AIM: Hepatitis G virus (HGV) is a newly identified RNA virus belonging to the Flaviviridae genus. HGV infection has been reported in 1-2% of blood donors and 5-20% of adult patients with various liver diseases. There are no published reports addressing the role of HGV infection in children. We have assessed the prevalence and impact of HGV infection in children with liver disease. METHOD: 107 children with liver disease were studied (12 chronic Hepatitis C virus (HCV) infection, 27 chronic Hepatitis B virus (HBV) infection, 12 fulminant hepatic failure (FHF, n = 12: 10 idiopathic; 2 due to HBV infection), 7 graft dysfunction following liver transplantation (GDF), 20 cryptogenic liver disease (CRY) and 29 autoimmune liver disease). Each patient was examined for HGV RNA by RT-PCR using primers specific for the 5′ non-coding region followed by ELISA (Boehringer Mannheim). Further samples were analysed from those who were found to be positive. RESULTS: HGV RNA was detected in 4/107 (one each with HBV, FHF, GDF and CRY). Risk factors were identified from 3 patients, including blood transfusion and/or medical treatment in Eastern Europe. In the case with HBV infection, HGV RNA was detected before interferon (IFN) therapy, but became negative after IFN. In the case of GDF, HGV RNA was positive before and after transplantation. No clear relationship between liver dysfunction and HGV RNA was found. CONCLUSIONS: The prevalence of HGV infection in children with liver disease is higher than that in blood donors but lower than that in adult patients with liver disease. However, HGV is not associated with any specific disease group and does not seem to be a major aetiological factor of liver disease in childhood in the UK.
We aimed to determine the association between the intensive care unit (ICU) model and in-hospital mortality of patients with severe sepsis and septic shock.This was a secondary analysis of a multicenter prospective observational study conducted in 59 ICUs in Japan from January 2016 to March 2017. We included adult patients (aged ≥16 years) with severe sepsis and septic shock based on the sepsis-2 criteria who were admitted to an ICU with a 1:2 nurse-to-patient ratio per shift. Patients were categorized into open or closed ICU groups, according to the ICU model. The primary outcome was in-hospital mortality.A total of 1018 patients from 45 ICUs were included in this study. Patients in the closed ICU group had a higher severity score and higher organ failure incidence than those in the open ICU group. The compliance rate for the sepsis care 3-h bundle was higher in the closed ICU group than in the open ICU group. In-hospital mortality was not significantly different between the closed and open ICU groups in a multilevel logistic regression analysis (odds ratio = 0.83, 95% confidence interval; 0.52-1.32, P = .43) and propensity score matching analysis (closed ICU, 21.2%; open ICU, 25.7%, P = .22).In-hospital mortality between the closed and open ICU groups was not significantly different after adjusting for ICU structure and compliance with the sepsis care bundle.
Acute kidney injury (AKI) is associated with high mortality. Multiple AKI severity scores have been derived to predict patient outcome. We externally validated new AKI severity scores using the Japanese Society for Physicians and Trainees in Intensive Care (JSEPTIC) database.New AKI severity scores published in the 21st century (Mehta, Stuivenberg Hospital Acute Renal Failure (SHARF) II, Program to Improve Care in Acute Renal Disease (PICARD), Vellore and Demirjian), Liano, Simplified Acute Physiology Score (SAPS) II and lactate were compared using the JSEPTIC database that collected retrospectively 343 patients with AKI who required continuous renal replacement therapy (CRRT) in 14 intensive care units. Accuracy of the severity scores was assessed by the area under the receiver-operator characteristic curve (AUROC, discrimination) and Hosmer-Lemeshow test (H-L test, calibration).The median age was 69 years and 65.8% were male. The median SAPS II score was 53 and the hospital mortality was 58.6%. The AUROC curves revealed low discrimination ability of the new AKI severity scores (Mehta 0.65, SHARF II 0.64, PICARD 0.64, Vellore 0.64, Demirjian 0.69), similar to Liano 0.67, SAPS II 0.67 and lactate 0.64. The H-L test also demonstrated that all assessed scores except for Liano had significantly low calibration ability.Using a multicenter database of AKI patients requiring CRRT, this study externally validated new AKI severity scores. While the Demirjian's score and Liano's score showed a better performance, further research will be required to confirm these findings.
Objectives We aimed to investigate the factors related to prolonged on-scene times, which were defined as being over 30 min, during ambulance transportation for critical emergency patients in the context of a large Japanese city. Design A population-based observational study. Setting Kawasaki City, Japan's eighth largest city. Participants The participants in this study were all critical patients (age ≥15 years) who were transported by ambulance between April 2010 and March 2013 (N=11 585). Outcome measures On-scene time during ambulance transportation for critical emergency patients. Results The median on-scene time for all patients was 17 min (IQR 13–23). There was a strong correlation between on-scene time and the number of phone calls to hospitals from emergency medical service (EMS) personnel (p<0.001). In multivariable logistic regression, the number of phone calls to hospitals from EMS personnel, intoxication, minor disease and geographical area were associated with on-scene times over 30 min. Age, gender, day of the week and time of the day were not associated with on-scene times over 30 min. Conclusions To make on-scene time shorter, it is vital to redesign our emergency system and important to develop a system that accommodates critical patients with intoxication and minor disease, and furthermore to reduce the number of phone calls to hospitals from EMS personnel.
Hepatitis GB virus-C (HGBV-C)/hepatitis G virus (HGV) infection was investigated in 106 children with liver disease (54 boys and 52 girls, mean age 7.3 years); 12 with chronic hepatitis C virus infection, 29 with positive hepatitis B surface antigen, nine with idiopathic fulminant hepatic failure, seven with graft dysfunction after liver transplantation associated with autoimmune features, 20 with cryptogenic liver disease, and 29 with autoimmune liver disease. HGV RNA detected by reverse transcription polymerase chain reaction was found to be positive in 4/106 patients (3.8%). Risk factors were identified in three patients, including blood transfusion and/or medical treatment in Eastern Europe. The prevalence was higher than that of blood donors but lower than that of 2 adult patients with liver disease. HGV is not associated with any specific disease group and does not seem to be a major aetiological agent of liver disease in childhood in the UK.
