1
|
Kugler S, Pólos M, Király Á, Pataki Á, Koppányi Á, Varga T, Szakál-Tóth Z, Parázs N, Teszák T, Tarjányi Z, Prinz G, Hartyánszky I, Szabolcs Z, Merkely B, Sax B. Pseudoaneurysm of the ascending aorta: case report of a donor-derived Pseudomonas infection in a heart transplant recipient. BMC Infect Dis 2021; 21:847. [PMID: 34418979 PMCID: PMC8379603 DOI: 10.1186/s12879-021-06557-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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/10/2021] [Indexed: 01/16/2023] Open
Abstract
Background Mycotic aortic pseudoaneurysm is a rare complication after heart transplantation (HTX) with remarkable mortality. Intrathoracic infection is a well-documented predisposing factor for this disease. Staphylococcus aureus, Pseudomonas aeruginosa or Candida species are commonly isolated from resected specimens of the pseudoaneurysms. We demonstrate a unique case of mycotic pseudoaneurysm caused by presumably donor-derived Pseudomonas infection in a heart transplant recipient. Case presentation Our 67-year-old male patient treated with diabetes mellitus underwent HTX. The donor suffered from epiglottic abscess and pneumonia with known microorganisms including Pseudomonas, therefore both the donor and recipient received targeted antimicrobial therapy and prophylaxis. Five months after the uneventful HTX, lab test of the asymptomatic patient showed moderate, increasing C-reactive protein level without obviuos source of infection. Chest computed tomography showed a large (90 mm) saccular dilatation of the tubular portion of ascending aorta. Urgent surgical intervention identified a pseudoaneurysm, histological examinations and cultures of the resected aorta verified Pseudomonas aeruginosa aortitis, while all blood cultures remained negative. Retrospective interrogation of other transplanted organs of the donor supported donor-derived infection as the transport fluid of the right kidney grew Pseudomonas. The patient received 3 weeks of ceftazidime followed by 7 months of oral ciprofloxacin therapy. One year after the operation the patient was asymptomatic with normal inflammatory markers. Conclusions Donor-derived infection is a rare but potential cause of aortitis. Early diagnosis, surgical intervention and adjuvant antibiotic therapy seem to be the keys to successful management of mycotic pseudoaneurysms after HTX.
Collapse
Affiliation(s)
- Szilvia Kugler
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary.
| | - Miklós Pólos
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - Ákos Király
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - Ákos Pataki
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - Ádám Koppányi
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - Tamás Varga
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - Zsófia Szakál-Tóth
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - Nóra Parázs
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - Tímea Teszák
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - Zoltán Tarjányi
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - Gyula Prinz
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - István Hartyánszky
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - Zoltán Szabolcs
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - Balázs Sax
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| |
Collapse
|
2
|
Kovács E, Gyarmathy VA, Pilecky D, Fekete-Győr A, Szakál-Tóth Z, Gellér L, Hauser B, Gál J, Merkely B, Zima E. An Interaction Effect Analysis of Thermodilution-Guided Hemodynamic Optimization, Patient Condition, and Mortality after Successful Cardiopulmonary Resuscitation. Int J Environ Res Public Health 2021; 18:ijerph18105223. [PMID: 34068997 PMCID: PMC8156244 DOI: 10.3390/ijerph18105223] [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] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/19/2021] [Accepted: 05/08/2021] [Indexed: 01/03/2023]
Abstract
Proper hemodynamic management is necessary among post-cardiac arrest patients to improve survival. We aimed to investigate the effects of PiCCO™-guided (pulse index contour cardiac output) hemodynamic management on mortality in post-resuscitation therapy. In this longitudinal analysis of 63 comatose patients after successful cardiopulmonary resuscitation cooled to 32–34 °C, 33 patients received PiCCO™, and 30 were not monitored with PiCCO™. Primary and secondary outcomes were 30 day and 1 year mortality. Kaplan–Meier curves and log-rank tests were used to assess differences in mortality among the groups. Interaction effects to disentangle the relationship between patient’s condition, PiCCO™ application, and mortality were assessed by means of Chi-square tests and logistic regression models. A 30 day mortality was significantly higher among PiCCO™ patients, while 1 year mortality was marginally higher. More severe patient condition per se was not the cause of higher mortality rate in the PiCCO™ group. Patients in better health conditions (without ST-elevation myocardial infarction, without cardiogenic shock, without intra-aortic balloon pump device, or without stroke in prior history) had worse outcomes with PiCCO™-guided therapy. Catecholamine administration worsened both 30 day and 1 year mortality among all patients. Our analysis showed that there was a complex interaction relationship between PiCCO™-guided therapy, patients’ condition, and 30 day mortality for most conditions.
Collapse
Affiliation(s)
- Enikő Kovács
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, H-1428 Budapest, Hungary; (B.H.); (J.G.)
- Correspondence:
| | - Valéria Anna Gyarmathy
- Medical Department, EpiConsult Biomedical Consulting and Medical Communication Agency, Dover, DE 19901, USA;
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Dávid Pilecky
- Department of Internal Medicine III, Klinikum Passau, 94032 Passau, Germany;
| | | | - Zsófia Szakál-Tóth
- Heart and Vascular Center, Semmelweis University, H-1428 Budapest, Hungary; (Z.S.-T.); (L.G.); (B.M.); (E.Z.)
| | - László Gellér
- Heart and Vascular Center, Semmelweis University, H-1428 Budapest, Hungary; (Z.S.-T.); (L.G.); (B.M.); (E.Z.)
| | - Balázs Hauser
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, H-1428 Budapest, Hungary; (B.H.); (J.G.)
| | - János Gál
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, H-1428 Budapest, Hungary; (B.H.); (J.G.)
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, H-1428 Budapest, Hungary; (Z.S.-T.); (L.G.); (B.M.); (E.Z.)
| | - Endre Zima
- Heart and Vascular Center, Semmelweis University, H-1428 Budapest, Hungary; (Z.S.-T.); (L.G.); (B.M.); (E.Z.)
| |
Collapse
|
3
|
Kugler S, Pólos M, Király Á, Koppányi Á, Varga T, Szakál-Tóth Z, Parázs N, Teszák T, Tarjányi Z, Prinz G, Hartyánszky I, Szabolcs Z, Merkely B, Sax B. Mycotic Pseudoaneurysm of the Ascending Aorta after Heart Transplantation. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
4
|
Kiss B, Fekete-Győr A, Szakál-Tóth Z, Párkányi A, Jenei Z, Nyéki P, Becker D, Molnár L, Ruzsa Z, Dér G, Kovács E, Pilecky D, Gellér L, Veli-Pekka H, Merkely B, Zima E. Pilot analysis of the usefulness of mortality risk score systems at resuscitated patients. Orv Hetil 2021; 162:52-60. [PMID: 33423023 DOI: 10.1556/650.2021.31949] [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: 06/01/2020] [Accepted: 07/24/2020] [Indexed: 11/19/2022]
Abstract
Összefoglaló. Bevezetés: A cardiovascularis halálokok közül világszerte nagy jelentőségű a hirtelen szívhalál. Annak ellenére, hogy a cardiopulmonalis resuscitatio és a postresuscitatiós intenzív osztályos kezelés is komoly metodikai és technikai fejlődésen ment keresztül az elmúlt időszakban, kevés az olyan validált pontrendszer, amely jól becsülné a beteg intenzív osztályra kerülésekor a mortalitási rizikót. Célkitűzés: A sikeres újraélesztést követő intenzív osztályos kezelés kezdetekor felmért, a cardiogen shock rizikóstratifikációjára alkalmazott CardShock Risk Score (CSRS) és az általunk hozzáadott, specifikus súlyozófaktorokkal (iniciális ritmus, inotropigény) módosított CardShock Risk Score (mCSRS) összevetése a mortalitás előrejelzésében post-cardiac arrest szindrómás betegeknél. Módszerek: Retrospektív vizsgálatunk során 172, kórházon kívül sikeresen újraélesztett és klinikánkon ellátott consecutiv betegből a CSRS- és mCSRS-pontrendszerek segítségével végül 123 beteg adatait elemeztük. A CSRS- és mCSRS-változók és a korai/késői mortalitás közötti összefüggést Cox-regressziós analízissel vizsgáltuk. A pontszámok alapján 3 csoportba (1-3, 4-6, 7+) soroltuk a betegeket. Az összevont csoportok túlélését log-rank teszttel hasonlítottuk össze. Eredmények: A betegpopuláció átlagéletkora 63,6 év volt (69% férfi), és a hirtelen szívhalál hátterében 80%-ban akut coronaria szindróma állt. A korai/késői mortalitást leginkább a felvétel utáni neurológiai állapot, a szérumlaktátszint, a vesefunkció, az iniciális ritmus és a beteg katecholaminigénye határozta meg. A mCSRS alkalmazását követően mind az "1-3" és a "4-6" (p≤0,001), mind a "4-6" és a "7+" (p = 0,006) csoportok között szignifikáns különbséget találtunk a túlélésben. Következtetés: A felvételkori pontok alapján a mCSRS pontosabban definiálja és differenciálja egymástól az általunk beválasztott két extra súlyozófaktorral az enyhe, a közepes és a magas mortalitási rizikóval bíró betegpopulációkat, mint a CSRS. Orv Hetil. 2021; 162(2): 52-60. SUMMARY INTRODUCTION Sudden cardiac death is one of the most significant cardiovascular causes of death worldwide. Although there have been immense methodological and technical advances in the field of cardiopulmonary resuscitation and following intensive care in the last decade, currently there are only a few validated risk-stratification scoring systems for the quick and reliable estimation of the mortality risk of these patients at the time of admission to the intensive care unit. OBJECTIVE Our aim was to correlate the mortality prediction risk points calculated by CardShock Risk Score (CSRS) and modified (m) CSRS based on the admission data of the post-cardiac arrest syndrome (PCAS) patients. METHODS The medical records of 172 out-of-hospital resuscitated cardiac arrest patients, who were admitted at the Heart and Vascular Centre of Semmelweis University, were screened retrospectively. Out of the 172 selected patients, 123 were eligible for inclusion to calculate CSRS and mCSRS. Based on CSRS score, we generated three different groups of patients, with scores 1 to 3, 4 to 6, and 7+, respectively. Mortality data of the groups were compared by log-rank test. RESULTS Mean age of the patients was 63.6 years (69% male), the cause of sudden cardiac death was acut coronary syndrome in 80% of the cases. The early and late mortality was predicted by neurological status, serum lactate level, renal function, initial rhythm, and the need of catecholamines. Using mCSRS, a significant survival difference was proven in between the groups "1-3" vs "4-6" (p≤0.001), "4-6" vs "7+" (p = 0.006). CONCLUSION Compared to the CSRS, the mCSRS expanded with the 2 additional weighting points differentiates more specifically the low-moderate and high survival groups in the PCAS patient population treated in our institute. Orv Hetil. 2021; 162(2): 52-60.
Collapse
Affiliation(s)
- Boldizsár Kiss
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Városmajori Szív- és Érgyógyászati Klinika, Budapest, Városmajor u. 68., 1122
| | | | - Zsófia Szakál-Tóth
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Városmajori Szív- és Érgyógyászati Klinika, Budapest, Városmajor u. 68., 1122
| | - Anna Párkányi
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Városmajori Szív- és Érgyógyászati Klinika, Budapest, Városmajor u. 68., 1122
| | - Zsigmond Jenei
- 3 Semmelweis Egyetem, Általános Orvostudományi Kar, Belgyógyászati és Hematológiai Klinika, Budapest
| | - Péter Nyéki
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Városmajori Szív- és Érgyógyászati Klinika, Budapest, Városmajor u. 68., 1122
| | - Dávid Becker
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Városmajori Szív- és Érgyógyászati Klinika, Budapest, Városmajor u. 68., 1122
| | - Levente Molnár
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Városmajori Szív- és Érgyógyászati Klinika, Budapest, Városmajor u. 68., 1122
| | - Zoltán Ruzsa
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Városmajori Szív- és Érgyógyászati Klinika, Budapest, Városmajor u. 68., 1122
| | - Gábor Dér
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Városmajori Szív- és Érgyógyászati Klinika, Budapest, Városmajor u. 68., 1122
| | - Enikő Kovács
- 4 Semmelweis Egyetem, Általános Orvostudományi Kar, Aneszteziológiai és Intenzív Terápiás Klinika, Budapest
| | | | - László Gellér
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Városmajori Szív- és Érgyógyászati Klinika, Budapest, Városmajor u. 68., 1122
| | - Harjola Veli-Pekka
- 6 Helsinki University Central Hospital, Department of Emergency Medicine, Helsinki
| | - Béla Merkely
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Városmajori Szív- és Érgyógyászati Klinika, Budapest, Városmajor u. 68., 1122
| | - Endre Zima
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Városmajori Szív- és Érgyógyászati Klinika, Budapest, Városmajor u. 68., 1122
| |
Collapse
|
5
|
Kovács E, Pilecky D, Szakál-Tóth Z, Fekete-Győr A, Gyarmathy VA, Gellér L, Hauser B, Gál J, Merkely B, Zima E. The role of age in post-cardiac arrest therapy in an elderly patient population. Physiol Int 2020; 107:319-336. [PMID: 32692712 DOI: 10.1556/2060.2020.00027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/04/2020] [Indexed: 01/17/2023]
Abstract
Aim We investigated the effect of age on post-cardiac arrest treatment outcomes in an elderly population, based on a local database and a systemic review of the literature. Methods Data were collected retrospectively from medical charts and reports. Sixty-one comatose patients, cooled to 32-34 °C for 24 h, were categorized into three groups: younger group (≤65 years), older group (66-75 years), and very old group (>75 years). Circumstances of cardiopulmonary resuscitation (CPR), patients' characteristics, post-resuscitation treatment, hemodynamic monitoring, neurologic outcome and survival were compared across age groups. Kruskal-Wallis test, Chi-square test and binary logistic regression (BLR) were applied. In addition, a literature search of PubMed/Medline database was performed to provide a background. Results Age was significantly associated with having a cardiac arrest on a monitor and a history of hypertension. No association was found between age and survival or neurologic outcome. Age did not affect hemodynamic parameter changes during target temperature management (TTM), except mean arterial pressure (MAP). Need of catecholamine administration was the highest among very old patients. During the literature review, seven papers were identified. Most studies had a retrospective design and investigated interventions and outcome, but lacked unified age categorization. All studies reported worse survival in the elderly, although old survivors showed a favorable neurologic outcome in most of the cases. Conclusion There is no evidence to support the limitation of post-cardiac arrest therapy in the aging population. Furthermore, additional prospective studies are needed to investigate the characteristics and outcome of post-cardiac arrest therapy in this patient group.
Collapse
Affiliation(s)
- E Kovács
- 1Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | | | - Z Szakál-Tóth
- 3Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - A Fekete-Győr
- 4St. George's University Hospitals NHS Foundation Trust, London, UK
| | | | - L Gellér
- 3Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - B Hauser
- 1Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - J Gál
- 1Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - B Merkely
- 3Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - E Zima
- 3Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| |
Collapse
|
6
|
Zima E, Kiss B, Párkányi A, Nyéki P, Fekete-Győr A, Szakál-Tóth Z, Heltai K, Kiss O, Kovács E, Perge P, Becker D, Gellér L, Merkely B. Analysis and application of FORECAST (Forecast of Mortality Risk Early in the post Cardiac Arrest Syndrome Therapy) pilot score for estimate early mortality in post cardiac arrest syndrome patient population. Resuscitation 2019. [DOI: 10.1016/j.resuscitation.2019.06.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|