PURPOSE: Recently, several studies for immature granulocyte proportion (IG%) in patients with sepsis have revealed its association with diagnosis and prognosis of patients with sepsis. In this study, we enrolled patients with severe sepsis and septic shock and compared IG% with other biologic markers as a predictor of 28-day mortality. METHODS: This was a retrospective study for patients with severe sepsis and septic shock who were admitted to the emergency department of a tertiary care hospital for four-months. The IG% measured using Sysmex XE-2100 and other inflammatory markers, including C-reactive protein, lactate, and procalcitonin were evaluated and compared for 28-day mortality. RESULTS: A total of 85 patients with septic shock and 45 patients with severe sepsis were enrolled. In the non-survivors group (n=32, 24.6%), APACHE II score (p=0.017), use of continuous renal replacement therapy (CRRT) (p=0.002), and septic shock (p=0.009) were statistically higher compared with thesurvivors group. APACHE II score (Odd ratio [OR] 1.099, p=0.008) and IG% (> or =0.5%) (OR 3.568, p=0.036) predicted the 28-day mortality independently after adjusting SOFA score, septic shock,disseminated intravascular coagulopathy, use of CRRT, and gender. However, IG (> or =0.5%) had low specificity of 33.7% and positive predictive value (PPV) of 30.1% for 28-day mortality. CONCLUSION: IG% could be a useful biologic marker for prediction of 28-day mortality in patients with severe sepsis or septic shock. However, the limitation of low specificity and PPV must be considered in clinical use.
APACHE ; Biomarkers ; C-Reactive Protein ; Diagnosis ; Emergency Service, Hospital ; Granulocytes* ; Humans ; Lactic Acid ; Mortality* ; Prognosis ; Renal Replacement Therapy ; Retrospective Studies ; Sensitivity and Specificity ; Sepsis* ; Shock, Septic* ; Tertiary Healthcare

Although the incidence of bleeding complications during extracorporeal membrane oxygenator (ECMO) support has decreased in various trials, bleeding is still the most fatal complication. We investigated the ideal dosage and efficacy of nafamostat mesilate for use with ECMO in patients with acute cardiac or respiratory failure. We assessed 73 consecutive patients who received ECMO due to acute cardiac or respiratory failure between January 2006 and December 2009. To evaluate the efficacy of nafamostat mesilate, we divided the patients into 2 groups according to the anticoagulants used during ECMO support. All patients of nafamostat mesilate group were male with a mean age of 49.2 yr. Six, 3, 5, and 3 patients were diagnosed with acute myocardial infarction, cardiac arrest, septic shock, and acute respiratory distress syndrome, respectively. The mean dosage of nafamostat mesilate was 0.64 mg/kg/hr, and the mean duration of ECMO was 270.7 hr. The daily volume of transfused packed red blood cells, fresh frozen plasma, and cryoprecipitate and the number of complications related to hemorrhage and thrombosis was lower in the nafamostat mesilate group than in the heparin group. Nafamostat mesilate should be considered as an alternative anticoagulant to heparin to reduce bleeding complications during ECMO.
Acute Disease ; Anticoagulants/*administration & dosage ; Dose-Response Relationship, Drug ; *Extracorporeal Membrane Oxygenation ; Female ; Guanidines/*administration & dosage ; Heart Failure/diagnosis/mortality/therapy ; Heparin/administration & dosage ; Humans ; Male ; Middle Aged ; Myocardial Infarction/diagnosis/mortality/therapy ; Respiratory Distress Syndrome, Adult/diagnosis/mortality/therapy ; Retrospective Studies ; Shock, Septic/diagnosis/mortality/therapy ; Survival Analysis

BACKGROUND: Nasopharyngeal carcinoma (NPC) is very rare in children and adolescents. The aim of this study was to evaluate clinical characteristics and treatment outcomes of pediatric NPC.METHODS: Medical records of 9 patients treated for NPC at the Seoul National University Children's Hospital between 1988 and 2012 were analyzed retrospectively.RESULTS: The median age at diagnosis was 11 years (range, 9-13 years). One patient had stage II disease, 3 had stage III disease, and 5 had stage IV disease. The histologic subtypes were undifferentiated carcinoma and squamous cell carcinoma in 7 and 2 patients, respectively. All patients were initially treated with cisplatin (100 mg/m2 intravenous [IV] every 4 weeks for 4-6 months), bleomycin (15 unit/m2 IV every 1 weekx7), and fluorouracil (1,000 mg/m2 IV every 4 weeks for 1 year). Eight patients received radiotherapy with doses of 45-59.4 Gy at the primary site and neck nodes. Seven patients (77.8%) achieved complete remission, 1 (11.1%) achieved partial remission, and 1 (11.1%) showed disease progression. Six patients developed fluorouracil-related neurotoxicity; the regimen was changed to cisplatin, epirubicin, and bleomycin in five of the 6 patients. One patient died of progressive disease without responding to treatment. Treatment-related mortality occurred in 1 patient owing to septic shock. Secondary osteosarcoma developed in 1 patient 6 years after treatment. The overall survival was 77.8%, with a median follow-up of 40.8 months (range, 4.5-287.6 months).CONCLUSION: Children and adolescents with advanced NPC treated with combined chemotherapy and radiotherapy have a good survival rate.
Adolescent ; Bleomycin ; Carcinoma ; Carcinoma, Squamous Cell ; Chemoradiotherapy ; Child ; Cisplatin ; Diagnosis ; Disease Progression ; Drug Therapy ; Epirubicin ; Fluorouracil ; Follow-Up Studies ; Humans ; Korea ; Medical Records ; Mortality ; Nasopharyngeal Neoplasms ; Neck ; Osteosarcoma ; Pediatrics ; Radiotherapy ; Retrospective Studies ; Seoul ; Shock, Septic ; Survival Rate

BACKGROUND/AIMS: The modified early warning score (MEWS) is used to predict patient intensive care unit (ICU) admission and mortality. Lactate (LA) in the blood lactate (BLA) is measured to evaluate disease severity and treatment efficacy in patients with severe sepsis/septic shock. The usefulness of a combination of MEWS and BLA to predict ICU transfer in severe sepsis/septic shock patients is unclear. We evaluated whether use of a combination of MEWS and BLA enhances prediction of ICU transfer and mortality in hospitalized patients with severe sepsis/septic shock. METHODS: Patients with severe sepsis/septic shock who were screened or contacted by a medical emergency team between January 2012 and August 2012 were enrolled at a university-affiliated hospital with ~2,700 beds, including 28 medical ICU beds. RESULTS: One hundred patients were enrolled and the rate of ICU admittance was 38%. MEWS (7.37 vs. 4.85) and BLA concentration (5 mmol/L vs. 2.19 mmol/L) were significantly higher in patients transferred to ICU than those in patients treated in general wards. The combination of MEWS and BLA was more accurate than MEWS alone in terms of ICU transfer (C-statistics: 0.898 vs. 0.816, p = 0.019). The 28-day mortality rate was 19%. MEWS was the only factor significantly associated with 28-day mortality rate (odds ratio, 1.462; 95% confidence interval, 1.122 to 1.905; p = 0.005). CONCLUSIONS: The combination of MEWS and BLA may enhance prediction of ICU transfer in patients with severe sepsis/septic shock.
Adult ; Aged ; Biomarkers/blood ; *Decision Support Techniques ; Female ; Health Status ; *Health Status Indicators ; Hospital Bed Capacity ; Hospital Mortality ; Hospitals, University ; Humans ; *Intensive Care Units ; Lactic Acid/*blood ; Male ; Middle Aged ; *Patient Transfer ; Predictive Value of Tests ; Prognosis ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Sepsis/blood/*diagnosis/mortality/therapy ; Shock, Septic/blood/*diagnosis/mortality/therapy ; Time Factors