Serum total carbon dioxide as a prognostic factor for 28-day mortality in patients with sepsis

Association between the anion-gap and 28-day mortality in critically ill adult patients with sepsis: A retrospective cohort study

Metabolic acidosis is usually associated with the severity of the condition of patients with sepsis or septic shock. Serum anion gap (AG) is one of the indicators of response metabolism. This study was performed to investigate whether the initial serum AG is associated with the 28-day mortality in critically ill adult patients with sepsis. This retrospective cohort study, a total of 15,047 patients with confirmed Sepsis disease from 2008 to 2019 from the Medical Information Mart for Intensive Care IV (MIMIC-IV) v1.0 database. The MIMIC-IV database is a comprehensive, de-identified clinical dataset originating from the Beth Israel Deaconess Medical Center in Boston, it includes extensive data on intensive care unit (ICU) patients, such as vital signs, lab results, and medication orders, spanning multiple years, accessible to researchers through an application process. AG can be obtained by direct extraction in the MIMIC-IV database (itemid = 50,868 from the laboratory events table of mimic_hosp), inclusion of AG values for the first test on first day of ICU admission. The patients were grouped into quartiles according to the AG interquartile range. The primary outcome was the 28-day mortality. Multiple logistic regression analysis was used to calculate the odds ratio (OR), while accounting for potential confounders, and the robustness of the results were evaluated in subgroup analyses. Among the 15,047 patients included in this study, the average age was 65.9 ± 16.0 years, 42.5% were female, 66.1% were Caucasian, and the 28-day mortality rate was 17.9% (2686/15,047). Multiple logistic regression analysis revealed the 28-day mortality in every increase of AG (per SD mEq/L), there is an associated 1.2 times (OR 1.2, 95% CI 1.12-1.29, P < .001) increase. Increased 28-day mortality (OR 1.53, 95% confidence interval 1.29-1.81, P < .001) in the group with the AG (15-18 mEq/L), and (OR 1.69, 95% confidence interval 1.4-2.04, P < .001) in the group with the highest AG (≥18 mEq/L), AG (<12 mEq/L) as a reference group, in the fully adjusted model. In adult patients with sepsis, the early AG at the time of ICU admission is an independent risk factor for prognosis.

Temperature trajectories and mortality in hypothermic sepsis patients

OBJECTIVES

Hypothermia is associated with poor outcomes in sepsis patients, and hypothermic sepsis patients exhibit temperature alterations during initial treatment. The objective of this study was to classify hypothermic sepsis patients based on body temperature trajectories and investigate the associations of these patients with 28-day mortality.

METHODS

This was a retrospective analysis of prospectively collected data from adult sepsis or septic shock patients who visited three emergency departments between August 2014 and December 2019. Hypothermic sepsis was defined as an initial body temperature <36 °C. delta temperature was calculated by subtracting the 0 h body temperature from the 6 h body temperature. We divided the patients into three groups according to delta temperature: Group A (delta temperature ≤ 0), Group B (0 < delta temperature ≤ 1) and Group C (delta temperature > 1). The primary outcome was 28-day mortality, and a multivariable Cox proportional hazards regression model was generated.

RESULTS

Among 7344 patients with sepsis or septic shock, 325 hypothermic patients were included in the analysis, and the overall mortality rate was 36%. While initial body temperature was not different between survivors and nonsurvivors, survivors exhibited a higher body temperature at 6 h. The 28-day mortality rates for Groups A, B and C were 53.1%, 36.0%, and 30.0%, respectively, and Group A had significantly higher mortality than Group C did (p < 0.05). Group C demonstrated a 44.2% decrease in 28-day mortality compared to Group A (adjusted hazard ratio of 0.558; 95% confidence interval of 0.330-0.941).

CONCLUSIONS

In hypothermic sepsis patients, an increase of 1 °C or more in body temperature after the initial 6 h is associated with a reduced risk of 28-day mortality.

The relationship between potassium levels and 28-day mortality in sepsis patients: Secondary data analysis using the MIMIC-IV database

Objective

The goal of the research is to investigate the link between serum potassium levels and death after 28 days in sepsis patients, utilizing an extensive sample of patients from the multi-center Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Current research on serum potassium levels and 28-day mortality in sepsis patients is questionable. This study adds to the growing body of evidence linking serum potassium levels to the 28-day possibility of death in patients with sepsis.

Methods

We collected 349,08 patients with sepsis from the retrospective cohort MIMIC-IV database, using serum potassium level on the first day of admission to the intensive care unit as the exposure variable and mortality at 28 days as the outcome variable. And controlled for confounding characteristics including gender, age, ethnicity, and vital signs during admission.

Results

Serum potassium has a U-shaped connection with 28-day mortality in patients suffering from sepsis. The turning point was 4.10 mmol/L (95 % confidence interval: 4.03 to 4.22). Serum potassium and 28-day mortality were negatively linked on the inflection point's left side (OR: 0.72; 95 % CI: 0.63 to 0.83, P < 0.0001); on the opposing side of the point of inflexion, serum potassium was enthusiastically attached to 28-day mortality. (OR: 1.13; 95 % CI: 1.06 to 1.21, P < 0.0001).

Conclusion

The research conducted found that too high or too low potassium levels were linked to a 28-day risk of mortality in humans with sepsis.

Effect of Intravenous Push and Piggyback Administration of Ceftriaxone on Mortality in Sepsis

BACKGROUND

There is a lack of evidence-based guidelines for the administration methods of ceftriaxone in emergency departments (EDs), resulting in the reliance on individual institutional protocols for decision-making.

OBJECTIVE

This study was performed to compare the effects of administering ceftriaxone via intravenous push (IVP) and intravenous piggyback (IVPB) on 28-day mortality in patients with sepsis.

METHODS

This was a retrospective study of patients aged 18 years or older with sepsis or septic shock who visited an ED and were treated with ceftriaxone as an initial antibiotic between March 2010 and February 2019. Patients were divided into the IVP group and the IVPB group based on the administration method. The primary outcome was 28-day mortality, and multivariable Cox proportional hazards regression analysis was performed to evaluate the relationship between antibiotic administration methods and 28-day mortality.

RESULTS

During the study period, a total of 939 patients were included in the final analysis, and the overall mortality rate was 12.2%. The antibiotic administration time was significantly lower in the IVP group than in the IVPB group, and the rates of antibiotic administration within 1 h and within 3 h were higher in the IVP group than in the IVPB group (p < 0.05). However, there was no significant difference in 28-day mortality between the two groups (hazard ratio 1.07, 95% confidence interval 0.69-1.65).

CONCLUSIONS

IVP administration of ceftriaxone reduced the time of antibiotic administration compared with IVPB, but there was no difference in 28-day mortality.

Associations of the Serum Total Carbon Dioxide Level with Long-Term Clinical Outcomes in Sepsis Survivors

INTRODUCTION

Sepsis is characterized by a dysregulated host response to infection that leads to multiple organ dysfunction and often complicated with metabolic acidosis. However, the associations between serum total carbon dioxide level (TCO₂) and long-term clinical outcomes in sepsis survivors remains unknown.

METHODS

A total of 7212 sepsis survivors aged ≥ 20 years who were discharged from January  1, 2008 to December 31, 2018 were included in our analyses. The sepsis survivors were further divided into high TCO₂ (≥ 18 mmol/L) and low TCO₂ (< 18 mmol/L) groups, comprising 5023 and 2189 patients, respectively. The following outcomes of interest were included: all-cause mortality, myocardial infarction, ischemic stroke, hospitalization for heart failure, ventricular arrhythmia, and end-stage renal disease (ESRD).

RESULTS

After propensity score matching, the low TCO₂ group was at higher risks of all-cause mortality (hazard ratio [HR] 1.28, 95% confidence interval [95% CI] 1.18-1.39), myocardial infarction (HR 1.83, 95% CI 1.39-2.43), and ESRD (HR 1.38, 95% CI 1.16-1.64) than the high TCO₂ group. The results remained similar after considering death as a competing risk.

CONCLUSION

Patients discharged from hospitalization for sepsis have higher risks of worse long-term clinical outcomes. Physicians may need to pay more attention to sepsis survivors whose TCO₂ was low.

Patient-Reported and Physiologic Outcomes Following Pelvic Exenteration for Non-Repairable Radiated Rectourethral Fistula

OBJECTIVE

To investigate the impact of pelvic exenteration (PelvEX) on patient-reported pain, distress, and quality of life along with physiologic indicators of health in cancer survivors with radiated, non-repairable rectourethral fistula (RUF).

MATERIALS AND METHODS

We reviewed a prospectively maintained quality improvement database of RUF patients at our institution from 2012 to 2020. Patients with radiated, non-repairable RUF who underwent PelvEX and had follow up to 1 year were included. Pain and distress scores were collected preoperatively and at 1-year follow up. Number of narcotic prescriptions in the 3 months before surgery and the year after surgery were abstracted. Short Form 12 surveys were administered in the postoperative period. Serum albumin, creatinine, carbon dioxide, hematocrit, and glucose were abstracted from electronic health records. Statistical analysis was performed using Wilcoxon signed-rank and Mann-Whitney tests.

RESULTS

Eleven patients met inclusion criteria. Patient-reported pain significantly decreased at 1 year follow-up compared to preoperative scores (median pre: 4 vs 1 year post: 0, P = .0312). Patient-reported distress significantly decreased pre- versus post-PelvEX (median pre: 5 vs post: 0, P = .0156). At the time of postoperative pain and distress surveys, 9 (82.8%) patients did not have narcotic prescriptions. Postoperative Short Form 12 scores were similar to an age-matched United States population (mental: P = .3125; physical: P = .1484). Serum-based indicators of health were not different in the pre- versus postoperative period (all P >.05).

CONCLUSION

PelvEX may be a valuable treatment option to decrease patient-reported pain and distress without compromising quality of life or physiologic health in patients with radiated, non-repairable RUF.