scholarly journals Significance of Early Acidosis in Predicting Early Mortality Among Flame Burned Patients in a Kenyan National Hospital

2021 ◽  
Author(s):  
Edward Nandi Mackutwa ◽  
Stanley Ominde Khainga ◽  
James Muturi Ndung'u ◽  
Charles Okwemba Anangwe
Keyword(s):  
Survival Curve ◽  
Serum Markers ◽  
Early Mortality ◽  
Base Deficit ◽  
Operating Characteristics ◽  
Predictive Values ◽  
Arterial Blood ◽  
Arterial Ph ◽  
Level Of Significance ◽  
Injured Patients

Abstract Background: Burn pathophysiology, fluid therapy and mortality have been assessed by various laboratory parameters including lactate and base deficit serum markers. This study targeted flame injured cohort with an objective to determine the significance of early acidosis, through measurement of three acid base indices at admission in predicting 5-day (early) mortality among the flame burned patients.Methodology: A cohort study. Eighty flame injured patients presenting within 24 hours of incident were assessed for arterial blood pH, lactate and base deficit (BD). Mortality was recorded until day 28. Receiver operating characteristics curves were drawn; area under curve, cut offs, sensitivities and specificities for BD, lactate and pH were determined for 5-day mortality. The cut offs were used to derive contingency tables for calculation of predictive values. Odds ratios were calculated at 95% confidence interval. 28 day survival curve was generated. Level of significance was <0.05.Results: 28-day mortality was 39%. Five-day mortality was 24%. The latter was predicted by a lactate level of 2.36 mmol/L, BD of -10.05 mmol/L and pH of 7.344 with 75%,74% and 95% sensitivities respectively. Odds of patients dying at these levels or worse were 6.3, 11.4 and 36.9 respectively all with significant p-values.Conclusion: Arterial pH, base deficit and lactate are good predictors of 5-day mortality among fire victims in the Kenyan context.

scholarly journals Significance of Early Acidosis In Predicting Early Mortality Among Flame Burned Patients In A Kenyan National Hospital

2021 ◽  
Author(s):  
Edward Nandi Mackutwa ◽  
Stanley Ominde Khainga ◽  
James Muturi Ndung'u ◽  
Charles Okwemba Anangwe
Keyword(s):  
Survival Curve ◽  
Serum Markers ◽  
Early Mortality ◽  
Base Deficit ◽  
Operating Characteristics ◽  
Predictive Values ◽  
Arterial Blood ◽  
Arterial Ph ◽  
Level Of Significance ◽  
Injured Patients

Abstract Introduction: Burn pathophysiology, fluid therapy and mortality have been assessed by various laboratory parameters including lactate and base deficit serum markers. This study targeted flame injured cohort with an objective to determine the significance of early acidosis, through measurement of three acid base indices at admission in predicting 5-day (early) mortality among the flame burned patients.Methodology: A cohort study. Eighty flame injured patients presenting within 24 hours of incident were assessed for arterial blood pH, lactate and base deficit (BD). Mortality was recorded until day 28. Receiver operating characteristics curves were drawn; area under curve, cut offs, sensitivities and specificities for BD, lactate and pH were determined for 5-day mortality. The cut offs were used to derive contingency tables for calculation of predictive values. Odds ratios were calculated at 95% confidence interval. 28 day survival curve was generated. Level of significance was <0.05.Results: 28-day mortality was 39%. Five-day mortality was 24%. The latter was predicted by a lactate level of 2.36 mmol/L, BD of -10.05 mmol/L and pH of 7.344 with 75%,74% and 95% sensitivities respectively. Odds of patients dying at these levels or worse were 6.3, 11.4 and 36.9 respectively all with significant p-values.Conclusion: Arterial pH, base deficit and lactate are good predictors of 5-day mortality among fire victims.

ARTERIAL BLOOD GAS AND ACID-BASE DISORDERS IN INFANTS AND CHILDREN WITH STATUS ASTHMATICUS

PEDIATRICS ◽  
1968 ◽  
Vol 42 (2) ◽  
pp. 238-249
Author(s):  
John J. Downes ◽  
David W. Wood ◽  
Theodore W. Striker ◽  
Joffie C. Pittman
Keyword(s):  
Status Asthmaticus ◽  
Clinical Signs ◽  
Arterial Oxygen Tension ◽  
Base Deficit ◽  
Infants And Children ◽  
Clinical Severity ◽  
Arterial Oxygen ◽  
Acid Base ◽  
Arterial Blood ◽  
Arterial Ph

The course of arterial oxygen tension (Pao2), pH, carbon dioxide tension (Paco2) and base deficit (negative base excess) was studied in 45 episodes of status asthmaticus occurring in 32 infants and children. The data indicate that arterial hypoxemia occurs in these patients due to alveolar hypoventilation and pulmonary arterial-venous shunts. Three fourths of the patients tested demonstrated a base deficit which was related in part to ketonemia. The Paco2 varied from below normal to 168 mm Hg, and arterial pH varied from 6.89 to 7.41 at the time of peak clinical severity. Clinical signs of respiratory failure associated with a Paco2 above 65 mm Hg occurred in 13 patients (18 episodes), all of whom were successfully managed by mechanical ventilation. These studies indicate the variability in alveolar ventilation and acid-base balance during an asthmatic episode and the need for repeated assessment of arterial pH and blood gases if one is to provide optimal management.

scholarly journals Predictive values of multiple serum biomarkers in women with suspected preeclampsia: a prospective study

2020 ◽  
Author(s):  
Jing Wang ◽  
Honghai Hu ◽  
Xiaowei Liu ◽  
Shenglong Zhao ◽  
Yuanyuan Zheng ◽  
...  
Keyword(s):  
Plasminogen Activator Inhibitor ◽  
Serum Levels ◽  
Serum Markers ◽  
Serum Biomarkers ◽  
Operating Characteristics ◽  
Serum Samples ◽  
Predictive Values ◽  
A Prospective Study ◽  
Activator Inhibitor

Abstract Background: Preeclampsia prediction improves maternal and fetal outcomes in pregnancy. We aimed to evaluate the preeclampsia prediction values of a series of serum biomarkers. Methods: Singleton pregnant women with preeclampsia-related clinical and/or laboratory presentations were recruited and had blood drawn at their first visits. The prospective cohort was further divided into preeclampsia-positive and preeclampsia-negative groups based on the follow-up results. The following markers were tested using the collected serum samples: soluble fms-like tyrosine kinase-1 ( sFlt-1); placental growth factor (PlGF); thrombomodulin (TM); tissue plasminogen activator inhibitor complex (tPAI-C); compliment factors C1q, B, and H; glycosylated fibronectin (GlyFn); pregnancy-associated plasma protein-A2 ( PAPP-A2); blood urea nitrogen (BUN); creatinine (Cre); uric acid (UA); and cystatin C (Cysc). Results: A total of 196 women with suspected preeclampsia were recruited with follow-up medical records. Twenty-five percent (n=49) of the recruited subjects developed preeclampsia before delivery, and 75% remained preeclampsia-negative (n=147). The serum levels of sFlt-1, BUN, Cre, UA, Cysc and PAPP-A2 were significantly elevated, and the PlGF level was significantly decreased in the preeclampsia-positive patients. In the receiver operating characteristics (ROC) analyses, the area under the curves were listed in the order of decreasing values: 0.73 (UA), 0.67 (sFlt-1/PlGF), 0.66 (Cysc), 0.65 (GlyFn/PlGF), 0.64 (PAPP-A2/PlGF), 0.63 (BUN), 0.63 (Cre), and 0.60 (PAPP-A2). With the cut-off values obtained from the ROC analyses, the positive predictive values of these serum markers were between 33.1% and 58.5%, and the negative predictive values were between 80.9% and 89.5%. Conclusions: Further studies are warranted to confirm the clinical utilities of the serum markers in preeclampsia prediction

scholarly journals Predictive values of multiple serum biomarkers in women with suspected preeclampsia: a prospective study

2020 ◽  
Author(s):  
Jing Wang ◽  
Honghai Hu ◽  
Xiaowei Liu ◽  
Shenglong Zhao ◽  
Yuanyuan Zheng ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Prospective Cohort ◽  
Serum Markers ◽  
Serum Biomarkers ◽  
Clinical Implementation ◽  
Operating Characteristics ◽  
Serum Samples ◽  
Multisystem Disorder ◽  
Predictive Values

Abstract Background: Preeclampsia is a common obstetric multisystem disorder causing maternal and fetal morbidity and mortality; it’s been shown that the prediction improves preeclampsia outcomes in pregnancy. However, the current serum biomarkers had low clinical application values and still lack validation studies. Here we aimed to evaluate the preeclampsia prediction values of a series of serum biomarkers in Chinese pregnant women of > 20 weeks of gestation. Methods: Singleton pregnant women with preeclampsia-related clinical and/or laboratory presentations were recruited and had blood drawn at their first visits. The prospective cohort was further divided into preeclampsia-positive and preeclampsia-negative groups based on the follow-up results. The following markers were tested using the collected serum samples: soluble fms-like tyrosine kinase-1 (sFlt-1); placental growth factor (PlGF); thrombomodulin (TM); tissue plasminogen activator inhibitor complex (tPAI-C); compliment factors C1q, B, and H; glycosylated fibronectin (GlyFn); pregnancy-associated plasma protein-A2 (PAPP-A2); blood urea nitrogen (BUN); creatinine (Cre); uric acid (UA); and cystatin C (Cysc). Results: A total of 196 women with suspected preeclampsia were recruited with follow-up medical records. Twenty-five percent (n=49) of the recruited subjects developed preeclampsia before delivery, and 75% remained preeclampsia-negative (n=147). The serum levels of sFlt-1, BUN, Cre, UA, Cysc and PAPP-A2 were significantly elevated, and the PlGF level was significantly decreased in the preeclampsia-positive patients. In the receiver operating characteristics (ROC) analyses, the area under the curves were listed in the order of decreasing values: 0.73 (UA), 0.67 (sFlt-1/PlGF), 0.66 (Cysc), 0.65 (GlyFn/PlGF), 0.64 (PAPP-A2/PlGF), 0.63 (BUN), 0.63 (Cre), and 0.60 (PAPP-A2). With the cut-off values obtained from the ROC analyses, the positive predictive values of these serum markers were between 33.1% and 58.5%, and the negative predictive values were between 80.9% and 89.5%. Conclusions: Although several serum markers were found to be significantly changed with current prospective cohort, their limited predictive values in preeclampsia development posed potential barrier in clinical implementation. Further studies with larger cohort are warranted to further reveal the clinical utilities of the serum markers in preeclampsia prediction.

scholarly journals A Comprehensive Evaluation of the Predictive Abilities of Fetal Electrocardiogram-Derived Parameters during Labor in Newborn Acidemia: Our Institutional Experience

2018 ◽  
Vol 2018 ◽  
pp. 1-10 ◽  
Author(s):  
Ning Tian ◽  
Weiyuan Zhang
Keyword(s):  
Umbilical Cord ◽  
Comprehensive Evaluation ◽  
Holter Monitoring ◽  
Operating Characteristics ◽  
Fetal Electrocardiogram ◽  
Predictive Values ◽  
Arterial Blood ◽  
Term Variation ◽  
Institutional Experience ◽  
Medical University

This study aimed to identify cardiotocography patterns that discriminate fetal acidemia newborns by comprehensively evaluating the parameters obtained from Holter monitoring during delivery. Between June 1, 2015, and August 1, 2016, a prospective observational study of 85 patients was conducted using fetal Holter monitoring at the Beijing Obstetrics and Gynecology Hospital, Capital Medical University, China. Umbilical cord blood was sampled immediately after delivery and fetal acidemia was defined as umbilical cord arterial blood pH < 7.20. Fetal electrocardiogram- (FECG-) derived parameters, including basal fetal heart rate (BFHR), short-term variation (STV), large acceleration (LA), deceleration capacity (DC), acceleration capacity (AC), proportion of episodes of high variation (PEHV), and proportion of episodes of low variation (PELV), were compared between 16 fetuses with acidemia and 47 without. The areas under the curve (AUC) of receiver operating characteristics (ROC) were calculated. Although all the computerized parameters showed predictive values for acidemia (all AUC > 0.50), STV (AUC = 0.84, P<0.001), DC (AUC = 0.84, P<0.001), AC (AUC = 0.80, P<0.001), and PELV (AUC = 0.71, P=0.012) were more strongly associated with fetal acidemia. Our institutional experience suggests that FECG-derived parameters from Holter monitoring are beneficial in reducing the incidence of neonatal acidemia.

Abstract 17352: Hand Grip Strength as a Predictor of Exercise Capacity in Coronary Heart Disease

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Cheol Ung Choi ◽  
Woohyeun Kim ◽  
Se-Hyun Park ◽  
Woo-Sub Kim ◽  
Won Young Jang ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Grip Strength ◽  
Exercise Capacity ◽  
Quadriceps Strength ◽  
Hand Grip Strength ◽  
Operating Characteristics ◽  
Predictive Values ◽  
Metabolic Equivalents ◽  
Hand Grip

Introduction: Exercise capacity is related to the prognosis of coronary heart disease (CHD). Recent study have shown that quadriceps strength can be used to predict exercise capacity levels in patients with CHD. Hypothesis: The aim of this study is to determine whether this relationship between muscular strength and exercise capacity is maintained in hand grip strength (HGS). Methods: We studied 310 participants (Age; 62.1 ± 11.5, Men; 77.4 %) who underwent coronary intervention and participated cardiac rehabilitation. Maximal HGS was expressed as absolute value (kg), and relative to bodyweight (%bodyweight). Logistic regression was used to assess the relationship of maximal HGS, age, sex, type of CHD, diabetes, hypertension, renal insufficiency, ejection fraction, body mass index, body weight, waist to hip ratio, and basal metabolic rate with distance walked on 6-minuite walk test (6MWT) and estimated metabolic equivalents (eMETs). Results: Maximal HGS was significantly related to distance walked on 6 MWT (r = 0.40 for %bodyweight, p < 0.001) and eMETs (r = 0.43 for %bodyweight, p < 0.001). Maximal HGS was the strongest predictor of exercise capacity in each distance walked on 6 MWT category. Receiver operating characteristics curves identified maximal HGS of 35.7, 42.0% bodyweight as the best predictive cut offs for 200, and 400 meters, respectively with positive predictive values of 0.64. They also identified HGS of 38.3, and 44.6% bodyweight as the best predictive cut offs for 6 and 8 eMETs, respectively with positive predictive values of 0.70. Conclusions: Maximal HGS is related with distance on 6 MWT and eMETs levels at exercise test in CHD patients. This result suggests that maximal HGS can be used to predict exercise capacity levels. Based on this result, prospective study investigating the association between HGS and clinical outcome of CHD is needed.

The adrenocorticotropic hormone and arginine vasopressin responses to hypercapnia in fetal and maternal sheep

1993 ◽  
Vol 264 (2) ◽  
pp. R324-R330 ◽  
Author(s):  
H. G. Chen ◽  
C. E. Wood
Keyword(s):  
Arginine Vasopressin ◽  
Adrenocorticotropic Hormone ◽  
Fetal Sheep ◽  
Arterial Pco2 ◽  
Fetal Plasma ◽  
Arterial Blood ◽  
Arterial Ph ◽  
Bilateral Vagotomy ◽  
Pregnant Ewe

Previous studies have demonstrated that fetal adrenocorticotropic hormone (ACTH) and arginine vasopressin (AVP) are increased during periods of acidemia produced by infusion of acid intravenously or by acidemia secondary to hypovolemia. The purpose of this study was to quantify ACTH and AVP responses to hypercapnic acidemia and to test the role of the peripheral chemoreceptors in the control of these responses. Chronically catheterized fetal sheep were subjected to carotid sinus denervation and bilateral vagotomy or were studied intact. At least 5 days after surgery, fetuses were exposed to a 60-min period of normocapnia or hypercapnia, delivered via a polyethylene bag containing 5-8% CO2 in 21% O2 fitted over the head of the pregnant ewe. Hypercapnia significantly increased fetal arterial PCO2 to 55.2 +/- 1.8 and 55.9 +/- 2.2 mmHg and decreased arterial pH to 7.257 +/- 0.011 and 7.281 +/- 0.010 in intact and denervated fetuses, respectively. Fetal mean arterial blood pressure was decreased slightly in the denervated fetuses during hypercapnia. Fetal plasma AVP was increased in both groups equally, and plasma ACTH and cortisol were increased in the denervated fetuses only. Fetal heart rate was increased significantly in intact but not denervated fetuses. We conclude that respiratory acidemia is a mild stimulus to AVP secretion and that this response is not attenuated by peripheral chemodenervation.

Acclimatization to high altitude in goats with ablated carotid bodies

1983 ◽  
Vol 55 (1) ◽  
pp. 16-21 ◽  
Author(s):  
R. A. Steinbrook ◽  
J. C. Donovan ◽  
R. A. Gabel ◽  
D. E. Leith ◽  
V. Fencl
Keyword(s):  
High Altitude ◽  
Pulmonary Ventilation ◽  
Base Deficit ◽  
Co2 Production ◽  
Regulation Of Respiration ◽  
Response Curves ◽  
Co2 Response ◽  
Arterial Blood ◽  
Carotid Bodies ◽  
Simulated High Altitude

In awake goats with ablated carotid bodies, we studied resting pulmonary ventilation, CO2 production, composition of arterial blood and cerebrospinal fluid (CSF), and ventilatory responsiveness to hyperoxic CO2 rebreathing at sea level (SL) and after 3 days at simulated high altitude (HA) (PB 446 +/- 5 Torr, equivalent to 4,300 m). At HA, resting pulmonary ventilation was increased, resulting in marked hypocapnia with appropriate base deficit in blood plasma; CSF became more alkaline; CO2-response curves were shifted to lower PCO2 levels, and their slopes were steeper than at SL. Although these changes in regulation of respiration were not demonstrably different from those seen after normal acclimatization to HA with carotid bodies intact, the mechanisms of their initiation and development are probably different.

scholarly journals Clinical and hematological prognostic factors in dogs with parvoviral enteritis and sepsis

2019 ◽  
Vol 40 (4) ◽  
pp. 1477
Author(s):  
Fernanda dos Santos Alves ◽  
Breno Curty Barbosa ◽  
Nathalia Dorneles das Graças Coelho ◽  
Paula Costa de Oliveira Pinto ◽  
Marco Túlio Gomes Campos ◽  
...  
Keyword(s):  
Complete Blood Count ◽  
Venous Blood ◽  
Univariate Analysis ◽  
Gas Analysis ◽  
Blood Samples ◽  
Factors Associated ◽  
Risk Of Death ◽  
Arterial Blood ◽  
Complete Physical Examination ◽  
Level Of Significance

Parvoviral enteritis is a common viral infection in dogs and is associated with many clinical and hematological changes. Bacterial translocation is a common complication and may result in sepsis. The objective of this study is to determine the presence of clinical and hematological factors associated with the risk of death in puppies with naturally occurring parvoviral enteritis and sepsis. Twenty-four dogs with parvoviral enteritis confirmed by chromatographic immunoassay during the clinical routine of a university veterinary hospital were selected. At admission and every 24 hours until the third day of hospitalization or until death, venous blood samples were collected for complete blood count, renal and hepatic biochemistry, and lactate and magnesium measurement; arterial blood samples were collected for gas analysis. Sodium, potassium, and ionized calcium were also analyzed, and a complete physical examination was performed. The factors associated with mortality were evaluated by Cox univariate analysis at a level of significance of 5%. The increase in urea and heart rate was associated with an increase in the risk of death. In contrast, an increase in total leukocytes, lymphocytes, monocytes, partial pressure of oxygen, base deficit, bicarbonate ion, and oxygen saturation were associated with a reduction in the risk of death.

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