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Early lactate clearance as a reliable predictor of initial poor graft function after orthotopic liver transplantation

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Hepatobiliary & Pancreatic Diseases International 2011年第6期10卷 587-592页

作者： Jian-Feng Wu,Rong-Yao Wu,Juan Chen,Bin Ou-Yang,Min-Ying Chen and Xiang-Dong Guan department of surgical intensive care unit,First Affiliated Hospital,Sun Yat-Sen University,Guangzhou 510080,China department of surgical intensive care unit First Affliated Hospital Sun Yat-Sen University Guangzhou 510080 China

BACKGROUND:Initial poor graft function (IPGF) following orthotopic liver transplantation is a major determinant of postoperative survival and *** clearance is a good marker of liver *** this study,we investigated the clinical utility of early lactate clearance as an early and accurate predictor for IPGF following liver ***:This was a prospective observational study of 222 patients referred to the surgical intensive care unit (SICU) after orthotopic liver *** IPGF group consisted of patients with alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST) >1500 IU/L within 72 hours after orthotopic liver *** lactate clearance was defined as lactate at SICU presentation (hour 0) minus lactate at hour 6,divided by lactate at SICU *** model for end-stage liver disease (MELD) score,Child-Pugh score and laboratory data including AST,ALT,total bilirubin (TB) and prothrombin time (PT) were recorded at SICU presentation and compared between the non-IPGF and IPGF groups Receiver operating characteristic (ROC) curves were plotted to measure the performance of early lactate clearance,MELD score,Child-Pugh score,TB and ***:IPGF occurred in 45 of the 222 patients (20.3%).The early lactate clearance in the non-IPGF group was markedly higher than that in the IPGF group (43.2±13.8% vs 13.4±13.7% P<0.001).The optimum cut-off value for early lactate clearance predicting IPGF was 24.8% (sensitivity 95.5%,specificity 88.9%).The area under the curve of the ROC was 0.961,which was significantly superior to MELD score,Child-Pugh score TB and *** with early lactate clearance ≤24.8% had a higher IPGF rate (OR=169) and a higher risk of in-hospital mortality (OR=3.625).CONCLUSIONS:Early lactate clearance can serve as a prompt and accurate bedside predictor of *** with early lactate clearance less than 24.8% are associated with a higher incidence of IPGF.

关键词： early lactate clearance initial poor graft function liver transplantation

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Sclerosing cholangitis in critically ill patients： an important and easily ignored problem based on a German experience

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Frontiers of Medicine 2014年第1期8卷 118-126页

作者： Ting Lin Kai Qu Xinsen Xu Min Tian Jie Gao Chun Zhang Ying Di Yuelang Zhang Chang Liu department of Hepatobiliary Surgery surgical intensive care unit department of Imaging the First Affiliated Hospital School ofMedicine Xi 'an Jiaotong University Xi 'an 710061 China

intensive care unit （ICU） is important in the rehabilitation of critically ill patients. In the past decades, many patients who received aggressive treatment in ICU developed sclerosing cholangitis in multiple centers. Sclerosing cholangitis in critically ill patients （SC-CIP） is a relatively new issue. To investigate the causes, clinical manifestation, treatment, and prognosis of SC-CIP, we searched for published cases in the databases of PubMed, Highwire, and Elsevier from 2001 to 2012. Data were extracted using a standard form and retrospectively analyzed. Twelve eligible studies covering 88 patients, with 64 men and 24 women, were mainly reported by German centers. The mean age was 49.8 years. All of the patients recovered from critical illnesses, such as trauma, infection, burn, and major surgeries. High pressure positive end-expiratory pressure （PEEP, peak level at 12.8 cm H20） was utilized for all patients, with the average duration of 36.3 d. In addition, vasopressor agents were administered in approximately 60% of SC-CIE A rapid increase in cholestasis and irregular strictures in the intrahepatic bile ducts was observed in the following months. With an average follow-up period of 17.9 months, poor outcomes were observed in 54 patients, including 34 deaths. In conclusion, ischemic injury of the biliary tree, which may be affected by PEEP and/or vasopressor administration, affects cholangiopathic procedure. As a newly discovered type of secondary sclerosing cholangitis, SC-CIP is a severe progressive complication of patients in ICU and should be carefully monitored by clinicians.

关键词： intensive care unit sclerosing cholangitis ischemic injury prognosis systemic review

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Postoperative jaundice after cardiac surgery

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Hepatobiliary & Pancreatic Diseases International 2007年第4期6卷 383-387页

作者： Aikaterini Mastoraki Emmanouil Karatzis Sotiria Mastoraki Ioannis Kriaras Petros Sfirakis Stefanos Geroulanos department of surgical intensive care unit Onassis Cardiac Surgery Center356 Sygrou Ave17674 AthensGreece

BACKGROUND:The frequency and pattern of hyperbili-rubinemia after open-heart surgery and its severe perioperative complications are not well clarified. The purpose of this study was to investigate the incidence and nature of postoperative jaundice in patients undergoing cardiac operation,to analyze the determinants,and to identify the clinical significance of this complication with regard to the associated morbidity and mortality. METHODS:A prospective observational study was made during the period of 2003-2004 in a surgical intensive care unit of a Cardiac Surgery Center,Athens. One hundred twenty-eight adult patients for open heart surgery were divided into three groups. Group A included 50 patients who underwent coronary artery bypass crafting(CABG),group B 31 patients who were subjected to aortic valve replacement(AVR)+CABG and group C 47 patients who underwent mitral valve replacement(MVR)+CABG. Aminotransferases,alkaline phosphatase,gamma-glutamyl-transpeptidase and both types of bilirubin were determined at admission,24 hours after the operation and thereafter according to clinical evolution. The presence of jaundice was associated with elevated serum bilirubin above 3 mg/dl. RESULTS:Hyperbilirubinemia developed in 34 patients(26.5%). The incidence of postoperative jaundice was higher in patients who were subjected to MVR+CABG than to CABG and AVR+CABG. Hyperbilirubinemia was correlated with prolonged cardiopulmonary by-passtime(P<0.001),aortic cross-clamping time(P<0.001),the use of intra aortic balloon pumping(P<0.001),the administration of inotrops and the number of blood and plasma transfusions. Postoperative jaundice resulted mainly from an increase in conjugated bilirubin. CONCLUSIONS:Although hyperbilirubinemia seems to be multifactorial,the type of operation,the preoperative hepatic dysfunction due to advanced heart failure(NYHA Ⅱ-Ⅲ) and the decreased hepatic flow during the operation seem to determine the incidence of jaundice.

关键词： jaundice conjugated bilirubin cardiac surgery prognosis

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Legionella pneumonia complicated with rhabdomyolysis and acute kidney injury diagnosed by metagenomic nextgeneration sequencing: a case report

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World Journal of Emergency Medicine 2023年第4期14卷 322-324页

作者： Bin Deng Junjie Hua Yufei Zhou Duoxian Zhan Lijuan Zhu Yixing Zhan Yumin Fang Yun Ji Libin Li department of intensive care unit Suichang People's HospitalLishui 323300China department of Emergency Medicine Suichang People's HospitalLishui 323300China department of surgical intensive care unit the Second Affiliated Hospital Zhejiang University School of MedicineHangzhou 310009China

The triad of Legionella pneumonia,rhabdomyolysis,and acute kidney injury(AKI)is uncommon but can be devastating.[1]It is vital to recognize Legionella species early as a potential cause of *** infection remains underdiagnosed because of the nonspecific nature of clinical features and the shortcomings of routinely available diagnostic tests.[2]Metagenomic next-generation sequencing(mNGS)is a culture-free and hypothesis-free diagnostic method that can rapidly identify almost all known pathogens in a sample.[3]Here,we present a successfully cured case of rhabdomyolysis and AKI caused by Legionella pneumophila with etiologic diagnosis aided by the use of mNGS.

关键词： pneumonia routine kidney

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Proton pump inhibitors and all-cause mortality risk among cancer patients

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World Journal of Clinical Oncology 2025年第1期16卷 34-42页

作者： Arunkumar Krishnan Carolin Victoria Schneider Declan Walsh department of Supportive Oncology Atrium Health Levine CancerCharlotteNC 28204United States department of Medicine Section of Hematology and OncologyWake Forest University School of MedicineWinston-SalemNC 27101United States department of Medicine Ⅲ GastroenterologyMetabolic Diseasesand Intensive CareUniversity Hospital RWTH AachenAachen 52074Germany

BACKGROUND Proton pump inhibitors(PPIs)are widely used,including among cancer patients,to manage gastroesophageal reflux and other gastric acid-related *** evidence suggests associations between long-term PPI use and higher risks for various adverse health outcomes,including greater *** To investigate the association between PPI use and all-cause mortality among cancer patients by a comprehensive analysis after adjustment for various confounders and a robust methodological approach to minimize *** This retrospective cohort study used data from the TriNetX research network,with electronic health records from multiple healthcare *** study employed a new-user,active comparator design,which compared newly treated PPI users with non-users and newly treated histamine2 receptor antagonists(H2RA)users among adult cancer *** prescribed PPIs(esomeprazole,lansoprazole,omeprazole,pantoprazole,or rabeprazole)users were compared to non-users or newly prescribed H2RAs(cimetidine,famotidine,nizatidine,or ranitidine)*** primary outcome was all-cause *** patient in the main group was matched to a patient in the control group using 1:1 propensity score matching to reduce confounding *** Cox regression models were used to estimate hazard ratios(HRs)and 95% confidence interval(CI).RESULTS During the follow-up period(median 5.4±1.8 years for PPI users and 6.5±1.0 years for non-users),PPI users demonstrated a higher all-cause mortality rate than non-users after 1 year,2 years,and at the end of follow up(HRs:2.34-2.72).Compared with H2RA users,PPI users demonstrated a higher rate of all-cause mortality HR:1.51(95%CI:1.41-1.69).Similar results were observed across sensitivity analyses by excluding deaths from the first 9 months and 1-year post-exposure,confirming the robustness of these *** a sensitivity analysis,we analyzed all-cause mortality outcomes between former PPI users and individual

关键词： All-cause mortality Cancer Histamine-2 receptor antagonists Mortality Malignancy Proton pump inhibitors Carcinoma Outcome

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Correlation of serum albumin level on postoperative day 2 with hospital length of stay in patients undergoing emergency surgery for perforated peptic ulcer

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World Journal of Gastrointestinal Surgery 2023年第7期15卷 1434-1441页

作者： Dan Xie Ping-Lan Lu Wen Xu Jing-Ya You Xiao-Gang Bi Ying Xian department of General intensive care unit Lingnan HospitalThe Third Affiliated Hospital of Sun Yat-sen UniversityGuangzhou 510530Guangdong ProvinceChina department of surgical intensive care unit The Third Affiliated Hospital of Sun Yat-sen UniversityGuangzhou 510000Guangdong ProvinceChina

BACKGROUND Perforated peptic ulcer(PPU)is a common emergency surgical condition and a significant cause of morbidity and mortality *** advances in surgical techniques have improved outcomes for patients with PPU,many factors still affect postoperative hospital stay and overall *** potential factor is the serum albumin(SA)level,a widely utilized marker of nutritional status that has been associated with length of stay and complications in various surgical *** To clarify the correlation of SA level on postoperative day 2 with hospital length of stay(HLOS)in patients undergoing emergency surgery for perforated peptic ulcer(PPU).METHODS We retrospectively collected and analyzed clinical baseline data,including blood routine and SA levels,of patients who underwent emergency PPU surgery and postoperative treatment at the Lingnan Hospital,the Third Affiliated Hospital of Sun Yat-sen University between December 2012 and September *** were grouped according to HLOS with 7 d as the cut-off value,and relevant indicators were analyzed using SPSS *** Of the 37 patients undergoing emergency surgery for PPU referred to our department,33 had gastric and 4 had duodenal ulcer *** median HLOS was 10 *** were 8 patients in the≤7-d group(median HLOS:7 d)and 29 patients in the>7-d group(median HLOS:10 d).The≤7-d group had markedly higher SA on postoperative day 2 than the>7-d group(37.7 g/L vs 32.6g/L;P7 d(Odds ratio=0.629,P=0.015).The cut-off of SA on postoperative day 2 was 30.6g/L,with an area under the curve of 0.86 and a negative predictive value of 100%for the prediction of HLOS≤7 *** The SA level on postoperative day 2 was associated with the HLOS in patients undergoing emergency surgery for *** pre-and post-operative albumin levels should be monitored,and infusion of human SA should be considered in a timely man

关键词： Perforated peptic ulcer Emergency surgery Serum albumin Hospital length of stay

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Original article Predictive value of RIFLE classification on prognosis of critically ill patients with acute kidney injury treated with continuous renal replacement therapy

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Chinese Medical Journal 2009年第9期 1020-1025页

作者： LI Wen-xiong CHEN Hui-de WANG Xiao-wen ZHAO Song CHEN Xiu-kai ZHENG Yue SONG Yang department of surgical intensive care unit Beijing Chaoyang Hospital Capital Medical University Beijing 100020 China

Background The optimal timing to start continuous renal replacement therapy （CRRT） for acute kidney injury （AKI） patients has not been accurately established. The recently proposed risk, injury, failure, loss, end-stage kidney disease （RIFLE） criteria for diagnosis and classification of AKI may provide a method for clinicians to decide the ＂optimal timing＂ for starting CRRT under uniform guidelines. The present study aimed：（1） to analyze the correlation between RIFLE stage at the start of CRRT and 90-day survival rate after CRRT start, （2） to further investigate the correlation of RIFLE stage with the malignant kidney outcome in the 90-day survivors, and （3） to determine the influence of the timing of CRRT defined by RIFLE classification on the 90-day survival and malignant kidney outcome in 90-day survivors.Methods A retrospective cohort analysis was performed on the data of 106 critically ill patients with AKI, treated with CRRT during a 6-year period in a university affiliated surgical intensive care unit （SICU）. Information such as sex, age, RIFLE stage, sepsis, sepsis-related organ failure assessment （SOFA） score, number of organ failures before CRRT, CRRT time during SICU, survival, and kidney outcome conditions at 90 days after CRRT start was collected. According to their baseline severity of AKI at the start of CRRT, the patients were assigned to three groups according to the increasing severity of RIFLE stages： RIFLE-R （risk of renal dysfunction, R）, RIFLE-I （injury to the kidney, I） and RIFLE-F （failure of kidney function, F） using RIFLE criteria. The malignant kidney outcome was classified as RIFLE-L （loss of kidney function L） or RIFLE-E （end-stage kidney disease, E） using RIFLE criteria. The correlation between RIFLE stage and 90-day survival rate was analyzed among these three RIFLE-categorized groups. Additionally, the association between RIFLE stage and the malignant kidney outcome （RIFLE-L＋RIFLF-E） in the 90-day survivors was *** Fif

关键词： RIFLE classification renal replacement therapy acute kidney injury prognosis

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Reactive oxygen species generation is essential for cisplatininduced accelerated senescence in hepatocellular carcinoma

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Frontiers of Medicine 2014年第2期8卷 227-235页

作者： Kai Qu Ting Lin Zhixin Wang Sinan Liu Hulin Chang Xinsen Xu Fandi Meng Lei Zhou Jichao Wei Minghui Tai Yafeng Dong Chang Liu department of Hepatobiliary Surgery surgical intensive care unit the First Affiliated Hospital School of Medicine Xi'an Jiaotong University Xi 'an 710061 China department of Obstetrics and Gynecology Kansas University Kansas City KS 66160 USA

Accelerated senescence is important because this process is involved in tumor suppression and has been induced by many chemotherapeutic agents. The platinum-based chemotherapeutic agent cisplatin displays a wide range of antitumor activities. However, the molecular mechanism of cisplatin-induced accelerated senescence in hepatocellular carcinoma （HCC） remains unclear. In the present study, the growth inhibitory effect of cisplatin on HepG2 and SMMC-7721 cells was detected by 3-（4,5-dimethylthiazol-2-yl）-2,5-diphenyltetrazolium bromide assay. Cellular senescence was then assessed by I^-galactosidase assay. Senescence-related factors, including p53, p21, and p16, were evaluated by quantitative reverse transcription-polymerase chain reaction. Reactive oxygen species （ROS） was analyzed by flow cytometry. Our results revealed that cisplatin reduced the proliferation of HepG2 and SMMC-7721 cells in a dose- and time-dependent manner. Senescent phenotype observed in cisplatin- treated hepatoma cells was dependent on p53 and p21 activation but not on pl 6 activation. Furthermore, cisplatininduced accelerated senescence depended on intracellular ROS generation. The ROS scavenger N-acetyl-Lcysteine also significantly suppressed the cisplatin-induced senescence of HepG2 and SMMC-7721 cells. In conclusion, our results revealed a functional link between intracellular ROS generation and cisplatin-indnced accelerated senescence, and this link may be used as a potential target of HCC.

关键词： reactive oxygen species senescence cisplatin hepatocellular carcinoma

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Early respiratory complications after liver transplantation

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World Journal of Gastroenterology 2013年第48期19卷 9271-9281页

作者： Paolo Feltracco Cristiana Carollo Stefania Barbieri Tommaso Pettenuzzo Carlo Ori department of Medicine Anesthesia and Intensive Care Unit Padova University Hospital35128 Padova Italy

The poor clinical conditions associated with end-stage cirrhosis,pre-existing pulmonary abnormalities,and high comorbidity rates in patients with high Model for End-Stage Liver Disease scores are all well-recognized factors that increase the risk of pulmonary complications after orthotopic liver transplantation(OLT)*** intraoperative and postoperative events,such as fluid overload,massive transfusion of blood products,hemodynamic instability,unexpected coagulation abnormalities,renal dysfunction,and serious adverse effects of reperfusion syndrome,are other factors that predispose an individual to postoperative respiratory *** advances in surgical techniques and anesthesiological management,the lung may still suffer throughout the perioperative period from various types of injury and ventilatory impairment,with different clinical *** complications after OLT can be classified as infectious or *** effusion,atelectasis,pulmonary edema,respiratory distress syndrome,and pneumonia may contribute considerably to early morbidity and mortality in liver transplant *** is of paramount importance to accurately identify lung disorders because infectious pulmonary complications warrant speedy and aggressive treatment to prevent diffuse lung injury and the risk of evolution into multisystem organ *** review discusses the most common perioperative factors that predispose an individual to postoperative pulmonary complications and these complications’early clinical manifestations after OLT and influence on patient outcome.

关键词： Respiratory complications Postoperative respiratory failure Liver transplantation Postoperative edema Post-transplant pneumonia

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Thrombosis prophylaxis in pediatric liver transplantation: A systematic review

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World Journal of Hepatology 2018年第10期10卷 752-760页

作者： Mirco Nacoti Giulia Maria Ruggeri Giovanna Colombo Ezio Bonanomi Federico Lussana department of Anesthesia and intensive care Pediatric Intensive Care Unit Papa Giovanni Ⅹ Hospital Hematology and Bone Marrow Transplant unit Papa Giovanni Ⅹ Hospital

AIM To review current literature of thrombosis prophylaxis in pediatric liver transplantation(PLT) as thrombosis remains a critical *** Studies were identified by electronic search of MEDLINE, EMBASE and Cochrane Library(CENTRAL) databases until March 2018. The search was supplemented by manually reviewing the references of included studies and the references of the main published systematic reviews on thrombosis and PLT. We excluded from this review case report, small case series, commentaries, conference abstracts, papers which describing less than 10 pediatric liver transplants/year and articles published before 1990. Two reviewers performed study selection independently, with disagreements solved through discussion and by the opinion of a third reviewer when *** Nine retrospective studies were included in this review. The overall quality of studies was poor. A pooled analysis of results from studies was not possible due to the retrospective design and heterogeneity of included studies. We found an incidence of portal vein thrombosis(PVT) ranging from 2% to 10% in pediatric living donorliver transplantation(LDLT) and from 4% to 33% in pediatric deceased donor liver transplantation(DDLT). Hepatic artery thrombosis(HAT) was observed mostly in mixed LDLT and DDLT pediatric population with an incidence ranging from 0% to 29%. In most of the studies Doppler ultrasonography was used as a first line diagnostic screening for thrombosis. Four different surgical techniques for portal vein anastomosis were reported with similar efficacy in terms of PVT reduction. Reduced size liver transplant was associated with a low risk of both PVT(incidence 4%) and HAT(incidence 0%, P surgical hepatic arterial reconstruction were associated with a significant reduced HAT incidence(6% and 0%, respectively). According to our inclusion and exclusion criteria, we did not find

关键词： Pediatric liver transplantation Prophylaxis Hepatic artery thrombosis surgical technique Portal vein thrombosis

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