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Yu J, Zhang K, Chen T, Lin R, Chen Q, Chen C, Tong M, Chen J, Yu J, Lou Y, Xu P, Zhong C, Chen Q, Sun K, Liu L, Cao L, Zheng C, Wang P, Chen Q, Yang Q, Chen W, Wang X, Yan Z, Zhang X, Cui W, Chen L, Zhang Z, Zhang G. Temporal patterns of organ dysfunction in COVID-19 patients hospitalized in the intensive care unit: A group-based multitrajectory modelling analysis. Int J Infect Dis 2024:107045. [PMID: 38604470 DOI: 10.1016/j.ijid.2024.107045] [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: 12/29/2023] [Revised: 03/19/2024] [Accepted: 04/07/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND The course of organ dysfunction (OD) in Corona Virus Disease 2019 (COVID-19) patients is unknown. Herein, we analyse the temporal patterns of OD in intensive care unit-admitted COVID-19 patients. METHODS Sequential organ failure assessment scores were evaluated daily within 2 weeks of admission to determine the temporal trajectory of OD using group-based multitrajectory modelling (GBMTM). RESULTS 392 patients were enrolled with a 28-day mortality rate of 53.6%. GBMTM identified four distinct trajectories. Group 1 (mild OD, n=64), with a median APACHE II score of 13 (IQR 9-21), had an early resolution of OD and a low mortality rate. Group 2 (moderate OD, n=140), with a median APACHE II score of 18 (IQR 13-22), had a 28-day mortality rate of 30.0%. Group 3 (severe OD, n=117), with a median APACHR II score of 20 (IQR 13-27), had a deterioration trend of respiratory dysfunction and a 28-day mortality rate of 69.2%. Group 4 (extremely severe OD, n=71), with a median APACHE II score of 20 (IQR 17-27), had a significant and sustained OD affecting all organ systems and a 28-day mortality rate of 97.2%. CONCLUSIONS Four distinct trajectories of OD were identified, and respiratory dysfunction trajectory could predict nonpulmonary OD trajectories and patient prognosis.
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Affiliation(s)
- Jiafei Yu
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, China; Department of Critical Care Medicine, People's Hospital of Haiyan, Zhejiang 314399, China
| | - Kai Zhang
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, China
| | - Tianqi Chen
- Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China
| | - Ronghai Lin
- Department of Critical Care Medicine, Taizhou Municipal Hospital, Zhejiang, 318000, China
| | - Qijiang Chen
- Intensive Care Unit, Ninghai First Hospital, Zhejiang, 315699, China
| | - Chensong Chen
- Intensive Care Unit, Xiangshan First People's Hospital Medical and Health Group, Zhejiang, 315700, China
| | - Minfeng Tong
- Department of Neurosurgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Zhejiang, 321000, China
| | - Jianping Chen
- Department of Emergency Medicine, Dongyang People' Hospital of Wenzhou Medical university, Zhejiang, 322100, China
| | - Jianhua Yu
- Department of Critical Care Medicine, Longquan People's Hospital, Zhejiang, 323700, China
| | - Yuhang Lou
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, China
| | - Panpan Xu
- Department of Critical Care Medicine, Taizhou Municipal Hospital, Zhejiang, 318000, China
| | - Chao Zhong
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, China; Intensive Care Unit, Ninghai First Hospital, Zhejiang, 315699, China
| | - Qianfeng Chen
- Intensive Care Unit, Xiangshan First People's Hospital Medical and Health Group, Zhejiang, 315700, China
| | - Kangwei Sun
- Department of Emergency Medicine, Dongyang People' Hospital of Wenzhou Medical university, Zhejiang, 322100, China
| | - Liyuan Liu
- Department of Critical Care Medicine, Longquan People's Hospital, Zhejiang, 323700, China
| | - Lanxin Cao
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, China
| | - Cheng Zheng
- Department of Critical Care Medicine, Taizhou Municipal Hospital, Zhejiang, 318000, China
| | - Ping Wang
- Intensive Care Unit, Ninghai First Hospital, Zhejiang, 315699, China
| | - Qitao Chen
- Department of Neurosurgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Zhejiang, 321000, China
| | - Qianqian Yang
- Department of Neurosurgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Zhejiang, 321000, China
| | - Weiting Chen
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, China; Department of Emergency and Intensive Care Unit, The First People's Hospital of Linhai, Taizhou, Zhejiang 317000, China
| | - Xiaofang Wang
- Department of Cardiovascular Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, China
| | - Zuxi Yan
- Department of Critical Care Medicine, People's Hospital of Haiyan, Zhejiang 314399, China
| | - Xuefeng Zhang
- Department of Critical Care Medicine, Second Affiliated Hospital, Jiaxing College School of Medicine, Jiaxing 314031, China
| | - Wei Cui
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, China
| | - Lin Chen
- Department of Neurosurgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Zhejiang, 321000, China
| | - Zhongheng Zhang
- Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China
| | - Gensheng Zhang
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, China; Key Laboratory of Multiple Organ Failure (Zhejiang University), Ministry of Education, Hangzhou 310009, China.
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Shimada H, Matsuoka Y, Miyakoshi C, Ito J, Seo R, Ariyoshi K, Yamamoto Y, Mima H. Predictive performance of the sequential organ failure assessment score for in-hospital mortality in patients with end-stage kidney disease in intensive care units: A multicenter registry in Japan. Ther Apher Dial 2024; 28:305-313. [PMID: 37985004 DOI: 10.1111/1744-9987.14089] [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: 08/31/2023] [Revised: 10/25/2023] [Accepted: 11/09/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION There is limited evidence regarding whether the performance of the Sequential Organ Failure Assessment (SOFA) score differs between patients with and without end-stage kidney disease (ESKD) in intensive care units (ICUs). METHODS We used a multicenter registry (Japanese Intensive care Patient Database) to enroll adult ICU patients between April 2018 and March 2021. We recalibrated the SOFA score using a logistic regression model and evaluated its predictive ability in both ESKD and non-ESKD groups. The primary outcome was in-hospital mortality. RESULTS 128 134 patients were enrolled. The AUROC of the SOFA score was lower in the ESKD group than in the non-ESKD group [0.789 (95% CI, 0.774-0.804) vs. 0.846 (95% CI, 0.841-0.850)]. The calibration plot revealed good performance in both groups. However, it overestimated in-hospital mortality in ESKD groups. CONCLUSION The SOFA score demonstrated good predictive ability in patients with and without ESKD, but it overestimated the in-hospital mortality in ESKD patients.
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Affiliation(s)
- Hiroki Shimada
- Department of Anesthesia and Critical Care, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Yoshinori Matsuoka
- Department of Emergency Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
- Center for Clinical Research and Innovation, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Chisato Miyakoshi
- Center for Clinical Research and Innovation, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Jiro Ito
- Department of Anesthesia and Critical Care, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Ryutaro Seo
- Department of Emergency Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Koichi Ariyoshi
- Department of Emergency Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Yosuke Yamamoto
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Hiroyuki Mima
- Department of Anesthesia and Critical Care, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
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Murata T, Yamaguchi N, Shimomoto Y, Mikajiri Y, Sasaki Y, Konagaya K, Igarashi Y, Sawamura N, Yamamoto K, Kume N, Suno Y, Kurata S, Kasetani T, Kato I, Nishida T, Hirata H, Miyake K, Oonishi T, Isogai N, Fukai R, Kanomata H, Shimoyama R, Kashiwagi H, Takenoue T, Terashima T, Murayama H, Kohriki S, Morita T, Takaki M, Ogino H, Kanemaru T, Sano K, Kurogi N, Watanabe K, Hirata M, Kawachi J. Preoperative prognostic predictors and treatment strategies for surgical procedure focused on the sequential organ failure assessment score in nonocclusive mesenteric ischemia: a multicenter retrospective cohort study. Int J Surg 2023; 109:4119-4125. [PMID: 37720948 PMCID: PMC10720829 DOI: 10.1097/js9.0000000000000733] [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: 06/12/2023] [Accepted: 08/21/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Several large-scale studies have assessed endovascular and surgical treatment methods for nonocclusive mesenteric ischemia (NOMI); however, the prognostic factors for NOMI remain unclear. Therefore, this study aimed to evaluate risk factors for in-hospital mortality among patients with NOMI who underwent laparotomy and to examine therapeutic strategies that may improve the prognosis. MATERIALS AND METHODS In this multicenter retrospective study, the authors reviewed the electronic medical records retrieved from the inpatient database of patients with NOMI at eight district general hospitals between January 2011 and January 2021. A total of 88 patients who underwent laparotomies were divided into survivor and nonsurvivor groups, and statistical analysis was performed to determine clinical and physiological factors. RESULTS Exploratory laparotomy based on second-look surgery was the first treatment choice. The overall mortality rate was 48.8%, with a male-to-female ratio of 1.1:1. The median Sequential Organ Failure Assessment (SOFA) score was 8 [interquartile range: 3.75-14.2], and the median SOFA scores were 5 [3-7] in the survivor group and 13 [9-17.5] in the nonsurvivor group. Univariate analysis revealed a significant difference in BMI ( P <0.001), hypoglycemia ( P =0.0012), previous cardiovascular surgery ( P =0.0019), catecholamine use ( P <0.001), SOFA score ( P <0.001), platelet count ( P =0.0023), and lactate level ( P <0.001). Logistic regression analysis using the factors with significant differences revealed that SOFA score ≥10 (odds ratio 23.3; 95% CI: 1.94-280.00; P =0.013) was an independent prognostic factor. In addition, catecholamine use was suggested as a factor with a SOFA score greater than or equal to 10. CONCLUSION This study confirmed that a SOFA score of greater than or equal to 10 may be associated with increased mortality. While closely monitoring low blood pressure and renal dysfunction, survival rates may be improved if surgical intervention is performed before the SOFA score reaches greater than or equal to 10.
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Affiliation(s)
| | | | - Yutaro Shimomoto
- Department of General Surgery, Tokyo Nishi Tokushukai Hospital, Tokyo, Japan
| | - Yumi Mikajiri
- Department of General Surgery, Shonan Atsugi Hospital
| | - Yuki Sasaki
- Department of General Surgery, Shonan Fujisawa Tokushukai Hospital
| | - Kensuke Konagaya
- Department of General Surgery, Narita Tomisato Tokushukai Hospital, Chiba
| | | | - Naoki Sawamura
- Department of General Surgery, Shonan Fujisawa Tokushukai Hospital
| | - Kota Yamamoto
- Department of General Surgery, Shonan Atsugi Hospital
| | - Nao Kume
- Department of General Surgery, Narita Tomisato Tokushukai Hospital, Chiba
| | | | - Shuji Kurata
- Department of General Surgery, Shonan Fujisawa Tokushukai Hospital
| | - Tetsuya Kasetani
- Department of General Surgery, Matsubara Tokushukai Hospital, Osaka
| | - Ichiro Kato
- Department of General Surgery, Sendai Tokushukai Hospital, Miyagi
| | | | - Hirohisa Hirata
- Department of General Surgery, Matsubara Tokushukai Hospital, Osaka
| | | | - Takahisa Oonishi
- Department of General Surgery, Yamato Tokushukai Hospital, Kanagawa
| | | | | | | | | | | | | | | | - Hiroyuki Murayama
- Department of General Surgery, Narita Tomisato Tokushukai Hospital, Chiba
| | - Shunsaku Kohriki
- Department of General Surgery, Shonan Fujisawa Tokushukai Hospital
| | - Takeshi Morita
- Department of General Surgery, Matsubara Tokushukai Hospital, Osaka
| | - Mutsuo Takaki
- Department of General Surgery, Tokyo Nishi Tokushukai Hospital, Tokyo, Japan
| | - Hidemitsu Ogino
- Department of General Surgery, Narita Tomisato Tokushukai Hospital, Chiba
| | | | - Ken Sano
- Department of General Surgery, Sendai Tokushukai Hospital, Miyagi
| | | | - Kazunao Watanabe
- Center for Clinical and Translational Science, Shonan Kamakura General Hospital
| | - Masahiro Hirata
- Center for Clinical and Translational Science, Shonan Kamakura General Hospital
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Kawasaki H, Fudamoto K, Yamamoto M, Iwaanakuchi T, Yoshida T, Hashiguchi T, Uto Y. Verification of the relationship between the sequential organ failure assessment score and the length of intensive care unit and hospital stay in terms of medical resources input. Medicine (Baltimore) 2023; 102:e34632. [PMID: 37657061 PMCID: PMC10476806 DOI: 10.1097/md.0000000000034632] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/17/2023] [Indexed: 09/03/2023] Open
Abstract
This study aimed to clarify the relationship between the sequential organ failure assessment (SOFA) score and the length of intensive care unit (ICU) and hospital stays and verify whether the SOFA score can indicate the optimal length of ICU stay. Medical resource input was evaluated as the medical treatment score, converted by volume, within 2 days after ICU admission. After classifying emergency patients into surgical and nonsurgical categories, the relationship between medical resources, SOFA score, and ICU and hospital stay lengths was analyzed. Medical resource input was high when the SOFA score was high after ICU admission. A positive correlation was confirmed between the SOFA score and length of ICU stay in surgical and nonsurgical patients. Nonsurgical patients are more likely to be discharged within the diagnosis procedure combination hospital stages I and II if medical resources are high in the initial stages of ICU admission. The SOFA score affects medical resource input and the length of ICU stay. The early input of medical resources after ICU admission reduces the length of hospital stay in the diagnosis procedure combination, suggesting that the SOFA score is a valuable indicator of the optimal length of ICU stay.
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Affiliation(s)
- Hirofumi Kawasaki
- Department of Medical Information Sciences, Graduate School of Medical and Dental Sciences, Kagoshima University, Sakuragaoka, Kagoshima-city, Kagoshima, Japan
- Department of Nursing, Kagoshima City Hospital, Uearata-cho, Kagoshima-city, Kagoshima, Japan
| | - Kazue Fudamoto
- Department of Nursing, Kagoshima City Hospital, Uearata-cho, Kagoshima-city, Kagoshima, Japan
| | - Mutsumi Yamamoto
- Department of Nursing, Kagoshima City Hospital, Uearata-cho, Kagoshima-city, Kagoshima, Japan
| | - Takashi Iwaanakuchi
- Department of Medical Information Sciences, Graduate School of Medical and Dental Sciences, Kagoshima University, Sakuragaoka, Kagoshima-city, Kagoshima, Japan
- Department of Medical Informatics, Kagoshima University Hospital, Sakuragaoka, Kagoshima-city, Kagoshima, Japan
| | - Takuma Yoshida
- Mathematics and Computer Science, Graduate School of Science and Engineering, Kagoshima University, Korimoto, Kagoshima-city, Kagoshima, Japan
| | - Teruto Hashiguchi
- Department of Laboratory and Vascular Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Sakuragaoka, Kagoshima-city, Kagoshima, Japan
| | - Yumiko Uto
- Department of Medical Informatics, Kagoshima University Hospital, Sakuragaoka, Kagoshima-city, Kagoshima, Japan
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Tang J, Yuan H, Wu YL, Fu S, Pan XY. The Predictive Value of Heparin-Binding Protein and D-Dimer in Patients with Sepsis. Int J Gen Med 2023; 16:2295-2303. [PMID: 37304904 PMCID: PMC10257474 DOI: 10.2147/ijgm.s409328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/10/2023] [Indexed: 06/13/2023] Open
Abstract
Objective To explore the serial measurement of heparin-binding protein and D-dimer in the prediction of 28-day mortality and efficacy evaluation of critically-ill patients with sepsis. Methods We recruited a total of 51 patients with sepsis in the ICU of our hospital. They were divided into a survival group or a death group according to their prognosis 28 days after treatment. The HBP and D-dimer levels in these patients were determined on the 1st (24h), 3rd, and 5th days. Besides, the sequential organ failure assessment (SOFA) score of these patients was recorded at admission. The patients in both groups were subjected to comparison regarding HBP and D-dimer levels and SOFA scores within 24h of admission. Additionally, a correlation between the levels of HBP and D-dimer and the SOFA score was statistically measured, while the predictive effectiveness of these factors for the prognosis of patients with sepsis was also determined. Moreover, the dynamic changes in HBP and D-dimer during the treatment of both groups were analyzed. Results The HBP and D-dimer levels and the SOFA scores in the survival group were considerably lower than those in the death group, and the differences were statistically significant (P<0.05). Additionally, the levels of HBP and D-dimer in sepsis patients were positively correlated with the SOFA score (P<0.05). The area under the curve (AUC) of HBP, D-dimer, and their combination in predicting the prognosis of patients with sepsis was 0.824, 0.771, and 0.830, respectively. Besides, the sensitivity and specificity of their combination in predicting the prognosis of patients with sepsis were 68.42% and 92.31%, respectively. The HBP and D-dimer levels presented a downward trend in the survival group during treatment, while they exhibited an upward trend in the death group. Conclusion HBP and D-dimer realize high predictive effectiveness for the prognosis of patients with sepsis, while the combined use of these two factors achieves superior effectiveness. Thus, they can be applied to the prediction of 28-day mortality and efficacy evaluation of sepsis patients.
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Affiliation(s)
- Jian Tang
- Department of Intensive Care, First People’s Hospital of Linping District, Hangzhou, Zhejiang Province, People’s Republic of China
| | - Hong Yuan
- Department of Cardiology, First People’s Hospital of Linping District, Hangzhou, Zhejiang Province, People’s Republic of China
| | - Yun Long Wu
- Department of Intensive Care, First People’s Hospital of Linping District, Hangzhou, Zhejiang Province, People’s Republic of China
| | - Shui Fu
- Clinical Laboratory Department, First People’s Hospital of Linping District, Hangzhou, Zhejiang Province, People’s Republic of China
| | - Xiao Yong Pan
- Clinical Laboratory Department, The People’s Hospital of Cangnan Zhejiang, Wenzhou, Zhejiang Province, People’s Republic of China
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Soltesz A, Molnar ZA, Szakal-Toth Z, Tamaska E, Katona H, Fabry S, Csikos G, Berzsenyi V, Tamas C, Edes IF, Gal J, Merkely B, Nemeth E. Influence of Venoarterial Extracorporeal Membrane Oxygenation Integrated Hemoadsorption on the Early Reversal of Multiorgan and Microcirculatory Dysfunction and Outcome of Refractory Cardiogenic Shock. J Clin Med 2022; 11:jcm11216517. [PMID: 36362744 PMCID: PMC9657372 DOI: 10.3390/jcm11216517] [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: 09/15/2022] [Revised: 10/25/2022] [Accepted: 10/29/2022] [Indexed: 11/06/2022] Open
Abstract
Background: The purpose of this investigation was to evaluate the impact of venoarterial extracorporeal membrane oxygenation (VA−ECMO) integrated hemoadsorption on the reversal of multiorgan and microcirculatory dysfunction, and early mortality of refractory cardiogenic shock patients. Methods: Propensity score−matched cohort study of 29 pairs of patients. Subjects received either VA−ECMO supplemented with hemoadsorption or standard VA−ECMO management. Results: There was a lower mean sequential organ failure assessment score (p = 0.04), lactate concentration (p = 0.015), P(v−a)CO2 gap (p < 0.001), vasoactive inotropic score (p = 0.007), and reduced delta C−reactive protein level (p = 0.005) in the hemoadsorption compared to control groups after 72 h. In−hospital mortality was similar to the predictions in the control group (62.1%) and was much lower than the predicted value in the hemoadsorption group (44.8%). There were less ECMO-associated bleeding complications in the hemoadsorption group compared to controls (p = 0.049). Overall, 90-day survival was better in the hemoadsorption group than in controls without statistical significance. Conclusion: VA−ECMO integrated hemoadsorption treatment was associated with accelerated recovery of multiorgan and microcirculatory dysfunction, mitigated inflammatory response, less bleeding complications, and lower risk for early mortality in comparison with controls.
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Affiliation(s)
- Adam Soltesz
- Heart and Vascular Center, Semmelweis University, H-1122 Budapest, Hungary
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, H-1085 Budapest, Hungary
| | - Zsofia Anna Molnar
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, H-1085 Budapest, Hungary
| | - Zsofia Szakal-Toth
- Heart and Vascular Center, Semmelweis University, H-1122 Budapest, Hungary
| | - Eszter Tamaska
- Heart and Vascular Center, Semmelweis University, H-1122 Budapest, Hungary
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, H-1085 Budapest, Hungary
| | - Hajna Katona
- Heart and Vascular Center, Semmelweis University, H-1122 Budapest, Hungary
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, H-1085 Budapest, Hungary
| | - Szabolcs Fabry
- Heart and Vascular Center, Semmelweis University, H-1122 Budapest, Hungary
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, H-1085 Budapest, Hungary
| | - Gergely Csikos
- Heart and Vascular Center, Semmelweis University, H-1122 Budapest, Hungary
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, H-1085 Budapest, Hungary
| | - Viktor Berzsenyi
- Heart and Vascular Center, Semmelweis University, H-1122 Budapest, Hungary
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, H-1085 Budapest, Hungary
| | - Csilla Tamas
- Heart and Vascular Center, Semmelweis University, H-1122 Budapest, Hungary
| | - Istvan Ferenc Edes
- Heart and Vascular Center, Semmelweis University, H-1122 Budapest, Hungary
| | - Janos Gal
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, H-1085 Budapest, Hungary
| | - Bela Merkely
- Heart and Vascular Center, Semmelweis University, H-1122 Budapest, Hungary
| | - Endre Nemeth
- Heart and Vascular Center, Semmelweis University, H-1122 Budapest, Hungary
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, H-1085 Budapest, Hungary
- Correspondence: ; Tel.: +36-1-4586810
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Veraar C, Kirschner E, Schwarz S, Jaksch P, Hoetzenecker K, Tschernko E, Dworschak M, Ankersmit HJ, Moser B. Follistatin-like 1 and Biomarkers of Neutrophil Activation Are Associated with Poor Short-Term Outcome after Lung Transplantation on VA-ECMO. Biology (Basel) 2022; 11:biology11101475. [PMID: 36290379 PMCID: PMC9598172 DOI: 10.3390/biology11101475] [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] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/17/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022]
Abstract
The investigation of biomarkers associated with undesired outcome following lung transplantation (LuTX) is essential for a better understanding of the underlying pathophysiology, an earlier identification of susceptible recipients and the development of targeted therapeutic options. We therefore determined the longitudinal perioperative course of putative cytokines related to neutrophil activation (chemokine CC motif ligand 4 (CCL-4), interleukin (IL)-23 and Lipocalin 2 (LCN2)) and a cytokine that has been implicated in graft-versus-host disease (Follistatin-like 1 (FSTL1)) in 42 consecutive patients undergoing LuTX. We plotted receiver-operating curves (ROC) to assess the predictive power of the measured cytokines for short-term outcomes namely primary graft dysfunction (PGD), early complications requiring extracorporeal membrane oxygenation (ECMO), and a high postoperative sequential organ failure assessment (SOFA). All cytokines increased immediately after surgery. ROC analyses determined significant associations between CCL4 and a high SOFA score (area under the curve (AUC) 0.74 (95%CI:0.5−0.9; p < 0.05), between LCN2 and postoperative ECMO support (AUC 0.73 (95%CI:0.5−0.9; p < 0.05), and between FSTL1 and PGD (AUC 0.70 (95%CI:0.5−0.9; p < 0.05). The serum concentrations of the neutrophil-derived cytokines LCN2 and CCL4 as well as FSTL1 were all related to poor outcome after LuTX. The specific predictive power, however, still has to be assessed in larger trials. The potential role of FSTL1 as a biomarker in the development of PGD could be of great interest particularly since this protein appears to play a crucial role in allograft tolerance.
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Affiliation(s)
- Cecilia Veraar
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, 1090 Vienna, Austria
- Applied Immunology Laboratory, Medical University of Vienna, 1090 Vienna, Austria
- Correspondence:
| | - Enzo Kirschner
- Department of Thoracic Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Stefan Schwarz
- Department of Thoracic Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Peter Jaksch
- Department of Thoracic Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Konrad Hoetzenecker
- Department of Thoracic Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Edda Tschernko
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Martin Dworschak
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Hendrik J. Ankersmit
- Applied Immunology Laboratory, Medical University of Vienna, 1090 Vienna, Austria
- Department of Thoracic Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Bernhard Moser
- Department of Thoracic Surgery, Medical University of Vienna, 1090 Vienna, Austria
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Oh AR, Park J, Lee JH, Choi DC, Yang K, Choi JH, Ahn J, Sung JD, Lee S. Association between Mortality and Sequential Organ Failure Assessment Score during a Short Stay in the Intensive Care Unit after Non-Cardiac Surgery. J Clin Med 2022; 11:jcm11195865. [PMID: 36233732 PMCID: PMC9573186 DOI: 10.3390/jcm11195865] [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: 08/29/2022] [Revised: 09/28/2022] [Accepted: 09/28/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The sequential organ failure assessment (SOFA) score has been validated in various clinical situations. However, it has not been investigated during a short stay in the intensive care unit (ICU). This study aimed to evaluate the association between the SOFA score and outcomes in patients who were monitored for less than one day after non-cardiac surgery. Methods: From a total of 203,787 consecutive adult patients who underwent non-cardiac surgery between January 2011 and June 2019, we selected 17,714 who were transferred to the ICU immediately after surgery and stayed for less than 24 h. Patients were divided according to quartile value and change between the initial and follow-up levels of SOFA score. Results: Three-year mortality tended to increase with a higher initial SOFA score (11.7%, 11.8%, 15.1%, and 17.8%, respectively). The patients were divided according to changes in the SOFA score at the midnight postoperative follow-up check: 16,176 (91.3%) in the stable group and 1538 (8.7%) in the worsened group. The worsened group showed significantly higher three-year mortality and complications (13.2% vs. 18.6%; HR [hazard ratio]: 1.236; 95% CI [confidence interval]: 1.108−1.402; p ≤ 0.0021 for three-year mortality and 3.8% vs. 9.1%; HR: 2.13; 95% CI: 1.73−2.60; p < 0.001 for acute kidney injury). Conclusions: The SOFA score during a short stay in the ICU after non-cardiac surgery showed an association with mortality. The change in SOFA score may need to be considered at discharge from the ICU.
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Affiliation(s)
- Ah Ran Oh
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Jungchan Park
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon 16499, Korea
| | - Jong-Hwan Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Dan-Cheong Choi
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Kwangmo Yang
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon 16499, Korea
- Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Jin-ho Choi
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Joonghyun Ahn
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul 06351, Korea
| | - Ji Dong Sung
- Rehabilitation and Prevention Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Seunghwa Lee
- Rehabilitation and Prevention Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul 07061, Korea
- Correspondence:
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Martens B, Driessen RG, Brandts L, Hoitinga P, van Veen F, Driessen M, Weberndörfer V, Kietselaer B, Ghossein-Doha C, Gietema HA, Vernooy K, van der Horst IC, Wildberger JE, van Bussel BC, Mihl C. Coronary Artery Calcifications Are Associated With More Severe Multiorgan Failure in Patients With Severe Coronavirus Disease 2019 Infection: Longitudinal Results of the Maastricht Intensive Care COVID Cohort. J Thorac Imaging 2022; 37:217-224. [PMID: 35412497 PMCID: PMC9223512 DOI: 10.1097/rti.0000000000000648] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is regarded as a multisystemic disease. Patients with preexisting cardiovascular disease have an increased risk for a more severe disease course. This study aimed to investigate if a higher degree of coronary artery calcifications (CAC) on a standard chest computed tomography (CT) scan in mechanically ventilated patients was associated with a more severe multiorgan failure over time. MATERIALS AND METHODS All mechanically ventilated intensive care unit patients with SARS-CoV-2 infection who underwent a chest CT were prospectively included. CT was used to establish the extent of CAC using a semiquantitative grading system. We categorized patients into 3 sex-specific tertiles of CAC: lowest, intermediate, and highest CAC score. Daily, the Sequential Organ Failure Assessment (SOFA) scores were collected to evaluate organ failure over time. Linear mixed-effects regression was used to investigate differences in SOFA scores between tertiles. The models were adjusted for age, sex, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, cardiovascular risk factors, and chronic liver, lung, and renal disease. RESULTS In all, 71 patients were included. Patients in the highest CAC tertile had, on average, over time, 1.8 (0.5-3.1) points higher SOFA score, compared with the lowest CAC tertile ( P =0.005). This association remained significant after adjustment for age, sex, and APACHE II score (1.4 [0.1-2.7], P =0.042) and clinically relevant after adjustment for cardiovascular risk factors (1.3 [0.0-2.7], P =0.06) and chronic diseases (1.3 [-0.2 to 2.7], P =0.085). CONCLUSION A greater extent of CAC is associated with a more severe multiorgan failure in mechanically ventilated coronavirus disease 2019 patients.
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Affiliation(s)
- Bibi Martens
- Departments of Radiology and Nuclear Medicine
- Cardiovascular Research Institute Maastricht (CARIM)
| | - Rob G.H. Driessen
- Intensive Care Medicine
- Cardiology
- Cardiovascular Research Institute Maastricht (CARIM)
| | - Lloyd Brandts
- Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+
| | | | | | | | | | - Bas Kietselaer
- Department of Cardiology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
| | - Chahinda Ghossein-Doha
- Intensive Care Medicine
- Cardiovascular Research Institute Maastricht (CARIM)
- School for Oncology & Developmental Biology (GROW)
- Department of Cardiology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
| | - Hester A. Gietema
- Departments of Radiology and Nuclear Medicine
- School for Oncology & Developmental Biology (GROW)
| | | | | | - Joachim E. Wildberger
- Departments of Radiology and Nuclear Medicine
- Cardiovascular Research Institute Maastricht (CARIM)
| | - Bas C.T. van Bussel
- Intensive Care Medicine
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht
| | - Casper Mihl
- Departments of Radiology and Nuclear Medicine
- Cardiovascular Research Institute Maastricht (CARIM)
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10
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Szczeklik W, Fronczek J. Should we revise the SOFA score? Yes. Acta Anaesthesiol Scand 2022; 66:658-659. [PMID: 35332524 DOI: 10.1111/aas.14060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/15/2022] [Accepted: 03/21/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Wojciech Szczeklik
- Centre for Intensive Care and Perioperative Medicine Jagiellonian University Medical College Kraków Poland
| | - Jakub Fronczek
- Centre for Intensive Care and Perioperative Medicine Jagiellonian University Medical College Kraków Poland
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11
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Kuroda H, Tatsumi H, Sonoda T, Masuda Y. A Suggested Link Between Antithrombin Dose and Rate of Recovery from Disseminated Intravascular Coagulation in Patients with Severe Organ Failure. Clin Appl Thromb Hemost 2022; 28:10760296221080942. [PMID: 35187966 PMCID: PMC8864266 DOI: 10.1177/10760296221080942] [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] [Indexed: 11/25/2022] Open
Abstract
Introduction The efficacy of antithrombin (AT) supplementation against septic disseminated
intravascular coagulation (DIC) may depend on various pre-existing factors,
particularly the AT dose and multiple organ dysfunction severity. This study
aimed to identify the impactful factors for early DIC recovery. Methods Patients’ clinical records, including AT therapy and septic DIC data, were
retrospectively extracted from January 2015 to December 2020. The patients
were divided into those with early DIC recovery (n = 34) and those without
(n = 37). Multivariate logistic regression analysis determined significant
independent factors. Time-to-event analysis confirmed how these factors
affected the DIC recovery time. Results The AT dose per patient body weight (odds ratio [95% confidence interval]:
2.879 [1.031-8.042], P = 0.044) and pre-existing organ
dysfunction severity (0.333 [0.120-0.920], P = 0.034) were
significant independent factors affecting early DIC recovery. A higher AT
dose significantly shortened the DIC recovery time among patients with
severe organ dysfunction (P < 0.01), but not among
non-severe patients (P = 0.855). Conclusion The therapeutic efficacy of AT treatment for septic DIC might depend on the
severity of pre-existing organ failure and the AT dose per patient body
weight.
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Affiliation(s)
- Hiromitsu Kuroda
- Department of Intensive Care Medicine, 13035Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hiroomi Tatsumi
- Department of Intensive Care Medicine, 13035Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tomoko Sonoda
- Department of Public Health, 92187Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yoshiki Masuda
- Department of Intensive Care Medicine, 13035Sapporo Medical University School of Medicine, Sapporo, Japan
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12
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Jin B, Cao D, Yang N, Wang L, Li R, Liu X, Gong P. Early High-dose Continuous Veno-venous Hemofiltration Alleviates the Alterations of CD4+ T Lymphocyte Subsets in Septic Patients Combined with Acute Kidney Injury. Artif Organs 2022; 46:1415-1424. [PMID: 35132659 DOI: 10.1111/aor.14199] [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: 09/21/2021] [Revised: 01/05/2022] [Accepted: 02/02/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study aims to determine whether early high-dose continuous venous-venous hemofiltration (CVVH) alleviates the alterations in CD4+ T lymphocyte subsets in septic patients combined with acute kidney injury. METHODS Enrolled septic patients combined with acute kidney injury were randomized into CVVH (n = 50) and conventional treatment (non-CVVH, n = 53) groups. Healthy volunteers (n = 21) were enrolled. CVVH was initiated within 12 h of intensive care unit (ICU) admission with the doses of 35 ~ 60 mL/kg/h and maintained for at least 72 h. Th1, Th2, Th17 and Treg were measured by flow cytometry on days 1, 3 and 7 of ICU admission. Sequential organ failure assessment (SOFA) scores were calculated. RESULTS Th1 percentages and Th1/Th2 ratios were lower, and Th2, Th17 and Treg percentages and Th17/Treg ratios were higher in septic patients compared to healthy volunteers. CVVH significantly increased Th1 percentages and Th1/Th2 ratios, and significantly decreased Th2, Th17 and Treg percentages and Th17/Treg ratios compared to non-CVVH. Th1 percentages and Th1/Th2 ratios were negatively correlated with SOFA scores, while Th2, Th17 and Treg percentages and Th17/Treg ratios were positively correlated with SOFA scores. Patients with CVVH had significantly lower SOFA scores on day 7 of ICU admission and a shorter ICU stay compared to those with non-CVVH. CONCLUSIONS Septic patients combined with acute kidney injury exhibit different alterations of CD4+ T lymphocyte subsets. Early high-dose CVVH alleviates the alterations, which may be one of factors associated with improved sepsis severity.
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Affiliation(s)
- Beibei Jin
- Department of Emergency, First Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, China.,Department of Emergency, First Affiliated Hospital of Hebei Medical University, Shijiazhuang City, Hebei Province, China
| | - Da Cao
- Department of Emergency, Southeast University Zhongda Hospital, 210009, Jiangsu, China
| | - Ning Yang
- Department of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, China
| | - Ling Wang
- Department of Emergency, First Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, China
| | - Ruifang Li
- Department of Emergency, First Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, China
| | - Xiumei Liu
- Department of Intensive Care Medicine, First Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, China
| | - Ping Gong
- Department of Emergency, First Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, China
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13
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Abstract
BACKGROUND The sequential organ failure assessment (SOFA) score, designed to evaluate sepsis-associated organ dysfunction in intensive care unit (ICU) patients, is associated with the prognosis of sepsis patients. MicroRNA-150 (miR-150) is one of the first miRs to be detected in patients with sepsis and other critical illnesses, and to have an association with the prognosis of critical illness and sepsis. OBJECTIVES To assess the predictive value of the combination of the SOFA score and miR-150 levels for the prognosis of sepsis patients. MATERIAL AND METHODS We retrospectively included 437 adult patients with sepsis who were divided into a death group (n = 138, 31.6%) and a survival group (n = 299, 68.4%), according to their survival status at the 28-day follow-up. Binary logistic regression was performed to identify independent associations. Receiver operator characteristic (ROC) curve was employed to assess the predictive values. The Z-test was used to compare the area under curve (AUC). RESULTS Multivariate analysis demonstrated that miR-150 (odds ratio (OR): 0.549, 95% confidence interval (95% CI) [0.372, 0.826], p < 0.001), the SOFA score (OR: 1.216, 95% CI [1.039, 1.807], p = 0.008), age, procalcitonin (PCT), and septic shock were independently associated with 28-day mortality of sepsis patients following the adjustment for chronic renal failure, hypertension, diabetes mellitus, activated partial thromboplastin time (APTT), serum creatinine (SCr), blood urea nitrogen (BUN), and total bilirubin (TBil). The AUC of miR-150, the SOFA score and their combination in predicting the 28-day mortality of sepsis patients was 0.762 (standard error (SE): 0.023, 95% CI [0.717, 0.808]), 0.735 (SE: 0.025, 95% CI [0.687, 0.784]) and 0.886 (SE: 0.015, 95% CI [0.857, 0.916]), respectively. The AUC of their combined prediction was significantly greater than the independent prediction (0.886 compared to 0.762, Z = 4.516, p < 0.001; 0.886 compared to 0.735, Z = 5.179, p < 0.001). The sensitivity and specificity of combination prediction were 86.2% and 80.6%, respectively. CONCLUSIONS The combination of the SOFA score and miR-150 could improve the prediction of prognosis in sepsis patients.
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Affiliation(s)
- Jun Yang
- Department of Critical Care Medicine, Central Hospital of Jiangjin District, Chongqing, China
| | - Youxin Liao
- Department of Medical Administration, Central Hospital of Jiangjin District, Chongqing, China
| | - Yonghong Dai
- Department of Critical Care Medicine, Central Hospital of Jiangjin District, Chongqing, China
| | - Ling Hu
- Department of Critical Care Medicine, Central Hospital of Jiangjin District, Chongqing, China
| | - Yihong Cai
- Department of Pediatrics, Central Hospital of Jiangjin District, Chongqing, China
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14
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Nandhini N, Malviya D, Parashar S, Pandey C, Nath SS, Tripathi M. Comparison of the effects of vitamin C and thiamine on refractory hypotension in patients with sepsis: A randomized controlled trial. Int J Crit Illn Inj Sci 2022; 12:138-145. [PMID: 36506923 PMCID: PMC9728072 DOI: 10.4103/ijciis.ijciis_107_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/28/2022] [Accepted: 02/02/2022] [Indexed: 12/15/2022] Open
Abstract
Background The study aimed to compare the effect of thiamine and ascorbic acid (AA) on mortality, sequential organ failure assessment (SOFA) score, duration and dose of vasopressor support, and need for renal replacement therapy (RRT) in patients with septic shock with refractory hypotension. Methods Consenting adult patients with septic shock and refractory hypotension were included in this study. Patients were divided into three groups: Group A received 100 ml of balanced salt solution 8 hourly, Group B received 2 mg/kg of thiamine 8 hourly, Group C received 25 mg/kg of AA 8 hourly intravenous (IV) for 72 h. All patients received IV infusion of hydrocortisone 200 mg/day for 72 h. Serum lactate, dose and duration of vasopressor support, SOFA score, need for RRT and hospital mortality were analyzed. Results The SOFA Score was significantly lower in Group B than in Group A and C at 24, 48, and 72 h. Dosage of norepinephrine was lower in Group B at 66 h and after that, whereas in Groups A and C, it was comparable at all time points. Mortality in Group B was significantly lower but comparable in Groups A and C. The need for RRT was significantly lower in Group B (44%) compared to the control group (88%) but comparable in Group C (76%). Conclusion In patients with septic shock treated with hydrocortisone, co-treatment with thiamine led to earlier correction of organ dysfunction, reduced need for RRT, and improved mortality compared to patients treated with AA or balanced salt solution. The addition of AA did not yield measurable benefits beyond hydrocortisone alone.
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Affiliation(s)
- N Nandhini
- Department of Anesthesiology and Critical Care Medicine, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Deepak Malviya
- Department of Anesthesiology and Critical Care Medicine, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Samiksha Parashar
- Department of Anesthesiology and Critical Care Medicine, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Chandrakant Pandey
- Department of Anesthesiology, Medanta Hospital, Lucknow, Uttar Pradesh, India
| | - Soumya Sankar Nath
- Department of Anesthesiology and Critical Care Medicine, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India,Address for correspondence: Dr. Soumya Sankar Nath, Department of Anaesthesiology and Critical Care Medicine, Dr. Ram Manohar Lohia Institute of Medical Sciences, Vibhuti Khand, Lucknow - 226 010, Uttar Pradesh, India. E-mail:
| | - Manoj Tripathi
- Department of Anesthesiology and Critical Care Medicine, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Murata T, Kawachi J, Igarashi Y, Suno Y, Nishida T, Miyake K, Isogai N, Fukai R, Kashiwagi H, Shimoyama R, Hirata M, Shinozaki N. Monitoring the Sequential Organ Failure Assessment score in nonocclusive mesenteric ischemia increases the survival rate: A single-center observational study. Medicine (Baltimore) 2021; 100:e28056. [PMID: 35049224 PMCID: PMC9191297 DOI: 10.1097/md.0000000000028056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 11/10/2021] [Indexed: 11/25/2022] Open
Abstract
Several large-scale studies have assessed the endovascular and surgical treatments for nonocclusive mesenteric ischemia (NOMI); nonetheless, the prognostic factors for NOMI remain unclear.In this single-center study, we retrospectively reviewed the electronic medical records of 197, 149 patients were retrieved from the inpatient database of our hospital from January 2011 to January 2020; 79 patients with NOMI were observed. A total of 44 patients who underwent laparotomy were statistically analyzed and divided into the survivor and non-survivor groups. Prognostic factors were compared between the 2 groups. Exploratory laparotomy based on a second-look surgery was the first treatment choice.The overall mortality rate was 61.3%, with a male-to-female ratio of 1.6:1. The median Sequential Organ Failure Assessment (SOFA) score was 11.06 [5.75-17.25]. The median SOFA score was 5 [interquartile range: 3-8] in the survivor group and 14.8 [interquartile range: 10.5-19] in the non-survivor group. The log-rank test showed a significant difference in the presence of diabetes mellitus (P = .025), hypoglycemia (P = .001), SOFA score ≥10 (P < .001), hemoglobin levels ≥11 g/dL (P = .003), platelet count ≥12.9 × 104/μL (P = .01), lactate levels ≥2.6 mmol/L (P = .005), and base excess <-3.0 (P < .023). Multivariate analysis using the factors with significant differences revealed that SOFA score ≥10 (hazard ratio for death, 1.199; 95% confidence interval, 1.101-1.305; P < .001) was an independent prognostic factor.The SOFA score can be used to assess disease severity. A SOFA score of ≥10 may be associated with increased mortality.
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Affiliation(s)
- Takaaki Murata
- Department of General Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Jun Kawachi
- Department of General Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Yuto Igarashi
- Department of General Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Yuma Suno
- Department of General Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Tomoki Nishida
- Department of Thoracic Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Katsunori Miyake
- Department of General Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Naoko Isogai
- Department of General Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Ryuta Fukai
- Department of Thoracic Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Hiroyuki Kashiwagi
- Department of General Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Rai Shimoyama
- Department of General Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Masahiro Hirata
- Center for Clinical and Translational Science, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Nobuaki Shinozaki
- Department of General Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
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16
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Gurbel PA, Bliden KP, Levy JH, Walia N, Rapista N, Cho A, Jerjian C, Tantry US. Thrombogenicity markers for early diagnosis and prognosis in COVID-19: a change from the current paradigm? Blood Coagul Fibrinolysis 2021; 32:544-549. [PMID: 34369413 PMCID: PMC8630843 DOI: 10.1097/mbc.0000000000001069] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/11/2021] [Accepted: 07/12/2021] [Indexed: 11/26/2022]
Abstract
Standard biomarkers have been widely used for COVID-19 diagnosis and prognosis. We hypothesize that thrombogenicity metrics measured by thromboelastography will provide better diagnostic and prognostic utility versus standard biomarkers in COVID-19 positive patients. In this observational prospective study, we included 119 hospitalized COVID-19 positive patients and 15 COVID-19 negative patients. On admission, we measured standard biomarkers and thrombogenicity using a novel thromboelastography assay (TEG-6s). In-hospital all-cause death and thrombotic occurrences (thromboembolism, myocardial infarction and stroke) were recorded. Most COVID-19 patients were African--Americans (68%). COVID-19 patients versus COVID-19 negative patients had higher platelet-fibrin clot strength (P-FCS), fibrin clot strength (FCS) and functional fibrinogen level (FLEV) (P ≤ 0.003 for all). The presence of high TEG-6 s metrics better discriminated COVID-19 positive from negative patients. COVID-19 positive patients with sequential organ failure assessment (SOFA) score at least 3 had higher P-FCS, FCS and FLEV than patients with scores less than 3 (P ≤ 0.001 for all comparisons). By multivariate analysis, the in-hospital composite endpoint occurrence of death and thrombotic events was independently associated with SOFA score more than 3 [odds ratio (OR) = 2.9, P = 0.03], diabetes (OR = 3.3, P = 0.02) and FCS > 40 mm (OR = 3.4, P = 0.02). This largest observational study suggested the early diagnostic and prognostic utility of thromboelastography to identify COVID-19 and should be considered hypothesis generating. Our results also support the recent FDA guidance regarding the importance of measurement of whole blood viscoelastic properties in COVID-19 patients. Our findings are consistent with the observation of higher hospitalization rates and poorer outcomes for African--Americans with COVID-19.
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Affiliation(s)
- Paul A. Gurbel
- Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Lifebridge Health, Baltimore, Maryland
| | - Kevin P. Bliden
- Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Lifebridge Health, Baltimore, Maryland
| | - Jerrold H. Levy
- Departments of Anesthesiology, Critical Care, and Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Naval Walia
- Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Lifebridge Health, Baltimore, Maryland
| | - Nicole Rapista
- Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Lifebridge Health, Baltimore, Maryland
| | - Alastair Cho
- Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Lifebridge Health, Baltimore, Maryland
| | - Christophe Jerjian
- Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Lifebridge Health, Baltimore, Maryland
| | - Udaya S. Tantry
- Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Lifebridge Health, Baltimore, Maryland
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Kuroda H, Masuda Y. Comparison of Protective Effects of Recombinant Antithrombin Gamma and Plasma-Derived Antithrombin on Sepsis-Induced Disseminated Intravascular Coagulation and Multiple Organ Failure. Clin Appl Thromb Hemost 2021; 26:1076029620981630. [PMID: 33332196 PMCID: PMC7750769 DOI: 10.1177/1076029620981630] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
In Japan, the dose of the new recombinant antithrombin III concentrate
(rAT-gamma) is titrated according to patient body weight (BW), while
conventional plasma-derived antithrombin concentrates (AT) are administered as a
fixed dose. Therefore, it is anticipated that rAT-gamma could produce better
treatment effects than AT. The aim of this study was to compare the organ
protective effects of doses of rAT-gamma and AT administered in clinical
practice for septic disseminated intravascular coagulation (DIC) and multiple
organ failure. This study was performed at a single university hospital in
Japan. A total of 49 patients with antithrombin deficiency secondary to septic
DIC who were administered either rAT-gamma (n = 26) or AT (n = 23) were
retrospectively analyzed to assess the dose of supplemental antithrombin
concentrates, plasma antithrombin activity, Japanese Association for Acute
Medicine (JAAM)-DIC score, and modified Sequential Organ Failure Assessment
(SOFA) score on days 0, 3 and 6. The AT-equivalent dose per kg BW of rAT-gamma
(equal to the initial rAT-gamma dose per kg BW divided by 1.2) was significantly
higher than the dose per kg BW of AT (AT 23.4 ± 5.1 vs. rAT 28.9 ± 3.9
IU/kg/day; P < 0.001). Consequently, serial increases in plasma antithrombin
levels occurred more rapidly in the rAT-gamma group (P = 0.036). JAAM DIC and
modified SOFA scores revealed significantly greater improvement in the rAT
versus the AT group (JAAM DIC score: P = 0.042, mSOFA score: P = 0.005). The
results of this study suggest that AT supplementation adjusted for patient BW
might further improve septic DIC and multiple organ failure.
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Affiliation(s)
- Hiromitsu Kuroda
- Department of Intensive Care Medicine, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Yoshiki Masuda
- Department of Intensive Care Medicine, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
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Gupta BK, Das BP, Mhaske VR, Tomar S, Rastogi K. Diagnostic Accuracy of Various Biomarkers of Sepsis (Serum Pro-Calcitonin, High-Sensitivity C-reactive Protein, and C-reactive Protein) and Band Cell Percentage in Critically lll Patients: A Prospective, Observational, Cohort Study. Anesth Essays Res 2021; 14:615-619. [PMID: 34349330 PMCID: PMC8294415 DOI: 10.4103/aer.aer_3_21] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/11/2021] [Accepted: 02/13/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Despite the advances in medical sciences, the morbidity and mortality due to sepsis in critically ill medical or surgical patients remains high, hence the need for an early and accurate diagnosis. In the current armamentarium, we have various biomarkers such as procalcitonin (PCT), high-sensitivity C-reactive protein (hs-CRP), CRP, and band cell percentage for an early clue. Aims: This study explores the accuracy of these markers in distinguishing sepsis from systemic inflammatory response syndrome (SIRS) and their correlation with sequential organ failure assessment (SOFA) scoring in critically ill patients. Materials and Methods: After ethical committee approval and written informed consent from guardians, 180 consecutive patients, with clinically suspected infection from any source fulfilling at least two criteria of SIRS, were enrolled and 150 eligible patients were investigated and analyzed prospectively in one cohort, which was later subdivided into two different groups (Group A and Group B) based on microbiology reports, as having SIRS or sepsis, respectively. Samples for cultures (blood, tracheal, or urine as required), biomarkers such as PCT, hs-CRP, and CRP, and band cell percentage were sent from each patient on days 1, 2, 3, and 5 and whenever there were fever spikes. Clinical follow-up was done for 28 days, and demographics, ventilator days, duration of intensive care unit (ICU) stay, and the survival rates were noted. Statistical Analysis: Receiver operating characteristics, area under curve (AUC-ROC) was used for each of the biomarker variables to decide the cutoff values and performance. Correlation coefficient was also seen for each of the biomarkers with SOFA scoring. Results: Attributes of performance for all the biomarkers were satisfactory but was best for PCT (AUC-ROC of 0.987) followed by band cell percentage (0.881). SOFA scoring could also be used with good diagnostic accuracy (AUC-ROC of 0.920). SOFA score correlated best with PCT among the four biomarkers in diagnosing sepsis (Spearman's coefficient of + 0.734). Band cell percentage was significantly higher in the expired group of sepsis patients than survived patients (P = 0.02) and correlated well with ICU stay and 28-day mortality than rest (Spearman's coefficient of − 0.54). Conclusions: The addition of PCT to the standard workup of critically ill patients with suspected sepsis increases diagnostic certainty and generates improved patient management. Band cell percentage also provides a cost-effective alternative to PCT with an analogous diagnostic performance.
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Affiliation(s)
- Bikram Kumar Gupta
- Department of Anaesthesiology, Division of Critical Care Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Badri Prasad Das
- Department of Anaesthesiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Vanita Ramesh Mhaske
- Department of Obstetrics and Gynaecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Shubham Tomar
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Kapil Rastogi
- Department of Anaesthesiology, Integral Institute of Medical Sciences and Research, Lucknow, Uttar Pradesh, India
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Otao G, Maruta T, Yonaha T, Igarashi K, Nagata S, Kitamura K, Tsuneyoshi I. The usefulness of plasma levels of mature and total adrenomedullin as biomarkers indicating the magnitude of surgical stress responses: A single-center, prospective, observational study. J Clin Transl Res 2021; 7:302-10. [PMID: 34179545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/30/2021] [Accepted: 03/30/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND AIM Adrenomedullin (AM), a vasodilatory peptide, is known for its pleiotropic actions. AM levels are increased under inflammatory conditions such as sepsis and can be useful as a prognostic biomarker. However, there are only a few reports on the physiological actions of AM in the perioperative period. The aim of this single-center, prospective, and observational study was to investigate the changes in the plasma levels of mature AM (mAM) and total AM (tAM) observed during the perioperative period. In addition, we aimed to determine the association between each AM level and immune-inflammatory parameters to explore the usefulness of AM as a biomarker of the magnitude of surgical stress responses. METHODS The levels of both mAM and tAM, in addition to the levels of presepsin, interleukin-6, procalcitonin, white blood cell, and C-reactive protein, were measured in blood samples obtained during the perioperative period. Other laboratory data, including sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation (APACHE) II scores, were obtained from individual clinical records. Correlations between each AM and clinical parameters were determined using Spearman's rank correlation. P<0.05 were considered statistically significant. RESULTS One hundred and twenty-three perioperative patients scheduled for three types of surgical procedures, including cardiopulmonary bypass surgery, abdominal surgery, and cervical laminoplasty, were included in this study. There was a moderate to strong correlation between each AM and immune-inflammatory parameters, SOFA score, and APACHE II score, as related to surgical trauma. Specifically, the strongest correlation was observed between each AM and SOFA score. CONCLUSIONS These findings suggest that plasma AM levels may represent the most important inflammatory mediators that are evident in surgical stress responses. RELEVANCE FOR PATIENTS Since the levels of both tAM and mAM show the same trend, mAM and tAM may be equally used as biomarkers for the evaluation of the physiological status of surgical patients. TRIAL REGISTRATION This observational study was retrospectively registered with Japanese Clinical Trial Registry "UMIN-CTR" on March 19, 2018, and was given a trial ID number UMIN000031792.
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Bhutani A, Kaushik RM, Kaushik R. A study on multi-organ dysfunction syndrome in malaria using sequential organ failure assessment score. Trop Parasitol 2021; 10:86-94. [PMID: 33747874 PMCID: PMC7951073 DOI: 10.4103/tp.tp_12_19] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 12/23/2019] [Accepted: 05/30/2020] [Indexed: 11/12/2022] Open
Abstract
Purpose: The purpose of this study is to examine the prevalence, clinical spectrum, prognostic factors, and outcome of multi-organ dysfunction syndrome (MODS) in patients with malaria. Materials and Methods: One hundred and twenty-four patients with malaria, diagnosed by a positive peripheral blood film and rapid malaria test, were studied for MODS using the sequential organ failure assessment (SOFA) score. The severity of malaria was assessed by the WHO criteria. Results: Severe malaria was present in 54 (43.54%) patients. MODS was detected in 108 (87.09%) patients with malaria (Plasmodium falciparum - 57 [85.07%], Plasmodium vivax - 46 [88.46%] and mixed P. falciparum and P. vivax malaria - 5 [100%] cases). SOFA scores of MODS-and non-MODS-patients differed significantly (P < 0.001). No significant association was seen between MODS and type of malaria (P = 0.894). Mortality among malaria patients with MODS was 5.55% (6/108) (P. falciparum 8.77% [5/57] and P. vivax 2.17% [1/46]). The outcome of MODS was associated significantly with the severity of the SOFA score at admission (P = 0.011) but not with the type of malaria, malaria parasite index, and the number of organs involved (P > 0.05 each). The SOFA score at admission correlated significantly with the duration of hospitalization (P < 0.0001). Conclusions: MODS occurs with high frequency in malaria and is not dependent on the type of malaria. The outcome of MODS and recovery time depends on the severity of MODS. The SOFA score is useful in detecting MODS and ascertaining its severity and prognosis in malaria.
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Affiliation(s)
- Amish Bhutani
- Department of Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Rajeev Mohan Kaushik
- Department of Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Reshma Kaushik
- Department of Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
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Liu Y, Peng H, Gui F. Long noncoding plasmacytoma variant translocation 1 facilitates the surveillance of acute respiratory distress syndrome and mortality prediction in sepsis. Biomark Med 2021; 15:401-412. [PMID: 33733809 DOI: 10.2217/bmm-2020-0506] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Aim: We aimed to investigate the association of long noncoding RNA plasmacytoma variant translocation 1 (lncRNA PVT1) expression with acute respiratory distress syndrome (ARDS) risk and its prognostic value for 28-day mortality in sepsis patients. Materials & methods: LncRNA PVT1 expression from 109 sepsis patients and 100 health controls was detected. General sepsis severity was assessed using acute physiology and chronic health evaluation II score and sequential organ failure assessment score. Results: LncRNA PVT1 had an acceptable predictive value for higher ARDS risk, then was identified as an independent risk factor for sepsis ARDS; LncRNA PVT1 expression positively correlated with general disease severity in sepsis patients; LncRNA PVT1 was overexpressed in 28-day deaths compared with 28-day survivors in sepsis patients. Conclusion: LncRNA PVT1 may facilitate the surveillance of ARDS, general disease severity and the prediction of mortality in sepsis patients.
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Affiliation(s)
- Yijue Liu
- Department of Emergency, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Huan Peng
- Department of Emergency, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Feng Gui
- Department of Emergency, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
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Shyam R, Patel ML, Kumar D, Sachan R, Chaudhary SC, Gupta KK. The prognostic value of neutrophil gelatinase-associated lipocalin in sepsis-associated acute kidney injury: A prospective observational study. Int J Crit Illn Inj Sci 2020; 10:6-10. [PMID: 33376683 PMCID: PMC7759065 DOI: 10.4103/ijciis.ijciis_80_19] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 01/18/2019] [Accepted: 11/01/2019] [Indexed: 11/25/2022] Open
Abstract
Background: Sepsis is one of the most common triggering factors for acute kidney injury (AKI). The aim of the study is to evaluate the outcome in sepsis with AKI and determine the prognostic value of urinary neutrophil gelatinase-associated lipocalin (NGAL) in septicemic AKI. Materials and Methods: This prospective follow-up study was carried out over a period of 1 year after ethical clearance from the Institutional Ethics committee, a total 165 cases of septicemia were recruited, of which 15 patients were dropped out, 150 patients were identified suffering from septicemia defined as per the organ dysfunction criteria (according to third international consensus 2016) and patients of AKI defined as per the Kidney Disease Improving Global Outcomes 2012 criteria). Results: Out of 150 patients of septicemia enrolled in the study, only 38 (25.33%) suffering from AKI were classified as Group I and rest 112 (74.67%) patients of septicemia not suffering from AKI were classified as Group II. In total, 60.0% (90) patients were discharged from the hospital, rest of the patients (40%) expired. Mean duration of survival was higher in Group II (21.29 ± 1.89 days) as compared to Group I (13.67 ± 1.06 days). Cases with ≥121.90 urine NGAL, rate of mortality (41.7%), were higher as compared to alive patients discharged (34.4%). Conclusion: Sequential organ failure assessment score, hospital stay, and mortality were high in septicemic patients with AKI as compared to sepsis without AKI. Survival of patients also not good with septic AKI, those patients who had high NGAL value had poor prognosis.
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Affiliation(s)
- Radhey Shyam
- Department of Geriatric Intensive Care Unit (Anaesthesiology) DGMH, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Munna Lal Patel
- Department of Internal Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Dhananjay Kumar
- Department of Internal Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Rekha Sachan
- Department of Obstetrics and Gynaecology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Shyam Chand Chaudhary
- Department of Internal Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - K K Gupta
- Department of Internal Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
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Qin W, Zhang X, Yang L, Li Y, Yang S, Li X, Hu W. Predictive value of the sequential organ failure assessment (SOFA) score for prognosis in patients with severe acute ischemic stroke: a retrospective study. J Int Med Res 2020; 48:300060520950103. [PMID: 32865055 PMCID: PMC7469749 DOI: 10.1177/0300060520950103] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/24/2020] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To identify the risk factors for early death and determine the predictive value of the sequential organ failure assessment (SOFA) score for prognosis of severe acute ischemic stroke (AIS). METHODS A total of 110 patients with severe AIS were enrolled and divided into the non-survivor (n = 34) and survivor groups (n = 76). Logistic regression analysis was conducted to identify risk factors for early death, while the receiver operator characteristic (ROC) curve was used to determine the predictive effect of the SOFA score on prognosis. RESULTS Logistic regression analysis showed that urinary tract infection (odds ratio [OR] = 17.364, 95% confidence interval [CI]: 1.903-158.427), mechanical ventilation (OR = 1.754, 95% CI: 1.648-2.219), and osmotic therapy (OR = 2.835, 95% CI: 1.871-5.102) were significantly correlated with early death of severe AIS. ROC curve analysis of the area under the curve after hospitalization showed that the maximum SOFA and ΔSOFA scores exceeded 0.7. CONCLUSION Our study shows that urinary tract infection, mechanical ventilation, and osmotic therapy are risk factors for early death of severe AIS. The SOFA score has good predictive value for prognosis of severe AIS. These findings may provide a guideline for improving clinical outcome.
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Affiliation(s)
- Wei Qin
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiaoyu Zhang
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Lei Yang
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yue Li
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Shuna Yang
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xuanting Li
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Wenli Hu
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Fernandes S, Wyawahare M. Utility of quick sepsis-related organ failure assessment (qSOFA) score to predict outcomes in out-of-ICU patients with suspected infections. J Family Med Prim Care 2020; 9:3251-3255. [PMID: 33102279 PMCID: PMC7567244 DOI: 10.4103/jfmpc.jfmpc_150_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/13/2020] [Accepted: 06/19/2020] [Indexed: 01/28/2023] Open
Abstract
Background: Referral of sepsis patients at the level of primary care is often delayed due to the lack of an assessment tool which effectively predicts sepsis. The quick Sepsis-related Organ Failure Assessment score (qSOFA) can be used in such scenarios to improve patient outcomes. Aim: To assess the prognostic accuracy of qSOFA score in predicting adverse outcomes in patients with suspected infections and to compare it with the SIRS (Systemic Inflammatory Response Syndrome) and the SOFA (Sequential Organ failure Assessment Score). Methods: This study included 180 participants admitted in the emergency wards of the Department of Medicine, over a period of one year with suspected infection. The primary outcome was the combined outcome of mortality and/or ICU stay of more than three days. Secondary outcomes were the duration of ICU stay, duration of inotrope use, and duration of mechanical ventilation. Statistical Analysis: Descriptive statistics using SPSS version 19.0 was applied in the study. Results: Of the 180 participants, 54 had a qSOFA score of 2 at admission, 52 participants had an SIRS score of 2. The qSOFA score had the highest AUC for both mortality and the combined outcome of mortality and prolonged ICU stay (0.740 and 0.835, respectively). For a combined outcome of mortality and ICU stay >3 days, the qSOFA score had a sensitivity of 75% and a specificity of 82%. The positive likelihood ratio was 4.17. Conclusion: In a primary care setting, the qSOFA score of more than 2 can be used reliably to refer patients for admission and intensive care as they are likely to need longer hospital stay and can have worse outcomes.
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Jia HM, Zheng Y, Han Y, Ma WL, Jiang YJ, Zheng X, Guo SY, Zhang TE, Li WX. Prognostic value of dynamic plasma endostatin for the prediction of mortality in acute kidney injury: A prospective cohort study. J Int Med Res 2020; 48:300060520940856. [PMID: 32691651 PMCID: PMC7375733 DOI: 10.1177/0300060520940856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective The aim of the current study was to evaluate the value of plasma endostatin for predicting 30-day mortality of patients with acute kidney injury (AKI). Methods Patients who underwent non-cardiac major surgery and developed AKI in the first 48 hours after admission to the intensive care unit were consecutively included. Concentrations of plasma neutrophil gelatinase-associated lipocalin (NGAL), cystatin C (Cys C), and endostatin were measured at three time points: 0, 24, and 48 hours after the AKI diagnosis. Clinical patient characteristics were recorded after AKI was diagnosed. Results A total of 256 new-onset AKI patients were enrolled. Of these, 48 (18.7%) patients died within 30 days. The difference in plasma endostatin values between 0 and 24 hours (ΔEndostatin-24h) yielded the best area under the curve (AUC) of 0.747 for predicting 30-day mortality in AKI patients; NGAL and Cys C achieved AUC of 0.672 and 0.647, respectively. The predictive AUC increased to 0.833 when ΔEndostatin-24h was combined with sequential organ failure assessment score and AKI classification. Conclusion Dynamic plasma endostatin is useful for predicting 30-day mortality in AKI patients. The predictive power of dynamic plasma endostatin can be significantly improved when it is combined with clinical patient data.
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Affiliation(s)
- Hui-Miao Jia
- Department of Surgical Intensive Care Unit, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Yue Zheng
- Department of Surgical Intensive Care Unit, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Yue Han
- Department of Surgical Intensive Care Unit, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Wen-Liang Ma
- Department of Surgical Intensive Care Unit, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Yi-Jia Jiang
- Department of Surgical Intensive Care Unit, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Xi Zheng
- Department of Surgical Intensive Care Unit, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Shu-Yan Guo
- Department of Surgical Intensive Care Unit, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | | | - Wen-Xiong Li
- Department of Surgical Intensive Care Unit, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
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Zhang HF, Zhang X, Sha YX, Zhou HQ, Pan JH, Xun X, Wang YY, Ge-Sang DJ. [Value of sTREM-1 in serum and bronchoalveolar lavage fluid, APACHE II score, and SOFA score in evaluating the conditions and prognosis of children with severe pneumonia]. Zhongguo Dang Dai Er Ke Za Zhi 2020; 22:626-631. [PMID: 32571463 PMCID: PMC7390213 DOI: 10.7499/j.issn.1008-8830.1912134] [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] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 05/12/2020] [Indexed: 05/21/2023]
Abstract
OBJECTIVE To study the significance of the level of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in serum and bronchoalveolar lavage fluid (BALF), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and Sequential Organ Failure Assessment (SOFA) score in evaluating the conditions and prognosis of children with severe pneumonia. METHODS A total of 76 children with severe pneumonia who were admitted from August 2017 to October 2019 were enrolled as the severe pneumonia group. According to the treatment outcome, they were divided into a non-response group with 34 children and a response group with 42 children. Ninety-four children with common pneumonia who were admitted during the same period of time were enrolled as the common pneumonia group. One hundred healthy children who underwent physical examination in the outpatient service during the same period of time were enrolled as the control group. The serum level of sTREM-1, APACHE II score, and SOFA score were measured for each group, and the level of sTREM-1 in BALF was measured for children with severe pneumonia. The correlation of the above indices with the severity and prognosis of severe pneumonia in children was analyzed. RESULTS The severe pneumonia group had significantly higher serum sTREM-1 level, APACHEII score, and SOFA score than the common pneumonia group and the control group (P<0.05). For the children with severe pneumonia, the non-response group had significant increases in the levels of sTREM-1 in serum and BALF and SOFA score on day 7 after admission, while the response group had significant reductions in these indices, and there were significant differences between the two groups (P<0.05). Positive correlation was found between any two of serum sTREM-1, BALF sTREM-1, and SOFA score (P<0.05). APACHE II score was not correlated with serum sTREM-1, BALF sTREM-1, and SOFA score (P>0.05). CONCLUSIONS The level of sTREM-1 in serum and BALF and SOFA score can be used to evaluate the severity and prognosis of severe pneumonia in children.
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Affiliation(s)
- Hui-Fang Zhang
- Department of Pediatrics, First Affiliated Hospital of University of Science and Technology of China, Hefei 230001, China.
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Xie H, Yang F, Hou D, Wang X, Wang L, Wang H, Hou X. Risk factors of in-hospital mortality in adult postcardiotomy cardiogenic shock patients successfully weaned from venoarterial extracorporeal membrane oxygenation. Perfusion 2019; 35:417-426. [PMID: 31854226 DOI: 10.1177/0267659119890214] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Mortality of adult postcardiotomy cardiogenic shock patients after successfully weaned from venoarterial extracorporeal membrane oxygenation remains high. The objective of this study is to identify the risk factors associated with mortality after successfully weaning from venoarterial extracorporeal membrane oxygenation in adult postcardiotomy cardiogenic shock patients. METHODS All consecutive patients who were successfully weaned from venoarterial extracorporeal membrane oxygenation between January 2011 and December 2016 at the Beijing Anzhen Hospital were analyzed retrospectively. Multivariate logistic regression was performed to identify risk factors associated with in-hospital mortality after successfully weaning from venoarterial extracorporeal membrane oxygenation. RESULTS In total, 212 (58.4%) of 363 postcardiotomy cardiogenic shock patients were successfully weaned from venoarterial extracorporeal membrane oxygenation. The non-survivors had a longer duration of extracorporeal membrane oxygenation than the survivors (120.0 (98.0, 160.50) vs. 100.0 (77.0, 126.0), p = 0.000). Variables associated with mortality of patients successfully weaned from extracorporeal membrane oxygenation by univariable analysis were age, diabetes, vasoactive inotropic score pre-extracorporeal membrane oxygenation, vasoactive inotropic score at weaning, left ventricular ejection fraction at weaning, central venous pressure at weaning, sequential organ failure assessment score pre-extracorporeal membrane oxygenation, sequential organ failure assessment at weaning, survival after venoarterial ECMO pre-extracorporeal membrane oxygenation, and survival after venoarterial ECMO at weaning. In the multivariate analysis, sequential organ failure assessment score at weaning (odds ratio = 1.889, 95% confidence interval = 1.460-2.455, p < 0.001) was an independent risk factor for in-hospital mortality of patients successfully weaned from venoarterial extracorporeal membrane oxygenation. The cumulative 30-day survival rate in patients with a sequential organ failure assessment score < 7 was significantly (p < 0.001) higher than in patients with a sequential organ failure assessment score ⩾ 7 (87% vs. 56.7%, p < 0.001). CONCLUSION Vasoactive inotropic score, left ventricular ejection fraction, central venous pressure, and sequential organ failure assessment score at weaning were associated with in-hospital mortality for postcardiotomy cardiogenic shock patients successfully weaned from venoarterial extracorporeal membrane oxygenation. Sequential organ failure assessment score might help clinicians to predict in-hospital mortality for patients successfully weaned from venoarterial extracorporeal membrane oxygenation.
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Affiliation(s)
- Haixiu Xie
- Center for Cardiac Intensive Care, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Feng Yang
- Center for Cardiac Intensive Care, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Dengbang Hou
- Center for Cardiac Intensive Care, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xiaomeng Wang
- Center for Cardiac Intensive Care, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Liangshan Wang
- Center for Cardiac Intensive Care, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Hong Wang
- Center for Cardiac Intensive Care, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xiaotong Hou
- Center for Cardiac Intensive Care, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
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Zhou LB, Chen J, DU XC, Wu SY, Bai ZJ, Lyu HT. [Value of three scoring systems in evaluating the prognosis of children with severe sepsis]. Zhongguo Dang Dai Er Ke Za Zhi 2019; 21:898-903. [PMID: 31506150 DOI: 10.7499/j.issn.1008-8830.2019.09.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To study the predictive value of Pediatric Age-adapted Sequential Organ Failure Assessment Score (pSOFA), Pediatric Risk of Mortality Score III (PRISM III), and Pediatric Critical Illness Score (PCIS) in children with severe sepsis. METHODS A retrospective analysis was performed for the clinical data of 193 hospitalized children with severe sepsis. According to the final outcome, these children were divided into a survival group with 151 children and a death group with 42 children. The scores of pSOFA, PRISM III, and PCIS were determined according to the worst values of each index within 24 hours after admission. The receiver operating characteristic (ROC) curve was used to analyze the efficiency of each scoring system in predicting the risk of death due to sepsis. Smooth curve fitting was used to analyze the correlation between the three scoring systems and the threshold effect of each scoring system. Decision curve analysis (DCA) was used to evaluate the application value of each scoring system. RESULTS The ROC analysis showed that PCIS and pSOFA had a similar predictive value (P=0.182) and that PRISM III and pSOFA had a similar predictive value (P=0.210), while PRISM III had a better predictive value than PCIS (P=0.045). PRISM III had the highest degree of fitting with prognosis, followed by pSOFA and PCIS. The DCA analysis showed that when the risk of death was 0.4 and 0.6 in children with severe sepsis and the three scoring systems were used as the basis for emergency intervention decision-making, pSOFA achieved the highest standardized net benefit, followed by PRISM III and PCIS. CONCLUSIONS All three scoring systems have a certain value in predicting the prognosis of children with severe sepsis, and pSOFA has a better value than PRISM III and PCIS.
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Zhou LB, Chen J, DU XC, Wu SY, Bai ZJ, Lyu HT. [Value of three scoring systems in evaluating the prognosis of children with severe sepsis]. Zhongguo Dang Dai Er Ke Za Zhi 2019; 21:898-903. [PMID: 31506150 PMCID: PMC7390254] [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] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 05/15/2019] [Indexed: 11/04/2023]
Abstract
OBJECTIVE To study the predictive value of Pediatric Age-adapted Sequential Organ Failure Assessment Score (pSOFA), Pediatric Risk of Mortality Score III (PRISM III), and Pediatric Critical Illness Score (PCIS) in children with severe sepsis. METHODS A retrospective analysis was performed for the clinical data of 193 hospitalized children with severe sepsis. According to the final outcome, these children were divided into a survival group with 151 children and a death group with 42 children. The scores of pSOFA, PRISM III, and PCIS were determined according to the worst values of each index within 24 hours after admission. The receiver operating characteristic (ROC) curve was used to analyze the efficiency of each scoring system in predicting the risk of death due to sepsis. Smooth curve fitting was used to analyze the correlation between the three scoring systems and the threshold effect of each scoring system. Decision curve analysis (DCA) was used to evaluate the application value of each scoring system. RESULTS The ROC analysis showed that PCIS and pSOFA had a similar predictive value (P=0.182) and that PRISM III and pSOFA had a similar predictive value (P=0.210), while PRISM III had a better predictive value than PCIS (P=0.045). PRISM III had the highest degree of fitting with prognosis, followed by pSOFA and PCIS. The DCA analysis showed that when the risk of death was 0.4 and 0.6 in children with severe sepsis and the three scoring systems were used as the basis for emergency intervention decision-making, pSOFA achieved the highest standardized net benefit, followed by PRISM III and PCIS. CONCLUSIONS All three scoring systems have a certain value in predicting the prognosis of children with severe sepsis, and pSOFA has a better value than PRISM III and PCIS.
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Affiliation(s)
- Li-Bing Zhou
- Department of Critical Care Medicine, Children's Hospital of Soochow University, Suzhou 215000, China.
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Iba T, Arakawa M, Mochizuki K, Nishida O, Wada H, Levy JH. Usefulness of Measuring Changes in SOFA Score for the Prediction of 28-Day Mortality in Patients With Sepsis-Associated Disseminated Intravascular Coagulation. Clin Appl Thromb Hemost 2019; 25:1076029618824044. [PMID: 30808223 PMCID: PMC6714949 DOI: 10.1177/1076029618824044] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The primary end point for sepsis trial is 28-day mortality. However, additional methods
for determining the efficacy may have benefits. The purpose of this study was to search a
useful indicator of anticoagulant therapy in patients with sepsis with disseminated
intravascular coagulation (DIC). Data from 323 patients with sepsis with coagulopathy
treated with antithrombin supplementation were analyzed. The changes in the Sequential
Organ Failure Assessment (Δ SOFA) score, the overt-DIC (Δ overt-DIC) score, and the
Japanese Society for Acute Medicine DIC (Δ JAAM DIC) score from baseline to day 7 were
retrospectively analyzed in relation to the 28-day mortality. Significant correlations
were found between the 28-day mortality and Δ SOFA, Δ overt-DIC score, and Δ JAAM DIC
score. The accuracy of the prediction was higher for Δ SOFA (80.5%) than for Δ overt-DIC
(66.7%, P < .001). The areas under the curve for mortality calculated
using a receiver operating characteristic curve analysis were 0.812 for Δ SOFA, 0.655 for
Δ overt-DIC, and 0.693 for Δ JAAM DIC. The mortality rate was significantly lower among
cases with an improved SOFA score compared to those without an improvement. The Δ SOFA had
the strongest association with the 28-day mortality in patients with sepsis and DIC.
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Affiliation(s)
- Toshiaki Iba
- 1 Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Makoto Arakawa
- 1 Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Katsunori Mochizuki
- 2 Department of Emergency and Critical Care Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Osamu Nishida
- 3 Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hideo Wada
- 4 Department of Molecular Laboratory Medicine, Mie University Graduate School of Medicine, Tsu, Japan
| | - Jerrold H Levy
- 5 Department of Anesthesiology and Critical Care, Duke University School of Medicine, Durham, NC, USA
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Iba T, Arakawa M, Ohchi Y, Arai T, Sato K, Wada H, Levy JH. Prediction of Early Death in Patients With Sepsis-Associated Coagulation Disorder Treated With Antithrombin Supplementation. Clin Appl Thromb Hemost 2018; 24:145S-149S. [PMID: 30198317 PMCID: PMC6714842 DOI: 10.1177/1076029618797474] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
For success in clinical trials, eliminating inclusion of patients with irreversible
recovery is important. The purpose of this study was to identify the patient population
who do not survive for more than 3 days. A total of 449 patients with sepsis suspected of
having disseminated intravascular coagulation (DIC) and treated with antithrombin were
examined. The patient characteristics, baseline sequential organ failure assessment (SOFA)
score, DIC score, and hemostatic markers were retrospectively analyzed in relation to
early death (died within 3 days). At the end of day 3, a total of 419 patients had
survived and 30 patients had died. A logistic regression analysis revealed a significant
association between early death and the baseline prothrombin time-international normalized
ratio PT-INR (P <.05) and the total SOFA score (P
<.01). In contrast, neither the platelet count, fibrinogen/fibrin degradation products,
and antithrombin activity nor the DIC score was associated with early death. Although the
accuracy for predicting early death defined by either baseline PT-INR of ≥1.57 or total
SOFA score of more than 13 was not high enough, that of “high-risk of early death (PT-INR
≥ 1.57 and SOFA score ≥ 13)” was 83.5%. Furthermore, the negative predictive of this
category was 96.0%. The baseline SOFA score and PT-INR were associated with early death
among patients with sepsis-associated coagulation disorders. Patients who do not meet the
“high-risk of early death” criteria were likely to survive for more than 3 days and
therefore should be considered for future therapeutic clinical trials.
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Affiliation(s)
- Toshiaki Iba
- Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Makoto Arakawa
- Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Yoshifumi Ohchi
- Department of Anesthesiology and Intensive Care, Oita University, Oita, Japan
| | - Takao Arai
- Department of Emergency and Critical Care Medicine, Trauma and Emergency Center, Hachioji Medical Center, Tokyo Medical University, Tokyo, Japan
| | - Koichi Sato
- Department of Surgery, Juntendo Shizuoka Hospital, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hideo Wada
- Department of Molecular Laboratory Medicine, Mie University Graduate School of Medicine, Mie, Japan
| | - Jerrold H Levy
- Department of Anesthesiology and Critical Care, Duke University School of Medicine, Durham, NC, USA
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Caserta S, Mengozzi M, Kern F, Newbury SF, Ghezzi P, Llewelyn MJ. Severity of Systemic Inflammatory Response Syndrome Affects the Blood Levels of Circulating Inflammatory-Relevant MicroRNAs. Front Immunol 2018; 8:1977. [PMID: 29459855 PMCID: PMC5807656 DOI: 10.3389/fimmu.2017.01977] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [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: 09/15/2017] [Accepted: 12/20/2017] [Indexed: 12/12/2022] Open
Abstract
The systemic inflammatory response syndrome (SIRS) is a potentially lethal response triggered by diverse forms of tissue injury and infection. When systemic inflammation is triggered by infection, the term sepsis is used. Understanding how inflammation is mediated and regulated is of enormous medical importance. We previously demonstrated that circulating inflammatory-relevant microRNAs (CIR-miRNAs) are candidate biomarkers for differentiating sepsis from SIRS. Here, we set out to determine how CIR-miRNA levels reflect SIRS severity and whether they derive from activated immune cells. Clinical disease severity scores and markers of red blood cell (RBC) damage or immune cell activation were correlated with CIR-miRNA levels in patients with SIRS and sepsis. The release of CIR-miRNAs modulated during SIRS was assessed in immune cell cultures. We show that severity of non-infective SIRS, but not sepsis is reflected in the levels of miR-378a-3p, miR-30a-5p, miR-30d-5p, and miR-192-5p. These CIR-miRNA levels positively correlate with levels of the redox biomarker, peroxiredoxin-1 (Prdx-1), which has previously been shown to be released by immune cells during inflammation. Furthermore, in vitro activated immune cells produce SIRS-associated miR-378a-3p, miR-30a-5p, miR-30d-5p, and miR-192-5p. Our study furthers the understanding of the origin, role, and trafficking of CIR-miRNAs as potential regulators of inflammation.
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Affiliation(s)
- Stefano Caserta
- Brighton and Sussex Medical School, University of Sussex, Falmer, United Kingdom
| | - Manuela Mengozzi
- Brighton and Sussex Medical School, University of Sussex, Falmer, United Kingdom
| | - Florian Kern
- Brighton and Sussex Medical School, University of Sussex, Falmer, United Kingdom.,Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Sarah F Newbury
- Brighton and Sussex Medical School, University of Sussex, Falmer, United Kingdom
| | - Pietro Ghezzi
- Brighton and Sussex Medical School, University of Sussex, Falmer, United Kingdom
| | - Martin J Llewelyn
- Brighton and Sussex Medical School, University of Sussex, Falmer, United Kingdom.,Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
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Gupta A, Juneja D, Singh O, Garg SK, Arora V, Deepak D. Clinical Profile, Intensive Care Unit Course, and Outcome of Patients Admitted in Intensive Care Unit with Chikungunya. Indian J Crit Care Med 2018; 22:5-9. [PMID: 29422725 PMCID: PMC5793025 DOI: 10.4103/ijccm.ijccm_336_17] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objective Chikungunya is generally a mild disease, rarely requiring Intensive Care Unit (ICU) admission. However, certain populations may develop organ dysfunction necessitating ICU admission. The purpose of the study was to assess the clinical profile and course of chikungunya patients admitted to the ICU, and to ascertain factors linked with poor outcome. Methods All patients with chikungunya admitted to ICU were included in the study. Admission Acute Physiology and Chronic Health Evaluation (APACHE) II score and sequential organ failure assessment (SOFA) score were calculated. Primary outcome measured was 28-day mortality and secondary outcomes measured were length of hospital and ICU stay and the need for vasopressor support, renal replacement therapy (RRT), and mechanical ventilation (MV). Logistic regression analysis was performed to identify factors predicting mortality. Results The most common complaints were fever (96.67%) and altered sensorium (56.67%). Mean admission APACHE II and SOFA scores were 17.28 ± 7.9 and 7.15 ± 4.2, respectively. Fifty-one patients had underlying comorbidities. Vasopressors were required by 46.76%; RRT by 26.67%, and MV by 58.33%, respectively. The 28-day mortality was 36.67%. High APACHE II score (odds ratio: 1.535; 95% confidence interval: 1.053-2.237; P = 0.026) and need for dialysis (odds ratio: 833.221; 95% confidence interval: 1.853-374,664.825; P = 0.031) could independently predict mortality. Conclusions Patients with chikungunya fever may require ICU admission for organ failure. They are generally elderly patients with underlying comorbidities. Despite aggressive resuscitation and organ support, these patients are at high risk of death. Admission APACHE II score and need for dialysis may predict patients at higher risk of death.
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Affiliation(s)
- Anish Gupta
- Institute of Critical Care Medicine, Max Super Speciality Hospital, New Delhi, India
| | - Deven Juneja
- Institute of Critical Care Medicine, Max Super Speciality Hospital, New Delhi, India
| | - Omender Singh
- Institute of Critical Care Medicine, Max Super Speciality Hospital, New Delhi, India
| | - Suneel Kumar Garg
- Institute of Critical Care Medicine, Max Super Speciality Hospital, New Delhi, India
| | - Varun Arora
- Institute of Critical Care Medicine, Max Super Speciality Hospital, New Delhi, India
| | - Desh Deepak
- Institute of Critical Care Medicine, Max Super Speciality Hospital, New Delhi, India
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Sun DQ, Zheng CF, Liu WY, Van Poucke S, Mao Z, Shi KQ, Wang XD, Wang JD, Zheng MH. AKI-CLIF-SOFA: a novel prognostic score for critically ill cirrhotic patients with acute kidney injury. Aging (Albany NY) 2017; 9:286-296. [PMID: 28114104 PMCID: PMC5310668 DOI: 10.18632/aging.101161] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 12/07/2016] [Accepted: 01/15/2017] [Indexed: 12/22/2022]
Abstract
Critically ill cirrhotic patients with acute kidney injury (AKI) are associated with high mortality rates. The aims of this study were to develop a specific prognostic score for critically ill cirrhotic patients with AKI, the acute kidney injury - Chronic Liver Failure - Sequential Organ Failure- Assessment score (AKI-CLIF-SOFA) score. This study focused on 527 cirrhotic patients with AKI admitted to intensive care unit and constructed a new scoring system, the AKI-CLIF-SOFA, which can be used to prognostically assess mortality in these patient population. Parameters included in this model were analysed by cox regression. The area under the receiver operating characteristic curve (auROC) of AKI-CLIF-SOFA scoring system was 0.74 in 30 days, 0.74 in 90 days, 0.72 in 270 days and 0.72 in 365 days. Additionally, this study demonstrated that the new model had more discriminatory power than chronic liver failure- sequential organ failure assessment score (CLIF-SOFA), SOFA, model for end stage liver disease (MELD), kidney disease improving global outcomes (KDIGO) and simplified acute physiology score II (SAPS II) (auROC: 0.72, 0.66, 0.64, 0.62, 0.63 and 0.65 respectively, all P < 0.05) for the prediction of the 365-days mortality. Therefore, AKI-CLIF-SOFA demonstrated a valuable discriminative ability compared with KDIGO, CLIF-SOFA, MELD, SAPS II and SOFA in critically ill cirrhotic patients with AKI.
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Affiliation(s)
- Dan-Qin Sun
- Department of Nephrology, Affiliated Wuxi Second Hospital, Nanjing Medical University, Wuxi 214002, China
| | - Chen-Fei Zheng
- Department of Nephrology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Wen-Yue Liu
- Department of Endocrinology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Sven Van Poucke
- Department of Anesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Zhi Mao
- Department of Critical Care Medicine, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Ke-Qing Shi
- Department of Hepatology, Liver Research Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.,Institute of Hepatology, Wenzhou Medical University, Wenzhou 325000, China
| | - Xiao-Dong Wang
- Department of Hepatology, Liver Research Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.,Institute of Hepatology, Wenzhou Medical University, Wenzhou 325000, China
| | - Ji-Dong Wang
- Department of Nephrology, Affiliated Wuxi Second Hospital, Nanjing Medical University, Wuxi 214002, China
| | - Ming-Hua Zheng
- Department of Hepatology, Liver Research Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.,Institute of Hepatology, Wenzhou Medical University, Wenzhou 325000, China
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Talakoub R, Bahrami M, Honarmand A, Abbasi S, Gerami H. The Predicting Ability of Serum Phosphorus to Assess the Duration of Mechanical Ventilation in Critically Ill Patients. Adv Biomed Res 2017; 6:51. [PMID: 28620595 PMCID: PMC5433651 DOI: 10.4103/2277-9175.205192] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: No previous study exists to evaluate serum phosphorus (Ph) level as a predictor of the need to mechanical ventilation (MV). This study was designed to determine the predictive ability of admission serum Ph level on MV in patients admitted in Intensive Care Unit (ICU). Materials and Methods: This prospective study was conducted on 100 patients (>16 years old), admitted to our ICU over 1-year. Patients were classified into two groups according to the days of the need to MV. Group A: Patients who required equal or <5 days MV, and Group B: Patients who required more than 5 days of MV. We measured total serum Ph concentrations at the times of ICU admission, connecting to the ventilator and weaning from the ventilator. Results: There were significant differences between serum Ph concentration on admission to ICU (Group A: 3.39 ± 0.39 mg/dl, Group B: 2.89 ± 0.31 mg/dl, P < 0.001), at the time of connecting to ventilator (Group A: 2.49 ± 0.38 mg/dl, Group B: 2.25 ± 0.26 mg/dl, P = 0.004) and weaning from ventilator (Group A: 3.42 ± 0.33 mg/dl, Group B: 2.98 ± 0.34 mg/dl, P < 0.001) between two groups. Duration of ICU stay in Group A was 6.08 ± 1.48 days and in Group B was 15.35 ± 6.45, this difference was significant (P < 0.001). We found the best cut-off point of 3.07 for serum Ph concentration to predict the longer duration of MV. Conclusion: According to the results of our study, hypophosphatemia may increase the need to MV. Therefore, monitoring serum Ph level is a good prognostic factor to predict the need to ventilation.
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Affiliation(s)
- Reihanak Talakoub
- Department of Anesthesiology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahshid Bahrami
- Department of Anesthesiology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azim Honarmand
- Department of Anesthesiology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saeed Abbasi
- Department of Anesthesiology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamideh Gerami
- Department of Anesthesiology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Jain A, Palta S, Saroa R, Palta A, Sama S, Gombar S. Sequential organ failure assessment scoring and prediction of patient's outcome in Intensive Care Unit of a tertiary care hospital. J Anaesthesiol Clin Pharmacol 2016; 32:364-8. [PMID: 27625487 PMCID: PMC5009845 DOI: 10.4103/0970-9185.168165] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background and Aims: The objective was to determine the accuracy of sequential organ failure assessment (SOFA) score in predicting outcome of patients in Intensive Care Unit (ICU). Material and Methods: Forty-four consecutive patients between 15 and 80 years admitted to ICU over 8 weeks period were studied prospectively. Three patients were excluded. SOFA score was determined 24 h postadmission to ICU and subsequently every 48 h for the first 10 days. Patients were followed till discharge/death/transfer from the ICU. Initial SOFA score, highest and mean SOFA scores were calculated and correlated with mortality and duration of stay in ICU. Results: The mortality rate was 39% and the mean duration of stay in the ICU was 9 days. The maximum score in survivors (3.92 ± 2.17) was significantly lower than nonsurvivors (8.9 ± 3.45). The initial SOFA score had a strong statistical correlation with mortality. Cardiovascular score on day 1 and 3, respiratory score on day 7, and coagulation profile on day 3 correlated significantly with the outcome. Duration of the stay did not correlate with the survival (P = 0.461). Conclusion: SOFA score is a simple, but effective prognostic indicator and evaluator for patient progress in ICU. Day 1 SOFA can triage the patients into risk categories. For further management, mean and maximum score help determine the severity of illness and can act as a guide for the intensity of therapy required for each patient.
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Affiliation(s)
- Aditi Jain
- Department of Anesthesia and Critical Care, Government Medical College and Hospital, Chandigarh, India
| | - Sanjeev Palta
- Department of Anesthesia and Critical Care, Government Medical College and Hospital, Chandigarh, India
| | - Richa Saroa
- Department of Anesthesia and Critical Care, Government Medical College and Hospital, Chandigarh, India
| | - Anshu Palta
- Department of Pathology, Government Medical College and Hospital, Chandigarh, India
| | - Sonu Sama
- Department of Anesthesia and Critical Care, Government Medical College and Hospital, Chandigarh, India
| | - Satinder Gombar
- Department of Anesthesia and Critical Care, Government Medical College and Hospital, Chandigarh, India
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Javdan Z, Talakoub R, Honarmand A, Golparvar M, Farsani EY. The predicting ability of serum potassium to assess the duration of mechanical ventilation in critically ill patients. Adv Biomed Res 2015; 4:133. [PMID: 26322281 PMCID: PMC4544123 DOI: 10.4103/2277-9175.161525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Accepted: 02/23/2014] [Indexed: 01/31/2023] Open
Abstract
Background: No previous study has been done to evaluate the admission serum potassium level as a predictor of morbidity or need for mechanical ventilation. The aim of this study is to determine the predictive ability of serum potassium on admission, in critically ill trauma patients, and to evaluate the relation of the potassium level to organ failure, length of stay, ventilator need, and duration of mechanical ventilation. Materials and Methods: A prospective, observational study was done on 100 patients >16 years old, admitted to the Medical-Surgical Intensive Care Units (ICU), for over one year. Patients were classified into Group A: Patients who required equal or less than five days of mechanical ventilation and Group B: Patients who required more than five days of mechanical ventilation. The total serum potassium concentrations were measured and the Sequential Organ Failure Assessment (SOFA) score was recorded at the time of admission to the ICU, when connected to the ventilator, and then at the time of weaning from the ventilator. Results: There was no significant difference between the Serum K concentrations between the two groups, on admission. However, there were significant difference between the Serum K concentrations at times of receiving and weaning from mechanical ventilation (MV) between the two groups. We found the best cut-off point of 3.45 for serum potassium concentration, to predict the need for longer duration of MV. Conclusion: Development of hypokalemia during an ICU stay is associated with the need for mechanical ventilation. Monitoring of the serum potassium levels may be a good prognostic factor for the requirement of mechanical ventilation.
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Affiliation(s)
- Zahra Javdan
- Department of Anesthesiology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reihanak Talakoub
- Department of Anesthesiology, School of Medicine, Anesthesia and Critical Care Research Center, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azim Honarmand
- Department of Anesthesiology, School of Medicine, Anesthesia and Critical Care Research Center, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Golparvar
- Department of Anesthesiology, School of Medicine, Anesthesia and Critical Care Research Center, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
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