Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. Sepsis-induced myocardial dysfunction represents reversible myocardial dysfunction which ...ultimately results in left ventricular dilatation or both, with consequent loss of contractility. Studies on septic cardiomyopathy report a wide range of prevalence ranging from 10% to 70%. Myocardial damage occurs as a result of weakened myocardial circulation, direct myocardial depression, and mitochondrial dysfunction. Mitochondrial dysfunction is the leading problem in the development of septic cardiomyopathy and includes oxidative phosphorylation, production of reactive oxygen radicals, reprogramming of energy metabolism, and mitophagy. Echocardiography provides several possibilities for the diagnosis of septic cardiomyopathy. Systolic and diastolic dysfunction of left ventricular is present in 50-60% of patients with sepsis. Right ventricular dysfunction is present in 50-55% of cases, while isolated right ventricular dysfunction is present in 47% of cases. Left ventricle (LV) diastolic dysfunction is very common in septic shock, and it represents an early biomarker, it has prognostic significance. Right ventricular dysfunction associated with sepsis patients with worse early prognosis. Global longitudinal stress and magnetic resonance imaging (MRI) of the heart are sufficiently sensitive methods, but at the same time MRI of the heart is difficult to access in intensive care units, especially when dealing with critically ill patients. Previous research has identified two biomarkers as a result of the integrated mitochondrial response to stress, and these are fibroblast growth factor-21 (FGF-21) and growth differentiation factor-15 (GDF-15). Both of the mentioned biomarkers can be easily quantified in serum or plasma, but they are difficult to be specific in patients with multiple comorbidities. Mitochondrial dysfunction is also associated with reduced levels of miRNA (microRNA), some research showed significance of miRNA in sepsis-induced myocardial dysfunction, but further research is needed to determine the clinical significance of these molecules in septic cardiomyopathy. Therapeutic options in the treatment of septic cardiomyopathy are not specific, and include the optimization of hemodynamic parameters and the use of antibiotic thera-pies with targeted action. Future research aims to find mechanisms of targeted action on the initial mechanisms of the development of septic cardiomyopathy.Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. Sepsis-induced myocardial dysfunction represents reversible myocardial dysfunction which ultimately results in left ventricular dilatation or both, with consequent loss of contractility. Studies on septic cardiomyopathy report a wide range of prevalence ranging from 10% to 70%. Myocardial damage occurs as a result of weakened myocardial circulation, direct myocardial depression, and mitochondrial dysfunction. Mitochondrial dysfunction is the leading problem in the development of septic cardiomyopathy and includes oxidative phosphorylation, production of reactive oxygen radicals, reprogramming of energy metabolism, and mitophagy. Echocardiography provides several possibilities for the diagnosis of septic cardiomyopathy. Systolic and diastolic dysfunction of left ventricular is present in 50-60% of patients with sepsis. Right ventricular dysfunction is present in 50-55% of cases, while isolated right ventricular dysfunction is present in 47% of cases. Left ventricle (LV) diastolic dysfunction is very common in septic shock, and it represents an early biomarker, it has prognostic significance. Right ventricular dysfunction associated with sepsis patients with worse early prognosis. Global longitudinal stress and magnetic resonance imaging (MRI) of the heart are sufficiently sensitive methods, but at the same time MRI of the heart is difficult to access in intensive care units, especially when dealing with critically ill patients. Previous research has identified two biomarkers as a result of the integrated mitochondrial response to stress, and these are fibroblast growth factor-21 (FGF-21) and growth differentiation factor-15 (GDF-15). Both of the mentioned biomarkers can be easily quantified in serum or plasma, but they are difficult to be specific in patients with multiple comorbidities. Mitochondrial dysfunction is also associated with reduced levels of miRNA (microRNA), some research showed significance of miRNA in sepsis-induced myocardial dysfunction, but further research is needed to determine the clinical significance of these molecules in septic cardiomyopathy. Therapeutic options in the treatment of septic cardiomyopathy are not specific, and include the optimization of hemodynamic parameters and the use of antibiotic thera-pies with targeted action. Future research aims to find mechanisms of targeted action on the initial mechanisms of the development of septic cardiomyopathy.
The main aim of this study was to examine the association of glucose and sodium level with diagnosis and disease outcome of critically ill patients. Glucose and sodium concentrations of 283 patients ...admitted in critical condition to the Intensive Care Unit of the Department of Internal Medicine in a period from November 1, 2015 to February 28, 2017 were reviewed. The most common diagnoses in critically ill patients were acute kidney injury (26.1%) and sepsis (including septic shock, 22.3%). Significantly lower glucose concentration was observed in patients with acute kidney injury (p=0.02), whereas patients in sepsis and septic shock had a significantly higher sodium concentration (p=0.04). Higher glucose level was related to higher mortality rate (p=0.001). On the other hand, sodium level was not significantly associated with survival. Higher mortality, as well as higher glucose concentration were more common in patients older than 65 years (p<0.001). Study results showed significantly lower glucose concentrations in patients with acute kidney injury, whereas in patients older than 65, glucose concentration was significantly higher. Patients in sepsis and septic shock had significantly higher sodium concentrations. Higher concentration of glucose was connected with higher mortality in the elderly, whereas sodium concentration did not show connection with mortality.
Nuclear factor erythroid 2-related factor 2 (Nrf2) and heme oxygenase-1 (HO-1) have significant roles in the development of a hyperinflammatory state in infectious diseases. We aimed to investigate ...the association of the serum concentrations of Nrf2 and HO-1 with the severity of COVID-19 disease. The study included 40 subjects with mild and moderately severe forms of the disease (MEWS scoring system ≤2). Twenty of the subjects had MEWS scores of 3 or 4, which indicate a severe form of the disease, and twenty subjects had a MEWS score of ≥5, which indicates a critical form of the disease. HO-1 and Nrf2 were measured using the commercially available Enzyme-Linked Immunosorbent Assay (ELISA). Subjects with the most severe form of COVID-19 (critically ill) had a lower concentration of Nrf2 that negatively correlated with the markers of hyperinflammatory response (CRP, IL-6, ferritin). This observation was not made for HO-1, and the correlation between Nrf2 and HO-1 values was not established. In the mild/moderate form of COVID-19 disease, Nrf2 was associated with an increased 1,25 dihydroxy vitamin D concentration. The results of this study show that Nrf2 has a role in the body’s anti-inflammatory response to COVID-19 disease, which makes it a potential therapeutic target.
Visceral adipose tissue is an independent risk factor for the development of atherosclerotic coronary disease, arterial hypertension, diabetes and metabolic syndrome. Right heart morphology often ...involves the presence of adipose tissue, which can be quantified by non-invasive imaging methods. The last decade brought a wealth of new insights into the function and morphology of adipose tissue, with great emphasis on its role in the pathogenesis of heart disease. Cardiac adipose tissue is involved in thermogenesis, mechanical protection of the heart and energy storage. However, it can also be an endocrine organ that synthesises numerous pro-inflammatory and anti-inflammatory cytokines, the effect of which is accomplished by paracrine and vasocrine mechanisms. Visceral adipose tissue has several compartments that differ in their embryological origin and vascularisation. Deficiency of cardiac adipose tissue, often due to chronic pathological conditions such as oncological diseases or chronic infectious diseases, predicts increased mortality and morbidity. To date, knowledge about the influence of visceral adipose tissue on cardiac morphology is limited, especially the effect on the morphology of the right heart in a state of excess or deficient visceral adipose tissue.
SARS-CoV-2 virus infection starts with the internalization of the viral particle into the host cells, mainly the upper respiratory system epithelial cells which have the highest expression of the ...ACE2 receptor which is essential for the internalization process. The pathophysiology of severe forms of COVID-19 disease results not only from direct, cytopathic viral effect but also from immune response dysregulation of the host resulting in hyperinflammatory state and oxidative stress. The nuclear factor erythroid 2-related factor 2 (Nrf2) ability to protect cells and induce a rapid anti-inflammatory and antioxidant response primarily depends on its constitutive cellular expression, which can be affected by numerous endogenous and exogenous factors. The binding of Nrf2 to cellular receptors leads to the transcription of a large number of genes encoding various antioxidant enzymes and other cytoprotective molecules, including heme oxygenase-1(HO-1). Activation of HO-1 results in antioxidant, anti-inflammatory and anti-apoptotic effects. Based on previous studies, the Nrf2/HO-1 pathway provides protection against oxidative stress and inflammatory and immune response which is significant in COVID-19 infection, which is characterized by a strong hyperinflammatory response. This narrative review aims to describe the role of the hyperinflammatory response in the development of COVID-19 infection, with a focus on the NrF2/HO-1 pathway.
Lemierre's syndrome refers to the septic thrombophlebitis of the internal jugular vein. The condition typically begins with an oropharyngeal infection and frequently involves inflammation within the ...wall of the vein, infected thrombus within the lumen, surrounding soft tissue inflammation, persistent bacteremia, and septic emboli. Lemierre's syndrome is a rare disease; it occurs most commonly in otherwise healthy young adults. The most common etiologic agent is Fusobacterium necrophorum. We present a case of Lemierre's syndrome in a young girl and the role of extracorporeal method of blood purification with continuous venous hemodiafiltration with the use of a highly adsorptive membrane (AN69 HeprAN), thus achieving the combined elimination of cytokines and endotoxins. The use of advanced methods, along with an antibiotic and surgical treatment, will certainly help reduce mortality in this syndrome.
The main aim of this study was to examine the association of glucose and sodium level with diagnosis and disease outcome of critically ill patients. Glucose and sodium concentrations of 283 patients ...admitted in critical condition to the Intensive Care Unit of the Department of Internal Medicine in a period from November 1, 2015 to February 28, 2017 were reviewed. The most common diagnoses in critically ill patients were acute kidney injury (26.1%) and sepsis (including septic shock, 22.3%). Significantly lower glucose concentration was observed in patients with acute kidney injury (p=0.02), whereas patients in sepsis and septic shock had a significantly higher sodium concentration (p=0.04). Higher glucose level was related to higher mortality rate (p=0.001). On the other hand, sodium level was not significantly associated with survival. Higher mortality, as well as higher glucose concentration were more common in patients older than 65 years (p<0.001). Study results showed significantly lower glucose concentrations in patients with acute kidney injury, whereas in patients older than 65, glucose concentration was significantly higher. Patients in sepsis and septic shock had significantly higher sodium concentrations. Higher concentration of glucose was connected with higher mortality in the elderly, whereas sodium concentration did not show connection with mortality. Key words: Critical illness; Glucose; Intensive care unit; Sodium Glavni cilj ovog istrazivanja bio je ispitati povezanost koncentracije glukoze i natrija s dijagnozom i ishodom bolesti kod bolesnika u kriticnom stanju. Pregledane su koncentracije glukoze i natrija kod 283 bolesnika primljenih u kriticnom stanju u Jedinicu intenzivnog lijecenja Klinike za unutarnje bolesti u razdoblju od 1. studenoga 2015. do 28. veljace 2017. godine. Najcesce dijagnoze bolesnika u kriticnom stanju bile su akutno zatajenje bubrega (26,1%) i sepsa (ukljucujuci septicki sok, 22,3%). Znacajno niza koncentracija glukoze zabiljezena je u bolesnika s akutnim zatajenjem bubrega (p=0,02), dok su bolesnici u sepsi i septickom soku imali znacajno visu koncentraciju natrija (p=0,04). Povisena koncentracija glukoze bila je povezana s povecanom smrtnoscu (p=0,001). S druge strane, koncentracija natrija nije bila znacajno povezana s prezivljenjem. Visa smrtnost kao i visa koncentracija glukoze bili su cesci u bolesnika starijih od 65 godina (p<0,001). U prikazanom istrazivanju utvrdene su znacajno nize koncentracije glukoze kod bolesnika s akutnim zatajenjem bubrega, dok su u bolesnika starijih od 65 godina bile znacajno vise koncentracije glukoze. Kod bolesnika u sepsi i septickom soku uocene su znacajno vise koncentracije natrija. Povisena koncentracija glukoze bila je povezana s visom smrtnoscu u starijih osoba, dok koncentracija natrija nije bila povezana s prezivljavanjem. Kljucne rijeci: Glukoza; Jedinica intenzivnog lijecenja; Kriticno stanje; Natrij
Introduction: CPR/albumin ratio represents a new biomarker that integrates two laboratory-tested acute phase reactants: a positive one (C-reactive protein) and a negative one (albumin), and which can ...be used as an indicator of the severity, progression and outcome of various illnesses, including critical illnesses. In this retrospective study, we investigated the impact of the CRP/albumin ratio on the clinical characteristics and outcome of the treatment of critically ill and mechanically ventilated adult patients. Patients and methods: This retrospective study included 100 critically ill patients (65 % males and 35 % females; median age of 67) treated at the medical intensive care unit (ICU) which required the use of invasive mechanical ventilation. The primary diagnoses upon admission to the intensive care unit were: sepsis and septic shock (39 %), acute heart failure or worsening chronic heart failure (20 %), exacerbation of chronic obstructive pulmonary disease (16 %), pneumonia (11 %), acute kidney injury or the exacerbation of chronic kidney disease (7 %) and other conditions (7 %). Results: Correlation analysis showed a significant moderate positive correlation between CRP/albumin ratio and the duration of mechanical ventilation measured in hours (r = 0.48, p = 0.001) and the time spent in the intensive care unit, measured in days (r = 0.44, p = 0.001). The median of the CRP/albumin ratio was 58.77 and the patients in the above-the-median group had a higher SOFA score. In terms of the outcomes, it has been determined that the surviving patients (56 %) had a significantly lower CRP/albumin ratio compared to those that had not survived (44 %), which correlates with their SOFA scores as well. In the group of survivors, the correlation between the ratio of CRP/albumin and the SOFA score is positive and statistically significant (r = 0.29, p = 0.03), in the group non-survivoris (r= 0.45, p = 0.003.) Conclusion: Based on the results of our study, the CRP/albumin ratio has proved to be a good predictor of clinical characteristics and outcomes of critically ill and mechanically ventilated patients.
Uvod: Omjer CPR/albumin predstavlja novi biomarker koji integrira dva laboratorijski ispitanareaktanta akutne faze: pozitivni (C-reaktivni protein) i negativni (albumin), a koji se može koristiti kaopokazatelj težine, progresije i ishoda raznih bolesti, uključujući kritične bolesti. U ovoj retrospektivnojstudiji istraživali smo utjecaj omjera CRP/albumin na kliničke karakteristike i ishod liječenja kritičnobolesnih, mehanički ventiliranih bolesnika.Bolesnici i metode: Ova retrospektivna studija uključila je 100 kritično oboljelih bolesnika (65 %muškaraca i 25 % žena, prosječne dobi 67 godina) liječenih na Jedinici intenzivnog liječenja (JIL) koji suzahtijevali primjenu invazivne mehaničke ventilacije. Primarne dijagnoze po prijemu u jedinicuintenzivnog liječenja bile su: sepsa i septički šok (39 %), akutno zatajenje srca ili pogoršanje kroničnogzatajenja srca (20 %), egzacerbacija kronične opstruktivne plućne bolesti (16 %), upala pluća (11 %),akutno oštećenje bubrega ili egzacerbacija kronične bubrežne bolesti (7 %) i druga stanja (7 %).Rezultati: Korelacijska analiza pokazala je značajnu umjerenu pozitivnu korelaciju između omjeraCRP/albumin i trajanja mehaničke ventilacije mjerenog u satima (r = 0,48, p = 0,001) i vremena provedenogu Jedinici intenzivne njege, mjerenog u danima (r = 0,44, p = 0,001). Medijan omjera CRP/albumin bio je58,77, a bolesnici u skupini iznad medijana imali su viši SOFA rezultat. Što se tiče ishoda, utvrđeno je dasu preživjeli bolesnici (56 %) imali značajno niži omjer CRP/albumin u usporedbi s onima koji nisupreživjeli (44 %), što također korelira s njihovim SOFA rezultatima. U skupini preživjelih korelacijaizmeđu omjera CRP/albumin i SOFA bodovnog zbroja je pozitivna i statistički značajna (r = 0,29, p =0,03), a u skupini preminulih (r= 0,45, p = 0,003).Zaključak: Na temelju rezultata naše studije, omjer CRP/albumin pokazao se kao dobar prediktorkliničkih karakteristika i ishoda kritično bolesnih, mehanički ventiliranih nekirurških bolesnika.
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