Heterogenous pattern of the inflammasome-related markers in the critically ill COVID-19 patients at the ICU admission.

Purpose: Development of targeted biological therapies to COVID-19 requires reliable biomarkers that could help to indicate the responding patients. Hyperactivation of the inflammasome by SARS-CoV2 virus is hypothesized to contribute to severe course of the COVID-19 disease. Therefore, we aimed to evaluate the prognostic value of several inflammasome-related cytokines and proteins at the admission to the intensive care unit. Patients and methods: Plasma samples were obtained from 45 critically-COVID-19 patients and from 10 patients with severe craniocerebral traumatic brain injury (TBI) at the admission to the ICU. The concentration of IL-1𝛼, IL-1𝛽, IL-18, IL-1RA, galectin-1, ASC, LDH, ferritin and gasdermin D were analyzed. A novel cell-free caspase-1 plasma assay was developed by inhibitor-based immunoprecipitation followed by Western Blot. Demographic and clinical characteristics were recorded. Results: The inflammasome-related biomarkers were in similar concentration in COVID-19 and TBI patients except for galectin-1 being lower in the former. None of the tested markers was related to the outcome, length of stay or development of secondary infections. Patients with SOFA score of >9 at admission who were at high risk of death had significantly higher galectin-1 but lower IL-1RA in comparison to low-risk patients. Weak but significant correlations were observed for IL-1𝛼 and IL-1𝛽 and platelets and also for ferritin and INR. Activated caspase-1 p35 was detectable in 12/22 COVID-19 patients and was related with higher fibrinogen and lower D-dimers. It was also significantly higher in patients with SOFA>9. Conclusion: Our results indicate that the activation of the inflammasome in critically ill COVID-19 patients is a heterogenous process and is not directly related with outcome. Therefore, potential interventions aimed at this pathway in this group of patients can be limited and should be biomarker-guided.

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Defining the prognostic value of [15O]H2O positron emission tomography-derived myocardial ischaemic burden

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa305 ◽

2020 ◽

Author(s):

Pepijn A van Diemen ◽

Jan-Thijs Wijmenga ◽

Roel S Driessen ◽

Michiel J Bom ◽

Stefan P Schumacher ◽

...

Keyword(s):

Positron Emission Tomography ◽

Prognostic Value ◽

Clinical Characteristics ◽

Emission Tomography ◽

Flow Reserve ◽

Positron Emission ◽

Risk Patients ◽

Artery Disease ◽

Event Rates ◽

Ischaemic Burden

Abstract Aims Myocardial ischaemic burden (IB) is used for the risk stratification of patients with coronary artery disease (CAD). This study sought to define a prognostic threshold for quantitative [15O]H2O positron emission tomography (PET)-derived IB. Methods and results A total of 623 patients with suspected or known CAD who underwent [15O]H2O PET perfusion imaging were included. The endpoint was a composite of death and non-fatal myocardial infarction (MI). A hyperaemic myocardial blood flow (hMBF) and myocardial flow reserve (MFR)-derived IB were determined. During a median follow-up time of 6.7 years, 62 patients experienced an endpoint. A hMBF IB of 24% and MFR IB of 28% were identified as prognostic thresholds. Patients with a high hMBF or MFR IB (above threshold) had worse outcome compared to patients with a low hMBF IB [annualized event rates (AER): 2.8% vs. 0.6%, P < 0.001] or low MFR IB [AER: 2.4% vs. 0.6%, P < 0.001]. Patients with a concordant high IB had the worst outcome (AER: 3.1%), whereas patients with a concordant low or discordant IB result had similar and low AERs of 0.5% and 0.9% (P = 0.953), respectively. Both thresholds were of prognostic value beyond clinical characteristics, however, only the hMBF IB threshold remained predictive when adjusted for clinical characteristics and combined use of the hMBF and MFR thresholds. Conclusion A hMBF IB ≥24% was a stronger predictor of adverse outcome than an MFR IB ≥28%. Nevertheless, classifying patients according to concordance of IB result allowed for the identification of low- and high-risk patients.

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Multi-Drug Resistance Bacterial Infections in Critically Ill Patients Admitted with COVID-19

Microorganisms ◽

10.3390/microorganisms9081773 ◽

2021 ◽

Vol 9 (8) ◽

pp. 1773

Author(s):

Daniela Pasero ◽

Andrea Pasquale Cossu ◽

Pierpaolo Terragni

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Bacterial Infections ◽

Invasive Mechanical Ventilation ◽

Multi Drug Resistance ◽

Icu Admission ◽

Risk Of Death ◽

Stewardship Program ◽

Secondary Infections ◽

Tract Infections

Introduction. It is known that bacterial infections represent a common complication during viral respiratory tract infections such as influenza, with a concomitant increase in morbidity and mortality. Nevertheless, the prevalence of bacterial co-infections and secondary infections in critically ill patients affected by coronavirus disease 2019 (COVID-19) is not well understood yet. We performed a review of the literature currently available to examine the incidence of bacterial secondary infections acquired during hospital stay and the risk factors associated with multidrug resistance. Most of the studies, mainly retrospective and single-centered, highlighted that the incidence of co-infections is low, affecting about 3.5% of hospitalized patients, while the majority are hospital acquired infections, developed later, generally 10–15 days after ICU admission. The prolonged ICU hospitalization and the extensive use of broad-spectrum antimicrobial drugs during the COVID-19 outbreak might have contributed to the selection of pathogens with different profiles of resistance. Consequently, the reported incidence of MDR bacterial infections in critically ill COVID-19 patients is high, ranging between 32% to 50%. MDR infections are linked to a higher length of stay in ICU but not to a higher risk of death. The only risk factor independently associated with MDR secondary infections reported was invasive mechanical ventilation (OR 1.062; 95% CI 1.012–1.114), but also steroid therapy and prolonged length of ICU stay may play a pivotal role. The empiric antimicrobial therapy for a ventilated patient with suspected or proven bacterial co-infection at ICU admission should be prescribed judiciously and managed according to a stewardship program in order to interrupt or adjust it on the basis of culture results.

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Epidemiological and clinical characteristics of sepsis-associated encephalopathy in the ICU: a retrospective observational study

10.21203/rs.2.14475/v1 ◽

2019 ◽

Author(s):

Dao-Ming Tong ◽

Ye-Ting Zhou ◽

Shao=Dan Wang ◽

Guang-Sheng Wang ◽

Yuan-Wei Wang ◽

...

Keyword(s):

Critically Ill ◽

Sofa Score ◽

Clinical Characteristics ◽

Clinical Predictors ◽

Organ Function ◽

Icu Patients ◽

Risk Of Death ◽

Critically Ill Adults ◽

Ill Adults ◽

Function Assessment

Abstract Background Sepsis has an annual incidence of 30 million new cases around worldwide. However, the epidemiological and clinical characteristics in patients with sepsis-associated encephalopathy (SAE) remain understudy.Methods We prospectively enrolled patients with acute critically ill from ICU during 2 years period (2014-2015). The epidemiological and clinical characteristics for critically ill adults with SAE in ICU were analyzed by related statistics.Results Of the 1349 ICU patients with acute critically ill, 748 were enrolled. Among these, the prevalence of sepsis was 48.4% (362/748), with fatality at initial 30 days was 62.4%. The prevalence of SAE accounted for 97.2% of sepsis (352/362), with fatality at initial 30 days was 65.1%. We found that the two strong clinical predictors for SAE were systemic inflammatory response syndrome (SIRS) ≥2 (OR, 3.2; 95% CI, 0.304- 0.673) and sequential (sepsis-related) organ function assessment (SOFA) score ≥6 (GCS<13)(OR, 3.0; 95% CI, 0.304-0.673); the sensitivity was 67.3% and specificity was 55.3% for SIRS≥2, while the sensitivity was 99.1% and specificity was 99.0% for SOFA score≥6. Cox logistic adjusted analysis revealed that lower mean arterial pressure (OR, 1.504; 95% CI, 1.001-1.707),higher SOFA score (OR, 1.783; 95% CI, 1.145- 1.923), and no using antibiotics treatment in initial 3 hours (OR, 0.683; 95% CI, 0.492-0.947) were the powerful predictors of the risk of death among ICU patients with SAE.Conclusion SAE is a best frequent epidemiological type of sepsis in ICU, with an high hospital fatality. No using antibiotics treatment within initial 3 hours was related to the worse survival SAE.

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Does the RIFLE Classification Improve Prognostic Value of the APACHE II Score in Critically Ill Patients?

International Journal of Nephrology ◽

10.1155/2013/406165 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Kátia M. Wahrhaftig ◽

Luis C. L. Correia ◽

Denise Matias ◽

Carlos A. M. De Souza

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Prognostic Value ◽

Kidney Injury ◽

Apache Ii ◽

Apache Ii Score ◽

Icu Mortality ◽

Risk Of Death ◽

Rifle Classification ◽

Critical Patients

Introduction.The RIFLE classification defines three severity criteria for acute kidney injury (AKI): risk, injury, and failure. It was associated with mortality according to the gradation of AKI severity. However, it is not known if the APACHE II score, associated with the RIFLE classification, results in greater discriminatory power in relation to mortality in critical patients.Objective.To analyze whether the RIFLE classification adds value to the performance of APACHE II in predicting mortality in critically ill patients.Methods.An observational prospective cohort of 200 patients admitted to the ICU from July 2010 to July 2011.Results.The age of the sample was 66 (±16.7) years, 53.3% female. ICU mortality was 23.5%. The severity of AKI presented higher risk of death: class risk (RR = 1.89 CI:0.97–3.38, ), grade injury (RR = 3.7 CI:1.71–8.08, ), and class failure (RR = 4.79 CI:2.10–10.6, ). The APACHE II had C-statistics of 0.75, 95% (CI:0.68–0.80, ) and 0.80 (95% CI:0.74 to 0.86, ) after being incorporated into the RIFLE classification in relation to prediction of death. In the comparison between AUROCs, .Conclusion.The severity of AKI, defined by the RIFLE classification, was a risk marker for mortality in critically ill patients, and improved the performance of APACHE II in predicting the mortality in this population.

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Katz Frailty Syndrom has no Predictive Value in Low-Risk Patients Undergoing Transcatheter Aortic Valve Implantation

Clinical Cardiology and Cardiovascular Interventions ◽

10.31579/2641-0419/227 ◽

2021 ◽

Vol 04 (16) ◽

pp. 01-08

Author(s):

Katarzyna Byczkowska

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Prognostic Value ◽

Frailty Syndrome ◽

Risk Of Death ◽

Transcatheter Aortic Valve ◽

Risk Patients ◽

Aortic Valve Implantation ◽

Valve Implantation ◽

Frailty Score

Background: Aortic stenosis is a disease of the elderly people, with multiple comorbidities and often with the frailty syndrome. Therefore, we decided that frailty as a clinical factor requires precise characterization as it is a valuable supplement to the risk stratification in transcatheter aortic Valve implantation (TAVI). Objective: The aim of our study was to evaluate the prognostic value of the Katz frailty scale in patients undergoing TAVI in relation to the risk of mortality assessed with the STS scale. Material and methods: The study included 105 patients with severe aortic stenosis (AS) treated with TAVI at the Department of Invasive Cardiology, Central Clinical Hospital of the Ministry of Interior. In our group, the Katz frailty syndrome confirmed in all patients, and 48% in the advanced stage. Results: Statistical analysis showed a significant difference between survival and Katz frailty score before TAVI. Analysis using Cox's model confirmed a significant prognostic value for the Katz frailty syndrome before TAVI. Patients with moderate to severe frailty on the Katz score (values ≤ 4) had a 13,68 times higher risk of death per year compared to the group with Katz frailty syndrome ≥ 5. Multivariate regression analysis indicated that Katz frailty score and STS score were prognostically significant factors of cardiovascular death in patients undergoing TAVI. Conclusion: The Katz frailty score had a significant prognostic value in the high- and intermediate risk patients. Katz frailty score and STS risk score significantly correlated with the risk of death from cardiovascular causes in frailty patients undergoing TAVI.

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EPIDEMIOLOGICAL AND CLINICAL CHARACTERISTICS OF COVID-19 PATIENTS IN KENYA

10.1101/2020.11.09.20228106 ◽

2020 ◽

Author(s):

Loice Achieng Ombajo ◽

Nyamai Mutono ◽

Paul Sudi ◽

Mbuvi Mutua ◽

Mohammed Sood ◽

...

Keyword(s):

Risk Factors ◽

Medical Records ◽

Clinical Characteristics ◽

Proportional Hazards ◽

Outcome Data ◽

Cox Proportional Hazards ◽

Rt Pcr ◽

Blood Cell Count ◽

Risk Of Death ◽

Risk Patients

AbstractBackgroundMore than 49,000 cases of infection and 900 deaths from COVID-19 have been recorded in the Kenya. However, the characteristics and risk factors for severe outcomes among hospitalized COVID-19 patients in this setting have not been described.MethodsWe extracted demographic, laboratory, clinical and outcome data from medical records of RT-PCR confirmed SARS-CoV2 patients admitted in six hospitals in Kenya between March and September, 2020. We used Cox proportional hazards regressions to determine factors related to in-hospital mortality.ResultsData from 787 COVID-19 patients was available. The median age was 43 years (IQR 30-53), with 505 (64%) males. At admission, 455 (58%) were symptomatic. The commonest symptoms were cough (337, 43%), loss of taste or smell (279, 35%), and fever (126, 16%). Co-morbidities were reported in 340 (43%), with cardiovascular disease, diabetes and HIV documented in 130 (17%), 116 (15%), 53 (7%) respectively. 90 (11%) were admitted to ICU for a mean of 11 days, 52 (7%) were ventilated with a mean of 10 days, 107 (14%) died. The risk of death increased with age [hazard ratio (HR) 1.57 (95% CI 1.13 – 2.19)] for persons >60 years compared to those <60 years old; having co-morbidities [HR 2.34 (1.68 – 3.25)]; and among males [HR 1.76 (1.27, 2.44)] compared to females. Elevated white blood cell count and aspartate aminotransferase were associated with higher risk of death.ConclusionsWe identify the risk factors for mortality that may guide stratification of high risk patients.

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TWILIGHT: A Randomized Trial of Ticagrelor Monotherapy Versus Ticagrelor Plus Aspirin Beginning at 3 Months in High-risk Patients Undergoing Percutaneous Coronary Intervention

US Cardiology Review ◽

10.15420/usc.2019.02 ◽

2020 ◽

Vol 14 ◽

Author(s):

Johny Nicolas ◽

Usman Baber ◽

Roxana Mehran

Keyword(s):

Percutaneous Coronary Intervention ◽

High Risk ◽

Antiplatelet Therapy ◽

Dual Antiplatelet Therapy ◽

Coronary Intervention ◽

Bleeding Events ◽

High Risk Patients ◽

Risk Of Death ◽

Percutaneous Coronary ◽

Risk Patients

A P2Y12 inhibitor-based monotherapy after a short period of dual antiplatelet therapy is emerging as a plausible strategy to decrease bleeding events in high-risk patients receiving dual antiplatelet therapy after percutaneous coronary intervention. Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention (TWILIGHT), a randomized double-blind trial, tested this approach by dropping aspirin at 3 months and continuing with ticagrelor monotherapy for an additional 12 months. The study enrolled 9,006 patients, of whom 7,119 who tolerated 3 months of dual antiplatelet therapy were randomized after 3 months into two arms: ticagrelor plus placebo and ticagrelor plus aspirin. The primary endpoint of interest, Bleeding Academic Research Consortium type 2, 3, or 5 bleeding, occurred less frequently in the experimental arm (HR 0.56; 95% CI [0.45–0.68]; p<0.001), whereas the secondary endpoint of ischemic events was similar between the two arms (HR 0.99; 95% CI [0.78–1.25]). Transition from dual antiplatelet therapy consisting of ticagrelor plus aspirin to ticagrelor-based monotherapy in high-risk patients at 3 months after percutaneous coronary intervention resulted in a lower risk of bleeding events without an increase in risk of death, MI, or stroke.

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