Journal of critical care
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Journal of critical care · Jun 2016
ReviewRole of albumin in diseases associated with severe systemic inflammation: Pathophysiologic and clinical evidence in sepsis and in decompensated cirrhosis.
The metabolism of albumin in inflammatory states such as sepsis or major surgery is complex and still not well characterized. Nevertheless, in inflammatory states, albumin synthesis has been observed to increase. By contrast, in decompensated cirrhosis, a disease characterized by systemic inflammation, albumin synthesis by the liver may decrease to 30% to 50% of normal values. ⋯ The discussion regarding the effect of exogenous albumin administration on intravascular volume in inflammatory states should therefore address albumin turnover. To add complexity to our understanding of the effects of albumin, there are many data indicating that the therapeutic action of albumin is mediated not only through the impact on plasma volume expansion but also through a modulatory effect on inflammation and oxidative stress. All these characteristics are relevant to diseases associated with systemic inflammation including sepsis and decompensated cirrhosis.
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Journal of critical care · Jun 2016
Procalcitonin cannot be used as a biomarker of infection in heart surgery patients with acute kidney injury.
We intended to assess how acute kidney injuy impacts on procalcitonin levels in cardiac surgery patients, with or without infection, and whether procalcitonin might be used as a biomarker of infection in acute kidney injuy. ⋯ In acute kidney injuy patients, high procalcitonin levels are a marker of acute kidney injuy but will not be able to differentiate infected from non-infected patients.
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Journal of critical care · Jun 2016
Prognostic value of extravascular lung water and its potential role in guiding fluid therapy in septic shock after initial resuscitation.
To explore whether extravascular lung water (EVLW) provides a valuable prognostic tool guiding fluid therapy in septic shock patients after initial resuscitation. ⋯ A higher EVLW in septic shock patients after initial resuscitation was associated with a more positive fluid balance and increased mortality, which is an independent predictor of the 28-day mortality in septic shock patients after initial resuscitation.
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Journal of critical care · Jun 2016
Procalcitonin concentrations as a predictor of unexpected readmission and mortality after intensive care unit discharge: A retrospective cohort study.
Procalcitonin (PCT) has been used to guide treatment in critically ill patients with sepsis, but whether PCT at intensive care unit (ICU) discharge can stratify risks of post-ICU readmission or mortality is unknown. This cohort study compared the ability of PCT with C-reactive protein (CRP) in predicting unexpected adverse post-ICU events. Of the 1877 patients admitted to the multidisciplinary ICU between 1 April 2012 and 31 March 2014, 1653 (88.1%) were discharged without treatment limitations. ⋯ Both PCT (0.6 vs 0.4 μg/L, P = .002) and a high CRP concentration >100 mg/L (58% vs 41%, P = .004) at ICU discharge were associated with an increased risk of adverse post-ICU events in the univariate analyses; however, the ability of PCT to discriminate between patients with and without adverse post-ICU outcomes was limited (area under the receiver operating characteristic curve = 0.61; 95% confidence interval, 0.55-0.66). In the multivariable analysis, only a high CRP concentration (odds ratio, 1.92; 95% confidence interval, 1.12-3.11; P = .008) was associated with an increased adverse post-ICU events. Elevated PCT concentration at ICU discharge was inadequate in its predictive ability to guide ICU discharge.