Presepsin as a diagnostic and prognostic biomarker in sepsis

Sepsis is a condition characterized by high morbidity and mortality which is commonly encountered in an emergency and critical care setting. Despite a substantial body of research, the ideal biomarker for the diagnosis and prognostic stratification of septic patients remains unknown. This review aimed to summarize the publications referring to the validity of the biomarker presepsin when used for the detection, monitoring and prognosis in patients suffering with sepsis. This work is a narrative review based on a PubMed/Medline search conducted in order to identify all relevant publications referring to the use of presepsin in sepsis. Search was not limited by year of publication so all articles archived in the database would be retrieved. No article from before 2010 was identified. A total of 57 publications of the last decade were included, all of which support the use of presepsin as a biomarker for the assessment of septic patients. It has been used alone or in combination with commonly used biomarkers in the evaluation of patients with sepsis in settings such as the emergency department and the intensive care unit. It is useful in the initial workup of patients with suspected sepsis in the emergency setting and may be a predictive factor of mortality and the most severe complication of sepsis. Presepsin seems to be a valuable tool for the laboratory workup of sepsis, especially when used in conjunction with other biomarkers and clinical rating scores with an established role in this population. Further research is needed to evaluate the clinical implications of utilizing presepsin measurements in the workup of sepsis

Continuous positive airway pressure in the treatment of COVID-19 patients with respiratory failure. A report of six cases with excellent outcome

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is currently considered a significant threat to global health and global economy. This new rapidly spreading virus causes enormous stress to healthcare systems as large number of patients present with respiratory failure, needing intubation and mechanical ventilation. While the industry is racing to meet the rising demand for ventilators, all the alternative respiratory support modalities are employed to save lives in hospitals around the globe. We hereby report 6 patients who were diagnosed with SARS-CoV-2 and treated with continuous positive airway pressure in a negative pressure isolated room in a tertiary center in western Greece. The rapid progression of mild flu-like symptoms to respiratory failure in all patients was controlled with the use of continuous positive airway pressure making this strategy a reasonable alternative to respiratory failure due to SARS-CoV-2 as it may avert intubation and mechanical ventilation

Evaluation of admission chest X-ray findings in patients with respiratory infection during the COVID-19 pandemic

AIMS: To evaluate the prevalence of X-ray findings in hospitalized patients requiring hospitalization with suspected Coronavirus disease 2019 (COVID-19) infection and potential differences in the laboratory values and clinical outcomes related to the presence of abnormal chest X-ray (CXR) findings. METHODS: RESULTS: CONCLUSION: CXR is a routine examination in all patients with symptoms of lower respiratory tract disease and its findings relate to in-hospital mortality and Pa

Cytokine production and outcome in MDR versus non-MDR gram-negative bacteraemia and sepsis

Background: Sepsis represents a life-threatening syndrome characterized by a cytokine storm. Whether cytokine levels are related to the susceptibility pattern of invasive micro-organism remains a matter of debate. The purpose of this study is to investigate the immune response in multidrug resistant (MDR) and non-MDR sepsis patients by measuring cytokine levels, compare the outcome and determine predictors of mortality. Materials and methods: A total of 128 septic patients, treated in intensive care unit (ICU) were enrolled in the study. Epidemiological and ICU data were recorded. Plasma concentrations of angiopoietin-2 (Ang-2), interleukin (IL)-6, IL-10, tumor necrosis factor-α (TNF-α) and soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) were measured on admission. Results: A total of 90 patients suffered from non-MDR and 38 from MDR gram-negative sepsis. Levels of TNF-α were significantly higher (p = .017) in non-MDR sepsis patients. All pro-inflammatory cytokines were significantly increased in severely ill patients compared to patients with lower acute physiology and chronic health evaluation (APACHE) II score. MDR positive patients had a significantly lower 28-d survival (p = .008). Factors that were independently associated with higher 28-d mortality were carbapenem resistance (OR 5.38 [1.032 − 28.12], p = .046), male gender (OR 2.76 [1.156 − 6.588], p = .022), APACHE II score (OR 1.126 [1.048 − 1.21], p = .001) and Ang-2 (OR 1.025 [1.001 − 20.1], p = .048). Conclusions: Sepsis evolution and outcome are influenced by multiple factors. Although MDR pathogens induced a weaker immune response characterized by lower TNF-α levels this was not accompanied by better survival. Increased Ang-2 levels, APACHE II score and carbapenem resistance are important factors associated with higher mortality.Εισαγωγή: H σήψη αποτελεί ένα δυνητικά απειλητικό για την ζωή σύνδρομο που χαρακτηρίζεται από μία καταιγίδα έκλυσης κυτταροκινών. Το αν τα επίπεδα των κυτταροκινών σχετίζονται με τα πρότυπα ευαισθησίας του παθογόνου μικροοργανισμού παραμένει αντικείμενο μελέτης. Ο σκοπός αυτής της μελέτης είναι να διερευνήσει την ανοσολογική απάντηση σε ασθενείς με σήψη από πολυανθεκτικούς (MDR – Multidrug resistant) και πολυευαίσθητους (non-MDR – non-Multidrug resistant) μικροοργανισμούς μετρώντας τα επίπεδα των κυτταροκινών, να συγκρίνει την έκβαση των ασθενών, αλλά και να καθορίσει πιθανούς προγνωστικούς παράγοντες θνητότητας.Υλικά και Μέθοδοι: Συνολικά εντάχθηκαν στην μελέτη 128 ασθενείς με σήψη, νοσηλευόμενοι σε Μονάδες Εντατικής Θεραπείας (ΜΕΘ). Καταγράφηκαν επιδημιολογικά στοιχεία των νοσηλευόμενων ασθενών σε ΜΕΘ. Κατά την εισαγωγή μετρήθηκαν συγκεντρώσεις στο πλάσμα αγγειοποιητίνης-2 (Ang-2 – Angiopoietin-2), ιντερλευκίνης 6 (IL-6 – Interleukin-6), ιντερλευκίνης 10 (IL-10 – Interleukin-10), παράγοντα νέκρωσης όγκων α (TNF-a – Tumor necrosis factor-a) και διαλυτού υποδοχέα ενεργοποίησης που εκφράζεται στα μυελοκύτταρα (sTREM-1 - soluble triggering receptor expressed on myeloid cells-1). Αποτελέσματα: Συνολικά 90 ασθενείς βρέθηκαν να πάσχουν από non-MDR και 38 ασθενείς από MDR Gram αρνητική σήψη. Τα επίπεδα του TNF-a βρέθηκαν σημαντικά υψηλότερα (p=.017) στους ασθενείς με non-MDR σήψη. Όλες οι προφλεγμονώδεις κυτταροκίνες ήταν σημαντικά αυξημένες στους βαρέως πάσχοντες ασθενείς συγκριτικά με αυτούς που είχαν χαμηλότερη βαθμολογία APACHE II. Οι ασθενείς με MDR σήψη είχαν σημαντικά χαμηλότερη επιβίωση στις 28 ημέρες (p=.008). Παράγοντες ανεξάρτητα σχετιζόμενοι με υψηλότερη θνητότητα στις 28 ημέρες ήταν η αντοχή στις καρβαπενέμες (OR 5.38 [1.032 - 28.12], p= .046) , το άρρεν φύλο (OR 2.76 [1.156 - 6.588], p= .022) , η βαθμολογία APACHE II (OR 1.126 [1.048 - 1.21], p= .001) και τα επίπεδα αγγειοποιητίνης 2 (OR 1.025 [1.001 - 20.1], p = .048). Συμπεράσματα: Η εξέλιξη του συνδρόμου της σήψης και η έκβαση της είναι πολυπαραγοντικό φαινόμενο. Παρ΄ότι τα MDR παθογόνα προκάλεσαν ασθενέστερη ανοσιακή απάντηση, χαρακτηριζόμενη από χαμηλότερα επίπεδα TNF-a , αυτό δεν συνοδεύτηκε από καλύτερη επιβίωση. Τα αυξημένα επίπεδα αγγειοποιητίνης-2, η βαθμολογία APACHE II και η αντοχή στις καρβαπενέμες φάνηκε ότι είναι παράγοντες που σχετίζονται με υψηλότερη θνητότητ

Continuous Positive Airway Pressure in the Treatment of COVID-19 Patients with Respiratory Failure. A Report of Six Cases with Excellent Outcome

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is currently considered a significant threat to global health and global economy. This new rapidly spreading virus causes enormous stress to healthcare systems as large number of patients present with respiratory failure, needing intubation and mechanical ventilation. While the industry is racing to meet the rising demand for ventilators, all the alternative respiratory support modalities are employed to save lives in hospitals around the globe. We hereby report 6 patients who were diagnosed with SARS-CoV-2 and treated with continuous positive airway pressure in a negative pressure isolated room in a tertiary center in western Greece. The rapid progression of mild flu-like symptoms to respiratory failure in all patients was controlled with the use of continuous positive airway pressure making this strategy a reasonable alternative to respiratory failure due to SARS-CoV-2 as it may avert intubation and mechanical ventilation

Relation Between Central Venous, Peripheral Venous and Arterial Lactate Levels in Patients With Sepsis in the Emergency Department

Background: Sepsis and multi-organ failure remain a major clinical problem with high morbidity and mortality worldwide. Lactate measurement remains part of the initial assessment and management of patients with sepsis. Although arterial blood is most commonly used for lactate measurement, there is increasing use of peripheral venous lactate for initial assessment and for monitoring of response to treatment in patients with sepsis. The aim of this study was to evaluate the relation between lactate levels measured from central line, peripheral vein and arterial line in patients treated for sepsis in the emergency department (ED). Methods: This prospective study enrolled 31 patients with diagnosis of sepsis who were evaluated and treated in the ED of a university hospital. During initial resuscitation, blood samples from the artery, peripheral vein and central vein (when available) were collected and lactate concentrations were measured. Correlation between lactate values from the three different locations was assessed using Pearson correlation. Bland-Altman plots were used to evaluate agreement between lactate measurements in different sampling locations. All patients were eventually admitted to the Internal Medicine Department ward or to the intensive care unit (ICU) for further treatment. Results: Our data showed strong, highly significant correlation between arterial and peripheral venous lactate levels (r = 0.880, P \u3c 0.0001), between arterial and central venous blood lactate (r = 0.898, P \u3c 0.0001) and between central and peripheral venous blood lactate (r = 0.941, P \u3c 0.0001). Conclusions: In this study we observed strong correlation between arterial, central vein and peripheral vein lactate concentrations in 31 patients assessed and treated for sepsis. We suggest that lactate measurement in peripheral venous blood could be used for screening and for monitoring response to therapy in sepsis patients. However, because this is a small study in only 31 patients and published data are limited, larger studies are needed in order to confirm the validity of our findings

High-flow versus conventional nasal cannula oxygen supplementation therapy and risk of hypoxia in gastrointestinal endoscopies: Α systematic review and meta-analysis.

BACKGROUND AND AIMS Gastrointestinal endoscopy (GIE) represents a mainstay diagnostic and therapeutic procedure in modern clinical practice. Hypoxemia and respiratory failure during endoscopy constitute major complications and concerns for endoscopists. Emerging evidence supports the utilization of high-flow nasal cannula (HFNC) over conventional nasal cannula (CNC) for oxygen supplementation and avoidance of hypoxemia. Aim of our study was to compare the risk of hypoxemia in patients undergoing GIE with HFNC versus CNC oxygen supplementation recruited by randomized controlled trials (RCTs). METHODS We conducted an electronic literature search in established medical databases i.e. PubMed, EMBASE and Cochrane to identify RCTs investigating the abovementioned association. The enrolled studies were evaluated for risk of bias and inserted into a random effects model for meta-analysis; sub-group analyses and publication bias were also assessed. RESULTS Out of 271 initially retrieved articles, five RCTs were eligible for meta-analysis with totally 2656 recruited patients (1299 HFNC and 1357 CNC). A statistically significant reduced relative risk (RR) of hypoxemia among HFNC patients was revealed (RR=0.18, CI95%: 0.05-0.61), whilst with high heterogeneity (I2:79.94%, p<0.01). Patients undergoing upper GIE with HFNC displayed a significantly lower risk of hypoxemia (96%, p<0.001, I2:15.59%), even after exclusion of endoscopic retrograde cholangiopancreatography (ERCP) cases (RR:0.03, CI95%: 0.01-0.21), albeit with higher heterogeneity (I2:41.82%). Contrariwise, colonoscopy with HFNC did not yield a statistically significant RR reduction (p=0.14). CONCLUSION Patients undergoing upper GIE with HFNC oxygen experience significantly less hypoxemia burden than CNC counterparts. Further research is warranted to establish this emerging association to target optimal safety during endoscopy

High-flow versus conventional nasal cannula oxygen supplementation therapy and risk of hypoxia in gastrointestinal endoscopies: a systematic review and meta-analysis

Background Gastrointestinal endoscopy (GIE) represents a mainstay diagnostic and therapeutic procedure in clinical practice. Hypoxemia constitutes a major complication for endoscopists. Emerging evidence supports the utilization of high-flow nasal cannula (HFNC) over conventional nasal cannula (CNC) for avoidance of hypoxemia. Our aim was to compare the hypoxemia risk in patients undergoing GIE with HFNC versus CNC oxygen supplementation recruited by randomized controlled trials (RCTs). Methods We searched in medical databases PubMed, EMBASE and Cochrane to identify RCTs investigating the abovementioned association. Enrolled studies were evaluated for risk of bias and inserted into a random effects model for meta-analysis; subgroup analyses and publication bias were also assessed. Results Out of 271 articles, five RCTs were eligible (patients n=2656, HFNC 1299 and CNC 1357). A statistically significant reduced relative risk (RR) of hypoxemia among HFNC patients was revealed (RR=0.18, CI95%: 0.05-0.61), whilst with high heterogeneity (I2:79.94%, p&lt;0.01). Patients undergoing upper GIE with HFNC displayed a significantly lower hypoxemia risk (96%, p&lt;0.001, I2:15.59%), even after exclusion of endoscopic retrograde cholangiopancreatography cases (RR:0.03, CI95%:0.01-0.21), albeit with higher heterogeneity (I2:41.82%). Conclusion Patients undergoing upper GIE with HFNC experience significantly less hypoxemia burden than CNC counterparts. Further research is warranted to target optimal safety during endoscopy

The impact of osteoporosis and vertebral compression fractures on mortality and association with pulmonary function in COPD: A meta-analysis

Objective: Osteoporosis is highly prevalent among patients with chronic obstructive pulmonary disease (COPD) and most commonly presents as a vertebral compression fracture (VCF). Our objective was to quantify the effect of osteoporosis and VCFs on the mortality and pulmonary function tests (PFTs), such as forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC), of patients with COPD. Methods: A PubMed/Medline search was conducted using the search terms “chronic obstructive pulmonary disease”, “osteoporosis” and “vertebral compression fracture”. Meta-analyses were conducted to evaluate the differences in mortality and PFTs between patients with COPD with and without osteoporosis or VCFs, according to PRISMA guidelines. PROSPERO registration: CRD42019120335. Results: Of the 896 abstracts identified, 27 studies describing 7662 patients with COPD of which 1883 (24.6%) had osteoporosis or VCFs, were included. Random effects model analysis demonstrated that patients with COPD and osteoporosis or VCFs had an increased OR for mortality of 2.40 (95% CI: 1.24; 4.64, I2 = 89%, P < 0.01), decreased FEV1/FVC with a mean difference of −4.80% (95% CI: −6.69; −2.90, I2 = 83%, P < 0.01) and decreased FEV1, with a mean difference of −4.91% (95% CI: −6.51; −3.31, I2 = 95%, P < 0.01) and −0.41 L (95% CI: −0.59; −0.24, I2 = 97%, P < 0.01), compared to control subjects. Apart from FEV1 (liters) in subgroup 1 (P = 0.06), all subgroup analyses found significant differences between groups, as did sensitivity analysis of low risk of bias studies. Conclusion: Osteoporosis and VCFs are associated with a significant reduction in survival and pulmonary function among patients with COPD