Tag Archives: critically ill patients

Endocrine Disorders in Critically Ill Patients – The Smooth Criminal?

Bianca-Liana Grigorescu, Raluca Ștefania Fodor

George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu-Mures, Romania

DOI: 10.2478/jccm-2024-0034

The hallmark of critical illness is the rapid initiation of numerous physiologic processes in an effort to reestablish homeostasis. Thus, critical illness can be considered the result of an acute physical stress that acts as a trigger for an acute aggressive inflammatory response [1,2].
The inflammatory response occurs early after primary injury, almost concomitant with coagulation cascade activation, micro- and macrovascular alterations, and hypothalamic-pituitary-peripheral axis disorders, proportionate to the severity of illness. In this context, “The Triad of Critically Illness” is a lethal interplay involving three key factors: inflammation, coagulopathy and hormonal imbalance. [More]

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Rebranding Nutritional Care for Critically Ill Patients

Liliana Elena Mirea, Cristian Cobilinschi, Ioana Marina Grințescu

Anaesthesia and Intensive Care Clinic, Clinical Emergency Hospital of Bucharest
“Carol Davila” University of General Medicine, Bucharest

DOI: 10.2478/jccm-2023-0008

Since the organic and molecular roles and function of nutrients in supporting homeostasis for hospitalized patients have been already stated, remarkable advances have been achieved in the field of clinical nutrition [1]. Replacing the old terminology of “nutritional support” with the new concept of “nutritional therapy” both European Society for Clinical Nutrition and Metabolism (ESPEN) and American Society for Enteral and Parenteral Nutrition (ASPEN) emphasized that adequate nutrients administration reduces oxidative stress, metabolic response and sustains the immune response [1, 2]. The persistently increased prevalence of hospital malnutrition, inappropriate nutritional support during hospitalisation contributes undeniably to an increased mortality, especially in intensive care units [3].
In order to promote the importance of nutritional care and increase awareness among authorities and clinicians, “The International Declaration on the Human Right to Nutritional Care” was adopted during ESPEN Congress 2022 in Vienna. This Declaration highlights that nutritional therapy is a human right in the same manner as the right to food and health [4]. Moreover, all the undersigned societies, including Romanian Society of Enteral and Parenteral Nutrition (ROSPEN), raise awareness of the high prevalence of disease-related malnutrition along with the lack of access to appropriate nutritional support during and after hospitalisation. [More]

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Plasma Neutrophil Gelatinase Associated Lipocalin (NGAL) – Early Biomarker for Acute Kidney Injury in Critically Ill Patients

Raluca Fodor1, Bianca Grigorescu2*, Mihaly Veres2, Monica Orlandea2, Judita Badea2, Katalin Hlavathy2, Adrian Cioc2

1 Department of Anaesthesiology and Intensive Care, University of Medicine and Pharmacy, Tirgu Mures, Romania
2 Department of Anaesthesiology and Intensive Care, Emergency County Hospital, Tirgu Mures, Romania

DOI: 10.1515/jccm-2015-0023

Introduction: NGAL (Neutrophil Gelatinase Associated Lipocalin) is a biomarker recently introduced into clinical practice for the early diagnosis of acute kidney injury (AKI). The aim of this study was to correlate the plasmatic NGAL value determined at admission with clinical progression and severity of AKI in critically ill patients.
Material and method: Thirty two consecutive critically ill adult patients at risk of developing AKI (trauma, sepsis), admitted in Intensive Care Unit of the Clinical County Emergency Hospital Mures, between January to March 2015 were enrolled in the study. For each patient included in the study plasma NGAL levels were determined on admission, and these were correlated with the degree of AKI development (according to AKIN criteria) at 48 hours and 5 days post admission. The discriminatory power of NGAL, creatinine, creatinine clearance and corrected creatinine (depending on water balance) were determined using the ROC (receiver-operating characteristic) and likelihood ratios.
Results: ROC curve analysis showed a better discriminatory capacity in terms of early diagnosis of AKI for NGAL (AUC=0.81 for NGAL, AUC=0.59 for creatinine, AUC=0.62 for corrected creatinine, AUC=0.29 for creatinine clearance). The value of likelihood ratio was also significantly higher for NGAL (3.01±2.73 for NGAL, 1.27±1.14 for creatinine, 1.78±1.81 for corrected creatinine, and 0.48±0.33 for creatinine clearance).
Conclusions: NGAL biomarker has a better discrimination capacity for early prediction of acute kidney injury compared to previously used markers.

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