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Zhong L, Wu M, Liu ZY, Liu Y, Liu ZF. Risk factors for brain injury in patients with exertional heatstroke: A 5-year experience. Chin J Traumatol 2024; 27:91-96. [PMID: 37973473 DOI: 10.1016/j.cjtee.2023.10.003] [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: 10/14/2022] [Revised: 09/21/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023] Open
Abstract
PURPOSE Minimal data exist on brain injury in patients with exertional heatstroke (EHS) in developing country. In this study, we explored the risk factors for brain injury induced by EHS 90-day after onset. METHODS A retrospective cohort study of patients with EHS was conducted in the intensive care unit of the General Hospital of Southern Theater Command of PLA in China from April 2014 to June 2019. Patients were divided into non-brain injury (fully recovered) and brain injury groups (comprising deceased patients or those with neurological sequelae). The brain injury group was further subdivided into a death group and a sequela group for detailed analysis. General information, neurological performance and information on important organ injuries in the acute stage were recorded and analysed. Multivariable logistic regression was used to identify risk factors for brain injury after EHS and mortality risk factors for brain injury, and Kaplan-Meier survival curve was used to evaluate the effect of the neurological dysfunction on survival. RESULTS Out of the 147 EHS patients, 117 were enrolled, of which 96 (82.1%) recovered, 13 (11.1%) died, and 8 (6.8%) experienced neurological sequelae. Statistically significant differences were found between non-brain injury and brain injury groups in age, hypotension, duration of consciousness disorders, time to drop core body temperature below 38.5°C, lymphocyte counts, platelet counts, procalcitonin, alanine aminotransferase, aspartate aminotransferase, creatinine, cystatin C, coagulation parameters, international normalized ratio, acute physiology and chronic health evaluation II scores, sequential organ failure assessment (SOFA) scores, and Glasgow coma scale scores (all p < 0.05). Multivariate logistic regression showed that age (OR = 1.090, 95% CI: 1.02 - 1.17, p = 0.008), time to drop core temperature (OR = 8.223, 95% CI: 2.30 - 29.40, p = 0.001), and SOFA scores (OR = 1.676, 95% CI: 1.29 - 2.18, p < 0.001) are independent risk factors for brain injury induced by EHS. The Kaplan-Meier curves suggest significantly prolonged survival (p < 0.001) in patients with early Glasgow coma scale score > 8 and duration of consciousness disorders ≤ 24 h. CONCLUSIONS Advanced age, delayed cooling, and higher SOFA scores significantly increase the risk of brain injury post-EHS. These findings underscore the importance of rapid cooling and early assessment of organ failure to improve outcomes in EHS patients.
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Affiliation(s)
- Li Zhong
- Department of Traditional Chinese Medicine, The First Affiliated Hospital, Guizhou University of Chinese Medicine, Guiyang, 550001, China
| | - Ming Wu
- Department of Infection and Critical Care Medicine, The Second People's Hospital of Shenzhen & First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen, Guangdong province, 518035, China
| | - Zhe-Ying Liu
- Department of Medical Critical Care Medicine, General Hospital of Southern Theatre Command of PLA, Guangzhou, 510010, China
| | - Yan Liu
- Department of Infection and Critical Care Medicine, The Second People's Hospital of Shenzhen & First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen, Guangdong province, 518035, China
| | - Zhi-Feng Liu
- Department of Medical Critical Care Medicine, General Hospital of Southern Theatre Command of PLA, Guangzhou, 510010, China; Guangdong Branch Center, National Clinical Research Center for Geriatric Diseases (Chinese PLA General Hospital), Guangzhou, 510010, China.
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Adnan Bukhari H. A Systematic Review on Outcomes of Patients with Heatstroke and Heat Exhaustion. Open Access Emerg Med 2023; 15:343-354. [PMID: 37771523 PMCID: PMC10522494 DOI: 10.2147/oaem.s419028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/30/2023] [Indexed: 09/30/2023] Open
Abstract
Introduction Heatstroke (HS) is a severe form of heat-related illness (HRI) associated with high morbidity and mortality, representing a condition that includes long-term multiorgan dysfunction and susceptibility to further heat illness. Methods In a systematic review searching Medline PubMed from the studies conducted between 2009 and 2020, 16 papers were identified. Results A hallmark symptom of heat stroke is CNS dysfunction (a hallmark sign of HS) which manifests as mental status changes, including agitation, delirium, epilepsy, or coma at the time of the collapse. Acute kidney injury (AKI), gut ischemia, blood clots in the stomach and small intestine, cytoplasmic protein clumps in the spleen, and injury of skeletal muscle (rhabdomyolysis) are all characteristics of peripheral tissue damage. Severe heat stroke tends to be complicated by rhabdomyolysis, especially in patients with exertional heat stroke. Rhabdomyolysis may lead to systemic effects, including the local occurrence of compartment syndrome, hyperkalemic cardiac arrest, and/or lethal disseminated intravascular coagulopathy. Untreated heat stroke might exacerbate psychosis, lactic acidosis, consumptive coagulopathy, hematuria, pulmonary edema, renal failure, and other metabolic abnormalities. Core body temperature and level of consciousness are the most significant indicators to diagnose the severity of heat stroke and prevent unfavorable consequences. Heatstroke is a life-threatening illness if not promptly recognized and effectively treated. Discussion This review highlighted that core body temperature and white blood cell count are significant contributing factors affecting heat stroke outcomes. Other factors contributing to the poor outcome include old age, low GCS, and prolonged hospital stay. The prevalence of both classic and exertional heatstroke can be reduced by certain simple preventive measures, such as avoiding strenuous activity in hot environments and reducing exposure to heat stress.
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Zhu C, Hou Z, Zhu R, Zhou B, Sun Y, Li Z, Li X, Ding R, Luan Z, Liang Y, Wang L, Ma X. Comparisons of coagulation characteristics between elderly and non-elderly patients with sepsis: A prospective study. Surgery 2023; 173:1303-1310. [PMID: 36774318 DOI: 10.1016/j.surg.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 12/11/2022] [Accepted: 01/06/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND A blunt host defense response in older patients may contribute to different coagulation responses during sepsis. We aimed to investigate the differences in coagulation parameters between elderly and non-elderly patients with sepsis. METHODS Adult patients diagnosed with sepsis within 24 hours after admission to the intensive care unit between September 2018 and December 2020 were prospectively enrolled. Patients were categorized into the adult (18-64 years) and elderly (age ≥65 years) groups. Conventional coagulation parameters and inflammatory markers were measured on intensive care unit admission and on Days 3 and 7. Thromboelastography was performed on intensive care unit admission. The differences in the coagulation parameters between the 2 groups were evaluated. The adult and elderly patients were matched to adjust for baseline characteristics. Correlations between inflammatory markers and coagulation-related parameters were also analyzed. RESULTS Of the 567 patients, 303 (53.4%) were elderly. Compared with adult patients, elderly patients had lower prothrombin time elevation, lower fibrinogen, D-dimer, and fibrin/Fib degradation product levels, and lower proportion of disseminated intravascular coagulation on intensive care unit admission; and, they had lower dynamic platelet, lower fibrinogen, and D-dimer levels during the first week in the intensive care unit. Thromboelastography parameters were generally within the normal range, although elderly patients had lower R and K values and a higher alpha angle. Comparisons of coagulation parameters between the 2 groups revealed similar results in the matched cohort. The inflammatory markers correlated with prothrombin time, activated partial thromboplastin time, and antithrombin III. CONCLUSION Elderly patients had milder coagulation activation, accompanied by a decreased inflammatory response during sepsis, compared to non-elderly patients.
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Affiliation(s)
- Chengrui Zhu
- Department of Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Zhenzhen Hou
- Department of Surgical Intensive Care Unit, Beijing Chaoyang Hospital Affiliated to Capital Medical University, China
| | - Ran Zhu
- Department of Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Baosen Zhou
- Department of Clinical Epidemiology, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Yini Sun
- Department of Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Zhiliang Li
- Department of Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Xu Li
- Department of Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Renyu Ding
- Department of Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Zhenggang Luan
- Department of Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Yingjian Liang
- Department of Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Liang Wang
- Department of Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Xiaochun Ma
- Department of Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning Province, China.
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Takegawa R, Kanda J, Yaguchi A, Yokobori S, Hayashida K. A prehospital risk assessment tool predicts clinical outcomes in hospitalized patients with heat-related illness: a Japanese nationwide prospective observational study. Sci Rep 2023; 13:1189. [PMID: 36681704 PMCID: PMC9867691 DOI: 10.1038/s41598-023-28498-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 01/19/2023] [Indexed: 01/22/2023] Open
Abstract
We previously developed a risk assessment tool to predict outcomes after heat-related illness (J-ERATO score), which consists of six binary prehospital vital signs. We aimed to evaluate the ability of the score to predict clinical outcomes for hospitalized patients with heat-related illnesses. In a nationwide, prospective, observational study, adult patients hospitalized for heat-related illnesses were registered. A binary logistic regression model and receiver operating characteristic (ROC) curve analysis were used to assess the relationship between the J-ERATO and survival at hospital discharge as a primary outcome. Among eligible patients, 1244 (93.0%) survived to hospital discharge. Multivariable logistic regression analysis revealed that the J-ERATO was an independent predictor for survival to discharge (adjusted odds ratio [OR] 0.47; 95% confidence interval [CI] 0.37-0.59) and occurrence of disseminated intravascular coagulation (DIC) on day 1 (adjusted OR 2.07; 95% CI 1.73-2.49). ROC analyses revealed an optimal J-ERATO cut-off of 5 for prediction of mortality at discharge (area under the curve [AUC] 0.742; 95% CI 0.691-0.787) and DIC development on day 1 (AUC 0.723; 95% CI 0.684-0.758). The J-ERATO obtained before transportation could be helpful in predicting the severity and mortality of hospitalized patients with heat-related illnesses.
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Affiliation(s)
- Ryosuke Takegawa
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Jun Kanda
- Department of Emergency Medicine, Teikyo University Hospital, Tokyo, Japan
| | - Arino Yaguchi
- Department of Critical Care and Emergency Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Kei Hayashida
- Department of Emergency and Critical Care Medicine, School of Medicine, Keio University, Tokyo, Japan.
- Department of Emergency Medicine, South Shore University Hospital, Northwell Health System, Bay Shore, NY, USA.
- The Feinstein Institutes for Medical Research, Northwell Health System, Manhasset, NY, USA.
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Disseminated Intravascular Coagulation Score Is Related to Short-term Mortality in Patients Undergoing Venoarterial Extracorporeal Membrane Oxygenation After Cardiac Surgery. ASAIO J 2021; 67:891-898. [PMID: 33470639 DOI: 10.1097/mat.0000000000001333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Disseminated intravascular coagulation (DIC) score is associated with short-term mortality in various conditions but has not been studied in postcardiotomy cardiogenic shock (PCS) patients supported with venoarterial extracorporeal membrane oxygenation (VA-ECMO). The objective of this study was to evaluate the relationship between DIC score at day 1 from VA-ECMO initiation and short-term mortality. We included all PCS patients supported with VA-ECMO at the Beijing Anzhen Hospital between January 2015 and December 2018. Multivariable logistic regression analysis was performed to assess the relationship between DIC score at day 1 and in-hospital mortality, and adjust for potential confounding variables. Of 222 PCS patients treated with VA-ECMO, 145 (65%) patients were weaned from VA-ECMO, and median (IQR) ECMO support duration was five (3-6) days. In-hospital mortality was 53%. The median (IQR) DIC score at day 1 was five (4-6). Patients with DIC score ≥5 at day 1 (overt DIC) had higher in-hospital mortality as compared with patients with DIC score <5 (64% vs. 22%; P < 0.001). After adjusting for age, sex, ECMO indication, and peak serum lactate, a one-point rise in DIC score [OR, 2.20; 95% confidence intervals (CI), 1.64-2.95] or DIC score ≥5 at day 1 (OR, 4.98; 95% CI, 2.42-10.24) was associated with an increased risk of in-hospital mortality. The area under the receiver operating characteristic curve for DIC score at day 1 was 0.76 (95% CI, 0.69-0.82). Our study suggests that DIC score at day 1 is associated with short-term mortality in patients undergoing VA-ECMO after cardiac surgery, independent of age, sex, disease characteristics, and severity of illness.
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Abstract
BACKGROUND Severe heat stroke is a clinical syndrome caused by host stress dysfunction due to heat stress and subsequent life-threatening organ dysfunction. We aimed to explore the early risk factors affecting the 90-day prognosis of severe heat stroke patients. METHODS A case-control study was used to retrospectively analyze the clinical data of 117 severe heat stroke patients admitted to the intensive care unit of the General Hospital of Southern Theater Command from April 2014 to May 2019. The risk factors affecting the 90-day mortality of the patients were analyzed, and subgroup analysis was performed comparing the complete recovery and the sequelae subgroups of survivors. RESULTS Thirteen patients (11.1%) died within 90 days. The multivariate Cox risk regression model showed that cooling time (HR 4.87; 95% CI: 1.94-12.18; P = 0.001), heart rate (HR 1.04; 95% CI: 1.01-1.09; P = 0.027), and Sequential Organ Failure (SOFA) score (HR 1.41; 95% CI: 1.21-1.65; P < 0.001) were independent risk factors affecting the survival of patients. The area under the Receiver Operating Characteristic (ROC) curve of the combination of cooling time, heart rate, and SOFA score for the prediction of mortality due to severe heat stroke was 98.1% (95% CI 0.957-1.000, P < 0.001), the sensitivity was 96.2%, and the specificity was 92.3%. CONCLUSIONS The longer the cooling duration, the faster the heart rate at admission, and the higher the SOFA score, the lower the 90-day survival rate was. These three indicators can be used in combination to predict 90-day mortality and poor prognosis in patients with severe heat stroke.
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Hifumi T, Fujishima S, Ubukata K, Hagiwara A, Abe T, Ogura H, Shiraishi A, Kushimoto S, Saitoh D, Mayumi T, Ikeda H, Ueyama M, Otomo Y, Okamoto K, Umemura Y, Kotani J, Sakamoto Y, Sasaki J, Shiino Y, Shiraishi SI, Takuma K, Tarui T, Tsuruta R, Nakada TA, Yamakawa K, Masuno T, Takeyama N, Yamashita N, Fujimi S, Gando S. Clinical characteristics of patients with severe sepsis and septic shock in relation to bacterial virulence of beta-hemolytic Streptococcus and Streptococcus pneumoniae. Acute Med Surg 2020; 7:e513. [PMID: 32489668 PMCID: PMC7262430 DOI: 10.1002/ams2.513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/16/2020] [Accepted: 04/12/2020] [Indexed: 12/29/2022] Open
Abstract
Aim Combined detailed analysis of patient characteristics and treatment as well as bacterial virulence factors, which all play a central role in the cause of infections leading to severe illness, has not been reported. We aimed to describe the patient characteristics (Charlson comorbidity index [CCI]), treatment (3‐h bundle), and outcomes in relation to bacterial virulence of Streptococcus pneumoniae and beta‐hemolytic Streptococcus (BHS). Methods This sepsis primary study is part of the larger Focused Outcomes Research in Emergency Care in Acute Respiratory Distress Syndrome, Sepsis and Trauma (FORECAST) study, a multicenter, prospective cohort study. We included patients diagnosed with S. pneumoniae and BHS sepsis and examined virulence, defining the high‐virulence factor as follows: S. pneumoniae serotype 3, 31, 11A, 35F, and 17F; Streptococcus pyogenes, emm 1; Streptococcus agalactiae, III; and Streptococcus dysgalactiae ssp. equisimilis, emm typing pattern stG 6792. Included patients were divided into high and normal categories based on the virulence factor. Results Of 1,184 sepsis patients enrolled in the Japanese Association for Acute Medicine’s FORECAST study, 62 were included in the current study (29 cases with S. pneumoniae sepsis and 33 with BHS). The CCI and completion of a 3‐h bundle did not differ between normal and high virulence groups. Risk of 28‐day mortality was significantly higher for high‐virulence compared to normal‐virulence when adjusted for CCI and completion of a 3‐h bundle (Cox proportional hazards regression analysis, hazard ratio 3.848; 95% confidence interval, 1.108–13.370; P = 0.034). Conclusion The risk of 28‐day mortality was significantly higher for patients with high‐virulence compared to normal‐virulence bacteria.
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Affiliation(s)
- Toru Hifumi
- Department of Emergency and Critical Care Medicine St. Luke's International Hospital Emergency Medical Center Tokyo Japan
| | - Seitaro Fujishima
- Center for General Medicine Education School of Medicine Keio University Tokyo Japan
| | - Kimiko Ubukata
- Center for General Medicine Education School of Medicine Keio University Tokyo Japan
| | - Akiyoshi Hagiwara
- Emergency Medicine Center Hospital of the National Center for Global Health and Medicine Tokyo Japan
| | - Toshikazu Abe
- Department of General Medicine Juntendo University Tokyo Japan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Suita Japan
| | | | - Shigeki Kushimoto
- Division of Emergency and Critical Care Medicine Tohoku University Graduate School of Medicine Sendai Japan
| | - Daizoh Saitoh
- Division of Traumatology Research Institute National Defense Medical College Saitama Japan
| | - Toshihiko Mayumi
- Department of Emergency Medicine School of Medicine University of Occupational and Environmental Health Kitakyushu Japan
| | - Hiroto Ikeda
- Department of Emergency Medicine Teikyo University School of Medicine Tokyo Japan
| | - Masashi Ueyama
- Department of Trauma Critical Care Medicine, and Burn Center Japan Community Healthcare Organization, Chukyo Hospital Nagoya Japan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Medical Center Medical Hospital Tokyo Medical and Dental University Tokyo Japan
| | - Kohji Okamoto
- Department of Surgery Center for Gastroenterology and Liver Disease Kitakyushu City Yahata Hospital Kitakyushu Japan
| | - Yutaka Umemura
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Suita Japan
| | - Joji Kotani
- Department of Emergency, Disaster and Critical Care Medicine Hyogo College of Medicine Nishinomiya Japan
| | - Yuichiro Sakamoto
- Emergency and Critical Care Medicine Saga University Hospital Saga Japan
| | - Junichi Sasaki
- Department of Emergency and Critical Care Medicine Keio University School of Medicine Tokyo Japan
| | - Yasukazu Shiino
- Department of Acute Medicine Kawasaki Medical School Kurashiki Japan
| | - Shin-Ichiro Shiraishi
- Department of Emergency and Critical Care Medicine Aizu Chuo Hospital Fukushima Japan
| | - Kiyotsugu Takuma
- Emergency and Critical Care Center Kawasaki Municipal Kawasaki Hospital Kawasaki Japan
| | - Takehiko Tarui
- Department of Trauma and Critical Care Medicine Kyorin University School of Medicine Mitaka Japan
| | - Ryosuke Tsuruta
- Advanced Medical Emergency and Critical Care Center Yamaguchi University Hospital Ube Japan
| | - Taka-Aki Nakada
- Department of Emergency and Critical Care Medicine Chiba University Graduate School of Medicine Chiba Japan
| | - Kazuma Yamakawa
- Division of Trauma and Surgical Critical Care Osaka General Medical Center Osaka Japan
| | - Tomohiko Masuno
- Department of Emergency and Critical Care Medicine Nippon Medical School Tokyo Japan
| | - Naoshi Takeyama
- Advanced Critical Care Center Aichi Medical University Hospital Nagakute Japan
| | - Norio Yamashita
- Advanced Emergency Medical Service Center Kurume University Hospital Kurume Japan
| | - Satoshi Fujimi
- Division of Trauma and Surgical Critical Care Osaka General Medical Center Osaka Japan
| | - Satoshi Gando
- Division of Acute and Critical Care Medicine Hokkaido University Graduate School of Medicine Sapporo Japan
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Mochizuki K, Mori K, Kamijo H, Ichikawa M, Nitta K, Imamura H. Beneficial effect modification on survival outcome of sepsis between ART-123 and polymyxin B‑immobilised haemoperfusion: a nationwide Japanese registry study. Ann Intensive Care 2020; 10:57. [PMID: 32405776 PMCID: PMC7221014 DOI: 10.1186/s13613-020-00674-8] [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: 01/30/2020] [Accepted: 05/04/2020] [Indexed: 12/20/2022] Open
Abstract
Background Although recently published randomised controlled trials did not confirm significant positive effect of ART-123 or polymyxin B‑immobilised haemoperfusion (PMX-HP) on survival outcome, previous studies using a dataset of 3195 patients with sepsis registered at 42 intensive care units throughout Japan revealed significantly reduced mortality following these treatments. A study has suggested the efficacy of combination therapy with ART-123 and PMX-HP; however, it did not evaluate the effect modification between them. We hypothesised that coadministration of ART-123 and PMX-HP has a significant positive effect modification on survival outcome. The purpose of this study was to evaluate the effect modification between ART-123 and PMX-HP treatment on the survival outcome of sepsis using post hoc analysis of the dataset of the Japan Septic Disseminated Intravascular Coagulation registry. Results Of the 3195 patients recorded in the registry, 2350 were analysed. The product term between ART-123 and PMX-HP was analysed by the Cox regression model to evaluate significance. The primary outcome of this study was hospital mortality. Although the administration of ART-123 was independently positively associated with survival outcome (adjusted hazard ratio [HR]: 0.834, 95% confidence interval [CI] 0.695–0.999; P = 0.049) in the model prior to the introduction of the product term, a significant effect modification on survival outcome was observed between the administration of ART-123 and PMX-HP treatment (adjusted HR: 0.667, 95% CI 0.462–0.961; P = 0.030). Conclusions The main effect of the administration of ART-123 may be beneficial for survival outcome in patients with sepsis. In addition, a significant beneficial effect modification on survival outcome was observed between the administration of ART-123 and PMX-HP treatment.
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Affiliation(s)
- Katsunori Mochizuki
- Department of Emergency and Critical Care Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.
| | - Kotaro Mori
- Department of Emergency and Critical Care Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Hiroshi Kamijo
- Department of Emergency and Critical Care Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Michitaro Ichikawa
- Department of Emergency and Critical Care Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Kenichi Nitta
- Department of Emergency and Critical Care Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Hiroshi Imamura
- Department of Emergency and Critical Care Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
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Abstract
Clostridium species are gram-positive, spore-forming, anaerobic rods normally found in the soil and gastrointestinal tract of humans and animals. Spontaneous sepsis due to C. perfringens is not caused by injury, which sets it apart from the classical gas gangrene that typically follows trauma. Spontaneous C. perfringens sepsis often develops as a rapidly progressive intravascular hemolysis and metabolic acidosis, with high mortality rates of over 70% with standard intensive care. In such cases, alpha toxin secreted by C. perfringens is considered the main toxin responsible for intravascular hemolysis, disseminated intravascular coagulopathy, and multiple organ failure. Theta-toxin causes a cytokine cascade, which results in peripheral vasodilation similar to that seen in septic shock. For C. perfringens infections, antibiotics, such as high-dose penicillin, and surgical drainage as early as possible are the principal treatments of choice. However, considering the current mortality rate of sepsis, outcomes have not improved with the current standard treatment for C. perfringens infections. Monoclonal antibody against theta toxin in combination with gas gangrene antitoxin presents a promising therapeutic option.
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Affiliation(s)
- Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital
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10
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Iba T, Levy JH, Warkentin TE, Thachil J, van der Poll T, Levi M. Diagnosis and management of sepsis-induced coagulopathy and disseminated intravascular coagulation. J Thromb Haemost 2019; 17:1989-1994. [PMID: 31410983 DOI: 10.1111/jth.14578] [Citation(s) in RCA: 332] [Impact Index Per Article: 66.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 07/12/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Toshiaki Iba
- Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Jerrold H Levy
- Department of Anesthesiology, Critical Care, and Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Theodore E Warkentin
- Department of Pathology and Molecular Medicine, and Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jecko Thachil
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
| | - Tom van der Poll
- Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Marcel Levi
- University College London Hospitals NHS Foundation Trust, London, UK
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Kondo Y, Hifumi T, Shimazaki J, Oda Y, Shiraishi SI, Hayashida K, Fukuda T, Wakasugi M, Kanda J, Moriya T, Yagi M, Kawahara T, Tonouchi M, Yokobori S, Yokota H, Miyake Y, Shimizu K. Comparison between the Bouchama and Japanese Association for Acute Medicine Heatstroke Criteria with Regard to the Diagnosis and Prediction of Mortality of Heatstroke Patients: A Multicenter Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183433. [PMID: 31527479 PMCID: PMC6765926 DOI: 10.3390/ijerph16183433] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 09/08/2019] [Accepted: 09/09/2019] [Indexed: 12/24/2022]
Abstract
Background: This study aims to compare the Bouchama heatstroke (B-HS) and Japanese Association for Acute Medicine heatstroke (JAAM-HS) criteria with regard to the diagnosis and prediction of mortality and neurological status of heatstroke patients. Methods: This multicenter observational study recruited eligible patients from the emergency departments of 110 major hospitals in Japan from 1 July to 30 September, 2014. Results: A total of 317 patients (median age, 65 years; interquartile range, 39–80 years) were included and divided into the B-HS, JAAM-HS, and non-HS groups, with each group consisting of 97, 302, and 15 patients, respectively. The JAAM-HS (1.0; 95% confidence interval [CI], 0.87–1.0) and B-HS (0.29; 95% CI, 0.14–0.49) criteria showed high and low sensitivity to mortality, respectively. Similarly, the JAAM-HS (1.0; 95% CI, 0.93–1.0) and B-HS (0.35; 95% CI, 0.23–0.49) criteria showed high and low sensitivity to poor neurological status, respectively. Meanwhile, the sequential organ failure assessment (SOFA) scores demonstrated good accuracy in predicting mortality among heat-related illness (HRI) patients. However, both JAAM-HS and B-HS criteria could not predict in-hospital mortality. The AUC of the SOFA score for mortality was 0.83 (day 3) among the HRI patients. The patients’ neurological status was difficult to predict using the JAAM-HS and B-HS criteria. Concurrently, the total bilirubin level could relatively predict the central nervous system function at discharge. Conclusions: The JAAM-HS criteria showed high sensitivity to mortality and could include all HRI patients who died. The JAAM-HS criterion was considered a useful tool for judgement of admission at ED. Further investigations are necessary to determine the accuracy of both B-HS and JAAM-HS criteria in predicting mortality and neurological status at discharge.
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Affiliation(s)
- Yutaka Kondo
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Chiba 279-0021, Japan.
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo 104-8560, Japan.
| | - Junya Shimazaki
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan.
| | - Yasutaka Oda
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Yamaguchi 755-8505, Japan.
| | - Shin-Ichiro Shiraishi
- Department of Emergency and Critical Care Medicine, Aidu Chuo Hospital, Fukushima 965-8611, Japan.
| | - Kei Hayashida
- Department of Emergency and Critical Care Medicine, School of Medicine, Keio University, Tokyo 160-8582, Japan.
| | - Tatsuma Fukuda
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan.
| | - Masahiro Wakasugi
- Emergency and Critical Care Center, Toyama University Hospital, Toyama 930-0152, Japan.
| | - Jun Kanda
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo 173-8606, Japan.
| | - Takashi Moriya
- Department of Emergency and Critical Care Medicine, Saitama Medical Center, Jichi Medical University, Saitama 330-8503, Japan.
| | - Masaharu Yagi
- Department of Emergency and Critical Care Medicine, Urasoe General Hospital, Okinawa 901-2132, Japan.
| | | | | | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo 113-8603, Japan.
| | - Hiroyuki Yokota
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo 113-8603, Japan.
| | - Yasufumi Miyake
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo 173-8606, Japan.
| | - Keiki Shimizu
- Emergency and Critical Care Center, Tokyo Metropolitan Tama Medical Centre, Tokyo 183-8524, Japan.
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12
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Hifumi T, Inoue A, Kokubu N, Hase M, Yonemoto N, Kuroda Y, Kawakita K, Sawano H, Tahara Y, Nishioka K, Shirai S, Hazui H, Arimoto H, Kashiwase K, Kasaoka S, Motomura T, Yasuga Y, Yokoyama H, Nagao K, Nonogi H. Association between rewarming duration and neurological outcome in out-of-hospital cardiac arrest patients receiving therapeutic hypothermia. Resuscitation 2019; 146:170-177. [PMID: 31394154 DOI: 10.1016/j.resuscitation.2019.07.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 07/23/2019] [Accepted: 07/26/2019] [Indexed: 02/08/2023]
Abstract
AIM The European Resuscitation Council guidelines recommend a slow rate of rewarming of 0.25 °C/h-0.5 °C/h for out-of-hospital cardiac arrest (OHCA) patients receiving therapeutic hypothermia (TH). Conversely, a very slow rewarming of 1 °C/day is generally applied in Japan. The rewarming duration ranged from less than 24 h up to more than 50 h. No randomized control trials have examined the optimal rewarming speed for TH in OHCA patients. Therefore, we examined the association between the rewarming duration and neurological outcomes in OHCA patients who received TH. METHODS This study was a secondary analysis of the Japanese Population-based Utstein-style study with defibrillation and basic/advanced Life Support Education and implementation-Hypothermia (J-PULSE-HYPO) study registry, a multicenter prospective cohort study. Patients suffering from OHCA who received TH (target temperature, 34 °C) after the return of spontaneous circulation from 2005 to 2011 in 14 hospitals throughout Japan were enrolled. The rewarming duration was defined as the time from the beginning of rewarming at a target temperature of 34 °C until reaching 36 °C. The primary outcome was an unfavorable neurological outcome at hospital discharge, i.e., a cerebral performance category of 3-5. RESULTS The J-PULSE-HYPO study enrolled 452 OHCA patients. Of these, 328 were analyzed; 79.9% survived to hospital discharge, of which 56.4% had a favorable neurological outcome. Multivariable logistic regression analysis revealed that the rewarming duration was independently associated with unfavorable neurological outcomes [odds ratio (per 5 h), 0.89; 95% confidence interval, 0.79-0.99; p = 0.032]. CONCLUSION A longer rewarming duration was significantly associated with and was an independent predictor of favorable neurological outcomes in OHCA patients who received TH.
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Affiliation(s)
- Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Japan; Emergency Medical Center, Kagawa University Hospital, Japan.
| | - Akihiko Inoue
- Emergency Medical Center, Kagawa University Hospital, Japan; Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Japan
| | - Nobuaki Kokubu
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University, Japan
| | | | - Naohiro Yonemoto
- Department of Biostatistics, Kyoto University School of Public Health, Japan
| | | | - Kenya Kawakita
- Emergency Medical Center, Kagawa University Hospital, Japan
| | - Hirotaka Sawano
- Senri Critical Care Medical Center, Saiseikai Senri Hospital, Japan
| | - Yoshio Tahara
- Division of Cardiovascular Care Unit, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Kenji Nishioka
- Department of Cardiology, Hiroshima City Hospital, Japan
| | | | - Hiroshi Hazui
- Emergency Medicine, Osaka Mishima Emergency and Critical Care Center, Japan
| | - Hideki Arimoto
- Emergency and Critical Care Medical Center, Osaka City General Hospital, Japan
| | - Kazunori Kashiwase
- Department of Internal Medicine, Division of Coronary Heart Disease, Hyogo College of Medicine, Japan
| | - Shunji Kasaoka
- Department of Emergency and General Medicine, Kumamoto University Hospital, Japan
| | - Tomokazu Motomura
- Shock & Trauma Center, Chiba Hokusoh Hospital, Nippon Medical School, Japan
| | - Yuji Yasuga
- Department of Cardiology, Sumitomo hospital, Japan
| | | | - Ken Nagao
- Cardiovascular Center, Nihon University Hospital, Japan
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13
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Diagnostic and Prognostic Value of Plasma Factor V Activity and Parameters in Thrombin Generation for Disseminated Intravascular Coagulation in Patients with Hematological Malignancies. Curr Med Sci 2019; 39:546-550. [DOI: 10.1007/s11596-019-2072-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 03/27/2019] [Indexed: 10/26/2022]
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14
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Iba T, Umemura Y, Watanabe E, Wada T, Hayashida K, Kushimoto S. Diagnosis of sepsis-induced disseminated intravascular coagulation and coagulopathy. Acute Med Surg 2019; 6:223-232. [PMID: 31304023 PMCID: PMC6603393 DOI: 10.1002/ams2.411] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 03/05/2019] [Indexed: 12/26/2022] Open
Abstract
Disseminated intravascular coagulation (DIC) is a frequent complication in sepsis. Once patients develop DIC, the mortality rate increases significantly. Moreover, recent studies have suggested that coagulation disorder plays a significant role in the development of organ dysfunction in sepsis. Thus, the early detection of DIC is vital in sepsis care, and the Japanese Association for Acute Medicine established a set of original diagnostic criteria in 2006 (JAAM DIC). Since then, the usefulness of the JAAM DIC has been repeatedly reported, and these criteria have been widely adopted in emergency and critical care settings in Japan. Different criteria have also been released by the International Society on Thrombosis and Haemostasis (ISTH overt-DIC), and the latter criteria are presently considered to be the international standard. Compared with the JAAM DIC, the ISTH overt-DIC criteria are stricter and the timing of diagnosis is later. This discrepancy is because of conceptual differences. As many physicians think sepsis-associated DIC is the target of anticoagulant therapies in Japan, the JAAM DIC criteria were designed to allow the early initiation of treatment. As other countries do not provide DIC-specific treatments, early diagnosis is not necessary, and this situation has led to a significant gap. However, as overt-DIC is a late-phase coagulation disorder, a need for early detection has been advocated, and members of the ISTH have recently proposed the category of sepsis-induced coagulopathy. In this review, we introduce the strengths and weaknesses of the major criteria including JAAM-DIC, ISTH overt-DIC, sepsis-induced coagulopathy, and Japanese Society on Thrombosis and Haemostasis-DIC.
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Affiliation(s)
- Toshiaki Iba
- Department of Emergency and Disaster MedicineJuntendo University Graduate School of MedicineTokyoJapan
| | - Yutaka Umemura
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Eizo Watanabe
- Department of General Medical Science Graduate School of MedicineChiba UniversityChiba CityJapan
- Department of Emergency and Critical Care MedicineEastern Chiba Medical CenterChibaJapan
| | - Takeshi Wada
- Department of Anesthesiology and Critical Care MedicineDivision of Acute and Critical Care MedicineHokkaido University Graduate School of MedicineSapporoJapan
| | - Kei Hayashida
- Department of Emergency and Critical Care MedicineSchool of MedicineKeio UniversityTokyoJapan
| | - Shigeki Kushimoto
- Division of Emergency and Critical Care MedicineTohoku University Graduate School of MedicineSendaiJapan
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15
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Saito S, Uchino S, Hayakawa M, Yamakawa K, Kudo D, Iizuka Y, Sanui M, Takimoto K, Mayumi T, Sasabuchi Y. Epidemiology of disseminated intravascular coagulation in sepsis and validation of scoring systems. J Crit Care 2019; 50:23-30. [DOI: 10.1016/j.jcrc.2018.11.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 09/17/2018] [Accepted: 11/13/2018] [Indexed: 12/31/2022]
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16
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Mei H, Jiang Y, Luo L, Huang R, Su L, Hou M, Wang X, Deng J, Hu Y. Evaluation the combined diagnostic value of TAT, PIC, tPAIC, and sTM in disseminated intravascular coagulation: A multi-center prospective observational study. Thromb Res 2019; 173:20-26. [DOI: 10.1016/j.thromres.2018.11.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/14/2018] [Accepted: 11/11/2018] [Indexed: 01/21/2023]
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17
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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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Luo L, Wu Y, Niu T, Han Y, Feng Y, Ding Q, Huang R, Zhang X, Feng J, Hou M, Peng J, Li Y, Zhou Y, Su L, Yang L, Zhou Z, Xue F, Gu J, Zhu T, Wang X, Deng J, Mei H, Hu Y. A multicenter, prospective evaluation of the Chinese Society of Thrombosis and Hemostasis Scoring System for disseminated intravascular coagulation. Thromb Res 2018; 173:131-140. [PMID: 30529391 DOI: 10.1016/j.thromres.2018.11.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 11/11/2018] [Accepted: 11/22/2018] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Disseminated intravascular coagulation (DIC) is a severe complication of critical conditions. There are several scoring systems used for the diagnosis of DIC, including the International Society on Thrombosis and Hemostasis (ISTH) Overt-DIC criteria, the Japanese Ministry of Health and Welfare (JMHW) criteria and the Chinese Society of Thrombosis and Hemostasis scoring system for DIC (CDSS). The objective of this prospective study was to evaluate the accuracy and predictive value of the CDSS. MATERIALS AND METHODS 1318 patients, aged 18-70 years old and suspected of DIC were enrolled from 18 hospitals across China. Participants were divided into two groups for analysis (group 1, non-hematological diseases; group 2, hematological diseases). 242 patients were excluded because of incomplete data collection and failure to follow-up. RESULTS AND CONCLUSIONS The rates of concordance of diagnosis of DIC between the CDSS and two other scoring systems were close to 80%. The area under ROC curves of CDSS had a slight advantage when using the ISTH, JMHW criteria or prognosis as gold standard, respectively. The CDSS DIC was an independent predictor of mortality, and its odds-ratio was superior or comparable to that of the ISTH and JMHW criteria in the two groups. The CDSS DIC score also had a significant correlation with the APACHE II and SOFA score (p < 0.05). In summary, as a quantification standard of the Chinese experts' consensus, the CDSS is conducive to the standardized diagnosis of DIC because of its favorable diagnostic and prognostic utility.
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Affiliation(s)
- Lili Luo
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yingying Wu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Ting Niu
- Department of Hematology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yue Han
- Department of Hematology, First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Ying Feng
- Department of Hematology, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, China
| | - Qiulan Ding
- Department of laboratory medicine, Ruijin Hospital Affiliated to Shanghai JiaoTong University School of Medicine, Shanghai 200025, China
| | - Ruibin Huang
- Department of Hematology, First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Xiaohui Zhang
- Department of Hematology, Peking University People's Hospital, Beijing 100044, China
| | - Jianming Feng
- Department of Hematology, Qinghai Provincial People's Hospital, Xining 810007, China
| | - Ming Hou
- Department of Hematology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Jun Peng
- Department of Hematology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Yan Li
- Department of Hematology, First Hospital of China Medical University, Shenyang 110001, China
| | - Yuhong Zhou
- Department of Hematology, First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang 310006, China
| | - Lei Su
- Department of Intensive Care Unit, General Hospital of Guangzhou Military Command, Guangzhou 510010, China
| | - Linhua Yang
- Department of Hematology, Second Hospital of Shanxi Medical University, Shanxi 030001, China
| | - Zeping Zhou
- Department of Hematology, Second Affiliated Hospital of Kunming Medical College, Kunming 650101, China
| | - Feng Xue
- Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - Jian Gu
- Department of Hematology, Clinical Medical College of Yangzhou University, Jiangsu 225001, China
| | - Tienan Zhu
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xiaomin Wang
- Department of Hematology, People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang 830001, China
| | - Jun Deng
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Heng Mei
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
| | - Yu Hu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
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19
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Padungmaneesub W, Reungrongrat S, Manowong S, Fanhchaksai K, Panyasit N, Natesirinilkul R. Biomarkers of disseminated intravascular coagulation in pediatric intensive care unit in Thailand. Int J Lab Hematol 2018; 41:32-38. [PMID: 30208259 DOI: 10.1111/ijlh.12917] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 07/16/2018] [Accepted: 07/25/2018] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Disseminated intravascular coagulation (DIC) is a systemic activation of hemostatic system caused by several causes. Biomarkers including antithrombin (AT), protein C (PC), and thrombomodulin (TM) were reported as the additional markers for DIC in adults. This study aimed to determine the association between biomarkers among patients with overt DIC (ODIC) and nonovert DIC (NDIC) in children in PICU. METHODS We enrolled 103 subjects, aged 1 month-18 years, who were admitted to PICU at Chiang Mai University (CMU) Hospital >24 hours with underlying conditions predisposing to DIC were enrolled. Biomarkers were tested after 24 hours of admission. Subject who had NDIC on the 1st investigations would have other tests on days 3-5 of admission. RESULTS The incidence of ODIC by the International Society on Thrombosis and Hemostasis (ISTH) DIC score was found 24%. The bleeding, thrombosis, and death were significantly higher in ODIC group (P < 0.05). Mean levels of AT and PC in ODIC group were significantly different from NDIC one (66.9% vs 79.9%, P < 0.001 and 46.1% vs 59.2%, P = 0.004, respectively) while mean level of TM was not different between two groups. Adding AT to DIC score was better than the original score for predict mortality [area under curve (AUC) = 0.662 vs AUC = 0.65] and bleeding (AUC = 0.751 vs AUC = 0.732). CONCLUSIONS ODIC is prevalent among critically ill children. Adverse outcomes were more commonly found in children with ODIC. AT and PC levels after 24 hours of PICU admission seem to be the useful biomarkers for ODIC in PICU.
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Affiliation(s)
| | - Sanit Reungrongrat
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Suphara Manowong
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kanda Fanhchaksai
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Noppamas Panyasit
- Hematology Laboratory, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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20
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Post-cardiotomy venovenous extracorporeal membrane oxygenation without heparinization. Gen Thorac Cardiovasc Surg 2018; 67:982-986. [DOI: 10.1007/s11748-018-0990-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 08/11/2018] [Indexed: 01/31/2023]
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Abstract
Background Heat stroke is a life-threatening injury requiring neurocritical care; however, heat stroke has not been completely examined due to several possible reasons, such as no universally accepted definition or classification, and the occurrence of heat wave victims every few years. Thus, in this review, we elucidate the definition/classification, pathophysiology, and prognostic factors related to heat stroke and also summarize the results of current studies regarding the management of heat stroke, including the use of intravascular balloon catheter system, blood purification therapy, continuous electroencephalogram monitoring, and anticoagulation therapy. Main body Two systems for the definition/classification of heat stroke are available, namely Bouchama’s definition and the Japanese Association for Acute Medicine criteria. According to the detailed analysis of risk factors, prevention strategies for heat stroke, such as air conditioner use, are important. Moreover, hematological, cardiovascular, neurological, and renal dysfunctions on admission are associated with high mortality, which thus represent the potential targets for intensive and specific therapies for patients with heat stroke. No prospective, comparable study has confirmed the efficacy of intravascular cooling devices, anticoagulation, or blood purification in heat stroke. Conclusion The effectiveness of cooling devices, drugs, and therapies in heat stroke remains inconclusive. Further large studies are required to continue to evaluate these treatment strategies.
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Affiliation(s)
- Toru Hifumi
- 1Emergency Medical Center, Kagawa University Hospital, 1750-1 Ikenobe, Miki, Kita, Kagawa 761-0793 Japan.,5Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560 Japan
| | - Yutaka Kondo
- 2Department of Emergency and Critical Care Medicine, Juntendo University, Urayasu Hospital, 2-1-1 Tomioka,Urayasu-shi, Chiba, 279-0021 Japan
| | - Keiki Shimizu
- Emergency and Critical Care Center, Tokyo Metropolitan Tama Medical Centre, 2-8-29 Musashidai, Fuchu-shi, Tokyo, 183-8524 Japan
| | - Yasufumi Miyake
- 4Department of Emergency Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-Ku, Tokyo, 173-8606 Japan
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22
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Hifumi T, Kondo Y, Shimazaki J, Oda Y, Shiraishi S, Wakasugi M, Kanda J, Moriya T, Yagi M, Ono M, Kawahara T, Tonouchi M, Yokota H, Miyake Y, Shimizu K. Prognostic significance of disseminated intravascular coagulation in patients with heat stroke in a nationwide registry. J Crit Care 2017; 44:306-311. [PMID: 29253838 DOI: 10.1016/j.jcrc.2017.12.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 12/02/2017] [Accepted: 12/07/2017] [Indexed: 11/16/2022]
Abstract
PURPOSE Heat stroke (HS) induces disseminated intravascular coagulation (DIC); however, the prognostic significance of DIC in patients with HS has not yet been fully assessed in large populations. The aim of this study was to examine the prognostic significance of DIC in patients with HS using a nationwide registry. MATERIALS AND METHODS Data regarding HS were obtained and analyzed from three prospective, observational, multicenter HS registries (HSRs): 2010, 2012, and 2014. Univariate and multivariate analyses were performed to identify independent predictors of hospital death. DIC was diagnosed according to the Japanese Association for Acute Medicine (JAAM) diagnostic criteria, with a total score≥4 implying a DIC diagnosis. RESULTS In total, 705 (median age, 68years; 501 men) were included in this study. Hospital mortality was 7.1% (50 patients). Multiple regression analysis revealed that hospital mortality was significantly associated with presence of DIC (odds ratio [OR], 2.16; 95% confidence interval [CI], 1.09-4.27; p=0.028). Mortality worsened as the DIC score increased, and increased remarkably to approximately 10% when the DIC score was 2. CONCLUSIONS Presence of DIC was an independent prognostic factor of hospital mortality in patients with HS. Hematological dysfunction represents potential target for specific therapies in HS.
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Affiliation(s)
- Toru Hifumi
- Emergency Medical Center, Kagawa University Hospital, 1750-1 Ikenobe, Miki, Kita, Kagawa 761-0793, Japan.
| | - Yutaka Kondo
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, United States
| | - Junya Shimazaki
- Trauma and Acute Critical Care Center, Osaka University Hospital, 2-15 Yamadaoka Suita, Osaka 565-0871, Japan
| | - Yasutaka Oda
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University School of Medicine, 1-1-1 Minami Kogushi, Ube, Yamaguchi 755-8505, Japan.
| | - Shinichiro Shiraishi
- Emergency and Critical Care Center, Aidu Chuo Hospital, 1-1, Tsurugamachi, aiduwakamatushi, Fukushima 965-8611, Japan.
| | - Masahiro Wakasugi
- Emergency and Critical Care Center, Toyama University Hospital, 2630 Sugitani, Toyamashi, Toyama 930-0152, Japan.
| | - Jun Kanda
- Department of Emergency Medicine, Teikyo University School of Medicine, 2-11-1 Kaga Itabashi-Ku, Tokyo 173-8606, Japan.
| | - Takashi Moriya
- Emergency Department, Saitama Medical Center Jichi Medical University, 1-847 Amanuma, Oomiya, Saitamashi, Saitama 330-8503, Japan.
| | - Masaharu Yagi
- Department of Emergency and Critical Care Medicine, Urasoe General Hospital, 4-16-1, Iso, Urasoe, Okinawa 901-2132, Japan
| | - Masaji Ono
- National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba-City, Ibaraki 305-8506, Japan.
| | - Takashi Kawahara
- Japan Sport Council, 2-8-35 Kita-Aoyama Minato-ku, Tokyo 107-0061, Japan
| | - Michihiko Tonouchi
- Japan Meteorological Business Support Center, To-nen Bld.,3-17 Kanda-Nishikicho, Chiyoda-ku, Tokyo 101-0054, Japan.
| | - Hiroyuki Yokota
- Advanced Medical Emergency and Critical Care Center, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo, Tokyo 113-8603, Japan.
| | - Yasufumi Miyake
- Department of Emergency Medicine, Teikyo University School of Medicine, 2-11-1 Kaga Itabashi-Ku, Tokyo 173-8606, Japan.
| | - Keiki Shimizu
- Emergency and Critical Care Center, Tokyo Metropolitan Tama Medical Centre, 2-8-29 Musashidai, Fuchu-shi, Tokyo 183-8524, Japan
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Wu Y, Luo L, Niu T, Han Y, Feng Y, Ding Q, Huang R, Zhang X, Feng J, Hou M, Peng J, Li Y, Zhou Y, Su L, Yang L, Zhou Z, Xue F, Gu J, Zhu T, Wang X, Deng J, Mei H, Hu Y. Evaluation of the new Chinese Disseminated Intravascular Coagulation Scoring System in critically ill patients: A multicenter prospective study. Sci Rep 2017; 7:9057. [PMID: 28831134 PMCID: PMC5567287 DOI: 10.1038/s41598-017-09190-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 07/24/2017] [Indexed: 02/05/2023] Open
Abstract
Disseminated intravascular coagulation (DIC) is a common life-threatening complication in critically ill patients. The diagnostic scoring systems of DIC enable a more prompt and accurate diagnosis of DIC, such as the International Society on Thrombosis and Haemostasis (ISTH), the Japanese Association for Acute Medicine (JAAM) and the Japanese Ministry of Health and Welfare (JMHW). This study prospectively evaluated the newly proposed Chinese DIC Scoring System (CDSS), which was conducted at 18 centers in China during a one-year period. Receiver operating characteristic (ROC) curves showed that, for diagnosis of DIC and for prediction of the 28-day all-cause mortality, the CDSS had larger areas under the ROC curve (AUCs) than the ISTH and the JAAM in different groups. The CDSS also had larger AUC than the JMHW for the ISTH DIC in non-infectious diseases. All of the AUCs of the CDSS were greater than 0.8, accompanied with both high sensitivity and high specificity. Furthermore, the CDSS score was an independent predictor of mortality (odds ratio, 1.882; p < 0.001), and could reflect the illness severity (p < 0.001 for Spearman’s rank correlations with the scores of severity). In conclusion, the CDSS is worthy of promotion with a better diagnostic and prognostic value for DIC.
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Affiliation(s)
- Yingying Wu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Lili Luo
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Ting Niu
- Department of Hematology, West China Hospital, Sichuan University, Sichuan, P.R. China
| | - Yue Han
- Department of Hematology, First Affiliated Hospital of Soochow University, Suzhou, P.R. China
| | - Ying Feng
- Department of Hematology, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, P.R. China
| | - Qiulan Ding
- Department of Laboratory Medicine, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Ruibin Huang
- Department of Hematology, First Affiliated Hospital of Nanchang University, Nanchang, P.R. China
| | - Xiaohui Zhang
- Department of Hematology, Peking University People's Hospital, Beijing, P.R. China
| | - Jianming Feng
- Department of Hematology, Qinghai Provincial People's Hospital, Xining, P.R. China
| | - Ming Hou
- Department of Hematology, Qilu Hospital of Shandong University, Jinan, P.R. China
| | - Jun Peng
- Department of Hematology, Qilu Hospital of Shandong University, Jinan, P.R. China
| | - Yan Li
- Department of Hematology, First Hospital of China Medical University, Shenyang, P.R. China
| | - Yuhong Zhou
- Department of Hematology, First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, P.R. China
| | - Lei Su
- Department of Intensive Care Unit, General Hospital of Guangzhou Military Command, Guangzhou, P.R. China
| | - Linhua Yang
- Department of Hematology, Second Hospital of Shanxi Medical University, Taiyuan, P.R. China
| | - Zeping Zhou
- Department of Hematology, Second Affiliated Hospital of Kunming Medical College, Kunming, P.R. China
| | - Feng Xue
- Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, P.R. China
| | - Jian Gu
- Department of Hematology, Clinical Medical College of Yangzhou University, Yangzhou, P.R. China
| | - Tienan Zhu
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Xiaomin Wang
- Department of Hematology, People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Uygur Autonomous Region, P.R. China
| | - Jun Deng
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Heng Mei
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China.
| | - Yu Hu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China.
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Proposal for new diagnostic criteria for DIC from the Japanese Society on Thrombosis and Hemostasis. Thromb J 2016; 14:42. [PMID: 27708553 PMCID: PMC5039801 DOI: 10.1186/s12959-016-0117-x] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 09/05/2016] [Indexed: 01/15/2023] Open
Abstract
Disseminated intravascular coagulation (DIC) is a serious disease that, in the presence of underlying disease, causes persistent, generalized, marked coagulation activation. Early treatment based on an appropriate diagnosis is very important for improving patients’ prognosis, to which end diagnostic criteria play a key role. Several criteria have been proposed, but each has its strengths and weaknesses, and improved criteria are needed. Widespread use of coagulofibrinolytic markers has elucidated that the pathology of DIC differs greatly as a function of the underlying disease. Thus, discriminating use of DIC diagnostic criteria that take underlying diseases into account is important. DIC diagnostic criteria that are well known in Japan include the Japanese Ministry of Health and Welfare’s old DIC diagnostic criteria (JMHW criteria), the International Society on Thrombosis and Haemostasis’s DIC diagnostic criteria (ISTH criteria), and the Japanese Association for Acute Medicine’s acute-stage DIC diagnostic criteria (JAAM criteria). Those criteria have their respective drawbacks: the sensitivity of the ISTH criteria is poor, the JAAM criteria cannot be applied to all underlying diseases, and the JMHW criteria have poor sensitivity in the case of infections, do not use molecular markers, and result in misdiagnosis. The Japanese Society on Thrombosis and Hemostasis’s newly proposed provisional draft DIC diagnostic criteria (new criteria) use diagnostic criteria classifications of “hematopoietic disorder type”, “infectious type”, and “basic type” based on the underlying pathology. For the hematopoietic disorder type the platelet count is omitted from the score, while for the infectious type, fibrinogen is omitted from the score. Also, points are added if the platelet count decreases with time. In the new criteria, molecular markers and antithrombin activity have been newly included, and as a countermeasure for misdiagnosis, 3 points are deducted if there is liver failure. In this paper, we discuss various problems encountered with DIC diagnosis, and we describe the new criteria together with the events that led to their creation. These new diagnostic criteria take into account the underlying diseases of wide area, and we expect that they will serve clinicians well due to the above adaptations and improvements.
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Can rotational thromboelastometry predict septic disseminated intravascular coagulation? Blood Coagul Fibrinolysis 2016. [PMID: 26196197 DOI: 10.1097/mbc.0000000000000351] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Rotational thromboelastometry (ROTEM), known as point-of-care testing, has been incorporated into various kinds of postsurgical management. However, the utility of ROTEM for rapid diagnosis of sepsis-induced disseminated intravascular coagulation (DIC) has not been investigated. This retrospective study includes 13 sepsis patients who underwent ROTEM in our emergency department in 2013. All patients were divided into two groups on the basis of the presence of DIC diagnosed by the Japanese Association for Acute Medicine (JAAM) DIC score. We evaluated the demographics, clinical characteristics, laboratory data, ROTEM test and outcomes for each patient. The correlations between JAAM DIC score and significantly different parameters by univariate analysis and receiver operating characteristic (ROC) analysis were performed to assess the accuracy of the variables. There were seven and six patients in the DIC group and non-DIC group, respectively. The DIC group showed significantly longer prothrombin times, international normalized ratio of prothrombin time and clotting times (CTs) in the EXTEM test, and higher fibrinogen and fibrin degradation products and D-dimer. The CT in EXTEM test was correlated more with JAAM DIC score (r = 0.798), than the standard coagulation test. These parameters were accurate predictors in the diagnosis of septic DIC, with an AUC of 0.952, and a cut-off value of more than 46.0 s, resulting in a sensitivity of 100.0% and a specificity of 83.3%. CT in the EXTEM test was a single reliable indicator of sepsis-induced DIC diagnosed by the JAAM DIC score, and strongly associated with severity of DIC.
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Fujishima S, Gando S, Daizoh S, Kushimoto S, Ogura H, Mayumi T, Takuma K, Kotani J, Yamashita N, Tsuruta R, Takeyama N, Shiraishi SI, Araki T, Suzuki K, Ikeda H, Miki Y, Suzuki Y, Yamaguchi Y, Aikawa N. Infection site is predictive of outcome in acute lung injury associated with severe sepsis and septic shock. Respirology 2016; 21:898-904. [PMID: 27028604 DOI: 10.1111/resp.12769] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 12/05/2015] [Accepted: 12/18/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Sepsis is a leading cause of acute lung injury (ALI); however, the characteristics and outcome of sepsis-associated ALI are poorly understood. We aimed to elucidate factors that predict patient outcome in sepsis-associated ALI. METHODS Secondary analysis of a multicenter, prospective, observational study was performed. RESULTS Among 624 patients with severe sepsis and septic shock, 251 (40.2%) fulfilled the definition of American-European Consensus Conference definition of ALI. All-cause 28-day and in-hospital mortalities were 30.7% and 38.6%, respectively. More than 40% of ALI patients had neurological, cardiovascular and haematological dysfunctions or disseminated intravascular coagulation, all of which were associated with higher mortality. We report a significant correlation between infection site and mortality in patients with ALI, but not in those without ALI. The proportion of ALI was significantly higher in pulmonary sepsis; further, a complication of ALI was associated with higher mortality in sepsis from pulmonary and other sources, but not in abdominal sepsis. Among the other sepsis sites, urinary tract, central nervous system, catheter-related and undetermined foci of infection had worse outcomes when associated with ALI. None of the individual severe sepsis bundles, including fluid resuscitation and early antibiotic administration, correlated with mortality. Compliance with a set of sepsis management bundles was associated with better outcomes. CONCLUSION In severe sepsis and septic shock, the proportion and effect on outcome was not uniform among infection sites. The infection site was predictive of outcome in patients with ALI but not in those without ALI.
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Affiliation(s)
- Seitaro Fujishima
- Center for General Medicine Education, School of Medicine, Keio University, Minato, Japan
| | - Satoshi Gando
- Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Saitoh Daizoh
- Division of Traumatology, Research Institute, National Defense Medical College, Tokorozawa, Japan
| | - Shigeki Kushimoto
- Division of Emergency Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Toshihiko Mayumi
- Department of Emergency Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kiyotsugu Takuma
- Emergency & Critical Care Center, Kawasaki Municipal Hospital, Kawasaki, Japan
| | - Joji Kotani
- Department of Emergency, Critical Care and Disaster Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Norio Yamashita
- Department of Emergency & Critical Care Medicine, School of Medicine, Kurume University, Kurume, Japan
| | - Ryosuke Tsuruta
- Advanced Medical Emergency & Critical Care Center, Yamaguchi University Hospital, Yamaguchi, Japan
| | - Naoshi Takeyama
- Department of Emergency and Acute Intensive Care Medicine, Fujita Health University, Toyoake, Japan
| | - Shin-Ichiro Shiraishi
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Tsunetoshi Araki
- Department of Emergency & Critical Care Medicine, Trauma Center St. Mary's Hospital
| | - Koichiro Suzuki
- Department of Acute Medicine, Kawasaki Medical School, Kurashiki, Japan
| | - Hiroto Ikeda
- Department of Emergency Medicine, Trauma and Resuscitation Center, Teikyo University School of Medicine, Tokyo, Japan
| | - Yasuo Miki
- Advanced Critical Care Center Aichi Medical University Hospital, Nagakute, Japan
| | - Yasushi Suzuki
- Department of Critical Care Medicine, Iwate Medical University, Morioka, Japan
| | - Yoshihiro Yamaguchi
- Department of Trauma & Critical Care Medicine, School of Medicine, Kyorin University, Tokyo, Japan
| | - Naoki Aikawa
- Department of Emergency & Critical Care Medicine, School of Medicine, Keio University, Tokyo, Japan
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Hifumi T, Fujishima S, Abe T, Kiriu N, Inoue J, Kato H, Koido Y, Kawakita K, Kuroda Y, Sasaki J, Hori S. Prognostic factors of Streptococcus pneumoniae infection in adults. Am J Emerg Med 2015; 34:202-6. [PMID: 26508390 DOI: 10.1016/j.ajem.2015.10.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 10/10/2015] [Accepted: 10/13/2015] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES The mortality of severe sepsis has markedly decreased since the implementation of the Surviving Sepsis Campaign guidelines. The next logical step is to examine the necessity of individualized management guidelines for targeted therapy against specific bacteria. Streptococcus pneumoniae is the leading cause of community-acquired severe sepsis; however, little is known regarding the prognostic factors in adult patients with S pneumoniae sepsis. We aimed to identify prognostic factors in patients with S pneumoniae sepsis and to explore a subgroup of patients at high risk for death with detailed Sequential Organ Failure Assessment (SOFA) score analysis. METHODS We retrospectively reviewed the records of patients with S pneumoniae infection treated between 1st January 2006 and 31st July 2012. We identified prognostic factors for 28-day mortality using univariate and multivariate logistic regression models. RESULTS Of 171 patients (median age, 72 years) with S pneumoniae infection who were included in this study, the 28-day mortality was 17% (29/171). The SOFA score (odds ratio, 2.25; 95% confidence interval, 1.60-3.18; P < .001) and bacteremia (odds ratio, 19.0; 95% confidence interval, 4.06-90.20; P < .001) were identified as prognostic factors for the 28-day mortality. In a subgroup analysis with a cutoff value of the SOFA score determined by receiver operating characteristic analysis, patients with bacteremia and a SOFA score of at least 7 had a significantly higher mortality than did patients without bacteremia and a SOFA score lower than 7 (84% vs 0%, respectively). CONCLUSIONS Bacteremia and a SOFA score at least 7 were independent prognostic factors of poor outcome in S pneumoniae sepsis.
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Affiliation(s)
- Toru Hifumi
- Emergency Medical Center, Kagawa University Hospital, Miki, Kita, Kagawa, Japan.
| | - Seitaro Fujishima
- Center for General Internal Medicine and Education, Keio University Hospital, Shinjuku-ku, Tokyo, Japan
| | - Takayuki Abe
- Center for Clinical Research, Department of Preventive Medicine and Public Health, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Nobuaki Kiriu
- Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, Tachikawa, Tokyo, Japan
| | - Junichi Inoue
- Division of Critical Care Medicine and Trauma, Yamanashi Prefectural Central Hospital, Kofu, Yamanashi, Japan
| | - Hiroshi Kato
- Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, Tachikawa, Tokyo, Japan
| | - Yuichi Koido
- Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, Tachikawa, Tokyo, Japan
| | - Kenya Kawakita
- Emergency Medical Center, Kagawa University Hospital, Miki, Kita, Kagawa, Japan
| | - Yasuhiro Kuroda
- Emergency Medical Center, Kagawa University Hospital, Miki, Kita, Kagawa, Japan
| | - Junichi Sasaki
- Department of Emergency Medicine and Critical Care Medicine, Keio University Hospital, Shinjuku-ku, Tokyo, Japan
| | - Shingo Hori
- Department of Emergency Medicine and Critical Care Medicine, Keio University Hospital, Shinjuku-ku, Tokyo, Japan
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Wang M, Kou H, Deng J, Wang H, Guo T, Mei H, Hu Y. Retrospective Evaluation of New Chinese Diagnostic Scoring System for Disseminated Intravascular Coagulation. PLoS One 2015; 10:e0129170. [PMID: 26076032 PMCID: PMC4467973 DOI: 10.1371/journal.pone.0129170] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 05/05/2015] [Indexed: 11/30/2022] Open
Abstract
Objectives To retrospectively validate the new Chinese DIC scoring system (CDSS). Methods This study retrospectively collected the information of 619 patients (371 cases with non-hematologic malignancies, 248 cases with hematologic malignancies) who suspected of DIC in Wuhan Union Hospital during 2013-4 to 2014-6. We validated CDSS by comparing it with three leading scoring systems, from International Society on Thrombosis and Haemostasis (ISTH), Japanese Association for Acute Medicine (JAAM) and Japanese Ministry of Health and Welfare (JMHW), and evaluated its prognostic value by 28 days mortality, APACHE II and SOFA score. Results In non-hematologic malignancies, CDSS was more specific than JAAM (72.55% vs. 50.49%, p<0.05) and more sensitive than ISTH (77.07% vs. 62.03%, p<0.05). In hematologic malignancies, the area under the ROC curve of CDSS was larger than ISTH and JMHW (0.933 vs. 0.889, p<0.01 with ISTH, 0.944 vs. 0.845, p<0.01 with JMHW). In addition, the 28-day mortality rate, SOFA scores, APACHE II scores of DIC patients diagnosed by CDSS were significantly greater than non-DIC (P <0.05). Conclusions We are the first group to propose CDSS. It emphasized the values of the clinical manifestations, the rapidly declining platelet count, APTT in the diagnosis of DIC and used D-dimer as the fibrin-related maker. DIC with hematological malignancies was treated as a special part. In this study we can see that CDSS displayed an acceptable property for the diagnosis of DIC with appropriate sensitivity and specificity, and also had a good prognostic value for DIC patients.
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Affiliation(s)
- Manzhi Wang
- Institute of Hematology, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Haiming Kou
- Institute of Hematology, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Deng
- Institute of Hematology, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Huafang Wang
- Institute of Hematology, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Tao Guo
- Institute of Hematology, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Heng Mei
- Institute of Hematology, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
- * E-mail: (YH); (HM)
| | - Yu Hu
- Institute of Hematology, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
- * E-mail: (YH); (HM)
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Role of plasma high mobility group box-1 in disseminated intravascular coagulation with leukemia. Thromb Res 2015; 136:422-6. [PMID: 26049171 DOI: 10.1016/j.thromres.2015.05.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 05/15/2015] [Accepted: 05/27/2015] [Indexed: 11/23/2022]
Abstract
INTRODUCTION High mobility group box 1(HMGB1) is a DNA-binding protein which can act as a proinflammatory cytokine when released by necrotic cells, monocytes or macrophages. It also plays a role in the coagulation activation and several tumors including leukemia. The objective of this study was to investigate the role of HMGB1 in the diagnosis of DIC with leukemia. METHODS 89 subjects with leukemia in Wuhan Union Hospital were prospectively recruited. Among them, 83 cases were suspected of DIC, while the other 6 were the negative controls. Their clinical data, laboratory tests and plasma samples were collected or measured respectively. Accordingly, we made scores for these subjects by the Japanese Ministry of Health and Welfare (JMHW) criteria. RESULTS This study demonstrated that the plasma levels of HMGB1 were higher in the DIC group than non-DIC (115.16 ng/ml vs. 63.94 ng/ml, p=0.003). The similar results were achieved in infected or non-infected groups. And along with the increase of DIC scores, the levels of HMGB1 increased gradually (p=0.006). In addition, HMGB1 was an independent factor in the diagnosis of DIC with leukemia(p<0.05). The diagnostic sensitivity of HMGB1 was high (Se=90.32%), and there was a tendency of increased HMGB1 levels in the pre-DIC patients. Three of these six pre-DIC patients were diagnosed as DIC by the new revised scoring system which contained HMGB1. Finally, the HMGB1 levels were significantly higher in patients with organ failures (SOFA≥2) than those without (118.76 vs. 72.75, p=0.032). CONCLUSION The increased plasma levels of HMGB1 were related tightly to the diagnosis and severity of DIC in leukemia patients. Furthermore, the diagnostic sensitivity of HMGB1 was high. So HMGB1 in plasma is a helpful molecular marker, and can be added in the scoring system for the early diagnosis of DIC with leukemia.
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Wu Q, Ren J, Hu D, Jiang P, Li G, Anjum N, Wang G, Gu G, Chen J, Wu X, Liu S, Li Y, Zhao Y, Li J. An elevated percentage of reticulated platelet is associated with increased mortality in septic shock patients. Medicine (Baltimore) 2015; 94:e814. [PMID: 25984667 PMCID: PMC4602582 DOI: 10.1097/md.0000000000000814] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Microcirculatory changes and coagulation disturbances are thought to play a key role in sepsis. Some evidence suggests that the percentage of reticulated platelets (RP%) may be a valuable and cost-effective sepsis screening parameter. This was a prospective study in surgical patients to investigate the potential value of RP% as a predictor of mortality in septic shock patients.This was a prospective study conducted in a surgical critical care center of a Chinese tertiary care hospital. Consecutive septic shock patients were enrolled at admission. Age- and sex-matched non-septic patients were recruited as control patients. RP% was determined by flow cytometry in 68 septic shock patients and 68 controls.Compared with survivors, septic patients who died presented with a significantly higher RP% (P < 0.001). The area under the receiver-operating characteristic curve for the RP% association with mortality was 0.867 (95 % CI 0.780-0.953, P < 0.001). Kaplan-Meier survival curves showed that mortality risk was significantly different when patients were stratified based on RP% (P < 0.001). This association was preserved in a multi-logistic regression analysis that included clinical confounders (P < 0.014).This prospective study demonstrates that increased RP% identifies septic shock patients who have a high risk of death. RP% has the potential to act as a marker for patient stratification in future clinical trials.
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Affiliation(s)
- Qin Wu
- From the Department of General Surgery, Jinling Hospital, Medical School of Nanjing University (QW, JR, DH, GL, NA, GW, GG, JC, XW, SL, YL, YZ, JL); and Department of Hematology, First Affiliated Hospital of Nanjing University of Medicine, Nanjing, China (PJ)
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Ogura H, Gando S, Saitoh D, Takeyama N, Kushimoto S, Fujishima S, Mayumi T, Araki T, Ikeda H, Kotani J, Miki Y, Shiraishi SI, Suzuki K, Suzuki Y, Takuma K, Tsuruta R, Yamaguchi Y, Yamashita N, Aikawa N. Epidemiology of severe sepsis in Japanese intensive care units: a prospective multicenter study. J Infect Chemother 2013; 20:157-62. [PMID: 24530102 DOI: 10.1016/j.jiac.2013.07.006] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 06/07/2013] [Accepted: 07/28/2013] [Indexed: 11/28/2022]
Abstract
Severe sepsis is a leading cause of morbidity and mortality in the intensive care unit (ICU). We conducted a prospective multicenter study to evaluate epidemiology and outcome of severe sepsis in Japanese ICUs. The patients were registered at 15 general critical care centers in Japanese tertiary care hospitals when diagnosed as having severe sepsis. Of 14,417 patients, 624 (4.3%) were diagnosed with severe sepsis. Demographic and clinical characteristics at enrollment (Day 1), physiologic and blood variables on Days 1 and 4, and mortality were evaluated. Mean age was 69.0 years, and initial mean Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores were 23.4 and 8.6, respectively. The 28-day mortality was 23.1%, and overall hospital mortality was 29.5%. SOFA score and disseminated intravascular coagulation (DIC) score were consistently higher in nonsurvivors than survivors on Days 1 and 4. SOFA score, DIC score on Days 1 and 4, and hospital mortality were higher in patients with than without septic shock. SOFA score on Days 1 and 4 and hospital mortality were higher in patients with than without DIC. Logistic regression analyses showed age, presence of septic shock, DIC, and cardiovascular dysfunction at enrollment to be predictors of 28-day mortality and presence of comorbidity to be an additional predictor of hospital mortality. Presence of septic shock or DIC resulted in approximately twice the mortality of patients without each factor, whereas the presence of comorbidity may be a significant predictor of delayed mortality in severe sepsis.
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Affiliation(s)
- Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan.
| | - Satoshi Gando
- Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, Kita 2 jou Nishi 5, Kitaku, Sapporo, Hokkaido 060-8638, Japan
| | - Daizoh Saitoh
- Division of Traumatology, Research Institute, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan
| | - Naoshi Takeyama
- Department of Emergency and Acute Intensive Care Medicine, Fujita Health University, Dengakugakubo 1-98, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan
| | - Shigeki Kushimoto
- Division of Emergency Medicine, Tohoku University Graduate School of Medicine, Seiryoumachi 2-1, Aobaku, Sendai, Miyagi 980-8575, Japan
| | - Seitaro Fujishima
- Department of Emergency & Critical Care Medicine, School of Medicine, Keio University, Shinanomachi 35, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Toshihiko Mayumi
- Emergency Center, Department of Emergency and Critical Care Medicine, Ichinomiya Municipal Hospital, Bunkyo 2-2-22, Ichinomiya, Aichi 491-8558, Japan
| | - Tsunetoshi Araki
- Department of Emergency & Critical Care Medicine, Trauma Center St. Mary's Hospital, Tsubukuhonmachi 422, Kurume, Fukuoka 830-8543, Japan
| | - Hiroto Ikeda
- Department of Emergency Medicine, Trauma and Resuscitation Center, Teikyo University School of Medicine, Kaga 2-11-1, Itabashi-ku, Tokyo 173-8606, Japan
| | - Joji Kotani
- Department of Emergency, Critical Care and Disaster Medicine, Hyogo College of Medicine, Mukogawa 1-1, Nishinomiya, Hyogo 663-8501, Japan
| | - Yasuo Miki
- Advanced Critical Care Center, Aichi Medical University Hospital, Yazakokarimata 1-1, Nagakute, Aichi 480-1195, Japan
| | - Shin-Ichiro Shiraishi
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Sendagi 1-1-5, Bunkyou-ku, Tokyo 113-8603, Japan
| | - Koichiro Suzuki
- Department of Acute Medicine, Kawasaki Medical School, Matsushima 577, Kurashiki, Okayama 701-0114, Japan
| | - Yasushi Suzuki
- Department of Critical Care Medicine, Iwate Medical University, Uchimaru 19-1, Morioka, Iwate 020-8505, Japan
| | - Kiyotsugu Takuma
- Emergency & Critical Care Center, Kawasaki Municipal Hospital, Shinkawadori 12-1, Kawasaki-ku, Kawasaki, Kanagawa 210-0013, Japan
| | - Ryosuke Tsuruta
- Advanced Medical Emergency & Critical Care Center, Yamaguchi University Hospital, Minamikogushi 1-1-1, Ube, Yamaguchi 755-8505, Japan
| | - Yoshihiro Yamaguchi
- Department of Trauma & Critical Care Medicine, Kyorin University, School of Medicine, Shinkawa 6-20-2, Mitaka, Tokyo 181-8611, Japan
| | - Norio Yamashita
- Department of Emergency & Critical Care Medicine, School of Medicine, Kurume University, Asahimachi 67, Kurume, Fukuoka 830-0011, Japan
| | - Naoki Aikawa
- Department of Emergency & Critical Care Medicine, School of Medicine, Keio University, Shinanomachi 35, Shinjuku-ku, Tokyo 160-8582, Japan
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Microparticles are new biomarkers of septic shock-induced disseminated intravascular coagulopathy. Intensive Care Med 2013; 39:1695-703. [PMID: 23793890 DOI: 10.1007/s00134-013-2993-x] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 06/04/2013] [Indexed: 12/20/2022]
Abstract
PURPOSE Septic shock-induced disseminated intravascular coagulopathy (DIC) contributes to multiple organ failure. Mechanisms governing vascular responses to open occurrence of DIC have not yet been established. Circulating plasma microparticles (MPs), released upon cell stress, constitute a catalytic procoagulant surface and are surrogates of vascular cell activation/injury. Herein, MPs were assessed as possible markers of haemostatic and vascular dysfunction in the DIC time course. METHODS One hundred patients with septic shock from three ICUs were enrolled and their haemostatic status evaluated at admission (D1), D2, D3 and D7. Circulating procoagulant MPs were isolated, quantified by prothrombinase assay and their cellular origin determined. DIC diagnosis was made according to the JAAM 2006 score. RESULTS Ninety-two patients were analysed and 40 had DIC during the first 24 h. Routine clotting times and factor/inhibitor activity did not allow assessing vascular cell involvement. At admission, thrombin generation and fibrinolysis were observed in both groups while impaired fibrin polymerisation was evidenced only in DIC patients. Sustained thrombin generation persisted over time in both groups at D7. While total microparticle concentrations were in the same range regardless of DIC diagnosis, specific phenotypes were already detected at admission in DIC patients. Endothelial- and leucocyte-derived MPs were higher in DIC while an increased soluble glycoprotein V/platelet ratio was delayed, underscoring the first involvement of endothelial cells and leucocytes whereas platelet activation was delayed. Endothelium-derived CD105-MPs (OR 6.55) and CD31-MPs (OR 0.49) were strongly associated with early DIC in multivariate analysis. CONCLUSION Endothelial-derived microparticles are relevant biomarkers of septic shock-induced DIC and could be used to evaluate early vascular injury.
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Gando S, Saitoh D, Ogura H, Fujishima S, Mayumi T, Araki T, Ikeda H, Kotani J, Kushimoto S, Miki Y, Shiraishi SI, Suzuki K, Suzuki Y, Takeyama N, Takuma K, Tsuruta R, Yamaguchi Y, Yamashita N, Aikawa N. A multicenter, prospective validation study of the Japanese Association for Acute Medicine disseminated intravascular coagulation scoring system in patients with severe sepsis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2013; 17:R111. [PMID: 23787004 PMCID: PMC4056654 DOI: 10.1186/cc12783] [Citation(s) in RCA: 142] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 06/20/2013] [Indexed: 12/28/2022]
Abstract
Introduction To validate the Japanese Association for Acute Medicine (JAAM) disseminated intravascular coagulation (DIC) scoring system in patients with severe sepsis, we conducted a multicenter, prospective study at 15 critical care centers in tertiary care hospitals. Methods This study included 624 severe sepsis patients. JAAM DIC was scored on the day of diagnosis of severe sepsis (day 1) and day 4. Scores for disease severity and organ dysfunction were also evaluated. Results The prevalence of JAAM DIC was 46.8% (292/624), and 21% of the DIC patients were scored according to the reduction rate of platelets. The JAAM DIC patients were more seriously ill and exhibited more severe systemic inflammation, a higher prevalence of multiple organ dysfunction syndrome (MODS) and worse outcomes than the non-DIC patients. Disease severity, systemic inflammation, MODS and the mortality rate worsened in accordance with an increased JAAM DIC score on day 1. The Kaplan-Meier curves demonstrated lower 1-year survival in the JAAM DIC patients than in those without DIC (log-rank test P <0.001). The JAAM DIC score on day 1 (odds ratio = 1.282, P <0.001) and the Delta JAAM DIC score (odds ratio = 0.770, P <0.001) were independent predictors of 28-day death. Dynamic changes in the JAAM DIC score from days 1 to 4 also affected prognoses. The JAAM DIC scoring system included all patients who met the International Society on Thrombosis and Haemostasis overt DIC criteria on day 1. The International Society on Thrombosis and Haemostasis scoring system missed a large number of nonsurvivors recognized by the JAAM scoring system. Conclusions The JAAM DIC scoring system exhibits good prognostic value in predicting MODS and poor prognosis in patients with severe sepsis and can detect more patients requiring treatment. Conducting repeated daily JAAM scoring increases the ability to predict the patient's prognosis.
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Miyoshi S, Hamada H, Ito R, Katayama H, Irifune K, Suwaki T, Nakanishi N, Kanematsu T, Dote K, Aibiki M, Okura T, Higaki J. Usefulness of a selective neutrophil elastase inhibitor, sivelestat, in acute lung injury patients with sepsis. DRUG DESIGN DEVELOPMENT AND THERAPY 2013; 7:305-16. [PMID: 23596346 PMCID: PMC3627345 DOI: 10.2147/dddt.s42004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Neutrophil elastase plays a crucial role in the development of acute lung injury (ALI) in patients with systemic inflammatory response syndrome (SIRS). The clinical efficacy of the neutrophil elastase inhibitor, sivelestat, for patients with ALI associated with SIRS has not been convincingly demonstrated. The aim of this study was to determine if there are clinical features of patients with this condition that affect the efficacy of sivelestat. METHODS This was a retrospective study of 110 ALI patients with SIRS. Clinical information, including the etiology of ALI, the number of organs failing, scoring systems for assessing the severity of illness, and laboratory data, was collected at the time of diagnosis. Information on the number of ventilator-free days (VFDs) and changes in PaO(2)/F(I)O(2) (ΔP/F) before and 7 days after the time of ALI diagnosis was also collected. The effect of sivelestat on ALI patients was also examined based on whether they had sepsis and whether their initial serum procalcitonin level was ≥0.5 ng/mL. RESULTS There were 70 patients who were treated with sivelestat and 40 control patients. VFDs and ΔP/F were significantly higher in the treated patients than in the control patients. However, there was no significant difference in the patient survival rate between the two groups. Sivelestat was more effective in ALI patients with a PaO(2)/F(I)O(2) ratio ≥ 140 mmHg or sepsis. Sivelestat significantly prolonged survival and led to higher VFDs and increased ΔP/F in septic patients and patients with initial serum procalcitonin levels ≥ 0.5 ng/mL. CONCLUSION The results may facilitate a future randomized controlled trial to determine whether sivelestat is beneficial for ALI patients with sepsis.
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Affiliation(s)
- Seigo Miyoshi
- Department of Integrated Medicine and Informatics, Ehime University, Graduate School of Medicine, Toon
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Gando S. The utility of a diagnostic scoring system for disseminated intravascular coagulation. Crit Care Clin 2012; 28:373-88, vi. [PMID: 22713612 DOI: 10.1016/j.ccc.2012.04.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Disseminated intravascular coagulation (DIC) is an acquired syndrome characterized by microvascular thrombosis resulting from systemic activation of coagulation, and it should be diagnosed and treated as early as possible. No single test is sufficiently accurate to establish or rule out a diagnosis of DIC. Therefore, diagnostic scoring uses a combination of several laboratory tests. Three diagnostic scoring systems are now available and validated. Because it is not easy to assess the superiority or inferiority of these scoring systems, it may be better to select the scoring system depending on the need for an early or affirmative diagnosis of DIC.
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Affiliation(s)
- Satoshi Gando
- Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
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