Association of serum soluble Fas concentrations and mortality of septic patients.

INTRODUCTION: Scarce data on Fas, one of the main receptors that activates the apoptosis extrinsic pathway, in septic patients exists. Higher blood soluble Fas (sFas) concentrations in non-survivor septic patients compared with survivors have been found in small studies; however, the association of blood sFas concentrations with mortality controlling for sepsis severity has not been stablished due to this small sample size in those studies. Thus, our main objective study was to determine whether an association between blood sFas concentrations and sepsis mortality controlling for sepsis severity exists. METHODS: We included septic patients in this observational and prospective study carried out in three Spanish Intensive Care Units. We obtained serum samples at sepsis diagnosis sepsis for sFas levels determination. RESULTS: Thirty-day non-surviving patients (n=85) compared to surviving patients (n=151) had higher serum sFas levels (p<0.001). We found in multiple logistic regression analysis an association of serum sFas levels with mortality controlling for age and SOFA (OR=1.004; 95% CI=1.002-1.006; p<0.001), and for age and APACHE-II (OR=1.004; 95% CI=1.002-1.006; p<0.001). Serum sFas levels showed and area under the curve for mortality prediction of 71% (95% CI=65-71%; p<0.001). Kaplan-Meier analysis showed higher mortality rate in patients with serum sFas levels>83.5ng/mL (Hazard ratio=3.2; 95% CI=2.1-5.0; p<0.001). CONCLUSIONS: That an association between blood sFas concentrations and sepsis mortality controlling for sepsis severity exists was our main new finding study.

Association of serum soluble Fas concentrations and mortality of septic patients / Asociación de concentraciones séricas de soluble Fas y mortalidad de pacientes sépticos

Introduction: Scarce data on Fas, one of the main receptors that activates the apoptosis extrinsic pathway, in septic patients exists. Higher blood soluble Fas (sFas) concentrations in non-survivor septic patients compared with survivors have been found in small studies; however, the association of blood sFas concentrations with mortality controlling for sepsis severity has not been stablished due to this small sample size in those studies. Thus, our main objective study was to determine whether an association between blood sFas concentrations and sepsis mortality controlling for sepsis severity exists. Methods: We included septic patients in this observational and prospective study carried out in three Spanish Intensive Care Units. We obtained serum samples at sepsis diagnosis sepsis for sFas levels determination. Results: Thirty-day non-surviving patients (n=85) compared to surviving patients (n=151) had higher serum sFas levels (p<0.001). We found in multiple logistic regression analysis an association of serum sFas levels with mortality controlling for age and SOFA (OR=1.004; 95% CI=1.002–1.006; p<0.001), and for age and APACHE-II (OR=1.004; 95% CI=1.002–1.006; p<0.001). Serum sFas levels showed and area under the curve for mortality prediction of 71% (95% CI=65–71%; p<0.001). Kaplan–Meier analysis showed higher mortality rate in patients with serum sFas levels>83.5ng/mL (Hazard ratio=3.2; 95% CI=2.1–5.0; p<0.001). Conclusions: That an association between blood sFas concentrations and sepsis mortality controlling for sepsis severity exists was our main new finding study.(AU)

Introducción: Existen pocos datos sobre Fas, uno de los principales receptores que activan la vía extrínseca de la apoptosis, en pacientes septicos. En estudios de pequeño tamaño muestral se han encontrado altas concentraciones sanguíneas de soluble Fas (sFas) en pacientes sépticos fallecidos en comparación con supervivientes; sin embargo, no ha sido establecida la asociación de concentraciones sanguíneas de sFas con mortalidad controlando por la gravedad de la sepsis. Por lo tanto, el principal objetivo de nuestro estudio fue determinar si existe una asociación entre concentraciones sanguíneas de sFas y la mortalidad en sepsis controlando por la gravedad. Métodos: Incluímos pacientes sépticos en este estudio observacional y prospectivo realizado en tres Unidades de Cuidados Intensivos españolas. Obtuvimos muestras de suero en el momento del diagnóstico de la sepsis para la determinación de concentraciones de sFas. Resultados: Los pacientes fallecidos durante los primeros treinta días (n=85) comparados con los supervivientes (n=151) tuvieron mayores concentraciones séricas de sFas (p<0,001). Se encontró una asociación de concentraciones séricas de sFas con mortalidad controlando por edad y SOFA (OR=1,004; 95% IC=1,002-1,006; p < 0,001), y por edad y APACHE-II (OR=1,004; 95% IC=1,002-1,006; p < 0,001). Las concentraciones séricas de sFas mostraron un área bajo la curva para la predicción de mortalidad del 71% (IC 95%=65%-71%; p < 0,001). El análisis Kaplan-Meier mostró una mayor mortalidad en los pacientes con concentraciones séricas de sFas > 83,5 ng/mL (Hazard ratio=3,2; 95% IC=2,1-5,0; p < 0,001). Conclusiones: La asociación entre concentraciones sanguíneas de sFas y la mortalidad en sepsis controlando por la gravedad fue el principal nuevo hallazgo de nuestro estudio.(AU)

Association of serum soluble Fas concentrations and mortality of septic patients.

INTRODUCTION: Scarce data on Fas, one of the main receptors that activates the apoptosis extrinsic pathway, in septic patients exists. Higher blood soluble Fas (sFas) concentrations in non-survivor septic patients compared with survivors have been found in small studies; however, the association of blood sFas concentrations with mortality controlling for sepsis severity has not been stablished due to this small sample size in those studies. Thus, our main objective study was to determine whether an association between blood sFas concentrations and sepsis mortality controlling for sepsis severity exists. METHODS: We included septic patients in this observational and prospective study carried out in three Spanish Intensive Care Units. We obtained serum samples at sepsis diagnosis sepsis for sFas levels determination. RESULTS: Thirty-day non-surviving patients (n=85) compared to surviving patients (n=151) had higher serum sFas levels (p<0.001). We found in multiple logistic regression analysis an association of serum sFas levels with mortality controlling for age and SOFA (OR=1.004; 95% CI=1.002-1.006; p<0.001), and for age and APACHE-II (OR=1.004; 95% CI=1.002-1.006; p<0.001). Serum sFas levels showed and area under the curve for mortality prediction of 71% (95% CI=65-71%; p<0.001). Kaplan-Meier analysis showed higher mortality rate in patients with serum sFas levels>83.5ng/mL (Hazard ratio=3.2; 95% CI=2.1-5.0; p<0.001). CONCLUSIONS: That an association between blood sFas concentrations and sepsis mortality controlling for sepsis severity exists was our main new finding study.

Chlorhexidine-silver sulfadiazine-impregnated venous catheters are efficient even at subclavian sites without tracheostomy.

BACKGROUND: Chlorhexidine-silver sulfadiazine (CHSS)-impregnated catheters have been found to decrease the risk of catheter-related bloodstream infection (CRBSI) and central venous catheter (CVC)-related costs. However, there are no published data about cost-effectiveness of the use of CHSS-impregnated catheters in subclavian venous access without the presence of tracheostomy (thus, with a very low risk of CRBSI). That was the objective of this study. METHODS: This was a retrospective study of patients admitted to a mixed intensive care unit who underwent placement of subclavian venous catheters without the presence of tracheostomy. RESULTS: Patients with standard catheters (n = 747) showed a higher CRBSI incidence density (0.95 vs 0/1,000 catheter-days; P = .02) and higher CVC-related cost per day ($3.78 ± $7.43 vs $3.31 ± $2.72; P < .001) than patients with a CHSS-impregnated catheter (n = 879). Exact logistic regression analysis showed that catheter duration (P = .02) and the type of catheter used (P = .01) were associated with the risk of CRBSI. Kaplan-Meier method showed that CHSS-impregnated catheters were associated with more prolonged CRBSI-free time than standard catheters (log-rank = 9.76; P = .002). Poisson regression analysis showed that CHSS-impregnated catheters were associated with a lower central venous catheter-related cost per day than standard catheters (odds ratio, 0.87; 95% confidence interval, 0.001-0.903; P < .001). CONCLUSIONS: The use of CHSS-impregnated catheters is an effective and efficient measure for the prevention of CRBSI even at subclavian venous access sites without the presence of tracheostomy.

Chlorhexidine-silver sulfadiazine- or rifampicin-miconazole-impregnated venous catheters decrease the risk of catheter-related bloodstream infection similarly.

BACKGROUND: The objective of this study was to compare the incidence of catheter-related bloodstream infection (CRBSI) with the use of second-generation chlorhexidine-silver sulfadiazine (CHSS)-impregnated catheters, rifampicin-miconazole (RM)-impregnated catheters, and standard catheters. METHODS: Retrospective study of patients admitted to an intensive care unit who received CHSS, RM, or standard catheters in femoral venous access. RESULTS: We diagnosed 18 CRBSIs in 245 patients with standard catheters in 2,061 days, zero CRBSI in 169 patients with CHSS-impregnated catheters in 1,489 days, and zero CRBSI in 227 patients with RM-impregnated catheters in 2,009 days. Patients with standard catheters compared with CHSS- and RM-impregnated catheters showed a higher rate of CRBSI (7.3%, 0%, and 0%, respectively; P < .001) and higher incidence density of CRBSI (8.7, 0, and 0 per 1,000 catheter days, respectively; P < .001). We found in the exact Poisson regression that standard catheters were associated with a higher CRBSI incidence than CHSS-impregnated catheters (P < .001) and RM-impregnated catheters (P < .001), controlling for catheter duration. We found in survival analysis that standard catheters were associated with a lower CRBSI-free time than CHSS-impregnated catheters (P < .001) and RM-impregnated catheters (P < .001). CONCLUSION: We found that CHSS- and RM-impregnated catheters decreased similarly the risk of CRBSI.

Chlorhexidine-silver sulfadiazine-impregnated venous catheters save costs.

BACKGROUND: Previous cost-effectiveness analyses have found that the use of chlorhexidine-silver sulfadiazine (CHSS)-impregnated catheters is associated with decreased catheter-related bloodstream infections (CRBSI) and central venous catheter (CVC)-related costs. However, in these analyses, the CVC-related cost included the increase of hospital stay. OBJECTIVE: Our aim was to determine the immediate CVC-related cost (including only the cost of CVC, diagnosis of CRBSI, and antimicrobials for the treatment of CRBSI) of using a CHSS or a standard catheter in internal jugular venous access. METHODS: We performed a prospective, observational, cohort study of patients admitted to the intensive care unit (ICU), Hospital Universitario de Canarias (Tenerife, Spain), who received 1 or more internal jugular venous catheters. RESULTS: The study included 245 CHSS-impregnated catheters and 391 standard catheters. Exact logistic regression analysis showed that CHSS-impregnated catheters were associated with a lower incidence of CRBSI, controlling for catheter duration, than standard catheters (0 vs 5.04 CRBSI per 1,000 catheter-days, respectively; odds ratio, 0.80; 95% confidence interval: 0.712-0.898; P < .001). Poisson regression showed that CHSS-impregnated catheters were associated with lower CVC-related cost per day than standard catheters (€3.78 ± €4.45 vs €7.28 ± €16.71, respectively; odds ratio, 0.52; 95% confidence interval: 0.504-0.535; P < .001). Survival analysis showed that CHSS-impregnated catheters were associated with increased CRBSI-free time compared with standard catheters (χ(2) = 14.9; P < .001). CONCLUSION: The use of CHSS-impregnated catheters reduced the incidence of CRBSI and immediate CVC-related costs in the internal jugular venous access.

Left atrial dysfunction and new-onset atrial fibrillation after cardiac surgery.

INTRODUCTION AND OBJECTIVES: Postoperative atrial fibrillation is a common complication of carrying out cardiac surgery with extracorporeal circulation (ECC). The aim of this study was to determine whether preoperative left atrial contractile dysfunction, as assessed by tissue Doppler echocardiography, is associated with the development of postoperative new-onset atrial fibrillation (PAF). METHODS: Transthoracic Doppler echocardiography was performed preoperatively in patients undergoing elective cardiac surgery. Left atrial contractile function was evaluated by tissue Doppler imaging (TDI) of the mitral annulus. RESULTS: The study included 92 patients in sinus rhythm preoperatively who underwent elective cardiac surgery with ECC: 73 (79%) were male and 19 (21%) were female, and their mean age was 67 (10) years. Of these, 19 (20.6%) developed PAF 34 (12) h postoperatively. Bivariate analysis showed that PAF was associated with older age (71 [7] years vs 66 [10] years; P=.034), a large left atrial diameter (LAD), and a low peak atrial systolic mitral annular velocity (A velocity) and a high mitral E/A ratio on TDI. Logistic regression analysis showed that PAF was independently associated with a large LAD (odds ratio [OR] =2.23; 95% confidence interval [CI], 1.05-4.76; P=.033) and a low A velocity (OR=0.70; 95% CI, 0.55-0.99; P=.034). CONCLUSIONS: Preoperative left atrial dysfunction, as assessed by TDI, was associated with an increased risk of PAF.

Disfunción auricular izquierda y fibrilación auricular de reciente comienzo en cirugía cardiaca / Left atrial dysfunction and new-onset atrial fibrillation after cardiac surgery

Introducción y objetivos. La fibrilación auricular postoperatoria es una complicación frecuente de la cirugía cardiaca con circulación extracorpórea (CEC). Hemos estudiado si la función contráctil auricular izquierda preoperatoria evaluada mediante ecocardiografía Doppler tisular se asocia a la aparición de fibrilación auricular postoperatoria (FAP) de reciente comienzo. Métodos. Realizamos una ecocardiografía transtorácica preoperatoria a pacientes intervenidos de cirugía cardiaca electiva. La función contráctil auricular izquierda se evaluó mediante el análisis por Doppler tisular del anillo mitral (DTm). Resultados. Estudiamos a 92 pacientes en ritmo sinusal previo intervenidos de cirugía coronaria electiva con CEC, 73 (79%) varones y 19 (21%) mujeres, con una media de edad de 67 ± 10 años; 19 (20,6%) pacientes presentaron FAP en torno a las 34 ± 12 h postoperatorias. En el análisis bivariable, una edad mayor (71 ± 7 frente a 66 ± 10; p = 0,034), un mayor tamaño de la aurícula izquierda (TAI), una menor velocidad del pico sistólico auricular del anillo mitral (a) y una mayor relación e/a (DTm) se asociaron con la FAP. En el análisis de regresión logística, el TAI (odds ratio [OR] = 2,23; intervalo de confianza [IC] del 95%, 1,05-4,76; p = 0,033) y una menor (a) (OR = 0,70; IC del 95%, 0,55-0,99; p = 0,034) se asociaron de forma independiente con la FAP. Conclusiones. Una disfunción auricular izquierda preoperatoria evaluada mediante DTm se asoció con un mayor riesgo de FAP (AU)

Introduction and objectives. Postoperative atrial fibrillation is a common complication of carrying out cardiac surgery with extracorporeal circulation (ECC). The aim of this study was to determine whether preoperative left atrial contractile dysfunction, as assessed by tissue Doppler echocardiography, is associated with the development of postoperative new-onset atrial fibrillation (PAF).Methods. Transthoracic Doppler echocardiography was performed preoperatively in patients undergoing elective cardiac surgery. Left atrial contractile function was evaluated by tissue Doppler imaging (TDI) of the mitral annulus. Results. The study included 92 patients in sinus rhythm preoperatively who underwent elective cardiac surgery with ECC: 73 (79%) were male and 19 (21%) were female, and their mean age was 67±10 years. Of these, 19 (20.6%) developed PAF 34±12 h postoperatively. Bivariate analysis showed that PAF was associated with older age (71±7 years vs. 66±10 years; P=.034), a large left atrial diameter (LAD), and a low peak atrial systolic mitral annular velocity (A velocity) and a high mitral E/A ratio on TDI. Logistic regression analysis showed that PAF was independently associated with a large LAD (odds ratio [OR]=2.23; 95% confidence interval [CI], 1.05-4.76; P=.033) and a low A velocity (OR=0.70; 95%CI, 0.55-0.99; P=.034).Conclusions. Preoperative left atrial dysfunction, as assessed by TDI, was associated with an increased risk of PAF (AU)