Background and Purpose Inflammatory biomarkers predict incident and recurrent cardiac events, but their relationship to stroke prognosis is uncertain. We hypothesized that high-sensitivity C-reactive protein (hsCRP) predicts recurrent ischemic stroke after recent lacunar stroke. Methods Levels of Inflammatory Markers in the Treatment of Stroke (LIMITS) was an international, multicenter, prospective ancillary biomarker study nested within Secondary Prevention of Small Subcortical Strokes (SPS3), a Phase III trial in patients with recent lacunar stroke. Patients were assigned in factorial design to aspirin versus aspirin plus clopidogrel, and higher versus lower blood pressure targets. Patients had blood samples collected at enrollment, and hsCRP measured using nephelometry at a central laboratory. Cox proportional hazards models were used to calculate hazard ratios and 95% confidence intervals (HR, 95%CI) for recurrence risks before and after adjusting for demographics, comorbidities, and statin use. Results Among 1244 lacunar stroke patients (mean 63.3 ± 10.8 years), median hsCRP was 2.16 mg/L. There were 83 recurrent ischemic strokes (including 45 lacunes), and 115 major vascular events (stroke, myocardial infarction, vascular death). Compared with the bottom quartile, those in the top quartile (hsCRP >4.86 mg/L) were at increased risk of recurrent ischemic stroke (unadjusted HR 2.54, 95%CI 1.30–4.96), even after adjusting for demographics and risk factors (adjusted HR 2.32, 95%CI 1.15–4.68). HsCRP predicted increased risk of major vascular events (top quartile adjusted HR 2.04, 95%CI 1.14–3.67). There was no interaction with randomized antiplatelet treatment. Conclusions Among recent lacunar stroke patients, hsCRP levels predict risk of recurrent strokes and other vascular events. HsCRP did not predict response to dual antiplatelets.

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Pneumatosis intestinalis and portal venous gas are findings usually associated with intra-abdominal surgical catastrophes that frequently require emergent surgical intervention. Herein we present a case of a patient who presented in septic shock, with extensive portal vein gas, diffuse intestinal wall thickening, and atherosclerotic vascular insufficiency in the absence of pneumatosis intestinalis. Given his advanced age, multiple comorbidities, magnitude of the initial findings, and his dramatic clinical response to aggressive fluid resuscitation, a cognitive decision was made to continue with nonoperative management. The patient recovered uneventfully and was discharged home in a stable condition.

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Background . Although rapid response teams (RRTs) decrease in-house cardiac arrests, signifi cant debate exists surrounding their impact on patient outcomes. We have implemented the continuum of care (CoC) model for the surgical services in our center as a novel approach to patient care. Methods . This study was designed to assess the utilization of RRT resources and cardiac arrests between RRT and CoC coverage. Results . Whereas hospital-wide RRT activations increased in incidence from 2007 to 2010 by 45%, CoC patients experienced steadily decreasing percentage of total RRT activations. Rapid response triggers that led to cardiac arrest under the CoC were 8% in comparison with 17% in the control group. Non-CoC model/RRT activations increased dramatically from 0.3% to 1.5% of total admissions over 4 years whereas CoC RRT activation rates minimally increased from 0.3% to 0.4% (events per total admission per year). Cardiac arrests occurred in 0.4% of non-CoC patients while only occurring in 0.03% of CoC patients, P < .0001. Conclusion . The implementation of the CoC model reduces events requiring RRT activations, preserves continuity of care by closely following high-risk patients, and reduces cardiac arrests via proactive intervention by critical care specialists.

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