Effect of Pentoxifylline on Organ Dysfunction and Mortality in Severe Sepsis

Background: Sepsis and infection are among the leading causes of death world-wide. The annual burden of sepsis in high-income countries is rising with a mortality rate of 40% and 90% of the worldwide deaths from pneumonia, meningitis or other infections occur in less developed countries. This study was performed to evaluate the therapeutic efficacy of pentoxifylline as an adjuvant therapy in septic patients and its effect on multiple organ dysfunction and mortality in septic patients. Methods: This randomized, double-blinded prospective study was conducted from October 2017 to November 2018, which included a total sample size of 52 cases of septic patients. Organ dysfunction was used as a primary outcome with proposed large effect size ((0.8) and alfa =0.05 and power=0.80, so, 26 cases were needed in each group). Secondary outcomes were inflammatory markers C-Reactive Protein (CRP) and pro-calcitonin, duration of hospital stay, need for hemodialysis, need for vasopressor & inotropes, need for mechanical ventilation and 28 days survival. Results: Fifty-two patients with sepsis were divided in 1: 1 ratio to receive pentoxifylline or not. The average age of the included patients was almost 53 years, chest disorders were the main cause of sepsis in both groups. There were no statistically significant differences between both groups in terms of Sequential Organ Failure Assessment (SOFA) score, lactate level, CRP level and pro-calcitonin level. As regards secondary outcomes, there were no statistically significant differences between study’s groups in terms of length of hospital stay (p =0.707), need for hemodialysis (p =0.541), need for vasopressor & inotropes (p =0.249), need for mechanical ventilation (p =0.703), and 28 days survival (p =0.5). Conclusion: We concluded that pentoxifylline as an adjuvant therapy in septic patients had no significant influence on multiple organ dysfunction and mortality.

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Effect of Pentoxifylline on Organ Dysfunction and Mortality in Severe Sepsis

QJM ◽

10.1093/qjmed/hcaa039.076 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

B E Hasan ◽

H A Elgendy ◽

A S Abdelkawe ◽

H M Ibrahim

Keyword(s):

Severe Sepsis ◽

Adjuvant Therapy ◽

Organ Dysfunction ◽

Low Income ◽

World Wide ◽

Length Of Hospital Stay ◽

Total Sample ◽

Developed Countries ◽

Low Income Countries ◽

Significant Difference

Abstract Background sepsis and infection are among the leading causes of death world-wide. The annual burden of sepsis in high income countries is rising with mortality of 40%. Despite these figures from industrialized countries, the largest part of the global sepsis burden occurs in middle and low- income countries, 90% of the world wide deaths from pneumonia, meningitis or other infections occur in less developed countries. Aim of the Work to evaluate the therapeutic efficiency of pentoxifylline as an adjuvant therapy in treatment of severe sepsis and its effect in multiple organ dysfunction and mortality in septic patients. Materials and Methods this is a randomized double blinded prospective study conducted from January 2015 to March 2016 included total sample size 52 cases (we used organ dysfunction as a primary outcome with proposed large effect size (0.8) and alfa=0.05 and power=0.80, so, 26 cases were needed in each group). Results we included 52 patients with sepsis who were divided in 1: 1 ratio to receive pentoxifylline or not. The average age of the included patients was almost 53 years, with no statistically significant different between both groups (p = 0.902); while the majority of the included patients were males, with no significant difference between both groups (p = 0.99). The mean weight was similar between both groups (84.50 ±11.25 vs. 83.65 ±10.54 years; p = 0.78) and chest disorders were the main cause of sepsis in both groups. Conclusion we concluded that PTX as an adjuvant therapy had no significant influence on the SOFA score, lactate level, CRP level, and pro-calcitonin level compared to control. Moreover, there were no statistically significant differences in terms of length of hospital stay, need for HD, need for vasopressor and inotropic, need for MV, and mortality rate. Further large clinical trials are recommended to assess the effectiveness of PTX especially with regards to organ failure, survival, and dose dependency.

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SEPSIS CAUSES DIAPHRAGM DYSFUNCTION INDEPENDENT OF MECHANICAL VENTILATION IN A PEDIATRIC SWINE MODEL OF METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS (MRSA) SEPSIS-INDUCED MULTIPLE ORGAN DYSFUNCTION SYNDROME (MODS)

CHEST Journal ◽

10.1016/j.chest.2019.08.1536 ◽

2019 ◽

Vol 156 (4) ◽

pp. A1764-A1765

Author(s):

Manpreet Virk ◽

Saul Flores ◽

Bobby Guillory ◽

Juan Marini ◽

Christian Villadolid ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Mechanical Ventilation ◽

Organ Dysfunction ◽

Multiple Organ Dysfunction Syndrome ◽

Methicillin Resistant Staphylococcus Aureus ◽

Multiple Organ ◽

Swine Model ◽

Multiple Organ Dysfunction ◽

Diaphragm Dysfunction ◽

Methicillin Resistant

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Intravenous immunoglobulin-based adjuvant therapy for severe COVID-19: a single-center retrospective cohort study

Virology Journal ◽

10.1186/s12985-021-01575-3 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Xiao Hou ◽

Li Tian ◽

Lei Zhou ◽

Xinhua Jia ◽

Li Kong ◽

...

Keyword(s):

Mechanical Ventilation ◽

Cohort Study ◽

Adjuvant Therapy ◽

Hospital Mortality ◽

Hospital Stay ◽

Intravenous Immunoglobulin ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Length Of Hospital Stay ◽

Single Center

Abstract Objective Coronavirus disease 2019 (COVID-19) is a major challenge facing the world. Certain guidelines issued by National Health Commission of the People's Repubilic of China recommend intravenous immunoglobulin (IVIG) for adjuvant treatment of COVID-19. However, there is a lack of clinical evidence to support the use of IVIG. Methods This single-center retrospective cohort study included all adult patients with laboratory-confirmed severe COVID-19 in the Respiratory and Critical Care Unit of Dabie Mountain Regional Medical Center, China. Patient information, including demographic data, laboratory indicators, the use of glucocorticoids and IVIG, hospital mortality, the application of mechanical ventilation, and the length of hospital stay was collected. The primary outcome was the composite end point, including death and the use of mechanical ventilation. The secondary outcome was the length of hospital stay. Results Of the 285 patients with confirmed COVID-19, 113 severely ill patients were included in this study. Compared to the non-IVIG group, more patients in the IVIG group reached the composite end point [12 (25.5%) vs 5 (7.6%), P = 0.008] and had longer hospital stay periods [23.0 (19.0–31.0) vs 16.0 (13.8–22.0), P < 0.001]. After adjusting for confounding factors, differences in primary outcomes between the two groups were not statistically significant (P = 0.167), however, patients in the IVIG group had longer hospital stay periods (P = 0.041). Conclusion Adjuvant therapy with IVIG did not improve in-hospital mortality rates or the need for mechanical ventilation in severe COVID-19 patients. Our study does not support the use of immunoglobulin in patients with severe COVID-19 patients.

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Increased complement activation 3 to 6 h after trauma is a predictor of prolonged mechanical ventilation and multiple organ dysfunction syndrome: a prospective observational study

Molecular Medicine ◽

10.1186/s10020-021-00286-3 ◽

2021 ◽

Vol 27 (1) ◽

Author(s):

Ingrid Nygren Rognes ◽

Søren Erik Pischke ◽

William Ottestad ◽

Jo Røislien ◽

Jens Petter Berg ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Organ Dysfunction ◽

Complement Activation ◽

Prolonged Mechanical Ventilation ◽

Multiple Organ ◽

Trauma Patients ◽

Multiple Organ Dysfunction ◽

Concentration Curves

Abstract Background Complement activation is a central mechanism in systemic inflammation and remote organ dysfunction following major trauma. Data on temporal changes of complement activation early after injury is largely missing. We aimed to describe in detail the kinetics of complement activation in individual trauma patients from admission to 10 days after injury, and the association with trauma characteristics and outcome. Methods In a prospective cohort of 136 trauma patients, plasma samples obtained with high time resolution (admission, 2, 4, 6, 8 h, and thereafter daily) were assessed for terminal complement complex (TCC). We studied individual TCC concentration curves and calculated a summary measure to obtain the accumulated TCC response 3 to 6 h after injury (TCC-AUC3–6). Correlation analyses and multivariable linear regression analyses were used to explore associations between individual patients’ admission TCC, TCC-AUC3–6, daily TCC during the intensive care unit stay, trauma characteristics, and predefined outcome measures. Results TCC concentration curves showed great variability in temporal shapes between individuals. However, the highest values were generally seen within the first 6 h after injury, before they subsided and remained elevated throughout the intensive care unit stay. Both admission TCC and TCC-AUC3–6 correlated positively with New Injury Severity Score (Spearman’s rho, p-value 0.31, 0.0003 and 0.21, 0.02) and negatively with admission Base Excess (− 0.21, 0.02 and − 0.30, 0.001). Multivariable analyses confirmed that deranged physiology was an important predictor of complement activation. For patients without major head injury, admission TCC and TCC-AUC3–6 were negatively associated with ventilator-free days. TCC-AUC3–6 outperformed admission TCC as a predictor of Sequential Organ Failure Assessment score at day 0 and 4. Conclusions Complement activation 3 to 6 h after injury was a better predictor of prolonged mechanical ventilation and multiple organ dysfunction syndrome than admission TCC. Our data suggest that the greatest surge of complement activation is found within the first 6 h after injury, and we argue that this time period should be in focus in the design of future experimental studies and clinical trials using complement inhibitors.

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Intravenous Immunoglobulin-based Adjuvant Therapy for Severe COVID-19: a Single-center Retrospective Cohort Study

10.21203/rs.3.rs-258587/v1 ◽

2021 ◽

Author(s):

Xiao Hou ◽

Li Tian ◽

Lei Zhou ◽

Xinhua Jia ◽

Li Kong ◽

...

Keyword(s):

Mechanical Ventilation ◽

Cohort Study ◽

Adjuvant Therapy ◽

Hospital Stay ◽

Retrospective Cohort ◽

Primary Outcome ◽

Length Of Hospital Stay ◽

Confounding Factors ◽

Single Center ◽

Significant Difference

Abstract Objective Coronavirus disease 2019 (COVID-19) is a major challenge facing the world. Certain guidelines recommend intravenous immunoglobulin (IVIG) for adjuvant treatment of COVID-19. However, there is a lack of clinical evidence to support the use of IVIG.Methods This single-center retrospective cohort study included all adult patients with laboratory-confirmed severe COVID-19 in the Respiratory and Critical Care Unit of Dabie Mountain Regional Medical Center, China. Patient information, including demographic data, laboratory indicators, the use of glucocorticoids and IVIG, hospital mortality, the application of mechanical ventilation, and the length of hospital stay was collected. The primary outcome was the composite end point, including death and the use of mechanical ventilation. The secondary outcome was the length of hospital stay.Results Of the 285 patients with confirmed COVID-19, 113 severely ill patients were included in this study. Compared with the non-IVIG group, more patients in the IVIG group reached the composite end point [12 (25.5%) vs 5 (7.6%), P=0.008]. However, there was no statistically significant difference in the primary outcome between the two groups (P=0.167) after adjusting for confounding factors. Patients in the IVIG group had a longer hospital stay [23.0 (19.0-31.0) vs 16.0 (13.8-22.0), P<0.001]. After adjusting for confounding factors, there was still a statistically significant difference between the two groups (P=0.041).Conclusion Adjuvant therapy with IVIG did not improve the in-hospital mortality rate or the need for mechanical ventilation in patients with severe COVID-19. In contrast, the application of IVIG was related to a longer hospital stay.

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Prognostic Analysis of Elderly Patients with Multiple Organ Dysfunction Syndrome Undergoing Invasive Mechanical Ventilation

Journal of Healthcare Engineering ◽

10.1155/2020/6432048 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Kun Xiao ◽

Bin Liu ◽

Wei Guan ◽

Peng Yan ◽

Licheng Song ◽

...

Keyword(s):

Mechanical Ventilation ◽

Organ Dysfunction ◽

Multiple Organ Dysfunction Syndrome ◽

Invasive Mechanical Ventilation ◽

The Elderly ◽

Multiple Organ ◽

Apache Ii ◽

Multiple Organ Dysfunction ◽

Saps Ii ◽

Apache Iii

Objective. To prospectively investigate early prognostic assessments of patients with Multiple Organ Dysfunction Syndrome in the Elderly (MODSE) who were receiving invasive mechanical ventilation (IMV). Methods. The clinical data of 351 patients were enrolled prospectively between January 2013 and January 2018. The Acute Physiology and Chronic Health Evaluation II (APACHE II), APACHE III, Simplified Acute Physiology Score (SAPS II), and Multiple Organ Dysfunction Score (MODS) were calculated. According to the outcome of 28-day, the patients were divided into survivors and nonsurvivors. Additionally, based on whether weaning could be implemented, all patients were divided into a successful-weaning group and a failure-to-wean group. Results. According to the prognosis, the areas under the receiver operating characteristic curve of the APACHE II, APACHE III, SAPS II, and MODS scoring systems were 0.837, 0.833, 0.784, and 0.860, respectively. MODS exhibited the highest sensitivity, whereas APACHE II showed the highest specificity, and successful weaning was conducive to ameliorating patients’ prognosis. Multivariate logistic regression analyses revealed that underlying lung disease, plasma albumin, serum creatinine level, number of failing organs, and IMV duration were related to prognosis of weaning, with odds ratios (ORs) of 1.447, 0.820, 1.603, 2.374, and 3.105, respectively. Conclusions. The APACHE II, APACHE III, SAPS II, and MODS systems could perform excellent prognostic assessment for patients with Multiple Organ Dysfunction Syndrome in the elderly. Underlying lung disease, plasma albumin, serum creatinine, number of failing organs, and IMV duration were independent prognostic factors of weaning in MODSE patients with invasive mechanical ventilation.

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Disseminated intravascular coagulation in meningococcal sepsis

Hämostaseologie ◽

10.1055/s-0037-1619581 ◽

2003 ◽

Vol 23 (03) ◽

pp. 125-130 ◽

Cited By ~ 2

Author(s):

S. Zeerleder ◽

R. Zürcher Zenklusen ◽

C. E. Hack ◽

W. A. Wuillemin

Keyword(s):

Organ Dysfunction ◽

Disseminated Intravascular Coagulation ◽

Skin Necrosis ◽

Multiple Organ ◽

Meningococcal Sepsis ◽

Multiple Organ Dysfunction ◽

Intravascular Coagulation ◽

Therapeutic Concepts ◽

New Therapeutic Concepts ◽

Coagulation And Fibrinolysis

SummaryWe report on a man (age: 49 years), who died from severe meningococcal sepsis with disseminated intravascular coagulation (DIC), multiple organ dysfunction syndrome and extended skin necrosis. We discuss in detail the pathophysiology of the activation of coagulation and fibrinolysis during sepsis. The article discusses new therapeutic concepts in the treatment of disseminated intravascular coagulation in meningococcal sepsis, too.

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Multiple Organ Dysfunction Syndrome of Alcoholic Origin in an 18-Year-Old Patient

The International Annals of Medicine ◽

10.24087/iam.2018.2.12.712 ◽

2018 ◽

Vol 2 (12) ◽

Author(s):

Francesco Gazia ◽

Giacomo De Luca ◽

Imbalzano Gabriele ◽

Vincenzo Pellicanò

Keyword(s):

Organ Dysfunction ◽

Multiple Organ Dysfunction Syndrome ◽

Multiple Organ ◽

Multiple Organ Dysfunction

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IMPACT probability of poor outcome and plasma cytokine concentrations are associated with multiple organ dysfunction syndrome following traumatic brain injury

Journal of Neurosurgery ◽

10.3171/2018.8.jns18676 ◽

2019 ◽

Vol 131 (6) ◽

pp. 1931-1937 ◽

Cited By ~ 2

Author(s):

Sungho Lee ◽

Hyunsoo Hwang ◽

Jose-Miguel Yamal ◽

J. Clay Goodman ◽

Imoigele P. Aisiku ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Organ Dysfunction ◽

Multiple Organ Dysfunction Syndrome ◽

Sofa Score ◽

Plasma Concentrations ◽

Multiple Organ ◽

Multiple Organ Dysfunction ◽

Poor Outcome ◽

Initial Plasma

OBJECTIVETraumatic brain injury (TBI) is a major cause of morbidity and mortality. Multiple organ dysfunction syndrome (MODS) occurs frequently after TBI and independently worsens outcome. The present study aimed to identify potential admission characteristics associated with post-TBI MODS.METHODSThe authors performed a secondary analysis of a recent randomized clinical trial studying the effects of erythropoietin and blood transfusion threshold on neurological recovery after TBI. Admission clinical, demographic, laboratory, and imaging parameters were used in a multivariable Cox regression analysis to identify independent risk factors for MODS following TBI, defined as maximum total Sequential Organ Failure Assessment (SOFA) score > 7 within 10 days of TBI.RESULTSTwo hundred patients were initially recruited and 166 were included in the final analysis. Respiratory dysfunction was the most common nonneurological organ system dysfunction, occurring in 62% of the patients. International Mission for Prognosis and Analysis of Clinical Trials (IMPACT) probability of poor outcome at admission was significantly associated with MODS following TBI (odds ratio [OR] 8.88, 95% confidence interval [CI] 1.94–42.68, p < 0.05). However, more commonly used measures of TBI severity, such as the Glasgow Coma Scale, Injury Severity Scale, and Marshall classification, were not associated with post-TBI MODS. In addition, initial plasma concentrations of interleukin (IL)–6, IL-8, and IL-10 were significantly associated with the development of MODS (OR 1.47, 95% CI 1.20–1.80, p < 0.001 for IL-6; OR 1.26, 95% CI 1.01–1.58, p = 0.042 for IL-8; OR 1.77, 95% CI 1.24–2.53, p = 0.002 for IL-10) as well as individual organ dysfunction (SOFA component score ≥ 1). Finally, MODS following TBI was significantly associated with mortality (OR 5.95, 95% CI 2.18–19.14, p = 0.001), and SOFA score was significantly associated with poor outcome at 6 months (Glasgow Outcome Scale score < 4) when analyzed as a continuous variable (OR 1.21, 95% CI 1.06–1.40, p = 0.006).CONCLUSIONSAdmission IMPACT probability of poor outcome and initial plasma concentrations of IL-6, IL-8, and IL-10 were associated with MODS following TBI.

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