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Sun M, Gu L, Li Y, Luo F, Tao Y, Shen W, Xie Z. Procalcitonin/Albumin Ratio Predicts the Outcome After Severe Traumatic Brain Injury: A Propensity Score-Matched Analysis. Neurocrit Care 2024; 40:664-673. [PMID: 37523109 DOI: 10.1007/s12028-023-01792-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/22/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND The procalcitonin/albumin ratio (PAR), a novel inflammation-based index, has been reported to predict the prognosis following cardiopulmonary bypass surgery and bacterial infection. However, whether PAR can predict the outcome of patients with severe traumatic brain injury (STBI) has not been fully elucidated. This study aimed to investigate the relationship between serum PAR levels and prognosis at 6 months after STBI. METHODS We retrospectively enrolled 129 patients diagnosed with STBI and collected relevant clinical and laboratory data. Logistic regression analysis was used to estimate the association of PAR with the prognosis of STBI. The receiver operating characteristics curve was performed to examine the predictive use of PAR for prognosis. Propensity score matching (PSM) analysis was also performed to improve the reliability of the results. The primary outcome measures were expressed as a score on the modified Rankin Scale at 6 months. RESULTS The unfavorable prognosis group had advanced age, lower Glasgow Coma Scale score, higher rate of cerebral hernia and intracranial infection, higher neutrophil/lymphocyte ratio (NLR) and C-reactive protein/albumin ratio (CAR), elevated PAR, and higher rate of pneumonia. Multivariate analysis showed that PAR (before PSM: odds ratio 3.473, 95% confidence interval 2.983-4.043, P < 0.001; after PSM: odds ratio 5.358, 95% confidence interval 3.689-6.491, P < 0.001) was independently associated with unfavorable outcome. The area under the curve of the PAR for predicting an unfavorable outcome was higher than that of the CAR and NLR. CONCLUSIONS The PAR might be a novel independent risk factor of the outcome after STBI. Moreover, PAR was a better biomarker in predicting the outcome of patients with STBI than CAR and NLR.
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Affiliation(s)
- Mingjiang Sun
- Department of Neurosurgery, The Second Affiliated Hospital, Chongqing Medical University, 76 Linjiang Road, Chongqing, 400010, China
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lingui Gu
- Department of Neurosurgery, Center for Malignant Brain Tumors, National Glioma Multi-disciplinary Team Alliance, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuanyou Li
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Fushu Luo
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Yihao Tao
- Department of Neurosurgery, The Second Affiliated Hospital, Chongqing Medical University, 76 Linjiang Road, Chongqing, 400010, China
| | - Weiwei Shen
- Department of Endocrinology, The First Affiliated Hospital, Chongqing Medical and Pharmaceutical College, Chongqing, China
| | - Zongyi Xie
- Department of Neurosurgery, The Second Affiliated Hospital, Chongqing Medical University, 76 Linjiang Road, Chongqing, 400010, China.
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Dehghani M, Pourmontaseri H. Aetiology, risk factors and treatment of typical and atypical pressure ulcers in patients with traumatic brain injury: A narrative review. Int Wound J 2024; 21:e14788. [PMID: 38420873 PMCID: PMC10902764 DOI: 10.1111/iwj.14788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 02/02/2024] [Indexed: 03/02/2024] Open
Abstract
Pressure ulcers are one of the leading complications in bedridden patients that result in multiple burdens on healthcare systems and patients (11 billion dollars/year). The prevalence of pressure ulcers in traumatic brain injury patients is 1.5-fold compared with the other bedridden patients. Moreover, critical traumatic brain injury patients who are admitted to the intensive care unit experience severe pressure ulcers and further complications. The motor/sensory disabilities and low supplementation and oxygenation to the pressured side were the main mechanisms of the typical pressure ulcers. Intellectual evaluation is the first essential step to prevent the development of pressure ulcers in high-risk patients. Till now, different scales, including Injury Scale Score and Braden Scale Score, have been provided to assess the pressure ulcer. Since low stages of pressure ulcers heal rapidly, traumatic brain injury patients require a periodical assessment to prevent further developments timely. Alongside different procedures provided to prevent and treat any pressure ulcer, traumatic brain injury patients required additional specific protections. For the first line, fast and efficient rehabilitation repairs motor/sensory disabilities and decreases the chance of pressure ulcer. Our review indicated that pressure ulcer in traumatic brain injury had several complex mechanisms that demand special care. Therefore, further studies are required to address these mechanisms and prevent their progression to typical and atypical pressure ulcers.
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Affiliation(s)
- Mohammadreza Dehghani
- Student Research Committee, Fasa University of Medical SciencesFasaIran
- Projects Support Division, Medical Students AssociationFasa University of Medical SciencesFasaIran
| | - Hossein Pourmontaseri
- Student Research Committee, Fasa University of Medical SciencesFasaIran
- Projects Support Division, Medical Students AssociationFasa University of Medical SciencesFasaIran
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Durak A, Binay Safer V, Catikkas NM. The relationship between pressure injuries and ultrasonographically measured rectus femoris muscle thickness. J Tissue Viability 2024; 33:60-66. [PMID: 38103986 DOI: 10.1016/j.jtv.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 11/13/2023] [Accepted: 12/07/2023] [Indexed: 12/19/2023]
Affiliation(s)
- Ayfer Durak
- University of Health Sciences Istanbul, Hamidiye Faculty of Medicine, Sancaktepe Prof. Dr. Ilhan Varank Training and Research Hospital, Department of Internal Medicine, Division of Geriatrics, Sancaktepe, 34785, Istanbul, Turkey.
| | - Vildan Binay Safer
- University of Health Sciences Istanbul, Hamidiye Faculty of Medicine, Sancaktepe Prof. Dr. Ilhan Varank Training and Research Hospital, Department of Internal Medicine / Department of Physical Medicine and Rehabilitation, Sancaktepe, 34785, Istanbul, Turkey
| | - Nezahat Muge Catikkas
- University of Health Sciences Istanbul, Hamidiye Faculty of Medicine, Sancaktepe Prof. Dr. Ilhan Varank Training and Research Hospital, Department of Internal Medicine, Division of Geriatrics, Sancaktepe, 34785, Istanbul, Turkey
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Fujimoto Y, Nakatani E, Tabara Y. Comorbidities associated with 2-year mortality in adults with cerebral palsy in Japan. Dev Med Child Neurol 2024; 66:244-249. [PMID: 37408168 DOI: 10.1111/dmcn.15705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/10/2023] [Accepted: 06/19/2023] [Indexed: 07/07/2023]
Abstract
AIM To clarify whether the Whitney Comorbidity Index (WCI) is useful in Asian adults with cerebral palsy (CP) and whether aspiration pneumonia and pressure ulcers improved the prognostic significance of the WCI. METHOD This cohort study evaluated individuals aged at least 18 years with CP in Japan. We used Cox proportional hazards regression to analyse 2-year mortality rates. The predictive performance of the Charlson Comorbidity Index, Elixhauser Comorbidity Index, and WCI were compared as comorbidity assessment criteria. Aspiration pneumonia and pressure ulcers were added to the Cox models, and their impact on hazard ratios was determined. RESULTS Of the 2232 adults with CP, 72 died during the 2 years. The model with a previously reported weighted WCI with aspiration pneumonia and pressure ulcers produced the best fit. Additionally, the hazard risk of 2-year mortality for an unweighted WCI score of at least 4 was 2.56; when CP-specific comorbidities were added, it increased to 8.94. INTERPRETATION This study showed that the WCI can be used in Asian adults with CP. Furthermore, assessing patient age, aspiration pneumonia, and pressure ulcers in addition to the WCI increased the predictive value for mortality. Our findings indicate that the WCI can promote valid comparisons between international populations. WHAT THIS PAPER ADDS The Whitney Comorbidity Index (WCI) is useful among adults with cerebral palsy, irrespective of ethnic differences. Assessment of aspiration pneumonia and pressure ulcers increased the WCI predictive value. The WCI helps identify adults with cerebral palsy at risk of adverse outcomes.
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Affiliation(s)
- Yoh Fujimoto
- Graduate School of Public Health, Shizuoka Graduate University of Public Health, Shizuoka, Japan
- Department of Pediatric Orthopedics, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Eiji Nakatani
- Graduate School of Public Health, Shizuoka Graduate University of Public Health, Shizuoka, Japan
| | - Yasuharu Tabara
- Graduate School of Public Health, Shizuoka Graduate University of Public Health, Shizuoka, Japan
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Estraneo A, Briand MM, Noé E. Medical comorbidities in patients with prolonged disorder of consciousness: A narrative review. NeuroRehabilitation 2024; 54:61-73. [PMID: 38217620 DOI: 10.3233/nre-230130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2024]
Abstract
BACKGROUND A few studies specifically addressed medical comorbidities (MCs) in patients with severe acquired traumatic or non-traumatic brain injury and prolonged disorders of consciousness (pDoC; i.e., patients in vegetative state/unresponsive wakefulness syndrome, VS/UWS, or in minimally conscious state, MCS). OBJECTIVE To provide an overview on incidence of MCs in patients with pDoC. METHODS Narrative review on most impacting MCs in patients with pDoC, both those directly related to brain damage (epilepsy, neurosurgical complications, spasticity, paroxysmal sympathetic hyperactivity, PSH), and those related to severe disability and prolonged immobility (respiratory comorbidities, endocrine disorders, metabolic abnormalities, heterotopic ossifications). RESULTS Patients with pDoC are at high risk to develop at least one MC. Moderate or severe respiratory and musculoskeletal comorbidities are the most common MCs. Epilepsy and PSH seem to be more frequent in patients in VS/UWS compared to patients in MCS, likely because of higher severity in the brain damage in VS. Endocrine metabolic, PSH and respiratory complications are less frequent in traumatic etiology, whereas neurogenic heterotopic ossifications are more frequent in traumatic etiology. Spasticity did not significantly differ between VS/UWS and MCS and in the three etiologies. MCs are associated with higher mortality rates, worse clinical improvement and can impact accuracy in the clinical diagnosis. CONCLUSIONS The frequent occurrence of several MCs requires a specialized rehabilitative setting with high level of multidisciplinary medical expertise to prevent, appropriately recognize and treat them. Comprehensive rehabilitation could avoid possible progression to more serious complications that can negatively impact clinical outcomes.
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Affiliation(s)
- Anna Estraneo
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Florence, Italy
| | - Marie-Michele Briand
- Research Center of Hôpital du Sacré-Coeur de Montréal, CIUSSS-NÎM, Montreal, QC, Canada
- Institutde Réadaptation en Déficience Physique de Québec, Quebec, QC, Canada
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Enrique Noé
- IRENEA-Instituto de Rehabilitación Neurológica, Fundación Hospitales Vithas, Valencia, Spain
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Wang X, Li X, Zhang J. Effects of refined nursing interventions in the operating room on surgical-site wound infection in patients with lung cancer: A meta-analysis. Int Wound J 2023; 21:e14391. [PMID: 37743559 PMCID: PMC10828123 DOI: 10.1111/iwj.14391] [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: 08/17/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/26/2023] Open
Abstract
In this study, a meta-analysis was conducted to assess the effect of refined nursing interventions in the operating room on the incidence of surgical-site wound infections in patients undergoing lung cancer surgery to provide an evidence base for the prevention and management of nosocomial infections. A computerised literature search was used to identify randomised controlled trials (RCTs) on the application of refined nursing interventions in the operating room in patients undergoing lung cancer surgery published in the PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure (CNKI), VIP and Wanfang databases from their inception until July 2023. The literature screening, data extraction and quality assessment of the included studies were performed independently by two researchers. RevMan 5.4 software was used for the meta-analysis. Twenty-eight studies were included in the analysis, with a total of 2406 patients, including 1210 patients in the refined nursing intervention group and 1196 patients in the control group. The results of the meta-analysis showed that the refined nursing interventions in the operating room significantly reduced the incidence of surgical-site wound infections in patients undergoing lung cancer surgery, compared with the control group (1.82% vs. 6.52%, odds ratio: 0.30, 95% CI: 0.19-0.47, p < 0.001), and shortened the length of hospital stay (standardised mean difference: -1.51 days, 95% CI: -1.92 to -1.11 days, p < 0.001). Current evidence suggests that the application of refined nursing interventions in the operating room is effective at reducing the incidence of surgical-site wound infections and shortening the length of hospital stay in patients undergoing lung cancer surgery. However, owing to the small number and low quality of the studies, more high-quality RCTs with large sample sizes are needed to confirm these results.
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Affiliation(s)
- Xiaorui Wang
- Department of AnesthesiaBeijing Electric Power HospitalBeijingChina
| | - Xia Li
- Department of AnesthesiaBeijing Electric Power HospitalBeijingChina
| | - Jiying Zhang
- Department of AnesthesiaBeijing Electric Power HospitalBeijingChina
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Gheri CF, Scalfi L, Biffi B, Pancani S, Madiai S, Di Vincenzo O, Ghaderi M, Celoni R, Dalladonna M, Draghi F, Maccanti D, Macchi C, Romoli AM, Cecchi F, Hakiki B, Luisi MLE. Relationship between Nutritional Risk, Clinical and Demographic Characteristics, and Pressure Ulcers in Patients with Severe Acquired Brain Injuries Attending a Rehabilitative Program. Nutrients 2023; 15:3336. [PMID: 37571274 PMCID: PMC10421108 DOI: 10.3390/nu15153336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/19/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
Preliminary evidence in the literature suggests a high prevalence of malnutrition (undernutrition) in patients with severe acquired brain injuries (sABI), with an expected negative impact on clinical outcomes and pressure ulcers (PUs) in particular. In a retrospective cohort study on patients discharged from intensive care units (ICU) and admitted to an intensive rehabilitation unit (IRU), the risk of malnutrition was systematically assessed, in addition to standard clinical procedures (including PUs evaluation), using two different tools: the Malnutrition Universal Screening Tool (MUST) and the Controlling Nutritional Status (CONUT) tool. Eighty-eight patients were included in the analysis. A high proportion (79.5%) of patients with sABI suffered from PUs, being older and more frequently men, with a longer ICU stay between the event and admission to IRU, and a greater MUST score. At discharge, when compared to patients whose PUs had healed, those with persisting PUs were more often men and had the worst cognitive performance at admission. As for nutritional risk, the baseline CONUT score was identified as an independent negative predictor of PUs at discharge by the logistic regression model. In conclusion, the assessment of nutritional risk using simple standard tools may be useful in the clinical evaluation of sABI patients with PUs.
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Affiliation(s)
- Chiara Francesca Gheri
- IRCCS Fondazione Don Carlo Gnocchi ONLUS Firenze, 50143 Florence, Italy (S.P.); (M.G.); (R.C.); (M.D.); (F.D.); (D.M.); (C.M.); (A.M.R.); (F.C.); (B.H.); (M.L.E.L.)
| | - Luca Scalfi
- Human Nutrition and Dietetics, Department of Public Health, Federico II University, 80131 Naples, Italy; (L.S.); (O.D.V.)
- Santa Maria del Pozzo Private Hospital, Somma Vesuviana, 80049 Naples, Italy
| | - Barbara Biffi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS Firenze, 50143 Florence, Italy (S.P.); (M.G.); (R.C.); (M.D.); (F.D.); (D.M.); (C.M.); (A.M.R.); (F.C.); (B.H.); (M.L.E.L.)
| | - Silvia Pancani
- IRCCS Fondazione Don Carlo Gnocchi ONLUS Firenze, 50143 Florence, Italy (S.P.); (M.G.); (R.C.); (M.D.); (F.D.); (D.M.); (C.M.); (A.M.R.); (F.C.); (B.H.); (M.L.E.L.)
| | - Sara Madiai
- IRCCS Fondazione Don Carlo Gnocchi ONLUS Firenze, 50143 Florence, Italy (S.P.); (M.G.); (R.C.); (M.D.); (F.D.); (D.M.); (C.M.); (A.M.R.); (F.C.); (B.H.); (M.L.E.L.)
| | - Olivia Di Vincenzo
- Human Nutrition and Dietetics, Department of Public Health, Federico II University, 80131 Naples, Italy; (L.S.); (O.D.V.)
| | - Michele Ghaderi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS Firenze, 50143 Florence, Italy (S.P.); (M.G.); (R.C.); (M.D.); (F.D.); (D.M.); (C.M.); (A.M.R.); (F.C.); (B.H.); (M.L.E.L.)
| | - Rebecca Celoni
- IRCCS Fondazione Don Carlo Gnocchi ONLUS Firenze, 50143 Florence, Italy (S.P.); (M.G.); (R.C.); (M.D.); (F.D.); (D.M.); (C.M.); (A.M.R.); (F.C.); (B.H.); (M.L.E.L.)
| | - Mara Dalladonna
- IRCCS Fondazione Don Carlo Gnocchi ONLUS Firenze, 50143 Florence, Italy (S.P.); (M.G.); (R.C.); (M.D.); (F.D.); (D.M.); (C.M.); (A.M.R.); (F.C.); (B.H.); (M.L.E.L.)
| | - Francesca Draghi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS Firenze, 50143 Florence, Italy (S.P.); (M.G.); (R.C.); (M.D.); (F.D.); (D.M.); (C.M.); (A.M.R.); (F.C.); (B.H.); (M.L.E.L.)
| | - Daniela Maccanti
- IRCCS Fondazione Don Carlo Gnocchi ONLUS Firenze, 50143 Florence, Italy (S.P.); (M.G.); (R.C.); (M.D.); (F.D.); (D.M.); (C.M.); (A.M.R.); (F.C.); (B.H.); (M.L.E.L.)
| | - Claudio Macchi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS Firenze, 50143 Florence, Italy (S.P.); (M.G.); (R.C.); (M.D.); (F.D.); (D.M.); (C.M.); (A.M.R.); (F.C.); (B.H.); (M.L.E.L.)
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 50134 Florence, Italy
| | - Anna Maria Romoli
- IRCCS Fondazione Don Carlo Gnocchi ONLUS Firenze, 50143 Florence, Italy (S.P.); (M.G.); (R.C.); (M.D.); (F.D.); (D.M.); (C.M.); (A.M.R.); (F.C.); (B.H.); (M.L.E.L.)
| | - Francesca Cecchi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS Firenze, 50143 Florence, Italy (S.P.); (M.G.); (R.C.); (M.D.); (F.D.); (D.M.); (C.M.); (A.M.R.); (F.C.); (B.H.); (M.L.E.L.)
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 50134 Florence, Italy
| | - Bahia Hakiki
- IRCCS Fondazione Don Carlo Gnocchi ONLUS Firenze, 50143 Florence, Italy (S.P.); (M.G.); (R.C.); (M.D.); (F.D.); (D.M.); (C.M.); (A.M.R.); (F.C.); (B.H.); (M.L.E.L.)
| | - Maria Luisa Eliana Luisi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS Firenze, 50143 Florence, Italy (S.P.); (M.G.); (R.C.); (M.D.); (F.D.); (D.M.); (C.M.); (A.M.R.); (F.C.); (B.H.); (M.L.E.L.)
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Wang Y, Gong Y, Chen D, Xu F, Yang P. C-Reactive Protein/Albumin Ratio Is Associated with Mortality in Patients with Moderate to Severe Traumatic Brain Injury. World Neurosurg 2023; 173:e234-e240. [PMID: 36796630 DOI: 10.1016/j.wneu.2023.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND The C-reactive protein/albumin ratio (CAR), Glasgow coma scale score, and blood glucose level serve as reference values to evaluate the prognosis of critically ill patients. However, the prognostic significance of the admission serum CAR for patients with moderate to severe traumatic brain injury (TBI) has remained unclear. We examined the effect of the admission CAR on the outcomes of patients with moderate to severe TBI. METHODS The clinical data from 163 patients with moderate to severe TBI were collected. Before analysis, the patients' records were anonymized and de-identified. Multivariate logistic regression analyses were used to investigate the risk factors and construct a prognostic model of in-hospital mortality. The predictive value of different models was compared by evaluating the areas under the receiver operating characteristic curve. RESULTS Of the 163 patients, those who had not survived (nonsurvivors, n = 34) had had a higher CAR than that of the survivors (3.8 vs. 2.6; P < 0.001). The results of multivariate logistic regression analysis indicated that the Glasgow coma scale score (odds ratio [OR], 0.430; P = 0.001), blood glucose (OR, 1.290; P = 0.017), and CAR (OR, 1.609; P = 0.036) were independent risk factors for mortality and were used to construct the prognostic model. The area under the receiver operating characteristic curve of the prognostic model was 0.922 (95% confidence interval, 0.875-0.970), higher than that for the CAR (P = 0.0409). We had screened 195 patients for inclusion in the present study and excluded 32 patients. CONCLUSIONS The CAR can serve as an independent risk factor of mortality for patients with moderate to severe TBI. Incorporating CAR into a predictive model could contribute to efficiently predicting the prognosis of adults with moderate to severe TBI.
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Affiliation(s)
- Yifei Wang
- The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yue Gong
- The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Du Chen
- The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Feng Xu
- The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Peng Yang
- The First Affiliated Hospital of Soochow University, Suzhou, China.
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Lu X, Liu WC, Qin Y, Chen D, Yang P, Chen XH, Wu SR, Xu F. C-reactive Protein/Albumin Ratio as a Prognostic Indicator in Posttraumatic Shock and Outcome of Multiple Trauma Patients. Curr Med Sci 2023; 43:360-366. [PMID: 36943544 DOI: 10.1007/s11596-023-2714-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 01/09/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE C-reactive protein (CRP)/albumin ratio (CAR) is a new inflammation-based index for predicting the prognosis of various diseases. The CAR determined on admission may help to predict the prognostic value of multiple trauma patients. METHODS A total of 264 adult patients with severe multiple trauma were included for the present retrospective study, together with the collection of relevant clinical and laboratory data. CAR, CRP, albumin, shock index and ISS were incorporated into the prognostic model, and the receiver operating characteristic (ROC) curve was drawn. Then, the shock index for patients with different levels of CAR was analyzed. Finally, univariate and multivariate logistic regression analyses were performed to identify the independent risk factors for the 28-day mortality of multiple trauma patients. RESULTS A total of 36 patients had poor survival outcomes, and the mortality rate reached 13.6%. Furthermore, after analyzing the shock index for patients with different levels of CAR, it was revealed that the shock index was significantly higher when CAR was ≥4, when compared to CAR <2 and 2≤ CAR <4, in multiple trauma patients. The multivariate logistic analysis helped to identify the independent association between the variables CAR (P=0.029) and shock index (P=0.019), and the 28-day mortality of multiple trauma patients. CONCLUSION CAR is higher in patients with severe multiple trauma. Furthermore, CAR serves as a risk factor for independently predicting the 28-day mortality of multiple trauma patients. The shock index was significantly higher when CAR was ≥4 in multiple trauma patients.
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Affiliation(s)
- Xin Lu
- Emergency Department, the First Affiliated Hospital of Soochow University, Suzhou, 215000, China
| | - Wei-Chen Liu
- Emergency Department, the First Affiliated Hospital of Soochow University, Suzhou, 215000, China
| | - Yan Qin
- Emergency Department, the First Affiliated Hospital of Soochow University, Suzhou, 215000, China
| | - Du Chen
- Emergency Department, the First Affiliated Hospital of Soochow University, Suzhou, 215000, China
| | - Peng Yang
- Emergency Department, the First Affiliated Hospital of Soochow University, Suzhou, 215000, China
| | - Xiong-Hui Chen
- Emergency Department, the First Affiliated Hospital of Soochow University, Suzhou, 215000, China
| | - Si-Rong Wu
- Emergency Department, the First Affiliated Hospital of Soochow University, Suzhou, 215000, China
| | - Feng Xu
- Emergency Department, the First Affiliated Hospital of Soochow University, Suzhou, 215000, China.
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Xiong Q, Le K, Wang Y, Tang Y, Dong X, Zhong Y, Zhou Y, Feng Z. A prediction model of clinical outcomes in prolonged disorders of consciousness: A prospective cohort study. Front Neurosci 2023; 16:1076259. [PMID: 36817098 PMCID: PMC9936154 DOI: 10.3389/fnins.2022.1076259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/31/2022] [Indexed: 02/05/2023] Open
Abstract
Objective This study aimed to establish and validate a prediction model for clinical outcomes in patients with prolonged disorders of consciousness (pDOC). Methods A total of 170 patients with pDOC enrolled in our rehabilitation unit were included and divided into training (n = 119) and validation sets (n = 51). Independent predictors for improved clinical outcomes were identified by univariate and multivariate logistic regression analyses, and a nomogram model was established. The nomogram performance was quantified using receiver operating curve (ROC) and calibration curves in the training and validated sets. A decision curve analysis (DCA) was performed to evaluate the clinical usefulness of this nomogram model. Results Univariate and multivariate logistic regression analyses indicated that age, diagnosis at entry, serum albumin (g/L), and pupillary reflex were the independent prognostic factors that were used to construct the nomogram. The area under the curve in the training and validation sets was 0.845 and 0.801, respectively. This nomogram model showed good calibration with good consistency between the actual and predicted probabilities of improved outcomes. The DCA demonstrated a higher net benefit in clinical decision-making compared to treating all or none. Conclusion Several feasible, cost-effective prognostic variables that are widely available in hospitals can provide an efficient and accurate prediction model for improved clinical outcomes and support clinicians to offer suitable clinical care and decision-making to patients with pDOC and their family members.
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Affiliation(s)
- Qi Xiong
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Kai Le
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yong Wang
- Department of Medical Oncology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yunliang Tang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xiaoyang Dong
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yuan Zhong
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yao Zhou
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Zhen Feng
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China,*Correspondence: Zhen Feng ✉
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Elsorady KE, Nouh AH. Biomarkers and clinical features associated with pressure injury among geriatric patients. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2023. [DOI: 10.29333/ejgm/12636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
<b>Purpose:</b> The study aims to identify biomarkers and clinical features associated with pressure injury (PI) among geriatric patients.<br />
<b>Methods:</b> A cross-sectional study including 191 patients aged ≥60 years. Patients were classified into those with and without PI. Assessing the risk of PI was performed on admission by applying the Braden scale (BS) for predicting pressure sore risk. Clinical history, baseline hematology, and biochemistry results were obtained. C-reactive protein to albumin ratio (CAR) and Charlson comorbidity index (CCI) were calculated. Statistical analyses were performed.<br />
<b>Results: </b>43 (22.5%) patients had PI. PI was significantly associated with higher CCI, total leukocyte count, and CAR, besides lower BS scores, serum albumin, and total proteins. Significant comorbidities were diabetes mellitus, stroke/transient ischemic attack, dementia, incontinence, and chronic kidney disease. The optimal cut-offs for PI occurrence were ≤14, ≤3.1 g/dl and >1.27 for BS, albumin, and CAR, respectively.
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Affiliation(s)
- Khalid Elsayed Elsorady
- Department of Geriatrics and Gerontology, Faculty of Medicine, Ain Shams University, Cairo, EGYPT
- Geriatrics Hospital, Ain Shams University Hospitals, Abbasia, Cairo, EGYPT
| | - Ahmed Hassan Nouh
- Department of Dermatology and Venereology, Al Azhar University, Cairo, EGYPT
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Jung E, Ryu HH, Ko CW, Lim YD. Elevated C-reactive protein-to-albumin ratio with fever is a predictor of poor functional outcome in patients with mild traumatic brain injury. Heliyon 2022; 8:e12153. [PMID: 36568655 PMCID: PMC9768302 DOI: 10.1016/j.heliyon.2022.e12153] [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: 07/10/2022] [Revised: 09/07/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction The C-reactive protein -to-albumin ratio (CAR), a novel inflammation-based prognostic score, is useful in predicting clinical outcomes, including those in central nervous system diseases. However, no report has identified the relationship between CAR and long-term clinical outcomes in patients with mild traumatic brain injury (mTBI). We aimed to evaluate the relationship between CAR and long-term functional outcomes in patients with mTBI and analyze whether CAR is associated with the presence of fever. Methods This was a retrospective observational study includes 387 adult patients with mTBI who were treated at a level-1 trauma center between 2017 and 2021. The main exposure variable was an elevated CAR, and the main outcomes were degrees of disability and quality of life measured using the modified Rankin Scale (mRS). A multivariable logistic regression analysis was performed to estimate the effect size of CAR on study outcomes. An interaction analysis was performed between CAR and fever on study outcomes. Results Elevated CAR had no significant association with poor functional outcomes (aOR [95% CI]: 1.35 [0.39-4.69]) in patients with mTBI. In the interaction analysis, elevated CAR was not associated with increased poor functional outcomes in the absence of fever (1.08 [0.55-2.13]), but a significant increase in poor functional outcomes was observed when elevated CAR was accompanied by fever (1.32 [1.14-2.56)). Conclusions Elevated CAR with fever increased the risk of poor functional recovery at 6 months after hospital discharge in patients with mTBI. Our study findings suggest the need for strategies for the prevention of long-term poor functional recovery in the presence of high CAR and fever in patients with mTBI.
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Affiliation(s)
- Eujene Jung
- Chonnam National University Hospital, Gwangju, South Korea
| | - Hyun Ho Ryu
- Chonnam National University Hospital, Gwangju, South Korea,Chonnam National University College of Medicine,Corresponding author.
| | - Cha won Ko
- Chonnam National University Hospital, Gwangju, South Korea
| | - Yong Deok Lim
- Chonnam National University Hospital, Gwangju, South Korea
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Gürsoy C, Gürsoy G, Demirbilek SG. C-reactive protein-albumin ratio and procalcitonin in predicting intensive care unit mortality in traumatic brain injury. Acute Crit Care 2022; 37:462-467. [PMID: 35977896 PMCID: PMC9475143 DOI: 10.4266/acc.2022.00052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 06/02/2022] [Indexed: 11/30/2022] Open
Abstract
Background Prediction of intensive care unit (ICU) mortality in traumatic brain injury (TBI), which is a common cause of death in children and young adults, is important for injury management. Neuroinflammation is responsible for both primary and secondary brain injury, and C-reactive protein-albumin ratio (CAR) has allowed use of biomarkers such as procalcitonin (PCT) in predicting mortality. Here, we compared the performance of CAR and PCT in predicting ICU mortality in TBI. Methods Adults with TBI were enrolled in our study. The medical records of 82 isolated TBI patients were reviewed retrospectively. Results The mean patient age was 49.0 ± 22.69 years; 59 of all patients (72%) were discharged, and 23 (28%) died. There was a statistically significant difference between PCT and CAR values according to mortality (P<0.05). The area under the curve (AUC) was 0.646 with 0.071 standard error for PCT and 0.642 with 0.066 standard error for CAR. The PCT showed a similar AUC of the receiver operating characteristic to CAR. Conclusions This study shows that CAR and PCT are usable biomarkers to predict ICU mortality in TBI. When the determined cut-off values are used to predict the course of the disease, the CAR and PCT biomarkers will provide more effective information for treatment planning and for preparation of the family for the treatment process and to manage their outcome expectations.
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Wang N, Lv L, Yan F, Ma Y, Miao L, Foon Chung LY, Han L. Biomarkers for the early detection of pressure injury: A systematic review and meta-analysis. J Tissue Viability 2022; 31:259-267. [PMID: 35227559 DOI: 10.1016/j.jtv.2022.02.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 02/13/2022] [Accepted: 02/21/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Pressure injury imposes a significant burden for patients and healthcare systems and the majority of pressure injuries are preventable. The early identification of pressure injury is critical for its prevention. As an objective measure, biomarkers have preliminarily shown the potential to identify individuals at risk for developing pressure injury before it is visually observed to occur. However, these results have not been synthesized. OBJECTIVE To assess and synthesise the predictive effect of different biomarkers in the early detection of pressure injury formation. DESIGN A systematic review and meta-analysis. DATA SOURCES PubMed, EMBASE, CINAHL Complete and the Cochrane Library were comprehensively searched for articles up to June 2021. No restrictions were applied to study design type, language, country, race or date of publication. REVIEW METHODS Two reviewers independently extracted data from all original eligible studies using a specified data extraction form, resolved disagreements through discussion and the involvement of an additional reviewer. Methodological quality of all included studies was independently appraised by two authors with the Joanna Briggs Institute (JBI) Critical Appraisal Checklist and the Newcastle-Ottawa Quality Assessment Scale (NOS). Heterogeneity of each study was estimated using the I2 statistic, and the data was synthesized using StataSE15. RESULTS Eight observational studies involving 10595 participants were included. The overall pooled area under curve (AUC) and the 95% confidence intervals (CIs) of Serum albumin (Alb) was 0.66(0.62-0.70), and the Serum haemoglobin (Hb) was 0.67(0.60-0.74). The AUC and 95% CI of C-reactive protein (CRP) was 0.62(0.50-0.74), Braden score was 0.56 (0.429-0.691), Waterlow score was 0.729(0.654-0.803), Alb with Waterlow was 0.741(0.694-0.787), and the combination of Hb, CRP, Alb, Age and Gender was 0.79(0.682-0.898). Besides, the chemokine interferon-γ-induced protein of 10kd/CXCL10, cytokine interferon-α, tumor necrosis factor-alpha (TNF-α), granulocyte-macrophage colony-stimulating factor (GM-CSF), interleukin-15 (IL-15) and combination of creatine kinase (CK), myoglobin (Mb), heart-type fatty acid binding protein (H-FABP) and CRP may prove potential for detecting pressure injury. CONCLUSION The findings suggest the combination of Hb, CRP, Alb, Age and Gender is superior to other biomarkers. However, the predictive effect of biomarkers needs to be confirmed by more researches and patient-level data.
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Affiliation(s)
- Ning Wang
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, 730000, Gansu Province, China.
| | - Lin Lv
- Wound and Ostomy Care Center, Gansu Provincial Hospital, Lanzhou City, 730000, Gansu Province, China.
| | - Fanghong Yan
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, 730000, Gansu Province, China.
| | - Yuxia Ma
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, 730000, Gansu Province, China.
| | - Lizhen Miao
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, 730000, Gansu Province, China.
| | - Loretta Yuet Foon Chung
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, 730000, Gansu Province, China.
| | - Lin Han
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, 730000, Gansu Province, China; Department of Nursing, Gansu Provincial Hospital, Lanzhou City, 730000, Gansu Province, China.
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Wang R, He M, Qu F, Zhang J, Xu J. Lactate Albumin Ratio Is Associated With Mortality in Patients With Moderate to Severe Traumatic Brain Injury. Front Neurol 2022; 13:662385. [PMID: 35432157 PMCID: PMC9011050 DOI: 10.3389/fneur.2022.662385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/03/2022] [Indexed: 11/28/2022] Open
Abstract
Background Traumatic brain injury (TBI) is a serious public health issue all over the world. This study was designed to evaluate the prognostic value of lactate to albumin ratio (LAR) on patients with moderate to severe TBI. Methods Clinical data of 273 moderate to severe TBI patients hospitalized in West China Hospital between May 2015 and January 2018 were collected. Multivariate logistic regression analyses were used to explore risk factors and construct a prognostic model of in-hospital mortality in this cohort. A receiver operating characteristic (ROC) curve was drawn to evaluate the discriminative ability of this model. Results Non-survivors had higher LAR than survivors (1.09 vs. 0.53, p < 0.001). Results of multivariate logistic regression analysis showed that Glasgow Coma Scale (GCS; odds ratio [OR] = 0.743, p = 0.001), blood glucose (OR = 1.132, p = 0.005), LAR (OR = 1.698, p = 0.022), subdural hematoma (SDH; OR = 2.889, p = 0.006), intraparenchymal hemorrhage (IPH; OR = 2.395, p = 0.014), and diffuse axonal injury (DAI; OR = 2.183, p = 0.041) were independent risk factors of in-hospital mortality in included patients. These six factors were utilized to construct the prognostic model. The area under the ROC curve (AUC) values of single lactate, albumin, and LAR were 0.733 (95% Cl; 0.673–0.794), 0.740 (95% Cl; 0.683–0.797), and 0.780 (95% Cl; 0.725–0.835), respectively. The AUC value of the prognostic model was 0.857 (95%Cl; 0.812–0.901), which was higher than that of LAR (Z = 2.1250, p < 0.05). Conclusions Lactate to albumin ratio is a readily available prognostic marker of moderate to severe TBI patients. A prognostic model incorporating LAR is beneficial for clinicians to evaluate possible progression and make treatment decisions in TBI patients.
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Affiliation(s)
- Ruoran Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Min He
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Min He
| | - Fengyi Qu
- Department of Radiation Oncolygy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jing Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jianguo Xu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
- Jianguo Xu
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AHMEDOV A, AHMEDOV Y. Follow-up of geriatric patients with pressure ulcers by plastic, reconstructive and aesthetic surgery in intensive care conditions. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2021. [DOI: 10.33808/clinexphealthsci.831458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Kumar S, Theis T, Tschang M, Nagaraj V, Berthiaume F. Reactive Oxygen Species and Pressure Ulcer Formation after Traumatic Injury to Spinal Cord and Brain. Antioxidants (Basel) 2021; 10:antiox10071013. [PMID: 34202655 PMCID: PMC8300734 DOI: 10.3390/antiox10071013] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/15/2021] [Accepted: 06/21/2021] [Indexed: 11/29/2022] Open
Abstract
Traumatic injuries to the nervous system, including the brain and spinal cord, lead to neurological dysfunction depending upon the severity of the injury. Due to the loss of motor (immobility) and sensory function (lack of sensation), spinal cord injury (SCI) and brain injury (TBI) patients may be bed-ridden and immobile for a very long-time. These conditions lead to secondary complications such as bladder/bowel dysfunction, the formation of pressure ulcers (PUs), bacterial infections, etc. PUs are chronic wounds that fail to heal or heal very slowly, may require multiple treatment modalities, and pose a risk to develop further complications, such as sepsis and amputation. This review discusses the role of oxidative stress and reactive oxygen species (ROS) in the formation of PUs in patients with TBI and SCI. Decades of research suggest that ROS may be key players in mediating the formation of PUs. ROS levels are increased due to the accumulation of activated macrophages and neutrophils. Excessive ROS production from these cells overwhelms intrinsic antioxidant mechanisms. While short-term and moderate increases in ROS regulate signal transduction of various bioactive molecules; long-term and excessively elevated ROS can cause secondary tissue damage and further debilitating complications. This review discusses the role of ROS in PU development after SCI and TBI. We also review the completed and ongoing clinical trials in the management of PUs after SCI and TBI using different technologies and treatments, including antioxidants.
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Affiliation(s)
- Suneel Kumar
- Department of Biomedical Engineering, Rutgers, The State University of New Jersey, Piscataway, NJ 08854, USA;
- Correspondence: ; Tel.: +1-848-445-6581
| | - Thomas Theis
- Keck Center for Collaborative Neuroscience, Department of Cell Biology and Neuroscience, Rutgers University, Piscataway, NJ 08554, USA; (T.T.); (V.N.)
| | - Monica Tschang
- School of Art and Sciences, Rutgers, The State University of New Jersey, Piscataway, NJ 08854, USA;
| | - Vini Nagaraj
- Keck Center for Collaborative Neuroscience, Department of Cell Biology and Neuroscience, Rutgers University, Piscataway, NJ 08554, USA; (T.T.); (V.N.)
| | - Francois Berthiaume
- Department of Biomedical Engineering, Rutgers, The State University of New Jersey, Piscataway, NJ 08854, USA;
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Bai Y, Su Y, Zheng Z. The clinical effect of nursing intervention in the operating room on the prevention of orthopedic wound infections. Am J Transl Res 2021; 13:3703-3709. [PMID: 34017554 PMCID: PMC8129312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/04/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To study the preventive effect of operating room nursing intervention on surgical incision infections in elderly patients undergoing orthopedic surgery. METHODS Altogether, 128 orthopedic patients were divided into an observation group and a control group according to the nursing method each patient underwent, with 64 patients in each group. RESULTS The grade A incision healing rate in the observation group was significantly higher than the rate in the control group (P<0.01). The eating and getting out of bed times, and the lengths of the hospital stays in the observation group were significantly shorter than the corresponding times in the control group (P<0.01). The incidences of postoperative wound infections in the observation group (0 cases) was significantly lower than the incidences in the control group (14 cases, accounting for 21.88%), and the difference was statistically significant (P<0.001). After the nursing, the prognoses and quality of life scores of the patients in the observation group were better than they were in the control group, and the differences were statistically significant (P<0.01). Our investigation indicated that, after the treatment, the overall patient satisfaction rate in the observation group (98.44%) was significantly higher than the patient satisfaction rate in the control group (84.38%), and the difference was statistically significant (χ2=27.349, P=0.000). CONCLUSION Operating room nursing intervention can effectively prevent postoperative wound infections and promote incision healing, so it is worthy of application.
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Affiliation(s)
- Yan Bai
- Department of Surgery and Anesthesiology, The Second Affiliated Hospital of Xi'an Medical University Xi'an, Shaanxi Province, China
| | - Yuqiang Su
- Department of Surgery and Anesthesiology, The Second Affiliated Hospital of Xi'an Medical University Xi'an, Shaanxi Province, China
| | - Zhonglei Zheng
- Department of Surgery and Anesthesiology, The Second Affiliated Hospital of Xi'an Medical University Xi'an, Shaanxi Province, China
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Bazaliński D, Midura B, Wójcik A, Więch P. Selected Biochemical Blood Parameters and a Risk of Pressure Ulcers in Patients Receiving Treatment in Intensive Care Units. ACTA ACUST UNITED AC 2021; 57:medicina57020177. [PMID: 33669609 PMCID: PMC7922769 DOI: 10.3390/medicina57020177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/14/2021] [Accepted: 02/16/2021] [Indexed: 12/15/2022]
Abstract
Background and Objectives: This study aimed to assess the level of selected biochemical parameters in venous blood and their potential effects on the development of pressure ulcers in patients treated in intensive care settings. Materials and Methods: Fifty patients hospitalised in an intensive care unit (ICU) were enrolled for the study. The methods used included controlled observation, literature review and medical record analysis. The observation protocol applied in the study consisted of two parts comprising the basic information, sociodemographic data, results of laboratory tests (CRP, PCT, albumin, protein and haemoglobin concentrations) as well as the Braden Scale for Predicting Pressure Ulcer Risk. Results: The subjects presented moderate to high risk of pressure ulcers, reflected by the mean score of 8.18 ± 1.3 points, with minimum and maximum scores of 6 and 12 points, respectively. Normal albumin level was identified in only five subjects (10.0%) while 45 subjects (90.0%) were found with results below the norm. A statistical relationship was observed between such variables as albumin concentration (p < 0.01) and total protein level (p = 0.007). The findings show a strong correlation between the score in the Braden Scale and the level of albumins (R = 0.55). Conclusions: In our study, lower concentrations of albumins and total proteins correspond to a greater risk of pressure ulcers.
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Affiliation(s)
- Dariusz Bazaliński
- Father B. Markiewicz Podkarpackie Specialist Oncology Centre, Specialist Hospital in Brzozów, 36-200 Brzozów, Poland; (D.B.); (A.W.)
- Clinical Provincial Hospital No. 2 in Rzeszów, Rzeszów, 35-959 Rzeszów, Poland;
| | - Beata Midura
- Clinical Provincial Hospital No. 2 in Rzeszów, Rzeszów, 35-959 Rzeszów, Poland;
| | - Anna Wójcik
- Father B. Markiewicz Podkarpackie Specialist Oncology Centre, Specialist Hospital in Brzozów, 36-200 Brzozów, Poland; (D.B.); (A.W.)
- Institute of Health Sciences, College of Medical Sciences of the University of Rzeszów, University of Rzeszów, 35-959 Rzeszów, Poland
| | - Paweł Więch
- Institute of Health Sciences, College of Medical Sciences of the University of Rzeszów, University of Rzeszów, 35-959 Rzeszów, Poland
- Correspondence: ; Tel.: +48-6671-92696
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A multi-domain prognostic model of disorder of consciousness using resting-state fMRI and laboratory parameters. Brain Imaging Behav 2020; 15:1966-1976. [PMID: 33040258 DOI: 10.1007/s11682-020-00390-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Although laboratory parameters have long been recognized as indicators of outcome of traumatic brain injury (TBI), it remains a challenge to predict the recovery of disorder of consciousness (DOC) in severe brain injury including TBI. Recent advances have shown an association between alterations in brain connectivity and recovery from DOC. In the present study, we developed a prognostic model of DOC recovery via a combination of laboratory parameters and resting-state functional magnetic resonance imaging (fMRI). METHODS Fifty-one patients with DOC (age = 52.3 ± 15.2 y, male/female = 31/20) were recruited from Hangzhou Hospital of Zhejiang CAPR and were sub-grouped into conscious (n = 34) and unconscious (n = 17) groups based upon their Glasgow Outcome Scale-Extended (GOS-E) scores at 12-month follow-ups after injury. Resting-state functional connectivity, network nodal measures (centrality), and laboratory parameters were obtained from each patient and served as features for support vector machine (SVM) classifications. RESULTS We found that functional connectivity was the most accurate single-domain model (ACC: 70.1% ± 4.5%, P = 0.038, 1000 permutations), followed by degree centrality, betweenness centrality, and laboratory parameters. The stacked multi-domain prognostic model (ACC: 73.4% ± 3.1%, P = 0.005, 1000 permutations) combining all single-domain models yielded a significantly higher accuracy compared to that of the best-performing single-domain model (P = 0.002). CONCLUSION Our results suggest that laboratory parameters only contribute to the outcome prediction of DOC patients, whereas combining information from neuroimaging and clinical parameters may represent a strategy to achieve a more accurate prognostic model, which may further provide better guidance for clinical management of DOC patients.
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Evaluation of pressure ulcer risk in hospitalized patients after metabolic surgery. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.799157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Wang R, He M, Ou X, Xie X, Kang Y. CRP Albumin ratio is positively associated with poor outcome in patients with traumatic brain injury. Clin Neurol Neurosurg 2020; 195:106051. [PMID: 32650209 DOI: 10.1016/j.clineuro.2020.106051] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 05/31/2020] [Accepted: 06/27/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The C-reactive protein/albumin ratio (CAR), a novel inflammation-based index, has been proved useful in predicting outcome of various diseases. We designed this study to explore the prognostic value of CAR in patients with traumatic brain injury (TBI). PATIENTS AND METHODS We retrospectively included 151 patients diagnosed with TBI and collected related clinical and laboratory data. Univariate and multivariate logistic regression were conducted to find independent risk factors of mortality. Then, we incorporated CAR into prognostic model and drew receiver operating characteristic (ROC) curve of models. Finally, we compared the predictive value of different models by evaluating the area under the receiver operating characteristic curves (AUC). RESULTS In this study, a total of 54 patients had poor survival outcome with mortality rate of 35.8 %. Results of multivariate analysis showed that GCS score in admission (OR 0.700, 95 %Cl 0.570-0.860, p=0.001), acute kidney injury (AKI) (OR 3.952, 95Cl 1.631-9.577, p=0.002) and CAR (OR 1.202, 95Cl 1.039-1.390, p=0.013) were independently associated with in-hospital mortality. The AUC value of predictive model composed of the above three factors was higher than GCS or CAR alone. CONCLUSION CAR is an independent risk factor of mortality in patients with TBI. Incorporating CAR into predictive model could increase the value in predicting outcome of TBI patients.
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Affiliation(s)
- Ruoran Wang
- Department of Intensive Care Unit, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Min He
- Department of Intensive Care Unit, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Xiaofeng Ou
- Department of Intensive Care Unit, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Xiaoqi Xie
- Department of Intensive Care Unit, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yan Kang
- Department of Intensive Care Unit, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
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Controlling nutritional status (CONUT) score is a predictive marker for patients with traumatic brain injury. Clin Neurol Neurosurg 2020; 195:105909. [PMID: 32652392 DOI: 10.1016/j.clineuro.2020.105909] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/09/2020] [Accepted: 05/09/2020] [Indexed: 02/08/2023]
Abstract
OBJECT We designed this study to evaluate whether controlling nutritional status (CONUT) score was valuable in predicting outcome of patients with traumatic brain injury (TBI). METHODS Clinical and laboratory data of patients admitted with TBI in our hospital between January 2015 and January 2018 was retrospectively collected. We divided patients into two groups according to in-hospital and 90-day outcome respectively and compared baseline characteristics of two groups. Multivariate analyses were conducted to evaluate whether CONUT score was associated with outcome of included patients. Receiver operating characteristics (ROC) curves were drawn to compare the predictive value of CONUT score and constructed models. RESULTS A total of 365 patients were included in our study. Multivariate logistic regression analyses showed that CONUT score was independently associated with in-hospital mortality (OR = 1.244, 95% CI: 1.099-1.408, p = 0.001) and 90-day outcome (OR = 1.441, 95% CI: 1.193-1.741, p < 0.001). ROC curve showed that area under the ROC curve (AUC) of CONUT score for predicting in-hospital mortality and 90-day outcome were 0.790 (95% CI: 0.745-0.836, p < 0.001) and 0.839 (95% CI: 0.792-0.886, p < 0.001), respectively. CONCLUSION CONUT score is independently associated with in-hospital mortality and 90-day outcome of patients with TBI.
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Role of Albumin as a Nutritional and Prognostic Marker in Elective Intestinal Surgery. Can J Gastroenterol Hepatol 2020; 2020:7028216. [PMID: 32351914 PMCID: PMC7174932 DOI: 10.1155/2020/7028216] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 01/20/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The aim of this study was to investigate albumin, nutritional status, and inflammation in the perioperative course of patients undergoing elective intestinal surgery. METHODS A retrospective analysis of patients with preoperative measurements of nutritional parameters who underwent intestinal surgery between April 2017 and August 2018 at our institution was performed. Preoperatively, the correlation of albumin levels with markers for inflammation and nutritional status was investigated. Postoperatively, albumin levels were assessed with regard to high-grade morbidity and inflammation. RESULTS A total of 105 patients were included. Preoperatively, albumin levels were correlated with both markers for nutritional status and inflammation, with phase angle (PA) (p=0.004) and C-reactive protein (CRP) (p < 0.001) as independent factors predicting the albumin levels in multivariable analysis. Postoperatively, the reduction in serum albumin (∆-albumin) on postoperative day (POD) 1/2 (p=0.025) and POD 4/5 (p=0.003) was significantly associated with Clavien-Dindo complications ≥grade III. A cut-off value of 27.3% for ∆-albumin on POD 1/2 predicted postoperative high-grade morbidity (sensitivity 75% and specificity 69%). The product of ∆-albumin and CRP on POD 4/5 identified patients with major complications more reliably than ∆-albumin or CRP alone (sensitivity 91% and specificity 72%). CONCLUSION Preoperatively, albumin was a marker for nutritional status even if an inflammatory component was present. Postoperatively, ∆-albumin on POD 1/2 predicted high-grade morbidity. A new marker to identify patients with major complications on POD 4/5 is presented.
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Yamaki T, Oka N, Odaki M, Kobayashi S. Usability of intravenous thiamine injection test compared with odor stick identification test for Japanese patients with severe traumatic brain injury. Auris Nasus Larynx 2019; 47:233-237. [PMID: 31326161 DOI: 10.1016/j.anl.2019.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 06/03/2019] [Accepted: 07/03/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Olfactory dysfunction is often observed after severe traumatic brain injury (sTBI). Its diagnosis is difficult because patients with sTBI have a communication disability following impaired consciousness and communication disorder. The intravenous thiamine injection (IT) test is one of the representative diagnostic examinations to identify dysfunction, and it is often used in medical certification for liability insurance of automobiles in Japan because it could be judged by a simple reaction. However, the extent of usefulness of the IT test in the diagnosis of olfactory dysfunction in patients with sTBI is unknown. In this study, we validated the usability of the IT test and compared the results with those of the odor stick identification test for the Japanese (OSIT-J) to evaluate the sensitivity of the IT test in patients with sTBI. METHODS The study enrolled 205 subjects, including 10 healthy volunteers and 195 patients with sTBI. First, we examined olfactory dysfunction in sTBI patients using OSIT-J. Subsequently, we performed the IT test among patients with olfactory dysfunction. RESULTS In the first part, 41 subjects, including 10 healthy volunteers, were examined by using the OSIT-J test. As a result, 28 patients were diagnosed with olfactory dysfunction (90.3%, p<0.0001), including anosmia and parosmia, compared with healthy volunteers. Among the 12 odors, garlic odor was easily recognized for patients with olfactory dysfunction. As a consequence of the IT test for 11 patients with olfactory dysfunction, four patients recognized thiamine odor, and seven patients did not. All four patients could recognize the garlic odor of OSIT-J, but 2 of the seven patients could recognize the garlic odor of OSIT-J, suggesting that the thiamine odor is linked to garlic odor (p=0.046), but not always. The detection rate of olfactory dysfunction through the IT test was 36.4%. CONCLUSION Our data showed that garlic odor, which is similar to thiamine odor, was easily recognizable for patients with sTBI. However, the IT test might overlook the diagnosis of olfactory dysfunction because it only identifies one odor. In addition, thiamine frequently induces angialgia. We should pay attention to the overconfidence of the IT test for patients with sTBI.
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Affiliation(s)
- Tomohiro Yamaki
- Division of Neurosurgery, Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, Chiba, Japan; Division of PET imaging, Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, Chiba, Japan.
| | - Nobuo Oka
- Division of Neurosurgery, Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, Chiba, Japan.
| | - Masaru Odaki
- Division of Neurosurgery, Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, Chiba, Japan.
| | - Shigeki Kobayashi
- Division of Neurosurgery, Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, Chiba, Japan.
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Scarponi F, Zampolini M, Zucchella C, Bargellesi S, Fassio C, Pistoia F, Bartolo M. Identifying clinical complexity in patients affected by severe acquired brain injury in neurorehabilitation: a cross sectional survey. Eur J Phys Rehabil Med 2019; 55:191-198. [DOI: 10.23736/s1973-9087.18.05342-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Risk of mortality and level of serum alanine aminotransferase among community-dwelling elderly in Israel. Eur J Gastroenterol Hepatol 2018; 30:1428-1433. [PMID: 30048334 DOI: 10.1097/meg.0000000000001225] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Serum alanine aminotransferase (ALT) levels below and above the reference range have been found to serve as a marker of liver injury and to predict all-cause mortality. The need to adjust the reference range by age, sex, or other parameters remains unclear. The current reference range of serum ALT in Israel is 0-34 IU/l for women and 0-45 IU/l for men. We aimed to test the applicability of the current reference range values of ALT in specific people - the elderly population. METHODS A retrospective design was used. The study population consisted of community-dwelling individuals aged at least 65 years who were tested for serum ALT in 2002 at a large health management organization and followed until the end of December 2012. Data were collected on demographics, laboratory tests, comorbidities, and mortality. RESULTS A total of 49 634 participants (59% women, mean age 83.2±6.3 years) were included. ALT levels between 16 and 25 IU/l were associated with the lowest mortality (hazard ratio=1), and values of less than 16 IU/l and more than 25 IU/l (unadjusted) were associated with higher mortality risk, yielding a U-shaped pattern.Highest mortality rates were also revealed at serum ALT levels more than 56 IU/l and less than 10 IU/l. A significant association of higher mortality risk was noted with lower mean values of hemoglobin, albumin, and total cholesterol, both for patients with lower serum ALT levels (<10 IU/l) and patients with higher serum levels (>56 IU/l). CONCLUSION Very low and very high levels of serum ALT within the current reference range are associated with an increased risk of death in community-dwelling individuals of at least 65 years old.
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Takahara M, Iida O, Soga Y, Azuma N, Nanto S. Length and Cost of Hospital Stay in Poor-Risk Patients With Critical Limb Ischemia Undergoing Revascularization. Circ J 2018; 82:2634-2639. [PMID: 30012928 DOI: 10.1253/circj.cj-18-0289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The aim of the current study was to identify the distribution of length and cost of hospital stay and their associated risk factors in poor-risk Japanese critical limb ischemia (CLI) patients undergoing revascularization. Methods and Results: We analyzed prospectively collected data from 507 CLI patients who required assistance in their daily lives due to disability in activities of daily living and/or cognitive function impairment and who underwent revascularization. The median length and cost of hospital stay were 23 days (IQR, 9-52 days) and ¥2.25m (IQR, ¥1.33m-3.58m), respectively. Reduced albumin, tissue loss, infection, surgical reconstruction, and bilateral revascularization were associated with prolonged hospital stay (P=0.012, 0.019, <0.001, <0.001, and <0.001, respectively). Doubling the length of the hospital stay was associated with a 44% increase in hospital cost. Regular dialysis, surgical reconstruction, and bilateral revascularization were independently associated with an approximately 20% increase in the cost of hospital stay (all P<0.001). CONCLUSIONS Length and cost of hospital stay varied considerably between patients. Low serum albumin, tissue loss, infection, surgical reconstruction, and bilateral revascularization were associated with longer hospital stay. Regular dialysis, surgical reconstruction, and bilateral revascularization were independently associated with an approximately 20% increase in the cost of hospital stay.
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Affiliation(s)
- Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine.,Department of Metabolic Medicine, Osaka University Graduate School of Medicine
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | | | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
| | - Shinsuke Nanto
- Department of Cardiology, Nishinomiya Municipal Central Hospital
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Do Medical Complications Impact Long-Term Outcomes in Prolonged Disorders of Consciousness? Arch Phys Med Rehabil 2018; 99:2523-2531.e3. [PMID: 29807003 DOI: 10.1016/j.apmr.2018.04.024] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/15/2018] [Accepted: 04/26/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To investigate medical complications (MCs) occurring within 6 months postinjury in brain-injured patients with prolonged disorders of consciousness (DoC) and to evaluate impact of MC on mortality and long-term clinical outcomes. DESIGN Prospective observational cohort study. SETTING Rehabilitation unit for acquired DoC. PARTICIPANTS Patients (N=194) with DoC (142 in vegetative state [VS], 52 in minimally conscious state; traumatic etiology 43, anoxic 69, vascular 82) consecutively admitted to a neurorehabilitation unit within 1-3 months postonset. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Mortality and improvements in clinical diagnosis and functional disability level (assessed by Coma Recovery Scale-Revised [CRS-R] and Disability Rating Scale) at 12, 24, and 36 months postonset. RESULTS Within 6 months postinjury, 188 of 194 patients (>95%) developed at least 1 MC and 142 of them (73%) showed at least 1 severe MC. Respiratory and musculoskeletal-cutaneous MCs were the most frequent, followed by endocrino-metabolic abnormalities. Follow-up, complete in 189 of 194 patients, showed that male sex and endocrine-metabolic MCs were associated with higher risk of mortality at all timepoints. Old age, anoxic etiology, lower CRS-R total scores, and diagnosis of VS at study entry predicted no clinical and functional improvements at most timepoints; however, epilepsy predicted no improvement in diagnosis at 24 months postonset only. CONCLUSIONS MCs are very frequent in patients with DoC within at least 6 months after brain injury, regardless of clinical diagnosis, etiology, and age. Endocrino-metabolic MCs are independent predictors of mortality at all timepoints; however,epilepsy predicted poor long-term outcome. Occurrence and severity of MCs in patients with DoC call for long-term appropriate levels of care after the postacute phase.
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Chen JH, Wu SC, Chen HJ, Kao CH, Tseng CH, Tsai CH. Risk of developing pressure sore in amyotrophic lateral sclerosis patients - a nationwide cohort study. J Eur Acad Dermatol Venereol 2018; 32:1589-1596. [PMID: 29512203 DOI: 10.1111/jdv.14911] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 02/08/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Prior investigations with few cases have disclosed lack of pressure sore (PrS) formation was characteristic in amyotrophic lateral sclerosis (ALS) patients. However, studies with larger samples are lacking to ascertain this concept. OBJECTIVE To investigate whether patients with ALS have higher risk of PrS. METHODS Utilizing a Taiwan National Insurance claims data set with 23 million participants, we extracted 514 patients with ALS and 2056 controls from 1 January 2000 to 31 December 2008. Both groups were followed up until PrS occurrence during study period (2000-2011). The PrS risk was calculated with Cox proportional regression model. RESULTS The patients with ALS had a greater PrS risk (adjusted hazard ratio [aHR] = 8.82, 95% confidence interval [CI] = 4.90-15.9, P < 0.001) than the controls did. PrS risk was much higher in ALS women (aHR = 26.6, 95% CI = 9.05-78.2, P < 0.001) than in ALS men (aHR = 4.38, 95% CI = 1.99-9.68, P < 0.001). Besides, in people aged 20-54, ALS was linked with a much greater PrS risk (aHR = 27.7, 95% CI = 5.79-132, P < 0.001) than in those aged ≥55 (aHR = 6.10, 95% CI = 3.10-12.0, P < 0.001). CONCLUSIONS Amyotrophic lateral sclerosis is discovered to be correlated with an enhanced PrS risk. For PrS prevention, it is needed to pay more attention to the management of the patients with ALS, particularly in women and those with relatively younger age. Further investigations are needed to confirm the findings in this study.
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Affiliation(s)
- J-H Chen
- Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - S-C Wu
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Trauma and Emergency Center, China Medical University Hospital, Taichung, Taiwan
| | - H-J Chen
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - C-H Kao
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
| | - C-H Tseng
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Neurology, China Medical University Hospital, Taichung, Taiwan
| | - C-H Tsai
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Neurology, China Medical University Hospital, Taichung, Taiwan
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Saghaleini SH, Dehghan K, Shadvar K, Sanaie S, Mahmoodpoor A, Ostadi Z. Pressure Ulcer and Nutrition. Indian J Crit Care Med 2018; 22:283-289. [PMID: 29743767 PMCID: PMC5930532 DOI: 10.4103/ijccm.ijccm_277_17] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Pressure ulcers can diminish global life quality, contribute to rapid mortality in some patients and pose a significant cost to health-care organizations. Accordingly, their prevention and management are highly important. Nutritional deprivation and insufficient dietary intake are the key risk factors for the development of pressure ulcers and impaired wound healing. Unplanned weight loss is a major risk factor for malnutrition and pressure ulcer development. Suboptimal nutrition interferes with the function of the immune system, collagen synthesis, and tensile strength. No laboratory test can exactly define an individual's nutritional status. Although serum albumin, prealbumin, transferrin, and retinol-binding protein as well as anthropometric measures such as height, weight, and body mass index and the other laboratory values may be suitable to establish the overall prognosis, still they might not well represent the nutritional status. Although the ideal nutrient intake to encourage wound healing is unknown, increased needs for energy, protein, zinc, and Vitamins A, C, and E and also amino acids such as arginine and glutamine have been documented. Hydration plays a vital role in the preservation and repair of skin integrity. Dehydration disturbs cell metabolism and wound healing. Adequate fluid intake is necessary to support the blood flow to wounded tissues and to prevent additional breakdown of the skin. The main aim of the present article is to review the current evidence related to hydration and nutrition for bedsore prevention and management in adults.
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Affiliation(s)
- Seied Hadi Saghaleini
- Department of Anesthesiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kasra Dehghan
- Department of Anesthesiology, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Kamran Shadvar
- Department of Anesthesiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sarvin Sanaie
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ata Mahmoodpoor
- Department of Anesthesiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zohreh Ostadi
- Department of Anesthesiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Esposito S, Bonavita S, Sparaco M, Gallo A, Tedeschi G. The role of diet in multiple sclerosis: A review. Nutr Neurosci 2017; 21:377-390. [PMID: 28338444 DOI: 10.1080/1028415x.2017.1303016] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Multiple sclerosis (MS) is a multifactorial, inflammatory, and neurodegenerative disease of the central nervous system, where environmental factors interact with genetic susceptibility. The role of diet on MS has not been comprehensively elucidated; therefore, through an extensive search of relevant literature, this review reports the most significant evidence regarding nutrition as a possible co-factor influencing the inflammatory cascade by acting on both its molecular pathways and gut microbiota. Since nutritional status and dietary habits in MS patients have not been extensively reported, the lack of a scientific-based consensus on dietary recommendation in MS could encourage many patients to experiment alternative dietetic regimens, increasing the risk of malnutrition. This work investigates the health implications of an unbalanced diet in MS, and collects recent findings on nutrients of great interest among MS patients and physicians. The aim of this review is to elucidate the role of an accurate nutritional counseling in MS to move toward a multidisciplinary management of the disease and to encourage future studies demonstrating the role of a healthy diet on the onset and course of MS.
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Affiliation(s)
- Sabrina Esposito
- a I Clinic of Neurology, Second University of Naples , 80138 , Italy.,b Department of Neuroscience, Psychology, Drug Research and Child Health , University of Florence , Italy
| | - Simona Bonavita
- a I Clinic of Neurology, Second University of Naples , 80138 , Italy.,c MRI Research Center SUN-FISM, Second University of Naples , Italy.,d Institute for Diagnosis and Care "Hermitage Capodimonte" , Naples , Italy
| | - Maddalena Sparaco
- a I Clinic of Neurology, Second University of Naples , 80138 , Italy
| | - Antonio Gallo
- a I Clinic of Neurology, Second University of Naples , 80138 , Italy.,c MRI Research Center SUN-FISM, Second University of Naples , Italy.,d Institute for Diagnosis and Care "Hermitage Capodimonte" , Naples , Italy
| | - Gioacchino Tedeschi
- a I Clinic of Neurology, Second University of Naples , 80138 , Italy.,c MRI Research Center SUN-FISM, Second University of Naples , Italy.,d Institute for Diagnosis and Care "Hermitage Capodimonte" , Naples , Italy
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Kahveci K, Dinçer M, Doger C, Yaricı AK. Traumatic brain injury and palliative care: a retrospective analysis of 49 patients receiving palliative care during 2013-2016 in Turkey. Neural Regen Res 2017; 12:77-83. [PMID: 28250751 PMCID: PMC5319246 DOI: 10.4103/1673-5374.198987] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Traumatic brain injury (TBI), which is seen more in young adults, affects both patients and their families. The need for palliative care in TBI and the limits of the care requirement are not clear. The aim of this study was to investigate the length of stay in the palliative care center (PCC), Turkey, the status of patients at discharge, and the need for palliative care in patients with TBI. The medical records of 49 patients with TBI receiving palliative care in PCC during 2013–2016 were retrospectively collected, including age and gender of patients, the length of stay in PCC, the cause of TBI, diagnosis, Glasgow Coma Scale score, Glasgow Outcome Scale score, Karnofsky Performance Status score, mobilization status, nutrition route (oral, percutaneous endoscopic gastrostomy), pressure ulcers, and discharge status. These patients were aged 45.4 ± 20.2 years. The median length of stay in the PCC was 34.0 days. These included TBI patients had a Glasgow Coma Scale score ≤ 8, were not mobilized, received tracheostomy and percutaneous endoscopic gastrostomy nutrition, and had pressure ulcers. No difference was found between those who were discharged to their home or other places (rehabilitation centre, intensive care unit and death) in respect of mobilization, percutaneous endoscopic gastrostomy, tracheostomy and pressure ulcers. TBI patients who were followed up in PCC were determined to be relatively young patients (45.4 ± 20.2 years) with mobilization and nutrition problems and pressure ulcer formation. As TBI patients have complex health conditions that require palliative care from the time of admittance to intensive care unit, provision of palliative care services should be integrated with clinical applications.
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Affiliation(s)
- Kadriye Kahveci
- Department of Anesthesiology and Reanimation, Ankara Ulus State Hospital, Ankara, Turkey
| | - Metin Dinçer
- Health Institutions Management, Yıldırım Beyazıt University, Faculty of Health Sciences, Ankara, Turkey; Ankara Ulus State Hospital, Ankara, Turkey
| | - Cihan Doger
- Department of Anesthesiology and Reanimation, Ankara Ataturk Training and Research Hospital, Ankara, Turkey
| | - Ayse Karhan Yaricı
- Department of Anesthesiology and Reanimation, Ankara Ulus State Hospital, Ankara, Turkey
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Park G, Lee JE, Han SJ. Nutritional Assessment in Vegetative and Minimally Conscious Patients. BRAIN & NEUROREHABILITATION 2017. [DOI: 10.12786/bn.2017.10.e12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Gahee Park
- Department of Rehabilitation Medicine, Ewha Womans University Medical Center, Ewha Womans University College of Medicine, Seoul, Korea
| | - Jeong Eun Lee
- Department of Rehabilitation Medicine, Seonam Hospital, Ewha Womans University Medical Center, Seoul, Korea
| | - Soo Jeong Han
- Department of Rehabilitation Medicine, Ewha Womans University Medical Center, Ewha Womans University College of Medicine, Seoul, Korea
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