Predictors of outcomes of patients ≥ 80 years old admitted to intensive care units in Poland - a post-hoc analysis of the VIP2 prospective observational study.

INTRODUCTION: Elderly patients pose a significant challenge to intensive care unit (ICU) clinicians. In this study we attempted to characterise the population of patients over 80 years old admitted to ICUs in Poland and identify associations between clinical features and short-term outcomes. MATERIAL AND METHODS: The study is a post-hoc analysis of the Polish cohort of the VIP2 European prospective observational study enrolling patients > 80 years old admitted to ICUs over a 6-month period. Data including clinical features, clinical frailty scale (CFS), geriatric scales, interventions within the ICU, and outcomes (30-day and ICU mortality and length of stay) were gathered. Univariate analyses comparing frail (CFS > 4) to non-frail patients and survivors to non-survivors were performed. Multivariable models with CFS, activities of daily living score (ADL), and the cognitive decline questionnaire IQCODE as predictors and ICU or 30-day mortality as outcomes were formed. RESULTS: A total of 371 patients from 27 ICUs were enrolled. Frail patients had significantly higher ICU (58% vs. 44.45%, P = 0.03) and 30-day (65.61% vs. 54.14%, P = 0.01) mortality compared to non-frail counterparts. The survivors had significantly lower SOFA score, CFS, ADL, and IQCODE than non-survivors. In multivariable analysis CFS (OR 1.15, 95% CI: 1.00-1.34) and SOFA score (OR 1.29, 95% CI: 1.19-1.41) were identified as significant predictors for ICU mortality; however, CFS was not a predictor for 30-day mortality ( P = 0.07). No statistical significance was found for ADL, IQCODE, polypharmacy, or comorbidities. CONCLUSIONS: We found a positive correlation between CFS and ICU mortality, which might point to the value of assessing the score for every patient admitted to the ICU. The older Polish ICU patients were characterised by higher mortality compared to the other European countries.

Humulus lupus extract rich in xanthohumol improves the clinical course in critically ill COVID-19 patients.

BACKGROUND: The systemic inflammatory response following severe COVID-19 is associated with poor outcomes. Several anti-inflammatory medications have been studied in COVID-19 patients. Xanthohumol (Xn), a natural extract from hop cones, possesses strong anti-inflammatory and antioxidative properties. The aim of this study was to analyze the effect of Xn on the inflammatory response and the clinical outcome of COVID-19 patients. METHODS: Adult patients treated for acute respiratory failure (PaO2/FiO2 less than 150) were studied. Patients were randomized into two groups: Xn - patients receiving adjuvant treatment with Xn at a daily dose of 4.5 mg/kg body weight for 7 days, and C - controls. Observations were performed at four time points: immediately after admission to the ICU and on the 3rd, 5th, and 7th days of treatment. The inflammatory response was assessed based on the plasma IL-6 concentration, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP) and D-dimer levels. The mortality rate was determined 28 days after admission to the ICU. RESULTS: Seventy-two patients were eligible for the study, and 50 were included in the final analysis. The mortality rate was significantly lower and the clinical course was shorter in the Xn group than in the control group (20% vs. 48%, p < 0.05, and 9 ± 3 days vs. 22 ± 8 days, p < 0.001). Treatment with Xn decreased the plasma IL-6 concentration (p < 0.01), D-dimer levels (p < 0.05) and NLR (p < 0.01) more significantly than standard treatment alone. CONCLUSION: Adjuvant therapy with Xn appears to be a promising anti-inflammatory treatment in COVID-19 patients.

Impact of the perioperative care model on mortality of patients treated in general surgery wards.

BACKGROUND: The risk of perioperative death in general surgery wards depends on many factors, including the underlying disease, type of surgical intervention and model of perioperative management. The aim of the study was to determine the reasons for major differences in mortality rates recorded in general surgery wards of the three university hospitals. METHODS: The retrospective study was carried out and involved the data of 32 231 surgical patients. In one of the hospitals, postoperative patients were treated in the recovery room supervised by anaesthetists; in the remaining two, perioperative care was delivered by surgical ward staff. A multiple regression model with random effects was used to adjust for differences in three death risk groups of patients according to underlying diseases: low, moderate and high. RESULTS: In the hospital with postoperative care administered by anaesthetic staff the mortality rate was 0.45 whereas in the two remaining ones with postoperative patients supervised by surgical staff - 1.86 and 2.52. In each group, increased mortality was observed among patients receiving therapy in general surgery wards after transfer from another hospital ward. CONCLUSION: The major factor determining the mortality rates in general surgery wards is the model of perioperative management.

Anaesthetic management of a patient with myasthenia gravis for abdominal surgery using sugammadex.

We report a case of a patient with tumor of the caecum with coexistent myasthenia gravis (a form according to Osserman II A), requiring general anesthesia for abdominal surgery. To reverse the neuromuscular block induced by vecuronium was used sugammadex.

Natriuretic peptides in cardiovascular diseases.

The natriuretic peptide family comprises atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), C-type natriuretic peptide (CNP), dendroaspis natriuretic peptide (DNP), and urodilatin. The activities of natriuretic peptides and endothelins are strictly associated with each other. ANP and BNP inhibit endothelin-1 (ET-1) production. ET-1 stimulates natriuretic peptide synthesis. All natriuretic peptides are synthesized from polypeptide precursors. Changes in natriuretic peptides and endothelin release were observed in many cardiovascular diseases: e.g. chronic heart failure, left ventricular dysfunction and coronary artery disease.

Serum matrix metalloproteinases MMP-2 and MMP-9 and metalloproteinase tissue inhibitors TIMP-1 and TIMP-2 in diabetic nephropathy.

BACKGROUND: The regulation of mesangial extracellular matrix (ECM) turnover engages a number of matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs). High glucose concentration affects ECM degradation and the activities of MMPs and TIMPs. ECM accumulation is involved in the pathogenesis of diabetic nephropathy. METHODS: Serum MMP-9, MMP-2, TIMP-2 and TIMP-1 were measured with ELISA in patients with either chronic renal failure (CRF, n=20), type 2 diabetes mellitus (DM2, n=16) or diabetic nephropathy (DM2+CRF, n=14), and healthy controls (n=20). RESULTS: Diabetic nephropathy was related with profound decrease of serum TIMP-2 (122.2 +/- 47.2 vs. 263.0 +/- 89.2 ng/mL), TIMP-1 (242.5 +/- 96.9 vs. 347.4 +/- 87.2 ng/mL) and MMP-2 (385.4 +/- 42.6 vs. 517.2 +/- 75.4 ng/mL) (p<0.001). Both TIMP-1 and TIMP-2 were reduced in diabetic nephropathy in comparison with either diabetes alone (p<0.01 and p<0.001; respectively) or CRF alone (p<0.001 for both). An approximately 2-fold increase of MMP-9/TIMP-1 and MMP-2/TIMP-2 ratio was found in diabetic nephropathy when compared with diabetes with normal renal function (p<0.01). Further, in DM2 patients, TIMP-2 was decreased when compared with CRF alone (219.2 +/- 71.8 vs. 296.8 +/- 58.4 ng/mL). MMP-2 was lowered in both groups of DM2 and CRF patients (413.8 +/- 59.0 ng/mL and 409.7 +/- 93.1 ng/mL, vs. normal control value of 517.2 +/- 75.4 ng/mL; p<0.001). CONCLUSIONS: These data indicate that circulating TIMP-1, TIMP-2 and MMP-2 are decreased in patients with diabetic nephropathy when compared with either CRF or diabetes.

L-arginine improves hemodynamic function and coronary flow in an experimental model of ischemia-reperfusion injury.

BACKGROUND: Ischemia and reperfusion injury decrease the release of nitric oxide by vessels endothelial cells, which influences postischaemic coronary flow and return of left ventricle haemodynamic function. The study was conducted to answer the question how addition of L-arginine in cardioplegic and reperfusion fluids influences nitric oxide release, inducing the coronary flow and postischaemic haemodynamic heart function. MATERIALS AND METHODS: The research was conducted on 56 rats, divided randomly into seven groups: control (C) and six experimental groups (E), where L-arginine was administrated in increasing doses of 0.3, 3.0 and 30.0 mM/L to cardioplegic (E1, E2 and E3 group) or reperfusion solution (E4, E5 and E6 group). To simulate a course of cardiac surgery the following stages of experiment were carried out: initial perfusion on the nonworking and working heart, cardioplegia, cold cardioplegic arrest and reperfusion of the non-working and working heart. RESULTS: Level of nitric oxide during cardioplegic perfusion decreased in all groups. During reperfusion on non-working and working heart model we noticed the significant increase of nitric oxide for all groups. Along with nitric oxide increase, coronary flow increases, whereas with the decrease of level of nitric oxide, the coronary flow also diminished. During cardioplegic perfusion coronary flow constantly decreased in all groups and during reperfusion we observed the new increase of coronary flow. In groups E1, E2 and E3 the increase of coronary flow was significant. CONCLUSIONS: Obtained data suggest that administration of L-arginine in the preischaemic and in the initial phase of reperfusion stimulates increase in nitric oxide release what is positively correlated with the increase of coronary flow.