TY  - JOUR
AB  - PURPOSE: Major cardiovascular surgery imposes high physiologic stress, often causing severe organ dysfunction and poor outcomes. The underlying mechanisms remain unclear. This study investigated metabolic changes induced by major cardiovascular surgery and the potential role of identified metabolic signatures in postoperative acute kidney injury (AKI). METHODS: A prospective observational study included 53 patients undergoing major cardiovascular surgery in 3 groups: cardiac surgery with cardiopulmonary bypass (CPB n = 33), without CPB (n = 10), and major vascular surgery (n = 10). For each patient, peripheral blood samples were collected pre-surgery, and at 6 h and 24 h post-surgery. Untargeted metabolomics using mass spectrometry quantified 8668 metabolic features in serum samples. Linear mixed-effect models (adjusted for age, sex, and body mass index) and pathway analyses were performed. RESULTS: In the cardiac surgery with CPB group, 772 features were significantly altered (P < 2.8E - 05) across the 3 time points. These features were enriched in five classes, all related to protein metabolism, with glycine and serine metabolism being the most represented. Cardiac surgery with CPB showed a distinct metabolic signature compared to other groups. Patients who developed postoperative AKI exhibited increased protein catabolism (including valine, leucine, and isoleucine degradation), disruptions in the citric acid cycle, and plasmatic accumulation of acylcarnitines. CONCLUSION: Major cardiovascular surgery, particularly with CPB, induces significant changes in protein metabolism. Patients developing postoperative AKI exhibited specific metabolic signatures. These findings may be critical for designing interventions to minimize organ dysfunction, including AKI, and improve outcomes in major cardiovascular surgery.
AU  - Velho, T.R.*
AU  - Pinto, F.*
AU  - Ferreira, R.C.*
AU  - Pereira, R.M.*
AU  - Duarte, A.*
AU  - Harada, M.
AU  - Willmann, K.*
AU  - Pedroso, D.*
AU  - Paixão, T.*
AU  - Guerra, N.C.*
AU  - Neves-Costa, A.*
AU  - Santos, I.*
AU  - Gouveia E Melo, R.*
AU  - Brito, D.*
AU  - Almeida, A.G.*
AU  - Nobre, A.*
AU  - Wang-Sattler, R.
AU  - Köcher, T.*
AU  - Pedro, L.M.*
AU  - Moita, L.F.*
C1  - 73187
C2  - 56951
CY  - One New York Plaza, Suite 4600, New York, Ny, United States
SP  - 259-271
TI  - Role of major cardiovascular surgery-induced metabolic reprogramming in acute kidney injury in critical care.
JO  - Intensive Care Med.
VL  - 51
IS  - 2
PB  - Springer
PY  - 2025
SN  - 0342-4642
ER  - 

TY  - JOUR
AB  - Purpose The coronavirus disease 2019 (COVID-19) poses major challenges to health-care systems worldwide. This pandemic demonstrates the importance of timely access to intensive care and, therefore, this study aims to explore the accessibility of intensive care beds in 14 European countries and its impact on the COVID-19 case fatality ratio (CFR). Methods We examined access to intensive care beds by deriving (1) a regional ratio of intensive care beds to 100,000 population capita (accessibility index, AI) and (2) the distance to the closest intensive care unit. The cross-sectional analysis was performed at a 5-by-5 km spatial resolution and results were summarized nationally for 14 European countries. The relationship between AI and CFR was analyzed at the regional level. Results We found national-level differences in the levels of access to intensive care beds. The AI was highest in Germany (AI = 35.3), followed by Estonia (AI = 33.5) and Austria (AI = 26.4), and lowest in Sweden (AI = 5) and Denmark (AI = 6.4). The average travel distance to the closest hospital was highest in Croatia (25.3 min by car) and lowest in Luxembourg (9.1 min). Subnational results illustrate that capacity was associated with population density and national-level inventories. The correlation analysis revealed a negative correlation of ICU accessibility and COVID-19 CFR (r = - 0.57;p < 0.001). Conclusion Geographical access to intensive care beds varies significantly across European countries and low ICU accessibility was associated with a higher proportion of COVID-19 deaths to cases (CFR). Important differences in access are due to the sizes of national resource inventories and the distribution of health-care facilities relative to the human population. Our findings provide a resource for officials planning public health responses beyond the current COVID-19 pandemic, such as identifying potential locations suitable for temporary facilities or establishing logistical plans for moving severely ill patients to facilities with available beds.
AU  - Bauer, J.*
AU  - Brüggmann, D.*
AU  - Klingelhöfer, D.*
AU  - Maier, W.
AU  - Schwettmann, L.
AU  - Weiss, D.J.*
AU  - Groneberg, D.A.*
C1  - 60027
C2  - 49176
CY  - One New York Plaza, Suite 4600, New York, Ny, United States
SP  - 2026-2034
TI  - Access to intensive care in 14 European countries: A spatial analysis of intensive care need and capacity in the light of COVID-19.
JO  - Intensive Care Med.
VL  - 46
IS  - 11
PB  - Springer
PY  - 2020
SN  - 0342-4642
ER  -