High Mortality of HLH in ICU Regardless Etiology or Treatment

Background: Adult hemophagocytic lymphohistiocytosis (HLH) is highly lethal in the ICU. The diagnostic and therapeutic emergency that HLH represents is compounded by its unknown pathophysiological mechanisms. Here, we report on a large cohort of adult HLH in the ICU (ICU-HLH). We analyzed prognostic factors associated with mortality to define the diagnostic and therapeutic challenges in this specific population.Methods: This retrospective study included adult patients diagnosed with HLH in four ICUs in Marseille, France between 2010 and 2020. Patients who fulfilled the HLH-2004 criteria (≥ 4/8) and/or had an HScore ≥ 169 were diagnosed with HLH. HLH was categorized into four groups according to etiology: sepsis-associated HLH, intracellular infection-associated HLH, malignancy-associated HLH, and idiopathic HLH.Results: Two hundred and sixty patients were included: 121 sepsis-associated HLH (47%), 84 intracellular infection-associated HLH (32%), 28 malignancy-associated HLH (11%), and 27 idiopathic HLH (10%). The ICU mortality rate reached 57% (n = 147/260) without a statistical difference between etiological groups. Independent factors associated with mortality in multivariate analysis included age (OR (5 years) = 1.31 [1.16–1.48], p < 0.0001), SOFA score at ICU admission (OR = 1.37 [1.21–1.56], p < 0.0001), degradation of the SOFA score between ICU arrival and HLH diagnosis (Delta SOFA) (OR = 1.47 [1.28–1.70], p < 0.0001), the presence of bone-marrow hemophagocytosis (OR = 5.27 [1.11–24.97], p = 0.04), highly severe anemia (OR = 1.44 [1.09–1.91], p = 0.01), and hypofibrinogenemia (OR = 1.21 [1.04–1.41], p = 0.02).Conclusions: In this large retrospective cohort study of critically ill patients, ICU-HLH in adults was associated with a 57% mortality rate, regardless of HLH etiology or specific treatment. Factors independently associated with prognosis included age, presence of hemophagocytosis in bone-marrow aspirates, organ failure at admission, and worsening organ failure during the ICU stay. Whether a rapid diagnosis and the efficacy of specific therapy improve outcome is yet to be prospectively investigated.

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Features of hemophagocytic lymphohistiocytosis in the intensive care unit (ICU) : a 260-patient retrospective analysis

10.21203/rs.3.rs-348702/v1 ◽

2021 ◽

Author(s):

Amandine BICHON ◽

Jérémy BOURENNE ◽

Jérôme ALLARDET-SERVENT ◽

Laurent PAPAZIAN ◽

Sami HRAIECH ◽

...

Keyword(s):

Bone Marrow ◽

Mortality Rate ◽

Organ Failure ◽

Sofa Score ◽

Hemophagocytic Lymphohistiocytosis ◽

Icu Mortality ◽

Specific Therapy ◽

Specific Population ◽

Factors Associated ◽

Intracellular Infection

Abstract Background Adult hemophagocytic lymphohistiocytosis (HLH) is highly lethal in the ICU. The diagnostic and therapeutic emergency that HLH represents is compounded by its unknown pathophysiological mechanisms. Here, we report on a large cohort of adult-acquired HLH in the ICU. We analyzed prognostic factors associated with mortality to define the diagnostic and therapeutic challenges in this specific population, Methods This retrospective study included adult patients diagnosed with HLH in four ICUs in Marseille, France between 2010 and 2020. Patients who fulfilled the HLH-2004 criteria (> 4/8) and/or had an HScore > 169 were diagnosed with HLH. HLH was categorized into four groups according to etiology: sepsis-associated HLH, intracellular infection-associated HLH, malignancy-associated HLH, and idiopathic HLH. Results 260 patients were included: 121 sepsis-associated HLH (47%), 84 intracellular infection-associated HLH (32%), 28 malignancy-associated HLH (11%), and 27 idiopathic HLH (10%). The ICU mortality rate reached 57% (n = 147/260) without a statistical difference between etiological groups. Independent factors associated with mortality in multivariate analysis included age (OR (5 years) = 1.31 [1.16–1.48], p < 0.0001), SOFA score at ICU admission (OR = 1.37 [1.21–1.56], p < 0.0001), degradation of the SOFA score between ICU arrival and HLH diagnosis (Delta SOFA) (OR = 1.47 [1.28–1.70], p < 0.0001), the presence of bone-marrow hemophagocytosis (OR = 5.27 [1.11–24.97], p = 0.04), highly severe anemia (OR = 1.44 [1.09–1.91], p = 0.01), and hypofibrinogenemia (OR = 1.21 [1.04–1.41], p = 0.02). Conclusions In this large retrospective cohort study of critically ill patients, ICU-acquired HLH in adults was associated with a 57% mortality rate, regardless of HLH etiology. Factors independently associated with prognosis included age, presence of hemophagocytosis in bone-marrow aspirates, organ failure at admission, and worsening organ failure during the ICU stay. Whether a rapid diagnosis and the efficacy of specific therapy improve outcome is yet to be prospectively investigated.

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Mesenchymal stem cells of the bone marrow in treatment of genital tuberculosis in rabbits (experimental research with morphological control)

Reviews on Clinical Pharmacology and Drug Therapy ◽

10.17816/rcf15247-55 ◽

2017 ◽

Vol 15 (2) ◽

pp. 47-55

Author(s):

Boris M Ariel ◽

Faina M Guseinova ◽

Tatiana I Vinogradova ◽

Natalia V Zabolotnykh ◽

Dariko A Niaury ◽

...

Keyword(s):

Stem Cells ◽

Bone Marrow ◽

Mesenchymal Stem Cells ◽

Experimental Research ◽

Specific Treatment ◽

Fallopian Tubes ◽

Genital Tuberculosis ◽

Specific Therapy ◽

Morphological Control ◽

Antituberculous Drug

The aim of this study was to evaluate a therapeutic efficacy of allogenic mesenchymal bone marrow stem cells (MSCs) (5 million / ml dose) in combination with specific therapy in experimental female genital tuberculosis (20 female “Chinchilla” rabbits). It has been shown that on the background of specific therapy the injection of MSCs actively affects reparative processes and promotes reepithelialization of the fallopian tubes 2 months after the inoculation. An active position of myofibroblasts differentiating from the MSC in the reparative reaction and promoting a normalization of epithelium and connective tissue relations was registered. At the same time, the introduction of a new antituberculous drug - tioureidoiminomethylpyridinium perhlorate (perhlozon) to the specific treatment, was contributed to a restoration of structural and functional integrity of the fallopian tubes, by reinforcing the effect of etiotropic substances and by accelerating abacillation. (For citation: Ariel BM, Guseinova FM, Vinogradova TI, et al. Mesenchymal stem cells of the bone marrow in treatment of genital tuberculosis in rabbits (experimental research with morphological control). Reviews on Clinical Pharmacology and Drug Therapy. 2017;15(2):47-55. doi: 10.17816/RCF15247-55).

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Out-of-Hospital ICU Transfers to an Oncological Referral Center

Journal of Intensive Care Medicine ◽

10.1177/0885066616686536 ◽

2016 ◽

Vol 34 (1) ◽

pp. 55-61

Author(s):

Cristina Gutierrez ◽

Yenny R. Cárdenas ◽

Kristie Bratcher ◽

Judd Melancon ◽

Jason Myers ◽

...

Keyword(s):

Mechanical Ventilation ◽

Organ Failure ◽

Critically Ill ◽

Resource Utilization ◽

Sofa Score ◽

Critically Ill Patients ◽

Level Of Care ◽

Icu Mortality ◽

Referral Center ◽

Patients With Cancer

Objective: To determine resource utilization and outcomes of out-of-hospital transfer patients admitted to the intensive care unit (ICU) of a cancer referral center. Design: Single-center cohort. Setting: A tertiary oncological center. Patients: Patients older than 18 years transferred to our ICU from an outside hospital between January 2013 and December 2015. Measurements and Main Results: A total of 2127 (90.3%) were emergency department (ED) ICU admissions and 228 (9.7%) out-of-hospital transfers. The ICU length of stay (LOS) was longer in the out-of-hospital transfers when compared to all other ED ICU admissions ( P = .001); however, ICU and hospital mortality were similar between both groups. The majority of patients were transferred for a higher level of care (77.2%); there was no difference in the amount of interventions performed, ICU LOS, and ICU mortality between nonhigher level-of-care and higher level-of-care patients. Factors associated with an ICU LOS ≥10days were a higher Sequential Organ Failure Assessment (SOFA) score, weekend admissions, presence of shock, need for mechanical ventilation, and acute kidney injury on admission or during ICU stay ( P < .008). The ICU mortality of transferred patients was 17.5% and associated risk factors were older age, higher SOFA score on admission, use of mechanical ventilation and vasopressors during ICU stay, and renal failure on admission ( P < .0001). Data related to the transfer such as LOS at the outside facility, time of transfer, delay in transfer, and longer distance traveled were not associated with increased LOS or mortality in our study. Conclusion: Organ failure severity on admission, and not transfer-related factors, continues to be the best predictor of outcomes of critically ill patients with cancer when transferred from other facilities to the ICU. Our data suggest that transferring critically ill patients with cancer to a specialized center does not lead to worse outcomes or increased resource utilization when compared to patients admitted from the ED.

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Sepsis induced sequential organ failure assessment score as a prognostic marker in surgical sepsis: a study of 30 cases in 02 years

International Surgery Journal ◽

10.18203/2349-2902.isj20210385 ◽

2021 ◽

Vol 8 (2) ◽

pp. 686

Author(s):

Tushar Nagyan ◽

Mriganko S. Ray ◽

Priyanshu M. Varshney ◽

Sarvpreet S. Malhi ◽

Naresh A. Modi ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Mortality Rate ◽

Sequential Organ Failure Assessment ◽

Organ Failure ◽

Critically Ill ◽

Sofa Score ◽

Fine Tuning ◽

Mortality And Morbidity ◽

Failure Assessment

Background: For the last few decades critical care medicine has been reinventing and fine-tuning organ dysfunction grading to establish a survival scoring system to accurately predict survivality and organ salvageability of critically ill patient in intensive care unit (ICU). The sequential organ failure assessment (SOFA) score assesses the performance of several organ systems in the body and assigns a score, where higher the SOFA score, higher the likelihood of mortality and morbidity. Early prediction of outcome in surgical sepsis is very likely to aid suitable modification of management strategies 13. This may improve prognosis in such patients and prevent mortality to some extent. Methods: Observational and prospective study of 30 cases, aged>18 years & patients admitted to post-operative ward and surgical intensive care unit (SICU) with suspected surgical infection, and with two or more criteria of SIRS. Results: In this study out of total 30 patients 63.3% patients survived and 36.6% succumbed to their illness. Our study depicted significant increase in mortality rate when the SOFA score was above 12. Ventilated patient showed a higher mortality rate. Delta, mean, total SOFA Score were statistically significant in our study.Conclusions: SOFA score is useful in predicting mortality and morbidity in critically ill patients, because has a strong correlation between a rise in the score and mortality in all stages of admission. In our study, out of 09 patients whose T0 SOFA score was very high (above 12) out of which 03 patients only survived.

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Mortality in Escherichia coli bloodstream infections: a multinational population-based cohort study

BMC Infectious Diseases ◽

10.1186/s12879-021-06326-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Melissa C. MacKinnon ◽

Scott A. McEwen ◽

David L. Pearl ◽

Outi Lyytikäinen ◽

Gunnar Jacobsson ◽

...

Keyword(s):

Escherichia Coli ◽

Mortality Rate ◽

Case Fatality ◽

Population Based ◽

Day Case ◽

Fatality Risk ◽

E Coli ◽

Factors Associated ◽

Case Fatality Risk ◽

Age And Sex

Abstract Background Escherichia coli is the most common cause of bloodstream infections (BSIs) and mortality is an important aspect of burden of disease. Using a multinational population-based cohort of E. coli BSIs, our objectives were to evaluate 30-day case fatality risk and mortality rate, and determine factors associated with each. Methods During 2014–2018, we identified 30-day deaths from all incident E. coli BSIs from surveillance nationally in Finland, and regionally in Sweden (Skaraborg) and Canada (Calgary, Sherbrooke, western interior). We used a multivariable logistic regression model to estimate factors associated with 30-day case fatality risk. The explanatory variables considered for inclusion were year (2014–2018), region (five areas), age (< 70-years-old, ≥70-years-old), sex (female, male), third-generation cephalosporin (3GC) resistance (susceptible, resistant), and location of onset (community-onset, hospital-onset). The European Union 28-country 2018 population was used to directly age and sex standardize mortality rates. We used a multivariable Poisson model to estimate factors associated with mortality rate, and year, region, age and sex were considered for inclusion. Results From 38.7 million person-years of surveillance, we identified 2961 30-day deaths in 30,923 incident E. coli BSIs. The overall 30-day case fatality risk was 9.6% (2961/30923). Calgary, Skaraborg, and western interior had significantly increased odds of 30-day mortality compared to Finland. Hospital-onset and 3GC-resistant E. coli BSIs had significantly increased odds of mortality compared to community-onset and 3GC-susceptible. The significant association between age and odds of mortality varied with sex, and contrasts were used to interpret this interaction relationship. The overall standardized 30-day mortality rate was 8.5 deaths/100,000 person-years. Sherbrooke had a significantly lower 30-day mortality rate compared to Finland. Patients that were either ≥70-years-old or male both experienced significantly higher mortality rates than those < 70-years-old or female. Conclusions In our study populations, region, age, and sex were significantly associated with both 30-day case fatality risk and mortality rate. Additionally, 3GC resistance and location of onset were significantly associated with 30-day case fatality risk. Escherichia coli BSIs caused a considerable burden of disease from 30-day mortality. When analyzing population-based mortality data, it is important to explore mortality through two lenses, mortality rate and case fatality risk.

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Establishment of a prognostic model based on the Sequential Organ Failure Assessment score for patients with first-time acute myocardial infarction

Journal of International Medical Research ◽

10.1177/03000605211011976 ◽

2021 ◽

Vol 49 (5) ◽

pp. 030006052110119

Author(s):

Shuai Zheng ◽

Jun Lyu ◽

Didi Han ◽

Fengshuo Xu ◽

Chengzhuo Li ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Intensive Care Unit ◽

Intensive Care ◽

Sequential Organ Failure Assessment ◽

Organ Failure ◽

Sofa Score ◽

Cardiovascular Events ◽

Failure Assessment ◽

First Time

Objective This study aimed to identify the prognostic factors of patients with first-time acute myocardial infarction (AMI) and to establish a nomogram for prognostic modeling. Methods We studied 985 patients with first-time AMI using data from the Multi-parameter Intelligent Monitoring for Intensive Care database and extracted their demographic data. Cox proportional hazards regression was used to examine outcome-related variables. We also tested a new predictive model that includes the Sequential Organ Failure Assessment (SOFA) score and compared it with the SOFA-only model. Results An older age, higher SOFA score, and higher Acute Physiology III score were risk factors for the prognosis of AMI. The risk of further cardiovascular events was 1.54-fold higher in women than in men. Patients in the cardiac surgery intensive care unit had a better prognosis than those in the coronary heart disease intensive care unit. Pressurized drug use was a protective factor and the risk of further cardiovascular events was 1.36-fold higher in nonusers. Conclusion The prognosis of AMI is affected by age, the SOFA score, the Acute Physiology III score, sex, admission location, type of care unit, and vasopressin use. Our new predictive model for AMI has better performance than the SOFA model alone.

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Sequential Organ Failure Assessment (SOFA) Score Is Superior to Classical Prognostic Indices in Prediction of Severity, Intensive Care Unit Admissions and Mortality in Acute Pancreatitis

HPB ◽

10.1016/j.hpb.2020.11.116 ◽

2021 ◽

Vol 23 ◽

pp. S48-S49

Author(s):

S. Baey ◽

T. Tan ◽

S.K. Gunasekaran ◽

S.P. Junnarkar ◽

J.K. Low ◽

...

Keyword(s):

Intensive Care Unit ◽

Acute Pancreatitis ◽

Intensive Care ◽

Sequential Organ Failure Assessment ◽

Organ Failure ◽

Sofa Score ◽

Failure Assessment ◽

Prognostic Indices

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Sex differences and correlates of poor glycaemic control in type 2 diabetes: a cross-sectional study in Brazil and Venezuela

BMJ Open ◽

10.1136/bmjopen-2018-023401 ◽

2019 ◽

Vol 9 (3) ◽

pp. e023401 ◽

Cited By ~ 5

Author(s):

Fernanda G Duarte ◽

Sandra da Silva Moreira ◽

Maria da Conceição C Almeida ◽

Carlos A de Souza Teles ◽

Carine S Andrade ◽

...

Keyword(s):

Type 2 Diabetes ◽

Glycaemic Control ◽

Treatment Guidelines ◽

Specific Treatment ◽

Nationwide Survey ◽

Haemoglobin A1c ◽

Cross Sectional ◽

Factors Associated ◽

Adherence To Diet

ObjectiveExamine whether glycaemic control varies according to sex and whether the latter plays a role in modifying factors associated with inadequate glycaemic control in patients with type 2 diabetes (T2D) in Brazil and Venezuela.Design, setting and participantsThis was a cross-sectional, nationwide survey conducted in Brazil and Venezuela from February 2006 to June 2007 to obtain information about glycaemic control and its determinants in patients with diabetes mellitus attending outpatient clinics.Main outcome measuresHaemoglobin A1c (HbA1c) level was measured by liquid chromatography, and patients with HbA1c ≥7.0% (53 mmol/mol) were considered to have inadequate glycaemic control. The association of selected variables with glycaemic control was analysed by multivariate linear regression, using HbA1c as the dependent variable.ResultsA total of 9418 patients with T2D were enrolled in Brazil (n=5692) and in Venezuela (n=3726). They included 6214 (66%) women and 3204 (34%) men. On average, HbA1c levels in women were 0.13 (95% CI 0.03 to 0.24; p=0.015) higher than in men, after adjusting for age, marital status, education, race, country, body mass index, duration of disease, complications, type of healthcare, adherence to diet, adherence to treatment and previous measurement of HbA1c. Sex modified the effect of some factors associated with glycaemic control in patients with T2D in our study, but had no noteworthy effect in others.ConclusionsWomen with T2D had worse glycaemic control than men. Possible causes for poorer glycaemic control in women compared with men include differences in glucose homeostasis, treatment response and psychological factors. In addition, sex modified factors associated with glycaemic control, suggesting the need to develop specific treatment guidelines for men and women.

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