Ferritin and transferrin saturation cannot be used to diagnose iron-deficiency anemia in critically ill patients

Abstract Introduction: Iron-deficiency anaemia (IDA) is the most common anaemia globally. The frequency of IDA among critically ill patients is not known. The aim of our study was to analyse performance of standard iron metabolism parameters in diagnosis of IDA in the critically ill. Material and methods: We performed a retrospective analysis of consecutive anaemic patients admitted to the intensive care unit. Based on various cut-off values for ferritin and/or transferrin saturation (TfS), we determined the incidence of IDA. Results: The population consisted of 27 (53%) men and 24 (47%) women. The median haemoglobin concentration was well 96 [interquartile range (IQR 87–109)] g/L. The studied population had markedly increased concentration of C-reactive protein [119 (IQR 44–196) mg/L], ferritin [686 (385–1114) µg/L], whereas iron concentration and TfS were below reference value. Depending on cut-off value chosen, IDA could be diagnosed in between 7.8 (ferritin < 100 µg/L +TfS < 20%) and 56.9 % (TfS < 20%) of patients. Conclusions: Ferritin and transferrin saturation cannot be used for precise diagnosis of IDA caused by absolute or functional iron deficiency in the critically ill

Thrombocytopenia in critically ill patients: single center data analysis

Introduction: Thrombocytopenia (TP) is one of the most frequent abnormalities of hemostasis found in laboratory tests in critically ill patients. The aim of this study was to determine the frequency and most probable causes of TP in patients hospitalized in the Intensive Care Unit (ICU). Material and methods: The documentation of all patients hospitalized in 2019 was analyzed retrospectively in the ICU of the university hospital. Patients diagnosed with TP at admission to the ward or during hospitalization were identified. Potential factors influencing the platelet count were analyzed. Results: During the analyzed period, 291 patients were hospitalized. In 93 patients (32%), TP was diagnosed, including 61 patients at admission (21%), and the remaining 32 patients (11%) during hospitalization. Patients with TP had higher SAPS II, APACHE II and SOFA scores than patients without TP (p <0.001 for all). Mortality in patients with TP was twice as high as in patients without TP (58% vs. 29%, p <0.001). In 18 patients (6%), only one cause of TP was potentially identified, while in 39 patients (13%), four or more factors that could potentially cause TP were identified. Conclusions: Thrombocytopenia is a relatively common problem in the critically ill population, but due to the challenges in differential diagnosis, a reliable assessment of the causes of its occurrence is difficult

Usefulness of Apfel score to predict postoperative nausea and vomiting – single-center experiences

INTRODUCTION: Postoperative nausea and vomiting (PONV) are uncomfortable for patients, can prolong hospita-lization and can lead to more serious complications, including inadequate pain control or respiratory failure. Accura-tely predicting which patients are at risk of PONV can help physicians decide when to recommend prophylactic anti-emetics. The aim of the study was verify whether the Apfel score is useful in predicting postoperative nausea and vo-miting. MATERIAL AND METHODS: A prospective observation was performed in a group of 101 patients (54F; median age 64y; 51 ASA3+) who underwent surgery between 01.2017 and 03.2017 in a high-volume university hospital. Demographic and clinical data was recorded and the Apfel score was calculated. For the final result, the occurrence of PONV on the first day after surgery was accepted. RESULTS: The mean time of anesthesia was 216 ± 121 min. Most patients (n = 86) underwent gastro-intestinal surgery. Antiemetic prophylaxis was given to 68 persons. The median Apfel score was 2 (IQR 2–3). An Apfel score of 4 pts was found in 14 subjects. Postoperative nausea and vomiting occurred in 9 patients. Although none of the individual components of the Apfel scale predicted PONV in bivariate comparisons, the total score was useful in predicting PONV (AUC = 0.734; 95% CI 0.636–0.817; p < 0.01). Antiemetic treatment resulted in a 65% reduction in the occurrence of PONV (OR = 0.35; 95% CI 0.08–1.4; p = 0.1). CONCLUSIONS: Although the Apfel score helps recognize patients at risk of PONV, identifying patients who should receive prophylactic antiemetics needs further investigation.WSTĘP: Pooperacyjne nudności i wymioty (postoperative nausea and vomiting – PONV) wpływają na pogorszenie komfortu pacjenta, przedłużają hospitalizację i mogą prowadzić do poważnych powikłań. Przewidywanie, u którego pacjenta ryzyko wystąpienia PONV jest duże, może pomóc lekarzowi w podjęciu decyzji o zastosowaniu profilaktyki przeciwwymiotnej. MATERIAŁ I METODY: Przeprowadzono prospektywną obserwację w grupie 101 pacjentów (w tym 54 kobiet; mediana wieku 64 lata; 51 ASA3+), poddanych zabiegom operacyjnym w okresie od 01.2017 r. do 03.2017 r. w Uniwersyteckim Centrum Klinicznym. Zebrano niezbędne dane demograficzne i kliniczne, oszacowano ryzyko w skali Apfel. Za ostateczny wynik przyjęto wystąpienie PONV w pierwszej dobie po zabiegu. WYNIKI: Średni czas znieczulenia wynosił 216 ± 121 min. Większość pacjentów (n = 86) była hospitalizowana na oddziale chirurgii przewodu pokarmowego. Profilaktykę antyemetyczną zastosowano u 68 osób. Mediana skali Apfel wynosiła 2 pkt (IQR 2–3). Wynik maksymalny w skali Apfel uzyskało 14 pacjentów, natomiast PONV wystąpiły u 9. Chociaż żaden z pojedynczych czynników ryzyka nie był w stanie przewidzieć z dobrą skutecznością wystąpienia PONV, to całkowity wynik skali Apfel był przydatny w ¾ przypadków (AUC = 0,734; 95% CI 0,636–0,817; p < 0,01). Zastosowanie leków przeciwwymiotnych spowodowało 65% redukcję występowania PONV (OR = 0,35; 95% CI 0,08–1,4; p = 0,1). WNIOSKI: Skala Apfel z dość dobrą skutecznością pozwoliła przewidzieć, u kogo wystąpią PONV, jednak potrzebne są dalsze badania nad identyfikacją pacjentów, u których powinno się zastosować profilaktykę przeciwwymiotną

Hemoglobin Determination Using Pulse Co-Oximetry and Reduced-Volume Blood Gas Analysis in the Critically Ill: A Prospective Cohort Study

Hospital-acquired anemia is common in patients hospitalized in the intensive care unit (ICU). A major source of iatrogenic blood loss in the ICU is the withdrawal of blood for laboratory testing. The aim of our study was to analyze the feasibility and accuracy of non-invasive spot-check pulse co-oximetry (SpHb), and a reduced-volume blood gas analysis (ABG Hb) for the determination of Hb concentration in critically ill patients. Comparisons between Hb determined with test devices and the gold standard&mdash;complete blood count (CBC)&mdash;were performed using Bland&ndash;Altman analysis and concordance correlation coefficient (CCC). The limits of agreement between SpHb and CBC Hb were &ndash;2.0 [95%CI &minus;2.3&ndash;(&minus;1.7)] to 3.6 (95%CI 3.3&ndash;3.9) g/dL. The limits of agreement between ABG Hb and CBC Hb were &minus;0.6 [95%CI &minus;0.7&ndash;(&minus;0.4)] to 2.0 (95%CI 1.9&ndash;2.2) g/dL. Spearman&rsquo;s coefficient and CCC between ABG Hb and CBC Hb were 0.96 (95%CI 0.95&ndash;0.97, p &lt; 0.001) and 0.91 (95%CI 0.88&ndash;0.92), respectively. Non-invasive spot-check Hb co-oximetry is not sufficiently accurate for the monitoring of hemoglobin concentration in critically ill patients. Reduced volume arterial blood gas analysis has acceptable accuracy and could replace complete blood count for the monitoring of Hb concentration in critically ill patients, leading to a significant reduction in blood volume lost for anemia diagnostics

Investigating Association between Intraoperative Hypotension and Postoperative Neurocognitive Disorders in Non-Cardiac Surgery: A Comprehensive Review

Postoperative delirium (POD) and postoperative cognitive decline (deficit) (POCD) are related to a higher risk of postoperative complications and long-term disability. Pathophysiology of POD and POCD is complex, elusive and multifactorial. Intraoperative hypotension (IOH) constitutes a frequent and vital health hazard in the perioperative period. Unfortunately, there are no international recommendations in terms of diagnostics and treatment of neurocognitive complications which may arise from hypotension-related hypoperfusion. Therefore, we performed a comprehensive review of the literature evaluating the association between IOH and POD/POCD in the non-cardiac setting. We have concluded that available data are quite inconsistent and there is a paucity of high-quality evidence convincing that IOH is a risk factor for POD/POCD development. Considerable heterogeneity between studies is the major limitation to set up reliable recommendations regarding intraoperative blood pressure management to protect the brain against hypotension-related hypoperfusion. Further well-designed and effectively-performed research is needed to elucidate true impact of intraoperative blood pressure variations on postoperative cognitive functioning

Antipsychotic Drugs in Prevention of Postoperative Delirium—What Is Known in 2020?

Delirium is one of the most frequently reported neuropsychiatric complications in the perioperative period, especially in the population of elderly patients who often suffer from numerous comorbidities undergoing extensive or urgent surgery. It can affect up to 80% of patients who require hospitalization in an intensive care setting postoperatively. Delirium increases mortality, morbidity, length of hospital stay, and cost of treatment. An episode of delirium in the acute phase may lower the general quality of life and increases the risk of cognitive decline long-term. Since pharmacological treatment of delirium is not highly effective, focus of research has shifted towards developing preventive strategies. We aimed to perform a review of the topic based on the most recent literature. We conclude that, based on the available data, it seems impossible to make strong recommendations for using antipsychotic drugs in prophylaxis. Further research should answer the question what, if any, benefit patients receive from the pharmacological prevention of delirium, and which agents should be used

Hepatic Encephalopathy Confirmed by Magnetic Resonance Imaging in a Patient with Unobvious Cause of Chronic Liver Disease Decompensation

Fifty-four-year old male was admitted to the intensive care unit (ICU) due to impaired consciousness. Past medical history included alcohol dependence, liver cirrhosis, esophageal varices, 2 esophageal varices banding procedures in the past, pathological obesity. Computed tomography (CT) examination of the head performed in the referring hospital was normal. At admission the CT examination of the head was repeated and showed no abnormalities. Urgent esophagogastroduodenoscopy revealed presence of esophageal varices and scarification following previous banding procedures located in the middle and lower part of the esophagus. Gastrointestinal bleeding being the most likely cause of chronic liver decompensation was therefore excluded. Multimodal neurologic diagnostic assessment was negative. Finally magnetic resonance imaging (MRI) of the head was performed. Taking into account clinical picture and the MRI result, the differential diagnosis included chronic liver encephalopathy, exacerbated acquired hepatocerebral degeneration, and acute liver encephalopathy. Due to history of umbilical hernia CT of the abdomen and pelvis was performed and showed intussusception of the ileum, confirming hepatic encephalopathy. In this case report the MRI suggested the diagnosis of hepatic encephalopathy and prompted search for alternative causes of decompensation of chronic liver disease

Usefulness of Selected Peripheral Blood Counts in Predicting Death in Patients with Severe and Critical COVID-19

Background. Immune dysregulation and hypoxemia are two important pathophysiological problems in patients with COVID-19 that affect peripheral blood count parameters. We hypothesized that assessment of the neutrophil&ndash;lymphocyte ratio (NLR) and red blood cell distribution width index (RDW-SD) could predict death in patients with severe and critical COVID-19. Methods. Seventy patients admitted to the intensive care unit (ICU) for COVID-19 acute respiratory failure were included in the study. RDW-SD and NLR on the day of ICU admission and peak values during the entire hospitalization were assessed. The primary endpoint was death before ICU discharge. Results. Patients who died had higher NLR on admission (20.3, IQR 15.3&ndash;30.2 vs. 11.0, IQR 6.8&ndash;16.9; p = 0.003) and higher RDW-SD (48.1 fL; IQR 43.1&ndash;50.5 vs. 43.9 fL; IQR 40.9&ndash;47.3, p = 0.01) than patients discharged from the ICU. NLR and RDW-SD values on ICU admission accurately predicted death in 76% (AUC = 0.76; 95%CI 0.65&ndash;0.86; p = 0.001; cut-off &gt; 14.38) and 72% of cases (AUC = 0.72; 95%CI 0.60&ndash;0.82; p = 0.003; cut-off &gt; 44.7 fL), respectively. Multivariable analysis confirmed that NLR &gt; 14.38 on the day of ICU admission was associated with a 12-fold increased risk of death (logOR 12.43; 95%CI 1.61&ndash;96.29, p = 0.02), independent of other blood counts, clinical and demographic parameters. Conclusions. Neutrophil&ndash;lymphocyte ratio determined on the day of ICU admission may be a useful biomarker predicting death in patients with severe and critical COVID-19