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Outcome of post-traumatic acute respiratory distress syndrome in young patients requiring extracorporeal membrane oxygenation (ECMO). Sci Rep 2022; 12:10609. [PMID: 35739167 PMCID: PMC9226058 DOI: 10.1038/s41598-022-14741-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
We aimed to evaluate the outcomes of post-traumatic acute respiratory distress syndrome (ARDS) in young patients with and without Extracorporeal membrane oxygenation (ECMO) support. A retrospective analysis was conducted for trauma patients who developed ARDS at a level I trauma facility between 2014 and 2020. Data were analyzed and compared between ECMO and non-ECMO group. We identified 85 patients with ARDS (22 patients had ECMO support and 63 matched patients managed by the conventional mechanical ventilation; 1:3 matching ratio). The two groups were comparable for age, sex, injury severity score, abbreviated injury score, shock index, SOFA score, and head injury. Kaplan Meier survival analysis showed that the survival in the ECMO group was initially close to that of the non-ECMO, however, during follow-up, the survival rate was better in the ECMO group, but did not reach statistical significance (Log-rank, p = 0.43 and Tarone-Ware, p = 0.37). Multivariable logistic regression analysis showed that acute kidney injury (AKI) (Odds ratio 13.03; 95% CI 3.17–53.54) and brain edema (Odds ratio 4.80; 95% CI 1.10–21.03) were independent predictors of mortality. Sub-analysis showed that in patients with severe Murray Lung Injury (MLI) scores, non-ECMO group had higher mortality than the ECMO group (100% vs 36.8%, p = 0.004). Although ARDS is uncommon in young trauma patients, it has a high mortality. ECMO therapy was used in a quarter of ARDS cases. AKI and brain edema were the predictors of mortality among ARDS patients. ECMO use did not worsen the outcome in trauma patients; however, the survival was better in those who had severe MLI and ECMO support. Further prospective study is needed to define the appropriate selection criteria for the use of ECMO to optimize the outcomes in trauma patients.
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Liu Y, Gao K, Deng H, Ling T, Lin J, Yu X, Bo X, Zhou J, Gao L, Wang P, Hu J, Zhang J, Tong Z, Liu Y, Shi Y, Ke L, Gao Y, Li W. A time-incorporated SOFA score-based machine learning model for predicting mortality in critically ill patients: A multicenter, real-world study. Int J Med Inform 2022; 163:104776. [PMID: 35512625 DOI: 10.1016/j.ijmedinf.2022.104776] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/11/2022] [Accepted: 04/14/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Organ dysfunction (OD) assessment is essential in intensive care units (ICUs). However, current OD assessment scores merely describe the number and the severity of each OD, without evaluating the duration of organ injury. The objective of this study is to develop and validate a machine learning model based on the Sequential Organ Failure Assessment (SOFA) score for the prediction of mortality in critically ill patients. MATERIAL AND METHODS Data from the eICU Collaborative Research Database and Medical Information Mart for Intensive Care (MIMIC) -III were mixed for model development. The MIMIC-IV and Nanjing Jinling Hospital Surgical ICU database were used as external test set A and set B, respectively. The outcome of interest was in-ICU mortality. A modified SOFA model incorporating time-dimension (T-SOFA) was stepwise developed to predict ICU mortality using extreme gradient boosting (XGBoost), support vector machine, random forest and logistic regression algorithms. Time-dimensional features were calculated based on six consecutive SOFA scores collected every 12 h within the first three days of admission. The predictive performance was assessed with the area under the receiver operating characteristic curves (AUROC) and calibration plot. RESULTS A total of 82,132 patients from the real-world datasets were included in this study, and 7,494 patients (9.12%) died during their ICU stay. The T-SOFA M3 that incorporated the time-dimension features and age, using the XGBoost algorithm, significantly outperformed the original SOFA score in the validation set (AUROC 0.800 95% CI [0.787-0.813] vs. 0.693 95% CI [0.678-0.709], p < 0.01). Good discrimination and calibration were maintained in the test set A and B, with AUROC of 0.803, 95% CI [0.791-0.815] and 0.830, 95% CI [0.789-0.870], respectively. CONCLUSIONS The time-incorporated T-SOFA model could significantly improve the prediction performance of the original SOFA score and is of potential for identifying high-risk patients in future clinical application.
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Affiliation(s)
- Yang Liu
- Department of Critical Care Medicine, Affiliated Jinling Hospital, School of Medicine, Southeast University& Nanjing University, Nanjing 210002, PR China
| | - Kun Gao
- Department of Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing 210002, PR China
| | - Hongbin Deng
- Department of Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing 210002, PR China
| | - Tong Ling
- National Institute of Healthcare Data Science at Nanjing University, Nanjing, 210023, PR China; National Key Laboratory for Novel Software Technology, Nanjing University, Nanjing, 210023, PR China
| | - Jiajia Lin
- Department of Critical Care Medicine, Affiliated Jinling Hospital, School of Medicine, Southeast University& Nanjing University, Nanjing 210002, PR China
| | - Xianqiang Yu
- Department of Critical Care Medicine, Affiliated Jinling Hospital, School of Medicine, Southeast University& Nanjing University, Nanjing 210002, PR China
| | - Xiangwei Bo
- Department of Critical Care Medicine, Affiliated Jinling Hospital, School of Medicine, Southeast University& Nanjing University, Nanjing 210002, PR China
| | - Jing Zhou
- Department of Critical Care Medicine, Affiliated Jinling Hospital, School of Medicine, Southeast University& Nanjing University, Nanjing 210002, PR China
| | - Lin Gao
- Department of Critical Care Medicine, Affiliated Jinling Hospital, School of Medicine, Southeast University& Nanjing University, Nanjing 210002, PR China
| | - Peng Wang
- Department of Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing 210002, PR China
| | - Jiajun Hu
- National Institute of Healthcare Data Science at Nanjing University, Nanjing, 210023, PR China; National Key Laboratory for Novel Software Technology, Nanjing University, Nanjing, 210023, PR China
| | - Jian Zhang
- National Institute of Healthcare Data Science at Nanjing University, Nanjing, 210023, PR China; National Key Laboratory for Novel Software Technology, Nanjing University, Nanjing, 210023, PR China
| | - Zhihui Tong
- Department of Critical Care Medicine, Affiliated Jinling Hospital, School of Medicine, Southeast University& Nanjing University, Nanjing 210002, PR China
| | - Yuxiu Liu
- Department of Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing 210002, PR China
| | - Yinghuan Shi
- National Institute of Healthcare Data Science at Nanjing University, Nanjing, 210023, PR China; National Key Laboratory for Novel Software Technology, Nanjing University, Nanjing, 210023, PR China.
| | - Lu Ke
- Department of Critical Care Medicine, Affiliated Jinling Hospital, School of Medicine, Southeast University& Nanjing University, Nanjing 210002, PR China; National Institute of Healthcare Data Science at Nanjing University, Nanjing, 210023, PR China.
| | - Yang Gao
- National Institute of Healthcare Data Science at Nanjing University, Nanjing, 210023, PR China; National Key Laboratory for Novel Software Technology, Nanjing University, Nanjing, 210023, PR China
| | - Weiqin Li
- Department of Critical Care Medicine, Affiliated Jinling Hospital, School of Medicine, Southeast University& Nanjing University, Nanjing 210002, PR China; National Institute of Healthcare Data Science at Nanjing University, Nanjing, 210023, PR China
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3
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Luís A, Hackl M, Jafarmadar M, Keibl C, Jilge JM, Grillari J, Bahrami S, Kozlov AV. Circulating miRNAs Associated With ER Stress and Organ Damage in a Preclinical Model of Trauma Hemorrhagic Shock. Front Med (Lausanne) 2020; 7:568096. [PMID: 33072784 PMCID: PMC7542230 DOI: 10.3389/fmed.2020.568096] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 08/18/2020] [Indexed: 12/26/2022] Open
Abstract
Circulating microRNAs (miRNA) alterations have been reported in severe trauma patients but the pathophysiological relevance of these changes is still unclear. miRNAs are critical biologic regulators of pathological events such as hypoxia and inflammation, which are known to induce endoplasmic reticulum (ER) stress. ER stress is emerging as an important process contributing to the development of single and/or multiple organ dysfunction after trauma hemorrhagic shock (THS) accompanied by impaired tissue microcirculation and inflammation. Here, we aim to bring new insights into the involvement of miRNAs associated with ER stress in THS. THS was induced in rats by a median laparotomy and blood withdrawal until mean arterial pressure (MAP) dropped to 30-35 mmHg followed by a restrictive (40 min) and full reperfusion (60 min) with Ringer's solution. Tunicamycin was used to induce ER stress. Blood samples were collected 24 h after THS for the determination of pathological changes in the blood (PCB) and circulating miRNAs. Plasma levels of circulating miRNAs were compared between THS, tunicamycin, and sham groups and correlated to biomarkers of PCB. MiRNA profile of THS animals showed that 40 out of 91 (44%) miRNAs were significantly upregulated compared to sham (p < 0.01). The data showed a very strong correlation between liver injury and miR−122-5p (r = 0.91, p < 0.00001). MiR-638, miR−135a-5p, miR−135b-5p, miR-668-3p, miR-204-5p, miR−146a-5p, miR−200a-3p, miR−17-5p, miR−30a-5p, and miR−214-3p were found positively correlated with lactate (r > 0.7, p < 0.05), and negatively with base excess (r ≤ 0.8, p < 0.05) and bicarbonate (r ≤ 0.8, p < 0.05), which are clinical parameters that reflected the shock severity. Tunicamycin significantly modified the microRNA profile of the animals, 33 out of 91 miRNAs were found differentially expressed. In addition, principal component analysis revealed that THS and tunicamycin induced similar changes in plasma miRNA patterns. Strikingly, the data showed that 15 (25.9%) miRNAs were regulated by both THS and tunicamycin (p < 0.01). This included miR−122-5p, a liver-specific microRNA, but also miR−17-5p and miR-125b-5p which are miRNAs remarkably involved in unfolded protein response (UPR)-mediating pro-survival signaling (IRE1α). Since miRNAs associated with ER stress are clearly correlated with THS, our data strongly suggest that interaction between miRNAs and ER stress is an important pathologic event occurring during THS. Overall, we consider that the miRNA profile developed in this study can provide a rationale for the development of bench-to-bedside strategies that target miRNAs in critical care diseases or be used as biomarkers in the prognosis of trauma patients.
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Affiliation(s)
- Andreia Luís
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
| | - Matthias Hackl
- TAmiRNA GmbH, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Medical University of Vienna, Vienna, Austria
| | - Mohammad Jafarmadar
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
| | - Claudia Keibl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
| | - Julia M Jilge
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
| | - Johannes Grillari
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Medical University of Vienna, Vienna, Austria.,Christian Doppler Laboratory for Biotechnology of Skin Aging, Department of Biotechnology, Institute of Molecular Biotechnology, BOKU-University of Natural Resources and Life Sciences, Vienna, Austria
| | - Soheyl Bahrami
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
| | - Andrey V Kozlov
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,Laboratory of Navigational Redox Lipidomics and Department of Human Pathology, IM Sechenov Moscow State Medical University, Moscow, Russia
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Abstract
Multiple organ dysfunction syndrome (MODS) is one of the most common syndromes of critical illness and the leading cause of mortality among critically ill patients. Multiple organ dysfunction syndrome is the clinical consequence of a dysregulated inflammatory response, triggered by clinically diverse factors with the main pillar of management being invasive organ support. During the last years, the advances in the clarification of the molecular pathways that trigger, mitigate, and determine the outcome of MODS have led to the increasing recognition of MODS as a distinct disease entity with distinct etiology, pathophysiology, and potential future therapeutic interventions. Given the lack of effective treatment for MODS, its early recognition, the early intensive care unit admission, and the initiation of invasive organ support remain the most effective strategies of preventing its progression and improving outcomes.
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Affiliation(s)
- Nicholas M Gourd
- Department of Intensive Care Medicine, Derriford Hospital, 6634University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom.,Faculty of Medicine and Dentistry, 6634University of Plymouth, Plymouth, United Kingdom
| | - Nikitas Nikitas
- Department of Intensive Care Medicine, Derriford Hospital, 6634University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
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Kim DU, Bae GS, Kim MJ, Choi JW, Kim DG, Song HJ, Park SJ. Icariin attenuates the severity of cerulein‑induced acute pancreatitis by inhibiting p38 activation in mice. Int J Mol Med 2019; 44:1563-1573. [PMID: 31432106 DOI: 10.3892/ijmm.2019.4312] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 07/08/2019] [Indexed: 11/06/2022] Open
Abstract
Acute pancreatitis (AP) is an inflammatory disease of the pancreas. Icariin (ICA), a flavonoid glycoside, has been reported to have several pharmacological effects; however, the anti‑inflammatory effects of ICA against AP require further study. Therefore, we aimed to investigate the effect of ICA on cerulein‑induced AP. In the present study, AP was induced by intraperitoneally administering a supramaximal concentration of cerulein (50 µg/kg/h) for 6 h. ICA was also administered intraperitoneally, and mice were sacrificed 6 h after the final cerulein injection. Blood samples were collected to determine serum amylase and lipase levels. The pancreas and lung were rapidly removed for histological examination, and the analysis of myeloperoxidase activity. In addition, reverse transcription‑quantitative polymerase chain reaction was conducted to analyze the expression of inflammatory cytokines in pancreatic tissues. Our results revealed that the administration of ICA prevented an increase in the pancreas weight/body weight ratio of mice and serum digestive enzyme levels. ICA treatment also inhibited cerulein‑induced histological injury and neutrophil infiltration of the pancreas and lung. In addition, ICA suppressed the production of pro‑inflammatory cytokines, including interleukin (IL)‑1β, IL‑6 and tumor necrosis factor‑α in the pancreas. Furthermore, ICA administration was observed to inhibit p38 activation during cerulein‑induced AP. Inhibition of p38 activation resulted in alleviated pancreatitis. Collectively, our results suggested that ICA exhibits anti‑inflammatory effects in cerulein‑induced AP via the inhibition of p38.
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Affiliation(s)
- Dong-Uk Kim
- Department of Herbology, School of Korean Medicine, Wonkwang University, Iksan, Jeonbuk 54538, Republic of Korea
| | - Gi-Sang Bae
- Hanbang Cardio‑Renal Syndrome Research Center, Wonkwang University, Iksan, Jeonbuk 54538, Republic of Korea
| | - Myoung-Jin Kim
- Department of Herbology, School of Korean Medicine, Wonkwang University, Iksan, Jeonbuk 54538, Republic of Korea
| | - Ji-Won Choi
- Department of Herbology, School of Korean Medicine, Wonkwang University, Iksan, Jeonbuk 54538, Republic of Korea
| | - Dong-Gu Kim
- Department of Herbology, School of Korean Medicine, Wonkwang University, Iksan, Jeonbuk 54538, Republic of Korea
| | - Ho-Joon Song
- Department of Herbology, School of Korean Medicine, Wonkwang University, Iksan, Jeonbuk 54538, Republic of Korea
| | - Sung-Joo Park
- Department of Herbology, School of Korean Medicine, Wonkwang University, Iksan, Jeonbuk 54538, Republic of Korea
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Jin X, Yao Y, Lu X, Xu P, Xia Y, Zhu S. Function and mechanism of pyrin and IL-10 in the regulation of the inflammasome in pulmonary vascular endothelial cells following hemorrhagic shock. Exp Ther Med 2019; 18:1768-1774. [PMID: 31410136 PMCID: PMC6676148 DOI: 10.3892/etm.2019.7757] [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: 05/07/2018] [Accepted: 05/23/2019] [Indexed: 11/18/2022] Open
Abstract
The present study aimed to evaluate the function of pyrin and interleukin-10 (IL-10) and the potential mechanisms underlying the regulation of inflammation in pulmonary vascular endothelial cells (ECs) following hemorrhagic shock (HS). Adult female Sprague-Dawley rats were divided into 4 groups (n=6 in each group) to examine the changes in pyrin expression following HS-lipopolysaccharide (LPS) administration, including the following groups: A sham operation (SM) + tracheal injection of saline (SAL) group; a HS + SAL group; a SM + LPS group (with a tracheal injection of endotoxin); and a HS + LPS group. An additional 4 groups were used to evaluate the function of IL-10, by the additional intratracheal injection of recombinant IL-10. Western blot analysis and immunofluorescence were performed in order to investigate the changes to pyrin and IL-10 expression in pulmonary vascular ECs. The expression levels of pyrin in the SM + LPS group were significantly increased in comparison with the SM + SAL group (P<0.01). Additionally, the expression levels of pyrin were significantly increased in the HS + LPS group compared with the HS + SAL group (P<0.01). The expression levels of caspase-1 were significantly increased in the HS + LPS group compared with those in the other three groups (P<0.01). The expression levels of pyrin in the HS + LPS + IL-10 group were significantly increased compared with the HS + LPS group (P<0.01). The expression levels of caspase-1 were significantly decreased following IL-10 treatment compared with those in the HS + LPS group (P<0.01). Therefore, HS attenuated LPS-induced pyrin expression in pulmonary vascular ECs and may also inhibit the expression of IL-10, resulting in the activation of caspase-1 subsequent to a second LPS insult.
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Affiliation(s)
- Xin Jin
- Department of Anesthesia, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, P.R. China.,Department of Anesthesia, Zhejiang Hospital, Hangzhou, Zhejiang 310013, P.R. China
| | - Yongxing Yao
- Department of Anesthesia, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, P.R. China
| | - Xing Lu
- Department of Anesthesia, Zhejiang Hospital, Hangzhou, Zhejiang 310013, P.R. China
| | - Peng Xu
- Department of Anesthesia, Zhejiang Hospital, Hangzhou, Zhejiang 310013, P.R. China
| | - Yanfei Xia
- Department of Anesthesia, Zhejiang Hospital, Hangzhou, Zhejiang 310013, P.R. China
| | - Shengmei Zhu
- Department of Anesthesia, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, P.R. China
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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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8
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Dat VQ, Long NT, Hieu VN, Phuc NDH, Kinh NV, Trung NV, van Doorn HR, Bonell A, Nadjm B. Clinical characteristics, organ failure, inflammatory markers and prediction of mortality in patients with community acquired bloodstream infection. BMC Infect Dis 2018; 18:535. [PMID: 30367601 PMCID: PMC6204014 DOI: 10.1186/s12879-018-3448-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 10/16/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Community acquired bloodstream infection (CABSI) in low- and middle income countries is associated with a high mortality. This study describes the clinical manifestations, laboratory findings and correlation of SOFA and qSOFA with mortality in patients with CABSI in northern Vietnam. METHODS This was a retrospective study of 393 patients with at least one positive blood culture with not more than one bacterium taken within 48 h of hospitalisation. Clinical characteristic and laboratory results from the first 24 h in hospital were collected. SOFA and qSOFA scores were calculated and their validity in this setting was evaluated. RESULTS Among 393 patients with bacterial CABSI, approximately 80% (307/393) of patients had dysfunction of one or more organ on admission to the study hospital with the most common being that of coagulation (57.1% or 226/393). SOFA performed well in prediction of mortality in those patients initially admitted to the critical care unit (AUC 0.858, 95%CI 0.793-0.922) but poor in those admitted to medical wards (AUC 0.667, 95%CI 0.577-0.758). In contrast qSOFA had poor predictive validity in both settings (AUC 0.692, 95%CI 0.605-0.780 and AUC 0.527, 95%CI 0.424-0.630, respectively). The overall case fatality rate was 28%. HIV infection (HR = 3.145, p = 0.001), neutropenia (HR = 2.442, p = 0.002), SOFA score 1-point increment (HR = 1.19, p < 0.001) and infection with Enterobacteriaceae (HR = 1.722, p = 0.037) were independent risk factors for in-hospital mortality. CONCLUSIONS Organ dysfunction was common among Vietnamese patients with CABSI and associated with high case fatality. SOFA and qSOFA both need to be further validated in this setting.
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Affiliation(s)
- Vu Quoc Dat
- Department of Infectious Diseases, Hanoi Medical University, no 1 Ton That Tung street, Dong Da district, Hanoi, Vietnam
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Hanoi, 78 Giai Phong street, Dong Da district, Hanoi, Vietnam
- National Hospital for Tropical Diseases, 78 Giai Phong street, Dong Da district, Hanoi, Vietnam
| | - Nguyen Thanh Long
- Department of Infectious Diseases, Hanoi Medical University, no 1 Ton That Tung street, Dong Da district, Hanoi, Vietnam
| | - Vu Ngoc Hieu
- Department of Microbiology, Hanoi Medical University, no 1 Ton That Tung street, Dong Da district, Hanoi, Vietnam
| | - Nguyen Dinh Hong Phuc
- Department of Infectious Diseases, Hanoi Medical University, no 1 Ton That Tung street, Dong Da district, Hanoi, Vietnam
| | - Nguyen Van Kinh
- National Hospital for Tropical Diseases, 78 Giai Phong street, Dong Da district, Hanoi, Vietnam
| | - Nguyen Vu Trung
- National Hospital for Tropical Diseases, 78 Giai Phong street, Dong Da district, Hanoi, Vietnam
- Department of Microbiology, Hanoi Medical University, no 1 Ton That Tung street, Dong Da district, Hanoi, Vietnam
| | - H. Rogier van Doorn
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Hanoi, 78 Giai Phong street, Dong Da district, Hanoi, Vietnam
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, University of Oxford, Oxford, UK
| | - Ana Bonell
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Hanoi, 78 Giai Phong street, Dong Da district, Hanoi, Vietnam
| | - Behzad Nadjm
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Hanoi, 78 Giai Phong street, Dong Da district, Hanoi, Vietnam
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, University of Oxford, Oxford, UK
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9
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Xiu G, Sun J, Li X, Jin H, Zhu Y, Zhou X, Liu P, Pan X, Li J, Ling B. The role of HMGB1 in BMSC transplantation for treating MODS in rats. Cell Tissue Res 2018; 373:395-406. [PMID: 29637307 DOI: 10.1007/s00441-018-2823-0] [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: 06/04/2017] [Accepted: 03/06/2018] [Indexed: 02/02/2023]
Abstract
The effect of bone marrow mesenchymal stem cells (BMSCs) in treatment for multiple organ dysfunction syndrome (MODS) remains unknown and the mechanism is still unclear. Therefore, the goal of this study is to investigate the effects of intracellular high mobility group box 1 protein (HMGB1) on BMSCs treating for MODS. The rats were given 15% blood loss plus 1 mg/kg lipopolysaccharide (LPS) via lower extremity superficial venous, then randomly allocated into four groups: sham group, MODS group, MODS plus BMSC group, MODS plus ethyl pyruvate (EP) group, MODS plus BMSCs plus EP group. Twenty-four hours later, rats in groups were sacrificed and then the blood and tissues were collected to evaluate the changes of tissue histopathology, cell apoptosis, inflammation level and organ function. The HGMB1 expression was monitored by RT-qPCR and Western blot. The expression of RAGE/TLR2/TLR4 and NF-κB at the protein levels was also assessed. BMSCs and/or EP exhibits an outstanding protective effect against LPS-induced histopathological injury by improving cell apoptosis, inflammatory response and the organ dysfunction but no effect on BMSC homing to the injury site. Moreover, BMSCs and/or EP inhibited LPS-induced upregulation of HMGB1, RAGE, TLR2 and TLR4 expression at protein levels and compromised p65 phosphorylation in the rat model of MODS. These findings suggest that HMGB1 is involved in BMSC treatment for MODS, through regulation of the TLR2, TLR4-mediated NF-κB signal pathway. It suggests that HMGB1 is an attractive potential target for the development of new therapeutic strategies for MODS.
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Affiliation(s)
- Guanghui Xiu
- Department of ICU, The Second People's Hospital of Yunnan Province, 176 Qingnian Road, Wuhua District, Kunming, 650021, China
| | - Jie Sun
- Department of ICU, The Second People's Hospital of Yunnan Province, 176 Qingnian Road, Wuhua District, Kunming, 650021, China
| | - Xiuling Li
- Department of Obstetrics, The First People's Hospital of Yunnan Province, Kunming, China
| | - Hua Jin
- Department of Anesthesiology, The First People's Hospital of Yunnan Province, Kunming, China
| | - Yichao Zhu
- Department of Anesthesiology, The affiliated Hospital of Binzhou Medical University, Binzhou, China
| | - Xia Zhou
- Department of ICU, The Second People's Hospital of Yunnan Province, 176 Qingnian Road, Wuhua District, Kunming, 650021, China
| | - Ping Liu
- Department of ICU, The Second People's Hospital of Yunnan Province, 176 Qingnian Road, Wuhua District, Kunming, 650021, China
| | - Xinghua Pan
- Stem Cell Engineering Laboratory of Yunnan Province, Kunming General Hospital, Chengdu Military Command, Kunming, China
| | - Jian Li
- Kunming Biological Diversity Regional Center of Instruments, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, China
| | - Bin Ling
- Department of ICU, The Second People's Hospital of Yunnan Province, 176 Qingnian Road, Wuhua District, Kunming, 650021, China.
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10
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Rus RR, Premru V, Novljan G, Grošelj-Grenc M, Ponikvar R. Fate of Central Venous Catheters Used for Acute Extracorporeal Treatment in Critically Ill Pediatric Patients: A Single Center Experience. Ther Apher Dial 2017; 20:308-11. [PMID: 27312920 DOI: 10.1111/1744-9987.12442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 03/23/2016] [Indexed: 11/28/2022]
Abstract
Renal replacement treatment (RRT) is required in severe acute kidney injury, and a functioning central venous catheter (CVC) is crucial. Twenty-eight children younger than 16 years have been treated at the University Medical Centre Ljubljana between 2003 and 2012 with either acute hemodialysis (HD) and/or plasma exchange (PE), and were included in our study. The age of the patients ranged from 2 days to 14.1 years. Sixty-six CVCs were inserted (52% de novo, 48% guide wire). The sites of insertion were the jugular vein in 20% and the femoral vein in 80%. Catheters were in function from 1 day to 27 days. The most common cause for CVC removal or exchange was catheter dysfunction (50%). CVCs were mostly inserted in the femoral vein, which is the preferred site of insertion in acute HD/PE because of the smaller number of complications.
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Affiliation(s)
- Rina R Rus
- Department of Nephrology, Division of Paediatrics, University Medical Centre, Ljubljana, Slovenia
| | - Vladimir Premru
- Department of Nephrology, Division of Internal Clinics, University Medical Centre, Ljubljana, Slovenia
| | - Gregor Novljan
- Department of Nephrology, Division of Paediatrics, University Medical Centre, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Mojca Grošelj-Grenc
- Department of Paediatric Surgery and Intensive Care, Division of Surgery, University Medical Centre, Ljubljana, Slovenia
| | - Rafael Ponikvar
- Department of Nephrology, Division of Internal Clinics, University Medical Centre, Ljubljana, Slovenia
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Maharjan L, Shah A, Shrestha KB, Shrestha G. Errors in cause-of-death statement on death certificates in intensive care unit of Kathmandu, Nepal. BMC Health Serv Res 2015; 15:507. [PMID: 26563325 PMCID: PMC4643506 DOI: 10.1186/s12913-015-1168-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 11/09/2015] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Death certificates (DC) are one of the most important medico-legal documents that physicians work through. DCs are extensively used in health statistics for epidemiological studies, and in health policy planning as a public health resource tool. Cause-of-death (COD) statement, which is vulnerable to various errors, is the vital part of a DC that has the potential to mislead the policy makers and statisticians. Hence, we evaluated and analyzed the errors prevalent in COD statement of DC. METHODS A retrospective observational study was conducted at medical Intensive Care Unit (ICU) of Blue Cross Hospital, Kathmandu, Nepal within two years of study period. A total of 204 medical records of the deceased patients were reviewed. Three sub-headings of COD statement of DC- Part I Immediate COD (ICOD), Part I Underlying COD (UCOD), and Part II Other significant conditions (OSC) were extensively evaluated for the major medical errors. RESULTS The study found errors in 78.4 % of DCs. The highest number of errors was in UCOD (83 %). Most common errors were "Mechanism of Death- terminal event" in ICOD, "More than one competing causes" in UCOD, and "OSC present but not listed" in OSC. The error in DC was found to be statistically significant with the severity of sepsis (p = 0.003), and presence of chronic organ failures (p = 0.034). Age, time of death, source of admission, and duration of ICU stay were not found to be statistically associated with the errors in DC. CONCLUSION Prevalence of errors in DC was quite high. Most errors were committed in underlying cause of death, which is the most important part of DC. Complexity of the cases was the key factor that increased the risks of committing errors. Specific education should supersede general educational interventions to minimize the errors considerably in writing DC in complex cases.
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Affiliation(s)
| | - Aarzoo Shah
- Kathmandu Medical College, Kathmandu, Nepal.
| | | | - Gambhir Shrestha
- School of Public Health & Community Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
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Al-Thani H, El-Menyar A, Shaikh N, Mudali IN, Mekkodathil A, Asim M, Gameil A, Tabeb A. Risk Stratification of Necrotizing Fasciitis Based on the Initial Procalcitonin Concentration: A Single Center Observational Study. Surg Infect (Larchmt) 2015; 16:806-12. [PMID: 26280767 DOI: 10.1089/sur.2014.249] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Necrotizing fasciitis (NF) is a potentially fatal subcutaneous tissue and fascia infection. We studied the role of serum procalcitonin in the identification and assessment of severity of sepsis in patients with NF. METHODS A retrospective analysis was conducted from January 2000 to December 2013 for all patients who admitted to surgical intensive care with provisional diagnosis of NF. Patients were categorized into four groups based on the initial procalcitonin concentrations (Group I: <0.5 low risk, Group II: ≥0.5-<2 moderate risk, Group III: ≥2-<10 high risk, and Group IV: ≥10 ng/mL high likelihood of severe sepsis). RESULTS During the study period, 331 cases were identified to have NF with a mean age of 51 ± 14 years. Serum procalcitonin was tested in 62 cases (only between 2011 and December 2013) and all were positive (Group I: 22%, Group II: 18%, Group III: 21%, and Group IV: 39%). The most common affected regions were thigh and chest in Group II (46% and 9%, respectively), lower limbs in Group III (46%), and perineum and abdomen in Group IV (25% and 21%, respectively). In the four groups, 21 patients developed septic shock (Group I: 0%, Group II: 14%, Group III: 24%, and Group IV: 62%). The cut off procalcitonin value for septic shock was 5.6 ng/mL. Using receiver-operating characteristic curve, this cut off with the Area under the Curve (AUC) of 0.77 was found to have sensitivity 81% and specificity 67%. Sequential Organ Failure Assessment (SOFA) score was substantially greater in Group III and Group IV in comparison to Group I and Group II, p = 0.006. Procalcitonin levels were correlated well with SOFA score (r = 0.34, p = 0.007). There were 17 deaths in the four groups (Group I: 6%, Group II: 23%, Group III: 12%, and Group IV: 59%). CONCLUSION Initial procalcitonin concentration in NF carries an important prognostic value and it correlates well with SOFA score and can predict the development of septic shock early in patients with NF.
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Affiliation(s)
- Hassan Al-Thani
- 1 Department of Surgery, Hamad General Hospital , Doha, Qatar
| | - Ayman El-Menyar
- 2 Department of Clinical Research, Trauma Surgery, Hamad General Hospital , Doha, Qatar .,3 Department of Clinical Medicine, Weill Cornell Medical School , Doha, Qatar
| | - Nissar Shaikh
- 4 Surgical Intensive Care Unit, Hamad General Hospital , Doha, Qatar
| | | | - Ahammed Mekkodathil
- 2 Department of Clinical Research, Trauma Surgery, Hamad General Hospital , Doha, Qatar
| | - Mohammad Asim
- 2 Department of Clinical Research, Trauma Surgery, Hamad General Hospital , Doha, Qatar
| | - Amna Gameil
- 1 Department of Surgery, Hamad General Hospital , Doha, Qatar
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Identification of Predictive Early Biomarkers for Sterile-SIRS after Cardiovascular Surgery. PLoS One 2015; 10:e0135527. [PMID: 26263001 PMCID: PMC4532358 DOI: 10.1371/journal.pone.0135527] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 07/22/2015] [Indexed: 12/21/2022] Open
Abstract
Systemic inflammatory response syndrome (SIRS) is a common complication after cardiovascular surgery that in severe cases can lead to multiple organ dysfunction syndrome and even death. We therefore set out to identify reliable early biomarkers for SIRS in a prospective small patient study for timely intervention. 21 Patients scheduled for planned cardiovascular surgery were recruited in the study, monitored for signs of SIRS and blood samples were taken to investigate biomarkers at pre-assigned time points: day of admission, start of surgery, end of surgery, days 1, 2, 3, 5 and 8 post surgery. Stored plasma and cryopreserved blood samples were analyzed for cytokine expression (IL1β, IL2, IL6, IL8, IL10, TNFα, IFNγ), other pro-inflammatory markers (sCD163, sTREM-1, ESM-1) and response to endotoxin. Acute phase proteins CRP, PCT and pro-inflammatory cytokines IL6 and IL8 were significantly increased (p<0.001) at the end of surgery in all patients but could not distinguish between groups. Normalization of samples revealed significant increases in IL1β changes (p<0.05) and decreased responses to endotoxin (p<0.01) in the SIRS group at the end of surgery. Soluble TREM-1 plasma concentrations were significantly increased in patients with SIRS (p<0.01). This small scale patient study could show that common sepsis markers PCT, CRP, IL6 and TNFα had low predictive value for early diagnosis of SIRS after cardiovascular surgery. A combination of normalized IL1β plasma levels, responses to endotoxin and soluble TREM-1 plasma concentrations at the end of surgery are predictive markers of SIRS development in this small scale study and could act as an indicator for starting early therapeutic interventions.
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