scholarly journals Ultra-early indicators of acute hypertriglyceridemic pancreatitis may affect treatment decision-making

2020 ◽  
Author(s):  
Jing Wu ◽  
Xiaoting Tang ◽  
Chaowei Li ◽  
Zilan Rao ◽  
Yizhi Liang ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Therapeutic Effect ◽  
Serum Calcium ◽  
Blood Purification ◽  
Clinical Decisions ◽  
Arterial Lactate ◽  
Stay Time ◽  
Lactate Levels ◽  
D Dimer ◽  
Early Indicators

Abstract Background: The present study aimed to investigate whether the ultra-early indicators can predict severity of acute hypertriglyceridemic pancreatitis (HTGP) and affect clinical decisions. Methods: We performed an observational retrospective study with data from 110 enrolled patients with HTGP from January 2017 to February 2020. According to the final clinical outcome, HTGP patients were divided into MAP group and MSAP-SAP group. Demographic and clinical data were collected, and ultra-early indicators (serum calcium, TG, IL-6, D-dimer, HbAc1, arterial lactate) levels were measured within 6 h of admission. A multivariate logistic regression analysis model and receiver operating characteristic curve were adopted to evaluate the value of ultra-early indicators for identifying high-risk patients. The chi-square test method was used to estimate the time of hospitalization and complications in MSAP-SAP group after plasma exchange within or more than 24 hours. Results: Of the 110 HTGP patients, a total of 56 patients with mild AP and 54 MSAP-SAP HTGP patients included. TG, IL-6, D-dimer, HbAc1, and arterial lactate levels which measured within 6 h after admission were significantly higher in the MSAP-SAP group, but serum calcium was significantly lower, versus the mild AP group. IL-6, D-dimer, and serum calcium were found to be risk factors for MSAP-SAP and could ultra-early predict HTGP severity, particularly within 6 hours of admission. We found that patients of MSAP-SAP treated with Blood purification within 24 hours of admission have shorter hospital stay time than over 24 hours of admission. Conclusion: Ultra-early indicators of IL-6, D-dimer, and serum calcium may be useful biomarkers for assessing AP severity in HTGP patients within 6 hours. Early blood purification therapy should be taken for MSAP-SAP patients within 24 hours, because fewer patients could suffer from complications and more patients had shorter hospital stay time. While traditional treatment could be implemented for MAP patients to reduce medical expenses and still obtain good therapeutic effect. Keywords: Hypertriglyceridemic pancreatitis, Ultra-early indicators, Clinical decisions, Therapeutic effect

scholarly journals Ultra-Early Indicators of Acute Hypertriglyceridemic Pancreatitis May Influence Treatment Decision-Making By Chinese Doctors

2021 ◽  
Author(s):  
Jing Wu ◽  
Yizhi Liang ◽  
Xiaoting Tang ◽  
Zilan Rao ◽  
Chaowei Li ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Serum Calcium ◽  
Blood Purification ◽  
Test Method ◽  
Arterial Lactate ◽  
Hospitalization Time ◽  
Lactate Levels ◽  
D Dimer ◽  
Early Indicators

Abstract Background: This study investigates whether ultra-early indicators can predict severity of acute hypertriyceridemic pancreatitis (HTGP) and affect clinical decisions. Methods: For this observational retrospective study, we analyzed data of 110 HTGP patients enrolled between January 2017 and February 2020. HTGP patients were categorized into mild acute pancreatitis (MAP) and moderately severe acute pancreatitis-severe acute pancreatitis (MSAP-SAP) groups, based on their final clinical outcomes. Demographic and clinical data were collected and ultra-early indicators (serum calcium, triglyceride (TG), interleukin-6(IL-6), D-dimer, hemoglobin A1c(HbAc1), arterial lactate) levels were measured within 6 hours of admission. A multivariate logistic regression analysis model and receiver operating characteristic curve were used to determine ultra-early indicators values of high-risk patients. The chi-square test method was applied to estimate the hospitalization time and associated complications in MSAP-SAP group post-plasma exchange within or more than 24 hours. Results: Among the 110 HTGP patients, 56 were in the MAP group whereas, 54 were in the MSAP-SAP group. TG, IL-6, D-dimer, HbAc1, and arterial lactate levels measured within 6 hours after admission were significantly higher in the MSAP-SAP group, but serum calcium was significantly lower, versus the mild AP group. IL-6, D-dimer and serum calcium were identified as the risk factors for MSAP-SAP and were potential ultra-early indicators for predicting HTGP severity within 6 hours of admission. MSAP-SAP patients that underwent blood purification therapy within 24 hours of admission had a shorter hospitalization time than those treated 24 hours post-admission. Conclusion: The present study reveals IL-6, D-dimer, and serum calcium - ultra-early indicators - as promising biomarkers in the assessment of AP severity in HTGP patients within 6 hours. Early blood purification presents a novel therapy among MSAP-SAP patients within 24 hours and is associated with fewer complications and a shorter hospitalization time. However, traditional therapy can be further integrated to manage MAP patients effectively with less medical expenses.

scholarly journals Red Blood Cells from COVID-19 Patients Show Evidence of Increased Oxidative Stress and Increased Lactate Influx

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 928-928
Author(s):  
Philip Murphy ◽  
Edel Mullen ◽  
Stephen Bergin ◽  
Geraldine Healy ◽  
Michelle Lavin ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Blood Lactate ◽  
Blood Cells ◽  
Research Funding ◽  
Surface Expression ◽  
Positive Group ◽  
Show Evidence ◽  
Lactate Levels ◽  
D Dimer

Abstract Red Blood Cells from COVID-19 Patients Show Evidence of Increased Oxidative Stress and Increased Lactate Influx Corona Disease 19 (COVID-19) is caused by SARS-CoV-2, a novel, highly infectious, single stranded RNA virus. In severe cases, excess oxidative stress produced by a 'cytokine storm' may generate excess reactive oxygen species (ROS) and lead to tissue damage in the lungs and elsewhere. As the potential role of RBCs in the pathophysiology of COVID-19 remains controversial (1), we investigated for evidence of increased oxidative stress and increased thrombotic tendency in RBCs from patients with COVID-19 infection. Following ethical approval and written informed consent, we used flow cytometry (BD FACSCanto II) to measure baseline RBC ROS following incubation with 2'-7'-dichlorofluorescein diacetate (DCF). RBC ROS were also measured following pre-incubation with hydrogen peroxide (H2O2) (2mM) +/- antioxidant N-acetyl cysteine (NAC) (0.6mM). We also measured RBC surface expression of adhesion molecules CD44, CD47 and CD242, as well as CD147. Results were expressed as mean +/- standard deviation (SD). RBC ROS were measured in 22 COVID-19 positive patients and in 10 age matched healthy controls. One patient died from respiratory failure, whilst only 3 others required ITU admission for continuous positive airway pressure (CPAP) or intubation. There was no statistical difference in mean basal RBC DCF mean fluorescence intensity (MFI) levels between COVID-19 positive patients and controls. However, mean increase in RBC DCF MFI following H2O2 incubation was significantly higher in the COVID-19 positive group (1105.7+/-336.3) compared to the control group (843.4+/-256.7)( p= 0.042). The increase in RBC DCF MFI in the COVID-19 positive group correlated with CRP (p=0.014) but not with D-dimer, serum ferritin or any complete blood count (CBC) parameters. Incubation of RBC with 0.6 mM NAC for 30 minutes prior to H2O2 exposure caused a mean reduction in DCF MFI of 26.7% in the COVID-19 positive group. RBC expression of CD44, CD47, CD242 and CD147 were measured In a separate cohort of COVID-19 positive patients (n=32), and in 22 age matched controls. There were no statistically significant differences in mean expression levels of CD44, CD47 and CD242 between the 2 groups. However, mean RBC CD147 MFI expression was higher in the COVID-19 group (1319.64+/-374.76) compared to controls (1061.59+/-253.33) (p=0.018). There was no significant correlation between RBC CD147 MFI and D-dimer, CRP, serum ferritin or any CBC parameters in the COVID-19 positive group. However, 21 of the 32 COVID-19 positive patients had blood lactate levels measured and there was a positive correlation between CD147 MFI expression and blood lactate (R=0.56, p=0.0077). Induction of oxidative stress by H2O2 resulted in a greater increase in ROS in RBCs from COVID-19 patients compared to controls and with correlation to CRP, despite the fact that there were very few patients with severe disease in the study. This suggests a role for oxidative stress in disease pathogenesis. Pre-incubation with NAC attenuated this increase in ROS, suggesting a possible role for antioxidants in therapy. Increased RBC cell surface expression of adhesion molecules CD44, CD47 and CD242 can facilitate RBC interaction with platelets and/or endothelial cells, potentially contributing to thrombosis. We found no increase in their expression in COVID-19 patients compared to controls although RBCs may contribute to thrombosis in COVID-19 infection by other means (1). CD147 is tightly associated with and enables proper expression of monocarboxylate transporter 1, the lactate transporter for RBCs. We found increased surface expression of CD147 on RBCs of COVID-19 patients, whilst CD147 expression showed a moderate correlation with serum lactate levels, suggesting that RBCs in COVID-19 infection may be acting as a lactate sink to protect against lactic acidosis. In summary, our study suggests that COVID-19 infection causes increased oxidative stress and increased lactate influx in RBCs. Further studies are warranted into the role of RBCs in COVID-19 infection. Reference: (1) Murphy P, Glavey S, Quinn J. Anemia and red blood cell abnormalities in COVID-19. Leuk Lymphoma 2021;62:1539 Disclosures Quinn: Takeda: Honoraria. Glavey: Abbvie: Research Funding; Celgene and BMS company: Research Funding; Janssen: Honoraria, Research Funding; Amgen: Honoraria, Research Funding.

507 Outcomes After the Administration of Hydroxocobalamin

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S90-S90
Author(s):  
Kaitlin A Pruskowski ◽  
Leopoldo C Cancio
Keyword(s):  
Hospital Mortality ◽  
Hospital Stay ◽  
Hospital Setting ◽  
Kidney Injury ◽  
Retrospective Chart Review ◽  
Lactate Clearance ◽  
Inhalation Injury ◽  
Icu Admission ◽  
Increased Risk ◽  
Lactate Levels

Abstract Introduction Hydroxocobalamin is administered to patients after injures sustained during structure fires or fires in enclosed spaces. It is unknown how the administration of hydroxocobalamin affects patient outcomes, however, there have been reports of increased risk of acute kidney injury (AKI). The purpose of this study was to determine the population in which hydroxocobalamin is administered and to assess outcomes in patients who receive this medication in the ICU setting. Methods This was a retrospective chart review that included all patients admitted to the burn ICU between July 2016 and April 2019. Patients were included if they received hydroxocobalamin after ICU admission. Patients who received hydroxocobalamin in the pre-ICU or pre-hospital setting were not included in this analysis. Data collected included demographic information, number of hydroxocobalamin doses administered, burn size (% TBSA), presence of inhalation injury (II), lactate levels during the first 72 hours of hospitalization, carboxyhemoglobin levels, need for continuous renal replacement therapy (CRRT), and in-hospital mortality. Results Thirty-five patients received hydroxocobalamin after ICU admission. Patients were, on average, 48 ± 19 years old with a 25.5 ± 24.8% TBSA burn. Twenty-nine patients (82.9%) who received hydroxocobalamin in the ICU were diagnosed with II via bronchoscopy. The median 24-hour fluid resuscitation requirement was 7.4 mL/kg/% TBSA (IQR 4.6, 12.7). Twenty-two patients (63%) who received hydroxocobalamin developed AKI during the first 72 hours of admission. Twenty-one patients (60%) required CRRT during their hospital stay; 42.8% of patients were started on CRRT during the resuscitation period. The mean admission lactate level was 4.4 ± 2.3 mmol/L. On average, lactate clearance occurred in 34.6 hours; 11 (31.4%) patients did not clear lactate within 72 hours. One patient had a carboxyhemoglobin level greater than 10% on admission. Ten (28.9%) patients died during their hospital stay. Conclusions Most patients who receive hydroxocobalamin after ICU admission developed AKI within the first 72 hours. Further studies on the relationship between the administration of hydroxocobalamin and the development of AKI and in-hospital mortality are warranted. Applicability of Research to Practice The use of hydroxocobalamin may carry an increased risk of AKI. Providers should be aware of this risk when prescribing this medication.

Lactate as substrate for glycogen resynthesis after exercise

1987 ◽  
Vol 62 (6) ◽  
pp. 2237-2240 ◽  
Author(s):  
R. W. Stevenson ◽  
D. R. Mitchell ◽  
G. K. Hendrick ◽  
R. Rainey ◽  
A. D. Cherrington ◽  
...  
Keyword(s):  
Muscle Glycogen ◽  
Recovery Period ◽  
Control Level ◽  
Lactate Concentration ◽  
Perfusion Medium ◽  
Muscle Lactate ◽  
Arterial Lactate ◽  
Medium Flow ◽  
Flow Through ◽  
Lactate Levels

Muscle glycogen levels in the perfused rat hemicorpus preparation were reduced two-thirds by electrical stimulation plus exposure to epinephrine (10(-7) M) for 30 min. During the contraction period muscle lactate concentrations increased from a control level of 3.6 +/- 0.6 to a final value of 24.1 +/- 1.6 mumol/g muscle. To determine whether the lactate that had accumulated in muscle during contraction could be used to resynthesize glycogen, glycogen levels were determined after 1–3 h of recovery from the contraction period during which time the perfusion medium (flow-through system) contained low (1.3 mmol/l) or high (10.5 or 18 mmol/l) lactate concentrations but no glucose. With the low perfusate lactate concentration, muscle lactate levels declined to 7.2 +/- 0.8 mumol/g muscle by 3 h after the contraction period and muscle glycogen levels did not increase (1.28 +/- 0.07 at 3 h vs. 1.35 +/- 0.09 mg glucosyl U/g at end of exercise). Lactate disappearance from muscle was accounted for entirely by output into the venous effluent. With the high perfusate lactate concentrations, muscle lactate levels remained high (13.7 +/- 1.7 and 19.3 +/- 2.0 mumol/g) and glycogen levels increased by 1.11 and 0.86 mg glucosyl U/g, respectively, after 1 h of recovery from exercise. No more glycogen was synthesized when the recovery period was extended. Therefore, it appears that limited resynthesis of glycogen from lactate can occur after the contraction period but only when arterial lactate concentrations are high; otherwise the lactate that builds up in muscle during contraction will diffuse into the bloodstream.

scholarly journals Surgical Correction of Unicoronal Craniosynostosis with Frontal Bone Symmetrization and Staggered Osteotomies

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Seyed Esmail Hassanpour ◽  
Masoumeh Abbasnezhad ◽  
Hamidreza Alizadeh Otaghvar ◽  
Adnan Tizmaghz
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Frontal Bone ◽  
Surgical Correction ◽  
Average Weight ◽  
Average Hospital ◽  
Starting Time ◽  
Icu Stay ◽  
Estimated Blood Loss ◽  
Stay Time

Background. Craniosynostosis is the premature fusion of one or more cranial sutures that produce abnormal head shape. Plagiocephaly is a general term that describes unilateral flattening of the anterior or posterior quarter of the cranium. Anterior plagiocephaly is almost always due to unilateral coronal synostosis. Early surgical treatment is the best option for these patients. The aim of this study was to investigate the surgical correction results of unicoronal craniosynostosis with frontal bone symmetrization and staggered osteotomies. Methods. All unicoronal craniosynostosis cases treated surgically from 2013 to 2016 at our hospital, with frontal bone symmetrization and staggered osteotomies and fronto-orbital advancement, were reviewed. The following variables were analyzed: sex, age, weight, hospital stay time, ICU stay time, per os (PO) starting time, anesthetic time, estimated blood loss volume (ml), estimated blood loss as percentage of total volume, surgical complication, follow-up time, and Whitaker grade. All data were analyzed with SPSS. Results. The study consisted of 33 patients (19 females, 14 males). Average age was 10.24 months, average weight was 8.97 Kg, average hospital stay time was 7.84 days, average ICU stay time was 1.69 days, average PO starting time was 1.24 days after surgery, average anesthetic time was 397.72 minutes, average estimated blood loss was 213.78 ml, and estimated blood loss as percentage of total volume was 31.69%. One case (3.03%) needed reoperation and two cases had postoperative seizure. No mortality was seen. Conclusion. It is supposed that surgical correction of unicoronal craniosynostosis with frontal bone symmetrization and staggered osteotomies results in lower blood loss, lower complication rate and reoperation, and more durable results.

scholarly journals Correlation of D-Dimer level with outcome in traumatic brain injury

2016 ◽  
Vol 17 (1) ◽  
pp. 21-30
Author(s):  
Pradip Prasad Subedi ◽  
Sushil Krishna Shilpakar
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Hospital Stay ◽  
Glasgow Outcome Scale ◽  
Significant Proportion ◽  
Duration Of Hospital Stay ◽  
Icu Stay ◽  
The Mean ◽  
Hospital Stay Duration ◽  
D Dimer

Introduction: Traumatic brain injury (TBI) is a common neurosurgical emergency and a common public health problem with high mortality and long term morbidity. The cost incurred by TBI is immense. The major determinant of outcome following TBI is the severity of the primary injury. However, secondary injuries including coagulopathy are treatable prognostic factors. Many studies have revealed that coagulopathy of trauma depicted by increasing level of D-dimer is associated with poor prognosis in TBI. So, early dectection and correction of such abnormality is very important in management of TBI.Methods: This is a prospective observational study conducted at Department of Surgery TUTH (Tribhuvan University Teaching Hospital), Kathmandu,Nepal over a period of one year. One hundred and forty eight patients of TBI were included in the study. Clinical profile of the patients and D-dimer level were monitored during the hospital course. D-dimer level was correlated with outcome variables including duration of hospital stay, duration of Intensive care unit (ICU) stay and Glasgow outcome scale (GOS).Results: A total of 194 patients were admitted with the diagnosis of traumatic brain injury during the study period and out of them 148 patients were enrolled for the study. Out of 148 patients one hundred and twenty (81.1%) were males and twenty eight (18.9%) were females. The mean age was 29.71±18.07 and the age ranged from 1 to 78 years. Seventy (47.3%) patient were between 21 to 40 years of age. The mean duration of hospital stay was 9.83±13.58 days and the mean duration of ICU stay was 3.78±7.06 days. Contusion was the most common lesion in our patients. Of the patients studied 111 patients (75%)  had good recovery with GOS of 5, 9  patients (6.1%)  had GOS of 4, 6 patients (4.1%)  had GOS of 3, 1 patients (0.7%)  had GOS of 2 and 21 patients (14.1%)  had GOS of 1. Normal D-dimer was seen in 102 patients (68.9%) and elevated D-dimer in 46 patients (31.1%). Man –Whitney test shows higher D-dimer levels positively correlated with duration of hospital stay, duration of ICU stay and Glasgow Outcome Scale. Pearson chi-square test revealed higher levels of D-dimer correlated with grade of injury but not with mode of injury.Conclusion: D-dimer is elevated in significant proportion of patients with TBI and abnormal D-dimer level is associated with poor outcome in TBI.Journal of Society of Surgeons of Nepal Vol.17(1) 2014: 21-30

scholarly journals Energy Dysfunction as a Predictor of Outcome after Moderate or Severe Head Injury: Indices of Oxygen, Glucose, and Lactate Metabolism

2003 ◽  
Vol 23 (10) ◽  
pp. 1239-1250 ◽  
Author(s):  
Thomas C Glenn ◽  
Daniel F Kelly ◽  
W John Boscardin ◽  
David L McArthur ◽  
Paul Vespa ◽  
...  
Keyword(s):  
Head Injury ◽  
Alternative Fuels ◽  
Severe Head Injury ◽  
Favorable Outcome ◽  
Neurologic Outcome ◽  
Arterial Lactate ◽  
Lactate Uptake ◽  
Lactate Levels ◽  
Abnormal Brain ◽  
Brain Lactate

The purpose of this study was to determine if the relationship between abnormalities in glucose, lactate, and oxygen metabolism were predictive of neurologic outcome after moderate or severe head injury, relative to other known prognostic factors. Serial assessments of the cerebral metabolic rates for glucose, lactate, and oxygen were performed using a modified Kety-Schmidt method. In total, 31 normal control subjects were studied once, and 49 TBI patients (mean age 36±16 years, median GCS 7) were studied five times median per patient from postinjury days 0 to 9. Univariate and multivariate analyses were performed. Univariate analysis showed that the 6-month postinjury Glasgow Outcome Scale (GOS) was most strongly associated with the mean cerebral metabolic rate of oxygen (CMRO2) ( P = 0.0001), mean arterial lactate level ( P = 0.0001), mean arterial glucose ( P = 0.0008), mean cerebral blood flow (CBF), ( P = 0.002), postresuscitation GCS ( P = 0.003), and pupillary status ( P = 0.004). Brain lactate uptake was observed in 44% of all metabolic studies, and 76% of patients had at least one episode of brain lactate uptake. By dichotomized GOS, patients achieving a favorable outcome (GOS 4-5) were distinguished from those with an unfavorable outcome (GOS1-3) by having a higher CMRO2 ( P = 0.003), a higher rate of abnormal brain lactate uptake relative to arterial lactate levels ( P = 0.04), and lesser degrees of blood-brain barrier damage based on CT findings ( P = 0.03). Conclusions: During the first 6 days after moderate or severe TBI, CMRO2 and arterial lactate levels are the strongest predictors of neurologic outcome. However, the frequent occurrence of abnormal brain lactate uptake despite only moderate elevations in arterial lactate levels in the favorable outcome patients suggests the brain's ability to use lactate as a fuel may be another key outcome predictor. Future studies are needed to determine to what degree nonglycolytic energy production from alternative fuels such as lactate occurs after TBI and whether alternative fuel administration is a viable therapy for TBI patients.

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