Prognosis factors in lung transplant recipients readmitted to the intensive care unit

B Suberviola,J Llorca,A Vallejo,E Miñambres,C Gonzalez Mansilla,A Gonzalez Castro

doi:10.1186/cc5634

Abstract

Objective. To identify outcome predictors and prognostic factors for survival among lung transplant recipients on readmission to the intensive care unit (ICU). Methods. This was a retrospective study of all lung transplant recipients during a 10-year period from 1997 to 2006. Data collection included age, gender, reason, and type of lung transplantation. Variables specific to individual ICU admissions included admission diagnosis, length of stay, duration of mechanical ventilation, interval from transplantation, Acute Physiology and Chronic Health Evaluation (APACHE) II score on ICU admission, and the identification of systemic organ dysfunction. We used Student t test (or where appropriate, its nonparametric equivalent) or the 2 test for comparisons among the patients who died and those who survived their ICU readmissions. Results. Among 144 lung transplant patients 28 were later readmitted to the ICU after at least 1 week. The admission diagnosis was sepsis in 20 cases (71.4%). Seventeen patients died during their ICU stay (60.7%). A higher APACHE II score (P .008), the presence of three or more dysfunctional organs upon readmission (P .016), and the need for mechanical ventilation (P .022) were risk factors for mortality. The mortality risk was also higher among the group with a longer delay to ICU readmission (P .003). Discussion. Readmission to the ICU, which is common among lung transplant recipients, was associated with a high mortality. Sepsis was the main cause of ICU readmission and the most frequent cause of death. APACHE II score, need for mechanical ventilation, number of dysfunctional organs, and delay in ICU readmission were important prognostic factors.

Highlights

To clarify the relation between ATP and prostaglandinE2 (PGE2) in the immunologic system, we investigated the acute and chronic effects of PGE2 on activation of purinergic signaling in monocytes by measuring the ATP-induced elevation of intracellularCa2+ ([Ca]i) in fura-2-loaded THP-1 monocytes
IFNγ plays a critical role in host defense by promoting Th1 phenotype and bacterial clearance
Low IFNγ levels are were washed, loaded with fura-2-AM, and transferred into a quartz associated with the Th2 phenotype consistent with critical illness cuvette and placed in the thermostat-regulated sample chamber of anergy [2]

Summary

Introduction

To clarify the relation between ATP and prostaglandinE2 (PGE2) in the immunologic system, we investigated the acute and chronic effects of PGE2 on activation of purinergic signaling in monocytes by measuring the ATP-induced elevation of intracellularCa2+ ([Ca]i) in fura-2-loaded THP-1 monocytes. Several experimental studies suggest that thrombolysis therapy acts directly on thrombi or emboli and enhances microcirculatory reperfusion In this retrospective study we investigated the extent of blood coagulation and fibrin formation via the plasma D-dimer level, an indicator of endogenous fibrinolytic activity, in patients who underwent inhospital and out-of-hospital cardiac arrest from nontraumatic causes. Methods MEDLINE, EMBASE, CINAHL, and the Cochrane Library were searched, and studies were included if they reported on ICU patients > 16 years old who were evaluated for CINMA clinically and electrophysiologically, and they contained sufficient data to quantitatively measure the association between CINMA and clinically relevant exposures and/or outcomes. Our aim was to evaluate the role of the cardiac markers NT-proBNP, Troponin T (TnT) and myoglobin as predictors of inhospital and 6-month all-cause mortality in patients admitted to a general adult ICU with severe sepsis/septic shock. Aging is associated with decreased cardiopulmonary and renal reserve as well as the development of progressive organ failure

Objectives

Methods

Results

Discussion

Conclusion