The systemic inflammatory response syndrome criteria and their differential association with mortality

Purpose: Despite the recent Sepsis-3 consensus, the Systemic Inflammatory Response Syndrome (SIRS) criteria continue to be assessed and recommended. Such use implies equivalence and interchangeability of criteria. Thus, we aimed to test whether such criteria are indeed equivalent and interchangeable. Materials and methods: From 2000 to 2015, we identified patients with infection, organ failure, and at least one SIRS criterion in 179 Intensive Care Units in Australia and New. Zealand. We studied the association of different SIRS criteria with hospital mortality. Results: Among 131,016 patients with infection and organ failure, mortality increased from 10.6% for the respiratory rate criterion to 15.8% for the heart rate criterion (P <0.01); from 10.1% for the high leukocyte count criterion to 20.0% for a low count and from 10.1% for a high temperature to 14.4% for a low temperature criterion. With any two SIRS criteria, hospital mortality varied from 11.5% to 30.8% depending on the combination of criteria. This difference remained unchanged after adjustments and was consistent over time. Conclusions: Different individual and combinations of SIRS criteria were associated with marked differences in hospital mortality. These differences remained unchanged after adjustment and over time and imply that individual SIRS criteria are not equivalent or interchangeable. (c) 2018 Elsevier Inc. All rights reserved.Peer reviewe

COVID-19-adenovirusvektorirokotteen aiheuttama hyytymishäiriö

Vertaisarvioitu.COVID-19-infektioiden estämiseen kehitetyt adenovirusvektorirokotteet aiheuttavat erittäin harvinaisena haittavaikutuksena vaikeita hyytymishäiriöitä, joissa kehittyy verihiutaleita aktivoivia vasta-aineita. Tilan kansainvälinen nimitys on vaccine-induced immune thrombotic thrombocytopenia (VITT) tai tromboottinen trombosytopeeninen oireyhtymä (TTS), jolle ominaisia ovat trombosytopenia, positiiviset verihiutaletekijä 4 (PF4) -hepariinivasta-aineet ilman hepariinin käyttöä sekä valtimo- ja laskimotukokset. Hyytymishäiriön nopea diagnosointi on tärkeää, sillä tilaan liittyy jopa 40 %:n kuolleisuus. Hoidon kulmakivet ovat antikoagulaatio muilla kuin hepariinivalmisteilla ja suonensisäisen immunoglobuliinin antaminen trombosyyttiaktivaatiota aiheuttavien vasta-aineiden syrjäyttämiseksi.Peer reviewe

Three-year mortality in 30-day survivors of critical care with acute kidney injury : data from the prospective observational FINNAKI study

Background: The role of an episode of acute kidney injury (AKI) in long-term mortality among initial survivors of critical illness is controversial. We aimed to determine whether AKI is independently associated with decreased survival at 3 years among 30-day survivors of intensive care. Results: We included 2336 30-day survivors of intensive care enrolled in the FINNAKI study conducted in seventeen medical-surgical ICUs in Finland during a 5-month period in 2011-2012. The incidence of AKI, defined by the Kidney Disease: Improving Global Outcomes criteria, was 34.6%, and 192 (8.3%) commenced RRT. The 3-year mortality among AKI patients was 23.5% (95% CI 20.6-26.4%) compared to 18.9% (17.0-20.9%) of patients without AKI, p = 0.01. However, after adjustments using Cox proportional hazards regression, AKI was not associated with decreased 3-year survival (HR 1.05; CI 95% 0.86-1.27), whereas advanced age, poor pre-morbid functional performance, and presence of several comorbidities were. Additionally, we matched AKI patients to non-AKI patients 1: 1 according to age, gender, presence of severe sepsis, and a propensity score to develop AKI. In the well-balanced matched cohort, 3-year mortality among AKI patients was 136 of 662 (20.5%; 17.5-23.6%) and among matched non-AKI patients 143 of 662 (21.6%; 18.5-24.7%), p = 0.687. Neither AKI nor RRT was associated with decreased survival at 3 years in the sensitivity analyses that excluded patients (1) with chronic kidney disease, (2) with AKI not commenced renal replacement therapy (RRT), and (3) with estimated pre-admission creatinine, chronic kidney disease, or AKI stage 1. Conclusion: AKI was not an independent risk factor for 3-year mortality among 30-day survivors. Increased 3-year mortality among patients with AKI who survive critical illness may not be related to AKI per se, but rather to advanced age and pre-existing comorbidities.Peer reviewe

Variation in the use of renal replacement therapy in patients with septic shock : a substudy of the prospective multicenter observational FINNAKI study

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Usefulness of neuron specific enolase in prognostication after cardiac arrest : Impact of age and time to ROSC

Aim of the study: We evaluated the impact of patient age and time from collapse to return of spontaneous circulation (ROSC) on the prognostic accuracy of neuron specific enolase (NSE) after out-of-hospital cardiac arrest (OHCA). Methods: Using electrochemiluminescence immunoassay, we measured serum concentrations of NSE in 249 patients who were admitted to intensive care units after resuscitation from OHCA. In each quartile according to age and time to ROSC, we evaluated the ability of NSE at 48 h after OHCA to predict poor outcome (Cerebral Performance Category 3-5) at 12 months. Results: The outcome at 12 months was poor in 121 (49%) patients. The prognostic performance of NSE was excellent (area under the receiver operating characteristic curve, AUROC, 0.91 [95% confidence interval, 0.81-1.00]) in the youngest quartile (18-56 years), but worsened with increasing age, and was poor (AUROC 0.53 [0.37-0.70]) in the oldest quartile (72 years or more). The prognostic performance of NSE was worthless (AUROC 0.45 [0.30-0.61]) in the quartile with the shortest time to ROSC (1-13 min), but improved with increasing time to ROSC, and was good (AUROC 0.84 [0.74-0.95]) in the quartile with the longest time to ROSC (29 min or over). Conclusion: NSE at 48 h after OHCA is a useful predictor of 12-month-prognosis in young patients and in patients with a long time from collapse to ROSC, but not in old patients or patients with a short time to ROSC.Peer reviewe

Functional outcome, cognition and quality of life after out-of-hospital cardiac arrest and therapeutic hypothermia : data from a randomized controlled trial

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