Are Early Antibiotics Important for Everyone?

One-Year Survival after Inhospital Cardiac Arrest-Does Prearrest Sepsis Matter?

AIM

Cardiac arrest is not a common complication of sepsis, although sepsis has been recognized as one condition behind cardiac arrest. Our aim was to evaluate the prevalence of sepsis among patients with inhospital cardiac arrest (IHCA), and to determine if sepsis is associated with inferior outcome after IHCA.

METHODS

All consecutive emergency team dispatches in Turku University Hospital in 2011 to 2014 (n = 607) were retrospectively reviewed to identify the patients undergoing cardiopulmonary resuscitation (CPR) for IHCA (n = 301). The patient records were reviewed for the criteria of severe sepsis, organ dysfunction, and chronic comorbidities before IHCA. Outcome was followed for 1 year.

RESULTS

The criteria for prearrest severe sepsis were met by 83/301 (28%) of the patients, and 93/301 (31%) had multiorgan dysfunction (3 or more organ systems). The patients with severe sepsis had higher mortality than those without severe sepsis, increasing from 30-day mortalities of 63/83 (76%) and 151/218 (69%), respectively (P = 0.256), to 1-year mortalities of 72/83 (87%) and 164/218 (75%), respectively (P = 0.030). Emergency admission, age, immunosuppression, DM, multiorgan dysfunction, and a nonshockable rhythm were independent predictors of 1-year mortality by multivariate logistic regression analysis. Six out of 83 patients with severe sepsis before IHCA (7%) survived 1 year with good neurological outcome (CPC scale 1).

CONCLUSIONS

A high proportion of patients with IHCA have sepsis and multiorgan dysfunction, and their prognosis is worse than the prognosis of patients with IHCA in general.

Early Diagnosis of Sepsis: Is an Integrated Omics Approach the Way Forward?

Sepsis remains one of the leading causes of death in the USA and it is expected to get worse as the population ages. Moreover, the standard of care, which recommends aggressive treatment with appropriate antibiotics, has led to an increase in multiple drug-resistant organisms. There is a dire need for the development of new antibiotics, improved antibiotic stewardship, and therapies that treat the host response. Development of new sepsis therapeutics has been a disappointment as no drugs are currently approved to treat the various complications from sepsis. Much of the failure has been blamed on animal models that do not accurately reflect the course of the disease. However, recent improvements in metabolomic, transcriptomic, genomic, and proteomic platforms have allowed for a broad-spectrum look at molecular changes in the host response using clinical samples. Integration of these multi-omic datasets allows researchers to perform systems biology approaches to identify novel pathophysiology of the disease. In this review, we highlight what is currently known about sepsis and how integrative omics has identified new diagnostic and predictive models of sepsis as well as novel mechanisms. These changes may improve patient care as well as guide future preclinical analysis of sepsis.