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Novikov N, Buch A, Yang H, Andruk M, Liu G, Wu M, Howell H, MacDonald B, Savage W. First-in-Human Phase 1 Study Evaluating the Safety, Pharmacokinetics, and Pharmacodynamics of DISC-0974, an Anti-Hemojuvelin Antibody, in Healthy Participants. J Clin Pharmacol 2024; 64:953-962. [PMID: 38515275 DOI: 10.1002/jcph.2432] [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: 12/06/2023] [Accepted: 02/27/2024] [Indexed: 03/23/2024]
Abstract
Pathologic elevations in hepcidin, a key regulator of iron homeostasis, contribute to anemia of inflammation in chronic disease. DISC-0974 is a monoclonal antibody that binds to hemojuvelin and blocks bone morphogenetic protein signaling, thereby suppressing hepcidin production. Reduction of systemic hepcidin levels is predicted to increase iron absorption and mobilize stored iron into circulation, where it may be utilized by red blood cell (RBC) precursors in the bone marrow to improve hemoglobin levels and to potentially alleviate anemia of inflammation. We conducted a first-in-human, double-blind, placebo-controlled, single-ascending dose study to evaluate safety, pharmacokinetics, and pharmacodynamics of DISC-0974 in healthy participants. Overall, 42 participants were enrolled and received a single dose of placebo or DISC-0974 at escalating dose levels (7-56 mg), administered intravenously (IV) or subcutaneously (SC). DISC-0974 was well tolerated, with a safety profile comparable to that of placebo. Pharmacokinetic data was dose and route related, with a terminal half-life of approximately 7 days. The bioavailability of SC dosing was ∼50%. Pharmacodynamic data showed dose-dependent decreases in serum hepcidin, with reductions of nearly 75% relative to baseline at the highest dose level tested, and corresponding increases in serum iron in response to DISC-0974 administration. Dose-dependent changes in serum ferritin and hematology parameters were also observed, indicating mobilization of iron stores and downstream effects of enhanced hemoglobinization and production of RBCs. Altogether, these data are consistent with the mechanism of action of DISC-0974 and support the selection of a biologically active dose range for evaluation in clinical trials for individuals with anemia of inflammation.
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MESH Headings
- Humans
- Male
- Adult
- Double-Blind Method
- Female
- Hepcidins/blood
- Middle Aged
- Healthy Volunteers
- Young Adult
- Hemochromatosis Protein
- GPI-Linked Proteins/antagonists & inhibitors
- Dose-Response Relationship, Drug
- Half-Life
- Antibodies, Monoclonal/pharmacokinetics
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/pharmacology
- Iron
- Injections, Subcutaneous
- Antibodies, Monoclonal, Humanized/pharmacokinetics
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/pharmacology
- Adolescent
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Affiliation(s)
| | - Akshay Buch
- Disc Medicine, Watertown, Massachusetts, USA
| | - Hua Yang
- Disc Medicine, Watertown, Massachusetts, USA
| | | | - Guowen Liu
- Disc Medicine, Watertown, Massachusetts, USA
| | - Min Wu
- Disc Medicine, Watertown, Massachusetts, USA
| | | | | | - Will Savage
- Disc Medicine, Watertown, Massachusetts, USA
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2
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Lobato CT, Castelo Branco S, Camões J, Molinos E. Rhabdomyolysis secondary to a weight-loss prescription. BMJ Case Rep 2024; 17:e258208. [PMID: 38857915 DOI: 10.1136/bcr-2023-258208] [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: 06/12/2024] Open
Abstract
We present a case of a case of a man in his 70s on multiple medications (including treatment of ischemic heart disease and diabetes who developed significant rhabdomyolysis, complicated by acute kidney injury (AKI) and encephalopathy, while using a compounded medication for weight loss. The patient was admitted to the intensive care unit and progressed favourably after haemodialysis and supportive care. Information regarding the ingestion of weight-loss drugs was unknown at the time of admission and was only discovered after resolution of encephalopathy, raising the possibility of toxin-associated rhabdomyolysis. This case emphasises the need for a thorough clinical history and scrutiny of the safety of weight-loss prescriptions, including preparations that comprise a combination of drugs and supplements that may adversely interact with chronic medications, especially in polymedicated patients.
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Affiliation(s)
| | | | - João Camões
- Emergency and Intensive Care, Hospital Pedro Hispano, Matosinhos, Portugal
| | - Elena Molinos
- Emergency and Intensive Care, Hospital Pedro Hispano, Matosinhos, Portugal
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3
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Wubet HB, Mengistu LH, Gobezie NZ, Mekuriaw BY, Mebratie AF, Sahile WA. The incidence and factors associated with anemia in elective surgical patients admitted to a surgical intensive care unit: a retrospective cohort study. Eur J Med Res 2024; 29:290. [PMID: 38764061 PMCID: PMC11103962 DOI: 10.1186/s40001-024-01887-4] [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: 12/28/2023] [Accepted: 05/15/2024] [Indexed: 05/21/2024] Open
Abstract
BACKGROUND Anemia is a frequently reported and commonly documented issue in intensive care units. In surgical intensive care units, more than 90% of patients are found to be anemic. It is a hematologic factor that contributes to extended mechanical ventilation, sepsis, organ failure, longer hospitalizations in critical care units, and higher mortality. Thus, this study aimed to determine the incidence and identify factors associated with anemia in elective surgical patients admitted to the surgical intensive care unit. METHODS A retrospective follow-up study involving 422 hospitalized patients was carried out between December 2019 and December 2022 in the surgical intensive care unit after elective surgery at Tikur-Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Data were gathered from the patients' charts, and study participants were chosen using methods of systematic random sampling. SPSS 26 (the statistical software for social science, version 26) was used to analyze the data. Bivariable and multivariable binary logistic regression were used to examine associations between variables. RESULTS The incidence of anemia in elective surgical patients admitted to the intensive care unit was 69.9% (95% CI 65.4-74.5%). American Society of Anesthesiologists' class III (ASA III) [AOR: 8.53, 95% CI 1.92-13.8], renal failure [AOR:2.53, 95% CI (1.91-5.81)], malignancy [AOR: 2.59, 95% CI (1.31-5.09)], thoracic surgery [AOR: 4.07, 95% CI (2.11-7.87)], urologic surgery [AOR: 6.22, 95% CI (2.80-13.80)], and neurosurgery [AOR: 4.51, 95% CI (2.53-8.03)] were significantly associated with anemia in surgical patients admitted to the intensive care unit. CONCLUSION More than two-thirds of the intensive care unit-admitted surgical patients experienced anemia. An American Society of Anesthesiologists' (ASA III score), renal failure, malignancy, thoracic surgery, urologic surgery, and neurosurgery were significantly associated with this condition. Early identification helps to institute preventive and therapeutic measures.
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Affiliation(s)
- Habtie Bantider Wubet
- Department of Anesthesia, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia.
| | - Lidya Haddis Mengistu
- Department of Anesthesia, College of Medicine and Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Negesse Zurbachew Gobezie
- Department of Anesthesia, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Begizew Yimenu Mekuriaw
- Department of Midwifery, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Alemie Fentie Mebratie
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Wosenyeleh Admasu Sahile
- Department of Anesthesia, College of Medicine and Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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4
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Zhu X, Xie M, Fan J, Geng B, Fei G, Zhou Q, Wu H, Liu X, Jiang X. Clinical characteristics and risk factors for late-onset pneumocystis jirovecii pneumonia in kidney transplantation recipients. Mycoses 2024; 67:e13688. [PMID: 38214337 DOI: 10.1111/myc.13688] [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: 08/29/2023] [Revised: 12/09/2023] [Accepted: 12/14/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Pneumocystis jirovecii pneumonia (PJP) is a common and troublesome complication of kidney transplantation. In the era of prophylaxis, the peak incidence of PJP after kidney transplantation and specific characteristics of late-onset PJP have always been debated. METHODS We performed a retrospective study by analysing the data of post-transplantation pneumonia in adult kidney transplantation recipients between March 2014 and December 2021 in The Affiliated First Hospital of University of Science and Technology of China (USTC). A total of 361 patients were included and divided into early-onset PJP, late-onset PJP and non-PJP groups. The characteristics of each group and related risk factors for the late-onset patients were investigated. RESULTS Some patients developed PJP 9 months later with a second higher occurrence between month 10 and 15 after transplantation. Compared with non-PJP, ABO-incompatible and cytomegalovirus (CMV) viremia were significantly associated with late onset of PJP in multivariate analysis. The use of tacrolimus, CMV viremia, elevated CD8(+) T cell percent and hypoalbuminemia were risk factors for late PJP. Receiver operating characteristic curve analysis demonstrated that a combination of those factors could increase the sensitivity of prediction remarkably, with an area under the curve of 0.82, a sensitivity of 80% and a specificity of 83%. CONCLUSIONS PJP could occur months after kidney transplantation. ABO-incompatible transplant recipients are at high risk of PJP. In the later stages of transplantation, CMV viremia, T lymphocyte subsets percentage and serum albumin levels should be monitored in patients using tacrolimus.
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Affiliation(s)
- Xiaofeng Zhu
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
- Department of Pulmonary Medicine, School of Clinical Medicine, Bengbu Medical College, Bengbu, China
| | - Mengshu Xie
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
- Department of Pulmonary Medicine, School of Clinical Medicine, Bengbu Medical College, Bengbu, China
| | - Jiaqi Fan
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Bei Geng
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Guangru Fei
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Qianqian Zhou
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Huimei Wu
- Anhui Geriatric Institute, Department of Geriatric Respiratory and Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xuehan Liu
- Core Facility Center for Medical Sciences, The First Affiliated Hospital of USTC, Hefei, China
| | - Xuqin Jiang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
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5
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Nwafor DC, Kirby BD, Ralston JD, Colantonio MA, Ibekwe E, Lucke-Wold B. Neurocognitive Sequelae and Rehabilitation after Subarachnoid Hemorrhage: Optimizing Outcomes. JOURNAL OF VASCULAR DISEASES 2023; 2:197-211. [PMID: 37082756 PMCID: PMC10111247 DOI: 10.3390/jvd2020014] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Subarachnoid hemorrhage (SAH) is a medical emergency that requires immediate intervention. The etiology varies between cases; however, rupture of an intracranial aneurysm accounts for 80% of medical emergencies. Early intervention and treatment are essential to prevent long-term complications. Over the years, treatment of SAH has drastically improved, which is responsible for the rapid rise in SAH survivors. Post-SAH, a significant number of patients exhibit impairments in memory and executive function and report high rates of depression and anxiety that ultimately affect daily living, return to work, and quality of life. Given the rise in SAH survivors, rehabilitation post-SAH to optimize patient outcomes becomes crucial. The review addresses the current rehabilitative strategies to combat the neurocognitive and behavioral issues that may arise following SAH.
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Affiliation(s)
- Divine C. Nwafor
- Department of Neuroscience, West Virginia University Health Science Center, Morgantown, WV 26506, USA
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV 26506, USA
| | - Brandon D. Kirby
- Department of Neuroscience, West Virginia University Health Science Center, Morgantown, WV 26506, USA
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV 26506, USA
| | - Jacob D. Ralston
- Department of Neuroscience, West Virginia University Health Science Center, Morgantown, WV 26506, USA
| | - Mark A. Colantonio
- Department of Neuroscience, West Virginia University Health Science Center, Morgantown, WV 26506, USA
| | - Elochukwu Ibekwe
- Department of Neurology and Neurocritical Care, The Ohio State University, Columbus, OH 43210, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, FL 32611, USA
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6
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Erkens R, Duse D, Wernly B, Flaatten H, Fjølner J, Bruno RR, Wolff G, Artigas A, Kelm M, Beil M, Sviri S, Schaller SJ, Fuest K, Szczeklik W, Piayda K, Elhadi M, Joannidis M, Nedergaard HK, Oeyen S, Moreno R, Leaver S, de Lange DW, Guidet B, Jung C. Associations of anemia and blood transfusions with mortality in old, critically ill COVID-19 patients - Results from the prospective COVIP Study. Clin Hemorheol Microcirc 2023; 84:309-320. [PMID: 37248892 DOI: 10.3233/ch-231790] [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: 05/31/2023]
Abstract
AIMS Anemia is common in the old and often observed in critically ill patients. Increased age is associated with higher mortality following a COVID-19 infection, making old patients prone to poor outcomes. We investigated whether anemia at admission to the ICU or the need for blood transfusion was associated with 90-day mortality in older, critically ill COVID-19 patients. METHODS In this prospective multicenter study, the 90-day mortality of COVID-19 patients≥70 years treated in 138 intensive care units (ICU) was analyzed. Associations between anemia (WHO definition) at admission and discharge from ICU and the use of red blood cell (RBC) transfusions with mortality were assessed. Hemoglobin thresholds of RBC transfusions in old, critically ill COVID-19 patients were recorded. RESULTS In 493 patients (350 anemic, 143 non-anemic), anemia (WHO definition) at the time of ICU admission was not associated with impaired overall survival. Transfusion and severe anemia (hemoglobin≤10 g/dL) at ICU discharge were independently associated with a higher risk of 90-day mortality. CONCLUSION The need for red blood cell transfusions and severe anemia at ICU discharge, but not at the timepoint of admission, were independently associated with 90-day mortality in critically-ill old COVID-19 patients.
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Affiliation(s)
- Ralf Erkens
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Dragos Duse
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Bernhard Wernly
- Department of Cardiology, Paracelsus Medical University, Salzburg, Austria
| | - Hans Flaatten
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Jesper Fjølner
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Raphael Romano Bruno
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Georg Wolff
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Antonio Artigas
- Department of Intensive Care Medicine, Parc Tauli Hospital Universitari, Institut d'Investigació I Innovacio Par tauli (I3PT-CERCA), CIBER Enfermedades Respiratorias, Autonomous University of Barcelona, Barcelona, Spain
| | - Malte Kelm
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
- CARID (Cardiovascular Research Institute Düsseldorf), Düsseldorf, Germany
| | - Michael Beil
- Department of Medical Intensive Care, Hadassah University Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sigal Sviri
- Department of Medical Intensive Care, Hadassah University Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Stefan J Schaller
- Department of Anesthesiology and Operative Intensive Care Medicine (CVK, CCM), Charitè-Universitätsmedizin Berlin, Freie Universiätt Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Kristina Fuest
- Klinikum Rechts der Isar, Department of Anaesthesiology & Intensive Care Medicine, School of Medicine, Technical University Munich, Munich, Germany
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Kerstin Piayda
- Department of Cardiology and Angiology, Universitätsklinikum Gießen und Marburg, Gießen, Germany
| | | | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Helene Korvenius Nedergaard
- Department of Anesthesiology and Intensive Care, University Hospital of Southern Denmark, Kolding, and Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Sandra Oeyen
- Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium
| | - Rui Moreno
- Unidade de Cuidados Intensivos Neurocríticos e Trauma, Hospital de São José, Centro Hospitalar Universitério de Lisboa Central, Faculdade de Ciências Médicas de Lisboa, Nova Médical School, Lisbon, Portugal
| | - Susannah Leaver
- General Intensive Care, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Dylan W de Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Bertrand Guidet
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: Épidémiologie Hospitalière Qualité et Organisation des Soins, Paris, France
- Assistance Publique -Hôpitaux de Paris, Hôpital Saint-Antoine, Service de Réanimation Médicale,, Paris, France
| | - Christian Jung
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
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Mathew SC, Bhatia G, Kaur R, Mathai AS. Appropriateness of red cell transfusion practices in an intensive care unit: A prospective observational study. Indian J Anaesth 2022; 66:796-799. [PMID: 36590190 PMCID: PMC9795497 DOI: 10.4103/ija.ija_1027_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 11/05/2022] [Accepted: 11/05/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Sona C. Mathew
- Department of Anaesthesia, CMC Vellore, Tamil Nadu, India,Address for correspondence: Dr. Sona C. Mathew, Department of Anaesthesia, Christian Medical College, IDA Scudder Rd, Vellore, Tamil Nadu - 632 004, India. E-mail:
| | - Gaurav Bhatia
- Department of Critical Care, SGHS Hospital, Sohana, Mohali, Punjab, India
| | - Rupinder Kaur
- Department of Pathology, MMIMSR, Mullana, Ambala, Haryana, India
| | - Ashu Sara Mathai
- Department of Anaesthesia, Believers Church Medical College, Thiruvalla, Kerala, India
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Juárez-Vela R, Andrés-Esteban EM, Santolalla-Arnedo I, Ruiz de Viñaspre-Hernández R, Benito-Puncel C, Serrano-Lázaro A, Marcos-Neira P, López-Fernández A, Tejada-Garrido CI, Sánchez-González JL, Quintana-Díaz M, García-Erce JA. Epidemiology and Associated Factors in Transfusion Management in Intensive Care Unit. J Clin Med 2022; 11:jcm11123532. [PMID: 35743602 PMCID: PMC9225042 DOI: 10.3390/jcm11123532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 06/16/2022] [Accepted: 06/16/2022] [Indexed: 11/16/2022] Open
Abstract
Severe traumatic injury is one of the main global health issues which annually causes more than 5.8 million worldwide deaths. Uncontrolled haemorrhage is the main avoidable cause of death among severely injured individuals. Management of trauma patients is the greatest challenge in trauma emergency care, and its proper diagnosis and early management of bleeding trauma patients, including blood transfusion, are critical for patient outcomes. Aim: We aimed to describe the epidemiology of transfusion practices in severe trauma patients admitted into Spanish Intensive Care Units. Material and Methods: We performed a multicenter cross-sectional study in 111 Intensive Care Units across Spain. Adult patients with moderate or severe trauma were eligible. Distribution of frequencies was used for qualitative variables and the mean, with its 95% CI, for quantitative variables. Transfusion programmes, the number of transfusions performed, and the blood component transfused were recorded. Demographic variables, mortality rate, hospital stay, SOFA-score and haemoglobin levels were also gathered. Results: We obtained results from 109 patients. The most transfused blood component was packet red blood cells with 93.8% of total transfusions versus 43.8% of platelets and 37.5% of fresh plasma. The main criteria for transfusion were analytical criteria (43.75%), and acute anaemia with shock (18.75%) and without haemodynamic impact (18.75%). Conclusion: Clinical practice shows a ratio of red blood cells, platelets, and Fresh Frozen Plasma (FFP) of 2:1:1. It is necessary to implement Massive Transfusion Protocols as they appear to improve outcomes. Our study suggests that transfusion of RBC, platelets and FFP in a 2:1:1 ratio could be beneficial for trauma patients.
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Affiliation(s)
- Raúl Juárez-Vela
- Doctoral Programme in Medicine and Surgery, Faculty of Medicine, Autonomous University of Madrid, 28049 Madrid, Spain;
- GRUPAC, Department of Nursing, University of La Rioja, 26004 Logroño, Spain; (I.S.-A.); (R.R.d.V.-H.)
- Research Institute IdiPaz, 28029 Madrid, Spain;
| | - Eva María Andrés-Esteban
- Research Institute IdiPaz, 28029 Madrid, Spain;
- Department of Business Economics and Applied Economy, Faculty of Legal and Economic Sciences, Rey Juan Carlos University, 28933 Madrid, Spain
| | - Ivan Santolalla-Arnedo
- GRUPAC, Department of Nursing, University of La Rioja, 26004 Logroño, Spain; (I.S.-A.); (R.R.d.V.-H.)
| | | | | | | | - Pilar Marcos-Neira
- Intensive Care Unit, Hospital Germans Trias i Pujol, 08916 Badalona, Spain;
| | | | - Clara Isabel Tejada-Garrido
- GRUPAC, Department of Nursing, University of La Rioja, 26004 Logroño, Spain; (I.S.-A.); (R.R.d.V.-H.)
- Correspondence: (C.I.T.-G.); (M.Q.-D.)
| | | | - Manuel Quintana-Díaz
- Research Institute IdiPaz, 28029 Madrid, Spain;
- Intensive Care Unit, University Hospital of La Paz, 28046 Madrid, Spain;
- Correspondence: (C.I.T.-G.); (M.Q.-D.)
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9
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Avoidable Blood Loss in Critical Care and Patient Blood Management: Scoping Review of Diagnostic Blood Loss. J Clin Med 2022; 11:jcm11020320. [PMID: 35054014 PMCID: PMC8777821 DOI: 10.3390/jcm11020320] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 12/27/2021] [Accepted: 01/04/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Anemia remains one of the most common comorbidities in intensive care patients worldwide. The cause of anemia is often multifactorial and triggered by underlying disease, comorbidities, and iatrogenic factors, such as diagnostic phlebotomies. As anemia is associated with a worse outcome, especially in intensive care patients, unnecessary iatrogenic blood loss must be avoided. Therefore, this scoping review addresses the amount of blood loss during routine phlebotomies in adult (>17 years) intensive care patients and whether there are factors that need to be improved in terms of patient blood management (PBM). Methods: A systematic search of the Medline Database via PubMed was conducted according to PRISMA guidelines. The reported daily blood volume for diagnostics and other relevant information from eligible studies were charted. Results: A total of 2167 studies were identified in our search, of which 38 studies met the inclusion criteria (9 interventional studies and 29 observational studies). The majority of the studies were conducted in the US (37%) and Canada (13%). An increasing interest to reduce iatrogenic blood loss has been observed since 2015. Phlebotomized blood volume per patient per day was up to 377 mL. All interventional trials showed that the use of pediatric-sized blood collection tubes can significantly reduce the daily amount of blood drawn. Conclusion: Iatrogenic blood loss for diagnostic purposes contributes significantly to the development and exacerbation of hospital-acquired anemia. Therefore, a comprehensive PBM in intensive care is urgently needed to reduce avoidable blood loss, including blood-sparing techniques, regular advanced training, and small-volume blood collection tubes.
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10
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Kuno T, Miyamoto Y, Iwagami M, Ishimaru M, So M, Takahashi M, Egorova NN. The association of hemoglobin drop with in-hospital outcomes in COVID-19 patients. QJM 2022; 114:789-794. [PMID: 34597401 PMCID: PMC8500138 DOI: 10.1093/qjmed/hcab251] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/16/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Bleeding events can be critical in hospitalized patients with COVID-19, especially those with aggressive anticoagulation therapy. AIM We aimed to investigate whether hemoglobin drop was associated with increased risk of acute kidney injury (AKI) and in-hospital mortality among patients with COVID-19. DESIGN Retrospective cohort study. METHODS This retrospective study was conducted by review of the medical records of 6683 patients with laboratory-confirmed COVID-19 hospitalized in the Mount Sinai Health system between 1st March 2020 and 30th March 2021. We compared patients with and without hemoglobin drop >3 g/dl during hospitalization within a week after admissions, using inverse probability treatment weighted analysis (IPTW). Outcomes of interest were in-hospital mortality and AKI which was defined as serum creatine change of 0.3 mg/dl increase or 1.5 times baseline. RESULTS Of the 6683 patients admitted due to COVID-19, 750 (11.2%) patients presented with a marked hemoglobin drop. Patients with hemoglobin drop were more likely to receive therapeutic anticoagulation within 2 days after admissions. Patients with hemoglobin drop had higher crude in-hospital mortality (40.8% vs. 20.0%, P < 0.001) as well as AKI (51.4% vs. 23.9%, P < 0.001) compared to those without. IPTW analysis showed that hemoglobin drop was associated with higher in-hospital mortality compared to those without (odds ratio (OR) [95% confidential interval (CI)]: 2.21 [1.54-2.88], P < 0.001) as well as AKI (OR [95% CI]: 2.79 [2.08-3.73], P < 0.001). CONCLUSIONS Hemoglobin drop during COVID-19 related hospitalizations was associated with a higher risk of AKI and in-hospital mortality.
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Affiliation(s)
- Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, NY, USA
- Address for correspondence: Toshiki Kuno, MD, PhD, Division of Cardiology, Montefiore Medical Center, Albert Einsten College of Medicine, 111 East 210th St, Bronx, NY 10467-2401,
| | | | - Masao Iwagami
- Department of Health Services Research, University of Tsukuba, Tsukuba, Japan
| | - Miho Ishimaru
- Department of Health Services Research, University of Tsukuba, Tsukuba, Japan
| | - Matsuo So
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, NY, USA
| | - Mai Takahashi
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, NY, USA
| | - Natalia N Egorova
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, NY, USA
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11
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Goodwin TR, Demner-Fushman D. A customizable deep learning model for nosocomial risk prediction from critical care notes with indirect supervision. J Am Med Inform Assoc 2021; 27:567-576. [PMID: 32065628 DOI: 10.1093/jamia/ocaa004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/06/2019] [Accepted: 01/17/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Reliable longitudinal risk prediction for hospitalized patients is needed to provide quality care. Our goal is to develop a generalizable model capable of leveraging clinical notes to predict healthcare-associated diseases 24-96 hours in advance. METHODS We developed a reCurrent Additive Network for Temporal RIsk Prediction (CANTRIP) to predict the risk of hospital acquired (occurring ≥ 48 hours after admission) acute kidney injury, pressure injury, or anemia ≥ 24 hours before it is implicated by the patient's chart, labs, or notes. We rely on the MIMIC III critical care database and extract distinct positive and negative cohorts for each disease. We retrospectively determine the date-of-event using structured and unstructured criteria and use it as a form of indirect supervision to train and evaluate CANTRIP to predict disease risk using clinical notes. RESULTS Our experiments indicate that CANTRIP, operating on text alone, obtains 74%-87% area under the curve and 77%-85% Specificity. Baseline shallow models showed lower performance on all metrics, while bidirectional long short-term memory obtained the highest Sensitivity at the cost of significantly lower Specificity and Precision. DISCUSSION Proper model architecture allows clinical text to be successfully harnessed to predict nosocomial disease, outperforming shallow models and obtaining similar performance to disease-specific models reported in the literature. CONCLUSION Clinical text on its own can provide a competitive alternative to traditional structured features (eg, lab values, vital signs). CANTRIP is able to generalize across nosocomial diseases without disease-specific feature extraction and is available at https://github.com/h4ste/cantrip.
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Affiliation(s)
- Travis R Goodwin
- Lister Hill National Center for Biomedical Communications, US National Library of Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Dina Demner-Fushman
- Lister Hill National Center for Biomedical Communications, US National Library of Medicine, National Institutes of Health, Bethesda, Maryland, USA
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12
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Diabetes Mellitus and Hypertension Increase Risk of Death in Novel Corona Virus Patients Irrespective of Age: a Prospective Observational Study of Co-morbidities and COVID-19 from India. ACTA ACUST UNITED AC 2021; 3:937-944. [PMID: 33718779 PMCID: PMC7939447 DOI: 10.1007/s42399-021-00851-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2021] [Indexed: 12/18/2022]
Abstract
Elderly people and people with co-morbidities have emerged as the most vulnerable group at risk of developing complications and succumbing to novel coronavirus (COVID-19) infection. We recorded the baseline demographic profile, baseline clinical and laboratory parameters, and prevalence of various co-morbidities and their effect on the prognosis of COVID-19 cases. We conducted a prospective observational study and analyzed baseline clinical and laboratory parameters and co-morbidities and their effect on severity and mortality in 710 COVID-19 cases. Seven hundred ten patients with laboratory-confirmed COVID-19 were recruited from the 28th of March to the 31st of August 2020. The mean age was 48.4 ± 16.4years. A total of 530 (74.6%) patients were male. Overall, the mean length of hospital stay was 12.7 days. In total, 645 patients(90.8%) were mild to moderate cases and did not require initial ICU care. Sixty-five (9.2%) cases required initial intensive care unit care. Fifty (7%) admitted patients succumbed to the illness. Diabetes mellitus and hypertension increased the risk of death in COVID-19 patients irrespective of age. Increasing age and co-morbidities adversely affect the prognosis of patients of COVID-19. Diabetes mellitus and hypertension increase the risk of death in COVID-19 patients and negate the incremental effect of age on death in these patients.
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13
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Jonmarker S, Hollenberg J, Dahlberg M, Stackelberg O, Litorell J, Everhov ÅH, Järnbert-Pettersson H, Söderberg M, Grip J, Schandl A, Günther M, Cronhjort M. Dosing of thromboprophylaxis and mortality in critically ill COVID-19 patients. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:653. [PMID: 33225952 PMCID: PMC7680989 DOI: 10.1186/s13054-020-03375-7] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/04/2020] [Indexed: 12/15/2022]
Abstract
Background A substantial proportion of critically ill COVID-19 patients develop thromboembolic complications, but it is unclear whether higher doses of thromboprophylaxis are associated with lower mortality rates. The purpose of the study was to evaluate the association between initial dosing strategy of thromboprophylaxis in critically ill COVID-19 patients and the risk of death, thromboembolism, and bleeding. Method In this retrospective study, all critically ill COVID-19 patients admitted to two intensive care units in March and April 2020 were eligible. Patients were categorized into three groups according to initial daily dose of thromboprophylaxis: low (2500–4500 IU tinzaparin or 2500–5000 IU dalteparin), medium (> 4500 IU but < 175 IU/kilogram, kg, of body weight tinzaparin or > 5000 IU but < 200 IU/kg of body weight dalteparin), and high dose (≥ 175 IU/kg of body weight tinzaparin or ≥ 200 IU/kg of body weight dalteparin). Thromboprophylaxis dosage was based on local standardized recommendations, not on degree of critical illness or risk of thrombosis. Cox proportional hazards regression was used to estimate hazard ratios with corresponding 95% confidence intervals of death within 28 days from ICU admission. Multivariable models were adjusted for sex, age, body mass index, Simplified Acute Physiology Score III, invasive respiratory support, and initial dosing strategy of thromboprophylaxis. Results A total of 152 patients were included: 67 received low-, 48 medium-, and 37 high-dose thromboprophylaxis. Baseline characteristics did not differ between groups. For patients who received high-dose prophylaxis, mortality was lower (13.5%) compared to those who received medium dose (25.0%) or low dose (38.8%), p = 0.02. The hazard ratio of death was 0.33 (95% confidence intervals 0.13–0.87) among those who received high dose, and 0.88 (95% confidence intervals 0.43–1.83) among those who received medium dose, as compared to those who received low-dose thromboprophylaxis. There were fewer thromboembolic events in the high (2.7%) vs medium (18.8%) and low-dose thromboprophylaxis (17.9%) groups, p = 0.04. Conclusions Among critically ill COVID-19 patients with respiratory failure, high-dose thromboprophylaxis was associated with a lower risk of death and a lower cumulative incidence of thromboembolic events compared with lower doses. Trial registration Clinicaltrials.gov NCT04412304 June 2, 2020, retrospectively registered. ![]()
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Affiliation(s)
- Sandra Jonmarker
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Department of Anaesthesia and Intensive Care, Södersjukhuset, Stockholm, Sweden
| | - Jacob Hollenberg
- Department of Medicine, Center for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Martin Dahlberg
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | - Otto Stackelberg
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Department of Surgery, Södersjukhuset, Stockholm, Sweden.,Institute of Environmental Medicine, Unit of Cardiovascular and Nutritional Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Jacob Litorell
- Department of Anaesthesia and Intensive Care, Södersjukhuset, Stockholm, Sweden
| | - Åsa H Everhov
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | - Hans Järnbert-Pettersson
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Mårten Söderberg
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Department of Internal Medicine, Södersjukhuset, Stockholm, Sweden
| | - Jonathan Grip
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Anna Schandl
- Department of Anaesthesia and Intensive Care, Södersjukhuset, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Mattias Günther
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Department of Anaesthesia and Intensive Care, Södersjukhuset, Stockholm, Sweden
| | - Maria Cronhjort
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden. .,Department of Anaesthesia and Intensive Care, Södersjukhuset, Stockholm, Sweden.
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14
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Hedayati S, Nachvak SM, Samadi M, Motamedi-Motlagh A, Moradi S. Malnutrition and nutritional status in critically ill patients with enteral nutrition. MEDITERRANEAN JOURNAL OF NUTRITION AND METABOLISM 2020. [DOI: 10.3233/mnm-200421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND & OBJECTIVE: The prevention of malnutrition is an important factor in the survival of critically ill patients with enteral nutrition. The present study aims to assess the nutritional status and its association with some blood-related markers in critically ill patients with enteral nutrition during hospitalization in the intensive care units (ICUs). METHODS: Totally, 110 patients participated in this study from the time of admission to discharge at five ICUs. The patients’ nutritional status was assessed by subjective global assessment (SGA), Acute Physiology and Chronic Health Evaluation and Albumin, Total Iron Binding Capacity (TIBC), Hemoglobin (Hb), Hematocrit (HCT), Ferritin, and Feas biochemical indices and anthropometric parameters. RESULTS: Malnutrition prevalence increased significantly on the day of discharge (83.6%) compared to the day of admission (41.8%), according to SGA (P < 0.001). Hb, HCT, serum Fe decreased and ferritin, also TIBC were increased during hospitalization in ICU. The malnutrition risk predictors based on the logistic regression were low levels of Hb (OR = 0.6), HCT (OR = 0.9), Fe (OR = 0.9), Albumin (OR = 0.3) and High Ferritin level (OR = 1.006) on the admission day. Anemia of inflammation (AI) was observed during ICU stay. CONCLUSION: This study demonstrated that malnutrition is an increasing phenomenon in the ICU patients and the delay in patient’s enteral feeding had a direct influence in the prevalence of malnutrition on discharge day.
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Affiliation(s)
- Safoora Hedayati
- Department of Nutrition, School of Nutrition Science and Food Technology, Committee of the Deputy of Research and Technology of Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Seyyed Mostafa Nachvak
- Department of Nutritional Sciences, Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mehnoosh Samadi
- Department of Nutritional Sciences, Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Shima Moradi
- Department of Nutritional Sciences, Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
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15
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Saban-Ruiz J, Ly-Pen D. COVID-19: A Personalized Cardiometabolic Approach for Reducing Complications and Costs. The Role of Aging beyond Topics. J Nutr Health Aging 2020; 24:550-559. [PMID: 32510105 PMCID: PMC7217344 DOI: 10.1007/s12603-020-1385-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 05/03/2020] [Indexed: 02/07/2023]
Abstract
COVID 19 is much more than an infectious disease by SARS-CoV-2 followed by a disproportionate immune response. An older age, diabetes and history of cardiovascular disease, especially hypertension, but also chronic heart failure and coronary artery disease among others, are between the most important risk factors. In addition, during the hospitalization both hyperglycaemia and heart failure are frequent. Less frequent are acute coronary syndrome, arrhythmias and stroke. Accordingly, not all prolonged stays or even deaths are due directly to SARS-CoV-2. To our knowledge, this is the first review, focusing both on cardiovascular and metabolic aspects of this dreadful disease, in an integrated and personalized way, following the guidelines of the Cardiometabolic Health/Medicine. Therefore, current personalized aspects such as ACEIs and ARBs, the place of statins and the most appropriate management of heart failure in diabetics are analysed. Aging, better than old age, as a dynamic process, is also considered in this review for the first time in the literature, and not only as a risk factor attributed to cardiovascular and non-cardiovascular comorbidities. Immunosenescence is also approached to build healthier elders, so they can resist present and future infectious diseases, and not only in epidemics or pandemics. In addition, to do this we must start knowing the molecular mechanisms that underlying Aging process in general, and immunosenescence in particular. Surprisingly, the endoplasmic reticulum stress and autophagy are implicated in both process. Finally, with a training in all the aspects covered in this review, not only the hospital stay, complications and costs of this frightening disease in high-risk population should be reduced. Likely, this paper will open a gate to the future for open-minded physicians.
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Affiliation(s)
- J Saban-Ruiz
- Prof. Saban-Ruiz, MD, PhD, d-médical Clinic, Madrid, Spain,
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16
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Abstract
Inflammation is an adaptive process to the noxious stimuli that the human body is constantly exposed to. From the local inflammatory response to a full-blown systemic inflammation, a wide complex sequence of events occurs. Persistent immunosuppression and catabolism may ensue, until multiple organ failure finally sets in. And since clinically useful and specific biomarkers are lacking, diagnosis may come late. A thorough understanding of these events (how they begin, how they evolve, and how to modulate them) is imperative, but as yet poorly studied. This review aims to consolidate current knowledge of these events so that the management of these patients is not only evidence-based, but also built on an understanding of the inner workings of the human body in health and in disease.
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Affiliation(s)
- Miguel Lourenço Varela
- Internal Medicine 1, Hospital de Faro, Centro Hospitalar Universitário do Algarve, Rua Leão Penedo, Faro, 8000-386, Portugal.
- Intensive Care Medicine 1, Hospital de Faro, Centro Hospitalar Universitário do Algarve, Rua Leão Penedo, Faro, 8000-386, Portugal.
| | - Mihail Mogildea
- Internal Medicine 1, Hospital de Faro, Centro Hospitalar Universitário do Algarve, Rua Leão Penedo, Faro, 8000-386, Portugal
| | - Ignacio Moreno
- Internal Medicine 1, Hospital de Faro, Centro Hospitalar Universitário do Algarve, Rua Leão Penedo, Faro, 8000-386, Portugal
| | - Ana Lopes
- Internal Medicine 1, Hospital de Faro, Centro Hospitalar Universitário do Algarve, Rua Leão Penedo, Faro, 8000-386, Portugal
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17
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Rako I, Mlinaric A, Dozelencic M, Juros GF, Rogic D. Effect of different pre-analytical conditions on plasma lactate concentration. Biochem Med (Zagreb) 2018; 28:020701. [PMID: 29666554 PMCID: PMC5898961 DOI: 10.11613/bm.2018.020701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 01/17/2018] [Indexed: 01/11/2023] Open
Abstract
Introduction Plasma lactate is a frequently used and important parameter for medical decision making. To setup a pre-analytical algorithm, we aimed to investigate the influence of different test tube additives, aliquoting, ice storage and haemolysis on plasma lactate concentrations for possible sparing critically ill (ICU) patients of additional blood drawing. Materials and methods In our study (N = 177), lactate concentration and haemolysis index (HI) were measured in aliquoted (AHP) and unaliquoted (HP) Li-heparin, NaF/K3EDTA and NaF/KOX plasma, centrifuged within 15 minutes after venipuncture, on Cobas c501 analyzer. Differences were tested using the Wilcoxon’s test and Passing-Bablok regression. Clinical accuracy of results was assessed in 107 ICU patients based on reference interval and clinical decision limits. Results Lactate concentrations did not differ in NaF/K3EDTA and NaF/KOX plasma (P = 0.855). No clinically significant difference of AHP compared to NaF/K3EDTA lactate was found (y = 0.13 (0.08 to 0.19) + 1.02 (0.99 to 1.08) x) if samples were aliquoted within 30 minutes after venipuncture. On contrary, lactate concentrations in HP showed significant proportional difference (y = 0.07 (- 0.12 to 1.24) + 1.37 (1.22 to 1.56) x) and were clinically incorrect in 14% of patients. Transport in ice bath increases HI in NaF/K3EDTA (P < 0.001), but without influencing lactate results compared to room temperature (y = 0.03 (- 0.06 to 1.00) + 1.05 (0.99 to 1.11) x). Conclusions Lactate determination in HP is unacceptable because of high proportional error and high risk of clinical inaccuracy compared to NaF/K3EDTA. If pre-analytical conditions are met, AHP, NaF/K3EDTA and NaF/KOX plasma can be used interchangeably. Aliquoted Li-heparin samples alow measurement of other biochemical tests from a single tube and can spare ICU patients from additional blood drawing. Storage in ice bath provides no additional stabilization in NaF/K3EDTA tubes.
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Affiliation(s)
- Ivana Rako
- Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Croatia
| | - Ana Mlinaric
- Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Croatia
| | - Monika Dozelencic
- Department of Biochemistry and Haematology, General Hospital "Dr. Ivo Pedišić", Sisak, Croatia
| | - Gordana Fressl Juros
- Department of Clinical Laboratory Diagnostics, Children's Hospital Srebrnjak, Zagreb, Croatia
| | - Dunja Rogic
- Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Croatia
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18
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Maqueda-Palau M, Pérez-Juan E. Blood volume extracted from the critical patient in the first 24 hours after admission. ENFERMERIA INTENSIVA 2017; 29:14-20. [PMID: 29275137 DOI: 10.1016/j.enfi.2017.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 09/10/2017] [Accepted: 09/25/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To calculate the number of analytical tests and blood volume drawn during the first 24hours of admission to the Intensive Care Unit (ICU). To analyse values of basal haemoglobin and at 24hours, relate them to blood loss, weight variation, and scoring system. METHOD An observational descriptive pilot study. Variables studied: age, sex, diagnosis on admission, analytical tests extracted, waste quantity before the extraction of samples, total volume blood extracted in 24hours, weight variation, APACHE, SAPS, basal haemoglobin and at 24hours. Statistical analysis with SPSS vs 20.0. Variables correlation sex, weight variation, the number of analytical tests and haemoglobin change. RESULTS The study included 100 patients. The average number of extractions per patient/day was 7.2 (±2.6). The average waste quantity was 32.61ml (±15.8). The blood volume used for determinations was 48.18ml / 24h (±16.74). The haemoglobin value decreased in the first 24hours of admission, being higher in men (P<.05). The scoring systems were statistically significant for levels of haemoglobin (Hb1 -0.3; P=.001; Hb2 -0.4; P=.001). CONCLUSIONS Of the total volume of blood extracted in ICU, 40% belongs to a volume of waste and 60% of blood is used for analytical tests. There is a decrease in haemoglobin exists 24hours after admission of the critical patient. Statistically, it has not been possible to demonstrate its relation with the number of analytical tests.
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Affiliation(s)
- M Maqueda-Palau
- Unidad de Cuidados Intensivos, Hospital Universitari Son Espases, Palma, Marllorca, España.
| | - E Pérez-Juan
- Unidad de Cuidados Intensivos, Hospital Universitari Son Espases, Palma, Marllorca, España
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Scarlatescu E, Tomescu D, Arama SS. Anticoagulant Therapy in Sepsis. The Importance of Timing. ACTA ACUST UNITED AC 2017; 3:63-69. [PMID: 29967873 PMCID: PMC5769917 DOI: 10.1515/jccm-2017-0011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 03/24/2017] [Indexed: 11/25/2022]
Abstract
Sepsis associated coagulopathy is due to the inflammation-induced activation of coagulation pathways concomitant with dysfunction of anticoagulant and fibrinolytic systems, leading to different degrees of haemostasis dysregulation. This response is initially beneficial, contributing to antimicrobial defence, but when control is lost coagulation activation leads to widespread microvascular thrombosis and subsequent organ failure. Large clinical trials of sepsis-related anticoagulant therapies failed to show survival benefits, but posthoc analysis of databases and several smaller studies showed beneficial effects of anticoagulants in subgroups of patients with early sepsis-induced disseminated intravascular coagulation. A reasonable explanation could be the difference in timing of anticoagulant therapy and patient heterogeneity associated with large trials. Proper selection of patients and adequate timing are required for treatment to be successful. The time when coagulation activation changes from advantageous to detrimental represents the right moment for the administration of coagulation-targeted therapy. In this way, the defence function of the haemostatic system is preserved, and the harmful effects of overwhelming coagulation activation are avoided.
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Affiliation(s)
- Ecaterina Scarlatescu
- Department of Anesthesiology and Intensive Care III, Fundeni Clinical Institute, Bucharest, Romania
| | - Dana Tomescu
- Department of Anesthesiology and Intensive Care III, Fundeni Clinical Institute, Bucharest, Romania.,University of Medicine and Pharmacy, "Carol Davila", Bucharest, Romania
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20
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Scarlatescu E, Tomescu D, Arama SS. Sepsis-Associated Coagulopathy. ACTA ACUST UNITED AC 2016; 2:156-163. [PMID: 29967855 DOI: 10.1515/jccm-2016-0024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 09/29/2016] [Indexed: 11/15/2022]
Abstract
Systemic inflammatory activation in sepsis often leads to coagulation activation, but the relationship is bilateral, as coagulation also modulates the inflammatory response. This close associate has significant consequences for the pathogenesis of microvascular thrombosis and organ dysfunction in sepsis. While coagulation activation can be beneficial for immune defense, it can also be detrimental once it becomes widespread and uncontrolled. The knowledge of the pathophysiologic mechanisms involved in the interaction between infection and coagulation may lead to the better timing for the administration of targeted antithrombotic therapies in septic patients. This brief review highlights the pathophysiologic pathways leading to the prothrombotic state in sepsis and the mechanisms that play a role in the interaction between infection and coagulation.
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Affiliation(s)
- Ecaterina Scarlatescu
- Department of Anesthesiology and Intensive Care III, Fundeni Clinical Institute, Bucharest, Romania
| | - Dana Tomescu
- Department of Anesthesiology and Intensive Care III, Fundeni Clinical Institute, Bucharest, Romania
- University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
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