共查询到20条相似文献，搜索用时 31 毫秒
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Gündüz Durmuş Erdal Belen Mehmet Mustafa Can 《Heart & lung : the journal of critical care》2018,47(3):243-247
Background
The neutrophil to lymphocyte ratio (NLR), has been proposed as potential indicator of cardiovascular events. Our aim was to determine the relationship between NLR and development of myocardial injury after non-cardiac surgery (MINS).Methods
This observational cohort study included 255 consecutive noncardiac surgery patients aged ≥45 years. Electrocardiography recordings and high sensitivity cardiac troponin T (hscTnT) levels of the patients were obtained for a period of 3 days postoperatively.Results
MINS was detected in 30 (11.8%) patients using the cut-off level of ≥14 ng/L for hscTnT. In the MINS group NLR (3.79 ± 0.7 vs. 2.69 ± 0.6, p < 0.000) values were higher than non-NLR group. The NLR to be independently associated with the development of MINS (OR: 11.690; CI: 4.619–29.585, p < 0.000).Conclusions
NLR seems to be a simple, easy and cheap tool to predict the development of MINS in patient undergoing non-cardiac surgery. 相似文献3.
Zachary L. Cox Pikki Lai Connie M. Lewis JoAnn Lindenfeld Sean P. Collins Daniel J. Lenihan 《Heart & lung : the journal of critical care》2018,47(4):290-296
Background
Nationally-derived models predicting 30-day readmissions following heart failure (HF) hospitalizations yield insufficient discrimination for institutional use.Objective
Develop a customized readmission risk model from Medicare-employed and institutionally-customized risk factors and compare the performance against national models in a medical center.Methods
Medicare patients age ≥ 65 years hospitalized for HF (n = 1,454) were studied in a derivation cohort and in a separate validation cohort (n = 243). All 30-day hospital readmissions were documented. The primary outcome was risk discrimination (c-statistic) compared to national models.Results
A customized model demonstrated improved discrimination (c-statistic 0.72; 95% CI 0.69 – 0.74) compared to national models (c-statistics of 0.60 and 0.61) with a c-statistic of 0.63 in the validation cohort. Compared to national models, a customized model demonstrated superior readmission risk profiling by distinguishing a high-risk (38.3%) from a low-risk (9.4%) quartile.Conclusions
A customized model improved readmission risk discrimination from HF hospitalizations compared to national models. 相似文献4.
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Federico Martinón-Torres Alfonso Carmona Martinez Róbert Simkó Pilar Infante Marquez Josep-Lluis Arimany Francisco Gimenez-Sanchez José Antonio Couceiro Gianzo Éva Kovács Pablo Rojo Huajun Wang Chiranjiwi Bhusal Daniela Toneatto 《The Journal of infection》2018,76(3):258-269
Objectives
This phase IIIb, open-label, multicentre, extension study (NCT01894919) evaluated long-term antibody persistence and booster responses in participants who received a reduced 2 + 1 or licensed 3 + 1 meningococcal serogroup B vaccine (4CMenB)-schedule (infants), or 2-dose catch-up schedule (2–10-year-olds) in parent study NCT01339923.Materials and methods
Children aged 35 months to 12 years (N = 851) were enrolled. Follow-on participants (N = 646) were randomised 2:1 to vaccination and non-vaccination subsets; vaccination subsets received an additional 4CMenB dose. Newly enrolled vaccine-naïve participants (N = 205) received 2 catch-up doses, 1 month apart (accelerated schedule). Antibody levels were determined using human serum bactericidal assay (hSBA) against MenB indicator strains for fHbp, NadA, PorA and NHBA. Safety was also evaluated.Results
Antibody levels declined across follow-on groups at 24–36 months versus 1 month post-vaccination. Antibody persistence and booster responses were similar between infants receiving the reduced or licensed 4CMenB-schedule. An additional dose in follow-on participants induced higher hSBA titres than a first dose in vaccine-naïve children. Two catch-up doses in vaccine-naïve participants induced robust antibody responses. No safety concerns were identified.Conclusion
Antibody persistence, booster responses, and safety profiles were similar with either 2 + 1 or 3 + 1 vaccination schedules. The accelerated schedule in vaccine-naïve children induced robust antibody responses. 相似文献6.
Monica Fabbrini Fabio Rigat Giovanna Tuscano Emiliano Chiarot Gilbert Donders Roland Devlieger Sara Filippini Elisabetta Frigimelica Pietro Forte Frederick Wittke Scott A. Halperin Karen Slobod Guido Grandi Immaculada Margarit 《The Journal of infection》2018,76(5):449-456
Objectives
The main aim of this exploratory study was to evaluate functional activity of antibodies elicited by a maternal Group B Streptococcus (GBS) investigational vaccine composed of capsular polysaccharides Ia, Ib, and III conjugated to genetically detoxified Diphtheria toxin CRM197. The second objective was to investigate the relationship between serotype-specific IgG concentrations and functional activity in maternal and cord sera.Methods
Maternal and cord sera collected at baseline and at delivery from vaccine and placebo recipients during a double-blind placebo-controlled Phase II study (www.clinicaltrials.gov, NCT01446289) were tested in an opsono-phagocytic bacterial killing assay. Cord sera from vaccine recipients were also passively transferred to newborn mice to investigate conferred protection against bacterial challenge.Results
Antibody-mediated GBS phagocytic killing was significantly increased in maternal serum at delivery and in cord sera from the investigational vaccine group as compared to the placebo group. Anti-capsular IgG concentrations above 1 µg/mL mediated in vitro killing against GBS strains belonging to all three serotypes and IgG levels correlated with functional titers. Passively administered cord sera elicited a dose-dependent protective response against all GBS serotypes in the in vivo model.Conclusions
The maternal vaccine elicited functional antibodies that were placentally transferred. Anti-capsular IgG concentrations in maternal and cord sera were predictive of functional activity and in vivo protection in the mouse model. 相似文献7.
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Jayne Rosenberger Susan McCrudden Carol McCullough Lu Wang Joni Kime Nancy M. Albert 《Heart & lung : the journal of critical care》2018,47(2):100-106
Background
Experts recommend obtaining one-time dual- (inter)-arm blood pressure (BP) measurements to predict cardiovascular morbidity risk.Objectives
To determine differences in inter-arm systolic (S)/diastolic (D) BPs obtained simultaneously and sequentially and examine associations between patient factors and clinical outcomes and inter-arm BP differences.Method
A comparative study of adults treated in intensive care; multivariable logistic models were created to determine the extent that inter-arm BP differences predicted outcomes.Results
Of 427 adults in intensive care units, 31.8% had differences of >10 mmHg on simultaneous measurement and 35.1% had differences of >10 mmHg on sequential measurement; differences >15 mmHg were 17.9% and 19.8%, respectively. After controlling for patient factors, simultaneous inter-arm DBP differences >15 mmHg were associated with shorter hospital and longer intensive care length of stay (p = 0.031 and 0.029, respectively) and a 79% reduction in the likelihood of discharge to home (p = 0.009).Conclusions
Simultaneous inter-arm DBP differences >15 mmHg were associated with clinical outcomes. 相似文献9.
Christina Orasch Dominik Mertz Jorge Garbino Christian van Delden Stephane Emonet Jacques Schrenzel Stefan Zimmerli Lauro Damonti Konrad Mühlethaler Alexander Imhof Christian Ruef Jan Fehr Reinhard Zbinden Katia Boggian Thomas Bruderer Ursula Flückiger Anna Conen Nina Khanna Reinhard Zbinden 《The Journal of infection》2018,76(5):489-495
Objectives
Breakthrough candidemia (BTC) on fluconazole was associated with non-susceptible Candida spp. and increased mortality. This nationwide FUNGINOS study analyzed clinical and mycological BTC characteristics.Methods
A 3-year prospective study was conducted in 567 consecutive candidemias. Species identification and antifungal susceptibility testing (CLSI) were performed in the FUNGINOS reference laboratory. Data were analyzed according to STROBE criteria.Results
43/576 (8%) BTC occurred: 37/43 (86%) on fluconazole (28 prophylaxis, median 200 mg/day). 21% BTC vs. 23% non-BTC presented severe sepsis/septic shock. Overall mortality was 34% vs. 32%. BTC was associated with gastrointestinal mucositis (multivariate OR 5.25, 95%CI 2.23–12.40, p < 0.001) and graft-versus-host-disease (6.25, 1.00–38.87, p = 0.05), immunosuppression (2.42, 1.03–5.68, p = 0.043), and parenteral nutrition (2.87, 1.44–5.71, p = 0.003). Non-albicans Candida were isolated in 58% BTC vs. 35% non-BTC (p = 0.005). 63% of 16 BTC occurring after 10-day fluconazole were non-susceptible (Candida glabrata, Candida krusei, Candida norvegensis) vs. 19% of 21 BTC (C. glabrata) following shorter exposure (7.10, 1.60–31.30, p = 0.007). Median fluconazole MIC was 4 mg/l vs. 0.25 mg/l (p < 0.001). Ten-day fluconazole exposure predicted non-susceptible BTC with 73% accuracy.Conclusions
Outcomes of BTC and non-BTC were similar. Fluconazole non-susceptible BTC occurred in three out of four cases after prolonged low-dose prophylaxis. This implies reassessment of prophylaxis duration and rapid de-escalation of empirical therapy in BTC after short fluconazole exposure. 相似文献10.
Robert L. Gottlieb Teena Sam Suzanne Y. Wada James F. Trotter Sumeet K. Asrani Brian Lima Susan M. Joseph Gonzalo V. Gonzalez-Stawinski Shelley A. Hall 《Journal of cardiac failure》2017,23(10):765-767
Background
Donors with hepatitis C (HCV) viremia are rarely used for orthotopic heart transplantation (HT) owing to post-transplantation risks. New highly effective HCV antivirals may alter the landscape.Methods
An adult patient unsuitable for bridging mechanical support therapy accepted a heart transplant offer from a donor with HCV viremia. On daily logarithmic rise in HCV viral load and adequate titers to ensure successful genotyping, once daily sofosbuvir (400?mg)–velpatasvir (100?mg) (Epclusa; Gilead) was initiated empirically pending HCV genotype (genotype 3a confirmed after initiation of therapy).Results
We report the kinetics of acute hepatitis C viremia and therapeutic response to treatment with a new pangenotypic antiviral agent after donor-derived acute HCV infection transmitted incidentally with successful cardiac transplantation to an HCV-negative recipient. Prompt resolution of viremia was noted by the 1st week of a 12 week course of antiviral therapy. Sustained virologic remission continued beyond 12 weeks after completion of HCV therapy (SVR-12).Conclusions
The availability of effective pangenotypic therapy for HCV may expand donor availability. The feasibility of early versus late treatment of HCV remains to be determined through formalized protocols. We hypothesize pharmacoeconomics to be the greatest limitation to widespread availability of this promising tool. 相似文献11.
Ann F. Jacobson Veronica Sumodi Nancy M. Albert Robert S. Butler Lori DeJohn Donna Walker Kelly Dion Hua-Li Lin Tai Donna M. Ross 《Heart & lung : the journal of critical care》2018,47(5):447-451
Background
More evidence is needed about factors that influence self-management behaviors in persons with heart failure.Objective
To test a correlational mediation model of the independent variables of health literacy, patient activation, and heart failure knowledge with heart failure self-management behaviors.Methods
The study used a prospective, cross-sectional, correlational design. Correlation and multiple regression were used to analyze associations among variables. Results: Of 151 participants, 57% were male, and mean age was 68 years. Heart failure self-management behaviors was positively correlated with patient activation level (p = .0008), but not with health literacy or heart failure knowledge.Conclusions
Persons with heart failure may better manage their condition if sufficiently activated, regardless of their level of health literacy or knowledge of heart failure disease and management processes. 相似文献12.
J. Guitard F. Isnard M.-D. Tabone M. Antignac E. Brissot Y. Senghor A. Petit G. Leverger C. Hennequin 《The Journal of infection》2018,76(5):483-488
Objectives
Definitive diagnosis of invasive candidiasis (IC) may be difficult to achieve in patients with haematological malignancy (PHM). We aimed to evaluate the performance of BDG for the diagnosis and the follow-up of IC in PHM.Patients and methods
We retrospectively reviewed the serological data of BDG assay in adult and paediatric PHM, who developed candidemia or chronic disseminated candidiasis (CDC) through a 4-year period. Sensitivity and kinetics of BDG were determined for both clinical forms.Results
In a panel of 3027 PHM, incidence rates of candidemia and CDC ranged between 0.74 and 0.77 and 0.30 and 0.44 according to the group of patients. At the time of diagnosis, 43.5% and 73% of cases of candidemia and CDC had a positive BDG assay, respectively. We found a significant correlation between the level of BDG at diagnosis and the outcome of candidemia (p = 0.022). In all cases of CDC, BDG negative results were obtained 2 to 6 months before recovery of the CT-scan lesions.Conclusions
BDG exhibits a low sensitivity to detect IC in PHM, but its kinetics correlates the clinical outcome. Additional studies are warranted in patients with CDC to evaluate the interest of monitoring BDG levels to anticipate the discontinuation of antifungal maintenance therapy. 相似文献13.
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Quin E. Denfeld James O. Mudd Wohaib Hasan Jill M. Gelow Shirin O. Hiatt Kerri Winters-Stone Christopher S. Lee 《Heart & lung : the journal of critical care》2018,47(4):281-284
Background
The relationship between physical heart failure (HF) symptoms and pathophysiological mechanisms is unclear.Objective
To quantify the relationship between plasma β-adrenergic receptor kinase-1 (βARK1) and physical symptoms among adults with HF.Methods
We performed a secondary analysis of data collected from two studies of adults with HF. Plasma βARK1 was quantified using an enzyme-linked immunosorbent assay. Physical symptoms were measured with the HF Somatic Perception Scale (HFSPS). Generalized linear modeling was used to quantify the relationship between βARK1 and HFSPS scores.Results
The average age (n = 94) was 54.5 ± 13.1 years, 76.6% were male, and a majority (83.0%) had Class III or IV HF. βARK1 was significantly associated with HFSPS scores (β = 0.22 ± 0.10, p = 0.038), adjusting for other predictors of physical symptoms (model R2 = 0.250, F(7, 70) = 3.34, p = 0.004).Conclusions
Higher βARK1 is associated with worse physical HF symptoms, pinpointing a potential pathophysiologic underpinning. 相似文献15.
Background
The short-term outcomes of patients with cystic fibrosis (CF) surviving critical illness were not examined systematically.Objectives
To determine the factors associated with and variation in rates of routine home discharge among ICU-managed adult CF patients.Methods
Predictors of routine home discharge and its hospital-level variation were examined in ICU-managed adults with cystic fibrosis in Texas during 2004–2013.Results
Older age, rural residence, and severity of illness decreased odds of routine home discharge, while hospitalization in facilities accredited as part of the Cystic Fibrosis Foundation Care Center Network nearly doubled the odds of routine home discharge. The median (interquartile) adjusted rate of routine home discharge was 62.0% (31.5–82.5).Conclusions
The identified determinants of routine home discharge can inform clinical decision-making, while the demonstrated wide variation in adjusted across-hospital rates of routine home discharge of ICU-managed adults with CF can provide benchmark data for future quality improvement efforts. 相似文献16.
Glenna Schluck Wei Wu James Whyte Laurie Abbott 《Heart & lung : the journal of critical care》2018,47(5):458-464
Background
Emergency room utilization and hospital readmission rates are disproportionately high for heart failure patients (HF). Emergency department (ED) utilization is intimately intertwined with hospital readmissions.Objective
Describe the arrival time distribution of HF patients presenting to the ED.Method
The study analyzed heart failure discharge data from the Florida State Emergency Department Database and the Florida State Inpatient Database from the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality. Data were treated as a Poisson process and analyzed using functional data analysis tools.Results
HF arrivals are multi-modal with the largest peak arrival time in the middle of the day as well as a smaller peak in the early morning hours, especially in rural areas.Conclusions
The arrival pattern has minor differences in rural and urban areas. HF clinic appointments should be established in the early morning hours when these patients utilize the ED. 相似文献17.
Leo F. Buckley Irene M. Cooper Kristina Navarro-Velez Elaine L. Shea Joanna M. Joly Mandeep R. Mehra Lynne W. Stevenson Akshay S. Desai 《Heart & lung : the journal of critical care》2018,47(4):304-307
Background
Concerns remain about the burden of nursing care required to implement pulmonary artery pressure monitoring of heart failure patients.Methods
We conducted a retrospective analysis of patients (N = 15) with a PAP sensor at our center. We defined three categories of PAP activity and estimated the nursing time spent on PAP monitoring.Results
During the 6 months after implantation, the median patient contact time was 67 (55–75) minutes/patient/month and the median frequency of patient contact was 5.8 (4.6–6.4) contacts/patient/month. The intensity of nurse-patient contact decreased after the first 3 months (81 [52–102] minutes/patient/month vs. 45 [29–61] minutes/patient/month; P = 0.005).Conclusions
The intensity of nurse-patient contact increased significantly after PAP sensor implantation but declined after the first 3 months with medical stabilization. These data from our center may serve as a benchmark to project the nursing time required to support PAP monitoring in practice. 相似文献18.
Xue Yu Qin Luo Zhihong Liu Zhihui Zhao Qing Zhao Chenhong An Zhiwei Huang Qi Jin Liu Gao Lu Yan 《Heart & lung : the journal of critical care》2018,47(4):308-313
Objectives
Iron deficiency (ID) prevalence in Chinese patients suffering from pulmonary hypertension (PH) is unclear so far. This study aimed to investigate ID prevalence in different subtypes of PH and its relevant factors.Methods
Hospitalized patients diagnosed with PH from September 2015 to March 2017 were retrospectively enrolled. Patients were grouped based on etiology. Logistic regression analysis was performed to determine factors associated with ID.Results
ID was found in 38.25% of 251 PH patients; with the highest prevalence in connective tissue disease associated pulmonary arterial hypertension (CTD-PAH). Univariate logistic regression analysis showed that female sex, age, CTD-PAH diagnosis and high sensitive C reactive protein (hs-CRP) were associated with ID. After adjusting for age, sex and hs-CRP, the diagnosis of CTD-PAH was still associated with ID (OR = 3.01, 95%CI 1.02–8.90, P < 0.05).Conclusions
ID is common in PH in China. CTD-PAH is independently associated with ID, after adjustment for age, sex, and hs-CRP. 相似文献19.
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Jose L. Diaz-Gomez Ami A. Grek Carla P. Venegas-Borsellino Andreea C. Chirila Angela M. Builes Robert A. Ratzlaff 《Heart & lung : the journal of critical care》2018,47(6):622-625