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Lee D, Lee B, Jeung K, Jung Y. The association between serum free fatty acid levels and neurological outcomes in out-of-hospital cardiac arrest patients: A prospective observational study. Medicine (Baltimore) 2024; 103:e38772. [PMID: 38968533 PMCID: PMC11224856 DOI: 10.1097/md.0000000000038772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 06/10/2024] [Indexed: 07/07/2024] Open
Abstract
Free fatty acids (FFA) are a known risk factor in the development of sudden cardiac death. However, the relationship between FFA and the outcome of out-of-hospital cardiac arrest (OHCA) patients remains unclear. We aimed to examine the association between FFA and neurological outcomes in OHCA patients. This prospective observational study included adult (≥18 years) OHCA patients between February 2016 and December 2022. We measured serial FFA levels within 1 hour after ROSC and at 6, 12, 24, 48, and 72 hours after the return of spontaneous circulation (ROSC). The primary outcome was neurological outcome at 6 months. A poor neurological outcome was defined by cerebral performance categories 3, 4, and 5. A total of 147 patients were included. Of them, 104 (70.7%) had poor neurological outcomes, whereby the median FFA levels within 1 hour after ROSC (0.72 vs 1.01 mol/L), at 6 hours (1.19 vs 1.90 mol/L), 12 hours (1.20 vs 1.66 mol/L), and 24 hours (1.20 vs 1.95 mol/L) after ROSC were significantly lower than in good outcome group. The FFA levels at 6 hours (odds ratio, 0.583; 95% confidence interval, 0.370-0.919; P = .020), and 12 hours (odds ratio, 0.509; 95% confidence interval, 0.303-0.854; P = .011) after ROSC were independently associated with poor neurological outcomes. The lower FFA levels at 6 hours and 12 hours after ROSC were associated with poor neurological outcomes in patients with OHCA. FFA may reflect oxidative metabolism as well as oxidative stress.
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Affiliation(s)
- Donghun Lee
- Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Byungkook Lee
- Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Kyungwoon Jeung
- Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Yonghun Jung
- Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
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Delignette MC, Stevic N, Lebossé F, Bonnefoy-Cudraz E, Argaud L, Cour M. Acute liver failure after out-of-hospital cardiac arrest: An observational study. Resuscitation 2024; 197:110136. [PMID: 38336284 DOI: 10.1016/j.resuscitation.2024.110136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/18/2024] [Accepted: 02/03/2024] [Indexed: 02/12/2024]
Abstract
RATIONALE Apart from hypoxic hepatitis (HH), the hepatic consequences of out-of-hospital cardiac arrest (OHCA) have been little studied. This cohort study aimed to investigate the characteristics of liver dysfunction resulting from OHCA and its association with outcomes. METHODS Among the conventional static liver function tests used to define acute liver failure (ALF), we determined which one correlated more closely with the reference indocyanine green (ICG) clearance test in a series of OHCA patients from the CYRUS trial (NCT01595958). Subsequently, we assessed whether ALF, in addition to HH (i.e., acute liver injury), was an independent risk factor for death in a large cohort of OHCA patients admitted to two intensive care units between 2007 and 2017. RESULTS ICG clearance, available for 22 patients, was impaired in 17 (77.3%) cases. Prothrombin time (PT) ratio was the only static liver function test that correlated significantly (r = -0.66, p < 0.01) with ICG clearance and was therefore used to define ALF, with the usual cutoff of < 50%. Of the 418 patients included in the analysis (sex ratio: 1.4; median age: 64 [53-75] years; non-shockable rhythm: 73%), 67 (16.0%) presented with ALF, and 61 (14.6%) had HH at admission. On day 28, 337 (80.6%) patients died. Following multivariate analysis, ALF at admission, OHCA occurring at home, absence of bystander, non-cardiac cause of OHCA, low-flow duration ≥ 20 min, and SOFA score excluding liver subscore at admission were independently associated with day 28 mortality. CONCLUSIONS ALF occurred frequently after OHCA and, unlike HH, was independently associated with day 28 mortality.
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Affiliation(s)
- Marie-Charlotte Delignette
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Médecine Intensive-Réanimation, Lyon, France; Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France.
| | - Neven Stevic
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Médecine Intensive-Réanimation, Lyon, France; Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France; INSERM U1060 CarMeN, IRIS, Lyon, France.
| | - Fanny Lebossé
- Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France; Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Institut d'Hépatologie de Lyon, Lyon, France; INSERM U1052, Centre de Recherche en Cancérologie de Lyon (CRCL), Lyon, France.
| | - Eric Bonnefoy-Cudraz
- Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France; Hospices Civils de Lyon, Hôpital Louis Pradel, Unité de Soins Intensifs Cardiologiques, Bron, France.
| | - Laurent Argaud
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Médecine Intensive-Réanimation, Lyon, France; Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France; INSERM U1060 CarMeN, IRIS, Lyon, France.
| | - Martin Cour
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Médecine Intensive-Réanimation, Lyon, France; Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France; INSERM U1060 CarMeN, IRIS, Lyon, France.
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Privšek M, Strnad M, Markota A. Addition of Vitamin C Does Not Decrease Neuron-Specific Enolase Levels in Adult Survivors of Cardiac Arrest-Results of a Randomized Trial. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:103. [PMID: 38256364 PMCID: PMC10818462 DOI: 10.3390/medicina60010103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/16/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024]
Abstract
Background and Objectives: Survival with favorable neurologic outcomes after out-of-hospital cardiac arrest (OHCA) remains elusive. Post-cardiac arrest syndrome (PCAS) involves myocardial and neurological injury, ischemia-reperfusion response, and underlying pathology. Neurologic injury is a crucial determinant of survival and functional outcomes, with damage caused by free radicals among the responsible mechanisms. This study explores the feasibility of adding intravenous vitamin C to the treatment of OHCA survivors, aiming to mitigate PCAS. Vitamin C, a nutrient with antioxidative and free radical-scavenging properties, is often depleted in critically ill patients. Materials and Methods: This randomized, double-blinded trial was conducted at a tertiary-level university hospital with adult OHCA survivors. Participants received either standard care or the addition of 1.5 g of intravenous vitamin C every 12 h for eight consecutive doses. Neurologic injury was assessed using neuron-specific enolase (NSE) levels, with additional clinical and laboratory outcomes, such as enhanced neuroprognostication factors, inflammatory markers, and cardiac parameters. Results: NSE levels were non-significantly higher in patients who received vitamin C compared to the placebo group (55.05 µg/L [95% confidence interval (CI) 26.7-124.0] vs. 39.4 µg/L [95% CI 22.6-61.9], p > 0.05). Similarly, a non-significantly greater proportion of patients in the vitamin C group developed myoclonus in the first 72 h. We also observed a non-significantly shorter duration of mechanical ventilation, fewer arrhythmias, and reduced length of stay in the intensive care unit in the group of patients who received vitamin C (p = 0.031). However, caution is warranted in interpretation of our results due to the small number of participants. Conclusions: Our findings suggest that intravenous vitamin C should not be used outside of clinical trials for OHCA survivors. Due to the small sample size and conflicting results, further research is needed to determine the potential role of vitamin C in post-cardiac arrest care.
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Affiliation(s)
- Matevž Privšek
- Emergency Medical Services, Healthcare Centre Dr. Adolf Drolc, Cesta Proletarskih Brigad 21, 2000 Maribor, Slovenia;
| | - Matej Strnad
- Emergency Medical Services, Healthcare Centre Dr. Adolf Drolc, Cesta Proletarskih Brigad 21, 2000 Maribor, Slovenia;
- Emergency Department, University Medical Centre Maribor, Ljubljanska Ulica 5, 2000 Maribor, Slovenia
- Department of Emergency Medicine, Faculty of Medicine, University of Maribor, Taborska Ulica 8, 2000 Maribor, Slovenia
| | - Andrej Markota
- Department of Medical Intensive Care, Clinic of Internal Medicine, University Medical Centre Maribor, 2000 Maribor, Slovenia;
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Hwang SY, Kim IK, Jeong D, Park JE, Lee GT, Yoo J, Choi K, Shin TG, Kim K. Prognostic Performance of Sequential Organ Failure Assessment, Acute Physiology and Chronic Health Evaluation III, and Simplified Acute Physiology Score II Scores in Patients with Suspected Infection According to Intensive Care Unit Type. J Clin Med 2023; 12:6402. [PMID: 37835046 PMCID: PMC10573563 DOI: 10.3390/jcm12196402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 09/28/2023] [Accepted: 10/07/2023] [Indexed: 10/15/2023] Open
Abstract
We investigated the prognostic performance of scoring systems by the intensive care unit (ICU) type. This was a retrospective observational study using data from the Marketplace for Medical Information in the Intensive Care IV database. The primary outcome was in-hospital mortality. We obtained Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation (APACHE) III, and Simplified Acute Physiology Score (SAPS) II scores in each ICU type. Prognostic performance was evaluated with the area under the receiver operating characteristic curve (AUROC) and was compared among ICU types. A total of 29,618 patients were analyzed, and the in-hospital mortality was 12.4%. The overall prognostic performance of APACHE III was significantly higher than those of SOFA and SAPS II (0.807, [95% confidence interval, 0.799-0.814], 0.785 [0.773-0.797], and 0.795 [0.787-0.811], respectively). The prognostic performance of SOFA, APACHE III, and SAPS II scores was significantly different between ICU types. The AUROC ranges of SOFA, APACHE III, and SAPS II were 0.723-0.826, 0.728-0.860, and 0.759-0.819, respectively. The neurosurgical and surgical ICUs had lower prognostic performance than other ICU types. The prognostic performance of scoring systems in patients with suspected infection is significantly different according to ICU type. APACHE III systems have the highest prediction performance. ICU type may be a significant factor in the prognostication.
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Affiliation(s)
- Sung-Yeon Hwang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (S.-Y.H.); (J.-E.P.)
| | - In-Kyu Kim
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul 06351, Republic of Korea
| | - Daun Jeong
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (S.-Y.H.); (J.-E.P.)
| | - Jong-Eun Park
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (S.-Y.H.); (J.-E.P.)
| | - Gun-Tak Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (S.-Y.H.); (J.-E.P.)
| | - Junsang Yoo
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul 06351, Republic of Korea
| | - Kihwan Choi
- Department of Emergency Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam 13496, Republic of Korea
| | - Tae-Gun Shin
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (S.-Y.H.); (J.-E.P.)
| | - Kyuseok Kim
- Department of Emergency Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam 13496, Republic of Korea
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Lee DH, Lee BK, Cho YS, Jeung KW, Jung YH, Ryu SJ, Kim DK. The Association Between Induction Rate and Neurologic Outcome in Patients Undergoing Targeted Temperature Management at 33°C. Ther Hypothermia Temp Manag 2023; 13:16-22. [PMID: 35708619 DOI: 10.1089/ther.2022.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
To determine the association between the induction rate and 6-month neurologic outcomes in out-of-hospital cardiac arrest (OHCA) survivors who underwent targeted temperature management (TTM). This retrospective observational study analyzed data prospectively collected from adult comatose OHCA survivors treated with TTM at the Chonnam National University Hospital in Gwangju, Korea, between October 2015 and December 2020. We measured the core body temperature (BT) through an esophageal probe and recorded it every 5 minutes throughout TTM. Induction time was defined as the elapsed time between the initiation of TTM and the achievement of target BT of 33°C. We calculated the induction rate as the change of BT divided by induction time. The primary outcome was a poor 6-month neurologic outcome, defined as cerebral performance category 3-5. Of the OHCA survivors, 218 patients were included, and 137 (62.8%) patients had a poor neurologic outcome. Patients with a poor neurologic outcome had lower BT at the initiation of TTM, shorter induction time, and higher induction rate than those with good neurologic outcomes. After adjusting for confounders, induction time (odds ratio [OR] 0.995; 95% confidence interval [CI], 0.992-0.999) and induction rate (OR 2.362; 95% CI, 1.178-4.734) were independently associated with poor neurologic outcome. BT at TTM initiation was not associated with a poor neurologic outcome. Induction rate was independently associated with a poor neurologic outcome in OHCA survivors who underwent TTM at 33°C.
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Affiliation(s)
- Dong Hun Lee
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Byung Kook Lee
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea.,Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Yong Soo Cho
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Kyung Woon Jeung
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea.,Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Yong Hun Jung
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea.,Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Seok Jin Ryu
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Dong Ki Kim
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
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Mao Y, Zhu S, Geng Y. Association between serum calcium and in-hospital mortality in critical patients with multiple myeloma: a cohort study. HEMATOLOGY (AMSTERDAM, NETHERLANDS) 2022; 27:795-801. [PMID: 35820067 DOI: 10.1080/16078454.2022.2095948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Elevated serum calcium levels may serve as a useful clinical biomarker of mortality in patients with multiple myeloma(MM). However, the clinical significance of the relationship between serum calcium levels and in-hospital mortality in MM patients admitted to the Intensive Care Unit (ICU) remains unclear. OBJECTIVES This study aimed to explore the association between serum calcium levels and in-hospital mortality in patients with MM in the ICU. METHODS Patients with MM were identified from the Medical Information Mart for Intensive Care IV(MIMIC-IV) database. The outcome was in-hospital mortality. Multivariable-adjusted Cox regression analysis, curve fitting, and threshold effects analysis were used to assess the relationship between serum calcium levels and in-hospital mortality in patients with MM in the ICU. RESULTS Our study included 262 patients with MM with a mean age of 72.3 ± 11.0 years, 63.4% of whom were male. The in-hospital mortality was 19.5% (51/262). The relationship between serum calcium levels and in-hospital mortality was nonlinear. The effect size on the left and right sides of the inflection point, were 0.270 (HR: 0.270, 95% CI 0.106-0.687, P < 0.05) and 2.104 (HR: 2.104, 95% CI 1.069-4.142, P < 0.05), respectively. The results of the sensitivity analysis remained stable. CONCLUSION Our findings show that a nonlinear relationship exists between serum calcium levels and in-hospital mortality in critically ill patients with MM. A serum calcium level of approximately 8.40 mg/dL was associated with the lowest risk of in-hospital mortality, which increases with rising serum calcium levels, and should be of concern to ICU physicians.
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Affiliation(s)
- Yafei Mao
- Department of Laboratory Medicine, The First Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Shumin Zhu
- Department of Laboratory Medicine, The First Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Yulan Geng
- Department of Laboratory Medicine, The First Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
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Han Chin Y, Yu Leon Yaow C, En Teoh S, Zhi Qi Foo M, Luo N, Graves N, Eng Hock Ong M, Fu Wah Ho A. Long-term outcomes after out-of-hospital cardiac arrest: a systematic review and meta-analysis. Resuscitation 2021; 171:15-29. [PMID: 34971720 DOI: 10.1016/j.resuscitation.2021.12.026] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/21/2021] [Accepted: 12/21/2021] [Indexed: 12/21/2022]
Abstract
AIMS Long term outcomes after out-of-hospital cardiac arrest (OHCA) are not well understood. This study aimed to evaluate the long-term (1-year and beyond) survival outcomes, including overall survival and survival with favorable neurological status and the quality-of-life (QOL) outcomes, among patients who survived the initial OHCA event (30 days or till hospital discharge). METHODS Embase, Medline and PubMed were searched for primary studies (randomized controlled trials, cohort and cross-sectional studies) which reported the long-term survival outcomes of OHCA patients. Data abstraction and quality assessment was conducted, and survival at predetermined timepoints were assessed via single-arm meta-analyses of proportions, using generalized linear mixed models. Comparative meta-analyses were conducted using the Mantel-Haenszel Risk Ratio (RR) estimates, using the DerSimonian and Laird model. RESULTS 67 studies were included, and among patients that survived to hospital discharge or 30-days, 77.3% (CI=71.2-82.4), 69.6% (CI=54.5-70.3), 62.7% (CI=54.5-70.3), 46.5% (CI=32.0-61.6), and 20.8% (CI=7.8-44.9) survived to 1-, 3-, 5-, 10- and 15-years respectively. Compared to Asia, the probability of 1-year survival was greater in Europe (RR=2.1, CI=1.8-2.3), North America (RR=2.0, CI=1.7-2.2) and Oceania (RR=1.9,CI=1.6-2.1). Males had a higher 1-year survival (RR:1.41, CI=1.25-1.59), and patients with initial shockable rhythm had improved 1-year (RR=3.07, CI=1.78-5.30) and 3-year survival (RR=1.45, CI=1.19-1.77). OHCA occurring in residential locations had worse 1-year survival (RR=0.42, CI=0.25-0.73). CONCLUSION Our study found that up to 20.8% of OHCA patients survived to 15-years, and survival was lower in Asia compared to the other regions. Further analysis on the differences in survival between the regions are needed to direct future long-term treatment of OHCA patients.
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Affiliation(s)
- Yip Han Chin
- School of Medicine, National University Singapore, Singapore, Singapore
| | | | - Seth En Teoh
- School of Medicine, National University Singapore, Singapore, Singapore
| | - Mabel Zhi Qi Foo
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University Singapore, Singapore
| | - Nicholas Graves
- Pre-hospital and Emergency Research Centre, Duke-NUS Medical School, Singapore
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore; Pre-hospital and Emergency Research Centre, Duke-NUS Medical School, Singapore
| | - Andrew Fu Wah Ho
- Department of Emergency Medicine, Singapore General Hospital, Singapore; Saw Swee Hock School of Public Health, National University Singapore, Singapore; Pre-hospital and Emergency Research Centre, Duke-NUS Medical School, Singapore.
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Xu F, Li W, Zhang C, Cao R. Performance of Sequential Organ Failure Assessment and Simplified Acute Physiology Score II for Post-Cardiac Surgery Patients in Intensive Care Unit. Front Cardiovasc Med 2021; 8:774935. [PMID: 34938790 PMCID: PMC8685393 DOI: 10.3389/fcvm.2021.774935] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/01/2021] [Indexed: 01/23/2023] Open
Abstract
Background: The aim of this study is to assess the performance of Sequential Organ Failure Assessment (SOFA) score and Simplified Acute Physiology Score (SAPS II) on outcomes of patients with cardiac surgery and identify the cutoff values to provide a reference for early intervention. Methods: All data were extracted from MIMIC-III (Medical Information Mart for Intensive Care-III) database. Cutoff values were calculated by the receiver-operating characteristic curve and Youden indexes. Patients were grouped, respectively, according to the cutoff values of SOFA and SAPS II. A non-adjusted model and adjusted model were established to evaluate the prediction of risk. Comparison of clinical efficacy between two scoring systems was made by decision curve analysis (DCA). The primary outcomes of this study were in-hospital mortality, 28-day mortality, 90-day mortality, and 1-year mortality after cardiac surgery. The secondary outcomes included length of hospital stay and intensive care unit (ICU) stay and the incidence of acute kidney injury (AKI) within 7 days after ICU admission. Results: A total of 6,122 patients were collected and divided into the H-SOFA group (SOFA ≥ 7) and L-SOFA group (SOFA < 7) or H-SAPS II group (SAPS II ≥ 43) and L-SAPS II group (SAPS II < 43). In-hospital mortality, 28-day mortality, 90-day mortality, and 1-year mortality were higher, the length of hospital and ICU stay were longer in the H-SOFA group than in the L-SOFA group (p < 0.05), while the incidence of AKI was not significantly different. In-hospital mortality, 28-day mortality, 90-day mortality, 1-year mortality, and the incidence of AKI were all significantly higher in the H-SAPS II group than in the L-SAPS II group (p < 0.05). Hospital stay and ICU stay were longer in the H-SAPS II group than in the L-SAPS II group (p < 0.05). According to DCA, the SAPS II scoring system had more net benefits on assessing the long-term mortality compared with the SOFA scoring system. Conclusion: Exceeding the cutoff values of SOFA and SAPS II scores could lead to increased mortality and extended length of ICU and hospital stay. The SAPS II scoring system had a better discriminative performance of 90-day mortality and 1-year mortality in post-cardiac surgery patients than the SOFA scoring system. Emphasizing the critical value of the scoring system is of significance for timely treatment.
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Affiliation(s)
- Fei Xu
- Department of Anesthesiology, Chengdu Women's and Children's Central Hospital, Chengdu, China
| | - Weina Li
- Department of Anesthesiology, Chengdu Women's and Children's Central Hospital, Chengdu, China
| | - Cheng Zhang
- Department of Anesthesiology, Chengdu Women's and Children's Central Hospital, Chengdu, China
| | - Rong Cao
- Department of Anesthesiology, Chengdu Women's and Children's Central Hospital, Chengdu, China
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Dong CH, Gao CN, An XH, Li N, Yang L, Li DC, Tan Q. Nocturnal dexmedetomidine alleviates post-intensive care syndrome following cardiac surgery: a prospective randomized controlled clinical trial. BMC Med 2021; 19:306. [PMID: 34865637 PMCID: PMC8647374 DOI: 10.1186/s12916-021-02175-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dexmedetomidine is a sedative agent that may have the potential to reduce the risk of post-intensive care syndrome (PICS). This study aimed to establish whether prophylactic nocturnal dexmedetomidine safely reduces postoperative PICS incidence and to develop an easy-to-use model for predicting the risk of PICS following cardiac surgery. METHODS This was a single-center, double-blind, randomized, prospective, placebo-controlled trial. Patients undergoing cardiac surgery were randomly assigned (1:1) to dexmedetomidine or placebo (normal saline) groups between January 2019 and July 2020. Dexmedetomidine or a similar volume of saline was administered, with an infusion rate up to 1.2 μg/kg/h until the RASS remained between - 1 and 0. The primary study endpoint was PICS incidence at 6 months follow-up, as defined by cognitive, physical, or psychological impairments. RESULTS We assessed 703 individuals for eligibility, of whom 508 were enrolled. Of these, there were 251 in the dexmedetomidine group and 257 in the placebo group that received the trial agent, forming a modified intention-to-treat population. PICS incidence at 6-month follow-up was significantly decreased in the dexmedetomidine group (54/251, 21.5%) relative to the placebo group (80/257, 31.1%) (odds ratio [OR] 0.793, 95% CI 0.665-0.945; p = 0.014). Psychological impairment was significantly reduced in the dexmedetomidine group relative to the placebo group (18.7% vs. 26.8%, OR 0.806, CI 0.672-0.967, p = 0.029). However, dexmedetomidine treatment was associated with a higher rate of hypotension. A nomogram revealed that age, education, a medical history of diabetes and smoking, dexmedetomidine treatment, postoperative atrial fibrillation, and sequential organ failure assessment scores at 8 h post-surgery were independent predictors of PICS. CONCLUSIONS Prophylactic nocturnal dexmedetomidine administration significantly reduced PICS incidence by a marked reduction in psychological impairment within a 6-month follow-up period. TRIAL REGISTRATION ChiCTR, ChiCTR1800014314 . Registered 5 January 2018, http://www.chictr.org.cn/index.aspx.
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Affiliation(s)
- Chun-hui Dong
- Department of Cardiac Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 9677 Jingshi Road, Jinan, 250021 Shandong China
| | - Chao-nan Gao
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012 Shandong China
- Healthcare Big Data Institute of Shandong University, Jinan, 250000 Shandong China
| | - Xiao-hua An
- Department of Anesthesiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021 Shandong China
| | - Na Li
- Department of Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021 Shandong China
| | - Le Yang
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021 Shandong China
| | - De-cai Li
- Department of Cardiac Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 9677 Jingshi Road, Jinan, 250021 Shandong China
| | - Qi Tan
- Department of Cardiac Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 9677 Jingshi Road, Jinan, 250021 Shandong China
- Department of Cardiac Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250021 Shandong China
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Liu C, Liu X, Mao Z, Hu P, Li X, Hu J, Hong Q, Geng X, Chi K, Zhou F, Cai G, Chen X, Sun X. Interpretable Machine Learning Model for Early Prediction of Mortality in ICU Patients with Rhabdomyolysis. Med Sci Sports Exerc 2021; 53:1826-1834. [PMID: 33787533 DOI: 10.1249/mss.0000000000002674] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE Rhabdomyolysis (RM) is a complex set of clinical syndromes that involves the rapid dissolution of skeletal muscles. Mortality from RM is approximately 10%. This study aimed to develop an interpretable and generalizable model for early mortality prediction in RM patients. METHOD Retrospective analyses were performed on two electronic medical record databases: the eICU Collaborative Research Database and the Medical Information Mart for Intensive Care III database. We extracted data from the first 24 h after patient ICU admission. Data from the two data sets were merged for further analysis. The merged data sets were randomly divided, with 70% used for training and 30% for validation. We used the machine learning model extreme gradient boosting (XGBoost) with the Shapley additive explanation method to conduct early and interpretable predictions of patient mortality. Five typical evaluation indexes were adopted to develop a generalizable model. RESULTS In total, 938 patients with RM were eligible for this analysis. The area under the receiver operating characteristic curve (AUC) of the XGBoost model in predicting hospital mortality was 0.871, the sensitivity was 0.885, the specificity was 0.816, the accuracy was 0.915, and the F1 score was 0.624. The XGBoost model performance was superior to that of other models (logistic regression, AUC = 0.862; support vector machine, AUC = 0.843; random forest, AUC = 0.825; and naive Bayesian, AUC = 0.805) and clinical scores (Sequential Organ Failure Assessment, AUC = 0.747; Acute Physiology Score III, AUC = 0.721). CONCLUSIONS Although the XGBoost model is still not great from an absolute performance perspective, it provides better predictive performance than other models for estimating the mortality of patients with RM based on patient characteristics in the first 24 h of admission to the ICU.
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Affiliation(s)
| | - Xiaoli Liu
- School of Biological Science and Medical Engineering, Beihang University, Beijing, CHINA
| | - Zhi Mao
- Department of Critical Care Medicine, Chinese PLA General Hospital, Beijing, CHINA
| | - Pan Hu
- Department of Anesthesiology, The 920 Hospital of Joint Logistic Support Force of Chinese PLA, Kunming Yunnan, CHINA
| | - Xiaoming Li
- Medical School of Chinese PLA, Beijing, CHINA
| | - Jie Hu
- Department of Critical Care Medicine, Chinese PLA General Hospital, Beijing, CHINA
| | | | | | | | - Feihu Zhou
- Department of Critical Care Medicine, Chinese PLA General Hospital, Beijing, CHINA
| | - Guangyan Cai
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, CHINA
| | - Xiangmei Chen
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, CHINA
| | - Xuefeng Sun
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, CHINA
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11
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Madelaine T, Cour M, Roy P, Vivien B, Charpentier J, Dumas F, Deye N, Bonnefoy E, Gueugniaud PY, Coste J, Cariou A, Argaud L. Prediction of Brain Death After Out-of-Hospital Cardiac Arrest: Development and Validation of the Brain Death After Cardiac Arrest Score. Chest 2021; 160:139-147. [PMID: 34116828 DOI: 10.1016/j.chest.2021.01.056] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 12/09/2020] [Accepted: 01/03/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Among patients successfully resuscitated after an out-of-hospital cardiac arrest (OHCA), 10% to 15% evolve toward brain death (BD), thus becoming potential organ donors. RESEARCH QUESTION Is it possible to establish a score for early estimation of BD risk after OHCA? STUDY DESIGN AND METHODS The BD after cardiac arrest (BDCA) score was developed from data available within 24 hours after OHCA from two OHCA trials: Cyclosporine in Cardiac Arrest Resuscitation and Erythropoietin After OHCA. The BDCA score was then validated in another large prospective multicenter data set. The main outcome was the occurrence of BD. Independent prognostic covariates for BD were identified using a binomial two-stage adaptive least absolute shrinkage and selection operator procedure. RESULTS The development cohort included 569 patients alive 24 hours after OHCA, among whom 84 (14.8%) experienced BD. Independent predictors of BD used to build the BDCA score were being female (4 points), nonshockable rhythm (24 points), cardiac cause of OHCA (-6 points), neurological cause of OHCA (45 points), natremia at 24 hours (natremia in millimoles per liter minus 140 points), and vasoactive drug at admission (4 points) and at 24 hours (6 points). The area under the curve (AUC) of the BDCA score was 0.82 (95% CI, 0.77-0.86), and the discrimination value in the validation cohort (n = 487) was consistent (AUC, 0.81; 95% CI, 0.76-0.86). In the validation cohort, BD occurred in 4.0%, 20.4%, and 67.7% of patients with scores of < 20, 20 to 50, and > 50, respectively. INTERPRETATION The BDCA score allows early detection of patients with a high probability of experiencing BD, which may help increase organ donation after OHCA. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov; No.: NCT01595958, and ClinicalTrials.gov; No.: NCT00999583; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Thomas Madelaine
- Médecine Intensive-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Martin Cour
- Médecine Intensive-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; INSERM UMR1060 (CarMeN), Université de Lyon, Lyon, France
| | - Pascal Roy
- Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
| | - Benoît Vivien
- SAMU de Paris, Hôpital Necker-Enfants Malades, Assistance Publique des Hôpitaux de Paris Paris, France
| | - Julien Charpentier
- Service de réanimation médicale, Hôpital Cochin, Assistance Publique des Hôpitaux de Paris Paris, France
| | - Florence Dumas
- Service des Urgences, Assistance Publique des Hôpitaux de Paris Paris, France
| | - Nicolas Deye
- Réanimation Médicale et Toxicologique, Hôpital Lariboisière, Assistance Publique des Hôpitaux de Paris Paris, France
| | - Eric Bonnefoy
- Unité de Soins Intensifs Cardiologiques, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France
| | | | - Joël Coste
- Unité de Biostatistique et d'Epidémiologie, Hôtel-Dieu de Paris, Assistance Publique des Hôpitaux de Paris Paris, France
| | - Alain Cariou
- Service de réanimation médicale, Hôpital Cochin, Assistance Publique des Hôpitaux de Paris Paris, France
| | - Laurent Argaud
- Médecine Intensive-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; INSERM UMR1060 (CarMeN), Université de Lyon, Lyon, France.
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12
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Kashyap R, Sherani KM, Dutt T, Gnanapandithan K, Sagar M, Vallabhajosyula S, Vakil AP, Surani S. Current Utility of Sequential Organ Failure Assessment Score: A Literature Review and Future Directions. Open Respir Med J 2021; 15:1-6. [PMID: 34249175 PMCID: PMC8227444 DOI: 10.2174/1874306402115010001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/13/2020] [Accepted: 01/13/2021] [Indexed: 02/08/2023] Open
Abstract
The Sequential Organ Failure Assessment (SOFA) score is commonly used in the Intensive Care Unit (ICU) to evaluate, prognosticate and assess patients. Since its validation, the SOFA score has served in various settings, including medical, trauma, surgical, cardiac, and neurological ICUs. It has been a strong mortality predictor and literature over the years has documented the ability of the SOFA score to accurately distinguish survivors from non-survivors on admission. Over the years, multiple variations have been proposed to the SOFA score, which have led to the evolution of alternate validated scoring models replacing one or more components of the SOFA scoring system. Various SOFA based models have been used to evaluate specific clinical populations, such as patients with cardiac dysfunction, hepatic failure, renal failure, different races and public health illnesses, etc. This study is aimed to conduct a review of modifications in SOFA score in the past several years. We review the literature evaluating various modifications to the SOFA score such as modified SOFA, Modified SOFA, modified Cardiovascular SOFA, Extra-renal SOFA, Chronic Liver Failure SOFA, Mexican SOFA, quick SOFA, Lactic acid quick SOFA (LqSOFA), SOFA in hematological malignancies, SOFA with Richmond Agitation-Sedation scale and Pediatric SOFA. Various organ systems, their relevant scoring and the proposed modifications in each of these systems are presented in detail. There is a need to incorporate the most recent literature into the SOFA scoring system to make it more relevant and accurate in this rapidly evolving critical care environment. For future directions, we plan to put together most if not all updates in SOFA score and probably validate it in a large database a single institution and validate it in multisite data base.
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Affiliation(s)
- Rahul Kashyap
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Khalid M Sherani
- Department of Internal Medicine, Jamaica Hospital Medical Center, Jamaica, NY 11418, USA.,Corpus Christi Medical Center, Corpus Christi, TX 78411, USA
| | - Taru Dutt
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester MN, USA and Hennepin County Medical Center, Minneapolis, MN 55905, USA
| | - Karthik Gnanapandithan
- Department of Internal Medicine, Yale-New Haven Hospital and Yale University School of Medicine, New Haven, CT 06510, USA
| | - Malvika Sagar
- Department of Pediatrics, McLane Children's Hospital, Baylor Scott and White Health, Temple, TX 76502, USA
| | | | - Abhay P Vakil
- Department of Pediatrics, McLane Children's Hospital, Baylor Scott and White Health, Temple, TX 76502, USA.,Critical Care Medicine, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Salim Surani
- Corpus Christi Medical Center, Corpus Christi, TX 78411, USA.,Texas A&M University System Health Science Center, Bryan, TX 77807, USA
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13
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Matsuda J, Kato S, Yano H, Nitta G, Kono T, Ikenouchi T, Murata K, Kanoh M, Inamura Y, Takamiya T, Negi K, Sato A, Yamato T, Inaba O, Morita H, Matsumura Y, Nitta J, Yonetsu T. The Sequential Organ Failure Assessment (SOFA) score predicts mortality and neurological outcome in patients with post-cardiac arrest syndrome. J Cardiol 2020; 76:295-302. [PMID: 32305260 DOI: 10.1016/j.jjcc.2020.03.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/26/2020] [Accepted: 03/09/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Patients experiencing out-of-hospital cardiac arrest (OHCA) and subsequent post-cardiac arrest syndrome are often compromised by multi-organ failure. The Sequential Organ Failure Assessment (SOFA) score has been used to predict clinical outcome of patients requiring intensive care for multi-organ failure. Thus, the assessment of SOFA score is recommended as a criterion for sepsis. Although post-cardiac arrest patients frequently develop sepsis-like status in ICU, there are limited reports evaluating the SOFA score in post-cardiac arrest patients. We investigated the predictive value of the SOFA score in survival and neurological outcomes in patients with post-cardiac arrest syndrome. METHODS A total of 231 cardiovascular arrest patients achieving return of spontaneous circulation (ROSC) were finally extracted from the institutional consecutive database comprised of 1218 OHCA patients transferred to the institution between January 2015 and July 2018. The SOFA score was calculated on admission and after 48h. Predictors of survival and neurological outcome defined as having cerebral-performance-category (CPC) 1 or 2 at 30 days were determined. RESULTS SOFA score was lower in survived patients (5.0 vs 10.0, p<0.001) and those with favorable neurological outcome (5.0 vs 8.0, p<0.001) as compared with the counterparts. The SOFA score on admission was an independent predictor of survival (OR 0.68, 95% confidence interval [CI] 0.59-0.78; p<0.001) and favorable neurological performance (OR 0.79; 95% CI 0.69-0.90; p<0.001) at 30 days. Furthermore, a change in SOFA score (48-0h) was predictive of favorable 30-day neurological outcome (OR 0.71, 95% CI 0.60-0.85; p<0.001). CONCLUSIONS Evaluation of the SOFA score in the ICU is useful to predict survival and neurological outcome in post-cardiac arrest patients.
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Affiliation(s)
- Junji Matsuda
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan; Department of Cardiovascular Surgery, Japanese Red Cross Saitama Hospital, Saitama, Japan.
| | - Shunichi Kato
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Hirotaka Yano
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Giichi Nitta
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Toshikazu Kono
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Takashi Ikenouchi
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Kazuya Murata
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Miki Kanoh
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Yukihiro Inamura
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Tomomasa Takamiya
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Ken Negi
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Akira Sato
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Tsunehiro Yamato
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Osamu Inaba
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Hideki Morita
- Department of Cardiovascular Surgery, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Yutaka Matsumura
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Junichi Nitta
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Taishi Yonetsu
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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14
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Chae MK, Lee SE, Min YG, Park EJ. Initial serum cholesterol level as a potential marker for post cardiac arrest patient outcomes. Resuscitation 2019; 146:50-55. [PMID: 31711917 DOI: 10.1016/j.resuscitation.2019.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/30/2019] [Accepted: 11/01/2019] [Indexed: 11/18/2022]
Abstract
AIM Cholesterol and lipoproteins have many roles during systemic inflammation in critically ill patients. Many previous studies have reported that low levels of cholesterol are associated with poor outcomes in these patients. The aim of this study was to investigate the association of initial total cholesterol with predicting neurologic outcome of post-cardiac arrest patients. METHODS This was a retrospective observational study of out-of-hospital-cardiac arrest (OHCA) survivors who had serum cholesterol levels at admission. Multivariate regression analysis was performed to investigate total cholesterol and its association with neurologic outcome. Area under receiver operator characteristic curve (AUROC) was assessed and cut off values for predicting good or poor neurologic outcomes were analysed. RESULTS A total of 355 patients were analysed. Lower total cholesterol was significantly associated with poor neurologic outcome [OR: 0.99 (95% CI: 0.98-0.99), p < 0.01] in the multivariate analysis. Cholesterol was also useful to screening for poor neurologic outcome [AUROC: 0.70 (95%CI: 0.63-0.77)]. Patients with cholesterol lower than 71 mg/dL had poor neurologic outcome with a specificity of 100%. CONCLUSIONS Initial cholesterol level is an easily obtained biomarker that showed association with neurologic outcomes of post cardiac arrest patients.
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Affiliation(s)
- Minjung Kathy Chae
- Department of Emergency Medicine, Ajou University Medical Center, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Sung Eun Lee
- Department of Emergency Medicine, Ajou University Medical Center, Ajou University School of Medicine, Suwon, Republic of Korea; Department of Neurology, Ajou University Medical Center, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Young Gi Min
- Department of Emergency Medicine, Ajou University Medical Center, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Eun Jung Park
- Department of Emergency Medicine, Ajou University Medical Center, Ajou University School of Medicine, Suwon, Republic of Korea.
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15
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Cour M, Buisson M, Klouche K, Bouzgarrou R, Schwebel C, Quenot JP, Zeni F, Beuret P, Ovize M, Argaud L. Remote ischemic conditioning in septic shock (RECO-Sepsis): study protocol for a randomized controlled trial. Trials 2019; 20:281. [PMID: 31118101 PMCID: PMC6532140 DOI: 10.1186/s13063-019-3406-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 05/06/2019] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Septic shock is a major public health problem that is associated with up to 50% mortality. Unfavorable outcomes are mainly attributed to multiple organ failure (MOF) resulting from an uncontrolled inflammatory response and ischemia-reperfusion processes. REmote ischemic COnditioning (RECO) is a promising intervention to prevent ischemia-reperfusion injury. We hypothesize that RECO would reduce the severity of septic shock-induced MOF. METHODS/DESIGN RECO in septic shock patients (RECO-Sepsis study) is an ongoing, prospective, multicenter, randomized, open-label trial, testing whether RECO, as an adjuvant therapy to conventional treatment in septic shock, decreases the severity of MOF as assessed by the Sequential Organ Failure Assessment (SOFA) score. Adult patients admitted to an intensive care unit with documented or suspected infection, lactatemia > 2 mmol/l, and treated with norepinephrine for less than 12 h are potentially eligible for the study. Non-inclusion criteria are: having expressed the wish not to be resuscitated, contraindication for the use of a brachial cuff on both arms, intercurrent disease with an expected life expectancy of less than 24 h, cardiac arrest, and pregnant or breastfeeding women. After enrollment, patients are randomized (n = 180) 1:1 to receive RECO or no adjunctive intervention. RECO consists of four cycles of cuff inflation to 200 mmHg for 5 min and then deflation to 0 mmHg for another 5 min. RECO is performed at inclusion and repeated 12 and 24 h later. The primary endpoint is the mean daily SOFA score up to day 4 after inclusion. Secondary outcomes include the need for organ support, hospital length of stay, and 90-day mortality. DISCUSSION Results of this proof-of-concept trial should provide information on the efficacy of RECO in patients with septic shock. TRIAL REGISTRATION ClinicalTrials.gov, ID: identifier: NCT03201575 . Registered on 28 June 2017.
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Affiliation(s)
- Martin Cour
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Médecine Intensive-Réanimation, 5, place d’Arsonval, 69437 Lyon Cedex 03, France
- Faculté de Médecine Lyon-Est, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Marielle Buisson
- Centre d’investigation Clinique – INSERM 1407, Hospices Civils de Lyon, Hôpital Cardiologique Louis Pradel, Bron, France
| | - Kada Klouche
- Service de Réanimation Médicale, CHU de Montpellier, Montpellier, France
| | - Radhia Bouzgarrou
- Service de Réanimation Médicale, CHU Gabriel Montpied, Clermont-Ferrand, France
| | - Carole Schwebel
- Service de Réanimation Médicale, CHU Albert Michallon, Grenoble, France
| | | | - Fabrice Zeni
- Service de Réanimation Médicale, CHU de Saint-Etienne, Saint-Etienne, France
| | - Pascal Beuret
- Service de Réanimation polyvalente, CHR de Roanne, Roanne, France
| | - Michel Ovize
- Faculté de Médecine Lyon-Est, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Centre d’investigation Clinique – INSERM 1407, Hospices Civils de Lyon, Hôpital Cardiologique Louis Pradel, Bron, France
| | - Laurent Argaud
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Médecine Intensive-Réanimation, 5, place d’Arsonval, 69437 Lyon Cedex 03, France
- Faculté de Médecine Lyon-Est, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
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16
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Cour M, Turc J, Madelaine T, Argaud L. Risk factors for progression toward brain death after out-of-hospital cardiac arrest. Ann Intensive Care 2019; 9:45. [PMID: 30963296 PMCID: PMC6453982 DOI: 10.1186/s13613-019-0520-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 04/02/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Successfully resuscitated out-of-hospital cardiac arrest (OHCA) may lead to brain death (BD) and good-quality transplantable organs. We aimed to determine risk factors for evolution toward BD after OHCA. We analyzed adult patients admitted to an intensive care unit (ICU) who survived at least 24 h after an OHCA between 2005 and 2015. BD was defined according to international guidelines. Multivariate logistic regression was used to identify potential risk factors for BD available 24 h after OHCA. RESULTS A total of 214 patients were included (median age 68 years; sex ratio 1.25; non-shockable OHCA: 88%). Among these, 42 (19.6%) developed BD, while 22 (10.3%) were alive at 1 year with a good neurological outcome. Independent risk factors for BD were age (OR per year 0.95; 95% CI [0.92-0.98]), female gender (OR 2.34; 95% CI [1.02-5.35]), neurological cause of OHCA (OR 14.72; 95% CI [3.03-71.37]), duration of the low-flow period > 16 min (OR 2.94, 95% CI [1.21-7.16]) and need of vasoactive drugs at 24 h (OR 6.20, 95% CI [2.41-15.93]). CONCLUSIONS The study identified, in a population of OHCA with predominantly non-shockable initial rhythms, five simple risk factors independently associated with progression toward BD.
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Affiliation(s)
- Martin Cour
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Médecine Intensive-Réanimation, 5, Place d’Arsonval, 69437 Lyon Cedex 03, France
- Faculté de médecine Lyon-Est, Université Claude Bernard Lyon 1, Université de Lyon, 69373 Lyon, France
- U1060 CarMeN, INSERM, 69373 Lyon, France
| | - Jean Turc
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Médecine Intensive-Réanimation, 5, Place d’Arsonval, 69437 Lyon Cedex 03, France
| | - Thomas Madelaine
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Médecine Intensive-Réanimation, 5, Place d’Arsonval, 69437 Lyon Cedex 03, France
- Faculté de médecine Lyon-Est, Université Claude Bernard Lyon 1, Université de Lyon, 69373 Lyon, France
| | - Laurent Argaud
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Médecine Intensive-Réanimation, 5, Place d’Arsonval, 69437 Lyon Cedex 03, France
- Faculté de médecine Lyon-Est, Université Claude Bernard Lyon 1, Université de Lyon, 69373 Lyon, France
- U1060 CarMeN, INSERM, 69373 Lyon, France
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17
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Pekkarinen PT, Bäcklund M, Efendijev I, Raj R, Folger D, Litonius E, Laitio R, Bendel S, Hoppu S, Ala-Kokko T, Reinikainen M, Skrifvars MB. Association of extracerebral organ failure with 1-year survival and healthcare-associated costs after cardiac arrest: an observational database study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:67. [PMID: 30819234 PMCID: PMC6396453 DOI: 10.1186/s13054-019-2359-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 02/14/2019] [Indexed: 01/31/2023]
Abstract
Background Organ dysfunction is common after cardiac arrest and associated with worse short-term outcome, but its impact on long-term outcome and treatment costs is unknown. Methods We used nationwide registry data from the intensive care units (ICU) of the five Finnish university hospitals to evaluate the association of 24-h extracerebral Sequential Organ Failure Assessment (24h-EC-SOFA) score with 1-year survival and healthcare-associated costs after cardiac arrest. We included adult cardiac arrest patients treated in the participating ICUs between January 1, 2003, and December 31, 2013. We acquired the confirmed date of death from the Finnish Population Register Centre database and gross 1-year healthcare-associated costs from the hospital billing records and the database of the Finnish Social Insurance Institution. Results A total of 5814 patients were included in the study, and 2401 were alive 1 year after cardiac arrest. Median (interquartile range (IQR)) 24h-EC-SOFA score was 6 (5–8) in 1-year survivors and 7 (5–10) in non-survivors. In multivariate regression analysis, adjusting for age and prior independency in self-care, the 24h-EC-SOFA score had an odds ratio (OR) of 1.16 (95% confidence interval (CI) 1.14–1.18) per point for 1-year mortality. Median (IQR) healthcare-associated costs in the year after cardiac arrest were €47,000 (€28,000–75,000) in 1-year survivors and €12,000 (€6600–25,000) in non-survivors. In a multivariate linear regression model adjusting for age and prior independency in self-care, an increase of one point in the 24h-EC-SOFA score was associated with an increase of €170 (95% CI €150–190) in the cost per day alive in the year after cardiac arrest. In the same model, an increase of one point in the 24h-EC-SOFA score was associated with an increase of €4400 (95% CI €3300–5500) in the total healthcare-associated costs in 1-year survivors. Conclusions Extracerebral organ dysfunction is associated with long-term outcome and gross healthcare-associated costs of ICU-treated cardiac arrest patients. It should be considered when assessing interventions to improve outcomes and optimize the use of resources in these patients. Electronic supplementary material The online version of this article (10.1186/s13054-019-2359-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pirkka T Pekkarinen
- Division of Intensive Care Medicine, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, PB 340, 00029, Helsinki, HUS, Finland.
| | - Minna Bäcklund
- Division of Intensive Care Medicine, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, PB 340, 00029, Helsinki, HUS, Finland
| | - Ilmar Efendijev
- Division of Intensive Care Medicine, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, PB 340, 00029, Helsinki, HUS, Finland
| | - Rahul Raj
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Daniel Folger
- Division of Intensive Care Medicine, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, PB 340, 00029, Helsinki, HUS, Finland
| | - Erik Litonius
- Division of Intensive Care Medicine, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, PB 340, 00029, Helsinki, HUS, Finland
| | - Ruut Laitio
- Division of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland
| | - Stepani Bendel
- Division of Intensive Care Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Sanna Hoppu
- Department of Intensive Care, Tampere University Hospital, Tampere, Finland
| | - Tero Ala-Kokko
- Department of Anaesthesiology, University of Oulu, Oulu, Finland.,Division of Intensive Care Medicine, Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - Matti Reinikainen
- University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Markus B Skrifvars
- Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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18
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Rey A, Rossetti AO, Miroz JP, Eckert P, Oddo M. Late Awakening in Survivors of Postanoxic Coma. Crit Care Med 2019; 47:85-92. [DOI: 10.1097/ccm.0000000000003470] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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19
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Nonogi H. The necessity of conversion from coronary care unit to the cardiovascular intensive care unit required for cardiologists. J Cardiol 2018; 73:120-125. [PMID: 30342787 DOI: 10.1016/j.jjcc.2018.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 09/18/2018] [Indexed: 12/22/2022]
Abstract
The in-hospital mortality rate of acute myocardial infarction (AMI) has dramatically decreased due to the treatment at the coronary care unit (CCU), especially with the progress of arrhythmia therapy and reperfusion therapy. On the other hand, severe heart failure and multiple organ failure are increasing due to aging populations and multiple organ diseases. As a result, patients with AMI without complications are less likely to be admitted to the CCU, and cardiologists staying in the CCU have also decreased. The mortality rate is high when complications such as cardiogenic shock, cardiac rupture, and in-hospital cardiac arrest occur in AMI, therefore careful intensive care even in low-risk AMI is necessary. For cardiologists, mechanical ventilation, renal replacement therapy, or infection control are necessary for cardiovascular intensive care, and integrated multidisciplinary care coordinated by skilled intensive care physicians, nurses, respiratory therapists, physiotherapists, pharmacists, nutritionists, social workers, and clinical engineers is important. Therefore, for the critical care of cardiovascular diseases, it is necessary to convert from CCU to the cardiovascular intensive care unit.
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Affiliation(s)
- Hiroshi Nonogi
- Intensive Care Center, Shizuoka General Hospital, Shizuoka, Japan.
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20
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The impact of diastolic blood pressure values on the neurological outcome of cardiac arrest patients. Resuscitation 2018; 130:167-173. [PMID: 30031784 DOI: 10.1016/j.resuscitation.2018.07.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 07/12/2018] [Accepted: 07/18/2018] [Indexed: 12/22/2022]
Abstract
AIM Which haemodynamic variable is the best predictor of neurological outcome remains unclear. We investigated the association of several haemodynamic variables with neurological outcome in CA patients. METHODS Retrospective analysis of adult comatose survivors of CA admitted to the intensive care unit (ICU) of a University Hospital. Exclusion criteria were early death due to withdrawal of care, missing haemodynamic data and use of intra-aortic balloon pump or extracorporeal membrane oxygenation. We retrieved CA characteristics; lactate concentration and cardiovascular sequential organ failure assessment (cSOFA) score on admission; systolic (SAP), diastolic (DAP), mean arterial pressure (MAP), and the use of vasopressors and inotropic agents during the first 6 h of ICU stay. Unfavourable neurological outcome (UO) was defined as a 3-month cerebral performance category score of 3-5. RESULTS Among the 170 patients (median age 63 years, 67% male, 60% out-of-hospital CA), 106 (63%) had UO. Admission lactate was higher in patients with UO than in those with favourable neurological outcome (4.0[2.4-7.3] vs. 2.5[1.4-6.0] mEq/L; p = 0.003) as was the cSOFA (3 [1-4] vs. 2[0-3]; p = 0.007). The lowest DAP during the first 6 h after ICU admission was significantly lower in patients with unfavourable neurological outcome, notably in patients with high cSOFA scores. In multivariable analysis, high adrenaline doses and the lowest value of DAP during the first 6 h after ICU admission was significantly associated with unfavourable neurological outcome. CONCLUSIONS In CA patients admitted to the ICU, low DAP during the first 6 h is an independent predictor of unfavourable neurological outcome at 3 months.
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21
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Kim SI, Kim YJ, Lee YJ, Ryoo SM, Sohn CH, Seo DW, Lee YS, Lee JH, Lim KS, Kim WY. APACHE II Score Immediately after Cardiac Arrest as a Predictor of Good Neurological Outcome in Out-of-Hospital Cardiac Arrest Patients Receiving Targeted Temperature Management. Acute Crit Care 2018; 33:83-88. [PMID: 31723867 PMCID: PMC6849058 DOI: 10.4266/acc.2017.00514] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 03/19/2018] [Accepted: 03/21/2018] [Indexed: 11/30/2022] Open
Abstract
Background This study assessed the association between the initial Acute Physiology and Chronic Health Evaluation (APACHE) II score and good neurological outcome in comatose survivors of out-of-hospital cardiac arrest who received targeted temperature management (TTM). Methods Data from survivors of cardiac arrest who received TTM between January 2011 and June 2016 were retrospectively analyzed. The initial APACHE II score was determined using the data immediately collected after return of spontaneous circulation rather than within 24 hours after being admitted to the intensive care unit. Good neurological outcome, defined as Cerebral Performance Category 1 or 2 on day 28, was the primary outcome of this study. Results Among 143 survivors of cardiac arrest who received TTM, 62 (43.4%) survived, and 34 (23.8%) exhibited good neurological outcome on day 28. The initial APACHE II score was significantly lower in the patients with good neurological outcome than in those with poor neurological outcome (23.71 ± 4.39 vs. 27.62 ± 6.16, P = 0.001). The predictive ability of the initial APACHE II score for good neurological outcome, assessed using the area under the receiver operating characteristic curve, was 0.697 (95% confidence interval [CI], 0.599 to 0.795; P = 0.001). The initial APACHE II score was associated with good neurological outcome after adjusting for confounders (odds ratio, 0.878; 95% CI, 0.792 to 0.974; P = 0.014). Conclusions In the present study, the APACHE II score calculated in the immediate post-cardiac arrest period was associated with good neurological outcome. The initial APACHE II score might be useful for early identification of good neurological outcome.
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Affiliation(s)
- Sang-Il Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Youn-Jung Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - You-Jin Lee
- Department of Emergency Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Seung Mok Ryoo
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang Hwan Sohn
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Woo Seo
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yoon-Seon Lee
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Ho Lee
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyoung Soo Lim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Young Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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22
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Cheng B, Li Z, Wang J, Xie G, Liu X, Xu Z, Chu L, Zhao J, Yao Y, Fang X. Comparison of the Performance Between Sepsis-1 and Sepsis-3 in ICUs in China: A Retrospective Multicenter Study. Shock 2018; 48:301-306. [PMID: 28448400 PMCID: PMC5516667 DOI: 10.1097/shk.0000000000000868] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The definition of sepsis was updated to sepsis-3 in February 2016. However, the performance of the previous and new definition of sepsis remains unclear in China. This was a retrospective multicenter study in six intensive care unit (ICUs) from five university-affiliated hospitals to compare the performance between sepsis-1 and sepsis-3 in China. From May 1, 2016 to June 1, 2016, 496 patients were enrolled consecutively. Data were extracted from the electronic clinical records. We evaluated the performance of sepsis-1 and sepsis-3 by measuring the area under the receiver operating characteristic curves (AUROC) to predict 28-day mortality rates. Of 496 enrolled patients, 186 (37.5%) were diagnosed with sepsis according to sepsis-1, while 175 (35.3%) fulfilled the criteria of sepsis-3. The AUROC of systemic inflammatory response syndrome (SIRS) is significantly smaller than that of sequential organ failure assessment (SOFA) (0.55 [95% confidence interval, 0.46–0.64] vs. 0.69 (95% confidence interval, 0.61–0.77], P = 0.008) to predict 28-day mortality rates of infected patients. Moreover, 5.9% infected patients (11 patients) were diagnosed as sepsis according to sepsis-1 but not to sepsis-3. The APACHE II, SOFA scores, and mortality rate of the 11 patients were significantly lower than of patients whose sepsis was defined by both the previous and new criteria (8.6±3.5 vs. 16.3±6.2, P = < 0.001; 1 (0–1) vs. 6 (4–8), P = <0.001; 0.0 vs. 33.1%, P = 0.019). In addition, the APACHE II, length of stay in ICU, and 28-day mortality rate of septic patients rose gradually corresponding with the raise in SOFA score (but not the SIRS score). Sepsis-3 performed better than sepsis-1 in the study samples in ICUs in China.
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Affiliation(s)
- Baoli Cheng
- *Department of Anesthesiology, The First Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, China †Trauma Research Center, The First Hospital Affiliated to the PLA General Hospital, Beijing, China
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Impella support compared to medical treatment for post-cardiac arrest shock after out of hospital cardiac arrest. Resuscitation 2018. [DOI: 10.1016/j.resuscitation.2018.03.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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24
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Serial evaluation of SOFA and APACHE II scores to predict neurologic outcomes of out-of-hospital cardiac arrest survivors with targeted temperature management. PLoS One 2018; 13:e0195628. [PMID: 29621337 PMCID: PMC5886591 DOI: 10.1371/journal.pone.0195628] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 03/25/2018] [Indexed: 11/19/2022] Open
Abstract
Objective This study was aimed at a serial evaluation and comparison of the prognostic values of Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores for neurologic outcomes in comatose, out-of-hospital cardiac arrest (OHCA) survivors, treated with targeted temperature management (TTM). Methods We analysed a prospective cohort of comatose OHCA patients, with TTM, admitted to an emergency intensive care unit (ICU), between January 2010 and December 2015. SOFA and APACHE II scores were calculated initially, and then at day 1, 2, 3, 5, and 7 after ICU admission. Primary and secondary outcomes were the 28-day neurologic outcome and the 28-day mortality, respectively. Prognostic value of the SOFA and APACHE II scores was analysed using the receiver operating characteristic curve. Results Of the 143 selected patients, 62 survived and 34 had good neurologic outcomes at day 28. There was no significant difference in the SOFA and extracerebral SOFA scores between the good and poor neurologic outcome groups. However, the APACHE II scores were significantly higher in the good outcome group; they displayed good discriminatory power in predicting poor outcomes, unlike the SOFA scores. The APACHE II score at day 3 had the highest prognostic value for predicting poor neurologic outcomes with an area under the cure of 0.793, and with a cut-off value of 20, the APACHE II score predicted poor neurologic outcomes with a sensitivity of 43.75%, a specificity of 94.12%, a positive predictive value of 94.59%, and a negative predictive value of 41.56%. Conclusions Identifying APACHE II score might assist as one piece of multimodal prognostic approach for the assessment of neurologic outcomes in OHCA survivors treated with TTM.
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25
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Organ support therapy in the intensive care unit and return to work in out-of-hospital cardiac arrest survivors–A nationwide cohort study. Resuscitation 2018; 125:126-134. [DOI: 10.1016/j.resuscitation.2018.01.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 12/22/2017] [Accepted: 01/01/2018] [Indexed: 01/26/2023]
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26
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Park MJ, Kwon WY, Kim K, Suh GJ, Shin J, Jo YH, Kim KS, Lee HJ, Kim J, Lee SJ, Kim JY, Cho JH. Prehospital Supraglottic Airway Was Associated With Good Neurologic Outcome in Cardiac Arrest Victims Especially Those Who Received Prolonged Cardiopulmonary Resuscitation. Acad Emerg Med 2017; 24:1464-1473. [PMID: 28898484 DOI: 10.1111/acem.13309] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 08/13/2017] [Accepted: 09/02/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We performed this study to investigate the association of prehospital supraglottic airway (SGA) on neurologic outcome in cardiac arrest victims with adjustment of postresuscitation variables as well as prehospital and resuscitation variables. METHODS This study was a retrospective study based on a multicenter prospective cohort registry from December 2013 to April 2016. According to the 28-day cerebral performance categories (CPCs) scale, patients were divided into the good-outcome group (CPC 1-2) and the poor-outcome group (CPC 3-5). We compared the two groups with respect to demographic variables, prehospital and in-hospital resuscitation variables, and postresuscitation variables. RESULTS A total of 869 cardiac arrest victims who received in-progress cardiopulmonary resuscitation (CPR) were delivered to the emergency department of three hospitals, and 310 patients were admitted to the intensive care unit. The use of a prehospital SGA was independently associated with 28-day good neurologic outcome (odds ratio [OR] = 7.88; 95% confidence interval [CI] = 1.33-46.53; p = 0.023] when postresuscitation variables were adjusted, although there were no significant association with the acquisition of sustained return of spontaneous circulation (OR = 0.992; 95% CI = 0.591-1.666; p = 0.976). Furthermore, a prehospital SGA was significantly associated with good neurologic outcome, especially in patients who received prolonged CPR (low flow time > 15 minutes; OR = 3.41; 95% CI = 1.23-9.45; p = 0.018) rather than in patients with nonprolonged CPR (OR = 4.50; 95% CI = 0.75-27.13; p = 0.101). CONCLUSIONS When postresuscitation variables were adjusted, the prehospital SGA was independently associated with 28-day good neurologic outcome in cardiac arrest victims.
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Affiliation(s)
- Min Ji Park
- Department of Emergency Medicine; Seoul National University Bundang Hospital; Seongnam-si Gyeonggi-do
| | - Woon Yong Kwon
- Department of Emergency Medicine; Seoul National University College of Medicine; Seoul
- Department of Emergency Medicine; Seoul National University Hospital; Seoul
| | - Kyuseok Kim
- Department of Emergency Medicine; Seoul National University Bundang Hospital; Seongnam-si Gyeonggi-do
| | - Gil Joon Suh
- Department of Emergency Medicine; Seoul National University College of Medicine; Seoul
- Department of Emergency Medicine; Seoul National University Hospital; Seoul
| | - Jonghwan Shin
- Department of Emergency Medicine; Seoul Metropolitan Government-Seoul National University Boramae Medical Center; Seoul
| | - You Hwan Jo
- Department of Emergency Medicine; Seoul National University Bundang Hospital; Seongnam-si Gyeonggi-do
| | - Kyung Su Kim
- Department of Emergency Medicine; Seoul National University College of Medicine; Seoul
- Department of Emergency Medicine; Seoul National University Hospital; Seoul
| | - Hui Jai Lee
- Department of Emergency Medicine; Seoul Metropolitan Government-Seoul National University Boramae Medical Center; Seoul
| | - Joonghee Kim
- Department of Emergency Medicine; Seoul National University Bundang Hospital; Seongnam-si Gyeonggi-do
| | - Se Jong Lee
- Department of Emergency Medicine; Seoul Metropolitan Government-Seoul National University Boramae Medical Center; Seoul
| | - Jeong Yeon Kim
- Department of Emergency Medicine; Seoul National University Hospital; Seoul
| | - Jun Hwi Cho
- Department of Emergency Medicine; Kangwon National University Hospital; Chuncheon-si Gangwon-do Republic of Korea
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Jentzer JC, Clements CM, Murphy JG, Scott Wright R. Recent developments in the management of patients resuscitated from cardiac arrest. J Crit Care 2017; 39:97-107. [PMID: 28242531 DOI: 10.1016/j.jcrc.2017.02.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 01/18/2017] [Accepted: 02/01/2017] [Indexed: 01/31/2023]
Abstract
Cardiac arrest is the leading cause of death in Europe and the United States. Many patients who are initially resuscitated die in the hospital, and hospital survivors often have substantial neurologic dysfunction. Most cardiac arrests are caused by coronary artery disease; patients with coronary artery disease likely benefit from early coronary angiography and intervention. After resuscitation, cardiac arrest patients remain critically ill and frequently suffer cardiogenic shock and multiorgan failure. Early cardiopulmonary stabilization is important to prevent worsening organ injury. To achieve best patient outcomes, comprehensive critical care management is needed, with primary goals of stabilizing hemodynamics and preventing progressive brain injury. Targeted temperature management is frequently recommended for comatose survivors of cardiac arrest to mitigate the neurologic injury that drives outcomes. Accurate neurologic assessment is central to managing care of cardiac arrest survivors and should combine physical examination with objective neurologic testing, with the caveat that delaying neurologic prognosis is essential to avoid premature withdrawal of supportive care. A combination of clinical findings and diagnostic results should be used to estimate the likelihood of functional recovery. This review focuses on recent advances in care and specific cardiac intensive care strategies that may improve morbidity and mortality for patients after cardiac arrest.
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Affiliation(s)
- Jacob C Jentzer
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
| | | | - Joseph G Murphy
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - R Scott Wright
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
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Vognsen M, Fabian-Jessing BK, Secher N, Løfgren B, Dezfulian C, Andersen LW, Granfeldt A. Contemporary animal models of cardiac arrest: A systematic review. Resuscitation 2017; 113:115-123. [PMID: 28214538 DOI: 10.1016/j.resuscitation.2017.01.024] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 01/21/2017] [Accepted: 01/25/2017] [Indexed: 01/01/2023]
Abstract
AIM OF THE STUDY Animal models are widely used in cardiac arrest research. This systematic review aimed to provide an overview of contemporary animal models of cardiac arrest. METHODS Using a comprehensive research strategy, we searched PubMed and EMBASE from March 8, 2011 to March 8, 2016 for cardiac arrest animal models. Two investigators reviewed titles and abstracts for full text inclusion from which data were extracted according to pre-defined definitions. RESULTS Search criteria yielded 1741 unique titles and abstracts of which 490 full articles were included. The most common animals used were pigs (52%) followed by rats (35%) and mice (6%). Studies favored males (52%) over females (16%); 17% of studies included both sexes, while 14% omitted to report on sex. The most common methods for induction of cardiac arrest were either electrically-induced ventricular fibrillation (54%), asphyxia (25%), or potassium (8%). The median no-flow time was 8min (quartiles: 5, 8, range: 0-37min). The majority of studies used adrenaline during resuscitation (64%), while bicarbonate (17%), vasopressin (8%) and other drugs were used less prevalently. In 53% of the studies, the post-cardiac arrest observation time was ≥24h. Neurological function was an outcome in 48% of studies while 43% included assessment of a cardiac outcome. CONCLUSIONS Multiple animal models of cardiac arrest exist. The great heterogeneity of these models along with great variability in definitions and reporting make comparisons between studies difficult. There is a need for standardization of animal cardiac arrest research and reporting.
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Affiliation(s)
- Mikael Vognsen
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Niels Secher
- Department of Anaesthesiology and Intensive Care Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Bo Løfgren
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark; Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Internal Medicine, Regional Hospital of Randers, Randers, Denmark
| | - Cameron Dezfulian
- Safar Center for Resuscitation Research, Vascular Medicine Institute and Critical Care Medicine Department, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Lars W Andersen
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Asger Granfeldt
- Department of Anaesthesiology and Intensive Care Medicine, Aarhus University Hospital, Aarhus, Denmark; Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.
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Monneret G, Venet F, Cour M, Argaud L. Danger associated molecular patterns in injury: a double-edged sword? J Thorac Dis 2016; 8:1060-1. [PMID: 27293819 DOI: 10.21037/jtd.2016.04.30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Guillaume Monneret
- 1 Immunology Department, Hospices Civils de Lyon, Lyon University Hospital, Edouard Herriot Hospital, Lyon, France ; 2 Université de Lyon, Claude Bernard University, EA PI3 "Pathology of Injury-induced Immunosuppression", Lyon, France ; 3 Department of Medical Intensive Care Unit, Hospices Civils de Lyon, Lyon University Hospital, Edouard Herriot Hospital, Lyon, France ; 4 INSERM UMR 1060, CarMeN, Team 5 "Cardioprotection", Lyon, France
| | - Fabienne Venet
- 1 Immunology Department, Hospices Civils de Lyon, Lyon University Hospital, Edouard Herriot Hospital, Lyon, France ; 2 Université de Lyon, Claude Bernard University, EA PI3 "Pathology of Injury-induced Immunosuppression", Lyon, France ; 3 Department of Medical Intensive Care Unit, Hospices Civils de Lyon, Lyon University Hospital, Edouard Herriot Hospital, Lyon, France ; 4 INSERM UMR 1060, CarMeN, Team 5 "Cardioprotection", Lyon, France
| | - Martin Cour
- 1 Immunology Department, Hospices Civils de Lyon, Lyon University Hospital, Edouard Herriot Hospital, Lyon, France ; 2 Université de Lyon, Claude Bernard University, EA PI3 "Pathology of Injury-induced Immunosuppression", Lyon, France ; 3 Department of Medical Intensive Care Unit, Hospices Civils de Lyon, Lyon University Hospital, Edouard Herriot Hospital, Lyon, France ; 4 INSERM UMR 1060, CarMeN, Team 5 "Cardioprotection", Lyon, France
| | - Laurent Argaud
- 1 Immunology Department, Hospices Civils de Lyon, Lyon University Hospital, Edouard Herriot Hospital, Lyon, France ; 2 Université de Lyon, Claude Bernard University, EA PI3 "Pathology of Injury-induced Immunosuppression", Lyon, France ; 3 Department of Medical Intensive Care Unit, Hospices Civils de Lyon, Lyon University Hospital, Edouard Herriot Hospital, Lyon, France ; 4 INSERM UMR 1060, CarMeN, Team 5 "Cardioprotection", Lyon, France
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