Commercial anti-CD19 CAR T cell therapy for patients with relapsed/refractory aggressive B cell lymphoma in a European center

Two autologous anti-CD19 chimeric antigen receptors (CAR) T cells (axicabtagene ciloleucel [axi-cel] and tisagenlecleucel [tisa-cel]) are commercially approved in Europe for relapsed/refractory (R/R) diffuse large B cell lymphoma (DLBCL). We performed a retrospective study to evaluate patterns of use, efficacy and safety for axi-cel and tisa-cel. Data from 70 patients who underwent apheresis for commercial CAR T cells between January 2018 and November 2019 in our institution were retrospectively collected. Sixty-one patients were infused. The median age at infusion was 59 years old (range 27-75 years). The median number of prior therapies was 3 (range, 2-6). The overall response rates (ORRs) at 1 month and 3 months were 63% and 45%, respectively, with 48% and 39% achieving a complete response (CR), respectively. After a median follow-up after infusion of 5.7 months, the median progression-free survival (PFS) was 3.0 months (95% CI, 2.8-8.8 months), and the median overall survival (OS) was 11.8 months (95% CI, 6.0-12.6 months). In multivariate analysis, factors associated with poor PFS were the number of previous lines of treatment before CAR T cells (≥4) (P = .010) and a C reactive protein (CRP) value >30 mg/L at the time of lymphodepletion (P < .001). Likewise, the only factor associated with a shorter OS was CRP >30 mg/L (P = .009). Cytokine release syndrome (CRS) of any grade occurred in 85% of patients, including 8% of patients with CRS of grade 3 or higher. Immune cell-associated neurotoxicity syndrome (ICANS) of any grade occurred in 28% of patients, including 10% of patients with ICANS of grade 3 or higher. Regarding efficacy and safety, no significant difference was found between axi-cel and tisa-cel. This analysis describes one of the largest real-life cohorts of patients treated with axi-cel and tisa-cel for R/R aggressive B cell lymphoma in Europe.     

Risk of COVID-19 in healthcare workers working in intensive care setting

BackgroundThe higher risk of COVID-19 in health care workers (HCWs) is well-known. However, the risk within HCWs is not fully understood. The objective was to compare the COVID-19 risk in intensive care unit (ICU) vs non-ICU locations.MethodsA prospective surveillance study was conducted among HCWs at a large tertiary care facility in Riyadh between March 1st to November 30th, 2020. HCWs included both clinical (provide direct patient care) and nonclinical positions (do not provide direct patient care).ResultsA total 1,594 HCWs with COVID-19 were included; 103 (6.5%) working in ICU and 1,491 (93.5%) working in non-ICU locations. Compared with non-ICU locations, ICU had more nurses (54.4% vs 22.1%, P < .001) and less support staff (2.9% vs 53.1%, P < .001). COVID-19 infection was similar in ICU and non-ICU locations (9.0% vs 9.8%, P = .374). However, it was significantly higher in ICU nurses (12.3% vs 6.5%, P < .001). Support staff had higher risk than other HCWs, irrespective of ICU working status (15.1% vs 7.2%, P < 0.001). The crude relative risk of COVID-19 in ICU vs non-ICU locations was 0.92, 95% confidence interval ( was 0.76-1.11 (P = .374). However, relative risk adjusted for professional category was significantly increased to 1.23, 95% confidence interval 1.01-1.50 (P = .036).ConclusionsICU had a significantly higher risk of COVID-19 infection only after adjusting for the distribution and risk of different professional categories. The latter is probably determined by both exposure level and protection practices. The finding underscores the importance of strict implementation of preventive measures among all HCWs, including those performing nonclinical services.     

The predictive value of proteinuria in acute pancreatitis

Background/objectivesAcute pancreatitis has a highly variable clinical course. Early and reliable predictors for the severity of acute pancreatitis are lacking. Proteinuria appears to be a useful predictor of disease severity and outcome in a variety of clinical conditions. This study aims to investigate the predictive value of proteinuria on admission for the severity of acute pancreatitis compared with other commonly used predictors; the APACHE II score, Modified Glasgow score and C-reactive protein (CRP).MethodsThis is a post-hoc analysis of 64 patients admitted with acute pancreatitis treated in one teaching hospital, who participated in a previous randomized trial. Proteinuria was defined as a Protein/Creatinine (P/C) ratio >23 mg/mmol. The primary endpoint was severe acute pancreatitis. Secondary endpoints included infectious complications, need for invasive intervention, ICU stay and in-hospital mortality.ResultsProteinuria was present in 30/64 patients (47%). Eleven patients (17%) had severe acute pancreatitis. There was no difference in incidence of severe acute pancreatitis between patients with and without proteinuria: 6/30 patients (20%) versus 5/34 patients (15%) respectively (p = 0.58). Likewise, the occurrence of infectious complications, need for intervention and ICU stay and mortality did not differ significantly (p = 0.58, p = 0.99, p = 0.33 and p = 0.60 respectively). The diagnostic performance of the P/C ratio for the prediction of severe pancreatitis was inferior to the Modified Glasgow score (p = 0.04) and CRP (p = 0.03).ConclusionProteinuria on admission does not seem to be a reliable predictor for disease severity in acute pancreatitis. The diagnostic performance of the P/C ratio is inferior to the Modified Glasgow score and CRP.     

Chronic inflammation is associated with overweight in Colombian school children

Background and AimsTo examine the cross-sectional associations of inflammatory markers in plasma including C-reactive protein (CRP) and ferritin, and white blood cell (WBC) count, with overweight, skinfold sum (subscapular + triceps), and skinfold ratio (subscapular/triceps) among children from Bogotá, Colombia.Methods and ResultsThe sample (n = 2614) represented low- and middle-income children, aged 5–12 years, from Bogotá. We assessed their anthropometry, sociodemographic characteristics, and circulating inflammatory markers. We defined overweight, including obesity, according to the International Obesity Task Force BMI criteria. After adjustment for potential confounders, children in the fourth quartile of the CRP distribution had a 37% higher prevalence of overweight compared to those in the first quartile (P for trend = 0.03); and children in the fourth quartile of ferritin had a 67% greater prevalence of overweight compared to children in the first quartile (P for trend <0.001). Children in the highest 3 quartiles of the WBC distribution had a 35% higher prevalence of overweight than those in the first quartile (P = 0.03). Ferritin was significantly and positively associated with skinfold sum (P for trend < 0.001), while WBC was significantly and positively associated with skinfold ratio (P for trend < 0.001). There was a significant interaction between CRP and ferritin; children in the highest quartiles of CRP and ferritin had twice the prevalence of overweight compared to those below the highest quartiles (P = 0.001).ConclusionBiomarkers of chronic inflammation are positively associated with child overweight. WBC is positively related to skinfold ratio, a proxy for truncal adiposity.     

Plasma B-type natriuretic peptide in predicting outcomes of elective coronary artery bypass surgery

The risks of surgery and its clinical outcome are of great importance for both patients and physicians when choosing coronary artery bypass (CABG) surgery for coronary artery disease. The purpose of the current study was to clarify the relationship between serum B-type natriuretic peptide (BNP) and patient clinical outcome. Seventy-six eligible patients who underwent CABG were enrolled into the prospective study. Venous blood samples were drawn for serum BNP and N-terminal (NT)-proBNP levels measurement on preoperative Day 1, postoperative Day 1, and postoperative Day 7. Clinical end points were: (1) intensive care unit (ICU) stay longer than 4 days postoperatively and/or hospital stay longer than 13 days postoperatively; (2) major complications and poor outcomes. Patients who had prolonged ICU stay and hospitalization had significantly higher postoperative Day 1 BNP and postoperative Day 1 NT-proBNP level (p = 0.02 and 0.005, respectively). Age was significantly older in patients with prolonged ICU stay and hospitalization than those without prolonged ICU stay and hospitalization (p = 0.03). Serum creatinine level was also significantly increased in patients with prolonged ICU stay and hospitalization (p = 0.009). However, age was the only remaining factor that correlated with prolonged ICU stay and hospitalization in the multivariate logistic regression model. These results suggest that research using BNP and NT-proBNP for predicting ICU stay and hospitalization in patients who have undergone CABG must adjust risk factors to present a more appropriate estimation of its clinical outcome.     

Assessment of ventricular dysfunction in Egyptian children with Beta-thalassemia major

Objective/BackgroundThe purpose of this study was to evaluate serum cardiac troponin I and serum N-terminal (NT) pro-brain natriuretic peptide (pro-BNP) levels and the utility of tissue Doppler imaging in assessing cardiovascular changes following left ventricular (LV) dysfunction in children with beta-thalassemia major (β-TM). In children with β-TM who depend on regular blood transfusion, cardiac iron toxicity is a common serious complication. The most common cause of death among these patients is congestive heart failure.MethodsThis is a cross-sectional study which included 50 patients with β-TM and 50 healthy controls. Tissue Doppler imaging was performed and levels of serum ferritin, cardiac troponin I, and NT pro-BNP were estimated for all included patients.ResultsSerum NT pro-BNP and cardiac troponin (cTnI) showed a significant increase in patients with β-TM (p < .001). In patients with β-TM, LV dimensions (LV end systolic diameter) and (LV end diastolic diameter) were large (p < .01); LV mass (p < .01), E wave, and E/A ratio (p < .01) were high (p < .05); and deceleration time was short (p < .05). Besides, transmitral ratio (E/E_m) (p < .05) and tricuspid valve velocity were higher (p < .05), and early diastolic velocity (E_m) (p < .05) and systolic wave velocity (S_m) were lower in patients with β-TM (p < .05). A significant positive correlation was detected between the pro-BNP and E wave (r = 0.558, p < .001), E/A ratio (r = 0.403, p < .001), E/E_m ratio (r = 0.576, p < .001), and ferritin (r = 0.545, p < .001).ConclusionPulsed wave tissue Doppler imaging and NT pro-BNP had a significant role in the estimation of ventricular dysfunction in children with β-TM.     

El índice proteína C reactiva/albúmina como marcador para detectar colitis aguda ulcerosa grave en pacientes egipcios

Introduction and aimThe C-reactive protein/albumin ratio (CAR) is an inflammatory marker that is considered to have prognostic value in many diseases. Our aim in the present study was to investigate the diagnostic performance of the CAR in determining the clinical severity of acute severe ulcerative colitis (ASUC).Materials and methodsA retrospective study on 200 UC patients that were admitted to the Gastroenterology unit of the Alexandria University, over an 8-year period from January 2012 to January 2020, was conducted. Patient demographic data, laboratory values, and clinical and endoscopic disease activity scores were evaluated. C-reactive protein (CRP) and albumin levels were recorded. The CAR was calculated to determine clinical severity.ResultsOf the 200 patients, 135 (67.5%) were men and 65 (32.5%) were women. Mean age was 43.5 ± 9.8 years. Patients were divided into groups with mild, moderate, or severe disease activity and there were statistically significant differences in the CAR, the erythrocyte sedimentation rate (ESR), CRP levels, and albumin levels (P = .001; P < .05). With a cut-off value of 0.6, the CAR performed best in defining patients with severe disease, with an area under the curve (AUC) of 0.985, 98% sensitivity, 100% specificity, positive predictive value (PPV) of 100%, and negative predictive value (NPV) of 97%, P < 0.001. AUC values for the diagnosis of severe disease were 0.985, 0.88, 0.72, and 0.65 for the CAR, CRP, albumin, and the ESR, respectively.ConclusionThere was a statistically significant association between the CAR and clinical disease activity in patients with UC. The CAR is a reliable and practical tool for detecting ASUC.     

Reducing ICU Utilization,Length of Stay,and Cost by Optimizing the Clinical Use of Continuous Monitoring System Technology in the Hospital

BackgroundContinuous monitoring system technology (CMST) aids in earlier detection of deterioration of hospitalized patients, but whether improved outcomes are sustainable is unknown.MethodsThis interrupted time series evaluation explored whether optimized clinical use of CMST was associated with sustained improvement in intensive care unit (ICU) utilization, hospital length of stay, cardiac arrest rates, code blue events, mortality, and cost across multiple adult acute care units.ResultsA total of 20,320 patients in the postoptimized use cohort compared with 16,781 patients in the preoptimized use cohort had a significantly reduced ICU transfer rate (1.73% vs 2.25%, P = .026) corresponding to 367.11 ICU days saved over a 2-year period, generating an estimated cost savings of more than $2.3 million. Among patients who transferred to the ICU, hospital length of stay was decreased (8.37 vs 9.64 days, P = .004). Cardiac arrest, code blue, and mortality rates did not differ significantly.ConclusionOpportunities exist to promote optimized adoption and use of CMST at acute care facilities to sustainably improve clinical outcomes and reduce cost.     

Site and size of extrapancreatic necrosis are associated with clinical outcomes in patients with acute necrotizing pancreatitis

BackgroundThe site and size of extrapancreatic necrosis (EPN) as assessed on computed tomography may influence the severity of acute necrotizing pancreatitis (ANP). The objective of the study was to evaluate the impact of site and size of EPN on the clinical outcomes in patients with acute necrotizing pancreatitis (ANP).Method and materialsThis retrospective study comprised of consecutive patients with ANP who were admitted between January 2017 and March 2019. Patients in whom the initial contrast enhanced CT showed EPN were eligible for inclusion. The site, volume and maximum dimension of EPN were recorded. The severity of AP and modified CT severity index (MCTSI) was calculated. Clinical outcomes were recorded.ResultsA total of 119 patients (mean age, 37.56 years, 91 males) were included. There was a significant association between the location of EPN and the outcome parameters. The left posterior pararenal collections were significantly associated with mortality (P = 0.041), left paracolic gutter collections with the length of hospitalisation (LOH) (P = 0.014), and right paracolic gutter and mesenteric collections with the intensive care unit (ICU) stay (P = 0.024, and P = 0.021, respectively). There was a significant correlation between the volume and the maximum dimension of collection with LOH and ICU stay. The area under the receiver operating characteristic curve for volume, maximum dimension and MCTSI for predicting death was 0.724 (95% CI, 0.612–0.837), 0.644 (95% CI, 0.516–0.772) and 0.574 (95% CI, 0.452–0.696), respectively.ConclusionThe site and size of EPN provide reliable and objective information for assessing clinical outcomes in patients with ANP.     

Outcomes and predictors of delayed endoscopic biliary drainage for severe acute cholangitis due to choledocholithiasis in an intensive care unit

BackgroundAcute cholangitis (AC) is an infection of the biliary tract secondary to biliary obstruction requiring biliary drainage through endoscopic retrograde cholangiopancreatography. This study aims to compare the outcome between the early and delayed ERCP in patients with severe AC.MethodsPatient with severe AC due to choledocholithiasis admitted to intensive care unit were included. Early ERCP was defined was as ERCP performed within 24 h following hospital admission. Propensity-score matching was used to reduce the imbalance between groups. The primary outcome was 30-day mortality. Secondary outcomes included length of hospital and ICU stay, onset or persistent organ failure.ResultsThe delayed ERCP group had a higher mortality rate at 30 days (45,5 versus 13%, <0.001) and at 1 year (59,7% versus 15,6%, p <0.001). Delayed ERCP had also a higher rate of respiratory adverse events (54,5 versus 27,8%, p = 0,002), longer ICU (7.41 versus 4.61, p = 0,004) and hospital (11,88 versus 9,22, p = 0,042) length of stay. Predictors of delayed ERCP were cardiac arrythmias, liver disease, creatinine value and white blood cell count at baseline.ConclusionsDelays in ERCP for patients with severe AC appear to be associated with higher mortality rate and prolonged ICU and hospital stays.     

Adalimumab dose escalation and dose de-escalation success rate and predictors in a large national cohort of Crohn's patients

Background and aimsAdalimumab is efficacious in inducing and maintaining remission in Crohn's disease but dose escalation is needed in 30–40% after 1 year. Attempts for dose de-escalation have not been studied. This study aimed to assess the need for, predictors, and outcome of dose escalation and de-escalation in a large cohort of adalimumab treated Crohn's patients.MethodsAll consecutive patients treated with open label adalimumab for active Crohn's disease from the participating centres were included in this cohort study. A detailed retrospective chart review was performed to look for possible factors predicting outcome.ResultsEighty four percent of 720 patients had a primary response and were followed up for a median of 14 months. Thirty four percent needed escalation after a median of 7 months (0–55 months). Multivariate predictors for dose escalation were the following: prior anti-TNF use (p < 0.0001), no concomitant azathioprine or < 3 m (p < 0.02) and abnormal CRP at start (p < 0.05). Dose escalation re-induced response for at least 6 months in 67%. Only abnormal CRP at start correlated with failure of dose escalation (p = 0.02). Dose de-escalation was attempted in 54% and was successful in 63%. After a median follow-up of 14 m adalimumab was discontinued in 29% of patients.ConclusionIn this study real life nationwide cohort of Crohn's patients treated with adalimumab dose escalation was needed in 34% and was successful in 67%. Dose de-escalation was attempted in 54% and was successful in 63%. Overall 71% of patients maintained long term response on adalimumab.     

Facteurs prédictifs de long séjour en réanimation après chirurgie cardiaque programmée de l’adulte : étude rétrospective monocentrique sur 5 ans et demi

AimThe aim of our study was to identify predictors for prolonged ICU stay following elective adult cardiac surgery under cardiopulmonary bypass.Patients and methodsA retrospective study was conducted during 5 years and a half period. Were included, patients age ≥ 18 years old, underwent elective cardiac surgery under cardiopulmonary bypass. Patients who died within 48 hours of surgery were excluded. Prolonged ICU stay was defined as stay in the ICU for 48 hours or more.ResultsDuring the review period, 610 patients were included. One hundred and sixty-four patients have required a prolonged ICU stay (26.9 %). In multivariate analysis, 5 predictors were identified: ejection fraction < 30 % (OR 19.991, IC 95 % [1.382–289.1], P = 0.028], pulmonary hypertension (OR 2.293, IC 95 % [1.058–4.973], P = 0.036), prolonged ventilation (≥ 12 hours) (OR 4.026, IC 95 % [2.407–6.733], P < 0.001). Number of blood units transfused (OR 1.568, IC 95 % [1.073–2.291], and postoperative acute renal failure (OR 2.620, IC 95 % [1.026–6.690], P = 0.044]. Prolonged ICU stay is significantly associated with prolonged hospital stay (17 days vs 13 days ; P < 0.001) and higher in hospital mortality (22 % vs. 3 %, P < 0.001).ConclusionThe identification of these patients at risk of prolonged ICU stay is crucial. It will aid to plan prophylactic measures to optimize their support.     

ICU-acquired central line-associated bloodstream infection and its associated factors in Oman

BackgroundDespite the extensive use of central lines for ICU patients in Oman, no studies have been conducted among adult ICU patients to assess the prevalence, and predictors of CLABSIs.AimTo estimate the prevalence of ICU-acquired CLABSIs, identify the most common causative microorganisms, and define possible related risk factors associated with ICU-acquired CLABSIs among adult ICU patients in Oman.MethodA retrospective case-control design was used to screen electronic medical records of for all adult ICU patients admitted over 2 years (2018-2019) in 2 tertiary hospitals in Oman. The CDC definition of CLABSIs was used to allocate a cases group (n = 58), and a randomly selected controls group (n = 174).ResultsThe prevalence of ICU-acquired CLABSIs was 8.9 and 8.31 per 1,000 catheter days for the years 2018 and 2019 respectively. The most common isolated microorganisms were gram-positive bacteria (46.6%). The risk factors for ICU-acquired CLABSIs are: heart failure (Odds Ratio [OR] = 11.67, P < .001), female gender (OR = 0.352, P = .035), presence of other infections (OR = 3.4, P = .009), tracheostomy (OR = 5.34, P = .004), and Total Parenteral Nutrition (OR = 3.469, P = .020).ConclusionsThe prevalence of ICU-acquired CLABSIs in developing countries like Oman is higher than most of developed countries. The current study provides baseline data that can be used as a reference for future national studies and help in building strategies to prevent and control ICU-acquired CLABSIs.     

Pacientes críticos COVID-19. ¿Han variado el manejo y los resultados en la UCI tras un año de pandemia? Estudio multicéntrico,prospectivo, observacional

ObjectiveTo compare the clinical characteristics, treatments, and evolution of critical patients with COVID-19 pneumonia treated in intensive care units (ICU) after one year of pandemic.MethodologyMulticenter, prospective study, which included critical COVID-19 patients in 9 ICUs in northwestern Spain. The clinical characteristics, treatments, and evolution of patients admitted to the ICU during the months of March-April 2020 (period 1) were compared with patients admitted in January-February 2021 (period 2).Results337 patients were included (98 in period 1 and 239 in period 2). In period 2, fewer patients required invasive mechanical ventilation (IMV) (65% vs. 84%, P < .001), using high-flow nasal cannulas (CNAF) more frequently (70% vs. 7%, P < .001), ventilation non-invasive mechanical (NIMV) (40% vs. 14%, P < .001), corticosteroids (100% vs. 96%, P = .007) and prone position in both awake (42% vs. 28%, P = .012), and intubated patients (67% vs. 54%, P = .034). The days of IMV, ICU stay and hospital stay were lower in period 2. Mortality was similar in the two periods studied (16% vs. 17%).ConclusionsAfter one year of pandemic, we observed that in patients admitted to the ICU, CNAF, NIMV, use of the prone position, and corticosteroids have been used more frequently, reducing the number of patients in IMV, and the length of stay in the ICU and hospital stay. Mortality was similar in the two study periods.     

Serum hepcidin levels are related to serum markers for iron metabolism and fibrosis stage in patients with chronic hepatitis B: A cross-sectional study

Background and study aimsThe clinical significance of serum parameters of iron metabolism and hepcidin in liver disease remains unknown. Therefore, this study aimed to evaluate the association of serum hepcidin levels with fibrosis stage and serum iron parameters in patients with chronic hepatitis B (CHB).Patients and MethodsThis cross-sectional study included 126 treatment-naïve patients with CHB (median age, 39.0 years; 64.3% males) who were positive for hepatitis B surface antigen and 23 healthy controls (median age, 33.0 years; 52.2% males). Data on patient demographics, serum hepcidin levels, liver function tests and serum iron parameters and liver biopsy findings including fibrosis grade, histological activity index (HAI) and liver iron level were recorded.ResultsThe median (minimum–maximum) serum hepcidin levels were significantly lower in the CHB group than in the control group [71.2 (13.3–672.7) vs. 657.5 (201.7–2714.2) pg/mL, p < 0.001]. Higher fibrosis stage was associated with higher transferrin saturation (p = 0.029), serum ferritin level (p < 0.001) and viral load (p < 0.001). Fibrosis stage and HAI were positively correlated with ferritin (r = 0.407, p < 0.001 and r = 0.415, p < 0.001, respectively) and transferrin saturation (r = 0.219, p = 0.026 and r = 0.290, p = 0.003, respectively) levels, whereas hepcidin level was negatively correlated with fibrosis stage (r = −0.175, p = 0.051), viral load (r = −0.209, p = 0.020) and ferritin level (r = −0.244, p = 0.006) level. There were no significant differences in serum iron level, total iron binding capacity and liver iron level among patients with different stages of fibrosis.ConclusionReduced hepcidin levels and elevated transferrin saturation and ferritin levels are linked to fibrosis severity and HAI in patients with CHB.     

Prognostic Utility of Anemia and Pro-B-Type Natriuretic Peptide in Patients With Nonischemic Dilated Cardiomyopathy and Normal Renal Function

BackgroundIdiopathic dilated cardiomyopathy frequently coexists with anemia and high plasma NT proBNP levels. However, the prognostic impact of these features on the disease course is uncertain, especially in patients with normal renal function.MethodsForty-seven patients with idiopathic dilated cardiomyopathy with sinus rhythm and normal renal function were prospectively followed for a mean 25 ± 18 months period. Clinical end points were death (sudden cardiac death and deaths because of worsening heart failure) and cardiac transplantation. Prognostic impact of NT proBNP levels, anemia, echocardiographic and clinical parameters on the clinical end points was evaluated with Kaplan-Meier survival analysis. Cut-off values of hemoglobin and plasma NT proBNP levels for predicting end points were determined by receiver operating curve analysis.ResultsTwenty-eight patients (59.6%) suffered clinical end points. The patients who suffered clinical end points were anemic (P = 0.002), had lower systolic (P < 0.003) and diastolic (P < 0.0001) blood pressures, and higher NYHA functional classes (P = 0.005), lower left ventricle ejection fractions (P = 0.003), higher E/A ratios (P = 0.001), shorter E-wave deceleration times (P = 0.001), isovolumetric relaxation times (P = 0.05) and pulmonary acceleration times (P = 0.004), and higher plasma NT proBNP levels (P < 0.0001). Anemic patients had more clinical end points (P = 0.002). In univariate analysis the prognostic predictors of life expectancy were log NT proBNP, anemia, NYHA functional class, systolic blood pressure, left ventricle ejection fraction, and E-wave deceleration time. However, multivariate analysis revealed only plasma NT proBNP as independent predictor of clinical end points.ConclusionTracking plasma NT proBNP levels is a useful strategy during routine follow-ups of patients with nonischemic dilated cardiomyopathy. Its predictive value for prognosis needs more evaluation in larger controlled studies. In addition, the importance of anemia in those patients needs more study.     

Daytime activity and sleep are associated with motor function in older intensive care unit survivors

BackgroundHospitalized older intensive care unit (ICU) survivors are often inactive and experience sleep disturbances.ObjectiveWe explored associations between post-ICU activity, sleep/rest, and motor function among hospitalized older ICU survivors.MethodsWe enrolled 30 older ICU survivors, ages 65 and older, within 24–48 h of ICU discharge. Actigraphy measured post-ICU activity and sleep/rest. Selected measures from the National Institutes of Health Toolbox Motor Battery assessed grip strength and dexterity. Multivariate regression examined associations between post-ICU activity, sleep/rest, and motor function, adjusting for covariates.ResultsLower daytime activity (β = 0.258, p = .035) and greater daytime sleep/rest (β = −0.295, p = .022) were associated with worse grip strength. Lower daytime activity (β = −0.376, p = .037) and greater daytime sleep/rest (β = 0.409, p = .026) were associated with worse dexterity.ConclusionPost-ICU inactivity and prolonged rest periods are associated with worse motor function in hospitalized older ICU survivors.     

Systemic inflammation as fuel for acute liver injury in COVID-19

BackgroundA cytokine storm conceivably contributes to manifestations of corona virus disease (COVID-19). Inflammatory cytokines such as interleukin-6 (IL-6) cause acute liver injury while serum detectability indicates systemic inflammation.AimsWe explored a link between systemic IL-6, related acute phase proteins and liver injury in hospitalized COVID-19 patients.Methods655 patients with suspected COVID-19 were screened in the emergency department at the University Hospital of Innsbruck, Austria, between February and April 2020. 96 patients (～15%) were hospitalized with COVID-19. 15 patients required intensive-care treatment (ICT). Plasma aminotransferases, alkaline phosphatase, bilirubin, and gamma glutamyl transferase, as well as IL-6, C-reactive protein (CRP), ferritin and lactate dehydrogenase (LDH) were determined by standard clinical assays.ResultsOf all hospitalized COVID-19 patients, 41 (42%) showed elevated aspartate aminotransferase (AST) concentration. COVID-19 patients with elevated AST exhibited significantly higher IL-6 (p < 0.001), ferritin (p < 0.001), LDH (p < 0.001) and CRP (p < 0.05) serum concentrations compared to patients with normal AST. Liver injury correlated with systemic IL-6 (p < 0.001), CRP (p < 0.001), ferritin (p < 0.001) and LDH (p < 0.001) concentration. In COVID-19 patients requiring ICT, correlations were more pronounced.ConclusionSystemic inflammation could be a fuel for hepatic injury in COVID-19.     

Mortality and costs related to severe acute pancreatitis in the intensive care units of Australia and New Zealand (ANZ), 2003–2020

Background and objectiveComprehensive data on the burden of severe acute pancreatitis (SAP) in global intensive care units (ICUs) and trends over time are lacking. Our objective was to compare trends in hospital and ICU mortality, in-hospital and ICU length of stay, and costs related to ICU admission in Australia and New Zealand (ANZ) for SAP.MethodsWe performed a retrospective, observational, cohort study of ICU admissions reported to the ANZ Intensive Care Society Adult Patient Database over three consecutive six-year time periods from 2003 to 2020.Results12,635 patients with SAP from 189 ICUs in ANZ were analysed. No difference in adjusted hospital mortality (11.4% vs 11.5% vs 11.0%, p = 0.85) and ICU mortality rates (7.5% vs 8.0% vs 8.1%, p = 0.73) were noted over the study period. Median length of hospital admission reduced over time (13.9 days in 2003-08, 13.1 days in 2009-14 and 12.5 days in 2015-20; p < 0.01). No difference in length of ICU stay was noted over the study period (p = 0.13). The cost of managing SAP in ANZ ICUs remained constant over the three time periods.ConclusionsIn critically-ill SAP patients in ANZ, no change in mortality has been noted over nearly two decades. There was a slight reduction in hospital stay (1 day), while the length of ICU stay remained unchanged. Given the significant costs related to care of patients with SAP in ICU, these findings highlight the need to prioritise resource allocation for healthcare delivery and targeted clinical research to identify treatments aimed at reducing mortality.