Background:One of the main components involving in the pathogenesis and prognosis of sepsis and septic shock is natriuretic peptide. Hemodynamic changes in sepsis or septic shock might explain increased plasma levels of these peptides circulations. Objectives: The present study aimed to assess the value of brain natriuretic peptide (BNP) in prediction of sepsis state and its related morbidity. We also attempted to determine the best cutoff point of BNP for diagnosis of sepsis state in those with critical illnesses, admitted to the hospital. Patients and Methods:In a cross-sectional study on critically ill patients referred to infections unit of Hazrat Rasoul Akram Hospital, the enrolled patients were assigned to one of the sepsis (n = 30) and nonsepsis (n = 30) groups, based on their results of blood culture and clinical manifestations. Plasma level of BNP was measured by immunoassay. Results: In-hospital mortality was only observed in one patient suffering from sepsis. Hospital length of stay (LOS) was significantly longer in the sepsis group compared with the nonsepsis one (17.47 ± 10.10 days versus 7.93 ± 2.92 days). The plasma BNP level, as a marker, was significantly higher in the sepsis group than the nonsepsis one (786.87 ± 164.11 ng/mL versus 154.57 ± 44.67 ng/mL, P = 0.039). The BNP level was significantly correlated with some baseline variables including respiratory rate (beta = 0.295, P = 0.022) and ESR measurement (beta = 0.296, P = 0.022), but not with other characteristics. Through multivariable linear regression analysis, having other patients' variables information including demographics and hemodynamic parameters, the BNP level was significantly higher in the sepsis group compared with the nonsepsis one (odds ratio = 1.008, P = 0.046). According to the receiver operating characteristic (ROC) curve analysis, BNP measurement had an acceptable value for discriminating sepsis and nonsepsis states (c = 0.734, 95% CI: 0.605-0.864, P = 0.002). The optimal cutoff point of BNP for discriminating sepsis and nonsepsis states was 170 ng/mL, yielding a sensitivity of 66.7% and a specificity of 60.0%. Conclusions: Elevated BNP level was associated with a significantly increased risk of sepsis state in critically ill patients.
Background: Sepsis is one of the most important causes of morbidity and mortality in the intensive care units (ICUs). It is difficult to accurately differentiate sepsis from similar diseases rapidly. Therefore, it becomes critical to identify any biomarker with the ability of differentiation between sepsis and nonsepsis conditions. The urokinase plasminogen activator receptor has been implicated as an important factor in regulation of leukocyte adhesion and migration. Objectives: In this study, we evaluated the value of soluble urokinase plasminogen activator receptor (suPAR), erythrocyte sedimentation (ESR), and C-reactive protein (CRP) serum levels in terms of their value for sepsis diagnosis in ICU patients. Patients and Methods:We enrolled 107 ICU patients; 40 with sepsis, 43 with systemic inflammatory response syndrome, and 24 as control group. Serum soluble urokinase plasminogen activator receptor, ESR, white blood cell (WBC), and CRP levels were measured on the day of admission. Results: The group with sepsis had higher suPAR, ESR, and CRP levels compared with the group with noninfectious systemic inflammatory response syndrome (SIRS) (P = 0.01, 0.00 and 0.00, respectively). CRP concentrations and ESR were higher in the sepsis group than in the non-SIRS group (P = 0.00 and 0.00, respectively). In a receiver-operating characteristic curve analysis, ESR, CRP and suPAR had an area under the curve larger than 0.65 (P = 0.00) in distinguishing between septic and noninfectious SIRS patients. CRP, ESR and suPAR had a sensitivity of 87%, 71% and 66% and a specificity of 59%, 76% and 74% respectively in diagnosing infection in SIRS. Conclusions:The diagnostic values of CRP and ESR were better than suPAR and WBC count in patients with sepsis.
Background: The SARS-CoV-2 pandemic is one of the most significant challenges for healthcare providers, particularly in the critical care setting. The timing of intubation in COVID-19 patients seems to be challenging. Therefore, we aimed to investigate how it may have a survival benefit, and we determined which clinical characteristics were associated with outcomes. Methods: This cross-sectional study was conducted in the Imam Khomeini Hospital Complex. We randomly selected patients admitted to intensive care units and, based on intubation status, categorized them into three subgroups (early, late, and not intubated). Early intubation is defined as intubation within 48 hours of ICU admission, and late intubation is defined as intubation after 48 hours of ICU admission. Results: Early-intubated patients were more likely to have dyspnea than late-intubated patients, and late-intubated patients had a higher mean heart rate than early-intubated patients. The neutrophil/lymphocyte ratio was significantly (P < 0.05) lower in not-intubated patients than in other patients. There was no difference in NLR between early- and late-intubated patients. Mean serum creatine phosphokinase and troponin I levels were higher in late-intubated patients than in early- and not-intubated patients. Early-intubated patients had a lower ROX index than late-intubated patients. Patients with higher scores of APACHE 2, respiratory rates, and neutrophil to lymphocyte ratio were more likely to be intubated. Increasing APACHE and SOFA scores were associated with decreased odds of survival. Conclusions: There were no statistically significant differences in total mortality between early- and late-intubated patients. APACHE 2 scores, NLR, RR, and history of ischemic heart disease are some of the appropriate predictors of intubation. Higher respiratory rates (tachypnea) can be an indicator of early intubation. The ROX index is one of the most sensitive and capable tools for predicting intubation. Intubation status is a potent predictor of in-hospital mortality.
Organ transplantation is known to be a new and innovative treatment for patients with progressive organ failures. The present study investigates the current status of transplantation from cadaver along with its socio-cultural acceptability in Iran. The present study is a descriptive research in a systematic review method. Here, by investigating previously conducted researches in Iran during the period 2002- 2010, the status of transplantation from cadaver and its socio-cultural acceptability in Iran has been investigated. To collect the data, the access to Iranmedex website, the premier medical data center in Iran, was made possible using the related keywords. The obtained data indicate whereas there is an increase in the number of organ donations from cadaver, it is still low in comparison to other countries. The lack of consent from families of brain-dead patients is a major hurdle on the way of organ transplantation in Iran. In the cases of willingness to donate organs, the major effective factors were the deceaseds religious beliefs and prior tendency. In 66% of the cases, the donors families deemed organ donation phenomenon effective in alleviating the sorrow after the death of their beloved ones. The number of organ donation from cadaver in Iran is low contrary to other countries. It seems that general instructions to raise the knowledge on the subject and lay the foundation to increase the tendency towards posthumous organ donation are necessary.International Journal of Natural Sciences (2012), 2(3):63-66 DOI: http://dx.doi.org/10.3329/ijns.v2i3.12133
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