scholarly journals Serum syndecan-1 reflects organ dysfunction in critically ill patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Keiko Suzuki ◽  
Hideshi Okada ◽  
Kazuyuki Sumi ◽  
Hiroyuki Tomita ◽  
Ryo Kobayashi ◽  
...  
Keyword(s):  
Risk Factor ◽  
Critically Ill ◽  
Organ Dysfunction ◽  
Critically Ill Patients ◽  
Repeated Measures ◽  
Significant Risk ◽  
Mixed Effects ◽  
Mixed Effects Models ◽  
Endothelial Glycocalyx ◽  
Outcome Variable

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.

scholarly journals Serum Syndecan-1 Reflects Organ Dysfunction in Critically Ill Patients

2020 ◽  
Author(s):  
Keiko Suzuki ◽  
Hideshi Okada ◽  
Kazuyuki Sumi ◽  
Hiroyuki Tomita ◽  
Ryo Kobayashi ◽  
...  
Keyword(s):  
Critically Ill ◽  
Organ Dysfunction ◽  
Critically Ill Patients ◽  
Repeated Measures ◽  
Mixed Effects ◽  
University Hospital ◽  
Mixed Effects Models ◽  
Endothelial Glycocalyx ◽  
Coagulation System ◽  
Outcome Variable

Abstract Syndecan-1 (SDC-1) is found in the endothelial glycocalyx and shed into the blood during systemic inflammatory conditions. We examined organ dysfunction associated with changing serum SDC-1 levels in critically ill patients. A single-center, retrospective, observational study was conducted at Gifu University Hospital. Patients admitted to the intensive care unit from March 2019 to February 2020 were enrolled. 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 from the day before significantly modified the effect between time and several outcomes, including AST, ALT, CRE, and BUN. Serum SDC-1 may be a useful biomarker for daily monitoring of critically ill patients with kidney, liver and coagulation system injuries.

scholarly journals Comparison of Length of Stay and Deep Vein Thrombosis (DVT) Incidents in Dr. Soetomo Hospital

2018 ◽  
Vol 54 (4) ◽  
pp. 278
Author(s):  
Elizeus Hanindito ◽  
Prananda Surya Airlangga ◽  
Soni Sunarso Sulistiawan ◽  
Bambang Pujo Semedi ◽  
Lucky Andriyanto ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Deep Vein Thrombosis ◽  
Length Of Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Significant Risk ◽  
Vein Thrombosis ◽  
Length Of Treatment ◽  
Deep Vein

Vein thrombosis may occur both in deep and superficial vein of all extremities. Ninety percent of vein thrombosis may progress into pulmonary embolism which is lethal. Deep vein thrombosis (DVT) is frequently found in critically ill patients in ICU, especially patients who are treated for a long time. This study aims to analyse the comparison between length of stay and DVT incidents in critically ill patients. A cross-sectional study was employed. We include all patients who were 18 years or older and  were treated in ICU of Dr Soetomo public hospital for at least 7 days. The patients were examined with Sonosite USG to look for any thrombosis in iliac, femoral, popliteal, and tibial veins and Well’s criteria were also taken. This study showed that length of stay is not the only risk factor for DVT in patients treated in ICU. In our data, we found out that the length of treatment did not significantly cause DVT. Other risk factors such as age and comorbidities in patients who are risk factors may support the incidence of DVT events. The diagnosis of DVT is enforced using an ultrasound performed by an expert in the use of ultrasound to locate thrombus in a vein. Length of treatment is not a significant risk factor for DVT. Several other factors still need to be investigated in order for DVT events to be detected early and prevented.

Censored mixed-effects models for irregularly observed repeated measures with applications to HIV viral loads

Test ◽  
2016 ◽  
Vol 25 (4) ◽  
pp. 627-653 ◽  
Author(s):  
Larissa A. Matos ◽  
Luis M. Castro ◽  
Víctor H. Lachos
Keyword(s):  
Repeated Measures ◽  
Mixed Effects ◽  
Mixed Effects Models ◽  
Viral Loads

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

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.

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

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.

Accuracy of a mixed effects model interpolation technique for the estimation of pregnancy weight values

2019 ◽  
Vol 73 (8) ◽  
pp. 786-792 ◽  
Author(s):  
Anne Marie Darling ◽  
Martha M Werler ◽  
David E Cantonwine ◽  
Wafaie W Fawzi ◽  
Thomas F McElrath
Keyword(s):  
Linear Model ◽  
Repeated Measures ◽  
Correlation Coefficients ◽  
Absolute Error ◽  
Mixed Effects ◽  
Mean Difference ◽  
Mixed Effects Models ◽  
Measured Weight ◽  
Mean Differences ◽  
Pregnancy Weight

BackgroundInterpolation of missing weight values is sometimes used in studies of gestational weight gain, but the accuracy of these methods has not been established. Our objective was to assess the accuracy of estimated weight values obtained by interpolating from the nearest observed weight values and by linear and spline regression models when compared with measured weight values.MethodsThe study population included participants enrolled in the LIFECODES cohort at Brigham and Women’s Hospital. We estimated weights at 28 (n=764) and 40 (n=382) weeks of gestation using participants’ two nearest observed weights and subject-specific slopes and intercepts derived from repeated measures mixed effects models. In separate models, gestational age was parameterised as a linear and restricted cubic spline variable. Mean differences, absolute error measures and correlation coefficients comparing observed and estimated weights were calculated.ResultsMean differences and mean absolute error for weights derived from the 28-week linear model (0.18 lbs (SD 6.92), 2.73 lbs (SD 6.35)) and 40-week linear model (−0.40 lbs (SD 5.43) and 2.84 lbs (SD 4.65)) were low. Mean differences were somewhat greater at 28 weeks for weight values derived from the nearest two observed values (mean difference −1.97 lbs (SD 8.74)) and from spline models (mean difference −2.25 lbs (SD 7.13)). Results were similar at 40 weeks.ConclusionsOverall, weight values estimated using this interpolation approach showed good agreement with observed values. When repeated measures of weight are available, mixed effects models may be used to interpolate of missing weight values with minimal error.

scholarly journals Obesity as a risk factor for unfavourable outcomes in critically ill patients affected by Covid 19

2020 ◽  
Author(s):  
Andrea P. Rossi ◽  
Leonardo Gottin ◽  
Katia Donadello ◽  
Vittorio Schweiger ◽  
Riccardo Nocini ◽  
...  
Keyword(s):  
Risk Factor ◽  
Critically Ill ◽  
Critically Ill Patients

Crystalloids in critical illness

2016 ◽  
Author(s):  
Karthik Raghunathan ◽  
Andrew Shaw
Keyword(s):  
Critical Illness ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Endothelial Glycocalyx ◽  
Strong Ion Difference ◽  
Negative Consequences ◽  
Negative Effects ◽  
Randomized Controlled Studies ◽  
Preload Responsiveness ◽  
Saline Solutions

‘Crystalloid’ refers to solutions of crystalline substances that can pass through a semipermeable membrane and are distributed widely in body fluid compartments. The conventional Starling model predicts transvascular exchange based on the net balance of opposing hydrostatic and oncotic forces. Based on this model, colloids might be considered superior resuscitative fluids. However, observations of fluid behaviour during critical illness are not consistent with such predictions. Large randomized controlled studies have consistently found that colloids offer no survival advantage relative to crystalloids in critically-ill patients. A revised Starling model describes a central role for the endothelial glycocalyx in determining fluid disposition. This model supports crystalloid utilization in most critical care settings where the endothelial surface layer is disrupted and lower capillary pressures (hypovolaemia) make volume expansion with crystalloids effective, since transvascular filtration decreases, intravascular retention increases and clearance is significantly reduced. There are important negative consequences of both inadequate and excessive crystalloid resuscitation. Precise dosing may be titrated based on functional measures of preload responsiveness like pulse pressure variation or responses to manoeuvres such as passive leg raising. Crystalloids have variable electrolyte concentrations, volumes of distribution, and, consequently variable effects on plasma pH. Choosing balanced crystalloid solutions for resuscitation may be potentially advantageous versus ‘normal’ (isotonic, 0.9%) saline solutions. When used as the primary fluid for resuscitation, saline solutions may have adverse effects in critically-ill patients secondary to a reduction in the strong ion difference and hyperchloraemic, metabolic acidosis. Significant negative effects on immune and renal function may result as well.

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