Hypermetabolism-Organ Failure Syndrome: A Metabolic Response to Injury

Cerra, Frank B.

doi:10.1016/s0749-0704(18)30437-8

Cited by 95 publications

(85 citation statements)

References 24 publications

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“…1 However, the main cause of mortality in such patients is multiple organ system dysfunction (MOSD) as a result of an exacerbated systemic infl ammatory response, with or without infection. 1,2 Preoperative identifi cation of patients at risk of postoperative complications may have an impact on surgical management and enable treatment modifi cations so as to reduce morbid-mortality. Thus, the identifi cation of variables of interest for predicting the risk of postoperative infections has become the main objective of several reports.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of National Nosocomial Infection Surveillance score, acute-phase proteins, and interleukin-6 for predicting postoperative infections following major gastrointestinal surgery

et al. 2007

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were studied. The NNIS score and the evolution of serum IL-6 and various acute-phase proteins (C-reactive protein [CRP], albumin, prealbumin and transferrin) were correlated with postoperative infections and length of hospital stay (LOS). RESULTS:NNIS > 1 (p = 0.01) and low preoperative albumin (p = 0.02) signifi cantly correlated with infection. IL-6 and CRP increased significantly more in patients with infections. Multivariate analysis showed greater risk of infection when NNIS > 1 (odds ratio, OR = 10.66; 95% confi dence interval, CI: 1.1-102.0; p = 0.04); preoperative albumin < 3 g/dl (OR = 8.77; 95% CI: 1.13-67.86; p = 0.03); CRP > 30 mg/l on the second postoperative day (OR = 8.27; 95% CI: 1.05-64.79; p = 0.03) and > 12 mg/l on the fi fth postoperative day (OR = 25.92; 95% CI: 2.17-332.71; p < 0.01); and IL-6 > 25 pg/ml on the fi fth postoperative day (OR = 15.46; 95% CI: 1.19-230.30; p = 0.03). Longer LOS was associated with cancer, transferrin, IL-6 and albumin (p < 0.05).CONCLUSIONS: NNIS, albumin, CRP and IL-6 may be useful as predictive markers for postoperative infections. For predicting LOS, malignant condition, transferrin, albumin and IL-6 are useful.

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Section: Introductionmentioning

confidence: 99%

“…1,2 Therefore, patients presenting acute-phase response during the preoperative period may be at risk. Studies focusing on the cause and functional characteristics of this preoperative or early postoperative sensitization could put forward therapeutic options for avoiding postoperative complications.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of National Nosocomial Infection Surveillance score, acute-phase proteins, and interleukin-6 for predicting postoperative infections following major gastrointestinal surgery

et al. 2007

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“…Tais fenômenos estão associados com o supercrescimento bacteriano no intestino delgado 1,35,40,41 e com a translocação através da mucosa intestinal 36 . A passagem de bactérias viáveis e suas toxinas pelo fluxo porta pode levar a um comprometimento sistêmico e hepático, assim como a um aumento da resposta metabólica 37 , em função da produção de agentes hepatotóxicos, tais como subprodutos bacterianos, endotoxinas e litocolato 1,38 . Todos esses eventos estariam relacionados com o desenvolvimento de colestase por inibição da secreção biliar 3,17 .…”

Section: Agente Etiológicounclassified

Parenteral nutrition related cholestasis: infection as the main risk factor

Carvalho

Silveira²

1995

J Pediatr (Rio J)

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Total parenteral nutrition-associated cholestasis (TPN-AC) is a clinical problem of special interest in neonates and in other age groups. This retrospective cohort study attempted to determine the incidence and the appearing time of cholestasis in Intensive Care Unit (ICU) patients beyond neonatal period, submitted to total parenteral nutrition (TPN) for more than five consecutive days, foccusing on the relation of TPN-AC and severe infection. Data on one hundred and thirteen patients, aged from one month to 14 years, collected over a period of ten years, were analyzed. All patients, followed up to the TPN stop or their death, were classified in two groups: with and without cholestasis. They were evaluated in relation to cholestasis potential risk factors, such as severe infection. Cholestasis was identified by a conjugated bilirrubin (DB) and total bilirrubin rate equal or superior to 40% and/or a DB equal or superior to 0.5 mg/dl during the TPN laboratory monitoring. Logistic regression analysis was used to control and to adjust for the cholestasis confusion factors. The incidence of cholestasis was 18%, but it was very important in patients younger than 6 months (26% vs 12%) (p=0.06), in patients that use TPN for more than 2 weeks (25% vs 8%) (p=0.01), as well as in patients with severe infection (24% vs 3%) (p=0.02). On the average cholestasis appeared 17.6 days after TPN inception, with a range of 5 to 35 days. Control of the simultaneous effect of age, TPN duration, and severe infection has shown that in patients with less than 6 months the relative risk was 2.6 (NS); in patients with TPN longer than 2 weeks it was 3.1 (p=0.02); and in patients with severe infection it was 7.4 (p=0.006). The results suggest that TPN-AC in children beyond neonatal period is a relatively frequent event (18%), and severe infection is the most important risk factor for cholestasis.J. pediatr. (Rio J.). 1995; 71(5):255-260: cholestasis, liver dysfunction, liver function tests, severe infection, total parenteral nutrition. ResumoA colestase associada à nutrição parenteral (CANP) é um problema clínico de especial interesse tanto no recém-nascido, quanto nas demais faixas etárias. O objetivo deste estudo de coorte (retrospectivo) foi o de determinar a incidência e o tempo de aparecimento de colestase em crianças com mais de um mês de idade hospitalizadas em Unidade de Tratamento Intensivo (UTI) Pediátrica e submetidas à nutrição parenteral (NP) por mais de cinco dias consecutivos, bem como, a relação entre a CANP e a infecção grave. Foram revisados 113 pacientes de UTI Pediátrica de hospital universitário de referência terciária, com idades de 1 mês a 14 anos, submetidos à NP por mais de 5 dias consecutivos, em um período de 10 anos. Os pacientes foram seguidos até a suspensão da NP ou até o óbito e classificados de acordo com o aparecimento de colestase. Também foram avaliados os potenciais fatores de risco para a colestase, entre os quais a infecção grave. A colestase foi caracterizada por uma relação da fração conjugada...

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“…In this connection, a promising solution is to create a system of early diagnosis of hypermetabolic syndrome, accessible to every intensive care doctor, enabling therapy correction prior to the development of decompensated multiple organ dysfunction [7,8].…”

Section: Introductionmentioning

confidence: 99%

“…Apart from that, the methods of correction of metabolic disorders accompanying MODS are not sufficiently developed [4,8,9].…”

Section: Introductionmentioning

confidence: 99%

Fatty Acid Composition of Erythrocytes and Blood Plasma in Multiple Organ Dysfunction Syndrome

Осипенко¹

2015

BIO

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This paper focused on analysis of fatty acids of erythrocytes and blood plasma in patients with multiple organ dysfunction syndrome. For the study, fatty acids ethyl esters, obtained during sample preparation from blood plasma and erythrocytes, were analyzed by capillary gas-liquid chromatography. Statistical analysis was performed using the Mann-Whitney U test (p<0.05). The conducted research has shown that blood plasma of MODS patients has a decreased relative level of polyunsaturated fatty acids and saturated stearic (C18:0) acid, while there is a significant increase in relative content of monounsaturated fatty acids. In conditions of an increased level of monounsaturated palmitoleic (C16:1) and oleic (C18:1) fatty acids in blood plasma, only the level of palmitoleic (C16:1) acid is increased in erythrocytes. The disorder of lipid composition constancy of erythrocyte membranes is also manifested by a change in the content of saturated palmitic (C16:0) and polyunsaturated linoleic (C18:2) fatty acids. The changes revealed in fatty acid composition of erythrocytes may indicate systemic modifications of cell membranes in multiple organ dysfunction syndrome. The changes in blood plasma fatty acid composition in patients with multiple organ dysfunction syndrome is mainly caused by activation of lipolysis in fat depots.

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Hypermetabolism-Organ Failure Syndrome: A Metabolic Response to Injury

Cited by 95 publications

References 24 publications

Efficacy of National Nosocomial Infection Surveillance score, acute-phase proteins, and interleukin-6 for predicting postoperative infections following major gastrointestinal surgery

Efficacy of National Nosocomial Infection Surveillance score, acute-phase proteins, and interleukin-6 for predicting postoperative infections following major gastrointestinal surgery

Parenteral nutrition related cholestasis: infection as the main risk factor

Fatty Acid Composition of Erythrocytes and Blood Plasma in Multiple Organ Dysfunction Syndrome

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