The role of resistin and myeloperoxidase in severe sepsis and septic shock: Results from the ALBIOS trial.

BACKGROUND: Inflammatory biomarkers are useful in detecting patients with sepsis. The prognostic role of resistin and myeloperoxidase (MPO) has been investigated in sepsis. MATERIALS AND METHODS: Plasma resistin and MPO were measured on days 1, 2 and 7 in 957 patients enrolled in the Albumin Italian Outcome Sepsis (ALBIOS) trial. The association between resistin and MPO levels on day 1, 2 and 7 and 90-day mortality was assessed. RESULTS: Plasma resistin and MPO concentrations were higher at day 1 and decreased until day 7. Both biomarkers were positively correlated with each other and with physiological parameters. Higher levels of resistin and MPO on day 1 were associated with the development of new organ failures. Patients experiencing death at 90 days showed higher levels of resistin and MPO compared with survivors. At day 1, only MPO in the 4th quartile (Q4), but not resistin, was found to predict 90-day death (adjusted hazard ratio [aHR] 1.55 vs Q1). At day 2, resistin in the Q3 and Q4 predicted a > 40% increase in mortality as also did MPO in the Q4. On day 7, Q4 resistin was able to predict 90-day mortality, while all quartiles of MPO were not. CONCLUSIONS: High levels of MPO, but not of resistin, on day 1 were able to predict 90-day mortality. These findings may either suggest that early hyper-activation of neutrophils is detrimental in patients with sepsis or reflect the burden of the inflammatory process caused by sepsis. Further studies are warranted to deepen these aspects (ALBIOS ClinicalTrials.gov Identifier: NCT00707122).

Impact of SARS-CoV-2 Omicron and Delta variants in patients requiring intensive care unit (ICU) admission for COVID-19, Northern Italy, December 2021 to January 2022.

This multicenter observational study included 171 COVID-19 adult patients hospitalized in the ICUs of nine hospitals in Lombardy (Northern Italy) from December, 1st 2021, to February, 9th 2022. During the study period, the Delta/Omicron variant ratio of cases decreased with a delay of two weeks in ICU patients compared to that in the community; a higher proportion of COVID-19 unvaccinated patients was infected by Delta than by Omicron whereas a higher rate of COVID-19 boosted patients was Omicron-infected. A higher number of comorbidities and a higher comorbidity score in ICU critically COVID-19 inpatients was positively associated with the Omicron infection as well in vaccinated individuals. Although people infected by Omicron have a lower risk of severe disease than those infected by Delta variant, the outcome, including the risk of ICU admission and the need for mechanical ventilation due to infection by Omicron versus Delta, remains uncertain. The continuous monitoring of the circulating SARS-CoV-2 variants remains a milestone to counteract this pandemic.

Acute pulmonary embolism in COVID-19 patient: a case report of free-floating right heart thrombus successfully treated with fibrinolysis.

BACKGROUND: Despite the fast-growing understanding of the coronavirus disease 2019 (COVID-19), patient management remains largely empirical or based on retrospective studies. In this complex scenario, an important clinical issue appears to be represented by the high prevalence of thromboembolic events, but the data regarding high-risk pulmonary embolism (PE) is still not available. CASE SUMMARY: A patient with COVID-19 developed sudden shortness of breath and hypoxia. Early echocardiographic diagnosis of high-risk PE related to right heart thrombus was performed. Systemic thrombolysis was administered with excellent clinical and haemodynamic response. DISCUSSION: Pulmonary thromboembolism is a common occurrence in severe COVID-19 infection. In our experience, systemic thrombolysis proved to be effective and for this reason may be considered for life-threatening PE in COVID-19 patients.

Higher levels of IgA and IgG at sepsis onset are associated with higher mortality: results from the Albumin Italian Outcome Sepsis (ALBIOS) trial.

BACKGROUND: The role of intravenous immunoglobulins (IVIG) during sepsis is controversial, as different trials on IVIG have observed inconsistent survival benefits. We aimed to elucidate the possible association and clinical significance between circulating levels of immunoglobulins. METHODS: In a subset of 956 patients with severe sepsis and septic shock of the multicentre, open-label RCT ALBIOS, venous blood samples were serially collected 1, 2, and 7 days after enrolment (or at ICU discharge, whichever came first). IgA, IgG and IgM concentrations were assayed in all patients on day 1 and in a subgroup of 150 patients on days 2 and 7. Ig concentrations were measured employing a turbidimetric assay, OSR61171 system. RESULTS: IgA on day 1 had a significant predictive value for both 28-day and 90-day mortality (28-day mortality, HR: 1.50 (95% CI 1.18-1.92); 90-day mortality, HR: 1.54 (95% CI 1.25-1.91)). IgG, but not IgM, on day 1 showed similar results for 28-day (HR 1.83 (95% CI 1.33-2.51) and 90-day mortality HR: 1.66 (95% CI 1.23-2.25)). In addition, lower levels of IgG but not of IgA and IgM, at day 1 were associated with significantly higher risk of secondary infections (533 [406-772] vs 600 [452-842] mg/dL, median [Q1-Q3], p = 0.007). CONCLUSIONS: In the largest cohort study of patients with severe sepsis or septic shock, we found that high levels of IgA and IgG on the first day of diagnosis were associated with a decreased 90-day survival. No association was found between IgM levels and survival. As such, the assessment of endogenous immunoglobulins could be a useful tool to identify septic patients at high risk of mortality. Trial registration #NCT00707122, Clinicaltrial.gov, registered 30 June 2008.

[Primary percutaneous coronary intervention and therapeutic hypothermia in comatose survivors after out-of-hospital cardiac arrest complicating acute myocardial infarction: a single-center experience]. / Angioplastica primaria ed ipotermia terapeutica in pazienti comatosi con infarto miocardico acuto sopravvissuti ad arresto cardiaco extraospedaliero: esperienza di un singolo centro.

BACKGROUND: Therapeutic hypothermia (TH) is associated with improved neurologic outcomes in comatose survivors of out-of-hospital cardiac arrest (OHCA). There are currently limited data on the outcomes of patients presenting with resuscitated OHCA in the setting of acute myocardial infarction. The aim of this study was to assess the outcomes of comatose survivors of OHCA complicating acute myocardial infarction treated with primary percutaneous coronary intervention (PCI) and TH. METHODS: A retrospective cohort analysis was performed on all consecutive patients referred for primary PCI and TH between August 2008 and December 2013 in a single center. The primary endpoint was survival to hospital discharge with sufficient neurologic recovery (defined as Cerebral Performance Category score <2). RESULTS: Among 886 consecutive patients referred for primary PCI, 24 were comatose survivors of OHCA complicating acute myocardial infarction. All these patients underwent primary PCI followed by TH. Median patient age was 59 (IQR 35-87) years and 11 (45.8%) patients had anterior ST-elevation myocardial infarction. Median OHCA-to-balloon time was 120 min (IQR 75-340) while median OHCA-to-TH initiation time was 250 min (IQR 180-310). Survival with sufficient neurologic recovery to enable discharge home was reached in 16 (66.7%) patients. Time between initiation of cardiopulmonary resuscitation (CPR) to return of spontaneous circulation (ROSC) <20 min was associated with a lower occurrence of death and poor neurologic outcome compared to CPR-to-ROSC time ≥20 min (15.4 vs 54.5%, p=0.05). The occurrence of major bleeding was 8.3%, while no stent thrombosis was reported. CONCLUSIONS: TH in conjunction with primary PCI is feasible and associated with acceptable outcome in the majority of comatose survivors of OHCA complicating acute myocardial infarction, especially if CPR-to-ROSC time was <20 min. Randomized studies are needed to better assess the superiority of TH and primary PCI vs primary PCI alone in this complex subset of OHCA patients.