Elevated Serum Levels of Mixed Lineage Kinase Domain-Like Protein Predict Survival of Patients during Intensive Care Unit Treatment

Mixed lineage kinase domain-like (MLKL), a crucial regulator of necroptotic cell death, was shown to play a role in inflammatory diseases. However, its role as a biomarker in critical illness and sepsis is currently unknown. We analyzed serum levels of MLKL in 136 critically ill patients at admission to the intensive care unit (ICU) and after three days of ICU treatment. Results were compared with 36 healthy controls and correlated with clinical and laboratory patients’ data. MLKL serum levels of critically ill patients at admission to the ICU were similar compared to healthy controls. At ICU admission, MLKL serum concentrations were independent of disease severity, presence of sepsis, and etiology of critical illness. In contrast, median serum levels of MLKL after three days of ICU treatment were significantly lower compared to those at admission to the ICU. While serum levels of MLKL at admission were not predictive for short-term survival during ICU treatment, elevated MLKL concentrations at day three were an independent negative predictor of patients’ ICU survival. Thus, elevated MLKL levels after three days of ICU treatment were predictive for patients’ mortality, indicating that sustained deregulated cell death is associated with an adverse prognosis in critical illness.

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Elevated Omentin Serum Levels Predict Long-Term Survival in Critically Ill Patients

Disease Markers ◽

10.1155/2016/3149243 ◽

2016 ◽

Vol 2016 ◽

pp. 1-9 ◽

Cited By ~ 8

Author(s):

Mark Luedde ◽

Fabian Benz ◽

Jennifer Niedeggen ◽

Mihael Vucur ◽

Hans-Joerg Hippe ◽

...

Keyword(s):

Critical Illness ◽

Critically Ill ◽

Critically Ill Patients ◽

Serum Levels ◽

Healthy Controls ◽

Serum Concentrations ◽

Term Survival ◽

Icu Patients ◽

Icu Treatment

Introduction. Omentin, a recently described adipokine, was shown to be involved in the pathophysiology of inflammatory and infectious diseases. However, its role in critical illness and sepsis is currently unknown. Materials and Methods. Omentin serum concentrations were measured in 117 ICU-patients (84 with septic and 33 with nonseptic disease etiology) admitted to the medical ICU. Results were compared with 50 healthy controls. Results. Omentin serum levels of critically ill patients at admission to the ICU or after 72 hours of ICU treatment were similar compared to healthy controls. Moreover, circulating omentin levels were independent of sepsis and etiology of critical illness. Notably, serum concentrations of omentin could not be linked to concentrations of inflammatory cytokines or routinely used sepsis markers. While serum levels of omentin were not predictive for short term survival during ICU treatment, low omentin concentrations were an independent predictor of patients’ overall survival. Omentin levels strongly correlated with that of other adipokines (e.g., leptin receptor or adiponectin), which have also been identified as prognostic markers in critical illness. Conclusions. Although circulating omentin levels did not differ between ICU-patients and controls, elevated omentin levels were predictive for an impaired patients’ long term survival.

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Myopathy and Neuropathy Acquired in the Intensive Care Unit

Mayo Clinic Critical and Neurocritical Care Board Review ◽

10.1093/med/9780190862923.003.0097 ◽

2019 ◽

pp. 677-684

Author(s):

Priya S. Dhawan ◽

Jennifer A. Tracy

Keyword(s):

Skeletal Muscle ◽

Intensive Care Unit ◽

At Risk ◽

Intensive Care ◽

Peripheral Neuropathy ◽

Critical Illness ◽

Critically Ill ◽

Critically Ill Patients ◽

Critical Illness Polyneuropathy ◽

Muscle Disorder

Acquired weakness in critically ill patients is common, affecting between one-third to one-half of patients in the intensive care unit (ICU). Exposure to simultaneous stressors such as metabolic derangements, fluid and electrolyte shifts, infection, catabolic stress, and medications put patients in the ICU at risk for damage to both nerve and skeletal muscle with substantial and often lasting morbidity. Critical illness polyneuropathy is a length-dependent, axonal peripheral neuropathy occurring in patients in the ICU and unrelated to the primary illness. Critical illness myopathy is an ICU-associated muscle disorder occurring independently of denervation and uniquely identified by electrophysiologic and histologic characteristics.

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The need to know: experiences of critically ill patients

American Journal of Critical Care ◽

10.4037/ajcc2000.9.3.192 ◽

2000 ◽

Vol 9 (3) ◽

pp. 192-198 ◽

Cited By ~ 40

Author(s):

JE Hupcey ◽

HE Zimmerman

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Critical Illness ◽

Critically Ill ◽

Nursing Staff ◽

Critically Ill Patients ◽

Second Phase ◽

The Past ◽

Intensive Care Unit Nurses ◽

Vivid Memories

BACKGROUND: Critically ill patients vary in their memories of their experience in the intensive care unit. Some have little recall and need to learn about their critical illness. Others have more vivid memories of their experiences, some of which were extremely unpleasant. Patients' not knowing what was happening may have exacerbated the unpleasant experiences. OBJECTIVES: To elicit the experience of knowing for critically ill patients and to explore the differences in perceptions between patients who were intubated and those who were not intubated during the illness. METHODS: Grounded theory was used to explore the meaning of knowing and not knowing and the process by which knowing occurs. Unstructured interviews were done with 14 patients. RESULTS: Knowing had 2 phases: the need to know (1) during and (2) after the critical illness. The first phase had 3 facets: needing information, needing to be oriented, and having confusing perceptions. The second phase had 2 facets: needing information about what had happened and piecing together events. Many experiences with knowing during and after a critical illness were similar for both intubated and nonintubated patients. The main difference was the intensity of the experience in some categories. CONCLUSIONS: Critically ill patients have a strong need to know throughout and after their time in the intensive care unit. Nurses must address this need for constant reorientation to the past and present in these patients. In addition, adequate nursing staff must be available for these patients.

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O futuro da nutrição parenteral no paciente crítico

Abr-Jun - Braspen Journal ◽

10.37111/braspenj.2020352013 ◽

2020 ◽

Vol 2 (35) ◽

pp. 187-192

Author(s):

Ivens Augusto Oliveira de Souza

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Critical Illness ◽

Parenteral Nutrition ◽

Indirect Calorimetry ◽

Critically Ill Patients ◽

Nutrient Intake ◽

Lipid Emulsions ◽

Gastrointestinal Dysfunction ◽

Best Value

Gastrointestinal dysfunction and inadequate nutrient intake are frequently seen in critically ill patients. Recent studies have shown that parenteral nutrition is safe among these patients. This narrative review aims to describe the risks associated with overfeeding and how to safely indicate and implement parenteral nutrition in the intensive care unit. After the acute phase of critical illness, individualized parenteral nutrition, using indirect calorimetry and balanced lipid emulsions, may be associated with better outcomes. The demand for ready-to-use bags has been growing intended to achieve the best value of care for patients and healthcare institutions.

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Albumin–Globulin Ratio Is an Independent Determinant of 28-Day Mortality in Patients with Critical Illness

Disease Markers ◽

10.1155/2021/9965124 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Bin Liu ◽

Kun Xiao ◽

Peng Yan ◽

Tianyu Sun ◽

Jiang Wang ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Critical Illness ◽

Critically Ill ◽

Critically Ill Patients ◽

Cox Regression ◽

Independent Predictor ◽

Laboratory Data ◽

Cox Regression Analysis ◽

Increased Risk

Background. Critical illness in the intensive care unit (ICU) has been a global health priority. Systemic nutritional status has turned out to be related to the prognosis of critically ill patients. The albumin-globulin ratio (AGR) has been reported to be a novel prognostic factor of many diseases. This study is aimed at investigating whether the AGR could predict the mortality risk in critically ill patients. Methods. We enrolled 582 adult patients admitted to the respiratory intensive care unit (RICU). We collected the clinical and laboratory data. X-tile software was used to determine the optimal cut-off values for the AGR. Patients were divided into three groups according to the AGR (low AGR group with AGR < 0.8 , medium AGR group with AGR ranging from 0.8 to 1.1, and high AGR group with AGR > 1.1 ). Kaplan-Meier analysis was used for survival analysis. A Cox proportional hazard model was applied to the univariate and multivariate analyses for the potential predictors associated with survival. Results. Our present study showed that the AGR was related to the 28-day survival of critically ill patients in the RICU. The rate of pneumonia in the low AGR group was significantly higher than that in the other groups. Patients with a lower AGR present an increased risk of 28-day mortality compared to patients with a higher AGR. Cox regression analysis showed that the AGR might be an independent predictor of prognosis to 28-day survival in critically ill patients in the RICU. Medium and high AGR values remained independently associated with better 28-day survival than low AGR values (HR: 0.484 (0.263-0.892) ( p = 0.02 ); HR: 0.332 (0.166-0.665) ( p = 0.002 )). Conclusion. The AGR might be an independent predictor of prognosis in critically ill patients.

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The Type II Iodothyronine Deiodinase Is Up-Regulated in Skeletal Muscle during Prolonged Critical Illness

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2007-0510 ◽

2007 ◽

Vol 92 (8) ◽

pp. 3330-3333 ◽

Cited By ~ 64

Author(s):

Liese Mebis ◽

Lies Langouche ◽

Theo J. Visser ◽

Greet Van den Berghe

Keyword(s):

Skeletal Muscle ◽

Intensive Care Unit ◽

Intensive Care ◽

Critical Illness ◽

Critically Ill ◽

Critically Ill Patients ◽

Surgical Intensive Care Unit ◽

Type Ii ◽

Low T3 Syndrome ◽

Low T3

Abstract Context: Critical illness is associated with the low T3 syndrome. It remains unclear whether altered type II deiodinase activity (D2) in skeletal muscle contributes to this syndrome. Objective: Our objective was to study D2 expression and activity in skeletal muscle of acute and prolonged critically ill patients. Design and Setting: We conducted a clinical observational study in acute and prolonged critical illness with comparison with healthy controls at a university hospital surgical intensive care unit. Patients: Subjects included 63 prolonged critically ill patients who died in the intensive care unit, 21 acutely ill patients, and 38 controls matched for age, gender, and body mass index. Results: Elevated expression of the D2 gene and D2 activity in skeletal muscle of prolonged, but not acute, critically ill patients were observed in the face of low circulating thyroid hormone levels. Conclusions: Reduced D2 activity does not appear to play a role in the pathogenesis of the low T3 syndrome of critical illness.

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