scholarly journals Two variants of the Nutritional Risk in the Critically Ill Score as predictors of mortality in Intensive Care Unit patients at a Brazilian University Hospital

2020 ◽  
Vol 33 ◽  
Author(s):  
Amanda Forte dos Santos SILVA ◽  
Audrey Machado dos REIS ◽  
Julia MARCHETTI ◽  
Oellen Stuani FRANZOSI ◽  
Thais STEEMBURGO
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Interleukin 6 ◽  
Characteristic Curve ◽  
University Hospital ◽  
Nutritional Risk ◽  
C Reactive Protein ◽  
Predictors Of Mortality ◽  
Reactive Protein

ABSTRACT Objective To evaluate the agreement between the modified version of the Nutritional Risk in the Critically Ill Score (without Interleukin-6) and a variant composed of C-Reactive Protein as well as its capacity to predict mortality. Methods A prospective cohort study was carried out with 315 patients in an Intensive Care Unit of a university hospital from October 2017 to April 2018. The agreement between the instruments was evaluated using the Kappa test. The predictive capacity for estimating mortality was assessed with the Receiver Operating Characteristic curve. Results The critical patients involved in the study had a mean age of 60.8±16.3 years and 53.5% were female. Most patients had C-Reactive Protein levels ?10mg/dL (n=263, 83.5%) and their admission in the Intensive Care Unit was medical (n=219, 69.5%). The prevalence of mortality was observed in 41.0% of the evaluated patients. The proportions at high nutritional risk according to Nutritional Risk in the Critically Ill without Interleukin-6 and with C-Reactive Protein were 57.5% and 55.6%, respectively. The tools showed strong and significant agreement(Kappa=0.935; p=0.020) and satisfactory performances in predicting mortality (area under the curve 0.695 [0.636-0.754] and 0.699 [0.640-0.758]). Conclusion Both versions of the Nutritional Risk in the Critically Ill tool show a satisfactory agreement and performance as predictors of mortality in critically ill patients. Further analysis of this variant and the association between nutrition adequacy and mortality is needed.

The role of IL-6 receptor inhibitor treatment in critical patient monitoring with COVID-19

2021 ◽  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Lactate Dehydrogenase ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Group 2 ◽  
D Dimer

Objectives: The COVID-19 disease can manifest itself with acute respiratory distress syndrome, renal failure, and septic shock in critically ill patients. There are opinions that there is a correlation between high IL-6 levels and disease severity. In our intensive care unit, we evaluated the changes in the laboratory data and radiological involvement severity of our patients who underwent tocilizumab treatment and examined the appropriate laboratory parameter in the treatment follow-up and its effect on survival. Methods: In the critical patient follow-up of COVID-19, 17 of the 23 patients treated with tocilizumab had a mortal course (Group 1) and the remaining 6 (Group 2) were. The C-reactive protein, lactate dehydrogenase, IL-6, D-dimer, procalcitonin, albumin, and ferritin values, which were routinely screened in our clinic on the day of tocilizumab treatment and the 5th day after, were recorded. Both the change between the two groups and the change between days 1 and 5 were analyzed. Results: A total of 23 patients (55.35 ± 13.31 years) were included in the study. The computed tomography severity score assessed at the intensive care unit admission was statistically significantly higher in Group 2. The procalcitonin and lactate dehydrogenase values measured on day 5 after tocilizumab were significantly lower in Group 2. On the 5th day after treatment, the levels of C-reactive protein, ferritin, chest X-rays, IL-6 and D-dimer statistically significantly changed compared to the first day of the treatment. In correlation with the decrease in PCT as of the 5th day after tocilizumab administration, an increasing tendency was observed in 28-day survival. Conclusion: This study demonstrated that tocilizumab treatment may positively contribute to the treatment by decreasing cytokine levels. PCT and LDH follow-up before and after treatment in critically ill patients who are receiving tocilizumab treatment can give an idea about survival.

scholarly journals Usefulness of Early C-Reactive Protein Kinetics in Response and Prognostic Assessment in Infected Critically Ill Patients: An Observational Retrospective Study

2019 ◽  
Vol 32 (12) ◽  
pp. 737
Author(s):  
Marta Ayres Pereira ◽  
Ana Lídia Rouxinol-Dias ◽  
Tatiana Vieira ◽  
José Artur Paiva
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Antibiotic Therapy ◽  
Critically Ill ◽  
Fast Response ◽  
C Reactive Protein ◽  
Protein Kinetics ◽  
Reactive Protein ◽  
Prognostic Assessment ◽  
One Year

Introduction: The ideal biomarker to assess response and prognostic assessment in the infected critically ill patient is still not available. The aims of our study were to analyze the association between early C-reactive protein kinetics and duration and appropriateness of antibiotic therapy and its usefulness in predicting mortality in infected critically ill patients.Material and Methods: We have carried out an observational retrospective study in a cohort of 60 patients with community-acquired pneumonia, aspiration pneumonia and bacteremia at an intensive care unit. We have collected C-reactive protein consecutive serum levels for eight days as well as duration and appropriateness of initial antibiotic therapy. C-reactive protein kinetic groups were defined based on the levels at days 0, 4 and 7. With a follow-up of one year, we have evaluated mortality at different time-points.Results: We have obtained three different C-reactive protein kinetic groups from the sample: fast response, delayed but fast response and delayed and slow response. We did not find statistically significant associations between C-reactive protein kinetics and early (intensive care unit, hospital and 28-days) or late (six months and one year) mortality and antibiotic therapy duration (p > 0.05). Although there were no statistically significant differences between the appropriateness of antibiotic therapy and the defined groups (p = 0.265), no patient with inappropriate antibiotic therapy presented a fast response pattern.Discussion: Several studies suggest the importance of this protein in infection.Conclusion: Early C-reactive protein kinetics is not associated with response and prognostic assessment in infected critically ill patients. Nevertheless, a fast response pattern tends to exclude initial inappropriate antibiotic therapy.

Ventilator-Associated Tracheobronchitis Increases the Length of Intensive Care Unit Stay

2013 ◽  
Vol 34 (8) ◽  
pp. 800-808 ◽  
Author(s):  
Marios Karvouniaris ◽  
Demosthenes Makris ◽  
Efstratios Manoulakas ◽  
Paris Zygoulis ◽  
Konstantinos Mantzarlis ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Protein Level ◽  
Significant Risk ◽  
University Hospital ◽  
C Reactive Protein ◽  
Prolonged Stay ◽  
Reactive Protein ◽  
Icu Stay ◽  
The Impact

Objective.To investigate prospectively the clinical course and risk factors for ventilator-associated tracheobronchitis (VAT) and the impact of VAT on intensive care unit (ICU) morbidity and mortality.Design.Prospective cohort study.Setting.University Hospital Larissa, Larissa, GreecePatients.Critical care patients who received mechanical ventilation for more than 48 hours were prospectively studied between 2009 and 2011.Methods.The modified Clinical Pulmonary Infection Score, white blood cell count, and C-reactive protein level were systematically assessed every 2 days for the first 2 weeks of ICU stay. Bronchial secretions were assessed daily. Quantitative cultures of endotracheal secretions were performed on the first ICU day for every patient and every 2 days thereafter for the first 2 weeks or more at the discretion of the attending physicians. Definition of VAT was based on previously published criteria.Results.A total of 236 patients were observed; 42 patients (18%) presented with VAT. Gram-negative pathogens, which were usually multidrug resistant, were responsible for 92.9% of cases. Patients with a neurosurgical admission presented with VAT significantly more often than did other ICU patients (28.5% vs 14.1%; P = .02). The occurrence of VAT was a significant risk factor for increased duration of ICU stay (OR [95% CI], 3.04 [1.35-6.85]; P = .01). Age (OR [95% CI], 1.04 [1.015-1.06]; P = .02), Acute Physiology and Chronic Health Evaluation II score (OR [95% CI], 1.08 [1.015-1.16]; P = .02), and C-reactive protein level at admission (OR [95% CI], 1.05 [1.011.1]; P = .02) were independent factors for ICU mortality.Conclusions.VAT is a nosocomial infection that might be associated with prolonged stay in the ICU, especially in neurocritical patients. VAT was not associated with increased mortality in our study.

scholarly journals C-Reactive Protein/Albumin Ratio as an Independent Predictor of Mortality in Critically Ill Pediatric Patients

2020 ◽  
Vol 10 (01) ◽  
pp. e1-e11
Author(s):  
Shereen A. Mohamed ◽  
Rabab ElHawary
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Pediatric Patients ◽  
Independent Predictor ◽  
Discriminatory Power ◽  
C Reactive Protein ◽  
Albumin Ratio ◽  
Reactive Protein ◽  
Risk Of Mortality

AbstractIt is necessary to stratify the risk of pediatric patients at the time of intensive care unit (ICU) admission and to predict their outcomes. This helps to allocate the scarce ICU resources to start the appropriate treatment. The objective of this study was to evaluate the prognostic value of C-reactive protein/albumin ratio on admission to pediatric intensive care unit (PICU) in predicting mortality, PICU length of stay, the need for mechanical ventilation, and the use of inotropic drugs. This cohort study was conducted at Pediatric Cairo University Hospital. The study included 178 critically ill children. Pediatric Risk of Mortality–III (PRISM-III) score was calculated; CRP and serum albumin levels were assessed within 24 hours from admission. The median CRP/albumin ratio was significantly higher in nonsurvivors than survivors (18.60 and 4.65, respectively). The CRP/albumin ratio at a cutoff of ≥25.83 had significant discriminatory power in predicting mortality (area under the curve [AUC] = 0.795 and p < 0.001) with 85.4% accuracy. Furthermore, CRP/albumin ratio alone showed a comparable discriminatory power to that of PRISM-III score (AUCs = 0.795 and 0.793, respectively). A multivariable logistic regression analysis revealed that each unit of increase in the CRP/albumin ratio increased the risk of mortality by 1.075 (odds ratio [OR] = 1.075). CRP/albumin ratio showed a significantly higher median in ventilated (6.86) compared with non-ventilated (5.22) patients. Patients supported with inotropes showed significantly higher median CRP/albumin ratio (11.70 and 3.68, respectively). CRP/albumin ratio at admission to PICU was a good independent predictor of mortality.

PROGNOSTIC VALUE OF INTERLEUKIN 6, PROCALCITONIN, AND C-REACTIVE PROTEIN LEVELS IN INTENSIVE CARE UNIT PATIENTS DURING FIRST INCREASE OF FEVER

Shock ◽  
2006 ◽  
Vol 26 (1) ◽  
pp. 10-12 ◽  
Author(s):  
Peter Fraunberger ◽  
Ying Wang ◽  
Ernst Holler ◽  
Klaus G. Parhofer ◽  
Dorothea Nagel ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Interleukin 6 ◽  
Prognostic Value ◽  
C Reactive Protein ◽  
Protein Levels ◽  
Reactive Protein

scholarly journals Potensi Pemberian Tocilizumab pada Pasien COVID-19 Di ICU RSUD Ulin Banjarmasin

2020 ◽  
Vol 12 (3) ◽  
pp. 17-33
Author(s):  
Rohmantuah Trada Purba ◽  
Mahendratama Purnama Adhi ◽  
Erna Kusumawardhani ◽  
Rapto Hardian ◽  
Andri Lumban Tobing
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Lactate Dehydrogenase ◽  
Interleukin 6 ◽  
Virus Disease ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Corona Virus ◽  
D Dimer

Latar Belakang: Corona Virus Disease 2019 (COVID-19) adalah penyakit pandemi yang menjadi masalah global yang melanda seluruh dunia. Manifestasi klinis dan tingkat keparahan penyakit COVID-19 sangat bervariasi. Pada pasien COVID-19 derajat kritis yang memerlukan perawatan di intensive care unit (ICU) telah ditemukan adanya proses badai sitokin yang meningkatkan mortalitas dan morbiditas. Interleukin-6 (IL-6) berperan dalam terjadinya badai sitokin.Kasus: Berikut kami laporkan serial kasus 5 pasien COVID-19 terkonfirmasi positif derajat sedang-kritis yang diberikan tocilizumab (TCZ) sebagai suatu IL-6 inhibitor yang memiliki potensi terapi menurunkan mortalitas dan morbiditas pasien COVID-19 derajat berat-kritis.Pembahasan: Dari 5 pasien yang diberikan TCZ, didapatkan hasil 3 pasien bisa pulang dan 2 pasien meninggal. Terdapat potensi pemberian IL-6 inhibitor karena dari patofisiologi penyakit COVID-19 yang berkaitan dengan IL-6 dan badai sitokin. IL-6 inhibitor dapat menurunkan mortalitas dan morbiditas dengan mencegah terjadinya badai sitokin. Hal ini diukur menggunakan evaluasi onset penyakit, kadar biomarker inflamasi dan gangguan koagulasi yang sering diteliti pada pasien COVID-19 seperti c-reactive protein (CRP), lactate dehydrogenase (LDH), D-Dimer dan ferritin.Kesimpulan: Pemberian TCZ memiliki potensi efek terapeutik jika diberikan pada onset penyakit <10 hari. Perlu dilakukan penelitian lebih lanjut untuk menilai efek terapeutik dan timing pemberian yang tepat.

scholarly journals TARGET, PRESCRIPTION AND INFUSION OF ENTERAL NUTRITIONAL THERAPY OF CRITICAL PATIENTS IN INTENSIVE CARE UNIT

2018 ◽  
Vol 55 (3) ◽  
pp. 283-289 ◽  
Author(s):  
Isabela Bernasconi JOSÉ ◽  
Vânia Aparecida LEANDRO-MERHI ◽  
José Luis Braga de AQUINO
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
High Risk ◽  
Critically Ill ◽  
Nutritional Therapy ◽  
Wilcoxon Test ◽  
Nutritional Risk ◽  
Albumin Ratio ◽  
Significant Difference ◽  
Prospective Longitudinal

ABSTRACT BACKGROUND: Enteral nutritional therapy (ENT) is the best route for the nutrition of critically ill patients with improved impact on the clinical treatment of such patients. OBJECTIVE: To investigate the energy and protein supply of ENT in critically ill in-patients of an Intensive Care Unit (ICU). METHODS: Prospective longitudinal study conducted with 82 critically ill in-patients of an ICU, receiving ENT. Anthropometric variables, laboratory tests (albumin, CRP, CRP/albumin ratio), NUTRIC-score and Nutritional Risk Screening (NRS-2002), energy and protein goals, and the inadequacies and complications of ENT were assessed. Statistical analysis was performed using the Chi-square or Fischer tests and the Wilcoxon test. RESULTS: A total of 48.78% patients were at high nutritional risk based on NUTRIC score. In the CRP/albumin ratio, 85.37% patients presented with a high risk of complications. There was a statistically significant difference (P<0.0001) for all comparisons made between the target, prescription and ENT infusion, and 72% of the quantities prescribed for both calories and proteins was infused. It was observed that the difference between the prescription and the infusion was 14.63% (±10.81) for calories and 14.21% (±10.5) for proteins, with statistically significant difference (P<0.0001). In the relationship between prescription and infusion of calories and proteins, the only significant association was that of patients at high risk of CRP/albumin ratio, of which almost 94% received less than 80% of the energy and protein volume prescribed (P=0.0111). CONCLUSION: The administration of ENT in severely ill patients does not meet their actual energy and protein needs. The high occurrence of infusion inadequacies, compared to prescription and to the goals set can generate a negative nutritional balance.

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