Renin as a Marker of Tissue-Perfusion and Prognosis in Critically Ill Patients*

Objectives: To characterize renin in critically ill patients. Renin is fundamental to circulatory homeostasis and could be a useful marker of tissue-perfusion. However, diurnal variation, continuous renal replacement therapy and drug-interference could confound its use in critical care practice. Design: Prospective observational study. Setting: Single-center, mixed medical-surgical ICU in Europe. Patients: Patients over 18 years old with a baseline estimated glomerular filtration rate greater than 30 mL/min/1.73 m2 and anticipated ICU stay greater than 24 hours. Informed consent was obtained from the patient or next-of-kin. Interventions: Direct plasma renin was measured in samples drawn 6-hourly from arterial catheters in recumbent patients and from extracorporeal continuous renal replacement therapy circuits. Physiologic variables and use of drugs that act on the renin-angiotensin-aldosterone system were recorded prospectively. Routine lactate measurements were used for comparison. Measurements and Main Results: One-hundred twelve arterial samples (n = 112) were drawn from 20 patients (65% male; mean ± SD, 60 ± 14 yr old) with septic shock (30%), hemorrhagic shock (15%), cardiogenic shock (20%), or no circulatory shock (35%). The ICU mortality rate was 30%. Renin correlated significantly with urine output (repeated-measures correlation coefficient = –0.29; p = 0.015) and mean arterial blood pressure (repeated-measure...
Source: Critical Care Medicine - Category: Emergency Medicine Tags: Feature Articles Source Type: research

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Purpose: In contrast to arterial lactate, previous studies have proposed central venous-to-arterial CO2 difference (P (v-a)CO2) as a more useful guide for categorizing patients at risk of developing septic shock. It is worthwhile studying P (v-a)CO2 in determining whether it could serve as a useful predictor for poor postoperative outcomes in patients undergoing cardiac surgery. We investigated the ability of P(v-a)CO2 to predict poor outcomes of patients with postoperative cardiogenic shock. Methods: In total, 1,672 patients were enrolled in this study from January 1, 2014 to June 1, 2017. Of these patients, 143 exhi...
Source: Shock - Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research
Conclusions: : The findings of current study emphasize that clinicians should be awareof the possibility of RFS in malnourished AP patients with electrolyte imbalances. PMID: 30970437 [PubMed - as supplied by publisher]
Source: Gut and Liver - Category: Gastroenterology Tags: Gut Liver Source Type: research
In this study they also showed PTX3 localized in NETs formed after neutrophil activation (5). Proteomics analysis revealed that PTX3 forms complexes with two anti-microbial proteins [azurocidin (AZU1) and myeloperoxidase (MPO)] associated to NETs (30). More recently, PTX3 localization in NETs has been confirmed, and the colocalization with AZU1 and MPO has been defined more accurately (31). Further investigation will be needed to understand the involvement of PTX3 interaction with AZU1 and MPO in their antibacterial role during NET formation. Regulation of Complement Activation PTX3 interaction with microorganisms is not...
Source: Frontiers in Immunology - Category: Allergy & Immunology Source Type: research
Conclusion In our Level-2 ICCU, predictors of in-hospital and long-term mortality are similar to those commonly found in a Level-3 ICU. These data strongly suggest that ICUs dealing with acute cardiovascular patients should be reorganized with a necessary upgrading of competences and resources for medical and nursing staff.
Source: Journal of Cardiovascular Medicine - Category: Cardiology Tags: Research articles: Coronary artery disease Source Type: research
an HA Abstract OBJECTIVE: Acute coronary syndrome (ACS) has become more frequent in the elderly population due to increased life expectancy. The aim of this trial was to determine clinical and laboratory factors related to in-hospital mortality in patients over 80 years of age who presented with ACS. METHODS: A total 171 patients (86 men, median age 83 years) who were over 80 years of age and were hospitalized due to a diagnosis of ACS were enrolled in this study. The patients' demographic data, clinical features, and laboratory values were screened retrospectively from hospital records. RESULTS: During ...
Source: Turk Kardiyoloji Dernegi arsivi - Category: Cardiology Authors: Tags: Turk Kardiyol Dern Ars Source Type: research
We present a case of female patient presented with cardiogenic shock after rupture globe operation, patient presented on mega doses of vasopressors and inotropes, peripheral percutaneous VA ECMO was instituted, IABP was put to deload leftventricle, 2 days later patient was shifted to VAV ECMO. After 4 days of ECMO run patient recovered left ventricular function and patient was weaned from all mechanical support devices. But patient developed septic shock refractory to vasopressors therapy and patient died.
Source: The Egyptian Journal of Critical Care Medicine - Category: Intensive Care Source Type: research
ConclusionFor the first time, a steep ECMO-learning curve using the CUSUM tool has been described. Obviously, the experience with ECMO has to be taken into account when defining the role of ECMO in ARDS, cardiogenic, and septic shock.
Source: Journal of Intensive Care - Category: Intensive Care Source Type: research
Authors: Kislitsina ON, Rich JD, Wilcox JE, Pham DT, Churyla A, Vorovich EB, Ghafourian K, Yancy CW Abstract The management of patients with shock is extremely challenging because of the myriad of possible clinical presentations in cardiogenic shock, septic shock and hypovolemic shock and the limitations of contemporary therapeutic options. The treatment of shock includes the administration of endogenous catecholamines (epinephrine, norepinephrine, and dopamine) as well as various vasopressor agents that have shown efficacy in the treatment of the various types of shock. In addition to the endogenous catecholamines...
Source: Current Cardiology Reviews - Category: Cardiology Tags: Curr Cardiol Rev Source Type: research
Conclusion: HS and SS are frequent etiological characteristics followed by NS and CS, whereas OS is a rare condition. We confirm the increasing trend of SS, as previously reported. Seven-day mortality ranged from 12.7% to 34.6%, while 90-day mortality ranged from 22.6% to 56.2%. The underlying etiology was an independent predictor of mortality.
Source: Shock - Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research
Background: Cardiogenic shock shares with septic shock common hemodynamic features, inflammatory patterns, and most likely similar complications such as critical illness-related corticosteroid insufficiency. The aim of this study was to evaluate the prevalence of critical illness-related corticosteroid insufficiency in cardiogenic shock patients and to secondarily assess its prognostic value on 90-day mortality. Methods: A single-center prospective observational study conducted over a 3-year period and including all patients with cardiogenic shock. Main exclusion criteria were patients with prior cardiac arrest, sepsi...
Source: Shock - Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research
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