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Fang M, Xiang S, Xiao X, Mo Q, Si Y. Circadian aspects of mortality in hospitalized patients: A retrospective observation from a large cohort. Nurs Open 2023. [PMID: 36890609 DOI: 10.1002/nop2.1711] [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: 08/31/2022] [Revised: 01/01/2023] [Accepted: 02/20/2023] [Indexed: 03/10/2023] Open
Abstract
AIM This study aimed to describe the circadian characteristics of hospitalized mortality in order to provide nursing guidance for preventing in-hospital mortality. DESIGN A retrospective analysis on inpatient information was implemented. METHODS Harmonic Analysis of Time Series was applied to quantify the periodic structure of the frequency of the occurrence of death. RESULTS A total of 3300 cases were included in the present study (male, 63.4% and median age 73 years), including 1540 (46.7%) ICU patients. Incidence of overall hospitalized death exhibited a circadian pattern, presenting peaks from 07:00 to 12:00 and 15:00 to 20:00 P.M., with 21.5% and 13.1% increase above the average at those peak points, respectively. Similarly, the incidence of sudden cardiac death (SCD) showed peaks between 06:00-12:00 and 15:00-20:00, with a 34.7% and 28.0% increase above the average at peak time, respectively. The distribution of death incidence revealed no statistical difference between SCD and non-SCD (p = 0.525).
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Affiliation(s)
- Miao Fang
- Department of Neurology, Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, Chengdu, China
| | - Shunju Xiang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China.,West China School of Nursing, Sichuan University, Chengdu, China
| | - Xiaoqiang Xiao
- Sichuan Provincial Center for Mental Health, The Center of Psychosomatic Medicine of Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Qianning Mo
- Department of Medical Administration, Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, Chengdu, China
| | - Yang Si
- Department of Neurology, Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, Chengdu, China.,University of Electronic Science and Technology of China, Chengdu, China
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Haahr‐Raunkjaer C, Mølgaard J, Elvekjaer M, Rasmussen SM, Achiam MP, Jorgensen LN, Søgaard MI, Grønbæk KK, Oxbøll A, Sørensen HBD, Meyhoff CS, Aasvang EK. Continuous monitoring of vital sign abnormalities; association to clinical complications in 500 postoperative patients. Acta Anaesthesiol Scand 2022; 66:552-562. [PMID: 35170026 PMCID: PMC9310747 DOI: 10.1111/aas.14048] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/12/2022] [Accepted: 02/07/2022] [Indexed: 12/15/2022]
Abstract
Background Patients undergoing major surgery are at risk of complications, so‐called serious adverse events (SAE). Continuous monitoring may detect deteriorating patients by recording abnormal vital signs. We aimed to assess the association between abnormal vital signs inspired by Early Warning Score thresholds and subsequent SAEs in patients undergoing major abdominal surgery. Methods Prospective observational cohort study continuously monitoring heart rate, respiratory rate, peripheral oxygen saturation, and blood pressure for up to 96 h in 500 postoperative patients admitted to the general ward. Exposure variables were vital sign abnormalities, primary outcome was any serious adverse event occurring within 30 postoperative days. The primary analysis investigated the association between exposure variables per 24 h and subsequent serious adverse events. Results Serious adverse events occurred in 37% of patients, with 38% occurring during monitoring. Among patients with SAE during monitoring, the median duration of vital sign abnormalities was 272 min (IQR 110–447), compared to 259 min (IQR 153–394) in patients with SAE after monitoring and 261 min (IQR 132–468) in the patients without any SAE (p = .62 for all three group comparisons). Episodes of heart rate ≥110 bpm occurred in 16%, 7.1%, and 3.9% of patients in the time before SAE during monitoring, after monitoring, and without SAE, respectively (p < .002). Patients with SAE after monitoring experienced more episodes of hypotension ≤90 mm Hg/24 h (p = .001). Conclusion Overall duration of vital sign abnormalities at current thresholds were not significantly associated with subsequent serious adverse events, but more patients with tachycardia and hypotension had subsequent serious adverse events. Trial registration Clinicaltrials.gov, identifier NCT03491137.
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Affiliation(s)
- Camilla Haahr‐Raunkjaer
- Department of Anaesthesiology Centre for Cancer and Organ Diseases Rigshospitalet University of Copenhagen Copenhagen Denmark
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital University of Copenhagen Copenhagen Denmark
- Copenhagen Centre for Translational Research Copenhagen University Hospital Bispebjerg and Frederiksberg Copenhagen Denmark
| | - Jesper Mølgaard
- Department of Anaesthesiology Centre for Cancer and Organ Diseases Rigshospitalet University of Copenhagen Copenhagen Denmark
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital University of Copenhagen Copenhagen Denmark
- Copenhagen Centre for Translational Research Copenhagen University Hospital Bispebjerg and Frederiksberg Copenhagen Denmark
| | - Mikkel Elvekjaer
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital University of Copenhagen Copenhagen Denmark
- Copenhagen Centre for Translational Research Copenhagen University Hospital Bispebjerg and Frederiksberg Copenhagen Denmark
| | - Søren M. Rasmussen
- Biomedical Engineering Department of Health Technology Technical University of Denmark Lyngby Denmark
| | - Michael P. Achiam
- Department of Surgical Gastroenterology Centre for Cancer and Organ Diseases Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Lars N. Jorgensen
- Digestive Disease Centre, Bispebjerg and Frederiksberg Hospital University of Copenhagen Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Mette I.V. Søgaard
- Department of Anaesthesiology Centre for Cancer and Organ Diseases Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Katja K. Grønbæk
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital University of Copenhagen Copenhagen Denmark
- Copenhagen Centre for Translational Research Copenhagen University Hospital Bispebjerg and Frederiksberg Copenhagen Denmark
| | - Anne‐Britt Oxbøll
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital University of Copenhagen Copenhagen Denmark
- Copenhagen Centre for Translational Research Copenhagen University Hospital Bispebjerg and Frederiksberg Copenhagen Denmark
| | - Helge B. D. Sørensen
- Biomedical Engineering Department of Health Technology Technical University of Denmark Lyngby Denmark
| | - Christian S. Meyhoff
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital University of Copenhagen Copenhagen Denmark
- Copenhagen Centre for Translational Research Copenhagen University Hospital Bispebjerg and Frederiksberg Copenhagen Denmark
| | - Eske K. Aasvang
- Department of Anaesthesiology Centre for Cancer and Organ Diseases Rigshospitalet University of Copenhagen Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
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Shirato K, Sato S. Macrophage Meets the Circadian Clock: Implication of the Circadian Clock in the Role of Macrophages in Acute Lower Respiratory Tract Infection. Front Cell Infect Microbiol 2022; 12:826738. [PMID: 35281442 PMCID: PMC8904936 DOI: 10.3389/fcimb.2022.826738] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/01/2022] [Indexed: 12/13/2022] Open
Abstract
The circadian rhythm is a biological system that creates daily variations of physiology and behavior with a 24-h cycle, which is precisely controlled by the molecular circadian clock. The circadian clock dominates temporal activity of physiological homeostasis at the molecular level, including endocrine secretion, metabolic, immune response, coupled with extrinsic environmental cues (e.g., light/dark cycles) and behavioral cues (e.g., sleep/wake cycles and feeding/fasting cycles). The other side of the clock is that the misaligned circadian rhythm contributes to the onset of a variety of diseases, such as cancer, metabolic diseases, and cardiovascular diseases, the acceleration of aging, and the development of systemic inflammation. The role played by macrophages is a key mediator between circadian disruption and systemic inflammation. At the molecular level, macrophage functions are under the direct control of the circadian clock, and thus the circadian misalignment remodels the phenotype of macrophages toward a ‘killer’ mode. Remarkably, the inflammatory macrophages induce systemic and chronic inflammation, leading to the development of inflammatory diseases and the dampened immune defensive machinery against infectious diseases such as COVID-19. Here, we discuss how the circadian clock regulates macrophage immune functions and provide the potential risk of misaligned circadian rhythms against inflammatory and infectious diseases.
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Affiliation(s)
- Ken Shirato
- Department of Molecular Predictive Medicine and Sport Science, Kyorin University School of Medicine, Mitaka, Japan
| | - Shogo Sato
- Center for Biological Clocks Research, Department of Biology, Texas A&M University, College Station, TX, United States
- *Correspondence: Shogo Sato,
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Bjurström MF, Irwin MR. Perioperative Pharmacological Sleep‐Promotion and Pain Control: A Systematic Review. Pain Pract 2019; 19:552-569. [DOI: 10.1111/papr.12776] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 01/21/2019] [Accepted: 02/07/2019] [Indexed: 01/15/2023]
Affiliation(s)
- Martin F. Bjurström
- Department of Anesthesiology and Intensive Care Skåne University Hospital LundSweden
- Department of Clinical Sciences Lund University Lund Sweden
- Cousins Center for Psychoneuroimmunology University of California, Los Angeles (UCLA) Los Angeles California U.S.A
| | - Michael R. Irwin
- Cousins Center for Psychoneuroimmunology University of California, Los Angeles (UCLA) Los Angeles California U.S.A
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du Fay de Lavallaz J, Puelacher C, Lurati Buse G, Bolliger D, Germanier D, Hidvegi R, Walter JE, Twerenbold R, Strebel I, Badertscher P, Sazgary L, Lampart A, Espinola J, Kindler C, Hammerer-Lercher A, Thambipillai S, Guerke L, Rentsch K, Buser A, Gualandro D, Jakob M, Mueller C. Daytime variation of perioperative myocardial injury in non-cardiac surgery and effect on outcome. Heart 2018; 105:826-833. [DOI: 10.1136/heartjnl-2018-313876] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/22/2018] [Accepted: 10/30/2018] [Indexed: 12/27/2022] Open
Abstract
ObjectiveRecently, daytime variation in perioperative myocardial injury (PMI) has been observed in patients undergoing cardiac surgery. We aim at investigating whether daytime variation also occurs in patients undergoing non-cardiac surgery.MethodsIn a prospective diagnostic study, we evaluated the presence of daytime variation in PMI in patients at increased cardiovascular risk undergoing non-cardiac surgery, as well as its possible impact on the incidence of acute myocardial infarction (AMI), and death during 1-year follow-up in a propensity score–matched cohort. PMI was defined as an absolute increase in high-sensitivity cardiac troponin T (hs-cTnT) concentration of ≥14 ng/L from preoperative to postoperative measurements.ResultsOf 1641 patients, propensity score matching defined 630 with similar baseline characteristics, half undergoing non-cardiac surgery in the morning (starting from 8:00 to 11:00) and half in the afternoon (starting from 14:00 to 17:00). There was no difference in PMI incidence between both groups (morning: 50, 15.8% (95% CI 12.3 to 20.3); afternoon: 52, 16.4% (95% CI 12.7 to 20.9), p=0.94), nor if analysing hs-cTnT release as a quantitative variable (median morning group: 3 ng/L (95% CI 1 to 7 ng/L); median afternoon group: 2 ng/L (95% CI 0 to 7 ng/L; p=0.16). During 1-year follow-up, the incidence of AMI was 1.2% (95% CI 0.4% to 3.2%) among morning surgeries versus 4.1% (95% CI 2.3% to 6.9%) among the afternoon surgeries (corrected HR for afternoon surgery 3.44, bootstrapped 95% CI 1.33 to 10.49, p log-rank=0.03), whereas no difference in mortality emerged (p=0.70).ConclusionsAlthough there is no daytime variation in PMI in patients undergoing non-cardiac surgery, the incidence of AMI during follow-up is increased in afternoon surgeries and requires further study.Clinical trial registrationNCT02573532;Results.
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Ayuse T, Kurata S, Sanuki T, Mishima G, Kiriishi K, Kawai M, Watanabe T, Ozaki-Honda Y, Tanoue N, Magata N, Yamaguchi K, Yoshida M, Ayuse T. Effects of general anesthesia on postoperative sleep cycles in dentally disabled patients. SPECIAL CARE IN DENTISTRY 2018; 39:3-9. [DOI: 10.1111/scd.12335] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 09/06/2018] [Accepted: 09/09/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Terumi Ayuse
- Special care dentistry; Nagasaki University Hospital; Nagasaki Japan
- Clinical Physiology; Nagasaki University Graduate School of Biomedical Sciences; Nagasaki Japan
| | - Shinji Kurata
- Dental anesthesia; Nagasaki University Hospital; Nagasaki Japan
| | - Takuro Sanuki
- Clinical Physiology; Nagasaki University Graduate School of Biomedical Sciences; Nagasaki Japan
| | - Gaku Mishima
- Dental anesthesia; Nagasaki University Hospital; Nagasaki Japan
| | | | - Mari Kawai
- Dental anesthesia; Nagasaki University Hospital; Nagasaki Japan
| | | | - Yu Ozaki-Honda
- Dental anesthesia; Nagasaki University Hospital; Nagasaki Japan
| | - Naomi Tanoue
- Special care dentistry; Nagasaki University Hospital; Nagasaki Japan
| | - Nobuaki Magata
- Special care dentistry; Nagasaki University Hospital; Nagasaki Japan
| | - Kaori Yamaguchi
- Special care dentistry; Nagasaki University Hospital; Nagasaki Japan
| | - Mizuki Yoshida
- Dental anesthesia; Nagasaki University Hospital; Nagasaki Japan
| | - Takao Ayuse
- Clinical Physiology; Nagasaki University Graduate School of Biomedical Sciences; Nagasaki Japan
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Alamili M, Bendtzen K, Lykkesfeldt J, Rosenberg J, Gögenur I. Pronounced inflammatory response to endotoxaemia during nighttime: a randomised cross-over trial. PLoS One 2014; 9:e87413. [PMID: 24475284 PMCID: PMC3903723 DOI: 10.1371/journal.pone.0087413] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 12/24/2013] [Indexed: 11/19/2022] Open
Abstract
Background Circadian variation in bodily functions has been shown to impact health in acute and chronic medical conditions. Little is known about the relationship between circadian rhythm and sepsis in humans. We aimed to investigate circadian variations in the host response in a human endotoxaemia model. Design and Methods A cross-over study, where 12 healthy young men received E. coli endotoxin (lipopolysaccharide, LPS) 0.3 ng/kg at 12 noon and, on another day, at 12 midnight. Blood samples were analysed for pro- and anti-inflammatory cytokines: tumour-necrosis factor (TNF)-alpha, soluble TNF receptors (sTNF-R)-1 and -2, interleukin (IL)-1beta, IL-1 receptor antagonist (IL-1Ra), IL-6, and IL-10 as well as YKL-40 and the oxidative stress markers malondialdehyde (MDA), ascorbic acid (AA) and dehydroascorbic acid (DHA) before and at 2, 4, 6 and 8 hours after LPS administration. Results The levels of MDA and IL-10 where significantly higher during the day time (P<0.05) whereas levels of TNF-alpha, sTNF-RI, sTNF-RII, IL-1Ra, IL-6, and YKL-40 were higher (P<0.01 for all comparisons) during the night time. No significant differences were seen in the levels of AA and DHA. Conclusion A day-night difference in the acute phase response to endotoxaemia exists in healthy volunteers with a more pronounced inflammatory response during the night time. This circadian difference in the response to endotoxaemia may play an important role in the clinical setting and should be investigated further.
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Affiliation(s)
- Mahdi Alamili
- Department of Surgical Gastroenterology, University of Copenhagen, Herlev Hospital, Herlev, Denmark
- * E-mail:
| | - Klaus Bendtzen
- Institute for Inflammation Research, Department of Rheumatology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Jens Lykkesfeldt
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Rosenberg
- Department of Surgical Gastroenterology, University of Copenhagen, Herlev Hospital, Herlev, Denmark
| | - Ismail Gögenur
- Department of Surgical Gastroenterology, University of Copenhagen, Herlev Hospital, Herlev, Denmark
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Lack of circadian variation and reduction of heart rate variability in women with breast cancer undergoing lumpectomy: a descriptive study. Breast Cancer Res Treat 2013; 140:317-22. [DOI: 10.1007/s10549-013-2631-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 07/04/2013] [Indexed: 10/26/2022]
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Sleep in anesthesiology – What can we learn about anesthesia from studying sleep? TRENDS IN ANAESTHESIA AND CRITICAL CARE 2012. [DOI: 10.1016/j.tacc.2011.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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