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Perez-Garzon M, Poveda-Henao C, Bastidas-Goyes A, Robayo-Amortegui H. Oxygen Debt as Predictor of Mortality and Multiple Organ Dysfunction Syndrome in Severe COVID-19 Patients: A Retrospective Study. J Intensive Care Med 2024; 39:358-367. [PMID: 37876236 DOI: 10.1177/08850666231208433] [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] [Indexed: 10/26/2023]
Abstract
Background: Oxygen debt (DEOx) represents the disparity between resting and shock oxygen consumption (VO2) and is associated with metabolic insufficiency, acidosis, severity, and mortality. This study aimed to assess the reliability of DEOx as an indirect quantitative measure for predicting multiple organ dysfunction syndrome (MODS) and 28-day mortality in patients admitted to the intensive care unit (ICU) with respiratory syndrome severe acute coronavirus type 2 (SARS-CoV-2) infection, in comparison to the Acute Physiology and Chronic Health Evaluation II (APACHE II), sepsis-related organ failure assessment (SOFA), and 4C scores. Methods: A retrospective cohort study was conducted, including ICU patients with SARS-CoV-2 infection between 2020 and 2021. Clinical data were extracted from the EPIMED Monitor Database®. APACHE II, SOFA, and 4C scores were calculated upon ICU admission, and their accuracy in predicting 28-day mortality and MODS was compared to DEOx. Multivariate logistic regression analysis was performed to analyze the outcome variables. Results: 708 patients were included, with a mortality rate of 44.4%. DEOx value was 11.16 ml O2/kg. The mean age was 58.7 years. Multivariate analysis showed that DEOx was independently associated with mortality, intubation, and renal injury. Each point increase in creatinine was associated with a higher risk of MODS. To determine the precision of the scores, area under the receiver operating characteristic curves (AUROC) analysis was performed with weak discrimination and similar behavior for the primary outcomes. The most accurate scale for mortality and MODS was 4C with an AUC of 0.683 and APACHE II with an AUC of 0.814, while that of the AUROC of DEOx was 0.612 and 0.646, respectively. Conclusions: DEOx showed similar predictive value to established scoring systems in critically ill patients with SARS-CoV-2 infection. The correlation of DEOx with these scores may facilitate early intervention in critically ill patients.
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Affiliation(s)
- Michel Perez-Garzon
- Department of Medicine, Universidad de La Sabana. Chia Cundinamarca. Bogotá DC, Colombia
- Critical Medicine and Intensive Care, Msc Mechanical Ventilation and Respiratory Support, Department of Investigation, Fundación Clínica Shaio. Bogota DC. Colombia
| | - Claudia Poveda-Henao
- Department of Medicine, Universidad de La Sabana. Chia Cundinamarca. Bogotá DC, Colombia
- Critical Medicine and Intensive Care, Msc Mechanical Ventilation and Respiratory Support, Department of Investigation, Fundación Clínica Shaio. Bogota DC. Colombia
- Clinical Cardiology, Intensive Care Department, Shaio Clinic Foundation. Bogota DC. Colombia
| | - Alirio Bastidas-Goyes
- Department of Medicine, Universidad de La Sabana. Chia Cundinamarca. Bogotá DC, Colombia
| | - Henry Robayo-Amortegui
- Critical Care Resident, Department of Medicine, Universidad de La Sabana. Chia Cundinamarca. Bogotá DC, Colombia
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Lee IJ, Pulido JS, Regillo CD, Leys M. MULTIPLE ORGAN DYSFUNCTION SYNDROME AND DISSEMINATED INTRAVASCULAR COAGULATION CAUSING EXTENSIVE MULTIPLE AMALRIC TRIANGULAR CHOROIDAL INFARCTIONS. Retin Cases Brief Rep 2024; 18:251-254. [PMID: 36730731 PMCID: PMC10885859 DOI: 10.1097/icb.0000000000001360] [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] [Indexed: 02/04/2023]
Abstract
PURPOSE To present a case of extensive bilateral choroidal infarctions from multiple organ dysfunction syndrome and disseminated intravascular coagulation. METHODS A retrospective case report. The medical and imaging records, including fundus photography, optical coherence tomography, fluorescein angiography, and visual fields, were reviewed. PATIENT A 49-year-old woman presented after a failed suicidal attempt from drug overdose. The patient was subsequently intubated for acute hypoxic respiratory failure with presumed septic shock from aspiration pneumonia while requiring exogenous adrenergic support. Her hospital course was further complicated by development of multiple organ dysfunction syndrome and disseminated intravascular coagulation. The patient complained of blurry vision in both eyes after regaining consciousness. RESULTS Fundus photography showed bilateral dot-blot hemorrhages and cotton wool spots followed by multiple areas of triangular granular pigmentation, consistent with choroidal infarcts. Fluorescein angiography revealed delayed patchy filling, followed by late staining. Optical coherence tomography showed diffuse thinning of the choroid with overlying retina pigment epithelium atrophy. Goldmann visual field displayed discrete areas of visual field deficits. At the most recent visit, the best-corrected final visual acuity remained 20/100 in the right eye and 20/30 in the left eye. CONCLUSION Disseminated intravascular coagulation has been associated with choroidal infarcts. We present a case of extensive bilateral choroidal infarction in a patient with combined disseminated intravascular coagulation and multiple organ dysfunction syndrome consistent with Amalric choroidal triangular sign.
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Affiliation(s)
- Ivan J. Lee
- West Virginia University Eye Institute, Morgantown, West Virginia; and
| | - Jose S. Pulido
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Carl D. Regillo
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Monique Leys
- West Virginia University Eye Institute, Morgantown, West Virginia; and
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Li G, Zhang Y, Sun T, Zhou L, Fan Z. Laparoscopic treatment of a patient with multiple organ dysfunction syndrome induced by necrotising fasciitis. J Wound Care 2024; 33:lxxxi-lxxxiv. [PMID: 38457270 DOI: 10.12968/jowc.2024.33.sup3a.lxxxi] [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] [Indexed: 03/10/2024]
Abstract
Necrotising fasciitis (NF) is an uncommon surgical emergency that threatens the life and health of patients. We report the treatment of a 76-year-old female patient with NF. The patient developed NF due to chronic poor glycaemic control, which further progressed to multiple organ dysfunction syndrome due to the severity of the hyperglycaemia. After resuscitation at the intensive care unit, surgical treatment was recommended and the patient underwent laparoscopic surgery. She had an uneventful post-operative recovery with aggressive anti-inflammatory therapy, glycaemic control and systemic nutritional support. There were no recurrences during the next 6 months of follow-up. NF should be diagnosed and treated as early as possible to gain valuable treatment time for the patient. Laparoscopic surgery is a treatment option.
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Affiliation(s)
- Guangyao Li
- Department of General Surgery, the Third People's Hospital of Dalian, Dalian Medical University, Dalian, 116033, China
- Cancer Hospital of Dalian University of Technology, Shenyang, 110000, China
| | - Yingyi Zhang
- Department of General Surgery, the Third People's Hospital of Dalian, Dalian Medical University, Dalian, 116033, China
| | - Tao Sun
- Cancer Hospital of Dalian University of Technology, Shenyang, 110000, China
| | - Lin Zhou
- Department of Outpatient, the NO. 967 Hospital of PLA Joint Logistics Support Force. Dalian, 116021, China
| | - Zhe Fan
- Department of General Surgery, the Third People's Hospital of Dalian, Dalian Medical University, Dalian, 116033, China
- Faculty of Medicine, Dalian University of Technology, 116024, Dalian, China
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4
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Li R, Zhou J. Sepsis and multi-organ failure due to genital herpes in a healthy person. Int J STD AIDS 2024:9564624241229465. [PMID: 38316151 DOI: 10.1177/09564624241229465] [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] [Indexed: 02/07/2024]
Abstract
Herpes simplex virus type 2 (HSV-2) is highly prevalent in several regions of the world and is the main pathogen causing genital herpes, which is transmitted almost exclusively through sexual contact. Systemically disseminated infections caused by HSV-2 are rare and most often seen in newborns, pregnant women, or immunocompromised populations. The virus can invade multiple organs and cause damage. In this paper, we present an extremely rare case of an immunocompetent 36-year-old male who came to our hospital with a high fever with abdominal pain and died of sepsis and multiple organ dysfunction syndrome within a short period. After the exclusion of common pathogens such as bacterial and fungal infections during hospitalization, metagenomic next generation sequencing of the patient's peripheral blood and ascites gave us the answer, and very high nucleic acid sequence counts of HSV-2 were detected in both his peripheral blood and ascites, confirming HSV-2 as the causative virus. In addition, this paper provides a brief review of the relevant literature.
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Affiliation(s)
- Ruolin Li
- Hebei Medical University, Shijiazhuang, China
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5
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Yuan S, Huang Y, Xie P, Li P. A Case of Severe Rhabdomyolysis, Acute Myocardial Damage and Multi-Organ Dysfunction Syndrome in a Patient with Novel Coronavirus Pneumonia. Open Access Emerg Med 2024; 16:19-28. [PMID: 38318470 PMCID: PMC10840558 DOI: 10.2147/oaem.s446994] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/24/2024] [Indexed: 02/07/2024] Open
Abstract
In recent years, healthcare systems worldwide have faced the challenge of the severe COVID-19 pandemic. However, cases of severe rhabdomyolysis, acute myocardial damage, and multiple organ dysfunction syndrome (MODS) caused by COVID-19 are currently rare. This report presents a case of severe rhabdomyolysis, acute myocardial damage, and MODS caused by COVID-19. The patient was treated at The University of Hong Kong-Shenzhen Hospital. The purpose of this report is to aid clinicians in quickly identifying and treating similar cases, ultimately improving patient outcomes.
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Affiliation(s)
- Shuaishuai Yuan
- Division of Cardiovascular Intensive Care (C-ICU), Cardiac and Vascular Center, The University of Hong Kong-Shenzhen Hospital, Guangdong, People’s Republic of China
| | - Yuting Huang
- Division of Cardiovascular Intensive Care (C-ICU), Cardiac and Vascular Center, The University of Hong Kong-Shenzhen Hospital, Guangdong, People’s Republic of China
| | - Pailing Xie
- Division of Cardiovascular Intensive Care (C-ICU), Cardiac and Vascular Center, The University of Hong Kong-Shenzhen Hospital, Guangdong, People’s Republic of China
| | - Peijun Li
- Division of Cardiovascular Intensive Care (C-ICU), Cardiac and Vascular Center, The University of Hong Kong-Shenzhen Hospital, Guangdong, People’s Republic of China
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Holm P, Erkinaro TM, Karhu JM, Ohtonen PP, Liisanantti JH, Taskinen P, Ala-Kokko TI, Kaakinen TI. Unresponsive Low Mixed Venous Oxygen Saturation During Early Intensive Care Unit Stay is Associated With Increased Risk of Organ Dysfunction After Cardiac Surgery: A Single-Center Retrospective Study. J Cardiothorac Vasc Anesth 2024; 38:423-429. [PMID: 38114371 DOI: 10.1053/j.jvca.2023.11.021] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/11/2023] [Accepted: 11/13/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVES The aim of the study was to determine if unresponsive mixed venous oxygen saturation (SvO2) values during early postoperative hours are associated with postoperative organ dysfunction. DESIGN A single-center retrospective observational study. SETTING A university hospital. PARTICIPANTS A total of 6,282 adult patients requiring cardiac surgery who underwent surgery in a University Hospital from 2007 to 2020. INTERVENTIONS A pulmonary artery catheter was used to gather SvO2 samples after surgery at admission to the intensive care unit (ICU) and 4 hours later. For the analysis, patients were divided into 4 groups according to their SvO2 values. The rate of organ dysfunctions categorized according to the SOFA score was then studied among these subgroups. MEASUREMENTS AND MAIN RESULTS The crude mortality rate for the cohort at 1 year was 4.3%. Multiple organ dysfunction syndrome (MODS) was present in 33.0% of patients in the early postoperative phase. During the 4-hour initial treatment period, 43% of the 931 patients with low SvO2 on admission responded to goal-directed therapy to increase SvO2 >60%; whereas, in 57% of the 931 patients, the low SvO2 was sustained. According to the adjusted logistic regression analyses, the odds ratio for MODS (4.23 [95% CI 3.41-5.25]), renal- replacement therapy (4.97 [95% CI 3.28-7.52]), time on a ventilator (2.34 [95% CI 2.17-2.52]), and vasoactive-inotropic score >30 (3.62 [95% CI 2.96-4.43]) were the highest in the group with sustained low SvO2. CONCLUSIONS Patients with SvO2 <60% at ICU admission and 4 hours later had the greatest risk of postoperative MODS. Responsiveness to a goal-directed therapy protocol targeting maintaining or increasing SvO2 ≥60% at and after ICU admission may be beneficial.
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Affiliation(s)
- Petteri Holm
- Research Group of Surgery, Intensive Care Unit, Anaesthesiology and Intensive Care Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; OYS Heart, Oulu University Hospital, Research Group of Anaesthesiology, MRC Oulu and University of Oulu, Oulu, Finland.
| | - Tiina M Erkinaro
- Research Group of Surgery, Intensive Care Unit, Anaesthesiology and Intensive Care Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; OYS Heart, Oulu University Hospital, Research Group of Anaesthesiology, MRC Oulu and University of Oulu, Oulu, Finland
| | - Jaana M Karhu
- Research Group of Surgery, Intensive Care Unit, Anaesthesiology and Intensive Care Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; OYS Heart, Oulu University Hospital, Research Group of Anaesthesiology, MRC Oulu and University of Oulu, Oulu, Finland
| | - Pasi P Ohtonen
- Research Group of Surgery, Intensive Care Unit, Anaesthesiology and Intensive Care Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Research Service Unit, Oulu University Hospital, Oulu, Finland
| | - Janne H Liisanantti
- Research Group of Surgery, Intensive Care Unit, Anaesthesiology and Intensive Care Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Panu Taskinen
- Research Group of Surgery, Intensive Care Unit, Anaesthesiology and Intensive Care Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; OYS Heart, Oulu University Hospital, Research Group of Anaesthesiology, MRC Oulu and University of Oulu, Oulu, Finland
| | - Tero I Ala-Kokko
- Research Group of Surgery, Intensive Care Unit, Anaesthesiology and Intensive Care Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Critical Care Center and Research Group of Intensive Care Medicine, Oulu University Hospital, MRC Oulu and University of Oulu, Oulu, Finland
| | - Timo I Kaakinen
- Research Group of Surgery, Intensive Care Unit, Anaesthesiology and Intensive Care Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; OYS Heart, Oulu University Hospital, Research Group of Anaesthesiology, MRC Oulu and University of Oulu, Oulu, Finland
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7
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Atreya MR, Piraino G, Cvijanovich NZ, Fitzgerald JC, Weiss SL, Bigham MT, Jain PN, Schwarz AJ, Lutfi R, Nowak J, Thomas NJ, Baines T, Haileselassie B, Zingarelli B. SERUM HUMANIN IN PEDIATRIC SEPTIC SHOCK-ASSOCIATED MULTIPLE-ORGAN DYSFUNCTION SYNDROME. Shock 2024; 61:83-88. [PMID: 37917869 PMCID: PMC10842252 DOI: 10.1097/shk.0000000000002266] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
ABSTRACT Background: Multiple-organ dysfunction syndrome disproportionately contributes to pediatric sepsis morbidity. Humanin (HN) is a small peptide encoded by mitochondrial DNA and thought to exert cytoprotective effects in endothelial cells and platelets. We sought to test the association between serum HN (sHN) concentrations and multiple-organ dysfunction syndrome in a prospectively enrolled cohort of pediatric septic shock. Methods: Human MT-RNR2 ELISA was used to determine sHN concentrations on days 1 and 3. The primary outcome was thrombocytopenia-associated multiorgan failure (TAMOF). Secondary outcomes included individual organ dysfunctions on day 7. Associations across pediatric sepsis biomarker (PERSEVERE)-based mortality risk strata and correlation with platelet and markers of endothelial activation were tested. Results: One hundred forty subjects were included in this cohort, of whom 39 had TAMOF. The concentration of sHN was higher on day 1 relative to day 3 and among those with TAMOF phenotype in comparison to those without. However, the association between sHN and TAMOF phenotype was not significant after adjusting for age and illness severity in multivariate models. In secondary analyses, sHN was associated with presence of day 7 sepsis-associated acute kidney injury ( P = 0.049). Furthermore, sHN was higher among those with high PERSEVERE-mortality risk strata and correlated with platelet counts and several markers of endothelial activation. Conclusion: Future investigation is necessary to validate the association between sHN and sepsis-associated acute kidney injury among children with septic shock. Furthermore, mechanistic studies that elucidate the role of HN may lead to therapies that promote organ recovery through restoration of mitochondrial homeostasis among those critically ill.
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Affiliation(s)
| | - Giovanna Piraino
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | | | - Scott L Weiss
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Parag N Jain
- Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Adam J Schwarz
- Children's Hospital of Orange County, Orange, California
| | - Riad Lutfi
- Riley Hospital for Children, Indianapolis, Indiana
| | - Jeffrey Nowak
- Children's Hospital and Clinics of Minnesota, Minneapolis, Minnesota
| | - Neal J Thomas
- Penn State Hershey Children's Hospital, Hershey, Pennsylvania
| | - Torrey Baines
- University of Florida Health Shands Children's Hospital, Gainesville, Florida
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Ge P, Luo Y, Zhang G, Chen H. The role of proteomics in acute pancreatitis: new and old knowledge. Expert Rev Proteomics 2024; 21:115-123. [PMID: 38372668 DOI: 10.1080/14789450.2024.2320810] [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: 10/06/2023] [Accepted: 01/10/2024] [Indexed: 02/20/2024]
Abstract
INTRODUCTION Around 20% of individuals diagnosed with acute pancreatitis (AP) may develop severe acute pancreatitis (SAP), possibly resulting in a mortality rate ranging from 15% to 35%. There is an urgent need to thoroughly understand the molecular phenotypes of SAP resulting from diverse etiologies. The field of translational research on AP has seen the use of several innovative proteomic methodologies via the ongoing improvement of isolation, tagging, and quantification methods. AREAS COVERED This paper provides a comprehensive overview of differentially abundant proteins (DAPs) identified in AP by searching the PubMed/MEDLINE database (2003-2023) and adds significantly to the current theoretical framework. EXPERT OPINION DAPs for potentially diagnosing AP based on proteomic identification need to be confirmed by multi-center studies that include larger samples. The discovery of DAPs in various organs at different AP stages via proteomic technologies is essential better to understand the pathophysiology of AP-related multiple organ dysfunction syndrome. Regarding the translational research of AP, novel approaches like single-cell proteomics and imaging using mass spectrometry may be used as soon as they become available.
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Affiliation(s)
- Peng Ge
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
- Institute (College) of Integrative Medicine, Dalian Medical University, Dalian, Liaoning, China
- Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yalan Luo
- Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
- Department of Gastroenterology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Guixin Zhang
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
- Institute (College) of Integrative Medicine, Dalian Medical University, Dalian, Liaoning, China
- Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Hailong Chen
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
- Institute (College) of Integrative Medicine, Dalian Medical University, Dalian, Liaoning, China
- Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
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9
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Chen QT, Chen MH, Lin YK, Yeh RH, Lu CC, Hsiao PJ, Sung YF. Case report: Hemophagocytic lymphohistiocytosis complicated by multiple organ dysfunction syndrome following aseptic encephalitis. Front Immunol 2023; 14:1296575. [PMID: 38193074 PMCID: PMC10773876 DOI: 10.3389/fimmu.2023.1296575] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/04/2023] [Indexed: 01/10/2024] Open
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a rare but potentially life-threatening condition caused by excessive immune activation. Secondary HLH is usually triggered by infection, most often from viral infection or malignancy. Here, we present a case of secondary HLH, complicated by multiple organ dysfunction syndrome triggered by critical aseptic encephalitis. A 27-year-old man without any underlying disease presented to our hospital with fever, disturbance of consciousness, and generalized seizures. The patient was diagnosed with aseptic encephalitis with super-refractory status epilepticus. Although antiseizure medications and immunoglobulins were administered, the patient developed multiple organ dysfunction syndrome. HLH was later diagnosed based on hypertriglyceridemia, hyperferritinemia, splenomegaly, cytopenia, and phagocytosis of nucleated cells, as shown by a blood smear of bone marrow aspiration. Treatment with pulse steroid therapy and plasmapheresis was initiated rather than chemotherapy because of the patient's critical condition. However, the patient died of profound shock and multiple organ failure. Diagnosis of HLH is challenging in patients with severe infections because of similar clinical manifestations and laboratory findings. The early recognition of HLH provides patients with the opportunity to receive appropriate treatment, which can lead to increased survival and remission rates.
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Affiliation(s)
- Quan-Ting Chen
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
| | - Ming-Hua Chen
- Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
| | - Yu-Kai Lin
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ren-Hua Yeh
- Division of Hematology/Oncology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chun-Chi Lu
- Division of Rheumatology/Immunology and Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Po-Jen Hsiao
- Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
| | - Yueh-Feng Sung
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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10
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Cleuren A, Molema G. Organotypic heterogeneity in microvascular endothelial cell responses in sepsis-a molecular treasure trove and pharmacological Gordian knot. Front Med (Lausanne) 2023; 10:1252021. [PMID: 38020105 PMCID: PMC10665520 DOI: 10.3389/fmed.2023.1252021] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
In the last decades, it has become evident that endothelial cells (ECs) in the microvasculature play an important role in the pathophysiology of sepsis-associated multiple organ dysfunction syndrome (MODS). Studies on how ECs orchestrate leukocyte recruitment, control microvascular integrity and permeability, and regulate the haemostatic balance have provided a wealth of knowledge and potential molecular targets that could be considered for pharmacological intervention in sepsis. Yet, this information has not been translated into effective treatments. As MODS affects specific vascular beds, (organotypic) endothelial heterogeneity may be an important contributing factor to this lack of success. On the other hand, given the involvement of ECs in sepsis, this heterogeneity could also be leveraged for therapeutic gain to target specific sites of the vasculature given its full accessibility to drugs. In this review, we describe current knowledge that defines heterogeneity of organ-specific microvascular ECs at the molecular level and elaborate on studies that have reported EC responses across organ systems in sepsis patients and animal models of sepsis. We discuss hypothesis-driven, single-molecule studies that have formed the basis of our understanding of endothelial cell engagement in sepsis pathophysiology, and include recent studies employing high-throughput technologies. The latter deliver comprehensive data sets to describe molecular signatures for organotypic ECs that could lead to new hypotheses and form the foundation for rational pharmacological intervention and biomarker panel development. Particularly results from single cell RNA sequencing and spatial transcriptomics studies are eagerly awaited as they are expected to unveil the full spatiotemporal signature of EC responses to sepsis. With increasing awareness of the existence of distinct sepsis subphenotypes, and the need to develop new drug regimen and companion diagnostics, a better understanding of the molecular pathways exploited by ECs in sepsis pathophysiology will be a cornerstone to halt the detrimental processes that lead to MODS.
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Affiliation(s)
- Audrey Cleuren
- Cardiovascular Biology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States
| | - Grietje Molema
- Department Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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11
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Elbashir H, Saeed L, Sabir D, Morgom M, Abuazab Y, Madebo T, Yusof AA. From Heat Stroke to Multi-Organ Failure: A Survivor's Case Report. Cureus 2023; 15:e48984. [PMID: 38111401 PMCID: PMC10726209 DOI: 10.7759/cureus.48984] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2023] [Indexed: 12/20/2023] Open
Abstract
A heat stroke (HS) is a medical emergency that can occur when the body is unable to cool itself down after overexertion in a hot condition. It is characterized by a high body temperature (usually greater than 40.5 degrees Celsius or 104.9 degrees Fahrenheit) and altered mental status. HS can cause a wide range of physiological changes in the body, including damage to the brain, heart, liver, kidneys, and muscles. In the case report presented, the patient was a 40-year-old man who developed severe HS. His condition rapidly deteriorated, and he developed multi-organ failure, involving the brain, liver, kidneys, muscles, and hematological system. The patient was admitted to the intensive care unit (ICU) and intubated, despite aggressive treatment. After an 18-day stay in the ICU, the patient achieved full recovery except for myopathy, which necessitated physiotherapy.
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Affiliation(s)
| | - Leena Saeed
- Internal Medicine, Hamad Medical Corporation, Doha, QAT
| | - Doaa Sabir
- Emergency Medicine, Hamad General Hospital, Doha, QAT
| | - Marwa Morgom
- Emergency Medicine, Hamad General Hospital, Doha, QAT
| | - Yara Abuazab
- Medicine and Surgery, Jordan University of Science and Technology, Irbid, JOR
| | - Tasneem Madebo
- Medicine and Surgery, National Ribat University, Khartoum, SDN
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12
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Shen Y, Wang X, Yao Y, Zhou X. Acute fatty liver of pregnancy causing multiple organ dysfunction syndrome in a Chinese intensive care unit. Nurs Crit Care 2023; 28:1170-1175. [PMID: 37114863 DOI: 10.1111/nicc.12916] [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: 06/25/2022] [Revised: 03/29/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023]
Abstract
Acute fatty liver of pregnancy (AFLP) is a rare but severe condition associated with high rates of maternal and foetal morbidity and mortality. Timely discontinuation of pregnancy, professional supervision and appropriate management are helpful for a successful discharge. This article reports the presentation and nursing care of a pregnant woman who was diagnosed with AFLP and discharged from the intensive care unit (ICU) after a prolonged hospitalization. The patient was admitted to the ICU on the first day after a caesarean section, with deterioration of liver, kidney and coagulation function. On day 1 of ICU admission, she underwent transnasal high-flow oxygen therapy. Owing to worsening respiratory status and oxygen saturation <85%, the patient was intubated on day 3 in the ICU. Her urine output decreased significantly, her bilirubin level progressively increased, and she was treated with bilirubin adsorption and haemodialysis. Multiple organ dysfunction syndrome occurred, along with many other complications, including subarachnoid haemorrhage and lower extremity venous thrombosis. The patient was finally extubated on day 7, and haemodialysis was discontinued on day 42, with a daily urine output of approximately 2000 mL. The patient was discharged from the ICU 43 days after admission. Treatment and care activities under qualified nursing care, including managing haemorrhage and anticoagulation in haemodialysis, pain care based on psychological support, early rehabilitation and nutrition and providing appropriate care for respiratory support, contributed to the successful discharge of the patient from the ICU. During the patient's 43-day stay in the ICU, strict monitoring and personalized nursing care were implemented.
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Affiliation(s)
- Yan Shen
- Department of Nursing, Shanghai General Hospital, Shanghai, China
| | - Xujuan Wang
- Department of Nursing, Shanghai General Hospital, Shanghai, China
| | - Yeying Yao
- Department of Nursing, Shanghai General Hospital, Shanghai, China
| | - Xingmei Zhou
- Department of Nursing, Shanghai General Hospital, Shanghai, China
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Flerlage T, Fan K, Qin Y, Agulnik A, Arias AV, Cheng C, Elbahlawan L, Ghafoor S, Hurley C, McArthur J, Morrison RR, Zhou Y, Park HJ, Carcillo JA, Hines MR. Mortality Risk Factors in Pediatric Onco-Critical Care Patients and Machine Learning Derived Early Onco-Critical Care Phenotypes in a Retrospective Cohort. Crit Care Explor 2023; 5:e0976. [PMID: 37780176 PMCID: PMC10538916 DOI: 10.1097/cce.0000000000000976] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023] Open
Abstract
OBJECTIVES To use supervised and unsupervised statistical methodology to determine risk factors associated with mortality in critically ill pediatric oncology patients to identify patient phenotypes of interest for future prospective study. DESIGN This retrospective cohort study included nonsurgical pediatric critical care admissions from January 2017 to December 2018. We determined the prevalence of multiple organ failure (MOF), ICU mortality, and associated factors. Consensus k-means clustering analysis was performed using 35 bedside admission variables for early, onco-critical care phenotype development. SETTING Single critical care unit in a subspeciality pediatric hospital. INTERVENTION None. PATIENTS There were 364 critical care admissions in 324 patients with underlying malignancy, hematopoietic cell transplant, or immunodeficiency reviewed. MEASUREMENTS Prevalence of multiple organ failure, ICU mortality, determination of early onco-critical care phenotypes. MAIN RESULTS ICU mortality was 5.2% and was increased in those with MOF (18.4% MOF, 1.7% single organ failure [SOF], 0.6% no organ failure; p ≤ 0.0001). Prevalence of MOF was 23.9%. Significantly increased ICU mortality risk was associated with day 1 MOF (hazards ratio [HR] 2.27; 95% CI, 1.10-6.82; p = 0.03), MOF during ICU admission (HR 4.16; 95% CI, 1.09-15.86; p = 0.037), and with invasive mechanical ventilation requirement (IMV; HR 5.12; 95% CI, 1.31-19.94; p = 0.018). Four phenotypes were derived (PedOnc1-4). PedOnc1 and 2 represented patient groups with low mortality and SOF. PedOnc3 was enriched in patients with sepsis and MOF with mortality associated with liver and renal dysfunction. PedOnc4 had the highest frequency of ICU mortality and MOF characterized by acute respiratory failure requiring invasive mechanical ventilation at admission with neurologic dysfunction and/or severe sepsis. Notably, most of the mortality in PedOnc4 was early (i.e., within 72 hr of ICU admission). CONCLUSIONS Mortality was lower than previously reported in critically ill pediatric oncology patients and was associated with MOF and IMV. These findings were further validated and expanded by the four derived nonsynonymous computable phenotypes. Of particular interest for future prospective validation and correlative biological study was the PedOnc4 phenotype, which was composed of patients with hypoxic respiratory failure requiring IMV with sepsis and/or neurologic dysfunction at ICU admission.
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Affiliation(s)
- Tim Flerlage
- Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, TN
| | - Kimberly Fan
- Division of Critical Care, Department of Pediatrics, MD Anderson Cancer Center, Houston, TX
| | - Yidi Qin
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Asya Agulnik
- Department of Global Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Anita V Arias
- Division of Critical Care, Department of Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Cheng Cheng
- Division of Critical Care, Department Biostatistics, St Jude Children's Research Hospital, Memphis, TN
| | - Lama Elbahlawan
- Division of Critical Care, Department of Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Saad Ghafoor
- Division of Critical Care, Department of Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Caitlin Hurley
- Division of Critical Care, Department of Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Jennifer McArthur
- Division of Critical Care, Department of Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - R Ray Morrison
- Division of Critical Care, Department of Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Yinmei Zhou
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN
| | - H J Park
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Joseph A Carcillo
- Division of Pediatric Critical Care, Department of Critical Care Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Melissa R Hines
- Division of Critical Care, Department of Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
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Ardila SM, Weeks HM, Dahmer MK, Kaciroti N, Quasney M, Sapru A, Curley MAQ, Flori HR. A Targeted Analysis of Serial Cytokine Measures and Nonpulmonary Organ System Failure in Children With Acute Respiratory Failure: Individual Measures and Trajectories Over Time. Pediatr Crit Care Med 2023; 24:727-737. [PMID: 37195096 PMCID: PMC10524322 DOI: 10.1097/pcc.0000000000003286] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
OBJECTIVES There is a need for research exploring the temporal trends of nonpulmonary organ dysfunction (NPOD) and biomarkers in order to identify unique predictive or prognostic phenotypes. We examined the associations between the number and trajectories of NPODs and plasma biomarkers of early and late inflammatory cascade activation, specifically plasma interleukin-1 receptor antagonist (IL-1ra) and interleukin-8 (IL-8), respectively, in the setting of acute respiratory failure (ARF). DESIGN Secondary analysis of the Randomized Evaluation for Sedation Titration for Respiratory Failure clinical trial and Biomarkers in Acute Lung Injury (BALI) ancillary study. SETTING Multicenter. PATIENTS Intubated pediatric patients with ARF. INTERVENTIONS NPODs were evaluated against plasma IL-1ra and IL-8 levels on individual days (1 to 4 d after intubation) and longitudinally across days. MEASUREMENTS AND MAIN RESULTS Within the BALI cohort, 432 patients had at least one value for IL-1ra or IL-8 within days 0 through 5. 36.6% had a primary diagnosis of pneumonia, 18.5% had a primary diagnosis of sepsis and 8.1% died. Multivariable logistic regression models showed that increasing levels of both plasma IL-1ra and IL-8 were statistically significantly associated with increasing numbers of NPODs (IL-1ra: days 1-3; IL-8: days 1-4), independent of sepsis diagnosis, severity of oxygenation defect, age, and race/ethnicity. Longitudinal trajectory analysis identified four distinct NPOD trajectories and seven distinct plasma IL-1ra and IL-8 trajectories. Multivariable ordinal logistic regression revealed that specific IL-1ra and IL-8 trajectory groups were associated with greater NPOD trajectory group ( p = 0.004 and p < 0.0001, respectively), independent of severity of oxygenation defect, age, sepsis diagnosis, and race/ethnicity. CONCLUSIONS Both the inflammatory biomarkers and number of NPODs exhibit distinct trajectories over time with strong associations with one another. These biomarkers and their trajectory patterns may be useful in evaluating the severity of multiple organ dysfunction syndrome in critically ill children and identifying those phenotypes with time-sensitive, treatable traits.
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Affiliation(s)
- Silvia M Ardila
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, MI
| | - Heidi M Weeks
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI
| | - Mary K Dahmer
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, MI
| | - Niko Kaciroti
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI
| | - Michael Quasney
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, MI
| | - Anil Sapru
- Department of Pediatrics, University of California, Los Angeles, Los Angeles, CA
| | - Martha A Q Curley
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, MI
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI
- Department of Pediatrics, University of California, Los Angeles, Los Angeles, CA
- Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA
- Anesthesia and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Research Institute, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Heidi R Flori
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, MI
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He Y, Liu X, Zhong S, Fu Q. Neutrophil-to-lymphocyte ratio in relation to trauma severity as prognosis factors in patients with multiple injuries complicated by multiple organ dysfunction syndrome: A retrospective analysis. Immun Inflamm Dis 2023; 11:e1031. [PMID: 37773708 PMCID: PMC10521378 DOI: 10.1002/iid3.1031] [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: 05/17/2023] [Accepted: 09/12/2023] [Indexed: 10/01/2023] Open
Abstract
OBJECTIVE This study aimed to explore potential risk factors for the occurrence of multiple organ dysfunction syndrome (MODS) in patients with multiple injuries by evaluating neutrophil-to-lymphocyte ratio (NLR)-associated trauma severity. METHODS This retrospective case-control study included 95 patients with multiple injuries, who were admitted to our hospital (between January 2018 and December 2020). Clinical data including gender, age, underlying disease, number of injury sites (NIS), injury severity score (ISS), hemoglobin level within 24 h of admission (HL-24h), neutrophil count (NC), white blood cell count, platelet count (PC), NLR, d-dimer level, activated partial thromboplastin time (APTT), complicated shock within 24 h of admission (CS-24h), length of stay, as well as prognostic outcome was systematically analyzed. According to MODS occurrence, patients were divided into a MODS group (n = 27) and a non-MODS group (n = 68). The risk factors affecting patients with multiple injuries complicated by MODS were identified using univariate and multivariate logistic regression analyses. Candidate risk factors were further analyzed using receiver operating characteristic (ROC) curves. RESULTS Univariate analysis revealed a significant difference between the MODS and non-MODA groups in terms of NIS, ISS, HL-24h, PC, APTT, d-dimer level, CS-24h, NLR, NC, prognostic outcome, and other indicators (p < .05). Multivariate logistic regression analysis showed that d-dimer levels within 24 h of admission and ISS, NLR, and CS-24h were significantly associated with multiple injuries complicated by MODS. Compared with the non-MODS controls, the NLR in the MODS group showed a much higher level and tended to rise with the increase in ISS score, indicating a significant intergroup difference (p < .05). The ROC curve analysis results suggested that the NLR had good sensitivity and specificity for predicting the prognosis of patients with MODS with multiple injuries. CONCLUSION d-dimer level, ISS, NLR, and CS-24h are important risk factors for MODS in patients with multiple injuries. Notably, NLR expression may be a good indicator of injury severity and predictor of the occurrence of MODS in patients with multiple injuries. Therefore, assessment of injury severity and coagulation function, active resuscitation, as well as prevention of infection should be emphasized during treatment of multiple injuries, to reduce and prevent the risk of MODS in patients with multiple injuries.
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Affiliation(s)
- Yong‐Ming He
- Department of EmergencyShenzhen Longhua District Center HospitalShenzhenChina
| | - Xing Liu
- Department of EmergencyShenzhen Longhua District Center HospitalShenzhenChina
- Department of EmergencyThe Second People's Hospital of Futian DistrictShenzhenChina
| | - Si‐Yi Zhong
- Department of EmergencyThe Second People's Hospital of Futian DistrictShenzhenChina
- Department of Public HealthGuangdong Medical UniversityDongguanChina
| | - Qiu‐Hong Fu
- Department of EmergencyShenzhen Longhua District Center HospitalShenzhenChina
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16
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Atreya MR, Cvijanovich NZ, Fitzgerald JC, Weiss SL, Bigham MT, Jain PN, Schwarz AJ, Lutfi R, Nowak J, Thomas NJ, Quasney M, Haileselassie B, Baines TD, Zingarelli B. SERUM SOLUBLE ENDOGLIN IN PEDIATRIC SEPTIC SHOCK-ASSOCIATED MULTIPLE ORGAN DYSFUNCTION SYNDROME. Shock 2023; 60:379-384. [PMID: 37493567 PMCID: PMC10529838 DOI: 10.1097/shk.0000000000002183] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
ABSTRACT Background: Endothelial activation is a key driver of multiple organ dysfunction syndrome (MODS). Soluble endoglin (sENG) is expressed by mature and progenitor endothelial cells and thought to have angiogenic properties. We sought to determine the association between sENG and pediatric sepsis-associated MODS. Methods: Prospective observational study of pediatric septic shock. Primary outcome of interest was complicated course-a composite of death by (or) MODS on day 7 of illness. Secondary outcomes included individual organ dysfunctions. Endothelial biomarkers including sENG were measured using multiplex Luminex assays among patients with existing data on the Pediatric Sepsis Biomarker Risk Model (PERSEVERE-II) data. Multivariable regression was used to test the independent association between sENG and clinical outcomes. Serum sENG concentrations across PERSEVERE-II mortality risk strata and correlations with established markers of endothelial dysfunction were determined. Results: Three hundred six critically ill children with septic shock were included. Serum sENG concentrations were higher among those with primary and secondary outcomes of interest, with the exception of acute neurological dysfunction. Soluble endoglin was independently associated with increased odds of complicated course (adjusted odds ratio, 1.53; 95% confidence interval, 1.02-2.27; P = 0.038) and acute renal dysfunction (adjusted odds ratio, 1.84; 95% confidence interval, 1.18-2.876; P = 0.006). Soluble endoglin demonstrated graded responses across PERSEVERE-II risk strata and was positively correlated with endothelial biomarkers, except angiopoietin-1. Conclusions: Serum sENG is independently associated with complicated course and acute renal dysfunction in pediatric septic shock. Future studies are required to validate our observational data, and mechanistic studies are necessary to elucidate whether endoglin plays an organ-specific role in the development or resolution of acute renal dysfunction in sepsis.
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Affiliation(s)
- Mihir R. Atreya
- Division of Critical Care Medicine, Cincinnati Children’s Hospital Medical Center and Cincinnati Children’s Research Foundation, Cincinnati, 45229, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | | | | | - Scott L. Weiss
- Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | | | - Parag N. Jain
- Texas Children’s Hospital and Baylor College of Medicine, Houston, TX 77030, USA
| | | | - Riad Lutfi
- Riley Hospital for Children, Indianapolis, IN 46202, USA
| | - Jeffrey Nowak
- Children’s Hospital and Clinics of Minnesota, Minneapolis, MN 55404, USA
| | - Neal J. Thomas
- Penn State Hershey Children’s Hospital, Hershey, PA 17033, USA
| | - Michael Quasney
- CS Mott Children’s Hospital at the University of Michigan, Ann Arbor, MI 48109, USA
| | | | - Torrey D. Baines
- University of Florida Health Shands Children’s Hospital, Gainesville, FL 32610, USA
| | - Basilia Zingarelli
- Division of Critical Care Medicine, Cincinnati Children’s Hospital Medical Center and Cincinnati Children’s Research Foundation, Cincinnati, 45229, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
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17
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Zhao D, Yang R, Liu S, Ge D, Su X. Study on the Characteristics of Early Cytokine Storm Response to Cardiac Surgery. J Interferon Cytokine Res 2023; 43:351-358. [PMID: 37566476 DOI: 10.1089/jir.2023.0044] [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] [Indexed: 08/13/2023] Open
Abstract
Cardiac surgery can provoke an acute cytokine storm that may contribute to the development of postoperative multiple organ dysfunction syndrome. We prospectively observed patients undergoing cardiac surgery and divided them into two groups: the severe group and the mild group. Healthy individuals were enrolled acting as the control group for comparison. Plasma samples and clinical data were recorded at the initiation of cardiac-pulmonary bypass (CPB) and 3, 6, 12, 24, and 48 h after initiation of CPB. Cytokine levels were detected using the Luminex® technique. Thirty-nine adults were enrolled in this study (14 in the severe group, 15 in the mild group, and 10 in the control group). Cytokine concentrations were significantly higher in the severe group. Principal component analysis was used to establish a cytokine storm intensity curve, which represented the overall trend of 10 cytokines. The peak concentrations of interleukin (IL)-6, IL-10, and IL-16 were 425.1, 198.5, and 623.0 pg/mL, which were more than 1,200, 1,800, and 240 times the normal level, respectively. The maximum cytokine storm intensity predated the maximum Vasoactive-Inotropic Score (VIS) and Sequential Organ Failure Assessment (SOFA) score in the severe group. Cytokine storm response to cardiac surgery occurred early and was associated with disease severity. Interventions to cytokine storm should be initiated early as guided by cytokine storm biomarkers such as IL-6, IL-10, and IL-16 in severe patients undergoing cardiac surgery. Clinical Trial Registration: ChiCTR1900021351.
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Affiliation(s)
- Danyang Zhao
- Department of Nephrology, Qingdao West Coast New District People's Hospital, Qingdao, China
| | - Rongli Yang
- Department of Critical Care Medicine, Central Hospital of Dalian University of Technology, Dalian, China
| | - Sibo Liu
- Department of Critical Care Medicine, Central Hospital of Dalian University of Technology, Dalian, China
| | - Dong Ge
- Department of Critical Care Medicine, Central Hospital of Dalian University of Technology, Dalian, China
| | - Xiaolei Su
- Department of Critical Care Medicine, Central Hospital of Dalian University of Technology, Dalian, China
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Yang Y, Zhang J, Xu R, Wang W, Wei L. Role of lncRNAs in the pathogenesis of sepsis and their clinical significance. Curr Mol Med 2023:CMM-EPUB-132820. [PMID: 37431903 DOI: 10.2174/1566524023666230710121347] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/29/2023] [Accepted: 05/31/2023] [Indexed: 07/12/2023]
Abstract
Sepsis is a fatal organ dysfunction caused by the host's uncontrolled response to infection, with high morbidity and mortality. Early diagnosis and intervention are the most effective methods to reduce the mortality due to sepsis. However, there is still a lack of definite biomarkers or intervention targets for the diagnosis, evaluation, prognosis, and treatment of sepsis. Long non-coding RNAs (lncRNAs) are a type of non-coding transcript with a length ranging from 200 to 100,000 nucleotides. LncRNAs mainly locate in the cytoplasm and nucleus and participate in various signaling pathways related to inflammatory reactions and organ dysfunction. Recent studies have reported that lncRNAs are involved in regulating the pathophysiological process of sepsis. Some classical lncRNAs have been confirmed as promising biomarkers to evaluate the severity and prognosis of sepsis. This review summarizes the mechanical studies on lncRNAs in sepsis-induced acute lung, kidney, myocardial, and liver injuries, analyzes the role of lncRNAs in the pathogenesis of sepsis, and explores the possibility of lncRNAs as potential biomarkers and intervention targets for sepsis-induced multiple organ dysfunction.
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Affiliation(s)
- Yongpeng Yang
- Centre for Pediatric Emergency Unit 1, Gansu Provincial Maternity and Child-care Hospital, Gansu Provincial Children's Medical Center, Lanzhou, Gansu 730050, China
| | - Jianping Zhang
- Department of Neurosurgery, Gansu Provincial Maternity and Child-care Hospital, Gansu Provincial Children's Medical Center, Lanzhou, Gansu 730050, China
| | - Ruifeng Xu
- Centre for Pediatric Emergency Unit 1, Gansu Provincial Maternity and Child-care Hospital, Gansu Provincial Children's Medical Center, Lanzhou, Gansu 730050, China
| | - Weikai Wang
- Centre for Pediatric Emergency Unit 2, Gansu Provincial Maternity and Child-care Hospital, Gansu Provincial Children's Medical Center, Lanzhou, Gansu 730050, China
| | - Lin Wei
- Centre for Pediatric Emergency Unit 1, Gansu Provincial Maternity and Child-care Hospital, Gansu Provincial Children's Medical Center, Lanzhou, Gansu 730050, China
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19
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Qian P, He X, Yang M, Wei L, Zhang L, Xing X. Detection of Severe Murine Typhus by Nanopore Targeted Sequencing, China. Emerg Infect Dis 2023; 29:1275-1277. [PMID: 37209688 DOI: 10.3201/eid2906.221929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023] Open
Abstract
We report a case of murine typhus in China caused by Rickettsia typhi and diagnosed by nanopore targeted sequencing of a bronchoalveolar lavage fluid sample. This case highlights that nanopore targeted sequencing can effectively detect clinically unexplained infections and be especially useful for detecting infections in patients without typical signs and symptoms.
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Hu P, Lu YH, Deng W, Li Q, Zhao N, Shao Q, Wu L, Wang XZ, Qian KJ, Liu F. The critical role of pancreatic stone protein/regenerating protein in sepsis-related multiorgan failure. Front Med (Lausanne) 2023; 10:1172529. [PMID: 37215716 PMCID: PMC10196489 DOI: 10.3389/fmed.2023.1172529] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 04/13/2023] [Indexed: 05/24/2023] Open
Abstract
Introduction Multiple organ dysfunction syndrome (MODS) is common in patients with sepsistic admitted to an intensive care unit (ICU) and greatly increases mortality. Pancreatic stone protein/regenerating protein (PSP/Reg) is a type of C-type lectin protein that is overexpressed during sepsis. This study aimed to evaluate the potential involvement of PSP/Reg in MODS development in patients with sepsis. Materials and methods The relationship between circulating PSP/Reg levels, patient prognosis, and progression to MODS was analyzed in patients with sepsis admitted to the ICU of a general tertiary hospital. Furthermore, to examine the potential involvement of PSP/Reg in sepsis-induced MODS, a septic mouse model was established per the cecal ligation and puncture procedure, randomized into three groups, and subjected to a caudal vein injection of recombinant PSP/Reg at two different doses and phosphate-buffered saline. Survival analyses and disease severity scoring were performed to evaluate the survival status of the mice; enzyme-linked immunosorbent assays were performed to detect the levels of inflammatory factors and organ-damage markers in murine peripheral blood; terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining was performed to measure apoptosis levels in lung, heart, liver, and kidney tissue sections and to visualize the degree of organ damage in the mouse model; myeloperoxidase activity assay, immunofluorescence staining, and flow cytometry were performed to detect neutrophil infiltration levels in vital murine organs and the activation indexes of neutrophils. Results and discussion Our findings indicated that Circulating PSP/Reg levels were correlated with patient prognosis and sequential organ failure assessment scores. Furthermore, PSP/Reg administration increased disease severity scores, shortened survival time, increased the TUNEL-positive staining rate, and increased the levels of inflammatory factors, organ-damage markers, and neutrophil infiltration in the organs. Neutrophils can be activated by PSP/Reg to an inflammatory state, both in vivo and in vitro, which is characterized by the increased levels of intercellular adhesion molecule 1 and CD29. Conclusion Patient prognosis and progression to MODS can be visualized by monitoring PSP/Reg levels upon ICU admission. Additionally, PSP/Reg administration in animal models exacerbates the inflammatory response and severity of multiorgan damage, which may be accomplished by promoting the inflammatory state of neutrophils.
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Affiliation(s)
- Ping Hu
- Department of Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yuan hua Lu
- Department of Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Wei Deng
- Department of Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Qi Li
- Department of Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Ning Zhao
- Department of Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Qiang Shao
- Department of Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Ling Wu
- Department of Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xu zhen Wang
- Department of Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Ke jian Qian
- Department of Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Fen Liu
- Department of Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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Sinha S, Agarwal M, Singh S, Dureja S. Maternal Near-Miss Secondary to Concealed History: A Case Report. Cureus 2023; 15:e39473. [PMID: 37250601 PMCID: PMC10212214 DOI: 10.7759/cureus.39473] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 05/31/2023] Open
Abstract
A mother and her child constitute an essential part of the healthcare system. Maternal death due to obstetrical causes is tragic for the family and the healthcare system. A maternal near-miss is a woman who survived problems during pregnancy and childbirth and has been examined as an intermediary for maternal deaths. Reviews of such situations are viewed as a less risky strategy by the service provider to improve maternal health care. This will allow us to take advantage of possibilities to prevent the deaths of mothers who may meet a similar fate. This is the case of a survivor of pregnancy termination challenges whose concealed history eventually led to a series of events compromising her health to a near-mortality condition. Providing complete information to a clinician is a crucial component of quality healthcare, as a family is the first in contact with a patient. The significance is evident in this case report.
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Affiliation(s)
- Shivangni Sinha
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, Patna, Patna, IND
| | - Mukta Agarwal
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, Patna, Patna, IND
| | - Smita Singh
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, Patna, Patna, IND
| | - Simran Dureja
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, Patna, Patna, IND
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22
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Patel NM, Oliveira FRMB, Ramos HP, Aimaretti E, Alves GF, Coldewey SM, Collino M, Sordi R, Thiemermann C. Inhibition of Bruton's Tyrosine Kinase Activity Attenuates Hemorrhagic Shock-Induced Multiple Organ Dysfunction in Rats. Ann Surg 2023; 277:e624-33. [PMID: 35129479 DOI: 10.1097/SLA.0000000000005357] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to investigate (a) the potential of the Bruton's tyrosine kinase (BTK) inhibitors acalabrutinib and fenebrutinib to reduce multiple organ dysfunction syndrome (MODS) in acute (short-term and long-term follow-up) hemorrhagic shock (HS) rat models and (b) whether treatment with either acalabrutinib or fenebrutinib attenuates BTK, NF-κB and NLRP3 activation in HS. BACKGROUND The MODS caused by an excessive systemic inflammatory response following trauma is associated with a high morbidity and mortality. The protein BTK is known to play a role in the activation of the NLRP3 inflammasome, which is a key component of the innate inflammatory response. However, its role in trauma-hemorrhage is unknown. METHODS Acute HS rat models were performed to determine the influence of acalabrutinib or fenebrutinib on MODS. The activation of BTK, NF-κB and NLRP3 pathways were analyzed by western blot in the kidney. RESULTS We demonstrated that (a) HS caused organ injury and/or dysfunction and hypotension (post-resuscitation) in rats, while (b) treatment of HS-rats with either acalabrutinib or fenebrutinib attenuated the organ injury and dysfunction in acute HS models and (c) reduced the activation of BTK, NF- kB and NLRP3 pathways in the kidney. CONCLUSION Our results point to a role of BTK in the pathophysiology of organ injury and dysfunction caused by trauma/hemorrhage and indicate that BTK inhibitors may be repurposed as a potential therapeutic approach for MODS after trauma and/or hemorrhage.
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23
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Atreya MR, Cvijanovich NZ, Fitzgerald JC, Weiss SL, Bigham MT, Jain PN, Schwarz AJ, Lutfi R, Nowak J, Allen GL, Thomas NJ, Grunwell JR, Baines T, Quasney M, Haileselassie B, Alder MN, Lahni P, Ripberger S, Ekunwe A, Campbell KR, Walley KR, Standage SW. Detrimental effects of PCSK9 loss-of-function in the pediatric host response to sepsis are mediated through independent influence on Angiopoietin-1. Res Sq 2023:rs.3.rs-2521836. [PMID: 36778250 PMCID: PMC9915797 DOI: 10.21203/rs.3.rs-2521836/v1] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background: Sepsis is associated with significant mortality, yet there are no efficacious therapies beyond antibiotics and supportive care. In adult sepsis studies, PCSK9 loss-of-function (LOF) and inhibition has shown therapeutic promise, likely through enhanced low-density lipoprotein receptor (LDLR) mediated endotoxin clearance. In contrast, we previously demonstrated higher mortality in septic juvenile hosts with PCSK9 LOF. In addition to direct influence on serum lipoprotein levels, PCSK9 likely exerts pleiotropic effects on vascular endothelium. Both mechanisms may influence sepsis outcomes. We sought to test the influence of PCSK9 LOF genotype on endothelial dysfunction in pediatric sepsis. Methods: Secondary analyses of a prospective observational cohort of pediatric septic shock. Single nucleotide polymorphisms of PCSK9 and LDLR genes were assessed. Serum PCSK9, lipoprotein, and endothelial marker concentrations were measured. Multivariable linear regression tested the influence of PCSK9 LOF genotype on endothelial markers, adjusted for age, complicated course, and low- and high-density lipoproteins (LDL and HDL). Causal mediation analyses assessed impact of select endothelial markers on the association between PCSK9 LOF genotype and mortality. Juvenile Pcsk9 null and wildtype mice were subject to cecal slurry sepsis and endothelial markers were quantified. Results: 474 patients were included. PCSK9 LOF was associated with several markers of endothelial dysfunction, with strengthening of associations after exclusion of patients homozygous for the rs688 LDLR variant that renders it insensitive to PCSK9. Serum PCSK9 levels did not correlate with endothelial dysfunction. PCSK9 LOF significantly influenced concentrations of Angiopoietin-1 (Angpt-1) and Vascular Cell Adhesion Molecule-1 (VCAM-1). However, upon adjusting for LDL and HDL, PCSK9 LOF remained significantly associated with low Angpt-1 alone. Causal Mediation Analysis demonstrated that the effect of PCSK9 LOF on mortality was partially mediated by Angpt-1 (p=0.0008). Murine data corroborated these results with lower Angpt-1 and higher soluble thrombomodulin among knockout mice with sepsis relative to the wildtype. Conclusions: PCSK9 LOF independently influences serum Angpt-1 levels in pediatric septic shock. Angpt-1 likely contributes mechanistically to the effect of PCSK9 LOF on mortality in juvenile hosts. Mechanistic studies on the role of PCSK9-LDLR pathway on vascular homeostasis may lead to the development of novel pediatric-specific sepsis therapies.
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Affiliation(s)
| | | | | | | | | | - Parag N. Jain
- Texas Children’s Hospital, Baylor College of Medicine
| | | | | | | | | | | | | | - Torrey Baines
- University of Florida Health Shands Children’s Hospital
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24
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Xu S, Cai J, Doomi A, Shi J. A prognostic assessment predicated by blood culture-based bacteria clustering from real-world evidence: Novel strategies and perspectives on prevention and management of sepsis. Front Mol Biosci 2023; 10:1160146. [PMID: 37065451 PMCID: PMC10098072 DOI: 10.3389/fmolb.2023.1160146] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/17/2023] [Indexed: 04/18/2023] Open
Abstract
Sepsis, a syndrome with disturbed host response to severe infection, is a critical health problem worldwide. It is urged to develop and update novel therapeutic strategies for improving the outcome of sepsis. In this study, we demonstrated that different bacteria clustering in sepsis patients may generate differences of prognosis results. We extracted all the sepsis patients from Medical Information Mart for Intensive Care IV 2.0 (MIMIC-IV 2.0) critical care data set according to certain standards and clinical score, a total of 2,339 patients were included in our study. Then we used multiple data analytics and machine learning methods to make all data deeply analyzed and elucidated. The results showed that the types of bacteria infected by patients with different ages, sex and race are different, the types of bacteria infected by patients with different SIRS values and GCS scores of the first day are different, and the severity of patients with different clusters is different, and most importantly, the survival rate of patients with different clusters also has this significant difference. We concluded prognostic assessment predicated by bacteria clustering might be a relatively potentially novel strategies and perspectives on prevention and management for sepsis in the future.
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Affiliation(s)
- Shaokang Xu
- Department of Hematology and Critical Care Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Jizhen Cai
- Department of Hematology and Critical Care Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Ahmed Doomi
- Miller School of Medicine, University of Miami, Miami, FL, United States
- Jackson Memorial Hospital, Miami, FL, United States
| | - Jian Shi
- Department of Hematology and Critical Care Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Jian Shi,
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25
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Abrams ST, Wang L, Yong J, Yu Q, Du M, Alhamdi Y, Cheng Z, Dart C, Lane S, Yu W, Toh CH, Wang G. The Importance of Pore-Forming Toxins in Multiple Organ Injury and Dysfunction. Biomedicines 2022; 10. [PMID: 36552012 DOI: 10.3390/biomedicines10123256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/03/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Multiple organ injury and dysfunction often occurs in acute critical illness and adversely affects survival. However, in patients who survive, organ function usually recovers without permanent damage. It is, therefore, likely that there are reversible mechanisms, but this is poorly understood in the pathogenesis of multiple organ dysfunction syndrome (MODS). AIMS Based on our knowledge of extracellular histones and pneumolysin, as endogenous and exogenous pore-forming toxins, respectively, here we clarify if the extent of cell membrane disruption and recovery is important in MODS. METHODS This is a combination of retrospective clinical studies of a cohort of 98 patients from an intensive care unit (ICU) in a tertiary hospital, with interventional animal models and laboratory investigation. RESULTS In patients without septic shock and/or disseminate intravascular coagulation (DIC), circulating histones also strongly correlated with sequential organ failure assessment (SOFA) scores, suggesting their pore-forming property might play an important role. In vivo, histones or pneumolysin infusion similarly caused significant elevation of cell damage markers and multiple organ injury. In trauma and sepsis models, circulating histones strongly correlated with these markers, and anti-histone reagents significantly reduced their release. Comparison of pneumolysin deletion and its parental strain-induced sepsis mouse model showed that pneumolysin was not essential for sepsis development, but enhanced multiple organ damage and reduced survival time. In vitro, histones and pneumolysin treatment disrupt cell membrane integrity, resulting in changes in whole-cell currents and elevated intracellular Ca2+ to lead to Ca2+ overload. Cell-specific damage markers, lactate dehydrogenase (LDH), alanine aminotransferase (ALT), and cardiac troponin I (cTnI), were released from damaged cells. Once toxins were removed, cell membrane damage could be rapidly repaired and cellular function recovered. CONCLUSION This work has confirmed the importance of pore-forming toxins in the development of MODS and proposed a potential mechanism to explain the reversibility of MODS. This may form the foundation for the development of effective therapies.
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26
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Saran S, Misra S, Siddiqui SS, Agrawal A, Gurjar M, Patwa AK, Muzaffar SN. Fulminant acute fatty liver of pregnancy presenting with multi-organ failure: A case series. Int J Crit Illn Inj Sci 2022; 12:239-243. [PMID: 36779214 PMCID: PMC9910109 DOI: 10.4103/ijciis.ijciis_31_22] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/14/2022] [Accepted: 06/20/2022] [Indexed: 12/24/2022] Open
Abstract
Liver disease in pregnancy can be classified into pregnancy-related, liver disease coincident with pregnancy or preexisting liver disease. Acute fatty liver of pregnancy (AFLP) is a rare liver disorder that is caused by defects in mitochondrial beta (β) oxidation of fatty acids. In view of its fulminant presentation and rapid progression to multiple organ failure (MOF), AFLP carries high maternal and fetal mortality. These patients are commonly present in the third trimester of pregnancy with gastrointestinal symptoms and complications such as hypoglycemia, lactic acidosis, hyperammonemia, leukocytosis, liver dysfunction, coagulopathy, and renal dysfunction. Diagnosis is mostly based on the Swansea diagnostic criteria and by excluding other etiologies of liver dysfunction. Liver biopsy is rarely performed owing to underlying coagulopathy and thrombocytopenia. In this case series, we intend to share our experience of managing four cases of AFLP that were admitted to the intensive care unit with fetal demise and MOF.
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Affiliation(s)
- Sai Saran
- Department of Critical Care Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Saumitra Misra
- Department of Critical Care Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Suhail Sarwar Siddiqui
- Department of Critical Care Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Avinash Agrawal
- Department of Critical Care Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Mohan Gurjar
- Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ajay Kumar Patwa
- Department of Medicine, Division of Gastromedicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Syed Nabeel Muzaffar
- Department of Critical Care Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
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27
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Patel NM, Yamada N, Oliveira FRMB, Stiehler L, Zechendorf E, Hinkelmann D, Kraemer S, Stoppe C, Collino M, Collotta D, Alves GF, Ramos HP, Sordi R, Marzi I, Relja B, Marx G, Martin L, Thiemermann C. Inhibition of Macrophage Migration Inhibitory Factor Activity Attenuates Haemorrhagic Shock-Induced Multiple Organ Dysfunction in Rats. Front Immunol 2022; 13:886421. [PMID: 35464452 PMCID: PMC9019168 DOI: 10.3389/fimmu.2022.886421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/14/2022] [Indexed: 12/13/2022] Open
Abstract
Objective The aim of this study was to investigate (a) macrophage migration inhibitory factor (MIF) levels in polytrauma patients and rats after haemorrhagic shock (HS), (b) the potential of the MIF inhibitor ISO-1 to reduce multiple organ dysfunction syndrome (MODS) in acute (short-term and long-term follow-up) HS rat models and (c) whether treatment with ISO-1 attenuates NF-κB and NLRP3 activation in HS. Background The MODS caused by an excessive systemic inflammatory response following trauma is associated with a high morbidity and mortality. MIF is a pleiotropic cytokine which can modulate the inflammatory response, however, its role in trauma is unknown. Methods The MIF levels in plasma of polytrauma patients and serum of rats with HS were measured by ELISA. Acute HS rat models were performed to determine the influence of ISO-1 on MODS. The activation of NF-κB and NLRP3 pathways were analysed by western blot in the kidney and liver. Results We demonstrated that (a) MIF levels are increased in polytrauma patients on arrival to the emergency room and in rats after HS, (b) HS caused organ injury and/or dysfunction and hypotension (post-resuscitation) in rats, while (c) treatment of HS-rats with ISO-1 attenuated the organ injury and dysfunction in acute HS models and (d) reduced the activation of NF-κB and NLRP3 pathways in the kidney and liver. Conclusion Our results point to a role of MIF in the pathophysiology of trauma-induced organ injury and dysfunction and indicate that MIF inhibitors may be used as a potential therapeutic approach for MODS after trauma and/or haemorrhage.
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Affiliation(s)
- Nikita M Patel
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Noriaki Yamada
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.,Gifu University Graduate School of Medicine, Department of Emergency and Disaster Medicine Gifu University Hospital Advanced Critical Care Center, Gifu, Japan
| | - Filipe R M B Oliveira
- Department of Pharmacology, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Lara Stiehler
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.,Department of Intensive Care and Intermediate Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Elisabeth Zechendorf
- Department of Intensive Care and Intermediate Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Daniel Hinkelmann
- Department of Intensive Care and Intermediate Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Sandra Kraemer
- Department of Intensive Care and Intermediate Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Christian Stoppe
- Department of Anesthesiology & Intensive Care Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Massimo Collino
- Department of Neurosciences "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Debora Collotta
- Department of Neurosciences "Rita Levi Montalcini", University of Turin, Turin, Italy
| | | | - Hanna Pillmann Ramos
- Department of Pharmacology, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Regina Sordi
- Department of Pharmacology, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Ingo Marzi
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Borna Relja
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.,Experimental Radiology, Department of Radiology and Nuclear Medicine, Otto-von-Guericke University, Magdeburg, Germany
| | - Gernot Marx
- Department of Intensive Care and Intermediate Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Lukas Martin
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.,Department of Intensive Care and Intermediate Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Christoph Thiemermann
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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28
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Xu F, Liu C, Zhou Q, Ma F. Effects of sequential blood purification on the organ function and lethality in patients with paraquat-induced multiple organ dysfunction syndrome. Am J Transl Res 2022; 14:1818-1825. [PMID: 35422907 PMCID: PMC8991169] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 01/22/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To explore the efficacy of sequential blood purification in paraquat (PQ) poisoning-induced multiple organ dysfunction syndrome (MODS). METHODS Forty-six patients with MODS caused by PQ poisoning admitted to our hospital during January 2016-December 2020 were retrospectively enrolled. The patients were allocated into the experimental group (n = 20) and the control group (n = 26) in accordance with the different treatment methods of blood purification. The experimental group was given sequential blood purification, and the control group was given separate blood purification. The two groups were compared in terms of blood biochemical indices, inflammatory factor levels, level of organ injury and treatment efficiency. RESULTS The blood biochemical indices and inflammatory factor levels after treatment were noticeably reduced in both groups (P < 0.05), and the experimental group exhibited lower alanine aminotransferase, MB isoenzyme of creatine kinase, creatinine and blood urea nitrogen than the control group at 3 and 5 days after treatment (P < 0.05). The experimental group exhibited remarkably lower aspartate aminotransferase, lactate dehydrogenase, interleukin-6 and tumor necrosis factor-α levels, and noticeably higher interleukin-10 levels than the control group at 5 days after treatment (P < 0.05). After treatment, the experimental group showed remarkably lower overall organ damage rate (10%) than the control group (58.69%). After treatment, the two groups exhibited remarkably lower disease severity than that before treatment (P < 0.05). At 5 days after treatment, the experimental group showed remarkably lower Acute Physiology and Chronic Health Evaluation II score than the control group (P < 0.05). The experimental group showed noticeably shorter duration of mechanical ventilation, length of coma, intensive care unit stay and hospital stay than the control group after treatment (P < 0.05). The experimental group showed a remarkably higher overall efficiency of treatment (90%) than the control group (76.92%). CONCLUSION Compared with blood purification therapy alone, sequential blood purification therapy can improve the indices of liver function and coma status, suppress the inflammatory response, reduce the APACHE II score, and shorten the overall duration of treatment of patients with PQ poisoning-induced MODS.
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Affiliation(s)
- Fei Xu
- Department of Emergency, 3201 Hospital of Xi’an Jiaotong University Health Science CenterHanzhong 723000, Shaanxi Province, China
| | - Chao Liu
- Department of Emergency, 3201 Hospital of Xi’an Jiaotong University Health Science CenterHanzhong 723000, Shaanxi Province, China
| | - Qiaozhi Zhou
- Department of Emergency, 3201 Hospital of Xi’an Jiaotong University Health Science CenterHanzhong 723000, Shaanxi Province, China
| | - Fei Ma
- Department of Emergency, Hanzhong Center HospitalHanzhong 723000, Shaanxi Province, China
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29
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Zhao W, Li H, Li J, Xu B, Xu J. The mechanism of multiple organ dyfunction syndrome in patients with COVID-19. J Med Virol 2022; 94:1886-1892. [PMID: 35088424 PMCID: PMC9015222 DOI: 10.1002/jmv.27627] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/07/2022] [Accepted: 01/22/2022] [Indexed: 01/06/2023]
Abstract
In late 2019, an outbreak of coronavirus disease 2019 (COVID‐19) arose, caused by severe acute respiratory syndrome coronavirus type 2 (SARS‐CoV‐2). This disease rapidly became a public health event of international concern. In addition to the most typical symptoms of dyspnea, numerous patients with COVID‐19 exhibited systemic symptoms, such as cardiovascular disease, liver and kidney failure, and disorders in coagulation. At present, clinical data indicates that numerous patients who are critically ill die from multiple organ dysfunction syndromes (MODS). Moreover, the entry of SARS‐CoV‐2 into cells causing severe pathology and progressive organ failure is precisely mediated by the human angiotensin‐converting enzyme 2 protein. This plays a role in maintaining both fluid and electrolyte homeostasis, ensuring the stability of the internal environment. Therefore, the present review aimed to investigate the pathogenesis of MODS caused by SARS‐CoV‐2 infection based on the current clinical data and previous studies. Inflammatory factor storm, oxidative stress, and disseminated intravascular coagulation cause multiple organ dysfunction syndromes (MODS) in coronavirus disease 2019 patients. Angiotensin‐converting enzyme 2 (ACE2) protein, closely related to viral infection, mediates organ damage and causes MODS. Aging, underlying disease, and obesity downregulate ACE2 and may exacerbate MODS.
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Affiliation(s)
- Wenbin Zhao
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Hanmeng Li
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, 310053, China.,Cixi Maternity&Child Health Care Hospital, Ningbo, 315300, China
| | - Jianghua Li
- The First Afiliated Hospital of Shihezi University School of Medicine Xinjiang Shihezi
| | - Bin Xu
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China
| | - Jian Xu
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, 310053, China
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30
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Ding M, Zhang Y, Xu W, Fang C, Zhang K. MicroRNA-200b-3p as a biomarker for diagnosis and survival prognosis of multiple organ dysfunction syndrome caused by acute paraquat poisoning. Hum Exp Toxicol 2022; 41:9603271221094008. [PMID: 35442113 DOI: 10.1177/09603271221094008] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Acute paraquat poisoning-induced multiple organ dysfunction syndrome (MODS) leads to the high mortality. This study aimed to investigate the clinical significance of microRNA-200b-3p (miR-200b-3p), an upstream inhibitor of high-mobility group box 1 (HMGB1), in acute paraquat poisoning patients for the prediction of MODS and survival. METHODS This study enrolled 80 patients with MODS induced by paraquat and 94 healthy volunteers. The interaction between miR-200b-3p and HMGB1 was identified by luciferase reporter assay. miR-200b-3p levels were measured by quantitative real-time (QRT) PCR. High-mobility group box 1 levels were measured by enzyme-linked immune sorbent assay (ELISA). Receiver operating characteristic analysis was used to evaluate the diagnostic value of miR-200b-3p in screening MODS patients. The relationship between miR-200b-3p and the 28-day survival of MODS patients was evaluated by Kaplan-Meier curves and log-rank test. Cox regression analysis was used to assess the prognostic value of miR-200b-3p. Correlation between miR-200b-3p and HMGB1 was confirmed by Pearson's correlation analysis. RESULTS miR-200b-3p directly target HMGB1. miR-200b-3p, decreased in MODS patients, had high diagnostic value to screen MODS patients from healthy controls. Additionally, serum miR-200b-3p was decreased in non-survivors, and patients with low miR-200b-3p level had poor 28-day survival. Serum miR-200b-3p could independently predict the survival prognosis. Moreover, serum HMGB1 level was increased in MODS patients, and was negatively correlated with miR-200b-3p level. CONCLUSION Decreased miR-200b-3p may function as a biomarker for the diagnosis and survival prognosis of MODS patients, and miR-200b-3p may be involved in the progression of acute paraquat-induced MODS via regulating inflammatory responses by targeting HMGB1.
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Affiliation(s)
- Minggang Ding
- Emergency Department, 155177Qingdao Hospital of Traditional Chinese Medicine (Qingdao Hiser hospital), Qingdao, Shandong, China
| | - Yi Zhang
- Emergency Department, 155177Qingdao Hospital of Traditional Chinese Medicine (Qingdao Hiser hospital), Qingdao, Shandong, China
| | - Weijun Xu
- Emergency Department, 155177Qingdao Hospital of Traditional Chinese Medicine (Qingdao Hiser hospital), Qingdao, Shandong, China
| | - Chongtao Fang
- Emergency Department, 155177Qingdao Hospital of Traditional Chinese Medicine (Qingdao Hiser hospital), Qingdao, Shandong, China
| | - Kaitai Zhang
- Emergency Department, 155177Qingdao Hospital of Traditional Chinese Medicine (Qingdao Hiser hospital), Qingdao, Shandong, China
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Abstract
Thrombotic microangiopathies (TMA) are a group of disorders characterized by generalized microvascular occlusion, thrombocytopenia, and microangiopathic hemolytic anemia, which may present with organ dysfunction. These include hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP) among others. The triad of anemia, thrombocytopenia, and acute kidney injury is the hallmark of HUS. It can be associated with Shiga toxin-producing Escherichia coli infection, complement-mediated (atypical HUS), coagulation or metabolism-mediated (predominantly in children of less than one year of age), or secondary HUS with the coexisting disease. HUS is a potentially fatal condition irrespective of its cause, and hence the diagnosis and management approach must be swift. The treatment is support-based; however, in severe cases, the use of plasmapheresis has shown favorable outcomes. In this report, we discuss a case of a 30-year-old male who presented with acalculous acute pancreatitis with HUS, a rare case of secondary HUS previously reported in a few case reports.
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Affiliation(s)
- Francisco Adragão
- Internal Medicine, Centro Hospitalar Universitário Do Algarve - Unidade Hospitalar de Portimão, Portimão, PRT
| | - Inês Nabais
- Internal Medicine, Hospital de Cascais Dr. José de Almeida, Cascais, PRT
| | - Rúben Reis
- Internal Medicine, Centro Hospitalar Barreiro Montijo, Barreiro, PRT
| | - Bernardo Pereira
- Critical Care Medicine, Hospital de Cascais Dr. José de Almeida, Cascais, PRT
| | - Armindo Ramos
- Critical Care Medicine, Hospital de Cascais Dr. José de Almeida, Cascais, PRT
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32
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Bonaroti J, Abdelhamid S, Kar U, Sperry J, Zamora R, Namas RA, McKinley T, Vodovotz Y, Billiar T. The Use of Multiplexing to Identify Cytokine and Chemokine Networks in the Immune-Inflammatory Response to Trauma. Antioxid Redox Signal 2021; 35:1393-1406. [PMID: 33860683 PMCID: PMC8905234 DOI: 10.1089/ars.2021.0054] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Significance: The immunoinflammatory responses that follow trauma contribute to clinical trajectory and patient outcomes. While remarkable advances have been made in trauma services and injury management, clarity on how the immune system in humans responds to trauma is lagging. Recent Advances: Multiplexing platforms have transformed our ability to analyze comprehensive immune mediator responses in human trauma. In parallel, with the establishment of large data sets, computational methods have been adapted to yield new insights based on mediator patterns. These efforts have added an important data layer to the emerging multiomic characterization of the human response to injury. Critical Issues: Outcome after trauma is greatly affected by the host immunoinflammatory response. Excessive or sustained responses can contribute to organ damage. Hence, understanding the pathophysiology behind traumatic injury is of vital importance. Future Directions: This review summarizes our work in the study of circulating immune mediators in trauma patients. Our foundational studies into dynamic patterns of inflammatory mediators represent an important contribution to the concepts and computational challenges that these large data sets present. We hope to see further integration and understanding of multiomics strategies in the field of trauma that can aid in patient endotyping and in potentially identifiying certain therapeutic targets in the future. Antioxid. Redox Signal. 35, 1393-1406.
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Affiliation(s)
- Jillian Bonaroti
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Pittsburgh Trauma Research Center, Division of Trauma and Acute Care Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sultan Abdelhamid
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Pittsburgh Trauma Research Center, Division of Trauma and Acute Care Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Upendra Kar
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Pittsburgh Trauma Research Center, Division of Trauma and Acute Care Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jason Sperry
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Pittsburgh Trauma Research Center, Division of Trauma and Acute Care Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ruben Zamora
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Center for Inflammation and Regeneration Modeling, McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rami Ahmd Namas
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Center for Inflammation and Regeneration Modeling, McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Todd McKinley
- Department of Orthopedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Yoram Vodovotz
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Pittsburgh Trauma Research Center, Division of Trauma and Acute Care Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Timothy Billiar
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Pittsburgh Trauma Research Center, Division of Trauma and Acute Care Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Tu J, Tu L, Jiang Y, Fu H, Mai Z, Wu X, Xu B. Sepsis Due to Bloodstream Ralstonia mannitolilytica Infection After Surgical Treatment of Perianal Abscess: A Case Report. Infect Drug Resist 2021; 14:4441-4445. [PMID: 34737584 PMCID: PMC8560170 DOI: 10.2147/idr.s329588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/07/2021] [Indexed: 11/23/2022] Open
Abstract
Background Ralstonia mannitolilytica can cause opportunistic infections. Reports on this pathogen identified in the bloodstream are rare worldwide, especially in China. Case Description We describe a 48-year-old man who developed sepsis due to bloodstream Ralstonia mannitolilytica infection after surgery for a perianal abscess. His condition deteriorated into multiple organ dysfunction syndromes until susceptible antibiotics (ceftriaxone and levofloxacin) were administrated based on the drug sensitivity test results. The patient had a satisfactory recovery with no complications during a 6-month follow-up period. Conclusion Ralstonia mannitolilytica blood-borne infection in patients evolves rapidly. The inconsistent sensitivity to antibiotics makes timely treatment difficult and can lead to serious complications. We report the clinical presentations and treatment outcomes for this patient here to remind clinicians about this rare opportunistic pathogen and to highlight the importance of bacterial culture, especially for immunocompromised patients.
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Affiliation(s)
- Jiamin Tu
- Department of Proctology, University of Chinese Academy of Science Shenzhen Hospital (GuangMing), Shenzhen, 518100, People's Republic of China
| | - Lei Tu
- Department of Proctology, University of Chinese Academy of Science Shenzhen Hospital (GuangMing), Shenzhen, 518100, People's Republic of China
| | - Yinping Jiang
- Department of Chinese Medicine, University of Chinese Academy of Science Shenzhen Hospital (GuangMing), Shenzhen, 518100, People's Republic of China
| | - Honghao Fu
- Department of Proctology, University of Chinese Academy of Science Shenzhen Hospital (GuangMing), Shenzhen, 518100, People's Republic of China
| | - Zijuan Mai
- Department of Medical Record Statistics Section, University of Chinese Academy of Science Shenzhen Hospital (GuangMing), Shenzhen, 518100, People's Republic of China
| | - Xianglin Wu
- Department of Laboratory, University of Chinese Academy of Science Shenzhen Hospital (GuangMing), Shenzhen, 518100, People's Republic of China
| | - Bing Xu
- Department of Proctology, University of Chinese Academy of Science Shenzhen Hospital (GuangMing), Shenzhen, 518100, People's Republic of China
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Sun GD, Zhang Y, Mo SS, Zhao MY. Multiple Organ Dysfunction Syndrome Caused by Sepsis: Risk Factor Analysis. Int J Gen Med 2021; 14:7159-7164. [PMID: 34737610 PMCID: PMC8559339 DOI: 10.2147/ijgm.s328419] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/28/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To analyze the risk factors of multiple organ dysfunction syndromes (MODS) caused by sepsis. Patients and Methods A total of 180 patients with sepsis admitted to The First Affiliated Hospital of Harbin Medical University (No. 23, Post Street, Nangang District, Harbin 150001, Heilongjiang province, China) from July 2018 to June 2019 were selected and divided into a non-MODS group and a MODS group, with 90 cases in each group. Clinical data of the patients were retrospectively analyzed, and univariable and multivariable analyses were performed. Results The univariable analysis showed that there were no significant differences in terms of age, body temperature, heart rate, respiration, mean arterial pressure, RBC specific volume, blood sodium, serum kalium, and infection site (P > 0.05). Whereas significant differences were found between the groups in terms of gender, arterial blood pH, WBC count, Apache II score, blood glucose, creatinine, chronic medical history, surgery, and ventilator usage (P < 0.05). The growth of bacterial culture, the increase of creatinine level, chronic diseases and Apache II score were discovered to have significant effects on the occurrence of MODS through the multivariable logistic regression analysis. Conclusion Bacterial culture, serum creatinine level, history of chronic disease and Apache II score may be risk factors of MODS in sepsis patients.
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Affiliation(s)
- Guo-Dong Sun
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, Heilongjiang Province, People's Republic of China
| | - Yang Zhang
- Department of Nursing, Central Hospital of Heilongjiang Province Prison, Harbin, 150001, Heilongjiang Province, People's Republic of China
| | - Shan-Shan Mo
- Pharmacy Department of Heilongjiang Sailors General Hospital, Harbin, 150001, Heilongjiang Province, People's Republic of China
| | - Ming-Yan Zhao
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, Heilongjiang Province, People's Republic of China
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35
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Dai Y, Liu X, Gao Y. Aberrant miR-219-5p is correlated with TLR4 and serves as a novel biomarker in patients with multiple organ dysfunction syndrome caused by acute paraquat poisoning. Int J Immunopathol Pharmacol 2021; 34:2058738420974888. [PMID: 33233960 PMCID: PMC7691899 DOI: 10.1177/2058738420974888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
This study aimed to investigate the clinical significance of serum
microRNA-219-5p (miR-219-5p) in patients with multiple organ dysfunction
syndrome (MODS) caused by acute paraquat (PQ) poisoning, and its correlation
with Toll-like Receptor 4 (TLR4). Luciferase reporter assay was used to
investigate in vitro the correlation of miR-219-5p with TLR4. Serum miR-219-5p
levels were evaluated by quantitative real-time polymerase chain reaction. Serum
levels of TLR4, IL-1β, and TNF-α were measured by Enzyme-linked immune sorbent
assay (ELISA). ROC analysis was performed to assess the diagnostic significance,
Kaplan-Meier survival curves and Cox regression analysis were used to evaluate
the prognostic value of miR-219-5p in MODS patients. TLR4 was a target gene of
miR-219-5p and was increased in MODS patients. Serum miR-219-5p level was
decreased and negatively correlated with TLR4 level in MODS patients
(r = −0.660, P < 0.001), which had
important diagnostic value and negatively correlated with APACHE II score in
MODS patients. The miR-219-5p expression was markedly associated with the WBC,
ALT, AST, PaCO2, Lac, and APACHE II score. Non-survivals had more
patients with low miR-219-5p expression. Patients with low miR-219-5p expression
had shorter survival time. MiR-219-5p and APACHE II score were two independently
prognostic factors for 28-day survival. MiR-219-5p was negatively correlated
with, while TLR4 was positively correlated with the levels of IL-1β and TNF-α.
The serum miR-219-5p level may be a potential biomarker for acute PQ-induced
MODS diagnosis and prognosis. Furthermore, miR-219-5p may be associated with the
progression of MODS by regulating TLR4-related inflammatory response.
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Affiliation(s)
- Yunxiang Dai
- Emergency Department, Qingdao Jiaozhou Central Hospital, Qingdao, Shandong, China
| | - Xia Liu
- Radiology Department, Qingdao Jiaozhou Central Hospital, Qingdao, Shandong, China
| | - Yuming Gao
- Emergency Department, Qingdao Jiaozhou Central Hospital, Qingdao, Shandong, China
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Zhou H, Li Z, Liang H, Yan Z. Thrombocytopenia and platelet count recovery in patients with sepsis-3: a retrospective observational study. Platelets 2021; 33:612-620. [PMID: 34448680 DOI: 10.1080/09537104.2021.1970124] [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] [Indexed: 10/20/2022]
Abstract
Thrombocytopenia is common in critical illness. But there are no studies that focus on thrombocytopenia and platelet recovery in Sepsis-3 patients. We employed a large database to identify sepsis based on Sepsis-3 criteria. Patients were grouped by nadir platelet count during ICU, propensity score matching was used to eliminate covariates imbalance, multivariable cox proportional hazard model was used for evaluating mortality. A total of 9709 patients were enrolled based on Sepsis-3, 1794 (18%) patients developed thrombocytopenia, with 858 (8.8%) exhibiting thrombocytopenia at ICU admission (prevalent), 891 (9.2%) developed thrombocytopenia during ICU stay (incident). In the incident thrombocytopenia group, survivors exhibited higher nadir platelet count, higher rate in platelet count recovery and shorter time to platelet recovery compared to non-survivors. Platelet recovery was not observed until 1 days (IQR, 1-2) after weaning of mechanical ventilation and 1 days (IQR, 1-3) after discontinuation of vasopressor in survivors of incident thrombocytopenia. Furthermore, thrombocytopenia was associated with longer duration of ICU length of stay, longer duration of mechanical ventilation and vasopressor use compared to no thrombocytopenia. Moderate (20-50 × 109/L) and severe (<20 × 109/L) thrombocytopenia group showed increased 28 days mortality compared to no thrombocytopenia, while the mortality rate between mild (51-100 × 109/L) and no thrombocytopenia group (≥100 × 109/L) showed no significant difference. Taken together these data revealed that thrombocytopenia occurred in 18% Sepsis-3 patients; platelet recovery occurred more frequent and earlier in survivors; platelet recovery was not observed until clinical improvement. Thrombocytopenia in Sepsis-3 demonstrated increased disease severity, and patients with platelet count <50 × 109/L showed increased 28 days mortality.
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Affiliation(s)
- Hui Zhou
- Department of Critical Care Medicine,Nanfang Hospital, Southern Medical University, Guangzhou, China.,Department of Anesthesiology, Nanfang Hospital,Southern Medical University, Guangzhou, China
| | - Zhifeng Li
- Department of Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou, China
| | - Hui Liang
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, Wuchang, Hubei Province, China
| | - Zhengzheng Yan
- Department of Anesthesiology, Nanfang Hospital,Southern Medical University, Guangzhou, China
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Abstract
Diquat is a widely used herbicide that is substituted for paraquat. With paraquat off the market, cases of diquat poisoning have been gradually increasing. The kidney is the most frequently impaired organ in diquat poisoning. Few cases of multiple organ failure caused by diquat have been reported. We herein describe a 30-year-old man who orally ingested about 160 mL of enriched diquat. Despite aggressive treatment, the patient’s condition progressed to multiple organ failure and death. The pulmonary lesions in this patient were different from those previously reported. This patient did not die of renal failure but of severe respiratory failure. He exhibited three different stages of pulmonary disease. The lung lesions in this case were unique. We hope that doctors will pay more attention to the lung lesions in patients with diquat poisoning in future and find new treatment methods to save the lives of such patients.
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Affiliation(s)
- Yanxia Huang
- Department of Critical Care Medicine, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Renjing Zhang
- Department of Critical Care Medicine, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Mei Meng
- Department of Critical Care Medicine, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Dechang Chen
- Department of Critical Care Medicine, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Yunxin Deng
- Department of Critical Care Medicine, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
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Umscheid JH, Nguyen KM, Vasudeva R, Agasthya N. Neonatal Appendicitis Presenting as Bilious Emesis and Septic Shock. Kans J Med 2021; 14:130-132. [PMID: 34084272 PMCID: PMC8158418 DOI: 10.17161/kjm.vol1414990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/22/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Jacob H Umscheid
- Department of Pediatrics, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Khai M Nguyen
- University of Kansas School of Pharmacy, Wichita, KS
| | - Rhythm Vasudeva
- Department of Pediatrics, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Nisha Agasthya
- Department of Pediatrics, University of Kansas School of Medicine-Wichita, Wichita, KS
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Ye R, Mai Z, Pan X, Cai S, Deng L. Acute fatty liver of pregnancy causes severe acute pancreatitis and stillborn fetus: A case report. Medicine (Baltimore) 2021; 100:e25524. [PMID: 33879692 PMCID: PMC8078285 DOI: 10.1097/md.0000000000025524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/25/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Acutefatty liver of pregnancy (AFLP) is a potentially fatal obstetric emergency characterized by acute hepatic failure secondary to fatty infiltration. The resultant effects include coagulopathy, electrolyte abnormalities, and multisystem organ dysfunction. Pancreatitis typically develops after the onset of renal and hepatic dysfunction. Pancreatitis has been suggested as a poor prognostic indicator because it is associated with more adverse outcomes. PATIENT CONCERNS A 29-year-old Chinese woman at 34.7 weeks pregnancy was admitted to hospital due to paroxysmal hypogastric pain and massive colporrhagia for 1 day. DIAGNOSIS Laboratory tests revealed hepatic and renal impairment, coagulopathy. Thoracoabdominal computed tomography (CT) scanning showed pleural and peritoneal effusion, fatty liver, and pancreatitis. She was diagnosed with AFLP, severe acute pancreatitis (SAP), multiple organ dysfunction syndrome (MODS), and intrauterine fetal death. INTERVENTIONS The patient was treated with blood component transfusions, plasma exchange combined with renal replacement therapy, antibiotic de-escalation, gastric and pancreatic secretion inhibitor, and enteral nutrition. OUTCOMES After successful management, the patient was discharged without any complications on day 35 of admission. At 10 months follow-up, thoracoabdominal enhanced CT revealed was normal and laboratory tests revealed normal liver and kidney function. LESSONS Once AFLP is highly suspected or confirmed, the pregnancy should be terminated in time and active symptomatic management should be given.
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Merkle JE, Boudreaux B, Langohr I, Hegler A, Ryan K, Fletcher J. Thyroid storm in a dog secondary to thyroid carcinoma. J Vet Emerg Crit Care (San Antonio) 2021; 31:428-431. [PMID: 33792155 DOI: 10.1111/vec.13051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/29/2018] [Revised: 06/29/2019] [Accepted: 07/09/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the clinical presentation, clinical course, and management of a dog with thyroid storm (TS) secondary to a functional thyroid carcinoma. CASE SUMMARY A 12-year-old neutered female Golden Retriever was evaluated for severe weight loss, hyperthermia, and tachycardia. The dog had a ventral neck mass and markedly increased thyroxine concentration. Cervical ultrasound showed a suspected left thyroid mass with invasion into the jugular vein. Despite aggressive therapy, the patient progressed to a clinical TS. Postmortem examination was supportive of the clinical diagnosis. NEW OR UNIQUE INFORMATION PROVIDED To the authors' knowledge, this is the first report of TS in a dog.
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Affiliation(s)
- Jennifer E Merkle
- Department of Veterinary Clinical Sciences, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Bonnie Boudreaux
- Department of Veterinary Clinical Sciences, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Ingeborg Langohr
- Department of Pathobiological Sciences, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Ashley Hegler
- Department of Veterinary Clinical Sciences, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Kirk Ryan
- Department of Veterinary Clinical Sciences, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Jon Fletcher
- Department of Veterinary Clinical Sciences, Louisiana State University, Baton Rouge, Louisiana, USA
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41
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Spoto S, Agrò FE, Sambuco F, Travaglino F, Valeriani E, Fogolari M, Mangiacapra F, Costantino S, Ciccozzi M, Angeletti S. High value of mid-regional proadrenomedullin in COVID-19: A marker of widespread endothelial damage, disease severity, and mortality. J Med Virol 2021; 93:2820-2827. [PMID: 33200824 PMCID: PMC7753433 DOI: 10.1002/jmv.26676] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/14/2020] [Accepted: 11/13/2020] [Indexed: 01/06/2023]
Abstract
The widespread endothelial damage due to severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) may lead to a disruption of the adrenomedullin (ADM) system responsible for vascular leakage, increased inflammatory status, and microvascular alteration with multi‐organs dysfunction. The aim of this study was to evaluate the role of mid‐regional proadrenomedullin (MR‐proADM) as a marker of SARS‐CoV2 related widespread endothelial damage, clinically identified by organs damage, disease severity and mortality. Patients with SARS‐CoV‐2 infection has been prospectively enrolled and demographic characteristic, clinical and laboratory data has been evaluated. In the overall population, 58% developed acute respiratory distress syndrome (ARDS), 23.3% of patients died, 6.5% acute cardiac injury, 1.4% of patients developed acute ischemic stroke, 21.2% acute kidney injury, 11.8% acute liver damage, and 5.4% septic shock. The best MR‐proADM cut‐off values for ARDS development and mortality prediction were 3.04 and 2 nmol/L, respectively. Patients presenting with MR‐proADM values ≥2 nmol/L showed a significantly higher mortality risk. In conclusion, MR‐proADM values ≥2 nmol/L identify those patients with high mortality risk related to a multiorgan dysfunction syndrome. These patients must be carefully evaluated and considered for an intensive therapeutic approach.
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Affiliation(s)
- Silvia Spoto
- Diagnostic and Therapeutic Medicine Department, University Campus Bio-Medico of Rome, Rome, Italy
| | - Felice E Agrò
- Intensive Care and Pain Management, Department of Anesthesia, University Campus Bio-Medico of Rome, Rome, Italy
| | - Federica Sambuco
- Emergency Department, University Campus Bio-Medico of Rome, Rome, Italy
| | | | - Emanuele Valeriani
- Diagnostic and Therapeutic Medicine Department, University Campus Bio-Medico of Rome, Rome, Italy
| | - Marta Fogolari
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy
| | - Fabio Mangiacapra
- Unit of Cardiovascular Science, University Campus Bio-Medico of Rome, Rome, Italy
| | - Sebastiano Costantino
- Diagnostic and Therapeutic Medicine Department, University Campus Bio-Medico of Rome, Rome, Italy
| | - Massimo Ciccozzi
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, Rome, Italy
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Leimanis-Laurens M, Gil D, Kampfschulte A, Krohn C, Prentice E, Sanfilippo D, Prokop JW, Lydic TA, Rajasekaran S. The Feasibility of Studying Metabolites in PICU Multi-Organ Dysfunction Syndrome Patients over an 8-Day Course Using an Untargeted Approach. Children (Basel) 2021; 8:151. [PMID: 33670443 DOI: 10.3390/children8020151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/07/2021] [Accepted: 02/11/2021] [Indexed: 12/14/2022]
Abstract
Metabolites are generated from critical biological functions and metabolism. This pediatric study reviewed plasma metabolites in patients suffering from multi-organ dysfunction syndrome (MODS) in the pediatric intensive care unit (PICU) using an untargeted metabolomics approach. Patients meeting the criteria for MODS were screened for eligibility and consented (n = 24), and blood samples were collected at baseline, 72 h, and 8 days; control patients (n = 4) presented for routine sedation in an outpatient setting. A subset of MODS patients (n = 8) required additional support with veno-atrial extracorporeal membrane oxygenation (VA-ECMO) therapy. Metabolites from thawed blood plasma were determined from ion pairing reversed-phase liquid chromatography–mass spectrometry (LC-MS) analysis. Chromatographic peak alignment, identification, relative quantitation, and statistical and bioinformatics evaluation were performed using MAVEN and MetaboAnalyst 4.0. Metabolite analysis revealed 115 peaks per sample. From the partial least squares-discriminant analysis (PLS-DA) with variance of importance (VIP) scores above ≥2.0, 7 dynamic metabolites emerged over the three time points: tauro-chenodeoxycholic acid (TCDCA), hexose, p-hydroxybenzoate, hydroxyphenylacetic acid (HPLA), 2_3-dihydroxybenzoic acid, 2-keto-isovalerate, and deoxyribose phosphate. After Bonferroni adjustment for repeated measures, hexose and p-hydroxybenzoate were significant at one time point or more. Kendall’s tau-b test was used for internal validation of creatinine. Metabolites may be benign or significant in describing a patient’s pathophysiology and require operator interpretation.
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43
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Chalkias A, Barreto EF, Laou E, Kolonia K, Scheetz MH, Gourgoulianis K, Pantazopoulos I, Xanthos T. A Critical Appraisal of the Effects of Anesthetics on Immune-system Modulation in Critically Ill Patients With COVID-19. Clin Ther 2021; 43:e57-e70. [PMID: 33549310 PMCID: PMC7833032 DOI: 10.1016/j.clinthera.2021.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/26/2020] [Accepted: 01/02/2021] [Indexed: 02/07/2023]
Abstract
Purpose The aim of the present article was to briefly summarize current knowledge about the immunomodulatory effects of general anesthetics and the possible clinical effects of this immunomodulation in patients with COVID-19. Methods The PubMed, Scopus, and Google Scholar databases were comprehensively searched for relevant studies. Findings The novel coronavirus causes a wide spectrum of clinical manifestations, with a large absolute number of patients experiencing severe pneumonia and rapid progression to acute respiratory distress syndrome and multiple organ failure. In these patients, the equilibrium of the inflammatory response is a major determinant of survival. The impact of anesthetics on immune-system modulation may vary and includes both pro-inflammatory and anti-inflammatory effects. Implications Inhibition of the development of severe inflammation and/or the enhancement of inflammation resolution by anesthetics may limit organ damage and improve outcomes in patients with COVID-19.
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Affiliation(s)
- Athanasios Chalkias
- Faculty of Medicine, Department of Anesthesiology, School of Health Sciences, University of Thessaly, Larisa, Greece.
| | - Erin F Barreto
- Department of Pharmacy, Mayo Clinic, Rochester, MN, USA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Eleni Laou
- Faculty of Medicine, Department of Anesthesiology, School of Health Sciences, University of Thessaly, Larisa, Greece
| | - Konstantina Kolonia
- Faculty of Medicine, Department of Anesthesiology, School of Health Sciences, University of Thessaly, Larisa, Greece
| | - Marc H Scheetz
- Department of Pharmacy Practice, Chicago College of Pharmacy, Midwestern University, Downers Grove, IL, USA; Pharmacometrics Center of Excellence, Chicago College of Pharmacy, Midwestern University, Downers Grove, IL, USA; Department of Pharmacology, College of Graduate Studies, Midwestern University, Downers Grove, IL, USA
| | - Konstantinos Gourgoulianis
- Faculty of Medicine, Department of Respiratory Medicine, School of Health Sciences, University of Thessaly, Larisa, Greece
| | - Ioannis Pantazopoulos
- Faculty of Medicine, Department of Emergency Medicine, School of Health Sciences, University of Thessaly, Larisa, Greece
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Cao G, Wu Y, Zhao Y, Wang L, Zhang Y. Assessment of extravascular lung water by measuring the number of pulmonary ultrasound B-lines before and after CBP in patients with MODS. Medicine (Baltimore) 2021; 100:e24181. [PMID: 33429806 PMCID: PMC7793418 DOI: 10.1097/md.0000000000024181] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 12/14/2020] [Indexed: 01/05/2023] Open
Abstract
To determine whether the change in the number of pulmonary ultrasound B-line can accurately assess the extravascular lung water (EVLW) before and after continuous bedside blood purification (CBP) in patients with multiple organ dysfunction syndrome (MODS).Seventy-six patients with MODS who underwent CBP were examined within 24 hours before and after CBP using pulmonary ultrasound to detect the number of ultrasound B-line or using pulse indicator continuous cardiac output method to examine extravascular lung water, blood oxygenation index, and B-type natriuretic peptide (BNP) content. The correlation of the change in the number of B lines before and after CBP treatment with the negative balance of 24 hours liquid, the change of oxygenation index, and BNP content were analyzed.In the 76 patients, CBP treatment significantly decreased EVLW, the number of B-line, and BNP (P < .05 for all), while it significantly increased the oxygenation index (P < .05). Correlation analysis showed that the decrease in B-line number after CBP treatment was positively correlated with the 24 hours negative lung fluid balance, decrease of EVLW, oxygenation index improvement, and decreased BNP content. The change in the numbers of pulmonary ultrasound B-line can accurately assess the change of EVLW before and after CBP treatment and reflect the efficiency of ventilation in the lungs and the risk of heart failure.Thus, it can replace pulse indicator continuous cardiac output as an indicator for evaluating EVLW in patients with MODS treated with CBP.
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Affiliation(s)
| | - Yu Wu
- Department of Nephrology, Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University
| | | | - Ling Wang
- Department of Nephrology, Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University
| | - Yang Zhang
- School of Anesthesiology, Xuzhou Medical University, Xuzhou, China
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Clements TW, Tolonen M, Ball CG, Kirkpatrick AW. Secondary Peritonitis and Intra-Abdominal Sepsis: An Increasingly Global Disease in Search of Better Systemic Therapies. Scand J Surg 2021; 110:139-149. [PMID: 33406974 DOI: 10.1177/1457496920984078] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 02/06/2023]
Abstract
Secondary peritonitis and intra-abdominal sepsis are a global health problem. The life-threatening systemic insult that results from intra-abdominal sepsis has been extensively studied and remains somewhat poorly understood. While local surgical therapy for perforation of the abdominal viscera is an age-old therapy, systemic therapies to control the subsequent systemic inflammatory response are scarce. Advancements in critical care have led to improved outcomes in secondary peritonitis. The understanding of the effect of secondary peritonitis on the human microbiome is an evolving field and has yielded potential therapeutic targets. This review of secondary peritonitis discusses the history, classification, pathophysiology, diagnosis, treatment, and future directions of the management of secondary peritonitis. Ongoing clinical studies in the treatment of secondary peritonitis and the open abdomen are discussed.
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Affiliation(s)
- T W Clements
- Foothills Medical Centre, Department of Critical Care Medicine and Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - M Tolonen
- HUS Helsinki University Hospital, Helsinki, Finland
| | - C G Ball
- Foothills Medical Centre, Department of Critical Care Medicine and Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - A W Kirkpatrick
- Foothills Medical Centre, Department of Critical Care Medicine and Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Canadian Forces Medical Services, University of Calgary, Calgary, AB, Canada
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46
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McKeone DJ, DeMartini TKM, Kavanagh RP, Halstead ES. Case Report: Rapid Recognition and Immune Modulation of Secondary HLH Due to Disseminated HSV Infection. Front Pediatr 2021; 9:681055. [PMID: 34277520 PMCID: PMC8282902 DOI: 10.3389/fped.2021.681055] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/26/2021] [Indexed: 11/23/2022] Open
Abstract
We describe the case of a newborn who presented with multiple organ dysfunction syndrome (MODS) and hyperferritinemia, who eventually met criteria for hemophagocytic lymphohistiocytosis (HLH) due to disseminated herpes simplex virus 1 (HSV-1). While the cytokine storm abated after administration of multiple immune modulatory therapies including dexamethasone, etoposide, intravenous immune globulin, anakinra, as well as the interferon gamma antagonist emapalumab, multiple organ dysfunction syndrome progressed. Care was withdrawn after 5 days. Subsequent genetic testing did not reveal any mutations associated with familial HLH. This case highlights that even with appropriate antiviral treatment and immune suppression, disseminated HSV is often fatal. Further study is warranted to determine whether early immune modulatory therapy including interferon gamma blockade can interrupt the HLH inflammatory cascade and prevent progression of MODS.
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Affiliation(s)
- Daniel J McKeone
- Penn State University College of Medicine, Hershey, PA, United States
| | | | - Robert P Kavanagh
- Penn State University College of Medicine, Hershey, PA, United States
| | - E Scott Halstead
- Penn State University College of Medicine, Hershey, PA, United States
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47
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Lindell RB, Wolf MS, Alcamo AM, Silverman MA, Dulek DE, Otto WR, Olson TS, Kitko CL, Paueksakon P, Chiotos K. Case Report: Immune Dysregulation Due to Toxoplasma gondii Reactivation After Allogeneic Hematopoietic Cell Transplant. Front Pediatr 2021; 9:719679. [PMID: 34447731 PMCID: PMC8382793 DOI: 10.3389/fped.2021.719679] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/08/2021] [Indexed: 11/23/2022] Open
Abstract
Disseminated toxoplasmosis is an uncommon but highly lethal cause of hyperferritinemic sepsis after hematopoietic cell transplantation (HCT). We report two cases of disseminated toxoplasmosis from two centers in critically ill adolescents after HCT: a 19-year-old who developed fever and altered mental status on day +19 after HCT and a 20-year-old who developed fever and diarrhea on day +52 after HCT. Both patients developed hyperferritinemia with multiple organ dysfunction syndrome and profound immune dysregulation, which progressed to death despite maximal medical therapies. Because disseminated toxoplasmosis is both treatable and challenging to diagnose, it is imperative that intensivists maintain a high index of suspicion for Toxoplasma gondii infection when managing immunocompromised children, particularly in those with known positive T. gondii serologies.
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Affiliation(s)
- Robert B Lindell
- Department of Anesthesia and Critical Care Medicine, Division of Critical Care Medicine, Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Michael S Wolf
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Monroe Carell Jr. Children's Hospital at Vanderbilt and the Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Alicia M Alcamo
- Department of Anesthesia and Critical Care Medicine, Division of Critical Care Medicine, Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Michael A Silverman
- Department of Pediatrics, Division of Infectious Diseases, Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Daniel E Dulek
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Monroe Carell Jr. Children's Hospital at Vanderbilt and the Vanderbilt University School of Medicine, Nashville, TN, United States
| | - William R Otto
- Department of Pediatrics, Division of Infectious Diseases, Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Timothy S Olson
- Department of Pediatrics, Division of Oncology, Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Carrie L Kitko
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, Monroe Carell Jr. Children's Hospital at Vanderbilt and the Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Paisit Paueksakon
- Department of Pathology, Microbiology, and Immunology, Monroe Carell Jr. Children's Hospital at Vanderbilt and the Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Kathleen Chiotos
- Department of Anesthesia and Critical Care Medicine, Division of Critical Care Medicine, Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States.,Department of Pediatrics, Division of Infectious Diseases, Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
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48
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Komara NL, Paragomi P, Greer PJ, Wilson AS, Breze C, Papachristou GI, Whitcomb DC. Severe acute pancreatitis: capillary permeability model linking systemic inflammation to multiorgan failure. Am J Physiol Gastrointest Liver Physiol 2020; 319:G573-G583. [PMID: 32877220 PMCID: PMC8087347 DOI: 10.1152/ajpgi.00285.2020] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Severe acute pancreatitis (SAP) includes persistent systemic inflammation (SIRS) and multiorgan failure (MOF). The mechanism of transition from SIRS to MOF is unclear. We developed a fluid compartment model and used clinical data to test predictions. The model includes vascular, interstitial and "third-space" compartments with variable permeability of plasma proteins at the capillaries. Consented patients from University of Pittsburgh Medical Center Presbyterian Hospital were studied. Preadmission and daily hematocrit (HCT), blood urea nitrogen (BUN), creatine (Cr), albumin (Alb), and total protein (TP) were collected, and nonalbumin plasma protein (NAPP = TP minus the Alb) was calculated. Subjects served as their own controls for trajectory analysis. Of 57 SAP subjects, 18 developed MOF (5 died), and 39 were non-MOF (0 died). Compared with preadmission levels, admission HCT increased in MOF +5.00 [25%-75% interquartile range, IQR] versus non-MOF -0.10 [-1.55, 1.40] (P < 0.002) with HCT > +3 distinguishing MOF from non-MOF (odds ratio 17.7, P = 0.014). Preadmission Alb fell faster in MOF than non-MOF (P < 0.01). By day 2, TP and NAPP dropped in MOF but not non-MOF (P < 0.001). BUN and Cr levels increased in MOF (P = 0.001), but BUN-to-Cr ratios remained constant. Pancreatic necrosis was more common in MOF (56%) than non-MOF (23%). Changing capillary permeability to allow loss of NAPP in this model predicts loss of plasma oncotic pressure and reduced vascular volume, hypotension with prerenal azotemia and acute kidney dysfunction, pancreas necrosis, and pulmonary edema from capillary leak in the lung with acute respiratory distress syndrome. Sequential biomarker analysis in humans with or without MOF is consistent with this model. This study is registered on https://clinicaltrials.gov at NCT03075605.NEW & NOTEWORTHY Acute pancreatitis is a sudden inflammatory response to pancreatic injury that may spread to systemic inflammation, multiorgan failure, and death in some patients. With the use of the predictions of a new mechanistic model, we compared patients with severe acute pancreatitis with or without multiorgan failure. All biomarkers of capillary leak and clinical features of multiorgan failure were accurately predicted. This provides a new paradigm for understanding and developing new treatments for patients with severe acute pancreatitis.
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Affiliation(s)
- Nicole L. Komara
- 1Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Pedram Paragomi
- 1Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Phil J. Greer
- 1Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anette S. Wilson
- 1Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Georgios I. Papachristou
- 1Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - David C. Whitcomb
- 1Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania,3Departments of Cell Biology and Molecular Physiology, University of Pittsburgh, Pittsburgh, Pennsylvania,4Department of Human Genetics, University of Pittsburgh, Pittsburgh, Pennsylvania
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Carlton EF, Close J, Paice K, Dews A, Gorga SM, Sturza J, Barbaro RP, Cornell TT, Prescott HC. Clinician Accuracy in Identifying and Predicting Organ Dysfunction in Critically Ill Children. Crit Care Med 2020; 48:e1012-e1019. [PMID: 32804793 PMCID: PMC7959260 DOI: 10.1097/ccm.0000000000004555] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To determine clinician accuracy in the identification and prediction of multiple organ dysfunction syndrome. DESIGN Prospective cohort study. SETTING University of Michigan's C.S. Mott Children's Hospital PICU. PATIENTS Patients admitted to the PICU with an anticipated PICU length of stay greater than 48 hours. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS For each patient, the clinical team (attending, fellow, resident/nurse practitioner) was surveyed regarding existing and anticipated organ dysfunction. The primary outcomes were clinicians' accuracy at identifying multiple organ dysfunction syndrome and predicting new or progressive multiple organ dysfunction syndrome, compared to the objective assessment of multiple organ dysfunction syndrome using Proulx criteria. We also measured sensitivity, specificity, negative and positive predictive values, and negative and positive likelihood ratios of clinician assessments. We tested for differences in accuracy by clinician type using chi-square tests. Clinicians rated their confidence in prediction on a 5-point Likert scale. There were 476 eligible PICU admissions, for whom 1,218 surveys were completed. Multiple organ dysfunction syndrome was present in 89 patients (18.7%) at enrollment, and new or progressive multiple organ dysfunction syndrome occurred in 39 (8.2%). Clinicians correctly identified multiple organ dysfunction syndrome with 79.9% accuracy and predicted additional organ dysfunction with 82.6% accuracy. However, the positive and negative likelihood ratios for new or progressive multiple organ dysfunction syndrome prediction were 3.0 and 0.7, respectively, indicating a weak relationship between the clinician prediction and development of new or progressive multiple organ dysfunction syndrome. The positive predictive value of new or progressive multiple organ dysfunction syndrome prediction was just 22.1%. We found no differences in accuracy by clinician type for either identification of multiple organ dysfunction syndrome (80.2% vs 78.2% vs 81.0%; p = 0.57) or prediction of new or progressive multiple organ dysfunction syndrome (84.8% vs 82.8% vs 80.3%; p = 0.26) for attendings, fellows, and residents/nurse practitioners, respectively. There was a weak correlation between the confidence and accuracy of prediction (pairwise correlation coefficient, 0.26; p < 0.001). CONCLUSIONS PICU clinicians correctly identified multiple organ dysfunction syndrome and predicted new or progressive multiple organ dysfunction syndrome with 80% accuracy. However, only 8% of patients developed new or progressive multiple organ dysfunction syndrome, so accuracy was largely due to true negative predictions. The positive predictive value for new or progressive multiple organ dysfunction syndrome prediction was just 22%. Accuracy did not differ by clinician type, but was correlated with self-rated confidence and was higher for negative predictions.
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Affiliation(s)
- Erin F. Carlton
- Department of Pediatrics, Division of Critical Care Medicine, University of Michigan, Ann Arbor, MI
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, MI
| | - Jeylan Close
- Department of Pediatrics, University of Michigan, Ann Arbor, MI
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Kelli Paice
- Department of Pediatrics, University of Michigan, Ann Arbor, MI
| | - Alyssa Dews
- College of Literature, Science and the Arts, University of Michigan, Ann Arbor, MI
| | - Stephen M. Gorga
- Department of Pediatrics, Division of Critical Care Medicine, University of Michigan, Ann Arbor, MI
| | - Julie Sturza
- Department of Pediatrics, University of Michigan, Ann Arbor, MI
| | - Ryan P. Barbaro
- Department of Pediatrics, Division of Critical Care Medicine, University of Michigan, Ann Arbor, MI
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, MI
| | - Timothy T. Cornell
- Department of Pediatrics, Division of Critical Care Medicine, Stanford University, Palo Alto, CA
| | - Hallie C. Prescott
- Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI
- VA Center for Clinical Management Research, HSR&D Center of Innovation, Ann Arbor, MI
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50
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Li LJ, Yang GH. [Establishment of An Improved Rat Model of Sepsis Induced by Cecal Ligation and Puncture]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2020; 42:468-476. [PMID: 32895098 DOI: 10.3881/j.issn.1000-503x.11686] [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] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective To establish an improved animal model of sepsis induced by cecal ligation and puncture(CLP). Methods Ninety-six male Sprague-Dawley rats were randomly divided into sham operation group(n=24),intubation group(n=24),CLP group(n=24),and CLP+intubation group(n=24).The mortality rate,abdominal cavity condition,pathological changes and pathological scores of heart,lungs,liver,and kidneys of rats in each group were observed after modeling.Blood samples were obtained from the inferior vena cava for measuring the whole blood cells(WBC)and platelets(PLT)counts and analyzing serum interleukin(IL)-6,tumor necrosis factor(TNF)-α,serum troponin T(cTnT),creatine kinase-MB(CK-MB),alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),creatinine(CREA),and blood urea nitrogen(BUN)levels.Blood gas analysis of the aorta was also performed. Results The mortality rates 24 h after modeling were 0 in sham operation group and intubation group,20.8% in CLP group,and 54.2% in CLP+intubation group.Pathologically,swelling and inflammatory cell infiltration in the heart,lungs,liver,and kidneys were seen in the CLP+intubation group,inflammatory cell infiltration in a single organ was seen in most rats in the CLP group,and no obvious swelling and infiltration of inflammatory cells was observed in the sham-operation group and intubation group.The myocardial histopathology score,lung tissue injury pathology score,and kidney tissue injury pathology score in both the sham-operation group and the intubation group were significantly lower than those in the CLP group and the CLP+intubation group(all P=0.000).TNF-α,PaO2,CK-MB,cTnT,AST,TBIL,BUN,and CREA were significantly different between sham-operation group and intubation group/CLP group/CLP+intubation group and between intubation group and CLP group/CLP+intubation group(all P=0.000).The pH level was significantly different between sham operation group and intubation group/CLP group,between intubation group and CLP group/CLP+intubate group(all P=0.000). Conclusions Although both CLP and CLP+intubation can well mimic the pathophysiological mechanism of sepsis in rats,multiple organ dysfunction occurs in the latter.Thus,CLP+intubation can establish animal models of multiple organ dysfunction caused by sepsis induced by clinically effective abdominal infection.
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Affiliation(s)
- Li-Jun Li
- Clinical Medicine College of Guizhou Medical Unicersity,Guiyang 550001,China
| | - Guo-Hui Yang
- Intensive Care Unit,Affiliated Hospital of Guizhou Medical University,Guiyang 550001,China
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