Changes in plasma endocan level are related to circulatory but not respiratory failure in critically ill patients with COVID-19.

The aim of this prospective, observational study was to assess whether changes in the level of endocan, a marker of endothelial damage, may be an indicator of clinical deterioration and mortality in critically ill COVID-19 patients. Endocan and clinical parameters were evaluated in 40 patients with acute respiratory failure on days 1-5 after admission to the intensive care unit. Endocan levels were not related to the degree of respiratory failure, but to the presence of cardiovascular failure. In patients with cardiovascular failure, the level of endocan increased over the first 5 days (1.63, 2.50, 2.68, 2.77, 3.31 ng/mL, p = 0.016), while in patients without failure it decreased (1.51, 1.50, 1.56, 1.42, 1.13 ng/mL, p = 0.046). In addition, mortality was more than twice as high in patients with acute cardiovascular failure compared to those without failure (68% vs. 32%, p = 0.035). Baseline endocan levels were lower in viral than in bacterial infections (1.57 ng/mL vs. 5.25 ng/mL, p < 0.001), with a good discrimination between infections of different etiologies (AUC of 0.914, p < 0.001). In conclusion, endocan levels are associated with the occurrence of cardiovascular failure in COVID-19 and depend on the etiology of the infection, with higher values for bacterial than for viral sepsis.

Alterations in Serum Concentration of Soluble CD163 within Five Study Days from ICU Admission Are Associated with In-Hospital Mortality of Septic Patients-A Preliminary Study.

BACKGROUND: CD163, a cell membrane surface molecule specifically expressed by macrophages with an anti-inflammatory phenotype, participates in innate immunity. The purpose of the study was to evaluate the clinical utility of sCD163 in septic patients in comparison to other parameters associated with infections, mainly PCT, CRP and IL-18. METHODS: Serum samples were obtained from 40 septic patients on the ICU admission day, 3rd and 5th study days. The control group consisted of 30 healthy volunteers from whom the specimen was collected once. An enzyme-linked immunosorbent assay (ELISA) was used to determine the concentrations of sCD163 and IL-18. CRP and PCT records, among others, were provided by the hospital. RESULTS: Septic shock was associated with the highest concentrations of sCD163 and IL-18. Admission values of sCD163 significantly contributed to mortality prediction in septic patients. CONCLUSIONS: The concentration of sCD163 determined on the ICU admission day may potentially be utilized in estimation of the odds of death among septic patients.

Intestinal Fatty Acid Binding Protein (I-FABP) as a Prognostic Marker in Critically Ill COVID-19 Patients.

Gastrointestinal symptoms are common in critically ill COVID-19 patients. There is currently no generally recognized method of assessing gastrointestinal injury in unconscious or sedated intensive care unit (ICU) patients. I-FABP (intestinal fatty acid binding protein) and citrulline have previously been studied as potential biomarkers of enterocyte damage in various gastrointestinal tract diseases, and changes in the levels of these markers may reflect intestinal wall damage in COVID-19. Patients with critical COVID-19, with diagnosed sepsis, or septic shock requiring ICU treatment were included in the study. Blood samples for citrulline and I-FABP were taken daily from day 1 to 5. I-FABP levels were significantly higher in patients who eventually died from COVID-19 than in survivors, and the optimal I-FABP cut-off point for predicting 28-day mortality was 668.57 pg/mL (sensitivity 0.739, specificity 0.765). Plasma levels of I-FABP, but not citrulline, were associated with significantly higher mortality and appeared to be a predictor of poor outcome in multivariate logistic regression analysis. In conclusion, I-FABP seems to be an effective prognostic marker in critically ill COVID-19 patients. Assessing mortality risk based on intestinal markers may be helpful in making clinical decisions regarding the management of intestinal injury, imaging diagnostics, and potential surgical interventions.

An analysis of urine and serum amino acids in critically ill patients upon admission by means of targeted LC-MS/MS: a preliminary study.

Sepsis, defined as a dysregulated host response to infection, causes the interruption of homeostasis resulting in metabolic changes. An examination of patient metabolites, such as amino acids, during the early stage of sepsis may facilitate diagnosing and assessing the severity of the sepsis. The aim of this study was to compare patterns of urine and serum amino acids relative to sepsis, septic shock and survival. Urine and serum samples were obtained from healthy volunteers (n = 15) once or patients (n = 15) within 24 h of a diagnosis of sepsis or septic shock. Concentrations of 25 amino acids were measured in urine and serum samples with liquid chromatography-electrospray mass spectrometry. On admission in the whole cohort, AAA, ABA, mHis, APA, Gly-Pro and tPro concentrations were significantly lower in the serum than in the urine and Arg, Gly, His, hPro, Leu, Ile, Lys, Orn, Phe, Sarc, Thr, Tyr, Asn and Gln were significantly higher in the serum than in the urine. The urine Gly-Pro concentration was significantly higher in septic shock than in sepsis. The serum Cit concentration was significantly lower in septic shock than in sepsis. The urine ABA, mHis and Gly-Pro, and serum Arg, hPro and Orn concentrations were over two-fold higher in the septic group compared to the control group. Urine and serum amino acids measured in septic patients on admission to the ICU may shed light on a patient's metabolic condition during sepsis or septic shock.

Influenza in patients with respiratory failure admitted to intensive care units in Poland and the use of extracorporeal respiratory support: a survey-based multicenter study.

BACKGROUND: In Poland, little is known about the most serious cases of influenza that need admittance to the intensive care unit (ICU), as well as the use of extracorporeal respiratory support. METHODS: This was an electronic survey comprising ICUs in two administrative regions of Poland. The aim of the study was to determine the number of influenza patients with respiratory failure admitted to the ICU in the autumn-winter season of 2018/2019. Furthermore, respiratory support, outcome and other pathogens detected in the airways were investigated. RESULTS: Influenza infection was confirmed in 76 patients. The A(H1N1)pdm09 strain was the most common. 34 patients died (44.7%). The median age was 62 years, the median sequential organ failure assessment (SOFA) score was 11 and was higher in patients who died (12 vs. 10, p = 0.017). Mechanical ventilation was used in 75 patients and high flow nasal oxygen therapy in 1 patient. Extracorporeal membrane oxygenation (ECMO) was used in 7 patients (6 survived), and extracorporeal carbon dioxide removal (ECCO2R) in 2 (1 survived). The prone position was used in 16 patients. In addition, other pathogens were detected in the airways on admittance to the ICU. CONCLUSION: A substantial number of influenza infections occurred in the autumn-winter season of 2018/2019 that required costly treatment in the intensive care units. Upon admission to the ICU, influenza patients had a high degree of organ failure as assessed by the SOFA score, and the mortality rate was 44.7%. Advanced extracorporeal respiratory techniques offer real survival opportunities to patients with severe influenza-related ARDS. The presence of coinfection should be considered in patients with influenza and respiratory failure.

Altered profiles of serum amino acids in patients with sepsis and septic shock - Preliminary findings.

BACKGROUND: The clinical and diagnostic significance of systemic amino acids in sepsis and septic shock is unclear. Hence, the purpose of our study was to assess amino acids relationship with sepsis-related clinical data and to analyze whether they might have prognostic and discriminative value in sepsis and septic shock. MATERIALS AND METHODS: Prospective and observational study with 5-day follow-up. Circulating amino acids were measured in 20 patients with sepsis or septic shock diagnosis and 30 healthy volunteers by means of targeted metabolomics (LC-MS/MS). RESULTS: Non-survivors were distinguished by significant elevated concentration of hPro (1st and 2nd day) and by mHis (5th day). Septic shock was associated with significant increased concentration of hPro (1st and 5th day) and Gly-Pro, His, Sarc and Phe (2nd day), Gly-Pro (3rd day) and Gly-Pro and mHis (5th day). In non-survivors was observed the rising trend in concentration of His (P = 0.04; 2nd day) and declining trend in concentration of Asn (P = 0.004; 5th day) and Pro (P = 0.03; 3rd day). In septic shock was observed mainly the declining trend in concentration of Arg (P = 0.03; 5th day), APA (P = 0.04; 2nd day), Lys (P = 0.02; 5th day), Sarc (P = 0.04; 5th day), Ser (P = 0.02; 5th day), Val (P = 0.04; 5th day), Trp (P = 0.03; 5th day) and Gly-Pro (P = 0.03; 2nd day; P = 0.02; 3rd day). CONCLUSION: Sepsis and septic shock are associated with altered concentration of serum amino acids indicative particularly of the intensified breakdown of muscle and connective tissue proteins leading to the accumulation of their characteristic degradation products. Some amino acids hold potential as predictors of sepsis progression and outcome but, in the light of discrepancies between studies, should be assessed in more numerous cohort study.

Sepsis diagnosis and monitoring - procalcitonin as standard, but what next?

Sepsis is a life-threatening organ dysfunction caused by a systemic altered host response to infection. According to the newest guidelines the sepsis treatment should be personalized and based on an approach specified by use of biomarkers to tailor therapy to each patient's needs. The main features of such biomarkers should be high specificity, sensitivity and ability to monitor the progress of sepsis. There is limited application of procalcitonin (PCT), C-reactive protein (CRP) and interleukin-6 (IL-6) for reaching this target, because of their secretion during non-infectious processes. The purpose of this review was to introduce four biomarkers, i.e. kallistatin, testican-1, presepsin and mid-regional pro-adrenomedullin, and compare their usefulness in diagnosing sepsis with PCT, CRP and IL-6.

Interleukin-18 serum levels in sepsis: Correlation with disease severity and inflammatory markers.

PURPOSE: Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection and a syndrome shaped by pathogen and host factors with characteristic that evolve over time. The study was conducted to evaluate the prognostic and discriminative value of IL-18 assessment in comparison to PCT, CRP, WBC in early stage of sepsis and septic shock. METHODS: An observational and prospective study was conducted in the group of 40 ICU patients with diagnosis of sepsis or septic shock, serum PCT, IL-18, CRP and WBC measurements were performed on admission, and on the 2nd, 3rd and 5th therapy day. The level of IL-18 was determined with commercially available test according to manufacturer's protocol. RESULTS: There were no statistically significant differences in IL-18 levels in survivors vs non-survivors and in sepsis vs septic shock subgroups the IL-18 levels were statistically significant in the course of the study except for the 5th day. CONCLUSION: The PCT, CRP and WBC levels revealed no significant differences between any analyzed subgroups in all time points during study. According to our results the IL-18 is a biomarker better differentiating sepsis and septic shock status than PCT, CRP and WBC but with no prognostic impact.

Neutrophils, NETs, NETosis - old or new factors in sepsis and septic shock?

Neutrophils are an key part of the innate immune system in the host's defences against pathogens. Circulating neutrophils are recruited at the sites of infection or sterile inflammation in response to pathogen and host-derived inflammatory mediators. In addition to phagocytosis and degranulation, neutrophils display the release of NETs in order to restrain infection. NETs are able to entrap and kill microbes, and display proinflammatory and prothrombotic properties.

Platelets in sepsis - are there any new aspects?

Platelets display a number of properties besides the crucial function of repairing a damaged vascular endothelium and stopping bleeding. Platelets constitutively express molecules that are classically acknowledged to function in primary haemostasis. Platelets specialize in pro-inflammatory activities, and can secrete a large number of molecules, many of which display biological response modifier functions. Recently, platelets expressing receptors for infectious and possibly noninfectious danger signals were shown to be involved in pathophysiological reactions including an immune-inflammatory response. In sepsis, platelets play a key role in immunothrombosis, participate in the formation of NETs (neutrophil extracellular trap) resulting in the trapping and killing of pathogens and are one of the main factors influencing mortality.

Coagulopathy in sepsis - a new look at an old problem.

Sepsis is a life-threatening condition characterized by a systemic response to microbial infection. Despite considerable progress in intensive care medicine, the incidence of sepsis and the number of sepsis-related deaths are increasing world-wide. There is a complex relationship between the coagulation, immune and inflammatory systems in sepsis. Activation of the coagulation cascade in sepsis is a result of a pathogen invasion and is a part of a immuno-inflammatory host response. In sepsis, the close cooperation of the immune and coagulation systems through cross signalling results in immunothrombosis. According to a recently described new theory, immunothrombosis is a immune response in which the local activation of coagulation facilitates the recognition and destruction of pathogens. Small amounts of clot formation are beneficial for the host because of bacteria trapping and prevention of the systemic spread of infection. Sepsis is a dynamic syndrome and in all patients with sepsis coagulation changes may progress from a normal profile to hypercoagulability and hypofibrinolysis, hyperfibrinolysis, and ultimately hypocoagulability.

Sepsis and septic shock-is a microcirculation a main player?

Shock, defined at a cellular level, is a condition in which oxygen delivery to the cells is not sufficient to sustain cellular activity and support organ function. The central role of microcirculation in providing oxygen to the cells makes it of prime importance in determining organ function. In sepsis and septic shock, macrocirculatory alterations and microcirculatory dysfunction participate concurrently in the pathophysiology of organ failure. Haemodynamic coherence in shock is a condition in which normalization of systemic haemodynamic variables results in simultaneous amelioration in the perfusion of the microcirculation and restoration of tissue oxygenation as a final result. Septic shock is most frequently characterized by a lack of microcirculatory recruitment despite of macrocirculatory successful resuscitation. The lack of haemodynamic coherence between macrocirculation and microcirculation in septic patients results in treatment failure and increased mortality. The monitoring of microcirculation and the effects of its changes are an important area of future clinical research and treatment modification.

Procalcitonin kinetics - prognostic and diagnostic significance in septic patients.

INTRODUCTION: Severe sepsis and septic shock are advanced clinical conditions representing the patient's response to infection and having a variable but high mortality rate. Early evaluation of sepsis stage and choice of adequate treatment are key factors for survival. Some study results suggest the necessity of daily procalcitonin (PCT) monitoring because of its prognostic and discriminative value. MATERIAL AND METHODS: An observational and prospective study was conducted to evaluate the prognostic and discriminative value of PCT kinetics in comparison to PCT absolute value measurements. In a group of 50 intensive care unit patients with diagnosis of severe sepsis or septic shock, serum PCT measurements were performed on admission, and on the 2(nd), 3(rd) and 5(th) day of therapy. The level of PCT was determined with a commercially available test according to the manufacturer's protocol. RESULTS: The kinetics of PCT assessed by ΔPCT was statistically significant in the survivors vs. the non-survivors subgroup (ΔPCT3/1, p = 0.022; ΔPCT5/1, p = 0.021). ΔPCT has no statistical significance in the severe sepsis and septic shock subgroups for all analyzed days. Only the 5(th) day PCT level was significantly higher in the non-survivors vs. survivors group (p = 0.008). The 1(st) day PCT level in the severe sepsis vs. septic shock group has a discriminative impact (p = 0.009). CONCLUSIONS: According to the results, single serum PCT measurement, regardless of absolute value, has a discriminative impact but no prognostic significance, during the first 2 days of therapy. The PCT kinetics is of prognostic value from the 3(rd) day and is of earlier prognostic significance in comparison to changes in the patient's clinical condition evaluated by SOFA score kinetics.

Recommendations for the management of trauma or surgery-related massive blood loss.

UNLABELLED: Exsanguination is an underestimated cause of treatment failures in patients with severe trauma or undergoing surgery. In some patients the primary dysfunction of blood clot formation is a direct cause of a massive blood loss. Patients without previous coagulation disorders are at risk of coagulopathy following intraoperative or post-traumatic bleeding, where the local haemostasis does not warrant bleeding cessation. THE AIM OF THE STUDY: was to assess the therapeutic value of various components of a complex interdisciplinary approach, based on the opinion of the experts treating patients with massive bleeding. MATERIAL AND METHODS: The study was conducted by anonymous questionnaire, using the analogue representation of the argument strength. The results were analyzed based on the techniques of descriptive statistics. The argument was considered a key parameter, when the median value of strength was located in the highest quartile. RESULTS: It was found that the arguments of the highest strength for the risk of developing the posthaemorrhagic coagulation disorders are: loss of more than one third of blood volume, fluid therapy in an amount greater than 35 ml/kg, administration of more than 5 units of packed red blood cells, insufficient supply of fresh frozen plasma and platelets in proportion to packed red blood cells, severe acidosis and hypothermia. The most important tests for post-haemorrhage coagulopathy are: anatomically non-localized bleed, abnormal values of the standard coagulation parameters and fibrinogen level below 1 g/L. In the treatment of post-haemorrhagic coagulopathy the team of experts pointed out the benefits of antifibrinolytic drugs, concentrates of prothrombin complex and recombinant activated coagulation factor VII. CONCLUSIONS: Multidisciplinary therapeutic management of bleeding patients is associated with employment of appropriate treatment methods to achieve the best possible outcome. Factors influencing the development of coagulopathy, the methods of diagnosis and proposed techniques of treatment may facilitate therapeutic decisions in bleeding patients requiring massive transfusion of blood components.

[Haemorrhagic shock complicating acute pancreatitis]. / Wstrzas krwotoczny w przebiegu powilanego zapalenia trzustki.

BACKGROUND: Acute pancreatitis may be accompanied by a number of complications. They include diffuse peritonitis, intra-abdominal and retroperitoneal abscesses, and severe haemorrhage. These complications are the cause of approximately 50% of all deaths in acute pancreatitis. CASE REPORT: A 33-year-old man was admitted to ITU with septic shock, due to acute pancreatitis and necrosis after multiple surgeries. On the fifth day after admission, his condition deteriorated due to respiratory distress and massive bleeding from the splenic region requiring surgical packing. On the next day, the bleeding became critical. More than 2000 mL of blood was evacuated from the peritoneal cavity, the bleeding site was re-packed, and the patient was transfused with RBCs, FFP and 0.04 mg kg(-1) of recombinant factor VIIa concentrate. This resulted in haemostasis, however the subsequent clinical course was complicated by septic shock, perforation of the transverse colon and peritonitis. The patient eventually recovered and was discharged home after 105 days in hospital. CONCLUSION: Multifactorial management of acute pancreatitis is essential; in cases of severe haemorrhage, surgical packing and administration of recombinant factor VIIa concentrate are key components of successful treatment.

End-of-life attitudes of intensive care physicians in Poland: results of a national survey.

PURPOSE: This study was designed to assess the ethical attitudes and practices of intensive care physicians regarding life-sustaining treatment in intensive care units (ICUs) in Poland. METHODS: A questionnaire was distributed to intensive care physicians taking part in a national medical congress. Participation in the study was voluntary and anonymous. RESULTS: A total of 400 questionnaires were distributed, of which 217 (54%) were returned completed. Almost all respondents (93%) reported having withheld therapy, and 75% of respondents reported withdrawing therapy. Physicians aged 40 years and over who had no religious affiliation more frequently reported withholding treatment. Only 5% of physicians reported deliberately administering drugs until death ensued. Respondents from large hospitals (more than 400 beds) more easily accepted foregoing life-sustaining therapy in ICU patients. In clinical scenario in which the family demanded the maximum available treatment, physicians reported that they were considerably influenced to modify decisions concerning life-sustaining therapy. CONCLUSIONS: The ethical attitudes of intensive care physicians regarding end-of-life decisions are similar to the opinion presented in other European survey studies. The practice of withholding and withdrawing therapy in ICU patients is common in Poland. Actively shortening life is considered unacceptable. The request of the family even without legal consultation can influence physicians' decisions.

[Newborn-child of substance dependent mother--always actual problem]. / Noworodek matki uzaleznionej--wciaz aktualny problem.

The adverse effects on fetal development of alcohol and other drugs such as tobacco, psychostimulants and opioids are well known. Women who are pregnant or who may become pregnant are therefore a high priority for interventions to reduce drug use. Substances discussed in this article include the licit substances (alcohol and tobacco), illicit substances (opioids and other drugs), and prescription medication known for its misuse (benzodiazepines and barbiturates). Other topics covered include breastfeeding, vertical transmission of blood-borne viruses, psychosocial issues, the management of neonatal abstinence syndrome and early childhood development.

[A giant left atrial myxoma as a cause of a low cardiac output syndrome: a case report]. / Dyslokacja olbrzymiego sluzaka lewego przedsionka jako przyczyna zespolu malego rzutu.

A case of a 75-year-old female with a giant left atrial myxoma (54 x 42 mm in transthoracic echocardiography) is presented. She remained in a stable condition, however, developed a low cardiac output syndrome shortly after echocardiographic examination. This was caused by tumour displacement from the atrial wall into the left ventricle. The patient underwent urgent surgery during which the tumour was successfully removed. Histopathological examination confirmed the diagnosis of myxoma. Six months after surgery the patient is doing well.