Diagnostics

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9 pages, 618 KiB

Open AccessArticle

Model for End-Stage Liver Disease Including Na, Age, and Sex Is Powerful Predictor of Survival in COVID-19 Patients on Extracorporeal Membrane Oxygenation

by Freya Sophie Jenkins, Mohammed Morjan, Jan-Philipp Minol, Esma Yilmaz, Ismail Dalyanoglu, Moritz Benjamin Immohr, Bernhard Korbmacher, Udo Boeken, Artur Lichtenberg and Hannan Dalyanoglu

Diagnostics 2024, 14(17), 1954; https://doi.org/10.3390/diagnostics14171954 - 4 Sep 2024

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Abstract

Aim: Extracorporeal membrane oxygenation (ECMO) is resource-intensive, is associated with significant morbidity and mortality, and requires careful patient selection. This study examined whether the model for end-stage liver disease (MELD) score is a suitable predictor of in-hospital mortality in patients with COVID-19. Materials [...] Read more.

Aim: Extracorporeal membrane oxygenation (ECMO) is resource-intensive, is associated with significant morbidity and mortality, and requires careful patient selection. This study examined whether the model for end-stage liver disease (MELD) score is a suitable predictor of in-hospital mortality in patients with COVID-19. Materials and Methods: We retrospectively assessed patients with COVID-19 on ECMO at our institution from March 2020 to May 2021. MELD scoring was performed using laboratory values recorded prior to ECMO initiation. A multiple logistic regression model was established. Results: A total of 66 patients with COVID-19 on ECMO were included (median age of 58.5 years; 83.3% male). The in-hospital mortality was 74.2%. In relation to mortality, patients with MELD Na scores >13.8 showed 6.5-fold higher odds, patients aged >53.5 years showed 18.4-fold higher odds, and male patients showed 15.9-fold higher odds. The predictive power of a model combining the MELD Na with age and sex was significant (AUC = 0.883, p < 0.001). The findings in the COVID-19 patients were not generalizable to a group of non-COVID-19 patients on ECMO. Conclusions: A model combining the MELD Na, age, and sex has high predictive power for in-hospital mortality in patients with COVID-19 on ECMO, and it may be clinically useful for guiding patient selection in critically ill COVID-19 patients both now and in the future, should the virus widely re-emerge. Full article

(This article belongs to the Special Issue ICU Disease Diagnosis)

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11 pages, 604 KiB

Open AccessArticle

Investigation of the Relationship between Vitamin D Deficiency and Vitamin D-Binding Protein Polymorphisms in Severe COVID-19 Patients

by Lutfiye Karcıoğlu Batur, Mehmet Dokur, Suna Koç, Mehmet Karabay, Zeyneb Nur Akcay, Ezgi Gunger and Nezih Hekim

Diagnostics 2024, 14(17), 1941; https://doi.org/10.3390/diagnostics14171941 - 3 Sep 2024

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Abstract

This study explores the association of vitamin D-binding protein (VDBP) gene polymorphisms, vitamin D levels, and the severity of COVID-19, including the need for intensive care unit (ICU) hospitalization. We analyzed a cohort of 56 consecutive age- and gender-matched adult COVID-19-positive patients and [...] Read more.

This study explores the association of vitamin D-binding protein (VDBP) gene polymorphisms, vitamin D levels, and the severity of COVID-19, including the need for intensive care unit (ICU) hospitalization. We analyzed a cohort of 56 consecutive age- and gender-matched adult COVID-19-positive patients and categorized them into three groups: outpatients with mild illness, inpatients with moderate disease, and ICU patients. We measured levels of free, total, and bioavailable 25-hydroxyvitamin D [25(OH)D], VDBP, and albumin. VDBP polymorphisms rs5488 and rs7041 were identified using real-time PCR. A significant proportion of ICU patients were vitamin D-deficient (56.25%) compared to outpatients (10%) and inpatients (5%) (p = 0.0003). ICU patients also had notably lower levels of VDBP (median: 222 mg/L) and total 25(OH)D (median: 18.8 ng/mL). Most patients carried heterozygous rs7041 (60.7%) and wild-type rs4588 (58.9%) genotypes. The distribution of rs7041 SNP varied significantly among groups (p = 0.0301), while rs4588 SNP distribution did not (p = 0.424). Heterozygous rs4588 patients had significantly lower VDBP levels (p = 0.029) and reduced bioavailable 25(OH)D compared to those with wild-type rs4588 (p = 0.020). Our findings indicate that VDBP gene polymorphisms, particularly rs7041 and rs4588, are associated with vitamin D status and the severity of COVID-19. The lower VDBP levels and bioavailable vitamin D in ICU patients suggest that these genetic variants may influence disease severity and hospitalization needs. These results highlight the potential role of VDBP polymorphisms in COVID-19 severity, suggesting that genetic screening could be valuable in assessing the risk of severe outcomes and guiding personalized treatment strategies. Full article

(This article belongs to the Special Issue ICU Disease Diagnosis)

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10 pages, 895 KiB

Open AccessArticle

Association between Inflammation-Based Prognostic Markers and Mortality in Patients Admitted to Intensive Care Units

by Ah Ran Oh, Jeong-Am Ryu, Seung Joo Lee, Chung Su Kim and Sangmin Maria Lee

Diagnostics 2024, 14(16), 1709; https://doi.org/10.3390/diagnostics14161709 - 6 Aug 2024

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Abstract

Background: We compared the prognostic value of the C-reactive protein (CRP)-to-albumin ratio (CAR), neutrophil-to-lymphocyte ratio (NLR), and modified Glasgow prognostic score (mGPS) with the Sequential Organ Failure Assessment (SOFA) score in an intensive care unit (ICUs). Methods: This study used the data of [...] Read more.

Background: We compared the prognostic value of the C-reactive protein (CRP)-to-albumin ratio (CAR), neutrophil-to-lymphocyte ratio (NLR), and modified Glasgow prognostic score (mGPS) with the Sequential Organ Failure Assessment (SOFA) score in an intensive care unit (ICUs). Methods: This study used the data of 53,877 adult patients admitted to an ICU between June 2013 and May 2022. Using the CAR, NLR, and mGPS values, as well as the SOFA score from the ICU, we conducted multivariable logistic regression analysis and used the receiver operating characteristic (ROC) curve to compare the predictive value for 28-day and 1-year mortality. Results: A total of 2419 patients (4.5%) died within 28 days, and 6209 (11.5%) patients died within 1 year. After an adjustment, all predictors were found to be independent risk factors for 28-day mortality (odds ratio [OR] 1.31, 95% confidence interval [CI] 1.29–1.33, p < 0.001 for the SOFA score; OR 1.05, 95% CI 1.03–1.07, p < 0.001 for CAR; OR 1.01, 95% CI 1.00–1.02, p < 0.001 for the NLR; and OR 1.19, 95% CI 1.08–1.30, p < 0.001 for the mGPS). This trend persisted for the 1-year mortality. In ROC curve analysis, the CAR showed better predictability than the NLR and mGPS. Furthermore, the predictive power of the CAR was significantly higher than that of the SOFA score for 1-year mortality. Conclusions: The CAR, NLR, and mGPS values at ICU admission were independent risk factors of mortality after ICU admission. The predictive value of CAR was higher than that of the SOFA score for 1-year mortality. CAR assessment at ICU admission may be a feasible predictor of long-term mortality. Full article

(This article belongs to the Special Issue ICU Disease Diagnosis)

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12 pages, 1156 KiB

Open AccessArticle

Patients with Severe Trauma Having an Injury Severity Score of 24 and above Develop Nutritional Disorders

by Minori Mizuochi, Junko Yamaguchi, Nobutaka Chiba and Kosaku Kinoshita

Diagnostics 2024, 14(12), 1307; https://doi.org/10.3390/diagnostics14121307 - 20 Jun 2024

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Abstract

In this single-center, retrospective, observational study, we aimed to assess the severity at which patients with trauma tend to develop metabolic disturbances that worsen their Controlling Nutritional Status (CONUT) scores. Participants were general adult patients with trauma hospitalized for at least one week. [...] Read more.

In this single-center, retrospective, observational study, we aimed to assess the severity at which patients with trauma tend to develop metabolic disturbances that worsen their Controlling Nutritional Status (CONUT) scores. Participants were general adult patients with trauma hospitalized for at least one week. Injury Severity Scores (ISSs) at admission and CONUT scores one week later were calculated, and correlation coefficients were examined. The receiver operating characteristic (ROC) curve was used to calculate the ISS cutoff value for a CONUT score of 5 or more on day 7 of hospitalization. The ISS was assessed using multiple logistic regression analysis to determine whether it predicts worse nutritional status. Forty-nine patients were included. ISSs correlated with CONUT scores on day 7 (r = 0.373, p = 0.008). Using the ROC curve, the cutoff value for the ISS was 23.5. Multiple logistic regression analyses showed that a high ISS (odds ratio [OR], 1.158; 95% confidence interval [CI], 1.034–1.296; p = 0.011) and older age (OR, 1.094; 95% CI, 1.027–1.165; p = 0.005) were associated with a CONUT score 5 or more on day 7 of hospitalization. Patients with trauma with an ISS of 24 or higher have worsening CONUT scores during hospitalization; these patients require careful nutritional management. Full article

(This article belongs to the Special Issue ICU Disease Diagnosis)

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14 pages, 2476 KiB

Open AccessArticle

The Role of Routine Electroencephalography in the Diagnosis of Seizures in Medical Intensive Care Units

by Cheng-Lun Hsiao, Pei-Ya Chen, I-An Chen and Shinn-Kuang Lin

Diagnostics 2024, 14(11), 1111; https://doi.org/10.3390/diagnostics14111111 - 27 May 2024

Cited by 1 | Viewed by 885

Abstract

Seizures should be diagnosed and treated to ensure optimal health outcomes in critically ill patients admitted in the medical intensive care unit (MICU). Continuous electroencephalography is still infrequently used in the MICU. We investigated the effectiveness of routine EEG (rEEG) in detecting seizures [...] Read more.

Seizures should be diagnosed and treated to ensure optimal health outcomes in critically ill patients admitted in the medical intensive care unit (MICU). Continuous electroencephalography is still infrequently used in the MICU. We investigated the effectiveness of routine EEG (rEEG) in detecting seizures in the MICU. A total of 560 patients admitted to the MICU between October 2018 and March 2023 and who underwent rEEG were reviewed. Seizure-related rEEG constituted 47% of all rEEG studies. Totally, 39% of the patients experienced clinical seizures during hospitalization; among them, 48% experienced the seizure, and 13% experienced their first seizure after undergoing an rEEG study. Seventy-seven percent of the patients had unfavorable short-term outcomes. Patients with cardiovascular diseases were the most likely to have the suppression/burst suppression (SBS) EEG pattern and the highest mortality rate. The rhythmic and periodic patterns (RPPs) and electrographic seizure (ESz) EEG pattern were associated with seizures within 24 h after rEEG, which was also related to unfavorable outcomes. Significant predictors of death were age > 59 years, the male gender, the presence of cardiovascular disease, a Glasgow Coma Scale score ≤ 5, and the SBS EEG pattern, with a predictive performance of 0.737 for death. rEEG can help identify patients at higher risk of seizures. We recommend repeated rEEG in patients with ESz or RPP EEG patterns to enable a more effective monitoring of seizure activities. Full article

(This article belongs to the Special Issue ICU Disease Diagnosis)

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13 pages, 1916 KiB

Open AccessArticle

Development of Prediction Model for Intensive Care Unit Admission Based on Heart Rate Variability: A Case–Control Matched Analysis

by Dong Hyun Choi, Hyunju Lee, Hyunjin Joo, Hyoun-Joong Kong, Seung Bok Lee, Sungwan Kim, Sang Do Shin and Ki Hong Kim

Diagnostics 2024, 14(8), 816; https://doi.org/10.3390/diagnostics14080816 - 14 Apr 2024

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Abstract

This study aimed to develop a predictive model for intensive care unit (ICU) admission by using heart rate variability (HRV) data. This retrospective case–control study used two datasets (emergency department [ED] patients admitted to the ICU, and patients in the operating room without [...] Read more.

This study aimed to develop a predictive model for intensive care unit (ICU) admission by using heart rate variability (HRV) data. This retrospective case–control study used two datasets (emergency department [ED] patients admitted to the ICU, and patients in the operating room without ICU admission) from a single academic tertiary hospital. HRV metrics were measured every 5 min using R-peak-to-R-peak (R-R) intervals. We developed a generalized linear mixed model to predict ICU admission and assessed the area under the receiver operating characteristic curve (AUC). Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated from the coefficients. We analyzed 610 (ICU: 122; non-ICU: 488) patients, and the factors influencing the odds of ICU admission included a history of diabetes mellitus (OR [95% CI]: 3.33 [1.71–6.48]); a higher heart rate (OR [95% CI]: 3.40 [2.97–3.90] per 10-unit increase); a higher root mean square of successive R-R interval differences (RMSSD; OR [95% CI]: 1.36 [1.22–1.51] per 10-unit increase); and a lower standard deviation of R-R intervals (SDRR; OR [95% CI], 0.68 [0.60–0.78] per 10-unit increase). The final model achieved an AUC of 0.947 (95% CI: 0.906–0.987). The developed model effectively predicted ICU admission among a mixed population from the ED and operating room. Full article

(This article belongs to the Special Issue ICU Disease Diagnosis)

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13 pages, 2019 KiB

Open AccessArticle

Characterisation and Outcomes of Patients with Solid Organ Malignancies Admitted to the Intensive Care Unit: Mortality and Impact on Functional Status and Oncological Treatment

by Marta García de Herreros, Juan Carlos Laguna, Joan Padrosa, Tanny Daniela Barreto, Manoli Chicote, Carme Font, Ignacio Grafiá, Lucía Llavata, Elia Seguí, Albert Tuca, Margarita Viladot, Carles Zamora-Martínez, Sara Fernández-Méndez, Adrián Téllez, Josep Maria Nicolás, Aleix Prat, Pedro Castro-Rebollo and Javier Marco-Hernández

Diagnostics 2024, 14(7), 730; https://doi.org/10.3390/diagnostics14070730 - 29 Mar 2024

Cited by 2 | Viewed by 1295

Abstract

Background: Despite the increasing number of ICU admissions among patients with solid tumours, there is a lack of tools with which to identify patients who may benefit from critical support. We aim to characterize the clinical profile and outcomes of patients with solid [...] Read more.

Background: Despite the increasing number of ICU admissions among patients with solid tumours, there is a lack of tools with which to identify patients who may benefit from critical support. We aim to characterize the clinical profile and outcomes of patients with solid malignancies admitted to the ICU. Methods: Retrospective observational study of patients with cancer non-electively admitted to the ICU of the Hospital Clinic of Barcelona (Spain) between January 2019 and December 2019. Data regarding patient and neoplasm characteristics, ICU admission features and outcomes were collected from medical records. Results: 97 ICU admissions of 84 patients were analysed. Lung cancer (22.6%) was the most frequent neoplasm. Most of the patients had metastatic disease (79.5%) and were receiving oncological treatment (75%). The main reason for ICU admission was respiratory failure (38%). Intra-ICU and in-hospital mortality rates were 9.4% and 24%, respectively. Mortality rates at 1, 3 and 6 months were 19.6%, 36.1% and 53.6%. Liver metastasis, gastrointestinal cancer, hypoalbuminemia, elevated basal C-reactive protein, ECOG-PS greater than 2 at ICU admission, admission from ward and an APACHE II score over 14 were related to higher mortality. Functional status was severely affected at discharge, and oncological treatment was definitively discontinued in 40% of the patients. Conclusion: Medium-term mortality and functional deterioration of patients with solid cancers non-electively admitted to the ICU are high. Surrogate markers of cachexia, liver metastasis and poor ECOG-PS at ICU admission are risk factors for mortality. Full article

(This article belongs to the Special Issue ICU Disease Diagnosis)

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12 pages, 1118 KiB

Open AccessArticle

Soluble Semaphorin 4D Serum Concentrations Are Elevated in Critically Ill Patients with Liver Cirrhosis and Correlate with Aminotransferases

by Samira Abu Jhaisha, Philipp Hohlstein, Eray Yagmur, Vera Köller, Maike R. Pollmanns, Jule K. Adams, Theresa H. Wirtz, Jonathan F. Brozat, Lukas Bündgens, Karim Hamesch, Ralf Weiskirchen, Frank Tacke, Christian Trautwein and Alexander Koch

Diagnostics 2024, 14(4), 370; https://doi.org/10.3390/diagnostics14040370 - 8 Feb 2024

Cited by 1 | Viewed by 1266

Abstract

Semaphorin 4D (Sema4D), also known as CD100, is a multifunctional transmembrane protein with immunoregulatory functions. Upon the activation of immune cells, soluble Semaphorin 4D (sSema4D) is proteolytically cleaved from the membrane by metalloproteinases. sSema4D levels are elevated in various (auto-)inflammatory diseases. Our aim [...] Read more.

Semaphorin 4D (Sema4D), also known as CD100, is a multifunctional transmembrane protein with immunoregulatory functions. Upon the activation of immune cells, soluble Semaphorin 4D (sSema4D) is proteolytically cleaved from the membrane by metalloproteinases. sSema4D levels are elevated in various (auto-)inflammatory diseases. Our aim was to investigate sSema4D levels in association with sepsis and critical illnesses and to evaluate sSema4D’s potential as a prognostic biomarker. We measured sSema4D levels in 192 patients upon admission to our medical intensive care unit. We found similar levels of sSema4D in 125 patients with sepsis compared to 67 non-septic patients. sSema4D levels correlated with leukocytes but not with other markers of systemic inflammation such as C-reactive protein or procalcitonin. Most interestingly, in a subgroup of patients suffering from pre-existing liver cirrhosis, we observed significantly higher levels of sSema4D. Consistently, sSema4D was also positively correlated with markers of hepatic and cholestatic injury. Our study suggests that sSema4D is not regulated in sepsis compared to other causes of critical illness. However, sSema4D seems to be associated with hepatic injury and inflammation. Full article

(This article belongs to the Special Issue ICU Disease Diagnosis)

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