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Liu C, Wang Y. DEVELOPMENT AND VALIDATION OF A MODEL FOR PREDICTION OF SEPTIC SHOCK IN NEONATES WITH SEPSIS. Shock 2024; 62:173-178. [PMID: 38661178 DOI: 10.1097/shk.0000000000002380] [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: 04/26/2024]
Abstract
ABSTRACT Purpose: This study aimed to develop and validate a model for prediction of septic shock in neonates with sepsis. Materials and methods: This retrospective study included early-onset septic neonates in the Renmin Hospital of Wuhan University between January 2017 and June 2021. The neonates were divided into the training set and the validation set in a ratio of 7:3 and further categorized into septic shock group and none-shock group according to presence or absence of shock symptoms. Results: A total of 406 septic neonates were enrolled, including 217 in septic shock group. Sex (odds ratio [OR] = 0.092, 95% confidence interval [CI]: 0.012 to 0.683, P = 0.020), C-reactive protein at 6 h (OR = 8.475, 95% CI: 3.154 to 22.774, P < 0.001), serum amyloid A at 6 h (OR = 1.179, 95% CI: 1.094 to 1.269, P < 0.01), white blood cells at 6 h (OR = 0.173, 95% CI: 0.092 to 0.326, P < 0.001), platelets at 6 h (OR = 0.985, 95% CI: 0.975 to 0.995, P < 0.001), and Ca 2+ at 6 h (OR = 1.44 × 10 11 , 95% CI: 2.70 × 10 6 to 7.70 × 10 15 , P < 0.001) were identified as independent risk factors for septic shock and were further included in the nomogram. The areas under the receiver operator characteristic curve were 0.873 and 0.920 in training and validation sets, respectively. Conclusions: A predictive model for early diagnosis of septic shock in neonates was developed and initially validated in this study, allowing for timely intervention.
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Kondo A, Morinishi T, Yamaguchi Y, Ikegame A. Identification of organs of origin of macrophages that produce presepsin via neutrophil extracellular trap phagocytosis. Sci Rep 2024; 14:16386. [PMID: 39013974 PMCID: PMC11252129 DOI: 10.1038/s41598-024-66916-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 07/05/2024] [Indexed: 07/18/2024] Open
Abstract
Presepsin (P-SEP) is a specific biomarker for sepsis. Monocytes produce P-SEP by phagocytosing neutrophil extracellular traps (NETs). Herein, we investigated whether M1 macrophages (M1 MΦs) are the primary producers of P-SEP after NET phagocytosis. We co-cultured M1 MΦs and NETs from healthy participants, measured P-SEP levels in the culture medium supernatant, and detected P-SEP using western blotting. When NETs were co-cultured with M1 MΦs, the P-SEP level of the culture supernatant was high. Notably, we demonstrated, for the first time, the intracellular kinetics of P-SEP production by M1 MΦs via NET phagocytosis: M1 MΦs produced P-SEP intracellularly 15 min after NET phagocytosis and then released it extracellularly. In a sepsis mouse model, the blood NET ratio and P-SEP levels, detected using ELISA, were significantly increased (p < 0.0001). Intracellular P-SEP analysis via flow cytometry demonstrated that lung, liver, and kidney MΦs produced large amounts of P-SEP. Therefore, we identified these organs as the origin of M1 MΦs that produce P-SEP during sepsis. Our data indicate that the P-SEP level reflects the trend of NETs, suggesting that monitoring P-SEP can be used to both assess NET-induced organ damage in the lungs, liver, and kidneys during sepsis and determine treatment efficacy.
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Affiliation(s)
- Akihiro Kondo
- Laboratory of Hematology, Department of Medical Technology, Kagawa Prefectural University of Health Sciences, 281-1, Hara, Mure-cho, Takamatsu, Kagawa, 761-0123, Japan.
| | - Tatsuya Morinishi
- Laboratory of Pathology, Department of Medical Technology, Kagawa Prefectural University of Health Sciences, Takamatsu, Kagawa, Japan
| | - Yusuke Yamaguchi
- Laboratory of Hematology, Department of Medical Technology, Kagawa Prefectural University of Health Sciences, 281-1, Hara, Mure-cho, Takamatsu, Kagawa, 761-0123, Japan
| | - Akishige Ikegame
- Laboratory of Hematology, Department of Medical Technology, Kagawa Prefectural University of Health Sciences, 281-1, Hara, Mure-cho, Takamatsu, Kagawa, 761-0123, Japan
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Gatto A, Mantani L, Gola C, Pansini V, Di Sarno L, Capossela L, Ferretti S, Graglia B, Chiaretti A. Presepsin Levels in Pediatric Patients with Fever and Suspected Sepsis: A Pilot Study in an Emergency Department. CHILDREN (BASEL, SWITZERLAND) 2024; 11:594. [PMID: 38790589 PMCID: PMC11119862 DOI: 10.3390/children11050594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/07/2024] [Accepted: 05/11/2024] [Indexed: 05/26/2024]
Abstract
Sepsis is a life-threatening condition that affects 1.2 million children annually. Although there are several criteria for diagnosing this condition, signs are often nonspecific, and identifying sepsis is challenging. In this context, presepsin (P-SEP) seems to be a promising new biomarker since its plasma levels increase earlier than other sepsis-related proteins and its measurement is faster. We enrolled 157 minors who presented to the Pediatric Emergency Department of Agostino Gemelli Hospital with fever and suspected sepsis. Biochemical, anamnestic, and clinical data were collected. Viral agents were identified as the causative factor in 64 patients, who had an average P-SEP value of 309.04 pg/mL (SD ± 273.2), versus an average P-SEP value of 526.09 pg/mL (SD ± 657) found in 27 bacterial cases (p value: 0.0398). Four cases of overt sepsis had an average P-SEP value of 3328.5 pg/mL (SD ± 1586.6). The difference in P-SEP levels in viral versus bacterial infections was found to be statistically significant; therefore, P-SEP may have a central role in the evaluation of febrile children, helping clinicians distinguish between these two etiologies. Furthermore, amongst the cases of confirmed sepsis, P-SEP was always greater than 2000 pg/mL, while C-reactive protein and procalcitonin values appeared lower than what was considered significant.
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Affiliation(s)
- Antonio Gatto
- Department of Pediatrics, Fondazione Policlinico Universitario A. Gemelli—IRCCS, 00168 Rome, Italy;
| | - Lucia Mantani
- Department of Pediatrics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (L.M.); (C.G.); (L.D.S.); (L.C.); (S.F.); (B.G.)
| | - Caterina Gola
- Department of Pediatrics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (L.M.); (C.G.); (L.D.S.); (L.C.); (S.F.); (B.G.)
| | - Valeria Pansini
- Department of Pediatrics, Fondazione Policlinico Universitario A. Gemelli—IRCCS, 00168 Rome, Italy;
| | - Lorenzo Di Sarno
- Department of Pediatrics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (L.M.); (C.G.); (L.D.S.); (L.C.); (S.F.); (B.G.)
| | - Lavinia Capossela
- Department of Pediatrics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (L.M.); (C.G.); (L.D.S.); (L.C.); (S.F.); (B.G.)
| | - Serena Ferretti
- Department of Pediatrics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (L.M.); (C.G.); (L.D.S.); (L.C.); (S.F.); (B.G.)
| | - Benedetta Graglia
- Department of Pediatrics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (L.M.); (C.G.); (L.D.S.); (L.C.); (S.F.); (B.G.)
| | - Antonio Chiaretti
- Department of Women’s Health Sciences, Fondazione Policlinico Universitario A. Gemelli—IRCCS, 00168 Rome, Italy;
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Yue J, Zhao H, Li J, Wu J, Zheng R. Knowledge, attitudes and practices towards the diagnosis and management of paediatric sepsis among paediatric physicians and nurses: a cross-sectional study of 21 hospitals in Hubei Province, China. BMJ Open 2024; 14:e079411. [PMID: 38417965 PMCID: PMC10900314 DOI: 10.1136/bmjopen-2023-079411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 02/14/2024] [Indexed: 03/01/2024] Open
Abstract
OBJECTIVES To evaluate the knowledge, attitudes and practices towards diagnosing and managing paediatric sepsis among paediatric physicians and nurses. DESIGN A cross-sectional, questionnaire-based study. SETTING 21 hospitals in Hubei Province between February 2023 and March 2023. PARTICIPANTS Paediatric physicians and nurses. INTERVENTIONS None. PRIMARY AND SECONDARY OUTCOME MEASURES The questionnaire contained 35 items across four dimensions (demographic information, knowledge, attitude and practice). RESULTS The study included 295 participants (173 women). The average knowledge, attitude and practice scores were 10.93±2.61 points (possible range, 0-20 points), 32.22±2.65 points (possible range, 7-35 points) and 36.54±5.24 points (possible range, 9-45 points), respectively. Knowledge had a direct influence on both attitude (β=0.240, 95% CI 0.136 to 0.365, p=0.009) and practice (β=0.278, 95% CI 0.084 to 0.513, p=0.010), which also indirectly influenced practice through attitude (β=0.162, 95% CI 0.078 to 0.290, p=0.007). Attitude directly influenced practice (β=0.677, 95% CI 0.384 to 0.902, p=0.025). A higher attitude score was associated with good practice (OR=1.392; 95% CI 1.231 to 1.576; p<0.001), while not working in a tertiary hospital reduced the odds of good practice (OR=0.443; 95% CI 0.2390.821; p=0.010). CONCLUSIONS The knowledge regarding paediatric sepsis, especially knowledge about sepsis management, is poor among paediatric physicians and nurses in Hubei Province. The findings of this study may facilitate the development and implementation of training programmes to improve the diagnosis and management of paediatric sepsis.
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Affiliation(s)
- Jing Yue
- Department of Emergence, Hubei Province Women and Children Hospital, Wuhan, Hubei, China
| | - Hui Zhao
- Department of Emergence, Hubei Province Women and Children Hospital, Wuhan, Hubei, China
| | - Jie Li
- Department of Emergence, Hubei Province Women and Children Hospital, Wuhan, Hubei, China
| | - Jiannan Wu
- Department of Emergence, Hubei Province Women and Children Hospital, Wuhan, Hubei, China
| | - Ronghao Zheng
- Department of Pediatric Nephrology, Rheumatology, and Immunology, Maternal and Child Health Hospital of Hubei Province, Wuhan, Hubei, China
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Casalta H, Bayrou C, Djebala S, Eppe J, Gille L, Gommeren K, Marduel E, Sartelet A, Seys C, Versyp J, Grulke S. Evaluation of Blood Lactate, Heart Rate, Blood Pressure, and Shock Index, and Their Association with Prognosis in Calves. Vet Sci 2024; 11:45. [PMID: 38275927 PMCID: PMC10819515 DOI: 10.3390/vetsci11010045] [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: 11/14/2023] [Revised: 12/26/2023] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
Diseases in young calves received as emergencies are often associated with hypovolemic and/or septic shocks. The objectives of our study were to (1) assess the correlation between clinical hemodynamic parameters and blood L-lactates (LAC), systolic blood pressure (SBP), and the shock index (SI) recorded upon arrival; and (2) to evaluate how these parameters were related to short-term outcomes in calves under 4 months of age presented as emergencies. We conducted a single-observer prospective observational study on calves aged from 1 day to 4 months, presented to the Veterinary Clinic for Ruminants of Liège from December 2020 to May 2022. Forty-five calves were included in the study. The statistical analysis revealed a significant correlation between LAC and heart rate (r = 0.570; p < 0.05) and LAC and SI (r = 0.373; p < 0.05). A high LAC value at admission was significantly associated with a negative outcome (death) (p < 0.05). In calves suffering from obstructive digestive diseases, the SI was related to the outcome and the analysis indicated a cut-off value of 1.13 (Se = 0.77, Spe = 1). In conclusion, in our study, the initial blood L-lactate value was correlated with heart rate, the shock index, and the clinical shock score, and admission hyperlactatemia was associated with a poor prognosis in calves under 4 months of age. In this cohort, the shock index in calves suffering from digestive diseases was linked with mortality.
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Affiliation(s)
- Hélène Casalta
- Clinical Department of Production Animals, Faculty of Veterinary Medicine, University of Liège, 4000 Liège, Belgium; (C.B.); (J.E.); (A.S.); (C.S.); (J.V.)
| | - Calixte Bayrou
- Clinical Department of Production Animals, Faculty of Veterinary Medicine, University of Liège, 4000 Liège, Belgium; (C.B.); (J.E.); (A.S.); (C.S.); (J.V.)
| | - Salem Djebala
- Independent Researcher, Muckerstaff Granard, N39AN52 Co Longford, Ireland;
| | - Justine Eppe
- Clinical Department of Production Animals, Faculty of Veterinary Medicine, University of Liège, 4000 Liège, Belgium; (C.B.); (J.E.); (A.S.); (C.S.); (J.V.)
| | - Linde Gille
- Independent Researcher, 1170 Watermael-Boitsfort, Belgium
| | - Kris Gommeren
- Clinical Department of Companions Animals, Faculty of Veterinary Medicine, University of Liège, 4000 Liège, Belgium;
| | - Eva Marduel
- Independent Researcher, 44200 Nantes, France;
| | - Arnaud Sartelet
- Clinical Department of Production Animals, Faculty of Veterinary Medicine, University of Liège, 4000 Liège, Belgium; (C.B.); (J.E.); (A.S.); (C.S.); (J.V.)
| | - Celine Seys
- Clinical Department of Production Animals, Faculty of Veterinary Medicine, University of Liège, 4000 Liège, Belgium; (C.B.); (J.E.); (A.S.); (C.S.); (J.V.)
| | - Jérôme Versyp
- Clinical Department of Production Animals, Faculty of Veterinary Medicine, University of Liège, 4000 Liège, Belgium; (C.B.); (J.E.); (A.S.); (C.S.); (J.V.)
| | - Sigrid Grulke
- Clinical Department of Equines, Faculty of Veterinary Medicine, University of Liège, 4000 Liège, Belgium;
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Ding X, Liang W, Xia H, Liu Y, Liu S, Xia X, Zhu X, Pei Y, Zhang D. Analysis of Immune and Prognostic-Related lncRNA PRKCQ-AS1 for Predicting Prognosis and Regulating Effect in Sepsis. J Inflamm Res 2024; 17:279-299. [PMID: 38229689 PMCID: PMC10790647 DOI: 10.2147/jir.s433057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/07/2023] [Indexed: 01/18/2024] Open
Abstract
Background Sepsis was a high mortality and great harm systemic inflammatory response syndrome caused by infection. lncRNAs were potential prognostic marker and therapeutic target. Therefore, we expect to screen and analyze lncRNAs with potential prognostic markers in sepsis. Methods Transcriptome sequencing and limma was used to screen dysregulated RNAs. Key RNAs were screened by correlation analysis, lncRNA-mRNA co-expression and weighted gene co-expression network analysis. Immune infiltration, gene set enrichment analysis and gene set variation analysis were used to analyze the immune correlation. Kaplan-Meier curve, receiver operator characteristic curve, Cox regression analysis and nomogram were used to analyze the correlation between key RNAs and prognosis. Sepsis model was established by lipopolysaccharide-induced HUVECs injury, and then cell viability and migration ability were detected by cell counting kit-8 and wound healing assay. The levels of apoptosis-related proteins and inflammatory cytokines were detected by RT-qPCR and Western blot. Reactive Oxygen Species and superoxide dismutase were detected by commercial kit. Results Fourteen key differentially expressed lncRNAs and 663 key differentially expressed genes were obtained. And these lncRNAs were closely related to immune cells, especially T cell activation, immune response and inflammation. Subsequently, Subsequently, lncRNA PRKCQ-AS1 was identified as the regulator for further investigation in sepsis. RT-qPCR results showed that PRKCQ-AS1 expression was up-regulated in clinical samples and sepsis model cells, which was an independent prognostic factor in sepsis patients. Immune correlation analysis showed that PRKCQ-AS1 was involved in the immune response and inflammatory process of sepsis. Cell function tests confirmed that PRKCQ-AS1 could inhibit sepsis model cells viability and promote cell apoptosis, inflammatory damage and oxidative stress. Conclusion We constructed immune-related lncRNA-mRNA regulatory networks in the progression of sepsis and confirmed that PRKCQ-AS1 is an important prognostic factor affecting the progression of sepsis and is involved in immune response.
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Affiliation(s)
- Xian Ding
- Department of Emergency, Third Affiliated Hospital of Naval Medical University, Shanghai, People’s Republic of China
| | - Wenqi Liang
- Department of Emergency, Shanghai Changhai Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Hongjuan Xia
- Department of Emergency, Third Affiliated Hospital of Naval Medical University, Shanghai, People’s Republic of China
| | - Yuee Liu
- Department of Emergency, Shanghai Changhai Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Shuxiong Liu
- Department of Emergency, Third Affiliated Hospital of Naval Medical University, Shanghai, People’s Republic of China
| | - Xinyu Xia
- Department of Emergency, Third Affiliated Hospital of Naval Medical University, Shanghai, People’s Republic of China
| | - Xiaoli Zhu
- Department of Emergency, Third Affiliated Hospital of Naval Medical University, Shanghai, People’s Republic of China
| | - Yongyan Pei
- School of Chemistry and Chemical Engineering, Guangdong Pharmaceutical University, Zhongshan, People’s Republic of China
| | - Dewen Zhang
- Longhua Clinical Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
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Xie F, Wang L, Chen L, Li S, Shen Q, Li X, Liu T, Chen Y, Wang D. Clinical Characteristics of Pediatric Patients With Septic Shock Caused by Acute Appendicitis: A Case Series. Pediatr Emerg Care 2023; 39:511-515. [PMID: 37083643 PMCID: PMC10317293 DOI: 10.1097/pec.0000000000002946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
OBJECTIVES This study aimed to explore the clinical characteristics of septic shock in pediatric patients caused by acute appendicitis. METHODS This case series included patients with septic shock caused by acute appendicitis in Beijing Children's Hospital between January 2015 and December 2020. RESULTS Six patients with septic shock caused by acute appendicitis were enrolled. One patient was an infant with extremely low weight; 2 patients were obese. The diagnosis was delayed in 4 patients (the time from onset to diagnosis was 5 days in 3 children and 4 days in 1 child). All patients had abnormally raised inflammatory markers (C-reactive protein 119.17 ± 48.36 mg/L, procalcitonin 129.95 ± 86.09 ng/mL). Severe abdominal infection was found in all patients. There was appendix perforation in 4 patients and diffused peritonitis in 3 patients. Two patients had metabolic diseases (Wilson disease and decreased biotinase activity, respectively). Five patients had an appendectomy and 1 patient received conservative treatment. Five patients were discharged in stable condition, while 1 patient died. CONCLUSIONS Children with delayed diagnosis, abnormal body weight, significant elevation in inflammatory markers, and underlying metabolic disease may be at greater risk of complicated appendicitis and septic shock. EVIDENCEBASED MEDICINE Level of Evidence: IV.
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Affiliation(s)
| | - Li Wang
- From the Departments of Emergency Surgery
| | - Long Chen
- From the Departments of Emergency Surgery
| | | | | | | | | | - Yongwei Chen
- Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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Forget A, Adegboye C, Alfieri M, Yim R, Flaherty K, Mathur H, O'Connell AE. A sepsis trigger tool reduces time to antibiotic administration in the NICU. J Perinatol 2023; 43:806-812. [PMID: 36813901 DOI: 10.1038/s41372-023-01636-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 02/06/2023] [Accepted: 02/13/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVE Prolonged time to antibiotic administration is associated with increased morbidity and mortality. Interventions to decrease the time to antibiotic administration may improve mortality and morbidity. STUDY DESIGN We identified possible change concepts for reducing time to antibiotic usage in the NICU. For the initial intervention, we developed a sepsis screening tool based on NICU-specific parameters. The main goal of the project was to reduce time to antibiotic administration by 10%. RESULTS The project was conducted from April 2017 until April 2019. There were no missed cases of sepsis in the project period. Time to antibiotic administration for patients who were started on antibiotics decreased during the project, with the mean shifting from 126 to 102 min, a reduction of 19%. CONCLUSIONS We successfully reduced time to antibiotic delivery in our NICU using a trigger tool to identifying potential cases of sepsis in the NICU environment. The trigger tool requires broader validation.
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Affiliation(s)
- Avery Forget
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Comfort Adegboye
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Maria Alfieri
- Department of Pediatrics Quality Program, Boston Children's Hospital, Boston, MA, USA
| | - Ramy Yim
- Department of Pediatrics Quality Program, Boston Children's Hospital, Boston, MA, USA
| | | | - Himi Mathur
- Department of Pediatrics Quality Program, Boston Children's Hospital, Boston, MA, USA
| | - Amy E O'Connell
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA.
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
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Zou Z, Yu J, Huang R, Yu J. Cx43-Delivered miR-181b Negatively Regulates Sirt1/FOXO3a Signalling Pathway-Mediated Apoptosis on Intestinal Injury in Sepsis. Digestion 2023; 104:370-380. [PMID: 37231890 DOI: 10.1159/000529102] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 01/09/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Gap junctions can transmit signals between cells, including miRNAs, leading to the amplification of adjacent cell damage. No previous study has addressed gap junctions and miRNAs in sepsis because the internal mechanism of sepsis-induced intestinal injury is complex. Therefore, we studied the relationship between connexin43 (Cx43) and miR-181b and provided a research direction for further study of sepsis. METHODS A mouse caecal ligation and puncture method was used to construct a mouse sepsis model. Firstly, damage to intestinal tissues at different time points was analysed. The levels of Cx43, miR-181b, Sirt1, and FOXO3a in intestinal tissues and the transcription and translation of the apoptosis-related genes Bim and puma, which are downstream of FOXO3a were analysed. Secondly, the effect of Cx43 levels on miR-181b and Sirt1/FOXO3a signalling pathway activity was explored by using the Cx43 inhibitor heptanol. Finally, luciferase assays were used to determine miR-181b binding to the predicted target sequence. RESULTS The results show that during sepsis, intestinal injury becomes increasingly worse with time, and the expression of Cx43 and miR-181b increase. In addition, we found that heptanol could significantly reduce intestinal injury. This finding indicates that inhibiting Cx43 regulates the transfer of miR-181b between adjacent cells, thereby reducing the activity of the Sirt1/FOXO3a signalling pathway and reducing the degree of intestinal injury during sepsis. CONCLUSIONS In sepsis, the enhancement of Cx43 gap junctions leads to an increase in miR-181b intercellular transfer, affects the downstream SIRT1/FOXO3a signalling pathway and causes cell and tissue damage.
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Affiliation(s)
- Zhaowei Zou
- Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jianyang Yu
- Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Renli Huang
- Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jinlong Yu
- Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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Downey D, Graber K, Lajoie D, Newman L, Weinstock P. Setting the Stage: Innovation in Port Access Education for Pediatric Emergency Nurses. J Emerg Nurs 2023:S0099-1767(23)00002-8. [PMID: 36872198 DOI: 10.1016/j.jen.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/12/2023] [Accepted: 01/17/2023] [Indexed: 03/06/2023]
Abstract
INTRODUCTION Pediatric port access can be challenging in the emergency department; however, it must be performed promptly and safely. Port education for nurses traditionally includes procedural practice on adult-size, tabletop manikins, which lacks the situational and emotional aspects inherent in pediatrics. The purpose of this foundational study was to describe the knowledge and self-efficacy gain from a simulation curriculum that promotes effective situational dialogue and sterile port access technique, while incorporating a wearable port trainer to enhance simulation fidelity. METHODS An educational intervention impact study was conducted using a curriculum integrating a comprehensive didactic session with simulation. A unique element included a novel port trainer worn by a standardized patient, along with a second actor portraying a distressed parent at the bedside. Participants completed precourse and postcourse surveys on the day of simulation and a 3-month follow-up survey. Sessions were video recorded for review and content analysis. RESULTS Thirty-four pediatric emergency nurses participated in the program and demonstrated an overall increase in knowledge and self-efficacy with port access that was sustained at the 3-month follow-up. Data revealed positive feedback regarding the participants' simulation experience. DISCUSSION Effective port access education for nurses requires a comprehensive curriculum integrating procedural aspects and situational techniques to address the components of a true port access experience involving pediatric patients and families. Our curriculum successfully combined skill-based practice with situational management, and promoted nursing self-efficacy and competence with port access in the pediatric population.
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Gill M, Raghu V, Ferguson E, Marcinick A, Rosen J, Butler G, Horvat C, Crowley K. Reduction in Antibiotic Delivery Time Following Improving Pediatric Sepsis Outcomes Quality Improvement Initiative at a Major Children's Hospital. J Pediatr Pharmacol Ther 2023; 28:55-62. [PMID: 36777976 PMCID: PMC9901321 DOI: 10.5863/1551-6776-28.1.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 02/23/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Sepsis causes morbidity and mortality in pediatric patients, but timely antibiotic administration can improve sepsis outcomes. The pharmacy department can affect the time from order to delivery of antibiotics. By evaluating the pharmacy process, this study aimed to decrease the time from antibiotic order to delivery to within 45 minutes. METHODS All antibiotic orders placed following a positive sepsis screen for acute care patients at a freestanding children's hospital from April 1, 2019, to December 31, 2019, were reviewed. Lean Six Sigma methodology including process mapping was used to identify and implement improvements, including educational interventions for providers. Outcome measures included time from antibiotic order placement to delivery and to administration. Additional assessment of process measures included evaluation of order priority, PowerPlan (an internally created order set) use, and delivery method. RESULTS Ninety-eight antibiotic orders for 85 patients were evaluated. In an individual chart of antibiotic delivery time, a trend towards faster delivery time was observed after interventions. Stat orders (40.5 minutes [IQR, 19.5-48]) were delivered more quickly than routine orders (51 minutes [IQR, 45-65]; p < 0.001). Orders using the PowerPlan (20.5 minutes [IQR, 18.5-38]) were delivered more quickly than those that did not (47 minutes [IQR, 34-64]; p < 0.01). Shorter time to administration was observed with pneumatic tube delivery (41 minutes [IQR, 20-50]) than with direct delivery to a health care provider (51 minutes [IQR, 31-83]; p < 0.05) or to the automated dispensing cabinet's refrigerator (47 minutes [IQR, 41-62]; p < 0.0001). CONCLUSIONS Multifactorial coordinated interventions within the pharmacy department improve medication delivery time for pediatric sepsis antibiotic orders.
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Affiliation(s)
- Meghan Gill
- Department of Pharmacy (EF, KC, MG), UPMC Children's Hospital of Pittsburgh
| | - Vikram Raghu
- Department of Pediatrics (VR, JR), UPMC Children's Hospital of Pittsburgh, PA
| | - Elizabeth Ferguson
- Department of Pharmacy (EF, KC, MG), UPMC Children's Hospital of Pittsburgh
| | - Adrienne Marcinick
- Health Informatics (AM, GB, CH), UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Johanna Rosen
- Department of Pediatrics (VR, JR), UPMC Children's Hospital of Pittsburgh, PA
| | - Gabriella Butler
- Health Informatics (AM, GB, CH), UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Christopher Horvat
- Pediatric Critical Care Medicine (CH), UPMC Children's Hospital of Pittsburgh, PA,Health Informatics (AM, GB, CH), UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Kelli Crowley
- Department of Pharmacy (EF, KC, MG), UPMC Children's Hospital of Pittsburgh
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12
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Evaluation Value and Clinical Significance of Cardiac Troponin Level and Pediatric Sequential Organ Failure Score in the Definition of Sepsis 3.0 in Critically Ill Children. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:9492178. [PMID: 35983521 PMCID: PMC9381193 DOI: 10.1155/2022/9492178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/04/2022] [Accepted: 07/14/2022] [Indexed: 11/17/2022]
Abstract
Objective A case-control study was conducted to explore the value and clinical significance of troponin level and pediatric sequential organ failure score in the evaluation of sepsis 3.0 definition in critically ill children. Methods 180 children with sepsis who were admitted to the ICU from March 2019 to June 2021 were enrolled in our hospital as the research objects. In addition, 100 children with general infection did not meet the diagnostic criteria of systemic inflammatory response syndrome (SIRS) as controls. The creatine kinase MB (CK-MB) and cardiac troponin I (cTnI) data at the 1st and 24-72 h after admission to pediatric intensive care unit (PICU) were enrolled as the observation indexes of myocardial enzymology. In the meantime, the relevant literature was reviewed to obtain the indicators related to sepsis death. The data of the first examination in the medical history data were enrolled for analysis. According to the definition of sepsis 3.0 in critically ill children, they were assigned into sepsis and nonsepsis group. According to the survival outcome of discharge and 30 days after discharge, the patients were assigned into the death subgroup and survival subgroup and were assigned into the sequential organ failure assessment (SOFA) score ≥ 2 subgroup and< 2 subgroup according to SOFA score. COX proportional hazard regression was used to analyze the relationship between CK-MB, cTnI, and SOFA scores and prognosis. ROC curve was adopted to analyze the value of CK-MB, cTnI, and SOFA scores in the evaluation of critical sepsis in children. Results Univariate analysis indicated that the prognosis of children with sepsis was correlated with abnormal levels of CK-MB and cTnI, SOFA score, oxygenation index < 200, mean arterial pressure, and Glasgow coma scale (GCS), and the difference was statistically significant (P < 0.05). The results of COX regression analysis indicated that the variables that were remarkably associated with death from sepsis in children were CK-MB, elevated cTnI levels, and SOFA score ≥ 2, and serum cTnI and/or CK-MB levels and SOFA score were remarkably higher correlation (r = 0.453, P < 0.05). In terms of the myocardial enzyme levels in the sepsis group and the nonsepsis group, the levels of CK-MB and (or) cTnI augmented in 121/180 cases (67.22%) in the sepsis group and in 19/100 cases (19.00%) in the nonsepsis group. The levels of CK-MB and (or) cTnI were augmented, and the difference was statistically significant (P < 0.05). The levels of CK-MB and cTnI in the sepsis group at admission to ICU and 24 to 72 hours after admission were remarkably higher compared to the nonsepsis group. The levels of CK-MB and cTnI at 24-72 h were higher compared to ICU. The myocardial enzyme levels of different SOFA scores and survival outcome subgroups in the sepsis group were compared. The subgroup with SFOA score ≥ 2 points had remarkably higher levels of CK-MB and (or) cTnI than the subgroup with <2 points. The survival subgroup of CK-MB and cTnI level was remarkably higher compared to the death subgroup, the CK-MB and cTnI levels in each subgroup at 224-72 hours were remarkably higher compared to the ICU, and the difference was statistically significant (P < 0.05). Kaplan-Meier method and log-rank test indicated that the survival rates of groups 1 to 4 at 30 days were 33.23%, 78.71%, 40.03%, and 100.00%, respectively. The average survival time and their 95% CI were 12.82 d (10.52~ 16.26 d), 22.34 d (18.76~ 25.81 d), 14.65 d (11.62~ 16.38 d), and 30 d (30.00~ 30.00 d), respectively. Pairwise comparison indicated that the survival time of children in group 1 was the shortest, and that in group 4 was the longest. The results of ROC curve research showed that the CK-MB, cTnI, and SOFA scores and AUC for the combination test were 0.778 (95% CI 0.642–0.914), 0.736 (95% CI 0.602–0.890), 0.848 (95% CI 0.733–0.963), and 0.934 (95% CI 0.854–0.999), respectively. The AUC of combined diagnosis was remarkably higher compared to single factor prediction, and the difference was statistically significant (P < 0.05). Predictive value showed the joint test > SOFA score > CK − MB > cTnI. Conclusion Troponin level and pediatric SOFA score can be adopted as effective indicators to assess the severity and prognosis of patients with sepsis and can guide the formulation of a reasonable treatment plan.
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13
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Perina V, Szaraz D, Harazim H, Urik M, Klabusayova E. Paediatric Deep Neck Infection—The Risk of Needing Intensive Care. CHILDREN 2022; 9:children9070979. [PMID: 35883963 PMCID: PMC9315740 DOI: 10.3390/children9070979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/19/2022] [Accepted: 06/28/2022] [Indexed: 11/16/2022]
Abstract
Deep neck infections are potentially dangerous complications of upper respiratory tract or odontogenic infections. The pathophysiology, clinical presentation, and potential spreading depend on the complex anatomy of the neck fascia. These infections can lead to severe pathological conditions, such as mediastinitis, sepsis, and especially airway impairment with difficult management. Because of the risk of life-threatening emergency situations and the possible impacts on the overall health status of affected children, their early recognition is of utmost importance. Torticollis, drooling, and stridor are the most common signs of advancing disease. Children presenting with these symptoms should be admitted to the paediatric intensive care unit for vital function monitoring, where the airway could be readily secured if function is compromised.
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Affiliation(s)
- Vojtech Perina
- Department of Oral and Maxillofacial Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Jihlavska 20, 625 00 Brno, Czech Republic; (V.P.); (D.S.)
| | - David Szaraz
- Department of Oral and Maxillofacial Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Jihlavska 20, 625 00 Brno, Czech Republic; (V.P.); (D.S.)
| | - Hana Harazim
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic;
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
| | - Milan Urik
- Department of Paediatric Otorhinolaryngology, University Hospital Brno, Faculty of Medicine, Masaryk University, Cernopolni 9, 662 63 Brno, Czech Republic;
| | - Eva Klabusayova
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic;
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
- Correspondence: ; Tel.: +420-532-234-693
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14
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Presepsin production in monocyte/macrophage-mediated phagocytosis of neutrophil extracellular traps. Sci Rep 2022; 12:5978. [PMID: 35396366 PMCID: PMC8993807 DOI: 10.1038/s41598-022-09926-y] [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: 02/10/2022] [Accepted: 03/30/2022] [Indexed: 12/22/2022] Open
Abstract
Presepsin, a biomarker discovered in Japan, has been clinically applied as a diagnostic aid for sepsis. Recently, however, it has been reported that presepsin levels are elevated in patients with severe systemic lupus erythematosus without infection, suggesting the existence of a production mechanism that does not involve bacterial phagocytosis. In this study, we aimed to elucidate the mechanism of presepsin production without bacterial phagocytosis and explore the clinical significance of presepsin. Neutrophil extracellular traps (NETs) were induced by Escherichia coli and phorbol myristate acetate (PMA) in neutrophils isolated from the peripheral blood of healthy subjects. NET induction alone did not increase presepsin levels, but co-culturing with monocytes significantly increased them. The addition of a NET formation inhibitor also suppressed presepsin levels, suggesting that presepsin production is greatly influenced by monocyte phagocytosis of NETs. Phagocytosis of NETs by THP-1 and U937 cells, which was induced by CD14 expression, also increased presepsin levels. This study suggests that presepsin can be used to assess the severity of inflammatory diseases, such as autoimmune diseases, and monitor treatment effects.
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15
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Borensztajn D, Hagedoorn NN, Carrol E, von Both U, Dewez JE, Emonts M, van der Flier M, de Groot R, Herberg J, Kohlmaier B, Levin M, Lim E, Maconochie I, Martinon Torres F, Nijman R, Pokorn M, Rivero-Calle I, Tsolia M, Vermont C, Zavadska D, Zenz W, Zachariasse J, Moll HA. Characteristics and management of adolescents attending the ED with fever: a prospective multicentre study. BMJ Open 2022; 12:e053451. [PMID: 35046001 PMCID: PMC8772429 DOI: 10.1136/bmjopen-2021-053451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Most studies on febrile children have focused on infants and young children with serious bacterial infection (SBI). Although population studies have described an increased risk of sepsis in adolescents, little is known about febrile adolescents attending the emergency department (ED). We aimed to describe patient characteristics and management of febrile adolescents attending the ED. DESIGN AND SETTING The MOFICHE/PERFORM study (Management and Outcome of Febrile Children in Europe/Personalised Risk assessment in Febrile illness to Optimise Real-life Management across the European Union), a prospective multicentre study, took place at 12 European EDs. Descriptive and multivariable regression analyses were performed, comparing febrile adolescents (12-18 years) with younger children in terms of patient characteristics, markers of disease severity (vital signs, clinical alarming signs), management (diagnostic tests, therapy, admission) and diagnosis (focus, viral/bacterial infection). RESULTS 37 420 encounters were included, of which 2577 (6.9%) were adolescents. Adolescents were more often triaged as highly urgent (38.9% vs 34.5%) and described as ill appearing (23.1% vs 15.6%) than younger children. Increased work of breathing and a non-blanching rash were present less often in adolescents, while neurological signs were present more often (1% vs 0%). C reactive protein tests were performed more frequently in adolescents and were more often abnormal (adjusted OR (aOR) 1.7, 95% CI 1.5 to 1.9). Adolescents were more often diagnosed with SBI (OR 1.8, 95% CI 1.6 to 2.0) and sepsis/meningitis (OR 2.3, 95% CI 1.1 to 5.0) and were more frequently admitted (aOR 1.3, 95% CI 1.2 to 1.4) and treated with intravenous antibiotics (aOR 1.7, 95% CI 1.5 to 2.0). CONCLUSIONS Although younger children presented to the ED more frequently, adolescents were more often diagnosed with SBI and sepsis/meningitis. Our data emphasise the importance of awareness of severe infections in adolescents.
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Affiliation(s)
- Dorine Borensztajn
- Department of Pediatrics, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Nienke N Hagedoorn
- Department of Pediatrics, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Enitan Carrol
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Ulrich von Both
- Division of Paediatric Infectious Diseases, Munich University Hospital Dr von Hauner Children's Hospital, Munchen, Germany
| | - Juan Emmanuel Dewez
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Marieke Emonts
- Paediatric Immunology, Infectious Diseases and Allergy, Newcastle upon Tyne Hospitals NHS Foundation Trust, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Michiel van der Flier
- Department of Paediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Ronald de Groot
- Stichting Katholieke Universiteit, Radboudumc Nijmegen, Nijmegen, Netherlands
| | - Jethro Herberg
- Section of Paediatric Infectious Diseases, Imperial College London, London, UK
| | - Benno Kohlmaier
- Department of General Paediatrics, Medical University of Graz, Graz, Steiermark, Austria
| | - Michael Levin
- Section of Paediatric Infectious Diseases, Imperial College London, London, UK
| | - Emma Lim
- Paediatric Immunology, Infectious Diseases and Allergy, Newcastle upon Tyne Hospitals NHS Foundation Trust, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Ian Maconochie
- Section of Paediatric Infectious Diseases, Imperial College London, London, UK
| | - Federico Martinon Torres
- Genetics, Vaccines, Infections and Pediatrics Research group (GENVIP), Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Ruud Nijman
- Section of Paediatric Infectious Diseases, Imperial College London, London, UK
| | - Marko Pokorn
- Department of Infectious Diseases, University of Ljubljana, Ljubljana, Slovenia
| | - Irene Rivero-Calle
- Genetics, Vaccines, Infections and Pediatrics Research group (GENVIP), Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Maria Tsolia
- Department of Paediatric Infectious Diseases, National and Kapodistrian University of Athens, Athens, Greece
| | - Clementien Vermont
- Department of Paediatric Infectious Diseases and Immunology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Dace Zavadska
- Department of Pediatrics, Riga Stradins University, Riga, Latvia
| | - Werner Zenz
- Department of General Paediatrics, Medical University of Graz, Graz, Steiermark, Austria
| | - Joany Zachariasse
- Department of Pediatrics, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Henriette A Moll
- Department of Pediatrics, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
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16
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Huang H, Chen J, Dang H, Liu C, Fu YQ. Comparing outcomes between culture-positive and culture-negative septic shock in a PICU: A retrospective cohort study. Front Pediatr 2022; 10:1001565. [PMID: 36313890 PMCID: PMC9608626 DOI: 10.3389/fped.2022.1001565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We assessed the outcomes and characteristics of culture-negative septic shock (CNSS) and culture-positive septic shock (CPSS) in pediatric intensive care unit (PICU). METHODS We performed a retrospective study on the data of children admitted to the PICU due to septic shock between January 2018 and December 2021. The primary outcome was in-hospital mortality. The secondary outcomes were the length of stay (LOS) of hospital, the need for mechanical ventilation (MV) and continue renal replacement therapy (CRRT). RESULTS Overall, 238 patients were enrolled. 114 patients (47.9%) had positive cultures (60 blood samples, 41 sputum samples, 17 pus samples, and 19 others), 18 of whom were cultured positive at two sites, 1 at three sites, and 3 had two different types of bacteria at same site. The in-hospital mortality was 47.1%. There were no significant differences in the in-hospital mortality (47.6% vs. 46.5%, P = 0.866), PRISM-III score (10 vs. 12, P = 0.409), PIM-3 score (0.08 vs. 0.07, P = 0.845), pSOFA score (10 vs. 10, P = 0.677) or the need for MV (64.5% vs. 68.4%, P = 0.524) and CRRT (29.8% vs. 34.2%, P = 0.470) between the CNSS group and the CPSS group. The Procalcitonin (8.89 ng/ml vs. 28.39 ng/ml, P = 0.001) and C-reactive protein (28 mg/L vs. 58 mg/L, P = 0.001) levels were significantly lower in the CNSS group than in the CPSS group, while WBC count (9.03 × 109/L vs. 5.02 × 109/L, P = 0.002) and serum sodium (137 mmol/L vs. 132 mmol/L, P = 0.001) was significantly higher in CNSS. The LOS of hospital was significantly longer (16 days vs. 11 days, P = 0.011) in the CPSS group than in the CNSS group, while the LOS of PICU (5 days vs. 4 days, P = 0.094) stay was not significantly different. CONCLUSION Compared with children with CNSS, children with CPSS had higher PCT and CRP levels, but lower WBC count. Children with CPSS had longer LOS of hospital. However, positive or negative culture results were not associated with in-hospital mortality, the LOS of PICU, the need for MV or CRRT in children with septic shock.
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Affiliation(s)
- Haixin Huang
- Department of Critical Care Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Jian Chen
- Department of Critical Care Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Hongxing Dang
- Department of Critical Care Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Chengjun Liu
- Department of Critical Care Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yue-Qiang Fu
- Department of Critical Care Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
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17
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COVID-19 in children and adolescents: MIS(-C)-taken diagnoses. Eur J Pediatr 2022; 181:3549-3554. [PMID: 35861880 PMCID: PMC9302213 DOI: 10.1007/s00431-022-04562-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 03/12/2022] [Accepted: 07/06/2022] [Indexed: 11/03/2022]
Abstract
UNLABELLED Multisystem inflammatory syndrome in children (MIS-C) is an inflammatory condition associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It is characterized by fever, gastro-intestinal symptoms, cardiovascular complications, conjunctivitis, skin involvement, elevated inflammatory markers, and coagulation abnormalities. The current ongoing COVID-19 pandemic causes an increased alertness to MIS-C. In combination with the heterogeneous clinical spectrum, this could potentially lead to diagnostic blindness, misdiagnosis of MIS-C, and overtreatment with expensive IVIG treatment. This report demonstrates the challenge of accurately distinguishing MIS-C from other more common inflammatory pediatric diseases, and the need to act with caution to avoid misdiagnoses in the current pandemic. We present a case series of 11 patients suspected of MIS-C based on the current definitions. Three of them were eventually diagnosed with a different disease. CONCLUSION Current definitions and diagnostic criteria lack specificity which potentially leads to misdiagnosis and overtreatment of MIS-C. We emphasize the need to act with caution in order to avoid MIS(-C)-taken diagnoses in the current pandemic. WHAT IS KNOWN • A pediatric multisystem inflammatory disease associated with SARS-CoV-2 has been described (MIS-C). • There are three definitions being used for MIS-C, all including fever for at least 24 h, laboratory evidence of inflammation, clinically severe illness with multi-organ (≥ 2) involvement, and no alternative plausible diagnosis. WHAT IS NEW • MIS-C has a heterogeneous clinical spectrum without distinctive features compared to more common childhood diseases. Current definitions and diagnostic criteria for MIS-C lack specificity which leads to misdiagnosis and overtreatment. • Amid the current excessive attention to COVID-19 and MIS-C, pediatricians should remain vigilant to avoid mistaken diagnoses.
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18
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Retrospective Analysis of the Clinical Efficacy of Early Goal-Directed Therapy Combined with Meticulous Nursing Intervention in Patients with Posttraumatic Sepsis. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:6706464. [PMID: 34938420 PMCID: PMC8687773 DOI: 10.1155/2021/6706464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/19/2021] [Indexed: 12/03/2022]
Abstract
Objective To explore the intervention effect of early goal-directed therapy (EGDT) combined with meticulous nursing on patients with posttraumatic sepsis. Methods The data of 50 patients with posttraumatic sepsis undergoing EGDT in the emergency department of our hospital from January 2020 to December 2020 were retrospectively analyzed. According to different nursing methods, they were divided into control group (n = 25) with routine nursing measures and observation group (n = 25) with meticulous nursing measures. The application effect of the two nursing modes was scientifically evaluated. Results No statistical differences in general data were found between the two groups (P > 0.05). After 6 h of intervention, the circulatory function, oxygenation function, and renal function of both groups were better than those before intervention, and central venous pressure (CVP), mean arterial pressure (MAP), blood oxygen (PaO2), oxygenation index (PaO2/FiO2), central venous oxygen saturation (ScvO2), and urine volume in the observation group were notably higher than those in the control group (P < 0.05). The heart rate (HR), serum creatinine (SCr), and blood lactic acid in the observation group were notably lower than those in the control group (P < 0.05). The 28-day survival rate and quality of life after intervention in the observation group were notably higher than those in the control group, with obvious differences between the two groups (P < 0.05). Conclusion Meticulous nursing intervention for patients with posttraumatic sepsis undergoing EGDT can effectively improve the body's functional indexes, which is superior to the routine nursing in controlling the patients' condition, improving the survival rate and quality of life after intervention, and ensuring the clinical treatment effect. Therefore, it is worthy of promotion.
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19
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Caffarelli C, Santamaria F, Procaccianti M, Piro E, delle Cave V, Borrelli M, Santoro A, Grassi F, Bernasconi S, Corsello G. Developments in pediatrics in 2020: choices in allergy, autoinflammatory disorders, critical care, endocrinology, genetics, infectious diseases, microbiota, neonatology, neurology, nutrition, ortopedics, respiratory tract illnesses and rheumatology. Ital J Pediatr 2021; 47:232. [PMID: 34876198 PMCID: PMC8650733 DOI: 10.1186/s13052-021-01184-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/22/2021] [Indexed: 11/25/2022] Open
Abstract
In this article, we describe the advances in the field of pediatrics that have been published in the Italian Journal of Pediatrics in 2020. We report progresses in understanding allergy, autoinflammatory disorders, critical care, endocrinology, genetics, infectious diseases, microbiota, neonatology, neurology, nutrition, orthopedics, respiratory tract illnesses, rheumatology in childhood.
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Affiliation(s)
- Carlo Caffarelli
- Clinica Pediatrica, Department of Medicine and Surgery, Azienda Ospedaliera-Universitaria, University of Parma, Via Gramsci, 14 Parma, Italy
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Michela Procaccianti
- Clinica Pediatrica, Department of Medicine and Surgery, Azienda Ospedaliera-Universitaria, University of Parma, Via Gramsci, 14 Parma, Italy
| | - Ettore Piro
- Department of Sciences for Health Promotion and Mother and Child Care ‘’G. D’Alessandro”, University of Palermo, Palermo, Italy
| | - Valeria delle Cave
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Melissa Borrelli
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Angelica Santoro
- Clinica Pediatrica, Department of Medicine and Surgery, Azienda Ospedaliera-Universitaria, University of Parma, Via Gramsci, 14 Parma, Italy
| | - Federica Grassi
- Clinica Pediatrica, Department of Medicine and Surgery, Azienda Ospedaliera-Universitaria, University of Parma, Via Gramsci, 14 Parma, Italy
| | | | - Giovanni Corsello
- Department of Sciences for Health Promotion and Mother and Child Care ‘’G. D’Alessandro”, University of Palermo, Palermo, Italy
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20
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Fernández-Sarmiento J, De Souza DC, Martinez A, Nieto V, López-Herce J, Soares Lanziotti V, Arias López MDP, De Carvalho WB, Oliveira CF, Jaramillo-Bustamante JC, Díaz F, Yock-Corrales A, Ruvinsky S, Munaico M, Pavlicich V, Iramain R, Márquez MP, González G, Yunge M, Tonial C, Cruces P, Palacio G, Grela C, Slöcker-Barrio M, Campos-Miño S, González-Dambrauskas S, Sánchez-Pinto NL, Celiny García P, Jabornisky R. Latin American Consensus on the Management of Sepsis in Children: Sociedad Latinoamericana de Cuidados Intensivos Pediátricos [Latin American Pediatric Intensive Care Society] (SLACIP) Task Force: Executive Summary. J Intensive Care Med 2021; 37:753-763. [PMID: 34812664 DOI: 10.1177/08850666211054444] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The aim of this study was to develop evidence-based recommendations for the diagnosis and treatment of sepsis in children in low- and middle-income countries (LMICs), more specifically in Latin America. Design: A panel was formed consisting of 27 experts with experience in the treatment of pediatric sepsis and two methodologists working in Latin American countries. The experts were organized into 10 nominal groups, each coordinated by a member. Methods: A formal consensus was formed based on the modified Delphi method, combining the opinions of nominal groups of experts with the interpretation of available scientific evidence, in a systematic process of consolidating a body of recommendations. The systematic search was performed by a specialized librarian and included specific algorithms for the Cochrane Specialized Register, PubMed, Lilacs, and Scopus, as well as for OpenGrey databases for grey literature. The GRADEpro GDT guide was used to classify each of the selected articles. Special emphasis was placed on search engines that included original research conducted in LMICs. Studies in English, Spanish, and Portuguese were covered. Through virtual meetings held between February 2020 and February 2021, the entire group of experts reviewed the recommendations and suggestions. Result: At the end of the 12 months of work, the consensus provided 62 recommendations for the diagnosis and treatment of pediatric sepsis in LMICs. Overall, 60 were strong recommendations, although 56 of these had a low level of evidence. Conclusions: These are the first consensus recommendations for the diagnosis and management of pediatric sepsis focused on LMICs, more specifically in Latin American countries. The consensus shows that, in these regions, where the burden of pediatric sepsis is greater than in high-income countries, there is little high-level evidence. Despite the limitations, this consensus is an important step forward for the diagnosis and treatment of pediatric sepsis in Latin America.
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Affiliation(s)
- Jaime Fernández-Sarmiento
- Fundación Cardioinfantil - Instituto de Cardiología, Universidad de la Sabana, CES Graduate School, Bogotá, Colombia
| | - Daniela Carla De Souza
- Hospital Universitario da Universidad de São Paulo and Hospital Sírio Libanês, Sao Paulo, Brazil
| | | | - Victor Nieto
- Department of Critical Care Medicine, Cobos Medical Center, Chief Research Group GriBos, Bogotá, Colombia
| | - Jesús López-Herce
- Department of Pediatric Intensive Care, Hospital General Universitario Gregorio Marañón; Department of Public and Maternal-Infant Health, Universidad Complutense de Madrid, Red de Salud Maternoinfantil y del Desarrollo, Madrid, España
| | - Vanessa Soares Lanziotti
- Pediatric Intensive Care Unit & Research and Education Division/Maternal and Child Health Postgraduate Program, Institute of Pediatrics, Federal University of Rio De Janeiro, Rio De Janeiro, Brazil
| | - María Del Pilar Arias López
- Pediatric Intensive Care Unit, Hospital de Niños Ricardo Gutierrez, Programa SATI-Q, Sociedad Argentina de Terapia Intensiva, Buenos Aires, Argentina
| | - Werther Brunow De Carvalho
- Neonatology and Intensive Care Pediatrics, Department of Medical University of São Paulo, São Paulo, Brazil
| | | | - Juan Camilo Jaramillo-Bustamante
- Department of Pediatrics and Intensive Care, Hospital General de Medellín, Universidad de Antioquia, Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Medellín, Colombia
| | - Franco Díaz
- Instituto de Ciencias e Innovacion en Medicina, Universidad del Desarrollo y Hospital El Carmen de Maipu, Santiago, Chile
| | - Adriana Yock-Corrales
- Emergency Department, Hospital Nacional de Niños "Dr. Carlos Saenz Herrera", CCSS, Pediatric Emergency Physician, San José, Costa Rica
| | - Silvina Ruvinsky
- Department of Infectious Diseases, Hospital de Pediatría Juan P. Garrahan, Latin American Society of Infectious Disease, Buenos Aires, Argentina
| | - Manuel Munaico
- Pediatric Intensive Care Unit, Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú
| | - Viviana Pavlicich
- Hospital General Pediátrico Niños de Acosta Ñu, Universidad Privada del Pacífico, Asunción, Paraguay
| | - Ricardo Iramain
- Pediatric Emergency Department, Hospital de Clínicas, Universidad Nacional de Asunción, Asunción, Paraguay
| | - Marta Patricia Márquez
- Department of Pediatric Intensive Care, Instituto Nacional de Pediatría, Ciudad de México, México
| | - Gustavo González
- Pediatric Intensive Care Unit, Complejo Médico "CHURUCA VISCA", Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Mauricio Yunge
- Department of Pediatric Intensive Care, Clínica Los Condes, Santiago, Chile
| | - Cristian Tonial
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Hospital São Lucas, Porto Alegre, RS, Brazil
| | - Pablo Cruces
- Department of Pediatric Intensive Care, Hospital El Carmen de Maipú, Centro de Investigación de Medicina Veterinaria, Facultad de Ciencias de la Vida, Universidad Andres Bello, Chile
| | - Gladys Palacio
- Department of Pediatric Intensive Care Unit Ricardo Gutiérrez Children's Hospital, Buenos Aires, Argentina
| | - Carolina Grela
- Universidad de la República, Centro Hospitalario Pereira Rossell, Montevideo, Uruguay
| | | | - Santiago Campos-Miño
- Department of Pediatric Intensive Care Unit, Hospital Metropolitano, Latin American Center for Clinical Research, Quito - Ecuador
| | - Sebastian González-Dambrauskas
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network) - Montevideo, Uruguay. Specialized Pediatric Intensive Care, Casa de Galicia, Montevideo, Uruguay
| | - Nelson L Sánchez-Pinto
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Pedro Celiny García
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Escola de Medicina, Serviço de Medicina Intensiva e Emergência, Porto Alegre, RS, Brazil
| | - Roberto Jabornisky
- Department of Pediatrics, Facultad de Medicina, Universidad Nacional del Nordeste, Argentina
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21
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Akcay N, Kihtir HS, Ozcelik G, Barlas UK, Petmezci MT, Sevketoglu E. Immunoadsorption therapy for a meningococcemia patient with myocarditis, adrenal hemorrhage, and purpura fulminans: a case report. Braz J Anesthesiol 2021; 72:819-822. [PMID: 34284056 DOI: 10.1016/j.bjane.2021.06.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 06/13/2021] [Accepted: 06/27/2021] [Indexed: 11/28/2022] Open
Abstract
Neisseria meningitidis, also known as meningococcus, is a relatively uncommon cause of invasive infection, but when it occurs, it is frequently severe and potentially life-threatening. A ten-year-old female patient developed a purpuric rash with fever. Upon arrival to the pediatric intensive care department, she was unconscious and in a poor general condition. We combined treatment with antibiotics, volume resuscitation, hydrocortisone, and CytoSorb® therapy resulted in a stabilization of hemodynamics, as well as control of hyperinflammation. We observed a significant decrease in vasopressor dosage in this patient.
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Affiliation(s)
- Nihal Akcay
- University of the Health Sciences, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Pediatric Intensive Care Unit, Istanbul, Turkey.
| | - Hasan Serdar Kihtir
- University of the Health Sciences, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Pediatric Intensive Care Unit, Istanbul, Turkey
| | - Guner Ozcelik
- University of the Health Sciences, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Pediatric Intensive Care Unit, Istanbul, Turkey
| | - Ulkem Kocoglu Barlas
- University of the Health Sciences, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Pediatric Intensive Care Unit, Istanbul, Turkey
| | - Mey Talip Petmezci
- University of the Health Sciences, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Pediatric Intensive Care Unit, Istanbul, Turkey
| | - Esra Sevketoglu
- University of the Health Sciences, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Pediatric Intensive Care Unit, Istanbul, Turkey
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22
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Repeated Emergency Department Visits Among Children with Invasive Bacterial Infections. Pediatr Infect Dis J 2021; 40:e205-e207. [PMID: 33464016 DOI: 10.1097/inf.0000000000003062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We carried out a retrospective cohort study of 271 previously healthy children younger than 14 years old diagnosed with invasive bacterial infection in an emergency department. Of them, 72 (26.6%) had previous visits to the emergency department. Not identifying children with an invasive bacterial infection and not administering antibiotics on the first visit was associated with a severe outcome.
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