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Author: search.filters.author.Abraham I. J. GajardoSubject: search.filters.subject.sepsis

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    Early high-sensitivity troponin elevation and short-term mortality in sepsis: a systematic review with meta-analysis
    (Springer Science and Business Media LLC, 2025-02-14)
    Abraham I. J. Gajardo
    ;
    Santiago Ferrière-Steinert
    ;
    Joaquín Valenzuela Jiménez
    ;
    Sebastián Heskia Araya
    ;
    Thomas Kouyoumdjian Carvajal
    Abstract Background Serum cardiac troponin (cTn) elevation is a well-established phenomenon in sepsis. However, the clinical signifcance of this phenomenon with high-sensitivity (hs) assays and the current sepsis defnition needs to be settled. Research Question What is the association between early serum cTn levels measured by hs-assays and the risk of short-term mortality in septic patients? Study Design and Methods We conducted a systematic review using a comprehensive PubMed, Scopus, and Embase search. Studies were eligible if they reported association data on early hs-cTn and mortality in an adult sample with sepsis that met the Sepsis-3 defnition. For the synthesis of the efect of hs-cTn on mortality, we applied random efect models on the pooled unadjusted and adjusted odds ratio (OR and aOR, respectively) of elevated vs. normal hs-cTn serum values, and on the crude standardized mean diference (SMD) of hs-cTn between survivors and non-survivors. Results In total, 6242 patients from 17 studies were included, with short-term mortality rates ranging from 16.9% to 53.8%. Using a crude analysis, non-survivor patients showed higher hs-cTn than survivors (SMD of 0.87, 95%CI: 0.41–1.33). Elevated hs-cTn was associated with increased mortality (OR=1.78, 95% CI: 1.41–2.25). However, this prognostic efect was absent in studies that adjusted for diferent confounders (aOR=1.06, 95% CI: 0.99–1.14). Discussion and Conclusions Non-survivors of sepsis exhibited signifcantly elevated hs-cTn levels. While elevated hs-cTn levels are associated with an increased risk of mortality, they are not independently associated with this outcome in sepsis
    Scopus© Citations 3  1
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    Early high-sensitivity troponin elevation in predicting short-term mortality in sepsis: A protocol for a systematic review with meta-analysis
    (2024)
    Santiago Ferrière-Steinert
    ;
    Joaquín Valenzuela Jiménez
    ;
    Sebastián Heskia Araya
    ;
    Thomas Kouyoumdjian
    ;
    José Ramos-Rojas
    <jats:sec id="sec001"> <jats:title>Background</jats:title> <jats:p>Sepsis is a common admission diagnosis in the intensive care unit (ICU). The Sepsis-3 consensus associates sepsis diagnosis with acute organ dysfunction. In these patients troponin elevation is a well-established phenomenon, but its clinical significance is not settled, as no systematic review has addressed the prognostic significance of the increasingly prevalent high-sensitivity troponin assays in acute organ dysfunction setting.</jats:p> <jats:p>This study aims to clarify the association between early serum troponin levels in high-sensitivity assays with short-term mortality risk in septic patients with acute organ dysfunction.</jats:p> </jats:sec> <jats:sec id="sec002"> <jats:title>Methods</jats:title> <jats:p>We will systematically search PubMed, Scopus and Embase for original articles; additionally, a manual search will be carried out through relevant literature. Generally, studies will be deemed eligible for inclusion if they evaluate the association between high-sensitivity troponin in the first 24 hours of admission and ICU, 30-days, or In-hospital mortality; in patients with septic shock or sepsis related to acute organ dysfunction. Two reviewers will independently select studies and extract the data. A meta-analysis for mortality outcome will be performed for comparative data regarding two effect measures: Odd ratios and Standardized Mean differences.</jats:p> </jats:sec> <jats:sec id="sec003"> <jats:title>Discussion</jats:title> <jats:p>This study will provide further evidence about the role of high-sensitivity troponin assays in predicting mortality in septic patients; potentially helping to guide further research and yielding valuable information for patient assessment.</jats:p> <jats:p>Conclusion about the certainty of evidence will be presented in a ´Summary of findings´ table.</jats:p> </jats:sec> <jats:sec id="sec004"> <jats:title>Trial registration</jats:title> <jats:p>PROSPERO registration:</jats:p> <jats:p>(<jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024468883" xlink:type="simple">CRD42024468883</jats:ext-link>).</jats:p> </jats:sec>
      8Scopus© Citations 3
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    Continuous prolonged prone positioning in COVID-19-related ARDS: a multicenter cohort study from Chile
    (2022)
    Rodrigo A. Cornejo
    ;
    Jorge Montoya
    ;
    Abraham I. J. Gajardo
    ;
    GRAF SANTOS, JERÓNIMO  
    ;
    Leyla Alegría
    <jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>Prone positioning is currently applied in time-limited daily sessions up to 24 h which determines that most patients require several sessions. Although longer prone sessions have been reported, there is scarce evidence about the feasibility and safety of such approach. We analyzed feasibility and safety of a continuous prolonged prone positioning strategy implemented nationwide, in a large cohort of COVID-19 patients in Chile.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>Retrospective cohort study of mechanically ventilated COVID-19 patients with moderate-to-severe acute respiratory distress syndrome (ARDS), conducted in 15 Intensive Care Units, which adhered to a national protocol of continuous prone sessions  ≥ 48 h and until PaO<jats:sub>2</jats:sub>:FiO<jats:sub>2</jats:sub> increased above 200 mm Hg. The number and extension of prone sessions were registered, along with relevant physiologic data and adverse events related to prone positioning. The cohort was stratified according to the first prone session duration: Group A, 2–3 days; Group B, 4–5 days; and Group C, &gt; 5 days. Multivariable regression analyses were performed to assess whether the duration of prone sessions could impact safety.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>We included 417 patients who required a first prone session of 4 (3–5) days, of whom 318 (76.3%) received only one session. During the first prone session the main adverse event was grade 1–2 pressure sores in 97 (23.9%) patients; severe adverse events were infrequent with 17 non-scheduled extubations (4.2%). 90-day mortality was 36.2%. Ninety-eight patients (24%) were classified as group C; they exhibited a more severe ARDS at baseline, as reflected by lower PaO<jats:sub>2</jats:sub>:FiO<jats:sub>2</jats:sub> ratio and higher ventilatory ratio, and had a higher rate of pressure sores (44%) and higher 90-day mortality (48%). However, after adjustment for severity and several relevant confounders, prone session duration was not associated with mortality or pressure sores.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Nationwide implementation of a continuous prolonged prone positioning strategy for COVID-19 ARDS patients was feasible. Minor pressure sores were frequent but within the ranges previously described, while severe adverse events were infrequent. The duration of prone session did not have an adverse effect on safety.</jats:p> </jats:sec>
    Scopus© Citations 17  1