scholarly journals Identifying early indicators of secondary peritonitis in critically ill patients with cirrhosis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Carole Ruault ◽  
Nathalie Zappella ◽  
Julien Labreuche ◽  
Pierrick Cronier ◽  
Baptiste Claude ◽  
...  

AbstractAscitic fluid infection (AFI) is a life-threatening complication of cirrhosis. We aimed to identify early indicators of secondary peritonitis (SP), which requires emergency surgery, and to describe the outcomes of SP and spontaneous bacterial/fungal peritonitis (SBFP). Adults with cirrhosis and AFI admitted to 16 university or university-affiliated ICUs in France between 2002 and 2017 were studied retrospectively. Cases were identified by searching the hospital databases for relevant ICD-10 codes and hospital charts for AFI. Logistic multivariate regression was performed to identify factors associated with SP. Secondary outcomes were short- and long-term mortality and survivors’ functional outcomes. Of 178 included patients (137 men and 41 women; mean age, 58 ± 11 years), 21 (11.8%) had SP, confirmed by surgery in 16 cases and by abdominal computed tomography in 5 cases. Time to diagnosis exceeded 24 h in 7/21 patients with SP. By multivariate analysis, factors independently associated with SP were ascitic leukocyte count > 10,000/mm3 (OR 3.70; 95%CI 1.38–9.85; P = 0.009) and absence of laboratory signs of decompensated cirrhosis (OR 4.53; 95%CI 1.30–15.68; P = 0.017). The 1-year mortality rates in patients with SBFP and SP were 81.0% and 77.5%, respectively (Log-rank test, P = 0.92). Patients with SP vs. SBFP had no differences in 1-year functional outcomes. This multicenter retrospective study identified two indicators of SP as opposed to SBFP in patients with cirrhosis. Using these indicators may help to provide early surgical treatment.

Author(s):  
Rizwan Alimohammad ◽  
Sayed Tariq ◽  
Ali Elkharbotly ◽  
Ed Timm ◽  
Mikhail Torosoff

Background: NSAIDs may exert direct deleterious effects on CV system, while non-selective (NS) -NSAIDs may also diminish cardio-protective effect of low-dose aspirin. On another hand, NSAIDs may decrease CRP levels and ameliorate systemic inflammation. We have investigated short and long-term outcomes associated with NSAIDs use in post-PCI patients. Methods and Material: NSAID utilization, hospital and long-term outcomes of 2933 percutaneous coronary revascularizations (PCI) were collected and analyzed. Patients not on aspirin, or treated with rofecoxib and valdecoxib were excluded. ANOVA, Chi-square, Kaplan-Meyer analysis with log-rank test, and logistic regression were utilized. The study was approved by the Institutional IRB. Results: Patients treated with NS-NSAIDs, but not celecoxib, experienced longer length of stay, higher incidence of peri-procedural myocardial infarction, and mildly increased post-PCI mortality (Table). These effects were unchanged after adjustment for age (p=0.001), ejection fraction (p<0.001), and history of previous MI (p<0.001). There was a trend towards lower long-term (50+/-15 months) mortality in NS-NSAIDs (9%) and celecoxib (6.7%) treated patients, when compared to the rest of the cohort (11.3%, Table). Conclusion: Non-selective NSAIDs, but not Celecoxib, are associated with prolonged hospital stay and increased peri-procedural myocardial infarction in PCI patients. Long-term mortality does not appear to be affected by the NSAIDs use at the time of PCI. Randomized studies of this important clinical question are needed.


1985 ◽  
Vol 6 (4) ◽  
pp. 772-779 ◽  
Author(s):  
Roop Lal ◽  
Peter D. Chapman ◽  
Gerald V. Naccarrelli ◽  
Paul J. Troup ◽  
Robert L. Rinkenberger ◽  
...  

2021 ◽  
Vol 12 ◽  
Author(s):  
Thomas Resch ◽  
Hubert Hackl ◽  
Hannah Esser ◽  
Julia Günther ◽  
Hubert Schwelberger ◽  
...  

In search for novel biomarkers to assess graft quality, we investigated whether defined candidate genes are predictive for outcome after liver transplantation (LT).Zero-hour liver biopsies were obtained from 88 livers. Gene expression of selected candidate markers was analyzed and correlated with clinical parameters as well as short and long-term outcomes post LT. Whereas both, the calculated Eurotransplant Donor-Risk-Index and the donor body mass index, had either a poor or no predictive value concerning serum levels indicative for liver function (ALT, AST, GGT, bilirubin) after 6 months, chronological donor age was weakly predictive for serum bilirubin (AUC=0.67). In contrast, the major histcompatibility complex class I related chain A (MICA) mRNA expression demonstrated a high predictive value for serum liver function parameters revealing an inverse correlation (e.g. for ALT: 3 months p=0.0332; 6 months p=0.007, 12 months 0.0256, 24 months p=0.0098, 36 months, p=0.0153) and proved significant also in a multivariate regression model. Importantly, high expression of MICA mRNA revealed to be associated with prolonged graft survival (p=0.024; log rank test) after 10 years of observation, whereas low expression was associated with the occurrence of death in patients with transplant related mortality (p=0.031). Given the observed correlation with short and long-term graft function, we suggest MICA as a biomarker for pre-transplant graft evaluation.


2021 ◽  
Vol 18 (2) ◽  
pp. 27-31
Author(s):  
Krishna Chandra Adhikari ◽  
Rabi Malla ◽  
Arun Maskey ◽  
Sujeeb Rajbhandari ◽  
Bishow Raj Baral ◽  
...  

Background and Aims: Worldwide many patients are receiving intravascular contrast media (CM) during interventional procedures. Contrast media are used to enhance visualization and guide percutaneous coronary interventions (PCI).1 However, the use of CM also carries the risk of complications and it is important to be aware of these complications. Complications with CM range from mild symptoms to life-threatening conditions like anaphylaxis, hypotension and renal dysfunction and contrast-induced nephropathy (CIN) is one of them which can have both short and long term consequences.2 This study aimed to know the incidence of CIN in our center and possible predictors associated with it. Methods: This is the single hospital based cross sectional observational study. Patients undergoing primary PCI were enrolled in the study. All the patients underwent thorough history taking and physical examination. Baseline required laboratory investigations were sent. Electrocardiogram and echocardiography screening was done before taking patient to primary PCI as per the protocol of the hospital. Results: The number of patients enrolled in the study was 83 out of which 65(78.2%) were males and mean age was 59.7±13.2. Mean Arterial Pressure (MAP) among the patients was 103.8±21.3. Almost 2/3rd of the population received intravenous fluids. Minimum contrast volume used was 50ml and maximum was 270. When absolute rise in creatinine was considered 12 (14.5%) had CIN and when percent rise was also considered total 28 (33.7%) had CIN. While evaluating the predictors of CIN, higher mean age (p=0.01), hypotension with mean MAP <60 mmhg (p=0.04)) and higher contrast volume >100ml (p=0.04) was found to be significant. Conclusion: The incidence of CIN in patients undergoing PPCI was similar to the studies done in other parts of the world. Evaluating the predictors of CIN, higher mean age, hypotension and higher contrast volume was the significant predictor.


Hematology ◽  
2017 ◽  
Vol 2017 (1) ◽  
pp. 251-258 ◽  
Author(s):  
Rachael Hough ◽  
Ajay Vora

AbstractThe improvement in overall survival in children with acute lymphoblastic leukemia (ALL) over the last 5 decades has been considerable, with around 90% now surviving long term. The risk of relapse has been reduced to such an extent that the risk of treatment-related mortality is now approaching that of mortality caused by relapse. Toxicities may also lead to the suboptimal delivery of chemotherapy (treatment delays, dose reductions, dose omissions), potentially increasing relapse risk, and short- and long-term morbidity, adding to the “burden of therapy” in an increasing number of survivors. Thus, the need to reduce toxicity in pediatric ALL is becoming increasingly important. This work focuses on the risk factors, pathogenesis, clinical features, and emergency management of the life-threatening complications of ALL at presentation and during subsequent chemotherapy, including leucostasis, tumor lysis syndrome, infection, methotrexate encephalopathy, thrombosis, and pancreatitis. Potential strategies to abrogate these toxicities in the future are also discussed.


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