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Kobara S, Yamamoto R, Rad MG, Grunwell JR, Hikota N, Uzawa Y, Hayashi Y, Coopersmith CM, Kamaleswaran R. Association between comorbidities at ICU admission and post-Sepsis physical impairment: A retrospective cohort study. J Crit Care 2024; 83:154833. [PMID: 38776846 DOI: 10.1016/j.jcrc.2024.154833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 04/27/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE Few studies have measured the association between pre-existing comorbidities and post-sepsis physical impairment. The study aimed to estimate the risk of physical impairment at hospital discharge among sepsis patients, adjusting for pre-existing physical impairment prior to ICU admission and in-hospital mortality. MATERIALS AND METHODS We analyzed all consecutive adult patients admitted to an ICU in a tertiary community hospital, Kameda Medical Center, with sepsis diagnosis from September 2014 to October 2020. Inverse probability attrition weighting using machine learning was employed to estimate the risk of physical impairment at hospital discharge for sepsis patients with and without pre-existing comorbidities at ICU admission. This estimation was adjusted for baseline covariates, pre-ICU physical impairment, and in-hospital mortality. RESULTS Of 889 sepsis patients analyzed, 668 [75.1%] had at least one comorbidity and 221 [24.9%] had no comorbidities at ICU admission. Upon adjusting for baseline covariates, pre-ICU physical impairment, and in-hospital mortality, pre-existing comorbidities were not associated with an elevated risk of physical impairment at hospital discharge (RR: 1.02, 95% CI: 0.92, 1.14). CONCLUSIONS Pre-existing comorbidities prior to ICU admission were not associated with an increased risk of physical impairment at hospital discharge among sepsis patients after adjusting for baseline covariates and in-hospital mortality.
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Affiliation(s)
- Seibi Kobara
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, USA.
| | - Ryohei Yamamoto
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Intensive Care, Kameda Medical Center, Chiba, Japan
| | - Milad G Rad
- Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Jocelyn R Grunwell
- Department of Pediatrics, Division of Critical Care, Emory University School of Medicine, Atlanta, GA, USA; Children's Healthcare of Atlanta, GA, USA
| | - Nao Hikota
- Department of Rehabilitation, Kameda Medical Center, Chiba, Japan
| | - Yoshihiro Uzawa
- Department of Rehabilitation, Kameda Medical Center, Chiba, Japan
| | - Yoshiro Hayashi
- Department of Intensive Care, Kameda Medical Center, Chiba, Japan
| | - Craig M Coopersmith
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA; Emory Critical Care Center, Emory University School of Medicine, Atlanta, GA, USA
| | - Rishikesan Kamaleswaran
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, USA; Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, USA; Department of Pediatrics, Division of Critical Care, Emory University School of Medicine, Atlanta, GA, USA; Emory Critical Care Center, Emory University School of Medicine, Atlanta, GA, USA; Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
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2
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Durojaiye OC, Kritsotakis EI. Evaluation of health-related quality of life in patients receiving outpatient parenteral antimicrobial therapy (OPAT) in a UK setting. Expert Rev Anti Infect Ther 2024:1-9. [PMID: 38511820 DOI: 10.1080/14787210.2024.2334059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 02/20/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Studies assessing the benefits of outpatient parenteral antimicrobial therapy (OPAT) have paid less attention to patient-centered factors such as patients' experiences and their health-related quality of life (HRQoL). RESEARCH DESIGN AND METHODS Prospective before-and-after quasi-experimental study enrolled adult patients receiving OPAT at a tertiary hospital in Derbyshire, UK, between October 2022 and October 2023. Consenting patients completed paired EQ-5D-3 L questionnaires before OPAT initiation and upon completion of therapy or 30 days after its commencement (whichever occurred first). Changes and predictors of change in HRQoL indicators and associations with clinical outcomes (treatment failure, adverse events, and 30-day unplanned readmission) were examined. RESULTS Health state index and visual analogue scale (EQ VAS) scores of 162 enrolled patients at baseline were significantly lower than the UK population averages, but the patients experienced significant improvements in both scores and in four EQ-5D dimensions (mobility, self-care, usual activities, and pain/discomfort). Baseline health index and EQ VAS scores were significant independent predictors of positive changes in HRQoL scores. CONCLUSIONS OPAT is associated with improved patient-reported quality of life and facilitates early return to work or school. Nevertheless, it is crucial to closely monitor patients with a lower baseline quality of life to optimize their overall OPAT experience.
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Affiliation(s)
- Oyewole Christopher Durojaiye
- Department of Microbiology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, Derbyshire, UK
- Department of Infection and Tropical Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, South Yorkshire, UK
| | - Evangelos I Kritsotakis
- School of Medicine and Population Health, University of Sheffield, Sheffield, South Yorkshire, UK
- Laboratory of Biostatistics, School of Medicine, University of Crete, Heraklion, Greece
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3
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van der Slikke EC, Beumeler LFE, Holmqvist M, Linder A, Mankowski RT, Bouma HR. Understanding Post-Sepsis Syndrome: How Can Clinicians Help? Infect Drug Resist 2023; 16:6493-6511. [PMID: 37795206 PMCID: PMC10546999 DOI: 10.2147/idr.s390947] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 09/21/2023] [Indexed: 10/06/2023] Open
Abstract
Sepsis is a global health challenge, with over 49 million cases annually. Recent medical advancements have increased in-hospital survival rates to approximately 80%, but the escalating incidence of sepsis, owing to an ageing population, rise in chronic diseases, and antibiotic resistance, have also increased the number of sepsis survivors. Subsequently, there is a growing prevalence of "post-sepsis syndrome" (PSS). This syndrome includes long-term physical, medical, cognitive, and psychological issues after recovering from sepsis. PSS puts survivors at risk for hospital readmission and is associated with a reduction in health- and life span, both at short and long term, after hospital discharge. Comprehensive understanding of PSS symptoms and causative factors is vital for developing optimal care for sepsis survivors, a task of prime importance for clinicians. This review aims to elucidate our current knowledge of PSS and its relevance in enhancing post-sepsis care provided by clinicians.
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Affiliation(s)
- Elisabeth C van der Slikke
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, 9713GZ, the Netherlands
| | - Lise F E Beumeler
- Department of Intensive Care, Medical Centre Leeuwarden, Leeuwarden, 8934AD, the Netherlands
- Department of Sustainable Health, Campus Fryslân, University of Groningen, Groningen, 8911 CE, the Netherlands
| | - Madlene Holmqvist
- Department of Infection Medicine, Skåne University Hospital Lund, Lund, 221 84, Sweden
| | - Adam Linder
- Department of Infection Medicine, Skåne University Hospital Lund, Lund, 221 84, Sweden
| | - Robert T Mankowski
- Department of Physiology and Aging, University of Florida, Gainesville, FL, 32610, USA
| | - Hjalmar R Bouma
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, 9713GZ, the Netherlands
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9713GZ, the Netherlands
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4
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Silva LMFD, Diogo LP, Vieira LB, Michielin FDC, Santarem MD, Machado MLP. Performance of scores in the prediction of clinical outcomes in patients admitted from the emergency service. Rev Lat Am Enfermagem 2021; 29:e3479. [PMID: 34495190 PMCID: PMC8432508 DOI: 10.1590/1518-8345.4722.3479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 04/17/2021] [Indexed: 11/24/2022] Open
Abstract
Objective: to evaluate the performance of the quickSOFA scores and Systemic Inflammatory Response Syndrome as predictors of clinical outcomes in patients admitted to an emergency service. Method: a retrospective cohort study, involving adult clinical patients admitted to the emergency service. Analysis of the ROC curve was performed to assess the prognostic indexes between scores and outcomes of interest. Multivariate analysis used Poisson regression with robust variance, evaluating the relationship between variables with biological plausibility and outcomes. Results: 122 patients were selected, 58.2% developed sepsis. Of these, 44.3% had quickSOFA ≥2 points, 87% developed sepsis, 55.6% septic shock and 38.9% died. In the evaluation of Systemic Inflammatory Response Syndrome, 78.5% obtained results >2 points; of these, 66.3% developed sepsis, 40% septic shock and 29.5% died. quickSOFA ≥2 showed greater specificity for diagnosis of sepsis in 86% of the cases, for septic shock 70% and for mortality 64%, whereas the second score showed better results for sensitivity with diagnosis of sepsis in 87.5%, septic shock in 92.7% and death in 90.3%. Conclusion: quickSOFA showed by its practicality that it can be used clinically within the emergency services, bringing clinical applicability from the risk classification of patients for the early recognition of unfavorable outcomes.
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Bench S, Stayt L, Shah A, Dhiman P, Czuber-Dochan W. Prevalence and experience of fatigue in survivors of critical illness: a mixed-methods systematic review. Anaesthesia 2021; 76:1233-1244. [PMID: 33694157 DOI: 10.1111/anae.15441] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2021] [Indexed: 12/11/2022]
Abstract
We conducted a mixed methods systematic review to investigate the prevalence, experience and management of fatigue in survivors of critical illness. We identified 76 studies investigating fatigue or vitality in adults discharged from an intensive care unit and split the extracted data into three datasets: vitality scores from the Short Form Health Survey-36 (n = 54); other quantitative data (n = 19); and qualitative data (n = 9). We assessed methodological quality using critical appraisal skills programme tools. We adopted a segregated approach to mixed-methods synthesis. In a final step, we attributed combined results to one of four qualitative themes: prevalence and severity; contributing factors; impacts on quality of life; and assessment and management. Prevalence of fatigue ranged from 13.8 to 80.9%. Short Form Health Survey-36 vitality scores were commonly used as a marker of fatigue. Vitality scores reached a nadir approximately one month following ICU discharge (mean (SD) 56.44 (32.30); 95%CI 52.92-59.97). They improved over time but seldom reached reference population scores. Associated biological, disease-related and psychological factors included age, poor pre-morbid status, sleep and psychological disturbance. Qualitative data highlight the profound negative impact of fatigue on survivors' quality of life. Survivors seldom had any information provided on the potential impact of fatigue. No fatigue assessment tools specific to critical illness or evidence-based interventions were reported. Fatigue is highly prevalent in survivors of critical illness, and negatively impacts recovery. Further research on developing fatigue assessment tools specifically for critically ill patients and evaluating the impact of pharmacological and non-pharmacology interventions is needed.
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Affiliation(s)
- S Bench
- School of Health and Social Care, London South Bank University, London, UK
| | - L Stayt
- Oxford Brookes University, Oxford, UK
| | - A Shah
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - P Dhiman
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - W Czuber-Dochan
- Florence Nightingale School of Nursing, Midwifery and Palliative Care, King's College London, London, UK
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6
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Gritte RB, Souza-Siqueira T, Curi R, Machado MCC, Soriano FG. Why Septic Patients Remain Sick After Hospital Discharge? Front Immunol 2021; 11:605666. [PMID: 33658992 PMCID: PMC7917203 DOI: 10.3389/fimmu.2020.605666] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 12/29/2020] [Indexed: 12/29/2022] Open
Abstract
Sepsis is well known to cause a high patient death rate (up to 50%) during the intensive care unit (ICU) stay. In addition, sepsis survival patients also exhibit a very high death rate after hospital discharge compared to patients with any other disease. The addressed question is then: why septic patients remain ill after hospital discharge? The cellular and molecular mechanisms involved in the high rate of septic patient deaths are still unknown. We described herein the studies that investigated the percentage of septic patients that died after hospital discharge ranging from 90 days up to 5 years. We also reported the symptoms of septic patients after hospital discharge and the development of the recently called post-sepsis syndrome (PSS). The most common symptoms of the PSS are cognitive disabilities, physical functioning decline, difficulties in performing routine daily activities, and poor life quality. The PSS also associates with quite often reinfection and re-hospitalization. This condition is the cause of the high rate of death mentioned above. We reported the proportion of patients dying after hospital discharge up to 5 years of followed up and the PSS symptoms associated. The authors also discuss the possible cellular and metabolic reprogramming mechanisms related with the low survival of septic patients and the occurrence of PSS.
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Affiliation(s)
- Raquel Bragante Gritte
- Interdisciplinary Post-Graduate Program in Health Sciences, Cruzeiro do Sul University, Sao Paulo, Brazil
| | - Talita Souza-Siqueira
- Interdisciplinary Post-Graduate Program in Health Sciences, Cruzeiro do Sul University, Sao Paulo, Brazil
| | - Rui Curi
- Interdisciplinary Post-Graduate Program in Health Sciences, Cruzeiro do Sul University, Sao Paulo, Brazil.,Immunobiological Production Section, Bioindustrial Center, Butantan Institute, São Paulo, Brazil
| | | | - Francisco Garcia Soriano
- University Hospital, University of São Paulo, São Paulo, Brazil.,Internal Medicine Department, School of Medicine, University of São Paulo, São Paulo, Brazil
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Wee LE, Sundarajoo M, Quah WF, Farhati A, Huang JY, Chua YY. Health-related quality of life and its association with outcomes of outpatient parenteral antibiotic therapy. Eur J Clin Microbiol Infect Dis 2019; 39:765-772. [PMID: 31873862 DOI: 10.1007/s10096-019-03787-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 12/02/2019] [Indexed: 01/09/2023]
Abstract
While health-related quality of life (HRQoL) is an important component of patient-centred care, few studies have looked at the association between HRQoL and outcomes while on OPAT. From 2014 to 2017, we conducted a prospective cohort study of all patients referred to Singapore General Hospital's (SGH) OPAT service. At baseline, we collected sociodemographic, clinical, and treatment-related factors for OPAT recipients. We also measured baseline HRQoL using the EuroQoL EQ5D-3 L. We evaluated the association between HRQoL and the following outcomes: complications experienced while on OPAT, early termination requiring readmission during planned course of OPAT, all-cause readmission 30 days after completion of OPAT, and return to work while on OPAT. We used chi-squared test for univariate analysis and cox regression for multivariate analysis. From 2014 to 2017, 1213 patients received OPAT at our centre. Of those, 13.2% (160/1213) developed complications. About 10% (132/1213) of patients were readmitted while on OPAT and OPAT was terminated early. Amongst patients who completed OPAT (N = 1081), about 3.6% (39/1081) were readmitted within 30 days after OPAT completion. About half (50.8%, 278/547) returned to work while on OPAT. On multivariate analysis, patients with perfect health-related quality of life (HRQoL) (adjusted relative risk, aRR = 0.62, 95%CI = 0.45-0.85) were less likely to experience complications, had lower risk of OPAT termination (aRR = 0.57, 95%0.38-0.86), and were more likely to return to work while on OPAT (aRR = 1.94, 95%CI = 1.30-2.89). HRQoL at baseline was significantly associated with lower risk of complications and early OPAT termination, as well as greater likelihood of return to work while on OPAT.
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Affiliation(s)
- Liang En Wee
- Duke-NUS Graduate Medical School, Singapore, Singapore. .,Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore.
| | | | - Way-Fang Quah
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| | - Ahmad Farhati
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| | - Jie-Ying Huang
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| | - Ying-Ying Chua
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
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8
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9
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Fontela PC, Abdala FANB, Forgiarini SGI, Luiz Jr. AF. Quality of life in survivors after a period of hospitalization in the intensive care unit: a systematic review. Rev Bras Ter Intensiva 2018; 30:496-507. [PMID: 30672974 PMCID: PMC6334481 DOI: 10.5935/0103-507x.20180071] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 07/10/2018] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To assess the long-term, health-related quality of life of intensive care unit survivors by systematic review. METHODS The search for, and selection and analysis of, observational studies that assessed the health-related quality of life of intensive care unit survivors in the electronic databases LILACS and MEDLINE® (accessed through PubMed) was performed using the indexed MESH terms "quality of life [MeSH Terms]" AND "critically illness [MeSH Terms]". Studies on adult patients without specific prior diseases published in English in the last 5 years were included in this systematic review. The citations were independently selected by three reviewers. Data were standardly and independently retrieved by two reviewers, and the quality of the studies was assessed using the Newcastle-Ottawa scale. RESULTS In total, 19 observational cohort and 2 case-control studies of 57,712 critically ill patients were included. The follow-up time of the studies ranged from 6 months to 6 years, and most studies had a 6-month or 1-year follow up. The health-related quality of life was assessed using two generic tools, the EuroQol and the Short Form Health Survey. The overall quality of the studies was low. CONCLUSIONS Long-term, health-related quality of life is compromised among intensive care unit survivors compared with the corresponding general population. However, it is not significantly affected by the occurrence of sepsis, delirium, and acute kidney injury during intensive care unit admission when compared with that of critically ill patient control groups. High-quality studies are necessary to quantify the health-related quality of life among intensive care unit survivors.
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Affiliation(s)
- Paula Caitano Fontela
- Programa de Pós-Graduação em
Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul -
Porto Alegre (RS), Brasil
| | | | | | - Alberto Forgiarini Luiz Jr.
- Programa de Pós-Graduação em
Biociências e Reabilitação e Reabilitação e
Inclusão, Centro Universitário Metodista IPA - Porto Alegre (RS),
Brasil
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10
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Su YX, Xu L, Gao XJ, Wang ZY, Lu X, Yin CF. Long-term quality of life after sepsis and predictors of quality of life in survivors with sepsis. Chin J Traumatol 2018; 21:216-223. [PMID: 30017545 PMCID: PMC6085193 DOI: 10.1016/j.cjtee.2018.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 04/29/2018] [Accepted: 05/07/2018] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To evaluate the quality of life among survivors after sepsis in 2 years, comparing with critical patients without sepsis and the general people, analyze the changes and the predictors of quality of life among septic survivors. METHODS This prospective case-control study screened the intensive care unit (ICU) patients in Tianjin Third Central Hospital from January 2014 to October 2017, and the Chinese general population in the previous studies was also included. According to inclusion criteria and exclusion criteria, 306 patients with sepsis were enrolled as the observation group, and another 306 patients without sepsis in ICU during the same period, whose ages, gender and Charlson Comorbidity Index matched with observation group, were enrolled as the control group. At 3 mo, 12 mo, and 24 mo after discharge, the Mos 36-item Short Form Health Survey (SF-36), the Euroqol-5 dimension (EQ-5D), and the activities of daily living (ADL) were evaluated in face-to-face for the quality of life among survivors. RESULTS There were 210 (68.6%) septic patients and 236 (77.1%) non-septic critically ill patients surviving. At 3 months after discharge, the observation and control groups had the similar demographic characteristics (age: 58.8 ± 18.1years vs. 57.5 ± 17.6 years, p = 0.542; male: 52.0% vs. 51.4%, p = 0.926). However, the observation group had higher acute physiology and chronic health evaluation II (APACHEII) scores, higher sequential organ failure assessment (SOFA) scores, longer hospital stay, and longer ICU stay than the control group did (p < 0.05). There were no significant differences in the eight dimensions of the SF36 scale, the EQ-5D health utility scores, and the activities of daily life scores between septic survivors and non-septic survivors (p > 0.05). In addition, compared with the quality of life of the Chinese general population (aged 55-64 years), the quality of life of septic patients were significantly lower at 3 months after discharge (p < 0.05). Comparing the quality of life of the ill patients who had been discharged at 3 mo and 24 mo, the general health improved statistically (p = 0.000) and clinically (score improvement > 5 points). Older age (OR, 1.050; 95% CI, 1.022-1.078, p = 0.000), female (OR, 3.375; 95% CI, 1.434-7.941, p = 0.005) and longer mechanical ventilation time (OR, 3.412; 95% CI, 1.413, 8.244, p = 0.006) were the risk factors for the quality of life of septic survivors. CONCLUSION The long-term quality of life of septic survivors was similar to that of non-sepsis critically ill survivors. After discharge, the general health of sepsis improved overtime. Age, female and mechanical ventilation time (>5 days) were the predictors of the quality of life after sepsis.
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Affiliation(s)
- Ya-Xiao Su
- Department of Critical Care Medicine, The Third Central Hospital of Tianjin, Tianjin, 300170, China,Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin, China,Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Lei Xu
- Department of Critical Care Medicine, The Third Central Hospital of Tianjin, Tianjin, 300170, China,Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin, China,Tianjin Institute of Hepatobiliary Disease, Tianjin, China,Corresponding author. Department of Critical Care Medicine, The Third Central Hospital of Tianjin, Tianjin, 300170, China.
| | - Xin-Jing Gao
- Department of Critical Care Medicine, The Third Central Hospital of Tianjin, Tianjin, 300170, China,Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin, China,Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Zhi-Yong Wang
- Department of Critical Care Medicine, The Third Central Hospital of Tianjin, Tianjin, 300170, China,Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin, China,Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Xing Lu
- Department of Critical Care Medicine, The Third Central Hospital of Tianjin, Tianjin, 300170, China,Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin, China,Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Cheng-Fen Yin
- Department of Critical Care Medicine, The Third Central Hospital of Tianjin, Tianjin, 300170, China,Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin, China,Tianjin Institute of Hepatobiliary Disease, Tianjin, China
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11
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Bertazone TMA, Aguiar GCSD, Bueno Júnior CR, Stabile AM. Physical fitness and physical function in survivors of sepsis after hospital discharge. FISIOTERAPIA EM MOVIMENTO 2018. [DOI: 10.1590/1980-5918.031.ao04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Severe sepsis may be accompanied by long-term sequelae, and physical aspects related to physical fitness and physical function of sepsis survivors after discharge are still poorly explored. Objective: This is an integrative review aimed at analyzing if sepsis survivors present impairment of the physical fitness components and/or physical conditioning and physical function after hospital discharge. Methods: The search was performed in six electronic databases: LILACS, PubMed, CINAHL, Cochrane Library, Web of Science and Scopus. Controlled descriptors (Sepsis, Septic Shock, Physical Fitness and Activities of Daily Living) and uncontrolled descriptors or keywords (Severe Sepsis, Physical Function, and Physical Status) were used. Results: The search resulted in a total of 434 articles, of which seven were eligible for analysis. Of these, none applied a specific physical test to assess the components of physical fitness. Regarding physical function, it was verified that four studies applied specific tests to evaluate the activities of daily living. However, it was observed in most of the studies that the physical aspects were only subjectively assessed through health-related quality of life questionnaires. Overall, all studies analyzed showed that the health-related quality of life of sepsis survivors may be impaired after long periods of hospital discharge. Conclusion: Most sepsis survivors presented impairments related to physical fitness and physical function after hospital discharge, as they showed impairments in their functional autonomy, resulting in loss of independence and autonomy in performing the activities of daily living.
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12
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Abubaih A, Weissman C. Anesthesia for Patients with Concomitant Sepsis and Cardiac Dysfunction. Anesthesiol Clin 2017; 34:761-774. [PMID: 27816133 DOI: 10.1016/j.anclin.2016.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Anesthesiologists faced with a patient with sepsis and concurrent cardiac dysfunction must be cognizant of the patient's cardiac status and cause of the cardiac problem to appropriately adapt physiologic and metabolic monitoring and anesthetic management. Anesthesia in such patients is challenging because the interaction of sepsis and cardiac dysfunction greatly complicates management. Intraoperative anesthesia management requires careful induction and maintenance of anesthesia; optimizing intravascular volume status; avoiding lung injury during mechanical ventilation; and close monitoring of arterial blood gases, serum lactate concentrations, and hematology renal and electrolyte parameters. Such patients have increased mortality because of their inability to adequately compensate for the cardiovascular changes caused by sepsis.
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Affiliation(s)
- Abed Abubaih
- Department of Anesthesiology and Critical Care Medicine, Hadassah - Hebrew University Medical Center, Hebrew University - Hadassah School of Medicine, Jerusalem, Israel
| | - Charles Weissman
- Department of Anesthesiology and Critical Care Medicine, Hadassah - Hebrew University Medical Center, Hebrew University - Hadassah School of Medicine, Jerusalem, Israel.
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13
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de Souza P, Guarido KL, Scheschowitsch K, da Silva LM, Werner MF, Assreuy J, da Silva-Santos JE. Impaired vascular function in sepsis-surviving rats mediated by oxidative stress and Rho-Kinase pathway. Redox Biol 2016; 10:140-147. [PMID: 27744119 PMCID: PMC5065648 DOI: 10.1016/j.redox.2016.09.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 09/27/2016] [Indexed: 12/19/2022] Open
Abstract
We investigated long-lasting changes in endothelial and vascular function in adult rat survivors of severe sepsis induced by cecal ligation and puncture (CLP) model. For this, male Wistar rats (200–350 g) had their cecum punctured once (non-transfixing hole) with a 14-gauge needle. Performed in this way, a mortality rate around 30% was achieved in the first 72 h. The survivors, together with age-matched control rats (not subjected to CLP), were maintained in our holding room for 60 days (S60 group) and had the descending thoracic aorta processed for functional, histological, biochemical or molecular analyses. Endothelium-intact aortic rings obtained from sepsis-surviving S60 group displayed increased angiotensin II-induced contraction, accompanied by decreased activity of the endogenous superoxide dismutase, augmented reactive oxygen species generation, and increased levels of tyrosine nitration compared with vessels from control group. The superoxide scavengers superoxide dismutase and tempol, and the antioxidant apocynin, were able to avoid this enhanced contractility to angiotensin II in aortic rings from the S60 group. In addition, aortic rings from the S60 group presented reduced sensitivity to Y-27632, a Rho-kinase (ROCK) inhibitor. Immunoblot analyses revealed augmented RhoA and ROCK II, and high levels of phosphorylation of myosin phosphatase target subunit 1 in vessels from S60 rats. In conclusion, aortic rings from sepsis-surviving rats display endothelial dysfunction mediated by the increased production of reactive oxygen species, which in turn reduces the bioavailability of nitric oxide and increases the formation of peroxynitrite, and enhances RhoA-ROCK-mediated calcium sensitization, leading to augmented contractile responses to angiotensin II. Notably, this is the first study demonstrating long-term dysfunction in the vasculature of sepsis-surviving rats, which take place or remain beyond the acute septic insult. Vessels from sepsis-surviving rats develop enhanced contractile responses to angiotensin II. This hyperreactivity is avoided by the superoxide scavengers superoxide dismutase and tempol. Generation of reactive oxygen species by angiotensin II is enhanced in these vessels. Vessels from sepsis-surviving rats present an augmented degree of tyrosine nitration. The activity of the RhoA-Rho-kinase pathway is enhanced in the aorta from sepsis-surviving rats.
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Affiliation(s)
- Priscila de Souza
- Department of Pharmacology, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Karla Lorena Guarido
- Department of Pharmacology, Laboratory of Cardiovascular Biology, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Karin Scheschowitsch
- Department of Pharmacology, Laboratory of Cardiovascular Biology, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Luísa Mota da Silva
- Department of Pharmacology, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Maria Fernanda Werner
- Department of Pharmacology, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Jamil Assreuy
- Department of Pharmacology, Laboratory of Cardiovascular Biology, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - José Eduardo da Silva-Santos
- Department of Pharmacology, Laboratory of Cardiovascular Biology, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil.
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14
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Liao X, Du B, Lu M, Wu M, Kang Y. Current epidemiology of sepsis in mainland China. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:324. [PMID: 27713882 DOI: 10.21037/atm.2016.08.51] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The disease burden of sepsis is a global issue. Most of the large-scale epidemiological investigations on sepsis have been carried out in developed countries. The population of 1.3 billion in mainland China accounts for approximately 1/5th of the whole world population. Thus, the knowledge of the incidence and mortality of sepsis in mainland China is vital before employing measures for its improvement. However, most of the epidemiological data of sepsis in mainland China was obtained from ICU settings, and thus lacks the population-based incidence and mortality of sepsis. In the present review, we summarized the limited literature encompassing the incidence, mortality, long-term outcome, and pathogens of sepsis in mainland China. Therefore, it might provide some valuable information regarding the sepsis disease burden and current issues in the management of sepsis in mainland China.
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Affiliation(s)
- Xuelian Liao
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Bin Du
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Meizhu Lu
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Minming Wu
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Yan Kang
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
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15
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Shankar-Hari M, Ambler M, Mahalingasivam V, Jones A, Rowan K, Rubenfeld GD. Evidence for a causal link between sepsis and long-term mortality: a systematic review of epidemiologic studies. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:101. [PMID: 27075205 PMCID: PMC4831092 DOI: 10.1186/s13054-016-1276-7] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 03/31/2016] [Indexed: 12/29/2022]
Abstract
Background In addition to acute hospital mortality, sepsis is associated with higher risk of death following hospital discharge. We assessed the strength of epidemiological evidence supporting a causal link between sepsis and mortality after hospital discharge by systematically evaluating the available literature for strength of association, bias, and techniques to address confounding. Methods We searched Medline and Embase using the following ‘mp’ terms, MESH headings and combinations thereof - sepsis, septic shock, septicemia, outcome. Studies published since 1992 where one-year post-acute mortality in adult survivors of acute sepsis could be calculated were included. Two authors independently selected studies and extracted data using predefined criteria and data extraction forms to assess risk of bias, confounding, and causality. The difference in proportion between cumulative one-year mortality and acute mortality was defined as post-acute mortality. Meta-analysis was done by sepsis definition categories with post-acute mortality as the primary outcome. Results The literature search identified 11,156 records, of which 59 studies met our inclusion criteria and 43 studies reported post-acute mortality. In patients who survived an index sepsis admission, the post-acute mortality was 16.1 % (95 % CI 14.1, 18.1 %) with significant heterogeneity (p < 0.001), on random effects meta-analysis. In studies reporting non-sepsis control arm comparisons, sepsis was not consistently associated with a higher hazard ratio for post-acute mortality. The additional hazard associated with sepsis was greatest when compared to the general population. Older age, male sex, and presence of comorbidities were commonly reported independent predictors of post-acute mortality in sepsis survivors, challenging the causality relationship. Sensitivity analyses for post-acute mortality were consistent with primary analysis. Conclusions Epidemiologic criteria for a causal relationship between sepsis and post-acute mortality were not consistently observed. Additional epidemiologic studies with recent patient level data that address the pre-illness trajectory, confounding, and varying control groups are needed to estimate sepsis-attributable additional risk and modifiable risk factors to design interventional trials. Electronic supplementary material The online version of this article (doi:10.1186/s13054-016-1276-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Manu Shankar-Hari
- Guy's and St Thomas' NHS Foundation Trust, ICU support Offices, 1st Floor, East Wing, St Thomas' Hospital, London, SE1 7EH, UK. .,Division of Asthma, Allergy and Lung Biology, Kings College London, London, SE1 9RT, UK.
| | - Michael Ambler
- Guy's and St Thomas' NHS Foundation Trust, ICU support Offices, 1st Floor, East Wing, St Thomas' Hospital, London, SE1 7EH, UK
| | - Viyaasan Mahalingasivam
- Guy's and St Thomas' NHS Foundation Trust, ICU support Offices, 1st Floor, East Wing, St Thomas' Hospital, London, SE1 7EH, UK
| | - Andrew Jones
- Guy's and St Thomas' NHS Foundation Trust, ICU support Offices, 1st Floor, East Wing, St Thomas' Hospital, London, SE1 7EH, UK.,Division of Asthma, Allergy and Lung Biology, Kings College London, London, SE1 9RT, UK
| | - Kathryn Rowan
- Intensive Care National Audit & Research Centre, Napier House, 24 High Holborn, London, WC1V 6AZ, UK
| | - Gordon D Rubenfeld
- Interdepartmental Division of Critical Care Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, D5 03, Toronto, Ontario, M4N 3M5, Canada
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16
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Rocha LL, Pessoa CMS, Corrêa TD, Pereira AJ, de Assunção MSC, Silva E. Conceitos atuais sobre suporte hemodinâmico e terapia em choque séptico. Braz J Anesthesiol 2015; 65:395-402. [DOI: 10.1016/j.bjan.2015.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 11/11/2014] [Indexed: 10/23/2022] Open
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17
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Current concepts on hemodynamic support and therapy in septic shock. Braz J Anesthesiol 2015; 65:395-402. [PMID: 26323739 DOI: 10.1016/j.bjane.2014.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 11/05/2014] [Accepted: 11/11/2014] [Indexed: 01/09/2023] Open
Abstract
Severe sepsis and septic shock represent a major healthcare challenge. Much of the improvement in mortality associated with septic shock is related to early recognition combined with timely fluid resuscitation and adequate antibiotics administration. The main goals of septic shock resuscitation include intravascular replenishment, maintenance of adequate perfusion pressure and oxygen delivery to tissues. To achieve those goals, fluid responsiveness evaluation and complementary interventions - i.e. vasopressors, inotropes and blood transfusion - may be necessary. This article is a literature review of the available evidence on the initial hemodynamic support of the septic shock patients presenting to the emergency room or to the intensive care unit and the main interventions available to reach those targets, focusing on fluid and vasopressor therapy, blood transfusion and inotrope administration.
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18
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Bhagwanjee S, Ugarte S. Sepsis in vulnerable populations. Glob Heart 2014; 9:281-8. [PMID: 25667179 DOI: 10.1016/j.gheart.2014.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 08/18/2014] [Indexed: 12/29/2022] Open
Abstract
Despite the acquisition of a large body of evidence, there are many unanswered questions about sepsis. The definition of this disease is plagued by the lack of a simple pathophysiological description linking cause to effect and the activation of host immune responses that hinders disease progression at the same time producing multiorgan dysfunction. A plethora of inconsistent clinical features has served to obfuscate rather than illuminate. The Surviving Sepsis Guidelines (SSG) are a major advance because it comprehensively interrogates all aspects of care for the critically ill. For vulnerable populations living in low- and middle-income countries, this guideline is ineffectual because of the lack of region-specific data, differences in etiology of sepsis and burden of disease, limited human capacity and infrastructure, as well as socioeconomic realities. Appropriate care must be guided by common sense guidelines that are sensitive to local realities and adapted as relevant data are acquired.
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Affiliation(s)
- Satish Bhagwanjee
- Department of Anaesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA.
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19
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Paratz JD, Kenardy J, Mitchell G, Comans T, Coyer F, Thomas P, Singh S, Luparia L, Boots RJ. IMPOSE (IMProving Outcomes after Sepsis)-the effect of a multidisciplinary follow-up service on health-related quality of life in patients postsepsis syndromes-a double-blinded randomised controlled trial: protocol. BMJ Open 2014; 4:e004966. [PMID: 24861549 PMCID: PMC4039866 DOI: 10.1136/bmjopen-2014-004966] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Patients post sepsis syndromes have a poor quality of life and a high rate of recurring illness or mortality. Follow-up clinics have been instituted for patients postgeneral intensive care but evidence is sparse, and there has been no clinic specifically for survivors of sepsis. The aim of this trial is to investigate if targeted screening and appropriate intervention to these patients can result in an improved quality of life (Short Form 36 health survey (SF36V.2)), decreased mortality in the first 12 months, decreased readmission to hospital and/or decreased use of health resources. METHODS AND ANALYSIS 204 patients postsepsis syndromes will be randomised to one of the two groups. The intervention group will attend an outpatient clinic two monthly for 6 months and receive screening and targeted intervention. The usual care group will remain under the care of their physician. To analyse the results, a baseline comparison will be carried out between each group. Generalised estimating equations will compare the SF36 domain scores between groups and across time points. Mortality will be compared between groups using a Cox proportional hazards (time until death) analysis. Time to first readmission will be compared between groups by a survival analysis. Healthcare costs will be compared between groups using a generalised linear model. Economic (health resource) evaluation will be a within-trial incremental cost utility analysis with a societal perspective. ETHICS AND DISSEMINATION Ethical approval has been granted by the Royal Brisbane and Women's Hospital Human Research Ethics Committee (HREC; HREC/13/QRBW/17), The University of Queensland HREC (2013000543), Griffith University (RHS/08/14/HREC) and the Australian Government Department of Health (26/2013). The results of this study will be submitted to peer-reviewed intensive care journals and presented at national and international intensive care and/or rehabilitation conferences. TRIAL REGISTRATION NUMBER Australian and New Zealand Clinical Trials Registry ACTRN12613000528752.
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Affiliation(s)
- Jennifer D Paratz
- Burn, Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- Department of Intensive Care Medicine, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
- School of Rehabilitation Sciences, Griffith University, Brisbane, Queensland, Australia
- Department of Physiotherapy, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
| | - Justin Kenardy
- CONROD, The University of Queensland, Brisbane, Queensland, Australia
| | - Geoffrey Mitchell
- School of Medicine (Ipswich Campus), The University of Queensland, Ipswich, Australia
| | - Tracy Comans
- School of Medicine, Griffith University, Brisbane, Queensland, Australia
| | - Fiona Coyer
- Nursing Faculty, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Peter Thomas
- Burn, Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- Department of Intensive Care Medicine, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
- Department of Physiotherapy, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
| | - Sunil Singh
- Intensive Care Unit, Bundaberg Hospital, Bundaberg, Queensland, Australia
| | - Louise Luparia
- Burn, Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- School of Rehabilitation Sciences, Griffith University, Brisbane, Queensland, Australia
| | - Robert J Boots
- Burn, Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- Department of Intensive Care Medicine, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
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