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Association of malnutrition status with 30-day mortality in patients with sepsis using objective nutritional indices: a multicenter retrospective study in South Korea. 利用客观营养指数分析败血症患者营养不良状况与 30 天死亡率的关系:韩国一项多中心回顾性研究。
IF 1.8 Q3 CRITICAL CARE MEDICINE Pub Date : 2024-02-01 Epub Date: 2024-02-20 DOI: 10.4266/acc.2023.01613
Moon Seong Baek, Young Suk Kwon, Sang Soo Kang, Daechul Shim, Youngsang Yoon, Jong Ho Kim

Background: The Controlling Nutritional Status (CONUT) score and the prognostic nutritional index (PNI) have emerged as important nutritional indices because they provide an objective assessment based on data. We aimed to investigate how these nutritional indices relate to outcomes in patients with sepsis.

Methods: Data were collected retrospectively at five hospitals for patients aged ≥18 years receiving treatment for sepsis between January 1, 2017, and December 31, 2021. Serum albumin and total cholesterol concentrations, and peripheral lymphocytes were used to calculate the CONUT score and PNI. To identify predictors correlated with 30-day mortality, analyses were conducted using univariate and multivariate Cox proportional hazards models.

Results: The 30-day mortality rate among 9,763 patients was 15.8% (n=1,546). The median CONUT score was 5 (interquartile range [IQR], 3-7) and the median PNI score was 39.6 (IQR, 33.846.4). Higher 30-day mortality rates were associated with individuals with moderate (CONUT score: 5-8; PNI: 35-38) or severe (CONUT: 9-12; PNI: <35) malnutrition compared with those with no malnutrition (CONUT: 0-1; PNI: >38). With CONUT scores, the hazard ratio (HR) associated with moderate malnutrition was 1.52 (95% confidence interval [CI], 1.24-1.87; P<0.001); for severe, HR=2.42 (95% CI, 1.95-3.02; P<0.001). With PNI scores, the HR for moderate malnutrition was 1.29 (95% CI, 1.09-1.53; P=0.003); for severe, HR=1.88 (95% CI, 1.67-2.12; P<0.001).

Conclusions: The nutritional indices CONUT score and PNI showed significant associations with mortality of sepsis patients within 30 days.

背景:控制营养状况(CONUT)评分和预后营养指数(PNI)提供了基于数据的客观评估,因此已成为重要的营养指数。我们旨在研究这些营养指数与脓毒症患者预后的关系:我们在五家医院回顾性收集了 2017 年 1 月 1 日至 2021 年 12 月 31 日期间接受脓毒症治疗的年龄≥18 岁患者的数据。血清白蛋白和总胆固醇浓度以及外周淋巴细胞用于计算 CONUT 评分和 PNI。为了确定与 30 天死亡率相关的预测因素,使用单变量和多变量 Cox 比例危险模型进行了分析:结果:9763 名患者的 30 天死亡率为 15.8%(n=1546)。CONUT评分中位数为5(四分位数间距[IQR],3-7),PNI评分中位数为39.6(IQR,33.846.4)。中度(CONUT 评分:5-8;PNI:35-38)或重度(CONUT:9-12;PNI:38)患者的 30 天死亡率较高。根据 CONUT 评分,与中度营养不良相关的危险比 (HR) 为 1.52(95% 置信区间 [CI],1.24-1.87;PConclusions:营养指数CONUT评分和PNI与脓毒症患者30天内的死亡率有显著关联。
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引用次数: 0
Diagnostic accuracy of left ventricular outflow tract velocity time integral versus inferior vena cava collapsibility index in predicting post-induction hypotension during general anesthesia: an observational study. 左心室流出道速度时间积分与下腔静脉塌陷指数在预测全身麻醉诱导后低血压方面的诊断准确性:一项观察性研究。
IF 1.8 Q3 CRITICAL CARE MEDICINE Pub Date : 2024-02-01 Epub Date: 2024-02-23 DOI: 10.4266/acc.2023.00913
Vibhuti Sharma, Arti Sharma, Arvind Sethi, Jyoti Pathania

Background: Point of care ultrasound (POCUS) is being explored for dynamic measurements like inferior vena cava collapsibility index (IVC-CI) and left ventricular outflow tract velocity time integral (LVOT-VTI) to guide anesthesiologists in predicting fluid responsiveness in the preoperative period and in treating post-induction hypotension (PIH) with varying accuracy.

Methods: In this prospective, observational study on included 100 adult patients undergoing elective surgery under general anesthesia, the LVOT-VTI and IVC-CI measurements were performed in the preoperative room 15 minutes prior to surgery, and PIH was measured for 20 minutes in the post-induction period.

Results: The incidence of PIH was 24%. The area under the curve, sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of the two techniques at 95% confidence interval was 0.613, 30.4%, 93.3%, 58.3%, 81.4%, 73.6% for IVC-CI and 0.853, 83.3%, 80.3%, 57.1%, 93.8%, 77.4% for LVOT-VTI, respectively. In multivariate analysis, the cutoff value for IVC-CI was >51.5 and for LVOT-VTI it was ≤17.45 for predicting PIH with odd ratio [OR] of 8.491 (P=0.025) for IVCCI and OR of 17.427 (P<0.001) for LVOT. LVOT-VTI assessment was possible in all the patients, while 10% of patients were having poor window for IVC measurements.

Conclusions: We recommend the use of POCUS using LVOT-VTI or IVC-CI to predict PIH, to decrease the morbidity of patients undergoing surgery. Out of these, we recommend LVOT-VTI measurements as it has showed a better diagnostic accuracy (77.4%) with no failure rate.

背景:目前正在探索利用护理点超声(POCUS)进行动态测量,如下腔静脉塌陷指数(IVC-CI)和左心室流出道速度时间积分(LVOT-VTI),以指导麻醉医生预测术前输液反应和治疗诱导后低血压(PIH),其准确性各不相同:在这项前瞻性观察研究中,100 名成人患者在全身麻醉下接受择期手术,术前 15 分钟在术前室进行 LVOT-VTI 和 IVC-CI 测量,诱导后 20 分钟测量 PIH:PIH发生率为24%。IVC-CI 和 LVOT-VTI 的曲线下面积、敏感性、特异性、阳性预测值、阴性预测值和诊断准确性在 95% 置信区间分别为 0.613、30.4%、93.3%、58.3%、81.4%、73.6% 和 0.853、83.3%、80.3%、57.1%、93.8%、77.4%。在多变量分析中,预测 PIH 的 IVC-CI 临界值>51.5,LVOT-VTI 临界值≤17.45,IVCCI 的奇数比[OR]为 8.491(P=0.025),PConclusions 的 OR 为 17.427:我们建议使用 LVOT-VTI 或 IVC-CI 进行 POCUS 预测 PIH,以降低手术患者的发病率。其中,我们推荐使用 LVOT-VTI 测量,因为它的诊断准确率更高(77.4%),且无失败率。
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引用次数: 0
Prolonged intensive care: muscular functional, and nutritional insights from the COVID-19 pandemic. 长期重症监护:从 COVID-19 大流行病中了解肌肉、功能和营养状况。
IF 1.8 Q3 CRITICAL CARE MEDICINE Pub Date : 2024-02-01 Epub Date: 2024-02-02 DOI: 10.4266/acc.2023.01284
Miguel Ángel Martínez-Camacho, Robert Alexander Jones-Baro, Alberto Gómez-González, Dalia Sahian Lugo-García, Pía Carolina Gallardo Astorga, Andrea Melo-Villalobos, Bárbara Kassandra Gonzalez-Rodriguez, Ángel Augusto Pérez-Calatayud

During the coronavirus disease 2019 (COVID-19) pandemic, clinical staff learned how to manage patients enduring extended stays in an intensive care unit (ICU). COVID-19 patients requiring critical care in an ICU face a high risk of experiencing prolonged intensive care (PIC). The use of invasive mechanical ventilation in individuals with severe acute respiratory distress syndrome can cause numerous complications that influence both short-term and long-term morbidity and mortality. Those risks underscore the importance of proactively addressing functional complications. Mitigating secondary complications unrelated to the primary pathology of admission is imperative in minimizing the risk of PIC. Therefore, incorporating strategies to do that into daily ICU practice for both COVID-19 patients and those critically ill from other conditions is significantly important.

在冠状病毒病 2019(COVID-19)大流行期间,临床医护人员学会了如何管理在重症监护室(ICU)长期住院的患者。需要在重症监护室接受重症监护的 COVID-19 患者面临着长期重症监护 (PIC) 的高风险。对患有严重急性呼吸窘迫综合征的患者使用有创机械通气可引起多种并发症,影响短期和长期的发病率和死亡率。这些风险凸显了积极应对功能性并发症的重要性。减轻与入院时的主要病理无关的继发性并发症对于最大限度地降低 PIC 风险至关重要。因此,无论是 COVID-19 患者还是其他病症的重症患者,在重症监护室的日常工作中纳入相关策略都非常重要。
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引用次数: 0
Clinical characteristics and outcomes of obstetric patients transferred directly to intensive care units. 直接转入重症监护室的产科病人的临床特征和预后。
IF 1.8 Q3 CRITICAL CARE MEDICINE Pub Date : 2024-02-01 Epub Date: 2024-02-15 DOI: 10.4266/acc.2023.01375
Saad Pirzada, Kimberly Boswell, Jerry Yang, Samantha Asuncion, Fernando Albelo, Amanda Tuchler, Lauren Becker, Allison Lankford, Emad Elsamadicy, Quincy K Tran

Background: Medical complications in peripartum patients are uncommon. Often, these patients are transferred to tertiary care centers, but their conditions and outcomes are not well understood. Our study examined peripartum patients transferred to an intensive care unit (ICU) at an academic quaternary center.

Methods: We reviewed charts of adult, non-trauma, interhospital transfer (IHT) peripartum patients sent to an academic quaternary ICU between January 2017 and December 2021. We conducted a descriptive analysis and used multivariable ordinal regression to examine associations of demographic and clinical factors with ICU length of stay (LOS) and hospital length of stay (HLOS).

Results: Of 1,794 IHT peripartum patients, 60 (3.2%) were directly transferred to an ICU. The average was 32 years, with a median Sequential Organ Failure Assessment (SOFA) score of 3 (1-4.25) and Acute Physiology and Chronic Health Evaluation (APACHE) II score of 8 (7-12). Respiratory failure was most common (32%), followed by postpartum hemorrhage (15%) and sepsis (14%). Intubation was required for 24 (41%), and 4 (7%) needed extracorporeal membrane oxygenation. Only 1 (1.7%) died, while 45 (76.3%) were discharged. Median ICU LOS and HLOS were 5 days (212) and 8 days (5-17). High SOFA score was linked to longer HLOS, as was APACHE II.

Conclusions: Transfers of critically ill peripartum patients between hospitals were rare but involved severe medical conditions. Despite this, their outcomes were generally positive. Larger studies are needed to confirm our findings.

背景:围产期患者的医疗并发症并不常见。这些患者通常会被转到三级医疗中心,但他们的病情和预后并不十分清楚。我们的研究考察了转入一家学术性四级中心重症监护室(ICU)的围产期患者:我们查阅了2017年1月至2021年12月期间被送往学术性四级中心重症监护室的成年、非创伤、院间转运(IHT)围产期患者的病历。我们进行了描述性分析,并使用多变量序数回归法研究了人口统计学和临床因素与重症监护室住院时间(LOS)和住院时间(HLOS)的相关性:在1794例IHT围产期患者中,有60例(3.2%)直接转入ICU。患者平均年龄为 32 岁,序贯器官衰竭评估(SOFA)中位数评分为 3 分(1-4.25),急性生理学和慢性健康评估(APACHE)II 评分为 8 分(7-12)。呼吸衰竭最常见(32%),其次是产后出血(15%)和败血症(14%)。有 24 人(41%)需要插管,4 人(7%)需要体外膜氧合。只有 1 人(1.7%)死亡,45 人(76.3%)出院。重症监护室的中位生存期和高危生存期分别为5天(212天)和8天(5-17天)。高SOFA评分与较长的HLOS有关,APACHE II评分也与较长的HLOS有关:结论:围产期危重病人在医院之间转院的情况很少见,但涉及严重的医疗状况。尽管如此,他们的转院结果普遍良好。需要更大规模的研究来证实我们的发现。
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引用次数: 0
Association between mechanical power and intensive care unit mortality in Korean patients under pressure-controlled ventilation. 压力控制通气下韩国患者的机械动力与重症监护室死亡率之间的关系。
IF 1.8 Q3 CRITICAL CARE MEDICINE Pub Date : 2024-02-01 Epub Date: 2024-01-26 DOI: 10.4266/acc.2023.00871
Jae Kyeom Sim, Sang-Min Lee, Hyung Koo Kang, Kyung Chan Kim, Young Sam Kim, Yun Seong Kim, Won-Yeon Lee, Sunghoon Park, So Young Park, Ju-Hee Park, Yun Su Sim, Kwangha Lee, Yeon Joo Lee, Jin Hwa Lee, Heung Bum Lee, Chae-Man Lim, Won-Il Choi, Ji Young Hong, Won Jun Song, Gee Young Suh

Background: Mechanical power (MP) has been reported to be associated with clinical outcomes. Because the original MP equation is derived from paralyzed patients under volume-controlled ventilation, its application in practice could be limited in patients receiving pressure-controlled ventilation (PCV). Recently, a simplified equation for patients under PCV was developed. We investigated the association between MP and intensive care unit (ICU) mortality.

Methods: We conducted a retrospective analysis of Korean data from the Fourth International Study of Mechanical Ventilation. We extracted data of patients under PCV on day 1 and calculated MP using the following simplified equation: MPPCV = 0.098 ∙ respiratory rate ∙ tidal volume ∙ (ΔPinsp + positive end-expiratory pressure), where ΔPinsp is the change in airway pressure during inspiration. Patients were divided into survivors and non-survivors and then compared. Multivariable logistic regression was performed to determine association between MPPCV and ICU mortality. The interaction of MPPCV and use of neuromuscular blocking agent (NMBA) was also analyzed.

Results: A total of 125 patients was eligible for final analysis, of whom 38 died in the ICU. MPPCV was higher in non-survivors (17.6 vs. 26.3 J/min, P<0.001). In logistic regression analysis, only MPPCV was significantly associated with ICU mortality (odds ratio, 1.090; 95% confidence interval, 1.029-1.155; P=0.003). There was no significant effect of the interaction between MPPCV and use of NMBA on ICU mortality (P=0.579).

Conclusions: MPPCV is associated with ICU mortality in patients mechanically ventilated with PCV mode, regardless of NMBA use.

背景:据报道,机械功率(MP)综合了影响呼吸机诱发肺损伤的呼吸机变量,与临床预后相关。由于最初的 MP 方程是从接受容量控制通气的瘫痪病人中推导出来的,因此其在接受压力控制通气(PCV)的病人中的实际应用可能会受到限制。最近,针对 PCV 患者开发了一个简化方程。我们研究了 MP 与重症监护病房(ICU)死亡率之间的关系:我们对韩国第四次国际机械通气研究的数据进行了回顾性分析。我们提取了第 1 天接受 PCV 的患者数据,并使用以下简化公式计算了 MP:MPPCV=0.098 ∙ RR ∙ VT ∙ (ΔPinsp + PEEP)。将患者分为存活者和非存活者,然后进行比较。进行多变量逻辑回归以确定 MPPCV 与 ICU 死亡率之间的关系。同时还分析了MPPCV与使用神经肌肉阻断剂(NMBA)之间的相互作用:共有 125 名患者符合最终分析条件,其中 38 人死于重症监护室。非存活患者的 MPPCV 较高(17.6 J/min 对 26.3 J/min,PC结论:在使用 PCV 模式进行机械通气的患者中,无论是否使用 NMBA,MPPCV 都与 ICU 死亡率相关。
{"title":"Association between mechanical power and intensive care unit mortality in Korean patients under pressure-controlled ventilation.","authors":"Jae Kyeom Sim, Sang-Min Lee, Hyung Koo Kang, Kyung Chan Kim, Young Sam Kim, Yun Seong Kim, Won-Yeon Lee, Sunghoon Park, So Young Park, Ju-Hee Park, Yun Su Sim, Kwangha Lee, Yeon Joo Lee, Jin Hwa Lee, Heung Bum Lee, Chae-Man Lim, Won-Il Choi, Ji Young Hong, Won Jun Song, Gee Young Suh","doi":"10.4266/acc.2023.00871","DOIUrl":"10.4266/acc.2023.00871","url":null,"abstract":"<p><strong>Background: </strong>Mechanical power (MP) has been reported to be associated with clinical outcomes. Because the original MP equation is derived from paralyzed patients under volume-controlled ventilation, its application in practice could be limited in patients receiving pressure-controlled ventilation (PCV). Recently, a simplified equation for patients under PCV was developed. We investigated the association between MP and intensive care unit (ICU) mortality.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of Korean data from the Fourth International Study of Mechanical Ventilation. We extracted data of patients under PCV on day 1 and calculated MP using the following simplified equation: MPPCV = 0.098 ∙ respiratory rate ∙ tidal volume ∙ (ΔPinsp + positive end-expiratory pressure), where ΔPinsp is the change in airway pressure during inspiration. Patients were divided into survivors and non-survivors and then compared. Multivariable logistic regression was performed to determine association between MPPCV and ICU mortality. The interaction of MPPCV and use of neuromuscular blocking agent (NMBA) was also analyzed.</p><p><strong>Results: </strong>A total of 125 patients was eligible for final analysis, of whom 38 died in the ICU. MPPCV was higher in non-survivors (17.6 vs. 26.3 J/min, P<0.001). In logistic regression analysis, only MPPCV was significantly associated with ICU mortality (odds ratio, 1.090; 95% confidence interval, 1.029-1.155; P=0.003). There was no significant effect of the interaction between MPPCV and use of NMBA on ICU mortality (P=0.579).</p><p><strong>Conclusions: </strong>MPPCV is associated with ICU mortality in patients mechanically ventilated with PCV mode, regardless of NMBA use.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"91-99"},"PeriodicalIF":1.8,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11002610/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139673234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Factors related to lung function outcomes in critically ill COVID-19 patients in South Korea. 韩国 COVID-19 重症患者肺功能结果的相关因素。
IF 1.8 Q3 CRITICAL CARE MEDICINE Pub Date : 2024-02-01 Epub Date: 2024-02-20 DOI: 10.4266/acc.2023.00668
Tae Hun Kim, Myung Jin Song, Sung Yoon Lim, Yeon Joo Lee, Young-Jae Cho

Background: New variants of the virus responsible for the coronavirus disease 2019 (COVID-19) pandemic continue to emerge. However, little is known about the effect of these variants on clinical outcomes. This study evaluated the risk factors for poor pulmonary lung function test (PFT).

Methods: The study retrospectively analyzed 87 patients in a single hospital and followed up by performing PFTs at an outpatient clinic from January 2020 to December 2021. COVID-19 variants were categorized as either a non-delta variant (November 13, 2020-July 6, 2021) or the delta variant (July 7, 2021-January 29, 2022).

Results: The median age of the patients was 62 years, and 56 patients (64.4%) were male. Mechanical ventilation (MV) was provided for 52 patients, and 36 (41.4%) had restrictive lung defects. Forced vital capacity (FVC) and diffusion capacity of the lung for carbon monoxide (DLCO ) were lower in patients on MV. Male sex (odds ratio [OR], 0.228) and MV (OR, 4.663) were significant factors for decreased DLCO . The duration of MV was associated with decreased FVC and DLCO . However, the type of variant did not affect the decrease in FVC (P=0.750) and DLCO (P=0.639).

Conclusions: Among critically ill COVID-19 patients, 40% had restrictive patterns with decreased DLCO . The reduction of PFT was associated with MV, type of variants.

背景:造成 2019 年冠状病毒病(COVID-19)大流行的病毒不断出现新的变种。然而,人们对这些变种对临床结果的影响知之甚少。本研究评估了肺功能测试(PFT)不良的风险因素:研究回顾性分析了一家医院的 87 名患者,并于 2020 年 1 月至 2021 年 12 月期间在门诊进行了 PFT 随访。COVID-19变异体被分为非delta变异体(2020年11月13日至2021年7月6日)或delta变异体(2021年7月7日至2022年1月29日):患者的中位年龄为 62 岁,56 名患者(64.4%)为男性。52 名患者接受了机械通气(MV),36 名患者(41.4%)有限制性肺缺损。接受机械通气的患者的用力肺活量(FVC)和肺对一氧化碳的弥散能力(DLCO)较低。男性性别(比值比 [OR],0.228)和 MV(比值比,4.663)是导致 DLCO 下降的重要因素。MV 持续时间与 FVC 和 DLCO 下降有关。然而,变异类型并不影响 FVC(P=0.750)和 DLCO(P=0.639)的下降:结论:在 COVID-19 重症患者中,40% 的患者具有限制性模式,DLCO 下降。结论:在COVID-19危重症患者中,40%的患者有DLCO下降的限制型模式。
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引用次数: 0
Pre-intubation huddle to reduce peri-intubation adverse events 插管前集合,减少插管周围的不良事件
IF 1.8 Q3 CRITICAL CARE MEDICINE Pub Date : 2024-01-03 DOI: 10.4266/acc.2023.01151
Anna M Budde, Jenna L Potter, Anna R Benson, Jared A Larson, Christopher A Linke, Kathryn M Pendleton
{"title":"Pre-intubation huddle to reduce peri-intubation adverse events","authors":"Anna M Budde, Jenna L Potter, Anna R Benson, Jared A Larson, Christopher A Linke, Kathryn M Pendleton","doi":"10.4266/acc.2023.01151","DOIUrl":"https://doi.org/10.4266/acc.2023.01151","url":null,"abstract":"","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"79 18","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139388170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Effectiveness of massage and range of motion exercises on muscle strength and intensive care unit-acquired weakness in Iranian patients with COVID-19: a randomized parallel-controlled trial 按摩和活动范围练习对伊朗 COVID-19 患者肌力和重症监护室获得性乏力的效果:随机平行对照试验
IF 1.8 Q3 CRITICAL CARE MEDICINE Pub Date : 2023-12-13 DOI: 10.4266/acc.2023.00416
M. Zakeri, Adnan Rashid Aziz, E. Rahiminezhad, M. Dehghan
{"title":"Effectiveness of massage and range of motion exercises on muscle strength and intensive care unit-acquired weakness in Iranian patients with COVID-19: a randomized parallel-controlled trial","authors":"M. Zakeri, Adnan Rashid Aziz, E. Rahiminezhad, M. Dehghan","doi":"10.4266/acc.2023.00416","DOIUrl":"https://doi.org/10.4266/acc.2023.00416","url":null,"abstract":"","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"14 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139004126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Biomarkers to predict mortality in patients with Fournier's gangrene admitted to the intensive care unit after surgery. 预测富尼耶坏疽患者术后重症监护病房死亡率的生物标志物。
IF 1.8 Q3 CRITICAL CARE MEDICINE Pub Date : 2023-11-21 DOI: 10.4266/acc.2023.00766
In Sik Shin, Seong Chan Gong, Sanghyun An, Kwangmin Kim

Background: The use of biomarkers to predict patient outcomes may be crucial for patients admitted to the intensive care unit (ICU) following surgery because biomarkers guide clinicians in tailoring treatment plans accordingly. Therefore, we aimed to identify potential biomarkers to predict the prognosis of patients with Fournier's gangrene (FG) admitted to the ICU after surgery.

Methods: We enrolled patients with FG admitted to our Hospital between January 2013 and December 2022. We retrospectively analyzed patient characteristics, factors related to management, scores known to be associated with the prognosis of FG, and laboratory data.

Results: The study population included 28 survivors and 13 nonsurvivors. The initial serum lactate level taken in the emergency department; white blood cell, neutrophil, and platelet counts; delta neutrophil index and international normalized ratio; albumin, glucose, HCO3, and postoperative lactate levels; and the laboratory risk indicator for necrotizing fasciitis differed between survivors and nonsurvivors. Postoperative lactate and initial albumin levels were independent predictors of mortality in patients with FG. In the receiver operating characteristic curve analysis, the postoperative lactate level was the best indicator of mortality (area under the curve, 0.877; 95% confidence interval, 0.711-1.000). The optimal cutoff postoperative lactate level for predicting mortality was 3.0 mmol/L (sensitivity, 80.0%; specificity, 95.0%).

Conclusions: Postoperative lactate and initial albumin levels could be potential predictors of mortality in patients with FG admitted to the ICU after surgery, and the optimal cutoff postoperative lactate and initial albumin levels to predict mortality were 3.0 mmol/L and 3.05 g/dl, respectively. Large-scale multicenter prospective studies are required to confirm our results.

背景:使用生物标志物来预测患者预后可能对手术后入住重症监护病房(ICU)的患者至关重要,因为生物标志物可以指导临床医生相应地制定治疗计划。因此,我们旨在寻找潜在的生物标志物来预测富尼耶坏疽(FG)患者术后入住ICU的预后。方法:纳入2013年1月至2022年12月在我院住院的FG患者。我们回顾性分析了患者特征、与治疗相关的因素、已知与FG预后相关的评分以及实验室数据。结果:研究人群包括28名幸存者和13名非幸存者。急诊科初测血清乳酸水平;白细胞、中性粒细胞和血小板计数;δ中性粒细胞指数与国际标准化比值;白蛋白、葡萄糖、HCO3和术后乳酸水平;而坏死性筋膜炎的实验室风险指标在幸存者和非幸存者之间存在差异。术后乳酸和初始白蛋白水平是FG患者死亡率的独立预测因子。在受试者工作特征曲线分析中,术后乳酸水平是死亡率的最佳指标(曲线下面积,0.877;95%置信区间0.711-1.000)。术后乳酸水平预测死亡率的最佳临界值为3.0 mmol/L(敏感性为80.0%;特异性,95.0%)。结论:术后乳酸和初始白蛋白水平可作为FG术后入住ICU患者死亡率的潜在预测指标,预测死亡率的最佳临界值分别为3.0 mmol/L和3.05 g/dl。需要大规模的多中心前瞻性研究来证实我们的结果。
{"title":"Biomarkers to predict mortality in patients with Fournier's gangrene admitted to the intensive care unit after surgery.","authors":"In Sik Shin, Seong Chan Gong, Sanghyun An, Kwangmin Kim","doi":"10.4266/acc.2023.00766","DOIUrl":"10.4266/acc.2023.00766","url":null,"abstract":"<p><strong>Background: </strong>The use of biomarkers to predict patient outcomes may be crucial for patients admitted to the intensive care unit (ICU) following surgery because biomarkers guide clinicians in tailoring treatment plans accordingly. Therefore, we aimed to identify potential biomarkers to predict the prognosis of patients with Fournier's gangrene (FG) admitted to the ICU after surgery.</p><p><strong>Methods: </strong>We enrolled patients with FG admitted to our Hospital between January 2013 and December 2022. We retrospectively analyzed patient characteristics, factors related to management, scores known to be associated with the prognosis of FG, and laboratory data.</p><p><strong>Results: </strong>The study population included 28 survivors and 13 nonsurvivors. The initial serum lactate level taken in the emergency department; white blood cell, neutrophil, and platelet counts; delta neutrophil index and international normalized ratio; albumin, glucose, HCO3, and postoperative lactate levels; and the laboratory risk indicator for necrotizing fasciitis differed between survivors and nonsurvivors. Postoperative lactate and initial albumin levels were independent predictors of mortality in patients with FG. In the receiver operating characteristic curve analysis, the postoperative lactate level was the best indicator of mortality (area under the curve, 0.877; 95% confidence interval, 0.711-1.000). The optimal cutoff postoperative lactate level for predicting mortality was 3.0 mmol/L (sensitivity, 80.0%; specificity, 95.0%).</p><p><strong>Conclusions: </strong>Postoperative lactate and initial albumin levels could be potential predictors of mortality in patients with FG admitted to the ICU after surgery, and the optimal cutoff postoperative lactate and initial albumin levels to predict mortality were 3.0 mmol/L and 3.05 g/dl, respectively. Large-scale multicenter prospective studies are required to confirm our results.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2023-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138296225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A successful application of adult polymyxin B-immobilized fiber column hemoperfusion to a neonate with septic shock 成人多粘菌素b固定化纤维柱血液灌流在新生儿感染性休克中的成功应用
Q3 CRITICAL CARE MEDICINE Pub Date : 2023-11-03 DOI: 10.4266/acc.2017.00528.e1
Young A Kim, Hyungtae Kim, Yu-Mi Kim, Su Eun Park
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引用次数: 0
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Acute and Critical Care
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