Immunoglobulin G treatment of postcardiac surgery patients with score-identified severe systemic inflammatory response syndrome—The ESSICS study*

Werdan, Karl; Pilz, Günter; Müller‐Werdan, Ursula; Enriquez, Monika Maas; Schmitt, D; Mohr, Friedrich–Wilhelm; Neeser, G.; Schöndube, Friedrich A.; Schäfers, Hans‐Joachim; Haverich, Axel; Fraunberger, Peter; Andersson, Jan; Kreuzer, E.; Thijs, L. G.

doi:10.1097/01.ccm.0b013e3181611f62f

Cited by 43 publications

(24 citation statements)

References 39 publications

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“…Preoperative intravenous methylprednisolone (10 mg/kg) caused a reduction in the serum concentrations of many of these cytokines after CPB, but this reduction was not associated with improved hemodynamic variables, diminished blood loss, less use of inotropic agents, shorter duration of ventilation, or shorter ICU length of stay (63). Similarly, the use of intravenous immunoglobulin G in patients with post-CPB SIRS has not been associated with decreased rates of short-term morbidity or 28-day mortality (64).…”

Section: Use Of Cpbmentioning

confidence: 97%

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

Hillis

Smith

Anderson³

et al. 2011

Journal of the American College of Cardiology

659

161

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Section: Use Of Cpbmentioning

confidence: 97%

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

Hillis

Smith

Anderson³

et al. 2011

Journal of the American College of Cardiology

659

161

View full text Add to dashboard Cite

“…For example, a pilot study found that the use of intravenous immune globulin (IVIG) following cardiac surgery in high‐risk patients significantly improved the Acute Physiology and Chronic Health Evaluation (APACHE) II scores, 8 a measure of overall disease severity in critically ill patients and a surrogate endpoint for mortality 9 . However, when the larger follow‐up RCT was completed, there was no difference in the 28‐day mortality in patients treated with IVIG 10 . In this case, the surrogate measure was not a good indicator of clinically relevant treatment effects.…”

Section: When Is a Surrogate Endpoint Useful?mentioning

confidence: 99%

The use and abuse of surrogate endpoints in clinical research in transfusion medicine

Arnold

Lim²

2008

Transfusion

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“…It is also important to consider serial scoring, which looks at the effectiveness of therapies and the trend during hospitali zation [42,43]. This aspect and the ana lysis of scorespecific subscores, especially the question on the role of inflammation and organ dysfunction, are very interest ing, and we are currently analyzing these data to publish them soon.…”

Section: Scoring In Cardiogenic Shockmentioning

confidence: 99%

“…Identification of these patients in the ICU is clinically important [34]. Previous studies of patients with MODS or sepsis have shown the rele vance of several scoring systems such as the APACHE II [22,42,43] Originalien culation is more complex and laborious. However, a scoring system is only valid for a special group of patients when it has been validated on this group.…”

mentioning

confidence: 99%

“…Identification of these patients in the ICU is clinically important [34]. Previous studies of patients with MODS or sepsis have shown the rele vance of several scoring systems such as the APACHE II [22,42,43], APACHE III [23], Elebute-Stoner [9], SOFA [40], and SAPS II [24] as predictors of prognosis [41]. The APACHE II score was primar ily designed to predict the mortality of patients in ICUs, but attempts have been made to apply this score to patients with severe trauma [37], abdominal complica tions [4], chronic obstructive pulmonary disease [12], acute pancreatitis [10], sepsis [42], and escalating SIRS after cardiac sur gery [43].…”

mentioning

confidence: 99%

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Predictive value of outcome scores in patients suffering from cardiogenic shock complicating AMI

Kellner

Prondzinsky

Pallmann

et al. 2013

Med Klin Intensivmed Notfmed

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Acute myocardial infarction (AMI) is complicated by cardiogenic shock (CS) in 7-10% of cases and the mortality rate is about 60-70% [13,16]. Early revascula rization by percutaneous coronary inter vention (PCI) and intensive care includ ing positive inotropic agents, vasopres sors, and circulatory assist devices are routinely used to improve cardiac output and to prevent multiorgan failure [1,5,16]. Intraaortic balloon pump (IABP) is a commonly used mechanical support sys tem for patients with CS [25,33]. Despite intensive therapy, these patients often de velop a systemic inflammatory response syndrome (SIRS) progressing to multiple organ dysfunction syndrome (MODS) and subsequent death due to multiple or gan failure [6,39]. Identification of these patients in the ICU is clinically important [34]. Previous studies of patients with MODS or sepsis have shown the rele vance of several scoring systems such as the APACHE II [22,42,43] Originalien culation is more complex and laborious. However, a scoring system is only valid for a special group of patients when it has been validated on this group. The objec tive of the present study was to evaluate the predictive value of the APACHE II, APACHE III, Elebute-Stoner, SOFA, and SAPS II scores on mortality, determined on the day of diagnosis/admission of infarctionrelated CS patients and at the point of maximum value. Methods Inclusion and exclusion criteriaPatients treated with primary PCI for CS secondary to AMI, who required inotro pic and/or vasopressor support despite appropriate volume filling, were includ ed in the study. For the diagnosis of CS, the definitions of Hochman et al. [16] and Reynolds et al. [36] were used. The inclu sion and exclusion criteria are shown in . Tab. 1. Study designIn this prospective observational study, carried out in a medical intensive care unit of a university hospital from 2004 to 2005, we consecutively enrolled 45 pa tients in CS. Patients underwent regu lar clinical assessment, complete inva sive monitoring, and frequent blood sam pling for laboratory markers. Datasets for the APACHE II, APACHE III, ElebuteStoner, SOFA, and SAPS II scores and for the patient parameters were calcu lated. Written informed consent was ob tained from all patients or their relatives. The trial was approved by the local eth ics committee. Primary endpointsThe primary endpoint was the value of the initial and the maximum value of the APACHE II, APACHE III, ElebuteStoner, SOFA, and SAPS II scores in pre dicting mortality. Scores were collected at enrollment and then daily for 4 days. Demographic data, admission diagnosis, mechanical ventilation, IABP use, hemo dynamic parameters, survivors, and non survivors were recorded. The APACHE II, APACHE III, Elebute-Stoner, SOFA, and SAPS II scores were determined by the worst value found during the initial 24 h after ICU admission and also by the max imum value during the following 96 h.A flowchart of the study is shown in . Fig. 1. Coronary angiography and PCICoronary angiography and PCI were per formed using...

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Immunoglobulin G treatment of postcardiac surgery patients with score-identified severe systemic inflammatory response syndrome—The ESSICS study*

Abstract: Patients undergoing cardiac surgery (involving cardiopulmonary bypass) who develop severe SIRS derive no improvement in short-term morbidity or 28-day mortality from ivIgG.

Cited by 43 publications

References 39 publications

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

The use and abuse of surrogate endpoints in clinical research in transfusion medicine

Predictive value of outcome scores in patients suffering from cardiogenic shock complicating AMI

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