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Article ; Online: Effects of vitamin D insufficiency on sepsis severity and risk of hospitalisation in emergency department patients: a cross-sectional study.

Vanichkulbodee, Alissara / Romposra, Muditha / Inboriboon, Pholaphat Charles / Trongtrakul, Konlawij

2023 Volume 13, Issue 1, Page(s) e064985

Abstract: Objective: To evaluate the association of 25-hydroxyvitamin D (25(OH)D) level on sepsis severity and risk of hospitalisation in emergency department (ED) septic patients when categorised as vitamin D insufficiency according to the level of 25(OH)D<30 ng/ ...

Abstract	Objective: To evaluate the association of 25-hydroxyvitamin D (25(OH)D) level on sepsis severity and risk of hospitalisation in emergency department (ED) septic patients when categorised as vitamin D insufficiency according to the level of 25(OH)D<30 ng/mL. Design: Cross-sectional observational study. Setting: A 900-bed academic tertiary hospital with an ED residency training programme in Bangkok, Thailand. Participants: An observational study of 101 ED septic patients aged ≥18 years was conducted between March 2015 and September 2015. Outcome measures: The level of 25(OH)D was analysed and correlated with sepsis severity assessed by Acute Physiology Age Chronic Health Evaluation-II (APACHE-II) and Mortality in ED Sepsis (MEDS) scores, and the risk of hospitalisation. Results: One hundred and one patients were enrolled, with an average age of 68±18 years, 56% female, APACHE-II score of 14±6, MEDS score of 8±5 and 25(OH)D level was 19±11 ng/mL. The prevalence of vitamin D insufficiency in our ED septic patients was 87% and the admission rate was 88%. A significant association between 25(OH)D level and sepsis severity scores was found, which was measured by APACHE-II and MEDS scores (-0.29; 95% CI -0.41 to -0.17, p<0.001 and -0.15; 95% CI -0.25 to -0.06, p=0.002, respectively). However, vitamin D insufficiency could not determine hospitalisation (OR=1.42; 95% CI 0.27 to 7.34; p=0.68 and OR=1.65; 95% CI 0.07 to 41.7; p=0.76 when adjusted by baseline covariates). Conclusions: The vitamin D insufficiency of septic patients in our ED was high and had a significant negative association with sepsis severity. However, vitamin D insufficiency status cannot predict the hospitalisation of septic patients who were admitted to the ED. Further research is needed to investigate the role of vitamin D supplementation in the ED in affecting sepsis severity. Trial registration number: TCTR20151127001.
MeSH term(s)	Humans ; Female ; Adolescent ; Adult ; Middle Aged ; Aged ; Aged, 80 and over ; Male ; Cross-Sectional Studies ; Severity of Illness Index ; Prognosis ; Thailand/epidemiology ; Sepsis/complications ; Sepsis/epidemiology ; Vitamin D ; Vitamins ; Hospitalization ; Emergency Service, Hospital
Chemical Substances	Vitamin D (1406-16-2) ; Vitamins
Language	English
Publishing date	2023-01-17
Publishing country	England
Document type	Observational Study ; Journal Article
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2022-064985
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Article ; Online: The use of respiratory rate-oxygenation index to predict failure of high-flow nasal cannula in patients with coronavirus disease 2019-associated acute respiratory distress syndrome: A retrospective study.

Poopipatpab, Sujaree / Nuchpramool, Pruchwilai / Phairatwet, Piyarat / Lertwattanachai, Todspol / Trongtrakul, Konlawij

PloS one

2023 Volume 18, Issue 6, Page(s) e0287432

Abstract: Patients with mild-to-moderate coronavirus disease 2019 (COVID-19)-associated acute respiratory distress syndrome (ARDS) can be treated with a high-flow nasal cannula (HFNC). The use of the respiratory rate-oxygenation (ROX) index, calculated as the ... ...

Abstract	Patients with mild-to-moderate coronavirus disease 2019 (COVID-19)-associated acute respiratory distress syndrome (ARDS) can be treated with a high-flow nasal cannula (HFNC). The use of the respiratory rate-oxygenation (ROX) index, calculated as the ratio of oxygen saturation (SpO2)/fractional oxygen (FiO2) to respiratory rate, in the first few hours after HFNC initiation can help identify patients who fail HFNC therapy later. However, few studies have documented the use of the ROX index during the period of HFNC therapy. Therefore, we aimed to demonstrate the diagnostic performance of the ROX index when calculated throughout the HFNC therapy period and to determine the best cut-off point for predicting HFNC failure. We conducted a retrospective study of patients with COVID-19-associated ARDS who commenced HFNC at the Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Thailand, between April 1 and August 30, 2021. We calculated the ROX index every 4 h throughout the HFNC therapy period and defined HFNC failure as a subsequent endotracheal tube intubation. The performance of the ROX index was analyzed using the area under the receiver operating characteristic curve (AUC). We applied the ROX index ≤ 4.88 to predict HFNC failure and obtained a new ROX cut-off point using Youden's method. In total, 212 patients with COVID-19 treated with HFNC were included in the study. Of these, 81 patients (38.2%) experienced HFNC failure. The ROX index ≤ 4.88 demonstrated a reasonable performance in predicting HFNC failure (AUC, 0.77; 95% confidence interval [CI], 0.72-0.83; p<0.001). However, compared with the original cut-off point of ≤ 4.88, the new ROX index cut-off point of ≤ 5.84 delivered optimal performance (AUC, 0.84; 95% CI, 0.79-0.88; p<0.001), with a significantly better discriminative ability (p = 0.007). In conclusion, a ROX index ≤ 5.84 was found to be optimal for predicting HFNC failure in patients with COVID-19-associated ARDS.
MeSH term(s)	Humans ; Cannula ; Retrospective Studies ; COVID-19/complications ; COVID-19/therapy ; Respiratory Rate ; Oxygen Inhalation Therapy/methods ; Respiratory Insufficiency/therapy ; Respiratory Insufficiency/complications ; Intubation, Intratracheal ; Respiratory Distress Syndrome/therapy ; Respiratory Distress Syndrome/complications ; Noninvasive Ventilation
Language	English
Publishing date	2023-06-21
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0287432
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Article ; Online: The effect of citrate in cardiovascular system and clot circuit in critically ill patients requiring continuous renal replacement therapy.

Trakarnvanich, Thananda / Sirivongrangson, Phatadon / Trongtrakul, Konlawij / Srisawat, Nattachai

Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs

2022 Volume 26, Issue 1, Page(s) 53–64

Abstract: We aimed to evaluate the impact of citrate on hemodynamic responses and secondary outcomes, including the filter life span, metabolic complications, and levels of inflammatory cytokines, in critically ill patients who required CRRT compared with those ... ...

Abstract	We aimed to evaluate the impact of citrate on hemodynamic responses and secondary outcomes, including the filter life span, metabolic complications, and levels of inflammatory cytokines, in critically ill patients who required CRRT compared with those who underwent the heparin-free method. This prospective, multicenter, open-label randomized trial compared regional citrate anticoagulation (RCA) with a heparin-free protocol in severe acute kidney injury (AKI) patients who received continuous venovenous hemodiafiltration (CVVHDF) in the postdilution mode. We measured hemodynamic changes using the FloTrac Sensor/EV1000™ Clinical Platform at certain time points after starting CRRT (0, 6, 12, 24, 48, and 72 h.). The levels of inflammatory cytokines (IL-1β, IL-6, IL-8, IL-10 and TNF-ɑ) were measured on days 1 and 3. Forty-one patients were recruited and randomized into the heparin (n = 20) and citrate groups (n = 21). The cardiac performances were not significantly different between the 2 groups at any time point. The inflammatory cytokines declined similarly in both treatment arms. The maximum filter survival time was insignificantly longer in the RCA group than in the heparin-free group (44.64 ± 26.56 h. vs p = 0.693 in citrate and heparin free group). No serious side effects were observed for either treatment arm, even in the group of liver dysfunction patients. RCA did not affect hemodynamic changes during CRRT. Inflammatory cytokines decreased similarly in both treatment arms.The filter life span was longer in the citrate group. RCA is a valid alternative to traditional anticoagulation and results in stable hemodynamic parameters.
MeSH term(s)	Humans ; Citric Acid ; Continuous Renal Replacement Therapy/adverse effects ; Anticoagulants/therapeutic use ; Critical Illness ; Prospective Studies ; Heparin/therapeutic use ; Citrates/therapeutic use ; Thrombosis/complications ; Cardiovascular System ; Cytokines ; Renal Replacement Therapy/methods ; Acute Kidney Injury/therapy
Chemical Substances	Citric Acid (2968PHW8QP) ; Anticoagulants ; Heparin (9005-49-6) ; Citrates ; Cytokines
Language	English
Publishing date	2022-04-12
Publishing country	Japan
Document type	Randomized Controlled Trial ; Multicenter Study ; Journal Article
ZDB-ID	1463555-0
ISSN	1619-0904 ; 1434-7229
ISSN (online)	1619-0904
ISSN	1434-7229
DOI	10.1007/s10047-022-01329-0
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Article: Outcomes of critically ill end-stage kidney disease patients who underwent major surgery.

Petchmak, Peerawitch / Wongmahisorn, Yuthapong / Trongtrakul, Konlawij

PeerJ

2021 Volume 9, Page(s) e11324

Abstract: Purpose: End-stage kidney disease (ESKD) is a major worldwide health problem. Patients with ESKD are thought to have a significant risk for development of complications following an operation. However, the study of ESKD and its outcomes following major ... ...

Abstract	Purpose: End-stage kidney disease (ESKD) is a major worldwide health problem. Patients with ESKD are thought to have a significant risk for development of complications following an operation. However, the study of ESKD and its outcomes following major operations remains rare, particularly in critical illness. Therefore, this study aimed to demonstrate how the outcomes of ESKD patients were affected when they underwent a major operation and were admitted to the intensive care unit (ICU), compared with non-ESKD patients. Methods: A retrospective matched case cohort study was conducted in 122 critically ill surgical patients who underwent a major operation and were admitted to the ICU, during 2013 and 2016. Sixty-one ESKD patients who required long-term dialysis were enrolled and compared with 61 matched non-ESKD patients. The matching criteria were the same age interval (±5 years), gender, and type of operation. The ICU mortality was compared to the primary outcome of the study. Results: Patients' baseline characteristics between ESKD and non-ESKD were similar to a priori matching criteria and other demographics, except for pre-existing diabetes mellitus and hypertension, which were found significantly more in ESKD ( Conclusion: Patients who underwent a major operation and needed intensive care admission with pre-existing ESKD requiring long-term dialysis were associated with greater mortality than patients without ESKD. More careful assessment before, during, and after major surgical procedures should be performed in this group of patients to improve post-operative outcomes.
Language	English
Publishing date	2021-05-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	2703241-3
ISSN	2167-8359
ISSN	2167-8359
DOI	10.7717/peerj.11324
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Article: Development of a clinical prediction tool for extubation failure in pediatric cardiac intensive care unit.

Saengsin, Kwannapas / Sittiwangkul, Rekwan / Borisuthipandit, Thirasak / Wongyikul, Pakpoom / Tanasombatkul, Krittai / Phanacharoensawad, Thanaporn / Moonsawat, Guanoon / Trongtrakul, Konlawij / Phinyo, Phichayut

Frontiers in pediatrics

2024 Volume 12, Page(s) 1346198

Abstract: Introduction/objective: Extubation failure in pediatric patients with congenital or acquired heart diseases increases morbidity and mortality. This study aimed to develop a clinical risk score for predicting extubation failure to guide proper clinical ... ...

Abstract	Introduction/objective: Extubation failure in pediatric patients with congenital or acquired heart diseases increases morbidity and mortality. This study aimed to develop a clinical risk score for predicting extubation failure to guide proper clinical decision-making and management. Methods: We conducted a retrospective study. This clinical prediction score was developed using data from the Pediatric Cardiac Intensive Care Unit (PCICU) of the Faculty of Medicine, Chiang Mai University, Thailand, from July 2016 to May 2022. Extubation failure was defined as the requirement for re-intubation within 48 h after extubation. Multivariable logistic regression was used for modeling. The score was evaluated in terms of discrimination and calibration. Results: A total of 352 extubation events from 270 patients were documented. Among these, 40 events (11.36%) were extubation failure. Factors associated with extubation failure included history of pneumonia (OR: 4.14, 95% CI: 1.83-9.37, Conclusion: The derived Pediatric CMU Extubation Failure Prediction Score (
Language	English
Publishing date	2024-03-05
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2711999-3
ISSN	2296-2360
ISSN	2296-2360
DOI	10.3389/fped.2024.1346198
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Article ; Online: Peripheral Blood Monocyte to Lymphocyte Ratio for Prediction of Tuberculous Pleuritis.

Sukson, Pasa / Liwsrisakun, Chalerm / Inchai, Juthamas / Trongtrakul, Konlawij / Tajarernmuang, Pattraporn

International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases

2021 Volume 112, Page(s) 212–216

Abstract: Objective: To examine the peripheral monocyte to lymphocyte ratio (ML ratio) of patients with tuberculous (TB) pleuritis and the ML ratio changes after treatment.: Methods: Clinical and laboratory information were collected from patients with ... ...

Abstract	Objective: To examine the peripheral monocyte to lymphocyte ratio (ML ratio) of patients with tuberculous (TB) pleuritis and the ML ratio changes after treatment. Methods: Clinical and laboratory information were collected from patients with lymphocytic exudative pleural effusion admitted to Chiang Mai University Hospital from 2013 to 2019. This study compared the ML ratios between tuberculous pleuritis and other diagnoses in patients who were followed after treatment. Results: A total of 152 patients were included: 57 with tuberculous pleuritis and 95 with other lymphocytic exudates. The majority of non-tuberculous effusion was malignant pleural effusion. The mean ML ratio of each group was 0.72±0.29 and 0.34±0.13 (p<0.001). The Area Under the Receiver Operative Characteristic Curve of the ML ratio for diagnosing tuberculous pleuritis was 0.91. The best cut-off point of the ML ratio for diagnosing tuberculous pleuritis was >0.45, where the sensitivity and specificity were 82.5% and 86.3%, respectively. The ML ratio gradually reduced after the anti-TB treatment. ML ratios at 0, 2, and 6 months after the treatment were 0.72±0.29, 0.40±0.37, and 0.30±0.27, respectively (p<0.001). Conclusion: The peripheral blood ML ratio is an easy and useful tool for diagnosing and predicting the treatment response in patients with tuberculous pleuritis.
MeSH term(s)	Humans ; Lymphocytes ; Monocytes ; Pleural Effusion ; Pleurisy/diagnosis ; Sensitivity and Specificity ; Tuberculosis, Pleural/diagnosis ; Tuberculosis, Pleural/drug therapy
Language	English
Publishing date	2021-09-20
Publishing country	Canada
Document type	Journal Article
ZDB-ID	1331197-9
ISSN	1878-3511 ; 1201-9712
ISSN (online)	1878-3511
ISSN	1201-9712
DOI	10.1016/j.ijid.2021.09.033
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Article: Prediction of Fluid Responsiveness by the Effect of the Lung Recruitment Maneuver on the Perfusion Index in Mechanically Ventilated Patients During Surgery.

Morakul, Sunthiti / Prachanpanich, Naruemol / Permsakmesub, Pattarada / Pinsem, Pimwatana / Mongkolpun, Wasineenart / Trongtrakul, Konlawij

Frontiers in medicine

2022 Volume 9, Page(s) 881267

Abstract: Introduction: Excessive or inadequate fluid administration during perioperative period affects outcomes. Adjustment of volume expansion (VE) by performing fluid responsiveness (FR) test plays an important role in optimizing fluid infusion. Since changes ...

Abstract	Introduction: Excessive or inadequate fluid administration during perioperative period affects outcomes. Adjustment of volume expansion (VE) by performing fluid responsiveness (FR) test plays an important role in optimizing fluid infusion. Since changes in stroke volume (SV) during lung recruitment maneuver (LRM) can predict FR, and peripheral perfusion index (PI) is related to SV; therefore, we hypothesized that the changes in PI during LRM (ΔPI Methods: Patients who were scheduled for elective non-laparoscopic surgery under general anesthesia with a mechanical ventilator and who required VE (250 mL of crystalloid solution infusion over 10 min) were included. Before VE, LRM was performed by a continuous positive airway pressure of 30 cm H Results: Of 32 mechanically ventilated adult patients included, 13 (41%) were in the Fluid-Res group. Before VE and LRM, there were no differences in the mean arterial pressure (MAP), heart rate, SV, and PI between patients in the Fluid-Res and fluid non-responders (Fluid-NonRes) groups. After LRM, SV, MAP, and, PI decreased in both groups, ΔPI Conclusions: ΔPI
Language	English
Publishing date	2022-06-17
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2775999-4
ISSN	2296-858X
ISSN	2296-858X
DOI	10.3389/fmed.2022.881267
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Article: Predictive factors of extubation failure in pediatric cardiac intensive care unit: A single-center retrospective study from Thailand.

Saengsin, Kwannapas / Sittiwangkul, Rekwan / Borisuthipandit, Thirasak / Trongtrakul, Konlawij / Tanasombatkul, Krittai / Phanacharoensawad, Thanaporn / Moonsawat, Guanoon / Phinyo, Phichayut

Frontiers in pediatrics

2023 Volume 11, Page(s) 1156263

Abstract: Introduction/objective: Extubation failure increases morbidity and mortality in pediatric cardiac patients, a unique population including those with congenital heart disease or acquired heart disease. This study aimed to evaluate the predictive factors ... ...

Abstract	Introduction/objective: Extubation failure increases morbidity and mortality in pediatric cardiac patients, a unique population including those with congenital heart disease or acquired heart disease. This study aimed to evaluate the predictive factors of extubation failure in pediatric cardiac patients and to determine the association between extubation failure and clinical outcomes. Methods: We conducted a retrospective study in the pediatric cardiac intensive care unit (PCICU) of the Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand, from July 2016 to June 2021. Extubation failure was defined as the re-insertion of the endotracheal tube within 48 hours after extubation. Multivariable log-binomial regression with generalized estimating equations (GEE) was performed to explore the predictive factors associated with extubation failure. Results: We collected 318 extubation events from 246 patients. Of these, 35 (11%) events were extubation failures. In physiologic cyanosis, the extubation failure group had significantly higher SpO Conclusion: Extubation failure was identified in 11% of extubation attempts in pediatric cardiac patients. The extubation failure was associated with a longer duration of PCICU stay but not with mortality. Patients with a history of pneumonia before extubation, history of re-intubation, post-operative palliative surgery, and post-extubation stridor should receive careful consideration before extubation and close monitoring afterward. Additionally, patients with physiologic cyanosis may require balanced circulation
Language	English
Publishing date	2023-04-17
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2711999-3
ISSN	2296-2360
ISSN	2296-2360
DOI	10.3389/fped.2023.1156263
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Article: Prevalence and association of vitamin D deficiency and mortality in patients with severe sepsis.

Trongtrakul, Konlawij / Feemuchang, Chookiat

International journal of general medicine

2017 Volume 10, Page(s) 415–421

Abstract: Background: Vitamin D is a steroid prohormone that regulates body calcium and phosphate metabolism. Recent studies have shown an association between low vitamin D status and high mortality in patients admitted to intensive care units. To date, there are ...

Abstract	Background: Vitamin D is a steroid prohormone that regulates body calcium and phosphate metabolism. Recent studies have shown an association between low vitamin D status and high mortality in patients admitted to intensive care units. To date, there are limited data available specifically about severely septic patients in medical units. Objectives: To determine the prevalence of vitamin D deficiency in severely septic patients and its clinical outcomes, including mortality rate. Methods: A prospective observational study was conducted to investigate the prevalence of vitamin D deficiency and its association with 30-day mortality in patients with severe sepsis. Patients admitted to medical wards at our hospital between November 2014 and March 2015 were included in the study. A 25-hydroxyvitamin D level <20 ng/mL was defined as vitamin D deficiency, and <12 ng/mL as severe deficiency. For an association analysis, the patients were grouped into deficient versus not deficient and severely deficient versus not severely deficient. Results: One hundred and ten eligible patients were enrolled. A total of 83 patients (75%) had vitamin D deficiency and 42 (38%) had severe deficiency. Despite an insignificant higher 30-day hospital mortality rate in vitamin D deficient versus non-deficient groups (16% vs 4%, Conclusion: The prevalence of vitamin D deficiency was very high in three-quarters of patients with severe sepsis. A significant higher mortality rate was observed, particularly in patients with severe vitamin D deficiency.
Language	English
Publishing date	2017-11-08
Publishing country	New Zealand
Document type	Journal Article
ZDB-ID	2452220-X
ISSN	1178-7074
ISSN	1178-7074
DOI	10.2147/IJGM.S147561
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Article: The National Early Warning Score 2 with Age and Body Mass Index (NEWS2 Plus) to Determine Patients with Severe COVID-19 Pneumonia.

Trongtrakul, Konlawij / Tajarernmuang, Pattraporn / Limsukon, Atikun / Theerakittikul, Theerakorn / Niyatiwatchanchai, Nutchanok / Surasit, Karjbundid / Glunriangsang, Pimpimok / Liwsrisakun, Chalerm / Bumroongkit, Chaiwat / Pothirat, Chaicharn / Inchai, Juthamas / Chaiwong, Warawut / Chanayat, Panida / Deesomchok, Athavudh

Journal of clinical medicine

2024 Volume 13, Issue 1

Abstract: 1) Background: Early identification of severe coronavirus disease 2019 (COVID-19) pneumonia at the initial phase of hospitalization is very crucial. To address this, we validated and updated the National Early Warning Score 2 (NEWS2) for this purpose. ( ... ...

Abstract	(1) Background: Early identification of severe coronavirus disease 2019 (COVID-19) pneumonia at the initial phase of hospitalization is very crucial. To address this, we validated and updated the National Early Warning Score 2 (NEWS2) for this purpose. (2) Methods: We conducted a study on adult patients with COVID-19 infection in Chiang Mai, Thailand, between May 2021 and October 2021. (3) Results: From a total of 725 COVID-19 adult patients, 350 (48.3%) patients suffered severe COVID-19 pneumonia. In determining severe COVID-19 pneumonia, NEWS2 and NEWS2 + Age + BMI (NEWS2 Plus) showed the C-statistic values of 0.798 (95% CI, 0.767-0.830) and 0.821 (95% CI, 0.791-0.850), respectively. The C-statistic values of NEWS2 Plus were significantly improved compared to those of NEWS2 alone (
Language	English
Publishing date	2024-01-04
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm13010298
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