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1.
A novel biomarker for predicting sepsis mortality: SCUBE-1.
Erdoğan, M, Findikli, HA, Okuducu Teran, İ
Medicine. 2021;(6):e24671
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Abstract
The mortality rate of patients diagnosed with sepsis is high. To date, many markers in sepsis patients have been studied to diagnose, determine their prognosis, and contribute to treatment. These studies were conducted in both experimental and clinical settings, but clinical trials remain limited. Therefore, more well-planned clinical studies are needed in patients with sepsis.The current study aimed to examine the prognostic role of signal peptide-CUB-epidermal growth factor-like domain-containing protein 1 (SCUBE-1) in sepsis and sepsis-related mortality. We also wanted to study its relationship with inflammatory markers and scoring systems.This prospective, cross-sectional, observational study included a total of 187 sepsis cases treated in the intensive care unit. Venous samples were obtained after diagnosis. The patients were separated into 2 groups: (1) the survivor group who were discharged or transferred within 28 days of the first diagnosis and (2) the nonsurvivor group who died within 28 days of the first diagnosis.The SCUBE-1, C-reactive protein, procalcitonin, creatinine, lactate values, acute physiology and chronic health evaluation 2, sequential organ failure assessment scores were significantly higher in the survivor group, and platelets were higher in the survivor group. In addition, SCUBE-1 positively correlated with the inflammatory markers C-reactive protein, lactate, sequential organ failure assessment, and acute physiology and chronic health evaluation 2. Additionally, the SCUBE-1 value predicts 28-day mortality, and the optimal cutoff value for predicting mortality is 4,73 pg/mL.Sepsis is a disease with high mortality. SCUBE-1 can be used as a new prognostic factor for sepsis patients.
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Comprehensive versus standard care in post-severe acute kidney injury survivors, a randomized controlled trial.
Thanapongsatorn, P, Chaikomon, K, Lumlertgul, N, Yimsangyad, K, Leewongworasingh, A, Kulvichit, W, Sirivongrangson, P, Peerapornratana, S, Chaijamorn, W, Avihingsanon, Y, et al
Critical care (London, England). 2021;(1):322
Abstract
BACKGROUND Currently, there is a lack of evidence to guide optimal care for acute kidney injury (AKI) survivors. Therefore, post-discharge care by a multidisciplinary care team (MDCT) may improve these outcomes. This study aimed to demonstrate the outcomes of implementing comprehensive care by a MDCT in severe AKI survivors. METHODS This study was a randomized controlled trial conducted between August 2018 to January 2021. Patients who survived severe AKI stage 2-3 were enrolled and randomized to be followed up with either comprehensive or standard care for 12 months. The comprehensive post-AKI care involved an MDCT (nephrologists, nurses, nutritionists, and pharmacists). The primary outcome was the feasibility outcomes; comprising of the rates of loss to follow up, 3-d dietary record, drug reconciliation, and drug alert rates at 12 months. Secondary outcomes included major adverse kidney events, estimated glomerular filtration rate (eGFR), and the amount of albuminuria at 12 months. RESULTS Ninety-eight AKI stage 3 survivors were enrolled and randomized into comprehensive care and standard care groups (49 patients in each group). Compared to the standard care group, the comprehensive care group had significantly better feasibility outcomes; 3-d dietary record, drug reconciliation, and drug alerts (p < 0.001). The mean eGFR at 12 months were comparable between the two groups (66.74 vs. 61.12 mL/min/1.73 m2, p = 0.54). The urine albumin: creatinine ratio (UACR) was significantly lower in the comprehensive care group (36.83 vs. 177.70 mg/g, p = 0.036), while the blood pressure control was also better in the comprehensive care group (87.9% vs. 57.5%, p = 0.006). There were no differences in the other renal outcomes between the two groups. CONCLUSIONS Comprehensive care by an MDCT is feasible and could be implemented for severe AKI survivors. MDCT involvement also yields better reduction of the UACR and better blood pressure control. Trial registration Clinicaltrial.gov: NCT04012008 (First registered July 9, 2019).
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Assessment of Sarcopenia in the Intensive Care Unit and 1-Year Mortality in Survivors of Critical Illness.
Yanagi, N, Koike, T, Kamiya, K, Hamazaki, N, Nozaki, K, Ichikawa, T, Matsunaga, A, Kuroiwa, M, Arai, M
Nutrients. 2021;(8)
Abstract
Skeletal muscle wasting in the intensive care unit (ICU) has been associated with mortality, but it is unclear whether sarcopenia, defined by skeletal muscle mass and function, is useful for detailed risk stratification after ICU discharge. In this cohort study, 72 critically ill patients with an ICU stay of ≥48 h were identified. Skeletal muscle mass was assessed from the muscle thickness (MT) of the patients' quadriceps using ultrasound images before ICU discharge. Skeletal muscle function was assessed from the patients' muscle strength (MS) before ICU discharge according to the Medical Research Council sum score. A diagnosis of sarcopenia in the ICU was made in patients with low MT and low MS. The study endpoint was 1-year mortality. Sarcopenia in the ICU was diagnosed in 26/72 patients (36%). After adjusting for covariates in the Cox regression, sarcopenia in the ICU was significantly associated with 1-year mortality (hazard ratio 3.82; 95% confidence interval, 1.40-10.42). Sarcopenia in the ICU, defined by low skeletal muscle mass and function, was associated with 1-year mortality in survivors of critical illness. Skeletal muscle mass and function assessed at the bedside could be used to identify higher-risk patients in the ICU.
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Skeletal Muscle Changes, Function, and Health-Related Quality of Life in Survivors of Pediatric Critical Illness.
Ong, C, Lee, JH, Wong, JJM, Leow, MKS, Puthucheary, ZA
Critical care medicine. 2021;(9):1547-1557
Abstract
OBJECTIVES To describe functional and skeletal muscle changes observed during pediatric critical illness and recovery and their association with health-related quality of life. DESIGN Prospective cohort study. SETTING Single multidisciplinary PICU. PATIENTS Children with greater than or equal to 1 organ dysfunction, expected PICU stay greater than or equal to 48 hours, expected survival to discharge, and without progressive neuromuscular disease or malignancies were followed from admission to approximately 6.7 months postdischarge. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Functional status was measured using the Functional Status Scale score and Pediatric Evaluation of Disability Inventory-Computer Adaptive Test. Patient and parental health-related quality of life were measured using the Pediatric Quality of Life Inventory and Short Form-36 questionnaires, respectively. Quadriceps muscle size, echogenicity, and fat thickness were measured using ultrasonography during PICU stay, at hospital discharge, and follow-up. Factors affecting change in muscle were explored. Associations between functional, muscle, and health-related quality of life changes were compared using regression analysis. Seventy-three survivors were recruited, of which 44 completed follow-ups. Functional impairment persisted in four of 44 (9.1%) at 6.7 months (interquartile range, 6-7.7 mo) after discharge. Muscle size decreased during PICU stay and was associated with inadequate energy intake (adjusted β, 0.15; 95% CI, 0.02-0.28; p = 0.030). No change in echogenicity or fat thickness was observed. Muscle growth postdischarge correlated with mobility function scores (adjusted β, 0.05; 95% CI, 0.01-0.09; p = 0.046). Improvements in mobility scores were associated with improved physical health-related quality of life at follow-up (adjusted β, 1.02; 95% CI, 0.23-1.81; p = 0.013). Child physical health-related quality of life at hospital discharge was associated with parental physical health-related quality of life (adjusted β, 0.09; 95% CI, 0.01-0.17; p = 0.027). CONCLUSIONS Muscle decreased in critically ill children, which was associated with energy inadequacy and impaired muscle growth postdischarge. Muscle changes correlated with change in mobility, which was associated with child health-related quality of life. Mobility, child health-related quality of life, and parental health-related quality of life appeared to be interlinked.
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5.
Activity Levels in Survivors of the Intensive Care Unit.
Gandotra, S, Files, DC, Shields, KL, Berry, M, Bakhru, RN
Physical therapy. 2021;(9)
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Abstract
OBJECTIVE Limited data exist on the quantification of activity levels and functional status in critically ill patients as they transition from the intensive care unit (ICU) to the wards and, subsequently, back into the community. The physical activity of critically ill patients from their ICU stay until 7 days after hospital discharge was characterized, as well as correlate physical activity levels with an objective measure of physical function. METHODS This prospective observational study of previously independent adults aged 55 or older, undergoing mechanical ventilation for up to 7 days, recruited participants at the time of spontaneous breathing trials or less than 24 hours after extubation. Participants received an accelerometer at enrollment to wear until 1 week after discharge. RESULTS Twenty-two participants received accelerometers; 15 were suitable for analysis. Participants had a mean (SD) age of 68 (9.6) years; 47% were female. Mean step counts were 95 (95% CI = 15-173) in the 3 days before ICU discharge, 257 (95% CI = 114-400) before hospital discharge, 1223 (95% CI = 376-2070) in the first 3 days at home, and 1278 (95% CI = 349-2207) between day 4 and 6 post-hospital discharge. Physical activity was significantly higher post- compared with pre-hospital discharge. Short Physical Performance Battery scores were poor at ICU and hospital discharge; however, they correlated moderately with physical activity levels immediately upon return home. CONCLUSIONS Physical activity remained low as survivors of critical illness transitioned from ICU to hospital wards, but significantly increased upon return to the community. Despite poor Short Physical Performance Battery scores at both ICU and hospital discharge, participants were significantly more active immediately after discharge than in their last 3 days of hospitalization. This may represent rapid functional improvement or, conversely, constrained physical activity in hospital. IMPACT This study highlights the need for further evaluation of physical activity constraints in hospital and ways to augment physical activity and function upon discharge. LAY SUMMARY Physical activity (step counts) increased modestly as survivors of critical illness transitioned from ICU to hospital wards, but significantly increased upon return to the community. This study highlights the need for further evaluation of physical activity constraints in the hospital setting and ways to augment physical activity and function postdischarge.
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Association of Positive Fluid Balance at Discharge After Sepsis Management With 30-Day Readmission.
Yoo, MS, Zhu, S, Lu, Y, Greene, JD, Hammer, HL, Iberti, CT, Nemazie, S, Ananias, MP, McCarthy, CM, O'Malley, RM, et al
JAMA network open. 2021;(6):e216105
Abstract
IMPORTANCE Although early fluid administration has been shown to lower sepsis mortality, positive fluid balance has been associated with adverse outcomes. Little is known about associations in non-intensive care unit settings, with growing concern about readmission from excess fluid accumulation in patients with sepsis. OBJECTIVE To evaluate whether positive fluid balance among non-critically ill patients with sepsis was associated with increased readmission risk, including readmission for heart failure. DESIGN, SETTING, AND PARTICIPANTS This multicenter retrospective cohort study was conducted between January 1, 2012, and December 31, 2017, among 57 032 non-critically ill adults hospitalized for sepsis at 21 hospitals across Northern California. Kaiser Permanente Northern California is an integrated health care system with a community-based population of more than 4.4 million members. Statistical analysis was performed from January 1 to December 31, 2019. EXPOSURES Intake and output net fluid balance (I/O) measured daily and cumulatively at discharge (positive vs negative). MAIN OUTCOMES AND MEASURES The primary outcome was 30-day readmission. The secondary outcomes were readmission stratified by category and mortality after living discharge. RESULTS The cohort included 57 032 patients who were hospitalized for sepsis (28 779 women [50.5%]; mean [SD] age, 73.7 [15.5] years). Compared with patients with positive I/O (40 940 [71.8%]), those with negative I/O (16 092 [28.2%]) were older, with increased comorbidity, acute illness severity, preexisting heart failure or chronic kidney disease, diuretic use, and decreased fluid administration volume. During 30-day follow-up, 8719 patients (15.3%) were readmitted and 3639 patients (6.4%) died. There was no difference in readmission between patients with positive vs negative I/O (HR, 1.00; 95% CI, 0.95-1.05). No association was detected between readmission and I/O using continuous, splined, and quadratic function transformations. Positive I/O was associated with decreased heart failure-related readmission (HR, 0.80 [95% CI, 0.71-0.91]) and increased 30-day mortality (HR, 1.23 [95% CI, 1.15-1.31]). CONCLUSIONS AND RELEVANCE In this large observational study of non-critically ill patients hospitalized with sepsis, there was no association between positive fluid balance at the time of discharge and readmission. However, these findings may have been limited by variable recording and documentation of fluid intake and output; additional studies are needed to examine the association of fluid status with outcomes in patients with sepsis to reduce readmission risk.
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Meta-analysis of Cardiovascular Events and Related Biomarkers Comparing Survivors Versus Non-survivors in Patients With COVID-19.
Shoar, S, Hosseini, F, Naderan, M, Mehta, JL
The American journal of cardiology. 2020;:50-61
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Abstract
Since the emergence of the coronavirus disease 19 (COVID-19), a number of studies have reported the presence of cardiovascular diseases in affected patients and linked them with a higher risk of mortality. We conducted an online search in Medline/PubMed to identify original cohorts comparing data between survivors and non-survivors from COVID-19. The presence of cardiovascular events and related biomarkers were compared between the 2 groups. Data on 1,845 hospitalized patients with COVID-19 were pooled from 12 comparative studies. The overall mortality rate in relation to COVID-19 was 17.6%. Men aged > 50 years old were more likely to die from COVID-19. Significant co-morbidities contributing to mortality were hypertension, diabetes mellitus, smoking, a previous history of cardiovascular disease including chronic heart failure, and cerebrovascular accidents. A significant relationship was observed between mortality and patient presentation with dyspnea, fatigue, tachycardia, and hypoxemia. Cardiovascular disease-related laboratory biomarkers related to mortality were elevated serum level of lactate dehydrogenase, creatine kinase, brain natriuretic peptide, and cardiac troponin I. Adverse cardiovascular disease-related clinical events preceding death were shock, arrhythmias, and acute myocardial injury. In conclusion, severe clinical presentation and elevated biomarkers in COVID-19 patients with established risk factors can predict mortality from cardiovascular causes.
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Active and sedentary bouts in people after stroke and healthy controls: An observational study.
Hassett, L, Ada, L, Hellweg, S, Paul, S, Alzahrani, M, Dean, C
Physiotherapy research international : the journal for researchers and clinicians in physical therapy. 2020;(3):e1845
Abstract
BACKGROUND AND PURPOSE Understanding how both active and sedentary time is accumulated in people after stroke may help to better target interventions to reduce stroke recurrence. This study aimed to determine the difference between stroke and healthy controls in (a) time spent in sedentary and active behaviour, (b) frequency of short and long active and sedentary bouts and (c) time spent in short and long active and sedentary bouts. METHODS Analysis of secondary outcomes from a cross-sectional study. Participants were 42 community-dwelling people after stroke and 21 age-matched healthy controls. An activity monitor was used to collect free-living active and sedentary behaviour. Total active (standing and walking) and sedentary (lying, reclining and sitting) time was calculated in minutes per day. Bouts were categorized as short (<5 min, 5-15 min, 15-30 min) or long (>30 min). The frequency of and time spent in each bout were calculated. RESULTS Relative to wear time, the stroke group spent 10% (95% confidence interval [CI] 3 to 17) more time in sedentary behaviour and had fewer long active bouts than the healthy controls. The stroke group spent 7% (95% CI 1-13) less time in long active bouts and 11% (95% CI 2-20) more time in long sedentary bouts than the healthy controls. CONCLUSIONS Community-dwelling people after stroke spent less time in active behaviour and accumulated more sedentary time in bouts longer than 30 min compared with healthy controls. Increasing active time and breaking up long sedentary time warrants investigation in people after stroke.
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Sexual dysfunction after stroke-A biopsychosocial perspective.
Na, Y, Htwe, M, Rehman, CA, Palmer, T, Munshi, S
International journal of clinical practice. 2020;(7):e13496
Abstract
OBJECTIVES Poststroke sexual dysfunction (PSSD) is widespread and underrecognised, affecting over half of stroke patients with significant effects on a patients' quality of life. We reviewed the postulated factors contributing to PSSD and explore the underrecognition by presenting a questionnaire study as well as examining existing literature. METHODS A literature search between January 1980 and December 2019 in electronic databases such as EMBASE, MEDLINE and PubMed was conducted. The questionnaire study involved all adult stroke patients attending the outpatient clinic over a 6-month period, containing multiple choice and open questions relating to prevalence, impact and provision provided for patients with PSSD. FINDINGS Poststroke sexual dysfunction is unlikely attributed solely to the physical effects of stroke. We present a biopsychosocial model summarising the wide range of factors which can contribute to PSSD. Less than 10% of patients receive any advice despite 90% of patients hoping for advice relating to sexual dysfunction in stroke. INTERPRETATION AND IMPLICATIONS A multidisciplinary, proactive involvement in screening and managing PSSD is required to successfully manage a commonly forgotten complication of stroke. As part of the wider theme of managing lifestyle factors poststroke (eg, smoking, driving advice, dietary advice, alcohol), the 'sexual function aspect' of patients' lives must not be ignored.
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Utility of neutrophil-to-lymphocyte ratio to identify long-term survivors among HCC patients treated with sorafenib.
Casadei-Gardini, A, Dadduzio, V, Rovesti, G, Cabibbo, G, Vukotic, R, Rizzato, MD, Orsi, G, Rossi, M, Guarneri, V, Lonardi, S, et al
Medicine. 2020;(22):e19958
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Abstract
Sorafenib is the first multikinase inhibitor demonstrating a survival benefit for patients suffering from advanced hepatocellular carcinoma (HCC). However, 1 issue remains open: what is the factor able to predict which patients will be long survivors?In the present study, we harnessed the potential of conditional survival, aiming at estimating the probability that a patient receiving sorafenib survives for more than 3 years.The present multicentric study was conducted on a cohort of 438 HCC patients. The primary end point was conditional overall survival. Kaplan-Meier survival analysis was used to calculate conditional overall survival probabilities at 3 years.The 3-year conditional survival of patients without disease progression highlights that NLR and ECOG are the factors that most accurately predict the probability of long survival. The 3-year conditional survival of patients with disease progression showed a medium effect size for HCV status, alpha-fetoprotein and NLR at all time-points. Macro-vascular portal vein invasion, extra hepatic disease, and BCLC we have a large effect size at 6 months and a medium effect size at 12 and 24 months.Our findings support the use of baseline NLR for the identification of patients with a higher probability of long-survival. NLR should be used as a stratification factor in the forthcoming clinical trials on the drugs for the advanced HCC now in pipeline.