Acute and Critical Care

Original Article

Liver
Bleeding complications associated with the molecular adsorbent recirculating system: a retrospective study: Seon Woo Yoo, Min-Jong Ki, Dal Kim, Seul Ki Kim, SeungYong Park, Hyo Jin Han, Heung Bum Lee; Acute Crit Care. 2021;36(4):322-331. Published online November 16, 2021; DOI: https://doi.org/10.4266/acc.2021.00276

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Background
The molecular adsorbent recirculating system (MARS) is a hepatic replacement system that supports excretory liver function in patients with liver failure. However, since MARS has been employed in our hospital, bleeding complications have occurred in many patients during or after MARS. The objective of this study was to determine how MARS affects coagulopathy and identify specific factors associated with bleeding complications.
Methods
We retrospectively analyzed data from 17 patients undergoing a total of 41 MARS sessions. Complete blood count, coagulation profiles, and blood chemistry values were compared before and after MARS. To identify pre-MARS factors associated with increased bleeding after MARS, we divided patients into bleeder and non-bleeder groups and compared their pre-MARS laboratory values.
Results
MARS significantly reduced bilirubin and creatinine levels. MARS also increased prothrombin time and reduced platelet and fibrinogen, thus negatively impacting coagulation. Pre-MARS hemoglobin was significantly lower in the bleeder group than in the non-bleeder group (P=0.015). When comparing the upper and lower 33% of MARS sessions based on the hemoglobin reduction rate, hemoglobin reduction was significantly greater in MARS sessions involving patients with low pre-MARS international normalized ratio of prothrombin time (PT-INR) and factor V (P=0.038 and P=0.023, respectively).
Conclusions
MARS could appears to alter coagulation-related factors such as factor V and increase the risk of bleeding complications particularly in patient with low hemoglobin. However, individual differences among patients were large, and various factors, such as low hemoglobin, PT-INR, and factor V levels, appear to be involved.

Citations

Citations to this article as recorded by

Fractionated plasma separation and adsorption integrated with continuous veno‐venous hemofiltration in patients with acute liver failure: A single center experience from China
Jianhua Dong, Li Huang, Chuan Li, Bian Wu, Xi Yang, Yongchun Ge
Journal of Clinical Apheresis.2024;[Epub] CrossRef
Crosslinked Bifunctional Particles for the Removal of Bilirubin in Hyperbilirubinemia Cases
María del Prado Garrido, Ana Maria Borreguero, Maria Jesús Ramos, Manuel Carmona, Francisco Javier Redondo Calvo, Juan Francisco Rodriguez
Materials.2023; 16(8): 2999. CrossRef
The Effect of Molecular Adsorbent Recirculating System in Patients With Liver Failure: A Case Series of 44 Patients
Shahin Isha, Anna S. Jenkins, Abby J. Hanson, Parthkumar H. Satashia, Sai Abhishek Narra, Gunjan D. Mundhra, Mohammed Mustafa Hasan, Ashrita Donepudi, Abishek Giri, Patrick W. Johnson, Dolores Villar, Christan Santos, Juan Canabal, Philip Lowman, Pablo Mo
Transplantation Proceedings.2023; 55(9): 2126. CrossRef
Extracorporeal organ support and the kidney
Maria-Jimena Muciño-Bermejo
Frontiers in Nephrology.2022;[Epub] CrossRef

Case Report

Infection
The first case of abdominal mycotic aneurysm caused by K1 hypervirulent Klebsiella pneumoniae in a healthy adult: Misun Kim, Jeong Rae Yoo, Hyunjoo Oh, Young Ree Kim, Keun Hwa Lee, Sang Taek Heo; Acute Crit Care. 2021;36(4):390-394. Published online November 16, 2021; DOI: https://doi.org/10.4266/acc.2021.00010

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Abstract PDF

Incidence of hypervirulent Klebsiella pneumoniae (hvKp) infection has been steadily increasing in the Asia-Pacific rim. The characteristic of hvKp infection is its ability to cause multiple site infections and unpredictable metastatic spread in the community. We describe the first case of mycotic aneurysm caused by hvKp serotype K1 in a previously healthy man and review the literature. Of a total of 13 cases, including our case, three cases were related to hvKp. Among patients with hvKp, the level of mycotic aneurysm in most patients was the infrarenal aorta, and they underwent an aortic graft or coil embolization. All strains were susceptible to most antimicrobial agents, except ampicillin. Early detection of hvKp can help to prevent the metastatic spread of pathogens and be useful for optimal patient care and epidemiologic research.

Citations

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Designing a conjugate vaccine targeting Klebsiella pneumoniae ST258 and ST11
Min Li, Mingkai Yu, Yigang Yuan, Danyang Li, Daijiao Ye, Min Zhao, Zihan Lin, Liuzhi Shi
Heliyon.2024; 10(5): e27417. CrossRef
Successful treatment of acute respiratory distress syndrome caused by hypervirulent Klebsiella pneumoniae with extracorporeal membrane oxygenation and continuous renal replacement therapy: A case report and literature review
Wenzhong Peng, Yanhao Wu, Rongli Lu, Yunpeng Zheng, Jie Chen, Pinhua Pan
Frontiers in Medicine.2022;[Epub] CrossRef
Gut microbiome sheds light on the development and treatment of abdominal aortic aneurysm
Xuebin Ling, Wei Jie, Xue Qin, Shuya Zhang, Kaijia Shi, Tianfa Li, Junli Guo
Frontiers in Cardiovascular Medicine.2022;[Epub] CrossRef

Original Articles

Thoracic Surgery
Perfusion parameters during cardiopulmonary bypass as a predictor of acute kidney injury after aortic valve replacement: Yeiwon Lee, Sue Hyun Kim, Ho Young Hwang, Suk Ho Sohn, Jae Woong Choi, Kyung Hwan Kim; Acute Crit Care. 2021;36(3):242-248. Published online August 12, 2021; DOI: https://doi.org/10.4266/acc.2021.00094

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Abstract PDF

Background
Acute kidney injury (AKI) is a major complication after cardiac surgery and significantly affects postoperative mortality and morbidity. This study was conducted to evaluate the association between target pump flow to achieve adequate oxygen delivery (DO₂) and postoperative renal function after aortic valve replacement.
Methods
From January 2017 to May 2020, 281 patients (male:female, 160:121; mean age, 68±11 years) who underwent aortic valve replacement were retrospectively reviewed. Target pump flow was calculated based on DO₂ level of 280 mL/min/m². The primary endpoint was postoperative renal dysfunction, defined as the ratio of postoperative peak creatinine level to preoperative value. The ratio of the lowest actual pump flow to the ideal target pump flow, other hemodynamic variables related with cardiopulmonary bypass, intraoperative transfusion, and preoperative characteristics were analyzed to identify factors associated with the primary endpoint using a multivariable linear regression model.
Results
Preoperative and peak postoperative creatinine levels were 0.94±0.33 mg/dl and 1.15±0.56 mg/dl, respectively (ratio, 1.22±0.33). The ideal target pump flow was 4.70±0.59 L/min, whereas the lowest actual pump flow was 3.77±0.47 L/min (ratio, 0.81±0.13). The multivariable model showed that the ratio of the lowest pump flow to target pump flow (β±standard error, –0.405±0.162, P=0.013), as well as sex, stroke history, emergency operation, and transfusion of red blood cells were associated with the primary endpoint.
Conclusions
Low actual nadir pump flow compared to the ideal target pump flow based on DO₂ is associated with the risk of AKI after aortic valve replacement.

Citations

Citations to this article as recorded by

Alterations to Kidney Physiology during Cardiopulmonary Bypass—A Narrative Review of the Literature and Practical Remarks
Jakub Udzik, Jerzy Pacholewicz, Andrzej Biskupski, Paweł Walerowicz, Kornelia Januszkiewicz, Ewa Kwiatkowska
Journal of Clinical Medicine.2023; 12(21): 6894. CrossRef

Basic science and research
Therapeutic hypothermia reduces inflammation and oxidative stress in the liver after asphyxial cardiac arrest in rats: Yoonsoo Park, Ji Hyeon Ahn, Tae-Kyeong Lee, Bora Kim, Hyun-Jin Tae, Joon Ha Park, Myoung Cheol Shin, Jun Hwi Cho, Moo-Ho Won; Acute Crit Care. 2020;35(4):286-295. Published online November 30, 2020; DOI: https://doi.org/10.4266/acc.2020.00304

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Abstract PDF

Background
Few studies have evaluated the effects of hypothermia on cardiac arrest (CA)-induced liver damage. This study aimed to investigate the effects of hypothermic therapy on the liver in a rat model of asphyxial cardiac arrest (ACA).
Methods
Rats were subjected to 5-minute ACA followed by return of spontaneous circulation (RoSC). Body temperature was controlled at 33°C±0.5°C or 37°C±0.5°C for 4 hours after RoSC in the hypothermia group and normothermia group, respectively. Liver tissues in each group were collected at 6 hours, 12 hours, 1 day, and 2 days after RoSC. To examine hepatic inflammation, mast cells were stained with toluidine blue. Superoxide anion radical production was evaluated using dihydroethidium fluorescence straining and expression of endogenous antioxidants (superoxide dismutase 1 [SOD1] and SOD2) was examined using immunohistochemistry.
Results
There were significantly more mast cells in the livers of the normothermia group with ACA than in the hypothermia group with ACA. Gradual increase in superoxide anion radical production was found with time in the normothermia group with ACA, but production was significantly suppressed in the hypothermia group with ACA relative to the normothermia group with ACA. SOD1 and SOD2 levels were higher in the hypothermia group with ACA than in the normothermia group with ACA.
Conclusions
Experimental hypothermic treatment after ACA significantly inhibited inflammation and superoxide anion radical production in the rat liver, indicating that this treatment enhanced or maintained expression of antioxidants. Our findings suggest that hypothermic therapy after CA can reduce mast cell-mediated inflammation through regulation of oxidative stress and the expression of antioxidants in the liver.

Citations

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Mechanisms of low-temperature rehabilitation technologies. Natural and artificial hypothermia
Oleg A. Shevelev, Marina V. Petrova, Elias M. Mengistu, Vladislav A. Yakimenko, Darina N. Menzhurenkova, Irina N. Kolbaskina, Maria A. Zhdanova, Nadezhda A. Khodorovich, Ekaterina O. Sheveleva
Physical and rehabilitation medicine, medical rehabilitation.2023; 5(2): 141. CrossRef
Continuously increased generation of ROS in human plasma after cardiac arrest as determined by Amplex Red oxidation
Muhammad Shoaib, Nancy Kim, Rishabh C. Choudhary, Blanca Espin, Mitsuaki Nishikimi, Ann Iverson, Tsukasa Yagi, Seyedeh Shadafarin Marashi Shoshtari, Koichiro Shinozaki, Lance B. Becker, Junhwan Kim
Free Radical Research.2023; 57(5): 384. CrossRef
Prevention and correction of postdecompression liver dysfunction in obstructive jaundice in experimental animals
M. M. Magomedov, M. A. Khamidov, H. M. Magomedov, K. I. Hajiyev
Bulletin of the Medical Institute "REAVIZ" (REHABILITATION, DOCTOR AND HEALTH).2021; 11(4): 45. CrossRef
Hypothermic treatment reduces matrix metalloproteinase-9 expression and damage in the liver following asphyxial cardiac arrest in rats
Donghwi Kim, Bora Kim, Hyejin Sim, Tae-Kyeong Lee, Hyun-Jin Tae, Jae-Chul Lee, Joon Ha Park, Jun Hwi Cho, Moo-Ho Won, Yoonsoo Park, Ji Hyeon Ahn
Laboratory Animal Research.2021;[Epub] CrossRef
High Oxygen Does Not Increase Reperfusion Injury Assessed with Lipid Peroxidation Biomarkers after Cardiac Arrest: A Post Hoc Analysis of the COMACARE Trial
Jaana Humaloja, Maximo Vento, Julia Kuligowski, Sture Andersson, José David Piñeiro-Ramos, Ángel Sánchez-Illana, Erik Litonius, Pekka Jakkula, Johanna Hästbacka, Stepani Bendel, Marjaana Tiainen, Matti Reinikainen, Markus B. Skrifvars
Journal of Clinical Medicine.2021; 10(18): 4226. CrossRef

Nephrology
The Association of Preoperative Body Mass Index with Acute Kidney Injury in Liver Transplantation Recipients: A Retrospective Study: Ju Yeon Park, Jung-Hyun Park, Su Sung Lee, Hyun-Su Ri, Hye-jin Kim, Yun Mi Choi, Yoon Ji Choi, Ji-Uk Yoon; Korean J Crit Care Med. 2017;32(3):265-274. Published online August 31, 2017; DOI: https://doi.org/10.4266/kjccm.2017.00178

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Abstract PDF

Background
Liver transplantation (LT) is a complicated procedure with a high incidence of postoperative acute kidney injury (AKI). Previous studies indicate that even transient or mild post-LT AKI can result in critical conditions, including prolonged stays in hospitals and intensive care units and increased morbidity and mortality. The aim of this study was to investigate the association between body mass index (BMI) and occurrence of AKI in LT recipients. Methods: Medical data from 203 patients who received LT surgery from January 2010 to August 2016 in a single university hospital setting were retrospectively collected and analyzed. Patients were classified as either underweight (BMI <20 kg/m²) or normal weight (20 ≤ BMI < 30 kg/m²). Demographic data, anesthetic methods, complications, and perioperative laboratory test values of each patient were assessed. Propensity analyses and logistic regression were performed to evaluate the association between BMI and post-LT AKI. Results: There was no significant difference in occurrence of post-LT AKI between underweight and normal weight patients. The underweight patient group had significantly longer hospital stay compared with the normal weight patient group (P = 0.023). Conclusions: BMI classification was neither a positive nor negative predictor of postoperative AKI occurrence. However, patients with lower BMI had significantly longer hospital stay compared with their counterparts. Although our study was limited by its retrospective design, our observations suggest that lower BMI might play a role in post-LT AKI.

Citations

Citations to this article as recorded by

Association of Body Mass Index and Acute Kidney Injury Incidence and Outcome: A Systematic Review and Meta-Analysis
Jiarong Lan, Guangxing Xu, Yongfu Zhu, Congze Lin, Ziyou Yan, Sisi Shao
Journal of Renal Nutrition.2023; 33(3): 397. CrossRef
Association of overweight with postoperative acute kidney injury among patients receiving orthotopic liver transplantation: an observational cohort study
Jian Zhou, Lin Lyu, Lin Zhu, Yongxin Liang, He Dong, Haichen Chu
BMC Nephrology.2020;[Epub] CrossRef

Case Reports

Neurology/Liver
Non-Convulsive Status Epilepticus following Liver Transplantation: Bora Lee, Nar Hyun Min, Sung Yeon Ham, Sungwon Na, Jeongmin Kim; Korean J Crit Care Med. 2016;31(1):49-53. Published online February 29, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.1.49

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Abstract

Neurological complications following liver transplantation are more common than after other organ transplants. These complications include seizure in about 8% of cases, which is associated with morbidity and mortality. Seizure should be treated immediately, and the process of differential diagnosis has to be performed appropriately in order to avoid permanent neurologic deficit. We herein report a case of status epilepticus after liver transplantation. The status epilepticus was treated promptly and the cause of seizure was assessed. The patient was discharged without any complication.

Citations

Citations to this article as recorded by

Early postoperative seizures in liver and kidney recipients
O. M. Tsirulnikova, A. V. Syrkina, I. A. Miloserdov, I. E. Pashkova, S. Yu. Oleshkevich, I. B. Komarova
Russian Journal of Transplantology and Artificial Organs.2021; 23(2): 158. CrossRef

Cardiology
ST-Segment Elevation Myocardial Infarction as a Result of Coronary Artery Ectasia-Related Intracoronary Thrombus in a Patient with Liver Cirrhosis: Ji Woong Roh, Eun Hyea Park, Joon Cheol Song, Young Seung Oh, Tong Yoon Kim, Hyo Suk Kim, Sungmin Lim; Korean J Crit Care Med. 2015;30(4):358-364. Published online November 30, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.4.358

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Abstract PDF: Coronary artery ectasia (CAE) is a rare condition defined as the dilatation of coronary artery to at least 1.5 times larger than the normal adjacent coronary artery. Clinical manifestations of CAE vary, ranging from asymptomatic to ST-segment elevation myocardial infarction (STEMI). Because of its rarity and clinical diversity, the best treatment strategy and prognosis for CAE remain unclear. We describe a case of STEMI caused by intracoronary thrombus formation within an ectatic area in a patient with liver cirrhosis (LC). The patient was successfully managed by thrombus aspiration only, without balloon angioplasty or stent implantation, and maintained by dual antiplatelet therapy with aspirin and ticagrelor, a potent new P2Y12 inhibitor.

Neurology/Liver
Fixed Pupillary Light Reflex due to Peripheral Neuropathy after Liver Transplantation: Kwan Hyung Kim, Namo Kim, Sungwon Na, Jaewon Jang, Jeongmin Kim; Korean J Crit Care Med. 2015;30(3):191-195. Published online August 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.3.191

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Abstract PDF: A 46- year-old female patient was admitted to the intensive care unit (ICU) after liver transplantation. About an hour later after the ICU admission, she had no pupillary light reflex. Both pupils were also fixed at 5 mm. Patients who undergo liver transplantation are susceptible to neurologic disorders including hepatic encephalopathy, thromboembolism and intracranial hemorrhage. Abnormal pupillary light reflex usually indicates a serious neurologic emergency in these patients; however, benign neurologic disorders such as peripheral autonomic neuropathy or Holmes-Adie syndrome should also be considered. We experienced a case of fixed pupillary light reflex after liver transplantation diagnosed as peripheral autonomic neuropathy.

Original Article

Trauma
Traumatic Liver Injury: Factors Associated with Mortality: Youn Suk Chai, Jae Kwang Lee, Seok Jin Heo, Yeong Ki Lee, Yong Woo Lee, Young Hwa Jo, Seong Soo Park, Hyun Jin Kim, In Gu Kang; Korean J Crit Care Med. 2014;29(4):320-327. Published online November 30, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.4.320

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Abstract PDF: BACKGROUND
We postulate that a delay in the implementation of hepatic arterial embolization for traumatic liver injury patients will negatively affect patient prognosis. Our work also seeks to identify factors related to the mortality rate among traumatic liver injury patients.
METHODS
From January 2008 to April 2014, patients who had been admitted to the emergency room, were subsequently diagnosed with traumatic liver injury, and later underwent hepatic arterial embolization were included in this retrospective study.
RESULTS
Of the 149 patients that underwent hepatic arterial embolization, 86 had the procedure due to traumatic liver injury. Excluding the 3 patients that were admitted to the hospital before procedure, the remaining 83 patients were used as subjects for the study. The average time between emergency room arrival and incidence of procedure was 164 min for the survival group and 132 min for the non-survival group; this was not statistically significant (p = 0.170). The average time to intervention was 182 min for the hemodynamically stable group, and 149 min for the hemodynamically unstable group, the latter having a significantly shorter wait time (p = 0.047). Of the factors related to the mortality rate, the odds ratio of the Glasgow Coma Score (GCS) was 18.48 (p < 0.001), and that of albumin level was 0.368 (p = 0.006).
CONCLUSIONS
In analyzing the correlation between mortality rate and the time from patient admission to arrival for hepatic arterial embolization, there was no statistical significance observed. Of the factors related to the mortality rate, GCS and albumin level may be used as prognostic factors in traumatic liver injury.

Case Reports

Gastroenterology
Successful Bridging Hemostasis Using a Sengstaken-Blakemore Tube in Massive Rectal Variceal Bleeding: Kyung Su Kim, Gil Joon Suh, Woon Yong Kwon; Korean J Crit Care Med. 2014;29(3):237-240. Published online August 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.3.237

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Abstract PDF

Life-threatening rectal variceal bleeding is a rare complication of liver cirrhosis. Various therapeutic interventions including endoscopic variceal ligation and percutaneous transvenous obliteration have been proposed to control significant rectal variceal bleeding. However, these definite hemostasis modalities are not readily available and require an experienced endoscopist or interventional radiologist. Therefore, bridging therapy to control active bleeding is necessary especially in patients with massive bleeding. We report a case of massive rectal variceal bleeding in which a Sengstaken-Blakemore tube was effective at stopping the bleeding until percutaneous transvenous obliteration could be performed.

Citations

Citations to this article as recorded by

Anorectal emergencies: WSES-AAST guidelines
Antonio Tarasconi, Gennaro Perrone, Justin Davies, Raul Coimbra, Ernest Moore, Francesco Azzaroli, Hariscine Abongwa, Belinda De Simone, Gaetano Gallo, Giorgio Rossi, Fikri Abu-Zidan, Vanni Agnoletti, Gianluigi de’Angelis, Nicola de’Angelis, Luca Ansaloni
World Journal of Emergency Surgery.2021;[Epub] CrossRef

Emergency/Liver
Liver Laceration with Hemoperitoneum after Cardiopulmonary Resuscitation: Jin Wi, Dongho Shin; Korean J Crit Care Med. 2014;29(2):141-143. Published online May 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.2.141

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Abstract PDF

It is well known that external chest compression during cardiopulmonary resuscitation is frequently associated with various complications. These complications predominantly involve trauma to the heart, lungs, and chest wall, whereas cases involving intra-abdominal injury are much less frequent. The present report describes a rare case of a female patient with severe hemoperitoneum associated with liver injury after cardiopulmonary resuscitation. Although emergent angiography and embolization of the hepatic artery were performed and transfusion of various kinds of blood products was done continuously, the patient expired the next day.

Citations

Citations to this article as recorded by

Major liver trauma post-mechanical cardiopulmonary resuscitation—the first reported case of survival with normal cardiovascular and neurological outcome
P Sharma, C Hernandez-Caballero
Oxford Medical Case Reports.2020;[Epub] CrossRef
Subcapsular Hepatic Hematoma after Cardiopulmonary Resuscitation
Song-I Lee
Kosin Medical Journal.2020; 35(2): 156. CrossRef
ICD lead extraction: Not a benign procedure. External chest compression: Not a benign manoeuvre
Federico Sertic, Paolo Bosco, Antonella Ferrara, Patrick Heck, Yasir Abu-Omar
JRSM Cardiovascular Disease.2017; 6: 204800401773104. CrossRef

Intraoperative Fluid Management in Combined Liver-Kidney Transplantation: Jong Hae Kim, Bo Reum Lim, Jin Yong Jung; Korean J Crit Care Med. 2013;28(4):309-313.; DOI: https://doi.org/10.4266/kjccm.2013.28.4.309

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Abstract PDF

A review of the literature regarding combined liver-kidney transplantation (CLKT) does not provide adequate central venous pressure (CVP) values that would allow for unimpaired hepatic venous outflow and early renal allograft diuresis during the procedure. We report a case of fluid management of CLKT based on the limited literature available in a 59-year-old male with liver cirrhosis and end-stage renal disease. During the preanhepatic phase, CVP was maintained at 5 mmHg. Following portal vein clamping, CVP was reduced to below 5 mmHg until venovenous bypass was initiated. From the neohepatic phase to 1 hour before renal allograft reperfusion, CVP was slowly increased to 10 mmHg. Within an hour before renal allograft reperfusion, maximal crystalloid hydration was used to increase CVP to 15 mmHg. The urine output was replaced to maintain CVP at 8 to 10 mmHg until the end of the surgery. The postoperative course was uneventful. In conclusion, fluid management tailored to each phase yielded beneficial results in a patient with CLKT.

Citations

Citations to this article as recorded by

Combined liver and kidney transplantation: Our experience and review of literature
KusumaRamachandra Halemani, N Bhadrinath
Indian Journal of Anaesthesia.2017; 61(1): 68. CrossRef

Original Article

The Analysis of Prognostic Factors in Patients with Decompensated Liver Cirrhosis Admitted to the Medical Intensive Care Unit: Gil Jae Lee, Jung Nam Lee, Iris Naheah Kim, Keon Kuk Kim, Woon Kee Lee, Jeong Heum Baek, Sang Tae Choi, Won Suk Lee, Byung Chul Yu, Yeon Jeong Park; Korean J Crit Care Med. 2013;28(2):101-107.; DOI: https://doi.org/10.4266/kjccm.2013.28.2.101

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Abstract PDF: BACKGROUND
Patients with decompensated liver cirrhosis usually resulted in admission to the intensive care unit (ICU) during hospitalization. When admitted to the ICU, the mortality was high. The aim of this study is to identify multiple prognostic factors for mortality and to analyze the significance of prognostic survival model with each scoring system in patients with decompensated liver cirrhosis who was admitted to the ICU.
METHODS
From January 2008 to December 2008, 60 consecutive patients with decompensated liver cirrhosis were admitted in the ICU and retrospectively reviewed. Prognostic models used were Child-Turcotte-Pugh (CTP), model for end-stage liver disease (MELD), model for end-stage liver disease with incorporation of serum sodium (MELD-Na), acute physiology and chronic health evaluation (APACHE) II, and sequential organ failure assessment (SOFA). The predictive prognosis was analyzed using the area under the receiver's operating characteristics curve (AUC).
RESULTS
The median follow up period was 20 months, and ICU mortality was 17% (n = 10). A total of 24 patients (40%) died during the study period. The average survival of five prognostic models was related with the severity of the disease. All of the five systems showed significant differences in the cumulative survival rate, according to the scores on admission, and the MELD-Na had the highest AUC (0.924). Multivariate analysis showed that bilirubin and albumin were significantly related to mortality.
CONCLUSIONS
The CPT, MELD, MELD-Na, APACHE II, and SOFA may predict the prognosis of patients with decompensated liver cirrhosis. The MELD-Na could be a better prognostic predictor than other scoring systems.

Case Report

Stress-induced Cardiomyopathy Following Cesarean Delivery with Hemorrhagic Shock: A Case Report: Youn Yi Jo, Ja Young Kwon, Yoon Seong Jang, Yong Seon Choi; Korean J Crit Care Med. 2011;26(1):34-37.; DOI: https://doi.org/10.4266/kjccm.2011.26.1.34

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Abstract PDF: Stress-induced cardiomyopathy is a recently described acute and transient cardiomyopathy with typical left ventricular apical ballooning mimicking the clinical scenario of an acute myocardial infarction. Cesarean delivery causes intense emotional and physical stresses, which may precipitate stress-induced cardiomyopathy. We report a case presenting stress-induced cardiomyopathy occurring during ICU care in the early postpartum period following cesarean delivery.

Original Article

Evaluating the Relationship between the Scoring Systems of Intensive Care Units (ICUs) and the Duration of Mechanical Ventilation after Liver Transplantation: Jeong Eun Kim, Sang Hoon Lee, Jong Ho Choi; Korean J Crit Care Med. 2009;24(2):69-74.; DOI: https://doi.org/10.4266/kjccm.2009.24.2.69

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Abstract PDF: BACKGROUND
Postoperative mechanical ventilation in liver transplant patient has an important role for reducing respiratory complications and multi-organ failure in intensive care unit (ICU). Yet there are no specific indications for predicting the duration of postoperative mechanical ventilation. Thus, we evaluated the correlation between the duration of mechanical ventilation and scoring systems such as the Acute Physiology and Chronic health Evaluation (APACHE) II score, the Sequential Organ Failure Assessment (SOFA) score, the Model for End-stage Liver Disease (MELD) score and the risk index.
METHODS
We retrospectively studied 183 patients who underwent living donor liver transplantation and we divided them into three groups based on the duration of mechanical ventilation: Group 1: <8 hr, Group 2: 8-12 hr and Group 3: >12 hr. We analyzed the correlation coefficients among the duration of mechanical ventilation, the risk index, and the SOFA, APACHE II and MELD scores.
RESULTS
The MELD and preoperative SOFA scores were significantly higher in group 3 (p = 0.003, p = 0.027). The MELD and SOFA scores were correlated with the duration of mechanical ventilation for all the patients (correlation coefficient = 0.22, 0.20, p = 0.003, 0.007, respectively). Yet the APACHE II score shows no correlation.
CONCLUSIONS
We found that the MELD and SOFA scores were correlated with the duration of mechanical ventilation in liver transplant patients. Thus, these scoring systems may be useful to determine the duration of mechanical ventilation.

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