Pulmonary Function and Arterial Stiffness in Chronic Heart Failure

Arterial stiffness contributes to heart failure and is decreased by angiotensin receptor blockers (ARBs). This cross-sectional study aimed to assess associations of lung function and ARB with arterial stiffness in patients with chronic heart failure. 354 outpatients (168 males; 186 females; 68.2 ± 7.2 years old) with chronic heart failure were evaluated. Lung function parameters, including forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and FEV1 to FVC ratio (FEV1/FVC), were assessed. The cardio-ankle vascular index (CAVI) was used to estimate arterial stiffness. Unadjusted correlation analyses revealed a positive association of CAVI with ARB but not ACEI, and a negative correlation with FEV1 (r=-0.2987, p<0.0001). Multiple stepwise regression analyses showed that ARB and FEV1 (p<0.0001) were independent predicting factors for CAVI. These findings suggest that reduced pulmonary function is associated with increased CAVI. Pulmonary function protection could be used to improve the prognosis in heart failure, but additional studies are necessary

Elevated miR-155 expression induces immunosuppression via CD39+ regulatory T-cells in sepsis patient

Background: An altered microRNA profile exists in many infectious diseases, including sepsis. CD39+ regulatory T-cells (Tregs) have a remarkable immunosuppressive effect and play an important role in the regulation of immune balance in sepsis. However, the correlation between microRNA changes and the ratio of CD39+ Tregs in sepsis patients has not yet been reported. The altered microRNA expression profile in sepsis patients was analyzed in this study. Moreover, the correlation between microRNAs and disease severity and prognosis was investigated. Furthermore, the correlation between microRNAs and the percentage of peripheral blood CD39+ Tregs was investigated and further verified in an animal model. Methods: Sixty sepsis patients and 30 healthy controls were included. The difference in microRNA expression was investigated by microRNA microarray and was further confirmed by real-time quantitative PCR. The correlations between microRNA changes and the Sepsis-related Organ Failure Assessment (SOFA) score, severity of sepsis, and survival were analyzed. The percentage CD39+ Tregs in the peripheral blood of sepsis patients was measured by flow cytometry. The correlation between microRNAs and the percentage CD39+ Tregs was analyzed and further confirmed in a mouse sepsis model. Results: Compared to healthy controls, sepsis patients exhibited a significantly elevated microRNA-155 (miR-155) level (p 2.47 had a lower 28-day survival (p < 0.05). The miR-155 level of patients was proportional to the percentage of CD39+ Tregs (r = 0.637, p < 0.05). After transfection with miR-155 inhibitor, the ratio of CD39+ Tregs in mice with sepsis was significantly reduced (p < 0.05). Conclusions: A higher level of miR-155 indicated a more severe condition and poorer prognosis in sepsis patients. The possible underlying mechanism could be that miR-155 induces an increased percentage of CD39+ Tregs and thus immunosuppression

Severity of acute gastrointestinal injury grade is a predictor of all-cause mortality in critically ill patients: a multicenter, prospective, observational study

Abstract Background In 2012, the European Society of Intensive Care Medicine proposed a definition for acute gastrointestinal injury (AGI) based on current medical evidence and expert opinion. The aim of the present study was to evaluate the feasibility of using the current AGI grading system and to investigate the association between AGI severity grades with clinical outcome in critically ill patients. Methods Adult patients at 14 general intensive care units (ICUs) with an expected ICU stay ≥24 h were prospectively studied. The AGI grade was assessed daily on the basis of gastrointestinal (GI) symptoms, intra-abdominal pressures, and feeding intolerance (FI) in the first week of admission to the ICU. Results Among the 550 patients enrolled, 456 patients (82.9%) received mechanical ventilation, and 470 patients were identified for AGI. The distribution of the global AGI grade was 24.5% with grade I, 49.4% with grade II, 20.6% with grade III, and 5.5% with grade IV. AGI grading was positively correlated with 28- and 60-day mortality (P < 0.0001). Univariate Cox regression analysis showed that age, sepsis, diabetes mellitus, coronary artery disease, the use of vasoactive drugs, serum creatinine and lactate levels, mechanical ventilation, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and the global AGI grade were significantly (P ≤ 0.02) associated with 60-day mortality. In a multivariate analysis including these variables, diabetes mellitus (HR 1.43, 95% CI 1.03–1.87; P = 0.05), the use of vasoactive drugs (HR 1.56, 95% CI 1.12–2.11; P = 0.01), serum lactate (HR 1.15, 95% CI 1.06–1.24; P = 0.03), global AGI grade (HR 1.65, 95% CI 1.28–2.12; P = 0.008), and APACHE II score (HR 1.04, 95% CI 1.02–1.06; P < 0.001) were independently associated with 60-day mortality. In a subgroup analysis of 402 patients with 7-day survival, in addition to clinical predictors and the AGI grade on the first day of ICU stay, FI within the first week of ICU stay had an independent and incremental prognostic value for 60-day mortality (χ2 = 41.9 vs. 52.2, P = 0.007). Conclusions The AGI grading scheme is useful for identifying the severity of GI dysfunction and could be used as a predictor of impaired outcomes. In addition, these results support the hypothesis that persistent FI within the first week of ICU stay is an independent determinant for mortality. Trial registration Chinese Clinical Trial Registry identifier: ChiCTR-OCS-13003824 . Registered on 29 September 2013

Additional file 1: Table S1. of Severity of acute gastrointestinal injury grade is a predictor of all-cause mortality in critically ill patients: a multicenter, prospective, observational study

Characteristics of the patients with and without AGI. (DOC 54 kb

Additional file 2: Table S2. of Severity of acute gastrointestinal injury grade is a predictor of all-cause mortality in critically ill patients: a multicenter, prospective, observational study

AGI grading during the 7-day ICU stay among survivors and nonsurvivors. (DOC 61 kb