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Todorovic Markovic M, Todorovic Mitic M, Ignjatovic A, Gottfredsson M, Gaini S. Mortality in Community-Acquired Sepsis and Infections in the Faroe Islands-A Prospective Observational Study. Infect Dis Rep 2024; 16:448-457. [PMID: 38804443 PMCID: PMC11130956 DOI: 10.3390/idr16030033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 05/04/2024] [Accepted: 05/06/2024] [Indexed: 05/29/2024] Open
Abstract
The aim of this study was to collect data and analyze mortality among patients hospitalized with community-acquired infections in the Faroe Islands. A prospective observational study was conducted in the Medical Department of the National Hospital of the Faroe Islands from October 2013 to April 2015. Cumulative all-cause, in-hospital, short-term, intermediate-term and long-term mortality rates were calculated. Kaplan-Meier survival curves comparing infection-free patients with infected patients of all severities and different age groups are presented. A log-rank test was used to compare groups. Mortality hazard ratios were calculated for subgroups using Cox regression multivariable models. There were 1309 patients without infection and 755 patients with infection. There were 51% female and 49% male patients. Mean age was 62.73 ± 19.71. Cumulative all-cause mortality and in-hospital mortality were highest in more severe forms of infection. This pattern remained the same for short-term mortality in the model adjusted for sex and age, while there were no significant differences among the various infection groups in regard to intermediate- or long-term survival after adjustment. Overall and short-term mortality rates were highest among those with severe manifestations of infection and those with infection compared to infection-free patients.
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Affiliation(s)
- Marija Todorovic Markovic
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Infectious Diseases, Odense University Hospital, 5000 Odense, Denmark
- Department of Medicine, Infectious Diseases Division, National Hospital of the Faroe Islands, JC. Svabosgøta 41-49, 100 Torshavn, Faroe Islands
| | | | - Aleksandra Ignjatovic
- Department of Medical Statistics and Informatics, School of Medicine, University of Nis, 18108 Nis, Serbia
| | - Magnús Gottfredsson
- Department of Infectious Diseases, Landspitali University Hospital, 105 Reykjavik, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, 101 Reykjavik, Iceland
| | - Shahin Gaini
- Department of Infectious Diseases, Odense University Hospital, 5000 Odense, Denmark
- Department of Medicine, Infectious Diseases Division, National Hospital of the Faroe Islands, JC. Svabosgøta 41-49, 100 Torshavn, Faroe Islands
- Faculty of Health Sciences, University of the Faroe Islands, 100 Torshavn, Faroe Islands
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Liu J, Ren J, Gao X, Zhang C, Deng G, Li J, Li R, Wang X, Wang G. A causal relationship between educational attainment and risk of infectious diseases: A Mendelian randomisation study. J Glob Health 2024; 14:04089. [PMID: 38665066 PMCID: PMC11046428 DOI: 10.7189/jogh.14.04089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
Background Previous observational studies have investigated the association between educational attainment and sepsis, pneumonia, and urinary tract infections (UTIs). However, their findings have been susceptible to reverse causality and confounding factors. Furthermore, no study has examined the effect of educational level on the risk of infections of the skin and subcutaneous tissue (SSTIs). Thus, we aimed to evaluate the causal relationships between educational level and the risk of four infectious diseases using Mendelian randomisation (MR) techniques. Methods We used univariable MR analysis to investigate the causal associations between educational attainment (years of schooling (n = 766 345) and holding college or university degree (n = 334 070)) and four infectious diseases (sepsis (n = 486 484), pneumonia (n = 486 484), UTIs (n = 463 010), and SSTIs (n = 218 792)). We included genetic instrumental variables with a genome-wide significance (P < 5 × 10-8) in the study. We used inverse variance-weighted estimation in the primary analysis and explored the stability of the results using multivariable MR analysis after adjusting for smoking, alcohol consumption, and body mass index. Results Genetically predicted years of schooling were associated with a reduced risk of sepsis (odds ratio (OR) = 0.763; 95% confidence interval (CI) = 0.668-0.870, P = 5.525 × 10-5), pneumonia (OR = 0.637; 95% CI = 0.577-0.702, P = 1.875 × 10-19), UTIs (OR = 0.995; 95% CI = 0.993-0.997, P = 1.229 × 10-5), and SSTIs (OR = 0.696; 95% CI = 0.605-0.801, P = 4.034 × 10-7). We observed consistent results for the correlation between qualifications and infectious diseases. These findings remained stable in the multivariable MR analyses. Conclusions Our findings suggest that increased educational attainment may be causally associated with a decreased risk of sepsis, pneumonia, UTIs, and SSTIs.
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Affiliation(s)
- Jueheng Liu
- Department of Critical Care Medicine, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Jiajia Ren
- Department of Critical Care Medicine, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Xiaoming Gao
- Department of Critical Care Medicine, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Chuchu Zhang
- Department of Critical Care Medicine, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Guorong Deng
- Department of Critical Care Medicine, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Jiamei Li
- Department of Critical Care Medicine, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Ruohan Li
- Department of Critical Care Medicine, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Xiaochuang Wang
- Department of Critical Care Medicine, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Gang Wang
- Department of Critical Care Medicine, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
- Key Laboratory of Surgical Critical Care and Life Support, Xi’an Jiaotong University, Ministry of Education, Xi’an, Shaanxi, China
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Guo DC, Zhuang HZ, Lin J, Zhi DY, Duan ML. Epidemiology of sepsis in Beijing from 2012 to 2018: analysis of hospital homepage databases derived from the Beijing Public Health System. BMC Public Health 2022; 22:2237. [PMID: 36451165 PMCID: PMC9713983 DOI: 10.1186/s12889-022-14725-1] [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: 09/20/2022] [Accepted: 11/24/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND We aimed to evaluate the epidemiology of sepsis in secondary and tertiary hospitals in Beijing, China between 2012 and 2018 using information derived from the Beijing Public Health System. METHODS The Beijing Public Health System accessed hospital homepage databases and identify patients who diagnosed sepsis or associated condition according to the International Classification of Diseases, 10th Edition, Clinical Modification codes. There are 125 hospitals involved in this study, including 61 secondary hospitals, accounting for 49.2%, and 63 tertiary hospitals, accounting for 50.8%. Patients were stratified by age as minors (0-17 years old), adults (18-64 years old), seniors (65-84 years old), and the elderly (≥ 85 years old). Patient's demographic information, treatments, outcomes, and all-cause hospitalization cost were evaluated. RESULTS This study involved 8,597 patients. Patients treated in tertiary hospitals or received blood transfusion decreased with age, while patients who were male, received ventilation, or took Traditional Chinese Medicine, and in-hospital mortality and hospitalization cost, increased with age. There were 2,729 (31.7%) deaths in this study. A slight increase in in-hospital mortality occurred from 2012 to 2018. Median hospitalization cost for all patients was ¥29,453 (15,011, 65,237). Hospitalization cost showed no significant change from 2012 to 2016, but increased in 2017 and 2018. CONCLUSION Sepsis is associated with high mortality and cost. From 2012 to 2018, in-hospital mortality and hospitalization cost of sepsis in Beijing increased significantly with age, and slightly by year.
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Affiliation(s)
- Dong-chen Guo
- grid.24696.3f0000 0004 0369 153XDepartment of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong’an Road, Xicheng District, 100050 Beijing, China
| | - Hai-zhou Zhuang
- grid.24696.3f0000 0004 0369 153XDepartment of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong’an Road, Xicheng District, 100050 Beijing, China
| | - Jin Lin
- grid.24696.3f0000 0004 0369 153XDepartment of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong’an Road, Xicheng District, 100050 Beijing, China
| | - De-yuan Zhi
- grid.24696.3f0000 0004 0369 153XDepartment of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong’an Road, Xicheng District, 100050 Beijing, China
| | - Mei-li Duan
- grid.24696.3f0000 0004 0369 153XDepartment of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong’an Road, Xicheng District, 100050 Beijing, China
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Chen Y, Ma XD, Kang XH, Gao SF, Peng JM, Li S, Liu DW, Zhou X, Weng L, Du B. Association of annual hospital septic shock case volume and hospital mortality. Crit Care 2022; 26:161. [PMID: 35659338 PMCID: PMC9166431 DOI: 10.1186/s13054-022-04035-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/26/2022] [Indexed: 12/13/2022] Open
Abstract
Background The burden of sepsis remains high in China. The relationship between case volume and hospital mortality among patients with septic shock, the most severe complication of sepsis, is unknown in China. Methods In this retrospective cohort study, we analyzed surveillance data from a national quality improvement program in intensive care units (ICUs) in China in 2020. Association between septic shock case volume and hospital mortality was analyzed using multivariate linear regression and restricted cubic splines. Results We enrolled a total of 134,046 septic shock cases in ICUs from 1902 hospitals in China during 2020. In this septic shock cohort, the median septic shock volume per hospital was 33 cases (interquartile range 14–76 cases), 41.4% were female, and more than half of the patients were over 61 years old, with average hospital mortality of 21.2%. An increase in case volume was associated with improved survival among septic shock cases. In the linear regression model, the highest quartile of septic shock volume was associated with lower hospital mortality compared with the lowest quartile (β − 0.86; 95% CI − 0.98, − 0.74; p < 0.001). Similar differences were found in hospitals of respective geographic locations and hospital levels. With case volume modeled as a continuous variable in a restricted cubic spline, a lower volume threshold of 40 cases before which a substantial reduction of the hospital mortality rate was observed. Conclusions The findings suggest that hospitals with higher septic shock case volume have lower hospital mortality in China. Further research is needed to explain the mechanism of this volume–outcome relationship. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-04035-8.
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Machine Learning Model to Identify Sepsis Patients in the Emergency Department: Algorithm Development and Validation. J Pers Med 2021; 11:jpm11111055. [PMID: 34834406 PMCID: PMC8623760 DOI: 10.3390/jpm11111055] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/11/2021] [Accepted: 10/18/2021] [Indexed: 12/23/2022] Open
Abstract
Accurate stratification of sepsis can effectively guide the triage of patient care and shared decision making in the emergency department (ED). However, previous research on sepsis identification models focused mainly on ICU patients, and discrepancies in model performance between the development and external validation datasets are rarely evaluated. The aim of our study was to develop and externally validate a machine learning model to stratify sepsis patients in the ED. We retrospectively collected clinical data from two geographically separate institutes that provided a different level of care at different time periods. The Sepsis-3 criteria were used as the reference standard in both datasets for identifying true sepsis cases. An eXtreme Gradient Boosting (XGBoost) algorithm was developed to stratify sepsis patients and the performance of the model was compared with traditional clinical sepsis tools; quick Sequential Organ Failure Assessment (qSOFA) and Systemic Inflammatory Response Syndrome (SIRS). There were 8296 patients (1752 (21%) being septic) in the development and 1744 patients (506 (29%) being septic) in the external validation datasets. The mortality of septic patients in the development and validation datasets was 13.5% and 17%, respectively. In the internal validation, XGBoost achieved an area under the receiver operating characteristic curve (AUROC) of 0.86, exceeding SIRS (0.68) and qSOFA (0.56). The performance of XGBoost deteriorated in the external validation (the AUROC of XGBoost, SIRS and qSOFA was 0.75, 0.57 and 0.66, respectively). Heterogeneity in patient characteristics, such as sepsis prevalence, severity, age, comorbidity and infection focus, could reduce model performance. Our model showed good discriminative capabilities for the identification of sepsis patients and outperformed the existing sepsis identification tools. Implementation of the ML model in the ED can facilitate timely sepsis identification and treatment. However, dataset discrepancies should be carefully evaluated before implementing the ML approach in clinical practice. This finding reinforces the necessity for future studies to perform external validation to ensure the generalisability of any developed ML approaches.
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Gaviria-Mendoza A, Machado-Alba JE, Benítez-Mejía JF, Correa-Ruiz S, Restrepo-López JS, Moreno-Gutiérrez PA, Gómez-González JF. Trends of vasopressor use in intensive care units in Colombia. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2021. [DOI: 10.5554/22562087.e996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction: Vasopressors are essential in the management of various types of shock.
Objective: To establish the trend of vasopressors use in the intensive care units (ICU) in a population of patients affiliated with the Colombian Health System, 2010-2017.
Methods: Observational trial using a population database of patients hospitalized in eleven ICUs in various cities in Colombia. The drugs dispensed to hospitalized patients over 18 years old, from January 2010 until December 2017 were considered. A review and analysis of the vasopressors dispensed per month was conducted, taking into account sociodemographic and pharmacological variables (vasopressor used and daily doses defined per 100/beds/day (DBD).
Results: 81,348 dispensations of vasopressors, equivalent to 26,414 treatments in 19,186 patients receiving care in 11 hospitals from 7 cities were reviewed. The mean age of patients was 66.3±18.1 years and 52.6 % were males. Of the total number of treatments recorded, 17,658 (66.8 %) were with just one vasopressor. Norepinephrine was the most frequently prescribed drug (75.9 % of the prescriptions dispensed; 60.5 DBD), followed by adrenaline (26.6 %; 41.6 DBD), dopamine (19.4%), dobutamine (16.0 %), vasopressin (8.5 %) and phenylephrine (0.9 %). The use of norepinephrine increased from 2010 to 2017 (+6.19 DBD), whilst the use of other drugs decreased, particularly the use of adrenaline (-60.6 DBD) and dopamine (-10.8 DBD).
Conclusions: Norepinephrine is the most widely used vasopressor showing a growing trend in terms of its use during the study period, which is supported by evidence in favor of its effectiveness and safety in patients with shock.
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Garay OU, Guiñazú G, Cornistein W, Farina J, Valentini R, Levy Hara G. Budget impact analysis of using procalcitonin to optimize antimicrobial treatment for patients with suspected sepsis in the intensive care unit and hospitalized lower respiratory tract infections in Argentina. PLoS One 2021; 16:e0250711. [PMID: 33930050 PMCID: PMC8087000 DOI: 10.1371/journal.pone.0250711] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 04/13/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Inappropriate antibiotic use represents a major global threat. Sepsis and bacterial lower respiratory tract infections (LRTIs) have been linked to antimicrobial resistance, carrying important consequences for patients and health systems. Procalcitonin-guided algorithms may represent helpful tools to reduce antibiotic overuse but the financial burden is unclear. The aim of this study was to estimate the healthcare and budget impact in Argentina of using procalcitonin-guided algorithms to guide antibiotic prescription. METHODS A decision tree was used to model health and cost outcomes for the Argentinean health system, over a one-year duration. Patients with suspected sepsis in the intensive care unit and hospitalized patients with LRTI were included. Model parameters were obtained from a focused, non-systematic, local and international bibliographic search, and validated by a panel of local experts. Deterministic and probabilistic sensitivity analyses were performed to analyze the uncertainty of parameters. RESULTS The model predicted that using procalcitonin-guided algorithms would result in 734.5 [95% confidence interval (CI): 1,105.2;438.8] thousand fewer antibiotic treatment days, 7.9 [95% CI: 18.5;8.5] thousand antibiotic-resistant cases avoided, and 5.1 [95% CI: 6.7;4.2] thousand fewer Clostridioides difficile cases. In total, this would save $422.4 US dollars (USD) [95% CI: $935;$267] per patient per year, meaning cost savings of $83.0 [95% CI: $183.6;$57.7] million USD for the entire health system and $0.4 [95% CI: $0.9;$0.3] million USD for a healthcare provider with 1,000 cases per year of sepsis and LRTI patients. The sensitivity analysis showed that the probability of cost-saving for the sepsis patient group was lower than for the LRTI patient group (85% vs. 100%). CONCLUSIONS Healthcare and financial benefits can be obtained by implementing procalcitonin-guided algorithms in Argentina. Although we found results to be robust on an aggregate level, some caution must be used when focusing only on sepsis patients in the intensive care unit.
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Affiliation(s)
- Osvaldo Ulises Garay
- Market Access and Medical Affairs, Roche Diagnostics, Buenos Aires, Argentina
- * E-mail:
| | - Gonzalo Guiñazú
- Ricardo Gutiérrez Children’s Hospital, Buenos Aires, Argentina
| | | | - Javier Farina
- Hospital Cuenca Alta Néstor Kirchner, Buenos Aires, Argentina
| | | | - Gabriel Levy Hara
- Unit of Infectious Diseases, Hospital Carlos G Durand, Buenos Aires, Argentina
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Hagiwara A, Tanaka N, Inaba Y, Gando S, Shiraishi A, Saitoh D, Otomo Y, Ikeda H, Ogura H, Kushimoto S, Kotani J, Sakamoto Y, Shiino Y, Shiraishi SI, Takuma K, Tarui T, Tsuruta R, Nakada TA, Hifumi T, Yamakawa K, Takeyama N, Yamashita N, Abe T, Ueyama M, Okamoto K, Sasaki J, Masuno T, Mayumi T, Fujishima S, Umemura Y, Fujimi S. Predictors of severe sepsis-related in-hospital mortality based on a multicenter cohort study: The Focused Outcomes Research in Emergency Care in Acute Respiratory Distress Syndrome, Sepsis, and Trauma study. Medicine (Baltimore) 2021; 100:e24844. [PMID: 33663106 PMCID: PMC7909210 DOI: 10.1097/md.0000000000024844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 01/28/2021] [Indexed: 01/05/2023] Open
Abstract
This study aimed to identify prognostic factors for severe sepsis-related in-hospital mortality using the structural equation model (SEM) analysis with statistical causality. Sepsis data from the Focused Outcomes Research in Emergency Care in Acute Respiratory Distress Syndrome, Sepsis, and Trauma study (FORECAST), a multicenter cohort study, was used. Forty seven observed variables from the database were used to construct 4 latent variables. SEM analysis was performed on these latent variables to analyze the statistical causality among these data. This study evaluated whether the variables had an effect on in-hospital mortality. Overall, 1148 patients were enrolled. The SEM analysis showed that the 72-hour physical condition was the strongest latent variable affecting mortality, followed by physical condition before treatment. Furthermore, the 72-hour physical condition and the physical condition before treatment strongly influenced the Sequential Organ Failure Assessment (SOFA) score with path coefficients of 0.954 and 0.845, respectively. The SOFA score was the strongest variable that affected mortality after the onset of severe sepsis. The score remains the most robust prognostic factor and can facilitate appropriate policy development on care.
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Affiliation(s)
- Akiyoshi Hagiwara
- Department of Emergency Medicine, Niizashiki Chuo General Hospital, Saitama
| | - Noriko Tanaka
- Biostatistics Section, Department of Data Science, Clinical Science Center, National Center for Global Health and Medicine, Tokyo
| | - Yosuke Inaba
- Biostatistics Section, Department of Data Science, Clinical Science Center, National Center for Global Health and Medicine, Tokyo
| | - Satoshi Gando
- Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, Sapporo
- Department of Acute and Critical Care Medicine, Sapporo Higashi Tokushima Hospital, Sapporo
| | | | - Daizoh Saitoh
- Division of Traumatology, Research Institute, National Defense Medical College, Tokorozawa
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Center, Medical Hospital, Tokyo Medical, and Dental University
| | - Hiroto Ikeda
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka
| | - Shigeki Kushimoto
- Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Miyagi
| | - Joji Kotani
- Department of Disaster and Emergency Medicine, Kobe University Graduate School of Medicine, Kobe
| | - Yuichiro Sakamoto
- Emergency and Critical Care Medicine, Saga University Hospital, Saga
| | - Yasukazu Shiino
- Department of Acute Medicine, Kawasaki Medical School, Kurashiki
| | - Shin-ichiro Shiraishi
- Department of Emergency and Critical Care Medicine, Aizu Chuo Hospital, Aizuwakamatsu
| | - Kiyotsugu Takuma
- Emergency and Critical Care Center, Kawasaki Municipal Kawasaki Hospital, Kawasaki, Kanagawa
| | - Takehiko Tarui
- Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, Mitaka
| | - Ryosuke Tsuruta
- Advanced Medical Emergency & Critical Care Center, Yamaguchi University Hospital, Ube
| | - Taka-aki Nakada
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Chūō, Tokyo
| | - Kazuma Yamakawa
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka
| | - Naoshi Takeyama
- Advanced Critical Care Center, Aichi Medical University Hospital, Aichi
| | - Norio Yamashita
- Advanced Emergency Medical Service Center, Kurume University Hospital, Kurume, Fukuoka
| | - Toshikazu Abe
- Department of General Medicine, Juntendo University, Tokyo
| | - Masashi Ueyama
- Department of Trauma, Critical Care Medicine, and Burn Center, Japan Community Healthcare Organization, Chukyo Hospital, Nagoya, Aichi
| | - Kohji Okamoto
- Department of Surgery, Center for Gastroenterology and Liver Disease, Kitakyushu City Yahata Hospital
| | - Junichi Sasaki
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Shinjuku City
| | - Tomohiko Masuno
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Bunkyo City, Tokyo
| | - Toshihiko Mayumi
- Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka
| | - Seitaro Fujishima
- Center for General Medicine Education, Keio University School of Medicine, Shinjuku City, Tokyo
| | - Yutaka Umemura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine
| | - Satoshi Fujimi
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Japan
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Lundqvist M, Levin LÅ. Cost-Effectiveness of the Use of Gold Anchor™ Markers in Prostate Cancer. Cureus 2020; 12:e11229. [PMID: 33269157 PMCID: PMC7706143 DOI: 10.7759/cureus.11229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction A common treatment for prostate cancer is external beam radiation therapy. A way to target the radiation is to use implantable gold fiducial markers (GFMs). The GFMs serve as reference points enabling tumor localization during treatment. Today, there are several GFMs available on the market but no clinical guidelines as to which one to use. The aim of this study was to estimate the cost-effectiveness of Gold Anchor GFMs (Naslund Medical AB, Huddinge, Sweden) implanted with a 22G needle, compared to other GFMs implanted with a 17-18G needle, in the prostate gland of patients with prostate cancer. Methods Costs, life years, and quality-adjusted life years (QALYs) were estimated over a lifelong time horizon for each treatment strategy using a decision-analytic model. Data used in the model were obtained from published literature or were estimated by an expert elicitation technique. The primary outcome measure was an incremental cost-effectiveness ratio (ICER). Results Gold Anchor GFM was found to be a dominant alternative with both lower costs [-8.7 US Dollars (USD)] and a gain in QALYs (0.015) when compared with other GFMs. The lower cost was achieved by fewer visits for imaging in treatment planning, and by reduced risk of infections and sepsis. The QALY gain was driven by a reduced risk of sepsis. Conclusion The use of Gold Anchor GFMs as reference points to target radiation is a cost-effective alternative when compared to other GFMs. However, this analysis is based on expert elicitation regarding some crucial parameters, and further clinical studies of the use of GFMs are needed.
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Affiliation(s)
- Martina Lundqvist
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, SWE
| | - Lars-Åke Levin
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, SWE
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Abstract
OBJECTIVES We performed a national cross-sectional survey to determine the epidemiologic characteristics of patients with sepsis in ICU in China. DESIGN A cross-section survey study. SETTING Forty-four hospitals in mainland China from December 1, 2015, to January 31, 2016. PATIENTS All septic patients diagnosed according sepsis-1 criteria admitted to participating ICU. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We recorded demographic, physiologic, and microbiological data with follow-up for 90 days or death, if sooner. The frequency of sepsis and 90-day mortality rate were computed, and the relationship with gross domestic product determined. Multivariate logistic regression analysis was used to determine risk factors for 90-day mortality in patients with sepsis. Two-thousand three-hundred twenty-two patients with sepsis were included in the analysis, of whom 786 patients (33.9%) had hospital-acquired sepsis. The most common infection site was the lung (68.2%), followed by abdomen (26.6%) and bloodstream (7.8%). The frequency of sepsis in the ICU was 20.6 cases per 100 ICU admissions (95% CI, 15.8-25.4) with a 90-day mortality of 35.5%. The proportion of sepsis, severe sepsis, and septic shock were 3.10%, 43.6%, and 53.3% with a 90-day mortality of 2.78%, 17.69%, and 51.94%, respectively. Older age, low body weight, higher Sequential Organ Failure Assessment score, the number of systemic inflammatory response syndrome criteria, comorbid with heart failure, hematologic cancer, immunosuppression, higher level of lactate, infection site (pneumonia and bloodstream) were associated with 90-day mortality. CONCLUSIONS Sepsis affects a fifth of patients admitted to ICUs in mainland China with a 90-day mortality rate of 35.5%. Our findings indicate that a large burden of sepsis, and we need to focus on sepsis as a quality improvement target in China given the high mortality. In addition, further studies are needed to delineate the epidemiology of sepsis outside the ICU.
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Singh K, Hariharan S, Ventour D, Chen DR, Merritt-Charles LG, Sookwah M, Maharaj D, Sankar-Maharaj S. Epidemiology and Management Trends of Patients With Sepsis and Septic Shock in the Intensive Care Unit: A Prospective Trial in the Caribbean. Cureus 2020; 12:e10980. [PMID: 33209536 PMCID: PMC7667708 DOI: 10.7759/cureus.10980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objectives To investigate the epidemiology, management, and predictors of mortality in severe sepsis and septic shock in the intensive care units (ICUs) of Trinidad, Trinidad & Tobago. Methods A prospective observational study in four ICUs over a one-year period (August 2017-August 2018) was conducted. Physiologic variables, treatment data, and outcomes were collected on admission to ICU and daily until 28 days. The 28-day mortality and ICU mortality were recorded. Subgroup analysis was performed based on survival, and predictors of mortality were determined through logistic regression. Results Outcome data were available for 163 patients. The 28-day mortality rates for sepsis and septic shock were 42% and 47%, respectively. ICU mortality rate for sepsis was 34%. The most common suspected source of infection was pneumonia (33%). Acute kidney injury (AKI) was common and present in 71% of patients, with renal replacement therapy only being used in 30% of cases. Mechanical ventilation was required in 84% of cases. Moderate-to-severe acute respiratory distress syndrome (ARDS) (OR: 4; 95% CI: 1.9-8.8; p < 0.001) and the development of AKI (all stages) (OR: 10; 95% CI: 3.9-30.2; p < 0.001) were found to be predictive of mortality. Incidence of mechanical ventilation, moderate-to-severe ARDS, stage 3 AKI, septic shock, and failure to achieve a mean arterial pressure of > 60 mmHg within the first 24 hours of admission were higher in patients who did not survive (p < 0.05). Conclusions Sepsis and septic shock are associated with a high 28-day mortality. Organ dysfunction with renal and pulmonary involvement was an important factor in predicting a higher mortality.
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Affiliation(s)
- Keevan Singh
- Anaesthesia and Intensive Care, University of the West Indies, St Augustine, TTO.,Anaesthesia and Intensive Care, San Fernando General Hospital, San Fernando, TTO
| | - Seetharaman Hariharan
- Anaesthesia and Intensive Care, University of the West Indies, St Augustine, TTO.,Anaesthesia and Intensive Care, Eric Williams Medical Sciences Complex, Mt. Hope, TTO
| | - Dale Ventour
- Anaesthesia and Intensive Care, University of the West Indies, St Augustine, TTO.,Anaesthesia and Intensive Care, Eric Williams Medical Sciences Complex, Mt. Hope, TTO
| | - Deryk R Chen
- Anaesthesia and Intensive Care, Eric Williams Medical Sciences Complex, Mt. Hope, TTO
| | - Lorna G Merritt-Charles
- Anaesthesia and Intensive Care, University of the West Indies, St Augustine, TTO.,Anaesthesia and Intensive Care, Eric Williams Medical Sciences Complex, Mt. Hope, TTO
| | - Mark Sookwah
- Anaesthesia and Intensive Care, San Fernando General Hospital, San Fernando, TTO
| | - Daynish Maharaj
- Anaesthesia and Intensive Care, Port of Spain General Hospital, Port of Spain, TTO
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12
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Caceres DH, Rivera SM, Armstrong PA, Escandon P, Chow NA, Ovalle MV, Díaz J, Derado G, Salcedo S, Berrio I, Espinosa-Bode A, Varón C, Stuckey MJ, Mariño A, Villalobos N, Lockhart SR, Chiller TM, Prieto FE, Jackson BR. Case-Case Comparison of Candida auris Versus Other Candida Species Bloodstream Infections: Results of an Outbreak Investigation in Colombia. Mycopathologia 2020; 185:917-923. [PMID: 32860564 DOI: 10.1007/s11046-020-00478-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/14/2020] [Indexed: 10/20/2022]
Abstract
BACKGROUND Candida auris is an emerging multidrug-resistant yeast that causes outbreaks in healthcare settings around the world. In 2016, clinicians and public health officials identified patients with C. auris bloodstream infections (BSI) in Colombian healthcare facilities. To evaluate potential risk factors and outcomes for these infections, we investigated epidemiologic and clinical features of patients with C. auris and other Candida species BSI. METHODS We performed a retrospective case-case investigation in four Colombian acute care hospitals, defining a case as Candida spp. isolated from blood culture during January 2015-September 2016. C. auris BSI cases were compared to other Candida species BSI cases. Odds ratio (OR), estimated using logistic regression, was used to assess the association between risk factors and outcomes. RESULTS We analyzed 90 patients with BSI, including 40 with C. auris and 50 with other Candida species. All had been admitted to the intensive care unit (ICU). No significant demographic differences existed between the two groups. The following variables were independently associated with C. auris BSI: ≥ 15 days of pre-infection ICU stay (OR: 5.62, CI: 2.04-15.5), evidence of severe sepsis (OR: 3.70, CI 1.19-11.48), and diabetes mellitus (OR 5.69, CI 1.01-31.9). CONCLUSION Patients with C. auris BSI had longer lengths of ICU stay than those with other candidemias, suggesting that infections are acquired during hospitalization. This is different from other Candida infections, which are usually thought to result from autoinfection with host flora.
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Affiliation(s)
- Diego H Caceres
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA. .,Center of Expertise in Mycology Radboudumc/CWZ, Nijmegen, The Netherlands.
| | | | | | | | - Nancy A Chow
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | | | - Jorge Díaz
- Instituto Nacional de Salud (INS), Bogotá, Colombia
| | - Gordana Derado
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | | | - Indira Berrio
- Medical and Experimental Mycology Group, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia.,Hospital general de Medellín, Medellín, Colombia
| | | | | | | | | | | | - Shawn R Lockhart
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Tom M Chiller
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
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13
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Epidemiology and burden of sepsis acquired in hospitals and intensive care units: a systematic review and meta-analysis. Intensive Care Med 2020; 46:1536-1551. [PMID: 32591853 PMCID: PMC7381455 DOI: 10.1007/s00134-020-06106-2] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/11/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE Sepsis is recognized as a global public health problem, but the proportion due to hospital-acquired infections remains unclear. We aimed to summarize the epidemiological evidence related to the burden of hospital-acquired (HA) and ICU-acquired (ICU-A) sepsis. METHODS We searched MEDLINE, Embase and the Global Index Medicus from 01/2000 to 03/2018. We included studies conducted hospital-wide or in intensive care units (ICUs), including neonatal units (NICUs), with data on the incidence/prevalence of HA and ICU-A sepsis and the proportion of community and hospital/ICU origin. We did random-effects meta-analyses to obtain pooled estimates; inter-study heterogeneity and risk of bias were assessed. RESULTS Of the 13,239 studies identified, 51 met the inclusion criteria; 22 were from low- and middle-income countries. Twenty-eight studies were conducted in ICUs, 13 in NICUs, and ten hospital-wide. The proportion of HA sepsis among all hospital-treated sepsis cases was 23.6% (95% CI 17-31.8%, range 16-36.4%). In the ICU, 24.4% (95% CI 16.7-34.2%, range 10.3-42.5%) of cases of sepsis with organ dysfunction were acquired during ICU stay and 48.7% (95% CI 38.3-59.3%, range 18.7-69.4%) had a hospital origin. The pooled hospital incidence of HA sepsis with organ dysfunction per 1000 patients was 9.3 (95% CI 7.3-11.9, range 2-20.6)). In the ICU, the pooled incidence of HA sepsis with organ dysfunction per 1000 patients was 56.5 (95% CI 35-90.2, range 9.2-254.4) and it was particularly high in NICUs. Mortality of ICU patients with HA sepsis with organ dysfunction was 52.3% (95% CI 43.4-61.1%, range 30.1-64.6%). There was a significant inter-study heterogeneity. Risk of bias was low to moderate in ICU-based studies and moderate to high in hospital-wide and NICU studies. CONCLUSION HA sepsis is of major public health importance, and the burden is particularly high in ICUs. There is an urgent need to improve the implementation of global and local infection prevention and management strategies to reduce its high burden among hospitalized patients.
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14
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López-Medina DC, Henao-Perez M, Arenas-Andrade J, Hinestroza-Marín ED, Jaimes-Barragán FA, Quirós-Gómez OI. Epidemiology of septic shock in prehospital medical services in five Colombian cities. Rev Bras Ter Intensiva 2020; 32:28-36. [PMID: 32401984 PMCID: PMC7206937 DOI: 10.5935/0103-507x.20200006] [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: 03/14/2019] [Accepted: 09/01/2019] [Indexed: 11/25/2022] Open
Abstract
Objective To explore the association between demographic and clinical factors and the presentation of septic shock in patients treated by prehospital emergency services in five Colombian cities between 2015 and 2016. Methods This was a cross-sectional study with retrospective data collection. Clinical and demographic data were collected from the medical records of patients diagnosed with sepsis who received prehospital care in five Colombian cities in 2015 and 2016. The diagnosis of septic shock was checked in 20% of the cases, generating two analyzed scenarios: observed and verified. Data were analyzed using the chi-square test, Student’s t test and an adjusted logistic regression model. Covariates with p < 0.05 were considered significant. Results There was a higher frequency of septic shock in women (62.6%) and in individuals older than 80 years (64.5%), but these were not differentiating factors for septic shock. The most common source of infection was the urinary tract. In the observed scenario, age over 60 (prevalence ratio (PR): 3.22; 95% confidence interval (CI): 1.45 - 35.01) and history of cancer (PR: 1.20; 95%CI: 1.2 - 12.87) were the characteristics associated with septic shock, whereas in the verified scenario, chronic obstructive pulmonary disease (PR: 1.99; 95%CI: 1.26 - 7.14), history of cancer (PR: 1.15; 95%CI: 1.11 - 6.62) and presence of hypovolemia (PR: 1.41; 95%CI: 1.02 - 5.50) were observed. Conclusion The most important risk factors for septic shock in prehospital care patients in five Colombian cities were oncological and pulmonary diseases and hypovolemia.
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Affiliation(s)
| | - Marcela Henao-Perez
- Facultad de Medicina, Universidad Cooperativa de Colombia, Antioquia, Colombia
| | | | | | | | - Oscar Iván Quirós-Gómez
- División de Salud Pública, Facultad de Medicina, Universidad CES - Medellín, Antioquia, Colombia
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15
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Wełna M, Adamik B, Goździk W, Kübler A. External validation of the sepsis severity score. Int J Immunopathol Pharmacol 2020; 34:2058738420936386. [PMID: 32602801 PMCID: PMC7328217 DOI: 10.1177/2058738420936386] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 06/02/2020] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. Mortality rates are high, exceeding 50% in patients with septic shock. The sepsis severity score (SSS) was developed to determine the severity of sepsis and as a prognostic model. The aim of this study was to externally validate the SSS model. METHODS Calibration and discrimination of the SSS were retrospectively evaluated using data from a single-center sepsis registry. RESULTS Data from 156 septic patients were recorded; 56% of them had septic shock, 94% of patients required mechanical ventilation. The observed hospital mortality was 60.3%. The mean SSS value was 94.4 (95% CI 90.5-98.3). The SSS presented excellent discrimination with an area under the receiver operating characteristic curve (AUC) of 0.806 (95% CI 0.734-0.866). The pairwise comparison of APACHE II (AUC = 0.789; 95% CI 0.715-0.851) with SSS and 1st day SOFA (AUC = 0.75; 95% CI 0.673-0.817) with SSS revealed no significant differences in discrimination between the models. The calibration of the SSS was good with the Hosmer-Lemeshow goodness-of-fit H test 9.59, P > 0.05. Analyses of calibration curve show absence of accurate predictions in lower deciles of lower risk (2nd and 4th). CONCLUSION The SSS demonstrated excellent discrimination. The calibration evaluation gave conflicting results; the H-L test result indicated a good calibration, while the visual analysis of the calibration curve suggested the opposite. The SSS requires further evaluation before it can be safely recommended as an outcome prediction model.
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Affiliation(s)
- Marek Wełna
- Department and Clinic of Anaesthesiology and
Intensive Therapy, Wroclaw Medical University, Wroclaw, Poland
| | - Barbara Adamik
- Department and Clinic of Anaesthesiology and
Intensive Therapy, Wroclaw Medical University, Wroclaw, Poland
| | - Waldemar Goździk
- Department and Clinic of Anaesthesiology and
Intensive Therapy, Wroclaw Medical University, Wroclaw, Poland
| | - Andrzej Kübler
- Department and Clinic of Anaesthesiology and
Intensive Therapy, Wroclaw Medical University, Wroclaw, Poland
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16
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Predictive Validity of Sepsis-3 Definitions and Sepsis Outcomes in Critically Ill Patients: A Cohort Study in 49 ICUs in Argentina. Crit Care Med 2019; 46:1276-1283. [PMID: 29742584 DOI: 10.1097/ccm.0000000000003208] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES The new Sepsis-3 definitions have been scarcely assessed in low- and middle-income countries; besides, regional information of sepsis outcomes is sparse. Our objective was to evaluate Sepsis-3 definition performance in Argentina. DESIGN Cohort study of 3-month duration beginning on July 1, 2016. SETTINGS Forty-nine ICUs. PATIENTS Consecutive patients admitted to the ICU with suspected infection that triggered blood cultures and antibiotic administration. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Patients were classified as having infection, sepsis (infection + change in Sequential Organ Failure Assessment ≥ 2 points), and septic shock (vasopressors + lactate > 2 mmol/L). Patients on vasopressors and lactate less than or equal to 2 mmol/L (cardiovascular dysfunction) were analyzed separately, as those on vasopressors without serum lactate measurement. Systemic inflammatory response syndrome was also recorded. Main outcome was hospital mortality. Of 809 patients, 6% had infection, 29% sepsis, 20% cardiovascular dysfunction, 40% septic shock, and 3% received vasopressors with lactate unmeasured. Hospital mortality was 13%, 20%, 39%, 51%, and 41%, respectively (p = 0.000). Independent predictors of outcome were lactate, Sequential Organ Failure Assessment score, comorbidities, prior duration of symptoms (hr), mechanical ventilation requirement, and infection by highly resistant microorganisms. Area under the receiver operating characteristic curves for mortality for systemic inflammatory response syndrome and Sequential Organ Failure Assessment were 0.53 (0.48-0.55) and 0.74 (0.69-0.77), respectively (p = 0.000). CONCLUSIONS Increasing severity of Sepsis-3 categories adequately tracks mortality; cardiovascular dysfunction subgroup, not included in Sepsis-3, has distinct characteristics. Sequential Organ Failure Assessment score shows adequate prognosis accuracy-contrary to systemic inflammatory response syndrome. This study supports the predictive validity of Sepsis-3 definitions.
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17
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Zeng R, Zheng Y, Fan R, Zhou G, Zhang Y, Mai S, Xie D, Weng Y, Du J, Han Y, Lai F. Si-ni-tang (a Chinese herbal formula) for improving immunofunction in sepsis: study protocol for a pilot randomized controlled trial. Trials 2019; 20:537. [PMID: 31462310 PMCID: PMC6714400 DOI: 10.1186/s13063-019-3646-3] [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: 12/27/2018] [Accepted: 08/10/2019] [Indexed: 12/29/2022] Open
Abstract
Background Immunologic derangement may be the critical pathophysiologic mechanism in sepsis, and immunotherapy might be a potential new treatment. Si-ni-tang (SNT), an ancient Chinese herbal formula documented in Shanghan Lun, has been used for treating severe sepsis for thousands of years. Research shows that it may have a therapeutic benefit for sepsis. This study will evaluate the feasibility of testing the effects of SNT on immune function in sepsis patients. Methods/design This is a pilot randomized controlled study. Eligible sepsis patients admitted to our medical intensive care unit will be randomly allocated to the control group or the SNT group. Both groups will receive standard therapy according to the recommendations of the Surviving Sepsis Campaign. In addition, the SNT group will receive SNT (150 mL per day for 3 days) orally or by gastric tube, while the control group will receive 150 mL of normal saline. The primary outcome is to assess the feasibility of this treatment. The secondary outcomes include: (1) immune function measured by monocyte human leukocyte antigen-DR (mHLA-DR) expression, procalcitonin, and the ratio of CD4+ to CD8+ T lymphocytes and (2) other clinical data, such as the 28-day all-cause mortality, Sequential Organ Failure Assessment (SOFA) scores, Acute Physiology and Chronic Health Evaluation (APACHE) II scores, both of the latter on days 0 and 3. Discussion This study aims to evaluate the feasibility of testing the efficacy of SNT for treating sepsis when used as an adjunctive treatment with the standard therapy recommended by the Surviving Sepsis Campaign. Trial registration ClinicalTrials.gov, NCT02777606. Registered on 22 June 2016. Retrospectively registered. https://clinicaltrials.gov/ Electronic supplementary material The online version of this article (10.1186/s13063-019-3646-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ruifeng Zeng
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.,Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China.,Doctoral student of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.,Guangdong Provincial Key Laboratory of Research on Emergency in TCM, Guangzhou, Guangdong, China
| | - Yi Zheng
- Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong, China
| | - Rongrong Fan
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.,Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China
| | - Gengbiao Zhou
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.,Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yan Zhang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.,Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China
| | - Shutao Mai
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.,Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China
| | - Dongping Xie
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.,Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yanna Weng
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.,Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China
| | - Jiongdong Du
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.,Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yun Han
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.,Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China.,Guangdong Provincial Key Laboratory of Research on Emergency in TCM, Guangzhou, Guangdong, China
| | - Fang Lai
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China. .,Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China. .,Doctoral student of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China. .,Guangdong Provincial Key Laboratory of Research on Emergency in TCM, Guangzhou, Guangdong, China.
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19
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Morello LG, Dalla-Costa LM, Fontana RM, Netto ACSDO, Petterle RR, Conte D, Pereira LA, Krieger MA, Raboni SM. Assessment of clinical and epidemiological characteristics of patients with and without sepsis in intensive care units of a tertiary hospital. EINSTEIN-SAO PAULO 2019; 17:eAO4476. [PMID: 30994701 PMCID: PMC6459321 DOI: 10.31744/einstein_journal/2019ao4476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 11/12/2018] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To describe the clinical and epidemiological features of patients with and without sepsis at critical care units of a public hospital. METHODS A cross-sectional study was carried out from May 2012 to April 2013. Clinical and laboratory data of patients with and without sepsis in the intensive care units were reviewed of medical records. RESULTS We evaluated 466 patients, 58% were men, median age was 40 years, and 146 (31%) of them were diagnosed with sepsis. The overall mortality was 20% being significantly higher for patients with sepsis (39%). The factors associated with intensive care unit mortality were the presence of sepsis (OR: 6.1, 95%CI: 3.7-10.5), age (OR: 3.6, 95%CI: 1.4-7.2), and length of hospital stay (OR: 0.96, 95%CI: 0.94-0.98). Pulmonary (49%) and intra-abdominal (20%) infections were most commonly identified sites, and coagulase-negative staphylococci and enteric Gram negative bacilli the most frequent (66%) pathogens isolated. CONCLUSION Although the impact of sepsis on mortality is related to patients' clinical and epidemiological characteristics, a critical evaluation of these data is important since they will allow the direct implementation of local policies for managing this serious public health problem.
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Affiliation(s)
| | | | | | | | | | - Danieli Conte
- Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | | | | | - Sonia Mara Raboni
- Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
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20
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Todorovic Markovic M, Pedersen C, Gottfredsson M, Todorovic Mitic M, Gaini S. Focus of infection and microbiological etiology in community-acquired infections in hospitalized adult patients in the Faroe Islands. BMC Infect Dis 2019; 19:16. [PMID: 30612543 PMCID: PMC6322335 DOI: 10.1186/s12879-018-3650-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 12/21/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The aim of the present study was to gain national data on the clinical and microbiological characteristics of community-acquired infections in the Faroe Islands and to compare these data with data from other geographical areas. METHODS A prospective, observational study involving all patients > = 16 years admitted at the Department of Medicine at the National Hospital, Torshavn, Faroe Islands from October 2013 until April 2015. RESULTS Of 5279 admissions, 1054 cases were with community-acquired infection and were included in the study. Out of these 1054 cases, 471 did not meet the criteria for SIRS (Systemic Inflammatory Response Syndrome), while the remaining 583 cases had sepsis. Mean age was 68 years. At least one comorbidity was found in 80% of all cases. Documented infections were present in 75%, and a plausible pathogen was identified in 29% of all cases. The most common gram-positive pathogen was Staphylococcus aureus, and the most frequent gram-negative pathogen was Escherichia coli. The most common focus of infection was lower respiratory tract, followed by urinary tract, and skin-soft tissue/bone-joint. Bacteremia was found in 10% of the cases. CONCLUSION In community-acquired infections in hospitalized patients in the Faroe Islands the lower respiratory tract and the urinary tract were the most frequent foci of infection. Gram-negative pathogens and Escherichia coli were the most frequent pathogens in infection without Systemic Inflammatory Response Syndrome, in sepsis and in bacteremia. Our data on clinical characteristics and microbiological etiology provide new information which may be used to develop local guidelines for the managing of patients admitted with community-acquired infections.
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Affiliation(s)
- Marija Todorovic Markovic
- Medical Department, Infectious Diseases Division, National Hospital of the Faroe Islands, JC. Svabosgøta 41-49, Tórshavn, Faroe Islands
- Department of Infectious Diseases, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Court Pedersen
- Department of Infectious Diseases, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Magnús Gottfredsson
- Department of Infectious Diseases, Landspitali University Hospital, Reykjavík, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | | | - Shahin Gaini
- Medical Department, Infectious Diseases Division, National Hospital of the Faroe Islands, JC. Svabosgøta 41-49, Tórshavn, Faroe Islands
- Department of Infectious Diseases, Odense University Hospital and University of Southern Denmark, Odense, Denmark
- Centre of Health Research and Department of Science and Technology, University of the Faroe Islands, Torshavn, Faroe Islands
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21
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Castaño P, Plaza M, Molina F, Hincapié C, Maya W, Cataño J, González J, León A, Jaimes F. Antimicrobial agent prescription: a prospective cohort study in patients with sepsis and septic shock. Trop Med Int Health 2018; 24:175-184. [PMID: 30489005 DOI: 10.1111/tmi.13186] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the true association between appropriate prescription of antibiotics and prognosis in patients with sepsis, a key issue in health care and quality improvement strategies. METHODS Prospective cohort study in three university hospitals to determine whether the empirical prescription of antibiotics was adequate or inadequate, and to compare hospital death rates and length of stay according to different classifications of antibiotics prescription. Logistic regression models for risk estimation were fitted. RESULTS A total of 705 patients with severe sepsis were included. No differences were found in positive-culture patients (n = 545) regarding the risk of death with insufficient spectrum antibiotics, compared to patients who received adequate spectrum antibiotics (OR = 0.90; 95% CI = 0.55-1.48). Delay in initiating antibiotics was not associated with the risk of death in patients with adequate spectrum of antibiotics, either with positive (OR = 1.04; 95% CI = 0.99-1.08) or negative cultures (OR = 0.98; 95% CI = 0.92-1.04). There were no differences in the length of hospital stay, according to the antibiotic prescription (median 11 days, IQR = 7-18 days for the whole cohort). CONCLUSIONS No associations were found between inadequate antibiotic prescription or delay to initiate therapy and mortality or length of stay.
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Affiliation(s)
- Pablo Castaño
- Department of Internal Medicine, Universidad de Antioquia, Medellín, Colombia
| | - Maribel Plaza
- Department of Internal Medicine, Universidad de Antioquia, Medellín, Colombia
| | - Fernando Molina
- GRAEPIC Research Group, Universidad de Antioquia, Medellín, Colombia
| | - Carolina Hincapié
- GRAEPIC Research Group, Universidad de Antioquia, Medellín, Colombia
| | - Wilmar Maya
- Hospital Universitario de San Vicente Fundación, Medellín, Colombia.,Clínica Las Américas, Medellín, Colombia
| | - Juan Cataño
- Department of Internal Medicine, Universidad de Antioquia, Medellín, Colombia.,Clínica CES, Medellín, Colombia
| | | | - Alba León
- GRAEPIC Research Group, Universidad de Antioquia, Medellín, Colombia.,School of Public Health, Universidad de Antioquia, Medellín, Colombia
| | - Fabián Jaimes
- Department of Internal Medicine, Universidad de Antioquia, Medellín, Colombia.,GRAEPIC Research Group, Universidad de Antioquia, Medellín, Colombia.,Research Unit, Hospital Pablo Tobón Uribe, Medellín, Colombia
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22
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Azevedo LCP, Cavalcanti AB, Lisboa T, Pizzol FD, Machado FR. Sepsis is an important healthcare burden in Latin America: a call to action! Rev Bras Ter Intensiva 2018; 30:402-404. [PMID: 30570031 PMCID: PMC6334489 DOI: 10.5935/0103-507x.20180061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 11/08/2018] [Indexed: 12/26/2022] Open
Affiliation(s)
| | | | - Thiago Lisboa
- Instituto Latino Americano de Sepse - São Paulo (SP), Brasil
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Escobar MF, Nasner D, Hurtado CF, Fernández PA, Echavarria MP. Characterization of obstetric patients with sepsis identified by two diagnostic scales at a fourth-level clinic in Colombia. Int J Gynaecol Obstet 2018; 143:71-76. [PMID: 29959769 DOI: 10.1002/ijgo.12580] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 05/11/2018] [Accepted: 06/28/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To compare the characterization of an obstetric population diagnosed with sepsis using systemic inflammatory response syndrome (SIRS) criteria and sepsis-related organ failure assessment (SOFA). METHODS The present retrospective observational descriptive study was conducted at a fourth-level clinic in Colombia among pregnant women who met the inclusion criteria (two SIRS criteria plus infection) between January 1, 2015, and December 31, 2016. Patients with systemic compromise were admitted to the high-complexity obstetric unit (HCOU), whereas those with multiorgan dysfunction were admitted to the intensive care unit (ICU). The SIRS scale was deemed positive if all four criteria were met. A SOFA score of at least 2 was considered a positive result. RESULTS The study included 688 patients. The SIRS test at admission was positive among 431 patients (62.6%); 279 (64.7%) in the HCOU group and 152 (35.2%) in the ICU group. The SOFA test at admission was positive in 69 (38.5%) of 179 patients with complete data. The concordance-measured using the κ statistic-between SIRS and SOFA was low (0.016). CONCLUSION Using the SIRS scale could promote early sepsis management by identifying patients who require admission to the HCOU or ICU; however, low concordance between the SIRS and SOFA results suggested a need to create diagnostic scales specifically for the obstetric population.
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Affiliation(s)
- María F Escobar
- High-Complexity Obstetric Unit, Department of Gynecology and Obstetrics, Fundación Clínica Valle del Lili, Santiago de Cali, Colombia.,Department of Health Sciences, Faculty of Medicine, Icesi University, Santiago de Cali, Colombia
| | - Daniela Nasner
- Department of Health Sciences, Faculty of Medicine, Icesi University, Santiago de Cali, Colombia
| | - Carlos F Hurtado
- Department of Health Sciences, Faculty of Medicine, Icesi University, Santiago de Cali, Colombia
| | - Paula A Fernández
- Clinical Investigation Center, Fundación Clínica Valle del Lili, Santiago de Cali, Colombia
| | - Maria P Echavarria
- High-Complexity Obstetric Unit, Department of Gynecology and Obstetrics, Fundación Clínica Valle del Lili, Santiago de Cali, Colombia.,Department of Health Sciences, Faculty of Medicine, Icesi University, Santiago de Cali, Colombia
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Molina F, Castaño P, Plaza M, Hincapié C, Maya W, Cataño JC, González J, León A, Jaimes F. Positive Culture and Prognosis in Patients With Sepsis: A Prospective Cohort Study. J Intensive Care Med 2018; 35:755-762. [PMID: 29925284 DOI: 10.1177/0885066618783656] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To analyze the prognostic role of positive cultures in patients with sepsis. METHODS A prospective cohort study in a tertiary referral hospital in Medellín, Colombia. Adults older than 18 years of age with a bacterial infection diagnosis according to Centers for Disease Control criteria and sepsis (evidence of organ dysfunction) were included. A logistic regression model was used to determine the association between positive cultures and hospital mortality, and a Cox regression with a competing risk modeling approach was used to determine the association between positive cultures and hospital stay as well as secondary infections. RESULTS Overall, 408 patients had positive cultures, of which 257 were blood culture, and 153 had negative cultures. Patients with positive cultures had a lower risk of mortality (odds ratio [OR], 0.43; 95% confidence interval [CI], 0.27-0.68), but this association was not maintained after adjusting for confounding factors (OR, 0.56; 95% CI, 0.31-1.01). No association was found with the hospital stay (adjusted subhazard ratio [SHR], 1.06; 95% CI, 0.83-1.35). There was no association between positive cultures and the presence of secondary infections (adjusted SHR, 0.99; 95% CI, 0.58-1.71). CONCLUSION Positive cultures are not associated with prognosis in patients with sepsis.
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Affiliation(s)
- Fernando Molina
- GRAEPIC Research Group, Universidad de Antioquia, Medellín, Colombia
| | - Pablo Castaño
- Department of Internal Medicine, Universidad de Antioquia, Medellín, Colombia
| | - Maribel Plaza
- Department of Internal Medicine, Universidad de Antioquia, Medellín, Colombia
| | - Carolina Hincapié
- GRAEPIC Research Group, Universidad de Antioquia, Medellín, Colombia.,Department of Internal Medicine, Universidad de Antioquia, Medellín, Colombia
| | - Wilmar Maya
- Hospital Universitario de San Vicente Fundación, Medellín, Colombia.,Clínica Las Américas, Medellín, Colombia
| | - Juan Carlos Cataño
- Department of Internal Medicine, Universidad de Antioquia, Medellín, Colombia.,Clínica CES, Medellín, Colombia
| | | | - Alba León
- GRAEPIC Research Group, Universidad de Antioquia, Medellín, Colombia.,School of Public Health, Universidad de Antioquia, Medellín, Colombia
| | - Fabián Jaimes
- GRAEPIC Research Group, Universidad de Antioquia, Medellín, Colombia.,Department of Internal Medicine, Universidad de Antioquia, Medellín, Colombia.,Research Unit, Hospital Pablo Tobón Uribe, Medellín, Colombia
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Maekawa H, Negishi K. Extended Sessions of Polymyxin-B Immobilized Fiber Column Hemoperfusion Ameliorate Renal Outcome and Mortality in Septic Shock with Acute Kidney Injury. Blood Purif 2018; 46:81-89. [DOI: 10.1159/000488639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 03/19/2018] [Indexed: 12/21/2022]
Abstract
Background/Aims: Polymyxin-B (PMX) treatment has been reported to decrease mortality in patients with septic shock and acute kidney injury (AKI). In this study, we aimed to evaluate whether extended sessions of PMX (Ext-PMX) immobilized fiber column hemoperfusion ameliorate clinical outcomes in patients complicated with septic shock and AKI without surgical control. Methods: Twenty-two patients with nonsurgical septic shock and AKI who received PMX were included. They were divided according to the duration of PMX treatment: Ext-PMX and standard PMX (Std-PMX). Results: The mean blood pressure increased and inotrope requirement decreased within 24 h after PMX initiation. The median value of predicted mortality was 52.5%, and the 28-day mortalities in the Ext-PMX and Std-PMX groups were 44.4 and 75% respectively. Renal replacement therapy (RRT) was also initiated in 17 patients, and renal insufficiency was recovered. Conclusion: Ext-PMX combined with RRT improved clinical outcomes in patients with nonsurgical septic shock and AKI.
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Epidemiology of sepsis in Brazil: Incidence, lethality, costs, and other indicators for Brazilian Unified Health System hospitalizations from 2006 to 2015. PLoS One 2018; 13:e0195873. [PMID: 29652944 PMCID: PMC5898754 DOI: 10.1371/journal.pone.0195873] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 03/30/2018] [Indexed: 12/20/2022] Open
Abstract
Background Sepsis is considered a major worldwide health burden, with high mortality and associated costs. Health indicators are essential to define strategies to improve the treatment of diseases, and the epidemiology information of sepsis in developing countries is scarce. Thus, the aim of this work is to assess trends in the incidence, lethality, costs, and other indicators of sepsis for Brazilian Unified Health System (SUS—Sistema Único de Saúde) hospitalizations for the period from January 2006 to December 2015. Materials and methods We conducted this study using data from the SUS hospital information system. We selected registries of SUS hospitalizations of patients diagnosed with sepsis (total of 724,458 cases from 4,271 public and private Brazilian hospitals). Results From 2006 to 2015, the annual sepsis incidence increased 50.5% from 31.5/100,000 to 47.4/100,000 persons. The mean hospital length of stay (LOS) was 9.0 days. A total of 29.1% of the hospitalizations had admission to the intensive care unit (ICU) with a mean ICU LOS of 8.0 days. The mean cost per hospitalization was US$624.0 and for hospitalizations requiring intensive care was U$1,708.1. The overall sepsis lethality rate was 46.3%, and for hospitalizations with admission to the ICU, it was 64.5%. During the study period, the lethality rate for children/teenagers decreased 40.1%, but for all other age groups it increased 11.4%. The sepsis lethality rate in public hospitals (55.5%) was higher than private hospitals (37.0%) (p < 0.001). The mean hospitalization LOS for public hospitals (10.3 days) was higher than private hospitals (7.6 days) (p < 0.001). Conclusions The incidence and lethality rate of sepsis increased in SUS hospitalizations during the study period. The SUS’s low reimbursement to hospitals for treating sepsis may be one of the reasons for the high lethality rate.
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Abstract
Sepsis is one of the oldest and complex syndromes in medicine that has been in debate for over two millennia. Valid and comparable data on the population burden of sepsis constitute an essential resource for guiding health policy and resource allocation. Despite current epidemiological data suggesting that the global burden of sepsis is huge, the knowledge of its incidence, prevalence, mortality, and case-fatality rates is subject to several flaws. The objective of this narrative review is to assess how sepsis incidence and mortality can be estimated, providing examples on how it has been done so far in medical literature and discussing its possible biases. Results of recent studies suggest that sepsis incidence rates are increasing consistently during the last decades. Although estimates might be biased, this probably reflects a real increase in incidence over time. Nevertheless, case fatality rates have decreased, which is a probable reflex of advances in critical care provision to this very sick population at high risk of death. This conclusion can only be drawn with a reasonable degree of certainty for high-income countries. Conversely, adequately designed studies from middle- and low-income countries are urgently needed. In these countries, sepsis incidence and case-fatality rates could be disproportionally higher due to health care provision constraints and ineffective preventive measures.
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Montoya-Ruiz C, Jaimes FA, Rugeles MT, López JÁ, Bedoya G, Velilla PA. Variants in LTA, TNF, IL1B and IL10 genes associated with the clinical course of sepsis. Immunol Res 2017; 64:1168-1178. [PMID: 27592234 DOI: 10.1007/s12026-016-8860-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The aim of this study was to explore the association between some SNPs of the TNF, LTA, IL1B and IL10 genes with cytokine concentrations and clinical course in Colombian septic patients. We conducted a cross-sectional study to genotype 415 septic patients and 205 patients without sepsis for the SNPs -308(G/A) rs1800629 of TNF; +252 (G/A) rs909253 of LTA; -511(A/G) rs16944 and +3953(C/T) rs1143634 of IL1B; and -1082(A/G) rs1800896, -819(C/T) rs1800871 and -592(C/A) rs1800872 of IL10. The association of theses SNPs with the following parameters was evaluated: (1) the presence of sepsis; (2) severity and clinical outcomes; (3) APACHE II and SOFA scores; and (4) procalcitonin, C-reactive protein, tumor necrosis factor, lymphotoxin alpha, interleukin 1 beta and interleukin 10 plasma concentrations. We found an association between the SNP LTA +252 with the development of sepsis [OR 1.29 (1.00-1.68)]; the SNP IL10 -1082 with sepsis severity [OR 0.53 (0.29-0.97)]; the TNF -308 with mortality [OR 0.33 (0.12-0.95)]; and the IL10 -592 and IL10 -1082 with admission to the intensive care unit (ICU) [OR 3.36 (1.57-7.18)] and [OR 0.18 (0.04-0.86)], respectively. None of the SNPs were associated with cytokine levels, procalcitonin and C-reactive protein serum concentrations, nor with APACHE II and SOFA scores. Our results suggest that these genetic variants play an important role in the development of sepsis and its clinical course.
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Affiliation(s)
- Carolina Montoya-Ruiz
- Grupo Inmunovirología, Facultad de Medicina, Universidad de Antioquia UdeA, Calle 70 No. 52-21, Medellín, Colombia
| | - Fabián A Jaimes
- Grupo Académico de Epidemiologia Clínica, Facultad de Medicina, Universidad de Antioquia UdeA, Calle 70 No. 52-21, Medellín, Colombia.,Departamento de Medicina Interna, Facultad de Medicina, Universidad de Antioquia UdeA, Calle 70 No. 52-21, Medellín, Colombia.,Unidad de Investigaciones, Hospital Pablo Tobón Uribe Medellín, Calle 78B No. 69-240, Medellín, Colombia
| | - Maria T Rugeles
- Grupo Inmunovirología, Facultad de Medicina, Universidad de Antioquia UdeA, Calle 70 No. 52-21, Medellín, Colombia
| | - Juan Álvaro López
- Escuela de Microbiología, Grupo Inmunodeficiencias Primarias-Facultad de Medicina, Universidad de Antioquia UdeA, Calle 70 No. 52-21, Medellín, Colombia
| | - Gabriel Bedoya
- Grupo Genética Molecular, Universidad de Antioquia UdeA, Calle 70 No. 52-21, Medellín, Colombia
| | - Paula A Velilla
- Grupo Inmunovirología, Facultad de Medicina, Universidad de Antioquia UdeA, Calle 70 No. 52-21, Medellín, Colombia. .,School of Medicine, University of Antioquia, Carrera 53 No. 61-30 Lab. 532, Sede de Investigación Universitaria - SIU, Medellín, Colombia.
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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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Tarui T, Yamaguchi Y, Suzuki K, Tsuruta R, Ikeda H, Ogura H, Kushimoto S, Kotani J, Shiraishi SI, Suzuki Y, Takuma K, Takeyama N, Fujishima S, Mayumi T, Miki Y, Yamashita N, Aikawa N, Gando S. Early evaluation of severity in patients with severe sepsis: a comparison with "septic shock" - subgroup analysis of the Japanese Association for Acute Medicine Sepsis Registry (JAAM-SR). Acute Med Surg 2017; 4:426-431. [PMID: 29123903 PMCID: PMC5649294 DOI: 10.1002/ams2.299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 06/16/2017] [Indexed: 01/20/2023] Open
Abstract
Aim The purpose of this subgroup analysis of a Japanese multicenter registry, the Japanese Association for Acute Medicine Sepsis Registry Advanced (JAAM‐SR‐Advanced), was to identify early outcome indicators for severe sepsis that are useful and more objective than “septic shock.” Methods Among 624 patients with severe sepsis registered in JAAM‐SR‐Advanced, 554 with valid serum lactate data were retrospectively studied. Hypotension before and after fluid resuscitation and the highest lactate values over the initial 24 h were compared for their ability to predict in‐hospital mortality. Results Of the study group, 155 (28.0%) patients were non‐survivors and had significantly lower systolic blood pressures and higher lactate peaks. The mortality of 364 patients with initial hypotension was higher than those patients without it (32.7% versus 19.1%, P < 0.01). Patients with the worst lactate values ≥4 mmol/L had much higher mortality than other patients (P < 0.001). In an attempt to predict outcomes, we combined initial hypotension and the worst lactate values. The patient group with initial hypotension and the worst lactate values ≥4 mmol/L (183 patients, 33.0%) had a significantly higher mortality rate of 48.6% than the other groups (P < 0.01). Conclusion The novel combined criterion of initial hypotension and the worst lactate values ≥4 mmol/L within the initial 24 h is potentially useful as a single outcome predictor for severe sepsis.
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Affiliation(s)
- Takehiko Tarui
- Department of Traumatology and Critical Care Medicine Kyorin University School of Medicine Tokyo Japan.,Japanese Association for Acute Medicine Sepsis Registry (JAAM-SR) Study Group Tokyo Japan
| | - Yoshihiro Yamaguchi
- Department of Traumatology and Critical Care Medicine Kyorin University School of Medicine Tokyo Japan.,Japanese Association for Acute Medicine Sepsis Registry (JAAM-SR) Study Group Tokyo Japan
| | - Koichiro Suzuki
- Japanese Association for Acute Medicine Sepsis Registry (JAAM-SR) Study Group Tokyo Japan
| | - Ryosuke Tsuruta
- Japanese Association for Acute Medicine Sepsis Registry (JAAM-SR) Study Group Tokyo Japan
| | - Hiroto Ikeda
- Japanese Association for Acute Medicine Sepsis Registry (JAAM-SR) Study Group Tokyo Japan
| | - Hiroshi Ogura
- Japanese Association for Acute Medicine Sepsis Registry (JAAM-SR) Study Group Tokyo Japan
| | - Shigeki Kushimoto
- Japanese Association for Acute Medicine Sepsis Registry (JAAM-SR) Study Group Tokyo Japan
| | - Joji Kotani
- Japanese Association for Acute Medicine Sepsis Registry (JAAM-SR) Study Group Tokyo Japan
| | - Shin-Ichiro Shiraishi
- Japanese Association for Acute Medicine Sepsis Registry (JAAM-SR) Study Group Tokyo Japan
| | - Yasushi Suzuki
- Japanese Association for Acute Medicine Sepsis Registry (JAAM-SR) Study Group Tokyo Japan
| | - Kiyotsugu Takuma
- Japanese Association for Acute Medicine Sepsis Registry (JAAM-SR) Study Group Tokyo Japan
| | - Naoshi Takeyama
- Japanese Association for Acute Medicine Sepsis Registry (JAAM-SR) Study Group Tokyo Japan
| | - Seitaro Fujishima
- Japanese Association for Acute Medicine Sepsis Registry (JAAM-SR) Study Group Tokyo Japan
| | - Toshihiko Mayumi
- Japanese Association for Acute Medicine Sepsis Registry (JAAM-SR) Study Group Tokyo Japan
| | - Yasuo Miki
- Japanese Association for Acute Medicine Sepsis Registry (JAAM-SR) Study Group Tokyo Japan
| | - Norio Yamashita
- Japanese Association for Acute Medicine Sepsis Registry (JAAM-SR) Study Group Tokyo Japan
| | - Naoki Aikawa
- Japanese Association for Acute Medicine Sepsis Registry (JAAM-SR) Study Group Tokyo Japan
| | - Satoshi Gando
- Japanese Association for Acute Medicine Sepsis Registry (JAAM-SR) Study Group Tokyo Japan
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Transient Receptor Potential Melastatin 2 Regulates Phagosome Maturation and Is Required for Bacterial Clearance in Escherichia coli Sepsis. Anesthesiology 2017; 126:128-139. [PMID: 27792045 DOI: 10.1097/aln.0000000000001430] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Transient receptor potential melastatin 2 is a Ca-permeable cation channel abundantly expressed in macrophages. Trpm2 mice showed exacerbated infection and mortality during polymicrobial sepsis, which is associated with inefficient bacterial killing in macrophages. However, the mechanism of transient receptor potential melastatin 2 regulating bacterial killing remains unknown. METHODS Trpm2 mice were intraperitoneally injected with Escherichia coli. The survival rate (n = 21) and bacterial burden (n = 5) were assessed. The processes of phagosome maturation and phagosome-lysosome fusion in peritoneal macrophages were extensively studied. The impact of increasing intracellular Ca concentration on bacterial clearance in macrophages (n = 3) and on survival rate of Trpm2 mice infected with E. coli (n = 21) was investigated. RESULTS Trpm2 mice exhibited increased mortality (85% vs. 54%; P < 0.01) and aggravated bacterial burden during E. coli sepsis. Trpm2 peritoneal macrophages infected with E. coli showed dampened recruitment of lysosomal-associated membrane protein 1 and impaired phagosome maturation evidenced by a decrease in the accumulation of early endosome antigen 1, whereas a normal acquisition of Ras-related protein in brain 5. Increasing the cytosolic Ca concentration in Trpm2 peritoneal macrophages via ionomycin treatment facilitated early endosome antigen 1 recruitment to Ras-related protein in brain 5 and phagosomal localization of lysosomal-associated membrane protein 1 and consequently enhanced bactericidal activity. Adoptive transfer of ionomycin-treated Trpm2 peritoneal macrophages improved bacterial clearance and survival (67% vs. 29%; P < 0.01) in Trpm2 mice challenged with E. coli. CONCLUSIONS Transient receptor potential melastatin 2 plays a critical role in host defense against invading bacteria via promoting phagosome maturation through facilitation of early endosome antigen 1 recruitment.
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Yang Y, Xie JF, Yu KJ, Yao C, Li JG, Guan XD, Yan J, Ma XC, Kang Y, Yang CS, Yao XQ, Shang HC, Qiu HB. Epidemiological Study of Sepsis in China: Protocol of a Cross-sectional Survey. Chin Med J (Engl) 2017; 129:2967-2973. [PMID: 27958229 PMCID: PMC5198532 DOI: 10.4103/0366-6999.195474] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background: Sepsis is the leading cause of death among critically ill patients. Herein, we conducted a national survey to provide data on epidemiology and treatment of sepsis in the clinical practice in China, which has no detailed epidemiological data available on sepsis. Methods: This was a prospective cross-sectional survey from December 1, 2015 to January 31, 2016 in all provinces/municipalities of the mainland of China. The primary outcome of this study was the incidence of sepsis, and the secondary outcome was its etiology in China. Patients with sepsis admitted to the Intensive Care Units were included in this study. The demographic, physiological, bacteriological, and therapeutic data of these patients were recorded. The incidence of sepsis was estimated using the data from the sixth census in China, reported by the Chinese National Health and Family Planning Commission and the National Bureau of Statistics as the standard population. The independent risk factors for increased mortality from sepsis were calculated. Conclusions: This study indicated the incidence and outcome of sepsis in China. It also showed the most common etiology of different sites and types of infection, which could guide empiric antibiotic therapy. Moreover, it provided information on the independent risk factors for increased mortality due to sepsis. The findings provide evidence to guide clinical management and may help improve the outcome in septic patients. Trial Registration: ClinicalTrials.gov, NCT02448472; https://clinicaltrials.gov/show/NCT02448472.
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Affiliation(s)
- Yi Yang
- Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, China
| | - Jian-Feng Xie
- Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, China
| | - Kai-Jiang Yu
- Department of Critical Care Medicine, The Third Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150040, China
| | - Chen Yao
- Clinical Research Center, Peking University First Hospital, Beijing 100034, China
| | - Jian-Guo Li
- Department of Critical Care Medicine, Zhongnan Hospital, Wuhan University, Wuhan, Hubei 430071, China
| | - Xiang-Dong Guan
- Department of Surgical Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Jing Yan
- Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, Zhejiang 310030, China
| | - Xiao-Chun Ma
- Department of Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, China
| | - Yan Kang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Cong-Shan Yang
- Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, China
| | - Xiao-Qing Yao
- Tianjin Chase Sun Pharmaceutical Co. Ltd., Tianjin 300170, China
| | - Hong-Cai Shang
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Hai-Bo Qiu
- Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, China
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Giraldo-Ramírez S, Díaz-Portilla OE, Miranda-Arboleda AF, Henao-Sierra J, Echeverri-Toro LM, Jaimes F. Urinary tract infection leading to hospital admission during the first year after kidney transplantation: A retrospective cohort study. TRANSPLANTATION REPORTS 2016. [DOI: 10.1016/j.tpr.2016.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Ruiz GO, Castell CD. Epidemiology of severe infections in Latin American intensive care units. Rev Bras Ter Intensiva 2016; 28:261-263. [PMID: 27737431 PMCID: PMC5051183 DOI: 10.5935/0103-507x.20160051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 04/20/2016] [Indexed: 12/18/2022] Open
Affiliation(s)
- Guillermo Ortiz Ruiz
- Posgrado de Medicina Interna y Neumología,
Universidad el Bosque - Bogotá, Colombia
- Cuidado Critico, Hospital Santa Clara - Bogotá,
Colombia
| | - Carmelo Dueñas Castell
- Universidad de Cartagena - Cartagena, Colombia
- Unidad de Cuidados Intensivos, Gestión Salud,
Linde HealthCare - Bogotá, Colombia
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Abstract
Cardiopulmonary resuscitation in patients with severe sepsis and septic shock is challenging and usually unsuccessful. The aim of the present study is to describe our swine model of cardiac arrest and resuscitation in severe sepsis and septic shock. In this prospective randomized animal study, 10 healthy female Landrace-Large White pigs with an average weight of 20 ± 1 kg (aged 19 - 21 weeks) were the study subjects. Septicemia was induced by an intravenous infusion of a bolus of 20-mL bacterial suspension in 2 min, followed by a continuous infusion during the rest of the experiment. After septic shock was confirmed, the animals were left untreated until cardiac arrest occurred. All animals developed pulseless electrical activity between the fifth and sixth hours of septicemia, whereas five (50%) of 10 animals were successfully resuscitated. Coronary perfusion pressure was statistically significantly different between surviving and nonsurviving animals. We found a statistically significant correlation between mean arterial pressure and unsuccessful resuscitation (P = 0.046), whereas there was no difference in end-tidal carbon dioxide (23.05 ± 1.73 vs. 23.56 ± 1.70; P = 0.735) between animals with return of spontaneous circulation and nonsurviving animals. During the 45-min postresuscitation monitoring, we noted a significant decrease in hemodynamic parameters, although oxygenation indices and lactate clearance were constantly increased (P = 0.001). This successful basic swine model was for the first time developed and may prove extremely useful in future studies on the periarrest period in severe sepsis and septic shock.
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Abstract
This article describes the trends in the incidence of and mortality from sepsis in the United States and globally. The article then discusses the known factors associated with increased risk for developing sepsis and the limitations of the current clinical definition and the clinical correlations of the current epidemiology.
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Affiliation(s)
- Jordan A Kempker
- Division of Pulmonary, Allergy, Sleep and Critical Care Medicine, Emory University School of Medicine, 615 Michael Street, Suite 205, Atlanta, GA 30322, USA.
| | - Greg S Martin
- Division of Pulmonary, Allergy, Sleep and Critical Care Medicine, Emory University School of Medicine, 615 Michael Street, Suite 205, Atlanta, GA 30322, USA
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Shankar-Hari M, Phillips GS, Levy ML, Seymour CW, Liu VX, Deutschman CS, Angus DC, Rubenfeld GD, Singer M. Developing a New Definition and Assessing New Clinical Criteria for Septic Shock: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016; 315:775-87. [PMID: 26903336 PMCID: PMC4910392 DOI: 10.1001/jama.2016.0289] [Citation(s) in RCA: 1348] [Impact Index Per Article: 168.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
IMPORTANCE Septic shock currently refers to a state of acute circulatory failure associated with infection. Emerging biological insights and reported variation in epidemiology challenge the validity of this definition. OBJECTIVE To develop a new definition and clinical criteria for identifying septic shock in adults. DESIGN, SETTING, AND PARTICIPANTS The Society of Critical Care Medicine and the European Society of Intensive Care Medicine convened a task force (19 participants) to revise current sepsis/septic shock definitions. Three sets of studies were conducted: (1) a systematic review and meta-analysis of observational studies in adults published between January 1, 1992, and December 25, 2015, to determine clinical criteria currently reported to identify septic shock and inform the Delphi process; (2) a Delphi study among the task force comprising 3 surveys and discussions of results from the systematic review, surveys, and cohort studies to achieve consensus on a new septic shock definition and clinical criteria; and (3) cohort studies to test variables identified by the Delphi process using Surviving Sepsis Campaign (SSC) (2005-2010; n = 28,150), University of Pittsburgh Medical Center (UPMC) (2010-2012; n = 1,309,025), and Kaiser Permanente Northern California (KPNC) (2009-2013; n = 1,847,165) electronic health record (EHR) data sets. MAIN OUTCOMES AND MEASURES Evidence for and agreement on septic shock definitions and criteria. RESULTS The systematic review identified 44 studies reporting septic shock outcomes (total of 166,479 patients) from a total of 92 sepsis epidemiology studies reporting different cutoffs and combinations for blood pressure (BP), fluid resuscitation, vasopressors, serum lactate level, and base deficit to identify septic shock. The septic shock-associated crude mortality was 46.5% (95% CI, 42.7%-50.3%), with significant between-study statistical heterogeneity (I2 = 99.5%; τ2 = 182.5; P < .001). The Delphi process identified hypotension, serum lactate level, and vasopressor therapy as variables to test using cohort studies. Based on these 3 variables alone or in combination, 6 patient groups were generated. Examination of the SSC database demonstrated that the patient group requiring vasopressors to maintain mean BP 65 mm Hg or greater and having a serum lactate level greater than 2 mmol/L (18 mg/dL) after fluid resuscitation had a significantly higher mortality (42.3% [95% CI, 41.2%-43.3%]) in risk-adjusted comparisons with the other 5 groups derived using either serum lactate level greater than 2 mmol/L alone or combinations of hypotension, vasopressors, and serum lactate level 2 mmol/L or lower. These findings were validated in the UPMC and KPNC data sets. CONCLUSIONS AND RELEVANCE Based on a consensus process using results from a systematic review, surveys, and cohort studies, septic shock is defined as a subset of sepsis in which underlying circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than sepsis alone. Adult patients with septic shock can be identified using the clinical criteria of hypotension requiring vasopressor therapy to maintain mean BP 65 mm Hg or greater and having a serum lactate level greater than 2 mmol/L after adequate fluid resuscitation.
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Affiliation(s)
- Manu Shankar-Hari
- Division of Asthma, Allergy, and Lung Biology, King's College London, London, United Kingdom2Department of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London SE17EH, United Kingdom
| | - Gary S Phillips
- The Ohio State University College of Medicine, Department of Biomedical Informatics, Center for Biostatistics, Columbus
| | - Mitchell L Levy
- Rhode Island Hospital, Brown University School of Medicine, Providence, Rhode Island
| | - Christopher W Seymour
- Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Department of Critical Care and Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Vincent X Liu
- Division of Research, Kaiser Permanente, Oakland, California
| | - Clifford S Deutschman
- Department of Pediatrics, Hofstra-North Shore-Long Island Jewish-Hofstra School of Medicine, Steven and Alexandra Cohen Children's Medical Center, New Hyde Park, New York8Department of Molecular Medicine, Hofstra-North Shore-Long Island Jewish-Hofstra Sch
| | - Derek C Angus
- Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Department of Critical Care and Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania10Associate Editor, JAMA
| | - Gordon D Rubenfeld
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada12Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Mervyn Singer
- Bloomsbury Institute of Intensive Care Medicine, University College London, London, United Kingdom
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Effect of Negative Pressure Therapy on the Inflammatory Response of the Intestinal Microenvironment in a Porcine Septic Model. Mediators Inflamm 2015; 2015:419841. [PMID: 26294849 PMCID: PMC4534613 DOI: 10.1155/2015/419841] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 06/16/2015] [Indexed: 12/20/2022] Open
Abstract
In a swine model of ischemia/reperfusion injury coupled with sepsis, we have previously shown attenuation of secondary organ injury and decreased mortality with negative pressure therapy (NPT). We hypothesized that NPT modulates the intestinal microenvironment by mediating the innate immune system. Sepsis was induced in 12 anesthetized female pigs. Group 1 (n = 6) was decompressed at 12 hrs after injury (T12) and treated with standard of care (SOC), and group 2 (n = 6) with NPT for up to T48. Immunoparalysis was evident as lymphocytopenia at T24 in both groups; however, survival was improved in the NPT group versus SOC (Odds ratio = 4.0). The SOC group showed significant reduction in lymphocyte numbers compared to NPT group by T48 (p < 0.05). The capacity of peritoneal fluid to stimulate a robust reactive oxygen species response in vitro was greater for the NPT group, peaking at T24 for both M1 (p = 0.0197) and M2 macrophages (p = 0.085). Plasma elicited little if any effect which was confirmed by microarray analysis. In this septic swine model NPT appeared to modulate the intestinal microenvironment, facilitating an early robust, yet transient, host defense mediated by M1 and M2 macrophages. NPT may help overcome immunoparalysis that occurs during inflammatory response to septic injury.
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Shaw E, Benito N, Rodríguez-Baño J, Padilla B, Pintado V, Calbo E, Pallarés MA, Gozalo M, Ruiz-Garbajosa P, Horcajada JP. Risk factors for severe sepsis in community-onset bacteraemic urinary tract infection: impact of antimicrobial resistance in a large hospitalised cohort. J Infect 2015; 70:247-54. [PMID: 25305497 DOI: 10.1016/j.jinf.2014.09.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 09/12/2014] [Accepted: 09/15/2014] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To determine risks factors associated with severe sepsis or septic shock (SS) at admission in patients with community-onset bacteraemic urinary tract infection (CO-BUTI) including the impact of multidrug-resistant (MDR) bacteria. METHODS We analysed a prospective cohort of all consecutive episodes of CO-BUTI requiring hospitalisation in 8 tertiary hospitals of Spain between October 2010 and June 2011. RESULTS Of an overall of 525 CO-BUTI episodes, 175 (33%) presented with SS at admission. MDR bacteria were isolated in 29% (51/175) of episodes with SS and in 33% (117/350) of those without SS (p = 0.32). The main MDR microorganism was Escherichia coli in both groups (25% and 28% respectively). Independent risk factors associated with SS at admission were: having fatal underlying conditions, McCabe score II/III (OR 1.90; 95%CI 1.23-2.92; p = 0.004), presence of an indwelling urethral catheter (OR 3.01; 95%CI 1.50-6.03; p = 0.002) and a history of urinary tract obstruction (OR 1.56; 95%CI 1.03-2.34; p = 0.03). After considering interactions, indwelling urethral catheters were a risk factor only for patients without fatal underlying conditions. CONCLUSIONS SS at hospital admission occurred in a third of CO-BUTI. Mainly host factors, and not the causative microorganisms or antimicrobial resistance patterns had an impact on the presence of SS.
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Affiliation(s)
- Evelyn Shaw
- Servicio de Enfermedades Infecciosas, Hospital Universitari de Bellvitge - IDIBELL, Barcelona, Spain.
| | - Natividad Benito
- Servicio de Enfermedades Infecciosas, Hospital de Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Jesús Rodríguez-Baño
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain
| | - Belén Padilla
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital Gregorio Marañón, Madrid, Spain
| | - Vicente Pintado
- Servicio de Enfermedades Infecciosas, Hospital Ramón y Cajal, Madrid, Spain
| | - Esther Calbo
- Servicio de Medicina Interna, Hospital Mútua de Terrassa, Barcelona, Spain
| | | | - Mónica Gozalo
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - Juan Pablo Horcajada
- Servicio de Enfermedades Infecciosas, Hospital Universitari del Mar and Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
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Contenti J, Corraze H, Lemoël F, Levraut J. Effectiveness of arterial, venous, and capillary blood lactate as a sepsis triage tool in ED patients. Am J Emerg Med 2015; 33:167-72. [DOI: 10.1016/j.ajem.2014.11.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 11/01/2014] [Indexed: 11/16/2022] Open
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Gomez HG, Rugeles MT, Jaimes FA. Características inmunológicas claves en la fisiopatología de la sepsis. INFECTIO 2015. [DOI: 10.1016/j.infect.2014.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Taniguchi LU, Bierrenbach AL, Toscano CM, Schettino GPP, Azevedo LCP. Sepsis-related deaths in Brazil: an analysis of the national mortality registry from 2002 to 2010. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:608. [PMID: 25370578 PMCID: PMC4240892 DOI: 10.1186/s13054-014-0608-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 10/20/2014] [Indexed: 12/22/2022]
Abstract
Introduction Limited population-based epidemiologic information about sepsis’ demography, including its mortality and temporal changes is available from developing countries. We investigated the epidemiology of sepsis deaths in Brazil using secondary data from the Brazilian Mortality Information System. Methods Retrospective descriptive analysis of Brazilian multiple-cause-of-death data between 2002 and 2010, with sepsis-associated International Classification of Diseases, 10th Revision (ICD-10) code indicated as the cause of death. Population-based sepsis associated mortality rates and trends were estimated. Annual population-based mortality rates were calculated using age-stratified population estimates from the 2010 census provided by the Brazilian Institute of Geography and Statistics as denominators. Results The total number of annual deaths recorded in Brazil increased over the decade, from 982,294 deaths reported in 2002 to 1,133,761 deaths reported in 2010. The number of sepsis associated deaths also increased both in absolute numbers and proportions from 95,972 (9.77% of total deaths) in 2002 to 186,712 deaths (16.46%) in 2010. The age-adjusted rate of sepsis-associated mortality increased from 69.5 deaths per 100,000 to 97.8 deaths per 100,000 population from 2002 to 2010 (P <0.001). Sepsis-associated mortality was higher in individuals older than 60 years of age as compared to subjects aged 0 to 20 years (adjusted rate ratio 15.7 (95% confidence interval (CI) 15.6 to 15.8)) and in male subjects (1.15 (95% CI 1.15 to 1.16)). Conclusions Between 2002 and 2010 the contribution of sepsis to all cause mortality as reported in multiple-cause-of-death forms increased significantly in Brazil. Age-adjusted mortality rates by sepsis also increased in the last decade. Our results confirm the importance of sepsis as a significant healthcare issue in Brazil. Electronic supplementary material The online version of this article (doi:10.1186/s13054-014-0608-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Leandro U Taniguchi
- Research and Education Institute (IEP), Hospital Sirio-Libanes, Rua Cel, Nicolau dos Santos 69, São Paulo, Brazil. .,Emergency Medicine Discipline, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av Enéas de Carvalho Aguiar 255 Sala 5023, São Paulo, Brazil.
| | - Ana Luiza Bierrenbach
- Research and Education Institute (IEP), Hospital Sirio-Libanes, Rua Cel, Nicolau dos Santos 69, São Paulo, Brazil. .,Sanas Epidemiology and Research, Avenida Paulista 2073, Edifício Horsa 1, salas 703/704, São Paulo, Brazil.
| | - Cristiana M Toscano
- Research and Education Institute (IEP), Hospital Sirio-Libanes, Rua Cel, Nicolau dos Santos 69, São Paulo, Brazil. .,Department of Collective Health, Federal University of Goias, Rua 235 s/n, Goias, Brazil.
| | - Guilherme P P Schettino
- Research and Education Institute (IEP), Hospital Sirio-Libanes, Rua Cel, Nicolau dos Santos 69, São Paulo, Brazil.
| | - Luciano C P Azevedo
- Research and Education Institute (IEP), Hospital Sirio-Libanes, Rua Cel, Nicolau dos Santos 69, São Paulo, Brazil. .,Emergency Medicine Discipline, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av Enéas de Carvalho Aguiar 255 Sala 5023, São Paulo, Brazil.
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Zhou J, Qian C, Zhao M, Yu X, Kang Y, Ma X, Ai Y, Xu Y, Liu D, An Y, Wu D, Sun R, Li S, Hu Z, Cao X, Zhou F, Jiang L, Lin J, Mao E, Qin T, He Z, Zhou L, Du B. Epidemiology and outcome of severe sepsis and septic shock in intensive care units in mainland China. PLoS One 2014; 9:e107181. [PMID: 25226033 PMCID: PMC4167333 DOI: 10.1371/journal.pone.0107181] [Citation(s) in RCA: 126] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 08/07/2014] [Indexed: 02/05/2023] Open
Abstract
Introduction Information about sepsis in mainland China remains scarce and incomplete. The purpose of this study was to describe the epidemiology and outcome of severe sepsis and septic shock in mixed ICU in mainland China, as well as the independent predictors of mortality. Methods We performed a 2-month prospective, observational cohort study in 22 closed multi-disciplinary intensive care units (ICUs). All admissions into those ICUs during the study period were screened and patients with severe sepsis or septic shock were included. Results A total of 484 patients, 37.3 per 100 ICU admissions were diagnosed with severe sepsis (n = 365) or septic shock (n = 119) according to clinical criteria and included into this study. The most frequent sites of infection were the lung and abdomen. The overall ICU and hospital mortality rates were 28.7% (n = 139) and 33.5% (n = 162), respectively. In multivariate analyses, APACHE II score (odds ratio[OR], 1.068; 95% confidential interval[CI], 1.027–1.109), presence of ARDS (OR, 2.676; 95%CI, 1.691–4.235), bloodstream infection (OR, 2.520; 95%CI, 1.142–5.564) and comorbidity of cancer (OR, 2.246; 95%CI, 1.141–4.420) were significantly associated with mortality. Conclusions Our results indicated that severe sepsis and septic shock were common complications in ICU patients and with high mortality in China, and can be of help to know more about severe sepsis and septic shock in China and to improve characterization and risk stratification in these patients.
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Affiliation(s)
- Jianfang Zhou
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Chuanyun Qian
- Department of Emergency Medicine and Medical ICU, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Mingyan Zhao
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiangyou Yu
- Department of Critical Care Medicine, First Affiliated Hospital, Xinjiang Medical University, Urumqi, China
| | - Yan Kang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaochun Ma
- Department of Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yuhang Ai
- Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Yuan Xu
- Department of Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Dexin Liu
- Department of Critical Care Medicine, The Second Hospital of Jilin University, Changchun, China
| | - Youzhong An
- Department of Critical Care Medicine, Peking University People's Hospital, Beijing, China
| | - Dawei Wu
- Department of Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Renhua Sun
- Department of Critical Care Medicine, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Shusheng Li
- Department of Critical Care Medicine, Tongji Hospital of Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Zhenjie Hu
- Department of Critical Care Medicine, Hebei Medical University Fourth Hospital, Shijiazhuang, China
| | - Xiangyuan Cao
- Department of Critical Care Medicine, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Fachun Zhou
- Department of Emergency and Intensive Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Jiang
- Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Jiandong Lin
- Department of Critical Care Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Enqiang Mao
- Emergency ICU, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Tiehe Qin
- Department of Critical Care Medicine, Guangdong General Hospital, Guangzhou, China
| | - Zhenyang He
- Department of Critical Care Medicine, Hainan Provincial People's Hospital, Haikou, China
| | - Lihua Zhou
- Department of Critical Care Medicine, The Affiliated Hospital of Inner Mongolia Medical University, Huhhot, China
| | - Bin Du
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
- * E-mail:
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Li YL, Chan CPY, Sin KK, Chan SSW, Lin PY, Chen XH, Smith BE, Joynt GM, Graham CA, Rainer TH. Validating a pragmatic definition of shock in adult patients presenting to the ED. Am J Emerg Med 2014; 32:1345-50. [PMID: 25227979 DOI: 10.1016/j.ajem.2014.08.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 08/12/2014] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE The importance of the early recognition of shock in patients presenting to emergency departments is well recognized, but at present, there is no agreed practical definition for undifferentiated shock. The main aim of this study was to validate an a priori clinical definition of shock against 28-day mortality. DESIGN, SETTING AND SUBJECTS This prospective, observational, cross-sectional, single-center study was conducted in Hong Kong, China. Data were collected between July 1, 2012, and January 31, 2013. An a priori definition of shock was designed, whereby patients admitted to the resuscitation room or high dependency area of the emergency department were divided into 1 of 3 groups-no shock, possible shock, and shock. The primary outcome was 28-day mortality. Secondary outcomes were in-hospital mortality or admission to the intensive or coronary care unit. MEASUREMENTS AND MAIN RESULTS A total of 111 patients (mean age, 67.2 ± 17.1 years; male = 69 [62%]) were recruited, of which 22 were classified as no shock, 54 as possible shock, and 35 as shock. Systolic blood pressure, mean arterial pressure, lactate, and base deficit correlated well with shock classifications (P < .05). Patients who had 3 or more positively defined shock variables had a 100% poor composite outcome rate (5 of 5). Patients with 2 shock variables had a 66.7% (4 of 6) poor composite outcome rate. CONCLUSIONS A simple, practical definition of undifferentiated shock has been proposed and validated in a group of patients presenting to an emergency department in Hong Kong. This definition needs further validation in a larger population and other settings.
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Affiliation(s)
- Yan-ling Li
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Hong Kong, China; Emergency Department, The Second Affiliated Hospital of Guangzhou Medical University, China.
| | - Cangel Pui-yee Chan
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Hong Kong, China.
| | - King-keung Sin
- Department of Chemistry, The Hong Kong University of Science and Technology, Hong Kong, China.
| | - Stewart S W Chan
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Hong Kong, China.
| | - Pei-yi Lin
- Emergency Department, The Second Affiliated Hospital of Guangzhou Medical University, China.
| | - Xiao-hui Chen
- Emergency Department, The Second Affiliated Hospital of Guangzhou Medical University, China.
| | - Brendan E Smith
- School of Biomedical Science, Charles Sturt University, Bathurst, New South Wales, Australia; Intensive Care Unit, Bathurst Base Hospital, Bathurst, New South Wales, Australia.
| | - Gavin M Joynt
- Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, China.
| | - Colin A Graham
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Hong Kong, China.
| | - Timothy H Rainer
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Hong Kong, China.
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Prise en charge des états septiques sévères chez l’adulte aux urgences. ANNALES FRANCAISES DE MEDECINE D URGENCE 2014. [DOI: 10.1007/s13341-014-0442-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Immunological characterization of compensatory anti-inflammatory response syndrome in patients with severe sepsis: a longitudinal study*. Crit Care Med 2014; 42:771-80. [PMID: 24365860 DOI: 10.1097/ccm.0000000000000100] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To perform a complete immunological characterization of compensatory anti-inflammatory response syndrome in patients with sepsis and to explore the relationship between these changes and clinical outcomes of 28-day mortality and secondary infections. DESIGN Prospective single-center study conducted between April 2011 and December 2012. SETTING ICUs from Hospital Universitario San Vicente Fundación at Medellin, Colombia. PATIENTS One hundred forty-eight patients with severe sepsis. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS At days 0, 1, 3, 5, 10, and 28, we determined the expression of HLA-DR in monocytes and the apoptosis and the proliferation index in T lymphocytes, as well as the levels of tumor necrosis factor-α, interleukin-6, interleukin-1β, interleukin-10, and transforming growth factor-β in both plasma and cell culture supernatants of peripheral blood mononuclear cells. The mean percentage of HLA-DR was 60.7 at enrollment and increased by 0.9% (95% CI, 0.7-1.2%) per day. The mean percentage of CD4 T cells and CD8 T cells AV+/7-AAD- at enrollment was 37.2% and 20.4%, respectively, but it diminished at a rate of -0.5% (95% CI, -0.7% to -0.3%) and -0.3% (95% CI, -0.4% to -0.2%) per day, respectively. Plasma levels of interleukin-6 and interleukin-10 were 290 and 166 pg/mL and decreased at a rate of -7.8 pg/mL (95% CI, -9.5 to -6.1 pg/mL) and -4 pg/mL (95% CI, -5.1 to -2.8 pg/mL) per day, respectively. After controlling for confounders, only sustained plasma levels of interleukin-6 increase the risk of death (hazard ratio 1.003; 95% CI, 1.001-1.006). CONCLUSIONS We found no evidence to support a two-phase model of sepsis pathophysiology. However, immunological variables did behave in a mixed and time-dependent manner. Further studies should evaluate changes over time of interleukin-6 plasma levels as a prognostic biomarker for critically ill patients.
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Papanikolaou J, Makris D, Mpaka M, Palli E, Zygoulis P, Zakynthinos E. New insights into the mechanisms involved in B-type natriuretic peptide elevation and its prognostic value in septic patients. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:R94. [PMID: 24887309 PMCID: PMC4075117 DOI: 10.1186/cc13864] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Accepted: 04/28/2014] [Indexed: 01/09/2023]
Abstract
Introduction Elevated plasma B-type natriuretic peptide (BNP) levels in patients with critical sepsis (severe sepsis and septic shock) may indicate septic cardiomyopathy. However, multiple heterogeneous conditions may also be involved in increased BNP level. In addition, the prognostic value of BNP in sepsis remains debatable. In this study, we sought to discover potential independent determinants of BNP elevation in critical sepsis. The prognostic value of BNP was also evaluated. Methods In this observational study, we enrolled mechanically ventilated, critically septic patients requiring hemodynamic monitoring through a pulmonary artery catheter. All clinical, laboratory and survival data were prospectively collected. Plasma BNP concentrations were measured daily for five consecutive days. Septic cardiomyopathy was assessed on day 1 on the basis of left and right ventricular ejection fractions (EF) derived from echocardiography and thermodilution, respectively. Mortality was recorded at day 28. Results A total of 42 patients with severe sepsis (N = 12) and septic shock (N = 30) were ultimately enrolled. Daily BNP levels were significantly elevated in septic shock patients compared with those with severe sepsis (P ≤0.002). Critical illness severity (assessed by Acute Physiology and Chronic Health Evaluation II and maximum Sequential Organ Failure Assessment scores), and peak noradrenaline dose on day 1 were independent determinants of BNP elevation (P <0.05). Biventricular EFs were inversely correlated with longitudinal BNP measurements (P <0.05), but not independently. Pulmonary capillary wedge pressures (PCWP) and volume expansion showed no correlation with BNP. In septic shock, increased central venous pressure (CVP) and CVP/PCWP ratio were independently associated with early BNP values (P <0.05). Twenty-eight-day mortality was 47.6% (20 of 42 patients). Daily BNP values poorly predicted outcome; BNP on day 1 > 800 pg/ml (the best cutoff point) fairly predicted mortality, with a sensitivity%, specificity% and area under the curve values of 65, 64 and 0.70, respectively (95% confidence interval = 0.54 to 0.86; P = 0.03). Plasma BNP levels declined faster in survivors than in nonsurvivors in both critical sepsis and septic shock (P ≤0.002). In septic shock, a BNP/CVP ratio >126 pg/mmHg/ml on day 2 and inability to reduce BNP <500 pg/ml implied increased mortality (P ≤0.036). Conclusions The severity of critical illness, rather than septic cardiomyopathy, is probably the major determinant of BNP elevation in patients with critical sepsis. Daily BNP values are of limited prognostic value in predicting 28-day mortality; however, fast BNP decline over time and a decrease in BNP <500 pg/ml may imply a favorable outcome.
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Cerro L, Valencia J, Calle P, León A, Jaimes F. [Validation of APACHE II and SOFA scores in 2 cohorts of patients with suspected infection and sepsis, not admitted to critical care units]. ACTA ACUST UNITED AC 2014; 61:125-32. [PMID: 24468009 DOI: 10.1016/j.redar.2013.11.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 11/19/2013] [Accepted: 11/28/2013] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To validate the APACHE II and SOFA scores in patients with suspected infection in clinical settings other than intensive care units. MATERIALS AND METHODS A secondary analysis was performed on 2,530 adult patients participating in 2 cohort studies, with suspected infection as admission diagnosis within the first 24 h of hospitalization. The performance of both scoring systems was studied in order to set calibration and discrimination, respectively, on the outcomes such as mortality, admission to Intensive Care Unit, development of septic shock, or multiple organ dysfunctions. RESULTS The AUC-ROC values for mortality at discharge and on day 28 in the first cohort were around 0.50 for the SOFA and APACHE II scores; whereas for the second cohort the discrimination value was around 0.70. Calibration of both scoring systems for primary outcomes, according to Hosmer-Lemeshow test, showed p>.05 in the first cohort; while in the second cohort calibration it only showed a p>.05 in the case of the SOFA for mortality at hospital discharge. CONCLUSION This validation study of SOFA and APACHE II scores in patients with suspected infection in-hospital units other than the Intensive Care Unit, showed no consistent performance for calibration and discrimination. Its application in emergency and in-hospital patients is limited.
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Affiliation(s)
- L Cerro
- Grupo Académico de Epidemiología Clínica, Departamento de Medicina Interna, Universidad de Antioquia, Medellín, Colombia
| | - J Valencia
- Grupo Académico de Epidemiología Clínica, Departamento de Medicina Interna, Universidad de Antioquia, Medellín, Colombia
| | - P Calle
- Grupo Académico de Epidemiología Clínica, Departamento de Medicina Interna, Universidad de Antioquia, Medellín, Colombia
| | - A León
- Grupo Académico de Epidemiología Clínica, Departamento de Medicina Interna, Universidad de Antioquia, Medellín, Colombia
| | - F Jaimes
- Grupo Académico de Epidemiología Clínica, Departamento de Medicina Interna, Universidad de Antioquia, Medellín, Colombia.
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Profile of the risk of death after septic shock in the present era: an epidemiologic study. Crit Care Med 2013; 41:2600-9. [PMID: 23963127 DOI: 10.1097/ccm.0b013e31829a6e89] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate mortality of ICU patients over a 3-month period after an initial episode of septic shock and to identify factors associated with mortality. DESIGN Prospective multicenter observational cohort study. SETTING Fourteen ICUs from 10 French nonacademic and university teaching hospitals. PATIENTS All consecutive adult patients with septic shock admitted between October 2009 and September 2011 were eligible. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS Multivariable analyses were performed using a Cox proportional hazard model and a flexible extension of the Cox model. In total, 1,495 of 10,941 patients (13.7%) had septic shock and 1,488 patients (99.5%) were included. Median age was 68 years (range, 58-78 yr). The majority of admissions (84%) were medical. Median (interquartile range) Simplified Acute Physiological Score II and Sequential Organ Failure Assessment were, respectively, 56 (45-70) and 11 (9-14). ICU and hospital mortality were, respectively, 39.4% and 48.6%. At 3 months, 776 patients (52.2%) had died. Factors significantly associated with increased risk of death in the multivariable Cox model were older age, male sex, comorbidities (immune deficiency, cirrhosis), Knaus C/D score, and high Sequential Organ Failure Assessment score. Flexible analyses indicated that the impact of Sequential Organ Failure Assessment score was greatest early after septic shock, while the onset of the effect of age, nosocomial infection, and cirrhosis was later. CONCLUSIONS This is the most recent large-scale epidemiological study to investigate medium-term mortality in nonselected patients hospitalized in the ICU for septic shock. Advances in early management have improved survival at the initial phase, but risk of death persists in the medium term. Flexible modeling techniques yield insights into the profile of the risk of death in the first 3 months.
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50
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Ogura H, Gando S, Saitoh D, Takeyama N, Kushimoto S, Fujishima S, Mayumi T, Araki T, Ikeda H, Kotani J, Miki Y, Shiraishi SI, Suzuki K, Suzuki Y, Takuma K, Tsuruta R, Yamaguchi Y, Yamashita N, Aikawa N. Epidemiology of severe sepsis in Japanese intensive care units: a prospective multicenter study. J Infect Chemother 2013; 20:157-62. [PMID: 24530102 DOI: 10.1016/j.jiac.2013.07.006] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 06/07/2013] [Accepted: 07/28/2013] [Indexed: 11/28/2022]
Abstract
Severe sepsis is a leading cause of morbidity and mortality in the intensive care unit (ICU). We conducted a prospective multicenter study to evaluate epidemiology and outcome of severe sepsis in Japanese ICUs. The patients were registered at 15 general critical care centers in Japanese tertiary care hospitals when diagnosed as having severe sepsis. Of 14,417 patients, 624 (4.3%) were diagnosed with severe sepsis. Demographic and clinical characteristics at enrollment (Day 1), physiologic and blood variables on Days 1 and 4, and mortality were evaluated. Mean age was 69.0 years, and initial mean Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores were 23.4 and 8.6, respectively. The 28-day mortality was 23.1%, and overall hospital mortality was 29.5%. SOFA score and disseminated intravascular coagulation (DIC) score were consistently higher in nonsurvivors than survivors on Days 1 and 4. SOFA score, DIC score on Days 1 and 4, and hospital mortality were higher in patients with than without septic shock. SOFA score on Days 1 and 4 and hospital mortality were higher in patients with than without DIC. Logistic regression analyses showed age, presence of septic shock, DIC, and cardiovascular dysfunction at enrollment to be predictors of 28-day mortality and presence of comorbidity to be an additional predictor of hospital mortality. Presence of septic shock or DIC resulted in approximately twice the mortality of patients without each factor, whereas the presence of comorbidity may be a significant predictor of delayed mortality in severe sepsis.
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Affiliation(s)
- Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan.
| | - Satoshi Gando
- Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, Kita 2 jou Nishi 5, Kitaku, Sapporo, Hokkaido 060-8638, Japan
| | - Daizoh Saitoh
- Division of Traumatology, Research Institute, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan
| | - Naoshi Takeyama
- Department of Emergency and Acute Intensive Care Medicine, Fujita Health University, Dengakugakubo 1-98, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan
| | - Shigeki Kushimoto
- Division of Emergency Medicine, Tohoku University Graduate School of Medicine, Seiryoumachi 2-1, Aobaku, Sendai, Miyagi 980-8575, Japan
| | - Seitaro Fujishima
- Department of Emergency & Critical Care Medicine, School of Medicine, Keio University, Shinanomachi 35, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Toshihiko Mayumi
- Emergency Center, Department of Emergency and Critical Care Medicine, Ichinomiya Municipal Hospital, Bunkyo 2-2-22, Ichinomiya, Aichi 491-8558, Japan
| | - Tsunetoshi Araki
- Department of Emergency & Critical Care Medicine, Trauma Center St. Mary's Hospital, Tsubukuhonmachi 422, Kurume, Fukuoka 830-8543, Japan
| | - Hiroto Ikeda
- Department of Emergency Medicine, Trauma and Resuscitation Center, Teikyo University School of Medicine, Kaga 2-11-1, Itabashi-ku, Tokyo 173-8606, Japan
| | - Joji Kotani
- Department of Emergency, Critical Care and Disaster Medicine, Hyogo College of Medicine, Mukogawa 1-1, Nishinomiya, Hyogo 663-8501, Japan
| | - Yasuo Miki
- Advanced Critical Care Center, Aichi Medical University Hospital, Yazakokarimata 1-1, Nagakute, Aichi 480-1195, Japan
| | - Shin-Ichiro Shiraishi
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Sendagi 1-1-5, Bunkyou-ku, Tokyo 113-8603, Japan
| | - Koichiro Suzuki
- Department of Acute Medicine, Kawasaki Medical School, Matsushima 577, Kurashiki, Okayama 701-0114, Japan
| | - Yasushi Suzuki
- Department of Critical Care Medicine, Iwate Medical University, Uchimaru 19-1, Morioka, Iwate 020-8505, Japan
| | - Kiyotsugu Takuma
- Emergency & Critical Care Center, Kawasaki Municipal Hospital, Shinkawadori 12-1, Kawasaki-ku, Kawasaki, Kanagawa 210-0013, Japan
| | - Ryosuke Tsuruta
- Advanced Medical Emergency & Critical Care Center, Yamaguchi University Hospital, Minamikogushi 1-1-1, Ube, Yamaguchi 755-8505, Japan
| | - Yoshihiro Yamaguchi
- Department of Trauma & Critical Care Medicine, Kyorin University, School of Medicine, Shinkawa 6-20-2, Mitaka, Tokyo 181-8611, Japan
| | - Norio Yamashita
- Department of Emergency & Critical Care Medicine, School of Medicine, Kurume University, Asahimachi 67, Kurume, Fukuoka 830-0011, Japan
| | - Naoki Aikawa
- Department of Emergency & Critical Care Medicine, School of Medicine, Keio University, Shinanomachi 35, Shinjuku-ku, Tokyo 160-8582, Japan
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