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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Predictors of outcomes of patients ≥ 80 years old admitted to intensive care units in Poland - a post-hoc analysis of the VIP2 prospective observational study

INTRODUCTION

Elderly patients pose a significant challenge to intensive care unit (ICU) clinicians. In this study we attempted to characterise the population of patients over 80 years old admitted to ICUs in Poland and identify associations between clinical features and short-term outcomes.

MATERIAL AND METHODS

The study is a post-hoc analysis of the Polish cohort of the VIP2 European prospective observational study enrolling patients > 80 years old admitted to ICUs over a 6-month period. Data including clinical features, clinical frailty scale (CFS), geriatric scales, interventions within the ICU, and outcomes (30-day and ICU mortality and length of stay) were gathered. Univariate analyses comparing frail (CFS > 4) to non-frail patients and survivors to non-survivors were performed. Multivariable models with CFS, activities of daily living score (ADL), and the cognitive decline questionnaire IQCODE as predictors and ICU or 30-day mortality as outcomes were formed.

RESULTS

A total of 371 patients from 27 ICUs were enrolled. Frail patients had significantly higher ICU (58% vs. 44.45%, P = 0.03) and 30-day (65.61% vs. 54.14%, P = 0.01) mortality compared to non-frail counterparts. The survivors had significantly lower SOFA score, CFS, ADL, and IQCODE than non-survivors. In multivariable analysis CFS (OR 1.15, 95% CI: 1.00-1.34) and SOFA score (OR 1.29, 95% CI: 1.19-1.41) were identified as significant predictors for ICU mortality; however, CFS was not a predictor for 30-day mortality ( P = 0.07). No statistical significance was found for ADL, IQCODE, polypharmacy, or comorbidities.

CONCLUSIONS

We found a positive correlation between CFS and ICU mortality, which might point to the value of assessing the score for every patient admitted to the ICU. The older Polish ICU patients were characterised by higher mortality compared to the other European countries.

Humulus lupus extract rich in xanthohumol improves the clinical course in critically ill COVID-19 patients

BACKGROUND

The systemic inflammatory response following severe COVID-19 is associated with poor outcomes. Several anti-inflammatory medications have been studied in COVID-19 patients. Xanthohumol (Xn), a natural extract from hop cones, possesses strong anti-inflammatory and antioxidative properties. The aim of this study was to analyze the effect of Xn on the inflammatory response and the clinical outcome of COVID-19 patients.

METHODS

Adult patients treated for acute respiratory failure (PaO₂/FiO₂ less than 150) were studied. Patients were randomized into two groups: Xn - patients receiving adjuvant treatment with Xn at a daily dose of 4.5 mg/kg body weight for 7 days, and C - controls. Observations were performed at four time points: immediately after admission to the ICU and on the 3rd, 5th, and 7th days of treatment. The inflammatory response was assessed based on the plasma IL-6 concentration, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP) and D-dimer levels. The mortality rate was determined 28 days after admission to the ICU.

RESULTS

Seventy-two patients were eligible for the study, and 50 were included in the final analysis. The mortality rate was significantly lower and the clinical course was shorter in the Xn group than in the control group (20% vs. 48%, p < 0.05, and 9 ± 3 days vs. 22 ± 8 days, p < 0.001). Treatment with Xn decreased the plasma IL-6 concentration (p < 0.01), D-dimer levels (p < 0.05) and NLR (p < 0.01) more significantly than standard treatment alone.

CONCLUSION

Adjuvant therapy with Xn appears to be a promising anti-inflammatory treatment in COVID-19 patients.

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

BACKGROUND

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

OBJECTIVE

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

DESIGN

Prospective cohort study.

SETTING

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

SUBJECTS

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

An evaluation of the usefulness of extracorporeal liver support techniques in patients with severe liver dysfunction

INTRODUCTION

The mortality rate in patients with severe liver dysfunction with no option of transplantation is unacceptably high. The main aim of this study was to evaluate the usefulness of applying extracorporeal liver support (ECLS) techniques in this group of patients.

MATERIAL AND METHODS

Data from hospital admissions of 101 patients with severe liver dysfunction who were admitted to the department of Anaesthesiology and intensive therapy between 2006 and 2015 were retrospectively analysed. The study group was divided into two subgroups. Standard Medical therapy (SMT) was a subgroup of patients receiving standard Medical therapy, and SMT + ECLS was a subgroup containing patients receiving standard medical therapy complemented by at least one extracorporeal liver support procedure.

RESULTS

Significantly lower intensive care unit (ICU) mortality and 30-day mortality rates were found in the SMT + ECLS subgroup (p = 0.0138 and p = 0.0238 respectively). No difference in 3-month mortality was identified between the two groups. In a multivariate model, independent risk factors for ICU mortality proved to be the SOFA score and prothrombin time. The highest discriminatory power for ICU mortality was demonstrated for the SOFA score, followed by APACHE II, SAPS II, MELD UNOS and GCS scores. For 30-day mortality, however, the best discriminatory power was shown for the SAPS II score, followed by SOFA, APACHE II, MELD UNOS and GCS scores.

CONCLUSIONS

Further studies are needed to assess the contribution of non-biological extracorporeal liver support procedures to a decrease in mortality rates in the population of patients with severe liver dysfunction.

Frailty is associated with an increased mortality among patients ≥ 80 years old treated in Polish ICUs

BACKGROUND

The increasing population of very old intensive care patients (VIPs) is a major challenge currently faced by clinicians and policymakers. Reliable indicators of VIPs' prognosis and purposefulness of their admission to the intensive care unit (ICU) are urgently needed.

METHODS

This is a report from the Polish sample of the VIP1 multicentre cohort study (NCT03134807). Patients ≥ 80 years of age admitted to the ICU were included in the study. Information on the type and reason for admission, demographics, utilisation of ICU procedures, ICU length of stay, organ dysfunction and the decision to apply end-of-life care was collected. The primary objective was to investigate the impact of frailty syndrome on ICU and 30-day survival of VIPs. Frailty was assessed with the Clinical Frailty Scale (≥ 5 points on a scale of 1-9).

RESULTS

We enrolled 272 participants with a median age of 84 (81-87) years. Frailty was diagnosed in 170 (62.5%) patients. The ICU and 30-day survival rates were equal to 54.6% and 47.3% respectively. Three variables were found to significantly increase the odds of death in the ICU in a multiple logistic regression model: SOFA score (OR = 1.16; 95%CI 1.16-1.24), acute mode of admission (OR = 5.1; 95%CI 1.67-15.57) and frailty (OR = 2.25; 95%CI 1.26-4.01).

CONCLUSION

Measuring frailty in critically ill older adults can facilitate making more informed clinical decisions and help avoid futile interventions.

An Evaluation of the Usefulness of Extracorporeal Liver Support Techniques in Patients Hospitalized in the ICU for Severe Liver Dysfunction Secondary to Alcoholic Liver Disease

BACKGROUND

The mortality rate in patients with severe liver dysfunction secondary to alcoholic liver disease (ALD) who do not respond to the standard treatment is exceptionally high.

OBJECTIVES

The main aim of this study was to evaluate the usefulness of applying extracorporeal liver support techniques to treat this group of patients.

PATIENTS AND METHODS

The data from 23 hospital admissions of 21 patients with ALD who were admitted to the department of anesthesiology and intensive therapy (A&IT) at the Dr Wł. Biegański Regional Specialist Hospital in Łódź between March 2013 and July 2015 were retrospectively analyzed.

RESULTS

A total of 111 liver dialysis procedures were performed during the 23 hospitalizations, including 13 dialyses using fractionated plasma separation and adsorption (FPSA) with the Prometheus® system, and 98 procedures using the single pass albumin dialysis (SPAD) system. Upon admission to the intensive care unit (ICU), the median (interquartile range [IQR]) Glasgow coma scale (GCS), sequential organ failure assessment (SOFA), acute physiology and chronic health evaluation (APACHE) II, and simplified acute physiology score (SAPS) II scores were 15 (14 - 15), 9 (7 - 13), 17 (14 - 24), and 32 (22 - 50), respectively. The ICU, 30-day, and three-month mortality rates were 43.48%, 39.13%, and 73.91%, respectively. As determined by the receiver operative characteristic (ROC) analysis for single-factor models, the significant predictors of death in the ICU included the patients' SOFA, APACHE II, SAPS II, and model of end-stage liver disease modified by the united network for organ sharing (MELD UNOS Modification) scores; the duration of stay (in days) in the A&IT Department; and bile acid, creatinine and albumin levels upon ICU admission. The ROC analysis indicated the significant discriminating power of the SOFA, APACHE II, SAPS II, and MELD UNOS modification scores on the three-month mortality rate.

CONCLUSIONS

The application of extracorporeal liver support techniques in patients with severe liver dysfunction secondary to ALD appears justified in the subset of patients with MELD UNOS Modification scores of 18 - 30.

Predictive value of the APACHE II, SAPS II, SOFA and GCS scoring systems in patients with severe purulent bacterial meningitis

BACKGROUND

Scoring systems in critical care patients are essential for predicting of the patient outcome and evaluating the therapy. In this study, we determined the value of the Acute Physiology and Chronic Health Evaluation II (APACHE II), Simplified Acute Physiology Score II (SAPS II), Sequential Organ Failure Assessment (SOFA) and Glasgow Coma Scale (GCS) scoring systems in the prediction of mortality in adult patients admitted to the intensive care unit (ICU) with severe purulent bacterial meningitis.

METHODS

We retrospectively analysed data from 98 adult patients with severe purulent bacterial meningitis who were admitted to the single ICU between March 2006 and September 2015.

RESULTS

Univariate logistic regression identified the following risk factors of death in patients with severe purulent bacterial meningitis: APACHE II, SAPS II, SOFA, and GCS scores, and the lengths of ICU stay and hospital stay. The independent risk factors of patient death in multivariate analysis were the SAPS II score, the length of ICU stay and the length of hospital stay. In the prediction of mortality according to the area under the curve, the SAPS II score had the highest accuracy followed by the APACHE II, GCS and SOFA scores.

CONCLUSIONS

For the prediction of mortality in a patient with severe purulent bacterial meningitis, SAPS II had the highest accuracy.

Hepatic encephalopathy in the course of alcoholic liver disease--treatment options in the intensive care unit

Hepatic encephalopathy occurs as a complication of alcoholic liver disease may require methods of dialysis available in intensive care units. There is described the case of a 27-year-old patient with jaundice and hepatic encephalopathy with long history of alcohol dependence and substance abuse. The patient was successfully treated using liver dialysis method (Prometheus® system). Basing on this case it is possible to conclude that use of dialysis liver with Prometheus® may be beneficial in patients with severe course of alcoholic liver disease.

Rationale of statin therapy in septic patients

Statins are well-established and effective drugs in the treatment of hyperlipidemias. However the effects of statins extend beyond lipid-lowering. The pleiotropic effects of statins have been shown to modify inflammatory cell signaling of the immune response to infection. Statins have emerged as potential immunomodulatory and antioxidant agents that might impact on sepsis outcomes. It was postulated that statins may be candidates for the treatment of sepsis. Recent animal and human data suggest that statin therapy might be beneficial in patients before the onset of sepsis or in its initial period, but should be used with care when patients are diagnosed with severe sepsis or septic shock. Some analyses also provide evidence for statins as an adjuvant therapy in sepsis. Because of the divergent results of studies, the potential benefit needs to be validated in randomized, controlled trials. In this review, we describe current evidence on the use of statins in the prevention and treatment of sepsis.

Risk management in intensive therapy units - the method of determination of black spots

BACKGROUND

Patients hospitalised in intensive care units are more likely to suffer an adverse event than those treated in other hospital wards. The aim of this study was to assess the usefulness of identifying the events (the so-called 'black spots') that constitute a significant threat to life and health of patients and/or financing of the hospital.

METHODS

We retrospectively analysed 30 medical records and other documents relating to the stay of patients hospitalised in the Department of Anaesthesiology and Intensive Care at the Regional Hospital in Swidnica in 2010. To determine the 'black spots', the authors used their own methods.

RESULTS

We identified 31 adverse events (12 types of events) that occurred during the provision of healthcare in the intensive care unit. Six black spots were determined based on the model adopted in the study.

CONCLUSIONS

Identifying black spots can help to substantially reduce morbidity and mortality in hospitalised patients. It also allows optimisation of therapeutic entities, particularly in intensive care units.

Adult intensive therapy services contracted by the National Health Fund in 2012

BACKGROUND

Limited financial resources of the National Health Fund (NHF) affect the extent of funding allocated for intensive therapy services. The objective of the study was to analyse the levels of funding the departments of anaesthesiology and intensive therapy are provided with by NHF regional branches in 2012.

METHODS

Websites of NHF regional branches were surveyed to obtain the data about the therapeutic entities containing departments of anaesthesiology and intensive therapy, whose services were contracted by NHF in 2012. The contract value, number of contracted points and price of a point were determined for each department. Moreover, based on preliminary survey of the National Official Register of Economic Entities (REGON), the number of intensive therapy beds in the departments in question was calculated.

RESULTS

The highest expenditure on adult intensive therapy per one citizen was found in the West Pomeranian, Podlasie and Lesser Poland provinces whereas the lowest one in Swietokrzyskie, Pomeranian and Lublin provinces.

CONCLUSION

Funds allocated by NHF for services of departments of anaesthesiology and intensive therapy are insufficient.

Paediatric intensive therapy services contracted by the National Health Fund in 2012

BACKGROUND

Departments of paediatric anaesthesiology and intensive therapy are relevant elements of the healthcare system in Poland. The aim of the present study was to analyse the level of funding of departments of paediatric anaesthesiology and intensive therapy provided by regional branches of the National Health Fund (NHF) in 2012.

METHODS

The survey of websites of regional branches of NHF provided data about therapeutic entities with departments of paediatric anaesthesiology and intensive therapy, whose services were contracted by NHF in 2012. The contract value for 2012, number of contracted points and price of a point were defined for each department. Moreover, using the Register of Therapeutic Entities, the number of intensive therapy beds in the departments of paediatric anaesthesiology and intensive therapy in these entities was determined.

RESULTS

The highest expenditure for intensive therapy of children and teenagers under 17 years of age per one citizen was found in the Silesian, Opole and Lodz provinces; the lowest expenditure was observed in the Lubusz (no contracted departments), Swietokrzyskie and Podkarpacie provinces.

CONCLUSION

The level of funding of departments of paediatric anaesthesiology and intensive therapy provided by NHF appears to be sufficient; however, the staff and equipment potential of many such departments is not fully exploited.

Common transcriptional effects in the mouse striatum following chronic treatment with heroin and methamphetamine

The molecular alterations that underlie the long-lasting behavioural effects of drugs of abuse, such as psychomotor sensitization and physical dependence, are still not known. Moreover, it is not known which molecular effects are similar for addictive drugs from various pharmacological classes. In this study, we utilized whole-genome microarray profiling to evaluate the detailed time-course of transcriptional alterations in the mouse striatum during chronic treatment with heroin (HER) and methamphetamine (METH) and after period of spontaneous withdrawal. We identified 27 genes regulated by chronic drug administration. The overlap between lists of HER- and METH-induced genes was highly significant. The most substantial impact on the gene expression profile was observed for circadian genes (Per1, Per2 and Nr1d1). However, changing the treatment scheme from diurnal to nocturnal was sufficient to attenuate the drug-induced changes in circadian gene mRNA levels. Both of the drugs caused a dose-dependent induction in glucocorticoid-dependent genes with relatively long mRNA half-lives (Fkbp5, Sult1a1 and Plin4). The analysis also showed a drug-regulated group of transcripts enriched in the nucleus accumbens and includes well known (Pdyn, Cartpt and Rgs2) as well as new (Fam40b and Inmt) candidate genes. All identified alterations in the striatal transcriptome were transient and persisted up to 6 days after withdrawal. Behavioural sensitization, however, was maintained throughout the 12-day withdrawal period for both HER and METH. We suggest that transient gene expression alterations during drug treatment and in the early period of withdrawal are involved in the establishment of persistent neuroplastic alterations responsible for the development of drug addiction.

Impact of the perioperative care model on mortality of patients treated in general surgery wards

BACKGROUND

The risk of perioperative death in general surgery wards depends on many factors, including the underlying disease, type of surgical intervention and model of perioperative management. The aim of the study was to determine the reasons for major differences in mortality rates recorded in general surgery wards of the three university hospitals.

METHODS

The retrospective study was carried out and involved the data of 32 231 surgical patients. In one of the hospitals, postoperative patients were treated in the recovery room supervised by anaesthetists; in the remaining two, perioperative care was delivered by surgical ward staff. A multiple regression model with random effects was used to adjust for differences in three death risk groups of patients according to underlying diseases: low, moderate and high.

RESULTS

In the hospital with postoperative care administered by anaesthetic staff the mortality rate was 0.45 whereas in the two remaining ones with postoperative patients supervised by surgical staff - 1.86 and 2.52. In each group, increased mortality was observed among patients receiving therapy in general surgery wards after transfer from another hospital ward.

CONCLUSION

The major factor determining the mortality rates in general surgery wards is the model of perioperative management.

Anaesthetic management of a patient with myasthenia gravis for abdominal surgery using sugammadex

We report a case of a patient with tumor of the caecum with coexistent myasthenia gravis (a form according to Osserman II A), requiring general anesthesia for abdominal surgery. To reverse the neuromuscular block induced by vecuronium was used sugammadex.

Application of manuka honey and GENADYNE A4 negative pressure wound therapy system in a 55-year-old woman with extensive phlegmonous and necrotic lesions in the abdominal integuments and lumbar region after traumatic rupture of the colon

BACKGROUND

Antibiotic resistance of bacteria is on the rise and thus, the discovery of alternative therapeutic agents is urgently needed. Honey possesses good therapeutic potential, including wound healing properties and antimicrobial activity.

CASE REPORT

The authors report on the case of a 55-year-old woman with extensive phlegmonous and necrotic lesions of the abdominal integuments and the lumbar area following traumatic colonic rupture, treated with Manuka honey wound dressings and the GENADYNE A4 negative pressure wound healing system.

CONCLUSIONS

The application of the Manuka honey and the GENADYNE A4 negative pressure wound healing system in treating phlegmonous lesions of the abdominal integuments after rupture of the colon brought good effects, ultimately enabling skin autografting on the wound site and complete wound healing.

Natriuretic peptides in septic patients

The natriuretic peptide family is comprised of atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), C-type natriuretic peptide (CNP), dendroaspis natriuretic peptide - DNP and urodilatin. They play a role in the diagnosis of several diseases, especially those involving the cardiovascular system. Sepsis is a complex condition that can lead to multiorgan failure, shock and death. The number of people developing sepsis is still increasing (approximately 750,000 cases of sepsis occur annually in the USA). Both ANP and pro-ANP have attracted interest as new markers for sepsis. Reports indicate that ANP or BNP levels are elevated in septic patients. However, many mechanisms are still unexplained. This situation is complicated by the fact that contradictory results have been published. There are several reasons for this controversy including differences in the techniques used to assay natriuretic peptides. Nevertheless, natriuretic peptides might eventually prove useful for the diagnosis and/or the treatment of septic patients.

Analysis of occurrence of virulence genes among Yersinia enterocolitica isolates belonging to different biotypes and serotypes

The 150 Y enterocolitica strains isolated from humans and from pigs belonged to biotypes 4 (68.7%), 1A (18.7%) and 2 (4%), or were biochemically untypeable (8.6%). Biotype 4 was comprised of Y. enterocolitica strains representing serotype O:3, within biotype 1A the strains either belonged to serotypes O:5 and O:6 or were untypeable, and biotype 2 was represented by the strains of serotype O:9. The strains which were biochemically untypeable belonged to serotypes O:5, O:6 and O:3. Among the strains tested there also were those of an unidentified biotype and serotype. Nearly all the strains of biotype 1A represented genotype ystB+myfA+, and few belonged to genotype ystB+. The presence of the ystB gene in the strains of biotype 1A and only occasional occurrence of the gene in the other biotypes makes ystB a distinguishing marker of biotype 1A. The strains of genotype ystA+ail+myfA+yadA+ predominated in biotype 4 (serotype O:3). The strains of biotype 2 (serotype O:9) represented genotype ystA+ail+myfA+, and the plasmid yadA gene was detected in some of them. Within the group of biochemically untypeable strains ystB- and myfA-specific PCR products were mainly obtained. The genotypes determined for the tested biotypes and serotypes of Y. enterocolitica, based upon the selected genes of virulence, can be applied as distinguishing markers and indicators of the potential virulence of Y. enterocolitica strains, excluding bioserotyping.

Atrial and Brain Natriuretic Peptide and Endothelin-1 Concentration in Patients with Idiopathic Arterial Hypertension: The Dependence on the Selected Morphological Parameters

INTRODUCTION

The aim of the work was to study the maintenance of atrial and brain natriuretic peptide (ANP, BNP) and endothelin-1 (ET-1) in patients with idiopathic arterial hypertension and the relationships between cardiac morphological parameters and concentrations of examined peptides in group of patients with left ventricular hypertrophy (LVH).

METHODS

Seventy-six patients were enrolled in the study: 21 patients with confirmed idiopathic arterial hypertension (group 1), 18 with idiopathic hypertension and eccentric hypertrophy (group 1a), 14 with idiopathic hypertension and concentric hypertrophy (group 1b), and 23 patients without arterial hypertension, organic heart disease, or chronic respiratory tract diseases (group 2 - control group). All subjects were submitted for echocardiographic evaluation. Posterior wall thickness (PWT), interventricular septum thickness (IVST), left ventricular end-diastolic diameter (LVEDd), left atrium diameter (LAD), left ventricular mass index (LVMI), ejection fraction (EF), fractional shortening (FS), midwall shortening fraction (MWS), and relative wall thickness index (RWT) were studied. Concentrations of ANP(1-28), BNP, and ET-1 were determined with the use of radioimmunological kits (RIA). The obtained results were subjected to statistical analysis.

RESULTS

A considerable increase of ANP and BNP was observed in all patients with hypertension (group 1) in comparison to patients without hypertension (group 2). Significant increases of ANP were found in groups 1a and 1b in comparison to group 1 and 2, as well as considerably increase of BNP in group 1b compared to groups 1, 1a, and 2. In the group of patients with hypertension (group 1), a significant increase in the concentration of ET-1 compared to group 2 was found. However, the concentrations of ET-1 in groups 1 and 2 were not statistically different. Significant differences in concentrations of ET-1 between groups 1a, 1b, and 1 and 2 were seen. Significant correlations were found between concentrations of ANP, BNP, ET-1 and morphological parameters: PWT, IVST, LVMI and RWT. In group 1b, a correlation between concentrations of ANP, BNP, MWS, and LAD was found. The multiple regression analysis showed that RWT independently correlates with concentrations of ANP and BNP, and the concentration of BNP is in closer relation to RWT than ANP. In the case of ET-1, the multiple regression analysis did not show that LVMI or RWT had any independent influence on secretion of ET-1 in patients with idiopathic hypertension and LVH.

CONCLUSIONS

Increased concentration of ANP in patients with idiopathic hypertension may point to the coexistence of complications with type of LVH. High concentration of BNP may specifically suggest concentric LVH. This is important - especially if there are difficulties in interpretations of results of other clinical examinations. However, increased concentrations of ET-1 in the plasma of patients with hypertension and LVH should not be treated as an indicator of LVH degree.

Natriuretic peptides in cardiovascular diseases

The natriuretic peptide family comprises atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), C-type natriuretic peptide (CNP), dendroaspis natriuretic peptide (DNP), and urodilatin. The activities of natriuretic peptides and endothelins are strictly associated with each other. ANP and BNP inhibit endothelin-1 (ET-1) production. ET-1 stimulates natriuretic peptide synthesis. All natriuretic peptides are synthesized from polypeptide precursors. Changes in natriuretic peptides and endothelin release were observed in many cardiovascular diseases: e.g. chronic heart failure, left ventricular dysfunction and coronary artery disease.

Plasma endothelin-1 levels in septic patients

Dysfunction of the vascular endothelium (ET) causes an increase in serum ET-1 concentration, as observed in septic patients. It was assumed that in this patient population the ET-1 level correlates with the degree of sepsis severity, including the level of organ dysfunction and, in particular, the level of circulatory dysfunction. The aim of the present study was to assess the relationship between levels of ET-1 and levels of N-terminal brain natriuretic propeptide (NT-proBNP), procalcitonin (PCT), and C-reactive protein (CRP), as well as the Sepsis-related Organ Failure Assessment (SOFA) score in septic patients. PCT and CRP were used to estimate the level of sepsis severity; the SOFA score was used to estimate multiorgan dysfunction; and NT-proBNP was used as a marker of cardiac dysfunction. Twenty patients with sepsis and severe sepsis were included in the study. Blood serum ET-1, NT-proBNP, PCT, and CRP concentrations were determined at specific time intervals, and the SOFA score was calculated. Mean ET-1, NT-proBNP, PCT, and CRP concentrations were 8.39 pg/ml +/- 6.39 pg/mL, 140.80 pg/mL +/- 84.65 pg/mL, 22.32 ng/mL +/- 97.41 ng/mL, and 128.51 mg/L +/- 79.05 mg/L, respectively. Correlation between ET-1 levels and levels of NT-proBNP, PCT, and CRP was .3879 (P < .001), .358 (P < .001), and .225 (P = .011), respectively. Mean SOFA score was 6.31 pts +/- 3.75 pts. Correlation between the ET-1 levels and SOFA score was .470 (P < .001). Six patients (30%) died during the observation period of 28 days. ET-1 levels correlate with levels of NT-proBNP, PCT, and CRP, as well as the SOFA score in septic patients.

The concentration of atrial and brain natriuretic peptide in patients with idiopathic hypertension

BACKGROUND

The aim was to study the maintenance of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) in patients with idiopathic hypertension and relationships between cardiac morphological parameters and concentrations of the peptides in patients with hypertension and left ventricular hypertrophy (LVH).

MATERIAL/METHODS

Seventy-six patients were enrolled: 21 with confirmed idiopathic hypertension (group I), 18 with idiopathic hypertension and eccentric hypertrophy (group Ia), 14 with idiopathic hypertension and concentric hypertrophy (group Ib), and 23 healthy controls (group II). All underwent echocardiographic evaluation. Posterior wall thickness (PWT), interventricular septum thickness (IVST), left ventricular mass index (LVMI), relative wall thickness index (RWT), fractional shortening (FS), midwall shortening fraction (MWS), and left atrium diameter (LAd) were studied.

RESULTS

Considerably increased ANP and BNP were observed in all patients with hypertension (group I) compared with controls (group II). Significant increases in ANP in groups Ia and Ib compared with groups I and II were found as well as considerably increased BNP in group Ib compared with groups I, Ia, and II. Significant correlations were found between ANP and BNP concentrations and PWT, IVST, LVMI, and RWT. In group Ib, correlation between ANP and BNP and MWS and LAd was found. Multiple regression analysis showed that RWT independently correlated with ANP and BNP and that BNP is more closely related to RWT than is ANP.

CONCLUSIONS

Increased ANP in patients with idiopathic hypertension may indicate the coexistence of complications with types of LVH. High concentrations of BNP may specifically suggest concentric LVH.

Serum matrix metalloproteinases MMP-2 and MMP-9 and metalloproteinase tissue inhibitors TIMP-1 and TIMP-2 in diabetic nephropathy

BACKGROUND

The regulation of mesangial extracellular matrix (ECM) turnover engages a number of matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs). High glucose concentration affects ECM degradation and the activities of MMPs and TIMPs. ECM accumulation is involved in the pathogenesis of diabetic nephropathy.

METHODS

Serum MMP-9, MMP-2, TIMP-2 and TIMP-1 were measured with ELISA in patients with either chronic renal failure (CRF, n=20), type 2 diabetes mellitus (DM2, n=16) or diabetic nephropathy (DM2+CRF, n=14), and healthy controls (n=20).

RESULTS

Diabetic nephropathy was related with profound decrease of serum TIMP-2 (122.2 +/- 47.2 vs. 263.0 +/- 89.2 ng/mL), TIMP-1 (242.5 +/- 96.9 vs. 347.4 +/- 87.2 ng/mL) and MMP-2 (385.4 +/- 42.6 vs. 517.2 +/- 75.4 ng/mL) (p<0.001). Both TIMP-1 and TIMP-2 were reduced in diabetic nephropathy in comparison with either diabetes alone (p<0.01 and p<0.001; respectively) or CRF alone (p<0.001 for both). An approximately 2-fold increase of MMP-9/TIMP-1 and MMP-2/TIMP-2 ratio was found in diabetic nephropathy when compared with diabetes with normal renal function (p<0.01). Further, in DM2 patients, TIMP-2 was decreased when compared with CRF alone (219.2 +/- 71.8 vs. 296.8 +/- 58.4 ng/mL). MMP-2 was lowered in both groups of DM2 and CRF patients (413.8 +/- 59.0 ng/mL and 409.7 +/- 93.1 ng/mL, vs. normal control value of 517.2 +/- 75.4 ng/mL; p<0.001).

CONCLUSIONS

These data indicate that circulating TIMP-1, TIMP-2 and MMP-2 are decreased in patients with diabetic nephropathy when compared with either CRF or diabetes.

N-terminal brain natriuretic propeptide levels correlate with procalcitonin and C-reactive protein levels in septic patients

The aim of this study was to find the relationship between N-terminal brain natriuretic propeptide (NT-proBNP), procalcitonin (PCT) and C-reactive protein (CRP) plasma concentrations in septic patients. This was a prospective study, performed at Medical University Hospital No. 5 in łódź. Twenty patients with sepsis and severe sepsis were included in the study. N-terminal brain natriuretic propeptide, procalcitonin and C-reactive protein concentrations, and survival were evaluated. In the whole studied group (128 measurements), the mean NT-proBNP, procalcitonin and C-reactive protein concentrations were, respectively: 140.80+/-84.65 pg/ml, 22.32+/-97.41 ng/ml, 128.51+/-79.05 mg/l. The correlations for the NT-proBNP level and procalcitonin and C-reactive protein levels were 0.3273 (p<0.001) and 0.4134 (p<0.001), respectively. NT-proBNP levels correlate with PCT and CRP levels in septic patients. In the survivor subgroup, the mean NT-proBNP plasma concentrations were significantly lower than in the non-survivor subgroup.

L-arginine improves hemodynamic function and coronary flow in an experimental model of ischemia-reperfusion injury

BACKGROUND

Ischemia and reperfusion injury decrease the release of nitric oxide by vessels endothelial cells, which influences postischaemic coronary flow and return of left ventricle haemodynamic function. The study was conducted to answer the question how addition of L-arginine in cardioplegic and reperfusion fluids influences nitric oxide release, inducing the coronary flow and postischaemic haemodynamic heart function.

MATERIALS AND METHODS

The research was conducted on 56 rats, divided randomly into seven groups: control (C) and six experimental groups (E), where L-arginine was administrated in increasing doses of 0.3, 3.0 and 30.0 mM/L to cardioplegic (E1, E2 and E3 group) or reperfusion solution (E4, E5 and E6 group). To simulate a course of cardiac surgery the following stages of experiment were carried out: initial perfusion on the nonworking and working heart, cardioplegia, cold cardioplegic arrest and reperfusion of the non-working and working heart.

RESULTS

Level of nitric oxide during cardioplegic perfusion decreased in all groups. During reperfusion on non-working and working heart model we noticed the significant increase of nitric oxide for all groups. Along with nitric oxide increase, coronary flow increases, whereas with the decrease of level of nitric oxide, the coronary flow also diminished. During cardioplegic perfusion coronary flow constantly decreased in all groups and during reperfusion we observed the new increase of coronary flow. In groups E1, E2 and E3 the increase of coronary flow was significant.

CONCLUSIONS

Obtained data suggest that administration of L-arginine in the preischaemic and in the initial phase of reperfusion stimulates increase in nitric oxide release what is positively correlated with the increase of coronary flow.

NT-proBNP levels correlate with organ failure in septic patients: a preliminary report

The aim of the study was to evaluate the relationship between N-terminal brain natriuretic propeptide (NT-proBNP) plasma concentrations and the severity of organ dysfunction assessed by the Sepsis-related Organ Failure Assessment (SOFA) score in septic patients

MATERIAL/METHODS

NT-proBNP, SOFA score, and survival were evaluated in 20 consecutive septic patients. They were prospectively included in the study when the sepsis criteria according to the ACCP/SCCM definitions (modified by the Polish Working Group for Sepsis) were fulfilled. Blood serum NT-proBNP concentrations were determined in each patient at given time intervals and the severity of organ dysfunction was estimated according to the SOFA score. The first measurement was performed within 12 h after the patient's inclusion into the study, the second, third, and fourth at 12, 24, and 48 hours after the first, and then every 48 hours thereafter

RESULTS

The mean NT-proBNP concentration and the mean SOFA score were 140.80+/-84.65 pg/ml and 6.31+/-3.75 points, respectively. The correlation coefficient between NT-proBNP level and SOFA score was R=0.5164 (p<0.05). The mortality in the studied group was 30%.

CONCLUSIONS

NT-proBNP levels correlate with the severity of organ dysfunction as assessed by the SOFA score in septic patients.

Quantitative morphological study of microglial cells in the ischemic rat brain using principal component analysis

Pathogenic stimuli induce alterations in the morphology of microglial cells. We analysed changes in lectin-stained cells on the 1st, 3rd, 7th or 14th day after transient global ischemia. Three areas differing in the degree of microglial reaction were selected for analysis: the upper cerebral cortex, the hippocampal CA1 area, and the hilus of the dentate gyrus. Nine morphological parameters, including fractal dimension, lacunarity, self-similarity range, solidity, convexity and form factor were determined. Then the resultant data were processed using principal component analysis (PCA). We found that the two first principal components together explained more than 73% of the observed variability, and may be sufficient both to describe the morphological diversity of the cells, and to determine the dynamics and direction of the changes. In both hippocampal areas, the transformation to hypertrophied and phagocytic cells was observed, but changes in the hilus were faster than in the CA1. In contrast, in the cortex, a microglial reaction was characterised by an increase in the complexity of processes. The results presented show that the quantitative morphological analysis can be an effective tool in research on the reactive behaviour of microglia and, particularly, in the detection of small and early changes in the cells.

[Early intervention of specialist in children with bronchial asthma as a result of Prevention Program of Allergic Diseases in children]

Nowadays allergic diseases are one of the most important challenges in medicine because of healthful and economical consequences. Early diagnosis and correct treatment of allergic diseases, especially bronchial asthma have become a very important problem. For this purpose, prophylactic and treatment allergic programs are created. In this paper authors describe results of prophylactic program for allergic disease in children in Łódź district in years 2000-2001. Program improved access to specialists and allowed early diagnosis of bronchial asthma and other allergic diseases in children.

[Preliminary results of prophylactic program of allergic diseases in children in Lodz district]

Allergic diseases are one of the most important problems in medicine. As a consequence of increased frequency of allergic diseases, negative health, economical and social problems appear. To eliminate these consequences prophylactic programmes are created. In this paper preliminary results of Prophylactic Program of Allergic Diseases in Children in Łodz district in 2000-2001 years is presented.