Acute Shock Research Articles

Severe community-acquired pneumonia compared to severe community-acquired Acinetobacter baumannii pneumonia in Reunion Island: A retrospective study.

Acinetobacter baumannii (Ab) has emerged in the last decades as a cause of community-acquired pneumonia (CAP) in tropical and subtropical regions. We previously conducted the first investigation on this topic in France with a case series of severe CAP-Ab in Reunion Island over an eight-year period. In the present work, we aim to highlight the specific aspects of CAP-Ab by comparing our case series with an historical cohort (PAC_RUN), obtained by retrospective chart review (2016-2021) of severe community-acquired pneumonia cases on Reunion Island, in which CAP-Ab was ruled out. During the study period, eight CAP-Ab cases were identified, giving an incidence of 0.1 cases per 100,000 people/year, and an incidence of 16.5 cases per 100,000 people/year for non-Ab-related CAP (n = 761). By comparing with non-Ab-related CAP, patients had more excessive alcohol use (75% vs. 25.6%, p = 0.005) and lower body mass index (21 vs. 24 kg/m2, p = 0.004). Six cases (75%) of CAP-Ab occurred during the rainy season (p = 0.06). Mortality was higher (62.5% vs. 24.3%, p = 0.02) and time to death was shorter (median 2 days vs. 7, p = 0.009) in the CAP-Ab group. Bacteraemic pneumonia was strongly associated with CAP-Ab (62.5% vs. 15.7%, p = 0.004). Significant differences were found in the need for renal replacement therapy (75% vs. 17.2%, p < 0.001), catecholamine use (100% vs. 54.5%, p = 0.01) and use of invasive mechanical ventilation (100% vs. 62.7%, p = 0.03). Also, in the proportion of severe acute respiratory distress syndrome (62.5% vs. 23.2%, p = 0.02), septic shock (100% vs. 40.6%, p < 0.001), and cardiogenic shock (87.5% vs. 15.9%, p < 0.001). Compared to severe non-Ab-related CAP, severe CAP-Ab is characterised by higher mortality, associated with a high frequency of multiple organ failure. Excessive alcohol consumption and malnutrition seem to be risk factors. To improve outcomes, broader spectrum antibiotic therapy must be immediately proposed when CAP-Ab is suspected.

Development and internal validation of time-to-event risk prediction models for major medical complications within 30 days after elective colectomy.

Patients undergoing colectomy are at risk of numerous major complications. However, existing binary risk stratification models do not predict when a patient may be at highest risks of each complication. Accurate prediction of the timing of complications facilitates targeted, resource-efficient monitoring. We sought to develop and internally validate Cox proportional hazards models to predict time-to-complication of major complications within 30 days after elective colectomy. We studied a retrospective cohort from the multicentered American College of Surgeons National Surgical Quality Improvement Program procedure-targeted colectomy dataset. Patients aged 18 years or above, who underwent elective colectomy between January 1, 2014 and December 31, 2019 were included. A priori candidate predictors were selected based on variable availability, literature review, and multidisciplinary team consensus. Outcomes were mortality, hospital readmission, myocardial infarction, cerebral vascular events, pneumonia, venous thromboembolism, acute renal failure, and sepsis or septic shock within 30 days after surgery. The cohort consisted of 132145 patients (mean ± SD age, 61 ± 15 years; 52% females). Complication rates ranged between 0.3% (n = 383) for cardiac arrest and acute renal failure to 5.3% (n = 6986) for bleeding requiring transfusion, with readmission rate of 8.6% (n = 11415). We observed distinct temporal patterns for each complication: the median [quartiles] postoperative day of complication diagnosis ranged from 1 [0, 2] days for bleeding requiring transfusion to 12 [6, 18] days for venous thromboembolism. Models for mortality, myocardial infarction, pneumonia, and renal failure showed good discrimination with a concordance > 0.8, while models for readmission, venous thromboembolism, and sepsis performed poorly with a concordance of 0.6 to 0.7. Models exhibited good calibration but ranges were limited to low probability areas. We developed and internally validated time-to-event prediction models for complications after elective colectomy. Once further validated, the models can facilitate tailored monitoring of high risk patients during high risk periods. Clinicaltrials.gov (NCT05150548; Principal Investigator: Janny Xue Chen Ke, M.D., M.Sc., F.R.C.P.C.; initial posting: November 25, 2021).

Association between the lowest level of serum albumin during hospitalization and adverse outcomes in older adults with COVID-19.

Serum albumin on admission has been investigated among inpatients with COVID-19. However, studies on the lowest level of serum albumin during hospitalization and adverse outcomes are limited. This research aimed to explore association between them in older adults with COVID-19. A retrospective study was conducted with 300 patients aged 60 or older with first confirmed COVID-19 from January to February 2023. An adverse outcome was defined as development of acute respiratory failure, shock, or death. Data on demographics, comorbidities, laboratory parameters, the initial phase of COVID-19, coinfection, sepsis, receipt of antiviral treatment and outcomes were gathered from the electronic medical records. The association between the lowest level of serum albumin and adverse outcomes was analyzed using univariate and multivariate regression models, along with generalized additive models. After adjusting potential confounders, nonlinear relationship with an inflection point of 29.1 g/L was detected between the lowest level of serum albumin and adverse outcomes in the elderly. The effect sizes and the confidence intervals on the left and right sides of the inflection point were 0.667 (0.520, 0.856) and 1.171 (0.875, 1.568), respectively. This demonstrated that the lowest level of serum albumin was negatively correlated with adverse outcomes when albumin was <29.1 g/L. A rise of 1 unit in the lowest level of albumin equated to a 33.3% decrease in the risk of adverse outcomes. The correlation between the lowest level of serum albumin and adverse outcomes of COVID-19 is a nonlinear. this study indicates that serum albumin levels should be sustained above the critical inflection point identified to reduce the risk of adverse outcomes.

Can a Bayesian approach clarify if corticosteroids are beneficial for severe community-acquired pneumonia?

Despite advances in the antimicrobial treatment of sepsis and organ support in the intensive care unit (ICU), community-acquired pneumonia (CAP) remains a leading cause of mortality and disability-adjusted life years lost globally.1 Severe CAP, where CAP becomes complicated by acute hypoxaemic respiratory failure or shock, is also the most common cause of sepsis, where complex and heterogeneous biological mechanisms underlie a dysregulated inflammatory host response that ultimately leads to major organ dysfunction and death. Along with the emerging threats of respiratory pandemics, antimicrobial resistance, ageing populations and the rise of chronic diseases, much research has been conducted to improve the treatment outcomes of CAP via host immunomodulation. These efforts have focused almost exclusively on anti-inflammatory effects of corticosteroids, which have a proven track record of improving outcomes in other forms of sepsis, such as bacterial meningitis, Pneumocystis jirovecii pneumonia and severe COVID-19.

Septic shock and death due to Dolosigranulum pigrum bacteremia: a case report.

We report the case of a 77-year-old Japanese woman with neuromyelitis optica spectrum disorder, treated with 15 mg of prednisolone daily, who presented with acute septic shock and altered consciousness due to Dolosigranulum pigrum bacteremia. Intravenous extracellular fluids and broad-spectrum antibiotics were administered as an initial treatment. However, the patient died shortly after admission. We performed 16S rRNA sequencing and analyzed the murJ gene. A phylogenetic tree constructed using the neighbor-joining method showed that the strain belonged to clade C3, according to the classification proposed by Flores Ramos et al. Although D. pigrum, a commensal bacterium of the upper respiratory tract, is rarely associated with infections, it occasionally causes serious infections. Accumulation of clinical and bacteriological data is crucial for understanding the pathogenicity and infections associated with this organism.

Controlling Nutritional Status (CONUT) Score: a new tool for characterization and prognosis of patients with infective endocarditis

Abstract Background malnutrition is a marker of unfavorable prognosis in different medical conditions, however, the association between new objective immunonutritional indexes and outcomes for patients with infective endocarditis (IE) is not fully studied. Purpose the aim of this study was to assess the role of the Controlling Nutritional Status (CONUT) Score in the characterization of patients with IE and its association with prognostic outcomes. Methods a total of 184 cases of confirmed IE were consecutively collected and followed during one year after diagnosis in two tertiary hospitals. CONUT score was calculated using serum albumin, total cholesterol and lymphocyte count [(range 0-12), the higher, the worse] at diagnosis, and patients were categorised as CONUT-high (&amp;gt;=6, n=98), and CONUT-low (&amp;lt;6, n=86) based on the sample median value. Results mean age was 70 [SD 15] years, 64% were men and community-acquired infections were 69%. Median score value was 6 (4). As shown in Table 1 and 2, diabetes and frailty were more prevalent in CONUT-high group, who showed a worse profile of nutritional biomarkers. Overall, the most frequent pathogen was S. viridans (n=43). By groups, S. aureus was predominantly isolated in CONUT-high (20 vs 8%; p 0.02), and non-viridans streptococci in CONUT-low (9 vs 2%, p 0.03). Regarding infection site, IE of aortic bioprostheses was more common in CONUT-high, whereas mechanical aortic valves and mitral bioprostheses were more frequently involved in CONUT-low. Larger vegetations [14 (11) vs 11 (7) mm, p 0.02], and more periannular abscesses (25 vs 13%, p 0.04) were detected in CONUT-high, who presented more acute kidney injury and septic shock during hospitalization. Despite higher predicted surgical risk in CONUT-high, neither the proportion of patients who underwent surgery nor in-hospital mortality, differed between groups. When analyzing according to the therapeutic approach, only among those medically managed patients without surgical indication, in-hospital mortality was higher in CONUT-high. At 1-year follow-up, rehospitalization rate tended to be lower in those with a better nutritional status (35% vs 51%, p 0.07). Conclusions in patients with IE and a high CONUT score, diabetes and frailty were more prevalent. In addition, virulent pathogens, larger vegetations and periannular complications were more frequently reported. Although surgery performance and in-hospital mortality did not differ between groups, a worse nutritional status was associated with a higher rate of clinical complications and higher mortality among patients with conservative management who did not meet surgical criteria.

Disseminated Toxoplasma Gondii Infection in a Deceased Donor Kidney Transplant Recipient: A Fatal Case Report

Abstract Introduction/Objective Post-transplant immunosuppression predisposes patients to severe complications from opportunistic infections, including Toxoplasma gondii. Typically asymptomatic and self-limited in immunocompetent individuals, Toxoplasma gondii can cause life-threatening disseminated disease in immunocompromised patients like solid organ transplant recipients. The challenge in diagnosing Toxoplasmosis is further exacerbated in patients receiving prophylactic therapy with agents such as Atovaquone, which may mask clinical suspicion. This case report describes a fatal presentation of disseminated Toxoplasmosis in a kidney transplant recipient. Methods/Case Report A 44-year-old male with a history of deceased donor kidney transplant presented to the emergency department two months post-transplant with symptoms of malaise, shortness of breath, hypoxemia, and hypotension. Despite medical interventions, the patient deteriorated rapidly, developing acute hypoxemic respiratory failure and septic shock requiring intubation. Subsequently, he succumbed to multisystem organ failure five days after admission. The autopsy revealed disseminated Toxoplasma gondii infection, with tachyzoites/bradyzoites identified in multiple organs, including the brain, bone marrow, and lymph nodes. Positive Toxoplasma immunohistochemical staining and PCR confirmed the diagnosis. Results (if a Case Study enter NA) NA Conclusion Toxoplasma infection in post-transplant patients can manifest as a severe and potentially fatal complication. Dissemination can arise from the reactivation of latent infection, donor transmission, or new acquisition. In this case, the infection likely resulted from the reactivation of latent infection in the donor, compounded by immunosuppression in the recipient. Notably, the patient received Atovaquone prophylaxis due to a sulfa allergy. Nonetheless, the case highlights the potential for delayed diagnosis due to atypical presentations in immunocompromised patients. Clinicians should maintain a high index of suspicion for Toxoplasma infection in post- transplant patients, particularly in those with unexplained clinical deterioration. This case emphasizes the importance of maintaining a high index of suspicion for T. gondii infection in post-transplant patients, even in those receiving prophylaxis.

Veno-arterial extracorporeal membrane oxygenation as bridge for fluid resuscitation in a patient with acute respiratory failure and circulatory shock two years post lung transplantation.

The use of extracorporeal membrane oxygenation (ECMO) continues to evolve and is recognized as an important adjunct as a bridge to recovery or a bridge to transplant. We wanted to share our experience of using veno-arterial (VA) ECMO as an adjunct to lung recovery and an aide for fluid resuscitation. We present the case of a 77-year-old man with a history of previous single lung transplant who had acute respiratory decompensation and cardiovascular collapse secondary to CMV pneumonia and septic shock. He was cannulated for VA ECMO, treated for CMV pneumonia and resuscitated with 5L of albumin 5% and antibiotics, within 12 hours of cannulation. He required twodays of VA ECMO and was ultimately decannulated and discharged to a rehabilitation facility on hospital day 73. This case emphasizes the challenging clinical scenario of fluid resuscitation in a lung transplant patient. With adequate patient selection, a multidisciplinary team and the use of VA ECMO, success can be achieved.

7442 Racial Disparities On Outcomes Of Hypoglycemia

Abstract Disclosure: S. Neupane: None. B. Neupane: None. S. Karki: None. U. Farooq: None. M. Quartuccio: None. Introduction: Numerous studies have been conducted on the differences in racial and ethnic groups' access to healthcare; some groups face greater challenges when it comes to insurance coverage and other healthcare services compared to others. Risk factors that may contribute to hypoglycemia include advanced age, concomitant conditions, aggressive hyperglycemia therapy, etc. Research on racial differences in hypoglycemia is limited. Objective:To investigate potential disparities in mortality rates, length of stay (LOS), and overall hospitalization costs between the white and black populations with the diagnosis of hypoglycemia. Methods: Using the National Inpatient Sample (NIS) for the years 2017 through 2020, we carried out a retrospective cohort study of adult patients (age &amp;gt;18) with a primary diagnosis of hypoglycemia. The disease and outcome codes were chosen using the International Classification of Diseases (ICD-10). The analysis was conducted using STATA. Adjusting for potential variables and calculating the adjusted odds ratio(aOR) were done using multivariate regression analysis. The student t-test was utilized to compare continuous variables, while the Fisher exact test was employed to compare proportions. Mortality was the primary outcome of the study; other secondary outcomes included LOS, total hospitalization costs, acute coronary syndrome (ACS), septic shock, pulmonary edema, acute respiratory failure (ARF), mechanical ventilation, acute respiratory distress syndrome (ARDS), acute kidney injury (AKI), and cerebrovascular accidents (CVA). Results: There was a total of 804,164 patients with the diagnosis of hypoglycemia; out of them, 515,264 were white, 200,955 were black, and the rest were from other races besides white and black. Blacks had increased LOS than whites by 0.53 days, (6.92 days vs. 7.87 days, p&amp;lt;0.001) and rates of mechanical ventilation (11.96% vs.10.05%, p&amp;lt;0.001). There were other significant outcomes in rates of acute coronary syndrome (1.59% vs.1.38%, p&amp;lt;0.001), septic shock (10.07% vs. 9.90%, p=0.028), and ARF (16.10% vs. 15.27%, p&amp;lt;0.001) on white compared to black population. There was no significant difference in the outcomes of mortality rates, total hospitalization costs, pulmonary edema, ARDS, AKI, and CVA in white compared to black population. Conclusion: In comparison to the black population, the white population had an increase in rates of ACS, septic shock, and ARF. The overall rate of LOS and mechanical ventilation was higher in the black population than in the white population. The rates of mortality, total hospital costs, pulmonary edema, ARDS, AKI, and CVA did not differ between the two groups. To prevent poorer outcomes, more research is needed to understand the pathophysiology and underlying reasons for racial differences in hypoglycemia. Presentation: 6/1/2024

Association of Serum Blood Urea Nitrogen to Albumin Ratio with in-Hospital Mortality in Patients with Acute Ischemic Stroke: A Retrospective Cohort Study of the eICU Database

Albumin (ALB) and blood urea nitrogen (BUN) are both associated with the prognosis of acute ischemic stroke (AIS). A recent prognostic marker, the BUN/ALB ratio (BAR), has been suggested as a simple and sensitive method to predict certain acute diseases. To determine the predictive value of BAR in relation to the risk of in-hospital mortality among AIS patients. Retrospective cohort study. Cox regression analysis was employed to assess the relationship between in-hospital mortality and BAR, with hazard ratios (HRs) and 95% confidence intervals. Subgroup analysis of acute pulmonary embolism, acute myocardial infarction (AMI), thrombolysis, thrombectomy, and septic shock was performed to further examine this relationship. The predictive value of BAR and BAR multivariate models for in-hospital mortality was evaluated and compared to BUN, ALB, the Acute Physiology and Chronic Health Evaluation IV (APACHE IV) score, and the Sequential Organ Failure Assessment Score (SOFA). Among the 1,635 eligible patients, 226 (13.81%) died during hospitalization. An elevated serum BAR level was associated with an increased in-hospital mortality risk (HR: 1.3) after covariates were adjusted. Additionally, this positive association was observed in patients without AP, AMI, thrombolysis, history of thrombectomy, or septic shock (all; p < 0.05). The efficacy of the BAR multivariate model in predicting in-hospital mortality among AIS patients was superior to that of both APACHE IV and SOFA, with an area under the curve of 0.87. Serum BAR exhibits the potential to identify AIS patients with high mortality risk, which may contribute to enhanced disease surveillance and risk stratification.

A clinical case of extremely severe COVID-19 with a favourable outcome

COVID-19 is an infectious disease that can progress from carrier and mild symptoms of acute respiratory infections to bilateral pneumonia, severe respiratory failure, acute respiratory distress syndrome (ARDS), multiorgan failure, sepsis and shock. One of the predictors of severe course of infection is advanced age and comorbidities. In this work we considered a clinical case of COVID-19 patient S., 86 years old, who was admitted to the hospital, to the intensive care unit on the 10th day of the disease, in an extremely severe condition. A diagnosis of bilateral polisegmental pneumonia with 70% lung involvement caused by SARS-CoV-2 virus was made. In addition to antiviral therapy with remdesivir and symptomatic therapy, pathogenetic therapy with tocilizumab was applied. On admission, the patient had leukopenia, thrombocytopenia, elevated values of COE, urea, significant elevation of inflammatory markers CRP and D-dimer, as well as pCo2. During inpatient treatment, positive dynamics of the condition and laboratory parameters were observed. The patient was discharged in satisfactory condition, all laboratory parameters were normalised, except for a slight increase in CRP and pCO2 levels. Despite the age of the patient and the severity of COVID-19 course, the combined use of drugs with multidirectional action, including tocilizumab, may improve the outcome of the disease.

Subgaleal hemorrhage in neonates: a comprehensive review and summary recommendations.

Subgaleal hemorrhages (SH) involve bleeding in the expansive compartment between the periosteum of the skull and the galea aponeurotica. The potentially rapid accumulation of blood in this space is responsible for the clinical severity, as neonates with SH can present with acute hypovolemia, shock and multiorgan failure. SH is associated with instrumented delivery, especially with use of vacuum extraction. Although infrequent, the incidence of SH has not decreased over the past several decades, despite improvements in obstetrical care. Management of severe SH is complex and requires cardiovascular support, management of co-existent encephalopathy, and most importantly correction of coagulopathy and anemia.

Inflammatory bowel disease and pulmonary embolism: a nationwide perspective.

To examine the characteristics and outcomes of patients with inflammatory bowel disease (IBD) hospitalized with pulmonary embolism (PE). This cross-sectional observational study analyzed data from the 2016 to 2019 National Inpatient Sample to investigate hospitalizations for PE in the USA, stratified by the presence or absence of IBD. Adult patients were selected using the International Classification of Diseases, Tenth Revision codes for PE, Crohn's disease, and ulcerative colitis. Data on patient demographics, comorbidities, and hospital characteristics were collected. Statistical analysis included univariable and multivariable logistic regression using Stata/BE 17.0, focusing on in-hospital mortality and complications in PE patients with and without IBD. Adjusted odds ratios (aOR) and their corresponding 95% confidence intervals (CI) were calculated when appropriate. PE/IBD group was younger (mean age 58.3 vs. 62.7 years; P < 0.001), had a higher proportion of white patients (81.2% vs. 70.9%; P < 0.001), and had a greater prevalence of chronic liver disease (7.54% vs. 6.02%; P = 0.002) when compared to PE/non-IBD patients. The PE/IBD group had lower prevalence rates of coronary artery disease, congestive heart failure, obesity, chronic obstructive pulmonary disease, hypertension, and diabetes. Regarding primary outcomes, there was no significant difference in in-hospital mortality between the two groups (aOR, 0.92; 95% CI, 0.77-1.09; P = 0.355). However, the IBD/PE group had a higher risk of acute kidney injury, sepsis, septic shock, cardiac arrhythmias, and deep vein thrombosis. As for secondary outcomes, PE/IBD patients had more extended hospital stays and higher healthcare costs compared with PE/non-IBD patients. Hospitalized PE patients with IBD differ demographically and have a different comorbidity profile compared to those without IBD. PE/IBD patients demonstrate greater use of healthcare resources and elevated risk of hospitalization adverse events than PE/non-IBD patients, highlighting the necessity for individualized management approaches in this population.

Discovery of natural product derivative triptolidiol as a direct NLRP3 inhibitor by reducing K63-specific ubiquitination.

NLRP3 is up-regulated in inflammatory and autoimmune diseases. The development of NLRP3 inhibitors is challenged by the identification of compounds with distinct mechanisms of action avoiding side effects and toxicity. Triptolide is a natural product with multiple anti-inflammatory activities, but a narrow therapeutic window. Natural product triptolide derivatives were screened for NLRP3 inhibitors in human THP-1 and mouse bone marrow-derived macrophages. The efficacy of potent NLRP3 inhibitors was evaluated in LPS-induced acute lung injury and septic shock models. Triptolidiol was identified as a selective inhibitor of NLRP3 with high potency. Triptolidiol inactivated the NLRP3 inflammasome in human THP-1 and mouse primary macrophages primed with LPS. Triptolidiol specifically inhibited pro-caspase 1 cleavage downstream of NLRP3, but not AIM2 or NLRC4 inflammasomes. Based on the structure-activity relationship study, the C8-β-OH group was critical for its binding to NLRP3. Triptolidiol exhibited a submicromolar KD for NLRP3, binding to residue C280. This binding prevented the interaction of NLRP3 with NEK7, the key regulator of NLRP3 inflammasome oligomerization and assembly, but not with the inflammasome adaptor protein ASC. Triptolidiol decreased the K63-specific ubiquitination of NLRP3, leading NLRP3 to a "closed" inactive conformation. Intraperitoneal administration of triptolidiol significantly attenuated LPS-induced acute lung injury and lethal septic shock. Triptolidiol is a novel NLRP3 inhibitor that regulates inflammasome assembly and activation by decreasing K63-linked ubiquitination. Triptolidiol has novel structural features that make it distinct from reported NLRP3 inhibitors and represents a viable therapeutic lead for inflammatory diseases.

Long-term thermal acclimation enhances heat resistance of Hong Kong catfish (Clarias fuscus) by modulating gill tissue structure, antioxidant capacity and immune metabolic pathways

The rapid temperature changes caused by global warming significantly challenge fish survival by affecting various biological processes. Fish generally mitigate stress through physiological plasticity, but when temperature changes exceed their tolerance limits, even adaptable species like Siluriformes can experience internal disruptions. This study investigates the effects of extreme thermal climate on Hong Kong catfish (Clarias fuscus), native to tropical and subtropical regions. C. fuscus were exposed to normal temperature (NT, 26 ℃) or high temperature (HT, 34 ℃) condition for 90 days. Subsequently, histological, biochemical, and transcriptomic changes in gill tissue were observed after exposure to acute high temperatures (34 ℃) and subsequent temperature recovery (26 ℃). Histological analysis revealed that C. fuscus in the HT group exhibited less impact from sudden temperature shifts compared to the NT group, as they adapted by reducing the interlamellar cell mass (ILCM) and lamellae thickness (LT) of gill tissue, thereby mitigating the aftermath of acute heat shock. Biochemical analysis showed that catalase (CAT) activity in the high temperature group continued to increase, while malondialdehyde (MDA) levels decreased, suggesting establishment of a new oxidative balance and enhanced environmental adaptability. Transcriptome analysis identified 520 and 463 differentially expressed genes in the NT and HT groups, respectively, in response to acute temperature changes. Enrichment analysis highlighted that in response to acute temperature changes, the NT group inhibited apoptosis and ferroptosis by regulating the activity of alox12, gclc, and hmox1a, thereby attenuating the adverse effects of heat stress. Conversely, the HT group increased the activity of pfkma and pkma to provide sufficient energy for tissue repair. The higher degree of heat shock protein (Hsp) response in NT group also indicated more severe heat stress injury. These findings demonstrate alterations in gill tissue structure, regulation of oxidative balance, and the response of immune metabolic pathways to acute temperature fluctuations in C. fuscus following thermal exposure, suggesting potential avenues for further exploration into the thermal tolerance plasticity of fish adapting to global warming.

Influence of Heart Failure Upon Incidence Rates of Pneumonia, Acute Respiratory Failure, Sepsis and Septic Shock in Patients With Polycythemia Vera

Influence of Heart Failure Upon Incidence Rates of Pneumonia, Acute Respiratory Failure, Sepsis and Septic Shock in Patients With Polycythemia Vera

MPN-451 Influence of Heart Failure Upon Incidence Rates of Pneumonia, Acute Respiratory Failure, Sepsis and Septic Shock in Patients With Polycythemia Vera

MPN-451 Influence of Heart Failure Upon Incidence Rates of Pneumonia, Acute Respiratory Failure, Sepsis and Septic Shock in Patients With Polycythemia Vera

Subcutaneous adipose tissue radiodensity: An emerging risk factor for severe COVID-19

BackgroundAdipose tissue radiodensity and metabolic activity may influence COVID-19 outcomes. This study evaluated the association between adipose tissue characteristics and clinical outcomes in COVID-19 patients. MethodsTwo retrospective cohorts of hospitalized COVID-19 patients were analyzed. Subcutaneous adipose tissue radiodensity (SATR) and visceral adipose tissue radiodensity were assessed by computed tomography. Fluorine-18-labelled fluorodeoxyglucose PET/computed tomography measured adipose tissue metabolic activity. Associations with mortality, length of stay, ventilation requirement, and complications were examined using regression analyses. ResultsHigh SATR was independently associated with increased mortality risk (OR: 2.70; P = 0.033), longer hospitalization (P < 0.001), higher rates of mechanical ventilation (P = 0.007), and complications: acute kidney injury (P = 0.001), secondary infection (P = 0.007), shock (P = 0.010), and pulmonary embolism (P = 0.011). SATR positively correlated with SAT glucose uptake (ρ = 0.52) and negatively with leptin levels (ρ = –0.48). ConclusionsElevated SATR at COVID-19 diagnosis predicts disease severity and worse outcomes. SATR is a potential prognostic biomarker for acute and chronic inflammatory conditions.

International consensus definitions for infection-triggered encephalopathy syndromes.

To develop standardized diagnostic criteria for 'infection-triggered encephalopathy syndrome (ITES)' and five specific clinical syndromes of ITES. The draft definitions were based on existing criteria, standardized, and discussed by a panel of international experts using nominal group technique over 18 months to achieve consensus. All criteria use the same format: (1) presence of infection/fever; (2) clinical features including encephalopathy; (3) neuroradiological features on magnetic resonance imaging; (4) exclusion of other causes. We first highlighted differences between ITES and infectious and autoimmune encephalitis, which is the most important differential diagnosis. Consensus was achieved to define five specific ITESs: acute encephalopathy with biphasic seizures and late reduced diffusion; acute necrotizing encephalopathy; mild encephalopathy with a reversible splenial lesion; acute fulminant cerebral oedema; and acute shock with encephalopathy and multiorgan failure. Two further conditions that are currently classified as epilepsy syndromes but have similar features to ITES, namely febrile infection-related epilepsy syndrome and hemiconvulsion-hemiplegia-epilepsy syndrome, are also discussed. The consensus definition is expected to improve awareness of this disease concept, provide diagnostic framework, and facilitate future international research and clinical trials.

Heat hardening improves thermal tolerance in abalone, without the trade-offs associated with chronic heat exposure

Marine animals are challenged by chronically raised temperatures alongside an increased frequency of discrete, severe warming events. Exposure to repeated heat shocks could result in heat hardening, where sub-lethal exposure to thermal stress temporarily enhances thermotolerance, and may be an important mechanism by which marine species will cope with future thermal challenges. However, we have relatively little understanding of the effects of heat hardening in comparison to chronic exposure to elevated temperatures. Therefore, we compared the effects of heat hardening from repeated exposure to acute heat shocks and chronic exposure to elevated temperatures on thermal tolerance in the European abalone, Haliotis tuberculata. Adult abalones were exposed to either control temperature (15 °C), chronic warming (20 °C) or a regime of two events of repeated acute heat shock cycles (23–25 °C) during six months, and their thermal tolerance and performance, based upon cardiac activity, compared using a dynamic ramping assay. The cost associated with each treatment was also estimated via measurements of condition index (CI). Abalone exposed to both temperature treatments had higher upper thermal limits than the control, but heat-hardened individuals had significantly higher CI values, indicating an enhancement in condition status. Differences in the shape of the thermal performance curve suggest different mechanisms may be at play under different temperature exposure treatments. We conclude that heat hardening can boost thermal tolerance in this species, without performance trade-offs associated with chronic warming.