Improved survival beyond 28 days up to 1 year after cytosorb treatment for refractory septic shock: A propensity-weighted retrospective survival analysis

Background and Aims: It is currently unknown whether CytoSorb treatment for septic shock improves long-term survival beyond 28 days

Hemoadsorption with CytoSorb shows a decreased observed versus expected 28-day all-cause mortality in ICU patients with septic shock: A propensity-score-weighted retrospective study

Background and aims: Innovative treatment modalities have not yet shown a clinical benefit in patients with septic shock. To reduce severe cytokinaemia, CytoSorb as an add-on to continuous renal replacement therapy (CRRT) showed promising results in case reports. However, there are no clinical trials investigating outcomes. Methods: In this investigator-initiated retrospective study, patients with septic shock were treated with CRRT + CytoSorb (n = 67) or CRRT alone (n = 49). The primary outcome was the 28-day all-cause mortality rate. Patients were weighted by stabilized inverse probability of treatment weights (sIPTW) to overcome differences in baseline characteristics. Results: At the start of therapy, CytoSorb-treated patients had higher lactate levels (p < 0.001), lower mean arterial pressure (p = 0.007) and higher levels of noradrenaline (p < 0.001) compared to the CRRT group. For CytoSorb, the mean predicted mortality rate based on a SOFA of 13.8 (n = 67) was 75% (95%CI 71-79%), while the actual 28-day mortality rate was 48% (mean difference - 27%, 95%CI - 38 to - 15%, p < 0.001). For CRRT, based on a SOFA of 12.8 (n = 49), the mean predicted versus observed mortality was 68% versus 51% (mean difference - 16.9% [95%CI - 32.6 to - 1.2%, p = 0.035]). By sIPTW analysis, patients treated with CytoSorb had a significantly lower 28-day mortality rate compared to CRRT alone (53% vs. 72%, respectively, p = 0.038). Independent predictors of 28-day mortality in the CytoSorb group were the presence of pneumosepsis (adjusted odds ratio [aOR] 5.47, p = 0.029), higher levels of lactate at the start of CytoSorb (aOR 1.15, p = 0.031) and older age (aOR per 10 years 1.67, p = 0.034). Conclusions: CytoSorb was associated with a decreased observed versus expected 28-day all-cause mortality. By IPTW analysis, intervention with CytoSorb may be associated with a decreased all-cause mortality at 28 days compared to CRRT alone

The intensive care infection score - a novel marker for the prediction of infection and its severity

Background: The prediction of infection and its severity remains difficult in the critically ill. A novel, simple biomarker derived from five blood-cell derived parameters that characterize the innate immune response in routine blood samples, the intensive care infection score (ICIS), could be helpful in this respect. We therefore compared the predictive value of the ICIS with that of the white blood cell count (WBC), C-reactive protein (CRP) and procalcitonin (PCT) for infection and its severity in critically ill patients. Methods: We performed a multicenter, cluster-randomized, crossover study in critically ill patients between January 2013 and September 2014. Patients with a suspected infection for which blood cultures were taken by the attending intensivist were included. Blood was taken at the same time for WBC, ICIS, CRP and PCT measurements in the control study periods. Results of imaging and cultures were collected. Patients were divided into groups of increasing likelihood of infection and invasiveness: group 1 without infection or with possible infection irrespective of cultures, group 2 with probable or microbiologically proven local infection without blood stream infection (BSI) and group 3 with BSI irrespective of local infection. Septic shock was assessed. Results: In total, 301 patients were enrolled. CRP, PCT and ICIS were higher in groups 2 and 3 than group 1. The area under the receiver operating characteristic curve (AUROC) for the prediction of infection was 0.70 for CRP, 0.71 for PCT and 0.73 for ICIS (P < 0.001). For the prediction of septic shock the AUROC was 0.73 for CRP, 0.85 for PCT and 0.76 for ICIS. These AUROC did not differ fro

Smith-Lemli-Opitz syndrome: A case report

Smith-Lemli-Opitz sendromu otozomal resesif geçen, çok sayıda doğuştan malformasyonun eşlik ettiği nadir görülen bir sendromdur. Smith-Lemli-Opitz sendromlu olgularda kolesterol biyosentezinin son basamağında 7-dehidrokolesterolü kolesterole çeviren ve geni 11q13'de lokalize bir enzim olan 7-dehidrokolesterol redüktazın doğuştan eksikliği mevcuttur. Otuz beş haftalık 1500 gr doğan bebeğin cildi kuru ve parşömen kâğıdı görünümünde, mikrognati, hipertelörizm, düşük kulak, antevert burun delikleri, belirgin filtrum, yarık damak, el parmaklarında ulnar deviasyon ve distal fleksiyon kontraktürü, çomaklaşma, ayaklarda pes ekino varus deformitesi ve çekiç topuk, sağ ayakta sindaktili, ambigius genitalya mevcuttu. İncelemelerde total kolesterol 108 mg/dl LDL kolesterol 48.8 mg/dl bulundu. Yirmi beşinci gün hayatını kaybeden olgunun otopsisinde iki loblu sağ akciğer, atriyal septal defekt, patent duktus arteriyozus, üreterlerde iki taraflı yerleşim anomalisi, sol sürrenalde insitu saptandı.Smith-Lemli-Opitz syndrome is a rare autosomal recessive disorder which is accompanied by many congenital malformations. The syndrome is caused by a congenital deficiency of 7-dehydrocholesterol reductase which is localized on 11q13 gene and it is the final enzyme in the sterol synthetic pathway that converts 7-dehydrocholesterol to cholesterol. The infant was born on the 35. week of gestation and weighed 1500 grams. Anomalies evident on physical examination included dry and thinned skin, micrognathia, hypertelorism, low-set ears, anteverted nares, a long philtrum, cleft palate, ulnar deviation and distal flexion contracture of the fingers, equinovarus deformity and hammer toe, syndactyly of the right toes and ambiguous genitalia. Total cholesterol concentration was 108 mg/dl and LDL-cholesterol was 48.8 mg/dl. The infant died on postnatal day 25 and her autopsy revealed a right lung with two lobes, atrial septal defect, patent ductus arteriosus, bilateral dislocation of the ureter and insitu in the left adrenal gland

Effects of copper (cu), zinc (zn), cadmium (cd) and their Mixture some hematological parameters of oreochromis niloticus.

TEZ8450Tez (Yüksek Lisans) -- Çukurova Üniversitesi, Adana, 2011.Kaynakça (s.23-35) var.vii, 37 s. : çizelge ; 29 cm.Since physiological changes in metabolic parameters are important factors in determining the stress conditions in fish, the aim of the present study was to determine the effects of copper (5 ppm ppm), zinc (5 ppm), cadmium (1 ppm) and their mixtures on hematocrit levels, erythrocyte and nucleus are and on the erythrocyte numbers of O niloticus after exposing the animals over 24, 48 and 96 hours. Hematocrit levels were determined as percentage on a hematocrit scale, erythrocyte counts were made carried by counting under a light microscope and the area of erythrocytes and nucleus were carried on by dyed spreaded slides under microscope. Hematocrit levels showed an increase under the effect o metal mixture after 96 hours of exposure while erythrocyte counts decreased after 48 hours of exposure under the effect of cadmium. No difference was observed in blood parameters at selected concentrations and periods. It can be concluded that the tested concentrations of the metals and exposure periods was too short to observe metal action, the blood parameters returned to normal due to homeostasis within 24 hours or the permanent effect of the metals shows itself in prolonged exposure periods, exceeding 96 hours of exposure in this species.Hematolojik parametrelerin balıklarda stres nedeni ile ortaya çıkan fizyolojik değişimleri saptamada önemli bir yer tutması nedeniyle, bu araştırmada bakır (5 ppm), çinko (5 ppm) ve kadmiyumun (1ppm) subletal derişmleri ile karışımlarının etkisinde Oreochronmis niloticus'ta hematokrit düzeyi, eritrosit alanı ve eritrosit nukleus alanı ile eritrosit sayılarının 24, 48 ve 96 saatlerde belirlenmesi amaçlanmıştır. Anılan parametrelerden hematokrit düzeyi kan örneklerinin hematokrit skalasında % olarak değerlendirilmesiyle, eritrosit sayıları ışık mikroskobunda sayma yöntemi ile eritrosit ve eritrosit nukleus alanları boyanmış yayma preparatların araştırma mikroskobunda incelenmesiyle belirlenmiştir. Hematokrit düzeyi karışımın etkisinde 96 saatte artma gösterirken, eritrosit sayısı 48 saatte Cd etkisinde düşmüştür. Belirlenen diğer kan parametrelerinde denenen süre ve derişimlerde bir değişim gözlenmemiştir. Bu bilgiler ışığında, O. niloticus'da denenen derişim ve sürelerde belirlenen metal ya da karışımlarının bu türde kısa sürede etki gösterdiği, homeostatik mekanizmaların 24 saat içerisinde devreye girerek kan parametrelerini normale dönüştürdüğünü ya da kalıcı etkinin uzun süreli etkide kalma ile ortaya çıktığını göstermektedir.Bu çalışma Ç.Ü. Bilimsel Araştırma Projeleri Birimi tarafından desteklenmiştir. Proje No: FEF2009YL67

EFFECTS OF SUBLETHAL CONCENTRATIONS OF COPPER, ZINC AND CADMIUM, APPLIED SINGLY AND IN MIXTURE, ON SOME HEMATOLOGICAL PARAMETERS OF OREOCHROMIS NILOTICUS (L., 1758)

WOS: 000327108100003The aim of the present study was to determine the effects of copper, zinc and cadmium, applied singly and in mixture, on hematocrit levels, erythrocyte area, erythrocyte nucleus area, and on erythrocyte numbers of Oreochromis niloticus after exposure to metals over 24, 48 and 96 hours. Hematocrit levels were determined using microhematocrit methods. Erythrocyte numbers were counted under a light microscope, and the areas of erythrocytes and nucleus were determined under the microscope from blood spread evenly on a slide and stained. Hematocrit levels showed an increase under the effect of a metal mixture after 96-h exposure while erythrocyte numbers increased compared with the control under the effect of metals, except 24-h exposure to copper. Erythrocyte and erythrocyte nucleus areas were not affected by metal exposure during the exposure periods. Stability in erythrocyte numbers with increasing exposure periods might be due to the action of homeostatic mechanisms

Sublingual Microcirculatory Evaluation of Extracorporeal Hemoadsorption with CytoSorb (R) in Abdominal Sepsis: A Case Report

Cytokemia is associated with microcirculatory alterations often with persistent loss of coherence between the micro- and macrocirculation, linked to organ failure and poor outcome of septic patients. Addition of a hemoadsorbant filter to an extracorporeal circuit next to conventional treatment of septic shock results in the hematological clearance of cytokines, hypothetically leading to normalization of the microcirculation and thus organ perfusion. Bedside sublingual microcirculatory assessment using handheld vital microscopy allows real-time direct visualization of the microcirculation and its response to therapy. This is demonstrated in the present case report of an 83-year-old man admitted to our intensive care unit after surgical repair of a colonic perforation for fecal soiling after a low anterior resection for a rectum carcinoma, with leakage of bowel content at the resection site. The clinical course of this patient can be described as having undergone adequate surgical treatment taking away the source of the disease, followed by optimal support including antibiotic treatment in the ICU. However, during the course of his stay in the ICU, his condition deteriorated with symptoms consistent with septic shock. Our report shows that the addition of a hemoadsorbent (CytoSorb) to the continuous renal replacement therapy circuit was associated with an improvement in the condition of our severely ill patient with abdominal sepsis. Parallel to the clinical improvement of our patient, the functional parameters of the microcirculation also showed improvement suggesting that such a noninvasive real-time evaluation of the status of the microcirculation may be a sensitive diagnostic tool to monitor the effectiveness of hemoadsorbent therapy