- Pulmonary
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Association between mechanical power and intensive care unit mortality in Korean patients under pressure-controlled ventilation
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Jae Kyeom Sim, Sang-Min Lee, Hyung Koo Kang, Kyung Chan Kim, Young Sam Kim, Yun Seong Kim, Won-Yeon Lee, Sunghoon Park, So Young Park, Ju-Hee Park, Yun Su Sim, Kwangha Lee, Yeon Joo Lee, Jin Hwa Lee, Heung Bum Lee, Chae-Man Lim, Won-Il Choi, Ji Young Hong, Won Jun Song, Gee Young Suh
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Acute Crit Care. 2024;39(1):91-99. Published online January 26, 2024
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DOI: https://doi.org/10.4266/acc.2023.00871
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Abstract
PDFSupplementary Material
- Background
Mechanical power (MP) has been reported to be associated with clinical outcomes. Because the original MP equation is derived from paralyzed patients under volume-controlled ventilation, its application in practice could be limited in patients receiving pressure-controlled ventilation (PCV). Recently, a simplified equation for patients under PCV was developed. We investigated the association between MP and intensive care unit (ICU) mortality. Methods: We conducted a retrospective analysis of Korean data from the Fourth International Study of Mechanical Ventilation. We extracted data of patients under PCV on day 1 and calculated MP using the following simplified equation: MPPCV = 0.098 ∙ respiratory rate ∙ tidal volume ∙ (ΔPinsp + positive end-expiratory pressure), where ΔPinsp is the change in airway pressure during inspiration. Patients were divided into survivors and non-survivors and then compared. Multivariable logistic regression was performed to determine association between MPPCV and ICU mortality. The interaction of MPPCV and use of neuromuscular blocking agent (NMBA) was also analyzed. Results: A total of 125 patients was eligible for final analysis, of whom 38 died in the ICU. MPPCV was higher in non-survivors (17.6 vs. 26.3 J/min, P<0.001). In logistic regression analysis, only MPPCV was significantly associated with ICU mortality (odds ratio, 1.090; 95% confidence interval, 1.029–1.155; P=0.003). There was no significant effect of the interaction between MPPCV and use of NMBA on ICU mortality (P=0.579). Conclusions: MPPCV is associated with ICU mortality in patients mechanically ventilated with PCV mode, regardless of NMBA use.
- Pulmonary
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Clinical outcomes of difficult-to-wean patients with ventilator dependency at intensive care unit discharge
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Jung Mo Lee, Sun-Min Lee, Joo Han Song, Young Sam Kim
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Acute Crit Care. 2020;35(3):156-163. Published online August 19, 2020
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DOI: https://doi.org/10.4266/acc.2020.00199
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Abstract
PDFSupplementary Material
- Background
Ventilator-dependent patients in the intensive care unit (ICU) who are difficult to wean from invasive mechanical ventilation (IMV) have been increasing in number. However, data on the clinical outcomes of difficult-to-wean patients are lacking. We aimed to evaluate clinical outcomes in patients discharged from the ICU with tracheostomy and ventilator dependency.
Methods We retrospectively investigated clinical course and survival in patients requiring home mechanical ventilation (HMV) with a tracheostomy and difficulty weaning from IMV during medical ICU admission from September 2013 through August 2016 at Severance Hospital, Yonsei University, Seoul, Korea.
Results Of 84 difficult-to-wean patients who were started on HMV in the medical ICU, 72 survived, were discharged from the ICU, and were included in this analysis. HMV was initiated after a median of 23 days of IMV, and the successful weaning rate was 46% (n=33). In-hospital mortality rate was significantly lower in the successfully weaned group than the unsuccessfully weaned group (0% vs. 23.1%, respectively; P=0.010). Weaning rates were similar according to primary diagnosis, but high body mass index (BMI), low Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) II score at ICU admission, and absence of neuromuscular disease were associated with weaning success. After a median follow-up of 4.6 months (range, 1–27 months) for survivors, 3-month (n=64) and 6-month (n=59) survival rates were 82.5% and 72.2%, respectively. Survival rates were higher in the successfully weaned group than the unsuccessfully weaned group at 3 months (96.4% vs. 69.0%; P=0.017) and 6 months (84.0% vs. 62.1%; P=0.136) following ICU discharge.
Conclusions In summary, 46% of patients who started HMV were successfully weaned from the ventilator in general wards. High BMI, low APACHE II score, and absence of neuromuscular disease were factors associated with weaning success.
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Citations
Citations to this article as recorded by
- Long-Term Mortality in Critically Ill Tracheostomized Patients Based on Home Mechanical Ventilation at Discharge
Won-Young Kim, Moon Seong Baek Journal of Personalized Medicine.2021; 11(12): 1257. CrossRef - Year 2020 in review - Post‑acute intensive care
J Djakow Anesteziologie a intenzivní medicína.2020; 31(6): 305. CrossRef
- Cardiology
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Predictors and outcomes of sepsis-induced cardiomyopathy in critically ill patients
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Myung Jin Song, Sang Hoon Lee, Ah Young Leem, Song Yee Kim, Kyung Soo Chung, Eun Young Kim, Ji Ye Jung, Young Ae Kang, Young Sam Kim, Joon Chang, Moo Suk Park
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Acute Crit Care. 2020;35(2):67-76. Published online May 15, 2020
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DOI: https://doi.org/10.4266/acc.2020.00024
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Abstract
PDF
- Background
Sepsis-induced cardiomyopathy (SIC) occurs frequently in critically ill patients, but the clinical features and prognostic impact of SIC on sepsis outcome remain controversial. Here, we investigated the predictors and outcomes of SIC.
Methods Patients admitted to a single medical intensive care unit from June 2016 to September 2017 were retrospectively reviewed. SIC was diagnosed by ejection fraction (EF) <50% and ≥10% decrease in baseline EF that recovered within 2 weeks.
Results In total, 342 patients with sepsis met the inclusion criteria, and 49 patients (14.3%) were diagnosed with SIC; the latter were compared with 259 patients whose EF was not deteriorated by sepsis (non-SIC). Low systolic blood pressure and increased left ventricular end-diastolic diameter (LVEDD) were identified as predictors of SIC. SIC and non-SIC patients did not differ significantly in terms of 28-day all-cause mortality (24.5% vs. 26.3%, P=0.936). Acute Physiology and Chronic Health Evaluation II (APACHE II; hazard ratio [HR], 1.10; 95% confidential interval [CI], 1.02 to 1.18; P=0.009) and delta neutrophil index (DNI; HR, 1.02; 95% CI, 1.00 to 1.08; P=0.026) were independent risk factors for 28-day mortality with SIC. DNI, APACHE II, and lactate were identified as risk factors for 28-day mortality in sepsis patients as a whole.
Conclusions SIC was not associated with increased mortality compared to non-SIC. Low systolic blood pressure and increased LVEDD were predictors of SIC. High APACHE II score and elevated DNI, which reflect sepsis severity, predict 28-day all-cause mortality.
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Citations
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- Testosterone and soluble ST2 as mortality predictive biomarkers in male patients with sepsis-induced cardiomyopathy
Lu Wang, Wen Dai, Ruiyao Zhu, Tingting Long, Zhaocai Zhang, Zhenju Song, Sucheng Mu, Shasha Wang, Huijuan Wang, Jiaxi Lei, Jing Zhang, Wenfang Xia, Guang Li, Wenwei Gao, Handong Zou, Yan Li, Liying Zhan Frontiers in Medicine.2024;[Epub] CrossRef - Meta-Analysis of Initial Natriuretic Peptides in the Setting of Sepsis-Induced Myocardial Dysfunction
Boyong He, Xin Wang, Liguo Shi, Hongbin Cheng, Luyi Zhao Biomarkers in Medicine.2024; 18(4): 145. CrossRef - Prevalence and Prognosis of Sepsis-Induced Cardiomyopathy: A Systematic Review and Meta-Analysis
Daisuke Hasegawa, Yoshiko Ishisaka, Tetsuro Maeda, Narut Prasitlumkum, Kazuki Nishida, Siddharth Dugar, Ryota Sato Journal of Intensive Care Medicine.2023; 38(9): 797. CrossRef - Research Progress on the Mechanism and Management of Septic Cardiomyopathy: A Comprehensive Review
Xue-Bin Pei, Bo Liu, Maciej Dyrbuś Emergency Medicine International.2023; 2023: 1. CrossRef - Biomarkers to Predict Multiorgan Distress Syndrome and Acute Kidney Injury in Critically Ill Surgical Patients
In Sik Shin, Da Kyung Kim, Sanghyun An, Sung Chan Gong, Moo Hyun Kim, Md Habibur Rahman, Cheol-Su Kim, Joon Hyeong Sohn, Kwangmin Kim, Hoon Ryu Medicina.2023; 59(12): 2054. CrossRef - Risk factors of postoperative septic cardiomyopathy in perioperative sepsis patients
Yuchang Xin, Ying Ge, Liuhui Chang, Yong Ni, Hairui Liu, Jiang Zhu BMC Anesthesiology.2022;[Epub] CrossRef - Effect of milrinone versus placebo on hemodynamic in patients with septic shock: A randomize control trial
Suratee Chobngam, Surat Tongyoo Clinical Critical Care.2022;[Epub] CrossRef - Association of sepsis-induced cardiomyopathy and mortality: a systematic review and meta-analysis
Yu-Min Lin, Mei-Chuan Lee, Han Siong Toh, Wei-Ting Chang, Sih-Yao Chen, Fang-Hsiu Kuo, Hsin-Ju Tang, Yi-Ming Hua, Dongmei Wei, Jesus Melgarejo, Zhen-Yu Zhang, Chia-Te Liao Annals of Intensive Care.2022;[Epub] CrossRef - Association of Sepsis-Induced Cardiomyopathy and Mortality: A Systematic Review and Meta-Analysis
Yu-Min Lin, Mei-Chuan Lee, Han Siong Toh, Wei-Ting Chang, Sih-Yao Chen, Fang-Hsiu Kuo, Hsin-Ju Tang, Yi-Ming Hua, Dongmei Wei, Jesus Melgarejo, Zhen-Yu Zhang, Chia-Te Liao SSRN Electronic Journal .2022;[Epub] CrossRef - Sepsis-induced cardiomyopathy is associated with higher mortality rates in patients with sepsis
Balaram Krishna J Hanumanthu, Anika Sasidharan Nair, Adarsh Katamreddy, Jason S Gilbert, Jee Young You, Obiageli Lynda Offor, Ankit Kushwaha, Ankita Krishnan, Marzio Napolitano, Leonidas Palaidimos, Joaquin Morante, Seema S. Tekwani, Suchita Mehta, Aancha Acute and Critical Care.2021; 36(3): 215. CrossRef - The Correlation Between Whole Blood Copper (Cu), Zinc (Zn) Levels and Cu/Zn Ratio and Sepsis-Induced Left Ventricular Systolic Dysfunction (SILVSD) in Patients with Septic Shock: A Single-Center Prospective Observational Study
Jian-Biao Meng, Ma-Hong Hu, Ming Zhang, Gong-Pai Hu, Wei Zhang, Shen-Jiang Hu International Journal of General Medicine.2021; Volume 14: 7219. CrossRef
- Liver
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The role of bilirubin to albumin ratio as a predictor for mortality in critically ill patients without existing liver or biliary tract disease
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Ji Soo Choi, Kyung Soo Chung, Eun Hye Lee, Su Hwan Lee, Sang Hoon Lee, Song Yee Kim, Ji Ye Jung, Young Ae Kang, Moo Suk Park, Young Sam Kim, Joon Chang, Ah Young Leem
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Acute Crit Care. 2020;35(1):24-30. Published online February 29, 2020
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DOI: https://doi.org/10.4266/acc.2019.00738
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Abstract
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- Background
Hyperbilirubinemia and hypoalbuminemia are frequently appeared and associated with poor prognosis in critically ill patients. We aim to evaluate the association between the bilirubin to albumin ratio and prognosis in intensive care unit (ICU) patients. Methods: This was a retrospective study of 731 patients who were admitted to the medical intensive care unit (MICU) at a tertiary-care center from July 2015 to September 2017. We analyzed the bilirubin to albumin ratio on admission to the MICU, including clinical characteristics and other examinations. Results: The overall 28-day survival of MICU patients was 69.1%. On univariate analysis, Acute Physiology and Chronic Health Evaluation (APACHE) II score (P<0.001), Sequential Organ Failure Assessment score (P<0.001), Simplified Acute Physiology Score II score (P<0.001), Creactive protein (P=0.015), and bilirubin/albumin ratio (P<0.001) were associated with mortality of ICU patients. The receiver operating characteristic curves for ICU patients mortality between bilirubin to albumin ratio and APACHE II score were not statistically significant (P=0.282). On multivariate analysis, higher APACHE II score (hazard ratio [HR], 1.05; 95% CI, 1.03 to 1.06; P<0.001) and bilirubin to albumin ratio (HR, 1.65; 95% CI, 1.23 to 2.20; P=0.001) were independently related to the ICU patient mortality. Conclusions: A higher bilirubin to albumin ratio was related to the unfavorable prognosis and mortality in critically ill patients.
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Citations
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- Role of serum bilirubin-to-albumin ratio as a prognostic index in critically ill children
You Min Kang, Ga Eun Kim, Mireu Park, Jong Deok Kim, Min Jung Kim, Yoon Hee Kim, Kyung Won Kim, Myung Hyun Son, Soo Yeon Kim Clinical and Experimental Pediatrics.2023; 66(2): 85. CrossRef - Association between total bilirubin/Albumin ratio and all-cause mortality in acute kidney injury patients: A retrospective cohort study
Ximei Huang, Yunhua Huang, Min Chen, Lin Liao, Faquan Lin, Eranga Sanjeewa Wijewickrama PLOS ONE.2023; 18(11): e0287485. CrossRef - The value of albumin-related ratios in predicting disease severity and mortality in acute cholangitis
Bayram YEŞİL, Bünyamin SEVİM Journal of Health Sciences and Medicine.2023; 6(6): 1244. CrossRef - Hepatic dysfunction in critically ill patients
Jeong Hoon Yang Acute and Critical Care.2020; 35(1): 44. CrossRef
- Surgery
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Critical Illness Neuromyopathy Complicating Cardiac Surgery
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Wan Ki Baek, Young Sam Kim, Joung Taek Kim, Byoung-Nam Yoon
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Acute Crit Care. 2018;33(1):51-56. Published online July 11, 2017
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DOI: https://doi.org/10.4266/acc.2016.00255
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6,391
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Abstract
PDF
- Critical illness neuromyopathy (CINM) is a sporadically reported disease in the setting of an intensive care unit developing in the process of managing a critical illness. The disease primarily affects the motor and sensory axons and results in severe limb weakness rendering ventilator weaning extremely difficult. We report a case of CINM after cardiac valve surgery. Quadriplegia developed after the operation and resolved slowly over the following 2 months. The patient was discharged home free of neurologic symptoms.
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Citations
Citations to this article as recorded by
- Quadriplegia after Mitral Valve Replacement in an Infective Endocarditis Patient with Cervical Spine Spondylitis
Ji Min Lee, Seon Yeong Heo, Dong Kyu Kim, Jong Pil Jung, Chang Ryul Park, Yong Jik Lee, Gwan Sic Kim Journal of Chest Surgery.2021; 54(3): 218. CrossRef - Perforated Toxic Megacolon: The Dreaded Complication in IBD
Kanmani Murugesu, PremanandanN Sivadasan, Michael Arvind, WilsonLiew Wei Xin World Journal of Colorectal Surgery.2020; 9(4): 70. CrossRef
- Rapid response system
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A Pilot Study of the Effectiveness of Medical Emergency System Implementation at a Single Center in Korea
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Su Hwan Lee, Ah Young Leem, Youngok Nho, Young Ah Kim, Kyung Duck Kim, Young Sam Kim, Se Kyu Kim, Kyung Soo Chung
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Korean J Crit Care Med. 2017;32(2):133-141. Published online May 16, 2017
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DOI: https://doi.org/10.4266/kjccm.2016.01011
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6,163
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Abstract
PDF
- Background
An automatic alarm system was developed was developed for unexpected vital sign instability in admitted patients to reduce staffing needs and costs related to rapid response teams. This was a pilot study of the automatic alarm system, the medical emergency system (MES), and the aim of this study was to determine the effectiveness of the MES before expanding this system to all departments.
Methods This retrospective, observational study compared the performance of patients admitted to the pulmonary department at a single center using patient data from three 3-month periods (before implementation of the MES: December 2013-February 2014; after implementation of the MES: December 2014-February 2015 and December 2015-February 2016).
Results A total of 571 patients were admitted to the pulmonary department during the three observation periods. During this pilot study, the MES automatically issued 568 alarms for 415 admitted patients. There was no significant difference in the rate of cardiopulmonary resuscitation (CPR) before and after application of the MES. The mortality rate also did not change. However, it appeared that CPR was prevented in four patients admitted from the general ward to the intensive care unit (ICU) during MES implementation. The median length of hospital stay and median length of ICU stay were not significantly different before and after MES implementation.
Conclusions Although we did not find a significant improvement in outcomes upon MES implementation, the CPR rate and mortality rate did not increase despite increased comorbidities. This was a small pilot study, and, based on these results, we believe that the MES may have significant effects in longer-term and larger-scale studies.
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Citations
Citations to this article as recorded by
- Society of Critical Care Medicine Guidelines on Recognizing and Responding to Clinical Deterioration Outside the ICU: 2023
Kimia Honarmand, Randy S. Wax, Daleen Penoyer, Geoffery Lighthall, Valerie Danesh, Bram Rochwerg, Michael L. Cheatham, Daniel P. Davis, Michael DeVita, James Downar, Dana Edelson, Alison Fox-Robichaud, Shigeki Fujitani, Raeann M. Fuller, Helen Haskell, Ma Critical Care Medicine.2024; 52(2): 314. CrossRef - Rapid response systems in Korea
Bo Young Lee, Sang-Bum Hong Acute and Critical Care.2019; 34(2): 108. CrossRef
- Infection
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Implications of Plasma Renin Activity and Plasma Aldosterone Concentration in Critically Ill Patients with Septic Shock
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Kyung Soo Chung, Joo Han Song, Won Jai Jung, Young Sam Kim, Se Kyu Kim, Joon Chang, Moo Suk Park
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Korean J Crit Care Med. 2017;32(2):142-153. Published online May 31, 2017
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DOI: https://doi.org/10.4266/kjccm.2017.00094
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8,832
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Abstract
PDFSupplementary Material
- Background
The renin-angiotensin-aldosterone system is closely associated with volume status and vascular tone in septic shock. The present study aimed to assess whether plasma renin activity (PRA) and plasma aldosterone concentration (PAC) measurements compared with conventional severity indicators are associated with mortality in patients with septic shock.
Methods We evaluated 105 patients who were admitted for septic shock. Plasma levels of the biomarkers PRA and PAC, the PAC/PRA ratio, C-reactive protein (CRP) level, and cortisol level on days 1, 3, and 7 were serially measured. During the intensive care unit stay, relevant clinical information and laboratory results were recorded.
Results Patients were divided into two groups according to 28-day mortality: survivors (n = 59) and non-survivors (n = 46). The survivor group showed lower PRA, PAC, Acute Physiologic and Chronic Health Evaluation (APACHE) II score, and Sequential Organ Failure Assessment (SOFA) score than did the non-survivor group (all P < 0.05). The SOFA score was positively correlated with PRA (r = 0.373, P < 0.001) and PAC (r = 0.316, P = 0.001). According to receiver operating characteristic analysis, the areas under the curve of PRA and PAC to predict 28-day mortality were 0.69 (95% confidence interval [CI], 0.58 to 0.79; P = 0.001) and 0.67 (95% CI, 0.56 to 0.77; P = 0.003), respectively, similar to the APACHE II scores and SOFA scores. In particular, the group with PRA value ≥3.5 ng ml-1 h-1 on day 1 showed significantly greater mortality than did the group with PRA value <3.5 ng ml-1 h-1 (log-rank test, P < 0.001). According to multivariate analysis, SOFA score (hazard ratio, 1.11; 95% CI, 1.01 to 1.22), PRA value ≥3.5 ng ml-1 h-1 (hazard ratio, 3.25; 95% CI, 1.60 to 6.60), previous history of cancer (hazard ratio, 3.44; 95% CI, 1.72 to 6.90), and coronary arterial occlusive disease (hazard ratio, 2.99; 95% CI, 1.26 to 7.08) were predictors of 28-day mortality.
Conclusions Elevated PRA is a useful biomarker to stratify the risk of critically ill patients with septic shock and is a prognostic predictor of 28-day mortality.
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Citations
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- Association of Active Renin Content With Mortality in Critically Ill Patients: A Post hoc Analysis of the Vitamin C, Thiamine, and Steroids in Sepsis (VICTAS) Trial*
Laurence W. Busse, Christopher L. Schaich, Mark C. Chappell, Michael T. McCurdy, Erin M. Staples, Caitlin C. Ten Lohuis, Jeremiah S. Hinson, Jonathan E. Sevransky, Richard E. Rothman, David W. Wright, Greg S. Martin, Ashish K. Khanna Critical Care Medicine.2024; 52(3): 441. CrossRef - Renin as a Prognostic Marker in Intensive Care and Perioperative Settings: A Scoping Review
Yuki Kotani, Alessandro Belletti, Giacomo Maiucci, Martina Lodovici, Stefano Fresilli, Giovanni Landoni, Rinaldo Bellomo, Alexander Zarbock Anesthesia & Analgesia.2024; 138(5): 929. CrossRef - Renin as a Prognostic and Predictive Biomarker in Sepsis: More Questions Than Answers?*
Emily J. See, James A. Russell, Rinaldo Bellomo, Patrick R. Lawler Critical Care Medicine.2024; 52(3): 509. CrossRef - Dysfunction of the renin-angiotensin-aldosterone system in human septic shock
Christopher L. Schaich, Daniel E. Leisman, Marcia B. Goldberg, Micheal R. Filbin, Ashish K. Khanna, Mark C. Chappell Peptides.2024; 176: 171201. CrossRef - Renin in critically ill patients
Yuki Kotani, Mark Chappell, Giovanni Landoni, Alexander Zarbock, Rinaldo Bellomo, Ashish K. Khanna Annals of Intensive Care.2024;[Epub] CrossRef - Blood urea nitrogen - independent marker of mortality in sepsis
Martin Harazim, Kaiquan Tan, Marek Nalos, Martin Matejovic Biomedical Papers.2023; 167(1): 24. CrossRef - Critically ill children with septic shock: time to rediscover renin?
Isabella Guzzo, Fabio Paglialonga Pediatric Nephrology.2023; 38(9): 2907. CrossRef - The role of proadrenomedullin, interleukin 6 and CD64 in the diagnosis and prognosis of septic shock
Yasemin Bozkurt Turan BMC Anesthesiology.2023;[Epub] CrossRef - Renin Kinetics Are Superior to Lactate Kinetics for Predicting In-Hospital Mortality in Hypotensive Critically Ill Patients*
Maniraj Jeyaraju, Michael T. McCurdy, Andrea R. Levine, Prasad Devarajan, Michael A. Mazzeffi, Kristin E. Mullins, Michaella Reif, David N. Yim, Christopher Parrino, Allison S. Lankford, Jonathan H. Chow Critical Care Medicine.2022; 50(1): 50. CrossRef - Mechanisms of Post-critical Illness Cardiovascular Disease
Andrew Owen, Jaimin M. Patel, Dhruv Parekh, Mansoor N. Bangash Frontiers in Cardiovascular Medicine.2022;[Epub] CrossRef - Renin as a Marker of Tissue Perfusion, Septic Shock and Mortality in Septic Patients: A Prospective Observational Study
Patrycja Leśnik, Lidia Łysenko, Małgorzata Krzystek-Korpacka, Ewa Woźnica-Niesobska, Magdalena Mierzchała-Pasierb, Jarosław Janc International Journal of Molecular Sciences.2022; 23(16): 9133. CrossRef - Angiotensin II and Vasopressin for Vasodilatory Shock: A Critical Appraisal of Catecholamine-Sparing Strategies
Mojdeh S. Heavner, Michael T. McCurdy, Michael A. Mazzeffi, Samuel M. Galvagno, Kenichi A. Tanaka, Jonathan H. Chow Journal of Intensive Care Medicine.2021; 36(6): 635. CrossRef - Treatment of Renin-Angiotensin-Aldosterone System Dysfunction With Angiotensin II in High-Renin Septic Shock
Jonathan H. Chow, Marianne Wallis, Allison S. Lankford, Zackary Chancer, Rolf N. Barth, Joseph R. Scalea, John C. LaMattina, Michael A. Mazzeffi, Michael T. McCurdy Seminars in Cardiothoracic and Vascular Anesthesia.2021; 25(1): 67. CrossRef - Good clinical practice for the use of vasopressor and inotropic drugs in critically ill patients: state-of-the-art and expert consensus
Andrea CARSETTI, Elena BIGNAMI, Andrea CORTEGIANI, Katia DONADELLO, Abele DONATI, Giuseppe FOTI, Giacomo GRASSELLI, Stefano ROMAGNOLI, Massimo ANTONELLI, Elvio DE BLASIO, Francesco FORFORI, Fabio GUARRACINO, Sabino SCOLLETTA, Luigi TRITAPEPE, Luigia SCUDE Minerva Anestesiologica.2021;[Epub] CrossRef - Use of Angiotensin II in Severe Vasoplegia After Left Pneumonectomy Requiring Cardiopulmonary Bypass: A Renin Response Analysis
Brian Trethowan, Christopher J. Michaud, Sarah Fifer Critical Care Medicine.2020; 48(10): e912. CrossRef - Renin as a Marker of Tissue-Perfusion and Prognosis in Critically Ill Patients*
Patrick J. Gleeson, Ilaria Alice Crippa, Wasineenart Mongkolpun, Federica Zama Cavicchi, Tess Van Meerhaeghe, Serge Brimioulle, Fabio Silvio Taccone, Jean-Louis Vincent, Jacques Creteur Critical Care Medicine.2019; 47(2): 152. CrossRef
- Basic science and research
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Changes in Insulin-like Growth Factor-1 Level in Patients with Sepsis and Septic Shock
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Sang Hoon Lee, Byung Hoon Park, Joo Han Song, Song Yee Kim, Kyung Soo Chung, Eun Young Kim, Ji Ye Jung, Young Sam Kim, Se Kyu Kim, Joon Chang, Moo Suk Park
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Korean J Crit Care Med. 2016;31(4):324-333. Published online November 30, 2016
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DOI: https://doi.org/10.4266/kjccm.2016.00024
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- Background
Despite many ongoing, prospective studies on the topic, sepsis still remains one of the main causes of death in hospital. The hormone insulin-like growth factor 1 (IGF-1) has a similar molecular structure to that of insulin. IGF-1 exerts anabolic effects and plays important roles in both normal physiology and pathologic processes. Previous studies have observed low serum IGF-1 level in patients with critical illnesses. Here, we evaluated changes in IGF-1 level based on survival of septic patients.
Methods We evaluated 140 patients with sepsis and septic shock (21 with sepsis and 119 with septic shock) admitted to the intensive care unit of a university-affiliated hospital in Korea. Serum IGF-1 level was measured on days 0, 1, 3, and 7. Patients with liver disease were excluded from this study. All data were analyzed using SPSS version 20 (SPSS Inc., Chicago, IL, USA).
Results Patients with septic shock had significantly lower serum IGF-1 level on days 1 and 3 than patients without septic shock (p = 0.002 and p = 0.007, respectively). Generally, there was a negative relationship between IGF-1 and serum cortisol levels; however, this relationship was only significant on day 3 (p = 0.029). Furthermore, renin showed significantly negative correlation with IGF-1 on day 3 (p = 0.038). IGF-1 level did not show significant difference between survivors and non-survivors.
Conclusions Our results showed that IGF-1 was associated with septic shock, and that the IGF-1 axis is severely disrupted in septic patients. Additionally, serum cortisol and renin levels were associated with IGF-1 level.
- Genetic
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Lethal Hyperammonemia due to Ornithine Transcarbamylase Deficiency in a Patient with Severe Septic Shock
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Ji An Hwang, Joo Han Song, Young Seok Lee, Kyung Soo Chung, Song Yee Kim, Eun Young Kim, Ji Ye Jung, Young Ae Kang, Young Sam Kim, Joon Chang, Moo Suk Park
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Korean J Crit Care Med. 2016;31(2):140-145. Published online May 31, 2016
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DOI: https://doi.org/10.4266/kjccm.2016.31.2.140
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- Severe hyperammonemia can occur as a result of inherited or acquired liver enzyme defects in the urea cycle, among which ornithine transcarbamylase deficiency (OTCD) is the most common form. We report a very rare case of a 45-year-old Korean male who was admitted to the intensive care unit (ICU) due to severe septic shock with acute respiratory failure caused by Pneumocystis jiroveci pneumonia. During his ICU stay with ventilator care, the patient suffered from marked hyperammonemia (>1,700 μg/dL) with abrupt mental change leading to life-threatening cerebral edema. Despite every effort including continuous renal replacement therapy and use of a molecular adsorbent recirculating system (extracorporeal liver support–albumin dialysis) to lower his serum ammonia level, the patient was not recovered. The lethal hyperammonemia in the patient was later proven to be a manifestation of acquired liver enzyme defect known as OTCD, which is triggered by serious catabolic conditions, such as severe septic shock with acute respiratory failure.
- Hematology/Pulmonary
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Hemophagocytic Lymphohistiocytosis after Lung Transplantation
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Ah Young Leem, Sung Woo Moon, Song Yee Kim, Moo Suk Park, Young Sam Kim, Se Kyu Kim, Joon Chang, Hyo Chae Paik, June Won Cheong, Kyung Soo Chung
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Korean J Crit Care Med. 2015;30(1):38-41. Published online February 28, 2015
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DOI: https://doi.org/10.4266/kjccm.2015.30.1.38
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Abstract
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- Hemophagocytic lymphohistiocytosis (HLH) is a rare but fatal complication after solid organ transplantation. Acquired forms of HLH are described in association with severe sepsis, autoimmune disorders, malignancy, immune-compromised states, infections, and solid organ transplantation. We experienced a case of hemophagocytic lymphohistiocytosis after bilateral lung transplantation. Leukopenia, thrombocytopenia, and hyperbilirubinemia were noted and became aggravated 50 days after transplantation. Diagnosis of HLH was based on clinical and laboratory findings of splenomegaly, cytopenia, elevated ferritin, elevated interleukin-2 receptor, and hemophagocytosis in bone marrow. Other features such as elevated bilirubin, lactate dehydrogenase, and D-dimer which can be present in HLH were also noted. The patient was immediately treated with etoposide and dexamethasone. Despite aggressive therapy, the patient deteriorated and died. Awareness of the diagnostic criteria of HLH after lung transplantation is important for clinicians.
- Hematology/Pulmonary
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Delayed Hemolytic Uremic Syndrome Presenting as Diffuse Alveolar Hemorrhage
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Ji Young Hong, Ji Ye Jung, Young Ae Kang, Yoon Sung Bae, Young Sam Kim, Se Kyu Kim, Joon Chang, Moo Suk Park
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Korean J Crit Care Med. 2014;29(1):43-47. Published online February 28, 2014
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DOI: https://doi.org/10.4266/kjccm.2014.29.1.43
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Abstract
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- Hemolytic uremic syndrome (HUS) is defined by the triad of mechanical intravascular hemolytic anemia with schistocytosis, thrombocytopenia and acute renal failure. Pulmonary involvement in HUS is known to be rare. We present the case of a 25-year-old male with diffuse alveolar hemorrhage and myocarditis followed by atypical hemolytic uremic syndrome. In this case, successful treatments included steroid pulse therapy for the fatal alveolar hemorrhage and plasma exchange for the hemolytic uremic syndrome.
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Citations
Citations to this article as recorded by
- Development and pilot implementation of Iranian Hemolytic Uremic Syndrome Registry
Mina Lazem, Nakysa Hooman, Abbas Sheikhtaheri Orphanet Journal of Rare Diseases.2022;[Epub] CrossRef - Lessons learned from hemolytic uremic syndrome registries: recommendations for implementation
Mina Lazem, Abbas Sheikhtaheri, Nakysa Hooman Orphanet Journal of Rare Diseases.2021;[Epub] CrossRef - The Prevalence and Incidence of Atypical Hemolytic Uremic Syndrome in Iran: A Systematic Review and Meta-Analysis Protocol Study
Nakysa Hooman, Mahnaz Sadeghian, Fariba Jahangiri, Soudabeh Hosseini Journal of Comprehensive Pediatrics.2017;[Epub] CrossRef - Subcapsular liver hematoma as a complication of an atypical hemolytic uremic syndrome
Emanuel Ferreira, Nuno Oliveira, Maria Marques, Helena Pinto, Ana Santos, Armando Carreira, Mário Campos Nefrología (English Edition).2015; 35(3): 337. CrossRef - Subcapsular liver hematoma as a complication of an atypical hemolytic uremic syndrome
Emanuel Ferreira, Nuno Oliveira, Maria Marques, Helena Pinto, Ana Santos, Armando Carreira, Mário Campos Nefrología.2015; 35(3): 337. CrossRef
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