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Musliha A, Dermawan D, Rahayu P, Tjandrawinata RR. Unraveling modulation effects on albumin synthesis and inflammation by Striatin, a bioactive protein fraction isolated from Channa striata: In silico proteomics and in vitro approaches. Heliyon 2024; 10:e38386. [PMID: 39398063 PMCID: PMC11467539 DOI: 10.1016/j.heliyon.2024.e38386] [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: 11/22/2023] [Revised: 09/23/2024] [Accepted: 09/23/2024] [Indexed: 10/15/2024] Open
Abstract
Hypoalbuminemia, associated with inflammation in severely ill patients, can emerge due to decreased albumin production. Transforming growth factor-beta (TGF-β) and nuclear factor-kappa B (NF-κB) are critical signaling pathways responsible for decreased albumin expression. This study explores the protein content and modulation effects of Striatin on albumin synthesis and inflammation, employing in silico proteomics and in vitro investigations. In the in silico proteomics realm, LC/MS-MS protein sequencing, 3D modeling, protein-protein docking simulations, 100 ns molecular dynamics (MD) simulations, and MM/PBSA binding free energy calculations were carried out. Complementing this, in vitro studies examined Albumin gene expression and extracellular secretion in HepG2 cells subjected to lipopolysaccharides-induced hypoalbuminemia. Furthermore, the study probed Striatin's influence on the NF-ᴋB expression, given albumin's role as a negative acute-phase protein. The results unveiled nucleoside diphosphate kinase (NdK) and parvalbumin (PV) as the prominent constituents within Striatin. Notably, NdK and PV exhibited the ability to disrupt hydrogen bonds with specific residues in both TGF-β and NF-κB complexes, thereby enhancing their flexibility, akin to the action of the FKBP12 complex (antagonist complex). In the in vitro experiments, Striatin demonstrated a dose and time-dependent inhibition of hypoalbuminemia, with peak efficacy observed at a concentration of 20 μg/mL. At this concentration, Striatin also suppressed NF-κB expression when co-incubated with lipopolysaccharides. While these findings suggest potential inhibitory effects of Striatin on TGF-β and NF-κB activities, they are preliminary and warrant further investigation. This study highlights Striatin's potential as a therapeutic agent for inflammation-related hypoalbuminemia, though additional research is needed to fully validate these results.
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Affiliation(s)
- Affina Musliha
- Dexa Laboratories of Biomolecular Sciences, PT Dexa Medica, Jababeka Industrial Estate II, Jl. Industri Selatan V Blok PP No. 7 Cikarang, 17550, Indonesia
| | - Doni Dermawan
- Dexa Laboratories of Biomolecular Sciences, PT Dexa Medica, Jababeka Industrial Estate II, Jl. Industri Selatan V Blok PP No. 7 Cikarang, 17550, Indonesia
| | - Puji Rahayu
- Dexa Laboratories of Biomolecular Sciences, PT Dexa Medica, Jababeka Industrial Estate II, Jl. Industri Selatan V Blok PP No. 7 Cikarang, 17550, Indonesia
| | - Raymond R. Tjandrawinata
- Dexa Laboratories of Biomolecular Sciences, PT Dexa Medica, Jababeka Industrial Estate II, Jl. Industri Selatan V Blok PP No. 7 Cikarang, 17550, Indonesia
- Faculty of Biotechnology, Atma Jaya Catholic University of Indonesia, South Jakarta 12930, Indonesia
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Zhang L, Yang P, Yin F, Zhang J, Zhao B, Zhou J. Association between frailty and hypoproteinaemia in older patients: meta-analysis and systematic review. BMC Geriatr 2024; 24:689. [PMID: 39154175 PMCID: PMC11329991 DOI: 10.1186/s12877-024-05275-9] [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: 04/17/2024] [Accepted: 08/02/2024] [Indexed: 08/19/2024] Open
Abstract
OBJECTIVE Frailty and hypoproteinaemia are common in older individuals. Although there is evidence of a correlation between frailty and hypoproteinaemia, the relationship between frailty and hypoproteinaemia in hospitalized/critically ill and older community residents has not been clarified. Therefore, the aim of our meta-analysis was to evaluate the associations between frailty and hypoproteinaemia in different types of patients. METHODS A systematic retrieval of articles published in the PubMed, Embase, Medline, Web of Science, Cochrane, Wanfang, and CNKI databases from their establishment to April 2024 was performed to search for studies on the associations between severity of frailty or prefrailty and hypoproteinaemia in older adults. The Newcastle‒Ottawa Scale and the Agency for Healthcare Research and Quality Scale were used to assess study quality. RESULTS Twenty-two studies were included including 90,351 frail older people were included. Meta-analysis revealed an association between frailty or prefrailty and hypoproteinaemia (OR = 2.37, 95% CI: 1.47, 3.83; OR = 1.62, 95% CI: 1.23, 2.15), there was no significant difference in the risk of hypoproteinaemia between patients with severe frailty and those with low or moderate frailty (OR = 0.62, 95% CI:0.44, 0.87). The effect of frailty on the occurrence of hypoproteinaemia was more obvious in hospitalized patients/critically ill patients than in surgical patients (OR = 3.75, 95% CI: 2.36, 5.96), followed by older community residents (OR = 2.30, 95% CI: 1.18, 4.49). CONCLUSION Frailty is associated with hypoproteinaemia in surgical patients, hospitalized older patients and older community residents. Future studies should focus on the benefits of albumin supplementation in preventing or alleviating frailty and related outcomes in the future.
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Affiliation(s)
- Linxue Zhang
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, China
- Nursing College, Zunyi Medical University, Zunyi, 563000, China
| | - Pingping Yang
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, China
- Nursing College, Zunyi Medical University, Zunyi, 563000, China
| | - Furong Yin
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, China
- Nursing College, Zunyi Medical University, Zunyi, 563000, China
| | - Jinbo Zhang
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, China
- Nursing College, Zunyi Medical University, Zunyi, 563000, China
| | - Benli Zhao
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, China
- Nursing College, Zunyi Medical University, Zunyi, 563000, China
| | - Jiamei Zhou
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, China.
- Nursing College, Zunyi Medical University, Zunyi, 563000, China.
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Valeriani E, Cangemi R, Carnevale R, Romiti GF, Pannunzio A, Pignatelli P, Violi F. Hypoalbuminemia as predictor of thrombotic events in patients with community-acquired pneumonia. Int J Cardiol 2024; 404:131942. [PMID: 38458384 DOI: 10.1016/j.ijcard.2024.131942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 02/25/2024] [Accepted: 03/05/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Hypoalbuminemia complicates acute diseases and infections and is associated with a worst prognosis. The aim is to evaluate whether hypoalbuminemia is associated with higher incidence and risk of thrombotic events in community-acquired pneumonia. METHODS We retrospectively collected data from a prospective study investigating the incidence of thrombotic events in community-acquired pneumonia hospitalized patients from 2011 to 2016 at University-Hospital Policlinico Umberto I. Baseline characteristics and outcomes were collected. Incidence of outcomes were calculated. Kaplan-Meier curves were created, Cox model used to identify predictors for the outcomes, and competing risk analysis performed. RESULTS From a total of 231 patients, 130 (56.3%) and 101 (43.7%) had or not hypoalbuminemia. Age, proportion of female, BMI, major comorbidities, and severity of pneumonia were similar between two subgroups. A less proportion of patients with hypoalbuminemia received antithrombotic and statin therapy. Median hospital stay was 11 days in both subgroups. Patients with hypoalbuminemia had higher D-dimer and high- sensitivity C-reactive-protein values with an inverse relation between albumin values and these markers. Incidence of thrombotic events was 26 and 11 per 1000 patient-days in patient with and without hypoalbuminemia. At Cox model, hypoalbuminemia was associated with thrombotic events development in univariable (hazard ratio; 2.67, 95% confidence intervals, 1.30-5.40) and multivariable (hazard ratio 3.19; 95% confidence intervals, 1.48-6.89) analysis. CONCLUSIONS More than a half of patients with community acquired pneumonia had hypoalbuminemia that is associated with a doubled incidence and a three-fold increased risk of thrombotic events. The inverse relation between baseline albumin and D-dimer values confirms this association.
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Affiliation(s)
- Emanuele Valeriani
- Department of General Surgery and Surgical Specialty Paride Stefanini, Sapienza University of Rome, Italy; Department of Infectious Disease, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Viale del Policlinico, 155, Roma, Italy
| | - Roberto Cangemi
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Roberto Carnevale
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica, Latina, Italy; IRCCS Neuromed, Località Camerelle, Pozzilli, IS, Italy
| | - Giulio Francesco Romiti
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy; Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Arianna Pannunzio
- Department of General Surgery and Surgical Specialty Paride Stefanini, Sapienza University of Rome, Italy
| | - Pasquale Pignatelli
- Sapienza University of Rome, Rome, Italy; Mediterranea Cardiocentro, Via Orazio, Naples, Italy
| | - Francesco Violi
- Sapienza University of Rome, Rome, Italy; Mediterranea Cardiocentro, Via Orazio, Naples, Italy.
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Tan Y, Xiang W, Chen Y, Huang J, Sun D. Effect of hypoproteinemia on mortality of elderly male patients with chronic heart failure. Medicine (Baltimore) 2024; 103:e37078. [PMID: 38306508 PMCID: PMC10843509 DOI: 10.1097/md.0000000000037078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/05/2024] [Indexed: 02/04/2024] Open
Abstract
To explore the effect of hypoproteinemia on cardiac function and prognosis in elderly male patients with chronic heart failure. Among the patients with chronic heart failure hospitalized in the General Hospital of Southern Theater Command from December 2014 to December 2015, 100 elderly male patients with chronic heart failure were selected. The patients were divided into 2 groups based on their serum albumin (ALB) levels: 53 cases in the normal group (ALB ≥ 35 g/L) and 47 cases in the hypoproteinemia group (ALB < 35 g/L). Using the method of prospective study, under the condition of routine treatment of heart failure, follow-up observation for 5 years, we collected relevant data and analyzed the level of serum ALB, cardiac function and prognosis of patients in these 2 groups. The mortality of patients in the hyporoteinemia group were significantly higher than those in the normal group. Left ventricular end-diastolic dimension (LVDD) and brain natriuretic peptide (BNP) in the normal group after 5 years were markedly lower compared with that in the hypoproteinemia group. The mortality of patients with chronic heart failure with hypoproteinemia were higher, and the present study indicated that the ALB level may be associated with the mortality of patients with chronic heart failure.
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Affiliation(s)
- Yan Tan
- Department of Geratology, General Hospital of Southern Theater Command, Guangzhou, China
| | - Wei Xiang
- Department of Geratology, General Hospital of Southern Theater Command, Guangzhou, China
| | - Yi Chen
- Department of Geratology, General Hospital of Southern Theater Command, Guangzhou, China
| | - Jing Huang
- Department of Geratology, General Hospital of Southern Theater Command, Guangzhou, China
| | - Dong Sun
- Department of Geratology, General Hospital of Southern Theater Command, Guangzhou, China
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Lee SM, Jo YH, Lee JH, Hwang JE, Park I, Baek S, Jeong H, Um YW, Kim HE. ASSOCIATIONS OF THE SERUM ALBUMIN CONCENTRATION AND SEQUENTIAL ORGAN FAILURE ASSESSMENT SCORE AT DISCHARGE WITH 1-YEAR MORTALITY IN SEPSIS SURVIVORS: A RETROSPECTIVE COHORT STUDY. Shock 2023; 59:547-552. [PMID: 36652385 DOI: 10.1097/shk.0000000000002083] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
ABSTRACT Introduction: This study was performed to investigate the predictors of 1-year mortality at discharge in sepsis survivors. Methods: This study was a retrospective analysis of patients with sepsis and septic shock at a single center. Patients who survived hospitalization for sepsis or septic shock between January 2016 and December 2017 were included in this study. Age, sex, body mass index, laboratory results such as blood cell count, C-reactive protein (CRP) and albumin levels, the Sequential Organ Failure Assessment (SOFA) score at the time of discharge and site of infection were compared between the survivors and nonsurvivors at 1 year postdischarge. Multivariate logistic regression was performed to identify the predictors of 1-year mortality. Results: During the study period, 725 sepsis patients were included in the analysis, 64 (8.8%) of whom died within the first year. The nonsurvivors were older and had a lower body mass index and a higher SOFA score at discharge than the survivors ( P < 0.05). Among the laboratory results at discharge, hemoglobin, platelet counts, and albumin concentrations were lower in the nonsurvivors than in the survivors, whereas CRP was higher in the nonsurvivors than in the survivors. In the multivariate logistic regression analysis, serum albumin <2.5 mg/dL and SOFA score ≥2 at discharge were identified as independent prognostic factors for 1-year mortality (odds ratio, 2.616; 95% confidence interval, 1.437-4.751 for albumin <2.5 mg/dL and 2.106, 1.199-3.801 for SOFA score ≥2, respectively). Conclusions: A low serum albumin concentration of <2.5 mg/dL and a high SOFA score of ≥2 at the time of discharge were prognostic factors for 1-year mortality in survivors of sepsis.
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Affiliation(s)
- Sang-Min Lee
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | | | - Jae Hyuk Lee
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Ji Eun Hwang
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Inwon Park
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Sumin Baek
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Hwain Jeong
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Young Woo Um
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Hee Eun Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
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Noegroho BS, Adi K, Mustafa A, Haq RS, Wijayanti Z, Liarto J. The role of quick Sepsis-related Organ Failure Assessment score as simple scoring system to predict Fournier gangrene mortality and the correlation with Fournier's Gangrene Severity Index: Analysis of 69 patients. Asian J Urol 2023; 10:201-207. [PMID: 36942123 PMCID: PMC10023526 DOI: 10.1016/j.ajur.2021.11.003] [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: 11/16/2020] [Revised: 04/06/2021] [Accepted: 05/13/2021] [Indexed: 11/26/2022] Open
Abstract
Objective Fournier's gangrene is a rare but life-threatening infection disease with high mortality rate. The quick Sepsis-related Organ Failure Assessment (qSOFA) is a new and simpler scoring system that may identify patients with suspected infection who are at greater risk for a poor outcome. The purpose of this study was to find out role of qSOFA in determining prognosis of Fournier's gangrene patients. Methods This study is a case control with retrospective review of Fournier's gangrene patients treated at Hasan Sadikin Hospital from January 2013 to December 2017 who met inclusion criteria. Participants were divided into two groups according to qSOFA score as high qSOFA (2-3) and low qSOFA (0-1). Results From 69 patients, the mortality rate was 24.6%. The sensitivity of qSOFA score to predict mortality was 88.2%; the specificity was 94.2%; positive predictive value was 83.3%; negative predictive value was 96.1%; positive likelihood ratio was 15.2; negative likelihood ratio was 0.12; and the area under the receiver operating characteristic curve of qSOFA was 94.2%. There was significant association between qSOFA scale and mortality with p-value of 0.0001. The qSOFA score has strong positive correlation with Fournier's Gangrene Severity Index (p<0.0001, r=0.704). Conclusion qSOFA scoring system has a high prognostic value and can be used to determine prognosis of Fournier's gangrene patients.
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Sawunyavisuth B, Sopapol N, Tseng CH, Sawanyawisuth K. Marketing factors associated with a continuous positive airway pressure machine purchasing in patients with obstructive sleep apnea. Future Sci OA 2023; 9:FSO844. [PMID: 37026026 PMCID: PMC10072120 DOI: 10.2144/fsoa-2022-0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/23/2023] [Indexed: 04/03/2023] Open
Abstract
Aim: Obstructive sleep apnea (OSA) is related with several cardiovascular diseases. It should be treated with a continuous positive airway pressure (CPAP) machine. There is limited data on marketing factors on a decision of CPAP machine purchasing in OSA patients. Materials & methods: We enrolled adult patients aged over 18 years with OSA who tried a CPAP. Marketing factors were evaluated for a decision of CPAP machine purchasing. Results: There were 95 OSA patients participated in the study. Nice color CPAP machine and good knowledge and informative salesperson had adjusted odds ratio (aOR) of 4.480 and 9.478, the other two factors had aOR at 0.102 and 0.217. Conclusion: Marketing factors related to CPAP machine purchasing in patients with OSA.
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Affiliation(s)
- Bundit Sawunyavisuth
- Department of Marketing, Faculty of Business Administration & Accountancy, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Nattaporn Sopapol
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Chi-Hsing Tseng
- Department of Marketing & Distribution Management, National Pingtung University, Pingtung, Taiwan, 900391, Republic of China
| | - Kittisak Sawanyawisuth
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
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Kim B, Boukebous B, White D, Baker JF. Septic arthritis of the native hip joint: a multi-pattern, multi-outcome disease. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023:10.1007/s00590-023-03477-2. [PMID: 36710273 PMCID: PMC10368560 DOI: 10.1007/s00590-023-03477-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/18/2023] [Indexed: 01/30/2023]
Abstract
PURPOSE Septic arthritis of the native hip joint (SANH) is an uncommon surgical and medical emergency with few reports. The aim of this study was to determine predictors of return to theatre (RTT), complications and mortality. METHODS Patients with SANH were identified from January 2009 to June 2022; 50 patients and three subgroups were identified: Pyogenic (surgical washout without systemic inflammatory disease), Systemic (surgical washout with SIDs) and patients managed non-surgically. Patterns of these groups were assessed with a principal component analysis. The cumulative incidences for death, any complication and RTT for repeat washout were calculated. The predictive variables associated with outcomes were selected with univariable models and then incorporated in multivariable CoxPH regressions. RESULTS The 1-year cumulative incidence was 14% for mortality and 48.5% for any complication. Amongst patients managed surgically, 1-year risk of RTT was 46% in Pyogenic subgroup and 21% in Systemic subgroup. Systemic subgroup had lower complications and RTT and higher rate of sterile aspirate, compared to Pyogenic. Charlson comorbidity index (CCI) (HR = 1.41, P value = 0.03), preoperative albumin (HR = 0.81, P value = 0.009) and preoperative haemoglobin (HR = 0.95, P value = 0.02) were significantly associated with 1-year mortality. Time between symptom onset and admission > 7 days (HR = 3.15, P value = 0.042), preoperative Hb (HR = 1.05, P value = 0.016), socioeconomic deprivation (HR = 1.18, P value = 0.04) and Systemic subgroup (HR = 0.25, P value = 0.04) were significantly associated with RTT. CONCLUSION Mortality was well predicted by the usual parameters including CCI, albumin, but also low haemoglobin. Patients presenting in a delayed fashion were more likely to have multiple lavages.
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Affiliation(s)
- Byungseob Kim
- Faculty of Medical and Health Science, University of Auckland, Grafton, Auckland, New Zealand.
| | - Baptiste Boukebous
- Department of Orthopaedic Surgery, Waikato Hospital, Hamilton, New Zealand.,ECAMO Team, CRESS, UMR1153, INSERM, Paris, France
| | - Douglas White
- Department of Rheumatology, Waikato Hospital, Hamilton, New Zealand.,Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Joseph F Baker
- Department of Orthopaedic Surgery, Waikato Hospital, Hamilton, New Zealand.,Department of Surgery, University of Auckland, Auckland, New Zealand
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Hu J, Lv C, Hu X, Liu J. Effect of hypoproteinemia on the mortality of sepsis patients in the ICU: a retrospective cohort study. Sci Rep 2021; 11:24379. [PMID: 34934165 PMCID: PMC8692355 DOI: 10.1038/s41598-021-03865-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 12/06/2021] [Indexed: 12/28/2022] Open
Abstract
The objective of the study was to evaluate the effect of hypoproteinemia on the prognosis of sepsis patients and the effectiveness of exogenous albumin supplementation. A retrospective cohort study was conducted in adult ICUs. The subjects were 1055 sepsis patients in MIMIC III database from June 2001 to October 2012. There were no interventions. A total of 1055 sepsis patients were enrolled and allocated into two groups based on the lowest in-hospital albumin level: 924 patients were in the hypoproteinemia group (the lowest in-hospital albumin ≤ 3.1 g/dL) and 131 patients were in the normal group (the lowest in-hospital albumin > 3.1 g/dL). A total of 378 patients [331 (35.8%) were in the hypoproteinemia group, and 47 (35.9%) were in the normal group] died at 28 days, and no statistically significant difference was found between the two groups (P = 0.99). The survival analysis of the 28-day mortality rate was performed using the Cox proportional risk model and it was found that the lowest in-hospital albumin level showed no significant effect on the 28-day mortality rate (P = 0.18, 95%CI). Patients in the hypoproteinemia group exhibited a longer length of stay in ICU and hospital and more complications with AKI than those in the normal group. However, multivariate regression analysis found that there was no statistical significance between the two groups. In addition, multivariate regression analysis showed that patients in the hypoproteinemia group had a shorter time without vasoactive drugs and time without mechanical ventilation than those in the normal group (P < 0.01). In the subgroup analysis, univariate analysis and multivariate regression analysis showed that there was no significant difference in the 28-day mortality rate (39.6% vs 37.5%, P = 0.80), the proportion of mechanical ventilation time (P = 0.57), and vasoactive drug time (P = 0.89) between patients with and without albumin supplementation. However, patients in the albumin supplementation group had a longer length of ICU stay and hospital stay than those in the non-supplementation group (P < 0.01). Albumin level may be an indicator of sepsis severity, but hypoproteinemia has no significant effect on the mortality of sepsis patients. Despite various physiological effects of albumin, the benefits of albumin supplementation in sepsis patients need to be evaluated with caution.
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Affiliation(s)
- Jing Hu
- Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu, China
| | - Chenwei Lv
- Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu, China
| | - Xingxing Hu
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China.
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China.
- Emergency Department, Jiangsu Province Academy of Traditional Chinese Medicine, No.100 Cross Street, Hongshan Road, Nanjing, Jiangsu, China.
| | - Jiangyun Liu
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China.
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China.
- Neurology Department, Jiangsu Province Academy of Traditional Chinese Medicine, No.100 Cross Street, Hongshan Road, Nanjing, Jiangsu, China.
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Vegas Cómitre MD, Cortellini S, Cherlet M, Devreese M, Roques BB, Bousquet-Melou A, Toutain PL, Pelligand L. Population Pharmacokinetics of Intravenous Amoxicillin Combined With Clavulanic Acid in Healthy and Critically Ill Dogs. Front Vet Sci 2021; 8:770202. [PMID: 34869739 PMCID: PMC8636140 DOI: 10.3389/fvets.2021.770202] [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: 09/03/2021] [Accepted: 10/18/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Data regarding antimicrobial pharmacokinetics (PK) in critically ill dogs are lacking and likely differ from those of healthy dogs. The aim of this work is to describe a population PK model for intravenous (IV) amoxicillin–clavulanic acid (AMC) in both healthy and sick dogs and to simulate a range of clinical dosing scenarios to compute PK/PD cutoffs for both populations. Methods: This study used a prospective clinical trial in normal and critically ill dogs. Twelve client-owned dogs hospitalized in the intensive care unit (ICU) received IV AMC 20 mg/kg every 8 h (0.5-h infusion) during at least 48 h. Eight blood samples were collected at predetermined times, including four trough samples before the next administration. Clinical covariates and outcome were recorded, including survival to discharge and bacteriologic clinical failure. Satellite PK data were obtained de novo from a group of 12 healthy research dogs that were dosed with a single AMC 20 mg/kg IV. Non-linear mixed-effects model was used to estimate the PK parameters (and the effect of health upon them) together with variability within and between subjects. Monte Carlo simulations were performed with seven dosage regimens (standard and increased doses). The correlation between model-derived drug exposure and clinical covariates was tested with Spearman's non-parametric correlation analysis. Outcome was recorded including survival to discharge and bacteriologic clinical failure. Results: A total of 218 amoxicillin concentrations in plasma were available for healthy and sick dogs. A tricompartmental model best described the data. Amoxicillin clearance was reduced by 56% in sick dogs (0.147 L/kg/h) compared with healthy dogs (0.336 L/kg/h); intercompartmental clearance was also decreased (p <0.01). None of the clinical data covariates were significantly correlated with individual exposure. Monte Carlo simulations showed that higher PK/PD cutoff values of 8 mg/L could be reached in sick dogs by extending the infusion to 3 h or doubling the dose. Conclusions: The PK of AMC is profoundly different in critically ill dogs compared with normal dogs, with much higher interindividual variability and a lower systemic clearance. Our study allows to generate hypotheses with regard to higher AMC exposure in clinical dogs and provides supporting data to revise current AMC clinical breakpoint for IV administration.
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Affiliation(s)
- Maria D Vegas Cómitre
- Department of Clinical Science and Services, The Royal Veterinary College, Hatfield, United Kingdom
| | - Stefano Cortellini
- Department of Clinical Science and Services, The Royal Veterinary College, Hatfield, United Kingdom
| | - Marc Cherlet
- Department of Pharmacology, Toxicology and Biochemistry, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Mathias Devreese
- Department of Pharmacology, Toxicology and Biochemistry, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | | | | | - Pierre-Louis Toutain
- INTHERES, Université de Toulouse, INRAE, ENVT, Toulouse, France.,Department of Comparative Biomedical Science, The Royal Veterinary College, Hatfield, United Kingdom
| | - Ludovic Pelligand
- Department of Clinical Science and Services, The Royal Veterinary College, Hatfield, United Kingdom.,Department of Comparative Biomedical Science, The Royal Veterinary College, Hatfield, United Kingdom
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Rejinold NS, Piao H, Jin GW, Choi G, Choy JH. Injectable niclosamide nanohybrid as an anti-SARS-CoV-2 strategy. Colloids Surf B Biointerfaces 2021; 208:112063. [PMID: 34482191 PMCID: PMC8383483 DOI: 10.1016/j.colsurfb.2021.112063] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/18/2021] [Accepted: 08/21/2021] [Indexed: 01/04/2023]
Abstract
COVID-19 is a rapidly evolving emergency, which necessitates scientific community to come up with novel formulations that could find quick relief to the millions affected around the globe. Remdesivir being the only injectable drug by FDA for COVID-19, it initially showed promising results, however, later on failed to retain its claims, hence rejected by the WHO. Therefore, it is important to develop injectable formulation that are effective and affordable. Here in this work, we formulated poly ethylene glycol (PEG) coated bovine serum albumin (BSA) stabilized Niclosamide (NIC) nanoparticles (NPs) (∼BSA-NIC-PEG NPs) as an effective injectable formulation. Here, serum albumin mediated strategy was proposed as an effective strategy to specifically target SARS-CoV-2, the virus that causes COVID-19. The in-vitro results showed that the developed readily water dispersible formulation with a particle size <120 nm size were well stable even after 3 weeks. Even though the in-vitro studies showed promising results, the in-vivo pharmaco-kinetic (PK) study in rats demands the need of conducting further experiments to specifically target the SARS-CoV-2 in the virus infected model. We expect that this present formulation would be highly preferred for targeting hypoalbuminemia conditions, which was often reported in elderly COVID-19 patients. Such studies are on the way to summarize its potential applications in the near future.
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Affiliation(s)
- N Sanoj Rejinold
- Intelligent Nanohybrid Materials Laboratory (INML), Institute of Tissue Regeneration Engineering (ITREN), Dankook University, Cheonan, 31116, Republic of Korea
| | - Huiyan Piao
- Intelligent Nanohybrid Materials Laboratory (INML), Institute of Tissue Regeneration Engineering (ITREN), Dankook University, Cheonan, 31116, Republic of Korea
| | - Geun-Woo Jin
- R&D Center, CnPharm Co., LTD., Seoul, 03759, Republic of Korea
| | - Goeun Choi
- Intelligent Nanohybrid Materials Laboratory (INML), Institute of Tissue Regeneration Engineering (ITREN), Dankook University, Cheonan, 31116, Republic of Korea; College of Science and Technology, Dankook University, Cheonan, 31116, Republic of Korea; Department of Nanobiomedical Science and BK21 PLUS NBM Global Research Center for Regenerative Medicine, Dankook University, Cheonan, 31116, Republic of Korea.
| | - Jin-Ho Choy
- Intelligent Nanohybrid Materials Laboratory (INML), Institute of Tissue Regeneration Engineering (ITREN), Dankook University, Cheonan, 31116, Republic of Korea; Department of Pre-Medical Course, College of Medicine, Dankook University, Cheonan, 31116, Republic of Korea; Tokyo Tech World Research Hub Initiative (WRHI), Institute of Innovative Research, Tokyo Institute of Technology, Yokohama, 226-8503, Japan.
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12
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Wiedermann CJ. Hypoalbuminemia as Surrogate and Culprit of Infections. Int J Mol Sci 2021; 22:4496. [PMID: 33925831 PMCID: PMC8123513 DOI: 10.3390/ijms22094496] [Citation(s) in RCA: 119] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/23/2021] [Accepted: 04/24/2021] [Indexed: 02/07/2023] Open
Abstract
Hypoalbuminemia is associated with the acquisition and severity of infectious diseases, and intact innate and adaptive immune responses depend on albumin. Albumin oxidation and breakdown affect interactions with bioactive lipid mediators that play important roles in antimicrobial defense and repair. There is bio-mechanistic plausibility for a causal link between hypoalbuminemia and increased risks of primary and secondary infections. Serum albumin levels have prognostic value for complications in viral, bacterial and fungal infections, and for infectious complications of non-infective chronic conditions. Hypoalbuminemia predicts the development of healthcare-associated infections, particularly with Clostridium difficile. In coronavirus disease 2019, hypoalbuminemia correlates with viral load and degree of acute lung injury and organ dysfunction. Non-oncotic properties of albumin affect the pharmacokinetics and pharmacodynamics of antimicrobials. Low serum albumin is associated with inadequate antimicrobial treatment. Infusion of human albumin solution (HAS) supplements endogenous albumin in patients with cirrhosis of the liver and effectively supported antimicrobial therapy in randomized controlled trials (RCTs). Evidence of the beneficial effects of HAS on infections in hypoalbuminemic patients without cirrhosis is largely observational. Prospective RCTs are underway and, if hypotheses are confirmed, could lead to changes in clinical practice for the management of hypoalbuminemic patients with infections or at risk of infectious complications.
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Affiliation(s)
- Christian J. Wiedermann
- Institute of General Practice, Claudiana–College of Health Professions, 39100 Bolzano, Italy;
- Department of Public Health, Medical Decision Making and HTA, University of Health Sciences, Medical Informatics and Technology, 6060 Hall in Tyrol, Austria
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13
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Johnson AS, Fatemi R, Winlow W. SARS-CoV-2 Bound Human Serum Albumin and Systemic Septic Shock. Front Cardiovasc Med 2020; 7:153. [PMID: 33088822 PMCID: PMC7498713 DOI: 10.3389/fcvm.2020.00153] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/22/2020] [Indexed: 12/26/2022] Open
Abstract
The emergence of the COVID-19 virus and the subsequent pandemic have driven a great deal of research activity. The effects of COVID-19 are caused by the severe respiratory syndrome coronavirus 2 (SARS-CoV-2) and it is the underlying actions of SARs-CoV-2 virions on the endothelial glycocalyx that we consider here. One of the key factors in COVID-19 infection is its almost unique age-related profile, with a doubling in mortality every 10 years after the age of 50. The endothelial glycocalyx layer is essential in maintaining normal fluid homeostasis, but is fragile and prone to pathophysiological damage. It is physiologically significant in capillary microcirculation and in fluid distribution to the tissues. Human serum albumin (HSA), the most abundant protein in plasma, is created in the liver which also maintains its concentration, but this reduces by 10-15% after 50 years of age. HSA transports hormones, free fatty acids and maintains oncotic pressure, but SARS-CoV-2 virions bind competitively to HSA diminishing its normal transport function. Furthermore, hypoalbuminemia is frequently observed in patients with such conditions as diabetes, hypertension, and chronic heart failure, i.e., those most vulnerable to SARS-CoV-2 infection. Hypoalbuminemia, coagulopathy, and vascular disease have been linked in COVID-19 and have been shown to predict outcome independent of age and morbidity. Hypoalbuminemia is also known factor in sepsis and Acute respiratory distress syndrome (ARDS) occurs when fluids build-up in the alveoli and it is associated with sepsis, whose mechanism is systemic, being associated with the fluid and logistic mechanisms of the circulation. Glycocalyx damage is associated with changes plasma protein concentration, particularly HSA and blockage of albumin transport can produce the systemic symptoms seen in SARS-CoV-2 infection and sepsis. We therefore conclude that albumin binding to SARS-CoV-2 virions may inhibit the formation of the endothelial glycocalyx by inhibition of albumin transport binding sites. We postulate that albumin therapy to replace bound albumin might alleviate some of the symptoms leading to sepsis and that clinical trials to test this postulation should be initiated as a matter of urgency.
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Affiliation(s)
- Andrew S. Johnson
- Dipartimento di Biologia, Università Degli Studi di Naples, Federico II, Naples, Italy
| | - Rouholah Fatemi
- Physiology Research Center (PRC), School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - William Winlow
- Dipartimento di Biologia, Università Degli Studi di Naples, Federico II, Naples, Italy
- Institute of Ageing and Chronic Diseases, The Apex Building, University of Liverpool, Liverpool, United Kingdom
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14
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Sun JK, Zhang WH, Zou L, Liu Y, Li JJ, Kan XH, Dai L, Shi QK, Yuan ST, Yu WK, Xu HY, Gu W, Qi JW. Serum calcium as a biomarker of clinical severity and prognosis in patients with coronavirus disease 2019. Aging (Albany NY) 2020; 12:11287-11295. [PMID: 32589164 PMCID: PMC7343468 DOI: 10.18632/aging.103526] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 05/30/2020] [Indexed: 01/08/2023]
Abstract
The aim of this study was to investigate the correlations between serum calcium and clinical outcomes in patients with coronavirus disease 2019 (COVID-19). In this retrospective study, serum calcium levels, hormone levels and clinical laboratory parameters on admission were recorded. The clinical outcome variables were also recorded. From February 10 to February 28, 2020, 241 patients were enrolled. Of these patients, 180 (74.7%) had hypocalcemia on admission. The median serum calcium levels were 2.12 (IQR, 2.04-2.20) mmol/L, median parathyroid hormone (PTH) levels were 55.27 (IQR, 42.73-73.15) pg/mL, and median 25-hydroxy-vitamin D (VD) levels were 10.20 (IQR, 8.20-12.65) ng/mL. The serum calcium levels were significantly positively correlated with VD levels (P =0.004) but negatively correlated with PTH levels (P =0.048). Patients with lower serum calcium levels (especially ≤2.0 mmol/L) had worse clinical parameters, higher incidences of organ injury and septic shock, and higher 28-day mortality. The areas under the receiver operating characteristic curves of multiple organ dysfunction syndrome, septic shock, and 28-day mortality were 0.923 (P <0.001), 0.905 (P =0.001), and 0.929 (P <0.001), respectively. In conclusion, serum calcium was associated with the clinical severity and prognosis of patients with COVID-19. Hypocalcemia may be associated with imbalanced VD and PTH levels.
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Affiliation(s)
- Jia-Kui Sun
- Department of Intensive Care Unit, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China
- Department of Isolation Units, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Jiangsu Province, China
| | - Wen-Hao Zhang
- Department of Intensive Care Unit, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China
- Department of Isolation Units, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Jiangsu Province, China
| | - Lei Zou
- Department of Intensive Care Unit, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China
- Department of Isolation Units, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Jiangsu Province, China
| | - Ying Liu
- Department of Intensive Care Unit, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China
- Department of Isolation Units, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Jiangsu Province, China
| | - Jing-Jing Li
- Department of Intensive Care Unit, Lishui People's Hospital, Nanjing, Jiangsu Province, China
- Department of Isolation Units, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Jiangsu Province, China
| | - Xiao-Hua Kan
- Department of Intensive Care Unit, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China
- Department of Isolation Units, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Jiangsu Province, China
| | - Lian Dai
- Department of Intensive Care Unit, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China
- Department of Isolation Units, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Jiangsu Province, China
| | - Qian-Kun Shi
- Department of Intensive Care Unit, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China
- Department of Isolation Units, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Jiangsu Province, China
| | - Shou-Tao Yuan
- Department of Intensive Care Unit, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China
- Department of Isolation Units, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Jiangsu Province, China
| | - Wen-Kui Yu
- Department of Intensive Care Unit, Drum Tower Hospital, Nanjing University, Nanjing, Jiangsu Province, China
- Department of Isolation Units, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Jiangsu Province, China
| | - Hong-Yang Xu
- Department of Intensive Care Unit, Wuxi People's Hospital, Nanjing Medical University, Wuxi, Jiangsu Province, China
- Department of Isolation Units, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Jiangsu Province, China
| | - Wei Gu
- Department of Intensive Care Unit, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China
- Department of Isolation Units, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Jiangsu Province, China
| | - Jian-Wei Qi
- Department of Intensive Care Unit, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China
- Department of Isolation Units, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Jiangsu Province, China
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15
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Kim Y, Jin Y, Jin T, Lee SM. Risk factors and outcomes of sepsis-associated delirium in intensive care unit patients: A secondary data analysis. Intensive Crit Care Nurs 2020; 59:102844. [PMID: 32253122 DOI: 10.1016/j.iccn.2020.102844] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 02/14/2020] [Accepted: 02/19/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To identify the risk factors of sepsis-associated delirium and determine their effect on intensive care unit adult patient outcomes. DESIGN A secondary analysis of data from system development studies. SETTING Korean intensive care unit patients in a university hospital who were diagnosed with sepsis. METHODS The risk factors for sepsis-associated delirium were classified into patient factors and sepsis clinical features and were analysed using hierarchical logistic regression analysis. Outcomes included in-hospital mortality, 30-day in-hospital mortality, duration of mechanical ventilation, length of stay in the intensive care unit, length of hospital stay, total medical expenses, discharge placement, re-hospitalisation and visits to the emergency department after discharge. RESULTS The risk factor for sepsis-associated delirium including patients aged 65 ≥years, dependent activity and high nursing needs (patient factors), low level of consciousness, tachypnoea, and thrombocytopaenia (clinical features of sepsis). Use of vasopressors/inotropes and albumin decreased the risk of sepsis-associated delirium. Mechanical ventilation duration was prolonged and discharge to skilled nursing facilities was increased by sepsis-associated delirium. CONCLUSIONS The risk factors for sepsis-associated delirium increased as the severity of condition for patients with sepsis increased. Early identification of risk factors associated with sepsis-associated delirium may improve patient outcomes.
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Affiliation(s)
- Yeunwoo Kim
- College of Nursing, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yinji Jin
- College of Nursing, The Catholic University of Korea, Seoul, Republic of Korea
| | - Taixian Jin
- College of Nursing, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sun-Mi Lee
- College of Nursing, The Catholic University of Korea, Seoul, Republic of Korea.
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16
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Yamaguchi J, Kinoshita K, Ihara S, Furukawa M, Sakurai A. The Clinical Significance of Low Serum Arachidonic Acid in Sepsis Patients with Hypoalbuminemia. Intern Med 2018; 57:1833-1840. [PMID: 29491308 PMCID: PMC6064683 DOI: 10.2169/internalmedicine.9124-17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Objectives Fatty acids (FAs) have various roles in pro-inflammatory and anti-inflammatory functions. Hypoalbuminemia is often observed in sepsis patients. An imbalance among these compounds formed from FAs caused by hypoalbuminemia may be related to increased mortality in sepsis patients. The purpose of this study was to investigate the correlations between serum albumin and FAs in sepsis and the outcome. Methods This study was an observational investigation. The clinical and laboratory data of sepsis patients were recorded and the Sequential Organ Failure Assessment (SOFA) score was calculated at admission. The serum arachidonic acid (AA), eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) and dihomo-gamma-linolenic acid (DHLA) levels were also measured as FAs. The body mass index (BMI) was used to determine the general nutrition status. Results Two hundred sepsis patients were enrolled during the study period. No significant correlations were observed between the BMI and the SOFA score or the serum albumin level at admission. The FA levels of the non-survivors were significantly lower, but there were no significant differences in the EPA/AA levels of the survivors and non-survivors. A low serum albumin level was closely related to low AA (p<0.0001), EPA (p<0.0001), DHA (p=0.0003), and DHLA levels (p<0.0001). A multiple logistic-regression analysis revealed that a high SOFA score [adjusted odds ratio, 1.19; 95% confidence interval (CI), 1.02-1.39, p=0.026] and low AA (adjusted odds ratio, 0.98; 95% CI, 0.978-0.994, p=0.041) were associated with a poor outcome. Conclusion A lower AA level was an important determinant of the outcome of patients with sepsis. These findings are consistent with the findings of previous studies, which reported that hypoalbuminemia might alter the AA metabolism in sepsis patients.
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Affiliation(s)
- Junko Yamaguchi
- Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Japan
| | - Kosaku Kinoshita
- Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Japan
| | - Shingo Ihara
- Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Japan
| | - Makoto Furukawa
- Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Japan
| | - Atsushi Sakurai
- Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Japan
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17
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Abstract
Human serum albumin (HSA) is the predominant product of hepatic protein synthesis and one of the more abundant plasma proteins. HSA is a monomeric multidomain macromolecule, representing the main determinant of plasma oncotic pressure and the main modulator of fluid distribution between body compartments. HSA displays an essential role in maintaining the integrity of the vascular barrier. HSA is the most important antioxidant capacity of human plasma, in addition to its ability to protect the body from the harmful effects of heavy metals such as iron and copper and reduce their ability to produce reactive oxygen radicals. HSA is the main depot for nitric oxide (NO) transport in the blood. HSA represents the main carrier for fatty acids, affects pharmacokinetics of many drugs, and provides the metabolic modification of some drugs and displays pseudo-enzymatic properties. HSA has been widely used successfully for more than 50 years in many settings of perioperative medicine including hypovolemia, shock, burns, surgical blood loss, sepsis, and acute respiratory distress syndrome (ARDS). Recently, the use of HSA has shown a promising neuroprotective effect in patients with subarachnoid hemorrhage. The most recent evidence-based functions and uses of HSA in the perioperative period are reviewed in this chapter.
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Affiliation(s)
- Ehab Farag
- grid.254293.b0000000404350569Cleveland Clinic Lerner College of Medicine Director of Clinical Research Staff Anesthesiologist General Anesthesia and Outcomes Research Cleveland Clinic, Cleveland, Ohio USA
| | - Andrea Kurz
- grid.254293.b0000000404350569Cleveland Clinic Lerner College of Medicine Chairman of General Anesthesia Cleveland Clinic, Cleveland, Ohio USA
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