Severity Of Organ Dysfunction Research Articles

Comparative analysis of multi-organ failure trajectories reflected by the MELD-3.0 following heart transplantation and heartmate 3 implantation

Abstract Background Multi-organ failure (MOF) frequently complicates advanced heart failure (HF), substantially impacting patient prognosis. The Model of End-Stage Liver Disease 3.0 (MELD-3.0) scale, encompassing liver and kidney function parameters, is a valuable tool for assessing the severity of organ dysfunction. Purpose This study aims to elucidate the trajectory of MOF in individuals undergoing either heart transplantation (HTx) or left ventricular assist device (LVAD) - HeartMate 3 implantation, utilizing the MELD-3.0 scale, over a 1-year follow-up period. Methods A comprehensive analysis was conducted, examining data from 1 month preceding to 1 year subsequent to the HTx or LVAD implantation. The MELD-3.0 score was calculated using the average values of international normalized ratio, bilirubin, creatinine, sodium, and albumin levels during this timeframe. Comparative assessments of the average MELD-3.0 scores were performed between the HTx and LVAD groups at 1 month pre-procedure, as well as at 1 week, 1 month, 3 months, 6 months, and 1 year post-procedure. Results The analysis included 107 patients undergoing HTx and 31 patients undergoing HMi, with a median age of 54 years (47-62), 85% were male. There was no difference in MELD-3.0 between HTx and LVAD patients in the pre-procedure period: 12.3 (7.3-15.9) vs 13.1 (7.7-16.6), p=0.95. There was also no difference in MELD-3.0 at 1 week and 1 month post-procedure. However, in the 3rd month, the difference gained statistical significance: 7.3 (4.6-9.4) vs 13.8 (11.5-19.7), p<0.01 and continued to be significant in the next follow-ups: 12-month 5.4 (3.1-10.2) vs 11.1 (6.7—15.1), p<0.01, comparing respectively HTx vs LVAD. In both groups of patients, a significant decrease in MELD-3.0 score from 3-month follow-up when compared to 1 month preceding the procedure was observed. Within 12 months post-procedure, 30 patients (22%) died (19 in HTx group and 11 in LVAD group), 8 LVAD patients (26%) had HTx. Conclusion The utilization of the MELD-3.0 scale reveals significant differences in the trajectory of multi-organ failure between HTx and LVAD patients. Both forms of advanced HF therapy result in an improvement of liver and kidney condition, while HTx patients' benefits are larger and last longer, highlighting the distinct impacts of this intervention on organ function.MELD 3.0 score in time

Increased Intra-Abdominal Pressure as One of the Links in the Pathogenesis of Secondary Diffuse Purulent Peritonitis

Aim: to present literature data on the importance of intra-abdominal hypertension in the pathogenesis of peritonitis. Key points. Secondary purulent peritonitis is a severe and fairly common form of abdominal infection with high mortality. According to statistics, hospitalization of patients with signs of local or diffuse peritonitis is more than 15 % among patients with acute surgical pathologies. One of the factors in the development of complications and an unfavorable prognosis for this disease is increased intra-abdominal pressure. To measure this indicator, a Foley catheter inserted into the bladder is used in medical practice. According to reference values, the optimal level of intra-abdominal pressure does not exceed 5 mmHg. A persistent increase in pressure of 12 mmHg and above indicates the development of intra-abdominal hypertension. An increase in the level of intra-abdominal pressure indicates the progression of the inflammatory destructive process in the abdominal cavity and contributes to the development of multiple organ failure with subsequent fatal outcome with untimely treatment. With an indicator exceeding 20 mmHg, there is a risk of developing abdominal compartment syndrome. This condition is characterized by increased pressure in two or more anatomical areas, which leads to decreased blood flow and subsequent tissue hypoxia. Intra-abdominal hypertension also increases the risk of developing postoperative peritonitis in patients who have undergone laparotomy. Conclusion. To predict the course of secondary diffuse purulent peritonitis, reduce the risk of complications and mortality, it is necessary to focus on measuring intra-abdominal pressure as a mandatory manipulation in surgical patients. Despite its general availability and ease of implementation, this technique allows assessing the severity of organ dysfunctions.

Association between Controlled and Uncontrolled DM and Prognosis of Critically ill Patients with Sepsis

Abstract Background In patients with sepsis, an inflammatory response can lead to destruction of the glycocalyx. These alterations cause the progression of organ dysfunction. Destruction of the glycocalyx can also occur in chronic hyperglycemia. Glycated hemoglobin (HbA1c) is a reliable marker of premorbid hyperglycemia. Aim of Work to investigate the association between HbA1c level including the difference between controlled and uncontrolled diabetes mellitus at admission and the degree of organ dysfunction progression 5 days after admission and ICU mortality. Patients and Methods This is a retrospective observational study that included 50 critically ill diabetic patients suffering from sepsis, conducted at the Intensive Care Department, Ain Shams University Hospital. The study design was approved by Ain Shams Faculty of Medicine’s Ethical Committee. All fifty patients were categorized as being diabetic suffering from sepsis into two groups: Group (A): included 25 patients with HBA1C 7% or below. Group (B): included 25 with HBA1C above 7%. Results HbA1C, procalcitonin, ALT, AST and lactic acid were significantly higher in group B compared to group A (P values <0.05) while PLT count was significantly higher in group A compared to group B (P value<0.001). Glucose, CRP and ALT were insignificantly different between the studied groups. Regarding urine analysis, number of patients who had acetone in urine was significantly higher in group B (with HbA1C > 7%) compared to group A (with HbA1C ≤ 7), therefore all those patients were diagnosed as DKA patients and needed insulin. Norepinephrine and Terlipressin use was significantly higher in group B compared to group A (P value = 0.022, 0.007) while epinephrine, dobutamine and dopamine use was insignificantly different between the two groups. Hemodialysis was significantly higher in patients with higher HbA1C level > 7% compared to those with lower HbA1C level (P value = 0.016), while ventilator use was comparable between the two groups. Within 5 days of ICU admission, the incidence of organ dysfunction was significantly higher in patients with higher HbA1C >7% compared to those with lower level of HbA1C (P value = 0.041). Mortality was significantly higher within significantly shorter time in patients with higher HbA1C >7% compared to those with lower level of HbA1C (P value = 0.002, 0.04 respectively). HbA1C can significantly predict the severity of organ dysfunction with AUC of 0.749 (P value <0.001), at cut off >6.9%, HbA1C is a significant predictor for organ dysfunction severity with sensitivity of 94.74%, specificity of 54.84%, PPV of 56.2% and NPV of 94.4%. Conclusion The most common causes of sepsis in ICU patient were pulmonary sepsis followed by urinary tract sepsis. Norepinephrine and terlipressin use was significantly higher in uncontrolled diabetes. Most of patients with uncontrolled diabetes were on hemodialysis while the ventilation use was comparable between the studied groups. Patients with non-controlled diabetes had higher incidence of organ dysfunction and mortality. Age, HbA1C, procalcitonin, PLT and lactic acid were significant predictors for the severity of organ dysfunction within 5 days of ICU admission. We concluded that HbA1C could predict the severity of organ dysfunction.

Severity of organ dysfunction in pediatric intensive care using PELOD-2

Objective: Organ dysfunction is an important factor determining the severity and outcome of critical illness in children. Organ dysfunction scores are based on the number of organs involved and the severity of dysfunction in each. This study aimed to evaluate organ dysfunction using PELOD-2 in critically ill children. Methods: This prospective observational study included all consecutive critically ill children with organ dysfunction aged one month to 15 years admitted to pediatric intensive care unit of a Ramaiah Medical College Hospital, Bangalore between January 2018 and December 2020. The severity of organ dysfunction was scored using Pediatric logistic organ dysfunction-2 (PELOD-2) and evaluated based on the outcome using SPSS and PASW statistics for Windows version 18.0. The sample size required for the study with 95% confidence level and 10% relative precision was 149 critically ill children. The children were classified based on the presence of single and multiple organ dysfunction. Demographics and laboratory parameters were compared between the two groups using non parametric tests. The factors affecting mortality among children with multiple organ dysfunction were assessed using univariate and multivariate analysis. Results: Of the 550 children admitted with critical illness during the study period, organ dysfunction was present in 84% of the patients. Of these, 43% had multiple-organ dysfunction. The median (interquartile range) of the patients was 5.5 (1, 11) years with a male-to-female ratio of 1.7:1. The mortality rate was 14.4%. The PELOD-2 score and mortality steadily increased with the number of organs involved. The presence of more than two organ dysfunctions had an odd ratio (OR) of 45.7 for mortality (95% CI: 18.9–110.6, P value<0.001). The area under the receiver operating curve (ROC) for predicting mortality using the number of organs affected was 0.96 (95% CI: 0.94–0.97, P value<0.001). Dysfunction in more than two organs had a sensitivity of 92.5% and a specificity of 91% in predicting mortality. The presence of cardiovascular dysfunction and the need for ventilation were found to be independent predictors of mortality. Conclusion: The presence of more than two organ dysfunctions in PELOD-2 increased the risk of mortality; the need for ventilation and the presence of cardiovascular dysfunction were independent predictors of mortality.

Emergency critical care: closing the gap between onset of critical illness and intensive care unit admission.

Critical illness is an exquisitely time-sensitive condition and follows adisease continuum, which always starts before admission to the intensive care unit (ICU), in the majority of cases even before hospital admission. Reflecting the common practice in many healthcare systems that critical care is mainly provided in the confined areas of an ICU, any delay in ICU admission of critically ill patients is associated with increased morbidity and mortality. However, if appropriate critical care interventions are provided before ICU admission, this association is not observed. Emergency critical care refers to critical care provided outside of the ICU. It encompasses the delivery of critical care interventions to and monitoring of patients at the place and time closest to the onset of critical illness as well as during transfer to the ICU. Thus, emergency critical care covers the most time-sensitive phase of critical illness and constitutes one missing link in the chain of survival of the critically ill patient. Emergency critical care is delivered whenever and wherever critical illness occurs such as in the pre-hospital setting, before and during inter-hospital transfers of critically ill patients, in the emergency department, in the operating theatres, and on hospital wards. By closing the management gap between onset of critical illness and ICU admission, emergency critical care improves patient safety and can avoid early deaths, reverse mild-to-moderate critical illness, avoid ICU admission, attenuate the severity of organ dysfunction, shorten ICU length of stay, and reduce short- and long-term mortality of critically ill patients. Future research is needed to identify effective models to implement emergency critical care systems in different healthcare systems.

Predictive value of left ventricular global longitudinal peak strain for the prognosis of septic patients

To investigate the predictive value of left ventricular global longitudinal peak strain (GLPS) for the prognosis of septic patients. A prospective cohort study was conducted. Patients diagnosed with sepsis and admitted to the intensive care unit (ICU) of the First Affiliated Hospital, Sun Yat-sen University from December 2018 to November 2019 were enrolled. The patient characteristics, cardiac ultrasound parameters [left ventricular ejection fraction (LVEF), right ventricular ejection fraction (RVEF), four-dimensional ejection fraction (4DEF), GLPS] and cardiac biomarkers [N-terminal pro-brain natriuretic peptide (NT-proBNP), cardiac troponin T (cTnT)] within 24 hours of ICU admission, organ support therapies, severity of illness, and prognostic indicators were documented. The differences in clinical parameters between patients with varying outcomes during ICU hospitalization were assessed. Pearson correlation analysis was employed to explore the correlation between GLPS and other cardiac systolic parameters, as well as the associations between various cardiac systolic parameters and sequential organ failure assessment (SOFA) score. Receiver operator characteristic curve (ROC curve) was drawn to analyze the predictive capacity of cardiac ultrasound parameters and cardiac biomarkers for death during ICU hospitalization in septic patients. A total of 50 septic patients were enrolled, with 40 surviving and 10 dying during ICU hospitalization, resulting in a mortality of 20.0%. All patients in the death group were male. Compared with the survival group, the patients in the death group were older, had a higher prevalence of diabetes mellitus, and received continuous renal replacement therapy (CRRT) more frequently, additionally, they exhibited more severe illness and had longer length of ICU stay. The levels of GLPS and cTnT in the death group were significantly elevated as compared with the survival group [GLPS: -7.1% (-8.5%, -7.0%) vs. -12.1% (-15.5%, -10.4%), cTnT (μg/L): 0.07 (0.05, 0.08) vs. 0.03 (0.02, 0.13), both P < 0.05]. However, no statistically significant difference was found in other cardiac ultrasound parameters or cardiac biomarkers between the two groups. Pearson correlation analysis revealed a negative correlation between GLPS and LVEF (r = -0.377, P = 0.014) and 4DEF (r = -0.697, P = 0.000), while no correlation was found with RVEF (r = -0.451, P = 0.069). GLPS demonstrated a positive correlation with SOFA score (r = 0.306, P = 0.033), while LVEF (r = 0.112, P = 0.481), RVEF (r = -0.134, P = 0.595), and 4DEF (r = -0.251, P = 0.259) showed no significant correlation with SOFA score. ROC curve analysis indicated that the area under the ROC curve (AUC) of GLPS for predicting death during ICU hospitalization in septic patients was higher than other cardiac systolic parameters, including LVEF, RVEF, and 4DEF, as well as cardiac biomarkers NT-proBNP and cTnT (0.737 vs. 0.628, 0.556, 0.659, 0.580 and 0.724). With an optimal cut-off value of -14.9% for GLPS, the sensitivity and negative predictive value reached to 100%. GLPS < -14.9% within 24 hours of ICU admission in septic patients indicated a reduced risk of death risk during ICU hospitalization, while also correlating with the severity of organ dysfunction in this patient population.

Evaluation of SOFA score (Sequential Organ Failure Assessment score) in hospitalised patients with sepsis

Considering sepsis as a common illness the following study studied the score and extrapolated with survival benefits in medical emergency patients. The score was made to determine population level burden of disease.Various studies recommended SOFA for screening sepsis and determine prognosis. The score has been used to determine injury to organs in admitted patients with infection. The cross sectional study was conducted at Vivekananda Institute of Medical Sciences, Kolkata over a period of one year (2019 till 2020) on sepsis patients admitted in medical ICU. The study revealed that more the scores on the day of admission, the more is the risk of adverse outcomes and subsequent early mortality (within day 7 of admission). In this study, among 56 cases of total death within the first 7 days of admission, 53 patients (94.64%) had day 0 SOFA score of &amp;#62;9 making it a significant outcome in this study. Baseline SOFA scores ≥ 9 and rising SOFA scores as day progresses can predict mortality in sepsis. The mean SOFA score on admission to the ICU was 9.2. The 28-day mortality rate was 28%. Patients with a SOFA score of 9 or more on admission to the ICU had a significantly higher mortality rate than those with a score of less than 9 (42% vs. 14%, p &amp;#60; 0.01). The SOFA score on day 3 of ICU stay was also significantly associated with mortality (p &amp;#60; 0.01). The SOFA score is a simple and easy-to-use tool that can be used to assess the severity of organ dysfunction in patients with sepsis. It is a good predictor of mortality in patients with sepsis admitted to the ICU.

A cross-sectional study on serum uric acid as an early marker in predicting the mortality and morbidity in patients with sepsis

Introduction Sepsis is a critical medical condition characterized by a dysregulated host response to infection, often resulting in acute organ dysfunction. Early diagnosis and timely intervention are essential for improving outcomes in sepsis patients. This study protocol outlines a cross-sectional investigation into the potential prognostic value of serum uric acid levels in sepsis cases, aiming to contribute to the early identification and management of this life-threatening condition. Methods The study will be conducted at the Acharya Vinoba Bhave Rural Hospital, a tertiary care teaching hospital in Wardha District. Patients aged 18 years and above, diagnosed with sepsis or septic shock according to the Third International Consensus definition, will be included. Detailed clinical data will be collected, including comorbidities, vital signs, and organ dysfunction scores. Serum uric acid levels will be measured upon admission and at recovery from sepsis or seven days of non-recovery. Expected outcomes The primary outcome is assessing whether serum uric acid levels can be an early marker for sepsis diagnosis and prognosis. Secondary outcomes include evaluating the correlation between uric acid levels and mortality rates, organ dysfunction severity, inflammatory response, treatment response, and hospital length of stay. Additionally, serum uric acid’s prognostic value will be compared with established biomarkers for sepsis.

DIFFERENTIATED APPROACH TO ANTIHYPOXIC, ENDOPORTAL AND PHAGE THERAPY FOR ADVANCED PURULENT PERITONITIS

The purpose of this study was to evaluate the results of differentiated use of enteral antihypoxic therapy (EAT), endoportal therapy (EPT), as well as phage therapy (PT) in patients with diffuse purulent peritonitis complicated by acute intestinal failure (AIF). Materials and Methods: 144 patients with diffuse peritonitis and AIF were treated. The patients were divided into two equal comparable groups: main (n=72) and comparison (n=72). In addition, each group was divided into three subgroups (24 patients each) depending on the degree of AIF. The groups were distributed using adaptive randomization. EAT was carried out by introducing oxygenated water through a nasogastrointestinal (NGI) tube. EPT was carried out by introducing an antibiotic, a hepatoprotector and an antihypoxant through a catheter into the portal system. PT was carried out by introducing a polyvalent bacteriophage through a NGI tube. The following were dynamically studied: EMFC, APACHE II, abdominal cavity index (ACI), acid-base status and blood gas composition, integral intestinal pressure (IIP), intra-abdominal pressure (IAP). Comparison of quantitative indicators in the study groups was carried out using the Wilcoxon-Mann-Whitney U test, as well as its multivariate generalization - the Kruskal-Wallis test, for checking the equality of medians of several samples. Results: The dynamic study of IIP and IAP in the study groups on the day 3 of treatment, showed significantly lower values in the main group (p≤0.05). There was a more rapid decrease in the manifestations of hypoxia in the main group, which was confirmed by an increase in the oxygen partial pressure in the blood. The average number of bed days in the intensive care unit was 4.2±0.3 days in the comparison group, and 3.3±0.2 days in the study group. The overall average number of bed-days was 15.8 in the study group, and 18.5 in the comparison group. Mortality was 16.3% in the comparison group, and 11.3% in the study group (a decrease of 30.7%). Thus, when prescribing NGI, EAT, EPT and PT, one should be guided by the severity of organ dysfunction and the AIF stage. With values of ACI &lt;13, APACHE II &lt;10 and EMFC &lt;5, NGI and EAT are indicated. With ACI 14-22, APACHE II 10-15, EMFC 5-25 - NGI and EAT are supplemented with PT. In the most severe cases, with ACI ≥23, APACHE II &gt;16 and EMFC &gt;25 points, EPT must be added to the above treatment methods. Conclusion: The proposed scheme for the differentiated use of EPT, EAT and PT in patients with diffuse peritonitis complicated by AIF allows to relatively quickly stop inflammation and prevent the development of multiple organ failure and sepsis.

Automated Calculator for the Pediatric Sequential Organ Failure Assessment Score: Development and External Validation in a Single-Center 7-Year Cohort, 2015-2021.

The pediatric Sequential Organ Failure Assessment (pSOFA) score summarizes severity of organ dysfunction and can be used to predict in-hospital mortality. Manual calculation of the pSOFA score is time-consuming and prone to human error. An automated method that is open-source, flexible, and scalable for calculating the pSOFA score directly from electronic health record data is desirable. Single-center, retrospective cohort study. Quaternary 40-bed PICU. All patients admitted to the PICU between 2015 and 2021 with ICU stay of at least 24 hours. None. We used 77 records to evaluate the automated score. The automated algorithm had an overall accuracy of 97%. The algorithm calculated the respiratory component of two cases incorrectly. An expert human annotator had an initial accuracy of 75% at the patient level and 95% at the component level. An untrained human annotator with general clinical research experience had an overall accuracy of 16% and component-wise accuracy of 67%. Weighted kappa for agreement between the automated method and the expert annotator's initial score was 0.92 (95% CI, 0.88-0.95), and between the untrained human annotator and the automated score was 0.50 (95% CI, 0.36-0.61). Data from 9146 patients (in-hospital mortality 3.6%) were included to validate externally the discriminability of the automated pSOFA score. The admission-day pSOFA score had an area under the receiver operating characteristic curve of 0.79 (95% CI, 0.77-0.82). The developed automated algorithm calculates pSOFA score with high accuracy and is more accurate than a trained expert rater and nontrained data abstracter. pSOFA's performance for predicting in-hospital mortality was lower in our cohort than it was for the originally derived score.

Efficacy of intensive therapy for massive intraoperative blood loss in children: experience of the Morozov Hospital

To evaluate the effectiveness of intensive therapy for massive intraoperative blood loss in children. A retrospective analysis of primary medical records of 39 children with massive intraoperative blood loss was performed. Patients were divided into two groups (younger 1 year (n=18) and older 1 year (n=21)). Each group was divided into two subgroups (blood loss <10% and >100% of total blood volume). We analyzed total intraoperative infusion, qualitative composition of transfusions, reinfusion of washed autologous erythrocytes and vasopressor support. In postoperative period, we assessed hemoglobin, platelets, albumin, fibrinogen, lactate, prothrombin index, duration of mechanical ventilation, severity of organ dysfunction (pSOFA score) after 1 and 3 days, ICU stay and incidence of repeated blood transfusions. With regard to transfusion volume, we found a general pattern (3 parts of crystalloids, 2 parts of erythrocyte-containing components and 1 part of fresh frozen plasma in all groups with the exception of children older 1 year with blood loss >100% of total blood volume. The last ones had ratio 3:5:1 due to large volume of reinfusion of washed autologous erythrocytes. In all groups, target levels of hemoglobin, platelets, albumin and prothrombin index were achieved. Serum fibrinogen was slightly lower in the group with blood loss >100% of total blood volume. There was a direct relationship between blood loss and ICU stay (Spearman's test rs=0.421, p<0.05), as well as duration of mechanical ventilation (Spearman's test rs=0.509, p<0.05). Mean pSOFA score upon admission to intensive care unit was 3-4 points in both groups with blood loss <100% of total blood volume. In patients with blood loss >100% of total blood volume, this indicator averaged 9 points and regressed to 3-4 points over the next 72 hours. Intraoperative intensive therapy contribute to minimal severity of postoperative organ dysfunction in children with blood loss < 100% of total blood volume and rapid regression of multiple organ failure in patients with blood loss exceeding this indicator.

Neutrophil-to-lymphocyte ratio as marker of organ dysfunction severity in patients with sepsis in the intensive care unit: An observational study

Abstract Background: The neutrophil-to-lymphocyte ratio (NLR) is an easily computable parameter and is believed to accurately determine the disease-related organ dysfunction severity and prognosis in sepsis. Methods: This study aimed at identifying the role of NLR in predicting organ dysfunction severity and prognosis in patients with sepsis requiring admission to an intensive care unit (ICU). In this observational study, NLR and Sequential Organ Failure Assessment (SOFA) scores were calculated at the time of admission in patients with sepsis. Patients were followed until discharge or death. Results: Fifty five ICU patients with sepsis were enrolled. The mean NLR and SOFA scores for the total study cohort were 7.91 ± 3.01 and 8.76 ± 3.16, respectively. The corresponding values for those in septic shock were 8.96 ± 2.80 and 9.94 ± 3.78. A positive correlation was observed between SOFA score and NLR in all patients (r = 0.5584, P &lt; 0.001); patients with sepsis only (r = 0.4821, P = 0.002); and patients with sepsis and shock (r = 0.6321, P = 0.004). In the total population, mean NLR was significantly higher among non-survivors, compared to survivors (9.17±3.1 vs. 7.09±2.7 ; P = 0.0054). Conclusions: NLR at admission shows a good correlation with the organ dysfunction severity in sepsis and may be used as a prognostic marker, thereby guiding the intensification of management.

Aortic Steal Correlates with Acute Organ Dysfunction and Short-Term Outcomes in Neonates with Vein of Galen Malformation

Plain Language SummaryVein of Galen malformation is a rare, congenital intracerebral arteriovenous malformation with high morbidity and mortality in neonatal manifestation despite modern interdisciplinary strategies. Currently, there is no valid, noninvasive parameter for early prediction of clinical progression at the bedside. A typical finding of hemodynamically relevant vein of Galen malformation is flow reversal in the descending aorta (aortic steal). Therefore, we developed a new ultrasound method to quantify the percentage of reflux in the preductal aortic isthmus and integrated the measurement method into routine clinical practice. In this study, we retrospectively investigated the association between percentage of aortic steal, organ dysfunction parameters, mortality, and brain injury on magnetic resonance imaging (MRI) at baseline and follow-up in 12 neonates with vein of Galen malformation admitted between January 2021 and June 2022. Statistical analyses showed that the severity of organ dysfunction, mortality, and brain damage on MRI increased with increasing percentage of aortic steal. These correlations and associations showed a linear relationship between percentage reflux in the aortic isthmus and all outcome parameters. The potential of sonographically determined aortic steal to predict clinical progression and short- and long-term outcomes needs to be investigated in larger, prospective cohorts. If this marker proves as promising as the data from this study suggest, it could become an important diagnostic component for management and decision-making in critically ill neonates with vein of Galen malformation.

The Anti-Oxidative, Anti-Inflammatory, Anti-Apoptotic, and Anti-Necroptotic Role of Zinc in COVID-19 and Sepsis.

Zinc is a structural component of proteins, functions as a catalytic co-factor in DNA synthesis and transcription of hundreds of enzymes, and has a regulatory role in protein-DNA interactions of zinc-finger proteins. For many years, zinc has been acknowledged for its anti-oxidative and anti-inflammatory functions. Furthermore, zinc is a potent inhibitor of caspases-3, -7, and -8, modulating the caspase-controlled apoptosis and necroptosis. In recent years, the immunomodulatory role of zinc in sepsis and COVID-19 has been investigated. Both sepsis and COVID-19 are related to various regulated cell death (RCD) pathways, including apoptosis and necroptosis. Lack of zinc may have a negative effect on many immune functions, such as oxidative burst, cytokine production, chemotaxis, degranulation, phagocytosis, and RCD. While plasma zinc concentrations decline swiftly during both sepsis and COVID-19, this reduction is primarily attributed to a redistribution process associated with the inflammatory response. In this response, hepatic metallothionein production increases in reaction to cytokine release, which is linked to inflammation, and this protein effectively captures and stores zinc in the liver. Multiple regulatory mechanisms come into play, influencing the uptake of zinc, the binding of zinc to blood albumin and red blood cells, as well as the buffering and modulation of cytosolic zinc levels. Decreased zinc levels are associated with increasing severity of organ dysfunction, prolonged hospital stay and increased mortality in septic and COVID-19 patients. Results of recent studies focusing on these topics are summarized and discussed in this narrative review. Existing evidence currently does not support pharmacological zinc supplementation in patients with sepsis or COVID-19. Complementation and repletion should follow current guidelines for micronutrients in critically ill patients. Further research investigating the pharmacological mechanism of zinc in programmed cell death caused by invasive infections and its therapeutic potential in sepsis and COVID-19 could be worthwhile.

Bedside Hyperspectral Imaging and Organ Dysfunction Severity in Critically Ill COVID-19 Patients-A Prospective, Monocentric Observational Study.

Hyperspectral imaging (HSI) is a non-invasive technology that provides information on biochemical tissue properties, including skin oxygenation and perfusion quality. Microcirculatory alterations are associated with organ dysfunction in septic COVID-19 patients. This prospective observational study investigated associations between skin HSI and organ dysfunction severity in critically ill COVID-19 patients. During the first seven days in the ICU, palmar HSI measurements were carried out with the TIVITA® tissue system. We report data from 52 critically ill COVID-19 patients, of whom 40 required extracorporeal membrane oxygenation (ECMO). HSI parameters for superficial tissue oxygenation (StO2) and oxygenation and perfusion quality (NPI) were persistently decreased. Hemoglobin tissue content (THI) increased, and tissue water content (TWI) was persistently elevated. Regression analysis showed strong indications for an association of NPI and weaker indications for associations of StO2, THI, and TWI with sequential organ failure assessment (SOFA) scoring. StO2 and NPI demonstrated negative associations with vasopressor support and lactate levels as well as positive associations with arterial oxygen saturation. These results suggest that skin HSI provides clinically relevant information, opening new perspectives for microcirculatory monitoring in critical care.

Distinct clinical phenotypes in paediatric cancer patients with sepsis are associated with different outcomes—an international multicentre retrospective study

Identifying phenotypes in sepsis patients may enable precision medicine approaches. However, the generalisability of these phenotypes to specific patient populations is unclear. Given that paediatric cancer patients with sepsis have different host response and pathogen profiles and higher mortality rates when compared to non-cancer patients, we determined whether unique, reproducible, and clinically-relevant sepsis phenotypes exist in this specific patient population. We studied patients with underlying malignancies admitted with sepsis to one of 25 paediatric intensive care units (PICUs) participating in two large, multi-centre, observational cohorts from the European SCOTER study (n=383 patients; study period between January 1, 2018 and January 1, 2020) and the U.S. Novel Data-Driven Sepsis Phenotypes in Children study (n=1898 patients; study period between January 1, 2012 and January 1, 2018). We independently used latent class analysis (LCA) in both cohorts to identify phenotypes using demographic, clinical, and laboratory data from the first 24h of PICU admission. We then tested the association of the phenotypes with clinical outcomes in both cohorts. LCA identified two distinct phenotypes that were comparable across both cohorts. Phenotype 1 was characterised by lower serum bicarbonate and albumin, markedly increased lactate and hepatic, renal, and coagulation abnormalities when compared to phenotype 2. Patients with phenotype 1 had a higher 90-day mortality (European cohort 29.2% versus 13.4%, U.S. cohort 27.3% versus 11.4%, p<0.001) and received more vasopressor and renal replacement therapy than patients with phenotype 2. After adjusting for severity of organ dysfunction, haematological cancer, prior stem cell transplantation and age, phenotype 1 was associated with an adjusted OR of death at 90-day of 1.9 (1.04-3.34) in the European cohort and 1.6 (1.2-2.2) in the U.S. cohort. We identified two clinically-relevant sepsis phenotypes in paediatric cancer patients that are reproducible across two international, multicentre cohorts with prognostic implications. These results may guide further research regarding therapeutic approaches for these specific phenotypes. Part of this study is funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Validity of the total SOFA score in patients ≥ 80 years old acutely admitted to intensive care units: a post-hoc analysis of the VIP2 prospective, international cohort study

BackgroundLittle is known about the performance of the Sequential Organ Failure Assessment (SOFA) score in older critically ill adults. We aimed to evaluate the prognostic impact of physiological disturbances in the six organ systems included in the SOFA score.MethodsWe analysed previously collected data from a prospective cohort study conducted between 2018 and 2019 in 22 countries. Consecutive patients ≥ 80 years old acutely admitted to intensive care units (ICUs) were eligible for inclusion. Patients were followed up for 30 days after admission to the ICU. We used logistic regression to study the association between increasing severity of organ dysfunction and mortality.ResultsThe median SOFA score among 3882 analysed patients was equal to 6 (IQR: 4–9). Mortality was equal to 26.1% (95% CI 24.7–27.5%) in the ICU and 38.7% (95% CI 37.1–40.2%) at day 30. Organ failure defined as a SOFA score ≥ 3 was associated with variable adjusted odds ratios (aORs) for ICU mortality dependant on the organ system affected: respiratory, 1.53 (95% CI 1.29–1.81); cardiovascular 1.69 (95% CI 1.43–2.01); hepatic, 1.74 (95% CI 0.97–3.15); renal, 1.87 (95% CI 1.48–2.35); central nervous system, 2.79 (95% CI 2.34–3.33); coagulation, 2.72 (95% CI 1.66–4.48). Modelling consecutive levels of organ dysfunction resulted in aORs equal to 0.57 (95% CI 0.33–1.00) when patients scored 2 points in the cardiovascular system and 1.01 (0.79–1.30) when the cardiovascular SOFA equalled 3.ConclusionsDifferent components of the SOFA score have different prognostic implications for older critically ill adults. The cardiovascular component of the SOFA score requires revision.

Organ dysfunctions and inflammatory reaction in acute post-manipulation pancreatitis in experiment

Objective: to prove the possibility of reducing the severity of the course of organ dysfunctions and inflammatory response with the compound L-17 in the model of acute post-manipulation pancreatitis (APMP). Material and methods. The APMP model was made on 40 rats. Animals were divided into control (without treatment) and experimental (with the introduction of the compound L-17) groups of 20 rats. The daily dose of the compound is 40 mg/kg. Results. APMP developed in all animals. In the control group, persistent organ dysfunction and inflammatory response corresponded to a severe course of acute pancreatitis with a mortality rate of 70%. In the experimental group, there was a decrease in the severity of organ dysfunction and inflammatory response, with a decrease in mortality up to 30%. Conclusion. The use of the compound L-17 reduces the severity of organ dysfunction and inflammatory response during APMP in the experiment.

The role of pediatric sequential organ failure assessment lactate score in predicting the clinical outcome of critically ill children: A single-center, prospective, observational study

Abstract Background: The Pediatric Sequential Organ Failure Assessment (pSOFA) score is a scoring system used to assess the severity of organ dysfunction in critically ill children. The aim of this study was to evaluate the effectiveness of the pSOFA lactate (pSOFA-L) score in predicting the clinical outcome of critically ill children. Subjects and Methods: This hospital-based, prospective, observational study was conducted in the pediatric intensive care unit of medical college from North India. A total of 100 children were included. Parameters pertaining to the various organ systems as designated in the pSOFA-L score were studied and compared the score with the clinical outcome. Results: In this study, there were 56 survivors and 44 nonsurvivors. On receiver operating characteristics curve analysis, the cutoff value of the pSOFA-L score in predicting mortality was 10 with a sensitivity of 81.8% and specificity of 85.7% and area under the curve: 0.882, which is statistically significant (P &lt; 0.001). In the present study, the mortality rate was 11.3%, 18.2%, and 70.5% in children with pSOFA-L score &lt;9, 9–11, and &gt;11, respectively. On bivariate analysis of the survivor and nonsurvivor group, nonsurvivors had a significantly higher pSOFA-L score (P = 0.000). The mean lactate level was significantly higher among nonsurvivor group (3.02 ± 1.59 vs. 1.75 ± 1.19, P = 0.000). Conclusions: pSOFA-L score is accurate in predicting mortality, with a higher score indicating a poor outcome. The study also found a significant relationship between serum lactate levels and the pSOFA-L score, with higher lactate levels indicating a poor prognosis.

Evaluation of the use of combined extracorporeal detoxification in patients with severe acute pancreatitis: a retrospective cohort study

INTRODUCTION: Morbidity and mortality of severe acute pancreatitis (SAP) remains high. The most important direction of therapy is the relief of endotoxicosis. The use of extracorporeal detoxification (ECD) is a debatable problem. OBJECTIVE: Improving the results of treatment of patients with SAP, through the use of ECD methods. MATERIALS AND METHODS: The study included 25 patients. Group 1: ECD included 9 patients who used standard therapy with selective hemoperfusion (HP) and continuous veno-venous hemofiltration (CVVHF). Group 2 (control) 16 patients received standard therapy. We performed a comparative analysis of the main clinical and laboratory parameters and treatment outcomes between the groups. RESULTS: The use of ECD allowed to reduce the number of leukocytes from 14.9 to 8.6 × 109/l by 5 days of therapy in group 1, and from 17.6 to 16.1 × 109/l in group 2, respectively. The dynamics of CRP concentration from 1 to 5 days changed from 315.6 to 184.6 mg/ml and 274.2 to 352.9 mg/ml in groups 1 and 2, respectively. The level of PCT concentration on days 1–5 decreased from 4.5 to 2.1 ng/ml and 3.95 to 6.9 ng/ml in groups 1 and 2, respectively. The concentration of IL-6 decreased from 1624.3 to 914.3 pg/ml in group 1, and increased from 1529.8 to 1861.8 pg/ml in group 2, respectively. The dynamics of pH in group 1 was from 7.14 to 7.4 by the 5th day of therapy and 7.13 to 7.22 in group 2, respectively. SOFA by day 5 in group 1 was 4 points and 11 points in group 2, respectively. CONCLUSIONS: The use of HP and CVVHF in complex intensive care is accompanied by a significant regression of markers of endogenous intoxication, resolution of the acid-base state and reduces the severity of organ dysfunction and the risk of adverse outcomes, compared with standard treatment.