Journal of critical care
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Journal of critical care · Jun 2014
Randomized Controlled Trial Multicenter StudyHeparin-induced thrombocytopenia in the critically ill: Interpreting the 4Ts test in a randomized trial.
Thrombocytopenia occurs in 20% to 45% of critically ill medical-surgical patients. The 4Ts heparin-induced thrombocytopenia (HIT) score (with 4 domains: Thrombocytopenia, Timing of thrombocytopenia, Thrombosis and oTher reason[s] for thrombocytopenia) might reliably identify patients at low risk for HIT. Interobserver agreement on 4Ts scoring is uncertain in this setting. ⋯ Real-time 4Ts scoring by research coordinators at the time of testing for HIT was not consistent with 4Ts scores obtained by central adjudicators. The results of this comprehensive HIT testing highlight the need for further research to improve the assessment of PTP scoring of HIT for critically ill patients.
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Journal of critical care · Jun 2014
Randomized Controlled TrialAssociation between sympathoadrenal activation, fibrinolysis, and endothelial damage in septic patients: A prospective study.
The purpose of this study is to investigate potential associations between sympathoadrenal activation and/or vasopressor/inotropic therapy and endothelial activation, damage, and coagulopathy in septic patients. ⋯ In septic patients, endogenous noradrenaline was independently associated with biomarkers of endothelial activation, damage, fibrinolysis and mortality, comparable with findings in trauma and myocardial infarction patients. The catecholamine surge in critical illness may contribute to balance endothelial damage and procoagulation with hypocoagulability and hyperfibrinolysis in the circulating blood.
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Journal of critical care · Jun 2014
Comparative StudyClinical outcome of kidney transplantation from deceased donors with acute kidney injury by Acute Kidney Injury Network criteria.
In this study, we investigated the outcome of kidney transplantation (KT) from deceased donors with acute kidney injury (AKI), as defined by the Acute Kidney Injury Network criteria. ⋯ In KT from deceased donors, the AKI group that received kidneys with AKI, as defined by the Acute Kidney Injury Network criteria, showed a higher delayed graft function rate and lower allograft function for 6 months after KT but no effect on allograft function 1 year after KT and on long-term allograft survival.
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Journal of critical care · Jun 2014
Observational StudyA preliminary investigation into adrenal responsiveness and outcomes in patients with cardiogenic shock after acute myocardial infarction.
This study investigated the significance of baseline cortisol levels and adrenal response to corticotropin in shocked patients after acute myocardial infarction (AMI). ⋯ A high baseline plasma TC was associated with a trend toward increased mortality in patients with cardiogenic shock post-AMI. Patients with lower baseline TC, but with an inducible adrenal response, appeared to have a survival benefit. A prognostic system based on basal TC and Δ max similar to that described in septic shock appears feasible in this cohort. Corticosteroid therapy was associated with adverse outcomes. These findings require further validation in larger studies.
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Journal of critical care · Jun 2014
Impact of Eastern Cooperative Oncology Group Performance Status on hospital mortality in critically ill patients.
This study evaluates the association between the Eastern Cooperative Oncology Group Performance Status (ECOG-PS) and hospital mortality in general critically ill patients. ⋯ Preadmission PS, assessed with ECOG-PS in critically ill patients, has prognostic value in general critically ill patients.