Furosemide-related thiamine deficiency in hospitalized hypervolemic patients with renal failure and heart failure.

Background: We aimed to describe the thiamine status in hospitalized hypervolemic heart failure (HF) and/or renal failure (RF) patients treated with furosemide and to investigate whether there was a difference in furosemide-related thiamine deficiency between patients with RF and HF. Methods: Patients who were diagnosed as hypervolemia and treated with intravenous furosemide (at least 40 mg/day) were included in this prospective observational study. Whole blood thiamine concentrations were measured 3 times during hospital follow-up of patients. Results: We evaluated 61 hospitalized hypervolemic patients, of which 22 (36%) were men and 39 (64%) were women, with a mean age of 69.00 ± 10.39 (45–90) years. The baseline and post–hospital admission days 2 and 4 mean thiamine levels were 51.71 ± 20.66 ng/ml, 47.64 ± 15.43 ng/ml and 43.78 ± 16.20 ng/ml, respectively. Thiamine levels of the hypervolemic patients decreased significantly during the hospital stay while furosemide treatment was continuing (p = 0.029). There was a significant decrease in thiamine levels in patients who had HF (p = 0.026) and also, thiamine was significantly lower in HF patients who had previously used oral furosemide before hospitalization. However, these findings were not present in patients with RF. Conclusions: Thiamine substantially decreases in most hypervolemic patients receiving intravenous furosemide treatment during the hospital stay. Thiamine levels were significantly decreased with furosemide treatment in especially HF patients, but the decrease in thiamine levels did not detected at the same rate in RF patients. Diuretic-induced thiamine loss may be less likely in RF patients, probably due to a reduction in excretion. Resumen: Antecedentes: Nos propusimos describir el estado de la tiamina en pacientes hospitalizados con insuficiencia cardíaca (IC) y/o insuficiencia renal (IR) hipervolémica tratados con furosemida, e investigar si había una diferencia en la deficiencia de tiamina relacionada con la furosemida entre los pacientes con IR y con IC. Métodos: En este estudio observacional prospectivo se incluyeron pacientes con diagnóstico de hipervolemia y tratados con furosemida intravenosa (al menos 40 mg/día). Se midieron las concentraciones de tiamina en sangre total 3 veces durante el seguimiento hospitalario de los pacientes. Resultados: Se evaluaron 61 pacientes hipervolémicos hospitalizados, de los cuales 22 (36%) eran hombres y 39 (64%) eran mujeres, con una edad media de 69,00±10,39 (45-90) años. Los niveles medios de tiamina en la línea de base y tras el ingreso hospitalario en los días 2 y 4 fueron de 51,71±20,66 ng/ml, 47,64±15,43 ng/ml y 43,78±16,20 ng/ml, respectivamente. Los niveles de tiamina de los pacientes hipervolémicos hipervolemia disminuyeron significativamente durante la estancia en el hospital mientras se mantenía el tratamiento con furosemida furosemida (p = 0,029). Hubo una disminución significativa de los niveles de tiamina en los pacientes que tenían IC (p = 0,026) y también, la tiamina fue significativamente menor en los pacientes con IC que habían habían utilizado previamente furosemida oral antes de la hospitalización. Sin embargo, estos hallazgos no se presentes en los pacientes con IC. Conclusiones: La tiamina disminuye sustancialmente en la mayoría de los pacientes hipervolémicos que reciben tratamiento con furosemida intravenosa durante la estancia hospitalaria. Los niveles de tiamina se redujeron significativamente con el tratamiento con furosemida, especialmente en los pacientes con IC, pero la disminución de los niveles de tiamina no se detectó al mismo ritmo en los pacientes con IC. La pérdida de tiamina inducida por los diuréticos inducida por los diuréticos puede ser menos probable en los pacientes con insuficiencia cardiaca, probablemente debido a una reducción de la excreción

Critically ill elderly patient mortality: Is age a risk factor? Yoğun bakımda yaşlı hasta mortalitesi: Yaş risk faktörü mü?

© 2014, AVES Ibrahim Kara. All Rights reserved.Objective: The aim of this study is to evaluate mortality rates and risk factors for mortality among patients more than 65 years old admitted to the medical intensive care unit (ICU). Material and Methods: ICU admissions of patients older than 65 years were retrospectively analyzed. Patients divided into three groups according to their age: 65-74 (group 1), 75-84 (group 2), and 85 age and over (group 3). Results: A total of 442 patients were included into the study. The mean age of the patients was 75±7 years, and 49% of them was female. The overall mortality rate was 83%. Every 1-point rise in Sequential Organ Failure Assessment (SOFA) score was associated with a 1.48-fold (95% CI 1.32-1.68, p<0.001) increase in mortality rate. Mechanical ventilation (MV) was associated with a 5.02-fold (95% CI 2.57-9.80, p<0.001) increase in mortality rate. MV (both invasive and non-invasive together) was associated with 4.32 fold increase in mortality. (95% CI 1.71-10.45, p=0.002). Conclusion: The comorbid conditions of patients and severity of disease should be considered for mortality prediction for critically ill elderly patients

Frequency and Related Risk Factors of Refeeding Hypophosphatemia in Patients with Liver Cirrhosis: A Pilot Study.

Background & Aims: Refeeding hypophosphataemia (RH) is associated with poor clinical outcomes and mortality rates. However, the presence of RH in patients with cirrhosis remains unknown. This study aimed to determine the relationship among the frequency of RH, nutritional status, and disease severity in patients with liver cirrhosis.Methods: This prospective study was conducted at a single-centre gastroenterology clinic. Malnutrition was identified using the Subjective Global Assessment (SGA). Disease severity was defined using the ChildTurcotte-Pugh (CTP) and the Model for End-Stage Liver Disease (MELD) scores. Hypophosphatemia was defined as a serum phosphate level of <2.0 mg/dL.Results: Twelve of 50 cirrhotic patients (24%) had RH during hospitalization. The most common RH was determined in four patients on day four during the study follow-up. The sharpest decline in serum phosphate levels was observed on day four (median: 2.3 mg/dL). The CTP score and MELD scores did not differ significantly between RH and non-RH groups ((p=0.478 and p=0.643), respectively. The rate of malnutrition according to the SGA was 56.0%. A total of 82%, 4%, 8%, and 4% of participants received regular diet and oral nutritional supplements, only enteral tube feeding, only parenteral nutrition, and combined enteral and parenteral nutrition, respectively. In the RH group, 32% of participants received only parenteral nutrition and had a higher prevalence of RH than that of patients receiving only oral or enteral tube feeding (p=0.001). The CTP score strongly and negatively correlated with serum phosphorus levels on days two (p=0.016), three (p=0.050), and seven (p=0.017) in the RH group.Conclusions: This study showed that artificial feeding (enteral or parenteral nutrition) carries a significant risk in terms of RH. Malnourished patients with liver cirrhosis who received parenteral nutrition were closely monitored for a high risk of RH. The CTP score strongly and negatively correlated with serum phosphorus levels

Measurement of serial serum total and acylated ghrelin levels in critically ill patients: A prospective and observational pilot study

© 2021 American Society for Parenteral and Enteral NutritionBackground: Ghrelin is a hormone that regulates appetite and energy metabolism. The change of serial serum total and acylated ghrelin levels during hospital stays of critical patients are unknown. In addition, the relationship of this change with the clinical results of patients in the intensive care unit (ICU) is also unknown. The aim of this study was to determine serum total and acylated ghrelin levels serially in critically ill patients. Methods: This prospective study was performed in the ICU. Patients who were >18 years old and stayed in ICU for >48 h were included in the study. Serum total and acylated ghrelin concentrations were measured at baseline in all participants and serially on the 2nd, 5th, and 10th day after entry into the study in those who remained in the ICU. Results: A total of 60 participants were included. The mean age was 56 ± 21 years. (Baseline, 2nd, 5th, and 10th day median serum total ghrelin levels were 3551 (1651–3995), 3485.20 (1379–4071), 3359 (1167–3919), and 3355 pg/ml (2207–3843), respectively. Baseline, 2nd, 5th, and 10th day acylated ghrelin levels were 47 (0–673), 50 (0–730), 73 (0–808), and 125 pg/ml (0–689), respectively. There was no significant difference between total ghrelin/acylated ghrelin levels and mortality (P >.05). ICU mortality was 30%. Conclusion: Ghrelin levels were decreased slightly and acylated ghrelin levels increased substantially over time in critically ill patients. There were no differences between serum total ghrelin/acylated ghrelin levels and ICU mortality

The Effect of Mesenchymal Stromal Cells on the Mortality of Patients with Sepsis and Septic Shock: A Promising Therapy

Purpose. Sepsis and septic shock are the major causes of death in intensive care units. This study aimed to evaluate the clinical safety and efficacy of mesenchymal stem cells (MSCs) in sepsis and septic shock patients. Methods. Ten patients were enrolled in the study. Adipose-derived MSC infusions were given (1 x 10(6)/kg, on the 1st, 3rd, 5th, 7th, and 9th days of therapy) together with standard therapy. Before the MSC applications, blood samples were collected for cytokine assessment (TNF-alpha, IFN-gamma, IL-2, IL-4, IL-6, IL-10). The clinical and laboratory improvements were recorded and compared with control groups selected retrospectively. The clinical trial was registered on 16.03.2022 with the registration number . Results. In the study group, the ages of patients ranged from 22 to 68 years, and APACHE II scores ranged from 14 to 42. In the control group, ages ranged from 22 to 80 years and their APACHE II scores were between 14-35. The survival rate in the study group was 100% on the 14th day whereas it was 70% on the 28th day. A significant decrease in the SOFA score (adjusted), clinical, and laboratory improvements were observed during the MSC administration. However, no significant cytokine level changes were observed. In the control group, the survival rate of 20 patients was 70% on the 14th day, whereas 60% was on the 28th day. While deaths were observed in the control group in the first week of treatment, deaths in the MSCs group were observed between the 15th and 28th days. Conclusion. MSCs treatment may have a positive impact on the survival rates of sepsis during the early phase. However, further randomized controlled studies with a large group of patients are needed

Serum trace elements levels in patients transferred from the intensive care unit to wards.

Background & aims: Trace elements act as co-factors and/or in co-enzymes in many metabolic pathways and its deficiency contributes to metabolic and infectious complications. The aim of this study was to determine serum zinc, selenium, cobalt, chromium, copper and ceruloplasmin levels for identify the need for post intensive care unit (ICU) nutritional follow-up