Acute Shock Research Articles

Burn wound conversion: clinical implications for the treatment of severe burns.

The identification of novel treatments for severe burn wounds relies on accurate clinical assessments of the extent of injury. However, evaluation of burn wound depth can be challenging due to the tendency for burn wounds to progress over time in a little-understood process known as 'burn wound conversion'. Local factors affecting the burn wound, such as inflammation, oxidative stress-induced tissue damage, vasostasis and bacterial infections, lead to increased cell death by apoptosis or oncosis, while systemic events may promote burn wound conversion. Acute shock, metabolic derangements, age or immunomodulation can modify cytokine secretion, lower immune responses, decrease blood flow or cause bacterial infection at the burn wound site. Therefore, therapeutic approaches targeting specific mechanisms that reduce cell death, improve wound reperfusion and promote tissue regrowth should favourably enhance burn wound healing, and long-term functional and aesthetic outcomes. Our current understanding of these mechanisms mostly comes from animal studies, underscoring the need for extensive research in humans. A streamlined approach would be to investigate the parallels in other disease states that exhibit ischaemia and potential reperfusion, such as ischaemic stroke and myocardial infarction. Moreover, in view of the limited knowledge available on the subject, the need exists for further clinical research into burn wound conversion and novel target pathways to ameliorate its effects. This review describes events that affect the viability of cells at the burn wound site resulting in burn wound conversion, and identifies potential targets for clinical interventions that may diminish burn wound conversion.

Study on immune status alterations in patients with sepsis

Sepsis, characterized by cytokine-mediated hyper-inflammation and a consistent decline in immune responsiveness, is associated with a high risk of death in the intensive care unit (ICU). Here, we for the first time investigated the changes in immune and inflammatory responses to understand the interactions between immune and inflammatory biomarkers and their association with patient outcomes. The cytokine and lymphocyte subset levels were analyzed in healthy donors (HD) and patients with sepsis upon admission to the ICU (D0), D3, D7, D14, and D28 using flow cytometry. The primary endpoint was mortality on day 90. The trends in lymphocyte subsets and cytokine levels in all patients (n=47), HD (n=27), and patient subgroups (surviving, n=30; dead, n=17) were analyzed using an independent sample t-test and principal component analysis. Age, steroids (steroids used>48h), secondary infection, acute heart failure, acute kidney injury, coagulopathy, hypohepatia, organ transplant and septic shock (when transferred to the ICU) were associated with mortality. Absolute lymphocyte counts and lymphocyte subsets levels were reduced in most patients with sepsis. The proportion of Tregs in the patients increased with disease progression and was associated with immunosuppression. In conclusion, sepsis downregulated adaptive immunity, and induced the transition of the patients to prolonged immune suppression. The study suggests that while cellular immunity recovered within 2weeks of admission, humoral and innate immunity recovery takes longer. These findings may assist in developing appropriate therapeutic approaches to improve the immune responses in patients with sepsis.

Acute kidney injury in patients with acute decompensated heart failure-cardiogenic shock: Prevalence, risk factors and outcome

BackgroundAcute Kidney Injury (AKI) represents a major complication of acute heart failure and cardiogenic shock (CS). There is a paucity of data on AKI complicating acutely decompensated heart failure patients presenting with CS (ADHF-CS). We aimed to investigate AKI prevalence, risk factors and outcomes in this subgroup of patients. MethodsRetrospective observational study on patients admitted for ADHF-CS to our 12-bed Intensive Care Unit (ICU), between January 2010 and December 2019. Demographic, clinical, and biochemical variables were collected at baseline and during hospital stay. ResultsEighty-eight patients were consecutively recruited. The predominant etiologies were idiopathic dilated cardiomyopathy (47%), followed by post-ischemic (24%). AKI was diagnosed in 70 (79.5%) of patients. Forty-three out of 70 patients met the criteria for AKI at ICU admission. On multivariate analysis, a central venous pressure (CVP) higher than 10 mmHg (OR 3.9; 95%CI 1.2–12.6; p = 0.025) and serum lactate higher than 3 mmol/L (OR 4.1; 95%CI 1.01–16.3; p = 0.048) were identified to be independently associated with AKI. Age and AKI stage were independent predictors of 90-day mortality. ConclusionAKI is a common and early complication of ADHF-CS. Venous congestion and severe hypoperfusion are risk factors for AKI development. Early detection and prevention of AKI could lead to better outcome in this clinical subgroup.

Previous BCG vaccination is associated with less severe clinical progression of COVID-19

BackgroundBCG vaccination, originally used to prevent tuberculosis, is known to “train” the immune system to improve defence against viral respiratory infections. We investigated whether a previous BCG vaccination is associated with less severe clinical progression of COVID-19MethodsA case-control study comparing the proportion with a BCG vaccine scar (indicating previous vaccination) in cases and controls presenting with COVID-19 to health units in Brazil. Cases were subjects with severe COVID-19 (O2 saturation < 90%, severe respiratory effort, severe pneumonia, severe acute respiratory syndrome, sepsis, and septic shock). Controls had COVID-19 not meeting the definition of “severe” above. Unconditional regression was used to estimate vaccine protection against clinical progression to severe disease, with strict control for age, comorbidity, sex, educational level, race/colour, and municipality. Internal matching and conditional regression were used for sensitivity analysis.ResultsBCG was associated with high protection against COVID-19 clinical progression, over 87% (95% CI 74–93%) in subjects aged 60 or less and 35% (95% CI − 44–71%) in older subjects.ConclusionsThis protection may be relevant for public health in settings where COVID-19 vaccine coverage is still low and may have implications for research to identify vaccine candidates for COVID-19 that are broadly protective against mortality from future variants. Further research into the immunomodulatory effects of BCG may inform COVID-19 therapeutic research.

Association between gestational age at delivery and indicator-specific severe maternal morbidity

Objective Individuals who deliver preterm are disproportionately affected by severe maternal morbidity. Limited data suggest that indicator-specific maternal morbidity varies by gestational age at delivery. We sought to evaluate the relationship between gestational age at delivery and the incidence of severe maternal morbidity and indicator-specific severe maternal morbidity. Methods We used a hospital administrative delivery database to identify all singleton deliveries between 16 and 42 weeks gestation from 2002 to 2018. We defined severe maternal morbidity as the presence of any International Classification of Disease diagnosis or procedure codes outlined by the Centers for Disease Control and Prevention, intensive care unit admission, and/or prolonged postpartum hospital length of stay. Indicator-specific severe maternal morbidity was based on the diagnosis and procedure codes and was characterized across gestational age epochs. We categorized gestational age into three epochs to capture extremely preterm birth (less than 28 weeks gestation), preterm birth (28-36 weeks gestation) and term birth (37 weeks gestation and above). Multivariable binomial regression was used to assess the association between categories of gestational age at delivery and severe maternal morbidity adjusting for confounders including age, race, body mass index (BMI), insurance status, and preexisting hypertension or diabetes. Results Severe maternal morbidity occurred in 2.5% of all deliveries. The unadjusted incidence of severe maternal morbidity by gestational age epoch was 12% at less than 28 weeks gestation, 8.4% at 28 to 36 weeks of gestation, and 1.7% at greater than or equal to 37 weeks gestation. After controlling for potential confounders the predicted probability of severe maternal morbidity was 16% (95% CI 14,17%) at 24 weeks compared to 2.2% (95% CI 2.1,2.3%) at 38 weeks. Sepsis, acute respiratory distress syndrome, mechanical ventilation, and shock were the most common diagnostic codes in deliveries less than 28 weeks gestation. Heart failure and cardiac arrhythmias were more common in patients with severe maternal morbidity delivering at term. Conclusion A high proportion of severe maternal morbidity occurred in preterm patients, with the highest rates occurring at less than 28 weeks gestation. Individuals with severe maternal morbidity who deliver preterm had distinct indicators of morbidity compared to those who deliver at term.

Extracorporeal blood purification benefits in post-caesarean patient with severe acute respiratory distress syndrome due to miliary tuberculosis: a case report

BackgroundMiliary tuberculosis is a life-threatening disease caused by the hematogenous spread of Mycobacterium tuberculosis. It is uncommon in pregnancy. Mortality rates for patients with miliary tuberculosis who require mechanical ventilation are high (60–70%).Case presentationWe reported a rare and challenging case, a 35-year-old Asian woman with 34 weeks of pregnancy, and miliary tuberculosis with acute respiratory distress syndrome and septic shock. The patient presented with severe acute respiratory distress syndrome, necessitating mechanical ventilation, vasopressor, and pregnancy termination with caesarean section. The patient underwent blood purification with continuous veno-venous hemofiltration using an oXiris filter for 24 hours. After continuous veno-venous hemofiltration, the patient’s condition was greatly improved, and the patient was successfully extubated and was able to breathe spontaneously without vasopressor on the third day. High levels of interleukin-6, interleukin-10, procalcitonin, C-reactive protein, interferon-γ, and tumor necrosis factor-α were found postoperatively.ConclusionThe bacterial infection of tuberculosis, acute respiratory distress syndrome, and the stress response from the caesarean section contributed to the high levels of cytokines, which correlated with the patient’s severe inflammatory condition. The cytokine levels were greatly reduced after the blood purification procedure and this might be associated with the patient’s clinical improvement. Extracorporeal blood purification could help to disrupt the vicious cycle of inflammation.

(226) Comparison of In-Hospital Outcomes in Acute Myocardial Infarction-Cardiogenic Shock (AMICS) versus Non-AMICS Following ECPELLA

(226) Comparison of In-Hospital Outcomes in Acute Myocardial Infarction-Cardiogenic Shock (AMICS) versus Non-AMICS Following ECPELLA

Systemic Anticoagulation and Inpatient Outcomes of Pancreatic Cancer: Real-World Evidence from U.S. Nationwide Inpatient Sample.

Background: Pancreatic cancer can induce a hypercoagulable state which may lead to clinically apparent thrombosis. However, the effect of anticoagulants remains ambiguous. This study aimed to investigate the potential effect of long-term systemic anticoagulant usage on hospitalization outcomes of patients with pancreatic cancer. Methods: This retrospective study extracted all data from the U.S. Nationwide Inpatient Sample (NIS) database from 2005 to 2018. We included hospitalized adults ≥18 years old with a pancreatic cancer diagnosis identified by International Classification of Diseases ninth revision (ICD-9) and tenth revision (ICD-10) codes. We utilized diagnostic codes ICD9 V58.61 and ICD10 Z79.01, i.e., 'long-term use of anticoagulant', to identify individuals who were on a long-term systemic anticoagulant. The study cohort were then further grouped as being with or without long-term systemic use of an anticoagulant. Propensity score matching was performed to balance the characteristics of the two groups. The risks of life-threatening events, e.g., acute myocardial infarction (AMI), acute heart failure (AHF), sepsis, shock, and acute kidney injury (AKI), in-hospital death, and prolonged length of stay (LOS) in the hospital were compared between the groups by univariable and multivariable logistic regression analyses. Results: The study population consisted of 242,903 hospitalized patients with pancreas cancer, 6.5% (n = 15,719) of whom were on long-term systemic anticoagulants. A multivariable regression analysis showed that long-term systemic anticoagulant use was independently associated with lower odds of sepsis (aOR: 0.81, 95% CI: 0.76-0.85), shock (aOR: 0.59, 95% CI: 0.51-0.68), AKI (aOR: 0.86, 95% CI: 0.81-0.91), in-hospital mortality (aOR: 0.65, 95% CI: 0.60-0.70), and prolonged LOS (aOR: 0.84, 95% CI: 0.80-0.89). Conclusions: Long-term systemic anticoagulant use is associated with better clinical outcomes in terms of decreased risks of some life-threatening events, in-hospital death, and prolonged LOS among hospitalized patients with pancreatic cancer in the U.S.

Mechanical Circulatory Support Devices in Acute Myocardial Infarction-Cardiogenic Shock: Current Studies and Future Directions.

Cardiogenic shock (CS) caused by acute myocardial infarction (AMI) accounts for most deaths in the population with AMI and continues to be associated with high short-term mortality. Several temporary mechanical circulatory support (MCS) devices have been developed to treat CS and studied in randomized controlled trials (RCTs) of patients with AMI-CS. Unfortunately, none of these RCTs has demonstrated an improvement in survival with temporary MCS in AMI-CS. Potential reasons for these negative results in RCTs are numerous and reflect the challenges of enrolling critically ill patients with CS. Researchers have used observational study designs to provide insights about outcomes associated with the use of temporary MCS in AMI-CS. These observational studies have yielded conflicting results, in some cases contrary to the results of RCTs. Several limitations pertinent to both RCTs and observational analyses, mostly relating to selection bias and failure to consider unmeasured confounding variables and population heterogeneity, preclude drawing strong inferences regarding the effects of temporary MCS on survival in populations with AMI-CS. Understanding these limitations is essential to correctly interpreting the literature regarding temporary MCS to treat AMI-CS and is necessary to inform the design of future studies that will potentially provide stronger evidence. Optimally matching temporary MCS devices to the needs of individual patients with AMI-CS will presumably be more successful than indiscriminate application in unselected patients. In this review, we discuss the existing literature on temporary MCS to treat AMI-CS and describe the specific challenges that must be overcome to develop an improved evidence base for guiding clinical practice.

WCN23-1200 Continuous Renal Replacement Therapy in Critical Patients With Acute Kidney Injury and Septic Shock

WCN23-1200 Continuous Renal Replacement Therapy in Critical Patients With Acute Kidney Injury and Septic Shock

Cardiac Asystole at Birth Re-Visited: Effects of Acute Hypovolemic Shock

Births involving shoulder dystocia or tight nuchal cords can deteriorate rapidly. The fetus may have had a reassuring tracing just before birth yet may be born without any heartbeat (asystole). Since the publication of our first article on cardiac asystole with two cases, five similar cases have been published. We suggest that these infants shift blood to the placenta due to the tight squeeze of the birth canal during the second stage which compresses the cord. The squeeze transfers blood to the placenta via the firm-walled arteries but prevents blood returning to the infant via the soft-walled umbilical vein. These infants may then be born severely hypovolemic resulting in asystole secondary to the loss of blood. Immediate cord clamping (ICC) prevents the newborn's access to this blood after birth. Even if the infant is resuscitated, loss of this large amount of blood volume may initiate an inflammatory response that can enhance neuropathologic processes including seizures, hypoxic-ischemic encephalopathy (HIE), and death. We present the role of the autonomic nervous system in the development of asystole and suggest an alternative algorithm to address the need to provide these infants intact cord resuscitation. Leaving the cord intact (allowing for return of the umbilical cord circulation) for several minutes after birth may allow most of the sequestered blood to return to the infant. Umbilical cord milking may return enough of the blood volume to restart the heart but there are likely reparative functions that are carried out by the placenta during the continued neonatal-placental circulation allowed by an intact cord.

Factors affecting COVID-19 disease severity in breast cancer patients: Single-Center experience

Objective: Coronavirus disease-19 (COVID-19) is one of the large-scale pandemics affecting the whole World. Breast cancer is the most common cancer in women. This study aims to examine the factors that may be effective on COVID-19 disease severity in breast cancer patients. Material and Methods: This study was carried out as a single-center and retrospective study with a total of 65 patients with a pathological diagnosis of breast cancer who were hospitalized between April 2020 and June 2021. The patients were divided into two groups, mild and severe. 35 patients were in the mild group and 30 patients were in the severe group. Patients with oxygen saturation below 93 percent, needing non-invasive or invasive mechanical ventilation, acute respiratory distress syndrome, shock, and multiple organ failure were included in the severe group. Results: A total of 17 parameters that may affect disease severity were analyzed. As a result of the univariate analysis performed to evaluate the potential factors that may affect the severity of the disease, statistically, significant differences were found: the patient had diabetes mellitus (P=0.050), the neutrophil count increased during hospitalization (P=0.002), the lymphocyte count decreased at admission (P). =0.001), high d-dimer level during hospitalization (P=0.007), lymphocyte to monocyte ratio above 2.55 (P=0.016). Conclusion: As a result, the presence of diabetes mellitus, neutrophilia, lymphocytopenia, high D-dimer, and increased lymphocyte to monocyte ratio in patients with breast cancer may aggravate the course of COVID-19 disease. These parameters may be predictive for closer follow-up in terms of clinical deterioration of the patients.

Metastatic Small Cell Lung Cancer Presenting as Acute Appendicitis: A Case-Report

Introduction and Importance: We present a case of extensive stage small cell lung cancer presenting as perforated appendicitis secondary to an appendiceal metastasis. This is a rare presentation with only 6 reported cases in the literature. Surgeons must be aware of unusual causes for perforated appendicitis as in our case the prognosis can be dire. Case Presentation: A 60-year-old man presented with an acute abdomen and septic shock. Computed tomography demonstrated perforated appendicitis and a widespread malignant process initially suspected as colonic origin malignancy. Urgent laparotomy and a subtotal colectomy was performed. Further imaging suggested the malignancy was secondary to a primary lung cancer. Histopathology demonstrated a ruptured small cell neuroendocrine carcinoma in the appendix with TTF1 positive immunohistochemistry. Unfortunately, the patient deteriorated due to respiratory compromise and was palliated on day 6 postoperatively. Discussion: The appendix is a rare site for metastasis of lung cancer and these metastases usually present as acute perforated appendicitis. Distinguishing the site of the primary tumor can be difficult when there is extensive metastatic disease, and this differentiation relies on immunohistochemistry. In our case the patient was managed surgically, however rapidly deteriorated post operatively from multi-organ metastatic disease. This demonstrates the diagnostic challenges in metastatic small cell lung carcinoma presenting as an acute appendicitis as well as the poor prognosis with advanced disease. Conclusion: Surgeons should consider a broad differential diagnosis for the cause of acute perforated appendicitis as this can rarely be due to a secondary metastatic deposit from a widespread malignant process.

Translational patterns of ionotropic glutamate and GABA receptors during brain development and behavioral stimuli revealed by polysome profiling.

mRNA translation is critical for regulation of various aspects of the nervous system. Ionotropic glutamate and gamma-aminobutyric acid type A (GABAA ) receptors are fundamental synaptic ion channels that control excitatory and inhibitory synaptic transmission, respectively. However, little is known about the translation of these receptors during brain development and function. By utilizing polysome profiling, a powerful tool for investigating translational machinery and mRNA translational states, we characterized the translational patterns of α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA), N-methyl-d-aspartate (NMDA), and GABAA receptor subunits, and compared them with total mRNA and protein levels during mouse brain development, in different brain regions, and in response to behavioral stimuli. Most of the receptor subunits exhibited developmental changes at total mRNA, translation, and protein levels, among which translation of Gria1, Gria2, Grin1, Grin2a, Gabra1, and Gabrg2 contributed greatly to their protein levels. Most of the receptor subunits also displayed differentiated levels of total mRNA, translation, and protein in the prefrontal cortex and hippocampus, among which translation of Gria1, Gria2, Gabrb2, and Gabrg2 contributed to their protein levels. Finally, we showed that acute foot shock stress had a rapid influence in both the prefrontal cortex and hippocampus, with the prefrontal cortex displaying more changes at translational and protein levels. Notably, Grin2a is translationally repressed by stress which was followed by a decrease of GluN2A protein in both brain regions. Together, this study provides a new understanding of the translational patterns of critical ionotropic synaptic receptors during brain development and behavioral stress.

Analysis of the conserved and mutated amino acid sequences in the spike protein enhances the understanding of phylognetic relationship among coronavirus variants from the wild type.

In the light of the COVID-19 pandemic, an elaborative computational analysis was conducted regarding coronaviruses, their phylogeny, and the different strains of the pathogen responsible for the disease, SARS-CoV-2. In the front, this disease looks like the common cold. However, it can lead to acute respiratory failure, septic shock, and organ failure. Like the Spanish flu pandemic in 1918, the COVID-19 pandemic also became the cause of millions of lives lost across the globe. Coronaviruses consist of four basic proteins - spike, nucleocapsid, membrane, and envelope proteins. Spike proteins (S) are structures protruding from the surface of the virus and facilitate its entry into the the host cells via interaction with the ACE-2 receptors who are also found on the surface of the host cells. For this research work, the entire sequence of the spike protein was considered, and a table was created carrying out the comparison between the spike protein sequences of the WT and 13 different variants (Alpha, Beta, Gamma, Kappa, Delta, Mu, Epsilon, Lambda, Omicron, Mu, Eta, Zeta, and Theta). This table helped detect the conserved parts of spike protein sequence across all variants, conserved mutations as well as mutations unique to certain variants. Findings from the table are then used to study phylogenetic trees which explain the emergence of new coronavirus variants and their genetic distances from the WT.

Predictors of mortality in Vietnamese patients with infective endocartis

Abstract Funding Acknowledgements Type of funding sources: None. Background Infective endocarditis (IE) has been associated with an elevated mortality rate despite major advances in diagnostic and therapeutic methods for the past decades. Purpose to evaluate predictors of in-hospital all-cause mortality in patients with IE. Methods This was a retrospective cross-sectional study among patients who were 15 years of age or older with the definite or probable diagnosis of IE according to the modified Duke criteria admitted to Cho Ray Hospital between January 1, 2015 and December 31, 2019. Patients whose medical records with insufficient data to collect were excluded from the study. The minimum sample size of the study was 99 patients. Results Of the 201 hospitalized patients with IE, 157 patients (78.1%) had definite diagnosis and 44 patients (21.9%) had probable diagnosis according to the modified Duke criteria. Men accounted for 65.2% and women accounted for 34.8%. The mean age of patients was 42.2±15.3. All-cause in-hospital mortality rate was 15.9%. Factors associated with in-hospital mortality in univariate analysis included sex, chronic kidney disease, prior heart failure, cough, Streptococci, Staphylococcus aureus, white blood cell count, estimated glomerular filtration rate, acute heart failure, septic shock, cerebral infarction, cerebral hemorrhage, and surgical treatment. Multivariate logistic regression analysis showed that five independent prognostic factors of in-hospital mortality were male gender (OR=0.33; 95% CI: 0.11–0.97; P=0.043); prior heart failure (OR=5.29; 95% CI: 1.42–19.65; P=0.013); estimated glomerular filtration rate (OR=0.98; 95% CI: 0.97–0.99; P=0.045); septic shock (OR=9.53; 95% CI: 1.76–51.76; P=0.009); and surgical treatment (OR=0.20; 95% CI: 0.05–0.75; P=0.017). Conclusions The rate of mortality in IE has remained high and its predictors should be taken into consideration to improve outcomes.

Clinical characteristics and risk factors of organ failure and death in necrotizing pancreatitis

BackgroundOrgan failure (OF) and death are considered the most significant adverse outcomes in necrotizing pancreatitis (NP). However, there are few NP-related studies describing the clinical traits of OF and aggravated outcomes.PurposeAn improved insight into the details of OF and death will be helpful to the management of NP. Thus, in our research, we addressed the risk factors of OF and death in NP patients.MethodsWe performed a study of 432 NP patients from May 2017 to December 2021. All patients with NP were followed up for 36 months. The primary end-points were risk factors of OF and death in NP patients. The risk factors were evaluated by logistic regression analysis.ResultsNP patients with OF or death patients were generally older, had a higher APACHE II score, longer hospital stay, longer ICU stay, as well as a higher incidence of severe acute pancreatitis (SAP), shock and pancreatic necrosis. Independent risk factors related to OF included BMI, APACHE II score and SAP (P < 0.05). Age, shock and APACHE II score (P < 0.05) were the most significant factors correlated with the risk of death in NP patients. Notably, increased mortality was linked to the number of failed organs.ConclusionsNP is a potentially fatal disease with a long hospital or ICU stay. Our study indicated that the incidence of OF and death in NP patients was 69.9% and 10.2%, respectively. BMI, SAP, APACHE II score, age and shock are potential risk factors of OF and death in NP patients. Clinicians should focus on these factors for early diagnosis and appropriate therapy.

Factors associated with mortality in critically ill patients with COVID-19

Background and objectives: COVID-19 is a life-threatening disease. Recognizing the main characteristics of the disease and its main complications will help future interventions, care, and management of health services since territorial and population diversities directly influence health outcomes. Our main objective is to describe the clinical characteristics, outcomes, and factors associated with mortality of patients with COVID-19 admitted to the intensive care unit of a public and tertiary hospital. Methods: Cohort study, conducted from March 1 to September 30, 2020. Poisson regression was performed to investigate the variables of hospital treatment as potential risk factors for in-hospital mortality. Results: Of the 283 eligible patients in this study, the hospital mortality rate was of 41.7% (n=118). The most common outcomes were acute respiratory distress syndrome, nosocomial infection, and septic shock. Factors independently associated with increased risk of death were age greater than 51 years old (RR=1.7, 95%CI=1.0-2.8), especially over 70 years old (RR=2.9, 95%CI=1.7-2.8), current smoker (RR=1.8, 95%CI=1.1-2.9), requiring the use of inotrope (RR=1.4, 95%CI=1.0-2.0), and presenting potassium greater than 5.0 mEq/l on admission (RR=1.3, 95%CI=1.0-1.7).

Clinical characteristics and early prediction of mortality risk in patients with acute organophosphate poisoning-induced shock.

To further get insights of clinical characteristics of acute organophosphate poisoning-induced shock, investigate the relationship between shock and prognosis, and screen risk indicators for prognosis. A total of 73 patients with acute organophosphate poisoning admitted to our hospital between January 2014 and December 2021 were enrolled in this retrospective study. Patients were divided into the shock group and the non-shock group. The pH value of blood, arterial blood carbon dioxide partial pressure (PaCO2), arterial partial pressure of oxygen (PaO2), base excess (BE), lactic acid (Lac), serum albumin (ALB), total bilirubin (TBIL), alanine aminotransferase (ALT), serum creatinine (Cr), serum potassium (K), serum calcium (Ca), serum sodium (Na), blood chloride (Cl), serum troponin I (cTNI), brain natriuretic peptide (BNP), white blood cell count (WBC), hemoglobin (HGB), platelet count (PLT), and other clinical indicators of patients were recorded. Incidence of shock, time of shock onset, and outcomes of patients were also recorded. Cox proportional hazards regression models were performed for analysis. The incidence of organophosphate poisoning-induced shock was 30.1% (22/73), and 72.7% of shock patients developed shock blood pressure within 6 h. The levels of blood lactate, ALT, Cr, cTNI, BNP, and Cl in the shock group were significantly higher than those in the non-shock group, while the level of Ca and pH value was significantly lower than that in the non-shock group (all p < 0.05). Moreover, compared with patients without shock (2.0%), the mortality rate was significantly increased in patients with shock (36.4%), which was supported by the results from adjusted Cox proportional hazards regression model. We found that shock and elevated serum creatinine were associated with increased risk of death in patients with organophosphate poisoning (shock: HR, 10.9; 95% CI 1.2-96.3; elevated serum creatinine: HR, 1.0, 95% CI 1.0-1.0). This study indicated the association between elevated serum creatinine and increased mortality rates in patients with organophosphate poisoning, highlighting the importance of the comprehensive management of shock, especially the control of renal function, in these poisoning patients.

Acute and Chronic Systemic Inflammation: Features and Differences in the Pathogenesis, and Integral Criteria for Verification and Differentiation.

Currently, there is rationale for separating the systemic manifestations of classical inflammation from systemic inflammation (SI) itself as an independent form of the general pathological process underlying the pathogenesis of the most severe acute and chronic diseases. With this aim in view, we used integral scales of acute and chronic SI (ChSI), including the following blood plasma parameters: interleukins 6, 8, 10; tumor necrosis factor alpha; C-reactive protein; D-dimer; cortisol; troponin I; myoglobin. The presence of multiple organ dysfunction according to the SOFA score was also taken into account. The effectiveness of the scales was tested in groups of intensive care patients during different periods of acute trauma, sepsis, and septic shock. The ChSI scale was applicable under systemic autoimmune diseases, chronic purulent infections, chronic limb threatening ischemia, and end-stage renal disease of various genesis. The number of examined patients was 764 in total. The scales allowed us to verify specific phases of acute SI and identify pathogenetic risk factors of lethal outcomes, as well as the most severe variants of the chronic pathologies course. These scales are open adaptable systems (in terms of the nomenclature and choice of indicators). They are primarily intended for scientific research. However, the SI verification methodology presented in this paper may be useful for developing advanced criteria for assessing both the typical links in the pathogenesis of many diseases and the severity of the overall condition of patients for clinical practice.