Acute and Critical Care

Original Articles

Cardiology
Predictors and outcomes of sepsis-induced cardiomyopathy in critically ill patients: Myung Jin Song, Sang Hoon Lee, Ah Young Leem, Song Yee Kim, Kyung Soo Chung, Eun Young Kim, Ji Ye Jung, Young Ae Kang, Young Sam Kim, Joon Chang, Moo Suk Park; Acute Crit Care. 2020;35(2):67-76. Published online May 15, 2020; DOI: https://doi.org/10.4266/acc.2020.00024

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Background
Sepsis-induced cardiomyopathy (SIC) occurs frequently in critically ill patients, but the clinical features and prognostic impact of SIC on sepsis outcome remain controversial. Here, we investigated the predictors and outcomes of SIC.
Methods
Patients admitted to a single medical intensive care unit from June 2016 to September 2017 were retrospectively reviewed. SIC was diagnosed by ejection fraction (EF) <50% and ≥10% decrease in baseline EF that recovered within 2 weeks.
Results
In total, 342 patients with sepsis met the inclusion criteria, and 49 patients (14.3%) were diagnosed with SIC; the latter were compared with 259 patients whose EF was not deteriorated by sepsis (non-SIC). Low systolic blood pressure and increased left ventricular end-diastolic diameter (LVEDD) were identified as predictors of SIC. SIC and non-SIC patients did not differ significantly in terms of 28-day all-cause mortality (24.5% vs. 26.3%, P=0.936). Acute Physiology and Chronic Health Evaluation II (APACHE II; hazard ratio [HR], 1.10; 95% confidential interval [CI], 1.02 to 1.18; P=0.009) and delta neutrophil index (DNI; HR, 1.02; 95% CI, 1.00 to 1.08; P=0.026) were independent risk factors for 28-day mortality with SIC. DNI, APACHE II, and lactate were identified as risk factors for 28-day mortality in sepsis patients as a whole.
Conclusions
SIC was not associated with increased mortality compared to non-SIC. Low systolic blood pressure and increased LVEDD were predictors of SIC. High APACHE II score and elevated DNI, which reflect sepsis severity, predict 28-day all-cause mortality.

Citations

Citations to this article as recorded by

Testosterone and soluble ST2 as mortality predictive biomarkers in male patients with sepsis-induced cardiomyopathy
Lu Wang, Wen Dai, Ruiyao Zhu, Tingting Long, Zhaocai Zhang, Zhenju Song, Sucheng Mu, Shasha Wang, Huijuan Wang, Jiaxi Lei, Jing Zhang, Wenfang Xia, Guang Li, Wenwei Gao, Handong Zou, Yan Li, Liying Zhan
Frontiers in Medicine.2024;[Epub] CrossRef
Meta-analysis of initial natriuretic peptides in the setting of sepsis-induced myocardial dysfunction
Boyong He, Xin Wang, Liguo Shi, Hongbin Cheng, Luyi Zhao
Biomarkers in Medicine.2024; 18(4): 145. CrossRef
Prevalence and Prognosis of Sepsis-Induced Cardiomyopathy: A Systematic Review and Meta-Analysis
Daisuke Hasegawa, Yoshiko Ishisaka, Tetsuro Maeda, Narut Prasitlumkum, Kazuki Nishida, Siddharth Dugar, Ryota Sato
Journal of Intensive Care Medicine.2023; 38(9): 797. CrossRef
Research Progress on the Mechanism and Management of Septic Cardiomyopathy: A Comprehensive Review
Xue-Bin Pei, Bo Liu, Maciej Dyrbuś
Emergency Medicine International.2023; 2023: 1. CrossRef
Biomarkers to Predict Multiorgan Distress Syndrome and Acute Kidney Injury in Critically Ill Surgical Patients
In Sik Shin, Da Kyung Kim, Sanghyun An, Sung Chan Gong, Moo Hyun Kim, Md Habibur Rahman, Cheol-Su Kim, Joon Hyeong Sohn, Kwangmin Kim, Hoon Ryu
Medicina.2023; 59(12): 2054. CrossRef
Risk factors of postoperative septic cardiomyopathy in perioperative sepsis patients
Yuchang Xin, Ying Ge, Liuhui Chang, Yong Ni, Hairui Liu, Jiang Zhu
BMC Anesthesiology.2022;[Epub] CrossRef
Effect of milrinone versus placebo on hemodynamic in patients with septic shock: A randomize control trial
Suratee Chobngam, Surat Tongyoo
Clinical Critical Care.2022;[Epub] CrossRef
Association of sepsis-induced cardiomyopathy and mortality: a systematic review and meta-analysis
Yu-Min Lin, Mei-Chuan Lee, Han Siong Toh, Wei-Ting Chang, Sih-Yao Chen, Fang-Hsiu Kuo, Hsin-Ju Tang, Yi-Ming Hua, Dongmei Wei, Jesus Melgarejo, Zhen-Yu Zhang, Chia-Te Liao
Annals of Intensive Care.2022;[Epub] CrossRef
Association of Sepsis-Induced Cardiomyopathy and Mortality: A Systematic Review and Meta-Analysis
Yu-Min Lin, Mei-Chuan Lee, Han Siong Toh, Wei-Ting Chang, Sih-Yao Chen, Fang-Hsiu Kuo, Hsin-Ju Tang, Yi-Ming Hua, Dongmei Wei, Jesus Melgarejo, Zhen-Yu Zhang, Chia-Te Liao
SSRN Electronic Journal .2022;[Epub] CrossRef
Sepsis-induced cardiomyopathy is associated with higher mortality rates in patients with sepsis
Balaram Krishna J Hanumanthu, Anika Sasidharan Nair, Adarsh Katamreddy, Jason S Gilbert, Jee Young You, Obiageli Lynda Offor, Ankit Kushwaha, Ankita Krishnan, Marzio Napolitano, Leonidas Palaidimos, Joaquin Morante, Seema S. Tekwani, Suchita Mehta, Aancha
Acute and Critical Care.2021; 36(3): 215. CrossRef
The Correlation Between Whole Blood Copper (Cu), Zinc (Zn) Levels and Cu/Zn Ratio and Sepsis-Induced Left Ventricular Systolic Dysfunction (SILVSD) in Patients with Septic Shock: A Single-Center Prospective Observational Study
Jian-Biao Meng, Ma-Hong Hu, Ming Zhang, Gong-Pai Hu, Wei Zhang, Shen-Jiang Hu
International Journal of General Medicine.2021; Volume 14: 7219. CrossRef

Liver
The role of bilirubin to albumin ratio as a predictor for mortality in critically ill patients without existing liver or biliary tract disease: Ji Soo Choi, Kyung Soo Chung, Eun Hye Lee, Su Hwan Lee, Sang Hoon Lee, Song Yee Kim, Ji Ye Jung, Young Ae Kang, Moo Suk Park, Young Sam Kim, Joon Chang, Ah Young Leem; Acute Crit Care. 2020;35(1):24-30. Published online February 29, 2020; DOI: https://doi.org/10.4266/acc.2019.00738

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Abstract PDF

Background
Hyperbilirubinemia and hypoalbuminemia are frequently appeared and associated with poor prognosis in critically ill patients. We aim to evaluate the association between the bilirubin to albumin ratio and prognosis in intensive care unit (ICU) patients. Methods: This was a retrospective study of 731 patients who were admitted to the medical intensive care unit (MICU) at a tertiary-care center from July 2015 to September 2017. We analyzed the bilirubin to albumin ratio on admission to the MICU, including clinical characteristics and other examinations. Results: The overall 28-day survival of MICU patients was 69.1%. On univariate analysis, Acute Physiology and Chronic Health Evaluation (APACHE) II score (P<0.001), Sequential Organ Failure Assessment score (P<0.001), Simplified Acute Physiology Score II score (P<0.001), Creactive protein (P=0.015), and bilirubin/albumin ratio (P<0.001) were associated with mortality of ICU patients. The receiver operating characteristic curves for ICU patients mortality between bilirubin to albumin ratio and APACHE II score were not statistically significant (P=0.282). On multivariate analysis, higher APACHE II score (hazard ratio [HR], 1.05; 95% CI, 1.03 to 1.06; P<0.001) and bilirubin to albumin ratio (HR, 1.65; 95% CI, 1.23 to 2.20; P=0.001) were independently related to the ICU patient mortality. Conclusions: A higher bilirubin to albumin ratio was related to the unfavorable prognosis and mortality in critically ill patients.

Citations

Citations to this article as recorded by

Role of serum bilirubin-to-albumin ratio as a prognostic index in critically ill children
You Min Kang, Ga Eun Kim, Mireu Park, Jong Deok Kim, Min Jung Kim, Yoon Hee Kim, Kyung Won Kim, Myung Hyun Son, Soo Yeon Kim
Clinical and Experimental Pediatrics.2023; 66(2): 85. CrossRef
Association between total bilirubin/Albumin ratio and all-cause mortality in acute kidney injury patients: A retrospective cohort study
Ximei Huang, Yunhua Huang, Min Chen, Lin Liao, Faquan Lin, Eranga Sanjeewa Wijewickrama
PLOS ONE.2023; 18(11): e0287485. CrossRef
The value of albumin-related ratios in predicting disease severity and mortality in acute cholangitis
Bayram YEŞİL, Bünyamin SEVİM
Journal of Health Sciences and Medicine.2023; 6(6): 1244. CrossRef
Hepatic dysfunction in critically ill patients
Jeong Hoon Yang
Acute and Critical Care.2020; 35(1): 44. CrossRef

Rapid response system
A Pilot Study of the Effectiveness of Medical Emergency System Implementation at a Single Center in Korea: Su Hwan Lee, Ah Young Leem, Youngok Nho, Young Ah Kim, Kyung Duck Kim, Young Sam Kim, Se Kyu Kim, Kyung Soo Chung; Korean J Crit Care Med. 2017;32(2):133-141. Published online May 16, 2017; DOI: https://doi.org/10.4266/kjccm.2016.01011

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Abstract PDF

Background
An automatic alarm system was developed was developed for unexpected vital sign instability in admitted patients to reduce staffing needs and costs related to rapid response teams. This was a pilot study of the automatic alarm system, the medical emergency system (MES), and the aim of this study was to determine the effectiveness of the MES before expanding this system to all departments.
Methods
This retrospective, observational study compared the performance of patients admitted to the pulmonary department at a single center using patient data from three 3-month periods (before implementation of the MES: December 2013-February 2014; after implementation of the MES: December 2014-February 2015 and December 2015-February 2016).
Results
A total of 571 patients were admitted to the pulmonary department during the three observation periods. During this pilot study, the MES automatically issued 568 alarms for 415 admitted patients. There was no significant difference in the rate of cardiopulmonary resuscitation (CPR) before and after application of the MES. The mortality rate also did not change. However, it appeared that CPR was prevented in four patients admitted from the general ward to the intensive care unit (ICU) during MES implementation. The median length of hospital stay and median length of ICU stay were not significantly different before and after MES implementation.
Conclusions
Although we did not find a significant improvement in outcomes upon MES implementation, the CPR rate and mortality rate did not increase despite increased comorbidities. This was a small pilot study, and, based on these results, we believe that the MES may have significant effects in longer-term and larger-scale studies.

Citations

Citations to this article as recorded by

Society of Critical Care Medicine Guidelines on Recognizing and Responding to Clinical Deterioration Outside the ICU: 2023
Kimia Honarmand, Randy S. Wax, Daleen Penoyer, Geoffery Lighthall, Valerie Danesh, Bram Rochwerg, Michael L. Cheatham, Daniel P. Davis, Michael DeVita, James Downar, Dana Edelson, Alison Fox-Robichaud, Shigeki Fujitani, Raeann M. Fuller, Helen Haskell, Ma
Critical Care Medicine.2024; 52(2): 314. CrossRef
Rapid response systems in Korea
Bo Young Lee, Sang-Bum Hong
Acute and Critical Care.2019; 34(2): 108. CrossRef

Case Report

Hematology/Pulmonary
Hemophagocytic Lymphohistiocytosis after Lung Transplantation: Ah Young Leem, Sung Woo Moon, Song Yee Kim, Moo Suk Park, Young Sam Kim, Se Kyu Kim, Joon Chang, Hyo Chae Paik, June Won Cheong, Kyung Soo Chung; Korean J Crit Care Med. 2015;30(1):38-41. Published online February 28, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.1.38

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Abstract PDF: Hemophagocytic lymphohistiocytosis (HLH) is a rare but fatal complication after solid organ transplantation. Acquired forms of HLH are described in association with severe sepsis, autoimmune disorders, malignancy, immune-compromised states, infections, and solid organ transplantation. We experienced a case of hemophagocytic lymphohistiocytosis after bilateral lung transplantation. Leukopenia, thrombocytopenia, and hyperbilirubinemia were noted and became aggravated 50 days after transplantation. Diagnosis of HLH was based on clinical and laboratory findings of splenomegaly, cytopenia, elevated ferritin, elevated interleukin-2 receptor, and hemophagocytosis in bone marrow. Other features such as elevated bilirubin, lactate dehydrogenase, and D-dimer which can be present in HLH were also noted. The patient was immediately treated with etoposide and dexamethasone. Despite aggressive therapy, the patient deteriorated and died. Awareness of the diagnostic criteria of HLH after lung transplantation is important for clinicians.

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