43 results on '"Varpula, Tero"'
Search Results
2. Lung function and exercise capacity 6 months after hospital discharge for critical COVID-19
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Kattainen, Salla, Lindahl, Anna, Vasankari, Tuula, Ollila, Henriikka, Volmonen, Kirsi, Piirilä, Päivi, Kauppi, Paula, Paajanen, Juuso, Kreivi, Hanna-Riikka, Ulenius, Linda, Varpula, Tero, Aro, Miia, Reijula, Jere, and Hästbacka, Johanna
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- 2022
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3. The Nordic perioperative and intensive care registries-Collaboration and research possibilities
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Kvale, Reidar, Moller, Morten Hylander, Porkkala, Timo, Varpula, Tero, Enlund, Gunnar, Engerström, Lars, Sigurdsson, Martin Ingi, Thormar, Katrin, Garde, Kim, Christensen, Steffen, Buanes, Eirik Alnes, Sverrisson, Kristinn, Kvale, Reidar, Moller, Morten Hylander, Porkkala, Timo, Varpula, Tero, Enlund, Gunnar, Engerström, Lars, Sigurdsson, Martin Ingi, Thormar, Katrin, Garde, Kim, Christensen, Steffen, Buanes, Eirik Alnes, and Sverrisson, Kristinn
- Abstract
Background: The Nordic perioperative and intensive care registries have been built up during the last 25 years to improve quality in intensive and perioperative care. We aimed to describe the Nordic perioperative and intensive care registries and to highlight possibilities and challenges in future research collaboration between these registries.Material and method: We present an overview of the following Nordic registries: Swedish Perioperative Registry (SPOR), the Danish Anesthesia Database (DAD), the Finnish Perioperative Database (FIN-AN), the Icelandic Anesthesia Database (IS-AN), the Danish Intensive Care Database (DID), the Swedish Intensive Care Registry (SIR), the Finnish Intensive Care Consortium, the Norwegian Intensive Care and Pandemic Registry (NIPaR), and the Icelandic Intensive Care Registry (IS-ICU).Results: Health care systems and patient populations are similar in the Nordic countries. Despite certain differences in data structure and clinical variables, the perioperative and intensive care registries have enough in common to enable research collaboration. In the future, even a common Nordic registry could be possible.Conclusion: Collaboration between the Nordic perioperative and intensive care registries is both possible and likely to produce research of high quality. Research collaboration between registries may have several add-on effects and stimulate international standardization regarding definitions, scoring systems, and benchmarks, thereby improving overall quality of care.
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- 2023
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4. Variation in Severity-Adjusted Resource use and Outcome for Neurosurgical Emergencies in the Intensive Care Unit
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Raj, Rahul, Moser, André, Starkopf, Joel, Reinikainen, Matti, Varpula, Tero, Jakob, Stephan M, and Takala, Jukka
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610 Medicine & health ,Neurology (clinical) ,610 Medizin und Gesundheit ,Critical Care and Intensive Care Medicine - Abstract
Background The correlation between the standardized resource use ratio (SRUR) and standardized hospital mortality ratio (SMR) for neurosurgical emergencies is not known. We studied SRUR and SMR and the factors affecting these in patients with traumatic brain injury (TBI), nontraumatic intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH). Methods We extracted data of patients treated in six university hospitals in three countries (2015–2017). Resource use was measured as SRUR based on purchasing power parity-adjusted direct costs and either intensive care unit (ICU) length of stay (costSRURlength of stay) or daily Therapeutic Intervention Scoring System scores (costSRURTherapeutic Intervention Scoring System). Five a priori defined variables reflecting differences in structure and organization between the ICUs were used as explanatory variables in bivariable models, separately for the included neurosurgical diseases. Results Out of 28,363 emergency patients treated in six ICUs, 6,162 patients (22%) were admitted with a neurosurgical emergency (41% nontraumatic ICH, 23% SAH, 13% multitrauma TBI, and 23% isolated TBI). The mean costs for neurosurgical admissions were higher than for nonneurosurgical admissions, and the neurosurgical admissions corresponded to 23.6–26.0% of all direct costs related to ICU emergency admissions. A higher physician-to-bed ratio was associated with lower SMRs in the nonneurosurgical admissions but not in the neurosurgical admissions. In patients with nontraumatic ICH, lower costSRURs were associated with higher SMRs. In the bivariable models, independent organization of an ICU was associated with lower costSRURs in patients with nontraumatic ICH and isolated/multitrauma TBI but with higher SMRs in patients with nontraumatic ICH. A higher physician-to-bed ratio was associated with higher costSRURs for patients with SAH. Larger units had higher SMRs for patients with nontraumatic ICH and isolated TBI. None of the ICU-related factors were associated with costSRURs in nonneurosurgical emergency admissions. Conclusions Neurosurgical emergencies constitute a major proportion of all emergency ICU admissions. A lower SRUR was associated with higher SMR in patients with nontraumatic ICH but not for the other diagnoses. Different organizational and structural factors seemed to affect resource use for the neurosurgical patients compared with nonneurosurgical patients. This emphasizes the importance of case-mix adjustment when benchmarking resource use and outcomes.
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- 2023
5. Three-year mortality in 30-day survivors of critical care with acute kidney injury: data from the prospective observational FINNAKI study
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Mildh, Henriikka, Pettilä, Ville, Korhonen, Anna-Maija, Karlsson, Sari, Ala-Kokko, Tero, Reinikainen, Matti, Vaara, Suvi T., Laru-Sompa, Raili, Pulkkinen, Anni, Saarelainen, Minna, Reilama, Mikko, Tolmunen, Sinikka, Rantalainen, Ulla, Miettinen, Marja, Suvela, Markku, Pesola, Katrine, Saastamoinen, Pekka, Kauppinen, Sirpa, Pettilä, Ville, Kaukonen, Kirsi-Maija, Nisula, Sara, Vaara, Suvi, Suojaranta-Ylinen, Raili, Mildh, Leena, Haapio, Mikko, Nurminen, Laura, Sutinen, Sari, Pettilä, Leena, Laitinen, Helinä, Syrjä, Heidi, Henttonen, Kirsi, Lappi, Elina, Boman, Hillevi, Varpula, Tero, Porkka, Päivi, Sivula, Mirka, Rahkonen, Mira, Tsurkka, Anne, Nieminen, Taina, Pirttinen, Niina, Alaspää, Ari, Salanto, Ville, Juntunen, Hanna, Sanisalo, Teija, Parviainen, Ilkka, Uusaro, Ari, Ruokonen, Esko, Bendel, Stepani, Rissanen, Niina, Lång, Maarit, Rahikainen, Sari, Rissanen, Saija, Ahonen, Merja, Halonen, Elina, Vaskelainen, Eija, Poukkanen, Meri, Lintula, Esa, Suominen, Sirpa, Heikkinen, Jorma, Lavander, Timo, Heinonen, Kirsi, Juopperi, Anne-Mari, Kaminski, Tadeusz, Gäddnäs, Fiia, Kuusela, Tuija, Roiko, Jane, Karlsson, Sari, Reinikainen, Matti, Surakka, Tero, Jyrkönen, Helena, Eiserbeck, Tanja, Kallinen, Jaana, Ala-Kokko, Tero, Laurila, Jouko, Sälkiö, Sinikka, Lund, Vesa, Tuominen, Päivi, Perkola, Pauliina, Tuominen, Riikka, Hietaranta, Marika, Johansson, Satu, Hovilehto, Seppo, Kirsi, Anne, Tiainen, Pekka, Myllärinen, Tuija, Leino, Pirjo, Toropainen, Anne, Kuitunen, Anne, Tenhunen, Jyrki, Leppänen, Ilona, Levoranta, Markus, Hoppu, Sanna, Sauranen, Jukka, Kukkurainen, Atte, Kortelainen, Samuli, Varila, Simo, Inkinen, Outi, Koivuviita, Niina, Kotamäki, Jutta, Laine, Anu, Koivisto, Simo-Pekka, Hautamäki, Raku, Skinnar, Maria, and the FINNAKI Study Group
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- 2016
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6. Procalcitonin and Presepsin as Prognostic Markers After Out-of-Hospital Cardiac Arrest
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Pekkarinen, Pirkka T., Ristagno, Giuseppe, Wilkman, Erika, Masson, Serge, Latini, Roberto, Laurikkala, Johanna, Bendel, Stepani, Ala-Kokko, Tero, Varpula, Tero, Vaahersalo, Jukka, Karlsson, Sari, Tiainen, Marjaana, Mion, Monica M., Plebani, Mario, Pettilä, Ville, and Skrifvars, Markus B.
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- 2018
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7. A descriptive study of the surge response and outcomes of ICU patients with COVID-19 during first wave in Nordic countries
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Chew, Michelle S., Kattainen, Salla, Haase, Nicolai, Buanes, Eirik A., Kristinsdottir, Linda B., Hofsø, Kristin, Laake, Jon Henrik, Kvåle, Reidar, Hästbacka, Johanna, Reinikainen, Matti, Bendel, Stepani, Varpula, Tero, Walther, Sten, Perner, Anders, Flaatten, Hans K., Sigurdsson, Martin I., Chew, Michelle S., Kattainen, Salla, Haase, Nicolai, Buanes, Eirik A., Kristinsdottir, Linda B., Hofsø, Kristin, Laake, Jon Henrik, Kvåle, Reidar, Hästbacka, Johanna, Reinikainen, Matti, Bendel, Stepani, Varpula, Tero, Walther, Sten, Perner, Anders, Flaatten, Hans K., and Sigurdsson, Martin I.
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Background: We sought to provide a description of surge response strategies and characteristics, clinical management and outcomes of patients with severe COVID-19 in the intensive care unit (ICU) during the first wave of the pandemic in Denmark, Finland, Iceland, Norway and Sweden. Methods: Representatives from the national ICU registries for each of the five countries provided clinical data and a description of the strategies to allocate ICU resources and increase the ICU capacity during the pandemic. All adult patients admitted to the ICU for COVID-19 disease during the first wave of COVID-19 were included. The clinical characteristics, ICU management and outcomes of individual countries were described with descriptive statistics. Results: Most countries more than doubled their ICU capacity during the pandemic. For patients positive for SARS-CoV-2, the ratio of requiring ICU admission for COVID-19 varied substantially (1.6%–6.7%). Apart from age (proportion of patients aged 65 years or over between 29% and 62%), baseline characteristics, chronic comorbidity burden and acute presentations of COVID-19 disease were similar among the five countries. While utilization of invasive mechanical ventilation was high (59%–85%) in all countries, the proportion of patients receiving renal replacement therapy (7%–26%) and various experimental therapies for COVID-19 disease varied substantially (e.g. use of hydroxychloroquine 0%–85%). Crude ICU mortality ranged from 11% to 33%. Conclusion: There was substantial variability in the critical care response in Nordic ICUs to the first wave of COVID-19 pandemic, including usage of experimental medications. While ICU mortality was low in all countries, the observed variability warrants further attention.
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- 2022
8. A descriptive study of the surge response and outcomes of ICU patients with COVID-19 during first wave in Nordic countries
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Chew, Michelle, Kattainen, Salla, Haase, Nicolai, Buanes, Eirik A., Kristinsdottir, Linda B., Hofso, Kristin, Laake, Jon Henrik, Kvale, Reidar, Hastbacka, Johanna, Reinikainen, Matti, Bendel, Stepani, Varpula, Tero, Walther, Sten, Perner, Anders, Flaatten, Hans K., Sigurdsson, Martin I, Chew, Michelle, Kattainen, Salla, Haase, Nicolai, Buanes, Eirik A., Kristinsdottir, Linda B., Hofso, Kristin, Laake, Jon Henrik, Kvale, Reidar, Hastbacka, Johanna, Reinikainen, Matti, Bendel, Stepani, Varpula, Tero, Walther, Sten, Perner, Anders, Flaatten, Hans K., and Sigurdsson, Martin I
- Abstract
Background We sought to provide a description of surge response strategies and characteristics, clinical management and outcomes of patients with severe COVID-19 in the intensive care unit (ICU) during the first wave of the pandemic in Denmark, Finland, Iceland, Norway and Sweden. Methods Representatives from the national ICU registries for each of the five countries provided clinical data and a description of the strategies to allocate ICU resources and increase the ICU capacity during the pandemic. All adult patients admitted to the ICU for COVID-19 disease during the first wave of COVID-19 were included. The clinical characteristics, ICU management and outcomes of individual countries were described with descriptive statistics. Results Most countries more than doubled their ICU capacity during the pandemic. For patients positive for SARS-CoV-2, the ratio of requiring ICU admission for COVID-19 varied substantially (1.6%-6.7%). Apart from age (proportion of patients aged 65 years or over between 29% and 62%), baseline characteristics, chronic comorbidity burden and acute presentations of COVID-19 disease were similar among the five countries. While utilization of invasive mechanical ventilation was high (59%-85%) in all countries, the proportion of patients receiving renal replacement therapy (7%-26%) and various experimental therapies for COVID-19 disease varied substantially (e.g. use of hydroxychloroquine 0%-85%). Crude ICU mortality ranged from 11% to 33%. Conclusion There was substantial variability in the critical care response in Nordic ICUs to the first wave of COVID-19 pandemic, including usage of experimental medications. While ICU mortality was low in all countries, the observed variability warrants further attention., Funding Agencies|NordForsk (Nordic COVID-19 Activities); Finnish Society of Intensive Care
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- 2022
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9. Additional file 1 of Lung function and exercise capacity 6 months after hospital discharge for critical COVID-19
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Kattainen, Salla, Lindahl, Anna, Vasankari, Tuula, Ollila, Henriikka, Volmonen, Kirsi, Piirilä, Päivi, Kauppi, Paula, Paajanen, Juuso, Kreivi, Hanna-Riikka, Ulenius, Linda, Varpula, Tero, Aro, Miia, Reijula, Jere, and Hästbacka, Johanna
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Additional file 1: Figure S1. Grading of pulmonary abnormalities in patients with history of COVID-19 pneumonitis.
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- 2022
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10. Koronaviruspandemiaan liittynyt tehohoidon tarve ja hoitotulokset Suomessa kevään ja kesän 2020 aikana
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Kattainen, Salla, Kiiski, Olli, Bendel, Stepani, Jokinen, Jukka, Reinikainen, Matti, Varpula, Tero, HUS Leikkaussalit, teho- ja kivunhoito, and Diagnostis-terapeuttinen osasto
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3126 Kirurgia, anestesiologia, tehohoito, radiologia - Abstract
Vertaisarvioitu. COVID-19-pandemia aiheutti merkittävää tehohoidon tarvetta keväällä 2020. Tilannekuvaa kokoamaan perustettiin tehohoidon koordinoiva toimisto, joka raportoi viranomaisille ajantasaista tietoa potilas- ja paikkamääristä koko maassa. Suurin tehohoidon kuormitus kohdistui HUS:n sairaaloihin. Teho-osastoilla hoidettiin yhteensä 227:ää COVID-19-potilasta, ja erillisiä tehohoitojaksoja kirjattiin 293. Suomessa COVID-19-potilaiden tehohoitokuolleisuus oli vähäistä, vain 15 %. Ikä ja krooniset sairaudet lisäsivät kuolleisuutta. Tehohoitojaksot olivat tavanomaisia tehohoitojaksoja pidempiä (14 vrk vs 3 vrk), ja 67 % potilaista tarvitsi hengityslaitehoitoa. Epidemian vaikeimmassa vaiheessa huhtikuun puolivälissä tehohoitokapasiteettia oli jo kasvatettu voimakkaasti, ja sen täyttöaste jäi alle puoleen.
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- 2021
11. Tehohoidon kapasiteetti COVID-19-epidemiassa
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Ala-Kokko, Tero, Pettilä, Ville, Karlsson, Sari, Valtonen, Mika, Reinikainen, Matti, Bendel, Stepani, Varpula, Tero, HUS Leikkaussalit, teho- ja kivunhoito, Diagnostis-terapeuttinen osasto, and Helsingin yliopisto
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Ventilators, Mechanical ,Critical Care ,3111 Biolääketieteet ,Patient Selection ,Health Status ,3126 Kirurgia, anestesiologia, tehohoito, radiologia ,Surge Capacity ,Respiratory Distress Syndrome, Adult ,Age Factors ,Disease Outbreaks ,3121 Yleislääketiede, sisätaudit ja muut kliiniset lääketieteet ,Health Workforce ,Coronavirus Infections ,Needs Assessment ,Aged - Abstract
Mitkä ovat käytössä olevat resurssit, miten ne saadaan riittämään ja kuinka hoito kohdennetaan mahdollisimman vaikuttavasti COVID-19-epidemian aikana? Tehohoitolääkärit vastaavat.
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- 2020
12. Lower heart rate is associated with good one-year outcome in post-resuscitation patients
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FINNRESUSCI Study Grp, Oksanen, Tuomas, Tiainen, Marjaana, Vaahersalo, Jukka, Bendel, Stepani, Varpula, Tero, Skrifvars, Markus, Pettilä, Ville, Wilkman, Erika, Anestesiologian yksikkö, Clinicum, Department of Diagnostics and Therapeutics, University of Helsinki, HUS Perioperative, Intensive Care and Pain Medicine, Neurologian yksikkö, Department of Neurosciences, and HUS Neurocenter
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Male ,Resuscitation ,Time Factors ,medicine.medical_treatment ,Hemodynamics ,Hypothermia ,030204 cardiovascular system & hematology ,Emergency Nursing ,Targeted temperature management ,0302 clinical medicine ,Hypothermia, Induced ,Outcome Assessment, Health Care ,Single-Blind Method ,Prospective Studies ,Outcome ,Therapeutic temperature management ,RESUSCITATION ,Middle Aged ,3. Good health ,Intensive Care Units ,Area Under Curve ,SURVIVAL ,Emergency Medicine ,Female ,FIBRILLATION ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Bradycardia ,medicine.medical_specialty ,THERAPEUTIC HYPOTHERMIA ,Heart rate ,03 medical and health sciences ,Internal medicine ,medicine ,Humans ,METAANALYSIS ,Aged ,Fibrillation ,Haemodynamics ,business.industry ,BETA-BLOCKERS ,ELEVATION MYOCARDIAL-INFARCTION ,HOSPITAL CARDIAC-ARREST ,030208 emergency & critical care medicine ,Recovery of Function ,RATE-VARIABILITY ,CARE ,Postresuscitation ,3126 Surgery, anesthesiology, intensive care, radiology ,Cardiopulmonary Resuscitation ,Clinical trial ,business ,Out-of-Hospital Cardiac Arrest - Abstract
Background: Optimal hemodynamic goals in post-resuscitation patients are not clear. Previous studies have reported an association between lower heart rate and good outcome in patients receiving targeted temperature management (TTM) after out-of-hospital cardiac arrest. Methods: We analyzed heart rate (HR) and outcome data of 504 post-resuscitation patients from the prospectively collected database of the FINNRESUSCI study. One-year neurologic outcome was dichotomized by the Cerebral Performance Category (CPC) to good (1-2) or poor (3-5). Results: Of 504 patients, 40.1% (202/504) had good and 59.9% (302/504) had poor one-year neurologic outcome. Patients with good outcome had lower time-weighted mean HR during the first 48 h in the ICU (69.2 bpm [59.2-75.1] vs. 76.6 bpm [65.72-89.6], p
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- 2018
13. Common Inflammation-Related Candidate Gene Variants and Acute Kidney Injury in 2647 Critically Ill Finnish Patients
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Vilander, Laura M., Vaara, Suvi T., Kaunisto, Mari A., Pettilä, Ville, FINNAKI Study Grp, Laru-Sompa, Raili, Pulkkinen, Anni, Saarelainen, Minna, Reilama, Mikko, Tolmunen, Sinikka, Rantalainen, Ulla, Miettinen, Marja, Suvela, Markku, Pesola, Katrine, Saastamoinen, Pekka, Kauppinen, Sirpa, Kaukonen, Kirsi-Maija, Korhonen, Anna-Maija, Nisula, Sara, Vaara, Suvi, Suojaranta-Ylinen, Raili, Mildh, Leena, Haapio, Mikko, Nurminen, Laura, Sutinen, Sari, Pettilä, Leena, Laitinen, Helinä, Syrja, Heidi, Henttonen, Kirsi, Lappi, Elina, Boman, Hillevi, Varpula, Tero, Porkka, Päivi, Sivula, Mirka, Rahkonen, Mira, Tsurkka, Anne, Prittinen, Niina, Alaspaa, Ari, Salanto, Ville, Juntunen, Hanna, Sanisalo, Teija, Parviainen, Ilkka, Uusaro, Ari, Ruokonen, Esko, Bendel, Stepani, Rissanen, Niina, Lång, Maarit, Rahikainen, Sari, Rissanen, Saija, Ahonen, Merja, Halonen, Elina, Vaskelainen, Eija, Poukkanen, Meri, Lintula, Esa, Suominen, Sirpa, Heikkinen, Jorma, Lavander, Timo, Heinonen, Kirsi, Juopperi, Anne-Mari, Kaminski, Tadeusz, Gäddnäs, Fiia, Kuusela, Tuija, Roiko, Jane, Karlsson, Sari, Reinikainen, Matti, Surakka, Tero, Jyrkönen, Helena, Eiserbeck, Tanja, Kallinen, Jaana, Lund, Vesa, Tuominen, Päivi, Perkola, Pauliina, Tuominen, Riikka, Hietaranta, Marika, Johansson, Satu, Hovilehto, Seppo, Kirsi, Anne, Tiainen, Pekka, Myllärinen, Tuija, Leino, Pirjo, Toropainen, Anne, Kuitunen, Anne, Leppänen, Ilona, Levoranta, Markus, Hoppu, Sanna, Sauranen, Jukka, Tenhunen, Jyrki, Kukkurainen, Atte, Kortelainen, Samuli, Varila, Simo, Inkinen, Outi, Koivuviita, Niina, Kotamäki, Jutta, Laine, Anu, Ala-Kokko, Tero, Laurila, Jouko J., Sälkiö, Sinikka, Koivisto, Simo-Pekka, Hautamäki, Raku, Skinnar, Maria, Anestesiologian yksikkö, Clinicum, Department of Diagnostics and Therapeutics, University of Helsinki, HUS Perioperative, Intensive Care and Pain Medicine, Institute for Molecular Medicine Finland, Helsinki Institute of Life Science HiLIFE, Nefrologian yksikkö, Department of Medicine, HUS Abdominal Center, and HYKS erva
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medicine.medical_specialty ,Candidate gene ,ADVERSE OUTCOMES ,lcsh:Medicine ,human genetics ,Genome-wide association study ,Article ,PROMOTER POLYMORPHISM ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Genetic model ,Genetic predisposition ,medicine ,GENOME-WIDE ASSOCIATION ,PLASMA-LEVELS ,030304 developmental biology ,0303 health sciences ,SEPSIS ,business.industry ,MORTALITY ,lcsh:R ,Acute kidney injury ,1184 Genetics, developmental biology, physiology ,NECROSIS-FACTOR-ALPHA ,General Medicine ,Odds ratio ,medicine.disease ,INTERLEUKIN-10 ,3. Good health ,acute kidney injury ,030220 oncology & carcinogenesis ,3121 General medicine, internal medicine and other clinical medicine ,Cohort ,genetic variation ,ENDOTHELIAL GROWTH-FACTOR ,RISK-FACTORS ,business ,Kidney disease - Abstract
Acute kidney injury (AKI) is a syndrome with high incidence among the critically ill. Because the clinical variables and currently used biomarkers have failed to predict the individual susceptibility to AKI, candidate gene variants for the trait have been studied. Studies about genetic predisposition to AKI have been mainly underpowered and of moderate quality. We report the association study of 27 genetic variants in a cohort of Finnish critically ill patients, focusing on the replication of associations detected with variants in genes related to inflammation, cell survival, or circulation. In this prospective, observational Finnish Acute Kidney Injury (FINNAKI) study, 2647 patients without chronic kidney disease were genotyped. We defined AKI according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria. We compared severe AKI (Stages 2 and 3, n = 625) to controls (Stage 0, n = 1582). For genotyping we used iPLEXTM Assay (Agena Bioscience). We performed the association analyses with PLINK software, using an additive genetic model in logistic regression. Despite the numerous, although contradictory, studies about association between polymorphisms rs1800629 in TNFA and rs1800896 in IL10 and AKI, we found no association (odds ratios 1.06 (95% CI 0.89–1.28, p = 0.51) and 0.92 (95% CI 0.80–1.05, p = 0.20), respectively). Adjusting for confounders did not change the results. To conclude, we could not confirm the associations reported in previous studies in a cohort of critically ill patients.
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- 2019
14. Early Lactate Values After Out-of-Hospital Cardiac Arrest: Associations With One-Year Outcome
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Laurikkala, Johanna, primary, Skrifvars, Markus B., additional, Bäcklund, Minna, additional, Tiainen, Marjaana, additional, Bendel, Stepani, additional, Karhu, Jaana, additional, Varpula, Tero, additional, Vaahersalo, Jukka, additional, Pettilä, Ville, additional, and Wilkman, Erika, additional
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- 2019
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15. Additional file 1: of Elevated plasma heparin-binding protein is associated with early death after resuscitation from cardiac arrest
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Ristagno, Giuseppe, Masson, Serge, Tiainen, Marjaana, Stepani Bendel, Bernasconi, Roberto, Varpula, Tero, Milani, Valentina, Vaahersalo, Jukka, Magnoli, Michela, Spanuth, Eberhard, Barlera, Simona, Latini, Roberto, Hoppu, Sanna, Pettilä, Ville, and Skrifvars, Markus
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Baseline characteristics and clinical factors in all FINNRESUSCI patients and in patients with blood samples. Description of data: a table reporting the main clinical characteristics of the patients included in the overall FINNRESUSCI trial and the patients included in the present biomarker substudy. (DOCX 14 kb)
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- 2016
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16. Additional file 2: of Elevated plasma heparin-binding protein is associated with early death after resuscitation from cardiac arrest
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Ristagno, Giuseppe, Masson, Serge, Tiainen, Marjaana, Stepani Bendel, Bernasconi, Roberto, Varpula, Tero, Milani, Valentina, Vaahersalo, Jukka, Magnoli, Michela, Spanuth, Eberhard, Barlera, Simona, Latini, Roberto, Hoppu, Sanna, Pettilä, Ville, and Skrifvars, Markus
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health services administration ,health care facilities, manpower, and services ,respiratory tract diseases - Abstract
Plasma levels of heparin-binding protein (HBP) at ICU admission in relationship to the 24-hour SOFA score and 24-hour cardiovascular SOFA score. Description of data: at ICU admission, plasma levels of HBP were significantly higher in patients with higher 24Â h SOFA scores. Moreover, HBP levels were significantly higher in patients who developed cardiovascular failure. (DOCX 19 kb)
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- 2016
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17. Osasto U2 : suunnitelmista tiloiksi ja toiminnaksi
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Varpula, Tero, Diagnostis-terapeuttinen osasto, and Clinicum
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Intensive Care Units ,Burn Units ,3126 Kirurgia, anestesiologia, tehohoito, radiologia ,Health Facilities - Published
- 2016
18. Additional file 3: of Elevated plasma heparin-binding protein is associated with early death after resuscitation from cardiac arrest
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Ristagno, Giuseppe, Masson, Serge, Tiainen, Marjaana, Stepani Bendel, Bernasconi, Roberto, Varpula, Tero, Milani, Valentina, Vaahersalo, Jukka, Magnoli, Michela, Spanuth, Eberhard, Barlera, Simona, Latini, Roberto, Hoppu, Sanna, Pettilä, Ville, and Skrifvars, Markus
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Receiver operating characteristic curves of the discrimination value of plasma HBP at intensive care unit (ICU) admission and lactate and multiple organ dysfunction syndrome (MODS), ICU death, and 12-month poor outcome. Description of data: there was no difference in the areas under the curve (AUCs) of HBP and lactate for the discrimination of MODS, ICU mortality or 12-month poor outcome. (DOCX 68 kb)
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- 2016
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19. Onko ylipainehappihoito vaikuttavaa?
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Reinikainen, Matti, Bendel, Stepani, Parviainen, Ilkka, Pettilä, Ville, Varpula, Tero, Uusaro, Ari, Clinicum, Anestesiologian yksikkö, and Diagnostis-terapeuttinen osasto
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3126 Kirurgia, anestesiologia, tehohoito, radiologia - Abstract
Kommentti Mika Valtosen kirjoitukseen Finnanest 48(3):230-237, 2015
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- 2016
20. Elevated plasma heparin-binding protein is associated with early death after resuscitation from cardiac arrest
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University of Helsinki, Dep. of Neurosciences (Institute fo Clinical Medicine) (-2009), University of Helsinki, Diagnostic-Therapeutic Department, University of Helsinki, Anestesiologian yksikkö, University of Helsinki, Clinicum, Ristagno, Giuseppe, Masson, Serge, Tiainen, Marjaana, Bendel, Stepani, Bernasconi, Roberto, Varpula, Tero M, Milani, Valentina, Vaahersalo, Jukka, Magnoli, Michela, Spanuth, Eberhard, Barlera, Simona, Latini, Roberto, Hoppu, Sanna, Pettila, Ville, Skrifvars, Markus, FINNRESUSCI Study Grp, University of Helsinki, Dep. of Neurosciences (Institute fo Clinical Medicine) (-2009), University of Helsinki, Diagnostic-Therapeutic Department, University of Helsinki, Anestesiologian yksikkö, University of Helsinki, Clinicum, Ristagno, Giuseppe, Masson, Serge, Tiainen, Marjaana, Bendel, Stepani, Bernasconi, Roberto, Varpula, Tero M, Milani, Valentina, Vaahersalo, Jukka, Magnoli, Michela, Spanuth, Eberhard, Barlera, Simona, Latini, Roberto, Hoppu, Sanna, Pettila, Ville, Skrifvars, Markus, and FINNRESUSCI Study Grp
- Abstract
Background: An intense systemic inflammatory response is observed following reperfusion after cardiac arrest. Heparin-binding protein (HBP) is a granule protein released by neutrophils that intervenes in endothelial permeability regulation. In the present study, we investigated plasma levels of HBP in a large population of patients resuscitated from out-of-hospital cardiac arrest. We hypothesized that high circulating levels of HBP are associated with severity of post-cardiac arrest syndrome and poor outcome. Methods: Plasma was obtained from 278 patients enrolled in a prospective multicenter observational study in 21 intensive care units (ICU) in Finland. HBP was assayed at ICU admission and 48 h later. Multiple organ dysfunction syndrome (MODS) was defined as the 24 h Sequential Organ Failure Assessment (SOFA) score >= 12. ICU death and 12-month Cerebral Performance Category (CPC) were evaluated. Multiple linear and logistic regression tests and receiver operating characteristic curves with area under the curve (AUC) were performed. Results: Eighty-two percent of patients (229 of 278) survived to ICU discharge and 48 % (133 of 276) to 1 year with a favorable neurological outcome (CPC 1 or 2). At ICU admission, median plasma levels of HBP were markedly elevated, 15.4 [9.6-31.3] ng/mL, and persisted high 48 h later, 14.8 [9.8-31.1] ng/mL. Admission levels of HBP were higher in patients who had higher 24 h SOFA and cardiovascular SOFA score (p <0.0001) and in those who developed MODS compared to those who did not (29.3 [13.7-60.1] ng/mL vs. 13.6 [9.1-26.2] ng/mL, p <0.0001; AUC = 0.70 +/- 0.04, p = 0.0001). Admission levels of HBP were also higher in patients who died in ICU (31.0 [17.7-78.2] ng/mL) compared to those who survived (13.5 [9.1-25.5] ng/mL, p <0.0001) and in those with an unfavorable 12-month neurological outcome compared to those with a favorable one (18.9 [11.3-44.3] ng/mL vs. 12.8 [8.6-30.4] ng/mL, p <0.0001). Admission levels of HBP predicted early I
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- 2016
21. Prognostic Value of Secretoneurin in Critically III Patients With Infections
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Røsjø, Helge, Stridsberg, Mats, Ottesen, Anett H., Nygård, Ståle, Christensen, Geir, Pettilä, Ville, Linko, Rita, Karlsson, Sari, Varpula, Tero, Ruokonen, Esko, Omland, Torbjorn, Røsjø, Helge, Stridsberg, Mats, Ottesen, Anett H., Nygård, Ståle, Christensen, Geir, Pettilä, Ville, Linko, Rita, Karlsson, Sari, Varpula, Tero, Ruokonen, Esko, and Omland, Torbjorn
- Abstract
Objectives : Secretoneurin is produced in neuroendocrine cells, and the myocardium and circulating secretoneurin levels provide incremental prognostic information to established risk indices in cardiovascular disease. As myocardial dysfunction contributes to poor outcome in critically ill patients, we wanted to assess the prognostic value of secretoneurin in two cohorts of critically ill patients with infections. Design: Two prospective, observational studies. Setting: Twenty-four and twenty-five ICUs in Finland. Patients: A total of 232 patients with severe sepsis (cohort #1) and 94 patients with infections and respiratory failure (cohort #2). Interventions: None. Measurements and Main Results: We measured secretoneurin levels by radioimmunoassay in samples obtained early after ICU admission and compared secretoneurin with other risk indices. In patients with severe sepsis, admission secretoneurin levels (logarithmically transformed) were associated with hospital mortality (odds ratio, 3.17 [95% CI, 1.12-9.00]; p = 0.030) and shock during the hospitalization (odds ratio, 2.17 [1.06-4.46]; p = 0.034) in analyses that adjusted for other risk factors available on ICU admission. Adding secretoneurin levels to age, which was also associated with hospital mortality in the multivariate model, improved the risk prediction as assessed by the category-free net reclassification index: 0.35 (95% CI, 0.06-0.64) (p = 0.02). In contrast, N-terminal pro B-type natriuretic peptide levels were not associated with mortality in the multivariate model that included secretoneurin measurements, and N-terminal pro B-type natriuretic peptide did not improve patient classification on top of age. Secretoneurin levels were also associated with hospital mortality after adjusting for other risk factors and improved patient classification in cohort #2. In both cohorts, the optimal cutoff for secretoneurin levels at ICU admission to predict hospital mortality was approximate to 175 pmol/L, and hi
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- 2016
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22. Association of oliguria with the development of acute kidney injury in the critically ill
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Vaara, Suvi T., primary, Parviainen, Ilkka, additional, Pettilä, Ville, additional, Nisula, Sara, additional, Inkinen, Outi, additional, Uusaro, Ari, additional, Laru-Sompa, Raili, additional, Pulkkinen, Anni, additional, Saarelainen, Minna, additional, Reilama, Mikko, additional, Tolmunen, Sinikka, additional, Rantalainen, Ulla, additional, Suvela, Markku, additional, Pesola, Katrine, additional, Saastamoinen, Pekka, additional, Kaukonen, Kirsi-Maija, additional, Korhonen, Anna-Maija, additional, Vaara, Suvi, additional, Suojaranta-Ylinen, Raili, additional, Mildh, Leena, additional, Haapio, Mikko, additional, Nurminen, Laura, additional, Sutinen, Sari, additional, Pettilä, Leena, additional, Laitinen, Helinä, additional, Syrjä, Heidi, additional, Henttonen, Kirsi, additional, Lappi, Elina, additional, Varpula, Tero, additional, Porkka, Päivi, additional, Sivula, Mirka, additional, Rahkonen, Mira, additional, Tsurkka, Anne, additional, Nieminen, Taina, additional, Alaspää, Ari, additional, Salanto, Ville, additional, Juntunen, Hanna, additional, Ruokonen, Esko, additional, Bendel, Stepani, additional, Rissanen, Niina, additional, Lång, Maarit, additional, Rahikainen, Sari, additional, Rissanen, Saija, additional, Ahonen, Merja, additional, Halonen, Elina, additional, Poukkanen, Meri, additional, Lintula, Esa, additional, Heikkinen, Jorma, additional, Lavander, Timo, additional, Heinonen, Kirsi, additional, Kaminski, Tadeusz, additional, Gäddnäs, Fiia, additional, Kuusela, Tuija, additional, Karlsson, Sari, additional, Reinikainen, Matti, additional, Surakka, Tero, additional, Jyrkönen, Helena, additional, Eiserbeck, Tanja, additional, Ala-Kokko, Tero, additional, Laurila, Jouko, additional, Lund, Vesa, additional, Tuominen, Päivi, additional, Perkola, Pauliina, additional, Tuominen, Riikka, additional, Hietaranta, Marika, additional, Hovilehto, Seppo, additional, Kirsi, Anne, additional, Tiainen, Pekka, additional, Myllärinen, Tuija, additional, Leino, Pirjo, additional, Kuitunen, Anne, additional, Tenhu-nen, Jyrki, additional, Leppänen, Ilona, additional, Levoranta, Markus, additional, Hoppu, Sanna, additional, Sauranen, Jukka, additional, Kukkurainen, Atte, additional, Kortelainen, Samuli, additional, Koivuviita, Niina, additional, Kotamäki, Jutta, additional, Koivisto, Simo-Pekka, additional, Hautamäki, Raku, additional, and Skinnar, Maria, additional
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- 2016
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23. Predictive value of urine interleukin-18 in the evolution and outcome of acute kidney injury in critically ill adult patients
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Nisula, S., primary, Yang, R., additional, Poukkanen, M., additional, Vaara, S.T., additional, Kaukonen, K.M., additional, Tallgren, M., additional, Haapio, M., additional, Tenhunen, J., additional, Korhonen, A.M., additional, Pettilä, V., additional, Laru-Sompa, Raili, additional, Pulkkinen, Anni, additional, Saarelainen, Minna, additional, Reilama, Mikko, additional, Tolmunen, Sinikka, additional, Rantalainen, Ulla, additional, Miettinen, Marja, additional, Suvela, Markku, additional, Pesola, Katrine, additional, Saastamoinen, Pekka, additional, Kauppinen, Sirpa, additional, Pettilä, Ville, additional, Kaukonen, Kirsi-Maija, additional, Korhonen, Anna-Maija, additional, Nisula, Sara, additional, Vaara, Suvi, additional, Suojaranta-Ylinen, Raili, additional, Mildh, Leena, additional, Haapio, Mikko, additional, Nurminen, Laura, additional, Sutinen, Sari, additional, Pettilä, Leena, additional, Laitinen, Helinä, additional, Syrjä, Heidi, additional, Henttonen, Kirsi, additional, Lappi, Elina, additional, Boman, Hillevi, additional, Varpula, Tero, additional, Porkka, Päivi, additional, Mira Rahkonen, Mirka Sivula, additional, Tsurkka, Anne, additional, Nieminen, Taina, additional, Prittinen, Niina, additional, Alaspää, Ari, additional, Salanto, Ville, additional, Juntunen, Hanna, additional, Sanisalo, Teija, additional, Parviainen, Ilkka, additional, Uusaro, Ari, additional, Ruokonen, Esko, additional, Bendel, Stepani, additional, Rissanen, Niina, additional, Lång, Maarit, additional, Rahikainen, Sari, additional, Rissanen, Saija, additional, Ahonen, Merja, additional, Halonen, Elina, additional, Vaskelainen, Eija, additional, Poukkanen, Meri, additional, Lintula, Esa, additional, Suominen, Sirpa, additional, Heikkinen, Jorma, additional, Lavander, Timo, additional, Heinonen, Kirsi, additional, Juopperi, Anne-Mari, additional, Kaminski, Tadeusz, additional, Gäddnäs, Fiia, additional, Kuusela, Tuija, additional, Roiko, Jane, additional, Karlsson, Sari, additional, Reinikainen, Matti, additional, Surakka, Tero, additional, Jyrkönen, Helena, additional, Eiserbeck, Tanja, additional, Kallinen, Jaana, additional, Lund, Vesa, additional, Tuominen, Päivi, additional, Perkola, Pauliina, additional, Tuominen, Riikka, additional, Hietaranta, Marika, additional, Johansson, Satu, additional, Hovilehto, Seppo, additional, Kirsi, Anne, additional, Tiainen, Pekka, additional, Myllärinen, Tuija, additional, Leino, Pirjo, additional, Toropainen, Anne, additional, Kuitunen, Anne, additional, Leppänen, Ilona, additional, Levoranta, Markus, additional, Hoppu, Sanna, additional, Sauranen, Jukka, additional, Tenhunen, Jyrki, additional, Kukkurainen, Atte, additional, Kortelainen, Samuli, additional, Varila, Simo, additional, Inkinen, Outi, additional, Koivuviita, Niina, additional, Kotamäki, Jutta, additional, Laine, Anu, additional, Ala-Kokko, Tero, additional, Laurila, Jouko, additional, Sälkiö, Sinikka, additional, Koivisto, Simo-Pekka, additional, Hautamäki, Raku, additional, and Skinnar, Maria, additional
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- 2015
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24. Functional outcome, cognition and quality of life after out-of-hospital cardiac arrest and therapeutic hypothermia: data from a randomized controlled trial
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Tiainen, Marjaana, primary, Poutiainen, Erja, additional, Oksanen, Tuomas, additional, Kaukonen, Kirsi-Maija, additional, Pettilä, Ville, additional, Skrifvars, Markus, additional, Varpula, Tero, additional, and Castrén, Maaret, additional
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- 2015
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25. Admission interleukin-6 is associated with post resuscitation organ dysfunction and predicts long-term neurological outcome after out-of-hospital ventricular fibrillation
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Vaahersalo, Jukka, Skrifvars, Markus B., Pulkki, Kari, Stridsberg, Mats, Rosjo, Helge, Hovilehto, Seppo, Tiainen, Marjaana, Varpula, Tero, Pettila, Ville, Ruokonen, Esko, Vaahersalo, Jukka, Skrifvars, Markus B., Pulkki, Kari, Stridsberg, Mats, Rosjo, Helge, Hovilehto, Seppo, Tiainen, Marjaana, Varpula, Tero, Pettila, Ville, and Ruokonen, Esko
- Abstract
Aim of the study: To study plasma concentrations of interleukin-6 (IL-6), high-sensitivity C-reactive protein (hs-CRP) and S-100B during intensive care after out-of-hospital cardiac arrest from ventricular fibrillation (OHCA-VF), and their associations with the duration of ischemia, organ dysfunction and long-term neurological outcome. Materials and methods: A 12-month prospective observational multicentre study was conducted in 21 Finnish intensive care units in 2011. IL-6, hs-CRP and S-100B were measured at 0-6 h, 24 h, 48 h and 96 h after ICU admission. Associations with the time to return of spontaneous circulation (ROSC), sequential organ failure assessment (SOFA) scores divided into tertiles and 12-month cerebral performance category (CPC) were tested. Results: Of 186 OHCA-VF patients included in the study, 110 (59.1%) patients survived with good neurological outcome (CPC 1-2) 12 months after cardiac arrest. Admission plasma concentrations of IL-6 but not hs-CRP were higher with prolonged time to ROSC (p < 0.001, 0.203, respectively), in patients with subsequent higher SOFA scores (p < 0.001, 0.069) and poor long-term neurological outcome (CPC 3-5) (p < 0.001, 0.315). S-100B concentrations over time were higher in patients with CPC of 3-5 (p < 0.001). The area under the curve for prediction of poor 12-month outcome for admission levels was 0.711 IL6, 0.663 for S-100B and 0.534 for hs-CRP. With multivariate logistic regression analysis only admission IL-6 (p = 0.046, OR 1.006, 95% CI 1.000-1.011/ng/L) was an independent predictor of poor neurological outcome. Conclusion: Admission high IL-6, but not hs-CRP or S-100B, is associated with extra-cerebral organ dysfunction and along with age and time to ROSC are independent predictors for 12-month poor neurologic outcome (CPC 3-5).
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- 2014
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26. The predictive value of soluble urokinase plasminogen activator receptor (SuPAR) regarding 90-day mortality and 12-month neurological outcome in critically ill patients after out-of-hospital cardiac arrest. Data from the prospective FINNRESUSCI study
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Jalkanen, Ville, Vaahersalo, Jukka, Pettila, Ville, Kurola, Jouni, Varpula, Tero, Tiainen, Marjaana, Huhtala, Heini, Alaspaa, Ari, Hovilehto, Seppo, Kiviniemi, Outi, Kuitunen, Anne, Tenhunen, Jyrki, Jalkanen, Ville, Vaahersalo, Jukka, Pettila, Ville, Kurola, Jouni, Varpula, Tero, Tiainen, Marjaana, Huhtala, Heini, Alaspaa, Ari, Hovilehto, Seppo, Kiviniemi, Outi, Kuitunen, Anne, and Tenhunen, Jyrki
- Abstract
Aim: The whole body ischaemia-reperfusion after cardiac arrest (CA) induces a systemic inflammation-reperfusion response. The expression of urokinase plasminogen activator receptor (uPAR) is known to be induced after hypoxia and increased levels of soluble form suPAR have been measured after hypoxia and ischaemia. Our aim was to evaluate, whether ischaemia/reperfusion injury after out-of-hospital cardiac arrest (OHCA) increases suPAR concentrations in serum and to evaluate the prognostic value of suPAR regarding 90-day mortality and 12-month neurological outcome. Methods: This is a pre-determined substudy of prospective FINNRESUSCI study. Total of 287 patients treated in the intensive care units after OHCA and with consent from the next-of-kin and serum samples between baseline and day 4 were included. Outcome and neurological outcome were evaluated according the Pittsburgh Cerebral Performance Categories (CPC). Kaplan-Meier survival curves, areas under receiver operational characteristics curves and positive likelihood ratios for mortality and poor neurological outcome were calculated. Results: Non-survivors had higher levels of suPAR after OHCA. Kaplan-Meier survival curves indicated high 90-day mortality in the highest concentration quintiles. LR+ for 1-year CPC 3-5 was 1.8-2.7 for the whole patient cohort and in shockable rhythms 2.0-2.4. In therapeutic hypothermia prognostic value remained. Conclusions: We found that high SuPAR concentrations were associated with poor outcome in patients with OHCA admitted to critical care. However, suPAR alone had inadequate predictive value for poor outcome and did not associate with 12-month neurological outcome.
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- 2014
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27. Treatment modalities of acute lung injury with special reference to airway pressure release ventilation
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Varpula, Tero, University of Helsinki, Faculty of Medicine, Institute of Clinical Medicine, Helsingin yliopisto, lääketieteellinen tiedekunta, kliininen laitos, and Helsingfors universitet, medicinska fakulteten, institutionen för klinisk medicin
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- 2004
28. Serum MMP-8 and TIMP-1 in Critically Ill Patients with Acute Respiratory Failure
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Hästbacka, Johanna, primary, Linko, Rita, additional, Tervahartiala, Taina, additional, Varpula, Tero, additional, Hovilehto, Seppo, additional, Parviainen, Ilkka, additional, Vaara, Suvi T., additional, Sorsa, Timo, additional, and Pettilä, Ville, additional
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- 2014
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29. Therapeutic hypothermia after out-of-hospital cardiac arrest in Finnish intensive care units : the FINNRESUSCI study
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Vaahersalo, Jukka, Hiltunen, Pamela, Tiainen, Marjaana, Oksanen, Tuomas, Kaukonen, Kirsi-Maija, Kurola, Jouni, Ruokonen, Esko, Tenhunen, Jyrki, Ala-Kokko, Tero, Lund, Vesa, Reinikainen, Matti, Kiviniemi, Outi, Silfvast, Tom, Kuisma, Markku, Varpula, Tero, Pettila, Ville, Vaahersalo, Jukka, Hiltunen, Pamela, Tiainen, Marjaana, Oksanen, Tuomas, Kaukonen, Kirsi-Maija, Kurola, Jouni, Ruokonen, Esko, Tenhunen, Jyrki, Ala-Kokko, Tero, Lund, Vesa, Reinikainen, Matti, Kiviniemi, Outi, Silfvast, Tom, Kuisma, Markku, Varpula, Tero, and Pettila, Ville
- Abstract
We aimed to evaluate post-resuscitation care, implementation of therapeutic hypothermia (TH) and outcomes of intensive care unit (ICU)-treated out-of-hospital cardiac arrest (OHCA) patients in Finland. We included all adult OHCA patients admitted to 21 ICUs in Finland from March 1, 2010 to February 28, 2011 in this prospective observational study. Patients were followed (mortality and neurological outcome evaluated by Cerebral Performance Categories, CPC) within 1 year after cardiac arrest. This study included 548 patients treated after OHCA. Of those, 311 patients (56.8 %) had a shockable initial rhythm (incidence of 7.4/100,000/year) and 237 patients (43.2 %) had a non-shockable rhythm (incidence of 5.6/100,000/year). At ICU admission, 504 (92 %) patients were unconscious. TH was given to 241/281 (85.8 %) unconscious patients resuscitated from shockable rhythms, with unfavourable 1-year neurological outcome (CPC 3-4-5) in 42.0 % with TH versus 77.5 % without TH (p < 0.001). TH was given to 70/223 (31.4 %) unconscious patients resuscitated from non-shockable rhythms, with 1-year CPC of 3-4-5 in 80.6 % (54/70) with TH versus 84.0 % (126/153) without TH (p = 0.56). This lack of difference remained after adjustment for propensity to receive TH in patients with non-shockable rhythms. One-year unfavourable neurological outcome of patients with shockable rhythms after TH was lower than in previous randomized controlled trials. However, our results do not support use of TH in patients with non-shockable rhythms.
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- 2013
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30. SuPAR and PAI-1 in critically ill, mechanically ventilated patients
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Jalkanen, Ville, Yang, Runkuan, Linko, Rita, Huhtala, Heini, Okkonen, Marjatta, Varpula, Tero, Pettilä, Ville, Tenhunen, Jyrki, Jalkanen, Ville, Yang, Runkuan, Linko, Rita, Huhtala, Heini, Okkonen, Marjatta, Varpula, Tero, Pettilä, Ville, and Tenhunen, Jyrki
- Abstract
PURPOSE: SuPAR (soluble urokinase plasminogen activator receptor) and PAI-1 (plasminogen activator inhibitor 1) are active in the coagulation-fibrinolysis pathway. Both have been suggested as biomarkers for disease severity. We evaluated them in prediction of mortality, acute lung injury (ALI)/acute respiratory distress syndrome (ARDS), sepsis and renal replacement therapy (RRT) in operative and non-operative ventilated patients. METHODS: We conducted a prospective, multicenter, observational study. Blood samples and data of intensive care were collected. Mechanically ventilated patients with baseline suPAR and PAI-1 measurements were included in the analysis, and healthy volunteers were analysed for comparison. Receiver operating characteristics (ROC), logistic regression, likelihood ratios and Kaplan-Meier analysis were performed. RESULTS: Baseline suPAR was 11.6 ng/ml (quartiles Q1-Q3, 9.6-14.0), compared to healthy volunteers with suPAR of 0.6 ng/ml (0.5-11.0). PAI-1 concentrations were 2.67 ng/ml (1.53-4.69) and 0.3 ng/ml (0.3-0.4), respectively. ROC analysis for suPAR 90-day mortality areas under receiver operating characteristic curves (AUC) 0.61 (95 % confidence interval (CI): 0.55-0.67), sepsis 0.68 (0.61-0.76), ALI/ARDS 0.64 (0.56-0.73) and RRT 0.65 (0.56-0.73). Patients with the highest quartile of suPAR concentrations had an odds ratio of 2.52 (1.37-4.64, p = 0.003) for 90-day mortality and 3.16 (1.19-8.41, p = 0.02) for ALI/ARDS. In non-operative patients, the AUC's for suPAR were 90-day mortality 0.61 (0.54-0.68), RRT 0.73 (0.64-0.83), sepsis 0.70 (0.60-0.80), ALI/ARDS 0.61 (0.51-0.71). Predictive value of PAI-1 was negligible. CONCLUSIONS: In non-operative patients, low concentrations of suPAR were predictive for survival and high concentrations for RRT and mortality. SuPAR may be used for screening for patients with potentially good survival. The association with RRT may supply an early warning sign for acute renal failure.
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- 2013
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31. Elevated plasma heparin-binding protein is associated with early death after resuscitation from cardiac arrest.
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Ristagno, Giuseppe, Masson, Serge, Tiainen, Marjaana, Bendel, Stepani, Bernasconi, Roberto, Varpula, Tero, Milani, Valentina, Vaahersalo, Jukka, Magnoli, Michela, Spanuth, Eberhard, Barlera, Simona, Latini, Roberto, Hoppu, Sanna, Pettilä, Ville, Skrifvars, Markus B., and FINNRESUSCI Study Group
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ANALYSIS of variance ,CARDIAC arrest ,CELL receptors ,COMPARATIVE studies ,HEALTH status indicators ,INTENSIVE care units ,LONGITUDINAL method ,RESEARCH methodology ,MEDICAL cooperation ,PROGNOSIS ,RESEARCH ,RESUSCITATION ,LOGISTIC regression analysis ,EVALUATION research ,RECEIVER operating characteristic curves ,BLOOD - Abstract
Background: An intense systemic inflammatory response is observed following reperfusion after cardiac arrest. Heparin-binding protein (HBP) is a granule protein released by neutrophils that intervenes in endothelial permeability regulation. In the present study, we investigated plasma levels of HBP in a large population of patients resuscitated from out-of-hospital cardiac arrest. We hypothesized that high circulating levels of HBP are associated with severity of post-cardiac arrest syndrome and poor outcome.Methods: Plasma was obtained from 278 patients enrolled in a prospective multicenter observational study in 21 intensive care units (ICU) in Finland. HBP was assayed at ICU admission and 48 h later. Multiple organ dysfunction syndrome (MODS) was defined as the 24 h Sequential Organ Failure Assessment (SOFA) score ≥ 12. ICU death and 12-month Cerebral Performance Category (CPC) were evaluated. Multiple linear and logistic regression tests and receiver operating characteristic curves with area under the curve (AUC) were performed.Results: Eighty-two percent of patients (229 of 278) survived to ICU discharge and 48 % (133 of 276) to 1 year with a favorable neurological outcome (CPC 1 or 2). At ICU admission, median plasma levels of HBP were markedly elevated, 15.4 [9.6-31.3] ng/mL, and persisted high 48 h later, 14.8 [9.8-31.1] ng/mL. Admission levels of HBP were higher in patients who had higher 24 h SOFA and cardiovascular SOFA score (p < 0.0001) and in those who developed MODS compared to those who did not (29.3 [13.7-60.1] ng/mL vs. 13.6 [9.1-26.2] ng/mL, p < 0.0001; AUC = 0.70 ± 0.04, p = 0.0001). Admission levels of HBP were also higher in patients who died in ICU (31.0 [17.7-78.2] ng/mL) compared to those who survived (13.5 [9.1-25.5] ng/mL, p < 0.0001) and in those with an unfavorable 12-month neurological outcome compared to those with a favorable one (18.9 [11.3-44.3] ng/mL vs. 12.8 [8.6-30.4] ng/mL, p < 0.0001). Admission levels of HBP predicted early ICU death with an AUC of 0.74 ± 0.04 (p < 0.0001) and were independently associated with ICU death (OR [95 %CI] 1.607 [1.076-2.399], p = 0.020), but not with unfavorable 12-month neurological outcome (OR [95 %CI] 1.154 [0.834-1.596], p = 0.387).Conclusions: Elevated plasma levels of HBP at ICU admission were independently associated with early death in ICU. [ABSTRACT FROM AUTHOR]- Published
- 2016
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32. Heme Oxygenase 1 Polymorphisms and Plasma Concentrations in Critically Ill Patients
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Saukkonen, Katri, primary, Lakkisto, Päivi, additional, Kaunisto, Mari A., additional, Varpula, Marjut, additional, Voipio-Pulkki, Liisa-Maria, additional, Varpula, Tero, additional, Pettilä, Ville, additional, and Pulkki, Kari, additional
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- 2010
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33. One-year mortality, quality of life and predicted life-time cost-utility in critically ill patients with acute respiratory failure
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Linko, Rita, primary, Suojaranta-Ylinen, Raili, additional, Karlsson, Sari, additional, Ruokonen, Esko, additional, Varpula, Tero, additional, Pettila, Ville, additional, and the FINNALI study investigators, The, additional
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- 2010
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34. Levosimendan for Calcium Channel Blocker Poisoning in Humans
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Varpula, Tero, primary, Rapola, Janne, additional, Sallisalmi, Marko, additional, and Kurola, Jouni, additional
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- 2009
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35. Treatment of Serious Calcium Channel Blocker Overdose With Levosimendan, a Calcium Sensitizer
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Varpula, Tero, primary, Rapola, Janne, additional, Sallisalmi, Marko, additional, and Kurola, Jouni, additional
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- 2009
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36. Early activation of the kynurenine pathway predicts early death and long-term outcome in patients resuscitated from out-of-hospital cardiac arrest.
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Ristagno, Giuseppe, Latini, Roberto, Vaahersalo, Jukka, Masson, Serge, Kurola, Jouni, Varpula, Tero, Lucchetti, Jacopo, Fracasso, Claudia, Guiso, Giovanna, Montanelli, Alessandro, Barlera, Simona, Gobbi, Marco, Tiainen, Marjaana, Pettilä, Ville, Skrifvars, Markus B., Pettilä, Ville, and FINNRESUSCI Investigators
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- 2014
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37. Plasma cell-free DNA in patients needing mechanical ventilation.
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Okkonen, Marjatta, Lakkisto, Päivi, Korhonen, Anna-Maija, Parviai-nen, Ilkka, Reinikainen, Matti, Varpula, Tero, and Pettilä, Ville
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DNA ,PLASMA cells ,ARTIFICIAL respiration ,FIRST aid in illness & injury ,RESPIRATORY therapy - Abstract
Introduction: Concentrations of plasma cell-free DNA are increased in various diseases and have shown some prognostic value in many patient groups, including critically ill patients. Pathophysiological processes behind the need for mechanical ventilation and the treatment itself could raise plasma levels of cell-free DNA. We evaluated levels of plasma cell-free DNA and their prognostic value in patients needing mechanical ventilation. Methods: We studied prospectively 580 mechanically ventilated critically ill patients. Blood samples were taken at study admission (Day 0) and on Day 2. Plasma cell-free DNA concentrations were measured by real-time quantitative PCR assay for the β-globin gene and are expressed as genome equivalents (GE)/ml. Results: Median (interquartile range, IQR) plasma cell-free DNA concentration was 11,853 GE/ml (5,304 to 24,620 GE/mL) at study admission, and 11,610 GE/mL (6,411 to 21,558 GE/mL) on Day 2. Concentrations at admission were significantly higher in 90-day non-survivors than survivors, 16,936 GE/mL (7,262 to 46,866 GE/mL) versus 10,026 GE/ mL (4,870 to 19,820 GE/mL), P < 0.001. In a multivariate logistic regression analysis plasma cell-free DNA concentration over 16,000 GE/ml remained an independent predictor of 90-day mortality (adjusted odds ratio 2.16, 95% confidence interval CI 1.37 to 3.40). Positive likelihood ratio of plasma cell-free DNA at admission for the prediction of 90-day mortality was 1.72 (95% CI 1.40 to 2.11). Conclusions: Plasma levels of cell-free DNA were significantly higher in non-survivors than survivors. Plasma DNA level at baseline was an independent predictor of 90-day mortality. However, its clinical benefit as a prognostic marker seems to be limited. [ABSTRACT FROM AUTHOR]
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- 2011
- Full Text
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38. Variation in severity-adjusted resource use and outcome in intensive care units
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Takala, Jukka, Moser, André, Raj, Rahul, Pettilä, Ville, Irincheeva, Irina, Selander, Tuomas, Kiiski, Olli, Varpula, Tero, Reinikainen, Matti, and Jakob, Stephan M.
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610 Medicine & health ,3. Good health - Abstract
PURPOSE Intensive care patients have increased risk of death and their care is expensive. We investigated whether risk-adjusted mortality and resources used to achieve survivors change over time and if their variation is associated with variables related to intensive care unit (ICU) organization and structure. METHODS Data of 207,131 patients treated in 2008-2017 in 21 ICUs in Finland, Estonia and Switzerland were extracted from a benchmarking database. Resource use was measured using ICU length of stay, daily Therapeutic Intervention Scoring System Scores (TISS) and purchasing power parity-adjusted direct costs (2015-2017; 17 ICUs). The ratio of observed to severity-adjusted expected resource use (standardized resource use ratio; SRUR) was calculated. The number of expected survivors and the ratio of observed to expected mortality (standardized mortality ratio; SMR) was based on a mortality prediction model covering 2015-2017. Fourteen a priori variables reflecting structure and organization were used as explanatory variables for SRURs in multivariable models. RESULTS SMR decreased over time, whereas SRUR remained unchanged, except for decreased TISS-based SRUR. Direct costs of one ICU day, TISS score and ICU admission varied between ICUs 2.5-5-fold. Differences between individual ICUs in both SRUR and SMR were up to > 3-fold, and their evolution was highly variable, without clear association between SRUR and SMR. High patient turnover was consistently associated with low SRUR but not with SMR. CONCLUSION The wide and independent variation in both SMR and SRUR suggests that they should be used together to compare the performance of different ICUs or an individual ICU over time.
39. Mortality prediction in intensive care units including premorbid functional status improved performance and internal validity
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Moser, Andr��, Reinikainen, Matti, Jakob, Stephan M., Selander, Tuomas, Pettil��, Ville, Kiiski, Olli, Varpula, Tero, Raj, Rahul, and Takala, Jukka
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610 Medicine & health ,3. Good health - Abstract
OBJECTIVE Prognostic models are key for benchmarking intensive care units (ICUs). They require up-to-date predictors and should report transportability properties for reliable predictions. We developed and validated an in-hospital mortality risk prediction model to facilitate benchmarking, quality assurance, and health economics evaluation. STUDY DESIGN AND SETTING We retrieved data from the database of an international (Finland, Estonia, Switzerland) multicenter ICU cohort study from 2015-2017. We used a hierarchical logistic regression model that included age, a modified Simplified Acute Physiology Score-II, admission type, premorbid functional status, and diagnosis as grouping variable. We used pooled and meta-analytic cross-validation approaches to assess temporal and geographical transportability. RESULTS We included 61,224 patients treated in the ICU (hospital mortality 10.6%). The developed prediction model had an area under the receiver operating characteristic curve 0.886, 95% confidence interval (CI) 0.882-0.890; a calibration slope 1.01, 95% CI (0.99-1.03); a mean calibration -0.004, 95% CI (-0.035-0.027). While the model showed very good internal validity and geographic discrimination transportability, we found substantial heterogeneity of performance measures between ICUs (I-squared: 53.4% to 84.7%). CONCLUSION A novel framework evaluating the performance of our prediction model provided key information to judge the validity of our model and its adaptation for future use. WHAT IS NEW?: : Key findings; Our mortality prediction model-which combined established clinically relevant predictors with premorbid functional status and diagnoses as modeling variables-showed very good internal validity, geographic discrimination and temporal transportability, with a substantial heterogeneity of performance measures between ICUs. What does this add to what is known? Premorbid functional status and diagnosis are known predictors of ICU-relevant study outcomes, but are not regularly implemented in established scoring systems. The inclusion of this information showed increased predictive model performance compared to predictions from established risk scoring systems, while showing good internal validation and transportability properties. What is the implication and what should change now? To the best of our knowledge, this is one of the first development and validation studies to investigate geographical and temporal transportability properties of an ICU mortality prediction model. Transportability properties are key in the reliable monitoring and benchmarking of ICUs and for their planning. They provide an important piece of information about the model validity in other study populations and settings, and should be quantified in future validation studies of ICU prediction models.
40. Incidence and outcome of out-of-hospital cardiac arrest patients in Finnish intensive care units
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Vaahersalo, Jukka, University of Helsinki, Faculty of Medicine, Institute of Clinical Medicine, Department of Perioperative, Intensive care and Pain Medicine, Helsingin yliopisto, lääketieteellinen tiedekunta, kliininen laitos, Helsingfors universitet, medicinska fakulteten, institutionen för klinisk medicin, Sunde, Kjetil, Pettilä, Ville, and Varpula, Tero
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lääketiede - Abstract
Aims The objectives of this study were to evaluate the incidence and neurological outcomes of out-of-hospital cardiac arrest (OHCA) patients in Finnish intensive care units (ICU). This study also investigated the use of therapeutic hypothermia (TH), arterial blood gas (ABG) pressures and different biomarkers association with one-year neurological outcome after OHCA. Materials and methods The FINNRESUSCI study was conducted in 21 out of 22 ICUs in Finland during a one-year study period. All adult patients after OHCA who were treated in ICU were included. Blood samples for biomarker evaluation were collected and neurological outcomes were determined 12 months after CA. All patients were included when evaluated the incidence, the implementation of TH and outcomes. In Study II, all ABG samples obtained from mechanically ventilated patients during the first 24h from ICU admission. In Study III and IV, biomarkers were measured from patients resuscitated from VF/VT. Main results FINNRESUSCI study included 548 patients, of whom 311 (56.8%) had shockable (VF/VT) and 237 (43.2%) non-shockable (PEA or asystole) as an initial rhythm. TH was induced totally in 311 unconscious patients 85.8% in VF/VT and 31.4% in PEA or asystole group. Good neurologic outcome was achieved in 58.0% patients with shockable rhythms and in 19.4% with non-shockable rhythms after TH treatment. The mean PaCO2 tension during the first 24-hour in ICU was an independent predictor of a good outcome with an odds ratio (OR) of 1.054, but the mean PaO2 tension was not. The time spent above PaCO2 45 mmHg was associated with good neurologic outcome and patients with the highest mean PaCO2 and PaO2 values had better neurologic outcome than predicted with an OR of 3.2 (95% CI 1.1-9.2). IL-6 and S-100B was associated with time to ROSC and poor neurological outcome (p less than 0.001). Admission IL-6 was associated with extra-cerebral organ dysfunction (p less than 0.001) and was an independent predictor of poor neurological outcome with an OR of 1.006 (95% CI 1.000-1.011). Hs-TnT levels were elevated in all of the patients, higher in patients with poor vs. good neurological outcome 739 vs. 334 ng/l (p=0.028), but there was no statistical difference in mortality. Conclusions TH is well implemented in clinical practice in Finnish ICUs. The majority of OHCA patients with shockable rhythms survive with good neurology, while the outcome of patients with non-shockable rhythms is poorer despite the TH treatment. There was no harmful association between hyperoxia and outcome, but instead mild hypercapnia combined with mild hyperoxia might be beneficial during the first 24 hours. IL-6 was associated with extra-cerebral organ dysfunction and predicted neurological outcome after OHCA-VF/VT, while hs-TnT does not give any additional prognostic information. Tavoitteet Tämän tutkimuksen tavoitteena oli selvittää sairaalan ulkopuolella sydänpysähdyksen saaneiden potilaiden esiintyvyys suomalaisilla teho-osastoilla ja neurologiset toipumistulokset vuoden kuluttua sydänpysähdyksestä. Lisäksi selvitettiin viilennyshoidon käyttöä, valtimoverikaasujen ja eri biomarkkereiden yhteyttä neurologiseen toipumiseen tehohoidetuilla sydänpysähdyspotilailla Potilaat ja menetelmät Kansalliseen FINNRESUSCI tutkimukseen osallistui 21 Suomen 22:sta sydänpysähdyspotilaita hoitavista teho-osastoista. Tutkimukseen kerättiin yhden vuoden aikana kaikki sairaalan ulkopuolella sydänpysähdyksen saanet aikuispotilaat, jotka päätyivät teho-osastolle jatkohoitoon. Verinäytteitä kerättiin neljässä aikapisteessä ja neurologinen toipuminen arvioitiin vuoden kuluttua sydänpysähdyksestä. Valtimoverinäytteet analysoitiin vain teho-osastolla hengityskonehoidossa olleilta potilaita ja biomarkkerit analysoitiin vain iskettävistä lähtörytmeistä (VF/VT) elvytetyiltä potilailta. Tulokset FINNRESUSCI tutkimuksen kerättiin yhteensä 548 potilasta, joista 311 (56.8%) oli elvytetty VF/VT- rytmeistä ja 237 (43.2%) muista lähtörytmeistä (PEA/ASY). Viilennyshoito aloitettiin yhteensä 311 potilaalle, 85.8% VF/VT-potilaalle ja 31.4% muista rytmeistä elvytetyille. Näistä potilaista VF/VT-ryhmästä neurologisesti toipui hyvin 58.0% ja PEA/ASY-ryhmästä 19.4%. Normaaliarvoja korkeampi hiilidioksidin (CO2) osapaine valtimoveressä assosioitui hyvään ennusteeseen, vastaavasti hapen (O2) osapaineella ei ollut itsenäistä vaikutusta ennusteeseen ensimmäisen 24 tunnin tehohoidon aikana. Potilailla joiden CO2 ja O2 osapaineet olivat korkeimmat toipuivat paremmin kuin oli ennustemallin mukaan oli odotettavissa. Tulovaiheen interleukiini-6 (IL-6) ja proteiini S100-B arvot assosioituivat sydänpysähdyksen kestoon ja neurologiseen toipumiseen ja korkeat tulovaiheen IL-6 arvot myös ennustivat huonoa neurologista toipumista. Herkkä troponiini-T arvo oli koholla kaikilla potilailla, huonosti toipuneilla merkitsevästi enemmän, mutta se ei tuonut lisäarvoa ennustearvion tekemiseen. Johtopäätökset Viilennyshoito on laajasti kliinisessä käytössä teho-osastoilla koko Suomessa ja kammiovärinästä elvytettyjen potilaiden hoitotulokset ovat erittäin hyvät. Muista lähtörytmeistä elvytettyjen potilaiden ennuste on selvästi huonompi riippumatta siitä annetaanko viilennyshoitoa vai ei. Hengityskoneen säädöillä, jotka vaikuttavat valtimoveren O2 ja CO2 osapaineisiin, on vaikutusta toipumiseen. Mitatuista laboratorioarvoista mitään ei voida yksinään hyödyntää sydänpysähdyspotilaiden ennusteen arvioimisessa.
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- 2016
41. Sydänpysähdyksestä elvytetyn potilaan tehohoito
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Oksanen, Tuomas, University of Helsinki, Faculty of Medicine, Institute of Clinical Medicine, Helsingin yliopisto, lääketieteellinen tiedekunta, kliininen laitos, Anestesiologia ja tehohoito, Helsingfors universitet, medicinska fakulteten, institutionen för klinisk medicin, Roine, Risto, Pettilä, Ville, and Varpula, Tero
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tehohoitolääketiede - Abstract
Aims of the study Intensive care is usually necessary for the good survival of postresuscitation patients. The use of some intensive care methods can make the survival better. The main focus of this thesis was to analyze implementation of therapeutic hypothermia in Finnish intensive care units (ICU) and its impact on survival, impact of strict glucose control on the survival of postresuscitation patients, incidence of postresuscitation myocardial depression during therapeutic hypothermia and usefulness of serum NSE concentration for prognostication. Patients and methods Implementation of therapeutic hypothermia and survival of postresuscitation patients in ICUs in Finland was analyzed retrospectively using data from the Finnish Intensive Care Consortium quality database. Impact of glucose control on survival of postresuscitation patients was studied in a randomized controlled study of patients treated with therapeutic hypothermia (24 hours at 33°C) in HUCH ICUs (n = 90). The study patients were randomized to strict (4 6 mmol/l) or moderate (6 8 mmol/l) glucose control for the first 48 hours. The incidence of myocardial depression was studied in a retrospective analysis of hemodynamic data from clinical information system database of 120 postresuscitation patients treated with therapeutic hypothermia (24 hours at 33°C) in HUCH ICUs. Usefulness of serum NSE and some other factors as prognostic tools were analyzed retrospectively from laboratory database of 90 postresuscitation patients treated with therapeutic hypothermia (24 hours at 33°C) in HUCH ICUs. Results Therapeutic hypothermia was implemented widely in Finnish ICUs in a few years after international guidelines were published in 2003. In the same time, mortality of postresuscitation patients treated in ICUs decreased. Mortality or serum NSE concentration did not differ between patients treated with strict or moderate glucose control. However, strict glucose control increased risk of hypoglycemia. Myocardial depression, manifesting as low cardiac output (CI less than 1.5 l/min/m2), was observed during the first 12 hours in two thirds of patients monitored with pulmonary artery catheter. Other hemodynamic parametres did not differ. Serum NSE concentration at 48 hours after cardiac arrest and decreasing concentration at that time point correlated with neurologic outcome, but with 100% specificity, sensitivity was low. Conclusions Therapeutic hypothermia was implemented rapidly in Finnish ICUs, compared with other European countries or USA. This was associated with better outcome, but causality is uncertain. Strict normoglycemia during intensive care of postresuscitation patients is not necessary. The optimal goal for blood glucose level is not known. Myocardial depression manifesting as low cardiac output is common in postresuscitation patients, but difficult to detect without monitoring cardiac output. The impact of recognition and treatment of myocardial depression on outcome requires further studies. Serum NSE measured at least 48 hours after resuscitation can be used as a prognostic tool together with other methods. Tavoitteet Sydänpysähdyksestä onnistuneesti elvytettyjen potilaiden toipuminen edellyttää useimmiten alkuvaiheen tehohoitoa. Eräillä tehohoidon menetelmillä on myös mahdollista merkittävästi parantaa toipumisennustetta. Tässä väitöskirjatyössä pyrittiin erityisesti selvittämään viilennyshoidon käyttöönottoa suomalaisilla teho-osastoilla ja sen vaikutusta toipumisennusteeseen, tiukasti normaaliksi hoidettavan verensokerin vaikutusta elvytettyjen toipumisennusteeseen, elvytyksen jälkitilaan liittyvän sydänlihaslaman esiintyvyyttä viilennyshoitoa saavilla potilailla sekä seerumin NSE-pitoisuuden käyttökelpoisuutta toipumisennusteen arvioinnissa. Potilaat ja menetelmät Viilennyshoidon käyttöönottoa ja sydänpysähdyksen jälkeen teho-osastoilla hoidettujen potilaiden toipumisennustetta koko Suomen laajuisesti tutkittiin Suomen Tehohoitokonsortion laatutietokantaan kerättyjen tietojen perusteella retrospektiivisesti. Verensokeritasapainon vaikutusta elvytettyjen potilaiden toipumisennusteeseen tutkittiin satunnaistetussa kontrolloidussa tutkimuksessa HYKS teho-osastoilla elvytyksen jälkeen viilennyshoidetuilla (24 tuntia 33°C lämpötilassa) potilailla (n = 90). Potilaat satunnaistettiin joko tiukan normoglykemian (4 6 mmol/l) tai kohtalaisen sokeritasapainon (6 8 mmol/l) ryhmiin ensimmäisten 48 tunnin ajaksi. Sydänlihaslaman esiintyvyyttä tutkittiin retrospektiivisesti keräämällä HYKS teho-osastoilla viilennyshoidossa (24 tuntia 33°C lämpötilassa) olleiden potilaiden (n = 120) verenkiertosuureita tehohoidon potilastietotietojärjestelmän tietokannasta. Seerumin NSE:n ja eräiden muiden tekijöiden yhteyttä toipumisennusteeseen tutkittiin retrospektiivisesti HYKS teho-osastoilla viilennyshoidettujen (24 tuntia 33°C lämpötilassa) potilaiden (n = 90) laboratoriotiedoista. Tulokset Viilennyshoito elvytyksen jälkeen otettiin suomalaisilla teho-osastoilla laajamittaiseen käyttöön jo muutamassa vuodessa sen jälkeen, kun siihen kehottava kansainvälinen hoitosuositus annettiin 2003. Samaan aikaan myös teho-osastoilla elvytyksen jälkeen hoidettujen potilaiden kuolleisuus pieneni merkittävästi. Tiukan tai kohtalaisen verensokeritavoitteen mukaan hoidettujen potilaiden 30 päivän kuolleisuudessa tai aivovaurion astetta kuvaavassa seerumin NSE-pitoisuudessa ei ollut eroa. Tiukka verensokeritavoite kuitenkin lisäsi hypoglykemian esiintyvyyttä. Matalana sydämen minuuttivirtauksena (CI alle 1.5 l/min/m2) ilmenevä sydänlihaslama havaittiin ensimmäisten 12 tunnin aikana kahdella kolmasosalla potilaista, joilla tätä monitoroitiin keuhkovaltimokatetrilla. Muut verenkiertosuureet eivät näillä potilailla eronneet. Seerumin NSE-pitoisuus 48 tuntia sydänpysähdyksestä mitattuna sekä tuossa vaiheessa laskusuuntainen pitoisuus oli yhteydessä toipumisennusteeseen, mutta tavoiteltaessa 100% tarkkuutta menetelmän herkkyys oli kehno. Johtopäätökset Viilennyshoito otettiin Suomessa nopeasti laajamittaiseen käyttöön teho-osastoilla, toisin kuin muualla Euroopassa tai USA:ssa. Menetelmän käyttöönotto oli myös ajallisesti yhteydessä toipumisennusteen paranemiseen, mutta syy-seuraussuhde on epävarma. Elvytyksen jälkeisessä tehohoidossa ei ole tarpeen pyrkiä tiukkaan normoglykemiaan. Optimaalinen verensokeritavoite on edelleen epävarma. Alentuneena sydämen minuuttivirtauksena ilmenevä sydänlihaslama on yleinen heti elvytyksen jälkeen. Sen havaitseminen ilman CI:n mittausta on vaikeaa. Ilmiön tunnistamisen ja hoitamisen vaikutus toipumisennusteeseen edellyttää lisätutkimuksia. Seerumin NSE-pitoisuutta vähintään 48 tuntia elvytyksen jälkeen mitattuna voidaan käyttää ennustearvion tukena muiden menetelmien ohessa.
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- 2015
42. Elevations of inflammatory markers PTX3 and sST2 after resuscitation from cardiac arrest are associated with multiple organ dysfunction syndrome and early death
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Giuseppe Ristagno, Tero Varpula, Serge Masson, Marta Greco, Barbara Bottazzi, Valentina Milani, Aneta Aleksova, Gianfranco Sinagra, Roberto Assandri, Marjaana Tiainen, Jukka Vaahersalo, Jouni Kurola, Simona Barlera, Alessandro Montanelli, Roberto Latini, Ville Pettilä, Stepani Bendel, Markus B. Skrifvars, null for the FINNRESUSCI Study Group, Ristagno, Giuseppe, Varpula, Tero, Masson, Serge, Greco, Marta, Bottazzi, Barbara, Milani, Valentina, Aleksova, Aneta, Sinagra, Gianfranco, Assandri, Roberto, Tiainen, Marjaana, Vaahersalo, Jukka, Kurola, Jouni, Barlera, Simona, Montanelli, Alessandro, Latini, Roberto, Pettilä, Ville, Bendel, Stepani, and Skrifvars, Markus B.
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Male ,medicine.medical_specialty ,Resuscitation ,Multiple Organ Failure ,medicine.medical_treatment ,Clinical Biochemistry ,cardiac arrest ,030204 cardiovascular system & hematology ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,pentraxin 3 (PTX3) ,ST2 ,Biochemistry (medical) ,law ,Internal medicine ,medicine ,Humans ,Receptors, Somatostatin ,Myocardial infarction ,Cardiopulmonary resuscitation ,Aged ,030304 developmental biology ,Inflammation ,0303 health sciences ,biology ,business.industry ,C-reactive protein ,General Medicine ,PTX3 ,Middle Aged ,medicine.disease ,Intensive care unit ,Heart Arrest ,3. Good health ,Serum Amyloid P-Component ,C-Reactive Protein ,Heart failure ,biology.protein ,Cardiology ,Female ,Multiple organ dysfunction syndrome ,business ,Biomarkers - Abstract
A systemic inflammatory response is observed after cardiopulmonary resuscitation. We investigated two novel inflammatory markers, pentraxin 3 (PTX3) and soluble suppression of tumorigenicity 2 (sST2), in comparison with the classic high-sensitivity C-reactive protein (hsCRP), for prediction of early multiple organ dysfunction syndrome (MODS), early death, and long-term outcome after out-of-hospital cardiac arrest.PTX3, sST2, and hsCRP were assayed at ICU admission and 48 h later in 278 patients. MODS was defined as the 24 h non-neurological Sequential Organ Failure Assessment (SOFA) score ≥12. Intensive care unit (ICU) death and 12-month Cerebral Performance Category (CPC) were evaluated.In total, 82% of patients survived to ICU discharge and 48% had favorable neurological outcome at 1 year (CPC 1 or 2). At ICU admission, median plasma levels of hsCRP (2.8 mg/L) were normal, while levels of PTX3 (19.1 ng/mL) and sST2 (117 ng/mL) were markedly elevated. PTX3 and sST2 were higher in patients who developed MODS (pHigher plasma levels of PTX3 and sST2, but not of hsCRP, at ICU admission were associated with higher risk of MODS and early death.
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- 2015
43. Biomarkers in acute respiratory failure
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Okkonen, Marjatta, University of Helsinki, Faculty of Medicine, Institute of Clinical Medicine, Helsingin yliopisto, lääketieteellinen tiedekunta, kliininen laitos, Helsingfors universitet, medicinska fakulteten, institutionen för klinisk medicin, Lundin, Stefan, Pettilä, Ville, and Varpula, Tero
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lääketiede - Abstract
Acute respiratory failure (ARF) is the most common type of organ failure leading to the need for intensive care. It is often secondary to acute lung injury (ALI) and its more severe form, acute respiratory distress syndrome (ARDS). ARF, and especially ALI and ARDS, cause increased morbidity, and mortality rates remain high (up to 40%). These disorders are characterised by inflammatory reaction and tissue damage. In some cases, inflammation continues and leads to an overwhelming repair process with ongoing fibrosis, accompanied by organ dysfunction and eventually a loss of function. Measuring the magnitude of the inflammation, and the repair process, would theoretically offer information concerning outcome. Early identification of patients whose disease process is likely to proceed unfavourably, would help clinicians to optimise their treatment. The aim of this study was to evaluate the epidemiology of ARF, its treatment, and outcome in Finland, with special interest in biomarkers, and their value in the prediction of mortality. Altogether, 958 adult patients treated with ventilatory support were prospectively included in this study during an eight week period in 2007 in 25 intensive care units. Plasma aminoterminal pro-brain natriuretic peptide (NT-pro-BNP) was assessed in 602 patients, and plasma cell-free DNA in 580 patients, to evaluate their prognostic value in ARF. Markers of collagen metabolism were studied in longitudinal serum samples in 68 patients in order to evaluate their evolution in ARF and the association to multiple organ dysfunction (MOD). Ventilatory support was used in 39% of all ICU patients. The estimated incidence of ARF was 149.5/100 000 per year. Median tidal volumes used were higher than recommended. Overall mortality at 90 days was 31%. Plasma NT-pro-BNP and cell-free DNA were highly increased in the majority of patients. Both markers were independent predictors of 90-day mortality, but their discriminative power was at most moderate when used separately. The mortality was highest in those patients, in whom both biomarkers were over their separate cut-off values. Thus, combined use of these biomarkers may increase their clinical value in the mortality prediction. The markers of collagen metabolism changed significantly over time in surviving patients. None of these markers did associate with MOD in these patients. Akuutti hengitysvajaus on yleisin tehohoitoon johtava elinhäiriö ja se lisää sairastavuutta ja kuolleisuutta (jopa 40%). Akuuttiin hengitysvajaukseen johtaa usein akuutti keuhkovaurio, jonka tyypillisiä piirteitä ovat tulehdusreaktio ja kudosvaurio. Joskus voimakas tulehdusreaktio johtaa jatkuvaan arpeuttavaan prosessiin ja pahimmassa tapauksessa vaikeaan keuhkojen toiminnanvajaukseen sekä monielinhäiriöön. Tulehdusreaktion sekä siihen liittyvän arpeuttavan prosessin voimakkuutta mittaamalla voitaisiin mahdollisesti tunnistaa ne potilaat, joiden sairaus etenee epätoivotusti. Tämä auttaisi hoidon ja voimavarojen oikeassa kohdentamisessa. Tämän etenevästi toteutetun kohorttitutkimuksen tarkoituksena oli tutkia akuutin hengitysvajauksen yleisyyttä, hoitoa ja ennustetta Suomessa, sekä erityisesti selvittää biologisten merkkiaineiden ennustearvoa. Akuutin hengitysvajauksen ilmaantuvuus oli 149.5/100 000 asukasta vuodessa. Hengityslaitehoitoa tarvitsi 39% kaikista teho-osastoilla hoidetuista potilaista. Näiden potilaiden kuolleisuus 90 päivän kohdalla oli 31%. Hengityslaitehoidossa käytetyt kertahengitystilavuudet olivat suositeltuja suurempia. Sekä plasman B-tyypin N-terminaalinen natriureettinen propeptidi (NT-pro-BNP) että plasman vapaa DNA olivat voimakkaasti koholla suurella osalla potilaista. Molemmat merkkiaineet ennustivat itsenäisesti kuolleisuutta 90 päivän kohdalla, mutta erillisinä mittareina kummankin tilastollinen erottelukyky oli enintään kohtalainen. Kun merkkiaineiden tulokset yhdistettiin, kuolleisuus oli selvästi korkein niillä potilailla, joilla kumpikin merkkiaine oli korkea. Kollageeniaineenvaihdunnan merkkiaineissa tapahtui ajan mittaan merkittävää vaihtelua niillä potilailla, jotka olivat elossa 3 viikon kohdalla. Millään kollageeniaineenvaihdunnan merkkiaineella ei ollut yhteyttä monielinhäiriöön tässä potilasryhmässä.
- Published
- 2012
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