Publications by authors named "Juan Carlos Ruiz-Rodriguez"

The most used vasopressors in critically ill patients are exogenous catecholamines, mainly norepinephrine. Their use can be associated with serious adverse events and even increased mortality, especially if administered at high doses. In recent years, the addition of vasopressin has been proposed to counteract the deleterious effects of high doses of catecholamines (decatecholaminization) with the intention of improving the prognosis of these patients.

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  • - The text discusses the need to identify specific subgroups of sepsis patients who might benefit from targeted treatments, known as rescue therapies, even while all patients receive standard care.
  • - It highlights the classification of sepsis into various phenotypes, which are based on differing immune responses, such as hyperinflammatory or immunosuppressive states, suggesting that each may require tailored therapies for better outcomes.
  • - The concept of precision medicine is emphasized, aiming to customize treatments according to the unique characteristics and mechanisms of sepsis in individual patients, focusing on developing targeted interventions.
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  • The study aimed to evaluate the feasibility and survival outcomes of a multidisciplinary extracorporeal cardiopulmonary resuscitation (ECPR) program at a university hospital in Spain over a four-year period.
  • The research analyzed data from 54 adult patients who received ECPR, noting that 16 patients (29.6%) were alive after 180 days, with 15 showing good neurological outcomes.
  • The results suggest that implementing an ECPR program is practical and can result in favorable survival rates and potential organ donation opportunities in a specialized medical center.
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Sepsis is a medical emergency resulting from a dysregulated response to an infection, causing preventable deaths and a high burden of morbidity. Protocolized and accurate interventions in sepsis are time-critical. Therefore, earlier recognition of cases allows for preventive interventions, early treatment, and improved outcomes.

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Objectives: Identifying host response biomarkers implicated in the emergence of organ failure during infection is key to improving the early detection of this complication.

Methods: Twenty biomarkers of innate immunity, T-cell response, endothelial dysfunction, coagulation, and immunosuppression were profiled in 180 surgical patients with infections of diverse severity (IDS) and 53 with no infection (nIDS). Those better differentiating IDS/nIDS in the area under the curve were combined to test their association with the sequential organ failure assessment score by linear regression analysis in IDS.

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  • Streptococcal toxic shock syndrome (STTS) is a severe medical emergency characterized by rapid symptom onset and high risks of morbidity and mortality, highlighting the need for quick recognition and intervention.
  • A study observed 13 patients at Vall d'Hebron University Hospital with invasive infections, primarily community-acquired pneumonia and skin infections, all receiving immediate antibiotic treatment and various organ support therapies.
  • The research identified three patient phenotypes (hyperinflammatory, low perfusion, hypogammaglobulinemic) that could help tailor personalized treatments, stressing the importance of combining rapid antibiotics and strategic source control to improve survival outcomes.
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Objectives: To determine vitamin C plasma kinetics, through the measurement of vitamin C plasma concentrations, in critically ill Coronavirus infectious disease 2019 (COVID-19) patients, identifying eventually the onset of vitamin C deficiency.

Design: Prospective, observational, single-center study.

Setting: Intensive Care Unit (ICU), Vall d'Hebron University Hospital, Barcelona.

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Background: Sepsis is associated with T-cell exhaustion, which significantly reduces patient outcomes. Therefore, targeting of immune checkpoints (ICs) is deemed necessary for effective sepsis management. Here, we evaluated the role of SIGLEC5 as an IC ligand and explored its potential as a biomarker for sepsis.

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In COVID-19, hyperinflammatory and dysregulated immune responses contribute to severity. Patients with pre-existing autoimmune conditions can therefore be at increased risk of severe COVID-19 and/or associated sequelae, yet SARS-CoV-2 infection in this group has been little studied. Here, we performed single-cell analysis of peripheral blood mononuclear cells from patients with three major autoimmune diseases (rheumatoid arthritis, psoriasis, or multiple sclerosis) during SARS-CoV-2 infection.

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Background: The baseline endotoxin activity (EA) may predict the outcome of critically ill septic patients who receive Polymyxin-B hemadsorption (PMX-HA), however, the clinical implications of specific EA trends remain unknown.

Methods: Subgroup analysis of the prospective, multicenter, observational study EUPHAS2. We included 50 critically ill patients with septic shock and EA ≥ 0.

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Early diagnosis and appropriate treatments are crucial to reducing mortality risk in septic patients. Low SOFA scores and current biomarkers may not adequately discern patients that could develop severe organ dysfunction or have an elevated mortality risk. The aim of this prospective observational study was to evaluate the predictive value of the biomarkers mid-regional pro-adrenomedullin (MR-proADM), procalcitonin (PCT), C-reactive protein (CRP), and lactate for 28-day mortality in patients with sepsis, and patients with a SOFA score ≤6.

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  • - The study aims to find new protein biomarkers for early diagnosis of sepsis and to understand their connection to organ dysfunction and mortality using advanced omics techniques.
  • - Researchers analyzed plasma proteins from 141 adult sepsis patients using mass spectrometry, identifying 177 proteins and establishing that nine are linked to organ dysfunction and twenty-two are associated with mortality.
  • - Results show these biomarkers have high accuracy and reliability, suggesting that specific protein patterns can indicate serious outcomes in sepsis patients.
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Background: COVID-19 manifests with a wide spectrum of clinical phenotypes, ranging from asymptomatic and mild to severe and critical. Severe and critical COVID-19 patients are characterized by marked changes in the myeloid compartment, especially monocytes. However, little is known about the epigenetic alterations that occur in these cells during hyperinflammatory responses in severe COVID-19 patients.

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  • - Sepsis has a significant impact on global health, with an incidence rate of 250 to 500 cases per 100,000 people, contributing to a high percentage of hospital admissions and healthcare costs, yet the effects of management changes on mortality remain unclear.
  • - A study based on Catalonia's hospital records from 2005 to 2019 identified 296,554 sepsis cases out of nearly 12 million discharges, with annual incidence rising sharply from 144.5 to 410.1 cases per 100,000 inhabitants.
  • - Although overall hospital mortality dropped from 25.7% in 2005 to 17.9% in 2019, significant improvements were noticed particularly in patients with cardiovascular
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  • This case report discusses a patient with Hemophagocytic lymphohistiocytosis (HLH) triggered by NK-type non-Hodgkin lymphoma and Epstein-Barr virus, leading to severe organ dysfunction and shock.
  • Comprehensive diagnostic tests, including a liver biopsy and bone marrow aspirate, confirmed the HLH diagnosis, and the patient met the HLH-2004 criteria.
  • Treatment included corticosteroids and etoposide, along with cytokine hemoadsorption, which dramatically improved the patient's hemodynamics and reduced the need for vasopressive medications.
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Background: Two years since the onset of the COVID-19 pandemic no predictive algorithm has been generally adopted for clinical management and in most algorithms the contribution of laboratory variables is limited.

Objectives: To measure the predictive performance of currently used clinical laboratory tests alone or combined with clinical variables and explore the predictive power of immunological tests adequate for clinical laboratories. Methods: Data from 2,600 COVID-19 patients of the first wave of the pandemic in the Barcelona area (exploratory cohort of 1,579, validation cohorts of 598 and 423 patients) including clinical parameters and laboratory tests were retrospectively collected.

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Multisystem inflammatory syndrome (MIS-C) is a new severe clinical condition that has emerged during the COVID-19 pandemic. MIS-C affects children and the young usually after a mild or asymptomatic COVID-19 infection. MIS-C has a high tropism for the cardiovascular system with need for inotropes and vasopressor support in 62% of cases.

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Sepsis is a heterogeneous disease with variable clinical course and several clinical phenotypes. As it is associated with an increased risk of death, patients with this condition are candidates for receipt of a very well-structured and protocolized treatment. All patients should receive the fundamental pillars of sepsis management, which are infection control, initial resuscitation, and multiorgan support.

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Sepsis and COVID-19 are two clinical conditions that can lead to a dysregulated inflammatory state causing multiorgan dysfunction, hypercytokinemia, and a high risk of death. Specific subgroups of critically ill patients with particular characteristics could benefit from rescue treatment with hemoadsorption. There is a lack of adequately designed randomized controlled trials evaluating the potential benefits of cytokine or endotoxin hemoadsorption.

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Sepsis and septic shock result from an inadequate host response to an infection, which causes organ dysfunction. The progression of this condition is manifested by the occurrence of successive clinical stages, resulting from the systemic inflammatory response secondary to the activation of different inflammatory mediators, leading to organ dysfunction. There is a high burden of evidence on the role of endotoxin in the pathogenesis of sepsis and its crucial role in triggering the inflammatory response in sepsis caused by gram-negative bacteria.

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Anemia is common in critically ill patients; almost 95% of patients admitted to intensive care units (ICUs) have hemoglobin levels below normal. Several causes may explain this phenomenon as well as the tendency to transfuse patients without adequate cause: due to a lack of adherence to protocols, lack of supervision, incomplete transfusion request forms, or a lack of knowledge about the indications, risks, and costs of transfusions. Daily sampling to monitor the coagulation parameters and the acid-base balance can aggravate anemia as the main iatrogenic factor in its production.

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Article Synopsis
  • A dysregulated inflammatory response, called "cytokine storm," is critical in the severity of COVID-19, making it important to identify patients at risk for severe complications like organ dysfunction and death.
  • The study evaluated the use of cytokine hemoadsorption as a rescue therapy in critically ill COVID-19 patients experiencing severe respiratory failure and an excess of cytokines.
  • Among 343 ICU patients with SARS-CoV-2 infection, six underwent hemoadsorption, showing significant improvements in markers like D-dimer, C-reactive protein, ferritin, and interleukin-6, along with better oxygenation levels post-treatment. *
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  • Serological tests are crucial for managing COVID-19, focusing on diagnostics, surveillance, and immunity studies.
  • A new plasmonic biosensor assay identifies SARS-CoV-2 antibodies in under 15 minutes using a custom-designed sensor, without needing signal amplification.
  • Clinical validation shows the biosensor offers high diagnostic sensitivity (99%) and specificity (100%), making it a reliable tool for rapid COVID-19 serology in various settings.
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Introduction: In the context of community transmission of the virus, the impact of the pandemic on health-care systems, mainly on intensive care units (ICU), was expected to be devastating. Vall d'Hebron University Hospital (HUVH) implemented an unprecedented critical patient-care planning and management of resources.

Methods: We describe a cohort of critically ill patients during the first two months of the pandemic (from March 3, 2020, to May 2, 2020) in HUVH, Barcelona.

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