Objective To study the clinical characteristics and prognosis of patients with persistent inflammation immunosuppression and catabolism syndrome(PICS)in ICU.Methods A total of 126 patients admitted to ICU(ICU stay of ...Objective To study the clinical characteristics and prognosis of patients with persistent inflammation immunosuppression and catabolism syndrome(PICS)in ICU.Methods A total of 126 patients admitted to ICU(ICU stay of more than 10 days,age≥18 years)between January 2014 and December 2014 were retrospectively studied.Data were collected from electronic medical records including demographics,underlying disease。展开更多
BACKGROUND Hypernatremia represents a significant electrolyte imbalance associated with numerous adverse outcomes,particularly in cases of intensive care unit(ICU)-acquired hypernatremia(IAH).Nevertheless,its relevanc...BACKGROUND Hypernatremia represents a significant electrolyte imbalance associated with numerous adverse outcomes,particularly in cases of intensive care unit(ICU)-acquired hypernatremia(IAH).Nevertheless,its relevance in patients with septic shock remains uncertain.AIM To identify independent risk factors and their predictive efficacy for IAH to improve outcomes in patients with septic shock.METHODS In the present retrospective single-center study,a cohort of 157 septic shock patients with concurrent hypernatremia in the ICU at The First Affiliated Hospital of Soochow University,between August 1,2018,and May 31,2023,were analyzed.Patients were categorized based on the timing of hypernatremia occurrence into the IAH group(n=62),the non-IAH group(n=41),and the normonatremia group(n=54).RESULTS In the present study,there was a significant association between the high serum sodium concentrations,excessive persistent inflammation,immunosuppression and catabolism syndrome and chronic critical illness,while rapid recovery had an apparent association with normonatremia.Moreover,multivariable analyses revealed the following independent risk factors for IAH:Total urinary output over the preceding three days[odds ratio(OR)=1.09;95%CI:1.02–1.17;P=0.014],enteral nutrition(EN)sodium content of 500 mg(OR=2.93;95%CI:1.13–7.60;P=0.027),and EN sodium content of 670 mg(OR=6.19;95%CI:1.75–21.98;P=0.005)were positively correlated with the development of IAH.Notably,the area under the curve for total urinary output over the preceding three days was 0.800(95%CI:0.678–0.922,P=0.001).Furthermore,maximum serum sodium levels,the duration of hypernatremia,and varying sodium correction rates were significantly associated with 28-day in-hospital mortality in septic shock patients(P<0.05).CONCLUSION The present findings illustrate that elevated serum sodium level was significantly associated with a poor prognosis in septic shock patients in the ICU.It is highly recommended that hypernatremia be considered a potentially important prognostic indicator for the outcome of septic shock.展开更多
The global incidence of critical illness has been steadily increasing,resulting in higher mortality rates thereby presenting substantial challenges for clinical mana-gement.Among these conditions,sepsis stands out as ...The global incidence of critical illness has been steadily increasing,resulting in higher mortality rates thereby presenting substantial challenges for clinical mana-gement.Among these conditions,sepsis stands out as the leading cause of critical illness,underscoring the urgent need for continued research to enhance patient care and deepen our understanding of its complex pathophysiology.Lympho-cytes play a pivotal role in both innate and adaptive immune responses,acting as key regulators of the balance between pro-inflammatory and anti-inflam-matory processes to preserve immune homeostasis.In the context of sepsis,an impaired immunity has been associated with disrupted lymphocytic metabolic activity,persistent pro-inflammatory state,and subsequent immunosuppression.These disruptions not only impair pathogen clearance but also predispose pati-ents to secondary infections and hinder recovery,highlighting the importance of targeting lymphocyte dysfunction in sepsis management.Moreover,studies have identified absolute lymphocyte counts and derived parameters as promising clinical biomarkers for prognostic assessment and therapeutic decision-making.In particular,neutrophil-to-lymphocyte ratio,and lymphopenia have gained reco-gnition in the literature as a critical prognostic markers and therapeutic target in the management of sepsis.This review aims to elucidate the multifaceted role of lymphocytes in pathophysiology,with a focus on recent advancements in their use as biomarkers and key findings in this evolving field.展开更多
Inflammation is a complex and highly regulated response that occurs early after infection or injury.This process is initiated by cells of the immune system to re-establish tissue homeostasis.When the injury is persist...Inflammation is a complex and highly regulated response that occurs early after infection or injury.This process is initiated by cells of the immune system to re-establish tissue homeostasis.When the injury is persistent,however,chronic inflammation leads to overproduction of noxious mediators that contribute to cell dysfunction and death.展开更多
文摘Objective To study the clinical characteristics and prognosis of patients with persistent inflammation immunosuppression and catabolism syndrome(PICS)in ICU.Methods A total of 126 patients admitted to ICU(ICU stay of more than 10 days,age≥18 years)between January 2014 and December 2014 were retrospectively studied.Data were collected from electronic medical records including demographics,underlying disease。
基金Supported by The National Natural Science Foundation of China,No.82072130Key Medical Research Projects in Jiangsu Province,No.ZD2022021Suzhou Clinical Medical Center for Anesthesiology,No.Szlcyxzxj202102。
文摘BACKGROUND Hypernatremia represents a significant electrolyte imbalance associated with numerous adverse outcomes,particularly in cases of intensive care unit(ICU)-acquired hypernatremia(IAH).Nevertheless,its relevance in patients with septic shock remains uncertain.AIM To identify independent risk factors and their predictive efficacy for IAH to improve outcomes in patients with septic shock.METHODS In the present retrospective single-center study,a cohort of 157 septic shock patients with concurrent hypernatremia in the ICU at The First Affiliated Hospital of Soochow University,between August 1,2018,and May 31,2023,were analyzed.Patients were categorized based on the timing of hypernatremia occurrence into the IAH group(n=62),the non-IAH group(n=41),and the normonatremia group(n=54).RESULTS In the present study,there was a significant association between the high serum sodium concentrations,excessive persistent inflammation,immunosuppression and catabolism syndrome and chronic critical illness,while rapid recovery had an apparent association with normonatremia.Moreover,multivariable analyses revealed the following independent risk factors for IAH:Total urinary output over the preceding three days[odds ratio(OR)=1.09;95%CI:1.02–1.17;P=0.014],enteral nutrition(EN)sodium content of 500 mg(OR=2.93;95%CI:1.13–7.60;P=0.027),and EN sodium content of 670 mg(OR=6.19;95%CI:1.75–21.98;P=0.005)were positively correlated with the development of IAH.Notably,the area under the curve for total urinary output over the preceding three days was 0.800(95%CI:0.678–0.922,P=0.001).Furthermore,maximum serum sodium levels,the duration of hypernatremia,and varying sodium correction rates were significantly associated with 28-day in-hospital mortality in septic shock patients(P<0.05).CONCLUSION The present findings illustrate that elevated serum sodium level was significantly associated with a poor prognosis in septic shock patients in the ICU.It is highly recommended that hypernatremia be considered a potentially important prognostic indicator for the outcome of septic shock.
文摘The global incidence of critical illness has been steadily increasing,resulting in higher mortality rates thereby presenting substantial challenges for clinical mana-gement.Among these conditions,sepsis stands out as the leading cause of critical illness,underscoring the urgent need for continued research to enhance patient care and deepen our understanding of its complex pathophysiology.Lympho-cytes play a pivotal role in both innate and adaptive immune responses,acting as key regulators of the balance between pro-inflammatory and anti-inflam-matory processes to preserve immune homeostasis.In the context of sepsis,an impaired immunity has been associated with disrupted lymphocytic metabolic activity,persistent pro-inflammatory state,and subsequent immunosuppression.These disruptions not only impair pathogen clearance but also predispose pati-ents to secondary infections and hinder recovery,highlighting the importance of targeting lymphocyte dysfunction in sepsis management.Moreover,studies have identified absolute lymphocyte counts and derived parameters as promising clinical biomarkers for prognostic assessment and therapeutic decision-making.In particular,neutrophil-to-lymphocyte ratio,and lymphopenia have gained reco-gnition in the literature as a critical prognostic markers and therapeutic target in the management of sepsis.This review aims to elucidate the multifaceted role of lymphocytes in pathophysiology,with a focus on recent advancements in their use as biomarkers and key findings in this evolving field.
基金supported by grants from the Canadian Institutes of Health Research and the Fonds de recherche du Québec-Santé (FRQS)National Chercheur Boursier award from FRQS
文摘Inflammation is a complex and highly regulated response that occurs early after infection or injury.This process is initiated by cells of the immune system to re-establish tissue homeostasis.When the injury is persistent,however,chronic inflammation leads to overproduction of noxious mediators that contribute to cell dysfunction and death.
