RÉSUMÉ
Chronic liver diseases (CLD) affect 1.5 billion patients worldwide, with dramatically increasing incidence in recent decades. It has been hypothesized that the chronic hyperinflammation associated with CLD may increase the risk of a more severe course of acute pancreatitis (AP). This study aims to investigate the underlying impact of CLD on the outcomes of AP. A systematic search was conducted in Embase, Medline, and Central databases until October 2022. Studies investigating patients with acute pancreatitis and CLD, were included in the meta-analysis. A total of 14,963 articles were screened, of which 36 were eligible to be included. CLD was a risk factor for increased mortality with an odds ratio (OR) of 2.53 (CI 1.30 to 4.93, p = 0.01). Furthermore, renal, cardiac, and respiratory failures were more common in the CLD group, with ORs of 1.92 (CI 1.3 to 2.83, p = 0.01), 2.11 (CI 0.93 to 4.77, p = 0.062) and 1.99 (CI 1.08 to 3.65, p = 0.033), respectively. Moreover, the likelihood of developing Systemic Inflammatory Response Syndrome (SIRS) was significantly higher, with an OR of 1.95 (CI 1.03 to 3.68, p = 0.042). CLD is an important risk factor for worse outcomes in AP pancreatitis, leading to higher mortality and increased rates of local and systemic complications.
Sujet(s)
Pancréatite , Humains , Facteurs de risque , Pancréatite/mortalité , Pancréatite/complications , Maladies du foie/mortalité , Maladies du foie/complications , Syndrome de réponse inflammatoire généralisée/complications , Syndrome de réponse inflammatoire généralisée/mortalité , Maladie chronique , Maladie aigüe , Odds ratioRÉSUMÉ
BACKGROUND: Knowledge about multisystem inflammatory syndrome in children (MIS-C) is evolving, and evidence-based standardised diagnostic and management protocols are lacking. Our review aims to summarise the clinical and diagnostic features, management strategies and outcomes of MIS-C and evaluate the variances in disease parameters and outcomes between high-income countries (HIC) and middle-income countries (MIC). METHODS: We searched four databases from December 2019 to March 2023. Observational studies with a sample size of 10 or more patients were included. Mean and prevalence ratios for various variables were pooled by random effects model using R. A mixed generalised linear model was employed to account for the heterogeneity, and publication bias was assessed via funnel and Doi plots. The primary outcome was pooled mean mortality among patients with MIS-C. Subgroup analysis was conducted based on the income status of the country of study. RESULTS: A total of 120 studies (20 881 cases) were included in the review. The most common clinical presentations were fever (99%; 95% CI 99.6% to 100%), gastrointestinal symptoms (76.7%; 95% CI 73.1% to 79.9%) and dermatological symptoms (63.3%; 95% CI 58.7% to 67.7%). Laboratory investigations suggested raised inflammatory, coagulation and cardiac markers. The most common management strategies were intravenous immunoglobulins (87.5%; 95% CI 82.9% to 91%) and steroids (74.7%; 95% CI 68.7% to 79.9%). Around 53.1% (95% CI 47.3% to 58.9%) required paediatric intensive care unit admissions, and overall mortality was 3.9% (95% CI 2.7% to 5.6%). Patients in MIC were younger, had a higher frequency of respiratory distress and evidence of cardiac dysfunction, with a longer hospital and intensive care unit stay and had a higher mortality rate than patients in HIC. CONCLUSION: MIS-C is a severe multisystem disease with better mortality outcomes in HIC as compared with MIC. The findings emphasise the need for standardised protocols and further research to optimise patient care and address disparities between HIC and MIC. PROSPERO REGISTRATION NUMBER: CRD42020195823.
Sujet(s)
Syndrome de réponse inflammatoire généralisée , Humains , Syndrome de réponse inflammatoire généralisée/diagnostic , Syndrome de réponse inflammatoire généralisée/thérapie , Syndrome de réponse inflammatoire généralisée/mortalité , Enfant , COVID-19/mortalité , COVID-19/diagnostic , COVID-19/thérapie , COVID-19/complicationsRÉSUMÉ
BACKGROUND: As the mortality of severe acute pancreatitis (SAP) is significantly higher than those with mild or moderate severity, it is of clinical significance to identify patients most likely to develop SAP at the time of emergency department (ED) presentation. OBJECTIVES: The aim of this study was to compare the performance of the Bedside Index for Severity in Acute Pancreatitis (BISAP) and the Emergency Department SpO2, Age and SIRS (ED-SAS) scoring systems as early risk assessment tools for identifying patients at high-risk of developing SAP. METHODS: We retrospectively reviewed adult patients with AP presented to ED between January 2019-September 2022. We calculated the scores of each patient with the parameters of the initial data. The primary outcome was SAP. The secondary outcomes were 30-day mortality, intensive care admission, and identifying low-risk patients without complications. RESULTS: Of 415 patients, 34 (8.2%) developed SAP and 15 (3.6%) died. With regard to predicting SAP, BISAP and ED-SAS scores had similar discriminative ability with area under the curves (AUCs) of 0.84 (95% confidence interval [CI]:0.80-0.88) and 0.83 (95% CI:0.79-0.86), respectively (p = 0.642). At a cut-off score of ≥2 for SAP, sensitivity/specificity values were 73.5%/82.4% for BISAP, 76.5%/83.2% for ED-SAS. BISAP and ED-SAS scores of ≥3, yielded sensitivity/specificity values of 50%/95.8% and 35.3%/95.5%, respectively. BISAP and ED-SAS were also similar in predicting mortality (AUCs of 0.92 vs. 0.90, respectively) and intensive care unit admission (AUCs 0.91 vs. 0.91). CONCLUSION: The BISAP and ED-SAS scores performed similarly in predicting SAP, mortality, and intensive care unit admission. As an easily calculated tool early in the ED, ED-SAS may be helpful in disposition decisions for emergency physicians.
Sujet(s)
Service hospitalier d'urgences , Pancréatite , Indice de gravité de la maladie , Syndrome de réponse inflammatoire généralisée , Humains , Mâle , Femelle , Service hospitalier d'urgences/organisation et administration , Adulte d'âge moyen , Études rétrospectives , Pancréatite/mortalité , Pancréatite/complications , Pancréatite/diagnostic , Pancréatite/physiopathologie , Syndrome de réponse inflammatoire généralisée/diagnostic , Syndrome de réponse inflammatoire généralisée/mortalité , Syndrome de réponse inflammatoire généralisée/physiopathologie , Sujet âgé , Adulte , Appréciation des risques/méthodes , Valeur prédictive des tests , Saturation en oxygène/physiologie , Facteurs âgesRÉSUMÉ
OBJECTIVE: In this study, we aimed to evaluate the death risk factors of patients included in the sepsis protocol bundle, using clinical data from qSOFA, SIRS, and comorbidities, as well as development of a mortality risk score. DESIGN: This retrospective cohort study was conducted between 2016 and 2021. SETTING: Two university hospitals in Brazil. PARTICIPANTS: Patients with sepsis. INTERVENTIONS: Several clinical and laboratory data were collected focused on SIRS, qSOFA, and comorbidities. MAIN VARIABLE OF INTEREST: In-hospital mortality was the primary outcome variable. A mortality risk score was developed after logistic regression analysis. RESULTS: A total of 1,808 patients were included with a death rate of 36%. Ten variables remained independent factors related to death in multivariate analysis: temperature ≥38⯰C (odds ratio [OR]â¯=â¯0.65), previous sepsis (ORâ¯=â¯1.42), qSOFAâ¯≥â¯2 (ORâ¯=â¯1.43), leukocytes >12,000 or <4,000â¯cells/mm3 (ORâ¯=â¯1.61), encephalic vascular accident (ORâ¯=â¯1.88), age >60 years (ORâ¯=â¯1.93), cancer (ORâ¯=â¯2.2), length of hospital stay before sepsis >7 days (ORâ¯=â¯2.22,), dialysis (ORâ¯=â¯2.51), and cirrhosis (ORâ¯=â¯3.97). Considering the equation of the binary regression logistic analysis, the score presented an area under curve of 0.668, is not a potential model for death prediction. CONCLUSIONS: Several risk factors are independently associated with mortality, allowing the development of a prediction score based on qSOFA, SIRS, and comorbidities data, however, the performance of this score is low.
Sujet(s)
Comorbidité , Mortalité hospitalière , Scores de dysfonction d'organes , Sepsie , Syndrome de réponse inflammatoire généralisée , Sujet âgé , Femelle , Humains , Mâle , Adulte d'âge moyen , Brésil/épidémiologie , Études rétrospectives , Appréciation des risques/méthodes , Facteurs de risque , Sepsie/mortalité , Syndrome de réponse inflammatoire généralisée/mortalité , Syndrome de réponse inflammatoire généralisée/épidémiologieRÉSUMÉ
BACKGROUND: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is responsible for an important mortality rate worldwide. We aimed to evaluate the actual imputability of SARS-CoV-2 on the mortality rate associated with SARS-CoV-2-related illnesses in the pediatric intensive care unit (PICU). Secondary objectives were to identify risk factors for death. METHODS: This national multicenter comparative study comprised all patients under 18 years old with positive SARS-CoV-2 polymerase chain reactions (PCRs) [acute corona virus disease 2019 (COVID-19) or incidental SARS-CoV-2 infection] and/or pediatric inflammatory multisystem syndrome (PIMS) recorded in the French PICU registry (PICURe) between September 1, 2021, and August 31, 2022. Included patients were classified and compared according to their living status at the end of their PICU stay. Deceased patients were evaluated by four experts in the field of pediatric infectiology and/or pediatric intensive care. The imputability of SARS-CoV-2 as the cause of death was classified into four categories: certain, very probable, possible, or unlikely, and was defined by any of the first three categories. RESULTS: There were 948 patients included of which 43 died (4.5%). From this, 26 deaths (67%) could be attributed to SARS-CoV-2 infection, with an overall mortality rate of 2.8%. The imputability of death to SARS-CoV-2 was considered certain in only one case (0.1%). Deceased patients suffered more often from comorbidities, especially heart disease, neurological disorders, hematological disease, cancer, and obesity. None of the deceased patients were admitted for pediatric inflammatory multisystem syndrome (PIMS). Mortality risk factors were male gender, cardiac comorbidities, cancer, and acute respiratory distress syndrome. CONCLUSIONS: SARS-CoV-2 mortality in the French pediatric population was low. Even though the imputability of SARS-CoV-2 on mortality was considered in almost two-thirds of cases, this imputability was considered certain in only one case.
Sujet(s)
COVID-19 , Unités de soins intensifs pédiatriques , Enregistrements , Humains , COVID-19/mortalité , COVID-19/épidémiologie , COVID-19/complications , France/épidémiologie , Enfant , Mâle , Femelle , Enfant d'âge préscolaire , Nourrisson , Unités de soins intensifs pédiatriques/statistiques et données numériques , Adolescent , Cause de décès , Facteurs de risque , Syndrome de réponse inflammatoire généralisée/mortalité , Syndrome de réponse inflammatoire généralisée/épidémiologie , SARS-CoV-2RÉSUMÉ
BACKGROUND: Multisystem inflammatory syndrome (MIS) is a hyperinflammatory shock associated with cardiac dysfunction and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, there are no reports on using MIS criteria, such as multisystemic inflammation (MSI) in fulminant myocarditis, without SARS-CoV-2 infection. This study investigated the differences in clinical characteristics and course between patients with fulminant lymphocytic myocarditis (FLM) plus MSI and those without MSI. METHODSâANDâRESULTS: This multicenter retrospective cohort study included 273 patients with FLM registered in the JROAD-DPC database between April 2014 and March 2017. We evaluated the presence of MSI using criteria modified from previously reported MIS criteria and compared the characteristics and risk of mortality or heart transplantation between FLM patients with MSI and without MSI. Of the 273 patients with FLM, 107 (39%) were diagnosed with MSI. The MSI group was younger (44 vs. 57 years; P<0.0001) and had more females (50% vs. 36%; P=0.0236), a higher incidence of pericardial effusion (58% vs. 40%; P=0.0073), and a lower 90-day mortality rate (19% vs. 33%; P=0.0185) than the non-MSI group. The risk of mortality at 90 days was lower in FLM patients aged <50 years with MSI aged <50 years than in those without MSI (P=0.0463). CONCLUSIONS: These results suggest that MSI may influence the prognosis of FLM, especially in patients aged <50 years.
Sujet(s)
Myocardite , Humains , Mâle , Femelle , Myocardite/mortalité , Myocardite/anatomopathologie , Études rétrospectives , Adulte d'âge moyen , Adulte , Pronostic , COVID-19/mortalité , COVID-19/complications , Sujet âgé , Lymphocytes/anatomopathologie , Syndrome de réponse inflammatoire généralisée/mortalité , Transplantation cardiaque , SARS-CoV-2 , Facteurs de risqueRÉSUMÉ
AIM: The early warning scores (EWS), quick Sequential Organ Failure Assessment (qSOFA) and systemic inflammatory response syndrome (SIRS) criteria have been proposed as sepsis screening tools. This review aims to summarise and compare the performance of EWS with the qSOFA and SIRS criteria for predicting sepsis diagnosis and in-hospital mortality in patients with sepsis. DESIGN: A systematic review with meta-analysis. REVIEW METHODS: Seven databases were searched from January 1, 2016 until March 10, 2022. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Sensitivity, specificity, likelihood ratios and diagnostic odd ratios were pooled by using the bivariate random effects model. Overall performance was summarised by using the hierarchical summary receiver-operating characteristics curve. This paper adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Diagnostic Test Accuracy Studies (PRISMA-DTA) guidelines. RESULTS: Ten studies involving 52,474 subjects were included in the review. For predicting sepsis diagnosis, the pooled sensitivity of EWS (65%, 95% CI: 55, 75) was similar to SIRS ≥2 (70%, 95% CI: 49, 85) and higher than qSOFA ≥2 (37%, 95% CI: 20, 59). The pooled specificity of EWS (77%, 95% CI: 64, 86) was higher than SIRS ≥2 (62%, 95% CI: 41, 80) but lower than qSOFA ≥2 (94%, 95% CI: 86, 98). Results were similar for the secondary outcome of in-hospital mortality. CONCLUSIONS: Although no one scoring system had both high sensitivity and specificity, the EWS had at least equivalent values in most measures of diagnostic accuracy compared with SIRS or qSOFA. IMPLICATIONS FOR THE PROFESSION: Healthcare systems in which EWS is already in place should consider whether there is any clinical benefit in adopting qSOFA or SIRS. NO PATIENT OR PUBLIC CONTRIBUTION: This systematic review did not directly involve patient or public contribution to the manuscript.
Sujet(s)
Mortalité hospitalière , Sepsie , Humains , Sepsie/mortalité , Sepsie/diagnostic , Score d'alerte précoce , Scores de dysfonction d'organes , Adulte , Syndrome de réponse inflammatoire généralisée/diagnostic , Syndrome de réponse inflammatoire généralisée/mortalité , Sensibilité et spécificitéRÉSUMÉ
BACKGROUND: During the coronavirus disease 2019 (COVID-19) pandemic, the world has a large number of reported COVID-19 cases and deaths. Information on characteristics and mortality rate of pediatric intensive care unit (PICU) cases with COVID-19 remains limited. This study aims to identify the risk factors for mortality related to COVID-19 in children admitted to PICU. METHODS: A retrospective multicenter cohort study was conducted between March 2020 and April 2021 at 44 PICUs in Turkey. Children who were 1 month-18-year of age with confirmed COVID-19 admitted to PICU were included in the study. Children with multisystem inflammatory syndrome and asymptomatic for COVID-19 were excluded. RESULTS: Of 335 patients with COVID-19, the median age was 6.8 years (IQR: 1.2-14) and 180 (53.7 %) were male, 215 (64.2 %) had at least one comorbidity. Age and gender were not related to mortality. Among 335 patients, 166 (49.5%) received mechanical ventilation, 17 (5.1%) received renal replacement therapy and 44 (13.1 %) died. Children with medical complexity, congenital heart disease, immunosuppression and malignancy had significantly higher mortality. On multivariable logistic regression analysis, organ failure index [odds ratio (OR): 2.1, 95 confidence interval (CI): 1.55-2.85], and having congenital heart disease (OR: 2.65, 95 CI: 1.03-6.80), were associated with mortality. CONCLUSIONS: This study presents detailed data on clinical characteristics and outcomes of patients with COVID-19 admitted to PICU in the first pandemic year in Turkey. Our study shows that having congenital heart disease is associated with mortality. In addition, the high organ failure score in follow-up predict mortality.
Sujet(s)
COVID-19/complications , Syndrome de réponse inflammatoire généralisée , Adolescent , COVID-19/mortalité , Enfant , Enfant d'âge préscolaire , Maladie grave , Femelle , Humains , Nourrisson , Unités de soins intensifs pédiatriques , Mâle , Études rétrospectives , Facteurs de risque , Syndrome de réponse inflammatoire généralisée/mortalité , Turquie/épidémiologieRÉSUMÉ
Multisystem inflammatory syndrome in adults (MIS-A) is a hyperinflammatory illness related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The characteristics of patients with this syndrome and the frequency with which it occurs among patients hospitalised after SARS-CoV-2 infection are unclear. Using the Centers for Disease Control and Prevention case definition for MIS-A, we created ICD-10-CM code and laboratory criteria to identify potential MIS-A patients in the Premier Healthcare Database Special COVID-19 Release, a database containing patient-level information on hospital discharges across the United States. Modified MIS-A criteria were applied to hospitalisations with discharge from March to December 2020. The proportion of hospitalisations meeting electronic health record criteria for MIS-A and descriptive statistics for patients in the potential MIS-A cohort were calculated. Of 34 515 SARS-CoV-2-related hospitalisations with complete clinical and laboratory data, 53 met modified criteria for MIS-A (0.15%). The median age was 62 years (IQR 52-74). Most patients met the severe cardiac illness criterion through either myocarditis (66.0%) or new-onset heart failure (35.8%). A total of 79.2% of patients required ICU admission, while 43.4% of patients in the cohort died. MIS-A appears to be a rare but severe outcome of SARS-CoV-2 infection. Additional studies are needed to investigate how this syndrome differs from severe coronavirus disease 2019 (COVID-19) in adults.
Sujet(s)
COVID-19/complications , Syndrome de réponse inflammatoire généralisée/diagnostic , Sujet âgé , COVID-19/diagnostic , COVID-19/ethnologie , COVID-19/mortalité , Études de cohortes , Bases de données factuelles , Femelle , Humains , Unités de soins intensifs , Mâle , Adulte d'âge moyen , Syndrome de réponse inflammatoire généralisée/ethnologie , Syndrome de réponse inflammatoire généralisée/mortalitéRÉSUMÉ
INTRODUCTION: Sepsis is a leading cause of mortality with more than 700,000 hospitalizations and 200,000 deaths annually in the United States. Early recognition of sepsis is critical for timely initiation of treatment and improved outcomes. We sought to evaluate. in-hospital mortality rates of patients diagnosed with sepsis before and after implementation of emergency department (ED) sepsis teams. METHODS: This was a retrospective study of adult patients seen at a tertiary care ED diagnosed with sepsis and severe sepsis. Pre-implementation study time frame was 5/1/2018-4/30/2019 and post-implementation was 11/1/2019-9/30/2020. A six-month washout period was utilized after implementation of ED-based sepsis teams. Indications for sepsis team activation were: two systemic inflammatory response syndrome (SIRS) criteria with suspected infection or two SIRS with confirmed infection during workup. Categorical variables are presented as frequencies and percentages. Continuous variables are presented as mean and standard deviation or median and quartiles depending on distribution. Multiple logistic regression compared mortality rates pre- and post-implementation while controlling for Charlson comorbidity index. Secondary objectives included comparing time metrics pre- and post-implementation. Student t-tests compared normally distributed variables and Wilcoxon rank sum tests compared non-normally distributed variables. RESULTS: There were 1188 participants included in the study; 553 before implementation of sepsis teams and 635 after implementation. Mean age of participants was 64 years. Patients were 74.7% white and 22.6% black. Medicare was the most common health insurance (59%). Mortality rates were significantly lower post-implementation of sepsis teams compared to pre-implementation with an adjusted odds ratio of 0.472, (95%CI, 0.352-0.632). ED LOS (95%CI (-67.2--11.3), hospital LOS (95%CI, -1.0--0.002) and time to lactic acid (95%CI, -10.0- -3.0) and antibiotics (95%CI, -29.0--11.0) were all significantly lower after implementation. CONCLUSION: Implementation of ED sepsis teams decreased inpatient hospital mortality rates, ED length of stay and hospital length of stay.
Sujet(s)
Service hospitalier d'urgences/organisation et administration , Mortalité hospitalière , Amélioration de la qualité/organisation et administration , Sepsie/diagnostic , Syndrome de réponse inflammatoire généralisée/diagnostic , Sujet âgé , Sujet âgé de 80 ans ou plus , Femelle , Humains , Durée du séjour , Modèles logistiques , Mâle , Adulte d'âge moyen , Ohio , , Études rétrospectives , Sepsie/mortalité , Sepsie/thérapie , Syndrome de réponse inflammatoire généralisée/mortalité , Syndrome de réponse inflammatoire généralisée/thérapieRÉSUMÉ
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is rarely fatal in children and young people (CYP, <18 years old), but quantifying the risk of death is challenging because CYP are often infected with SARS-CoV-2 exhibiting no or minimal symptoms. To distinguish between CYP who died as a result of SARS-CoV-2 infection and those who died of another cause but were coincidentally infected with the virus, we undertook a clinical review of all CYP deaths with a positive SARS-CoV-2 test from March 2020 to February 2021. The predominant SARS-CoV-2 variants were wild-type and Alpha. Here we show that, of 12,023,568 CYP living in England, 3,105 died, including 61 who were positive for SARS-CoV-2. Of these deaths, 25 were due to SARS-CoV-2 infection (mortality rate, two per million), including 22 due to coronavirus disease 2019-the clinical disease associated with SARS-CoV-2 infection-and 3 were due to pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2. In total, 99.995% of CYP with a positive SARS-CoV-2 test survived. CYP older than 10 years, Asian and Black ethnic backgrounds and comorbidities were over-represented in SARS-CoV-2-related deaths compared with other CYP deaths. These results are important for guiding decisions on shielding and vaccinating children. New variants might have different mortality risks and should be evaluated in a similar way.
Sujet(s)
COVID-19/complications , COVID-19/mortalité , Ethnies/statistiques et données numériques , Syndrome de réponse inflammatoire généralisée/mortalité , Adolescent , Répartition par âge , Asiatiques/statistiques et données numériques , /statistiques et données numériques , COVID-19/épidémiologie , COVID-19/ethnologie , Cause de décès , Enfant , Enfant d'âge préscolaire , Angleterre/épidémiologie , Femelle , Humains , Nourrisson , Nouveau-né , Mâle , SARS-CoV-2 , Syndrome de réponse inflammatoire généralisée/épidémiologie , Syndrome de réponse inflammatoire généralisée/ethnologie , /statistiques et données numériquesRÉSUMÉ
OBJECTIVES: Multicenter data on the characteristics and outcomes of children hospitalized with coronavirus disease 2019 are limited. Our objective was to describe the characteristics, ICU admissions, and outcomes among children hospitalized with coronavirus disease 2019 using Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study: Coronavirus Disease 2019 registry. DESIGN: Retrospective study. SETTING: Society of Critical Care Medicine Viral Infection and Respiratory Illness Universal Study (Coronavirus Disease 2019) registry. PATIENTS: Children (< 18 yr) hospitalized with coronavirus disease 2019 at participating hospitals from February 2020 to January 2021. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary outcome was ICU admission. Secondary outcomes included hospital and ICU duration of stay and ICU, hospital, and 28-day mortality. A total of 874 children with coronavirus disease 2019 were reported to Viral Infection and Respiratory Illness Universal Study registry from 51 participating centers, majority in the United States. Median age was 8 years (interquartile range, 1.25-14 yr) with a male:female ratio of 1:2. A majority were non-Hispanic (492/874; 62.9%). Median body mass index (n = 817) was 19.4 kg/m2 (16-25.8 kg/m2), with 110 (13.4%) overweight and 300 (36.6%) obese. A majority (67%) presented with fever, and 43.2% had comorbidities. A total of 238 of 838 (28.2%) met the Centers for Disease Control and Prevention criteria for multisystem inflammatory syndrome in children, and 404 of 874 (46.2%) were admitted to the ICU. In multivariate logistic regression, age, fever, multisystem inflammatory syndrome in children, and pre-existing seizure disorder were independently associated with a greater odds of ICU admission. Hospital mortality was 16 of 874 (1.8%). Median (interquartile range) duration of ICU (n = 379) and hospital (n = 857) stay were 3.9 days (2-7.7 d) and 4 days (1.9-7.5 d), respectively. For patients with 28-day data, survival was 679 of 787, 86.3% with 13.4% lost to follow-up, and 0.3% deceased. CONCLUSIONS: In this observational, multicenter registry of children with coronavirus disease 2019, ICU admission was common. Older age, fever, multisystem inflammatory syndrome in children, and seizure disorder were independently associated with ICU admission, and mortality was lower among children than mortality reported in adults.
Sujet(s)
COVID-19/complications , COVID-19/épidémiologie , COVID-19/physiopathologie , Enfant hospitalisé/statistiques et données numériques , Syndrome de réponse inflammatoire généralisée/épidémiologie , Syndrome de réponse inflammatoire généralisée/physiopathologie , Adolescent , Facteurs âges , Indice de masse corporelle , COVID-19/mortalité , Enfant , Enfant d'âge préscolaire , Comorbidité , Femelle , Mortalité hospitalière/tendances , Humains , Nourrisson , Unités de soins intensifs/statistiques et données numériques , Modèles logistiques , Mâle , Études rétrospectives , SARS-CoV-2 , Syndrome de réponse inflammatoire généralisée/mortalitéRÉSUMÉ
BACKGROUND: Obesity is an established risk factor for severe COVID-19 outcomes. The mechanistic underpinnings of this association are not well-understood. OBJECTIVE: To evaluate the mediating role of systemic inflammation in obesity-associated COVID-19 outcomes. METHODS: This hospital-based, observational study included 3828 SARS-CoV-2-infected patients who were hospitalized February to May 2020 at Massachusetts General Hospital (MGH) or Columbia University Irving Medical Center/New York Presbyterian Hospital (CUIMC/NYP). We use mediation analysis to evaluate whether peak inflammatory biomarkers (C-reactive protein [CRP], erythrocyte sedimentation rate [ESR], D-dimer, ferritin, white blood cell count and interleukin-6) are in the causal pathway between obesity (BMI ≥ 30) and mechanical ventilation or death within 28 days of presentation to care. RESULTS: In the MGH cohort (n = 1202), obesity was associated with greater likelihood of ventilation or death (ORâ =â 1.73; 95% CIâ =â [1.25, 2.41]; Pâ =â 0.001) and higher peak CRP (Pâ <â 0.001) compared with nonobese patients. The estimated proportion of the association between obesity and ventilation or death mediated by CRP was 0.49 (Pâ <â 0.001). Evidence of mediation was more pronounced in patientsâ <â 65 years (proportion mediatedâ =â 0.52 [Pâ <â 0.001] vs 0.44 [Pâ =â 0.180]). Findings were more moderate but consistent for peak ESR. Mediation by other inflammatory markers was not supported. Results were replicated in CUIMC/NYP cohort (nâ =â 2626). CONCLUSION: Findings support systemic inflammatory pathways in obesity-associated severe COVID-19 disease, particularly in patientsâ <â 65 years, captured by CRP and ESR. Contextualized in clinical trial findings, these results reveal therapeutic opportunity to target systemic inflammatory pathways and monitor interventions in high-risk subgroups and particularly obese patients.
Sujet(s)
COVID-19/complications , Obésité/complications , Syndrome de réponse inflammatoire généralisée/étiologie , Adulte , Sujet âgé , Sujet âgé de 80 ans ou plus , Vieillissement , Sédimentation du sang , Protéine C-réactive/analyse , COVID-19/mortalité , Femelle , Ferritines/sang , Produits de dégradation de la fibrine et du fibrinogène/analyse , Humains , Interleukine-6/sang , Numération des leucocytes , Mâle , Adulte d'âge moyen , Obésité/mortalité , Facteurs de risque , Syndrome de réponse inflammatoire généralisée/mortalité , Résultat thérapeutique , États-Unis/épidémiologieRÉSUMÉ
OBJECTIVE: The aim of this study was to investigate the association between post-implantation syndrome (PIS) and long term outcomes, with emphasis on cardiovascular prognosis. METHODS: One hundred and forty-nine consecutive patients undergoing EVAR in a tertiary institution were previously included in a study investigating the risk factors and short term consequences of PIS (defined as tympanic temperature ≥ 38°C and CRP > 10 mg/L, after excluding complications with an effect on inflammatory markers). This study was based on a prospectively maintained database. Survival status was derived from inquiry of civil registry database information and causes of death from the Dutch Central Bureau of Statistics. The primary endpoint was cardiovascular events. Secondary endpoints were overall and specific cause mortality (cardiovascular, ischaemic heart disease, AAA, and cancer related mortality). Aneurysm sac dynamics and occurrence of endoleaks were also analysed. Survival estimates were obtained using Kaplan-Meier plots and a multivariable model was constructed to correct for confounders. RESULTS: The PIS incidence was 39% (58/149). At the time of surgery, patients had a mean age of 73 ± 7 years and were predominantly male. There were no baseline differences between the PIS and non-PIS groups. The median follow up was 6.4 years (3.2 - 8.3), similar in both groups (p = .81). There was no difference in cardiovascular events for PIS and non-PIS patients (p = .63). However, Kaplan-Meier plots suggest a trend towards a higher rate of cardiovascular events in PIS patients during the first years: freedom from cardiovascular events at one year was 94% vs. 89% and at three years 90% vs. 82%. No differences were found in overall and specific cause mortality. There was a higher rate of type II endoleaks for non-PIS patients (28% vs. 9%, p = .005). Sac dynamics were similar in both groups. CONCLUSION: The results suggest that PIS is not associated with a statistically significantly higher risk of cardiovascular events. PIS had no impact on mortality. Lastly, PIS patients had fewer type II endoleaks, but sac dynamics were analogous.
Sujet(s)
Anévrysme de l'aorte abdominale/chirurgie , Implantation de prothèses vasculaires/effets indésirables , Maladies cardiovasculaires/épidémiologie , Procédures endovasculaires/effets indésirables , Syndrome de réponse inflammatoire généralisée/épidémiologie , Sujet âgé , Sujet âgé de 80 ans ou plus , Anévrysme de l'aorte abdominale/imagerie diagnostique , Anévrysme de l'aorte abdominale/mortalité , Implantation de prothèses vasculaires/mortalité , Maladies cardiovasculaires/diagnostic , Maladies cardiovasculaires/mortalité , Bases de données factuelles , Procédures endovasculaires/mortalité , Femelle , Humains , Incidence , Mâle , Pays-Bas/épidémiologie , Enregistrements , Études rétrospectives , Appréciation des risques , Facteurs de risque , Syndrome de réponse inflammatoire généralisée/diagnostic , Syndrome de réponse inflammatoire généralisée/mortalité , Facteurs temps , Résultat thérapeutiqueRÉSUMÉ
OBJECTIVES: To describe the demographics, clinical characteristics, and hospital course among persons <21 years of age with a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-associated death. METHODS: We conducted a retrospective case series of suspected SARS-CoV-2-associated deaths in the United States in persons <21 years of age during February 12 to July 31, 2020. All states and territories were invited to participate. We abstracted demographic and clinical data, including laboratory and treatment details, from medical records. RESULTS: We included 112 SARS-CoV-2-associated deaths from 25 participating jurisdictions. The median age was 17 years (IQR 8.5-19 years). Most decedents were male (71, 63%), 31 (28%) were Black (non-Hispanic) persons, and 52 (46%) were Hispanic persons. Ninety-six decedents (86%) had at least 1 underlying condition; obesity (42%), asthma (29%), and developmental disorders (22%) were most commonly documented. Among 69 hospitalized decedents, common complications included mechanical ventilation (75%) and acute respiratory failure (82%). The sixteen (14%) decedents who met multisystem inflammatory syndrome in children (MIS-C) criteria were similar in age, sex, and race and/or ethnicity to decedents without MIS-C; 11 of 16 (69%) had at least 1 underlying condition. CONCLUSIONS: SARS-CoV-2-associated deaths among persons <21 years of age occurred predominantly among Black (non-Hispanic) and Hispanic persons, male patients, and older adolescents. The most commonly reported underlying conditions were obesity, asthma, and developmental disorders. Decedents with coronavirus disease 2019 were more likely than those with MIS-C to have underlying medical conditions.
Sujet(s)
COVID-19/complications , Syndrome de réponse inflammatoire généralisée/mortalité , Adolescent , COVID-19/diagnostic , COVID-19/mortalité , Enfant , Enfant d'âge préscolaire , Femelle , Humains , Nourrisson , Mâle , Études rétrospectives , Syndrome de réponse inflammatoire généralisée/complications , Syndrome de réponse inflammatoire généralisée/diagnostic , États-Unis/épidémiologieRÉSUMÉ
BACKGROUND: Lymphopenia is associated with various pathologies such as sepsis, burns, trauma, general anesthesia and major surgeries. All these pathologies are clinically expressed by the so-called Systemic Inflammatory Response Syndrome which does not include lymphopenia into defining criteria. The main objective of this work was to analyze the diagnosis of patients admitted to a hospital related to lymphopenia during hospital stay. In addition, we investigated the relationship of lymphopenia with the four levels of the Severity of Illness (SOI) and the Risk of Mortality (ROM). METHOD AND FINDINGS: Lymphopenia was defined as Absolute Lymphocyte Count (ALC) <1.0 x109/L. ALC were analyzed every day since admission. The four levels (minor, moderate, major and extreme risk) of both SOI and ROM were assessed. A total of 58,260 hospital admissions were analyzed. More than 41% of the patients had lymphopenia during hospital stay. The mean time to death was shorter among patients with lymphopenia on admission 65.6 days (CI95%, 57.3-73.8) vs 89.9 (CI95%, 82.4-97.4), P<0.001. Also, patients with lymphopenia during hospital stay had a shorter time to the mortality, 67.5 (CI95%, 61.1-73.9) vs 96.9 (CI95%, 92.6-101.2), P<0.001. CONCLUSIONS: Lymphopenia had a high prevalence in hospitalized patients with greater relevance in infectious pathologies. Lymphopenia was related and clearly predicts SOI and ROM at the time of admission, and should be considered as clinical diagnostic criteria to define SIRS.
Sujet(s)
Maladies transmissibles/mortalité , Maladies gastro-intestinales/mortalité , Maladies du rein/mortalité , Maladies pulmonaires/mortalité , Lymphopénie/mortalité , Syndromes myéloprolifératifs/mortalité , Sepsie/mortalité , Syndrome de réponse inflammatoire généralisée/mortalité , Sujet âgé , Sujet âgé de 80 ans ou plus , Maladies transmissibles/diagnostic , Maladies transmissibles/physiopathologie , Femelle , Maladies gastro-intestinales/diagnostic , Maladies gastro-intestinales/physiopathologie , Mortalité hospitalière/tendances , Hôpitaux , Humains , Maladies du rein/diagnostic , Maladies du rein/physiopathologie , Durée du séjour/statistiques et données numériques , Maladies pulmonaires/diagnostic , Maladies pulmonaires/physiopathologie , Numération des lymphocytes , Lymphopénie/diagnostic , Lymphopénie/physiopathologie , Mâle , Adulte d'âge moyen , Syndromes myéloprolifératifs/diagnostic , Syndromes myéloprolifératifs/physiopathologie , Études rétrospectives , Sepsie/diagnostic , Sepsie/physiopathologie , Indice de gravité de la maladie , Syndrome de réponse inflammatoire généralisée/diagnostic , Syndrome de réponse inflammatoire généralisée/physiopathologieRÉSUMÉ
BACKGROUND: It is unclear whether the innate immune response represents a therapeutic target for organ protection strategies in cardiac surgery. METHODS: A systematic review of trials of interventions targeting the inflammatory response to cardiac surgery reporting treatment effects on both innate immune system cytokines and organ injury was performed. The protocol was registered at the International Prospective Register of Systematic Reviews: CRD42020187239. Searches of the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase were performed. Random-effects meta-analyses were used for the primary analysis. A separate analysis of individual patient data from six studies (n=785) explored sources of heterogeneity for treatment effects on cytokine levels. RESULTS: Searches to May 2020 identified 251 trials evaluating 24 interventions with 20 582 participants for inclusion. Most trials had important limitations. Methodological limitations of the included trials and heterogeneity of the treatment effects on cytokine levels between trials limited interpretation. The primary analysis demonstrated inconsistency in the direction of the treatment effects on innate immunity and organ failure or death between interventions. Analyses restricted to important subgroups or trials with fewer limitations showed similar results. Meta-regression, pooling available data from all trials, demonstrated no association between the direction of the treatment effects on inflammatory cytokines and organ injury or death. The analysis of individual patient data demonstrated heterogeneity in the association between the cytokine response and organ injury after cardiac surgery for people >75 yr old and those with some chronic diseases. CONCLUSIONS: The certainty of the evidence for a causal relationship between innate immune system activation and organ injury after cardiac surgery is low.
Sujet(s)
Procédures de chirurgie cardiaque/effets indésirables , Immunité innée , Syndrome de réponse inflammatoire généralisée/immunologie , Sujet âgé , Sujet âgé de 80 ans ou plus , Anti-inflammatoires/usage thérapeutique , Procédures de chirurgie cardiaque/mortalité , Cytokines/sang , Cytokines/immunologie , Femelle , Humains , Immunité innée/effets des médicaments et des substances chimiques , Mâle , Adulte d'âge moyen , Essais contrôlés randomisés comme sujet , Appréciation des risques , Facteurs de risque , Syndrome de réponse inflammatoire généralisée/sang , Syndrome de réponse inflammatoire généralisée/mortalité , Syndrome de réponse inflammatoire généralisée/prévention et contrôle , Résultat thérapeutiqueRÉSUMÉ
PURPOSE: There is still scarce data on SARS-CoV-2 infection in patients with Inborn Errors of Immunity (IEI) and many unresolved questions. We aimed to describe the clinical outcome of SARS-CoV-2 infection in Brazilian IEI patients and identify factors influencing the infection. METHODS: We did a cross-sectional, multicenter study that included patients of any age affected by IEI and SARS-CoV-2 infection. The variables studied were sex, age, type of IEI, comorbidities (number and type), treatment in use for IEI, clinical manifestations and severity of SARS-CoV-2 infection. RESULTS: 121 patients were included: 55.4% female, ages from six months to 74 yo (median age = 25.1 yo). Most patients had predominantly antibody deficiency (n = 53). The infection was mostly asymptomatic (n = 21) and mild (n = 66), and one child had multisystem inflammatory syndrome (MIS-C). We could not observe sex-related susceptibility, and there was a weak correlation between age and severity of infection. The number of comorbidities was higher in severe cases, particularly bronchiectasis and cardiopathy. There were no severe cases in hereditary angioedema patients. Six patients aged 2 to 74 years died, three of them with antibody deficiency. CONCLUSION: The outcome was mild in most patients, but the Case Fatality Ratio was higher than in the general population. However, the type of IEI was not a determining factor for severity, except for complement deficiencies linked to milder COVID-19. The severity of SARS-CoV-2 infection seems to be more related to older age, a higher number of comorbidities and type of comorbidities (bronchiectasis and cardiopathy).
Sujet(s)
COVID-19/diagnostic , Maladies d'immunodéficience primaire/diagnostic , SARS-CoV-2/physiologie , Syndrome de réponse inflammatoire généralisée/diagnostic , Adulte , Maladies asymptomatiques , Brésil , COVID-19/mortalité , Études transversales , Évolution de la maladie , Femelle , Humains , Mâle , Adulte d'âge moyen , Maladies d'immunodéficience primaire/mortalité , Indice de gravité de la maladie , Analyse de survie , Syndrome de réponse inflammatoire généralisée/mortalité , Jeune adulteRÉSUMÉ
Critical illness-related corticosteroid insufficiency (CIRCI) refers to a lack of adequate corticosteroid activity, which occurs in up to 48% of dogs with sepsis. However, data regarding the occurrence of CIRCI in critically-ill dogs are still scarce. This study aimed to assess: (1) the relationship between CIRCI and clinicopathological inflammatory markers, hypotension and mortality; and (2) the impact of low-dose hydrocortisone treatment on survival. Twenty-one dogs diagnosed with systemic inflammatory response syndrome (SIRS) were enrolled in a prospective case-control study. All dogs were initially evaluated for adrenal function with an ACTH stimulation test and dogs with Δcortisol ≤ 3 µg/dL were diagnosed with CIRCI. Mean arterial pressure (MAP), white blood cell (WBC), band neutrophils (bNs), c-reactive protein (CRP), and 28-day mortality rate were assessed. Fourteen dogs were treated with low-dose hydrocortisone. The relationships between CIRCI and MAP, WBC, bN, CRP, basal cortisol and mortality were investigated, as was the association between mortality and hydrocortisone treatment. Ten of 21 (48%) dogs were diagnosed with CIRCI. Increased bNs were associated with the presence of CIRCI (P = 0.0075). CRP was higher in dogs with CIRCI (P = 0.02). Fourteen of 21 (66%) dogs died during the study (6/14 had CIRCI). Basal hypercortisolemia (>5 µg/dL) was associated with increased risk of mortality (P = 0.025). Based on our diagnostic criteria, CIRCI occurs frequently in dogs with SIRS and was associated with increased bNs and increased CRP. In this study, CIRCI and low-dose hydrocortisone treatment were not significantly associated with mortality, but basal hypercortisolemia was associated with increased mortality.
Sujet(s)
Hormones corticosurrénaliennes/déficit , Hydrocortisone/usage thérapeutique , Syndrome de réponse inflammatoire généralisée/médecine vétérinaire , Animaux , Études cas-témoins , Maladie grave/mortalité , Maladies des chiens/traitement médicamenteux , Maladies des chiens/physiopathologie , Chiens , Femelle , Hydrocortisone/sang , Hypotension artérielle/médecine vétérinaire , Mâle , Granulocytes neutrophiles , Projets pilotes , Études prospectives , Syndrome de réponse inflammatoire généralisée/traitement médicamenteux , Syndrome de réponse inflammatoire généralisée/mortalité , Syndrome de réponse inflammatoire généralisée/physiopathologieRÉSUMÉ
We describe a child with acute fever and abdominal pain who developed rash and edema of extremities. Blood test revealed thrombocytopenia, lymphopenia, positive dengue-IgM, and hypoalbuminemia with elevated procalcitonin. Right pleural effusion revealed from chest x-ray. Diagnosed as dengue hemorrhagic fever (DHF) grade 1, however, at 7th day of illness, altered mental status, respiratory and circulatory failure occurred. Laboratory examination showed marked thrombocytopenia, transaminitis, metabolic acidosis, elevated D-dimer, decrease fibrinogen, and elevated cardiac marker (troponin I and CKMB). The patient then developed catecholamine-resistant shock and did not survive after 48 hours. Although rapid test of SARS CoV-2 infection was negative, rapid deterioration with some unusual clinical feature suggest multisystem inflammatory syndrome in children (MIS-C) related to SARS-CoV-2 infection. This case raises an awareness of MIS-C that clinical features resemble dengue infection.