Analysis of Relationship Between ICU Admission Criteria and End Results of Caring of Obstetrics/Gynecologic ICU Patients

Abstract Background Analyses of blood biomarkers involved in the host response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral infection can reveal distinct biological pathways and inform development and testing of therapeutics for COVID-19. Our objective was to evaluate host endothelial, epithelial and inflammatory biomarkers in COVID-19. Methods We prospectively enrolled 171 ICU patients, including 78 (46%) patients positive and 93 (54%) negative for SARS-CoV-2 infection from April to September, 2020. We compared 22 plasma biomarkers in blood collected within 24 h and 3 days after ICU admission. Results In critically ill COVID-19 and non-COVID-19 patients, the most common ICU admission diagnoses were respiratory failure or pneumonia, followed by sepsis and other diagnoses. Similar proportions of patients in both groups received invasive mechanical ventilation at the time of study enrollment. COVID-19 and non-COVID-19 patients had similar rates of acute respiratory distress syndrome, severe acute kidney injury, and in-hospital mortality. While concentrations of interleukin 6 and 8 were not different between groups, markers of epithelial cell injury (soluble receptor for advanced glycation end products, sRAGE) and acute phase proteins (serum amyloid A, SAA) were significantly higher in COVID-19 compared to non-COVID-19, adjusting for demographics and APACHE III scores. In contrast, angiopoietin 2:1 (Ang-2:1 ratio) and soluble tumor necrosis factor receptor 1 (sTNFR-1), markers of endothelial dysfunction and inflammation, were significantly lower in COVID-19 (p < 0.002). Ang-2:1 ratio and SAA were associated with mortality only in non-COVID-19 patients. Conclusions These studies demonstrate that, unlike other well-studied causes of critical illness, endothelial dysfunction may not be characteristic of severe COVID-19 early after ICU admission. Pathways resulting in elaboration of acute phase proteins and inducing epithelial cell injury may be promising targets for therapeutics in COVID-19.

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Glutamine and glutathione at ICU admission in relation to outcome

Clinical Science ◽

10.1042/cs20110520 ◽

2012 ◽

Vol 122 (12) ◽

pp. 591-597 ◽

Cited By ~ 112

Author(s):

Paul Castillo Rodas ◽

Olav Rooyackers ◽

Christina Hebert ◽

Åke Norberg ◽

Jan Wernerman

Keyword(s):

Risk Factor ◽

Organ Failure ◽

Independent Predictor ◽

Apache Ii ◽

University Hospital ◽

Glutathione Depletion ◽

Glutamine Supplementation ◽

Limiting Factor ◽

Icu Patients ◽

Icu Admission

Glutamine depletion is demonstrated to be an independent predictor of hospital mortality in ICU (intensive care unit) patients. Today glutamine supplementation is recommended to ICU patients on parenteral nutrition. In addition to glutamine, glutathione may be a limiting factor in ICU patients with MOF (multiple organ failure). To study the prevalence of glutamine and glutathione depletion an observational study was performed. The results were analysed in relation to mortality and the conventional predictors of mortality outcome, APACHE II (Acute Physiology and Chronic Health Evaluation II) and SOFA (Sequential Organ Failure Assessment). Consecutive patients admitted to the ICU at Karolinska University Hospital Huddinge were studied. Patient admission scoring of APACHE II and SOFA were registered as well as mortality up to 6 months. Plasma glutamine concentration and whole blood glutathione status at admittance were analysed. The admission plasma glutamine concentrations were totally independent of the conventional risk scoring at admittance, and a subnormal concentration was an independent predictor of mortality. In addition, glutathione redox status was also an independent mortality predictor, but here a normal ratio was the risk factor. In both cases the mortality risk was mainly confined to the post-ICU period. A low plasma concentration of glutamine at ICU admission is an independent risk factor for post-ICU mortality. The possible benefit of extending glutamine supplementation post-ICU should be evaluated prospectively.

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Predicting value of prehospital body temperature for ICU admission of septic shock patients

Acute Medicine Journal ◽

10.52964/amja.0751 ◽

2019 ◽

Vol 18 (1) ◽

pp. 56-58

Author(s):

Romain Jouffroy ◽

◽

Anastasia Saade ◽

Stephane Durand ◽

Pascal Philippe ◽

...

Keyword(s):

Intensive Care Unit ◽

Septic Shock ◽

Body Temperature ◽

Propensity Score Analysis ◽

Call Centre ◽

Icu Patients ◽

Icu Admission ◽

Score Analysis ◽

The Mean ◽

Proper Orientation

To specify whether an association exists between pre-hospital body temperature collected by the emergency medical services (EMS) call centre, and intensive care unit (ICU) admission of patients with septic shock. An observational study based on data collected by the EMS of Paris. All septic shocks were included. Among, the 140 calls concerning septic shock, 22 patients (16%) were admitted to ICU. The mean core temperature was 37.4±1.6°C for ICU and 38.6±1.1°C (p<4.10^-5) for non-ICU patients. Using propensity score analysis, the relative risk for ICU admission of patients with pre-hospital fever or hypothermia was 0.31 and 2 respectively. The study highlights the potential usefulness of early temperature measurement in septic shock patients to allow early proper orientation.

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Interim-analysis of the COSA (COVID-19 patients treated with the Seraph® 100 Microbind® Affinity filter) registry

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab347 ◽

2021 ◽

Author(s):

Julius J Schmidt ◽

Dan Nicolae Borchina ◽

Mariet van´t Klooster ◽

Khalida Bulhan-Soki ◽

Reuben Okioma ◽

...

Keyword(s):

Mortality Rate ◽

Sofa Score ◽

Cox Regression ◽

Treatment Time ◽

Outcome Data ◽

Adverse Outcomes ◽

Icu Patients ◽

Icu Admission ◽

Late Initiation ◽

Bacterial Superinfection

Abstract Background The Seraph®100 Microbind Affinity Blood Filter® is a hemoperfusion device that is licensed for the reduction of pathogens, including several viruses, in the blood. It received Emergency Use Authorization (EUA) for the treatment of severe coronavirus disease 2019 (COVID-19) by the FDA. Several studies have shown that the blood viral load of SARS-CoV-2 correlates with adverse outcomes and removal of the nucleocapsid of the SARS-CoV-2 virus by the Seraph®100 has been recently demonstrated. The aim of this registry was to evaluate safety and efficacy of Seraph®100 treatment for COVID-19 patients. Methods Twelve hospitals from six countries representing two continents documented patient and treatment characteristics as well as outcome parameters without reimbursement. Additionally, mortality and safety results of the device were reported. One hundred-and-two treatment sessions in 82 patients were documented in the registry. Four patients were excluded from mortality analysis due to incomplete outcome data, which were available in the other 78 patients. Results Overall, a 30-day mortality rate of 46.2% in the 78 patients with complete follow up was reported. Median treatment time was 5.00 [4.00–13.42] h. and 43.1% of the treatments were performed as hemoperfusion only. Adverse events of the Seraph®100 treatment were reported in 8.8% of the 102 treatments and represented premature end of treatment due to circuit failure. Patients that died were treated later in their ICU stay and onset of COVID symptoms. They also had higher ferritin levels. Multivariate Cox regression revealed that delayed Seraph®100 treatment after ICU admission (>60 hours) as well as bacterial superinfection were associated with mortality. While average predicted mortality rate according to SOFA score in ICU patients was 56.7% the observed mortality was 50.7%. In non-ICU patients 4C-Score average predicted a mortality rate of 38.0% while the observed mortality rate was 11.1% Conclusions The treatment of COVID-19 patients with Seraph®100 is well tolerated and the circuit failure rate was lower than previously reported for KRT in COVID-19 patients. Mortality corelated with late initiation of Seraph treatment after ICU admission and bacterial superinfection infection. Compared to predicted mortality according to 4C-Score and SOFA Score, mortality of Seraph®100 treated patients reported in the registry was lower.

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Clinical diagnoses vs. autopsy findings in early deceased septic patients in the intensive care: a retrospective cohort study

Virchows Archiv ◽

10.1007/s00428-020-02984-5 ◽

2020 ◽

Author(s):

Rob G. H. Driessen ◽

Bartholomeus G. H. Latten ◽

Dennis C. J. J. Bergmans ◽

Riquette P. M. G. Hulsewe ◽

Johanna W. M. Holtkamp ◽

...

Keyword(s):

Intensive Care ◽

Clinical Diagnosis ◽

Causes Of Death ◽

Early Death ◽

Class I ◽

Icu Patients ◽

Icu Admission ◽

Clinical Diagnoses ◽

Important Diagnostic Tool ◽

Record Review

AbstractEarly death in sepsis occurs frequently; however, specific causes are largely unknown. An autopsy can contribute to ascertain causes of death. The objective of the study was to determine discrepancies in clinical diagnosis and postmortem findings in septic intensive care unit (ICU) patients deceased within 48 h after ICU admission. All septic ICU patients who deceased within 48 h after ICU admission were identified and included. Four intensivists determined the clinical cause of death by medical record review. An autopsy was performed within 24 h of death. Clinical diagnosis and postmortem findings were compared and classified as autopsy-identified missed clinical diagnoses and autopsy-refuted diagnoses. Class I and II missed major diagnoses using the Goldman criteria were scored. Between 2012 and 2017, 1107 septic patients were admitted to ICU. Of these, 344 patients (31%) died, of which 97 patients (28%) deceased within 48 h. In 32 (33%) early deceased patients, an autopsy was agreed. There were 26 autopsy-identified missed clinical diagnoses found, mostly myocardial infarction (n = 4) and pneumonia (n = 4). In four patients (13%), a class I discrepancy was found. In fourteen patients (42%), a class II discrepancy was found. In conclusion, an autopsy is an important diagnostic tool that can identify definite causes of death. These diagnoses deviate from diagnoses established during admission in early deceased sepsis patients.

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Colistin-Resistant Acinetobacter Baumannii Bacteremia: A Serious Threat for Critically Ill Patients

Microorganisms ◽

10.3390/microorganisms8020287 ◽

2020 ◽

Vol 8 (2) ◽

pp. 287 ◽

Cited By ~ 4

Author(s):

Georgios Papathanakos ◽

Ioannis Andrianopoulos ◽

Athanasios Papathanasiou ◽

Efthalia Priavali ◽

Despoina Koulenti ◽

...

Keyword(s):

Septic Shock ◽

Acinetobacter Baumannii ◽

Critically Ill ◽

Critically Ill Patients ◽

Clinical Problem ◽

Hospital Infections ◽

Colistin Resistance ◽

Icu Patients ◽

Icu Admission ◽

Comorbidity Index

The prevalence of acinetobacter baumannii (AB) as a cause of hospital infections has been rising. Unfortunately, emerging colistin resistance limits therapeutic options and affects the outcome. The aim of the study was to confirm our clinically-driven hypothesis that intensive care unit (ICU) patients with AB resistant-to-colistin (ABCoR) bloodstream infection (BSI) develop fulminant septic shock and die. We conducted a 28-month retrospective observational study including all patients developing AB infection on ICU admission or during ICU stay. From 622 screened patients, 31 patients with BSI sepsis were identified. Thirteen (41.9%) patients had ABCoR BSI and 18/31 (58.1%) had colistin-susceptible (ABCoS) BSI. All ABCoR BSI patients died; of them, 69% (9/13) presented with fulminant septic shock and died within the first 3 days from its onset. ABCoR BSI patients compared to ABCoS BSI patients had higher mortality (100% vs. 50%, respectively (p = 0.001)), died sooner (p = 0.006), had lower pH (p = 0.004) and higher lactate on ICU admission (p = 0.0001), and had higher APACHE II (p = 0.01) and Charlson Comorbidity Index scores (p = 0.044). In conclusion, we documented that critically ill patients with ABCoR BSI exhibit fulminant septic shock with excessive mortality. Our results highlight the emerging clinical problem of AB colistin resistance among ICU patients.

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Serum Coenzyme Q10 Levels are Decreased in Critically-Ill Septic Patients: Results From a Preliminary Study

Biological Research For Nursing ◽

10.1177/1099800420944489 ◽

2020 ◽

pp. 109980042094448

Author(s):

Alice G. Vassiliou ◽

Zafeiria Mastora ◽

Edison Jahaj ◽

Chrysi Keskinidou ◽

Maria E. Pratikaki ◽

...

Keyword(s):

Oxidative Stress ◽

Septic Shock ◽

Critically Ill ◽

Coenzyme Q10 ◽

Inflammatory Biomarkers ◽

Healthy Controls ◽

Icu Patients ◽

Icu Admission ◽

Icu Discharge ◽

Sepsis And Septic Shock

Background: The increased oxidative stress resulting from the inflammatory responses in sepsis initiates changes in mitochondrial function which may result in organ damage, the most common cause of death in the intensive care unit (ICU). Deficiency of coenzyme Q10 (CoQ10), a key cofactor in the mitochondrial respiratory chain, could potentially disturb mitochondrial bioenergetics and oxidative stress, and may serve as a biomarker of mitochondrial dysfunction. Hence, we aimed to investigate in initially non-septic patients whether CoQ10 levels are decreased in sepsis and septic shock compared to ICU admission, and to evaluate its associations with severity scores, inflammatory biomarkers, and ICU outcomes. Methods: Observational retrospective analysis on 86 mechanically-ventilated, initially non-septic, ICU patients. CoQ10 was sequentially measured on ICU admission, sepsis, septic shock or at ICU discharge. CoQ10 was additionally measured in 25 healthy controls. Inflammatory biomarkers were determined at baseline and sepsis. Results: On admission, ICU patients who developed sepsis had lower CoQ10 levels compared to healthy controls (0.89 vs. 1.04 µg/ml, p < 0.05), while at sepsis and septic shock CoQ10 levels decreased further (0.63 µg/ml; p < 0.001 and 0.42 µg/ml; p < 0.0001, respectively, from admission). In ICU patients who did not develop sepsis, admission CoQ10 levels were also lower than healthy subjects (0.81 µg/ml; p < 0.001) and were maintained at the same levels until discharge. Conclusion: CoQ10 levels in critically-ill patients are low on ICU admission compared to healthy controls and exhibit a further decrease in sepsis and septic shock. These results suggest that sepsis severity leads to CoQ10 depletion.

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Intensive Care Admissions and Associated Severity of Influenza B Versus A During Influenza B Vaccine–mismatched Seasons

Clinical Infectious Diseases ◽

10.1093/cid/ciz053 ◽

2019 ◽

Vol 69 (6) ◽

pp. 1049-1052 ◽

Cited By ~ 6

Author(s):

Maya Korem ◽

Efrat Orenbuch-Harroch ◽

Eli Ben-Chetrit ◽

Sarah Israel ◽

Matan J Cohen ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Disease Severity ◽

Influenza B ◽

Icu Patients ◽

Icu Admission ◽

Severe Influenza ◽

Trivalent Vaccine ◽

Quadrivalent Vaccines

Abstract Patients admitted to hospital with influenza B and A in Jerusalem, Israel, during the 2015–2016 and 2017–2018 influenza seasons demonstrated similar rates of intensive care unit (ICU) admission and associated disease severity. Most (63%) influenza B ICU patients received influenza B–mismatched trivalent vaccine. These findings call into question the equivalence of trivalent and quadrivalent vaccines in preventing severe influenza B.

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Association of Serum Calprotectin Concentrations with Mortality in Critically Ill and Septic Patients

Diagnostics ◽

10.3390/diagnostics10110990 ◽

2020 ◽

Vol 10 (11) ◽

pp. 990

Author(s):

Theresa H. Wirtz ◽

Lukas Buendgens ◽

Ralf Weiskirchen ◽

Sven H. Loosen ◽

Nina Haehnsen ◽

...

Keyword(s):

Overall Survival ◽

Critically Ill ◽

Critically Ill Patients ◽

University Hospital ◽

Therapeutic Interventions ◽

Neutrophil Granulocytes ◽

Icu Patients ◽

Long Term Outcome ◽

Icu Admission

Background: Calprotectin is present in the cytosol of neutrophil granulocytes and released upon activation. Fecal calprotectin is applied in the clinical management of inflammatory bowel disease whereas serum calprotectin has been discussed as a biomarker in inflammatory disorders. However, its long-term prognostic relevance in critical illness remains unclear. Our aim was to investigate serum calprotectin concentrations as a prognostic biomarker in critically ill and septic patients. Methods: Serum calprotectin concentrations were analyzed in 165 critically ill patients (108 with sepsis, 57 without sepsis) included in our observational study. Patients were enrolled upon admission to the medical intensive care unit (ICU) of the RWTH Aachen University Hospital. Calprotectin concentrations were compared to 24 healthy controls and correlated with clinical parameters, therapeutic interventions, and survival. Results: Serum calprotectin concentrations were significantly increased in ICU patients as well as in septic patients compared to respective controls (p < 0.001 for ICU patients and p = 0.001 for septic patients). Lower calprotectin concentrations were measured in patients with comorbidities i.e., coronary artery disease. Calprotectin concentrations strongly correlated with the C-reactive protein (p < 0.001) and were closely associated to parameters of mechanical ventilation (i.a. inspiratory oxygen fraction, FiO2; p < 0.001). The overall survival was significantly impaired in septic patients with high baseline calprotectin concentrations (p = 0.036). However, patients with increasing calprotectin serum concentrations within the first week of ICU admission showed an improved overall survival (p = 0.009). Conclusions: In summary, serum calprotectin concentrations are significantly increased in critically ill patients with sepsis. High calprotectin concentrations at ICU admission predict long-term mortality risk, whereas increasing calprotectin concentrations are associated with a favorable long-term outcome.

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