Recently, augmented renal clearance (ARC), which accelerates glomerular filtration of renally eliminated drugs thereby reducing the systemic exposure to these drugs, has started to receive attention. However, the clinical features associated with ARC are still not well understood, especially in the Japanese population. This study aimed to evaluate the clinical characteristics and outcomes of ARC patients with infections in Japanese intensive care unit (ICU) settings. We conducted a retrospective observational study from April 2013 to May 2017 at two tertiary level ICUs in Japan, which included 280 patients with infections (median age 74 years; interquartile range, 64–83 years). We evaluated the estimated glomerular filtration rate (eGFR) at ICU admission using the Japanese equation, and ARC was defined as eGFR >130 mL/min/1.73 m2. Multivariable logistic regression analysis was performed to identify the independent risk factors for ARC and to determine if it was a predictor of ICU mortality. In addition, a receiver operating curve (ROC) analysis was performed, and the area under the ROC (AUROC) was determined to examine the significant variables that predict ARC. In total, 19 patients (6.8%) manifested ARC. Multivariable logistic regression analysis identified younger age as an independent risk factor for ARC (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.91–0.96). However, ARC was not found to be a predictor of ICU mortality (OR, 0.57; 95% CI, 0.11–2.92). In addition, the AUROC of age was 0.79 (95% CI, 0.68–0.91), and the optimal cut off age for ARC was ≤63 years (sensitivity, 68.4%; specificity, 78.9%). The incidence of ARC was, therefore, low among patients with infections in the Japanese ICUs. Although younger age was associated with the incidence of ARC, it was not an independent predictor of ICU mortality.

A 72-year-old patient was admitted to the ICU due to acute respiratory distress syndrome caused by coronavirus disease 2019. On day 20, the patient experienced shock. The electrocardiogram showed ST segment elevation in leads V3–V6 and severe left ventricular dysfunction with an ejection fraction of 35%–40%. The left ventricle showed basal hypokinesis and apical akinesis, while the creatine kinase level was normal, indicating Takotsubo cardiomyopathy. On day 24, the patient died of multiple organ failure. In post-mortem biopsy, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antigen was detected in cardiomyocytes by immunostaining. Moreover, SARS-CoV-2 RNA was detected in heart tissue. We need to further analyze the direct link between SARS-CoV2 and cardiomyocytes.

未満に低下したのは 1 例のみであった．prothrombin time-international normalized ratio(PT-INR)は経過を通じて概ね正常で，activated partial thromboplastin time(APTT)は経過中 5 例で正常上限を上回ったが，1 例を除き大きく延長する事は無かった．一方，FDP と D-dimer は経 過中，正常上限を超えて推移し，2 例は第 7 病日以降に著明な再上昇を来した．以上より，重症 COVID-19 患者は感染症にも関わらず，凝固線溶異常は「線溶抑制型」でなく，あたかも「線溶亢 進型」の様相を呈していた．6 例中 4 例が Japanese Association for Acute Medicine criteria(JAAM) disseminated intravascular coagulation(DIC)診断基準で DIC と診断され，遺伝子組換え型ヒト可溶性 トロンモジュリン(rhsTM)が投与され，3 例が投与終了時点で DIC から離脱した．

Introduction:Lower gastrointestinal perforation is one of the most common conditions causing sepsis. In this study, we evaluated coagulopathy in the elderly with lower gastrointestinal perforation. Methods: Patients with lower gastrointestinal perforation admitted to our ICU post emergency surgery were enrolled from April 2011 to March 2017. They were classified into the elderly (aged ≥ 75 years) and non-elderly (aged < 75 years) groups. The two groups were compared in terms of coagulation and fibrinolysis markers, DIC score, and SOFA score on days 0, 1, and 2 of ICU admission. Additionally, we evaluated the 28-day survival rate. Results: Overall, 46 patients were included in the study, 23 in the elderly group and 23 in the non-elderly group. DIC scores on days 0 and 1 were significantly higher in the elderly group than in the non-elderly group (both P<0.01), and SOFA score on day 1 was significantly higher in the elderly group than in the non-elderly group (P<0.05). There was no significant difference between two groups in 28-day survival rate [65％ (15/23) vs. 83％ (19/23), P ＝ 0.18; log-rank test, P ＝ 0.17]. Conclusions: Lower gastrointestinal perforation in elderly patients tends to be complicated by coagulopathy.

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