Duration Of Systemic Inflammatory Response Syndrome Research Articles

Effect of ghrelin administration on postoperative inflammatory response and bodyweight loss in patients with oesophageal cancer undergoing oesophagectomy: a systematic review and meta-analysis

ObjectivesTo investigate the effect of postoperative ghrelin therapy on postoperative inflammatory response and bodyweight loss in patients undergoing an oesophagectomy for oesophageal cancer.MethodsWe conducted a systematic search using electronic information databases in accordance to PRISMA standards to identify studies comparing outcomes after oesophagectomy in patients who were and were not administered ghrelin in the postoperative period. Meta-analysis of the outcomes using random effects modelling was conducted. The Cochrane collaboration’s tool and ROBINS-I tool were used for risk of bias assessment of the included studies.ResultsFive studies including 192 patients were selected for analysis. Ghrelin therapy was associated with a significantly shorter duration of systemic inflammatory response syndrome (SIRS) (MD: − 2.72, P = 0.0001), lower CRP level on postoperative day 3 (MD: − 3.64, P < 0.0001), and less total bodyweight loss (MD: − 1.87, P = 0.14). There was no differences between the two groups in IL-6 level on postoperative day 3 (MD: − 19.65, P = 0.32), total lean body weight loss (MD: − 1.87, P = 0.14), total body fat loss (MD: 0.15, P = 0.84), pulmonary complications (OR: 0.47, P = 0.12), anastomotic leak (OR: 1.17, P = 0.78), wound complications (OR: 1.64, P = 0.63), postoperative bleeding (OR: 0.32, P = 0.33), arrhythmia (OR: 1.22, P = 0.77).ConclusionsAdministration of ghrelin following oesophagoectomy may reduce duration of postoperative SIRS and bodyweight loss. Whether shorter duration of SIRS and less bodyweight loss resulted from postoperative ghrelin therapy can translate into improved morbidity or mortality outcomes remains unknown. There is a need for randomised controlled trials with robust statistical power to investigate the role of postoperative ghrelin therapy on morbidity and mortality outcomes in patients undergoing oesophagectomy.

The Effect of immunonutrition in patients undergoing pancreaticoduodenectomy: a systematic review and meta-analysis

BackgroundPancreaticoduodenectomy (PD) is a complex and traumatic abdominal surgery with a high risk of postoperative complications. Nutritional support, including immunonutrition (IMN) with added glutamine, arginine, and ω-3 polyunsaturated fatty acids, can improve patients’ prognosis by regulating postoperative inflammatory response. However, the effects of IMN on PD patients’ outcomes require further investigation.MethodsPMC, EMbase, web of science databases were used to search literatures related to IMN and PD. Data such as length of hospital stay, infectious complications, non-infectious complications, postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE), mortality, systemic inflammatory response syndrome (SIRS) duration, IL-6, and C-reactive protein (CRP) were extracted, and meta-analyses were performed on these data to study their pooled results, heterogeneity, and publication bias.ResultsThis meta-analysis involved 10 studies and a total of 572 patients. The results showed that the use of IMN significantly reduced the length of hospital stay for PD patients (MD = -2.31; 95% CI = -4.43, -0.18; P = 0.03) with low heterogeneity. Additionally, the incidence of infectious complications was significantly reduced (MD = 0.42; 95% CI = 0.18, 1.00, P = 0.05), with low heterogeneity after excluding one study. However, there was no significant impact on non-infectious complications, the incidence of POPF and DGE, mortality rates, duration of SIRS, levels of IL-6 and CRP.ConclusionThe use of IMN has been shown to significantly shorten hospital stays and decrease the frequency of infectious complications in PD patients. Early implementation of IMN is recommended for those undergoing PD. However, further research is needed to fully assess the impact of IMN on PD patients through larger and higher-quality studies.

Гемостаз та запалення у пацієнтів із політравмою

Актуальність. Причинами смерті при тяжких травмах є як ушкодження, несумісні з життям, так і тяжкі кровотечі. Коагулопатію, асоційовану з травмою, виявляють у 46 % пацієнтів уже на місці події та у 60 % пацієнтів — при надходженні на лікування. Мета: встановити наявність зв’язку між показниками загальної відповіді організму на запалення та показниками судинно-тромбоцитарного і коагуляційного гемостазу у пацієнтів з політравмою. Матеріали та методи. Проведено проспективне обсерваційне дослідження 20 пацієнтів віком від 19 до 55 років з політравмою, які перебували на лікуванні у відділенні анестезіології з ліжками інтенсивної терапії в Комунальному некомерційному підприємстві «8-ма міська клінічна лікарня м. Львова». Пацієнтів оцінювали за Injury Severity Score (ISS) та шкалою APACHE II (Acute Physiology And Chronic Health Evaluation II) з урахуванням тривалості синдрому загальної відповіді організму на запалення і лікування у відділенні інтенсивної терапії (ВІТ) та госпіталізації. Етапи дослідження: надходження на лікування у ВІТ (d1), третя доба (d3), п’ята доба (d5). Основними оцінюваними клінічними маркерами були показники: загальної відповіді організму на запалення, судинно-тромбоцитарного гемостазу (внутрішньосудинна активація тромбоцитів, агрегація тромбоцитів, індукована адреналіном і аденозиндифосфатом), коагуляційного гемостазу (міжнародне нормалізоване відношення, активований частковий тромбопластиновий час, рівень загального фібриногену та D-димерів). Результати. Встановлено наявність вірогідного (p &lt; 0,05) позитивного кореляційного зв’язку між співвідношенням рівнів дискоехіноцитів до сфероехіноцитів та рівнем загального фібриногену на етапі d1, а також тенденцію (p = 0,09) до наявності позитивного кореляційного зв’язку між цим співвідношенням та температурою тіла пацієнта. Виявлено вірогідний (p &lt; 0,05) зворотний кореляційний зв’язок між цим співвідношенням і рівнем тяжкості стану пацієнтів за шкалою APACHE II та прямий вірогідний (p &lt; 0,05) кореляційний зв’язок із тривалістю госпіталізації у ВІТ, а також тенденції до зворотного кореляційного зв’язку з тяжкістю ушкоджень за шкалою ISS (p = 0,07) та до прямого кореляційного внаслідок Systemic Inflammatory Response Syndrome (SIRS) (p = 0,12). Висновки. У пацієнтів із політравмою встановлено: наявність вірогідного (p &lt; 0,05) позитивного кореляційного зв’язку між співвідношенням дискоехіноцити/сфероехіноцити та рівнем загального фібриногену; тенденцію (p = 0,09) до позитивного кореляційного зв’язку між цим співвідношенням та температурою тіла пацієнта; вірогідний (p &lt; 0,05) зворотний кореляційний зв’язок з рівнем тяжкості стану пацієнтів за шкалою APACHE II; прямий вірогідний (p &lt; 0,05) кореляційний зв’язок з тривалістю госпіталізації у ВІТ; тенденцію (p = 0,07) до зворотного кореляційного зв’язку з тяжкістю ушкоджень за шкалою ISS та тенденцію (p = 0,12) до прямого кореляційного зв’язку з тривалістю SIRS.

Mortality in acute pancreatitis with persistent organ failure is determined by the number, type, and sequence of organ systems affected

BackgroundPersistent organ failure (POF) is the strongest determinant of mortality in acute pancreatitis (AP). There is a paucity of data regarding the impact of different POF attributes on mortality and the role of different characteristics of systemic inflammatory response syndrome (SIRS) in the risk of developing POF.ObjectiveWe aimed to assess the association of POF dynamic features with mortality and SIRS characteristics with POF.MethodsWe studied 1544 AP subjects prospectively enrolled at 22 international centers (APPRENTICE consortium). First, we estimated the association of onset, duration, and maximal score of SIRS with POF. Then, we evaluated the risk of mortality based on POF onset, duration, number, type, and sequence of organs affected. Analyses were adjusted for potential confounders.Results58% had SIRS, 11% developed POF, and 2.5% died. Early SIRS, persistent SIRS, and maximal SIRS score ≥ 3 were independently associated with higher risk of POF (p < 0.05). Mortality risk in POF was higher with two (33%, odds ratio [OR] = 10.8, 3.3–34.9) and three (48%, OR = 20.2, 5.9–68.6) organs failing, in comparison to single POF (4%). In subjects with multiple POF, mortality was higher when the cardiovascular and respiratory systems failed first or concurrently as compared to when the renal system failed first or concurrently with other organ (p < 0.05). In multivariate regression model, the number and sequence of organs affected in POF were associated with mortality (p < 0.05). Onset and duration of POF had no impact mortality.ConclusionIn AP patients with POF, the risk of mortality is influenced by the number, type, and sequence of organs affected. These results are useful for future revisions of AP severity classification systems.

The duration of systemic inflammatory response syndrome is a reliable indicator of long-term survival after curative esophagectomy for esophageal squamous cell carcinoma

We focused on the Systemic Inflammatory Response Syndrome (SIRS) duration after surgery for esophageal squamous cell carcinoma (ESCC) as the prognostic marker. We enrolled a total of 222 patients with local ESCC, who underwent curative esophagectomy between 2005 and 2015. SIRS was diagnosed according to the criteria as a condition involving two or more of the following factors after surgery: (a) body temperature of > 38°C or < 36°C; (b) heart rate > 90 beats/min; (c) respiratory rate > 20 breaths/min (d) WBC count > 12,000 or < 4000 cells/mm3. We defined SIRS duration as the total sum of the days defined as SIRS conditions during 7days after surgery. The SIRS duration was analyzed by Cox hazards modeling to determine the independent prognostic factors for overall survival (OS) and Cancer-specific survival (CSS). The cutoff point of SIRS duration was determined to be set at 5.0days according to the receiver operating characteristic (ROC) curve, which was plotted using 5-year OS as the endpoint. Of the 222 patients, 165 (74.4%) and 57 (25.6%) were classified as having short (< 5.0) and long (≥ 5.0) SIRS, respectively. The long SIRS was significantly associated with postoperative pneumonia (Hazard Ratio (HR):9.07; P < 0.01), great amount of blood loss during surgery (HR: 2.20: P = 0.04), preoperative high CRP value (HR: 2.45: P = 0.04) and preoperative low albumin (HR: 2.79: P = 0.03) by logistic-regression multivariate analysis. Cox Hazard Multivariate analyses revealed that long SIRS was a worse prognostic factor for OS (HR: 2.36; 95% Confidence Interval (CI):1.34-4.20, P < 0.01) and CSS (HR: 2.07; 95% CI:1.06-4.06, P = 0.03), while postoperative pneumonia and postoperative high CRP value were not worse prognostic factors for OS and CSS. SIRS duration is a more reliable prognostic marker than the development of pneumonia and high postoperative CRP value after surgery for ESCC. The surgeons should aim to reduce the SIRS duration to improve the prognosis of ESCC patients.

The impact of perioperative enteral immunonutrition on frequent clinical outcome in patients with digestive system cancer

Background: Forepassed trials have indicated that perioperative enteral immunonutrition can improve the clinical outcome for patients with digestive system cancer. The purpose of this study was to evaluate the effect of perioperative enteral immunonutrition on immunity and postoperative complications in patients with digestive system cancer. Methods: A group of 64 patients with digestive system cancer was randomly assigned for perioperative enteral immunonutrition (n=32) or standard enteral nutrition (n=32). The postoperative clinical outcome was assessed based on a clinical index, including postoperative complications, and systemic inflammatory response syndrome (SIRS) duration. Also, the postoperative cellular immunity was compared and evaluated between the two groups. Results: The nutritional therapy of both groups were completed. The occurrence of postoperative infectious complications in the immunonutrition group (6%) was significantly (P=0.020) lower than that of the standard nutrition group (28%). The duration of SIRS in the immunonutrition group (0.77±0.91 days) was significantly shorter than that in the standard nutrition group (1.34±1.46 days) (P=0.012). The postoperative lymphocyte counts and CD4+ T-cells counts significantly declined (P Conclusions: In comparison to standard enteral nutrition, perioperative enteral immunonutrition with glutamine (Gln), ω-3 fatty acids, nucleotide and arginine (Arg) improved the immune status of the patients, reduced the occurrence of postoperative infectious complications and decreased the duration of SIRS. CD4+ T-cells immunity possibly played a vital role in the inflammatory response and the modulation of postoperative immunity after surgery with digestive system cancer.

Early Systemic Inflammatory Response Syndrome Duration Predicts Infected Pancreatic Necrosis

Background and PurposeSystemic inflammatory response syndrome (SIRS) was considered to play an important role in the progress of acute pancreatitis, but its specific relation with infected pancreatic necrosis remains largely unclear. We aimed to investigate the correlation between SIRS duration and infected pancreatic necrosis, and its application in prediction of infected pancreatic necrosis. MethodsA prospective observational cohort study of 2130 patients with acute pancreatitis from 2012 to 2017. The SIRS duration at the first week was registered daily, and demographic, radiology, and all clinical laboratory data were prospectively collected and retrospectively reviewed. ResultsA significant upward tendency of infected pancreatic necrosis incidence was observed with increased SIRS duration. In multivariate logistic regression, SIRS duration (odds ratio, 1.305; 95% CI, 1.161–1.468) was independently associated with infected pancreatic necrosis. ROC analysis demonstrated that the areas under curves of SIRS duration for predicting persistent multi-organ failure, pancreatic infection, and mortality were 0.97 (95% CI, 0.96–0.98), 0.92 (95% CI, 0.91–0.94), and 0.86 (95% CI, 0.83–0.90), respectively, which were comparable to, or even greater than, the area under curves of APACHE II and CT severity index scores. ConclusionsEarly SIRS duration was strongly associated with infected pancreatic necrosis and could serve as an easy bedside indicator to predict pancreatic infection.

The prognostic value of microalbuminuria in puppies with canine parvoviral enteritis

Abstract Increased urine albumin concentration (UALB) or urine albumin-to-creatinine ratio (UACR) at admission has been associated with systemic disease and increased morbidity and mortality in critically ill canine patients. The objective of this study was to assess the prognostic value of UALB and UACR for the survival, as well as for the development and duration of systemic inflammatory response syndrome (SIRS) in puppies with canine parvoviral enteritis (CPVE). Unvaccinated puppies, aged 1-12 months with confirmed CPVE, hospitalized for ≥5 days were included. Urine was collected at admission via cystocentesis; albumin was measured immunoturbidimetrically and creatinine spectrophotometrically. The presence of SIRS was daily evaluated. Statistical analysis was conducted using R language. Twenty-six dogs were enrolled; 12/26 (46%) developed SIRS during hospitalization, while 5/26 (19%) died. A significant correlation was found between UALB and UACR (ϱ=0.868, p&lt;0.001). The dogs with SIRS had higher median UALB [0.5 (0-12.7) mg/dL] and UACR [4.2 (0-2,093) mg/g] compared to dogs without SIRS [UALB= 0.1 (0-0.8) mg/dL, UACR= 1.6 (0-5.6) mg/g], but the differences were non-significant (p&gt;0.05). SIRS duration was significantly correlated with UACR (ϱ=0.427, p=0.030), but not with UALB (ϱ=0.386, p=0.052). The non-survivors had higher median UALB [0.6 (0.1-12.7) mg/dL] and UACR [19.6 (0.7-2,093) mg/g] compared to survivors [UALB= 0.2 (0-1.5) mg/dL, UACR= 2.3 (0-16.9) mg/g], but the differences were non-significant (p&gt;0.05). UACR appears to be a prognostic indicator of SIRS duration in puppies with CPVE. However, a large-scale study is warranted to confirm the usefulness of UALB and UACR for clinical risk assessment in puppies with CPVE.

Predictive value of immature granulocytes for persistent systemic inflammatory response syndrome in patients with acute pancreatitis: analysis of 1 973 cases

To analyze the clinical value of immature granulocytes in peripheral blood for prediction of persistent systemic inflammatory response syndrome (SIRS) in patients with acute pancreatitis (AP). 1 973 patients with AP in Hunan People's Hospital from 2012 to 2017 were retrospectively enrolled and divided by SIRS duration into the persistent SIRS group, temporary SIRS group and non-SIRS group. The independent risk factor for persistent SIRS in AP patients was evaluated by Logistic regression analysis, and predictive value of immature granulocytes for persistent SIRS in AP patients was analyzed by the receiver operating characteristic (ROC) curve. These 1 973 AP patients (1 165 males, 59.0%) with an average age of 49 (40, 60) years old, including 288 persistent SIRS, 189 temporary SIRS and 1 496 non-SIRS cases. There was no significant difference in gender, age and etiology among three groups. Compared with non-SIRS group, more severe symptoms were observed in the temporary and persistent SIRS groups. Moreover, The acute physiology and chronic health evaluation II (APACHE II), CT severity index (CTSI), multiple organ failure (MOF) and acute respiratory distress syndrome (ARDS) incidence, mortality and C-reactive protein (CRP), white blood cell count (WBC), procalcitonin (PCT) and immature granulocytes in persistent SIRS group were further higher than those in the temporary SIRS group [APACHE II: 9 (6, 12) vs. 5 (3, 7), CTSI: 6 (4, 6) vs. 4 (3, 6), MOF incidence: 92.0% vs. 32.8%, ARDS incidence: 39.9% vs. 10.1%, morbidity: 11.1% vs. 4.2%, CRP (mg/L): 25.00 (0.80, 212.25) vs. 0.80 (0.80, 123.50), WBC (×109/L): 15.17±6.78 vs. 14.84±5.86, PCT (g/L): 0.23 (0.10, 1.76) vs. 0.10 (0.10, 0.31), immature granulocytes: 1.95 (0.90, 4.95) % vs. 0.80 (0.40, 2.10) %, all P < 0.05]. Logistic regression analysis showed that besides pancreatic necrosis, WBC and CRP, immature granulocyte was an independent risk factor for persistent SIRS associated with AP [odds ratio (OR) = 1.844, 95% confidence interval (95%CI) = 1.372-2.220]. ROC curve showed that immature granulocytes had better predictive value for persistent SIRS, the area under the curve (AUC) was 0.806, which was significantly higher than the APACHE II (AUC = 0.783), CTSI (AUC = 0.752), PCT (AUC = 0.676), CRP (AUC = 0.677), WBC (AUC = 0.644). The cut-off value of immature granulocyte was 0.65%, the sensitivity was 84.0%, the specificity was 66.3%, the positive predictive value was 62.4%, and the negative predictive value was 76.3%. Immature granulocyte in peripheral blood is a potential indicator for persistent SIRS in AP patients.

Minimally invasive esophagectomy in the prone position improves postoperative outcomes: role of C-reactive protein as an indicator of surgical invasiveness.

The aim of the study was to assess serum C-reactive protein (CRP) level immediately after minimally invasive esophagectomy (MIE) as a surrogate of surgical invasiveness in patients who underwent esophagectomy. In total, 104 patients were enrolled in the study: 37 patients underwent MIE in the left lateral decubitus position (MIE-LP) and 67 patients underwent MIE in the prone position (MIE-PP). Serum CRP levels were assessed on POD 1, 3, 5, and 7 after MIE, and were compared with surgical outcomes and duration of systemic inflammatory response syndrome (SIRS) to investigate less invasiveness of the MIE. Reduced serum CRP level on POD 1 was associated with PP during MIE (P<0.001) and decreased blood loss (P=0.03). MIE-PP was identified as a significant independent predictor of reduced CRP level on POD 1 (odds ratio 3.65, P=0.042). CRP level on POD 7 was associated with gender (P=0.02), position of MIE (P=0.011), blood loss (P=0.02), and respiratory complications and/or anastomotic leakage (P<0.001). Postoperative respiratory and/or anastomotic complication was identified as a significant predictor of elevated serum CRP level on POD 7 (odds ratio 3.44, P=0.048). Shorter duration of SIRS was shown in the patients with reduced serum CRP level on POD 1 and 7 (P=0.03 and P<0.001, respectively). Serial assessments of serum CRP level immediately after MIE may be a possible indicator that can reflect surgical invasiveness and postoperative complications.

Evaluation of Pharmacotherapy on Emergency and Intensive Care Medicine: The Influence of Intensity and Duration of Invasion

Critically ill patients who receive high-level invasion show physiological changes different from those under more normal conditions, along with variable therapeutic effects and pharmacokinetics. The concept of systemic inflammatory response syndrome (SIRS) has been introduced to describe the clinical state resulting from invasive actions taken under acute circumstances, resulting in an acute-phase systemic response. In particular, dosages of vancomycin (VCM) and phenytoin (PHT) need to be adjusted by therapeutic drug monitoring (TDM) because of their narrow therapeutic concentration windows. However, there are few reports on the pharmacokinetics of VCM and PHT in patients with SIRS. We performed a retrospective cohort study of patients treated with VCM and PHT. These studies suggest that the pharmacokinetics of VCM are affected by SIRS score and duration. Furthermore, the concentration of PHT was also shown to be higher in SIRS patients compared with non-SIRS patients. These findings suggest that the pharmacokinetics of VCM and PHT may be affected by the pathology of SIRS, rather than by other patient characteristics. Modifying dosing according to SIRS will improve the prediction accuracy of drug concentration based on TDM. In this review, I introduce work conducted by pharmacists in the clinical study of critically ill patients, and will be discussing the evaluation of pharmacotherapy in emergency and intensive care medicine.

ВПЛИВ ОЖИРІННЯ НА ПЕРЕБІГ ТА ПРОГНОЗ ГОСТРОГО ПАНКРЕАТИТУ

Вступ. Ожиріння є фактором ризику виникнення гострого панкреатиту (ГП). Сьогодні аналіз несприятливого впливу ожиріння на тяжкість перебігу та прогноз ГП не застосовують на практиці для прогнозування та оптимізації лікувальної тактики.&#x0D; Мета дослідження: проаналізувати вплив індивідуальних параметрів ожиріння на тяжкість перебігу ГП.&#x0D; Матеріали і методи. Проведений проспективний аналіз результатів лікування 30 хворих з приводу ГП. Досліджене співвідношення індивідуальних параметрів ожиріння за даними комп’ютерної томографії (КТ) та тяжкості перебігу ГП, його локальних та системних ускладнень.&#x0D; Результати. Найбільш значуща кореляція встановлена між площею вісцерального жиру і електронним індексом маси тіла (еІМТ) та тяжкістю синдрому поліорганної недостатності (СПОН), тривалістю SIRS (systemic inflammatory response syndrome), тяжкістю локальних ускладнень за шкалою Balthazar. На основі результатів кореляційного аналізу відзначено, що найбільше на тривалість лікування хворих у стаціонарі впливали тривалість SIRS, тяжкість СПОН, КТ індекс тяжкості за Balthazar. На основі мультиваріантного аналізу, єдиним параметром, що впливає на тривалість лікування хворого у стаціонарі, є тривалість SIRS, решта параметрів, в тому числі індивідуальні параметри ожиріння, на цей показник не впливали. У хворих при ожирінні достовірно частіше виявляли інфікування скупчень рідини в поєднанні з інфікуванням вогнищ некрозу порівняно з такими у хворих за збільшеної та нормальної маси тіла, проте, у них частіше спостерігали формування псевдокіст підшлункової залози (р &lt; 0,05). При дослідженні інфікування скупчень рідини і вогнищ некрозу достовірно частіше інфікування спостерігали у хворих при ожирінні. У пацієнтів при ожирінні спостерігали більш раннє інфікування скупчень рідини і вогнищ некрозу (p = 0,006).&#x0D; Висновки. Ожиріння є фактором, що впливає на тяжкість перебігу ГП, частоту локальних і системних ускладнень.&#x0D; Ключові слова: гострий панкреатит; ожиріння; ускладнення; синдром системної запальної відповіді; поліорганна недостатність.

Duration of Systemic Inflammatory Response Syndrome Influences Serum Vancomycin Concentration in Patients With Sepsis

PurposeVancomycin (VCM) is used in the treatment of methicillin-resistant Staphylococcus aureus infection. The dosage of VCM must be adjusted by using therapeutic drug monitoring because of the drug’s narrow therapeutic concentration window. Although optimal administration based on population pharmacokinetic (PPK) analysis and/or a Bayesian method has improved prediction accuracy, serum concentrations of VCM in patients with sepsis often deviate significantly from predicted values. We investigated factors influencing prediction errors with PPK analysis in VCM dosing. MethodsThis retrospective cohort study included patients treated with VCM. Their clinical data were recorded, and there were 27 nonseptic patients and 68 septic patients. VCM concentrations were predicted by using PPK analysis and data compared with observed concentrations. FindingsPatients with sepsis had a higher mean absolute error than nonseptic patients, indicating a deviation of VCM concentrations from predicted values in the septic patients. To determine factors influencing prediction errors, we classified patients with sepsis into 3 subgroups according to the mean absolute error value (2.17) for the nonseptic patients: “lower” group (prediction errors, below –2.17), “upper” group (>2.17), and “no change” group (–2.17 to 2.17). In a comparison of clinical characteristics of the 3 groups, significant differences were found in the duration of systemic inflammatory response syndrome (SIRS), SIRS score, disseminated intravascular coagulation score, and levels of creatinine clearance (CrCl), hemoglobin, and diastolic blood pressure. Multiple logistic regression analysis identified SIRS duration and CrCl as factors associated with VCM concentrations in the lower and/or upper groups of septic patients. Shorter and longer SIRS duration were associated with VCM concentrations in the lower group and the upper group, respectively, compared with predicted values in patients with sepsis. According to receiver-operating characteristic curve analysis, the optimal cutoff value of SIRS duration for the lower group was 2 days; for the upper group, it was 6 days. VCM clearance in patients with an SIRS duration <2 days was higher than that for patients with an SIRS duration ≥6 days. ImplicationsSIRS duration was identified as influencing VCM concentration in patients with sepsis. This study has 2 limitations. First, we performed blood sampling only for trough concentrations. Repeated blood sampling for both peak and trough concentrations should be performed for more accurate pharmacokinetic evaluation in critically ill patients. Second, we determined CrCl by using the Cockcroft-Gault formula, which may not be accurate in critically ill patients. Modifying VCM dosing according to SIRS duration will improve prediction accuracy of VCM concentration based on therapeutic drug monitoring.

Perioperative ω-3 Polyunsaturated Fatty Acid Nutritional Support in Gastrointestinal Cancer Surgical Patients: A Systematic Evaluation

ABSTRACTThis study was a systematic evaluation of the beneficial effects of n-3 polyunsaturated fatty acid (PUFA) in abdominal cancer surgical patients. A literature search of the databases PubMed, Medline, Cochrane, and EMBASE was conducted for studies published up to November 2014 in English language journals. Randomized controlled trials (RCTs) examining the effects of n-3 PUFA intake relative to conventional nutrition in surgical patients were included. The main outcomes were the duration of systemic inflammatory response syndrome (SIRS), length of hospital stay (LOS), serum C-reactive protein (CRP) levels, and postoperative complications. We identified 15 RCTs among 158 relevant trials. The results indicated the associations between n-3 PUFA intake and reduced LOS [mean differences (MDs), −2.47 d; 95% confidence intervals (CIs), −3.25 to −1.69], duration of SIRS (MD, −0.57 d; 95% CI, −0.92 to −0.22), and serum CRP levels (MD, −3.97 mg/l; 95% CI, −7.88 to −0.07) compared with consumption of conventional nutrition, as well as reduced incidence of postoperative infectious complications (risk ratio, 0.66; 95% CI, 0.49–0.87). This systematic evaluation suggests that n-3 PUFA significantly reduces the postoperative infectious complication rate, and shortens hospitalization and SIRS duration, particularly in malnourished gastrointestinal cancer patients.

Randomized Phase II Study of the Anti-inflammatory Effect of Ghrelin During the Postoperative Period of Esophagectomy

A prospective randomized phase II trial was conducted to evaluate the efficacy of ghrelin administration in reducing systemic inflammatory response syndrome (SIRS) duration after esophagectomy. Esophagectomy for esophageal cancer is highly invasive and leads to prolonged SIRS duration and postoperative complications. Ghrelin has multiple effects, including anti-inflammatory effects. Forty patients undergoing esophagectomy were randomly assigned to either the ghrelin group (n = 20), which received continuous infusion of ghrelin (0.5 μg/kg/h) for 5 days, or the placebo group (n = 20), which received pure saline for 5 days. The primary endpoint was SIRS duration. The secondary endpoints were the incidence of postoperative complications, time of a negative nitrogen balance, changes in body weight and composition, and levels of inflammatory markers, including C-reactive protein (CRP) and interleukin-6 (IL-6). The ghrelin group had a shorter SIRS duration and lower CRP and IL-6 levels than did the placebo group. The incidence of pulmonary complications was lower in the ghrelin group than in the placebo group, whereas other complications did not differ between the groups. Although time of the negative nitrogen balance was shorter in the ghrelin group than in the placebo group, changes in total body weight and lean body weight did not differ significantly. Postoperative ghrelin administration was effective for inhibiting inflammatory mediators and improving the postoperative clinical course of patients with esophageal cancer.

The duration of SIRS before organ failure is a significant prognostic factor of sepsis

BackgroundThe mortality rate of patients complicated with sepsis-associated organ failure remains high in spite of intensive care treatment. The purpose of this study was to define the duration of systemic inflammatory response syndrome (SIRS) before organ failure (DSOF) and determine the value of DSOF as a prognostic factor in septic patients.MethodsThis retrospective cohort study was conducted in an 11-bed medical and surgical intensive care unit (ICU) in a university hospital. The primary endpoint was in-hospital mortality of the septic patients.ResultsOne hundred ten septic patients with organ failure and/or shock were enrolled in this study. The in-hospital mortality rate was 36.9%. The median DSOF was 28.5 h. As a metric variable, DSOF was a statistically significant prognostic factor according to univariate analysis (survivor: 74.7 ± 9.6 h, non-survivor: 58.8 ± 16.5 h, p = 0.015). On the basis of the ROC curve, we defined an optimal cutoff of 24 h, with which we divided the patients as follows: group 1 (n = 50) comprised patients with a DSOF ≤24 h, and group 2 (n = 60) contained patients with a DSOF >24 h. There were statistically significant differences in the in-hospital mortality rate between the two groups (52.0% vs. 25.0%, p = 0.004). Furthermore, by multivariate analysis, DSOF ≤24 h (odds ratio: 5.89, 95% confidence interval: 1.46-23.8, p = 0.013) was a significant independent prognostic factor.ConclusionDSOF may be a useful prognostic factor for severe sepsis.

Reduced plasma ghrelin levels on day 1 after esophagectomy: a new predictor of prolonged systemic inflammatory response syndrome

Ghrelin, a stomach-derived hormone, stimulates growth hormone secretion and appetite, and inhibits excessive inflammatory response. Plasma ghrelin might affect the inflammatory response to stressful surgical interventions. The aim of this study was to investigate the relationship between serial changes in plasma ghrelin concentrations and the postoperative clinical course after esophagectomy. The prospective cohort study subjects were 20 patients with esophageal cancer, who underwent esophagectomy with gastric tube reconstruction. Blood samples were taken six times perioperatively during the course of esophagectomy. The plasma ghrelin level decreased to 33 % (range 15-90 %) on postoperative day (POD) 1, relative to the preoperative level, then recovered to about 50 % by POD 3-10. The duration of systemic inflammatory response syndrome (SIRS) was significantly longer in patients with a marked ghrelin reduction to <33 % on POD 1, than in those with less marked reduction of ≥ 33 % (6.1 ± 1.3 vs. 2.1 ± 0.6 days, P = 0.019). On POD 1, the only inflammatory marker that correlated with the duration of SIRS was the % ghrelin, whereas C-reactive protein, leukocyte count, and IL-6 did not. An early postoperative drop in plasma ghrelin correlated with prolonged SIRS after esophagectomy. Thus, the supplementation of low plasma ghrelin may help minimize excess inflammatory response in these patients.

Impact of perioperative administration of synbiotics in patients with esophageal cancer undergoing esophagectomy: A prospective randomized controlled trial

The clinical value of synbiotics in patients undergoing esophagectomy remains unclear. This study investigated the effects of synbiotics on intestinal microflora and surgical outcomes in a clinical setting. We studied 70 patients with esophageal cancer who were scheduled to undergo esophagectomy. They were randomly allocated to 2 groups: 1 group received synbiotics before and after surgery, and the other did not. Fecal microflora and organic acid concentrations were determined. Postoperative infections, abdominal symptoms, and duration of systemic inflammatory response syndrome (SIRS) were recorded. Of the patients, 64 completed the trial (synbiotics, 30; control, 34). The counts of beneficial bacteria and harmful bacteria in the group given synbiotics were significantly larger and smaller, respectively, than those in the control group on postoperative day (POD) 7. The concentrations of total organic acid and acetic acid were higher in the synbiotics group than in the control group (P < .01), and the intestinal pH in the synbiotics group was lower than that in the control (P < .05) on POD 7. The rate of infections was 10% in the synbiotics group and 29.4% in the control group (P = .0676). The duration of SIRS in the synbiotics group was shorter than in the control group (P = .0057). The incidence of interruption or reduction of enteral nutrition by abdominal symptoms was 6.7% in the synbiotics group and 29.4% in the control group (P = .0259). Perioperative administration of synbiotics in patients with esophagectomy is useful because they suppress excessive inflammatory response and relieve uncomfortable abdominal symptoms through the adjustment of the intestinal microfloral environment.

Video-assisted thoracoscopic surgery for esophageal cancer attenuates postoperative systemic responses and pulmonary complications

Less invasive operations such as laparoscopic surgery have been developed for treating gastrointestinal malignancies. However, the advantages of video-assisted thoracoscopic surgery for esophageal cancer (VATS-e) with regard to postoperative morbidity and mortality remains controversial. We investigated the postoperative clinical course of patients who underwent esophagectomy for esophageal cancer in terms of systemic inflammatory response syndrome (SIRS) induced by VATS-e (VATS-e group) or conventional open surgery (OS group) combined with laparoscopic gastric tube reconstruction. Compared with the OS group (n = 27), the VATS-e group (n = 22) had a greater thoracic operation time (VATS-e versus OS, 181 ± 56 vs 143 ± 45 minutes, respectively), and lesser duration ofstay in the intensive care unit (17 ± 2 vs 32 ± 21 hours, respectively). The VATS-e group also had alesser SIRS duration (1.5 vs 4.3 days), a lesser incidence of SIRS, a lesser number of positive SIRS criteria, and lesser serum interleukin-6 levels immediately after operation and on postoperative day (POD) 1. The heart rate in the VATS-e group was less than that in the OS group on POD 3. The respiratory rate in the VATS-e group was significantly less than that in the OS group on PODs 3, 5, and 7. Although no difference was observed in the frequencies of postoperative complications between the 2groups, the VATS-e group had less postoperative pneumonia. VATS-e attenuates postoperative SIRS, and is therefore a potentially less invasive operative procedure.

The Postoperative Serum Interleukin-15 Concentration Correlates with Organ Dysfunction and the Prognosis of Septic Patients Following Emergency Gastrointestinal Surgery

To clarify the time course of changes in the serum interleukin-15 (IL-15) concentrations in septic patients undergoing emergency surgery for abdominal infection and to investigate whether the serum IL-15 levels correlate with the postoperative clinical course of septic patients. Twenty-four septic patients who had intra-abdominal infection and who underwent an emergency operation were enrolled in this study. The serum IL-15 levels were measured before surgery, and on postoperative d 1 (POD1), POD3, and POD5, and the relationship between the serum IL-15 levels and the postoperative clinical course estimated by the Systemic Inflammatory Response Syndrome (SIRS) criteria, Acute Physiology and Chronic Health Evaluation (APACHE-II) score, the parameters of organ function, and the 30-d mortality were evaluated. The time course of changes of the serum IL-15 levels were significantly different between survivors and non-survivors (P < 0.05, by repeated measures analysis of variance [ANOVA]). There was a statistically significant relationship between the serum IL-15 levels on POD1 or POD3 and the duration of SIRS (R = 0.50, P < 0.05, R = 0.65, P < 0.01, respectively). Furthermore, a significant positive correlation was observed between the serum IL-15 levels on POD1 and the creatinine levels on POD1 or POD3 (R = 0.48, P < 0.05, R = 0.50, P < 0.05, respectively), and a significant negative correlation between the serum IL-15 levels on POD1 or POD 3 and the PaO(2)/FiO(2) on POD3 (R = -0.51, P < 0.05, R = -0.69, P < 0.01, respectively). The measurement of postoperative serum level of IL-15 might be useful for predicting the severity of SIRS and organ dysfunction, especially renal and pulmonary dysfunction.