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Langensee L, Rumetshofer T, Mårtensson J. Interplay of socioeconomic status, cognition, and school performance in the ABCD sample. NPJ Sci Learn 2024; 9:17. [PMID: 38467686 PMCID: PMC10928106 DOI: 10.1038/s41539-024-00233-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 02/29/2024] [Indexed: 03/13/2024]
Abstract
Coming from a disadvantaged background can have negative impact on an individual's educational trajectory. Some people however seem unaffected and cope well with the demands and challenges posed by school education, despite growing up in adverse conditions, a phenomenon termed academic resilience. While it is uncertain which underlying factors make some people more likely to circumvent unfavorable odds than others, both socioeconomic status (SES) and cognitive ability have robustly been linked to school performance. The objective of the present work is to investigate if individual cognitive abilities and SES interact in their effect on grades. For this purpose, we analyzed SES, cognitive, and school performance data from 5001 participants from the Adolescent Brain Cognitive Development (ABCD) Study. Ordinal logistic regression models suggest similar patterns of associations between three SES measures (parental education, income-to-needs ratio, and neighborhood deprivation) and grades at two timepoints, with no evidence for interaction effects between SES and time. Parental education and income-to-needs ratio were associated with grades at both timepoints, irrespective of whether cognitive abilities were modeled or not. Neighborhood deprivation, in contrast, was only a statistically significant predictor of reported grades when cognitive abilities were not factored in. Cognitive abilities interacted with parental education level, meaning that they could be a safeguard against effects of SES on school performance.
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Affiliation(s)
- Lara Langensee
- Department of Clinical Sciences Lund, Division of Logopedics, Phoniatrics and Audiology, Lund University, Scania, Sweden.
| | - Theodor Rumetshofer
- Department of Clinical Sciences Lund, Division of Logopedics, Phoniatrics and Audiology, Lund University, Scania, Sweden
| | - Johan Mårtensson
- Department of Clinical Sciences Lund, Division of Logopedics, Phoniatrics and Audiology, Lund University, Scania, Sweden
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Christensen J, Andersson E, Sjöberg F, Hellgren E, Harbut P, Harbut J, Sjövall F, von Bruhn Gufler C, Mårtensson J, Rubenson Wahlin R, Joelsson-Alm E, Cronhjort M. Adverse Events of Peripherally Administered Norepinephrine During Surgery: A Prospective Multicenter Study. Anesth Analg 2024:00000539-990000000-00695. [PMID: 38180886 DOI: 10.1213/ane.0000000000006806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
BACKGROUND Perioperative treatment of hypotension by intravenous administration of norepinephrine in a peripheral vein can lead to adverse events, for example, tissue necrosis. However, the incidence and severity of adverse events during perioperative administration are unknown. METHODS This was a prospective observational study conducted at 3 Swedish hospitals from 2019 to 2022. A total of 1004 patients undergoing surgery, who met the criteria for perioperative peripheral norepinephrine administration, were included. The infusion site was inspected regularly. If swelling or paleness of skin was detected, the infusion site was changed to a different peripheral line. Systolic blood pressure and pulse frequency were monitored during the infusion time and defined as adverse events at >220 mm Hg and <40 beats•min-1. In case of adverse events, patients were observed for up to 48 hours. The primary outcome was prevalence of extravasation, defined as swelling around the infusion site. Secondary outcomes were all types of adverse events and associations between predefined clinical variables and risk of adverse events. RESULTS We observed 2.3% (95% confidence interval [CI], 1.4%-3.2%) extravasation of infusion and 0.9% (95% CI, 0.4%-1.7%) bradycardia. No cases of tissue necrosis or severe hypertension were detected. All adverse events had dissipated spontaneously within 48 hours. Proximal catheter placement was associated with more adverse events. CONCLUSIONS Extravasation of peripherally administrated norepinephrine in the perioperative period occurred at similar rates as in previous studies in critically ill patients. In our setting, where we regularly inspected the infusion site and shifted site in case of swelling or paleness of skin, we observed no case of severe adverse events. Given that severe adverse events were absent, the potential benefit of this preventive approach requires confirmation in a larger population.
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Affiliation(s)
- Jens Christensen
- From the Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Anaesthesia and Intensive Care, Södersjukhuset, Stockholm, Sweden
| | - Elisabeth Andersson
- From the Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Anaesthesia and Intensive Care, Södersjukhuset, Stockholm, Sweden
| | - Fredric Sjöberg
- From the Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Anaesthesia and Intensive Care, Södersjukhuset, Stockholm, Sweden
| | - Elisabeth Hellgren
- Department of Anaesthesia and Intensive Care, Södersjukhuset, Stockholm, Sweden
| | - Piotr Harbut
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
- Department of Anaesthesia and Intensive Care, Danderyd Hospital, Stockholm, Sweden
| | - Joanna Harbut
- Department of Anaesthesia and Intensive Care, Danderyd Hospital, Stockholm, Sweden
| | - Fredrik Sjövall
- Department of Intensive and Perioperative Care, Skåne University Hospital, Malmö, Sweden
| | | | - Johan Mårtensson
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- Department of Physiology and Pharmacology, Section of Anaesthesia and Intensive Care, Karolinska Institutet, Stockholm, Sweden
| | - Rebecka Rubenson Wahlin
- From the Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Anaesthesia and Intensive Care, Södersjukhuset, Stockholm, Sweden
| | - Eva Joelsson-Alm
- From the Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Anaesthesia and Intensive Care, Södersjukhuset, Stockholm, Sweden
| | - Maria Cronhjort
- From the Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Anaesthesia and Intensive Care, Danderyd Hospital, Stockholm, Sweden
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Flam B, Andersson Franko M, Skrifvars MB, Djärv T, Cronhjort M, Jonsson Fagerlund M, Mårtensson J. Trends in Incidence and Outcomes of Cardiac Arrest Occurring in Swedish ICUs. Crit Care Med 2024; 52:e11-e20. [PMID: 37747306 DOI: 10.1097/ccm.0000000000006067] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
OBJECTIVE To determine temporal trends in the incidence of cardiac arrest occurring in the ICU (ICU-CA) and its associated long-term mortality. DESIGN Retrospective observational study. SETTING Swedish ICUs, between 2011 and 2017. PATIENTS Adult patients (≥18 yr old) recorded in the Swedish Intensive Care Registry (SIR). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS ICU-CA was defined as a first episode of cardiopulmonary resuscitation and/or defibrillation following an ICU admission, as recorded in SIR or the Swedish Cardiopulmonary Resuscitation Registry. Annual adjusted ICU-CA incidence trend (all admissions) was estimated using propensity score-weighted analysis. Six-month mortality trends (first admissions) were assessed using multivariable mixed-effects logistic regression. Analyses were adjusted for pre-admission characteristics (sex, age, socioeconomic status, comorbidities, medications, and healthcare utilization), illness severity on ICU admission, and admitting unit. We included 231,427 adult ICU admissions. Crude ICU-CA incidence was 16.1 per 1,000 admissions, with no significant annual trend in the propensity score-weighted analysis. Among 186,530 first admissions, crude 6-month mortality in ICU-CA patients was 74.7% (95% CI, 70.1-78.9) in 2011 and 68.8% (95% CI, 64.4-73.0) in 2017. When controlling for multiple potential confounders, the adjusted 6-month mortality odds of ICU-CA patients decreased by 6% per year (95% CI, 2-10). Patients admitted after out-of-hospital or in-hospital cardiac arrest had the highest ICU-CA incidence (136.1/1,000) and subsequent 6-month mortality (76.0% [95% CI, 73.6-78.4]). CONCLUSIONS In our nationwide Swedish cohort, the adjusted incidence of ICU-CA remained unchanged between 2011 and 2017. More than two-thirds of patients with ICU-CA did not survive to 6 months following admission, but a slight improvement appears to have occurred over time.
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Affiliation(s)
- Benjamin Flam
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- Section of Anesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Andersson Franko
- Department of Clinical Science and Education, South General Hospital, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Markus B Skrifvars
- Department of Emergency Care and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Therese Djärv
- Medical Unit Acute/Emergency Department, Karolinska University Hospital, Stockholm, Sweden
- Division of Clinical Medicine, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Maria Cronhjort
- Department of Clinical Science and Education, South General Hospital, Karolinska Institutet, Stockholm, Sweden
- Department of Anesthesiology and Intensive Care, South General Hospital, Stockholm, Sweden
| | - Malin Jonsson Fagerlund
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- Section of Anesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Johan Mårtensson
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- Section of Anesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
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Wennberg L, Mårtensson J, Langensee L, Sundgren PC, Markenroth Bloch K, Hansson B. Effects of ultra-high field MRI environment on cognitive performance in healthy participants. Radiography (Lond) 2024; 30:95-99. [PMID: 37879122 DOI: 10.1016/j.radi.2023.10.006] [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: 07/03/2023] [Revised: 09/14/2023] [Accepted: 10/05/2023] [Indexed: 10/27/2023]
Abstract
INTRODUCTION Ultra-high field MRI (UHF MRI) is rapidly becoming an essential part of our toolbox within health care and research studies; therefore, we need to get a deeper understanding of the physiological effects of ultra-high field. This study aims to investigate the cognitive performance of healthy participants in a 7 T (T) MRI environment in connection with subjectively experienced effects. METHODS We measured cognitive performance before and after a 1-h 7T MRI scanning session using a Digit Symbol Substitution Test (DSST) in 42 subjects. Furthermore, a computer-based survey regarding the subjectively experienced effects in connection with the MRI examination was distributed. Similarly, two DSSTs were also performed by a control group of 40 participants. RESULTS Even though dizziness was the strongest sensory perception in connection to the MRI scanning, we did not find any correlation between dizziness and cognitive performance. Whilst the control group improved (p=<0.001) on their second DSST the MRI group showed no significant difference (p=0.741) in the DSST before and after MRI scanning. CONCLUSION Transient effect on cognition after undergoing MRI scanning can't be ruled out as the expected learning effect on the DSST was not observed. IMPLICATIONS FOR PRACTICE Increasing understanding of the possible adverse effects may guide operators in performing UHF MRI in a safe way and with person-centered care. Furthermore, it can guide researchers in setting up research protocols to minimize confounding factors in their fMRI studies due to the transient adverse effects of the UHF environment.
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Affiliation(s)
- L Wennberg
- Department of Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences Lund/ Diagnostic Radiology, Faculty of Medicine, Lund University, Lund, Sweden.
| | - J Mårtensson
- Department of Clinical Sciences Lund/Logopedics, Phoniatrics and Audiology, Faculty of Medicine, Lund University, Lund, Sweden
| | - L Langensee
- Department of Clinical Sciences Lund/Logopedics, Phoniatrics and Audiology, Faculty of Medicine, Lund University, Lund, Sweden
| | - P C Sundgren
- Department of Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences Lund/ Diagnostic Radiology, Faculty of Medicine, Lund University, Lund, Sweden; Lund BioImaging Centre, Faculty of Medicine, Lund University, Lund, Sweden
| | - K Markenroth Bloch
- Lund BioImaging Centre, Faculty of Medicine, Lund University, Lund, Sweden
| | - B Hansson
- Department of Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences Lund/ Diagnostic Radiology, Faculty of Medicine, Lund University, Lund, Sweden
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Langensee L, Spotorno N, Mårtensson J. Beyond the language network: Associations between reading, receptive vocabulary, and grey matter volume in 10-year-olds. Neuropsychologia 2023; 191:108719. [PMID: 37939873 DOI: 10.1016/j.neuropsychologia.2023.108719] [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: 03/20/2023] [Revised: 10/28/2023] [Accepted: 10/30/2023] [Indexed: 11/10/2023]
Abstract
Most research on the neurostructural basis of language abilities in children stems from small samples and surface-based measures. To complement and expand the existent knowledge, we investigated associations between grey matter volume and language performance in a large sample of 9-to-11-year-old children, using data from the Adolescent Brain Cognitive Development (ABCD) Study (N = 1865) and an alternative measure of grey matter morphology. We estimated whole-brain grey matter volume for one half of the sample (N = 939) and tested for correlations with scores on a picture vocabulary and a letter and word reading test, with and without factoring in general intelligence and total grey matter volume as additional covariates. The initial analyses yielded correlations between grey matter in the right occipital fusiform gyrus, the right lingual gyrus, and the cerebellum for both vocabulary and reading. Employing the significant clusters from the first analyses as regions of interest in the second half of the cohort (N = 926) in correlational and multiple regression analyses suggests the cluster in the right occipital fusiform and lingual gyri to be most robust. Overall, the amount of variance explained by grey matter volume is limited and factoring in additional covariates paints an inconsistent picture. The present findings reinforce existent doubt with respect to explaining individual differences in reading and vocabulary performance based on unique contributions of macrostructural brain features.
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Affiliation(s)
- Lara Langensee
- Department of Clinical Sciences, Lund University, Lund, Sweden.
| | - Nicola Spotorno
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
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Lampinen B, Szczepankiewicz F, Lätt J, Knutsson L, Mårtensson J, Björkman-Burtscher IM, van Westen D, Sundgren PC, Ståhlberg F, Nilsson M. Probing brain tissue microstructure with MRI: principles, challenges, and the role of multidimensional diffusion-relaxation encoding. Neuroimage 2023; 282:120338. [PMID: 37598814 DOI: 10.1016/j.neuroimage.2023.120338] [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: 02/02/2023] [Revised: 06/30/2023] [Accepted: 08/17/2023] [Indexed: 08/22/2023] Open
Abstract
Diffusion MRI uses the random displacement of water molecules to sensitize the signal to brain microstructure and to properties such as the density and shape of cells. Microstructure modeling techniques aim to estimate these properties from acquired data by separating the signal between virtual tissue 'compartments' such as the intra-neurite and the extra-cellular space. A key challenge is that the diffusion MRI signal is relatively featureless compared with the complexity of brain tissue. Another challenge is that the tissue microstructure is wildly different within the gray and white matter of the brain. In this review, we use results from multidimensional diffusion encoding techniques to discuss these challenges and their tentative solutions. Multidimensional encoding increases the information content of the data by varying not only the b-value and the encoding direction but also additional experimental parameters such as the shape of the b-tensor and the echo time. Three main insights have emerged from such encoding. First, multidimensional data contradict common model assumptions on diffusion and T2 relaxation, and illustrates how the use of these assumptions cause erroneous interpretations in both healthy brain and pathology. Second, many model assumptions can be dispensed with if data are acquired with multidimensional encoding. The necessary data can be easily acquired in vivo using protocols optimized to minimize Cramér-Rao lower bounds. Third, microscopic diffusion anisotropy reflects the presence of axons but not dendrites. This insight stands in contrast to current 'neurite models' of brain tissue, which assume that axons in white matter and dendrites in gray matter feature highly similar diffusion. Nevertheless, as an axon-based contrast, microscopic anisotropy can differentiate gray and white matter when myelin alterations confound conventional MRI contrasts.
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Affiliation(s)
- Björn Lampinen
- Clinical Sciences Lund, Diagnostic Radiology, Lund University, Lund, Sweden.
| | | | - Jimmy Lätt
- Department of Medical Imaging and Physiology, Skåne University Hospital Lund, Lund, Sweden
| | - Linda Knutsson
- Clinical Sciences Lund, Medical Radiation Physics, Lund University, Lund, Sweden; Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States; F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Johan Mårtensson
- Clinical Sciences Lund, Logopedics, Phoniatrics and Audiology, Lund University, Lund, Sweden
| | - Isabella M Björkman-Burtscher
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Danielle van Westen
- Clinical Sciences Lund, Diagnostic Radiology, Lund University, Lund, Sweden; Department of Medical Imaging and Physiology, Skåne University Hospital Lund, Lund, Sweden
| | - Pia C Sundgren
- Clinical Sciences Lund, Diagnostic Radiology, Lund University, Lund, Sweden; Department of Medical Imaging and Physiology, Skåne University Hospital Lund, Lund, Sweden; Lund University BioImaging Centre (LBIC), Lund University, Lund, Sweden
| | - Freddy Ståhlberg
- Clinical Sciences Lund, Diagnostic Radiology, Lund University, Lund, Sweden; Clinical Sciences Lund, Medical Radiation Physics, Lund University, Lund, Sweden
| | - Markus Nilsson
- Clinical Sciences Lund, Diagnostic Radiology, Lund University, Lund, Sweden
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Hedberg P, Baltzer N, Granath F, Fored M, Mårtensson J, Nauclér P. Clinical outcomes during and beyond different COVID-19 critical illness variant periods compared with other lower respiratory tract infections. Crit Care 2023; 27:427. [PMID: 37932793 PMCID: PMC10629059 DOI: 10.1186/s13054-023-04722-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/02/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND It is yet to be better understood how outcomes during and after the critical illness potentially differ between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants from other lower respiratory tract infections (LRTIs). We aimed to compare outcomes in adults admitted to an intensive care unit (ICU) with coronavirus disease 2019 (COVID-19) during the Wild-type, Alpha, Delta, and Omicron periods with individuals admitted with other LRTI. METHODS Population-based cohort study in Stockholm, Sweden, using health registries with high coverage, including ICU-admitted adults from 1 January 2016 to 15 September 2022. Outcomes were in-hospital mortality, 180-day post-discharge mortality, 180-day hospital readmission, 180-day days alive and at home (DAAH), and incident diagnoses registered during follow-up. RESULTS The number of ICU admitted individuals were 1421 Wild-type, 551 Alpha, 190 Delta, 223 Omicron, and 2380 LRTI. In-hospital mortality ranged from 28% (n = 665) in the LRTI cohort to 35% (n = 77) in the Delta cohort. The adjusted cause-specific hazard ratio (CSHR) compared with the LRTI cohort was 1.33 (95% confidence interval [CI] 1.16-1.53) in the Wild-type cohort, 1.53 (1.28-1.82) in the Alpha cohort, 1.70 (1.30-2.24) in the Delta cohort, and 1.59 (1.24-2.02) in the Omicron cohort. Among patients discharged alive from their COVID-19 hospitalization, the post-discharge mortality rates were lower (1-3%) compared with the LRTI cohort (9%), and the risk of hospital readmission was lower (CSHRs ranging from 0.42 to 0.68). Moreover, all COVID-19 cohorts had compared with the LRTI cohort more DAAH after compared with before the critical illness. CONCLUSION Overall, COVID-19 critical was associated with an increased hazard of in-hospital mortality, but among those discharged alive from the hospital, less severe long-term outcomes were observed compared with other LRTIs.
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Affiliation(s)
- Pontus Hedberg
- Department of Medicine, Huddinge, Karolinska Institutet, H7 Medicin, Huddinge, H7 Infektion och Hud Sönnerborg, 171 77, Stockholm, Sweden.
| | - Nicholas Baltzer
- Division of Infectious Diseases, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Granath
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Michael Fored
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Johan Mårtensson
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Pontus Nauclér
- Division of Infectious Diseases, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
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Jonmarker S, Litorell J, Alarcon F, Al-Abani K, Björkman S, Farm M, Grip J, Söderberg M, Hollenberg J, Wahlin RR, Kander T, Rimling L, Mårtensson J, Joelsson-Alm E, Dahlberg M, Cronhjort M. A retrospective multicenter cohort study of the association between anti-Factor Xa values and death, thromboembolism, and bleeding in patients with critical COVID-19. Thromb J 2023; 21:101. [PMID: 37784131 PMCID: PMC10544466 DOI: 10.1186/s12959-023-00541-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/05/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Patients with critical COVID-19 have a high risk of thromboembolism, but intensified thromboprophylaxis has not been proven beneficial. The activity of low-molecular-weight heparins can be monitored by measuring anti-Factor Xa. We aimed to study the association between anti-Factor Xa values and death, thromboembolism, and bleeding in patients with critical COVID-19. METHOD This retrospective cohort study included adult patients with critical COVID-19 admitted to an intensive care unit at three Swedish hospitals between March 2020 and May 2021 with at least one valid peak and/or trough anti-Factor Xa value. Within the peak and trough categories, patients' minimum, median, and maximum values were determined. Logistic regressions with splines were used to assess associations. RESULTS In total, 408 patients had at least one valid peak and/or trough anti-Factor Xa measurement, resulting in 153 patients with peak values and 300 patients with trough values. Lower peak values were associated with thromboembolism for patients' minimum (p = 0.01), median (p = 0.005) and maximum (p = 0.001) values. No association was seen between peak values and death or bleeding. Higher trough values were associated with death for median (p = 0.03) and maximum (p = 0.002) values and with both bleeding (p = 0.01) and major bleeding (p = 0.02) for maximum values, but there were no associations with thromboembolism. CONCLUSIONS Measuring anti-Factor Xa activity may be relevant for administrating low-molecular-weight heparin to patients with critical COVID-19. Lower peak values were associated with an increased risk of thromboembolism, and higher trough values were associated with an increased risk of death and bleeding. Prospective studies are needed to confirm the results. TRIAL REGISTRATION The study was retrospectively registered at Clinicaltrials.gov, NCT05256524, February 24, 2022.
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Affiliation(s)
- Sandra Jonmarker
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.
- Department of Anaesthesia and Intensive Care, Södersjukhuset, Stockholm, Sweden.
| | - Jacob Litorell
- Department of Anaesthesia and Intensive Care, Södersjukhuset, Stockholm, Sweden
| | - Felix Alarcon
- Department of Anaesthesia and Intensive Care, Södersjukhuset, Stockholm, Sweden
| | - Kais Al-Abani
- Department of Emergency and Reparative Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Sofia Björkman
- Department of Clinical Science, Anaesthesiology and Intensive Care, Lund University, Skåne University Hospital, Lund, Sweden
| | - Maria Farm
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Chemistry, Karolinska University Hospital, Stockholm, Sweden
| | - Jonathan Grip
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Mårten Söderberg
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
- Department of Internal Medicine, Södersjukhuset, Stockholm, Sweden
| | - Jacob Hollenberg
- Department of Clinical Science and Education, Centre for Resuscitation Science, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Rebecka Rubenson Wahlin
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
- Department of Anaesthesia and Intensive Care, Södersjukhuset, Stockholm, Sweden
| | - Thomas Kander
- Department of Clinical Science, Anaesthesiology and Intensive Care, Lund University, Skåne University Hospital, Lund, Sweden
| | - Liivi Rimling
- Department of Anaesthesia and Intensive Care, Södersjukhuset, Stockholm, Sweden
| | - Johan Mårtensson
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- Department of Physiology and Pharmacology, Section of Anaesthesia and Intensive Care, Karolinska Institutet, Stockholm, Sweden
| | - Eva Joelsson-Alm
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
- Department of Anaesthesia and Intensive Care, Södersjukhuset, Stockholm, Sweden
| | - Martin Dahlberg
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
- Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | - Maria Cronhjort
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
- Department of Anaesthesia and Intensive Care, Södersjukhuset, Stockholm, Sweden
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Balintescu A, Rysz S, Hertz C, Grip J, Cronhjort M, Oldner A, Svensen C, Mårtensson J. Prevalence and impact of chronic dysglycaemia among patients with COVID-19 in Swedish intensive care units: a multicentre, retrospective cohort study. BMJ Open 2023; 13:e071330. [PMID: 37730398 PMCID: PMC10510869 DOI: 10.1136/bmjopen-2022-071330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 08/29/2023] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVE Using glycated haemoglobin A1c (HbA1c) screening, we aimed to determine the prevalence of chronic dysglycaemia among patients with COVID-19 admitted to the intensive care unit (ICU). Additionally, we aimed to explore the association between chronic dysglycaemia and clinical outcomes related to ICU stay. DESIGN Multicentre retrospective observational study. SETTING ICUs in three hospitals in Stockholm, Sweden. PARTICIPANTS COVID-19 patients admitted to the ICU between 5 March 2020 and 13 August 2020 with available HbA1c at admission. Chronic dysglycaemia was determined based on previous diabetes history and HbA1c. PRIMARY AND SECONDARY OUTCOMES Primary outcome was the actual prevalence of chronic dysglycaemia (pre-diabetes, unknown diabetes or known diabetes) among COVID-19 patients. Secondary outcome was the association of chronic dysglycaemia with 90-day mortality, ICU length of stay, duration of invasive mechanical ventilation (IMV) and renal replacement therapy (RRT), accounting for treatment selection bias. RESULTS A total of 308 patients with available admission HbA1c were included. Chronic dysglycaemia prevalence assessment was restricted to 206 patients admitted ICUs in which HbA1c was measured on all admitted patients. Chronic dysglycaemia was present in 82.0% (95% CI 76.1% to 87.0%) of patients, with pre-diabetes present in 40.2% (95% CI 33.5% to 47.3%), unknown diabetes in 20.9% (95% CI 15.5% to 27.1%), well-controlled diabetes in 7.8% (95% CI 4.5% to 12.3%) and uncontrolled diabetes in 13.1% (95% CI 8.8% to 18.5%). All patients with available HbA1c were included for the analysis of the relationship between chronic dysglycaemia and secondary outcomes. We found no independent association between chronic dysglycaemia and 90-day mortality, ICU length of stay or duration of IMV. After excluding patients with specific treatment limitations, no association between chronic dysglycaemia and RRT use was observed. CONCLUSIONS In our cohort of critically ill COVID-19 patients, the prevalence of chronic dysglycaemia was 82%. We found no robust associations between chronic dysglycaemia and clinical outcomes when accounting for treatment limitations.
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Affiliation(s)
- Anca Balintescu
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden
| | - Susanne Rysz
- Department of Perioperative Medicine and Intensive Care, Karolinska Institute, Stockholm, Sweden
| | - Carl Hertz
- Department of Anesthesia and Intensive Care, Stockholm South General Hospital Anaesthesia, Stockholm, Sweden
| | - Jonathan Grip
- Department of Perioperative Medicine and Intensive Care, Karolinska Institute, Stockholm, Sweden
| | - Maria Cronhjort
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden
| | - Anders Oldner
- Department of Perioperative Medicine and Intensive Care, Karolinska Institute, Stockholm, Sweden
| | - Christer Svensen
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden
| | - Johan Mårtensson
- Department of Perioperative Medicine and Intensive Care, Karolinska Institute, Stockholm, Sweden
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Havelka A, Larsson AO, Mårtensson J, Bell M, Hultström M, Lipcsey M, Eriksson M. Analysis of Calprotectin as an Early Marker of Infections Is Economically Advantageous in Intensive Care-Treated Patients. Biomedicines 2023; 11:2156. [PMID: 37626653 PMCID: PMC10452832 DOI: 10.3390/biomedicines11082156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/28/2023] [Accepted: 07/30/2023] [Indexed: 08/27/2023] Open
Abstract
Calprotectin is released from neutrophil granulocytes upon activation. Several studies have indicated that plasma calprotectin is an early determinant of bacterial infections, which may serve as a diagnostic tool facilitating decision making on antibiotic treatment. The study objective was to explore the health and economic implications of calprotectin as a predictive tool to initiate antimicrobial therapy in a cohort of critically ill patients. Thus, data obtained from a previously published study on calprotectin as a hypothetical early biomarker of bacterial infections in critically ill patients were evaluated regarding the potential cost-effective impact of early analysis of calprotectin on an earlier start of antibiotic treatment. Under the assumption that calprotectin is used predictively and comparators (white blood cells, procalcitonin, and C-reactive protein) are used diagnostically, a cost-effective impact of EUR 11,000-12,000 per patient would be obtained. If calprotectin would be used predictively and comparators would be used predictively for 50% of patients, it is hypothesized that cost-effectiveness would be between EUR 6000 and 7000 per patient, based on reduced stay in the ICU and general ward, respectively. Furthermore, predictive use of calprotectin seems to reduce both mortality and the length of hospital stay. This health economic analysis on the predictive use of plasma calprotectin, which facilitates clinical decision making in cases of suspected sepsis, indicates that such determination has a cost-saving and life-saving impact on the healthcare system.
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Affiliation(s)
- Aleksandra Havelka
- Department of Molecular Medicine and Surgery, Karolinska Institute, 171 76 Stockholm, Sweden;
- Gentian Diagnostics AS, 1596 Moss, Norway
| | - Anders O. Larsson
- Department of Medical Sciences, Clinical Chemistry, Uppsala University, 751 85 Uppsala, Sweden
| | - Johan Mårtensson
- Department of Physiology and Pharmacology, Section of Anaesthesiology and Intensive Care Medicine, Karolinska Institute, 171 77 Stockholm, Sweden
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Max Bell
- Department of Physiology and Pharmacology, Section of Anaesthesiology and Intensive Care Medicine, Karolinska Institute, 171 77 Stockholm, Sweden
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Michael Hultström
- Department of Surgical Sciences, Section of Anaesthesiology and Intensive Care Medicine, Uppsala University, 751 85 Uppsala, Sweden
- Department of Medical Cell Biology, Integrative Physiology, Uppsala University, 751 23 Uppsala, Sweden
- Department of Epidemiology, McGill University, Montréal, QC H3A 0G4, Canada
- Lady Davis Institute of Medical Research, Jewish General Hospital, Montréal, QC H3T 1E2, Canada
| | - Miklós Lipcsey
- Department of Surgical Sciences, Section of Anaesthesiology and Intensive Care Medicine, Uppsala University, 751 85 Uppsala, Sweden
- Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, 751 85 Uppsala, Sweden
| | - Mats Eriksson
- Department of Surgical Sciences, Section of Anaesthesiology and Intensive Care Medicine, Uppsala University, 751 85 Uppsala, Sweden
- NOVA Medical School, New University of Lisbon, 1099-085 Lisbon, Portugal
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11
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Cardeña E, Lindström L, Goldin P, van Westen D, Mårtensson J. A neurophenomenological fMRI study of a spontaneous automatic writer and a hypnotic cohort. Brain Cogn 2023; 170:106060. [PMID: 37421816 DOI: 10.1016/j.bandc.2023.106060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/28/2023] [Accepted: 06/28/2023] [Indexed: 07/10/2023]
Abstract
PURPOSE To evaluate the neurophenomenology of automatic writing (AW) in a spontaneous automatic writer (NN) and four high hypnotizables (HH). METHODS During fMRI, NN and the HH were cued to perform spontaneous (NN) or induced (HH) AW, and a comparison task of copying complex symbols, and to rate their experience of control and agency. RESULTS Compared to copying, for all participants AW was associated with less sense of control and agency and decreased BOLD signal responses in brain regions implicated in the sense of agency (left premotor cortex and insula, right premotor cortex, and supplemental motor area), and increased BOLD signal responses in the left and right temporoparietal junctions and the occipital lobes. During AW, the HH differed from NN in widespread BOLD decreases across the brain and increases in frontal and parietal regions. CONCLUSIONS Spontaneous and induced AW had similar effects on agency, but only partly overlapping effects on cortical activity.
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Affiliation(s)
- Etzel Cardeña
- CERCAP, Department of Psychology, Lund University, Sweden.
| | - Lena Lindström
- CERCAP, Department of Psychology, Lund University, Sweden
| | | | - Danielle van Westen
- Institution for Clinical Sciences, Diagnostic Radiology, Lund University, Sweden
| | - Johan Mårtensson
- Department of Clinical Sciences Lund, Logopedics, Phoniatrics and Audiology, Lund University, Sweden
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12
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Kjær MBN, Meyhoff TS, Sivapalan P, Granholm A, Hjortrup PB, Madsen MB, Møller MH, Egerod I, Wetterslev J, Lange T, Cronhjort M, Laake JH, Jakob SM, Nalos M, Ostermann M, Gould D, Cecconi M, Malbrain MLNG, Ahlstedt C, Kiel LB, Bestle MH, Nebrich L, Hildebrandt T, Russell L, Vang M, Rasmussen ML, Sølling C, Brøchner AC, Krag M, Pfortmueller C, Kriz M, Siegemund M, Albano G, Aagaard SR, Bundgaard H, Crone V, Wichmann S, Johnstad B, Martin YK, Seidel P, Mårtensson J, Hollenberg J, Wistrand M, Donati A, Barbara E, Karvunidis T, Hollinger A, Carsetti A, Lumlertgul N, Joelsson-Alm E, Lambiris N, Aslam TN, Friberg FF, Vesterlund GK, Mortensen CB, Vestergaard SR, Caspersen SF, Jensen DB, Borup M, Rasmussen BS, Perner A. Long-term effects of restriction of intravenous fluid in adult ICU patients with septic shock. Intensive Care Med 2023; 49:820-830. [PMID: 37330928 PMCID: PMC10354110 DOI: 10.1007/s00134-023-07114-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/28/2023] [Indexed: 06/20/2023]
Abstract
PURPOSE To assess long-term outcomes of restrictive versus standard intravenous (IV) fluid therapy in adult intensive care unit (ICU) patients with septic shock included in the European Conservative versus Liberal Approach to Fluid Therapy in Septic Shock in Intensive Care (CLASSIC) trial. METHODS We conducted the pre-planned analyses of mortality, health-related quality of life (HRQoL) using EuroQol (EQ)-5D-5L index values and EQ visual analogue scale (VAS), and cognitive function using Mini Montreal Cognitive Assessment (Mini MoCA) test at 1 year. Deceased patients were assigned numerical zero for HRQoL as a state equal to death and zero for cognitive function outcomes as worst possible score, and we used multiple imputation for missing data on HRQoL and cognitive function. RESULTS Among 1554 randomized patients, we obtained 1-year data on mortality in 97.9% of patients, HRQoL in 91.3%, and cognitive function in 86.3%. One-year mortality was 385/746 (51.3%) in the restrictive-fluid group versus 383/767 (49.9%) in the standard-fluid group, absolute risk difference 1.5%-points [99% confidence interval (CI) - 4.8 to 7.8]. Mean differences were 0.00 (99% CI - 0.06 to 0.05) for EQ-5D-5L index values, - 0.65 for EQ VAS (- 5.40 to 4.08), and - 0.14 for Mini MoCA (- 1.59 to 1.14) for the restrictive-fluid group versus the standard-fluid group. The results for survivors only were similar in both groups. CONCLUSIONS Among adult ICU patients with septic shock, restrictive versus standard IV fluid therapy resulted in similar survival, HRQoL, and cognitive function at 1 year, but clinically important differences could not be ruled out.
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Affiliation(s)
- Maj-Brit Nørregaard Kjær
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark.
| | - Tine Sylvest Meyhoff
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Praleene Sivapalan
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Anders Granholm
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Peter Buhl Hjortrup
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Cardiothoracic Anaesthesia and Intensive Care, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Martin Bruun Madsen
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Cardiothoracic Anaesthesia and Intensive Care, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Morten Hylander Møller
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Ingrid Egerod
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Jørn Wetterslev
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Theis Lange
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Maria Cronhjort
- Section of Anaesthesia and Intensive Care, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Jon Henrik Laake
- Division of Emergencies and Critical Care, Department of Anaesthesiology and Intensive Care Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Stephan M Jakob
- Department of Intensive Care Medicine, University Hospital Bern (Inselspital), University of Bern, Bern, Switzerland
| | - Marek Nalos
- Medical Intensive Care Unit, First Department of Internal Medicine, Faculty of Medicine, Teaching Hospital and Biomedical Center in Pilsen, Charles University, Pilsen, Czech Republic
| | - Marlies Ostermann
- Department of Intensive Care, Guy's and St Thomas' Hospital, London, UK
| | - Doug Gould
- Clinical Trial Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK
| | - Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University Pieve Emanuele, Milan, Italy
- Anaesthesia and Intensive Care Medicine IRCCS, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Manu L N G Malbrain
- Department of Intensive Care Medicine, University Hospital Brussels (UZB), Jette, Belgium
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- First Department of Anaesthesiology and Intensive Therapy, Medical University Lublin, Lublin, Poland
| | - Christian Ahlstedt
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Louise Bendix Kiel
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital, Bispebjerg, Copenhagen, Denmark
| | - Morten H Bestle
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-North Zealand, Hilleroed, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lars Nebrich
- Department of Anaesthesia and Intensive Care, Zealand University Hospital, Køge, Denmark
| | - Thomas Hildebrandt
- Department of Anaesthesia and Intensive Care, Zealand University Hospital, Roskilde, Denmark
| | - Lene Russell
- Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, Copenhagen, Denmark
| | - Marianne Vang
- Department of Anaesthesia and Intensive Care, Randers Hospital, Randers, Denmark
| | | | - Christoffer Sølling
- Department of Anaesthesia and Intensive Care, Viborg Hospital, Viborg, Denmark
| | - Anne Craveiro Brøchner
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
- Department of Anaesthesia and Intensive Care, Kolding, University Hospital of Southern Denmark, Odense, Denmark
| | - Mette Krag
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Anaesthesia and Intensive Care, Holbæk Hospital, Holbæk, Denmark
| | - Carmen Pfortmueller
- Department of Intensive Care Medicine, University Hospital Bern (Inselspital), University of Bern, Bern, Switzerland
| | - Miroslav Kriz
- Medical Intensive Care Unit, First Department of Internal Medicine, Faculty of Medicine, Teaching Hospital and Biomedical Center in Pilsen, Charles University, Pilsen, Czech Republic
| | - Martin Siegemund
- Intensive Care Unit, Basel University Hospital, Basel, Switzerland
| | - Giovanni Albano
- Department of Anaesthesia and Intensive Care, Humanitas Gavazzeni Hospital Bergamo, Bergamo, Italy
| | - Søren Rosborg Aagaard
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Helle Bundgaard
- Department of Anaesthesia and Intensive Care, Randers Hospital, Randers, Denmark
| | - Vera Crone
- Department of Anaesthesia and Intensive Care, Holbæk Hospital, Holbæk, Denmark
| | - Sine Wichmann
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-North Zealand, Hilleroed, Denmark
| | - Bror Johnstad
- Department of Intensive Care, Hospital Innland Hamar, Hamar, Norway
| | - Yvonne Karin Martin
- Department of Anesthesia and Intensive Care Medicine, Hospital Østfold Kalnes, Grålum, Norway
| | - Philipp Seidel
- Department of Intensive Care Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Johan Mårtensson
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden
| | - Jacob Hollenberg
- Department of Clinical Science and Education, Södersjukhuset, Medical Intensive Care Unit, Center for Resuscitation Science, Karolinska Institutet, Solna, Sweden
| | - Mats Wistrand
- Department of Emergency Medicine, Capio St Görans Hospital, Stockholm, Sweden
- Department of Anaesthesia and Intensive Care, Capio St Görans Hospital, Stockholm, Sweden
| | - Abele Donati
- Department of Biomedical Sciences and Public Health, Università Politecnica Delle Marche, Ancona, Italy
| | - Enrico Barbara
- Anesthesia and Intensive Care Unit, Humanitas Research Hospital, Castellanza, Italy
| | - Thomas Karvunidis
- Medical Intensive Care Unit, First Department of Internal Medicine, Faculty of Medicine, Teaching Hospital and Biomedical Center in Pilsen, Charles University, Pilsen, Czech Republic
| | - Alexa Hollinger
- Intensive Care Unit, Basel University Hospital, Basel, Switzerland
| | - Andrea Carsetti
- Department of Biomedical Sciences and Public Health, Università Politecnica Delle Marche, Ancona, Italy
- Anesthesia and Intensive Care Unit, Azienda Ospedaliero Universitaria Delle Marche, Ancona, Italy
| | - Nuttha Lumlertgul
- Department of Intensive Care, Guy's and St Thomas' Hospital, London, UK
- Division of Nephrology, Faculty of Medicine, Excellence Centre in Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Eva Joelsson-Alm
- Section of Anaesthesia and Intensive Care, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Nikolas Lambiris
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden
| | - Tayyba Naz Aslam
- Division of Emergencies and Critical Care, Department of Anaesthesiology and Intensive Care Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Fredrik Femtehjell Friberg
- Department of Intensive Care, Hospital Innland Hamar, Hamar, Norway
- Department of Anesthesia and Intensive Care, Oslo University Hospital Ullevål, Oslo, Norway
| | - Gitte Kingo Vesterlund
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | | | - Stine Rom Vestergaard
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | | | - Diana Bertelsen Jensen
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital, Bispebjerg, Copenhagen, Denmark
| | - Morten Borup
- Department of Anaesthesia and Intensive Care, Kolding, University Hospital of Southern Denmark, Odense, Denmark
| | - Bodil Steen Rasmussen
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Anders Perner
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
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Mårtensson J, Bellomo R. Sodium-glucose co-transporter-2 inhibitors in the intensive care unit setting: do we really need sodium increase, especially in sepsis? Reply. Crit Care 2023; 27:225. [PMID: 37291591 DOI: 10.1186/s13054-023-04513-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/10/2023] Open
Affiliation(s)
- Johan Mårtensson
- Department of Physiology and Pharmacology, Section of Anaesthesia and Intensive Care, Karolinska Institutet, Stockholm, Sweden.
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, 171 76, Stockholm, Sweden.
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Health, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
- Department of Critical Care, Melbourne University, Melbourne, VIC, Australia
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Australia
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14
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Mårtensson J, Cutuli SL, Osawa EA, Yanase F, Toh L, Cioccari L, Luethi N, Maeda A, Bellomo R. Sodium glucose co-transporter-2 inhibitors in intensive care unit patients with type 2 diabetes: a pilot case control study. Crit Care 2023; 27:189. [PMID: 37194077 DOI: 10.1186/s13054-023-04481-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/08/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Sodium glucose co-transporter-2 (SGLT2) inhibitors improve long-term cardiovascular and renal outcomes in individuals with type 2 diabetes. However, the safety of SGLT2 inhibitors in ICU patients with type 2 diabetes is uncertain. We aimed to perform a pilot study to assess the relationship between empagliflozin therapy and biochemical, and clinical outcomes in such patients. METHODS We included 18 ICU patients with type 2 diabetes receiving empagliflozin (10 mg daily) and insulin to target glucose range of 10-14 mmol/l according to our liberal glucose control protocol for patients with diabetes (treatment group). Treatment group patients were matched on age, glycated hemoglobin A1c, and ICU duration with 72 ICU patients with type 2 diabetes exposed to the same target glucose range but who did not receive empagliflozin (control group). We compared changes in electrolyte and acid-base parameters, hypoglycemia, ketoacidosis, worsening kidney function, urine culture findings, and hospital mortality between the groups. RESULTS Median (IQR) maximum increase in sodium and chloride levels were 3 (1-10) mmol/l and 3 (2-8) mmol/l in the control group and 9 (3-12) mmol/l and 8 (3-10) mmol/l in the treatment group (P = 0.045 for sodium, P = 0.059 for chloride). We observed no differences in strong ion difference, pH or base excess. Overall, 6% developed hypoglycemia in each group. No patient in the treatment group and one patient in the control group developed ketoacidosis. Worsening kidney function occurred in 18% and 29% of treatment and control group patients, respectively (P = 0.54). Urine cultures were positive in 22% of treatment group patients and 13% of control group patients (P = 0.28). Overall, 17% of treatment group patients and 19% of control group patients died in hospital (P = 0.79). CONCLUSIONS In our pilot study of ICU patients with type 2 diabetes, empagliflozin therapy was associated with increases in sodium and chloride levels but was not significantly associated with acid-base changes, hypoglycemia, ketoacidosis, worsening kidney function, bacteriuria, or mortality.
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Affiliation(s)
- Johan Mårtensson
- Department of Physiology and Pharmacology, Section of Anaesthesia and Intensive Care, Karolinska Institutet, Stockholm, Sweden.
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, 171 76, Stockholm, Sweden.
| | - Salvatore Lucio Cutuli
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, L.Go F. Vito 1, 00168, Rome, Italy
| | - Eduardo A Osawa
- Cardiology Intensive Care Unit, Hospital DF-Star, Brasília, Brazil
| | - Fumitaka Yanase
- Department of Intensive Care, Austin Health, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Lisa Toh
- Department of Intensive Care, Austin Health, Melbourne, VIC, Australia
| | - Luca Cioccari
- Department of Intensive Care Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Nora Luethi
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Akinori Maeda
- Department of Intensive Care, Austin Health, Melbourne, VIC, Australia
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Health, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
- Department of Critical Care, Melbourne University, Melbourne, VIC, Australia
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Australia
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15
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Balintescu A, Lind M, Andersson Franko M, Oldner A, Cronhjort M, Eliasson B, Svensen C, Mårtensson J. Glycemic control and sepsis risk in adults with type 1 diabetes. Diabetes Obes Metab 2023. [PMID: 36949627 DOI: 10.1111/dom.15060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/09/2023] [Accepted: 03/17/2023] [Indexed: 03/24/2023]
Abstract
AIMS To study the association between HbA1c and sepsis in adults with type 1 diabetes, and to explore the relationship between HbA1c and mortality among individuals who developed sepsis. MATERIALS AND METHODS We included 33,549 adult individuals with type 1 diabetes recorded in the Swedish National Diabetes Register between January, 2005 and December, 2015. We used multivariable Cox regression and restricted cubic spline analyses to study the relationship between HbA1c values and sepsis occurrence and association between HbA1c and mortality among those with sepsis. RESULTS A total of 713 (2.1%) individuals developed sepsis during the study period. Compared to the HbA1c reference interval of 48-52 mmol/mol (6.5-6.9%), the adjusted hazard ratio for sepsis was 2.50 (95% CI 1.18-5.29) for HbA1c <43 mmol/mol, 1.88 (95% CI 0.96-3.67) for HbA1c 43-47 mmol/mol, 1.78 (95% CI 1.09-2.89) for HbA1c 53-62 mmol/mol, 1.86 (95% CI 1.14-3.03) for HbA1c 63-72 mmol/mol, 3.15 (95% CI 1.91-5.19) for HbA1c 73-82 mmol/mol, and 4.26 (95% CI 2.53-7.16) for HbA1c >82 mmol/mol. On multivariable restricted cubic spline analysis we found a J-shaped association between HbA1c and sepsis risk, with the lowest risk observed around a HbA1c of 53 mmol/mol. We found no association between HbA1c and mortality among those individuals who developed sepsis. CONCLUSIONS In our nationwide observational study of adult individuals with type 1 diabetes we found a J-shaped relationship between HbA1c and risk of sepsis, with lowest risk at HbA1c levels around 53 mmol/mol (7.0%). HbA1c was not associated with mortality in individuals affected by sepsis. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Anca Balintescu
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Marcus Lind
- Department of Medicine, NU Hospital Group, Uddevalla, Sweden
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Mikael Andersson Franko
- Department of Clinical Science and Education Södersjukhuset, Unit of Statistics, Karolinska Institutet, Stockholm, Sweden
| | - Anders Oldner
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- Department of Physiology and Pharmacology, Section of Anaesthesia and Intensive Care, Karolinska Institutet, Stockholm, Sweden
| | - Maria Cronhjort
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Björn Eliasson
- Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christer Svensen
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Johan Mårtensson
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- Department of Physiology and Pharmacology, Section of Anaesthesia and Intensive Care, Karolinska Institutet, Stockholm, Sweden
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16
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Jonmarker S, Alarcón F, Litorell J, Granholm A, Alm EJ, Chew M, Russell L, Weihe S, Madsen EK, Meier N, Leistner JW, Mårtensson J, Hollenberg J, Perner A, Kjær MBN, Munch MW, Dahlberg M, Cronhjort M, Wahlin RR. Effects of 12 mg vs. 6 mg dexamethasone on thromboembolism and bleeding in patients with critical COVID-19 - a post hoc analysis of the randomized, blinded COVID STEROID 2 trial. Ann Intensive Care 2023; 13:12. [PMID: 36862239 PMCID: PMC9979892 DOI: 10.1186/s13613-023-01115-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 02/23/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Thromboembolism is more common in patients with critical COVID-19 than in other critically ill patients, and inflammation has been proposed as a possible mechanism. The aim of this study was to investigate if 12 mg vs. 6 mg dexamethasone daily reduced the composite outcome of death or thromboembolism in patients with critical COVID-19. METHODS Using additional data on thromboembolism and bleeding we did a post hoc analysis of Swedish and Danish intensive care unit patients enrolled in the blinded randomized COVID STEROID 2 trial comparing 12 mg vs. 6 mg dexamethasone daily for up to 10 days. The primary outcome was a composite outcome of death or thromboembolism during intensive care. Secondary outcomes were thromboembolism, major bleeding, and any bleeding during intensive care. RESULTS We included 357 patients. Whilst in intensive care, 53 patients (29%) in the 12 mg group and 53 patients (30%) in the 6 mg group met the primary outcome with an unadjusted absolute risk difference of - 0.5% (95% CI - 10 to 9.5%, p = 1.00) and an adjusted OR of 0.93 (CI 95% 0.58 to 1.49, p = 0.77). We found no firm evidence of differences in any of the secondary outcomes. CONCLUSIONS Among patients with critical COVID-19, 12 mg vs. 6 mg dexamethasone daily did not result in a statistically significant difference in the composite outcome of death or thromboembolism. However, uncertainty remains due to the limited number of patients.
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Affiliation(s)
- Sandra Jonmarker
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden. .,Department of Anaesthesia and Intensive Care, Södersjukhuset, Sjukhusbacken 10, SE-118 83, Stockholm, Sweden.
| | - Felix Alarcón
- grid.416648.90000 0000 8986 2221Department of Anaesthesia and Intensive Care, Södersjukhuset, Sjukhusbacken 10, SE-118 83 Stockholm, Sweden
| | - Jacob Litorell
- grid.416648.90000 0000 8986 2221Department of Anaesthesia and Intensive Care, Södersjukhuset, Sjukhusbacken 10, SE-118 83 Stockholm, Sweden
| | - Anders Granholm
- grid.475435.4Department of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark ,grid.512292.fCollaborations for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Eva Joelsson Alm
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden ,grid.416648.90000 0000 8986 2221Department of Anaesthesia and Intensive Care, Södersjukhuset, Sjukhusbacken 10, SE-118 83 Stockholm, Sweden
| | - Michelle Chew
- grid.5640.70000 0001 2162 9922Department of Anaesthesia and Intensive Care Medicine, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Lene Russell
- grid.475435.4Department of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark ,grid.411646.00000 0004 0646 7402Department of Anaesthesiology and Intensive Care, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - Sarah Weihe
- grid.512923.e0000 0004 7402 8188Department of Anaesthesiology, Zealand University Hospital, Koege, Denmark
| | - Emilie Kabel Madsen
- grid.154185.c0000 0004 0512 597XDepartment of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Nick Meier
- grid.475435.4Department of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jens Wolfgang Leistner
- grid.475435.4Department of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Johan Mårtensson
- grid.4714.60000 0004 1937 0626Department of Physiology and Pharmacology, Section of Anaesthesia and Intensive Care, Karolinska Institutet, Stockholm, Sweden ,grid.24381.3c0000 0000 9241 5705Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Jacob Hollenberg
- Department of Clinical Science and Education, Centre for Resuscitation Science, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Anders Perner
- grid.475435.4Department of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark ,grid.512292.fCollaborations for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Maj-Brit Nørregaard Kjær
- grid.475435.4Department of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark ,grid.512292.fCollaborations for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Marie Warrer Munch
- grid.475435.4Department of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark ,grid.512292.fCollaborations for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Martin Dahlberg
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden ,grid.416648.90000 0000 8986 2221Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | - Maria Cronhjort
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden ,grid.416648.90000 0000 8986 2221Department of Anaesthesia and Intensive Care, Södersjukhuset, Sjukhusbacken 10, SE-118 83 Stockholm, Sweden ,grid.512292.fCollaborations for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Rebecka Rubenson Wahlin
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden ,grid.416648.90000 0000 8986 2221Department of Anaesthesia and Intensive Care, Södersjukhuset, Sjukhusbacken 10, SE-118 83 Stockholm, Sweden ,grid.512292.fCollaborations for Research in Intensive Care (CRIC), Copenhagen, Denmark
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17
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Malmgren L, Öberg C, den Bakker E, Leion F, Siódmiak J, Åkesson A, Lindström V, Herou E, Dardashti A, Xhakollari L, Grubb G, Strevens H, Abrahamson M, Helmersson-Karlqvist J, Magnusson M, Björk J, Nyman U, Ärnlöv J, Ridefelt P, Åkerfeldt T, Hansson M, Sjöström A, Mårtensson J, Itoh Y, Grubb D, Tenstad O, Hansson LO, Olafsson I, Campos AJ, Risch M, Risch L, Larsson A, Nordin G, Pottel H, Christensson A, Bjursten H, Bökenkamp A, Grubb A. The complexity of kidney disease and diagnosing it - cystatin C, selective glomerular hypofiltration syndromes and proteome regulation. J Intern Med 2023; 293:293-308. [PMID: 36385445 PMCID: PMC10107454 DOI: 10.1111/joim.13589] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Estimation of kidney function is often part of daily clinical practice, mostly done by using the endogenous glomerular filtration rate (GFR)-markers creatinine or cystatin C. A recommendation to use both markers in parallel in 2010 has resulted in new knowledge concerning the pathophysiology of kidney disorders by the identification of a new set of kidney disorders, selective glomerular hypofiltration syndromes. These syndromes, connected to strong increases in mortality and morbidity, are characterized by a selective reduction in the glomerular filtration of 5-30 kDa molecules, such as cystatin C, compared to the filtration of small molecules <1 kDa dominating the glomerular filtrate, for example water, urea and creatinine. At least two types of such disorders, shrunken or elongated pore syndrome, are possible according to the pore model for glomerular filtration. Selective glomerular hypofiltration syndromes are prevalent in investigated populations, and patients with these syndromes often display normal measured GFR or creatinine-based GFR-estimates. The syndromes are characterized by proteomic changes promoting the development of atherosclerosis, indicating antibodies and specific receptor-blocking substances as possible new treatment modalities. Presently, the KDIGO guidelines for diagnosing kidney disorders do not recommend cystatin C as a general marker of kidney function and will therefore not allow the identification of a considerable number of patients with selective glomerular hypofiltration syndromes. Furthermore, as cystatin C is uninfluenced by muscle mass, diet or variations in tubular secretion and cystatin C-based GFR-estimation equations do not require controversial race or sex terms, it is obvious that cystatin C should be a part of future KDIGO guidelines.
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Affiliation(s)
- Linnea Malmgren
- Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit, Lund University, Malmö, Sweden.,Department of Geriatrics, Skåne University Hospital, Malmö, Sweden
| | - Carl Öberg
- Department of Clinical Sciences Lund, Division of Nephrology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Emil den Bakker
- Department of Pediatrics, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Felicia Leion
- Department of Clinical Chemistry, Skåne University Hospital, Lund University, Lund, Sweden
| | - Joanna Siódmiak
- Department of Laboratory Medicine, Faculty of Pharmacy, Ludwik Rydygier Collegium Medicum (Nicolaus Copernicus University in Torun), Bydgoszcz, Poland
| | - Anna Åkesson
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.,Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden
| | - Veronica Lindström
- Department of Clinical Chemistry, Skåne University Hospital, Lund University, Lund, Sweden
| | - Erik Herou
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Alain Dardashti
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Liana Xhakollari
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Nephrology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Gabriel Grubb
- Department of Radiology, Skåne University Hospital, Lund, Sweden
| | - Helena Strevens
- Department of Clinical Sciences Lund, Department of Obstetrics and Gynaecology, Lund University, Lund, Sweden
| | - Magnus Abrahamson
- Department of Clinical Chemistry, Skåne University Hospital, Lund University, Lund, Sweden
| | | | - Martin Magnusson
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Cardiology, Skåne University Hospital, Malmö, Sweden.,Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden.,Hypertension in Africa Research Team (HART), North West University, Potchefstroom, South Africa
| | - Jonas Björk
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.,Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden
| | - Ulf Nyman
- Department of Translational Medicine, Division of Medical Radiology, University of Lund, Malmö, Sweden
| | - Johan Ärnlöv
- Department of Neurobiology, Care Sciences and Society (NVS), Family Medicine and Primary Care Unit, Karolinska Institute, Huddinge, Sweden.,School of Health and Social Studies, Dalarna University, Falun, Sweden
| | - Peter Ridefelt
- Department of Medical Sciences, Clinical Chemistry, Uppsala University Hospital, Uppsala, Sweden
| | - Torbjörn Åkerfeldt
- Department of Medical Sciences, Clinical Chemistry, Uppsala University Hospital, Uppsala, Sweden
| | - Magnus Hansson
- Department of Clinical Chemistry, Karolinska University Hospital, Huddinge, Sweden
| | - Anna Sjöström
- Department of Clinical Chemistry, Karolinska University Hospital, Huddinge, Sweden
| | - Johan Mårtensson
- Department of Physiology and Pharmacology, Section of Anaesthesia and Intensive Care, Karolinska Institute, Stockholm, Sweden
| | - Yoshihisa Itoh
- Clinical Laboratory, Eiju General Hospital, Life Extension Research Institute, Tokyo, Japan
| | - David Grubb
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Olav Tenstad
- Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Lars-Olov Hansson
- Department of Clinical Chemistry, Karolinska University Hospital, Huddinge, Sweden
| | - Isleifur Olafsson
- Department of Clinical Biochemistry, Landspitali - National University Hospital of Iceland, Reykjavik, Iceland
| | - Araceli Jarquin Campos
- Faculty of Medical Sciences, Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Martin Risch
- Central Laboratory, Cantonal Hospital Graubünden, Chur, Switzerland
| | - Lorenz Risch
- Faculty of Medical Sciences, Private University in the Principality of Liechtenstein, Triesen, Liechtenstein.,University Institute of Clinical Chemistry, University Hospital and University of Bern, Inselspital, Bern, Switzerland
| | - Anders Larsson
- Department of Medical Sciences, Clinical Chemistry, Uppsala University Hospital, Uppsala, Sweden
| | | | - Hans Pottel
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Anders Christensson
- Department of Nephrology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Henrik Bjursten
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Arend Bökenkamp
- Department of Pediatric Nephrology, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Anders Grubb
- Department of Clinical Chemistry, Skåne University Hospital, Lund University, Lund, Sweden
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18
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Mårtensson J, Cutuli S, Yanase F, Ancona P, Toh L, Osawa E, Bellomo R. Glycemic control and blood gas sampling frequency during continuous glucose monitoring in the intensive care unit: A before-and-after study. Acta Anaesthesiol Scand 2023; 67:86-93. [PMID: 36263915 PMCID: PMC10092568 DOI: 10.1111/aas.14159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 08/21/2022] [Accepted: 10/16/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Whether subcutaneous continuous glucose monitoring (CGM) can safely replace intermittent arterial blood gas glucose analyses in intensive care unit (ICU) patients remains uncertain. We aimed to compare CGM to blood gas glucose values and assess whether CGM use reduces blood gas sampling frequency and glucose variability in ICU patients with type 2 diabetes managed with liberal glucose control. METHODS We used the FreeStyle Libre CGM in 15 ICU patients and compared their blood glucose metrics with a pre-CGM control population of 105 ICU patients with type 2 diabetes. Both groups received insulin to target glucose range of 10-14 mmol/L. We used linear regression analysis adjusted for illness severity to assess the association of CGM use with blood gas sampling frequency and glucose variability. We used mean absolute relative difference (MARD) and Clarke error grid analysis to assess accuracy of matched CGM-blood glucose values overall, across glucose stata (<10, 10-14, >14 mmol/L), and over time (≤48, 48-96, >96 h). RESULTS We analyzed 483 matched glucose values. Overall MARD was 11.5 (95% CI, 10.7-12.3)% with 99% of readings in Clarke zones A and B. MARD was 15.5% for glucose values <10 mmol/L, 11.1% at 10-14 mmol/L, and 11.4% >14 mmol/L. MARD was 13.8% in the first 48 h, 10.9% at 48-96 h, and 8.9% beyond 96 h. CGM use was associated with 30% reduction in blood gas sampling frequency. CGM use was not associated with glucose variability as determined by glycemic lability index or standard deviation of blood glucose. CONCLUSIONS In our cohort of ICU patients with type 2 diabetes receiving liberal glycemic control, CGM showed acceptable accuracy and was associated with a reduction in blood gas sampling frequency without compromising glucose control. Lowest accuracy was observed at glucose values below 10 mmol/L and during the first 48 h of CGM use.
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Affiliation(s)
- Johan Mårtensson
- Department of Physiology and Pharmacology, Section of Anaesthesia and Intensive Care, Karolinska Institutet, Stockholm, Sweden.,Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Salvatore Cutuli
- Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia.,Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Fumitaka Yanase
- Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia.,Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Paolo Ancona
- Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia
| | - Lisa Toh
- Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia
| | - Eduardo Osawa
- Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia.,Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia.,Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia.,Data Analytics Research and Evaluation Center, Austin Hospital, Melbourne, Victoria, Australia.,Intensive Care Unit, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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19
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Lindström L, Goldin P, Mårtensson J, Cardeña E. Nonlinear brain correlates of trait self-boundarylessness. Neurosci Conscious 2023; 2023:niad006. [PMID: 37114163 PMCID: PMC10129386 DOI: 10.1093/nc/niad006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/24/2023] [Accepted: 03/27/2023] [Indexed: 04/29/2023] Open
Abstract
Alterations of the sense of self induced by meditation include an increased sense of boundarylessness. In this study, we investigated behavioural and functional magnetic resonance imaging correlates of trait self-boundarylessness during resting state and the performance of two experimental tasks. We found that boundarylessness correlated with greater self-endorsement of words related to fluidity and with longer response times in a math task. Boundarylessness also correlated negatively with brain activity in the posterior cingulate cortex/precuneus during mind-wandering compared to a task targeting a minimal sense of self. Interestingly, boundarylessness showed quadratic relations to several measures. Participants reporting low or high boundarylessness, as compared to those in between, showed higher functional connectivity within the default mode network during rest, less brain activity in the medial prefrontal cortex during self-referential word processing, and less self-endorsement of words related to constancy. We relate these results to our previous findings of a quadratic relation between boundarylessness and the sense of perspectival ownership of experience. Additionally, an instruction to direct attention to the centre of experience elicited brain activation similar to that of meditation onset, including increases in anterior precentral gyrus and anterior insula and decreases in default mode network areas, for both non-meditators and experienced meditators.
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Affiliation(s)
- Lena Lindström
- * Corresponding author. Department of Psychology, Lund University, Box 213, Lund 221 00, Sweden. E-mail:
| | - Philippe Goldin
- Department of Psychology, Lund University, Box 213, Lund 221 00, Sweden
- Betty Irene Moore School of Nursing, University of California Davis Medical Center, 2570 48th Street, Sacramento, CA 95817, United States
| | - Johan Mårtensson
- Department of Clinical Sciences, Logopedics, Phoniatrics and Audiology, Lund University, Box 213, Lund 221 00, Sweden
| | - Etzel Cardeña
- Department of Psychology, Lund University, Box 213, Lund 221 00, Sweden
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20
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Engerström L, Thermaenius J, Mårtensson J, Oldner A, Petersson J, Kåhlin J, Larsson E. Prevalence and impact of early prone position on 30-day mortality in mechanically ventilated patients with COVID-19: a nationwide cohort study. Crit Care 2022; 26:264. [PMID: 36058932 PMCID: PMC9441133 DOI: 10.1186/s13054-022-04122-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 07/29/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
COVID-19 ARDS shares features with non-COVID ARDS but also demonstrates distinct physiological differences. Despite a lack of strong evidence, prone positioning has been advocated as a key therapy for COVID-19 ARDS. The effects of prone position in critically ill patients with COVID-19 are not fully understood, nor is the optimal time of initiation defined. In this nationwide cohort study, we aimed to investigate the association between early initiation of prone position and mortality in mechanically ventilated COVID-19 patients with low oxygenation on ICU admission.
Methods
Using the Swedish Intensive Care Registry (SIR), all Swedish ICU patients ≥ 18 years of age with COVID-19 admitted between March 2020, and April 2021 were identified. A study-population of patients with PaO2/FiO2 ratio ≤ 20 kPa on ICU admission and receiving invasive mechanical ventilation within 24 h from ICU admission was generated. In this study-population, the association between early use of prone position (within 24 h from intubation) and 30-day mortality was estimated using univariate and multivariable logistic regression models.
Results
The total study cohort included 6350 ICU patients with COVID-19, of whom 46.4% were treated with prone position ventilation. Overall, 30-day mortality was 24.3%. In the study-population of 1714 patients with lower admission oxygenation (PaO2/FiO2 ratio ≤ 20 kPa), the utilization of early prone increased from 8.5% in March 2020 to 48.1% in April 2021. The crude 30-day mortality was 27.2% compared to 30.2% in patients not receiving early prone positioning. We found no significant association between early use of prone positioning and survival.
Conclusions
During the first three waves of the COVID-19 pandemic, almost half of the patients in Sweden were treated with prone position ventilation. We found no association between early use of prone positioning and survival in patients on mechanical ventilation with severe hypoxemia on ICU admission. To fully elucidate the effect and timing of prone position ventilation in critically ill patients with COVID-19 further studies are desirable.
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21
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Mele A, Cerminara E, Häbel H, Rodriguez-Galvez B, Oldner A, Nelson D, Gårdh J, Thobaben R, Jonmarker S, Cronhjort M, Hollenberg J, Mårtensson J. Fluid accumulation and major adverse kidney events in sepsis: a multicenter observational study. Ann Intensive Care 2022; 12:62. [PMID: 35781636 PMCID: PMC9250912 DOI: 10.1186/s13613-022-01040-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 06/23/2022] [Indexed: 12/14/2022] Open
Abstract
Background Whether early fluid accumulation is a risk factor for adverse renal outcomes in septic intensive care unit (ICU) patients remains uncertain. We assessed the association between cumulative fluid balance and major adverse kidney events within 30 days (MAKE30), a composite of death, dialysis, or sustained renal dysfunction, in such patients. Methods We performed a multicenter, retrospective observational study in 1834 septic patients admitted to five ICUs in three hospitals in Stockholm, Sweden. We used logistic regression analysis to assess the association between cumulative fluid balance during the first two days in ICU and subsequent risk of MAKE30, adjusted for demographic factors, comorbidities, baseline creatinine, illness severity variables, haemodynamic characteristics, chloride exposure and nephrotoxic drug exposure. We assessed the strength of significant exposure variables using a relative importance analysis. Results Overall, 519 (28.3%) patients developed MAKE30. Median (IQR) cumulative fluid balance was 5.3 (2.8–8.1) l in the MAKE30 group and 4.1 (1.9–6.8) l in the no MAKE30 group, with non-resuscitation fluids contributing to approximately half of total fluid input in each group. The adjusted odds ratio for MAKE30 was 1.05 (95% CI 1.02–1.09) per litre cumulative fluid balance. On relative importance analysis, the strongest factors regarding MAKE30 were, in decreasing order, baseline creatinine, cumulative fluid balance, and age. In the secondary outcome analysis, the adjusted odds ratio for dialysis or sustained renal dysfunction was 1.06 (95% CI 1.01–1.11) per litre cumulative fluid balance. On separate sensitivity analyses, lower urine output and early acute kidney injury, respectively, were independently associated with MAKE30, whereas higher fluid input was not. Conclusions In ICU patients with sepsis, a higher cumulative fluid balance after 2 days in ICU was associated with subsequent development of major adverse kidney events within 30 days, including death, renal replacement requirement, or persistent renal dysfunction. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-022-01040-6.
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Affiliation(s)
- Alessandro Mele
- Department of Physiology and Pharmacology, Section of Anaesthesia and Intensive Care, Karolinska Institutet, Stockholm, Sweden.,Instituto Di Anestesiologia E Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Emanuele Cerminara
- Department of Physiology and Pharmacology, Section of Anaesthesia and Intensive Care, Karolinska Institutet, Stockholm, Sweden.,Instituto Di Anestesiologia E Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Henrike Häbel
- Institute of Environmental Medicine, Division of Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Borja Rodriguez-Galvez
- School of Electrical Engineering and Computer Science, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Anders Oldner
- Department of Physiology and Pharmacology, Section of Anaesthesia and Intensive Care, Karolinska Institutet, Stockholm, Sweden.,Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - David Nelson
- Department of Physiology and Pharmacology, Section of Anaesthesia and Intensive Care, Karolinska Institutet, Stockholm, Sweden.,Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Johannes Gårdh
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Ragnar Thobaben
- School of Electrical Engineering and Computer Science, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Sandra Jonmarker
- Department of Clinical Science and Education Södersjukhuset, Section of Anaesthesia and Intensive Care, Karolinska Institute, Stockholm, Sweden.,Department of Anaesthesia and Intensive Care, Södersjukhuset, Stockholm, Sweden
| | - Maria Cronhjort
- Department of Clinical Science and Education Södersjukhuset, Section of Anaesthesia and Intensive Care, Karolinska Institute, Stockholm, Sweden.,Department of Anaesthesia and Intensive Care, Södersjukhuset, Stockholm, Sweden
| | - Jacob Hollenberg
- Department of Clinical Science and Education Södersjukhuset, Center for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Johan Mårtensson
- Department of Physiology and Pharmacology, Section of Anaesthesia and Intensive Care, Karolinska Institutet, Stockholm, Sweden. .,Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, 171 76, Stockholm, Sweden.
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22
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Holmqvist J, Brynolf A, Zhao J, Halmin M, Hollenberg J, Mårtensson J, Bell M, Block L, Edgren G. Patterns and determinants of blood transfusion in intensive care in Sweden between 2010 and 2018: A nationwide, retrospective cohort study. Transfusion 2022; 62:1188-1198. [PMID: 35638740 PMCID: PMC9328318 DOI: 10.1111/trf.16942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/28/2022] [Accepted: 03/28/2022] [Indexed: 11/30/2022]
Abstract
Background Intensive care unit (ICU) patients are transfused with blood products for a number of reasons, from massive ongoing hemorrhage, to mild anemia following blood sampling, combined with bone marrow depression due to critical illness. There's a paucity of data on transfusions in ICUs and most studies are based on audits or surveys. The aim of this study was to provide a complete picture of ICU‐related transfusions in Sweden. Methods We conducted a register based retrospective cohort study with data on all adult patient admissions from 82 of 84 Swedish ICUs between 2010 and 2018, as recorded in the Swedish Intensive Care Register. Transfusions were obtained from the SCANDAT‐3 database. Descriptive statistics were computed, characterizing transfused and nontransfused patients. The distribution of blood use comparing different ICUs was investigated by computing the observed proportion of ICU stays with a transfusion, as well as the expected proportion. Results In 330,938 ICU episodes analyzed, at least one transfusion was administered for 106,062 (32%). For both red‐cell units and plasma, the fraction of patients who were transfused decreased during the study period from 31.3% in 2010 to 24.6% in 2018 for red‐cells, and from 16.6% in 2010 to 9.4% in 2018 for plasma. After adjusting for a range of factors, substantial variation in transfusion frequency remained, especially for plasma units. Conclusion Despite continuous decreases in utilization, transfusions remain common among Swedish ICU patients. There is considerable unexplained variation in transfusion rates. More research is needed to establish stronger critiera for when to transfuse ICU patients.
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Affiliation(s)
- Jacob Holmqvist
- Department of Anaestesia and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Anesthesia and Intensive Care, Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Anne Brynolf
- Department of Medicine, Solna, Clinical Epidemiology Division, Stockholm, Sweden
| | - Jingcheng Zhao
- Department of Medicine, Solna, Clinical Epidemiology Division, Stockholm, Sweden
| | - Märit Halmin
- Department of Cardiology, Södersjukhuset, Stockholm, Sweden
| | - Jacob Hollenberg
- Department of Cardiology, Södersjukhuset, Stockholm, Sweden.,Department of Clinical Science and Education, Center for Resuscitation Science, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Johan Mårtensson
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden.,Department of Physiology and Pharmacology, Section of Anesthesiology and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Max Bell
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden.,Department of Physiology and Pharmacology, Section of Anesthesiology and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Linda Block
- Department of Anaestesia and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Anesthesia and Intensive Care, Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Gustaf Edgren
- Department of Medicine, Solna, Clinical Epidemiology Division, Stockholm, Sweden.,Department of Cardiology, Södersjukhuset, Stockholm, Sweden
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23
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Poole AP, Finnis ME, Anstey J, Bellomo R, Bihari S, Birardar V, Doherty S, Eastwood G, Finfer S, French CJ, Heller S, Horowitz M, Kar P, Kruger PS, Maiden MJ, Mårtensson J, McArthur CJ, McGuinness SP, Secombe PJ, Tobin AE, Udy AA, Young PJ, Deane AM. The Effect of a Liberal Approach to Glucose Control in Critically Ill Patients with Type 2 Diabetes: A multicenter, parallel-group, open-label, randomized clinical trial. Am J Respir Crit Care Med 2022; 206:874-882. [PMID: 35608484 DOI: 10.1164/rccm.202202-0329oc] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale Blood glucose concentrations affect outcomes in critically ill patients but the optimal target blood glucose range in those with type 2 diabetes is unknown. Objective To evaluate the effects of a 'liberal' approach to targeted blood glucose range during intensive care unit (ICU) admission. Methods This mutlicenter, parallel-group, open-label, randomized clinical trial included 419 adult patients with type 2 diabetes expected to be in the ICU on at least three consecutive days. In the intervention group intravenous insulin was commenced at a blood glucose >252 mg/dL and titrated to a target range of 180 to 252 mg/dL. In the comparator group insulin was commenced at a blood glucose >180 mg/dL and titrated to a target range of 108 to 180 mg/dL. The primary outcome was incident hypoglycemia (<72 mg/dL). Secondary outcomes included glucose metrics and clinical outcomes. Main Results At least one episode of hypoglycemia occurred in 10 of 210 (5%) patients assigned the intervention and 38 of 209 (18%) patients assigned the comparator (incident rate ratio: 0.21 (95% CI, 0.09 to 0.49); P<0.001). Those assigned the intervention had greater blood glucose concentrations (daily mean, minimum, maximum), less glucose variability and less relative hypoglycaemia (P<0.001 for all comparisons). By day 90, 62 of 210 (29.5%) in the intervention and 52 of 209 (24.9%) in the comparator group had died (absolute difference 4.6 percentage points (95%CI, -3.9 to 13.2%); P=0.29). Conclusions A liberal approach to blood glucose targets reduced incident hypoglycemia but did not improve patient-centered outcomes. Clinical trial registration available at www.anzctr.org.au, ID: ACTRN12616001135404.
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Affiliation(s)
- Alexis P Poole
- The University of Adelaide Discipline of Acute Care Medicine, 242032, Adelaide, South Australia, Australia.,Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Adelaide, Australia.,Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Mark E Finnis
- Royal Adelaide Hospital, Department of Critical Care Services, Adelaide, South Australia, Australia.,University of Adelaide, Discipline of Acute Care Medicine, Adelaide, South Australia, Australia
| | - James Anstey
- Saint Vincent's Hospital Melbourne, 60078, Department of Intensive Care, Fitzroy, Victoria, Australia
| | | | - Shailesh Bihari
- Flinders Medical Centre and Flinders University, Department of Intensive Care Medicine, Bedford park, South Australia, Australia
| | - Vishwanath Birardar
- The University of Adelaide Discipline of Acute Care Medicine, 242032, Adelaide, South Australia, Australia.,Lyell McEwin Hospital, 3187, Intensive Care Unit, Elizabeth Vale, South Australia, Australia
| | - Sarah Doherty
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Glenn Eastwood
- Austin hospital, Intensive care unit, Heidelgerg, Victoria, Australia
| | - Simon Finfer
- University of Sydney, Intensive Care, St. Leonards, New South Wales, Australia
| | - Craig J French
- Western Health, Victoria, Intensive Care Unit, Melbourne, Victoria, Australia
| | - Simon Heller
- Clinical Diabetes, Endocrinology and Metabolism, University of Sheffield, Sheffield, United Kingdom of Great Britain and Northern Ireland
| | - Michael Horowitz
- The University of Adelaide Adelaide Medical School, 110466, Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide, South Australia, Australia
| | - Palash Kar
- The University of Adelaide Discipline of Acute Care Medicine, 242032, Adelaide, South Australia, Australia.,Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Peter S Kruger
- Princess Alexandra Hospital, Intensive Care Unit, Brisbane, Queensland, Australia.,University of Queensland, Critical Care, Endocrinology and Metabolism Research Unit, Brisbane, Queensland, Australia
| | - Matthew J Maiden
- Royal Adelaide Hospital, Intensive Care Unit, Adelaide, South Australia, Australia.,University of Adelaide, Discipline of Acute Care Medicine, Adelaide, South Australia, Australia
| | - Johan Mårtensson
- Karolinska Institutet Department of Physiology and Pharmacology, 111126, Stockholm, Sweden.,Karolinska University Hospital, 59562, Perioperative Medicine and Intensive Care, Stockholm, Sweden
| | | | - Shay P McGuinness
- Auckland District Health Board, Cardiothoracic and Vascular ICU, Aucklanad, New Zealand
| | - Paul J Secombe
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Department of Intensive Care, Alice Springs Hospital, Alice Springs, Australia
| | - Antony E Tobin
- The University of Melbourne, Melbourne Medical School, Department of Critical Care, Melbourne, Victoria, Australia.,Department of Intensive Care, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Andrew A Udy
- Monash University, School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Paul J Young
- Wellington Hospital, Intensive Care Unit, Wellington, New Zealand.,Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Adam M Deane
- The University of Melbourne, 2281, Centre for Integrated Critical Care , Melbourne, Victoria, Australia.,Royal Melbourne Hospital, 90134, Intensive Care Unit, Melbourne, Victoria, Australia.,Royal Melbourne Hospital, 90134, Department of Medicine, Melbourne, Victoria, Australia;
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24
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Langensee L, Mårtensson J, Jönsen A, Zervides K, Bengtsson A, Nystedt J, Cannerfelt B, Nilsson P, Mannfolk P, Lätt J, Rumetshofer T, Sundgren PC. Cognitive performance in systemic lupus erythematosus patients: a cross-sectional and longitudinal study. BMC Rheumatol 2022; 6:22. [PMID: 35440096 PMCID: PMC9019974 DOI: 10.1186/s41927-022-00253-3] [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: 11/19/2021] [Accepted: 02/16/2022] [Indexed: 12/02/2022] Open
Abstract
Background Previous research has provided evidence for cognitive dysfunction as a common symptom of systemic lupus erythematosus (SLE). In light of this, the primary goal of this study was to investigate how cognitive impairment in this patient group develops over time. In addition, the present dataset contributes to delineating the specific abilities that are impaired in SLE patients as well as answering the question whether the disease affects the cognition of SLE patients with neuropsychiatric manifestations (NPSLE) and without (non-NPSLE) in distinct ways. Methods 91 female participants (33 NPSLE, 29 non-NPSLE, 29 healthy controls (HC)) underwent standardized neurocognitive testing. A total of ten different cognitive abilities were assessed, among others executive function, memory, and attention. Some of the participants (30 NPSLE patients, 22 non-NPSLE, 13 HC) were tested twice (mean time between testing sessions: 50 months) to enable longitudinal tracking of cognitive abilities. Analyses of Variance (ANOVA) were conducted to determine whether cognitive performance differed cross-sectionally between the groups. Linear mixed effects models were fit to investigate performance differences between the groups over time. Results Cross-sectional analysis at follow-up demonstrated that the cognitive performance of both NPSLE and non-NPSLE was significantly lower than that of HC for the motor speed and the psychomotor speed domain. Additionally, NPSLE patients performed significantly weaker than HC in the complex attention domain. At the same time, the cross-sectional data did not yield any support for performance differences between NPSLE and non-NPSLE patients. Weak positive correlations between disease duration and psychomotor speed, motor speed and reaction time emerged. A temporal progression of cognitive dysfunction in SLE patients was not confirmed. Conclusions Cognitive performance is affected in both non-NPSLE and NPSLE patients. However, a linear decline in performance over time could not be verified. More in-depth longitudinal assessments of cognition in SLE patients are needed to establish how cognitive abilities in this patient population develop over time. Supplementary Information The online version contains supplementary material available at 10.1186/s41927-022-00253-3.
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Affiliation(s)
- L Langensee
- Department of Clinical Sciences Lund, Logopedics, Phoniatrics and Audiology, Faculty of Medicine, Lund University, 22185, Lund, Sweden
| | - J Mårtensson
- Department of Clinical Sciences Lund, Logopedics, Phoniatrics and Audiology, Faculty of Medicine, Lund University, 22185, Lund, Sweden
| | - A Jönsen
- Department of Clinical Sciences Lund, Rheumatology, Faculty of Medicine, Lund University, 22185, Lund, Sweden
| | - K Zervides
- Department of Clinical Sciences Lund, Rheumatology, Faculty of Medicine, Lund University, 22185, Lund, Sweden.,Department of Clinical Sciences Lund, Neurology, Faculty of Medicine, Lund University, 22185, Lund, Sweden
| | - A Bengtsson
- Department of Clinical Sciences Lund, Rheumatology, Faculty of Medicine, Lund University, 22185, Lund, Sweden
| | - J Nystedt
- Department of Clinical Sciences Lund, Radiology, Faculty of Medicine, Lund University, 22185, Lund, Sweden
| | - B Cannerfelt
- Department of Medical Imaging and Physiology, Skåne University Hospital, 221 85, Lund, Sweden
| | - P Nilsson
- Department of Clinical Sciences Lund, Neurology, Faculty of Medicine, Lund University, 22185, Lund, Sweden
| | - P Mannfolk
- Department of Medical Imaging and Physiology, Skåne University Hospital, 221 85, Lund, Sweden
| | - J Lätt
- Department of Medical Imaging and Physiology, Skåne University Hospital, 221 85, Lund, Sweden
| | - T Rumetshofer
- Department of Clinical Sciences Lund, Logopedics, Phoniatrics and Audiology, Faculty of Medicine, Lund University, 22185, Lund, Sweden
| | - P C Sundgren
- Department of Clinical Sciences Lund, Radiology, Faculty of Medicine, Lund University, 22185, Lund, Sweden. .,Department of Medical Imaging and Physiology, Skåne University Hospital, 221 85, Lund, Sweden. .,Lund University BioImaging Center (LBIC), Lund University, 22185, Lund, Sweden.
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25
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Svärd D, Erfurth EM, Hellerstedt R, Mannfolk P, Mårtensson J, Sundgren P, Follin C. Cognitive interference processing in adult survivors of childhood acute lymphoblastic leukemia using functional magnetic resonance imaging. Acta Oncol 2022; 61:333-340. [PMID: 34637675 DOI: 10.1080/0284186x.2021.1987514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Childhood acute lymphoblastic leukemia (ALL) is associated with cognitive impairment in adulthood. Cognitive interference processing and its correlated functional magnetic resonance imaging (fMRI) activity in the brain have not yet been studied in this patient group. MATERIAL Twenty-six adult childhood ALL survivors (median [interquartile range {IQR}] age, 40.0 [37.0-42.3] years) were investigated at median age (IQR), 35.0 (32.0-37.0) years after treatment with intrathecal and intravenous chemotherapy as well as cranial radiotherapy (24 Gy) and compared with 26 matched controls (median [IQR] age, 37.5 [33.0-41.5] years). METHODS Cognitive interference processing was investigated in terms of behavioral performance (response times [ms] and accuracy performance [%]) and fMRI activity in the cingulo-fronto-parietal (CFP) attention network as well as other parts of the brain using the multisource interference task (MSIT). RESULTS ALL survivors had longer response times and reduced accuracy performance during cognitive interference processing (median [IQR] interference effect, 371.9 [314.7-453.3] ms and 6.7 [4.2-14.7]%, respectively) comparedwith controls (303.7 [275.0-376.7] ms and 2.3 [1.6-4.3]%, respectively), but did not exhibit altered fMRI activity in the CFP attention network or elsewhere in the brain. CONCLUSION Adult childhood ALL survivors demonstrated impaired behavioral performance but no altered fMRI activity when performing cognitive interference processing when compared with controls. The results can be used to better characterize this patient group and to optimize follow-up care and support for these individuals.
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Affiliation(s)
- Daniel Svärd
- Department of Diagnostic Radiology, Lund University, Lund, Sweden
- Department of Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
| | - Eva Marie Erfurth
- Department of Endocrinology, Skåne University Hospital, Lund, Sweden
| | - Robin Hellerstedt
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| | - Peter Mannfolk
- Department of Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
| | - Johan Mårtensson
- Department of Logopedics, Phoniatrics and Audiology, Lund University, Lund, Sweden
| | - Pia Sundgren
- Department of Diagnostic Radiology, Lund University, Lund, Sweden
- Department of Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
- Lund University BioImaging Center, Lund University, Lund, Sweden
| | - Cecilia Follin
- Department of Oncology, Skåne University Hospital, Lund, Sweden
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26
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Kühn S, Mascherek A, Filevich E, Lisofsky N, Becker M, Butler O, Lochstet M, Mårtensson J, Wenger E, Lindenberger U, Gallinat J. Spend time outdoors for your brain - an in-depth longitudinal MRI study. World J Biol Psychiatry 2022; 23:201-207. [PMID: 34231438 DOI: 10.1080/15622975.2021.1938670] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The effects of nature on physical and mental health are an emerging topic in empirical research with increasing influence on practical health recommendations. Here we set out to investigate the association between spending time outdoors and brain structural plasticity in conjunctions with self-reported affect. METHODS We established the Day2day study, which includes an unprecedented in-depth assessment of variability of brain structure in a serial sequence of 40-50 structural magnetic resonance imaging (MRI) acquisitions of each of six young healthy participants for 6-8 months (n = 281 MRI scans in total). RESULTS A whole-brain analysis revealed that time spent outdoors was positively associated with grey matter volume in the right dorsolateral prefrontal cortex and positive affect, also after controlling for physical activity, fluid intake, free time, and hours of sunshine. CONCLUSIONS Results indicate remarkable and potentially behaviorally relevant plasticity of cerebral structure within a short time frame driven by the daily time spent outdoors. This is compatible with anecdotal evidence of the health and mood-promoting effects of going for a walk. The study may provide the first evidence for underlying cerebral mechanisms of so-called green prescriptions with possible consequences for future interventions in mental disorders.
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Affiliation(s)
- Simone Kühn
- Lise Meitner Group for Environmental Neuroscience, Max Planck Institute for Human Development, Berlin, Germany.,Clinic and Policlinic for Psychiatry and Psychotherapy, University Clinic Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Mascherek
- Clinic and Policlinic for Psychiatry and Psychotherapy, University Clinic Hamburg-Eppendorf, Hamburg, Germany
| | - Elisa Filevich
- Center for Lifespan Psychology, Max Planck Institute for Human Development, Berlin, Germany.,Bernstein Center for Computational Neuroscience Berlin, Berlin, Germany.,Institute for Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Nina Lisofsky
- Clinic and Policlinic for Psychiatry and Psychotherapy, University Clinic Hamburg-Eppendorf, Hamburg, Germany.,Center for Lifespan Psychology, Max Planck Institute for Human Development, Berlin, Germany
| | - Maxi Becker
- Clinic and Policlinic for Psychiatry and Psychotherapy, University Clinic Hamburg-Eppendorf, Hamburg, Germany
| | - Oisin Butler
- Center for Lifespan Psychology, Max Planck Institute for Human Development, Berlin, Germany
| | | | - Johan Mårtensson
- Faculty of Medicine, Department of Clinical Sciences Lund, Logopedics, Phoniatrics and Audiology, Lund University, Lund, Sweden
| | - Elisabeth Wenger
- Center for Lifespan Psychology, Max Planck Institute for Human Development, Berlin, Germany
| | - Ulman Lindenberger
- Center for Lifespan Psychology, Max Planck Institute for Human Development, Berlin, Germany.,Max Planck UCL Centre for Computational Psychiatry and Ageing Research, Berlin, Germany
| | - Jürgen Gallinat
- Clinic and Policlinic for Psychiatry and Psychotherapy, University Clinic Hamburg-Eppendorf, Hamburg, Germany
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27
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Jonmarker S, Litorell J, Dahlberg M, Stackelberg O, Everhov ÅH, Söderberg M, Rubenson‐Wahlin R, Günther M, Mårtensson J, Hollenberg J, Joelsson‐Alm E, Cronhjort M. An observational study of intermediate- or high-dose thromboprophylaxis for critically ill COVID-19 patients. Acta Anaesthesiol Scand 2022; 66:365-374. [PMID: 34875111 DOI: 10.1111/aas.14013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 03/30/2021] [Revised: 10/13/2021] [Accepted: 11/16/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Critically ill COVID-19 patients have a high reported incidence of thromboembolic complications and the optimal dose of thromboprophylaxis is not yet determined. The aim of this study was to investigate if 90-day mortality differed between patients treated with intermediate- or high-dose thromboprophylaxis. METHOD In this retrospective study, all critically ill COVID-19 patients admitted to intensive care from March 6th until July 15th, 2020, were eligible. Patients were categorized into groups according to daily dose of thromboprophylaxis. Dosing was based on local standardized recommendations, not on degree of critical illness or risk of thrombosis. Cox proportional hazards regression was used to estimate hazard ratios of death within 90 days from ICU admission. Multivariable models were adjusted for sex, age, body-mass index, Simplified Acute Physiology Score III, invasive respiratory support, glucocorticoids, and dosing strategy of thromboprophylaxis. RESULTS A total of 165 patients were included; 92 intermediate- and 73 high-dose thromboprophylaxis. Baseline characteristics did not differ between groups. The 90-day mortality was 19.6% in patients with intermediate-dose and 19.2% in patients with high-dose thromboprophylaxis. Multivariable hazard ratio of death within 90 days was 0.74 (95% CI, 0.36-1.53) for the high-dose group compared to intermediate-dose group. Multivariable hazard ratio for thromboembolic events and bleedings within 28 days was 0.93 (95% CI 0.37-2.29) and 0.84 (95% CI 0.28-2.54) for high versus intermediate dose, respectively. CONCLUSIONS A difference in 90-day mortality between intermediate- and high-dose thromboprophylaxis could neither be confirmed nor rejected due to a small sample size.
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Affiliation(s)
- Sandra Jonmarker
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet Stockholm Sweden
- Department of Anaesthesia and Intensive Care Södersjukhuset Stockholm Sweden
| | - Jacob Litorell
- Department of Anaesthesia and Intensive Care Södersjukhuset Stockholm Sweden
| | - Martin Dahlberg
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet Stockholm Sweden
- Department of Surgery Södersjukhuset Stockholm Sweden
| | - Otto Stackelberg
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet Stockholm Sweden
- Department of Surgery Södersjukhuset Stockholm Sweden
- Institute of Environmental Medicine Unit of Cardiovascular and Nutritional Epidemiology, Karolinska Institutet Stockholm Sweden
| | - Åsa H. Everhov
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet Stockholm Sweden
- Department of Surgery Södersjukhuset Stockholm Sweden
| | - Mårten Söderberg
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet Stockholm Sweden
- Department of Internal Medicine Södersjukhuset Stockholm Sweden
| | - Rebecka Rubenson‐Wahlin
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet Stockholm Sweden
- Department of Anaesthesia and Intensive Care Södersjukhuset Stockholm Sweden
| | - Mattias Günther
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet Stockholm Sweden
- Department of Anaesthesia and Intensive Care Södersjukhuset Stockholm Sweden
| | - Johan Mårtensson
- Department of Physiology and Pharmacology Section of Anaesthesia and Intensive Care, Karolinska Institutet Stockholm Sweden
- Department of Perioperative Medicine and Intensive Care Karolinska University Hospital Stockholm Sweden
| | - Jacob Hollenberg
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet Stockholm Sweden
- Department of Cardiology Södersjukhuset Stockholm Sweden
| | - Eva Joelsson‐Alm
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet Stockholm Sweden
- Department of Anaesthesia and Intensive Care Södersjukhuset Stockholm Sweden
| | - Maria Cronhjort
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet Stockholm Sweden
- Department of Anaesthesia and Intensive Care Södersjukhuset Stockholm Sweden
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28
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Franzén S, Semenas E, Taavo M, Mårtensson J, Larsson A, Frithiof R. Renal function during sevoflurane or total intravenous propofol anaesthesia a single-centre parallel randomised controlled study. Br J Anaesth 2022; 128:838-848. [DOI: 10.1016/j.bja.2022.02.030] [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] [Received: 11/17/2021] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 11/02/2022] Open
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29
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Rysz S, Jonsson Fagerlund M, Rimes‐Stigare C, Larsson E, Campoccia Jalde F, Mårtensson J. Chronic dysglycemia and risk of SARS-CoV-2 associated respiratory failure in hospitalized patients. Acta Anaesthesiol Scand 2022; 66:48-55. [PMID: 34582033 PMCID: PMC8653023 DOI: 10.1111/aas.13982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 09/13/2021] [Accepted: 09/18/2021] [Indexed: 11/28/2022]
Abstract
Background Diabetes is common among patients with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2)‐induced respiratory failure. We aimed to investigate the relationship between different stages of chronic dysglycemia and development of respiratory failure in hospitalized SARS‐CoV‐2 positive patients. Methods In this retrospective observational study, we included 385 hospitalized SARS‐CoV‐2 positive patients at Karolinska University Hospital, Sweden with an HbA1c test obtained within 3 months before admission. Based on HbA1c level and previous diabetes history, we classified patients into the following dysglycemia categories: prediabetes, unknown diabetes, controlled diabetes, or uncontrolled diabetes. We used multivariable logistic regression analysis adjusted for age, sex, and body mass index, to assess the association between dysglycemia categories and development of SARS‐CoV‐2‐induced respiratory failure. Results Of the 385 study patients, 88 (22.9%) had prediabetes, 68 (17.7%) had unknown diabetes, 36 (9.4%) had controlled diabetes, and 83 (21.6%) had uncontrolled diabetes. Overall, 299 (77.7%) patients were admitted with or developed SARS‐CoV‐2‐induced respiratory failure during hospitalization. In multivariable logistic regression analysis compared with no chronic dysglycemia, prediabetes (OR 14.41, 95% CI 5.27–39.43), unknown diabetes (OR 15.86, 95% CI 4.55–55.36), and uncontrolled diabetes (OR 17.61, 95% CI 5.77–53.74) was independently associated with increased risk of SARS‐CoV‐2‐induced respiratory failure. Conclusion In our cohort of hospitalized SARS‐CoV‐2 positive patients with available HbA1c data, prediabetes, undiagnosed diabetes, and poorly controlled diabetes were associated with a markedly increased risk of SARS‐CoV‐2‐associated respiratory failure.
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Affiliation(s)
- Susanne Rysz
- Department of Perioperative Medicine and Intensive Care Karolinska University Hospital Stockholm Sweden
- Department of Medicine Solna Karolinska Institutet Stockholm Sweden
| | - Malin Jonsson Fagerlund
- Department of Perioperative Medicine and Intensive Care Karolinska University Hospital Stockholm Sweden
- Department of Physiology and Pharmacology Karolinska Institutet Stockholm Sweden
| | - Claire Rimes‐Stigare
- Department of Perioperative Medicine and Intensive Care Karolinska University Hospital Stockholm Sweden
| | - Emma Larsson
- Department of Perioperative Medicine and Intensive Care Karolinska University Hospital Stockholm Sweden
- Department of Physiology and Pharmacology Karolinska Institutet Stockholm Sweden
| | - Francesca Campoccia Jalde
- Department of Perioperative Medicine and Intensive Care Karolinska University Hospital Stockholm Sweden
- Department of Molecular Medicine and Surgery Karolinska Institutet Stockholm Sweden
| | - Johan Mårtensson
- Department of Perioperative Medicine and Intensive Care Karolinska University Hospital Stockholm Sweden
- Department of Physiology and Pharmacology Karolinska Institutet Stockholm Sweden
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Balintescu A, Lind M, Franko MA, Oldner A, Cronhjort M, Svensson AM, Eliasson B, Mårtensson J. Glycemic Control and Risk of Sepsis and Subsequent Mortality in Type 2 Diabetes. Diabetes Care 2022; 45:127-133. [PMID: 34716212 DOI: 10.2337/dc21-1050] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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] [Received: 05/15/2021] [Accepted: 10/02/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate the nature of the relationship between HbA1c and sepsis among individuals with type 2 diabetes, and to assess the association between sepsis and all-cause mortality in such patients. RESEARCH DESIGN AND METHODS We included 502,871 individuals with type 2 diabetes recorded in the Swedish National Diabetes Register and used multivariable Cox regression and restricted cubic spline analyses to assess the association between time-updated HbA1c values and sepsis occurrence between 1 January 2005 and 31 December 2015. The association between sepsis and death was examined using multivariable Cox regression analysis. RESULTS Overall, 14,534 (2.9%) patients developed sepsis during the study period. On multivariable Cox regression analysis, compared with an HbA1c of 48-52 mmol/mol (6.5-6.9%), the adjusted hazard ratio for sepsis was 1.15 (95% CI 1.07-1.24) for HbA1c <43 mmol/mol (6.1%), 0.93 (0.87-0.99) for HbA1c 53-62 mmol/mol (7.0-7.8%), 1.05 (0.97-1.13) for HbA1c 63-72 mmol/mol (7.9-8.7%), 1.14 (1.04-1.25) for HbA1c 73-82 mmol/mol (8.8-9.7%), and 1.52 (1.37-1.68) for HbA1c >82 mmol/mol (9.7%). In the cubic spline model, a reduction of the adjusted risk was observed within the lower HbA1c range until 53 mmol/mol (7.0%), with a hazard ratio of 0.78 (0.73-0.82) per SD; it increased thereafter (P for nonlinearity <0.001). As compared with patients without sepsis, the adjusted hazard ratio for death among patients with sepsis was 4.16 (4.03-4.30). CONCLUSIONS In a nationwide cohort of individuals with type 2 diabetes, we found a U-shaped association between HbA1c and sepsis and a fourfold increased risk of death among those developing sepsis.
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Affiliation(s)
- Anca Balintescu
- 1Section of Anaesthesia and Intensive Care, Department of Clinical Science and Education, South General Hospital, Karolinska Institute, Stockholm, Sweden
| | - Marcus Lind
- 2Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden.,3Department of Medicine, NU Hospital Group, Uddevalla, Sweden
| | - Mikael Andersson Franko
- 1Section of Anaesthesia and Intensive Care, Department of Clinical Science and Education, South General Hospital, Karolinska Institute, Stockholm, Sweden
| | - Anders Oldner
- 4Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.,5Section of Anaesthesia and Intensive Care, Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
| | - Maria Cronhjort
- 1Section of Anaesthesia and Intensive Care, Department of Clinical Science and Education, South General Hospital, Karolinska Institute, Stockholm, Sweden
| | - Ann-Marie Svensson
- 2Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden.,6Swedish National Diabetes Register, Västra Götalandsregionen, Gothenburg, Sweden
| | - Björn Eliasson
- 2Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Johan Mårtensson
- 4Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.,5Section of Anaesthesia and Intensive Care, Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
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Plečko D, Bennett N, Mårtensson J, Dam TA, Entjes R, Rettig TCD, Dongelmans DA, Boelens AD, Rigter S, Hendriks SHA, Jong R, Kamps MJA, Peters M, Karakus A, Gommers D, Ramnarain D, Wils E, Achterberg S, Nowitzky R, Tempel W, Jager CPC, Nooteboom FGCA, Oostdijk E, Koetsier P, Cornet AD, Reidinga AC, Ruijter W, Bosman RJ, Frenzel T, Urlings‐Strop LC, Jong P, Smit EG, Cremer OL, Mehagnoul‐Schipper DJ, Faber HJ, Lens J, Brunnekreef GB, Festen‐Spanjer B, Dormans T, Bruin DP, Lalisang RCA, Vonk SJJ, Haan ME, Fleuren LM, Thoral PJ, Elbers PWG, Bellomo R. Rapid Evaluation of Coronavirus Illness Severity (RECOILS) in intensive care: Development and validation of a prognostic tool for in-hospital mortality. Acta Anaesthesiol Scand 2022; 66:65-75. [PMID: 34622441 PMCID: PMC8652966 DOI: 10.1111/aas.13991] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/16/2021] [Accepted: 09/27/2021] [Indexed: 01/08/2023]
Abstract
Background The prediction of in‐hospital mortality for ICU patients with COVID‐19 is fundamental to treatment and resource allocation. The main purpose was to develop an easily implemented score for such prediction. Methods This was an observational, multicenter, development, and validation study on a national critical care dataset of COVID‐19 patients. A systematic literature review was performed to determine variables possibly important for COVID‐19 mortality prediction. Using a logistic multivariable model with a LASSO penalty, we developed the Rapid Evaluation of Coronavirus Illness Severity (RECOILS) score and compared its performance against published scores. Results Our development (validation) cohort consisted of 1480 (937) adult patients from 14 (11) Dutch ICUs admitted between March 2020 and April 2021. Median age was 65 (65) years, 31% (26%) died in hospital, 74% (72%) were males, average length of ICU stay was 7.83 (10.25) days and average length of hospital stay was 15.90 (19.92) days. Age, platelets, PaO2/FiO2 ratio, pH, blood urea nitrogen, temperature, PaCO2, Glasgow Coma Scale (GCS) score measured within +/−24 h of ICU admission were used to develop the score. The AUROC of RECOILS score was 0.75 (CI 0.71–0.78) which was higher than that of any previously reported predictive scores (0.68 [CI 0.64–0.71], 0.61 [CI 0.58–0.66], 0.67 [CI 0.63–0.70], 0.70 [CI 0.67–0.74] for ISARIC 4C Mortality Score, SOFA, SAPS‐III, and age, respectively). Conclusions Using a large dataset from multiple Dutch ICUs, we developed a predictive score for mortality of COVID‐19 patients admitted to ICU, which outperformed other predictive scores reported so far.
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Affiliation(s)
- Drago Plečko
- Department of Intensive Care Medicine Laboratory for Critical Care Computational Intelligence Amsterdam Medical Data Science Amsterdam UMC Amsterdam The Netherlands
- Department of Mathematics Seminar for Statistics ETH Zürich Zurich Switzerland
| | - Nicolas Bennett
- Department of Mathematics Seminar for Statistics ETH Zürich Zurich Switzerland
| | - Johan Mårtensson
- Department of Physiology and Pharmacology Section of Anaesthesia and Intensive Care Karolinska Institutet Stockholm Sweden
- Department of Perioperative Medicine and Intensive Care Karolinska University Hospital Stockholm Sweden
| | - Tariq A. Dam
- Department of Intensive Care Medicine Laboratory for Critical Care Computational Intelligence Amsterdam Medical Data Science Amsterdam UMC Amsterdam The Netherlands
| | - Robert Entjes
- Department of Intensive Care Admiraal De Ruyter Ziekenhuis Goes The Netherlands
| | | | - Dave A. Dongelmans
- Department of Intensive Care Medicine Laboratory for Critical Care Computational Intelligence Amsterdam Medical Data Science Amsterdam UMC Amsterdam The Netherlands
| | | | - Sander Rigter
- Department of Anesthesiology and Intensive Care St. Antonius Hospital Nieuwegein The Netherlands
| | | | - Remko Jong
- Intensive Care Bovenij Ziekenhuis Amsterdam The Netherlands
| | | | - Marco Peters
- Intensive Care Canisius Wilhelmina Ziekenhuis Nijmegen The Netherlands
| | - Attila Karakus
- Department of Intensive Care Diakonessenhuis Hospital Utrecht The Netherlands
| | - Diederik Gommers
- Department of Intensive Care Erasmus Medical Center Rotterdam The Netherlands
| | | | - Evert‐Jan Wils
- Department of Intensive Care Franciscus Gasthuis & Vlietland Rotterdam The Netherlands
| | | | | | - Walter Tempel
- Department of Intensive Care Ikazia Ziekenhuis Rotterdam Rotterdam The Netherlands
| | | | | | | | - Peter Koetsier
- Intensive Care Medisch Centrum Leeuwarden Leeuwarden The Netherlands
| | - Alexander D. Cornet
- Department of Intensive Care Medisch Spectrum Twente Enschede The Netherlands
| | | | - Wouter Ruijter
- Department of Intensive Care Medicine Northwest Clinics Alkmaar The Netherlands
| | | | - Tim Frenzel
- Department of Intensive Care Medicine Radboud University Medical Center Nijmegen The Netherlands
| | | | - Paul Jong
- Department of Anesthesia and Intensive Care Slingeland Ziekenhuis Doetinchem The Netherlands
| | - Ellen G.M. Smit
- Intensive Care Spaarne GasthuisHaarlem en Hoofddorp The Netherlands
| | | | | | | | - Judith Lens
- ICU ICU, IJsselland ZiekenhuisCapelle aan den IJssel The Netherlands
| | | | | | - Tom Dormans
- Intensive care Zuyderland MC Heerlen The Netherlands
| | | | | | | | - Martin E. Haan
- Department of Intensive Care Medicine Laboratory for Critical Care Computational Intelligence Amsterdam Medical Data Science Amsterdam UMC Amsterdam The Netherlands
| | - Lucas M. Fleuren
- Department of Intensive Care Medicine Laboratory for Critical Care Computational Intelligence Amsterdam Medical Data Science Amsterdam UMC Amsterdam The Netherlands
| | - Patrick J. Thoral
- Department of Intensive Care Medicine Laboratory for Critical Care Computational Intelligence Amsterdam Medical Data Science Amsterdam UMC Amsterdam The Netherlands
| | - Paul W. G. Elbers
- Department of Intensive Care Medicine Laboratory for Critical Care Computational Intelligence Amsterdam Medical Data Science Amsterdam UMC Amsterdam The Netherlands
| | - Rinaldo Bellomo
- Australian and New Zealand Intensive Care Research CentreSchool of Public Health and Preventative MedicineMonash University Melbourne Australia
- Department of Critical Care The University of Melbourne Melbourne Australia
- Data Analytics Research and Evaluation Centre Department of Medicine and Radiology The University of Melbourne
- Austin Hospital Melbourne Australia
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Svärd D, Follin C, Fjalldal S, Hellerstedt R, Mannfolk P, Mårtensson J, Sundgren P, Erfurth EM. Cognitive interference processing in adults with childhood craniopharyngioma using functional magnetic resonance imaging. Endocrine 2021; 74:714-722. [PMID: 34292485 PMCID: PMC8571203 DOI: 10.1007/s12020-021-02824-9] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 07/07/2021] [Indexed: 11/04/2022]
Abstract
PURPOSE To assess cognitive interference processing in adults with childhood craniopharyngioma (CP), with and without hypothalamic injury, respectively, in terms of behavioral performance and functional magnetic resonance imaging (fMRI) activity, using the multi-source interference task (MSIT). METHODS Twenty-eight CP patients (median age 34.5 [29.0-39.5] years) were investigated at median 20.5 (16.3-28.8) years after treatment with surgical resection and in some cases additional radiotherapy (n = 10) and compared to 29 matched controls (median age 37.0 [32.5-42.0] years). The subjects performed the MSIT during fMRI acquisition and behavioral performance in terms of response times (ms) and accuracy performance (%) were recorded. RESULTS The MSIT activated the cingulo-fronto-parietal (CFP) attention network in both CP patients and controls. No differences were found in behavioral performance nor fMRI activity between CP patients (interference effect 333.9 [287.3-367.1] ms and 3.1 [1.6-5.6]%, respectively) and controls (309.1 [276.4-361.0] ms and 2.6 [1.6-4.9]%). No differences were found in behavioral performance nor fMRI activity between the two subgroups with (332.0 [283.6-353.4] ms and 4.2 [2.3-5.7]%, respectively) and without hypothalamic injury (355.7 [293.7-388.7] ms and 2.1 [1.0-5.2]%, respectively), respectively, and controls. CONCLUSION Adults with childhood CP performed cognitive interference processing equally well as controls and demonstrated no compensatory fMRI activity in the CFP attention network compared to controls. This was also true for the two subgroups with and without hypothalamic injury. The results can be useful to better characterize this condition, and to optimize treatment and support for these individuals.
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Affiliation(s)
- Daniel Svärd
- Department of Diagnostic Radiology, Lund University, Lund, Sweden.
- Department of Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden.
| | - Cecilia Follin
- Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - Sigridur Fjalldal
- Department of Endocrinology, Skåne University Hospital, Lund, Sweden
| | | | - Peter Mannfolk
- Department of Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
| | - Johan Mårtensson
- Department of Logopedics, Phoniatrics and Audiology, Lund University, Lund, Sweden
| | - Pia Sundgren
- Department of Diagnostic Radiology, Lund University, Lund, Sweden
- Department of Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
- Lund University BioImaging Center, Lund University, Lund, Sweden
| | - Eva Marie Erfurth
- Department of Endocrinology, Skåne University Hospital, Lund, Sweden
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Al-Abani K, Kilhamn N, Maret E, Mårtensson J. Thrombosis and Bleeding After Implementation of an Intermediate-Dose Prophylactic Anticoagulation Protocol in ICU Patients With COVID-19: A Multicenter Screening Study. J Intensive Care Med 2021; 37:480-490. [PMID: 34821162 DOI: 10.1177/08850666211051960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Thrombosis and bleeding after implementation of an intermediate-dose prophylactic anticoagulation protocol in intensive care unit (ICU) patients with coronavirus disease 2019 (COVID-19): a multicenter screening study Background: Venous thromboembolism (VTE) is common among critically ill patients with COVID-19. Information regarding VTE prevalence and bleeding complications after implementation of intermediate-dose prophylactic anticoagulation in such patients is, however, limited. Methods: We performed a prospective, observational study in 6 ICUs in 2 university-affiliated teaching hospitals in Sweden. After implementation of an intermediate-dose prophylactic anticoagulation protocol, we performed ultrasound screening for proximal lower-extremity deep vein thrombosis (DVT) and collected routine computed tomography pulmonary angiography exam results. Results: A total of 100 COVID-19 patients were included from June 21, 2020, through February 18, 2021. During a median follow-up of 120 (IQR, 89-134) days, we found VTE in 37 patients with the majority (78.4%) being diagnosed after ICU arrival. Overall, 20 patients had proximal lower-extremity DVT with 95% being detected on ultrasound screening; 22 patients had pulmonary vascular thrombosis; and 4 patients had venous thrombosis at other sites. A total of 6 patients had both proximal lower-extremity DVT and pulmonary vascular thrombosis. On univariate logistic regression analysis of 14 baseline characteristics, only pre-existing heart failure was associated with VTE (OR 4.67, 95% CI 1.13-19.34). Major and non-major bleeding occurred in 10 and 18 patients, respectively. Conclusions: In our cohort of ICU patients with COVID-19, we observed a high prevalence of VTE and bleeding complications after implementation of intermediate-dose anticoagulation. In approximately half of patients, VTE was identified on screening ultrasound.
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Affiliation(s)
- Kais Al-Abani
- 59562Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Naima Kilhamn
- 59562Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Eva Maret
- 27106Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden.,27106Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Johan Mårtensson
- 59562Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.,27106Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
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Abstract
BACKGROUND A high body mass index (BMI) has been associated with decreased mortality in critically ill patients. This association may, in part, relate to the impact of BMI on glycemia. We aimed to study the relationship between BMI, glycemia and hospital mortality. METHODS We included all patients with a recorded BMI from four large international clinical databases (n = 259,177). We investigated the unadjusted association of BMI with average glucose levels, mortality and hypoglycemia rate. We applied multivariate analysis to investigate the impact of BMI on hypoglycemia rate, after adjusting for glycemia-relevant treatments (insulin, dextrose, corticosteroids, enteral and parenteral nutrition) and key physiological parameters (previous blood glucose level, blood lactate, shock state, SOFA score). RESULTS We analyzed 5,544,366 glucose measurements. On unadjusted analysis, increasing BMI was associated with increasing glucose levels (average increase of 5 and 10 mg/dL for the 25-30, 30-35 kg/m2 BMI groups compared to normal BMI (18.5-25 kg/m2) patients). Despite greater hyperglycemia, increasing BMI was associated with lower hospital mortality (average decrease of 2% and 3.25% for the 25-30, 30-35 kg/m2 groups compared to normal BMI patients) and lower hypoglycemia rate (average decrease of 2.5% and 3.5% for the 25-30, 30-35 kg/m2 groups compared to normal BMI patients). Increasing BMI was significantly independently associated with reduced hypoglycemia rate, with odds ratio (OR) 0.72 and 0.65, respectively (95% CIs 0.67-0.77 and 0.60-0.71, both p < 0.001) when compared with normal BMI. Low BMI patients showed greater hypoglycemia rate, with OR 1.6 (CI 1.43-1.79, p < 0.001). The association of high BMI and decreased mortality did not apply to diabetic patients. Although diabetic patients had higher rates of hypoglycemia overall and higher glucose variability (p < 0.001), they also had a reduced risk of hypoglycemia with higher BMI levels (p < 0.001). CONCLUSIONS Increasing BMI is independently associated with decreased risk of hypoglycemia. It is also associated with increasing hyperglycemia and yet with lower mortality. Lower risk of hypoglycemia might contribute to decreased mortality and might partly explain the obesity paradox. These associations, however, were markedly modified by the presence of diabetes.
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Affiliation(s)
- Drago Plečko
- Seminar for Statistics, Department of Mathematics, ETH Zürich, Zürich, Switzerland.
| | - Nicolas Bennett
- Seminar for Statistics, Department of Mathematics, ETH Zürich, Zürich, Switzerland
| | - Johan Mårtensson
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- Department of Physiology and Pharmacology, Section of Anaesthesia and Intensive Care, Karolinska Institutet, Stockholm, Sweden
| | - Rinaldo Bellomo
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
- Department of Critical Care, The University of Melbourne, Melbourne, Australia
- Data Analytics Research and Evaluation Centre, Department of Medicine and Radiology, The University of Melbourne, Melbourne, Australia
- Austin Hospital, Melbourne, Australia
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Hanna M, Balintescu A, Glassford N, Lipcsey M, Eastwood G, Oldner A, Bellomo R, Mårtensson J. Glycemic lability index and mortality in critically ill patients-A multicenter cohort study. Acta Anaesthesiol Scand 2021; 65:1267-1275. [PMID: 33964015 DOI: 10.1111/aas.13843] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/19/2021] [Accepted: 04/13/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Emerging evidence indicates a relationship between glycemic variability during intensive care unit (ICU) admission and death. We assessed whether mean glucose, hypoglycemia occurrence, or premorbid glycemic control modified this relationship. METHODS In this retrospective, multicenter cohort study, we included adult patients admitted to five ICUs in Australia and Sweden with available preadmission glycated hemoglobin A1c (HbA1c) and three or more glucose readings. We calculated the glycemic lability index (GLI), a measure of glycemic variability, and the time-weighted average blood glucose (TWA-BG) from all glucose readings. We used logistic regression analysis with adjustment for hypoglycemia and admission characteristics to assess the independent association of GLI (above vs. below cohort median) and TWA-BG (above vs. below cohort median) with hospital mortality. RESULTS Among 2305 patients, 859 (37%) had diabetes, median GLI was 40 [mmol/L]2 /h/week, median TWA-BG was 8.2 mmol/L, 171 (7%) developed hypoglycemia, and 371 (16%) died. The adjusted odds ratio for death was 1.61 (95% CI, 1.19-2.15; P = .002) for GLI above versus below median and 1.06 (95% CI, 0.80-1.41; P = .67) for TWA-BG above versus below median. The relationship between GLI and mortality was not modified by TWA-BG (P [interaction] = 0.66), a history of diabetes (P [interaction] = 0.89) or by HbA1c ≥52 mmol/mol (vs. <52 mmol/mol) (P [interaction] = 0.29). CONCLUSION In adult patients admitted to an ICU in Sweden and Australia, a high GLI was associated with increased hospital mortality irrespective of the level of mean glycemia, hypoglycemia occurrence, or premorbid glycemic control. These findings support the assessment of interventions to reduce glycemic variability during critical illness.
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Affiliation(s)
- Michel Hanna
- Department of Perioperative Medicine and Intensive Care Karolinska University Hospital Stockholm Sweden
| | - Anca Balintescu
- Department of Clinical Science and Education Södersjukhuset Section of Anaesthesia and Intensive Care Karolinska Institutet Stockholm Sweden
| | - Neil Glassford
- Department of Intensive Care Austin Hospital Melbourne Australia
| | - Miklos Lipcsey
- Hedenstierna Laboratory Department of Surgical Sciences Section of Anaesthesiology and Intensive care Uppsala University Uppsala Sweden
| | - Glenn Eastwood
- Department of Intensive Care Austin Hospital Melbourne Australia
| | - Anders Oldner
- Department of Perioperative Medicine and Intensive Care Karolinska University Hospital Stockholm Sweden
- Department of Physiology and Pharmacology Section of Anaesthesia and Intensive Care Karolinska Institutet Stockholm Sweden
| | - Rinaldo Bellomo
- Department of Intensive Care Austin Hospital Melbourne Australia
| | - Johan Mårtensson
- Department of Perioperative Medicine and Intensive Care Karolinska University Hospital Stockholm Sweden
- Department of Physiology and Pharmacology Section of Anaesthesia and Intensive Care Karolinska Institutet Stockholm Sweden
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Lindström AC, Eriksson M, Mårtensson J, Oldner A, Larsson E. Nationwide case-control study of risk factors and outcomes for community-acquired sepsis. Sci Rep 2021; 11:15118. [PMID: 34301988 PMCID: PMC8302728 DOI: 10.1038/s41598-021-94558-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 03/31/2021] [Accepted: 07/05/2021] [Indexed: 12/29/2022] Open
Abstract
Sepsis is the main cause of death in the intensive care units (ICU) and increasing incidences of ICU admissions for sepsis are reported. Identification of patients at risk for sepsis and poor outcome is therefore of outmost importance. We performed a nation-wide case-control study aiming at identifying and quantifying the association between co-morbidity and socio-economic factors with intensive care admission for community-acquired sepsis. We also explored 30-day mortality. All adult patients (n = 10,072) with sepsis admitted from an emergency department to an intensive care unit in Sweden between 2008 and 2017 and a control population (n = 50,322), matched on age, sex and county were included. In the sepsis group, 69% had a co-morbid condition at ICU admission, compared to 31% in the control group. Multivariable conditional logistic regression analysis was performed and there was a large variation in the influence of different risk factors associated with ICU-admission, renal disease, liver disease, metastatic malignancy, substance abuse, and congestive heart failure showed the strongest associations. Low income and low education level were more common in sepsis patients compared to controls. The adjusted OR for 30-day mortality for sepsis patients was 132 (95% CI 110-159) compared to controls.
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Affiliation(s)
- Ann-Charlotte Lindström
- Perioperative Medicine and Intensive Care, Karolinska University Hospital Solna, 171 76, Stockholm, Sweden.
- Section of Anaesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
| | - Mikael Eriksson
- Department of Anaesthesia, Operation and Intensive Care, Uppsala University Hospital, Uppsala, Sweden
- Section of Anaesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Johan Mårtensson
- Perioperative Medicine and Intensive Care, Karolinska University Hospital Solna, 171 76, Stockholm, Sweden
- Section of Anaesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Anders Oldner
- Perioperative Medicine and Intensive Care, Karolinska University Hospital Solna, 171 76, Stockholm, Sweden
- Section of Anaesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Emma Larsson
- Perioperative Medicine and Intensive Care, Karolinska University Hospital Solna, 171 76, Stockholm, Sweden
- Section of Anaesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
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Hedberg P, Karlsson Valik J, van der Werff S, Tanushi H, Requena Mendez A, Granath F, Bell M, Mårtensson J, Dyrdak R, Hertting O, Färnert A, Ternhag A, Naucler P. Clinical phenotypes and outcomes of SARS-CoV-2, influenza, RSV and seven other respiratory viruses: a retrospective study using complete hospital data. Thorax 2021; 77:154-163. [PMID: 34226206 PMCID: PMC8260304 DOI: 10.1136/thoraxjnl-2021-216949] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 01/25/2021] [Accepted: 05/25/2021] [Indexed: 12/29/2022]
Abstract
Background An understanding of differences in clinical phenotypes and outcomes COVID-19 compared with other respiratory viral infections is important to optimise the management of patients and plan healthcare. Herein we sought to investigate such differences in patients positive for SARS-CoV-2 compared with influenza, respiratory syncytial virus (RSV) and other respiratory viruses. Methods We performed a retrospective cohort study of hospitalised adults and children (≤15 years) who tested positive for SARS-CoV-2, influenza virus A/B, RSV, rhinovirus, enterovirus, parainfluenza viruses, metapneumovirus, seasonal coronaviruses, adenovirus or bocavirus in a respiratory sample at admission between 2011 and 2020. Results A total of 6321 adult (1721 SARS-CoV-2) and 6379 paediatric (101 SARS-CoV-2) healthcare episodes were included in the study. In adults, SARS-CoV-2 positivity was independently associated with younger age, male sex, overweight/obesity, diabetes and hypertension, tachypnoea as well as better haemodynamic measurements, white cell count, platelet count and creatinine values. Furthermore, SARS-CoV-2 was associated with higher 30-day mortality as compared with influenza (adjusted HR (aHR) 4.43, 95% CI 3.51 to 5.59), RSV (aHR 3.81, 95% CI 2.72 to 5.34) and other respiratory viruses (aHR 3.46, 95% CI 2.61 to 4.60), as well as higher 90-day mortality, ICU admission, ICU mortality and pulmonary embolism in adults. In children, patients with SARS-CoV-2 were older and had lower prevalence of chronic cardiac and respiratory diseases compared with other viruses. Conclusions SARS-CoV-2 is associated with more severe outcomes compared with other respiratory viruses, and although associated with specific patient and clinical characteristics at admission, a substantial overlap precludes discrimination based on these characteristics.
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Affiliation(s)
- Pontus Hedberg
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden .,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - John Karlsson Valik
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Suzanne van der Werff
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Hideyuki Tanushi
- Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Ana Requena Mendez
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Fredrik Granath
- Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Max Bell
- Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden.,Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Johan Mårtensson
- Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden.,Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Robert Dyrdak
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden.,Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Olof Hertting
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.,Department of Paediatric Infectious Diseases, Astrid Lindgren's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Färnert
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Anders Ternhag
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Pontus Naucler
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
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Skrifvars MB, Bailey M, Moore E, Mårtensson J, French C, Presneill J, Nichol A, Little L, Duranteau J, Huet O, Haddad S, Arabi YM, McArthur C, Cooper DJ, Bendel S, Bellomo R. A Post Hoc Analysis of Osmotherapy Use in the Erythropoietin in Traumatic Brain Injury Study-Associations With Acute Kidney Injury and Mortality. Crit Care Med 2021; 49:e394-e403. [PMID: 33566466 PMCID: PMC7963441 DOI: 10.1097/ccm.0000000000004853] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Mannitol and hypertonic saline are used to treat raised intracerebral pressure in patients with traumatic brain injury, but their possible effects on kidney function and mortality are unknown. DESIGN A post hoc analysis of the erythropoietin trial in traumatic brain injury (ClinicalTrials.gov NCT00987454) including daily data on mannitol and hypertonic saline use. SETTING Twenty-nine university-affiliated teaching hospitals in seven countries. PATIENTS A total of 568 patients treated in the ICU for 48 hours without acute kidney injury of whom 43 (7%) received mannitol and 170 (29%) hypertonic saline. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We categorized acute kidney injury stage according to the Kidney Disease Improving Global Outcome classification and defined acute kidney injury as any Kidney Disease Improving Global Outcome stage-based changes from the admission creatinine. We tested associations between early (first 2 d) mannitol and hypertonic saline and time to acute kidney injury up to ICU discharge and death up to 180 days with Cox regression analysis. Subsequently, acute kidney injury developed more often in patients receiving mannitol (35% vs 10%; p < 0.001) and hypertonic saline (23% vs 10%; p < 0.001). On competing risk analysis including factors associated with acute kidney injury, mannitol (hazard ratio, 2.3; 95% CI, 1.2-4.3; p = 0.01), but not hypertonic saline (hazard ratio, 1.6; 95% CI, 0.9-2.8; p = 0.08), was independently associated with time to acute kidney injury. In a Cox model for predicting time to death, both the use of mannitol (hazard ratio, 2.1; 95% CI, 1.1-4.1; p = 0.03) and hypertonic saline (hazard ratio, 1.8; 95% CI, 1.02-3.2; p = 0.04) were associated with time to death. CONCLUSIONS In this post hoc analysis of a randomized controlled trial, the early use of mannitol, but not hypertonic saline, was independently associated with an increase in acute kidney injury. Our findings suggest the need to further evaluate the use and choice of osmotherapy in traumatic brain injury.
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Affiliation(s)
- Markus B Skrifvars
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Division of Intensive Care, Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Department of Emergency Care and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Centre for Integrated Critical Care, The University of Melbourne, Melbourne, VIC, Australia
- Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Physiology and Pharmacology, Section of Anaesthesia and Intensive Care, Karolinska Institutet, Stockholm, Sweden
- Department of Intensive Care, Western Health, Melbourne, VIC, Australia
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
- School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
- St. Vincent's University Hospital, Dublin, Ireland
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC, Australia
- Department of Anaesthesia and Intensive Care, Hôpitaux universitaires Paris Sud (HUPS), Université Paris Sud XI, Paris, France
- Departement d'anesthésie-réanimation, Hopital de la Cavale Blanche, Boulevard Tanguy Prigent, CHRU de Brest, Univeristé de Bretagne Occidental, Brest, France
- King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand
- Department of Anesthesiology and Intensive Care, Kuopio University Hospital & University of Eastern Finland, Kuopio, Finland
- Department of Intensive Care, Austin Health, Melbourne, VIC, Australia
| | - Michael Bailey
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Centre for Integrated Critical Care, The University of Melbourne, Melbourne, VIC, Australia
| | - Elizabeth Moore
- Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Johan Mårtensson
- Department of Physiology and Pharmacology, Section of Anaesthesia and Intensive Care, Karolinska Institutet, Stockholm, Sweden
| | - Craig French
- Department of Intensive Care, Western Health, Melbourne, VIC, Australia
| | - Jeffrey Presneill
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Alistair Nichol
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Lorraine Little
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jacques Duranteau
- Department of Anaesthesia and Intensive Care, Hôpitaux universitaires Paris Sud (HUPS), Université Paris Sud XI, Paris, France
| | - Olivier Huet
- Departement d'anesthésie-réanimation, Hopital de la Cavale Blanche, Boulevard Tanguy Prigent, CHRU de Brest, Univeristé de Bretagne Occidental, Brest, France
| | - Samir Haddad
- King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Yaseen M Arabi
- King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Colin McArthur
- Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand
| | - David James Cooper
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC, Australia
| | - Stepani Bendel
- Department of Anesthesiology and Intensive Care, Kuopio University Hospital & University of Eastern Finland, Kuopio, Finland
| | - Rinaldo Bellomo
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Centre for Integrated Critical Care, The University of Melbourne, Melbourne, VIC, Australia
- Department of Intensive Care, Austin Health, Melbourne, VIC, Australia
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Flam B, Wintzell V, Ludvigsson JF, Mårtensson J, Pasternak B. Direct oral anticoagulant use and risk of severe COVID-19. J Intern Med 2021; 289:411-419. [PMID: 33258156 PMCID: PMC7753564 DOI: 10.1111/joim.13205] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/03/2020] [Accepted: 11/09/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Hypercoagulability and thromboembolism are prominent features of severe COVID-19, and ongoing anticoagulant use might be protective. METHODS We conducted a nationwide register-based cohort study in Sweden, February through May, 2020, to assess whether ongoing direct oral anticoagulant (DOAC) use was associated with reduced risk of hospital admission for laboratory-confirmed COVID-19, or a composite of intensive care unit (ICU) admission or death due to laboratory-confirmed COVID-19. RESULTS DOAC use (n = 103 703) was not associated with reduced risk of hospital admission for COVID-19 (adjusted hazard ratio [aHR] [95% confidence interval] 1.00 [0.75-1.33] vs. nonuse atrial fibrillation comparator [n = 36 875]; and aHR 0.94 [0.80-1.10] vs. nonuse cardiovascular disease comparator [n = 355 699]), or ICU admission or death due to COVID-19 (aHRs 0.76 [0.51-1.12], and 0.90 [0.71-1.15], respectively). CONCLUSION Ongoing DOAC use was not associated with reduced risk of severe COVID-19, indicating that prognosis would not be modified by early outpatient DOAC initiation.
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Affiliation(s)
- B Flam
- From the, Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.,Section of Anaesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - V Wintzell
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - J F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.,Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - J Mårtensson
- From the, Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.,Section of Anaesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - B Pasternak
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
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40
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Zettersten E, Engerström L, Bell M, Jäderling G, Mårtensson J, Block L, Larsson E. Long-term outcome after intensive care for COVID-19: differences between men and women-a nationwide cohort study. Crit Care 2021; 25:86. [PMID: 33632273 PMCID: PMC7906087 DOI: 10.1186/s13054-021-03511-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/17/2021] [Indexed: 12/15/2022]
Abstract
Background Questions remain about long-term outcome for COVID-19 patients in general, and differences between men and women in particular given the fact that men seem to suffer a more dramatic course of the disease. We therefore analysed outcome beyond 90 days in ICU patients with COVID-19, with special focus on differences between men and women. Methods We identified all patient ≥ 18 years with COVID-19 admitted between March 6 and June 30, 2020, in the Swedish Intensive Care Registry. Patients were followed until death or study end-point October 22, 2020. Association with patient sex and mortality, in addition to clinical variables, was estimated using Cox regression. We also performed a logistic regression model estimating factors associated with 90-day mortality. Results In total, 2354 patients with COVID-19 were included. Four patients were still in the ICU at study end-point. Median follow-up time was 183 days. Mortality at 90-days was 26.9%, 23.4% in women and 28.2% in men. After 90 days until end of follow-up, only 11 deaths occurred. On multivariable Cox regression analysis, male sex (HR 1.28, 95% CI 1.06–1.54) remained significantly associated with mortality even after adjustments. Additionally, age, COPD/asthma, immune deficiency, malignancy, SAPS3 and admission month were associated with mortality. The logistic regression model of 90-day mortality showed almost identical results.
Conclusions In this nationwide study of ICU patients with COVID-19, men were at higher risk of poor long-term outcome compared to their female counterparts. The underlying mechanisms for these differences are not fully understood and warrant further studies. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-021-03511-x.
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Affiliation(s)
- Erik Zettersten
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, 171 76, Stockholm, Sweden. .,Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
| | - Lars Engerström
- Department of Cardiothoracic Surgery, Anesthesia and Intensive Care, Linköping University Hospital, Linköping, Sweden.,Department of Anesthesia and Intensive Care, Vrinnevi Hospital, Norrköping, Sweden.,Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,The Swedish Intensive Care Registry, Karlstad, Sweden
| | - Max Bell
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, 171 76, Stockholm, Sweden.,Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Gabriella Jäderling
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, 171 76, Stockholm, Sweden.,Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Johan Mårtensson
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, 171 76, Stockholm, Sweden.,Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Linda Block
- Department of Anesthesiology and Intensive Care, Institution of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Emma Larsson
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, 171 76, Stockholm, Sweden.,Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.,The Swedish Intensive Care Registry, Karlstad, Sweden
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Lloyd-Donald P, Vasudevan A, Angus P, Gow P, Mårtensson J, Glassford N, Eastwood GM, Hart GK, Jones D, Weinberg L, Bellomo R. Comparison of Thromboelastography and Conventional Coagulation Tests in Patients With Severe Liver Disease. Clin Appl Thromb Hemost 2021; 26:1076029620925915. [PMID: 32496878 PMCID: PMC7427018 DOI: 10.1177/1076029620925915] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Thromboelastography (TEG) may provide rapid and clinically important coagulation information in acutely ill patients with chronic liver disease (CLD). Our objective was to describe the relationship between TEG and conventional coagulation tests (CCTs), which has not been previously explored in this population. METHODS In acutely ill patients with severe CLD (Child-Pugh score > 9, category C), we conducted a prospective observational study investigating coagulation assessment as measured by both CCTs and TEG. We used quantile regression to explore 30 associations between TEG parameters and corresponding CCTs. We compared TEG and CCT measures of coagulation initiation, clot formation, clot strength, and fibrinolysis. RESULTS We studied 34 patients on a total of 109 occasions. We observed inconsistent associations between TEG and CCT measures of coagulation initiation: TEG (citrated kaolin [CK] assay) standard reaction time and international normalized ratio: R 2 = 0.117 (P = .044). Conversely, there were strong and consistent associations between tests of clot formation: TEG (CK) kinetics time and fibrinogen: R 2 = 0.202 (P < .0001) and TEG (CK) α angle and fibrinogen 0.263 (P < .0001). We also observed strong associations between tests of clot strength, specifically TEG MA and conventional fibrinogen levels, across all TEG assays: MA (CK) and fibrinogen: R 2 = 0.485 (P < .0001). There were no associations between TEG and D-dimer levels. CONCLUSIONS In acutely ill patients with CLD, there are strong and consistent associations between TEG measures of clot formation and clot strength and conventional fibrinogen levels. There are weak and/or inconsistent associations between TEG and all other conventional measures of coagulation.
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Affiliation(s)
- Patryck Lloyd-Donald
- Department of Intensive Care, Austin Health, Heidelberg, Melbourne, Australia.,Department of Anaesthesia, Austin Health, Heidelberg, Melbourne, Australia
| | - Abhinav Vasudevan
- Department of Gastroenterology and Hepatology, Austin Health, Heidelberg, Melbourne, Australia
| | - Peter Angus
- Department of Gastroenterology and Hepatology, Austin Health, Heidelberg, Melbourne, Australia
| | - Paul Gow
- Department of Gastroenterology and Hepatology, Austin Health, Heidelberg, Melbourne, Australia
| | - Johan Mårtensson
- Department of Intensive Care, Austin Health, Heidelberg, Melbourne, Australia.,Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Karolinska Universitetssjukhuset, Solna, Sweden.,Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Neil Glassford
- Department of Intensive Care, Austin Health, Heidelberg, Melbourne, Australia.,Department of Intensive Care, Melbourne Health, Parkville, Melbourne, Australia.,Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | - Glenn M Eastwood
- Department of Intensive Care, Austin Health, Heidelberg, Melbourne, Australia
| | - Graeme K Hart
- Department of Intensive Care, Austin Health, Heidelberg, Melbourne, Australia
| | - Daryl Jones
- Department of Intensive Care, Austin Health, Heidelberg, Melbourne, Australia
| | - Laurence Weinberg
- Department of Anaesthesia, Austin Health, Heidelberg, Melbourne, Australia
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Health, Heidelberg, Melbourne, Australia.,Department of Intensive Care, The University of Melbourne, Austin Hospital, Melbourne, Australia
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Balintescu A, Palmgren I, Lipcsey M, Oldner A, Larsson A, Cronhjort M, Lind M, Wernerman J, Mårtensson J. Prevalence and impact of chronic dysglycemia in intensive care unit patients-A retrospective cohort study. Acta Anaesthesiol Scand 2021; 65:82-91. [PMID: 32888188 DOI: 10.1111/aas.13695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/19/2020] [Accepted: 08/20/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The prevalence of chronic dysglycemia (diabetes and prediabetes) in patients admitted to Swedish intensive care units (ICUs) is unknown. We aimed to determine the prevalence of such chronic dysglycemia and asses its impact on blood glucose control and patient-centered outcomes in critically ill patients. METHODS In this retrospective observational cohort study, we obtained glycated hemoglobin A1c (HbA1c) in patients admitted to four tertiary ICUs in Sweden between March and August 2016. Based on previous diabetes history and HbA1c we determined the prevalence of chronic dysglycemia. We used multivariable regression analyses to study the association of chronic dysglycemia with the time-weighted average blood glucose concentration, glycemic lability index (GLI), and development of hypoglycemia (co-primary outcomes), and with ICU length of stay, mechanical ventilation duration, renal replacement therapy (RRT) use, vasopressor use, ICU-acquired infections, and mortality (exploratory clinical outcomes). RESULTS Of 943 patients, 312 (33%) had chronic dysglycemia. Of these 312 patients, 84 (27%) had prediabetes, 43 (14%) had undiagnosed diabetes and 185 (59%) had known diabetes. Chronic dysglycemia was independently associated with higher time-weighted average blood glucose concentration (P < .001), higher GLI (P < .001), and hypoglycemia (P < .001). Chronic dysglycemia was independently associated with RRT use (adjusted odds ratio 1.97, 95% CI 1.24-3.13, P = .004) but not with other exploratory clinical outcomes. CONCLUSIONS In four tertiary Swedish ICUs, measurement of HbA1c showed that one-third of patients had chronic dysglycemia. Chronic dysglycemia was associated with marked derangements in glycemic control, and a greater need for renal replacement therapy.
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Affiliation(s)
- Anca Balintescu
- Section of Anaesthesia and Intensive Care Department of Clinical Science and Education Södersjukhuset Karolinska Institute Stockholm Sweden
| | - Ida Palmgren
- Section of Anaesthesia and Intensive Care Hudiksvall Hospital Hudiksvall Sweden
| | - Miklós Lipcsey
- Hedenstierna Laboratory Section of Anaesthesiology and Intensive Care Department of Surgical Sciences Uppsala University Uppsala Sweden
| | - Anders Oldner
- Department of Perioperative Medicine and Intensive Care Karolinska University Hospital Stockholm Sweden
- Section of Anaesthesia and Intensive Care Department of Physiology and Pharmacology Karolinska Institute Stockholm Sweden
| | - Anders Larsson
- Department of Medical Sciences Clinical Chemistry Uppsala University Uppsala Sweden
| | - Maria Cronhjort
- Section of Anaesthesia and Intensive Care Department of Clinical Science and Education Södersjukhuset Karolinska Institute Stockholm Sweden
| | - Marcus Lind
- Department of Medicine NU Hospital Group Uddevalla Sweden
- Department of Molecular and Clinical Medicine University of Gothenburg Gothenburg Sweden
| | - Jan Wernerman
- Division of Anaesthesia and Intensive Care Department of Clinical Science Intervention and Technology (CLINTEC) Karolinska Institute Stockholm Sweden
| | - Johan Mårtensson
- Department of Perioperative Medicine and Intensive Care Karolinska University Hospital Stockholm Sweden
- Section of Anaesthesia and Intensive Care Department of Physiology and Pharmacology Karolinska Institute Stockholm Sweden
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Larsson E, Brattström O, Agvald‐Öhman C, Grip J, Campoccia Jalde F, Strålin K, Nauclér P, Oldner A, Konrad D, Persson BP, Eriksson LI, Mårtensson J. Characteristics and outcomes of patients with COVID-19 admitted to ICU in a tertiary hospital in Stockholm, Sweden. Acta Anaesthesiol Scand 2021; 65:76-81. [PMID: 32892337 PMCID: PMC7756749 DOI: 10.1111/aas.13694] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/18/2020] [Accepted: 08/20/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Information on characteristics and outcomes of intensive care unit (ICU) patients with COVID-19 remains limited. We examined characteristics, clinical course and early outcomes of patients with COVID-19 admitted to ICU. METHODS We included all 260 patients with COVID-19 admitted to nine ICUs at the Karolinska University Hospital (Stockholm, Sweden) between 9 March and 20 April 2020. Primary outcome was in-hospital mortality among patients with definite outcomes (discharged from ICU or death), as of 30 April 2020 (study end point). Secondary outcomes included ICU length of stay, the proportion of patients receiving mechanical ventilation and renal replacement therapy, and hospital discharge destination. RESULTS Of 260 ICU patients with COVID-19, 208 (80.0%) were men, the median age was 59 (IQR 51-65) years, 154 (59.2%) had at least one comorbidity, and the median duration of symptoms preceding ICU admission was 11 (IQR 8-14) days. Sixty-two (23.8%) patients remained in ICU at study end point. Among the 198 patients with definite outcomes, ICU length of stay was 12 (IQR, 6-18) days, 163 (82.3%) received mechanical ventilation, 28 (14.1%) received renal replacement therapy, 60 (30.3%) died, 62 (31.3%) were discharged home, 47 (23.7%) were discharged to ward, and 29 (14.6%) were discharged to another health care facility. On multivariable logistic regression analysis, older age and admission from the emergency department was associated with higher mortality. CONCLUSION This study presents detailed data on clinical characteristics and early outcomes of consecutive patients with COVID-19 admitted to ICU in a large tertiary hospital in Sweden.
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Affiliation(s)
- Emma Larsson
- Department of Physiology and Pharmacology Karolinska Institutet Stockholm Sweden
- Department of Perioperative Medicine and Intensive Care Karolinska University Hospital Stockholm Sweden
| | - Olof Brattström
- Department of Physiology and Pharmacology Karolinska Institutet Stockholm Sweden
- Department of Perioperative Medicine and Intensive Care Karolinska University Hospital Stockholm Sweden
| | - Christina Agvald‐Öhman
- Department of Perioperative Medicine and Intensive Care Karolinska University Hospital Stockholm Sweden
- Department of Clinical Science Intervention and Technology (CLINTEC) Karolinska Institutet Stockholm Sweden
| | - Jonathan Grip
- Department of Perioperative Medicine and Intensive Care Karolinska University Hospital Stockholm Sweden
- Department of Clinical Science Intervention and Technology (CLINTEC) Karolinska Institutet Stockholm Sweden
| | - Francesca Campoccia Jalde
- Department of Physiology and Pharmacology Karolinska Institutet Stockholm Sweden
- Department of Perioperative Medicine and Intensive Care Karolinska University Hospital Stockholm Sweden
| | - Kristoffer Strålin
- Department of Infectious Diseases Karolinska University Hospital Stockholm Sweden
- Department of Medicine, Huddinge Karolinska Institutet Stockholm Sweden
| | - Pontus Nauclér
- Department of Infectious Diseases Karolinska University Hospital Stockholm Sweden
- Division of Infectious Diseases Department of Medicine, Solna Karolinska Institutet Stockholm Sweden
| | - Anders Oldner
- Department of Physiology and Pharmacology Karolinska Institutet Stockholm Sweden
- Department of Perioperative Medicine and Intensive Care Karolinska University Hospital Stockholm Sweden
| | - David Konrad
- Department of Physiology and Pharmacology Karolinska Institutet Stockholm Sweden
- Department of Perioperative Medicine and Intensive Care Karolinska University Hospital Stockholm Sweden
| | - Björn P. Persson
- Department of Physiology and Pharmacology Karolinska Institutet Stockholm Sweden
- Department of Perioperative Medicine and Intensive Care Karolinska University Hospital Stockholm Sweden
| | - Lars I. Eriksson
- Department of Physiology and Pharmacology Karolinska Institutet Stockholm Sweden
- Department of Perioperative Medicine and Intensive Care Karolinska University Hospital Stockholm Sweden
| | - Johan Mårtensson
- Department of Physiology and Pharmacology Karolinska Institutet Stockholm Sweden
- Department of Perioperative Medicine and Intensive Care Karolinska University Hospital Stockholm Sweden
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Albert C, Zapf A, Haase M, Röver C, Pickering JW, Albert A, Bellomo R, Breidthardt T, Camou F, Chen Z, Chocron S, Cruz D, de Geus HRH, Devarajan P, Di Somma S, Doi K, Endre ZH, Garcia-Alvarez M, Hjortrup PB, Hur M, Karaolanis G, Kavalci C, Kim H, Lentini P, Liebetrau C, Lipcsey M, Mårtensson J, Müller C, Nanas S, Nickolas TL, Pipili C, Ronco C, Rosa-Diez GJ, Ralib A, Soto K, Braun-Dullaeus RC, Heinz J, Haase-Fielitz A. Neutrophil Gelatinase-Associated Lipocalin Measured on Clinical Laboratory Platforms for the Prediction of Acute Kidney Injury and the Associated Need for Dialysis Therapy: A Systematic Review and Meta-analysis. Am J Kidney Dis 2020; 76:826-841.e1. [PMID: 32679151 PMCID: PMC8283708 DOI: 10.1053/j.ajkd.2020.05.015] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 05/24/2020] [Indexed: 01/02/2023]
Abstract
RATIONALE & OBJECTIVE The usefulness of measures of neutrophil gelatinase-associated lipocalin (NGAL) in urine or plasma obtained on clinical laboratory platforms for predicting acute kidney injury (AKI) and AKI requiring dialysis (AKI-D) has not been fully evaluated. We sought to quantitatively summarize published data to evaluate the value of urinary and plasma NGAL for kidney risk prediction. STUDY DESIGN Literature-based meta-analysis and individual-study-data meta-analysis of diagnostic studies following PRISMA-IPD guidelines. SETTING & STUDY POPULATIONS Studies of adults investigating AKI, severe AKI, and AKI-D in the setting of cardiac surgery, intensive care, or emergency department care using either urinary or plasma NGAL measured on clinical laboratory platforms. SELECTION CRITERIA FOR STUDIES PubMed, Web of Science, Cochrane Library, Scopus, and congress abstracts ever published through February 2020 reporting diagnostic test studies of NGAL measured on clinical laboratory platforms to predict AKI. DATA EXTRACTION Individual-study-data meta-analysis was accomplished by giving authors data specifications tailored to their studies and requesting standardized patient-level data analysis. ANALYTICAL APPROACH Individual-study-data meta-analysis used a bivariate time-to-event model for interval-censored data from which discriminative ability (AUC) was characterized. NGAL cutoff concentrations at 95% sensitivity, 95% specificity, and optimal sensitivity and specificity were also estimated. Models incorporated as confounders the clinical setting and use versus nonuse of urine output as a criterion for AKI. A literature-based meta-analysis was also performed for all published studies including those for which the authors were unable to provide individual-study data analyses. RESULTS We included 52 observational studies involving 13,040 patients. We analyzed 30 data sets for the individual-study-data meta-analysis. For AKI, severe AKI, and AKI-D, numbers of events were 837, 304, and 103 for analyses of urinary NGAL, respectively; these values were 705, 271, and 178 for analyses of plasma NGAL. Discriminative performance was similar in both meta-analyses. Individual-study-data meta-analysis AUCs for urinary NGAL were 0.75 (95% CI, 0.73-0.76) and 0.80 (95% CI, 0.79-0.81) for severe AKI and AKI-D, respectively; for plasma NGAL, the corresponding AUCs were 0.80 (95% CI, 0.79-0.81) and 0.86 (95% CI, 0.84-0.86). Cutoff concentrations at 95% specificity for urinary NGAL were>580ng/mL with 27% sensitivity for severe AKI and>589ng/mL with 24% sensitivity for AKI-D. Corresponding cutoffs for plasma NGAL were>364ng/mL with 44% sensitivity and>546ng/mL with 26% sensitivity, respectively. LIMITATIONS Practice variability in initiation of dialysis. Imperfect harmonization of data across studies. CONCLUSIONS Urinary and plasma NGAL concentrations may identify patients at high risk for AKI in clinical research and practice. The cutoff concentrations reported in this study require prospective evaluation.
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Affiliation(s)
- Christian Albert
- University Clinic for Cardiology and Angiology, Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany; Diaverum Renal Services Germany, Potsdam, Germany.
| | - Antonia Zapf
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg-Eppendorf, Germany
| | - Michael Haase
- Faculty of Medicine, Otto-von-Guericke University, Magdeburg, Germany; Diaverum Renal Services Germany, Potsdam, Germany
| | - Christian Röver
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - John W Pickering
- Department of Medicine, University of Otago Christchurch; Emergency Department, Christchurch Hospital, Christchurch, New Zealand
| | - Annemarie Albert
- Diaverum Renal Services Germany, Potsdam, Germany; Department for Nephrology and Endocrinology, Klinikum Ernst von Bergmann, Potsdam, Germany
| | - Rinaldo Bellomo
- Department of Intensive Care, The Austin Hospital, Melbourne, Australia; Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Australia
| | - Tobias Breidthardt
- Department of Internal Medicine, University Hospital Basel, Basel, Switzerland; Department of Nephrology, University Hospital Basel, Basel, Switzerland; Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Fabrice Camou
- Service de réanimation médicale, hôpital Saint-André, CHU de Bordeaux, France
| | - Zhongquing Chen
- Department of Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangdong, China
| | - Sidney Chocron
- Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France
| | - Dinna Cruz
- Division of Nephrology-Hypertension, University of California, San Diego, CA
| | - Hilde R H de Geus
- Department of Intensive Care, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Prasad Devarajan
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital, University of Cincinnati, Cincinnati, OH
| | - Salvatore Di Somma
- Emergency Medicine, Department of Medical-Surgery Sciences and Translational Medicine, Sapienza' University of Rome S. Andrea Hospital, Rome, Italy
| | - Kent Doi
- Department of Emergency and Critical Care Medicine, The University of Tokyo, Tokyo, Japan
| | - Zoltan H Endre
- Department of Nephrology, Prince of Wales Hospital and Clinical School, University of New South Wales, Sydney, Australia
| | | | - Peter B Hjortrup
- Department of Intensive Care, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mina Hur
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Georgios Karaolanis
- Vascular Unit, First Department of Surgery, "Laiko" General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Cemil Kavalci
- Emergency Department, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Hanah Kim
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Paolo Lentini
- Department of Nephrology and Dialysis, San Bassiano Hospital, Bassano del Grappa, Italy
| | | | - Miklós Lipcsey
- CIRRUS, Hedenstierna laboratory, Anaesthesiology and Intensive care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Johan Mårtensson
- Section of Anaesthesia and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Christian Müller
- Department of Internal Medicine, University Hospital Basel, Basel, Switzerland; Department of Nephrology, University Hospital Basel, Basel, Switzerland; Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Serafim Nanas
- First Critical Care Department, 'Evangelismos' General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Thomas L Nickolas
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Chrysoula Pipili
- First Critical Care Department, 'Evangelismos' General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Claudio Ronco
- Department of Nephrology, Dialysis & Transplantation, University of Padova, Vicenza, Italy; International Renal Research Institute, San Bortolo Hospital, Vicenza, Italy
| | - Guillermo J Rosa-Diez
- Department of Nephrology, Dialysis and Transplantation, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Azrina Ralib
- Department of Anaesthesiology and Intensive Care, International Islamic University Malaysia, Pahang, Malaysia
| | - Karina Soto
- Department of Nephrology, Hospital Fernando Fonseca, Lisbon, Portugal; CEAUL, Centro de Estatística e Aplicações da Universidade de Lisboa, Lisbon, Portugal
| | - Rüdiger C Braun-Dullaeus
- University Clinic for Cardiology and Angiology, Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany
| | - Judith Heinz
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Anja Haase-Fielitz
- Department of Cardiology, Immanuel Diakonie Bernau, Heart Center Brandenburg, Brandenburg Medical School Theodor Fontane, Faculty of Health Sciences, University of Potsdam, Potsdam, Germany
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Tseitkin B, Mårtensson J, Eastwood GM, Brown A, Ancona P, Lucchetta L, Iwashyna TJ, Robbins R, Bellomo R. Nature and impact of in-hospital complications associated with persistent critical illness. CRIT CARE RESUSC 2020; 22:378-387. [PMID: 38046870 PMCID: PMC10692497 DOI: 10.51893/2020.4.oa11] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Persistent critical illness (PerCI) is defined as an intensive care unit (ICU) admission lasting ≥ 10 days. The in-hospital complications associated with its development are poorly understood. Aims: To test whether PerCI is associated with a greater prevalence, rate and specific types of in-hospital complications. Methods: Single-centre, retrospective, observational case-control study. Results: We studied 1200 patients admitted to a tertiary ICU from 2010 to 2015. Median ICU length of stay was 16 days (interquartile range [IQR], 12-23) for PerCI patients v 2.3 days (IQR, 1.1-3.7) for controls, and median hospital length of stay was 41 days (IQR, 22-75) v 8 days (IQR, 4-17) respectively. A greater proportion of PerCI patients received acute renal replacement therapy (37% v 6.8%) or underwent reintubation (17% v 1%) and/or tracheostomy (36% v 0.6%); P < 0.0001. Despite these complications, PerCI patients had similar hospital mortality (29% v 27%; P = 0.53). PerCI patients experienced a greater absolute number of complications (12.1 v 4.0 complications per patient; P < 0.0001) but had fewer exposure-adjusted complications (202 v 272 complications per 1000 hospital bed-days; P < 0.001) and a particularly high overall prevalence of specific complications. Conclusions: PerCI patients experience a higher prevalence, but not a higher rate, of exposure-adjusted complications. Some of these complications appear amenable to prevention, helping to define intervention targets in patients at risk of PerCI. Funding: Austin Hospital Intensive Care Trust Fund.
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Affiliation(s)
- Boris Tseitkin
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
| | - Johan Mårtensson
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Glenn M. Eastwood
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Society Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Alastair Brown
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
| | - Paolo Ancona
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
- Department of Intensive Care Medicine, Catholic University of the Sacred Heart, “A. Gemelli” University Hospital, Rome, Italy
| | - Luca Lucchetta
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Theodore J. Iwashyna
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Raymond Robbins
- Department of Administrative Informatics, Austin Hospital, Melbourne, VIC, Australia
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Society Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- School of Medicine, University of Melbourne, Melbourne, VIC, Australia
- Data Analytics Research and Evaluation (DARE) Centre, Austin Hospital and University of Melbourne, Melbourne, VIC, Australia
- Department of Intensive Care, Royal Melbourne Hospital, VIC, Australia
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Mårtensson J, Engerström L, Walther S, Grip J, Berggren RK, Larsson E. COVID-19 critical illness in Sweden: characteristics and outcomes at a national population level. CRIT CARE RESUSC 2020; 22:312-320. [PMID: 38046874 PMCID: PMC10692548 DOI: 10.51893/2020.4.oa3] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: During the coronavirus disease 2019 (COVID-19) pandemic, baseline demographics and comorbidities of patients with COVID-19 have been presented, but there are limited data on outcomes of severely ill patients. We aimed to examine the association between patient characteristics and 30-day mortality among patients with COVID-19 treated in the intensive care unit (ICU). Design: Population-based cohort study. Setting: ICUs in Sweden. Participants: All consecutive patients with COVID-19 admitted to Swedish ICUs from 6 March to 5 April 2020. Main outcome measures: The primary outcome was 30-day mortality after ICU admission. Patient demographics, comorbidities and clinical characteristics were also retrieved. Results: A total of 604 patients were included. The median age was 61 years (interquartile range [IQR], 52-70 years) and 458 patients (76%) were males. The most common comorbidities were hypertension (35.9%) and diabetes (25.7%), whereas 36.4% of patients had no comorbidities. Median Simplified Acute Physiology Score (SAPS) 3 was 53 (IQR, 46-60). Of 573 patients with available respiratory support data, 487 (85.0%) received invasive mechanical ventilation. Among 518 patients with available data, 117 (22.6%) received renal replacement therapy. Median length of stay was 13 days (IQR, 6-20 days). Mortality at 30 days was 32.6%. In the multivariable Cox regression model, age (hazard ratio [HR] 1.06; 95% CI, 1.04-1.07 per year), the presence of one or more comorbidities (HR, 1.80; 95% CI, 1.20-2.68), chronic obstructive pulmonary disease or asthma (HR, 1.68; 95% CI, 1.12-2.50), hypertension (HR, 1.41; 95% CI, 1.01-1.99), and acute illness severity (SAPS 3 excluding age and comorbidity) (HR, 1.06; 95% CI, 1.04-1.09) were associated with 30-day mortality. Conclusions: This population-based cohort study presents 30-day mortality of 604 ICU patients with COVID-19. The higher mortality was explained by older age, the presence chronic illness, and acute illness severity.
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Affiliation(s)
- Johan Mårtensson
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Lars Engerström
- Department of Cardiothoracic Surgery, Anesthesia and Intensive Care; Linköping University Hospital, Linköping, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- The Swedish Intensive Care Registry, Karlstad, Sweden
| | - Sten Walther
- Department of Cardiothoracic Surgery, Anesthesia and Intensive Care; Linköping University Hospital, Linköping, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- The Swedish Intensive Care Registry, Karlstad, Sweden
| | - Jonathan Grip
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Ritva Kiiski Berggren
- The Swedish Intensive Care Registry, Karlstad, Sweden
- Department of Anesthesia, Intensive Care and Perioperative Services, Umeå University Hospital, Umeå, Sweden
| | - Emma Larsson
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- The Swedish Intensive Care Registry, Karlstad, Sweden
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Madsen SS, Møller K, Olsen KS, Vestergaard MB, Lindberg U, Larsson HBW, Mårtensson J, Werner MU, Santos SAG, Asghar MS. Neuroplasticity induced by general anaesthesia: study protocol for a randomised cross-over clinical trial exploring the effects of sevoflurane and propofol on the brain - A 3-T magnetic resonance imaging study of healthy volunteers. Trials 2020; 21:805. [PMID: 32962743 PMCID: PMC7506820 DOI: 10.1186/s13063-020-04468-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 05/30/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Although used extensively worldwide, the effects of general anaesthesia on the human brain remain largely elusive. Moreover, general anaesthesia may contribute to serious conditions or adverse events such as postoperative cognitive dysfunction and delirium. To understand the basic mechanisms of general anaesthesia, this project aims to study and compare possible de novo neuroplastic changes induced by two commonly used types of general anaesthesia, i.e. inhalation anaesthesia by sevoflurane and intravenously administered anaesthesia by propofol. In addition, we wish to to explore possible associations between neuroplastic changes, neuropsychological adverse effects and subjective changes in fatigue and well-being. METHODS This is a randomised, participant- and assessor-blinded, cross-over clinical trial. Thirty healthy volunteers (male:female ratio 1:1) will be randomised to general anaesthesia by either sevoflurane or propofol. Multimodal magnetic resonance imaging (MRI) of the brain will be performed before and after general anaesthesia and repeated after 1 and 8 days. Each magnetic resonance imaging session will be accompanied by cognitive testing and questionnaires on fatigue and well-being. After a wash-out period of 4 weeks, the volunteers will receive the other type of anaesthetic (sevoflurane or propofol), followed by the same series of tests. Primary outcomes: changes in T1-weighted 3D anatomy and diffusion tensor imaging. SECONDARY OUTCOMES changes in resting-state functional magnetic resonance imaging, fatigue, well-being, cognitive function, correlations between magnetic resonance imaging findings and the clinical outcomes (questionnaires and cognitive function). Exploratory outcomes: changes in cerebral perfusion and oxygen metabolism, lactate, and response to visual stimuli. DISCUSSION To the best of our knowledge, this is the most extensive and advanced series of studies with head-to-head comparison of two widely used methods for general anaesthesia. Recruitment was initiated in September 2019. TRIAL REGISTRATION Approved by the Research Ethics Committee in the Capital Region of Denmark, ref. H-18028925 (6 September 2018). EudraCT and Danish Medicines Agency: 2018-001252-35 (23 March 2018). www.clinicaltrials.gov , ID: NCT04125121 . Retrospectively registered on 10 October 2019.
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Affiliation(s)
- Signe Sloth Madsen
- Department of Neuroanaesthesiology, The Neuroscience Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Neuroanaesthesiology, Rigshospitalet Glostrup, University of Copenhagen, Valdemar Hansens Vej 15, 2600 Glostrup, Denmark
| | - Kirsten Møller
- Department of Neuroanaesthesiology, The Neuroscience Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Karsten Skovgaard Olsen
- Department of Neuroanaesthesiology, The Neuroscience Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Mark Bitsch Vestergaard
- Functional Imaging Unit, Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Valdemar Hansens Vej 1-23, entrance 5, 2600 Glostrup, Denmark
| | - Ulrich Lindberg
- Functional Imaging Unit, Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Valdemar Hansens Vej 1-23, entrance 5, 2600 Glostrup, Denmark
| | - Henrik Bo Wiberg Larsson
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Functional Imaging Unit, Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Valdemar Hansens Vej 1-23, entrance 5, 2600 Glostrup, Denmark
| | - Johan Mårtensson
- Faculty of Medicine, Department of Clinical Sciences Lund, Logopedics, Phoniatrics and Audiology, Lund University, 22100 Lund, Sweden
| | - Mads U. Werner
- Multidisciplinary Pain Center, The Neuroscience Center, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Sofia Alexandra Gaspar Santos
- Department of Neuroanaesthesiology, The Neuroscience Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Mohammad Sohail Asghar
- Department of Neuroanaesthesiology, The Neuroscience Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
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Vaara ST, Glassford N, Eastwood GM, Canet E, Mårtensson J, Bellomo R. Point-of-care creatinine measurements to predict acute kidney injury. Acta Anaesthesiol Scand 2020; 64:766-773. [PMID: 32057092 DOI: 10.1111/aas.13564] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/22/2020] [Accepted: 02/10/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Plasma creatinine (Cr) is a marker of kidney function and typically measured once daily. We hypothesized that Cr measured by point-of-care technology early after ICU admission would be a good predictor of acute kidney injury (AKI) the next day in critically ill patients. METHODS We conducted a retrospective database audit in a single tertiary ICU database. We included patients with normal first admission Cr (CrF ) and identified a Cr value (CrP ) obtained within 6-12 hours from ICU admission. We used their difference converted into percentage (delta-Cr-%) to predict subsequent AKI (based on Cr and/or need for renal replacement therapy) the next day. We assessed predictive value by calculating area under the receiver characteristic curve (AUC), logistic regression models for AKI with and without delta-Cr-%, and the category-free net reclassifying index (cfNRI). RESULTS We studied 780 patients. Overall, 70 (9.0%) fulfilled the Cr AKI definition by CrP measurement. On day 2, 148 patients (19.0%) were diagnosed with AKI. AUC (95% CI) for delta-Cr-% to predict AKI on day 2 was 0.82 (95% CI 0.78-0.86), and 0.74 (95% CI 0.69-0.80) when patients with AKI based on the CrP were excluded. Using a cut-off of 17% increment, the positive likelihood ratio (95% CI) for delta-Cr-% to predict AKI was 3.5 (2.9-4.2). The cfNRI was 90.0 (74.9-106.1). CONCLUSIONS Among patients admitted with normal Cr, early changes in Cr help predict AKI the following day.
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Affiliation(s)
- Suvi T. Vaara
- Division of Intensive Care Medicine Department of Anesthesiology, Intensive Care and Pain Medicine University of Helsinki and Helsinki University Hospital Helsinki Finland
- Department of Intensive Care Austin Hospital Austin Health Melbourne Vic Australia
| | - Neil Glassford
- Department of Intensive Care Austin Hospital Austin Health Melbourne Vic Australia
- Intensive Care Unit Royal Melbourne Hospital Melbourne Health Melbourne Vic Australia
- Department of Epidemiology and Preventative Medicine School of Public Health and Preventative Medicine Monash University Melbourne Vic Australia
- Centre for Integrated Critical Care Department of Medicine & Radiology Melbourne Medical School The University of Melbourne Melbourne Vic Australia
| | - Glenn M. Eastwood
- Department of Intensive Care Austin Hospital Austin Health Melbourne Vic Australia
| | - Emmanuel Canet
- Department of Intensive Care Austin Hospital Austin Health Melbourne Vic Australia
- Intensive Care Unit Nantes University Hospital University of Nantes Nantes France
| | - Johan Mårtensson
- Department of Physiology and Pharmacology Karolinska Institutet Stockholm Sweden
| | - Rinaldo Bellomo
- Department of Intensive Care Austin Hospital Austin Health Melbourne Vic Australia
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49
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Bengtsson J, Bodén R, Olsson EMG, Mårtensson J, Gingnell M, Persson J. Autonomic modulation networks in schizophrenia: The relationship between heart rate variability and functional and structural connectivity in the brain. Psychiatry Res Neuroimaging 2020; 300:111079. [PMID: 32283474 DOI: 10.1016/j.pscychresns.2020.111079] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 03/17/2020] [Accepted: 03/19/2020] [Indexed: 12/30/2022]
Abstract
Heart rate variability (HRV), a measurement of autonomic nervous system (ANS) activity, has been found reduced in schizophrenia. The anterior cingulate cortex (ACC), which is important in regulating the ANS, is structurally and functionally affected in schizophrenia. We investigate the relationship between HRV and functional and structural connectivity of the ACC in patients with schizophrenia and healthy controls. Ten patients with a diagnosis of schizophrenia and ten healthy controls were recruited. Heart rate was monitored in a naturalistic out-of-clinic setting. Magnetic resonance imaging (MRI) was performed, including resting-state functional MRI and diffusion tensor imaging. Patients with schizophrenia had significantly lower HRV compared to controls. A positive correlation between ACC connectivity with the bilateral cerebellum and HRV was found in the patients. HRV was also positively correlated with amplitude of low frequency fluctuations (ALFF) in the cerebellum, and with axial diffusivity in the middle cerebellar peduncle, in the patients. There was a significant negative relationship between antipsychotic medication dosage, HRV and all neuroimaging measures related to HRV. We conclude that ACC connectivity seems to be affected in schizophrenia, both structurally and functionally, and that the ACC-cerebellum connectivity, as well as cerebellar function, is associated with ANS regulation in patients with schizophrenia.
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Affiliation(s)
- J Bengtsson
- Dept. of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden.
| | - R Bodén
- Dept. of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - E M G Olsson
- Dept. of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - J Mårtensson
- Dept. of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden; Dept. of Medical Physics, Uppsala University Hospital, Uppsala, Sweden
| | - M Gingnell
- Dept. of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - J Persson
- Dept. of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
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Poole AP, Finnis ME, Anstey J, Bellomo R, Bihari S, Biradar V, Doherty S, Eastwood G, Finfer S, French CJ, Ghosh A, Heller S, Horowitz M, Kar P, Kruger PS, Maiden MJ, Mårtensson J, McArthur CJ, McGuinness SP, Secombe PJ, Tobin AE, Udy AA, Young PJ, Deane AM. Study protocol and statistical analysis plan for the Liberal Glucose Control in Critically Ill Patients with Pre-existing Type 2 Diabetes (LUCID) trial. CRIT CARE RESUSC 2020; 22:133-141. [PMID: 32389105 PMCID: PMC10692470] [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: 02/07/2023]
Abstract
BACKGROUND Contemporary glucose management of intensive care unit (ICU) patients with type 2 diabetes is based on trial data derived predominantly from patients without type 2 diabetes. This is despite the recognition that patients with type 2 diabetes may be relatively more tolerant of hyperglycaemia and more susceptible to hypoglycaemia. It is uncertain whether glucose targets should be more liberal in patients with type 2 diabetes. OBJECTIVE To detail the protocol, analysis and reporting plans for a randomised clinical trial - the Liberal Glucose Control in Critically Ill Patients with Pre-existing Type 2 Diabetes (LUCID) trial - which will evaluate the risks and benefits of targeting a higher blood glucose range in patients with type 2 diabetes. DESIGN, SETTING, PARTICIPANTS AND INTERVENTION A multicentre, parallel group, open label phase 2B randomised controlled clinical trial of 450 critically ill patients with type 2 diabetes. Patients will be randomised 1:1 to liberal blood glucose (target 10.0-14.0 mmol/L) or usual care (target 6.0-10.0 mmol/L). MAIN OUTCOME MEASURES The primary endpoint is incident hypoglycaemia (< 4.0 mmol/L) during the study intervention. Secondary endpoints include biochemical and feasibility outcomes. RESULTS AND CONCLUSION The study protocol and statistical analysis plan described will delineate conduct and analysis of the trial, such that analytical and reporting bias are minimised. TRIAL REGISTRATION This trial has been registered on the Australian New Zealand Clinical Trials Registry (ACTRN No. 12616001135404) and has been endorsed by the Australian and New Zealand Intensive Care Society Clinical Trials Group.
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Affiliation(s)
- Alexis P Poole
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia.
| | - Mark E Finnis
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia
| | - James Anstey
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
| | - Shailesh Bihari
- Department of Intensive and Critical Care Unit, Flinders Medical Centre, Adelaide, SA, Australia
| | - Vishwanath Biradar
- Department of Intensive Care, Lyell McEwin Hospital, Adelaide, SA, Australia
| | - Sarah Doherty
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Glenn Eastwood
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
| | - Simon Finfer
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Craig J French
- Department of Intensive Care, Western Health, Melbourne, VIC, Australia
| | - Angaj Ghosh
- Intensive Care Unit, Northern Health, Melbourne, VIC, Australia
| | - Simon Heller
- Clinical Diabetes, Endocrinology and Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Michael Horowitz
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Palash Kar
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Peter S Kruger
- Department of Intensive Care, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Matthew J Maiden
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Johan Mårtensson
- Section of Anaesthesia and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Solna, Sweden
| | - Colin J McArthur
- Department of Critical Care Medicine, Auckland District Health Board, Auckland, New Zealand
| | - Shay P McGuinness
- Cardiothoracic and Vascular Intensive Care and High Dependency Unit, Auckland District Health Board, Auckland, New Zealand
| | - Paul J Secombe
- Department of Intensive Care, Alice Springs Hospital, Alice Springs, NT, Australia
| | - Antony E Tobin
- Department of Intensive Care, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Andrew A Udy
- Department of Intensive Care, The Alfred Hospital, Melbourne, VIC, Australia
| | - Paul J Young
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Adam M Deane
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia.
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