Recognizing the critically ill patient

Robertson, Laura C.; Al-Haddad, Mohammed

doi:10.1016/j.mpaic.2012.11.010

Cited by 32 publications

(30 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The disruption of the microbiome homeostasis, known as "dysbiosis" or "pathobiome", can be as important as the host genetics for the development of various conditions, such as inflammatory bowel disease, obesity, diabetes, or cardiovascular disease. In critically ill patients, who are affected by a life-threatening multisystem process that can result in significant morbidity or mortality [1], many factors can contribute to the development of a pathobiome, including intrinsic factors, like genetics or age, and those that can be manipulated by either the human host or medical interventions, such as diet, geographic location, or drug therapy [2][3][4]. Lately, special attention has been paid to the relationship between nutrition and the microbiome, but more data is needed to understand which nutrients participate in the maintenance of the microbiome homeostasis in health and disease, and which interventions could help to recover this homeostasis during and after critical illness, like nutritional supports or the use of probiotics, prebiotics, and fecal transplantation.…”

Section: Introductionmentioning

confidence: 99%

The Importance of the Microbiome in Critically Ill Patients: Role of Nutrition

et al. 2019

View full text Add to dashboard Cite

Critically ill patients have an alteration in the microbiome in which it becomes a disease-promoting pathobiome. It is characterized by lower bacterial diversity, loss of commensal phyla, like Firmicutes and Bacteroidetes, and a domination of pathogens belonging to the Proteobacteria phylum. Although these alterations are multicausal, many of the treatments administered to these patients, like antibiotics, play a significant role. Critically ill patients also have a hyperpermeable gut barrier and dysregulation of the inflammatory response that favor the development of the pathobiome, translocation of pathogens, and facilitate the emergence of sepsis. In order to restore the homeostasis of the microbiome, several nutritional strategies have been evaluated with the aim to improve the management of critically ill patients. Importantly, enteral nutrition has proven to be more efficient in promoting the homeostasis of the gut microbiome compared to parenteral nutrition. Several nutritional therapies, including prebiotics, probiotics, synbiotics, and fecal microbiota transplantation, are currently being used, showing variable results, possibly due to the unevenness of clinical trial conditions and the fact that the beneficial effects of probiotics are specific to particular species or even strains. Thus, it is of great importance to better understand the mechanisms by which nutrition and supplement therapies can heal the microbiome in critically ill patients in order to finally implement them in clinical practice with optimal safety and efficacy.

show abstract

Section: Introductionmentioning

confidence: 99%

The Importance of the Microbiome in Critically Ill Patients: Role of Nutrition

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Currently, there is no univocal definition of critical illness: for this reason, in order to outline the critically ill subjects, we selected all the patients affected by a life-threatening condition with signs of physiological deterioration 11 , defined as the presence of at least one abnormal vital sign and one end-organ dysfunction at the admission.…”

mentioning

confidence: 99%

The Prognostic Role of Procalcitonin in Critically Ill Patients Admitted in a Medical Stepdown Unit: A Retrospective Cohort Study

Zaccone

Falsetti

Nitti

et al. 2020

Sci Rep

View full text Add to dashboard Cite

Procalcitonin (PCT) is a a marker of bacterial infection. Its prognostic role in the critically-ill patient, however, is still object of debate. Aim of this study was to evaluate the capacity of admission PCT (apct) in assessing the prognosis of the critically-ill patient regardless the presence of bacterial infection. A single-cohort, single-center retrospective study was performed evaluating critically-ill patients admitted to a stepdown care unit. Age, sex, Simplified Acute Physiology Score II (SAPS-II), shock, troponin-I, aPCT, serum creatinine, cultures and clinical endpoints (in-hospital mortality or Intensive Care Unit (ICU) transfer) were collected. Time free from adverse event (TF-AE) was defined as the time between hospitalization and occurrence of one of the clinical endpoints, and calculated with Kaplan-Meier curves. We engineered a new predictive model (POCS) adopting aPCT, age and shock. We enrolled 1063 subjects: 450 reached the composite outcome of death or ICU transfer. aPCT was significantly higher in this group, where it predicted TF-AE both in septic and non-septic patients. aPCT and POCS showed a good prognostic performance in the whole sample, both in septic and non-septic patients. aPCT showed a good prognostic accuracy, adding informations on the rapidity of clinical deterioration. pocS model reached a performance similar to SApS-ii. Procalcitonin (PCT) is a pro-hormone of human calcitonin synthesized by the parafollicular C cells of the thyroid and involved in calcium homeostasis. PCT is produced in large quantities by different cell types in patients affected by bacterial infections 1. Several studies have shown low-to moderately-elevated PCT levels also among critically-ill patients without evidence of infection (trauma, major surgery, multi-organ failure and myocardial infarction) 2,3. Clinically, PCT represents a quantitative biomarker which is currently used to help predicting the probability of bacterial infections 4 and guide the duration of antibiotic therapy 5. PCT demonstrated not only a diagnostic, but also an elevated prognostic value in septic patients. A recent meta-analysis concluded that increased PCT concentrations and absence of PCT clearance were strongly associated with all-cause mortality in septic patients 6. Clinical and pathophysiological data suggest a role of PCT in prognostic evaluation of critically-ill patients regardless the presence of a bacterial infection 7 , but large and conclusive data are still lacking. Main objective of the present study was to assess the prognostic value of PCT, evaluated as a single assay at the admission (aPCT) within the first 12 hours, in critically-ill patients regardless of the presence of bacterial infection. We also engineered a new predictive model, named "Procalcitonin and Other Clinical Score" (POCS), adopting both clinical and laboratoristic variables (aPCT, age and shock), to improve the prediction of outcomes and compared its performances with other validated prognostic markers, as Troponin I (TnI) 8 and the Simplified ...

show abstract

“…Articles were included if they fulfilled the following criteria: cohort in design; focused on assessing mNUTRIC score in critically ill patients admitted to ICUs who are above 20-years-old; relative risks were reported with their corresponding 95% CIs or original data were available to allow for computing them; and at least one of these outcomes was assessed: a) 28-day mortality, b) length of ICU stay, C) duration of mechanical ventilation and d) incidence of infection. A critically ill patient was defined as patient who has a lifethreatening multisystem process that can result in significant morbidity and mortality, and in most cases is preceded by a period of physiological deterioration [12].…”

Section: Inclusion Criteriamentioning

confidence: 99%