scholarly journals Evaluation of Endothelial Biomarkers on the Prognosis of Patients on Extracorporeal Membrane Oxygenation

2019 ◽  
Author(s):  
Tsung-Yu Tsai ◽  
Kun-Hua Tu ◽  
Feng-Chun Tsai ◽  
Yu-Yun Nan ◽  
Pei-Chun Fan ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Extracorporeal Membrane Oxygenation ◽  
Characteristic Curve ◽  
Tertiary Care ◽  
Laboratory Data ◽  
Endothelial Activation ◽  
Organ Damage ◽  
Care Hospital ◽  
Serum Samples ◽  
Membrane Oxygenation

Abstract Background Extracorporeal membrane oxygenation (ECMO) is often used in critical patients with severe myocardial failure. However, patients on ECMO often have high mortality rate and poor prognosis. Recent studies suggest that endothelial activation with subsequent vascular barrier breakdown is a critical pathogenic mechanism in organ damage and related to the outcome in critical illness. This study aimed to determine whether the endothelial biomarkers could serve as prognostic factors for the outcome of patients on ECMO. Methods This prospective study enrolled total 23 critically ill patients on veno-arterial ECMO in the intensive care units of a tertiary care hospital between March 2014 and February 2015. Serum samples were tested for thrombomodulin, angiopoietin (Ang)-1, Ang-2, and vascular endothelial growth factor (VEGF). Demographic, clinical, and laboratory data were also collected. Results The overall mortality rate was 56.5%. The combination of Ang-2 at the time of ECMO support (day 0) and VEGF at day 2 had modest prognostic ability of discriminating mortality (area under receiver operating characteristic curve [AUROC], 0.854; 95% confidence interval: 0.645-0.965). Conclusions In this study, we found that the combination of Ang-2 at day 0 and VEGF at day 2 was a modest model for mortality discrimination in this group of patients.

scholarly journals Prognostic value of endothelial biomarker in refractory cardiogenic shock with ECLS: a prospective monocentric study

2019 ◽  
Author(s):  
Tsung-Yu Tsai ◽  
Kun-Hua Tu ◽  
Feng-Chun Tsai ◽  
Yu-Yun Nan ◽  
Pei-Chun Fan ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Characteristic Curve ◽  
Tertiary Care ◽  
Laboratory Data ◽  
Endothelial Activation ◽  
Organ Damage ◽  
Care Hospital ◽  
Serum Samples ◽  
Critical Patients ◽  
Endothelial Growth Factor

Abstract Background Extracorporeal membrane oxygenation (ECMO) is often used in critical patients with severe myocardial failure. However, the mortality rate of patients on ECMO is often high. Recent studies have suggested that endothelial activation with subsequent vascular barrier breakdown is a critical pathogenic mechanism of organ damage and is related to the outcome of critical illness. This study aimed to determine whether endothelial biomarkers can be served as prognostic factors for the outcome of patients on ECMO. Methods This prospective study enrolled 23 critically ill patients on veno-arterial ECMO in the intensive care units of a tertiary care hospital between March 2014 and February 2015. Serum samples were tested for thrombomodulin, angiopoietin (Ang)-1, Ang-2, and vascular endothelial growth factor (VEGF). Demographic, clinical, and laboratory data were also collected. Results The overall mortality rate was 56.5%. The combination of Ang-2 at the time of ECMO support (day 0) and VEGF at day 2 had the ability to discriminate mortality (area under receiver operating characteristic curve [AUROC], 0.854; 95% confidence interval: 0.645-0.965). Conclusions In this study, we found that the combination of Ang-2 at day 0 and VEGF at day 2 was a modest model for mortality discrimination in this group of patients.

scholarly journals Prognostic value of endothelial biomarker in refractory cardiogenic shock with ECLS: a prospective monocentric study

2019 ◽  
Author(s):  
Tsung-Yu Tsai ◽  
Kun-Hua Tu ◽  
Feng-Chun Tsai ◽  
Yu-Yun Nan ◽  
Pei-Chun Fan ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Characteristic Curve ◽  
Tertiary Care ◽  
Laboratory Data ◽  
Endothelial Activation ◽  
Organ Damage ◽  
Care Hospital ◽  
Serum Samples ◽  
Critical Patients ◽  
Endothelial Growth Factor

Abstract Background Extracorporeal membrane oxygenation (ECMO) is often used in critical patients with severe myocardial failure. However, patients on ECMO often have high mortality rate. Recent studies suggest that endothelial activation with subsequent vascular barrier breakdown is a critical pathogenic mechanism in organ damage and related to the outcome in critical illness. This study aimed to determine whether the endothelial biomarkers could serve as prognostic factors for the outcome of patients on ECMO. Methods This prospective study enrolled total 23 critically ill patients on veno-arterial ECMO in the intensive care units of a tertiary care hospital between March 2014 and February 2015. Serum samples were tested for thrombomodulin, angiopoietin (Ang)-1, Ang-2, and vascular endothelial growth factor (VEGF). Demographic, clinical, and laboratory data were also collected. Results The overall mortality rate was 56.5%. The combination of Ang-2 at the time of ECMO support (day 0) and VEGF at day 2 had the ability of discriminating mortality (area under receiver operating characteristic curve [AUROC], 0.854; 95% confidence interval: 0.645-0.965). Conclusions In this study, we found that the combination of Ang-2 at day 0 and VEGF at day 2 was a modest model for mortality discrimination in this group of patients.

scholarly journals Evaluation of Endothelial Biomarkers on the Prognosis of Patients on Extracorporeal Membrane Oxygenation

2018 ◽  
Author(s):  
Tsung-Yu Tsai ◽  
Kun-Hua Tu ◽  
Feng-Chun Tsai ◽  
Yu-Yun Nan ◽  
Pei-Chun Fan ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Cell Injury ◽  
Characteristic Curve ◽  
Tertiary Care ◽  
Laboratory Data ◽  
Vascular Endothelial Cell ◽  
Vascular Endothelial ◽  
Care Hospital ◽  
Serum Samples ◽  
Membrane Oxygenation

Abstract Background: Extracorporeal membrane oxygenation (ECMO) is often used in critical patients with severe myocardial failure. However, acute kidney injury (AKI) commonly occurs in patients on ECMO and usually brings about poor outcome. Recent studies suggest that renal vascular endothelial cell injury participates in the extent and maintenance of AKI. This study aimed to determine whether the endothelial biomarkers could serve as prognostic factors for the outcome of patients on ECMO. Methods: This prospective study enrolled total 23 critically ill patients on veno-arterial ECMO in the intensive care units of a tertiary care hospital between March 2014 and February 2015. Serum samples were tested for thrombomodulin, angiopoietin (Ang)-1, Ang-2, and vascular endothelial growth factor (VEGF). Demographic, clinical, and laboratory data were also collected. Results: The overall mortality rate was 56.5%. The combination of Ang-2 at the time of ECMO support (day 0) and VEGF at day 2 had modest prognostic ability of discriminating mortality (area under receiver operating characteristic curve [AUROC], 0.854; 95% confidence interval: 0.645-0.965). Conclusions: In this study, we found that the combination of Ang-2 at day 0 and VEGF at day 2 was a modest model for mortality discrimination in this group of patients.

scholarly journals Prevalence and clinical correlation of hepatitis E virus antibody in the patients’ serum samples from a tertiary care hospital in Thailand during 2015–2018

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Atiporn Boonyai ◽  
Anchalee Thongput ◽  
Thidarat Sisaeng ◽  
Parisut Phumchan ◽  
Navin Horthongkham ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Tertiary Care ◽  
Laboratory Data ◽  
Organ Transplant ◽  
Hospital Setting ◽  
Antibody Detection ◽  
Enzyme Linked Immunosorbent Assay ◽  
Care Hospital ◽  
Serum Samples ◽  
Igm Antibodies

Abstract Background Prevalence and incidence of hepatitis caused by HEV infection are usually higher in developing countries. This study demonstrated the HEV seroprevalence and incidence of HEV infection in patients with clinical hepatitis in a tertiary hospital in Thailand. Methods A laboratory-based cross-sectional study was conducted using 1106 serum samples from patients suspected of HEV infection sent to the Serology laboratory, Siriraj Hospital, for detecting HEV antibodies during 2015–2018. Prevalence of anti-HEV IgG and IgM antibodies in general patients, including organ transplant recipients and pregnant women in a hospital setting, were determined using indirect enzyme-linked immunosorbent assay (ELISA) kits. Comparison of laboratory data between groups with different HEV serological statuses was performed. Results HEV IgG antibodies were detected in 40.82% of 904 serum samples, while HEV IgM antibodies were detected in 11.75% of 1081 serum samples. Similar IgG and IgM antibody detection rates were found in pregnant women. Interestingly, anti-HEV IgM antibodies were detected in 38.5% of patients who underwent organ transplantation. Patients who tested positive for anti-HEV IgM antibodies had higher alanine aminotransferase levels than those who had not. In contrast, patients who tested positive for anti-HEV IgG had more elevated levels of total bilirubin than those who tested negative. Conclusions HEV seroprevalence and incidence in patients with clinical hepatitis were relatively high in the Thai population, including the pregnancy and organ transplant subgroups. The results potentially benefit the clinicians in decision-making to investigate HEV antibodies and facilitating proper management for patients.

Rates of nosocomial infection associated with interhospital transfer of patients receiving extracorporeal membrane oxygenation

2021 ◽  
pp. 1-6
Author(s):  
Joseph E. Marcus ◽  
Valerie G. Sams ◽  
James K. Aden ◽  
Andriy Batchinsky ◽  
Michal J. Sobieszczyk ◽  
...  
Keyword(s):  
Nosocomial Infection ◽  
Extracorporeal Membrane Oxygenation ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Subsequent Development ◽  
High Risk Population ◽  
Care Hospital ◽  
Membrane Oxygenation ◽  
Interhospital Transfer ◽  
Increased Risk

Abstract Objectives: Critically ill patients requiring extracorporeal membrane oxygenation (ECMO) frequently require interhospital transfer to a center that has ECMO capabilities. Patients receiving ECMO were evaluated to determine whether interhospital transfer was a risk factor for subsequent development of a nosocomial infection. Design: Retrospective cohort study. Setting: A 425-bed academic tertiary-care hospital. Patients: All adult patients who received ECMO for >48 hours between May 2012 and May 2020. Methods: The rate of nosocomial infections for patients receiving ECMO was compared between patients who were cannulated at the ECMO center and patients who were cannulated at a hospital without ECMO capabilities and transported to the ECMO center for further care. Additionally, time to infection, organisms responsible for infection, and site of infection were compared. Results: In total, 123 patients were included in analysis. For the primary outcome of nosocomial infection, there was no difference in number of infections per 1,000 ECMO days (25.4 vs 29.4; P = .03) by univariate analysis. By Cox proportional hazard analysis, transport was not significantly associated with increased infections (hazard ratio, 1.7; 95% confidence interval, 0.8–4.2; P = .20). Conclusion: In this study, we did not identify an increased risk of nosocomial infection during subsequent hospitalization. Further studies are needed to identify sources of nosocomial infection in this high-risk population.

scholarly journals Evaluation of Heparin Anti–Factor Xa Levels Following Antithrombin Supplementation in Pediatric Patients Supported With Extracorporeal Membrane Oxygenation

2020 ◽  
Vol 25 (8) ◽  
pp. 717-722
Author(s):  
Sharon E. Gordon ◽  
Travis S. Heath ◽  
Ali B.V. McMichael ◽  
Christoph P. Hornik ◽  
Caroline P. Ozment
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Pediatric Patients ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Tertiary Care ◽  
Factor Xa ◽  
Care Hospital ◽  
Membrane Oxygenation ◽  
Support Organization ◽  
Clinical Benefits

OBJECTIVE Thrombotic events are potential complications in patients receiving extracorporeal membrane oxygenation (ECMO) necessitating the use of systemic anticoagulation with heparin. Heparin works by potentiating the effects of antithrombin (AT), which may be deficient in critically ill patients and can be replaced. The clinical benefits and risks of AT replacement in children on ECMO remain incompletely understood. METHODS This single-center, retrospective study reviewed 28 neonatal and pediatric patients supported on ECMO at a tertiary care hospital between April 1, 2013, and October 31, 2014, who received at least 1 dose of AT during their ECMO course. The primary outcome of the study was the change in anti–factor Xa levels after pooled human AT supplementation. Secondary outcomes included the percentage of anti–factor Xa levels within the therapeutic range surrounding AT administration; survival to decannulation; 30 days after cannulation and discharge; time to first circuit change; and incidence of bleeding and thrombotic events. RESULTS A total of 78 doses of AT were administered during the study period. The mean increase in anti–factor Xa level following AT administration in patients without a ≥10% concurrent change in heparin was 0.075 ± 0.13 international units/mL. A greater percentage of anti–factor Xa levels were therapeutic for the 48 hours following AT administration (64.2% vs 38.6%). Survival and adverse events were similar to Extracorporeal Life Support Organization averages, with the exception of a higher incidence of intracranial hemorrhage. CONCLUSIONS Patients experienced a small but significant increase in anti–factor Xa level and a greater percentage of therapeutic anti–factor Xa levels following AT supplementation.

Elective Extracorporeal Membrane Oxygenation: An Improved Perioperative Technique in the Treatment of Tracheal Obstruction

2001 ◽  
Vol 110 (3) ◽  
pp. 205-209 ◽  
Author(s):  
Kieran M. Connolly ◽  
William F. McGuirt
Keyword(s):  
High Pressure ◽  
Extracorporeal Membrane Oxygenation ◽  
Tracheal Stenosis ◽  
Tertiary Care ◽  
Upper Airway ◽  
Care Hospital ◽  
Endotracheal Tubes ◽  
Perioperative Morbidity ◽  
Membrane Oxygenation ◽  
Anastomotic Breakdown

The surgical management of children with tracheal stenosis and obstruction is complicated by the perioperative needs of pressure ventilation and indwelling endotracheal tubes. These factors predispose to surgical failure and anastomotic breakdown, restenosis, and pneumomediastinum. The use of extracorporeal membrane oxygenation (ecmo) to manage ventilation during tracheal repair allows better visualization at the surgical site and obviates the need for indwelling endotracheal tubes and high-pressure ventilation. Six children were treated with elective ecmo at a tertiary care hospital. All 6 underwent successful surgical repair, and 4 of the 6 were ultimately extubated. There were no significant complications at the surgical site. There was 1 death from postoperative complications, and 2 patients required tracheotomy. One tracheotomy was performed for upper airway obstruction secondary to retrognathia, and this patient was subsequently decannulated. Medical complications were confined to 2 patients and included sepsis, hyperbilirubinemia, seizure disorder, renal failure, intracranial hemorrhage, and hydrocephalus. Elective ecmo provides a reliable perioperative technique for airway management of children with tracheal stenosis or obstruction. This technique offers the advantage of improved visibility at the operative site and eliminates the need for high-pressure ventilation, thereby likely reducing the risk of perioperative morbidity.

TO DETERMINE THE ROLE OF CA125 IN THE DIAGNOSIS OF ACUTE APPENDICITIS

2020 ◽  
Vol 4 (7) ◽  
Author(s):  
Vinod Kumar ◽  
Bhupen Songra ◽  
Richa Jain ◽  
Deeksha Mehta
Keyword(s):  
Acute Appendicitis ◽  
Clinical Diagnosis ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Ca 125 ◽  
Care Hospital ◽  
Serum Samples ◽  
Roc Curve Analysis ◽  
Surgery Department

Background: the present study was under taken to determine the role of CA-125 in the diagnosis of acute appendicitis (AA), to prevent its complications and also in preventing negative appendicectomies in tertiary care hospital. Methods: The study was conducted at a tertiary care and research center between 01/03/2018 to 30/06/2019. Patients admitted to the surgery department with diagnosis of AA were considered for the study. After informed consent, a, standardized history was obtained as a case Performa. Serum samples from all the cases with clinical diagnosis of AA were obtained and stored. Only the cases with histopathologically approved AA were included in the study. Cases operated for clinical diagnosis of AA, but not histopathologically proven AA was not included in the study. CA125 levels in cases with definitive diagnosis of AA were measured. Results: In present study, ROC curve analysis revealed the sensitivity of 87.27 % and specificity of 90.91 % when the CA 125 cut-off value of > 16.8 was taken to diagnose acute appendicitis. AUC was 0.911 with a standard error of 0.0292. Conclusion: In this study we have observed that CA125 showed a positive correlation with acute appendicitis, that was statistically not significant (P>0.05). We didn’t evaluate the correlation with the disease severity. We consider that CA125 can be used as a marker in acute appendicitis cases although further research is still needed. Keywords: CA125, Acute Appendicitis, Surgery.

Rising Economic Impact of Clostridium difficile-Associated Disease in Adult Hospitalized Patient Population

2008 ◽  
Vol 29 (9) ◽  
pp. 823-828 ◽  
Author(s):  
Xiaoyan Song ◽  
John G Bartlett ◽  
Kathleen Speck ◽  
April Naegeli ◽  
Karen Carroll ◽  
...  
Keyword(s):  
At Risk ◽  
Mortality Rate ◽  
Clostridium Difficile ◽  
Economic Burden ◽  
Excess Mortality ◽  
Tertiary Care ◽  
Severity Of Illness ◽  
Adult Patients ◽  
Care Hospital ◽  
Course Of Illness

Background.Clostridium difficile-associated disease (CDAD) is responsible for increased morbidity and a substantial economic burden. Incidences of CDAD, including those with a severe course of illness, have been increasing rapidly.Objective.To evaluate the excess mortality, increased length of stay (LOS) in the hospital, and additional costs associated with CDAD.Design.A retrospective matched cohort study.Patients.Adult patients admitted to a large tertiary care hospital between January 2000 and October 2005.Methods.Adult patients were tested with a C. difficile laboratory assay at admission or 72 hours after admission. Infected patients had lor more positive assay results and were individually matched to 1 uninfected patient who had negative assay results, by exposure time, age, ward, and at least 2 measurements for comorbidity and severity of illness.Results.The incidence rate of CDAD among adult patients increased from 0.57 cases per 1,000 patient-days at risk before 2004 to 0.88 cases per 1,000 patient-days at risk after 2004 (P < .001). The 630 infected patients had a mortality rate of 11.9%; the 630 uninfected patients had a mortality rate of 15.1% (P = .02). After adjustment in the multivariate analysis, we found that the LOS for infected patients was 4 days longer than that for uninfected patients (P < .001). If CDAD occurred after 2004, the additional LOS increased to 5.5 days. The direct cost associated with CDAD was $306 per case; after year 2004, it increased to $6,326 per case.Conclusions.There may be no excess mortality among patients with CDAD, compared with patients without it, but the economic burden of CDAD is increasing. By 2004, CDAD-associated medical expenditures approached $1,000,000 per year at our institution alone.

scholarly journals Epidemiology, species distribution, and outcome of nosocomial Candida spp. bloodstream infection in Shanghai: an 11-year retrospective analysis in a tertiary care hospital

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Yan-Jun Zheng ◽  
Ting Xie ◽  
Lin Wu ◽  
Xiao-Ying Liu ◽  
Ling Zhu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mortality Rate ◽  
Antifungal Therapy ◽  
Species Distribution ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Clinical Severity ◽  
Severe Neutropenia ◽  
Care Hospital ◽  
The Impact

Abstract Background The incidence of Candida bloodstream infections (BSIs), has increased over time. In this study, we aimed to describe the current epidemiology of Candida BSI in a large tertiary care hospital in Shanghai and to determine the risk factors of 28-day mortality and the impact of antifungal therapy on clinical outcomes. Methods All consecutive adult inpatients with Candida BSI at Ruijin Hospital between January 1, 2008, and December 31, 2018, were enrolled. Underlying diseases, clinical severity, species distribution, antifungal therapy, and their impact on the outcomes were analyzed. Results Among the 370 inpatients with 393 consecutive episodes of Candida BSI, the incidence of nosocomial Candida BSI was 0.39 episodes/1000 hospitalized patients. Of the 393 cases, 299 (76.1%) were treated with antifungal therapy (247 and 52 were treated with early appropriate and targeted antifungal therapy, respectively). The overall 28-day mortality rate was 28.5%, which was significantly lower in those who received early appropriate (25.5%) or targeted (23.1%) antifungal therapy than in those who did not (39.4%; P = 0.012 and P = 0.046, respectively). In multivariate Cox regression analysis, age, chronic renal failure, mechanical ventilation, and severe neutropenia were found to be independent risk factors of the 28-day mortality rate. Patients who received antifungal therapy had a lower mortality risk than did those who did not. Conclusions The incidence of Candida BSI has increased steadily in the past 11 years at our tertiary care hospital in Shanghai. Antifungal therapy influenced short-term survival, but no significant difference in mortality was observed between patients who received early appropriate and targeted antifungal therapy.

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