Journal of critical care
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Journal of critical care · Dec 2011
Acute kidney injury on ventilator initiation day independently predicts prolonged mechanical ventilation in intensive care unit patients.
The purpose of this study is to identify the predictors for prolonged mechanical ventilation (PMV) of more than 21 days among intensive care unit (ICU) patients. ⋯ Acute kidney injury on MV initiation day is an independent risk factor for PMV of more than 21 days, which may be helpful for clinicians to refine their management of these ICU patients early.
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Journal of critical care · Dec 2011
Subtle change of cystatin C, with or without acute kidney injury, associated with increased mortality in the intensive care unit.
Recent epidemiologic studies suggest a significant association between small increases in serum creatinine (sCr) and adverse outcomes. The Acute Kidney Injury Network (AKIN) sought to increase the sensitivity of the AKIN criteria for acute kidney injury (AKI) by recommending the use of small changes in sCr for the diagnosis of AKI. Several recent studies have reported that serum cystatin C (cysC) is more accurate than sCr as a surrogate for the glomerular filtration rate. This study was performed to determine whether small increases in cysC (≥0.3 mg/L within 48 hours) are associated with clinical outcomes in critically ill patients. ⋯ Small increases of cysC were associated with increased mortality in intensive care unit patients independent of diagnosis of AKI by AKIN criteria.
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Journal of critical care · Dec 2011
Suppression of high-mobility group box-1 and receptor for advanced glycation end-product axis by polymyxin B-immobilized fiber hemoperfusion in septic shock patients.
Endotoxin plays a role in organ failure in septic shock patients. High-mobility group box 1 (HMGB1) and receptor for advanced glycation end-products (RAGE) axis is also involved in septic shock. We investigated here the effects of endotoxin removal by polymyxin B-immobilized polystyrene fiber (PMX-F) treatment on circulating levels of HMGB1, soluble RAGE (sRAGE), and interleukin-6 (IL-6) in septic shock patients. ⋯ Our present study suggests that PMX-F treatment could block the HMGB1-RAGE axis in patients with septic shock via removal of endotoxin-induced inflammatory reactions.
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Journal of critical care · Dec 2011
Elevated plasma matrix metalloproteinases and their tissue inhibitors in patients with severe sepsis.
Matrix metalloproteinases (MMPs) are essential for tissue remodeling. Our objectives were to determine (1) the concentrations of MMPs and their tissue inhibitors (TIMPs) in plasma obtained from patients with severe sepsis, (2) to correlate changes in MMP and TIMP levels with disease severity, and (3) to investigate recombinant activated protein C (rAPC) actions on plasma MMP2, 9 activities from severe sepsis patients. ⋯ Most plasma MMPs and TIMPS were elevated in patients with severe sepsis, but only a limited subset of MMPs (7, 9) negatively correlated with disease severity. Recombinant activated protein C does not appear to directly alter MMP2, 9 activities.
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Journal of critical care · Dec 2011
Plasma gelsolin levels and 1-year mortality after first-ever ischemic stroke.
Plasma gelsolin depletion has been associated with poor outcome of critically ill patients. We sought to investigate change in plasma gelsolin level after ischemic stroke and to evaluate its relation with disease outcome. ⋯ Plasma gelsolin level is a useful, complementary tool to predict mortality after ischemic stroke.