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Muñoz-Terol JM, Rocha JL, Castro-de la Nuez P, Egea-Guerrero JJ, Gil-Sacaluga L, García-Cabrera E, Vilches-Arenas A. Prognosis Factors of Patients Undergoing Renal Replacement Therapy. J Pers Med 2023; 13:jpm13040605. [PMID: 37108991 PMCID: PMC10141530 DOI: 10.3390/jpm13040605] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 03/28/2023] [Accepted: 03/28/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Survival in patients with end-stage kidney disease (ESKD) on renal replacement therapy (RRT) is less than that of the general population of the same age, and depends on patient factors, the medical care received, and the type of RRT used. The objective of this study is to analyze the factors associated with survival in patients undergoing RRT. METHODS We conducted a retrospective observational study of adult patients with an incident of ESKD on RRT in Andalusia from 1 January 2008 to 31 December 2018. Patient characteristics, nephrological care received, and survival from the beginning of RRT were evaluated. A survival model for the patient was developed according to the variables studied. RESULTS A total of 11,551 patients were included. Median survival was 6.8 years (95% CI (6.6; 7.0)). After starting RRT, survival at one year and five years was 88.7% (95% CI (88.1; 89.3)) and 59.4% (95% CI (58.4; 60.4)), respectively. Age, initial comorbidity, diabetic nephropathy, and a venous catheter were independent risk factors. However, non-urgent initiation of RRT and follow-up in consultations for more than six months had a protective effect. It was identified that renal transplantation (RT) was the most influential independent factor in patient survival, with a risk ratio of 0.13 (95% CI (0.11; 0.14)). CONCLUSIONS The receiving of a kidney transplant was the most beneficial modifiable factor in the survival of incident patients on RRT. We consider that the mortality of the renal replacement treatment should be adjusted, taking into account both modifiable and nonmodifiable factors to achieve a more precise and comparable interpretation.
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Affiliation(s)
- José Manuel Muñoz-Terol
- Department of Nephrology, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain
- Department of Medicine, University of Seville, 41009 Seville, Spain
| | - José L Rocha
- Department of Nephrology, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain
- Department of Medicine, University of Seville, 41009 Seville, Spain
| | - Pablo Castro-de la Nuez
- Information System of the Autonomic Transplant Coordination of Andalusia (SICATA), 41013 Seville, Spain
| | - Juan José Egea-Guerrero
- Neurocritical Care Unit, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain
- Institute of Biomedicine of Seville (IBiS)/Consejo Superior de Investigaciones Científicas (CSIC), University of Seville, 41013 Seville, Spain
| | - Luis Gil-Sacaluga
- Department of Nephrology, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain
| | - Emilio García-Cabrera
- Preventive Medicine and Public Health Department, University of Seville, 41009 Seville, Spain
| | - Angel Vilches-Arenas
- Preventive Medicine and Public Health Department, University of Seville, 41009 Seville, Spain
- Department of Preventive Medicine, Hospital Universitario Virgen Macarena, 41009 Seville, Spain
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Egea-Guerrero JJ, Quintana-Diaz M. Role of prothrombin complex concentrate in the severe trauma patient. Front Med (Lausanne) 2022; 9:988919. [DOI: 10.3389/fmed.2022.988919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/16/2022] [Indexed: 11/06/2022] Open
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3
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Jiménez-Guerra E, Revuelto-Rey J, Rocchetti NS, Egea-Guerrero JJ. Possible adverse effects of the blood donation from brain-dead patients. Med Intensiva 2022; 46:539-540. [PMID: 35753973 DOI: 10.1016/j.medine.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 01/09/2022] [Indexed: 06/15/2023]
Affiliation(s)
- E Jiménez-Guerra
- Servicio de Medicina Intensiva, Hospital Universitario Puerta del Mar, Cádiz, Spain.
| | - J Revuelto-Rey
- Servicio de Medicina Intensiva, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - N S Rocchetti
- Unidad de Cuidados Intensivos, Hospital Eva Perón, Granadero Balgorria, Sante Fe, Argentina; Facultad de Ciencias Médicas, Universidad Nacional de Rosario, Rosario, Santa Fe, Argentina
| | - J J Egea-Guerrero
- Unidad de Neurocríticos, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Egea-Guerrero JJ, Revuelto-Rey J. Social media and intensive care medicine: To be or not to be. Med Intensiva 2022; 46:289-290. [PMID: 35248507 DOI: 10.1016/j.medine.2022.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/04/2021] [Accepted: 03/05/2021] [Indexed: 06/14/2023]
Affiliation(s)
- J J Egea-Guerrero
- Facultativo Especialista del Área de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
| | - J Revuelto-Rey
- Facultativo Especialista del Área de Medicina Intensiva, Hospital Universitario Puerta del Mar, Cádiz, Spain
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5
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Egea-Guerrero JJ, Revuelto-Rey J, Vilches Arenas Á. Emergency medicine and social media - friends or foes? Emergencias 2022; 34:144-145. [PMID: 35275467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Juan José Egea-Guerrero
- Medicina Intensiva, Unidad de Neurocríticos, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Jaume Revuelto-Rey
- Medicina Intensiva, Hospital Universitario Puerta del Mar, Cádiz, España
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Mesa Galán LA, Henríquez Recine MA, Robles Caballero A, Yus Teruel S, García Martínez JR, Egea-Guerrero JJ, Quintana-Diaz M. Ultrasound diagnosis of Terson syndrome as an indicator of extreme severity in neurocritical care patients. Neurologia 2022; 38:181-187. [PMID: 35305963 DOI: 10.1016/j.nrleng.2020.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 04/25/2020] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Terson syndrome (TS) is defined as any intraocular haemorrhage identified in patients with acute intracranial pathology. TS appears to be associated with clinical severity in patients with subarachnoid haemorrhage (SAH), but the association is yet to be defined in patients with traumatic brain injury (TBI) and intracerebral haemorrhage (ICH). This study aimed to evaluate the diagnostic performance of ocular ultrasound (OU) and its usefulness in clinical practice. MATERIAL AND METHODS We performed an observational, prospective, single-centre study of neurocritical care patients. We analysed cases and controls, defined according to indirect ophthalmoscopy (IO) and OU findings. We determined the diagnostic characteristics of OU. A multivariate analysis was performed to identify clinically relevant associations. RESULTS The sample included 91 patients diagnosed with ICH (41.76%), SAH (29.67%), and TBI (28.57%). TS was identified by OU in 8 patients (8.79%) and by IO in 24 (24.37%). The adjusted mortality rate in patients with TS showed an odds ratio (OR) of 4.15 (95% confidence interval [CI], 1.52-11.33). All patients with TS detected by OU presented Glasgow Coma Scale scores < 9, with an elevated risk of needing decompressive craniectomy (OR: 9.84; 95% CI, 1.64-59). OU presented an overall sensitivity of 30.43%, specificity of 98.53%, and diagnostic accuracy of 81.32%. For the detection of vitreous haemorrhage, sensitivity and specificity were 87.5% and 98.5%, respectively. CONCLUSIONS OU diagnosis of TS identifies extremely critical patients, who may require the highest level of care; TS is an independent risk factor for in-hospital mortality.
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Affiliation(s)
- L A Mesa Galán
- Servicio de Medicina Intensiva, Hospital Universitario La Paz, Madrid, Spain.
| | | | - A Robles Caballero
- Servicio de Medicina Intensiva, Hospital Universitario La Paz, Madrid, Spain
| | - S Yus Teruel
- Servicio de Medicina Intensiva, Hospital Universitario La Paz, Madrid, Spain
| | | | - J J Egea-Guerrero
- Servicio de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - M Quintana-Diaz
- Servicio de Medicina Intensiva, Hospital Universitario La Paz, Madrid, Spain
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Egea-Guerrero JJ, García-Sáez I, Quintana-Díaz M. Trigger transfusion in severe traumatic brain injury. Med Intensiva 2021; 46:157-160. [PMID: 34952791 DOI: 10.1016/j.medine.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/08/2021] [Accepted: 03/21/2021] [Indexed: 11/28/2022]
Affiliation(s)
- J J Egea-Guerrero
- Unidad de Gestión Clínica de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, IBIS/CSIC/Universidad de Sevilla, Sevilla, Spain.
| | - I García-Sáez
- Servicio de Medicina Intensiva, Hospital Universitario de Donostia, San Sebastián, Guipúzcoa, Spain
| | - M Quintana-Díaz
- Servicio de Medicina Intensiva, Hospital Universitario de La Paz, Idipaz, Madrid, Spain
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8
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Egea-Guerrero JJ. On death past, present, and future. Emergencias 2021; 33:143-147. [PMID: 33750058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Juan José Egea-Guerrero
- Servicio de Urgencias y Cuidados Críticos, Hospital Universitario Virgen del Rocío, IBiS/CSIC/Universidad de Sevilla, España
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Egea-Guerrero JJ, García-Sáez I, Quintana-Díaz M. Trigger transfusion in severe traumatic brain injury. Med Intensiva 2021; 46:S0210-5691(21)00071-1. [PMID: 33962806 DOI: 10.1016/j.medin.2021.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/08/2021] [Accepted: 03/21/2021] [Indexed: 11/17/2022]
Affiliation(s)
- J J Egea-Guerrero
- Unidad de Gestión Clínica de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla. IBIS/CSIC/Universidad de Sevilla, Sevilla, España.
| | - I García-Sáez
- Servicio de Medicina Intensiva, Hospital Universitario de Donostia, San Sebastián, Guipúzcoa, España
| | - M Quintana-Díaz
- Servicio deMedicina Intensiva, Hospital Universitario de La Paz. Idipaz, Madrid, España
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Egea-Guerrero JJ, Revuelto-Rey J. Social media and intensive care medicine: To be or not to be. Med Intensiva 2021; 46:S0210-5691(21)00040-1. [PMID: 33875311 DOI: 10.1016/j.medin.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/04/2021] [Accepted: 03/05/2021] [Indexed: 11/24/2022]
Affiliation(s)
- J J Egea-Guerrero
- Facultativo Especialista del Área de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - J Revuelto-Rey
- Facultativo Especialista del Área de Medicina Intensiva, Hospital Universitario Puerta del Mar, Cádiz, España
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11
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Martín-Villen L, Ruiz de Azúa-López Z, Revuelto-Rey J, Aldabó-Pallás T, Alonso-Gil M, Egea-Guerrero JJ. Public-private collaboration in Seville as a strategy to expand organ and tissue donors: Think there is no box. Med Intensiva 2021; 46:S0210-5691(20)30398-3. [PMID: 33509645 DOI: 10.1016/j.medin.2020.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 11/24/2022]
Affiliation(s)
- L Martín-Villen
- Medicina Intensiva, HU Virgen del Rocío, Sevilla, España; Coordinación Sectorial Trasplantes de Sevilla y Huelva, España
| | - Z Ruiz de Azúa-López
- Medicina Intensiva, HU Virgen del Rocío, Sevilla, España; Coordinación Sectorial Trasplantes de Sevilla y Huelva, España
| | - J Revuelto-Rey
- Coordinación Sectorial Trasplantes de Sevilla y Huelva, España; Medicina Intensiva, HU Puerta del Mar, Cádiz, España
| | - T Aldabó-Pallás
- Coordinación Sectorial Trasplantes de Sevilla y Huelva, España; Medicina Intensiva, HU Puerta del Mar, Cádiz, España
| | - M Alonso-Gil
- Coordinación Autonómica de Trasplantes, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - J J Egea-Guerrero
- Medicina Intensiva, HU Virgen del Rocío, Sevilla, España; Coordinación Autonómica de Trasplantes, Hospital Universitario Virgen del Rocío, Sevilla, España; IBiS/CSIC Universidad de Sevilla, Sevilla, España.
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12
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Sprigg N, Flaherty K, Appleton JP, Al-Shahi Salman R, Bereczki D, Beridze M, Ciccone A, Collins R, Dineen RA, Duley L, Egea-Guerrero JJ, England TJ, Karlinski M, Krishnan K, Laska AC, Law ZK, Ovesen C, Ozturk S, Pocock SJ, Roberts I, Robinson TG, Roffe C, Peters N, Scutt P, Thanabalan J, Werring D, Whynes D, Woodhouse L, Bath PM. Tranexamic acid to improve functional status in adults with spontaneous intracerebral haemorrhage: the TICH-2 RCT. Health Technol Assess 2020; 23:1-48. [PMID: 31322116 DOI: 10.3310/hta23350] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Tranexamic acid reduces death due to bleeding after trauma and postpartum haemorrhage. OBJECTIVE The aim of the study was to assess if tranexamic acid is safe, reduces haematoma expansion and improves outcomes in adults with spontaneous intracerebral haemorrhage (ICH). DESIGN The TICH-2 (Tranexamic acid for hyperacute primary IntraCerebral Haemorrhage) study was a pragmatic, Phase III, prospective, double-blind, randomised placebo-controlled trial. SETTING Acute stroke services at 124 hospitals in 12 countries (Denmark, Georgia, Hungary, Ireland, Italy, Malaysia, Poland, Spain, Sweden, Switzerland, Turkey and the UK). PARTICIPANTS Adult patients (aged ≥ 18 years) with ICH within 8 hours of onset. EXCLUSION CRITERIA Exclusion criteria were ICH secondary to anticoagulation, thrombolysis, trauma or a known underlying structural abnormality; patients for whom tranexamic acid was thought to be contraindicated; prestroke dependence (i.e. patients with a modified Rankin Scale [mRS] score > 4); life expectancy < 3 months; and a Glasgow Coma Scale score of < 5. INTERVENTIONS Participants, allocated by randomisation, received 1 g of an intravenous tranexamic acid bolus followed by an 8-hour 1-g infusion or matching placebo (i.e. 0.9% saline). MAIN OUTCOME MEASURE The primary outcome was functional status (death or dependency) at day 90, which was measured by the shift in the mRS score, using ordinal logistic regression, with adjustment for stratification and minimisation criteria. RESULTS A total of 2325 participants (tranexamic acid, n = 1161; placebo, n = 1164) were recruited from 124 hospitals in 12 countries between 2013 and 2017. Treatment groups were well balanced at baseline. The primary outcome was determined for 2307 participants (tranexamic acid, n = 1152; placebo, n = 1155). There was no statistically significant difference between the treatment groups for the primary outcome of functional status at day 90 [adjusted odds ratio (aOR) 0.88, 95% confidence interval (CI) 0.76 to 1.03; p = 0.11]. Although there were fewer deaths by day 7 in the tranexamic acid group (aOR 0.73, 95% CI 0.53 to 0.99; p = 0.041), there was no difference in case fatality at 90 days (adjusted hazard ratio 0.92, 95% CI 0.77 to 1.10; p = 0.37). Fewer patients experienced serious adverse events (SAEs) after treatment with tranexamic acid than with placebo by days 2 (p = 0.027), 7 (p = 0.020) and 90 (p = 0.039). There was no increase in thromboembolic events or seizures. LIMITATIONS Despite attempts to enrol patients rapidly, the majority of participants were enrolled and treated > 4.5 hours after stroke onset. Pragmatic inclusion criteria led to a heterogeneous population of participants, some of whom had very large strokes. Although 12 countries enrolled participants, the majority (82.1%) were from the UK. CONCLUSIONS Tranexamic acid did not affect a patient's functional status at 90 days after ICH, despite there being significant modest reductions in early death (by 7 days), haematoma expansion and SAEs, which is consistent with an antifibrinolytic effect. Tranexamic acid was safe, with no increase in thromboembolic events. FUTURE WORK Future work should focus on enrolling and treating patients early after stroke and identify which participants are most likely to benefit from haemostatic therapy. Large randomised trials are needed. TRIAL REGISTRATION Current Controlled Trials ISRCTN93732214. FUNDING This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 35. See the NIHR Journals Library website for further project information. The project was also funded by the Pragmatic Trials, UK, funding call and the Swiss Heart Foundation in Switzerland.
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Affiliation(s)
- Nikola Sprigg
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK.,Stroke, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Katie Flaherty
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Jason P Appleton
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | | | - Daniel Bereczki
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Maia Beridze
- The First University Clinic of Tbilisi State Medical University, Tbilisi, Georgia
| | - Alfonso Ciccone
- Neurology Unit, Azienda Socio Sanitaria Territoriale di Mantova, Mantua, Italy
| | - Ronan Collins
- Stroke Service, Adelaide and Meath Hospital, Tallaght, Ireland
| | - Robert A Dineen
- Radiological Sciences, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK.,NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Lelia Duley
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Juan José Egea-Guerrero
- UGC de Medicina Intensiva, Hospital Universitario Virgen del Rocío, IBiS/CSIC/Universidad de Sevilla, Seville, Spain
| | - Timothy J England
- Vascular Medicine, Division of Medical Sciences & GEM, University of Nottingham, Derby, UK
| | - Michal Karlinski
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Kailash Krishnan
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK.,Stroke, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Ann Charlotte Laska
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Zhe Kang Law
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK.,Stroke, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Department of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Christian Ovesen
- Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Department of Neurology, Copenhagen, Denmark
| | - Serefnur Ozturk
- Department of Neurology, Selcuk University Medical Faculty, Konya, Turkey
| | - Stuart J Pocock
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Ian Roberts
- Clinical Trials Unit, London School of Hygiene & Tropical Medicine, London, UK
| | - Thompson G Robinson
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Christine Roffe
- Stroke Research, Faculty of Medicine and Health Sciences, Keele University, Keele, UK
| | - Nils Peters
- Department of Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland
| | - Polly Scutt
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Jegan Thanabalan
- Division of Neurosurgery, Department of Surgery, National University of Malaysia, Kuala Lumpur, Malaysia
| | - David Werring
- Stroke Research Centre, University College London Queen Square Institute of Neurology, Faculty of Brain Sciences of University College London, University College London, London, UK.,National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - David Whynes
- School of Economics, University of Nottingham, Nottingham, UK
| | - Lisa Woodhouse
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Philip M Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK.,Stroke, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Rocchetti NS, Rodríguez-Rodríguez A, Egea-Guerrero JJ. Tools for the early identification of patients who progress to brain death: seen from the vantage of emergency department staff. Emergencias 2020; 31:435-437. [PMID: 31777217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
| | - Ana Rodríguez-Rodríguez
- IBiS/CSIC/Universidad de Sevilla. UGC Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Juan José Egea-Guerrero
- IBiS/CSIC/Universidad de Sevilla. UGC Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, España
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Mesa Galán LA, Henríquez Recine MA, Robles Caballero A, Yus Teruel S, García Martínez JR, Egea-Guerrero JJ, Quintana-Diaz M. Ultrasound diagnosis of Terson syndrome as an indicator of extreme severity in neurocritical care patients. Neurologia 2020; 38:S0213-4853(20)30219-X. [PMID: 32912744 DOI: 10.1016/j.nrl.2020.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 04/18/2020] [Accepted: 04/25/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Terson syndrome (TS) is defined as any intraocular haemorrhage identified in patients with acute intracranial pathology. TS appears to be associated with clinical severity in patients with subarachnoid haemorrhage (SAH), but the association is yet to be defined in patients with traumatic brain injury (TBI) and intracerebral haemorrhage (ICH). This study aimed to evaluate the diagnostic performance of ocular ultrasound (OU) and its usefulness in clinical practice. MATERIAL AND METHODS We performed an observational, prospective, single-centre study of neurocritical care patients. We analysed cases and controls, defined according to indirect ophthalmoscopy (IO) and OU findings. We determined the diagnostic characteristics of OU. A multivariate analysis was performed to identify clinically relevant associations. RESULTS The sample included 91 patients diagnosed with ICH (41.76%), SAH (29.67%), and TBI (28.57%). TS was identified by OU in 8 patients (8.79%) and by IO in 24 (24.37%). The adjusted mortality rate in patients with TS showed an odds ratio (OR) of 4.15 (95% confidence interval [CI], 1.52-11.33). All patients with TS detected by OU presented Glasgow Coma Scale scores < 9, with an elevated risk of needing decompressive craniectomy (OR: 9.84; 95% CI, 1.64-59). OU presented an overall sensitivity of 30.43%, specificity of 98.53%, and diagnostic accuracy of 81.32%. For the detection of vitreous haemorrhage, sensitivity and specificity were 87.5% and 98.5%, respectively. CONCLUSIONS OU diagnosis of TS identifies extremely critical patients, who may require the highest level of care; TS is an independent risk factor for in-hospital mortality.
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Affiliation(s)
- L A Mesa Galán
- Servicio de Medicina Intensiva. Hospital Universitario La Paz, Madrid, España.
| | | | - A Robles Caballero
- Servicio de Medicina Intensiva. Hospital Universitario La Paz, Madrid, España
| | - S Yus Teruel
- Servicio de Medicina Intensiva. Hospital Universitario La Paz, Madrid, España
| | | | - J J Egea-Guerrero
- Servicio de Medicina Intensiva. Hospital Universitario Virgen del Rocío, Sevilla, España
| | - M Quintana-Diaz
- Servicio de Medicina Intensiva. Hospital Universitario La Paz, Madrid, España
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Egea-Guerrero JJ, Ballesteros MÁ, Quintana-Díaz M. Tranexamic acid in patients with multiple injuries: good, elegant, and cheap? Emergencias 2020; 31:281-282. [PMID: 31347809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Juan José Egea-Guerrero
- Cuidados Críticos y Urgencias, Hospital Universitario Virgen del Rocío, IBIS/CSIC/Universidad de Sevilla, Sevilla, España
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Martin-Villen L, Cabeza-Cabeza F, Egea-Guerrero JJ. Intensivist or transplant coordinator: It makes no difference. Med Intensiva 2019; 44:62-63. [PMID: 31668750 DOI: 10.1016/j.medin.2019.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 07/20/2019] [Accepted: 07/29/2019] [Indexed: 11/29/2022]
Affiliation(s)
- L Martin-Villen
- Unidad de Gestión Clínica de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, España; Coordinación Sectorial de Trasplantes de Sevilla-Huelva, Consejería de Salud y Familias.
| | - F Cabeza-Cabeza
- Unidad de Gestión Clínica de Medicina Intensiva, Hospital Universitario Juan Ramón Jiménez, Huelva, España; Coordinación Sectorial de Trasplantes de Sevilla-Huelva, Consejería de Salud y Familias
| | - J J Egea-Guerrero
- Unidad de Gestión Clínica de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, España; Coordinación Autonómica de Trasplantes de Andalucía, Consejería de Salud y Familias
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17
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Palomo-López N, Martín-Sastre S, Martín-Villén L, Ruiz de Azúa-López Z, Solis-Clavijo D, Caballero-Gálvez S, Carballo-Caro JM, Egea-Guerrero JJ. Normothermic Regional Perfusion and Donation After Circulatory Death (Controlled and Uncontrolled): Metabolic Differences and Kidney Transplantation Evolution. Transplant Proc 2019; 51:3044-3046. [PMID: 31627924 DOI: 10.1016/j.transproceed.2019.08.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To analyze metabolic differences during normothermic regional perfusion (NRP) between the dissimilar types of donation after circulatory death, uncontrolled (uDCD) and controlled (cDCD), and the evolution of the transplanted kidneys. METHODS Observational, prospective, cohort study. We included patients from uDCD and cDCD maintained with NRP in 2017. Six consecutive blood gases were collected with determination of pH and lactic acid. Creatinine levels were monitored at 24 hours, 3 months, and 6 months after transplant and the need for renal replacement therapy was evaluated. Descriptive statistical analysis was performed, presenting the qualitative variables as frequencies and percentages, and quantitative as mean ± SD or median (interquartile range [IQR]). We used χ2 testing for bivariate analysis of qualitative variables. RESULTS We collected 18 donors. Fifteen out of 18 (83.3%) were men with a median of 51 years (IQR, 46-60). Eleven out of 18 (61.1%) were cDCD and 7 out of 18 (38.9%) were uDCD. The blood gas results are illustrated in Table 1. A total of 28 renal transplants were obtained with a median age of 47 years (IQR, 45-57); 83% were male. Ten out of 28 (35.7%) came from uDCD and 18 out of 28 (64.7%) from cDCD. Table 2 shows the monitoring of the creatinine values of the recipients after the transplantation. CONCLUSIONS There are more metabolic disorders in our series in uDCD organ donation compared with cDCD. The recovery of the renal function of organs from uDCD is slower than that of cDCD, however; the tendency is toward normality.
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Affiliation(s)
- Nora Palomo-López
- Intensive Care Unit, University Hospital Virgen del Rocío, Sevilla, Spain.
| | - Sara Martín-Sastre
- Intensive Care Unit, University Hospital Virgen del Rocío, Sevilla, Spain
| | - Luis Martín-Villén
- Division of Transplantation, University Hospital Virgen del Rocío, Sevilla, Spain
| | | | - Diego Solis-Clavijo
- Division of Transplantation, University Hospital Virgen del Rocío, Sevilla, Spain
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Palomo-López N, Quintana-Díaz M, Egea-Guerrero JJ. Early fresh frozen plasma for hemorrhagic shock: Are we sure? Emergencias 2019; 31:353-354. [PMID: 31625308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Nora Palomo-López
- Servicio de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, España
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19
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Ferrete-Araujo AM, Rodríguez-Rodríguez A, Egea-Guerrero JJ, Vilches-Arenas Á, Godoy DA, Murillo-Cabezas F. Brain Injury Biomarker Behavior in Spontaneous Intracerebral Hemorrhage. World Neurosurg 2019; 132:e496-e505. [PMID: 31449996 DOI: 10.1016/j.wneu.2019.08.090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 08/13/2019] [Accepted: 08/14/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND S100B and neuron-specific enolase (NSE) have been widely studied in diverse neurocritical pathologies, being recognized as the most promising biomarkers for brain injury assessment. However, their role in intracerebral hemorrhage (ICH) has not been widely analyzed. METHODS This was an observational prospective cohort study of patients with ICH admitted to a neurocritical care unit. Blood samples were collected on admission and at 24 hours, 48 hours, and 72 hours. Patient outcomes were assessed at 6 months after the event. RESULTS Thirty-six patients with ICH were included in the study. The mortality rate was 36%. Nonsurvivors had higher S100B values than survivors at admission, 24 hours, and 48 hours (P < 0.05). Likewise, S100B levels were higher in patients with poor outcomes (modified Rankin Scale [mRS] score >4) compared with those with good outcome (mRS score ≤3) in the 24-hour, 48-hour, and 72-hour samples. Receiver operating characteristic (ROC) curve analysis showed that S100B at admission, 24 hours, and 48 hours can discriminate between patients who survive and those who die as a consequence of ICH. The 48-hour sample (area under the ROC curve, 0.817; P = 0.003) reached the best values for sensitivity (75%) and specificity (80%); cutoff, 0.250 μg/L. For 6-month functional outcome, S100B protein could differentiate between groups at 24, 48, and 72 hours. The S100B 24-hour sample had the best values for sensitivity (82.6%) and specificity (72.7%), with a cutoff of 0.202 μg/L. We found no clear relationship between NSE values and clinical characteristics. CONCLUSIONS S100B protein acts as early predictor of mortality and functional outcome in patients with ICH. This biomarker measurement can provide additional information beyond clinical and radiologic findings to guide physicians in the management of these patients.
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Affiliation(s)
- Ana María Ferrete-Araujo
- NeuroCritical Care Unit, Virgen del Rocío University Hospital, IBIS/CSIC/University of Seville, Seville, Spain.
| | - Ana Rodríguez-Rodríguez
- NeuroCritical Care Unit, Virgen del Rocío University Hospital, IBIS/CSIC/University of Seville, Seville, Spain
| | - Juan José Egea-Guerrero
- NeuroCritical Care Unit, Virgen del Rocío University Hospital, IBIS/CSIC/University of Seville, Seville, Spain
| | - Ángel Vilches-Arenas
- Department of Preventive Medicine and Public Health, Virgen Macarena University Hospital, University of Seville, Seville, Spain
| | | | - Francisco Murillo-Cabezas
- NeuroCritical Care Unit, Virgen del Rocío University Hospital, IBIS/CSIC/University of Seville, Seville, Spain
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20
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Daga-Ruiz D, Perez-Villares JM, Martín-Villén L, Egea-Guerrero JJ. The right to become an organ and tissue donor at the end of life of critically ill patient. Med Intensiva 2019; 44:59-60. [PMID: 30665688 DOI: 10.1016/j.medin.2018.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 11/13/2018] [Indexed: 11/19/2022]
Affiliation(s)
- D Daga-Ruiz
- Coordinación Autonómica de Trasplantes de Andalucía, Servicio Andaluz de Salud, Hospitales Universitarios: Regional de Málaga, Virgen de las Nieves de Granada y Virgen del Rocío de Sevilla, Málaga, España.
| | - J M Perez-Villares
- Coordinación Autonómica de Trasplantes de Andalucía, Servicio Andaluz de Salud, Hospitales Universitarios: Regional de Málaga, Virgen de las Nieves de Granada y Virgen del Rocío de Sevilla, Málaga, España
| | - L Martín-Villén
- Coordinación Autonómica de Trasplantes de Andalucía, Servicio Andaluz de Salud, Hospitales Universitarios: Regional de Málaga, Virgen de las Nieves de Granada y Virgen del Rocío de Sevilla, Málaga, España
| | - J J Egea-Guerrero
- Coordinación Autonómica de Trasplantes de Andalucía, Servicio Andaluz de Salud, Hospitales Universitarios: Regional de Málaga, Virgen de las Nieves de Granada y Virgen del Rocío de Sevilla, Málaga, España
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21
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Ballesteros MÁ, Llompart-Pou JA, Egea-Guerrero JJ. Temporary inferior vena cava filters in major trauma. Med Intensiva 2018; 43:500-502. [PMID: 30385089 DOI: 10.1016/j.medin.2018.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 09/06/2018] [Accepted: 09/06/2018] [Indexed: 10/28/2022]
Affiliation(s)
- M Á Ballesteros
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España.
| | - J A Llompart-Pou
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca, España
| | - J J Egea-Guerrero
- Servicio de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, España
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22
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Egea-Guerrero JJ, Martín-Villén L, Pérez-Villares JM. Key role for out-of-hospital emergency teams in non-heart-beating donor programs in Andalusia. Emergencias 2018; 30:368-369. [PMID: 30260137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Juan José Egea-Guerrero
- Coordinación Sectorial de Trasplantes de SevillaHuelva, España. Servicio de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Luis Martín-Villén
- Coordinación Sectorial de Trasplantes de SevillaHuelva, España. Servicio de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - José Miguel Pérez-Villares
- Coordinación Sectorial de Trasplantes de Granada, España. Servicio de Medicina Intensiva, Hospital Universitario Virgen de las Nieves, Granada, España
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23
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Naranjo-Izurieta JR, Ruiz de Azúa-López Z, Lameirao J, Martín-Villén L, Roldán-Reina A, Porras-López M, Rodríguez-Rodríguez A, Egea-Guerrero JJ. Orthotopic Liver Transplantation: Preliminary Analysis of Complications With Grafts From Elderly Donors. Transplant Proc 2018; 50:644-645. [PMID: 29579876 DOI: 10.1016/j.transproceed.2017.12.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 11/30/2017] [Accepted: 12/04/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVE This study aims to determine if donor grafts of patients older than 65 years develop more post-transplantation complications than those of younger patients. DESIGN This is a retrospective, observational study of liver transplant recipients during 12 months in Virgen del Rocio University Hospital. We compare incidence rates of reperfusion syndrome, acute kidney injury, and need for intra- and postoperative red blood cell transfusions in two donor age groups in which group A is <65 years old and group B is ≥65 years old. RESULTS Sixty cases were included. Reperfusion syndrome, acute kidney injury, and both intra- and postoperative red blood cell transfusion were more frequent in group A than group B (11.4% vs. 4%, P = .390; 44% vs. 32%, P = .423; 68.8% vs. 48%, P = .120; and 70.6% vs. 64%, P = .779, respectively). Six recipients (17.1%) died at 12 months from group A whereas there were no deaths register in group B during that time (P = .036). CONCLUSION Our results showed that including elderly donors does not aggravate incidence of complications, emphasizing that advanced age should not be an exclusion criteria for liver transplantation.
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Affiliation(s)
- J R Naranjo-Izurieta
- Management Unit of Critical Care, University Hospital Virgen del Rocío, Seville, Spain.
| | - Z Ruiz de Azúa-López
- Management Unit of Critical Care, University Hospital Virgen del Rocío, Seville, Spain; Intrahospital Transplant Coordination, University Hospital Virgen del Rocío, Seville, Spain
| | - J Lameirao
- Management Unit of Critical Care, University Hospital Virgen del Rocío, Seville, Spain
| | - L Martín-Villén
- Management Unit of Critical Care, University Hospital Virgen del Rocío, Seville, Spain; Intrahospital Transplant Coordination, University Hospital Virgen del Rocío, Seville, Spain
| | - A Roldán-Reina
- Management Unit of Critical Care, University Hospital Virgen del Rocío, Seville, Spain
| | - M Porras-López
- Management Unit of Critical Care, University Hospital Virgen del Rocío, Seville, Spain
| | - A Rodríguez-Rodríguez
- Management Unit of Critical Care, University Hospital Virgen del Rocío, Seville, Spain
| | - J J Egea-Guerrero
- Management Unit of Critical Care, University Hospital Virgen del Rocío, Seville, Spain; Sectorial Coordination of Transplants, Sevilla-Huelva, Sevilla, Spain
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24
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Rocchetti NS, Egea-Guerrero JJ, Ruiz de Azua-Lopez Z, Martin-Villen L, Rodriguez-Rodriguez A, Vilches-Arenas A, Correa-Chamorro E, Settecase CJ, Bagilet DH. [APACHE II and SAPS II as predictors of brain death development in neurocritical care patients]. Rev Neurol 2018; 67:121-128. [PMID: 30039839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
AIM To assess the prognostic value of APACHE II and SAPS II scales to predict brain death evolution of neurocritical care patients. PATIENTS AND METHODS Retrospective observational study performed in a tertiary hospital. Include 508 patients over 16 years old, hospitalized in ICU for at least 24 hours. The variables of interest were: demographic data, risk factors, APACHE II, SAPS II and outcome. RESULTS Median age: 41 years old (IR: 25-57). Males: 76.2%. Most frequent reason for admission: trauma (55.3%). Medians: Glasgow Coma Scale (GCS), 10 points; APACHE II, 13 points; SAPS II, 31 points; and ICU stay, 5 days. Mortality in the ICU was 28.5% (n = 145) of whom 44 (8.7%) evolved to brain death. Univariate logistic regression analysis showed that GCS, APACHE II and SAPS II scores, as well as ICU stay days behaved as predictors of brain death evolution. However, the multivariate analysis performed including APACHE II and SAPS II scores showed that only APACHE II maintained statistical significance, despite the good discrimination of both scores. CONCLUSION Transplant coordinators might use the APACHE II score as a tool to detect patients at risk of progression to brain death, minimizing the loss of potential donors.
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Affiliation(s)
| | - J J Egea-Guerrero
- Universidad de Sevilla, Sevilla, Espana
- Hospital Universitario Virgen del Rocio, Sevilla, Espana
| | | | | | | | | | | | | | - D H Bagilet
- Hospital Eva Peron, Granadero Baigorria, Argentina
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25
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González-Montelongo MDC, Egea-Guerrero JJ, Murillo-Cabezas F, González-Montelongo R, Ruiz de Azúa-López Z, Rodríguez-Rodríguez A, Vilches-Arenas A, Castellano A, Ureña J. Relation of RhoA in Peripheral Blood Mononuclear Cells With Severity of Aneurysmal Subarachnoid Hemorrhage and Vasospasm. Stroke 2018; 49:1507-1510. [DOI: 10.1161/strokeaha.117.020311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 04/09/2018] [Accepted: 04/12/2018] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | | | | | | | - Angel Vilches-Arenas
- Dpto. de Medicina Preventiva y Salud Pública, Hospital Universitario Virgen Macarena (A.V.-A.), Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Spain
| | - Antonio Castellano
- From the Dpto. de Fisiología Médica y Biofísica (M.d.C.G.-M., R.G.-M., A.C., J.U.)
| | - Juan Ureña
- From the Dpto. de Fisiología Médica y Biofísica (M.d.C.G.-M., R.G.-M., A.C., J.U.)
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26
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Gil-Salazar T, Egea-Guerrero JJ, Martin-Villen L, Ruiz de Azua-López Z. Organ donor management: Common recommendations that deserve evidence. Med Intensiva 2018; 42:513. [PMID: 29622462 DOI: 10.1016/j.medin.2018.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 02/24/2018] [Indexed: 11/29/2022]
Affiliation(s)
- T Gil-Salazar
- Unidad de Trasplantes, Fundación Valle Del Lili, Cali, Valle del Cauca, Colombia
| | - J J Egea-Guerrero
- Coordinación de Trasplantes, Hospital Universitario Virgen del Rocío, IBiS/CSIC/Universidad de Sevilla, Sevilla, España.
| | - L Martin-Villen
- Coordinación de Trasplantes, Hospital Universitario Virgen del Rocío, IBiS/CSIC/Universidad de Sevilla, Sevilla, España
| | - Z Ruiz de Azua-López
- Coordinación de Trasplantes, Hospital Universitario Virgen del Rocío, IBiS/CSIC/Universidad de Sevilla, Sevilla, España
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27
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Toapanta Gaibor NG, González-Roncero FM, Cintra Cabrera M, Suñer Poblet M, Bernal Blanco G, Suarez Benjumea A, Pérez-Valdivia MA, Egea-Guerrero JJ, Rocha Castilla JL, Gentil Govantes MA. Survival and Evolution of Renal Function in Kidney Transplant Recipients From Type II Asystolic Donations: A Single-center Experience. Transplant Proc 2018; 50:565-568. [PMID: 29579853 DOI: 10.1016/j.transproceed.2017.11.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 10/19/2017] [Accepted: 11/11/2017] [Indexed: 10/17/2022]
Abstract
BACKGROUND In recent years, stagnation in the number of kidneys from after brain-dead donors (DBD) has stimulated the use of non-heart beating donors (NHBDs). Herein we present our 5-year experience with type II Maastricht NHBDs in renal transplantation. METHODS All patients (n = 50) in this study received type II Maastricht NHBD kidneys (March 2012 to February 2017), with a median follow-up of 33 months. RESULTS Mean donor age was 39 ± 12 years, mean creatinine 1.24 ± 0.2 mg/dL, and the most frequently observed blood group (donors and recipients) was type A (64%). Recipients were slightly younger (51 ± 11 years old), with mean time on dialysis of 30 ± 24 months. Almost all were primary transplants. Pre-transplant panel-reactive antibodies (PRA) were <25%; initial immunosuppression was thymoglobulin, corticosteroids, mycophenolate mofetil, and delayed introduction of tacrolimus. Six percent were nonfunctioning kidneys; 79.6% presented with delayed renal function (mean duration 14 ± 9 days). Acute rejection was seen in 6% of patients. Mean creatinine at month 3 was 1.7 ± 0.8 mg/dL, and 1.5 ± 0.8 mg/dL in the first year. The last available mean creatinine was 1.54 ± 0.7 mg/dL. Proteinuria in the third month, first year, and third year was 0.70, 0.41, and 0.26 g/d, respectively. Recipient survival at the first, third, and fifth year was 100%, 100%, and 86%, and when graft-censored for death was 94%, 91%, and 91%, respectively. The incidence of acute rejection during first year was 6%, and 2% in the second year. Exitus incidence was 4% and cytomegalovirus infection was 21.3%. BK viremia between 1000 and 10,000 copies/mL was seen in 4.3%, and reached >10,000 copies/mL in 2.1%. CONCLUSIONS Type II NHBD has shown limited frequency of nonfunctioning kidney and high functional delay. The results in survival and renal function are very acceptable, comparable with levels seen in donation after brain death.
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Affiliation(s)
- N G Toapanta Gaibor
- Department of Nephrology, Virgen del Rocío University Hospital, Seville, Spain.
| | | | - M Cintra Cabrera
- Department of Nephrology, Virgen del Rocío University Hospital, Seville, Spain
| | - M Suñer Poblet
- Department of Nephrology, Virgen del Rocío University Hospital, Seville, Spain
| | - G Bernal Blanco
- Department of Nephrology, Virgen del Rocío University Hospital, Seville, Spain
| | - A Suarez Benjumea
- Department of Nephrology, Virgen del Rocío University Hospital, Seville, Spain
| | - M A Pérez-Valdivia
- Department of Nephrology, Virgen del Rocío University Hospital, Seville, Spain
| | - J J Egea-Guerrero
- Department of Nephrology, Virgen del Rocío University Hospital, Seville, Spain
| | - J L Rocha Castilla
- Department of Nephrology, Virgen del Rocío University Hospital, Seville, Spain
| | - M A Gentil Govantes
- Department of Nephrology, Virgen del Rocío University Hospital, Seville, Spain
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28
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Egea-Guerrero JJ, Martín-Villén L, Ruiz de Azúa-López Zaida Z, Bonilla-Quintero Francisco F, Pérez-López Enrique E, Marín-Andrés R, Correa-Chamorro E, Vilches-Arenas Á. Short-term Results From a Training Program to Improve Organ Donation in Uncontrolled Donation After Circulatory Death. Transplant Proc 2018; 50:530-532. [PMID: 29579843 DOI: 10.1016/j.transproceed.2017.09.074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 09/21/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND In all organ transplantation programs, election of the proper protocol relies primarily on the professionals involved in the detection of potential donors. The objective of our study was to assess the impact of a series of prehospital training sessions, as well as to develop several positive feedback strategies within the uncontrolled organ donation after circulatory death (uDCD) program in our city. METHODS A before-after intervention study was carried out in 3 steps. First, professionals enrolled in the Emergency Health Services Agency-061 (EPES-061) program underwent specific training to identify potential donors. Second, a specific logotype was designed to alert emergency health care professionals that in cases where cardiopulmonary resuscitation was ineffective and after treatment of all potentially reversible causes, the "chain of survival" should be considered a "chain of opportunities." Third, a positive feedback strategy was put in place, whereby each time a donation was procured, the EPES-061 personnel that had identified the potential donor were notified by phone and in a personal letter. RESULTS The mean age for donors was 50.5 years of age (interquartile range 37-52.5), and 89.5% of all donations came from male subjects. Positive feedback letters and phone calls, including information on final outcome, were provided to the appropriate personnel in 100% of the cases. Postintervention information showed an increase in both eligible and utilized donors. CONCLUSIONS Interventions outside the hospital setting that facilitate optimal implementation of the uDCD program are an essential part of this strategy to increase the donor pool and make the wait shorter for transplant patients.
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Affiliation(s)
- J J Egea-Guerrero
- Donation and Transplantation Programs Department, H.U. Virgen del Rocío, Seville, Spain; Instituto de Biomedicina (IBiS)/CSIC/University of Seville, Seville, Spain.
| | - L Martín-Villén
- Donation and Transplantation Programs Department, H.U. Virgen del Rocío, Seville, Spain
| | - Z Ruiz de Azúa-López Zaida
- Donation and Transplantation Programs Department, H.U. Virgen del Rocío, Seville, Spain; Instituto de Biomedicina (IBiS)/CSIC/University of Seville, Seville, Spain
| | | | | | | | - E Correa-Chamorro
- Donation and Transplantation Programs Department, H.U. Virgen del Rocío, Seville, Spain
| | - Á Vilches-Arenas
- Instituto de Biomedicina (IBiS)/CSIC/University of Seville, Seville, Spain; Department of Public Health and Preventive Medicine, University of Seville, Seville, Spain
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29
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Roldán-Reina AJ, Martín-Villén L, Palomo-López N, Hannon V, Cuenca-Apolo DX, Adriaensens-Pérez M, Porras-López M, Ruiz de Azúa-López Z, Corcia-Palomo Y, Egea-Guerrero JJ. Living Donor in Renal Transplantation: Minimizing Risks. Transplant Proc 2018; 50:543-545. [PMID: 29579847 DOI: 10.1016/j.transproceed.2017.11.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 10/21/2017] [Accepted: 11/11/2017] [Indexed: 11/29/2022]
Abstract
In recent years, the broadening of indications for renal transplantation, together with the progressive reduction of donations following brain stem death, has led to living donation being considered in increasing numbers of cases for renal transplantation. To investigate this further, it is necessary to assess the impact it has on the postoperative outcomes in the intensive care unit (ICU). Our group conducted a retrospective, observational, single-center study from 2013 to 2016 to evaluate differences in outcomes between living and cadaveric kidney donation both during ICU admission and total hospitalization. We compared differences in characteristics between living and deceased graft recipients including demographics, comorbidities, analytical data, radioisotope imaging test results, complications, ICU and hospital ward length of stay, and mortality. In all, 387 patients were eligible for analysis, and 13% received living donor grafts. Our results demonstrate that this group had significantly fewer complications, shorter length of hospital stay, and reduced mortality in comparison with recipients of cadaveric donor grafts. The better postoperative outcomes from living donor grafts could result from careful selection of the donor and less inflammatory injury, minimizing risk in the postoperative period.
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Affiliation(s)
- A J Roldán-Reina
- Intensive Care Unit, Virgen del Rocío University Hospital, Seville, Spain.
| | | | - N Palomo-López
- Intensive Care Unit, Virgen del Rocío University Hospital, Seville, Spain
| | - V Hannon
- Intensive Care Unit, The Royal Free Hospital, London, UK
| | - D X Cuenca-Apolo
- Intensive Care Unit, Virgen del Rocío University Hospital, Seville, Spain
| | | | - M Porras-López
- Intensive Care Unit, Virgen del Rocío University Hospital, Seville, Spain
| | | | - Y Corcia-Palomo
- Intensive Care Unit, Virgen del Rocío University Hospital, Seville, Spain
| | - J J Egea-Guerrero
- Coordination of Transplants: Seville-Huelva Sector, Instituto de Biomedicina de Sevilla (IBiS), Consejo Superior de Investigaciones Científicas (CSIC), Seville University, Spain
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Palomo-López N, Martín-Villén L, Roldán-Reina ÁJ, Ruiz de Azúa-López Z, Cuenca-Apolo DX, Adriaensens-Pérez M, Corcia-Palomo Y, Egea-Guerrero JJ. Results of Controlled Donation After Circulatory Death in a Third-Level Hospital. Transplant Proc 2018; 50:536-538. [PMID: 29579845 DOI: 10.1016/j.transproceed.2017.11.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 10/09/2017] [Accepted: 11/11/2017] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To investigate the characteristics and evolution of controlled donation after circulatory death (DCD) type III. MATERIALS AND METHODS Observational and retrospective study of controlled DCD type III of donors conducted from 2014 to 2016. Clinical data, intensive care unit (ICU) stay, cause of death, warm ischemia time, and total time were collected. Delayed graft function (DGF) and survival of renal transplant were also registered. Qualitative variables are described as frequencies and absolute values and quantitative variables as medians and interquartile ranges. RESULTS A total of 21 donors were collected; 71% (15) were males, median age was 55 years (interquartile range [IR] 48-72), and median ICU stay was 7 days (IR 4-12). The main cause of death was anoxic encephalopathy (57%, 12), followed by intracerebral hemorrhage (28%, 6). In 48%, withdrawal of life support occurred in the operating room, and 98% of donors were preserved by abdominal super-rapid cannulation technique. Average warm ischemia time was 20 minutes (IR 16-24), and total ischemia time was 26 minutes (IR 23-34). Of the donations, 57% were livers and 90% were kidneys. Out of 42 kidneys donated, 54% (23) of them were valid. Median renal transplant hospital stay was 18 days (IR 6-24), and 46% develop DGF. Survival at discharge was 100%. CONCLUSION DCD type III ensures a source of organs. The main cause of death was anoxic encephalopathy. Most donors were able to donate some solid organ.
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Affiliation(s)
- N Palomo-López
- Intensive Care Unit, University Hospital Virgen del Rocío, Sevilla, Spain.
| | - L Martín-Villén
- Transplant Coordinator Huelva-Sevilla, University Hospital Virgen del Rocío, Sevilla, Spain
| | - Á J Roldán-Reina
- Intensive Care Unit, University Hospital Virgen del Rocío, Sevilla, Spain
| | - Z Ruiz de Azúa-López
- Transplant Coordinator Huelva-Sevilla, University Hospital Virgen del Rocío, Sevilla, Spain
| | - D X Cuenca-Apolo
- Intensive Care Unit, University Hospital Virgen del Rocío, Sevilla, Spain
| | | | - Y Corcia-Palomo
- Intensive Care Unit, University Hospital Virgen del Rocío, Sevilla, Spain
| | - J J Egea-Guerrero
- Transplant Coordinator Huelva-Sevilla, University Hospital Virgen del Rocío, Sevilla, Spain
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31
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Lagerstedt L, Egea-Guerrero JJ, Rodríguez-Rodríguez A, Bustamante A, Montaner J, El Rahal A, Andereggen E, Rinaldi L, Sarrafzadeh A, Schaller K, Sanchez JC. Early measurement of interleukin-10 predicts the absence of CT scan lesions in mild traumatic brain injury. PLoS One 2018; 13:e0193278. [PMID: 29466474 PMCID: PMC5821397 DOI: 10.1371/journal.pone.0193278] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 02/07/2018] [Indexed: 12/26/2022] Open
Abstract
Traumatic brain injury is a common event where 70%-90% will be classified as mild TBI (mTBI). Among these, only 10% will have a brain lesion visible via CT scan. A triage biomarker would help clinicians to identify patients with mTBI who are at risk of developing a brain lesion and require a CT scan. The brain cells damaged by the shearing, tearing and stretching of a TBI event set off inflammation cascades. These cause altered concentrations of a high number of both pro-inflammatory and anti-inflammatory proteins. This study aimed to discover a novel diagnostic biomarker of mTBI by investigating a broad panel of inflammation biomarkers and their capacity to correctly identify CT-positive and CT-negative patients. Patients enrolled in this study had been diagnosed with mTBI, had a GCS score of 15 and suffered from at least one clinical symptom. There were nine patients in the discovery group, 45 for verification, and 133 mTBI patients from two different European sites in the validation cohort. All patients gave blood samples, underwent a CT scan and were dichotomised into CT-positive and CT-negative groups for statistical analyses. The ability of each protein to classify patients was evaluated with sensitivity set at 100%. Three of the 92 inflammation proteins screened-MCP-1, MIP-1alpha and IL-10 -were further investigated in the verification group, and at 100% sensitivity their specificities reached 7%, 0% and 31%, respectively. IL-10 was validated on a larger cohort in comparison to the most studied mTBI diagnostic triage protein to date, S100B. Levels of both proteins were significantly higher in CT-positive than in CT-negative patients (p < 0.001). S100B's specificity at 100% sensitivity was 18% (95% CI 10.8-25.2), whereas IL-10 reached a specificity of 27% (95% CI 18.9-35.1). These results showed that IL-10 might be an interesting and clinically useful diagnostic tool, capable of differentiating between CT-positive and CT-negative mTBI patients.
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Affiliation(s)
- Linnéa Lagerstedt
- Department of Human Protein Sciences, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | | | | | - Alejandro Bustamante
- Neurovascular Research Laboratory, Vall d’Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joan Montaner
- Neurovascular Research Laboratory, Vall d’Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
- Stroke Research Programme, IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Seville, Spain
- Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Amir El Rahal
- Division of Neurosurgery, Geneva Neuroscience Center, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Elisabeth Andereggen
- Emergency Center, Geneva University Hospitals, Geneva, Switzerland
- Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Lara Rinaldi
- Emergency Center, Geneva University Hospitals, Geneva, Switzerland
| | - Asita Sarrafzadeh
- Division of Neurosurgery, Geneva Neuroscience Center, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Karl Schaller
- Division of Neurosurgery, Geneva Neuroscience Center, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Jean-Charles Sanchez
- Department of Human Protein Sciences, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Egea-Guerrero JJ, Rodríguez-Rodríguez A, Quintana-Díaz M, Freire-Aragón MD, Raya-Collados D, Hernández-García C, Ortiz-Manzano Á, Vilches-Arenas Á, Díez-Naz A, Guerrero JM, Murillo-Cabezas F. Validation of S100B use in a cohort of Spanish patients with mild traumatic brain injury: a multicentre study. Brain Inj 2018; 32:459-463. [PMID: 29355397 DOI: 10.1080/02699052.2018.1429019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION The aim of this study was to validate the S100B protein as a diagnostic tool for ruling out the presence of intracranial lesion (IL) after mild traumatic brain injury (mTBI). Subjects with a Glasgow Coma Scale (GCS) score of 15 and at least one neurological symptom post-trauma were selected from a large Spanish cohort. METHODS A number of 260 patients with mTBI were enrolled. Blood samples were extracted within 6 h and CT scan performed within 24 h post-injury. Blood samples were also drawn from 18 healthy subjects. RESULTS CT scan revealed the presence of IL in 22 patients (8.5%). Patients with mTBI had higher S100B serum levels (p = 0.008) than the healthy subjects (p < 0.001). The ROC analysis of S100B discriminated between patients with and without IL (AUC: 0.671; 95%CI: 0.574-0.769; p = 0.008). The multivariate analysis identified male gender (OR: 5.39; 95%CI: 1.45-20.10; p = 0.012), age > 65 (OR: 2.97; 95%CI: 1.04-8.44; p = 0.041) and S100B level >0.10 µg/L (OR: 7.93; 95%CI: 1.03-60.76; p = 0.046) as independent risk factors for IL in patients with mTBI. CONCLUSION Measurement of S100B within 6 h of mTBI accurately predicts risk of IL in patients with a GCS score of 15 and at least one neurological symptom.
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Affiliation(s)
- Juan José Egea-Guerrero
- a NeuroCritical Care Unit , Virgen del Rocío University Hospital, IBIS/CSIC/University of Seville , Seville , Spain
| | - Ana Rodríguez-Rodríguez
- b Emergency Department , Virgen del Rocío University Hospital, IBIS/CSIC/University of Seville , Seville , Spain
| | - Manuel Quintana-Díaz
- c Critical Care and Emergency Medicine , La Paz University Hospital , Madrid , Spain
| | - María Dolores Freire-Aragón
- a NeuroCritical Care Unit , Virgen del Rocío University Hospital, IBIS/CSIC/University of Seville , Seville , Spain
| | - Diego Raya-Collados
- d Critical Care and Emergency Medicine , Virgen de las Nieves University Hospital , Granada , Spain
| | - Conary Hernández-García
- e Department of Clinical Biochemistry , Virgen del Rocio University Hospital, IBIS/CSIC/University of Seville , Seville , Spain
| | - Álvaro Ortiz-Manzano
- f Critical Care and Emergency Medicine , Torrecárdenas Hospital , Almería , Spain
| | - Ángel Vilches-Arenas
- g Department of Preventive Medicine and Public Health , University of Seville , Seville , Spain
| | - Ana Díez-Naz
- b Emergency Department , Virgen del Rocío University Hospital, IBIS/CSIC/University of Seville , Seville , Spain
| | - Juan Miguel Guerrero
- e Department of Clinical Biochemistry , Virgen del Rocio University Hospital, IBIS/CSIC/University of Seville , Seville , Spain
| | - Francisco Murillo-Cabezas
- a NeuroCritical Care Unit , Virgen del Rocío University Hospital, IBIS/CSIC/University of Seville , Seville , Spain
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33
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Roldán-Reina AJ, Egea-Guerrero JJ, Palomo-López N, Cuenca-Apolo DX, Adriaensens-Pérez M, Martín-Villén L. Kidney transplantation in the Intensive Care Unit: Graft evaluation using imaging tests. Med Intensiva 2017; 43:384-386. [PMID: 29110916 DOI: 10.1016/j.medin.2017.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 08/20/2017] [Accepted: 09/04/2017] [Indexed: 11/19/2022]
Affiliation(s)
- A J Roldán-Reina
- UGC de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - J J Egea-Guerrero
- UGC de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, España; Coordinación de Trasplantes, Hospital Universitario Virgen del Rocío, Sevilla, España; IBiS-CSIC-Universidad de Sevilla, Sevilla, España
| | - N Palomo-López
- UGC de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - D X Cuenca-Apolo
- UGC de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - M Adriaensens-Pérez
- UGC de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - L Martín-Villén
- UGC de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, España; Coordinación de Trasplantes, Hospital Universitario Virgen del Rocío, Sevilla, España
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34
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Rodríguez-Rodríguez A, Egea-Guerrero JJ, Vilches-Arenas Á, Gordillo-Escobar E, Ruiz de Azúa-López Z, Murillo-Cabezas F. Prognostic value of total antioxidant capacity to predict functional outcome in traumatic brain injury patients. Clin Chem Lab Med 2017; 55:e265-e267. [PMID: 28412718 DOI: 10.1515/cclm-2017-0022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 03/20/2017] [Indexed: 11/15/2022]
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35
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Freire-Aragón MD, Rodríguez-Rodríguez A, Egea-Guerrero JJ. Update in mild traumatic brain injury. Med Clin (Barc) 2017; 149:122-127. [PMID: 28571951 DOI: 10.1016/j.medcli.2017.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 05/01/2017] [Indexed: 01/15/2023]
Abstract
There has been concern for many years regarding the identification of patients with mild traumatic brain injury (TBI) at high risk of developing an intracranial lesion (IL) that would require neurosurgical intervention. The small percentage of patients with these characteristics and the exceptional mortality associated with mild TBI with IL have led to the high use of resources such as computerised tomography (CT) being reconsidered. The various protocols developed for the management of mild TBI are based on the identification of risk factors for IL, which ultimately allows more selective indication or discarding both the CT application and the hospital stay for neurological monitoring. Finally, progress in the study of brain injury biomarkers with prognostic utility in different clinical categories of TBI has recently been incorporated by several clinical practice guidelines, which has allowed, together with clinical assessment, a more accurate prognostic approach for these patients to be established.
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36
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Affiliation(s)
- Z Ruiz de Azúa-López
- Coordinación Intrahospitalaria de Trasplantes, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - L Martín-Villén
- Coordinación Intrahospitalaria de Trasplantes, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - J J Egea-Guerrero
- Coordinación Intrahospitalaria de Trasplantes, Hospital Universitario Virgen del Rocío, Sevilla, España; Coordinación Sectorial de Trasplantes Sevilla-Huelva, España
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37
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Rodríguez-Rodríguez A, Egea-Guerrero JJ, Vilches-Arenas Á, Quintanilla-Vázquez MJ, Murillo-Cabezas F, Muñoz-Sánchez MÁ. Comparison of two competitive enzyme immunoassay kits for quantification of plasma Urotensin-II in rats. J Immunoassay Immunochem 2017; 38:247-256. [DOI: 10.1080/15321819.2016.1250772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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38
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Egea-Guerrero JJ, Martín-Villén L, Ruiz de Azúa-López Z. El proceso de donación tras reanimación cardiopulmonar fallida. Med Clin (Barc) 2017; 148:430. [DOI: 10.1016/j.medcli.2016.12.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 12/01/2016] [Indexed: 11/28/2022]
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39
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de-Bonilla-Damiá Á, Fernández-López R, Capote-Huelva FJ, de la Cruz-Vicente F, Egea-Guerrero JJ, Borrego-Dorado I. Role of 18F-FDG PET/CT in primary brain lymphoma. Rev Esp Med Nucl Imagen Mol 2017; 36:298-303. [PMID: 28438519 DOI: 10.1016/j.remn.2017.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 03/02/2017] [Accepted: 03/15/2017] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To study the usefulness of 18F-FDG PET/CT in the initial evaluation and in the response assessment in primary brain lymphoma. MATERIAL AND METHODS A retrospective analysis was carried out on 18 patients diagnosed with primary brain lymphoma, a histological subtype of diffuse large B-cell lymphoma, on whom an initial 18F-FDG PET/CT and MRI was performed, with 7 of the cases being analysed after the completion of treatment in order to assess response and clinical follow up. RESULTS Initial 18F-FDG PET/CT showed 26 hypermetabolic foci, whereas 46 lesions were detected by MRI. The average SUV maximum of the lesions was 17.56 with T/N 3.55. The concordance of both tests for identifying the same number of lesions was moderate, obtaining a kappa index of 0.395 (P<.001). In the evaluation of treatment, MRI identified 16 lesions compared to 7 pathological accumulations observed by 18F-FDG PET/CT. The concordance of both tests to assess type of response to treatment was moderate (kappa index 0.41) (P=.04). In both the initial evaluation and the assessment of the response to treatment, PET/CT led to a change strategy in 22% of patients who had lesions outside the cerebral parenchyma. CONCLUSIONS MRI appears to be the method of choice for detecting brain disease in patients with primary brain lymphoma, whereas 18F-FDG PET/CT seems to play a relevant role in the assessment of extra-cerebral disease.
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Affiliation(s)
- Á de-Bonilla-Damiá
- Servicio de Medicina Nuclear, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - R Fernández-López
- Servicio de Medicina Nuclear, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - F J Capote-Huelva
- Unidad de Gestión Clínica de Hematología y Hemoterapia, Hospital Universitario Puerta del Mar, Cádiz, España
| | - F de la Cruz-Vicente
- Unidad de Gestión Clínica de Hematología y Hemoterapia, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - J J Egea-Guerrero
- Unidad de Gestión Clínica de Medicina Intensiva, Hospital Universitario Virgen del Rocío, IBiS, CSIC, Universidad de Sevilla, Sevilla, España
| | - I Borrego-Dorado
- Servicio de Medicina Nuclear, Hospital Universitario Virgen del Rocío, Sevilla, España
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40
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Lagerstedt L, Egea-Guerrero JJ, Bustamante A, Montaner J, Rodríguez-Rodríguez A, El Rahal A, Turck N, Quintana M, García-Armengol R, Prica CM, Andereggen E, Rinaldi L, Sarrafzadeh A, Schaller K, Sanchez JC. H-FABP: A new biomarker to differentiate between CT-positive and CT-negative patients with mild traumatic brain injury. PLoS One 2017; 12:e0175572. [PMID: 28419114 PMCID: PMC5395174 DOI: 10.1371/journal.pone.0175572] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 03/28/2017] [Indexed: 11/18/2022] Open
Abstract
The majority of patients with mild traumatic brain injury (mTBI) will have normal Glasgow coma scale (GCS) of 15. Furthermore, only 5%-8% of them will be CT-positive for an mTBI. Having a useful biomarker would help clinicians evaluate a patient's risk of developing intracranial lesions. The S100B protein is currently the most studied and promising biomarker for this purpose. Heart fatty-acid binding protein (H-FABP) has been highlighted in brain injury models and investigated as a biomarker for stroke and severe TBI, for example. Here, we evaluate the performances of S100B and H-FABP for differentiating between CT-positive and CT-negative patients. A total of 261 patients with a GCS score of 15 and at least one clinical symptom of mTBI were recruited at three different European sites. Blood samples from 172 of them were collected ≤ 6 h after trauma. Patients underwent a CT scan and were dichotomised into CT-positive and CT-negative groups for statistical analyses. H-FABP and S100B levels were measured using commercial kits, and their capacities to detect all CT-positive scans were evaluated, with sensitivity set to 100%. For patients recruited ≤ 6 h after trauma, the CT-positive group demonstrated significantly higher levels of both H-FABP (p = 0.004) and S100B (p = 0.003) than the CT-negative group. At 100% sensitivity, specificity reached 6% (95% CI 2.8-10.7) for S100B and 29% (95% CI 21.4-37.1) for H-FABP. Similar results were obtained when including all the patients recruited, i.e. hospital arrival within 24 h of trauma onset. H-FABP out-performed S100B and thus seems to be an interesting protein for detecting all CT-positive mTBI patients with a GCS score of 15 and at least one clinical symptom.
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Affiliation(s)
- Linnéa Lagerstedt
- Department of Human Protein Sciences, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | | | - Alejandro Bustamante
- Neurovascular Research Laboratory, Vall d’Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joan Montaner
- Neurovascular Research Laboratory, Vall d’Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Amir El Rahal
- Division of Neurosurgery, Geneva Neuroscience Center, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Natacha Turck
- Department of Human Protein Sciences, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Manuel Quintana
- Intensive Medicine Unit, Hospital Universitario La Paz, idiPAZ, Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Roser García-Armengol
- Neurosurgical department, Neuroscience Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Elisabeth Andereggen
- Emergency Center, Geneva University Hospitals, Geneva, Switzerland
- Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Lara Rinaldi
- Emergency Center, Geneva University Hospitals, Geneva, Switzerland
| | - Asita Sarrafzadeh
- Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Karl Schaller
- Division of Neurosurgery, Geneva Neuroscience Center, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Jean-Charles Sanchez
- Department of Human Protein Sciences, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- * E-mail:
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41
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Muñoz-Sánchez MÁ, Rodríguez-Rodríguez A, Egea-Guerrero JJ, Gordillo-Escobar E, Vilches-Arenas Á, Carrillo-Vico A, Guerrero JM, Murillo-Cabezas F. Urotensinergic system genes in experimental subarachnoid hemorrhage. Med Intensiva 2017; 41:468-474. [PMID: 28081921 DOI: 10.1016/j.medin.2016.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 10/14/2016] [Accepted: 10/23/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Cerebral vasospasm, one of the main complications of subarachnoid hemorrhage (SAH), is characterized by arterial constriction and mainly occurs from day 4 until the second week after the event. Urotensin-II (U-II) has been described as the most potent vasoconstrictor peptide in mammals. An analysis is made of the serum U-II concentrations and mRNA expression levels of U-II, urotensin related peptide (URP) and urotensin receptor (UT) genes in an experimental murine model of SAH. DESIGN An experimental study was carried out. SETTING Experimental operating room of the Biomedicine Institute of Seville (IBiS), Virgen del Rocío University Hospital (Seville, Spain). PARTICIPANTS 96 Wistar rats: 74 SAH and 22 sham intervention animals. INTERVENTIONS Day 1: blood sampling, followed by the percutaneous injection of 100μl saline (sham) or blood (SAH) into the subarachnoid space. Day 5: blood sampling, followed by sacrifice of the animals. MAIN VARIABLES OF INTEREST Weight, early mortality, serum U-II levels, mRNA values for U-II, URP and UT. RESULTS Serum U-II levels increased in the SAH group from day 1 (0.62pg/mL [IQR 0.36-1.08]) to day 5 (0.74pg/mL [IQR 0.39-1.43]) (p<0.05), though not in the sham group (0.56pg/mL [IQR 0.06-0.83] day 1; 0.37pg/mL [IQR 0.23-0.62] day 5; p=0.959). Between-group differences were found on day 5 (p<0.05). The ROC analysis showed that the day 5 serum U-II levels (AUC=0.691), URP mRNA (AUC=0.706) and UT mRNA (AUC=0.713) could discriminate between sham and SAH rats. The normal serum U-II concentration range in rats was 0.56pg/mL (IQR 0.06-0.83). CONCLUSION The urotensinergic system is upregulated on day 5 in an experimental model of SAH.
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MESH Headings
- Animals
- Biomarkers
- Disease Models, Animal
- Gene Expression Regulation
- Peptide Hormones/biosynthesis
- Peptide Hormones/blood
- Peptide Hormones/genetics
- RNA, Messenger/biosynthesis
- RNA, Messenger/blood
- RNA, Messenger/genetics
- ROC Curve
- Rats
- Rats, Wistar
- Real-Time Polymerase Chain Reaction
- Receptors, G-Protein-Coupled/biosynthesis
- Receptors, G-Protein-Coupled/blood
- Receptors, G-Protein-Coupled/genetics
- Sensitivity and Specificity
- Subarachnoid Hemorrhage/complications
- Subarachnoid Hemorrhage/genetics
- Urotensins/biosynthesis
- Urotensins/blood
- Urotensins/genetics
- Vasoconstriction/genetics
- Vasospasm, Intracranial/etiology
- Vasospasm, Intracranial/genetics
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Affiliation(s)
- M Á Muñoz-Sánchez
- Servicio de Urgencias, Hospital Universitario Virgen del Rocío, IBIS/CSIC/Universidad de Sevilla, Spain
| | - A Rodríguez-Rodríguez
- Cuidados Críticos, Hospital Universitario Virgen del Rocío, IBIS/CSIC/Universidad de Sevilla, Spain.
| | - J J Egea-Guerrero
- Cuidados Críticos, Hospital Universitario Virgen del Rocío, IBIS/CSIC/Universidad de Sevilla, Spain
| | - E Gordillo-Escobar
- Cuidados Críticos, Hospital Universitario Virgen del Rocío, IBIS/CSIC/Universidad de Sevilla, Spain
| | - Á Vilches-Arenas
- Servicio de Medicina Preventiva y Salud Pública, Hospital Virgen Macarena, Universidad de Sevilla, Spain
| | - A Carrillo-Vico
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Spain; Departamento de Bioquimica Médica, Biología molecular e Inmunología, Facultad de Medicina, Universidad de Sevilla, Spain
| | - J M Guerrero
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Spain; Departamento de Bioquimica Médica, Biología molecular e Inmunología, Facultad de Medicina, Universidad de Sevilla, Spain
| | - F Murillo-Cabezas
- Cuidados Críticos, Hospital Universitario Virgen del Rocío, IBIS/CSIC/Universidad de Sevilla, Spain
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Rodríguez-Rodríguez A, Egea-Guerrero JJ. The utility of biomarkers in traumatic brain injury clinical management. Crit Care 2016; 20:376. [PMID: 27855696 PMCID: PMC5114747 DOI: 10.1186/s13054-016-1545-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 10/26/2016] [Indexed: 11/23/2022] Open
Affiliation(s)
- Ana Rodríguez-Rodríguez
- Emergency Department, Virgen del Rocío University Hospital, IBIS/CSIC/University of Seville, Seville, Spain
| | - Juan José Egea-Guerrero
- NeuroCritical Care Unit, Virgen del Rocío University Hospital, IBIS/CSIC/University of Seville, Avda. Manuel Siurot s/n, 41013, Seville, Spain.
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Egea-Guerrero JJ, Martín-Villén L, Ruiz de Azúa-López Z. [Quality of life after kidney transplant]. Med Clin (Barc) 2016; 147:326. [PMID: 27431889 DOI: 10.1016/j.medcli.2016.05.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 05/19/2016] [Indexed: 10/21/2022]
Affiliation(s)
| | - Luis Martín-Villén
- Coordinación Médica de Trasplantes, Hospital Universitario Virgen del Rocío, Sevilla, España
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Egea-Guerrero JJ, Rodríguez-Rodríguez A. Sepsis biomarkers in severe burn patients: Cut-off point or time profile? Med Intensiva 2016; 40:595-596. [PMID: 27267774 DOI: 10.1016/j.medin.2016.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 04/04/2016] [Indexed: 11/17/2022]
Affiliation(s)
- J J Egea-Guerrero
- U.G.C. Cuidados Críticos y Urgencias, H.U. Virgen del Rocío, IBiS/CSIC/Universidad de Sevilla, Sevilla, Spain.
| | - A Rodríguez-Rodríguez
- U.G.C. Cuidados Críticos y Urgencias, H.U. Virgen del Rocío, IBiS/CSIC/Universidad de Sevilla, Sevilla, Spain
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de Azúa López ZR, Egea-Guerrero JJ, Rivera-Rubiales G, Rodríguez-Rodríguez A, Vilches-Arenas Á, Murillo-Cabezas F. Serum brain injury biomarkers as predictors of mortality after severe aneurysmal subarachnoid hemorrhage: preliminary results. Clin Chem Lab Med 2016; 53:e179-81. [PMID: 25781685 DOI: 10.1515/cclm-2014-1189] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 01/26/2015] [Indexed: 11/15/2022]
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Chico-Fernández M, Llompart-Pou JA, Sánchez-Casado M, Alberdi-Odriozola F, Guerrero-López F, Mayor-García MD, Egea-Guerrero JJ, Fernández-Ortega JF, Bueno-González A, González-Robledo J, Servià-Goixart L, Roldán-Ramírez J, Ballesteros-Sanz MÁ, Tejerina-Alvarez E, Pino-Sánchez FI, Homar-Ramírez J. Mortality prediction using TRISS methodology in the Spanish ICU Trauma Registry (RETRAUCI). Med Intensiva 2016; 40:395-402. [PMID: 27068001 DOI: 10.1016/j.medin.2015.11.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 11/09/2015] [Accepted: 11/20/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To validate Trauma and Injury Severity Score (TRISS) methodology as an auditing tool in the Spanish ICU Trauma Registry (RETRAUCI). DESIGN A prospective, multicenter registry evaluation was carried out. SETTING Thirteen Spanish Intensive Care Units (ICUs). PATIENTS Individuals with traumatic disease and available data admitted to the participating ICUs. INTERVENTIONS Predicted mortality using TRISS methodology was compared with that observed in the pilot phase of the RETRAUCI from November 2012 to January 2015. Discrimination was evaluated using receiver operating characteristic (ROC) curves and the corresponding areas under the curves (AUCs) (95% CI), with calibration using the Hosmer-Lemeshow (HL) goodness-of-fit test. A value of p<0.05 was considered significant. MAIN VARIABLES OF INTEREST Predicted and observed mortality. RESULTS A total of 1405 patients were analyzed. The observed mortality rate was 18% (253 patients), while the predicted mortality rate was 16.9%. The area under the ROC curve was 0.889 (95% CI: 0.867-0.911). Patients with blunt trauma (n=1305) had an area under the ROC curve of 0.887 (95% CI: 0.864-0.910), and those with penetrating trauma (n=100) presented an area under the curve of 0.919 (95% CI: 0.859-0.979). In the global sample, the HL test yielded a value of 25.38 (p=0.001): 27.35 (p<0.0001) in blunt trauma and 5.91 (p=0.658) in penetrating trauma. TRISS methodology underestimated mortality in patients with low predicted mortality and overestimated mortality in patients with high predicted mortality. CONCLUSIONS TRISS methodology in the evaluation of severe trauma in Spanish ICUs showed good discrimination, with inadequate calibration - particularly in blunt trauma.
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Affiliation(s)
- M Chico-Fernández
- Trauma and Emergencies ICU, Department of Intensive Care Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J A Llompart-Pou
- Department of Intensive Care Medicine, Hospital Universitari Son Espases, Palma de Mallorca, Spain.
| | - M Sánchez-Casado
- Department of Intensive Care Medicine, Hospital Virgen de la Salud, Toledo, Spain
| | - F Alberdi-Odriozola
- Department of Intensive Care Medicine, Hospital Universitario de Donostia, San Sebastián, Spain
| | - F Guerrero-López
- Department of Intensive Care Medicine, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - M D Mayor-García
- Department of Intensive Care Medicine, Complejo Hospitalario de Torrecárdenas, Almería, Spain
| | - J J Egea-Guerrero
- Department of Intensive Care Medicine, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - J F Fernández-Ortega
- Department of Intensive Care Medicine, Hospital Universitario Carlos Haya, Málaga, Spain
| | - A Bueno-González
- Department of Intensive Care Medicine, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - J González-Robledo
- Department of Intensive Care Medicine, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - L Servià-Goixart
- Department of Intensive Care Medicine, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - J Roldán-Ramírez
- Department of Intensive Care Medicine, Complejo Hospitalario de Pamplona, Navarra, Spain
| | - M Á Ballesteros-Sanz
- Department of Intensive Care Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - E Tejerina-Alvarez
- Department of Intensive Care Medicine, Hospital Universitario de Getafe, Madrid, Spain
| | - F I Pino-Sánchez
- Department of Intensive Care Medicine, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - J Homar-Ramírez
- Department of Intensive Care Medicine, Hospital Universitari Son Espases, Palma de Mallorca, Spain
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Freire-Aragón MD, Martínez-Roldán A, Egea-Guerrero JJ, Rivera-Fernandez V. Fogging effect. Do we have in mind in early cerebral infarction following aneurysmal subarachnoid hemorrhage? Med Intensiva 2016; 40:590-592. [PMID: 27015788 DOI: 10.1016/j.medin.2016.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 01/15/2016] [Accepted: 01/18/2016] [Indexed: 11/17/2022]
Affiliation(s)
- M D Freire-Aragón
- Unidad de Neurocríticos, Unidad de Gestión Clínica de Cuidados Críticos y Urgencias, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, España
| | - A Martínez-Roldán
- Unidad de Neurocríticos, Unidad de Gestión Clínica de Cuidados Críticos y Urgencias, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, España
| | - J J Egea-Guerrero
- Unidad de Neurocríticos, Unidad de Gestión Clínica de Cuidados Críticos y Urgencias, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, España.
| | - V Rivera-Fernandez
- Unidad de Neurocríticos, Unidad de Gestión Clínica de Cuidados Críticos y Urgencias, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, España
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Rodríguez-Rodríguez A, Egea-Guerrero JJ, Gordillo-Escobar E, Enamorado-Enamorado J, Hernández-García C, Ruiz de Azúa-López Z, Vilches-Arenas Á, Guerrero JM, Murillo-Cabezas F. S100B and Neuron-Specific Enolase as mortality predictors in patients with severe traumatic brain injury. Neurol Res 2016; 38:130-7. [PMID: 27078699 DOI: 10.1080/01616412.2016.1144410] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To determine temporal profile and prognostic ability of S100B protein and neuron-specific enolase (NSE) for prediction of short/long-term mortality in patients suffering from severe traumatic brain injury (sTBI). METHODS Ninety-nine patients with sTBI were included in the study. Blood samples were drawn on admission and on subsequent 24, 48, 72, and 96 h. RESULTS 15.2% of patients died in NeuroCritical Care Unit, and 19.2% died within 6 months of the accident. S100B concentrations were significantly higher in patients who died compared to survivors. NSE levels were different between groups just at 48 h. In the survival group, S100B levels decreased from 1st to 5th sample (p < 0.001); NSE just from 1st to 3rd (p < 0.001) and then stabilized. Values of S100B and NSE in non-survival patients did not significantly vary over the four days post sTBI. ROC-analysis showed that all S100B samples were useful tools for predicting mortality, the best the 72 h sample (AUC 0.848 for discharge mortality, 0.855 for six-month mortality). NSE ROC-analysis indicated that just the 48-h sample predicted mortality (AUC 0.733 for discharge mortality, 0.720 for six-month mortality). CONCLUSION S100B protein showed higher prognostic capacity than NSE to predict short/long-term mortality in sTBI patients.
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Affiliation(s)
- Ana Rodríguez-Rodríguez
- a NeuroCritical Care Unit , Virgen del Rocío University Hospital, IBIS/CSIC/University of Seville , Seville , Spain
| | - Juan José Egea-Guerrero
- a NeuroCritical Care Unit , Virgen del Rocío University Hospital, IBIS/CSIC/University of Seville , Seville , Spain
| | - Elena Gordillo-Escobar
- a NeuroCritical Care Unit , Virgen del Rocío University Hospital, IBIS/CSIC/University of Seville , Seville , Spain
| | - Judy Enamorado-Enamorado
- a NeuroCritical Care Unit , Virgen del Rocío University Hospital, IBIS/CSIC/University of Seville , Seville , Spain
| | - Conary Hernández-García
- b Department of Clinical Biochemistry , Virgen del Rocio University Hospital, IBIS/CSIC/University of Seville , Seville , Spain
| | - Zaida Ruiz de Azúa-López
- a NeuroCritical Care Unit , Virgen del Rocío University Hospital, IBIS/CSIC/University of Seville , Seville , Spain
| | | | - Juan Miguel Guerrero
- b Department of Clinical Biochemistry , Virgen del Rocio University Hospital, IBIS/CSIC/University of Seville , Seville , Spain
| | - Francisco Murillo-Cabezas
- a NeuroCritical Care Unit , Virgen del Rocío University Hospital, IBIS/CSIC/University of Seville , Seville , Spain
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Revuelto-Rey J, Rosich-Andreu S, Egea-Guerrero JJ. Intracranial pressure and hypercapnia during the apnoea test for the diagnosis of brain death. Eur J Neurol 2016; 22:e84. [PMID: 26538271 DOI: 10.1111/ene.12786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 06/05/2015] [Indexed: 11/28/2022]
Affiliation(s)
- J Revuelto-Rey
- Hospital Universitari Joan XXIII de Tarragona, Tarragona, Spain
| | - S Rosich-Andreu
- Hospital Universitari Joan XXIII de Tarragona, Tarragona, Spain
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García-Navia JT, Tornero López J, Egea-Guerrero JJ, Vilches Arenas A, Vázquez Gutiérrez T. Effect of a single dose of lidocaine and ketamine on intraoperative opioids requirements in patients undergoing elective gynecological laparotomies under general anesthesia. A randomized, placebo controlled pilot study. Farm Hosp 2016; 40:44-51. [PMID: 26882833 DOI: 10.7399/fh.2016.40.1.9339] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
UNLABELLED Background and goal of study: there is evidence that perioperative intravenous ketamine and lidocaine reduce postoperative pain, postoperative opioids consumption, shortens hospital stay and accelerates intestinal function recovery. However, it has not been studied the beneficial effects in the intraoperative period. The aim of this study was to evaluate the effect of a single dose of lidocaine and ketamine on intraoperative opioids requirements in patients undergoing elective gynecological laparotomies under general anesthesia. MATERIALS AND METHODS we performed a single-centre, prospective, randomized, double-blinded, placebo-controlled study. We included 33 patients (11 in the ketamine group, 11 in the lidocaine group and 11 in the placebo group). Postoperative analgesia was accomplished by patient-controlled morphine. Patients were randomly assigned to receive either a 1.5 mg/kg of 2% lidocaine, 0.5 mg/kg of 5% ketamine or 0.9% saline bolus. The primary outcome was the opioids consumption during surgery. The secondary outcomes included: emergence time, pain scores, opioids consumption within 24 h after surgery and side effects. RESULTS decreased intraoperative opioids requirements were noted in the experimental groups (ketamine: 402.3 } 106.3 and lidocaine: 397.7 } 107.5, compared with saline: 561.4 } 97.1); p = 0.001. We found a positive correlation between intraoperative opioids consumption and emergence time (r = 0.864, p < 0.001). There was no significant difference between the groups in VAS pain scores at rest within the first 24 postoperative hours. Total morphine consumption within 24 h after surgery did not differ significantly among the groups (placebo: 27.54 } 11.75; ketamine: 30.95 } 7.88; lidocaine 34.77 } 4510.25; p = 0.26). Postoperative nausea and vomiting were more common in placebo group (it was observed in 3 subjects in ketamine group, in 5 subjects in lidocaine group and in 9 subjects in placebo group; p = 0.027). CONCLUSION our results do not support the use of intraoperative single dose of lidocaine or ketamine to reduce postoperative pain and postoperative opioids consumption after open gynecological surgery. However, they seem to decrease intraoperative opioids requirements and shorten emergence time. Nevertheless, these findings should be validating in further studies with large sample size.
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Affiliation(s)
| | - Javier Tornero López
- Hospital Universitario Nuestra Señora de Valme, Universidad de Sevilla, Sevilla..
| | - Juan José Egea-Guerrero
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, CSIC, Universidad de Sevilla, Unidad de Neurocríticos, Sevilla..
| | - Angel Vilches Arenas
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, CSIC, Universidad de Sevilla, Departamento de Medicina Preventiva y Salud Pública, Sevilla. Spain..
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