Acute and Critical Care

Original Articles

Immunology
Patterns of inflammatory immune responses in patients with septic shock receiving vitamin C, hydrocortisone, and thiamine: clustering analysis in Korea: Seung-Hun You, Oh Joo Kweon, Sun-Young Jung, Moon Seong Baek, Won-Young Kim; Acute Crit Care. 2023;38(3):286-297. Published online August 21, 2023; DOI: https://doi.org/10.4266/acc.2023.00507

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Background
Sepsis is characterized by heterogeneous immune responses that may evolve during the course of illness. This study identified inflammatory immune responses in septic patients receiving vitamin C, hydrocortisone, and thiamine.
Methods
This was a single-center, post-hoc analysis of 95 patients with septic shock who received the vitamin C protocol. Blood samples were drawn on days 1–2, 3–4, and 6–8 after shock onset. Group-based multi-trajectory modeling was used to identify immune trajectory groups.
Results
The median age was 78 years (interquartile range, 70–84 years), and 56% were male. Clustering analysis identified group 1 (n=41), which was characterized by lower interleukin (IL)-6, tumor necrosis factor (TNF)-α, and IL-10 levels, and these levels remained stationary or mildly increased until day 7. Conversely, group 2 (n=54) expressed initially higher IL-6, TNF-α, and IL-10 levels that decreased rapidly by day 4. There was a nonsignificant increase in lymphocyte count and a decrease in C-reactive protein level until day 7 in group 2. The intensive care unit mortality rate was significantly lower in group 2 (39.0% vs. 18.5%, P=0.03). Group 2 also had a significantly higher decrease in the mean (standard deviation) vasopressor dose (norepinephrine equivalent: –0.09±0.16 μg/kg/min vs. –0.23±0.31 μg/kg/min, P<0.001) and Sequential Organ Failure Assessment score (0±5 vs. –4±3, P=0.002) between days 1 and 4.
Conclusions
There may be different subphenotypes in septic patients receiving the vitamin C protocol.

Citations

Citations to this article as recorded by

Micronutrients as therapy in critical illness
Christian Stoppe, Ellen Dresen, Angelique de Man
Current Opinion in Critical Care.2024; 30(2): 178. CrossRef

Infection
In-hospital mortality prediction using frailty scale and severity score in elderly patients with severe COVID-19: Yong Sub Na, Jin Hyoung Kim, Moon Seong Baek, Won-Young Kim, Ae-Rin Baek, Bo young Lee, Gil Myeong Seong, Song-I Lee; Acute Crit Care. 2022;37(3):303-311. Published online July 5, 2022; DOI: https://doi.org/10.4266/acc.2022.00017

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Abstract PDF

Background
Elderly patients with coronavirus disease 2019 (COVID-19) have a high disease severity and mortality. However, the use of the frailty scale and severity score to predict in-hospital mortality in the elderly is not well established. Therefore, in this study, we investigated the use of these scores in COVID-19 cases in the elderly.
Methods
This multicenter retrospective study included severe COVID-19 patients admitted to seven hospitals in Republic of Korea from February 2020 to February 2021. We evaluated patients’ Acute Physiology and Chronic Health Evaluation (APACHE) II score; confusion, urea nitrogen, respiratory rate, blood pressure, 65 years of age and older (CURB-65) score; modified early warning score (MEWS); Sequential Organ Failure Assessment (SOFA) score; clinical frailty scale (CFS) score; and Charlson comorbidity index (CCI). We evaluated the predictive value using receiver operating characteristic (ROC) curve analysis.
Results
The study included 318 elderly patients with severe COVID-19 of whom 237 (74.5%) were survivors and 81 (25.5%) were non-survivors. The non-survivor group was older and had more comorbidities than the survivor group. The CFS, CCI, APACHE II, SOFA, CURB-65, and MEWS scores were higher in the non-survivor group than in the survivor group. When analyzed using the ROC curve, SOFA score showed the best performance in predicting the prognosis of elderly patients (area under the curve=0.766, P<0.001). CFS and SOFA scores were associated with in-hospital mortality in the multivariate analysis.
Conclusions
The SOFA score is an efficient tool for assessing in-hospital mortality in elderly patients with severe COVID-19.

Citations

Citations to this article as recorded by

Omicron, Long-COVID, and the Safety of Elective Surgery for Adults and Children: Joint Guidance from the Therapeutics and Guidelines Committee of the Surgical Infection Society and the Surgery Strategic Clinical Network, Alberta Health Services
Philip S. Barie, Mary E. Brindle, Rachel G. Khadaroo, Tara L. Klassen, Jared M. Huston
Surgical Infections.2023; 24(1): 6. CrossRef
Evaluation of risk scores as predictors of mortality and hospital length of stay for older COVID‐19 patients
Banu Buyukaydin, Tahsin Karaaslan, Omer Uysal
AGING MEDICINE.2023; 6(1): 56. CrossRef
Atypical presentation of COVID-19 in older patients is associated with frailty but not with adverse outcomes
Joy E. van Son, Elisabeth C. P. Kahn, Jessica M. van der Bol, Dennis G. Barten, Laura C. Blomaard, Carmen van Dam, Jacobien Ellerbroek, Steffy W. M. Jansen, Anita Lekx, Carolien M. J. van der Linden, Roy Looman, Huub A. A. M. Maas, Francesco U. S. Mattace
European Geriatric Medicine.2023;[Epub] CrossRef
Neurological Manifestations and Complications of the Central Nervous System as Risk Factors and Predictors of Mortality in Patients Hospitalized with COVID-19: A Cohort Study
Ana Luisa Corona-Nakamura, Martha Judith Arias-Merino, Rayo Morfín-Otero, Guillermo Rodriguez-Zavala, Alfredo León-Gil, Juan Ramsés Camarillo-Escalera, Idarmis Brisseida Reyes-Cortés, María Gisela Valdovinos-Ortega, Erick René Nava-Escobar, Ana María de l
Journal of Clinical Medicine.2023; 12(12): 4065. CrossRef
Modified Early Warning Score: Clinical Deterioration of Mexican Patients Hospitalized with COVID-19 and Chronic Disease
Nicolás Santiago González, María de Lourdes García-Hernández, Patricia Cruz-Bello, Lorena Chaparro-Díaz, María de Lourdes Rico-González, Yolanda Hernández-Ortega
Healthcare.2023; 11(19): 2654. CrossRef
Risk Factors and Predictive Model for Mortality of Hospitalized COVID-19 Elderly Patients from a Tertiary Care Hospital in Thailand
Mallika Chuansangeam, Bunyarat Srithan, Pattharawin Pattharanitima, Pawit Phadungsaksawasdi
Medicines.2023; 10(11): 59. CrossRef

Infection
Current Status and Survival Impact of Infectious Disease Consultation for Multidrug-Resistant Bacteremia in Ventilated Patients: A Single-Center Experience in Korea: Insu Kim, Won-Young Kim, Eun Suk Jeoung, Kwangha Lee; Acute Crit Care. 2018;33(2):73-82. Published online April 26, 2018; DOI: https://doi.org/10.4266/acc.2017.00591

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Abstract PDF

Background
We evaluated the current status and survival impact of infectious disease consultation (IDC) in ventilated patients with multidrug-resistant (MDR) bacteremia.
Methods
One hundred sixty-one consecutive patients from a single tertiary care hospital were enrolled over a 5-year period. Patients with at least one of the following six MDR bacteremias were included: methicillin-resistant Staphylococcus aureus, extended-spectrum β-lactamase-producing gram-negative bacteria (Escherichia coli and Klebsiella pneumonia), carbapenem-resistant gram-negative rods (Acinetobacter baumannii and Pseudomonas aeruginosa), and vancomycin-resistant Enterococcus faecium.
Results
Median patient age was 66 years (range, 18 to 95), and 57.8% of subjects were male. The 28-day mortality after the day of blood culture was 52.2%. An IDC was requested for 96 patients based on a positive blood culture (59.6%). Patients without IDC had significantly higher rate of hemato-oncologic diseases as a comorbidity (36.9% vs. 11.5%, P < 0.001). Patients without an IDC had higher Acute Physiology and Chronic Health Evaluation (APACHE) II score (median, 20; range, 8 to 38 vs. median, 16; range, 5 to 34, P < 0.001) and Sequential Organ Failure Assessment (SOFA) score (median, 9; range, 2 to 17 vs. median, 7; range, 2 to 20; P = 0.020) on the day of blood culture and a higher 28-day mortality rate (72.3% vs. 38.5%, P < 0.001). In patients with SOFA ≥9 (cut-off level based on Youden’s index) on the day of blood culture and gram-negative bacteremia, IDC was also significantly associated with lower 28-day mortality (hazard ratio [HR], 0.298; 95% confidence interval [CI], 0.167 to 0.532 and HR, 0.180; 95% CI, 0.097 to 0.333; all P < 0.001] based on multivariate Cox regression analysis.
Conclusions
An IDC for MDR bacteremia was requested less often for ventilated patients with greater disease severity and higher 28- day mortality after blood was drawn. In patients with SOFA ≥9 on the day of blood culture and gram-negative bacteremia, IDC was associated with improved 28-day survival after blood draw for culture.

Citations

Citations to this article as recorded by

Impact of a Pro-Active Infectious Disease Consultation on the Management of a Multidrug-Resistant Organisms Outbreak in a COVID-19 Hospital: A Three-Months Quasi-Experimental Study
Davide Fiore Bavaro, Nicolò De Gennaro, Alessandra Belati, Lucia Diella, Roberta Papagni, Luisa Frallonardo, Michele Camporeale, Giacomo Guido, Carmen Pellegrino, Maricla Marrone, Alessandro Dell’Erba, Loreto Gesualdo, Nicola Brienza, Salvatore Grasso, Gi
Antibiotics.2023; 12(4): 712. CrossRef
The role of infectious disease consultations in the management of patients with fever in a long-term care facility
Soo-youn Moon, Kyoung Ree Lim, Jun Seong Son, Ali Amanati
PLOS ONE.2023; 18(9): e0291421. CrossRef
Impact of infectious diseases consultation among patients with infections caused by gram-negative rod bacteria: a systematic literature review and meta-analysis
Shinya Hasegawa, Satoshi Kakiuchi, Joseph Tholany, Takaaki Kobayashi, Alexandre R. Marra, Marin L. Schweizer, Riley J. Samuelson, Hiroyuki Suzuki
Infectious Diseases.2022; 54(8): 618. CrossRef
Infectious Disease Consults of Pseudomonas aeruginosa Bloodstream Infection and Impact on Health Outcomes
Swetha Ramanathan, Fritzie S Albarillo, Margaret A Fitzpatrick, Katie J Suda, Linda Poggensee, Amanda Vivo, Martin E Evans, Makoto Jones, Nasia Safdar, Chris Pfeiffer, Bridget Smith, Geneva Wilson, Charlesnika T Evans
Open Forum Infectious Diseases.2022;[Epub] CrossRef
Timeliness of Infectious Diseases Referral and Inappropriate Antibiotic Usage Post-Referral in an Asian Tertiary Hospital
Liang En Wee, Aidan Lyanzhiang Tan, Limin Wijaya, Maciej Piotr Chlebicki, Julian Thumboo, Ban Hock Tan
Tropical Medicine and Infectious Disease.2019; 4(4): 137. CrossRef

Infection
Clinical Application of the Quick Sepsis-Related Organ Failure Assessment Score at Intensive Care Unit Admission in Patients with Bacteremia: A Single-Center Experience of Korea: Hae Jung Na, Eun Suk Jeong, Insu Kim, Won-Young Kim, Kwangha Lee; Korean J Crit Care Med. 2017;32(3):247-255. Published online August 31, 2017; DOI: https://doi.org/10.4266/kjccm.2017.00241

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Abstract PDF

Background
We evaluated the clinical usefulness of the quick Sepsis-Related Organ Failure Assessment (qSOFA) score (based on the 2016 definition of sepsis) at intensive care unit admission in Korean patients with bacteremia. Methods: We retrospectively analyzed clinical data from 236 patients between March 2011 and February 2016. In addition to the qSOFA, the Modified Early Warning score (MEWS) and systemic inflammatory response syndrome (SIRS) criteria were calculated. Results: The patients’ median age was 69 years, and 61.0% were male. Of the patients, 127 (53.8%) had a qSOFA score ≥2 points. They had significantly higher rates of septic shock, thrombocytopenia, and hyperlactatemia, and increased requirements for ventilator care, neuromuscular blocking agents, vasopressors, and hemodialysis within 72 hours after intensive care unit admission. They also had a significantly higher 28-day mortality rate. When analyzed using common thresholds (MEWS ≥5 and ≥2 SIRS criteria), patients with a MEWS ≥5 had the same results as those with a qSOFA score ≥2 (P < 0.05). However, patients with ≥2 SIRS criteria showed no significant differences. Conclusions: Our results show that a qSOFA score ≥2 at admission is a useful screening tool for predicting disease severity and medical resource usage within 72 hours after admission, and for predicting 28-day mortality rates in patients with bacteremia. In addition, qSOFA scores may be more useful than SIRS criteria in terms of prognostic utility.

Citations

Citations to this article as recorded by

A catalogue of tools and variables from crisis and routine care to support decision-making about allocation of intensive care beds and ventilator treatment during pandemics: Scoping review
Magnolia Cardona, Claudia C. Dobler, Eyza Koreshe, Daren K. Heyland, Rebecca H. Nguyen, Joan P.Y. Sim, Justin Clark, Alex Psirides
Journal of Critical Care.2021; 66: 33. CrossRef
Consensus recommendation: Indications and methods for microbiological wound diagnostics
Axel Kramer, Ojan Assadian, Jürgen Bohnert, Georg Daeschlein, Joachim Dissemond, Veronika Gerber, Peter Hinz, Adam Junka, Simon Kim, Roald Papke, Christian Willy
Wound Medicine.2018; 23: 53. CrossRef

Case Report

Pulmonary
Lung Transplantation for Chronic Humidifier Disinfectant-Associated Lung Injury: Won-Young Kim, So-Woon Kim, Kyung-Wook Jo, Sae Hoon Choi, Hyung Ryul Kim, Yong-Hee Kim, Dong Kwan Kim, Seung-Il Park, Sang-Bum Hong; Korean J Crit Care Med. 2016;31(2):146-151. Published online May 31, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.2.146

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Abstract PDF

In the spring of 2011, a cluster of lung injuries caused by humidifier disinfectant (HD) usage were reported in Korea. Many patients required mechanical ventilation, extracorporeal membrane oxygenation, and even lung transplantation (LTPL). However, the long-term course of HD-associated lung injury remains unclear because the majority of survivors recovered normal lung function. Here we report a 33-year-old woman who underwent LTPL approximately four years after severe HD-associated lung injury. The patient was initially admitted to the intensive care unit and was supported by a high-flow nasal cannula. Although she had been discharged, she was recurrently admitted to our hospital due to progressive lung fibrosis and a persistent decline in lung function. Finally, sequential double LTPL was successfully performed, and the patient’s clinical and radiological findings showed significant improvement. Therefore, we conclude that LTPL can be a therapeutic option for patients with chronic inhalation injury.

Citations

Citations to this article as recorded by

Humidifier Disinfectant-Associated Lung Injury: Six Years after the Tragic Event
Won-Young Kim, Sang-Bum Hong
Tuberculosis and Respiratory Diseases.2017; 80(4): 351. CrossRef

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