1
|
Silver E, Nahmias J, Lekawa M, Inaba K, Schellenberg M, De Virgilio C, Grigorian A. Immediate Operative Trauma Assessment Score: A Simple and Reliable Predictor of Mortality in Trauma Patients Undergoing Urgent/Emergent Surgery. Am Surg 2024; 90:2463-2470. [PMID: 38641872 DOI: 10.1177/00031348241248784] [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: 04/21/2024]
Abstract
Objective: Many current trauma mortality prediction tools are either too intricate or rely on data not readily available during a trauma patient's initial evaluation. Moreover, none are tailored to those necessitating urgent or emergent surgery. Our objective was to design a practical, user-friendly scoring tool using immediately available variables, and then compare its efficacy to the widely-known Revised Trauma Score (RTS). Methods: The adult 2017-2021 Trauma Quality Improvement Program (TQIP) database was queried to identify patients ≥18 years old undergoing any urgent/emergent operation (direct from Emergency Department to operating room). Patients were divided into derivation and validation groups. A three-step methodology was used. First, multiple logistic regression models were created to determine risk of death using only variables available upon arrival. Second, the weighted average and relative impact of each independent predictor was used to derive an easily calculated Immediate Operative Trauma Assessment Score (IOTAS). We then validated IOTAS using AUROC and compared it to RTS. Results: From 249 208 patients in the derivation-set, 14 635 (5.9%) died. Age ≥65, Glasgow Coma Scale score <9, hypotension (SBP <90 mmHg), and tachycardia (>120/min) on arrival were identified as independent predictors for mortality. Using these, the IOTAS was structured, offering scores between 0-8. The AUROC for this was .88. A clear escalation in mortality was observed across scores: from 4.4% at score 1 to 60.5% at score 8. For the validation set (250 182 patients; mortality rate 5.8%), the AUROC remained consistent at .87, surpassing RTS's AUROC of .83. Conclusion: IOTAS is a novel, accurate, and now validated tool that is intuitive and efficient in predicting mortality for trauma patients requiring urgent or emergent surgeries. It outperforms RTS, and thereby may help guide clinicians when determining the best course of action in patient management as well as counseling patients and their families.
Collapse
Affiliation(s)
| | | | | | - Kenji Inaba
- University of Southern California, Los Angeles, CA, USA
| | | | | | | |
Collapse
|
2
|
Zuo S, Feng Y, Sun J, Liu G, Cai H, Zhang X, Hu Z, Liu Y, Yao Z. The assessment of consciousness status in primary brainstem hemorrhage (PBH) patients can be achieved by monitoring changes in basic vital signs. Geriatr Nurs 2024; 59:498-506. [PMID: 39146640 DOI: 10.1016/j.gerinurse.2024.07.006] [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: 03/07/2024] [Revised: 06/28/2024] [Accepted: 07/13/2024] [Indexed: 08/17/2024]
Abstract
The objective of the study was to explore the association between basic vital signs and consciousness status in patients with primary brainstem hemorrhage (PBH). Patients with PBH were categorized into two groups based on Glasgow Coma Scale (GCS) scores: disturbance of consciousness (DOC) group (GCS=3-8) and non-DOC group (GCS=15). Within DOC group, patients were further divided into behavioral (GCS=4-8) and non-behavioral (GCS=3) subgroups. Basic vital signs, such as body temperature, heart rate, and respiratory rate, were monitored every 3 hours during the acute bleeding phase (1st day) and the bleeding stable phase (7th day) of hospitalization. The findings revealed a negative correlation between body temperature and heart rate with GCS scores in DOC group at both time points. Moreover, basic vital signs were notably higher in the DOC group compared to non-DOC group. Specifically, the non-behavioral subgroup within DOC group exhibited significantly elevated heart rates on the 1st day of hospitalization and moderately increased respiratory rates on the 7th day compared to the control group. Scatter plots illustrated a significant relationship between body temperature and heart rate with consciousness status, while no significant correlation was observed with respiratory rate. In conclusion, the study suggests that monitoring basic vital signs, particularly body temperature and heart rate, can serve as valuable indicators for evaluating consciousness status in PBH patients. These basic vital signs demonstrated variations corresponding to lower GCS scores. Furthermore, integrating basic vital sign monitoring with behavioral assessment could enhance the assessment of consciousness status in PBH patients.
Collapse
Affiliation(s)
- Shiyi Zuo
- Department of Pain and Rehabilitation, Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yuting Feng
- Department of Pain and Rehabilitation, Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Juan Sun
- Department of Pain and Rehabilitation, Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Guofang Liu
- Department of Radiology, Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Hanxu Cai
- Department of Physiology, College of Basic Medical Sciences, Army Medical University (Third Military Medical University), Chongqing, China
| | - Xiaolong Zhang
- Department of Physiology, College of Basic Medical Sciences, Army Medical University (Third Military Medical University), Chongqing, China
| | - Zhian Hu
- Department of Physiology, College of Basic Medical Sciences, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yong Liu
- Department of Pain and Rehabilitation, Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Zhongxiang Yao
- Department of Physiology, College of Basic Medical Sciences, Army Medical University (Third Military Medical University), Chongqing, China.
| |
Collapse
|
3
|
Yamada M, Hino S, Iijima Y, Horie N, Kaneko T. What are the Characteristics of Oral Injuries Caused by Playground Equipment? J Craniofac Surg 2024; 35:1456-1460. [PMID: 38861333 DOI: 10.1097/scs.0000000000010376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 05/06/2024] [Indexed: 06/13/2024] Open
Abstract
PURPOSE Studies regarding oral injuries from playground equipment in children remain limited. This study aimed to clarify the characteristics of oral injury caused by playground equipment and identify associations with concomitant head injury. METHODS Children treated between 2011 and 2021 at an oral surgery clinic for oral injuries from playground equipment were retrospectively investigated. The following factors were analyzed: demographic characteristics, mechanism of injury, type of equipment causing the injury, classification of oral injury, and whether the Department of Emergency and Critical Care Medicine was consulted regarding the head injury. The data collected were statistically analyzed using the Fisher-Freeman-Halton test with significance adopted at the 5% level. RESULTS This study analyzed data from 82 children. Injuries were concentrated in age groups of 2 to 3 years (32.9%), 4 to 5 years (28.0%), and 6 to 7 years (25.6%). Regarding the mechanism of injury, falls were more common (89.0%) than impact/striking (11.0%). The type of equipment most frequently causing injury was slides (29.3%), followed by swings (23.2%) and iron bars (18.3%). Injuries were classified as soft tissue injury alone (56.1%) or tooth injury and/or jaw fracture (43.9%). Consultation with the Department of Emergency and Critical Care Medicine for head injury was uncommon (13.4%), and all consultations for brain injury diagnosed minor injuries. CONCLUSION Oral injuries caused by playground equipment were frequent between 2 and 7 years old. The most common cause was falls, with most injuries caused by slides, swings, or iron bars. Approximately half of the oral injuries were soft tissue injuries only, while the other half were associated with tooth and/or jaw injuries. Department of Emergency and Critical Care Medicine consultations for head trauma were uncommon and consistently confirmed minor injuries.
Collapse
Affiliation(s)
- Miki Yamada
- Department of Oral and Maxillofacial Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | | | | | | | | |
Collapse
|
4
|
Wang XC, Gao SJ, Zhuo SL, Weng CL, Feng HW, Lin J, Lin XS, Huang L. Predictive factors for cerebrocardiac syndrome in patients with severe traumatic brain injury: a retrospective cohort study. Front Neurol 2023; 14:1192756. [PMID: 37538256 PMCID: PMC10394875 DOI: 10.3389/fneur.2023.1192756] [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: 03/23/2023] [Accepted: 07/03/2023] [Indexed: 08/05/2023] Open
Abstract
Background and objective Cerebrocardiac syndrome (CCS) is a severe complication of severe traumatic brain injury (sTBI) that carries high mortality and disability rates. Early identification of CCS poses a significant clinical challenge. The main objective of this study was to investigate potential risk factors associated with the development of secondary CCS in patients with sTBI. It was hypothesized that elevated right heart Tei index (TI), lower Glasgow Coma Scale (GCS) scores, and elevated cardiac troponin-I (cTnI) levels would independently contribute to the occurrence of CCS in sTBI patients. Methods A retrospective cohort study was conducted to identify risk factors for CCS secondary to sTBI. One hundred and fifty-five patients were enrolled with sTBI admitted to the hospital between January 2016 and December 2020 and divided them into a CCS group (n = 75) and a non-CCS group (n = 80) based on the presence of CCS. This study involved the analysis and comparison of clinical data from two patient groups, encompassing demographic characteristics, peripheral oxygen saturation (SPO2), neuron-specific enolase (NSE), cardiac troponin-I (cTnI), N-terminal pro-brain natriuretic peptide (NT-proBNP), optic nerve sheath diameter (ONSD), cardiac ultrasound, acute physiology and chronic health evaluation (APACHE II) scores, and GCS scores and so on. Multivariate logistic regression was employed to identify independent risk factors for CCS, and receiver operating characteristic (ROC) curves were used to assess their predictive value for CCS secondary to sTBI. Results The study revealed that 48.4% of sTBI patients developed secondary CCS. In the multivariate analysis model 1 that does not include NT-proBNP and cTnI, ONSD (OR = 2.582, 95% CI: 1.054-6.327, P = 0.038), right heart Tei index (OR = 2.81, 95% CI: 1.288-6.129, P = 0.009), and GCS (OR = 0.212, 95% CI: 0.086-0.521, P = 0.001) were independent risk factors for secondary CCS in sTBI patients. In multivariate analysis model 2 that includes NT-proBNP and cTnI, cTnI (OR = 27.711, 95%CI: 3.086-248.795, P = 0.003), right heart Tei index (OR = 2.736, 95% CI: 1.056-7.091, P = 0.038), and GCS (OR = 0.147, 95% CI: 0.045-0.481, P = 0.002) were independent risk factors for secondary CCS in sTBI patients. The area under the ROC curve for ONSD, Tei index, GCS, and cTnI were 0.596, 0.613, 0.635, and 0.881, respectively. ONSD exhibited a positive predictive value (PPV) of 0.704 and a negative predictive value (NPV) of 0.634. The Tei index demonstrated a PPV of 0.624 and an NPV of 0.726, while GCS had a PPV of 0.644 and an NPV of 0.815. On the other hand, cTnI exhibited a significantly higher PPV of 0.936 and an NPV of 0.817. These findings indicate that the Tei index, GCS score, and cTnI possess certain predictive value for secondary CCS in patients with sTBI. Conclusions The study provides valuable insights into the identification of independent risk factors for CCS secondary to sTBI. The findings highlight the significance of right heart Tei index, GCS score, and cTnI as potential predictive factors for CCS in sTBI patients. Further larger-scale studies are warranted to corroborate these findings and to provide robust evidence for the development of early intervention strategies aimed at reducing the incidence of CCS in this patient population.
Collapse
Affiliation(s)
- Xin-Cai Wang
- Department of Critical Care Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital South Branch, Fuzhou, China
- Fujian Provincial Key Laboratory of Critical Care Medicine, Fuzhou, China
| | - Shang-Jun Gao
- Department of Critical Care Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital South Branch, Fuzhou, China
- Department of Orthopedics, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital South Branch, Fuzhou, China
| | - Shi-Long Zhuo
- Department of School of Electronic, Electrical Engineering and Physics, Fujian University of Technology, Fuzhou, China
| | - Cui-Lian Weng
- Department of Critical Care Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital South Branch, Fuzhou, China
- Fujian Provincial Key Laboratory of Critical Care Medicine, Fuzhou, China
| | - Hang-Wei Feng
- Department of Critical Care Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital South Branch, Fuzhou, China
- Fujian Provincial Key Laboratory of Critical Care Medicine, Fuzhou, China
| | - Jian Lin
- Department of Critical Care Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital South Branch, Fuzhou, China
- Fujian Provincial Key Laboratory of Critical Care Medicine, Fuzhou, China
| | - Xing-Sheng Lin
- Department of Critical Care Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital South Branch, Fuzhou, China
- Fujian Provincial Key Laboratory of Critical Care Medicine, Fuzhou, China
| | - Long Huang
- Department of Critical Care Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital South Branch, Fuzhou, China
- Fujian Provincial Key Laboratory of Critical Care Medicine, Fuzhou, China
| |
Collapse
|
5
|
Jung E, Ryu HH, Heo BG. The reverse shock index multiplied by Glasgow coma scale (rSIG) is predictive of mortality in trauma patients according to age. Brain Inj 2023; 37:430-436. [PMID: 36703294 DOI: 10.1080/02699052.2023.2168301] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The role of reverse shock index multiplied Glasgow coma scale (rSIG) in patients post-trauma with traumatic brain injury (TBI) has not yet been defined well. Our study aimed to investigate the predictive performance of rSIG according to age group. METHOD This is a prospective multi-national and multi-center cohort study using Pan-Asian Trauma Outcome Study registry in Asian-Pacific, conducted on patients post-trauma who visited participating hospitals. The main exposure was low rSIG measured at emergency department. The main outcome was in-hospital mortality. We performed multilevel logistic regression analysis to estimate the association low rSIG and study outcomes. Interaction analysis between rSIG and age group were also conducted. RESULTS Low rSIG was significantly associated with an increase in in-hospital mortality in patients post-trauma with and without TBI (aOR (95% CI): 1.49 (1.04-2.13) and 1.71 (1.16-2.53), respectively). The ORs for in-hospital mortality differed according to the age group in patients post-trauma with TBI (1.72 (1.44-1.94) for the young group and 1.13 (1.07-1.52) for the old group; p < 0.05). CONCLUSION Low rSIG is associated with an increase in in-hospital mortality in adult patients post-trauma. However, in patients with TBI, the prediction of mortality is significantly better in younger patient group.
Collapse
Affiliation(s)
- Eujene Jung
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Hyun Ho Ryu
- College of Medicine, Chonnam National University, Gwangju, Korea
| | - Bang Geul Heo
- Department of Nursing, Gyeongsang National University, Gwangju, Korea
| |
Collapse
|
6
|
Zhou L, Chen Y, Liu Z, You J, Chen S, Liu G, Yu Y, Wang J, Chen X. A predictive model for consciousness recovery of comatose patients after acute brain injury. Front Neurosci 2023; 17:1088666. [PMID: 36845443 PMCID: PMC9945265 DOI: 10.3389/fnins.2023.1088666] [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: 11/03/2022] [Accepted: 01/23/2023] [Indexed: 02/10/2023] Open
Abstract
Background Predicting the consciousness recovery for comatose patients with acute brain injury is an important issue. Although some efforts have been made in the study of prognostic assessment methods, it is still unclear which factors can be used to establish model to directly predict the probability of consciousness recovery. Objectives We aimed to establish a model using clinical and neuroelectrophysiological indicators to predict consciousness recovery of comatose patients after acute brain injury. Methods The clinical data of patients with acute brain injury admitted to the neurosurgical intensive care unit of Xiangya Hospital of Central South University from May 2019 to May 2022, who underwent electroencephalogram (EEG) and auditory mismatch negativity (MMN) examinations within 28 days after coma onset, were collected. The prognosis was assessed by Glasgow Outcome Scale (GOS) at 3 months after coma onset. The least absolute shrinkage and selection operator (LASSO) regression analysis was applied to select the most relevant predictors. We combined Glasgow coma scale (GCS), EEG, and absolute amplitude of MMN at Fz to develop a predictive model using binary logistic regression and then presented by a nomogram. The predictive efficiency of the model was evaluated with AUC and verified by calibration curve. The decision curve analysis (DCA) was used to evaluate the clinical utility of the prediction model. Results A total of 116 patients were enrolled for analysis, of which 60 had favorable prognosis (GOS ≥ 3). Five predictors, including GCS (OR = 13.400, P < 0.001), absolute amplitude of MMN at Fz site (FzMMNA, OR = 1.855, P = 0.038), EEG background activity (OR = 4.309, P = 0.023), EEG reactivity (OR = 4.154, P = 0.030), and sleep spindles (OR = 4.316, P = 0.031), were selected in the model by LASSO and binary logistic regression analysis. This model showed favorable predictive power, with an AUC of 0.939 (95% CI: 0.899-0.979), and calibration. The threshold probability of net benefit was between 5% and 92% in the DCA. Conclusion This predictive model for consciousness recovery in patients with acute brain injury is based on a nomogram incorporating GCS, EEG background activity, EEG reactivity, sleep spindles, and FzMMNA, which can be conveniently obtained during hospitalization. It provides a basis for care givers to make subsequent medical decisions.
Collapse
Affiliation(s)
- Liang Zhou
- Department of Neurosurgery, Xiangya Hospital of Central South University, Changsha, Hunan, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China
| | - Yuanyi Chen
- Central of Stomatology, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Ziyuan Liu
- Department of Neurosurgery, Xiangya Hospital of Central South University, Changsha, Hunan, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China
| | - Jia You
- Department of Neurosurgery, Xiangya Hospital of Central South University, Changsha, Hunan, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China
| | - Siming Chen
- Department of Neurosurgery, Xiangya Hospital of Central South University, Changsha, Hunan, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China
| | - Ganzhi Liu
- Department of Neurosurgery, Xiangya Hospital of Central South University, Changsha, Hunan, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China
| | - Yang Yu
- College of Intelligence Science and Technology, National University of Defense Technology, Changsha, Hunan, China
| | - Jian Wang
- Department of Neurosurgery, Xiangya Hospital of Central South University, Changsha, Hunan, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China,*Correspondence: Jian Wang,
| | - Xin Chen
- Department of Neurosurgery, Xiangya Hospital of Central South University, Changsha, Hunan, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China,Xin Chen,
| |
Collapse
|
7
|
Wang X, Gao H, Song J, Jing P, Wang C, Yu N, Wu S, Zhu J, Gao Z. How somatosensory evoked potentials improve the diagnosis of the disturbance of consciousness: A retrospective analysis. NETWORK (BRISTOL, ENGLAND) 2023; 34:392-407. [PMID: 37855276 DOI: 10.1080/0954898x.2023.2269263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 10/06/2023] [Indexed: 10/20/2023]
Abstract
The interpeak latency is a crucial characteristic of upper limb somatosensory evoked potentials (USEPs). However, the existing research on the correlation between interpeak latency and consciousness disorders is currently limited. We aimed to investigate how USEPs can contribute to the diagnosis of consciousness disorders. A retrospective analysis was conducted on 10 patients who underwent repetitive transcranial magnetic stimulation (rTMS) for consciousness disorders. The interpeak latency N13-N20, Glasgow coma scale (GCS), and Chinese Nanjing persistent vegetative state scale (CNPVSS) were evaluated before and after rTMS treatment, and the linear correlation between N13-N20, GCS, and CNPVSS was analysed. The scores of CNPVSS and GCS significantly increased in the first, second, and third months after rTMS. The N13-N20 was shorter in the second and third months after rTMS compared to before treatment. rTMS was found to shorten the N13-N20 latency, and there was a negative correlation between N13-N20 and the score of consciousness disorders. N13-N20 can serve as an objective index for evaluating consciousness disorders. This research provides potential insights for doctors in diagnosing patients with consciousness disorders.
Collapse
Affiliation(s)
- Xinwei Wang
- Nanjing Zijin Hospital, Nanjing, Jiangsu, China
| | | | - Jiulong Song
- The Fourth Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Peng Jing
- Nanjing Zijin Hospital, Nanjing, Jiangsu, China
| | - Chao Wang
- Nanjing Zijin Hospital, Nanjing, Jiangsu, China
| | - Nuanxin Yu
- Nanjing Zijin Hospital, Nanjing, Jiangsu, China
| | - Shanshan Wu
- Nanjing Zijin Hospital, Nanjing, Jiangsu, China
| | - Jianxiong Zhu
- School of Mechanical Engineering, Southeast University, Nanjing, P. R. China
- Guangxi Key Laboratory of Automatic Detecting Technology and Instruments, Guilin University of Electronic Technology, Guilin, P. R. China
| | | |
Collapse
|
8
|
Changes and roles of IL-17A, VEGF-A and TNF-α in patients with cerebral infarction during the acute phase and early stage of recovery. Clin Biochem 2022; 107:67-72. [PMID: 35550786 DOI: 10.1016/j.clinbiochem.2022.05.001] [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: 12/09/2021] [Revised: 04/23/2022] [Accepted: 05/05/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND PURPOSE Interleukin 17A (IL-17A), vascular endothelial growth factor A (VEGF-A) and tumour necrosis factor alpha (TNF-α) are important cytokines detected mostly within two weeks after stroke in previous clinical studies. Longer clinical studies investigating these cytokines are lacking. We aimed to explore the roles of these cytokines in patients within 35 days after cerebral infarction. METHODS Thirty patients with cerebral infarction and 30 healthy individuals were enrolled. Venous blood was collected from each patient at specific times and from each healthy individual only once. Coma and neurological functional deficits of the patients were evaluated by the Glasgow Coma Scale (GCS) and the National Institutes of Health Stroke Scale (NIHSS), respectively. Three cytokines were measured. The correlations among the three cytokines and between each cytokine and the GCS/NIHSS scores were analysed. RESULTS IL-17A and TNF-α began to increase on day 1 after cerebral infarction, peaked on day 4, then decreased, and increased again on day 18. IL-17A returned to normal on day 35, but TNF-α remained higher than normal on day 35. VEGF-A began to increase on day 1, peaked on day 7, and returned to normal on day 35. From days 18 to 35, IL-17A was positively correlated with the GCS scores, and both IL-17A and VEGF-A were negatively correlated with the NIHSS scores. CONCLUSION After cerebral infarction, VEGF-A from the acute phase and IL-17A from the early stage of recovery may be important for nerve protection and repair; TNF-α plays a complex role within 35 days.
Collapse
|
9
|
Khari S, Zandi M, Yousefifard M. Glasgow Coma Scale Versus Physiologic Scoring Systems in Predicting the Outcome of ICU admitted Trauma Patients; a Diagnostic Accuracy Study. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2022; 10:e25. [PMID: 35573721 PMCID: PMC9078058 DOI: 10.22037/aaem.v10i1.1483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction There is no consensus on the performance of decision rules in predicting the prognosis of trauma patients. Therefore, the present study aimed to compare the value of Glasgow coma scale (GCS) and physiologic scoring systems in predicting mortality and poor outcome of trauma patients. Methods This diagnostic accuracy study was conducted on multiple trauma patients admitted to the intensive care units of two hospitals in Tehran, Iran, from 21 November 2020 to 22 May 2021. The patients' demographic characteristics, length of stay in the intensive care unit (ICU), the vital signs, and the GCS on admission were recorded. Finally, the mortality, disability, and complete recovery of patients at the time of discharge were evaluated and receiver operating characteristics (ROC) curve analysis was used to compare the performance of physiologic scoring systems with GCS. Results 200 trauma patients with the mean age of 43.53±19.84 years were evaluated (74% male). The area under the ROC curve for New Trauma Score (NTS), Revised Trauma Score (RTS), Worthing Physiological Scoring System (WPSS), Rapid Acute Physiology Score (RAPS), Rapid Emergency Medicine Score (REMS), Modified Early Warning Score (MEWS), National Early Warning Score (NEWS), Glasgow Coma Scale, Age, and Systolic Blood Pressure score (GAPS) ,Glasgow coma scale (GCS) in prediction of mortality were 0.95, 0.95, 0.83, 0.89, 0.91, 0.84, 0.77, 0.97, and 0.98 respectively. The performance of GCS was statistically superior to RTS (P=0.005), WPSS (P=0.0001), RAPS (P=0.0002), REMS (P=0.002), MEWS (P<0.0001), and NEWS (P<0.0001). However, the performance of GCS, NTS (P=0.146), and GAPS (P=0.513) were not significantly different. Also, in prediction of poor outcomes, the AUC of GCS (0.98) was significantly higher than RTS (0.95), RAPS (0.85), REMS (0.85), MEWS (0.84), NEWS (0.77), and WPSS (0.75). Conclusion The GCS score seems to be a better instrument to predict mortality and poor outcome in trauma patients compared to other tools due to its high accuracy, wide application, and easy calculation.
Collapse
Affiliation(s)
- Sorour Khari
- Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mitra Zandi
- School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahmoud Yousefifard
- Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
10
|
Ni BK, Cai JY, Wang XB, Lin Q, Zhang XN, Wu JH. Utility of Serum Growth Arrest-Specific Protein 6 as a Biomarker of Severity and Prognosis After Severe Traumatic Brain Injury: A Prospective Observational Study. Neuropsychiatr Dis Treat 2022; 18:1441-1453. [PMID: 35859802 PMCID: PMC9293383 DOI: 10.2147/ndt.s372904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 07/07/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Growth arrest-specific protein 6 (Gas6) may harbor protective effects in acute brain injury. This study was designed to determine the relation of serum Gas6 levels to severity and prognosis after traumatic brain injury (TBI). METHODS In this prospective cohort study of 114 controls and 114 patients with severe TBI, multivariate analysis was used to assess relationships between serum Gas6 levels, Glasgow coma scale (GCS) score, Rotterdam computed tomography (CT) score, postinjury 180-day mortality, overall survival and poor prognosis (Extended Glasgow outcome scale score 1-4). RESULTS Significantly increased serum Gas6 levels of patients (median, 10.3 ng/mL versus 32.5 ng/mL; P < 0.001), as compared with controls, were independently correlated with Rotterdam CT score (t = 3.629, P < 0.001) and GCS score (t=-3.393, P = 0.001), and independently predicted 180-day mortality (odds ratio, 1.078; 95% confidence interval (CI), 1.007-1.154), overall survival (hazard ratio, 1.074; 95% CI, 1.012-1.139) and poor prognosis (odds ratio, 1.129; 95% CI, 1.059-1.205). Areas under receiver operating characteristic curve (AUCs) of serum Gas6 levels for discriminating risks of 180-day mortality and poor prognosis were 0.785 (95% CI, 0.699-0.857) and 0.793 (95% CI, 0.707-0.863), respectively; and serum Gas6 levels above 30.9 ng/mL and 28.3 ng/mL predicted 180-day mortality and poor prognosis with maximum Youden indices of 0.451 and 0.468, respectively. The predictive ability of serum Gas6 levels for mortality was similar to those of GCS score (AUC, 0.833; 95% CI, 0.751-0.896; P = 0.286) and Rotterdam CT score (AUC, 0.823; 95% CI, 0.740-0.888; P = 0.432). The discriminatory capability of serum Gas6 levels for the risk of poor prognosis was in the range of GCS score (AUC, 0.846; 95% CI, 0.766-0.906; P = 0.178) and Rotterdam CT score (AUC, 0.831; 95% CI, 0.750-0.895; P = 0.368). CONCLUSION Serum Gas6 may appear as a promising biochemical parameter for aiding in the assessment of trauma severity and prediction of prognosis among patients with severe TBI.
Collapse
Affiliation(s)
- Bu-Kao Ni
- Intensive Care Unit, The Wenzhou Central Hospital, Wenzhou, People's Republic of China
| | - Jian-Yong Cai
- Department of Neurosurgery, The Wenzhou Central Hospital, Wenzhou, People's Republic of China
| | - Xiao-Bo Wang
- Intensive Care Unit, The Wenzhou Central Hospital, Wenzhou, People's Republic of China
| | - Qun Lin
- Department of Neurosurgery, The Wenzhou Central Hospital, Wenzhou, People's Republic of China
| | - Xue-Na Zhang
- Intensive Care Unit, The Wenzhou Central Hospital, Wenzhou, People's Republic of China
| | - Jian-Hua Wu
- Intensive Care Unit, The Wenzhou Central Hospital, Wenzhou, People's Republic of China
| |
Collapse
|
11
|
Lorente L, Martín MM, González-Rivero AF, Pérez-Cejas A, Ramos-Gómez L, Solé-Violán J, Cáceres JJ, Ferrer-Moure C, Jiménez A. Association between serum concentrations of anti-apoptotic B-cell lymphoma-2 protein and traumatic brain injury mortality. Expert Rev Mol Diagn 2021; 22:125-129. [PMID: 34878357 DOI: 10.1080/14737159.2022.2016394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND There are scarce and contradictory data existing about B-cell lymphoma 2 (Bcl2), one of the Bcl2 family of anti-apoptotic proteins, in traumatic brain injury (TBI) patients. Thus, the objective of this study was to analyze whether blood concentrations of Bcl2 are associated with mortality. METHODS Patients with isolated and severe TBI, defined as <10 points of the Injury Severity Score (ISS) in non-cranial aspects and <9 points in Glasgow Coma Scale (GCS), were included. This was an observational and prospective study carried out in five Intensive Care Units. Serum Bcl2 concentrations on day 1 of TBI were determined. RESULTS Serum Bcl2 concentrations were lower (p < 0.001) in surviving patients (n = 59) compared to non-survivors (n = 24). We found an association between serum Bcl2 levels and mortality controlling for age and GCS (OR = 1.149; 95% CI = 1.056-1.251; p = 0.001) and controlling for computer tomography findings (OR = 1.147; 95% CI = 1.056-1.246; p = 0.001). CONCLUSIONS This study reports for the first time an association between serum Bcl2 levels and 30-day mortality in TBI patients.
Collapse
Affiliation(s)
- Leonardo Lorente
- Intensive Care Unit. Hospital Universitario de Canarias. Ofra, Santa Cruz de Tenerife, Spain
| | - María M Martín
- Intensive Care Unit, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | | | | | - Luis Ramos-Gómez
- Intensive Care Unit, Hospital General de La Palma, Breña Alta, La Palma, Spain
| | - Jordi Solé-Violán
- Intensive Care Unit, Hospital Universitario Dr. Negrín. CIBERES, Las Palmas de Gran Canaria, Spain
| | - Juan J Cáceres
- Intensive Care Unit, Hospital Insular, Las Palmas de Gran Canaria, Spain
| | - Carmen Ferrer-Moure
- Laboratory Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Alejandro Jiménez
- Research Unit, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| |
Collapse
|
12
|
Forssten MP, Bass GA, Scheufler KM, Mohammad Ismail A, Cao Y, Martin ND, Sarani B, Mohseni S. Mortality risk stratification in isolated severe traumatic brain injury using the revised cardiac risk index. Eur J Trauma Emerg Surg 2021; 48:4481-4488. [PMID: 34839374 DOI: 10.1007/s00068-021-01841-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/10/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE Traumatic brain injury (TBI) continues to be a significant cause of mortality and morbidity worldwide. As cardiovascular events are among the most common extracranial causes of death after a severe TBI, the Revised Cardiac Risk Index (RCRI) could potentially aid in the risk stratification of this patient population. This investigation aimed to determine the association between the RCRI and in-hospital deaths among isolated severe TBI patients. METHODS All adult patients registered in the TQIP database between 2013 and 2017 who suffered an isolated severe TBI, defined as a head AIS ≥ 3 with an AIS ≤ 1 in all other body regions, were included. Patients were excluded if they had a head AIS of 6. The association between different RCRI scores (0, 1, 2, 3, ≥ 4) and in-hospital mortality was analyzed using a Poisson regression model with robust standard errors while adjusting for potential confounders, with RCRI 0 as the reference. RESULTS 259,399 patients met the study's inclusion criteria. RCRI 2 was associated with a 6% increase in mortality risk [adjusted IRR (95% CI) 1.06 (1.01-1.12), p = 0.027], RCRI 3 was associated with a 17% increased risk of mortality [adjusted IRR (95% CI) 1.17 (1.05-1.31), p = 0.004], and RCRI ≥ 4 was associated with a 46% increased risk of in-hospital mortality [adjusted IRR(95% CI) 1.46 (1.11-1.90), p = 0.006], compared to RCRI 0. CONCLUSION An elevated RCRI ≥ 2 is significantly associated with an increased risk of in-hospital mortality among patients with an isolated severe traumatic brain injury. The simplicity and bedside applicability of the index makes it an attractive choice for risk stratification in this patient population.
Collapse
Affiliation(s)
- Maximilian Peter Forssten
- School of Medical Sciences, Orebro University, 702 81, Örebro, Sweden.,Division of Trauma and Emergency Surgery, Orebro University Hospital, 70185, Örebro, Sweden
| | - Gary Alan Bass
- School of Medical Sciences, Orebro University, 702 81, Örebro, Sweden.,Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Kai-Michael Scheufler
- Department of Neurosurgery, Orebro University Hospital, 70185, Örebro, Sweden.,Medical School, Heinrich-Heine University Dusseldorf, Düsseldorf, Germany
| | - Ahmad Mohammad Ismail
- School of Medical Sciences, Orebro University, 702 81, Örebro, Sweden.,Division of Trauma and Emergency Surgery, Orebro University Hospital, 70185, Örebro, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Orebro University, Örebro, Sweden
| | - Niels Douglas Martin
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Babak Sarani
- Division of Trauma and Acute Care Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Shahin Mohseni
- School of Medical Sciences, Orebro University, 702 81, Örebro, Sweden. .,Division of Trauma and Emergency Surgery, Orebro University Hospital, 70185, Örebro, Sweden.
| |
Collapse
|
13
|
Sun Y, Yang Y, Zhang Z, Li Y, Hu Y, Wang N. Early enteral nutrition combined with PSS-based nursing in the treatment of organophosphorus pesticide poisoning. Am J Transl Res 2021; 13:9315-9323. [PMID: 34540048 PMCID: PMC8430133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/08/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To investigate the administration of early enteral nutrition combined with poisoning severity score (PSS)-based nursing in the treatment of organophosphorus pesticide poisoning (OPP). METHODS A total of 99 OPP patients treated in our hospital between June 2019 and June 2020 were enrolled in this study and were divided into the conventional group (n=46, early enteral nutrition support + routine care) and the combined group (n=53, PSS-based nursing + early enteral nutrition support + routine care). The nutritional status indicators, the hemoglobin (Hb) and blood glucose levels, the Glasgow coma scale (GCS) scores, and the complications were compared between the two groups. RESULTS The total protein (TP), albumin (ALB), and prealbumin (PAB) levels were reduced in the conventional group after the intervention (P<0.05) but were significantly lower than they were in the combined group (P<0.05). The Hb and blood glucose levels were decreased in the conventional group after the intervention (P<0.05) and were significantly higher than they were in the combined group (P<0.05). The GCS scores increased significantly as the treatment progressed (P<0.05), and the GCS scores in the combined group were significantly higher than the GCS scores in the conventional group at 3 and 5 days after the treatment (P<0.05). The time to the recovery of 60% cholinesterase (CHE) activity, the durations of the mechanical ventilation, the lengths of the hospital stays, and the hospital costs in the combined group were significantly lower than they were in the conventional group (P<0.05). The complication rate in the combined group (9.43%) was significantly lower than the complication rate in the conventional group (32.61%) (P<0.05). CONCLUSION Early enteral nutrition combined with PSS-based nursing can effectively control the blood glucose, improve the nutritional disorders, promote recovery, and reduce complications in OPP patients.
Collapse
Affiliation(s)
- Yan Sun
- Emergency Department, Jinan City People’s HospitalJi’nan, Shandong Province, China
| | - Yuhua Yang
- Department of Drug Dispensing, Zibo Central HospitalZibo, Shandong Province, China
| | - Zhifang Zhang
- Department of Dermatology, Binzhou Hospital of Traditional Chinese MedicineBinzhou, Shandong Province, China
| | - Yunxia Li
- Department of Geriatrics, Binzhou Hospital of Traditional Chinese MedicineBinzhou, Shandong Province, China
| | - Yanyan Hu
- Medical Record Room, Huafeng Coal Mine Hospital of Xinwen Mining GroupTai’an, Shandong Province, China
| | - Ning Wang
- Department of Disease Control, Qingdao Women and Children’s HospitalQingdao, Shandong Province, China
| |
Collapse
|
14
|
Zhou L, Wang J, Wu Y, Liu ZY, Yu Y, Liu JF, Chen X. Clinical significance of mismatch negativity in predicting the awakening of comatose patients after severe brain injury. J Neurophysiol 2021; 126:140-147. [PMID: 34038175 DOI: 10.1152/jn.00658.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We assessed the clinical significance of mismatch negativity (MMN) in predicting the awakening of comatose patients with severe brain injury. The clinical data of patients with severe brain injury, admitted to the neurosurgical intensive care unit of Xiangya Hospital of Central South University from July 2018 to March 2020, who underwent auditory MMN examinations within 28 days after coma onset, were reviewed. Correlations between clinical factors and prognosis [Glasgow Outcome Scale (GCS) for 3 mo] were analyzed. Fifty-three patients were included; 37 (69.8%) had favorable outcomes. A univariate analysis revealed the Glasgow Coma Scale (GCS) and absolute MMN amplitudes at electrodes Fz and Cz were significantly correlated with prognosis. Only GCS scores and MMN amplitude at Fz were independent predictors in multivariate logistic regression analysis (area under the curve 0.744 vs. 0.753, respectively); both combined, improved accuracy to 84.6%. MMN amplitudes at Fz were dichotomized at a value of 1.08 μV with a sensitivity and specificity of 81.1% and 68.7%, respectively, for predicting comatose patients' awakening. In conclusion, MMN amplitude at Fz is a reliable prognostic indicator for comatose patients with severe brain injury; the prediction value improved when combined with GCS. Thus, an event-related potential component with a clear site and cutoff value may support prognostication in severe brain injury.NEW & NOTEWORTHY Mismatch negativity (MMN) can assess the prognosis of comatose patients after severe brain injury, especially for MMN amplitude. In addition, MMN analysis at electrode Fz best predicts recovery of consciousness in patients with severe brain injury. Importantly, a quantitative approach (cutoff value of 1.08 μV) may improve the use of MMN for prognostication.
Collapse
Affiliation(s)
- Liang Zhou
- Department of Neurosurgery, Xiangya Hospital Central South University, Changsha, Hunan Province, China
| | - Jian Wang
- Department of Neurosurgery, Xiangya Hospital Central South University, Changsha, Hunan Province, China
| | - Yun Wu
- Department of Neurosurgery, Xiangya Hospital Central South University, Changsha, Hunan Province, China
| | - Zi-Yuan Liu
- Department of Neurosurgery, Xiangya Hospital Central South University, Changsha, Hunan Province, China
| | - Yang Yu
- College of Intelligence Science and Technology, National University of Defense Technology, Changsha, Hunan Province, China
| | - Jin-Fang Liu
- Department of Neurosurgery, Xiangya Hospital Central South University, Changsha, Hunan Province, China
| | - Xin Chen
- Department of Neurosurgery, Xiangya Hospital Central South University, Changsha, Hunan Province, China
| |
Collapse
|
15
|
Lin Y, Zhang S, Zhang W, Wang X, Huang L, Luo H. The prediction value of Glasgow coma scale-pupils score in neurocritical patients: a retrospective study. Brain Inj 2021; 35:547-553. [PMID: 33645359 DOI: 10.1080/02699052.2021.1890821] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND External validation is necessary before its clinical recommendation in new setting. The aim is to externally validate Glasgow Coma Scale-pupils score (GCS-P) in neurocritical patients and to compare its performances with Glasgow Coma Scale (GCS) and its derivatives. METHODS GCS-P at admission was calculated for individual based on the model developed by Brennan et al. Area under the receiver operating characteristic curves (AUCs), Nagelkerke's R2 and Brier scores were used to assess external validity of GCS-P to predict mortality in neurocritical patients and to compare predictive performance with GCS and its derivatives. SUBJECTS 4372 neurocritical patients from intensive care units of Beth Israel Deaconess Medical Center, United States between 2001 and 2012. RESULTS GCS-P showed good discrimination (AUC 0.847 for in-hospital mortality and 0.774 for ninety-day mortality), modest calibration (Nagelkerke's R2 33.1% for in-hospital mortality and 23.3% for ninety-day mortality). Predictive performances of GCS and its derivatives was inferior to GCS-P. CONCLUSIONS GCP-P discriminated well in between death in neurocritical patients. GCP-P improved predictive performance for short-term mortality over GCS and its derivatives in neurocritical patients. It would be a simple, early and reasonable daily routine option for prognosis assessment in neurocritical setting.
Collapse
Affiliation(s)
- Yingxin Lin
- Department of Intensive Care, Peking University Shenzhen Hospital, Shenzhen, China
| | - Sheng Zhang
- Department of Intensive Care, Peking University Shenzhen Hospital, Shenzhen, China
| | - Weixing Zhang
- Department of Intensive Care, Peking University Shenzhen Hospital, Shenzhen, China
| | - Xinxin Wang
- Department of Intensive Care, Peking University Shenzhen Hospital, Shenzhen, China
| | - Lei Huang
- Department of Intensive Care, Peking University Shenzhen Hospital, Shenzhen, China
| | - Hua Luo
- Department of Intensive Care, Peking University Shenzhen Hospital, Shenzhen, China
| |
Collapse
|
16
|
Zhong M, Xu W, Qiu Y, Li L, Qu H, Chen E. Association of Changes in Acute Gastrointestinal Injury Grade with Prognosis in Critically Ill Patients: A Prospective, Single-Center, Observational Study. J Multidiscip Healthc 2021; 14:279-286. [PMID: 33574672 PMCID: PMC7872930 DOI: 10.2147/jmdh.s291883] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/07/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the association between the change of acute gastrointestinal injury (AGI) grade and the outcome in critically ill patients. Methods This was a prospectively observational study. All patients admitted in the ICU from October 2013 to June 2015, with the duration of ICU > 72 h and age >18 years, were enrolled in this study. The AGI grade and gastrointestinal symptoms were evaluated during ICU stay following the 2012 ESICM recommendation. The ICU mortality, duration of ICU stay, mechanical ventilation (MV) use, vasoactive drug use, and continuous renal replacement therapy of patients were recorded accordingly. Results A total of 320 patients were included, and 265 of them were diagnosed with AGI. The overall ICU mortality was 11.88%, while it was 13.58% in patients with AGI. In logistic regression analyses, the decreasing trend of AGI grade was identified as a protective factor for ICU death (odds ratio (OR), 0.484; 95% confidence interval (CI), 0.26–0.90), while the max AGI grade was a risk factor (OR, 3.464; 95% CI, 2.71–8.47) for ICU death. Conclusion The changes of AGI grades in critically ill patients were associated with their clinical outcomes. The ICU-acquired AGI patients associated with longer ICU stay days.
Collapse
Affiliation(s)
- Ming Zhong
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Wen Xu
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Yuzhen Qiu
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Lei Li
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Hongping Qu
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Erzhen Chen
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| |
Collapse
|
17
|
Kazakova M, Pavlov G, Dichev V, Simitchiev K, Stefanov C, Sarafian V. Relationship between YKL-40, neuron-specific enolase, tumor necrosis factor-a, interleukin-6, and clinical assessment scores in traumatic brain injury. ARCHIVES OF TRAUMA RESEARCH 2021. [DOI: 10.4103/atr.atr_43_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
18
|
Jiang X. An improved modified early warning score that incorporates the abdomen score for identifying multiple traumatic injury severity. PeerJ 2020; 8:e10242. [PMID: 33194421 PMCID: PMC7597630 DOI: 10.7717/peerj.10242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 10/05/2020] [Indexed: 11/20/2022] Open
Abstract
Background Rapid identification of trauma severity is essential for the timely triage of multiple trauma patients. Tools such as the modified early warning score (MEWS) are used for determining injury severity. Although the conventional MEWS is a good predictor of mortality, its performance assessing injury severity is moderate. This study hypothesized that adding an injury site severity-related score (e.g., abdomen score) may enhance the capability of the MEWS for identifying severe trauma. Method To validate the hypothesis, we propose an improved modified early warning score called MEWS-A, which incorporates an injury site-specific severity-related abdomen score to MEWS. The utility of MEWS and MEWS-A were retrospectively evaluated and compared for identifying trauma severity in adult multiple trauma patients admitted to the emergency department. Results We included 1,230 eligible multiple trauma patients and divided them into minor and severe trauma groups based on the injury severity score. Results of logistic regression and receiver operating characteristic (ROC) curve analyses showed that the MEWS-A had a higher area under the ROC curve (AUC: 0.81 95% CI [0.78-0.83]) than did the MEWS (AUC: 0.77 95% CI [0.74-0.79]), indicating that the MEWS-A is superior to the MEWS in identifying severe trauma. The optimal MEWS-A cut-off score is 4, with a specificity of 0.93 and a sensitivity of 0.54. MEWS-A ≥ 4 can be used as a protocol for decision-making in the emergency department. Conclusions Our study suggests that while the conventional MEWS is sufficient for predicting mortality risk, adding an injury site-specific score (e.g., abdomen score) can enhance its performance in determining injury severity in multiple trauma patients.
Collapse
Affiliation(s)
- Xiaobin Jiang
- Emergency Department 1, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| |
Collapse
|
19
|
Ţolescu RĂŞ, ZorilĂ MV, ZĂvoi RE, Popescu C, Dumitru I, Oprica AC, MogoantĂ L. Correlations Between the Glasgow Score and the Survival Period in Patients with Severe Traumatic Brain Injury. CURRENT HEALTH SCIENCES JOURNAL 2020; 46:412-419. [PMID: 33717517 PMCID: PMC7948015 DOI: 10.12865/chsj.46.04.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/15/2020] [Indexed: 11/18/2022]
Abstract
Traumatic brain injury (TBI) contributes by 30% to the mortality induced by traumatic injuries, also being one of the major causes of invalidity worldwide. The clinical classification of the severity of mild, moderate or severe TBI is made according to the Glasgow scale, according to the patient's conscious state, motric changes, speech changes and eye opening. In our study, we evaluated the correlation between the Glasgow score at admission and the survival period of patients suffering from TBI, using the data recorded in the Forensic Medicine Institute of Craiova between 2011-2017 on 1005 cases with the diagnosis of death by TBI. We observed that TBI affects persons of all ages, starting from babies up to the elderly aged over 90 years old. Regarding the generation mechanism, most deaths were caused by fallings (438 cases, 43.58%), followed by car accidents (333 cases, representing 33.13%). The number of patients who presented a post-traumatic survival period was 802 (79.80%), of which 779 adults (77.51%) and 23 children (2.29%). Among these, 785 (78.11%-764 adults and 21 children) were hospitalized, while in 64.58% of the TBI patients there was recorded the Glasgow score at admission. 75% of the TBI patients in whom there was recorded the Glasgow score presented a 1st-4th coma degree, with a Glasgow score from 3 to 8 and only 25% had a slightly altered or preserved conscious state, with a Glasgow score=9-15. The survival period varied from less than 24 hours to over 15 days. In the hospitalized patients, there were performed emergency surgeries in 269 (26.76%) cases, the surgical intervention being temporized in 108 (10.74%) patients.
Collapse
Affiliation(s)
- RĂzvan Ştefan Ţolescu
- PhD Student, Department of Histology, University of Medicine and Pharmacy of Craiova, Romania
| | - Marian Valentin ZorilĂ
- Department of Forensic Medicine, University of Medicine and Pharmacy of Craiova, Romania
| | - Roxana Eugenia ZĂvoi
- Department of Forensic Medicine, University of Medicine and Pharmacy of Craiova, Romania
| | - Cristina Popescu
- Department of Anatomy, University of Medicine and Pharmacy of Craiova, Romania
| | - Ilie Dumitru
- Department of Road Vehicles, Transportation and Industrial Engineering, Faculty of Mechanics, University of Craiova, Romania
| | - Alexandru Constantin Oprica
- PhD Student, Department of Road Vehicles, Transportation and Industrial Engineering, Faculty of Mechanics, University of Craiova, Romania
| | - LaurenŢiu MogoantĂ
- Department of Histology, University of Medicine and Pharmacy of Craiova, Romania
| |
Collapse
|
20
|
Shi YJ, Zheng GH, Qian LY, Qsman RA, Li GG, Zhang GJ. Longitudinal Analysis of Risk Factors for Clinical Outcomes of Enterobacteriaceae Meningitis/Encephalitis in Post-Neurosurgical Patients: A Comparative Cohort Study During 2014-2019. Infect Drug Resist 2020; 13:2161-2170. [PMID: 32753912 PMCID: PMC7351632 DOI: 10.2147/idr.s252331] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/17/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Our study is a retrospective observational study conducted in one of the largest clinical centers of neurosurgery in China. We aimed to investigate the antimicrobial susceptibility patterns of the Enterobacteriaceae isolates responsible for nosocomial meningitis/encephalitis in post-neurosurgical patients. Meanwhile, we tried to evaluate the risk factors for mortality following Enterobacteriaceae meningitis/encephalitis. Patients and Methods Medical data on clinical characteristics, antibiotic susceptibilities, and mortality were reviewed until patients’ discharge or death in the hospital. Data for a total of 164 cerebrospinal fluid (CSF) infection cases due to Enterobacteriaceae after neurosurgery were collected between January 2014 and November 2019 in order to identify risk factors affecting the outcome. Kaplan–Meier survival analysis and multivariable Cox proportional hazard models were applied. Results In this study, a total of 2416 neurosurgical meningitis/encephalitis cases were reported between 2014 and 2019. Enterobacteriaceae accounted for 7.3% (176/2416) of all the bacterial infections. Of them, 164 Enterobacteriaceae isolates were available to divide into two groups according to the final outcome of whether the patient died or survived. In total, 38 patients died (23.2%) and 126 patients survived (76.8%). The most frequent infecting species was Klebsiella pneumoniae (47.0%, 77/164). Fourteen-day and 30-day mortality rates were 7.9% (13/164) and 15.2% (25/164). Kaplan–Meier survival analysis revealed that the risk factors of Enterobacteriaceae meningitis/encephalitis that resulted in poor outcomes included comorbidities, Glasgow Coma Scale (GCS) score, sepsis, intensive care unit (ICU) admission, extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae, and ventilation. A GCS score of less than or equal to 8 (P=0.04, HR 2.562) was identified to be a significant risk factor for mortality according to the multivariable Cox proportional hazards model. Conclusion In-hospital mortality caused by Enterobacteriaceae meningitis/encephalitis in neurosurgery was high. A GCS score of ≤8 was an independent risk factor for mortality following Enterobacteriaceae meningitis/encephalitis in post-neurosurgical patients.
Collapse
Affiliation(s)
- Yi-Jun Shi
- Department of Clinical Diagnosis, Laboratory of Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,Beijing Engineering Research Center of Immunological Reagents Clinical Research, Beijing, People's Republic of China
| | - Guang-Hui Zheng
- Department of Clinical Diagnosis, Laboratory of Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,Beijing Engineering Research Center of Immunological Reagents Clinical Research, Beijing, People's Republic of China
| | - Ling-Ye Qian
- Department of Clinical Diagnosis, Laboratory of Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,Beijing Engineering Research Center of Immunological Reagents Clinical Research, Beijing, People's Republic of China
| | - Rasha Alsamani Qsman
- Department of Clinical Diagnosis, Laboratory of Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,Beijing Engineering Research Center of Immunological Reagents Clinical Research, Beijing, People's Republic of China
| | - Guo-Ge Li
- Department of Clinical Diagnosis, Laboratory of Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,Beijing Engineering Research Center of Immunological Reagents Clinical Research, Beijing, People's Republic of China
| | - Guo-Jun Zhang
- Department of Clinical Diagnosis, Laboratory of Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,Beijing Engineering Research Center of Immunological Reagents Clinical Research, Beijing, People's Republic of China
| |
Collapse
|
21
|
Ke X, Yang M, Luo JM, Zhang Y, Chen XY. The role of serum Dickkopf-1 in predicting 30-day death in severe traumatic brain injury. Brain Behav 2020; 10:e01589. [PMID: 32324340 PMCID: PMC7303377 DOI: 10.1002/brb3.1589] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/06/2020] [Accepted: 02/17/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Dickkopf-1 (DKK-1), an inhibitor of the canonical/-catenin cascade of the Wnt pathway, was upregulated in brain tissues of hemorrhagic stroke rats, and its rising circulating levels were associated with poor prognosis of acute ischemic stroke patients. We attempted to ascertain the relationship between serum DKK-1 levels and 30-day death after severe traumatic brain injury (sTBI). MATERIALS AND METHODS Serum DKK-1 levels were gauged in a total of 94 sTBI patients and 94 healthy controls. Trauma severity was assessed using Glasgow Coma Scale (GCS) and Rotterdam classification based on head computerized tomography scan. Prognostic variable was 30-day death. RESULTS Compared with controls, serum DKK-1 levels were substantially elevated in patients (median value, 3.7 versus 1.0 ng/ml). Area under receiver operating characteristic curve was 0.802 (95% confidence interval (CI), 0.708-0.877) for predicting 30-day death. Adjusted logistic regression showed that serum DKK-1 levels above 3.7 ng/ml remained as an independent marker of 30-day death (odds ratio, 8.573; 95% CI, 1.386-53.020) and overall survival (hazard ratio, 7.322; 95% CI, 1.320-40.622). An intimate correlation existed between DKK-1 levels and GCS scores (r = -.649) in addition to Rotterdam classification (r = .664). CONCLUSIONS High serum levels of DKK-1 are closely associated with increasing severity and rising short-term mortality of sTBI.
Collapse
Affiliation(s)
- Xin Ke
- Department of Critical Medicine, The Taizhou First People's Hospital, Taizhou, China
| | - Ming Yang
- Department of Neurosurgery, The Taizhou First People's Hospital, Taizhou, China
| | - Jin-Ming Luo
- Department of Critical Medicine, The Taizhou First People's Hospital, Taizhou, China
| | - Yu Zhang
- Department of Critical Medicine, The Taizhou First People's Hospital, Taizhou, China
| | - Xiao-Yu Chen
- Department of Critical Medicine, The Taizhou First People's Hospital, Taizhou, China
| |
Collapse
|
22
|
Zhou J, Yang CS, Shen LJ, Lv QW, Xu QC. Usefulness of serum glucose and potassium ratio as a predictor for 30-day death among patients with severe traumatic brain injury. Clin Chim Acta 2020; 506:166-171. [PMID: 32240656 DOI: 10.1016/j.cca.2020.03.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 03/26/2020] [Accepted: 03/26/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Serum glucose and potassium ratio (GPR) was recently found to be related to outcome of aneurysmal subarachnoid hemorrhage. This retrospectively study was to investigate the association of serum GPR with mortality in severe traumatic brain injury (sTBI). METHODS Clinical data were retrospectively reviewed of isolated sTBI patients admitted within 12 h after trauma between January 2014 and January 2019. We analyzed relationships between admission serum GPR and post-traumatic 30-day mortality in addition to admission Glasgow coma scale (GCS) scores. Discriminative ability was evaluated using area under receiver operating characteristic curve (AUC). RESULTS A total of 146 patients, of whom 37 (25.3%) died within 30 days following trauma, were included. Admission serum GPR emerged as an independent predictor for 30-day mortality (odds ratio, 5.256; 95% confidence interval (CI), 1.111-14.856) and overall survival (hazard ratio, 4.822; 95% CI, 1.157-12.870), with an AUC of 0.777 (95% CI, 0.693-0.835), which was equivalent to that of GCS scores (AUC, 0.831; 95% CI, 0.760-0.888; P = 0.179). There was a significant correlation between admission serum GPR and GCS scores (r2 = 0.293). CONCLUSIONS Serum GPR in cases of sTBI is substantially associated with trauma severity and 30-day mortality. Therefore, the potential value of serum GPR for predicting short-term mortality of sTBI patients is favorable.
Collapse
Affiliation(s)
- Jing Zhou
- Department of Neurosurgery, Shengzhou People's Hospital (The First Affiliated Hospital of Zhejiang University Shengzhou Branch), No. 666 Dangui Road, Shengzhou 312400, Zhejiang, China
| | - Chun-Song Yang
- Department of Neurosurgery, Shengzhou People's Hospital (The First Affiliated Hospital of Zhejiang University Shengzhou Branch), No. 666 Dangui Road, Shengzhou 312400, Zhejiang, China.
| | - Liang-Jun Shen
- Department of Neurosurgery, Shengzhou People's Hospital (The First Affiliated Hospital of Zhejiang University Shengzhou Branch), No. 666 Dangui Road, Shengzhou 312400, Zhejiang, China
| | - Qing-Wei Lv
- Department of Neurosurgery, Shengzhou People's Hospital (The First Affiliated Hospital of Zhejiang University Shengzhou Branch), No. 666 Dangui Road, Shengzhou 312400, Zhejiang, China
| | - Qi-Chen Xu
- Department of Neurosurgery, Shengzhou People's Hospital (The First Affiliated Hospital of Zhejiang University Shengzhou Branch), No. 666 Dangui Road, Shengzhou 312400, Zhejiang, China
| |
Collapse
|
23
|
Lentsck MH, de Oliveira RR, Corona LP, Mathias TADF. Risk factors for death of trauma patients admitted to an Intensive Care Unit. Rev Lat Am Enfermagem 2020; 28:e3236. [PMID: 32074207 PMCID: PMC7021481 DOI: 10.1590/1518-8345.3482.3236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 09/23/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the risk factors for death of trauma patients admitted to the intensive care unit (ICU). METHOD Retrospective cohort study with data from medical records of adults hospitalized for trauma in a general intensive care unit. We included patients 18 years of age and older and admitted for injuries. The variables were grouped into levels in a hierarchical manner. The distal level included sociodemographic variables, hospitalization, cause of trauma and comorbidities; the intermediate, the characteristics of trauma and prehospital care; the proximal, the variables of prognostic indices, intensive admission, procedures and complications. Multiple logistic regression analysis was performed. RESULTS The risk factors associated with death at the distal level were age 60 years or older and comorbidities; at intermediate level, severity of trauma and proximal level, severe circulatory complications, vasoactive drug use, mechanical ventilation, renal dysfunction, failure to perform blood culture on admission and Acute Physiology and Chronic Health Evaluation II. CONCLUSION The identified factors are useful to compose a clinical profile and to plan intensive care to avoid complications and deaths of traumatized patients.
Collapse
Affiliation(s)
- Maicon Henrique Lentsck
- Universidade Estadual de Maringá, Departamento de Enfermagem,
Maringá, PR, Brazil
- Universidade Estadual do Centro-Oeste, Departamento de Enfermagem,
Guarapuava, PR, Brazil
| | - Rosana Rosseto de Oliveira
- Universidade Estadual de Maringá, Departamento de Enfermagem,
Maringá, PR, Brazil
- Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal
de Nível Superior (CAPES), Brazil
| | - Ligiana Pires Corona
- Universidade Estadual de Campinas, Faculdade de Ciências Aplicadas,
Campinas, SP, Brazil
| | | |
Collapse
|
24
|
Reverse shock index multiplied by Glasgow Coma Scale (rSIG) predicts mortality in severe trauma patients with head injury. Sci Rep 2020; 10:2095. [PMID: 32034233 PMCID: PMC7005840 DOI: 10.1038/s41598-020-59044-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 01/22/2020] [Indexed: 11/09/2022] Open
Abstract
The reverse shock index (rSI), a ratio of systolic blood pressure (SBP) to heart rate (HR), is used to identify prognosis in trauma patients. Multiplying rSI by Glasgow Coma Scale (rSIG) can possibly predict better in-hospital mortality in patients with trauma. However, rSIG has never been used to evaluate the mortality risk in adult severe trauma patients (Injury Severity Score [ISS] ≥ 16) with head injury (head Abbreviated Injury Scale [AIS] ≥ 2) in the emergency department (ED). This retrospective case control study recruited adult severe trauma patients (ISS ≥ 16) with head injury (head AIS ≥ 2) who presented to the ED of two major trauma centers between January 01, 2014 and May 31, 2017. Demographic data, vital signs, ISS scores, injury mechanisms, laboratory data, managements, and outcomes were included for the analysis. Logistic regression and receiver operating characteristic analysis were used to evaluate the accuracy of rSIG score in predicting in-hospital mortality. In total, 438 patients (mean age: 56.48 years; 68.5% were males) were included in this study. In-hospital mortality occurred in 24.7% patients. The median (interquartile range) ISS score was 20 (17-26). Patients with rSIG ≤ 14 had seven-fold increased risks of mortality than those without rSIG ≤ 14 (odds ratio: 7.64; 95% confidence interval: 4.69-12.42). Hosmer-Lemeshow goodness-of-fit test and area under the curve values for rSIG score were 0.29 and 0.76, respectively. The sensitivity, specificity, positive predictive value, and negative predictive values of rSIG ≤ 14 were 0.71, 0.75, 0.49, and 0.89, respectively. The rSIG score is a prompt and simple tool to predict in-hospital mortality among adult severe trauma patients with head injury.
Collapse
|
25
|
Distributions and Reference Ranges for Automated Pupillometer Values in Neurocritical Care Patients. J Neurosci Nurs 2019; 51:335-340. [DOI: 10.1097/jnn.0000000000000478] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
26
|
Lorente L, Martín MM, Pérez-Cejas A, González-Rivero AF, Argueso M, Ramos L, Solé-Violán J, Cáceres JJ, Jiménez A, García-Marín V. Serum caspase-3 levels during the first week of traumatic brain injury. Med Intensiva 2019; 45:131-137. [PMID: 31677852 DOI: 10.1016/j.medin.2019.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/10/2019] [Accepted: 09/01/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Confluence between the intrinsic and extrinsic apoptosis pathways is reached at the point of caspase-3 activation, which induces death cell. Higher serum caspase-3 levels have been recorded on day 1 of traumatic brain injury (TBI) in 30-day non-survivors compared to survivors. The objectives of this study therefore were to determine whether serum caspase-3 levels are persistently higher in non-survivors than in survivors, and whether these levels may be used to predict 30-day mortality. DESIGN A prospective observational study was carried out. SETTING Six Spanish Intensive Care Units. PATIENTS Patients with severe isolated TBI (defined as Glasgow Coma Scale <9 points and non-cranial Injury Severity Score <10 points). INTERVENTIONS Serum caspase-3 concentrations were measured on days 1, 4 and 8 of TBI. MAIN VARIABLES OF INTEREST Thirty-day mortality was considered as the study endpoint. RESULTS In comparison with non-survivors (n=34), 30-day survivors (n=90) showed lower serum caspase-3 levels on days 1 (p=0.001), 4 (p<0.001) and 8 (p<0.001) of TBI. Analysis of the ROC curves showed serum caspase-3 concentrations on days 1, 4 and 8 of TBI to have an AUC (95% CI) in predicting 30-day mortality of 0.70 (0.61-0.78; p=0.001), 0.83 (0.74-0.89; p<0.001) and 0.87 (0.79-0.93; p<0.001), respectively. CONCLUSIONS The novel findings of our study were that serum caspase-3 levels during the first week of TBI were lower in survivors and could predict 30-day mortality.
Collapse
Affiliation(s)
- L Lorente
- Intensive Care Unit, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain.
| | - M M Martín
- Intensive Care Unit, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - A Pérez-Cejas
- Laboratory Department, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
| | - A F González-Rivero
- Laboratory Department, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
| | - M Argueso
- Intensive Care Unit, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - L Ramos
- Intensive Care Unit, Hospital General de La Palma, Breña Alta, La Palma, Spain
| | - J Solé-Violán
- Intensive Care Unit, Hospital Universitario Dr. Negrín, CIBERES, Las Palmas de Gran Canaria, Spain
| | - J J Cáceres
- Intensive Care Unit, Hospital Insular, Las Palmas de Gran Canaria, Spain
| | - A Jiménez
- Research Unit, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
| | - V García-Marín
- Department of Neurosurgery, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
| |
Collapse
|
27
|
Imran I, Syahrul S, Sofia S, Farida F, Musadir N, Fajar JK. Association of angiotensin-converting enzyme G2350A gene polymorphisms with hypertension among patients with intracerebral haemorrhage. J Taibah Univ Med Sci 2019; 14:300-305. [PMID: 31435421 PMCID: PMC6694934 DOI: 10.1016/j.jtumed.2019.04.004] [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: 01/06/2019] [Revised: 04/21/2019] [Accepted: 04/24/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To evaluate the correlation of angiotensin-converting enzyme (ACE) G2350A gene polymorphisms with hypertension, brain hematoma volume (BHV), level of consciousness, and disease outcome among intracerebral haemorrhage (ICH) patients. METHODS A cross-sectional study was conducted in Zainoel Abidin General Hospital from May 2016 to June 2017. Polymerase chain reaction was used to genotype ACE G2350A gene polymorphisms. BHV was assessed using the ABC/2 volume estimation formula. Level of consciousness was assessed by Glasgow coma scale (GCS). Disease outcome was assessed using Glasgow outcome scale (GOS). Association tests for ACE G2350A genotype in the context of hypertension status, BHV, GCS score, and GOS score in subjects with ICH was analysed by multiple logistic regression. RESULTS A total of 75 ICH patients were included in the study. Of those, 59 patients exhibited hypertension, 24 patients had BHV ≥60 cm3, 16 patients possessed GCS scores ≤8, and 72 patients had GOS scores of 1-3. Our analysis determined that the A allele of the ACE G2350A gene polymorphism was significantly associated with a 3.6-fold increase in hypertension; however, this polymorphism was not associated with BHV, level of consciousness, and disease outcome among ICH patients. CONCLUSION The A allele of the ACE G2350A gene polymorphisms is associated with hypertension among ICH patients.
Collapse
Affiliation(s)
- Imran Imran
- Department of Neurology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Syahrul Syahrul
- Department of Neurology, Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia
| | - Sofia Sofia
- Department of Biochemistry, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Farida Farida
- Department of Neurology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Nasrul Musadir
- Department of Neurology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Jonny K. Fajar
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| |
Collapse
|
28
|
Nosocomial Infections among Patients with Intracranial Hemorrhage: A Retrospective Data Analysis of Predictors and Outcomes. Clin Neurol Neurosurg 2019; 182:158-166. [PMID: 31151044 DOI: 10.1016/j.clineuro.2019.05.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 05/15/2019] [Accepted: 05/18/2019] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Intracranial hemorrhage is a critical medical emergency. Nosocomial infections may promote worse outcomes in these vulnerable patients. This study investigated microbial features, predictors, and clinical outcomes of nosocomial infections among patients with multiple subtypes of intracranial hemorrhage. PATIENTS AND METHODS We conducted a retrospective cohort study of patients that were hospitalized with intracranial hemorrhage between January 2015 and October 2018, and divided them into two groups based on the development of nosocomial infection. Within the cohort of patients with nosocomial infections, microbiology and resistance patterns were established across multiple sites of infection. Moreover, consequences of nosocomial infection such as mortality and length of hospital stay were determined. RESULTS A total of 233 cases were identified that met our inclusion and exclusion criteria out of which were 94 cases of nosocomial infection (40.3%) versus 139 cases with no nosocomial infection (59.7%). The most common infections were pneumonia, urinary tract infections, and bacteremia. Resistance accounted for 70.2% of cultures. Multivariable analysis revealed significant association of nosocomial infections with hypertension (OR: 2.62, 95% CI: 1.11-6.16, p = 0.027), hospital LOS (OR: 1.08, 95% CI: 1.05-1.12, p < 0.001), levetiracetam (OR: 3.6, 95% CI: 1.41-0.922, p = 0.007), and GCS category (OR: 5.42, 95% CI: 1.67-17.55, p = 0.005 and OR: 7.63, 95% CI: 2.44-23.87, p < 0.001 for moderate and severe, respectively). Patients with nosocomial infections witnessed a significant increase in the length of hospital stay (23 versus 8 hospital days, p < 0.001). This finding was significant across most types of brain hemorrhage. Mortality was significantly associated with GCS category (OR: 10.1, 95% CI: 4-25.7, p < 0.001) and percutaneous endoscopic gastrostomy tube insertion (OR: 19.6, 95% CI: 4.1-91, p < 0.001). CONCLUSIONS Collectively, these findings suggest that nosocomial infections are common among patients with intracranial hemorrhage and can be predictable by considering certain risk factors. Future studies are warranted to evaluate the efficacy of implementing infection control strategies or protocols on these patients to achieve better therapeutic outcomes.
Collapse
|
29
|
Chen TJ, Ji MX, Tao ZQ, Fu QY, Xiong K, Cheng B. The relationship between serum fibrinogen-like protein 2 concentrations and 30-day mortality of patients with traumatic brain injury. Clin Chim Acta 2018; 489:53-57. [PMID: 30503273 DOI: 10.1016/j.cca.2018.11.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 11/28/2018] [Accepted: 11/28/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Fibrinogen-like protein 2 (FGL2) is an inflammatory procoagulant protein. We discerned the impact of serum FGL2 on trauma severity and 30-day mortality in patients with traumatic brain injury (TBI). METHODS A total of 114 severe TBI patients were subjected to assessment of trauma severity using the Glasgow coma scale (GCS). Measurement of the serum concentrations of FGL2 was done. 114 matched control subjects for their age and sex were included for comparison of serum concentration of FGL2. RESULTS The concentration of FGL2 was dramatically increased in the patients as compared with the control subjects. FGL2 concentration was inversely correlated with GCS score among the patients. The non-survivors within 30 days exhibited substantially higher FGL2 concentrations than the alive. FGL2 concentrations discriminated the patients at risk of 30-day death with significantly high area under receiver operating characteristic curve. Serum FGL2 emerged as an independent predictor for mortality and overall survival at 30 days after head trauma. CONCLUSIONS Serum FGL2 is a promising biomarker for assessing the severity and prognosis in severe TBI.
Collapse
Affiliation(s)
- Tie-Jiang Chen
- Department of Emergency Surgery, Yiwu Central Hospital, 699 Jiangdong Road, Yiwu 322000, Zhejiang Province, China.
| | - Ming-Xia Ji
- Department of Emergency Surgery, Yiwu Central Hospital, 699 Jiangdong Road, Yiwu 322000, Zhejiang Province, China
| | - Zhi-Qiang Tao
- Department of Emergency Surgery, Yiwu Central Hospital, 699 Jiangdong Road, Yiwu 322000, Zhejiang Province, China
| | - Qing-Yang Fu
- Department of Emergency Surgery, Yiwu Central Hospital, 699 Jiangdong Road, Yiwu 322000, Zhejiang Province, China
| | - Kai Xiong
- Department of Emergency Surgery, Yiwu Central Hospital, 699 Jiangdong Road, Yiwu 322000, Zhejiang Province, China
| | - Bin Cheng
- Department of Emergency Surgery, Yiwu Central Hospital, 699 Jiangdong Road, Yiwu 322000, Zhejiang Province, China
| |
Collapse
|
30
|
The Reverse Shock Index Multiplied by Glasgow Coma Scale Score (rSIG) and Prediction of Mortality Outcome in Adult Trauma Patients: A Cross-Sectional Analysis Based on Registered Trauma Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15112346. [PMID: 30355971 PMCID: PMC6266192 DOI: 10.3390/ijerph15112346] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 10/19/2018] [Accepted: 10/20/2018] [Indexed: 11/17/2022]
Abstract
The reverse shock index (rSI) multiplied by Glasgow Coma Scale (GCS) score (rSIG), calculated by multiplying the GCS score with systolic blood pressure (SBP)/hear rate (HR), was proposed to be a reliable triage tool for identifying risk of in-hospital mortality in trauma patients. This study was designed to externally validate the accuracy of the rSIG in the prediction of mortality in our cohort of trauma patients, in comparison with those that were predicted by the Revised Trauma Score (RTS), shock index (SI), and Trauma and Injury Severity Score (TRISS). Adult trauma patients aged ≥20 years who were admitted to the hospital from 1 January 2009 to 31 December 2017, were included in this study. The rSIG, RTS, and SI were calculated according to the initial vital signs and GCS scores of patients upon arrival at the emergency department (ED). The end-point of primary outcome is in-hospital mortality. Discriminative power of each score to predict mortality was measured using area under the curve (AUC) by plotting the receiver operating characteristic (ROC) curve for 18,750 adult trauma patients, comprising 2438 patients with isolated head injury (only head Abbreviated Injury Scale (AIS) ≥ 2) and 16,312 without head injury (head AIS ≤ 1). The predictive accuracy of rSIG was significantly lower than that of RTS in all trauma patients (AUC 0.83 vs. AUC 0.85, p = 0.02) and in patients with isolated head injury (AUC 0.82 vs. AUC 0.85, p = 0.02). For patients without head injury, no difference was observed in the predictive accuracy between rSIG and RTS (AUC 0.83 vs. AUC 0.83, p = 0.97). Based on the cutoff value of 14.0, the rSIG can predict the probability of dying in trauma patients without head injury with a sensitivity of 61.5% and specificity of 94.5%. The predictive accuracy of both rSIG and RTS is significantly poorer than that of TRISS, in all trauma patients (AUC 0.93) or in patients with (AUC 0.89) and without head injury (AUC 0.92). In addition, SI had the significantly worse predictive accuracy than all of the other three models in all trauma patients (AUC 0.57), and the patients with (AUC 0.53) or without (AUC 0.63) head injury. This study revealed that rSIG had a significantly higher predictive accuracy of mortality than SI in all of the studied population but a lower predictive accuracy of mortality than RTS in all adult trauma patients and in adult patients with isolated head injury. In addition, in the adult patients without head injury, rSIG had a similar performance as RTS to the predictive risk of mortality of the patients.
Collapse
|