Parathyroid hormone and ionized calcium levels are related to the severity of illness and survival in critically ill patients

1998 ◽  
Vol 28 (11) ◽  
pp. 898-903 ◽  
Author(s):  
Carlstedt ◽  
Lind ◽  
Rastad ◽  
Stjernström ◽  
Wide ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Severity Of Illness ◽  
Ionized Calcium

scholarly journals Severe liver dysfunction complicating course of COVID-19 in the critically ill: multifactorial cause or direct viral effect?

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kevin Roedl ◽  
Dominik Jarczak ◽  
Andreas Drolz ◽  
Dominic Wichmann ◽  
Olaf Boenisch ◽  
...  
Keyword(s):  
Critically Ill ◽  
Liver Dysfunction ◽  
Critically Ill Patients ◽  
Severity Of Illness ◽  
University Hospital ◽  
Severe Liver ◽  
Saps Ii ◽  
Severe Liver Dysfunction ◽  
Global Threat ◽  
The University

Abstract Background SARS-CoV-2 caused a pandemic and global threat for human health. Presence of liver injury was commonly reported in patients with coronavirus disease 2019 (COVID-19). However, reports on severe liver dysfunction (SLD) in critically ill with COVID-19 are lacking. We evaluated the occurrence, clinical characteristics and outcome of SLD in critically ill patients with COVID-19. Methods Clinical course and laboratory was analyzed from all patients with confirmed COVID-19 admitted to ICU of the university hospital. SLD was defined as: bilirubin ≥ 2 mg/dl or elevation of aminotransferase levels (> 20-fold ULN). Results 72 critically ill patients were identified, 22 (31%) patients developed SLD. Presenting characteristics including age, gender, comorbidities as well as clinical presentation regarding COVID-19 overlapped substantially in both groups. Patients with SLD had more severe respiratory failure (paO2/FiO2: 82 (58–114) vs. 117 (83–155); p < 0.05). Thus, required more frequently mechanical ventilation (95% vs. 64%; p < 0.01), rescue therapies (ECMO) (27% vs. 12%; p = 0.106), vasopressor (95% vs. 72%; p < 0.05) and renal replacement therapy (86% vs. 30%; p < 0.001). Severity of illness was significantly higher (SAPS II: 48 (39–52) vs. 40 (32–45); p < 0.01). Patients with SLD and without presented viremic during ICU stay in 68% and 34%, respectively (p = 0.002). Occurrence of SLD was independently associated with presence of viremia [OR 6.359; 95% CI 1.336–30.253; p < 0.05] and severity of illness (SAPS II) [OR 1.078; 95% CI 1.004–1.157; p < 0.05]. Mortality was high in patients with SLD compared to other patients (68% vs. 16%, p < 0.001). After adjustment for confounders, SLD was independently associated with mortality [HR3.347; 95% CI 1.401–7.999; p < 0.01]. Conclusion One-third of critically ill patients with COVID-19 suffer from SLD, which is associated with high mortality. Occurrence of viremia and severity of illness seem to contribute to occurrence of SLD and underline the multifactorial cause.

Low-serum 25-hydroxyvitamin D reflects severity of illness in critically ill patients

2012 ◽  
Vol 40 (8) ◽  
pp. 2530 ◽  
Author(s):  
Ben G. Shelley ◽  
Tara Quasim ◽  
John Kinsella ◽  
Dinesh Talwar ◽  
Donald C. McMillan
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Severity Of Illness ◽  
Hydroxyvitamin D ◽  
25 Hydroxyvitamin D ◽  
Low Serum

Serum Albumin Levels: Who Needs Them?

2020 ◽  
pp. 106002802095934 ◽  
Author(s):  
Brian L. Erstad
Keyword(s):  
Clinical Practice ◽  
Serum Albumin ◽  
Critically Ill ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Critically Ill Patients ◽  
Severity Of Illness ◽  
Current Clinical Practice ◽  
Albumin Administration ◽  
Nutritional Monitoring

Objectives The purpose of this critical narrative review is to discuss common indications for ordering serum albumin levels in adult critically ill patients, evaluate the literature supporting these indications, and provide recommendations for the appropriate ordering of serum albumin levels. Data Sources PubMed (1966 to August 2020), Cochrane Library, and current clinical practice guidelines were used, and bibliographies of retrieved articles were searched for additional articles. Study Selection and Data Extraction Current clinical practice guidelines were the preferred source of recommendations regarding serum albumin levels for guiding albumin administration and for nutritional monitoring. When current comprehensive reviews were available, they served as a baseline information with supplementation by subsequent studies. Data Synthesis Serum albumin is a general marker of severity of illness, and hypoalbuminemia is associated with poor patient outcome, but albumin is an acute phase protein, so levels vacillate in critically ill patients in conjunction with illness fluctuations. The most common reasons for ordering serum albumin levels in intensive care unit (ICU) settings are to guide albumin administration, to estimate free phenytoin or calcium levels, for nutritional monitoring, and for severity-of-illness assessment. Relevance to Patient Care and Clinical Practice Because hypoalbuminemia is common in the ICU setting, inappropriate ordering of serum albumin levels may lead to unnecessary albumin administration or excessive macronutrient administration in nutritional regimens, leading to possible adverse effects and added costs. Conclusions With the exception of the need to order serum albumin levels as a component of selected severity-of-illness scoring systems, there is little evidence or justification for routinely ordering levels in critically ill patients.

PP041-SUN THE SEVERITY OF ILLNESS AND PROTEIN DELIVERY IN CRITICALLY ILL PATIENTS

2012 ◽  
Vol 7 (1) ◽  
pp. 41
Author(s):  
L.R. Abrahão ◽  
D.O. Toledo ◽  
A.L. Nunes ◽  
S. Gomes ◽  
F. Fernandes
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Protein Delivery ◽  
Severity Of Illness

scholarly journals The Burden of Hyperbilirubinemia in Critically Ill Patients with Hematological Malignancies: Post-hoc Analysis of a Prospective Multicenter Multinational Study

2020 ◽  
Author(s):  
Magali Bisbal ◽  
Michael Darmon ◽  
Colombe Saillard ◽  
Vincent Mallet ◽  
Charlotte Mouliade ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Critically Ill ◽  
Cancer Progression ◽  
Critically Ill Patients ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Hematological Malignancies ◽  
Severity Of Illness ◽  
Rank Test ◽  
Total Serum

Abstract BackgroundThe evidence on the clinical significance of hyperbilirubinemia (HB) in critically ill patients with hematological malignancies is scarce. We therefore studied its burden in a 2010-2011 Franco-Belgian multicenter prospective study designed to evaluate the prognosis of these patients.Patients and methodsThe cohort comprised 893 patients from 17 centers, 61% men, with a median (interquartile range) age of 60 (49 – 70) years, and preferentially with underlying non-Hodgkin lymphoma (32%) or acute myeloid leukemia (27%). HB was defined as a total serum bilirubin ≥ 33 µmol/L at intensive care unit (ICU) admission. Our main goal was to evaluate the relationship between HB and outcome of critically ill hematological patients. Causes and management of HB in the ICU were analyzed as secondary end points.ResultsHB concerned 185 (21%) patients. Cyclosporine and antimicrobial treatments, ascites and cirrhosis, acute kidney injury, neutropenia, and myeloma (adjusted odd ratio [aOR] 0.38, p=0.006) were risk factors. Hospital mortality was 56.3% and 36.3% in patients with and without HB, respectively (p<0.0001 with the log-rank test). Adjusted for severity of illness, the adjusted odds ratio (95% confidence interval) of HB for in-hospital mortality was 1.86 (1.28, 2.72). HB was overlooked by the ICU team for 92 (53%) patients. Overwise, liver workups for HB led to treatment modifications in 32 (40%) patients, including chemotherapy for cancer progression that was associated with reduced mortality with an adjusted odds ratio of 0.23, (p=0.02).ConclusionHB is associated with outcome of critically ill hematological adult patients and should be systematically explored and treated.

The role and limitations of scoring systems

2016 ◽  
Author(s):  
Hannah Wunsch ◽  
Andrew A. Kramer
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Molecular Level ◽  
Severity Of Illness ◽  
Scoring Systems ◽  
Patient Characteristics ◽  
Clinical Assessments ◽  
Risk Of Death ◽  
Individual Care ◽  
Severity Scores

Scoring systems for critically-ill patients provide a measure of the severity of illness of patients admitted to intensive care units (ICUs). They are primarily based on patient characteristics, physiological derangement, and/or clinical assessments. Severity scores themselves allow for risk-adjusting outcomes, but they can also be used to provide a prediction of the overall risk of death, length of stay, or other outcome for critically ill patients. This allows for comparison of outcomes between different cohorts of patients or between observed and predicted ICU performance. There are a number of general ICU scoring systems that are in use. All scoring systems have limitations. Future scoring systems may include prediction of longer-term outcomes, and assimilation of granular data temporally and at the molecular level that could result in more personalized severity scores to help guide individual care decisions.

Diagnostic and prognostic value of presepsin vs. established biomarkers in critically ill patients with sepsis or systemic inflammatory response syndrome

2018 ◽  
Vol 56 (4) ◽  
pp. 658-668 ◽  
Author(s):  
Helena Brodska ◽  
Jiri Valenta ◽  
Kveta Pelinkova ◽  
Zdenek Stach ◽  
Robert Sachl ◽  
...  
Keyword(s):  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Critically Ill ◽  
Sofa Score ◽  
Critically Ill Patients ◽  
Severity Of Illness ◽  
Systemic Inflammatory Response ◽  
Reactive Protein ◽  
Failure Assessment ◽  
Clinical Illness

Abstract Background: Inflammatory biomarkers may aid to distinguish between systemic inflammatory response syndrome (SIRS) vs. sepsis. We tested the hypotheses that (1) presepsin, a novel biomarker, can distinguish between SIRS and sepsis, and (2) higher presepsin levels will be associated with increased severity of illness and (3) with 28-day mortality, outperforming traditional biomarkers. Methods: Procalcitonin (PCT), C-reactive protein (CRP), presepsin, and lactate were analyzed in 60 consecutive patients (sepsis and SIRS, n=30 per group) on day 1 (D1) to D3 (onset sepsis, or after cardiac surgery). The systemic organ failure assessment (SOFA) score was determined daily. Results: There was no difference in mortality in sepsis vs. SIRS (12/30 vs. 8/30). Patients with sepsis had higher SOFA score vs. patients with SIRS (11±4 vs. 8±5; p=0.023), higher presepsin (AUC=0.674; p<0.021), PCT (AUC=0.791; p<0.001), CRP (AUC=0.903; p<0.0001), but not lactate (AUC=0.506; p=0.941). Unlike other biomarkers, presepsin did not correlate with SOFA on D1. All biomarkers were associated with mortality on D1: presepsin (AUC=0.734; p=0.0006; best cutoff=1843 pg/mL), PCT (AUC=0.844; p<0.0001), CRP (AUC=0.701; p=0.0048), and lactate (AUC=0.778; p<0.0001). Multiple regression analyses showed independent associations of CRP with diagnosis of sepsis, and CRP and lactate with mortality. Increased neutrophils (p=0.002) and decreased lymphocytes (p=0.007) and monocytes (p=0.046) were also associated with mortality. Conclusions: Presepsin did not outperform traditional sepsis biomarkers in diagnosing sepsis from SIRS and in prognostication of mortality in critically ill patients. Presepsin may have a limited adjunct value for both diagnosis and an early risk stratification, performing independently of clinical illness severity.

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