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Chafranska L, Stenholt OO, Sørensen RH, Abdullah SMOB, Nielsen FE. Predictors for mortality in patients admitted with suspected bacterial infections - A prospective long-term follow-up study. Am J Emerg Med 2022; 56:236-243. [PMID: 35462153 DOI: 10.1016/j.ajem.2022.04.002] [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: 10/17/2021] [Revised: 03/10/2022] [Accepted: 04/07/2022] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE The aim was to examine predictors for all-cause mortality in a long-term follow-up study of adult patients with infectious diseases of suspected bacterial origin. METHODS A prospective observational study of patients admitted to the emergency department during 1.10.2017-31.03.2018. We used Cox regression to estimate adjusted hazard ratios (aHR) with 95% confidence intervals for mortality. RESULTS A total of 2110 patients were included (median age 73 years). After a median follow-up of 2.1 years 758 (35.9%, 95% CI 33.9-38.0%) patients had died. Age (aHR1.05; 1.04-1.05), male gender (aHR 1.21; 1.17-1.25), cancer (aHR 1.80; 1.73-1.87), misuse of alcohol (aHR 1.30; 1.22-1.38), if admitted with sepsis within the last year before index admission (aHR 1.56;1.50-1.61), a Sequential Organ Failure Assessment (SOFA) score ≥2 (aHR 1.90; 1.83-1.98), SIRS criteria ≥2 (aHR 1.23;1.18-1.28) at admission to the ED, length of stay (aHR 1.05; 1.04-1.05) and devices and implants as sources of infection (aHR 7.0; 5.61-8.73) were independently associated with mortality. Skin infections and increasing haemoblobin values reduced the risk of death. CONCLUSIONS More than one-third of a population of patients admitted to the emergency department with infectious diseases of suspected bacterial origin had died during a median follow up of 2.1 years. The study identified several independent predictors for mortality.
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Affiliation(s)
- Lana Chafranska
- Department of Emergency Medicine, Copenhagen University Hospital, Bispebjerg, Frederiksberg, Denmark.
| | - Oscar Overgaard Stenholt
- Department of Emergency Medicine, Copenhagen University Hospital, Bispebjerg, Frederiksberg, Denmark
| | | | | | - Finn Erland Nielsen
- Department of Emergency Medicine, Copenhagen University Hospital, Bispebjerg, Frederiksberg, Denmark.
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Donati P, Londoño LA, Tunes M, Villalta C, Guillemi EC. Retrospective evaluation of the use of quick Sepsis-related Organ Failure Assessment (qSOFA) as predictor of mortality and length of hospitalization in dogs with pyometra (2013-2019): 52 cases. J Vet Emerg Crit Care (San Antonio) 2022; 32:223-228. [PMID: 35166423 DOI: 10.1111/vec.13103] [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: 10/30/2019] [Revised: 03/04/2020] [Accepted: 03/18/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the prognostic utility of quick Sepsis-related Organ Failure Assessment (qSOFA) for prediction of in-hospital mortality and length of hospitalization in dogs with pyometra. DESIGN Retrospective cohort study from February 2013 to April 2019 SETTING: Tertiary referral hospital ANIMALS: Fifty-two dogs referred with confirmed diagnosis of pyometra INTERVENTIONS: None MEASUREMENTS AND PRINCIPAL OUTCOMES: Sixty-five percent of dogs survived to discharge. A cut-off score of ≥2 for qSOFA was associated with in-hospital mortality (odds ratio 6.51 [95% CI: 1.35 - 31.3]) P = 0.019. The area under the receiver operator characteristic curve for a qSOFA score ≥ 2 for mortality was 0.72 (95% CI: 0.59-0.85), with a sensitivity of 77.8% and a specificity of 66.7%. The mean ± SD number of organs with dysfunction was significantly higher in dogs with a qSOFA score ≥2 1.76 ± 0.83 compared to dogs with a qSOFA score < 2 1.08 ± 1.09, P = 0.015. The presence of a qSOFA score ≥ 2 was associated with a longer time of hospitalization in survivors with a median (interquartile range) length of stay in qSOFA < 2 (48 [33]) hours versus qSOFA score ≥ 2 (78 [52]) hours, P = 0.027. CONCLUSIONS In dogs with pyometra, the qSOFA score was associated with mortality and length of hospitalization. This score might be useful to improve the risk stratification in dogs with pyometra. Further studies are necessary to evaluate the predictive capacity of qSOFA in other septic patient populations.
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Affiliation(s)
| | - Leonel A Londoño
- Department of Small Animal Clinical Sciences, University of Florida, Gainesville, Florida, USA
| | | | - Cesar Villalta
- Clínica Veterinaria VET`S, Suecia 3580, Providencia, Santiago, Chile
| | - Eliana C Guillemi
- Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires, Argentina
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Comparison of different sepsis scoring systems and pathways: qSOFA, SIRS, Shapiro criteria and CEC SEPSIS KILLS pathway in bacteraemic and non-bacteraemic patients presenting to the emergency department. BMC Infect Dis 2022; 22:76. [PMID: 35065617 PMCID: PMC8783440 DOI: 10.1186/s12879-022-07070-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 01/17/2022] [Indexed: 12/30/2022] Open
Abstract
Background Bacteraemia is associated with high morbidity and mortality, with delayed antibiotic treatment associated with poorer outcomes. Early identification is challenging, but clinically important. Multiple scoring systems have been developed to identify individuals in the broader categories of sepsis. We designed this study to assess the performance of existing scoring systems and pathways—CEC SEPSIS KILLS pathway (an Australian sepsis care package), quick sequential organ failure score (qSOFA), systemic inflammatory response syndrome (SIRS) and the Shapiro criteria. Methods This was a retrospective cohort study performed in two metropolitan hospitals in NSW, consisting of adult patients (> 18 years) with positive blood cultures containing a true pathogen and patients matched by age without positive blood cultures. Performance (sensitivity, specificity, and mortality prediction) of recognised sepsis and bacteraemia criteria and pathways—qSOFA, SIRS, Shapiro criteria and CEC SEPSIS KILLS pathway in the first 4 h following ED triage was assessed. Results There were 251 patients in each cohort. Sepsis-related mortality was higher in the bacteraemic group (OR 0.4, p = 0.03). Of the criteria studied, the modified Shapiro criteria had the highest sensitivity (88%) with modest specificity (37.85%), and qSOFA had the highest specificity (83.67%) with poor sensitivity (19.82%). SIRS had reasonable sensitivity (82.07%), with poor sensitivity (20.72%). The CEC SEPSIS pathway sensitivity of 70.1% and specificity of 71.1%. The SEPSIS KILLS was activated on only 14% of bacteraemic patients. Conclusion The performance of all scoring systems and pathways was suboptimal in the identification of patients at risk of bacteraemia presenting to the emergency department. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07070-6.
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Habib S, Yarlagadda S, Carreon TA, Schader LM, Hsu CH. Fungal Infection in Acutely Decompensated Cirrhosis Patients: Value of Model for End-Stage Liver Disease Score. Gastroenterology Res 2020; 13:199-207. [PMID: 33224366 PMCID: PMC7665857 DOI: 10.14740/gr1255] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 10/20/2020] [Indexed: 11/11/2022] Open
Abstract
Background Infection in acute-on-chronic liver failure (ACLF) patients is known to cause higher mortality. The current approach is to culture all patient samples. There are no published data evaluating fungal infections in acutely decompensated patients. In this study, we aim to identify clinical factors predictive of infections within ACLF patients and assess workup compliance within 24 h of hospital admission. Methods We retrospectively analyzed the charts of 457 ACLF patients seen at the University of Arizona between January 1, 2014 and December 31, 2014. We used logistic regression to identify potential risk indicators for bacterial, fungal, and any infections. In order to proceed to a systemic infection workup, the following parameters were assessed: complete blood count, urinalysis, urine culture, bacterial blood culture, chest X-ray, and ascitic fluid analysis in patients with ascites. Additionally, serological markers were also assessed in patient samples. Systemic inflammatory response syndrome (SIRS) was defined as the presence of two or more of the following criteria: temperature > 38 °C or < 36 °C, heart rate > 90 beats/min, respiratory rate > 20 breaths/min, white blood cell count > 12,000 or < 4,000 cells/mm or > 10% bands. Results An established infection was observed in 60.61% of ACLF patients. SIRS criteria predicted infections with concordance statistic (C-statistic) of 0.71 (odds ratio (OR) 6.85, 95% confidence interval (CI): 4.33, 10.85) for any infection, 0.63 (OR 2.88, 95% CI: 1.96, 4.23) for bacterial infection, and 0.53 (OR 1.32, 95% CI: 0.59, 2.96) for fungal infection. After including other significant variables (over 10 additional variables), predictive ability improved, C-statistic 0.83 (95% CI: 0.77, 0.90) for any infection and 0.71 (95% CI: 0.65, 0.77) for bacterial infections. The combination of model for end-stage liver disease (MELD) and hemoglobin (Hb) predicted fungal infections with C-statistic 0.74 (95% CI: 0.63, 0.84). Workup within 24 h of admission was obtained in 12% of patients. Conclusions Fungal infections in ACLF patients results in an increased mortality rate. Elevated MELD and low Hb in combination predict fungal infections. Compliance is very poor to obtain diagnostic workup efficiently, better tools are needed to predict infection upon admission.
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Affiliation(s)
- Shahid Habib
- Liver Institute PLLC, 5295 E. Knight Dr, Tucson, AZ 85712, USA
| | | | | | | | - Chiu-Hsieh Hsu
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, The University of Arizona, 1295 N. Martin Ave., Drachman Hall, PO Box 245210, Tucson, AZ 85724, USA
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Zhu L, Jiang R, Pei L, Li X, Kong X, Wang X. Risk factors for the fever after percutaneous nephrolithotomy: a retrospective analysis. Transl Androl Urol 2020; 9:1262-1269. [PMID: 32676409 PMCID: PMC7354332 DOI: 10.21037/tau.2020.03.37] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background It’s very common to see the onset of fever after percutaneous nephrolithotomy (PCNL), it’s necessary to analyze the risk factors for the fever following PCNL, and to provide evidence for infection prevention after PCNL. Methods A total of 546 adult PCNL patients were included as study subjects and retrospective studies were performed. We collected clinical data of patients using a prospectively designed database. Univariate and multivariate logistic regression analyses were performed to identify the potential risk factors for the fever after PCNL. Results Of the included 546 PCNL patients, there were 82 fever patients and 464 no-fever patients following PCNL. Escherichia coli and Proteus mirabilis are the two most common infectious bacteria. Preoperative urinary tract infection (OR =4.38, 95% CI: 1.15–9.53), multiple access (OR =5.31, 95% CI: 1.23–10.75), diabetes (OR =4.97, 95% CI: 1.37–9.86), length of operation ≥60 min (OR =5.67, 95% CI: 2.24–13.42), estimated blood loss in PCNL ≥500 mL (OR=2.78, 95% CI: 2.32–3.61) were the independent risk factors associated with postoperative infection. Conclusions Effective control of urinary tract infection, reduction of access number, strict control of blood glucose, length of operation control, reduction of intraoperative bleeding should be considered as measures to prevent postoperative fever for patients with PCNL.
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Affiliation(s)
- Likun Zhu
- Department of Urology Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China.,Nephropathy Clinical Medical Research Center of Sichuan Province, Luzhou 646000, China
| | - Rui Jiang
- Department of Urology Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China.,Nephropathy Clinical Medical Research Center of Sichuan Province, Luzhou 646000, China
| | - Lijun Pei
- Department of Urology Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China.,Nephropathy Clinical Medical Research Center of Sichuan Province, Luzhou 646000, China
| | - Xu Li
- Department of Urology Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China.,Nephropathy Clinical Medical Research Center of Sichuan Province, Luzhou 646000, China
| | - Xiangjun Kong
- Department of Urology Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China.,Nephropathy Clinical Medical Research Center of Sichuan Province, Luzhou 646000, China
| | - Xinwei Wang
- Department of Urology Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China.,Nephropathy Clinical Medical Research Center of Sichuan Province, Luzhou 646000, China
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Bakhtawar S, Sheikh S, Qureshi R, Hoodbhoy Z, Payne B, Azam I, von Dadelszen P, Magee L. Risk factors for postpartum sepsis: a nested case-control study. BMC Pregnancy Childbirth 2020; 20:297. [PMID: 32410594 PMCID: PMC7227107 DOI: 10.1186/s12884-020-02991-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 05/04/2020] [Indexed: 11/10/2022] Open
Abstract
Background The Majority (99%) of maternal deaths occur in low and middle-income countries. The three most important causes of maternal deaths in these regions are postpartum hemorrhage, pre-eclampsia and puerperal sepsis. There are several diagnostic criteria used to identify sepsis and one of the commonly used criteria is systematic inflammatory response syndrome (SIRS). However, these criteria require laboratory investigations that may not be feasible in resource-constrained settings. Therefore, this study aimed to develop a model based on risk factors and clinical signs and symptoms that can identify sepsis early among postpartum women. Methods A case-control study was nested in an ongoing cohort of 4000 postpartum women who delivered or were admitted to the study hospital. According to standard criteria of SIRS, 100 women with sepsis (cases) and 498 women without sepsis (controls) were recruited from January to July 2017. Information related to the socio-demographic status, antenatal care and use of tobacco were obtained via interview while pregnancy and delivery related information, comorbid and clinical sign and symptoms were retrieved from the ongoing cohort. Multivariable logistic regression was performed and discriminative performance of the model was assessed using area under the curve (AUC) of the receiver operating characteristic (ROC). Results Multivariable analysis revealed that 1–4 antenatal visits (95% CI 0.01–0.62). , 3 or more vaginal examinations (95% CI 1.21–3.65), home delivery (95% CI 1.72–50.02), preterm delivery, diabetes in pregnancy (95% CI 1.93–20.23), lower abdominal pain (95% CI 1.15–3.42)) vaginal discharge (95% CI 2.97–20.21), SpO2 < 93% (95% CI 4.80–37.10) and blood glucose were significantly associated with sepsis. AUC was 0.84 (95% C.I 0.80–0.89) which indicated that risk factors and clinical sign and symptoms-based model has adequate ability to discriminate women with and without sepsis. Conclusion This study developed a non-invasive tool that can identify postpartum women with sepsis as accurately as SIRS criteria with good discriminative ability. Once validated, this tool has the potential to be scaled up for community use by frontline health care workers.
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Affiliation(s)
- Samina Bakhtawar
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Sana Sheikh
- Department of obstetrics and gynecology, Aga Khan University, Karachi, Pakistan.
| | - Rahat Qureshi
- Department of obstetrics and gynecology, Aga Khan University, Karachi, Pakistan
| | - Zahra Hoodbhoy
- Department of obstetrics and gynecology, Aga Khan University, Karachi, Pakistan
| | - Beth Payne
- University of British Columbia, Vancouver, Canada
| | - Iqbal Azam
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | | | - Laura Magee
- Global Women's Health, King's College, London, UK
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Kovach CP, Fletcher GS, Rudd KE, Grant RM, Carlbom DJ. Comparative prognostic accuracy of sepsis scores for hospital mortality in adults with suspected infection in non-ICU and ICU at an academic public hospital. PLoS One 2019; 14:e0222563. [PMID: 31525224 PMCID: PMC6746500 DOI: 10.1371/journal.pone.0222563] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 09/03/2019] [Indexed: 12/20/2022] Open
Abstract
Background Sepsis is a global healthcare challenge and reliable tools are needed to identify patients and stratify their risk. Here we compare the prognostic accuracy of the sepsis-related organ failure assessment (SOFA), quick SOFA (qSOFA), systemic inflammatory response syndrome (SIRS), and national early warning system (NEWS) scores for hospital mortality and other outcomes amongst patients with suspected infection at an academic public hospital. Measurements and main results 10,981 adult patients with suspected infection hospitalized at a U.S. academic public hospital between 2011–2017 were retrospectively identified. Primary exposures were the maximum SIRS, qSOFA, SOFA, and NEWS scores upon inclusion. Comparative prognostic accuracy for the primary outcome of hospital mortality was assessed using the area under the receiver operating characteristic curve (AUROC). Secondary outcomes included mortality in ICU versus non-ICU settings, ICU transfer, ICU length of stay (LOS) >3 days, and hospital LOS >7 days. Adjusted analyses were performed using a model of baseline risk for hospital mortality. 774 patients (7.1%) died in hospital. Discrimination for hospital mortality was highest for SOFA (AUROC 0.90 [95% CI, 0.89–0.91]), followed by NEWS (AUROC 0.85 [95% CI, 0.84–0.86]), qSOFA (AUROC 0.84 [95% CI, 0.83–0.85]), and SIRS (AUROC 0.79 [95% CI, 0.78–0.81]; p<0.001 for all comparisons). NEWS (AUROC 0.94 [95% CI, 0.93–0.95]) outperformed other scores in predicting ICU transfer (qSOFA AUROC 0.89 [95% CI, 0.87–0.91]; SOFA AUROC, 0.84 [95% CI, 0.82–0.87]; SIRS AUROC 0.81 [95% CI, 0.79–0.83]; p<0.001 for all comparisons). NEWS (AUROC 0.86 [95% CI, 0.85–0.86]) was also superior to other scores in predicting ICU LOS >3 days (SOFA AUROC 0.84 [95% CI, 0.83–0.85; qSOFA AUROC, 0.83 [95% CI, 0.83–0.84]; SIRS AUROC, 0.75 [95% CI, 0.74–0.76]; p<0.002 for all comparisons). Conclusions Multivariate prediction scores, such as SOFA and NEWS, had greater prognostic accuracy than qSOFA or SIRS for hospital mortality, ICU transfer, and ICU length of stay. Complex sepsis scores may offer enhanced prognostic performance as compared to simple sepsis scores in inpatient hospital settings where more complex scores can be readily calculated.
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Affiliation(s)
- Christopher P. Kovach
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington, United States of America
- * E-mail:
| | - Grant S. Fletcher
- Division of Hospital Medicine, Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Kristina E. Rudd
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington, United States of America
- Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Rosemary M. Grant
- Professional Development and Nursing Excellence, Harborview Medical Center, Seattle, Washington, United States of America
| | - David J. Carlbom
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington, United States of America
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Shafik S, Mallick S, Fogel J, Tetrokalashvili M, Hsu CD. The utility of systemic inflammatory response syndrome (SIRS) for diagnosing sepsis in the immediate postpartum period. J Infect Public Health 2019; 12:799-802. [PMID: 31010644 DOI: 10.1016/j.jiph.2019.04.003] [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: 10/24/2018] [Revised: 01/03/2019] [Accepted: 04/01/2019] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND The systemic inflammatory response syndrome (SIRS) and sepsis definitions were developed to improve the ability for early detection of infection and sepsis. We studied the incidence of immediate postpartum SIRS and sepsis. We further studied immediate postpartum SIRS as a potential predictor for immediate postpartum sepsis. METHODS This was a retrospective study of 638 immediate postpartum women who delivered either vaginally or by cesarean section. Multivariate logistic regression was used for statistical analysis. Predictor variables included demographic, labor and delivery, and SIRS variables to determine their association with acute immediate postpartum sepsis. RESULTS We found that 72.10% of vital signs of immediate postpartum women met SIRS criteria while only 1.25% had sepsis. Both preterm gestational age of <37 weeks (OR:19.09, 95% CI:4.13, 88.36, p < 0.001) and only one of the four SIRS criteria of abnormal temperature (OR:25.90, 95% CI: 3.17, 211.52, p = 0.002) were each significantly associated with increased odds for sepsis. CONCLUSION Our findings suggest that immediate postpartum SIRS is not useful for the identification of immediate postpartum sepsis. Furthermore, SIRS does not appear to be a useful screening tool for infection and sepsis in the immediate postpartum period.
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Affiliation(s)
- Susan Shafik
- Department of Obstetrics and Gynecology, Nassau University Medical Center, East Meadow, New York, USA
| | - Sobiah Mallick
- Department of Obstetrics and Gynecology, Nassau University Medical Center, East Meadow, New York, USA; Department of Obstetrics and Gynecology, St Joseph's Women's Hospital, Tampa, FL, USA
| | - Joshua Fogel
- Department of Obstetrics and Gynecology, Nassau University Medical Center, East Meadow, New York, USA; Department of Business Management, Brooklyn College, Brooklyn, NY, USA
| | - Maggie Tetrokalashvili
- Department of Obstetrics and Gynecology, Nassau University Medical Center, East Meadow, New York, USA.
| | - Chaur-Dong Hsu
- Department of Obstetrics and Gynecology, Nassau University Medical Center, East Meadow, New York, USA; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
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Rothrock SG, Cassidy DD, Bienvenu D, Heine E, Guetschow B, Briscoe JG, Isaak SF, Chang K, Devaux M. Derivation of a screen to identify severe sepsis and septic shock in the ED-BOMBARD vs. SIRS and qSOFA. Am J Emerg Med 2018; 37:1260-1267. [PMID: 30245079 DOI: 10.1016/j.ajem.2018.09.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 09/04/2018] [Accepted: 09/15/2018] [Indexed: 12/29/2022] Open
Abstract
STUDY OBJECTIVE To predict severe sepsis/septic shock in ED patients. METHODS We conducted a retrospective case-control study of patients ≥18 admitted to two urban hospitals with a combined ED census of 162,000. Study cases included patients with severe sepsis/septic shock admitted via the ED. Controls comprised admissions without severe sepsis/septic shock. Using multivariate logistic regression, a prediction rule was constructed. The model's AUROC was internally validated using 1000 bootstrap samples. RESULTS 143 study and 286 control patients were evaluated. Features predictive of severe sepsis/septic shock included: SBP ≤ 110 mm Hg, shock index/SI ≥ 0.86, abnormal mental status or GCS < 15, respirations ≥ 22, temperature ≥ 38C, assisted living facility residency, disabled immunity. Two points were assigned to SI and temperature with other features assigned one point (mnemonic: BOMBARD). BOMBARD was superior to SIRS criteria (AUROC 0.860 vs. 0.798, 0.062 difference, 95% CI 0.022-0.102) and qSOFA scores (0.860 vs. 0.742, 0.118 difference, 95% CI 0.081-0.155) at predicting severe sepsis/septic shock. A BOMBARD score ≥ 3 was more sensitive than SIRS ≥ 2 (74.8% vs. 49%, 25.9% difference, 95% CI 18.7-33.1) and qSOFA ≥ 2 (74.8% vs. 33.6%, 41.2% difference, 95% CI 33.2-49.3) at predicting severe sepsis/septic shock. A BOMBARD score ≥ 3 was superior to SIRS ≥ 2 (76% vs. 45%, 32% difference, 95% CI 10-50) and qSOFA ≥ 2 (76% vs. 29%, 47% difference, 95% CI 25-63) at predicting sepsis mortality. CONCLUSION BOMBARD was more accurate than SIRS and qSOFA at predicting severe sepsis/septic shock and sepsis mortality.
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Affiliation(s)
- Steven G Rothrock
- Department of Emergency Medicine, Dr. P. Phillips Hospital, Orlando Health, United States of America
| | - David D Cassidy
- Department of Emergency Medicine, Orlando Regional Medical Center (ORMC), Orlando Health, United States of America; Department of Emergency Medicine, Residency in Emergency Medicine, Orlando Health, Orlando, FL, United States of America
| | - Drew Bienvenu
- Department of Emergency Medicine, Residency in Emergency Medicine, Orlando Health, Orlando, FL, United States of America
| | - Erich Heine
- Department of Emergency Medicine, Residency in Emergency Medicine, Orlando Health, Orlando, FL, United States of America
| | - Brian Guetschow
- Department of Emergency Medicine, Residency in Emergency Medicine, Orlando Health, Orlando, FL, United States of America
| | - Joshua G Briscoe
- Department of Emergency Medicine, Orlando Regional Medical Center (ORMC), Orlando Health, United States of America; Department of Emergency Medicine, South Lake Hospital, Orlando Health, United States of America; Department of Emergency Medicine, Residency in Emergency Medicine, Orlando Health, Orlando, FL, United States of America
| | - Sean F Isaak
- Department of Emergency Medicine, South Seminole Hospital, Orlando Health, United States of America
| | - Kenneth Chang
- Department of Emergency Medicine, Residency in Emergency Medicine, Orlando Health, Orlando, FL, United States of America
| | - Mikaela Devaux
- Department of Emergency Medicine, Residency in Emergency Medicine, Orlando Health, Orlando, FL, United States of America
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Kemperman H, Schrijver IT, Roest M, Kesecioglu J, van Solinge WW, de Lange DW. Osteoprotegerin is Higher in Sepsis Than in Noninfectious SIRS and Predicts 30-Day Mortality of SIRS Patients in the Intensive Care. J Appl Lab Med 2018; 3:559-568. [PMID: 31639725 DOI: 10.1373/jalm.2018.026559] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 05/29/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND Systemic inflammatory response syndrome (SIRS) is a complex disease involving multiple pathways and organs. Biomarkers reflecting these pathways and organ function could correlate with the severity of the disease. Osteoprotegerin (OPG), mainly known for its role in bone metabolism, is also involved in the immune and vascular system and is therefore an interesting biomarker to study in SIRS patients. In this prospective observational study, we investigated the correlation of plasma OPG concentrations, sepsis, and 30-day mortality of SIRS patients in the intensive care unit (ICU). METHODS This observational, single-center, cohort study included 313 consecutive patients admitted to the ICU, with an anticipated stay of more than 48 h and SIRS on admission. Data from included patients were collected daily until discharge or death for a maximum of 10 days. Thirty-day mortality was retrospectively assessed. OPG concentrations were measured in the first 48 h after admission. The relation of OPG with no sepsis, sepsis, and septic shock was assessed with the Kruskal-Wallis test and the Mann-Whitney U-test. Cox proportional hazards regression was used to study OPG concentrations and 30-day mortality. RESULTS OPG concentrations were higher in patients with sepsis and septic shock than in patients without sepsis. Furthermore, patients with OPG concentrations in the highest tertile at admission in the ICU have an increased risk of mortality within 30 days when compared to patients with OPG concentrations in the lowest and middle tertiles, independent of acute physiologic and chronic health evaluation (APACHE) and sequential organ failure assessment (SOFA) scores. CONCLUSIONS We show that OPG is a biomarker that correlates with sepsis and predicts mortality of SIRS patients in the ICU.
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Affiliation(s)
- Hans Kemperman
- Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands;
| | - Irene T Schrijver
- Intensive Care Center, University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - Mark Roest
- Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - Jozef Kesecioglu
- Intensive Care Center, University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - Wouter W van Solinge
- Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - Dylan W de Lange
- Intensive Care Center, University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
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GYM score: 30-day mortality predictive model in elderly patients attended in the emergency department with infection. Eur J Emerg Med 2017; 24:183-188. [DOI: 10.1097/mej.0000000000000321] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Pinnington S, Atterton B, Ingleby S. Making the journey safe: recognising and responding to severe sepsis in accident and emergency. BMJ QUALITY IMPROVEMENT REPORTS 2016; 5:bmjqir.u210706.w4335. [PMID: 27752314 PMCID: PMC5051421 DOI: 10.1136/bmjquality.u210706.w4335] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/22/2016] [Indexed: 01/20/2023]
Abstract
Severe sepsis is a clinical emergency. Despite the nationwide recognition of the sepsis six treatment bundle as the first line emergency treatment for this presentation, compliance in sepsis six provision remains inadequately low. The project goals were to improve compliance with the implementation of the Sepsis Six in patients with severe sepsis and/or septic shock. In improving timely care delivery it was anticipated improvements would be made in relation to patient safety and experience, and reductions in length of stay (LoS) and mortality. The project intended to make the pathway for those presenting with sepsis safe and consistent, where sepsis is recognised and treated in a timely manner according to best practice. The aim of the project was to understand the what the barriers where to providing safe effective care for the patient presenting with severe sepsis in A&E. Using the Safer Clinical Systems (SCS) tools developed byte Health Foundation and Warwick University, the project team identified the hazards and associated risks in the septic patient pathway. The level of analysis employed enabled the project team to identify the major risks, themes, and factors of influence within this pathway. The analysis identified twenty nine possible interventions, of which six were chosen following option appraisal. Further interventions were recommended to the accident and emergency as part of a business case and further changes in process. Audits identified all severely septic patients presenting to A&E in October 2014 (n=67) and post intervention in September 2015 (n=93). Compared analysis demonstrated an increase in compliance with the implementation of the sepsis six care bundle from 7% to 41%, a reduction in LoS by 1.9 days and a decrease in 30 day mortality by 50%. Additional audit reviewed the management of 10 septic patients per week for the duration of the project to assess the real time impact of the selected interventions.
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Affiliation(s)
- Sarah Pinnington
- Central Manchester University Hospitals NHS Foundation Trust, UK
| | - Brigid Atterton
- Central Manchester University Hospitals NHS Foundation Trust, UK
| | - Sarah Ingleby
- Central Manchester University Hospitals NHS Foundation Trust, UK
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Long B, Koyfman A. Best Clinical Practice: Blood Culture Utility in the Emergency Department. J Emerg Med 2016; 51:529-539. [PMID: 27639424 DOI: 10.1016/j.jemermed.2016.07.003] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 06/01/2016] [Accepted: 07/19/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Bacteremia affects 200,000 patients per year, with the potential for significant morbidity and mortality. Blood cultures are considered the most sensitive method for detecting bacteremia and are commonly obtained in patients with fever, chills, leukocytosis, focal infections, and sepsis. OBJECTIVE We sought to provide emergency physicians with a review of the literature concerning blood cultures in the emergency department. DISCUSSION The utility of blood cultures has been a focus of controversy, prompting research evaluating effects on patient management. Bacteremia is associated with increased mortality, and blood cultures are often obtained for suspected infection. False-positive blood cultures are associated with harm, including increased duration of stay and cost. This review suggests that blood cultures are not recommended for patients with cellulitis, simple pyelonephritis, and community-acquired pneumonia, because the chance of a false-positive culture is greater than the prevalence of true positive cultures. Blood cultures are recommended for patients with sepsis, meningitis, complicated pyelonephritis, endocarditis, and health care-associated pneumonia. Clinical prediction rules that predict true positive cultures may prove useful. The clinical picture should take precedence. If cultures are obtained, two bottles of ≥7 mL should be obtained from separate peripheral sites. CONCLUSIONS Blood cultures are commonly obtained but demonstrate low yield in cellulitis, simple pyelonephritis, and community-acquired pneumonia. The Shapiro decision rule for predicting true bacteremia does show promise, but clinical gestalt should take precedence. To maximize utility, blood cultures should be obtained before antibiotic therapy begins. At least two blood cultures should be obtained from separate peripheral sites.
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Affiliation(s)
- Brit Long
- Department of Emergency Medicine, San Antonio Military Medical Center, Fort Sam Houston, Texas
| | - Alex Koyfman
- Department of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
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Kelly BJ, Lautenbach E, Nachamkin I, Coffin SE, Gerber JS, Fuchs BD, Garrigan C, Han X, Bilker WB, Wise J, Tolomeo P, Han JH. Combined biomarkers discriminate a low likelihood of bacterial infection among surgical intensive care unit patients with suspected sepsis. Diagn Microbiol Infect Dis 2016; 85:109-15. [PMID: 26971636 DOI: 10.1016/j.diagmicrobio.2016.01.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 12/30/2015] [Accepted: 01/06/2016] [Indexed: 01/11/2023]
Abstract
Among surgical intensive care unit (SICU) patients, it is difficult to distinguish bacterial sepsis from other causes of systemic inflammatory response syndrome (SIRS). Biomarkers have proven useful to identify the presence of bacterial infection. We enrolled a prospective cohort of 69 SICU patients with suspected sepsis and assayed the concentrations of 9 biomarkers (α-2 macroglobulin [A2M], C-reactive protein, ferritin, fibrinogen, haptoglobin, procalcitonin [PCT], serum amyloid A, serum amyloid P, and tissue plasminogen activator) at baseline, 24, 48, and 72hours. Forty-two patients (61%) had bacterial sepsis by chart review. A2M concentrations were significantly lower, and PCT concentrations were significantly higher in subjects with bacterial sepsis at 3 of 4 time points. Using optimal cutoff values, the combination of baseline A2M and 72-hour PCT achieved a negative predictive value of 75% (95% confidence interval, 54-96%). The combination of A2M and PCT discriminated bacterial sepsis from other SIRS among SICU patients with suspected sepsis.
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Affiliation(s)
- Brendan J Kelly
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Ebbing Lautenbach
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Biostatistics and Epidemiology, Perelman School of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Irving Nachamkin
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Susan E Coffin
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jeffrey S Gerber
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Biostatistics and Epidemiology, Perelman School of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Barry D Fuchs
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Charles Garrigan
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Xiaoyan Han
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Warren B Bilker
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Biostatistics and Epidemiology, Perelman School of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jacqueleen Wise
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Pam Tolomeo
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jennifer H Han
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Biostatistics and Epidemiology, Perelman School of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Zhang H, Wang WC, Chen JK, Zhou L, Wang M, Wang ZD, Yang B, Xia YM, Lei S, Fu EQ, Jiang T. ZC3H12D attenuated inflammation responses by reducing mRNA stability of proinflammatory genes. Mol Immunol 2015; 67:206-12. [PMID: 26059755 DOI: 10.1016/j.molimm.2015.05.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 05/07/2015] [Accepted: 05/16/2015] [Indexed: 10/23/2022]
Abstract
Infection in airspaces and lung parenchyma may cause acute lung injury and multiple organ dysfunction syndrome due to acute inflammatory response, leading to organ failure and high mortality. ZC3H12D has been shown to modulate Toll-like receptor signaling. This study aimed to investigate the change of ZC3H12D during acute lung injury and its role in inflammation processes. Mice were challenged with lipopolysaccharides (LPS) intratracheally. The expression levels of Zc3h12d, NF-κB, and cytokines were analyzed by quantitative real-time PCR (qPCR), ELISA, and Western blot. The mRNA stability was assessed by qPCR after cells were treated with actinomycin D for specified times. The 3' untranslated region (3'-UTR) of c-fos was cloned immediately downstream of the luciferase coding sequence driven by CMV promoter and luciferase activity was measured with a Luciferase Assay kit. Upon LPS treatment, ZC3H12D levels were reduced in mouse immune cells, whereas levels of NF-κB, IL-6, and TNF-α were significantly increased. Knockdown Zc3h12d in THP1 cells resulted in the upregulation of NF-κB while overexpression of Zc3h12d inhibited NF-κB expression. Ectopic Zc3h12d significantly reduced the mRNA stability of c-fos, NF-κB, TNF-α, IL-1β, and IL-6. Attachment of the c-fos 3'-UTR made luciferase expression levels sensitive to levels of ZC3H12D. The data indicated that ZC3H12D could suppress both the initial inflammation storm and chronic inflammation by targeting the mRNA of cytokines as well as NF-κB and c-fos.
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Affiliation(s)
- Hong Zhang
- Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Wen-chen Wang
- Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Jia-kuan Chen
- Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Lin Zhou
- Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Ming Wang
- Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Zhen-dong Wang
- Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Bo Yang
- Department of Thoracic Surgery, Tianjin First Center Hospital, Tianjin, China
| | - Yan-ming Xia
- Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Shi Lei
- The College of Biology and Pharmacy, China Three Gorges University, Yichang, Hubei 443002, China
| | - En-qing Fu
- Department of Respiratory Medicine, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Tao Jiang
- Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China.
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Kaukonen KM, Bailey M, Pilcher D, Cooper DJ, Bellomo R. Systemic inflammatory response syndrome criteria in defining severe sepsis. N Engl J Med 2015; 372:1629-38. [PMID: 25776936 DOI: 10.1056/nejmoa1415236] [Citation(s) in RCA: 713] [Impact Index Per Article: 79.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The consensus definition of severe sepsis requires suspected or proven infection, organ failure, and signs that meet two or more criteria for the systemic inflammatory response syndrome (SIRS). We aimed to test the sensitivity, face validity, and construct validity of this approach. METHODS We studied data from patients from 172 intensive care units in Australia and New Zealand from 2000 through 2013. We identified patients with infection and organ failure and categorized them according to whether they had signs meeting two or more SIRS criteria (SIRS-positive severe sepsis) or less than two SIRS criteria (SIRS-negative severe sepsis). We compared their characteristics and outcomes and assessed them for the presence of a step increase in the risk of death at a threshold of two SIRS criteria. RESULTS Of 1,171,797 patients, a total of 109,663 had infection and organ failure. Among these, 96,385 patients (87.9%) had SIRS-positive severe sepsis and 13,278 (12.1%) had SIRS-negative severe sepsis. Over a period of 14 years, these groups had similar characteristics and changes in mortality (SIRS-positive group: from 36.1% [829 of 2296 patients] to 18.3% [2037 of 11,119], P<0.001; SIRS-negative group: from 27.7% [100 of 361] to 9.3% [122 of 1315], P<0.001). Moreover, this pattern remained similar after adjustment for baseline characteristics (odds ratio in the SIRS-positive group, 0.96; 95% confidence interval [CI], 0.96 to 0.97; odds ratio in the SIRS-negative group, 0.96; 95% CI, 0.94 to 0.98; P=0.12 for between-group difference). In the adjusted analysis, mortality increased linearly with each additional SIRS criterion (odds ratio for each additional criterion, 1.13; 95% CI, 1.11 to 1.15; P<0.001) without any transitional increase in risk at a threshold of two SIRS criteria. CONCLUSIONS The need for two or more SIRS criteria to define severe sepsis excluded one in eight otherwise similar patients with infection, organ failure, and substantial mortality and failed to define a transition point in the risk of death. (Funded by the Australian and New Zealand Intensive Care Research Centre.).
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Affiliation(s)
- Kirsi-Maija Kaukonen
- From the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University (K.-M.K., M.B., D.P., D.J.C., R.B.), the Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation (D.P.), and the Department of Intensive Care, Alfred Hospital (D.P.), Melbourne, VIC, and the Intensive Care Unit, Austin Health, Heidelberg, VIC (R.B.) - all in Australia; and the Neurosurgical Unit, Department of Anesthesiology, Intensive Care and Pain Medicine, Helsinki University Central Hospital, Helsinki (K.-M.K.)
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Shi E, Vilke GM, Coyne CJ, Oyama LC, Castillo EM. Clinical outcomes of ED patients with bandemia. Am J Emerg Med 2015; 33:876-81. [PMID: 25937377 DOI: 10.1016/j.ajem.2015.03.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 03/13/2015] [Accepted: 03/15/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Although an elevated white blood cell count is a widely utilized measure for evidence of infection and an important criterion for evaluation of systemic inflammatory response syndrome, its component band count occupies a more contested position within clinical emergency medicine. Recent studies indicate that bandemia is highly predictive of a serious infection, suggesting that clinicians who do not appreciate the value of band counts may delay diagnosis or overlook severe infections. OBJECTIVES Whereas previous studies focused on determining the quantitative value of the band count (ie, determining sensitivity, threshold for bandemia, etc.), this study directs attention to patient-centered outcomes, hypothesizing that the degree of bandemia predisposes patients to subsequent negative clinical outcomes associated with underappreciated severe infections. METHODS This retrospective study of electronic medical records includes patients who initially presented to the emergency department (ED) with bandemia and were subsequently discharged from the ED. These patients were screened for repeat ED visits within 7 days and death within 30 days. RESULTS In patients with severe bandemia who were discharged from the ED, there was a 20.9% revisit rate at 7 days and a 4.9% mortality rate at 30 days, placing severely bandemic patients at 5 times significantly greater mortality compared to nonbandemic patients (P = .032). CONCLUSION Our review of patient outcomes suggests that the degree of bandemia, especially in the setting of concurrent tachycardia or fever, is associated with greater likelihood of negative clinical outcomes.
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Affiliation(s)
- Eileen Shi
- University of California San Diego Division of Biological Sciences, La Jolla, CA 92093-0935; University of California San Diego School of Medicine, La Jolla, CA 92093-0935.
| | - Gary M Vilke
- University of California San Diego School of Medicine, Department of Emergency Medicine, La Jolla, CA 92093-0935
| | - Christopher J Coyne
- University of California San Diego School of Medicine, Department of Emergency Medicine, La Jolla, CA 92093-0935
| | - Leslie C Oyama
- University of California San Diego School of Medicine, Department of Emergency Medicine, La Jolla, CA 92093-0935
| | - Edward M Castillo
- University of California San Diego School of Medicine, Department of Emergency Medicine, La Jolla, CA 92093-0935
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