Organ System Dysfunction Research Articles

Consequences of COVID-19 for the Pancreas.

Although coronavirus disease 2019 (COVID-19)-related major health consequences involve the lungs, a growing body of evidence indicates that COVID-19 is not inert to the pancreas either. This review presents a summary of the molecular mechanisms involved in the development of pancreatic dysfunction during the course of COVID-19, the comparison of the effects of non-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on pancreatic function, and a summary of how drugs used in COVID-19 treatment may affect this organ. It appears that diabetes is not only a condition that predisposes a patient to suffer from more severe COVID-19, but it may also develop as a consequence of infection with this virus. Some SARS-CoV-2 inpatients experience acute pancreatitis due to direct infection of the tissue with the virus or due to systemic multiple organ dysfunction syndrome (MODS) accompanied by elevated levels of amylase and lipase. There are also reports that reveal a relationship between the development and treatment of pancreatic cancer and SARS-CoV-2 infection. It has been postulated that evaluation of pancreatic function should be increased in post-COVID-19 patients, both adults and children.

Association between plasma glycocalyx component levels and poor prognosis in severe influenza type A (H1N1)

Influenza A virus infection causes a series of diseases, but the factors associated with disease severity are not fully understood. Disruption of the endothelial glycocalyx contributes to acute lung injury in sepsis, but has not been well studied in H1N1 influenza. We aim to determine whether the plasma glycocalyx components levels are predictive of disease severity in H1N1 influenza. This prospective observational study included 53 patients with influenza A (H1N1) during the influenza season, and 30 healthy controls in our hospital. Patients were grouped by severity and survival. We collected clinical data and blood samples at admission. Inflammatory factors (tumor necrosis factor-α, interleukin-6, interleukin-10) and endothelial glycocalyx components (syndecan-1, hyaluronan, heparan sulfate) were measured. The plasma levels of syndecan-1, hyaluronan, and heparan sulfate were significantly higher in patients with severe influenza A (H1N1) than in mild cases. Syndecan-1 and hyaluronan were positively correlated with disease severity, which was indicated by the APACHE II and SOFA scores and lactate levels, and negatively correlated with albumin levels. At a cutoff point ≥ 173.9 ng/mL, syndecan-1 had a 81.3% sensitivity and 70.3% specificity for predicting of 28-day mortality. Kaplan–Meier analysis demonstrated a strong association between syndecan-1 levels and 28-day mortality (log-rank 11.04, P = 0.001). Elevated plasma levels of syndecan-1 has a potential role in systemic organ dysfunction and may be indicative of disease severity in patients with influenza A (H1N1).

Idiopathic multicentric Castleman disease with positive antiphospholipid antibody: atypical and undiagnosed autoimmune disease?

Idiopathic multicentric Castleman disease (iMCD) is a systemic disorder characterized by systemic inflammation and organ dysfunction associated with an increase in pro-inflammatory cytokines. Some patients with iMCD are positive for autoantibodies, although their significance and relationship with specific associated autoimmune diseases are unclear. This study retrospectively analyzed the clinicopathological features of iMCD patients focusing on autoantibodies. Among 63 iMCD patients in our database, 19 were positive for at least one autoantibody. Among the 19, we identified five with plasma cell type (PC)-iMCD lymph node histopathology and positive anti-phospholipid antibodies. These patients were likely to have thrombocytopenia, anasarca, fever, reticulin fibrosis or renal insufficiency, organomegaly (TAFRO) symptoms, and thrombotic events. The present study suggests that patients with undiagnosed or atypical autoimmune diseases, including anti-phospholipid syndrome (APS), were treated for iMCD. APS may present with thrombocytopenia or even multi-organ failure, which overlap with clinical presentations of iMCD. Due to differences in the treatment regimen and follow-up, recognition of the undiagnosed autoimmune disease process in those suspected of iMCD is essential. Our study highlights the importance of complete exclusion of differential diagnoses in patients with iMCD in their diagnostic workup.

A specialized multi-disciplinary care program for children with sepsis and multiple organ dysfunction-associated immune dysregulation.

The complex physiology and medical requirements of children with sepsis and multiple organ dysfunction syndrome (MODS) challenge traditional care coordination models. While the involvement of multiple clinical subspecialty services is often necessary to support different care processes and individual organ system dysfunctions, it can also delay the diagnostic process, monitoring, and treatment. The logistics of coordinating with many specialty providers for critically ill patients are challenging and time consuming, and often can result in fragmented communication. To address these and other related issues, we developed a new multi-disciplinary consult service focused on streamlining diagnostics, management, and communication for patients with sepsis and MODS-associated immune dysregulation. The service, called the Program in Inflammation, Immunity, and the Microbiome (PrIIMe), is now a hospital-wide clinical consult service at our institution caring for a broad group of patients with immune dysregulation, particularly focusing on patients with sepsis and MODS. In this paper, we summarize the development, structure, and function of the program, as well as the initial impact. This information may be helpful to clinicians and healthcare leaders who are developing multi-disciplinary consult services for children with complex care needs, especially those with sepsis and MODS-associated immune dysregulation.Impact The care of children with sepsis and multiple organ dysfunction-associated immune dysregulation requires rapid and flexible involvement of multiple clinical subspecialists that is difficult to achieve without fragmented care and delayed decision making.In this narrative review we describe the development, structure, and function of a multi-disciplinary consult service at a children’s hospital dedicated to helping coordinate management and provide continuity of care for patients with sepsis and multiple organ dysfunction-associated immune dysregulation.This information may be helpful to clinicians and healthcare leaders who are developing multi-disciplinary consult services for children with complex care needs, especially those with sepsis and MODS-associated immune dysregulation.

Refining the Pediatric Multiple Organ Dysfunction Syndrome

Since its introduction into the medical literature in the 1970s, the term multiple organ dysfunction syndrome (or some variant) has been applied broadly to any patient with >1 concurrent organ dysfunction. However, the epidemiology, mechanisms, time course, and outcomes among children with multiple organ dysfunction vary substantially. We posit that the term pediatric multiple organ dysfunction syndrome (or MODS) should be reserved for patients with a systemic pathologic state resulting from a common mechanism (or mechanisms) that affects numerous organ systems simultaneously. In contrast, children in whom organ injuries are attributable to distinct mechanisms should be considered to have additive organ system dysfunctions but not the syndrome of MODS. Although such differentiation may not always be possible with current scientific knowledge, we make the case for how attempts to differentiate multiple organ dysfunction from other states of additive organ dysfunctions can help to evolve clinical and research priorities in diagnosis, monitoring, and therapy from largely organ-specific to more holistic strategies.

Ethanol Consumption and Sepsis: Mechanisms of Organ Damage

Sepsis is highly prevalent, and is one of the main causes of mortality among hospitalized patients. Ethanol consumption in large quantities compromises the normal functioning of the body, leading to dysfunction of multiple different organ systems.

Misa, Post COVID complication

Multisystem inflammatory syndrome in adults (MIS-A) is an rare and underrecognised postinfectious manifestation that occurs 4–6 weeks after COVID-19 infection. Patients affected tend to be young or middle-aged, from ethnic minority backgrounds and previously healthy. The patient suffer from high fever and myalgia, and there is myriad of extrapulmonary symptoms and signs, including cardiac, gastrointestinal, neurological and dermatological involvement. Cardiovascular shock and markedly raised inflammatory markers are prominent features, while significant hypoxia is uncommon. Patients respond well to corticosteroid therapy, but failure of clinicians to recognise this recently identified phenomenon, which can mimic common conditions including sepsis, could delay diagnosis and treatment. Here we present a case of MIS-A in an adult men, with severe illness and positive test result for SARS-CoV-2 infection (PC, antigen, or antibody).There was severe extrapulmonary organ system dysfunction;There was markedly elevated acute inflammatory markers; .there was no any respiratory illness.

Prevalence and Pregnancy Outcome of Preeclampsia Using International Society for the Study of Hypertension in Pregnancy 2018 Criteria in Comparison to 2001

Introduction: Criteria of preeclampsia (PE) have evolved over years to increase the prediction of adverse pregnancy outcomes. Revised International Society for the Study of Hypertension in Pregnancy (ISSHP) 2018 criteria incorporates organ system dysfunction with or without proteinuria. This study aims to determine changes in prevalence and pregnancy outcome of PE diagnosed by revised criteria compared to traditional ones. Methods: This was a cross-sectional study conducted in the department of Obstetrics and Gynecology from July to October 2021. Women with hypertensive disorders in pregnancy (HDP) were classified according to ISSHP 2001 and 2018 criteria to study the prevalence and pregnancy outcomes. Data were analyzed using Statistical Package for the Social Sciences version 21. Results: There was an increase in the prevalence of PE applying ISSHP 2018 criteria (12.6% vs 4.6%). The proportion of cases of PE in HDP increased from 19.4% to 52.7%. Preterm delivery was more in the group diagnosed using old criteria compared to revised criteria (52% vs 33.8%). Maternal morbidity like operative delivery, severe hypertension, eclampsia, abruptio, intrauterine growth restriction, were more in women diagnosed only with proteinuria. Low birth weight, Apgar less than 7 at one and five minutes, perinatal morbidity and mortality, were also more in PE diagnosed using old criteria compared to revised criteria. Conclusion: The prevalence of PE increased without changes in the pregnancy outcome when revised ISSHP 2018 criteria were applied over the traditional 2001.

The renin-angiotensin system and cardiovascular autonomic control in aging

Aging is the greatest independent risk factor for developing hypertension and cardiovascular-related diseases including systolic hypertension, vascular disease, ischemic events, arrhythmias, and heart failure. Age-related cardiovascular risk is associated with dysfunction of peripheral organ systems, such as the heart and vasculature, as well as an imbalance in the autonomic nervous system characterized by increased sympathetic and decreased parasympathetic neurotransmission. Given the increasing prevalence of aged individuals worldwide, it is critical to better understand mechanisms contributing to impaired cardiovascular autonomic control in this population. In this regard, the renin-angiotensin system has emerged as an important hormonal modulator of cardiovascular function in aging, in part through modulation of autonomic pathways controlling sympathetic and parasympathetic outflow to cardiovascular end organs. This review will summarize the role of the RAS in cardiovascular autonomic control during aging, with a focus on current knowledge of angiotensin II versus angiotensin-(1−7) pathways in both rodent models and humans, pharmacological treatment strategies targeting the renin-angiotensin system, and unanswered questions for future research.

Use of Different Types of Alternative Medicine in the Treatment of Diabetes Mellitus

Introduction: Diabetes is a chronic metabolic disorder whose hallmarks are hyperglycemia accompanied by persistent damage, dysfunction and failure of various organ systems.
 Objectives of the Study: To assess the frequency of use alternative medicine for Diabetes Mellitus.
 Methodology of the Study: This cross sectional study was conducted during June 2019 to April 2020 at Sahiwal Medical College, Sahiwal. Data regarding prevalence of alternative medicines usage in Pakistan, is not available. Thus, to calculate sample size, prevalence of India is being used which is 67%.
 Results: The data was collected from 400 patients and there was 167 male and 233 female. The mean age was 52.93±12.97 years. There are 113 patients who was suffering from diabetes from less than 5 years and almost 187 patients who was suffering more than 10 years. There were 189 patients who have good diabetic control as compared to others. There are 158 patients who used CAM for diseases control.
 Conclusion: It is concluded that patients might be less compelled to seek a CAM therapy or any other medical therapy if they have relatively few symptoms.

An eye exam leads to the diagnosis of a rare lysosomal storage disorder: Fabry disease

A healthy 33-year-old female was referred for an ophthalmic examination for bilateral intermittent blurring of vision. She had a photorefractive keratectomy 8 years prior. Uncorrected vision was 20/20 OU. Slit-lamp examination of the anterior segment revealed bilateral whorl-like golden-brown streaks stemming from the central cornea called cornea verticillata (Fig. 1), classically seen in Fabry disease. This is a lysosomal storage disorder characterized by deficient activity of α‐galactosidase, leading to sphingolipid accumulation in various cells and subsequent organ system dysfunction.

Advance in sepsis-related coagulation disorders and immunity response

Coagulation disorder or disseminated intravascular coagulation (DIC) is a clinicopathological syndrome, in which the imbalance between coagulation and fibrinolysis is the main pathogenesis, and systemic microthrombosis and systemic bleeding tendency are the main clinical manifestations. The clinical outcome is often the induction of systemic multiple organ dysfunction. As a common complication of sepsis, DIC significantly increases the mortality of septic patients. The coagulation disorder in sepsis is closely related to the inflammatory response of the body. Studying the mechanism of sepsis-related coagulation disorder will provide new possibilities for its early diagnosis and prognosis evaluation. This article reviews the latest research progress on the molecular mechanism of sepsis-related coagulation disorders in immunity and inflammation, in order to provide new possibilities for potential therapeutic targets.

Donor Screening for Fecal Microbiota Transplantation in China: Evaluation of 8483 Candidates

Donor Screening for Fecal Microbiota Transplantation in China: Evaluation of 8483 Candidates

Red Blood Cell Morphological Changes and Enlarged Platelets Found in Idiopathic Multicentric Castleman Disease

BACKGROUNDIdiopathic multicentric Castleman disease (iMCD) is a rare polyclonal lymphoproliferative disorder characterized by systemic inflammatory symptoms, cytopenias, generalized lymphadenopathy, and multiple organ system dysfunction. iMCD is subclassified into iMCD-TAFRO, with thrombocytopenia, anasarca, fever/elevated C-reactive protein, reticulin myelofibrosis/renal failure, and organomegaly, and iMCD-NOS (not otherwise specified), with high platelet counts and hypergammaglobulinemia. Despite recent diagnostic guidelines, iMCD diagnosis remains challenging because many of the histopathologic features and clinical/laboratory abnormalities are non-specific. Characterization of easily measurable findings from minimally invasive procedures, such as peripheral blood smear, could help to improve the accuracy of diagnosis as well as potentially providing insights into disease pathogenesis. Peripheral blood smears are often performed during routine clinical evaluation and enable morphologic evaluation of red blood cells (RBCs) and white blood cells (WBCs). In this study, we systematically characterized peripheral blood smear morphologic findings in iMCD for the first time.METHODSPeripheral blood smear morphologic findings in medical records from 68 iMCD patients, who were enrolled in an international registry for CD patients and had been confirmed to meet iMCD criteria by an expert panel, were reviewed and analyzed. Patients were also categorized into iMCD-TAFRO (N=39) or iMCD-NOS (N=29) based on clinical and laboratory data. Two-sample proportion tests were used to compare the frequency of features between iMCD-TAFRO and iMCD-NOS, when the abnormality was present in ≥ 5 subjects in both subtypes. P-value correction was not performed as findings are preliminary and hypothesis generating.RESULTSAmong the 68 iMCD patients, average age was 35.8 years (14-61); 46% were female, 54% were male; racial distribution was 62% white; 10% Black; 15% Asian; 13% other. The most common peripheral blood smear findings across all iMCD patients included abnormalities in RBC size and color, with anisocytosis (58.8%), polychromasia (57.4%), hypochromia (55.9%), and microcytosis (50.0%) being the most prevalent findings in the overall cohort (Table 1). Other RBC abnormalities were observed but less frequently, including abnormalities in shape such as poikilocytosis (44.1%). Giant or large platelets were found in 47% of iMCD cases. Abnormalities in WBCs, including toxic granulation, atypical lymphocytes, and toxic vacuolization, were detected less frequently. When comparing the two clinical subtypes, patients with iMCD-TAFRO had more frequent anisocytosis (p=0.043), hypochromia (p=0.002), polychromasia (p=0.022), and giant/large platelets (p<0.001) versus iMCD-NOS.DISCUSSIONHere, we have characterized peripheral blood morphologic abnormalities in iMCD for the first time. The most common findings in this cohort included abnormalities in RBC size and color. These abnormalities can be found in a number of conditions, including myelofibrosis, autoimmune diseases, and other inflammatory conditions. In iMCD, they are likely related to cytokine-driven anemia of chronic inflammation. The presence of large or giant platelets in nearly half of iMCD patients, with significantly more in iMCD-TAFRO than iMCD-NOS, is particularly notable since this has not been described in iMCD. These enlarged platelets, which can be found in immune thrombocytopenic purpura, myeloproliferative disorders, pseudothrombocytopenia, and inherited platelet disorders, may reflect hyperactivity of megakaryocytes and/or early release from the bone marrow in response to peripheral platelet sequestration. Though less common in this cohort, there are additional changes in RBC shape and WBC features that may be more specific to iMCD and potentially informative in increasing the index of suspicion for iMCD. These findings suggest that the peripheral blood smear may be able to support the diagnosis of iMCD and result in faster treatment administration. Future work is needed to determine whether the constellation of findings in the peripheral blood identified herein is unique to iMCD or seen in various other infectious, malignant, and autoimmune diseases. [Display omitted] DisclosuresFajgenbaum: Pfizer: Other: Study drug for clinical trial of sirolimus; EUSA Pharma: Research Funding; N/A: Other: Holds pending provisional patents for ‘Methods of treating idiopathic multicentric Castleman disease with JAK1/2 inhibition’ and ‘Discovery and validation of a novel subgroup and therapeutic target in idiopathic multicentric Castleman disease’.

Effect of intraoperative fluid type on postoperative systemic inflammatory response and end organ dysfunction following total pancreatectomy with islet autotransplantation in children

PurposeTo evaluate the effect of intraoperative fluid type [half normal saline (0.45NS) or lactated Ringer's solution (LR)] on the risk of systemic inflammatory response syndrome (SIRS) and acute kidney injury after total pancreatectomy with islet autotransplantation in children. MethodsRetrospective review where demographics, operative details, systemic inflammatory response, and evaluation for end organ dysfunction over the first 5 postoperative days was obtained. Mixed effects Poisson regression compared risk of SIRS and acute kidney injury by intraoperative fluid type. ResultsForty three patients were included with no difference in demographic characteristics between groups. SIRS was observed in 95, 77, and 71% over post operative days 1, 3, and 5. Intraoperative fluid type was found to not be associated with postoperative SIRS (RR: 0.91, p = 0.23). However, female sex (RR: 1.30, p < 0.01), increased BMI (RR: 1.08, p < 0.01), and longer operative time (RR: 1.07, p < 0.01) were found to be factors that are associated with increased risk of postoperative SIRS. Intraoperative 0.45NS use was associated with increased acute kidney injury compared to LR on postoperative day 1 (52% vs 0%, p < 0.01), but not on postoperative days 3 or 5. ConclusionIntraoperative fluid type (0.45NS vs LR) does not increase the risk of postoperative SIRS in children after TPIAT. Predictive factors that are associated with an increased risk of eliciting postoperative SIRS includes female sex, increased BMI, and longer operative times. Level of evidenceIII

Dependent functional status rather than age is a better predictor of adverse outcomes after excision of an infected abdominal aortic graft

ObjectiveThe optimal management of infected abdominal aortic grafts is complete surgical excision plus in situ or extra-anatomic revascularization in patients who can tolerate this morbid operation. In addition to using age and the presence of comorbidities for risk assessment, physicians form a global clinical impression when deciding whether to offer excision or to manage conservatively. Functional status is a distinct objective measure that can inform this decision. This study examines the relative impact of age and functional status on outcomes of infected abdominal aortic graft excision to guide surgical decision-making. MethodsCurrent Procedural Terminology code 35907 was used to identify patients undergoing excision of infected abdominal aortic graft in the 2005 to 2017 American College of Surgeons – National Surgical Quality Improvement Program (NSQIP) database. Patients were stratified by the upper age quartile (75 years old) as a cutoff, and then by functional status, independent vs dependent (as defined by NSIQIP). The patients were then stratified into four groups: Younger (<75)/Independent, Younger (<75)/Dependent, Older (≥75)/Independent, and Older (≥75)/Dependent. Outcomes measured included 30-day mortality and major organ-system dysfunction. ResultsThere were 814 patients who underwent infected abdominal aortic graft excision: 508 patients (62%) were Younger/Independent, 89 patients (11%) were Younger/Dependent, 176 patients (22%) were Older/Independent, and 41 patients (5%) were Older/Dependent. There was no statistically significant difference in 30-day mortality for Younger/Dependent (odds ratio [OR], 1.66; 95% confidence interval [CI], 0.90-3.09; P = .536) or Older/Independent (OR, 1.31; 95% CI, 0.78-2.19; P = .311) patients when compared with Younger/Independent patients, which suggests that neither old age nor dependent functional status by itself adversely affects mortality. However, when both factors were present, Older/Dependent patients had three times higher mortality when compared with Younger/Independent patients (41.5% vs 13.4%, respectively; OR, 3.13; 95% CI, 1.46-6.71; P = .003). Furthermore, as long as patients presented with independent functional status, old age by itself did not adversely affect major organ-system dysfunction (ORs for Older/Independent vs Younger/Independent were 0.76 [P = .454], 1.04 [P = .874], and 0.90 [P = .692] for cardiac, pulmonary, and renal complications, respectively). On the contrary, even in younger patients, dependent functional status was significantly associated with higher pulmonary complications (Younger/Dependent vs Younger/Independent: OR, 2.22; 95% CI, 1.33-3.73; P = .002) and higher rates of unplanned reoperation (OR, 2.67; 95% CI, 1.62-4.41; P < .0001). ConclusionsDependent functional status has significant association with adverse outcomes after excision of infected abdominal aortic grafts, whereas old age alone does not. Therefore, this procedure could be considered in appropriately selected elderly patients with otherwise good functional status. However, caution should be applied in dependent patients regardless of age due to the risk of pulmonary complications.

Intra-abdominal pressure monitoring in the management of patients with blunt injury abdomen: Prospective observational study

Background and Aim: Abdominal trauma can result in the increase of intra-abdominal pressure (IAP) for a variety of reasons including the accumulation of blood or free fluid in the peritoneal cavity, oedema of the intestinal wall, retroperitoneal hematoma or abdominal packing for haemorrhage control. The aim was to study the role of intra-abdominal pressure (IAP) monitoring in the management of patients with blunt injury abdomen. Material and Methods: Hospital based prospective observational study in 100 patients who presented to emergency medicine department later shifted to department of general surgery in Tertiary care Institute of India, over a period of 18 months. IAP was measured in emergency medicine department and ICU at presentation, that is, 0 hours, 3 hours, 6 hours, 12 hours, 24 hours, 48 hours, 72 hours and 96 hours. Parameters noted were blood pressure, pulse rate, respiratory rate, oxygen saturation (SpO2), urine output, blood urea, serum creatinine, IAP, time of presentation to hospital after injury, duration of ICU and hospital stay, need for ventilatory support, morbidity (new organsystem dysfunction) and mortality. Results: Correlation between IAP and vital parameters, renal parameters at 0, 3, 6, 24 and 72 hours were found statistically significant. Observation between IAP and vital parameters, renal parameters at 12 hours all parameters are significant except IAP has weak positive correlation with DBP and this was found statistically insignificant. Hospital stay decreased as IAP increases in surgically intervened group because IAP returned to normal after surgical decompression, but this finding was statistically significant only at 72 hours in our study. Conclusion: Before development of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS), the potential candidates should be offered surgical decompression at proper time.

Cardiology meets neurology: Clinical presentation and management of patients with primary neurogenic disorders and orthostatic intolerance

Patients with primary neurogenic disorders such as pure autonomic failure or multiple system atrophy may present first with cardiocirculatory symptoms such as orthostatic intolerance or fluctuations in heart rate with symptomatic tachycardia. It is therefore clinically important to identify such patients since circulatory manifestations are only one of a series of symptoms resulting from autonomic dysfunction in various organ systems. These patients need a multimodal diagnostic and therapeutic approach and should undergo extensive evaluation in a specialized autonomic nervous system (ANS) outpatient unit.

Sampling Thoracic Duct Lymph After Esophagectomy: A Pilot Study Investigating the "Gut-Lymph" Concept.

Background: Gut-lymph in animal models of acute disease is altered by intestinal ischemia and contributes to the development of systemic inflammation and organ dysfunction. Investigating gut-lymph in humans is hampered difficulty in accessing the thoracic duct (TD) for lymph sampling. The aims of this study were to develop and pilot a technique of intraoperative TD cannulation with delayed embolization to serially measure TD lymph pressure, flow, and composition (including markers of intestinal injury) during the early postoperative period and in response to enteral feeding and vasopressor treatment. Methods: A Seldinger technique was used for percutaneous TD cannulation during an Ivor Lewis esophagogastrectomy. Lymph flow rate and pressure were measured. TD lymph and plasma were sampled at 12 hourly intervals for up to 120 hours after surgery and before TD embolization. Biochemistry, lipids, cytokines, and markers of intestinal injury were measured before and after enteral feeding commenced at 36 hours. Results: Intraoperative TD cannulation was technically feasible in three of four patients. Delayed TD embolization was only successful in one of three patients, with two patients requiring a re-thoracotomy to treat chylothorax. Profound changes in TD composition, but not flow rate, occurred over time and in response to enteral feeding and vasopressors. TD lymph compared with plasma had significantly higher lipase (1.4-17 × ), interleukin-6 (8-108 × ), tumor necrosis factor-α (2.7-17 × ), d-lactate (0.3-23 × ), endotoxin (0.1-41 × ), and intestinal fatty acid binding protein (1.1-853 × ). Conclusions: Although TD cannulation and lymph sampling were successful, TD embolization failed in two of three patients. The composition of sampled TD lymph changed dramatically in response to enteral feeding, indicating intestinal ischemia that could be exacerbated by nonselective vasopressors. The higher concentration of proinflammatory cytokines and gut injury markers in TD lymph, compared with plasma, lends support to the gut-lymph concept.

IgM, IgA, IgG, and complement components as pre-operative markers for the development of multiple organ dysfunction syndrome in patients with infective endocarditis in early postoperative period

Aim. Here, we studied whether the immunoreactivity in pre-operative period defines early postoperative complications in patients with infective endocarditis (IE).Materials and Methods. We consecutively enrolled 110 patients with subacute IE (80 with native-valve IE and 30 with prosthetic valve IE) who underwent a heart valve replacement, then measuring the levels of IgM, IgA, IgG, and complement components in their serum and evaluating their correlation with an adverse early postoperative outcome.Results. Compared with patients&lt; 50 years of age, those ≥ 50 years of age had 2-foldand 3-foldhigher prevalence of systemic inflammatory response syndrome and multiple organ dysfunction syndrome in the early postoperative period. Notably, these numbers correlated with increased С3d and С5а along with reduced Ig М and IgG. IgМ below 9.5 mg/mL and IgG below 2.0mg/mL indicated a 3-foldhigher risk of multiple organ dysfunction syndrome (OR = 3.07, 95% CI = 1.96-4.04, р=0,001).Conclusion. Serum IgM, IgG, and complements factors C3d and C5a may be used as prognostic markers of multiple organ dysfunction syndrome in the early postoperative period.