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Objective: The use of serum ammonia as a novel marker for sepsis compared to lactic acid levels in intensive care unit (ICU) patients. Design and Interventions: Single arm, prospective clinical trial to collect arterial blood samples from patients with sepsis. Serial ammonia and lactic acid levels were sent every six hours for a total of three days. Measurements and results: Compare mean levels of ammonia and lactic acid in terms of diagnosing sepsis and patient outcome, including length of stay and mortality. A total of 30 patients were enrolled in the pilot study. On admission, mean ammonia level was 35.7 μmol/L and lactic acid was 3.06 mmole/L. Ammonia levels checked at the end of day 2 (ammonia 2-4) and the beginning of day 3 (ammonia 3-1) were higher in patients who had a microbial culture-proven sepsis (p-values 0.029 and 0.002, respectively) compared to those without culture-positive sepsis. Ammonia levels did predict a longer hospital stay; ammonia level of more than 40 μmol/L had a mean hospital stay of 17.6 days vs. patients with normal levels who had a mean hospital stay of 9.62 days (p-value 0.0082). Conclusion: Elevated ammonia level can be a novel biomarker for sepsis, comparable to conventional markers. Ammonia levels have a prognostic utility as elevated levels were associated with longer hospital stay.

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BackgroundMultiple studies have shown that trans-radial access (TRA) for women undergoing coronary angiography/intervention (CA/I) has a lower risk of vascular access site complications as compared with trans-femoral access (TFA). In patients who had previously undergone coronary artery bypass grafting (CABG), studies also showed no significant difference between TRA and TFA in terms of contrast amount (CA), procedure time (PT), and fluoroscopy time (FT). However, those studies mainly included men. Limited information is available on the relative merits of TRA as compared with TFA for cardiac catheterization in females who previously undergone CABG. The purpose of this study was to determine the efficacy and safety of TRA versus TFA in women with prior CABG surgery who are undergoing CA/I in regard to CA, PT, and FT. MethodsIn this single-center retrospective cohort study, females with a history of CABG who underwent CA/I in the period from January 2013 to September 2016 were included. A total of 584 patients were included and divided into two groups: TRA group (49 patients) and TFA group (535 patients). The primary endpoints were CA, PT, and FT. The means for the primary outcomes were compared between the two using the independent t-score test. ResultsA total of 584 female patients with a history of CABG had cardiac catheterization from January 2013 to September 2016 at our center. Trans-femoral access accounted for 91.6% (n=535) of the patients while trans-radial access accounted for 8.4% (n=49) of the patients. A comparison of procedural variables between TRA and TFA revealed that there was no statistical significance in procedure time, fluoroscopy time, or the contrast volume. The access site crossover rate was 6.12% (n=3) from radial to femoral while there was a 0% rate in the femoral to radial access.

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