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Cavalli I, Stella C, Stoll T, Mascia L, Salvagno M, Coppalini G, Diosdado A, Menozzi M, Diaferia D, Ndieugnou Djangang N, Oliveira F, Schuind S, Taccone FS, Gouvêa Bogossian E. Serum LDH levels may predict poor neurological outcome after aneurysmal subarachnoid hemorrhage. BMC Neurol 2023; 23:228. [PMID: 37312033 PMCID: PMC10262567 DOI: 10.1186/s12883-023-03282-8] [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: 04/25/2023] [Accepted: 06/07/2023] [Indexed: 06/15/2023] Open
Abstract
INTRODUCTION Serum lactate dehydrogenase (LDH) levels are often elevated in cardiovascular diseases. Their prognostic role after subarachnoid hemorrhage (SAH) remains poorly evaluated. METHODS This is a retrospective single-center study of patients with non-traumatic SAH admitted to the intensive care unit (ICU) of an University Hospital from 2007 to 2022. Exclusion criteria were pregnancy and incomplete medical records or follow-up data. Baseline information, clinical data, radiologic data, the occurrence of neurological complications as well as serum LDH levels during the first 14 days of ICU stay were collected. Unfavorable neurological outcome (UO) at 3 months was defined as a Glasgow Outcome Scale of 1-3. RESULTS Five hundred and forty-seven patients were included; median serum LDH values on admission and the highest LDH values during the ICU stay were 192 [160-230] IU/L and 263 [202-351] IU/L, respectively. The highest LDH value was recorded after a median of 4 [2-10] days after ICU admission. LDH levels on admission were significantly higher in patients with UO. When compared with patients with favorable outcome (FO), patients with UO had higher serum LDH values over time. In the multivariate logistic regression model, the highest LDH value over the ICU stay (OR 1.004 [95% CI 1.002 - 1.006]) was independently associated with the occurrence of UO; the area under the receiving operator (AUROC) curve for the highest LDH value over the ICU stay showed a moderate accuracy to predict UO (AUC 0.76 [95% CI 0.72-0.80]; p < 0.001), with an optimal threshold of > 272 IU/L (69% sensitivity and 74% specificity). CONCLUSIONS The results in this study suggest that high serum LDH levels are associated with the occurrence of UO in SAH patients. As a readily and available biomarker, serum LDH levels should be evaluated to help with the prognostication of SAH patients.
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Affiliation(s)
- Irene Cavalli
- Department of Intensive Care, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Route de Lennik, 8081070, Brussels, Belgium
- Department Medical and Surgical Science, Unit of Anesthesia and Intensive Care Medicine, Policlinico Di Sant'Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Claudia Stella
- Department of Intensive Care, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Route de Lennik, 8081070, Brussels, Belgium
| | - Timothée Stoll
- Department of Intensive Care, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Route de Lennik, 8081070, Brussels, Belgium
| | - Luciana Mascia
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Michele Salvagno
- Department of Intensive Care, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Route de Lennik, 8081070, Brussels, Belgium
| | - Giacomo Coppalini
- Department of Intensive Care, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Route de Lennik, 8081070, Brussels, Belgium
| | - Alberto Diosdado
- Department of Intensive Care, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Route de Lennik, 8081070, Brussels, Belgium
| | - Marco Menozzi
- Department of Intensive Care, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Route de Lennik, 8081070, Brussels, Belgium
| | - Daniela Diaferia
- Department of Intensive Care, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Route de Lennik, 8081070, Brussels, Belgium
| | - Narcisse Ndieugnou Djangang
- Department of Intensive Care, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Route de Lennik, 8081070, Brussels, Belgium
| | - Fernando Oliveira
- Department of Intensive Care, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Route de Lennik, 8081070, Brussels, Belgium
| | - Sophie Schuind
- Department of Neurosurgery, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Fabio Silvio Taccone
- Department of Intensive Care, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Route de Lennik, 8081070, Brussels, Belgium
| | - Elisa Gouvêa Bogossian
- Department of Intensive Care, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Route de Lennik, 8081070, Brussels, Belgium.
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Fratino S, Garré A, Garufi A, Hafidi S, Migliorino E, Stropeni S, Bogossian EG, Ndieugnou Djangang N, Albano G, Creteur J, Peluso L, Taccone FS. Evaluation of nociception in unconscious critically ill patients using a multimodal approach. Anaesth Crit Care Pain Med 2023; 42:101175. [PMID: 36396073 DOI: 10.1016/j.accpm.2022.101175] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/05/2022] [Accepted: 11/07/2022] [Indexed: 11/16/2022]
Abstract
This prospective observational study included 80 adults (>18 years) patients admitted to the intensive care unit who were unconscious (Glasgow Coma Scale [GCS] score <9 with a motor response <5) and receiving mechanical ventilation. A tetanic stimulation was used to assess nociception; automated pupillometry (Algiscan, ID-MED, France) was used to compute the pupillary pain index score (PPI), with a PPI > 4 considered as nociception. Concomitantly, the number of skin conductance fluctuations (NSCF) per second, measured using a Skin Conductance Algesimeter (SCA, MEDSTORM Innovation AS, Norway; > 0.27 fluctuations/sec indicating nociception), and the instantaneous Analgesia Nociception Index (iANI, MDoloris Medical Systems, France; <50 indicating nociception) were collected. Tetanic stimulation resulted in a median pupillary dilation of 16 [6-25]% and a PPI of 5 [2-7]. According to the PPI assessment, 44 patients (55%) had nociception, whereas 23 (29%) and 18 (23%) showed nociception according to the algesimeter and iANI assessment, respectively. No significant changes in measured physiologic variables were observed after the tetanic stimulation. There were no correlations between PPI, post-stimulation iANI, and SCA-derived variables. There were no differences in PPI, iANI, and SCA variables in patients with low and normal baseline EEG power at baseline. PERSPECTIVES: Detection of nociception varies across different devices in unconscious critically ill patients. Further studies are required to understand which method to implement for analgesic administration in this patient population.
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Affiliation(s)
- Sara Fratino
- Department of Intensive Care, Erasme University Hospital - Université Libre de Bruxelles, Brussels, Belgium.
| | - Annalisa Garré
- Department of Intensive Care, Erasme University Hospital - Université Libre de Bruxelles, Brussels, Belgium
| | - Alessandra Garufi
- Department of Intensive Care, Erasme University Hospital - Université Libre de Bruxelles, Brussels, Belgium
| | - Sofia Hafidi
- Department of Intensive Care, Erasme University Hospital - Université Libre de Bruxelles, Brussels, Belgium
| | - Ernesto Migliorino
- Department of Intensive Care, Erasme University Hospital - Université Libre de Bruxelles, Brussels, Belgium
| | - Serena Stropeni
- Department of Intensive Care, Erasme University Hospital - Université Libre de Bruxelles, Brussels, Belgium
| | - Elisa Gouvea Bogossian
- Department of Intensive Care, Erasme University Hospital - Université Libre de Bruxelles, Brussels, Belgium
| | | | - Giovanni Albano
- Department of Anesthesiology and Intensive Care, Humanitas Gavazzeni, Bergamo, Italy
| | - Jacques Creteur
- Department of Intensive Care, Erasme University Hospital - Université Libre de Bruxelles, Brussels, Belgium
| | - Lorenzo Peluso
- Department of Intensive Care, Erasme University Hospital - Université Libre de Bruxelles, Brussels, Belgium; Department of Anesthesiology and Intensive Care, Humanitas Gavazzeni, Bergamo, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Fabio Silvio Taccone
- Department of Intensive Care, Erasme University Hospital - Université Libre de Bruxelles, Brussels, Belgium
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Peluso L, Ferlini L, Talamonti M, Ndieugnou Djangang N, Gouvea Bogossian E, Menozzi M, Annoni F, Macchini E, Legros B, Severgnini P, Creteur J, Oddo M, Vincent JL, Gaspard N, Taccone FS. Automated Pupillometry for Prediction of Electroencephalographic Reactivity in Critically Ill Patients: A Prospective Cohort Study. Front Neurol 2022; 13:867603. [PMID: 35386412 PMCID: PMC8977520 DOI: 10.3389/fneur.2022.867603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/28/2022] [Indexed: 12/27/2022] Open
Abstract
Background Electroencephalography (EEG) is widely used to monitor critically ill patients. However, EEG interpretation requires the presence of an experienced neurophysiologist and is time-consuming. Aim of this study was to evaluate whether parameters derived from an automated pupillometer (AP) might help to assess the degree of cerebral dysfunction in critically ill patients. Methods Prospective study conducted in the Department of Intensive Care of Erasme University Hospital in Brussels, Belgium. Pupillary assessments were performed using the AP in three subgroups of patients, concomitantly monitored with continuous EEG: "anoxic brain injury", "Non-anoxic brain injury" and "other diseases". An independent neurologist blinded to patient's history and AP results scored the degree of encephalopathy and reactivity on EEG using a standardized scale. The mean value of Neurologic Pupil Index (NPi), pupillary size, constriction rate, constriction and dilation velocity (CV and DV) and latency for both eyes, obtained using the NPi®-200 (Neuroptics, Laguna Hills, CA, USA), were reported. Results We included 214 patients (mean age 60 years, 55% male). EEG tracings were categorized as: mild (n = 111, 52%), moderate (n = 65, 30%) or severe (n = 16, 8%) encephalopathy; burst-suppression (n = 19, 9%) or suppression background (n = 3, 1%); a total of 38 (18%) EEG were classified as "unreactive". We found a significant difference in all pupillometry variables among different EEG categories. Moreover, an unreactive EEG was associated with lower NPi, pupil size, pupillary reactivity, CV and DV and a higher latency than reactive recordings. Low DV (Odds ratio 0.020 [95% confidence intervals 0.002-0.163]; p < 0.01) was independently associated with an unreactive EEG, together with the use of analgesic/sedative drugs and high lactate concentrations. In particular, DV values had an area under the curve (AUC) of 0.86 [0.79-0.92; p < 0.01] to predict the presence of unreactive EEG. In subgroups analyses, AUC of DV to predict unreactive EEG was lower (0.72 [0.56-0.87]; p < 0.01) in anoxic brain injury than Non-anoxic brain injury (0.92 [0.85-1.00]; p < 0.01) and other diseases (0.96 [0.90-1.00]; p < 0.01). Conclusions This study suggests that low DV measured by the AP might effectively identify an unreactive EEG background, in particular in critically ill patients without anoxic brain injury.
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Affiliation(s)
- Lorenzo Peluso
- Department of Intensive Care, Erasme University Hospital, Brussels, Belgium
| | - Lorenzo Ferlini
- Department of Neurology, Erasme University Hospital, Brussels, Belgium
| | - Marta Talamonti
- Department of Intensive Care, Erasme University Hospital, Brussels, Belgium
| | | | | | - Marco Menozzi
- Department of Intensive Care, Erasme University Hospital, Brussels, Belgium
| | - Filippo Annoni
- Department of Intensive Care, Erasme University Hospital, Brussels, Belgium
| | | | - Benjamin Legros
- Department of Neurology, Erasme University Hospital, Brussels, Belgium
| | - Paolo Severgnini
- Department of Biotechnology and Life Sciences, Insubria University, Cardiac Anesthesiology and Intensive Care - ASST Sette Laghi, Varese, Italy
| | - Jacques Creteur
- Department of Intensive Care, Erasme University Hospital, Brussels, Belgium
| | - Mauro Oddo
- Critical Care Clinical Research Unit, Department of Intensive Care Medicine, CHUV-Lausanne University Hospital, Lausanne, Switzerland
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme University Hospital, Brussels, Belgium
| | - Nicolas Gaspard
- Department of Neurology, Erasme University Hospital, Brussels, Belgium.,Department of Neurology, Yale University Medical School, New Haven, CT, United States
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Gouvea Bogossian E, Diaferia D, Ndieugnou Djangang N, Menozzi M, Vincent JL, Talamonti M, Dewitte O, Peluso L, Barrit S, Al Barajraji M, Andre J, Schuind S, Creteur J, Taccone FS. Brain tissue oxygenation guided therapy and outcome in non-traumatic subarachnoid hemorrhage. Sci Rep 2021; 11:16235. [PMID: 34376735 PMCID: PMC8355344 DOI: 10.1038/s41598-021-95602-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 07/27/2021] [Indexed: 02/08/2023] Open
Abstract
Brain hypoxia can occur after non-traumatic subarachnoid hemorrhage (SAH), even when levels of intracranial pressure (ICP) remain normal. Brain tissue oxygenation (PbtO2) can be measured as a part of a neurological multimodal neuromonitoring. Low PbtO2 has been associated with poor neurologic recovery. There is scarce data on the impact of PbtO2 guided-therapy on patients’ outcome. This single-center cohort study (June 2014–March 2020) included all patients admitted to the ICU after SAH who required multimodal monitoring. Patients with imminent brain death were excluded. Our primary goal was to assess the impact of PbtO2-guided therapy on neurological outcome. Secondary outcome included the association of brain hypoxia with outcome. Of the 163 patients that underwent ICP monitoring, 62 were monitored with PbtO2 and 54 (87%) had at least one episode of brain hypoxia. In patients that required treatment based on neuromonitoring strategies, PbtO2-guided therapy (OR 0.33 [CI 95% 0.12–0.89]) compared to ICP-guided therapy had a protective effect on neurological outcome at 6 months. In this cohort of SAH patients, PbtO2-guided therapy might be associated with improved long-term neurological outcome, only when compared to ICP-guided therapy.
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Affiliation(s)
- Elisa Gouvea Bogossian
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium.
| | - Daniela Diaferia
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium
| | - Narcisse Ndieugnou Djangang
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium
| | - Marco Menozzi
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium
| | - Marta Talamonti
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium
| | - Olivier Dewitte
- Department of Neurosurgery, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium
| | - Lorenzo Peluso
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium
| | - Sami Barrit
- Department of Neurosurgery, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium
| | - Mejdeddine Al Barajraji
- Department of Neurosurgery, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium
| | - Joachim Andre
- Department of Radiology, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium
| | - Sophie Schuind
- Department of Neurosurgery, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium
| | - Jacques Creteur
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium
| | - Fabio Silvio Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium
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Peluso L, Montanaro F, Izzi A, Garufi A, Ndieugnou Djangang N, Polain A, Minini A, Gouvea Bogossian E, Annoni F, Spadaro S, Creteur J, Taccone FS. Fever management in critically ill COVID-19 patients: a retrospective analysis. Minerva Anestesiol 2021; 87:1217-1225. [PMID: 34337916 DOI: 10.23736/s0375-9393.21.15711-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Fever has been reported as a common symptom in COVID-19 patients. The aim of the study was to describe the characteristics of COVID-19 critically ill patients with fever and to assess if fever management had an impact on some physiologic variables. METHODS This is a retrospective monocentric cohort analysis of critically ill COVID-19 patients admitted to the Department of Intensive Care Unit (ICU) of Erasme Hospital, Brussels, Belgium, between March 2020 and May 2020. Fever was defined as body temperature ≥ 38° C during the ICU stay. We assessed the independent predictors of fever during ICU stay. We reported the clinical and physiological variables before and after the first treated episode of fever during the ICU stay. RESULTS A total of 72 critically ill COVID-19 patients were admitted to the ICU over the study period and were all eligible for the final analysis; 53 (74%) of them developed fever, after a median of 4 [0-13] hours since ICU admission. In the multivariable analysis, male gender (OR 5.41 [C.I. 95% 1.34-21.92]; p=0.02) and low PaO2/FiO2 ratio (OR 0.99 [C.I. 95% 0.99-1.00]; p=0.04) were independently associated with fever. After the treatment of the first febrile episode, heart rate and respiratory rate significantly decreased together with an increase in PaO2 and SaO2. CONCLUSIONS In our study, male gender and severe impairment of oxygenation were independently associated with fever in critically ill COVID-19 patients. Fever treatment reduced heart rate and respiratory rate and improved systemic oxygenation.
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Affiliation(s)
- Lorenzo Peluso
- Department of Intensive Care Medicine, Erasme University Hospital, Brussels, Belgium -
| | - Federica Montanaro
- Department of Intensive Care Medicine, Erasme University Hospital, Brussels, Belgium.,Intensive Care Unit, Department of Morphology, Surgery and Experimental Medicine, Azienda Ospedaliera Universitaria Sant'Anna Hospital, Ferrara, Italy
| | - Antonio Izzi
- Department of Intensive Care Medicine, Erasme University Hospital, Brussels, Belgium
| | - Alessandra Garufi
- Department of Intensive Care Medicine, Erasme University Hospital, Brussels, Belgium
| | | | - Amandine Polain
- Department of Intensive Care Medicine, Erasme University Hospital, Brussels, Belgium
| | - Andrea Minini
- Department of Intensive Care Medicine, Erasme University Hospital, Brussels, Belgium
| | | | - Filippo Annoni
- Department of Intensive Care Medicine, Erasme University Hospital, Brussels, Belgium
| | - Savino Spadaro
- Intensive Care Unit, Department of Morphology, Surgery and Experimental Medicine, Azienda Ospedaliera Universitaria Sant'Anna Hospital, Ferrara, Italy
| | - Jacques Creteur
- Department of Intensive Care Medicine, Erasme University Hospital, Brussels, Belgium
| | - Fabio Silvio Taccone
- Department of Intensive Care Medicine, Erasme University Hospital, Brussels, Belgium
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Gouvêa Bogossian E, Diaferia D, Minini A, Ndieugnou Djangang N, Menozzi M, Peluso L, Annoni F, Creteur J, Schuind S, Dewitte O, Taccone FS. Time course of outcome in poor grade subarachnoid hemorrhage patients: a longitudinal retrospective study. BMC Neurol 2021; 21:196. [PMID: 33985460 PMCID: PMC8117582 DOI: 10.1186/s12883-021-02229-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/06/2021] [Indexed: 12/17/2022] Open
Abstract
Background Neurological outcome and mortality of patients suffering from poor grade subarachnoid hemorrhage (SAH) may have changed over time. Several factors, including patients’ characteristics, the presence of hydrocephalus and intraparenchymal hematoma, might also contribute to this effect. The aim of this study was to assess the temporal changes in mortality and neurologic outcome in SAH patients and identify their predictors. Methods We performed a single center retrospective cohort study from 2004 to 2018. All non-traumatic SAH patients with poor grade on admission (WFNS score of 4 or 5) who remained at least 24 h in the hospital were included. Time course was analyzed into four groups according to the years of admission (2004–2007; 2008–2011; 2012–2015 and 2016–2018). Results A total of 353 patients were included in this study: 202 patients died (57 %) and 260 (74 %) had unfavorable neurological outcome (UO) at 3 months. Mortality tended to decrease in in 2008–2011 and 2016–2018 periods (HR 0.55 [0.34–0.89] and HR 0.33 [0.20–0.53], respectively, when compared to 2004–2007). The proportion of patients with UO remained high and did not vary significantly over time. Patients with WFNS 5 had higher mortality (68 % vs. 34 %, p = 0.001) and more frequent UO (83 % vs. 54 %, p = 0.001) than those with WFNS 4. In the multivariable analysis, WFNS 5 was independently associated with mortality (HR 2.12 [1.43–3.14]) and UO (OR 3.23 [1.67–6.25]). The presence of hydrocephalus was associated with a lower risk of mortality (HR 0.60 [0.43–0.84]). Conclusions Both hospital mortality and UO remained high in poor grade SAH patients. Patients with WFNS 5 on admission had worse prognosis than others; this should be taken into consideration for future clinical studies. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02229-1.
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Affiliation(s)
- Elisa Gouvêa Bogossian
- Department of Intensive Care Erasmus Hospital, Université Libre de Bruxelles (ULB), Route de Lennik, 808, 1070, Brussels, Belgium.
| | - Daniela Diaferia
- Department of Intensive Care Erasmus Hospital, Université Libre de Bruxelles (ULB), Route de Lennik, 808, 1070, Brussels, Belgium
| | - Andrea Minini
- Department of Intensive Care Erasmus Hospital, Université Libre de Bruxelles (ULB), Route de Lennik, 808, 1070, Brussels, Belgium
| | - Narcisse Ndieugnou Djangang
- Department of Intensive Care Erasmus Hospital, Université Libre de Bruxelles (ULB), Route de Lennik, 808, 1070, Brussels, Belgium
| | - Marco Menozzi
- Department of Intensive Care Erasmus Hospital, Université Libre de Bruxelles (ULB), Route de Lennik, 808, 1070, Brussels, Belgium
| | - Lorenzo Peluso
- Department of Intensive Care Erasmus Hospital, Université Libre de Bruxelles (ULB), Route de Lennik, 808, 1070, Brussels, Belgium
| | - Filippo Annoni
- Department of Intensive Care Erasmus Hospital, Université Libre de Bruxelles (ULB), Route de Lennik, 808, 1070, Brussels, Belgium
| | - Jacques Creteur
- Department of Intensive Care Erasmus Hospital, Université Libre de Bruxelles (ULB), Route de Lennik, 808, 1070, Brussels, Belgium
| | - Sophie Schuind
- Department of Neurosurgery Erasmus Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Olivier Dewitte
- Department of Neurosurgery Erasmus Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Fabio Silvio Taccone
- Department of Intensive Care Erasmus Hospital, Université Libre de Bruxelles (ULB), Route de Lennik, 808, 1070, Brussels, Belgium
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Gorham J, Moreau A, Corazza F, Peluso L, Ponthieux F, Talamonti M, Izzi A, Nagant C, Ndieugnou Djangang N, Garufi A, Creteur J, Taccone FS. Interleukine-6 in critically ill COVID-19 patients: A retrospective analysis. PLoS One 2020; 15:e0244628. [PMID: 33382773 PMCID: PMC7774924 DOI: 10.1371/journal.pone.0244628] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/15/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Coronavirus disease 2019 (COVID-19) appeared in China in December 2019 and has spread around the world. High Interleukin-6 (IL-6) levels in COVID-19 patients suggest that a cytokine storm may play a major role in the pathophysiology and are considered as a relevant parameter in predicting most severe course of disease. The aim of this study was to assess repeated IL-6 levels in critically ill COVID-19 patients admitted to our Intensive Care Unit (ICU) and to evaluate their relationship with patient's severity and outcome. METHODS We conducted a retrospective study on patients admitted to the ICU with a diagnosis of COVID-19 between March 10 (i.e. the date of the first admitted patients) and April 30, 2020. Demographic, clinical and laboratory data were collected at admission. On the day of IL-6 blood concentration measurement, we also collected results of D-Dimers, C-Reactive Protein, white blood cells and lymphocytes count, lactate dehydrogenase (LDH) and ferritin as well as microbiological samples, whenever present. RESULTS Of a total of 65 patients with COVID-19 admitted to our ICU we included 41 patients with repeated measure of IL-6. There was a significant difference in IL-6 levels between survivors and non-survivors over time (p = 0.001); moreover, non survivors had a significantly higher IL-6 maximal value when compared to survivors (720 [349-2116] vs. 336 [195-646] pg/mL, p = 0.01). The IL-6 maximal value had a significant predictive value of ICU mortality (AUROC 0.73 [95% CI 0.57-0.89]; p = 0.01). CONCLUSIONS Repeated measurements of IL-6 can help clinicians in identifying critically ill COVID-19 patients with the highest risk of poor prognosis.
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Affiliation(s)
- Julie Gorham
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Anthony Moreau
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Francis Corazza
- Department of Immunology, Laboratoire Hospitalier Universitaire de Bruxelles (LHUB-ULB), Translational Research, Campus Horta, ULB, Brussels, Belgium
| | - Lorenzo Peluso
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Fanny Ponthieux
- Department of Immunology, Laboratoire Hospitalier Universitaire de Bruxelles (LHUB-ULB), Translational Research, Campus Horta, ULB, Brussels, Belgium
| | - Marta Talamonti
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Antonio Izzi
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Carole Nagant
- Department of Immunology, Laboratoire Hospitalier Universitaire de Bruxelles (LHUB-ULB), Translational Research, Campus Horta, ULB, Brussels, Belgium
| | | | - Alessandra Garufi
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Jacques Creteur
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Fabio Silvio Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
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Ndieugnou Djangang N, Ramunno P, Izzi A, Garufi A, Menozzi M, Diaferia D, Peluso L, Prezioso C, Talamonti M, Njimi H, Schuind S, Vincent JL, Creteur J, Taccone FS, Gouvea Bogossian E. The Prognostic Role of Lactate Concentrations after Aneurysmal Subarachnoid Hemorrhage. Brain Sci 2020; 10:brainsci10121004. [PMID: 33348866 PMCID: PMC7766816 DOI: 10.3390/brainsci10121004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/04/2020] [Accepted: 12/16/2020] [Indexed: 12/14/2022] Open
Abstract
Blood lactate concentrations are often used to assess global tissue perfusion in critically ill patients; however, there are scarce data on lactate concentrations after subarachnoid hemorrhage (SAH). We aimed to assess the prognostic role of serial blood lactate measurements on hospital mortality and neurological outcomes at 3 months after SAH. We reviewed all SAH patients admitted to the intensive care unit from 2007 to 2019 and recorded the highest daily arterial lactate concentration for the first 6 days. Patients with no lactate concentration were excluded. Hyperlactatemia was defined as a blood lactate concentration >2.0 mmol/L. A total of 456 patients were included: 158 (35%) patients died in hospital and 209 (46%) had an unfavorable outcome (UO) at 3 months. The median highest lactate concentration was 2.7 (1.8–3.9) mmol/L. Non-survivors and patients with UO had significantly higher lactate concentrations compared to other patients. Hyperlactatemia increased the chance of dying (OR 4.19 (95% CI 2.38–7.39)) and of having UO in 3 months (OR 4.16 (95% CI 2.52–6.88)) after adjusting for confounding factors. Therefore, initial blood lactate concentrations have prognostic implications in patients with SAH; their role in conjunction with other prognostic indicators should be evaluated in prospective studies.
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Affiliation(s)
- Narcisse Ndieugnou Djangang
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808 1070 Brussels, Belgium; (N.N.D.); (P.R.); (A.I.); (A.G.); (M.M.); (D.D.); (L.P.); (C.P.); (M.T.); (H.N.); (J.-L.V.); (J.C.); (F.S.T.)
| | - Pamela Ramunno
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808 1070 Brussels, Belgium; (N.N.D.); (P.R.); (A.I.); (A.G.); (M.M.); (D.D.); (L.P.); (C.P.); (M.T.); (H.N.); (J.-L.V.); (J.C.); (F.S.T.)
| | - Antonio Izzi
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808 1070 Brussels, Belgium; (N.N.D.); (P.R.); (A.I.); (A.G.); (M.M.); (D.D.); (L.P.); (C.P.); (M.T.); (H.N.); (J.-L.V.); (J.C.); (F.S.T.)
| | - Alessandra Garufi
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808 1070 Brussels, Belgium; (N.N.D.); (P.R.); (A.I.); (A.G.); (M.M.); (D.D.); (L.P.); (C.P.); (M.T.); (H.N.); (J.-L.V.); (J.C.); (F.S.T.)
| | - Marco Menozzi
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808 1070 Brussels, Belgium; (N.N.D.); (P.R.); (A.I.); (A.G.); (M.M.); (D.D.); (L.P.); (C.P.); (M.T.); (H.N.); (J.-L.V.); (J.C.); (F.S.T.)
| | - Daniela Diaferia
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808 1070 Brussels, Belgium; (N.N.D.); (P.R.); (A.I.); (A.G.); (M.M.); (D.D.); (L.P.); (C.P.); (M.T.); (H.N.); (J.-L.V.); (J.C.); (F.S.T.)
| | - Lorenzo Peluso
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808 1070 Brussels, Belgium; (N.N.D.); (P.R.); (A.I.); (A.G.); (M.M.); (D.D.); (L.P.); (C.P.); (M.T.); (H.N.); (J.-L.V.); (J.C.); (F.S.T.)
| | - Chiara Prezioso
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808 1070 Brussels, Belgium; (N.N.D.); (P.R.); (A.I.); (A.G.); (M.M.); (D.D.); (L.P.); (C.P.); (M.T.); (H.N.); (J.-L.V.); (J.C.); (F.S.T.)
| | - Marta Talamonti
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808 1070 Brussels, Belgium; (N.N.D.); (P.R.); (A.I.); (A.G.); (M.M.); (D.D.); (L.P.); (C.P.); (M.T.); (H.N.); (J.-L.V.); (J.C.); (F.S.T.)
| | - Hassane Njimi
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808 1070 Brussels, Belgium; (N.N.D.); (P.R.); (A.I.); (A.G.); (M.M.); (D.D.); (L.P.); (C.P.); (M.T.); (H.N.); (J.-L.V.); (J.C.); (F.S.T.)
| | - Sophie Schuind
- Department of Neurosurgery, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808 1070 Brussels, Belgium;
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808 1070 Brussels, Belgium; (N.N.D.); (P.R.); (A.I.); (A.G.); (M.M.); (D.D.); (L.P.); (C.P.); (M.T.); (H.N.); (J.-L.V.); (J.C.); (F.S.T.)
| | - Jacques Creteur
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808 1070 Brussels, Belgium; (N.N.D.); (P.R.); (A.I.); (A.G.); (M.M.); (D.D.); (L.P.); (C.P.); (M.T.); (H.N.); (J.-L.V.); (J.C.); (F.S.T.)
| | - Fabio Silvio Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808 1070 Brussels, Belgium; (N.N.D.); (P.R.); (A.I.); (A.G.); (M.M.); (D.D.); (L.P.); (C.P.); (M.T.); (H.N.); (J.-L.V.); (J.C.); (F.S.T.)
| | - Elisa Gouvea Bogossian
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808 1070 Brussels, Belgium; (N.N.D.); (P.R.); (A.I.); (A.G.); (M.M.); (D.D.); (L.P.); (C.P.); (M.T.); (H.N.); (J.-L.V.); (J.C.); (F.S.T.)
- Correspondence:
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Ndieugnou Djangang N, Peluso L, Talamonti M, Izzi A, Gevenois PA, Garufi A, Goffard JC, Henrard S, Severgnini P, Vincent JL, Creteur J, Taccone FS. Eosinopenia in COVID-19 Patients: A Retrospective Analysis. Microorganisms 2020; 8:microorganisms8121929. [PMID: 33291791 PMCID: PMC7762070 DOI: 10.3390/microorganisms8121929] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/15/2020] [Accepted: 12/03/2020] [Indexed: 12/24/2022] Open
Abstract
Objectives: The aim of this study was to assess the diagnostic role of eosinophils count in COVID-19 patients. Methods: Retrospective analysis of patients admitted to our hospital with suspicion of COVID-19. Demographic, clinical and laboratory data were collected on admission. Eosinopenia was defined as eosinophils < 100 cells/mm3. The outcomes of this study were the association between eosinophils count on admission and positive real-time reverse transcription polymerase chain reaction (rRT-PCR) test and with suggestive chest computerized tomography (CT) of COVID-19 pneumonia. Results: A total of 174 patients was studied. Of those, 54% had positive rRT-PCR for SARS-CoV-2. A chest CT-scan was performed in 145 patients; 71% showed suggestive findings of COVID-19. Eosinophils on admission had a high predictive accuracy for positive rRT-PCR and suggestive chest CT-scan (area under the receiver operating characteristic-ROC curve, 0.84 (95% CIs 0.78-0.90) and 0.84 (95% CIs 0.77-0.91), respectively). Eosinopenia and high LDH were independent predictors of positive rRT-PCR, whereas eosinopenia, high body mass index and hypertension were predictors for suggestive CT-scan findings. Conclusions: Eosinopenia on admission could predict positive rRT-PCR test or suggestive chest CT-scan for COVID-19. This laboratory finding could help to identify patients at high-risk of COVID-19 in the setting where gold standard diagnostic methods are not available.
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Affiliation(s)
- Narcisse Ndieugnou Djangang
- Department of Intensive Care, Clinique Universitaire de Bruxelles Hôpital Erasme, 1070 Brussels, Belgium; (N.N.D.); (M.T.); (A.I.); (A.G.); (J.-L.V.); (J.C.); (F.S.T.)
| | - Lorenzo Peluso
- Department of Intensive Care, Clinique Universitaire de Bruxelles Hôpital Erasme, 1070 Brussels, Belgium; (N.N.D.); (M.T.); (A.I.); (A.G.); (J.-L.V.); (J.C.); (F.S.T.)
- Correspondence: ; Tel.: +32-25553416
| | - Marta Talamonti
- Department of Intensive Care, Clinique Universitaire de Bruxelles Hôpital Erasme, 1070 Brussels, Belgium; (N.N.D.); (M.T.); (A.I.); (A.G.); (J.-L.V.); (J.C.); (F.S.T.)
| | - Antonio Izzi
- Department of Intensive Care, Clinique Universitaire de Bruxelles Hôpital Erasme, 1070 Brussels, Belgium; (N.N.D.); (M.T.); (A.I.); (A.G.); (J.-L.V.); (J.C.); (F.S.T.)
| | - Pierre Alain Gevenois
- Department of Radiology, Clinique Universitaire de Bruxelles Hôpital Erasme, 1070 Brussels, Belgium;
| | - Alessandra Garufi
- Department of Intensive Care, Clinique Universitaire de Bruxelles Hôpital Erasme, 1070 Brussels, Belgium; (N.N.D.); (M.T.); (A.I.); (A.G.); (J.-L.V.); (J.C.); (F.S.T.)
| | - Jean-Christophe Goffard
- Department of Internal Medicine, Clinique Universitaire de Bruxelles Hôpital Erasme, 1070 Brussels, Belgium; (J.-C.G.); (S.H.)
| | - Sophie Henrard
- Department of Internal Medicine, Clinique Universitaire de Bruxelles Hôpital Erasme, 1070 Brussels, Belgium; (J.-C.G.); (S.H.)
| | - Paolo Severgnini
- Dipartimento Biotecnologie e Scienze della Vita, Università degli studi dell’ Insubria, U.O. Anestesia e Rianimazione Cardiologica ASST Sette Laghi, 21100 Varese, Italy;
| | - Jean-Louis Vincent
- Department of Intensive Care, Clinique Universitaire de Bruxelles Hôpital Erasme, 1070 Brussels, Belgium; (N.N.D.); (M.T.); (A.I.); (A.G.); (J.-L.V.); (J.C.); (F.S.T.)
| | - Jacques Creteur
- Department of Intensive Care, Clinique Universitaire de Bruxelles Hôpital Erasme, 1070 Brussels, Belgium; (N.N.D.); (M.T.); (A.I.); (A.G.); (J.-L.V.); (J.C.); (F.S.T.)
| | - Fabio Silvio Taccone
- Department of Intensive Care, Clinique Universitaire de Bruxelles Hôpital Erasme, 1070 Brussels, Belgium; (N.N.D.); (M.T.); (A.I.); (A.G.); (J.-L.V.); (J.C.); (F.S.T.)
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