Plasma Midkine Is Associated With 28-Day Mortality and Organ Function in Sepsis

2019 ◽  
Vol 35 (11) ◽  
pp. 1290-1296
Author(s):  
Wei Chang ◽  
Fei Peng ◽  
Qin Sun ◽  
Shan-Shan Meng ◽  
Hai-Bo Qiu ◽  
...  
Keyword(s):  
Tissue Injury ◽  
Kidney Injury ◽  
Tertiary Hospital ◽  
Organ Function ◽  
Lung Water ◽  
Pulmonary Vascular Permeability ◽  
Pulmonary Vascular Permeability Index ◽  
Water Index ◽  
All Cause Mortality ◽  
Baseline Characteristics

Background: Midkine has been reported to play a crucial role in inflammatory, hypoxia, and tissue injury processes. We aimed to investigate plasma midkine in septic patients and its association with 28-day mortality and organ function. Methods: Septic patients admitted to the Department of Critical Care Medicine, Zhongda Hospital, a tertiary hospital, from November 2017 to March 2018 were enrolled in the study. The baseline characteristics of the septic patients were recorded at admission. A peripheral blood sample was obtained at admission, and plasma midkine levels were evaluated with an immunoassay. All patients were followed up with for 28 days, with all-cause mortality being recorded. Results: A total of 26 septic patients were enrolled, which included 18 survivors and 8 nonsurvivors at day 28. Plasma midkine levels were significantly elevated in the nonsurvivor group compared with the survivors (ng/L, 763.6 [404.7-1305], 268.5 [147.8-511.4]; P = .0387]. Plasma midkine levels were elevated in septic patients with moderate/severe acute respiratory distress syndrome (ARDS) compared with patients with non/mild ARDS (ng/L, 522.3 [336.6-960.1] vs 243.8 [110.3-478.9]; P = .0135) and in those with acute kidney injury compared with those without (ng/L, 489.8 [259.2-1058] vs 427.9 [129.6-510.3]; P = .0973). Changes in plasma midkine levels were also associated with extravascular lung water index ( P = .063) and pulmonary vascular permeability index ( P = .049). Conclusions: Plasma midkine was associated with 28-day mortality, as well as pulmonary and kidney injury, in septic patients.

scholarly journals Increased extravascular lung water index (EVLWI) reflects rapid inflammatory oedema and mortality in COVID-19 associated ARDS

2020 ◽  
Author(s):  
Sebastian Rasch ◽  
Paul Schmidle ◽  
Senguel Sancak ◽  
Alexander Herner ◽  
Christina Huberle ◽  
...  
Keyword(s):  
Pulmonary Oedema ◽  
Extravascular Lung Water ◽  
Transpulmonary Thermodilution ◽  
Control Group ◽  
Intensive Care Treatment ◽  
Lung Water ◽  
Pulmonary Vascular Permeability ◽  
Pulmonary Vascular Permeability Index ◽  
Extravascular Lung Water Index ◽  
Water Index

OBJECTIVE: Nearly 5 % of the patients with COVID-19 develop an acute respiratory distress syndrome (ARDS). Extravascular lung water index (EVLWI) is a marker of pulmonary oedema which is associated with mortality in ARDS. In this study we evaluate whether EVLWI is higher in patients with COVID-19 associated ARDS as compared to controls and whether EVLWI has the potential to monitor disease progression. METHODS: From the day of intubation, EVLWI, cardiac function were monitored by transpulmonary thermodilution in n=25 patients with COVID-19 and compared to a control group of 49 non-COVID-19 ARDS-patients. RESULTS: EVLWI in COVID-19-patients was noticeably elevated and significantly higher than in the control group (17 (11-38) vs. 11 (6-26) mL/kg; p<0.001). High pulmonary vascular permeability index values (2.9 (1.0-5.2) versus 1.9 (1.0-5.2); p=0.003) suggest inflammatory oedema. By contrast, the cardiac parameters SVI, GEF and GEDVI were comparable. High EVLWI values were associated with viral persistence, prolonged intensive care treatment and mortality (23.2±6.7% vs. 30.3±6.0%, p=0.025). CONCLUSIONS: Compared to the control group, COVID-19 results in markedly elevated EVLWI-values in patients with ARDS. EVLWI reflects a non-cardiogenic pulmonary oedema in COVID-19 associated ARDS and could serve as parameter to monitor ARDS progression.

Predictive performance of PiCCO system and blood gas parameters for early prognosis of patients with sepsis

2020 ◽  
Author(s):  
JING YUAN ◽  
XueMei Qin ◽  
Tao Wang ◽  
Tong Wang ◽  
Jinyi Wu ◽  
...  
Keyword(s):  
Characteristic Curve ◽  
Predictive Performance ◽  
Blood Gas ◽  
Lung Water ◽  
Pulmonary Vascular Permeability ◽  
Pulmonary Vascular Permeability Index ◽  
Water Index ◽  
Survivor Group ◽  
Blood Gas Parameters ◽  
Invasive Hemodynamics

Abstract Purpose: Invasive hemodynamics monitor directed fluids resuscitation remains misgiving issues. This study aims to explore the predictive value of the PiCCO system (pulse indicator continuous cardiac output device) and blood gas parameters on the early prognosis of patients with sepsis.Methods: 42 patients with sepsis were included from January 2013 to January 2015. All patients were stratified into survivor group (n=29) and nonsurvivor group (n=13) based on seven day-mortality. The PiCCO and blood gas parameters at enrollment and 24 hours were compared between two groups. The predictive performance of these parameters was distinguished with Area Under the Receiver Operating Characteristic Curve (AUC). Results: At 24 hours after enrollment, the HR (97.27±22.07 vs. 120.20±20.56), extravascular lung water index (EVLWI) (7.32±2.96 vs. 15.9±11.2), and lactic acid (Lac) (1.62±0.92 vs. 6.33±5.83) level were significantly lower in survivor group (P < 0.05), whereas the cardiac index (CI) (3.67±0.85 vs. 2.98±0.73) and PaO2/FiO2 (242.8±89.68 vs.136.07±78.01) increased significantly. Meanwhile PaO2/FiO2 was negatively correlated with EVLWI (r= -0.673, P < 0.01). The AUC of the combination of Lac with PaO2/FiO2, HR, EVLWI, pulmonary vascular permeability index (PVPI) and Lac at 24 hours were 0.853, 0.739, 0.776, 0.764, and 0.794.Conclusions: The PiCCO and blood gas parameters exhibit superior predictive capability for early prognosis in patients with sepsis, and the combination Lac with PaO2/FiO2 was noninferior under the circumstance of unavailability with PiCCO.

scholarly journals COVID-19 ARDS is characterized by higher extravascular lung water than non-COVID-19 ARDS: the PiCCOVID study

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Rui Shi ◽  
Christopher Lai ◽  
Jean-Louis Teboul ◽  
Martin Dres ◽  
Francesca Moretto ◽  
...  
Keyword(s):  
Extravascular Lung Water ◽  
Transpulmonary Thermodilution ◽  
Diffuse Alveolar Damage ◽  
Lung Mechanics ◽  
Arterial Oxygen ◽  
Prone Positioning ◽  
University Hospitals ◽  
Lung Water ◽  
Pulmonary Vascular Permeability ◽  
Water Index

Abstract Background In acute respiratory distress syndrome (ARDS), extravascular lung water index (EVLWi) and pulmonary vascular permeability index (PVPI) measured by transpulmonary thermodilution reflect the degree of lung injury. Whether EVLWi and PVPI are different between non-COVID-19 ARDS and the ARDS due to COVID-19 has never been reported. We aimed at comparing EVLWi, PVPI, respiratory mechanics and hemodynamics in patients with COVID-19 ARDS vs. ARDS of other origin. Methods Between March and October 2020, in an observational study conducted in intensive care units from three university hospitals, 60 patients with COVID-19-related ARDS monitored by transpulmonary thermodilution were compared to the 60 consecutive non-COVID-19 ARDS admitted immediately before the COVID-19 outbreak between December 2018 and February 2020. Results Driving pressure was similar between patients with COVID-19 and non-COVID-19 ARDS, at baseline as well as during the study period. Compared to patients without COVID-19, those with COVID-19 exhibited higher EVLWi, both at the baseline (17 (14–21) vs. 15 (11–19) mL/kg, respectively, p = 0.03) and at the time of its maximal value (24 (18–27) vs. 21 (15–24) mL/kg, respectively, p = 0.01). Similar results were observed for PVPI. In COVID-19 patients, the worst ratio between arterial oxygen partial pressure over oxygen inspired fraction was lower (81 (70–109) vs. 100 (80–124) mmHg, respectively, p = 0.02) and prone positioning and extracorporeal membrane oxygenation (ECMO) were more frequently used than in patients without COVID-19. COVID-19 patients had lower maximal lactate level and maximal norepinephrine dose than patients without COVID-19. Day-60 mortality was similar between groups (57% vs. 65%, respectively, p = 0.45). The maximal value of EVLWi and PVPI remained independently associated with outcome in the whole cohort. Conclusion Compared to ARDS patients without COVID-19, patients with COVID-19 had similar lung mechanics, but higher EVLWi and PVPI values from the beginning of the disease. This was associated with worse oxygenation and with more requirement of prone positioning and ECMO. This is compatible with the specific lung inflammation and severe diffuse alveolar damage related to COVID-19. By contrast, patients with COVID-19 had fewer hemodynamic derangement. Eventually, mortality was similar between groups. Trial registration number and date of registration ClinicalTrials.gov (NCT04337983). Registered 30 March 2020—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04337983.

scholarly journals Evaluation of ventilator on lung profile of piglets (Sus scrofa) in hypovolemic shock treated with hypervolemic crystalloid resuscitation

2019 ◽  
Vol 12 (4) ◽  
pp. 565-571
Author(s):  
Gunanti Soedjono ◽  
Eva Harlina ◽  
Antonius H. Pudjiadi ◽  
Melpa Susanti Purba ◽  
Setyo Jatimahardhiko Widodo
Keyword(s):  
Lung Injury ◽  
Hypovolemic Shock ◽  
Peak Inspiratory Pressure ◽  
Pulse Contour ◽  
Lung Water ◽  
Shock Condition ◽  
Pulmonary Vascular Permeability ◽  
Water Index ◽  
Before And After ◽  
Shallow Breathing

Aim: This study was conducted to assess the effect of ventilators on the lung profile of piglets in the hypovolemic shock before and after the excessive resuscitation of the crystalloid fluid. Materials and Methods: Five male piglets were used in this study as the models of shock, and there are four phases of treatment: Stabilization, shock of bleeding, normovolemic resuscitation, and hypervolemic resuscitation. The application of mechanical ventilation to patients who suspected of having lung injury may worsen the patient's conditions. The purpose of this study was to set the ventilator with the set of positive end-expiratory pressure (PEEP) of 5 cm H2O, the fraction of inspired oxygen (FiO2) of 0.5, and the inspiration: expiration (I: E) ratio of 1:2, which was applied from the stabilization phase. The shock induction was performed by removing the blood until the mean arterial pressure decreasing by 20% from the stabilization. The solution of NaCl 0.9% was used for the normovolemic and hypervolemic resuscitation. The parameter of observation consisted of extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI) on pulse contour cardiac output 2 and exhaled tidal volume (VTE), peak inspiratory pressure (PIP), and respiratory rate (RR) on ventilators. Results: EVLWI does not indicate pulmonary edema. A significant decrease in VTE without any significant alterations in EVLWI, PIP, and RR has indicated the shallow breathing in the shock condition. Therefore, the PVPI parameter cannot be used as a parameter for capillary permeability since its formulation does not reinforce the results of data in the shock condition. The set of the ventilator may prevent the increase of EVLWI, and the uses of ventilators do not worsen the patient's conditions during the crystalloid resuscitation. Conclusion: The use of mechanical ventilator as the support does not worsen the hypovolemic condition and is safe to use as long as the lung profile is not indicated to have lung injury.

scholarly journals Increased extravascular lung water index (EVLWI) reflects rapid non-cardiogenic oedema and mortality in COVID-19 associated ARDS

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sebastian Rasch ◽  
Paul Schmidle ◽  
Sengül Sancak ◽  
Alexander Herner ◽  
Christina Huberle ◽  
...  
Keyword(s):  
Pulmonary Oedema ◽  
Extravascular Lung Water ◽  
Control Group ◽  
Intensive Care Treatment ◽  
Cardiogenic Pulmonary Oedema ◽  
Lung Water ◽  
Pulmonary Vascular Permeability ◽  
Extravascular Lung Water Index ◽  
Water Index ◽  
Within Subjects

AbstractNearly 5% of patients suffering from COVID-19 develop acute respiratory distress syndrome (ARDS). Extravascular lung water index (EVLWI) is a marker of pulmonary oedema which is associated with mortality in ARDS. In this study, we evaluate whether EVLWI is higher in patients with COVID-19 associated ARDS as compared to COVID-19 negative, ventilated patients with ARDS and whether EVLWI has the potential to monitor disease progression. EVLWI and cardiac function were monitored by transpulmonary thermodilution in 25 patients with COVID-19 ARDS subsequent to intubation and compared to a control group of 49 non-COVID-19 ARDS patients. At intubation, EVLWI was noticeably elevated and significantly higher in COVID-19 patients than in the control group (17 (11–38) vs. 11 (6–26) mL/kg; p < 0.001). High pulmonary vascular permeability index values (2.9 (1.0–5.2) versus 1.9 (1.0–5.2); p = 0.003) suggested a non-cardiogenic pulmonary oedema. By contrast, the cardiac parameters SVI, GEF and GEDVI were comparable in both cohorts. High EVLWI values were associated with viral persistence, prolonged intensive care treatment and in-hospital mortality (23.2 ± 6.7% vs. 30.3 ± 6.0%, p = 0.025). Also, EVLWI showed a significant between-subjects (r = − 0.60; p = 0.001) and within-subjects correlation (r = − 0.27; p = 0.028) to Horowitz index. Compared to non COVID-19 ARDS, COVID-19 results in markedly elevated EVLWI-values in patients with ARDS. High EVLWI reflects a non-cardiogenic pulmonary oedema in COVID-19 ARDS and could serve as parameter to monitor ARDS progression on ICU.

Abstract 258: Dynamic Assessment of Lung Injury by Ultrasound in a Porcine Model of Cardiac Arrest Undergoing Therapeutic Hypothermia

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Chunshuang Wu ◽  
Jiefeng Xu ◽  
Xiaohong Jin ◽  
Qijiang Chen ◽  
Moli Wang ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Lung Injury ◽  
Therapeutic Hypothermia ◽  
Porcine Model ◽  
Lung Ultrasound ◽  
Dynamic Assessment ◽  
Control Group ◽  
Lung Water ◽  
Pulmonary Vascular Permeability ◽  
Water Index

Introduction: Acute lung injury (ALI) is common in post-cardiac arrest syndrome (PCAS), which is associated with increased morbidity and mortality. Lung ultrasound, known as a noninvasive and easily-performed method, has a growing role in the assessment of lung injury. In this study, we investigated the effectiveness of lung ultrasound in monitoring ALI in a porcine model of cardiac arrest undergoing therapeutic hypothermia. Hypothesis: Lung ultrasound would be a promising approach to evaluate the severity of ALI in PCAS. Methods: Twenty-three male domestic swine weighing 36±3 kg were randomized into three groups: 1) therapeutic hypothermia (TH, n=9), 2) normothermia (NT, n=9), and 3) sham control (Control, n=5). Sham animals underwent the surgical preparation only. The animal model was established by 8 mins of ventricular fibrillation and then 5 mins of cardiopulmonary resuscitation. At 5 mins after resuscitation, therapeutic hypothermia was induced and maintained until 24 hrs post-resuscitation in the TH group. Body temperature was normally maintained in the other two groups. Lung ultrasound score (LUS), extra-vascular lung water index (ELWI), pulmonary vascular permeability index (PVPI) and PO 2 /FiO 2 were measured at baseline and at 1, 3, 6, 12, 24 hrs after resuscitation. Results: After resuscitation, LUS, ELWI and PVPI were significantly increased and PO 2 /FiO 2 was significantly decreased in the HT and NT groups than in the Control group. However, all of them were significantly better in the HT group compared to the NT group (Table). Additionally, increases in LUS were highly correlated with increases in ELWI ( r =0.613; p <0.001) and PVPI ( r =0.683; p <0.001), and decreases in PO 2 /FiO 2 ( r =-0.468; p <0.001). Conclusions: Lung ultrasound was a feasible approach to evaluate the severity of ALI in PCAS.

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