Prevalence of life-sustaining treatment limitations in Polish very old intensive care patients (VIPs). A post-hoc analysis of two prospective observational studies

PURPOSE

Several initiatives have recently focused on raising awareness about limitations of treatment in Poland. We aimed to assess if the propensity to limit LST among elderly patients in 2018-2019 increased compared to 2016-2017.

METHODS

We analysed Polish cohorts from studies VIP1 (October 2016 - May 2017) and VIP2 (May 2018 - May 2019) that enrolled critical patients aged >80. We collected data on demographics, clinical features limitations of LST. Primary analysis assessed factors associated with prevalence of limitations of LST, A secondary analysis explored differences between patients with and without limitations of LST.

RESULTS

601 patients were enrolled. Prevalence of LST limitations was 16.1% in 2016-2017 and 20.5% in 2018-2019. No difference was found in univariate analysis (p = 0.22), multivariable model showed higher propensity towards limiting LST in the 2018-2019 cohort compared to 2016-2017 cohort (OR 1.07;95%CI, 1.01-1.14). There was higher mortality and a longer length of stay of patients with limitations of LST compared to the patients without limitations of LST. (11 vs. 6 days, p = 0.001).

CONCLUSIONS

The clinicians in Poland have become more proactive in limiting LST in critically ill patients ≥80 years old over the studied period, however the prevalence of limitations of LST in Poland remains low.

Frailty is associated with long-term outcome in patients with sepsis who are over 80 years old: results from an observational study in 241 European ICUs

BACKGROUND

Sepsis is one of the most frequent reasons for acute intensive care unit (ICU) admission of very old patients and mortality rates are high. However, the impact of pre-existing physical and cognitive function on long-term outcome of ICU patients ≥ 80 years old (very old intensive care patients (VIPs)) with sepsis is unclear.

OBJECTIVE

To investigate both the short- and long-term mortality of VIPs admitted with sepsis and assess the relation of mortality with pre-existing physical and cognitive function.

DESIGN

Prospective cohort study.

SETTING

241 ICUs from 22 European countries in a six-month period between May 2018 and May 2019.

SUBJECTS

Acutely admitted ICU patients aged ≥80 years with sequential organ failure assessment (SOFA) score ≥ 2.

METHODS

Sepsis was defined according to the sepsis 3.0 criteria. Patients with sepsis as an admission diagnosis were compared with other acutely admitted patients. In addition to patients' characteristics, disease severity, information about comorbidity and polypharmacy and pre-existing physical and cognitive function were collected.

RESULTS

Out of 3,596 acutely admitted VIPs with SOFA score ≥ 2, a group of 532 patients with sepsis were compared to other admissions. Predictors for 6-month mortality were age (per 5 years): Hazard ratio (HR, 1.16 (95% confidence interval (CI), 1.09-1.25, P < 0.0001), SOFA (per one-point): HR, 1.16 (95% CI, 1.14-1.17, P < 0.0001) and frailty (CFS > 4): HR, 1.34 (95% CI, 1.18-1.51, P < 0.0001).

CONCLUSIONS

There is substantial long-term mortality in VIPs admitted with sepsis. Frailty, age and disease severity were identified as predictors of long-term mortality in VIPs admitted with sepsis.

Protocol for a prospective cohort study on the use of clinical nutrition and assessment of long-term clinical and functional outcomes in critically ill adult patients

BACKGROUND AND AIMS

Limited data are available on the impact of clinical nutrition over the course of critical illness and post-discharge outcomes. The present study aims to characterize the use of nutrition support in patients admitted to European intensive care units (ICUs), and its impact on clinical outcomes. Here we present the procedures of data collection and evaluation.

METHODS

Around 100 medical, surgical, or trauma ICUs in 11 countries (Austria, Belgium, Czech Republic, Germany, France, Hungary, Italy, Poland, Spain, Sweden, United Kingdom) participate in the study. In defined months between November 2019 and April 2020, approximately 1250 patients are enrolled if staying in ICU for at least five consecutive days. Data from ICU day 1-4 are collected retrospectively, followed by a prospective observation period from day 5-90 after ICU admission. Data collection includes patient characteristics, nutrition parameters, complications, ICU and hospital length of stay, discharge status, and functional outcomes. For data analysis, the target is 1000 patients with complete data. Statistical analyses will be descriptive, with multivariate analyses adjusted for potential confounders to explore associations between nutritional balance and change in functional status, time-to-weaning from invasive mechanical ventilation, time to first clinical complication, and overall 15, 30 and 90-day survival.

ETHICS AND DISSEMINATION

This non-interventional study was reviewed and approved by the ethics committee of the Medical University Vienna, Vienna, Austria (approval number 1678/2019), and the respective ethical committees from participating sites at country and/or local level, as required. Results will be shared with investigators on a country level, and a publication and results presentation at the 2021 ESPEN Congress is planned.

TRIAL REGISTRATION

ClinicalTrials.gov identifier NCT04143503.

Clinical usefulness of the international renal research institute of vicenza (irriv) score in the intensive care subjects with renal failure: single-centre experience

OBJECTIVE

The aim: Acute kidney injury (AKI) is a common and clinically important condition that affects both kidney structure and function. International Renal Research Institute of Vicenza (IRRIV) score has been designed to enable early identification of patients who may require renal replacement therapy (RRT). We aimed to assess the usefulness of the IRRIV score in predicting the outcome in the intensive care unit (ICU) patients who may require renal replacement therapy (RRT).

PATIENTS AND METHODS

Material and Methods: This retrospective study screened 955 consecutive patients hospitalized in a mixed tertiary ICU between Jan 2015 and Jul 2018. Patients with sCr>3.5 mg/dl on the first 24 hours post-admission constituted the study group 1 (G1, n=54). Subjects who underwent RRT based on indications other than elevated sCr level were a study group 2 (G2, n=31). ICU mortality, a need for RRT and ICU length of stay (LoS) were the outcomes.

RESULTS

Results: Median IRRIV score was 5.5 points (IQR 4.5-6.5) in G1 and 3.5 points (IQR 3-5.5) in G2. IRRIV score poorly predicted the need for RRT implementation (AUC=0.652, 95%CI 0.510-0.776, P=0.048). The IRRIV score failed to predict mortality in both groups (G1: AUC=0.610, 95%CI 0.468-0.740, P=0.16; G2: AUC=0.530, 95%CI 0.343-0.710, P=0.79). No correlation was found between the score and ICU LoS (G1: R= -0.13, P=0.36; G2: R= -0.27, P=0.15).

CONCLUSION

Conclusions: The retrospective analysis of our regional data did not confirm the expected usefulness of the IRRIV score in predicting the need for RRT nor in the prognostication of the patients admitted to the ICU due to renal failure.

Non-Anaesthetic Effects of Volatile Anaesthetics: A Short Trip on the Sea of Translational Medicine

BACKGROUND

Volatile Anaesthetics (VA) are commonly used worldwide for induction and/or maintenance of general anaesthesia. They act in the central nervous system to reduce sensation and motor response during surgical and invasive diagnostic procedures. VAs also have some non-anaesthetic properties in the brain when administrated to patients at the extremes of age. Their biological impact on other organs should be taken into account during administration of anaesthesia.

OBJECTIVE

In this review we summarize the recent knowledge on the non-anaesthetic effects of inhaled halogenic ethers on cells and tissues.

RESULTS AND CONCLUSION

Exposure to VAs may promote lasting neuro-behavioural deficits in the brains of developing children and deterioration in cognitive performance in elderly individuals. Preconditioning with VAs can prevent or minimise tissue ischaemia in the heart and brain. VAs act as an antiinflammatory in response to tissue damage during surgery and may attenuate both local and systemic inflammatory response. Further research is needed to elucidate a link between laboratory findings and their possible effects in humans. Because many questions remain unanswered in this field, translational medicine should be more focused on safety in anaesthesia for the improvement public health.

Association between standard laboratory and functional tests of coagulation in dilutional coagulopathy: an in vitro study

Standard laboratory tests (SLTs) of coagulation are in common use in clinical practice. We aimed to determine the association between SLTs and functional tests of coagulation in blood samples diluted with balanced crystalloid and colloid solutions in an ex vivo setting. The study group comprised 32 healthy young male volunteers. Whole blood samples were diluted at a 4:1 ratio with balanced crystalloid (Plasmalyte®) and two balanced colloids, 6% hydroxyethyl starch 130/0.4 (Volulyte®) and succinylated gelatin (Geloplasma®). SLTs included aPTT (activated partial thromboplastin time), PT (prothrombin time), fibrinogen concentration (FIB), D-dimers and number of platelets (PLT). Platelet aggregation was determined using multiple electrode aggregometry (MEA) with TRAP (thrombin receptor activating protein-6) as an assay activator. Coagulation and fibrinolysis were assessed functionally using rotational thromboelastometry (ROTEM). We found correlation between aPTT and INTEM (i.e. intrinsic coagulation pathway screening test) clotting time (R = 0.38 to 0.77; P < 0.05) for both undiluted and diluted samples. FIB and PLT were shown to be correlated with alpha angle in both INTEM and EXTEM (i.e. extrinsic coagulation pathway screening test) (FIB: R = 0.38 to 0.69; P < 0.05; PLT: 0.41 to 0.56; P < 0.05) again for both undiluted and diluted samples. FIB and PLT were associated with clot formation time in both INTEM and EXTEM (FIB: R = -0.44 to -0.70; P < 0.05; PLT: -0.36 to -0.58; P < 0.05). MEA results shown no correlation with ROTEM findings. There was also no correlation between number of platelets and their function as determined by MEA. Fibrinogen concentration correlated positively with fibrinogen function as determined by FIBTEM (i.e. fibrinogen deficiency/dysfunction screening test) maximum clot firmness (R = 0.49 to 0.73; P < 0.05). ROTEM results were predominantly associated with fibrinogen concentration and number of platelets. When there is no access to functional tests, concentration of fibrinogen is the most reliable test of coagulation, also in the context of fluid-induced coagulopathy.

Reduced risk of myocardial infarct and revascularization following coronary artery bypass grafting compared with percutaneous coronary intervention in patients with chronic kidney disease

Coronary atherosclerotic disease is highly prevalent in chronic kidney disease (CKD). Although revascularization improves outcomes, procedural risks are increased in CKD, and unbiased data comparing coronary artery bypass grafting (CABG) and percutaneous intervention (PCI) in CKD are sparse. To compare outcomes of CABG and PCI in stage 3 to 5 CKD, we identified randomized trials comparing these procedures. Investigators were contacted to obtain individual, patient-level data. Ten of 27 trials meeting inclusion criteria provided data. These trials enrolled 3993 patients encompassing 526 patients with stage 3 to 5 CKD of whom 137 were stage 3b-5 CKD. Among individuals with stage 3 to 5 CKD, mortality through 5 years was not different after CABG compared with PCI (hazard ratio [HR] 0.99, 95% confidence interval [CI] 0.67-1.46) or stage 3b-5 CKD (HR 1.29, CI 0.68-2.46). However, CKD modified the impact on survival free of myocardial infarction: it was not different between CABG and PCI for individuals with preserved kidney function (HR 0.97, CI 0.80-1.17), but was significantly lower after CABG in stage 3-5 CKD (HR 0.49, CI 0.29-0.82) and stage 3b-5 CKD (HR 0.23, CI 0.09-0.58). Repeat revascularization was reduced after CABG compared with PCI regardless, of baseline kidney function. Results were limited by unavailability of data from several trials and paucity of enrolled patients with stage 4-5 CKD. Thus, our patient-level meta-analysis of individuals with CKD randomized to CABG versus PCI suggests that CABG significantly reduces the risk of subsequent myocardial infarction and revascularization without affecting survival in these patients.

Statistical agreement of left ventricle measurements using cardiac magnetic resonance and 2D echocardiography in ischemic heart failure

Background

The aim of this study was to compare cardiac magnetic resonance imaging (CMR) with 2-dimensional echocardiography (2D echo) in the assessment of left ventricle (LV) function parameters and mass in patients with ischemic heart disease and severely depressed LV function. Although 2D echo is commonly used to assess LV indices, CMR is the state-of-the-art technique. Agreement between these 2 methods in these patients has not been well established.

Material/Methods

LV indexed end systolic and diastolic volumes (EDVi and ESVi), indexed mass (LVMi) and ejection fraction (EF) were assessed in 67 patients (12 women), using 2D echo and CMR.

Results

According to statistical analysis (Bland-Altman), 2D echo underestimated LV EDV and ESV and overestimated EF and LVMi compared to CMR. The highest correlation between 2D echo and CMR was found for EDVi (R²=0.73, p<0.0001) and ESVi (R²=0.69, p<0.0001) and the lowest for EF (R²=0.21, p=0.001) and LVMi (R²=0.20, p=0.002). The maximal differences between 2D echo and CMR were found for highest mesurements of LV volumes and mass, and for lowest EF values.

Conclusions

There is moderate to strong correlation between CMR and 2D echo in the assessment of LV function parameters and mass in patients with ischemic heart failure. Between-method agreement depends on the degree of LV dysfunction. The results of assessment of the severely damaged LV obtained by the use of 2D echo should be interpreted with caution.

Treatment of hypertension in patients undergoing coronary artery by-pass grafting

Hypertension occurs in up to 80% of patients scheduled to coronary artery by-pass grafting (CABG). In hemodynamically stable patients all anti-hypertensive drugs should be continued till a day of surgery. For vast majority of patients there is no need to use blood pressure lowering agents during CABG, however it is necessary to maintain blood pressure level and avoid extreme blood pressure variations. Upon CABG hypotensive therapy should be modified to the needs of the individual patient and should be monitored individually. Treatment of hypertension ought to be started with caution with lowest possible dosage. Aggressive therapy is strongly discouraged to avoid hemodynamic collapse. Beta-blockers should be administered to all CABG patients unless contraindicated.

Quality of life in patients after minimally invasive endoscopic atraumatic coronary artery bypass grafting: a long-term follow-up

BACKGROUND

Quality of life (QoL) is an acknowledged parameter that subjectively describes treatment effectiveness and is used also in cardiac surgery. Minimally-invasive totally endoscopic atraumatic coronary artery bypass grafting (EACAB) does not require the use of cardiopulmonary bypass, reduces hospital stay and facilitates early rehabilitation. Therefore, this procedure should significantly improve QoL in patients with coronary artery disease.

AIM

To assess QoL during a 12-year follow-up in patients who underwent EACAB.

METHODS

The study group comprised 706 consecutive patients who underwent EACAB between April 1998 and December 2010. Median duration of follow-up was 1918 days. QoL was assessed by either telephone interview or letter correspondence. Complete data were obtained from 413 persons aged 59 ± 6 years. We evaluated the effect of pre- and postoperative variables on QoL.

RESULTS

Compared with the preoperative period, a marked improvement in QoL after EACAB was reported by 38.6%, and improvement by 37.2% of patients. No change in QoL was noted by 18.8% of subjects, and 5.4% of responders reported deterioration of QoL. The following parameters were found to have no impact on QoL: gender (p = 0.3), myocardial infarction (MI) before EACAB (p = 0.3), diabetes mellitus (p = 0.7), and baseline angina severity by the Canadian Cardiovascular Society (CCS) classification (p = 0.8). Time delay between the surgery and QoL assessment had no impact on the results. During the follow-up, reported QoL was related to the severity of angina symptoms (p = 0.006), need for rehospitalisation (p = 0.02), MI (p = 0.04) and repeated revascularisation (p = 0.02). In multivariate analysis, only MI had a significant impact on QoL (p = 0.04). Current drug therapy had no impact on QoL.

CONCLUSIONS

EACAB significantly improved QoL in coronary patients. MI during follow-up was associated with deterioration of QoL.

Assessment of data quality in an international multi-centre randomised trial of coronary artery surgery

Background

ART is a multi-centre randomised trial of cardiac surgery which provided a unique opportunity to evaluate the data from a large number of centres from a variety of countries. We attempted to assess data quality, including recruitment rates, timeliness and completeness of the data obtained from the centres in different socio-economic strata.

Methods

The analysis was based on the 2-page CRF completed at the 6 week follow-up. CRF pages were categorised into "clean" (no edit query) and "dirty" (any incomplete, inconsistent or illegible data). The timelines were assessed on the basis of the time interval from the visit and receipt of complete CRF. Data quality was defined as the number of data queries (in percent) and time delay (in days) between visit and receipt of correct data. Analyses were stratified according to the World Bank definitions into: "Developing" countries (Poland, Brazil and India) and "Developed" (Italy, UK, Austria and Australia).

Results

There were 18 centres in the "Developed" and 10 centres in the "Developing" countries. The rate of enrolment did not differ significantly by economic level ("Developing":4.1 persons/month, "Developed":3.7 persons/month). The time interval for the receipt of data was longer for "Developing" countries (median:37 days) compared to "Developed" ones (median:11 days) (p < 0.001). The median number of data queries was 23% in "Developed" countries compared to 19% in "Developing" ones (p = ns).

Conclusions

In this study we showed that data quality was comparable between centres from "Developed" and "Developing" countries. Data was received in a less timely fashion from Developing countries and appropriate systems should be instigated to minimize any delays. Close attention should be paid to the training of centres and to the central management of data quality.

Trial registration

ISRCTN46552265

[Late preterm infants--complications during the early period of adaptation]

A subgroup of more mature preterm infants, so-called "near term" ("late preterm") infants, 34 weeks 0/7 days to 36 weeks 6/7 days, have become the interest of countless research recently

OBJECTIVES

the aim of the study is the observation of more frequent occurrence of clinical problems in near-term infants in comparison with term infants.

METHODS

A retrospective review, conducted from January 1, 2008 to December 31, 2008, included 1271 neonatal records and subset analyses of 312 near-term infants and 812 full term infants.

RESULTS

Late preterm newborns were at higher risk of respiratory distress syndrome (p < 0.01), infections, (p = 0.00012) hyperbilirubinemia (p < 0.001), temperature instability (p < 0.001) and intraventricular hemorrhage (p < 0.001) than term infants. A prolonged infant stay at hospital (beyond 72 hours after vaginal delivery and 96 hours after a cesarean delivery) resulting from specific clinical problems was observed.

CONCLUSIONS

Even a little shortened period of pregnancy influences the adaptation period of the infants and increases the occurrence of clinical problems like respiratory distress syndrome, hyperbilirubinemia, infections, temperature instability and intraventricular hemorrhage, when comparing to term infants.

Effect of gender on efficacy of preoperative intra-aortic balloon pump in high risk patients undergoing surgical coronary revascularisation

BACKGROUND

There is no strong evidence supporting the use of preoperative intra-aortic balloon pump (IABP) in high-risk patients undergoing coronary artery bypass grafting (CABG). This issue has only been investigated in small studies which analysed the general population of patients, without focusing on specific subgroups, including gender.

AIM

We sought to determine if there is any benefit from preoperative IABP in high-risk patients undergoing CABG with the analysis of its determinants including gender.

METHODS

We randomly assigned 502 high-risk patients (351 men, 151 women) to the group receiving preoperative IABP support or to the control group with no preoperative IABP. Primary end-point was a major adverse cardiac or cerebrovascular event (MACCE), defined as death from any cause, myocardial infarction, cerebrovascular accident or repeat revascularisation within 30 days post-surgery.

RESULTS

A significant reduction of MACCE rate in patients with the preoperative IABP counterpulsation in comparison to controls was noticed in the total population of high risk patients (p=0.001) and in the female subgroup (p=0.005). After adjustment for baseline characteristics, the hazard ratio for MACCE was 0.7 (p=0.005) in the total population; 0.6 (p=0.01) for females and 0.8 (p=0.1) for males.

CONCLUSIONS

There is a beneficial effect of preoperative IABP use in high-risk patients undergoing CABG, particularly in women and patients with co-morbidities (diabetes, obesity, and peripheral vascular disease).

Intima-media thickness and flow-mediated dilatation in the diagnosis of coronary artery disease in perimenopausal women

INTRODUCTION

Noninvasive diagnosis of coronary artery disease (CAD) in perimenopausal women is a considerable challenge for the clinical practice.

OBJECTIVES

The aim of the study was to investigate whether ultrasound examination of the endothelial function and arterial remodeling can be useful for CAD risk assessment in perimenopausal women.

PATIENTS AND METHODS

The study involved 65 women with chest pain and positive stress test. Based on the results of coronary angiography, they were divided into 2 groups: a study group with coronary lesions (n = 32) and a control group without coronary lesions (n = 33). The mean age was 50.3 +/-3.2 years (study group: 50.3 +/-3.5 years; control group: 50.2 +/-3.0 years; P = 0.9). Atherosclerotic risk factors were analyzed in all patients. The ultrasound examination was used to assess early atherosclerotic remodeling of the artery by measuring the intima-media thickness (IMT) and endothelial dysfunction by measuring the flow-mediated dilatation (FMD).

RESULTS

The IMT was significantly higher in the study group compared with controls (0.059 +/-0.01 mm vs. 0.049 +/-0.01 mm, respectively; P <0.001); FMD was significantly lower in the study group compared with controls (6.53 +/-0.98 vs. 7.89 +/-0.85, respectively; P <0.001). For IMT, the area under the receiver operating characteristic curve (AUROC) was 0.73 (95% confidence interval [CI] 0.6-0.85; P <0.001); therefore, this parameter cannot be used as a predictor of CAD. FMD with the AUROC of 0.85 (95% CI 0.76-0.94; P <0.001) had a good predictive value for CAD.

CONCLUSIONS

Evaluation of IMT and FMD in perimenopausal women can be a useful noninvasive diagnostic tool for CAD risk assessment.

Diagnostic value of flow mediated dilatation measurement for coronary artery lesions in men under 45 years of age

BACKGROUND

In those without symptoms of coronary artery disease (CAD), the incidence of coronary events is still high. The aim of this study was to evaluate whether flow mediated dilatation (FMD) is a useful tool in identifying those with CAD in who are under 45 years of age.

METHODS AND RESULTS

Seventy five men below 45 years of age, hospitalized in order to perform elective coronary angiography, were enrolled into the study. Based on coronary angiography findings, they were divided into two groups: study group (Group A, n = 55) with obstructive coronary lesions and the control group (Group B, n = 20) without significant lesions in coronary arteries. In all subjects atherosclerosis risk factors were analyzed. Endothelial dysfunction was assessed in ultrasound via FMD. FMD was significantly lower in the study group than in the control group (3.92 +/- 1.1 vs 6.51 +/- 1.1, p < 0.001). FMD, as well as age, diabetes and positive family history, appeared to be statistically significant CAD risk factors. AUROC for FMD was 0.957 (p < 0.001), meaning this model had an almost complete ability to predict the presence of CAD. AUROC for CAD diagnosis on the basis of significant clinical parameters was 0.992 (p < 0.001), also representing almost complete ability of this model to identify asymptomatic subjects with CAD risk.

CONCLUSIONS

The evaluation of endothelial function by the use of FMD in the population of men below 45 years of age with diabetes and positive family history can help in identifying subjects at high risk of coronary artery disease.

Quality of life in young, professionally active men undergoing on-pump coronary artery bypass grafting--short-term follow-up results

BACKGROUND

The impact of coronary artery bypass grafting (CABG) on the quality of life (QoL) is one of the important measures of the efficacy of the procedure. This issue in young, professionally active male patients has not been extensively studied.

AIM

To assess QoL before and after on-pump CABG, and before and after cardiac rehabilitation in young men with low operative risk.

METHODS

The study group comprised 50 men aged 54.4 +/- 5.6 years who were professionally active before the surgery. The QoL was assessed on the basis of the MacNew questionnaire (in points). We analysed QoL changes and effects of basic demographic and peri-operative data on QoL during a short-term follow-up.

RESULTS

All components of QoL deteriorated shortly after CABG: emotional - from 4.97 +/- 0.96 to 4.66 +/- 1.0 (p = 0.03); physical - from 4.49 +/- 1.1 to 4.2 +/- 1.2 (p = 0.02); and social - from 4.68 +/- 1.0 to 4.47 +/- 1.1 (p = 0.1). Pre-operative physical and social QoL positively correlated with age (r = 0.45 and r = 0.37, respectively) and left ventricular ejection fraction (LVEF) (r = 0.49 and r = 0.48, respectively). However, there was a negative impact of history of myocardial infarction on physical QoL (p < 0.05). A negative influence of cardiopulmonary bypass time (r = -0.45) and cross-aortic clamp time (r = -0.36) on physical QoL was also noted. The QoL values were also influenced by class of angina symptoms (R = -0.33 / -0.42), total drainage (r = -0.11 / -0.34) and quantity of grafts (R = -0.35 / -0.42). During rehabilitation, QoL significantly improved: emotional - from 5.29 +/- 0.92 to 5.96 +/- 0.9 (p = 0.01); physical - from 4.66 +/- 1.1 to 5.42 +/- 1.2 (p < 0.01); and social - from 4.69 +/- 1.2 to 5.65 +/- 1.1 (p < 0.01). The QoL during rehabilitation was correlated with baseline peri-operative risk (for logistic EuroSCORE algorithm r = -0.21 / -0.31 and for EuroSCORE R = -0.47 / -0.89). Significant determinants of some components of QoL were also LVEF (r= 0.26 / 0.47), morphological blood parameters (r = 0.37 / 0.43), baseline CCS class (R = 0.31 / 0.58), age (r = -0.41 / -0.83), and extent of surgery defined by cardiopulmonary bypass time, cross-aortic clamp duration and total drainage.

CONCLUSIONS

Quality of life in young, professionally active men significantly deteriorates a few days after on-pump CABG but systematically improves during the next weeks, particularly after rehabilitation. Pre-operative QoL correlates positively with age and LVEF, and negatively with a history of myocardial infarction. Age, pre-operative risk, angina symptoms and the extent of surgery have negative effects on physical QoL after CABG during short-term observation.

No improvement in studies reporting the diagnostic accuracy of B-type natriuretic peptide

BACKGROUND

B-type natriuretic peptides (BNP and NT-proBNP) appeared as important tools for diagnosis, risk stratification, and therapeutic decision making in cardiovascular diseases. The aim of the study was to assess fulfillment of the QUADAS and major STARD criteria in B-type natriuretic peptide diagnostic accuracy studies and describe the relationship between the year of study publication. the journal's impact factor, and the quality of diagnostic accuracy.

MATERIAL/METHODS

In a cross-sectional study, electronic and manual searches of MEDLINE and EMBASE databases from January 2004 through April 2007 for diagnostic accuracy studies of BNP and NT-proBNP were performed. The quality of articles was assessed using of the 14-item QUADAS tool supplemented by a subjectively prepared list of 8 less reproducible STARD criteria (total of 22 possible points).

RESULTS

Twenty-eight articles suitable for analysis were found. The median number of points was 15. Only 2 of the 28 articles satisfied all 22 criteria. Clinical data availability was the only item described sufficiently in all papers. A flow diagram was found in only one paper. There were no differences in article quality in relation to the year of publication and no association between article quality and the impact factor of the journal in which it was published.

CONCLUSIONS

Imperfect quality of studies reporting the diagnostic accuracy of B-type natriuretic peptides is related to neither the year of publication nor the journal's impact factor. The problem of reporting diagnostic accuracy cannot be neglected, especially when a new index test becomes common in clinical practice.

Blood pressure variability in children with essential hypertension

The aim of this study was to assess blood pressure variability (BPV) and its determinants in untreated hypertensive children. The study group consisted of 124 children, 91 boys and 33 girls, aged 14.9+/-2.5 with essential hypertension and no use of antihypertensive drugs. The subjects underwent routine examination, blood tests and ambulatory blood pressure (BP) monitoring. BPV was defined as the value of the standard deviation of BP for day- and night time periods. Daytime BPV was higher than night time BPV, and systolic BPV was higher than diastolic BPV. Significant positive correlations between 24-h, day- and night time systolic blood pressure (SBP), but not for diastolic blood pressure (DBP), and BPV were observed. In univariate analysis, day- and night time systolic BPVs were correlated with fasting glucose (r=0.609, P=0.02 and r=0.439, P=0.04); daytime systolic BPV, daytime diastolic BPV and night time systolic BPV were correlated with birth length (r=0.428, P=0.04; r=0.426, P=0.04 and r=0.439, P=0.04, respectively), and night time systolic BPV and night time diastolic BPV were correlated with age (r=0.604, P=0.02 and r=0.833, P=0.0001). However, in multiple linear regression analysis, daytime diastolic BPV was determined only by gender and systolic 24-h BP; night time systolic BPV depended on age, daytime SBP and DBP values, and daytime SBP and DBPs were determinants of night time diastolic BPV. The results highlighted the complex nature of BPV, with favourable role of host factors in its aetiology. The determinants of BPV in children are consistent with those in adults. Relationships between BPV and its determinants in untreated hypertensive subjects ought to be investigated in further researches.