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Fragkou PC, Karagiannis SP, Dimopoulou D, Kefala S, Fligou F, Gallos P, Jahaj E, Bellou A, Koukaki E, Magira E, Orfanos P, Papathanakos G, Papathanasiou A, Pediaditis E, Pontikis K, Rovina N, Vaporidi K, Xenikakis M, Theodorakopoulou M, Kotanidou A. Intensive Care Unit Mortality Trends during the First Two Years of the COVID-19 Pandemic in Greece: A Multi-Center Retrospective Study. Viruses 2024; 16:488. [PMID: 38675831 PMCID: PMC11054592 DOI: 10.3390/v16040488] [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: 02/15/2024] [Revised: 03/14/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024] Open
Abstract
Data on COVID-19 mortality among patients in intensive care units (ICUs) from Eastern and/or Southern European countries, including Greece, are limited. The purpose of this study was to evaluate the ICU mortality trends among critically ill COVID-19 patients during the first two years of the pandemic in Greece and to further investigate if certain patients' clinical characteristics contributed to this outcome. We conducted a multi-center retrospective observational study among five large university hospitals in Greece, between February 2020 and January 2022. All adult critically ill patients with confirmed COVID-19 disease who required ICU admission for at least 24 h were eligible. In total, 1462 patients (66.35% males) were included in this study. The mean age of this cohort was 64.9 (±13.27) years old. The 28-day mortality rate was 35.99% (n = 528), while the overall in-hospital mortality was 50.96% (n = 745). Cox regression analysis demonstrated that older age (≥65 years old), a body mass index within the normal range, and a delay in ICU admission from symptom onset, as well as worse baseline clinical severity scores upon ICU admission, were associated with a greater risk of death. Mortality of critically ill COVID-19 patients was high during the first two years of the pandemic in Greece but comparable to other countries. Risk factors for death presented in this study are not different from those that have already been described for COVID-19 in other studies.
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Affiliation(s)
- Paraskevi C. Fragkou
- First Department of Critical Care and Pulmonary Diseases, Evangelismos General Hospital of Athens, National and Kapodistrian University of Athens, 10676 Athens, Greece; (S.P.K.); (E.J.); (E.M.); (M.T.); (A.K.)
| | - Sotirios P. Karagiannis
- First Department of Critical Care and Pulmonary Diseases, Evangelismos General Hospital of Athens, National and Kapodistrian University of Athens, 10676 Athens, Greece; (S.P.K.); (E.J.); (E.M.); (M.T.); (A.K.)
| | - Dimitra Dimopoulou
- Second Department of Pediatrics, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece;
| | - Sotiria Kefala
- Division of Anesthesiology and Intensive Care Medicine, School of Medicine, University of Patras, 26504 Patras, Greece; (S.K.); (F.F.); (A.B.)
| | - Fotini Fligou
- Division of Anesthesiology and Intensive Care Medicine, School of Medicine, University of Patras, 26504 Patras, Greece; (S.K.); (F.F.); (A.B.)
| | - Parisis Gallos
- Computational Biomedicine Laboratory, Department of Digital Systems, University of Piraeus, 18534 Piraeus, Greece;
| | - Edison Jahaj
- First Department of Critical Care and Pulmonary Diseases, Evangelismos General Hospital of Athens, National and Kapodistrian University of Athens, 10676 Athens, Greece; (S.P.K.); (E.J.); (E.M.); (M.T.); (A.K.)
| | - Angeliki Bellou
- Division of Anesthesiology and Intensive Care Medicine, School of Medicine, University of Patras, 26504 Patras, Greece; (S.K.); (F.F.); (A.B.)
| | - Evangelia Koukaki
- Intensive Care Unit, First Department of Respiratory Medicine, School of Medicine, National and Kapodistrian University of Athens, Sotiria Chest Hospital, 11527 Athens, Greece; (E.K.); (K.P.); (N.R.)
| | - Eleni Magira
- First Department of Critical Care and Pulmonary Diseases, Evangelismos General Hospital of Athens, National and Kapodistrian University of Athens, 10676 Athens, Greece; (S.P.K.); (E.J.); (E.M.); (M.T.); (A.K.)
| | - Philippos Orfanos
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Georgios Papathanakos
- Department of Intensive Care Medicine, University Hospital of Ioannina, 45500 Ioannina, Greece; (G.P.); (A.P.); (M.X.)
| | - Athanasios Papathanasiou
- Department of Intensive Care Medicine, University Hospital of Ioannina, 45500 Ioannina, Greece; (G.P.); (A.P.); (M.X.)
| | - Emmanouil Pediaditis
- Department of Intensive Care Unit, University Hospital of Heraklion, School of Medicine, University of Crete, 70013 Heraklion, Greece; (E.P.); (K.V.)
| | - Konstantinos Pontikis
- Intensive Care Unit, First Department of Respiratory Medicine, School of Medicine, National and Kapodistrian University of Athens, Sotiria Chest Hospital, 11527 Athens, Greece; (E.K.); (K.P.); (N.R.)
| | - Nikoletta Rovina
- Intensive Care Unit, First Department of Respiratory Medicine, School of Medicine, National and Kapodistrian University of Athens, Sotiria Chest Hospital, 11527 Athens, Greece; (E.K.); (K.P.); (N.R.)
| | - Katerina Vaporidi
- Department of Intensive Care Unit, University Hospital of Heraklion, School of Medicine, University of Crete, 70013 Heraklion, Greece; (E.P.); (K.V.)
| | - Menelaos Xenikakis
- Department of Intensive Care Medicine, University Hospital of Ioannina, 45500 Ioannina, Greece; (G.P.); (A.P.); (M.X.)
| | - Maria Theodorakopoulou
- First Department of Critical Care and Pulmonary Diseases, Evangelismos General Hospital of Athens, National and Kapodistrian University of Athens, 10676 Athens, Greece; (S.P.K.); (E.J.); (E.M.); (M.T.); (A.K.)
| | - Anastasia Kotanidou
- First Department of Critical Care and Pulmonary Diseases, Evangelismos General Hospital of Athens, National and Kapodistrian University of Athens, 10676 Athens, Greece; (S.P.K.); (E.J.); (E.M.); (M.T.); (A.K.)
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De Waele JJ, Coccolini F, Lagunes L, Maseda E, Rausei S, Rubio-Perez I, Theodorakopoulou M, Arvanti K. Optimized Treatment of Nosocomial Peritonitis. Antibiotics (Basel) 2023; 12:1711. [PMID: 38136745 PMCID: PMC10740749 DOI: 10.3390/antibiotics12121711] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/24/2023] [Accepted: 12/01/2023] [Indexed: 12/24/2023] Open
Abstract
This comprehensive review aims to provide a practical guide for intensivists, focusing on enhancing patient care associated with nosocomial peritonitis (NP). It explores the epidemiology, diagnosis, and management of NP, a significant contributor to the mortality of surgical patients worldwide. NP is, per definition, a hospital-acquired condition and a consequence of gastrointestinal surgery or a complication of other diseases. NP, one of the most prevalent causes of sepsis in surgical Intensive Care Units (ICUs), is often associated with multi-drug resistant (MDR) bacteria and high mortality rates. Early clinical suspicion and the utilization of various diagnostic tools like biomarkers and imaging are of great importance. Microbiology is often complex, with antimicrobial resistance escalating in many parts of the world. Fungal peritonitis and its risk factors, diagnostic hurdles, and effective management approaches are particularly relevant in patients with NP. Contemporary antimicrobial strategies for treating NP are discussed, including drug resistance challenges and empirical antibiotic regimens. The importance of source control in intra-abdominal infection management, including surgical and non-surgical interventions, is also emphasized. A deeper exploration into the role of open abdomen treatment as a potential option for selected patients is proposed, indicating an area for further investigation. This review underscores the need for more research to advance the best treatment strategies for NP.
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Affiliation(s)
- Jan J. De Waele
- Department of Intensive Care Medicine, Ghent University Hospital, 9000 Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, 56124 Pisa, Italy;
| | - Leonel Lagunes
- Vall d’Hebron Institut de Recerca CRIPS, 08035 Barcelona, Spain;
- Facultad de Medicina, Universidad Autónoma de San Luis Potosi, 78210 San Luis Potosi, Mexico
| | - Emilio Maseda
- Department of Anesthesia and Critical Care, Hospital Quironsalud Valle del Henares, 28850 Madrid, Spain;
- Department of Pharmacology and Toxicology, Complutense University of Madrid, 28040 Madrid, Spain
| | - Stefano Rausei
- General Surgery Unit, Department of Surgery, Cittiglio-Angera Hospital, ASST SetteLaghi, 21100 Varese, Italy;
| | - Ines Rubio-Perez
- Colorectal Surgery Unit, Department of General Surgery, Hospital Universitario La Paz, 28029 Madrid, Spain;
- Hospital La Paz Institute for Health Research (Idipaz), 28029 Madrid, Spain
- Universidad Autonoma de Madrid, 28029 Madrid, Spain
| | - Maria Theodorakopoulou
- 1st Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 10675 Athens, Greece;
| | - Kostoula Arvanti
- Department of Intensive Care Medicine, Papageorgiou Hospital, 54646 Thessaloniki, Greece;
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Papadopoulou A, Karavalakis G, Papadopoulou E, Xochelli A, Bousiou Z, Vogiatzoglou A, Papayanni PG, Georgakopoulou A, Giannaki M, Stavridou F, Vallianou I, Kammenou M, Varsamoudi E, Papadimitriou V, Giannaki C, Sileli M, Stergiouda Z, Stefanou G, Kourlaba G, Gounelas G, Triantafyllidou M, Siotou E, Karaglani A, Zotou E, Chatzika G, Boukla A, Papalexandri A, Koutra MG, Apostolou D, Pitsiou G, Morfesis P, Doumas M, Karampatakis T, Kapravelos N, Bitzani M, Theodorakopoulou M, Serasli E, Georgolopoulos G, Sakellari I, Fylaktou A, Tryfon S, Anagnostopoulos A, Yannaki E. SARS-CoV-2-specific T cell therapy for severe COVID-19: a randomized phase 1/2 trial. Nat Med 2023; 29:2019-2029. [PMID: 37460756 DOI: 10.1038/s41591-023-02480-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 06/28/2023] [Indexed: 07/22/2023]
Abstract
Despite advances, few therapeutics have shown efficacy in severe coronavirus disease 2019 (COVID-19). In a different context, virus-specific T cells have proven safe and effective. We conducted a randomized (2:1), open-label, phase 1/2 trial to evaluate the safety and efficacy of off-the-shelf, partially human leukocyte antigen (HLA)-matched, convalescent donor-derived severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific T cells (CoV-2-STs) in combination with standard of care (SoC) in patients with severe COVID-19 compared to SoC during Delta variant predominance. After a dose-escalated phase 1 safety study, 90 participants were randomized to receive CoV-2-ST+SoC (n = 60) or SoC only (n = 30). The co-primary objectives of the study were the composite of time to recovery and 30-d recovery rate and the in vivo expansion of CoV-2-STs in patients receiving CoV-2-ST+SoC over SoC. The key secondary objective was survival on day 60. CoV-2-ST+SoC treatment was safe and well tolerated. The study met the primary composite endpoint (CoV-2-ST+SoC versus SoC: recovery rate 65% versus 38%, P = 0.017; median recovery time 11 d versus not reached, P = 0.052, respectively; rate ratio for recovery 1.71 (95% confidence interval 1.03-2.83, P = 0.036)) and the co-primary objective of significant CoV-2-ST expansion compared to SοC (CoV-2-ST+SoC versus SoC, P = 0.047). Overall, in hospitalized patients with severe COVID-19, adoptive immunotherapy with CoV-2-STs was feasible and safe. Larger trials are needed to strengthen the preliminary evidence of clinical benefit in severe COVID-19. EudraCT identifier: 2021-001022-22 .
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Affiliation(s)
- Anastasia Papadopoulou
- Hematopoietic Cell Transplantation Unit, Department of Hematology Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece
| | - George Karavalakis
- Hematopoietic Cell Transplantation Unit, Department of Hematology Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Efthymia Papadopoulou
- Department of Respiratory Medicine, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Aliki Xochelli
- Department of Immunology, National Peripheral Histocompatibility Center, Hippokration General Hospital, Thessaloniki, Greece
| | - Zoi Bousiou
- Hematopoietic Cell Transplantation Unit, Department of Hematology Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece
| | | | - Penelope-Georgia Papayanni
- Hematopoietic Cell Transplantation Unit, Department of Hematology Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece
- Department of Genetics, Development and Molecular Biology, School of Biology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aphrodite Georgakopoulou
- Hematopoietic Cell Transplantation Unit, Department of Hematology Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece
- Department of Genetics, Development and Molecular Biology, School of Biology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Giannaki
- Hematopoietic Cell Transplantation Unit, Department of Hematology Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Fani Stavridou
- Hematopoietic Cell Transplantation Unit, Department of Hematology Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Ioanna Vallianou
- Hematopoietic Cell Transplantation Unit, Department of Hematology Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Maria Kammenou
- Hematopoietic Cell Transplantation Unit, Department of Hematology Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Evangelia Varsamoudi
- Hematopoietic Cell Transplantation Unit, Department of Hematology Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Vasiliki Papadimitriou
- Hematopoietic Cell Transplantation Unit, Department of Hematology Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Chrysavgi Giannaki
- 'A' Intensive Care Unit, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Maria Sileli
- 'B' Intensive Care Unit, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Zoi Stergiouda
- Department of Anesthesiology, George Papanikolaou Hospital, Thessaloniki, Greece
| | | | - Georgia Kourlaba
- Department of Nursing, University of Peloponnese, Tripolis, Greece
| | | | - Maria Triantafyllidou
- Hematopoietic Cell Transplantation Unit, Department of Hematology Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Eleni Siotou
- Hematopoietic Cell Transplantation Unit, Department of Hematology Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece
| | | | - Eleni Zotou
- Hematopoietic Cell Transplantation Unit, Department of Hematology Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece
- Department of Genetics, Development and Molecular Biology, School of Biology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgia Chatzika
- Department of Immunology, National Peripheral Histocompatibility Center, Hippokration General Hospital, Thessaloniki, Greece
| | - Anna Boukla
- Department of Immunology, National Peripheral Histocompatibility Center, Hippokration General Hospital, Thessaloniki, Greece
| | - Apostolia Papalexandri
- Hematopoietic Cell Transplantation Unit, Department of Hematology Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Maria-Georgia Koutra
- Hematopoietic Cell Transplantation Unit, Department of Hematology Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Dimitra Apostolou
- Department of Respiratory Failure, George Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgia Pitsiou
- Department of Respiratory Failure, George Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Petros Morfesis
- 1st Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michalis Doumas
- 2nd Propedeutic Department of Internal Medicine, Hippokrateio Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | - Militsa Bitzani
- 'A' Intensive Care Unit, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Maria Theodorakopoulou
- National and Kapodistrian University of Athens, Evaggelismos General Hospital, Athens, Greece
| | - Eva Serasli
- Department of Respiratory Medicine, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Grigorios Georgolopoulos
- Hematopoietic Cell Transplantation Unit, Department of Hematology Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Ioanna Sakellari
- Hematopoietic Cell Transplantation Unit, Department of Hematology Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Asimina Fylaktou
- Department of Immunology, National Peripheral Histocompatibility Center, Hippokration General Hospital, Thessaloniki, Greece
| | - Stavros Tryfon
- Department of Respiratory Medicine, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Achilles Anagnostopoulos
- Hematopoietic Cell Transplantation Unit, Department of Hematology Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Evangelia Yannaki
- Hematopoietic Cell Transplantation Unit, Department of Hematology Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece.
- Department of Medicine, University of Washington, Seattle, WA, USA.
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Panteris V, Feretzakis G, Karantanos P, Kalles D, Verykios VV, Panoutsakou M, Karagianni E, Zoubouli C, Vgenopoulou S, Pierrakou A, Theodorakopoulou M, Papalois AE, Thomaidis T, Dalainas I, Kouroumalis E. Convolutional Neural Networks for Optical Discrimination Between Histological Types of Colorectal Polyps Based on White Light Endoscopic Images. Stud Health Technol Inform 2023; 302:576-580. [PMID: 37203751 DOI: 10.3233/shti230208] [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] [Indexed: 05/20/2023]
Abstract
The objective of this study was to compare different convolutional neural networks (CNNs), as employed in a Python-produced deep learning process, used on white light images of colorectal polyps acquired during the process of a colonoscopy, in order to estimate the accuracy of the optical recognition of particular histologic types of polyps. The TensorFlow framework was used for Inception V3, ResNet50, DenseNet121, and NasNetLarge, which were trained with 924 images, drawn from 86 patients.
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Affiliation(s)
- Vasileios Panteris
- Gastroenterology Department, Sismanogleio General Hospital, Marousi, Greece
- Hellenic Society of Gastrointestinal Oncology
| | - Georgios Feretzakis
- School of Science and Technology, Hellenic Open University, Patras, Greece
- Department of Quality Control, Research and Continuing Education, Sismanogleio General Hospital, Marousi, Greece
| | | | - Dimitris Kalles
- School of Science and Technology, Hellenic Open University, Patras, Greece
| | | | - Maria Panoutsakou
- Gastroenterology Department, Sismanogleio General Hospital, Marousi, Greece
| | - Eirini Karagianni
- Gastroenterology Department, Sismanogleio General Hospital, Marousi, Greece
| | | | | | | | | | - Apostolos E Papalois
- Special Unit for Biomedical Research and Education, School of Medicine, Aristotle University of Thessaloniki, Greece
- Hellenic Society of Gastrointestinal Oncology
| | - Thomas Thomaidis
- 2nd Gastroenterology Department, Hygeia Hospital, Athens, Greece
- Hellenic Society of Gastrointestinal Oncology
| | - Ilias Dalainas
- Administration, Sismanogleio General Hospital, Marousi, Greece
| | - Elias Kouroumalis
- Department of Gastroenterology, University of Crete Medical School, Heraklion, Greece
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Kasti AN, Theodorakopoulou M, Katsas K, Synodinou KD, Nikolaki MD, Zouridaki AE, Fotiou S, Kapetani A, Armaganidis A. Factors Associated with Interruptions of Enteral Nutrition and the Impact on Macro- and Micronutrient Deficits in ICU Patients. Nutrients 2023; 15:nu15040917. [PMID: 36839275 PMCID: PMC9959226 DOI: 10.3390/nu15040917] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/02/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND AND AIM Feeding interruptions in critical care patients are often unjustified. We aimed to determine the causes, duration, and frequency of enteral nutrition interruptions (ENIs) and to assess macronutrients and antioxidant deficits according to European Society of Parenteral Enteral Nutrition (ESPEN) guidelines. METHODS We prospectively enrolled Intensive Care Unit (ICU) patients admitted for more than 48 h with an inability to orally eat from April to December 2019. The type of enteral nutrition, the number of calories administered, the time of feeding initiation, the reasons for delaying feeding, and the causes for ENI were recorded. RESULTS 81 patients were enrolled, with a median duration of ENIs of 5.2 (3.4-7.4) hours/day. Gastric residual volume (GRV) monitoring-a highly controversial practice-was the most common cause of ENI (median duration 3 (2.3-3) hours/day). The mean energy intake was 1037 ± 281 kcal/day, while 60.5% of patients covered less than 65% of the total energy needs (1751 ± 295 kcal/day, according to mean Body Mass Index (BMI)). The median daily protein intake did not exceed 0.43 ± 0.3 gr/kg/day of the actual body weight (BW), whereas ESPEN recommends 1.3 gr/kg/day for adjusted BW (p < 0.001). The average administration of micronutrients and antioxidants (arginine, selenium, zinc, vitamins) was significantly less than the dietary reference intake (p < 0.01). CONCLUSION ENIs lead to substantial caloric, protein, and antioxidant deficits.
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Affiliation(s)
- Arezina N. Kasti
- Department of Nutrition and Dietetics, Attikon University General Hospital, 12462 Athens, Greece
| | - Maria Theodorakopoulou
- 1st ICU Department, Evangelismos Hospital, Intensive Care Medicine, 10676 Athens, Greece
- 2nd ICU Department, Attikon University Hospital, Intensive Care Medicine, 12461 Athens, Greece
| | - Konstantinos Katsas
- Department of Nutrition and Dietetics, Attikon University General Hospital, 12462 Athens, Greece
- Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Kalliopi D. Synodinou
- Department of Nutrition and Dietetics, Attikon University General Hospital, 12462 Athens, Greece
| | - Maroulla D. Nikolaki
- Department of Nutrition and Dietetics, Attikon University General Hospital, 12462 Athens, Greece
- Department of Nutrition and Dietetics Sciences, Hellenic Mediterranean University, 72300 Crete, Greece
- Correspondence: (M.D.N.); (A.A.)
| | - Alice Efstathia Zouridaki
- Department of Nutrition and Dietetics, Attikon University General Hospital, 12462 Athens, Greece
- Department of Human Biology and Health Studies, University of Toronto, Toronto, ON M5S, Canada
| | - Stylianos Fotiou
- Department of Nutrition and Dietetics, Attikon University General Hospital, 12462 Athens, Greece
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17676 Athens, Greece
| | - Aliki Kapetani
- Department of Nutrition and Dietetics, Attikon University General Hospital, 12462 Athens, Greece
| | - Apostolos Armaganidis
- 2nd ICU Department, Attikon University Hospital, Intensive Care Medicine, 12461 Athens, Greece
- Correspondence: (M.D.N.); (A.A.)
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Trøseid M, Arribas JR, Assoumou L, Holten AR, Poissy J, Terzić V, Mazzaferri F, Baño JR, Eustace J, Hites M, Joannidis M, Paiva JA, Reuter J, Püntmann I, Patrick-Brown TDJH, Westerheim E, Nezvalova-Henriksen K, Beniguel L, Dahl TB, Bouscambert M, Halanova M, Péterfi Z, Tsiodras S, Rezek M, Briel M, Ünal S, Schlegel M, Ader F, Lacombe K, Amdal CD, Rodrigues S, Tonby K, Gaudet A, Heggelund L, Mootien J, Johannessen A, Møller JH, Pollan BD, Tveita AA, Kildal AB, Richard JC, Dalgard O, Simensen VC, Baldé A, de Gastines L, del Álamo M, Aydin B, Lund-Johansen F, Trabaud MA, Diallo A, Halvorsen B, Røttingen JA, Tacconelli E, Yazdanpanah Y, Olsen IC, Costagliola D, Dyrhol-Riise AM, Stiksrud B, Jenum S, MacPherson ME, Aarskog NR, Røstad K, Skeie LG, Dahl Å, Steen JK, Nur S, Segers F, Korsan KA, Sethupathy A, Sandstå AJ, Paulsen GJ, Ueland T, Michelsen A, Aukrust P, Berdal JE, Melkeraaen I, Tollefsen MM, Andreassen J, Dokken J, Müller KE, Woll BM, Opsand H, Bogen M, Rød LT, Steinsvik T, Åsheim-Hansen B, Bjerkreim RH, Berg Å, Moen S, Kvalheim S, Strand K, Gravrok B, Skogen V, Lorentzen EM, Schive SW, Rossvoll L, Hoel H, Engebråten S, Martinsson MS, Thallinger M, Ådnanes E, Hannula R, Bremnes N, Liyanarachi K, Ehrnström B, Kvalshaug M, Berge K, Bygdås M, Gustafsson L, AballiB S, Strand M, Andersen B, Aukrust P, Barratt-Due A, Henriksen KN, Kåsine T, Dyrhol-Riise AM, Berdal JE, Favory R, Nseir S, Preau S, Jourdain M, Ledoux G, Durand A, Houard M, Moreau AS, Rouzé A, Tortuyaux R, Degouy G, Levy C, Liu V, Dognon N, Mariller L, Delcourte C, Reguig Z, Cerf A, Cuvelliez M, Kipnis E, Boyer-Beysserre M, Bignon A, Parmentier L, Meddour D, Frade S, Timsit JF, Peiffer-Smadja N, Wicky PH, De Montmollin E, Bouadma L, Dessajan J, Sonneville R, Patrier J, Presente S, Sylia Z, Rioux C, Thy M, Collias L, Bouaraba Y, Dobremel N, Dureau AF, Oudeville P, Pointurier V, Rabouel Y, Stiel L, Alzina C, Ramstein C, Ait-Oufella H, Hamoudi F, Urbina T, Zerbib Y, Maizel J, Wilpotte C, Piroth L, Blot M, Sixt T, Moretto F, Charles C, Gohier S, Roux D, Le Breton C, Gernez C, Thiry I, Baboi L, Malvy D, Boyer A, Perreau P, Armellini M, De Luca G, Di Pietro OSMM, Romanin B, Brogi M, Castelli F, Amadasi S, Barchiesi F, Canovari B, Coppola N, Pisaturo M, Russo A, Occhiello L, Cataldo F, Rillo MM, Queiruga J, Seco E, Stewart S, Borobia AM, Moraga P, Prieto R, García I, Rivera C, Narro JL, Chacón N, de la Rosa S, Macías M, Barrera L, Serna A, Palomo V, Sánchez MIG, Gutiérrez D, Campos AS, Garfia MÁG, Toyos EB, Cabrera JS, Lucena MI, Lapique EL, Englert P, Khalil Z, Jacobs F, Malaise J, Mukangenzi O, Smissaert C, Hildebrand M, Martiny D, Vervacke A, Scarnière A, Yin N, Michel C, Seyler L, Allard S, Van Laethem J, Verschelden G, Meeuwissen A, De Waele A, Van Buggenhout V, Monteyne D, Noppe N, Belkhir L, Yombi JC, De Greef J, Mesland JB, De Ghellinck L, Kin V, D’Aoust C, Bouvier A, Dekeister AC, Hawia E, Gaillet A, Deshorme H, Halleux S, Galand V, Roncon-Albuquerque R, Santos LL, Vieira CB, Magalhaes R, Ferreira S, Bernardo M, Jackson A, Sadlier C, O’Connell S, Blair M, Manning E, Cusack F, Kelly N, Stephenson H, Keane R, Murphy A, Cunnane M, Keane F, O’Regan MC, de Barra E, Bellone AM, O’Regan S, Carey P, Harte J, Coakley P, Heeney A, Ryan D, Curley G, McConkey S, Sulaiman I, Costello R, McNally C, Foley C, Trainor S, Jacob B, Vengathodi S, Kent B, Bergin C, Townsend L, Kerr C, Panti N, Sanz AG, Benny B, Dea EO, Galvin N, Burke C, Galvin A, Aisiyabi S, Lobo D, Laffey J, McNicolas B, Cosgrave D, Sheehan JR, Nita C, Hanley C, Kelly C, Kernan M, Murray J, Staub T, Henin T, Damilot G, Bintener T, Colling J, Ferretti C, Werer C, Stammet P, Braquet P, Arendt V, Calvo E, Michaux C, Mediouni C, Znati A, Montanes G, Garcia L, Thomé C, Breitkopf R, Peer A, Lehner G, Bellman R, Ditlbacher A, Finkenstedt A, Zotter K, Hernandez CP, Rajsic S, Lanthaler B, Greil R, Tamás K, Kovácsné-Levang S, Sipos D, Kappéter A, Halda-Kiss B, Madarassi-Papp E, Hajdu E, Bende B, Konstantinos T, Moschopoulos C, Labrou E, Tsakona M, Grigoropoulos I, Kotanidou A, Fragkou P, Theodorakopoulou M, Pantazi E, Jahai E, Moukouli M, Siafakas D, Mühlbauer B, Dembinski R, Stich K, Schneider G, Nagy A, Grodová K, Kubelová M, Součková L, Švábová HK, Demlová R, Sonderlichová S, Unal S, Inkaya AC, de Bono S, Kartman CE, Adams DH, Crowe B, Yazdanapanah Y, Unal S, Schneider G, Mühlbauer B, Ødegård T, Bakkehøi G, Autran B, Bjørås M, Lambellerie XD, Mezzarri F, Guedj J, Esperou H, Lumbroso J, Welte T, Calmy A, Pischke S, Treweek S, Goetghebeur E, Doussau A, Weiss L, Hulstaert F, Botgros R, del Alamo M, Chung F, Lumbroso J, Zeitlinger M, Escalera BN, Csajka C, Williams C, Amstutz A, Rüegg CS, Burdet C, Massonnaud C, Belhadi D, Mentré F, Aroun M, Mentré F, Ehrmann S, Espoerou H, Burdet C, Falk RS, Bjordal K, Bakkehøi G, Ødegård T, Barratt-Due A. Efficacy and safety of baricitinib in hospitalized adults with severe or critical COVID-19 (Bari-SolidAct): a randomised, double-blind, placebo-controlled phase 3 trial. Crit Care 2023; 27:9. [PMID: 36627655 PMCID: PMC9830601 DOI: 10.1186/s13054-022-04205-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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: 10/06/2022] [Accepted: 10/13/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Baricitinib has shown efficacy in hospitalized patients with COVID-19, but no placebo-controlled trials have focused specifically on severe/critical COVID, including vaccinated participants. METHODS Bari-SolidAct is a phase-3, multicentre, randomised, double-blind, placebo-controlled trial, enrolling participants from June 3, 2021 to March 7, 2022, stopped prematurely for external evidence. Patients with severe/critical COVID-19 were randomised to Baricitinib 4 mg once daily or placebo, added to standard of care. The primary endpoint was all-cause mortality within 60 days. Participants were remotely followed to day 90 for safety and patient related outcome measures. RESULTS Two hundred ninety-nine patients were screened, 284 randomised, and 275 received study drug or placebo and were included in the modified intent-to-treat analyses (139 receiving baricitinib and 136 placebo). Median age was 60 (IQR 49-69) years, 77% were male and 35% had received at least one dose of SARS-CoV2 vaccine. There were 21 deaths at day 60 in each group, 15.1% in the baricitinib group and 15.4% in the placebo group (adjusted absolute difference and 95% CI - 0.1% [- 8·3 to 8·0]). In sensitivity analysis censoring observations after drug discontinuation or rescue therapy (tocilizumab/increased steroid dose), proportions of death were 5.8% versus 8.8% (- 3.2% [- 9.0 to 2.7]), respectively. There were 148 serious adverse events in 46 participants (33.1%) receiving baricitinib and 155 in 51 participants (37.5%) receiving placebo. In subgroup analyses, there was a potential interaction between vaccination status and treatment allocation on 60-day mortality. In a subsequent post hoc analysis there was a significant interaction between vaccination status and treatment allocation on the occurrence of serious adverse events, with more respiratory complications and severe infections in vaccinated participants treated with baricitinib. Vaccinated participants were on average 11 years older, with more comorbidities. CONCLUSION This clinical trial was prematurely stopped for external evidence and therefore underpowered to conclude on a potential survival benefit of baricitinib in severe/critical COVID-19. We observed a possible safety signal in vaccinated participants, who were older with more comorbidities. Although based on a post-hoc analysis, these findings warrant further investigation in other trials and real-world studies. Trial registration Bari-SolidAct is registered at NCT04891133 (registered May 18, 2021) and EUClinicalTrials.eu ( 2022-500385-99-00 ).
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Affiliation(s)
- Marius Trøseid
- grid.55325.340000 0004 0389 8485Section for Clinical Immunology and Infectious Diseases, Oslo University Hospital, Oslo, Norway ,grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - José R. Arribas
- grid.81821.320000 0000 8970 9163Infectious Diseases Unit, Internal Medicine Department, La Paz University Hospital, IdiPAZ, Madrid, Spain ,grid.512890.7Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Lambert Assoumou
- grid.7429.80000000121866389Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie Et de Santé Publique (IPLESP), Paris, France
| | - Aleksander Rygh Holten
- grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Oslo, Norway ,grid.55325.340000 0004 0389 8485Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
| | - Julien Poissy
- grid.503422.20000 0001 2242 6780Lille University, Lille, France/CHU Lille - Hôpital Roger Salengro, Lille, France ,grid.457369.aL’Institut National de La Santé Et de La Recherche Médicale (Inserm), Paris, France
| | - Vida Terzić
- Maladies Infectieuses Emergentes, 75015 Paris, France ,grid.7429.80000000121866389Institut National de La Santé Et de La Recherche Médicale, INSERM, 75013 Paris, France
| | - Fulvia Mazzaferri
- grid.5611.30000 0004 1763 1124Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Jesús Rodríguez Baño
- grid.411375.50000 0004 1768 164XDepartment of Medicine, Virgen Macarena University Hospital, Seville, Spain ,grid.9224.d0000 0001 2168 1229University of Sevilla and Biomedicines Institute of Seville (IBiS)/CSIC, Seville, Spain ,grid.413448.e0000 0000 9314 1427CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Joe Eustace
- grid.7872.a0000000123318773University College Cork, Cork, Ireland
| | - Maya Hites
- grid.412157.40000 0000 8571 829XBrussels University Hospital-Erasme, Brussels, Belgium ,grid.4989.c0000 0001 2348 0746Université Libre de Bruxelles, Brussels, Belgium
| | - Michael Joannidis
- grid.5361.10000 0000 8853 2677Medical University Innsbruck, Innsbruck, Austria
| | - José-Artur Paiva
- grid.414556.70000 0000 9375 4688Intensive Care Medicine Department, Centro Hospitalar Universitário Sao Joao, Porto, Portugal ,grid.5808.50000 0001 1503 7226Faculty of Medicine, University of Porto, Porto, Portugal
| | - Jean Reuter
- grid.418041.80000 0004 0578 0421Centre Hospitalier de Luxembourg, Service de Réanimation-Soins Intensifs, 1210 Luxembourg, Luxembourg
| | - Isabel Püntmann
- Institute of Pharmacology, Hospital Group Gesundheit Nord gGmbH, Bremen, Germany
| | - Thale D. J. H. Patrick-Brown
- grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Oslo, Norway ,grid.55325.340000 0004 0389 8485Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway
| | - Elin Westerheim
- grid.55325.340000 0004 0389 8485Section for Monitoring, Clinical Trial Unit (CTU), Oslo University Hospital, Oslo, Norway
| | - Katerina Nezvalova-Henriksen
- grid.55325.340000 0004 0389 8485Department of Haematology, Oslo University Hospital and Oslo Hospital Pharmacy, Oslo, Norway
| | - Lydie Beniguel
- grid.7429.80000000121866389Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie Et de Santé Publique (IPLESP), Paris, France
| | - Tuva Børresdatter Dahl
- grid.55325.340000 0004 0389 8485Research Institute for Internal Medicine, Oslo University Hospital, Oslo, Norway ,grid.55325.340000 0004 0389 8485Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Maude Bouscambert
- grid.413852.90000 0001 2163 3825Laboratoire de Virologie, Institut Des Agents Infectieux de Lyon, Centre National de Reference Des Virus Des Infections Respiratoires France Sud, Hospices Civils de Lyon, 69317 Lyon, France
| | - Monika Halanova
- grid.11175.330000 0004 0576 0391Department of Epidemiology, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, Košice, Slovakia
| | - Zoltán Péterfi
- grid.9679.10000 0001 0663 94791St Department of Internal Medicine, Division of Infectology, University of Pécs, Pécs, Hungary
| | - Sotirios Tsiodras
- grid.5216.00000 0001 2155 0800National and Kapodistrian University of Athens, Athens, Greece ,grid.411449.d0000 0004 0622 4662University Hospital of Athens Attikon, Athens, Greece
| | - Michael Rezek
- grid.412554.30000 0004 0609 2751St. Anne University Hospital, Brno, Czech Republic
| | - Matthias Briel
- grid.410567.1Swiss Clinical Trial Organisation and Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Serhat Ünal
- grid.411920.f0000 0004 0642 1084Hacettepe University Hospital, Ankara, Turkey
| | - Martin Schlegel
- grid.6936.a0000000123222966Department of Anesthesiology and Intensive Care Medicine, Klinikum Rechts Der Isar, Technische Universität München, Munich, Germany
| | - Florence Ader
- grid.413852.90000 0001 2163 3825Hospices Civils de Lyon, Département Des Maladies Infectieuses Et Tropicales, 69004 Lyon, France ,grid.15140.310000 0001 2175 9188Centre International de Recherche en Infectiologie (CIRI), Inserm 1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, École Normale Supérieure de Lyon, Univ Lyon, 69007 Lyon, France
| | - Karine Lacombe
- grid.7429.80000000121866389Sorbonne Université, Institut Pierre-Louis d’Épidemiologie Et de Santé Publique, INSERM, 75013 Paris, France ,grid.412370.30000 0004 1937 1100APHP, Hôpital Saint-Antoine, Service de Maladies Infectieuses Et Tropicales, 75012 Paris, France
| | - Cecilie Delphin Amdal
- grid.55325.340000 0004 0389 8485Research support service and Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Serge Rodrigues
- grid.7429.80000000121866389Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie Et de Santé Publique (IPLESP), Paris, France
| | - Kristian Tonby
- grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Oslo, Norway ,grid.55325.340000 0004 0389 8485Deptartment of Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Alexandre Gaudet
- grid.410463.40000 0004 0471 8845Critical Care Center, Department of Intensive Care Medicine, CHU Lille, 59000 Lille, France ,grid.503422.20000 0001 2242 6780Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019-UMR9017-CIIL-Centre d’Infection Et d’Immunité de Lille, 59000 Lille, France
| | - Lars Heggelund
- grid.459157.b0000 0004 0389 7802Medical Department, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway ,grid.7914.b0000 0004 1936 7443Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Joy Mootien
- grid.414085.c0000 0000 9480 048XService, de Réanimation Médiale, GHRMSA Hopital Emile Muller, Mulhouse, France
| | - Asgeir Johannessen
- grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Oslo, Norway ,grid.417292.b0000 0004 0627 3659Department of Infectious Diseases, Vestfold Hospital Trust, Tønsberg, Norway
| | - Jannicke Horjen Møller
- grid.412835.90000 0004 0627 2891Department of Intensive Care Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Beatriz Diaz Pollan
- grid.81821.320000 0000 8970 9163Infectious Diseases Unit, Internal Medicine Department, La Paz University Hospital, Madrid, Spain ,grid.81821.320000 0000 8970 9163Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), IdiPAZ, Madrid, Spain
| | - Anders Aune Tveita
- grid.414168.e0000 0004 0627 3595Department of Medicine, Bærum Hospital, Vestre Viken, Bærum, Norway
| | - Anders Benjamin Kildal
- grid.412244.50000 0004 4689 5540Department of Anesthesiology and Intensive Care, University Hospital of North Norway, Tromsø, Norway
| | - Jean-Christophe Richard
- grid.413306.30000 0004 4685 6736Service de Médecine Intensive-Réanimation, Hôpital de La Croix - Rousse - HCL, Lyon, France ,grid.7429.80000000121866389CREATIS INSERM U1206-CNRS UMR 5220, Lyon, France
| | - Olav Dalgard
- grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Oslo, Norway ,grid.411279.80000 0000 9637 455XAkershus University Hospital, Lørenskog, Norway
| | - Victoria Charlotte Simensen
- grid.418193.60000 0001 1541 4204Division of Health Services, Department of Global Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Aliou Baldé
- grid.7429.80000000121866389Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie Et de Santé Publique (IPLESP), Paris, France
| | - Lucie de Gastines
- Maladies Infectieuses Emergentes, 75015 Paris, France ,grid.7429.80000000121866389Institut National de La Santé Et de La Recherche Médicale, INSERM, 75013 Paris, France
| | | | - Burç Aydin
- grid.55325.340000 0004 0389 8485Department of Immunology, Oslo University Hospital, Oslo, Norway
| | - Fridtjof Lund-Johansen
- grid.55325.340000 0004 0389 8485Department of Immunology, Oslo University Hospital, Oslo, Norway
| | - Mary-Anne Trabaud
- grid.134996.00000 0004 0593 702XLaboratoire de Virologie, Institut Des Agents Infectieux de Lyon, Centre National de Reference Des Virus Respiratoires France Sud, 69317 Hospices Civils de LyonLyon, France
| | - Alpha Diallo
- Maladies Infectieuses Emergentes, 75015 Paris, France ,grid.7429.80000000121866389Institut National de La Santé Et de La Recherche Médicale, INSERM, 75013 Paris, France
| | - Bente Halvorsen
- grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Oslo, Norway ,grid.55325.340000 0004 0389 8485Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - John-Arne Røttingen
- grid.418193.60000 0001 1541 4204Norwegian Institute of Public Health, Oslo, Norway
| | - Evelina Tacconelli
- grid.5611.30000 0004 1763 1124Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy ,grid.411475.20000 0004 1756 948XVerona University Hospital, Verona, Italy
| | - Yazdan Yazdanpanah
- grid.512950.aUniversité de Paris, IAME, INSERM, 75018 Paris, France ,grid.411119.d0000 0000 8588 831XAP-HP, Hôpital Bichat, Service de Maladies Infectieuses Et Tropicales, 75018 Paris, France
| | - Inge C. Olsen
- grid.55325.340000 0004 0389 8485Department of Research Support for Clinical Trials, Oslo University Hospital, Oslo, Norway
| | - Dominique Costagliola
- grid.7429.80000000121866389Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie Et de Santé Publique (IPLESP), Paris, France
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Papadopoulou A, Karavalakis G, Papadopoulou E, Xochelli A, Bousiou Z, Vogiatzoglou A, Papayanni P, Georgakopoulou A, Giannaki M, Stavridou F, Vallianou I, Kammenou M, Varsamoudi E, Papadimitriou V, Giannaki C, Sileli M, Stergiouda Z, Stefanou G, Kourlaba G, Triantafyllidou M, Siotou E, Karaglani A, Zotou E, Chatzika G, Boukla A, Apostolou D, Pitsiou G, Morfesis P, Bartzoudis D, Imprialos K, Karampatakis T, Kapravelos N, Bitzani M, Theodorakopoulou M, Serasli E, Sakellari I, Fylaktou A, Tryfon S, Anagnostopoulos A, Yannaki E. Immunotherapy: SAFETY AND EFFICACY OF SARS-COV-2-SPECIFIC T CELLS AS ADOPTIVE IMMUNOTHERAPY FOR HIGH-RISK COVID-19 PATIENTS: A PHASE I/II, RANDOMIZED CLINICAL TRIAL. Cytotherapy 2022. [PMCID: PMC9035757 DOI: 10.1016/s1465-3249(22)00147-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Miliaraki M, Briassoulis P, Ilia S, Polonifi A, Mantzourani M, Briassouli E, Vardas K, Nanas S, Pistiki A, Theodorakopoulou M, Tavladaki T, Spanaki AM, Kondili E, Dimitriou H, Tsiodras S, Georgopoulos D, Armaganidis A, Daikos G, Briassoulis G. Survivin and caspases serum protein levels and survivin variants mRNA expression in sepsis. Sci Rep 2021; 11:1049. [PMID: 33441606 PMCID: PMC7806640 DOI: 10.1038/s41598-020-78208-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 11/09/2020] [Indexed: 12/12/2022] Open
Abstract
Sepsis is a dysregulated host response to infection related to devastating outcomes. Recently, interest has been shifted towards apoptotic and antiapoptotic pathobiology. Apoptosis is executed through the activation of caspases regulated by a number of antiapoptotic proteins, such as survivin. The survivin and caspases’ responses to sepsis have not yet been elucidated. This is a multicenter prospective observational study concerning patients with sepsis (n = 107) compared to patients with traumatic systemic inflammatory response syndrome (SIRS) (n = 75) and to healthy controls (n = 89). The expression of survivin was quantified through real-time quantitative polymerase chain reaction for the different survivin splice variants (wild type-WT, ΔEx3, 2B, 3B) in peripheral blood leukocytes. The apoptotic or antiapoptotic tendency was specified by measuring survivin-WT, caspase-3, and -9 serum protein concentrations through enzyme-linked immunosorbent assay. The survivin-WT, -2B, -ΔΕx3 mRNA, survivin protein, and caspases showed an escalated increase in SIRS and sepsis, whereas survivin-3B was repressed in sepsis (p < 0.05). Survivin correlated with IL-8 and caspase-9 (p < 0.01). For discriminating sepsis, caspase-9 achieved the best receiver operating characteristic curve (AUROC) of 0.95. In predicting mortality, caspase-9 and survivin protein achieved an AUROC of 0.70. In conclusion, specific apoptotic and antiapoptotic pathways might represent attractive targets for future research in sepsis.
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Affiliation(s)
- Marianna Miliaraki
- Pediatric Intensive Care Unit, Medical School, University of Crete, Heraklion, Crete, Greece.,Postgraduate Program "Emergencies and Intensive Care in Children Adolescents and Young Adults", Medical School, University of Crete, Heraklion, Crete, Greece
| | - Panagiotis Briassoulis
- Pediatric Intensive Care Unit, Medical School, University of Crete, Heraklion, Crete, Greece.,Postgraduate Program "Emergencies and Intensive Care in Children Adolescents and Young Adults", Medical School, University of Crete, Heraklion, Crete, Greece
| | - Stavroula Ilia
- Pediatric Intensive Care Unit, Medical School, University of Crete, Heraklion, Crete, Greece.,Postgraduate Program "Emergencies and Intensive Care in Children Adolescents and Young Adults", Medical School, University of Crete, Heraklion, Crete, Greece
| | - Aikaterini Polonifi
- First Department of Internal Medicine - Propaedeutic, National and Kapodistrian University of Athens, Athens, Greece
| | - Marina Mantzourani
- First Department of Internal Medicine - Propaedeutic, National and Kapodistrian University of Athens, Athens, Greece
| | - Efrossini Briassouli
- First Department of Internal Medicine - Propaedeutic, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Vardas
- First Critical Care Department, Evangelismos University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Serafim Nanas
- First Critical Care Department, Evangelismos University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Pistiki
- 4th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Theodorakopoulou
- 2nd Department of Critical Care, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Theonymfi Tavladaki
- Pediatric Intensive Care Unit, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Anna Maria Spanaki
- Pediatric Intensive Care Unit, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Eumorfia Kondili
- Intensive Care Unit, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Helen Dimitriou
- Division of Mother and Child Health, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Sotirios Tsiodras
- 4th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Apostolos Armaganidis
- 2nd Department of Critical Care, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - George Daikos
- First Department of Internal Medicine - Propaedeutic, National and Kapodistrian University of Athens, Athens, Greece
| | - George Briassoulis
- Pediatric Intensive Care Unit, Medical School, University of Crete, Heraklion, Crete, Greece. .,Postgraduate Program "Emergencies and Intensive Care in Children Adolescents and Young Adults", Medical School, University of Crete, Heraklion, Crete, Greece.
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9
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Vrettou CS, Korompoki E, Sarri K, Papachatzakis I, Theodorakopoulou M, Chrysanthopoulou E, Andrianakis IA, Routsi C, Zakynthinos S, Kotanidou A. Pupillometry in critically ill patients with COVID-19: a prospective study. Clin Auton Res 2020; 30:563-565. [PMID: 33029750 PMCID: PMC7539751 DOI: 10.1007/s10286-020-00737-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/28/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Charikleia S Vrettou
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital-Medical School of National and Kapodistrian University of Athens, 45-47 Ipsilantou St, 106 76, Athens, Greece.
| | - Eleni Korompoki
- Department of Clinical Therapeutics, Alexandra Hospital-Medical School of Athens, 80 Vass. Sofias Av., 115 28, Athens, Greece
- Division of Brain Sciences, Charing Cross Hospital-Imperial College London, Fulham Palace Road, London, W6 8RF, UK
| | - Katerina Sarri
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital-Medical School of National and Kapodistrian University of Athens, 45-47 Ipsilantou St, 106 76, Athens, Greece
| | - Ioannis Papachatzakis
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital-Medical School of National and Kapodistrian University of Athens, 45-47 Ipsilantou St, 106 76, Athens, Greece
| | - Maria Theodorakopoulou
- Second Department of Critical Care Medicine, Attikon Hospital-National and Kapodistrian University of Athens, 1 Rimini St., 124 62, Athens, Greece
| | - Evangelia Chrysanthopoulou
- Second Department of Critical Care Medicine, Attikon Hospital-National and Kapodistrian University of Athens, 1 Rimini St., 124 62, Athens, Greece
| | - Ilias A Andrianakis
- Department of Intensive Care, Ygeia Hospital, 4 Erythrou Stavrou and Kifisias Av., 151 25, Athens, Greece
| | - Christina Routsi
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital-Medical School of National and Kapodistrian University of Athens, 45-47 Ipsilantou St, 106 76, Athens, Greece
| | - Spyros Zakynthinos
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital-Medical School of National and Kapodistrian University of Athens, 45-47 Ipsilantou St, 106 76, Athens, Greece
| | - Anastasia Kotanidou
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital-Medical School of National and Kapodistrian University of Athens, 45-47 Ipsilantou St, 106 76, Athens, Greece
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10
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Anthi A, Konstantonis D, Theodorakopoulou M, Apostolopoulou O, Karampela I, Konstantopoulou G, Patsilinakou S, Armaganidis A, Dimopoulos G. A Severe COVID-19 Case Complicated by Right Atrium Thrombus. Am J Case Rep 2020; 21:e926915. [PMID: 32963216 PMCID: PMC7520871 DOI: 10.12659/ajcr.926915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Patient: Male, 73-year-old Final Diagnosis: Severe COVID-19 pneumonia complicated by right atrium thrombus Symptoms: Fever • dyspnea • cough Medication:— Clinical Procedure: — Specialty: Critical Care Medicine
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Affiliation(s)
- Anastasia Anthi
- 2nd Department of Critical Care, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Konstantonis
- 2nd Department of Critical Care, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Theodorakopoulou
- 2nd Department of Critical Care, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Olympia Apostolopoulou
- 2nd Department of Critical Care, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Irene Karampela
- 2nd Department of Critical Care, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgia Konstantopoulou
- 2nd Department of Critical Care, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavroula Patsilinakou
- 2nd Department of Critical Care, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Apostolos Armaganidis
- 2nd Department of Critical Care, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - George Dimopoulos
- 2nd Department of Critical Care, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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11
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Frantzeskaki FG, Dimopoulos S, Konstantonis D, Katsibri P, Kostopanagiotou K, Theodorakopoulou M, Diakaki C, Dougenis D, Boumpas D, Karabinis A, Armaganidis A, Tsangaris I. Life-threatening antineutrophil cytoplasmic antibody-associated vasculitis after influenza A H1N1 infection requiring veno-venous extracorporeal membrane oxygenation. Perfusion 2020; 35:546-549. [PMID: 32529913 DOI: 10.1177/0267659120927210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 02/05/2023]
Abstract
INTRODUCTION Antineutrophil cytoplasmic autoantibody-associated vasculitis is an immune-mediated necrotizing vasculitis, affecting small- and medium-sized vessels. CASE REPORT A 22-year-old female patient with free medical history presented with life-threatening pulmonary hemorrhage due to antineutrophil cytoplasmic autoantibody-associated vasculitis, temporarily associated with influenza A H1N1 infection. Due to rapidly worsening respiratory failure, despite conventional management, veno-venous peripheral extracorporeal membrane oxygenation was initiated and continued for 26 days, with subsequent renal replacement therapy. DISCUSSION We present a case of severe antineutrophil cytoplasmic autoantibody-associated pulmonary vasculitis, managed with veno-venous extracorporeal membrane oxygenation at the initial phase. Despite the significant challenges raised with the use of extracorporeal membrane oxygenation in pulmonary hemorrhage cases, extracorporeal membrane oxygenation may have a significant impact on outcome in this setting, by providing adequate time for a successful immunosuppressive treatment.
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Affiliation(s)
- Frantzeska G Frantzeskaki
- 2nd Critical Care Department, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Dimitrios Konstantonis
- 2nd Critical Care Department, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Pelagia Katsibri
- 4th Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Kostantinos Kostopanagiotou
- Department of Cardiac Surgery, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Theodorakopoulou
- 2nd Critical Care Department, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Chrysi Diakaki
- 2nd Critical Care Department, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Dougenis
- Department of Cardiac Surgery, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Boumpas
- 4th Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Apostolos Armaganidis
- 2nd Critical Care Department, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Iraklis Tsangaris
- 2nd Critical Care Department, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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12
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Halvatsiotis P, Kotanidou A, Tzannis K, Jahaj E, Magira E, Theodorakopoulou M, Konstandopoulou G, Gkeka E, Pourzitaki C, Kapravelos N, Papoti S, Sileli M, Gogos C, Velissaris D, Markou N, Stefanatou E, Vlachogianni G, Aimoniotou E, Komnos A, Zafeiridis T, Koulouvaris P, Armaganidis A, Bamias A, Dimopoulos G. Demographic and clinical features of critically ill patients with COVID-19 in Greece: The burden of diabetes and obesity. Diabetes Res Clin Pract 2020; 166:108331. [PMID: 32682810 PMCID: PMC7366091 DOI: 10.1016/j.diabres.2020.108331] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [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: 05/21/2020] [Revised: 07/09/2020] [Accepted: 07/13/2020] [Indexed: 01/08/2023]
Abstract
AIMS The aim of the study was to investigate the association between type-2 diabetes mellitus, other underlying diseases and obesity with the outcomes of critically ill Covid-19 patients in Greece. METHODS In this retrospective observational multi-centre study, data and outcomes of 90 RNA 2109-nCoV confirmed critically ill patients from 8 hospitals throughout Greece, were analysed. All reported information stand through April 13th 2020. RESULTS The median age of the patients was 65.5 (IQR 56-73), majority were male (80%) and obesity was present in 34.4% of patients most prevalent to younger than 55 years. Hypertension was the prevailing comorbidity (50%), followed by cardiovascular diseases (21.1%) and type-2 diabetes (18.9%). At admission, common symptoms duration had a median of 8 (IQR 5-11) days. A 13.3% of the patients were discharged, 53.4% were still in the ICUs and 28.9% deceased who were hospitalised for fewer days than the survivors [6 (IQR 3-9) vs. 9 (IQR 7-14.5) respectively]. Aging was not a risk factor but diabetes deteriorates the outcomes. Obesity poses a suggestive burden as it was more notable in deceased versus survivors. CONCLUSIONS Type 2 diabetes and obesity may have contributed to disease severity and mortality in COVID-19 critically ill patients in Greece.
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Affiliation(s)
- P Halvatsiotis
- 2nd Propaedeutic Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Rimini 1, Chaidari 124 62, Greece.
| | - A Kotanidou
- 1st Department of Critical Care, Medical School of National and Kapodistrian University of Athens, "EVANGELISMOS" General Hospital, 45-47 Ipsilantou str, 10675 Athens, Greece
| | - K Tzannis
- 2nd Propaedeutic Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Rimini 1, Chaidari 124 62, Greece
| | - E Jahaj
- 1st Department of Critical Care, Medical School of National and Kapodistrian University of Athens, "EVANGELISMOS" General Hospital, 45-47 Ipsilantou str, 10675 Athens, Greece
| | - E Magira
- 1st Department of Critical Care, Medical School of National and Kapodistrian University of Athens, "EVANGELISMOS" General Hospital, 45-47 Ipsilantou str, 10675 Athens, Greece
| | - M Theodorakopoulou
- 2nd Department of Critical Care, Medical School of National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Rimini 1, Chaidari 124 62, Greece
| | - G Konstandopoulou
- 2nd Department of Critical Care, Medical School of National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Rimini 1, Chaidari 124 62, Greece
| | - E Gkeka
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, School of Health Sciences of Aristotle University of Thessaloniki, AHEPA University Hospital, Kyriakidi 1, Thessaloniki 54621, Greece
| | - C Pourzitaki
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, School of Health Sciences of Aristotle University of Thessaloniki, AHEPA University Hospital, Kyriakidi 1, Thessaloniki 54621, Greece
| | - N Kapravelos
- 2nd Critical Care Department, General Hospital of Thessaloniki "G. PAPANIKOLAOU" Leof. Papanikolaou, Pilaia Chortiatis 57011, Greece
| | - S Papoti
- 2nd Critical Care Department, General Hospital of Thessaloniki "G. PAPANIKOLAOU" Leof. Papanikolaou, Pilaia Chortiatis 57011, Greece
| | - M Sileli
- 2nd Critical Care Department, General Hospital of Thessaloniki "G. PAPANIKOLAOU" Leof. Papanikolaou, Pilaia Chortiatis 57011, Greece
| | - C Gogos
- Emergency Department and Department of Internal Medicine of Patras University, Medical School, University Hospital of Patras, Rio, Patras 26504, Greece.
| | - D Velissaris
- Emergency Department and Department of Internal Medicine of Patras University, Medical School, University Hospital of Patras, Rio, Patras 26504, Greece
| | - N Markou
- LATSION Burn Center - Intensive Care Unit, General Hospital of Eleusis "THRIASSIO", Leof G Gennimata, Elefsina 19600, Greece
| | - E Stefanatou
- LATSION Burn Center - Intensive Care Unit, General Hospital of Eleusis "THRIASSIO", Leof G Gennimata, Elefsina 19600, Greece
| | - G Vlachogianni
- Department of Critical Care, AGIOS DIMITRIOS General Hospital of Thessaloniki, Elenis Zografou 2, Thessaloniki 54634, Greece.
| | - E Aimoniotou
- Department of Critical Care, AGIOS DIMITRIOS General Hospital of Thessaloniki, Elenis Zografou 2, Thessaloniki 54634, Greece
| | - A Komnos
- Department of Critical Care, General Hospital of Larisa "KOUTLIMPANIO", Tsakalof 1, Larisa 41221, Greece
| | - T Zafeiridis
- Department of Critical Care, General Hospital of Larisa "KOUTLIMPANIO", Tsakalof 1, Larisa 41221, Greece
| | - P Koulouvaris
- 1st Department of Orthopaedics, Medical School of National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Rimini 1, Chaidari 124 62, Greece.
| | - A Armaganidis
- 2nd Department of Critical Care, Medical School of National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Rimini 1, Chaidari 124 62, Greece.
| | - A Bamias
- 2nd Propaedeutic Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Rimini 1, Chaidari 124 62, Greece.
| | - G Dimopoulos
- 2nd Department of Critical Care, Medical School of National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Rimini 1, Chaidari 124 62, Greece.
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13
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Frantzeskaki F, KONSTANTONIS DIMITRIOS, Diakaki C, Theodorakopoulou M, Chrysanthopoulou E, Armaganidis A, Tsangaris I. A PATIENT WITH INFLUENZA A INFECTION AND ANCA-ASSOCIATED VASCULITIS. Chest 2019. [DOI: 10.1016/j.chest.2019.08.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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14
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Loutradis C, Papadopoulos CE, Sachpekidis V, Pagourelias E, Ekart R, Krunic B, Toumpourleka M, Theodorakopoulou M, Pateinakis P, Zoccali C, London G, Vassilikos V, Sarafidis P, Papagianni A. P2640The effect of dry-weight reduction guided by lung ultrasound on ambulatory aortic blood pressure and arterial stiffness parameters in hemodialysis patients. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction and purpose
Arterial stiffness and aortic blood pressure (BP) augmentation are significantly increased in hemodialysis patients. Recent studies suggest that the prognostic significance of ambulatory recordings of arterial stiffness is high in hemodialysis. This study examines for the first time the effect of dry weight reduction with a standardized lung-ultrasound-guided strategy on ambulatory aortic BP and arterial stiffness parameters in hypertensive hemodialysis patients.
Methods
A total 71 hemodialysis patients with hypertension (mean home BP ≥135/85 mmHg), that were clinically euvolemic, were included in this single-blind randomized clinical trial. Patients were randomized in a 1:1 ratio in the active group (n=35), following a strategy for dry-weight reduction guided by the total number of US-B lines (US-B lines score) prior to a mid-week dialysis session and the control group (n=), following standard-of-care treatment. All patients underwent 48-hour ABPM with the Mobil-O-Graph monitor (IEM, Stolberg, Germany) and PWV measurement in office with SphygmoCor (ArtCor, Sydney, Australia) at baseline and after 8-weeks.
Results
Overall, the US-B lines change during follow-up were −5.3±12.5 in active versus +2.2±7.6 in control group (p<0.001), which corresponded to dry-weight changes of −0.71±1.39 versus +0.51±0.98 kg (p<0.001). The change in 48-hour cSBP was significantly greater in the active group (−6.30±8.90 vs −0.50±12.46, p=0.027); the relevant cDBP fall was marginally greater (−3.85±6.61 vs −0.63±8.36, p=0.077) in the active group. 48-hour cPP (41.51±9.63 vs 39.06±9.61 mmHg, p=0.004) and 48-hour PWV (9.30±2.00 vs 9.08±2.04 m/sec, p=0.032) were significantly reduced from baseline to study-end in the active group but remained unchanged in controls. In contrast, 48-hour AIx and AIx(75) did not change between baseline and study-end in both groups; changes in AIx(75) were similar in the two groups (−0.97±3.51 vs −0.36±4.25, p=0.517). PWV measured in office was decreased from baseline to study-end in the active (10.07±2.66 vs 9.79±2.81, p=0.038) but not in the control group.
Conclusions
A lung-ultrasound-guided strategy for dry-weight reduction reduces ambulatory aortic BP and ambulatory or office PWV, but not ambulatory AIx(75). These results suggest that dry-weight reduction can primarily reduce aortic BP levels and large arteries stiffness but not wave reflections from the periphery.
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Affiliation(s)
- C Loutradis
- Aristotle University of Thessaloniki, Hippokration Hospital, Department of Nephrology, Thessaloniki, Greece
| | - C E Papadopoulos
- Aristotle University of Thessaloniki, Hippokration Hospital, 3rd Department of Cardiology, Thessaloniki, Greece
| | - V Sachpekidis
- Hospital Papageorgiou, Department of Cardiology, Thessaloniki, Greece
| | - E Pagourelias
- Aristotle University of Thessaloniki, Hippokration Hospital, 3rd Department of Cardiology, Thessaloniki, Greece
| | - R Ekart
- University Medical Centre Maribor, Clinic for Internal Medicine, Department of Dialysis, Maribor, Slovenia
| | - B Krunic
- University Medical Centre Maribor, Clinic for Internal Medicine, Department of Cardiology, Maribor, Slovenia
| | - M Toumpourleka
- Hospital Papageorgiou, Department of Cardiology, Thessaloniki, Greece
| | - M Theodorakopoulou
- Aristotle University of Thessaloniki, Hippokration Hospital, Department of Nephrology, Thessaloniki, Greece
| | - P Pateinakis
- Hospital Papageorgiou, Department of Nephrology, Thessaloniki, Greece
| | - C Zoccali
- CNR-IFC Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - G London
- Hospital and FCRIN INI-CRCTC, Manhes, France
| | - V Vassilikos
- Aristotle University of Thessaloniki, Hippokration Hospital, 3rd Department of Cardiology, Thessaloniki, Greece
| | - P Sarafidis
- Aristotle University of Thessaloniki, Hippokration Hospital, Department of Nephrology, Thessaloniki, Greece
| | - A Papagianni
- Aristotle University of Thessaloniki, Hippokration Hospital, Department of Nephrology, Thessaloniki, Greece
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15
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Kasti A, Solakis F, Katsas K, Skoufi A, Mainas N, Nikolaki M, Tsochatzis A, Kelekis N, Armaganidis A, Theodorakopoulou M. MON-PO483: Modified Nutrition Risk in Critically Ill (mNutric) vs Malnutrition Universal Screening (MUST) Tool: Detecting Malnutrition, Sarcopenia and Mortality. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32316-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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16
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Ilias I, Nikitas N, Theodorakopoulou M, Dimopoulou I. Microdialysis-Assessed Adipose Tissue Metabolism in Critically Ill Patients. ACTA ACUST UNITED AC 2018; 11:32-38. [PMID: 28595555 DOI: 10.2174/1872214811666170608114933] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 06/05/2017] [Accepted: 06/05/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Microdialysis is a minimally invasive technique that allows direct in situ and in vivo sampling, studies and manipulations of the interstitial/extracellular fluid/space. It has been shown to be of use mainly in acute brain injury/neurocritical care. METHODS Microdialysis has been used to study obesity, diabetes mellitus, inflammation and pharmacokinetics at the adipose tissue level. In critically ill patients (and particularly in those with sepsis or septic shock), within days to weeks, adipose tissue shows profound alterations; under such conditions, the implementation of microdialysis can provide researchers with interesting findings. RESULTS The well-known association between lipolysis and cortisol has been verified at the tissue level with microdialysis. Specific metabolic aberrations in critically ill patients with septic shock have been noted in adipose tissue - assessed with microdialysis before becoming evident in the systemic circulation. Measurement of the lactate to pyruvate ratio in adipose tissue - also assessed with microdialysis - in patients with septic shock has prognostic value equal to that of universally accepted clinical severity scores. CONCLUSION Microneedle arrays have been already used to assess interstitial fluid glucose. Possibly, the implementation of microneedle and lab-on-a-chip technology, might complement the current use of microdialysis in the study of the interstitial space/adipose tissue metabolism in health and disease.
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Affiliation(s)
- Ioannis Ilias
- Endocrinology Unit, Elena Venizelou Hospital, Athens, Greece
| | - Nikitas Nikitas
- Department of Critical Care Medicine, North Middlesex Hospital, London, United Kingdom
| | - Maria Theodorakopoulou
- Second Department of Critical Care Medicine, Attikon Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - Ioanna Dimopoulou
- Department of Experimental Physiology, National & Kapodistrian University of Athens, Athens, Greece
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17
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Ilias I, Apollonatou S, Nikitas N, Theodorakopoulou M, Vassiliou AG, Kotanidou A, Dimopoulou I. Microdialysis-Assessed Adipose Tissue Metabolism, Circulating Cytokines and Outcome in Critical Illness. Metabolites 2018; 8:metabo8040062. [PMID: 30301230 PMCID: PMC6316198 DOI: 10.3390/metabo8040062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 10/02/2018] [Accepted: 10/03/2018] [Indexed: 01/02/2023] Open
Abstract
Microdialysis (MD) can provide continuous information about tissue composition. To assess in critically ill patients adipose tissue metabolic patterns, the relationships between metabolic patterns and blood cytokine concentration associations of adipose tissue energy metabolism and clinical outcome we studied 203 mechanically ventilated general intensive care unit (ICU) patients. Upon ICU admission an MD catheter was inserted into the subcutaneous adipose tissue of the upper thigh to measure lactate (L), glucose, pyruvate (P), and glycerol. Serum concentrations of IL-10, IL-6, IL-8, and TNF-α were determined within 48 h from ICU admission. Mitochondrial dysfunction was defined as L/P ratio >30 and pyruvate ≥70 μmol/L, ischemia as L/P ratio >30 and pyruvate <70 μmol/L and no ischemia/no mitochondrial dysfunction (i.e., aerobic metabolism) was as L/P ratio ≤30. Metabolism was aerobic in 74% of patients. In 13% of patients there was biochemical evidence of ischemia and in 13% of patients of mitochondrial dysfunction. Mitochondrial dysfunction was associated with poor outcome. In conclusion, MD showed that about two thirds of critically ill patients have normal aerobic adipose tissue metabolism. Mitochondrial dysfunction was not common but was associated with poor outcome. Identifying subgroups of critically ill patients is crucial as different treatment strategies may improve survival.
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Affiliation(s)
- Ioannis Ilias
- Endocrine Unit, Elena Venizelou Hospital, GR-11521 Athens, Greece.
| | - Sofia Apollonatou
- Second Department of Critical Care Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, GR-12462 Athens, Greece.
| | - Nikitas Nikitas
- Department of Critical Care Medicine, North Middlesex Hospital, London N18 1QX, UK.
| | - Maria Theodorakopoulou
- Second Department of Critical Care Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, GR-12462 Athens, Greece.
| | - Alice G Vassiliou
- First Department of Critical Care Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, Medical School, GR-10552 Athens, Greece.
| | - Anastasia Kotanidou
- First Department of Critical Care Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, Medical School, GR-10552 Athens, Greece.
| | - Ioanna Dimopoulou
- First Department of Critical Care Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, Medical School, GR-10552 Athens, Greece.
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Ilias I, Apollonatou S, Vassiliadi DA, Nikitas N, Theodorakopoulou M, Diamantakis A, Kotanidou A, Dimopoulou I. Adipose Tissue Lactate Clearance but Not Blood Lactate Clearance Is Associated with Clinical Outcome in Sepsis or Septic Shock during the Post-Resuscitation Period. Metabolites 2018; 8:metabo8020028. [PMID: 29690538 PMCID: PMC6027221 DOI: 10.3390/metabo8020028] [Citation(s) in RCA: 3] [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: 03/13/2018] [Revised: 04/16/2018] [Accepted: 04/20/2018] [Indexed: 12/29/2022] Open
Abstract
No study has directly measured tissue lactate clearance in patients with sepsis during the post-resuscitation period. In this study we aimed to assess in ICU patients with sepsis (n = 32) or septic shock (n = 79)—during the post-resuscitation phase—the relative kinetics of blood/tissue lactate clearances and to examine whether these are associated with outcome. We measured serially—over a 48-h period—blood and adipose tissue interstitial fluid lactate levels (with microdialysis) and we calculated lactate clearance. Statistics included mixed model analysis, Friedman’s analysis of variance, Wilcoxon’s test, Mann-Whitney’s test, receiver operating characteristics curves and logistic regression. Forty patients died (28-day mortality rate = 28%). Tissue lactate clearance was higher compared to blood lactate clearance at 0–8, 0–12, 0–16, 0–20 and 0–24 h (all p < 0.05). Tissue lactate clearance was higher in survivors compared to non-survivors at 0–12, 0–20 and 0–24 h (all p = 0.02). APACHE II along with tissue lactate clearance <30% at 0–12, 0–20 and 0–24 h were independent outcome predictors. We did not find blood lactate clearance to be related to survival. Thus, in critically ill septic patients, elevated tissue (but not blood) lactate clearance, was associated with a favorable clinical outcome.
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Affiliation(s)
- Ioannis Ilias
- Endocrine Unit, Elena Venizelou Hospital, Athens 11521, Greece.
| | - Sofia Apollonatou
- Second Department of Critical Care Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens 10462, Greece.
| | | | - Nikitas Nikitas
- Second Department of Critical Care Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens 10462, Greece.
| | - Maria Theodorakopoulou
- Second Department of Critical Care Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens 10462, Greece.
| | - Argyris Diamantakis
- Second Department of Critical Care Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens 10462, Greece.
| | - Anastasia Kotanidou
- First Department of Critical Care Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, Medical School, Athens 10676, Greece.
| | - Ioanna Dimopoulou
- First Department of Critical Care Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, Medical School, Athens 10676, Greece.
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Deskoulidi P, Sofopoulos M, Diamantopoulos P, Nikolaidou T, Maltzaris N, Theodorakopoulou M, Klonaris C, Arnogiannaki N, Kotrotsiou M, Stavrianos S. Dermatofibrosarcoma protuberans coexisting in a patient with a vascular malformation-a rare coincidence. J Surg Case Rep 2017; 2017:rjx192. [PMID: 29026517 PMCID: PMC5633650 DOI: 10.1093/jscr/rjx192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 09/16/2017] [Indexed: 11/24/2022] Open
Abstract
Dermatofibrosarcoma protuberans with fibrosarcomatous differentiation (DFSP-FS) is a rare soft tissue tumor with more aggressive behavior and it is not clear what causes this type of skin cancer. We describe the case of a 48-year-old woman who was born with a vascular malformation in the sternal region and presented suddenly with a soft tissue sarcoma (DFSP-FS) in the same territory. She was initially treated by embolization as the sarcoma was misdiagnosed but the tumor within 6 months seemed to be growing rapidly and reached a giant dimension with ulceration and required surgical intervention. The patient underwent a surgical removal of the mass but as the pathology report included a DFSP-FS with close margins,a second operation was required. A wide local excision was performed and reconstruction of defect by using bilateral pectoralis major muscle flaps and a full thickness skin graft from the abdominal wall. Post operatively the patient was treated with radiotherapy.
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Affiliation(s)
- Parthena Deskoulidi
- Department of Plastic Surgery, St. Savvas Cancer Hospital of Athens, 171 Alexandras Avenue, Athens 11522, Greece
| | - Michael Sofopoulos
- Department of Surgical Pathology, St. Savvas Cancer Hospital of Athens, 171 Alexandras Avenue, Athens 11522, Greece
| | - Pantelis Diamantopoulos
- Department of Plastic Surgery, St. Savvas Cancer Hospital of Athens, 171 Alexandras Avenue, Athens 11522, Greece
| | - Thaleia Nikolaidou
- Department of Plastic Surgery, St. Savvas Cancer Hospital of Athens, 171 Alexandras Avenue, Athens 11522, Greece
| | - Nikolaos Maltzaris
- Department of Plastic Surgery, St. Savvas Cancer Hospital of Athens, 171 Alexandras Avenue, Athens 11522, Greece
| | - Maria Theodorakopoulou
- Department of Surgical Pathology, St. Savvas Cancer Hospital of Athens, 171 Alexandras Avenue, Athens 11522, Greece
| | - Christos Klonaris
- Vascular Surgery Unit, Laiko General Hospital of Athens, Agiou Thoma17, Athens 11527, Greece
| | - Niki Arnogiannaki
- Department of Surgical Pathology, St. Savvas Cancer Hospital of Athens, 171 Alexandras Avenue, Athens 11522, Greece
| | - Maria Kotrotsiou
- Department of Plastic Surgery, Evangelismos General Hospital of Athens, Ipsilantou 45-47, Athens 106 76, Greece
| | - Spiros Stavrianos
- Department of Plastic Surgery, St. Savvas Cancer Hospital of Athens, 171 Alexandras Avenue, Athens 11522, Greece
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20
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Papadopoulos P, Pistiki A, Theodorakopoulou M, Christodoulopoulou T, Damoraki G, Goukos D, Briassouli E, Dimopoulou I, Armaganidis A, Nanas S, Briassoulis G, Tsiodras S. Immunoparalysis: Clinical and immunological associations in SIRS and severe sepsis patients. Cytokine 2017; 92:83-92. [PMID: 28119177 DOI: 10.1016/j.cyto.2017.01.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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: 02/25/2016] [Revised: 01/06/2017] [Accepted: 01/13/2017] [Indexed: 01/05/2023]
Abstract
INTRODUCTION This study was designed to identify changes in the monocytic membrane marker HLA-DR and heat shock proteins (HSPs) in relation to T-regulatory cells (T-regs) and other immunological marker changes in patients with systemic inflammatory response syndrome (SIRS) or sepsis/septic shock. METHODS Healthy volunteers, intensive care unit (ICU) patients with SIRS due to head injury and ICU patients with severe sepsis/septic shock were enrolled in the current study. Determination of CD14+/HLA-DR+ cells, intracellular heat-shock proteins and other immunological parameters were performed by flow cytometry and RT-PCR techniques as appropriate. Univariate and multivariate analysis examined associations of CD14/HLA-DR, HSPs, T-regs and suppressor of cytokine signalling (SOCS) proteins with SIRS, sepsis and outcome. RESULTS Fifty patients (37 with severe sepsis and 13 with SIRS) were enrolled, together with 20 healthy volunteers used as a control group. Compared to healthy individuals, patients with SIRS and severe sepsis showed progressive decline of their CD14/HLA-DR expression (0% to 7.7% to 50% within each study subpopulation, p<0.001). Mean fluorescent intensity (MFI) levels of HSP70 and HSP90 on monocytes and polymorphonuclear cells were significantly higher in SIRS patients compared to controls and fell significantly in severe sepsis/septic shock patients (p<0.05 for all comparisons). There was no statistically significant difference between subgroups for levels of T-regulatory cells or relative copies of Suppressor of Cytokine Signalling 3 (SOCS3) proteins. In univariate models percent of CD14/HLA-DR was associated with mortality (OR: 1.8 95%CI 1.02-3.2, p=0.05), while in multivariate models after adjusting for CD14/HLA-DR only younger age and lower Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were associated with increased chances of survival (beta -0.05, OR 0.9, 95% CI 0.9-0.99, p=0.038 for age and beta -0.11, OR 0.89, 95% CI 0.8-0.99, p=0.037 for APACHE II score). CONCLUSIONS Significant associations with SIRS and sepsis were found for CD14/HLA-DR expression and monocyte and polymorphonuclear cell levels of HSP70 and 90. The role of these biomarkers in assessing the prognosis of sepsis needs to be further explored and validated in prospective studies.
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Affiliation(s)
- Panagiotis Papadopoulos
- 2nd Department of Critical Care, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Pistiki
- 4th Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Theodorakopoulou
- 2nd Department of Critical Care, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodora Christodoulopoulou
- 2nd Department of Critical Care, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgia Damoraki
- 4th Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitris Goukos
- First Department of Propaedeutic Internal Medicine, Laikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Efrossini Briassouli
- First Department of Propaedeutic Internal Medicine, Laikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioanna Dimopoulou
- 2nd Department of Critical Care, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Apostolos Armaganidis
- 2nd Department of Critical Care, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Serafim Nanas
- First Critical Care Department, Evangelismos Hospital, University of Athens, Athens, Greece
| | - George Briassoulis
- Pediatric Intensive Care Unit, University Hospital, University of Crete, Heraklion, Greece
| | - Sotirios Tsiodras
- 4th Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
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Velasquez T, Mackey G, Lusk J, Kyle UG, Fontenot T, Marshall P, Shekerdemian LS, Coss-Bu JA, Nishigaki A, Yatabe T, Tamura T, Yamashita K, Yokoyama M, Ruiz-Rodriguez JC, Encina B, Belmonte R, Troncoso I, Tormos P, Riveiro M, Baena J, Sanchez A, Bañeras J, Cordón J, Duran N, Ruiz A, Caballero J, Nuvials X, Riera J, Serra J, Rutten AMF, van Ieperen SNM, Der Kinderen EPHM, Van Logten T, Kovacikova L, Skrak P, Zahorec M, Kyle UG, Akcan-Arikan A, Silva JC, Mackey G, Lusk J, Goldsworthy M, Shekerdemian LS, Coss-Bu JA, Wood D, Harrison D, Parslow R, Davis P, Pappachan J, Goodwin S, Ramnarayan P, Chernyshuk S, Yemets H, Zhovnir V, Pulitano’ SM, De Rosa S, Mancino A, Villa G, Tosi F, Franchi P, Conti G, Patel B, Khine H, Shah A, Sung D, Singer L, Haghbin S, Inaloo S, Serati Z, Idei M, Nomura T, Yamamoto N, Sakai Y, Yoshida T, Matsuda Y, Yamaguchi Y, Takaki S, Yamaguchi O, Goto T, Longani N, Medar S, Abdel-Aal IR, El Adawy AS, Mohammed HMEH, Mohamed AN, Parry SM, Knight LD, Denehy L, De Morton N, Baldwin CE, Sani D, Kayambu G, da Silva VZM, Phongpagdi P, Puthucheary ZA, Granger CL, Rydingsward JE, Horkan CM, Christopher KB, Muscedere J, Scott SH, Saha T, Hamilton A, Petsikas D, Payne D, Boyd JG, Puthucheary ZA, McNelly AS, Rawal J, McWilliams D, Connolly B, McPhail MJ, Sidhu P, Rowlerson A, Moxham J, Harridge SD, Hart N, Montgomery HE, Jovaisa T, Thomas B, Jones C, Gupta D, Wijayatilake DS, Shum HP, King HS, Chan KC, Tang KB, Yan WW, Arias CC, Latorre J, De La Rica AS, Reeves E, Garrido EM, Feijoo AM, Gancedo CH, Tofiño AL, Rodríguez FG, Gemmell LK, Campbell R, Doherty P, MacKay A, Singh N, Atkins G, Vitaller S, Nagib H, Prieto J, Del Arco A, Zayas B, Gomez C, Tirumala S, Pasha SA, Kumari BK, Martinez-Lopez P, Snelson C, Puerto-Morlán A, Nuevo-Ortega P, Pujol LM, Dolset RA, González BS, Riera SQ, Álvarez JT, Quintana S, Martínez L, Algarte R, Aitken LM, Sánchez B, Trenado J, Tomas E, Brock N, Viegas E, Filipe E, Cottle D, Traynor T, Martínez MVT, Márquez MP, Rattray J, Gómez LC, Martínez NA, Muñoz JMM, Bellver BQ, Varea MM, Llorente MÁA, Calvo CP, Hillier SD, Faulds MC, Hendra H, Kenardy J, Lawrence N, Maekawa K, Hayakawa M, Ono Y, Kodate A, Sadamoto Y, Tominaga N, Mizugaki A, Murakami H, Yoshida T, Hull AM, Katabami K, Wada T, Sawamura A, Gando S, Silva S, Kerhuel L, Malagurski B, Citerio G, Chabanne R, Laureys S, Ullman A, Puybasset L, Nobile L, Pognuz ER, Rossetti AO, Verginella F, Gaspard N, Creteur J, Ben-Hamouda N, Oddo M, Taccone FS, Le Brocque R, Ono Y, Hayakawa M, Iijima H, Maekawa K, Kodate A, Sadamoto Y, Mizugaki A, Murakami H, Katabami K, Wada T, Mitchell M, Sawamura A, Gando S, Kodate A, Katabami K, Wada T, Ono Y, Maekawa K, Hayakawa M, Sawamura A, Gando S, Davis C, Andersen LW, Raymond T, Berg R, Nadkarni V, Grossestreuer A, Kurth T, Donnino M, Krüger A, Ostadal P, Janotka M, Macfarlane B, Vondrakova D, Kongpolprom N, Cholkraisuwat J, Pekkarinen PT, Ristagno G, Masson S, Latini R, Bendel S, Ala-Kokko T, Varpula T, Azevedo JC, Vaahersalo J, Hoppu S, Tiainen M, Mion MM, Plebani M, Pettilä V, Skrifvars M, Son Y, Kim KS, Suh GJ, Rocha LL, Kwon WY, Ko JI, Park MJ, Cavicchi FZ, Iesu E, Nobile L, Vincent JL, Creteur J, Taccone FS, Tanaka H, De Freitas FFM, Otani N, Ode S, Ishimatsu S, Martínez L, Algarte R, Sánchez B, Romero I, Martínez F, Quintana S, Trenado J, Cavalheiro AM, Vondrakova D, Ostadal P, Kruger A, Janotka M, Malek F, Neuzil P, Yeh YC, Chen YS, Wang CH, Huang CH, Lucinio NM, Chao A, Lee CT, Lai CH, Chan WS, Cheng YJ, Sun WZ, Kaese S, Horstmann C, Lebiedz P, Mourad M, Lobato MS, Gaudard P, Eliet J, Zeroual N, Colson P, Ostadal P, Mlcek M, Hrachovina M, Kruger A, Vondrakova D, Janotka M, Ebeling G, Mates M, Hala P, Kittnar O, Neuzil P, Jacky A, Rudiger A, Spahn DR, Bettex DA, Kara A, Akin S, Kraegpoeth A, Dos reis Miranda D, Struijs A, Caliskan K, van Thiel RJ, Dubois EA, de Wilde W, Zijlstra F, Gommers D, Ince C, Marca L, Laerkner E, Xini A, Mongkolpun W, Cordeiro CPR, Leite RT, Lheureux O, Bader A, Rincon L, Santacruz C, Preiser JC, Chao A, De Brito-Ashurst I, Chao AS, Chen YS, Kim W, Ahn C, Cho Y, Lim TH, Oh J, Choi KS, Jang BH, Ha JK, White C, Mecklenburg A, Stamm J, Soeffker G, Kubik M, Sydow K, Reichenspurner H, Kluge S, Braune S, Bergantino B, Ruberto F, Gregory S, Magnanimi E, Privato E, Zullino V, Bruno K, Pugliese F, Sales G, Girotto V, Vittone F, Brazzi L, Fritz C, Forni LG, Kimmoun A, Vanhuyse F, Trifan B, Orlowski S, Albuisson E, Tran N, Levy B, Chhor V, Joachim J, Follin A, Flowers E, Champigneulle B, Chatelon J, Fave G, Mantz J, Pirracchio R, Diaz DD, Villanova M, Aguirregabyria M, Andrade G, López L, Curtis A, Palencia E, John G, Cowan R, Hart R, Lake K, Litchfield K, Song JW, Lee YJ, Cho YJ, Choi S, Wood CA, Vermeir P, Vandijck D, Blot S, Mariman A, Verhaeghe R, Deveugele M, Vogelaers D, Chok L, Bachli EB, Bettex D, Siu K, Cottini SR, Keller E, Maggiorini M, Schuepbach R, Fiks T, Stiphout C, Grevelink M, Vaneker I, Ruijter A, Buise M, Venkatesan K, Spronk PE, Tena SA, Barrachina LG, Portillo JHR, Aznar GP, Campos LM, Sellés MDF, Tomás MA, Muncharaz AB, Skinner L, Muhammad JBH, Monsalvo S, Olavarria E, Stümpfle R, Na SJ, Park J, Chung CR, Park CM, Suh GY, Yang JH, Witter T, Ng L, Brousseau C, Butler MB, Erdogan M, Dougall PCM, Green RS, Abbott TEF, Torrance HDT, Cron N, Vaid N, Emmanuel J, Seet E, Siddiqui SS, Prabu N, Chaudhari HK, Patil VP, Divatia JV, Solanki S, Kulkarni AP, Gutierrez LAR, Bader A, Brasseur A, Baptista N, Lheureux O, Vincent JL, Creteur J, Taccone FS, Hempel D, Stauffert N, Recker F, Schröder T, Reusch S, Schleifer J, Escoval A, Breitkreutz R, Sjövall F, Perner A, Møller MH, Moraes RB, Borges FK, Guillen JAV, Zabaletta WJC, Ruiz-Ramos J, Ramirez P, Tomas E, Marqués-Miñana MR, Villarreal E, Gordon M, Sosa M, Concha P, Castellanos A, Menendez R, Ramírez CS, Santana MC, Balcázar LC, Agrawal R, Escalada SH, Viera MAH, Vázquez CFL, Díaz JJD, Campelo FA, Monroy NS, Santana PS, Santana SR, Gutiérrez-Pizarraya A, Garnacho-Montero J, Mathew R, Martin C, Baumstarck K, Leone M, Martín-Loeches I, Pirracchio R, Legrand M, Mainardi JL, Mantz J, Cholley B, Hubbard A, Varma A, Frontera PR, Vega LMC, Miguelena PRDG, Usón MCV, López AR, Clemente EA, Ibañes PG, Aguilar ALR, Palomar M, Olaechea P, Dima E, Uriona S, Vallverdu M, Catalan M, Nuvials X, Aragon C, Lerma FA, Jeon YD, Jeong WY, Kim MH, Jeong IY, Charitidou E, Ahn MY, Ahn JY, Han SH, Choi JY, Song YG, Kim JM, Ku NS, Bassi GL, Xiol EA, Senussi T, Perivolioti E, Idone FA, Motos A, Chiurazzi C, Travierso C, Fernández-Barat L, Amaro R, Hua Y, Ranzani OT, Bobi Q, Rigol M, Pratikaki M, Torres A, Fernández IF, Soler EA, de Vera APR, Pastor EE, Hernandis V, Ros Martínez J, Rubio RJ, Torner MM, Brugger SC, Vrettou C, Eroles AA, Moles SI, Cabello JT, Schoenenberger JA, Casals XN, Vidal MV, Garrido BB, Martinez MP, Mirabella L, Cotoia A, Giannopoulos A, Tullo L, Stella A, Di Bello F, Di Gregorio A, Dambrosio M, Cinnella G, Rosario LEDLC, Lesmes SPG, Romero JCG, Herrera ANG, Zakynthinos S, Pertuz EDD, Sánchez MJG, Sanz ER, Hualde JB, Hernández AA, Ramirez JR, Takahashi H, Kazutoshi F, Okada Y, Oobayashi W, Routsi C, Naito T, Baidya DK, Maitra S, Anand RK, Ray BR, Arora MK, Ruffini C, Rota L, Corona A, Sesana G, Atchade E, Ravasi S, Catena E, Naumann DN, Mellis C, Husheer SL, Bishop J, Midwinter MJ, Hutchings S, Corradi F, Brusasco C, Houzé S, Manca T, Ramelli A, Lattuada M, Nicolini F, Gherli T, Vezzani A, Young A, Carmona AF, Santiago AI, Guillamon LN, Jean-Baptiste S, Delgado MJG, Delgado-Amaya M, Curiel-Balsera E, Rivera-Romero L, Castillo-Lorente E, Carrero-Gómez F, Aguayo-DeHoyos E, Healey AJ, Cameron C, Jiao L, Thabut G, Stümpfle R, Pérez A, Martin S, del Moral OL, Toval S, Rico J, Aldecoa C, Oguzhan K, Demirkiran O, Kirman M, Genève C, Bozbay S, Kosuk ME, Asyralyyeva G, Dilek M, Duzgun M, Telli S, Aydin M, Yilmazer F, Hodgson LE, Dimitrov BD, Tanaka S, Stubbs C, Forni LG, Venn R, Vedage D, Shawaf S, Naran P, Sirisena N, Kinnear J, Dimitrov BD, Hodgson LE, Lortat-Jacob B, Stubbs C, Forni LG, Venn R, Londoño JG, Cardenas CL, Ginés AS, Gubianas CM, Sánchez EC, Sirvent JM, Panafidina V, Augustin P, Shlyk I, Ilyina V, Judickas S, Kezyte G, Urbanaviciute I, Serpytis M, Gaizauskas E, Sipylaite J, Sprung CL, Munteanu G, Desmard M, Morales RC, Kasdan H, Volker T, Reiter A, Cohen Y, Himmel Y, Meissonnier J, Banderas-Bravo ME, Gómez-Jiménez C, García-Martínez MV, Montravers P, Martínez-Carmona JF, Fernández-Ortega JF, O‘Dwyer MJ, Starczewska M, Wilks M, Vincent JL, Torsvik M, Gustad LT, Bangstad IL, Vinje LJ, de Molina FJG, Damås JK, Solligård E, Mehl A, Tsunoda M, Kang M, Saito M, Saito N, Akizuki N, Namiki M, Takeda M, Barbadillo S, Yuzawa J, Yaguchi A, Frantzeskaki F, Tsirigotis P, Chondropoulos S, Paramythiotou E, Theodorakopoulou M, Stamouli M, Gkirkas K, Dimopoulou IK, Alejandro R, Makiko S, Tsunoda M, Kang M, Yuzawa J, Akiduki N, Namiki M, Takeda M, Yaguchi A, Preau S, Ambler M, Álvarez-Lerma F, Sigurta A, Saeed S, Singer M, Jochmans S, Chelly J, Vong LVP, Sy O, Serbource-Goguel J, Rolin N, Weyer CM, Vallés J, Abdallah RI, Adrie C, Vinsonneau C, Monchi M, Mayr U, Huber W, Karsten E, Lahmer T, Thies P, Henschel B, Catalán RM, Fischer G, Schmid RM, Ediboglu O, Ataman S, Naz I, Yaman G, Kirakli C, Su PL, Kou PS, Lin WC, Palencia E, Chen CW, Lozano JAB, Sánchez PC, Francioni JEB, Ferrón FR, Simón JMS, Riad Z, Mezidi M, Aublanc M, Perinel S, Jareño A, Lissonde F, Louf-Durier A, Yonis H, Tapponnier R, Richard JC, Louis B, Guérin C, Mezidi M, Yonis H, Aublanc M, Granada RM, Lissonde F, Louf-Durier A, Perinel S, Tapponnier R, Richard JC, Guérin C, Marmanidou K, Oikonomou M, Nouris C, Loizou C, Ignacio ML, Soilemezi E, Matamis D, Somhorst P, Gommers D, Hayashi K, Hirayama T, Yumoto T, Tsukahara K, Iida A, Nosaka N, Cui N, Sato K, Ugawa T, Nakao A, Ujike Y, Hirohata S, Mojoli F, Torriglia F, Giannantonio M, Orlando A, Bianzina S, Liu D, Tavazzi G, Mongodi S, Pozzi M, Iotti GA, Braschi A, Jansen D, Gadgil S, Doorduin J, Roesthuis L, van der Hoeven JG, Wang H, Heunks LMA, Chen GQ, Sun XM, He X, Yang YL, Shi ZH, Xu M, Zhou JX, Pereira SM, Tucci MR, Su L, Tonelotto BFF, Simoes CM, Morais CCA, Pompeo MS, Kay FU, Amato MBP, Vieira JE, Suzuki S, Mihara Y, Hikasa Y, Qiu H, Okahara S, Morimatsu H, Kwon HM, Moon YJ, Lee SH, Jung KW, Shin WJ, Jun IG, Song JG, Hwang GS, Li R, Lee S, Moon YJ, Kwon HM, Jung K, Shin WJ, Jun IG, Song JG, Hwang GS, Ramelli A, Manca T, Jaffal K, Corradi F, Brusasco C, Nicolini F, Gherli T, Brianti R, Fanzaghi P, Vezzani A, Tudor BA, Klaus DA, Lebherz-Eichinger D, Rouzé A, Lechner C, Schwarz C, Bodingbauer M, Seemann R, Kaczirek K, Fleischmann E, Roth GA, Krenn CG, Malyshev A, Sergey S, Poissy J, Yamaguchi Y, Nomura T, Yoshitake E, Idei M, Yoshida T, Takaki S, Yamaguchi O, Kaneko M, Goto T, Tencé N, Sendid B, Zaien I, Wolf M, Trouiller P, Jacobs FM, Kelly JM, Veigas P, Hollands S, Min A, Rizoli S, Robles CMC, Nseir S, de Oca Sandoval MAM, Tarabrin O, Gavrychenko D, Mazurenko G, 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E, Juliarena A, Bisso MC, Grando M, Tapia A, Camargo M, Ulla DV, Corzo L, dos Santos HP, Ramos A, Doglia JA, Estenssoro E, Carbonara M, Magnoni S, Donald CLM, Shimony JS, Conte V, Triulzi F, Stretti F, Macrì M, Snyder AZ, Stocchetti N, Brody DL, Podlepich V, Shimanskiy V, Savin I, Lapteva K, Chumaev A, Tjepkema-Cloostermans MC, Hofmeijer J, Beishuizen A, Hom H, Blans MJ, van Putten MJAM, Longhi L, Frigeni B, Curinga M, Mingone D, Beretta S, Patruno A, Gandini L, Vargiolu A, Ferri F, Ceriani R, Rottoli MR, Lorini L, Citerio G, Pifferi S, Battistini M, Cordolcini V, Agarossi A, Di Rosso R, Ortolano F, Stocchetti N, Lourido CM, Cabrera JLS, Santana JDM, Alzola LM, del Rosario CG, Pérez HR, Torrent RL, Eslami S, Dalhuisen A, Fiks T, Schultz MJ, Hanna AA, Spronk PE, Wood M, Maslove D. ESICM LIVES 2016: part three. Intensive Care Med Exp 2016. [PMCID: PMC5042925 DOI: 10.1186/s40635-016-0100-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Martínez ÁF, Lai CH, Hsu YC, Yeh YC, Cheng YJ, Colella V, Zarrillo N, D’Amico M, Forfori F, Pezza B, Laddomada T, Aliaga SM, Beltramelli V, Pizzaballa ML, Doronzio A, Balicco B, Kiers D, van der Heijden W, Gerretsen J, de Mast Q, el Messaoudi S, Rongen G, Para LH, Gomes M, Kox M, Pickkers P, Riksen NP, Kashiwagi Y, Okada M, Hayashi K, Inagaki Y, Fujita S, Nakamae MN, Payá JM, Kang YR, Souza RB, Liberatore AMA, Koh IHJ, Blet A, Sadoune M, Lemarié J, Bihry N, Bern R, Polidano E, Mulero FR, Merval R, Launay JM, Lévy B, Samuel JL, Mebazaa A, Hartmann J, Harm S, Weber V, Guerci P, Ince Y, Heeman P, Ergin B, Ince C, Uz Z, Massey M, Ince Y, Papatella R, Bulent E, Guerci P, Toraman F, Ince C, Longbottom ER, Torrance HD, Owen HC, Hinds CJ, Pearse RM, O’Dywer MJ, Trogrlic Z, van der Jagt M, Lingsma H, Ponssen HH, Schoonderbeek JF, Schreiner F, Verbrugge SJ, Duran S, van Achterberg T, Bakker J, Gommers DAMPJ, Ista E, Krajčová A, Waldauf P, Duška F, Shah A, Roy N, McKechnie S, Doree C, Fisher S, Stanworth SJ, Jensen JF, Overgaard D, Bestle MH, Christensen DF, Egerod I, Pivkina A, Gusarov V, Zhivotneva I, Pasko N, Zamyatin M, Jensen JF, Egerod I, Bestle MH, Christensen DF, Alklit A, Hansen RL, Knudsen H, Grode LB, Overgaard D, Hravnak M, Chen L, Dubrawski A, Clermont G, Pinsky MR, Parry SM, Knight LD, Connolly BC, Baldwin CE, Puthucheary ZA, Denehy L, Hart N, Morris PE, Mortimore J, Granger CL, Jensen HI, Piers R, Van den Bulcke B, Malmgren J, Metaxa V, Reyners AK, Darmon M, Rusinova K, Talmor D, Meert AP, Cancelliere L, Zubek L, Maia P, Michalsen A, Decruyenaere J, Kompanje E, Vanheule S, Azoulay E, Vansteelandt S, Benoit D, Van den Bulcke B, Piers R, Jensen HI, Malmgren J, Metaxa V, Reyners AK, Darmon M, Rusinova K, Talmor D, Meert AP, Cancelliere L, Zubek L, Maia P, Michalsen A, Decruyenaere J, Kompanje E, Vanheule S, Azoulay E, Vansteelandt S, Benoit D, Ryan C, Dawson D, Ball J, Noone K, Aisling B, Prudden S, Ntantana A, Matamis D, Savvidou S, Giannakou M, Gouva M, Nakos G, Koulouras V, Aron J, Lumley G, Milliken D, Dhadwal K, McGrath BA, Lynch SJ, Bovento B, Sharpe G, Grainger E, Pieri-Davies S, Wallace S, McGrath B, Lynch SJ, Bovento B, Grainger E, Pieri-Davies S, Sharpe G, Wallace S, Jung M, Cho J, Park H, Suh G, Kousha O, Paddle J, Gripenberg LG, Rehal MS, Wernerman J, Rooyackers O, de Grooth HJ, Choo WP, Spoelstra-de Man AM, Swart EL, Oudemans-van Straaten HM, Talan L, Güven G, Altıntas ND, Padar M, Uusvel G, Starkopf L, Starkopf J, Blaser AR, Kalaiselvan MS, Arunkumar AS, Renuka MK, Shivkumar RL, Volbeda M, ten Kate D, Hoekstra M, van der Maaten JM, Nijsten MW, Komaromi A, Rooyackers O, Wernerman J, Norberg Å, Smedberg M, Mori M, Pettersson L, Norberg Å, Rooyackers O, Wernerman J, Theodorakopoulou M, Christodoulopoulou T, Diamantakis A, Frantzeskaki F, Kontogiorgi M, Chrysanthopoulou E, Lygnos M, Diakaki C, Armaganidis A, Gundogan K, Dogan E, Coskun R, Muhtaroglu S, Sungur M, Ziegler T, Guven M, Kleyman A, Khaliq W, Andreas D, Singer M, Meierhans R, Schuepbach R, De Brito-Ashurst I, Zand F, Sabetian G, Nikandish R, Hagar F, Masjedi M, Maghsudi B, Vazin A, Ghorbani M, Asadpour E, Kao KC, Chiu LC, Hung CY, Chang CH, Li SH, Hu HC, El Maraghi S, Ali M, Rageb D, Helmy M, Marin-Corral J, Vilà C, Masclans JR, Vàzquez A, Martín-Loeches I, Díaz E, Yébenes JC, Rodriguez A, Álvarez-Lerma F, Varga N, Cortina-Gutiérrez A, Dono L, Martínez-Martínez M, Maldonado C, Papiol E, Pérez-Carrasco M, Ferrer R, Nweze K, Morton B, Welters I, Houard M, Voisin B, Ledoux G, Six S, Jaillette E, Nseir S, Romdhani S, Bouneb R, Loghmari D, Aicha NB, Ayachi J, Meddeb K, Chouchène I, Khedher A, Boussarsar M, Chan KS, Yu WL, Marin-Corral J, Vilà C, Masclans JR, Nolla J, Vidaur L, Bonastre J, Suberbiola B, Guerrero JE, Rodriguez A, Coll NR, Jiménez GJ, Brugger SC, Calero JC, Garrido BB, García M, Martínez MP, Vidal MV, de la Torre MC, Vendrell E, Palomera E, Güell E, Yébenes JC, Serra-Prat M, Bermejo-Martín JF, Almirall J, Tomas E, Escoval A, Froe F, Pereira MHV, Velez N, Viegas E, Filipe E, Groves C, Reay M, Chiu LC, Hu HC, Hung CY, Chang CH, Li SH, Kao KC, Ballin A, Facchin F, Sartori G, Zarantonello F, Campello E, Radu CM, Rossi S, Ori C, Simioni P, Umei N, Shingo I, Santos AC, Candeias C, Moniz I, Marçal R, e Silva ZC, Ribeiro JM, Georger JF, Ponthus JP, Tchir M, Amilien V, Ayoub M, Barsam E, Martucci G, Panarello G, Tuzzolino F, Capitanio G, Ferrazza V, Carollo T, Giovanni L, Arcadipane A, Sánchez ML, González-Gay MA, Díaz FJL, López MIR, Zogheib E, Villeret L, Nader J, Bernasinski M, Besserve P, Caus T, Dupont H, Morimont P, Habran S, Hubert R, Desaive T, Blaffart F, Janssen N, Guiot J, Pironet A, Dauby P, Lambermont B, Zarantonello F, Ballin A, Facchin F, Sartori G, Campello E, Pettenuzzo T, Citton G, Rossi S, Simioni P, Ori C, Kirakli C, Ediboglu O, Ataman S, Yarici M, Tuksavul F, Keating S, Gibson A, Gilles M, Dunn M, Price G, Young N, Remeta P, Bishop P, Zamora MDF, Muñoz-Bono J, Curiel-Balsera E, Aguilar-Alonso E, Hinojosa R, Gordillo-Brenes A, Arboleda-Sánchez JA, Skorniakov I, Vikulova D, Whiteley C, Shaikh O, Jones A, Ostermann M, Forni L, Scott M, Sahatjian J, Linde-Zwirble W, Hansell D, Laoveeravat P, Srisawat N, Kongwibulwut M, Peerapornrattana S, Suwachittanont N, Wirotwan TO, Chatkaew P, Saeyub P, Latthaprecha K, Tiranathanagul K, Eiam-ong S, Kellum JA, Berthelsen RE, Perner A, Jensen AEK, Jensen JU, Bestle MH, Gebhard DJ, Price J, Kennedy CE, Akcan-Arikan A, Liberatore AMA, Souza RB, Martins AMCRPF, Vieira JCF, Kang YR, Nakamae MN, Koh IHJ, Hamed K, Khaled MM, Soliman RA, Mokhtar MS, Seller-Pérez G, Arias-Verdú D, Llopar-Valdor E, De-Diós-Chacón I, Quesada-García G, Herrera-Gutierrez ME, Hafes R, Carroll G, Doherty P, Wright C, Vera IGG, Ralston M, Gemmell ML, MacKay A, Black E, Wright C, Docking RI, Appleton R, Ralston MR, Gemmell L, Appleton R, Wright C, Docking RI, Black E, Mackay A, Rozemeijer S, Mulier JLGH, Röttgering JG, Elbers PWG, Spoelstra-de Man AME, Tuinman PR, de Waard MC, Oudemans-van Straaten HM, Mejeni N, Nsiala J, Kilembe A, Akilimali P, Thomas G, Egerod I, Andersson AE, Fagerdahl AM, Knudsen V, Meddeb K, Cheikh AB, Hamdaoui Y, Ayachi J, Guiga A, Fraj N, Romdhani S, Sma N, Bouneb R, Chouchene I, Khedher A, Bouafia N, Boussarsar M, Amirian A, Ziaian B, Masjedi M, Fleischmann C, Thomas-Rueddel DO, Schettler A, Schwarzkopf D, Stacke A, Reinhart K, Filipe E, Escoval A, Martins A, Sousa P, Velez N, Viegas E, Tomas E, Snell G, Matsa R, Paary TTS, Kalaiselvan MS, Cavalheiro AM, Rocha LL, Vallone CS, Tonilo A, Lobato MDS, Malheiro DT, Sussumo G, Lucino NM, Zand F, Rosenthal VD, Masjedi M, Sabetian G, Maghsudi B, Ghorbani M, Dashti AS, Yousefipour A, Goodall JR, Williamson M, Tant E, Thomas N, Balci C, Gonen C, Haftacı E, Gurarda H, Karaca E, Paldusová B, Zýková I, Šímová D, Houston S, D’Antona L, Lloyd J, Garnelo-Rey V, Sosic M, Sotosek-Tokmazic V, Kuharic J, Antoncic I, Dunatov S, Sustic A, Chong CT, Sim M, Lyovarin T, Díaz FMA, Galdó SN, Garach MM, Romero OM, Bailón AMP, Pinel AC, Colmenero M, Gritsan A, Gazenkampf A, Korchagin E, Dovbish N, Lee RM, Lim MPP, Chong CT, Lim BCL, See JJ, Assis R, Filipe F, Lopes N, Pessoa L, Pereira T, Catorze N, Aydogan MS, Aldasoro C, Marchio P, Jorda A, Mauricio MD, Guerra-Ojeda S, Gimeno-Raga M, Colque-Cano M, Bertomeu-Artecero A, Aldasoro M, Valles SL, Tonon D, Triglia T, Martin JC, Alessi MC, Bruder N, Garrigue P, Velly L, Spina S, Scaravilli V, Marzorati C, Colombo E, Savo D, Vargiolu A, Cavenaghi G, Citerio G, Andrade AHV, Bulgarelli P, Araujo JAP, Gonzalez V, Souza VA, Costa A, Massant C, Filho CACA, Morbeck RA, Burgo LE, van Groenendael R, van Eijk LT, Leijte GP, Koeneman B, Kox M, Pickkers P, García-de la Torre A, de la Torre-Prados M, Fernández-Porcel A, Rueda-Molina C, Nuevo-Ortega P, Tsvetanova-Spasova T, Cámara-Sola E, García-Alcántara A, Salido-Díaz L, Liao X, Feng T, Zhang J, Cao X, Wu Q, Xie Z, Li H, Kang Y, Winkler MS, Nierhaus A, Mudersbach E, Bauer A, Robbe L, Zahrte C, Schwedhelm E, Kluge S, Zöllner C, Morton B, Mitsi E, Pennington SH, Reine J, Wright AD, Parker R, Welters ID, Blakey JD, Rajam G, Ades EW, Ferreira DM, Wang D, Kadioglu A, Gordon SB, Koch R, Kox M, Rahamat-Langedoen J, Schloesser J, de Jonge M, Pickkers P, Bringue J, Guillamat-Prats R, Torrents E, Martinez ML, Camprubí-Rimblas M, Artigas A, Blanch L, Park SY, Park YB, Song DK, Shrestha S, Park SH, Koh Y, Park MJ, Hong CW, Lesur O, Coquerel D, Sainsily X, Cote J, Söllradl T, Murza A, Dumont L, Dumaine R, Grandbois M, Sarret P, Marsault E, Salvail D, Auger-Messier M, Chagnon F, Lauretta MP, Greco E, Dyson A, Singer M, Preau S, Ambler M, Sigurta A, Saeed S, Singer M, Sarıca LT, Zibandeh N, Genc D, Gul F, Akkoc T, Kombak E, Cinel L, Akkoc T, Cinel I, Pollen SJ, Arulkumaran N, Singer M, Torrance HD, Longbottom ER, Warnes G, Hinds CJ, Pennington DJ, Brohi K, O’Dwyer MJ, Kim HY, Na S, Kim J, Chang YF, Chao A, Shih PY, Lee CT, Yeh YC, Chen LW, Adriaanse M, Trogrlic Z, Ista E, Lingsma H, Rietdijk W, Ponssen HH, Schoonderbeek JF, Schreiner F, Verbrugge SJ, Duran S, Gommers DAMPJ, van der Jagt M, Funcke S, Sauerlaender S, Saugel B, Pinnschmidt H, Reuter DA, Nitzschke R, Perbet S, Biboulet C, Lenoire A, Bourdeaux D, Pereira B, Plaud B, Bazin JE, Sautou V, Mebazaa A, Constantin JM, Legrand M, Boyko Y, Jennum P, Nikolic M. ESICM LIVES 2016: part one. Intensive Care Med Exp 2016. [PMCID: PMC5042924 DOI: 10.1186/s40635-016-0098-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Theodorakopoulou M, Frantzeskaki F, Apollonatou S, Nikitas N, Kopterides P, Diamantakis A, Dimopoulou I. Bedside adipose tissue metabolism in acute critical care illness monitored by microdialysis (MD). Intensive Care Med Exp 2015. [PMCID: PMC4797596 DOI: 10.1186/2197-425x-3-s1-a582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Frantzeskaki F, Merkouri E, Gialeraki A, Paramythiotou E, Theodorakopoulou M, Travlou O, Armaganidis A, Dimopoulou I. Coagulation disorders and the role of tissue factor and tissue factor pathway inhibitor in critically ill patients. Intensive Care Med Exp 2015. [PMCID: PMC4797052 DOI: 10.1186/2197-425x-3-s1-a297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Ilias I, Tzanela M, Nikitas N, Vassiliadi DA, Theodorakopoulou M, Apollonatou S, Tsagarakis S, Dimopoulou I. Evidence of Subcutaneous Tissue Lipolysis Enhancement by Endogenous Cortisol in Critically Ill Patients Without Shock. In Vivo 2015; 29:497-499. [PMID: 26130795] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND/AIM Cortisol is involved in in many aspects of adipose tissue metabolism. A positive association between plasma cortisol and lipolysis has been observed. Critically ill patients exhibit 'lipemia of sepsis'. The aim of the present study was to study, in septic ICU patients, adipose tissue lipolysis in relation to tissue cortisol using microdialysis (MD). PATIENTS AND METHODS We studied 17 mechanically-ventilated patients (9 men; mean±SD age=63±19 years) with a diagnosis of severe sepsis. Upon ICU admission, an MD catheter was inserted under sterile conditions into the subcutaneous adipose tissue of the upper thigh. On days 2, 3 and 4, MD samples were collected six times per day for glycerol (used as an index of lipolysis) and tissue cortisol determinations. The mean of these six collections was used for analysis (normal values for adipose tissue glycerol <200 μmol/l). Statistics were carried-out with analysis of covariance (ANCOVA) and linear regression. RESULTS More than half of the samplings (19/31) indicated accentuated lipolysis with above-normal MD glycerol levels. By ANCOVA, MD glycerol (log values) was associated with MD cortisol (log values) (p=0.012) and was not associated with age or day of sampling. Furthermore, MD glycerol (log values) was positively correlated to MD cortisol (log values) (r=0.490, p=0.012). DISCUSSION Changes in interstitial/tissue cortisol may not be reflected in (total) plasma cortisol concentration. Thus, it is interesting that we observed, albeit weak, an association between tissue lipolysis (via MD glycerol levels) and MD cortisol, verifying (although modestly so) the well-known association between lipolysis and cortisol.
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Affiliation(s)
- Ioannis Ilias
- Endocrine Unit, Elena Venizelou Hospital, Athens, Greece
| | | | - Nikitas Nikitas
- Second Department of Critical Care Medicine, University of Athens Medical School, Attikon Hospital, Athens, Greece
| | - Dimitra A Vassiliadi
- Second Department of Critical Care Medicine, University of Athens Medical School, Attikon Hospital, Athens, Greece
| | - Maria Theodorakopoulou
- Second Department of Critical Care Medicine, University of Athens Medical School, Attikon Hospital, Athens, Greece
| | - Sofia Apollonatou
- Second Department of Critical Care Medicine, University of Athens Medical School, Attikon Hospital, Athens, Greece
| | | | - Ioanna Dimopoulou
- Second Department of Critical Care Medicine, University of Athens Medical School, Attikon Hospital, Athens, Greece
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Dimopoulos G, Theodorakopoulou M, Armaganidis A, Tzepi IM, Lignos M, Giamarellos-Bourboulis EJ, Tsaganos T. Esmolol: immunomodulator in pyelonephritis by Pseudomonas aeruginosa. J Surg Res 2015; 198:175-84. [PMID: 26073350 DOI: 10.1016/j.jss.2015.05.026] [Citation(s) in RCA: 3] [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: 01/21/2015] [Revised: 05/03/2015] [Accepted: 05/15/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Based on previous animal studies showing promising immunomodulatory efficacy esmolol, a selective β1-blocker, it was assumed that administration of esmolol in experimental pyelonephritis by multidrug-resistant Pseudomonas aeruginosa would prolong survival and modulate immune response. METHODS Acute pyelonephritis was induced in 80 rabbits and assigned to eight groups receiving normal saline (controls), esmolol, amikacin, or both agents as pretreatment and as treatment. Blood was sampled for measurement of malondialdehyde and tumor necrosis factor alpha. Animals were followed up for survival, and after death quantitative tissue cultures were performed. The in vitro effect of esmolol on bacterial growth and on the oxidative burst of neutrophils of healthy controls and of sepsis patients was studied. RESULTS Survival of pretreatment groups administered single esmolol or esmolol and amikacin was prolonged compared with that of controls (P = 0.018 and P = 0.014, respectively); likewise, survival of treatment groups administered single esmolol or both agents was prolonged compared with that of controls (P = 0.007 and P = 0.014, respectively). Circulating malondialdehyde was significantly lower in pretreated animals administered esmolol or esmolol and amikacin compared with that in controls and in treated animals administered both agents compared with in controls (P = 0.020). In these groups, the bacterial load of the lung was significantly lower compared with controls. Serum tumor necrosis factor alpha did not change. Amikacin was increased in serum of esmolol-treated animals at levels which inhibited the in vitro growth of the studied isolate. Esmolol did not modify the in vitro growth of P aeruginosa and the oxidative burst of neutrophils. CONCLUSIONS It is concluded that esmolol prolonged survival after experimental infection by multidrug-resistant P aeruginosa. Survival benefit may be related with pleiotropic actions connected with modulation of pharmacokinetics and attenuation of inflammation.
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Affiliation(s)
- George Dimopoulos
- 2nd Department of Critical Care Medicine, University of Athens Medical School, Athens, Greece
| | - Maria Theodorakopoulou
- 2nd Department of Critical Care Medicine, University of Athens Medical School, Athens, Greece
| | - Apostolos Armaganidis
- 2nd Department of Critical Care Medicine, University of Athens Medical School, Athens, Greece
| | - Ira-Maria Tzepi
- 4th Department of Internal Medicine, University of Athens Medical School, Athens, Greece
| | - Michael Lignos
- 2nd Department of Critical Care Medicine, University of Athens Medical School, Athens, Greece
| | | | - Thomas Tsaganos
- 4th Department of Internal Medicine, University of Athens Medical School, Athens, Greece.
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Theodorakopoulou M, Apollonatou S, Nikitas N, Vassiliadi D, Diamantakis A, Tsagkari V, Frantzeskaki F, Dimopoulou I. Mitochondrial dysfunction and ischemia in critical illness: an adipose tissue microdialysis study in 203 ICU patients. Crit Care 2015. [PMCID: PMC4470667 DOI: 10.1186/cc14112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Papadopoulos P, Pistiki A, Christodoulopoulou T, Theodorakopoulou M, Tsagkari V, Armaganidis A, Tsiodras S, Dimopoulou I, Briassoulis G, Briassoulis G. Heat shock proteins 70/90 and associations with immunosuppression along with sepsis: preliminary data. Crit Care 2015. [PMCID: PMC4471461 DOI: 10.1186/cc14122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Ilias I, Vassiliadi DA, Theodorakopoulou M, Boutati E, Maratou E, Mitrou P, Nikitas N, Apollonatou S, Dimitriadis G, Armaganidis A, Dimopoulou I. Adipose tissue lipolysis and circulating lipids in acute and subacute critical illness: effects of shock and treatment. J Crit Care 2014; 29:1130.e5-9. [PMID: 25012960 DOI: 10.1016/j.jcrc.2014.06.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 05/26/2014] [Accepted: 06/01/2014] [Indexed: 02/08/2023]
Abstract
PURPOSE The purpose of this study is to assess lipid metabolism at the tissue level in critically ill subjects. MATERIALS AND METHODS We studied 182 patients with systemic inflammatory response syndrome/severe sepsis or shock during the acute (day 1) and subacute phase of critical illness (day 6). All subjects had a tissue microdialysis (MD) catheter placed in femoral adipose tissue upon admission to the intensive care unit (ICU). Plasma cholesterol, high-density lipoprotein, low-density lipoprotein, free fatty acids (FFAs), triglyceride, and MD glycerol (GLYC) were measured on days 1 and 6 in the ICU. RESULTS On admission, 56% of the patients had increased levels (>200 μmol/L) of MD GLYC. Patients with shock displayed more pronounced subcutaneous tissue lipolysis and more profound derangements of circulating lipids vs patients without shock (but no appreciable differences in FFA levels). Furthermore, in patients with shock during the acute period, there were positive, albeit weak, correlations of subcutaneous tissue lipolysis (MD GLYC), plasma FFAs (r=0.260; P=.01), and norepinephrine's dose (r=0.230; P=.01), whereas during the subacute phase, MD GLY levels were higher in patients receiving glucocorticoids (344.7±276.0 μmol/L vs 252.2±158.4 μmol/L; P=.03). CONCLUSIONS Subcutaneous tissue lipolysis is only one of the many determinants of plasma FFAs. Routinely applied therapeutic modalities in the ICU interfere with adipose tissue metabolism.
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Affiliation(s)
- I Ilias
- Endocrine Department, E. Venizelou Hospital, Athens, Greece.
| | - D A Vassiliadi
- Second Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - M Theodorakopoulou
- Second Department of Critical Care Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - E Boutati
- Second Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - E Maratou
- Second Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - P Mitrou
- Second Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - N Nikitas
- Second Department of Critical Care Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - S Apollonatou
- Second Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - G Dimitriadis
- Second Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - A Armaganidis
- Second Department of Critical Care Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - I Dimopoulou
- Second Department of Critical Care Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
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Theodorakopoulou M, Dimopoulou I, Karambi S, Strilakou A, Diamantakis A, Orfanos S, Armaganidis A. Early enteral feeding in the septic critically ill patient: evaluation of our feeding protocol. Crit Care 2014. [PMCID: PMC4069561 DOI: 10.1186/cc13616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Theodorakopoulou M, Orfanos S, Nikitas N, Vasilliadi D, Apolonatou S, Diamantakis A, Karkouli G, Diakaki C, Armaganidis A, Dimopoulou I. Adipose tissue lactate clearance but not blood lactate clearance is associated with clinical outcome in severe sepsis or septic shock during the post-resuscitation period. Crit Care 2014. [PMCID: PMC4068836 DOI: 10.1186/cc13362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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32
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Nikitas N, Kopterides P, Ilias I, Theodorakopoulou M, Vassiliadi DA, Armaganidis A, Dimopoulou I. Elevated adipose tissue lactate to pyruvate (L/P) ratio predicts poor outcome in critically ill patients with septic shock: a microdialysis study. Minerva Anestesiol 2013; 79:1229-1237. [PMID: 23857439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Sepsis is a disease affecting tissue metabolism; in vivo microdialysis (MD) is a bedside technique enabling researchers to monitor tissue metabolic changes. We conducted this study aiming to evaluate the relationship between lactate to pyruvate (L/P) ratio, a sensitive marker of tissue oxygenation and perfusion, and mortality in critically ill septic patients. METHODS We enrolled 105 patients with septic shock hospitalized in the mixed intensive care unit of a tertiary hospital. A MD catheter was inserted in the subcutaneous adipose tissue of the upper thigh and interstitial fluid samples were collected and analyzed for glucose, lactate, pyruvate, and glycerol. RESULTS Multivariate regression analysis showed that among variables registered on day 1, APACHE II and SOFA scores, blood lactate and microdialysis-assessed tissue L/P ratio were independently associated with 28-day mortality. Even in patients with normal (<2 mmol/L) blood lactate, adipose tissue L/P ratio showed a strong trend to statistical significance. During the 6-day study period, non-survivors had significantly higher L/P ratios compared to survivors (P=0.001) and mixed model analysis revealed a different pattern of evolution in time with non-survivors experiencing an increase while survivors had a late decline in their L/P ratio. The AUC for L/P ratio was similar to that of APACHE II (P=0.67) and SOFA score (P=0.73). Comparison of the Kaplan-Meier 28-day survival curves of patients with normal (≤ 25) versus elevated (>25) L/P ratios showed that the latter survived significantly less (P=0.02; log-rank test). CONCLUSION Elevated adipose tissue L/P ratio is associated with poor outcome in critically ill patients with septic shock. Microdialysis deserves to be further studied as a research tool in the multi-modal monitoring of septic critically ill patients.
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Affiliation(s)
- N Nikitas
- Second Department of Critical Care Medicine, "Attiko" University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece -
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Abstract
Fungi are major causes of infections among immunocompromised or hospitalized patients with serious underlying diseases and comorbidities. Candida species remain the most important cause of opportunistic infections worldwide, affecting predominantly patients over 65 years old, while they are considered to be the fourth most common cause of nosocomial bloodstream infections. The rapidly growing elderly population has specific physiological characteristics, which makes it susceptible to colonization and subsequent infection due to Candida species. Comorbidities and multidrug use should be taken into account any time the therapeutic regimen is under consideration. Different classes of antifungal drugs are available for the treatment of invasive fungal infections but echinocandins, apart from their activity against resistant strains (Candida glabrata and Candida krusei), seem to be safe, with limited adverse events and minimal drug-drug interactions in comparison to the other regimens. Therefore, these agents are strongly recommended when dealing with elderly patients suffering from an invasive form of Candida infection.
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Affiliation(s)
- Aikaterini Flevari
- Department of Critical Care, University Hospital Attikon, Medical School, Athens, Greece
| | - Maria Theodorakopoulou
- Department of Critical Care, University Hospital Attikon, Medical School, Athens, Greece
| | - Aristea Velegraki
- Mycology Laboratory, Department of Microbiology, Medical School, University of Athens, Athens, Greece
| | - Apostolos Armaganidis
- Department of Critical Care, University Hospital Attikon, Medical School, Athens, Greece
| | - George Dimopoulos
- Department of Critical Care, University Hospital Attikon, Medical School, Athens, Greece
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Theodorakopoulou M, Perros E, Giamarellos-Bourboulis EJ, Dimopoulos G. Controversies in the management of the critically ill: the role of probiotics. Int J Antimicrob Agents 2013; 42 Suppl:S41-4. [PMID: 23664676 DOI: 10.1016/j.ijantimicag.2013.04.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Probiotics are commercially available, viable, non-pathogenic micro-organisms that, when ingested in sufficient quantities, exert a health benefit to the host derived through modification of the gut flora, local release of antimicrobial factors, maintenance of integrity of the gut barrier, competition for epithelial adherence, prevention of bacterial translocation, and modulation of the local immune response. In critically ill patients, probiotics appear to lead to decreased susceptibility to antibiotic-associated diarrhoea, Clostridium difficile infections, ventilator-associated pneumonia, necrotising enterocolitis, acute severe pancreatitis, sepsis and multiple organ dysfunction syndrome as well as a shortened duration of infections. Current scientific evidence supporting the use of probiotics is not conclusive and is mainly derived from single-centre, not very well designed trials that are limited by many factors including small sample sizes, heterogeneity in the probiotic strains used, effectiveness of the combined strains, optimum dose regimens, frequency and duration of administration, and certainly incomplete knowledge of the mechanism of action of each strain. Probiotics appear to be well tolerated, whilst adverse events are very rare. The most commonly reported adverse events include bacteraemia, fungaemia and sepsis. At present, based on the available evidence and although helpful and relatively safe for certain disease conditions, routine use of probiotics in the critically ill is not recommended.
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Kopterides P, Theodorakopoulou M, Ilias I, Nikitas N, Frantzeskaki F, Vassiliadi DA, Armaganidis A, Dimopoulou I. Interrelationship between blood and tissue lactate in a general intensive care unit: a subcutaneous adipose tissue microdialysis study on 162 critically ill patients. J Crit Care 2012; 27:742.e9-18. [PMID: 23089678 DOI: 10.1016/j.jcrc.2012.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 08/04/2012] [Accepted: 08/07/2012] [Indexed: 01/10/2023]
Abstract
PURPOSE The aim of the study was to study the interrelationship between blood and tissue lactate in critically ill patients with or without shock admitted in a general intensive care unit. MATERIALS AND METHODS We studied 162 mechanically ventilated patients: 106 with shock (septic shock, 97; cardiogenic shock, 9) and 56 without shock (severe sepsis, 38; systemic inflammatory response syndrome, 18). A microdialysis catheter was inserted in the subcutaneous adipose tissue of the upper thigh, and interstitial fluid was collected every 4 hours for a maximum of 6 days. We assessed the relationship between tissue and blood lactate using cross-approximate entropy and cross-correlation analysis. RESULTS Patients with shock had higher area under the curve for blood (261 vs 175 mmol/L*hours, P < .0001) and tissue lactate (386 vs 281 mmol/L*hours, P < .0001) compared with patients without shock. The interrelationship of tissue-blood lactate, as assessed with cross-approximate entropy, was more regular in patients with shock compared with patients without shock. Cross-correlation of tissue vs blood lactate yielded higher correlation coefficients in patients with shock compared with those without shock, being higher when tissue lactate preceded blood lactate by 4 hours compared with tissue vs blood lactate with no lag time. CONCLUSIONS In critical illness, the detailed dynamics between blood and tissue lactate are affected by the presence of shock. In patients with shock, microdialysis-assessed tissue lactate is higher compared with those without shock and may detect metabolic disturbances before these become evident in the systemic circulation.
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Affiliation(s)
- Petros Kopterides
- Second Department of Critical Care Medicine, Attiko University Hospital, National and Kapodistrian University of Athens, Medical School, 124 62 Haidari, Athens, Greece
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Kopterides P, Nikitas N, Theodorakopoulou M, Diamantakis A, Vassiliadi D, Kaziani A, Assoti S, Drakopanagiotakis F, Antonopoulou A, Papadopoulos P, Mavrou E, Georgiadou C, Tsantes A, Armaganidis A, Dimopoulou I. Red blood cell transfusion improves microdialysis-assessed interstitial lactate/pyruvate ratio in critically ill septic patients. Crit Care 2012. [PMCID: PMC3363864 DOI: 10.1186/cc11053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Ilias I, Kopterides P, Nikitas N, Vassiliadi D, Theodorakopoulou M, Papadomichelakis E, Lygnos M, Flevari A, Rizos M, Frantzeskaki F, Diakaki C, Paramythiotou E, Dimitriadou E, Orfanos S, Armaganidis A, Dimopoulou I. Cross-correlation analysis of blood and microdialysis-assessed tissue lactate monitoring: a study in critically ill septic patients. Crit Care 2012. [PMCID: PMC3363678 DOI: 10.1186/cc10867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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38
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Poukoulidou T, Spyridaki A, Mihailidou I, Kopterides P, Pistiki A, Alexiou Z, Chrisofos M, Dimopoulou I, Drimoussis P, Giamarellos-Bourboulis EJ, Koutelidakis I, Marioli A, Mega A, Orfanos SE, Theodorakopoulou M, Tsironis C, Maggina N, Polychronopoulos V, Tsangaris I. TREM-1 expression on neutrophils and monocytes of septic patients: relation to the underlying infection and the implicated pathogen. BMC Infect Dis 2011; 11:309. [PMID: 22050935 PMCID: PMC3241479 DOI: 10.1186/1471-2334-11-309] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Accepted: 11/04/2011] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Current knowledge on the exact ligand causing expression of TREM-1 on neutrophils and monocytes is limited. The present study aimed at the role of underlying infection and of the causative pathogen in the expression of TREM-1 in sepsis. METHODS Peripheral venous blood was sampled from 125 patients with sepsis and 88 with severe sepsis/septic shock. The causative pathogen was isolated in 91 patients. Patients were suffering from acute pyelonephritis, community-acquired pneumonia (CAP), intra-abdominal infections (IAIs), primary bacteremia and ventilator-associated pneumonia or hospital-acquired pneumonia (VAP/HAP). Blood monocytes and neutrophils were isolated. Flow cytometry was used to estimate the TREM-1 expression from septic patients. RESULTS Within patients bearing intrabdominal infections, expression of TREM-1 was significantly lower on neutrophils and on monocytes at severe sepsis/shock than at sepsis. That was also the case for severe sepsis/shock developed in the field of VAP/HAP. Among patients who suffered infections by Gram-negative community-acquired pathogens or among patients who suffered polymicrobial infections, expression of TREM-1 on monocytes was significantly lower at the stage of severe sepsis/shock than at the stage of sepsis. CONCLUSIONS Decrease of the expression of TREM-1 on the membrane of monocytes and neutrophils upon transition from sepsis to severe sepsis/septic shock depends on the underlying type of infection and the causative pathogen.
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Affiliation(s)
- Thekla Poukoulidou
- 4th Department of Internal Medicine, University of Athens, Medical School, ATTIKON General Hospital, 1 Rimini Str,, 12462 Athens, Greece.
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Kopterides P, Nikitas N, Vassiliadi D, Orfanos SE, Theodorakopoulou M, Ilias I, Boutati E, Dimitriadis G, Maratou E, Diamantakis A, Armaganidis A, Ungerstedt U, Dimopoulou I. Microdialysis-assessed interstitium alterations during sepsis: relationship to stage, infection, and pathogen. Intensive Care Med 2011; 37:1756-64. [PMID: 21847648 DOI: 10.1007/s00134-011-2336-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2011] [Accepted: 07/25/2011] [Indexed: 01/19/2023]
Abstract
PURPOSE More than a disorder of macrocirculation, sepsis is a disease affecting the microcirculation and the tissue metabolism. In vivo microdialysis (MD) is a bedside technique that can monitor tissue metabolic changes. We conducted this study aiming (1) to assess whether patients at different sepsis stages present with different MD-assessed tissue metabolic profiles and (2) to determine if different underlying types of infections and implicated pathogens are associated with dissimilar metabolic alterations. METHODS We studied 90 mechanically ventilated patients, 65 with septic shock and 25 with severe sepsis. An MD catheter was inserted in the subcutaneous adipose tissue of the upper thigh and interstitial fluid samples were collected along with arterial blood samples every 4 h for a maximum of 6 days. Lactate, pyruvate, glycerol, and glucose concentrations were measured. RESULTS During the study period, patients with septic shock had higher MD-assessed glycerol (P = 0.009), glycerol gradient (P = 0.016), and glucose (P = 0.004) than patients with severe sepsis, whereas tissue lactate, lactate gradient, and pyruvate dropped significantly with time (P = 0.007, <0.001, and <0.001, respectively) in both patient groups without any observed between-group difference. In addition, there was no between-group difference in their tissue lactate/pyruvate ratio on any day, nor did the ratio decrease significantly with time. Compared with pneumonia patients, and despite similar baseline clinical characteristics, those suffering from intra-abdominal infections showed a pattern of higher and progressively increasing tissue levels of glucose (P = 0.001) and glycerol (P = 0.001). Finally, patients harboring gram-positive infections had higher tissue levels of glycerol (P = 0.027) and glycerol gradient (P = 0.029) than patients with gram-negative infections. CONCLUSIONS MD can detect tissue metabolic abnormalities that differ in relation to the sepsis stage and the type of underlying infection or responsible pathogen. Some of the MD-assessed abnormalities are not reflected by conventional blood measurements and possess prognostic potential. It remains to be determined if this type of metabolic monitoring can find clinical applications in the wide population of septic critically ill patients.
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Affiliation(s)
- Petros Kopterides
- Second Department of Critical Care Medicine, Attiko University Hospital, Medical School, National and Kapodistrian University of Athens, 1 Rimini Street, Haidari, 12462, Athens, Greece.
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Frantzeskaki F, Theodorakopoulou M, Mavrou I, Armaganidis A. Acute renal failure and neurological manifestations following ingestion of wild mushrooms. Indian J Nephrol 2011; 19:175-7. [PMID: 20535261 PMCID: PMC2875715 DOI: 10.4103/0971-4065.59347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- F Frantzeskaki
- 2 Department of Critical Care, Atticon University Hospital, Athens, Greece
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Theodorakopoulou M, Nikitas N, Ilias I, Tzanela M, Vassiliadi D, Kopterides P, Maniatis N, Diamantakis A, Orfanos S, Perogamvros I, Armaganidis A, Ungerstedt U, Keevil K, Tsagarakis T, Dimopoulou D. Interstitial cortisol levels obtained by adipose tissue microdialysis in mechanically ventilated septic patients: correlations with total and free serum cortisol. Crit Care 2011. [PMCID: PMC3068340 DOI: 10.1186/cc9831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Flevari AG, Maniatis N, Dimitriadou E, Theodorakopoulou M, Paramythiotou E, Christoforidis N, Kaziani A, Koukios D, Drakopanagiotakis F, Armaganidis A. Rohrer's constant, k2, as a factor for determining endotracheal tube obstruction. Crit Care 2011. [PMCID: PMC3061786 DOI: 10.1186/cc9576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Vassiliadi D, Mavrou I, Tzanela M, Nikitas N, Theodorakopoulou M, Orfanos S, Armaganidis A, Tsagarakis S, Dimopoulou I. Salivary cortisol measurements in mechanically ventilated patients. Crit Care 2011. [PMCID: PMC3068338 DOI: 10.1186/cc9829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Theodorakopoulou M, Nikitas N, Orfanos S, Maratou I, Boutati E, Diamantakis A, Armaganidis A, Dimopoulou I. Lipid metabolism in critically ill patients: a microdialysis study. Crit Care 2011. [PMCID: PMC3066959 DOI: 10.1186/cc9705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Georgopoulou AP, Savva A, Giamarellos-Bourboulis EJ, Georgitsi M, Raftogiannis M, Antonakos N, Apostolidou E, Carrer DP, Dimopoulos G, Economou A, Efthymiou G, Galanakis N, Galani L, Gargalianos P, Karaiskos I, Katsenos C, Kavatha D, Koratzanis E, Labropoulos P, Lada M, Nakos G, Paggalou E, Panoutsopoulos G, Paraschos M, Pavleas I, Pontikis K, Poulakou G, Prekates A, Sybardi S, Theodorakopoulou M, Trakatelli C, Tsiaoussis P, Gogos C, Giamarellou H, Armaganidis A, Meisner M. Early changes of procalcitonin may advise about prognosis and appropriateness of antimicrobial therapy in sepsis. J Crit Care 2010; 26:331.e1-7. [PMID: 20869839 DOI: 10.1016/j.jcrc.2010.07.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Revised: 07/20/2010] [Accepted: 07/21/2010] [Indexed: 11/25/2022]
Abstract
PURPOSE The objective of this study is to define if early changes of procalcitonin (PCT) may inform about prognosis and appropriateness of administered therapy in sepsis. METHODS A prospective multicenter observational study was conducted in 289 patients. Blood samples were drawn on day 1, that is, within less than 24 hours from advent of signs of sepsis, and on days 3, 7, and 10. Procalcitonin was estimated in serum by the ultrasensitive Kryptor assay (BRAHMS GmbH, Hennigsdorf, Germany). Patients were divided into the following 2 groups according to the type of change of PCT: group 1, where PCT on day 3 was decreased by more than 30% or was below 0.25 ng/mL, and group 2, where PCT on day 3 was either increased above 0.25 ng/mL or decreased less than 30%. RESULTS Death occurred in 12.3% of patients of group 1 and in 29.9% of those of group 2 (P < .0001). Odds ratio for death of patients of group 1 was 0.328. Odds ratio for the administration of inappropriate antimicrobials of patients of group 2 was 2.519 (P = .003). CONCLUSIONS Changes of serum PCT within the first 48 hours reflect the benefit or not of the administered antimicrobial therapy. Serial PCT measurements should be used in clinical practice to guide administration of appropriate antimicrobials.
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Theodorakopoulou M, Orfanos S, Diamantakis A, Tsafou E, Karkouli G, Nikitas N, Ikonomidis I, Ilias I, Tsangaris I, Armaganidis A, Dimopoulou I. Tissue microdialysis in critically ill septic patients: associations with sepsis severity and mortality. Crit Care 2010. [PMCID: PMC2934197 DOI: 10.1186/cc8380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Theodorakopoulou M, Nikitas N, Orfanos S, Vassiliadou D, Diamantakis A, Kotanidou A, Kopterides P, Maniatis N, Armaganidis A, Dimopoulou I. Extracellular metabolic alterations in critically ill septic patients studied by adipose tissue microdialysis. Crit Care 2010. [PMCID: PMC3254949 DOI: 10.1186/cc9134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Dimopoulou I, Orfanos SE, Pelekanou A, Kotanidou A, Livaditi O, Augustatou C, Zervou M, Douka E, Theodorakopoulou M, Karagianni V, Douzinas E, Armaganidis A, Giamarellos-Bourboulis EJ. Serum of patients with septic shock stimulates the expression of Trem-1 on U937 monocytes. Inflamm Res 2009; 58:127-32. [PMID: 19109693 DOI: 10.1007/s00011-008-7039-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To describe the concentrations of sTREM-1 in patients with sepsis and to explore the effects of their serum on the expression of TREM-1 on U937 monocytes. METHODS Blood was sampled at regular time intervals in 56 patients with sepsis. Concentrations of tumour necrosis factor-alpha (TNFalpha), interleukin-1beta (IL-1alpha), IL-6, IL-8, IL-10 and IL-12p70 and sTREM-1 were measured. U937 monocytes were incubated in the presence of serum at sepsis onset. RESULTS Median sTREM-1 concentration on day 1 for patients with septic shock was 915 pg/ml and 228.5 pg/ml for those without shock (p = 0.002). TNFalpha, IL-1alpha, IL-6, IL-8 and IL-10 did not differ between them. A positive correlation was found between changes of sTREM-1 and SOFA scores from day 1 to 7. Sera of patients with septic shock evoked a significant increase of the expression of TREM-1. The concentrations of TNFalpha and IL-8 in supernatants increased only after stimulating with sera of patients without shock, but not after stimulating with sera of patients with shock. CONCLUSIONS Levels of sTREM-1 correlated with sepsis severity. sTREM-1 is considerably higher in patients with shock compared to patients without shock. The serum of shocked patients could stimulate the expression of TREM-1 on U937 monocytes.
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Affiliation(s)
- I Dimopoulou
- 2nd Department of Critical Care Medicine, University of Athens, Greece
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Kopterides P, Mavrou I, Kostadima E, Zakynthinos E, Lignos M, Kontopithari G, Papadomichelakis E, Theodorakopoulou M, Tsangaris I, Dimopoulos G, Dimopoulou I, Orfanos S, Bonovas S, Armaganidis A. Venous oxygen saturation and lactate gradient from the superior vena cava to the pulmonary artery in ICU patients with septic shock. Crit Care 2009. [PMCID: PMC4084121 DOI: 10.1186/cc7399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Kopterides P, Synetos A, Theodorakopoulou M, Armaganidis A, Lerakis S. Osborn waves in sepsis-induced hypothermia. Int J Cardiol 2008; 129:297-9. [PMID: 17651838 DOI: 10.1016/j.ijcard.2007.06.055] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2007] [Accepted: 06/23/2007] [Indexed: 11/29/2022]
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