PubMed · 15249432
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Thomas L Higgins. 2004. Timing is everything.. https://doi.org/10.1378/chest.126.1.4
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AIM: To investigate the clinical characteristics and prognostic factors of a consecutive series of patients with severe acute pancreatitis (SAP). METHODS: Clinical data of SAP patients admitted to our hospital from January 2003 to January 2004 were retrospectively reviewed. Collected data included the age, gender, etiology, length of hospitalization, APACHE II score at admission, local and organ/systemic complications of the patients. RESULTS: Of the 268 acute pancreatitis patients, 94 developed SAP. The mean age of SAP patients was 52 years, the commonest etiology was cholelithiasis (45.7%), the mean length of hospitalization was 70 d, the mean score of APACHE II was 7.7. Fifty-four percent of the patients developed necrosis, 25% abscess, 58% organ/systemic failure. A total of 23.4% (22/94) of the SAP patients died. Respiratory failure was the most common organ dysfunction (90.9%) in deceased SAP patients, followed by cardiovascular failure (86.4%), renal failure (50.0%). In the SAP patients, 90.9% (20/22) developed multiple organ/systemic failures. There were significant differences in age, length of hospitalization, APACHE II score and incidences of respiratory failure, renal failure, cardiovascular failure and hematological failure between deceased SAP patients and survived SAP patients. By multivariate logistic regression analysis, independent prognostic factors for mortality were respiratory failure, cardiovascular failure and renal failure. CONCLUSION: SAP patients are characterized by advanced age, high APACHE II score, organ failure and their death is mainly due to multiple organ/systemic failures. In patients with SAP, respiratory, cardiovascular and renal failures can predict the fatal outcome and more attention should be paid to their clinical evaluation.
The monocyte function of patients with severe tetramine poisoning and the effects of sequential hemoperfusion (HP) and continuous veno-venous hemofiltration (CVVH) on the immune status of the patients were investigated. Eleven patients with severe acute tetramine poisoning were treated with sequential HP and CVVH. The APACHE II score and Glasgow score were used to evaluate the disease status during the therapy. Blood samples were collected at 0, 2, 6, 12, 24, 48, and 72 h. Peripheral monocytes were isolated and stimulated with lipopolysaccharide (LPS) to detect the ability of monocytes to secrete tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-6, and IL-10. The number of monocytes was counted at the same time. As expected, three patients died and the clinical manifestations were improved in the other patients. The production of cytokines (TNF-alpha, IL-6, and IL-10) by monocytes of patients with tetramine poisoning was much lower than normal controls (P<0.001), and was significantly increased after HP and CVVH in the survivors (TNF-alpha, IL-6, IL-10, P<0.05, P<0.01, P<0.05, respectively). The blood concentration of tetramine was 0.124+/-0.082 mg/l at prehemoperfusion and 0.080+/-0.055 mg/l at posthemoperfusion (P<0.05). It was concluded that there was severe damage to monocyte function in patients with tetramine poisoning, and that sequential HP and CVVH can effectively ameliorated monocyte function and eliminate tetramine from blood.
BACKGROUND: Candidemia is a common cause of bloodstream infections in patients with cancer, with the majority of these infections being caused by a single Candida species. Studies of multiple-species candidemia (MSC) have rarely been reported. METHODS: The authors identified 33 patients with cancer who had candidemia (diagnosed between 1993 and 2000) caused by more than 1 Candida species. This group of 33 patients was compared with a control group of 66 patients with cancer who had C. albicans candidemia that arose soon before or soon after each case of MSC that was investigated in the current study. RESULTS: Patients with MSC, compared with control patients, were more likely to have leukemia (33% vs. 8%; P = 0.001), to have had prolonged neutropenia before the onset of their infection (mean +/- standard deviation, 10 +/- 17 days vs. 3 +/- 6 days; P = 0.02), and to have received chemotherapy within 1 month before their infection (42% vs. 18%; P = 0.01). Patients with MSC also had higher Acute Physiology and Chronic Health Evaluation II scores at the onset of infection (score > or = 16, 45% vs. 26%; P = 0.05) and were more likely to have received previous antifungal prophylaxis compared with patients who had candidemia caused by C. albicans (33% vs. 11%; P = 0.006). The response of C. albicans candidemia to single-agent antifungal therapy was significantly better than that of MSC (69% vs. 35% P = 0.004). CONCLUSIONS: In patients with cancer, MSC was more likely to occur as breakthrough candidemia, predominantly in those with leukemia and prolonged neutropenia, and was associated with suboptimal responses to single-agent antifungal therapy.