Associations between interleukin-1-B gene -511G/A polymorphism and sepsis risk: A meta-analysis.

The role of the cytokine (IL) gene has been indicated in the progression of sepsis. Nevertheless, the outcomes remain controversial. This meta-analysis aimed to examine the relationship of IL-1B gene -511G/A polymorphism and the risk of sepsis. To perform a retrospective database analysis, the CNKI PubMed,EMBASE and Cochrane Library databases were searched for related articles. Then, the combined odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) were calculated using a fixed- or a random-effects model. A total of six related articles were discovered. The result of the meta-analysis showed that IL-1B -511G/A polymorphism was not significantly correlated with sepsis risk in the total population, but in the subgroup analysis we found that IL-1B -511G/A polymorphism was associated with sepsis risk in Caucasian populations (A vs. G: OR = 1.22, 95 %CI = 1.01-1.48; AA vs. GG: OR = 2.14, 95 %CI = 1.33-3.43; Recessive model: OR = 2.59, 95 %CI = 1.68-4.01). This meta-analysis showed that the IL-1B -511A allele might be a low-penetrant risk factor for sepsis in Caucasians.

Interleukin-1 Beta +3594 C/T Gene Polymorphism and Susceptibility to Sepsis: A Meta-Analysis.

Emerging evidence has indicated that the interleukin-1B (IL-1B) +3954 C > T polymorphism may affect individual susceptibility to sepsis. However, the results of published studies are inconclusive. The aim of this meta-analysis was to elucidate the association of this polymorphism with sepsis risk. Eligible studies were identified by a search of electronic databases. Overall and subgroup analyses were performed. Odds ratio (OR) and 95% confidence interval (CI) were applied to assess the associations between the IL-1B +3954 C > T polymorphism and sepsis risk. Six case-control studies were included in this meta-analysis. The pooled analysis indicated that the IL-1B +3954 C > T polymorphism significantly decreased the risk of sepsis under the homozygote model (TT vs. CC: OR = 0.57, 95% CI:0.37-0.88). In stratified analysis, we found that the protective effect of the IL-1B +3954 C > T polymorphism on sepsis risk remained significant in the subgroup of Caucasians and for high-quality studies. In conclusion, the IL-1B +3954 C > T polymorphism is associated with decreased sepsis risk in Caucasians. Further well-designed studies with large sample sizes are required to confirm this conclusion.

The effects of statin therapy on mortality in patients with sepsis: A meta-analysis of randomized trials.

BACKGROUND: Much controversy persists regarding the role of statins therapy in patients with sepsis. This systematic review and meta-analysis of randomized trials aimed to evaluate the clinical efficacy of statin therapy on mortality from sepsis. METHODS: We comprehensively searched PubMed, Embase, and Cochrane controlled trials register for relevant clinical studies. Randomized controlled trials reporting the effect of statin therapy on mortality in septic patients were included. Pooled risk estimates were calculated with a fixed-effects model. Heterogeneity was determined by Cochran chi-square test and the I statistic. RESULTS: Nine trials with a total of 2333 patients were included. Seven randomized trials were eligible for the in-hospital mortality analysis. There were 257 deaths among 1078 individuals in the statin treatment group and 268 deaths among 1081 individuals in the control group. There was no statistically significant difference (RR, 0.96; 95% CI, 0.83-1.11). Five randomized trials reported data on 28 day-hospital mortality. There were 123 deaths among 613 individuals in the statin treatment group and 141 deaths among 633 individuals in the control group. There was no statistically significant difference (RR, 0.90; 95% CI, 0.73-1.11). CONCLUSION: This systematic review and meta-analysis of randomized trials indicates that statin therapy has no effect on mortality outcomes in patients with sepsis compared with placebo.

Effectiveness of enteral feeding protocol on clinical outcomes in critically ill patients: A before and after study.

BACKGROUND AND OBJECTIVE: Enteral nutrition (EN) feeding protocol was proposed to have positive impact on critically ill patients. However, current studies showed conflicting results. The present study aimed to investigate whether enteral feeding protocol was able to improve clinical outcomes in critically ill patients. METHODS: A before (stage 1) and after (stage 2) interventional study was performed in 10 tertiary care hospitals. All patients expected to stay in the intensive care unit (ICU) for over three days were potentially eligible. Clinical outcomes such as 28-day mortality, ICU length of stay, duration of mechanical ventilation (MV), and nosocomial infection were compared between the two stages. MAIN RESULTS: A total of 410 patients were enrolled during the study period, including 236 in stage 1 and 174 in stage 2. EN feeding protocol was able to increase the proportion of EN in day 2 (41.8±22.3 vs. 50.0±28.3%; p = 0.006) and day 6 (70.3±25.2 vs. 77.6±25.8%; p = 0.006). EN percentages tended to be higher in stage 1 than that in stage 2 on other days, but statistical significance was not reached. There was no difference in 28-day mortality between stage 1 and 2 (0.14 vs. 0.14; p = 0.984). Implementation of EN feeding protocol marginally reduced ICU length of stay (19.44±18.48 vs. 16.29±16.19 days; p = 0.077). There was no difference in the duration of MV between stage a and stage 2 (14.24±14.49 vs. 14.51±17.55 days; p = 0.877). CONCLUSIONS: The study found that the EN feeding protocol was able to increase the proportion of EN feeding, but failed to reduce 28-day mortality, incidence of nosocomial infection or duration of MV.

Effect of rhubarb on extravascular lung water in patients with acute respiratory distress syndrome.

OBJECTIVE:: The aim of this study was to evaluate the effect of rhubarb on extravascular lung water (EVLW) in patients with acute respiratory distress syndrome (ARDS). METHOD:: A total of 80 patients with ARDS were randomly divided into a treatment group (40 cases) and control group (40 cases). Patients in the treatment group received rhubarb (30.0 g/d) and patients in the control group received conventional therapy for seven consecutive days. Extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI) were determined using pulse contour cardiac output (PiCCO) technology, and the oxygenation index was measured by blood gas analysis at baseline and on days 3, 5 and 7 after treatment. RESULTS:: The oxygenation index was higher and the levels of EVLWI and PVPI were lower after treatment in the two groups; however, these indexes showed significant differences on the 5th and 7th days after rhubarb treatment compared with the results in the control group (p<0.05). CONCLUSION:: Rhubarb can decrease EVLWI and PVPI, and improve oxygenation in patients with ARDS.

Effect of rhubarb on extravascular lung water in patients with acute respiratory distress syndrome

Summary Objective: The aim of this study was to evaluate the effect of rhubarb on extravascular lung water (EVLW) in patients with acute respiratory distress syndrome (ARDS). Method: A total of 80 patients with ARDS were randomly divided into a treatment group (40 cases) and control group (40 cases). Patients in the treatment group received rhubarb (30.0 g/d) and patients in the control group received conventional therapy for seven consecutive days. Extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI) were determined using pulse contour cardiac output (PiCCO) technology, and the oxygenation index was measured by blood gas analysis at baseline and on days 3, 5 and 7 after treatment. Results: The oxygenation index was higher and the levels of EVLWI and PVPI were lower after treatment in the two groups; however, these indexes showed significant differences on the 5th and 7th days after rhubarb treatment compared with the results in the control group (p<0.05). Conclusion: Rhubarb can decrease EVLWI and PVPI, and improve oxygenation in patients with ARDS.

Peripheral arterial volume distensibility changes with applied external pressure: significant difference between arteries with different compliance.

This study aimed to quantify the different effect of external cuff pressure on arterial volume distensibility between peripheral arteries with different compliance. 30 healthy subjects were studied with the arm at two positions (0° and 45° from the horizontal level) to introduce different compliance of arteries. The electrocardiogram and finger and ear photoplethysmograms were recorded simultaneously under five external cuff pressures (0, 10, 20, 30 and 40 mmHg) on the whole arm to obtain arterial volume distensibility. With the applied external cuff pressures of 10, 20, 30 and 40 mmHg, the overall changes in arterial volume distensibility referred to those without external pressure were 0.010, 0.029, 0.054 and 0.108% per mmHg for the arm at the horizontal level, and 0.026, 0.071, 0.170 and 0.389% per mmHg for the arm at 45° from the horizontal level, confirming the non-linearity between arterial volume distensibility and external pressure. More interestingly, the significant differences in arterial volume distensibility changes were observed between the two arm positions, which were 0.016, 0.043, 0.116 and 0.281% per mmHg (all P < 0.01). Our findings demonstrated that arterial volume distensibility of peripheral arm arteries increased with external pressure, with a greater effect for more compliant arteries.

Effectiveness of enteral feeding protocol on clinical outcomes in critically ill patients: a study protocol for before-and-after design.

INTRODUCTION: Enteral feed is an important component of nutritional therapy in critically ill patients and underfeeding has been associated with adverse outcomes. The article developed an enteral feeding protocol and planed a before-and-after comparative trial to explore whether implementation of enteral feeding protocol was able to improve clinical outcomes. METHODS AND ANALYSIS: The study will be conducted in intensive care units (ICUs) of ten tertiary care academic centers. Critically ill patients expected to stay in ICU for over 3 days and require enteral nutrition (EN) were potentially eligible. This is a before-and-after study comprising three phases: The first phase is the period without enteral feeding protocol; the second phase involves four-week training program, and the last phase is to perform the protocol in participating centers. We plan to enroll a total of 350 patients to provide an 80% power and 0.05 error rate to detect a 15% reduction of mortality. The primary outcome is 28-day mortality. ETHICS AND DISSEMINATION: Ethical approval to conduct the research has been obtained from all participating centers. Additionally, the results will be published in peer-reviewed journal. TRIAL REGISTRATION: The study was registered at International Standard Registered Clinical/soCial sTudy Number (ISRCTN) registry (ISRCTN10583582).