Is red blood cell distribution width a marker of severity in patients discharged from the ICU?

We have read the study about the association between high red blood cell distribution width and higher ward mortality after intensive care unit discharge. The study increases the evidence that RDW may be a marker of severity for patients discharged from the ICU. However, in this letter, we comment on issues that need further discussion

Secreção de aldosterona em pacientes com choque séptico : estudo prospectivo

Objective: To assess serum levels of the main factors that regulate the activation of the zona glomerulosa and aldosterone production in patients with septic shock, as well as their response to a high-dose (250 μg) adrenocorticotropic hormone (ACTH) stimulation test. Subjects and methods: In 27 patients with septic shock, baseline levels of aldosterone, cortisol, ACTH, renin, sodium, potassium, and lactate were measured, followed by a cortrosyn test. Results: Renin correlated with baseline aldosterone and its variation after cortrosyn stimulation. Baseline cortisol and its variation did not correlate with ACTH. Only three patients had concomitant dysfunction of aldosterone and cortisol secretion. Conclusions: Activation of the zona glomerulosa and zona fasciculata are independent. Aldosterone secretion is dependent on the integrity of the renin-angiotensin-aldosterone system, whereas cortisol secretion does not appear to depend predominantly on the hypothalamic-pituitaryadrenal axis. These results suggest that activation of the adrenal gland in critically ill patients occurs by multiple mechanisms.Objetivo: Avaliar os níveis séricos dos principais fatores que regulam a ativação da zona glomerulosa e a produção de aldosterona em pacientes com choque séptico, assim como sua resposta ao teste de cortrosina em alta dose (250 μg). Sujeitos e métodos: Em 27 portadores de choque séptico, foram aferidos níveis basais de aldosterona, cortisol, ACTH, renina, sódio, potássio e lactato, bem como realizado teste de cortrosina. Resultados: Renina se correlacionou com níveis basais de aldosterona e sua variação após teste de cortrosina. Cortisol basal e sua variação não se correlacionaram com ACTH. Apenas três pacientes apresentaram disfunção concomitante da secreção de aldosterona e cortisol. Conclusões: Ativação das zonas fasciculada e glomerulosa são independentes. Secreção de aldosterona é dependente da integridade do sistema renina-angiotensina-aldosterona, enquanto secreção de cortisol não parece predominantemente dependente do eixo hipotálamo-hipófise-adrenal. Esses resultados sugerem que a ativação da adrenal em pacientes críticos ocorre por múltiplos mecanismos

Nutritional therapy and outcomes in underweight critically ill patients

Background & aims: Critically ill patients with body mass index (BMI) < 20 kg/m2 have worse outcomes than normal/overweight patients possibly because underweight is a marker of malnutrition. To assess the effects of nutrition therapy in this population during the first week of an ICU stay. Methods: Prospective, 2-centre, observational study. Nutritional evaluations were performed between days 2 and 3 (first) and between days 5 and 7 (second) of ICU admission. In the first evaluation, patients were divided into non-fed (without nutritional support) and early-fed (those already receiving nutritional support) groups. In the second evaluation, patients were divided according to caloric intake (≥or<20 kcal/kg) and protein intake (≥or<1.3 g of protein/kg). Results: Of the 4236 patients screened and 342 were included in the cohort. Mortality was 58.5% (median 21 [11–38.25] days of follow-up). Unadjusted patient survival was worse in the non-fed group than in the early-fed group (HR 1.66; 95%CI, 1.18 to 2.32). There was no difference in mortality between groups after adjusting for the SOFA score on the day of the evaluation. At the second evaluation, unadjusted analysis showed better in-hospital survival in patients with higher caloric (HR0.58; 95%CI, 0.40 to 0.86) and protein intake (HR0.59; 95%CI, 0.42 to 0.82); there was no association between mortality and caloric or protein intake after adjusting for the SOFA score on the day of the evaluation. Conclusion: Nutritional therapy in the first week of ICU stay did not affect vital outcome after adjusting for the SOFA score on the day of the evaluation in underweight critically ill patients

The PREDICTS database: a global database of how local terrestrial biodiversity responds to human impacts

Biodiversity continues to decline in the face of increasing anthropogenic pressures such as habitat destruction, exploitation, pollution and introduction of alien species. Existing global databases of species’ threat status or population time series are dominated by charismatic species. The collation of datasets with broad taxonomic and biogeographic extents, and that support computation of a range of biodiversity indicators, is necessary to enable better understanding of historical declines and to project – and avert – future declines. We describe and assess a new database of more than 1.6 million samples from 78 countries representing over 28,000 species, collated from existing spatial comparisons of local-scale biodiversity exposed to different intensities and types of anthropogenic pressures, from terrestrial sites around the world. The database contains measurements taken in 208 (of 814) ecoregions, 13 (of 14) biomes, 25 (of 35) biodiversity hotspots and 16 (of 17) megadiverse countries. The database contains more than 1% of the total number of all species described, and more than 1% of the described species within many taxonomic groups – including flowering plants, gymnosperms, birds, mammals, reptiles, amphibians, beetles, lepidopterans and hymenopterans. The dataset, which is still being added to, is therefore already considerably larger and more representative than those used by previous quantitative models of biodiversity trends and responses. The database is being assembled as part of the PREDICTS project (Projecting Responses of Ecological Diversity In Changing Terrestrial Systems – www.predicts.org.uk). We make site-level summary data available alongside this article. The full database will be publicly available in 2015

Associação do red blood cell distribution width (RDW) com readmissão e mortalidade de pacientes críticos na unidade de terapia intensiva

Introdução: O Red blood cell distribution width (RDW) é um preditor de mortalidade em pacientes criticamente enfermos. A associação do RDW na alta da UTI com o risco de readmissão à UTI não é conhecida. Nós fizemos este estudo com o objetivo de investigar a associação entre a presença de anisocitose na alta da UTI e o risco de readmissão à UTI ou óbito inesperado na enfermaria. Métodos: Estudo de coorte retrospectivo que incluiu 813 pacientes com alta da UTI para a enfermaria em um hospital terciário de Porto Alegre, Brasil. A variável de interesse foi o RDW coletado no momento da alta da UTI. Anisocitose foi definida como RDW > 16%. Desfechos de interesse foram readmissão à UTI, óbito inesperado na enfermaria e óbito hospitalar. Hazard ratios (HR) foram estimadas usando o Modelo de Riscos proporcionais de Cox. Variáveis com P 16%. Outcomes of interest included readmission to the ICU, unexpected death in the ward and in-hospital death. Hazard ratios (HR) were estimated using the Cox proportional hazards model. Variables with a value of P < 0.1 in the univariate analysis were included in the multivariate analysis for adjustment. Results: Anisocytosis at ICU discharge was independently associated with readmission to the ICU or unexpected death in the ward (HR: 1.682; 95% CI 1.219-2.322; P = 0.002). Other variables associated with this outcome included age, Sequential Organ Failure Assessment (SOFA) score at ICU discharge and tracheostomy. Similar significant results were obtained after the exclusion of unexpected deaths in the ward (HR 2.031; CI 1.428 – 2.889; P < 0.001) and for in-hospital deaths (HR 1.716; 95% CI 1.141-2.580; P = 0.01). Conclusions: Anisocytosis at ICU discharge is independently associated with ICU readmission and in-hospital death