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Andersen SK, Herridge MS, Fiest KM. Recovery from Sepsis: Management beyond Acute Care. Semin Respir Crit Care Med 2024. [PMID: 38968959 DOI: 10.1055/s-0044-1787993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2024]
Abstract
Recovery from sepsis is a key global health issue, impacting 38 million sepsis survivors worldwide per year. Sepsis survivors face a wide range of physical, cognitive, and psychosocial sequelae. Readmissions to hospital following sepsis are an important driver of global healthcare utilization and cost. Family members of sepsis survivors also experience significant stressors related to their role as informal caregivers. Increasing recognition of the burdens of sepsis survivorship has led to the development of postsepsis recovery programs to better support survivors and their families, although optimal models of care remain uncertain. The goal of this article is to perform a narrative review of recovery from sepsis from the perspective of patients, families, and health systems.
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Affiliation(s)
- Sarah K Andersen
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, Alberta, Canada
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Margaret S Herridge
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
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2
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Shen J, Pan L, Chen W, Wu Y. Long non‑coding RNAs MALAT1, NEAT1 and DSCR4 can be serum biomarkers in predicting urosepsis occurrence and reflect disease severity. Exp Ther Med 2024; 28:289. [PMID: 38827469 PMCID: PMC11140293 DOI: 10.3892/etm.2024.12578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 04/03/2024] [Indexed: 06/04/2024] Open
Abstract
Sepsis commonly occurs in patients with serious infections. It severely threatens the health of patients and has very high mortality rates. Urosepsis is a type of sepsis in which the serious infection originates from the urinary system. Early diagnosis of the occurrence and severity of urogenital sepsis is crucial for improving patient prognosis. Long noncoding RNAs (LncRNAs) play important roles in the occurrence of a number of diseases, including sepsis, and can be potential biomarkers that predict disease development. The present study aimed to discover potential LncRNAs that can predict the occurrence of urosepsis. RNA-sequence data from patients with sepsis from the GEO database was analyzed and LncRNAs associated with sepsis were identified. The expression of LncRNAs associated with sepsis was tested in clinical urosepsis samples. Finally, the value of these LncRNAs in predicting urosepsis was verified using clinical samples. From the GEO database a total of nine LncRNAs (MALAT1, NEAT1, RMRP, LncIRX5, LINC01742, DSCR4, C22ORF34, LINC00381, and LINC01102) were identified that had expression changes corresponding with the occurrence of sepsis. Specifically, MALAT1, NEAT1 and DSCR4 revealed differential expression in patients with urosepsis. Moreover, MALAT1, and DSCR4 were shown to be significant risk indicators for urosepsis, and NEAT1 was shown to reflect disease severity. Therefore, the present study indicated that the LncRNAs, MALAT1, NEAT1 and DSCR4 can reflect the occurrence and severity of urosepsis and may act as potential biomarkers.
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Affiliation(s)
- Jianliang Shen
- Department of Urology, Tinglin Hospital of Jinshan District, Shanghai 201505, P.R. China
| | - Liangming Pan
- Department of Urology, Tinglin Hospital of Jinshan District, Shanghai 201505, P.R. China
| | - Wei Chen
- Community Health Service Center of Fengjing Town, Shanghai 201501, P.R. China
| | - Yechen Wu
- Department of Urology, Baoshan Branch, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201900, P.R. China
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Sheikh F, Chechulina V, Garber G, Hendrick K, Kissoon N, Proulx L, Russell K, Fox-Robichaud AE, Schwartz L, Barrett KA. Reducing the burden of preventable deaths from sepsis in Canada: A need for a national sepsis action plan. Healthc Manage Forum 2024:8404704241240956. [PMID: 38597370 DOI: 10.1177/08404704241240956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
Sepsis is a global health threat with significant morbidity and mortality. Despite clinical practice guidelines and developed health systems, sepsis is often unrecognized or misdiagnosed, leading to preventable harm. In Canada, sepsis is responsible for 1 in 20 deaths and is a significant driver of health system costs. Despite being a signatory to the World Health Organization's Resolution WHA 70.7, adopted in 2017, Canada has not lived up to its commitment. Many existing sepsis policies were developed in response to a specific tragedy, and there is no national sepsis action plan. In this article, we describe the burden of sepsis, provide examples of existing, context-specific, reactionary sepsis policies, and urge a coordinated, proactive Canadian sepsis action plan to reduce the burden of sepsis.
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Affiliation(s)
| | | | - Gary Garber
- Canadian Medical Protective Association, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
| | - Kathryn Hendrick
- Sepsis Canada Patient Advisory Council, Hamilton, Ontario, Canada
| | - Niranjan Kissoon
- BC Children's Hospital, Vancouver, British Columbia, Canada
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Laurie Proulx
- Sepsis Canada Patient Advisory Council, Hamilton, Ontario, Canada
- Canadian Arthritis Patient Alliance, Ottawa, Ontario, Canada
| | - Kristine Russell
- Sepsis Canada Patient Advisory Council, Hamilton, Ontario, Canada
- University of Calgary, Calgary, Alberta, Canada
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4
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Ntiamoah M, Xavier T, Lambert J. Sentiment Analysis of Patient- and Family-Related Sepsis Events: Exploratory Study. JMIR Nurs 2024; 7:e51720. [PMID: 38557694 PMCID: PMC11019419 DOI: 10.2196/51720] [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: 08/09/2023] [Revised: 01/24/2024] [Accepted: 02/07/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Despite the life-threatening nature of sepsis, little is known about the emotional experiences of patients and their families during sepsis events. We conducted a sentiment analysis pertaining to sepsis incidents involving patients and families, leveraging textual data retrieved from a publicly available blog post disseminated by the Centers for Disease Control and Prevention (CDC). OBJECTIVE This investigation involved a sentiment analysis of patient- and family-related sepsis events, leveraging text responses sourced from a publicly accessible blog post disseminated by the CDC. Driven by the imperative to elucidate the emotional dynamics encountered by patients and their families throughout sepsis incidents, the overarching aims centered on elucidating the emotional ramifications of sepsis on both patients and their families and discerning potential avenues for enhancing the quality of sepsis care. METHODS The research used a cross-sectional data mining methodology to investigate the sentiments and emotional aspects linked to sepsis, using a data set sourced from the CDC, which encompasses 170 responses from both patients and caregivers, spanning the period between September 2014 and September 2020. This investigation used the National Research Council Canada Emotion Lexicon for sentiment analysis, coupled with a combination of manual and automated techniques to extract salient features from textual responses. The study used negative binomial least absolute shrinkage and selection operator regressions to ascertain significant textual features that correlated with specific emotional states. Moreover, the visualization of Plutchik's Wheel of Emotions facilitated the discernment of prevailing emotions within the data set. RESULTS The results showed that patients and their families experienced a range of emotions during sepsis events, including fear, anxiety, sadness, and gratitude. Our analyses revealed an estimated incidence rate ratio (IRR) of 1.35 for fear-related words and a 1.51 IRR for sadness-related words when mentioning "hospital" in sepsis-related experiences. Similarly, mentions of "intensive care unit" were associated with an average occurrence of 12.3 fear-related words and 10.8 sadness-related words. Surviving patients' experiences had an estimated 1.15 IRR for joy-related words, contrasting with discussions around organ failure, which were associated with multiple negative emotions including disgust, anger, fear, and sadness. Furthermore, mentions of "death" were linked to more fear and anger words but fewer joy-related words. Conversely, longer timelines in sepsis events were associated with more joy-related words and fewer fear-related words, potentially indicating improved emotional adaptation over time. CONCLUSIONS The study's outcomes underscore the imperative for health care providers to integrate emotional support alongside medical interventions for patients and families affected by sepsis, emphasizing the emotional toll incurred and highlighting the necessity of acknowledgment and resolution, advocating for the use of sentiment analysis as a means to tailor personalized emotional aid, and thereby potentially augmenting both patient and family welfare and overall outcomes.
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Affiliation(s)
| | - Teenu Xavier
- University of Cincinnati, Cincinnati, OH, United States
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5
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Li C, Song J, Chen Q, Ge D, Li Q, Yang Y. Whole-genome shotgun sequencing unravels the influence of environmental microbial co-infections on the treatment efficacy for severe pediatric infectious diseases. Front Microbiol 2024; 15:1308871. [PMID: 38328429 PMCID: PMC10847551 DOI: 10.3389/fmicb.2024.1308871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 01/03/2024] [Indexed: 02/09/2024] Open
Abstract
Background The microbiome plays a pivotal role in mediating immune deviation during the development of early-life viral infections. Recurrent infections in children are considered a risk factor for disease development. This study delves into the metagenomics of the microbiome in children suffering from severe infections, seeking to identify potential sources of these infections. Aims The aim of this study was to identify the specific microorganisms and factors that significantly influence the treatment duration in patients suffering from severe infections. We sought to understand how these microbial communities and other variables may affect the treatment duration and the use of antibiotics of these patients with severe infections. Method Whole-genome shotgun sequencing was conducted on samples collected from children aged 0-14 years with severe infections, admitted to the Pediatrics Department of Xiamen First Hospital. The Kraken2 algorithm was used for taxonomic identification from sequence reads, and linear mixed models were employed to identify significant microorganisms influencing treatment duration. Colwellia, Cryptococcus, and Citrobacter were found to significantly correlate with the duration of clinical treatment. Further analysis using propensity score matching (PSM) and rank-sum test identified clinical indicators significantly associated with the presence of these microorganisms. Results Using a linear mixed model after removed the outliers, we identified that the abundance of Colwellia, Cryptococcus, and Citrobacter significantly influences the treatment duration. The presence of these microorganisms is associated with a longer treatment duration for patients. Furthermore, these microorganisms were found to impact various clinical measures. Notably, an increase in hospitalization durations and medication costs was observed in patients with these microorganisms. In patients with Colwellia, Cryptococcus, and Citrobacter, we discover significant differences in platelets levels. We also find that in patients with Cryptococcus, white blood cells, hemoglobin, and neutrophils levels are lower. Conclusion These findings suggest that Colwellia, Cryptococcus, and Citrobacter, particularly Cryptococcus, could potentially contribute to the severity of infections observed in this cohort, possibly as co-infections. These microorganisms warrant further investigation into their pathogenic roles and mechanisms of action, as their presence in combination with disease-causing organisms may have a synergistic effect on disease severity. Understanding the interplay between these microorganisms and pathogenic agents could provide valuable insights into the complex nature of severe pediatric infections and guide the development of targeted therapeutic strategies.
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Affiliation(s)
- Chengxin Li
- Department of Pediatrics, Pediatric Key Laboratory of Xiamen, The First Affiliated Hospital of Xiamen University, Institute of Pediatrics, School of Medicine, Xiamen University, Xiamen, China
- National Institute for Data Science in Health and Medicine, School of Medicine, Xiamen University, Xiamen, China
| | - Jing Song
- Department of Pediatrics, Pediatric Key Laboratory of Xiamen, The First Affiliated Hospital of Xiamen University, Institute of Pediatrics, School of Medicine, Xiamen University, Xiamen, China
| | - Qihong Chen
- Department of Pediatrics, Pediatric Key Laboratory of Xiamen, The First Affiliated Hospital of Xiamen University, Institute of Pediatrics, School of Medicine, Xiamen University, Xiamen, China
| | - Dandan Ge
- Department of Pediatrics, Pediatric Key Laboratory of Xiamen, The First Affiliated Hospital of Xiamen University, Institute of Pediatrics, School of Medicine, Xiamen University, Xiamen, China
| | - Qiyuan Li
- Department of Pediatrics, Pediatric Key Laboratory of Xiamen, The First Affiliated Hospital of Xiamen University, Institute of Pediatrics, School of Medicine, Xiamen University, Xiamen, China
- National Institute for Data Science in Health and Medicine, School of Medicine, Xiamen University, Xiamen, China
| | - Yungang Yang
- Department of Pediatrics, Pediatric Key Laboratory of Xiamen, The First Affiliated Hospital of Xiamen University, Institute of Pediatrics, School of Medicine, Xiamen University, Xiamen, China
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Luijks ECN, van der Slikke EC, van Zanten ARH, Ter Maaten JC, Postma MJ, Hilderink HBM, Henning RH, Bouma HR. Societal costs of sepsis in the Netherlands. Crit Care 2024; 28:29. [PMID: 38254226 PMCID: PMC10802003 DOI: 10.1186/s13054-024-04816-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 01/18/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Sepsis is a life-threatening syndrome characterized by acute loss of organ function due to infection. Sepsis survivors are at risk for long-term comorbidities, have a reduced Quality of Life (QoL), and are prone to increased long-term mortality. The societal impact of sepsis includes its disease burden and indirect economic costs. However, these societal costs of sepsis are not fully understood. This study assessed sepsis's disease-related and indirect economic costs in the Netherlands. METHODS Sepsis prevalence, incidence, sepsis-related mortality, hospitalizations, life expectancy, QoL population norms, QoL reduction after sepsis, and healthcare use post-sepsis were obtained from previous literature and Statistics Netherlands. We used these data to estimate annual Quality-adjusted Life Years (QALYs), productivity loss, and increase in healthcare use post-sepsis. A sensitivity analysis was performed to analyze the burden and indirect economic costs of sepsis under alternative assumptions, resulting in a baseline, low, and high estimated burden. The results are presented as a baseline (low-high burden) estimate. RESULTS The annual disease burden of sepsis is approximately 57,304 (24,398-96,244; low-high burden) QALYs. Of this, mortality accounts for 26,898 (23,166-31,577) QALYs, QoL decrease post-sepsis accounts for 30,406 (1232-64,667) QALYs. The indirect economic burden, attributed to lost productivity and increased healthcare expenditure, is estimated at €416.1 (147.1-610.7) million utilizing the friction cost approach and €3.1 (0.4-5.7) billion using the human capital method. Cumulatively, the combined disease and indirect economic burdens range from €3.8 billion (friction method) to €6.5 billion (human capital method) annually within the Netherlands. CONCLUSIONS Sepsis and its complications pose a substantial disease and indirect economic burden to the Netherlands, with an indirect economic burden due to production loss that is potentially larger than the burden due to coronary heart disease or stroke. Our results emphasize the need for future studies to prevent sepsis, saving downstream costs and decreasing the economic burden.
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Affiliation(s)
- Erik C N Luijks
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Elisabeth C van der Slikke
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Arthur R H van Zanten
- Department of Intensive Care Medicine, Gelderse Vallei Hospital, Ede, The Netherlands
- Division of Human Nutrition and Health, Wageningen University Research, Wageningen, The Netherlands
| | - Jan C Ter Maaten
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Maarten J Postma
- Department of Economics, Econometrics and Finance, Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
- Department of Health Sciences, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Henk B M Hilderink
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Robert H Henning
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Hjalmar R Bouma
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
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7
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Boni S, Sartini M, Del Puente F, Adriano G, Blasi Vacca E, Bobbio N, Carbone A, Feasi M, Grasso V, Lattuada M, Nelli M, Oliva M, Parisini A, Prinapori R, Santarsiero MC, Tigano S, Cristina ML, Pontali E. Innovative Approaches to Monitor Central Line Associated Bloodstream Infections (CLABSIs) Bundle Efficacy in Intensive Care Unit (ICU): Role of Device Standardized Infection Rate (dSIR) and Standardized Utilization Ratio (SUR)-An Italian Experience. J Clin Med 2024; 13:396. [PMID: 38256530 PMCID: PMC10816537 DOI: 10.3390/jcm13020396] [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: 12/20/2023] [Revised: 12/30/2023] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
In several settings, the COVID-19 pandemic determined a negative impact on the occurrence of healthcare-associated infection, particularly for on central lines associated bloodstream infections (CLABSI). In our setting, we observed a significant increase in CLABSI in our intensive care unit (ICU) during 2020 and 2021 vs. 2018 to 2019. A refresher training activity on central venous catheter (CVC) management bundles was carried out in September-October 2021 for the ICU health staff. We assessed the impact of bundle implementation by means of standardized indicators, such as the Device Utilization Ratio (DUR), in this case, the Central Line Utilization Ratio, the Standardized Utilization Ratio (SUR), and the device Standardized Infection Ratio (dSIR). Standardized ratios for device use and infection ratio were computed using data from 2018 and 2019 as expectation data. After bundle implementation, we observed a significant reduction of dSIR (p < 0.001), which dropped from 3.23 and 2.99 in the 2020-2021 biennium to 1.11 in 2022 (CLABSI in the first quarter only); no more CLABSI were observed afterwards. Standardized ratios proved helpful in identify increasing trends of CLABSI in the ICU and monitoring the impact of a simple effective tool, i.e., training on and implementation of a bundle for CVC management.
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Affiliation(s)
- Silvia Boni
- Department of Infectious Diseases, Galliera Hospital, 16128 Genoa, Italy; (S.B.); (F.D.P.); (E.B.V.); (N.B.); (M.F.); (A.P.); (R.P.); (S.T.)
| | - Marina Sartini
- Operating Unit Hospital Hygiene, Galliera Hospital, 16128 Genoa, Italy; (M.S.); (A.C.); (M.O.); (M.L.C.)
- Department of Health Sciences, University of Genoa, 16132 Genoa, Italy
| | - Filippo Del Puente
- Department of Infectious Diseases, Galliera Hospital, 16128 Genoa, Italy; (S.B.); (F.D.P.); (E.B.V.); (N.B.); (M.F.); (A.P.); (R.P.); (S.T.)
| | - Giulia Adriano
- Hospital Infection Control Committee, Galliera Hospital, 16128 Genoa, Italy; (G.A.); (M.C.S.)
| | - Elisabetta Blasi Vacca
- Department of Infectious Diseases, Galliera Hospital, 16128 Genoa, Italy; (S.B.); (F.D.P.); (E.B.V.); (N.B.); (M.F.); (A.P.); (R.P.); (S.T.)
| | - Nicoletta Bobbio
- Department of Infectious Diseases, Galliera Hospital, 16128 Genoa, Italy; (S.B.); (F.D.P.); (E.B.V.); (N.B.); (M.F.); (A.P.); (R.P.); (S.T.)
| | - Alessio Carbone
- Operating Unit Hospital Hygiene, Galliera Hospital, 16128 Genoa, Italy; (M.S.); (A.C.); (M.O.); (M.L.C.)
| | - Marcello Feasi
- Department of Infectious Diseases, Galliera Hospital, 16128 Genoa, Italy; (S.B.); (F.D.P.); (E.B.V.); (N.B.); (M.F.); (A.P.); (R.P.); (S.T.)
| | - Viviana Grasso
- Anaesthesia and Intensive Care Unit, E.O. Ospedali Galliera, 16128 Genoa, Italy; (V.G.); (M.L.)
| | - Marco Lattuada
- Anaesthesia and Intensive Care Unit, E.O. Ospedali Galliera, 16128 Genoa, Italy; (V.G.); (M.L.)
| | - Mauro Nelli
- Medical Service Management, Galliera Hospital, 16128 Genoa, Italy;
| | - Martino Oliva
- Operating Unit Hospital Hygiene, Galliera Hospital, 16128 Genoa, Italy; (M.S.); (A.C.); (M.O.); (M.L.C.)
| | - Andrea Parisini
- Department of Infectious Diseases, Galliera Hospital, 16128 Genoa, Italy; (S.B.); (F.D.P.); (E.B.V.); (N.B.); (M.F.); (A.P.); (R.P.); (S.T.)
| | - Roberta Prinapori
- Department of Infectious Diseases, Galliera Hospital, 16128 Genoa, Italy; (S.B.); (F.D.P.); (E.B.V.); (N.B.); (M.F.); (A.P.); (R.P.); (S.T.)
| | | | - Stefania Tigano
- Department of Infectious Diseases, Galliera Hospital, 16128 Genoa, Italy; (S.B.); (F.D.P.); (E.B.V.); (N.B.); (M.F.); (A.P.); (R.P.); (S.T.)
| | - Maria Luisa Cristina
- Operating Unit Hospital Hygiene, Galliera Hospital, 16128 Genoa, Italy; (M.S.); (A.C.); (M.O.); (M.L.C.)
- Department of Health Sciences, University of Genoa, 16132 Genoa, Italy
| | - Emanuele Pontali
- Department of Infectious Diseases, Galliera Hospital, 16128 Genoa, Italy; (S.B.); (F.D.P.); (E.B.V.); (N.B.); (M.F.); (A.P.); (R.P.); (S.T.)
- Operating Unit Hospital Hygiene, Galliera Hospital, 16128 Genoa, Italy; (M.S.); (A.C.); (M.O.); (M.L.C.)
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Kim B, Yu JE, Yeo IJ, Son DJ, Lee HP, Roh YS, Lim KH, Yun J, Park H, Han SB, Hong JT. (E)-2-methoxy-4-(3-(4-methoxyphenyl)prop-1-en-1-yl)phenol alleviates inflammatory responses in LPS-induced mice liver sepsis through inhibition of STAT3 phosphorylation. Int Immunopharmacol 2023; 125:111124. [PMID: 37977740 DOI: 10.1016/j.intimp.2023.111124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 10/13/2023] [Accepted: 10/20/2023] [Indexed: 11/19/2023]
Abstract
Sepsis is a life-threatening disease with limited treatment options, and the inflammatory process represents an important factor affecting its progression. Many studies have demonstrated the critical roles of signal transducer and activator of transcription 3 (STAT3) in sepsis pathophysiology and pro-inflammatory responses. Inhibition of STAT3 activity may therefore represent a promising treatment option for sepsis. We here used a mouse model to demonstrate that (E)-2-methoxy-4-(3-(4-methoxyphenyl)prop-1-en-1-yl)phenol (MMPP) treatment prevented the liver sepsis-related mortality induced by 30 mg/kg lipopolysaccharide (LPS) treatment and reduced LPS-induced increase in alanine transaminase, aspartate transaminase, and lactate dehydrogenase levels, all of which are markers of liver sepsis progression. These recovery effects were associated with decreased LPS-induced STAT3, p65, and JAK1 phosphorylation and proinflammatory cytokine (interleukin 1 beta, interleukin 6, and tumor necrosis factor alpha) level; expression of cyclooxygenase-2 and induced nitric oxide synthase were also reduced by MMPP. In an in vitro study using the normal liver cell line THLE-2, MMPP treatment prevented the LPS-induced increase of STAT3, p65, and JAK1 phosphorylation and inflammatory protein expression in a dose-dependent manner, and this effect was enhanced by combination treatment with MMPP and STAT3 inhibitor. The results clearly indicate that MMPP treatment prevents LPS-induced mortality by inhibiting the inflammatory response via STAT3 activity inhibition. Thus, MMPP represents a novel agent for alleviating LPS-induced liver sepsis.
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Affiliation(s)
- Boyoung Kim
- College of Pharmacy & Medical Research Center, Chungbuk National University, Osongsaengmyeong 1-ro 194-21, Osong-eup, Heungduk-gu, Cheongju, Chungbuk 28160, Republic of Korea.
| | - Ji Eun Yu
- College of Pharmacy & Medical Research Center, Chungbuk National University, Osongsaengmyeong 1-ro 194-21, Osong-eup, Heungduk-gu, Cheongju, Chungbuk 28160, Republic of Korea.
| | - In Jun Yeo
- College of Pharmacy & Medical Research Center, Chungbuk National University, Osongsaengmyeong 1-ro 194-21, Osong-eup, Heungduk-gu, Cheongju, Chungbuk 28160, Republic of Korea.
| | - Dong Ju Son
- College of Pharmacy & Medical Research Center, Chungbuk National University, Osongsaengmyeong 1-ro 194-21, Osong-eup, Heungduk-gu, Cheongju, Chungbuk 28160, Republic of Korea.
| | - Hee Pom Lee
- College of Pharmacy & Medical Research Center, Chungbuk National University, Osongsaengmyeong 1-ro 194-21, Osong-eup, Heungduk-gu, Cheongju, Chungbuk 28160, Republic of Korea.
| | - Yoon Seok Roh
- College of Pharmacy & Medical Research Center, Chungbuk National University, Osongsaengmyeong 1-ro 194-21, Osong-eup, Heungduk-gu, Cheongju, Chungbuk 28160, Republic of Korea.
| | - Key-Hwan Lim
- College of Pharmacy & Medical Research Center, Chungbuk National University, Osongsaengmyeong 1-ro 194-21, Osong-eup, Heungduk-gu, Cheongju, Chungbuk 28160, Republic of Korea.
| | - Jaesuk Yun
- College of Pharmacy & Medical Research Center, Chungbuk National University, Osongsaengmyeong 1-ro 194-21, Osong-eup, Heungduk-gu, Cheongju, Chungbuk 28160, Republic of Korea.
| | - Hanseul Park
- College of Pharmacy & Medical Research Center, Chungbuk National University, Osongsaengmyeong 1-ro 194-21, Osong-eup, Heungduk-gu, Cheongju, Chungbuk 28160, Republic of Korea.
| | - Sang Bae Han
- College of Pharmacy & Medical Research Center, Chungbuk National University, Osongsaengmyeong 1-ro 194-21, Osong-eup, Heungduk-gu, Cheongju, Chungbuk 28160, Republic of Korea.
| | - Jin Tae Hong
- College of Pharmacy & Medical Research Center, Chungbuk National University, Osongsaengmyeong 1-ro 194-21, Osong-eup, Heungduk-gu, Cheongju, Chungbuk 28160, Republic of Korea.
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9
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Zhang W, Jiang H, Wu G, Huang P, Wang H, An H, Liu S, Zhang W. The pathogenesis and potential therapeutic targets in sepsis. MedComm (Beijing) 2023; 4:e418. [PMID: 38020710 PMCID: PMC10661353 DOI: 10.1002/mco2.418] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 10/01/2023] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
Sepsis is defined as "a life-threatening organ dysfunction caused by dysregulated host systemic inflammatory and immune response to infection." At present, sepsis continues to pose a grave healthcare concern worldwide. Despite the use of supportive measures in treating traditional sepsis, such as intravenous fluids, vasoactive substances, and oxygen plus antibiotics to eradicate harmful pathogens, there is an ongoing increase in both the morbidity and mortality associated with sepsis during clinical interventions. Therefore, it is urgent to design specific pharmacologic agents for the treatment of sepsis and convert them into a novel targeted treatment strategy. Herein, we provide an overview of the molecular mechanisms that may be involved in sepsis, such as the inflammatory response, immune dysfunction, complement deactivation, mitochondrial damage, and endoplasmic reticulum stress. Additionally, we highlight important targets involved in sepsis-related regulatory mechanisms, including GSDMD, HMGB1, STING, and SQSTM1, among others. We summarize the latest advancements in potential therapeutic drugs that specifically target these signaling pathways and paramount targets, covering both preclinical studies and clinical trials. In addition, this review provides a detailed description of the crosstalk and function between signaling pathways and vital targets, which provides more opportunities for the clinical development of new treatments for sepsis.
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Affiliation(s)
- Wendan Zhang
- Shanghai Frontiers Science Center of TCM Chemical BiologyInstitute of Interdisciplinary Integrative Medicine ResearchShanghai University of Traditional Chinese MedicineShanghaiChina
- Faculty of PediatricsNational Engineering Laboratory for Birth defects prevention and control of key technologyBeijing Key Laboratory of Pediatric Organ Failurethe Chinese PLA General HospitalBeijingChina
| | - Honghong Jiang
- Shanghai Frontiers Science Center of TCM Chemical BiologyInstitute of Interdisciplinary Integrative Medicine ResearchShanghai University of Traditional Chinese MedicineShanghaiChina
- Faculty of PediatricsNational Engineering Laboratory for Birth defects prevention and control of key technologyBeijing Key Laboratory of Pediatric Organ Failurethe Chinese PLA General HospitalBeijingChina
| | - Gaosong Wu
- Shanghai Frontiers Science Center of TCM Chemical BiologyInstitute of Interdisciplinary Integrative Medicine ResearchShanghai University of Traditional Chinese MedicineShanghaiChina
| | - Pengli Huang
- Shanghai Frontiers Science Center of TCM Chemical BiologyInstitute of Interdisciplinary Integrative Medicine ResearchShanghai University of Traditional Chinese MedicineShanghaiChina
| | - Haonan Wang
- Shanghai Frontiers Science Center of TCM Chemical BiologyInstitute of Interdisciplinary Integrative Medicine ResearchShanghai University of Traditional Chinese MedicineShanghaiChina
| | - Huazhasng An
- Shandong Provincial Key Laboratory for Rheumatic Disease and Translational MedicineThe First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan HospitalJinanShandongChina
| | - Sanhong Liu
- Shanghai Frontiers Science Center of TCM Chemical BiologyInstitute of Interdisciplinary Integrative Medicine ResearchShanghai University of Traditional Chinese MedicineShanghaiChina
| | - Weidong Zhang
- Shanghai Frontiers Science Center of TCM Chemical BiologyInstitute of Interdisciplinary Integrative Medicine ResearchShanghai University of Traditional Chinese MedicineShanghaiChina
- Department of PhytochemistrySchool of PharmacySecond Military Medical UniversityShanghaiChina
- The Research Center for Traditional Chinese MedicineShanghai Institute of Infectious Diseases and BiosecurityShanghai University of Traditional Chinese MedicineShanghaiChina
- Institute of Medicinal Plant DevelopmentChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
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10
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Chen C, Wu X, Zhang W, Pu Y, Xu X, Sun Y, Fei Y, Zhou S, Fang B. Predictive value of risk factors for prognosis of patients with sepsis in intensive care unit. Medicine (Baltimore) 2023; 102:e33881. [PMID: 37335653 DOI: 10.1097/md.0000000000033881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
Sepsis has emerged as a major global public health concern due to its elevated mortality and high cost of care. This study aimed to evaluate the risk factors associated with the mortality of sepsis patients in the Intensive Care Unit (ICU), and to intervene in the early stages of sepsis in order to improve patient outcomes and reduce mortality. From January 1st, 2021 to December 31st, 2021, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Huashan Hospital Affiliated to Fudan University, and The Seventh People's Hospital Affiliated to Shanghai University of Traditional Chinese Medicine were designated as sentinel hospitals, and sepsis patients in their respective ICU and Emergency ICU were selected as research subjects, and divided into survivors and non-survivors according to their discharge outcomes. The mortality risk of sepsis patients was subsequently analyzed by logistic regression. A total of 176 patients with sepsis were included, of which 130 (73.9%) were survivors and 46 (26.1%) were non-survivors. Factors identified as having an impact on death among sepsis patients included female [Odds Ratio (OR) = 5.135, 95% confidence interval (CI): 1.709, 15.427, P = .004)], cardiovascular disease (OR = 6.272, 95% CI: 1.828, 21.518, P = .004), cerebrovascular disease (OR = 3.133, 95% CI: 1.093, 8.981, P = .034), pulmonary infections (OR = 6.700, 95% CI: 1.744, 25.748, P = .006), use of vasopressors (OR = 34.085, 95% CI: 10.452, 111.155, P < .001), WBC < 3.5 × 109/L (OR = 9.752, 95% CI: 1.386, 68.620, P = .022), ALT < 7 U/L (OR = 7.672, 95% CI: 1.263, 46.594, P = .027), ALT > 40 U/L (OR = 3.343, 95% CI: 1.097, 10.185, P = .034). Gender, cardiovascular disease, cerebrovascular disease, pulmonary infections, the use of vasopressors, WBC, and ALT are important factors in evaluating the prognostic outcome of sepsis patients in the ICU. This suggests that medical professionals should recognize them expeditiously and implement aggressive treatment tactics to diminish the mortality rate and improve outcomes.
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Affiliation(s)
- Caiyu Chen
- Department of Emergency, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Xinxin Wu
- Department of Emergency, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Wen Zhang
- Department of Emergency, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Yuting Pu
- Department of Emergency, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Xiangru Xu
- Department of Emergency, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Yuting Sun
- Department of Emergency, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Yuerong Fei
- Department of Emergency, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Shuang Zhou
- Acupuncture and Massage College, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Bangjiang Fang
- Department of Emergency, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
- Institute of Emergency and Critical Care Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
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11
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Bircak-Kuchtova B, Chung HY, Wickel J, Ehler J, Geis C. Neurofilament light chains to assess sepsis-associated encephalopathy: Are we on the track toward clinical implementation? Crit Care 2023; 27:214. [PMID: 37259091 DOI: 10.1186/s13054-023-04497-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/18/2023] [Indexed: 06/02/2023] Open
Abstract
Sepsis is the most common cause of admission to intensive care units worldwide. Sepsis patients frequently suffer from sepsis-associated encephalopathy (SAE) reflecting acute brain dysfunction. SAE may result in increased mortality, extended length of hospital stay, and long-term cognitive dysfunction. The diagnosis of SAE is based on clinical assessments, but a valid biomarker to identify and confirm SAE and to assess SAE severity is missing. Several blood-based biomarkers indicating neuronal injury have been evaluated in sepsis and their potential role as early diagnosis and prognostic markers has been studied. Among those, the neuroaxonal injury marker neurofilament light chain (NfL) was identified to potentially serve as a prognostic biomarker for SAE and to predict long-term cognitive impairment. In this review, we summarize the current knowledge of biomarkers, especially NfL, in SAE and discuss a possible future clinical application considering existing limitations.
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Affiliation(s)
- Barbora Bircak-Kuchtova
- Section Translational Neuroimmunology, Department for Neurology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Ha-Yeun Chung
- Section Translational Neuroimmunology, Department for Neurology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
- Center for Sepsis Control and Care, Jena University Hospital, 07747, Jena, Germany.
| | - Jonathan Wickel
- Section Translational Neuroimmunology, Department for Neurology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
- Center for Sepsis Control and Care, Jena University Hospital, 07747, Jena, Germany
| | - Johannes Ehler
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, 07747, Jena, Germany
| | - Christian Geis
- Section Translational Neuroimmunology, Department for Neurology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
- Center for Sepsis Control and Care, Jena University Hospital, 07747, Jena, Germany
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12
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Fleischmann-Struzek C, Ditscheid B, Rose N, Spoden M, Wedekind L, Schlattmann P, Günster C, Reinhart K, Hartog CS, Freytag A. Return to work after sepsis-a German population-based health claims study. Front Med (Lausanne) 2023; 10:1187809. [PMID: 37305145 PMCID: PMC10248449 DOI: 10.3389/fmed.2023.1187809] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Background Long-term impairments after sepsis can impede the return to work in survivors. We aimed to describe rates of return to work 6 and 12 months postsepsis. Methods This retrospective, population-based cohort study was based on health claims data of the German AOK health insurance of 23.0 million beneficiaries. We included 12-months survivors after hospital-treated sepsis in 2013/2014, who were ≤60 years at the time of the admission and were working in the year presepsis. We assessed the prevalence of return to work (RTW), persistent inability to work and early retirement. Results Among 7,370 working age sepsis survivors, 69.2% returned to work at 6 months postsepsis, while 22.8% were on sick leave and 8.0% retired early. At 12 months postsepsis, the RTW rate increased to 76.9%, whereas 9.8% were still on sick leave and 13.3% retired early. Survivors who returned to work had a mean of 70 (SD 93) sick leave days in the 12 months presepsis (median 28 days, IQR 108 days). Conclusion One out of four working age sepsis survivors does not resume work in the year postsepsis. Specific rehabilitation and targeted aftercare may be opportunities to reduce barriers to RTW after sepsis.
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Affiliation(s)
- Carolin Fleischmann-Struzek
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
- Center for Sepsis Control and Care, Jena University Hospital/Friedrich Schiller University Jena, Jena, Germany
| | - Bianka Ditscheid
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
| | - Norman Rose
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
- Center for Sepsis Control and Care, Jena University Hospital/Friedrich Schiller University Jena, Jena, Germany
| | - Melissa Spoden
- Research Institute of the Local Health Care Funds, Berlin, Germany
- Federal Association of the Local Health Care Funds, Berlin, Germany
| | - Lisa Wedekind
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Jena, Germany
| | - Peter Schlattmann
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Jena, Germany
| | - Christian Günster
- Research Institute of the Local Health Care Funds, Berlin, Germany
- Federal Association of the Local Health Care Funds, Berlin, Germany
| | - Konrad Reinhart
- Department of Anesthesiology and Operative Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Christiane S. Hartog
- Department of Anesthesiology and Operative Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
- Klinik Bavaria, Kreischa, Germany
| | - Antje Freytag
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
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13
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Singh P, Mohsin M, Sultan A, Jha P, Khan MM, Syed MA, Chopra M, Serajuddin M, Rahmani AH, Almatroodi SA, Alrumaihi F, Dohare R. Combined Multiomics and In Silico Approach Uncovers PRKAR1A as a Putative Therapeutic Target in Multi-Organ Dysfunction Syndrome. ACS OMEGA 2023; 8:9555-9568. [PMID: 36936296 PMCID: PMC10018728 DOI: 10.1021/acsomega.3c00020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
Despite all epidemiological, clinical, and experimental research efforts, therapeutic concepts in sepsis and sepsis-induced multi-organ dysfunction syndrome (MODS) remain limited and unsatisfactory. Currently, gene expression data sets are widely utilized to discover new biomarkers and therapeutic targets in diseases. In the present study, we analyzed MODS expression profiles (comprising 13 sepsis and 8 control samples) retrieved from NCBI-GEO and found 359 differentially expressed genes (DEGs), among which 170 were downregulated and 189 were upregulated. Next, we employed the weighted gene co-expression network analysis (WGCNA) to establish a MODS-associated gene co-expression network (weighted) and identified representative module genes having an elevated correlation with age. Based on the results, a turquoise module was picked as our hub module. Further, we constructed the PPI network comprising 35 hub module DEGs. The DEGs involved in the highest-confidence PPI network were utilized for collecting pathway and gene ontology (GO) terms using various libraries. Nucleotide di- and triphosphate biosynthesis and interconversion was the most significant pathway. Also, 3 DEGs within our PPI network were involved in the top 5 significantly enriched ontology terms, with hypercortisolism being the most significant term. PRKAR1A was the overlapping gene between top 5 significant pathways and GO terms, respectively. PRKAR1A was considered as a therapeutic target in MODS, and 2992 ligands were screened for binding with PRKAR1A. Among these ligands, 3 molecules based on CDOCKER score (molecular dynamics simulated-based score, which allows us to rank the binding poses according to their quality and to identify the best pose for each system) and crucial interaction with human PRKAR1A coding protein and protein kinase-cyclic nucleotide binding domains (PKA RI alpha CNB-B domain) via active site binding residues, viz. Val283, Val302, Gln304, Val315, Ile327, Ala336, Ala337, Val339, Tyr373, and Asn374, were considered as lead molecules.
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Affiliation(s)
- Prithvi Singh
- Centre
for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, New Delhi 110025, India
| | - Mohd Mohsin
- Department
of Biotechnology, Faculty of Natural Sciences, Jamia Millia Islamia, New Delhi 110025, India
| | - Armiya Sultan
- Department
of Biotechnology, Faculty of Natural Sciences, Jamia Millia Islamia, New Delhi 110025, India
| | - Prakash Jha
- Laboratory
of Molecular Modeling and Anticancer Drug Development, Dr. B. R. Ambedkar
Center for Biomedical Research, University
of Delhi, New Delhi 110007, India
| | - Mohd Mabood Khan
- Department
of Zoology, University of Lucknow, Lucknow, Uttar Pradesh, 226007, India
| | - Mansoor Ali Syed
- Department
of Biotechnology, Faculty of Natural Sciences, Jamia Millia Islamia, New Delhi 110025, India
| | - Madhu Chopra
- Laboratory
of Molecular Modeling and Anticancer Drug Development, Dr. B. R. Ambedkar
Center for Biomedical Research, University
of Delhi, New Delhi 110007, India
| | - Mohammad Serajuddin
- Department
of Zoology, University of Lucknow, Lucknow, Uttar Pradesh, 226007, India
| | - Arshad Husain Rahmani
- Department
of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraydah 51452, Saudi Arabia
| | - Saleh A. Almatroodi
- Department
of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraydah 51452, Saudi Arabia
| | - Faris Alrumaihi
- Department
of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraydah 51452, Saudi Arabia
| | - Ravins Dohare
- Centre
for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, New Delhi 110025, India
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14
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Polushin YS, Sokolov DV, Dreval RO, Zabotina AN. Clinical and Economic Evaluation of the Blood Purification with Selective Sorption Techniques in ICU Patients. MESSENGER OF ANESTHESIOLOGY AND RESUSCITATION 2023. [DOI: 10.24884/2078-5658-2023-20-1-6-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
The objective was to analyze the clinical and economic feasibility of using selective methods of lipopolysaccharide (LPS) sorption for sepsis treatment.Materials and methods. A clinical and economic model was used to assess the feasibility of using some technologies of selective lipopolysaccharide sorption. The model was developed in accordance with the current industry standard «Clinical and Economic Research» used in Russia. The target population was patients of 18 years old and older with sepsis. The methodology involved the evaluation of available randomized clinical trials, as well as studies involving data from network meta-analyses and systematic reviews of the use of the studied technologies. The calculation of direct medical and indirect non-medical costs was made with an analysis of the impact on the budget during the first year and on the time horizon for five years.Results. The value of direct and indirect costs was determined when using sorption devices based on Efferon LPS, Toraymyxin, Alteco LPS Adsorber, Toxipak columns. It was shown that among the therapeutic alternatives, the use of the Efferon LPS column had the least burden on the budget.Conclusion. The use of selective lipopolysaccharide sorption technologies in the intensive care program for sepsis patients, although accompanied by an increase in direct and indirect financial costs, leads to budget savings in the medium term. Improving the mechanism for compensating the costs of using this technology is a promising way to improve the outcomes of sepsis treatment.
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Affiliation(s)
| | | | - R. O. Dreval
- Nonprofit Partnership «Center for Social Economics»
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15
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Li X, Yin Z, Yan W, Wang M, Xue L, Zhou Q, Sun Y. Baseline red blood cell distribution width and perforin, dynamic levels of interleukin 6 and lactate are predictors of mortality in patients with sepsis. J Clin Lab Anal 2023; 37:e24838. [PMID: 36631067 PMCID: PMC9978088 DOI: 10.1002/jcla.24838] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/07/2022] [Accepted: 12/30/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Sepsis is a critical illness often encountered in the intensive care unit. However, prognostic biomarkers for sepsis have limited sensitivity. This study aimed to identify more sensitive predictors of mortality through repeated monitoring of laboratory parameters. METHODS Patients with sepsis (Sepsis 3.0 criteria met) were recruited and divided into the survivor and nonsurvivor groups after 28 days. Data on blood biochemistry, lymphocyte subsets, and cytokines were obtained on the first and seventh hospitalization days. Univariate and multivariate Cox regression analyses were performed to explore the correlation between these variables and patient mortality. RESULTS Forty patients with sepsis were included. The mortality rate was 37.5%. Red blood cell distribution width-standard deviation (RDWSD) (hazard ratio [HR] = 1.107 [95% CI: 1.005-1.219], p = 0.040) and perforin level (HR = 1.001 [95% CI: 1-1.003], p = 0.035) on the first day, as well as lactate (HR = 112.064 [95% CI: 2.192-5729.629], p = 0.019) and interleukin 6 (IL-6) (HR = 1.005 [95% CI: 1.001-1.008], p = 0.014) levels on the seventh day, were independent risk factors of mortality. If the patients were divided into two groups based on RDWSD (normal: n = 31; increased: n = 9), the Kaplan-Meier curves showed that the group with increased RDWSD had a lower survival (p = 0.025). CONCLUSION Baseline RDWSD and perforin, along with dynamic IL-6 and lactate levels, were independent predictors of mortality in patients with sepsis.
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Affiliation(s)
- Xin Li
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, China
| | - Zhongnan Yin
- Institute of Medical Innovation and Research, Peking University Third Hospital, Beijing, China.,Biobank, Peking University Third Hospital, Beijing, China
| | - Wei Yan
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, China
| | - Meng Wang
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, China
| | - Lixiang Xue
- Institute of Medical Innovation and Research, Peking University Third Hospital, Beijing, China.,Biobank, Peking University Third Hospital, Beijing, China
| | - Qingtao Zhou
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, China
| | - Yongchang Sun
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, China
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16
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Brusco NK, Sykes K, Cheng AC, Radia-George C, Travis D, Sullivan N, Dinh T, Foster S, Thursky K. A state-wide implementation of a whole of hospital sepsis pathway with a mortality based cost-effectiveness analysis from a healthcare sector perspective. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000687. [PMID: 37205639 DOI: 10.1371/journal.pgph.0000687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 04/10/2023] [Indexed: 05/21/2023]
Abstract
With global estimates of 15 million cases of sepsis annually, together with a 24% in-hospital mortality rate, this condition comes at a high cost to both the patient and to the health services delivering care. This translational research determined the cost-effectiveness of state-wide implementation of a whole of hospital Sepsis Pathway in reducing mortality and/or hospital admission costs from a healthcare sector perspective, and report the cost of implementation over 12-months. A non-randomised stepped wedge cluster implementation study design was used to implement an existing Sepsis Pathway ("Think sepsis. Act fast") across 10 of Victoria's public health services, comprising 23 hospitals, which provide hospital care to 63% of the State's population, or 15% of the Australian population. The pathway utilised a nurse led model with early warning and severity criteria, and actions to be initiated within 60 minutes of sepsis recognition. Pathway elements included oxygen administration; blood cultures (x2); venous blood lactate; fluid resuscitation; intravenous antibiotics, and increased monitoring. At baseline there were 876 participants (392 female (44.7%), mean 68.4 years); and during the intervention, there were 1,476 participants (684 female (46.3%), mean 66.8 years). Mortality significantly reduced from 11.4% (100/876) at baseline to 5.8% (85/1,476) during implementation (p>0.001). Respectively, at baseline and intervention the average length of stay was 9.1 (SD 10.3) and 6.2 (SD 7.9) days, and cost was $AUD22,107 (SD $26,937) and $14,203 (SD $17,611) per patient, with a significant 2.9 day reduction in length of stay (-2.9; 95%CI -3.7 to -2.2, p<0.01) and $7,904 reduction in cost (-$7,904; 95%CI -$9,707 to -$6,100, p<0.01). The Sepsis Pathway was a dominant cost-effective intervention due to reduced cost and reduced mortality. Cost of implementation was $1,845,230. In conclusion, a well-resourced state-wide Sepsis Pathway implementation initiative can save lives and dramatically reduce the health service cost per admission.
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Affiliation(s)
- Natasha K Brusco
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, Australia
- College of Science, Health and Engineering, La Trobe University, Bundoora, Australia
- Health Economics Department, Alpha Crucis Group, Langwarrin, Australia
| | - Kelly Sykes
- Department of Health, Victoria State Government, Melbourne, Australia
| | - Allen C Cheng
- Monash Infectious Diseases, Monash Health and School of Clinical Sciences, Monash University, Clayton, Australia
- School of Public Health and Preventive Medicine, Monash University, Clayton, Australia
- Department of Infectious Diseases, Alfred Health, Melbourne, Australia
| | | | - Douglas Travis
- Department of Medicine, Western Health, Melbourne, Australia
| | - Natalie Sullivan
- College of Science, Health and Engineering, La Trobe University, Bundoora, Australia
- Health Economics Department, Alpha Crucis Group, Langwarrin, Australia
- EACH, Ringwood, Australia
| | - Tammy Dinh
- Department of Health, Victoria State Government, Melbourne, Australia
| | - Sarah Foster
- Health Economics Department, Alpha Crucis Group, Langwarrin, Australia
- Department of Infection Control, Peninsula Health, Frankston, Australia
| | - Karin Thursky
- Guidance Group, Royal Melbourne Hospital, Melbourne, Australia
- Department of Infectious Diseases, National Centre for Antimicrobial Stewardship, Melbourne Medical School, University of Melbourne, Melbourne, Australia
- Department of Health Services Research, Deputy Head of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
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17
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Zhang R, Liu H, Dai D, Ding X, Wang D, Wang Y, Shi X, Zhang S, Duan X, Wang H, Luo Y, Liu S, Han B, Zhang X, Fang Y, Yang J, Xu W, Sun T. Adjunctive sepsis therapy with aminophylline (STAP): a randomized controlled trial. Chin Med J (Engl) 2022; 135:2843-2850. [PMID: 36728571 PMCID: PMC9944697 DOI: 10.1097/cm9.0000000000002282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Sepsis is a serious disease caused by infection. Aminophylline has anti-asthma and anti-inflammatory effects. We aimed to explore the safety and effect of aminophylline in sepsis. METHODS We conducted a clinical randomized controlled trial involving 100 patients diagnosed with sepsis within 48 h after intensive care unit (ICU) admission in two sites. All patients were randomized in a 1:1 ratio to receive standard therapy with or without aminophylline. The primary clinical outcome was all-cause mortality at 28 days. RESULTS From September 27, 2018 to February 12, 2020, we screened 277 septic patients and eventually enrolled 100 patients, with 50 assigned to the aminophylline group and 50 to the usual-care group. At 28 days, 7 of 50 patients (14.0%) in the aminophylline group had died, compared with 16 of 50 (32.0%) in the usual-care group ( P = 0.032). Cox regression showed that the aminophylline group had a lower hazard of death (hazard ratio = 0.312, 95% confidence interval: 0.129-0.753). Compared with the usual-care group, patients in the aminophylline group had a longer survival time ( P = 0.039 by the log-rank test). The effects of aminophylline on vasopressor dose, oxygenation index, and sequential organ failure assessment score were time-dependent with treatment. There were no significant differences in total hospitalization days, ICU hospitalization days, and rates of serious adverse events (all P > 0.05). No adverse events were observed in the trial. CONCLUSIONS Aminophylline as an adjunct therapy could significantly reduce the risk of death and prolong the survival time of patients with sepsis. TRIAL REGISTRATION ChiCTR.org.cn, ChiCTR1800019173.
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Affiliation(s)
- Ruifang Zhang
- General ICU, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis, Henan Engineering Research Center for Critical Care Medicine, Zhengzhou, Henan 450052, China
| | - Huan Liu
- General ICU, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis, Henan Engineering Research Center for Critical Care Medicine, Zhengzhou, Henan 450052, China
| | - Dongmei Dai
- Department of Intensive Care Unit, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
| | - Xianfei Ding
- General ICU, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis, Henan Engineering Research Center for Critical Care Medicine, Zhengzhou, Henan 450052, China
| | - Dong Wang
- General ICU, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis, Henan Engineering Research Center for Critical Care Medicine, Zhengzhou, Henan 450052, China
| | - Yan Wang
- General ICU, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis, Henan Engineering Research Center for Critical Care Medicine, Zhengzhou, Henan 450052, China
| | - Xuexiu Shi
- General ICU, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis, Henan Engineering Research Center for Critical Care Medicine, Zhengzhou, Henan 450052, China
| | - Shuguang Zhang
- General ICU, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis, Henan Engineering Research Center for Critical Care Medicine, Zhengzhou, Henan 450052, China
| | - Xiaoguang Duan
- General ICU, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis, Henan Engineering Research Center for Critical Care Medicine, Zhengzhou, Henan 450052, China
| | - Haixu Wang
- General ICU, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis, Henan Engineering Research Center for Critical Care Medicine, Zhengzhou, Henan 450052, China
| | - Yonggang Luo
- General ICU, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis, Henan Engineering Research Center for Critical Care Medicine, Zhengzhou, Henan 450052, China
| | - Shaohua Liu
- General ICU, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis, Henan Engineering Research Center for Critical Care Medicine, Zhengzhou, Henan 450052, China
| | - Bing Han
- General ICU, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis, Henan Engineering Research Center for Critical Care Medicine, Zhengzhou, Henan 450052, China
| | - Xiaojuan Zhang
- General ICU, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis, Henan Engineering Research Center for Critical Care Medicine, Zhengzhou, Henan 450052, China
| | - Yu Fang
- General ICU, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis, Henan Engineering Research Center for Critical Care Medicine, Zhengzhou, Henan 450052, China
| | - Jing Yang
- Precision Medicine Monitoring Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Wangbin Xu
- Department of Intensive Care Unit, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
| | - Tongwen Sun
- General ICU, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis, Henan Engineering Research Center for Critical Care Medicine, Zhengzhou, Henan 450052, China
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18
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Jelinek M, Duris K. Inflammatory Response in Sepsis and Hemorrhagic Stroke. BRAIN HEMORRHAGES 2022. [DOI: 10.1016/j.hest.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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19
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Zhou Y, Wu C, Ouyang L, Peng Y, Zhong D, Xiang X, Li J. Application of oXiris-continuous hemofiltration adsorption in patients with sepsis and septic shock: A single-centre experience in China. Front Public Health 2022; 10:1012998. [PMID: 36249210 PMCID: PMC9557776 DOI: 10.3389/fpubh.2022.1012998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 09/12/2022] [Indexed: 01/27/2023] Open
Abstract
oXiris is a new, high-adsorption membrane filter in continuous hemofiltration adsorption to reduce the inflammatory response in sepsis. The investigators retrospectively reviewed patients with sepsis/septic shock who underwent at least one oXiris-treatment from November 2020 to March 2022. The demographic data, baseline levels before treatment, clinical datas, prognosis, and the occurrence of adverse events during treatment were recorded. 90 patients were enrolled in this study. The hemodynamic indices, sequential organ failure assessment score, lactate, inflammatory biomarkers levels were significantly improved at 12 h and 24 h after treatment. Procalcitonin and interleukin-6 reduction post-treatment of oXiris were most pronounced in infection from skin and soft tissue, urinary and abdominal cavity. Logistic regression analysis showed that pre-treatment sequential organ failure assessment score (p = 0.034), percentage decrease in sequential organ failure assessment score (p = 0.004), and age (p = 0.011) were independent risk factors for intensive care unit mortality. In conclusion, oXiris-continuous hemofiltration adsorption may improve hemodynamic indicators, reduce the use of vasoactive drugs, reduce lactate level and infection indicators. Of note, oXiris improve organ function in sepsis, which may result to higher survival rate.
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20
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Jansen A, Bruse N, Waalders N, Gerretsen J, Rijbroek D, Pickkers P, Kox M. Ex vivo and in vitro Monocyte Responses Do Not Reflect in vivo Immune Responses and Tolerance. J Innate Immun 2022; 15:174-187. [PMID: 35940121 PMCID: PMC10643897 DOI: 10.1159/000525572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/16/2022] [Indexed: 11/19/2022] Open
Abstract
Cytokine production by ex vivo (EV)-stimulated leukocytes is commonly used to gauge immune function and frequently proposed to guide immunomodulatory therapy. However, whether EV cytokine production capacity accurately reflects the in vivo (IV) immune status is largely unknown. We investigated relationships between EV monocyte cytokine responses and IV cytokine responses in a large cohort of healthy volunteers using a highly standardized IV model of short-lived LPS-induced systemic inflammation, which captures hallmarks of both hyperinflammation and immunological tolerance. Therefore, 110 healthy volunteers were intravenously challenged with 1 ng/kg LPS twice: on day 0 to determine the extent of the IV (hyper)inflammatory response and on day 7 to determine the degree of IV endotoxin tolerance. Baseline EV monocyte cytokine production capacity was assessed prior to LPS administration. Short-term and long-term EV tolerance was assessed in monocytes isolated 4 h and 7 days after LPS administration, respectively. No robust correlations were observed between baseline EV cytokine production capacity and IV cytokine responses following LPS administration. However, highly robust inverse correlations were observed between IV cytokine responses and EV cytokine responses of monocytes isolated 4 h after IV LPS administration. No correlations between IV and EV tolerance were found. In conclusion, attenuated EV cytokine production capacity reflects ongoing IV inflammation rather than immune suppression. Results of EV assays should be interpreted with caution at the risk of improper use of immuno-stimulatory drugs.
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Affiliation(s)
- Aron Jansen
- Department of Intensive Care Medicine, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
- Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Niklas Bruse
- Department of Intensive Care Medicine, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
- Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nicole Waalders
- Department of Intensive Care Medicine, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
- Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jelle Gerretsen
- Department of Intensive Care Medicine, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
- Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Daniëlle Rijbroek
- Department of Intensive Care Medicine, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
- Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter Pickkers
- Department of Intensive Care Medicine, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
- Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Matthijs Kox
- Department of Intensive Care Medicine, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
- Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, The Netherlands
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21
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Walker SV, Steffens B, Sander D, Wetsch WA. Implementation of Antibiotic Stewardship Improves the Quality of Blood Culture Diagnostics at an Intensive Care Unit of a University Hospital. J Clin Med 2022; 11:jcm11133675. [PMID: 35806960 PMCID: PMC9267444 DOI: 10.3390/jcm11133675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 06/21/2022] [Accepted: 06/21/2022] [Indexed: 01/27/2023] Open
Abstract
Background: Bloodstream infections increase morbidity and mortality in hospitalized patients and pose a significant burden for health care systems worldwide. Optimal blood culture diagnostics are essential for early detection and specific treatment. After assessing the quality parameters at a surgical intensive care unit for six months, we implemented a diagnostic stewardship bundle (DSB) to optimize blood culture diagnostics and then reevaluated its effects after six months. Material and Methods: All patients ≥18 years old and on the ward were included: pre-DSB 137 and post-DSB 158. The standard quality parameters were defined as the number of blood culture sets per diagnostic episode (≥2), the rate of contamination (2–3%), the rate of positivity (5–15%), the collection site (≥1 venipuncture per episode) and the filling volume of the bottles (8–10 mL, only post-DSB). The DSB included an informational video, a standard operating procedure, and ready-to-use paper crates with three culture sets. Results: From pre- to post-interventional, the number of ≥2 culture sets per episode increased from 63.9% (257/402) to 81.3% (230/283), and venipunctures increased from 42.5% (171/402) to 77.4% (219/283). The positivity rate decreased from 15.1% (108/714) to 12.8% (83/650), as did the contamination rate (3.8% to 3.6%). The majority of the aerobic bottles were filled within the target range (255/471, 54.1%), but in 96.6%, the anaerobic bottles were overfilled (451/467). Conclusions: The implementation of DSB improved the quality parameters at the unit, thus optimizing the blood culture diagnostics. Further measures seem necessary to decrease the contamination rate and optimize bottle filling significantly.
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Affiliation(s)
- Sarah V. Walker
- Faculty of Medicine, University of Cologne, 50923 Cologne, Germany; (B.S.); (D.S.); (W.A.W.)
- Institute for Medical Microbiology, Immunology and Hygiene, University Hospital of Cologne, 50935 Cologne, Germany
- German Centre for Infection Research (DZIF), 38124 Braunschweig, Germany
- Correspondence:
| | - Benedict Steffens
- Faculty of Medicine, University of Cologne, 50923 Cologne, Germany; (B.S.); (D.S.); (W.A.W.)
- Institute for Medical Microbiology, Immunology and Hygiene, University Hospital of Cologne, 50935 Cologne, Germany
| | - David Sander
- Faculty of Medicine, University of Cologne, 50923 Cologne, Germany; (B.S.); (D.S.); (W.A.W.)
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, 50937 Cologne, Germany
| | - Wolfgang A. Wetsch
- Faculty of Medicine, University of Cologne, 50923 Cologne, Germany; (B.S.); (D.S.); (W.A.W.)
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, 50937 Cologne, Germany
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22
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Dono A, Esquenazi Y, Choi HA. Gut microbiome and neurocritically ill patients. JOURNAL OF NEUROCRITICAL CARE 2022. [DOI: 10.18700/jnc.220058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Since the times of Rokitansky and Cushing, we have been fascinated by the connections between the gut and the brain. Recent advances in next-generation sequencing techniques have shown that this relationship is even more complex and integral to our sense of self than previously imagined. As these techniques refine our understanding of the abundance and diversity of the gut bacterial microbiome, the relationship between the gut and the brain has been redefined. Now, this is understood as a complex symbiotic network with bidirectional communication, the gut-brain axis. The implication of this communication involves an intense focus of research on a variety of chronic psychiatric, neurological, neurodegenerative, and neuro-oncological diseases. Recently, the gut-brain axis has been studied in neurologically ill patients requiring intensive care. Preliminary studies have shown that acute brain injury changes the bacterial phenotype from one that is symbiotic with the host human to one that is pathologic, termed the “pathobiome.” This can contribute to nosocomial pneumonia and sepsis. The first studies in neurologically ill patients in the neurointensive care unit (NeuroICU) demonstrated changes in the gut microbiome between neuroICU patients and healthy matched subjects. Specifically, a decrease in short-chain fatty acid-producing bacteria and increase in harmful gut microbes have been associated with mortality and decreased function at discharge. Although these preliminary findings are exciting and have opened a new field of research in the complex NeuroICU population, there are several limitations and challenges. Further investigation is needed to confirm these correlations and understand their implications on patients in a complex intensive care environment.
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23
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Pandolfi F, Guillemot D, Watier L, Brun-Buisson C. Trends in bacterial sepsis incidence and mortality in France between 2015 and 2019 based on National Health Data System (Système National des données de Santé (SNDS)): a retrospective observational study. BMJ Open 2022; 12:e058205. [PMID: 35613798 PMCID: PMC9125708 DOI: 10.1136/bmjopen-2021-058205] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE This study aims to provide a case definition of sepsis of presumed bacterial aetiology based on 10th revision of the International Classification of Diseases (ICD-10) codes, to assess trends in sepsis incidence and mortality between 2015 and 2019 in France, and to describe the characteristics of affected patients and hospital stays. DESIGN Nationwide, population-based, retrospective observational study. SETTING Metropolitan France between 2015 and 2019. PARTICIPANTS Between 2015 and 2019, 1 224 433 patients with sepsis of presumed bacterial aetiology were selected from the French National Hospital Discharge Database (Programme de Médicalisation des Systèmes d'Information) and were identified from corresponding ICD-10 codes for explicit sepsis or implicit sepsis. MAIN OUTCOMES MEASURES Annual overall and age-specific and gender-specific incidence and 95% CI, as well as trends in sepsis incidence and mortality, were estimated. Comorbidities, length of hospital stay and outcomes were described. RESULTS The sex-standardised and age-standardised incidence per 100 000 (95% CI) increased from 357 (356.0 to 359.0) in 2015 to 403 (401.9 to 405.0) in 2019 and remained higher for males compared with females. Children under 1 year and patients over 75 years consistently had the highest incidence. The most common comorbidities were cancer and chronic heart failure. The median hospital length of stay was 12 days. Most patients came from home, but only half returned home after their hospital stay and approximately 15% were discharged to long-term care. In-hospital mortality was about 25% and declined along the study period. CONCLUSIONS Medico-administrative databases can be used to provide nationwide estimates of the in-hospital burden of bacterial sepsis. The results confirm the high burden of sepsis in France. These data should be complemented by estimating the additional burden associated with fungal and viral infections during the COVID-19 pandemic.
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Affiliation(s)
- Fanny Pandolfi
- Epidemiology and Modeling of bacterial Evasion to Antibacterials Unit (EMEA), Institut Pasteur, Paris, France
- Centre de recherche en Epidémiologie et Santé des Populations (CESP), INSERM, Paris, France
| | - Didier Guillemot
- Epidemiology and Modeling of bacterial Evasion to Antibacterials Unit (EMEA), Institut Pasteur, Paris, France
- Centre de recherche en Epidémiologie et Santé des Populations (CESP), INSERM, Paris, France
- Hôpital Raymond-Poincaré, APHP, Paris, France
| | - Laurence Watier
- Epidemiology and Modeling of bacterial Evasion to Antibacterials Unit (EMEA), Institut Pasteur, Paris, France
- Centre de recherche en Epidémiologie et Santé des Populations (CESP), INSERM, Paris, France
| | - Christian Brun-Buisson
- Epidemiology and Modeling of bacterial Evasion to Antibacterials Unit (EMEA), Institut Pasteur, Paris, France
- Centre de recherche en Epidémiologie et Santé des Populations (CESP), INSERM, Paris, France
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Schmidt KFR, Huelle K, Reinhold T, Prescott HC, Gehringer R, Hartmann M, Lehmann T, Mueller F, Reinhart K, Schneider N, Schroevers MJ, Kosilek RP, Vollmar HC, Heintze C, Gensichen JS. Healthcare Utilization and Costs in Sepsis Survivors in Germany-Secondary Analysis of a Prospective Cohort Study. J Clin Med 2022; 11:jcm11041142. [PMID: 35207415 PMCID: PMC8879304 DOI: 10.3390/jcm11041142] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/09/2022] [Accepted: 02/11/2022] [Indexed: 02/05/2023] Open
Abstract
Background: Survivors of sepsis often face long-term sequelae after intensive care treatment. Compared to the period of hospitalization, little is known about the ambulatory healthcare utilization in sepsis patients. The study evaluated healthcare utilization and associated costs of sepsis care including allied health professions after initial hospitalization. Methods: Secondary analysis was performed on data in 210 sepsis patients prospectively enrolled from nine intensive care study centers across Germany. Data was collected via structured surveys among their Primary care (Family-) physicians (PCPs) within the first month after discharge from ICU (baseline) and again at 6, 12 and 24 months after discharge, each relating to the period following the last survey. Costs were assessed by standardized cost unit rates from a health care system’s perspective. Changes in healthcare utilization and costs over time were calculated using the Wilcoxon rank-sum test. Results: Of the 210 patients enrolled, 146 (69.5%) patients completed the 24 months follow-up. In total, 109 patients were hospitalized within the first 6 months post-intensive care. Mean total direct costs per patient at 0–6 months were €17,531 (median: €6047), at 7–12 months €9029 (median: €3312), and at 13–24 months €18,703 (median: €12,828). The largest contributor to the total direct costs within the first 6 months was re-hospitalizations (€13,787 (median: €2965). After this first half year, we observed a significant decline in inpatient care costs for re-hospitalizations (p ≤ 0.001). PCPs were visited by more than 95% of patients over 24 months. Conclusions: Sepsis survivors have high health care utilization. Hospital readmissions are frequent and costly. Highest costs and hospitalizations were observed in more than half of patients within the first six months post-intensive care. Among all outpatient care providers, PCPs were consulted most frequently. Clinical impact: Sepsis survivors have a high healthcare utilization and related costs which persist after discharge from hospital. Within outpatient care, possible needs of sepsis survivors as physiotherapy or psychotherapy seem not to be met appropriately. Development of sepsis aftercare programs for early detection and treatment of complications should be prioritized.
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Affiliation(s)
- Konrad F. R. Schmidt
- Institute of General Practice and Family Medicine, Jena University Hospital, D-07743 Jena, Germany; (K.H.); (R.G.)
- Center of Sepsis Control and Care (CSCC), Jena University Hospital, D-07747 Jena, Germany
- Institute of General Practice and Family Medicine, Charité University Medicine, D-10117 Berlin, Germany;
- Correspondence: or ; Tel.: +49-3641-9395800 or +49-30-450-514-133; Fax: +49-3641-9395802 or +49-30-450-514-932
| | - Katharina Huelle
- Institute of General Practice and Family Medicine, Jena University Hospital, D-07743 Jena, Germany; (K.H.); (R.G.)
| | - Thomas Reinhold
- Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medicine, D-10117 Berlin, Germany;
| | - Hallie C. Prescott
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109-5368, USA;
- VA Center for Clinical Management Research, Ann Arbor, MI 48105, USA
| | - Rebekka Gehringer
- Institute of General Practice and Family Medicine, Jena University Hospital, D-07743 Jena, Germany; (K.H.); (R.G.)
| | - Michael Hartmann
- Hospital Pharmacy, Jena University Hospital, D-07747 Jena, Germany;
| | - Thomas Lehmann
- Institute of Medical Statistics, Information Sciences and Documentation, Jena University Hospital, D-07747 Jena, Germany;
| | - Friederike Mueller
- Institute of General Practice and Family Medicine, Jena University Hospital, D-07743 Jena, Germany; (K.H.); (R.G.)
- Thiem-Research GmbH, Carl-Thiem-Klinikum, D-03048 Cottbus, Germany;
| | - Konrad Reinhart
- Center of Sepsis Control and Care (CSCC), Jena University Hospital, D-07747 Jena, Germany
- Department of Anaesthesiology and Intensive Care Medicine, Charité University Medicine Berlin, D-10117 Berlin, Germany;
| | - Nico Schneider
- Institute of General Practice and Family Medicine, Jena University Hospital, D-07743 Jena, Germany; (K.H.); (R.G.)
- Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, D-07743 Jena, Germany;
| | - Maya J. Schroevers
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, NL-9700 AB Groningen, The Netherlands;
| | - Robert P. Kosilek
- Institute of General Practice and Family Medicine, University Hospital of the Ludwig-Maximilians-University Munich, D-80336 Munich, Germany; (R.P.K.); (J.S.G.)
| | - Horst C. Vollmar
- Institute of General Practice and Family Medicine, Jena University Hospital, D-07743 Jena, Germany; (K.H.); (R.G.)
- Department of Family Medicine, Ruhr-University Bochum Medical School, D-44801 Bochum, Germany;
| | - Christoph Heintze
- Institute of General Practice and Family Medicine, Charité University Medicine, D-10117 Berlin, Germany;
| | - Jochen S. Gensichen
- Institute of General Practice and Family Medicine, Jena University Hospital, D-07743 Jena, Germany; (K.H.); (R.G.)
- Center of Sepsis Control and Care (CSCC), Jena University Hospital, D-07747 Jena, Germany
- Institute of General Practice and Family Medicine, University Hospital of the Ludwig-Maximilians-University Munich, D-80336 Munich, Germany; (R.P.K.); (J.S.G.)
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25
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Badran S, Chen M, Coia JE. Multiplex Droplet Digital Polymerase Chain Reaction Assay for Rapid Molecular Detection of Pathogens in Patients With Sepsis: Protocol for an Assay Development Study. JMIR Res Protoc 2021; 10:e33746. [PMID: 34898460 PMCID: PMC8713102 DOI: 10.2196/33746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 10/24/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Blood cultures are the cornerstone of diagnosis for detecting the presence of bacteria or fungi in the blood, with an average detection time of 48 hours and failure to detect a pathogen occurring in approximately 50% of patients with sepsis. Rapid diagnosis would facilitate earlier treatment and/or an earlier switch to narrow-spectrum antibiotics. OBJECTIVE The aim of this study is to develop and implement a multiplex droplet digital polymerase chain reaction (ddPCR) assay as a routine diagnostic tool in the detection and identification of pathogens from whole blood and/or blood culture after 3 hours of incubation. METHODS The study consists of three phases: (1) design of primer-probe pairs for accurate and reliable quantification of the most common sepsis-causing microorganisms using a multiplex reaction, (2) determination of the analytical sensitivity and specificity of the multiplex ddPCR assay, and (3) a clinical study in patients with sepsis using the assay. The QX200 Droplet Digital PCR System will be used for the detection of the following species-specific genes in blood from patients with sepsis: coa (staphylocoagulase) in Staphylococcus aureus, cpsA (capsular polysaccharide) in Streptococcus pneumoniae, uidA (beta-D-glucuronidase) in Escherichia coli, oprL (peptidoglycan-associated lipoprotein) in Pseudomonas aeruginosa, and the highly conserved regions of the 16S rRNA gene for Gram-positive and Gram-negative bacteria. All data will be analyzed using QuantaSoft Analysis Pro Software. RESULTS In phase 1, to determine the optimal annealing temperature for the designed primer-probe pairs, results from a gradient temperature experiment will be collected and the limit of detection (LOD) of the assay will be determined. In phase 2, results for the analytical sensitivity and specificity of the assay will be obtained after an optimization of the extraction and purification method in spiked blood. In phase 3, clinical sensitivity and specificity as compared to the standard blood culture technique will be determined using 301 clinical samples. CONCLUSIONS Successful design of primer-probe pairs in the first phase and subsequent optimization and determination of the LOD will allow progression to phase 3 to compare the novel method with existing blood culture methods. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/33746.
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Affiliation(s)
- Samir Badran
- Research Unit in Clinical Microbiology, Department of Clinical Diagnostics, Hospital South West Jutland, University Hospital of Southern Denmark, Esbjerg, Denmark.,Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Ming Chen
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Department of Clinical Microbiology, Hospital of Southern Jutland, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - John E Coia
- Research Unit in Clinical Microbiology, Department of Clinical Diagnostics, Hospital South West Jutland, University Hospital of Southern Denmark, Esbjerg, Denmark.,Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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26
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Merdji H, Schini-Kerth V, Meziani F, Toti F. Long-term cardiovascular complications following sepsis: is senescence the missing link? Ann Intensive Care 2021; 11:166. [PMID: 34851467 PMCID: PMC8636544 DOI: 10.1186/s13613-021-00937-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 10/08/2021] [Indexed: 12/14/2022] Open
Abstract
Among the long-term consequences of sepsis (also termed “post-sepsis syndrome”) the increased risk of unexplained cardiovascular complications, such as myocardial infarction, acute heart failure or stroke, is one of the emerging specific health concerns. The vascular accelerated ageing also named premature senescence is a potential mechanism contributing to atherothrombosis, consequently leading to cardiovascular events. Indeed, vascular senescence-associated major adverse cardiovascular events (MACE) are a potential feature in sepsis survivors and of the elderly at cardiovascular risk. In these patients, accelerated vascular senescence could be one of the potential facilitating mechanisms. This review will focus on premature senescence in sepsis regardless of age. It will highlight and refine the potential relationships between sepsis and accelerated vascular senescence. In particular, key cellular mechanisms contributing to cardiovascular events in post-sepsis syndrome will be highlighted, and potential therapeutic strategies to reduce the cardiovascular risk will be further discussed. With improved management of patients, sepsis survivors are increasing each year. Early cardiovascular complications, of yet undeciphered mechanisms, are an emerging health issue in post-sepsis syndrome. Premature senescence of endothelium and vascular tissue is proven an accelerated process of atherogenesis in young septic rats. An increasing body of clinical evidence point at endothelial senescence in the initiation and development of atherosclerosis. Prevention of premature senescence by senotherapy and cardiological follow-up could improve long-term septic patients’ outcomes.
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Affiliation(s)
- Hamid Merdji
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), CRBS (Centre de Recherche en Biomédecine de Strasbourg), FMTS (Fédération de Médecine Translationnelle de Strasbourg), University of Strasbourg, Strasbourg, France.,Department of Intensive Care (Service de Médecine Intensive-Réanimation), Nouvel Hôpital Civil, Hôpital Universitaire de Strasbourg, 1, place de l'Hôpital, 67091, Strasbourg Cedex, France
| | - Valérie Schini-Kerth
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), CRBS (Centre de Recherche en Biomédecine de Strasbourg), FMTS (Fédération de Médecine Translationnelle de Strasbourg), University of Strasbourg, Strasbourg, France.,Faculté de Pharmacie, Université de Strasbourg, Strasbourg, France
| | - Ferhat Meziani
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), CRBS (Centre de Recherche en Biomédecine de Strasbourg), FMTS (Fédération de Médecine Translationnelle de Strasbourg), University of Strasbourg, Strasbourg, France. .,Department of Intensive Care (Service de Médecine Intensive-Réanimation), Nouvel Hôpital Civil, Hôpital Universitaire de Strasbourg, 1, place de l'Hôpital, 67091, Strasbourg Cedex, France.
| | - Florence Toti
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), CRBS (Centre de Recherche en Biomédecine de Strasbourg), FMTS (Fédération de Médecine Translationnelle de Strasbourg), University of Strasbourg, Strasbourg, France.,Faculté de Pharmacie, Université de Strasbourg, Strasbourg, France
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27
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Li JY, Yao RQ, Liu SQ, Zhang YF, Yao YM, Tian YP. Efficiency of Monocyte/High-Density Lipoprotein Cholesterol Ratio Combined With Neutrophil/Lymphocyte Ratio in Predicting 28-Day Mortality in Patients With Sepsis. Front Med (Lausanne) 2021; 8:741015. [PMID: 34722578 PMCID: PMC8548423 DOI: 10.3389/fmed.2021.741015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/30/2021] [Indexed: 12/29/2022] Open
Abstract
Background: Sepsis can cause unpredictable harm, and early identification of risk for mortality may be conducive to clinical diagnosis. The present study proposes to assess the efficacy of the monocyte/high-density lipoprotein cholesterol ratio (MHR) combined with the neutrophil/lymphocyte ratio (NLR) on the day of admission in predictive efficacy in the 28-day mortality risk in critical patients with sepsis. Material and Methods: We administered observational and retrospective cohort research from a single center. The correlation of the clinical variables, together with the system severity scores of APACHE II and SOFA, are displayed by correlation analysis, and a Cox regression model could be performed to screen the independent risk factors and estimate the capacity of multiple markers in predicting 28-day mortality. The receiver operating characteristic (ROC) curve served as an applied method to output cutoff values for the diagnosis and prognostic risk, and the area under the ROC curve and net reclassification improvement index (NRI), as well as integrated discrimination improvement index (IDI) were employed to assess the feasibility of multiple parameters for predictive value in 28-day mortality of septic patients. Results: The study enrolled 274 eligible patients with sepsis. The correlation analysis indicated NLR and MHR were related to the sepsis severity. A multivariate Cox regression analysis indicated that NLR together with MHR displayed a close relation to death rate after adjusting for other potential confounders (NLR, HR = 1.404 [95% CI 1.170–1.684], P < 0.001; MHR, HR = 1.217 [95% CI 1.112–1.331], P < 0.001). The AUC of NLR, MHR, NLR_MHR was 0.827, 0.876, and 0.934, respectively. The addition on the biomarker NLR_MHR to the prediction model improved IDI by 18.5% and NRI by 37.8%. Conclusions: Our findings suggest that NLR and MHR trend to an elevated level in non-surviving patients with sepsis. Evaluation of NLR_MHR, an independent risk factor for increased mortality, might improve the predictive efficacy for 28-day mortality risk in septic patients.
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Affiliation(s)
- Jing-Yan Li
- Department of Emergency, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ren-Qi Yao
- Translational Medicine Research Center, Medical Innovation Research Division and Fourth Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Shuang-Qing Liu
- Translational Medicine Research Center, Medical Innovation Research Division and Fourth Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Yun-Fei Zhang
- Department of Emergency, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yong-Ming Yao
- Department of Emergency, The Second Hospital of Hebei Medical University, Shijiazhuang, China.,Translational Medicine Research Center, Medical Innovation Research Division and Fourth Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Ying-Ping Tian
- Department of Emergency, The Second Hospital of Hebei Medical University, Shijiazhuang, China
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28
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Brenner T, Skarabis A, Stevens P, Axnick J, Haug P, Grumaz S, Bruckner T, Luntz S, Witzke O, Pletz MW, Ruprecht TM, Marschall U, Altin S, Greiner W, Berger MM. Optimization of sepsis therapy based on patient-specific digital precision diagnostics using next generation sequencing (DigiSep-Trial)-study protocol for a randomized, controlled, interventional, open-label, multicenter trial. Trials 2021; 22:714. [PMID: 34663439 PMCID: PMC8522064 DOI: 10.1186/s13063-021-05667-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 09/28/2021] [Indexed: 12/19/2022] Open
Abstract
Background Sepsis is triggered by an infection and represents one of the greatest challenges of modern intensive care medicine. With regard to a targeted antimicrobial treatment strategy, the earliest possible pathogen detection is of crucial importance. Until now, culture-based detection methods represent the diagnostic gold standard, although they are characterized by numerous limitations. Culture-independent molecular diagnostic procedures represent a promising alternative. In particular, the plasmatic detection of circulating, cell-free DNA by next-generation sequencing (NGS) has shown to be suitable for identifying disease-causing pathogens in patients with bloodstream infections. Methods The DigiSep-Trial is a randomized, controlled, interventional, open-label, multicenter trial characterizing the effect of the combination of NGS-based digital precision diagnostics with standard-of-care microbiological analyses compared to solely standard-of-care microbiological analyses in the clinical picture of sepsis/septic shock. Additional anti-infective expert consultations are provided for both study groups. In 410 patients (n = 205 per arm) with sepsis/septic shock, the study examines whether the so-called DOOR-RADAR (Desirability of Outcome Ranking/Response Adjusted for Duration of Antibiotic Risk) score (representing a combined endpoint including the criteria (1) intensive/intermediate care unit length of stay, (2) consumption of antibiotics, (3) mortality, and (4) acute kidney injury (AKI)) can be improved by an additional NGS-based diagnostic concept. We also aim to investigate the cost-effectiveness of this new diagnostic procedure. It is postulated that intensive/intermediate care unit length of stay, mortality rate, incidence of AKI, the duration of antimicrobial therapy as well as the costs caused by complications and outpatient aftercare can be reduced. Moreover, a significant improvement in patient’s quality of life is expected. Discussion The authors´ previous work suggests that NGS-based diagnostics have a higher specificity and sensitivity compared to standard-of-care microbiological analyses for detecting bloodstream infections. In combination with the here presented DigiSep-Trial, this work provides the optimal basis to establish a new NGS-driven concept as part of the national standard based on the best possible evidence. Trial registrations DRKS-ID DRKS00022782. Registered on August 25, 2020 ClinicalTrials.govNCT04571801. Registered October 1, 2020 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05667-x.
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Affiliation(s)
- Thorsten Brenner
- Department of Anesthesiology and Intensive Care Medicine, Essen University Hospital, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.
| | - Annabell Skarabis
- Department of Anesthesiology and Intensive Care Medicine, Essen University Hospital, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | | | | | - Peter Haug
- Noscendo GmbH, Königstraße 34, 47198, Duisburg, Germany
| | - Silke Grumaz
- Noscendo GmbH, Königstraße 34, 47198, Duisburg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Steffen Luntz
- Coordination Centre for Clinical Trials (KKS), Ruprecht-Karls-University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Oliver Witzke
- Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Mathias W Pletz
- Center for Infectious Diseases and Infection Control, Jena University Hospital, Erlanger Allee 101, 07740, Jena, Germany
| | - Thomas M Ruprecht
- Techniker Krankenkasse, Bramfelder Str. 140, 22305, Hamburg, Germany
| | | | - Sibel Altin
- AOK Rheinland/Hamburg, Kasernenstr. 61, 40213, Düsseldorf, Germany
| | - Wolfgang Greiner
- Health Economics and Health Care Management, Bielefeld University, P.O. Box 10 01 31, 33501, Bielefeld, Germany
| | - Marc Moritz Berger
- Department of Anesthesiology and Intensive Care Medicine, Essen University Hospital, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
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29
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Qiu X, Li J, Bonenfant J, Jaroszewski L, Mittal A, Klein W, Godzik A, Nair MG. Dynamic changes in human single-cell transcriptional signatures during fatal sepsis. J Leukoc Biol 2021; 110:1253-1268. [PMID: 34558746 DOI: 10.1002/jlb.5ma0721-825r] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 07/30/2021] [Accepted: 09/03/2021] [Indexed: 12/11/2022] Open
Abstract
Systemic infections, especially in patients with chronic diseases, may result in sepsis: an explosive, uncoordinated immune response that can lead to multisystem organ failure with a high mortality rate. Patients with similar clinical phenotypes or sepsis biomarker expression upon diagnosis may have different outcomes, suggesting that the dynamics of sepsis is critical in disease progression. A within-subject study of patients with Gram-negative bacterial sepsis with surviving and fatal outcomes was designed and single-cell transcriptomic analyses of peripheral blood mononuclear cells (PBMC) collected during the critical period between sepsis diagnosis and 6 h were performed. The single-cell observations in the study are consistent with trends from public datasets but also identify dynamic effects in individual cell subsets that change within hours. It is shown that platelet and erythroid precursor responses are drivers of fatal sepsis, with transcriptional signatures that are shared with severe COVID-19 disease. It is also shown that hypoxic stress is a driving factor in immune and metabolic dysfunction of monocytes and erythroid precursors. Last, the data support CD52 as a prognostic biomarker and therapeutic target for sepsis as its expression dynamically increases in lymphocytes and correlates with improved sepsis outcomes. In conclusion, this study describes the first single-cell study that analyzed short-term temporal changes in the immune cell populations and their characteristics in surviving or fatal sepsis. Tracking temporal expression changes in specific cell types could lead to more accurate predictions of sepsis outcomes and identify molecular biomarkers and pathways that could be therapeutically controlled to improve the sepsis trajectory toward better outcomes.
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Affiliation(s)
- Xinru Qiu
- Graduate Program in Genetics, Genomics and Bioinformatics, University of California Riverside, Riverside, California, USA
| | - Jiang Li
- Division of Biomedical Sciences, School of Medicine, University of California Riverside, Riverside, California, USA
| | - Jeff Bonenfant
- Division of Pulmonary and Critical Care, Riverside University Health System Medical Center, Riverside, California, USA.,Department of Internal Medicine, Division of Pulmonary and Critical Care, Loma Linda University, Loma Linda, California, USA
| | - Lukasz Jaroszewski
- Division of Biomedical Sciences, School of Medicine, University of California Riverside, Riverside, California, USA
| | - Aarti Mittal
- Division of Pulmonary and Critical Care, Riverside University Health System Medical Center, Riverside, California, USA
| | - Walter Klein
- Division of Pulmonary and Critical Care, Riverside University Health System Medical Center, Riverside, California, USA
| | - Adam Godzik
- Division of Biomedical Sciences, School of Medicine, University of California Riverside, Riverside, California, USA
| | - Meera G Nair
- Division of Biomedical Sciences, School of Medicine, University of California Riverside, Riverside, California, USA
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30
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Hussein AA, Sabry NA, Abdalla MS, Farid SF. A prospective, randomised clinical study comparing triple therapy regimen to hydrocortisone monotherapy in reducing mortality in septic shock patients. Int J Clin Pract 2021; 75:e14376. [PMID: 34003568 DOI: 10.1111/ijcp.14376] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 05/09/2021] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES This prospective, comparative and randomised clinical study evaluated the effectiveness of triple therapy regimen (hydrocortisone, thiamine and vitamin C) versus hydrocortisone alone in reducing the mortality rate and preventing progressive organ dysfunction in septic shock patients. METHODS A total of 94 patients were randomly assigned to one of two groups: the first group received hydrocortisone 50 mg/6-h IV for 7 days or till intensive care unit (ICU) discharge, if sooner, followed by tapering. The second group received hydrocortisone 50 mg/6-h IV for 7 days or ICU discharge followed by tapering, vitamin C 1.5 g/6-h IV for 4 days or till ICU discharge and thiamine 200 mg/12-h IV for 4 days or till ICU discharge. RESULTS The triple therapy regimen showed a non-significant reduction in 28-day mortality compared to hydrocortisone alone (17 [36.2%] vs. 21 [44.7%]; P = .4005), but it was significantly lower than the control group regarding shock time and the duration of vasopressor use in days (4.000 [3.000-7.000]; 5.000 [4.000-8.000], [P = .0100]). The patients in the control group were likely to get 0.59 more in SCr level than those in the intervention group by a linear regression model which was significant (P < .05). Also, the number of patients who developed a fever after 216 hours was significantly higher in the control group (P value = .0299). CONCLUSION Vitamin C, thiamine, and hydrocortisone regimen for septic shock management showed non-significant efficacy in decreasing 28-day mortality when compared to hydrocortisone monotherapy. On the other hand, it showed significant efficacy in decreasing the shock time and duration on vasopressors.
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Affiliation(s)
| | - Nirmeen A Sabry
- Clinical pharmacy department, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Maged S Abdalla
- Anaesthesia and Critical Care department, Faculty of Medicine (Kasr-el Ainy), Cairo University, Cairo, Egypt
| | - Samar F Farid
- Department of Clinical Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt
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31
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Kronstadt SM, Pottash AE, Levy D, Wang S, Chao W, Jay SM. Therapeutic Potential of Extracellular Vesicles for Sepsis Treatment. ADVANCED THERAPEUTICS 2021; 4:2000259. [PMID: 34423113 PMCID: PMC8378673 DOI: 10.1002/adtp.202000259] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Indexed: 12/14/2022]
Abstract
Sepsis is a deadly condition lacking a specific treatment despite decades of research. This has prompted the exploration of new approaches, with extracellular vesicles (EVs) emerging as a focal area. EVs are nanosized, cell-derived particles that transport bioactive components (i.e., proteins, DNA, and RNA) between cells, enabling both normal physiological functions and disease progression depending on context. In particular, EVs have been identified as critical mediators of sepsis pathophysiology. However, EVs are also thought to constitute the biologically active component of cell-based therapies and have demonstrated anti-inflammatory, anti-apoptotic, and immunomodulatory effects in sepsis models. The dual nature of EVs in sepsis is explored here, discussing their endogenous roles and highlighting their therapeutic properties and potential. Related to the latter component, prior studies involving EVs from mesenchymal stem/stromal cells (MSCs) and other sources are discussed and emerging producer cells that could play important roles in future EV-based sepsis therapies are identified. Further, how methodologies could impact therapeutic development toward sepsis treatment to enhance and control EV potency is described.
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Affiliation(s)
- Stephanie M Kronstadt
- Fischell Department of Bioengineering, University of Maryland, 3102 A. James Clark Hall, College Park, MD 20742, USA
| | - Alex E Pottash
- Fischell Department of Bioengineering, University of Maryland, 3102 A. James Clark Hall, College Park, MD 20742, USA
| | - Daniel Levy
- Fischell Department of Bioengineering, University of Maryland, 3102 A. James Clark Hall, College Park, MD 20742, USA
| | - Sheng Wang
- Translational Research Program, Department of Anesthesiology and Center for Shock Trauma and Anesthesiology Research, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Wei Chao
- Translational Research Program, Department of Anesthesiology and Center for Shock Trauma and Anesthesiology Research, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Steven M Jay
- Fischell Department of Bioengineering and Program in Molecular and, Cell Biology, University of Maryland, 3102 A. James Clark Hall, College Park, MD 20742, USA
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32
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Probiotics for the Management of Sepsis: Advances in Animal Models and Intensive Care Unit Environments. MICROBIOLOGY RESEARCH 2021. [DOI: 10.3390/microbiolres12030039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Sepsis frequently leads to multiple organ failure and is a major cause of morbidity and mortality in critically ill patients. Although intensive care protocols and antibiotic therapy have improved sepsis treatment, specific management is lacking with respect to efficient protection from tissue damage and long-term outcomes. Probiotics are live microbes that modulate the immune system and inflammation and colonize the gut. In this narrative review, we have traced the evolution of the administration of probiotics in an animal model of sepsis and treatment alternatives in the intensive care unit setting. First, probiotics are categorized by species before describing their modulation of the microbiota, repair of tissue-specific damage, immune response, and molecular pathways to prevent complications. The impact on therapy for infant and adult patients is also addressed. Finally, we have emphasized the challenges and gaps in current studies as well as future perspectives for further investigation. The present review can open up avenues for new strategies that employ promising probiotic strains for the treatment of sepsis and discusses their ability to prevent disease-associated long-term complications.
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33
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Fu M, Zhang K. MAPK interacting serine/threonine kinase 1 ( MKNK1), one target gene of miR-223-3p, correlates with neutrophils in sepsis based on bioinformatic analysis. Bioengineered 2021; 12:2550-2562. [PMID: 34115574 PMCID: PMC8806917 DOI: 10.1080/21655979.2021.1935405] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Sepsis, resulting from a harmful or damaging response to infection, is a complex and severe disease that causes high mortality. Three independent expression profiles of miRNA – GSE94717, GSE149764, and GSE101639 – were collected and integrated to analyze miRNAs associated with sepsis. One miRNA, miR-223-3p, was detected significantly downregulated in patients with sepsis. The upregulated miR-223-3p target genes in patients with sepsis were enriched in central carbon metabolism associated with HIF-1 signaling and galactose metabolism. Specially, three HIF-1 signaling genes – hypoxia-inducible factor 1-alpha (HIF1A), hexokinase 2 (HK2), and MAP kinase-interacting serine/threonine-protein kinase 1 (MKNK1) – were found significantly upregulated in patients with sepsis. Additionally, MKNK1 expression was downregulated in septic responders to early therapeutic treatments. Neutrophils were significantly accumulated in patients with sepsis and decreased in responders after therapy; MKNK1 was significantly positively correlated with neutrophils. Our findings indicate MKNK1, one targets of miR-223-3p, might be involved in sepsis via regulating the neutrophils abundance by mediating the expression inflammation factors.
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Affiliation(s)
- Mingmin Fu
- Department of Intensive Care Unit, Huzhou Cent Hosp, Affiliated Cent Hosp HuZhou University, Huzhou, Zhejiang, Peoples R China
| | - Kai Zhang
- Department of Emergency, Huzhou Cent Hosp, Affiliated Cent Hosp HuZhou University, Huzhou, Zhejiang, Peoples R China
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34
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Accuracy of Heparin-Binding Protein in Diagnosing Sepsis: A Systematic Review and Meta-Analysis. Crit Care Med 2021; 49:e80-e90. [PMID: 33196528 DOI: 10.1097/ccm.0000000000004738] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Existing studies evaluating the accuracy of heparin-binding protein for the diagnosis of sepsis have been inconsistent. We conducted a systematic review and meta-analysis to assess the totality of current evidence regarding the utility of heparin-binding protein to diagnose sepsis in patients with presumed systemic infection. DATA SOURCE PubMed, Embase, the China National Knowledge infrastructure, and WangFang electronic database were searched from inception to December of 2019. STUDY SELECTION Two independent reviewers identified eligible studies. Cohort and case-control studies, which measured serum levels of heparin-binding protein among adult patients with suspected sepsis, were eligible for inclusion. DATA EXTRACTION Two reviewers independently extracted data elements from the selected studies. A bivariate random-effects meta-analysis model was used to synthesize the prognostic accuracy measures. Risk of bias of studies was assessed with Quality Assessment of Diagnostic Accuracy Studies 2 tool. DATA SYNTHESIS We identified 26 studies with 3,868 patients in the meta-analysis. Heparin-binding protein had a pooled sensitivity of 0.85 (95% CI, 0.79-0.90) and a pooled specificity of 0.91 (95% CI, 0.82-0.96) for the diagnosis of sepsis. There was low heterogeneity between the studies (I2 = 12%), and no evidence of publication bias was detected. Heparin-binding protein had a higher sensitivity and specificity when compared with procalcitonin (0.75 [95% CI, 0.62-0.85] and 0.85 [95% CI, 0.73-0.92]) as well as C-reactive protein (0.75 [95% CI, 0.65-0.84] and 0.71 [95% CI, 0.63-0.77]). Serial measurements of heparin-binding protein also showed that heparin-binding protein levels rose significantly at least 24 hours before a diagnosis of sepsis. CONCLUSIONS The diagnostic ability of heparin-binding protein is favorable, demonstrating both high sensitivity and specificity in predicting progression to sepsis in critically ill patients. Future studies could assess the incremental value that heparin-binding protein may add to a multimodal sepsis identification and prognostication algorithm for critically ill patients.
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35
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Lu Z, Zhang J, Hong J, Wu J, Liu Y, Xiao W, Hua T, Yang M. Development of a Nomogram to Predict 28-Day Mortality of Patients With Sepsis-Induced Coagulopathy: An Analysis of the MIMIC-III Database. Front Med (Lausanne) 2021; 8:661710. [PMID: 33889591 PMCID: PMC8056034 DOI: 10.3389/fmed.2021.661710] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Sepsis-induced coagulopathy (SIC) is a common cause for inducing poor prognosis of critically ill patients in intensive care unit (ICU). However, currently there are no tools specifically designed for assessing short-term mortality in SIC patients. This study aimed to develop a practical nomogram to predict the risk of 28-day mortality in SIC patients. Methods: In this retrospective cohort study, we extracted patients from the Medical Information Mart for Intensive Care III (MIMIC-III) database. Sepsis was defined based on Sepsis 3.0 criteria and SIC based on Toshiaki Iba's criteria. Kaplan–Meier curves were plotted to compare the short survival time between SIC and non-SIC patients. Afterward, only SIC cohort was randomly divided into training or validation set. We employed univariate logistic regression and stepwise multivariate analysis to select predictive features. The proposed nomogram was developed based on multivariate logistic regression model, and the discrimination and calibration were verified by internal validation. We then compared model discrimination with other traditional severity scores and machine learning models. Results: 9432 sepsis patients in MIMIC III were enrolled, in which 3280 (34.8%) patients were diagnosed as SIC during the first ICU admission. SIC was independently associated with the 7- and 28-day mortality of ICU patients. K–M curve indicated a significant difference in 7-day (Log-Rank: P < 0.001 and P = 0.017) and 28-day survival (Log-Rank: P < 0.001 and P < 0.001) between SIC and non-SIC groups whether the propensity score match (PSM) was balanced or not. For nomogram development, a total of thirteen variables of 3,280 SIC patients were enrolled. When predicted the risk of 28-day mortality, the nomogram performed a good discrimination in training and validation sets (AUROC: 0.78 and 0.81). The AUROC values were 0.80, 0.81, 0.71, 0.70, 0.74, and 0.60 for random forest, support vector machine, sequential organ failure assessment (SOFA) score, logistic organ dysfunction score (LODS), simplified acute physiology II score (SAPS II) and SIC score, respectively, in validation set. And the nomogram calibration slope was 0.91, the Brier value was 0.15. As presented by the decision curve analyses, the nomogram always obtained more net benefit when compared with other severity scores. Conclusions: SIC is independently related to the short-term mortality of ICU patients. The nomogram achieved an optimal prediction of 28-day mortality in SIC patient, which can lead to a better prognostics assessment. However, the discriminative ability of the nomogram requires validation in external cohorts to further improve generalizability.
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Affiliation(s)
- Zongqing Lu
- The 2nd Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, China.,The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jin Zhang
- The 2nd Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, China.,The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jianchao Hong
- The 2nd Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, China.,The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jiatian Wu
- The 2nd Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, China.,The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yu Liu
- Key Laboratory of Intelligent Computing & Signal Processing, Ministry of Education, Anhui University, Hefei, China
| | - Wenyan Xiao
- The 2nd Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, China.,The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Tianfeng Hua
- The 2nd Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, China.,The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Min Yang
- The 2nd Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, China.,The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
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36
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Abstract
Sepsis is both common and costly. Successful implementation of guidelines in the acute care setting has decreased mortality and increased the number of sepsis survivors. However, patients returning to the community continue to experience complications related to sepsis and many are poorly prepared to manage these long-term complications. These long-term complications are collectively referred to as post-sepsis syndrome. The purpose of this review is to increase knowledge about post-sepsis syndrome and to compare post-sepsis syndrome with post-intensive care unit syndrome.
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Affiliation(s)
- Sherry Leviner
- Fayetteville State University, Fayetteville, North Carolina
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37
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Oshima K, King SI, McMurtry SA, Schmidt EP. Endothelial Heparan Sulfate Proteoglycans in Sepsis: The Role of the Glycocalyx. Semin Thromb Hemost 2021; 47:274-282. [PMID: 33794552 DOI: 10.1055/s-0041-1725064] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
There is increasing recognition of the importance of the endothelial glycocalyx and its in vivo manifestation, the endothelial surface layer, in vascular homeostasis. Heparan sulfate proteoglycans (HSPGs) are a major structural constituent of the endothelial glycocalyx and serve to regulate vascular permeability, microcirculatory tone, leukocyte and platelet adhesion, and hemostasis. During sepsis, endothelial HSPGs are shed through the induction of "sheddases" such as heparanase and matrix metalloproteinases, leading to loss of glycocalyx integrity and consequent vascular dysfunction. Less well recognized is that glycocalyx degradation releases HSPG fragments into the circulation, which can shape the systemic consequences of sepsis. In this review, we will discuss (1) the normal, homeostatic functions of HSPGs within the endothelial glycocalyx, (2) the pathological changes in HSPGs during sepsis and their consequences on the local vascular bed, and (3) the systemic consequences of HSPG degradation. In doing so, we will identify potential therapeutic targets to improve vascular function during sepsis as well as highlight key areas of uncertainty that require further mechanistic investigation.
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Affiliation(s)
- Kaori Oshima
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Samantha I King
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Sarah A McMurtry
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Eric P Schmidt
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,Department of Medicine, Denver Health Medical Center, Denver, Colorado
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38
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Liu Y, Wang X, Yu L. Th17, rather than Th1 cell proportion, is closely correlated with elevated disease severity, higher inflammation level, and worse prognosis in sepsis patients. J Clin Lab Anal 2021; 35:e23753. [PMID: 33704828 PMCID: PMC8128311 DOI: 10.1002/jcla.23753] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/14/2021] [Accepted: 02/23/2021] [Indexed: 11/21/2022] Open
Abstract
Objective The current study aimed to investigate the prognostic value of T helper (Th) 1 and Th17 proportions in sepsis patients. Methods Th1 and Th17 cells in blood CD4+ T cells were detected by flow cytometry in 210 sepsis patients and 100 healthy controls (HCs). Besides, serum interferon‐γ (IFN‐γ), tumor necrosis factor‐α (TNF‐α), and interleukin‐17 (IL‐17) levels in the enrolled sepsis patients were determined with enzyme‐linked immunosorbent assay. Results Compared with HCs, Th1 and Th17 proportions were elevated in sepsis patients (both p < .001). Meanwhile, Th1 proportion was strongly correlated with IFN‐γ (p < .001, r = .484) but weakly correlated with TNF‐α (p = .024, r = .156) and IL‐17 (p = .002, r = .212), while Th17 proportion showed faint correlation with IFN‐γ (p = .015, r = .168), but strong correlations with TNF‐α (p < .001, r = .602) and IL‐17 (p < .001, r = .498) in sepsis patients. Besides, Th1 proportion was weakly associated with APACHE II score (p = .030, r = .150), but Th17 proportion was closely associated with APACHE II score (p < .001, r = .322) and SOFA score (p < .001, r = .337) in sepsis patients. Regarding their prognostic value, Th1 proportion (p = .042) was slightly, while Th17 proportion (p < .001) was dramatically, increased in septic deaths compared with survivors, and Th17 possessed good predictive value for 28‐day mortality risk (AUC: 0.748, 95% CI: 0.659–0.836). Conclusion Th1 and Th17 proportions are elevated in sepsis patients compared with HCs, and Th17 proportion is correlated with increased disease severity, higher inflammation level, and worse prognosis in sepsis patients.
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Affiliation(s)
- Yu Liu
- Department of Intensive Care Unit, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaopin Wang
- Department of Intensive Care Unit, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Yu
- Department of Intensive Care Unit, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Montealegre F, Lyons BM. Fluid Therapy in Dogs and Cats With Sepsis. Front Vet Sci 2021; 8:622127. [PMID: 33718468 PMCID: PMC7947228 DOI: 10.3389/fvets.2021.622127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/03/2021] [Indexed: 01/20/2023] Open
Abstract
Sepsis is currently defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Sepsis may occur secondary to infection anywhere in the body, and its pathogenesis is complex and not yet fully understood. Variations in the host immune response result in diverse clinical manifestations, which complicates clinical recognition and fluid therapy both in humans and veterinary species. Septic shock is a subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone. Although septic shock is a form of distributive shock, septic patients frequently present with hypovolemic and cardiogenic shock as well, further complicating fluid therapy decisions. The goals of this review are to discuss the clinical recognition of sepsis in dogs and cats, the basic mechanisms of its pathogenesis as it affects hemodynamic function, and considerations for fluid therapy. Important pathophysiologic changes, such as cellular interaction, microvascular alterations, damage to the endothelial glycocalyx, hypoalbuminemia, and immune paralysis will be also reviewed. The advantages and disadvantages of treatment with crystalloids, natural and synthetic colloids, and blood products will be discussed. Current recommendations for evaluating fluid responsiveness and the timing of vasopressor therapy will also be considered. Where available, the veterinary literature will be used to guide recommendations.
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Affiliation(s)
- Federico Montealegre
- Department of Medical and Scientific Affairs, Nova Biomedical, Waltham, MA, United States
| | - Bridget M Lyons
- Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, MO, United States
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Carlton EF, Weiss SL, Prescott HC, Prosser LA. What's the Cost? Measuring the Economic Impact of Pediatric Sepsis. Front Pediatr 2021; 9:761994. [PMID: 34869119 PMCID: PMC8634593 DOI: 10.3389/fped.2021.761994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/20/2021] [Indexed: 11/13/2022] Open
Abstract
Sepsis, life-threatening organ dysfunction secondary to infection, hospitalizes nearly 75,000 children each year in the United States. Most children survive sepsis. However, there is increasing recognition of the longer-term consequences of pediatric sepsis hospitalization on both the child and their family, including medical, psychosocial, and financial impacts. Here, we describe family spillover effects (the impact of illness on caregivers) of pediatric sepsis, why measurement of family spillover effects is important, and the ways in which family spillover effects can be measured.
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Affiliation(s)
- Erin F Carlton
- Division of Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States.,Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
| | - Scott L Weiss
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States.,Pediatric Sepsis Program, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Hallie C Prescott
- Veterans Affairs Center for Clinical Management Research, Health Services Research & Development Center of Innovation, Ann Arbor, MI, United States.,Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI, United States
| | - Lisa A Prosser
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States.,Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, United States
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Antaya TC, Allen BN, Richard L, Shariff SZ, Saposnik G, Burneo JG. Epilepsy risk among survivors of intensive care unit hospitalization for sepsis. Neurology 2020; 95:e2271-e2279. [PMID: 32887778 DOI: 10.1212/wnl.0000000000010609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 05/14/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether survivors of intensive care unit (ICU) hospitalizations with sepsis experience higher epilepsy risk than survivors of ICU hospitalizations without sepsis, and to identify sepsis survivors at highest risk. METHODS We used linked, administrative health care databases to conduct a population-based, retrospective matched cohort study of adult Ontario residents discharged from an ICU between January 1, 2010, and December 31, 2015, identified using the Discharge Abstract Database. We used propensity scores to match patients who experienced sepsis during their index ICU hospitalization with up to 4 patients who did not experience sepsis. We applied marginal Cox proportional hazards regression to estimate the risk of epilepsy within 2 years following the index ICU hospitalization. Among sepsis survivors, Cox proportional hazards regression was used to identify factors associated with epilepsy. RESULTS A total of 143,892 patients were included, 32,252 (22.4%) of whom were exposed. Sepsis survivors were at significantly higher epilepsy risk (hazard ratio [HR] 1.44, 95% confidence interval [CI] 1.15-1.80). The risk of epilepsy marginally decreased with increasing age (HR 0.97, 95% CI 0.96-0.99); patients with chronic kidney disease (HR 2.25, 95% CI 1.48-3.43) were at highest risk. CONCLUSIONS In this real-world analysis, sepsis survivors, particularly those who are younger and have chronic kidney disease, are at significantly higher epilepsy risk. These findings indicate that sepsis may be an unrecognized epilepsy risk factor.
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Affiliation(s)
- Tresah C Antaya
- From the Neuroepidemiology Research Unit (T.C.A., J.G.B.), Department of Clinical Neurological Sciences, Western University; ICES Western (B.N.A., L.R., S.Z.S., J.G.B.), London, Canada; and Department of Medicine (G.S.), Division of Neurology, University of Toronto, Canada
| | - Britney N Allen
- From the Neuroepidemiology Research Unit (T.C.A., J.G.B.), Department of Clinical Neurological Sciences, Western University; ICES Western (B.N.A., L.R., S.Z.S., J.G.B.), London, Canada; and Department of Medicine (G.S.), Division of Neurology, University of Toronto, Canada
| | - Lucie Richard
- From the Neuroepidemiology Research Unit (T.C.A., J.G.B.), Department of Clinical Neurological Sciences, Western University; ICES Western (B.N.A., L.R., S.Z.S., J.G.B.), London, Canada; and Department of Medicine (G.S.), Division of Neurology, University of Toronto, Canada
| | - Salimah Z Shariff
- From the Neuroepidemiology Research Unit (T.C.A., J.G.B.), Department of Clinical Neurological Sciences, Western University; ICES Western (B.N.A., L.R., S.Z.S., J.G.B.), London, Canada; and Department of Medicine (G.S.), Division of Neurology, University of Toronto, Canada
| | - Gustavo Saposnik
- From the Neuroepidemiology Research Unit (T.C.A., J.G.B.), Department of Clinical Neurological Sciences, Western University; ICES Western (B.N.A., L.R., S.Z.S., J.G.B.), London, Canada; and Department of Medicine (G.S.), Division of Neurology, University of Toronto, Canada
| | - Jorge G Burneo
- From the Neuroepidemiology Research Unit (T.C.A., J.G.B.), Department of Clinical Neurological Sciences, Western University; ICES Western (B.N.A., L.R., S.Z.S., J.G.B.), London, Canada; and Department of Medicine (G.S.), Division of Neurology, University of Toronto, Canada.
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Gabriel RA, Trivedi S, Schmidt UH. A Point-Based Risk Calculator Predicting Mortality in Patients That Developed Postoperative Sepsis. J Intensive Care Med 2020; 36:1443-1449. [DOI: 10.1177/0885066620960991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background: Predicting the mortality from post-operative sepsis remains a continuing problem. We built a statistical model using national data to predict mortality in patients who developed post-operative sepsis. Methods: This is a retrospective study using the American College of Surgeons National Quality Surgical Improvement Program database, in which we gathered data from adult patients between 2011 and 2016 who experienced postoperative sepsis. We designed a predictive model using multivariable logistic regression on a training set and validated the model on a separate test set. Results: There were 128,325 patients included in the final dataset, in which 18,499 (14.4%) died within 30-days of surgery. The model consisted of 10 covariates: American Society of Anesthesiologists Physical Status classification score, preoperative sepsis, age, chronic obstructive pulmonary disease, postoperative myocardial infarction, postoperative stroke, postoperative acute renal failure, transfusion requirement, and infection type. A point-based risk calculator was developed, which had an area under the receiver operating characteristics curve of 0.819 (95% confidence interval 0.814-0.823). Conclusion: Although further work is needed to confirm and validate our model on external datasets, our scoring system provides a novel way to measure mortality in septic post-operative patients.
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Affiliation(s)
- Rodney A. Gabriel
- Department of Anesthesiology, University of California, San Diego, CA, USA
- Division of Biomedical Informatics, University of California, San Diego, CA, USA
| | - Suraj Trivedi
- Department of Anesthesiology, University of California, San Diego, CA, USA
| | - Ulrich H. Schmidt
- Department of Anesthesiology, University of California, San Diego, CA, USA
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Mishra HK, Ma J, Mendez D, Hullsiek R, Pore N, Walcheck B. Blocking ADAM17 Function with a Monoclonal Antibody Improves Sepsis Survival in a Murine Model of Polymicrobial Sepsis. Int J Mol Sci 2020; 21:ijms21186688. [PMID: 32932701 PMCID: PMC7555020 DOI: 10.3390/ijms21186688] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 12/24/2022] Open
Abstract
Sepsis is the culmination of hyperinflammation and immune suppression in response to severe infection. Neutrophils are critical early responders to bacterial infection but can become highly dysfunctional during sepsis and other inflammatory disorders. The transmembrane protease ADAM17 (a disintegrin and metalloproteinase 17) is expressed by leukocytes and most other cells and has many substrates that regulate inflammation. We have reported that conditional knockout mice lacking ADAM17 in all leukocytes had a survival advantage during sepsis, which was associated with improved neutrophil effector functions. These and other findings indicate aberrant ADAM17 activity during sepsis. For this study, we evaluated for the first time the effects of an ADAM17 function blocking monoclonal antibody (mAb) on the pathogenesis of polymicrobial sepsis. Mice treated with the ADAM17 mAb MEDI3622 prior to sepsis induction exhibited significantly decreased mortality. When the ADAM17 mAb was combined with antibiotic administration, sepsis survival was markedly enhanced compared to either intervention alone, which was associated with a significant reduction in plasma levels of various inflammation-related factors. MEDI3622 and antibiotic administration after sepsis induction also significantly improved survival. Our results indicate that the combination of blocking ADAM17 as an immune modulator and appropriate antibiotics may provide a new therapeutic avenue for sepsis treatment.
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Affiliation(s)
- Hemant K. Mishra
- Department of Veterinary and Biomedical Sciences, University of Minnesota, St. Paul, MN 55108, USA; (H.K.M.); (J.M.); (D.M.); (R.H.)
| | - Jing Ma
- Department of Veterinary and Biomedical Sciences, University of Minnesota, St. Paul, MN 55108, USA; (H.K.M.); (J.M.); (D.M.); (R.H.)
| | - Daniel Mendez
- Department of Veterinary and Biomedical Sciences, University of Minnesota, St. Paul, MN 55108, USA; (H.K.M.); (J.M.); (D.M.); (R.H.)
| | - Robert Hullsiek
- Department of Veterinary and Biomedical Sciences, University of Minnesota, St. Paul, MN 55108, USA; (H.K.M.); (J.M.); (D.M.); (R.H.)
| | - Nabendu Pore
- Early Oncology Clinical Science, Astra Zeneca, One Medimmune Way, Gaithersburg, MD 20878, USA;
| | - Bruce Walcheck
- Department of Veterinary and Biomedical Sciences, University of Minnesota, St. Paul, MN 55108, USA; (H.K.M.); (J.M.); (D.M.); (R.H.)
- Correspondence:
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Nrp-1 Mediated Plasmatic Ago2 Binding miR-21a-3p Internalization: A Novel Mechanism for miR-21a-3p Accumulation in Renal Tubular Epithelial Cells during Sepsis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2370253. [PMID: 32923478 PMCID: PMC7453242 DOI: 10.1155/2020/2370253] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/24/2020] [Accepted: 07/30/2020] [Indexed: 12/13/2022]
Abstract
The mechanism underlying sepsis-associated acute kidney injury (SAKI), which is an independent risk factor for sepsis-associated death, is unclear. A previous study indicates that during sepsis miR-21a-3p accumulates in renal tubular epithelial cells (TECs) as the mediator of inflammation and mediates TEC malfunction by manipulating its metabolism. However, the specific mechanism responsible for the accumulation of miR-21a-3p in TECs during sepsis is unrevealed. In this study, a cecal ligation and puncture- (CLP-) induced sepsis rat model and rat TEC line were used to elucidate the mechanism. Firstly, miR-21a-3p and Ago2 levels were found out to increase in both plasma and TECs during sepsis, and the increase of intracellular Ago2 and miR-21a-3p could be mitigated when Ago2 was either inactivated or downregulated in septic plasma. Moreover, membrane Nrp-1 expression of TECs was increased significantly during sepsis and Nrp-1 knockdown also mitigated the rise of both the intracellular Ago2 and miR-21a-3p levels in TECs incubated with septic plasma. Furthermore, it was revealed that Ago2 can be internalized by TECs mediated with Nrp-1 and this process had no effect on the intracellular content of miR-21a-3p. Both Ago2 and miR-21a-3p could bind to TECs derived Nrp-1 directly. Finally, it was determined that miR-21a-3p was internalized by TECs via Nrp-1 and Ago2 facilitated this process. Taken together, it can be concluded from our results that Ago2 binding miR-21a-3p from septic plasma can be actively internalized by TECs via Nrp-1 mediated cell internalization, and this mechanism is crucial for the rise of intracellular miR-21a-3p content of TECs during sepsis. These findings will improve our understanding of the mechanisms underlying SAKI and aid in developing novel therapeutic strategies.
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Zhang Y, Feng Q, Zhou S, Chen H. Downregulation of serum survivin correlates with increased inflammation, enhanced disease severity and worse prognosis in sepsis patients. Medicine (Baltimore) 2020; 99:e20272. [PMID: 32664056 PMCID: PMC7360292 DOI: 10.1097/md.0000000000020272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
This study aimed to determine the role of survivin in sepsis patients.Serum samples of 288 sepsis patients and 290 healthy individuals (as healthy controls) were collected 24 hours within enrollment. Serum survivin and inflammatory cytokines were detected by enzyme-linked immunosorbent assay, and biochemical indexes were recorded. In sepsis patients, acute pathologic and chronic health evaluation II score and sequential organ failure assessment score were evaluated, and 28-day mortality was recorded.Survivin was greatly decreased in sepsis patients compared to healthy controls (P < .001) and it predicted decreased sepsis risk (area under curve (AUC): 0.921, 95% confidence interval (CI): 0.900-0.942). For clinical characteristics of sepsis patients, survivin was negatively correlated with acute pathologic and chronic health evaluation II score (P < .001), score and sequential organ failure assessment score (P < .001), serum creatinine (P < .001), white blood cell (P = .037), C-reactive protein (P < .001), tumor necrosis factor-α (P < .001), interleukin (IL)-1β (P < .001), IL-6 (P < .001), and IL-8 (P < .001), while positively correlated with albumin (P < .001). For prognosis of sepsis patients, survivin was decreased in deaths compared to survivors (P < .001), and it predicted decreased death risk (AUC: 0.625, 95% CI: 0.558-0.692). Meanwhile, accumulating mortality was decreased in survivin high patients compared to survivin low patients (P = .006). However, multivariate logistic regression revealed survivin was not an independent predictive factor for 28-day mortality, indicating it might interact with other independent factors to affect prognosis of sepsis patients.Survivin was decreased in sepsis patients and predicted decreased sepsis risk. Meanwhile, survivin was correlated with declined inflammation, reduced disease severity, and favorable prognosis in sepsis patients.
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Affiliation(s)
- Yanmin Zhang
- Emergency Department, HanDan Central Hospital (East), Handan, China
| | - Qiang Feng
- Department of Cardiology, HanDan Central Hospital, Handan, China
| | - Shaoying Zhou
- Emergency Department, HanDan Central Hospital (East), Handan, China
| | - Huimin Chen
- Emergency Department, HanDan Central Hospital (East), Handan, China
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Darbà J, Marsà A. Epidemiology, management and costs of sepsis in Spain (2008-2017): a retrospective multicentre study. Curr Med Res Opin 2020; 36:1089-1095. [PMID: 32329375 DOI: 10.1080/03007995.2020.1760809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Objective: To update the profile of patients attended with sepsis in specialised care centres in Spain, to analyse in-hospital mortality, disease management and costs between 2008 and 2017.Methods: Admission records registered between 1 January 2008 and 31 December 2017 obtained from a Spanish National hospital discharge database for public and private hospitals. Centres are responsible for data codification, evaluation and confidentiality. The database is validated internally and is subjected to periodic audits. Files corresponding to patients with sepsis and septic shock were selected by means of the International Statistical Classification of Diseases and Related Health Problems, 9th version and 10th version codes. These criteria claimed 311,674 records of 288,211 patients. Direct medical costs of secondary healthcare include expenses derived from the admission: examination, medication, treatment and costs of nutrition, personnel, medical equipment and resources.Results: More than 53% of all patients were males, with a mean age of 73.0 years. Fifty-one percent of the identified admissions were due to a sepsis without organ dysfunction, 21.5% to sepsis with organ dysfunction, and 27.3% registered a septic shock. The incidence of sepsis increased 2.7 times between 2008 and 2017, reaching a hospital incidence of 5.7 per 10,000 inhabitants in 2017. Case fatality rate (CFR) was 23.2% and 35.0% in patients without and with organ dysfunction in 2017, respectively, and 42.9% in patient with septic shock, decreasing over time. Mean annual direct medical costs of specialised care over the study period were €6664 and €8084 per patient in patients with sepsis without and with organ dysfunction, respectively, and €11,359 per patient in those with septic shock.Conclusions: The social and economic burden of sepsis in Spain continues to grow (incidence, total costs). Despite its general decreasing trend, CFR remains elevated, thus, patients could benefit from further research and protocol revision.
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Affiliation(s)
- Josep Darbà
- Department of Economics, Universitat de Barcelona, Barcelona, Spain
| | - Alicia Marsà
- BCN Health Economics & Outcomes Research S.L., Travessera de Gràcia, Barcelona, Spain
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Zhang K, Lv D, Deng Y, Zhu C, Gao Y, Huang Y, Xu X. STAPLAg: a convenient early warning score for use in infected patients in the intensive care unit. Medicine (Baltimore) 2020; 99:e20274. [PMID: 32481394 DOI: 10.1097/md.0000000000020274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Sepsis is a life-threatening disease in the intensive care unit (ICU). The current diagnostic criteria for sequential organ failure assessment (SOFA) scores do not reflect the current understanding of sepsis. We developed a novel and convenient score to aid early prognosis.Retrospective multivariable regression analysis of 185 infected emergency ICU (EICU) patients was conducted to identify independent variables associated with death, to develop the new "STAPLAg" score; STAPLAg was then validated in an internal cohort (n = 106) and an external cohort (n = 78) and its predictive efficacy was compared with that of the initial SOFA score.Age, and initial serum albumin, sodium, PLR, troponin, and lactate tests in the emergency department were independent predictors of death in infected EICU patients, and were used to establish the STAPLAg score (area under the curve [AUC] 0.865). The initial SOFA score on admission was predictive of death (AUC 0.782). Applying the above categories to the derivation cohort yielded mortality risks of 7.7% for grade I, 56.3% for grade II, and 75.0% for grade III. Internal (AUC 0.884) and external (AUC 0.918) cohort validation indicated that the score had good predictive power.The STAPLAg score can be determined early in infected EICU patients, and exhibited better prognostic capacity than the initial SOFA score on admission in both internal and external cohorts. STAPLAg constitutes a new resource for use in the clinical diagnosis of sepsis and can also predict mortality in infected EICU patients. REGISTRATION NUMBER:: ChinCTR-PNC-16010288.
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Affiliation(s)
| | | | - Yuxiao Deng
- Department of Surgery Intensive Care Unit, Ren Ji Hospital
| | | | - Yuan Gao
- Department of Surgery Intensive Care Unit, Ren Ji Hospital
| | - Yuan Huang
- Department of Critical Care Medicine, Shanghai General Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
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BIG1 controls macrophage pro-inflammatory responses through ARF3-mediated PI(4,5)P2 synthesis. Cell Death Dis 2020; 11:374. [PMID: 32415087 PMCID: PMC7229175 DOI: 10.1038/s41419-020-2590-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/29/2020] [Indexed: 12/29/2022]
Abstract
Sepsis is caused by a dysregulated host inflammatory response to serious infections resulting in life-threatening organ dysfunction. The high morbidity and mortality make sepsis still a major clinical problem. Here, we investigated the roles of Brefeldin A-inhibited guanine nucleotide-exchange factor 1 (BIG1) in the pathogenesis process of sepsis and the underlying mechanisms. We found myeloid cell-specific BIG1 knockout (BIG1 cKO) significantly reduced the mortality and organ damage in LPS-induced and CLP-induced polymicrobial sepsis mouse model. The serum concentration and mRNA expression of pro-inflammatory cytokines including TNF-α, IL-6, IL-1β, and IL-12 were obviously decreased in BIG1 cKO mice. In bone marrow-derived macrophages or THP-1 cells, BIG1 deficiency caused an inhibited ARF3 activation, which reduced PI(4,5)P2 synthesis and the recruitment of TIRAP to the plasma membrane through inhibiting the activation of PIP5K induced by LPS, and eventually resulted in the inhibitory activity of TLR4-MyD88 signaling pathway. These results reveal a crucial new role of BIG1 in regulating macrophage inflammation responses, and provide evidence for BIG1 as a potential promising therapeutic target in sepsis.
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Burdick H, Pino E, Gabel-Comeau D, McCoy A, Gu C, Roberts J, Le S, Slote J, Pellegrini E, Green-Saxena A, Hoffman J, Das R. Effect of a sepsis prediction algorithm on patient mortality, length of stay and readmission: a prospective multicentre clinical outcomes evaluation of real-world patient data from US hospitals. BMJ Health Care Inform 2020; 27:e100109. [PMID: 32354696 PMCID: PMC7245419 DOI: 10.1136/bmjhci-2019-100109] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/25/2019] [Accepted: 02/14/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Severe sepsis and septic shock are among the leading causes of death in the USA. While early prediction of severe sepsis can reduce adverse patient outcomes, sepsis remains one of the most expensive conditions to diagnose and treat. OBJECTIVE The purpose of this study was to evaluate the effect of a machine learning algorithm for severe sepsis prediction on in-hospital mortality, hospital length of stay and 30-day readmission. DESIGN Prospective clinical outcomes evaluation. SETTING Evaluation was performed on a multiyear, multicentre clinical data set of real-world data containing 75 147 patient encounters from nine hospitals across the continental USA, ranging from community hospitals to large academic medical centres. PARTICIPANTS Analyses were performed for 17 758 adult patients who met two or more systemic inflammatory response syndrome criteria at any point during their stay ('sepsis-related' patients). INTERVENTIONS Machine learning algorithm for severe sepsis prediction. OUTCOME MEASURES In-hospital mortality, length of stay and 30-day readmission rates. RESULTS Hospitals saw an average 39.5% reduction of in-hospital mortality, a 32.3% reduction in hospital length of stay and a 22.7% reduction in 30-day readmission rate for sepsis-related patient stays when using the machine learning algorithm in clinical outcomes analysis. CONCLUSIONS Reductions of in-hospital mortality, hospital length of stay and 30-day readmissions were observed in real-world clinical use of the machine learning-based algorithm. The predictive algorithm may be successfully used to improve sepsis-related outcomes in live clinical settings. TRIAL REGISTRATION NUMBER NCT03960203.
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Affiliation(s)
- Hoyt Burdick
- Cabell Huntington Hospital, Huntington, West Virginia, USA
- Marshall University School of Medicine, Huntington, West Virginia, USA
| | - Eduardo Pino
- Cabell Huntington Hospital, Huntington, West Virginia, USA
- Marshall University School of Medicine, Huntington, West Virginia, USA
| | | | - Andrea McCoy
- Cape May Regional Medical Center, Cape May Court House, New Jersey, USA
| | - Carol Gu
- Dascena Inc, Oakland, California, USA
| | | | - Sidney Le
- Dascena Inc, Oakland, California, USA
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Impact of a qSOFA-based triage procedure on antibiotic timing in ED patients with sepsis: A prospective interventional study. Am J Emerg Med 2020; 38:477-484. [DOI: 10.1016/j.ajem.2019.05.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 05/07/2019] [Indexed: 11/23/2022] Open
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