C-reactive protein clustering to clarify persistent inflammation, immunosuppression and catabolism syndrome

Nakamura, Kensuke; Ogura, Kentaro; Nakano, Hidehiko; Naraba, Hiromu; Takahashi, Yūji; Sonoo, Tomohiro; Hashimoto, Hideki; Morimura, Naoto

doi:10.1007/s00134-019-05851-3

Cited by 35 publications

(34 citation statements)

References 26 publications

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“…The number of absolute lymphocyte measurements conducted in this study was rather scarce, and although the high group tended to reach lower values, medians were still above the initially defined threshold of 0.800 G/L. Interestingly, this is in line with other studies on PICS, which have also shown very similar values, so the sensitivity of the propagated threshold may be questionable [ 18 , 21 , 42 ]. Readily identifying profuse catabolism can also be challenging.…”

Section: Discussionsupporting

confidence: 80%

“…The transition point to a beginning PICS potentially ending in CCI seems to be between ICU day 7 and 10 [ 17 , 18 ], hence the definition of the main observation period in this study. Regarding markers of inflammation, CRP levels were clearly within the PICS definition, even when utilizing a recently published threshold of 3 mg/dL derived from a retrospective study on CRP clustering in PICS [ 42 ]. Immunosuppression, however, is not so easily proven.…”

Section: Discussionmentioning

confidence: 99%

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ICU-Acquired Hypernatremia Is Associated with Persistent Inflammation, Immunosuppression and Catabolism Syndrome

Rugg

Ströhle

Treml

et al. 2020

JCM

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Developing hypernatremia while on intensive care unit (ICU) is a common problem with various undesirable effects. A link to persistent inflammation, immunosuppression and catabolism syndrome (PICS) can be established in two ways. On the one hand, hypernatremia can lead to inflammation and catabolism via hyperosmolar cell stress, and on the other, profound catabolism can lead to hypernatremia via urea-induced osmotic diuresis. In this retrospective single-center study, we examined 115 patients with prolonged ICU stays (≥14 days) and sufficient renal function. Depending on their serum sodium concentrations between ICU day 7 and 21, allocation to a hypernatremic (high) and a nonhypernatremic group (low) took place. Distinct signs of PICS were detectable within the complete cohort. Thirty-three of them (28.7%) suffered from ICU-acquired hypernatremia, which was associated with explicitly higher signs of inflammation and ongoing catabolism as well as a prolonged ICU length of stay. Catabolism was discriminated better by the urea generation rate and the urea-to-creatinine ratio than by serum albumin concentration. An assignable cause for hypernatremia was the urea-induced osmotic diuresis. When dealing with ICU patients requiring prolonged treatment, hypernatremia should at least trigger thoughts on PICS as a contributing factor. In this regard, the urea-to-creatinine ratio is an easily accessible biomarker for catabolism.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

ICU-Acquired Hypernatremia Is Associated with Persistent Inflammation, Immunosuppression and Catabolism Syndrome

Rugg

Ströhle

Treml

et al. 2020

JCM

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“…Moreover, this CRP value was apparently too low. An earlier report described day 14 CRP as an equally suitable criterion to 3.0 mg/dL for PIICS [ 6 ]. With such clinical criteria to detect PIICS development, the patients’ immunosuppression can be evaluated before actual infection occurs.…”

Section: Introductionmentioning

confidence: 99%

Disseminated Intravascular Coagulopathy Is Associated with the Outcome of Persistent Inflammation, Immunosuppression and Catabolism Syndrome

Nakamura

Ogura

Nakano

et al. 2020

JCM

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Persistent inflammation, immunosuppression and catabolism syndrome (PIICS) often occur after critical care. Disseminated intravascular coagulation (DIC) is expected to be associated independently with PIICS development. We retrospectively analyzed 5397 patients admitted to the Hitachi General Hospital emergency and critical care center during four years. We classified PIICS as C-reactive protein > 3.0 mg/dL or albumin < 3.0 g/dL or lymphocyte count < 800/μL on day 14. Prolonged hospital stay (>14 days) without PIICS and early recovery (discharged alive within 14 days) were assigned as non-PIICS. Early death (death within 14 days) was identified. We analyzed the association between the International Society on Thrombosis and Haemostasis overt DIC and PIICS outcomes. Results revealed 488 PIICS, 416 early death and 4493 non-PIICS cases. Analyses showed DIC as associated significantly with mortality, the Barthel index at discharge and PIICS development. Multivariate regression analysis and a generalized structural equation model identified DIC on admission as an independent risk factor for PIICS in surviving patients.

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“…13,14 In Japan, the Next Stage ER system (NSER; TXP Medical Co. Ltd, Tokyo, Japan) has been increasingly implemented in EDs of university and tertiary care hospitals. 15 The NSER system supports not only physician decision making, clinician workflow, and communication but also EMR standardization. Through the prespecified forms for each component of medical records (e.g., chief complaints), the NSER system automatically translates recorded free-text EMRs into structured data regardless of the EMR software.…”

Section: Introductionmentioning

confidence: 99%

“…Several studies have utilized artificial intelligent algorithms to automatically extract structured information from clinical notes in EMRs 13,14 . In Japan, the Next Stage ER system (NSER; TXP Medical Co. Ltd, Tokyo, Japan) has been increasingly implemented in EDs of university and tertiary care hospitals 15 . The NSER system supports not only physician decision making, clinician workflow, and communication but also EMR standardization.…”

Section: Introductionmentioning

confidence: 99%

Validation of chief complaints, medical history, medications, and physician diagnoses structured with an integrated emergency department information system in Japan: the Next Stage ER system

Goto

Hara

Hashimoto

et al. 2020

Acute Medicine & Surgery

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Aim Emergency department information systems (EDIS) facilitate free‐text data use for clinical research; however, no study has validated whether the Next Stage ER system (NSER), an EDIS used in Japan, accurately translates electronic medical records (EMRs) into structured data. Methods This is a retrospective cohort study using data from the emergency department (ED) of a tertiary care hospital from 2018 to 2019. We used EMRs of 500 random samples from 27,000 ED visits during the study period. Through the NSER system, chief complaints were translated into 231 chief complaint categories based on the Japan Triage and Acuity Scale. Medical history and physician’s diagnoses were encoded using the International Classification of Diseases, 10th Revision; medications were encoded as Anatomical Therapeutic Chemical Classification System codes. Two reviewers independently reviewed 20 items (e.g., presence of fever) for each study component (e.g., chief complaints). We calculated association measures of the structured data by the NSER system, using the chart review results as the gold standard. Results Sensitivities were very high (>90%) in 17 chief complaints. Positive predictive values were high for 14 chief complaints (≥80%). Negative predictive values were ≥96% for all chief complaints. For medical history and medications, most of the association measures were very high (>90%). For physicians’ ED diagnoses, sensitivities were very high (>93%) in 16 diagnoses; specificities and negative predictive values were very high (>97%). Conclusions Chief complaints, medical history, medications, and physician’s ED diagnoses in EMRs were well‐translated into existing categories or coding by the NSER system.

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C-reactive protein clustering to clarify persistent inflammation, immunosuppression and catabolism syndrome

Cited by 35 publications

References 26 publications

ICU-Acquired Hypernatremia Is Associated with Persistent Inflammation, Immunosuppression and Catabolism Syndrome

ICU-Acquired Hypernatremia Is Associated with Persistent Inflammation, Immunosuppression and Catabolism Syndrome

Disseminated Intravascular Coagulopathy Is Associated with the Outcome of Persistent Inflammation, Immunosuppression and Catabolism Syndrome

Validation of chief complaints, medical history, medications, and physician diagnoses structured with an integrated emergency department information system in Japan: the Next Stage ER system

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