Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：English   Publishing type：Research paper (scientific journal)  

AIM: Although the obesity paradox is known for various diseases, including cancer and acute respiratory distress syndrome, little is known about veno-venous extracorporeal membrane oxygenation (VV-ECMO) in patients with coronavirus disease 2019 (COVID-19). In this study, we aimed to investigate the association between body mass index (BMI) and prognosis in critical patients with COVID-19 requiring VV-ECMO. METHODS: We conducted a retrospective observational single-center study at Yokohama City University Civic General Medical Center between March 2020 and October 2021. Participants were patients with COVID-19 who required VV-ECMO. They were classified into two groups: BMI ≤30 kg/m2 and >30 kg/m2. RESULTS: In total, 23 patients were included in the analysis, with a median BMI of 28.7 kg/m2. Overall, 22 patients were successfully weaned from the ECMO. When comparing the two groups, there was a trend toward fewer days from onset to ECMO induction in the BMI >30 kg/m2 group. Moreover, the two groups had a similar prognosis. There were no statistically significant differences in the number of days from onset to hospitalization or the duration of ECMO induction between the groups. CONCLUSION: VV-ECMO induction for patients with COVID-19 may lead to earlier indications in patients with BMI >30 kg/m2 than in those with BMI ≤30 kg/m2.

DOI： 10.1002/ams2.871

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Language：Japanese   Publisher：日本救急医学会-関東地方会  

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Arterial lactate (AL) level is an important predictor of patient prognosis. AL and peripheral venous lactate (PVL) in blood gas analysis have a low concordance rate, and PVL cannot be used as a substitute for AL. However, if the AL range can be predicted from PVL, PVL may be an alternative method for predicting patient prognosis, and the risk of arterial puncture complications with AL may be reduced. This could be a safe and rapid test method. METHODS: This was a retrospective observational study of 125 cases in which blood gas analysis was performed on both arterial and venous blood with an infectious disease in an emergency department. Spearman's rank correlation coefficient (r) and Bland-Altman analyses were performed. Sensitivity, specificity, and area under the curve (AUC) were calculated for PVL to predict AL < 2 mmol/L or < 4 mmol/L. RESULTS: The median [interquartile range] AL and PVL were 1.82 [1.25-2.46] vs. 2.08 [1.57-3.28], respectively, r was 0.93 (p < 0.0001), and a strong correlation was observed; however, Bland-Altman analysis showed disagreement. When AL < 2 mmol/L was used as the outcome, AUC was 0.970, the PVL cutoff value was 2.55 mmol/L, sensitivity was 85.71%, and specificity was 96.05%. If PVL < 2 mmol/L was the outcome, the sensitivity for AL < 2mmol/L was 100%, and for PVL levels ≥ 3 mmol/L, the specificity was 100%. When AL < 4 mmol/L was used as the outcome, AUC was 0.967, the PVL cutoff value was 3.4 mmol/L, sensitivity was 100%, and specificity was 85.84%. When PVL < 3.5 mmol/L was the outcome, the sensitivity for AL < 4 mmol/L was 100%, and for PVL levels ≥ 4 mmol/L, the specificity was 93.81%. CONCLUSIONS: This study revealed that PVL and AL levels in the same critically ill patients did not perfectly agree with each other but were strongly correlated. Furthermore, the high accuracy for predicting AL ranges from PVL levels explains why PVL levels could be used as a substitute for AL level ranges.

DOI： 10.1186/s12245-022-00410-y

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Language：Japanese   Publisher：(公社)神奈川県医師会  

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: The outcomes of coronavirus disease 2019 (COVID-19) treatment have improved due to vaccination and the establishment of better treatment regimens. However, the emergence of variants of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19, and the corresponding changes in the characteristics of the disease present new challenges in patient management. This study aimed to analyze predictors of COVID-19 severity caused by the delta and omicron variants of SARS-CoV-2. METHODS: We retrospectively analyzed the data of patients who were admitted for COVID-19 at Yokohama City University Hospital from August 2021 to March 2022. RESULTS: A total of 141 patients were included in this study. Of these, 91 had moderate COVID-19, whereas 50 had severe COVID-19. There were significant differences in sex, vaccination status, dyspnea, sore throat symptoms, and body mass index (BMI) (p <0.0001, p <0.001, p <0.001, p = 0.02, p< 0.0001, respectively) between the moderate and severe COVID-19 groups. Regarding comorbidities, smoking habit and renal dysfunction were significantly different between the two groups (p = 0.007 and p = 0.01, respectively). Regarding laboratory data, only LDH level on the first day of hospitalization was significantly different between the two groups (p<0.001). Multiple logistic regression analysis revealed that time from the onset of COVID-19 to hospitalization, BMI, smoking habit, and LDH level were significantly different between the two groups (p<0.03, p = 0.039, p = 0.008, p<0.001, respectively). The cut-off value for the time from onset of COVID-19 to hospitalization was four days (sensitivity, 0.73; specificity, 0.70). CONCLUSIONS: Time from the onset of COVID-19 to hospitalization is the most important factor in the prevention of the aggravation of COVID-19 caused by the delta and omicron SARS-CoV-2 variants. Appropriate medical management within four days after the onset of COVID-19 is essential for preventing the progression of COVID-19, especially in patients with smoking habits.

DOI： 10.1371/journal.pone.0273134

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(NPO)日本急性血液浄化学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：English  

DOI： 10.1038/s41598-021-96408-2

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Coronavirus disease 2019 (COVID-19) pneumonitis associated with severe respiratory failure is associated with high mortality. The pathogenesis of COVID-19 is associated with microembolism or microvascular endothelial injuries. Here, we report that syndecan-1 (SDC-1), a component of the endothelial glycocalyx, may be a biomarker of severity classification for COVID-19 related to endothelial injury. METHODS AND ANALYSIS: We analyzed the data of COVID-19 patients for 1 year from February 2020 at Yokohama City University Hospital and Yokohama City University Medical Center Hospital. We selected COVID-19 patients who required admission care, including intensive care, and analyzed the classification of severe and critical COVID-19 retrospectively, using various clinical data and laboratory data with SDC-1 by ELISA. RESULTS: We analyzed clinical and laboratory data with SDC-1 in five severe COVID-19 and ten critical COVID-19 patients. In the two groups, their backgrounds were almost the same. In laboratory data, the LDH, CHE, and CRP levels showed significant differences in each group (P = 0.032, P < 0.0001, and P = 0.007, respectively) with no significant differences in coagulation-related factors (platelet, PT-INR, d-dimer, ISTH score; P = 0.200, 0.277, 0.655, and 0.36, respectively). For the clinical data, the SOFA score was significantly different from admission day to day 14 of admission (p < 0.0001). The SDC-1 levels of critical COVID-19 patients were significantly higher on admission day and all-time course compared with the levels of severe COVID-19 patients (P = 0.009 and P < 0.0001, respectively). CONCLUSIONS: Temporal change of SDC-1 levels closely reflect the severity of COVID-19, therefore, SDC-1 may be a therapeutic target and a biomarker for the severity classification of Covid-19.

DOI： 10.1186/s12959-021-00308-4

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Language：English   Publishing type：Research paper (scientific journal)  

Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that leads to severe respiratory failure (RF). It is known that host exposure to viral infection triggers an iron-lowering response to mitigate pathogenic load and tissue damage. However, the association between host iron-lowering response and COVID-19 severity is not clear. This two-center observational study of 136 adult hospitalized COVID-19 patients analyzed the association between disease severity and initial serum iron, total iron-binding capacity (TIBC), and transferrin saturation (TSAT) levels. Serum iron levels were significantly lower in patients with mild RF than in the non-RF group; however, there were no significant differences in iron levels between the non-RF and severe RF groups, depicting a U-shaped association between serum iron levels and disease severity. TIBC levels decreased significantly with increasing severity; consequently, TSAT was significantly higher in patients with severe RF than in other patients. Multivariate analysis including only patients with RF adjusted for age and sex demonstrated that higher serum iron and TSAT levels were independently associated with the development of severe RF, indicating that inadequate response to lower serum iron might be an exacerbating factor for COVID-19.

DOI： 10.1038/s41598-021-92921-6

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Language：English   Publishing type：Research paper (scientific journal)  

The Coronavirus disease 2019 pandemic continues to spread worldwide. Because of the absence of reliable rapid diagnostic systems, patients with symptoms of Coronavirus disease 2019 are treated as suspected of the disease. Use of computed tomography findings in Coronavirus disease 2019 are expected to be a reasonable method for triaging patients, and computed tomography-first triage strategies have been proposed. However, clinical evaluation of a computed tomography-first triage protocol is lacking.The aim of this study is to investigate the real-world efficacy and limitations of a computed tomography-first triage strategy in patients with suspected Coronavirus disease 2019.This was a single-center cohort study evaluating outpatients with fever who received medical examination at Yokohama City University Hospital, prospectively registered between 9 February and 5 May 2020. We treated according to the computed tomography-first triage protocol. The primary outcome was efficacy of the computed tomography-first triage protocol for patients with fever in an outpatient clinic. Efficacy of the computed tomography-first triage protocol for outpatients with fever was evaluated using sensitivity, specificity, positive predictive value, and negative predictive value. We conducted additional analyses of the isolation time of feverish outpatients and final diagnoses.In total, 108 consecutive outpatients with fever were examined at our hospital. Using the computed tomography-first triage protocol, 48 (44.9%) patients were classified as suspected Coronavirus disease 2019. Nine patients (18.8%) in this group were positive for severe acute respiratory syndrome coronavirus 2 using polymerase chain reaction; no patients in the group considered less likely to have Coronavirus disease 2019 tested positive for the virus. The protocol significantly shortened the duration of isolation for the not-suspected versus the suspected group (70.5 vs 1037.0 minutes, P < .001).Our computed tomography-first triage protocol was acceptable for screening patients with suspected Coronavirus disease 2019. This protocol will be helpful for appropriate triage, especially in areas where polymerase chain reaction is inadequate.

DOI： 10.1097/MD.0000000000026161

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Coronavirus disease (COVID-19) pneumonitis associated with severe respiratory failure has a high mortality rate. Based on recent reports, the most severely ill patients present with coagulopathy, and disseminated intravascular coagulation (DIC)-like massive intravascular clot formation is frequently observed. Coagulopathy has emerged as a significant contributor to thrombotic complications. Although recommendations have been made for anticoagulant use for COVID-19, no guidelines have been specified. We describe four cases of critical COVID-19 with thrombosis detected by enhanced CT scan. The CT findings of all cases demonstrated typical findings of COVID-19 and pulmonary embolism or deep venous thrombus without critical exacerbation. Two patients died of respiratory failure due to COVID-19. DISCUSSION: Previous reports have suggested coagulopathy with thrombotic signs as the main pathological feature of COVID-19, but no previous reports have focused on coagulopathy evaluated by whole-body enhanced CT scan. Changes in hemostatic biomarkers, represented by an increase in D-dimer and fibrin/fibrinogen degradation products, indicated that the essence of coagulopathy was massive fibrin formation. Although there were no clinical symptoms related to their prognosis, critical COVID-19-induced systemic thrombus formation was observed. CONCLUSIONS: Therapeutic dose anticoagulants should be considered for critical COVID-19 because of induced coagulopathy, and aggressive follow-up by whole body enhanced CT scan for systemic venous thromboembolism (VTE) is necessary.

DOI： 10.1186/s12959-021-00280-z

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Language：Japanese   Publisher：日本救急医学会-関東地方会  

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J01057&link_issn=&doc_id=20210408300001&doc_link_id=10.24697%2Fjaamkanto.42.2_4&url=https%3A%2F%2Fdoi.org%2F10.24697%2Fjaamkanto.42.2_4&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic rapidly increases the use of mechanical ventilation (MV). Such cases further require extracorporeal membrane oxygenation (ECMO) and have a high mortality. OBJECTIVE: We aimed to identify prognostic biomarkers pathophysiologically reflecting future deterioration of COVID-19. METHODS: Clinical, laboratory, and outcome data were collected from 102 patients with moderate to severe COVID-19. Interleukin (IL)-6 level and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA copy number in plasma were assessed with ELISA kit and quantitative PCR. RESULTS: Twelve patients died or required ECMO owing to acute respiratory distress syndrome despite the use of MV. Among various variables, a ratio of oxygen saturation to fraction of inspired oxygen (SpO2/FiO2), IL-6, and SARS-CoV-2 RNA on admission before intubation were strongly predictive of fatal outcomes after the MV use. Moreover, among these variables, combining SpO2/FiO2, IL-6, and SARS-CoV-2 RNA showed the highest accuracy (area under the curve: 0.934). In patients with low SpO2/FiO2 (< 261), fatal event-rate after the MV use at the 30-day was significantly higher in patients with high IL-6 (> 49 pg/mL) and SARS-CoV-2 RNAaemia (> 1.5 copies/μL) compared to those with high IL-6 or RNAaemia or without high IL-6 and RNAaemia (88% vs. 22% or 8%, log-rank test P = 0.0097 or P < 0.0001, respectively). CONCLUSIONS: Combining SpO2/FiO2 with high IL-6 and SARS-CoV-2 RNAaemia which reflect hyperinflammation and viral overload allows accurately and before intubation identifying COVID-19 patients at high risk for ECMO use or in-hospital death despite the use of MV.

DOI： 10.1371/journal.pone.0256022

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：English  

DOI： 10.1016/j.jinf.2020.08.021

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Language：Japanese   Publisher：日本救急医学会-関東地方会  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J01057&link_issn=&doc_id=20200420370027&doc_link_id=10.24697%2Fjaamkanto.41.2_329&url=https%3A%2F%2Fdoi.org%2F10.24697%2Fjaamkanto.41.2_329&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：日本救急医学会-関東地方会  

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Language：Japanese   Publisher：日本救急医学会-関東地方会  

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Language：Japanese   Publisher：日本救急医学会-関東地方会  

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Language：Japanese   Publisher：(一社)日本災害医学会  

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Language：Japanese   Publisher：(一社)日本災害医学会  

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Language：Japanese   Publisher：(一社)医療の質・安全学会  

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Language：Japanese   Publisher：(一社)医療の質・安全学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：English   Publishing type：Research paper (scientific journal)  

Background: Outcomes in emergent patients with suspected infection depend on how quickly clinicians evaluate the patients and start treatment. This study was performed to compare the predictive ability of the quantitative capillary refill time (Q-CRT) as a new rapid index versus the quick sequential organ failure assessment (qSOFA) score and the systemic inflammatory response syndrome (SIRS) score for sepsis screening in the emergency department. Methods: This was a multicenter, observational, retrospective study of adult patients with suspected infection. The area under the curve (AUC) of receiver operating characteristic curve analyses and multivariate analyses were used to explore associations of the Q-CRT with the qSOFA score, SIRS score, and lactate concentration. Results: Of the 75 enrolled patients, 48 had sepsis. The AUC, sensitivity, and specificity of Q-CRT were 0.74, 58%, and 81%, respectively; those for the qSOFA score were 0.83, 66%, and 100%, respectively; those for the SIRS score were 0.61, 81%, and 40%, respectively, for SIRS score; and those for the lactate concentration were 0.76, 72%, and 81%, respectively. We found no statistically significant differences in the AUC between the scores. We then combined the Q-CRT and qSOFA score (Q-CRT/qSOFA combination) for sepsis screening. The AUC, sensitivity, and specificity of Q-CRT/qSOFA combination were 0.82, 83%, and 81%, respectively. Conclusions: In this study, Q-CRT/qSOFA combination had better sensitivity than the qSOFA score alone and better specificity than the SIRS score alone. There was no significant difference in accuracy between Q-CRT/qSOFA combination and the qSOFA score or lactate concentration. The ability of the Q-CRT to predict sepsis may be similar to that of the qSOFA score or serum lactate concentration; therefore, measurement of the Q-CRT may be an alternative for invasive measurement of the blood lactate concentration in evaluating patients with suspected sepsis.

DOI： 10.1186/s40560-019-0382-4

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Language：English   Publishing type：Research paper (scientific journal)  

Aim: Capillary refill time has been widely adopted for clinical assessment of the circulatory status of patients in emergency settings. We previously introduced quantitative capillary refill time and found a positive association between longer quantitative capillary refill time and higher lactate levels in the intensive care units, but not in the emergency department. In this study, we aimed to identify a quantitative and clinically applicable index of circulatory status (ΔAb) that can be measured with quantitative capillary refill time, then evaluated the linear association between this index and lactate levels in the emergency department. Methods: We undertook a prospective single-center observational study at a university hospital from November 2015 to July 2016. We included 139 patients with endogenous diseases to test the association between quantitative capillary refill time, ΔAb (measured with a pulse oximeter), and lactate levels. Results: ΔAb was independently and significantly associated with high lactate levels (odds ratio [95% confidence interval]: 0.16 [0.05-0.45]). Conclusions: We introduced ΔAb, measured using quantitative capillary refill time, as a surrogate index of lactate levels to overcome the shortcomings of capillary refill time. We showed that ΔAb is a feasible, non-invasive, and rapid assessment of patients with high lactate levels in emergency primary care settings. Future multicenter studies with a longitudinal design should be undertaken to verify our findings.

DOI： 10.1002/ams2.348

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Language：Japanese   Publisher：日本救急医学会-関東地方会  

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Language：Japanese   Publisher：日本救急医学会-関東地方会  

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Language：Japanese   Publisher：日本救急医学会-関東地方会  

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Language：Japanese   Publisher：日本救急医学会-関東地方会  

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Language：Japanese   Publisher：日本救急医学会-関東地方会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：日本救急医学会-関東地方会  

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Language：English   Publishing type：Research paper (scientific journal)  

Mumps virus infection primarily affects the salivary glands and may incur various complications. Laryngeal edema is such a rare complication that few adult cases have been reported. We report the first known pediatric patient with mumps with laryngeal edema. An 8-year-old boy developed dyspnea after a rapidly progressive swelling of his face and neck. Laryngoscopy revealed edematous changes in the supraglottic and subglottic regions, and computed tomography confirmed significant laryngeal edema in addition to swelling of the cervical soft tissue and the salivary glands. Laboratory findings revealed a high serum amylase level and confirmed the diagnosis of mumps. Intravenous steroid administration alleviated the dyspnea, although the patient required temporary tracheal intubation to maintain airway patency. He did not need tracheotomy and did not experience any other complications. Laryngeal edema must be regarded as a rare, potentially life-threatening complication of mumps. When mumps is diagnosed with significant swelling of the neck, an emergency airway should be established to prevent airway obstruction.

DOI： 10.1097/PEC.0b013e3182a60049

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：日本救急医学会-関東地方会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(株)メディカ出版  

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Language：Japanese   Publisher：医学図書出版(株)  

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Language：Japanese   Publisher：日本救急医学会-関東地方会  

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Language：Japanese   Publisher：(株)自然科学社  

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Language：Japanese   Publisher：(一社)日本外傷学会  

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Language：Japanese   Publisher：日本救急医学会-関東地方会  

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Language：Japanese   Publisher：日本病院前救急診療医学会  

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Language：Japanese   Publisher：医学図書出版(株)  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese  

J-GLOBAL

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Language：Japanese  

J-GLOBAL

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Language：Japanese  

J-GLOBAL

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