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Aberrant circulating omentin-1, which is an anti-inflammatory and pro-apoptotic adipokine, has been reported in various solid tumors. Therefore, we investigated whether or not circulating omentin-1 could be associated with postmenopausal BC (PBC) and could be used as a potential diagnostic and clinical tool taking into consideration clinicopathologic features, tumor markers, as well as anthropometric, metabolic, and inflammatory parameters. Serum omentin-1, tumor markers (CA15-3 and CEA), metabolic (insulin, glucose, HOMA index, and serum lipids), anthropometric (BMI, waist circumference, and fat mass), and inflammatory (TNF-α, IL-6, hsCRP) parameters, classic adipokines (leptin and adiponectin), the Mediterranean diet (MedDiet) score, and cardiovascular (CVD) risk were determined in 103 postmenopausal women with pathologically confirmed incident invasive BC, 103 controls matched on age, 51 patients with benign breast lesions (BBL), and 50 obese postmenopausal women of similar age. The mean serum omentin-1 was significantly lower in cases than in controls and patients with BBL (p &lt, 0.001). In the patients, omentin-1 was inversely associated with tumor, metabolic and inflammatory biomarkers, cancer stage, and the number of infiltrated lymph nodes (p &lt, 0.05). In all study participants, omentin-1 was negatively correlated with CVD risk and positively correlated with MedDiet score. Lower circulating omentin-1 was independently associated with PBC occurrence above and beyond known risk factors. According to the ROC curve analysis, the overall diagnostic performance of omentin-1 (0.84, 95% CI 0.79–0.89) is similar to CA15-3. Circulating omentin-1 may be a biomarker at the intersection of PBC and cardiometabolic risk in postmenopausal women, and could be modulated by the adoption of a MedDiet. Further mechanistic and large multicentric prospective and longitudinal studies are required to elucidate the ontological role of omentin-1 in BC and CVD risks, as well as its diagnostic and prognostic ability and its therapeutic potential.

BACKGROUND Leptin, the prototype adipokine, exerts immunomodulatory actions being implicated in inflammatory responses during sepsis. Clinical evidence regarding its role in sepsis has been contradictory, while free leptin has not been studied. The aim of this study was to jointly investigate circulating total leptin, its soluble receptor (sOB-R), and free leptin, as well as their kinetics in critically ill patients with sepsis regarding their diagnostic and prognostic value. METHODS In a prospective study, serum total leptin, sOB-R and free leptin index (FLI) were determined in 102 critically ill patients with sepsis within 48 hours from sepsis onset and one week after enrollment, and in 102 age and gender-matched healthy controls. RESULTS Upon enrolment, total leptin, sOB-R and FLI were significantly higher in septic patients compared to controls and they were positively correlated with sepsis severity scores, while they presented a significant decrease during the first week (P

The adipocytokines eNampt and resistin are involved in the regulation of inflammation exerting pro-inflammatory actions. Our aim was to jointly investigate whether circulating eNampt and resistin, and their kinetics predict 28-day mortality of sepsis.In a prospective study, serum eNampt and resistin were determined in 102 critically ill patients fulfilling the diagnostic criteria of SEPSIS-3, at enrollment and one week after, and in 102 healthy controls matched on age, gender and month of diagnosis.Serum eNampt and resistin were significantly higher in septic patients than controls (p 0.001), and higher in septic shock compared to sepsis (p 0.001). Both eNampt and resistin decreased significantly during the first week of sepsis (p 0.001). However, patients with septic shock presented a sustained elevation of eNampt and resistin compared to patients with sepsis. Both adipocytokines were positively correlated with sepsis severity scores and lactate. Baseline eNampt was a better discriminator of sepsis and septic shock compared to C-reactive protein and procalcitonin. Serum eNampt and resistin were higher in nonsurvivors than in survivors during the first week of sepsis. Prolonged and sustained elevation of both eNampt and resistin, as reflected by a lower percentage change from their baseline values, was independently associated with 28-day mortality (HR: 0.05, 95% C.I. 0.01-0.28, p = 0.001; HR: 0.19, 95% C.I. 0.07-0.50, p = 0.001, respectively), after adjustment for significant clinical and laboratory biomarkers.Circulating eNampt and resistin, and their kinetics may represent useful diagnostic and prognostic biomarkers in critically ill septic patients. More prospective studies are needed to elucidate their ontological and pathophysiological role in sepsis.

Liver dysfunction during sepsis is associated with increased bilirubin and decreased fetuin-A, a major hepatokine. We aimed to explore the association of bilirubin to fetuin-A (B/F) ratio early in sepsis with severity and outcome in critically ill patients. Based on a previous prospective study, we analyzed data of 90 critically ill patients (52 males, age: 65 ± 15 years, APACHE II: 24 ± 7 and SOFA: 10 ± 3) with sepsis. Bilirubin and fetuin-A increased during the first week of sepsis, (median (IQR) 0.45 (0.32-1) vs 0.55 (0.29-0.78) mg/dL, p = 0.03 and 302 (248-336) vs 358 (307-399) μg/mL, p < 0.001, respectively) while the B/F ratio did not change significantly. However, the B/F ratio at baseline and one week later was significantly higher in patients with septic shock (N = 38) and nonsurvivors (N = 28) compared to patients with sepsis (N = 52) and survivors (N = 62), respectively. The B/F ratio was positively associated with severity scores and outperformed bilirubin as a predictor of mortality in ROC curve analysis (AUC 0.78 (0.69-0.88), p < 0.001 and 0.69 (0.57-0.8), p = 0.003 respectively). The B/F ratio may be a promising sepsis biomarker with possible predictive value in critically ill patients.

Aims and Objectives: Sepsis is an acute life-threatening systemic inflammatory response to infection. C-reactive protein (CRP) and albumin are positive and negative acute phase proteins respectively, following opposing patterns in sepsis. We aim to investigate whether CRP/albumin ratio is a better prognostic marker of 28-day mortality in critically ill patients with sepsis than CRP alone. Methods: In a prospective study, CRP and albumin were determined in serum of 102 critically ill patients (57 males, age 65±15 years, APACHE II 23±7, SOFA 10±3) at sepsis onset and one week after. Results: Thirty patients (29.4%) died within 28 days from enrolment. CRP and CRP/albumin ratio decreased significantly one week after sepsis onset (145±94 vs 91±71mg/L, p Conclusions: CRP/albumin ratio is a good predictor of 28-day mortality in critically ill patients with sepsis, similar to CRP but better than SOFA and APACHE II scores.

Aims and Objectives: Sepsis constitutes an acute inflammatory response to infection affecting liver function. Increased serum bilirubin as well as decreased fetuin-A, a major hepatokine, have been shown in critically ill patients with sepsis. We aim to explore the association of serum bilirubin/fetuin-A (B/F) ratio early in sepsis with severity and outcome. Methods: In a prospective study, serum total bilirubin and fetuin-A were determined in 90 critically ill patients (52 males, age 65±15 years, APACHE II 24 ±7, SOFA 10±3) at sepsis onset and one week after. B/F ratio was calculated using the formula 10.000 x Bilirubin (mg/dL) / Fetuin-A (μg/mL). Mortality rate at 28 days after enrollment was the primary outcome. Results: Twenty eight patients (31%) died within 28 days. Bilirubin and fetuin-A increased one week after sepsis onset compared to baseline (1.16±2.3 vs 1.38±2.84mg/dL, p=0.03 and 306±107 vs 372±147μg/mL, p Conclusions: B/F ratio at sepsis onset is associated with severity and outcome and may be a useful prognostic biomarker in critically ill septic patients.

Aims and Objectives: Sepsis results in severe lipid metabolic alterations. Lipids exert important immunomodulatory actions during infection. We aim to investigate whether serum lipid changes early in sepsis are associated with severity and outcome. Methods: In a prospective study, serum total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL) and triglycerides (TG) were determined in 82 critically ill patients (49 males, age 65±14 years, APACHE II 23±7, SOFA 10±3) at sepsis onset and one week after, and in 82 age and gender-matched healthy controls. Results: Upon enrollment, TC, HDL and LDL were significantly lower and TG were higher in patients compared to controls (p Conclusions: Critically ill septic patients exhibit significant alterations of serum lipids associated with sepsis severity and outcome.

Patient: Male, 73-year-old Final Diagnosis: Severe COVID-19 pneumonia complicated by right atrium thrombus Symptoms: Fever • dyspnea • cough Medication:— Clinical Procedure: — Specialty: Critical Care Medicine Objective: Educational purpose Background: Recent studies demonstrated evidence of coagulation dysfunction in hospitalized patients with severe coronavirus disease 2019 (COVID-19) due to excessive inflammation, hypoxia, platelet activation, endothelial dysfunction, and stasis. Effective anticoagulation therapy may play a dominant role in the management of severe COVID-19 cases. Case Report: A 73-year-old man with a 6-day history of fever up to 38.5°C, dyspnea, cough, and fatigue was diagnosed with COVID-19. He had a past medical history significant for hypertension and coronary artery bypass grafting. Two days after hospital admission, the patient developed acute respiratory failure, requiring intubation, mechanical ventilation, and transfer to the intensive care unit (ICU). He received treatment including antibiotics, hydroxychloroquine, tocilizumab, vasopressors, prone positioning, and anticoagulation with enoxaparin at a prophylactic dose. After a 15-day ICU stay, the patient was hemodynamically stable but still hypoxemic; a transthoracic echocardiogram at that time, followed by a transesophageal echocardiogram for better evaluation, revealed the presence of a right atrium thrombus without signs of acute right ventricular dilatation and impaired systolic function. Since the patient was hemodynamically stable, we decided to treat him with conventional anticoagulation under close monitoring for signs of hemodynamic deterioration; thus, the prophylactic dose of enoxaparin was replaced by therapeutic dosing, which was a key component of the patient’s successful outcome. Over the next few days he showed significant clinical improvement. The follow-up transesophageal echo-cardiogram 3 weeks after effective therapeutic anticoagulation revealed no signs of right heart thrombus. Conclusions: The presented COVID-19 case, one of the first reported cases with evidence of right heart thrombus by transesophageal echocardiography, highlights the central role of diagnostic imaging strategies and the importance of adequate anticoagulation therapy in the management of severe COVID-19 cases in the ICU.

The most severe presentation of COVID-19 is characterized by a hyperinflammatory state attributed to the massive pro-inflammatory cytokine release, called "cytokine storm". Several specific anti-inflammatory/immunosuppressive agents are being evaluated by ongoing clinical trials; however, there is currently insufficient evidence for their efficacy and safety in COVID-19 treatment. Given the role of phosphodiesterase 4 (PDE) 4 and cyclic adenosine monophosphate in the inflammatory response, we hypothesize that selective PDE4 inhibition may attenuate the cytokine storm in COVID-19, through the upstream inhibition of pro-inflammatory molecules, particularly TNF-α, and the regulation of the pro-inflammatory/anti-inflammatory balance. Conversely, other anti-cytokine agents lead to the downstream inhibition of specific targets, such as IL-1, IL-6 or TNF-α, and may not be efficient in blocking the cytokine storm, once it has been triggered. Due to their mechanism of action targeting an early stage of the inflammatory response and ameliorating lung inflammation, we believe that selective PDE4 inhibitors may represent a promising treatment option for the early phase of COVID-19 pneumonia before the cytokine storm and severe multiorgan dysfunction take place. Furthermore, PDE4 inhibitors present several advantages including an excellent safety profile; the oral route of administration; the convenient dosing; and beneficial metabolic properties. Interestingly, obesity and diabetes mellitus type 2 have been reported to be risk factors for the severity of COVID-19. Therefore, randomized clinical trials of PDE4 inhibitors are necessary to explore their potential therapeutic effect as an adjunct to supportive measures and other therapeutic regiments.

Chemerin is an emerging adipocytokine at the intersection of inflammation, chemotaxis, thrombosis, fibrinolysis and metabolism. Our aims were 1) to explore circulating chemerin in resectable non-small cell lung cancer (NSCLC) taking into account its several interfaces; 2) to study its diagnostic potential; and 3) to assess its associations with clinicopathological features of NSCLC.In a large case-control study, serum chemerin, insulin resistance and lipid parameters, classic adipocytokines, inflammatory, coagulation, fibrinolysis and tumor biomarkers were determined in 110 consecutive patients with resectable NSCLC and 110 healthy controls matched on age (± 5 years), gender and date of blood draw (± 1 month).NSCLC cases exhibited significantly elevated circulating chemerin compared to controls (p 0.001). In NSCLC cases, chemerin was positively associated with Homeostasis model assessment score of insulin resistance (HOMA-IR), fibrinogen, plasminogen activity, tumor and inflammatory biomarkers, adiponectin, number of infiltrated lymph nodes and NSCLC stage. In control participants, circulating chemerin was positively correlated with somatometric, metabolic, lipid, hemostatic and inflammatory biomarkers, and leptin. Serum chemerin was independently associated with NSCLC, above and beyond NSCLC risk factors (OR: 2.20, 95% CI: 1.09-4.40, p = 0.03). In cases, hemostatic parameters (platelet count and plasminogen activity), HOMA-IR, CYFRA 21-1, creatinine and plant food consumption emerged as independent predictors of circulating chemerin (p 0.05). Serum chemerin greater than 220 μg/L (cut-off point) yielded a sensitivity and a specificity of 63% and 91.8% respectively with a modest discriminative ability (AUC = 0.72, 95% C.I. 0.64-0.79) for the diagnosis of NSCLC.Chemerin may represent a potentially useful biomarker in NSCLC integrating tumor-promoting networks, inflammatory and hemostatic mechanisms, and cancer-related metabolic pathways. More preclinical, prospective and longitudinal studies highlighting the pathogenetic role of chemerin in NSCLC are needed to corroborate and extend these data.

Fetuin-A and adiponectin, major hepatokine and adipokine respectively, have been implicated in systematic inflammation. Our aim was to jointly investigate whether kinetics of circulating fetuin-A, adiponectin and its isoform HMWA predict 28-day mortality in sepsis.In a prospective study, serum fetuin-A, adiponectin and HMWA were determined in 102 ICU patients fulfilling the diagnostic criteria of SEPSIS-3, at enrollment and one week after, and in 102 healthy controls matched on age and gender.Serum fetuin-A was significantly lower in septic patients than controls (p0.001). Among septic patients, those with septic shock and nonsurvivors presented lower fetuin-A, but higher adiponectin and HMWA compared to patients with sepsis and survivors respectively, both at baseline and day 7 (p0.001). Fetuin-A exhibited negative correlations with APACHE II, CRP, procalcitonin, adiponectin and IL-6 but a positive one with albumin. Reduced fetuin-A as well as lower serum kinetics of fetuin-A (HR: 0.55, 95% C.I. 0.34-0.91, p=0.02), adiponectin but not HMWA were independently associated with 28-day mortality adjusting for age, gender, BMI, APACHE II, septic shock and laboratory biomarkers.Circulating fetuin-A kinetics may be a prognostic biomarker in septic patients. More research is essential to elucidate fetuin-A's ontological role in sepsis pathophysiology.

Introduction: Non small cell lung cancer (NSCLC) is the leading cause of cancer-related death globally. There is a tremendous interest in identifying novel biomarkers. The pathophysiological role of classic and novel adipokines in NSCLC is not yet fully understood and their value as diagnostic biomarkers is currently under research. Aim: To explore the diagnostic potential of classic (leptin, adiponectin) and novel adipokines (chemerin, plasminogen activator inhibitor-1 activity/PAI-1) in resectable NSCLC. Methods: In a large case-control study, circulating chemerin, adiponectin, leptin and PAI-1 were determined in 110 consecutive patients with resectable NSCLC and 110 healthy controls matched on age (± 5 years), gender and date of blood draw (± 1 month). Serum leptin, chemerin and adiponectin were determined by ELISA (BioVendor and ALPCO). Plasma PAI-1 activity was determined using Berichrom® PAI (Siemens). Results: Patients with NSCLC had significantly higher chemerin and PAI-1 activity (p Conclusion: Novel adipokines showed higher discriminative ability than classic adipokines in the NSCLC diagnosis. More prospective studies are required to assess the potential diagnostic significance of novel adipokines in NSCLC.

Introduction: Non-traumatic coma (NTC) is a common cause of critical illness with diverse etiology and prognosis Aim: To investigate the etiology and outcome of NTC in ICU patients and to explore prognostic factors Methods: In a retrospective study we reviewed the medical records of all patients admitted to the ICU of a teaching hospital due to NTC, from January 2018 to January 2019. Demographic data, medical history, APACHE II score, etiology of coma and ICU mortality were recorded. Results: Among 250 medical records, we identified 30 cases (16 males, mean age 68±14, APACHE II 21±7) of NTC. The etiology of NTC was: intracerebral hemorrhage (8), respiratory failure (6), sepsis (5), post-anoxic (4), CNS infection (3), ischemic stroke (2), metabolic coma (2). Thirteen patients died in the ICU (43%) and 17 were discharged. Sepsis presented the highest ICU mortality (80%), followed by post-anoxic (75%), intracerebral hemorrhage (62%) and ischemic stroke (50%). All patients with respiratory failure, CNS infection and metabolic coma survived to discharge. Sex, age, APACHE II score and history of chronic kidney, respiratory, cardiovascular disease or malignancy were not correlated with ICU mortality (p>0.05). Elevated serum lactate (p:0.018), acute kidney injury (p:0.005) and hypotension (p:0.033) at admission were associated with ICU mortality. Acute kidney injury on the day of admission tripled the risk of death (HR:2.8, 95%CI: 1.2-6.6, p Conclusion: Intracerebral hemorrhage was the leading cause of NTC, followed by respiratory failure and sepsis. Acute kidney injury was the best predictor of ICU mortality.

The pandemic of COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) poses a significant threat to global health. Currently, no specific prophylactic and therapeutic treatment is available. No evidence from randomized clinical trials (RCTs) that a treatment may ameliorate the clinical outcome of patients with COVID-19 exists with the only exception of preliminary evidence from remdesivir trials. Here, we present evidence from the literature and a compelling hypothesis on the potential immunomodulatory, iron chelating and anti-oxidant effects of iron chelators in the treatment of COVID-19 and its complications. Interestingly, iron chelation has been shown in vitro to suppress endothelial inflammation in viral infection, which is the main pathophysiologic mechanism behind systemic organ involvement induced by SARS-CoV-2, by inhibiting IL-6 synthesis through decreasing NF-kB. Iron chelators exhibit iron chelating, antiviral and immunomodulatory effects in vitro and in vivo, particularly against RNA viruses. These agents could attenuate ARDS and help control SARS-CoV-2 via multiple mechanisms including: 1) inhibition of viral replication; 2) decrease of iron availability; 3) upregulation of B cells; 4) improvement of the neutralizing anti-viral antibody titer; 5) inhibition of endothelial inflammation and 6) prevention of pulmonary fibrosis and lung decline via reduction of pulmonary iron accumulation. Both retrospective analyses of data in electronic health records, as well as proof of concept studies in humans and large RCTs are needed to fully elucidate the efficacy and safety of iron chelating agents in the therapeutic armamentarium of COVID-19, probably as an adjunctive treatment.

Background: Experimental and clinical data have shown that the adipocytokines eNAMPT and resistin interact with cytokines and other inflammatory molecules in the pathogenesis of sepsis. Objective: To investigate eNAMPT and resistin’s role as biomarkers of sepsis compared to well-established inflammatory markers and cytokines. Methods: We prospectively studied 102 critically ill patients (57 males, mean age 65±15years) fulfilling the diagnostic criteria of SEPSIS-3, during the first week of sepsis. Serum eNAMPT and resistin were determined by ELISA (Phoenix Pharmaceuticals, CA, USA) at sepsis onset and one week after. We also determined C-reactive protein (CRP), procalcitonin, interleukins IL-6, IL-10, tumor necrosis factor alpha (TNF-α) and soluble urokinase-type plasminogen activator receptor (suPAR). The discriminating power of measured parameters as predictors of sepsis and septic shock was obtained by Receiver Operating Characteristic (ROC) curves. Results: Sixty patients presented with sepsis and 42 with septic shock. Mortality within 28 days was 29.4%. eNAMPT exhibited significantly positive correlations with CRP, procalcitonin and IL-10 at admission, and with procalcitonin one week after enrollment. Resistin was positively correlated with IL-6, IL-10 and TNF-α at admission and with procalcitonin one week after enrollment. Area under ROC curves showed that eNAMPT (AUROC>0.83) and CRP (AUROC>0.78) outperformed procalcitonin (AUROC>0.71), resistin (AUROC>0.69), IL-6 (AUROC>0.69), IL-10 (AUROC>0.68) and suPAR (AUROC>0.64) in discriminating sepsis from septic shock. Conclusion: eNAMPT is a better discriminator biomarker for sepsis and septic shock, while resistin’s performance is comparable to procalcitonin.

Background: eNAMPT, an adipokine with pro-inflammatory properties, has been implicated in acute and chronic inflammation. However, its kinetics has not been studied in sepsis. Objective: To investigate whether eNAMPT and its kinetics early in sepsis predict severity and outcome. Methods: In a prospective case-control study, serum eNAMPT concentrations were determined by ELISA in 102 critically ill patients (57 males, mean age 65±15 years) fulfilling the diagnostic criteria of SEPSIS-3, at sepsis onset and one week after, and in 102 age and gender-matched healthy controls. Results: Sixty patients presented with sepsis and 42 with septic shock. Mean APACHE II was 23±7. Thirty patients died within 28 days (mortality 29.4%). At admission, serum eNAMPT was significantly higher in patients compared to controls (79.1±19.5 vs 44.9±27.5ng/mL, p Conclusion: eNAMPT in early sepsis may be a novel diagnostic and prognostic biomarker in critically ill septic patients.

Irisin, a newly discovered adipo-myokine, is implicated in the modulation of the adipose phenotype, increasing energy expenditure and ameliorating systemic metabolism. Our aim was to investigate circulating irisin in subclinical hypothyroidism (SH) and study its associations with cardiometabolic risk factors. In a large case–control study, serum irisin, insulin resistance and lipid parameters, classic adipokines, inflammatory and hepatic biomarkers, and cardiovascular risk factors were determined in 120 consecutive patients with SH and 120 healthy controls matched on age, gender, and date of blood draw. Sixteen patients with SH received L-T4 treatment and, after 6 months, serum irisin and other biomarkers were assessed. SH cases exhibited significantly higher circulating irisin than controls (p

Background: Adiponectin, the most abundant active adipokine, exhibits anti-inflammatory properties affecting survival in critical illness. Objective: To explore whether kinetics of serum adiponectin and its main isoform HMWA is associated with 28-day mortality in sepsis. Methods: In a prospective study, serum adiponectin and HMWA concentrations were determined by ELISA (ALPCO) in 102 ICU patients fulfilling the diagnostic criteria of SEPSIS-3, at enrollment and one week after, and in 102 healthy controls matched on age and gender. Results: At admission, serum adiponectin (and HMWA) was significantly elevated in septic patients than in healthy controls (10.33 ± 2.96 vs 6.25 ± 1.53 μg/mL, p Conclusion: Kinetics of serum adiponectin may be independently associated with mortality in septic patients.

Contains fulltext : 138898.pdf (Publisher’s version ) (Closed access) BACKGROUND: Infections are a leading cause of death in patients with advanced cirrhosis, but there are relatively few data on the epidemiology of infection in intensive care unit (ICU) patients with cirrhosis. AIMS: We used data from the Extended Prevalence of Infection in Intensive Care (EPIC) II 1-day point-prevalence study to better define the characteristics of infection in these patients. METHODS: We compared characteristics, including occurrence and types of infections in non-cirrhotic and cirrhotic patients who had not undergone liver transplantation. RESULTS: The EPIC II database includes 13,796 adult patients from 1265 ICUs: 410 of the patients had cirrhosis. The prevalence of infection was higher in cirrhotic than in non-cirrhotic patients (59 vs. 51%, P < 0.01). The lungs were the most common site of infection in all patients, but abdominal infections were more common in cirrhotic than in non-cirrhotic patients (30 vs. 19%, P < 0.01). Infected cirrhotic patients more often had Gram-positive (56 vs. 47%, P < 0.05) isolates than did infected non-cirrhotic patients. Methicillin-resistant Staphylococcus aureus (MRSA) was more frequent in cirrhotic patients. The hospital mortality rate of cirrhotic patients was 42%, compared to 24% in the non-cirrhotic population (P < 0.001). Severe sepsis and septic shock were associated with higher in-hospital mortality rates in cirrhotic than in non-cirrhotic patients (41% and 71% vs. 30% and 49%, respectively, P < 0.05). CONCLUSIONS: Infection is more common in cirrhotic than in non-cirrhotic ICU patients and more commonly caused by Gram-positive organisms, including MRSA. Infection in patients with cirrhosis was associated with higher mortality rates than in non-cirrhotic patients.

Background: Abdominal infections are frequent causes of sepsis and septic shock in the intensive care unit (ICU) and are associated with adverse outcomes. We analyzed the characteristics, treatments and outcome of ICU patients with abdominal infections using data extracted from a one-day point prevalence study, the Extended Prevalence of Infection in the ICU (EPIC) II.Methods: EPIC II included 13,796 adult patients from 1,265 ICUs in 75 countries. Infection was defined using the International Sepsis Forum criteria. Microbiological analyses were performed locally. Participating ICUs provided patient follow-up until hospital discharge or for 60 days.Results: Of the 7,087 infected patients, 1,392 (19.6%) had an abdominal infection on the study day (60% male, mean age 62 ± 16 years, SAPS II score 39 ± 16, SOFA score 7.6 ± 4.6). Microbiological cultures were positive in 931 (67%) patients, most commonly Gram-negative bacteria (48.0%). Antibiotics were administered to 1366 (98.1%) patients. Patients who had been in the ICU for ≤2 days prior to the study day had more Escherichia coli, methicillin-sensitive Staphylococcus aureus and anaerobic isolates, and fewer enterococci than patients who had been in the ICU longer. ICU and hospital mortality rates were 29.4% and 36.3%, respectively. ICU mortality was higher in patients with abdominal infections than in those with other infections (29.4% vs. 24.4%, p < 0.001). In multivariable analysis, hematological malignancy, mechanical ventilation, cirrhosis, need for renal replacement therapy and SAPS II score were independently associated with increased mortality.Conclusions: The characteristics, microbiology and antibiotic treatment of abdominal infections in critically ill patients are diverse. Mortality in patients with isolated abdominal infections was higher than in those who had other infections. © 2014 De Waele et al. licensee BioMed Central Ltd., SCOPUS: ar.j, info:eu-repo/semantics/published

The role of the D allele of the angiotensin-converting enzyme (ACE) gene I/D polymorphism in the clinical outcomes of patients with acute lung injury and acute respiratory distress syndrome (ALI/ARDS) remains controversial. We assessed simultaneously the effect of the ACE I/D polymorphisms as well as the serum and BALF ACE levels on prognosis of ARDS patients.