About efficiency of the pharmacological scores as a predictors of outcomes after cardiac surgery

Баутин, А. Е.; Ксендикова, А В; Belolipetskiy, S.S.; Абуталимова, Н. Р.; Маричев, А. О.; Наймушин, А. В.; Этин, В. Л.; Radovskiy, A. M.; Karpova, L.I.; Гребенник, В. К.; Гордеев, М. Л.

doi:10.21320/1818-474x-2019-2-66-74

Cited by 7 publications

(2 citation statements)

References 15 publications

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“…ст.) / доза НА (нг/кг/мин), инотропный индекс (ИИ 1-3 ) и вазоактивно-инотропный индекс (ВИИ 1-3 ) [13]. ИИ и ВИИ рассчитывали по формулам: ИИ (усл.…”

Section: методыunclassified

N-terminal pro-B-type natriuretic peptide is a biomarker of myocardial stress in abdominal sepsis and septic shock

Tyurin¹,

Раутбарт²,

Protsenko³

et al. 2020

PKiK

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Aim. To evaluate the dynamics and prognostic significance of serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) level in patients with severe abdominal sepsis.Methods. We analysed survey data of 54 patients (28 men and 26 women) aged 64.5 years [56.25–78.00] with abdominal sepsis or septic shock. Disease severity scored according to the Acute Physiology and Chronic Health Evaluation II criteria was 16.3 ± 0.8 and according to the Sequential Organ Failure Assessment (SOFA) was 3 [3–6]. Statistical analysis of these data was performed using correlation analysis, logistic regression and receiver operating characteristic analysis.Results. Serum NT-proBNP level during the 1st week following admission to the intensive care unit (ICU) exceeded normal values, i.e. 2,570 [116.25–6,559.5] to 4,600 [1,680–18,200] pg/ml. At all disease stages, serum NT-proBNP level correlated with sepsis severity scores (SOFA), procalcitonin (PCT) levels, lactatemia, mean arterial pressure, heart rate and inotropic and vasoactive–inotropic scales (rho = 0.329–0.433; p < 0.02). On ICU days 3–4, serum NT-proBNP level of >5100 pg/ml was associated with increased risk of mortality [65.6%–88.2%; area under the curve (AUC) = 0.806; р < 0.0001]. Similarly, during this interval, elevated serum NT-proBNP level was associated with the use of inotropic drugs (OR = 1.0001, 95% CI = 1.000–1.0002, p < 0.0059). Notably, we found that 76.9%–79.0% of the patients with serum NT-proBNP level of >5250 pg/ml were receiving inotropic drugs including adrenaline, dopamine and dobutamine. We were unable to identify a specific association between serum NT-proBNP level and norepinephrine administration. On ICU days 7 and 8, among patients with serum NT-proBNP level of >3450 pg/ml, we observed a very close relationship between serum NT-proBNP level and PCT (sensitivity = 63.6%, specificity = 66.7%, AUC = 0.708; р = 0.0041).Conclusion. Serum NT-proBNP level is considerably elevated in patients with abdominal sepsis or septic shock. NT-proBNP level was associated with both traditional indicators of sepsis severity and indicators characterising the state of systemic circulation. Notably, serum NT-proBNP level correlates with cardiac failure and inotropic drug requirement. Although the mechanisms underlying the observed increases in serum NT-proBNP level remain unclear, the present findings indicate that this mediator is clearly a significant biomarker and predictor of adverse outcomes related to abdominal sepsis and septic shock. Received 22 January 2020. Revised 27 January 2020. Accepted 11 February 2020.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Author contributions Conception and study design: I.N. Tyurin, D.N. Protsenko, I.A. Kozlov Data collection and analysis: I.N. Tyurin, S.A. Rautbart, S.N. Shurygin Statistical analysis: I.N. Tyurin, S.A. Rautbart Drafting the article: I.N. Tyurin, D.N. Protsenko, I.A. Kozlov, S.N. Shurygin Critical revision of the article: I.N. Tyurin, I.A. Kozlov Final approval of the version to be published: I.N. Tyurin, S.A. Rautbart, D.N. Protsenko, S.N. Shurygin, I.A. Kozlov

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Section: методыunclassified

N-terminal pro-B-type natriuretic peptide is a biomarker of myocardial stress in abdominal sepsis and septic shock

Tyurin¹,

Раутбарт²,

Protsenko³

et al. 2020

PKiK

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“…Диуретики, ультрафильтрация (при неэффективности диуретиков), вазодилататоры Неоднозначно можно оценить и дизайн некоторых исследований, посвященных левосимендану [3]. Например, в некоторых из них не соблюдена инструкция по разведению препарата (CHEETAN) или были включены пациенты с вазоплегией, что является противопоказанием к назначению левосимендана (CHEETAN, LEOPARD) [2]. Вполне логичным выглядит опубликованный группой авторитетных экспертов тезис о неправомочности оценки эффективности препаратов с коротким периодом действия на основании долгосрочных конечных точек, таких как 180-дневная летальность [25].…”

Section: вазодилататоры диуретикиunclassified

Pharmacological therapy of acute heart failure: what is available now and what is expected in future

Еременко

2020

Vestn. anesteziol. reanimatol.

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Цель: представить обзор современных подходов к медикаментозному лечению острой сердечной недостаточности (ОСН).Результаты: обсуждены лекарственные средства, доступные на сегодня и активно изучаемые в клинических исследованиях. Отмечены недостатки и нежелательные эффекты современных медикаментозных средств лечения ОСН. Вазодилататоры не могут использоваться при артериальной гипотонии, инотропные препараты (катехоламины и ингибиторы фосфодиэстеразы) имеют проаритмогенный эффект, повышают потребность миокарда в кислороде, могут вызывать избыточную вазодилатацию. Летальность больных, получающих эти препараты и вазопрессорные средства, остается на высоком уровне. Приведены данные о положительном гемодинамическом эффекте кальциевого сенситайзера левосимендана у пациентов с выраженной сердечной недостаточностью, а также у некоторых других категорий кардиохирургических больных, однако подчеркнуто, что отношение к влиянию его на долгосрочную выживаемость пациентов остается неоднозначным. Для снятия противоречий необходимы исследования с продуманным дизайном, не противоречащим показаниям и противопоказаниям, отмеченным в инструкции по его применению. Высказано мнение, что в таких исследованиях, в частности, целесообразно использовать временные конечные точки исследования, сопоставимые с продолжительностью действия изучаемых препаратов. В ближайшей перспективе будут получены данные, которые позволят оценить возможность широкого клинического использования новых групп препаратов: активаторов сердечного миозина, натрийуретических пептидов, ингибиторов рецепторов вазопрессина, препаратов, влияющих на экспрессию кальциевой АТФ-азы сердечной саркоплазматической сети (SERCA2a), в том числе полученных с помощью генно-инженерных технологий.

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Levosimendan Hemodynamic Effects Depending on the Outcome of Sepsis

Tyurin

Проценко

Kozlov

2022

Vestn. anesteziol. reanimatol.

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The objective: to study hemodynamic and clinical effects of levosimendan depending on the clinical outcome in patients with sepsis and impaired cardiac pumping function.Subjects and Methods. the retrospective study involved 31 patients of 52.7 ± 2.8 years old with sepsis or septic shock which were treated with levosimendan at the dose of 0.16 [0.15‒0.17] mg/kg (0.11 [0.1‒0.12] μg × kg-1 × min-1) on days 1–4 of ICU stay. The patients were divided into the following groups: Group 1 ‒ survivors (n = 19) and Group 2 – non-survivors (n = 12). Central hemodynamics was assessed through transpulmonary thermodilution. The differences were considered statistically significant at p < 0.05.Results. Most of the hemodynamic parameters and vasopressors and inotropes doses had no differences between the groups before levosimendan administration. There were no differences in the cardiac index (3.8 ± 0.3 vs 3.5 ± 0.3 L/min/m2; p = 0.479) between the groups following levosimendan administration, however, Group 1 demonstrated the following parameters to be lower versus Group 2: central venous pressure (7 ± 0.7 vs 11 ± 1 mm Hg; p = 0.005), blood lactate (1 [0.9‒1.8] vs 2.4 [2.2‒3.3] mmol/L; p = 0.04), norepinephrine dosages (0.2 [0.15‒0.35] and 0.5 [0.4‒0.6] ng/kg/min; p = 0.023 ), global end-diastolic volume index (693 [688‒28] vs 870 [779‒961] mL/m2; p =0,0009) and the level of NT-proBNP (1,590 [1,080‒3,160] vs 35,000 [21,400‒35,000] pg/mL; p = 0,0001). Global heart ejection fraction (23 [21‒27] vs 15 [12‒20]%; p = 0.015) and heart function index (6 [5‒8] vs 3 [ 3-4] min-1; p = 0.003) ) were higher in Group 1 versus Group 2. APACHE II >19 (AUC 0.906; p < 0.0001), SOFA > 9 (AUC 0.805; p = 0.0002); heart rate > 114 min-1 (AUC 0.755; p = 0.0095), and index of total peripheral vascular resistance < 1,700 dyn × s × cm-5 × m2 (AUC 0.806; p = 0.001) before levosimendan administration were the independent predictors of death in patients treated with levosimendan.Conclusion: non-survivors patients with sepsis had significantly higher APACHE II and SOFA scores, higher heart rate and lower index of total peripheral vascular resistance before levosimendan infusion. In survivors levosimendan infusion at a standard dose led to a significant improvement in the heart pumping function accompanying by global heart ejection fraction and heart function index increasing and NT-proBNP decreasing. In non-survivors such favorable central hemodynamics changes did not occur, although the cardiac index increased after inodilator administration. Further studies of levosimendan efficacy in patients with sepsis of varying severity are advisable. It is necessary to specify the indications and contraindications for levosimendan administration to patients with sepsis.

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About efficiency of the pharmacological scores as a predictors of outcomes after cardiac surgery

Cited by 7 publications

References 15 publications

N-terminal pro-B-type natriuretic peptide is a biomarker of myocardial stress in abdominal sepsis and septic shock

N-terminal pro-B-type natriuretic peptide is a biomarker of myocardial stress in abdominal sepsis and septic shock

Pharmacological therapy of acute heart failure: what is available now and what is expected in future

Levosimendan Hemodynamic Effects Depending on the Outcome of Sepsis

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