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Immunology
Patterns of inflammatory immune responses in patients with septic shock receiving vitamin C, hydrocortisone, and thiamine: clustering analysis in Korea
Seung-Hun You, Oh Joo Kweon, Sun-Young Jung, Moon Seong Baek, Won-Young Kim
Acute Crit Care. 2023;38(3):286-297.   Published online August 21, 2023
DOI: https://doi.org/10.4266/acc.2023.00507
  • 1,764 View
  • 80 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract PDFSupplementary Material
Background
Sepsis is characterized by heterogeneous immune responses that may evolve during the course of illness. This study identified inflammatory immune responses in septic patients receiving vitamin C, hydrocortisone, and thiamine.
Methods
This was a single-center, post-hoc analysis of 95 patients with septic shock who received the vitamin C protocol. Blood samples were drawn on days 1–2, 3–4, and 6–8 after shock onset. Group-based multi-trajectory modeling was used to identify immune trajectory groups.
Results
The median age was 78 years (interquartile range, 70–84 years), and 56% were male. Clustering analysis identified group 1 (n=41), which was characterized by lower interleukin (IL)-6, tumor necrosis factor (TNF)-α, and IL-10 levels, and these levels remained stationary or mildly increased until day 7. Conversely, group 2 (n=54) expressed initially higher IL-6, TNF-α, and IL-10 levels that decreased rapidly by day 4. There was a nonsignificant increase in lymphocyte count and a decrease in C-reactive protein level until day 7 in group 2. The intensive care unit mortality rate was significantly lower in group 2 (39.0% vs. 18.5%, P=0.03). Group 2 also had a significantly higher decrease in the mean (standard deviation) vasopressor dose (norepinephrine equivalent: –0.09±0.16 μg/kg/min vs. –0.23±0.31 μg/kg/min, P<0.001) and Sequential Organ Failure Assessment score (0±5 vs. –4±3, P=0.002) between days 1 and 4.
Conclusions
There may be different subphenotypes in septic patients receiving the vitamin C protocol.

Citations

Citations to this article as recorded by  
  • Micronutrients as therapy in critical illness
    Christian Stoppe, Ellen Dresen, Angelique de Man
    Current Opinion in Critical Care.2024; 30(2): 178.     CrossRef
Infection
In-hospital mortality prediction using frailty scale and severity score in elderly patients with severe COVID-19
Yong Sub Na, Jin Hyoung Kim, Moon Seong Baek, Won-Young Kim, Ae-Rin Baek, Bo young Lee, Gil Myeong Seong, Song-I Lee
Acute Crit Care. 2022;37(3):303-311.   Published online July 5, 2022
DOI: https://doi.org/10.4266/acc.2022.00017
  • 3,991 View
  • 214 Download
  • 6 Web of Science
  • 7 Crossref
AbstractAbstract PDF
Background
Elderly patients with coronavirus disease 2019 (COVID-19) have a high disease severity and mortality. However, the use of the frailty scale and severity score to predict in-hospital mortality in the elderly is not well established. Therefore, in this study, we investigated the use of these scores in COVID-19 cases in the elderly.
Methods
This multicenter retrospective study included severe COVID-19 patients admitted to seven hospitals in Republic of Korea from February 2020 to February 2021. We evaluated patients’ Acute Physiology and Chronic Health Evaluation (APACHE) II score; confusion, urea nitrogen, respiratory rate, blood pressure, 65 years of age and older (CURB-65) score; modified early warning score (MEWS); Sequential Organ Failure Assessment (SOFA) score; clinical frailty scale (CFS) score; and Charlson comorbidity index (CCI). We evaluated the predictive value using receiver operating characteristic (ROC) curve analysis.
Results
The study included 318 elderly patients with severe COVID-19 of whom 237 (74.5%) were survivors and 81 (25.5%) were non-survivors. The non-survivor group was older and had more comorbidities than the survivor group. The CFS, CCI, APACHE II, SOFA, CURB-65, and MEWS scores were higher in the non-survivor group than in the survivor group. When analyzed using the ROC curve, SOFA score showed the best performance in predicting the prognosis of elderly patients (area under the curve=0.766, P<0.001). CFS and SOFA scores were associated with in-hospital mortality in the multivariate analysis.
Conclusions
The SOFA score is an efficient tool for assessing in-hospital mortality in elderly patients with severe COVID-19.

Citations

Citations to this article as recorded by  
  • Risk factors for progressing to critical illness in patients with hospital-acquired COVID-19
    Kyung-Eui Lee, Jinwoo Lee, Sang-Min Lee, Hong Yeul Lee
    The Korean Journal of Internal Medicine.2024; 39(3): 477.     CrossRef
  • Omicron, Long-COVID, and the Safety of Elective Surgery for Adults and Children: Joint Guidance from the Therapeutics and Guidelines Committee of the Surgical Infection Society and the Surgery Strategic Clinical Network, Alberta Health Services
    Philip S. Barie, Mary E. Brindle, Rachel G. Khadaroo, Tara L. Klassen, Jared M. Huston
    Surgical Infections.2023; 24(1): 6.     CrossRef
  • Evaluation of risk scores as predictors of mortality and hospital length of stay for older COVID‐19 patients
    Banu Buyukaydin, Tahsin Karaaslan, Omer Uysal
    AGING MEDICINE.2023; 6(1): 56.     CrossRef
  • Atypical presentation of COVID-19 in older patients is associated with frailty but not with adverse outcomes
    Joy E. van Son, Elisabeth C. P. Kahn, Jessica M. van der Bol, Dennis G. Barten, Laura C. Blomaard, Carmen van Dam, Jacobien Ellerbroek, Steffy W. M. Jansen, Anita Lekx, Carolien M. J. van der Linden, Roy Looman, Huub A. A. M. Maas, Francesco U. S. Mattace
    European Geriatric Medicine.2023;[Epub]     CrossRef
  • Neurological Manifestations and Complications of the Central Nervous System as Risk Factors and Predictors of Mortality in Patients Hospitalized with COVID-19: A Cohort Study
    Ana Luisa Corona-Nakamura, Martha Judith Arias-Merino, Rayo Morfín-Otero, Guillermo Rodriguez-Zavala, Alfredo León-Gil, Juan Ramsés Camarillo-Escalera, Idarmis Brisseida Reyes-Cortés, María Gisela Valdovinos-Ortega, Erick René Nava-Escobar, Ana María de l
    Journal of Clinical Medicine.2023; 12(12): 4065.     CrossRef
  • Modified Early Warning Score: Clinical Deterioration of Mexican Patients Hospitalized with COVID-19 and Chronic Disease
    Nicolás Santiago González, María de Lourdes García-Hernández, Patricia Cruz-Bello, Lorena Chaparro-Díaz, María de Lourdes Rico-González, Yolanda Hernández-Ortega
    Healthcare.2023; 11(19): 2654.     CrossRef
  • Risk Factors and Predictive Model for Mortality of Hospitalized COVID-19 Elderly Patients from a Tertiary Care Hospital in Thailand
    Mallika Chuansangeam, Bunyarat Srithan, Pattharawin Pattharanitima, Pawit Phadungsaksawasdi
    Medicines.2023; 10(11): 59.     CrossRef
Infection
Current Status and Survival Impact of Infectious Disease Consultation for Multidrug-Resistant Bacteremia in Ventilated Patients: A Single-Center Experience in Korea
Insu Kim, Won-Young Kim, Eun Suk Jeoung, Kwangha Lee
Acute Crit Care. 2018;33(2):73-82.   Published online April 26, 2018
DOI: https://doi.org/10.4266/acc.2017.00591
  • 6,442 View
  • 109 Download
  • 5 Web of Science
  • 5 Crossref
AbstractAbstract PDF
Background
We evaluated the current status and survival impact of infectious disease consultation (IDC) in ventilated patients with multidrug-resistant (MDR) bacteremia.
Methods
One hundred sixty-one consecutive patients from a single tertiary care hospital were enrolled over a 5-year period. Patients with at least one of the following six MDR bacteremias were included: methicillin-resistant Staphylococcus aureus, extended-spectrum β-lactamase-producing gram-negative bacteria (Escherichia coli and Klebsiella pneumonia), carbapenem-resistant gram-negative rods (Acinetobacter baumannii and Pseudomonas aeruginosa), and vancomycin-resistant Enterococcus faecium.
Results
Median patient age was 66 years (range, 18 to 95), and 57.8% of subjects were male. The 28-day mortality after the day of blood culture was 52.2%. An IDC was requested for 96 patients based on a positive blood culture (59.6%). Patients without IDC had significantly higher rate of hemato-oncologic diseases as a comorbidity (36.9% vs. 11.5%, P < 0.001). Patients without an IDC had higher Acute Physiology and Chronic Health Evaluation (APACHE) II score (median, 20; range, 8 to 38 vs. median, 16; range, 5 to 34, P < 0.001) and Sequential Organ Failure Assessment (SOFA) score (median, 9; range, 2 to 17 vs. median, 7; range, 2 to 20; P = 0.020) on the day of blood culture and a higher 28-day mortality rate (72.3% vs. 38.5%, P < 0.001). In patients with SOFA ≥9 (cut-off level based on Youden’s index) on the day of blood culture and gram-negative bacteremia, IDC was also significantly associated with lower 28-day mortality (hazard ratio [HR], 0.298; 95% confidence interval [CI], 0.167 to 0.532 and HR, 0.180; 95% CI, 0.097 to 0.333; all P < 0.001] based on multivariate Cox regression analysis.
Conclusions
An IDC for MDR bacteremia was requested less often for ventilated patients with greater disease severity and higher 28- day mortality after blood was drawn. In patients with SOFA ≥9 on the day of blood culture and gram-negative bacteremia, IDC was associated with improved 28-day survival after blood draw for culture.

Citations

Citations to this article as recorded by  
  • Impact of a Pro-Active Infectious Disease Consultation on the Management of a Multidrug-Resistant Organisms Outbreak in a COVID-19 Hospital: A Three-Months Quasi-Experimental Study
    Davide Fiore Bavaro, Nicolò De Gennaro, Alessandra Belati, Lucia Diella, Roberta Papagni, Luisa Frallonardo, Michele Camporeale, Giacomo Guido, Carmen Pellegrino, Maricla Marrone, Alessandro Dell’Erba, Loreto Gesualdo, Nicola Brienza, Salvatore Grasso, Gi
    Antibiotics.2023; 12(4): 712.     CrossRef
  • The role of infectious disease consultations in the management of patients with fever in a long-term care facility
    Soo-youn Moon, Kyoung Ree Lim, Jun Seong Son, Ali Amanati
    PLOS ONE.2023; 18(9): e0291421.     CrossRef
  • Impact of infectious diseases consultation among patients with infections caused by gram-negative rod bacteria: a systematic literature review and meta-analysis
    Shinya Hasegawa, Satoshi Kakiuchi, Joseph Tholany, Takaaki Kobayashi, Alexandre R. Marra, Marin L. Schweizer, Riley J. Samuelson, Hiroyuki Suzuki
    Infectious Diseases.2022; 54(8): 618.     CrossRef
  • Infectious Disease Consults of Pseudomonas aeruginosa Bloodstream Infection and Impact on Health Outcomes
    Swetha Ramanathan, Fritzie S Albarillo, Margaret A Fitzpatrick, Katie J Suda, Linda Poggensee, Amanda Vivo, Martin E Evans, Makoto Jones, Nasia Safdar, Chris Pfeiffer, Bridget Smith, Geneva Wilson, Charlesnika T Evans
    Open Forum Infectious Diseases.2022;[Epub]     CrossRef
  • Timeliness of Infectious Diseases Referral and Inappropriate Antibiotic Usage Post-Referral in an Asian Tertiary Hospital
    Liang En Wee, Aidan Lyanzhiang Tan, Limin Wijaya, Maciej Piotr Chlebicki, Julian Thumboo, Ban Hock Tan
    Tropical Medicine and Infectious Disease.2019; 4(4): 137.     CrossRef
Infection
Clinical Application of the Quick Sepsis-Related Organ Failure Assessment Score at Intensive Care Unit Admission in Patients with Bacteremia: A Single-Center Experience of Korea
Hae Jung Na, Eun Suk Jeong, Insu Kim, Won-Young Kim, Kwangha Lee
Korean J Crit Care Med. 2017;32(3):247-255.   Published online August 31, 2017
DOI: https://doi.org/10.4266/kjccm.2017.00241
  • 6,811 View
  • 180 Download
  • 1 Web of Science
  • 2 Crossref
AbstractAbstract PDF
Background
We evaluated the clinical usefulness of the quick Sepsis-Related Organ Failure Assessment (qSOFA) score (based on the 2016 definition of sepsis) at intensive care unit admission in Korean patients with bacteremia. Methods: We retrospectively analyzed clinical data from 236 patients between March 2011 and February 2016. In addition to the qSOFA, the Modified Early Warning score (MEWS) and systemic inflammatory response syndrome (SIRS) criteria were calculated. Results: The patients’ median age was 69 years, and 61.0% were male. Of the patients, 127 (53.8%) had a qSOFA score ≥2 points. They had significantly higher rates of septic shock, thrombocytopenia, and hyperlactatemia, and increased requirements for ventilator care, neuromuscular blocking agents, vasopressors, and hemodialysis within 72 hours after intensive care unit admission. They also had a significantly higher 28-day mortality rate. When analyzed using common thresholds (MEWS ≥5 and ≥2 SIRS criteria), patients with a MEWS ≥5 had the same results as those with a qSOFA score ≥2 (P < 0.05). However, patients with ≥2 SIRS criteria showed no significant differences. Conclusions: Our results show that a qSOFA score ≥2 at admission is a useful screening tool for predicting disease severity and medical resource usage within 72 hours after admission, and for predicting 28-day mortality rates in patients with bacteremia. In addition, qSOFA scores may be more useful than SIRS criteria in terms of prognostic utility.

Citations

Citations to this article as recorded by  
  • A catalogue of tools and variables from crisis and routine care to support decision-making about allocation of intensive care beds and ventilator treatment during pandemics: Scoping review
    Magnolia Cardona, Claudia C. Dobler, Eyza Koreshe, Daren K. Heyland, Rebecca H. Nguyen, Joan P.Y. Sim, Justin Clark, Alex Psirides
    Journal of Critical Care.2021; 66: 33.     CrossRef
  • Consensus recommendation: Indications and methods for microbiological wound diagnostics
    Axel Kramer, Ojan Assadian, Jürgen Bohnert, Georg Daeschlein, Joachim Dissemond, Veronika Gerber, Peter Hinz, Adam Junka, Simon Kim, Roald Papke, Christian Willy
    Wound Medicine.2018; 23: 53.     CrossRef
Case Report
Pulmonary
Lung Transplantation for Chronic Humidifier Disinfectant-Associated Lung Injury
Won-Young Kim, So-Woon Kim, Kyung-Wook Jo, Sae Hoon Choi, Hyung Ryul Kim, Yong-Hee Kim, Dong Kwan Kim, Seung-Il Park, Sang-Bum Hong
Korean J Crit Care Med. 2016;31(2):146-151.   Published online May 31, 2016
DOI: https://doi.org/10.4266/kjccm.2016.31.2.146
  • 7,016 View
  • 108 Download
  • 1 Crossref
AbstractAbstract PDF
In the spring of 2011, a cluster of lung injuries caused by humidifier disinfectant (HD) usage were reported in Korea. Many patients required mechanical ventilation, extracorporeal membrane oxygenation, and even lung transplantation (LTPL). However, the long-term course of HD-associated lung injury remains unclear because the majority of survivors recovered normal lung function. Here we report a 33-year-old woman who underwent LTPL approximately four years after severe HD-associated lung injury. The patient was initially admitted to the intensive care unit and was supported by a high-flow nasal cannula. Although she had been discharged, she was recurrently admitted to our hospital due to progressive lung fibrosis and a persistent decline in lung function. Finally, sequential double LTPL was successfully performed, and the patient’s clinical and radiological findings showed significant improvement. Therefore, we conclude that LTPL can be a therapeutic option for patients with chronic inhalation injury.

Citations

Citations to this article as recorded by  
  • Humidifier Disinfectant-Associated Lung Injury: Six Years after the Tragic Event
    Won-Young Kim, Sang-Bum Hong
    Tuberculosis and Respiratory Diseases.2017; 80(4): 351.     CrossRef

ACC : Acute and Critical Care