BACKGROUND:Candidaemia remains a common, life-threatening infection among intensive care unit (ICU) patients, with high mortality, particularly in patients with delayed diagnosis and treatment. OBJECTIVES:This international, multicentre, prospective, observational study aimed to identify risk factors for candidaemia in ICU patients and to develop an easy-to-use predictive tool, the CanDi-Score, for early initiation of empirical antifungal treatment. PATIENTS/METHODS:All adults over 18 years hospitalised for more than 48 h in the ICUs were included in the study and followed for 30 days. Data on demographics, comorbidities, clinical severity scores including APACHE II and SOFA scores, Charlson comorbidity index (CCI), established risk factors for candidaemia and their time-dependent effects such as total parenteral nutrition (TPN), mechanical ventilation (MV), and central venous catheter (CVC) were collected. Univariate and multivariate logistic regression analyses were used to identify factors associated with candidaemia development, and fast backwards variable selection was used. To account for between-centre heterogeneity, sensitivity analyses were performed using mixed-effects logistic regression models including centre-specific random intercepts. A nomogram model was constructed using independent risk factors identified in multivariable analysis, and its predictive performance was evaluated with Area Under the Curve (AUC), sensitivity, and specificity. RESULTS:A total of 2,704 ICU patients, including 204 with candidaemia, were enrolled. Patients with candidaemia had higher APACHE II (19 vs. 13) and CCI scores (6 vs. 5; both p < 0.001), and more frequently had chronic renal failure, haemodialysis, malignancy, recent gastrointestinal surgery, and neutropenia (all p ≤ 0.05). Patients were randomly split into development (80%) and validation (20%) cohorts. Multivariate analysis identified higher CCI, concurrent infection, neutropenia, ICU stay > 14 days, MV > 3 days, CVC duration and TPN > 14 days as independent risk factors. The risk associated with CVC increased substantially with prolonged use (OR: 0-7 days: 3.69; 8-21 days: 8.58; > 21 days: 17.21). The model demonstrated good performance in both the development and validation cohorts, with sensitivity, specificity, and AUC values of 79.6%, 76.5%, and 0.86 (95% CI: 0.83-0.88) in the development cohort, respectively, and comparable predictive performance in the validation cohort. The score model was demonstrated by a nomogram. CONCLUSIONS:Given the high mortality of candidaemia in ICU patients, the CanDi-Score may serve as a valuable tool for early prediction and timely empirical antifungal treatment. Key predictors include CCI, presence of concurrent infections, the duration of CVC use, and TPN administration. CanDi-Score provides clinicians with a practical approach to identify high-risk patients and guides decision-making for the early initiation of antifungal treatment.

BACKGROUND:Infections are frequent in critically ill patients with earthquake-associated crush injury (CI) and contribute to poor outcomes, yet the immune pathways underlying posttrauma susceptibility remain poorly defined. We investigated longitudinal changes in damage-associated molecular pattern (DAMP)/PAMP sensing and downstream inflammatory programs in CI patients requiring intensive care. METHODS:Nineteen CI patients admitted to the ICU after the February 6, 2023 Kahramanmaraş earthquake and 18 age- and sex-matched healthy controls were enrolled. Peripheral blood was collected on hospital days 7 and 21. DAMP/PAMP receptor expression was assessed by flow cytometry and RT-qPCR, and pathway activation was evaluated by phospho-flow (pSTING, pIRF3, pNF-κB, and p-cJun) in gated lymphocytes and monocytes. Plasma cytokines/alarmins and select DAMPs were quantified by multiplex enzyme-linked immunosorbent assay (ELISA)/assays. RESULTS:CI patients demonstrated broad remodeling of nucleic acid-sensing programs, including reduced expression of TLR7, STING, and IRF7, with a discordant signaling pattern characterized by increased IRF3 phosphorylation, transiently reduced pSTING, and sustained reduction of p-cJun, while NF-κB activation remained comparatively stable. In plasma, IL-33 and IFN-α2 were reduced on Day 7, and type 3 immunity-associated cytokines IL-23 and IL-17A were significantly decreased by Day 21, consistent with impaired antimicrobial barrier-supporting responses. Circulating DAMPs were dynamically altered, with increased S100A9 and HMGB1 and decreased ATP following injury. CONCLUSIONS:Earthquake-associated CI is associated with dynamic DAMP release and dysregulated innate sensing accompanied by suppression of antiviral and type 3 immune cytokine programs. These immune alterations may contribute to heightened vulnerability to secondary infections in critically ill CI patients.

Objective:Teicoplanin, a glycopeptide antibiotic, is used to treat infections caused by Gram-positive pathogens. Trough-level monitoring of teicoplanin is recommended in specific -patient populations, including critically ill patients. This study aimed to develop and validate a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method to quantify teicoplanin in human plasma and adapt the method to a critically ill patient sample. Materials and Methods:Teicoplanin trough levels were measured using a newly validated LC-MS/MS method. Analysis was conducted using a C18 column with an inner diameter of 2.7 μm (50.0 x 3.0 mm), and vancomycin hydrochloride was used as the internal standard. The method's run time per sample was 5.5 minutes. Non-parametric tests were used for statistical analysis. Univariate and multivariate logistic regression were performed to identify teicoplanin target attainment factors. A p-value of <0.05 was considered statistically significant. Results:The method demonstrated linearity between 1.56-100 mg/L teicoplanin concentration and had a lower limit of detection and quantification of 0.33 mg/L and 1.00 mg/L, respectively. Precision, accuracy, recovery rate, and carry-over effects were all within acceptable limits, according to the U.S. Food and Drug Administration (FDA) guidance. Twenty patients were included in the study. The target teicoplanin trough level (≥10 mg/L) attainment rate was 50%. The patient's laboratory values did not significantly change after teicoplanin treatment (p>0.05), except for erythrocyte count, haemoglobin, and haematocrit values, which decreased significantly (p<0.05). Multivariate analysis revealed no significant factors affecting target attainment (p>0.05). Conclusion:The LC-MS/MS assay validated in this study is high-throughput, robust, and quick enough to be implemented in clinical therapeutic drug monitoring (TDM) laboratories. More large-scale studies are needed to understand better the relationship between teicoplanin trough levels and patient-related factors.

Amaç: Bu çalışmanın amacı meme kanseri cerrahisinde erektör spina plan bloğunun post-operatif analjezik tüketimi, ağrı skorları, hasta memnuniyeti ve cerrahi sonrası persistan ağrı üzerine olan etkisini araştırmaktır. Gereç ve Yöntemler: Etik kurul onayı alındıktan sonra Eylül 2018-Aralık 2019 tarihleri arasında elektif meme kanseri geçiren hastalar retrospektif olarak incelendi. Dışlanma kriterleri uygulandıktan sonra kalan 40 hasta çalışmaya alındı. Hastalar ESPB grubu (n=20) ve kontrol grubu (n=20) olarak ikiye ayrıldı. Hastaların postoperatif morfin tüketim miktarı kaydedildi. Vizüel Analog Skala (VAS) kullanılarak değerlendirilen ağrı skorları değerlendirildi. Taburculuk sonrası 3. ve 6. aydaki kronik ve nöropatik ağrı insidansı kaydedildi. Bulgular: Postoperatif ilk 24 saatteki morfin tüketimi tüm ölçüm zamanlarında ESPB grubunda kontrol grubundan daha düşüktü (p

Scarce evidence is available on the epidemiology of microbiologically proven clinical infections in patients admitted to the intensive care unit (ICU) after a great earthquake. The main aim of this study was to assess clinical infections and microbiological features in patients admitted to the ICU following the 2023 earthquake in the southeastern region of Türkiye with a focus on the timing of culture positivity during their ICU stay. The secondary objectives included determining antibiotic susceptibility patterns, identifying the types of antibiotics administered upon ICU admission, evaluating the appropriateness of antibiotic usage, assessing patient outcomes, and identifying factors that influence microbiologically confirmed clinical infections. A retrospective, multicenter, observational study was conducted on adult earthquake victims admitted to the ICU after the 2023 earthquake in southeastern Türkiye. Patients were categorized into four groups on the basis of culture positivity timing at the 72-hour breakpoint and clinical characteristics were compared among these groups. Factors influencing microbiologically proven clinical infections were also analysed. A total of 107 earthquake-affected adults (58 females and 49 males, median [IQR] age: 37 [27–57] years) were analysed. Infection was present in 50.5

IntroductionThe outcomes of patients admitted to intensive care units (ICUs) after earthquakes that occurred on the 6th of February 2023 in Türkiye are unknown. Our objective was to delineate the demographic and clinical characteristics, therapeutic approaches, and ICU outcomes of earthquake victims who were hospitalized in Turkish ICUs.MethodsThis was a retrospective multicenter study of adult patients admitted to 12 ICUs across eight tertiary hospitals located in five different cities within 2 weeks after consecutive earthquakes. Clinical and laboratory data were documented at four specific time intervals: upon hospital admission and during the first, second, and third days of ICU admission. To identify independent predictors of ICU mortality, a binary logistic regression model was used for variables identified from the univariate analysis.ResultsA total of 201 patients were admitted to ICUs. The median age of the entire cohort was 36 [26–54] years. 87 patients were male (43.3%), and 114 were female (56.7%). The majority of patients (79.1%) were initially admitted to the emergency department. The median duration of being trapped under the rubble was 12 [5–31] hours. The primary reason (63.7%) for ICU admission was crush syndrome. Acute kidney injury (AKI) was identified in 61.5% of patients. Of 201 patients, 184 had information regarding ICU survival. The ICU mortality rate was 10%. A five-year increase in age, the presence of crush syndrome, and the requirement for vasopressor therapy during ICU care were independently associated with increased ICU mortality rates, while an increase of one point in the Glasgow Coma Scale (GCS) score was favorable for ICU mortality.ConclusionThis study demonstrated that crush syndrome accounted for 63.7% of the reasons for ICU admissions. The ICU mortality rate was recorded as 10%. Noteworthy independent risk factors for mortality were the presence of crush syndrome, increased age, vasopressor treatment and lower GCS score.

On February 6, 2023 a devastating earthquake hit the south-eastern region of Türkiye and thousands of people were either injured or died. The aim was to determine the characteristics, treatment and clinical outcomes of critically ill patients with crush injuries in ICU. This study was performed with a retrospective design in ICU. Patients were included as follows; effected 6 February earthquake, need ICU treatment and being crush syndrome. A total of 62 patients were included. The mean age was 41 ± 19 years and 47

Background: This study aimed to identify factors that influence the mortality rate of patients with coronavirus disease (COVID-19)-associated pulmonary aspergillosis (CAPA). Methods: In this cross-sectional study, data from 23 centers across 15 countries, spanning the period of March 2020 to December 2021, were retrospectively collected. The study population comprised patients who developed invasive pulmonary aspergillosis while being treated for COVID-19 in the intensive care unit. Cox regression and decision tree analyses were used to identify factors associated with mortality in patients with CAPA. Results: A total of 162 patients (males, 65.4 %; median age: 64 [25th–75th: 54.0–73.8] years) were included in the study, of whom 113 died during the 90-day follow-up period. The median duration from CAPA diagnosis to death was 12 (25th–75th: 7–19) days. In the multivariable Cox regression model, an age of ≥65 years (hazard ratio [HR]: 2.05, 95 % confidence interval [CI]: 1.37–3.07), requiring vasopressor therapy at the time of CAPA diagnosis (HR: 1.80, 95 % CI: 1.17–2.76), and receiving renal replacement therapy at the time of CAPA diagnosis (HR: 2.27, 95 % CI: 1.35–3.82) were identified as predictors of mortality. Decision tree analysis revealed that patients with CAPA aged ≥65 years who received corticosteroid treatment for COVID-19 displayed higher mortality rates (estimated rate: 1.6, observed in 46 % of patients). Conclusion: This study concluded that elderly patients with CAPA who receive corticosteroids are at a significantly higher risk of mortality, particularly if they experience multiorgan failure.

Background: During the COVID pandemic, research has shown an increase in candidemia cases following severe COVID infection and the identification of risk factors associated with candidemia. However, there is a lack of studies that specifically explore clinical outcomes and mortality rates related to candidemia after COVID infection.Objectives: The aim of this international study was to evaluate the clinical outcomes and identify factors influencing mortality in patients who developed candidemia during their COVID infection.Patients/Methods: This study included adult patients (18 years of age or older) admitted to the intensive care unit (ICU) and diagnosed with COVID-associated candidemia (CAC). The research was conducted through ID-IRI network and in collaboration with 34 medical centres across 18 countries retrospectively, spanning from the beginning of the COVID pandemic until December 2021.Results: A total of 293 patients diagnosed with CAC were included. The median age of the patients was 67, and 63% of them were male. The most common Candida species detected was C. albicans. The crude 30-day mortality rate was recorded at 62.4%. The logistic regression analysis identified several factors significantly impacting mortality, including age (odds ratio [OR] 1.04, 95% confidence interval [CI] 1.02-1.07, p < .0005), SOFA score (OR 1.307, 95% CI 1.17-1.45, p < .0005), invasive mechanical ventilation (OR 7.95, 95% CI 1.44-43.83, p < .017) and duration of mechanical ventilation (OR 0.98, 95% CI 0.96-0.99, p < .020).Conclusions: By recognising these prognostic factors, medical professionals can customise their treatment approaches to offer more targeted care, leading to improved patient outcomes and higher survival rates for individuals with COVID-associated candidemia.

OBJECTIVE: A 1-day point prevalence study was planned to obtain country data by determining the clinical characteristics, follow-up and treatment methods of coronavirus disease 2019 (COVID-19) cases that required intensive care unit (ICU) treatment in the second year of the pandemic. MATERIAL AND METHODS: All patients who were hospitalized in the ICUs due to COVID-19 between March 11, 2022, 08.00 am, and March 12, 2022, 08.00 am, were included in the study. Demographic characteristics, intensive care and laboratory data, radiological characteristics, and follow-up results of the patients were recorded. RESULTS: A total of 811 patients from 59 centers were included in the study, 59% of the cases were male, and the mean age was 74 ± 14 years. At least one comorbid disease was present in 94% of the cases, and hypertension was the most common. When ICU weight scores were examined, Acute Physiology and Chronic Health Evaluation-II: 19 (15-27) and Sequential Organ Failure Assessment: 7 (4-10) were seen. Sepsis was present in 37% (n = 298) of cases. PaO2/FiO2 ratios of the patients were 190 the highest and 150 the lowest and 51% of the cases were followed via invasive mechanical ventilation. On the study day, 73% bilateral involvement was seen on chest x-ray, and ground-glass opacities (52%) were the most common on chest tomography. There was growth in culture in 40% (n = 318) of the cases, and the most common growth was in the tracheal aspirate (42%). CONCLUSION: The clinical course of COVID-19 is variable, and ICU follow-up was required due to advanced age, comorbidity, presence of respiratory symptoms, and widespread radiological involvement. The need for respiratory support and the presence of secondary infection are important issues to be considered in the follow-up. Despite the end of the second year of the pandemic and vaccination, the high severity of the disease as well as the need for follow-up in ICUs has shown that COVID-19 is an important health problem.

Objective: In this study, we evaluated the effects of a cup of coffee given to patients before surgery in a cesarean section by means of intraoperative hypotension, ephedrine requirement, and the incidence of postdural puncture headache (PDPH). Methods: A total of 140 patients undergoing elective cesarean section with spinal anesthesia were included in this study. Participants who drank a single cup of filtered coffee two hours before spinal anesthesia were included in the coffee group, and those who drank water were in the control group. In each group, 70 patients were included. Hemodynamic parameters were recorded every three to five minutes after spinal anesthesia. Intraoperative use of ephedrine was recorded. The PDPH was monitored for three days. Results: The incidence of intraoperative hypotension was 48.6% in the coffee group and 71.4% in the control group (p = 0.006). The rate of ephedrine usage (25.7%) was significantly lower in the coffee group (p = 0.001). The incidence of PDPH in the first 24 hours (2.9%) was significantly lower in the coffee group (11.4%). The visual analog scale (VAS) score was similar between groups (p = 0.048, p > 0.05). Conclusions: Consumption of a single cup of coffee before spinal anesthesia reduced the incidence of intraoperative hypotension and the rate of ephedrine usage in cesarean sections.

Aim: This study aimed to evaluate the incidence of nosocomial infections caused by extended-spectrum beta-lactamase (ESBL) producing bacteria and related antimicrobial susceptibility in critically ill patients over a 5-year period. Material and Methods: The retrospective study was carried out in critically ill patients infected with ESBL-producing pathogens during intensive care unit (ICU) stay. Participants' medical data between 2014 and 2018 were included. ESBL-positive isolates from clinical specimens were evaluated by species and antibiotic susceptibility. Results: Ninety of 2456 critically ill patients had ESBL-positive bacterial infections. The mean age of the study sample was 58.7 +/- 19.1 years and 53.3% were males. ESBL-producing E. coli was noted in 60 (66.7%) patients, K. pneumoniae in 27 (30.0%) patients and K. oxytoca in 3 (3.3%) patients. Colistin (100%), meropenem (94.9%), imipenem (94.0%), and amikacin (90.0%) were active against >= 90% of ESBL-producing pathogens, while ertapenem (89.4%), fosfomycin (87.5%), tigecycline (80.0%) were active against >= 80% of pathogens in ICU. Susceptibility of ESBL producers was remarkably low against levofloxacin (30.8%) and ciprofloxacin (36.7%). The mortality rate of the sample was 25.5%. Discussion: Our findings revealed that ESBL-producing E. coli was highly responsible for ESBL-positive bacterial infections in ICU. The continued efficacy of colistin, carbapenems and amikacin against ESBL-producing E. coli and K. pneumoniae was exhibited.

Temel, Sahin1; Yuksel, Recep1; Kaynar, Ahmet1; Çalişkan, Mustafa1; Demir, Berna1; Alkan, Mustafa1; Ulger, Birkan2; Deveci, Kamil2; Sipahioglu, Hilal2; Metin, Hatice1; Kayaalti, Selda1; Kaya, Elif3; Unal, Canan1; Esmaoglu, Aliye1; Sungur, Murat1; Gundogan, Kursat1 Author Information

ÖZ Giriş: Nozokomiyal infeksiyonlar, COVID-19 Yoğun bakım ünitesinde (YBÜ) takipli hastalarda morbidite ve mortaliteyi arttırmaktadır. Bu çalışmada COVID-19 YBÜ'de takip edilen hastalarda gelişen nozokomiyal infeksiyonlar için risk faktörlerinin

In an effort to better manage critically ill patients hospitalised in the intensive care unit (ICU) after experiencing multiple traumas, the present study aimed to assess whether plasma levels of intestinal epithelial cell barrier proteins, including occludin, claudin-1, junctional adhesion molecule (JAM-1), tricellulin and zonulin, could be used as novel biomarkers. Additional potential markers such as intestinal fatty acid-binding protein (I-FABP), d-lactate, lipopolysaccharide (LPS) and citrulline were also evaluated. We also aimed to determine the possible relationships between the clinical, laboratory, and nutritional status of patients and the measured marker levels. Plasma samples from 29 patients (first, second, fifth and tenth days in the ICU and on days 7, 30 and 60 after hospital discharge) and 23 controls were subjected to commercial enzyme-linked immunosorbent assay (ELISA) testing. On first day (admission) and on the second day, plasma I-FABP, d-lactate, citrulline, occludin, claudin-1, tricellulin and zonulin levels were high in trauma patients and positively correlated with lactate, C-reactive protein (CRP), number of days of ICU hospitalisation, Acute Physiology and Chronic Health Evaluation II (APACHE II) score and daily Sequential Organ Failure Assessment (SOFA) scores (P < 0.05–P < 0.01). The results of the present study showed that occludin, claudin-1, tricellulin and zonulin proteins, as well as I-FABP, d-lactate and citrulline, may be used as promising biomarkers for the evaluation of disease severity in critically ill trauma patients, despite the complexity of the analysis of various barrier markers. However, our results should be supported by future studies.

OBJECTIVE:To assess the demographic and clinical characteristics, laboratory findings, and economic burden of patients with a diagnosis of complicated skin and soft tissue infection (cSSTI).METHOD:The demographic and clinical characteristics, laboratory findings, surgical interventions, cost of treatment, and outcome of patients diagnosed with cSSTIs between January 2017 and December 2019 were retrospectively analysed.RESULTS:A total of 24 patients with cSSTIs were included in the study. The median age was 53 (22-85) years, and 14 (58%) were female. The most common comorbidity was diabetes (54%). On admission, 75% of patients presented with sepsis, and 70% had a high-grade Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) score. The causative microorganism was isolated from 21 (87%) patients, and the multidrug resistance rate of Gram-negative bacteria was 50%. The median number of debridements was 3 (1-12). In all, 11 patients were followed up in the intensive care unit, and the mortality rate was 29%. The presence of confusion (p=0.025), causative Gram-negative microorganisms (p=0.009), hyponatraemia (p=0.034), the need for intensive care (p=0.001), anti-meticillin-resistant Staphylococcus aureus antibiotics (p=0.023) and the rate of antibiotic changes during treatment (p=0.019) were significantly higher in the non-survival patient group. Hyponatraemia was a significant independent risk factor for mortality (p=0.048). The median cost of per-patient treatment was $9453 USD in the non-surviving and $1536 in the surviving group.CONCLUSION:It is important to know possible factors and local resistance rates at the beginning of empirical antibacterial and surgical treatment. The presence of hyponatraemia, sepsis and a high LRINEC score can be considered to be the mortality predictors.

Introduction: Nosocomial infections (NI) increase morbidity and mortality in patients in the COVID-19 ICU. In this study, it was aimed to determine the risk factors for nosocomial infections in patients treated in the COVID-19 ICU. Materials and Methods: Patients who were treated in the COVID-19 and non-COVID-19 ICU between March 2020 and June 2021 were analyzed retrospectively. Demographic data, chronic diseases, invasive procedures and risk factors were compared between patients with and without NI. Results: The study included 174 patients, and 84 from COVID-19 ICU. The median age of the patients was 66.5 (21-92) and the male gender rate was 56.9%. The frequency of hospitalization in the last three months and the mean Charlson comorbidity index were higher in patients treated in the COVID-19 ICU (p= 0.001). Presence of any nosocomial infection (64% vs 46%), rate of nosocomial pneumonia (10.7% vs. 2.2%), and catheter-related bloodstream infection rate were higher in the COVID-19 ICU. The 14-day mortality rates were 57% in the COVID-19 ICU, while it was 33% in the non-COVID-19 ICU (p=0.002). Advanced age [OR=0.97 (95% CI= 0.94-1.0) p= 0.049], prolonged stay in the ICU [OR= 1.28 (95% CI= 1.16-1.41) p=0.001], chronic kidney disease [OR= 10.57 (95% CI= 2.02-54.56) p= 0.05], and coronary artery disease [OR= 4.61 (95% CI= 1.44-14.79) p= 0.010] were found to be risk factors for NI, while other risk factors were enteral nutrition [OR= 2.69 (95% CI= 1.03-7.04) p= 0.043], central catheter [OR= 4.60 (95% CI= 1.88-11.22) p= 0.001] and a history of hospitalization in the ICU in the last three months [OR= 3.59 (95% CI= 1.01-12.83) p= 0.048]. Risk factors for NI in the COVID-19 ICU include prolonged ICU stay and enteral nutrition. Conclusion: The presence of COVID-19 in patients treated in the ICU is important . Long-term ICU follow-up, invasive procedures and enteral nutrition practices are important risk factors for the development of NI in patients with a diagnosis of COVID-19.

Background Acute kidney injury (AKI) treated with continuous renal replacement therapy (CRRT) may deplete micronutrient levels. Patients are also at risk for micronutrient depletion due to underlying illness(s), poor nutrient intake prior to intensive care unit (ICU) admission and/or increased requirements. We determined vitamin and trace element status before, during and after CRRT in critically ill patients. Methods This prospective observational study performed in mixed medical and surgical ICU patients. Serial serum vitamin B6 and vitamin C concentrations were measured by HPLC and folic acid by ECLIA. Serum chromium, copper, selenium, and zinc were measured using ICP-MS. Serum ceruloplasmin was measured by the Erel method. Results Fifty adult ICU patients with AKI were recruited. The median APACHE II score on ICU admission was high at 24.0 (6.0-33.0). The median days on CRRT was 2.0 (2.0-4.0) days. At baseline (within 10-15 minutes of CRRT initiation), serum vitamin C, selenium and zinc were below normal. Serum vitamin B6 levels at 72 hours on CRRT were significantly lower than at 24 hours (p = 0.011). Serum vitamin C values fell significantly at 24 and 72 hours during CRRT (p = 0.030 and p = 0.001), respectively, and remained low 24 and 48 hours after CRRT was stopped (p = 0.021). At baseline and during CRRT, 96% of participants had at least two or more micronutrient levels below the normal range. Conclusion Serum vitamin C, selenium and zinc concentrations were below the normal range at baseline. CRRT was associated with a significant further decrease in levels of vitamin C, selenium and zinc.