Presence Of Systemic Inflammatory Response Syndrome Research Articles

Relationships between haptoglobin and inter-alpha trypsin inhibitor heavy chain 4 levels inlocal and peripheral blood and systemic inflammatory response syndrome in bitches withpyometra.

We aimed to assess the usefulness of monitoring inter-alpha trypsin inhibitor heavy chain 4 (ITIH4) and haptoglobin (Hp) in peripheral and local blood in canine pyometra, and evaluation the relationships among acute phase proteins (APPs), systemic inflammatory response syndrome (SIRS) and the presence of bacteria. The material was collected from bitches with pyometra and from healthy ones. Blood was taken from the cephalic and uterine veins. APPs levels were quantified by ELISA. In the peripheral circulation, the Hp was higher in animals with open-cervix pyometra (OCP) than in the closed-cervix pyometra (CCP) and the control group. The Hp concentration was not correlated with age, with the presence of SIRS or with the type of bacteria (Gram-negative, Gram-positive or mixed flora). The ITIH4 concentrations in the peripheral blood did not differ significantly in the cases of pyometra. The Hp concentration in the local circulation increased in the OCP but not in the CCP groups, although the histopathological changes in the endometrium were similar. Peripheral Hp concentrations may be a useful tool in differentiating between the types of pyometra.

O impacto da apresentação clínica, presença de SIRS e disfunção de órgãos em cadelas com piometra

ABSTRACT: This retrospective study evaluated the impact of the clinical presentation of pyometra on the morbidity and mortality of the affected bitches. The medical records of 47 bitches surgically treated for pyometra between May and December 2017 were evaluated. The admission data were analyzed to classify the animals according to the clinical presentation of pyometra, presence of systemic inflammatory response syndrome (SIRS) and organic dysfunctions (cardiovascular, neurological, renal, and hemostatic). The outcomes were recorded for up to 14 days. The overall mortality rate was 13%. Open and closed pyometra were identified in 62% (n= 29) and 38% (n= 18) of the cases, respectively. The SIRS was present in 44 (94%) bitches, and 27 (57%) had at least one organ dysfunction. The most prevalent dysfunction was hemostatic, followed by neurological, cardiovascular, and renal dysfunction. The clinical presentation of pyometra and the presence of SIRS did not correlate with each other, or with the presence of organ dysfunction and mortality. However, cumulative organ dysfunction (r=0.532, P=<0.001) and the presence of neurological (r= -0.371; P=0.012) and renal dysfunction (r=0.303; P=0.041) were correlated with mortality. Thus, the identification of organ dysfunction through physical examination and routine laboratory analysis proved to be more effective in identifying and predicting the critically ill patients than the SIRS criteria or clinical presentation of the disease.

Pneumonia in the first week after polytrauma is associated with reduced blood levels of soluble herpes virus entry mediator.

Pneumonia develops frequently after major surgery and polytrauma and thus in the presence of systemic inflammatory response syndrome (SIRS) and organ dysfunction. Immune checkpoints balance self-tolerance and immune activation. Altered checkpoint blood levels were reported for sepsis. We analyzed associations of pneumonia incidence in the presence of SIRS during the first week of critical illness and trends in checkpoint blood levels. Patients were studied from day two to six after admission to a surgical intensive care unit (ICU). Blood was sampled and physician experts retrospectively adjudicated upon the presence of SIRS and Sepsis-1/2 every eight hours. We measured the daily levels of immune checkpoints and inflammatory markers by bead arrays for polytrauma patients developing pneumonia. Immune checkpoint time series were additionally determined for clinically highly similar polytrauma controls remaining infection-free during follow-up. We performed cluster analyses. Immune checkpoint time trends in cases and controls were compared with hierarchical linear models. For patients with surgical trauma and with and without sepsis, selected immune checkpoints were determined in study baseline samples. In polytrauma patients with post-injury pneumonia, eleven immune checkpoints dominated subcluster 3 that separated subclusters 1 and 2 of myeloid markers from subcluster 4 of endothelial activation, tissue inflammation, and adaptive immunity markers. Immune checkpoint blood levels were more stable in polytrauma cases than controls, where they trended towards an increase in subcluster A and a decrease in subcluster B. Herpes virus entry mediator (HVEM) levels (subcluster A) were lower in cases throughout. In unselected surgical patients, sepsis was not associated with altered HVEM levels at the study baseline. Pneumonia development after polytrauma until ICU-day six was associated with decreased blood levels of HVEM. HVEM signaling may reduce pneumonia risk by strengthening myeloid antimicrobial defense and dampening lymphoid-mediated tissue damage. Future investigations into the role of HVEM in pneumonia and sepsis development and as a predictive biomarker should consider the etiology of critical illness and the site of infection.

Impact of endoprosthesis type on inflammatory response in patients undergoing endoscopic drainage of pancreatic fluid collections.

To study the impact of endoprosthesis type on inflammatory response in patients undergoing endoscopic ultrasound (EUS)-guided drainage of pancreatic fluid collections (PFC). Patients undergoing EUS-guided PFC drainage and treated using lumen-apposing metal stents (LAMS) or plastic endoprostheses constituted the study cohort. The primary outcome was the presence of systemic inflammatory response syndrome (SIRS) after index intervention. Secondary outcomes were persistent organ failure, new onset organ failure, duration of hospitalization, and treatment success. In all, 303 patients were treated using LAMS (n = 247) or plastic stents (n = 56). At 48 h postintervention, the presence of SIRS (25.0 vs. 14.2%, P = 0.047), new onset SIRS (10.0 vs. 1.8%, P = 0.017), and new organ failure (5.4 vs. 0.4%, P = 0.003) were significantly higher in the plastic stent cohort compared to LAMS. On multivariable logistic regression analysis, the use of plastic stents (odds ratio [OR] 2.7, 95% confidence interval [CI] 1.2-6.0, P = 0.014), patients receiving high-acuity care (OR 5.1, 95% CI 2.5-10.4, P < 0.001) and the presence of ≥33% of necrosis (OR 4.5, 95% CI 2.0-10.0, P < 0.001) were significantly associated with the presence of SIRS or new organ failure. While there was no significant difference in treatment success (96.4 vs. 95.5%, P = 0.77), duration of hospitalization was significantly longer for the plastic stent cohort (mean [standard deviation] 12.5 [17.8] vs. 7.9 [10.1] days, P = 0.009). Use of plastic stents as compared to LAMS was associated with a higher proportion of SIRS and new organ failure that prolonged hospital stay. Therefore, placement of LAMS is recommended in sick patients and those with ≥33% necrosis to minimize inflammatory response.

Systemic Inflammatory Response Syndrome on Admission and Clinical Outcomes After Intracerebral Hemorrhage.

Since studies on systemic inflammatory response syndrome (SIRS) in patients with acute intracerebral hemorrhage (ICH) are insufficient. This study investigated the associations between SIRS on admission and clinical outcomes after acute ICH. The study included 1159 patients with acute spontaneous ICH from January 2014 to September 2016. In accordance with standard criteria, SIRS was defined as two or more of the following: (1) body temperature >38°C or <36°C, (2) respiratory rate >20 per minute, (3) heart rate >90 per minute, and (4) white blood cell count >12,000/μL or <4000/μL. The clinical outcomes of interest were death and major disability (defined as a modified Rankin Scale of 6 and 3-5), combined and separate at 1 month, 3 months and 1 year follow-up. SIRS was observed in 13.5% (157/1159) of patients and independently increased the risk of death at 1 month, 3 months, or 1 year: hazard ratio (HR) 2.532 (95% confidence interval [CI] 1.487-4.311), HR 2.436 (95% CI 1.499-3.958), HR 2.030 (95% CI 1.343-3.068), respectively (P<0.05 for all). The relationship between SIRS and ICH mortality was more pronounced in older patients or patients with larger hematoma volumes. Patients with in-hospital infections were at greater risk of major disability. The risk was enhanced when SIRS was incorporated. The presence of SIRS at the time of admission was associated with mortality in patients with acute ICH, particularly in older patients and those with large hematomas. SIRS may exacerbate the disability caused by in-hospital infections in patients with ICH.

Novel predictors of response to therapy with terlipressin and albumin in hepatorenal syndrome-acute kidney injury.

A combination of terlipressin and albumin is the first-line pharmacologic treatment for hepatorenal syndrome-acute kidney injury (HRS-AKI). We assessed the response rates to terlipressin-albumin therapy in patients with HRS-AKI and determined early predictors of treatment response and survival. A total of 84 patients with HRS-AKI (International Club of Ascites definition 2015) treated with terlipressin-albumin were included. Predictors of HRS reversal were identified by logistic regression analysis. Survival analysis was performed using the Kaplan-Meier method, and Cox regression models were used to determine independent predictors of mortality. Complete response to therapy was observed in 54.8%, partial response in 14.3%, and no response in 31% of patients. The factors associated with complete treatment response were the presence of systemic inflammatory response syndrome (SIRS), baseline serum creatinine, a rise in mean arterial pressure by day 3, and a reduction in the renal resistive index (ΔRRI) by day 3 of treatment. Independent predictors of HRS reversal were the presence of SIRS at baseline (P=0.022; odds ratio [OR] 15.74, 95% confidence interval [CI] 1.47-167.82) and ΔRRI ≥5% by day 3 of treatment (P=0.048; OR 6.67, 95%CI 1.021-43.62). Mean transplant-free survival at 6 months was significantly better in treatment responders (148 vs. 90 days, P<0.001). Independent predictors of 6-month mortality were response to treatment (P=0.004) and model for end-stage liver disease-sodium >23 (P=0.018). SIRS and ΔRRI are simple parameters to predict treatment response in HRS-AKI. Non-responders have higher mortality and should be identified early to expedite liver transplantation.

Eosinophil count: a predictor of in-hospital mortality in a cohort of cirrhosis patients with sepsis

BackgroundDeclining eosinophil count has recently been associated with sepsis. Thus, absolute eosinophil count (AEC) can be used as a marker of the severity of sepsis, which helps in the early identification of high-risk patients, and better management can be offered to such patients. The aim of this study was to assess whether AEC at the time of ICU admission can be used as a predictor of in-hospital mortality in cirrhotics with sepsis.ResultsThis was a retrospective study which was conducted in 105 cirrhotic patients admitted with sepsis in the Department of Gastroenterology, Medical College Trivandrum, from May 2014 to October 2014. Every consecutive patient with cirrhosis and sepsis (defined as systemic inflammatory response syndrome (SIRS) and the presence of infections) admitted to the ICU/high dependency unit was recruited for the study. Among the various parameters analyzed, model for end-stage liver disease (MELD) score, Child-Pugh Turcot (CTP) score, albumin levels, total count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), alanine aminotransferase (ALT), bilirubin, creatinine, urea, and absolute eosinophil count were statistically significant in predicting in-hospital mortality. The AUROC of AEC was plotted and found to be 0.881, which was better than other parameters for predicting in-hospital mortality. The cutoff of AEC by Youden’s index was 110 cells/cumm (sensitivity 91.3%, specificity 89%, positive predictive value 87.5%, and negative predictive value 93%) to predict in-hospital mortality. The AUROC of MELD was 0.78 with a cutoff of > 24 (sensitivity 89%, specificity 74.6%, positive predictive value 73%, and negative predictive value 89%) to predict the mortality. The odds ratio for predicting mortality was highest for absolute eosinophil count (92.75) followed by MELD (24.57), total count (20.475), CTP (10), and the presence of SIRS (9.08).ConclusionIn critically ill cirrhosis patients with sepsis, AEC < 110 cells/cumm can predict in-hospital mortality.

Presepsin (soluble CD14 subtype) as a risk factor for the development of infectious and inflammatory complications in operated colorectal cancer patients.

In this pilot study the dynamic of presepsin (soluble CD14 subtype, sCD14-ST) in blood serum was assessed as a possible risk factor for the development of systemic inflammatory response syndrome (SIRS) and infectious and inflammatory complications in operated colorectal cancer patients. To determine sCD14-ST by enzyme-linked immunosorbent assay method venous blood was taken 1 hour before surgery and 72 hours after it (3rd day). The presence of SIRS and organ dysfunctions (ODs) according to the Sequential Organ Failure Assessment scale were assessed. Thiry-six patients with colorectal cancer were enrolled in the study. sCD14-ST level before surgery was 269.8±103.1 pg/mL (interquartile range [IQR], 196.7-327.1 pg/mL). Despite the presepsin level on the 3rd day being higher (291.1±136.5 pg/mL; IQR, 181.2-395.5 pg/mL), there was no statistical significance in its dynamics (P=0.437). sCD14-ST value both before surgery and on the 3rd day after it was significantly higher in patients with bowel obstruction (P=0.038 and P=0.007). sCD14-ST level before surgery above 330 pg/mL showed an increase in the probability of complications, SIRS, and OD (odds ratio [OR], 5.5; 95% confidence interval [CI], 1.1-28.2; OR, 7.0; 95% CI, 1.3-36.7; and OR, 13.0; 95% CI, 1.1-147.8; respectively). Patients with OD had higher levels on the 3rd day after surgery (P=0.049). sCD14-ST level in operated colorectal cancer patients was much higher if they were admitted with complication like bowel obstruction. Higher preoperative levels of sCD14-ST increase the probability of postoperative complications, SIRS, and OD. Therefore, further studies with large sample size are needed.

Роль та місце ω-3 жирних кислот у регуляції синдрому системної відповіді на запалення в пацієнтів, які отримують інтенсивну терапію

У статті проаналізовано сучасні наукові дані про роль ω-3 жирних кислот у комплексі нутритивної підтримки у хворих у критичному стані, їх вплив на динаміку синдрому системної відповіді на запалення (SIRS), синдрому протизапальної відповіді (CARS), а також синдрому змішаної антагоністичної дії (MАRS), що розвивається при взаємодії різноспрямованої (запальної/протизапальної) відповіді (SIRS/САRS). Призначення замісної імунокорекції в комплексі інтенсивної терапії критичних станів патогенетично обґрунтоване і показане як компонент цілеспрямованої органопротективної терапії. Наявність у пацієнтів синдромів SIRS або CARS повинно визначати вибір ліпідної емульсії в комплексі парентерального харчування з уключенням емульсій МСТ/ЛСТ з ω-3 жирними кислотами у хворих у клініці інтенсивної терапії. Використання ліпідних емульсій, збагачених риб’ячим жиром, сприяє зменшенню тривалості лікування в стаціонарі пацієнтів із критичними станами.

Serum haptoglobin concentration and liver enzyme activity as indicators of systemic inflammatory response syndrome and survival of sick calves.

BackgroundIncreased concentration of haptoglobin (Hp) in serum is associated with survival of critically ill humans and horses. High serum activity of liver‐derived enzyme is associated with sepsis in children and foals.Hypothesis/ObjectivesInvestigate whether admission serum Hp and glutamic dehydrogenase (GLDH) are associated with systemic inflammatory response syndrome (SIRS) and survival of sick calves.AnimalsOne hundred two calves.MethodsRetrospective cross‐sectional study. Electronic medical records from all calves <30 days of age admitted to a teaching hospital for 8 years were reviewed. The signalment, clinicopathological findings, the presence of SIRS, final diagnosis, hospitalization time and outcome were recorded. A Cox proportional hazard ratio (HzR) were calculated to assess the association between clinicopathological variables and survival to discharge.ResultsSerum Hp concentrations were similar between SIRS (0.29 g/L; range, 0.05‐3.6) and non‐SIRS calves (0.22 g/L; range, 0‐4.2; P = .62). GLDH activity was similar between SIRS (12 U/L; range, 1‐1025) and non‐SIRS calves (9 U/L; range, 2‐137; P = .2). Absent suckle reflex (HzR: 6.44, 95% CI: 1.44‐28.86), heart rate (HR) < 100 beats per minute (bpm; HzR: 12.2; 95% CI: 2.54‐58.62), HR > 140 bpm (HzR: 3.59, 95% CI: 1.05‐12.33), neutrophil count <1.7 × 109/L (HzR: 7.36; 95% CI: 2.03‐26.66) and increased gamma‐glutamyl transferase activity (every 50‐unit, HzR: 1.12; 95% CI: 1.03‐1.21) were predictive of nonsurvival.Conclusions and Clinical ImportanceThe use of Hp and GLDH for prediction of survival in sick calves cannot be recommended at this time.

Novel predictors of response to therapy with terlipressin and albumin in Hepatorenal Syndrome-Acute Kidney Injury

Background and Aim: Prognostication of response to pharmacological treatment of Hepatorenal Syndrome-Acute Kidney Injury (HRS-AKI), is crucial to identify patients with a low likelihood of treatment response, and fast track them for liver transplantation. We assessed the response rates to terlipressin-albumin therapy in HRS-AKI and determined early predictors of treatment response and survival. Methods: 84 patients diagnosed to have HRS-AKI (as per new ICA definition) and treated with terlipressin-albumin were included. Demographic, clinical, and laboratory variables obtained at baseline and changes during treatment were analyzed as predictors of HRS reversal by logistic regression analysis. Cox-regression models were used for assessing the association of variables with overall survival. Results: A complete response to therapy was seen in 54.8%, partial response in 14.3%, and no response in 31% of patients. The factors associated with complete response were the presence of systemic inflammatory response syndrome (SIRS), baseline serum creatinine, a rise in mean arterial pressure by day 3, and a reduction in the renal resistive index (Delta-RRI) by day 3 of treatment. Variables with independent predictive value of HRS reversal were the presence of SIRS at baseline (p=0.022;OR-15.749(CI:1.478-167.82)) and Delta-RRI >5% by day 3 (p=0.048;OR=6.67(CI:1.021-43.625)). Non-responders had higher mortality as compared to treatment responders at one month (27% vs 9%) and six months (74% vs 45%). Mean transplant-free survival at six months was significantly longer in complete responders (148 days vs 90 days,p<0.001). Response to treatment(HR-0.527;p=0.004) and MELD Na > 23(HR-1.071; p=0.018) were independent predictors of six-month mortality. Conclusions: SIRS and Delta-RRI are simple parameters to predict treatment response in HRS-AKI. Non-responders have higher mortality and should be identified early to expedite liver transplantation. In HRS-AKI, renal resistive index is a measure of the intrarenal vasoconstriction, and SIRS reflects the exaggerated systemic inflammation, both of which are reversed by terlipressin, leading to enhanced treatment response.

Pneumonia and systemic inflammatory response syndrome as predictors for difficult-/prolonged-weaning after invasive ventilation in myasthenic crisis: A retrospective analysis of a Chinese cohort

Weaning from invasive mechanical ventilation (MV) represents a pivotal step for myasthenic crisis (MC) patients. The aim was to evaluate the association between the weaning process and clinical outcomes, as well as to determine the independent predictors for difficult-/prolonged-weaning in MC. MC patients requiring invasive MV were recruited from Jan 2014 through Sep 2020. Among 124 consecutive MC patients, we finally included 66 patients (age 48.4 ± 18.7 years, female 45.5%). According to the WIND (Weaning according to a New Definition) classification, these patients were classified into no-weaning (n = 5, 7.6%), short-weaning (n = 13, 19.7%), difficult-weaning (n = 26, 39.4%), and prolonged-weaning group (n = 22, 33.3%). Four-week functional assessment in short-weaning group was more favorable than that in difficult-/prolonged-weaning group (p<0.001). Length of hospital stay (23.0 (15.0–28.0) vs. 37.5 (27.0–54.8), p<0.001), length of ICU stay (17.0 (8.5–22.5) vs. 34.0 (20.3–45.0), p<0.001), duration on ventilation (6.0 (6.0–8.5) vs. 18.0 (13.3–30.0), p<0.001), and time interval from MV to first weaning (6.0 (6.0–8.0) vs. 11.0 (8.0–20.8), p<0.001) in short-weaning group were significantly shorter than those in difficult-/prolonged-weaning group. Short-weaning group had a lower prevalence of pneumonia (23.1% vs. 75.0%) and systemic inflammatory response syndrome (SIRS) (38.5% vs. 85.4%), and a higher value in the lowest hemoglobin level (123.0 ± 12.9 g/L vs. 108.3 ± 18.1 g/L) and the lowest serum albumin level (33.2 ± 3.4 g/L vs. 29.9 ± 4.2 g/L) than difficult-/prolonged-weaning group. Multivariate logistic regression analysis identified pneumonia and the presence of SIRS within one week of MC as independent predictors for difficult-/prolonged-weaning. The weaning process is associated with clinical outcomes in MC patients requiring ventilation. Pneumonia concurrence and the presence of SIRS within one week of MC were identified as independent predictors for difficult-/prolonged-weaning after invasive MV.

1360. Prevalence of Bacteremia in Hospitalized Patients with Skin and Soft Tissue Infections (SSTI)

BackgroundSkin and soft tissue infections (SSTI) are common in outpatient and inpatient settings. The prevalence of positive blood cultures (BC) ranges from 2% to 52%. Because of the variations in published data, the exact prevalence of bacteremia in hospitalized patients with SSTI is unknown. Our objective is to determine the prevalence of bacteremia in hospitalized patients with SSTI.MethodsRetrospective chart review from January 2017 to December 2018. Patients older than 18 years admitted with SSTI who required BC on admission were included. Patients who met the criteria for systemic inflammatory response syndrome (SIRS)/sepsis or severe SSTI, or had an underlying immunodeficiency underwent BC collection. Patients with diabetic foot ulcer, device related SSTI, necrotizing fasciitis, and osteomyelitis were excluded. Patients were divided into 3 groups: true positive (TP) defined as a true pathogen, false positive (FP) defined as a contaminant, and true negative (TN) defined as no growth in BC. Physician assessment, microorganisms isolated, number of positive bottles/culture sets, and timing of growth were reviewed. Patients’ comorbidities, presence of SIRS, laboratory data, duration of antibiotic use, and length of stay (LOS) were compared.ResultsWe screened 583 patients and included 541 patients. The mean age was 62 ± 18.4 years, and 60% were male. 47/ 541 (8.6%) had skin abscesses. 57 patients (11%) had positive BC, of whom 32 were TP (6%), and 25 were FP (5%). 89% of patients (484) had TN BC. The organisms isolated are described in Figures 1 and 2. Patients in the FP and TN groups had prior antibiotic use, compared to TP (P< 0.05). The FP group had a longer LOS and duration of antibiotic use compared to the TN group (p< 0.05). 76% of FP had repeated BC. Beta-lactam antibiotics were mostly used, followed by anti-MRSA antibiotics (40%). We did not find risk factors to predict the likelihood of bacteremia. The outcome was not different among the 3 groups.Figure 1. Microorganisms isolated from blood cultures of patients with SSTI – True pathogens Figure 2. Microorganisms isolated from blood cultures of patients with SSTI – Isolated contaminants ConclusionThere was a low incidence of true bacteremia (6%) in hospitalized patients with SSTI. More than 90% of TP were predictable causal microorganisms, which are covered by empiric antibiotics. BC may not affect the initial treatment of SSTI. FP BC were associated with an increased LOS, longer antibiotic use, and increased healthcare cost.Disclosures All Authors: No reported disclosures

Effect of the qualitative composition of a high-fat diet in rats with systemic inflammatory response syndrome upon myocardial resistance to ischemic-reperfusion injury and cytokine levels

Overweight and obesity are among the main factors of cardiovascular risk, but the prospective studies on the dependence between high-fat diets and weight gain yielded contradictory results. Different types of fats exert varying metabolic effects, and this fact leads to a difference in the risk associated with increasing body weight. The effects of fat quality in the daily diet on immunological status and resistance of myocardium to ischemic-reperfusion damage should be studied experimentally in biomedical models. The purpose of this work was to assess the effect of the qualitative composition of a high-fat diet used for induction of primary visceral obesity (PVO) in rats with systemic inflammatory response syndrome (SIRS) upon myocardial resistance to ischemic-reperfusion injury, and levels of pro- and anti-inflammatory cytokines.The experiments were performed on adult male Wistar rats with PVO caused by 28-day consumption of any fat types: hydrogenated fats (HF), vegetable oils (VO), animal fats (AF) or milk fat (MF). The SIRS model included a combination of chemically induced colitis (CIC) and intragastric injection of a broad-spectrum antimicrobial agent (AMA) for three days. Five days later, immunological and biochemical studies were conducted, as well as composition of intestinal microbiota in faecal samples, morphological changes in the structure of the large intestine, hemodynamic parameters and myocardial resistance to ischemic-reperfusion injury were studied in the model of isolated heart perfusion, by Langendorff technique.There was a significant increase in the concentration of anti-inflammatory cytokines in animals with SIRS, i.e., TNFα, IL-1α, IL-2, IL-8, as well as a decrease in TGF-1β, an anti-inflammatory cytokine. SIRS was accompanied by severe dietary disorders and evacuatory function of the gastrointestinal tract. Minimal changes in the intestinal microbiota composition, as well as the most pronounced regeneration signs of intestinal epithelium was observed in rats in the group with MF injection. There was a trend for increasing size of infarction in all the groups as compared with control, directly correlating with increase in BDNF and IL-2 production. However, a significant increase in the infarction size was found only in the group receiving milkfat, thus suggesting a decrease in myocardial resistance to ischemic reperfusion injury (IRI).Thus, the presence of SIRS in the primary obesity model is characterized by controllable change of inflammation markers and depends on the quality of dietary fats. The degree of morphofunctional deterioration of isolated heart, including a decrease in resistance to ischemia-reperfusion injury, correlates with the concentration of BDNF and IL-2 during the studied observation terms.

THE CORTISOL SERUM LEVELS IN PATIENTS WITH SEVERE LUNG INFECTIONS REQUIRING SURGERY

TOPIC: Chest Infections TYPE: Late Breaking PURPOSE: Activation of the hypothalamic-pituitary-adrenal axis represents one of several important responses to stressful events and critical illnesses. Despite a large volume of published data, several controversies continue to be debated, such as the definition of normal adrenal response, the concept of relative adrenal insufficiency, and the use of glucocorticoids in the setting of critical illness. Stress-dose glucocorticoid administration may be is required during the perioperative period because of the possibility of failure of cortisol secretion to cope with the increased cortisol requirement due to surgical stress, adrenal insufficiency, hemodynamic instability, and the possibility of adrenal crisis. The aim of our study was to assess the cortisol serum levels in males with acute lung abscess or gangrene requiring surgery to determine the accordance of perioperative glucocorticoids. METHODS: The serum levels of cortisol (normal range: 170–720 nmol/L) were measured by radio-immune method in 80 adult males with acute lung abscess (38 cases) or gangrene (42 cases) requiring surgery. The age of the patients was between 29 and 84 (Ме [LQ; UQ] – 54.5 [44; 61.5]) years. The duration of the disease at the time of admission to the thoracic surgery department ranged from 1 to 8 (3 [2; 4]) weeks. Pleural empyema was diagnosed in 40 out of 80 (50%) patients, of which 8 cases (20% of all pleural empyema) had pyopneumothorax, systemic inflammatory response syndrome (SIRS) – in 43 (54%), sepsis (Sepsis-3) – in 16 (20%) cases. RESULTS: Cortisol serum levels was between 83 and 1689 (595 [429; 730]) nmol/L. Cortisol serum levels did not correlate with the age of the patients (rS=0.10, p=0.38) and with disease duration (rS=-0.14, p=0.22). Cortisol serum levels did not differ in patients with abscesses and gangrene (U=756, рMann-Whitney=0.69), and did not depend on the presence of SIRS, pleural empyema, sepsis, or a combination of both (H=4.04, pKruskal-Wallis=0.54). The 6 (8%, 95% confidence interval (CI): 2-14) patients had cortisol serum levels below 170 (range at 83 to 145, 94 [89; 100]) nmol/L. The 21 (26%, 95% CI: 16-36) patients had cortisol serum levels above 720 (range at 723 to 1689, 879 [774; 1040]) nmol/L. Cortisol serum levels were within the normal range (at 186 to 718, 526 [429; 633] nmol/L) in 53 (66%, 95% CI: 56-76) patients. CONCLUSIONS: The findings indicate that cortisol serum level varies widely in males with acute lung abscess or gangrene. It does not depend on the age of the patients, the disease duration, the type of disease and complications. Assessment of cortisol serum levels requires laboratory determination. In at least 8% of patients with low cortisol level it possible to use perioperative glucocorticoids to prevent the negative consequences of surgical stress. The effectiveness of this approach needs clinical validation. CLINICAL IMPLICATIONS: The information can be used in justification and development of programs for the perioperative use of glucocorticoids in the surgery of severe lung infections. DISCLOSURES: No relevant relationships by Siarhei Yermashkevich, source=Web Response

Evaluation of coagulation parameters in dogs with gallbladder mucoceles.

BackgroundGallbladder mucocele (GBM) is a common biliary disorder in dogs. Limited information is available on the coagulation status of dogs with GBM.Hypothesis/ObjectivesTo determine patterns of coagulation alterations in dogs with GBM and correlate them with clinicopathologic abnormalities and ultrasonographic findings of disease severity.AnimalsTwenty‐three dogs with GBM identified on ultrasound examination were prospectively enrolled.MethodsAt the time of GBM identification, blood and urine were collected for CBC, serum biochemical panel, urinalysis, prothrombin time, activated partial thromboplastin time (aPTT), factor VIII, protein C (PC), von Willebrand's factor (vWF), antithrombin activity, fibrinogen, D‐dimers, and thromboelastrography (TEG). Gallbladder mucoceles were classified into ultrasound types 1 to 5. Medical records were reviewed for clinical presentation, underlying conditions and to determine if systemic inflammatory response syndrome (SIRS) was present.ResultsBased on TEG parameters, maximal amplitude, and G, 19/23 (83%) of dogs with GBM had evaluations consistent with hypercoagulability. On plasma‐based coagulation testing, dogs with GBM had increased total PC activity (20/23, 87%), fibrinogen (9/23, 39%), platelet count (9/23, 39%), and D‐dimers (6/15, 40%) as well as prolongations in aPTT (9/22, 41%) and low vWF activity (5/21, 24%). No correlation was found between TEG G value and any coagulation or clinical pathology variables, ultrasound stage of GBM or disease severity as assessed by the presence of SIRS.Conclusions and Clinical ImportanceDogs with ultrasonographically identified GBM have changes in whole blood kaolin‐activated TEG supporting a hypercoagulable state although traditional plasma‐based coagulation testing suggests that a complex state of hemostasis exists.

Population Pharmacokinetics and Outcomes of Critically Ill Pediatric Patients Treated with Intravenous Colistin at Higher Than Recommended Doses.

Limited pharmacokinetic (PK) data suggest that currently recommended pediatric dosages of colistimethate sodium (CMS) by the Food and Drug Administration and European Medicines Agency may lead to suboptimal exposure, resulting in plasma colistin concentrations that are frequently <2 mg/liter. We conducted a population PK study in 17 critically ill patients 3 months to 13.75 years (median, 3.3 years) old who received CMS for infections caused by carbapenem-resistant Gram-negative bacteria. CMS was dosed at 200,000 IU/kg/day (6.6 mg colistin base activity [CBA]/kg/day; 6 patients), 300,000 IU/kg/day (9.9 mg CBA/kg/day; 10 patients), and 350,000 IU/kg/day (11.6 mg CBA/kg/day; 1 patient). Plasma colistin concentrations were determined using ultraperformance liquid chromatography combined with electrospray ionization-tandem mass spectrometry. Colistin PK was described by a one-compartment disposition model, including creatinine clearance, body weight, and the presence or absence of systemic inflammatory response syndrome (SIRS) as covariates (P < 0.05 for each). The average colistin plasma steady-state concentration (Css,avg) ranged from 1.11 to 8.47 mg/liter (median, 2.92 mg/liter). Ten patients had Css,avg of ≥2 mg/liter. The presence of SIRS was associated with decreased apparent clearance of colistin (47.8% of that without SIRS). The relationship between the number of milligrams of CBA per day needed to achieve each 1 mg/liter of plasma colistin Css,avg and creatinine clearance (in milliliters per minute) was described by linear regression with different slopes for patients with and without SIRS. Nephrotoxicity, probably unrelated to colistin, was observed in one patient. In conclusion, administration of CMS at the above doses improved exposure and was well tolerated. Apparent clearance of colistin was influenced by creatinine clearance and the presence or absence of SIRS.

Systemic Inflammatory Response Syndrome in Patients Hospitalized for Acute Decompensation of Cirrhosis.

Background Although recently challenged, systemic inflammatory response syndrome (SIRS) criteria are still commonly used in daily practice to define sepsis. However, several factors in liver cirrhosis may negatively impact its prognostic ability. Goals. To investigate the factors associated with the presence of SIRS, the characteristics of SIRS related to infection, and its prognostic value among patients hospitalized for acute decompensation of cirrhosis. Study. In this cohort study from two tertiary hospitals, 543 patients were followed up, up to 90 days. Data collection, including the prognostic models, was within 48 hours of admission. Results SIRS was present in 42.7% of the sample and was independently associated with upper gastrointestinal bleeding (UGB), ACLF, infection, and negatively related to beta-blockers. SIRS was associated with mortality in univariate analysis, but not in multiple Cox regression analysis. The Kaplan–Meier survival probability of patients without SIRS was 73.0% and for those with SIRS was 64.7%. The presence of SIRS was not significantly associated with mortality when considering patients with or without infection, separately. Infection in SIRS patients was independently associated with Child-Pugh C and inversely related to UGB. Among subjects with SIRS, mortality was independently related to the presence of infection, ACLF, and Child-Pugh C. Conclusions SIRS was common in hospitalized patients with cirrhosis and was of no prognostic value, even in the presence of infection.

Abstract P458: Systemic Inflammatory Response Syndrome is Associated With Hematoma Expansion in Intracerebral Hemorrhage

Objective: Systemic inflammatory response syndrome (SIRS) and hematoma expansion are both associated with worse outcomes after intracerebral hemorrhage (ICH), but their relationship remains unclear. We sought to determine the association between SIRS and hematoma expansion after ICH. Methods: We performed a retrospective cohort study of patients admitted to our hospital from 2013 to 2020 with primary spontaneous ICH with at least two head CTs within the first 24 hours. Patients were excluded if they had a decompressive craniectomy, intracranial vascular lesions or malignancy, or coagulopathy. Hematoma volume was measured using the ABC/2 method; hematoma expansion was defined as 6mL or 33% growth between the first and second scan. We compared patients with and without SIRS using Pearson’s χ2, students T and Wilcoxon rank sum tests. The relationship between admission SIRS and hematoma expansion was assessed using univariate and multivariate regression analysis. Results: Of 187 patients with ICH, 73 (39%; mean age 6617, 40% female) met inclusion criteria. Of those, 38 (52%) had SIRS on admission. Admission systolic blood pressure (SBP) was significantly higher in patients with SIRS compared to those without (169 [IQR 133- 205] vs 152 [125- 179] mm Hg, p= 0.02). There was no difference in mean days to first antibiotic administration (6.3 vs 5.6, p=0.78), admission platelets (227 vs 243, p= 0.38) or initial hematoma volume (23 vs 15, p=0.16). Hematoma expansion occurred in 14 patients, 11 (79%) of whom also had SIRS. A significantly greater percentage of patients with SIRS had mRS 4-6 at discharge (87 vs 67%, p=0.05). SIRS was significantly associated with hematoma expansion (OR 4.35, 95% CI 1.10-17.20, p= 0.04) on univariate analysis. The association remained statistically significant after adjusting for admission SBP, platelets, and initial hematoma volume (OR 4.54, 95% CI 1.01-20.60, p= 0.05). Conclusion: Presence of SIRS on admission is associated with hematoma expansion within the first 24 hours. Further research is needed to better understand this association, which may enable us to identify early on and treat those patients at highest risk for decompensation.

Systemic inflammatory response syndrome in dogs naturally infected with Babesia canis: Association with the parasite load and host factors

The common signs of canine babesiosis caused by an infection with Babesia canis are fever, anorexia, lethargy, pulse alterations, anemia, and occasionally mild icterus. Dogs with these clinical signs can be divided into two groups: those with acute-phase reaction and those with systemic inflammatory response syndrome (SIRS). Factors associated with the occurrence of SIRS in canine babesiosis have not been thoroughly researched. This article outlines a cross-sectional study of 54 client-owned dogs with an acute B. canis infection, and evaluates the differences in age, gender, laboratory findings, parasite load, and seroreactivity against B. canis between the SIRS and the SIRS-free dogs. We have analyzed a complete blood count, serum biochemistry, serum amyloid A, ceruloplasmin, paraoxonase-1, serology, and PCR testing using standard methodologies. The frequency of SIRS among the investigated dogs reached 0.59. Male dogs and those seronegative against B. canis, were more frequent in the SIRS group, whilst age and parasite load could not be associated with the presence of SIRS. Dogs with SIRS had a lower count of total leukocytes, neutrophils, lymphocytes, and monocytes, and a lower concentration of iron and bilirubin compared with SIRS-free dogs. No significant differences in the concentration of acute-phase proteins have been noticed to exist between the groups of dogs. Further, the seronegative dogs had a lower count of lymphocytes and monocytes and a higher parasite load than the seroreactive dogs. Multivariate logistic regression analysis has identified leukopenia (<6 × 109/L) and monocytopenia (<0.2 × 109/L) as independent associates of SIRS in the investigated dogs, thus implying that these routine tests could be used as reliable markers for SIRS.