Progression Of Multiple Organ Failure Research Articles

Predictors of Fatal Outcome in Newly Diagnosed Tuberculosis/HIV Co-Infection with Chronic Alcoholism (Clinical Case)

Our own case of tuberculosis/HIV co-infection’s diagnosis in chronic alcoholism and analysis of the fatal outcome predictors are presented. The patient abused alcohol for a long time in the presented case, he was hospitalised with acute psychosis in a psychoneurological dispensary, where pulmonary tuberculosis and HIV infection were diagnosed for the first time during additional examination. The patient was admitted to the department in serious condition after prolonged alcohol intoxication. The patient’s condition stabilized after detoxification therapy. Antimycobacterial therapy according to the scheme of an individual treatment regimen, antiretroviral therapy, treatment of hepatitis B and C, detoxification therapy, prophylaxis with Biseptol and Fluconazole and symptomatic therapy were prescribed. After 20 days immune reconstitution inflammatory syndrome developed. It was manifested with meningitis and cryptococci were detected in the cerebrospinal fluid 17 days later. Prescribed treatment of cryptococcal meningoencephalitis with fluconazole in high doses intravenously had a significant positive effect, which made it possible to reduce the dose of the drug to the maintenance level. The treatment was not stopped, but sterility of the liquor was not achieved. After 98 days the patient entered a coma and after 113 days he died from the progression of multiple organ failure and cryptococcal meningitis. It should be noted that the patient was diagnosed with tuberculosis with multiple drug resistance for the first time, the treatment of which had positive dynamics, despite the progression of multiple organ failure and the presence of cryptococcal meningoencephalitis. Therefore, although tuberculosis was not the direct cause of the patient’s death, the disease itself deepened the severity of the general condition. Considering the presented clinical case, it was established that predictors of the fatal outcome of newly diagnosed tuberculosis/HIV co-infection in chronic alcoholism are: antisocial lifestyle; concomitant diseases (tuberculosis, chronic viral hepatitis B and C); cryptococcal meningoencephalitis; fever, altered mental status, cryptococci in the cerebrospinal fluid; the number of CD4+ lymphocytes is less than 200/μL; lack of early screening for CrAg; early initiation of antiretroviral therapy before the diagnosis of cryptococcal meningoencephalitis, which provokes immune reconstitution inflammatory syndrome, against the background of which cryptococcal infection progresses; monotherapy of cryptococcal meningoencephalitis with Fluconazole. Knowledge and practice gaps among medical practitioners contribute to the high fatality rate of cryptococcal meningoencephalitis in tuberculosis/HIV co-infection in chronic alcoholism.

ПРИМЕНЕНИЕ КРИОСУПЕРНАТАНТНОЙ ФРАКЦИИ ПЛАЗМЫ В КОМПЛЕКСНОМ ЛЕЧЕНИИ БОЛЬНЫХ РАСПРОСТРАНЕННЫМИ ФЛЕГМОНАМИ МЯГКИХ ТКАНЕЙ, ОСЛОЖНЕННЫХ СЕПСИСОМ

The study aimed to compare the outcomes of treating patients with widespread soft tissue phlegmon complicated by sepsis using cryosupernatant plasma and freshly frozen plasma. A total of 61 sepsis-diagnosed patients were involved in the study, divided into two groups. Group 1 received complex treatment with cryosupernatant plasma (CSNP), while group 2 received fresh frozen plasma (FFP). The use of CSNP in the complex treatment of septic patients, as opposed to FFP, resulted in improved treatment outcomes, reduced progression of multiple organ failure, prevention of thrombotic and thromboembolic complications, decreased mortality, and faster normalization of hemocoagulation and fibrinolysis system indicators.

ПРОГНОЗИРОВАНИЕ НЕБЛАГОПРИЯТНЫХ КЛИНИЧЕСКИХ ИСХОДОВ ПАЦИЕНТОВ С КАРДИОГЕННЫМ ШОКОМ ПОСЛЕ ОПЕРАЦИЙ НА ОТКРЫТОМ СЕРДЦЕ ПРИ ПОДКЛЮЧЕНИИ ВНУТРИАОРТАЛЬНОЙ БАЛЛОННОЙ КОНТРАПУЛЬСАЦИИ

Aim. To determine preimplantation risk factors and predictors of unfavorable outcome in patients with cardiogenic shock after open-heart surgery, who had an intraoperative system of mechanical circulatory support – intra-aortic balloon contrapulsation. Methods. A retrospective study was conducted at the Republican Scientific and Practical Center “Cardiology” for 2015–2020. It included 66 patients who underwent heart surgery on bypass and who intraoperatively developed cardiogenic shock, refractory to drug therapy, which resulted in the use of intra-aortic balloon counterpulsation. The diagnosis of cardiogenic shock was determined based on the generally accepted criteria, as well as based on the SCAI (Society for Cardiovascular Angiography and Interventions) classification of shock: systolic blood pressure < 90 mmHg for > 30 minutes or the need for infusion of vasopressors or inotropes to achieve the blood pressure of ≥ 90 mm Hg. The Pearson Chi-square test used for nonparametric analysis of qualitative characteristics. The predictors were identified based on logistic regression. Differences were considered significant at p < 0.05 (5%).Results. Risk factors for adverse outcome in case of CS before the use of IABP were: age over 65 years OR = 6.04 [95% CI 1.73 – 21.06], p = 0.003; female gender OR = 3.24 [95% CI 1.064 – 9.873], p = 0.048; vasoactive and inotropic support of more than 42 points OR = 7.85 [95% CI 2.33 – 26.45], p = 0.001; blood lactate of more than 4.7 mmol/l OR = 4.12 [95% CI 1.27 – 13.37], p = 0.014; blood acidity pH < 7.33 OR = 6.34 [95% CI 1.97 – 20.37], p = 0.003; base deficit BE > –5.6 OR = 7.32 [95% CI 2.19 – 24.42], p = 0.001. According to the β-coefficients of the logistic regression equation, predictors were scored as follows: age > 65 years = 2 points, VIP > 42 = 2 points, lactate > 4.7 mmol/L = 1 point. The cumulative probability of 30-day mortality was as follows: 9% when defined as 1 point, 20% – 2 points, 55% – 3 points, 60% – 4 points, 75% – 5 points (Chi-square 24.1; df = 5; p = 0.001). Conclusions. Cardiogenic shock is a fatal complication in cardiac surgery. The use of vasopressor and inotropic drugs has an important role in the treatment of CS; however, escalation of catecholamine doses leads to the progression of multiple organ failure due to hypoperfusion and hypoxia of target organs. Therefore, the use of intra-aortic balloon counterpulsation can improve the results of CS treatment. However, the effect of IABP is limited to increasing cardiac output by no more than 1 l/minute. Based on the calculator we developed, when determining a high risk of an unfavorable outcome of the IABP use, options for circulatory support should be considered including extracorporeal membrane oxygenation, ventricular assist device.

Acute non-occlusive mesenteric ischemia in patients with various types of comorbidities and postoperative complications: clinical case and observation.

Aim. To enhance the outcomes of treating patients with acute non-occlusive mesenteric ischemia (focal) following colostomy, aiming to gain a better understanding of the prevalent risk factors for complications and exploring ways of their reduction.Materials and methods. A clinical case detailing the treatment of a patient with acute non-occlusive mesenteric ischemia amidst abdominal sepsis and stoma necrosis, compounded by inflammatory disease of the spinal cord membranes, is presented. Additionally, the clinical observation of a patient experiencing postoperative complications, including coronavirus infection and bilateral hydrothorax, is provided.Results. In a patient presenting severe coronary pathology alongside a nuanced clinical manifestation of mesenteric ischemia in the delayed phase, a surgical intervention involving intestinal tract resection and subsequent stoma removal was conducted. Regrettably, stoma necrosis ensued, necessitating reconstructive surgery. The patient’s initial critical state, compounded by the requirement for repeated surgical intervention, precipitated a swift progression of multiple organ failure, culminating in mortality. Conversely, another patient, postoperatively diagnosed with coronavirus infection and bilateral hydrothorax, exhibited amelioration in clinical status following administered treatment, ultimately warranting hospital discharge.Conclusions. Early diagnosis and timely surgical intervention contribute to improving the prognosis of treatment. Early postoperative complications and repeated surgical interventions significantly worsen the prognosis.

Acute gastrointestinal injury: Stages, role in formation and progression of multiple organ failure syndrome, main stages of intensive therapy (literature review)

Acute gastrointestinal injury develops in more than half of all patients in the intensive care unit, regardless of the underlying pathology and it is one of the main reasons for the onset and progression of multiple organ failure and systemic inflammatory response syndrome. The severity of the acute gastrointestinal injury correlates with the risk of death. A deeper understanding of the pathogenetic mechanisms of dysfunction of the gastrointestinal tract in critically ill patients is necessary for the development and implementation of an intensive care regimen that allows to quickly restore the function of the gastrointestinal tract and break the vicious circle of pathophysiological changes, which will ultimately lead to improvement treatment outcomes for critically ill patients and reduced mortality.

ОСТРЫЙ ГНОЙНЫЙ ДВУСТОРОННИЙ ПИЕЛОНЕФРИТ: ДИАГНОСТИКА И ЛЕЧЕНИЕ

Background. Acute purulent bilateral pyelonephritis is the most severe form of acute pyelonephritis. The disease is often accompanied with oligo- or anuria and is complicated by urosepsis. Purpose of the study. To analyze information content of diagnostic methods and immediate results of treatment of patients with acute bilateral pyelonephritis in the phase of purulent inflammation. Material and methods. 44 patients with acute bilateral pyelonephritis were observed. The purulent process in both kidneys was diagnosed by ultrasound and contrast-enhanced computed tomography (CT). Urosepsis was laboratory confirmed in 34 patients. All patients were operated on both sides. Organ-preserving surgeries were performed in 43 cases, and both kidneys were removed in one patient. Histological examination of fragments of the kidney parenchyma confirmed the purulent process in 41 patients. After surgery all patients received targeted antibacterial and detoxification therapy. Results. After operations 5 patients died due to the progression of multiple organ failure. After surgery two patients required hemodialysis due to the development of anuria. 37 patients were discharged from the clinic in a satisfactory condition. 1 year after the operation 19 were diagnosed with chronic renal failure stage III. Conclusions. 1. CT with contrast enhancement is the best method for detecting foci of purulent destruction in the renal parenchyma. 2. Acute purulent bilateral pyelonephritis in 77.3% is complicated by urosepsis which requires intensive complex treatment: surgical debridement of purulent foci in both kidneys followed by long-term targeted antibacterial and detoxication therapy. 3. The prognosis for acute purulent bilateral pyelonephritis is always uncertain for life and poor for recovery.

Emphasis on the prevention and treatment of hepatic vascular diseases

Portal hypertension, as a common and complex hepatic vascular disease, is a key pathophysiological link in many events of acute cirrhosis decompensation and the progression of multiple organ failure. The most effective measure to reduce portal hypertension is a transjugular intrahepatic portosystemic shunt (TIPS). Maintaining liver function, reducing complications, and improving patients' quality of life and survival time are positively impacted by early TIPS insertion. Patients with cirrhosis have a risk of portal vein thrombosis (PVT) that is 1 000 times higher than that of the normal population. Hepatic sinusoidal obstruction syndrome has a severe clinical course and a high mortality risk. The primary treatment approaches for PVT and HSOS are anticoagulation and TIPS. The innovative magnetic anastomosis vascular technique significantly shortens the anhepatic time and restores normal liver function in patients following liver transplantation.

Treatment of Patients with Thrombosis of the Arteries of the Lower Extremities and Coronavirus Infection

The course of severe coronavirus infection is accompanied by hypercoagulability with micro- and macroangiopathy, which may be the cause of arterial and venous thrombosis. In March, 2021 — May 2021, 14 patients with COVID-19 and acute ischemia of the lower extremities due to arterial thrombosis were operated in the Infectious Pavilion of the N.V. Sklifosovsky Research Institute for Emergency Medicine. Retrombosis in the immediate postoperative period developed in 4 patients (26.7%). The amputation at the level of the thigh was performed in 2 patients (13.3%) due to the development of ischemic gangrene. The mortality was 71.4%, 10 patients died. The main cause of death was the progression of multiple organ failure in the course of severe viral-bacterial pneumonia. The best results were obtained with a combination of open surgery and endovascular technique, performing hybrid operations.

Intolerance to Early Nasogastric and Nasojejunal Enteral Nutrition in Patients with Moderately Severe Acute Pancreatitis

RELEVANCE Early enteral nutrition is an essential element of intensive care for acute pancreatitis. Its intolerance is manifested by high gastric residual volumes, pain syndrome, bloating, diarrhea, nausea and vomiting. The relevance of our study is determined by the lack of information on how the routes of nutrient delivery affect its tolerability considering the gradual «as­per­protocol» increase in nutrition volumes for patients with moderately severe acute pancreatitis.THE AIM OF THE STUDY Was to identify the key factors that determine intolerance to early nasogastric and nasojejunal enteral feeding in ICU patients with the early phase of moderately severe acute pancreatitis.MATERIAL AND METHODS We conducted an open randomized controlled trial. Out of 64 patients with predicted severe course of acute pancreatitis, we identified a cohort with moderately severe acute pancreatitis, in which 17 (51.5%) patients received early enteral nutrition through a nasogastric tube, and 16 (48.5%) via an endoscopically placed nasojejunal tube. The criteria for nutrition intolerance were as follows: nasogastric tube discharge of more than 500±100 ml at a time or more than 500 ml/day in comparison with the enterally administered during this period, increased pain, bloating, diarrhea, nausea and vomiting. Using the method of logistic regression, indicators with prognostic significance were determined. The null hypothesis was rejected at p<0.05.RESULTS Regardless of the nutrition route, the progression of multiple organ failure increases the incidence of high gastric residual volumes (SOFA — OR (odds ratio) — 1.337, 95% CI (confidence interval) 1.001–1.787; p = 0.049). Pain syndrome is less common on the day of surgery (OR 0.258, 95% CI 0.110–0.606; p=0.002). Nasojejunal feeding was associated with a lower incidence of nausea and vomiting (OR 0.168, 95% CI 0.06–0.473; p=0.001), but with more diarrhea (OR 6.411, 95% CI 1.274–32.262; p=0.024).CONCLUSION The progression of multiple organ failure increases the incidence of high gastric residual volumes. The pain syndrome is less pronounced on the day of surgery and more intense in case of nasogastric nutrition. Postpyloric nutrition reduces the incidence of nausea and vomiting, but increases diarrhea.

АНАЛИЗ ЛЕТАЛЬНОСТИ ПРИ СПАЕЧНОЙ БОЛЕЗНИ ОРГАНОВ БРЮШНОЙ ПОЛОСТИ

Adhesive disease of the abdominal cavity is currently an important medical and social problem, characterized by frequent relapses, decreased ability to work and the quality of life. The aim of the study was to analyze the patterns of development of adhesive disease of the abdominal organs on the basis of autopsy protocols. As a result of the study, it was proved that the likelihood of an unfavorable outcome is significantly influenced by the age and time of seeking medical care from the moment of the onset of the disease. While the older the patient, the later he seeks medical help and the longer he is in hospital; surgical treatment of adhesive intestinal obstruction in comparison with planned adhesiolysis is associated with an increase in the likelihood of complications, in particular: early adhesive obstruction by 88.9%, perforation of the hollow organ by 73.9%, peritonitis by 72.7%, which proves the presence of a syndrome of mutual burden, progression of multiple organ failure and the need for an integrated approach to patient treatment. In the pathological diagnosis of the abdominal adhesions, 29% of the deceased were noted, while 71% of the surgical procedures mentioned it, which indicates the prevalence of this disease.

Энтеральная недостаточность в патогенезе острой кишечной непроходимости и методы ее коррекции (обзор литературы)

Enteral insufficiency syndrome in acute intestinal obstruction leads to a violation of the motor evacuation, secretory, digesting, absorbing, endocrine, immune, metabolic and barrier functions of the intestine. The accumulation of intestinal contents contributes to an increase in intracavitary pressure (compartment syndrome), violation of intramural hemocirculation, the development of interstitial edema, colonization and translocation of microbacteria. Nasointestinal intubation restores the evacuation function of the intestine, frees it from its contents, reduces pressure in the intestinal cavity, relieving microcirculatory disorders in the intestinal wall. In the future, the patient is prescribed enteral nutrition, selective intestinal decontamination and enterosorption are carried out. To restore the motor-evacuation function of the intestine, various types of electrical stimulation are successfully used. Thus, early diagnosis and timely correction of enteral insufficiency syndrome prevents the progression of multiple organ failure in acute intestinal obstruction.

The importance of eliminating microcirculatory disorders in the complex treatment of common soft tissue phlegmon

Background. The treatment of purulent-inflammatory processes of soft tissues remains today an area of surgery that is not given enough attention by specialists of both inpatient and outpatient levels, with many unresolved problems. Of particular importance in the pathogenesis of purulent-septic processes are the emerging microcirculation disorders due to the formation of micro-clots. An important point that aggravates the course of the disease is the development of thrombohemorrhagic syndrome. As a result, even with a variety of antibacterial drugs and the ыavailability of new treatment methods, it is often not possible to achieve positive results in the treatment of this heavy contingent of patients.Aim: to improve the effectiveness of complex therapy of patients with extensive soft tissue phlegmon by relieving thrombohemorrhagic syndrome.Materials and methods. Cryoplasma-anti-enzyme therapy in the composition of complex treatment was received by 59 (48.8 %) patients of the main group, 62 (51.2 %) patients of the comparison group received only the generally accepted treatment. In each group, there are three variants of the course of the disease – moderate, severe and septic.Results. The analysis of the clinical course of the disease showed that in patients of the first group, wounds were cleared of necrotic masses and purulent discharge with filling them with healthy granulation tissue 5.3 days faster than in the second group (p˂0.001). The number of deaths decreased – 11.9 % in the first group against 27.4 % in the second group (p˂ 0.001). The number of deaths decreased – 11.9 % in the first group against 27.4 % in the second group (p˂ 0.001). The proportion of thrombotic and thromboembolic causes of death in the first group (14.3 %) was lower than in the second (17.7 %) (p˂ 0.05).Conclusion. The use of cryoplasma-anti-enzyme therapy as part of complex treatment contributed to the effective relief of thrombohemorrhagic syndrome, the elimination of microcirculatory disorders, which allowed performing plastic closure of a wound defect 1.6 times faster, prevented the progression of multiple organ failure, and contributed to a reduction in mortality.

Prophylactic effect of myricetin and apigenin against lipopolysaccharide-induced acute liver injury.

Liver has an important role in the initiation and progression of multiple organ failure that occurs in sepsis. Many natural active substances can be used to reduce the liver injury caused by sepsis. For this aim, the effects of myricetin and apigenin on mice model of acute liver injury was evaluated in this study. Thirty-six mice were randomly divided into six groups as; control, lipopolysaccharide (LPS) (5mg/kg), LPS + myricetin (100mg/kg), LPS + myricetin (200mg/kg), LPS + apigenin (100mg/kg), and LPS + apigenin (200mg/kg) groups. Myricetin and apigenin were administered orally for 7days, and LPS was administered intraperitoneally only on the 7th day of the study. 24h after LPS application, all animals were sacrificed and serum biochemical parameters, histopathology and oxidative stress and inflammation markers of liver tissue were examined. Myricetin and apigenin pre-treatments increased serum albumin and total protein levels, liver GSH level and catalase and SOD activities and decreased serum ALT, AST, ALP, γ-GT, CRP, total and direct bilirubin levels, liver MPO activity, MDA, NOx, PGE2, TNF-α, IL-1β, and IL-6 levels, iNOS and COX-2 mRNA levels, phosphorylation of NF-κB p65, IκB, and IKK proteins but not p38, ERK, and JNK proteins in LPS-treated mice. Myricetin and apigenin administration also regained the hepatic architecture disrupted during LPS application. Myricetin and apigenin pre-treatments led to reduction of liver injury indices and oxidative stress and inflammatory events and these flavonoids has probably hepatoprotective effects in acute liver injury.

Влияние цитофлавина на эффективность интенсивной терапии новорожденных с некротизирующим энтероколитом

Postoperative treatment of necrotizing enterocolitis (NEC) in newborns is a challenging problem in pediatric surgery due to high mortality rate among these patients. It is extremely important to search for novel treatments that will not only reduce the death rate, but also improve patients' quality of life. Objective. To improve the outcomes of newborns with NEC in the early postoperative period using cytoflavin, a metabolic antihypoxant/antioxidant. Patients and methods. This study included 77 newborns with NEC operated on in the Department of Neonatal Surgery between 2018 and 2021. All study participants were divided into two groups according to their treatment in the postoperative period. Group 1 (experimental) included 41 NEC patients (53.2%), whereas group 2 (control) included 36 NEC patients (46.8%). The sequential organ failure assessment (SOFA) scale adjusted for neonates was used to evaluate patients' condition. Results. Participants from the experimental group stayed in the intensive care unit for 7.46 ± 1.8 days on average. The maximum SOFA score was 12 and lasted for 3 days in 14 infants (34.1%). Twenty-eight patients had lung ventilation for a mean time of 36.3 ± 4.9 h. Newborns from the control group stayed in the intensive care unit for 10.7 ± 1.2 days on average. Seventeen patients (47.2%) had the maximum SOFA score of 12 for 3 days. The mean duration of lung ventilation was 58.7 ± 4.8 h. Recovery of intestinal transit by 72 h postoperatively was observed in 8 patients from Group 1 and 2 patients from Group 2 (the difference was significant p < 0.05). Conclusion. Hypoxic intestinal damage plays a significant role in NEC development; therefore, metabolic therapy in newborns with NEC ensures a rapid positive effect and faster improvement. Early administration of metabolic therapy with cytoflavin in newborns with NEC reduces the incidence and severity of complications and prevents the progression of multiple organ failure. Key words: necrotizing enterocolitis, postoperative period, cytoflavin

The Using of Cryodestruction Methods in the Treatment of Primary Liver Cancer

Objective: to improve treatment outcomes, quality and life expectancy in patients with primary liver cancer. Materials and methods: Since 2012, cryodestruction (CD) was performed in 14 patients with primary liver cancer, in 6 patients with hepatocellular cancer (HCR) and 8 patients with cholangiocellular cancer (CCR), 5 women and 8 men. The size of the lesions in the liver was 2-8 cm, the number of lesions was 1-8 (3±2). The exposure time was 3-5 min, the exposure temperature was -186С. CD in combination with RFA was performed in 5 patients, CD+liver resection-in 2 patients, a CD+RFA+liver resection - in 2 patients. All patients were subsequently given adjuvant chemotherapy. Results: Severe life-threatening complications were observed in 2 (7.1%) operated patients: - 1 (7.1%) intra-abdominal bleeding, 1 - death due to progression of multiple organ failure during sepsis after application of CD in combination with liver resection and RFA. Survival in patients after the use of cryodestruction in combination with other methods of local destruction was 20.5±5 months, after cryodestruction - 12.56±3 months. (p < 0.05). Survival in patients after the use of cryodestruction in combination with other methods of local destruction with CCR was 9.2±4.5 months (p < 0.05), with cryodestruction - 7 + 2.5 months. (p < 0.05). Conclusion: Cryodestruction in combination with other methods of local destruction in primary liver cancer in unresectable patients is an intervention that significantly improves the quality of life of cancer patients. When using adjuvant chemotherapy, there is also a slight improvement in survival rates.

Extracorporeal detoxification techniques in septic complications in children at the acute stage of severe combined injury

Relevance. The given literature review analyzes current approaches to the extracorporeal detoxification (ECD) in ICU in patients with sepsis. In case of severe polytrauma in a child, anatomical and physiological features of his/her organism, marked severity and rapid progression of multiple organ failure as well problems in taking anamnesis put specialists into a challenging situation. A pathogenetically differentiated approach to the choice of extracorporeal detoxification technique in the complex treatment of sepsis – with respect to the syndrome of endogenous intoxication - will increase the effectiveness of therapeutic measures of intensive care in children at their acute stage after severe combined injuryObjective. To improve outcomes in children at the acute stage of severe combined injury by applying differentiated techniques for extracorporeal detoxification in septic complications .Material and methods. The most common techniques were analyzed: hemosorption, plasmapheresis, prolonged veno-venous hemofiltration and hemodiafiltration.Results. A large number of works have been published which confirm ECD effectiveness in adult patients with severe sepsis and septic shock. However, in the available literary sources, there are almost no information on the differentiated approach to various ECD techniques in children with severe combined injury who have traumatic endotoxicosis and multiple organ failure. Conclusion. Clinical trials and prospective researches on practical aspects of extracorporeal treatment in pediatrics are priority and compulsory because of the gained world experience of its application in patients with septic endotoxicosis. This impels towards further clinical researches in this direction.

КЛИНИЧЕСКОЕ НАБЛЮДЕНИЕ НЕЛЕЧЕННОЙ СИСТЕМНОЙ КРАСНОЙ ВОЛЧАНКИ С ИНФЕКЦИОННЫМИ ОСЛОЖНЕНИЯМИ И ФАТАЛЬНЫМ ИСХОДОМ

Among rheumatic diseases, a special place is occupied by systemic lupus erythematosus (SLE), this is due to its variety of clinical nonspecific manifestations, which leads to diagnostic difficulties in the early stages.This article presents a clinical case of severe SLE, previously not diagnosed and untreated, with the rapid progression of multiple organ failure (damage to the lungs, cardiovascular system, kidneys), which led to death. Previously, the patient was treated in the oncology and surgical departments with an abscess of the omental bursa and steatopancreonecrosis, later she was hospitalized in the hematology department with three-growth pancytopenia and hemolytic anemia, and from there transferred to the rheumatology department. This clinical situation demonstrates the importance of timely diagnosis, diagnosis and treatment of SLE.

Associations of NT-proBNP and hepcidin levels with clinical and laboratory parameters in patients with heart failure with various severity of left ventricular systolic dysfunction

Data on hepcidin levels in patients with heart failure (HF) are contradictory and do not make clear its contribution to the progression of multiple organ failure. There remain a number of issues about the prognostic significance of the N-terminal pro-brain natriuretic peptide (NT-proBNP) in HF with preserved ejection fraction (EF). The authors suggested the relationships between these markers in decompensated HF, as well as their associations with other clinical and laboratory parameters.Aim. To identify the association of NT-proBNP and hepcidin levels with clinical and laboratory parameters in patients with HF with various severity of left ventricular (LV) systolic dysfunction.Material and methods. The study included 68 patients (29 women, 39 men; mean age — 72,3±11,7 years) hospitalized due to decompensated HF. Patients were divided into three groups: reduced (HFrEF) (n=20), mid-range (HFmrEF) (n=23), and preserved EF (HFpEF) (n=24). Upon admission, along with standard diagnostic tests, all patients were examined for NT-proBNP and hepcidin levels by enzyme-linked immunosorbent assay. Statistical processing was carried out using the software package Statistica 8.0.Results. NT-proBNP levels in the entire sample was 315,9 [129,9; 576,1] pg/ml. Significantly higher concentrations of NT-proBNP were found in patients with lower EF: 433,05 (346,8-892,6) pg/ml for HFrEF, 289,97 (185,9-345,3) pg/ml for HFmrEF pg/ml and 214,98 (207,37-562,31) pg/ ml for HFpEF (p&lt;0,05). At the same time, hepcidin levels in the HFrEF group (31,63 ng/ml [22,0; 71,6]) was significantly higher than in the HFmrEF (23,89 ng/ml [21,1; 27,9]) (p&lt;0,05) and HFpEF (26,91 ng/ml [18,6; 31,1]) (p&lt;0,05). In HFpEF patients, there was a correlation of hepcidin level with body mass index (r=0,47, p&lt;0,05) and chronic obstructive airway diseases (r=0,44, p&lt;0,05). A correlation of hepcidin level with cardiac arrhythmias (r=0,61, p&lt;0,05) was revealed in the HFmrEF group. In the HFrEF group, there were correlations of a significantly increased level of NT-proBNP (median — 433,05; 95% confidence interval: 346,8-892,6) with indicators of disease severity and multiple organ dysfunction: decrease in systolic blood pressure, cardiorenal syndrome, decrease in hemoglobin level and mean corpuscular hemoglobin concentration, characteristic of iron-deficiency anemia.Conclusion. Patients with lower EF showed higher NT-proBNP values and a trend towards higher hepcidin levels. Relationships of hepcidin and NT-proBNP levels with following clinical parameters were found: body mass index, presence of obstructive airway diseases, cardiac arrhythmias, as well as low cardiac output syndrome, cardiorenal syndrome and anemia.

Hepcidin and MELD-XI score as markers of multiple organ failure in patients with heart failure with preserved and reduced ejection fraction

Data on the changes in hepcidin levels in heart failure (HF) patients are contradictory and do not give an answer about its effect on the progression of multiple organ failure. Since the model of end-stage liver disease excluding INR (MELD-XI) reflects the severity of liver and kidney dysfunction, these markers have been suggested to be associated with decompensated HF.Aim. To assess the MELD-XI score and serum hepcidin levels in patients with decompensated HF with different values of left ventricular ejection fraction (EF).Material and methods. The study included 68 patients (29 women, 39 men; mean age 72,3±11,7 years) hospitalized due to decompensated HF. Patients were divided into three groups: reduced (HFrEF) (n=20), mid-range (HFmrEF) (n=23), and preserved EF (HFpEF) (n=24)). Upon admission, along with standard diagnostic tests, all patients were examined for hepcidin-25 levels by enzyme-linked immunosorbent assay. MELD-XI score was calculated. Statistical processing was carried out using the software package Statistica 8.0.Results. Hepcidin levels in the HFrEF group (31,63 ng/ml [22,0; 71,6]) were significantly higher than in the HFmrEF (23,89 ng/ml [21,1; 27,9]) (p&lt;0,05) and HFpEF (26,91 ng/ml [18,6; 31,1]) (p&lt;0,05) groups. In HFpEF, there was a correlation of hepcidin level with body mass index (r=0,47, p&lt;0,05) and chronic obstructive airway diseases (r=0,44, p&lt;0,05). A correlation of hepcidin level with significant cardiac arrhythmias (r=0,61, p&lt;0,05) was revealed in HFmrEF patients. MELD-XI score were significantly increased from 9,44±3,96 for HFpEF and 11,53±3,82 for HFmrEF to 14,3±4,3 for HFrEF (p&lt;0,005). We also revealed correlation of MELD-XI score with hepcidin levels (r=0,3, p&lt;0,05) and EF (r=-0,43, p&lt;0,0003). Patients with a MELD-XI score of &gt;10,4 were more likely to have NYHA class III-IV HF, HFrEF and significantly higher levels of hepcidin (p&lt;0,05 for all) These patients were also more likely to have chronic kidney disease (p&lt;0,05).Conclusion. Hepcidin level and MELD-XI score in patients with decompensated HF are inversely related to left ventricular EF. There is a direct relationship between hepcidin levels and other clinical parameters: body mass index, the presence of chronic obstructive airway diseases and cardiac arrhythmias.

Association between increased arterial stiffness and clinical outcomes in patients with early sepsis: a prospective observational cohort study

BackgroundConduit arteries, especially the aorta, play a major role in ensuring efficient cardiac function and optimal microvascular flow due to their viscoelastic properties. Studies in animals and on isolated arteries show that acute systemic inflammation can cause aortic stiffening which affects hemodynamic efficiency. Carotid-femoral pulse wave velocity, a measure of aortic stiffness, may be useful as a bedside investigational method in patients with early sepsis admitted to intensive care, as circulatory changes can lead to multiple organ failure and increased mortality. This study aims to investigate arterial stiffness in early sepsis and its association with clinical outcomes.MethodsThis prospective observational study included adult patients with severe sepsis or septic shock admitted to our intensive care unit (n = 45). Their carotid-femoral pulse wave velocity was measured within 24 h of admission. We assessed the progression of multiple organ as well as cardiovascular failure by sequential SOFA scores. Prediction models for the progression of multiple organ and cardiovascular failure were constructed using multivariate logistic regression with pulse wave velocity and vasopressor use as predictors. A Cox proportional hazards model was used to examine the relationship between pulse wave velocity and survival time.ResultsThe median pulse wave velocity for the cohort was 14.6 (8.1–24.7) m/s. There was no association between pulse wave velocity and the progression of multiple organ failure, before or after adjustment for vasopressor use. No association was found between pulse wave velocity and subsequent improvement in cardiovascular failure in the subgroup of patients who had cardiovascular instability at baseline. Cox regression and survival analyses with age, APACHE II, and baseline SOFA as confounders showed a shorter hospital survival time for patients with pulse wave velocity > 24.7 m/s (HR = 9.45, 95% CI 1.24–72.2; P = 0.03).ConclusionsPatients with severe sepsis and septic shock admitted to intensive care have higher arterial stiffness than in the general population. No convincing association was found between pulse wave velocity at admission and the progression of multiple organ or cardiovascular failure, although the group with pulse wave velocity > 24.7 m/s had shorter survival time.