scholarly journals Prediction of Microbial Infection and Mortality in Medical Patients with Fever: Plasma Procalcitonin, Neutrophilic Elastase‐α‐Antitrypsin, and Lactoferrin Compared with Clinical Variables

1999 ◽  
Vol 29 (2) ◽  
pp. 398-407 ◽  
Author(s):  
Ailko W. J. Bossink ◽  
A. B. Johan Groeneveld ◽  
Lambertus G. Thijs
Keyword(s):  
Medical Patients ◽  
Microbial Infection ◽  
Clinical Variables ◽  
Neutrophilic Elastase

Early Inhibition of Activated Fibrinolysis Predicts Microbial Infection, Shock and Mortality in Febrile Medical Patients

2001 ◽  
Vol 86 (08) ◽  
pp. 543-549 ◽  
Author(s):  
Joost Raaphorst ◽  
Ailko Bossink ◽  
C. Erik Hack ◽  
A. B. Johan Groeneveld
Keyword(s):  
Plasminogen Activator ◽  
Plasma Levels ◽  
Peak Plasma ◽  
Febrile Illness ◽  
Plasminogen Activator Inhibitor ◽  
Tissue Type ◽  
Medical Patients ◽  
Microbial Infection ◽  
Plasminogen Activator Inhibitor 1 ◽  
Pai 1

SummaryTo evaluate the contribution of an imbalance between coagulation activation and fibinolysis activation and inhibition to morbidity and mortality in sepsis, we determined in medical hospitalized patients at inclusion (day 0) for fever (temperature above 38.0° C axillary or 38.3° C rectally), and daily thereafter for two days, circulating thrombin-antithrombin III (TAT) complexes, plasmin- 2-antiplasmin (PAP) complexes (day 0 only), tissue-type plasminogen activator (t-PA), plasminogen activator inhibitor-1 (PAI-1) and interleukin (IL)-6, the latter as a marker of the inflammatory host response. Study variables were 1) positive microbiological results for specimens from local sites associated with a clinical infection, positive blood cultures (including parasitemia) or both, within 7 days after inclusion, 2) development of shock, i.e. systolic blood pressure <90 mmHg or a reduction of 40 mmHg from baseline within 7 days after inclusion, and 3) death related to febrile illness within 28 days after inclusion. The peak plasma levels of TAT complexes were elevated in 44% and the PAP complexes in all patients. The t-PA and PAI-1 levels were elevated in 74 and 94% of patients, respectively. Values for TAT and PAP did not differ among subgroups, while peak t-PA and IL-6 levels were higher in patients with positive microbiological results, developing shock or ultimately dying than in those without the complications (p <0.005). Peak PAI-1 levels were elevated in patients developing shock and ultimate death versus those with an uncomplicated course (p <0.05). Peak IL-6 related to PAI-1 and t-PA levels, which interrelated. Patients with elevated TAT levels had increased plasma levels of IL-6, PAP, PAI-1 and t-PA versus those with normal TAT (p <0.05). Our data indicate that inhibition of activated fibrinolysis, which may partly depend on both cytokinemia and activation of coagulation, predicts microbial infection, septic shock and mortality of febrile medical patients. This suggests an early pathogenic role of inhibition of activated fibrinolysis in the downhill course of serious microbial infection.

The Clinical Host Response to Microbial Infection in Medical Patients With Fever

CHEST Journal ◽  
1999 ◽  
Vol 116 (2) ◽  
pp. 380-390 ◽  
Author(s):  
Ailko W.J. Bossink ◽  
A. B. Johan Groeneveld ◽  
C. Erik Hack ◽  
Lambertus G. Thijs
Keyword(s):  
Host Response ◽  
Medical Patients ◽  
Microbial Infection

Quality management in the prophylaxis of venous thrombembolism - Results of a survey including 464 medical and surgical patients

VASA ◽  
2011 ◽  
Vol 40 (2) ◽  
pp. 123-130
Author(s):  
Klein-Weigel ◽  
Richter ◽  
Arendt ◽  
Gerdsen ◽  
Härtwig ◽  
...  
Keyword(s):  
Renal Function ◽  
High Risk ◽  
Quality Management ◽  
High Risk Group ◽  
Surgical Patients ◽  
Medical Patients ◽  
Risk Status ◽  
Vte Prophylaxis ◽  
Safety Concerns

Background: We surveyed the quality of risk stratification politics and monitored the rate of entries to our company-wide protocol for venous thrombembolism (VTE) prophylaxis in order to identify safety concerns. Patients and methods: Audit in 464 medical and surgical patients to evaluate quality of VTE prophylaxis. Results: Patients were classified as low 146 (31 %), medium 101 (22 %), and high risk cases 217 (47 %). Of these 262 (56.5 %) were treated according to their risk status and in accordance with our protocol, while 9 more patients were treated according to their risk status but off-protocol. Overtreatment was identified in 73 (15.7 %), undertreatment in 120 (25,9 %) of all patients. The rate of incorrect prophylaxis was significantly different between the risk categories, with more patients of the high-risk group receiving inadequate medical prophylaxis (data not shown; p = 0.038). Renal function was analyzed in 392 (84.5 %) patients. In those patients with known renal function 26 (6.6 %) received improper medical prophylaxis. If cases were added in whom prophylaxis was started without previous creatinine control, renal function was not correctly taken into account in 49 (10.6 %) of all patients. Moreover, deterioration of renal function was not excluded within one week in 78 patients (16.8 %) and blood count was not re-checked in 45 (9.7 %) of all patients after one week. There were more overtreatments in surgical (n = 53/278) and more undertreatments in medical patients (n = 54/186) (p = 0.04). Surgeons neglected renal function and blood controls significantly more often than medical doctors (p-values for both < 0.05). Conclusions: We found a low adherence with our protocol and substantial over- and undertreatment in VTE prophylaxis. Besides, we identified disregarding of renal function and safety laboratory examinations as additional safety concerns. To identify safety problems associated with medical VTE prophylaxis and “hot spots” quality management-audits proved to be valuable instruments.

Analysis of Deliberate Self-Wrist-Cutting Episodes Presenting to the Emergency Department

Crisis ◽  
2016 ◽  
Vol 37 (2) ◽  
pp. 155-160 ◽  
Author(s):  
Jin Kim ◽  
Han Joon Kim ◽  
Soo Hyun Kim ◽  
Sang Hoon Oh ◽  
Kyu Nam Park
Keyword(s):  
Emergency Department ◽  
Medical Records ◽  
Attempted Suicide ◽  
Suicide Attempts ◽  
Psychiatric Interview ◽  
Clinical Variables ◽  
Completed Suicide ◽  
Number Of Patients ◽  
Group A ◽  
Efficacy Of Treatment

Abstract. Background: Previous suicide attempts increase the risk of a completed suicide. However, a large proportion of patients with deliberate self-wrist cutting (DSWC) are often discharged without undergoing a psychiatric interview. Aims: The aims of this study were to investigate the differences in the characteristics and outcomes of patients with DSWC and those with deliberate self-poisoning (DSP) episodes. The results of this study may be used to improve the efficacy of treatment for DSWC patients. Method: We retrospectively reviewed the medical records of 598 patients with DSWC and DSP who were treated at the emergency department of Seoul Saint Mary's Hospital between 2008 and 2013. We assessed sociodemographic information, clinical variables, the reasons for the suicide attempts, and the severity of the suicide attempts. Results: A total of 141 (23.6%) patients were included in the DSWC group, and 457 (76.4%) were included in the DSP group. A significantly greater number of patients in the DSWC group had previously attempted suicide (p = .014). A total of 63 patients (44.7%) in the DSWC group and 409 patients (89.5%) in the DSP group underwent psychiatric interviews. Conclusion: More DSWC patients had previously attempted suicide, but fewer of them underwent psychiatric interviews compared with the DSP patients.

Computer Telephony Screening of Medical Patients for Unhealthy Substance Use

2009 ◽  
Author(s):  
Amy Rubin ◽  
Erin Cunniff ◽  
Mary Brolin ◽  
Christopher W. Shanahan ◽  
Indira Persand ◽  
...  
Keyword(s):  
Substance Use ◽  
Medical Patients

Sustained Increase in Anti-Xa Activity by Low-Dose Heparin in Medical Patients

1982 ◽  
Vol 47 (03) ◽  
pp. 296-296
Author(s):  
Gordon Lowe ◽  
Jill Belch ◽  
Karen Regan ◽  
Charles Forbes ◽  
Colin Prentice
Keyword(s):  
Low Dose ◽  
Medical Patients ◽  
Dose Heparin ◽  
Low Dose Heparin ◽  
Sustained Increase

Living on the Fat of the Land: The Changing Face of Malnutrition amongst Medical Patients

Endoscopy ◽  
2004 ◽  
Vol 36 (10) ◽  
Author(s):  
A Coss ◽  
M Doherty ◽  
A Geary ◽  
C Keenan ◽  
J Mahon ◽  
...  
Keyword(s):  
Medical Patients
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