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Assessing the prognosis of cirrhotic patients in the intensive care unit:What we know and what we need to know better

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World Journal of Hepatology 2021年第10期13卷 1341-1350页

作者： Fernando da Silveira Pedro H R Soares luana Q Marchesan Roberto S A da Fonseca wagner l nedel Programa de Pos-Graduacao em Pneumologia Universidade Federal do Rio Grande do SulPorto Alegre 91430835Brazil Intensive Care Unit Grupo Hospitalar ConceiçãoPorto Alegre 91430835Brazil Programa de Pos-Graduacao em Neurociencias Universidade Federal do Rio Grande do SulPorto Alegre 91430835Brazil Programa de Pos-Graduacao em Ciencias da Saude Universidade Federal de Santa MariaSanta Maria 97105900Brazil Programa de Pos-Graduacao em Bioquimica Universidade Federal do Rio Grande do SulPorto Alegre 91430835Brazil

Critically ill cirrhotic patients have high in-hospital mortality and utilize significant health care resources as a consequence of the need for multiorgan *** this fact,their mortality has decreased in recent decades due to improved care of critically ill ***-on-chronic liver failure(AClF),sepsis and elevated hepatic scores are associated with increased mortality in this population,especially among those not eligible for liver *** score is superior to another in the prognostic assessment of these patients,and both liver-specific and intensive care unit-specific scores have satisfactory predictive *** sequential assessment of the scores,especially the Sequential Organ Failure Assessment(SOFA)and Chronic liver Failure Consortium(ClIF)-SOFA scores,may be useful as an auxiliary tool in the decision-making process regarding the benefits of maintaining supportive therapies in this population.A ClIF-AClF>70 at admission or at day 3 was associated with a poor prognosis,as well as SOFA score>19 at baseline or increasing SOFA score>*** studies addressing the prognostic assessment of these patients are necessary.

关键词： Cirrhosis Extrahepatic organ failure Organ replacement therapy Mortality Prognostic scores Chronic liver Failure Consortium-Sequential Organ Failure Assessment Sequential Organ Failure Assessment Model for End-stage liver Disease

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Impact of cytomegalovirus reactivation just before liver transplantation:A prospective cohort study

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World Journal of Gastrointestinal Pathophysiology 2021年第3期12卷 51-58页

作者： Claudio Marcel B Stadnik Cassia Ferreira B Caurio Edison M Rodrigues-Filho wagner l nedel Guido PC Cantisani Maria l Zanotelli Alessandro C Pasqualotto Infection Control Department Santa Casa de Misericordia de Porto AlegrePorto Alegre 90075075RSBrazil Molecular Biology laboratory Santa Casa de Misericordia de Porto AlegrePorto Alegre 90075075RSBrazil Intensive Care Santa Casa de Misericordia de Porto AlegrePorto Alegre 90075075RSBrazil liver Transplant Unit Santa Casa de Misericordia de Porto AlegrePorto Alegre 90075075RSBrazil Infectious Diseases Unit Universidade Federal de Ciencias da Saude de Porto AlegrePorto Alegre 90035075RSBrazil

BACKGROUND Cytomegalovirus(CMV)is the most common viral pathogen after liver transplantation(lT).Although reactivation of CMV infection is generally described in the context of immunosuppression,it has also been described in critically ill immunocompetent patients including cirrhotic *** To determine the incidence of reactivated CMV prior to *** This was a prospective cohort study evaluating adult patients who underwent lT between 2014 and 2016.A plasma sample was obtained from all patients for CMV quantitative real-time PCR testing right before *** were followed for at least 1 year to assess the following outcomes:Incidence of CMV infection,organ rejection and overall *** A total of 72 patients were *** patients died before transplantation,thus 68 patients were followed up for a median of 44 mo(20-50 mo).In 23/72 patients(31.9%)CMV was reactivated before ***-transplantation,16/68(23.5%)patients had CMV infection and that was significantly associated with the recipient being CMV negative and a CMV-positive *** CMV reactivation was not associated with overall mortality(log rank:0.9).CONClUSION This study shows that CMV infection is common in patients with chronic liver disease just before lT,but the clinical impact of this infection seems to be negligible.

关键词： liver transplantation Cytomegalovirus infection Quantitative real-time PCR Risk factors liver cirrhosis Molecular biology

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Why should lymphocytes immune profile matter in sepsis?

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World Journal of Critical Care Medicine 2025年第2期14卷 18-26页

作者： wagner nedel lílian R Henrique luis Valmor Portela Department of Intensive Care Unit Conceição Hospital GroupPorto Alegre 91350200Brazil Department of Biochemistry Institute of Basic Health SciencesFederal University of Rio Grande do SulPorto Alegre 90035-003Brazil

The global incidence of critical illness has been steadily increasing,resulting in higher mortality rates thereby presenting substantial challenges for clinical *** 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 ***-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 *** the context of sepsis,an impaired immunity has been associated with disrupted lymphocytic metabolic activity,persistent pro-inflammatory state,and subsequent *** 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 ***,studies have identified absolute lymphocyte counts and derived parameters as promising clinical biomarkers for prognostic assessment and therapeutic *** 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 *** 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.

关键词： lymphocytes Neutrophil-to-lymphocyte ratio Sepsis Septic shock Chronic critical illness Persistent inflammation,immunosuppression,and catabolism syndrome

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Sepsis-induced mitochondrial dysfunction:A narrative review

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World Journal of Critical Care Medicine 2023年第3期12卷 139-152页

作者： wagner nedel Caroline Deutschendorf luis Valmor Cruz Portela Intensive Care Unit Grupo Hospitalar ConceiçãoPorto Alegre 91350200Brazil laboratory of Neurotrauma and Biomarkers Departamento de BioquímicaICBSUniversidade Federal do Rio Grande do SulPorto Alegre 90035-003Brazil Brazilian Research in Intensive Care Network-BRICNet São Paulo 04039-002Brazil Infection Control Committee Hospital de Clínicas de Porto AlegrePorto Alegre 90410-000Brazil

Sepsis represents a deranged and exaggerated systemic inflammatory response to infection and is associated with vascular and metabolic abnormalities that trigger systemic organic *** function has been shown to be severely impaired during the early phase of critical illness,with a reduction in biogenesis,increased generation of reactive oxygen species and a decrease in adenosine triphosphate synthesis of up to 50%.Mitochondrial dysfunction can be assessed using mitochondrial DNA concentration and respirometry assays,particularly in peripheral mononuclear *** of monocytes and lymphocytes seems to be the most promising strategy for measuring mitochondrial activity in clinical settings because of the ease of collection,sample processing,and clinical relevance of the association between metabolic alterations and deficient immune responses in mononuclear *** have reported alterations in these variables in patients with sepsis compared with healthy controls and non-septic ***,few studies have explored the association between mitochondrial dysfunction in immune mononuclear cells and unfavorable clinical *** improvement in mitochondrial parameters in sepsis could theoretically serve as a biomarker of clinical recovery and response to oxygen and vasopressor therapies as well as reveal unexplored pathophysiological mechanistic *** features highlight the need for further studies on mitochondrial metabolism in immune cells as a feasible tool to evaluate patients in intensive care *** evaluation of mitochondrial metabolism is a promising tool for the evaluation and management of critically ill patients,especially those with *** this article,we explore the pathophysiological aspects,main methods of measurement,and the main studies in this field.

关键词： Sepsis Mitochondria Mitochondrial dysfunction Oxidative phosphorylation Inflammation Respirometry

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Corticosteroids for severe influenza pneumonia: A critical appraisal

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World Journal of Critical Care Medicine 2016年第1期5卷 89-95页

作者： wagner luis nedel David Garcia Nora Jorge Ibrain Figueira Salluh Thiago lisboa Pedro Póvoa Intensive Care Unit Hospital Nossa Senhora da Concei??o Intensive Care Unit Vila Franca de Xira Hospital D’or Institute for Research and Education Critical Care Department Hospital de Clinicas de Porto Alegre Post-Graduation Program (PPG) Pneumology Universidade Federal do Rio Grande do Sul Polyvalent Intensive Care Unit S?o Francisco Xavier Hospital Centro Hospitalar de Lisboa Ocidental Nova Medical School CEDOC New University of Lisbon

Influenza pneumonia is associated with high number of severe cases requiring hospital and intensive care unit(ICU) admissions with high mortality. Systemic steroids are proposed as a valid therapeutic option even though its effects are still controversial. Heterogeneity of published data regarding study design, population demographics, severity of illness, dosing, type and timing of corticosteroids administered constitute an important limitation for drawing robust conclusions. However, it is reasonable to admit that, as it was not found any advantage of corticosteroid therapy in so diverse conditions, such beneficial effects do not exist at all. Its administration is likely to increase overall mortality and such trend is consistent regardless of the quality as well as the sample size of studies. Moreover it was shown that corticosteroids might be associated with higher incidence of hospital-acquired pneumonia and longer duration of mechanical ventilation and ICU stay. Finally, it is reasonable to conclude that corticosteroids failed to demonstrate any beneficial effects in the treatment of patients with severe influenza infection. Thus its current use in s evere influenza pneumonia should be restricted to very selected cases and in the setting of clinical trials.

关键词： Influenza Mechanical ventilation Pneumonia Corticosteroids Respiratory failure

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