Nuclear factor erythroid 2-related factor 2 (Nrf2) and heme oxygenase-1 (HO-1) have significant roles in the development of a hyperinflammatory state in infectious diseases. We aimed to investigate the association of the serum concentrations of Nrf2 and HO-1 with the severity of COVID-19 disease. The study included 40 subjects with mild and moderately severe forms of the disease (MEWS scoring system ≤2). Twenty of the subjects had MEWS scores of 3 or 4, which indicate a severe form of the disease, and twenty subjects had a MEWS score of ≥5, which indicates a critical form of the disease. HO-1 and Nrf2 were measured using the commercially available Enzyme-Linked Immunosorbent Assay (ELISA). Subjects with the most severe form of COVID-19 (critically ill) had a lower concentration of Nrf2 that negatively correlated with the markers of hyperinflammatory response (CRP, IL-6, ferritin). This observation was not made for HO-1, and the correlation between Nrf2 and HO-1 values was not established. In the mild/moderate form of COVID-19 disease, Nrf2 was associated with an increased 1,25 dihydroxy vitamin D concentration. The results of this study show that Nrf2 has a role in the body’s anti-inflammatory response to COVID-19 disease, which makes it a potential therapeutic target.

Aim: The outbreak of novel coronavirus pneumonia that was first detected in Wuhan in December 2019 resulted in a worldwide pandemic. Approximately 25% of confirmed cases developed a severe disease and the need for intensive care unit admission. The aim of this study was to determine the role of three inflammatory scoring systems, C-reactive protein/albumin ratio, fibrinogen/albumin ratio, C-reactive protein/lymphocyte ratio and their association with survival, comorbidities, and the occurrence of additional complications in the intensive care of these patients. Materials and methods: This retrospective study was conducted based on data collected by the Department of Respiratory Center. Ethical approval for the study was obtained from the Ethics Committee of Osijek University Hospital. This study analysed data retrospectively between October and December 2020, and included 137 critically ill patients with a diagnosis of COVID-19. Results: Data analysis of three examined inflammatory points of the system, below and above the median found a significant association in the group below the median C-reactive protein/albumin ratio with the presence of complications (p= 0,039) in the group above the median in the study of fibrinogen/albumin ratio found a significant association with sepsis (p=0,043). In the group of participants who were above its median in terms of C-reactive protein/lymphocyte ratio, there were more of those with the development of acute kidney injury (p=0,014), and sepsis (p=0,009). Conclusion: Inflammatory scoring systems, C-reactive protein/albumin ratio, fibrinogen/albumin ratio and C‐reactive protein/lymphocyte ratio represent an independent prognostic indicator of the clinical course in critically ill patients with COVID-19 infection.

Lemierre's syndrome refers to the septic thrombophlebitis of the internal jugular vein. The condition typically begins with an oropharyngeal infection and frequently involves inflammation within the wall of the vein, infected thrombus within the lumen, surrounding soft tissue inflammation, persistent bacteremia, and septic emboli. Lemierre's syndrome is a rare disease; it occurs most commonly in otherwise healthy young adults. The most common etiologic agent is Fusobacterium necrophorum. We present a case of Lemierre's syndrome in a young girl and the role of extracorporeal method of blood purification with continuous venous hemodiafiltration with the use of a highly adsorptive membrane (AN69 HeprAN), thus achieving the combined elimination of cytokines and endotoxins. The use of advanced methods, along with an antibiotic and surgical treatment, will certainly help reduce mortality in this syndrome.

Background: One of the major challenges in improving sepsis care is early prediction of sepsis complications. The endocannabinoid system has been intensely studied in recent years; however, little is known about its role in sepsis in humans. This study aimed to assess the prognostic role of endocannabinoids, anandamide (AEA) and 2-arachidonoylglycerol (2-AG), as early predictors of mortality, invasive mechanical ventilation (IMV) requirement, and length of stay (LOS) in patients with sepsis. Materials and Methods: In total, 106 patients with confirmed sepsis were enrolled in this study. The patients were divided into groups according to mortality outcome (survival, N =53; nonsurvival, N =53), IMV requirement (IMV group, N =26; non-IMV group, N =80), and LOS (LOS <10 days, N =59; LOS ≥10 days, N =47). Patients' clinical status was assessed along with laboratory biomarkers as well as AEA and 2-AG concentration measurements early on admission to emergency units. AEA and 2-AG levels were measured by enzyme-linked immunosorbent assay (ELISA) using an ELISA processor, EtiMax 3000 (DiaSorin, Saluggia, Italy). The predictive value of AEA and 2-AG for the studied sepsis outcomes and complications was analyzed using univariate and multivariate analyses and receiver operating characteristic (ROC) curve analysis. Results: Two endocannabinoids showed no significant difference between survivors and nonsurvivors, although an AEA concentration <7.16 μg/L predicted mortality outcome with a sensitivity of 57% (95% confidence interval [CI] 42–71) and specificity of 80% (95% CI 66–91). AEA concentrations ≤17.84 μg/L predicted LOS ≥10 days with sensitivity of 98% (95% CI 89–100) and specificity of 34% (95% CI 22–47). When analyzing IMV requirement, levels of AEA and 2-AG were significantly lower within the IMV group compared with the non-IMV group (5.94 μg/L [2.04–9.44] and 6.70 μg/L [3.50–27.04], p =0.043, and 5.68 μg/L [2.30–8.60] and 9.58 μg/L [4.83–40.05], p =0.002, respectively). The 2-AG showed the best performance for IMV requirement prediction, with both sensitivity and specificity of 69% ( p <0.001). Endocannabinoid AEA was an independent risk factor of LOS ≥10 days (odds ratio [OR] 23.59; 95% CI 3.03–183.83; p =0.003) and IMV requirement in sepsis (OR 0.79; 95% CI, 0.67–0.93; p =0.004). Conclusion: Low AEA concentration is a prognostic factor of hospital LOS longer than 10 days. Lower AEA and 2-AG concentrations obtained at the time of admission to the hospital are predictors of IMV requirement.

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