scholarly journals Is It Time to Beta Block the Septic Patient?

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Philip Pemberton ◽  
Tonny Veenith ◽  
Catherine Snelson ◽  
Tony Whitehouse
Keyword(s):  
Heart Failure ◽  
Septic Shock ◽  
Chronic Heart Failure ◽  
Animal Models ◽  
Septic Patient ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Beta Blockers ◽  
Adrenergic System

Beta blockers are some of the most studied drugs in the pharmacopoeia. They are already widely used in medicine for treating hypertension, chronic heart failure, tachyarrhythmias, and tremor. Whilst their use in the immediate perioperative patient has been questioned, the use of esmolol in the patients with established septic shock has been recently reported to have favourable outcomes. In this paper, we review the role of the adrenergic system in sepsis and the evidence for the use of beta stimulation and beta blockers from animal models to critically ill patients.

scholarly journals Fibrinogen Level Predicts Outcomes in Critically Ill Patients with Acute Exacerbation of Chronic Heart Failure

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Zhongyuan Meng ◽  
Yaxin Zhao ◽  
Yan He
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Acute Exacerbation ◽  
Critically Ill ◽  
Roc Curve ◽  
Critically Ill Patients ◽  
Medical Information ◽  
Fibrinogen Level ◽  
Cox Model ◽  
Hazard Ratio

Background. Heart failure (HF) is a common cardiovascular disease, which is related to systemic inflammation for decades. Fibrinogen (FIB) is a sign of thrombosis and inflammation, which is associated with the prognosis of many diseases. Nevertheless, the role of fibrinogen level in the prognosis of critically ill patients with acute exacerbation of chronic heart failure is unclear. Methods. The data are from the Medical Information Mart for Intensive Care III (MIMIC III) database, which is a freely accessible critical care database. The primary outcome in our study was 90-day mortality. The prognostic value of fibrinogen was analyzed with receiver operating characteristic (ROC) curve analysis, Kaplan-Meier curve, and Cox model. Results. A total of 554 patients were included. Patients were divided into two groups, low fibrinogen level (<284 mg/dl) and high fibrinogen level (≥284 mg/dl), through the cut-off value of the ROC curve. The area under the ROC curve of fibrinogen for predicting 90-day mortality was 0.65 (95% CI: 0.59–0.70). In the unadjusted Cox model, compared with the low fibrinogen level (<284 mg/dl), the 90-day mortality of the hazard ratio (HR) with 95% confidence intervals (CI) of the high fibrinogen level is 3.33 (95% CI 2.15-5.15). In different multivariable Cox models, compared with the low fibrinogen level (<284 mg/dl), the 90-day mortality of the hazard ratio of the high fibrinogen level is from 2.83 to 3.13. In subgroup analyses, significant interactions were observed only in age, chronic kidney disease (CKD), and APS III scores. Conclusion. Our data suggest that high fibrinogen levels (≥284 mg/dl) independently predict mortality in critically ill patients with acute exacerbation of chronic heart failure. Our findings need to be further validated by large prospective studies and longer follow-up time.

scholarly journals PROCALCITONIN FOR IMPROVED ASSESSMENT AND AN ANSWER TO SEPSIS DILEMMA IN CRITICALLY ILL - A MYTH, A HYPE, OR A REALITY ?

2014 ◽  
Vol 04 (01) ◽  
pp. 057-065
Author(s):  
Raghava Sharma ◽  
Maniyar Vijayakumar
Keyword(s):  
Septic Shock ◽  
Clinical Practice ◽  
Material Culture ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Tertiary Care ◽  
Specific Marker ◽  
Suspected Sepsis ◽  
Number Of Patients

Abstract: Background and objectives: “Sepsis is a major cause for mortality in critically ill patients all over the world. The number of patients presenting with sepsis, septic shock is gradually increasing in daily clinical practice. Mortality in sepsis is mainly due to a delay in diagnosis and initiation of specific therapy(antibiotics).This is in turn mainly attributed to the difficulty in differentiating infectious trigger(sepsis) from non infectious triggers as both present with similar clinical features. Lack of specific marker adds to this dilemma of differentiating infectious and non infectious factors in critically ill patients.Recently there are some reports from European countries on role of Procalcitonin (PCT) in critically ill patients. Draw backs of these studies are galore mainly due to the difficulties in interpretation of results, as varying definitions for sepsis are used. But also there is paucity of data on Procalcitonin from Indian sub continent. Hence in the present single centre prospective observational study conducted at tertiary care medical college hospital , A total of 50 adult patients with sepsis fulfilling ACCP/SCCM guidelines were included, out of which 23 were in SIRS/Sepsis, 14 in severe sepsis and 13 in septic shock. Procalcitonin was evaluated in the first 24 hours after admission and before initiation of any antibiotic therapy. The role of procalcitonin was analyzed in relation to confirming sepsis, assessing the severity of sepsis and assessing the prognosis(possible out come) of sepsis. Combined role of procalcitonin with other indicators especially ESR, SOFA Score, Blood/relevant material culture was explored. Results: Our study confirmed the importance of procalcitonin in critically ill patients particularly in improving the predictive power while solving the sepsis dilemma. Conclusions: From our study, we conclude that Procalcitonin is not a myth nor a hype but it is a hard reality and is an answer to sepsis dilemma. It is therefore preferable to add Procalcitonin into the standard workup of critically ill patients with suspected sepsis in every day clinical practice.

scholarly journals Heart Failure Probability and Early Outcomes of Critically Ill Patients With COVID-19: A Prospective, Multicenter Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Weibo Gao ◽  
Jiasai Fan ◽  
Di Sun ◽  
Mengxi Yang ◽  
Wei Guo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Fatal Outcome ◽  
Hospital Death ◽  
Cut Point ◽  
Cardiac Functions ◽  
Selection Operator ◽  
Prognostic Risk Factors

Background: The relationship between cardiac functions and the fatal outcome of coronavirus disease 2019 (COVID-19) is still largely underestimated. We aim to explore the role of heart failure (HF) and NT-proBNP in the prognosis of critically ill patients with COVID-19 and construct an easy-to-use predictive model using machine learning.Methods: In this multicenter and prospective study, a total of 1,050 patients with clinical suspicion of COVID-19 were consecutively screened. Finally, 402 laboratory-confirmed critically ill patients with COVID-19 were enrolled. A “triple cut-point” strategy of NT-proBNP was applied to assess the probability of HF. The primary outcome was 30-day all-cause in-hospital death. Prognostic risk factors were analyzed using the least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression, further formulating a nomogram to predict mortality.Results: Within a 30-day follow-up, 27.4% of the 402 patients died. The mortality rate of patients with HF likely was significantly higher than that of the patient with gray zone and HF unlikely (40.8% vs. 25 and 16.5%, respectively, P &lt; 0.001). HF likely [Odds ratio (OR) 1.97, 95% CI 1.13–3.42], age (OR 1.04, 95% CI 1.02–1.06), lymphocyte (OR 0.36, 95% CI 0.19–0.68), albumin (OR 0.92, 95% CI 0.87–0.96), and total bilirubin (OR 1.02, 95% CI 1–1.04) were independently associated with the prognosis of critically ill patients with COVID-19. Moreover, a nomogram was developed by bootstrap validation, and C-index was 0.8 (95% CI 0.74–0.86).Conclusions: This study established a novel nomogram to predict the 30-day all-cause mortality of critically ill patients with COVID-19, highlighting the predominant role of the “triple cut-point” strategy of NT-proBNP, which could assist in risk stratification and improve clinical sequelae.

scholarly journals Correlation of Redox Status with Procalcitonin and C-reactive Protein in Septic Patients

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Jasna Petrovic ◽  
Tamara Nikolic Turnic ◽  
Vladimir Zivkovic ◽  
Marijana Andjic ◽  
Nevena Draginic ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Septic Shock ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Case Series ◽  
Redox Status ◽  
Prospective Clinical Study ◽  
C Reactive Protein ◽  
Reactive Protein

Based on the role of oxidative stress in the pathophysiological mechanisms of sepsis and the importance of PCT as a clinically applicable biomarker for early detection of inflammatory response initiation, we aimed this study at examining the correlation between PCT levels and oxidative stress parameters (prooxidants and antioxidants) in patients with sepsis. This study was designed as a case-series prospective clinical study which involved 103 critically ill patients and 17 healthy participants with diagnosis of sepsis/septic shock (over 18 years of age, both gender) admitted to the Intensive Care Unit (ICU) of Valjevo General Hospital in Serbia. All subjects were divided into patients who were operated on/underwent surgery before sampling and have sepsis (n=24), patients who were operated on/underwent surgery before sampling and have septic shock (n=25), patients who were not operated on/did not undergo surgery before sampling and have sepsis (n=26), patients who were not operated on/did not undergo surgery before sampling and have septic shock (n=28), and participants who are healthy (n=17). PCT has confirmed a positive correlation with prooxidants and type of critical illness, and performing surgical intervention diminished oxidative stress in patients with septic shock. Prognosis in critically ill patients was strongly associated with PCT levels but not with nonspecifically C-reactive protein.

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