Interleukin 1 Receptor Antagonist Anakinra, Intravenous Immunoglobulin, and Corticosteroids in the Management of Critically Ill Adult Patients With Hemophagocytic Lymphohistiocytosis

2017 ◽  
Vol 34 (9) ◽  
pp. 723-731 ◽  
Author(s):  
Philipp Wohlfarth ◽  
Hermine Agis ◽  
Guido A. Gualdoni ◽  
Johannes Weber ◽  
Thomas Staudinger ◽  
...  
Keyword(s):  
Survival Rate ◽  
Intravenous Immunoglobulin ◽  
Critically Ill ◽  
Organ Dysfunction ◽  
Sofa Score ◽  
Hemophagocytic Lymphohistiocytosis ◽  
Interleukin 1 ◽  
Adult Patients ◽  
Hospital Survival ◽  
Icu Discharge

Background: Hemophagocytic lymphohistiocytosis (HLH) causes multiple organ dysfunction frequently leading to intensive care unit (ICU) referral and/or death. We report on a series of critically ill adult patients treated with a non-etoposide-based regimen including interleukin 1 antagonist anakinra, intravenous immunoglobulin (IVIG), and/or corticosteroids (CS) for HLH. Methods: Eight adult (≥18 years) ICU patients having received treatment with anakinra ± IVIG ± CS for HLH between March 2014 and March 2016 at a large tertiary care university hospital (Medical University of Vienna, Vienna, Austria) were retrospectively analyzed. Results: Eight patients (median age: 38 years; range: 20-58 years; 4 males and 4 females) received anakinra together with IVIG (n = 7) and/or high-dose CS (n = 5) for suspected reactive HLH (median H-score: 214; range: 171-288). Seven (88%) patients required vasopressors and invasive mechanical ventilation and 6 (75%) patients required renal replacement therapy (median Sequential Organ Failure Assessment [SOFA] score at HLH diagnosis: 9.5; range: 6-14). Six patients showed a significant decline in the SOFA score at 1 and 2 weeks following treatment initiation ( P = .03), and the remainder 2 patients experienced early death. Five patients survived to ICU discharge, 4 of them could further be discharged from hospital (hospital survival rate: 50%). No overt treatment-related toxicity was noted. Conclusion: Anakinra in combination with IVIG and/or CS resulted in a hospital survival rate of 50% in 8 critically ill adult patients with HLH despite a vast degree of organ dysfunction and the need for aggressive ICU treatment. Further research on non-etoposide-based treatment strategies for HLH in critically ill adults is warranted.

scholarly journals In-line filtration of intravenous infusion may reduce organ dysfunction of adult critical patients

Critical Care ◽  
2019 ◽  
Vol 23 (1) ◽  
Author(s):  
Elke Schmitt ◽  
Patrick Meybohm ◽  
Eva Herrmann ◽  
Karin Ammersbach ◽  
Raphaela Endres ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Critically Ill ◽  
Organ Dysfunction ◽  
Kidney Injury ◽  
Adult Patients ◽  
Brain Inflammation ◽  
Critically Ill Children ◽  
Respiratory Dysfunction ◽  
Time Period ◽  
Fine Filter

Abstract Background The potential harmful effects of particle-contaminated infusions for critically ill adult patients are yet unclear. So far, only significant improved outcome in critically ill children and new-borns was demonstrated when using in-line filters, but for adult patients, evidence is still missing. Methods This single-centre, retrospective controlled cohort study assessed the effect of in-line filtration of intravenous fluids with finer 0.2 or 1.2 μm vs 5.0 μm filters in critically ill adult patients. From a total of n = 3215 adult patients, n = 3012 patients were selected by propensity score matching (adjusting for sex, age, and surgery group) and assigned to either a fine filter cohort (with 0.2/1.2 μm filters, n = 1506, time period from February 2013 to January 2014) or a control filter cohort (with 5.0 μm filters, n = 1506, time period from April 2014 to March 2015). The cohorts were compared regarding the occurrence of severe vasoplegia, organ dysfunctions (lung, kidney, and brain), inflammation, in-hospital complications (myocardial infarction, ischemic stroke, pneumonia, and sepsis), in-hospital mortality, and length of ICU and hospital stay. Results Comparing fine filter vs control filter cohort, respiratory dysfunction (Horowitz index 206 (119–290) vs 191 (104.75–280); P = 0.04), pneumonia (11.4% vs 14.4%; P = 0.02), sepsis (9.6% vs 12.2%; P = 0.03), interleukin-6 (471.5 (258.8–1062.8) ng/l vs 540.5 (284.5–1147.5) ng/l; P = 0.01), and length of ICU (1.2 (0.6–4.9) vs 1.7 (0.8–6.9) days; P <  0.01) and hospital stay (14.0 (9.2–22.2) vs 14.8 (10.0–26.8) days; P = 0.01) were reduced. Rate of severe vasoplegia (21.0% vs 19.6%; P > 0.20) and acute kidney injury (11.8% vs 13.7%; P = 0.11) was not significantly different between the cohorts. Conclusions In-line filtration with finer 0.2 and 1.2 μm filters may be associated with less organ dysfunction and less inflammation in critically ill adult patients. Trial registration The study was registered at ClinicalTrials.gov (number: NCT02281604).

scholarly journals SOFA scoring system in assessing prognosis of critically ill surgical and trauma patients: a prospective study

2018 ◽  
Vol 5 (7) ◽  
pp. 2528
Author(s):  
Mohan Kumar ◽  
Chandan C. S.
Keyword(s):  
Prospective Study ◽  
Organ Failure ◽  
Critically Ill ◽  
Organ Dysfunction ◽  
Sofa Score ◽  
Scoring System ◽  
Evaluation System ◽  
Scoring Systems ◽  
Trauma Patients ◽  
A Prospective Study

Background: Major trauma, major surgery or sepsis include the bulk of Surgical patients who become critically ill. This relates to significant injury of a single organ system or anatomical part, or multiple injuries, often of varying severity, of different body parts good scoring or predicting system essentially clears this confusion. Predicting the patients’ outcome depends on good scoring system. Scoring systems are composed of degrees of organ dysfunction, organ failure or multiple organ failures, and anatomical derangements which eventually contribute to morbidity and mortality. With the help of such evaluation system. A well-performing ICU prognostic model helps to make meaningful comparison of the hospital’s current performance with the past. But present study focuses on mainly on SOFA score. Sequential organ failure assessment score.Methods: Scoring systems in assessing prognosis of critically ill surgical and trauma patients - a prospective study was undertaken at MVJ Medical Hospital and Research Hospital, Bangalore after the approval from Ethics Committee. The study was carried out in the period of November 2016 to September 2017 and 50 patients were included in the study.Results: Studies have shown that in the SOFA scores; cardiovascular, neurological, and respiratory, renal, haematological and hepatic dysfunctions were independent risk factors for mortality.Conclusions: In this study, extensive study of SOFA score was done from day 1 to the last day. The SOFA score on day 1 was high among non-survivors and survivors which was statistically significant (9.33 v/s 6.62, p<0.001). Also, SOFA score showed significant increasing trend in the first week, especially on first 3 days, which signifies progressive organ dysfunction among non-survivors.

scholarly journals Utility of sequential organ failure assessment score in predicting outcome for patients with peritoneal sepsis

2019 ◽  
Vol 6 (3) ◽  
pp. 696
Author(s):  
G. S. Abdul Razack ◽  
T. Kavya ◽  
B. D. Manjunath ◽  
Mohammed Arafath Ali ◽  
K. Avinash ◽  
...  
Keyword(s):  
Survival Rate ◽  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Organ Dysfunction ◽  
Sofa Score ◽  
Abdominal Sepsis ◽  
Prognostic Information ◽  
Lower Survival Rate ◽  
Organ Systems ◽  
Failure Assessment

Background: Severe complicated intra-abdominal sepsis (SCIAS) is a worldwide challenge with increasing incidence. The sequential organ failure assessment (SOFA) score numerically quantifies the number and severity of failed organs. We examined the utility of the SOFA score for assessing outcome of patients with severe peritoneal sepsis.Methods: This is a prospective observational study. A total of 100 patients who presented to emergency department of Victoria hospital with features suggestive of peritoneal sepsis from January 2018 to August 2018 were included in the study. The presence of organ dysfunction was assessed using a sequential organ failure assessment (SOFA). Clinical, microbiologic, and laboratory factors were considered for assessing the outcome.Results: Forty-two patients had two or more sites of infection on admission. Bacteraemia was confirmed in 20 patients. 88 patients were surgical. The median age of patients was 69 years. Males being more commonly affected than females. Twenty-eight days survival rate was 41%. The incidence of organ dysfunction on day 1 was noted more frequently for renal, cardiovascular, and neurological systems. SOFA score on day 1 and day 3 were significantly higher in non-survivors than those in survivors. Patients with three and higher number of organ systems with dysfunction had a lower survival rate than the subgroups of patients with one or two organ systems with dysfunction.Conclusions: The SOFA score provides potentially valuable prognostic information on in hospital survival when applied to patients with severe peritoneal sepsis.

Clinical Profile and Outcome of Multiple Organ Dysfunction Syndrome (MODS) in a Tertiary Care Centre of Manipal, Karnataka

2021 ◽  
Vol 8 (41) ◽  
pp. 3547-3552
Author(s):  
Manthappa Marijayanth ◽  
Ashok Horatti ◽  
Varsha Tandure ◽  
Suheil Dhanse
Keyword(s):  
Organ Dysfunction ◽  
Multiple Organ Dysfunction Syndrome ◽  
Sofa Score ◽  
Tertiary Care ◽  
Ventilatory Support ◽  
Multiple Organ ◽  
Adult Patients ◽  
Clinical Profile ◽  
Care Hospital ◽  
Multiple Organ Dysfunction

BACKGROUND To study the clinical profile and outcome of multiple organ dysfunction syndrome (MODS) in previously healthy adult patients and to assess the correlation between sequential organ failure assessment (SOFA) score at admission and mortality in these patients. METHODS This study was conducted at a tertiary care hospital attached to a medical college of south India. This was a prospective observational study. All adult patients presenting with multiple organ dysfunction syndrome between October 2010 and June 2012 were selected for the study. SOFA score was recorded for all the patients at the time of admission. Patients were followed up till the time of death or discharge. RESULTS In this study, majority of the cases were males and belonged to middle age group. Epidemic diseases such as scrub typhus and leptospirosis were the most common causes of MODS. Fever was the most common presenting symptom of MODS. Majority of patients recovered. Higher SOFA score at admission is associated with increased mortality, duration of hospital stay, requirement of ventilatory support, haemodialysis, and central venous access. CONCLUSIONS Infectious diseases are responsible for most cases of MODS. Higher SOFA score at admission is associated with increased morbidity and mortality. Majority of people recover with appropriate treatment. KEYWORDS MODS, Clinical Profile, SOFA Score, Outcome

Hemoperfusion with CytoSorb to Manage Multiorgan Dysfunction in the Spectrum of Hemophagocytic Lymphohistiocytosis Syndrome in Critically Ill Children

2021 ◽  
pp. 1-8
Author(s):  
Gabriella Bottari ◽  
Manuel Murciano ◽  
Pietro Merli ◽  
Claudia Bracaglia ◽  
Isabella Guzzo ◽  
...  
Keyword(s):  
Critically Ill ◽  
Organ Dysfunction ◽  
Hemophagocytic Lymphohistiocytosis ◽  
Therapeutic Option ◽  
Scientific Evidence ◽  
Pediatric Intensive Care ◽  
Interleukin 10 ◽  
Critically Ill Children ◽  
Logistic Organ Dysfunction ◽  
The Impact

Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening condition characterized by a state of hyperinflammation. Blood purification techniques can blunt the inflammatory process with a rapidly relevant nonselective effect on the cytokine storm, thus potentially translating into survival benefit for these patients. In this cohort, we evaluated the impact of hemoadsorption with CytoSorb combined with continuous kidney replacement therapy used as adjunctive therapy in 6 critically ill children with multiple organ dysfunction due to HLH. In our series, we found a reduction in inflammatory biomarkers in patients with HLH secondary to infection. Ferritin, one of the most important bedside biomarkers of HLH, showed a reduction in most of the treated patients. The same results were found measuring interleukin-6 and interleukin-10. The same patients showed hemodynamic stabilization measured by the Vasopressor-Inotropic-Score, and reduction in the organ disease score measured with the Pediatric Logistic Organ Dysfunction score. In our cohort, mortality was less than expected based on the Pediatric Index of Mortality 3 score at pediatric intensive care unit admission. Our study shows that hemoperfusion could be a valuable therapeutic option in HLH: stronger scientific evidence is needed to confirm our preliminary experience.

Meta-analysis: Intravenous Immunoglobulin in Critically Ill Adult Patients with Sepsis

2007 ◽  
Vol 146 (3) ◽  
pp. 193 ◽  
Author(s):  
Alexis F. Turgeon ◽  
Brian Hutton ◽  
Dean A. Fergusson ◽  
Lauralyn McIntyre ◽  
Alan A. Tinmouth ◽  
...  
Keyword(s):  
Intravenous Immunoglobulin ◽  
Critically Ill ◽  
Meta Analysis ◽  
Adult Patients

scholarly journals Differential contractile response of critically ill patients to neuromuscular electrical stimulation

Critical Care ◽  
2019 ◽  
Vol 23 (1) ◽  
Author(s):  
Julius J. Grunow ◽  
Moritz Goll ◽  
Niklas M. Carbon ◽  
Max E. Liebl ◽  
Steffen Weber-Carstens ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Muscle Strength ◽  
Critically Ill ◽  
Sofa Score ◽  
Critically Ill Patients ◽  
Contractile Response ◽  
Neuromuscular Electrical Stimulation ◽  
Electrical Current ◽  
Icu Discharge ◽  
Muscle Groups

Abstract Background Neuromuscular electrical stimulation (NMES) has been investigated as a preventative measure for intensive care unit-acquired weakness. Trial results remain contradictory and therefore inconclusive. As it has been shown that NMES does not necessarily lead to a contractile response, our aim was to characterise the response of critically ill patients to NMES and investigate potential outcome benefits of an adequate contractile response. Methods This is a sub-analysis of a randomised controlled trial investigating early muscle activating measures together with protocol-based physiotherapy in patients with a SOFA score ≥ 9 within the first 72 h after admission. Included patients received protocol-based physiotherapy twice daily for 20 min and NMES once daily for 20 min, bilaterally on eight muscle groups. Electrical current was increased up to 70 mA or until a contraction was detected visually or on palpation. Muscle strength was measured by a blinded assessor at the first adequate awakening and ICU discharge. Results One thousand eight hundred twenty-four neuromuscular electrical stimulations in 21 patients starting on day 3.0 (2.0/6.0) after ICU admission were included in this sub-analysis. Contractile response decreased from 64.4% on day 1 to 25.0% on day 7 with a significantly lower response rate in the lower extremities and proximal muscle groups. The electrical current required to elicit a contraction did not change over time (day 1, 50.2 [31.3/58.8] mA; day 7, 45.3 [38.0/57.5] mA). The electrical current necessary for a contractile response was higher in the lower extremities. At the first awakening, patients presented with significant weakness (3.2 [2.5/3.8] MRC score). When dividing the cohort into responders and non-responders (> 50% vs. ≤ 50% contractile response), we observed a significantly higher SOFA score in non-responders. The electrical current necessary for a muscle contraction in responders was significantly lower (38.0 [32.8/42.9] vs. 54.7 [51.3/56.0] mA, p < 0.001). Muscle strength showed higher values in the upper extremities of responders at ICU discharge (4.4 [4.1/4.6] vs. 3.3 [2.8/3.8] MRC score, p = 0.036). Conclusion Patients show a differential contractile response to NMES, which appears to be dependent on the severity of illness and also relevant for potential outcome benefits. Trial registration ISRCTN ISRCTN19392591, registered 17 February 2011

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