Critical Care 2017, 21(Suppl 1):P349 Introduction Imbalance in cellular energetics has been suggested to be an important mechanism for organ failure in sepsis and septic shock. We hypothesized that such energy imbalance would either be caused by metabolic changes leading to decreased energy production or by increased energy consumption. Thus, we set out to investigate if mitochondrial dysfunction or decreased energy consumption alters cellular metabolism in muscle tissue in experimental sepsis. Methods We submitted anesthetized piglets to sepsis (n = 12) or placebo (n = 4) and monitored them for 3 hours. Plasma lactate and markers of organ failure were measured hourly, as was muscle metabolism by microdialysis. Energy consumption was intervened locally by infusing ouabain through one microdialysis catheter to block major energy expenditure of the cells, by inhibiting the major energy consuming enzyme, N+/K + -ATPase. Similarly, energy production was blocked infusing sodium cyanide (NaCN), in a different region, to block the cytochrome oxidase in muscle tissue mitochondria. Results All animals submitted to sepsis fulfilled sepsis criteria as defined in Sepsis-3, whereas no animals in the placebo group did. Muscle glucose decreased during sepsis independently of N+/K + -ATPase or cytochrome oxidase blockade. Muscle lactate did not increase during sepsis in naïve metabolism. However, during cytochrome oxidase blockade, there was an increase in muscle lactate that was further accentuated during sepsis. Muscle pyruvate did not decrease during sepsis in naïve metabolism. During cytochrome oxidase blockade, there was a decrease in muscle pyruvate, independently of sepsis. Lactate to pyruvate ratio increased during sepsis and was further accentuated during cytochrome oxidase blockade. Muscle glycerol increased during sepsis and decreased slightly without sepsis regardless of N+/K + -ATPase or cytochrome oxidase blocking. There were no significant changes in muscle glutamate or urea during sepsis in absence/presence of N+/K + -ATPase or cytochrome oxidase blockade. ConclusionsThese results indicate increased metabolism of energy substrates in muscle tissue in experimental sepsis. Our results do not indicate presence of energy depletion or mitochondrial dysfunction in muscle and should similar physiologic situation be present in other tissues, other mechanisms of organ failure must be considered. , and long-term follow up has shown increased fracture risk [2]. It is unclear if these changes are a consequence of acute critical illness, or reduced activity afterwards. Bone health assessment during critical illness is challenging, and direct bone strength measurement is not possible. We used a rodent sepsis model to test the hypothesis that critical illness causes early reduction in bone strength and changes in bone architecture. Methods 20 Sprague-Dawley rats (350 ± 15.8g) were anesthetised and randomised to receive cecal ligation and puncture (CLP) (50% cecum length, 18G needle single pass through anterior and posterior wa...
BackgroundTo establish the prognostic value of procalcitonin, C-reactive protein and cholesterol levels for mortality in patients with an infection and multiple organ dysfunction.MethodsA prospective case-control study was performed, including 67 patients admitted to the intensive care unit with an infection and multiple organ dysfunction in whom cholesterol, procalcitonin, and C-reactive protein levels were measured on admission and during the course of treatment.ResultsThe associations between in-hospital mortality and procalcitonin, C-reactive protein, and cholesterol levels were analyzed. Logistic regression analysis showed that cholesterol (odds ratio [OR], 1.858; 95% CI, 1.170–2.949; P = 0.009) and C-reactive protein (OR, 4.408; 95% CI, 2.019–9.624; P < 0.001) levels were predictors of mortality. A receiver operating characteristic curve analysis yielded an area under the curve (AUC) of 0.774 and 95% CI of 0.693–0.855 (P < 0.001) for C-reactive protein, an AUC of 0.66 and 95% CI of 0.535–0.784 (P = 0.019) for procalcitonin, and an AUC of 0.654 and 95% CI of 0.593–0.715 (P < 0.001) for cholesterol as predictors of mortality. When combined with the bioscore system for mortality, these markers yielded an AUC of 0.845 and 95% CI of 0.770–0.921 (P < 0.001), with sensitivity of 89.1% and specificity of 83.1%.ConclusionsThe combination of procalcitonin, C-reactive protein, and cholesterol levels in a single scoring system yielded high predictive value for mortality.
ПРЕДИКТОРЫ РАЗВИТИЯ СИНДРОМА ПОЛИОРГАННОЙ ДИСФУНКЦИИ У ПАЦИЕНТОВ ПОСЛЕ АБДОМИНАЛЬНЫХ ХИРУРГИЧЕСКИХ ВМЕШАТЕЛЬСТВУЗ «Могилевская областная больница», г. Могилев, Республика БеларусьЦель. Оценить диагностическую значимость клинических и лабораторных показателей пациентов в первые сутки после абдоминальных хирургических вмешательств, как предикторов развития синдрома по-лиорганной дисфункции (СПОД).Материал и методы. Проведено проспективное исследование случай-контроль у 157 пациентов, ко-торым определяли ряд клинических и лабораторных показателей в первые сутки после абдоминальных хирургических вмешательств. Были выделены две группы: первая (n=88) -без признаков СПОД, вторая (n=69) -с наличием СПОД.Результаты. У пациентов во второй группе установлено значимое увеличение частоты сердечных сокращений (р=0,005), снижение среднего артериального давления (р=0,045) и индекса оксигенации (р=0,001). Диурез у пациентов не различался между группами, однако мочевина и креатинин значимо повышались во второй группе (р<0,001). Из показателей, отражающих изменение метаболизма, во второй группе отмечено снижение общего белка (р=0,007) и холестерина (р=0,029).Анализ характеристических кривых показал, что наибольшей прогностической ценностью в отношении СПОД обладают шкалы SOFA (площадь под кривой (AUC) 0,857; 95% доверительный интервал (ДИ) 0,773-0,941; р<0,001) и Apache III (AUC 0,83; 95% ДИ 0,734-0,916; р<0,001). Высокой прогностической эффективно-стью характеризуются индекс оксигенации (AUC 0,717; 95% ДИ 0,621-0,813; р=0,001) и уровень холестерина (AUC 0,724; 95% ДИ 0,667-0,782; р<0,001). Общий белок является показателем со средней диагностической эффективностью (AUC 0,65; 95% ДИ 0,549-0,746; р=0,02). Повышение С-реактивного белка не является мар-кером развития СПОД у пациентов в первые сутки после абдоминальных хирургических вмешательств.Заключение. Шкала SOFA имеет преимущества по сравнению со шкалой Apache III для прогнозиро-вания СПОД, поскольку она более простая. Пациентам после абдоминальных операций при поступлении в отделение анестезиологии и реанимации требуется определение индекса оксигенации. Уровень общего холестерина из-за простоты и дешевизны может использоваться как скрининг СПОД. Ключевые слова: синдром полиорганной дисфункции, предикторы, индекс оксигенации, холестерин, общий белок, С-реактивный белок, абдоминальная хирургияObjectives. To determine the diagnostic value of clinical and laboratory findings in patients within the first 24 hours after the abdominal surgery as a predictive factor for prognosis of multiple organ dysfunction syndrome (MODS) development.Methods. A prospective case-control study in patients (n=157) was carried out, which identified a number of clinical and laboratory findings within the first day after the abdominal surgery. Two groups were singled out: the first one (n=88) -without any symptoms of MODS, the second (n=69) -with the presence of MODS.Results. It was revealed that the patients in the second group had a significant increase in heart rate variability (p=0.005), a reduction of...
Резюме. Цель исследования-выявить изменения показателей тетраполярной реогепатографии (РГГ) у потенциальных доноров перед забором органов и тканей для трансплантации. Материал и методы. В проспективное пилотное исследование было включено 30 потенциальных доноров органов и тканей (пациенты с необратимым повреждением головного мозга (смертью мозга)). Средний возраст потенциального донора был равен 56 (49;59) лет, мужчин-18 (60%), женщин-12 (40%). Причиной смерти мозга были нарушения мозгового кровообращения у 25 (83,3%) пациентов, черепно-мозговая травма-у 5 (16,7%) пациентов. У всех потенциальных доноров с целью оценки функции печеночного графта перед забором органов и тканей для трансплантации была проведена тетраполярная реогепатография. Результаты. При сравнении показателей РГГ у эффективных доноров печеночного графта (n=9) и у доноров без забора печеночного графта (n=21) были выявлены статистически значимые отличия: время быстрого кровенаполнения
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