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Analysis of oxidative stress-related markers in critically ill polytrauma patients: An observational prospective single-center study.

ABSTRACT: Critically ill polytrauma patients have increased production of free radicals (FRs) and consequent alterations in biochemical pathways, as well as disruption of cellular integrity, due to increased lipid peroxidation. The aim of this study was to investigate several biomarkers associated with increased oxidative stress in critically ill polytrauma patients, and to evaluate the effect of antioxidant treatment on the clinical outcome in these patients. A total of 67 polytrauma patients from an intensive care unit met the selection criteria. Antiox group included 35/67 patients who received antioxidant therapy, while 32/67 patients without antioxidant treatment were considered as control group. Antioxidant therapy consisted of simultaneous administration of Vitamin C (sodium ascorbate) and N-acetylcysteine, through continuous intravenous infusion. Clinical and paraclinical evaluation of the patients was performed daily until discharge or death. At admission, laboratory parameters did not differ significantly between two groups. At discharge/upon death, statistically significant differences in favor of Antiox group were observed in the following parameters: thrombocytes, activated partial thromboplastin time, prothrombin time, total bilirubin, total cholesterol, high-density lipoproteins, low-density lipoproteins, erythrocyte sedimentation rate, interleukin 6 (all p = 0.0001), total protein (p = 0.0005), serum albumin (p = 0.0004), lactate dehydrogenase (p = 0.0006), and C-reactive protein (p = 0.0014). Starting from day 5, the APACHE II score was significantly decreased in Antiox versus control group (p < 0.05). Finally, the sepsis incidence and mortality rate were significantly lower in Antiox group (p < 0.05). Decreasing the level of oxidative stress by antioxidant substances significantly correlated with a better prognosis and outcome in our patients. Further studies should elucidate more clearly the mechanism of action of antioxidants in critically ill polytrauma patients.

SUBMITTER: Sandesc M

PROVIDER: S-EPMC5988539 | biostudies-literature | 2018 May

REPOSITORIES: biostudies-literature

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Analysis of oxidative stress-related markers in critically ill polytrauma patients: An observational prospective single-center study.

Sandesc Mihai M Rogobete Alexandru Florin AF Bedreag Ovidiu Horea OH Dinu Anca A Papurica Marius M Cradigati Carmen Alina CA Sarandan Mirela M Popovici Sonia Elena SE Bratu Lavinia Melania LM Bratu Tiberiu T Stan Adrian Tudor AT Sandesc Dorel D

Bosnian journal of basic medical sciences 20180520 2

Critically ill polytrauma patients have increased production of free radicals (FRs) and consequent alterations in biochemical pathways, as well as disruption of cellular integrity, due to increased lipid peroxidation. The aim of this study was to investigate several biomarkers associated with increased oxidative stress in critically ill polytrauma patients, and to evaluate the effect of antioxidant treatment on the clinical outcome in these patients. A total of 67 polytrauma patients from an int ...[more]

PMID: 29310566

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Project description:Independent predictors of mortality and transfusion therapy in polytrauma patients from the Chinese population remain unknown. Here, we aimed to identify these predictors by retrospectively collecting and analyzing vital signs and laboratory results for 408 critically ill patients suffering from polytrauma who were treated in Affiliated Kunshan Hospital of Jiangsu University, Jiangsu Province, China from January 2020 to December 2021. We identified risk factors for mortality and transfusion therapy using logistic regression analysis. As a results, we enrolled a total of 408 polytrauma patients, with a male-to-female ratio of 2:1, a mean age of 49.02 ± 16.84 years, a mortality rate of 15.9 %, and a blood transfusion rate of 45.8 %. The multivariate logistic regression showed that decreased Glasgow Coma Scale (GCS) score (Odds ratio (OR) = 0.72, 95 % confidence interval (95%CI): 0.63-0.83, P < 0.001), decreased base excess (BE) (OR = 0.77, 95%CI: 0.67-0.87, P < 0.001), and increased Injury Severity Score (ISS) (OR = 1.12, 95%CI: 1.06-1.17, P < 0.001) were independent risk factors for the mortality. In addition, increased GCS score (OR = 1.17, 95%CI: 1.03-1.35, P = 0.020), increased heart rate (OR = 1.05, 95%CI: 1.04-1.07, P < 0.001), decreased systolic blood pressure (SBP) (OR = 0.97, 95%CI: 0.96-0.99, P < 0.001), increased peripheral oxygen saturation (SpO2) (OR = 1.10, 95%CI: 1.04-1.16, P = 0.002), decreased serum lactate (OR = 0.58, 95%CI: 0.42-0.79, P = 0.001), decreased BE (OR = 0.49, 95%CI: 0.39-0.62, P < 0.001), and increased ISS (OR = 1.25, 95%CI: 1.18-1.33, P < 0.001) were independent risk factors for blood transfusion. The area under receiver operating characteristic curves (AUROCs) of the model to predict mortality and blood transfusion were 0.976 (95%CI: 0.960-0.992, P < 0.001) and 0.973 (95%CI: 0.958-0.987, P < 0.001). In conclusion, decreased BE level was significantly associated with all-cause mortality in polytrauma patients. BE, ISS, and GCS might be independent important predictors for mortality and blood transfusion of polytrauma patients.

Project description:BackgroundExtracorporeal membrane oxygenation (ECMO) is an integral method of life support in critically ill patients with severe cardiopulmonary failure; however, such patients generally require prolonged mechanical ventilation and exhibit high mortality rates. Tracheostomy is commonly performed in patients on mechanical ventilation, and its early implementation has potential advantages for favorable patient outcomes. This study aimed to investigate the association between tracheostomy timing and patient outcomes, including mortality, in patients requiring ECMO.MethodsWe conducted a single-center retrospective observational study of consecutively admitted patients who were supported by ECMO and underwent tracheostomy during intensive care unit (ICU) admission at a tertiary care center from April 2014 until December 2021. The primary outcome was hospital mortality. Using the quartiles of tracheostomy timing, the patients were classified into four groups for comparison. The association between the quartiles of tracheostomy timing and mortality was explored using multivariable logistic regression models.ResultsOf the 293 patients treated with ECMO, 98 eligible patients were divided into quartiles 1 (≤ 15 days), quartile 2:16-19 days, quartile 3:20-26 days, and 4 (> 26 days). All patients underwent surgical tracheostomy and 35 patients underwent tracheostomy during ECMO. The complications of tracheostomy were comparable between the groups, whereas the duration of ECMO and ICU length of stay increased significantly as the quartiles of tracheostomy timing increased. Patients in quartile 1 had the lowest hospital mortality rate (19.2%), whereas those in quartile 4 had the highest mortality rate (50.0%). Multivariate logistic regression analysis showed a significant association between the increment of the quartiles of tracheostomy timing and hospital mortality (adjusted odds ratio for quartile increment:1.55, 95% confidence interval 1.03-2.35, p for trend = 0.037).ConclusionsThe timing of tracheostomy in patients requiring ECMO was significantly associated with patient outcomes in a time-dependent manner. Further investigation is warranted to determine the optimal timing of tracheostomy in terms of mortality.

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Analysis of oxidative stress-related markers in critically ill polytrauma patients: An observational prospective single-center study.

Publications

Analysis of oxidative stress-related markers in critically ill polytrauma patients: An observational prospective single-center study.

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