РЕТРОСПЕКТИВНЫЙ АНАЛИЗ ПРИЧИН ЛЕТАЛЬНОСТИ У БОЛЬНЫХ С ТЯЖЕЛЫМ ТЕЧЕНИЕМ COVID-19

In Ukraine, more than 3.5 million cases of COVID-19 have been registered during the pandemic, and the death toll is almost 90,000. Ukraine is a leader in Europe in the growth of new cases of COVID-19 and mortality from this disease. The search for effective treatment regimens and new approaches to the management of patients with coronavirus disease in order to reduce the severity of coronavirus disease, reduce mortality, the number of complications and improve the rehabilitation period is very important nowadays. The aim of the work. To determine the main causes of mortality in patients with severe COVID-19 by analyzing the frequency and structure of complications in deceased patients. Materials and methods. The study conducted a retrospective analysis of 122 medical charts of deceased patients with COVID-19 who were hospitalized in a communal non-profit enterprise “Kyiv city clinical hospital №17” for the period from September 2020 to November 2021. Results and discussion. The overall mortality among patients with COVID-19 was 9.3%, in the intensive care unit (ICU) – 48.4%. The most common causes of death in patients with COVID-19 were: respiratory failure (RF) – 100% of cases, pulmonary embolism (PE) and acute heart failure (AHF) - about 60%. The average length of stay of patients in inpatient treatment was 11.67 ± 8.05 days, and in the intensive care unit – 7.94 ± 6.24 days. The mean age of patients hospitalized in the ICU was 63.5 ± 12.9 years and the mean age of patients who died was 71.2 ± 10.29 years. Prognostically significant criteria for lethal consequences were the presence of comorbidity: cardiovascular diseases- 92.3%, endocrine system diseases – 28.4%, nervous system diseases – 23.07%, kidney diseases – 9.6%, cancer – 9,6%, autoimmune conditions – 7.69%, varicose veins – 5.7%, respiratory system diseases – 5.7%. In patients with fatal outcome lymphopenia (84.6%) was observed in patients on admission to the ICU. Vasopressor and inotropic support was performed in 50 % of patients with COVID-19. In 25 % of those who died during long-term treatment and long-term respiratory support, there was the development of multiple organ failure, which in most cases was the point of no return. Conclusions. The most common causes of death were: respiratory failure, thrombosis, acute cardiovascular failure, sepsis and multiple organ failure. The main nature of the complications is common, but the cohort may be affected by different factors and the percentage of complications may differ in other hospitals.

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Rehabilitation Results of Patients with Multiple Injuries and Multiple Organ Failure and Long-term Intensive Care

The Journal of Trauma: Injury, Infection, and Critical Care ◽

10.1097/00005373-199705000-00024 ◽

1997 ◽

Vol 42 (5) ◽

pp. 919-926 ◽

Cited By ~ 28

Author(s):

M. Grotz ◽

A. Hohensee ◽

D. Remmers ◽

T. O. F. Wagner ◽

G. Regel

Keyword(s):

Intensive Care ◽

Multiple Organ Failure ◽

Organ Failure ◽

Multiple Organ ◽

Multiple Injuries

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Severe form of hemolytic-uremic syndrome with multiple organ failure in a child: a case report

F1000Research ◽

10.12688/f1000research.2546.1 ◽

2014 ◽

Vol 3 ◽

pp. 79

Author(s):

Dino Mijatovic ◽

Ana Blagaic ◽

Zeljko Zupan

Keyword(s):

Intensive Care Unit ◽

Renal Failure ◽

Acute Renal Failure ◽

Intensive Care ◽

Multiple Organ Failure ◽

Hemolytic Uremic Syndrome ◽

Organ Failure ◽

Hemolytic Anemia ◽

Multiple Organ ◽

Uremic Syndrome

Introduction: Hemolytic-uremic syndrome (HUS) is a leading cause of acute renal failure in infants and young children. It is traditionally defined as a triad of acute renal failure, hemolytic anemia and thrombocytopenia that occur within a week after prodromal hemorrhagic enterocolitis. Severe cases can also be presented by acute respiratory distress syndrome (ARDS), toxic megacolon with ileus, pancreatitis, central nervous system (CNS) disorders and multiple organ failure (MOF).Case presentation: A previously healthy 4-year old Caucasian girl developed acute renal failure, thrombocytopenia and hemolytic anemia following a short episode of abdominal pain and bloody diarrhea. In the next week of, what initially appeared as typical HUS, she developed MOF, including ileus, pancreatitis, hepatitis, coma and ARDS, accompanied by hemodynamic instability and extreme leukocytosis. Nonetheless, the girl made a complete recovery after one month of the disease. She was successfully treated in the intensive care unit and significant improvement was noticed after plasmapheresis and continuous veno-venous hemodialysis.Conclusions: Early start of plasmapheresis and meticulous supportive treatment in the intensive care unit, including renal placement therapy, may be the therapy of choice in severe cases of HUS presented by MOF. Monitoring of prognostic factors is important for early performance of appropriate diagnostic and therapeutical interventions.

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Use of CT-Based Scoring System in Assessment of Pancreatitis Severity

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2019.597 ◽

2019 ◽

Vol 7 (23) ◽

pp. 3997-4003

Author(s):

Madina Ermekova

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Multiple Organ Failure ◽

Organ Failure ◽

Death Rate ◽

Clinical Laboratory ◽

Early Stage ◽

Multiple Organ ◽

Important Indicator ◽

Pancreas Necrosis

BACKGROUND: Severity of AP is an important indicator of death rate, playing a crucial role in defining a correct dealing with a patient at his/her initial admission, in deciding on the need to transfer a patient to the intensive care unit. Many studies point out a direct relation between the death rate and the number of affected organs. In light of this, looking for the new criteria of multiple organ failure is still useful in clinical practice. Typically, assessment of multiple organ failure with patients undergoing treatment in the intensive care unit is carried out with the use of various integrated scores based both on clinical laboratory assessment of patient’s condition and on data obtained by advanced imaging methods. However, many scientists point out that the facilities of diagnostic radiology, including in particularly computerised tomography, are not used to the full extent. AIM: We developed a CT score for assessment of pancreatitis severity that takes into consideration not only alterations of the pancreas but also enables evaluation of multiple organ failure with the examined patients. METHODS: We have examined 100 patients with suspected pancreatitis. Among them 30 patients had pancreatitis without alterations of the vital organs; 70 patients had alterations of the vital organs, suffered organ or multiple organ failure and received treatment in the surgery unit and intensive care unit of the Department of Surgical Conditions of Karaganda Medical University. RESULTS: Because of CT results, based on the proposed score, we assessed a degree of pancreas necrosis, analysed the relation between organ failure and degree of pancreas necrosis. Finally, we evaluated the connection between multiple organ failure and the specific failure of one organ and the presence of necrosis and death rate. CONCLUSION: The proposed score for CT-based assessment of pancreatitis severity can be used not only for identification but also for prediction of organ failure at the early stage of pancreatitis to a high accuracy as compared to conventional CT systems for assessment of the condition of patients affected by pancreatitis. It can also be used to differentiate the severity of organ failure and the number of affected organs.

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Case Report: Severe form of hemolytic-uremic syndrome with multiple organ failure in a child: a case report

F1000Research ◽

10.12688/f1000research.2546.2 ◽

2014 ◽

Vol 3 ◽

pp. 79

Author(s):

Dino Mijatovic ◽

Ana Blagaic ◽

Zeljko Zupan

Keyword(s):

Intensive Care Unit ◽

Renal Failure ◽

Acute Renal Failure ◽

Intensive Care ◽

Case Report ◽

Multiple Organ Failure ◽

Hemolytic Uremic Syndrome ◽

Organ Failure ◽

Multiple Organ ◽

Uremic Syndrome

Introduction: Hemolytic-uremic syndrome (HUS) is a leading cause of acute renal failure in infants and young children. It is traditionally defined as a triad of acute renal failure, hemolytic anemia and thrombocytopenia that occur within a week after prodromal hemorrhagic enterocolitis. Severe cases can also be presented by acute respiratory distress syndrome (ARDS), toxic megacolon with ileus, pancreatitis, central nervous system (CNS) disorders and multiple organ failure (MOF).Case presentation: A previously healthy 4-year old Caucasian girl developed acute renal failure, thrombocytopenia and hemolytic anemia following a short episode of abdominal pain and bloody diarrhea. By the end of the first week the diagnosis of the typical HUS was established. During the second week the disease progressed into MOF that included ileus, pancreatitis, hepatitis, coma and ARDS, accompanied by hemodynamic instability and extreme leukocytosis. Nonetheless, the girl made a complete recovery after one month of the disease. She was successfully treated in the intensive care unit and significant improvement was noticed after plasmapheresis and continuous veno-venous hemodialysis.Conclusions: Early start of plasmapheresis and meticulous supportive treatment in the intensive care unit, including renal placement therapy, may be the therapy of choice in severe cases of HUS presented by MOF. Monitoring of prognostic factors is important for early performance of appropriate diagnostic and therapeutical interventions.

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Characterization of Obstetric Patients with Multiple Organ Failure in the Intensive Care Unit of a Havana Teaching Hospital, 1998 to 2006

MEDICC Review ◽

10.37757/mr2010.v12.n2.7 ◽

2010 ◽

Vol 12 (2) ◽

pp. 27 ◽

Cited By ~ 6

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Multiple Organ Failure ◽

Organ Failure ◽

Teaching Hospital ◽

Multiple Organ

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Strong vasopressor support may be futile in the intensive care unit patient with multiple organ failure

Critical Care Medicine ◽

10.1097/00003246-200004000-00006 ◽

2000 ◽

Vol 28 (4) ◽

pp. 947-949 ◽

Cited By ~ 47

Author(s):

Omar Abid ◽

Serdar Akça ◽

Philip Haji-Michael ◽

Jean-Louis Vincent

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Intensive Care Unit Patient ◽

Multiple Organ Failure ◽

Organ Failure ◽

Multiple Organ ◽

Vasopressor Support

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Severe mesenteric ischemia with multiple organ failure in a patient previously treated with a humanized monoclonal antibody against programmed death receptor-1 (pembrolizumab), a case of pembrolizumab associated catastrophic antiphospholipid syndrome?

SAGE Open Medical Case Reports ◽

10.1177/2050313x20972225 ◽

2020 ◽

Vol 8 ◽

pp. 2050313X2097222

Author(s):

E M W Mintjens-Jager ◽

M E Vos ◽

G Kats-Ugurlu ◽

G A P Hospers ◽

A Rutgers ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Multiple Organ Failure ◽

Organ Failure ◽

Antiphospholipid Syndrome ◽

Immune Checkpoint ◽

Immune Checkpoint Inhibitors ◽

Checkpoint Inhibitors ◽

Multiple Organ ◽

Catastrophic Antiphospholipid Syndrome

Immune checkpoint inhibitors are used in the treatment of different types of tumors including melanoma and non-small cell lung carcinoma. The use of these inhibitors is associated with a broad spectrum of immune-related adverse effects. Here we report a case of a patient admitted to the intensive care unit with multiple organ failure due to catastrophic antiphospholipid syndrome following treatment with pembrolizumab, an immune checkpoint inhibitor, because of metastatic melanoma. The presented patient had multiple organ failure of lung, gastro-intestinal, renal, and the liver. Vascular thrombosis was confirmed by both imaging (pulmonary embolism on computed tomography–thorax) and histopathological examination of the intestines. In combination with the presence of IgA anti-cardiolipin antibodies and initially IgM anti-cardiolipin antibodies, catastrophic antiphospholipid syndrome was suspected. Despite treatment with plasmapheresis and corticosteroids, the patient died due to multiple organ failure. Catastrophic antiphospholipid syndrome is difficult to recognize and has high mortality rates despite supportive treatment. In this case report, discussion is provided regarding the possible immunological mechanism behind catastrophic antiphospholipid syndrome during or after treatment with immune checkpoint inhibitors. It is important to realize that in modern intensive care unit, more patients with immune-related adverse effects of the treatment with immune checkpoint inhibitors will be admitted, because of an increase in the number of patients treated with these checkpoint inhibitors. When these patients are admitted on the intensive care unit, multi-disciplinary consultation is important because of the difficulty of early recognition and optimal treatment of these possible lethal side effects.

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