Analysis of Prognostic Risk Factors of Sepsis Patients in Intensive Care Unit Based on Data Analysis

Point-of-Care Serum Proenkephalin as an Early Predictor of Mortality in Patients Presenting to the Emergency Department with Septic Shock

BACKGROUND

The aim of the present study is to investigate the prognostic utility of point-of-care (POC)-measured proenkephalin (PENK), a novel biomarker, in terms of predicting in-hospital mortality in patients presenting to the emergency department (ED) with septic shock.

METHODS

Bedside PENK was measured in consecutive patients presenting to the ED with septic shock according to the Sepsis-3 clinical criteria. The association of PENK with inflammatory and routine biomarkers, and its role as a predictor of in-hospital mortality, was examined.

RESULTS

Sixty-one patients with septic shock [53% females, median age 83 years (IQR 71-88)] were evaluated. Median (IQR) values of creatinine, plasma lactate, soluble urokinase plasminogen activator receptor (SuPAR), procalcitonin and PENK were 1.7 (1.0-2.9) mg/dL, 3.6 (2.1-6.8) mmol/L, 13.1 (10.0-21.4) ng/mL, 2.06 (0.84-3.49) ng/mL, and 205 (129-425) pmol/L, respectively. LogPENK significantly correlated with LogLactate (rho = 0.369, p = 0.004), LogCreatinine (rho = 0.537, p < 0.001), LogProcalcitonin (rho = 0.557, p < 0.001), and LogSuPAR (rho = 0.327, p = 0.011). During hospitalization, 39/61 (64%) patients died. In a multivariable logistic regression model, logPENK was an independent predictor of in-hospital mortality (OR 11.9, 95% CI: 1.7-84.6, p = 0.013).

CONCLUSION

POC PENK levels measured upon presentation to the ED strongly correlated with metabolic, renal and inflammatory biomarkers, and may serve as a predictor of in-hospital mortality in patients with septic shock.

Association between chronic obstructive pulmonary disease and 28-day mortality in patients with sepsis: a retrospective study based on the MIMIC-III database

BACKGROUND

Sepsis is a common cause of mortality in critically ill patients, and chronic obstructive pulmonary disease (COPD) is one of the most common comorbidities in septic patients. However, the impact of COPD on patients with sepsis remained unclear. Therefore, the purpose of this study aimed to assess the effect of COPD on the prognosis of septic patients based on Medical Information Mart for Intensive Care (MIMIC-III) database.

METHODS

In this retrospective study based on the (MIMIC)-III database version 1.4 (v1.4), we collected clinical data and 28-day all-cause mortality from patients with sepsis in intensive care unit (ICU) and these patients met the diagnostic criteria of Sepsis 3 on ICU admission between 2008 and 2012. International Classification of Diseases (ICD-9) (4660, 490, 4910, 4911, 49120, 49121, 4918, 4919, 4920, 4928, 494, 4940, 4941, 496) was used to identified COPD. We applied Kaplan-Meier analysis to compare difference of 28-day all-cause mortality between septic patients with and without COPD. Cox proportional-hazards model was applied to explore the risk factor associated with 28-day all-cause mortality in patients with sepsis.

RESULTS

Six thousand two hundred fifty seven patients with sepsis were included in this study, including 955 (15.3%) patients with COPD and 5302 patients without COPD (84.7%). Compared with patients without COPD, patients with COPD were older (median: 73.5 [64.4, 82.0] vs 65.8 [52.9, 79.1], P < 0.001), had higher simplified acute physiology score II (SAPSII) (median: 40.0 [33.0, 49.0] vs 38.0 [29.0,47.0], P < 0.001) and greater proportion of mechanical ventilatory support (MV) (55.0% vs 48.9%, P = 0.001). In our study, septic patients with COPD had higher 28-day all-cause mortality (23.6% vs 16.4%, P < 0.001) than patients without COPD. After adjusting for covariates, the results showed that COPD was an independent risk factor for the 28-day all-cause mortality of patients with sepsis (HR 1.30, 95%CI: 1.12-1.50, P = 0.001).

CONCLUSIONS

COPD was an independent risk factor of 28-day all-cause mortality in septic patients. Clinically, septic patients with COPD should be given additional care.

Chemo Markers as Biomarkers in Septic Shock: A Comprehensive Review of Their Utility and Clinical Applications

Sepsis is a life-threatening condition characterized by a dysregulated host response to infection, often leading to septic shock. Early diagnosis and prompt intervention are crucial for improving patient outcomes. Chemo markers, which are measurable biological substances associated with the pathophysiology of septic shock, have emerged as potential biomarkers for the identification, risk stratification, and management of this condition. This comprehensive review aims to thoroughly evaluate the utility and clinical applications of chemo markers in septic shock. The review begins by discussing the criteria for ideal chemo markers, including specificity, sensitivity, dynamic range, stability, non-invasiveness, and prognostic value. These characteristics ensure accurate diagnosis, early detection, effective monitoring, and prediction of clinical outcomes. Furthermore, the review explores the role of chemo markers in monitoring treatment response and disease progression, highlighting their ability to serve as objective indicators for assessing the effectiveness of interventions and making timely adjustments in management strategies. Moreover, the prognostic value of chemo markers in predicting outcomes is discussed, emphasizing their association with mortality, hospital stays, and the development of complications. Integration of chemo markers into prognostic models or scoring systems enhances risk stratification and informs therapeutic decisions. The review also delves into recent advances in chemo marker research and technology, emphasizing the potential for discovering novel chemo markers with enhanced diagnostic and prognostic capabilities. It highlights the use of high-throughput proteomics, genomics, and transcriptomics in identifying specific molecular signatures associated with septic shock. This contributes to a deeper understanding of the complex immune and inflammatory responses involved. In conclusion, chemo markers have emerged as valuable biomarkers in septic shock, offering potential utility in diagnosis, risk stratification, treatment monitoring, and prediction of outcomes. Continued research, validation, and integration into clinical practice are necessary to fully realize their potential in improving patient care and outcomes in septic shock.

A Pilot Study on Human Circulating System Indicated That Regenerating Islet-Derived Protein 3 Gamma (REG3A) is a Potential Prognostic Biomarker for Sepsis

It is critical to find fast and robust biomarkers for sepsis to reduce the patient's risk for morbidity and mortality. In this work, we compared serum protein expression levels of regenerating islet-derived protein 3 gamma (REG3A) between patients with sepsis and healthy controls and found that serum REG3A protein was significantly elevated in patients with sepsis. In addition, expression level of serum REG3A protein was markedly correlated with the Sequential Organ Failure Assessment score, Acute Physiology and Chronic Health Evaluation II score, and C-reactive protein levels of patients with sepsis. Serum REG3A protein expression level was also confirmed to have good diagnostic value to differentiate patients with sepsis from healthy controls. Finally, serum REG3A protein expression level was found to have good prognostic value to predict the 28-day survival rate of patients with sepsis. In conclusion, our work indicated that serum REG3A may be a novel biomarker for sepsis.

Thromboelastography Parameters in Urosepsis: A Retrospective Study

Thromboelastography (TEG) is usually used to monitor coagulation disorder clinically. It is unclear whether TEG has association with urosepsis and sepsis-induced coagulopathy (SIC). The purpose of this study was to investigate the clinical significance of TEG parameters in urosepsis. 90 patients who were admitted to the Emergency Ward and Emergency Intensive Care Unit (EICU) of Ren Ji Hospital affiliated to Shanghai Jiao Tong University School of Medicine due to urinary infection from February 2014 to February 2022 were retrospectively studied. Urosepsis patients and non-sepsis patients were separately investigated according to the final discharge diagnosis and Sepsis 3.0. At the same time, patients with urosepsis were further divided into groups of SIC and non-SIC based on the definition of SIC. The data of clinical features, laboratory biomarkers, and TEG parameters were collected and analyzed. There were significant differences in white blood cell count, C-reactive protein (CRP), platelet count, procalcitonin (PCT), fibrinogen (FIB), international normalized ratio (INR), prothrombin time (PT), D-dimer, and incidence of urinary tract obstruction between the urosepsis group and non-sepsis group (P < 0.05). In the comparison with non-sepsis group, K value was significantly lower (P = 0.006), while α-angle (P = 0.003) and clot index (CI) (P = 0.048) were significantly higher in urosepsis group. The area under the K value curve excluding urosepsis was 0.667. The areas under CI and α-angle curves for diagnosing urosepsis were 0.682 and 0.621, respectively. The patients in SIC group had significantly higher K value, lower α-angle, and maximum amplitude (MA) than those in non-SIC group (P < 0.05). Coagulopathy is prone to occur in patients with urosepsis. TEG is helpful for assessment of hypercoagulable state in urosepsis and prediction of hypocoagulability in SIC patients implying the dynamic process of DIC.