Nutritional responsiveness affects novel neutrophil parameters and reduces in-hospital mortality and costs in elective cancer oesophagectomy - a single centre, prospective, observational study.

INTRODUCTION: Malnutrition in surgical patients remains a common issue affecting the perioperative period. Oesophageal cancer is a disease associated with one of the highest malnutrition rates. Assessment of patient nutritional status remains a challenge due to limited validated tools. Novel parameters to identify malnourished patients and the effectiveness of preoperative nutritional intervention might improve treatment results in the perioperative period. MATERIAL AND METHODS: This was a prospective, observational, single-centre study of patients scheduled for elective oesophagectomy. The primary aim of this study was to establish the correlation between neutrophil reactivity intensity (NEUT-RI) and neutrophil granularity intensity (NEUT-GI) and patients' nutritional status. We divided patients into nutritional responders (R group) and nutritional non-responders (NR group) defined as regaining at least 25% of the maximum preoperative body weight loss during the preoperative period. RESULTS: The R group had significantly shorter intensive care unit (ICU) stays: 5.5 (4-8) vs. 13 (7-31) days ( P = 0.01). It resulted in a lower cost of ICU stays in the R group: 4775.2 (3938.9-7640.7) vs. 12255.8 (7787.6-49108.7) euro in the NR group ( P = 0.01). Between the R group and the NR group, we observed statistically significant differences in both preoperative NEUT-RI (48.6 vs. 53.4, P = 0.03) and NEUT-GI (154.6 vs. 159.3, P = 0.02). Apart from the T grade, the only preoperative factor associated with reduced mortality was the nutritional responsiveness: 11.1% vs. 71.4% ( P = 0.008). CONCLUSIONS: Preoperative nutritional responsiveness affects neutrophil intensity indexes and reduces in-hospital mortality and costs associated with hospital stay. Further research is required to determine the correlation between novel neutrophil parameters and patients' nutritional status.

Pharmacokinetics of ciprofloxacin during continuous renal replacement therapy in intensive care patients - new assessment.

INTRODUCTION: The first studies on the pharmacokinetics of ciprofloxacin during continuous renal replacement therapy were conducted using filters with a relatively small surface area and with lower intensity of the procedure than nowadays. The aim of this study was to assess the pharmacokinetics and the probability of achieving pharmacokinetic/pharmacodynamic (PK/PD) target for ciprofloxacin during renal replacement therapy using a filter with large surface area and higher intensity. MATERIAL AND METHODS: Eighteen patients were considered eligible for treatment with ciprofloxacin (400 mg every eight hours intravenously) during continuous renal replacement therapy. Blood samples were collected from the arterial line of the renal replacement circuit before (time 0) and after 30, 60, 75, 90, 120, 180, 240, and 480 minutes following the initiation of ciprofloxacin infusion. Ciprofloxacin concentrations in the collected samples were determined using fully validated liquid chromatography. The pharmacokinetic analysis was performed using non-compartmental analysis. The measure adopted to assess the efficacy of the antibiotic therapy was the proportion of patients for whom pre-defined PK/PD indices were achieved. RESULTS: There was a considerable inter-individual variability observed in pharmacokinetic parameters for ciprofloxacin. 100% of patients achieved PK/PD target AUC0-24/MIC > 40, AUC0-24/MIC > 125, AUC0-24/MIC > 250 for MIC 1, 0.25, and 0.125 µg mL-1, respectively. CONCLUSIONS: High doses of ciprofloxacin (400 mg every eight hours intravenously) during continuous renal replacement therapy should be used to maximally increase the proportion of patients in whom clinical efficacy, expressed as achieving the PK/PD target, is reached.