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Verras C, Bezati S, Bistola V, Ventoulis I, Matsiras D, Tsiodras S, Parissis J, Polyzogopoulou E. Point-of-Care Serum Proenkephalin as an Early Predictor of Mortality in Patients Presenting to the Emergency Department with Septic Shock. Biomedicines 2024; 12:1004. [PMID: 38790966 PMCID: PMC11117930 DOI: 10.3390/biomedicines12051004] [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: 03/30/2024] [Revised: 04/21/2024] [Accepted: 04/30/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND The aim of the present study is to investigate the prognostic utility of point-of-care (POC)-measured proenkephalin (PENK), a novel biomarker, in terms of predicting in-hospital mortality in patients presenting to the emergency department (ED) with septic shock. METHODS Bedside PENK was measured in consecutive patients presenting to the ED with septic shock according to the Sepsis-3 clinical criteria. The association of PENK with inflammatory and routine biomarkers, and its role as a predictor of in-hospital mortality, was examined. RESULTS Sixty-one patients with septic shock [53% females, median age 83 years (IQR 71-88)] were evaluated. Median (IQR) values of creatinine, plasma lactate, soluble urokinase plasminogen activator receptor (SuPAR), procalcitonin and PENK were 1.7 (1.0-2.9) mg/dL, 3.6 (2.1-6.8) mmol/L, 13.1 (10.0-21.4) ng/mL, 2.06 (0.84-3.49) ng/mL, and 205 (129-425) pmol/L, respectively. LogPENK significantly correlated with LogLactate (rho = 0.369, p = 0.004), LogCreatinine (rho = 0.537, p < 0.001), LogProcalcitonin (rho = 0.557, p < 0.001), and LogSuPAR (rho = 0.327, p = 0.011). During hospitalization, 39/61 (64%) patients died. In a multivariable logistic regression model, logPENK was an independent predictor of in-hospital mortality (OR 11.9, 95% CI: 1.7-84.6, p = 0.013). CONCLUSION POC PENK levels measured upon presentation to the ED strongly correlated with metabolic, renal and inflammatory biomarkers, and may serve as a predictor of in-hospital mortality in patients with septic shock.
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Affiliation(s)
- Christos Verras
- University Emergency Department, Attikon University Hospital, 12462 Athens, Greece; (S.B.); (D.M.); (J.P.); (E.P.)
| | - Sofia Bezati
- University Emergency Department, Attikon University Hospital, 12462 Athens, Greece; (S.B.); (D.M.); (J.P.); (E.P.)
| | - Vasiliki Bistola
- 2nd Cardiology Department, Attikon University Hospital, 12462 Athens, Greece;
| | - Ioannis Ventoulis
- Department of Occupational Therapy, University of Western Macedonia, 50200 Ptolemaida, Greece;
| | - Dionysis Matsiras
- University Emergency Department, Attikon University Hospital, 12462 Athens, Greece; (S.B.); (D.M.); (J.P.); (E.P.)
| | - Sotirios Tsiodras
- 4th Department of Internal Medicine, Attikon University Hospital, 12462 Athens, Greece;
| | - John Parissis
- University Emergency Department, Attikon University Hospital, 12462 Athens, Greece; (S.B.); (D.M.); (J.P.); (E.P.)
| | - Effie Polyzogopoulou
- University Emergency Department, Attikon University Hospital, 12462 Athens, Greece; (S.B.); (D.M.); (J.P.); (E.P.)
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Albarracin Duarte JA, Chaparro Hernández J, Rojas Aceros JA, Valoyes Gélvez JE, Ascuntar J, Jaimes F. Association between early manifestations of infection or sepsis and prognosis in a high complexity hospital in the city of Medellín. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2024; 71:394-402. [PMID: 38588770 DOI: 10.1016/j.redare.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/07/2023] [Indexed: 04/10/2024]
Abstract
OBJECTIVE To identify the first symptoms and signs of patients with suspected infection or sepsis and their association with the composite outcome of admission to the Intensive Care Unit (ICU) or mortality. DESIGN Prospective cohort study between June 2019 and March 2020. SETTING Hospital Universitario San Vicente Fundación, Colombia. PATIENTS Over 18 years of age with suspicion or confirmation of sepsis, which required hospitalization. INTERVENTIONS None. MAIN VARIABLES OF INTEREST Symptoms and signs associated with infection, with their time of evolution, specified in the study. RESULTS From 1005 eligible patients, 261 were included. After multivariable adjustment with a logistic regression model, the main factors for ICU admission or mortality were heart rate (OR 1.04 with 95% CI 1.04-3.7), respiratory rate (OR 1.19 with 95% CI 1.0-1.4) and capillary refill time (OR 3.4 with 95% CI 1.9-6.1). CONCLUSIONS Heart rate, respiratory rate, and capillary refill may behave as early predictors of ICU admission and mortality in cases of sepsis.
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Affiliation(s)
| | | | | | | | - J Ascuntar
- Gerente en Sistemas de Información en Salud, GRAEPIC (Grupo Académico de Epidemiología Clínica), Universidad de Antioquia, Medellín, Colombia
| | - F Jaimes
- Médico Internista, Epidemiólogo y Doctor en Epidemiologia en Enfermedad Infecciosas, GRAEPIC (Grupo Académico de Epidemiología Clínica), Departamento de Medicina Interna, Universidad de Antioquia, Medellín, Colombia.
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Sharma A, Elligsen M, Daneman N, Lam PW. Patient predictors of pathogenic versus commensal Gram-positive bacilli organisms isolated from blood cultures. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e245. [PMID: 38156236 PMCID: PMC10753492 DOI: 10.1017/ash.2023.506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/27/2023] [Accepted: 11/03/2023] [Indexed: 12/30/2023]
Abstract
Objective Gram-positive bacilli represent a diverse species of bacteria that range from commensal flora to pathogens implicated in severe and life-threatening infection. Following the isolation of Gram-positive bacilli from blood cultures, the time to species identification may take upward of 24 hours, leaving clinicians to conjecture whether they may represent a contaminant (inadvertent inoculation of commensal flora) or pathogenic organism. In this study, we sought to identify patient variables that could help predict the isolation of contaminant versus pathogenic Gram-positive bacilli from blood cultures. Design Retrospective cohort study. Settings One quaternary academic medical center affiliated with the University of Toronto. Patients Adult inpatients were admitted to hospital over a 5-year period (May 2014 to December 2019). Methods A total of 260 unique Gram-positive bacilli blood culture results from adult inpatients were reviewed and analyzed in both a univariable and multivariable model. Results Malignancy (aOR 2.78, 95% CI 1.33-5.91, p = 0.007), point increments in the Quick Sepsis Related Organ Failure Assessment score for sepsis (aOR 2.25, 95% CI 1.50-3.47, p < 0.001), peptic ulcer disease (aOR 5.63, 95% CI 1.43-21.0, p = 0.01), and the receipt of immunosuppression prior to a blood culture draw (aOR 3.80, 95% CI 1.86-8.01, p < 0.001) were associated with an increased likelihood of speciating pathogenic Gram-positive bacilli from blood cultures such as Clostridium species and Listeria monocytogenes. Conclusion Such predictors can help supplement a clinician's assessment on determining when empirical therapy is indicated when faced with Gram-positive bacilli from blood cultures and may direct future stewardship interventions for responsible antimicrobial prescribing.
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Affiliation(s)
- Arjun Sharma
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Marion Elligsen
- Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Nick Daneman
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Philip W. Lam
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Kim YJ, Kim JW, Lee KR, Hong DY, Park SO, Lee YH, Kim SY. The S-S.M.A.R.T: A New Prognostic Tool for Patients with Suspected Sepsis in the Emergency Department. Emerg Med Int 2023; 2023:8852135. [PMID: 37599813 PMCID: PMC10435300 DOI: 10.1155/2023/8852135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/11/2023] [Accepted: 07/28/2023] [Indexed: 08/22/2023] Open
Abstract
Background The sepsis screening tool is essential because it enables the rapid identification of high-risk patients and facilitates prompt treatment. Quick Sequential Organ Failure Assessment (qSOFA) is a widely used screening tool for sepsis. However, it has limitations in predicting patient prognosis. We developed the S-S.M.A.R.T (sepsis evaluation with shock index, mental status, age, and ROX index on triage) and aimed at evaluating it as a screening tool for patients with suspected sepsis in the emergency department. Methods We conducted a single-center retrospective chart review of patients with suspected sepsis in the emergency department. We compared the prognosis prediction abilities of the S-S.M.A.R.T and qSOFA scores in patients with suspected sepsis. The primary outcome was 7-day mortality, and the secondary outcomes included 30-day mortality and ICU admission. The receiver operating characteristic (ROC) curve analysis and the chi-square test were used. Results In total, 401 patients were enrolled. The mean age of the patients was 72.2 ± 15.6 years, and 213 (53.1%) of them were female. The S-S.M.A.R.T had superior predictive ability for prognosis of patients with suspected sepsis compared to qSOFA (area under the ROC curve (AUC) of 0.789 vs. 0.699; p=0.02 for 7-day mortality, AUC of 0.786 vs. 0.681; p < 0.001 for 30-day mortality, AUC 0.758 vs 0.717; p=0.05 for ICU admission). Conclusion The S-S.M.A.R.T can be useful in predicting the prognosis of patients with suspected sepsis in the emergency department.
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Affiliation(s)
- Ye Jin Kim
- Department of Emergency Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Jong Won Kim
- Department of Emergency Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
- Department of Emergency Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Kyeong Ryong Lee
- Department of Emergency Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
- Department of Emergency Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Dae Young Hong
- Department of Emergency Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
- Department of Emergency Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Sang O Park
- Department of Emergency Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
- Department of Emergency Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Young Hwan Lee
- Department of Emergency Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
- Department of Emergency Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Sin Young Kim
- Department of Emergency Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
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5
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Chen CH, Lien CJ, Huang YS, Ho YJ, Lin SY, Fan CY, Chen JW, Pei-Chuan Huang E, Sung CW. A simplified scoring model for predicting bacteremia in the unscheduled emergency department revisits: The SADFUL score. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2023; 56:793-801. [PMID: 37062621 DOI: 10.1016/j.jmii.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 03/29/2023] [Accepted: 04/01/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND Bacteremia is a severe complication of infectious disease. Patients with a high bacteremia risk in the emergency department (ED) but misidentified would lead to the unscheduled revisits. This study aimed to develop a simplified scoring model to predict bacteremia in patients with unscheduled ED revisits. METHODS Adult patients with unscheduled ED revisits within 72 h with a final diagnosis of infectious disease were retrospectively included. The development cohort included patients visiting the ED from January 1, 2019 to December 31, 2021. Internal validation was performed in patients visiting the ED from January 1, 2022 to March 31, 2022. Variables including demographics, pre-comorbidities, triage levels, vital signs, chief complaints, and laboratory data in the index visit were analyzed. Bacteremia was the primary outcome determined by blood culture in either index visits or revisits. RESULTS The SADFUL score for predicting bacteremia comprised the following predictors: "S"egmented neutrophil percentage (+3 points), "A"ge > 55 years (+1 point), "D"iabetes mellitus (+1 point), "F"ever (+2 points), "U"pper respiratory tract symptoms (-2 points), and "L"eukopenia (2 points). The area under receiver operating characteristic curve with 95% confidence interval in the development (1802 patients, 190 [11%] with bacteremia) and the validation cohort (134 patients, 17 [13%] with bacteremia) were 0.78 (0.74-0.81) and 0.79 (0.71-0.88), respectively. CONCLUSIONS The SADFUL score is a simplified useful tool for predicting bacteremia in patients with unscheduled ED revisits. The scoring model could help ED physicians decrease misidentification of patients at a high risk for bacteremia and potential complications.
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Affiliation(s)
- Chi-Hsin Chen
- Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Chun-Ju Lien
- Department of Medical Education, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Yu-Sheng Huang
- Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Yi-Ju Ho
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Shao-Yung Lin
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Cheng-Yi Fan
- Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Jiun-Wei Chen
- Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Edward Pei-Chuan Huang
- Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan; Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chih-Wei Sung
- Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan.
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Morita N, Hoshi M, Tezuka H, Ando T, Yoshida S, Sato F, Yokoi H, Ito H, Saito K. CD8+ Regulatory T Cells Induced by Lipopolysaccharide Improve Mouse Endotoxin Shock. Immunohorizons 2023; 7:353-363. [PMID: 37212786 PMCID: PMC10579971 DOI: 10.4049/immunohorizons.2200074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 05/03/2023] [Indexed: 05/23/2023] Open
Abstract
Sepsis is a systemic inflammatory disease caused by a bacterial infection that leads to severe mortality, especially in elderly patients, because of an excessive immune response and impaired regulatory functions. Antibiotic treatment is widely accepted as the first-line therapy for sepsis; however, its excessive use has led to the emergence of multidrug-resistant bacteria in patients with sepsis. Therefore, immunotherapy may be effective in treating sepsis. Although CD8+ regulatory T cells (Tregs) are known to have immunomodulatory effects in various inflammatory diseases, their role during sepsis remains unclear. In this study, we investigated the role of CD8+ Tregs in an LPS-induced endotoxic shock model in young (8-12 wk old) and aged (18-20 mo old) mice. The adoptive transfer of CD8+ Tregs into LPS-treated young mice improved the survival rate of LPS-induced endotoxic shock. Moreover, the number of CD8+ Tregs in LPS-treated young mice increased through the induction of IL-15 produced by CD11c+ cells. In contrast, LPS-treated aged mice showed a reduced induction of CD8+ Tregs owing to the limited production of IL-15. Furthermore, CD8+ Tregs induced by treatment with the rIL-15/IL-15Rα complex prevented LPS-induced body wight loss and tissue injury in aged mice. In this study, to our knowledge, the induction of CD8+ Tregs as novel immunotherapy or adjuvant therapy for endotoxic shock might reduce the uncontrolled immune response and ultimately improve the outcomes of endotoxic shock.
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Affiliation(s)
- Nanaka Morita
- Department of Disease Control and Prevention, Fujita Health University, Toyoake, Aichi, Japan
| | - Masato Hoshi
- Department of Disease Control and Prevention, Fujita Health University, Toyoake, Aichi, Japan
- Department of Informative Clinical Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Hiroyuki Tezuka
- Cellular Function Analysis, Research Promotion Headquarters, Fujita Health University, Toyoake, Aichi, Japan
| | - Tatsuya Ando
- Joint Research Laboratory of Clinical Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Sayaka Yoshida
- Department of Informative Clinical Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Fumiaki Sato
- Department of Informative Clinical Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Hiroyuki Yokoi
- Department of Informative Clinical Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Hiroyasu Ito
- Cellular Function Analysis, Research Promotion Headquarters, Fujita Health University, Toyoake, Aichi, Japan
| | - Kuniaki Saito
- Department of Disease Control and Prevention, Fujita Health University, Toyoake, Aichi, Japan
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Shappell C, Rhee C, Klompas M. Update on Sepsis Epidemiology in the Era of COVID-19. Semin Respir Crit Care Med 2023; 44:173-184. [PMID: 36646093 DOI: 10.1055/s-0042-1759880] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Timely and accurate data on the epidemiology of sepsis is essential to inform public policy, clinical practice, and research priorities. Recent studies have illuminated several ongoing questions about sepsis epidemiology, including the incidence and outcomes of sepsis in non-Western countries and in specialized populations such as surgical patients, patients with cancer, and the elderly. There have also been new insights into the limitations of current surveillance methods using administrative data and increasing experience tracking sepsis incidence and outcomes using "big data" approaches that take advantage of detailed electronic health record data. The COVID-19 pandemic, however, has fundamentally changed the landscape of sepsis epidemiology. It has increased sepsis rates, helped highlight ongoing controversies about how to define sepsis, and intensified debate about the possible unintended consequences of overly rigid sepsis care bundles. Despite these controversies, there is a growing consensus that severe COVID-19 causing organ dysfunction is appropriate to label as sepsis, even though it is treated very differently from bacterial sepsis, and that surveillance strategies need to be modified to reliably identify these cases to fully capture and delineate the current burden of sepsis. This review will summarize recent insights into the epidemiology of sepsis and highlight several urgent questions and priorities catalyzed by COVID-19.
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Affiliation(s)
- Claire Shappell
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Chanu Rhee
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Michael Klompas
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Colbert JF, Kirsch JM, Erzen CL, Langouët-Astrié CJ, Thompson GE, McMurtry SA, Kofonow JM, Robertson CE, Kovacs EJ, Sullivan RC, Hippensteel JA, Sawant NV, De Nisco NJ, McCollister BD, Schwartz RS, Horswill AR, Frank DN, Duerkop BA, Schmidt EP. Aging-associated augmentation of gut microbiome virulence capability drives sepsis severity. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.01.10.523523. [PMID: 36711447 PMCID: PMC9882086 DOI: 10.1101/2023.01.10.523523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Prior research has focused on host factors as mediators of exaggerated sepsis-associated morbidity and mortality in older adults. This focus on the host, however, has failed to identify therapies that improve sepsis outcomes in the elderly. We hypothesized that the increased susceptibility of the aging population to sepsis is not only a function of the host, but also reflects longevity-associated changes in the virulence of gut pathobionts. We utilized two complementary models of gut microbiota-induced experimental sepsis to establish the aged gut microbiome as a key pathophysiologic driver of heightened disease severity. Further murine and human investigations into these polymicrobial bacterial communities demonstrated that age was associated with only subtle shifts in ecological composition, but an overabundance of genomic virulence factors that have functional consequence on host immune evasion. One Sentence Summary The severity of sepsis in the aged host is in part mediated by longevity-associated increases in gut microbial virulence.
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9
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Michels EHA, Butler JM, Reijnders TDY, Cremer OL, Scicluna BP, Uhel F, Peters-Sengers H, Schultz MJ, Knight JC, van Vught LA, van der Poll T, Bos LDJ, Glas GJ, Hoogendijk AJ, van Hooijdonk RTM, Horn J, Huson MA, Schouten LRA, Straat M, Wieske L, Wiewel MA, Witteveen E, Bonten MJM, Cremer OM, Ong DSY, Frencken JF, Klouwenberg PMCK, Koster‐Brouwer ME, van de Groep K, Verboom DM. Association between age and the host response in critically ill patients with sepsis. Crit Care 2022; 26:385. [PMID: 36514130 PMCID: PMC9747080 DOI: 10.1186/s13054-022-04266-9] [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: 10/04/2022] [Accepted: 12/05/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The association of ageing with increased sepsis mortality is well established. Nonetheless, current investigations on the influence of age on host response aberrations are largely limited to plasma cytokine levels while neglecting other pathophysiological sepsis domains like endothelial cell activation and function, and coagulation activation. The primary objective of this study was to gain insight into the association of ageing with aberrations in key host response pathways and blood transcriptomes in sepsis. METHODS We analysed the clinical outcome (n = 1952), 16 plasma biomarkers providing insight in deregulation of specific pathophysiological domains (n = 899), and blood leukocyte transcriptomes (n = 488) of sepsis patients stratified according to age decades. Blood transcriptome results were validated in an independent sepsis cohort and compared with healthy individuals. RESULTS Older age was associated with increased mortality independent of comorbidities and disease severity. Ageing was associated with lower endothelial cell activation and dysfunction, and similar inflammation and coagulation activation, despite higher disease severity scores. Blood leukocytes of patients ≥ 70 years, compared to patients < 50 years, showed decreased expression of genes involved in cytokine signaling, and innate and adaptive immunity, and increased expression of genes involved in hemostasis and endothelial cell activation. The diminished expression of gene pathways related to innate immunity and cytokine signaling in subjects ≥ 70 years was sepsis-induced, as healthy subjects ≥ 70 years showed enhanced expression of these pathways compared to healthy individuals < 50 years. CONCLUSIONS This study provides novel evidence that older age is associated with relatively mitigated sepsis-induced endothelial cell activation and dysfunction, and a blood leukocyte transcriptome signature indicating impaired innate immune and cytokine signaling. These data suggest that age should be considered in patient selection in future sepsis trials targeting the immune system and/or the endothelial cell response.
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Affiliation(s)
- Erik H. A. Michels
- grid.7177.60000000084992262Center of Experimental and Molecular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands
| | - Joe M. Butler
- grid.7177.60000000084992262Center of Experimental and Molecular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands
| | - Tom D. Y. Reijnders
- grid.7177.60000000084992262Center of Experimental and Molecular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands
| | - Olaf L. Cremer
- grid.7692.a0000000090126352Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Brendon P. Scicluna
- grid.7177.60000000084992262Center of Experimental and Molecular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands ,grid.4462.40000 0001 2176 9482Department of Applied Biomedical Science, Faculty of Health Sciences, Mater Dei Hospital, University of Malta, Msida, Malta ,grid.4462.40000 0001 2176 9482Centre for Molecular Medicine and Biobanking, University of Malta, Msida, Malta
| | - Fabrice Uhel
- grid.7177.60000000084992262Center of Experimental and Molecular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands
| | - Hessel Peters-Sengers
- grid.7177.60000000084992262Center of Experimental and Molecular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands
| | - Marcus J. Schultz
- grid.7177.60000000084992262Department of Intensive Care, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands ,grid.10223.320000 0004 1937 0490Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand ,grid.4991.50000 0004 1936 8948Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Julian C. Knight
- grid.4991.50000 0004 1936 8948Nuffield Department of Medicine, University of Oxford, Oxford, UK ,grid.4991.50000 0004 1936 8948Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Lonneke A. van Vught
- grid.7177.60000000084992262Center of Experimental and Molecular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands ,grid.7177.60000000084992262Department of Intensive Care, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Tom van der Poll
- grid.7177.60000000084992262Center of Experimental and Molecular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands ,grid.7177.60000000084992262Division of Infectious Diseases, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
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10
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Lu J, Liu J, Zhu L, Zhang Y, Li A. The effect of age on the clinical characteristics and innate immune cell function in the patients with abdominal sepsis. Front Physiol 2022; 13:952434. [PMID: 36237524 PMCID: PMC9551265 DOI: 10.3389/fphys.2022.952434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/05/2022] [Indexed: 11/25/2022] Open
Abstract
Sepsis is a life-threatening dysregulated host response to infection that compromises organ health, and abdominal sepsis is a commonly presenting critical illness in intensive care units (ICU). In this study, we investigate the effect of age on clinical sepsis characteristics and innate immune cells (neutrophils and monocytes) functionality in abdominal sepsis patients. We recruited 32 patients with abdominal sepsis from the Beijing Ditan Hospital’s ICU from February 2021 to September 2021, and selected 18 healthy volunteers that were age- and sex-matched as controls for a prospective cohort study. Elderly abdominal sepsis patients (age >65 years) had the following altered characteristics compared to nonelderly patient controls: lower mean arterial pressure, monocytes percentage, and red blood cell volume distribution width (p < 0.05); higher neutrophils percentage and neutrophils-to-lymphocytes ratio (p < 0.05); significantly increased monocyte-produced reactive oxygen (p < 0.05); increases neutrophilic secretion of TNF-α, as well as lower monocytic secretion of TNF-α (p < 0.05); higher neutrophil percentage (which was significantly higher in peripheral blood than monocyte percentage). Elderly patients also had significantly increased phagocytic activity in their neutrophils and monocytes (p < 0.05), significantly reduced neutrophils-produced reactive oxygen (p < 0.001), and significantly increased TNF-α secretion by monocytes and neutrophils (p < 0.05). We found that elderly patients have decreased immune cell function and increased release of cytokines compared to younger patients, suggesting individualized treatment plans targeting the elderly septic microenvironment could help prevent organ failure in elderly septic patients and improves patient survival.
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Affiliation(s)
- Jiaqi Lu
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Jingyuan Liu
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Liuluan Zhu
- Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- National Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yue Zhang
- Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- National Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Ang Li
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- *Correspondence: Ang Li,
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11
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Rosenstrom E, Meshkinfam S, Ivy JS, Goodarzi SH, Capan M, Huddleston J, Romero-Brufau S. Optimizing the First Response to Sepsis: An Electronic Health Record-Based Markov Decision Process Model. DECISION ANALYSIS 2022. [DOI: 10.1287/deca.2022.0455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Sepsis is considered a medical emergency where delays in initial treatment are associated with increased morbidity and mortality, yet there is no gold standard for identifying sepsis onset and thus treatment timing. We leverage electronic health record (EHR) data with clinical expertise to develop a continuous-time Markov decision process (MDP) optimal stopping model that identifies the optimal first intervention action (anti-infective, fluid, or wait). To study the impact of initial treatment of patients at risk for developing sepsis, we define the delayed treatment population who received delayed treatment upon admission or during hospitalization and serves as an approximation of the natural history of sepsis. We apply the optimal first treatment policy to sample patient visits from the nondelayed treatment population. This analysis indicates the average risk of death could be reduced by approximately 2.2%, the average time until treatment could be reduced by 106 minutes, and the average severity of the treatment state could be reduced by 15.5% compared with the treatment they received in the hospital. We study the properties of the optimal policy to define an easily interpretable initial treatment heuristic that considers a patient’s organ dysfunction, location, and septic shock status. This generalizable framework can inform personalized treatment of patients at risk for sepsis.
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Affiliation(s)
- Erik Rosenstrom
- Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, North Carolina 27606
| | - Sareh Meshkinfam
- Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, North Carolina 27606
- Dynamic Ideas LLC, Waltham, Massachusetts 02452
| | - Julie Simmons Ivy
- Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, North Carolina 27606
| | - Shadi Hassani Goodarzi
- Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, North Carolina 27606
| | - Muge Capan
- Department of Mechanical and Industrial Engineering, University of Massachusetts Amherst, Amherst, Massachusetts 01003
| | - Jeanne Huddleston
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota 55902
| | - Santiago Romero-Brufau
- Department of Otolaryngology (ENT) / Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota 55902
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts 02115
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12
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Park EJ, Shimaoka M, Kiyono H. Functional Flexibility of Exosomes and MicroRNAs of Intestinal Epithelial Cells in Affecting Inflammation. Front Mol Biosci 2022; 9:854487. [PMID: 35647030 PMCID: PMC9130772 DOI: 10.3389/fmolb.2022.854487] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/13/2022] [Indexed: 12/13/2022] Open
Abstract
Intestinal epithelial cells (IECs) are a mucosal immune barrier essential to coordinate host–microbe crosstalk. Sepsis is a systemic inflammatory syndrome with dysfunction in multiple organs including the intestine whose epithelial barrier is deregulated. Thus, IECs are a main contributor to intestinal permeability and inflammation in sepsis. Exosomes emerge as a mediator of intercellular and inter-organic communications. Recently, IEC-derived exosomes and their cargoes, such as microRNAs (miRNAs), in sepsis were shown to regulate the expression of proinflammatory mediators in the inflamed gut tissues. It is a compelling hypothesis that these IEC exosomes exhibit their dynamic activity to deliver their functional miRNA cargoes to immune cells in local and distant organs to regulate proinflammatory responses and alleviate tissue injury. Also, epithelial tight junction (TJ) proteins are downregulated on gut inflammation. Some of the IEC miRNAs were reported to deteriorate the epithelial integrity by diminishing TJ expressions in intestines during sepsis and aging. Thus, it is worth revisiting and discussing the diverse functions of IEC exosomes and miRNAs in reshaping inflammations. This review includes both iterative and hypothetical statements based on current knowledge in this field.
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Affiliation(s)
- Eun Jeong Park
- Department of Molecular Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, Tsu, Japan
- *Correspondence: Eun Jeong Park,
| | - Motomu Shimaoka
- Department of Molecular Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hiroshi Kiyono
- Department of Mucosal Immunology, IMSUT Distinguished Professor Unit, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
- Division of Mucosal Vaccines, International Research and Development Center for Mucosal Vaccines, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
- Mucosal Immunology and Allergy Therapeutics, Institute for Global Prominent Research, Future Medicine Education and Research Organization, Chiba University, Chiba, Japan
- CU-UCSD Center for Mucosal Immunology, Allergy, and Vaccine (cMAV), Division of Gastroenterology, Department of Medicine, University of California, San Diego, CA, United States
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13
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Ohta R, Ikeda H, Kubota S, Sano C. Acute Cholecystitis in an Elderly Patient With Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: A Case Report. Cureus 2022; 14:e21877. [PMID: 35265413 PMCID: PMC8898073 DOI: 10.7759/cureus.21877] [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] [Accepted: 02/03/2022] [Indexed: 11/25/2022] Open
Abstract
A diagnosis of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis is difficult to establish in elderly patients. Herein, we report a case of acute cholecystitis mimicking sepsis in an elderly patient with ANCA-associated vasculitis. A 99-year-old woman was transferred to a rural community hospital on account of anorexia and hypotension; there, she was initially diagnosed with sepsis and treated accordingly. However, she developed new-onset right upper quadrant tenderness on indirect fist percussion of the liver, and Murphy’s sign was positive. While imaging did not reveal any findings suggestive of cholecystitis, the high index of suspicion for cholecystitis prompted an exploratory laparoscopy. Intraoperatively, the gallbladder wall was found to be inflamed, necessitating laparoscopic cholecystectomy. Histopathologic examination of the resected gallbladder showed neutrophilic infiltration and fibrinoid necrosis of the arterial walls. Perinuclear ANCA titers were elevated. These findings were consistent with a diagnosis of ANCA-associated vasculitis, and treatment with prednisolone markedly improved her condition. This case shows the difficulty encountered in differentiating between sepsis and ANCA-related vasculitis based on clinical features and relatively non-invasive diagnostic strategies alone. This study highlights the utility of invasive diagnostic procedures (e.g., biopsy) in elderly patients in whom a diagnosis of ANCA-associated vasculitis is difficult to establish.
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14
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Karcıoglu O, Yilmaz S, Kilic M, Suzer NE, Ozbay S, Tatlıparmak AC, Ayan M. Geriatric Sepsis in the COVID-19 Era: Challenges in Diagnosis and Management. INTERNATIONAL JOURNAL OF PHARMACEUTICAL RESEARCH AND ALLIED SCIENCES 2022. [DOI: 10.51847/leeequplat] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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15
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Kamalapathy PN, Vatani J, Raso J, Hassanzadeh H, Li X. How old is too old?: Matched analysis of geriatric patients undergoing anterior lumbar interbody fusion. Clin Neurol Neurosurg 2021; 212:107090. [PMID: 34922291 DOI: 10.1016/j.clineuro.2021.107090] [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: 10/28/2021] [Revised: 12/10/2021] [Accepted: 12/12/2021] [Indexed: 11/28/2022]
Abstract
STUDY DESIGN Retrospective Review INTRODUCTION/OBJECTIVE: The aim of this study is to utilize a national database to identify how age affects patient outcomes following anterior lumbar interbody fusion (ALIF). There are no established age guidelines for the geriatric population within the spine specialty, which makes patient selection challenging. Furthermore, there are conflicting studies for the risks of performing spine surgeries in the elderly. METHODS A retrospective review of the Mariner Claims Database was conducted on patients who underwent a single level ALIF (CPT 22558) between 2010 and 2018. Patients were separated into three groups by age: 50-64, 65-74, and 75-84 and matched with respect to gender, smoking, and comorbidity burden. Multivariable logistic regression was used to determine the independent effect of outpatient surgery on the postoperative outcomes after adjusting for demographic factors and pertinent comorbidities. Statistical significance was set at p < 0.05. RESULTS The study identified 8459 matched patients (3350 50-64; 3350 65-74; and 1759 75-84). Compared with patients aged 50-64, patients aged 65-74 and 75-84 had significantly increased risks of pneumonia (65-74: OR 1.53, 95% CI 1.06-2.24, p = 0.025; 75-84: OR 1.62, 95% CI 1.07-2.42, p = 0.022), sepsis (65-74: OR 2.20, 95% CI 1.36-3.76, p = 0.002; 75-84: OR 2.42, 95% CI 1.43-4.13, p = 0.001), and major complications (65-74: OR 1.35, 95% CI 1.05-1.74, p = 0.021; 75-84: OR 1.48, 95% CI 1.11-1.95, p = 0.006) (Table 2). There were no significant differences between patients aged 65-74 and 75-84 for risks of postoperative pneumonia, sepsis, and major complications (p > 0.05). There were no differences between any groups in terms of long-term outcomes such as pseudoarthrosis, implant related complications, or reoperation (p > 0.05) (Table 3). DISCUSSION/CONCLUSION The study showed that those older than 65 had a significant increase in risk of pneumonia, sepsis, and major complications following ALIF. In the two cohorts above the age of 65 (65-74 and 75-84) there was no significant differences in postoperative outcomes. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Pramod N Kamalapathy
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Jasmine Vatani
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Jon Raso
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Hamid Hassanzadeh
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Xudong Li
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA.
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16
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Dellinger RP, Levy MM, Schorr CA, Townsend SR. 50 Years of Sepsis Investigation/Enlightenment Among Adults-The Long and Winding Road. Crit Care Med 2021; 49:1606-1625. [PMID: 34342304 DOI: 10.1097/ccm.0000000000005203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- R Phillip Dellinger
- Cooper Medical School of Rowan University and Cooper University Health, Camden, NJ
| | | | - Christa A Schorr
- Cooper Medical School of Rowan University and Cooper University Health, Camden, NJ
| | - Sean R Townsend
- University of California Pacific Medical Center, (Sutter Health), San Francisco, CA
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17
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Denis M, Dupas T, Persello A, Dontaine J, Bultot L, Betus C, Pelé T, Dhot J, Erraud A, Maillard A, Montnach J, Leroux AA, Bigot-Corbel E, Vertommen D, Rivière M, Lebreton J, Tessier A, Waard MD, Bertrand L, Rozec B, Lauzier B. An O-GlcNAcylomic Approach Reveals ACLY as a Potential Target in Sepsis in the Young Rat. Int J Mol Sci 2021; 22:ijms22179236. [PMID: 34502162 PMCID: PMC8430499 DOI: 10.3390/ijms22179236] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/18/2021] [Accepted: 08/24/2021] [Indexed: 12/12/2022] Open
Abstract
Sepsis in the young population, which is particularly at risk, is rarely studied. O-GlcNAcylation is a post-translational modification involved in cell survival, stress response and metabolic regulation. O-GlcNAc stimulation is beneficial in adult septic rats. This modification is physiologically higher in the young rat, potentially limiting the therapeutic potential of O-GlcNAc stimulation in young septic rats. The aim is to evaluate whether O-GlcNAc stimulation can improve sepsis outcome in young rats. Endotoxemic challenge was induced in 28-day-old rats by lipopolysaccharide injection (E. Coli O111:B4, 20 mg·kg−1) and compared to control rats (NaCl 0.9%). One hour after lipopolysaccharide injection, rats were randomly assigned to no therapy, fluidotherapy (NaCl 0.9%, 10 mL·kg−1) ± NButGT (10 mg·kg−1) to increase O-GlcNAcylation levels. Physiological parameters and plasmatic markers were evaluated 2h later. Finally, untargeted mass spectrometry was performed to map cardiac O-GlcNAcylated proteins. Lipopolysaccharide injection induced shock with a decrease in mean arterial pressure and alteration of biological parameters (p < 0.05). NButGT, contrary to fluidotherapy, was associated with an improvement of arterial pressure (p < 0.05). ATP citrate lyase was identified among the O-GlcNAcylated proteins. In conclusion, O-GlcNAc stimulation improves outcomes in young septic rats. Interestingly, identified O-GlcNAcylated proteins are mainly involved in cellular metabolism.
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Affiliation(s)
- Manon Denis
- Université de Nantes, CHU Nantes, CNRS, INSERM, l’Institut du Thorax, F-44000 Nantes, France; (M.D.); (T.D.); (A.P.); (C.B.); (T.P.); (J.D.); (A.E.); (A.M.); (J.M.); (A.A.L.); (M.D.W.); (B.R.)
- Pediatric Intensive Care Unit, CHU de Nantes, F-44000 Nantes, France
| | - Thomas Dupas
- Université de Nantes, CHU Nantes, CNRS, INSERM, l’Institut du Thorax, F-44000 Nantes, France; (M.D.); (T.D.); (A.P.); (C.B.); (T.P.); (J.D.); (A.E.); (A.M.); (J.M.); (A.A.L.); (M.D.W.); (B.R.)
| | - Antoine Persello
- Université de Nantes, CHU Nantes, CNRS, INSERM, l’Institut du Thorax, F-44000 Nantes, France; (M.D.); (T.D.); (A.P.); (C.B.); (T.P.); (J.D.); (A.E.); (A.M.); (J.M.); (A.A.L.); (M.D.W.); (B.R.)
- InFlectis BioScience, F-44000 Nantes, France
| | - Justine Dontaine
- Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Pôle of Cardiovascular Research, B-1200 Brussels, Belgium; (J.D.); (L.B.); (L.B.)
| | - Laurent Bultot
- Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Pôle of Cardiovascular Research, B-1200 Brussels, Belgium; (J.D.); (L.B.); (L.B.)
| | - Charlotte Betus
- Université de Nantes, CHU Nantes, CNRS, INSERM, l’Institut du Thorax, F-44000 Nantes, France; (M.D.); (T.D.); (A.P.); (C.B.); (T.P.); (J.D.); (A.E.); (A.M.); (J.M.); (A.A.L.); (M.D.W.); (B.R.)
| | - Thomas Pelé
- Université de Nantes, CHU Nantes, CNRS, INSERM, l’Institut du Thorax, F-44000 Nantes, France; (M.D.); (T.D.); (A.P.); (C.B.); (T.P.); (J.D.); (A.E.); (A.M.); (J.M.); (A.A.L.); (M.D.W.); (B.R.)
| | - Justine Dhot
- Université de Nantes, CHU Nantes, CNRS, INSERM, l’Institut du Thorax, F-44000 Nantes, France; (M.D.); (T.D.); (A.P.); (C.B.); (T.P.); (J.D.); (A.E.); (A.M.); (J.M.); (A.A.L.); (M.D.W.); (B.R.)
- Sanofi R&D, 1 Avenue Pierre Brossolette, F-44000 Chilly Mazarin, France
| | - Angélique Erraud
- Université de Nantes, CHU Nantes, CNRS, INSERM, l’Institut du Thorax, F-44000 Nantes, France; (M.D.); (T.D.); (A.P.); (C.B.); (T.P.); (J.D.); (A.E.); (A.M.); (J.M.); (A.A.L.); (M.D.W.); (B.R.)
| | - Anaïs Maillard
- Université de Nantes, CHU Nantes, CNRS, INSERM, l’Institut du Thorax, F-44000 Nantes, France; (M.D.); (T.D.); (A.P.); (C.B.); (T.P.); (J.D.); (A.E.); (A.M.); (J.M.); (A.A.L.); (M.D.W.); (B.R.)
| | - Jérôme Montnach
- Université de Nantes, CHU Nantes, CNRS, INSERM, l’Institut du Thorax, F-44000 Nantes, France; (M.D.); (T.D.); (A.P.); (C.B.); (T.P.); (J.D.); (A.E.); (A.M.); (J.M.); (A.A.L.); (M.D.W.); (B.R.)
| | - Aurélia A. Leroux
- Université de Nantes, CHU Nantes, CNRS, INSERM, l’Institut du Thorax, F-44000 Nantes, France; (M.D.); (T.D.); (A.P.); (C.B.); (T.P.); (J.D.); (A.E.); (A.M.); (J.M.); (A.A.L.); (M.D.W.); (B.R.)
- University Animal Hospital, Oniris Ecole Nationale Vétérinaire, Agroalimentaire et de l’Alimentation Nantes Atlantique, F-44000 Nantes, France
| | | | - Didier Vertommen
- Université Catholique de Louvain, de Duve Institute, Mass Spectrometry Platform, B-1200 Brussels, Belgium;
| | - Matthieu Rivière
- Université de Nantes, CNRS, Chimie et Interdisciplinarité: Synthèse, Analyse, Modélisation (CEISAM), UMR CNRS 6230, Faculté des Sciences et des Techniques, F-44000 Nantes, France; (M.R.); (J.L.); (A.T.)
| | - Jacques Lebreton
- Université de Nantes, CNRS, Chimie et Interdisciplinarité: Synthèse, Analyse, Modélisation (CEISAM), UMR CNRS 6230, Faculté des Sciences et des Techniques, F-44000 Nantes, France; (M.R.); (J.L.); (A.T.)
| | - Arnaud Tessier
- Université de Nantes, CNRS, Chimie et Interdisciplinarité: Synthèse, Analyse, Modélisation (CEISAM), UMR CNRS 6230, Faculté des Sciences et des Techniques, F-44000 Nantes, France; (M.R.); (J.L.); (A.T.)
| | - Michel De Waard
- Université de Nantes, CHU Nantes, CNRS, INSERM, l’Institut du Thorax, F-44000 Nantes, France; (M.D.); (T.D.); (A.P.); (C.B.); (T.P.); (J.D.); (A.E.); (A.M.); (J.M.); (A.A.L.); (M.D.W.); (B.R.)
| | - Luc Bertrand
- Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Pôle of Cardiovascular Research, B-1200 Brussels, Belgium; (J.D.); (L.B.); (L.B.)
- WELBIO, B-1200 Brussels, Belgium
| | - Bertrand Rozec
- Université de Nantes, CHU Nantes, CNRS, INSERM, l’Institut du Thorax, F-44000 Nantes, France; (M.D.); (T.D.); (A.P.); (C.B.); (T.P.); (J.D.); (A.E.); (A.M.); (J.M.); (A.A.L.); (M.D.W.); (B.R.)
| | - Benjamin Lauzier
- Université de Nantes, CHU Nantes, CNRS, INSERM, l’Institut du Thorax, F-44000 Nantes, France; (M.D.); (T.D.); (A.P.); (C.B.); (T.P.); (J.D.); (A.E.); (A.M.); (J.M.); (A.A.L.); (M.D.W.); (B.R.)
- Correspondence: E-mail: ; Tel.: +33-2-28-08-01-57
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18
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Chronic kidney disease patients with intertrochanteric fracture have a high mortality rate. Injury 2021; 52:2350-2355. [PMID: 34134855 DOI: 10.1016/j.injury.2021.05.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 05/21/2021] [Accepted: 05/28/2021] [Indexed: 02/02/2023]
Abstract
AIMS The prognosis of patients with chronic kidney disease (CKD) and intertrochanteric fractures is unclear. This study was aimed to analyze the mortality and complication rates among CKD patients with intertrochanteric femoral fractures and the risk factors of one-year mortality after surgery. PATIENTS AND METHODS This retrospective cohort study included 49 patients diagnosed with grades III, IV, or V CKD who were surgically treated for an intertrochanteric fracture between January 2011 and February 2019 at a tertiary university hospital. Preoperative parameters, including age, gender, bone mineral density, follow-up period (mean: 8.6 months range: 1~82 months), underlying disease, American Society of Anesthesiologists classification, fracture classification, and grade of CKD were identified, and complications and mortality rates after surgery were examined. The patients were divided into two groups according to whether one-year mortality after surgery had occurred or not, and a logistic regression analysis was performed to analyze the risk factors of mortality. RESULTS Of the 49 total patients, 16 died <1 year postoperatively. Pneumonia (n = 11) was the most common postoperative complication. Twenty-one patients died during the follow-up period. Significant differences in gender (p = 0.006) and grade of CKD (p = 0.022) distributions were found between the two groups, divided according to whether one-year mortality had occurred or not. In a univariate analysis, CKD grade and postoperative septic shock were highly associated with one-year mortality. In a multivariate analysis, septic shock, acute kidney injury, and CKD grade were identified as the risk factors of one-year mortality. CONCLUSION The mortality and complication rates were high among the CKD patients with intertrochanteric fractures. Grades of CKD significantly correlated with one-year mortality after surgery; therefore, they and an important factor that must be considered when developing a strategy to improve the postoperative survival rate of patients with CKD.
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Forget MF, Del Degan S, Leblanc J, Tannous R, Desjardins M, Durand M, Vu TTM, Nguyen QD, Desmarais P. Delirium and Inflammation in Older Adults Hospitalized for COVID-19: A Cohort Study. Clin Interv Aging 2021; 16:1223-1230. [PMID: 34234422 PMCID: PMC8242147 DOI: 10.2147/cia.s315405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/10/2021] [Indexed: 01/08/2023] Open
Abstract
Purpose The occurrence and predictors of delirium in older adults hospitalized for coronavirus disease 2019 (COVID-19) have not been well described. Highlighting the association with inflammatory markers may be useful for identifying delirium. This study aimed to determine the prevalence and incidence of delirium and explore its association with the C-reactive protein (CRP). Patients and Methods This cohort study of adults aged 65 and older with a COVID-19 diagnosis took place at an academic healthcare institution between April and May 2020. COVID-19 was diagnosed by positive nasopharyngeal swab. Serum levels of CRP were collected as a marker of systemic inflammation. The primary outcome was the prevalence and incidence of delirium. Delirium was diagnosed primarily during a patient's stay in hospital based on the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5). To ensure that no delirium diagnosis was missed during hospital stay, clinical records were reviewed by clinicians with geriatric medicine training for retrospective diagnoses. Results A total of 127 patients aged 65 and older were hospitalized with a diagnosis of COVID-19. The median age was 82 years (IQR: 74–88), with 54 (43%) females. Overall, delirium was present in 62 (49%) patients: manifestations of delirium were present on the first day of hospitalization in 53 of these cases (86%), while 9 cases (14%) developed delirium during hospitalization. After controlling for age and sex, the mean CRP value over the first 3 days since arrival was associated with a higher risk of delirium (OR 1.35; 95% CI: 1.01–1.85) for every 50 mg/L increase. Conclusion In this cohort of older adults hospitalized for COVID-19, delirium was highly prevalent. An early increase in CRP levels should raise suspicion about the occurrence of delirium and could improve its diagnosis.
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Affiliation(s)
- Marie-France Forget
- Department of Medicine, Division of Geriatrics, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Sophie Del Degan
- Department of Medicine, Division of Geriatrics, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Julie Leblanc
- Department of Medicine, Division of Geriatrics, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Rita Tannous
- Department of Medicine, Division of Geriatrics, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Michaël Desjardins
- Department of Medicine, Division of Infectious Disease, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Madeleine Durand
- Department of Medicine, Division of Internal Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.,Innovation Hub, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Thien Tuong Minh Vu
- Department of Medicine, Division of Geriatrics, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.,Department of Neurosciences, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Quoc Dinh Nguyen
- Department of Medicine, Division of Geriatrics, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.,Innovation Hub, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Philippe Desmarais
- Department of Medicine, Division of Geriatrics, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.,Department of Neurosciences, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
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20
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Stiehl JB. Bacterial Autofluorescence Digital Imaging Guides Treatment in Stage 4 Pelvic Pressure Injuries: A Preliminary Case Series. Diagnostics (Basel) 2021; 11:839. [PMID: 34066962 PMCID: PMC8148547 DOI: 10.3390/diagnostics11050839] [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] [Received: 03/21/2021] [Revised: 05/06/2021] [Accepted: 05/06/2021] [Indexed: 02/06/2023] Open
Abstract
Pelvic pressure injuries in long-term care facilities are at high risk for undetected infection and complications from bacterial contamination and stalling of wound healing. Contemporary wound healing methods must address this problem with mechanical debridement, wound irrigation, and balanced dressings that reduce bacterial burden to enable the normal healing process. This study evaluated the impact of bacterial autofluorescence imaging to indicate wound bacterial contamination and guide treatment for severe stage 4 pelvic pressure injuries. A handheld digital imaging system was used to perform bacterial autofluorescence imaging in darkness on five elderly, high-risk, long-term care patients with advanced stage 4 pelvic pressure injuries who were being treated for significant bacterial contamination. The prescient findings of bacterial autofluorescence imaging instigated treatment strategies and enabled close monitoring of the treatment efficacy to ameliorate the bacterial contamination. Wound sepsis recurrence, adequate wound cleansing, and diagnosis of underlying periprosthetic total joint infection were confirmed with autofluorescence imaging showing regions of high bacterial load. By providing objective information at the point of care, imaging improved understanding of the bacterial infections and guided treatment strategies.
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21
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Devia Jaramillo G, Ibáñez Pinilla M. Quick Sequential Organ Failure Assessment, Sequential Organ Failure Assessment, and Procalcitonin for Early Diagnosis and Prediction of Death in Elderly Patients with Suspicion of Sepsis in the Emergency Department, Based on Sepsis-3 Definition. Gerontology 2021; 68:171-180. [PMID: 33951628 DOI: 10.1159/000515851] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 03/15/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Sepsis is a disease with a high mortality rate without prompt treatment. However, this entity is difficult to diagnose in the elderly population in the emergency room; for this reason, it is necessary to have diagnostic tools for early detection. OBJECTIVE The aim of the study was to determine the highest diagnostic yield of procalcitonin (PCT), Quick Sequential Organ Failure Assessment (qSOFA), and Sequential Organ Failure Assessment (SOFA) for sepsis (based on the sepsis-3 consensus), on admission at the emergency department, in those older than 65 years. METHODS This is a diagnostic test study of a historical cohort of 65-year-old patients with suspected sepsis. RESULTS In the sample of 179 patients, 53.6% had confirmed sepsis. Significant differences were found (p < 0.0001), with a greater diagnostic and predictive capacity of PCT for the diagnosis of sepsis (receiver operating characteristics curve area [area under the curve (AUC) = 0.883, 95% CI: 0.835-0.931] than qSOFA (AUC = 0.559, 95% CI: 0.485-0.663) and SOFA (AUC = 0.662, 95% CI: 0.584-0.739); these results were similar in the cohort of patients ≥75 years. In positive PCT(≥0.5 ng/mL), the sensitivity was 71.8% (95% CI: 62.36-81.39), specificity of 89.1% (95% CI: 81.87-96.45%), V+ 88.4% (95% CI: 80.73-96.19%), V- of 73.2% (95% CI: 64.14-82.39%), positive likelihood ratio of 6.63 (95% CI: 3.53-12.44), and negative likelihood ratio of 0.32 (95% CI: 0.23-0.44); these results were similar in the cohort of patients ≥75 years. Lactate ≥2 mmol/L (RR = 1.659 [95% CI: 1.002-2.747]) and PCT ≥0.5 ng/mL (RR = 1.942 [95% CI: 1.157-3.261]) showed a significant association with in-hospital mortality. CONCLUSION In the elderly population with suspicion of infection on admission to the emergency department, qSOFA presents a low diagnostic performance of confirmed sepsis and in-hospital mortality, for which other tools with higher diagnostic and prognostic performance should be added, such as PCT and lactate.
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Affiliation(s)
- German Devia Jaramillo
- Hospital Universitario Mayor Méderi, Bogotá, Colombia.,Instructor Assistant, Department of Emergency Medicine-Internal Medicine, Universidad del Rosario, Bogotá, Colombia
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22
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Bloodstream infections in the elderly: what is the real goal? Aging Clin Exp Res 2021; 33:1101-1112. [PMID: 31486996 DOI: 10.1007/s40520-019-01337-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 08/22/2019] [Indexed: 12/13/2022]
Abstract
Bloodstream infections (BSI) represent a serious bacterial infection with substantial morbidity and mortality. Population-based studies demonstrate an increased incidence, especially among elderly patients. Controversy exists regarding whether presentation of BSI are different in older patients compared to younger patients; our narrative review of the literature suggests that BSI in elderly patients would probably include one or more of the traditional symptoms/signs of fever, severe sepsis or septic shock, acute kidney injury, and/or leukocytosis. Sources of BSI in older adults are most commonly the urinary tract (more so than in younger adults) and the respiratory tract. Gram-negative bacteria are the most common isolates in the old (~ 40-60% of BSI); isolates from the elderly patient population show higher antibiotic resistance rates, with long-term care facilities serving as reservoirs for multidrug-resistant bacteria. BSI entail significantly higher rates of mortality in older age, both short and long term. Some of the risk factors for mortality are modifiable, such as the appropriateness of empirical antibiotic therapy and nosocomial acquisition of infection. Health-related quality of life issues regarding the elderly patient with BSI are not well addressed in the literature. Utilization of comprehensive geriatric assessment and comprehensive geriatric discharge planning need to be investigated further in this setting and might serve as key for improved results in this population. In this review, we address all these aspects of BSI in old patients with emphasis on future goals for management and research.
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23
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He W, Xiao K, Fang M, Xie L. Immune Cell Number, Phenotype, and Function in the Elderly with Sepsis. Aging Dis 2021; 12:277-296. [PMID: 33532141 PMCID: PMC7801284 DOI: 10.14336/ad.2020.0627] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/27/2020] [Indexed: 12/12/2022] Open
Abstract
Sepsis is a form of life-threatening organ dysfunction caused by dysregulated host responses to an infection that can be partly attributed to immune dysfunction. Although sepsis affects patients of all ages, elderly individuals display increased susceptibility and mortality. This is partly due to immunosenescence, a decline in normal immune system function associated with physiological aging that affects almost all cell types in the innate and adaptive immune systems. In elderly patients with sepsis, these alterations in immune cells such as endothelial cells, neutrophils, monocytes, macrophages, natural killer cells, dendritic cells, T lymphocytes, and B lymphocytes, are largely responsible for their poor prognosis and increased mortality. Here, we review recent studies investigating the events affecting both innate and adaptive immune cells in elderly mice and patients with sepsis, including alterations in their number, phenotype, and function, to shed light on possible new therapeutic strategies.
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Affiliation(s)
- Wanxue He
- 1College of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, China
| | - Kun Xiao
- 1College of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, China
| | - Min Fang
- 2Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Lixin Xie
- 1College of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, China
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24
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Jiménez-Zarazúa O, González-Carrillo PL, Vélez-Ramírez LN, Alcocer-León M, Salceda-Muñoz PAT, Palomares-Anda P, Nava-Quirino OA, Escalante-Martínez N, Sánchez-Guzmán S, Mondragón JD. Survival in septic shock associated with thrombocytopenia. Heart Lung 2020; 50:268-276. [PMID: 33373942 DOI: 10.1016/j.hrtlng.2020.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 12/07/2020] [Accepted: 12/15/2020] [Indexed: 11/26/2022]
Affiliation(s)
- O Jiménez-Zarazúa
- Department of Medicine and Nutrition, Universidad de Guanajuato, Mexico; Department of Internal Medicine, Hospital General León, Mexico
| | | | - L N Vélez-Ramírez
- Department of Medicine and Nutrition, Universidad de Guanajuato, Mexico; Department of Radiology, Hospital General León, Mexico
| | - M Alcocer-León
- Department of Medicine and Nutrition, Universidad de Guanajuato, Mexico; Department of Internal Medicine, Hospital Regional ISSSTE León, Mexico
| | | | | | - O A Nava-Quirino
- Department of Medicine and Nutrition, Universidad de Guanajuato, Mexico; Department of Internal Medicine, Hospital UMAE No. 1 Centro Médico del Bajío León, Mexico
| | | | - S Sánchez-Guzmán
- School of Medicine, Universidad del Valle de México-Campus Querétaro, Mexico
| | - J D Mondragón
- Department of Neurology, University of Groningen, University Medical Center Groningen, the Netherlands; Alzheimer Center Groningen, University of Groningen, University Medical Center Groningen, the Netherlands.
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25
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Isik AT. Covid-19 Infection in Older Adults: A Geriatrician's Perspective. Clin Interv Aging 2020; 15:1067-1069. [PMID: 32753857 PMCID: PMC7351627 DOI: 10.2147/cia.s260972] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 06/26/2020] [Indexed: 12/15/2022] Open
Abstract
The pandemic of the Covid-19 virus has become the main issue all over the world. In its current form, the disease is more severe in geriatric cases and individuals with chronic disease, even causing death. In older adults and atypical presentations, testing strategies for Covid-19, potential drug interactions of experimental Covid-19 therapies, and ageism are important issues in the course of the disease. Therefore, health-care professionals should be aware of these, and screening policies for Covid-19 should also include atypical presentations with or without classical symptoms of the illness in older adults. Furthermore, evaluation of individuals > 65 years of age from a geriatrician's perspective is very important, because Covid-19 is severe and fatal in seniors.
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Affiliation(s)
- Ahmet Turan Isik
- Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Balcova, Izmir, Turkey
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26
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Bal AM, Palchaudhuri M. Candidaemia in the elderly: Epidemiology, management and adherence to the European Confederation of Medical Mycology quality indicators. Mycoses 2020; 63:892-899. [DOI: 10.1111/myc.13134] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/07/2020] [Accepted: 06/11/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Abhijit M. Bal
- Department of Microbiology University Hospital Crosshouse Kilmarnock UK
| | - Mihir Palchaudhuri
- Department of Care of the Elderly University Hospital Crosshouse Kilmarnock UK
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27
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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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28
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Hsiao CY, Chen TH, Lee YC, Hsiao MC, Hung PH, Wang MC. Risk factors for uroseptic shock in hospitalized patients aged over 80 years with urinary tract infection. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:477. [PMID: 32395521 PMCID: PMC7210120 DOI: 10.21037/atm.2020.03.95] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background The purpose of this study was to compare clinical characteristics and outcomes in individuals of different age groups with urinary tract infection (UTI), and to identify the relationships among advanced age and uroseptic shock. Methods This retrospective study compared clinical characteristics and outcomes in patients in different age groups with UTI and identified relationships between advanced age and uroseptic shock among hospitalized patients with UTI in an acute hospital care setting from January 2006 to October 2018. Patients were divided into young (age below 65 years), old (65–80 years), and very old (above 80 years) groups. Results Of 1,043 participants, 269 (25.8%) were very old and 200 (19.2%) developed uroseptic shock. Very old age [odds ratio (OR) 1.99, 95% confidence interval (CI): 1.25–3.19, P=0.004], male (OR 1.54, 95% CI: 1.07–2.24, P=0.022), presented flank pain (OR 1.54, 95% CI: 1.05–2.24, P=0.025), congestive heart failure (CHF) (OR 2.54, 95% CI: 1.27–5.06, P=0.008), acute kidney injury (AKI) (OR 4.19, 95% CI: 2.78–6.30, P<0.001), bacteremia (OR 1.78, 95% CI: 1.25–2.53, P=0.001), and multiple drug-resistant (MDR) bacteria (OR 1.43, 95% CI: 1.02–2.00, P=0.039) were associated with an increased risk of uroseptic shock in patients with UTI. In very old patients with UTI, bacteremia (OR 2.54, 95% CI: 1.38–4.69, P=0.003) and AKI (OR 4.37, 95% CI: 2.15–8.90, P<0.001) were independently associated with uroseptic shock. Conclusions Very old patients with UTI had a higher risk of developing uroseptic shock than younger patients. Bacteremia was an independent risk factor for uroseptic shock in very old patients with UTI.
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Affiliation(s)
- Chih-Yen Hsiao
- Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi.,Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan
| | - Tsung-Hsien Chen
- Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi
| | - Yi-Chien Lee
- Department of Internal Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei.,School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei
| | - Meng-Chang Hsiao
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - Peir-Haur Hung
- Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi.,Department of Applied Life Science and Health, Chia Nan University of Pharmacy and Science, Tainan
| | - Ming-Cheng Wang
- Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
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29
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Rhee C, Klompas M. Sepsis trends: increasing incidence and decreasing mortality, or changing denominator? J Thorac Dis 2020; 12:S89-S100. [PMID: 32148931 DOI: 10.21037/jtd.2019.12.51] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Numerous studies suggest that the incidence of sepsis has been steadily increasing over the past several decades while mortality rates are falling. However, reliably assessing trends in sepsis epidemiology is challenging due to changing diagnosis and coding practices over time. Ongoing efforts by clinicians, administrators, policy makers, and patient advocates to increase sepsis awareness, screening, and recognition are leading to more patients being labeled with sepsis. Subjective clinical definitions and heterogeneous presentations also allow for wide discretion in diagnosing sepsis rather than specific infections alone or non-specific syndromes. These factors create a potential ascertainment bias whereby the inclusion of less severely ill patients in sepsis case counts over time leads to a perceived increase in sepsis incidence and decrease in sepsis mortality rates. Analyses that rely on administrative data alone are further confounded by changing coding practices in response to new policies, financial incentives, and efforts to improve documentation. An alternate strategy for measuring sepsis incidence, outcomes, and trends is to use objective and consistent clinical criteria rather than administrative codes or registries to identify sepsis. This is feasible using data routinely found in electronic health record systems, such as blood culture draws and sustained courses of antibiotics to identify infection and laboratory values, vasopressors, and mechanical ventilation to measure acute organ dysfunction. Recent surveillance studies using this approach suggest that sepsis incidence and mortality rates have been essentially stable over the past decade. In this review, we summarize the major epidemiologic studies of sepsis trends, potential biases in these analyses, and the recent change in the surveillance paradigm toward using objective clinical data from electronic health records to more accurately characterize sepsis trends.
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Affiliation(s)
- Chanu Rhee
- Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA, USA.,Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA
| | - Michael Klompas
- Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA, USA.,Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA
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30
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Yao Y, Xu K, Sun Y, Tian T, Shen W, Sun F, Yuan W, Wu H, Chen G, Yuan L, Zhang W, Lu M, Lei M. MiR-215-5p inhibits the inflammation injury in septic H9c2 by regulating ILF3 and LRRFIP1. Int Immunopharmacol 2019; 78:106000. [PMID: 31806569 DOI: 10.1016/j.intimp.2019.106000] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 10/21/2019] [Accepted: 10/22/2019] [Indexed: 12/19/2022]
Abstract
MicroRNAs (miRNAs) are small non-coding RNAs (ncRNAs) playing crucial roles in sepsis-induced diseases, including myocardial inflammation. Nevertheless, the expression pattern and role of miR-215-5p in myocardial inflammation are still un-investigated up to now. The purpose of our study is to further inquire the effect of miR-215-5p on lipopolysaccharide (LPS)-activated inflammation injury in H9c2 cells and the possibly associated mechanisms. First of all, LPS-induced H9c2 cells models were constructed and affirmed via detection of pro-inflammatory factors, the viability and apoptosis. MiR-215-5p was overtly down-regulated in LPS-treated H9c2 cells and miR-215-5p overexpression could suppress the inflammation injury. LRRFIP1 was proved to be the target gene of miR-215-5p and meanwhile, miR-215-5p also targeted ILF3 that experimented to bind to and stabilize LRRFIP1. Final rescue assays confirmed that the overexpression of LRRFIP1 or ILF3 rescued the repressive effect of miR-215-5p up-regulation on the inflammation injury in septic H9c2. Totally, miR-215-5p exerted protective function in the inflammation injury in septic H9c2 via targeting ILF3 and LRRFIP1, suggesting an additional treatment method for sepsis-activated myocardial inflammation.
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Affiliation(s)
- Yulong Yao
- Intensive Care Department, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, NO.358, Datong Road, Pudong New District, Shanghai 200137, China
| | - Kailiang Xu
- Intensive Care Department, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, NO.358, Datong Road, Pudong New District, Shanghai 200137, China
| | - Yuxia Sun
- Intensive Care Department, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, NO.358, Datong Road, Pudong New District, Shanghai 200137, China
| | - Tianyu Tian
- Trauma Emergency Center, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, NO.358, Datong Road, Pudong New District, Shanghai 200137, China
| | - Weihong Shen
- Intensive Care Department, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, NO.358, Datong Road, Pudong New District, Shanghai 200137, China
| | - Fangyuan Sun
- Intensive Care Department, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, NO.358, Datong Road, Pudong New District, Shanghai 200137, China
| | - Weifang Yuan
- Intensive Care Department, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, NO.358, Datong Road, Pudong New District, Shanghai 200137, China
| | - Hao Wu
- Trauma Emergency Center, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, NO.358, Datong Road, Pudong New District, Shanghai 200137, China
| | - Gang Chen
- Intensive Care Department, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, NO.358, Datong Road, Pudong New District, Shanghai 200137, China
| | - Lin Yuan
- Intensive Care Department, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, NO.358, Datong Road, Pudong New District, Shanghai 200137, China
| | - Wei Zhang
- Trauma Emergency Center, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, NO.358, Datong Road, Pudong New District, Shanghai 200137, China
| | - Ming Lu
- Trauma Emergency Center, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, NO.358, Datong Road, Pudong New District, Shanghai 200137, China.
| | - Ming Lei
- Intensive Care Department, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, NO.358, Datong Road, Pudong New District, Shanghai 200137, China.
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Abstract
OBJECTIVE We aimed to compare the sepsis incidence, mortality rates, and primary sites of infection among adult, elderly, and octogenarian patients with sepsis. DESIGN Population-based cohort study. SETTING The entire health insurance claims data of Taiwan, which enrolled 99.8% of the 23 million Taiwanese population. PATIENTS Sepsis patients were identified by International Classification of Diseases, 9th Edition, Clinical Modification codes for both infection and organ dysfunction from January 1, 2002, to December 31, 2012. Patients were categorized into three age groups: 1) adults (18-64 yr); 2) elderly (65-84 yr); and 3) oldest old (≥ 85 yr). The 30-day all-cause mortality was verified by a linked national death certificate database. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS From 2002 to 2012, we identified 1,259,578 patients with sepsis, of which 417,328 (33.1%) were adults, 652,618 (51.8%) were elderly, and 189,632 (15.1%) were oldest old. We determined that the incidence of sepsis in the oldest old was 9,414 cases per 100,000 population on 2012, which was 31-fold greater than the adult incidence (303 cases per 100,000 population) and three-fold greater than the elderly incidence (2,908 cases per 100,000 population). Despite the increasing trend in incidence, the mortality decreased by 34% for adults, 24% for elderly, and 22% for oldest old. However, systemic fungal infection was disproportionately increased in oldest old patients (1.76% annual increase) and the elderly patients (1.00% annual increase). CONCLUSION The incidence of sepsis is disproportionately increased in elderly and oldest old patients. Despite the increasing trend in incidence, the mortality rate in geriatric patients with sepsis has decreased. However, the increased incidence of fungal infections in the geriatric population warrants further attention.
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Li J, Li Y, Song N, Chen Y. Risk factors for carbapenem-resistant Klebsiella pneumoniae infection: A meta-analysis. J Glob Antimicrob Resist 2019; 21:306-313. [PMID: 31525540 DOI: 10.1016/j.jgar.2019.09.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/21/2019] [Accepted: 09/07/2019] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES Rates of nosocomial infections caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) have increased. A meta-analysis was conducted to explore risk factors for CRKP infection in order to provide a theoretical basis for reducing the CRKP infection rate and actively preventing CRKP infection. METHODS Online databases, including PubMed, EMBASE, OVID, ClinicalKey, CNKI, CBM, Wanfang Database and CHKD, were searched from inception up to 31 October 2018 for articles regarding risk factors for CRKP infection. Relevant articles were retrieved, supplemented by retrospective and manual search literature. RevMan 5.3 software was used for statistical analysis. RESULTS A total of 30 articles comprising 5075 cases were included in the study, of which 24 were in English and 6 were in Chinese. The results showed that age, sex and diabetes mellitus were not associated with CRKP infection. The odds ratio (95% confidence interval) of risk factors for CRKP infection were as follows: immunosuppression, 1.47 (1.14-1.90); ICU admission, 3.25 (2.36-4.47); antibiotic exposure, 2.53 (1.56-4.11); carbapenem exposure, 3.99 (2.86-5.56); quinolone exposure, 1.75 (1.38-2.22); glycopeptide exposure, 3.08 (1.93-4.91); β‑lactam/β‑lactamase inhibitor (BL/BLI) exposure, 2.28 (1.37-3.80); surgery, 1.59 (1.08-2.34); mechanical ventilation, 2.91 (1.96-4.31); central venous catheterisation, 2.93 (2.00-4.28); indwelling catheter, 2.62 (1.65-4.17); and nasogastric intubation, 2.38 (1.22-4.62). CONCLUSION Immunosuppression, ICU admission, antibiotic exposure (including carbapenems, quinolones, glycopeptides and BL/BLIs), surgery, mechanical ventilation, central venous catheterisation, indwelling catheter and nasogastric intubation were identified as risk factors for CRKP infection and should to be considered in clinical practice.
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Affiliation(s)
- Jihong Li
- Department of Laboratory Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yuanyuan Li
- Department of Infectious Diseases, The Second Hospital of Hebei Medical University, No. 215 Heping Western Road, Xinhua District, Shijiazhuang 050000, Hebei, China
| | - Ning Song
- Department of Infectious Diseases, The Second Hospital of Hebei Medical University, No. 215 Heping Western Road, Xinhua District, Shijiazhuang 050000, Hebei, China.
| | - Yuan Chen
- Department of Pediatrics, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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Tai HCH, Yeh CC, Chen YA, Hsu CC, Chen JH, Chen WL, Huang CC, Chung JY. Utilization of systemic inflammatory response syndrome criteria in predicting mortality among geriatric patients with influenza in the emergency department. BMC Infect Dis 2019; 19:639. [PMID: 31324224 PMCID: PMC6642574 DOI: 10.1186/s12879-019-4288-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 07/15/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Systemic Inflammatory Response Syndrome (SIRS) criteria are often used to evaluate the risk of sepsis and to identify in-hospital mortality among patients with suspected infection. However, utilization of the SIRS criteria in mortality prediction among geriatric patients with influenza in the emergency department (ED) remains unclear. Therefore, we conducted a research to delineate this issue. METHODS This is a retrospective case-control study including geriatric patients (age ≥ 65 years) with influenza, who presented to the ED of a medical center between January 1, 2010 and December 31, 2015. Vital signs, past history, subtype of influenza, demographic data, and outcomes were collected from all patients and analyzed. We calculated the accuracy for predicting 30-days mortality using the SIRS criteria. We also performed covariate adjustment of the area under the receiver operating characteristic curve (AUROC) via regression modeling. RESULTS We recruited a total of 409 geriatric patients in the ED, with mean age 79.5 years and an equal sex ratio. The mean SIRS criteria score was 1.9 ± 1.1. The result of a Hosmer-Lemeshow goodness-of-fit test was 0.34 for SIRS criteria. SIRS criteria score ≥ 3 showed better mortality prediction, with odds ratio (OR) 3.37 (95% confidence interval (CI), 1.05-10.73); SIRS score ≥ 2 showed no statistical significance, with p = 0.85 (OR, 1.15; 95% CI, 0.28-4.69). SIRS score ≥ 3 had acceptable 30-days mortality discrimination, with AUROC 0.77 (95% CI, 0.68-0.87) after adjustment. SIRS score ≥ 3 also had a notable negative predictive value of 0.97 (95% CI, 0.94-0.99). CONCLUSION The presence of a higher number of SIRS criteria (≥ 3) showed greater accuracy for predicting mortality among geriatric patients with influenza.
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Affiliation(s)
| | - Chien-Chun Yeh
- Department of Emergency Medicine, Cathay General Hospital, Taipei, Taiwan
| | - Yen-An Chen
- Department of Emergency Medicine, Cathay General Hospital, Taipei, Taiwan
| | - Chien-Chin Hsu
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Jiann-Hwa Chen
- Department of Emergency Medicine, Cathay General Hospital, Taipei, Taiwan
- Fu Jen Catholic University School of Medicine, Taipei, Taiwan
| | - Wei-Lung Chen
- Department of Emergency Medicine, Cathay General Hospital, Taipei, Taiwan
- Fu Jen Catholic University School of Medicine, Taipei, Taiwan
| | - Chien-Cheng Huang
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Senior Services, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Jui-Yuan Chung
- Department of Emergency Medicine, Cathay General Hospital, Taipei, Taiwan
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Valles J, Fontanals D, Oliva JC, Martínez M, Navas A, Mesquida J, Gruartmoner G, de Haro C, Mestre J, Guía C, Rodriguez A, Torrents E, Espinal C, Ochagavía A, Diaz E. Trends in the incidence and mortality of patients with community-acquired septic shock 2003-2016. J Crit Care 2019; 53:46-52. [PMID: 31195155 DOI: 10.1016/j.jcrc.2019.05.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 05/20/2019] [Accepted: 05/31/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the incidence and mortality of adult patients with community-acquired septic shock (CASS) and the influence of source control (SC) and other risk factors on the outcome. MATERIAL AND METHODS The study included patients with CASS admitted to the ICU at a university hospital (2003-2016). Multivariate analyses were performed to identify risk factors of ICU mortality. RESULTS A total of 625 patients were included. The incidence showed an average annual increase of 4.9% and the mortality an average annual decrease of 1.4%. The patients who required SC showed a lower mortality (20.4%) than patients who did not require SC (31.3%) (p = 0.002). However, the evolution in mortality was different: Mortality decreased in patients who did not require SC (from 56.3% to 20%; p = 0.02), but did not differ in those who required SC (from 21.4% to 27.6%; p = 0.43). In the multivariate analysis, severity at admission, age, alcoholism, cirrhosis, ARDS, neutropenia and thrombocytopenia were associated with worse outcome, whereas appropriate antibiotic treatment and adequate SC were independently associated with better survival. CONCLUSIONS The incidence of CASS increased and the ICU mortality decreased during the study period. The mortality was mainly due to a decrease in mortality in infections not requiring SC.
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Affiliation(s)
- Jordi Valles
- Critical Care Department, Hospital Universitari Parc Taulí, Sabadell, Spain.
| | - Dionisia Fontanals
- Microbiology Department, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - Joan Carles Oliva
- Fundació Parc Taulí, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - Melcior Martínez
- Critical Care Department, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - Ana Navas
- Critical Care Department, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - Jaume Mesquida
- Critical Care Department, Hospital Universitari Parc Taulí, Sabadell, Spain
| | | | - Candelaria de Haro
- Critical Care Department, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - Jaume Mestre
- Critical Care Department, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - Consuelo Guía
- Critical Care Department, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - Andrey Rodriguez
- Critical Care Department, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - Eva Torrents
- Critical Care Department, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - Cristina Espinal
- Critical Care Department, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - Ana Ochagavía
- Critical Care Department, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - Emili Diaz
- Critical Care Department, Hospital Universitari Parc Taulí, Sabadell, Spain
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Paik S, Choe JH, Choi GE, Kim JE, Kim JM, Song GY, Jo EK. Rg6, a rare ginsenoside, inhibits systemic inflammation through the induction of interleukin-10 and microRNA-146a. Sci Rep 2019; 9:4342. [PMID: 30867482 PMCID: PMC6416268 DOI: 10.1038/s41598-019-40690-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 02/15/2019] [Indexed: 12/14/2022] Open
Abstract
The immunobiological functions of Rg6, a rare ginsenoside from ginseng, have been largely unreported. In this paper, we demonstrate that Rg6 has a significant immunosuppressive function on Toll-like receptor (TLR) 4-induced systemic inflammatory responses. Rg6 was found to negatively regulate pro-inflammatory responses and severity in vivo, and thus induced recovery in mice with lipopolysaccharide (LPS)-induced septic shock and cecal ligation and puncture (CLP)-induced sepsis. Rg6 treatment also facilitated recovery in mice with LPS-induced lung damage via reduced neutrophil infiltration and tumor necrosis factor-α expression in lung tissues. Rg6 injection also downregulated pro-inflammatory cytokines and increased the levels of interleukin (IL)-10 in the serum of septic mice. Mechanistically, Rg6 did not induce TLR negative regulators, such as A20 and IRAK-M, in bone marrow-derived macrophages (BMDMs). Instead, addition of Rg6 to LPS-activated BMDMs augmented IL-10 expression, whereas it inhibited inflammatory signaling, such as by nuclear factor κB activation and mitogen-activated protein kinases. Furthermore, Rg6 significantly induced miR-146a, an operator miRNA for anti-inflammation, in BMDMs. Collectively, these data indicate that Rg6 inhibits inflammatory responses through the induction of IL-10 and miR-146a.
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Affiliation(s)
- Seungwha Paik
- Department of Microbiology, Chungnam National University School of Medicine, Daejeon, 35015, Republic of Korea.,Department of Medical Science, Chungnam National University School of Medicine, Daejeon, 35015, Republic of Korea.,Infection Control Convergence Research Center, Chungnam National University, Daejeon, 35015, Republic of Korea
| | - Jin Ho Choe
- Department of Microbiology, Chungnam National University School of Medicine, Daejeon, 35015, Republic of Korea.,Department of Medical Science, Chungnam National University School of Medicine, Daejeon, 35015, Republic of Korea.,Infection Control Convergence Research Center, Chungnam National University, Daejeon, 35015, Republic of Korea
| | - Ga-Eun Choi
- Infection Control Convergence Research Center, Chungnam National University, Daejeon, 35015, Republic of Korea.,College of Pharmacy, Chungnam National University, Daejeon, 34134, Republic of Korea
| | - Ji-Eun Kim
- Infection Control Convergence Research Center, Chungnam National University, Daejeon, 35015, Republic of Korea.,College of Pharmacy, Chungnam National University, Daejeon, 34134, Republic of Korea
| | - Jin-Man Kim
- Department of Medical Science, Chungnam National University School of Medicine, Daejeon, 35015, Republic of Korea.,Infection Control Convergence Research Center, Chungnam National University, Daejeon, 35015, Republic of Korea.,Department of Pathology, Chungnam National University School of Medicine, Daejeon, 35015, Republic of Korea
| | - Gyu Yong Song
- Infection Control Convergence Research Center, Chungnam National University, Daejeon, 35015, Republic of Korea. .,College of Pharmacy, Chungnam National University, Daejeon, 34134, Republic of Korea.
| | - Eun-Kyeong Jo
- Department of Microbiology, Chungnam National University School of Medicine, Daejeon, 35015, Republic of Korea. .,Department of Medical Science, Chungnam National University School of Medicine, Daejeon, 35015, Republic of Korea. .,Infection Control Convergence Research Center, Chungnam National University, Daejeon, 35015, Republic of Korea.
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Fujiya Y, Hayakawa K, Gu Y, Yamamoto K, Mawatari M, Kutsuna S, Takeshita N, Kato Y, Kanagawa S, Ohmagari N. Age-related differences in clinical characteristics of invasive group G streptococcal infection: Comparison with group A and group B streptococcal infections. PLoS One 2019; 14:e0211786. [PMID: 30845149 PMCID: PMC6405256 DOI: 10.1371/journal.pone.0211786] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 01/22/2019] [Indexed: 12/22/2022] Open
Abstract
Purpose Invasive Group G streptococcal infection (iGGS) has increasingly been recognized as a cause of severe disease, mainly among elderly people with chronic illnesses. This study aimed to examine age-related differences in clinical characteristics of iGGS and describe its characteristics among very elderly individuals (≥80 years). Methods Fifty-four iGGS patients for whom detailed clinical information was available were identified from 2002 to 2014 in a tertiary care hospital in Japan. iGGS (n = 54) was compared with invasive Group A (iGAS; n = 17) and B streptococcal infection patients (iGBS; n = 52) based on patient age. Results The incidence of iGGS in our catchment area significantly increased during the study period. The prevalence of iGGS in the very elderly population was higher than that of iGAS or iGBS (p<0.001). Among iGGS patients, cardiovascular disease, chronic kidney disease, oxygen demand, and bacteremia with unknown focus of infection were more frequent in the very elderly population (p = 0.009, p = 0.02, p = 0.04, and p = 0.04, respectively). Altered mental status was present in half of iGGS patients aged ≥60 years (p = 0.03). In contrast, alcohol drinking and liver cirrhosis were significantly more frequent in patients with iGGS aged <60 years than in other age groups (p<0.001, p = 0.001, respectively). Levofloxacin resistance in GBS isolates was significantly more frequent among very elderly patients than among other age groups (p<0.001). Conclusions The burden of iGGS has been increasing in our catchment area. Different iGGS-associated clinical characteristics were found in each age group. Unclear and atypical clinical manifestations and syndromes were likely to be observed in very elderly patients. Alcohol drinking and liver cirrhosis may contribute to iGGS even in patients aged <60 years. Understanding these age-related differences could be helpful for optimal diagnosis and treatment.
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Affiliation(s)
- Yoshihiro Fujiya
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
- * E-mail:
| | - Kayoko Hayakawa
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yoshiaki Gu
- AMR Clinical Reference Center, National Center for Global Health and Medicine Hospital, Shinjuku-ku, Tokyo, Japan
| | - Kei Yamamoto
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Momoko Mawatari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Satoshi Kutsuna
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Nozomi Takeshita
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yasuyuki Kato
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Shuzo Kanagawa
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
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Sathananthan M, Sathananthan A, Jeganathan N. Characteristics and Outcomes of Patients With and Without Type 2 Diabetes Mellitus and Pulmonary Sepsis. J Intensive Care Med 2019; 35:836-843. [PMID: 30841774 DOI: 10.1177/0885066619833910] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE To date, studies have provided conflicting results regarding the impact of type 2 diabetes mellitus (DM) on sepsis-related outcomes. Our objective is to understand the impact of type 2 DM in bacterial pneumonia and sepsis-related intensive care unit (ICU) outcomes. METHODS Retrospective study using Multiparameter Intelligent Monitoring in Intensive Care III database. We included 1698 unique patients admitted with sepsis secondary to bacterial pneumonia to the ICU within the time period of 2001 to 2012. RESULTS The type 2 DM group had an increased incidence of acute kidney injury (67.9% vs 58.1%, P < .01) and need for dialysis compared to the non-DM group. There was no difference in mortality, microbiology, other organ failure, or hospital length of stay between the type 2 DM and non-DM group. Lower admission blood glucose was associated with increased mortality in patients with type 2 DM (49% at ≤120 mg/dL, 35.1% at 121-180 mg/dL, and 32.1% at >180 mg/dL) but not in non-DM patients. Conversely, higher mean glucose during the hospital stay was associated with increased mortality in non-DM patients (24.7% at ≤120 mg/dL, 45.1% at 121-180 mg/dL, and 73.0% at >180 mg/dL) but not in patients with type 2 DM. CONCLUSIONS Our findings demonstrated that type 2 DM does not increase the overall mortality. Our findings of increased mortality in both type 2 DM patients with lower admission glucose, and non-DM patients with higher mean glucose during the hospital stay needs to be further evaluated. Future studies in regards to this could lead to personalized glucose treatment goals for patients.
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Affiliation(s)
| | - Airani Sathananthan
- Department of Internal Medicine, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA, USA
| | - Niranjan Jeganathan
- Division of Pulmonary and Critical Care, Loma Linda University Health, Loma Linda, CA, USA
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38
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Amesz AL, de Visser M, de Groot B. Recognition of acute organ failure and associated fluid and oxygen resuscitation by emergency medical services of emergency department patients with a suspected infection. Int Emerg Nurs 2019; 43:92-98. [DOI: 10.1016/j.ienj.2018.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 11/18/2018] [Accepted: 11/22/2018] [Indexed: 11/25/2022]
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A New Proposal of Criteria for the Future Remnant Liver Volume in Older Patients Undergoing Major Hepatectomy for Biliary Tract Cancer. Ann Surg 2019; 267:338-345. [PMID: 27849659 DOI: 10.1097/sla.0000000000002080] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To evaluate whether advanced age increases the risk of severe complications after major hepatectomy with bile duct resection (BDR) in patients with biliary tract cancer, and to establish new criteria for the percentage of the future remnant liver volume (%FLV) in older patients undergoing this operation. BACKGROUND Advanced age is reported to inhibit liver regeneration and suppress immune function; however, little is known about the risk of aging in high-stress surgery, such as biliary tract surgery. METHODS Consecutive patients who underwent major hepatectomy with BDR between 2000 and 2013 were retrospectively reviewed. Severe postoperative complications were defined as Clavien-Dindo grade ≥IV. RESULTS In 225 patients undergoing major hepatectomy with BDR, advanced age was significantly correlated with the incidence of severe postoperative complications, with cut-off value of 69 years. In comparing postoperative complications, the incidences of hyperbilirubinemia, liver failure, respiratory failure, sepsis, severe complications, and operation-related death were more frequent in the older group. Moreover, advanced age (≥69 years) was an independent risk factor associated with severe complications after major hepatectomy with BDR. Delayed liver regeneration was the reason for the age-related risks. The incidence of severe postoperative complications in older patients was significantly decreased if %FLV was set at ≥45%. CONCLUSIONS Advanced age is a strong independent risk factor for severe complications after major hepatectomy with BDR. To decrease the risk of advanced age, the minimum limit of %FLV for this operation should be set at ≥45% in patients aged ≥69 years.
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40
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Ko SY, Esteve Cuevas LM, Willeboer M, Ansems A, Blomaard LC, Lucke JA, Mooijaart SP, de Groot B. The association between intravenous fluid resuscitation and mortality in older emergency department patients with suspected infection. Int J Emerg Med 2019; 12:1. [PMID: 31179911 PMCID: PMC6326108 DOI: 10.1186/s12245-018-0219-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 12/11/2018] [Indexed: 12/29/2022] Open
Abstract
Objective Recent studies suggest that hypotension thresholds in current guidelines might be too low for older patients due to arterial stiffening, possibly leading to insufficient fluid resuscitation. We compared intravenous (IV) fluid volumes that older (≥ 70 years) and younger (< 70 years) patients with suspected infection with similar initial systolic blood pressure (SBP) received in the emergency department (ED) and investigated whether this was associated with in-hospital mortality in older patients. Methods This was an observational multicenter study using an existing database in which consecutive ED patients hospitalized with suspected infection were prospectively included. We first compared the fluid volumes older and younger ED patients received per initial SBP category. Patients were then stratified into two SBP categories (≤ or > 120 mmHg; 120 has been suggested to be a better threshold) and thereafter into three fluid volume categories: 0–1 L, 1–2 L, or > 2 L. In each SBP and fluid category, case-mix-adjusted in-hospital mortality was compared between older and younger patients, using multivariable logistic regression analysis. Results The included 981 (37%) older and 1678 (63%) younger ED patients received similar IV fluid volumes per initial SBP category. Older patients with an initial SBP > 120 mmHg had a higher adjusted OR of 2.06 (95% CI 1.02–4.16), in the 0–1 L category, while this association was not found in the higher fluid categories of 1–2 L or > 2 L. In the SBP ≤ 120 mmHg category, this association was also absent. Conclusion This hypothesis-generating study suggests that older patients with suspected infection may need higher fluid volumes than younger patients, when having a seemingly normal initial SBP. Electronic supplementary material The online version of this article (10.1186/s12245-018-0219-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sin Y Ko
- Department of Emergency Medicine, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands.
| | - Laura M Esteve Cuevas
- Department of Emergency Medicine, Albert Schweitzer Ziekenhuis, Albert Schweitzerplaats 25, 3318 AT, Dordrecht, the Netherlands
| | - Merel Willeboer
- Department of Emergency Medicine, Albert Schweitzer Ziekenhuis, Albert Schweitzerplaats 25, 3318 AT, Dordrecht, the Netherlands
| | - Annemieke Ansems
- Department of Emergency Medicine, Albert Schweitzer Ziekenhuis, Albert Schweitzerplaats 25, 3318 AT, Dordrecht, the Netherlands
| | - Laura C Blomaard
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands
| | - Jacinta A Lucke
- Department of Emergency Medicine, Albert Schweitzer Ziekenhuis, Albert Schweitzerplaats 25, 3318 AT, Dordrecht, the Netherlands
| | - Simon P Mooijaart
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands.,Institute for Evidence-based Medicine in Old Age
- IEMO, Albinusdreef 2, 2300 RC, Leiden, the Netherlands
| | - Bas de Groot
- Department of Emergency Medicine, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands
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Liu ES, Chiang CH, Hung WT, Tang PL, Hung CC, Kuo SH, Liu CP, Chen YS, Mar GY, Huang WC. Comparison of long-term mortality in patients with acute myocardial infarction associated with or without sepsis. Int J Infect Dis 2018; 79:169-178. [PMID: 30503653 DOI: 10.1016/j.ijid.2018.11.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 11/20/2018] [Accepted: 11/25/2018] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES Although the association between systemic infection and cardiovascular events has been identified, uncertainty remains regarding the incidence and prognosis of sepsis in acute myocardial infarction (AMI). The purpose of this research was to assess the impact of sepsis on survival after first AMI. METHODS This was a nationwide cohort study involving the analysis of data from the Taiwan National Health Insurance Research Database for the period 2000-2012, for patients with a primary diagnosis of first AMI. Among the 186112 prospective patients, sepsis was diagnosed in 13065 (7.0%). The propensity score matching technique was used to match 13065 controls to the patients with sepsis and AMI with similar baseline characteristics. Cox proportional hazards regression models, including sepsis, percutaneous coronary intervention (PCI), and comorbidities, were performed to further evaluate the different influences on the mortality risk in patients hospitalized for first AMI. RESULTS Overall, the 12-year survival rate was lower in AMI patients with sepsis than in those without sepsis (log rank p-value <0.001); this was also shown in the different age and sex groups. The AMI patients with sepsis had a longer length of hospital stay than those without sepsis (32.5days vs. 11.74 days, p<0.001). In the Cox proportional hazards regression analysis, sepsis was an independent risk factor for mortality in patients after AMI (hazard ratio 1.78; 95% confidence interval 1.72-1.83). Interventional management with PCI or coronary artery bypass grafting improved survival in both the sepsis and non-sepsis patients after first AMI. CONCLUSIONS In conclusion, sepsis significantly increased the mortality risk of patients after first AMI. PCI may improve the long-term survival of patients in comparison to those managed conservatively.
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Affiliation(s)
- En-Shao Liu
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Cheng-Hung Chiang
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan
| | - Wang-Ting Hung
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Pei-Ling Tang
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Cheng Chung Hung
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Shu-Hung Kuo
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chun-Peng Liu
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yao-Shen Chen
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Guang-Yuan Mar
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
| | - Wei-Chun Huang
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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A systematic investigation on animal models of cyclosporine A combined with Escherichia coli to simulate the immunosuppressive status of sepsis patients before onset. Int Immunopharmacol 2018; 62:67-76. [DOI: 10.1016/j.intimp.2018.05.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 05/29/2018] [Accepted: 05/29/2018] [Indexed: 02/07/2023]
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43
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Yang HW, Su YJ. Purple Urine Bag Syndrome in the Elderly. INT J GERONTOL 2018. [DOI: 10.1016/j.ijge.2018.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Samsudin MI, Liu N, Prabhakar SM, Chong SL, Kit Lye W, Koh ZX, Guo D, Rajesh R, Ho AFW, Ong MEH. A novel heart rate variability based risk prediction model for septic patients presenting to the emergency department. Medicine (Baltimore) 2018; 97:e10866. [PMID: 29879021 PMCID: PMC5999455 DOI: 10.1097/md.0000000000010866] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
A quick, objective, non-invasive means of identifying high-risk septic patients in the emergency department (ED) can improve hospital outcomes through early, appropriate management. Heart rate variability (HRV) analysis has been correlated with mortality in critically ill patients. We aimed to develop a Singapore ED sepsis (SEDS) predictive model to assess the risk of 30-day in-hospital mortality in septic patients presenting to the ED. We used demographics, vital signs, and HRV parameters in model building and compared it with the modified early warning score (MEWS), national early warning score (NEWS), and quick sequential organ failure assessment (qSOFA) score.Adult patients clinically suspected to have sepsis in the ED and who met the systemic inflammatory response syndrome (SIRS) criteria were included. Routine triage electrocardiogram segments were used to obtain HRV variables. The primary endpoint was 30-day in-hospital mortality. Multivariate logistic regression was used to derive the SEDS model. MEWS, NEWS, and qSOFA (initial and worst measurements) scores were computed. Receiver operating characteristic (ROC) analysis was used to evaluate their predictive performances.Of the 214 patients included in this study, 40 (18.7%) met the primary endpoint. The SEDS model comprises of 5 components (age, respiratory rate, systolic blood pressure, mean RR interval, and detrended fluctuation analysis α2) and performed with an area under the ROC curve (AUC) of 0.78 (95% confidence interval [CI]: 0.72-0.86), compared with 0.65 (95% CI: 0.56-0.74), 0.70 (95% CI: 0.61-0.79), 0.70 (95% CI: 0.62-0.79), 0.56 (95% CI: 0.46-0.66) by qSOFA (initial), qSOFA (worst), NEWS, and MEWS, respectively.HRV analysis is a useful component in mortality risk prediction for septic patients presenting to the ED.
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Affiliation(s)
| | - Nan Liu
- Duke-NUS Medical School, National University of Singapore
- Health Services Research Centre, Singapore Health Services
| | | | - Shu-Ling Chong
- Department of Emergency Medicine, KK Women's and Children's Hospital
| | - Weng Kit Lye
- Duke-NUS Medical School, National University of Singapore
| | - Zhi Xiong Koh
- Department of Emergency Medicine, Singapore General Hospital
| | - Dagang Guo
- Department of Emergency Medicine, Singapore General Hospital
| | - R. Rajesh
- Yong Loo Lin School of Medicine, National University of Singapore
| | | | - Marcus Eng Hock Ong
- Duke-NUS Medical School, National University of Singapore
- Department of Emergency Medicine, Singapore General Hospital
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van der Geest KSM, Kroesen BJ, Horst G, Abdulahad WH, Brouwer E, Boots AMH. Impact of Aging on the Frequency, Phenotype, and Function of CD161-Expressing T Cells. Front Immunol 2018; 9:752. [PMID: 29725326 PMCID: PMC5917671 DOI: 10.3389/fimmu.2018.00752] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 03/26/2018] [Indexed: 12/27/2022] Open
Abstract
Immune-aging is associated with perturbed immune responses in the elderly. CD161-expressing T cells, i.e., the previously described subsets of CD161+ CD4+ T cells, CD161high CD8+ T cells, and CD161int CD8+ T cells, are highly functional, pro-inflammatory T cells. These CD161-expressing T cells are critical in immunity against microbes, while possibly contributing to autoimmune diseases. So far, little is known about the impact of aging on the frequency, phenotype, and function of these CD161-expressing T cells. In the current study, we investigated the impact of aging on CD161+ CD4+ T cells, CD161high CD8+ T cells, and CD161int CD8+ T cells in peripheral blood samples of 96 healthy subjects (age 20–84). Frequencies of CD161+ CD4+ T cells and CD161int CD8+ T cells were stable with aging, whereas frequencies of CD161high CD8+ T cells declined. Although CD161high CD8+ T cells were mostly T cell receptor-Vα7.2+ mucosal-associated invariant T cells, CD161 expressing CD4+ and CD8+ T cells showed a limited expression of markers for gamma–delta T cells or invariant natural killer (NK) T cells, in both young and old subjects. In essence, CD161-expressing T cells showed a similar memory phenotype in young and old subjects. The expression of the inhibitory NK receptor KLRG1 was decreased on CD161+ CD4+ T cells of old subjects, whereas the expression of other NK receptors by CD161-expressing T cells was unaltered with age. The expression of cytotoxic effector molecules was similar in CD161high and CD161int CD8+ T cells of young and old subjects. The ability to produce pro-inflammatory cytokines was preserved in CD161high and CD161int CD8+ T cells of old subjects. However, the percentages of IFN-γ+ and interleukin-17+ cells were significantly lower in CD161+ CD4+ T cells of old individuals than those of young individuals. In addition, aging was associated with a decrease of nonclassic T helper 1 cells, as indicated by decreased percentages of CD161-expressing cells within the IFN-γ+ CD4+ T cell compartment of old subjects. Taken together, aging is associated with a numerical decline of circulating CD161high CD8+ T cells, as well as a decreased production of pro-inflammatory cytokines by CD161+ CD4+ T cells. These aging-associated changes could contribute to perturbed immunity in the elderly.
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Affiliation(s)
- Kornelis S M van der Geest
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Bart-Jan Kroesen
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Gerda Horst
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Wayel H Abdulahad
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.,Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Elisabeth Brouwer
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Annemieke M H Boots
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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Camm CF, Hayward G, Elias TCN, Bowen JST, Hassanzadeh R, Fanshawe T, Pendlebury ST, Lasserson DS. Sepsis recognition tools in acute ambulatory care: associations with process of care and clinical outcomes in a service evaluation of an Emergency Multidisciplinary Unit in Oxfordshire. BMJ Open 2018; 8:e020497. [PMID: 29632083 PMCID: PMC5892763 DOI: 10.1136/bmjopen-2017-020497] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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 To assess the performance of currently available sepsis recognition tools in patients referred to a community-based acute ambulatory care unit. DESIGN Service evaluation of consecutive patients over a 4-month period. SETTING Community-based acute ambulatory care unit. DATA COLLECTION AND OUTCOME MEASURES Observations, blood results and outcome data were analysed from patients with a suspected infection. Clinical features at first assessment were used to populate sepsis recognition tools including: systemic inflammatory response syndrome (SIRS) criteria, National Early Warning Score (NEWS), quick Sequential Organ Failure Assessment (qSOFA) and National Institute for Health and Care Excellence (NICE) criteria. Scores were assessed against the clinical need for escalated care (use of intravenous antibiotics, fluids, ongoing ambulatory care or hospital treatment) and poor clinical outcome (all-cause mortality and readmission at 30 days after index assessment). RESULTS Of 533 patients (median age 81 years), 316 had suspected infection with 120 patients requiring care escalated beyond simple community care. SIRS had the highest positive predictive value (50.9%, 95% CI 41.6% to 60.3%) and negative predictive value (68.9%, 95% CI 62.6% to 75.3%) for the need for escalated care. Both NEWS and SIRS were better at predicting the need for escalated care than qSOFA and NICE criteria in patients with suspected infection (all P<0.001). While new-onset confusion predicted the need for escalated care for infection in patients ≥85 years old (n=114), 23.7% of patients ≥85 years had new-onset confusion without evidence for infection. CONCLUSIONS Acute ambulatory care clinicians should use caution in applying the new NICE endorsed criteria for determining the need for intravenous therapy and hospital-based location of care. NICE criteria have poorer performance when compared against NEWS and SIRS and new-onset confusion was prevalent in patients aged ≥85 years without infection.
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Affiliation(s)
| | - Gail Hayward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Tania C N Elias
- Emergency Multidisciplinary Unit, Abingdon Hospital, Oxford Health NHS Foundation Trust, Oxford, UK
- Department of Geratology, Oxford University Hospitals NHS Foundation Trust, London, UK
| | - Jordan S T Bowen
- Emergency Multidisciplinary Unit, Abingdon Hospital, Oxford Health NHS Foundation Trust, Oxford, UK
- Department of Geratology, Oxford University Hospitals NHS Foundation Trust, London, UK
| | - Roya Hassanzadeh
- Department of Public Health and Primary Care, Imperial College London, London, UK
| | - Thomas Fanshawe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sarah T Pendlebury
- Department of Geratology, Oxford University Hospitals NHS Foundation Trust, London, UK
- Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
| | - Daniel S Lasserson
- Department of Geratology, Oxford University Hospitals NHS Foundation Trust, London, UK
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Murphy LS, Wickersham N, McNeil JB, Shaver CM, May AK, Bastarache JA, Ware LB. Endothelial glycocalyx degradation is more severe in patients with non-pulmonary sepsis compared to pulmonary sepsis and associates with risk of ARDS and other organ dysfunction. Ann Intensive Care 2017; 7:102. [PMID: 28986821 PMCID: PMC5630541 DOI: 10.1186/s13613-017-0325-y] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 09/23/2017] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Disruption of the endothelial glycocalyx contributes to acute lung injury in experimental sepsis but has not been well studied in humans. To study glycocalyx degradation in sepsis-induced ARDS, we measured plasma levels of syndecan-1, a marker for glycocalyx degradation. METHODS The present study is a retrospective observational study of 262 ventilated medical ICU patients at risk of ARDS due to severe sepsis and APACHE II ≥ 25. Plasma syndecan-1 was measured at study enrollment. Primary analysis focused on the association between syndecan-1 levels and the development of ARDS, other organ dysfunction (Brussels criteria), or in-hospital mortality. RESULTS Overall, 135 (52%) patients developed ARDS. In patients with non-pulmonary sepsis, syndecan-1 levels were associated with ARDS (p = 0.05). Regardless of etiology of sepsis, higher syndecan-1 levels were associated with hepatic (p < 0.001), renal (p = 0.003), coagulation (p = 0.001), and circulatory (p = 0.02) failure as well as in-hospital mortality (p = 0.001), and there was a significant association between syndecan-1 levels and the number of vasopressors required in the first 24 h (p < 0.001). In addition, elevated syndecan levels were independently predictive of mortality in multivariable logistic regression adjusted for age and APACHE II score (odds ratio 1.85 per log increase in syndecan-1, 95% CI 1.056-3.241, p = 0.03). CONCLUSION The extent of endothelial glycocalyx degradation is associated with non-pulmonary organ dysfunction in subjects with sepsis and is associated with ARDS but only in the subgroup with non-pulmonary sepsis. Measurement of syndecan-1 levels in sepsis patients might be useful for identifying patients at high risk of organ dysfunction and mortality as well as those who could benefit from therapies targeted at protecting or restoring the glycocalyx.
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Affiliation(s)
- Laura S. Murphy
- 0000 0001 2264 7217grid.152326.1Vanderbilt University School of Medicine, Nashville, TN USA
| | - Nancy Wickersham
- 0000 0001 2264 7217grid.152326.1Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Vanderbilt University School of Medicine, T1218 Medical Center North, 1161 21st Avenue S, Nashville, TN 37232-2650 USA
| | - J. Brennan McNeil
- 0000 0001 2264 7217grid.152326.1Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Vanderbilt University School of Medicine, T1218 Medical Center North, 1161 21st Avenue S, Nashville, TN 37232-2650 USA
| | - Ciara M. Shaver
- 0000 0001 2264 7217grid.152326.1Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Vanderbilt University School of Medicine, T1218 Medical Center North, 1161 21st Avenue S, Nashville, TN 37232-2650 USA
| | - Addison K. May
- 0000 0004 1936 9916grid.412807.8Department of Surgery, Vanderbilt University Medical Center, Nashville, TN USA
| | - Julie A. Bastarache
- 0000 0001 2264 7217grid.152326.1Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Vanderbilt University School of Medicine, T1218 Medical Center North, 1161 21st Avenue S, Nashville, TN 37232-2650 USA
| | - Lorraine B. Ware
- 0000 0001 2264 7217grid.152326.1Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Vanderbilt University School of Medicine, T1218 Medical Center North, 1161 21st Avenue S, Nashville, TN 37232-2650 USA ,0000 0001 2264 7217grid.152326.1Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN USA
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Attenuation of the physiological response to infection on adults over 65 years old admitted to the emergency room (ER). Aging Clin Exp Res 2017; 29:847-856. [PMID: 27854067 DOI: 10.1007/s40520-016-0679-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 11/03/2016] [Indexed: 12/22/2022]
Abstract
It has been considered that the elderly have clinical manifestations different from the ones observed in middle-age adults during an injury event. This hypothesis has not been extensively explored in sepsis and bacterial infections. Secondary analysis of two prospective studies including 2611 patients over 18 years of age admitted to the emergency room with confirmed or probable bacterial infections and sepsis. The outcome measures were heart rate, respiratory rate, systolic blood pressure, temperature, Glasgow Coma Scale, creatinine, PaO2/FiO2 and platelets daily during the first week. Compared to survivors younger than 65, the deceased under 65 had an average heart rate of 12.5 beats per minute per day higher (95% CI 9.32; 15.61), while patients over 65 who died barely had an average 5.7 beats per minute per day higher than the same reference group (95% CI 3.45; 8.06). The systolic blood pressure had a significant decreased in those who died younger than 65, compared to survivors with the same age, in both cohorts (-5.2 mmHg, 95% CI -8.17; -2.23 and -8.5 mmHg, 95% CI -13.48; -3.54, respectively), while those older than 65 who died had a nonsignificant increase (+1.6 mmHg, 95% CI -1.33; 4.62 and +0.1, 95% CI -6.48; 6.72, respectively) compared to the same reference group. The behavior of most clinical and laboratory variables suggests a less pronounced response of subjects above 65 years of age who died 28 days after being diagnosed with sepsis.
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Warmerdam M, Stolwijk F, Boogert A, Sharma M, Tetteroo L, Lucke J, Mooijaart S, Ansems A, Esteve Cuevas L, Rijpsma D, de Groot B. Initial disease severity and quality of care of emergency department sepsis patients who are older or younger than 70 years of age. PLoS One 2017; 12:e0185214. [PMID: 28945774 PMCID: PMC5612649 DOI: 10.1371/journal.pone.0185214] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 09/10/2017] [Indexed: 12/05/2022] Open
Abstract
Objective Due to atypical symptom presentation older patients are more prone to delayed sepsis recognition. We investigated whether initial disease severity before emergency department (ED) treatment (including treatable acute organ dysfunction), quality of ED sepsis care and the impact on mortality was different between patients older and younger than 70 years. If differences exist, improvements are needed for ED management of older patients at risk for sepsis. Methods In this observational multicenter study, ED patients who were hospitalized with a suspected infection were stratified by age <70 and ≥70 years. The presence of treatable and potentially reversible acute organ dysfunction was measured by the RO components of the Predisposition, Infection, Response and Organ dysfunction (PIRO) score, reflecting acute sepsis-related organ dysfunction developed before ED presentation. Quality of care, as assessed by the full compliance with nine quality performance measures and the standardized mortality ratio (SMR: observed/expected in-hospital mortality), was compared between older and younger patients. Results The RO-components of the PIRO score were 8 (interquartile range; 4–9) in the 833 older patients, twice as high as the 4 (2–8; P<0.001) in the 1537 younger patients. However, full compliance with all nine quality performance measures was achieved in 34.2 (31.0–37.4)% of the older patients, not higher than the 33.0 (30.7–35.4)% in younger patients (P = 0.640). In-hospital mortality was 9.2% (95%-CI, 7.3–11.2) in patients ≥70, twice as high as the 4.6% (3.6–5.6) in patients <70 years, resulting in an SMR (in study period) of ~0.7 in both groups (P>0.05). Conclusion Older sepsis patients are sicker at ED presentation but are not treated more expediently or reliably despite their extra acuity The presence of twice as much treatable acute organ dysfunction before ED treatment suggests that acute organ dysfunction is recognized relatively late by general practitioners or patients in the out of hospital setting.
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Affiliation(s)
- Mats Warmerdam
- Emergency Department, Leiden University Medical Centre, Leiden, Zuid-Holland, the Netherlands
- * E-mail:
| | - Frank Stolwijk
- Emergency Department, Leiden University Medical Centre, Leiden, Zuid-Holland, the Netherlands
| | - Anjelica Boogert
- Emergency Department, Leiden University Medical Centre, Leiden, Zuid-Holland, the Netherlands
| | - Meera Sharma
- Emergency Department, Leiden University Medical Centre, Leiden, Zuid-Holland, the Netherlands
| | - Lisa Tetteroo
- Emergency Department, Leiden University Medical Centre, Leiden, Zuid-Holland, the Netherlands
| | - Jacinta Lucke
- Emergency Department, Leiden University Medical Centre, Leiden, Zuid-Holland, the Netherlands
| | - Simon Mooijaart
- Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, Zuid-Holland, The Netherlands & Institute for Evidence-based Medicine in Old Age | IEMO, Leiden, The Netherlands
| | - Annemieke Ansems
- Emergency Department, Albert Schweitzer Ziekenhuis, Dordrecht, Zuid-Holland, the Netherlands
| | - Laura Esteve Cuevas
- Emergency Department, Albert Schweitzer Ziekenhuis, Dordrecht, Zuid-Holland, the Netherlands
| | - Douwe Rijpsma
- Emergency Department, Rijnstate Ziekenhuis, Arnhem, Gelderland, the Netherlands
| | - Bas de Groot
- Emergency Department, Leiden University Medical Centre, Leiden, Zuid-Holland, the Netherlands
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50
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Agarwal M, Larson EL. Risk of drug resistance in repeat gram-negative infections among patients with multiple hospitalizations. J Crit Care 2017; 43:260-264. [PMID: 28946105 DOI: 10.1016/j.jcrc.2017.09.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 09/05/2017] [Accepted: 09/15/2017] [Indexed: 12/11/2022]
Abstract
PURPOSE Drug resistance in gram-negative bacterial hospital-acquired infections (GNB HAIs) has become ubiquitous in recent years. Patients who experience multiple hospitalizations are at high risk of developing repeat GNB HAIs. This study aims to evaluate the relationship between repeat GNB HAIs and antibiotic susceptibility patterns. METHODS Using electronic medical records from three hospitals, 4053 patients were identified with at least one HAI caused by K. pneumoniae or P. aeruginosa over multiple hospitalizations in a 9-year period. Modified Poisson regression was used to evaluate the risk of drug resistance with increasing number of prior susceptible infections. Drug resistance was defined as resistant to carbapenems for K. pneumoniae and resistant to levofloxacin for P. aeruginosa. RESULTS In patients with repeat infections, almost 15% of consecutive infections changed from susceptible to drug-resistant. Patients with K. pneumoniae infections had a 1.14 times increased risk of acquiring a drug-resistant HAI with each prior HAI, after adjusting for potential confounders and antibiotic use prior to infection. Patients with P. aeruginosa infections had a 1.23 times increased risk of a drug-resistant infection with each prior P. aeruginosa HAI. CONCLUSIONS Prevention of repeat infections in high healthcare utilizers may be important in reducing drug resistance in this population.
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Affiliation(s)
- Mansi Agarwal
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, United States; School of Nursing, Columbia University, 617 West 168th Street, New York, NY 10032, United States.
| | - Elaine L Larson
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, United States; School of Nursing, Columbia University, 617 West 168th Street, New York, NY 10032, United States
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