scholarly journals Sepsis Diagnostics: Intensive Care Scoring Systems Superior to MicroRNA Biomarker Testing

Diagnostics ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. 701
Author(s):  
Fabian Link ◽  
Knut Krohn ◽  
Anna-Maria Burgdorff ◽  
Annett Christel ◽  
Julia Schumann
Keyword(s):  
Intensive Care ◽  
Scoring Systems ◽  
Digital Pcr ◽  
Absolute Quantification ◽  
Medical Problem ◽  
Control Group ◽  
Multiple Parameters ◽  
Sepsis Diagnosis ◽  
Intensive Care Patients ◽  
Healthy Control

Sepsis represents a serious medical problem accounting for numerous deaths of critically ill patients in intensive care units (ICUs). An early, sensitive, and specific diagnosis is considered a key element for improving the outcome of sepsis patients. In addition to classical laboratory markers, ICU scoring systems and serum miRNAs are discussed as potential sepsis biomarkers. In the present prospective observational study, the suitability of miRNAs in sepsis diagnosis was tested based on proper validated and normalized data (i.e., absolute quantification by means of Droplet Digital PCR (ddPCR)) in direct comparison to classical sepsis markers and ICU scores within the same patient cohort. Therefore, blood samples of septic intensive care patients (n = 12) taken at day of admission at ICU were compared to non-septic intensive care patients (n = 12) and a healthy control group (n = 12). Our analysis indicates that all tested biomarkers have only a moderate informative power and do not allow an unequivocal differentiation between septic and non-septic ICU patients. In conclusion, there is no standalone laboratory parameter that enables a reliable diagnosis of sepsis. miRNAs are not superior to classical parameters in this respect. It seems recommendable to measure multiple parameters and scores and to interpret them with regard to the clinical presentation.

Effect of abdominal massage on prevention of aspiration in intubated and enterally fed patients: A randomized controlled trial

2020 ◽  
Vol 17 (3) ◽  
Author(s):  
Mahlagha Dehghan ◽  
Amanollah Fatehi Poor ◽  
Roghayeh Mehdipour-Rabori ◽  
Mehdi Ahmadinejad
Keyword(s):  
Intensive Care ◽  
Confidence Interval ◽  
Endotracheal Tube ◽  
Intervention Group ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Respiratory Secretion ◽  
Intensive Care Patients ◽  
Randomized Controlled ◽  
Abdominal Massage

AbstractBackgroundAspiration is a serious side effect of delayed gastric emptying and increased residual volume in intensive care patients. Aspiration can increase the risk of pneumonia and death. Currently, pharmaceutical methods are the most commonly used techniques for decreasing aspiration, but non-pharmaceutical methods may also be effective in reducing aspiration. One of these methods is an abdominal massage. The present study aimed to examine the effect of abdominal massage on aspiration incidence in intensive care patients with an endotracheal tube.MethodsThis study was a randomized controlled clinical trial. Seventy intensive care patients with an endotracheal tube were chosen by convenience sampling and allocated to an intervention or a control group by the minimization method. The intervention group was provided with a 15-min abdominal massage twice a day for 3 days, while the control group received only routine cares. The patients’ respiratory secretion was suctioned before and after the intervention, and immediately after suctioning, the incidence of the aspiration was assessed using special strips which are sensitive to respiratory secretion pH and glucose. SPSS 18 was used to analyze data. Descriptive statistics were used. T independent, Mann-Whitney U, χ2, and Fisher exact tests were used to compare two groups.ResultsThe incidence rates of the aspiration were 5.7% (confidence interval: 0.0–14.3%) and 20% (confidence interval: 8.6–34.3%) in the abdominal massage and the control groups, respectively. The incidence of aspiration differed between two groups, but it was not statistically significant (p=0.07).ConclusionAlthough the low rate of aspiration in the abdominal massage group did not differ significantly with that of the control group, it can be clinically important. It is suggested that further studies be conducted to confirm the effect of abdominal massage on the prevention of aspiration in intensive care patients with an endotracheal tube.

scholarly journals MRI Assessment of Global and Regional Diaphragmatic Motion in Critically Ill Patients Following Prolonged Ventilator Weaning

2019 ◽  
Vol 7 (5) ◽  
pp. 66
Author(s):  
Khurram Saleem Khan ◽  
James Meaney ◽  
Ignacio Martin-Loeches ◽  
Daniel V. Collins
Keyword(s):  
Intensive Care ◽  
Vertical Displacement ◽  
Interquartile Range ◽  
Control Group ◽  
P Value ◽  
Diaphragmatic Dysfunction ◽  
Intensive Care Patients ◽  
The Right ◽  
Ventilated Patients ◽  
Left Hemi

Introduction: diaphragmatic dysfunction is a common cause of slow weaning in mechanically ventilated patients. Diaphragmatic dysfunction in ventilated patients can be global or regional. The aim of our study was to evaluate the motion of the entire diaphragm in patients who were ventilated for a protracted period in comparison with healthy controls by using Magnetic Resonance Imaging (MRI). Methods: Intensive care patients who had a prolonged ventilator wean and required tracheostomies were enrolled based on extensive exclusion criteria. MRI dynamic sequence and subtraction images were used to measure vertical displacement at five different points on each hemi-diaphragm during normal tidal breathing. Tidal displacement of each point on the right and left hemi-diaphragms of the patients were compared to the precise respective points on the right and left hemi-diaphragms of enrolled controls. Results: Eight intensive care patients and eight controls were enrolled. There were observed significant differences in the displacements of the left hemi-diaphragm between the two groups (median 6.4 mm [Interquartile range (IQR), 4.6–12.5]) vs. 11.6 mm [IQR, 9.5–14.5], p = 0.02). There were also observed significant differences in the displacements at five evaluated study points on the left hemi-diaphragms of the patients when compared to the precise respective points in controls, especially at the dome (median 6.7 mm [IQR, 5.0–11.4] vs. 13.5 mm [IQR 11.5-18], p value = 0.005) and the anterior zone of apposition (median 5.0 mm [IQR, 3.3–7.1] vs. 7.8mm [IQR, 7.1–10.5], p value = 0.01). The intensive care patients showed lower minimal and maximal values of displacement of right hemi-diaphragms compared to the controls, suggesting that the differences in the displacement of right hemi-diaphragm are possible; however, the differences in the mean values of displacement of right hemi-diaphragm between the intensive care patient group and the control group (median 9.8 mm [IQR (Interquartile range), 5.0–12.3] vs. 10.1 mm [IQR 8.3–18.5], p = 0.12) did not reach the level of significance. Conclusion: Although frequently global, diaphragm dysfunction in ventilated patients after prolonged ventilation can also be regional or focal when assessed by MRI dynamic sequence. The vertical displacement of both right and left hemi-diaphragms at various anatomical locations had different values in both controls, and patients. There were significant focal variations in the movement of diaphragm in patients with ventilator-induced diaphragmatic dysfunction.

Mechanical Ventilation and Cytopathological Changes in the Oral Mucosa

2017 ◽  
Vol 26 (4) ◽  
pp. 297-302 ◽  
Author(s):  
Ana Carolina Machado Landgraf ◽  
Angélica Reinheimer ◽  
Júlio Cezar Merlin ◽  
Soraya de Azambuja Berti Couto ◽  
Paulo Henrique Couto Souza
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Oral Mucosa ◽  
Oral Care ◽  
The Other ◽  
Control Group ◽  
Oral Epithelium ◽  
Exfoliative Cytology ◽  
Intensive Care Patients ◽  
Glass Slides

BackgroundThe oral mucosa is an important defense barrier to penetration of microorganisms. Thus, changes in the oral epithelium might indicate risk for infection in intensive care patients receiving mechanical ventilation.ObjectiveTo evaluate the oral mucosa of intensive care patients who did or did not receive mechanical ventilation by using liquid-base exfoliative cytology.MethodsThe sample consisted of 3 groups: 27 patients admitted to intensive care during a 7- to 14-day period who received mechanical ventilation, 29 patients admitted during the same period who did not receive mechanical ventilation, and 27 healthy patients who had no lesions in the mouth. For all 3 groups, samples were collected from the buccal mucosa by using cytology brushes. Smears were applied to glass slides before Papanicolaou staining and were codified for blind analyses by a cytopathologist. Kruskal-Wallis and Dunn tests were used to analyze the results.ResultsPatients receiving mechanical ventilation had higher prevalence and intensity of karyomegaly, perinuclear halos, cell keratinization, deep cells, and leukocyte infiltrates than did patients in the other 2 groups (P < .05). No significant differences were observed between the control group and the group who did not receive mechanical ventilation.ConclusionsLiquid-base exfoliative cytology can be used to detect preclinical alterations in the oral mucosa. Patients treated with mechanical ventilation are vulnerable to infections, and oral care may be valuable in their prognosis.

Prognostic Scoring Systems: Facing Difficult Decisions with Objective Data

1993 ◽  
Vol 2 (2) ◽  
pp. 185-191 ◽  
Author(s):  
Kent Sasse
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Scoring Systems ◽  
The United States ◽  
Assisted Ventilation ◽  
Intensive Care Patients ◽  
Coronary Care ◽  
Cardiopulmonary Performance ◽  
The Cost ◽  
Prognostic Scoring Systems

In the United States, at least 6% of all hospital beds are in the intensive care unit (ICU) or coronary care unit. The cost of treating a patient in an intensive care unit averages from $2,000 to $3,500 per day. At least 10–40% of intensive care patients will not survive to hospital discharge. Today, every major category of disease may be found in the modern ICU; common diagnoses are septicemia, postsurgical complications, cerebrovascular accidents, gastrointestinal bleeding, neoplasia, and respiratory failure. ICUs employ some of the most sophisticated medical technology, routinely monitoring the cardiopulmonary performance of patients and often providing assisted ventilation. ICUs are high intensity in terms of their staffing, involving 24-hour physician supervision and nurse:patient ratios from 1:3 to 1:1.

scholarly journals The association between four scoring systems and 30-day mortality among intensive care patients with sepsis: a cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Tianyang Hu ◽  
Huajie Lv ◽  
Youfan Jiang
Keyword(s):  
Cohort Study ◽  
Intensive Care ◽  
Scoring Systems ◽  
Roc Curves ◽  
The Elderly ◽  
Net Benefit ◽  
Intensive Care Patients ◽  
Saps Ii ◽  
Saps Ii Score ◽  
Net Benefits

AbstractSeveral commonly used scoring systems (SOFA, SAPS II, LODS, and SIRS) are currently lacking large sample data to confirm the predictive value of 30-day mortality from sepsis, and their clinical net benefits of predicting mortality are still inconclusive. The baseline data, LODS score, SAPS II score, SIRS score, SOFA score, and 30-day prognosis of patients who met the diagnostic criteria of sepsis were retrieved from the Medical Information Mart for Intensive Care III (MIMIC-III) intensive care unit (ICU) database. Receiver operating characteristic (ROC) curves and comparisons between the areas under the ROC curves (AUC) were conducted. Decision curve analysis (DCA) was performed to determine the net benefits between the four scoring systems and 30-day mortality of sepsis. For all cases in the cohort study, the AUC of LODS, SAPS II, SIRS, SOFA were 0.733, 0.787, 0.597, and 0.688, respectively. The differences between the scoring systems were statistically significant (all P-values < 0.0001), and stratified analyses (the elderly and non-elderly) also showed the superiority of SAPS II among the four systems. According to the DCA, the net benefit ranges in descending order were SAPS II, LODS, SOFA, and SIRS. For stratified analyses of the elderly or non-elderly groups, the results also showed that SAPS II had the most net benefit. Among the four commonly used scoring systems, the SAPS II score has the highest predictive value for 30-day mortality from sepsis, which is better than LODS, SIRS, and SOFA. The results of the DCA curves show that using the SAPS II score to predict the 30-day mortality of intensive care patients with sepsis to guide clinical applications may obtain the highest net benefit.

scholarly journals Effectiveness of LODS, OASIS, and SAPS II to predict in-hospital mortality for intensive care patients with ST elevation myocardial infarction

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Liang Wang ◽  
Zhengwei Zhang ◽  
Tianyang Hu
Keyword(s):  
Myocardial Infarction ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Clinical Benefit ◽  
Predictive Value ◽  
Scoring Systems ◽  
Study Cohort ◽  
Intensive Care Patients ◽  
Saps Ii ◽  
Saps Ii Score

AbstractThe relationship between three scoring systems (LODS, OASIS, and SAPS II) and in-hospital mortality of intensive care patients with ST segment elevation myocardial infarction (STEMI) is currently inconclusive. The baseline data, LODS score, OASIS score, SAPS II score, and in-hospital prognosis of intensive care patients with STEMI were retrieved from the Medical Information Mart for Intensive Care IV database. Propensity score matching analysis was performed to reduce bias. Receiver operating characteristic curves (ROC) were drawn for the three scoring systems, and comparisons between the areas under the ROC curves (AUC) were conducted. Decision curve analysis (DCA) was performed to determine the net benefits of the three scoring systems. LODS and SAPS II were independent risk factors for in-hospital mortality. For the study cohort, the AUCs of LODS, OASIS, SAPS II were 0.867, 0.827, and 0.894; after PSM, the AUCs of LODS, OASIS, SAPS II were 0.877, 0.821, and 0.881. A stratified analysis of the patients who underwent percutaneous coronary intervention/coronary artery bypass grafting (PCI/CABG) or not was conducted. In the PCI/CABG group, the AUCs of LODS, OASIS, SAPS II were 0.853, 0.825, and 0.867, while in the non-PCI/CABG group, the AUCs of LODS, OASIS, SAPS II were 0.857, 0.804, and 0.897. The results of the Z test suggest that the predictive value of LODS and SAPS II was not statistically different, but both were higher than OASIS. According to the DCA, the net clinical benefit of LODS was the greatest. LODS and SAPS II have excellent predictive value, and in most cases, both were higher than OASIS. With a more concise composition and greater clinical benefit, LODS may be a better predictor of in-hospital mortality for intensive care patients with STEMI.

scholarly journals Vitamin D in acutely ill patients

2018 ◽  
Vol 46 (10) ◽  
pp. 4246-4257 ◽  
Author(s):  
Ifigenia Kostoglou-Athanassiou ◽  
Eleni Pantazi ◽  
Sofoklis Kontogiannis ◽  
Dimitrios Kousouris ◽  
Iordanis Mavropoulos ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Inverse Relationship ◽  
Control Group ◽  
C Reactive Protein ◽  
Protein Levels ◽  
Reactive Protein ◽  
Control Subjects ◽  
Healthy Control ◽  
The Mean

Objective To investigate 25(OH)D3 levels and their relationship to survival in a cohort of acutely ill patients on admission to an intensive care unit. Methods This study enrolled acutely ill patients at admission to an intensive care unit and a group of sex- and age-matched healthy control subjects. The 25(OH)D3 levels were measured using an enzyme immunoassay. C-reactive protein and procalcitonin levels were also measured using immunoassays. Results A total of 50 acutely ill patients and 50 healthy control subjects were enrolled in the study. The mean ± SEM 25(OH)D3 levels were significantly lower in the acutely ill patients compared with the control group (11.74 ± 0.88 ng/ml versus 24.66 ± 1.60 ng/ml, respectively). The 25(OH)D3 levels were not related to survival. An inverse relationship was observed between 25(OH)D3 levels and C-reactive protein levels. A weak inverse relationship was also observed between 25(OH)D3 levels and procalcitonin levels. Conclusions The 25(OH)D3 levels were decreased in acutely ill patients admitted to an intensive care unit compared with healthy control subjects. 25(OH)D3 levels may be inversely related to C-reactive protein and procalcitonin levels.

scholarly journals Is dynamic thiol/disulfide homeostasis associated with the prognosis of myelodysplastic syndrome?

2019 ◽  
Vol 0 (0) ◽  
Author(s):  
Mehmet Ali Ucar ◽  
Anıl Tombak ◽  
Simten Dagdas ◽  
Aydan Akdeniz ◽  
Funda Ceran ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myelodysplastic Syndrome ◽  
Cox Regression ◽  
Bone Marrow Aspiration ◽  
Scoring Systems ◽  
Control Group ◽  
Total Thiol ◽  
Healthy Control ◽  
Prognostic Scoring Systems ◽  
Relationship Of

Summary Background This study planned to investigate the relationship of dynamic thiol/disulfide homeostasis with the prognosis of myelodysplastic syndrome (MDS). Methods 80 patients who had been diagnosed with MDS between 2012 and 2017 and who were older than 18 were included in the study together with 80 healthy control subjects. The MDS diagnosis was confirmed using bone marrow aspiration-biopsy immunostaining. Dynamic thiol/disulfide homeostasis and ischemia-modified albumin (IMA) levels were examined. Results The average IMA (0.71±0.08 vs. 0.67±0.09; p=0.002), median disulfide (18.0 vs. 11.6; p<0.001), median disulfide/native thiol (6 vs. 3; p<0.001), and median disulfide/total thiol (5.4 vs. 2.9; p<0.001) were found higher in the MDS patients compared to control group, and the median hemoglobin, median white blood cell count, median neutrophil count, median lymphocyte count, average native thiol (290.7±48.5 vs. 371.5±103.8; p<0.001), average total thiol (328.2±48.9 vs. 393±105.5; p<0.001), and average native thiol/total thiol (%) (88.3±4.3 vs. 94.2±2.1; p<0.001) were found to be low. Risk factors such as collagen tissue disease (HR:9.17; p=0.005), MDS-EB-1 (HR:10.14; p=0.032), MDS-EB-2 (HR:18.2; p=0.043), and disulfide/native thiol (HR:1.17; p=0.023) were found as the independent predictors anticipating progression to acute myeloid leukemia. In the Cox regression model, risk factors such as age (HR:1.05; p=0.002), MDS-EB-1 (HR:12.58; p<0.001), MDS-EB-2 (HR:5.75; p=0.033), disulfide/native thiol (HR:1.14; p=0.040), and hemoglobin (HR:0.64; p=0.007) were found as predictors anticipating for mortality. Conclusions We can argue that dynamic thiol/disulfide homeostasis could have significant effects on both the etiopathogenesis and the survival of patients with MDS, and it could be included in new prognostic scoring systems.

scholarly journals Analysis of Let-7 Family miRNA in Plasma as Potential Predictive Biomarkers of Diagnosis for Papillary Thyroid Cancer

Diagnostics ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. 130 ◽  
Author(s):  
Ewelina Perdas ◽  
Robert Stawski ◽  
Krzysztof Kaczka ◽  
Maria Zubrzycka
Keyword(s):  
Thyroid Cancer ◽  
Predictive Biomarkers ◽  
Radical Resection ◽  
Digital Pcr ◽  
Droplet Digital Pcr ◽  
Control Group ◽  
Papillary Thyroid ◽  
Healthy Control ◽  
Noninvasive Biomarkers ◽  
Common Histological Type

The most common histological type of thyroid cancer is papillary thyroid carcinoma (PTC). Radical resection of the thyroid gland is currently the recommended method of treatment. Almost 75% of thyroidectomies performed just for diagnostic purposes are benign. Thus, the confirmation of innovative and more precise noninvasive biomarkers holds promise for the detection of PTC, which may decrease the number of unnecessary thyroid lobectomies. In this work, using the droplet digital PCR (ddPCR) method, we have analyzed the level of five miRNAs (let-7a, let-7c, let-7d, let-7f, and let-7i) in the plasma of patients with PTC and compared them with those of a healthy control group to investigate whether miRNAs also have value in the management of PTC. Levels of four miRNAs, namely let-7a, let-7c, let-7d, and let-7f, were significantly higher in PTC patients than healthy controls. Thus, the analysis of circulating let-7 can be a useful tool and support the currently used methods for PTC diagnosis. However, our observation requires further research on a larger patient group.

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