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Gago C, Lorenzo C, Pinto S, R Sousa A, Camilo C, Abecasis F. Extracorporeal Membrane Oxygenation in an Adolescent with Multisystem Inflammatory Syndrome in Children. ACTA MEDICA PORT 2023; 36:740-745. [PMID: 37185328 DOI: 10.20344/amp.19053] [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: 09/11/2022] [Accepted: 03/21/2023] [Indexed: 05/17/2023]
Abstract
Multisystem inflammatory syndrome in children is a rare and potentially life-threatening disease that is associated with SARS-CoV-2 infection, characterized by hyperinflammation and multiorgan involvement. Cardiovascular involvement is common, including myocardial dysfunction often leading to cardiogenic shock. We present the case of a 17-year-old boy with fever, odynophagia, maculopapular rash and abdominal pain who developed a cardiogenic shock. Due to progressive deterioration of cardiac function despite optimized vasoactive support, veno-arterial extracorporeal membrane oxygenation support was initiated 12 hours after admission, with successful decannulation after seven days and discharge after 23 days, with normal cardiac function. The patient received corticosteroids and intravenous immunoglobulin. Early recognition and intensive care support are crucial for ensuring a successful outcome in severe cases of multisystem inflammatory syndrome. In cases of severe cardiogenic shock, extracorporeal membrane oxygenation support can be critical for survival and rapid recovery.
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Affiliation(s)
- Cristina Gago
- Pediatric Intensive Care Unit. Department of Pediatrics. Hospital de Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisboa.; Pediatric Functional Unit. Children Department. Hospital de Cascais Dr. José de Almeida. Cascais. Portugal
| | - Cristina Lorenzo
- Pediatric Intensive Care Unit. Department of Pediatrics. Hospital de Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisbon. Portugal
| | - Sara Pinto
- Pediatric Intensive Care Unit; Pediatric Infectious Diseases and Immunodeficiencies Unit.. Department of Pediatrics. Hospital de Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Portugal
| | - Ana R Sousa
- Pediatric Cardiology Unit. Department of Pediatrics. Hospital de Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisbon. Portugal
| | - Cristina Camilo
- Pediatric Intensive Care Unit. Department of Pediatrics. Hospital de Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisbon. Portugal
| | - Francisco Abecasis
- Pediatric Intensive Care Unit. Department of Pediatrics. Hospital de Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisbon. Portugal
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de Oliveira JLR, dos Santos MA, Timerman A. Endothelial Microparticles: Markers of Inflammatory Response After Sutureless Valve Implantation. Braz J Cardiovasc Surg 2023; 39:e20230111. [PMID: 37889214 PMCID: PMC10610908 DOI: 10.21470/1678-9741-2023-0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 06/12/2023] [Indexed: 10/28/2023] Open
Abstract
INTRODUCTION Systemic inflammatory response syndrome (SIRS) is related to increased circulating endothelial microparticles (EMP). OBJECTIVE The aim of this study was to compare the plasma concentration of EMP between patients undergoing aortic valve replacement with conventional bioprosthesis implantation and Perceval™ S (LivaNova) and to evaluate its impact on the inflammatory response in the short-term follow-up. METHODS This is a randomized clinical trial with 24 patients submitted to isolated aortic valve replacement divided into two groups: Perceval™ S (Group P) and conventional bioprostheses (Group C). Incidence of severe SIRS (three or more criteria) in the first 48 hours postoperatively, EMP release profile, interleukins (IL) 6 and 8, C-reactive protein, and procalcitonin were analyzed preand postoperatively at 24 hours and three months. RESULTS There were 24 patients (12 in each group), mean age was 69.92±5.17 years, 83.33% were female, the incidence of severe SIRS was 66.7% and 50% in groups C and P, respectively (P=0.68), and EMP showed a significant increase in the 24-hour postoperative period (P≤0.001) and subsequent decrease in the three-month postoperative period (P≤0.001), returning to baseline levels. For IL-6 and IL-8, there was a greater increase in group C at 24 hours postoperatively (P=.0.02 and P<0.001). CONCLUSION The incidence of severe SIRS was similar in both groups, with significantly higher levels of IL-6 and IL-8, at the 24-hour postoperative period, in group C, however with higher levels of EMP in group P, and subsequent return to baseline levels at the three-month postoperative period in both groups.
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Affiliation(s)
- Jenny Lourdes Rivas de Oliveira
- Department of Cardiovascular Surgery, Instituto Dante Pazzanese de
Cardiologia, Universidade de São Paulo, São Paulo, São Paulo,
Brazil
| | - Magaly Arrais dos Santos
- Department of Cardiovascular Surgery, Instituto Dante Pazzanese de
Cardiologia, Universidade de São Paulo, São Paulo, São Paulo,
Brazil
- Department of Cardiovascular Surgery, Hospital do
Coração, Universidade de São Paulo, São Paulo,
São Paulo, Brazil
| | - Ari Timerman
- Department of Clinical Division, Instituto Dante Pazzanese de
Cardiologia, Universidade de São Paulo, São Paulo, São Paulo,
Brazil
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Silveira TT, Stefenon DO, Júnior EL, Konstantyner T, Leite HP, Moreno YMF. Assessment of trace elements in critically ill patients with systemic inflammatory response syndrome: A systematic review. J Trace Elem Med Biol 2023; 78:127155. [PMID: 36948044 DOI: 10.1016/j.jtemb.2023.127155] [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: 11/03/2022] [Revised: 02/21/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND Zinc (Zn), copper (Cu), and selenium (Se) are involved in immune and antioxidant defense. Their role in systemic inflammatory response syndrome (SIRS) treatment and outcomes remains unclear. This systematic review aimed to describe trace element concentrations in different types of biological samples and their relationship with morbidity and mortality in patients with SIRS. METHODS Literature was systematically reviewed according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA). The search results were screened and evaluated for eligibility, and data were extracted and summarized in tables and figures. RESULTS Most of the 38 included studies evaluated Se (75%), followed by Zn (42%) and Cu (22%). Plasma was the main biological sample evaluated (58%). Thirteen studies found lower plasma/serum concentrations of Zn, Se, and Cu in SIRS patients than in controls upon admission, 11 studies on adults (intensive care unit-ICU) and two in pediatric ICU (PICU). Three ICU studies found no difference in erythrocyte trace element concentrations in patients with SIRS. In all studies, the two main outcomes investigated were organ failure and mortality. In seven ICU studies, patients with lower plasma or serum Zn/Se levels had higher mortality rates. A study conducted in the PICU reported an association between increased Se variation and lower 28-day mortality. In an ICU study, lower erythrocyte selenium levels were associated with higher ICU/hospital mortality, after adjustment. Five ICU studies associated lower plasma/serum Zn/Se levels with higher organ failure scores and one PICU study showed an association between higher erythrocyte Se levels and lower organ dysfunction scores. CONCLUSION There was no difference in erythrocyte Se levels in patients with SIRS. Serum/Plasma Zn and serum/plasma/erythrocyte Se are associated with organ dysfunction, mortality, and inflammation. Trace element deficiencies should be diagnosed by erythrocyte, or complementary measurements in the presence of inflammation.
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Affiliation(s)
- Taís Thomsen Silveira
- Graduate Program in Nutrition, Federal University of Santa Catarina, Santa Catarina, Brazil
| | | | - Emílio Lopes Júnior
- Discipline of Nutrition and Metabolism, Department of Pediatrics, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Tulio Konstantyner
- Discipline of Nutrition and Metabolism, Department of Pediatrics, Universidade Federal de São Paulo, São Paulo, Brazil; Department of Pediatrics, Hospital Geral de Itapecerica da Serra-HGIS, Itapecerica da Serra, São Paulo, Brazil
| | - Heitor Pons Leite
- Discipline of Nutrition and Metabolism, Department of Pediatrics, Universidade Federal de São Paulo, São Paulo, Brazil
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Liu X, Luo W, Chen J, Hu C, Mutsinze RN, Wang X, Zhang Y, Huang L, Zuo W, Liang G, Wang Y. USP25 Deficiency Exacerbates Acute Pancreatitis via Up-Regulating TBK1-NF-κB Signaling in Macrophages. Cell Mol Gastroenterol Hepatol 2022; 14:1103-1122. [PMID: 35934222 PMCID: PMC9490099 DOI: 10.1016/j.jcmgh.2022.07.013] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 07/18/2022] [Accepted: 07/18/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND & AIMS Severe acute pancreatitis can easily lead to systemic inflammatory response syndrome and death. Macrophages are known to be involved in the pathophysiology of acute pancreatitis (AP), and macrophage activation correlates with disease severity. In this study, we examined the role of ubiquitin-specific protease 25, a deubiquitinating enzyme and known regulator of macrophages, in the pathogenesis of AP. METHODS We used L-arginine, cerulein, and choline-deficient ethionine-supplemented diet-induced models of AP in Usp25-/- mice and wild-type mice. We also generated bone marrow Usp25-/- chimeric mice and initiated L-arginine-mediated AP. Primary acinar cells and bone marrow-derived macrophages were isolated from wild-type and Usp25-/- mice to dissect molecular mechanisms. RESULTS Our results show that Usp25 deficiency exacerbates pancreatic and lung injury, neutrophil and macrophage infiltration, and systemic inflammatory responses in L-arginine, cerulein, and choline-deficient ethionine-supplemented diet-induced models of AP. Bone marrow Usp25-/- chimeric mice challenged with L-arginine show that Usp25 deficiency in macrophages exaggerates AP by up-regulating the TANK-binding kinase 1 (TBK1)-nuclear factor-κB (NF-κB) signaling pathway. Similarly, in vitro data confirm that Usp25 deficiency enhances the TBK1-NF-κB pathway, leading to increased expression of inflammatory cytokines in bone marrow-derived macrophages. CONCLUSIONS Usp25 deficiency in macrophages enhances TBK1-NF-κB signaling, and the induction of inflammatory chemokines and type I interferon-related genes exacerbates pancreatic and lung injury in AP.
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Affiliation(s)
- Xin Liu
- Chemical Biology Research Center, School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Wu Luo
- Medical Research Center, First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jiahao Chen
- Chemical Biology Research Center, School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Chenghong Hu
- Chemical Biology Research Center, School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Rumbidzai N. Mutsinze
- Chemical Biology Research Center, School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xu Wang
- Chemical Biology Research Center, School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yanmei Zhang
- School of Pharmaceutical Sciences, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Lijiang Huang
- Department of Gastroenterology, Affiliated Xiangshan Hospital of Wenzhou Medial University, Xiangshan, Zhejiang, China
| | - Wei Zuo
- Department of Gastroenterology, Affiliated Xiangshan Hospital of Wenzhou Medial University, Xiangshan, Zhejiang, China
| | - Guang Liang
- Chemical Biology Research Center, School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China,School of Pharmaceutical Sciences, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Yi Wang
- Chemical Biology Research Center, School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China,Department of Gastroenterology, Affiliated Xiangshan Hospital of Wenzhou Medial University, Xiangshan, Zhejiang, China,Correspondence Address correspondence to: Yi Wang, PhD, Chemical Biology Research Center, School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang 325035, China. fax: (86) 577 85773060
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Vieira de Melo J, Valsassina R, Garcia AM, Silva T, Gouveia C, Brito MJ. Multisystem Inflammatory Syndrome in Children Associated with COVID-19 in a Tertiary Level Hospital in Portugal. ACTA MEDICA PORT 2022; 35:881-890. [PMID: 35639579 DOI: 10.20344/amp.17797] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 05/12/2022] [Accepted: 05/19/2022] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Multisystem inflammatory syndrome in children (MIS-C) is a rare and severe manifestation of coronavirus disease 2019 (COVID-19). The aim of this study was to describe the characteristics of children with MIS-C admitted to a pediatric tertiary hospital in Portugal. MATERIAL AND METHODS Observational descriptive study of MIS-C patients admitted between April 2020 and April 2021. Demographic and clinical characteristics, diagnostic tests, and treatment data were collected. The diagnosis of MIS-C was based on the World Health Organization and Centers for Disease Control and Prevention criteria. RESULTS We reported 45 children with MIS-C. The median age was seven years (IQR 4 - 10 years) and 60.0% were previously healthy. SARS-CoV-2 infection was confirmed in 77.8% by RT-PCR or antibody testing for SARS-CoV-2, and in 73.3%, an epidemiological link was confirmed. All the patients had a fever and organ system involvement: hematologic (100%), cardiovascular (97.8%), gastrointestinal (97.8%), mucocutaneous (86.7%), respiratory (26.7%), neurologic (15.6%), and renal (13.3%) system. Neurological (p = 0.035) and respiratory (p = 0.035) involvement were observed in patients with a more severe presentation. There was a significant difference of medians when comparing disease severity groups, namely in the values of hemoglobin (p = 0.015), lymphocytes (p = 0.030), D-dimer (p = 0.019), albumin (p < 0.001), NT-proBNP (p = 0.005), ferritin (p = 0.048), CRP (p = 0.006), procalcitonin (p = 0.005) and IL-6 (p = 0.002). From the total number of children, 93.3% received intravenous immunoglobulin, 91.1% methylprednisolone, and one patient (2.2%) received anakinra. Thirteen patients (28.8%) required intensive care and there were no deaths. Of the 21 patients evaluated, 90.4% had reduction of exercise capacity and of the 15 patients who underwent cardiac magnetic resonance, 53.3% had sequelae of cardiac injury. CONCLUSION We observed a large spectrum of disease presentation in a group of patients where most were previously healthy. A small percentage of patients (28.9%) had a severe presentation of the disease. MIS-C is a challenge in current clinical practice and its diagnosis requires a high level of clinical suspicion as the timely initiation of therapy is essential to prevent complications. However, there is no scientific consensus on the treatment and follow-up of these patients.
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Affiliation(s)
- Joana Vieira de Melo
- Unidade de Infecciologia Pediátrica. Hospital Dona Estefânia. Centro Hospitalar Universitário Lisboa Central. Lisboa. Portugal
| | - Rita Valsassina
- Unidade de Infecciologia Pediátrica. Hospital Dona Estefânia. Centro Hospitalar Universitário Lisboa Central. Lisboa. Portugal
| | - Ana Margarida Garcia
- Unidade de Infecciologia Pediátrica. Hospital Dona Estefânia. Centro Hospitalar Universitário Lisboa Central. Lisboa. Portugal
| | - Tiago Silva
- Unidade de Infecciologia Pediátrica. Hospital Dona Estefânia. Centro Hospitalar Universitário Lisboa Central. Lisboa. Portugal
| | - Catarina Gouveia
- Unidade de Infecciologia Pediátrica. Hospital Dona Estefânia. Centro Hospitalar Universitário Lisboa Central. Lisboa. Portugal
| | - Maria João Brito
- Unidade de Infecciologia Pediátrica. Hospital Dona Estefânia. Centro Hospitalar Universitário Lisboa Central. Lisboa. Portugal
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Khan A, Sarma D, Gowda C, Rodrigues G. The Role of Modified Early Warning Score (MEWS) in the Prognosis of Acute Pancreatitis. Oman Med J 2021; 36:e272. [PMID: 34239713 PMCID: PMC8222709 DOI: 10.5001/omj.2021.72] [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: 03/24/2020] [Accepted: 10/06/2020] [Indexed: 11/25/2022] Open
Abstract
Objectives Modified Early Warning Score (MEWS) is a reliable, safe, instant, and inexpensive score for prognosticating patients with acute pancreatitis (AP) due to its ability to reflect ongoing changes of the systemic inflammatory response syndrome associated with AP. Our study sought to determine an optimal MEWS value in predicting severity in AP and determine its accuracy in doing so. Methods Patients diagnosed with AP and admitted to a single institution were analyzed to determine the value of MEWS in identifying severe AP (SAP). The highest MEWS (hMEWS) score for the day and the mean of all the scores of a given day (mMEWS) were determined for each day. Sensitivity, specificity, negative predictive value (NPV), and positive predictive values (PPV) were calculated for the optimal MEWS values obtained. Results Two hundred patients were included in the study. The data suggested that an hMEWS value > 2 on day one is most accurate in predicting SAP, with a specificity of 90.8% and PPV of 83.3%. An mMEWS of > 1.2 on day two was the most accurate in predicting SAP, with a sensitivity of 81.2%, specificity of 76.6%, PPV of 69.8%, and NPV of 85.9%. These were found to be more accurate than previous studies. Conclusions MEWS provides a novel, easy, instant, repeatable, and reliable prognostic score that is comparable, if not superior, to existing scoring systems. However, its true value may lie in its use in resource-limited settings such as primary health care centers.
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Affiliation(s)
- Amena Khan
- Department of General Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Digvijoy Sarma
- Department of General Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Chiranth Gowda
- Department of General Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Gabriel Rodrigues
- Department of General Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
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Furuta K, Akamatsu H, Sada R, Miyamoto K, Teraoka S, Hayata A, Ozawa Y, Nakanishi M, Koh Y, Yamamoto N. Comparison of Systemic Inflammatory Response Syndrome and quick Sequential Organ Failure Assessment scores in predicting bacteremia in the emergency department. Acute Med Surg 2021; 8:e654. [PMID: 33968417 PMCID: PMC8088398 DOI: 10.1002/ams2.654] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/08/2021] [Accepted: 03/31/2021] [Indexed: 11/08/2022] Open
Abstract
Aim The emergency department requires simple and useful clinical indicators to identify bacteremia. This retrospective study explored the Systemic Inflammatory Response Syndrome (SIRS) and quick Sequential Organ Failure Assessment (qSOFA) scores for predicting bacteremia. Methods Between April and September 2017, we assessed blood cultures of 307 patients in our emergency department. We calculated the SIRS and qSOFA scores for these patients and evaluated their correlation with bacteremia. Results Of 307 patients, 66 (21.5%) had bacteremia, 237 (77.2%) were SIRS-positive, and 123 (40.0%) were qSOFA-positive. The sensitivity and specificity of the SIRS score for predicting bacteremia were 87.9% and 25.7%, respectively. The sensitivity and specificity of the qSOFA score were 47.0% and 61.8%, respectively. Multivariate analysis revealed that body temperature (odds ratio, 2.16; 95% confidence interval, 1.22-3.84; P = 0.009) and blood pressure (odds ratio, 2.72; 95% confidence interval, 1.39-5.35; P = 0.004) significantly associated with bacteremia. Conclusions The SIRS score was a more sensitive indicator than the qSOFA score for predicting bacteremia.
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Affiliation(s)
- Katsuyuki Furuta
- Internal Medicine III Wakayama Medical University Wakayama Japan
| | - Hiroaki Akamatsu
- Internal Medicine III Wakayama Medical University Wakayama Japan
| | - Ryuichi Sada
- Department of General Internal Medicine Tenri Hospital Tenri Japan
| | - Kyohei Miyamoto
- Department of Emergency and Critical Care Medicine Wakayama Medical University Wakayama Japan
| | - Shunsuke Teraoka
- Internal Medicine III Wakayama Medical University Wakayama Japan
| | - Atsushi Hayata
- Internal Medicine III Wakayama Medical University Wakayama Japan
| | - Yuichi Ozawa
- Internal Medicine III Wakayama Medical University Wakayama Japan
| | | | - Yasuhiro Koh
- Internal Medicine III Wakayama Medical University Wakayama Japan
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Chan JY, Wong VK, Wong J, Paterson RF, Lange D, Chew BH, Scotland KB. Predictors of urosepsis in struvite stone patients after percutaneous nephrolithotomy. Investig Clin Urol 2021; 62:201-209. [PMID: 33660448 PMCID: PMC7940850 DOI: 10.4111/icu.20200319] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/10/2020] [Accepted: 11/18/2020] [Indexed: 01/14/2023] Open
Abstract
Purpose This study aims to identify clinical factors that may predispose struvite stone patients to urosepsis following percutaneous nephrolithotomy (PCNL). Materials and Methods A retrospective review was conducted on patients who received PCNL for struvite stones. The Systemic Inflammatory Response Syndrome (SIRS) criteria and quick-Sepsis Related Organ Failure Assessment (q-SOFA) criteria were used to identify patients who were at an increased risk for urosepsis. Statistical analysis was performed using Fisher's exactness test, Wilcoxon rank test, and logistic regression. Results Chart review identified 99 struvite stone patients treated with PCNL. Post-operatively, 40 patients were SIRS positive (≥2 criteria) and/or q-SOFA positive (score ≥2). Using SIRS as an approximation for urosepsis, longer operative times (p<0.001), higher pre-operative white blood cell counts (p=0.01), greater total stone surface area (p<0.0001), and pre-operative stenting (OR, 5.75; p=0.01) were identified as independent risk factors for urosepsis. Multivariate analysis demonstrated pre-operative stenting (OR, 1.46; p=0.01) to be a risk factor. With q-SOFA, univariable analysis found that antibiotic use within 3 months prior to a PCNL (OR, 4.44; p=0.04), medical comorbidities (OR, 4.80; p=0.02), longer operative times (p<0.001), lengthier post-operative hospitalization (p<0.01), and greater total stone surface area (p<0.0001) were risk factors for urosepsis. Multivariate analysis revealed that bladder outlet obstruction (OR, 2.74; p<0.003) and pre-operative stenting (OR, 1.27; p=0.01) significantly increased odds of being q-SOFA positive. Conclusions Several risk factors for urosepsis following PCNL for struvite stones have been identified. These risk factors should be taken into consideration in peri-operative care to mitigate the risks of urosepsis.
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Affiliation(s)
- Justin Yh Chan
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Victor Kf Wong
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Julie Wong
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Ryan F Paterson
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Dirk Lange
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Ben H Chew
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Kymora B Scotland
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada.,Department of Urology, University of California, Los Angeles, CA, USA.
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Pérez-Rubio Á, Sebastián Tomás JC, Navarro-Martínez S, Gonzálvez Guardiola P, Torrecillas Meroño DG, Domingo Del Pozo C. Incidence of surgical abdominal emergencies during SARS-CoV-2 pandemic. Cir Esp 2020; 98:618-624. [PMID: 32768138 PMCID: PMC7340032 DOI: 10.1016/j.ciresp.2020.06.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 05/03/2020] [Revised: 06/10/2020] [Accepted: 06/26/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Since the appearance of SARS-CoV-2 in December 2019 in the Chinese city of Wuhan, we have experienced a reduction in admissions in our Service and a decrease in urgent surgical activity. Therefore, this study aimed to assess the incidence of potentially surgical abdominal emergency in our center during the epidemic of COVID-19. METHODS A retrospective study was designed. It included all patients admitted for urgent abdominal pathology with potential surgical treatment in our General and Digestive Surgery Department from February 24, 2020 to April 19, 2020. RESULTS Eighty-nine patients with a mean age of 58.85±22.2 were included. The median time from symptom onset to the Emergency Department (ED) visit was 48 (P25-P75 = 24-96) hours. On arrival at the ED, 18 (20%) patients presented with systemic inflammatory response syndrome criteria. Fifty-one (57%) surgical procedures were performed. The rate of post-surgical complications at 30 days was 31% and the mortality rate was 2%. Concerning the same period from 2017 to 2019, the mean number of admissions from the ED to our Department decreased by 14% during the epidemic period. CONCLUSION There has been a decrease in the number of patients admitted for urgent, potentially surgical, abdominal pathology during the period of the COVID-19 epidemic in our center.
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Affiliation(s)
- Álvaro Pérez-Rubio
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Doctor Peset, Valencia, España.
| | | | - Sergio Navarro-Martínez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Doctor Peset, Valencia, España
| | - Paula Gonzálvez Guardiola
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Doctor Peset, Valencia, España
| | | | - Carlos Domingo Del Pozo
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Doctor Peset, Valencia, España
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Sadeghi M, Kiani A, Sheikhy K, Taghavi K, Farrokhpour M, Abedini A. Abdominal Compartment Syndrome in Critically Ill Patients. Open Access Maced J Med Sci 2019; 7:1097-1102. [PMID: 31049088 PMCID: PMC6490480 DOI: 10.3889/oamjms.2019.228] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND: Abdominal compartment syndrome patients suffer severe obstacles such as kidney failure and shock. To evade further complications, identifying the abdominal compartment syndrome (ACS) and Intra-abdominal hypertension (IAH), in critically ill individuals and hospitalised in the intensive care unit (ICU) is obligated. AIM: The current study intended to study the abdominal compartment syndrome and the concomitant risk factors among hospitalised patients in ICU, by using the Intra-abdominal pressure test. MATERIAL AND METHODS: One hundred and twenty-five hospitalised patients at ICU entered the current survey. Abdominal pressure was measured by standard intravesical technique. The SPSS 21 analysed the preoperative and intraoperative factors such as demographic records and comorbidities. RESULTS: Seventy-three (58.4%) participants were males and 52 (41.6%) were women in the mean age of 55.1 ± 18.3 years. Eighty-nine patients (71.2%) showed normal intra-abdominal pressure since 31 patients (24.8%), and 5 patients (4%) developed IAH and ACS. The intra-abdominal pressure (IAP) applied to Glasgow Coma Scale (GCS), Acute Physiology, shock, Systemic Inflammatory Response Syndrome (SIRS), central venous oxygen saturation and Chronic Health Evaluation (APACHE II) score (P < 0.05). Patients with high IAP have shown a higher mortality frequency, compared to others (P < 0.05). CONCLUSION: Current findings showed a correlation between IAP hospitalised patients in ICU and shock, SIRS, APACHE II, central venous oxygen saturation and GCS. Intra-abdominal pressure test, as a valuable prognosis test for the abdominal compartment syndrome (ACS) and Intra-abdominal hypertension (IAH), may offer better results when added to the routine medical checkup of ICU patients.
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Affiliation(s)
- Mohsen Sadeghi
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arda Kiani
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kambiz Sheikhy
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kimia Taghavi
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Farrokhpour
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atefeh Abedini
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Bhatraju PK, Zelnick LR, Katz R, Mikacenic C, Kosamo S, Hahn WO, Dmyterko V, Kestenbaum B, Christiani DC, Liles WC, Himmelfarb J, Wurfel MM. A Prediction Model for Severe AKI in Critically Ill Adults That Incorporates Clinical and Biomarker Data. Clin J Am Soc Nephrol 2019; 14:506-514. [PMID: 30917991 PMCID: PMC6450340 DOI: 10.2215/cjn.04100318] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 01/28/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND OBJECTIVES Critically ill patients with worsening AKI are at high risk for poor outcomes. Predicting which patients will experience progression of AKI remains elusive. We sought to develop and validate a risk model for predicting severe AKI within 72 hours after intensive care unit admission. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We applied least absolute shrinkage and selection operator regression methodology to two prospectively enrolled, critically ill cohorts of patients who met criteria for the systemic inflammatory response syndrome, enrolled within 24-48 hours after hospital admission. The risk models were derived and internally validated in 1075 patients and externally validated in 262 patients. Demographics and laboratory and plasma biomarkers of inflammation or endothelial dysfunction were used in the prediction models. Severe AKI was defined as Kidney Disease Improving Global Outcomes (KDIGO) stage 2 or 3. RESULTS Severe AKI developed in 62 (8%) patients in the derivation, 26 (8%) patients in the internal validation, and 15 (6%) patients in the external validation cohorts. In the derivation cohort, a three-variable model (age, cirrhosis, and soluble TNF receptor-1 concentrations [ACT]) had a c-statistic of 0.95 (95% confidence interval [95% CI], 0.91 to 0.97). The ACT model performed well in the internal (c-statistic, 0.90; 95% CI, 0.82 to 0.96) and external (c-statistic, 0.93; 95% CI, 0.89 to 0.97) validation cohorts. The ACT model had moderate positive predictive values (0.50-0.95) and high negative predictive values (0.94-0.95) for severe AKI in all three cohorts. CONCLUSIONS ACT is a simple, robust model that could be applied to improve risk prognostication and better target clinical trial enrollment in critically ill patients with AKI.
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Affiliation(s)
- Pavan Kumar Bhatraju
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, .,Division of Nephrology, Department of Medicine, Kidney Research Institute
| | - Leila R Zelnick
- Division of Nephrology, Department of Medicine, Kidney Research Institute
| | - Ronit Katz
- Division of Nephrology, Department of Medicine, Kidney Research Institute
| | - Carmen Mikacenic
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - Susanna Kosamo
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - William O Hahn
- Division of Allergy and Infectious Diseases, Department of Medicine, and
| | - Victoria Dmyterko
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - Bryan Kestenbaum
- Division of Nephrology, Department of Medicine, Kidney Research Institute
| | - David C Christiani
- Department of Environmental Health and.,Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts; and.,Pulmonary and Critical Care Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - W Conrad Liles
- Department of Medicine, University of Washington, Seattle, Washington
| | | | - Mark M Wurfel
- Division of Pulmonary and Critical Care Medicine, Department of Medicine.,Division of Nephrology, Department of Medicine, Kidney Research Institute
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12
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Okumura Y, Hiki N, Kumagai K, Ida S, Nunobe S, Ohashi M, Sano T. Postoperative Prolonged Inflammatory Response as a Poor Prognostic Factor After Curative Resection for Gastric Cancer. World J Surg 2018; 41:2611-2618. [PMID: 28451762 DOI: 10.1007/s00268-017-4032-5] [Citation(s) in RCA: 9] [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] [Indexed: 01/03/2023]
Abstract
BACKGROUND Postoperative inflammatory complications are associated with poorer prognosis in gastrointestinal malignancies. The aims of this study were to clarify the impact of postoperative inflammation itself on overall survival (OS) and relapse-free survival (RFS) in advanced gastric cancer patients. METHODS We retrospectively analyzed 490 patients who underwent curative resection for pStage II and III gastric cancer from 2005 to 2008. We evaluated postoperative inflammation based on duration of hyperthermia (body temperature ≥38 °C) and leukocytosis (≥12,000/µL-1). OS and RFS were compared between a prolonged inflammation group and non-prolonged inflammation group. Multivariate analysis using the Cox proportional hazard model was performed to identify independent prognostic factors. RESULTS The prolonged inflammation group comprised 57 (11.7%) patients who had hyperthermia for 4 days or longer and 42 (8.6%) patients who had leukocytosis for 7 days or longer. OS and RFS were significantly worse in the prolonged hyperthermia group (OS: hazard ratio (HR) 1.84, 95% confidence interval (CI) 1.19-2.73, P = 0.004; RFS: HR 1.66, 95% CI 1.08-2.45, P = 0.015). The prolonged leukocytosis group also showed significantly worse OS (HR 1.92, 95% CI 1.19-2.96, P = 0.004) and RFS (HR 1.90, 95% CI 1.19-2.88, P = 0.004). Multivariate analysis identified prolonged hyperthermia as an independent factor for predicting poor prognosis (OS: HR 1.77, 95% CI 1.13-2.68, P = 0.013; RFS: HR 1.60; 95% CI 1.03-2.39, P = 0.038). CONCLUSIONS Prolonged hyperthermia and leukocytosis after curative gastrectomy were associated with poorer OS and RFS in advanced gastric cancer patients.
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Affiliation(s)
- Yasuhiro Okumura
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Naoki Hiki
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
| | - Koshi Kumagai
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Satoshi Ida
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Souya Nunobe
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Manabu Ohashi
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Takeshi Sano
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
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13
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Gupta A, Liu T, Shepherd S, Paiva W. Using Statistical and Machine Learning Methods to Evaluate the Prognostic Accuracy of SIRS and qSOFA. Healthc Inform Res 2018; 24:139-147. [PMID: 29770247 PMCID: PMC5944188 DOI: 10.4258/hir.2018.24.2.139] [Citation(s) in RCA: 12] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/19/2018] [Accepted: 04/20/2018] [Indexed: 01/20/2023] Open
Abstract
Objectives The objective of this study was to compare the performance of two popularly used early sepsis diagnostic criteria, systemic inflammatory response syndrome (SIRS) and quick Sepsis-related Organ Failure Assessment (qSOFA), using statistical and machine learning approaches. Methods This retrospective study examined patient visits in Emergency Department (ED) with sepsis related diagnosis. The outcome was 28-day in-hospital mortality. Using odds ratio (OR) and modeling methods (decision tree [DT], multivariate logistic regression [LR], and naïve Bayes [NB]), the relationships between diagnostic criteria and mortality were examined. Results Of 132,704 eligible patient visits, 14% died within 28 days of ED admission. The association of qSOFA ≥2 with mortality (OR = 3.06; 95% confidence interval [CI], 2.96–3.17) greater than the association of SIRS ≥2 with mortality (OR = 1.22; 95% CI, 1.18–1.26). The area under the ROC curve for qSOFA (AUROC = 0.70) was significantly greater than for SIRS (AUROC = 0.63). For qSOFA, the sensitivity and specificity were DT = 0.39, LR = 0.64, NB = 0.62 and DT = 0.89, LR = 0.63, NB = 0.66, respectively. For SIRS, the sensitivity and specificity were DT = 0.46, LR = 0.62, NB = 0.62 and DT = 0.70, LR = 0.59, NB = 0.58, respectively. Conclusions The evidences suggest that qSOFA is a better diagnostic criteria than SIRS. The low sensitivity of qSOFA can be improved by carefully selecting the threshold to translate the predicted probabilities into labels. These findings can guide healthcare providers in selecting risk-stratification measures for patients presenting to an ED with sepsis.
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Affiliation(s)
- Akash Gupta
- Industrial Engineering and Management, Oklahoma State University, Stillwater, OK, USA
| | - Tieming Liu
- Industrial Engineering and Management, Oklahoma State University, Stillwater, OK, USA
| | - Scott Shepherd
- Center for Health Systems Innovation, Oklahoma State University, Stillwater, OK, USA
| | - William Paiva
- Center for Health Systems Innovation, Oklahoma State University, Stillwater, OK, USA
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14
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Ioakeimidou A, Pagalou E, Kontogiorgi M, Antoniadou E, Kaziani K, Psaroulis K, Giamarellos-Bourboulis EJ, Prekates A, Antonakos N, Lassale P, Gogos C; Hellenic Sepsis Study Group. Increase of circulating endocan over sepsis follow-up is associated with progression into organ dysfunction. Eur J Clin Microbiol Infect Dis 2017; 36:1749-56. [PMID: 28455780 DOI: 10.1007/s10096-017-2988-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 04/13/2017] [Indexed: 12/23/2022]
Abstract
How circulating inflammatory mediators change upon sepsis progression has not been studied. We studied the follow-up changes of circulating vasoactive peptides and cytokines until the improvement or the worsening of a patient and progression into specific organ dysfunctions. In a prospective study, concentrations of tumor necrosis factor-alpha (TNFα), interleukin (IL)-6, IL-8, IL-10, interferon-gamma (IFNγ), endocan and angiopoietin-2 (Ang-2) were measured in serum by an enzyme immunoassay in 175 patients at baseline; this was repeated within 24 h upon progression into new organ dysfunction (n = 141) or improvement (n = 34). Endocan and Ang-2 were the only parameters that were significantly increased among patients who worsened. Any increase of endocan was associated with worsening with odds ratio 16.65 (p < 0.0001). This increase was independently associated with progression into acute respiratory distress syndrome (ARDS) as shown after logistic regression analysis (odds ratio 2.91, p: 0.002). Changes of circulating cytokines do not mediate worsening of the critically ill patients. Instead endocan and Ang2 are increased and this may be interpreted as a key-playing role in the pathogenesis of ARDS and septic shock. Any increase of endocan is a surrogate of worsening of the clinical course.
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15
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Affiliation(s)
- Luregn J Schlapbach
- Paediatric Critical Care Research Group, Mater Research Institute, University of Queensland, Brisbane, Australia.,Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Brisbane, Australia.,Department of Pediatrics, Inselspital, University of Bern, Bern, Switzerland
| | - Etienne Javouhey
- Pediatric Emergency and Intensive Care Unit, Hôpital Femme Mère Enfant, Hospices Civils Lyon, Bron, France.,University of Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Nicolaas J G Jansen
- Chairman of the Section Infection, Inflammation and Sepsis of ESPNIC, Pediatric Intensive Care Unit, Wilhelmina Children's Hospital, University Medical Center Utrecht, KG.01.319.0, P.O. Box 85090, 3508 AB, Utrecht, The Netherlands. .,Child Health, Science for Life, Research Group, University Medical Center Utrecht, Utrecht, The Netherlands.
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16
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Brabrand M, Havshøj U, Graham CA. Validation of the qSOFA score for identification of septic patients: A retrospective study. Eur J Intern Med 2016; 36:e35-e36. [PMID: 27640097 DOI: 10.1016/j.ejim.2016.09.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 09/02/2016] [Accepted: 09/07/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Mikkel Brabrand
- Department of Emergency Medicine, Hospital of South West Jutland, Finsensgade 35, DK-6700 Esbjerg, Denmark; Department of Emergency Medicine, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense C, Denmark.
| | - Ulrik Havshøj
- Department of Emergency Medicine, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense C, Denmark
| | - Colin A Graham
- Chinese University of Hong Kong, Department of Emergency Medicine, Shatin, NT, Hong Kong, China
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Sato H, Nakamura K, Baba Y, Terada S, Goto T, Kurahashi K. Low tidal volume ventilation with low PEEP during surgery may induce lung inflammation. BMC Anesthesiol 2016; 16:47. [PMID: 27473050 DOI: 10.1186/s12871-016-0209-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 07/15/2016] [Indexed: 12/31/2022] Open
Abstract
Background Compared to conventional tidal volume ventilation, low tidal-volume ventilation reduces mortality in cased of acute respiratory distress syndrome. The aim of the present study is to determine whether low tidal-volume ventilation reduces the production of inflammatory mediators in the lungs and improves physiological status during hepatic surgery. Methods We randomly assigned patients undergoing hepatectomy into 2 groups: conventional tidal-volume vs. low tidal-volume (12 vs. 6 mL•kg−1 ideal body weight) ventilation with a positive end-expiratory pressure of 3 cm H2O. Arterial blood and airway epithelial lining fluid were sampled immediately after intubation and every 3 h thereafter. Results Twenty-five patients were analyzed. No significant changes were found in hemodynamics or acid–base status during the study. Interleukin-8 was significantly elevated in epithelial lining fluid from the low tidal-volume group. Oxygenation evaluated immediately after admission to the post-surgical care unit was significantly worse in the low tidal-volume group. Conclusions Low tidal-volume ventilation with low positive end-expiratory pressure may lead to pulmonary inflammation during major surgery such as hepatectomy. Trial registration The effect of ventilatory tidal volume on lung injury during hepatectomy that requires transient liver blood flow interruption. UMIN000021371 (03/07/2016); retrospectively registered
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18
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Ostadrahimi A, Nagili B, Asghari-Jafarabadi M, Beigzali S, Zalouli H, Lak S. A Proper Enteral Nutrition Support Improves Sequential Organ Failure Score and Decreases Length of Stay in Hospital in Burned Patients. Iran Red Crescent Med J 2016; 18:e21775. [PMID: 27186387 PMCID: PMC4867160 DOI: 10.5812/ircmj.21775] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Revised: 08/17/2014] [Accepted: 09/20/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Severe burned patients developed metabolic imbalances and systemic inflammatory response syndrome (SIRS), which can lead to malnutrition, impaired immunologic response, multiple organ failure and death. Studies have shown that providing an early and adequate nutrition support can lower hypermetabolic response and improve the outcome. Unfortunately, little emphasis has been given to the role of nutritional support, especially for demonstrating the importance of a proper nutritional support in determining the outcome of critically burned patients. OBJECTIVES This study was designed to determine the possible protective effect of early and adequate nutrition support on sequential organ failure assessment (SOFA) score and length of stay (LOS) in hospital, in thermal burn victims. PATIENTS AND METHODS Thirty patients with severe thermal burn (More than 20% of total body surface area [TBSA] burn), on the first day in the intensive care unit, joined this double-blinded randomized controlled clinical trial. Patients were randomly divided into two groups: control group (group C, 15 patients) received hospital routine diet (liquid and chow diet, ad libitum) while intervention group (group I, 15 patients) received commercially prepared solution, with oral or tube feeding. The caloric requirement for these patients was calculated, according to the Harris-Benedict formula. The SOFA score was also measured on admission (SOFA0), day 2 (SOFA1), day 5 (SOFA2) and day 9 (SOFA3), consequently. The difference between the last measurement (SOFA3) and day 2 (SOFA1) was calculated. RESULTS The results showed that there was a significant change between SOFA3 and SOFA1, {-1[(-1) - 0], P = 0.013 vs. -1 [(-2) - 0], P = 0.109}. Mean LOS in hospital, for patients consuming commercial standard food, also proved to be shorter than those consuming hospital routine foods (17.64 ± 8.2 vs. 23.07 ± 11.89). CONCLUSIONS This study shows that an adequate nutritional support, in patients with severe burn injury, can improve SOFA score. It is also more cost-effective, resulting in a shorter LOS in hospital.
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Affiliation(s)
- Alireza Ostadrahimi
- Nutrition Research Center, Faculty of Nutrition, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Behrooz Nagili
- Infectious and Tropical Disease Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | | | - Sanaz Beigzali
- Student Research Committee, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Hossein Zalouli
- Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Sima Lak
- Infectious and Tropical Disease Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran
- Corresponding Author: Sima Lak, Infectious and Tropical Disease Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran. Tel: +98-9144053184, Fax: +98-4135533315, E-mail:
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Abstract
Sepsis is a clinical syndrome characterized by systemic inflammation, usually in response to infection. The signs and symptoms are very similar to Systemic Inflammatory Response Syndrome (SIRS), which typically occur consequent to trauma and auto-immune diseases. Common treatments of sepsis include administration of antibiotics and oxygen. Oxygen is administered due to ischemia in tissues, which results in the production of free radicals. Poor utilization of oxygen by the mitochondrial electron transport chain can increase oxidative stress during ischemia and exacerbate the severity and outcome in septic patients. This course of treatment virtually mimics the conditions seen in ischemia-reperfusion disorders. Therefore, this review proposes that the mechanism of free radical production seen in sepsis and SIRS is identical to the oxidative stress seen in ischemia-reperfusion injury. Specifically, this is due to a biochemical mechanism within the mitochondria where the oxidation of succinate to fumarate by succinate dehydrogenase (complex II) is reversed in sepsis (hypoxia), leading to succinate accumulation. Oxygen administration (equivalent to reperfusion) rapidly oxidizes the accumulated succinate, leading to the generation of large amounts of superoxide radical and other free radical species. Organ damage possibly leading to multi-organ failure could result from this oxidative burst seen in sepsis and SIRS. Accordingly, we postulate that temporal administration with anti-oxidants targeting the mitochondria and/or succinate dehydrogenase inhibitors could be beneficial in sepsis and SIRS patients.
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20
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Buhl SF, Andersen AL, Andersen JR, Andersen O, Jensen JEB, Rasmussen AML, Pedersen MM, Damkjær L, Gilkes H, Petersen J. The effect of protein intake and resistance training on muscle mass in acutely ill old medical patients - A randomized controlled trial. Clin Nutr 2015; 35:59-66. [PMID: 25796103 DOI: 10.1016/j.clnu.2015.02.015] [Citation(s) in RCA: 9] [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: 08/06/2014] [Revised: 12/29/2014] [Accepted: 02/23/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND & AIM Stress metabolism is associated with accelerated loss of muscle that has large consequences for the old medical patient. The aim of this study was to investigate if an intervention combining protein and resistance training was more effective in counteracting loss of muscle than standard care. Secondary outcomes were changes in muscle strength, functional ability and body weight. METHODS 29 acutely admitted old (>65 years) patients were randomly assigned to the intervention (n = 14) or to standard care (n = 15). The Intervention Group received 1.7 g protein/kg/day during admission and a daily protein supplement (18.8 g protein) and resistance training 3 times per week the 12 weeks following discharge. Muscle mass was assessed by Dual-energy X-ray Absorptiometry. Muscle strength was assessed by Hand Grip Strength and Chair Stand Test. Functional ability was assessed by the de Morton Mobility Index, the Functional Recovery Score and the New Mobility Score. Changes in outcomes from time of admission to three-months after discharge were analysed by linear regression analysis. RESULTS The intention-to-treat analysis showed no significant effect of the intervention on lean mass (unadjusted: β-coefficient = -1.28 P = 0.32, adjusted for gender: β-coefficient = -0.02 P = 0.99, adjusted for baseline lean mass: β-coefficient = -0.31 P = 0.80). The de Morton Mobility Index significantly increased in the Control Group (β-coefficient = -11.43 CI: 0.72-22.13, P = 0.04). No other differences were found. CONCLUSION No significant effect on muscle mass was observed in this group of acutely ill old medical patients. High compliance was achieved with the dietary intervention, but resistance training was challenging. Clinical trials identifier NCT02077491.
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Affiliation(s)
- Sussi F Buhl
- Optimed, Clinical Research Centre (056), Amager Hvidovre Hospital, University of Copenhagen, DK-2650 Hvidovre, Denmark; Department of Nutrition, Exercise and Sports, University of Copenhagen, DK-1958 Frederiksberg C, Denmark.
| | - Aino L Andersen
- Optimed, Clinical Research Centre (056), Amager Hvidovre Hospital, University of Copenhagen, DK-2650 Hvidovre, Denmark; Department of Nutrition, Exercise and Sports, University of Copenhagen, DK-1958 Frederiksberg C, Denmark
| | - Jens R Andersen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, DK-1958 Frederiksberg C, Denmark; Nutrition Unit 5711, Rigshospitalet, DK-2100 Copenhagen Oe, Denmark
| | - Ove Andersen
- Optimed, Clinical Research Centre (056), Amager Hvidovre Hospital, University of Copenhagen, DK-2650 Hvidovre, Denmark
| | - Jens-Erik B Jensen
- Department of Endocrinology (541), Amager Hvidovre Hospital, DK-2650 Hvidovre, Denmark
| | | | - Mette M Pedersen
- Optimed, Clinical Research Centre (056), Amager Hvidovre Hospital, University of Copenhagen, DK-2650 Hvidovre, Denmark
| | - Lars Damkjær
- Department of Rehabilitation, Municipality of Copenhagen, DK-2200 Copenhagen N, Denmark
| | - Hanne Gilkes
- Optimed, Clinical Research Centre (056), Amager Hvidovre Hospital, University of Copenhagen, DK-2650 Hvidovre, Denmark
| | - Janne Petersen
- Optimed, Clinical Research Centre (056), Amager Hvidovre Hospital, University of Copenhagen, DK-2650 Hvidovre, Denmark
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Abstract
OBJECTIVE Recent growing evidence suggests that beta-blocker treatment could improve cardiovascular dynamics and possibly the outcome of patients admitted to intensive care with severe sepsis or septic shock. DESIGN Systematic review. DATA SOURCES MEDLINE and EMBASE healthcare databases. REVIEW METHODS To investigate this topic, we conducted a systematic review of the above databases up to 31 May 2015. Due to the clinical novelty of the subject, we also included non-randomized clinical studies. We focused on the impact of beta-blocker treatment on mortality, also investigating its effects on cardiovascular, immune and metabolic function. Evidence from experimental studies was reviewed as well. RESULTS From the initial search we selected 10 relevant clinical studies. Five prospective studies (two randomized) assessed the hemodynamic effects of the beta1-blocker esmolol. Heart rate decreased significantly in all, but the impact on other parameters differed. The imbalance between prospective studies' size (10 to 144 patients) and the differences in their design disfavor a meta-analysis. One retrospective study showed improved hemodynamics combining metoprolol and milrinone in septic patients, and another retrospective study found no association between beta-blocker administration and mortality. We also found three case series. Twenty-one experimental studies evaluated the hemodynamic, immune and/or metabolic effects of selective and/or non-selective beta-blockers in animal models of sepsis (dogs, mice, pigs, rats, sheep), yielding conflicting results. CONCLUSIONS Whilst there is not enough prospective data to conduct a meta-analysis, the available clinical data are promising. We discuss the ability of beta blockade to modulate sepsis-induced alterations at cardiovascular, metabolic, immunologic and coagulation levels.
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Affiliation(s)
- Filippo Sanfilippo
- a a Cardiothoracic Intensive Care Unit, Intensive Care Directorate - St George's University Hospitals NHS Foundation Trust , London , United Kingdom
| | - Cristina Santonocito
- b b Cardiothoracic Critical Care Unit, Oxford Heart Centre - John Radcliffe Hospital, Oxford University Hospitals , Oxford , United Kingdom
| | - Andrea Morelli
- c c Department of Cardiovascular , Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, University of Rome , 'La Sapienza' , Rome , Italy
| | - Pierre Foex
- d d Nuffield Division of Anaesthetics, University of Oxford - John Radcliffe Hospital , Oxford , United Kingdom
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Karvellas CJ, Cavazos J, Battenhouse H, Durkalski V, Balko J, Sanders C, Lee WM. Effects of antimicrobial prophylaxis and blood stream infections in patients with acute liver failure: a retrospective cohort study. Clin Gastroenterol Hepatol 2014. [PMID: 24674942 DOI: 10.106/j.cgh.2014.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND & AIMS We investigated whether antimicrobial prophylaxis alters the incidence of bloodstream infection in patients with acute liver failure (ALF), and whether bloodstream infections affect overall mortality within 21 days after development of ALF. METHODS We performed a retrospective cohort analysis of 1551 patients with ALF enrolled by the US Acute Liver Failure Study Group from January 1998 through November 2009. We analyzed data on infections in the first 7 days after admission and the effects of prophylaxis with antimicrobial drugs on the development of bloodstream infections and 21-day mortality. RESULTS In our study population, 600 patients (39%) received antimicrobial prophylaxis and 226 patients (14.6%) developed at least 1 bloodstream infection. Exposure to antimicrobial drugs did not affect the proportion of patients who developed bloodstream infections (12.8% in patients with prophylaxis vs 15.7% in nonprophylaxed patients; P = .12), but a greater percentage of patients who received prophylaxis received liver transplants (28% vs 22%; P = .01). After adjusting for confounding factors, overall mortality within 21 days was associated independently with age (odds ratio [OR], 1.014), Model for End-stage Liver Disease score at admission (OR, 1.078), and vasopressor administration at admission (OR, 2.499). Low grade of coma (OR, 0.47) and liver transplantation (OR, 0.101) reduced mortality. Although bloodstream infection was associated significantly with 21-day mortality (P = .004), an interaction between bloodstream infection and etiology was detected: blood stream infection affected mortality to a greater extent in nonacetaminophen ALF patients (OR, 2.03) than in acetaminophen ALF patients (OR, 1.14). CONCLUSIONS Based on a large, observational study, antimicrobial prophylaxis does not reduce the incidence of bloodstream infection or mortality within 21 days of ALF. However, bloodstream infections were associated with increased 21-day mortality in patients with ALF-to a greater extent in patients without than with acetaminophen-associated ALF. Our findings do not support the routine use of antimicrobial prophylaxis in patients with ALF.
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Affiliation(s)
| | - Jorge Cavazos
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Holly Battenhouse
- Faculty of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Valerie Durkalski
- Faculty of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Jody Balko
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Corron Sanders
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas
| | - William M Lee
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas.
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Karvellas CJ, Cavazos J, Battenhouse H, Durkalski V, Balko J, Sanders C, Lee WM; US Acute Liver Failure Study Group. Effects of antimicrobial prophylaxis and blood stream infections in patients with acute liver failure: a retrospective cohort study. Clin Gastroenterol Hepatol 2014; 12:1942-9.e1. [PMID: 24674942 DOI: 10.1016/j.cgh.2014.03.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 03/11/2014] [Accepted: 03/12/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS We investigated whether antimicrobial prophylaxis alters the incidence of bloodstream infection in patients with acute liver failure (ALF), and whether bloodstream infections affect overall mortality within 21 days after development of ALF. METHODS We performed a retrospective cohort analysis of 1551 patients with ALF enrolled by the US Acute Liver Failure Study Group from January 1998 through November 2009. We analyzed data on infections in the first 7 days after admission and the effects of prophylaxis with antimicrobial drugs on the development of bloodstream infections and 21-day mortality. RESULTS In our study population, 600 patients (39%) received antimicrobial prophylaxis and 226 patients (14.6%) developed at least 1 bloodstream infection. Exposure to antimicrobial drugs did not affect the proportion of patients who developed bloodstream infections (12.8% in patients with prophylaxis vs 15.7% in nonprophylaxed patients; P = .12), but a greater percentage of patients who received prophylaxis received liver transplants (28% vs 22%; P = .01). After adjusting for confounding factors, overall mortality within 21 days was associated independently with age (odds ratio [OR], 1.014), Model for End-stage Liver Disease score at admission (OR, 1.078), and vasopressor administration at admission (OR, 2.499). Low grade of coma (OR, 0.47) and liver transplantation (OR, 0.101) reduced mortality. Although bloodstream infection was associated significantly with 21-day mortality (P = .004), an interaction between bloodstream infection and etiology was detected: blood stream infection affected mortality to a greater extent in nonacetaminophen ALF patients (OR, 2.03) than in acetaminophen ALF patients (OR, 1.14). CONCLUSIONS Based on a large, observational study, antimicrobial prophylaxis does not reduce the incidence of bloodstream infection or mortality within 21 days of ALF. However, bloodstream infections were associated with increased 21-day mortality in patients with ALF-to a greater extent in patients without than with acetaminophen-associated ALF. Our findings do not support the routine use of antimicrobial prophylaxis in patients with ALF.
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Yilmaz TU, Kerem M, Demirtaş CY, Pasaoǧlu Ö, Taşcilar Ö, Şakrak Ö, Dikmen K, Karahan T. Increased Resistin Levels in Intra-abdominal Sepsis: Correlation with proinflammatory cytokines and Acute Physiology and Chronic Health Evaluation (APACHE) II scores. Sultan Qaboos Univ Med J 2014; 14:e506-e512. [PMID: 25364554 PMCID: PMC4205063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Revised: 04/08/2014] [Accepted: 04/24/2014] [Indexed: 06/04/2023] Open
Abstract
OBJECTIVES Resistin, a hormone secreted from adipocytes and considered to be a likely cause of insulin resistance, has recently been accepted as a proinflammatory cytokine. This study aimed to determine the correlation between resistin levels in patients with intra-abdominal sepsis and mortality. METHODS Of 45 patients with intra-abdominal sepsis, a total of 35 adult patients were included in the study. This study was undertaken from December 2011 to December 2012 and included patients who had no history of diabetes mellitus and who were admitted to the general surgery intensive care units of Gazi University and Bülent Ecevit University School of Medicine, Turkey. Evaluations were performed on 12 patients with sepsis, 10 patients with severe sepsis, 13 patients with septic shock and 15 healthy controls. The patients' plasma resistin, interleukin-6 (IL-6), tumour necrosis factor alpha (TNF-α), interleukin-1 beta (IL-1β), procalcitonin, lactate and glucose levels and Acute Physiology and Chronic Health Evaluation (APACHE) II scores were studied daily for the first five days after admission. A correlation analysis of serum resistin levels with cytokine levels and APACHE II scores was performed. RESULTS Serum resistin levels in patients with sepsis were significantly higher than in the healthy controls (P <0.001). A significant correlation was found between serum resistin levels and APACHE II scores, serum IL-6, IL-1β, TNF-α, procalcitonin, lactate and glucose levels. Furthermore, a significant correlation was found between serum resistin levels and all-cause mortality (P = 0.02). CONCLUSION The levels of resistin were significantly positively correlated with the severity of disease and were a possible mediator of a prolonged inflammatory state in patients with intra-abdominal sepsis.
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Affiliation(s)
- Tonguç U. Yilmaz
- Department of General Surgery, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Mustafa Kerem
- Departments of General Surgery, Gazi University, Ankara, Turkey
| | | | - Özge Pasaoǧlu
- Medical Biochemistry, Gazi University, Ankara, Turkey
| | - Öge Taşcilar
- Departments of General Surgery, Gazi University, Ankara, Turkey
| | - Ömer Şakrak
- Medical Biochemistry, Gazi University, Ankara, Turkey
| | - Kürşat Dikmen
- Departments of General Surgery, Gazi University, Ankara, Turkey
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Çekmen N, Açiksöz S, Serdaroğlu H, Erdemli Ö. A pulmonary aspergillosis case with fatal course in a patient with SIRS clinic. J Res Med Sci 2011; 16:219-23. [PMID: 22091235 PMCID: PMC3214307] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Accepted: 08/12/2010] [Indexed: 11/02/2022]
Abstract
A 77-year-old male patient with a history of tuberculosis applied to emergency service with complaints of confusion, shortness of breath, tachycardia, hypothermia and hypotension. A bronchoalveolar lavage culture was collected because a fungus ball was seen on repeat chest X-ray and thoracic CT of the patient. Aspergillus fumigatus grew and voricona-zole treatment was started, but the patient was lost from multiple organ failure (MOF). In diagnosis of patients with SIRS clinic, causative factor may be aspergillus located in an old tuberculosis cavity, and this may have a fatal course in an old patient having previous pulmonary and systemic diseases.
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Affiliation(s)
- Nedim Çekmen
- Güven Hospital, Department of Anesthesiology and Intensive Care, Şimşek Sok, Kavaklıdere, Ankara, Turkey., Corresponding Author E-mail:
| | - Sonay Açiksöz
- Güven Hospital, Department of Anesthesiology and Intensive Care, Şimşek Sok, Kavaklıdere, Ankara, Turkey
| | - Hacer Serdaroğlu
- Güven Hospital, Department of Anesthesiology and Intensive Care, Şimşek Sok, Kavaklıdere, Ankara, Turkey
| | - Özcan Erdemli
- Güven Hospital, Department of Anesthesiology and Intensive Care, Şimşek Sok, Kavaklıdere, Ankara, Turkey
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