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Mizuochi M, Yamaguchi J, Chiba N, Kinoshita K. Patients with Severe Trauma Having an Injury Severity Score of 24 and above Develop Nutritional Disorders. Diagnostics (Basel) 2024; 14:1307. [PMID: 38928722 PMCID: PMC11202517 DOI: 10.3390/diagnostics14121307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/08/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024] Open
Abstract
In this single-center, retrospective, observational study, we aimed to assess the severity at which patients with trauma tend to develop metabolic disturbances that worsen their Controlling Nutritional Status (CONUT) scores. Participants were general adult patients with trauma hospitalized for at least one week. Injury Severity Scores (ISSs) at admission and CONUT scores one week later were calculated, and correlation coefficients were examined. The receiver operating characteristic (ROC) curve was used to calculate the ISS cutoff value for a CONUT score of 5 or more on day 7 of hospitalization. The ISS was assessed using multiple logistic regression analysis to determine whether it predicts worse nutritional status. Forty-nine patients were included. ISSs correlated with CONUT scores on day 7 (r = 0.373, p = 0.008). Using the ROC curve, the cutoff value for the ISS was 23.5. Multiple logistic regression analyses showed that a high ISS (odds ratio [OR], 1.158; 95% confidence interval [CI], 1.034-1.296; p = 0.011) and older age (OR, 1.094; 95% CI, 1.027-1.165; p = 0.005) were associated with a CONUT score 5 or more on day 7 of hospitalization. Patients with trauma with an ISS of 24 or higher have worsening CONUT scores during hospitalization; these patients require careful nutritional management.
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Affiliation(s)
| | - Junko Yamaguchi
- Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan; (M.M.); (N.C.); (K.K.)
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Klainbart S, Shipov A, Madhala O, Oron LD, Weingram T, Segev G, Kelmer E. Dog bite wounds in cats: a retrospective study of 72 cases. J Feline Med Surg 2022; 24:107-115. [PMID: 33980052 PMCID: PMC10812173 DOI: 10.1177/1098612x211010735] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Bite wounds are a common cause of trauma in cats; nevertheless, large-scale studies of this trauma in cats are lacking. The aims of the present study were to characterise the clinical and clinicopathological findings in these cats, to assess the association of these variables and therapeutic measures with survival, and to assess the association between the animal trauma triage (ATT) score and severity of injuries score (SS) at presentation with survival. METHODS The medical records of cats presented to a veterinary teaching hospital and two large referral clinics were reviewed retrospectively. RESULTS The study included 72 cats diagnosed with canine bite wounds (with the dog attacks having been witnessed). Seventy-one percent of cats suffered multiple injuries, and there was a significant association between the number of injured body areas and survival, and between severity of injury and survival (P = 0.02 and P = 0.012, respectively). The median ATT scores and SSs for non-survivors were significantly higher compared with survivors (P <0.0001). There was a strong and significant correlation between ATT scores and SSs (r = 0.704, P <0.0001). Total protein and albumin were significantly lower and alanine aminotransferase significantly higher in non-survivors compared with survivors (P ⩽0.032). Fifty percent of cats were treated conservatively, 32% by local surgical debridement and 18% of cats required an exploratory procedure. Cats undergoing more aggressive treatments were significantly less likely to survive (P = 0.029). Fifty-seven cats (79%) survived to discharge. CONCLUSIONS AND RELEVANCE Cats sustaining canine bite wounds have a good overall prognosis for survival to discharge. High ATT score, high SS, multiple body area injuries, penetrating injuries, radiographic evidence of vertebral body fractures and body wall abnormalities, as well as hypoproteinaemia and elevated alanine aminotransferase, are negative predictors of survival.
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Affiliation(s)
- Sigal Klainbart
- Department of Small Animal Emergency and Critical Care, The Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Anna Shipov
- Small Animal Surgery, The Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Ori Madhala
- Department of Small Animal Emergency and Critical Care, The Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Liron D Oron
- Knowledge Farm Specialty Referral Center, Beit Berl, Israel
| | - Tomer Weingram
- Herzliya Veterinary Hospital, Ben Gurion 26 Herzliya, Israel
| | - Gilad Segev
- Small Animal Internal Medicine, The Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Efrat Kelmer
- Department of Small Animal Emergency and Critical Care, The Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
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Alay H, Laloglu E, Kesmez Can F. An evaluation of ischaemia-modified albumin levels in the development of diabetic foot ulcer. Int J Clin Pract 2021; 75:e14589. [PMID: 34227201 DOI: 10.1111/ijcp.14589] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 07/01/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION This study investigated the status of serum ischaemia-modified albumin (IMA) levels in the development of diabetic foot ulcer (DFU) in patients with diabetes mellitus (DM) and in predicting ulcer formation and ulcer grading. MATERIALS AND METHOD Thirty patients with DM, 30 with DFU and 30 healthy controls were included in the study. All participants' demographic characteristics and serum IMA, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and white blood cell (WBC) levels and DFU infection grades were recorded. RESULTS Nine (30%) patients with DFU were grade 2 according to the grading of International Working Group of the Diabetic Foot, 14 (46.7%) were grade 3 and seven (23.3%) were grade 4. Significant, powerful and positive correlation was determined between serum IMA and albumin-adjusted IMA levels and degrees of DFU (r = 0.878 and r = 0.846, P < .001 for both). Serum IMA levels in the DFU group were significantly higher than in the DM and control groups (P < .001). The optimal cut-off values for IMA in predicting DFU was 23.5 ng/mL (sensitivity 96%, specificity 87% and AUC = 0.97, P < .001). Additionally, at a cut-off value of 20.6 ng/mL, serum albumin-adjusted IMA differentiated cases of DFU from healthy individuals with 90% sensitivity and 83% specificity (AUC = 0.95, P < .001) Serum IMA levels exhibited significant, positive correlation with CRP, ESR, WBC, fasting plasma glucose and HbA1c (r = 0.575, r = 0.592, r = 0.597, r = 0.68 and r = 0.74, respectively, P < .001). Serum albumin levels were significantly negatively correlated with IMA, CRP, ESR and WBC values (r = -0.49, r = -0.56, r = -0.62 and r = -0.53, respectively, P < .001). CONCLUSION Our study findings indicate that together with CRP, ESH, WBC and albumin, increased IMA levels in patients with DM can be useful in the early prevention of DFU development and in predicting the severity of DFU infection.
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Affiliation(s)
- Handan Alay
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Esra Laloglu
- Department of Medical Biochemistry, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Fatma Kesmez Can
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
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Klainbart S, Bibring U, Strich D, Chai O, Bdolah-Abram T, Aroch I, Kelmer E. Retrospective evaluation of 140 dogs involved in road traffic accidents. Vet Rec 2017; 182:196. [PMID: 29259067 DOI: 10.1136/vr.104293] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 10/19/2017] [Accepted: 11/11/2017] [Indexed: 11/03/2022]
Abstract
This study has retrospectively reviewed the medical records of 140 dogs sustaining road traffic accident (RTA), and has examined the population characteristics, medical history, injury type, physical examination, emergency laboratory tests and radiography findings, the animal trauma triage (ATT) score, the length of hospitalisation, the complications and the outcome. The survival rate was 83.2 per cent. Younger dogs sustained more frequently lung contusions and limb fractures, while larger dogs more frequently suffered limb fractures, and smaller dogs and older ones sustained more frequently pelvic fractures and sacroiliac luxation (P<0.05 for all). Dogs sustaining orthopaedic injuries required longer hospitalisation (P<0.001). The survival rates of non-ambulatory dogs (P<0.001) and those with neurological abnormalities (P<0.001), abnormal body temperature (P=0.001), hyperglycaemia (P=0.026) or hypoproteinaemia (P=0.04) at presentation were lower compared with those in which these were absent. The number of injured body systems was significantly (P<0.001) and positively associated with death. Dogs surviving RTA to presentation to the hospital have a good prognosis for survival to discharge. Older age, and high ATT score, abnormal body temperature, neurological deficits, hyperglycaemia and hypoproteinaemia at presentation, and occurrence of multiorgan trauma are negative prognostic indicators in such dogs.
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Affiliation(s)
- Sigal Klainbart
- Department of Small Animal Emergency and Critical Care, The Hebrew University Veterinary Teaching Hospital and Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Uri Bibring
- Department of Radiology, The Hebrew University Veterinary Teaching Hospital and Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Dalia Strich
- Department of Small Animal Emergency and Critical Care, The Hebrew University Veterinary Teaching Hospital and Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Orit Chai
- Department of Neurology, The Hebrew University Veterinary Teaching Hospital and Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Tali Bdolah-Abram
- The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Koret School of Veterinary Medicine, Rehovot, Israel
| | - Itamar Aroch
- Small Animal Internal Medicine, The Hebrew University Veterinary Teaching Hospital and Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Efrat Kelmer
- Department of Small Animal Emergency and Critical Care, The Hebrew University Veterinary Teaching Hospital and Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
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Kim SC, Kim DH, Kim TY, Kang C, Lee SH, Jeong JH, Park YJ, Lee SB, Lim D. The Revised Trauma Score plus serum albumin level improves the prediction of mortality in trauma patients. Am J Emerg Med 2017. [PMID: 28637583 DOI: 10.1016/j.ajem.2017.06.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The Revised Trauma Score (RTS) is used worldwide in prehospital practice and in the emergency department (ED) settings to triage trauma patients. The main purpose of this study was to evaluate the value of the RTS plus serum albumin (RTS-A) and to compare it with other existing trauma scores as well as to compare the predictive performance of the Trauma and Injury Severity Score with the RTS-A (TRISS-A) with the original TRISS. METHODS This was a single center, trauma registry based observational cohort study. Data were collected from consecutive patients with blunt or penetrating injuries who presented to the emergency department of a tertiary referral hospital, between January 2012 and June 2016. 3145 and 2447 patients were assigned to the derivation group and validation group, respectively. Main outcome was in-hospital mortality. RESULTS Among patients in the derivation group, the median [interquartile range] age was 59 [43-73] years, and 66.7% were male. The area under the receiver operating characteristic curves (AUC) of the RTS-A (0.948; 95% CI: 0.939-0.955) was higher than that of the RTS (0.919; 95% CI: 0.909-0.929). In patients with blunt trauma, the AUC of the TRISS-A (0.960; 95% CI: 0.952-0.967) was significantly higher than that of the original TRISS (0.949; 95% CI: 0.941-0.957). CONCLUSION The value of the RTS-A predicts the in-hospital mortality of trauma patients better than the RTS, and the TRISS-A is a better mortality predictor compared to the original TRISS in patients with blunt trauma.
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Affiliation(s)
- Seong Chun Kim
- Department of Emergency Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Dong Hoon Kim
- Department of Emergency Medicine, Gyeongsang National University School of Medicine, 15, Jinju-daero 816beon-gil, Jinju-si, Republic of Korea; Gyeongsang Institute of Health Sciences, Gyeongsang National University School of Medicine, 15, Jinju-daero 816beon-gil, Jinju-si, Gyeongsangnam-do, Republic of Korea.
| | - Tae Yun Kim
- Department of Emergency Medicine, Gyeongsang National University School of Medicine, 15, Jinju-daero 816beon-gil, Jinju-si, Republic of Korea
| | - Changwoo Kang
- Department of Emergency Medicine, Gyeongsang National University School of Medicine, 15, Jinju-daero 816beon-gil, Jinju-si, Republic of Korea
| | - Soo Hoon Lee
- Department of Emergency Medicine, Gyeongsang National University School of Medicine, 15, Jinju-daero 816beon-gil, Jinju-si, Republic of Korea
| | - Jin Hee Jeong
- Department of Emergency Medicine, Gyeongsang National University School of Medicine, 15, Jinju-daero 816beon-gil, Jinju-si, Republic of Korea; Gyeongsang Institute of Health Sciences, Gyeongsang National University School of Medicine, 15, Jinju-daero 816beon-gil, Jinju-si, Gyeongsangnam-do, Republic of Korea
| | - Yong Joo Park
- Department of Emergency Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Sang Bong Lee
- Department of Emergency Medicine, Gyeongsang National University School of Medicine, 15, Jinju-daero 816beon-gil, Jinju-si, Republic of Korea
| | - Daesung Lim
- Department of Emergency Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
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Lee SH, Jang JY, Lee JG. Clinical Significance of Postoperative Prealbumin and Albumin Levels in Critically Ill Patients who Underwent Emergency Surgery for Acute Peritonitis. Korean J Crit Care Med 2013. [DOI: 10.4266/kjccm.2013.28.4.247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Seung Hwan Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Young Jang
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Gil Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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Serum albumin and survival in glioblastoma multiforme. J Neurooncol 2011; 105:77-81. [PMID: 21409514 DOI: 10.1007/s11060-011-0562-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Accepted: 02/26/2011] [Indexed: 12/11/2022]
Abstract
Serum albumin is an established predictor of survival in numerous cancers but its prognostic value in central nervous system tumours has not been established. Here we have examined prognostic factors in 685 patients with histologically proven glioblastoma multiforme (GBM), the majority of which (n = 549) had pre-operative serum albumin assayed. Mean serum albumin was 34.7 g/l (SD 5.2). Post-operative survival was significantly less for patients with hypoalbuminaemia (<30 g/l, n = 82) than for patients with normal albumin level (median 2.3 vs. 5.6 months, P < 0.001 Log-rank test). Furthermore, patients with lower normal albumin (30-40 g/l, n = 371) had significantly shorter survival compared against patients with albumin in the upper normal range (40-50 g/l, n = 96; median 5.1 vs. 8.8 months, P < 0.001). Multivariate Cox regression showed the independent predictors of survival were age, debulking surgery, chemoradiotherapy, and serum albumin (Hazard Ratio 0.97 per g/l, P < 0.005). This study suggests pre-operative serum albumin level is a significant predictor of survival in patients with GBM. Further studies are needed to examine the relationship between albumin and other known prognostic factors, and to determine if pre-operative serum albumin is a clinically useful predictor of survival.
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Association between ischemia modified albumin, inflammation and hyperglycemia in type 2 diabetes mellitus. Clin Biochem 2010; 43:450-4. [DOI: 10.1016/j.clinbiochem.2009.11.018] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Revised: 10/28/2009] [Accepted: 11/23/2009] [Indexed: 12/18/2022]
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Takata Y, Ansai T, Soh I, Awano S, Sonoki K, Akifusa S, Kagiyama S, Hamasaki T, Torisu T, Yoshida A, Nakamichi I, Takehara T. Serum albumin levels as an independent predictor of 4-year mortality in a community-dwelling 80-year-old population. Aging Clin Exp Res 2010; 22:31-5. [PMID: 20305365 DOI: 10.1007/bf03324812] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Although serum albumin levels are associated with mortality in non-institutionalized elderly people under 80 years old, as well as in the institutionalized very elderly, little is known about the relationship in community-dwelling very elderly people. We, therefore, examined the association in a Japanese population of 80-year-old community residents. METHODS Serum albumin levels were measured in 672 (267 men, 405 women) out of 1282 80-year-old individuals. Over the following 4 years, the dates and causes of death were recorded from resident registration cards and official death certificates. RESULTS Of the above individuals, 107 subjects died (58 men, 49 women: 27 due to cancer, 27 cardiovascular disease, and 22 pneumonia). Survival rates were compared among 4 groups (highest >or=45 g/L, higher than 43-44 g/L, lower than 41-42 g/L, lowest <or=40 g/L). After adjustment for confounding factors, total death or cardiovascular death in the lowest albumin group was 3.1 times and 10.7 times more incident than in the highest albumin group, but there were no differences among groups as regards deaths due to cancer or pneumonia. CONCLUSION Serum albumin levels are an independent predictor of mortality due to all-cause or cardiovascular disease, but not of mortality due to cancer or pneumonia in very elderly Japanese community residents.
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Affiliation(s)
- Yutaka Takata
- Division of General Internal Medicine, Kyushu Dental College, Kitakyushu, 803-8580, Japan.
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Badia-Tahull M, Llop-Talaveron J, Fort-Casamartina E, Farran-Teixidor L, Ramon-Torrel J, Jódar-Masanés R. Preoperative albumin as a predictor of outcome in gastrointestinal surgery. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.eclnm.2009.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Grimm G, Haslacher H, Kampitsch T, Endler G, Marsik C, Schickbauer T, Wagner O, Jilma B. Sex differences in the association between albumin and all-cause and vascular mortality. Eur J Clin Invest 2009; 39:860-5. [PMID: 19645741 DOI: 10.1111/j.1365-2362.2009.02189.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Low serum albumin levels are associated with cardiovascular disease and mortality risk. This study evaluated the predictive value of low serum albumin for all-cause-mortality in a large Viennese patient cohort and investigated sex differences in the association between serum albumin and mortality. MATERIALS AND METHODS Serum albumin concentrations of 285 930 patients, who attended the General Hospital Vienna between 1992 and 2002, were evaluated and linked with the Austrian Death Registry. The median observation period was 7.4 +/- 4.0 years and the death rate was 16.8%. For Cox regression analysis, albumin levels were divided into deciles, the highest category served as reference value. To analyse associations between albumin and mortality independent of liver function, results were adjusted for cholinesterase, which indicates protein synthesis capacity of the liver. RESULTS Hazard ratios for all-cause-mortality increased linearly with decreasing albumin levels from 1.05 in the 9th to 2.98 in the 1st decile. Adjusted for cholinesterase, the relative risk for mortality was still 1.91 in the lowest category. Compared with women, men had an average 50% increased risk of death in almost every decile, adjusting for cholinesterase reduced the sex difference to a 10-20% higher mortality risk for men. In critically ill patients, hazard ratios for all-cause-mortality ranged from 4.5 in the 9th decile to 9.5 in the lowest albumin category. CONCLUSION This study demonstrates a strong inverse association between serum albumin and mortality in a large patient cohort. The predictive value of low albumin was remarkably higher in men than in women.
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Affiliation(s)
- G Grimm
- Medical University of Vienna, 1090 Vienna, Austria
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Clark IA, Budd AC, Alleva LM. Sickness behaviour pushed too far--the basis of the syndrome seen in severe protozoal, bacterial and viral diseases and post-trauma. Malar J 2008; 7:208. [PMID: 18854046 PMCID: PMC2576339 DOI: 10.1186/1475-2875-7-208] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Accepted: 10/14/2008] [Indexed: 12/03/2022] Open
Abstract
Certain distinctive components of the severe systemic inflammatory syndrome are now well-recognized to be common to malaria, sepsis, viral infections, and post-trauma illness. While their connection with cytokines has been appreciated for some time, the constellation of changes that comprise the syndrome has simply been accepted as an empirical observation, with no theory to explain why they should coexist. New data on the effects of the main pro-inflammatory cytokines on the genetic control of sickness behaviour can be extended to provide a rationale for why this syndrome contains many of its accustomed components, such as reversible encephalopathy, gene silencing, dyserythropoiesis, seizures, coagulopathy, hypoalbuminaemia and hypertriglyceridaemia. It is thus proposed that the pattern of pathology that comprises much of the systemic inflammatory syndrome occurs when one of the usually advantageous roles of pro-inflammatory cytokines – generating sickness behaviour by moderately repressing genes (Dbp, Tef, Hlf, Per1, Per2 and Per3, and the nuclear receptor Rev-erbα) that control circadian rhythm – becomes excessive. Although reversible encephalopathy and gene silencing are severe events with potentially fatal consequences, they can be viewed as having survival advantages through lowering energy demand. In contrast, dyserythropoiesis, seizures, coagulopathy, hypoalbuminaemia and hypertriglyceridaemia may best be viewed as unfortunate consequences of extreme repression of these same genetic controls when the pro-inflammatory cytokines that cause sickness behaviour are produced excessively. As well as casting a new light on the previously unrationalized coexistence of these aspects of systemic inflammatory diseases, this concept is consistent with the case for a primary role for inflammatory cytokines in their pathogenesis across this range of diseases.
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Affiliation(s)
- Ian A Clark
- School of Biochemistry and Molecular Biology, Australian National University, Canberra, Australia.
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The cobalt–albumin binding assay: Insights into its mode of action. Clin Chim Acta 2008; 387:120-7. [DOI: 10.1016/j.cca.2007.09.018] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2007] [Revised: 09/02/2007] [Accepted: 09/24/2007] [Indexed: 02/01/2023]
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Chalidis B, Kanakaris N, Giannoudis PV. Safety and efficacy of albumin administration in trauma. Expert Opin Drug Saf 2007; 6:407-15. [PMID: 17688384 DOI: 10.1517/14740338.6.4.407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Albumin is one of the oldest known and studied human proteins. It is characterised by diverse physiological and biochemical properties that render it relevant to many aspects of the disordered vascular and cellular functions after trauma. Apart from the ability to maintain the colloid oncotic pressure, human serum albumin has multiple effects, including antioxidant activity and binding affinity for drugs and toxic substances, inhibition of apoptosis and modulation of trauma-induced inflammatory response. According to the current state of knowledge, there are conflicting results regarding the benefits of albumin administration in critically ill patients. Further investigations are warranted to resolve the continued uncertainty about the safety and efficacy of human serum albumin in specific clinical circumstances and selected populations of severely injured patients.
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Affiliation(s)
- Byron Chalidis
- University of Leeds, School of Medicine, Academic Department of Trauma & Orthopaedics, LGI University Hospital, Clarendon Wing, Great George Sreet, Leeds, UK
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Can M, Demirtas S, Polat O, Yildiz A. Evaluation of effects of ischaemia on the albumin cobalt binding (ACB) assay in patients exposed to trauma. Emerg Med J 2006; 23:537-9. [PMID: 16794097 PMCID: PMC2579548 DOI: 10.1136/emj.2005.030486] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND In the emergency department (ED), the diagnosis of acute myocardial ischaemia is very difficult because of the absence of a rapid, reliable diagnostic test. The albumin cobalt binding (ACB) assay is a good candidate as a marker for for detection of myocardial ischaemia, as it is an easy and rapid test. To date, however, the way in which alterations in metal binding sites of human serum albumin depend on ischaemic events has not been reported in detail. METHODS We studied 92 patients admitted to the ED within 1 hour after exposure to trauma. Trauma patients divided into two groups according to their Injury Severity Score (ISS): group 1 comprised mildly injured patients who had ISS trauma score <15 (n = 60), and group 2 comprised moderately injured patients with ISS trauma score >15 (n = 32). The blood specimens of 30 healthy volunteers were studied as a control group. RESULTS Group 2 showed significantly increased ACB levels (0.63 (0.18) absorbance units (ABSU)) compared with group 1 (0.54 (0.14) ABSU) (p<0.05) and controls (0.39 (0.05) ABSU) (p<0.01). Group 1 showed significantly enhanced ACB values compared with controls (0.54 (0.14) v 0.39 (0.05) ABSU) (p<0.01). CONCLUSION Consequently, trauma enhances ACB levels, which may affect the diagnostic performance of the ACB assay, and this effect can limit the ability of the assay for detection of myocardial ischaemia in patients exposed to trauma.
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Affiliation(s)
- M Can
- Department of Biochemistry, Karaelmas University of Medicine, Zonguldak, Turkey.
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Iwata M, Kuzuya M, Kitagawa Y, Iguchi A. Prognostic value of serum albumin combined with serum C-reactive protein levels in older hospitalized patients: continuing importance of serum albumin. Aging Clin Exp Res 2006; 18:307-11. [PMID: 17063065 DOI: 10.1007/bf03324664] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIMS Although both serum albumin and C-reactive protein (CRP) levels are separately recognized as predictors of adverse outcomes in many illnesses, the predictive value of their combination for adverse outcomes has not been evaluated. We therefore sought to examine the prognostic value of serum albumin for in-hospital mortality in the presence or absence of severe inflammation, as indicated by high CRP levels. METHODS In this cohort study, we measured serum albumin and CRP levels in 1638 older patients (aged 65 years or older) hospitalized for medical problems, and examined their utility, both separately and in combination, for predicting in-hospital mortality. RESULTS In separate analyses of CRP and albumin, both high CRP levels (> or =5 mg/dl) and hypoalbuminemia (<3.5 g/dl) were associated with risk of in-hospital death. After dividing participants into four groups based on CRP and albumin levels (<5 mg/dl CRP and <3.5 mg/dl albumin), subjects with severe inflammation (CRP > or =5 mg/dl) and hypoalbuminemia were associated with an adjusted relative risk (ARR) of 3.8 for in-hospital mortality when compared with the reference (high albumin and low CRP). Even in the absence of severe inflammation, the presence of severe hypoalbuminemia was associated with an ARR of 2.6 for in-hospital mortality, when compared with patients without hypoalbuminemia. CONCLUSIONS Both serum CRP and albumin levels are predictors of in-hospital mortality. However, high serum albumin levels may have a protective effect in older patients, regardless of degree of inflammation. Serum albumin levels remain a useful predictor for in-hospital mortality in older hospitalized patients.
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Affiliation(s)
- Mitsunaga Iwata
- Department of Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Aichi 466-8550, Japan.
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ten Boekel E, Vroonhof K, Huisman A, van Kampen C, de Kieviet W. Clinical laboratory findings associated with in-hospital mortality. Clin Chim Acta 2006; 372:1-13. [PMID: 16697361 DOI: 10.1016/j.cca.2006.03.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2006] [Revised: 03/17/2006] [Accepted: 03/21/2006] [Indexed: 01/08/2023]
Abstract
The diagnostic approach and the clinical management of critically ill patients is challenging. The recognition of biomarkers related to in-hospital mortality is of importance for identification of patients at increased risk of death. Many prediction models assessing the severity of illness and likelihood of hospital survival were developed using logistic regression analyses. These models include several laboratory parameters, such as white blood cell counts, serum bilirubin, serum albumin, blood glucose, serum electrolytes and markers which reflect acid-base disturbances. Recently, several other biomarkers, including troponin, B-type natriuretic peptide (BNP), N-terminal proBNP, C-reactive protein, procalcitonin, cholesterol and coagulation related markers have emerged as clinically useful tools for risk stratification and mortality prediction of heterogeneous and more specific subgroups of critically ill patients. More investigations are required to verify whether risk stratification based on mortality-related biomarkers may translate into targeted treatment strategies to improve clinical outcome of the critical illness. Biomarkers which are related to in-hospital mortality are highlighted in the current review.
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Affiliation(s)
- Edwin ten Boekel
- Clinical Laboratory, Sint Lucas Andreas Hospital, P.O. Box 9243, 1006 AE Amsterdam, The Netherlands.
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Adams BD, Bonzani TA, Hunter CJ. The anion gap does not accurately screen for lactic acidosis in emergency department patients. Emerg Med J 2006; 23:179-82. [PMID: 16498152 PMCID: PMC2464445 DOI: 10.1136/emj.2005.026096] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Lactic acidosis portends a poor prognosis in trauma, sepsis, and other shock states and is useful for triaging and resuscitating emergency department (ED) patients. The authors sought to determine whether the AG is a reliable screen for lactic acidosis when applied specifically in the ED setting. METHODS The authors performed a retrospective cohort study over a seven month period. Subjects were all ED patients that had a serum lactate obtained. Sensitivity analyses of the AG for detecting presence of lactic acidosis were calculated for the traditional AG normal value (AG <12) and for the lower AG normal value when using newer ion selective electrode assays (AG <6). RESULTS Serum lactate levels were ordered in the ED on 440 occasions. 137 samples were excluded by protocol. Using an AG cutoff of 12, the sensitivity for detecting lactic acidosis was 58.2%, specificity was 81.0%, and the negative predictive value was 89.7%. Using the AG cutoff of 6, the sensitivity was 93.2%, the specificity was 17.3%, and the negative predictive value was 91.8%. CONCLUSIONS The traditional definition of AG >12 was insensitive for the presence of lactic acidosis. Using the revised AG of >6 is more sensitive but non-specific for lactic acidosis. The authors conclude that employing the AG as a screen for LA may be inappropriate in ED patients. Instead, they recommend ordering a serum lactate immediately upon suspicion of a shock state. A prospective study to confirm these findings is needed.
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Affiliation(s)
- B D Adams
- US Army, Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, Brooke Army Medical Center, San Antonio, TX 78234, USA
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Bar-Or D, Rael LT, Bar-Or R, Slone DS, Craun ML. The formation and rapid clearance of a truncated albumin species in a critically ill patient. Clin Chim Acta 2006; 365:346-9. [PMID: 16176812 DOI: 10.1016/j.cca.2005.08.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2005] [Revised: 08/10/2005] [Accepted: 08/11/2005] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Hypoalbuminemia is known to occur in critically ill patients and is associated with increased mortality. We observed a potentially novel, partial explanation for the hypoalbuminemia noticed in a severely traumatized patient. CASE REPORT We report of a severely, multi-system traumatized patient in whom hypoalbuminemia was present (1-2 g/dl). The plasma albumin (HSA) was analyzed by liquid chromatography/positive electrospray ionization mass spectrometry. A high percentage of a truncated albumin that lost its carboxy terminal amino acid leucine (HSA-L) associated with a 10-fold increase in plasma carboxypeptidase A (CPA) activity (R(2)=0.994) were found. We estimated the half life of this truncated albumin species to be <80 h. CONCLUSIONS The increased CPA activity encountered following a traumatic event and subsequent rapid clearance of the resulting HSA-L from plasma might be a contributing factor to the hypoalbuminemia observed in the critically ill patients.
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Affiliation(s)
- David Bar-Or
- Swedish Medical Center, Trauma Research Laboratory, 501 E. Hampden Ave., Englewood, CO 80113, USA.
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Freire AX, Bridges L, Umpierrez GE, Kuhl D, Kitabchi AE. Admission Hyperglycemia and Other Risk Factors as Predictors of Hospital Mortality in a Medical ICU Population. Chest 2005; 128:3109-16. [PMID: 16304250 DOI: 10.1378/chest.128.5.3109] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Tight glycemic control is recommended for patients in the ICU, as hyperglycemia is associated with increased morbidity and mortality. DESIGN Observational cohort of patients admitted to a 12-bed, inner-city, medical ICU (MICU). SUBJECTS A total of 1,185 of 1,506 patients from July 1, 1999, to December 31, 2002, selected based on a diagnosis other than diabetic ketoacidosis or glycemia > 280 mg/dL or < 80 mg/dL. PURPOSES To determine if the highest serum glucose level within 24 h after ICU admission is associated with increased hospital mortality when adjusted for confounders. MEASUREMENTS Age, gender, race, worst values within 24 h after ICU admission to construct the acute physiology and chronic health evaluation (APACHE) II score, and highest glucose within 24 h after ICU admission. Hospital mortality was the primary outcome. Admitting diagnosis, MICU length of stay (LOS), and hospital LOS were obtained. Glucose, albumin (n = 867), and lactic acid (n = 319) were stratified for analysis. ANALYSIS Univariate analysis identified factors included in the multivariate model. RESULTS Patients were predominantly African-American (79%) and men (56%; mean age, 49.2 years). The mean ICU admission highest glucose level was 139 +/- 43.7 mg/dL (+/- SD). MICU LOS and hospital LOS were 6.2 days and 12.9 days, respectively, and 50% of patients received mechanical ventilation. MICU and hospital mortality were 18% and 20%, respectively; standardized mortality ratio was 66%. On univariate analysis, survivors (n = 945) and nonsurvivors (n = 240) showed APACHE II score, mechanical ventilation, hypoalbuminemia, lactic acidemia, and logistic organ dysfunction system score to be hospital mortality predictors; however, the highest admission serum glucose level was not. Logistic regression estimated APACHE II score/per point (odds ratio, 1.06; 95% confidence interval, 1.02 to 1.11), mechanical ventilation (odds ratio, 3.06; 95% confidence interval, 1.34 to 6.96), severe hypoalbuminemia (< 2 g/dL) [odds ratio, 2.98; 95% confidence interval, 1.3 to 7.02], and severe lactic acidemia (> or = 8 mmol/L) [odds ratio, 7.3; 95% confidence interval, 2.14 to 24.9], but not ICU admission hyperglycemia, to be associated with hospital mortality. CONCLUSIONS Conventional factors of disease severity, but not highest glucose value during the first 24 h after ICU admission, predict hospital mortality in an inner-city MICU.
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Affiliation(s)
- Amado X Freire
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Medicine, University of Tennessee Health Science Center, Memphis, 38163, USA.
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21
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Jeschke MG, Rensing H, Klein D, Schubert T, Mautes AEM, Bolder U, Croner RS. Insulin prevents liver damage and preserves liver function in lipopolysaccharide-induced endotoxemic rats. J Hepatol 2005; 42:870-9. [PMID: 15885358 DOI: 10.1016/j.jhep.2004.12.036] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2004] [Revised: 12/15/2004] [Accepted: 12/29/2004] [Indexed: 01/04/2023]
Abstract
BACKGROUND/AIMS Liver integrity and function are crucial for survival of patients suffering from trauma, operations or infections. Insulin decreased mortality and prevented the incidence of multi organ failure and infection in critically ill patients. The aim of the present study was to determine whether insulin exerts positive effects on hepatic homeostasis and function during endotoxemia. METHODS Endotoxemic rats received either saline or insulin. Hepatic morphology and function was determined by measuring the effect of insulin on liver proteins, enzymes, hepatocyte apoptosis and proliferation including caspases-3 and -9 and Bcl-2. Intrahepatic ATP, glucose and lactate concentration were determined by bioluminescence. To determine possible molecular changes the effect of insulin on hepatic cytokine mRNA and gene profile analysis were assessed. RESULTS Insulin significantly improved hepatic protein synthesis by increasing albumin and decreasing c-reactive protein, P<0.05. Insulin attenuated hepatic damage by decreasing AST and ALT, P<0.05. Improved liver morphology was due to decreased hepatocyte apoptosis along with decreased caspase-3 concentration and increased hepatocyte proliferation along with Bcl-2 concentration, P<0.05. Insulin decreased hepatic IL-1beta, IL-6 and MIF mRNA and improved hepatic glucose metabolism and glycolysis, P<0.05. GeneChip analysis revealed an anti-inflammatory effect of insulin. CONCLUSIONS Insulin improves hepatic integrity, hepatic glucose metabolism and hepatic function by increasing cell survival and attenuating the hepatic inflammatory response in endotoxemic rats.
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Affiliation(s)
- Marc G Jeschke
- Shriners Hospital for Children and Department of Surgery, The University Texas Medical Branch, Galveston Burns Unit, 815 Market Street, Galveston, TX 77550, USA.
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Vroonhof K, van Solinge WW, Rovers MM, Huisman A. Differences in mortality on the basis of laboratory parameters in an unselected population at the Emergency Department. Clin Chem Lab Med 2005; 43:536-41. [PMID: 15899676 DOI: 10.1515/cclm.2005.093] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AbstractThe objective of this study was to relate multiple laboratory results of initial blood gas analysis in patients visiting the emergency department to mortality. A total of 1806 adult patients visiting the emergency department for any reason, who underwent blood gas analysis, were included in this study. The results of nine laboratory parameters (ionised calcium, potassium, sodium, glucose, lactate, pH, pCO
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Affiliation(s)
- Karen Vroonhof
- Department of Clinical Chemistry and Laboratory Medicine, University Medical Center Utrecht, The Netherlands
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Sung J, Bochicchio GV, Joshi M, Bochicchio K, Costas A, Tracy K, Scalea TM. Admission Serum Albumin is Predicitve of Outcome in Critically Ill Trauma Patients. Am Surg 2004. [DOI: 10.1177/000313480407001214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
There is a paucity of data evaluating serum albumin on admission as a predictor of outcome in adult trauma patients. Our objectives were to evaluate whether or not hypoalbuminemia on admission is a predictor of adverse outcome in trauma patients. Prospective data was collected daily on 1023 patients over a 2-year period. Patients were stratified by serum albumin level on admission, age, gender, injury severity, and comorbid conditions. Outcome was measured by ICU and hospital length of stay, ventilator days, incidence of infection, and mortality. Student t test, χ2, and multilinear regression analysis were used to determine level of significance. Blunt injuries accounted for the majority (78%) of the admissions. The mean age of the study population was 43 ± 21 years with a mean Injury Severity Score (ISS) of 21.4 ± 12. The majority of patients were male (74.5%). The mean albumin level on admission was 2.9 ± 1.8. Five hundred ninety-three (58%) patients were admitted with a serum albumin level of ≥2.6 as compared to 430 patients (42%) with an admission albumin level of <2.6. Patients with a lower serum albumin level were found to have a significantly greater ICU (17.1 vs 14.2 days) and hospital length of stay (17.3 vs 20.1 days, P < 0.05), ventilator days (11.1 vs 13.5 days, P < 0.05), and mortality ( P = 0.008) when matched for age and injury severity. The relative risk of infection and mortality increased greater than 2.5-fold in patients with increased age and low serum albumin when analyzed by multilinear regression analysis, P < 0.001. An admission serum albumin level of <2.6 g/dL is a significant independent predictor of morbidity and mortality in trauma patients. The combination of increased age and low albumin level was most predictive of infection and mortality. Early nutrition should be considered in these high-risk patients.
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Affiliation(s)
- Jin Sung
- R. Adams Cowley Shock Trauma Center, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Grant V. Bochicchio
- R. Adams Cowley Shock Trauma Center, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Manjari Joshi
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Kelly Bochicchio
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Ainhoa Costas
- R. Adams Cowley Shock Trauma Center, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Kate Tracy
- Department of Epidemiology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Thomas M. Scalea
- R. Adams Cowley Shock Trauma Center, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
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