explored to date. This study aimed to investigate the incidence of gastrointestinal bleeding and the rate of administering stress ulcer prophylaxis medication before and after setting administration criteria for stress ulcer prophylaxis and introducing a medical checklist for critically ill adults. Methods This was a retrospective pre-post study at a single-center, tertiary adult and pediatric mixed ICU. Adult patients (≥ 18 years) who were admitted to the ICU for reasons other than gastrectomy, esophagectomy, pancreatoduodenectomy, and gastrointestinal bleeding were analyzed. A medical checklist and stress ulcer prophylaxis criteria were introduced on December 22, 2014, and the patients were classified into the preintervention group (from September to December 21, 2014) and the postintervention group (from December 22, 2014, to April 2015). The primary outcome was the incidence of upper gastrointestinal bleeding, and the secondary outcome was the proportion administered stress ulcer prophylaxis medications. Results One hundred adult patients were analyzed. The incidence of upper gastrointestinal bleeding in the pre- and postintervention groups was both 4.0% [95% confidence interval, 0.5–13.7%]. The proportion administered stress ulcer prophylaxis medications decreased from 100 to 38% between the pre- and post-intervention groups. Conclusions After the checklist and the criteria were introduced, the administration of stress ulcer prophylaxis medications decreased without an increase in upper gastrointestinal bleeding in critically ill adults. Prospective studies are necessary to evaluate the causal relationship between the introduction of them and gastrointestinal adverse events in critically ill adults.
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Affiliation(s)
- Osamu Ogasawara
- 1Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Science, 1-Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601 Japan
| | - Taiki Kojima
- Department of Anesthesiology, Aichi Children's Health and Medical Center, 7-426, Morioka-cho, Obu, Aichi 474-0031 Japan
| | - Mitsunori Miyazu
- Department of Anesthesiology, Aichi Children's Health and Medical Center, 7-426, Morioka-cho, Obu, Aichi 474-0031 Japan
| | - Kazuya Sobue
- 1Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Science, 1-Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601 Japan
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163
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A new simplified and accurate sa-SOFA score. J Crit Care 2020; 57:240-245. [PMID: 31926636 DOI: 10.1016/j.jcrc.2019.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 09/30/2019] [Accepted: 11/14/2019] [Indexed: 01/20/2023]
Abstract
PURPOSE Several remarks have been raised regarding the variables and cut-points used in the Sequential Organ Failure Assessment (SOFA) score. This study revisited the SOFA score and created a new simplified and accurate sa-SOFA score. METHODS The study grouped four prospective cohorts (2005-2016) of patients with Systemic Inflammatory Response Syndrome. It collected 28-day mortality, sociodemographic characteristics, and the SOFA score with all variable values at Day 1. A logistic regression analysis was used to select the most relevant variables and a minimum p value approach with a 10-fold cross-validation were used to find the optimal partition of selected variables. The minimum number of cut-points (2, 3, or 4) was also tested by comparing the distributions of areas under receiver operating characteristic (AUROC) curves. RESULTS Among the 1436 participants, 416 died within 28 days (28.9%). The sa-SOFA kept one variable per dimension and two cut-points per variable. The AUROC curves that investigated the abilities of the sa-SOFA and SOFA scores to predict 28-day mortality were 0.739 [0.712-0.768] and 0.687 [0.656-0.717], respectively (p-value of DeLong test <0.001). CONCLUSION Keeping the conventional SOFA dimension variables, the new sa-SOFA proved to be simpler and more accurate in predicting 28-day mortality.
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Renjen P, Chaudhari D, Mishra A, Bukhari I. COVID-19 and stroke – Updated review. APOLLO MEDICINE 2020. [DOI: 10.4103/am.am_89_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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165
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Song F, Liu C, Zhang J, Lei Y, Hu Z. Antibacterial effect of fosfomycin tromethamine on the bacteria inside urinary infection stones. Int Urol Nephrol 2019; 52:645-654. [PMID: 31832876 DOI: 10.1007/s11255-019-02358-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 12/05/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study sought to evaluate the antibacterial effect of fosfomycin tromethamine (FT) on the bacteria inside urinary infection stones. METHODS The internal structures of urinary stones were observed via scanning electron microscopy to verify the presence of internal bacteria. We randomly assigned equal numbers of patients with kidney stones who met the inclusion criteria into two groups in a prospective study and treated them with different perioperative antibiotics. One group (experimental group) was treated with FT, and the other (control group) was treated with cefuroxime sodium. All stone specimens were collected via percutaneous nephrolithotomy (PCNL). The primary infection stones were screened via a stone component analysis, 30 cases in the experimental group and 31 cases in the control group. High-performance liquid chromatography (HPLC)-mass spectrometry was used to measure the drug concentration inside the stones, the bacterial count was calculated via stone culture, and the clinical infection index were monitored for between-group comparisons. RESULTS Compared with the control group, the experimental group had a higher internal drug concentration, a higher drug sensitivity against various pathogenic bacteria, a lower bacterial colony count in the stone culture, and a lower incidence of postoperative clinical infection. CONCLUSIONS FT is more effective than cefuroxime, which is commonly used during the perioperative period of urinary stones, and exerts a high antibacterial effect on these internal bacteria, and effectively reduces the probability of infection and sepsis after urinary stone surgery. FT can be used as an antibiotic during the perioperative period of urinary stones.
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Affiliation(s)
- Fei Song
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chuan Liu
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Junyong Zhang
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yusheng Lei
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zili Hu
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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166
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Lambden S, Laterre PF, Levy MM, Francois B. The SOFA score-development, utility and challenges of accurate assessment in clinical trials. Crit Care 2019; 23:374. [PMID: 31775846 PMCID: PMC6880479 DOI: 10.1186/s13054-019-2663-7] [Citation(s) in RCA: 406] [Impact Index Per Article: 81.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 10/29/2019] [Indexed: 12/29/2022] Open
Abstract
The Sequential Organ Failure Assessment or SOFA score was developed to assess the acute morbidity of critical illness at a population level and has been widely validated as a tool for this purpose across a range of healthcare settings and environments.In recent years, the SOFA score has become extensively used in a range of other applications. A change in the SOFA score of 2 or more is now a defining characteristic of the sepsis syndrome, and the European Medicines Agency has accepted that a change in the SOFA score is an acceptable surrogate marker of efficacy in exploratory trials of novel therapeutic agents in sepsis. The requirement to detect modest serial changes in a patients' SOFA score therefore means that increased clarity on how the score should be assessed in different circumstances is required.This review explores the development of the SOFA score, its applications and the challenges associated with measurement. In addition, it proposes guidance designed to facilitate the consistent and valid assessment of the score in multicentre sepsis trials involving novel therapeutic agents or interventions.ConclusionThe SOFA score is an increasingly important tool in defining both the clinical condition of the individual patient and the response to therapies in the context of clinical trials. Standardisation between different assessors in widespread centres is key to detecting response to treatment if the SOFA score is to be used as an outcome in sepsis clinical trials.
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Affiliation(s)
- Simon Lambden
- Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, CB20Q, UK
| | - Pierre Francois Laterre
- St Luc University Hospital, Université Catholique de Louvain, Avenue Hippocrate 12, 1200, Brussels, Belgium
| | - Mitchell M Levy
- Rhode Island Hospital, Alpert Medical School, Brown University, Providence, RI, USA
| | - Bruno Francois
- Intensive care unit & Inserm CIC 1435 & Inserm UMR 1092, Dupuytren University Hospital, Limoges, France.
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167
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Tran QK, O'Connor J, Vesselinov R, Haase D, Duncan R, Aitken A, Rea JH, Jones K, Dinardo T, Scalea T, Menaker J, Rubinson L. The Critical Care Resuscitation Unit Transfers More Patients From Emergency Departments Faster and Is Associated With Improved Outcomes. J Emerg Med 2019; 58:280-289. [PMID: 31761462 DOI: 10.1016/j.jemermed.2019.09.041] [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] [Received: 05/31/2019] [Revised: 09/19/2019] [Accepted: 09/24/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Transfer delays of critically ill patients from other hospitals' emergency departments (EDs) to an appropriate referral hospital's intensive care unit (ICU) are associated with poor outcomes. OBJECTIVES We hypothesized that an innovative Critical Care Resuscitation Unit (CCRU) would be associated with improved outcomes by reducing transfer times to a quaternary care center and times to interventions for ED patients with critical illnesses. METHODS This pre-post analysis compared 3 groups of patients: a CCRU group (patients transferred to the CCRU during its first year [July 2013 to June 2014]), a 2011-Control group (patients transferred to any ICU between July 2011 and June 2012), and a 2013-Control group (patients transferred to other ICUs between July 2013 and June 2014). The primary outcome was time from transfer request to ICU arrival. Secondary outcomes were the interval between ICU arrival to the operating room and in-hospital mortality. RESULTS We analyzed 1565 patients (644 in the CCRU, 574 in the 2011-Control, and 347 in 2013-Control groups). The median time from transfer request to ICU arrival for CCRU patients was 108 min (interquartile range [IQR] 74-166 min) compared with 158 min (IQR 111-252 min) for the 2011-Control and 185 min (IQR 122-283 min) for the 2013-Control groups (p < 0.01). The median arrival-to-urgent operation for the CCRU group was 220 min (IQR 120-429 min) versus 439 min (IQR 290-645 min) and 356 min (IQR 268-575 min; p < 0.026) for the 2011-Control and 2013-Control groups, respectively. After adjustment with clinical factors, transfer to the CCRU was associated with lower mortality (odds ratio 0.64 [95% confidence interval 0.44-0.93], p = 0.019) in multivariable logistic regression. CONCLUSION The CCRU, which decreased time from outside ED's transfer request to referral ICU arrival, was associated with lower mortality likelihood. Resuscitation units analogous to the CCRU, which transfer resource-intensive patients from EDs faster, may improve patient outcomes.
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Affiliation(s)
- Quincy K Tran
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland; The R. Adams Cowley Shock Trauma Center, Program in Trauma, University of Maryland School of Medicine, Baltimore, Maryland
| | - James O'Connor
- The R. Adams Cowley Shock Trauma Center, Program in Trauma, University of Maryland School of Medicine, Baltimore, Maryland; Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Roumen Vesselinov
- Department of Epidemiology and Public Health, University of Maryland at Baltimore, Baltimore, Maryland
| | - Daniel Haase
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland; The R. Adams Cowley Shock Trauma Center, Program in Trauma, University of Maryland School of Medicine, Baltimore, Maryland
| | - Rebecca Duncan
- The R. Adams Cowley Shock Trauma Center, Program in Trauma, University of Maryland School of Medicine, Baltimore, Maryland
| | - Ashley Aitken
- University of Maryland Medical Center, Baltimore, Maryland
| | - Jeffrey H Rea
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland; The R. Adams Cowley Shock Trauma Center, Program in Trauma, University of Maryland School of Medicine, Baltimore, Maryland
| | - Kevin Jones
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland; The R. Adams Cowley Shock Trauma Center, Program in Trauma, University of Maryland School of Medicine, Baltimore, Maryland
| | | | - Thomas Scalea
- The R. Adams Cowley Shock Trauma Center, Program in Trauma, University of Maryland School of Medicine, Baltimore, Maryland; Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jay Menaker
- The R. Adams Cowley Shock Trauma Center, Program in Trauma, University of Maryland School of Medicine, Baltimore, Maryland; Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Lewis Rubinson
- The R. Adams Cowley Shock Trauma Center, Program in Trauma, University of Maryland School of Medicine, Baltimore, Maryland; Department of Internal Medicine, University of Maryland School of Medicine, Baltimore, Maryland
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Naderpour Z, Momeni M, Vahidi E, Safavi J, Saeedi M. Procalcitonin and D-dimer for Predicting 28-Day-Mortality Rate and Sepsis Severity based on SOFA Score; A Cross-sectional Study. Bull Emerg Trauma 2019; 7:361-365. [PMID: 31857998 PMCID: PMC6911710 DOI: 10.29252/beat-070404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objective: To determine the possible relationship of procalcitonin (PCT) and D-dimer with the 28-day-mortality rate and severity of sepsis based on sequential organ failure assessment (SOFA) score. Methods: In this cross-sectional study, patients were enrolled based on their signs and symptoms of sepsis confirmed by essential laboratory studies. Demographic data, Glasgow coma scale and vital signs, serum PCT and D-dimer levels, creatinine, bilirubin level, arterial blood gas analysis and platelet count were recorded. Disease severity index was assessed based on SOFA score. Patients’ 28-day-mortality rate and hospital length of stay were compared with the study variables. Results: Sixty-four patients with the mean age of 78.3±11.6 were included of whom 34 cases (53.1%) were male. The 28-day-mortality rate was 17%. The analysis showed that only patients’ age (p=0.01) and platelet count (p=0.02) had a statistically significant association with the mortality rate. SOFA score had no statistically significant correlation with PCT or D-dimer; and these two markers didn’t have any significant correlation in terms of predicting mortality due to the sepsis. Conclusion: In our study, PCT and D-dimer failed to show any significant correlation with 28-day-mortality rate of sepsis.
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Affiliation(s)
- Zeinab Naderpour
- Department of Internal Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Momeni
- Prehosptal and Hospital Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Elnaz Vahidi
- Prehosptal and Hospital Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Javad Safavi
- Department of Internal Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Morteza Saeedi
- Prehosptal and Hospital Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Yoshida T, Uchino S, Sasabuchi Y, Hagiwara Y, Yoshida T, Nashiki H, Suzuki H, Takahashi H, Kishihara Y, Nagasaki S, Okazaki T, Katayama S, Sakuraya M, Ogura T, Inoue S, Uchida M, Osaki Y, Kuriyama A, Irie H, Kyo M, Shima N, Saito J, Nakayama I, Jingushi N, Nishiyama K, Masuda T, Tsujita Y, Okumura M, Inoue H, Aoki Y, Kondo T, Nagata I, Igarashi T, Saito N, Nakasone M. Prognostic impact of sustained new-onset atrial fibrillation in critically ill patients. Intensive Care Med 2019; 46:27-35. [DOI: 10.1007/s00134-019-05822-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 10/04/2019] [Indexed: 12/11/2022]
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170
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Peterson SJ, McKeever L, Lateef OB, Freels S, Fantuzzi G, Braunschweig CA. Combination of High-Calorie Delivery and Organ Failure Increases Mortality Among Patients With Acute Respiratory Distress Syndrome. Crit Care Med 2019; 47:69-75. [PMID: 30303837 DOI: 10.1097/ccm.0000000000003476] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Among critically ill patients, the benefits of nutrition support may vary depending on severity of organ dysfunction. The objective of the current article was to explore the relationship between organ failure and calories exposure with hospital mortality during the first week of acute respiratory distress syndrome. DESIGN Retrospective observational study. SETTING Single-center ICU. PATIENTS Adults admitted to the ICU with a diagnosis of acute respiratory distress syndrome. INTERVENTIONS Calorie delivery from enteral nutrition, parenteral nutrition, propofol, and dextrose containing fluids were collected for 7 days following intubation. Sequential Organ Failure Assessment score was calculated at ICU admit and for the same 7 days to describe organ dysfunction; four different Sequential Organ Failure Assessment variables were created 1) Sequential Organ Failure Assessment at ICU admit, 2) average Sequential Organ Failure Assessment for the first 7 days following intubation, 3) the highest Sequential Organ Failure Assessment for the first 7 days following intubation, and 4) change in Sequential Organ Failure Assessment from intubation to 7 days later. MEASUREMENTS AND MAIN RESULTS A total of 298 patients were included. Sequential Organ Failure Assessment at ICU admit, average Sequential Organ Failure Assessment for the first 7 days following intubation, highest Sequential Organ Failure Assessment for the first 7 days following intubation, change in Sequential Organ Failure Assessment from intubation to 7 days later, and calorie delivery the first 7 days following intubation were all associated with increased likelihood of mortality. Compared with patients with low organ failure and low-calorie delivery, those with high-calorie delivery and low organ failure, low-calorie delivery and high organ failure, and the combination of both high organ failure with high-calorie delivery were associated with an incremental increase in the likelihood or mortality. CONCLUSIONS Organ failure appears to modify the relationship between calorie exposure and ICU outcome. Additional research is needed to identify appropriate thresholds for safe calorie exposure with increased organ failure.
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Affiliation(s)
- Sarah J Peterson
- Department of Clinical Nutrition, Rush University, Rush University Medical Center, Chicago, IL
| | - Liam McKeever
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL
| | - Omar B Lateef
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL
| | - Sally Freels
- Department of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, IL
| | - Giamila Fantuzzi
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL
| | - Carol A Braunschweig
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL
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Pérez Pérez ML, Gonzaga López A, Balandín Moreno B, Maximiano Alonso C, Palacios Castañeda D, Ferreres Franco J, García Sanz J, Villanueva Fernández H, Valdivia de la Fuente M, Ortega López A, Alcántara Carmona S, Pérez Redondo M, Royuela Vicente A. Characteristics and outcome of patients with solid tumour requiring admission to the intensive care unit. Usefulness of three severity score systems. Med Clin (Barc) 2019; 153:270-275. [DOI: 10.1016/j.medcli.2019.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 01/01/2019] [Accepted: 01/10/2019] [Indexed: 02/08/2023]
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172
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Gong Y, Ding F, Zhang F, Gu Y. Investigate predictive capacity of in-hospital mortality of four severity score systems on critically ill patients with acute kidney injury. J Investig Med 2019; 67:1103-1109. [PMID: 31575668 PMCID: PMC6900215 DOI: 10.1136/jim-2019-001003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2019] [Indexed: 11/16/2022]
Abstract
Although significant improvements have been achieved in the renal replacement therapy of acute kidney injury (AKI), the mortality of patients with AKI remains high. The aim of this study is to prospectively investigate the capacity of Acute Physiology and Chronic Health Evaluation version II (APACHE II), Simplified Acute Physiology Score version II (SAPS II), Sepsis-related Organ Failure Assessment (SOFA) and Acute Tubular Necrosis Individual Severity Index (ATN-ISI) to predict in-hospital mortality of critically ill patients with AKI. A prospective observational study was conducted in a university teaching hospital. 189 consecutive critically ill patients with AKI were selected according Risk, Injury, Failure, Loss, or End-stage kidney disease criteria. APACHE II, SAPS II, SOFA and ATN-ISI counts were obtained within the first 24 hours following admission. Receiver operating characteristic analyses (ROCs) were applied. Area under the ROC curve (AUC) was calculated. Sensitivity and specificity of in-hospital mortality prediction were calculated. In this study, the in-hospital mortality of critically ill patients with AKI was 37.04% (70/189). AUC of APACHE II, SAPS II, SOFA and ATN-ISI was 0.903 (95% CI 0.856 to 0.950), 0.893 (95% CI 0.847 to 0.940), 0.908 (95% CI 0.866 to 0.950) and 0.889 (95% CI 0.841 to 0.937) and sensitivity was 90.76%, 89.92%, 90.76% and 89.08% and specificity was 77.14%, 70.00%, 71.43% and 71.43%, respectively. In this study, it was found APACHE II, SAPS II, SOFA and ATN-ISI are reliable in-hospital mortality predictors of critically ill patients with AKI. Trial registration number: NCT00953992.
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Affiliation(s)
- Yu Gong
- Department of Internal Medicine, Division of Nephrology, Shanghai Municipal Eighth People's Hospital, Shanghai, China
| | - Feng Ding
- Huashan Hospital, Fudan University, Shanghai, China
| | - Fen Zhang
- School of Public Health, Fudan University, Shanghai, China
| | - Yong Gu
- Huashan Hospital, Fudan University, Shanghai, China
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173
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Aperstein Y, Cohen L, Bendavid I, Cohen J, Grozovsky E, Rotem T, Singer P. Improved ICU mortality prediction based on SOFA scores and gastrointestinal parameters. PLoS One 2019; 14:e0222599. [PMID: 31568512 PMCID: PMC6768479 DOI: 10.1371/journal.pone.0222599] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 09/02/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The Sequential Organ Failure Assessment (SOFA) score is commonly used in ICUs around the world, designed to assess the severity of the patient's clinical state based on function/dysfunction of six major organ systems. The goal of this work is to build a computational model to predict mortality based on a series of SOFA scores. In addition, we examined the possibility of improving the prediction by incorporating a new component designed to measure the performance of the gastrointestinal system, added to the other six components. METHODS In this retrospective study, we used patients' three latest SOFA scores recorded during an individual ICU stay as input to different machine learning models and ensemble learning models. We added three validated parameters representing gastrointestinal failure. Among others, we used classification models such as Support Vector Machines (SVMs), Neural Networks, Logistic Regression and a penalty function used to increase model robustness in regard to certain extreme cases, which may be found in ICU population. We used the Area under Curve (AUC) performance metric to examine performance. RESULTS We found an ensemble model of linear and logistic regression achieves a higher AUC compared related works in past years. After incorporating the gastrointestinal failure score along with the penalty function, our best performing ensemble model resulted in an additional improvement in terms of AUC metrics. We implemented and compared 36 different models that were built using both the information from the SOFA score as well as that of the gastrointestinal system. All compared models have approximately similar and relatively large AUC (between 0.8645 and 0.9146) with the best results are achieved by incorporating the gastrointestinal parameters into the prediction models. CONCLUSIONS Our findings indicate that gastrointestinal parameters carry significant information as a mortality predictor in addition to the conventional SOFA score. This information improves the predictive power of machine learning models by extending the SOFA to include information related to gastrointestinal organ system. The described method improves mortality prediction by considering the dynamics of the extended SOFA score. Although tested on a limited data set, the results' stability across different models suggests robustness in real-time use.
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Affiliation(s)
- Yehudit Aperstein
- Department of Industrial Engineering and Management, Afeka Academic College of Engineering, Tel Aviv, Israel
| | - Lidor Cohen
- Department of Industrial Engineering and Management, Afeka Academic College of Engineering, Tel Aviv, Israel
| | - Itai Bendavid
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- * E-mail:
| | - Jonathan Cohen
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Elad Grozovsky
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Tammy Rotem
- Department of Industrial Engineering and Management, Afeka Academic College of Engineering, Tel Aviv, Israel
| | - Pierre Singer
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
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174
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Pregnancy-Related ICU Admissions From 2008 to 2016 in China: A First Multicenter Report. Crit Care Med 2019; 46:e1002-e1009. [PMID: 30059363 PMCID: PMC6147102 DOI: 10.1097/ccm.0000000000003355] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objectives: To identify the key points for improving severe maternal morbidity by analyzing pregnancy-related ICU admissions in Beijing. Design: This was a retrospective, multicenter cohort study. Setting: Three ICUs in tertiary hospitals in Beijing. Patients: A total of 491 severe maternal cases in any trimester of pregnancy or within 42 days of delivery were reviewed between January 1, 2008, and December 31, 2016. Interventions: None. Measurements and Main Results: Among 491 obstetric ICU admissions (median Sequential Organ Failure Assessment score, 2) out of 87,850 hospital deliveries (a frequency of 5.6 admissions per 1,000 deliveries), the leading diagnoses were postpartum hemorrhage (170; 34.62%), hypertensive disorders of pregnancy (156; 31.77%), and cardio-cerebrovascular diseases (78; 15.9%). Comparing 2008–2011 to 2012–2016, the rates of maternal mortality (2.5% vs 1.9%; p = 0.991) and fetal loss (8.5% vs 8.6%; p = 0.977) did not decrease significantly, whereas the rates of ICU admission (3.05% vs 7.85%; p trends < 0.001) and postpartum hemorrhage (23% vs 38.5%; p = 0.002) increased. Hypertensive disorder (150/156; 96.2% transferred to the ICU postpartum, 24/28 women with fetal loss transferred from lower-level hospitals) was an independent maternal factor associated with fetal loss, and infections were the leading cause of maternal death (6/10) in the ICU. Conclusions: Our study highlights the increasing rate of intensive care admissions for postpartum hemorrhage. Improving prenatal care quality for pregnancy-induced hypertension and sepsis at lower-level hospitals may improve maternal and fetal outcomes. Specifically, providing more effective regional cooperation before transfer and shifting patients who require continuous surveillance but not necessarily intensive care to a transitional ward in a tertiary hospital would provide more ICU beds for more prenatal intensive care for the most complex medical conditions.
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175
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Kim H, Hur M, Struck J, Bergmann A, Di Somma S. Circulating Biologically Active Adrenomedullin Predicts Organ Failure and Mortality in Sepsis. Ann Lab Med 2019; 39:454-463. [PMID: 31037864 PMCID: PMC6502946 DOI: 10.3343/alm.2019.39.5.454] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/11/2019] [Accepted: 04/19/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Biologically active adrenomedullin (bio-ADM) is an emerging biomarker for sepsis. We explored whether bio-ADM concentration could predict severity, organ failure, and 30-day mortality in septic patients. METHODS In 215 septic patients (109 patients with sepsis; 106 patients with septic shock), bio-ADM concentration was measured at diagnosis of sepsis, using sphingotest bio-ADM (Sphingotec GmbH, Hennigsdorf, Germany) and analyzed in terms of sepsis severity, vasopressor use, and 30-day mortality. The number of organ failures, sequential (sepsis-related) organ failure assessment (SOFA) score, and 30-day mortality were compared according to bio-ADM quartiles. RESULTS Bio-ADM concentration was significantly higher in patients with septic shock, vasopressor use, and non-survivors than in patients with solitary sepsis, no vasopressor use, and survivors, respectively (all P<0.0001). Bio-ADM quartiles were associated with the number of organ failures (P<0.0001), as well as SOFA cardiovascular, renal, coagulation, and liver subscores (all P<0.05). The 30-day mortality rate showed a stepwise increase in each bio-ADM quartile (all P<0.0001). Bio-ADM concentration and SOFA score equally predicted the 30-day mortality (area under the curve: 0.827 vs 0.830). CONCLUSIONS Bio-ADM could serve as a useful and objective biomarker to predict severity, organ failure, and 30-day mortality in septic patients.
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Affiliation(s)
- Hanah Kim
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Mina Hur
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea.
| | | | | | - Salvatore Di Somma
- Departments of Medical-Surgery Sciences and Translational Medicine, School of Medicine and Psychology, Sapienza - University, Sant' Andrea Hospital, Rome, Italy
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176
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Gubari MIM, Norouzy A, Hosseini M, Mohialdeen FA, Hosseinzadeh-Attar MJ. The Relationship between Serum Concentrations of Pro- and Anti-Inflammatory Cytokines and Nutritional Status in Patients with Traumatic Head Injury in the Intensive Care Unit. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E486. [PMID: 31443251 PMCID: PMC6723863 DOI: 10.3390/medicina55080486] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 08/12/2019] [Accepted: 08/12/2019] [Indexed: 01/04/2023]
Abstract
Background and objective: The aim of the present study was to examine the relationship between serum levels of pro-inflammatory cytokines (IL-6, IL-1β, and TNF-α) and anti-inflammatory cytokines (IL-10) measured once at the baseline with changes in nutritional status of patients with traumatic head injury (THI) assessed at three consecutive times (24 h after admission, day 6 and day 13) during hospital stay in the intensive care unit (ICU). Materials and Methods: Sixty-four patients with THI were recruited for the current study (over 10 months). The nutritional status of the patients was determined within 24 h after admission and on days 6 and 13, using actual body weight, body composition analysis, and anthropometric measurements. The APACHE II score and SOFA score were also assessed within 24 h of admission and on days 6 and 13 of patients staying in the ICU. Circulatory serum levels of cytokines (IL-6, IL-1β, TNF-α, and IL-10) were assessed once within 24 h of admission. Results: The current study found a significant reduction in BMI, FBM, LBM, MAUAC, and APM, of THI patients with high serum levels the cytokines, over the course of time from the baseline to day 7 and to day 13 in patients staying in the ICU (p < 0.001). It was also found that patients with low levels of some studied cytokines had significant improvement in their nutritional status and clinical outcomes in term of MAUAC, APM, APACHE II score and SOFA score (p < 0.001 to p < 0.01). Conclusion: THI patients who had high serum levels of studied cytokines were more prone to develop a reduction of nutritional status in terms of BMI, FBM, LBM MAUAC and APM over the course of time from patient admission until day 13 of ICU admission.
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Affiliation(s)
- Mohammed I M Gubari
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetic, Tehran University of Medical Sciences, Tehran 1416643931, Iran
| | - Abdolreza Norouzy
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetic, Tehran University of Medical Sciences, Tehran 1416643931, Iran
| | - Mostafa Hosseini
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran 1417613151, Iran
| | - Fadhil A Mohialdeen
- Community Health Department, Technical College of health, Sulaimani Polytechnic University, Sulaimani 46001, Iraq
| | - Mohammad Javad Hosseinzadeh-Attar
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetic, Tehran University of Medical Sciences, Tehran 1416643931, Iran.
- Centre of Research Excellence in Translating, Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA 5005, Australia.
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177
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Bahloul M, Regaieg K, Dlela M, Turki O, Nouri H, Bradaii S, Ben Hamida C, Bouaziz NK, Chabchoub I, Haddar S, Chelly H, Bouaziz M. Pulmonary embolism in intensive care units: More frequent or more Known? Prospective study of 75 cases. CLINICAL RESPIRATORY JOURNAL 2019; 13:513-520. [PMID: 31287237 DOI: 10.1111/crj.13053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 01/15/2019] [Accepted: 07/01/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE to evaluate the current rate of pulmonary embolism (PE) in our medico-surgical intensive care unit (ICU), to identify risk factors, and to determine the outcome of PE in ICU. METHODS We performed a prospective cohort study of consecutive patients requiring intensive care admission during a one-year period. We included, in this prospective study, all the patients with confirmed PE admitted in ICU with more than 18 years of age, and expected to stay in ICU for more than 48 hours. Only the patients who had a clinical suspicion (unexplained hypoxemia and/or shock) for PE underwent diagnostic studies. RESULTS During the study period, 842 patients were admitted in our ICU. One hundred and two patients were excluded. The diagnosis of PE was confirmed in 75 patients (10.1%). In our study, all patients (100%) had received some forms of pharmaceutical prophylaxis (PP) during ICU stay. The median time from ICU admission to diagnosis of PE was 6 days. The diagnosis of PE was made by spiral CT in 74 patients (98.7%), and by echocardiography in 1 case (1.3%). The mean ICU stay was 26.3 ± 26.5 days (median: 20 days). During their ICU stay, 73 patients (97.3%) developed one, or more, organ failure. Respiratory failure was the most observed (97.3%). Moreover, 38 patients (50.6%) developed nosocomial infections and 29 (38.6%) died. The multivariate analysis showed that the risk factors associated with mortality were the presence of shock the day of PE diagnosis and the presence of right ventricular dilatation on echocardiography. CONCLUSION Our findings confirm that subjects in the ICU are at high risk of PE, due to a high number of risk-factors. PE was associated with higher ICU mortality and a significantly higher ICU LOS. Our results invite to revise the preventive strategies of deep venous thrombosis and PE in patients requiring ICU admission.
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Affiliation(s)
- Mabrouk Bahloul
- Department of Intensive Care, Habib Bourguiba University Hospital, Sfax, Tunisia.,Faculté de medicine de Sfax, Sfax University, Sfax, Tunisia
| | - Kais Regaieg
- Department of Intensive Care, Habib Bourguiba University Hospital, Sfax, Tunisia.,Faculté de medicine de Sfax, Sfax University, Sfax, Tunisia
| | - Mariem Dlela
- Department of Intensive Care, Habib Bourguiba University Hospital, Sfax, Tunisia.,Faculté de medicine de Sfax, Sfax University, Sfax, Tunisia
| | - Olfa Turki
- Department of Intensive Care, Habib Bourguiba University Hospital, Sfax, Tunisia.,Faculté de medicine de Sfax, Sfax University, Sfax, Tunisia
| | - Hana Nouri
- Department of Intensive Care, Habib Bourguiba University Hospital, Sfax, Tunisia.,Faculté de medicine de Sfax, Sfax University, Sfax, Tunisia
| | - Sabrine Bradaii
- Department of Intensive Care, Habib Bourguiba University Hospital, Sfax, Tunisia.,Faculté de medicine de Sfax, Sfax University, Sfax, Tunisia
| | - Chokri Ben Hamida
- Department of Intensive Care, Habib Bourguiba University Hospital, Sfax, Tunisia.,Faculté de medicine de Sfax, Sfax University, Sfax, Tunisia
| | | | - Imen Chabchoub
- Department of Pediatrics Hedi Chaker University Hospital, Sfax University, Sfax, Tunisia
| | - Sondes Haddar
- Department of Radiology Habib Bourguiba University Hospital, Sfax University, Sfax, Tunisia
| | - Hedi Chelly
- Department of Intensive Care, Habib Bourguiba University Hospital, Sfax, Tunisia.,Faculté de medicine de Sfax, Sfax University, Sfax, Tunisia
| | - Mounir Bouaziz
- Department of Intensive Care, Habib Bourguiba University Hospital, Sfax, Tunisia.,Faculté de medicine de Sfax, Sfax University, Sfax, Tunisia
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178
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Iba T, Arakawa M, Mochizuki K, Nishida O, Wada H, Levy JH. Usefulness of Measuring Changes in SOFA Score for the Prediction of 28-Day Mortality in Patients With Sepsis-Associated Disseminated Intravascular Coagulation. Clin Appl Thromb Hemost 2019; 25:1076029618824044. [PMID: 30808223 PMCID: PMC6714949 DOI: 10.1177/1076029618824044] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The primary end point for sepsis trial is 28-day mortality. However, additional methods
for determining the efficacy may have benefits. The purpose of this study was to search a
useful indicator of anticoagulant therapy in patients with sepsis with disseminated
intravascular coagulation (DIC). Data from 323 patients with sepsis with coagulopathy
treated with antithrombin supplementation were analyzed. The changes in the Sequential
Organ Failure Assessment (Δ SOFA) score, the overt-DIC (Δ overt-DIC) score, and the
Japanese Society for Acute Medicine DIC (Δ JAAM DIC) score from baseline to day 7 were
retrospectively analyzed in relation to the 28-day mortality. Significant correlations
were found between the 28-day mortality and Δ SOFA, Δ overt-DIC score, and Δ JAAM DIC
score. The accuracy of the prediction was higher for Δ SOFA (80.5%) than for Δ overt-DIC
(66.7%, P < .001). The areas under the curve for mortality calculated
using a receiver operating characteristic curve analysis were 0.812 for Δ SOFA, 0.655 for
Δ overt-DIC, and 0.693 for Δ JAAM DIC. The mortality rate was significantly lower among
cases with an improved SOFA score compared to those without an improvement. The Δ SOFA had
the strongest association with the 28-day mortality in patients with sepsis and DIC.
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Affiliation(s)
- Toshiaki Iba
- 1 Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Makoto Arakawa
- 1 Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Katsunori Mochizuki
- 2 Department of Emergency and Critical Care Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Osamu Nishida
- 3 Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hideo Wada
- 4 Department of Molecular Laboratory Medicine, Mie University Graduate School of Medicine, Tsu, Japan
| | - Jerrold H Levy
- 5 Department of Anesthesiology and Critical Care, Duke University School of Medicine, Durham, NC, USA
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Aksu A, Gulen M, Avci A, Satar S. Adding lactate to SOFA and qSOFA scores predicts in-hospital mortality better in older patients in critical care. Eur Geriatr Med 2019; 10:445-453. [PMID: 34652794 DOI: 10.1007/s41999-019-00179-z] [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: 10/15/2018] [Accepted: 03/06/2019] [Indexed: 10/27/2022]
Abstract
AIM The aim of this study was to determine whether the addition of the lactate level to the SOFA score (SOFA-Laktat) and qSOFA Score (qSOFA-Laktat) improves the performance of the SOFA score and qSOFA score alone in predicting the hospital mortality of critically ill older patients. MATERIAL AND METHOD A total of 799 patients over 65 years of age admitted to Emergency Department and hospitalized to intensive care unit (ICU) of our hospital between May 1, 2016, and April 30, 2017, were included in this study. The parameters gender, age, initial complaint, duration of time between the start of their complaint and emergency admission, comorbidities, SOFA scores, qSOFA scores, arterial lactate (AL) values and reason for acute admission, which intensive care unit admitted to, length of stay and patients outcomes (discharge, exitus) were recorded. The primary outcome was to evaluate whether the addition of the evaluation of AL value increased the performance of the SOFA score and qSOFA score in predicting hospital mortality. RESULTS Data of 799 patients were analyzed, in which 52.8% (n = 422) were male and 47.3% (n = 377) were female. Most frequently hospitalized clinic was coronary ICU (34.7%, n = 277). Mean duration of hospitalization was 5.2 ± 8.7 days. Hospitalization was prolonged with increased lactate, SOFA and qSOFA levels. Cutoff value for lactate was 2.3 mmol/L in our ROC analyses. Predictive value of SOFA-Lactate2.3 for mortality was significantly higher than SOFA score (p < 0.001). Also, predictive value of qSOFA-Lactate2.3 for mortality was significantly higher than qSOFA score (p < 0.001). CONCLUSION The lactate 2.3 mmol/L threshold-based SOFA-Lactate2.3 and qSOFA-Lactate2.3 scores perform better than SOFA and qSOFA alone in identifying hospital mortality risks of patients over 65 who are admitted to the ICU.
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Affiliation(s)
- Arif Aksu
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Muge Gulen
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey.
| | - Akkan Avci
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Salim Satar
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
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180
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Soo A, Zuege DJ, Fick GH, Niven DJ, Berthiaume LR, Stelfox HT, Doig CJ. Describing organ dysfunction in the intensive care unit: a cohort study of 20,000 patients. Crit Care 2019; 23:186. [PMID: 31122276 PMCID: PMC6533687 DOI: 10.1186/s13054-019-2459-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 04/26/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Multiple organ dysfunction is a common cause of morbidity and mortality in intensive care units (ICUs). Original development of the Sequential Organ Failure Assessment (SOFA) score was not to predict outcome, but to describe temporal changes in organ dysfunction in critically ill patients. Organ dysfunction scoring may be a reasonable surrogate outcome in clinical trials but further exploration of the impact of case mix on the temporal sequence of organ dysfunction is required. Our aim was to compare temporal changes in SOFA scores between hospital survivors and non-survivors. METHODS We performed a population-based observational retrospective cohort study of critically ill patients admitted from January 1, 2004, to December 31, 2013, to 4 multisystem adult intensive care units (ICUs) in Calgary, Canada. The primary outcome was temporal changes in daily SOFA scores during the first 14 days of ICU admission. SOFA scores were modeled between hospital survivors and non-survivors using generalized estimating equations (GEE) and were also stratified by admission SOFA (≤ 11 versus > 11). RESULTS The cohort consisted of 20,007 patients with at least one SOFA score and was mostly male (58.2%) with a median age of 59 (interquartile range [IQR] 44-72). Median ICU length of stay was 3.5 (IQR 1.7-7.5) days. ICU and hospital mortality were 18.5% and 25.5%, respectively. Temporal change in SOFA scores varied by survival and admission SOFA score in a complicated relationship. Area under the receiver operating characteristic (ROC) curve using admission SOFA as a predictor of hospital mortality was 0.77. The hospital mortality rate was 5.6% for patients with an admission SOFA of 0-2 and 94.4% with an admission SOFA of 20-24. There was an approximately linear increase in hospital mortality for SOFA scores of 3-19 (range 8.7-84.7%). CONCLUSIONS Examining the clinical course of organ dysfunction in a large non-selective cohort of patients provides insight into the utility of SOFA. We have demonstrated that hospital outcome is associated with both admission SOFA and the temporal rate of change in SOFA after admission. It is necessary to further explore the impact of additional clinical factors on the clinical course of SOFA with large datasets.
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Affiliation(s)
- Andrea Soo
- Department of Critical Care Medicine, University of Calgary, McCaig Tower, Ground Floor, 3134 Hospital Drive NW, Calgary, Alberta T2N 5A1 Canada
| | - Danny J. Zuege
- Department of Critical Care Medicine, University of Calgary, McCaig Tower, Ground Floor, 3134 Hospital Drive NW, Calgary, Alberta T2N 5A1 Canada
| | - Gordon H. Fick
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6 Canada
| | - Daniel J. Niven
- Department of Critical Care Medicine, University of Calgary, McCaig Tower, Ground Floor, 3134 Hospital Drive NW, Calgary, Alberta T2N 5A1 Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6 Canada
| | - Luc R. Berthiaume
- Department of Critical Care Medicine, University of Calgary, McCaig Tower, Ground Floor, 3134 Hospital Drive NW, Calgary, Alberta T2N 5A1 Canada
| | - Henry T. Stelfox
- Department of Critical Care Medicine, University of Calgary, McCaig Tower, Ground Floor, 3134 Hospital Drive NW, Calgary, Alberta T2N 5A1 Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6 Canada
| | - Christopher J. Doig
- Department of Critical Care Medicine, University of Calgary, McCaig Tower, Ground Floor, 3134 Hospital Drive NW, Calgary, Alberta T2N 5A1 Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6 Canada
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181
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Lee YS, Min KH, Lee SY, Shim JJ, Kang KH, Cho WH, Jeon D, Kim YS. The value of glycated hemoglobin as predictor of organ dysfunction in patients with sepsis. PLoS One 2019; 14:e0216397. [PMID: 31059556 PMCID: PMC6502339 DOI: 10.1371/journal.pone.0216397] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 04/21/2019] [Indexed: 12/29/2022] Open
Abstract
Background In patients with sepsis, an inflammatory response can lead to destruction of the glycocalyx. These alterations cause the progression of organ dysfunction. Destruction of the glycocalyx can also occur in chronic hyperglycemia. Glycated hemoglobin (HbA1c) is a reliable marker of premorbid hyperglycemia. We investigated the association between HbA1c level at admission and the degree of organ dysfunction progression 72 hours after admission and ICU mortality. Methods and findings This study was a retrospective observational study. Logistic regression and correlation analyses were performed to evaluate the association between the HbA1c level and the degree of organ dysfunction progression 72 hours after ICU admission. We applied survival analysis to examine the association between HbA1c level and ICU mortality. A total of 90 patients were included in this study. The association between HbA1c level and degree of organ dysfunction progression was significant (r = 0.320; P = 0.002). Multivariable logistic regression analysis showed that high HbA1c level (≥6.5%) (OR, 2.98; 95% CI, 1.033–8.567; P = 0.043) were significant, independent predictors of severe organ dysfunction progression. Patients with an HbA1c level ≥6.5% exhibited significantly greater liver and kidney dysfunction progression 72 hours after ICU admission compared with those with an HbA1c level <6.5%. Kaplan-Meier analysis showed that the survival period was significantly shorter in patients with an HbA1c level ≥6.5% than in those with an HbA1c level <6.5% (P < 0.001). Multivariable Cox proportional hazard analysis showed that HbA1c level ≥6.5% (HR, 3.49; 95% CI, 1.802–6.760; P <0.001) were significant, independent predictors of ICU mortality. Conclusions In patients with sepsis, the HbA1c level at ICU admission is associated with progression of organ dysfunction 72 hours later and with ICU mortality. It may be important to assess HbA1c level at ICU admission because it may be a predictor of ICU outcome. For patients with a high HbA1c level (≥6.5%), greater attention should be paid to the possibility of organ dysfunction progression.
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Affiliation(s)
- Young Seok Lee
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Korea University Medical Center, Guro Hospital, Seoul, Republic of Korea
| | - Kyung Hoon Min
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Korea University Medical Center, Guro Hospital, Seoul, Republic of Korea
| | - Sung Yong Lee
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Korea University Medical Center, Guro Hospital, Seoul, Republic of Korea
| | - Jae Jeong Shim
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Korea University Medical Center, Guro Hospital, Seoul, Republic of Korea
| | - Kyung Ho Kang
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Korea University Medical Center, Guro Hospital, Seoul, Republic of Korea
| | - Woo Hyun Cho
- Department of Pulmonary and Critical Care Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Doosoo Jeon
- Department of Pulmonary and Critical Care Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Yun Seong Kim
- Department of Pulmonary and Critical Care Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
- * E-mail:
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182
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Vest MT, Newell E, Shapero M, McGraw P, Jurkovitz C, Lennon SL, Trabulsi J. Energy balance in obese, mechanically ventilated intensive care unit patients. Nutrition 2019; 66:48-53. [PMID: 31207439 PMCID: PMC6702036 DOI: 10.1016/j.nut.2019.02.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/06/2019] [Accepted: 02/24/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The aims of this study were, first, to compare the predicted (calculated) energy requirements based on standard equations with target energy requirement based on indirect calorimetry (IC) in critically ill, obese mechanically ventilated patients; and second, to compare actual energy intake to target energy requirements. METHODS We conducted a prospective cohort study of mechanically ventilated critically ill patients with body mass index ≥30.0 kg/m2 for whom enteral feeding was planned. Clinical and demographic data were prospectively collected. Resting energy expenditure was measured by open-circuit IC. American Society of Parenteral and Enteral Nutrition (APSPEN)/Society of Critical Care Medicine (SCCM) 2016 equations were used to determine predicted (calculated) energy requirements. Target energy requirements were set at 65% to 70% of measured resting energy expenditure as recommended by ASPEN/SCCM. Nitrogen balance was determined via simultaneous measurement of 24-h urinary nitrogen concentration and protein intake. RESULTS Twenty-five patients (mean age: 64.5 ± 11.8 y, mean body mass index: 35.2 ± 3.6 kg/m2) underwent IC. The mean predicted energy requirement was 1227 kcal/d compared with mean measured target energy requirement of 1691 kcal/d. Predicted (calculated) energy requirements derived from ASPEN/SCCM equations were less than the target energy requirements in most cases. Actual energy intake from enteral nutrition met 57% of target energy requirements. Protein intake met 25% of target protein requirement and the mean nitrogen balance was -2.3 ± 5.1 g/d. CONCLUSIONS Predictive equations underestimated target energy needs in this population. Further, we found that feeding to goal was often delayed resulting in failure to meet both protein and energy intake goals.
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Affiliation(s)
- Michael T Vest
- Critical Care Medicine, Department of Medicine, Christiana Care Healthcare System, Christiana Care Value Institute, Newark, Delaware, USA, Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA.
| | - Emma Newell
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, Delaware, USA
| | - Mary Shapero
- Department of Food and Nutrition Services, Christiana Care Healthcare System, Newark, Delaware, USA
| | - Patricia McGraw
- Department of Medicine Research, Christiana Care Healthcare System, Newark, Delaware, USA
| | | | - Shannon L Lennon
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA
| | - Jillian Trabulsi
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, Delaware, USA
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Ryu JA, Jung W, Jung YJ, Kwon DY, Kang K, Choi H, Kong DS, Seol HJ, Lee JI. Early prediction of neurological outcome after barbiturate coma therapy in patients undergoing brain tumor surgery. PLoS One 2019; 14:e0215280. [PMID: 30995269 PMCID: PMC6469802 DOI: 10.1371/journal.pone.0215280] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 03/31/2019] [Indexed: 11/18/2022] Open
Abstract
After a difficult brain tumor surgery, refractory intracranial hypertension (RICH) may occur due to residual tumor or post-operative complications such as hemorrhage, infarction, and aggravated brain edema. We investigated which predictors are associated with prognosis when using barbiturate coma therapy (BCT) as a second-tier therapy to control RICH after brain tumor surgery. The study included adult patients who underwent BCT after brain tumor surgery between January 2010 and December 2016. The primary outcome was neurological status upon hospital discharge, which was assessed using the Glasgow Outcome Scale (GOS). In the study period, 4,296 patients underwent brain tumor surgery in total. Of these patients, BCT was performed in 73 patients (1.7%). Among these 73 patients, 56 (76.7%) survived to discharge and 25 (34.2%) showed favorable neurological outcomes (GOS scores of 4 and 5). Invasive monitoring of intracranial pressure (ICP) was performed in 60 (82.2%) patients, and revealed that the maximal ICP within 6 h after BCT was significantly lower in patients with favorable neurological outcome as well as in survivors (p = 0.008 and p = 0.028, respectively). Uncontrolled RICH (ICP ≥ 22 mm Hg within 6 h of BCT) was an important predictor of mortality after BCT (adjusted hazard ratio 12.91, 95% confidence interval [CI] 2.788–59.749), and in particular, ICP ≥ 15 mm Hg within 6 h of BCT was associated with poor neurological outcome (adjusted odds ratio 9.36, 95% CI 1.664–52.614). Therefore, early-controlled ICP after BCT was associated with clinical prognosis. There were no significant differences in the complications associated with BCT between the two neurological outcome groups. No BCT-induced death was observed. The active and timely control of RICH may be beneficial for clinical outcomes in patients with RICH after brain tumor surgery.
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Affiliation(s)
- Jeong-Am Ryu
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Wonkyung Jung
- Department of Nursing, Neurosurgery Intensive Care Unit, Samsung Medical Center, Seoul, Republic of Korea
| | - Yoo Jin Jung
- Department of Nursing, Neurosurgery Intensive Care Unit, Samsung Medical Center, Seoul, Republic of Korea
| | - Do Yeon Kwon
- Department of Nursing, Neurosurgery Intensive Care Unit, Samsung Medical Center, Seoul, Republic of Korea
| | - Kina Kang
- Department of Nursing, Neurosurgery Intensive Care Unit, Samsung Medical Center, Seoul, Republic of Korea
| | - Hyeok Choi
- Department of Nursing, Neurosurgery Intensive Care Unit, Samsung Medical Center, Seoul, Republic of Korea
| | - Doo-Sik Kong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ho Jun Seol
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung-Il Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- * E-mail:
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Pinder N, Bruckner T, Lehmann M, Motsch J, Brenner T, Larmann J, Knebel P, Hoppe-Tichy T, Swoboda S, Weigand MA, Hofer S, Zimmermann JB. Effect of physostigmine on recovery from septic shock following intra-abdominal infection - Results from a randomized, double-blind, placebo-controlled, monocentric pilot trial (Anticholium® per Se). J Crit Care 2019; 52:126-135. [PMID: 31035187 DOI: 10.1016/j.jcrc.2019.04.012] [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] [Received: 01/19/2019] [Revised: 04/02/2019] [Accepted: 04/07/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE The cholinergic anti-inflammatory pathway has been shown to be accessible by physostigmine salicylate in animal models. However, the cholinesterase inhibitor is not approved for adjunctive therapy in sepsis, and tolerability and safety of high initial doses followed by continuous infusion have not been investigated. MATERIALS AND METHODS In this trial, 20 patients with perioperative septic shock due to intra-abdominal infection were eligible. The physostigmine group received an initial dose of 0.04 mg/kg physostigmine salicylate, followed by continuous infusion of 1 mg/h for 120 h; the placebo group was treated with 0.9% sodium chloride. Primary outcome was the mean Sequential Organ Failure Assessment (SOFA) score during treatment and up to 14 days. RESULTS Administration of physostigmine salicylate was well tolerated. Mean SOFA scores were 8.9 ± 2.5 and 11.3 ± 3.6 (mean ± SD) for physostigmine and placebo group, respectively. Adjusted for age, difference between means was not statistically significant (-2.37, 95% CI: -5.43 to 0.70, p = 0.121). Norepinephrine doses required only appeared lower in the physostigmine group (p = 0.064), along with a more rapid reduction from an elevated heart rate possibly indicating less hemodynamic instability. CONCLUSIONS Treatment with physostigmine salicylate was feasible and safe. Further studies are justified to assess the effect on recovery from septic shock. TRIAL REGISTRATION EudraCT Number 2012-001650-26, ClinicalTrials.gov identifier NCT03013322.
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Affiliation(s)
- Nadine Pinder
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Pharmacy Department, Heidelberg University Hospital, Im Neuenheimer Feld 670, 69120 Heidelberg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics (IMBI), Heidelberg University Hospital, Marsilius-Arkaden, Tower West, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Monika Lehmann
- Coordination Centre for Clinical Trials (KKS), Heidelberg University Hospital, Marsilius-Arkaden, Tower West, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Johann Motsch
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Thorsten Brenner
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Jan Larmann
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Phillip Knebel
- Department of General, Visceral, and Transplant Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Torsten Hoppe-Tichy
- Pharmacy Department, Heidelberg University Hospital, Im Neuenheimer Feld 670, 69120 Heidelberg, Germany
| | - Stefanie Swoboda
- Pharmacy Department, Heidelberg University Hospital, Im Neuenheimer Feld 670, 69120 Heidelberg, Germany
| | - Markus A Weigand
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Stefan Hofer
- Department of Anesthesiology, Kaiserslautern Westpfalz Hospital, Hellmut-Hartert-Straße 1, 67655 Kaiserslautern, Germany
| | - Johannes B Zimmermann
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
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Filling the gaps: A mixed-methods study exploring the use of patient diaries in the critical care unit. Intensive Crit Care Nurs 2019; 51:27-34. [DOI: 10.1016/j.iccn.2018.10.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 05/02/2018] [Accepted: 10/29/2018] [Indexed: 11/18/2022]
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TNFAIP3, TNIP1, and MyD88 Polymorphisms Predict Septic-Shock-Related Death in Patients Who Underwent Major Surgery. J Clin Med 2019; 8:jcm8030283. [PMID: 30813592 PMCID: PMC6463255 DOI: 10.3390/jcm8030283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 02/15/2019] [Accepted: 02/18/2019] [Indexed: 12/29/2022] Open
Abstract
Background: In many immune-related diseases, inflammatory responses and several clinical outcomes are related to increased NF-κB activity. We aimed to evaluate whether SNPs related to the NF-κB signaling pathway are associated with higher susceptibility to infection, septic shock, and septic-shock-related death in European patients who underwent major surgery. Methods: We performed a case-control study on 184 patients with septic shock and 212 with systemic inflammatory response syndrome, and a longitudinal substudy on septic shock patients. Thirty-three SNPs within genes belonging to or regulating the NF-κB signaling pathway were genotyped by Agena Bioscience’s MassARRAY platform. Results: No significant results were found for susceptibility to infection and septic shock in the multivariate analysis after adjusting for multiple comparisons. Regarding septic-shock-related death, patients with TNFAIP3 rs6920220 AA, TNIP1 rs73272842 AA, TNIP1 rs3792783 GG, and TNIP1 rs7708392 CC genotypes had the highest risk of septic-shock-related death in the first 28 and 90 days. Also, the MyD88 rs7744 GG genotype was associated with a higher risk of death during the first 90 days. Haplotype analysis shows us that patients with the TNIP1 GAG haplotype (composed of rs73272842, rs3792783, and rs7708392) had a lower risk of death in the first 28 days and the TNIP1 AGC haplotype was associated with a higher risk of death in the first 90 days. Conclusions: The SNPs in the genes TNFAIP3, TNIP1, and MyD88 were linked to the risk of septic-shock-related death in patients who underwent major surgery.
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Kotani Y, Fujii T, Uchino S, Doi K. Modification of sequential organ failure assessment score using acute kidney injury classification. J Crit Care 2019; 51:198-203. [PMID: 30878015 DOI: 10.1016/j.jcrc.2019.02.026] [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] [Received: 11/04/2018] [Revised: 02/06/2019] [Accepted: 02/25/2019] [Indexed: 01/31/2023]
Abstract
PURPOSE To assess the predictive validity of a modified Sequential Organ Failure Assessment (SOFA) score, of which the renal component was replaced with Kidney Disease Improving Global Outcomes (KDIGO) classification of Acute Kidney Injury (AKI). MATERIALS AND METHODS Using a prospective cohort study on AKI in Japan, we replaced the renal component of SOFA score with AKI stages according to the KDIGO criteria except that initiation of renal replacement therapy was assigned four points. We assessed the predictive validity of KDIGO-based SOFA score for hospital and ICU mortality by comparing the areas under the receiver operating characteristic curve (AUC) derived from logistic regression models with that of the original SOFA score. RESULTS 2292 patients were registered. Overall hospital mortality was 11.6%, and ICU mortality was 5.1%. KDIGO-based SOFA score was moderately correlated with APACHE II score (rho = 0.476). The AUC for hospital and ICU mortality of KDIGO-based and the original SOFA score were 0.749 vs 0.745 (p = .393) and 0.790 vs 0.791 (p = .900). CONCLUSIONS The prognostic performance of KDIGO-based SOFA score was not superior but comparable to that of the original SOFA score.
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Affiliation(s)
- Yuki Kotani
- Department of Critical Care Medicine, Japanese Red Cross Society Wakayama Medical Center, 4-20, Komatsubara-dori, Wakayama, Japan; Department of Intensive Care Medicine, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Japan.
| | - Tomoko Fujii
- Department of Epidemiology and Preventive Medicine, Kyoto University Graduate School of Medicine, Yoshida Hon-machi, Sakyo-ku, Kyoto, Japan; Japan Society for the Promotion of Science. 5-3-1 Kojimachi, Chiyoda-ku, Tokyo, Japan.
| | - Shigehiko Uchino
- Intensive Care Unit, Department of Anaesthesiology, Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, Japan
| | - Kent Doi
- Department of Emergency and Critical Care Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan.
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Utility of SOFA and Δ-SOFA scores for predicting outcome in critically ill patients from the emergency department. Eur J Emerg Med 2019; 25:387-393. [PMID: 28509709 DOI: 10.1097/mej.0000000000000472] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The condition of critically ill patients in the emergency department (ED) varies from moment to moment. The aims of this study are to quantify sequential organ failure assessment (SOFA) and changes in SOFA scores over time and determine its prognostic impact. PATIENTS AND METHODS This is a prospective observational cohort study. We included 269 patients consecutively admitted to the ICU from the ED over 18 months. The SOFA scores at ED admission (ED-SOFA) and ICU admission (ICU-SOFA) were obtained. Relative changes in SOFA scores were calculated as follows: Δ-SOFA=ICU-SOFA-ED-SOFA. Patients were divided into two groups depending on the Δ-SOFA score: (a) Δ-SOFA=0-1; and (b) Δ-SOFA more than or equal to 2. RESULTS The median ED-SOFA score was two points (interquartile range: 1-4.5) and the Δ-SOFA score was 2 points (interquartile range: 0-3). The Δ-SOFA score was more powerful (area under the curve: 0.81) than the ED-SOFA score (area under the curve: 0.75) in predicting hospital mortality. Sixteen (6%) patients had a Δ-SOFA score less than 0, 116 (43%) patients had a Δ-SOFA=0-1, and 137 (51%) patients had a Δ-SOFA of at least 2 points. The probability of being alive at hospital discharge was 51 and 86.5% in Δ-SOFA of at least 2 and Δ-SOFA=0-1 groups, respectively (P<0.001). Risk factors for an increase of two or more SOFA points were age, cirrhosis, a diagnosis of sepsis, and a prolonged ED stay. CONCLUSION SOFA and changes in the SOFA score over time are potentially useful tools for risk stratification when applied to critically ill patients admitted to ICUs from the ED.
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Chourdakis M, Grammatikopoulou MG, Poulia KA, Passakiotou M, Pafili ZK, Bouras E, Doundoulakis I, Galitsianos I, Lappa T, Karakatsanis A, Heyland DK. Translation of the modified NUTRIC score and adaptation to the Greek ICU setting. Clin Nutr ESPEN 2019; 29:72-76. [DOI: 10.1016/j.clnesp.2018.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 12/05/2018] [Indexed: 01/04/2023]
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Abstract
Abstract
Editor’s Perspective
What We Already Know about This Topic
What This Article Tells Us That Is New
Background
Patients with initial mild acute respiratory distress syndrome are often underrecognized and mistakenly considered to have low disease severity and favorable outcomes. They represent a relatively poorly characterized population that was only classified as having acute respiratory distress syndrome in the most recent definition. Our primary objective was to describe the natural course and the factors associated with worsening and mortality in this population.
Methods
This study analyzed patients from the international prospective Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) who had initial mild acute respiratory distress syndrome in the first day of inclusion. This study defined three groups based on the evolution of severity in the first week: “worsening” if moderate or severe acute respiratory distress syndrome criteria were met, “persisting” if mild acute respiratory distress syndrome criteria were the most severe category, and “improving” if patients did not fulfill acute respiratory distress syndrome criteria any more from day 2.
Results
Among 580 patients with initial mild acute respiratory distress syndrome, 18% (103 of 580) continuously improved, 36% (210 of 580) had persisting mild acute respiratory distress syndrome, and 46% (267 of 580) worsened in the first week after acute respiratory distress syndrome onset. Global in-hospital mortality was 30% (172 of 576; specifically 10% [10 of 101], 30% [63 of 210], and 37% [99 of 265] for patients with improving, persisting, and worsening acute respiratory distress syndrome, respectively), and the median (interquartile range) duration of mechanical ventilation was 7 (4, 14) days (specifically 3 [2, 5], 7 [4, 14], and 11 [6, 18] days for patients with improving, persisting, and worsening acute respiratory distress syndrome, respectively). Admissions for trauma or pneumonia, higher nonpulmonary sequential organ failure assessment score, lower partial pressure of alveolar oxygen/fraction of inspired oxygen, and higher peak inspiratory pressure were independently associated with worsening.
Conclusions
Most patients with initial mild acute respiratory distress syndrome continue to fulfill acute respiratory distress syndrome criteria in the first week, and nearly half worsen in severity. Their mortality is high, particularly in patients with worsening acute respiratory distress syndrome, emphasizing the need for close attention to this patient population.
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191
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Silvestre J, Coelho L, Pereira JG, Mendes V, Tapadinhas C, Póvoa P. suPAR in the assessment of post intensive care unit prognosis: a pilot study. Rev Bras Ter Intensiva 2019; 30:453-459. [PMID: 30652779 PMCID: PMC6334487 DOI: 10.5935/0103-507x.20180062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 07/04/2018] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To determine the performance of soluble urokinase-type plasminogen activator receptor upon intensive care unit discharge to predict post intensive care unit mortality. METHODS A prospective observational cohort study was conducted during a 24-month period in an 8-bed polyvalent intensive care unit. APACHE II, SOFA, C-reactive protein, white cell count and soluble urokinase-type plasminogen activator receptor on the day of intensive care unit discharge were collected from patients who survived intensive care unit admission. RESULTS Two hundred and two patients were included in this study, 29 patients (18.6%) of whom died after intensive care unit discharge. Nonsurvivors were older and more seriously ill upon intensive care unit admission with higher severity scores, and nonsurvivors required extended use of vasopressors than did survivors. The area under the receiver operating characteristics curves of SOFA, APACHE II, C-reactive protein, white cell count, and soluble urokinase-type plasminogen activator receptor at intensive care unit discharge as prognostic markers of hospital death were 0.78 (95%CI 0.70 - 0.86); 0.70 (95%CI 0.61 - 0.79); 0.54 (95%CI 0.42 - 0.65); 0.48 (95%CI 0.36 - 0.58); and 0.68 (95%CI 0.58 - 0.78), respectively. SOFA was independently associated with a higher risk of in-hospital mortality (OR 1.673; 95%CI 1.252 - 2.234), 28-day mortality (OR 1.861; 95%CI 1.856 - 2.555) and 90-day mortality (OR 1.584; 95%CI 1.241 - 2.022). CONCLUSION At intensive care unit discharge, soluble urokinase-type plasminogen activator receptor is a poor predictor of post intensive care unit prognosis.
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Affiliation(s)
- Joana Silvestre
- Unidade de Terapia Intensiva Polivalente, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental - Lisboa, Portugal.,. Centro de Estudos de Doenças Crônicas, Faculdade de Ciências Médicas, Universidade Nova de Lisboa - Lisboa, Portugal
| | - Luis Coelho
- Unidade de Terapia Intensiva Polivalente, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental - Lisboa, Portugal.,. Centro de Estudos de Doenças Crônicas, Faculdade de Ciências Médicas, Universidade Nova de Lisboa - Lisboa, Portugal
| | - João Gonçalves Pereira
- Unidade de Terapia Intensiva Polivalente, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental - Lisboa, Portugal.,. Centro de Estudos de Doenças Crônicas, Faculdade de Ciências Médicas, Universidade Nova de Lisboa - Lisboa, Portugal
| | - Vitor Mendes
- Unidade de Terapia Intensiva Polivalente, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental - Lisboa, Portugal
| | - Camila Tapadinhas
- Unidade de Terapia Intensiva Polivalente, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental - Lisboa, Portugal
| | - Pedro Póvoa
- Unidade de Terapia Intensiva Polivalente, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental - Lisboa, Portugal.,. Centro de Estudos de Doenças Crônicas, Faculdade de Ciências Médicas, Universidade Nova de Lisboa - Lisboa, Portugal
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Rose L, Presneill JJ, Johnston L, Nelson S, Cade JF. Ventilation and Weaning Practices in Australia and New Zealand. Anaesth Intensive Care 2019; 37:99-107. [DOI: 10.1177/0310057x0903700117] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- L. Rose
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada and Intensive Care Unit, St Vincent's Hospital, Department of Medicine, University of Melbourne and Royal Melbourne Hospital, Melbourne, Victoria, Australia and School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland
- Lawrence S. Bloomberg Limited Term Professor in Critical Care, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto
| | - J. J. Presneill
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada and Intensive Care Unit, St Vincent's Hospital, Department of Medicine, University of Melbourne and Royal Melbourne Hospital, Melbourne, Victoria, Australia and School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland
- Intensive Care Unit, St Vincent's Hospital and Associate Professor, Department of Medicine, University of Melbourne
| | - L. Johnston
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada and Intensive Care Unit, St Vincent's Hospital, Department of Medicine, University of Melbourne and Royal Melbourne Hospital, Melbourne, Victoria, Australia and School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland
- School of Nursing and Midwifery, Queen's University Belfast
| | - S. Nelson
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada and Intensive Care Unit, St Vincent's Hospital, Department of Medicine, University of Melbourne and Royal Melbourne Hospital, Melbourne, Victoria, Australia and School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto
| | - J. F. Cade
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada and Intensive Care Unit, St Vincent's Hospital, Department of Medicine, University of Melbourne and Royal Melbourne Hospital, Melbourne, Victoria, Australia and School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland
- Intensive Care Unit, Royal Melbourne Hospital
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Yokoyama Y, Ito T, Yasuda T, Furubeppu H, Kamikokuryo C, Yamada S, Maruyama I, Kakihana Y. Circulating histone H3 levels in septic patients are associated with coagulopathy, multiple organ failure, and death: a single-center observational study. Thromb J 2019; 17:1. [PMID: 30651722 PMCID: PMC6330748 DOI: 10.1186/s12959-018-0190-4] [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: 09/25/2018] [Accepted: 12/27/2018] [Indexed: 11/10/2022] Open
Abstract
Background Nuclear histone proteins are released into the extracellular space, and act as major mediators of coagulopathy and remote organ failure in septic animals. However, the circulating histone levels in septic patients have not been precisely quantified. Methods Using a novel enzyme-linked immunosorbent assay for histone H3 detection, we measured the serum histone H3 levels in 85 patients admitted to the intensive care unit because of infectious diseases. We then evaluated the associations of circulating histone H3 levels with organ failure, coagulopathy, and mortality. Results Circulating histone H3 levels were significantly higher in patients with coagulopathy, and were positively correlated with numbers of organ failures. Circulating histone H3 levels were also associated with fatal outcome. Receiver-operating characteristic analyses revealed that the predictive performance of circulating histone H3 levels for mortality was higher than that of conventional inflammatory markers, including white blood cell count, C-reactive protein, and cell-free DNA. Conclusions Circulating histone H3 levels are associated with coagulopathy, multiple organ failure, and death in patients requiring intensive care because of infectious diseases.
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Affiliation(s)
- Yayoi Yokoyama
- 1Department of Emergency and Intensive Care Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544 Japan
| | - Takashi Ito
- 1Department of Emergency and Intensive Care Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544 Japan.,2Department of Systems Biology in Thromboregulation, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Tomotsugu Yasuda
- 1Department of Emergency and Intensive Care Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544 Japan
| | - Hiroaki Furubeppu
- 1Department of Emergency and Intensive Care Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544 Japan
| | - Chinatsu Kamikokuryo
- 1Department of Emergency and Intensive Care Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544 Japan
| | - Shingo Yamada
- R&D Center, Shino-Test Corporation, Sagamihara, Japan
| | - Ikuro Maruyama
- 2Department of Systems Biology in Thromboregulation, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Yasuyuki Kakihana
- 1Department of Emergency and Intensive Care Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544 Japan
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Ehooman F, Biard L, Lemiale V, Contou D, de Prost N, Mokart D, Pène F, Kouatchet A, Mayaux J, Demoule A, Vincent F, Nyunga M, Bruneel F, Rabbat A, Lebert C, Perez P, Meert AP, Benoit D, Hamidfar R, Darmon M, Azoulay E, Zafrani L. Long-term health-related quality of life of critically ill patients with haematological malignancies: a prospective observational multicenter study. Ann Intensive Care 2019; 9:2. [PMID: 30612249 PMCID: PMC6320707 DOI: 10.1186/s13613-018-0478-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 12/24/2018] [Indexed: 12/18/2022] Open
Abstract
Background Although outcomes of critically ill patients with haematological malignancies (HMs) have been fully investigated in terms of organ failure and mortality, data are scarce on health-related quality of life (HRQOL) in this population. We aim to assess post-intensive care unit (ICU) burden and HRQOL of critically ill patients with HMs and to identify risk factors for quality-of-life (QOL) impairment. Results In total, 1011 patients with HMs who required ICU admission in 17 ICUs in France and Belgium were included in the study; 278 and 117 patients were evaluated for QOL at 3 months and 1 year, respectively, after ICU discharge. HRQOL was determined by applying the interview form of the Short Form 36 (SF-36) questionnaire. Psychological distress symptoms were evaluated using the Hospital Anxiety Depression Score (HADS) and the Impact of Event Scale (IES). In-hospital mortality rates at 3 months and 1 year were, respectively, 39.1, 50.7 and 57.2%, respectively. At 3 months, median [IQR] physical and mental component summary scores (PCS and MCS) (SF-36) were 37 [28–46] and 51 [45–58], respectively. PCS was lower in ICU patients with HMs when compared to general ICU septic patients (52 [5–13], p = 0.00001). The median combined HAD score was 8 [5–13], and the median IES score was 8 [3–16]. However, recovery during the first year after ICU discharge was not consistent in all dimensions of HRQOL. Three months after ICU discharge, the maximum daily Sequential Organ Failure Assessment score and status of the underlying malignancy at ICU admission were significantly associated with MCS impairment (− 0.54 points [95% CI − 0.99; − 0.1], p = 0.018 and − 4.83 points [95% CI − 8.44; − 1.22], p = 0.009, respectively). Conclusion HRQOL is strongly impaired in critically ill patients with HMs at 3 months and 1 year after ICU discharge. Organ failure and disease status are strongly associated with QOL. The kinetic evaluation of QOL at 3 months and 1 year offers the opportunity to focus on QOL aspects that may be improved by therapeutic interventions during the first year after ICU discharge. Electronic supplementary material The online version of this article (10.1186/s13613-018-0478-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Franck Ehooman
- Medical ICU, Saint-Louis Teaching Hospital, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Lucie Biard
- Biostatistics Department, Saint-Louis Teaching Hospital, Paris, France
| | - Virginie Lemiale
- Medical ICU, Saint-Louis Teaching Hospital, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Damien Contou
- Medical ICU, Henri Mondor Teaching Hospital, Paris, France.,ICU, Albert Michallon University Hospital, Grenoble, France.,ICU, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Nicolas de Prost
- Medical ICU, Henri Mondor Teaching Hospital, Paris, France.,ICU, Albert Michallon University Hospital, Grenoble, France.,ICU, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Djamel Mokart
- Medical ICU, Henri Mondor Teaching Hospital, Paris, France
| | | | | | - Julien Mayaux
- Medical ICU, Angers Teaching Hospital, Angers, France
| | | | | | | | | | | | | | | | | | - Dominique Benoit
- Service soins intensifs et urgences oncologiques, Institut Jules Bordet, Brussels, Belgium
| | | | - Michael Darmon
- ICU, Albert Michallon University Hospital, Grenoble, France
| | - Elie Azoulay
- Medical ICU, Saint-Louis Teaching Hospital, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Lara Zafrani
- Medical ICU, Saint-Louis Teaching Hospital, 1 Avenue Claude Vellefaux, 75010, Paris, France.
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195
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Pathophysiology of Acute Illness and Injury. OPERATIVE TECHNIQUES AND RECENT ADVANCES IN ACUTE CARE AND EMERGENCY SURGERY 2019. [PMCID: PMC7122041 DOI: 10.1007/978-3-319-95114-0_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The pathophysiology of acute illness and injury recognizes three main effectors: infection, trauma, and ischemia-reperfusion injury. Each of them can act by itself or in combination with the other two in developing a systemic inflammatory reaction syndrome (SIRS) that is a generalized reaction to the morbid event. The time course of SIRS is variable and influenced by the number and severity of subsequent insults (e.g., reparative surgery, acquired hospital infections). It occurs simultaneously with a complex of counter-regulatory mechanisms (compensatory anti-inflammatory response syndrome, CARS) that limit the aggressive effects of SIRS. In adjunct, a progressive dysfunction of the acquired (lymphocytes) immune system develops with increased risk for immunoparalysis and associated infectious complications. Both humoral and cellular effectors participate to the development of SIRS and CARS. The most important humoral mediators are pro-inflammatory (IL-1β, IL-6, IL-8, IL-12) and anti-inflammatory (IL-4, IL-10) cytokines and chemokines, complement, leukotrienes, and PAF. Effector cells include neutrophils, monocytes, macrophages, lymphocytes, and endothelial cells. The endothelium is a key factor for production of remote organ damage as it exerts potent chemo-attracting effects on inflammatory cells, allows for leukocyte trafficking into tissues and organs, and promotes further inflammation by cytokines release. Moreover, the loss of vasoregulatory properties and the increased permeability contribute to the development of hypotension and tissue edema. Finally, the disseminated activation of the coagulation cascade causes the widespread deposition of microthrombi with resulting maldistribution of capillary blood flow and ultimately hypoxic cellular damage. This mechanism together with increased vascular permeability and vasodilation is responsible for the development of the multiple organ dysfunction syndrome (MODS).
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196
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Chourdakis M, Grammatikopoulou MG, Day AG, Bouras E, Heyland DK. Are all low-NUTRIC-score patients the same? Analysis of a multi-center observational study to determine the relationship between nutrition intake and outcome. Clin Nutr 2018; 38:2783-2789. [PMID: 30579667 DOI: 10.1016/j.clnu.2018.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 10/10/2018] [Accepted: 12/03/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND The NUTrition Risk in the Critically Ill (NUTRIC) scoring system is a tool useful, discriminating critically-ill patients benefiting from optimal nutrition intake (>80% of prescription). Recent recommendations advocate for withholding artificial nutrition among low-NUTRIC patients, however, we hypothesized that some low-NUTRIC patients would show an association between nutrition intake and outcome. METHODS Patients were selected from the 2013-2014 International Nutrition Surveys when ICU length of stay (LICU) ≥72 h, baseline mNUTRIC score ≤4 and had at least three evaluable nutrition days (N = 2781). Proportion of prescription received during evaluable days was associated to 60-day hospital mortality by a logistic regression modelling. A priori, we expected that the association between proportion of prescription received and mortality might differ according to: LICU, BMI and prior unintentional weight loss or reduced oral intake. RESULTS A total of 2781 patients fulfilled the inclusion criteria and participated in the study. Ten percent of the sample had a BMI <20 kg/m2 and 20% experienced either unintentional weight loss during the last 3 months, or reduced food intake over the last week. Sixty-day hospital mortality was 15% and median LICU reached 11.3 [6.3-21.7] days. Mean total prescription received by any means of nutritional support during the first 12 evaluable days was 57.4 ± 28.1% for energy and 53.7 ± 29.2% for protein. In the pooled, subgroup and sensitivity analyses, no significant associations were identified. CONCLUSION Low-NUTRIC (≤4) patients demonstrate a prolonged LICU, while experiencing significant mortality and a high prevalence of malnutrition risk factors. Although improvements in mortality were not achieved with increased nutritional intake, this should not be construed as a rationale for withholding artificial nutrition among this patient group.
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Affiliation(s)
- Michael Chourdakis
- Department of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Maria G Grammatikopoulou
- Department of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Andrew G Day
- Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada.
| | - Emmanouil Bouras
- Department of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Daren K Heyland
- Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada; Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada.
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197
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Mochizuki K, Mori K, Nakamura Y, Uchimido R, Kamijo H, Takeshige K, Nitta K, Imamura H. Early Changes in the Sequential Organ Failure Assessment Score Among Patients With Sepsis-Induced Disseminated Intravascular Coagulation. Clin Appl Thromb Hemost 2018; 24:332S-339S. [PMID: 30486666 PMCID: PMC6714847 DOI: 10.1177/1076029618814346] [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] [Indexed: 11/17/2022] Open
Abstract
It is unclear whether initial infection control or anticoagulant therapy exerts a greater
effect on early changes in the Sequential Organ Failure Assessment (SOFA) score among
patients with sepsis-induced disseminated intravascular coagulation (DIC). This
retrospective propensity score cohort study aimed to evaluate whether adequacy of
infection control or anticoagulation therapy had a greater effect on early changes in the
SOFA scores among 52 patients with sepsis-induced DIC. Inadequate initial infection
control was associated with a lower 28-day survival rate among patients with
sepsis-induced DIC (odds ratio [OR]: 0.116, 95% confidence interval [CI]: 0.022-0.601;
P = .010); however, the adequacy was not associated with an early
improvement in the SOFA score. However, despite adjusting for inadequate initial infection
control, administration of recombinant human soluble thrombomodulin was associated with an
early improvement in the SOFA score (OR: 5.058, 95% CI: 1.047-24.450; P =
.044). Therefore, early changes in the SOFA score within 48 hours after the DIC diagnosis
were more strongly affected by the administration of recombinant human soluble
thrombomodulin than the adequacy of initial infection control.
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Affiliation(s)
- Katsunori Mochizuki
- Department of Emergency and Critical Care Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kotaro Mori
- Department of Emergency and Critical Care Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yuta Nakamura
- Department of Emergency Medicine, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Ryo Uchimido
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Hiroshi Kamijo
- Department of Emergency and Critical Care Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kanako Takeshige
- Department of Emergency and Critical Care Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kenichi Nitta
- Department of Emergency and Critical Care Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hiroshi Imamura
- Department of Emergency and Critical Care Medicine, Shinshu University School of Medicine, Matsumoto, Japan
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198
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Zhang Y, Khalid S, Jiang L. Diagnostic and predictive performance of biomarkers in patients with sepsis in an intensive care unit. J Int Med Res 2018; 47:44-58. [PMID: 30477377 PMCID: PMC6384460 DOI: 10.1177/0300060518793791] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Objective This study was performed to compare the predictive performance of serum procalcitonin (PCT), N-terminal brain natriuretic propeptide (NT-proBNP), interleukin-6 (IL-6), prothrombin time (PT), thrombin time (TT), and Sequential Organ Failure Assessment (SOFA) score in the intensive care unit (ICU). Methods This retrospective cohort study enrolled 150 patients with sepsis and septic shock and 30 control patients without sepsis. Each patient was followed until death or 28 days. Correlations between variables were assessed with Spearman’s rho test. The Kruskal–Wallis and Mann–Whitney U tests were used for between-group comparisons. Results Receiver operating characteristic curve analysis of the SOFA score, PCT, NT-proBNP, IL-6, PT, and TT showed an area under the curve of 0.872, 0.732, 0.711, 0.706, 0.806, and 0.691, respectively, for diagnosing sepsis. Binary logistic regression demonstrated that the SOFA score was an independent predictor of 28-day mortality and septic shock. The correlation coefficient (r) between SOFA and PCT, NT-proBNP and SOFA, IL-6 and SOFA, PT and SOFA, and TT and SOFA was 0.79, 0.52, 0.57, 0.56, and 0.58, respectively. Conclusion While the SOFA score is the gold standard, analysis of multiple biomarkers could increase the performance capacity for diagnosis and prognosis in patients with sepsis in the ICU.
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Affiliation(s)
- Yu Zhang
- 1 Emergency Department, First Affiliated Hospital of Dalian Medical University, China
| | | | - Li Jiang
- 1 Emergency Department, First Affiliated Hospital of Dalian Medical University, China
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199
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Barcella M, Bollen Pinto B, Braga D, D'Avila F, Tagliaferri F, Cazalis MA, Monneret G, Herpain A, Bendjelid K, Barlassina C. Identification of a transcriptome profile associated with improvement of organ function in septic shock patients after early supportive therapy. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:312. [PMID: 30463588 PMCID: PMC6249814 DOI: 10.1186/s13054-018-2242-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 10/16/2018] [Indexed: 12/24/2022]
Abstract
Background Septic shock is the most severe complication of sepsis and this syndrome is associated with high mortality. Treatment of septic shock remains largely supportive of hemodynamics and tissue perfusion. Early changes in organ function assessed by the Sequential Organ Function Assessment (SOFA) score are highly predictive of the outcome. However, the individual patient’s response to supportive therapy is very heterogeneous, and the mechanisms underlying this variable response remain elusive. The aim of the study was to investigate the transcriptome of whole blood in septic shock patients with different responses to early supportive hemodynamic therapy assessed by changes in SOFA scores within the first 48 h from intensive care unit (ICU) admission. Methods We performed whole blood RNA sequencing in 31 patients: 17 classified as responders (R) and 14 as non-responders (NR). Gene expression was investigated at ICU admission (time point 1, or T1), comparing R with NR [padj < 0.01; Benjamini–Hochberg (BH)] and over time from T1 to T2 (48 h later) in R and NR independently (paired analysis, padj < 0.01; BH). Then the differences in gene expression trends over time were evaluated (Mann–Whitney, P <0.01). To identify enriched biological processes, we performed an over-representation analysis based on a right-sided hypergeometric test with Bonferroni step-down as multiple testing correction (padj < 0.05). Results At ICU admission, we did not identify differentially expressed genes (DEGs) between the two groups. In the transition from T1 to T2, the activation of genes involved in T cell–mediated immunity, granulocyte and natural killer (NK) cell functions, and pathogen lipid clearance was noted in the R group. Genes involved in acute inflammation were downregulated in both groups. Conclusions Within the limits of a small sample size, our results could suggest that early activation of genes of the adaptive immune response is associated with an improvement in organ function. Electronic supplementary material The online version of this article (10.1186/s13054-018-2242-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Matteo Barcella
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Via Rudini 8, 20142, Milan, Italy.,Fondazione Filarete, Viale Ortles 22/4, 20139, Milan, Italy
| | - Bernardo Bollen Pinto
- Department of Anaesthesia, Pharmacology and Intensive Care, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva, 1205, Switzerland
| | - Daniele Braga
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Via Rudini 8, 20142, Milan, Italy.,Fondazione Filarete, Viale Ortles 22/4, 20139, Milan, Italy
| | - Francesca D'Avila
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Via Rudini 8, 20142, Milan, Italy.,Fondazione Filarete, Viale Ortles 22/4, 20139, Milan, Italy
| | - Federico Tagliaferri
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Via Rudini 8, 20142, Milan, Italy.,Fondazione Filarete, Viale Ortles 22/4, 20139, Milan, Italy
| | - Marie-Angelique Cazalis
- Laboratoire Commun de Recherche HCL-bioMérieux, Hôpital Edouard Herriot, 376 Chemin de l'Orme, 6928 Marcy-l'Etoile, Lyon, France
| | - Guillaume Monneret
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Laboratoire d'Immunologie, 5 Place d'Arsonval, 69437, Lyon cedex 03, France
| | - Antoine Herpain
- Department of Intensive Care, Hospital Erasme, Hospital, Université Libre de Bruxelles, Route de Lennik 808, Brussels, 1070, Belgium
| | - Karim Bendjelid
- Department of Anaesthesia, Pharmacology and Intensive Care, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva, 1205, Switzerland
| | - Cristina Barlassina
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Via Rudini 8, 20142, Milan, Italy. .,Fondazione Filarete, Viale Ortles 22/4, 20139, Milan, Italy.
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Exploring Epidemiological Aspects, Distribution of WHO Maternal Near Miss Criteria, and Organ Dysfunction Defined by SOFA in Cases of Severe Maternal Outcome Admitted to Obstetric ICU: A Cross-Sectional Study. BIOMED RESEARCH INTERNATIONAL 2018; 2018:5714890. [PMID: 30539015 PMCID: PMC6257901 DOI: 10.1155/2018/5714890] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 09/07/2018] [Accepted: 10/30/2018] [Indexed: 11/17/2022]
Abstract
Objective To explore the epidemiological aspects, to describe the frequency and distribution of WHO maternal near miss (MNM) criteria and the presence of organ dysfunction and failure measured by the maximum SOFA (Sequential Organ Failure Assessment) score (SOFA max) in cases of severe maternal outcome (SMO). Methods In an observational cross-sectional study performed between January 2013 and December 2015, 279 pregnant or postpartum women were admitted to an obstetric ICU (intensive care unit) in Brazil. MNM, maternal death (grouped as SMO), and potentially life-threatening conditions (PLTC) were defined according to WHO criteria. For categorical variables, a descriptive analysis was carried out. Frequency and distribution of WHO criteria, organ dysfunction, or failure defined by SOFA max were performed. Results WHO criteria identified 65 SMO and 214 PLTC. Management criteria were present in 58/65 (89.2%) while 61/65 (93.8%) of SMO cases had dysfunction or failure by SOFA. Conclusions The systematic evaluation of the organic function by SOFA max score identified the presence of organic dysfunction or failure in almost all SMO cases. Management criteria were present in all MD cases. Our results indicate the need for new studies evaluating the parameterization of the WHO laboratory criteria for values compatible with the definition of organic dysfunction by the SOFA to identify MNM.
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