Pietro Caironi's research while affiliated with Università degli Studi di Torino and other places
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Publications (360)
It is commonly assumed that changes in plasma strong ion difference (SID) result in equal changes in whole-blood base excess (BE). However, at varying pH, albumin ionic-binding and transerythrocyte shifts alter the SID of plasma without affecting that of whole-blood (SID wb), i.e., the BE. We hypothesize that, during acidosis, 1) an expected plasma...
Objective
Sepsis and septic shock are major challenges and economic burdens to healthcare, impacting millions of people globally and representing significant causes of mortality. Recently, a large number of quality improvement programs focused on sepsis resuscitation bundles have been instituted worldwide. These educational initiatives have been sh...
Background
in COVID-19 acute respiratory failure, the effects of CPAP and FiO 2 on respiratory effort and lung stress are unclear. We hypothesize that, in the compliant lungs of early Sars-CoV-2 pneumonia, the application of positive pressure through Helmet-CPAP may not decrease respiratory effort, and rather worsen lung stress and oxygenation when...
Background: Tracheal intubation is a high-risk procedure in the critically ill, with increased intubation failure rates and a high risk of other adverse events. Videolaryngoscopy might improve intubation outcomes in this population, but evidence remains conflicting, and its impact on adverse event rates is debated.
Although effective and appropriate fluid management is a critical aspect of quality care during hospitalization, the widespread adoption of consistent policies that ensure adequate fluid stewardship has been slow and heterogenous. Despite evidence-based guidelines on fluid management being available, clinical opinions continue to diverge on importa...
Background:
Tracheal intubation is a high-risk procedure in the critically ill, with increased intubation failure rates and a high risk of other adverse events. Videolaryngoscopy might improve intubation outcomes in this population, but evidence remains conflicting, and its impact on adverse event rates is debated.
Methods:
This is a subanalysis...
Physiologic dead space is a well-established independent predictor of death in patients with acute respiratory distress syndrome (ARDS). Here, we explore the association between a surrogate measure of dead space (DS) and early outcomes of mechanically ventilated patients admitted to Intensive Care Unit (ICU) because of COVID-19-associated ARDS. Ret...
Background:
Administration of supplemental oxygen is a life-saving treatment in critically ill patients. Still, optimal dosing remains unclear during sepsis. The aim of this post-hoc analysis was to assess the association between hyperoxemia and 90-day mortality in a large cohort of septic patients.
Methods:
This is a post-hoc analysis of the Al...
Background:
Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation.
Methods:
WEAN SAFE was an international, multi...
Background
The efficacy of early treatment with convalescent plasma in patients with COVID-19 is debated. Nothing is known about the potential effect of other plasma components other than anti-SARS-CoV-2 antibodies.
Methods
To determine whether convalescent or standard plasma would improve outcomes for adults in early phase of Covid19 respiratory...
Since the beginning of the COVID-19 pandemic, the impact of superinfections in intensive care units (ICUs) has progressively increased, especially carbapenem-resistant Acinetobacter baumannii (CR-Ab). This observational, multicenter, retrospective study was designed to investigate the characteristics of COVID-19 ICU patients developing CR-Ab coloni...
Background: The factors that may contribute to learners’ perception about the usefulness of Anaesthesia Crisis Resource Management (ACRM) key points are little known. Objectives: We investigated the link between demographic factors and the effect of an ACRM simulation training on anaesthesiologists’ perceived value of ACRM key points. Design: A pro...
Low serum albumin (SA) correlates with mortality in critically ill patients, including those with COVID-19. We aimed to identify SA thresholds to predict the risk of longer hospital stay, severe respiratory failure, and death in hospitalized adult patients with COVID-19 pneumonia. A prospective longitudinal study was conducted at the Infectious Dis...
Background:
Delirium is thought to be common across various settings of care; however, still little research has been conducted in rehabilitation.
Aim:
We investigated the prevalence of delirium, its features and motor subtypes in older patients admitted to rehabilitation facilities during the three editions of the "Delirium Day project".
Metho...
Purpose
We aimed to assess the combined role of vitamin D and albumin serum levels as predictors of COVID-19 disease progression.
Methods
We conducted a prospective observational study on adult patients hospitalized for SARS-CoV-2 pneumonia (March–September 2020). Vitamin D and albumin serum levels were measured on admission. These variables were...
Introduction
Delirium and sarcopenia are common, although underdiagnosed, geriatric syndromes. Several pathological mechanisms can link delirium and low skeletal muscle mass, but few studies have investigated their association. We aimed to investigate (1) the association between delirium and low skeletal muscle mass and (2) the possible role of cal...
Purpose
Iatrogenic fluid overload is a potential side effect of intravenous fluid therapy in the hospital. Little attention has been paid to sodium administration as a separate cause of harm. With this narrative review, we aim to substantiate the hypothesis that a considerable amount of fluid-induced harm is caused not only by fluid volume, but als...
Background
Septic shock is characterized by breakdown of the endothelial glycocalyx and endothelial damage, contributing to fluid extravasation, organ failure and death. Albumin has shown benefit in septic shock patients. Our aims were: (1) to identify the relations between circulating levels of syndecan-1 (SYN-1), sphingosine-1-phosphate (S1P) (en...
Background
The role of intravenous immunoglobulins (IVIG) during sepsis is controversial, as different trials on IVIG have observed inconsistent survival benefits. We aimed to elucidate the possible association and clinical significance between circulating levels of immunoglobulins.
Methods
In a subset of 956 patients with severe sepsis and septic...
Background
International guidelines suggest using a higher (>10 cmH2O) positive end-expiratory pressure (PEEP) in patients with moderate-to-severe acute respiratory distress syndrome (ARDS) due to the novel coronavirus disease (COVID-19). However, even if oxygenation generally improves with a higher PEEP, compliance and arterial carbon dioxide tens...
Inflammation and oxidative stress characterize sepsis and determine its severity. In this study, we investigated the relationship between albumin oxidation and sepsis severity in a selected cohort of patients from the Albumin Italian Outcome Study (ALBIOS). A retrospective analysis was conducted on the oxidation forms of human albumin [human mercap...
Letter to editor regarding "Endothelial damage in septic shock patients as evidenced by circulating syndecan-1, sphingosine-1-phosphate and soluble VE-cadherin: a substudy of ALBIOS" by Piotti et al. [1].
We read with great interest the article by Piotti et al. which showed that soluble VE-cadherin was independently associated with the need for re...
Rationale: Septic patients have typically reduced concentrations of hemoglobin and albumin, the major components of non-carbonic buffer power(β). This could expose patients to high pH variations during acid-base disorders. Objectives: To compare, in-vitro, non-carbonic β of septic patients with that of healthy volunteers, and evaluate its distinct...
Mortality risk in COVID-19 patients is determined by several factors. The aim of our study was to adopt an integrated approach based on clinical, laboratory and chest x-ray (CXR) findings collected at the patient’s admission to Emergency Room (ER) to identify prognostic factors. Retrospective study on 346 consecutive patients admitted to the ER of...
The long pentraxin 3 (PTX3), described initially as a microvascular inflammation marker, is an acute‐phase protein released by several cell types in response to infection or tissue damage. It contributes to resistance to bacteria, fungi, viruses, and inflammation regulation (1). Circulating PTX3 was abnormally high (>2 ng/ml) in all 958 patients wi...
Background
The best fluid replacement strategy and the role of albumin in immunocompromised patients with sepsis is unclear.
Methods
We performed a secondary analysis of immunocompromised patients enrolled in the ALBIOS trial which randomized patients with severe sepsis or septic shock to receive either 20% albumin (target 30 g per liter or more)...
Intravenous fluid administration should be considered as any other pharmacological prescription. There are three main indications: resuscitation, replacement, and maintenance. Moreover, the impact of fluid administration as drug diluent or to preserve catheter patency, i.e., fluid creep, should also be considered. As for antibiotics, intravenous fl...
Objective
Sensory deficits are important risk factors for delirium but have been investigated in single-center studies and single clinical settings. This multicenter study aims to evaluate the association between hearing and visual impairment or bi-sensory impairment (visual and hearing impairment) and delirium.
Design
Cross-sectional study nested...
Background
Pro‐protein convertase subtilisin/kexin 9 (PCSK9) is a proenzyme primarily known to regulate low‐density lipoprotein receptor re‐uptake on hepatocytes. Whether PCSK9 can concurrently trigger inflammation or not remains unclear. Here, we investigated the potential association between circulating levels of PCSK9 and mortality in patients w...
Background
Inflammatory biomarkers are useful in detecting patients with sepsis. The prognostic role of resistin and myeloperoxidase (MPO) has been investigated in sepsis.
Materials and Methods
Plasma resistin and MPO were measured on days 1, 2, and 7 in 957 patients enrolled in the Albumin Italian Outcome Sepsis (ALBIOS) trial. The association be...
Objective:
To investigate the behavior of pentraxin-3 (PTX3), troponin T (hsTnT), N-terminal pro-B type Natriuretic Peptide (NT-proBNP) in sepsis and their relationships with sepsis severity and oxygen transport/utilization impairment.
Design:
Retrospective analysis of PTX3, hsTnT, NT-proBNP levels at day 1, 2 and 7 after admission in the intens...
Background
Inflammatory biomarkers could be useful to stratify the risk of sepsis adverse outcome and potentially improving the clinical management. Here, we investigated the prognostic role of the inflammatory molecule osteopontin (OPN) in patients with severe sepsis with and without septic shock.
Material and methods
This is a sub-analysis of 95...
Background:
D-dimer (DD) is the most used fibrin-related marker and has been proposed, either alone or in combination with other variables, as prognostic factor in patients with sepsis. However, DD generation depends on both coagulation and fibrinolysis, meaning that it may give false negative results in conditions associated with marked fibrinoly...
RATIONALE: Acidemia is a severe condition among critically ill patients. Despite lack of evidence, sodium bicarbonate is frequently used to correct pH. However, its administration is burdened by several side effects. We hypothesized that the reduction of plasma chloride concentration could be an alternative strategy to correct acidemia.
OBJECTIVES:...
Abstract Background A reanalysis of the ALBIOS trial suggested that patients with septic shock - defined by vasopressor-dependent hypotension in the presence of severe sepsis (Shock-2) - had a survival benefit when treated with albumin. The new septic shock definition (Shock-3) added the criterion of a lactate threshold of 2 mmol/L. We investigated...
Introduction: Subglottic stenosis (SS) is a congenital or acquired constriction of the airways. Treatment of major SS could be very challenging, as concomitant airway management could require extraordinary techniques and planning.
Case: On July 4 2018, an 81-years-old woman underwent an interventional bronchoscopy dilatation due to severe chronic,...
Background:
Acute kidney injury (AKI)9 occurs in many critically ill patients and is associated with high mortality. We examined whether proenkephalin could predict incident AKI and its improvement in septic patients.
Methods:
Plasma proenkephalin A 119-159 (penKid) was assayed in 956 patients with sepsis or septic shock enrolled in the multicen...
![TABLE 1 ] Comparison of Baseline Characteristics, Physiological...](profile/Alessandro-Protti/publication/325254638/figure/tbl1/AS:668907903930369@1536491480110/Comparison-of-Baseline-Characteristics-Physiological-Variables-and-Laboratory_Q320.jpg)
![TABLE 1 ] (Continued)](profile/Alessandro-Protti/publication/325254638/figure/tbl2/AS:668907903909890@1536491480164/Continued_Q320.jpg)
Background:
Relevance of low (<70%) central venous oxygen saturation (ScvO2) during early sepsis has been recently questioned by three negative trials (ProCESS, ARISE and ProMISe) on early goal-directed therapy (EGDT). However, subjects included in those trials had ScvO2 at enrolment as high as 71±13%, 73±11% and 70±12%. Herein we assessed the ass...
In this work, we examined plasma metabolome, proteome and clinical features in patients with severe septic shock enrolled in the multicenter ALBIOS study. The objective was to identify changes in the levels of metabolites involved in septic shock progression and to integrate this information with the variation occurring in proteins and clinical dat...
Objectives:
Secretoneurin directly influences cardiomyocyte calcium handling, and circulating secretoneurin levels seem to improve risk prediction in patients with myocardial dysfunction by integrating information on systemic stress, myocardial function, and renal function. Accordingly, in this study, we hypothesized that secretoneurin would impro...
The present chapter summarizes (1) the mechanisms regulating spontaneous breathing activity fundamental to understand the pathophysiology of respiratory acid-base disorders, (2) the compensatory mechanisms, (3) signs and symptoms of hypercapnia and hypocapnia, and (4) causes of and treatment options for acute and chronic respiratory acid-base disor...
Objective:
Thrombocytopenia is the most common hemostatic disorder during sepsis and is associated with high mortality. We examined whether fibrinolytic changes precede incident thrombocytopenia and predict outcome in patients with severe sepsis.
Design:
Nested study from the multicenter, randomized, controlled trial on the efficacy of albumin r...
Background:
The biological role of adrenomedullin, a hormone involved in hemodynamic homeostasis, is controversial in sepsis, since administration of either the peptide or an antibody against it may be beneficial.
Methods:
Plasma bio-ADM was assessed on days 1, 2 and 7 after randomization of 956 patients with sepsis or septic shock to albumin or...
Severe sepsis and septic shock are major causes of morbidity and mortality in patients entering the emergency department (ED) or intensive care unit (ICU). Despite substantial efforts to improve patient outcome, treatment of sepsis remains challenging to clinicians. In this context, early goal directed therapy (EGDT) represents an important concept...
Background:
Although the loop-diuretic furosemide is widely employed in critically ill patients with known long-term effects on plasma electrolytes, accurate data describing its acute effects on renal electrolyte handling and the generation of plasma electrolyte alterations are lacking. We hypothesized that the long-term effects of furosemide on p...
Background:
The long pentraxin PTX3 is a key component of the humoral arm of innate immunity related to sepsis severity and mortality. We evaluated the clinical and prognostic significance of circulating PTX3 in the largest cohort ever reported of patients with severe sepsis or septic shock.
Design:
Plasma PTX3 was measured on days 1, 2 and 7 af...
Sepsis is a heterogeneous disease caused by an infection stimulus that triggers several complex local and systemic immuno-inflammatory reactions, which results in multiple organ dysfunction and significant morbidity and mortality. The diagnosis of sepsis is challenging because there is no gold standard for diagnosis. As a result, the clinical diagn...
Purpose of review:
The review focuses on fluid resuscitation of critically ill patients with either colloid or crystalloid solutions.
Recent findings:
In healthy patients, the volume expanding effect of colloids is greater than that of crystalloids. However, in critically ill patients, a similar amount of crystalloids and colloids is required fo...
Table of contents:
PHYSICIANS ABSTRACTSO1 Impact of tracheal cuff shape on microaspiration of gastric contents in intubated critically ill patients: a multicenter randomized controlled study (BEST CUFF)Emmanuelle Jaillette, Christophe Girault, Guillaume Brunin, Farid Zerimech, Arnaud Chiche, Céline Broucqsault-Dedrie, Cyril Fayolle, Franck Minacor...
https://www.area-c54.it/public/abstractbook%20siaarti%202015.pdf
Septic shock remains a major problem in Intensive Care Unit, with high lethality and high-risk second lines treatments. In this preliminary retrospective investigation we examined plasma metabolome and clinical features in a subset of 20 patients with severe septic shock (SOFA score >8), enrolled in the multicenter Albumin Italian Outcome Sepsis st...
Among several alterations affecting the cardiovascular system during severe sepsis or septic shock, myocardial depression has been pointed out with increasing attention over the last 30 years as a frequent and often misdiagnosed clinical condition. As expected, patients with cardiac dysfunction during sepsis have a worse prognosis than those withou...
"Balanced" solutions are commonly defined as intravenous fluids having an electrolyte composition close to that of plasma. As such, they should minimally affect acid-base equilibrium, as compared to the commonly reported 0.9% NaCl-related hyperchloremic metabolic acidosis. Recently, the term "balanced" solution has been also employed to indicate in...
Objectives:
Myocardial dysfunction is a frequent complication in patients with severe sepsis and can worsen the prognosis. We investigated whether circulating biomarkers related to myocardial function and injury predicted outcome and were associated with albumin replacement.
Design:
A multicenter, randomized clinical trial about albumin replacem...
Background: Plasma secretoneurin (SN) is directly correlated to cardiomyocyte Ca ²⁺ handling and provides independent prognostic information in cardiovascular disease. Whether SN may predict mortality in patients with severe sepsis or septic shock is not established.
Methods: We measured SN levels in serial plasma samples collected on days 1, 2, an...
Introduction:
Elucidation of early metabolic signatures that predict survival in septic shock might help clinicians in prioritizing individual patient treatment. In this preliminary investigation, we examined plasma metabolome and clinical features in a subset of 20 patients with septic shock, enrolled in the multicenter Albumin Italian Outcome Se...
The use of albumin-containing solutions in critically ill patients has been recently revisited, following evidence on harmful effects of synthetic colloids, and novel randomized controlled trials (RCTs) in sepsis. Here, we review the most recent findings on albumin administration in acutely ill and septic patients.
The revision of Starling's theory...
https://www.area-c54.it/public/abstractbook%20siaarti%202015.pdf
Acid-base effects of different crystalloid solutions for ECMO priming: preliminary report
E Scotti,1 M Ferrari,1 M Chiodi,1 F Zadek,1 I Belloni,1 L Zazzeron,1 T Langer,1 L Gattinoni,1 and P Caironi1
Introduction
The induction of ECMO may result in metabolic acidosis [1] due to circuit priming with chloride-rich fluids, and the sudden decrease in p...
The kidney, being one of the most fascinating and commonly studied organs within human physiology, has a crucial role in maintaining the homeostasis of our organism from several different perspectives, from clearing of cellular catabolism products, to body fluids and electrolyte content regulation, hemodynamic stability and acid-base equilibrium [1...
Objectives:
The Berlin definition of acute respiratory distress syndrome has introduced three classes of severity according to PaO2/FIO2 thresholds. The level of positive end-expiratory pressure applied may greatly affect PaO2/FIO2, thereby masking acute respiratory distress syndrome severity, which should reflect the underlying lung injury (lung...
Purpose:
Presepsin is a soluble fragment of the cluster-of-differentiation marker protein 14 (CD14) involved in pathogen recognition by innate immunity. We evaluated the relation between its circulating concentration, host response, appropriateness of antibiotic therapy, and mortality in patients with severe sepsis.
Methods:
Plasma presepsin was...
Intravenous fluid administration is a medical intervention performed worldwide on a daily basis. Nevertheless, only a few physicians are aware of the characteristics of intravenous fluids and their possible effects on plasma acid-base equilibrium. According to Stewart's theory, pH is independently regulated by three variables: partial pressure of c...
Purpose:
Partial pressure of carbon dioxide (PCO2), strong ion difference (SID), and total amount of weak acids independently regulate pH. When blood passes through an extracorporeal membrane lung, PCO2 decreases. Furthermore, changes in electrolytes, potentially affecting SID, were reported. We analyzed these phenomena according to Stewart's appr...
We read with interest the editorial by Flannery and colleagues [1], who proposed ‘a dose of healthy skepticism’ toward the findings of our Albumin Italian Outcome Sepsis (ALBIOS) trial [2]. Although we feel uncertain about where such ‘health’ may come from, we consider a few extra words necessary. First, the rationale of the subgroup analysis of 90...
Human beings are constituted mainly of water. In particular, children's total body water might reach 75-80% of their body weight, compared to 60-70% in adults. It is therefore not surprising, that children, especially hospitalized newborns and infants, are markedly prone to water and electrolyte imbalances. Parenteral fluid therapy is a cornerstone...
Background:
Although previous studies have suggested the potential advantages of albumin administration in patients with severe sepsis, its efficacy has not been fully established.
Methods:
In this multicenter, open-label trial, we randomly assigned 1818 patients with severe sepsis, in 100 intensive care units (ICUs), to receive either 20% album...
BACKGROUND
Although previous studies have suggested the potential advantages of albumin administration
in patients with severe sepsis, its efficacy has not been fully established.
METHODS
In this multicenter, open-label trial, we randomly assigned 1818 patients with severe
sepsis, in 100 intensive care units (ICUs), to receive either 20% albumin an...
Sepsis, a leading cause of death in critically ill patients, is the result of complex interactions between the infecting microorganisms and the host responses that influence clinical outcomes. We evaluated the prognostic value of presepsin (sCD14-ST), a novel biomarker of bacterial infection, and compared it with procalcitonin.
This is a retrospect...
Introduction: Low levels of IgG have been associated with poor outcome in sepsis; however, previous studies focused only on small cohorts of patients. Also, few data are available on the evolution of immunoglobulin levels over time. The aim of this study was to evaluate the incidence of hypogammaglobulinemia and their prognostic value in a large co...
Positive end-expiratory pressure exerts its effects keeping open at end-expiration previously collapsed areas of the lung; consequently, higher positive end-expiratory pressure should be limited to patients with high recruitability. We aimed to determine which bedside method would provide positive end-expiratory pressure better related to lung recr...
Introduction: Sepsis, a leading cause of death in critically ill patients, is the result of complex interactions between the infecting microorganisms and the host responses that influence clinical outcomes. We evaluated the prognostic value of presepsin (sCD14-ST), a novel biomarker of bacterial infection, and compared it with procalcitonin (PCT).
Introduction
The biochemical characteristics of infused fluids may be important in regulating acid-base balance, by modifying plasmatic volume and strong ion difference. In vitro and animal studies [1,2] have shown that volume and strong ion difference of infused fluids (SIDin) as well as the arterial baseline bicarbonate concentration (HCO3-a) inf...
Introduction
Furosemide is one of the most employed diuretics in the ICU for its ability to induce negative water balance. However, one common side effect is metabolic alkalosis [1]. We aimed to describe the time course of urinary excretion and changes in plasmatic acid-base balance in response to the administration of furosemide.
Methods
We con...
Sepsis results from complex interactions between infecting microorganisms and host responses, often leading to multiple organ failures and death. Over the years, its treatment has been standardized in early goal-oriented therapies, which may benefit from circulating biomarkers for early risk stratification. We aimed to evaluate the prognostic value...
Citations
... Fluid management is an important component of ERAS, and the implementation of early postoperative water intake is a critical initiative to promote fluid management and a favourable condition that facilitates gastrointestinal function recovery and reduces adverse stress reactions [3,4]. According to traditional concepts, patients are required to abstain from routine food and fluid intake In the early postoperative stage, and considering patient safety during the postoperative period, to avoid complications such as aspiration and vomiting due to incomplete water intake on regaining consciousness [5]. ...
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... This subgroup re-analysis was also intentionally restricted to elective surgical patients, since it represents the most controlled clinical environment where airway management occurs and where VL skills can be most effectively taught to all airway managers [18]. However, it is important to recognize the advantages of VL over DL extend beyond the operating theatre and elective setting, as clearly demonstrated by the recent 'DEVICE' and 'INTUBE' studies in the emergency department and intensive care environments [19,20]. Transferability of skills, personnel and the device itself make standardization of VL equipment across an entire hospital/group of hospitals all the more attractive. ...
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... Like in ARDS patients, COVID-19 pneumonia is characterized by an increase in minute ventilation and an increase in the dead space fraction [19,20]. Additionally, in COVID-19 ARDS patients, there is a significant association between the amount of dead space computed in the first 7 days and mortality [21]. According to a secondary analysis of the PRoVENT COVID-19 study, the dead space fraction is significantly greater in nonsurvivors and increases more during the first four days than in survivors, suggesting that dynamic changes during the initial week in the intensive care unit (ICU) are crucial for evaluating outcomes [22]. ...
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... In a previous study of patients with septic shock, those who received mechanical ventilation with a fraction of inspired oxygen (FiO 2 ) set at 100% during the first ICU had a higher tendency of mortality than those who had a conventional PaO 2 target [13]. However, a study focusing on the oxygen target in patients with sepsis has recently suggested that a higher-thanusual oxygen target might lead to a better prognosis [14]. Another recent research found a trend toward higher mortality in patients treated with low oxygen targets (PaO 2 55-80 mm Hg) compared to a high oxygenation strategy (PaO 2 110-150 mm Hg) [15]. ...
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... Respiratory care centers (RCCs), specialized units downstream of ICUs in Taiwan, provide effective care for patients who have repeatedly experienced ventilator weaning failure while in intensive care and have undergone prolonged mechanical ventilation [1]. In previous investigations, weaning success rates ranged from 38-70% [2][3][4][5][6][7]. Successful weaning has been attributed to several factors including age, nutritional status, comorbid conditions, muscle strength, lung mechanics, renal function, and hemoglobin (Hb) levels [1,2,[8][9][10]. ...
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... After the exclusion of 130 records, 94 full-text articles were identified and assessed for eligibility, resulting in the selection of 48 RCTs. Finally, after the exclusion of 16 RCTs (see Supplementary Table S1 for the reasons for their exclusion), 32 RCTs [7,8,10,[12][13][14][15][16][17][18][20][21][22]25,26,28,[30][31][32]34,35,[37][38][39]41,43,[45][46][47][48][49]51] were included in the systematic review. The study selection process is summarized in the PRISMA flow diagram in Figure 1. ...
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... The need for a pre-pandemic control population becomes even more relevant if we consider countries burdened by a high incidence of multidrug-resistant (MDR) organisms, since it is difficult to define the impact of these pathogens on mortality. Although an insight into risk factors for VAP in COVID-19 patients is given in the coVAPid study [6] -a large multicenter retrospective cohort study comparing COVID-19 ICU patients with patients with influenza and no viral infection -a particularly high percentage of MDR pathogens, especially carbapenem-resistant Acinetobacter baumannii (CR-Ab) [14], has been documented in countries, such as Italy, already affected by antimicrobial resistance. ...
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... Chen et al. demonstrated that age independently predicted decreased albumin in COVID-19 patients, with a 4.4% increased risk of hypoalbuminemia per additional year of age 13 . Earlier studies indicated a decline in serum albumin concentrations, particularly in the presence of sepsis, poor liver function, and severe disease, with a more pronounced effect in men and, notably, in the context of COVID-19 14,15 . Reduced albumin in the elderly may be linked to factors such as altered dietary intake, changes in taste and smell, hormonal shifts affecting gastrointestinal motility, and variations in mood [16][17][18] . ...
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... Physical disability has been widely associated as a risk factor for the onset of delirium; an example of this is the study by Sidoli et al. [39] in which 1237 patients aged 65 years or older were studied and it was found that non-modifiable factors, such as physical disability, and modifiable factors, such as physical restrictions, were associated with the onset of delirium. ...
... Since the beginning of the pandemic, scientists have focused their efforts on identifying COVID-19 risks and prognostic factors (Sambataro et al., 2020). Several clinical studies have correlated a significant decrease in human serum albumin (HSA) levels in plasma with poor COVID-19 prognosis, suggesting that hypoalbuminemia (HSA levels < 3.5 g/dL) predisposes patients to a faster progression of SARS-CoV-2 infection and systemic complications Kheir et al., 2021;Soetedjo et al., 2021;Sanson et al., 2023;Zekri-Nechar et al., 2022;Zerbato et al., 2022). Indeed, COVID-19 patients with hypoalbuminemia are 2.1 times more likely to have severe disease and 1.5 times more likely to be hospitalized than patients with normal albumin levels. ...
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