Prognostic contributions of the underlying inflammatory disease and acute organ dysfunction in critically ill patients with systemic rheumatic diseases

AbstractSyndecan-1 (SDC-1) is found in the endothelial glycocalyx and shed into the blood during systemic inflammatory conditions. We investigated organ dysfunction associated with changing serum SDC-1 levels for early detection of organ dysfunction in critically ill patients. To evaluate the effect of SDC-1 on laboratory parameters measured the day after SDC-1 measurement with consideration for repeated measures, linear mixed effects models were constructed with each parameter as an outcome variable. A total of 94 patients were enrolled, and 831 samples were obtained. Analysis using mixed effects models for repeated measures with adjustment for age and sex showed that serum SDC-1 levels measured the day before significantly affected several outcomes, including aspartate aminotransferase (AST), alanine transaminase (ALT), creatinine (CRE), blood urea nitrogen (BUN), antithrombin III, fibrin degradation products, and D-dimer. Moreover, serum SDC-1 levels of the prior day significantly modified the effect between time and several outcomes, including AST, ALT, CRE, and BUN. Additionally, increasing serum SDC-1 level was a significant risk factor for mortality. Serum SDC-1 may be a useful biomarker for daily monitoring to detect early signs of kidney, liver and coagulation system dysfunction, and may be an important risk factor for mortality in critically ill patients.

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Risk Potential for Organ Dysfunction Associated with Sodium Bicarbonate Therapy (SBT) in Critically Ill Patients with Hemodynamic Worsening

10.21203/rs.3.rs-182629/v1 ◽

2021 ◽

Author(s):

Tiehua Wang ◽

Lingxian Yi ◽

Hua Zhang ◽

Tianhao Wang ◽

Jingjing Xi ◽

...

Keyword(s):

Logistic Regression ◽

Metabolic Acidosis ◽

Sodium Bicarbonate ◽

Critically Ill ◽

Organ Dysfunction ◽

Critically Ill Patients ◽

Control Group ◽

Increased Risk ◽

Bicarbonate Therapy ◽

Risk Potential

Abstract Background: The role of sodium bicarbonate therapy (SBT) remains controversial. This study aimed to investigate whether hemodynamic status before SBT contributed to the heterogeneous outcomes associated with SBT in acute critically ill patients.Methods: We obtained data from patients with metabolic acidosis from the Medical Information Mart for Intensive Care (MIMIC)-III database. Propensity score matching (PSM) was applied to match the SBT group with the control group. Logistic regression and Cox regression were used to analyze a composite of newly “developed or exacerbated organ dysfunction” (d/eOD) within 7 days of ICU admission and 28-day mortality associated with SBT for metabolic acidosis.Results: A total of 1765 patients with metabolic acidosis were enrolled, and 332 pairs obtained by PSM were applied to the final analyses in the study. An increased incidence of newly d/eOD was observed in the SB group compared with the control group (54.8% vs 44.6%, p<0.01). Multivariable logistic regression indicated that the adjusted OR of SBT for this composite outcome was no longer significant [OR (95% CI): 1.39 (0.9, 1.85); p=0.164]. This effect of SBT did not change with the quintiles stratified by pH. Interestingly, SBT was associated with an increased risk of the composite of newly d/eOD in the subgroup of patients with worsening hemodynamics before SBT [adjusted OR (95% CI): 3.6 (1.84, 7.22), p< 0.001]. Moreover, the risk potential for this composite of outcomes was significantly increased in patients characterized by both worsening [adjusted OR (95% CI): 2.91 (1.54, 5.47), p< 0.001] and unchanged hemodynamics [adjusted OR (95% CI): 1.94 (1.01, 3.72), p=0.046) compared to patients with improved hemodynamics before SBT. Our study failed to demonstrate an association between SBT and 28-day mortality in acute critically ill patients with metabolic acidosis.Conclusions: Our findings suggested that SBT for metabolic acidosis was associated with an increased risk potential for subsequent d/eOD, while the hemodynamic status remained unstable during the acute phase of critical illness.

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Relationship between amikacin pharmacokinetics and biological parameters associated with organ dysfunction: a case series study of critically ill patients with intra-abdominal sepsis

European Journal of Hospital Pharmacy ◽

10.1136/ejhpharm-2021-003089 ◽

2021 ◽

pp. ejhpharm-2021-003089

Author(s):

Bita Shahrami ◽

Aida Sefidani Forough ◽

Seyedeh Sana Khezrnia ◽

Farhad Najmeddin ◽

Amir Ahmad Arabzadeh ◽

...

Keyword(s):

Critically Ill ◽

Organ Dysfunction ◽

Critically Ill Patients ◽

Case Series ◽

Abdominal Sepsis ◽

Biological Parameters ◽

Case Series Study ◽

Series Study

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Soluble Triggering Receptor Expressed on Myeloid Cells-1 (sTREM-1) is Highly Associated With Mortality and Persistent Organ Dysfunction in the Critically Ill: a Cohort Study

10.21203/rs.3.rs-45875/v1 ◽

2020 ◽

Author(s):

Neha Alhad Sathe ◽

Pavan K. Bhatraju ◽

Carmen Mikacenic ◽

Eric D. Morrell ◽

W. Conrad Liles ◽

...

Keyword(s):

Mechanical Ventilation ◽

Respiratory Failure ◽

Critically Ill ◽

Organ Dysfunction ◽

Critically Ill Patients ◽

Academic Medical Center ◽

Myeloid Cells ◽

Soluble Form ◽

Hypoxemic Respiratory Failure ◽

Study Enrollment

Abstract Background. The triggering receptor expressed on myeloid cells-1 (TREM-1) mediates fatal septic shock in murine models, but studies linking the soluble form of TREM-1 (sTREM-1) to mortality in clinical sepsis are inconclusive, and few have examined its relationship to organ dysfunction. We sought to identify associations between circulating sTREM-1 and both mortality and organ dysfunction among a broad cohort of critically ill medical, post-surgical and trauma patients. Methods. We enrolled a prospective cohort of patients who met two or more criteria for the systemic inflammatory response syndrome (SIRS) within 24 hours of intensive care unit (ICU) admission at a large academic medical center. sTREM-1 concentrations were measured at study enrollment. We used relative risk regression, adjusted for age, sex, and Charlson comorbidity index, to determine associations between sTREM-1 and the primary outcome of 28-day mortality. We also examined secondary outcomes of prevalent organ dysfunction on enrollment, and composites of persistent organ dysfunction or death at day 7. Results. Among 231 critically ill patients, non-survivors (n=19, 8%) had a higher proportion of pre-existing comorbidities, mechanical ventilation (79% vs. 44%) and shock (58% vs. 28%) compared to survivors. At study enrollment, increasing sTREM-1 was associated with a higher risk of severe acute kidney injury (AKI), shock, and acute hypoxemic respiratory failure requiring mechanical ventilation. sTREM-1 was higher among non-survivors than survivors (885 vs 336 pg/mL); each doubling of sTREM-1 concentration was associated with a 2.41-fold higher risk of 28-day mortality (95% CI 1.57, 3.72). Among 92 patients with shock on enrollment, doubling of sTREM-1 was associated with a 3.89-fold higher risk of persistent shock or death by day 7 (95% CI 1.85, 8.17). Higher sTREM-1 was also associated with a higher risk of both persistent AKI and persistent hypoxemic respiratory failure or death. Conclusions. Elevated plasma sTREM-1 is highly associated with 28-day mortality and organ dysfunction across a diverse critically ill population. These data support that early activation of the innate immune system plays a role in the development of organ dysfunction and death. Further studies should address whether modulation of the TREM-1 pathway might be beneficial in critically ill patients.

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Evaluation of the logistic organ dysfunction system for the assessment of organ dysfunction and mortality in critically ill patients

Intensive Care Medicine ◽

10.1007/s001340100888 ◽

2001 ◽

Vol 27 (6) ◽

pp. 992-998 ◽

Cited By ~ 26

Author(s):

P.G.H. Metnitz ◽

J.-R. Le Gall ◽

H. Steltzer ◽

C.-G. Krenn ◽

T. Lang ◽

...

Keyword(s):

Critically Ill ◽

Organ Dysfunction ◽

Critically Ill Patients ◽

Logistic Organ Dysfunction

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SOLUBLE FAS LEVELS CORRELATE WITH MULTIPLE ORGAN DYSFUNCTION SEVERITY, SURVIVAL AND NITRATE LEVELS, BUT NOT WITH CELLULAR APOPTOTIC MARKERS IN CRITICALLY ILL PATIENTS

Shock ◽

10.1097/00024382-200014020-00005 ◽

2000 ◽

Vol 14 (2) ◽

pp. 107-112 ◽

Cited By ~ 23

Author(s):

Elizabeth D. E. Papathanassoglou ◽

Jan A. Moynihan ◽

Dianne L. Vermillion ◽

Michael P. McDermott ◽

Michael H. Ackerman

Keyword(s):

Critically Ill ◽

Organ Dysfunction ◽

Critically Ill Patients ◽

Multiple Organ ◽

Multiple Organ Dysfunction ◽

Soluble Fas ◽

Apoptotic Markers

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REducing Deaths due to OXidative Stress (The REDOXS© Study): rationale and study design for a randomized trial of glutamine and antioxidant supplementation in critically-ill patients

Proceedings of The Nutrition Society ◽

10.1079/pns2006505 ◽

2006 ◽

Vol 65 (3) ◽

pp. 250-263 ◽

Cited By ~ 106

Author(s):

Daren K. Heyland ◽

Rupinder Dhaliwal ◽

Andrew G. Day ◽

John Muscedere ◽

John Drover ◽

...

Keyword(s):

Oxidative Stress ◽

Randomized Trial ◽

Critically Ill ◽

Organ Dysfunction ◽

Critically Ill Patients ◽

Tertiary Care ◽

Antioxidant Therapy ◽

Favourable Effect ◽

High Dose ◽

Antioxidant Supplementation

Critically-ill patients experience an extent of hyperinflammation, cellular immune dysfunction, oxidative stress and mitochondrial dysfunction. Supplementation with key nutrients, such as glutamine and antioxidants, is most likely to have a favourable effect on these physiological derangements, leading to an improvement in clinical outcomes. The results of two meta-analyses suggest that glutamine and antioxidants may be associated with improved survival. The purpose of the present paper is to report the background rationale and study protocol for the evaluation of the effect of high-dose glutamine and antioxidant supplementation on mortality in a large-scale randomized trial in 1200 mechanically-ventilated, critically-ill patients. Patients admitted to an intensive care unit (ICU) with clinical evidence of severe organ dysfunction will be randomized to one of four treatments in a 2×2 factorial design: (1) glutamine; (2) antioxidant therapy; (3) glutamine and antioxidant therapy; (4) placebo. The primary outcome for this study is 28 d mortality. The secondary outcomes are duration of stay in ICU, adjudicated diagnosis of infection, multiple organ dysfunction, duration of mechanical ventilation, length of stay in hospital and health-related quality of life at 3 and 6 months. A novel design feature is the combined use of parenteral and enteral study nutrients dissociated from the nutrition support. The therapeutic strategies tested in the randomized trial may lead to less morbidity and improved survival in critically-ill patients. The trial will be conducted in approximately twenty tertiary-care ICU in Canada and the first results are expected in 2009.

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