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1. Extracellular vesicle tissue factor and tissue factor pathway inhibitor are independent discriminators of sepsis-induced coagulopathy

Author

Anna K. Tobiasch, Georg F. Lehner, Clemens Feistritzer, Andreas Peer, Birgit Zassler, Viktoria M. Neumair, Sebastian J. Klein, and Michael Joannidis

Subjects
disseminated intravascular coagulation, endothelial cells, extracellular vesicles, sepsis, tissue factor, tissue factor pathway inhibitor, Diseases of the blood and blood-forming organs, RC633-647.5
Abstract

Background: Sepsis-induced disseminated intravascular coagulopathy (DIC) remains a challenging clinical entity associated with significant morbidity and mortality. Endothelial injury or activation and extracellular vesicles (EV) are postulated as important determinants of DIC. Objectives: The aim of this study was to test the discriminatory ability of E-selectin, EV, tissue factor (TF) and TF pathway inhibitor (TFPI) in sepsis-induced coagulopathy. Methods: In this prospective, single-center study, we collected plasma samples within 24 hours after sepsis diagnosis and followed these patients for 5 consecutive days. Overt DIC was determined by the International Society on Thrombosis and Haemostasis (ISTH) DIC score. Eighty-seven sepsis patients were recruited (35 with overt DIC) who presented with increased levels of EV, EV-associated TF procoagulant activity (TF-PCA), E-selectin, TF, and TFPI at admission compared with healthy subjects. Results: Only TFPI levels and TF-PCA discriminated between sepsis patients with or without DIC (area under the curve = 0.76; P = .0002). Increased TF-PCA was not sensitive in detecting sepsis-associated DIC; however, levels above 1.38 pg/mL showed high specificity in this cohort (sensitivity 27%, specificity 95%). The hazard ratio to progress to DIC over 5 days was 1.14 (95% CI, 0.64-2.07) for TF-PCA levels of 0.5 pg/mL or higher and 3.18 (95% CI, 1.74-5.79) for TFPI levels of 22.28 ng/mL or higher at admission. Conclusion: These findings highlight the pivotal roles of TF-PCA and TFPI in an early phase of sepsis-induced DIC. Only EV-associated and functionally active TF and not TF antigen levels showed a predictive potential regarding DIC. These novel results might support the improvement of diagnostic or even therapeutic strategies to mitigate the devastating consequences of DIC in septic patients.

Published
2024
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2. Low bicarbonate replacement fluid normalizes metabolic alkalosis during continuous veno-venous hemofiltration with regional citrate anticoagulation

Author

Paul Köglberger, Sebastian J. Klein, Georg Franz Lehner, Romuald Bellmann, Andreas Peer, Daniel Schwärzler, and Michael Joannidis

Subjects
Metabolic alkalosis, Phoxilium®, Biphozyl®, Continuous veno-venous hemofiltration, Regional citrate anticoagulation, Acute kidney injury, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Metabolic alkalosis is a frequently occurring problem during continuous veno-venous hemofiltration (CVVH) with regional citrate anticoagulation (RCA). This study aimed to evaluate the effectiveness of switching from high to low bicarbonate (HCO3 −) replacement fluid in alkalotic critically ill patients with acute kidney injury treated by CVVH and RCA. Methods A retrospective-comparative study design was applied. Patients who underwent CVVH with RCA in the ICU between 09/2016 and 11/2017 were evaluated. Data were available from the clinical routine. A switch of the replacement fluid Phoxilium® (30 mmol/l HCO3 −) to Biphozyl® (22 mmol/l HCO3 −) was performed as blood HCO3 − concentration persisted ≥ 26 mmol/l despite adjustments of citrate dose and blood flow. Data were collected from 72 h before the switch of the replacement solutions until 72 h afterwards. Results Of 153 patients treated with CVVH during that period, 45 patients were switched from Phoxilium® to Biphozyl®. Forty-two patients (42 circuits) were available for statistical analysis. After switching the replacement fluid from Phoxilium® to Biphozyl® the serum HCO3 − concentration decreased significantly from 27.7 mmol/l (IQR 26.9–28.9) to 25.8 mmol/l (IQR 24.6–27.7) within 24 h (p

Published
2021
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3. Radiologic complete response (rCR) in contrast-enhanced magnetic resonance imaging (CE-MRI) after neoadjuvant chemotherapy for early breast cancer predicts recurrence-free survival but not pathologic complete response (pCR)

Author

Simon Peter Gampenrieder, Andreas Peer, Christian Weismann, Matthias Meissnitzer, Gabriel Rinnerthaler, Johanna Webhofer, Theresa Westphal, Marina Riedmann, Thomas Meissnitzer, Heike Egger, Frederike Klaassen Federspiel, Roland Reitsamer, Cornelia Hauser-Kronberger, Katharina Stering, Klaus Hergan, Brigitte Mlineritsch, and Richard Greil

Subjects
Breast cancer, MRI, Neoadjuvant chemotherapy, Prediction of complete pathologic response, Survival, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Abstract Background Patients with early breast cancer (EBC) achieving pathologic complete response (pCR) after neoadjuvant chemotherapy (NACT) have a favorable prognosis. Breast surgery might be avoided in patients in whom the presence of residual tumor can be ruled out with high confidence. Here, we investigated the diagnostic accuracy of contrast-enhanced MRI (CE-MRI) in predicting pCR and long-term outcome after NACT. Methods Patients with EBC, including patients with locally advanced disease, who had undergone CE-MRI after NACT, were retrospectively analyzed (n = 246). Three radiologists, blinded to clinicopathologic data, reevaluated all MRI scans regarding to the absence (radiologic complete remission; rCR) or presence (no-rCR) of residual contrast enhancement. Clinical and pathologic responses were compared categorically using Cohen’s kappa statistic. The Kaplan-Meier method was used to estimate recurrence-free survival (RFS) and overall survival (OS). Results Overall rCR and pCR (no invasive tumor in the breast and axilla (ypT0/is N0)) rates were 45% (111/246) and 29% (71/246), respectively. Only 48% (53/111; 95% CI 38–57%) of rCR corresponded to a pCR (= positive predictive value - PPV). Conversely, in 87% (117/135; 95% CI 79–92%) of patients, residual tumor observed on MRI was pathologically confirmed (= negative predictive value - NPV). Sensitivity to detect a pCR was 75% (53/71; 95% CI 63–84%), while specificity to detect residual tumor and accuracy were 67% (117/175; 95% CI 59–74%) and 69% (170/246; 95% CI 63–75%), respectively. The PPV was significantly lower in hormone-receptor (HR)-positive compared to HR-negative tumors (17/52 = 33% vs. 36/59 = 61%; P = 0.004). The concordance between rCR and pCR was low (Cohen’s kappa − 0.1), however in multivariate analysis both assessments were significantly associated with RFS (rCR P = 0.037; pCR P = 0.033) and OS (rCR P = 0.033; pCR P = 0.043). Conclusion Preoperative CE-MRI did not accurately predict pCR after NACT for EBC, especially not in HR-positive tumors. However, rCR was strongly associated with favorable RFS and OS.

Published
2019
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4. Effect of high-dose vitamin D3 on 28-day mortality in adult critically ill patients with severe vitamin D deficiency: a study protocol of a multicentre, placebo-controlled double-blind phase III RCT (the VITDALIZE study)

Author

Dhruv Parekh, David Thickett, Gemma Slinn, Peter Brocklehurst, Danny Mcauley, Maria Wittmann, Teresa Melody, Jaimin Patel, Gavin Perkins, Markus Kredel, Peter Kranke, Christian Stoppe, Lars Hummitzsch, Norbert Weiler, Karin Amrein, Sabine Westphal, Jean-Charles Preiser, Andrea Berghold, Regina Riedl, Philipp Eller, Peter Schellongowski, Patrick Meybohm, Corinna Marschalek, Rene Schmutz, Martin Clodi, Michael Resl, Mario Krasser, Matthias Michlmayr, Johann Reisinger, Alexandra Schiller, Nicolas Dominik Verheyen, Dirk von Lewinski, Marlene Sandra Deininger, Andreas Muench, Holger Simonis, Paul Zajic, Ines Lindenau, Alexander Holl, Alexander Pichler, Tadeja Urbanic Purkart, Katharina Ritsch, Simon Schmidt, Romuald Bellmann, Anna Brandtner, Adelheid Ditlbacher, Julia Hasslacher, Michael Joannidis, Andreas Peer, Klemens Zotter, Christoph Martin Biedermann, Andreas Valentin, Franz Wimmer, Susanne Demschar, Markus Koestenberger, Rudolf Likar, Stefan Neuwersch, Michael Pogatschnigg, Brigitte Trummer, Martin Duenser, Jens Meier, Johann Kainz, Romana Sommer, Otmar Schindler, Alexander Lehr, Guenter Mesaric, Yasmin Tinawi, Norbert Watzinger, Randolf Hammerl, Peter Krippl, Stefan Langner, Martin Lux, Matthias Unteregger, Gerwig Fruehauf, Barbara Gruber, Bertram Harzl, Viktor Wutzl, Juergen Berghofer, Nadine Fuch, Gilbert Hainzl, Isolde Pessentheiner, Michael Zink, Petra Hoernler, Ernst Trampitsch, Jakob Muehlbacher, Philipp Riss, Roman Ullrich, Martin Bernardi, Michael Hiesmayr, Katharina Kovac, Cecilia Veraar, Bernhard Zapletal, Elisabeth Lobmeyr, Esther Tiller, Georg Hinterholzer, Daniel Mydza, Sabine Schmaldienst, Maxime van Cutsem, Marianne Blockmans, Alain D’hondt, Vincent Fraipont, Sophie Jacquet, Caroline Abbenhuijs, Katarina Helenarova, Romain Courcelle, Dominique Durand, Amedee Ego, Amina Khaldi, Itesa Nancy Matumikina, Kai Zacharowski, Simone Lindau, Philipp Helmer, Gunnar Elke, Guenther Zick, Tobias Becher, Dirk Schaedler, Matthias Kott, Barbara Vogt, Ingmar Lautenschlaeger, Georg Fuernau, Christian Putensen, Stefan Ehrentraut, Barbara Kapfer, Thomas Felbinger, Ines Kaufmann, Bjoern Andrew Rempiss, Claudia Spiess, Stefan Schaller, Tobias Schlesinger, Magdalena Sitter, Jan Stumpner, Nico Schlegel, Christoph Schimmer, Ekkehard Kunze, Thomas Kerz, Dominik Wesp, Axel Neule, Florian Ringel, Mario Maggiorini, Stephan Jakob, Joerg Schefold, Rebekah Wale, Marlies Ostermann, Matthew Morgan, Mervyn Singer, and Matthew Rowland

Subjects
Medicine
Abstract

Introduction Observational studies have demonstrated an association between vitamin D deficiency and increased risk of morbidity and mortality in critically ill patients. Cohort studies and pilot trials have suggested promising beneficial effects of vitamin D replacement in the critical ill, at least in patients with severe vitamin D deficiency. As vitamin D is a simple, low-cost and safe intervention, it has potential to improve survival in critically ill patients.Methods and analysis In this randomised, placebo-controlled, double-blind, multicentre, international trial, 2400 adult patients with severe vitamin D deficiency (25-hydroxyvitamin D≤12 ng/mL) will be randomised in a 1:1 ratio by www.randomizer.at to receive a loading dose of 540 000 IU cholecalciferol within 72 hours after intensive care unit (ICU) admission, followed by 4000 IU daily for 90 days or placebo. Hypercalcaemia may occur as a side effect, but is monitored by regular checks of the calcium level. The primary outcome is all-cause mortality at 28 days after randomisation. Secondary outcomes are: ICU, hospital, 90-day and 1-year mortality; hospital and ICU length of stay, change in organ dysfunction on day 5 as measured by Sequential Organ Function Assessment (SOFA) score, number of organ failures; hospital and ICU readmission until day 90; discharge destination, self-reported infections requiring antibiotics until day 90 and health-related quality of life. Recruitment status is ongoing.Ethics and dissemination National ethical approval was obtained by the Ethics Committee of the University of Graz for Austria, Erasme University Brussels (Belgium) and University Hospital Frankfurt (Germany), and will further be gained according to individual national processes. On completion, results will be published in a peer-reviewed scientific journal. The study findings will be presented at national and international meetings with abstracts online.Trial registration NCT03188796, EudraCT-No: 2016-002460-13.

Published
2019
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5. Preparation of Modified RNA Sequences for Biological Research

Author

Stefan Pitsch, Philipp Wenter, Alfred Stutz, Luc Reymond, Sébastien Porcher, Andreas Peer, Evelyne Muller, Muthulaniappan Meyyappan, Frédéric Meylan, Cyrille Denarie, Damian Ackermann, and Xiaolin Wu

Subjects
Ligation, Nucleic acids, Organic synthesis, Phosphoramidites, Rna, Chemistry, QD1-999
Abstract

Our group is working on the development of reliable access to biologically relevant, long, and modified RNA sequences. Here, we briefly present the chemical synthesis of such sequences with 2?-O-triisopropylsilyloxymethyl (= 2?-O-tom) protected ribonucleoside phosphoramidites, their template-directed enzymatic ligation, and some examples of modified nucleotides, designed to promote structural and biological studies.

Published
2005
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11. In-hospital and 6-month outcomes in patients with COVID-19 supported with extracorporeal membrane oxygenation (EuroECMO-COVID): a multicentre, prospective observational study

Author

Roberto Lorusso, Maria Elena De Piero, Silvia Mariani, Michele Di Mauro, Thierry Folliguet, Fabio Silvio Taccone, Luigi Camporota, Justyna Swol, Dominik Wiedemann, Mirko Belliato, Lars Mikael Broman, Alain Vuylsteke, Yigal Kassif, Anna Mara Scandroglio, Vito Fanelli, Philippe Gaudard, Stephane Ledot, Julian Barker, Udo Boeken, Sven Maier, Alexander Kersten, Bart Meyns, Matteo Pozzi, Finn M Pedersen, Peter Schellongowski, Kaan Kirali, Nicholas Barrett, Jordi Riera, Thomas Mueller, Jan Belohlavek, Valeria Lo Coco, Iwan C C Van der Horst, Bas C T Van Bussel, Ronny M Schnabel, Thijs Delnoij, Gil Bolotin, Luca Lorini, Martin O Schmiady, David Schibilsky, Mariusz Kowalewski, Luis F Pinto, Pedro E Silva, Igor Kornilov, Aaron Blandino Ortiz, Leen Vercaemst, Simon Finney, Peter P Roeleveld, Matteo Di Nardo, Felix Hennig, Marta Velia Antonini, Mark Davidson, Tim J Jones, Thomas Staudinger, Peter Mair, Juliane Kilo, Christoph Krapf, Kathrin Erbert, Andreas Peer, Nikolaos Bonaros, Florian Kotheletner, Niklas Krenner Mag, Liana Shestakova, Greet Hermans, Dieter Dauwe, Philippe Meersseman, Bernard Stockman, Leda Nobile, Olivier Lhereux, Alexandre Nrasseurs, Jacques Creuter, Daniel De Backer, Simone Giglioli, Gregoire Michiels, Pierre Foulon, Matthias Raes, Inez Rodrigus, Matthias Allegaert, Philippe Jorens, Gerd Debeucklare, Michael Piagnerelli, Patrick Biston, Harlinde Peperstraete, Komeel Vandewiele, Olivier Germay, Dimitri Vandeweghe, Sven Havrin, Marc Bourgeois, Marc-Gilbert Lagny, Genette Alois, Nathalie Lavios, Benoit Misset, Romain Courcelle, Philippe J Timmermans, Alaaddin Yilmaz, Michiel Vantomout, Jerone Lehaen, Ame Jassen, Herbert Guterman, Maarten Strauven, Piet Lormans, Bruno Verhamme, catherine Vandewaeter, Frederik Bonte, Dominique Vionne, Martin Balik, Jan Blàha, Michal Lips, Michal Othal, Filip Bursa, Radim Spacek, Steffen Christensen, Vibeke Jorgensen, Marc Sorensen, Soren A Madsen, Severin Puss, Aleksandr Beljantsev, gabriel Saiydoun, Antonio Fiore, Pascal Colson, Florian Bazalgette, Xavier Capdevila, Sebastien Kollen, Laurent Muller, Jean-Francois Obadia, Pierre-Yves Dubien, Lucrezia Ajrhourh, Pierre G Guinot, Jonathan Zarka, Patricia Besserve, Maximilian V Malfertheiner, Esther Dreier, Birgit Heinze, Payam Akhyari, Artur Lichtenberg, Hug Aubin, Alexander Assman, Diyar Saeed, Holger Thiele, Matthias Baumgaertel, Jan D Schmitto, Natanov Ruslan, Axel Haverich, Matthias Thielmann, Thorsten Brenner, Arjang Ruhpawar, Christoph Benk, Martin Czerny, Dawid L Staudacher, Fridhelm Beyersdorf, Johannes Kalbhenn, Philipp Henn, Aron-Frederik Popov, Torje Iuliu, Ralf Muellenbach, Christian Reyher, Caroline Rolfes, Gosta Lotz, Michael Sonntagbauer, Helen Winkels, Julia Fichte, Robert Stohr, Sebastian Kalverkamp, Christian Karagiannidis, Simone Schafer, Alexei Svetlitchny, Hans-Bernd Hopf, Dominik Jarczak, Heinirich Groesdonk, Magdalena Rommer, Jan Hirsch, Christian Kaehny, Dimitros Soufleris, Georgios Gavriilidis, Kostantinos Pontikis, Magdalini Kyriakopoulou, Anna Kyriakoudi, Serena O'Brien, Ian Conrick-Martin, Edmund Carton, Maged Makhoul, Josef Ben-Ari, Amir Hadash, Alexander Kogan, Reut Kassif Lerner, Anas Abu-Shakra, Moshe Matan, Ahmad Balawona, Erez Kachel, Roman Altshuler, Ori Galante, Lior Fuchs, Yaniv Almog, Yaron S Ishay, Yael Lichter, Amir Gal-oz, Uri Carmi, Asaph Nini, Arie Soroksky, Hagi Dekel, Ziv Rozman, Emad Tayem, Eduard Ilgiyaev, Yuval Hochman, daniel Miltau, Avigal Rapoport, Arieh Eden, Dmitry Kompanietz, Michael Yousif, Miri Golos, Lorenzo Grazioli, Davide Ghitti, Antonio Loforte, Daniela Di Luca, Massimo Baiocchi, Davide Pacini, Antioco Cappai, Paolo Meani, Michele Mondino, Claudio F Russo, Marco Ranucci, Dario Fina, Marco Cotza, Andrea Ballotta, Giovanni Landoni, Pasquale Nardelli, Eygeny V Fominski, Luca Brazzi, Giorgia Montrucchio, Gabriele Sales, Umberto Simonetti, Sergio Livigni, Daniela Silengo, Giulia Arena, Stefania S Sovatzis, Antonella Degani, Mariachiara Riccardi, Elisa Milanesi, Giuseppe Raffa, Gennaro Martucci, Antonio Arcadipane, Giovanna Panarello, Giovanni Chiarini, Sergio Cattaneo, Carmine Puglia, Stefano Benussi, Giuseppe Foti, Marco Giani, Michela Bombino, Maria Cristina Costa, Roberto Rona, Leonello Avalli, Abele Donati, Roberto Carozza, Francesco Gasparri, Andrea Carsetti, Marco Picichè, Anna Marinello, Vinicio Danzi, Anita Zanin, Ignazio Condello, Flavio Fiore, Marco Moscarelli, Giuseppe Nasso, Giuseppe Speziale, Luca Sandrelli, Andrea Montalto, Francesco Musumeci, Alessandro Circelli, Emanuele Russo, Vanni Agnoletti, Ruggero Rociola, Aldo D Milano, Emanuele Pilato, Giuseppe Comentale, Andrea Montisci, Francesco Alessandri, Antonella Tosi, Francesco Pugliese, Giovanni Giordano, Simone Carelli, Domenico L Grieco, Antonio M Dell'Anna, Massimo Antonelli, Enrico Ramoni, Josè Zulueta, Mauro Del Giglio, Sebastiano Petracca, Pietro Bertini, Fabio Guarracino, Luigi De Simone, Paolo M Angeletti, Francesco Forfori, Francesco Taraschi, Veronica N Quintiliani, Robertas Samalavicius, Agne Jankuviene, Nadezda Scupakova, Karolis Urbonas, Juozas Kapturauskas, Gro Soerensen, Piotr Suwalski, Luis Linhares Santos, Ana Marques, Marisa Miranda, Sonia Teixeira, Andrea Salgueiro, Filipe Pereira, Michail Ketskalo, Sergey Tsarenko, Alexandra Shilova, Ivan Afukov, Konstantin Popugaev, Sergei Minin, Daniil Shelukhin, Olga Malceva, Moroz Gleb, Alexander Skopets, Roman Kornelyuk, Alexandr Kulikov, Vadim Okhrimchuk, Alexandr Turchaninov, Maxim Petrushin, Anastasia Sheck, Akhmed Mekulov, Svetlana Ciryateva, Dmitry Urusov, Vojka Gorjup, Alenka Golicnik, Tomaz Goslar, Ricard Ferrer, Maria Martinez-Martinez, Eduard Argudo, Neiser Palmer, Raul De Pablo Sanchez, Lucas Juan Higuera, Lucas Arnau Blasco, Josè A Marquez, Fabrizio Sbraga, Mari Paz Fuset, Pablo Ruiz De Gopegui, Luis M Claraco, Josè A De Ayala, Maranta Peiro, Pilar Ricart, Sergio Martinez, Fernando Chavez, Marc Fabra, elena Sandoval, David Toapanta, Albert Carraminana, Adrian Tellez, Jeysson Ososio, Pablo Milan, Jorge Rodriguez, Garcia Andoni, Carola Gutierrez, Enrique Perez de la Sota, Andrea Eixeres-Esteve, Maria Teresa Garcia-Maellas, Judit Gutierrez-Gutierrez, Rafael Arboleda-Salazar, Patricia Santa Teresa, Alexis Jaspe, Alberto Garrido, Galo Castaneda, Sara Alcantara, Nuria Martinez, Marina Perez, Hector Villanueva, Anxela Vidal Gonzalez, Juan Paez, Arnoldo Santon, Cesar Perez, Marta Lopez, Maria Isabel Rubio Lopez, Antonio Gordillo, Jose Naranjo-Izurieta, Javier Munoz, Immaculada Alcalde, Fernando Onieva, Ricardo Gimeno Costa, Francisco Perez, Isabel Madrid, Monica Gordon, Carlos L Albacete Moreno, Daniel Perez, Nayara Lopez, Domingo Martinenz, Pablo Blanco-Schweizer, Cristina Diez, David Perez, Ana Prieto, Gloria Renedo, Elena Bustamante, Ramon Cicuendez, Rafael Citores, Victoria Boado, Katherine Garcia, Roberto Voces, Monica Domezain, Jose Maria Nunez Martinez, Raimundo Vicente, David Martin, Antonio Andreu, Vanesa Gomez Casal, Ignacio Chico, Eva Maria Menor, Sabela Vara, Jose Gamacho, Helen Perez-Chomon, Francisco Javier Gonzales, Irene Barrero, Luis Martin-Villen, Esperanza Fernandez, Maria Mendoza, Joaquin Navarro, Joaquin Colomina Climent, Alfredo Gonzales-Perez, Guillermo Muniz-Albaceita, Laura Amado, Raquel Rodriguez, Emilio Ruiz, Maria Eiras, Edgars Grins, Rosen Magnus, Mikael Kanetoft, Marcus Eidevald, Pia Watson, Paul R Vogt, Peter Steiger, Tobias Aigner, Alberto Weber, Jurg Grunefelder, Martin Kunz, Martin Grapow, Thierry Aymard, Diana Reser, Gianluca Agus, Jolanda Consiglio, Matthias Haenggi, Jenni Hansjoerg, Manuela Iten, Thomas Doeble, Urs Zenklusen, Xavier Bechtold, Giovanni Faedda, Manuel Iafrate, Amanda Rohjer, Layla Bergamaschi, Jos Maessen, Dinis Reis Miranda, H Endeman, D Gommers, C Meuwese, Jacinta Maas, MJ Van Gijlswijk, RN Van Berg, Dario Candura, Marcel Van der Linden, Merijin Kant, JJ Van der Heijden, Eric Scholten, Nicole Van Belle-van Haren, WK Lagrand, Alexander P Vlaar, Syste De Jong, Basar Cander, Murat Sargin, Murat Ugur, Mehmet A Kaygin, Kathleen Daly, Nicola Agnew, Laura Head, Laura Kelly, Gunawardena Anoma, Clare Russell, Verna Aquino, Ian Scott, Lucy Flemming, Stuart Gillon, Olivia Moore, Elton Gelandt, George Auzinger, Sameer Patel, Robert Loveridge, MUMC+: MA Cardiothoracale Chirurgie (3), CTC, RS: Carim - V04 Surgical intervention, University of Zurich, and Lorusso, Roberto

Subjects
Pulmonary and Respiratory Medicine, 2740 Pulmonary and Respiratory Medicine, 610 Medicine & health, 10023 Institute of Intensive Care Medicine
Abstract

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) has been widely used in patients with COVID-19, but uncertainty remains about the determinants of in-hospital mortality and data on post-discharge outcomes are scarce. The aims of this study were to investigate the variables associated with in-hospital outcomes in patients who received ECMO during the first wave of COVID-19 and to describe the status of patients 6 months after ECMO initiation.METHODS: EuroECMO-COVID is a prospective, multicentre, observational study developed by the European Extracorporeal Life Support Organization. This study was based on data from patients aged 16 years or older who received ECMO support for refractory COVID-19 during the first wave of the pandemic-from March 1 to Sept 13, 2020-at 133 centres in 21 countries. In-hospital mortality and mortality 6 months after ECMO initiation were the primary outcomes. Mixed-Cox proportional hazards models were used to investigate associations between patient and management-related variables (eg, patient demographics, comorbidities, pre-ECMO status, and ECMO characteristics and complications) and in-hospital deaths. Survival status at 6 months was established through patient contact or institutional charts review. This study is registered with ClinicalTrials.gov, NCT04366921, and is ongoing.FINDINGS: Between March 1 and Sept 13, 2020, 1215 patients (942 [78%] men and 267 [22%] women; median age 53 years [IQR 46-60]) were included in the study. Median ECMO duration was 15 days (IQR 8-27). 602 (50%) of 1215 patients died in hospital, and 852 (74%) patients had at least one complication. Multiorgan failure was the leading cause of death (192 [36%] of 528 patients who died with available data). In mixed-Cox analyses, age of 60 years or older, use of inotropes and vasopressors before ECMO initiation, chronic renal failure, and time from intubation to ECMO initiation of 4 days or more were associated with higher in-hospital mortality. 613 patients did not die in hospital, and 547 (95%) of 577 patients for whom data were available were alive at 6 months. 102 (24%) of 431 patients had returned to full-time work at 6 months, and 57 (13%) of 428 patients had returned to part-time work. At 6 months, respiratory rehabilitation was required in 88 (17%) of 522 patients with available data, and the most common residual symptoms included dyspnoea (185 [35%] of 523 patients) and cardiac (52 [10%] of 514 patients) or neurocognitive (66 [13%] of 512 patients) symptoms.INTERPRETATION: Patient's age, timing of cannulation (FUNDING: None.

Published
2023
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14. Low-Molecular-Weight Heparin Resistance and Its Viscoelastic Assessment in Critically Ill COVID-19 Patients

Author

Johannes Bösch, Christopher Rugg, Volker Schäfer, Philipp Lichtenberger, Nikolai Staier, Benjamin Treichl, Sasa Rajsic, Andreas Peer, Wolfgang Schobersberger, Dietmar Fries, and Mirjam Bachler

Subjects
Heparin, Critical Illness, Anticoagulants, Viper Venoms, Hematology, Heparin, Low-Molecular-Weight, Hemostatics, Antithrombins, COVID-19 Drug Treatment, C-Reactive Protein, Humans, Enoxaparin, Cardiology and Cardiovascular Medicine, Factor Xa Inhibitors
Abstract

Critically ill COVID-19 patients present an inflammatory and procoagulant status with a high rate of relevant macro- and microvascular thrombosis. Furthermore, high rates of heparin resistance have been described; yet, individualized anticoagulation by drug monitoring has not been sufficiently researched. We analyzed data from critically ill COVID-19 patients treated at Innsbruck Medical University Hospital with routinely adapted low-molecular-weight heparin (LMWH) doses according to anti-Xa peak levels, and regularly performed ClotPro analyses (a viscoelastic hemostatic whole blood test). A total of 509 anti-Xa peak measurements in 91 patients were categorized as below ( 0.012 IU/mL/mg) expected ranges with respect to the administered LMWH doses. Besides intergroup comparisons, correlations between anti-Xa levels and ClotPro clotting times (CTs) were performed (226 time points in 84 patients). Anti-Xa peak levels remained below the expected range in the majority of performed measurements (63.7%). Corresponding patients presented with higher C-reactive protein and D-dimer but lower antithrombin levels when compared with patients achieving or exceeding the expected range. Consequently, higher enoxaparin doses were applied in the sub-expected anti-Xa range group. Importantly, 47 (51.6%) patients switched between groups during their intensive care unit (ICU) stay. Anti-Xa levels correlated weakly with IN test CT and moderately with Russell's viper venom (RVV) test CT. Critically ill COVID-19 patients present with a high rate of LMWH resistance but with a variable LMWH response during their ICU stay. Therefore, LMWH–anti-Xa monitoring seems inevitable to achieve adequate target ranges. Furthermore, we propose the use of ClotPro's RVV test to assess the coagulation status during LMWH administration, as it correlates well with anti-Xa levels but more holistically reflects the coagulation cascade than anti-Xa activity alone.

Published
2022
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15. The Effect of an Accelerated Renal Replacement Therapy Initiation Is Not Modified by Baseline Risk

Author

Federico Angriman, Bruno L. Ferreyro, Natalia Angeloni, Bruno R. da Costa, Ron Wald, Sean M. Bagshaw, Neill K.J. Adhikari, Rinaldo Bellomo, Didier Dreyfuss, Bin Du, Martin P. Gallagher, Stéphane Gaudry, François Lamontagne, Michael Joannidis, Kathleen D. Liu, Daniel F. McAuley, Shay P. McGuinness, Alistair D. Nichol, Marlies Ostermann, Paul M. Palevsky, Haibo Qiu, Ville Pettilä, Antoine G. Schneider, Orla M. Smith, Suvi T. Vaara, Matthew Weir, Glenn M. Eastwood, Leah Peck, Helen Young, Peter Kruger, Gordon Laurie, Emma Saylor, Jason Meyer, Ellen Venz, Krista Wetzig, Craig French, Forbes McGain, John Mulder, Gerard Fennessy, Sathyajith Koottayi, Samantha Bates, Miriam Towns, Rebecca Morgan, Anna Tippett, Andrew Udy, Chris Mason, Elisa Licari, Dashiell Gantner, Jason McClure, Alistair Nichol, Phoebe McCracken, Jasmin Board, Emma Martin, Shirley Vallance, Meredith Young, Chelsey Vladic, Steve McGloughlin, David Gattas, Heidi Buhr, Jennifer Coles, Debra Hutch, James Wun, Louise Cole, Christina Whitehead, Julie Lowrey, Kristy Masters, Rebecca Gresham, Victoria Campbell, David Gutierrez, Jane Brailsford, Loretta Forbes, Lauren Murray, Teena Maguire, Martina NiChonghaile, Neil Orford, Allison Bone, Tania Elderkin, Tania Salerno, Tim Chimunda, Jason Fletcher, Emma Broadfield, Sanjay Porwal, Cameron Knott, Catherine Boschert, Julie Smith, Angus Richardson, Dianne Hill, Graeme Duke, Peter Oziemski, Santiago Cegarra, Peter Chan, Deborah Welsh, Stephanie Hunter, Owen Roodenburg, John Dyett, Nicos Kokotsis, Max Moser, Yang Yang, Laven Padayachee, Joseph Vetro, Himangsu Gangopadhyay, Melissa Kaufman, Angaj Ghosh, Simone Said, Alpesh Patel, Shailesh Bihari, Elisha Matheson, Xia Jin, Tapaswi Shrestha, Kate Schwartz, Rosalba Cross, Winston Cheung, Helen Wong, Mark Kol, Asim Shah, Amanda Y. Wang, Zoltan Endre, Celia Bradford, Pierre Janin, Simon Finfer, Naomi Diel, Jonathan Gatward, Naomi Hammond, Anthony Delaney, Frances Bass, Elizabeth Yarad, Hergen Buscher, Claire Reynolds, Nerilee Baker, Romuald Bellmann, Andreas Peer, Julia Hasslacher, Paul Koglberger, Sebastian Klein, Klemens Zotter, Anna Brandtner, Armin Finkenstedt, Adelheid Ditlbacher, Frank Hartig, Dietmar Fries, Mirjam Bachler, Bettina Schenk, Martin Wagner, Philipp Eller, Thomas Staudinger, Esther Tiller, Peter Schellongowski, Andja Bojic, Eric A. Hoste, Stephanie Bracke, Luc De Crop, Daisy Vermeiren, Fernando Thome, Bianca Chiella, Lucia Fendt, Veronica Antunes, Frédérick D'Aragon, Charles St-Arnaud, Michael Mayette, Élaine Carbonnaeu, Joannie Marchand, Marie-Hélène Masse, Marilène Ladouceur, Alexis F. Turgeon, François Lauzier, David Bellemare, Charles Langis Francoeur, Guillaume LeBlanc, Gabrielle Guilbault, Stéphanie Grenier, Eve Cloutier, Annick Boivin, Charles Delisle-Thibault, Panagiota Giannakouros, Olivier Costerousse, Jean-François Cailhier, François-Martin Carrier, Ali Ghamraoui, Martine Lebrasseur, Fatna Benettaib, Maya Salamé, Dounia Boumahni, Ying Tung Sia, Jean-François Naud, Isabelle Roy, Henry T. Stelfox, Stacey Ruddell, Braden J. Manns, Shelley Duggan, Dominic Carney, Jennifer Barchard, Richard P. Whitlock, Emilie Belley-Cote, Nevena Savija, Alexandra Sabev, Troy Campbell, Thais Creary, Kelson Devereaux, Shira Brodutch, Claudio Rigatto, Bojan Paunovic, Owen Mooney, Anna Glybina, Oksana Harasemiw, Michelle Di Nella, John Harmon, Navdeep Mehta, Louis Lakatos, Nicole Haslam, Francois Lellouche, Mathieu Simon, Ying Tung, Patricia Lizotte, Pierre-Alexandre Bourchard, Bram Rochwerg, Tim Karachi, Tina Millen, John Muscedere, David Maslove, J. Gordon Boyd, Stephanie Sibley, John Drover, Miranda Hunt, Ilinca Georgescu, Randy Wax, Ilan Lenga, Kavita Sridhar, Andrew Steele, Kelly Fusco, Taneera Ghate, Michael Tolibas, Holly Robinson, Matthew A. Weir, Ravi Taneja, Ian M. Ball, Amit Garg, Eileen Campbell, Athena Ovsenek, Sean van Diepen, Nadia Baig, Sheldon Magder, Han Yao, Ahsan Alam, Josie Campisi, Erika MacIntyre, Ella Rokosh, Kimberly Scherr, Stephen Lapinsky, Sangeeta Mehta, Sumesh Shah, Daniel J. Niven, Michael Russell, Kym Jim, Gillian Brown, Kerry Oxtoby, Adam Hall, Luc Benoit, Colleen Sokolowski, Bhanu Prasad, Jag Rao, Shelley Giebel, Demetrios J. Kutsogiannis, Patricia Thompson, Tayne Thompson, Robert Cirone, Kanthi Kavikondala, Mark Soth, France Clarke, Alyson Takaoka, David Mazer, Karen Burns, Jan Friedrich, David Klein, Gyan Sandhu, Marlene Santos, Imrana Khalid, Jennifer Hodder, Peter Dodek, Najib Ayas, Victoria Alcuaz, Gabriel Suen, Oleksa Rewa, Gurmeet Singh, Sean Norris, Neil Gibson, Castro Arias, Aysha Shami, Celine Pelletier, Alireza Zahirieh, Andre Amaral, Nicole Marinoff, Navjot Kaur, Adic Perez, Jane Wang, Gregory Haljan, Christopher Condin, Lauralyn McIntyre, Brigette Gomes, Rebecca Porteous, Irene Watpool, Swapnil Hiremath, Edward Clark, Margaret S. Herridge, Felicity Backhouse, M. Elizabeth Wilcox, Karolina Walczak, Vincent Ki, Asheer Sharman, Martin Romano, R.T. Noel Gibney, Adam S. Romanovsky, Lorena McCoshen, Gordon Wood, Daniel Ovakim, Fiona Auld, Gayle Carney, Meili Duan, Xiaojun Ji, Dongchen Guo, Zhili Qi, Jin Lin, Meng Zhang, Lei Dong, Jingfeng Liu, Pei Liu, Deyuan Zhi, Guoqiang Bai, Yu Qiu, Ziqi Yang, Jing Bai, Zhuang Liu, Haizhou Zhuang, Haiman Wang, Jian Li, Mengya Zhao, Xiao Zhou, Xianqing Shi, Baning Ye, Manli Liu, Jing Wu, Yongjian Fu, Dali Long, Yu Pan, Jinlong Wang, Huaxian Mei, Songsong Zhang, Mingxiang Wen, Enyu Yang, Sijie Mu, Jianquan Li, Tingting Hu, Bingyu Qin, Min Li, Cunzhen Wang, Xin Dong, Kaiwu Wang, Haibo Wang, Jianxu Yang, Chuanyao Wang, Dongxin Wang, Nan Li, Zhui Yu, Song Xu, Lan Yao, Guo Hou, Zhou Liu, Liping Lu, Yingtao Lian, Chunting Wang, Jichen Zhang, Ruiqi Ding, Guoqing Qi, Qizhi Wang, Peng Wang, Zhaoli Meng, Man Chen, Xiaobo Hu, Xiandi He, Shibing Zhao, Lele Hang, Rui Li, Suhui Qin, Kun Lu, Shijuan Dun, Cheng Liu, Qi Zhou, Zhenzhen Chen, Jing Mei, Minwei Zhang, Hao Xu, Jincan Lin, Qindong Shi, Lijuan Fu, Qinjing Zeng, Hongye Ma, Jinqi Yan, Lan Gao, Hongjuan Liu, Lei Zhang, Hao Li, Xiaona He, Jingqun Fan, Litao Guo, Yu Liu, Xue Wang, Jingjing Sun, Zhongmin Liu, Juan Yang, Lili Ding, Lulu Sheng, Xingang Liu, Jie Yan, Quihui Wang, Yifeng Wang, Dan Zhao, Shuangping Zhao, Chenghuan Hu, Jing Li, Fuxing Deng, Haibo Qui, Yi Yang, Min Mo, Chun Pan, Changde Wu, Yingzi Huang, Lili Huang, Airan Liu, Anna-Maija Korhonen, Sanna Törnblom, Sari Sutinen, Leena Pettilä, Jonna Heinonen, Eliria Lappi, Taria Suhonen, Sari Karlsson, Sanna Hoppu, Ville Jalkanen, Anne Kuitunen, Markus Levoranta, Jaakko Långsjö, Sanna Ristimäki, Kaisa Malila, Anna Wootten, Simo Varila, Mikko J Järvisalo, Outi Inkinen, Satu Kentala, Keijo Leivo, Paivi Haltia, Jean-Damien Ricard, Jonathan Messika, Abirami Tiagarajah, Malo Emery, Aline Dechanet, Coralie Gernez, Damien Roux, Laurent Martin-Lefevre, Maud Fiancette, Isabelle Vinatier, Jean Claude Lacherade, Gwenhaël Colin, Christine Lebert, Marie-Ange Azais, Aihem Yehia, Caroline Pouplet, Matthieu Henry- Lagarrigue, Amélie Seguin, Laura Crosby, Julien Maizel, Dimitri Titeca-Beauport, Alain Combes, Ania Nieszkowska, Paul Masi, Alexandre Demoule, Julien Mayaux, Martin Dres, Elise Morawiec, Maxens Decalvele, Suela Demiri, Morgane Faure, Clémence Marios, Maxime Mallet, Marie Amélie Ordon, Laura Morizot, Marie Cantien, François Pousset, Florent Poirson, Yves Cohen, Laurent Argaud, Martin Cour, Laurent Bitker, Marie Simon, Romain Hernu, Thomas Baudry, Sylvie De La Salle, Adrien Robine, Nicholas Sedillot, Xavier Tchenio, Camille Bouisse, Sylvie Roux, Fabienne Tamion, Steven Grangé, Dorothée Carpentier, Guillaume Chevrel, Luis Ensenyat-Martin, Sophie Marque, Jean-Pierre Quenot, Pascal Andreu, Auguste Dargent, Audrey Large, Nicolas Chudeau, Mickael Landais, Benoit Derrien, Jean Christophe Callahan, Christophe Guitton, Charlène Le Moal, Alain Robert, Karim Asehnoune, Raphaël Cinotti, Nicolas Grillot, Dominique Demeure, Christophe Vinsonneau, Imen Rahmani, Mehdi Marzouk, Thibault Dekeyser, Caroline Sejourne, Mélanie Verlay, Fabienne Thevenin, Lucie Delecolle, Didier Thevenin, Bertrand Souweine, Elisabeth Coupez, Mireille Adda, Jean-Pierre Eraldi, Antoine Marchalot, Nicolas De Prost, Armand Mekontso Dessap, Keyvan Razazi, Ferhat Meziani, Julie Boisrame-Helms, Raphael Clere-Jehl, Xavier Delabranche, Christine Kummerlen, Hamid Merdji, Alexandra Monnier, Yannick Rabouel, Hassene Rahmani, Hayat Allam, Samir Chenaf, Vincenta Franja, Bertrand Pons, Michel Carles, Frédéric Martino, Régine Richard, Benjamin Zuber, Guillaume Lacave, Karim Lakhal, Bertrand Rozec, Hoa Dang Van, Éric Boulet, Fouad Fadel, Cedric Cleophax, Nicolas Dufour, Caroline Grant, Marie Thuong, Jean Reignier, Emmanuel Canet, Laurent Nicolet, Thierry Boulain, Mai-Anh Nay, Dalila Benzekri, François Barbier, Anne Bretagnol, Toufik Kamel, Armelle Mathonnet, Grégoire Muller, Marie Skarzynski, Julie Rossi, Amandine Pradet, Sandra Dos Santos, Aurore Guery, Lucie Muller, Luis Felix, Julien Bohé, Guillaume Thiéry, Nadia Aissaoui, Damien Vimpere, Morgane Commeureuc, Jean-Luc Diehl, Emmanuel Guerot, Orfeas Liangos, Monika Wittig, Alexander Zarbock, Mira Küllmar, Thomas van Waegeningh, Nadine Rosenow, Kathy Brickell, Peter Doran, Patrick T. Murray, Giovanni Landoni, Rosalba Lembo, Alberto Zangrillo, Giacomo Monti, Margherita Tozzi, Matteo Marzaroli, Gaetano Lombardi, Gianluca Paternoster, Michelangelo Vitiello, Shay McGuinness, Rachael Parke, Magdalena Butler, Eileen Gilder, Keri-Anne Cowdrey, Samantha Wallace, Jane Hallion, Melissa Woolett, Philippa Neal, Karina Duffy, Stephanie Long, Colin McArthur, Catherine Simmonds, Yan Chen, Rachael McConnochie, Lynette Newby, David Knight, Seton Henderson, Jan Mehrtens, Stacey Morgan, Anna Morris, Kymbalee Vander Hayden, Tara Burke, Matthew Bailey, Ross Freebairn, Lesley Chadwick, Penelope Park, Christine Rolls, Liz Thomas, Ulrike Buehner, Erin Williams, Jonathan Albrett, Simon Kirkham, Carolyn Jackson, Troy Browne, Jennifer Goodson, David Jackson, James Houghton, Owen Callender, Vicki Higson, Owen Keet, Clive Dominy, Paul Young, Anna Hunt, Harriet Judd, Cassie Lawrence, Shaanti Olatunji, Yvonne Robertson, Charlotte Latimer-Bell, Deborah Hendry, Agnes Mckay-Vucago, Nina Beehre, Eden Lesona, Leanlove Navarra, Chelsea Robinson, Ryan Jang, Andrea Junge, Bridget Lambert, Michel Thibault, Philippe Eckert, Sébastien Kissling, Erietta Polychronopoulos, Elettra Poli, Marco Altarelli, Madeleine Schnorf, Samia Abed Mallaird, Claudia Heidegger, Aurelie Perret, Philippe Montillier, Frederic Sangla, Seigenthaller Neils, Aude De Watteville, Mandeep-Kaur Phull, Aparna George, Nauman Hussain, Tatiana Pogreban, Steve Lobaz, Alison Daniels, Mishell Cunningham, Deborah Kerr, Alice Nicholson, Pradeep Shanmugasundaram, Judith Abrams, Katarina Manso, Geraldine Hambrook, Elizabeth McKerrow, Juvy Salva, Stephen Foulkes, Matthew Wise, Matt Morgan, Jenny Brooks, Jade Cole, Tracy Michelle Davies, Helen Hill, Emma Thomas, Marcela Vizcaychipi, Behrad Baharlo, Jaime Carungcong, Patricia Costa, Laura Martins, Ritoo Kapoor, Tracy Hazelton, Angela Moon, Janine Musselwhite, Ben Shelley, Philip McCall, Gill Arbane, Aneta Bociek, Martina Marotti, Rosario Lim, Sara Campos, Neus Grau Novellas, Armando Cennamo, Andrew Slack, Duncan Wyncoll, Luigi Camporota, Simon Sparkes, Rosalinde Tilley, Austin Rattray, Gayle Moreland, Jane Duffy, Elizabeth McGonigal, Philip Hopkins, Clare Finney, John Smith, Harriet Noble, Hayley Watson, Claire-Louise Harris, Emma Clarey, Eleanor Corcoran, James Beck, Clare Howcroft, Nora Youngs, Elizabeth Wilby, Bethan Ogg, Adam Wolverson, Sandra Lee, Susie Butler, Maryanne Okubanjo, Julia Hindle, Ingeborg Welters, Karen Williams, Emily Johnson, Julie Patrick-Heselton, David Shaw, Victoria Waugh, Richard Stewart, Esther Mwaura, Lynn Wren, Louise Mew, Sara-Beth Sutherland, Jane Adderley, Jim Ruddy, Margaret Harkins, Callum Kaye, Teresa Scott, Wendy Mitchell, Felicity Anderson, Fiona Willox, Vijay Jagannathan, Michele Clark, Sarah Purv, Andrew Sharman, Megan Meredith, Lucy Ryan, Louise Conner, Cecilia Peters, Dan Harvey, Ashraf Roshdy, Amy Collins, Malcolm Sim, Steven Henderson, Nigel Chee, Sally Pitts, Katie Bowman, Maria Dilawershah, Luke Vamplew, Elizabeth Howe, Paula Rogers, Clara Hernandez, Clara Prendergast, Jane Benton, Alex Rosenberg, Lui G. Forni, Alice Grant, Paula Carvelli, Ajay Raithatha, Sarah Bird, Max Richardson, Matthew Needham, Claire Hirst, Jonathan Ball, Susannah Leaver, Luisa Howlett, Carlos Castro Delgado, Sarah Farnell-Ward, Helen Farrah, Geraldine Gray, Gipsy Joseph, Francesca Robinson, Ascanio Tridente, Clare Harrop, Karen Shuker, Derek McLaughlan, Judith Ramsey, Sharon Meehan, Bernd Oliver Rose, Rosie Reece-Anthony, Babita Gurung, Tony Whitehouse, Catherine Snelson, Tonny Veenith, Andy Johnston, Lauren Cooper, Ron Carrera, Karen Ellis, Emma Fellows, Samanth Harkett, Colin Bergin, Elaine Spruce, Liesl Despy, Stephanie Goundry, Natalie Dooley, Tracy Mason, Amy Clark, Gemma Dignam, Geraldine Ward, Ben Attwood, Penny Parsons, Sophie Mason, Michael Margarson, Jenny Lord, Philip McGlone, Luke E. Hodgson, Indra Chadbourn, Raquel Gomez, Jordi Margalef, Rinus Pretorius, Alexandra Hamshere, Joseph Carter, Hazel Cahill, Lia Grainger, Kate Howard, Greg Forshaw, Zoe Guy, Kianoush B. Kashani, Robert C. Albright, Amy Amsbaugh, Anita Stoltenberg, Alexander S. Niven, Matthew Lynch, AnnMarie O'Mara, Syed Naeem, Sairah Sharif, Joyce McKenney Goulart, Ashita Tolwani, Claretha Lyas, Laura Latta, Azra Bihorac, Haleh Hashemighouchani, Philip Efron, Matthew Ruppert, Julie Cupka, Sean Kiley, Joshua Carson, Peggy White, George Omalay, Sherry Brown, Laura Velez, Alina Marceron, Javier A. Neyra, Juan Carlos Aycinena, Madona Elias, Victor M. Ortiz-Soriano, Caroline Hauschild, and Robert Dorfman

Subjects
Renal Replacement Therapy, Pulmonary and Respiratory Medicine, Critical Illness, Medicine and Health Sciences, Humans, Acute Kidney Injury
Published
2022
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26. Changes in characteristics and outcomes of critically ill COVID-19 patients in Tyrol (Austria) over 1 year

Author

Anna Fiala, Raimund Helbok, Simon Mathis, Michael Joannidis, Andreas Mayr, Romuald Bellmann, Georg F. Lehner, Jürgen Brunner, Eva Foidl, Armin Kalenka, Birgit Stögermüller, Sebastian J. Klein, Lukas Gasteiger, Claudius Thomé, Markus Mittermayr, Timo Mayerhöfer, Eugen Ladner, Alexandra Ribitsch, Tatjana Heiner, Miriam Potocnik, Stefanie Zagitzer-Hofer, Dietmar Fries, Andreas Peer, Bruno Reitter, Christoph Krismer, Agnes Pechlaner, Christian Preuß-Hernandez, Julia Hasslacher, Stephan Eschertzhuber, Lukas Kirchmair, Walter R. Hasibeder, and Fabian Perschinka

Subjects
medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), medicine.medical_treatment, Critical Illness, Logistic regression, Elderly, Mechanical ventilation, medicine, Humans, Renal replacement therapy, Pandemics, Aged, Retrospective Studies, business.industry, Critically ill, SARS-CoV-2, Mortality rate, Acute kidney injury, Second wave, COVID-19, General Medicine, Middle Aged, medicine.disease, Respiration, Artificial, Intensive Care Units, SARS-CoV‑2, Austria, Emergency medicine, Cohort, Original Article, business
Abstract

SummaryBackgroundWidely varying mortality rates of critically ill Coronavirus disease 19 (COVID-19) patients in the world highlighted the need for local surveillance of baseline characteristics, treatment strategies and outcome. We compared two periods of the COVID-19 pandemic to identify important differences in characteristics and therapeutic measures and their influence on the outcome of critically ill COVID-19 patients.MethodsThis multicenter prospective register study included all patients with a SARS-CoV‑2 infection confirmed by polymerase chain reaction, who were treated in 1 of the 12 intensive care units (ICU) from 8 hospitals in Tyrol, Austria during 2 defined periods (1 February 2020 until 17 July: first wave and 18 July 2020 until 22 February 2021: second wave) of the COVID-19 pandemic.ResultsOverall, 508 patients were analyzed. The majority (n = 401) presented during the second wave, where the median age was significantly higher (64 years, IQR 54–74 years vs. 72 years, IQR 62–78 years,p p = 0.003), as was the use of vasopressors (50.3% vs. 69.2%,p = 0.001) and renal replacement therapy (12.0% vs. 19.6%,p = 0.061), which resulted in shorter ICU length of stay (10 days, IQR 5–18 days vs. 18 days, IQR 5–31 days,p p = 0.159) and hospital mortality even increased (22.4% vs. 33.4%,p = 0.039) in the second period. Age, frailty and the number of comorbidities were significant predictors of hospital mortality in a multivariate logistic regression analysis of the overall cohort.ConclusionAdvanced treatment strategies and learning effects over time resulted in reduced rates of mechanical ventilation and vasopressor use in the second wave associated with shorter ICU length of stay. Despite these improvements, age appears to be a dominant factor for hospital mortality in critically ill COVID-19 patients.

Published
2021

29. Structured ICU resource management in a pandemic is associated with favorable outcome in critically ill COVID‑19 patients

Author

Wilhelm Furtwängler, Michael Joannidis, Lukas Kirchmair, Christoph Hochhold, Dietmar Fries, Romuald Bellmann, Raimund Helbok, Simon Mathis, Mathias Ströhle, Christoph Krismer, Andreas Mayr, Georg F. Lehner, Markus Mittermayr, Eugen Ladner, Stephan Eschertzhuber, Claudius Thomé, Lukas Gasteiger, Sebastian J. Klein, Andreas Peer, Walter R. Hasibeder, Michael Swoboda, Bruno Reitter, Christian Preuß Hernández, Stefanie Hofer, and Hannes Dejaco

Subjects
Male, medicine.medical_specialty, Critical Illness, medicine.medical_treatment, Pneumonia, Viral, Comorbidity, law.invention, Cohort Studies, Betacoronavirus, 03 medical and health sciences, 0302 clinical medicine, Interquartile range, law, Intensive care, Extracorporeal membrane oxygenation, Humans, Medicine, 030212 general & internal medicine, Renal replacement therapy, Invasive mechanical ventilation, Pandemics, Aged, Mechanical ventilation, SARS-CoV-2, business.industry, COVID-19, Main Topic, 030208 emergency & critical care medicine, General Medicine, Middle Aged, medicine.disease, Intensive care unit, Acute kidney injury, Intensive Care Units, Treatment Outcome, SARS-CoV‑2, Austria, Emergency medicine, Female, Coronavirus Infections, business, Cohort study
Abstract

Summary Introduction On February 25, 2020, the first 2 patients were tested positive for severe acute respiratory syndrome coronavirus‑2 (SARS-CoV-2) in Tyrol, Austria. Rapid measures were taken to ensure adequate intensive care unit (ICU) preparedness for a surge of critically ill coronavirus disease-2019 (COVID-19) patients. Methods This cohort study included all COVID-19 patients admitted to an ICU with confirmed or strongly suspected COVID-19 in the State of Tyrol, Austria. Patients were recorded in the Tyrolean COVID-19 intensive care registry. Date of final follow-up was July 17, 2020. Results A total of 106 critically ill patients with COVID-19 were admitted to 1 of 13 ICUs in Tyrol from March 9 to July 17, 2020. Median age was 64 years (interquartile range, IQR 54–74 years) and the majority of patients were male (76 patients, 71.7%). Median simplified acute physiology score III (SAPS III) was 56 points (IQR 49–64 points). The median duration from appearance of first symptoms to ICU admission was 8 days (IQR 5–11 days). Invasive mechanical ventilation was required in 72 patients (67.9%) and 6 patients (5.6%) required extracorporeal membrane oxygenation treatment. Renal replacement therapy was necessary in 21 patients (19.8%). Median ICU length of stay (LOS) was 18 days (IQR 5–31 days), median hospital LOS was 27 days (IQR 13–49 days). The ICU mortality was 21.7% (23 patients), hospital mortality was 22.6%. There was no significant difference in ICU mortality in patients receiving invasive mechanical ventilation and in those not receiving it (18.1% vs. 29.4%, p = 0.284). As of July 17th, 2020, two patients are still hospitalized, one in an ICU, one on a general ward. Conclusion Critically ill COVID-19 patients in Tyrol showed high severity of disease often requiring complex treatment with increased lengths of ICU and hospital stay. Nevertheless, the mortality was found to be remarkably low, which may be attributed to our adaptive surge response providing sufficient ICU resources.

Published
2020
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30. First Responder Situation Reporting in Virtual Reality Training with Evaluation of Cognitive-emotional Stress using Psychophysiological Measures

Author

Michael Schneeberger, Lucas Paletta, K Wolfgang Kallus, Lilian Reim, Christian Schönauer, Andreas Peer, Richard Feischl, Georg Aumayr, Martin Pszeida, Amir Dini, Stefan Ladstätter, Anna Weber, Alexander Almer, and Dietmar Wallner

Abstract

First responders engage in highly stressful situations at the emergency site that may induce stress, fear, panic and a collapse of clear thinking. Staying cognitively under control under these circumstances is a necessary condition to avoid useless risk-taking and particularly to provide accurate situation reports to remote units to be able to organize appropriate support in time. This work applied a flexible virtual reality (VR) training environment with the purpose to investigate the performance of reporting under rather realistically simulated mission conditions. In a pilot study, representative emergency forces of the Austrian volunteer fire brigade and paramedics of the Johanniter organization were subjected to a test program that tested a formalized reporting schema (LEDVV), inducing equivalent strain in both, real environment and VR-based training scenarios. Wearable psychophysiological measuring technology was applied to estimate the cognitive-emotional stress level under both training conditions. The results indicate that both situation reports achieve a rather high level of cognitive-emotional stress and should be thoroughly trained. Furthermore, the results motivate the use of VR environments for the training of stress-resilient decision-making behavior of emergency forces.

Published
2022
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31. Evaluation of Virtual Reality-based First Responder Training under Physiological and Cognitive-Emotional Strain

Author

Lilian Reim, K Wolfgang Kallus, Martin Pszeida, Michael Schneeberger, Christian Schönauer, Andreas Peer, Richard Feischl, Georg Aumayr, Dietmar Wallner, Amir Dini, Anna Weber, Stefan Ladstätter, Alexander Almer, and Lucas Paletta

Abstract

First responders are faced with various challenges and critical situations during their operations. Virtual Reality (VR) training environments offer a great opportunity to create realistic operational scenarios with appropriate levels of difficulty. To evaluate VR-based training regarding cognitive-emotional and physical strain, a pilot study with 13 first responders (firefighters and paramedics) was conducted. The study plan aimed to induce equivalent strain in both, real environment (‘RC’) and VR-based (‘VR’), training scenarios. In summary, the results indicate that training sessions in real and in VR-based environments have a comparable impact on physical strain, on different dimensions of workload like physical and cognitive demand, and specific physical and emotional states. Most important, we could show that physical strain, which is a critical factor for appropriate training of first responders, cannot only be induced by traditional real-life training, but also by an immersive VR training environment. These results confirm and motivate the use of VR environments for the training of stress-resilient decision-making behaviour for emergency forces.

Published
2022
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33. Death of unknown cause? Post-mortem diagnosis of fulminant course of an EBV-associated secondary hemophagocytic lymphohistiocytosis

Author

Eberhard Gunsilius, Gernot Fritsche, Stefan Köck, Josia Fauser, Michael Joannidis, Andreas Peer, Andreas Pircher, Adelheid Ditlbacher, Dominik Wolf, and Andreas Chott

Subjects
Secondary Hemophagocytic Lymphohistiocytosis, endocrine system, Fulminant, Hemophagocytosis, HScore, Case Report, Disease, Hemophagocytic lymphohistiocytosis, medicine.disease_cause, Epstein–Barr virus, Immune system, hemic and lymphatic diseases, medicine, Fever of unknown origin, business.industry, fungi, Hematology, medicine.disease, musculoskeletal system, Oncology, Immunology, business, hormones, hormone substitutes, and hormone antagonists
Abstract

SummaryHLH is a life-threatening disease, which is characterized by a dysregulated immune response with uncontrolled T cell and macrophage activation. The often fulminant course of the disease needs a fast diagnostic work-up to initiate as soon as possible the appropriate therapy. We present herein the case of a 71-year-old patient with rapidly progressive hyperinflammatory syndrome, which post mortem resulted in the diagnosis of EBV-associated HLH. With this case report, we intend to highlight the relevance of the HScore in the diagnosis of HLH, to create a greater awareness for EBV as a trigger of HLH, and to demonstrate the importance of treating EBV-associated HLH as early as possible.

Published
2021

34. Correlation of interleukin-6 with Epstein–Barr virus levels in COVID-19

Author

Sebastian J. Klein, Romuald Bellmann, Georg F. Lehner, Michael Joannidis, Andreas Peer, and Heinz Zoller

Subjects
Adult, Male, Herpesvirus 4, Human, Coronavirus disease 2019 (COVID-19), Pneumonia, Viral, Cytomegalovirus, Critical Care and Intensive Care Medicine, medicine.disease_cause, Polymerase Chain Reaction, Epstein–Barr virus, EBV, Research Letter, medicine, Severe acute respiratory syndrome coronavirus 2, Humans, Registries, Viremia, Interleukin 6, Aged, Retrospective Studies, Inflammation, IL-6, Coronavirus disease 2019, biology, SARS-CoV-2, Interleukin-6, business.industry, COVID-19, Middle Aged, Viral Load, Respiration, Artificial, Virology, Intensive Care Units, Austria, biology.protein, Female, business, Biomarkers
Published
2020
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35. Structured ICU Resource Management in a Pandemic is Associated with Good Outcome in Critically Ill COVID-19 Patients

Author

Sebastian J Klein, Romuald Bellmann, Hannes Dejaco, Stephan Eschertzhuber, Dietmar Fries, Wilhelm Furtwängler, Lukas Gasteiger, Walter Hasibeder, Raimund Helbok, Christoph Hochhold, Stefanie Hofer, Lukas Kirchmair, Christoph Krismer, Eugen Ladner, Georg F Lehner, Simon Mathis, Andreas Mayr, Markus Mittermayr, Andreas Peer, Christian Preuß Hernández, Bruno Reitter, Mathias Ströhle, Michael Swoboda, Claudius Thomé, and Michael Joannidis

Abstract

Introduction On February 25th, 2020, the first two patients were tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Tyrol, Austria. Based on alarming reports from the neighboring region Lombardy in Italy, rapid measures were taken to ensure adequate intensive care unit (ICU) preparedness for a surge of critically ill coronavirus disease 2019 (COVID-19) patients.Methods A coordinated county wide step-up approach ensured adequate ICU bed availability for COVID-19 patients avoiding shortage of mechanical ventilation capacity. All patients admitted to an ICU with confirmed or strongly suspected COVID-19 in the region of Tyrol, Austria were recorded in the Tyrolean COVID-19 Intensive Care Registry. Data were censored on July 17th, 2020.Results From March 9th, 2020 to July 17th, 2020, 106 critically ill patients with COVID-19 were admitted to an ICU. Median age was 64 (interquartile range [IQR], 54-74) years and the majority of patients were male (76 patients [71.7%]). Median simplified acute physiology score III (SAPS III) was 56 (IQR, 49-64) points. The median duration from appearance of first symptoms to ICU admission was 8 (IQR, 5-11) days. Frequently observed comorbidities were arterial hypertension in 71 patients (67.0%), cardiovascular (45 patients [42.5%]) and renal comorbidities (21 patients [19.8%]). Invasive mechanical ventilation was required in 72 patients (67.9%), 6 patients (5.6%) required extracorporeal membrane oxygenation treatment. Renal replacement therapy was necessary in 21 patients (19.8%). Median ICU length of stay (LOS) was 18 (IQR, 5-31) days, median hospital LOS was 27 (IQR, 13-49) days.ICU mortality was 21.7% (23 patients), while only one patient (0.9%) died after ICU discharge on a general ward (hospital mortality 22,6%). As of July 17th, 2020, two patients are still hospitalized, one in an ICU, one on a general ward.Conclusions Critically ill COVID-19 patients admitted to an ICU in the region of Tyrol, Austria, showed a high severity of disease often requiring complex treatments with increased lengths of ICU- and hospital stay. Despite that, we found ICU and hospital mortality in this cohort to be remarkably low. Adaptive surge response providing sufficient ICU resources presumably has contributed to the overall favorable outcome.

Published
2020
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36. Physical object interaction in first responder mixed reality training

Author

Andreas Peer, Thomas Wechdorn, Johannes Göllner, Christian Schönauer, Annette Mossel, Chris Bösch, and Hannes Kaufmann

Subjects
First responder, Computer science, Human–computer interaction, Training system, Optical head-mounted display, Augmented virtuality, Virtual reality, Competence (human resources), Mixed reality, Visualization
Abstract

Virtual Reality (VR) systems can improve the training of first responders and soldiers in multi-domain operations in a number of ways. Realistic simulation of physical objects, however, is challenging. The huge variety of equipment pieces and other objects specialists in first responder units - and in particular CBRN-troops - interact with further increases the effort. In this paper, we present a novel and flexible Mixed Reality (MR) training system for first responders that enables the integration of physical objects by using Augmented Virtuality (AV) and binary tracking". A Head Mounted Display (HMD) immerses the user in VR, while augmenting the visualization with 3D imagery of real objects, captured by an RGB-D sensor. In addition, a RFID-reader at the user's hand detects the presence or absence (binary response) of certain equipment items. Our proposed MR system fuses this information with data of an inertial motion capture suit to an approximate global object pose and distributes it. Our solution provides a wide range of options for physical object interaction and collaboration in a multi-user MR environment. In addition, we demonstrate the training capabilities of our proposed system with a multi-user training scenario, simulating a CBRN crisis. Results from our technical and quantitative user evaluation with 13 experts in CBRN response from the Austrian Armed Forces (National Defense Academy and Competence Center NBC Defense) indicate strong applicability and user acceptance. Over 80% of the participants found it easy or very easy to interact with physical objects and liked the multi-user training much or very much.

Published
2020
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37. Cardiopulmonary recovery after COVID-19: an observational prospective multicentre trial

Author

Michael Joannidis, Judith Löffler-Ragg, Christoph Schwabl, Amra Tancevski, Gudrun Feuchtner, Anna Boehm, Sophie Wildner, Alexander E. Egger, Frank Hartig, Raimund Helbok, Johannes Holfeld, Bernhard Puchner, Magdalena Aichner, Marc Schaber, Günter Weiss, Markus Theurl, Richard Hilbe, Piotr Tymoszuk, Anna Schapfl, Verena Petzer, Florian Kronenberg, Almut Lorsbach-Köhler, Can Gollmann-Tepeköylü, David Haschka, Bettina Sonnweber, Katharina Kurz, Thomas Sonnweber, Andreas Peer, Romuald Bellmann, Malte Aßhoff, Anna Luger, Christoph Tschurtschenthaler, Manfred Nairz, Rudolf Kirchmair, Rosa Bellmann-Weiler, Ewald Wöll, Gernot Fritsche, Doris Hüttenberger, Gregor Hoermann, Andrea Schroll, Dietmar Rieder, Helmut Prosch, Ivan Tancevski, Alex Pizzini, Gerlig Widmann, Zlatko Trajanoski, Sabine Koppelstätter, Sabina Sahanic, and Daniela Lener

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, Lung, medicine.diagnostic_test, business.industry, Physical examination, medicine.disease, Pulmonary hypertension, 03 medical and health sciences, 0302 clinical medicine, medicine.anatomical_structure, Internal medicine, Diffusing capacity, Pulmonary fibrosis, Cohort, medicine, Cardiology, Original Article, 030212 general & internal medicine, Respiratory system, Prospective cohort study, business, 030217 neurology & neurosurgery
Abstract

Background After the 2002/2003 SARS outbreak, 30% of survivors exhibited persisting structural pulmonary abnormalities. The long-term pulmonary sequelae of coronavirus disease 2019 (COVID-19) are yet unknown, and comprehensive clinical follow-up data are lacking. Methods In this prospective, multicentre, observational study, we systematically evaluated the cardiopulmonary damage in subjects recovering from COVID-19 at 60 and 100 days after confirmed diagnosis. We conducted a detailed questionnaire, clinical examination, laboratory testing, lung function analysis, echocardiography, and thoracic low-dose computed tomography (CT). Results Data from 145 COVID-19 patients were evaluated, and 41% of all subjects exhibited persistent symptoms 100 days after COVID-19 onset, with dyspnea being most frequent (36%). Accordingly, patients still displayed an impaired lung function, with a reduced diffusing capacity in 21% of the cohort being the most prominent finding. Cardiac impairment, including a reduced left ventricular function or signs of pulmonary hypertension, was only present in a minority of subjects. CT scans unveiled persisting lung pathologies in 63% of patients, mainly consisting of bilateral ground-glass opacities and/or reticulation in the lower lung lobes, without radiological signs of pulmonary fibrosis. Sequential follow-up evaluations at 60 and 100 days after COVID-19 onset demonstrated a vast improvement of both, symptoms and CT abnormalities over time. Conclusion A relevant percentage of post-COVID-19 patients presented with persisting symptoms and lung function impairment along with pulmonary abnormalities more than 100 days after the diagnosis of COVID-19. However, our results indicate a significant improvement in symptoms and cardiopulmonary status over time., 100 days after COVID-19 onset, a high portion of patients exhibit persisting symptoms and cardiopulmonary impairment. Still, a marked improvement of symptoms, pulmonary function, and CT pathologies was found at follow-up.

Published
2020
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39. VROnSite: Towards immersive training of first responder squad leaders in untethered virtual reality

Author

Andreas Peer, Annette Mossel, Christian Schoenauer, Hannes Kaufmann, Mario Froeschl, and Johannes Goellner

Subjects
Multimedia, Iterative design, Process (engineering), Computer science, business.industry, 05 social sciences, 050301 education, 020207 software engineering, 02 engineering and technology, Virtual reality, computer.software_genre, Training (civil), Electronic mail, First responder, Design rationale, Human–computer interaction, 0202 electrical engineering, electronic engineering, information engineering, Immersion (virtual reality), Mobile telephony, business, 0503 education, computer
Abstract

We present the VROnSite platform that enables immersive training of first responder on-site squad leaders. Our training platform is fully immersive, entirely untethered to ease use and provides two means of navigation — abstract and natural walking — to simulate stress and exhaustion, two important factors for decision making. With the platform's capabilities, we close a gap in prior art for first responder training. Our research is closely interlocked with stakeholders from fire brigades and paramedics to gather early feedback in an iterative design process. In this paper, we present our first research results, which are the system's design rationale, the single user training prototype and results from a preliminary user study.

Published
2017
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40. Scenario Space for Alternative Futures of Security Research

Author

Andreas Peer, Thomas Benesch, Walter Seboeck, Johannes Goellner, and Johann Hoechtl

Subjects
Knowledge management, Computer science, business.industry, media_common.quotation_subject, Context (language use), Environmental economics, Interdependence, Futures studies, Business intelligence, Member state, Network security policy, Position (finance), business, Futures contract, media_common
Abstract

FOCUS (“Foresight Security Scenarios – Mapping Research to a Comprehensive Approach to Exogenous EU Roles”) aims namely to define the most plausible threat scenarios that affect the “borderline” between the EU’s external and internal dimensions to security. This article presents scenarios about alternative futures of security research to support a comprehensive approach of the “EU 2035” as a civil security provider. Three scenarios were selected as context scenarios for alternative futures of security research afterwards they have been lined up with drivers identified in a matrix procedure. From these three context scenarios six alternative futures for security research were evaluated using the portfolio-cluster-method. The weighting was done from a dual and interdependent perspective: a) nation/ member state vs. EU-level/international approach to civil security and b) position of the scenario on the continuum of internal/external security. Finally, the article introduces each scenario for alternative future of security research in detail.

Published
2013
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42. Lack of Association of Soluble CD40 Ligand with the Presence of Acute Myocardial Infarction or Ischemic Stroke in the Emergency Department

Author

Andrea Griesmacher, Christoph Schmidauer, Andreas Peer, Gerda Falkensammer, Michaela Plaikner, Johannes Mair, Otmar Pachinger, and Christoph Pechlaner

Subjects
Adult, Male, medicine.medical_specialty, Adolescent, CD40 Ligand, Clinical Biochemistry, Myocardial Infarction, Subgroup analysis, Sensitivity and Specificity, Brain Ischemia, Central nervous system disease, Brain ischemia, Internal medicine, Humans, Medicine, Prospective Studies, Myocardial infarction, Stroke, Aged, Aged, 80 and over, Immunoassay, business.industry, Vascular disease, Cerebral infarction, Biochemistry (medical), Reproducibility of Results, Emergency department, Middle Aged, medicine.disease, Surgery, Solubility, Female, Emergency Service, Hospital, business, Biomarkers
Abstract

Background: Soluble CD40 ligand (sCD40L) has been proposed as a new risk marker for cardiovascular diseases; however, its possible role as a diagnostic marker in the emergency department (ED) has not yet been investigated. Methods: We investigated sCD40L for the diagnosis of acute myocardial infarction or ischemic stroke in 1089 consecutive patients (525 males, 564 females; age, 17–98 years; median, 56 years) in an ED treating mainly adults with medical or neurologic emergencies. We used a research assay from Roche Diagnostics to measure sCD40L in heparinized plasma prepared from routinely drawn blood samples. Results: Intraassay and interassay CVs in our laboratory ranged from 1.6%–4.2% and from 4.4%–4.9%, respectively. A multiple linear regression analysis revealed sCD40L concentration to be significantly associated with C-reactive protein concentration (P = 0.012) and platelet count (P < 0.001). In addition, a subgroup analysis revealed a significant association between smoking and sCD40L concentration (P = 0.006). All other tested variables, including discharge diagnosis, age, sex, and other laboratory variables, showed no significant associations. Conclusions: In adults presenting to the ED, sCD40L is not useful as a diagnostic marker for acute cardiac, cerebrovascular ischemic, or thromboembolic events.

Published
2009
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43. Limited utilities of N-terminal pro B-type natriuretic peptide and other newer risk markers compared with traditional risk factors for prediction of significant angiographic lesions in stable coronary artery disease

Author

Hanno Ulmer, Hannes Alber, Andreas Peer, Johannes Mair, Gerda Falkensammer, Alexander Kroiss, Otmar Pachinger, and Andrea Griesmacher

Subjects
Adult, Male, medicine.medical_specialty, medicine.drug_class, Renal function, Coronary Artery Disease, Coronary Angiography, Logistic regression, Sensitivity and Specificity, Coronary artery disease, Young Adult, Risk Factors, Internal medicine, Natriuretic Peptide, Brain, medicine, Natriuretic peptide, Humans, cardiovascular diseases, Myocardial infarction, Risk factor, Aged, Aged, 80 and over, Analysis of Variance, Predictive marker, business.industry, gamma-Glutamyltransferase, Middle Aged, Brain natriuretic peptide, medicine.disease, Peptide Fragments, Surgery, C-Reactive Protein, Cross-Sectional Studies, Logistic Models, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Biomarkers, hormones, hormone substitutes, and hormone antagonists
Abstract

Objective: To investigate the usefulness of N-terminal pro-brain natriuretic peptide (NT-proBNP) as a predictive marker for angiographically significant coronary artery disease (CAD) and CAD severity compared with other newer biochemical risk markers and classic risk factors in patients with clinically suspected CAD. Design: Cross-sectional evaluation of NT-proBNP in a large consecutive series of patients without a history of myocardial infarction referred for elective coronary angiography (CAG) between March 2004 and January 2005. The value of NT-proBNP for predicting CAD was assessed and compared with high sensitivity C-reactive protein (hs-CRP), γ-glutamyltransferase (GGT) and traditional risk factors. Setting: Tertiary care centre, Department of Cardiology, Innsbruck Medical University, Austria. Patients: 561 men and 287 women aged between 20–86 years (median 65 years). Interventions: None. Main outcome measures: Association of NT-proBNP with the severity of CAD, left ventricular dysfunction and comparison of predictive values of NT-proBNP, hs-CRP, GGT and traditional CAD risk factors. Results: Of all tested newer biochemical risk markers NT-proBNP performed best. In a multinomial logistic regression model NT-proBNP but not hs-CRP or GGT was significantly associated with three-vessel CAD adjusted for age, sex, ventricular, renal function and classic risk factors (odds ratio = 1.667; 95% CI 1.003 to 2.772; p = 0.049). However, NT-proBNP had no additive predictive value to traditional cardiovascular risk factors for the prediction of angiographically significant CAD in a binary logistic regression model. Conclusions: The predictive value of NT-proBNP for CAD severity is better than that of hs-CRP or GGT. However, NT-proBNP is also of limited value compared with traditional risk factors for predicting significant CAD.

Published
2008
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44. A General Framework for Using Social and Traditional Media During Natural Disasters: QuOIMA and the Central European Floods of 2013

Author

Gerald Quirchmayr, Christian Schmidt, Gerhard Backfried, Andreas Peer, Dorothea Aniola, Johannes Göllner, Gerald Czech, Klaus Mak, Markus Glanzer, and Christian Meurers

Subjects
Situation awareness, Emergency management, Event (computing), business.industry, Context (language use), Computer security, computer.software_genre, Data science, First responder, Geography, Social media, Natural disaster, Resilience (network), business, computer
Abstract

Traditional media have a long history in covering natural disasters and crises. In many instances, these media remain major providers of information about an event. In recent years, however, information about natural disasters has increasingly been disseminated on a significant scale via Social Media platforms. These media provide new, additional and complementary angles on events and, combined with traditional media, produce a more complete spectrum of coverage. We present an approach, combining information from across the different kinds of media—traditional as well as social—and also across multiple languages, providing opportunities for first responders and decision makers to gain improved situational awareness and allowing for improved disaster relief, support, mitigation and resilience measures. The approach is put into context by relating it to a long-term strategic model including horizon-scanning and risk-management activities and a 5-phase disaster model forming the basis for information gathering and dissemination activities. To illustrate the research efforts the QuOIMA (Quelloffene Integrierte Multimedia Analyse) project, based on the pillars of cross-media, multimedia, and multilingual processing and representing major aspects of the general framework is presented. QuOIMA focuses on the information gathering aspects from the point of view of a first responder and crisis manager or -communicator rather than the management of active (outgoing) communication. Initial findings on data collected during the 2013 Central European floods are reported and discussed.

Published
2016
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45. Synthesis of anL-Fucose-Derived Cyclic Nitrone and its Conversion toα-L-Fucosidase Inhibitors

Author

Andrea Vasella and Andreas Peer

Subjects
chemistry.chemical_classification, Indolizidines, biology, Stereochemistry, Organic Chemistry, Alkylation, Biochemistry, Catalysis, Fucose, Nitrone, Inorganic Chemistry, chemistry.chemical_compound, Hydroxylamine, chemistry, Diamine, Drug Discovery, biology.protein, Imidazole, Fucosidase, Physical and Theoretical Chemistry
Abstract

The L-fuco-nitrone 1 has been synthesized from allyl 4,6-O-benzylidene-α-D-glucopyranoside (4) in 11 steps and an overall yield of 18%. The key step is the intramolecular alkylation of an intermediary 1,1-bis(hydroxylamine) derived from the tosyloxy oximes (E/Z)-2. The nitrone 1 has been transformed into the diamine 30, the indolizidines 39 and 40, the indolizidinones 34 and 35, and the imidazole 44, all inhibiting bovine epididymis α-L-fucosidase with IC50 values between 105 nM and 240 μM.

Published
1999
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46. Integration of Media Sources for Situation Analysis in the Different Phases of Disaster Management: The QuOIMA Project

Author

Johannes Göllner, Georg Thallinger, Gert Kienast, Gerhard Backfried, Andreas Peer, Christian Schmidt, Karin Rainer, and Gerald Qirchmayr

Subjects
Knowledge management, Emergency management, business.industry, Content analysis, Computer science, Social media, Work in process, business, Risk management, Content management, Terminology, Situation analysis
Abstract

In this paper we describe work in progress on a cross-media content analysis approach and framework, which is currently being developed within the QuOIMA project. We describe the role of media, and how possible links between social and traditional media and terminology and communication patterns are envisioned to be connected to the different phases of a disaster model. The paper continues with a discussion of potential benefits for decision makers and planners and concludes with an outlook on further planned activities and developments.

Published
2013
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48. Preparation of Modified RNA Sequences for Biological Research

Author

Frederic Meylan, Luc Reymond, Muthulaniappan Meyyappan, Xiaolin Wu, Stefan Pitsch, Alfred Stutz, Evelyne Muller, Andreas Peer, Cyrille Denarie, Damian Ackermann, Phillipp Wenter, and Sebastien Porcher

Subjects
chemistry.chemical_classification, Phosphoramidites, RNA, Organic synthesis, General Medicine, General Chemistry, Biology, Ribonucleoside, Nucleic acids, chemistry.chemical_compound, Chemistry, Biochemistry, chemistry, Nucleic acid, Rna, Nucleotide, Ligation, QD1-999
Abstract

Our group is working on the development of reliable access to biologically relevant, long, and modified RNA sequences. Here, we briefly present the chemical synthesis of such sequences with 2?-O-triisopropylsilyloxymethyl (= 2?-O-tom) protected ribonucleoside phosphoramidites, their template-directed enzymatic ligation, and some examples of modified nucleotides, designed to promote structural and biological studies.

Published
2005

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