Early Phase In Patients Research Articles

Predicting the dynamics of organ failure in patients with acute pancreatitis depending on the mean platelet volume

BackgroundThe aim of this study is to determine the correlation between the blood serum mean platelet volume (MPV) and the dynamics of the OF course during the early phase in patients with moderately severe and severe acute pancreatitis (AP). MethodsThe predetermined criterion was the presence of the OF according to the revised Atlanta criteria 2012 for moderately severe and severe AP. A prospective sample of patients was stratified by severity, and two groups were defined based on MPV. Demographic indicators, comorbidities and clinical outcomes were compared between these groups. Multifactorial analysis determined whether an elevated MPV is independently associated with early OF and other unfavorable outcomes. ResultsOut of 108 patients, 20 had moderately severe AP and 88 had severe AP. The blood serum MPV, measured within 72 h of the onset of AP symptoms was lower 11.8 fL in 32 patients and equal to or greater 11.8 fL in 76 patients. Patients with elevated MPV were older (63 vs. 48 years), had obesity (59.2 % vs. 25 %), diabetes mellitus (DM) (51.3 % vs. 12.5 %), ischemic heart disease (70.8 % vs. 28.1 %) and more frequently experienced persistent OF (93.4 % vs. 53.1 %) compared to those with MPV lower 11.8 fL. The incidence of early OF increased proportionally with the severity of MPV (81.6 % vs. 34.4 % in the group with MPV lower 11.8 fL, Ptrend < 0.0001). In multifactorial analysis, adjusted for body mass index and DM, MPV equal to or greater 11.8 fL was independently associated with early OF. ConclusionsElevated blood serum MPV of patients with AP are independently and proportionally correlated with early organ failure in patients with alcoholic and idiopathic etiology of AP. Key messageThe study provides an evaluation of MPV as a prognostic marker for organ failure within the initial 7 days following the onset of acute pancreatitis symptoms. Additionally, alterations in MPV were identified in patients with acute pancreatitis who had diabetes or ischemic heart disease within the first 24 h of hospitalization.

Prediction of high-flow nasal cannula outcomes at the early phase using the modified respiratory rate oxygenation index

BackgroundThis study was designed to explore the early predictive value of the respiratory rate oxygenation (ROX) index modified by PaO2 (mROX) in high-flow nasal cannula (HFNC) therapy in patients with acute hypoxemia respiratory failure (AHRF).MethodSeventy-five patients with AHRF treated with HFNC were retrospectively reviewed. Respiratory parameters at baseline and 2 h after HFNC initiation were analyzed. The predictive value of the ROX (ratio of pulse oximetry/FIO2 to respiratory rate) and mROX (ratio of arterial oxygen /FIO2 to respiratory rate) indices with two variations by adding heart rate to each index (ROX-HR and mROX-HR) was evaluated.ResultsHFNC therapy failed in 24 patients, who had significantly higher intensive care unit (ICU) mortality and longer ICU stay. Both the ROX and mROX indices at 2 h after HFNC initiation can predict the risk of intubation after HFNC. Two hours after HFNC initiation, the mROX index had a higher area under the receiver operating characteristic curve (AUROC) for predicting HFNC success than the ROX index. Besides, baseline mROX index of greater than 7.1 showed a specificity of 100% for HFNC success.ConclusionThe mROX index may be a suitable predictor of HFNC therapy outcomes at the early phase in patients with AHRF.

Abstract 13368: Clinical Impact of Heart Rate Change in Early Phase in Patients With Acute Decompensated Heart Failure

Introduction: Several studies have evaluated prognostic value of heart rate (HR) change during hospitalization in patients with acute heart failure (AHF). However, the relationship between HR change in early phase after admission and prognosis have not been fully elucidated. Hypothesis: The aim of this study was to evaluate the prognostic value of HR change in early phase in patients with AHF. Methods: We used a data of multicenter retrospective registry for the consecutive hospitalized patients due to AHF since January 2012 to March 2019. Patients were divided into three groups according to tertiles of HR at admission: lower tertile, HR &lt;85 bpm; middle tertile, HR 85-108 bpm; higher tertile, HR &gt;108 bpm. And, (HR [at admission] - HR [at 12 hour after admission]) * 100 / HR [at admission] was calculated as HR change (%). Results: Total of 1625 patients were analyzed. The median HR at admission was 96 bpm, and HR decreased to 81 bpm at 12 hours after admission (p &lt; 0.001). Larger HR change was observed according to increase in HR at admission (HR change; lower tertile, 1.0%; middle tertile, 12.5%, higher tertile, 38.0%, p &lt; 0.001). In Kaplan-Meier analysis, the cumulative event-free rates in the composite endpoint of death and re-hospitalization due to AHF showed better according to higher HR at admission (p &lt; 0.001, log-rank) (Figure). After dividing the patient into two groups in each tertiles based on the median HR change, the cumulative event-free rates were comparable between higher HR change group and lower HR change group in all tertiles (Figure). Cox proportional hazards analysis showed that HR change was not the independent predictors of composite endpoint adjusted by covariates in each tertile (lower tertile, p = 0.81; middle tertile, p = 0.78; higher tertile, p = 0.90). Conclusions: HR decreased significantly until 12 hours after admission. However, HR change in early phase did not have prognostic value in patients with AHF.

Hepatic Perfusion Alterations in Septic Shock Patients

Background:Early goal-directed therapy (EGDT) has become an important therapeutic management in early salvage stage of septic shock. However, splenic organs possibly remained hypoperfused and hypoxic despite fluid resuscitation. This study aimed to evaluate the effect of EGDT on hepatic perfusion in septic shock patients.Methods:A prospective observational study was carried out in early septic shock patients who were admitted to Intensive Care Unit within 24 h after onset and who met all four elements of the EGDT criteria after treatment with the standard EGDT procedure within 6 h between December 1, 2012 and November 30, 2013. The hemodynamic data were recorded, and oxygen metabolism and hepatic functions were monitored. An indocyanine green clearance test was applied to detect the hepatic perfusion. The patients’ characteristics were compared before treatment (T0), immediately after EGDT (T1), and 24 h after EGDT (T2). This study is registered at ClinicalTrials.org, NCT02060773.Results:Twenty-one patients were included in the study; however, the hepatic perfusion data were not included in the analysis for two patients; therefore, 19 patients were eligible for the study. Hemodynamics data, as monitored by pulse-indicator continuous cardiac output, were obtained from 16 patients. There were no significant differences in indocyanine green plasma disappearance rate (ICG-PDR) and 15-min retention rate (R15) at T0 (11.9 ± 5.0%/min and 20.0 ± 13.2%), T1 (11.4 ± 5.1%/min and 23.6 ± 14.9%), and T2 (11.0 ± 4.5%/min and 23.7 ± 15.3%) (all P > 0.05). Both of the alterations of ICG-PDR and R15 showed no differences at T0, T1, and T2 in the patients of different subgroups that achieved different resuscitation goal numbers when elected (P > 0.05).Conclusion:There were no hepatic perfusion improvements after EGDT in the early phase of patients with septic shock.Trial Registration:Clinicaltrials.gov NCT02060773 (https://clinicaltrials.gov/ct2/show/NCT02060773).

Clinical efficacy of the highly sensitive hepatitis C virus RNA quantitative assay in patients with relapse following interferon-based therapy with second-generation direct-acting antivirals.

For refractory chronic hepatitis C, interferon (IFN)-based triple-agent combination therapy with second-generation direct-acting antivirals (DAAs) has been established as the standard treatment method. The rate of decrease in the viral load and the negative conversion of hepatitis C virus (HCV) RNA in the early phase following treatment initiation are considered important factors for predicting the therapeutic outcome. In the present study, the Roche Cobas AmpliPrep/COBAS TaqMan (CAP/CTM) HCV v2.0 assay and the AccuGENE m-HCV RNA quantitative assay [Abbott RealTime HCV (ART) assay] were analyzed for their clinical efficacy and ability to predict therapeutic outcomes in the early phase in patients with relapse following IFN-based second-generation DAA therapy. Of the 56 patients who received IFN-based second-generation DAA therapy since December 2013, 6 achieved an end-of-treatment response (ETR), but subsequently experienced relapse. In these 6 patients, fluctuations in viral loads in the early phase detected by the CAP/CTM and ART assays were compared. At 4 weeks after treatment initiation, 4 of the 6 patients were diagnosed as negative by the CAP/CTM assay, whereas 2 of these 4 patients were not identified as negative by the ART assay. Of the 2 patients, one was signal-positive with an HCV RNA load <1.08 Log IU/ml, and the other patient had a viral load of 1.12 Log IU/ml. At 8 weeks after treatment initiation, 1 patient was found to be negative by the CAP/CTM assay, but signal-positive with a viral load <1.08 Log IU/ml by the ART assay. From 4 to 8 weeks after treatment initiation, 3 of the 6 patients appeared to be discrepant cases. In conclusion, of the 6 patients who achieved an ETR, 4 were determined to have achieved a rapid virological response (RVR) by the CAP/CTM assay, but may not have actually become negative. The ART assay is highly sensitive, has a wide measurement range, may be suitable for monitoring HCV RNA loads, and is expected to have an important role in providing a predictive marker for early therapeutic outcomes. In discrepant cases in which no RVR is proved by either assay, it was assumed important to consider continuation of treatment and to attempt to achieve a sustained virological response.

Changes of the corticospinal tract in the unaffected hemisphere in stroke patients: A diffusion tensor imaging study

We investigated changes of the corticospinal tract (CST) in the unaffected hemisphere according to severity of the CST injury, using diffusion tensor imaging (DTI). According to the severity of the CST injury in the affected hemisphere, the stroke patients showed different aspects of fiber volume increment of the CST in the unaffected hemisphere; the fiber volume was increased in the early phase in patients with mild injury of CST and later phase in patients with severe injury of CST.

Relation between Hemodynamic Parameters on Admission and Worsening Renal Function in Early Phase in Patients with Acute Decompensated Heart Failure

In patients admitted for acute decompensated heart failure (ADHF), the relation between hemodynamic parameters on admission and worsening renal function (WRF, serum creatinine rise ≥0.3 mg/dl from admission) at an early phase remains unclear. We investigated 1420 consecutive patients admitted for

Utilization of the DaT-SCAN SPECT in the Diagnosis of Parkinson's Disease in Older Subjects

The diagnosis of parkinsonism is essentially made by the presence of typical features including bradykinesia, plastic rigidity and resting tremor. However, in older persons, where the prevalence of parkinsonism is higher, the diagnosis is often inaccurate. The utilization of new radiological techniques, such as the DaT-SCAN SPECT, can improve the early diagnosis and treatment of these patients. However, no data are available at this moment in older population. Aims of this study were to investigate the role of the DaT-SCAN SPECT in the diagnosis of parkinsonism in older persons, and to propose a new diagnostic algorithm on DaT-SCAN SPECT to be used in older persons with parkinsonism. Patients evaluated at the Nuclear Medicine Unit of the University Hospital of Parma for diagnosis of parkinsonism from January 2009 to June 2012 who underwent clinical evaluation, and radiological assessment with DaT-SCAN SPECT, brain CT and MRI. A total of 267 patients, 147 men (55.06%) and 120 women(44.94%) with a mean age of 73.12 ± 5.08 years were enrolled in the study. In the multivariate linear regression analysis including age, sex, and bradykinesia, the presence of cerebral vascular lesions in the CT or MRI was the most significant predictive factor of abnormal DaT-SCAN SPECT uptake (beta± SE, p=0.002). The presence of bradykinesia remained also significantly associated with the DaT- SCAN SPECT uptake. In older subjects, the CT or MRI detection of cerebral vascular lesions and the presence of bradykinesia are the most significant predictors of abnormal DaT-SCANTM SPECT uptake. The timing of scan execution and the coexistence of motor and cognitive deficits, are key elements to improve the accuracy of early detection of altered nigrostriatal system, for avoiding misdiagnosis and side-effects of medications inappropriately started in older persons. This study could facilitate clinicians to treat older persons with Parkinson's disease and to ameliorate the accuracy of the diagnosis for testing the effects of new drugs affecting the natural history of this neurodegenerative disease. The accuracy of the diagnosis could permit an early identification of these diseases, and could permit to test neuroprotective drugs in early phase of patients with Parkinson's disease. Keywords: DAT-SPECT, Parkinson's disease, Vascular Parkinsonism, Parkinsonism, Older Persons, diagnosis.

Pulmonary function assessment in the early phase of patients with smoke inhalation injury from fire.

Fire smoke contains toxic gases and numerous chemical compounds produced by incomplete combustion, and may cause injury to the airways. Increased airway reactivity, as well as a decrease in lung function, has been reported as a sequela of smoke inhalation injury. This study was undertaken to assess lung functions in the early phase of patients with smoke inhalation damage from fires. A total of 15 patients with fire smoke inhalation (fire smoke group) and 15 subjects with chronic cough but no previous history of lung disease (chronic cough group) were enrolled. For diagnosis of inhalation injury, we performed bronchoscopy, high-resolution computed tomography (HRCT), as well as arterial carboxyhemoglobin (COHb) at admission. Clinical characteristics, pulmonary function tests (PFTs) and mannitol bronchial provocation tests (BPTs) were analyzed and compared between the two groups. In fire smoke group, initial COHb levels and the PaO2/FiO2 ratio were (14.8±18.49)% and 425.7±123.68, respectively. Of seven patients performing HRCT, 4 (57.1%) showed the CT findings compatible with lung involvement of inhalation injury. Post bronchodilator value of the percent of forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) were (76.0±24.27)% and (79.8±27.82)%, respectively. Pre-and post- bronchodilator forced expiratory flow between 25% and 75% of the FVC (FEF25-75) and the percent predicted FEF25-75 were 2.41±1.47 vs. 2.65±1.45 L (P=0.045), and (68.7±37.29)% vs. (76.4±36.70)% (P=0.031), respectively. Two patients (13.3%) had positive bronchodilator response (BDR). In fire smoke and chronic cough group, all the subjects showed mannitol BPTs within normal limits. Fire smoke inhalation leads to mild obstructive small airway disease pattern of pulmonary function in the early phase of patients with fire smoke damage. Further studies, however, need to be followed to identify the relationship between airway narrowing to inhaled mannitol and smoke inhalation injury.

Renal Enzymes and Microglobulins in Patients with Rheumathoid Arthritis

Aim: The aim of this study was to detect and compare the enzymes, globulins and reactants of the early phase in patients with untreated rheumatoid arthritis and to reveal the effect of untreated rheumatoid arthritis on tubular function and sensitivity on brush border area. Material and Methods: The samples of serum and urine were examined in 70 participants (35 patients with untreated rheumatoid arthritis, 35 individuals of the healthy control group). We used in the study the kinetic assay for determination of alanine aminopeptidase (AAP) (Standards methods under IFCC), γ-glutamiytransferase and MEIA (Microparticle Enzyme Immunoassay) (Abbot Axsym system) for detection of β 2-microglobulin in urine. Results: Of 35 patients with RA, 16 patients showed presence of γ-GT (sensitivity of the test - 45.71%), 24 patients showed presence of AAP enzymuria (sensitivity of the test - 68.57%), while the presence of β2-microglobulin in urine was very low (sensitivity of the test - 0%). From 18 RF negative patients, 14 patients were AAP positive, 10 patients were γ-GT positive, while the presence of β2-microglobulin in urine was not detected. Among 17 RF positive patients with RA, the presence of AAP was detected in 10 patients, the presence of γ-GT in 6 patients, while the presence of β2-microglobulin in urine was not detected. Conclusion: In untreated rheumatoid arthritis AAP had higher sensitivity than γ-GT and β2-microglobulin in detection of asymptomatic renal damage

Correlation Among Systemic Inflammatory Parameter, Occurrence of Delayed Neurological Deficits, and Outcome After Aneurysmal Subarachnoid Hemorrhage

The role and impact of systemic inflammatory response after aneurysmal subarachnoid hemorrhage remain to be elucidated. To assess the time course and correlation of systemic inflammatory parameters with outcome and the occurrence of delayed ischemic neurological deficits (DINDs) after subarachnoid hemorrhage. Besides the baseline characteristics, daily interleukin-6 (IL-6), procalcitonin, C-reactive protein levels, and leukocyte counts were prospectively measured until day 14 after subarachnoid hemorrhage. Occurrence of infectious complications and application of therapeutic hypothermia were assessed as confounding factors. The primary end point was outcome after 3 months, assessed by Glasgow outcome scale; the secondary end point was the occurrence of DINDs. During a 3-year period, a total of 138 patients were included. All inflammatory parameters measured were higher in patients with unfavorable outcome (Glasgow outcome scale score, 1-3). After adjustment for confounding factors, elevated IL-6 and leukocyte counts remained significant risk factors for unfavorable outcome. The odds ratio for log IL-6 was 4.07 (95% confidence interval, 1.18 to 14.03; P = .03) and for leukocyte counts was 1.24 (95% confidence interval, 1.06-1.46, P = .008). The analysis of the time course established that IL-6 was the only significantly elevated parameter in the early phase in patients with unfavorable outcome. Higher IL-6 levels in the early phase (days 3-7) were associated with the occurrence of DINDs. The adjusted odds ratio for log IL-6 was 4.03 (95% confidence interval, 1.21-13.40; P = .02). Higher IL-6 levels are associated with worse clinical outcome and the occurrence of DINDs. Because IL-6 levels were significantly elevated in the early phase, they might be a useful parameter to monitor.

Skin toxicities and survival in advanced hepatocellular carcinoma patients treated with sorafenib

Sorafenib is the first small molecule with significant clinical activity for advanced hepatocellular carcinoma (HCC). However, intolerable adverse events are sometimes observed. On the other hand, it has been reported that some toxicities of molecular targeted drugs, such as skin toxicities and arterial hypertension, are correlated with good clinical outcomes in other cancers. We identified the correlations between adverse events and prognosis for sorafenib therapy in all patients with HCC treated at the institutions of the Saga Liver Cancer Study Group. The toxicities were assessed using the Common Terminology Criteria for Adverse Events version 4.0. Ninety-four patients received sorafenib until August 2010. The overall incidence of treatment-related adverse events was 98% of patients. Skin toxicities, including palmar-plantar erythrodysesthesia syndrome, rash, pruritus and alopecia, were the most common adverse events and were observed in 58 patients (62%). Hypertension was observed in 23 patients (24%). The median survival time was 12.5 months among the total patients. The patients with skin toxicities showed significantly longer survival than the patients without these toxicities (hazard ratio, 0.449; 95% confidence interval, 0.256-0.786; P = 0.005). Hypertension had no correlation with survival. Skin toxicities were also significant prognostic factors in a multivariate analysis (hazard ratio, 0.522; 95% confidence interval, 0.274-0.997; P = 0.049), along with Child-Pugh class and α-fetoprotein level. The median development time for skin toxicities was 21 days. Skin toxicities occur commonly at the early phase in patients treated with sorafenib, and could be a promising surrogate marker for the treatment outcome.

The safety of bedside bowel movement during the early phase of patients with acute myocardial infarction

Objective To explore the safety of bedside bowel movement during the earlY phase of patients with acute myocardial infarction(AMI).Methods 55 patients were randomly divided into the experimental group(28 cases)and the control group(27 cases).The experimental group adopted bedside bowel movement while the control group used routine in-bed bowel movement.The heart rate,blood pressure and myocardial oxygen comsumption(D-P)were observed.Results The heart rate,systolic blood pressure,and diastolic blood pressure in the control group were higher than those in steady state(P＜0.05).While in the experimental group the above factors were not statistically different from those in steady state (P＞0.05).The D-P both increased in the two groups compared with that in steady state(P＜0.05).The incidence of uncomfortable complaint and complications were not different between the two groups but the rate of constipation and mean in-hospital days were lower than those in the control group(P＜0.05).Conclusion It proved safe and applicable for patients with AMI to adopt bedside bowel movement during 24 to 72hours after infarction under the electrocardiac and blood pressure monitoring if their vital signs were steady and did not have any serious complications. Key words: Acute myocardial infarction; Bowel movement; Safe

Vascular emergencies in liver trauma

The use of CT in the diagnosis and management of liver trauma is responsible for the shift from routine surgical versus non-surgical treatment in the management of traumatic liver injuries, even when they are of high grade. The main cause of compli cation and of death in liver trauma is related to vascular injury. The goal of this review focussed on the vascular complications of liver trauma is to describe the elementary lesions shown by CT in liver trauma including laceration, parenchymal hematoma and contusions, partial devascularisation, subcapsular hematomas, hemoperitoneum, active bleeding, pseudoaneurysm of the hepatic artery, bile leak, and periportal oedema, to illustrate the possible pitfalls in CT diagnosis of liver trauma and to underline the key-points which may absolutely be present in a CT report of liver trauma. Then we will remind the grading system based on the CT features and we will analyze the interest and limitations of such grading systems. Last we will discuss the diagnostic strategy at the early phase in patients with suspected liver trauma according to their clinical conditions and underline the conditions of arterial embolization, and then we will discuss the diagnosis strategy at the delayed phase according to the suspected complications.