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1.
PLoS One ; 19(7): e0306468, 2024.
Article in English | MEDLINE | ID: mdl-39074134

ABSTRACT

BACKGROUND: Total hip (THA) or knee (TKA) arthroplasty is still a traumatic and challenging operation that induces inflammation, with a particularly high risk of acute-phase reaction. The aim of this study was to predict the likelihood of implant-associated complications during the preoperative and postoperative course. METHODS: The prospective observational, non-interventional study of patients diagnosed with primary knee or hip osteoarthrosis undergoing THA or TKA during the study period was conducted. The inflammatory and malnutrition parameters were collected for each patient one day before surgery, two days after surgery, and in outpatient follow-up. RESULTS: Of 159 patients analysed, 12 developed implant-associated complications. The albumin, prealbumin, Intensive Care Infection Score (ICIS), Nutritional Risk Index, and white blood cell counts were found to be potential predictors. Notably, preoperative albumin levels significantly differed between groups with and without complications (P-value = 0.042). CONCLUSION: Our study definitively shows that WBC, prealbumin, Nutritional Risk Index, ICIS as a novel marker, and significantly albumin, outperform C-reactive protein in predicting implant-associated complications in hip and knee arthroplasty.


Subject(s)
Arthroplasty, Replacement, Hip , Arthroplasty, Replacement, Knee , Postoperative Complications , Humans , Male , Female , Arthroplasty, Replacement, Hip/adverse effects , Arthroplasty, Replacement, Knee/adverse effects , Aged , Prospective Studies , Postoperative Complications/etiology , Postoperative Complications/blood , Middle Aged , Risk Factors , Aged, 80 and over , Prealbumin/metabolism , Prealbumin/analysis , Biomarkers/blood , C-Reactive Protein/metabolism , C-Reactive Protein/analysis , Serum Albumin/analysis , Serum Albumin/metabolism , Osteoarthritis, Hip/surgery
2.
BMC Musculoskelet Disord ; 24(1): 383, 2023 May 15.
Article in English | MEDLINE | ID: mdl-37189111

ABSTRACT

BACKGROUND: Implant-associated infection (IAI) is a potential complication following total hip (THA) or knee arthroplasty (TKA). The initial phase of the inflammatory process can be measured by applying one of the inflammatory blood parameters (IBP). This systematic review aims to assess the response of IBP to trauma caused by orthopedic surgery and evaluate the clinical utility of quantitative measurements of IBP as prognostic factors for infection. METHODS: All studies indexed in Ovid MEDLINE (PubMed), Ovid EMBASE, the Cochrane Library and the ISI Web of Science databases, from inception until January 31, 2020, were analyzed. Studies included were those on adults who underwent THA or TKA with minimum follow up of 30 days after surgery. In addition to minimum follow up, data on the prognostic factors for pre- or post-THA/TKA IAI were mandatory. The Quality Assessment of Diagnostic Accuracy tool (version 2) (QUADAS-2) and Standards for Reporting of Diagnostic Accuracy Studies guideline 2015 (STARD) were used for quality assessment. RESULTS: Twelve studies fulfilled the inclusion and exclusion criteria. C-reactive protein was analyzed in seven studies, interleukin-6 in two studies and erythrocyte sedimentation rate in eight studies. White blood cell count and procalcitonin were analyzed in the only study. The overall quality of included studies was low. A potential for other cytokines (IL-1ra, IL-8) or MCP-1 was observed. CONCLUSIONS: This is the first systematic review of IBP response to orthopedic surgery which identified some IBP for pre/post-operative screening, despite insufficient data supporting their prognostic potential for patient risk stratification.


Subject(s)
Arthroplasty, Replacement, Hip , Arthroplasty, Replacement, Knee , Orthopedic Procedures , Adult , Humans , Prognosis , Arthroplasty, Replacement, Knee/adverse effects , Arthroplasty, Replacement, Hip/adverse effects , Postoperative Complications
3.
BMJ Open ; 11(9): e046027, 2021 09 21.
Article in English | MEDLINE | ID: mdl-34548343

ABSTRACT

INTRODUCTION: Surgical site infection (SSI) is a potential complication of surgical procedure. SSI after implant surgery is a disaster both for patients and surgeons. Although predictive tools for SSI are available, none of them estimate early infection based on inflammatory blood parameters. The inflammatory process can be measured using several parameters including interleukin-6, C reactive protein, neutrophil to lymphocyte ratio, white cell count, erythrocyte sedimentation rate or procalcitonin. This systematic review aims to determine whether inflammatory blood parameters could be used as significant predictive factors for SSI after primary hip or knee arthroplasty. METHODS AND ANALYSIS: A systematic review of randomised controlled trials, cross-sectional studies, case-control studies and cohort studies, published in English, will be searched in the following electronic bibliographic databases: MEDLINE, Embase, PubMed, Cochrane Central Register of Controlled Trials and Web of Science. Studies performed in adult patients of all ages who underwent knee or hip arthroplasty, studies containing data on the risk/prognostic factors for preknee or postknee or hip arthroplasty SSI and studies with a minimum follow-up of 30 days after surgery will be included. A standardised form will be used to extract data from the included studies comprising study characteristics, participant characteristics, details of the intervention, study methodology and outcomes. Quality Assessment of Diagnostic Accuracy tool, second version, and Standards for Reporting of Diagnostic Accuracy Studies checklist will be used to assess risk of bias. Heterogeneity will be assessed using Cochran χ² statistic and I2 statistics where applicable. Grading of Recommendations Assessment, Development and Evaluation and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance will be used to report findings. ETHICS AND DISSEMINATION: No ethics approval is required. The findings will be disseminated at national and international scientific sessions, also to be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42020147925.


Subject(s)
Arthroplasty, Replacement, Hip , Arthroplasty, Replacement, Knee , Arthroplasty, Replacement, Hip/adverse effects , Arthroplasty, Replacement, Knee/adverse effects , Cross-Sectional Studies , Humans , Prognosis , Surgical Wound Infection/diagnosis , Surgical Wound Infection/epidemiology , Surgical Wound Infection/etiology , Systematic Reviews as Topic
4.
Nutrition ; 78: 110808, 2020 10.
Article in English | MEDLINE | ID: mdl-32540676

ABSTRACT

OBJECTIVES: The quantitative importance of prescribed intravenous (IV) medication to water and sodium intake in routine clinical practice is undocumented, with uncertain influence on clinical outcomes. The present study aimed to redress this issue in surgical patients with gastrointestinal problems. METHODS: The prescription and administration of IV medication and fluids were retrospectively reviewed for water and sodium over 24-h periods in 86 patients in upper and lower gastrointestinal surgical wards in two teaching hospitals. Changes over 5 y were assessed in the same two wards using the same methodology. RESULTS: Among 90.7% of patients prescribed IV medication, the median intake was 272 mL water/d (range, 40-2687 mL water/d) and 27 mmol sodium/d (range, 2-420 mmol sodium/d), with no significant difference between hospitals or ward type. In 28.2% of patients receiving any infusates, the only source of water and sodium was IV medication, and in 14.3% of patients, the medication provided more sodium than other infusates. Antibiotic agents and paracetamol accounted for 58.3% of water and 52.3% of sodium in IV medication. Historic data of IV medicine-related water and sodium intake did not differ significantly from current data. The literature suggests that clinical outcomes can be modulated by variations in water and sodium intake well within the range provided by IV medication. CONCLUSION: IV medicine prescriptions, particularly antibiotic agents and paracetamol, can make substantial and clinically relevant contributions to daily water and sodium intake. These contributions have persisted over time and should be considered during routine assessments of fluid balance and interventions aiming to improve clinical outcomes.


Subject(s)
Sodium, Dietary , Water , Fluid Therapy , Humans , Retrospective Studies , Sodium
5.
J Rehabil Med ; 50(8): 696-704, 2018 Aug 22.
Article in English | MEDLINE | ID: mdl-30080234

ABSTRACT

OBJECTIVE: Loss of muscle mass in critically ill patients is associated with serious consequences, such as prolonged mechanical ventilation, intensive care unit confinement, and higher mortality. Thus, monitoring muscle mass, and especially its decline, should provide a useful indicator of morbidity and mortality. Performing evaluations according only to body mass index is imperfect, therefore the aim of this article was to evaluate appropriate methods for muscle mass loss determination in ICU patients. METHODS: For this review, the literature searches were conducted through Embase and Medline, PubMed and Google Scholar databases up to February 2018 for the following Medical Subject Headings terms muscle atrophy, protein catabolism, ICU-aquaired weakness, muscle muss loss, myolysis, critical illness, stress metabolism, computed tomography, magnetic resonance imaging, dual-energy X-ray absorptiometry, neutron activation analysis, anthropometric examination, determination of endogenous metabolites of the skeletal muscles, bioimpedance spectroscopy, ultrasound. RESULT: It appears that ultrasound, which is widely available in hospitals, is the most advantageous method. Muscle ultrasound is non-invasive, relatively inexpensive, and is a bedside method that is free of ionizing radiation. Furthermore, muscle ultrasound also seems to be valid in patients with severe fluid retention, which is a typical complication with other conventional methods. CONCLUSION: Early detection of critical illness neuromyo-pathy could be beneficial for improving the standards of intensive care, and thus reducing the risk of mortality in these patients.


Subject(s)
Body Mass Index , Critical Illness/mortality , Humans , Morbidity , Prognosis , Survival Rate
6.
Nutrition ; 49: 90-95, 2018 05.
Article in English | MEDLINE | ID: mdl-29500970

ABSTRACT

OBJECTIVE: The association between energy metabolism and prognosis in polytrauma patients has not yet been defined. The aim of this study was to describe energy metabolism and analyze the prognostic value of respiratory quotient (RQ) and nonprotein respiratory quotient (npRQ) in fasting polytrauma patients (fPP) and polytrauma patients with nutritional support (nsPP). METHODS: Twenty-two polytrauma patients (before and after parenteral nutrition administration) and 22 healthy controls (after overnight fasting) were examined on day 4 (median) after admission to the intensive care unit. To evaluate energy expenditure in nsPP and resting energy expenditure in fPP and controls with RQ and npRQ in all groups, we used indirect calorimetry. With regression analysis, the descriptive models of intensive care unit (ICU) length of stay (LOS) and mechanical ventilation time (VT) were derived. RESULTS: RQ and npRQ were significantly lower in fPP than in controls (P < 0.05 and P < 0.01, respectively) and in nsPP (P < 0.05). In nsPP, relationships between RQ or npRQ and the ICU LOS or mechanical VT were demonstrated (P < 0.0001, r = -0.78 for RQ and VT; P < 0.0001, r = -0.78 for npRQ and VT; P < 0.001, r = -0.69 for RQ and LOS; P < 0.001, r = -0.72 for npRQ and LOS). CONCLUSIONS: RQ and npRQ parameters measured by indirect calorimetry in polytrauma patients with parenteral nutrition on the fourth day of ICU stay related to clinical outcomes such as duration of mechanical ventilation and ICU LOS.


Subject(s)
Calorimetry, Indirect/statistics & numerical data , Length of Stay/statistics & numerical data , Multiple Trauma/physiopathology , Parenteral Nutrition/statistics & numerical data , Respiratory Function Tests/statistics & numerical data , Adult , Basal Metabolism , Calorimetry, Indirect/methods , Energy Metabolism , Fasting , Female , Humans , Intensive Care Units , Male , Middle Aged , Multiple Trauma/therapy , Pilot Projects , Prognosis , Prospective Studies , Regression Analysis , Respiration, Artificial/statistics & numerical data , Respiratory Function Tests/methods , Time Factors , Treatment Outcome
7.
Int J Chron Obstruct Pulmon Dis ; 12: 3429-3435, 2017.
Article in English | MEDLINE | ID: mdl-29238187

ABSTRACT

PURPOSE: Patients with COPD present peripheral muscle dysfunction and atrophy, expressed as muscle strength and endurance reduction. The goal of this study was direct dynamometric assessment of hand grip endurance and strength in relation to the stage of disease, multidimensional predictors of mortality, and 6-minute walk test (6MWT). To the best of our knowledge, there has been no previous study determining these parameters. PATIENTS AND METHODS: In this observational study, 58 consecutive outpatients with stable COPD and 25 volunteers without respiratory problems were compared. All COPD subjects underwent a comprehensive examination to determine COPD severity, prognostic scales, and 6MWT. Body composition, basic spirometric parameters, and hand grip strength and endurance were determined in all study participants. RESULTS: Patients in the COPD group had a 15% decrease in maximum strength (P=0.012) and a 28% decrease in area under the force/time curve (AUC) of the endurance test (P<0.001) compared to the control group. Dynamometric parameters were significantly negatively associated with the stage of disease and values of multivariable prediction indexes, and positively associated with the results of 6MWT. In most cases, closer associations were found with AUC than with 6MWT and in the gender-specific groups. CONCLUSION: Both hand grip strength and endurance are impaired in COPD patients in comparison with the control group. In particular, AUC could be considered as an attractive option not only to assess exercise capacity but also as a predictive marker with a better prognostic value than 6MWT in COPD patients. This is the first study to observe the dependence of hand grip endurance on combined COPD assessment.


Subject(s)
Exercise Tolerance , Hand Strength , Lung/physiopathology , Muscle, Skeletal/physiopathology , Physical Endurance , Pulmonary Disease, Chronic Obstructive/diagnosis , Walk Test , Aged , Area Under Curve , Body Composition , Case-Control Studies , Female , Health Status , Humans , Male , Middle Aged , Predictive Value of Tests , Prognosis , Pulmonary Disease, Chronic Obstructive/physiopathology , ROC Curve , Reproducibility of Results , Severity of Illness Index , Spirometry
8.
Adv Nutr ; 8(4): 624-634, 2017 Jul.
Article in English | MEDLINE | ID: mdl-28710148

ABSTRACT

The guidelines for nutritional support in critically ill adult patients differ in various aspects. The optimal amount of energy and nutritional substrates supplied is important for reducing morbidity and mortality, but unfortunately this is not well known, because the topic is complex and every patient is individual. The aim of this review was to gather recent pertinent information concerning the nutritional support of critically ill patients in the intensive care unit (ICU) with respect to the energy, protein, carbohydrate, and lipid intakes and the effect of their specific utilization on morbidity and mortality. Enteral nutrition (EN) is generally recommended over parenteral nutrition (PN) and is beneficial when administered within 24-48 h after ICU admission. In contrast, early PN does not provide substantial advantages in terms of morbidity and mortality, and the time when it is safe and beneficial remains unclear. The most advantageous recommendation seems to be administration of a hypocaloric (<20 kcal · kg-1 · d-1), high-protein diet (amino acids at doses of ≥2 g · kg-1 · d-1), at least during the first week of critical illness. Another important factor for reducing morbidity is the maintenance of blood glucose concentrations at 120-150 mg/dL, which is accomplished with the use of insulin and lower doses of glucose of 1-2 g · kg-1 · d-1, because this prevents the risk of hypoglycemia and is associated with a better prognosis according to recent studies. A fat emulsion is used as a source of required calories because of insulin resistance in the majority of patients. In addition, lipid oxidation in these patients is ∼25% higher than in healthy subjects.


Subject(s)
Critical Illness/epidemiology , Critical Illness/therapy , Dietary Fats/administration & dosage , Dietary Proteins/administration & dosage , Energy Intake , Adult , Blood Glucose/metabolism , Dietary Carbohydrates/administration & dosage , Energy Metabolism , Enteral Nutrition , Humans , Insulin/blood , Intensive Care Units , Meta-Analysis as Topic , Morbidity , Mortality , Nutritional Requirements , Observational Studies as Topic , Parenteral Nutrition , Randomized Controlled Trials as Topic
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