Ventilator-associated pneumonia in patients with cerebral hemorrhage: Impact on mortality and microbiological characterization / Neumonía asociada a ventilación mecánica en pacientes con hemorragia cerebral: mortalidad y caracterización microbiana

Ventilator-associated pneumonia (VAP) is a major complication among critically ill patients who depend on mechanical ventilation. Few reports have focused on intracerebral hemorrhage patients with VAP. Our main objective was to investigate the bacteria distribution characteristics and the impact of ventilator-associated pneumonia mortality in critical cerebral hemorrhage patients. This retrospective study included 89 cases of cerebral hemorrhage patients with VAP admitted to the ICU of Huashan Hospital. We used the chi-square test to compare qualitative variables and Student's t-test to compare means between groups of normally distributed quantitative variables. Multiple logistic regression analysis was used to assess mortality-independent predictors in the ICU. A total of 42% patients with cerebral hemorrhage were diagnosed with VAP in the ICU during the study period, and the mortality rate was 18%. Acinetobacter baumannii (n=58), Klebsiella pneumoniae (n=52), and Pseudomonas aeruginosa (n=21) were the most common pathogenic bacteria. Blood volume >30ml, tracheal ventilation mode and head of bed elevation were independent factors associated with increased mortality. Glasgow Coma Scale (GCS), Acute Physiology and Chronic Health Evaluation II (APACHE II) score and the time from bleeding to intubation were other potentially important factors. While the number of infecting bacteria may not be directly related to death, it can increase antibiotic consumption and length of intensive care unit (ICU) stays. Blood volume >30ml, tracheal ventilation mode and head of bed elevation were directly related to the death of critical cerebral hemorrhage patients with ventilator-associated pneumonia

La neumonía asociada a ventilación mecánica (NAV) es una complicación mayor entre los pacientes críticos que dependen de la ventilación mecánica. Pocos artículos se han centrado en los pacientes de hemorragia cerebral con NAV. Nuestro objetivo principal fue investigar las características de la distribución bacteriana y el impacto de la mortalidad de la neumonía asociada a ventilación mecánica en pacientes críticos de hemorragia cerebral. Este estudio retrospectivo incluyó 89 casos de pacientes de hemorragia cerebral con NAV ingresados en la unidad de cuidados intensivos (UCI) del Hospital Huashan. Utilizamos la prueba χ2 para comparar las variables cualitativas, y la t de Student para comparar las medias entre grupos de las variables cuantitativas normalmente distribuidas. Utilizamos análisis de regresión logística múltiple para valorar los factores predictivos independientes de la mortalidad en la UCI. Diagnosticamos NAV en el 42% de los pacientes con hemorragia en la UCI durante el periodo de estudio, y la tasa de mortalidad fue del 18%. Acinetobacter baumannii (n=58), Klebsiella pneumoniae (n=52) and Pseudomonas aeruginosa (n=21) fueron las bacterias patogénicas más comunes. El volumen sanguíneo >30ml, el modo de ventilación traqueal y la inclinación del cabecero de la cama fueron factores independientes asociados al incremento de la mortalidad. La Glasgow Coma Scale (GCS) y el Acute Physiology and Chronic Health EvaluationII (APACHE II), así como el tiempo transcurrido entre el sangrado y la intubación, fueron otros factores potencialmente importantes. A pesar de que el número de bacterias infecciosas puede no estar directamente relacionado con la muerte, puede incrementar el consumo de antibióticos y la duración de la estancia en la UCI. El volumen sanguíneo >30ml, el modo de ventilación traqueal y la inclinación del cabecero de la cama guardaron una relación directa con la muerte de los pacientes críticos de hemorragia cerebral con neumonía asociada a ventilación mecánica

Ventilator-associated pneumonia in patients with cerebral hemorrhage: Impact on mortality and microbiological characterization.

Ventilator-associated pneumonia (VAP) is a major complication among critically ill patients who depend on mechanical ventilation. Few reports have focused on intracerebral hemorrhage patients with VAP. Our main objective was to investigate the bacteria distribution characteristics and the impact of ventilator-associated pneumonia mortality in critical cerebral hemorrhage patients. This retrospective study included 89 cases of cerebral hemorrhage patients with VAP admitted to the ICU of Huashan Hospital. We used the chi-square test to compare qualitative variables and Student's t-test to compare means between groups of normally distributed quantitative variables. Multiple logistic regression analysis was used to assess mortality-independent predictors in the ICU. A total of 42% patients with cerebral hemorrhage were diagnosed with VAP in the ICU during the study period, and the mortality rate was 18%. Acinetobacter baumannii (n=58), Klebsiella pneumoniae (n=52), and Pseudomonas aeruginosa (n=21) were the most common pathogenic bacteria. Blood volume >30ml, tracheal ventilation mode and head of bed elevation were independent factors associated with increased mortality. Glasgow Coma Scale (GCS), Acute Physiology and Chronic Health Evaluation II (APACHE II) score and the time from bleeding to intubation were other potentially important factors. While the number of infecting bacteria may not be directly related to death, it can increase antibiotic consumption and length of intensive care unit (ICU) stays. Blood volume >30ml, tracheal ventilation mode and head of bed elevation were directly related to the death of critical cerebral hemorrhage patients with ventilator-associated pneumonia.

Glycyrrhizin affects monocyte migration and apoptosis by blocking HMGB1 signaling.

Monocytes serve an important role in systemic inflammation. High mobility group box­1 protein (HMGB1) promotes recruitment and suppresses apoptosis in monocytes through the receptor for advanced glycation end products/ nuclear factor (NF)­κB and toll­like receptor 4/mitogen­activated protein kinase (MAPK)/extracellular signal­regulated kinase (ERK) signaling pathways. Glycyrrhizin (GL), an effective component of licorice, weakens the proinflammatory effect of HMGB1. The present study investigated the effect of GL on the migration and apoptosis of monocytes associated with HMGB1 signaling. THP­1 cells were used to evaluate the behavior of monocytes in response to GL treatment, and the downstream pathways were investigated. GL suppressed HMGB1­induced monocyte migration and increased HMGB1­inhibited monocyte apoptosis. GL inhibited the activation of the NF­κB and MAPK/ERK signaling pathways induced by HMGB1 and decreased the expression of monocyte chemoattractant protein­1 (MCP­1) and myeloid cell leukemia 1 (Mcl­1). Taken together, the results indicated that GL may suppress the migration of monocytes and induce apoptosis to reduce systemic inflammation by blocking downstream NF­κB/MCP­1 and MAPK/ERK/Mcl­1 signaling pathways.

The relationship between serum levels of uric acid and prognosis of infection in critically ill patients.

BACKGROUND: Serum uric acid level is associated with some chronic diseases and prognosis of severe infection. This study aimed to investigate the relationship between serum uric acid (SUA) and prognosis of infection in critically ill patients. METHODS: The data from 471 patients with infection admitted from January 2003 to April 2010 were analyzed retrospectively at Huashan Hospital Affiliated to Fudan University, Shanghai, China. The data of SUA, serum creatinine, blood urea nitrogen (BUN) and other relevant examinations within 24 hours after admission were recorded and the levels of SUA in those patients were described, then Student's t test was used to evaluate the relationship between SUA and pre-existing disorders. Different levels of SUA were graded for further analysis. The Chi-square test was used to examine the difference in the prognosis of infection. RESULTS: The mean initial level of SUA within 24 hours after admission was 0.232±0.131 mmol/L and the median was 0.199 mmol/L. Remarkable variations in the initial levels of SUA were observed in patients with pre-existing hypertension (t=-3.084, P=0.002), diabetes mellitus (t=-2.487, P=0.013), cerebral infarction (t=-3.061, P=0.002), renal insufficiency (t=-4.547, P<0.001), central nervous system infection (t=5.096, P<0.001) and trauma (t=2.875, P=0.004). SUA was linearly correlated with serum creatinine and BUN (F=159.470 and 165.059, respectively, P<0.001). No statistical correlation was found between the initial levels of SUA and prognosis of infection (χ2=60.892, P=0.100). CONCLUSION: The current study found no direct correlation between the initial levels of SUA after admission and prognosis of infection in critically ill patients.