multiple organ failure
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Author(s):  
Rim M Harfouch ◽  

Cytokine storm syndrome (CSS) is a critical condition induced by a cascade of cytokine activation, characterized by overwhelming systemic inflammation, hyperferritinaemia, haemodynamic instability and multiple organ failure. At the end of 2019, the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, China, and rapidly developed into a global pandemic. There is a dramatic increase of inflammatory cytokines in patients with COVID-19, suggesting the existence of cytokine storm in some critical illness patients. Here, we summarize the p


Vestnik ◽  
2021 ◽  
pp. 228-231
Author(s):  
Ф.А. Бердалиева ◽  
Г.Н. Абуова ◽  
Т.В. Полукчи ◽  
Д.С. Алиев ◽  
С.П. Ауезханов

На современном этапе в вопросах причинно-следственной связи патофизиологических, иммунологических, биохимических и других процессов, обуславливающих механизм возникновения и течения ККГЛ определены основные векторы: повреждение вирусом клеток - мишеней ( эндотелий сосудистой системы в органах и тканях, моноцитарные макрофаги, гепатоциты и др.); высокий потенциал вируса к репликации; стремительная вирусемия; развертывание локального и генерализованного иммуновоспалительного ответа; нарушение гемостаза и гемодинамики; развитие ДВС синдрома; синдрома полиорганной недостаточности. At the present stage, the main vectors have been identified in the causal relationship of pathophysiological, immunological, biochemical and other processes that determine the mechanism of the occurrence and course of CCGL: damage to target cells by the virus ( endothelium of the vascular system in organs and tissues, monocytic macrophages, hepatocytes, etc.); high potential of the virus for replication; rapid viremia; deployment of a local and generalized immuno-inflammatory response; violation of hemostasis and hemodynamics; development of DIC syndrome; multiple organ failure.


Vestnik ◽  
2021 ◽  
pp. 341-344
Author(s):  
М.А. Жанузаков ◽  
М.К. Бапаева ◽  
Г.К. Джалилова ◽  
А.Ж. Шурина ◽  
Э.М. Утежанов

Клинические проявления катастрофического антифосфолипидного синдрома многообразны, что затрудняет своевременную диагностику и соответственно адекватное лечение. Цель: устранить трудности, возникающие у практических врачей при постановке диагноза, дифференциальной диагностике и лечении катастрофического антифосфолипидного синдрома, основываясь на анализе данных литературы и на примере клинического случая. Материалы и методы: исследований по данной проблеме в отечественных источниках мы не встретили, что привело к необходимости остановиться на литературных данных и клиническом примере. Результаты: на основании анамнеза заболевания, результатов клинического и дополнительных методов исследования пациента, установлен диагноз катастрофического антифосфолипидного синдрома. Выводы: для ранней диагностики катастрофического антифосфолипидного синдрома необходима настороженность при возникновении признаков ДВС-синдрома и быстро развивающейся полиорганной недостаточности. Clinical manifestations of the catastrophic antiphospholipid syndrome are diverse, which complicates timely diagnosis and, accordingly, adequate treatment. Goal: eliminate the difficulties encountered by practitioners in the diagnosis, differential diagnosis and treatment of catastrophic antiphospholipid syndrome, based on the analysis of literature data and on the example of a clinical case. Materials and methods: we did not find any studies on this issue in domestic sources, which led to the need to focus on literature data and a clinical example. Results: on the basis of the anamnesis of the disease, the results of clinical and additional research methods of the patient, a diagnosis of catastrophic antiphospholipid syndrome was established. Conclusions: for early diagnosis of catastrophic antiphospholipid syndrome, alertness is required when signs of disseminated intravascular coagulation and rapidly developing multiple organ failure occur.


Author(s):  
Alessandro Feola ◽  
Paola Ciamarra ◽  
Mariavictoria De Simone ◽  
Anna Carfora ◽  
Gelsomina Mansueto ◽  
...  

Background: Haematological malignancies, such as lymphoma and leukaemia, can have a variety of clinical manifestations. The most frequent cause of death from haematological malignancies is multiple organ failure due to neoplastic organ infiltration and/or septic shock. Histiocytic sarcoma (HS) is a rare malignant nodal or extranodal tumour with histiocytic immunophenotype that originates from a lymphohematopoietic precursor. The patients with HS usually have a poor prognosis due to its aggressive clinical behaviour. Rare cases of undiagnosed sudden HS death have been described in the literature. Methods: A forensic autopsy of a 46-year-old white male who died at home suddenly and unexpectedly without warning conditions or known diseases. Gross analysis, histology and toxicology were also performed. Results: The diagnosis of HS of the ileum with secondary nodal and cardiac metastatization was made. Conclusions: A prompt diagnosis of HS in life is paramount because it can make a difference in prognostic outcomes.


2021 ◽  
Author(s):  
Yidi Qin ◽  
Kate F. Kernan ◽  
Zhenjiang Fan ◽  
Hyun-Jung Park ◽  
Soyeon Kim ◽  
...  

ABSTRACTObjectiveThrombotic microangiopathy induced Thrombocytopenia Associated Multiple Organ Failure and hyperinflammatory Macrophage Activation Syndrome are important causes of late pediatric sepsis mortality that are often missed or have delayed diagnosis. Our objective is to derive computable 24-hour sepsis phenotypes to facilitate enrollment in early precise anti-inflammatory trials targeting mortality from these conditions.DesignMachine learning analysis using consensus k-means clustering.SettingNine pediatric intensive care units.Patients404 children with severe sepsis.Interventions24-hour computable phenotypes derived using 25 bedside variables including C-reactive protein and ferritin.Measurements and Main ResultsFour computable phenotypes (PedSep-A, B, C, and D) are derived. Compared to the overall population mean, PedSep-A has the least inflammation (median C-reactive protein 7.3 mg/dL, ferritin 125 ng/mL), younger age, less chronic illness, and more respiratory failure (n = 135; 2% mortality); PedSep-B (median C-reactive protein 13.2 mg/dL, ferritin 225 ng/ mL) has organ failure with intubated respiratory failure, shock, and Glasgow Coma Scale score < 7 (n = 102, 12% mortality); PedSep-C (median C-reactive protein 15.2 mg/dL, ferritin 405 ng/mL) has elevated ferritin, lymphopenia, more shock, more hepatic failure and less respiratory failure (n = 110; mortality 10%); and, PedSep D (median C-reactive protein 13.1 mg/dL ferritin 610 ng/mL), has hyperferritinemic, thrombocytopenic multiple organ failure with more cardiovascular, respiratory, hepatic, renal, hematologic, and neurologic system failures (n = 56, 34% mortality). PedSep-D has highest likelihood of Thrombocytopenia Associated Multiple Organ Failure (Adj OR 47.51 95% CI [18.83-136.83], p < 0.0001) and Macrophage Activation Syndrome (Adj OR 38.63 95% CI [13.26-137.75], p <0.0001), and an observed survivor interaction with combined methylprednisolone and intravenous immunoglobulin therapies (p < 0.05).CONCLUSIONS AND RELEVANCEMachine learning identifies four computable phenotypes (www.pedsepsis.pitt.edu). Membership in PedSep-D appears optimal for enrollment in early anti-inflammatory trials targeting Thrombocytopenia Associated Multiple Organ Failure and Macrophage Activation Syndrome.Author’s CommentQuestionCan machine learning methods derive 24-hour computable pediatric sepsis phenotypes that facilitate early identification of patients for enrollment in precise anti-inflammatory therapy trials?FindingsFour distinct phenotypes (PedSep-A, B, C, and D) were derived by assessing 25 bedside clinical variables in 404 children with sepsis. PedSep-D patients had a thrombotic microangiopathy and hyperinflammatory macrophage activation biomarker response, and improved survival odds associated with combined methylprednisolone plus intravenous immunoglobulin therapy.MeaningFour novel computable 24-hour phenotypes are identifiable (www.pedsepsis.pitt.edu) that could potentially facilitate enrollment in early precise anti-inflammatory trials targeting thrombotic microangiopathy and macrophage activation in pediatric sepsis.


2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Helge Eberbach ◽  
Rolf Lefering ◽  
Sven Hager ◽  
Klaus Schumm ◽  
Lisa Bode ◽  
...  

AbstractThoracic trauma has decisive influence on the outcome of multiply-injured patients and is often associated with clavicle fractures. The affected patients are prone to lung dysfunction and multiple organ failure. A multi-center, retrospective analysis of patient records documented in the TraumaRegister DGU was performed to assess the influence of surgical stabilization of clavicle fractures in patients with thoracic trauma. A total of 3,209 patients were included in the analysis. In 1362 patients (42%) the clavicle fracture was treated operatively after 7.1 ± 5.3 days. Surgically treated patients had a significant reduction in lung failure (p = 0.013, OR = 0.74), multiple organ failure (p = 0.001, OR = 0.64), intubation time (p = 0.004; −1.81 days) and length of hospital stay (p = 0.014; −1.51 days) compared to non-operative treatment. Moreover, surgical fixation of the clavicle within five days following hospital admission significantly reduced the rates of lung failure (p = 0.01, OR = 0.62), multiple organ failure (p = 0.01, OR = 0.59) and length of hospital stay (p = 0.01; −2.1 days). Based on our results, multiply-injured patients with thoracic trauma and concomitant clavicle fracture may benefit significantly from surgical stabilization of a clavicle fracture, especially when surgery is performed within the first five days after hospital admission.


Author(s):  
S. SEREDA ◽  
S. DUBROV ◽  
M. DENYSIUK ◽  
O KOTLIAR ◽  
S. CHERNIAIEV ◽  
...  

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.


Medicine ◽  
2021 ◽  
Vol 100 (46) ◽  
pp. e27891
Author(s):  
Keun Taek Lee ◽  
Won Young Sung

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