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1.
Medicine (Baltimore) ; 100(12): e25143, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33761680

RESUMO

BACKGROUND: Whether to use limited fluid resuscitation (LFR) in patients with hemorrhagic shock or septic shock remains controversial. This research was aimed to assess the pros and cons of utilizing LFR in hemorrhagic shock or septic shock patients. METHODS: PubMed, Cochrane Library, Embase, Web of science, CNKI, VIP, and Wan Fang database searches included for articles published before December 15, 2020. Randomized controlled trials of LFR or adequate fluid resuscitation in hemorrhagic shock or septic shock patients were selected. RESULT: This meta-analysis including 28 randomized controlled trials (RCTs) and registered 3288 patients. The 7 of 27 RCTs were the patients with septic shock. Others were traumatic hemorrhagic shock patients. Comparing LFR or adequate fluid resuscitation in hemorrhagic shock or septic shock patients, the summary odds ratio (OR) was 0.50 (95% confidence interval [CI] 0.42-0.60, P < .00001) for mortality, 0.46 (95% CI 0.31-0.70, P = .0002) for multiple organ dysfunction syndrome (MODS), 0.35 (95% CI 0.25-0.47) for acute respiratory distress syndrome (ARDS), and 0.33 (95% CI 0.20-0.56) for disseminated intravascular coagulation (DIC). CONCLUSION: Limited fluid resuscitation is the benefit of both traumatic hemorrhagic shock patients and septic shock patients.


Assuntos
Hidratação/mortalidade , Ressuscitação/mortalidade , Choque Hemorrágico/terapia , Choque Séptico/terapia , Choque Traumático/terapia , Hidratação/métodos , Humanos , Insuficiência de Múltiplos Órgãos/etiologia , Insuficiência de Múltiplos Órgãos/mortalidade , Razão de Chances , Ensaios Clínicos Controlados Aleatórios como Assunto , /mortalidade , Ressuscitação/métodos , Choque Hemorrágico/complicações , Choque Hemorrágico/mortalidade , Choque Séptico/complicações , Choque Séptico/mortalidade , Choque Traumático/complicações , Choque Traumático/mortalidade , Resultado do Tratamento
3.
Sci Rep ; 11(1): 4263, 2021 02 19.
Artigo em Inglês | MEDLINE | ID: mdl-33608563

RESUMO

Infection by the new corona virus strain SARS-CoV-2 and its related syndrome COVID-19 has been associated with more than two million deaths worldwide. Patients of higher age and with preexisting chronic health conditions are at an increased risk of fatal disease outcome. However, detailed information on causes of death and the contribution of pre-existing health conditions to death yet is missing, which can be reliably established by autopsy only. We performed full body autopsies on 26 patients that had died after SARS-CoV-2 infection and COVID-19 at the Charité University Hospital Berlin, Germany, or at associated teaching hospitals. We systematically evaluated causes of death and pre-existing health conditions. Additionally, clinical records and death certificates were evaluated. We report findings on causes of death and comorbidities of 26 decedents that had clinically presented with severe COVID-19. We found that septic shock and multi organ failure was the most common immediate cause of death, often due to suppurative pulmonary infection. Respiratory failure due to diffuse alveolar damage presented as immediate cause of death in fewer cases. Several comorbidities, such as hypertension, ischemic heart disease, and obesity were present in the vast majority of patients. Our findings reveal that causes of death were directly related to COVID-19 in the majority of decedents, while they appear not to be an immediate result of preexisting health conditions and comorbidities. We therefore suggest that the majority of patients had died of COVID-19 with only contributory implications of preexisting health conditions to the mechanism of death.


Assuntos
/mortalidade , Causas de Morte , Mortalidade Hospitalar , Adulto , Idoso , Idoso de 80 Anos ou mais , Autopsia , Berlim/epidemiologia , /terapia , Comorbidade , Feminino , Hospitais de Ensino/estatística & dados numéricos , Humanos , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/mortalidade , Insuficiência de Múltiplos Órgãos/virologia , Isquemia Miocárdica/epidemiologia , Obesidade/epidemiologia , Estudos Prospectivos , Choque Séptico/mortalidade , Choque Séptico/virologia
4.
Medicine (Baltimore) ; 99(36): e21596, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32898996

RESUMO

INTRODUCTION: Globally, the coronavirus disease 2019 (COVID-19) is still spreading rapidly. At present, there are no specifically approved therapeutic agents or vaccines for its treatment. Previous studies have shown that the convalescent plasma therapy (CPT) is effective in patients with COVID-19. However, its efficacy in patients with persistently positive nucleic acid test is unknown. PATIENT CONCERNS: In this report, we present the clinical data of 5 critically ill COVID-19 patients admitted, between January 16 and February 26, 2020, in intensive care unit of Xiaogan Central Hospital. DIAGNOSIS AND INTERVENTIONS: All these patients had a persistently positive nucleic acid test and received CPT. All 5 patients had severe respiratory failure, and thus, required invasive mechanical ventilation. The median time from the onset of symptoms to initiating the CPT was 37 (Interquartile range, 34-44) days. OUTCOMES: Only 2 patients were cured and subsequently discharged, while 3 patients succumbed due to multiple organ failure. CONCLUSION: The time of initiating the CPT may be an important factor affecting its efficacy, and its therapeutic effect in the treatment of COVID-19, in the late stage, is limited.


Assuntos
Infecções por Coronavirus/terapia , Estado Terminal/terapia , Pneumonia Viral/terapia , APACHE , Idoso , Betacoronavirus , Infecções por Coronavirus/mortalidade , Estado Terminal/mortalidade , Feminino , Humanos , Imunização Passiva , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/mortalidade , Técnicas de Amplificação de Ácido Nucleico , Pandemias , Pneumonia Viral/mortalidade , Respiração Artificial
5.
Medicine (Baltimore) ; 99(36): e22075, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899077

RESUMO

Red blood cell distribution width (RDW) is a component of routine complete blood count, which reflects variability in the size of circulating erythrocytes. Recently, there have been many reports about RDW as a strong prognostic marker in various disease conditions in the adult population. However, only a few studies have been performed in children. This study aimed to investigate the association between RDW and pediatric intensive care unit (PICU) mortality in critically ill children. This study includes 960 patients admitted to the PICU from November 2012 to May 2018. We evaluated the associations between RDW and clinical parameters including PICU mortality outcomes. The median age of the study population was 15.5 (interquartile range, 4.8-54.5) months. The mean RDW was 15.6% ±â€Š3.3%. The overall PICU mortality was 8.8%. As we categorized patients into 3 groups with respect to RDW values (Group 1: ≤14.5%; Group 2: 14.5%-16.5%; and Group 3: >16.5%) and compared clinical parameters, the higher RDW groups (Groups 2 and 3) showed more use of vasoactive-inotropic drugs, mechanical ventilator support, higher severity scores, including pediatric risk of mortality III, pediatric sequential organ failure assessment, pediatric logistic organ dysfunction-2 (PELOD-2), and pediatric multiple organ dysfunction syndrome scores, and higher PICU mortality than the lower RDW group (Group 1) (P < .05). Based on multivariate logistic regression analysis adjusted for age and sex, higher RDW value (≥14.5%) was an independent risk factor of PICU mortality. Moreover, adding RDW improved the performance of the PELOD-2 score in predicting PICU mortality (category-free net reclassification index 0.357, 95% confidence interval 0.153-0.562, P = .001). In conclusion, higher RDW value was significantly associated with worse clinical parameters including PICU mortality. RDW was an independent risk factor of PICU mortality and the addition of RDW significantly improved the performance of PELOD-2 score in predicting PICU mortality. Thus, RDW could be a promising prognostic factor with advantages of simple and easy measurement in critically ill pediatric patients.


Assuntos
Estado Terminal/mortalidade , Mortalidade Hospitalar/tendências , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Fatores Etários , Biomarcadores , Pré-Escolar , Índices de Eritrócitos , Feminino , Humanos , Lactente , Masculino , Insuficiência de Múltiplos Órgãos/mortalidade , Escores de Disfunção Orgânica , Prognóstico , Estudos Prospectivos , Curva ROC , República da Coreia/epidemiologia , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais
6.
Medicine (Baltimore) ; 99(31): e21491, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756180

RESUMO

BACKGROUND: To investigate the effect of high-volume hemofiltration (HVHF) on Th17/Treg imbalance in patients with severe acute pancreatitis (SAP). METHODS: Forty-two patients with SAP were randomly received 24 hours of continuous HVHF (n = 21) or without HVHF (n = 21). At day 28, all 42 patients were divided into survival group (n = 32) and non-survival group (n = 10). Venous blood samples collected at 0, 6, 12, and 24 hours during HVHF treatment (or equivalent time in non-HVHF group) were assessed by flow cytometry to detect Th17 and Treg cells. Concentrations of IL-6, IL-17, IL-10, and TGF-ß1 were detected by enzyme-linked immunosorbent assay. RESULTS: Th17%, Treg%, Th17/Treg, and levels of related cytokines were significantly higher in SAP patients than healthy controls (P < .05), and these changes were more pronounced in SAP patients with multiple organ failure than those with single organ failure (P < .05). After HVHF treatment, Th17%, Treg%, Th17/Treg, IL-6, IL-17, and IL-10 significantly reduced (P < .05), while there were no significant changes in non-HVHF group (P > .05). In addition, acute physiology and chronic health evaluation II and sequential organ failure assessment scores decreased markedly after HVHF treatment. Baselines of Th17%, Treg%, Th17/Treg, and related cytokines were significantly higher in non-survival group than survival group. Both acute physiology and chronic health evaluation I score and IL-6 level were positively correlated with Th17% before and after HVHF treatment (P < .01). CONCLUSIONS: Th17/Treg imbalance is present in SAP and may be correlated with its severity and prognosis. HVHF effectively attenuates the Th17/Treg imbalance in SAP patients. The beneficial effect of HVHF on Th17/Treg imbalance is possibly associated with removing excess inflammatory mediators.


Assuntos
Hemofiltração/métodos , Pancreatite/sangue , Pancreatite/terapia , Linfócitos T Reguladores/metabolismo , Células Th17/metabolismo , Doença Aguda , Adulto , Idoso , Citocinas/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/sangue , Insuficiência de Múltiplos Órgãos/mortalidade , Insuficiência de Múltiplos Órgãos/terapia , Pancreatite/mortalidade , Resultado do Tratamento , Adulto Jovem
7.
Chem Biol Interact ; 329: 109220, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32763245

RESUMO

The sepsis is considered as serious clinic-pathological condition related with high rate of morbidity and mortality in critical care settings. In the proposed study, the hydrazides derivatives N-(benzylidene)-2-((2-hydroxynaphthalen-1-yl)diazenyl)benzohydrazides (1-2) (NCHDH and NTHDH) were investigated against the LPS-induced sepsis in rodents. The NCHDH and NTHDH markedly improved the physiological sign and symptoms associated with the sepsis such as mortality, temperature, and clinical scoring compared to negative control group, which received only LPS (i.p.). The NCHDH and NTHDH also inhibited the production of the NO and MPO compared to the negative control. Furthermore, the treatment control improved the histological changes markedly of all the vital organs. Additionally, the Masson's trichrome and PAS (Periodic Acid Schiff) staining also showed improvement in the NCHDH and NTHDH treated group in contrast to LPS-induced group. The antioxidants were enhanced by the intervention of the NCHDH and NTHDH and the level of the MDA and POD were attenuated marginally compared to the LPS-induced group. The hematology study showed marked improvement and the reversal of the LPS-induced changes in blood composition compared to the negative control. The synthetic function of the liver and kidney were preserved in the NCHDH and NTHDH treated group compared to the LPS-induced group. The NCHDH and NTHDH markedly enhanced the Nrf2, HO-1 (Heme oxygenase-1), while attenuated the Keap1 and TRPV1 expression level as compared to LPS treated group. Furthermore, the NCHDH and NTHDH treatment showed marked increased in the mRNA expression level of the HSP70/90 proteins compared to the negative control.


Assuntos
Hidrazinas/farmacologia , Insuficiência de Múltiplos Órgãos/etiologia , Sepse/etiologia , Transdução de Sinais/efeitos dos fármacos , Animais , Sobrevivência Celular/efeitos dos fármacos , Proteínas de Choque Térmico/genética , Proteínas de Choque Térmico/metabolismo , Heme Oxigenase-1/metabolismo , Hidrazinas/química , Hidrazinas/uso terapêutico , Proteína 1 Associada a ECH Semelhante a Kelch/genética , Proteína 1 Associada a ECH Semelhante a Kelch/metabolismo , Lipopolissacarídeos/toxicidade , Fígado/efeitos dos fármacos , Fígado/metabolismo , Fígado/patologia , Macrófagos/citologia , Macrófagos/efeitos dos fármacos , Macrófagos/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Insuficiência de Múltiplos Órgãos/tratamento farmacológico , Insuficiência de Múltiplos Órgãos/mortalidade , Fator 2 Relacionado a NF-E2/metabolismo , Óxido Nítrico/metabolismo , Estresse Oxidativo/efeitos dos fármacos , Peroxidase/metabolismo , Sepse/tratamento farmacológico , Sepse/mortalidade , Canais de Cátion TRPV/genética , Canais de Cátion TRPV/metabolismo
8.
Nursing ; 50(7): 54-60, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32558792

RESUMO

The prognosis for a patient with multiple organ dysfunction syndrome (MODS)-also known as organ dysfunction or organ failure-is grave, and mortality can be high when three or more organ systems fail. This article reviews ongoing abnormalities of organ-specific parameters and a bedside clinical scoring assessment tool to identify the mortality of MODS, focusing on the management of MODS resulting from cardiogenic shock in ICU patients who require support of failing organs to survive.


Assuntos
Insuficiência de Múltiplos Órgãos/enfermagem , Choque Cardiogênico/enfermagem , Humanos , Unidades de Terapia Intensiva , Insuficiência de Múltiplos Órgãos/etiologia , Insuficiência de Múltiplos Órgãos/mortalidade , Insuficiência de Múltiplos Órgãos/fisiopatologia , Avaliação em Enfermagem , Diagnóstico de Enfermagem , Testes Imediatos , Choque Cardiogênico/complicações
9.
Med Clin (Barc) ; 155(5): 191-196, 2020 09 11.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32586669

RESUMO

OBJECTIVE: The purpose of our study was to assess organ function in 102 patients with severe COVID-19 infections, using retrospective clinical analysis. MATERIAL AND METHODS: A retrospective analysis was conducted on 102 patients with severe COVID-19 infections. The patients were divided into a survival group (n=73) and a non-survival group (n=29) according to their prognosis. The age, sex, underlying diseases, clinical laboratory data within 48h (routine blood tests, ALT, AST, TBIL, ALB, BUN, CR, D-Dimer, PT, APTT, FIB, F VIII:C, CK-MB, CK, and LDH), and ventilation status were collected. The organ functions of these severe COVID-19 patients were assessed by comparing the differences between the two groups. RESULTS: AST, BUN, CR, CK-MB, LDH, and CK in the non-survival group were higher than those in the survival group, and the differences were statistically significant (P<0.05). D-Dimer, PT, FIB, and F VIII:C in the non-survival group were higher than the values observed in the survival group, and the differences were statistically significant (P<0.05). PLT, AST, BUN, CR, D-Dimer, PT, FIB, F VIII:C, CK-MB, CK, and LDH predicted the area under the ROC curve (AUC) of the COVID19 endpoint events and were 0.721, 0.854, 0.867, 0.757, 0.699, 0.679, 0.715, 0.811, 0.935, and 0.802, respectively. CONCLUSION: The results showed that there were different degrees of damage to the liver, kidneys, blood coagulation, and heart function in the non-survival group. In addition, PLT, AST, BUN, CR, D-Dimer, PT, FIB, F VIII:C, CK-MB, CK, and LDH had value in evaluating disease prognosis.


Assuntos
Betacoronavirus , Infecções por Coronavirus/fisiopatologia , Insuficiência de Múltiplos Órgãos/virologia , Pneumonia Viral/fisiopatologia , Índice de Gravidade de Doença , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Estudos de Casos e Controles , China/epidemiologia , Técnicas de Laboratório Clínico , Infecções por Coronavirus/sangue , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/sangue , Insuficiência de Múltiplos Órgãos/diagnóstico , Insuficiência de Múltiplos Órgãos/mortalidade , Escores de Disfunção Orgânica , Pandemias , Pneumonia Viral/sangue , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Prognóstico , Curva ROC , Estudos Retrospectivos
10.
Medicine (Baltimore) ; 99(19): e20130, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384493

RESUMO

To evaluate the utility of unenhanced postmortem computed tomography (PMCT) for the investigation of in-hospital nontraumatic death in children up to 3 years of age.This study included the cadavers of children who died from intrinsic diseases before 3 years of age. The major underlying disease and the main organ-disease systems associated with the immediate causes of death were determined by clinical evaluation, PMCT, and autopsy, which were used as a reference standard. The rates of concordance between the former two methods and autopsy were calculated for all cases.In total, 22 cadavers (12 male and 10 female; mean age, 6.1 ±â€Š8.2 months) were included. The rates of concordance between clinical evaluation/PMCT and autopsy for diagnosis of the major underlying disease and main organ-disease systems associated with the immediate causes of death were 100%/36% (P = .0015) and 59%/41% (P = .37), respectively. In cases where the respiratory system was associated with the immediate cause of death, PMCT showed greater diagnostic sensitivity (90%) than did clinical evaluation (20%). In contrast, the diagnostic sensitivity of PMCT was lower than that of clinical evaluation in cases involving disorders of the cardiac system and multiple organ systems (0% vs 100% for both).The findings of this study suggest that the use of unenhanced PMCT with clinical evaluation can result in improved detection of the immediate cause of death in select cases of in-hospital nontraumatic death before 3 years of age.


Assuntos
Autopsia/métodos , Autopsia/estatística & dados numéricos , Causas de Morte , Tomografia Computadorizada por Raios X/métodos , Fatores Etários , Pré-Escolar , Feminino , Cardiopatias/diagnóstico , Mortalidade Hospitalar , Humanos , Lactente , Japão , Masculino , Insuficiência de Múltiplos Órgãos/diagnóstico , Insuficiência de Múltiplos Órgãos/mortalidade , Doenças Respiratórias/diagnóstico , Doenças Respiratórias/mortalidade , Sensibilidade e Especificidade , Centros de Atenção Terciária
11.
Medicine (Baltimore) ; 99(20): e20188, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32443339

RESUMO

INTRODUCTION: The Chinese herb da huang (DH) (Rhubarb) is commonly used for GIF intensive care unit (ICU)/pediatric intensive care unit (PICU) gastrointestinal failure (GIF) patients in China. However, the potential preventive and therapeutic effect of DH in these patients has not yet been studied systematically. OBJECTIVES: The aim of this study was to evaluate the preventive and therapeutic effects of DH in treating ICU/PICU GIF patients with the most recent evidence. METHODS: We systematically searched 7 databases from inception to March 30, 2018. RevMan 5.3 software was used to perform a meta-analysis. GRADE methodology was applied to evaluate the quality of evidence for each outcome. The review protocol was registered on PROSPERO (CRD42018092710) in advance. RESULTS: Seven studies comprising 788 pediatric or adult participants were included in this analysis. Three indicators, including GIF occurrence rates (gastrointestinal mucosal hemorrhage, enteroplegia), multiple organ dysfunction syndrome (MODS)-related items (occurrence rates of MODS, mortality rates of MODS) and duration in the ICU was analyzed. The GIF occurrence rate meta-analysis result was (RR 0.47, CI 95% 0.37-0.60; P = .95); MODS related items indicator result was (RR 0.44, CI 95% 0.33-0.59; P = .41); ICU duration ICU result was (RR -2.87, CI 95% -3.53--2.21; P = .40). The safety of Chinese herb DH (Rhubarb) remains unclear. CONCLUSION: Current evidence suggests that the Chinese herb rhubarb (DH) powder combined with Western medicine was inferior to Western medicine alone in terms of preventive and therapeutic effects in ICU/PICU patients in terms of decreasing GIF occurrence rates (gastrointestinal mucosal hemorrhage and enteroplegia), occurrence rates of MODS, mortality from MODS, and shortened duration time in the ICU/PICU. However, larger sample sizes and rigorously-designed studies are necessary to conclusively determine the association between DH powder and outcomes in ICU/PICU GIF patients.


Assuntos
Gastroenteropatias/tratamento farmacológico , Unidades de Terapia Intensiva Pediátrica/normas , Unidades de Terapia Intensiva/normas , Rheum/efeitos adversos , Adulto , Criança , China/epidemiologia , Medicamentos de Ervas Chinesas/efeitos adversos , Medicamentos de Ervas Chinesas/uso terapêutico , Feminino , Gastroenteropatias/patologia , Hemorragia Gastrointestinal/tratamento farmacológico , Hemorragia Gastrointestinal/prevenção & controle , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Masculino , Insuficiência de Múltiplos Órgãos/epidemiologia , Insuficiência de Múltiplos Órgãos/mortalidade , Resultado do Tratamento
12.
Cytokine Growth Factor Rev ; 53: 38-42, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32360420

RESUMO

Clinical intervention in patients with corona virus disease 2019 (COVID-19) has demonstrated a strong upregulation of cytokine production in patients who are critically ill with SARS-CoV2-induced pneumonia. In a retrospective study of 41 patients with COVID-19, most patients with SARS-CoV-2 infection developed mild symptoms, whereas some patients later developed aggravated disease symptoms, and eventually passed away because of multiple organ dysfunction syndrome (MODS), as a consequence of a severe cytokine storm. Guidelines for the diagnosis and treatment of SARS-CoV-2 infected pneumonia were first published January 30th, 2020; these guidelines recommended for the first time that cytokine monitoring should be applied in severely ill patients to reduce pneumonia related mortality. The cytokine storm observed in COVID-19 illness is also an important component of mortality in other viral diseases, including SARS, MERS and influenza. In view of the severe morbidity and mortality of COVID-19 pneumonia, we review the current understanding of treatment of human coronavirus infections from the perspective of a dysregulated cytokine and immune response.


Assuntos
Betacoronavirus/imunologia , Infecções por Coronavirus/patologia , Síndrome da Liberação de Citocina/patologia , Citocinas/sangue , Insuficiência de Múltiplos Órgãos/mortalidade , Pneumonia Viral/patologia , Corticosteroides/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Terapia de Substituição Renal Contínua/métodos , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/imunologia , Síndrome da Liberação de Citocina/tratamento farmacológico , Citocinas/biossíntese , Feminino , Humanos , Interferon-alfa/uso terapêutico , Masculino , Insuficiência de Múltiplos Órgãos/imunologia , Insuficiência de Múltiplos Órgãos/patologia , Pandemias , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/imunologia , Polietilenoglicóis/uso terapêutico , Proteínas Recombinantes/uso terapêutico , Estudos Retrospectivos
13.
Cell Metab ; 31(6): 1068-1077.e3, 2020 06 02.
Artigo em Inglês | MEDLINE | ID: mdl-32369736

RESUMO

Type 2 diabetes (T2D) is a major comorbidity of COVID-19. However, the impact of blood glucose (BG) control on the degree of required medical interventions and on mortality in patients with COVID-19 and T2D remains uncertain. Thus, we performed a retrospective, multi-centered study of 7,337 cases of COVID-19 in Hubei Province, China, among which 952 had pre-existing T2D. We found that subjects with T2D required more medical interventions and had a significantly higher mortality (7.8% versus 2.7%; adjusted hazard ratio [HR], 1.49) and multiple organ injury than the non-diabetic individuals. Further, we found that well-controlled BG (glycemic variability within 3.9 to 10.0 mmol/L) was associated with markedly lower mortality compared to individuals with poorly controlled BG (upper limit of glycemic variability exceeding 10.0 mmol/L) (adjusted HR, 0.14) during hospitalization. These findings provide clinical evidence correlating improved glycemic control with better outcomes in patients with COVID-19 and pre-existing T2D.


Assuntos
Glicemia/análise , Infecções por Coronavirus/mortalidade , Diabetes Mellitus Tipo 2/sangue , Índice Glicêmico/fisiologia , Hiperglicemia/sangue , Pneumonia Viral/mortalidade , Idoso , Betacoronavirus/patogenicidade , Infecções por Coronavirus/complicações , Infecções por Coronavirus/patologia , Diabetes Mellitus Tipo 2/complicações , Suscetibilidade a Doenças/patologia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Hiperglicemia/complicações , Hipoglicemiantes/uso terapêutico , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/complicações , Insuficiência de Múltiplos Órgãos/mortalidade , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/patologia , Estudos Retrospectivos
14.
Cleve Clin J Med ; 87(7): 384-388, 2020 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-32371564

RESUMO

Information about the clinical presentation and course of COVID-19 is evolving rapidly. On presentation, cough and fever predominate, but extrapulmonary symptoms are also common; in some patients, loss of sense of smell may be an early but favorable sign. The mortality rate varies widely in different reports but should become clearer as more data are collected. Risk factors for severe disease and death include comorbid conditions such as hypertension, cardiovascular disease, diabetes mellitus, and chronic obstructive pulmonary disease. Other implicated factors include older age, obesity, end-stage renal disease, and a higher neutrophil-lymphocyte ratio.


Assuntos
Betacoronavirus/isolamento & purificação , Insuficiência de Múltiplos Órgãos , Pneumonia Viral , Avaliação de Sintomas/métodos , Deterioração Clínica , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Humanos , Mortalidade , Múltiplas Afecções Crônicas/epidemiologia , Insuficiência de Múltiplos Órgãos/diagnóstico , Insuficiência de Múltiplos Órgãos/etiologia , Insuficiência de Múltiplos Órgãos/mortalidade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/epidemiologia , Pneumonia Viral/etiologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Prognóstico , Radiografia Torácica/métodos , Medição de Risco/métodos , Fatores de Risco , Análise de Sobrevida , Avaliação de Sintomas/estatística & dados numéricos
15.
An. pediatr. (2003. Ed. impr.) ; 92(5): 277-285, mayo 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-195971

RESUMO

OBJETIVOS: Analizar el rendimiento de la escala Sequential Organ Failure Assessme (SOFA) adaptada por edad en niños ingresados en la unidad de cuidados intensivos pediátricos (UCIP) y establecer si la escala SOFA puede competir con el síndrome de respuesta inflamatoria sistémica (SRIS) para el diagnóstico de sepsis, de acuerdo con las recomendaciones del consenso Sepsis-3. MÉTODOS: Estudio prospectivo observacional en 2 centros con 281 niños ingresados en la UCIP. Se calcularon las puntuaciones de las escalas SOFA, Pediatric Risk of Mortality (PRISM) y Pediatric Index of Mortality-2 (PIM2) y se evaluó la presencia de SRIS al ingreso. La variable primaria fue la mortalidad a los 30 días. RESULTADOS: La puntuación SOFA fue más alta en los no supervivientes (p < 0,001) y la mortalidad se incrementó progresivamente de los subgrupos con las puntuaciones SOFA más bajas a aquellos con las puntuaciones más altas. El análisis de las curvas de las características operativas del receptor (ROC) mostró que el área bajo la curva (AUC) para la predicción de la mortalidad a 30 días con la puntuación SOFA fue de 0,89, comparado con 0,84 y 0,79 con las escalas PRISM y PIM2, respectivamente. La AUC de la puntuación SOFA para la predicción de estancia prolongada en la UCIP fue de 0,67. La escala SOFA se correlacionó con las escalas PRISM (coeficiente de correlación de Spearman rs = 0,59) y PIM2 (rs = 0,51). En niños con infección, la AUC de la escala SOFA para la predicción de la mortalidad fue de 0,87, mientras que la AUC del SRIS fue de 0,60. El diagnóstico de sepsis definido como una puntuación SOFA de 3 o más predijo la mortalidad mejor que el SRIS y que la escala SOFA con el punto de corte de 2 puntos recomendada en el consenso Sepsis-3. CONCLUSIONES: La puntuación SOFA al ingreso es útil como predictor de la evolución en la población general de la UCIP y es más apropiada que el SRIS para definir la sepsis pediátrica


OBJECTIVES: To assess performance of the age-adapted SOFA score in children admitted into Paediatric Intensive Care Units (PICUs) and whether the SOFA score can compete with the systemic inflammatory response syndrome (SIRS) in diagnosing sepsis, as recommended in the Sepsis-3 consensus definitions. METHODS: Two-centre prospective observational study in 281 children admitted to the PICU. We calculated the SOFA, Pediatric Risk of Mortality (PRISM), and Pediatric Index of Mortality-2 (PIM2) scores and assessed for the presence of SIRS at admission. The primary outcome was 30-day mortality. RESULTS: The SOFA score was higher in nonsurvivors (P<.001) and mortality increased progressively across patient subgroups from lower to higher SOFA scores. The receiver operating characteristic (ROC) curve analysis revealed that the area under the curve (AUC) of the SOFA score for predicting 30-day mortality was 0.89, compared to AUCs of 0.84 and 0.79 for the PRISM and PIM2 scores, respectively. The AUC of the SOFA score for predicting a prolonged stay in the PICU was 0.67. The SOFA score was correlated to the PRISM score (rs = 0.59) and the PIM2 score (rs = 0.51). In children with infection, the AUC of the SOFA score for predicting mortality was 0.87 compared to an AUC of 0.60 using SIRS. The diagnosis of sepsis applying a SOFA cutoff of 3 points predicted mortality better than both the SIRS and the SOFA cutoff of 2 points recommended by the Sepsis-3 consensus. Conclusions; The SOFA score at admission is useful for predicting outcomes in the general PICU population and is more accurate than SIRS for definition of paediatric sepsis


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Síndrome de Resposta Inflamatória Sistêmica/mortalidade , Unidades de Terapia Intensiva Pediátrica , Insuficiência de Múltiplos Órgãos/mortalidade , Escores de Disfunção Orgânica , Valor Preditivo dos Testes , Mortalidade Hospitalar , Estudos Prospectivos , Prognóstico , Curva ROC
17.
Am J Cardiol ; 125(6): 840-844, 2020 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-31932083

RESUMO

Patients with influenza infection are at increased risk of acute myocardial infarction (AMI). There are limited data on the short-term prognosis and management of patients with AMI and concomitant influenza. We examined the National Inpatient Sample from 2010 to 2014 for adult patients with a diagnosis of AMI. Patients were stratified into those with or without concomitant influenza. In-hospital therapies and outcomes were compared between groups in unadjusted and adjusted analyses. Standardized differences of >10% and p values <0.05 were considered significant. Propensity matching was performed using a caliper radius of 0.01*sigma. Of 4,285,641 patients with a discharge diagnosis of AMI, 12,830 had concomitant influenza. Patients with influenza were older, had a higher burden of co-morbidities, and more often presented with non-ST elevation AMI (90% vs 74%) as compared with those without influenza. Coronary angiography (23% vs 54%) and revascularization (11% vs 41%) were less often pursued in AMI patients with influenza. Patients with AMI and influenza had elevated in-hospital mortality (14%) and multiorgan failure (33%). In a propensity-matched analysis of 23,415 patients, in-hospital mortality (odds ratio [OR] 1.26; p = 0.01), acute kidney injury (OR 1.36; p <0.01), multiorgan failure (OR 1.81; p <0.01), length-of-stay, and hospital costs were significantly higher in those with influenza. In conclusion, patients with AMI and concomitant influenza have an adverse in-hospital prognosis as compared with those without influenza.


Assuntos
Influenza Humana/complicações , Influenza Humana/terapia , Infarto do Miocárdio/complicações , Infarto do Miocárdio/terapia , Admissão do Paciente , Lesão Renal Aguda/complicações , Lesão Renal Aguda/mortalidade , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Mortalidade Hospitalar , Humanos , Influenza Humana/mortalidade , Tempo de Internação/estatística & dados numéricos , Masculino , Análise por Pareamento , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/complicações , Insuficiência de Múltiplos Órgãos/mortalidade , Insuficiência de Múltiplos Órgãos/terapia , Infarto do Miocárdio/mortalidade , Avaliação de Resultados em Cuidados de Saúde , Prognóstico , Pontuação de Propensão , Fatores de Risco , Estados Unidos
18.
J Postgrad Med ; 66(2): 67-72, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31997781

RESUMO

Introduction: There is a paucity of studies on the progression and outcome of Systemic Inflammatory Response Syndrome (SIRS) with its determinants. Aims and Objectives: To determine the predictors of the outcome and progression of pediatric sepsis and septic shock. Materials and Methods: Prospective observational study of children fulfilling criteria of SIRS and their progression to sepsis, severe sepsis, and septic shock (clinically and biochemically) was conducted at a tertiary care center. Results: Totally, 200 children were recruited over a period of 21 months (from February 2016 to October 2017). Most cases (80, 40%) were infants. Of the total, 188 (94%) cases were of an infective etiology (mostly respiratory system). Temperature and heart rate were the two commonest SIRS parameters which were deranged. Blood cultures were positive in only 25 (12.5%) cases. Out of the total 200 children, 108 progressed to sepsis, of which 26 progressed to severe sepsis, of which 22 progressed to septic shock. Abnormal leukocyte count, culture positivity and severe acute malnutrition were significantly associated with progression of SIRS patients to septic shock (P = 0.001, 0.00001 and 0.002, respectively). Factors associated with mortality were positive blood culture, multiorgan dysfunction, late hospital admissions, severe acute malnutrition, and requirement of supportive care (P values-<0.0001, <0.0001, 0.03, <0.0001 and <0.0001, respectively). Conclusions: SIRS can progress to septic shock if not identified early. The predictors of mortality were positive blood cultures, multiorgan dysfunction, late hospital admissions, severe acute malnutrition, and requirement of supportive care. The predictors of progression to septic shock were abnormal leukocyte count, culture positivity, and severe acute malnutrition.


Assuntos
Infecções Bacterianas/epidemiologia , Sepse/mortalidade , Choque Séptico/mortalidade , Síndrome de Resposta Inflamatória Sistêmica/mortalidade , Infecções Bacterianas/mortalidade , Pré-Escolar , Feminino , Febre/etiologia , Humanos , Índia/epidemiologia , Lactente , Unidades de Terapia Intensiva , Masculino , Desnutrição , Mortalidade , Insuficiência de Múltiplos Órgãos/etiologia , Insuficiência de Múltiplos Órgãos/mortalidade , Prevalência , Estudos Prospectivos , Sepse/etiologia , Sepse/microbiologia , Choque Séptico/etiologia , Choque Séptico/microbiologia , Análise de Sobrevida , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/microbiologia
19.
J Clin Oncol ; 38(1): 29-42, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31622133

RESUMO

PURPOSE: Exercise intolerance, associated with heart failure and death in general populations, is not well studied in survivors of childhood cancer. We examined prevalence of exercise intolerance in survivors exposed or not to cardiotoxic therapy, and associations among organ system function, exercise intolerance, and mortality. METHODS: Participants consisted of 1,041 people who had survived cancer ≥ 10 years (and had or did not have exposure to anthracyclines and/or chest-directed radiation) and 285 control subjects. Exercise intolerance was defined as peak oxygen uptake < 85% predicted from maximal cardiopulmonary exercise testing; organ functions were ascertained with imaging or clinical testing. Multivariable regression of the data was performed to compare exercise capacity between survivors exposed or unexposed to cardiotoxic therapy and control subjects, and to evaluate associations between treatment and organ function, and organ function and exercise intolerance. Propensity score methods in time-to-event analyses evaluated associations between exercise intolerance and mortality. RESULTS: Survivors (mean age ± standard deviation [SD], 35.6 ± 8.8 years) had lower mean (± SD) peak oxygen uptake (exposed: 25.74 ± 8.36 mL/kg/min; unexposed: 26.82 ± 8.36 mL/kg/min) than did control subjects (32.69 ± 7.75 mL/kg/min; P for all < .001). Exercise intolerance was present in 63.8% (95% CI, 62.0% to 65.8%) of exposed survivors, 55.7% (95% CI, 53.2% to 58.2%) of unexposed survivors, and 26.3% (95% CI, 24.0% to 28.3%) of control subjects, and was associated with mortality (hazard ratio, 3.9; 95% CI, 1.09 to 14.14). Global longitudinal strain (odds ratio [OR], 1.71; 95% CI, 1.11 to 2.63), chronotropic incompetence (OR, 3.58; 95% CI, 1.75 to 7.31); forced expiratory volume in 1 second < 80% (OR, 2.59; 95% CI, 1.65 to 4.09), and 1 SD decrease in quadriceps strength (OR, 1.49; 95% CI, 1.23 to 1.82) were associated with exercise intolerance. Ejection fraction < 53% was not associated with exercise intolerance. CONCLUSION: Exercise intolerance is prevalent among childhood cancer survivors and associated with all-cause mortality. Treatment-related cardiac (detected by global longitudinal strain), autonomic, pulmonary, and muscular impairments increased risk. Survivors with impairments may require referral to trained specialists to learn to accommodate specific deficits when engaging in exercise.


Assuntos
Sobreviventes de Câncer/estatística & dados numéricos , Tolerância ao Exercício/fisiologia , Insuficiência de Múltiplos Órgãos/mortalidade , Insuficiência de Múltiplos Órgãos/fisiopatologia , Neoplasias/mortalidade , Neoplasias/fisiopatologia , Adulto , Antraciclinas/administração & dosagem , Antraciclinas/efeitos adversos , Teste de Esforço , Feminino , Cardiopatias/epidemiologia , Cardiopatias/mortalidade , Cardiopatias/fisiopatologia , Humanos , Masculino , Insuficiência de Múltiplos Órgãos/epidemiologia , Neoplasias/tratamento farmacológico , Neoplasias/epidemiologia , Consumo de Oxigênio/fisiologia , Ensaios Clínicos Controlados Aleatórios como Assunto
20.
J Intensive Care Med ; 35(3): 279-283, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29141526

RESUMO

PURPOSE: Gastrointestinal dysfunction and failure (GID and GIF) in critically ill patients are a common, relevant, and underestimated complications in ICU patients. The aims of this study were (1) to determine plasmatic levels of citrulline, glutamine, and arginine as markers of GID/GIF in critically ill patients with or without GID/GIF with or without multiple organ failure (MOF) and (2) to assess the role of intra-abdominal hypertension in these patient groups. MATERIALS AND METHODS: This is a 1-year, monocentric (Italian hospital), prospective observational study. Inclusion criteria were adult patients with GID/GIF, with or without MOF. The GIF score was daily evaluated in 39 critically ill patients. Amino acids were measured at the time of GID or GIF. RESULTS: We enrolled 39 patients. Nine patients developed GID and 7 GIF; 6 of patients with GID/GIF developed MOF. Citrulline was lower (P < .001) in patients with GID/GIF (11.3 [4.4] µmol/L), compared to patients without GID/GIF (22.4 [6.8] µmol/L); likewise, glutamine was lower in patients with GID/GIF, whereas arginine was nonstatistically different between the 2 groups. Intra-abdominal pressure was higher in patients affected by MOF (13.0 [2.2] mm Hg) than in patients with GIF/GID without MOF (9.6 [2.6] mm Hg) and compared to patients without GID/GIF (7.2 [2.1] mm Hg). CONCLUSIONS: Both GID and GIF in critically ill patients are associated with low levels of citrulline and glutamine, which could be considered as markers of small bowel dysfunction. The higher the GIF score, the lower the citrulline levels. Patients affected by MOF had higher levels of intra-abdominal pressure.


Assuntos
Citrulina/sangue , Gastroenteropatias/sangue , Insuficiência de Múltiplos Órgãos/sangue , Escores de Disfunção Orgânica , Idoso , Arginina/sangue , Biomarcadores/sangue , Estado Terminal , Feminino , Gastroenteropatias/complicações , Gastroenteropatias/mortalidade , Glutamina/sangue , Humanos , Unidades de Terapia Intensiva , Hipertensão Intra-Abdominal/sangue , Hipertensão Intra-Abdominal/etiologia , Hipertensão Intra-Abdominal/mortalidade , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/complicações , Insuficiência de Múltiplos Órgãos/mortalidade , Estudos Prospectivos
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