Platelet cytochrome c oxidase activity and quantity in septic patients.

OBJECTIVE: The cytopathic hypoxia theory proposes that there is an impaired cellular oxygen utilization during sepsis. Respiratory complex IV, or cytochrome c oxidase, was only previously studied in muscle biopsies of 16 surviving and 12 nonsurviving septic patients. We hypothesized that higher activities and quantities of this enzyme complex could be associated with septic patient survival. The objective was to evaluate the relationship between cytochrome c oxidase activities and quantities and 6-month survival in a larger series of septic patients using a less invasive method (circulating platelets). DESIGN: Prospective, multicenter, observational study. SETTING: The study was carried out in six Spanish intensive care units. PATIENTS: We included 96 septic patients. INTERVENTIONS: We determined the cytochrome c oxidase activity per citrate synthase activity ratio and cytochrome c oxidase quantity per citrate synthase activity ratio in circulating platelets at the time of diagnosis and related them to 6-month survival. The written informed consent from the family members was obtained. MEASUREMENTS AND MAIN RESULTS: Survivor patients (n = 54) showed higher cytochrome c oxidase activity per citrate synthase activity ratio (p = .04) and cytochrome c oxidase quantity per citrate synthase activity ratio (p = .006) than nonsurvivors (n = 42). Logistic regression analyses confirmed that the cytochrome c oxidase activity per citrate synthase activity ratio (p = .04) and cytochrome c oxidase quantity per citrate synthase activity ratio (p = .02) were independent predictors of 6-month survival. The area under the curve to predict 6-month survival was 0.62 (95% confidence interval 0.51-0.74; p = .04) for the cytochrome c oxidase activity per citrate synthase activity ratio and 0.67 (95% confidence interval 0.56-0.76; p = .003) for the cytochrome c oxidase quantity per citrate synthase activity ratio. A negative correlation was found between the cytochrome c oxidase quantity per citrate synthase activity ratio and Sepsis-Related Organ Failure Assessment score (p = .04). CONCLUSIONS: Platelet cytochrome c oxidase activity and quantity were independent predictors of 6-month survival and could be used as biomarkers of sepsis mortality. This is a rapid, easy, and less invasive protocol to assess mitochondrial function. Patients with lower cytochrome c oxidase activity and quantity could benefit from drugs that improve mitochondrial function.

Prognosis of critical surgical patients depending on the duration of stay in the ICU.

OBJECTIVE: To analyze the epidemiological and prognostic differences between critical surgical patients admitted to intensive care unit (ICU) according to length of stay in the ICU. MATERIALS AND METHODS: Retrospective observational study on patients with surgical pathology admitted to ICU of a tertiary hospital, during 7 years, with a stay ≥ 5 days. The variables analyzed were age, sex, Acute Physiology and Chronic Health Evaluation II (APACHE II), duration of stay, hospital and ICU mortality, original service, reason for admission, geographical place of residence, and the use of invasive techniques such as mechanical ventilation (MV), tracheotomy, and techniques of continuous renal replacement (CRR). Two groups were defined; one with intermediate stay, the one that exceeds the average of our population (> 5 days) and another with long stay patients (> 14 days). Readmissions were excluded. Firstly, the analysis of differential characteristics of patients was performed, this was according to the duration of their stay using either a contrast equal averages when the variable contrast between the two groups was quantitative or the Chi-square test when the variable analyzed was qualitative. For both tests, the existence of significant differences between groups was considered when the significance level was less than 5%. And, secondly, a model forecast ICU survival of these patients, regardless of length of stay in ICU, using a binary logistic regression analysis was performed. RESULTS: Among the 540 patients analyzed, no significant differences were observed, depending on the length of stay in the ICU, except the need for invasive techniques such as MV or tracheotomy in those of longer stay (P = 0.000). However, ICU mortality was significantly higher for patients with intermediate stay (30 vs 17: 5%; P = 0.000), without observing differences in hospital mortality. ICU survival was influenced by age, APACHE II levels, admission to the ICU in a coma state, and the application of the three invasive techniques discussed. CONCLUSION: Surgical patients who survive in the ICU, regardless of the length of their stay in it, have the same odds of hospital survival. Found as predictors of mortality in ICU APACHE II, age, admission in a coma state, and application of invasive techniques.

Comparative study on the prognosis of critical ill patients transferred from another island compared to those patients transferred from emergency department to intensive care unit.

OBJECTIVE: To compare outcomes of critically ill patients transferred from another island compared to those patients with direct admission from Emergency Department to intensive care unit (ICU). PATIENTS AND METHODS: Retrospective study of prospectively collected data during 8 years. The population studied was all critical adult patients transferred from another island to our hospital and those directly admitted from the Emergency Department. Variables were age, sex, clinical diagnosis (coronary, medical, surgical, or trauma), acute physiology and chronic health evaluation (APACHE) II score at admission, ICU days of stay, days of mechanical ventilation and ICU mortality. RESULTS: During the period of study, 3,115 patients coming from Emergency Department (Group 1) were admitted to our ICU and 138 were transferred from another island (Group 2). No significant statistically differences were found between both groups neither age, sex, APACHE II, ICU days, days of mechanical ventilation, and mortality rate (17.5% versus 20.3%, P = 0.43). The multivariate analysis showed that age, APACHE II score, ICU days of stay, type of patient, and days of mechanical ventilation were independent variables associated with mortality. CONCLUSIONS: No differences were found in the global prognosis of the admitted patients transferred from another island compared to those who were admitted directly from the Emergency Department. There is no impact on mortality in transferring a patient in our study population.

Differences in the prognosis among severe trauma and medical patients requiring mechanical ventilation.

Objetive. To find the differences between the prognosis of the patients with severe traumatism injury and those who were admitted with medical pathology who also required mechanical ventilation in our ICU. Patients and Method. Retrospective descriptive study in a polyvalent ICU of a third level hospital for a period of 8 years. Epidemiological variables such as age, sex, average stay, mortality, APACHE II at admission and days of mechanical ventilation, were analyzed in patients with severe traumatism injury and patients with medical pathology that were admitted in ICU and received mechanical ventilation during this period. Results. During the study period were admitted 208 patients with severe traumatism injury and 732 medical patients, all of them required mechanical ventilation. Patients with severe traumatism injury are more younger (41.8 vs 55.3 years, p = 0.001) and entered ICU in a state of minor severity, according to the prognostic index APACHE II (14.8 vs 17.4, p < 0.001), despite which they required more days of mechanical ventilation (9.8 vs 7.8 days, p = 0.017) and had a higher average stay (11.4 vs 9.4 days, p = 0.027), although the mortality was significantly lower (38.2% vs 28.2%, p = 0.005). Multivariate analysis showed as independent variables associated with mortality, the APACHE II (p < 0.0001), the average stay in ICU (p < 0.0001), days of mechanical ventilation (p < 0.0001) and type patient (p = 0.016). Conclusions. Patients with severe traumatic injury that require mechanical ventilation despite to be admitted in ICU in a state of greater severity, having an increased ICU stay and more days of mechanical ventilation, have a better prognosis than medical patients that required also mechanical ventilation at ICU stay, likely to be younger.

Complications of post-injury decompressive craniectomy.

Decompressive craniectomy (DC) is a useful technique for the treatment of traumatic brain injuries (TBI) with intracranial hypertension (ICHT) resistant to medical treatment, increasing survival, although its role in the functional prognosis of patients is not defined. It is also a technique that is not without complications, and may increase the patient's morbidity and mortality. We report two cases of patients with TBI who required DC and suffered complications from the technique.