1
|
Balk R, Esper AM, Martin GS, Miller RR, Lopansri BK, Burke JP, Levy M, Opal S, Rothman RE, D’Alessio FR, Sidhaye VK, Aggarwal NR, Greenberg JA, Yoder M, Patel G, Gilbert E, Parada JP, Afshar M, Kempker JA, van der Poll T, Schultz MJ, Scicluna BP, Klein Klouwenberg PMC, Liebler J, Blodget E, Kumar S, Navalkar K, Yager TD, Sampson D, Kirk JT, Cermelli S, Davis RF, Brandon RB. Validation of SeptiCyte RAPID to Discriminate Sepsis from Non-Infectious Systemic Inflammation. J Clin Med 2024; 13:1194. [PMID: 38592057 PMCID: PMC10931699 DOI: 10.3390/jcm13051194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 02/08/2024] [Accepted: 02/18/2024] [Indexed: 04/10/2024] Open
Abstract
(1) Background: SeptiCyte RAPID is a molecular test for discriminating sepsis from non-infectious systemic inflammation, and for estimating sepsis probabilities. The objective of this study was the clinical validation of SeptiCyte RAPID, based on testing retrospectively banked and prospectively collected patient samples. (2) Methods: The cartridge-based SeptiCyte RAPID test accepts a PAXgene blood RNA sample and provides sample-to-answer processing in ~1 h. The test output (SeptiScore, range 0-15) falls into four interpretation bands, with higher scores indicating higher probabilities of sepsis. Retrospective (N = 356) and prospective (N = 63) samples were tested from adult patients in ICU who either had the systemic inflammatory response syndrome (SIRS), or were suspected of having/diagnosed with sepsis. Patients were clinically evaluated by a panel of three expert physicians blinded to the SeptiCyte test results. Results were interpreted under either the Sepsis-2 or Sepsis-3 framework. (3) Results: Under the Sepsis-2 framework, SeptiCyte RAPID performance for the combined retrospective and prospective cohorts had Areas Under the ROC Curve (AUCs) ranging from 0.82 to 0.85, a negative predictive value of 0.91 (sensitivity 0.94) for SeptiScore Band 1 (score range 0.1-5.0; lowest risk of sepsis), and a positive predictive value of 0.81 (specificity 0.90) for SeptiScore Band 4 (score range 7.4-15; highest risk of sepsis). Performance estimates for the prospective cohort ranged from AUC 0.86-0.95. For physician-adjudicated sepsis cases that were blood culture (+) or blood, urine culture (+)(+), 43/48 (90%) of SeptiCyte scores fell in Bands 3 or 4. In multivariable analysis with up to 14 additional clinical variables, SeptiScore was the most important variable for sepsis diagnosis. A comparable performance was obtained for the majority of patients reanalyzed under the Sepsis-3 definition, although a subgroup of 16 patients was identified that was called septic under Sepsis-2 but not under Sepsis-3. (4) Conclusions: This study validates SeptiCyte RAPID for estimating sepsis probability, under both the Sepsis-2 and Sepsis-3 frameworks, for hospitalized patients on their first day of ICU admission.
Collapse
Affiliation(s)
- Robert Balk
- Rush Medical College and Rush University Medical Center, Chicago, IL 60612, USA; (J.A.G.); (M.Y.); (G.P.)
| | - Annette M. Esper
- Grady Memorial Hospital and Emory University School of Medicine, Atlanta, GA 30322, USA; (A.M.E.); (G.S.M.); (J.A.K.)
| | - Greg S. Martin
- Grady Memorial Hospital and Emory University School of Medicine, Atlanta, GA 30322, USA; (A.M.E.); (G.S.M.); (J.A.K.)
| | | | - Bert K. Lopansri
- Intermountain Medical Center, Murray, UT 84107, USA; (B.K.L.); (J.P.B.)
- School of Medicine, University of Utah, Salt Lake City, UT 84132, USA
| | - John P. Burke
- Intermountain Medical Center, Murray, UT 84107, USA; (B.K.L.); (J.P.B.)
- School of Medicine, University of Utah, Salt Lake City, UT 84132, USA
| | - Mitchell Levy
- Warren Alpert Medical School, Brown University, Providence, RI 02912, USA; (M.L.); (S.O.)
| | - Steven Opal
- Warren Alpert Medical School, Brown University, Providence, RI 02912, USA; (M.L.); (S.O.)
| | - Richard E. Rothman
- School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA; (R.E.R.); (F.R.D.); (V.K.S.)
| | - Franco R. D’Alessio
- School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA; (R.E.R.); (F.R.D.); (V.K.S.)
| | - Venkataramana K. Sidhaye
- School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA; (R.E.R.); (F.R.D.); (V.K.S.)
| | - Neil R. Aggarwal
- Anschutz Medical Campus, University of Colorado, Denver, CO 80045, USA;
| | - Jared A. Greenberg
- Rush Medical College and Rush University Medical Center, Chicago, IL 60612, USA; (J.A.G.); (M.Y.); (G.P.)
| | - Mark Yoder
- Rush Medical College and Rush University Medical Center, Chicago, IL 60612, USA; (J.A.G.); (M.Y.); (G.P.)
| | - Gourang Patel
- Rush Medical College and Rush University Medical Center, Chicago, IL 60612, USA; (J.A.G.); (M.Y.); (G.P.)
| | - Emily Gilbert
- Loyola University Medical Center, Maywood, IL 60153, USA; (E.G.); (J.P.P.)
| | - Jorge P. Parada
- Loyola University Medical Center, Maywood, IL 60153, USA; (E.G.); (J.P.P.)
| | - Majid Afshar
- School of Medicine and Public Health, University of Wisconsin, Madison, WI 53705, USA;
| | - Jordan A. Kempker
- Grady Memorial Hospital and Emory University School of Medicine, Atlanta, GA 30322, USA; (A.M.E.); (G.S.M.); (J.A.K.)
| | - Tom van der Poll
- Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (T.v.d.P.); (M.J.S.)
| | - Marcus J. Schultz
- Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (T.v.d.P.); (M.J.S.)
| | - Brendon P. Scicluna
- Centre for Molecular Medicine and Biobanking, University of Malta, Msida MSD 2080, Malta;
- Department of Applied Biomedical Science, Faculty of Health Sciences, Mater Dei Hospital, University of Malta, Msida MSD 2080, Malta
| | | | - Janice Liebler
- Keck Hospital of University of Southern California (USC), Los Angeles, CA 90033, USA; (J.L.); (S.K.)
- Los Angeles General Medical Center, Los Angeles, CA 90033, USA
| | - Emily Blodget
- Keck Hospital of University of Southern California (USC), Los Angeles, CA 90033, USA; (J.L.); (S.K.)
- Los Angeles General Medical Center, Los Angeles, CA 90033, USA
| | - Santhi Kumar
- Keck Hospital of University of Southern California (USC), Los Angeles, CA 90033, USA; (J.L.); (S.K.)
- Los Angeles General Medical Center, Los Angeles, CA 90033, USA
| | - Krupa Navalkar
- Immunexpress Inc., Seattle, DC 98109, USA; (K.N.); (J.T.K.); (S.C.); (R.F.D.)
| | - Thomas D. Yager
- Immunexpress Inc., Seattle, DC 98109, USA; (K.N.); (J.T.K.); (S.C.); (R.F.D.)
| | - Dayle Sampson
- Immunexpress Inc., Seattle, DC 98109, USA; (K.N.); (J.T.K.); (S.C.); (R.F.D.)
| | - James T. Kirk
- Immunexpress Inc., Seattle, DC 98109, USA; (K.N.); (J.T.K.); (S.C.); (R.F.D.)
| | - Silvia Cermelli
- Immunexpress Inc., Seattle, DC 98109, USA; (K.N.); (J.T.K.); (S.C.); (R.F.D.)
| | - Roy F. Davis
- Immunexpress Inc., Seattle, DC 98109, USA; (K.N.); (J.T.K.); (S.C.); (R.F.D.)
| | - Richard B. Brandon
- Immunexpress Inc., Seattle, DC 98109, USA; (K.N.); (J.T.K.); (S.C.); (R.F.D.)
| |
Collapse
|
2
|
Zeng Y, Liu Z, Xu F, Tang Z. Intravenous high-dose vitamin C monotherapy for sepsis and septic shock: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2023; 102:e35648. [PMID: 37861551 PMCID: PMC10589557 DOI: 10.1097/md.0000000000035648] [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: 03/05/2023] [Accepted: 09/22/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Vitamin C has been used as an adjuvant in the treatment of sepsis and septic shock; however, its role remains controversial. This study aimed to assess the effectiveness of intravenous high-dose vitamin C in sepsis and septic shock patients by meta-analysis. METHODS The PubMed, Embase, and Cochrane Library electronic databases were searched to identify relevant studies. The primary outcome was defined as the short-term all-cause mortality rate. Secondary outcomes included duration of vasoactive drug use, intensive care unit length of stay, sequential organ failure assessment scores up to 96 hours after treatment and 90-day mortality. Review Manager version 5.4 was used to perform the meta-analysis. Relative risk and mean differences (MD) with 95% confidence intervals were determined using fixed- or random-effects models. RESULTS Eight randomized controlled trials (RCTs) comprising 1394 patients were eligible for assessment. Overall, the pooled results showed that high-dose vitamin C decreased short-term all-cause mortality in patients with sepsis, but no significant differences were observed in patients with septic shock. Additionally, high-dose vitamin C was associated with decreased duration of vasoactive drug use in patients with sepsis, but not in patients with septic shock. However, it did not significantly affect the duration of intensive care unit stay in RCTs of patients with sepsis and septic shock. Additionally, it did not significantly affect sequential organ failure assessment scores 96 hours post-treatment or 90-day mortality. CONCLUSION These results suggest that intravenous high-dose vitamin C may improve outcomes in patients with sepsis, but do not benefit patients with septic shock. Further RCTs and other studies should be conducted to determine whether vitamin C should be recommended as an adjunctive sepsis treatment.
Collapse
Affiliation(s)
- Yiqian Zeng
- Department of Intensive Care Unit, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Department of Trauma Center, Zhuzhou Central Hospital, Zhuzhou, China
| | - Zhao Liu
- Department of Critical Care Medicine, Zhuzhou Central Hospital, Zhuzhou, China
| | - Fei Xu
- Department of Intensive Care Unit, The Guilin Medical College Affiliated Hospital, Guilin, China
| | - Zhanhong Tang
- Department of Intensive Care Unit, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| |
Collapse
|
3
|
Lee KJ, Park JY, Jeon K, Ko RE, Suh GY, Lim SY, Lee YJ, Oh DK, Park MH, Lim CM, Park S. Impact of sepsis on Eastern Cooperative Oncology Group performance status among fully ambulatory patients: a prospective nationwide multicenter cohort. J Thorac Dis 2023; 15:4681-4692. [PMID: 37868852 PMCID: PMC10586999 DOI: 10.21037/jtd-23-405] [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: 03/15/2023] [Accepted: 07/28/2023] [Indexed: 10/24/2023]
Abstract
Background Investigations of the impact of sepsis on the Eastern Cooperative Oncology Group performance status (ECOG PS) of fully ambulatory patients are scarce. Methods This is a retrospective analysis of prospectively collected nationwide data on septic patients recruited from 19 hospitals of the Korean Sepsis Alliance between August 2019 and December 2020. Adult septic patients with good ECOG PS (i.e., 0 or 1) before sepsis were enrolled in this study. The change in ECOG PS and the prevalence of disability (ECOG PS ≥2) at hospital discharge were recorded. Results Of the 4,145 septic patients, 1,735 (41.9%) patients who had ECOG PS of 0 or 1 before sepsis and eventually survived to discharge were selected. After treatment for sepsis, the ECOG PS deteriorated in 514 (29.6%) patients; 376 (21.7%) patients had poor ECOG PS (i.e., ≥2) at hospital discharge. The proportion of patients with poor ECOG PS at hospital discharge increased with increases in the initial sequential organ failure assessment (SOFA) score and lactate level. Furthermore, poor ECOG PS at hospital discharge was found in young patients (aged <65 years, 17.4%), those with no history of cancer (18.2%) or with low comorbidities [Charlson comorbidity index (CCI) ≤2; 13.6%], and those without septic shock (19.9%). In multivariable analysis, age, solid cancer, immunocompromised condition, SOFA score, mechanical ventilation, and use of inappropriate empirical antibiotics (odds ratio: 1.786; 95% confidence interval: 1.151-2.771) were significant risk factors for poor ECOG PS. Conclusions One in five septic patients who were fully ambulatory before sepsis were not functionally independent at hospital discharge. Incomplete functional recovery was also seen in a substantial proportion of younger patients, those with low comorbidities, and those without septic shock. However, the adequacy of empirical antibiotics may improve the functional status in such patients.
Collapse
Affiliation(s)
- Kyu Jin Lee
- Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Ji Young Park
- Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Kyeongman Jeon
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ryoung-Eun Ko
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Gee Yong Suh
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Yun Lim
- Department of Pulmonary and Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Yeon Joo Lee
- Department of Pulmonary and Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Dong Kyu Oh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Mi-Hyeon Park
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chae-Man Lim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sunghoon Park
- Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| |
Collapse
|
4
|
Lombardi S, Partanen P, Francia P, Calamai I, Deodati R, Luchini M, Spina R, Bocchi L. Classifying sepsis from photoplethysmography. Health Inf Sci Syst 2022; 10:30. [PMID: 36330224 PMCID: PMC9622958 DOI: 10.1007/s13755-022-00199-3] [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: 02/21/2022] [Accepted: 10/09/2022] [Indexed: 11/05/2022] Open
Abstract
Sepsis is a life-threatening organ dysfunction. It is caused by a dysregulated immune response to an infection and is one of the leading causes of death in the intensive care unit (ICU). Early detection and treatment of sepsis can increase the survival rate of patients. The use of devices such as the photoplethysmograph could allow the early evaluation in addition to continuous monitoring of septic patients. The aim of this study was to verify the possibility of detecting sepsis in patients from whom the photoplethysmographic signal was acquired via a pulse oximeter. In this work, we developed a deep learning-based model for sepsis identification. The model takes a single input, the photoplethysmographic signal acquired by pulse oximeter, and performs a binary classification between septic and nonseptic samples. To develop the method, we used MIMIC-III database, which contains data from ICU patients. Specifically, the selected dataset includes 85 septic subjects and 101 control subjects. The PPG signals acquired from these patients were segmented, processed and used as input for the developed model with the aim of identifying sepsis. The proposed method achieved an accuracy of 76.37% with a sensitivity of 70.95% and a specificity of 81.04% on the test set. As regards the ROC curve, the Area Under Curve reached a value of 0.842. The results of this study indicate how the plethysmographic signal can be used as a warning sign for the early detection of sepsis with the aim of reducing the time for diagnosis and therapeutic intervention. Furthermore, the proposed method is suitable for integration in continuous patient monitoring.
Collapse
Affiliation(s)
- Sara Lombardi
- Department of Information Engineering, University of Florence, Via S. Marta, 3, 50139 Florence, Italy
| | - Petri Partanen
- Faculty of Information Technology and Electrical Engineering, University of Oulu, Pentti Kaiteran katu 1, 90570 Oulu, Finland
| | - Piergiorgio Francia
- Department of Information Engineering, University of Florence, Via S. Marta, 3, 50139 Florence, Italy
| | - Italo Calamai
- S.O.C. Anestesia e Rianimazione, Ospedale S. Giuseppe, viale Giovanni Boccaccio, 16, 50053 Empoli, Italy
| | - Rossella Deodati
- S.O.C. Anestesia e Rianimazione, Ospedale S. Giuseppe, viale Giovanni Boccaccio, 16, 50053 Empoli, Italy
| | - Marco Luchini
- S.O.C. Anestesia e Rianimazione, Ospedale S. Giuseppe, viale Giovanni Boccaccio, 16, 50053 Empoli, Italy
| | - Rosario Spina
- S.O.C. Anestesia e Rianimazione, Ospedale S. Giuseppe, viale Giovanni Boccaccio, 16, 50053 Empoli, Italy
| | - Leonardo Bocchi
- Department of Information Engineering, University of Florence, Via S. Marta, 3, 50139 Florence, Italy
| |
Collapse
|
5
|
Piccioni A, Saviano A, Cicchinelli S, Valletta F, Santoro MC, de Cunzo T, Zanza C, Longhitano Y, Tullo G, Tilli P, Candelli M, Covino M, Franceschi F. Proadrenomedullin in Sepsis and Septic Shock: A Role in the Emergency Department. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57090920. [PMID: 34577843 PMCID: PMC8472723 DOI: 10.3390/medicina57090920] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/27/2021] [Accepted: 08/28/2021] [Indexed: 02/05/2023]
Abstract
Sepsis and septic shock represent a leading cause of mortality in the Emergency Department (ED) and in the Intensive Care Unit (ICU). For these life-threating conditions, different diagnostic and prognostic biomarkers have been studied. Proadrenomedullin (MR-proADM) is a biomarker that can predict organ damage and the risk of imminent death in patients with septic shock, as shown by a large amount of data in the literature. The aim of our narrative review is to evaluate the role of MR-proADM in the context of Emergency Medicine and to summarize the current knowledge of MR-proADM as a serum indicator that is useful in the Emergency Department (ED) to determine an early diagnosis and to predict the long-term mortality of patients with sepsis and septic shock. We performed an electronic literature review to investigate the role of MR-proADM in sepsis and septic shock in the context of ED. We searched papers on PubMed®, Cochrane®, UptoDate®, and Web of Science® that had been published in the last 10 years. Data extracted from this literature review are not conclusive, but they show that MR-proADM may be helpful as a prognostic biomarker to stratify the mortality risk in cases of sepsis and septic shock with different degrees of organ damage, guiding emergency physicians in the diagnosis and the succeeding therapeutic workup. Sepsis and septic shock are conditions of high complexity and have a high risk of mortality. In the ED, early diagnosis is crucial in order to provide an early treatment and to improve patient survival. Diagnosis and prognosis are often the result of a combination of several tests. In our opinion, testing for MR-proADM directly in the ED could contribute to improving the prognostic assessment of patients, facilitating the subsequent clinical management and intensive treatment by the emergency physicians, but more studies are needed to confirm these results.
Collapse
Affiliation(s)
- Andrea Piccioni
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy; (A.P.); (S.C.); (F.V.); (M.C.S.); (T.d.C.); (C.Z.); (G.T.); (P.T.); (M.C.); (M.C.); (F.F.)
| | - Angela Saviano
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy; (A.P.); (S.C.); (F.V.); (M.C.S.); (T.d.C.); (C.Z.); (G.T.); (P.T.); (M.C.); (M.C.); (F.F.)
- Correspondence:
| | - Sara Cicchinelli
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy; (A.P.); (S.C.); (F.V.); (M.C.S.); (T.d.C.); (C.Z.); (G.T.); (P.T.); (M.C.); (M.C.); (F.F.)
| | - Federico Valletta
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy; (A.P.); (S.C.); (F.V.); (M.C.S.); (T.d.C.); (C.Z.); (G.T.); (P.T.); (M.C.); (M.C.); (F.F.)
| | - Michele Cosimo Santoro
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy; (A.P.); (S.C.); (F.V.); (M.C.S.); (T.d.C.); (C.Z.); (G.T.); (P.T.); (M.C.); (M.C.); (F.F.)
| | - Tommaso de Cunzo
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy; (A.P.); (S.C.); (F.V.); (M.C.S.); (T.d.C.); (C.Z.); (G.T.); (P.T.); (M.C.); (M.C.); (F.F.)
| | - Christian Zanza
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy; (A.P.); (S.C.); (F.V.); (M.C.S.); (T.d.C.); (C.Z.); (G.T.); (P.T.); (M.C.); (M.C.); (F.F.)
| | - Yaroslava Longhitano
- Dietetics and Clinical Nutrition Unit, Department of Internal Medicine, University of Genoa, IRCCS Polyclinic Hospital San Martino, 16132 Genoa, Italy;
| | - Gianluca Tullo
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy; (A.P.); (S.C.); (F.V.); (M.C.S.); (T.d.C.); (C.Z.); (G.T.); (P.T.); (M.C.); (M.C.); (F.F.)
| | - Pietro Tilli
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy; (A.P.); (S.C.); (F.V.); (M.C.S.); (T.d.C.); (C.Z.); (G.T.); (P.T.); (M.C.); (M.C.); (F.F.)
| | - Marcello Candelli
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy; (A.P.); (S.C.); (F.V.); (M.C.S.); (T.d.C.); (C.Z.); (G.T.); (P.T.); (M.C.); (M.C.); (F.F.)
| | - Marcello Covino
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy; (A.P.); (S.C.); (F.V.); (M.C.S.); (T.d.C.); (C.Z.); (G.T.); (P.T.); (M.C.); (M.C.); (F.F.)
| | - Francesco Franceschi
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy; (A.P.); (S.C.); (F.V.); (M.C.S.); (T.d.C.); (C.Z.); (G.T.); (P.T.); (M.C.); (M.C.); (F.F.)
| |
Collapse
|
6
|
Wang L, Guo W, Shen H, Guo J, Wen D, Yu Y, Wu W. Plasma Microbial Cell-Free DNA Sequencing Technology for the Diagnosis of Sepsis in the ICU. Front Mol Biosci 2021; 8:659390. [PMID: 34124149 PMCID: PMC8194294 DOI: 10.3389/fmolb.2021.659390] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/13/2021] [Indexed: 02/05/2023] Open
Abstract
Sepsis is a common life-threatening disease in the intensive care unit (ICU) that is usually treated empirically without pathogen identification. As a non-invasive and high-throughput technology, plasma microbial cell-free DNA (mcfDNA) sequencing can detect unknown pathogens independent of previous clinical or laboratory information. In this study, a total of 199 cases suspected of bloodstream infection (BSI) from January 2020 to June 2020 were collected, and potential pathogens were detected by simultaneous blood culture and plasma mcfDNA sequencing. Other clinical microbiological assays were performed within 7 days of plasma mcfDNA sequencing, including smear, culture of samples taken from relevant infected sites, and β-D-glucan/galactomannan (BDG/GM) tests, among others. The diagnoses were classified as sepsis [94 (47.2%)], non-sepsis [87 (43.7%)], and non-infectious disease [18 (9.0%)]. The sensitivity and specificity of plasma mcfDNA sequencing for diagnosing sepsis were 68.1 and 63.2%, respectively, which were significantly better than those of blood culture, especially for the common bacteria that cause hospital-acquired infection, namely, Acinetobacter baumannii (p < 0.01) and Klebsiella pneumoniae (p < 0.01), and DNA viruses (plasma mcfDNA sequencing only, p < 0.01). However, there was no significant difference in the rate of positivity between plasma mcfDNA sequencing and blood culture for antibiotic-non-exposed cases (43.6 vs. 30.9%, p = 0.17). In the non-sepsis group, 44.8% of cases (13/29) detected only by plasma mcfDNA sequencing showed infections in other parts of the body, such as lower respiratory infection (LRI), intra-abdominal infection (IAI) and central nervous system infection (CNSI). For some common pathogens (not including anaerobes), turnaround time (TAT) 3 (TAT from the initiation of blood sample processing by nucleic acid extraction to the completion of sequencing analysis) was longer than TAT1 (TAT from blood culture bottles in Virtuo to off Virtuo). With disease progression, significant dynamic changes in microbial species were clearly detected by plasma mcfDNA sequencing.
Collapse
Affiliation(s)
- Lili Wang
- Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wenzheng Guo
- Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hui Shen
- Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jian Guo
- Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Donghua Wen
- Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yuetian Yu
- Department of Critical Care Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenjuan Wu
- Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| |
Collapse
|
7
|
Zhu C, Zhang S, Zhong H, Gu Z, Kang Y, Pan C, Xu Z, Chen E, Yu Y, Wang Q, Mao E. Intra-abdominal infection in acute pancreatitis in eastern China: microbiological features and a prediction model. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:477. [PMID: 33850874 PMCID: PMC8039642 DOI: 10.21037/atm-21-399] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background This study aimed to investigate the microbiol distribution of intra-abdominal infection in patients with acute pancreatitis, and to develop a reliable prediction model to guide the use of antibiotics. Methods Inpatient with acute pancreatitis between January 2015 and June 2020 were enrolled in the study. Participants were divided into the intra-abdominal infection group and non-infection group. Isolated pathogens and antibiotic susceptibility were documented. Characteristics parameters, laboratory results, and outcomes were also compared. Least absolute shrinkage and selection operator (LASSO) regression model was used to select the risk factors associated with intra-abdominal infection in patients with acute pancreatitis. Logistic regression analysis, random forest model, and artificial neural network were also used to validate the performance of the selected predictors in intra-abdominal infection prediction. A novel nomogram based on selected predictors was established to provide individualized risk of developing intra-abdominal infection in patients with acute pancreatitis. Results A total amount of 711 participants were enrolled in the study, and of these, 182 (25.6%) had intra-abdominal infection. Of the 247 isolated pathogens, 45 (18.2%) were multidrug-resistant bacteria, and antibiotic susceptibility was lower than that of China Antimicrobial Surveillance Network 2020. The LASSO method identified 5 independent predictors [intra-abdominal pressure (IAP), acute physiology and chronic health evaluation II (APACHE II), computed tomography severity index (CTSI), the severity of pancreatitis, and intensive care unit (ICU) admission] of intra-abdominal infection, which were validated by three different models. The area under the curve was >0.95 for all 5 predictors. A clinically useful nomogram based on these predictors was successfully established. Conclusions Multidrug-resistant bacteria were quite common in intra-abdominal infection. IAP, APACHE II, CTSI, the severity of pancreatitis, and ICU admission were identified as risk factors and the new nomogram based on these could help clinicians estimate the risk of intra-abdominal infection and optimize antimicrobial prescription for acute pancreatitis patients.
Collapse
Affiliation(s)
- Cheng Zhu
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Sheng Zhang
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Han Zhong
- Department of Pharmacy, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhichun Gu
- Department of Pharmacy, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuening Kang
- Department of Rheumatology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chun Pan
- Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Zhijun Xu
- Department of Critical Care Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Erzhen Chen
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuetian Yu
- Department of Critical Care Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qian Wang
- Department of Emergency Internal Medicine, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Enqiang Mao
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
8
|
Zhang Z, Navarese EP, Zheng B, Meng Q, Liu N, Ge H, Pan Q, Yu Y, Ma X. Analytics with artificial intelligence to advance the treatment of acute respiratory distress syndrome. J Evid Based Med 2020; 13:301-312. [PMID: 33185950 DOI: 10.1111/jebm.12418] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 10/21/2020] [Indexed: 02/05/2023]
Abstract
Artificial intelligence (AI) has found its way into clinical studies in the era of big data. Acute respiratory distress syndrome (ARDS) or acute lung injury (ALI) is a clinical syndrome that encompasses a heterogeneous population. Management of such heterogeneous patient population is a big challenge for clinicians. With accumulating ALI datasets being publicly available, more knowledge could be discovered with sophisticated analytics. We reviewed literatures with big data analytics to understand the role of AI for improving the caring of patients with ALI/ARDS. Many studies have utilized the electronic medical records (EMR) data for the identification and prognostication of ARDS patients. As increasing number of ARDS clinical trials data is open to public, secondary analysis on these combined datasets provide a powerful way of finding solution to clinical questions with a new perspective. AI techniques such as Classification and Regression Tree (CART) and artificial neural networks (ANN) have also been successfully used in the investigation of ARDS problems. Individualized treatment of ARDS could be implemented with a support from AI as we are now able to classify ARDS into many subphenotypes by unsupervised machine learning algorithms. Interestingly, these subphenotypes show different responses to a certain intervention. However, current analytics involving ARDS have not fully incorporated information from omics such as transcriptome, proteomics, daily activities and environmental conditions. AI technology is assisting us to interpret complex data of ARDS patients and enable us to further improve the management of ARDS patients in future with individual treatment plans.
Collapse
Affiliation(s)
- Zhongheng Zhang
- Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Eliano Pio Navarese
- Interventional Cardiology and Cardiovascular Medicine Research, Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Bydgoszcz, Poland
- Faculty of Medicine, University of Alberta, Edmonton, Canada
| | - Bin Zheng
- Department of Surgery, 2D, Walter C Mackenzie Health Sciences Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Qinghe Meng
- Department of Surgery, State University of New York Upstate Medical University, Syracuse, New York
| | - Nan Liu
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Huiqing Ge
- Department of Respiratory Care, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qing Pan
- College of Information Engineering, Zhejiang University of Technology, Hangzhou, China
| | - Yuetian Yu
- Department of Critical Care Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xuelei Ma
- Department of biotherapy, State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
9
|
International Survey on Determinants of Antibiotic Duration and Discontinuation in Pediatric Critically Ill Patients. Pediatr Crit Care Med 2020; 21:e696-e706. [PMID: 32639469 DOI: 10.1097/pcc.0000000000002397] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES We hypothesized that antibiotic use in PICUs is based on criteria not always supported by evidence. We aimed to describe determinants of empiric antibiotic use in PICUs in eight different countries. DESIGN Cross-sectional survey. SETTING PICUs in Canada, the United States, France, Italy, Saudi Arabia, Japan, Thailand, and Brazil. SUBJECTS Pediatric intensivists. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We used literature review and focus groups to develop the survey and its clinical scenarios (pneumonia, septic shock, meningitis, and intra-abdominal infections) in which cultures were unreliable due to antibiotic pretreatment. Data analyses included descriptive statistics and linear regression with bootstrapped SEs. Overall response rate was 39% (482/1,251), with individual country response rates ranging from 25% to 76%. Respondents in all countries prolonged antibiotic duration based on patient characteristics, disease severity, pathogens, and radiologic findings (from a median increase of 1.8 d [95% CI, 0.5-4.0 d] to 9.5 d [95% CI, 8.5-10.5 d]). Younger age, severe disease, and ventilator-associated pneumonia prolonged antibiotic treatment duration despite a lack of evidence for such practices. No variables were reported to shorten treatment duration for all countries. Importantly, more than 39% of respondents would use greater than or equal to 7 days of antibiotics for patients with a positive viral polymerase chain reaction test in all scenarios, except in France for pneumonia (29%), septic shock (13%), and meningitis (6%). The use of elevated levels of inflammatory markers to prolong antibiotic treatment duration varied among different countries. CONCLUSIONS Antibiotic-related decisions are complex and may be influenced by cultural and contextual factors. Evidence-based criteria are necessary to guide antibiotic duration and ensure the rational use of antibiotics in PICUs.
Collapse
|
10
|
Guo CA, Ma L, Su XL, Wang YZ, Zhen LL, Zhang B, An H, Liu HB. Esmolol inhibits inflammation and apoptosis in the intestinal tissue via the overexpression of NF-κB-p65 in the early stage sepsis rats. TURKISH JOURNAL OF GASTROENTEROLOGY 2020; 31:331-341. [PMID: 32412904 DOI: 10.5152/tjg.2020.19341] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND/AIMS Accumulating evidence reveals esmolol could protect the gut mucosa through the regulation of immune response and inflammation in patients with sepsis. However, its underlying mechanism is not fully understood. MATERIALS AND METHODS Diamine oxidase (DAO), intestinal fatty acid-binding protein (I-FABP), interleukin (IL)-6, and IL-10 in the plasma of rats were detected by ELISA assay. Western blotting was utilized to measure the expression levels of NF-kappa B-p65, Bcl-2, and cleaved caspase-3 in the intestinal tissues. The survival analysis was performed in each group. RESULTS The plasma levels of DAO and IL-10 levels were increased, whereas that of I-FABP and IL-6 were decreased in the sepsis rats after esmolol treatment, indicating that after the esmolol treatment, the intestinal inflammation and damages were remarkably reduced as compared to those in the normal saline treated sepsis rats. NF-κB-p65 and Bcl-2 were highly expressed, but cleaved caspase-3 showed lower expression in the esmolol treated groups. However, at the same time, we observed contrasting results in the normal saline treated group. Western blotting data indicated that the esmolol treatment inhibited the inflammation and apoptosis in the intestinal tissue due to the overexpression of NF-κB-p65 in the celiac sepsis rats. The survival analysis results indicate that the esmolol infusion should be used in the early stages sepsis rats. CONCLUSION Esmolol can suppress inflammation and apoptosis in the intestinal tissue via the overexpression of NF-kappa B-p65 in the early stage sepsis rats. kappa BEarly-stage use of esmolol might be an ideal treatment method for sepsis.
Collapse
Affiliation(s)
- Chang-An Guo
- Second Clinical Medical College, Lanzhou University, Gansu Province, China;First Aid Center, Lanzhou University Second Hospital, Gansu Province, China;Department of General Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, China
| | - Li Ma
- Intensive Care Unit, Lanzhou University Second Hospital, Gansu Province, China
| | - Xiao-Lu Su
- Department of Pathology, Lanzhou University Second Hospital, Gansu Province, China
| | - Ying-Zhen Wang
- Intensive Care Unit, Lanzhou University Second Hospital, Gansu Province, China
| | - Ling-Ling Zhen
- Intensive Care Unit, Lanzhou University Second Hospital, Gansu Province, China
| | - Bei Zhang
- Intensive Care Unit, Lanzhou University Second Hospital, Gansu Province, China
| | - Hong An
- Intensive Care Unit, Lanzhou University Second Hospital, Gansu Province, China
| | - Hong-Bin Liu
- Department of General Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, China
| |
Collapse
|
11
|
Maillet F, Bonnet N, Billard-Pomares T, El Alaoui Magdoud F, Tandjaoui-Lambiotte Y. Fatal Legionella pneumophila serogroup 1 pleural empyema: A case report. World J Crit Care Med 2019; 8:99-105. [PMID: 31750087 PMCID: PMC6854392 DOI: 10.5492/wjccm.v8.i6.99] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 08/29/2019] [Accepted: 09/09/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Legionella pneumophila (L. pneumophila) is a gram-negative intracellular bacillus composed of sixteen different serogroups. It is mostly known to cause pneumonia in individuals with known risk factors as immunocompromised status, tobacco use, chronic organ failure or age older than 50 years. Although parapneumonic pleural effusion is frequent in legionellosis, pleural empyema is very uncommon. In this study, we report a case of fatal pleural empyema caused by L. pneumophila serogroup 1 in an 81-year-old man with multiple risk factors.
CASE SUMMARY An 81-year-old man presented to the emergency with a 3 wk dyspnea, fever and left chest pain. His previous medical conditions were chronic lymphocytic leukemia, diabetes mellitus, chronic kidney failure, hypertension and hyperlipidemia, without tobacco use. Chest X-ray and comouted tomography-scan confirmed a large left pleural effusion, which puncture showed a citrine exudate with negative standard bacterial cultures. Despite intravenous cefotaxime antibiotherapy, patient’s worsening condition after 10 d led to thoracocentesis and evacuation of 2 liters of pus. The patient progressively developed severe hypoxemia and multiorgan failure occurred. The patient was treated by antibiotherapy with cefepime and amikacin and with adequate symptomatic shock treatment, but died of uncontrolled sepsis. The next day, cultures of the surgical pleural liquid samples yielded L. pneumophila serogroup 1, consistent with the diagnosis of pleural legionellosis.
CONCLUSION L. pneumophila should be considered in patients with multiple risk factors and undiagnosed pleural empyema unresponsive to conventional antibiotherapy.
Collapse
Affiliation(s)
- François Maillet
- Intensive Care Unit, Avicenne Hospital, Assistance Publique – Hôpitaux de Paris, Bobigny 93000, France
| | - Nicolas Bonnet
- Intensive Care Unit, Avicenne Hospital, Assistance Publique – Hôpitaux de Paris, Bobigny 93000, France
- Paris XIII University, Bobigny 93000, France
| | - Typhaine Billard-Pomares
- Microbiology Department, Avicenne Hospital, Assistance Publique – Hôpitaux de Paris, Bobigny 93000, France
| | - Fatma El Alaoui Magdoud
- Microbiology Department, Jean Verdier Hospital, Assistance Publique–Hôpitaux de Paris, Bondy 93140, France
| | | |
Collapse
|
12
|
Xu Q, Yan Q, Chen S. Use of ulinastatin was associated with reduced mortality in critically ill patients with sepsis. J Thorac Dis 2019; 11:1911-1918. [PMID: 31285884 DOI: 10.21037/jtd.2019.05.03] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Ulinastatin has anti-inflammatory properties and could potentially benefit critically ill septic patients. Nevertheless, clinical studies have yielded conflicting results. The present study examined the efficacy of ulinastatin in intensive care unit (ICU) patients with sepsis and/or septic shock. Methods All septic patients admitted to the ICU of Wuhu No. 2 People's Hospital between 2014 and 2017 were screened for potential eligibility for this retrospective study. The primary outcome was 28-day mortality, and its correlation with ulinastatin was assessed using multiple logistic regression models. Results The study included 263 patients, with an overall 28-day mortality of 38%. Patients receiving ulinastatin showed significantly lower mortality than the control patients (31% vs. 55%; P<0.001). Ulinastatin use was associated with significantly reduced risk of death (OR: 0.317, 95% CI: 0.158-0.621; P=0.001) after adjustment for age, Sequential Organ Failure Assessment score, vasopressor use, and patient type as determined with a multivariable regression model. Conclusions Treatment with ulinastatin was associated with a decrease in 28-day mortality in critically ill septic patients.
Collapse
Affiliation(s)
- Qiancheng Xu
- Department of Critical Care Medicine, Wuhu No. 2 People's Hospital, Wannan Medical College, Wuhu 241000, China
| | - Qian Yan
- Department of Critical Care Medicine, Wuhu No. 2 People's Hospital, Wannan Medical College, Wuhu 241000, China
| | - Shanghua Chen
- Department of Critical Care Medicine, Wuhu No. 2 People's Hospital, Wannan Medical College, Wuhu 241000, China
| |
Collapse
|
13
|
Zhang Z. Human recombinant alkaline phosphatase: a promising, yet-to-be-tested agent for the treatment sepsis-induced acute kidney injury. ANNALS OF TRANSLATIONAL MEDICINE 2019; 6:S124. [PMID: 30740445 DOI: 10.21037/atm.2018.12.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Zhongheng Zhang
- Department of emergency medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| |
Collapse
|
14
|
Zhang Y, Khalid S, Jiang L. Diagnostic and predictive performance of biomarkers in patients with sepsis in an intensive care unit. J Int Med Res 2018; 47:44-58. [PMID: 30477377 PMCID: PMC6384460 DOI: 10.1177/0300060518793791] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Objective This study was performed to compare the predictive performance of serum procalcitonin (PCT), N-terminal brain natriuretic propeptide (NT-proBNP), interleukin-6 (IL-6), prothrombin time (PT), thrombin time (TT), and Sequential Organ Failure Assessment (SOFA) score in the intensive care unit (ICU). Methods This retrospective cohort study enrolled 150 patients with sepsis and septic shock and 30 control patients without sepsis. Each patient was followed until death or 28 days. Correlations between variables were assessed with Spearman’s rho test. The Kruskal–Wallis and Mann–Whitney U tests were used for between-group comparisons. Results Receiver operating characteristic curve analysis of the SOFA score, PCT, NT-proBNP, IL-6, PT, and TT showed an area under the curve of 0.872, 0.732, 0.711, 0.706, 0.806, and 0.691, respectively, for diagnosing sepsis. Binary logistic regression demonstrated that the SOFA score was an independent predictor of 28-day mortality and septic shock. The correlation coefficient (r) between SOFA and PCT, NT-proBNP and SOFA, IL-6 and SOFA, PT and SOFA, and TT and SOFA was 0.79, 0.52, 0.57, 0.56, and 0.58, respectively. Conclusion While the SOFA score is the gold standard, analysis of multiple biomarkers could increase the performance capacity for diagnosis and prognosis in patients with sepsis in the ICU.
Collapse
Affiliation(s)
- Yu Zhang
- 1 Emergency Department, First Affiliated Hospital of Dalian Medical University, China
| | | | - Li Jiang
- 1 Emergency Department, First Affiliated Hospital of Dalian Medical University, China
| |
Collapse
|
15
|
Ulinastatin is effective in reducing mortality for critically ill patients with sepsis: a causal mediation analysis. Sci Rep 2018; 8:14360. [PMID: 30254204 PMCID: PMC6156583 DOI: 10.1038/s41598-018-32533-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 09/10/2018] [Indexed: 12/29/2022] Open
Abstract
Ulinastatin has been found to have anti-inflammatory effect for patients with sepsis. However, its clinical effects were conflicting. The study aimed to investigate the cost-effectiveness of ulinastatin and to perform mediation analysis to explore the proportion of the total effects that can be explained by inflammatory responses. This is a retrospective study involving critically ill patients with sepsis from January 2014 to July 2017. A total of 263 patients were included in the study, involving 179 patients in the ulinastatin group and 84 in the control group. Ulinastatin group showed significantly lower 28-day mortality rate than that in the control group (31% vs. 55%; p < 0.001). Both total (46330 [26000,83500] vs. 19870 [8747,41140] RMB; p < 0.01) and drug cost (18210 [9492,31920] vs. 7230 [2675,19270] RMB; p < 0.01) were significantly higher in the ulinastatin group than the control group. In multivariable model, the adjusted odds ratio for ulinastatin was 0.304 (95% CI: 0.152 to 0.592; p = 0.001). The mediation analysis showed that the use of ulinastatin was able to reduce the probability of death by 23.5%. The average causal mediation effect of delta C-reactive protein (CRP) was 8%, accounting for 35% of the total effect.
Collapse
|
16
|
Xing J, Zhang Z, Ke L, Zhou J, Qin B, Liang H, Chen X, Liu W, Liu Z, Ai Y, Wang D, Wang Q, Zhou Q, Zhang F, Qian K, Jiang D, Zang B, Li Y, Huang X, Qu Y, Xie Y, Xu D, Zou Z, Zheng X, Liu J, Guo F, Liang Y, Sun Q, Gao H, Liu Y, Chang P, Ceng A, Yang R, Yao G, Sun Y, Wang X, Zhang Y, Wen Y, Yu J, Sun R, Li Z, Yuan S, Song Y, Gao P, Liu H, Zhang Z, Wu Y, Ma B, Guo Q, Shan F, Yang M, Li H, Li Y, Lu W, Wang L, Qian C, Wang Z, Lin J, Zhang R, Wan P, Peng Z, Gong Y, Huang L, Wu G, Sun J, Deng Y, Shi D, Zhou L, Zhou F, Shi Q, Guo X, Liu X, Wu W, Meng X, Li L, Chen W, Li S, Wan X, Chao Z, Zhang A, Gu L, Chen W, Wu J, Zhou L, Zhang Z, Weng Y, Feng Y, Yang C, Feng Y, Zhao S, Tong F, Hao D, Han H, Fu B, Gong C, Li Z, Hu K, Kou Q, Zhang H, Liu J, Fan C, Zhou X, Chen X, Sun J, Zhou X, Song B, Sun C, Zhao L, Dong X, Zhang L, Tong D, Pan Z, Cai C, Wang D, Dong Y, Gong Y, Wu Z, Meng X, Wang P, Li W. Enteral nutrition feeding in Chinese intensive care units: a cross-sectional study involving 116 hospitals. Crit Care 2018; 22:229. [PMID: 30244686 PMCID: PMC6151932 DOI: 10.1186/s13054-018-2159-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 08/10/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND There is a lack of large-scale epidemiological data on the clinical practice of enteral nutrition (EN) feeding in China. This study aimed to provide such data on Chinese hospitals and to investigate factors associated with EN delivery. METHODS This cross-sectional study was launched in 118 intensive care units (ICUs) of 116 mainland hospitals and conducted on April 26, 2017. At 00:00 on April 26, all patients in these ICUs were included. Demographic and clinical variables of patients on April 25 were obtained. The dates of hospitalization, ICU admission and nutrition initiation were reviewed. The outcome status 28 days after the day of investigation was obtained. RESULTS A total of 1953 patients were included for analysis, including 1483 survivors and 312 nonsurvivors. The median study day was day 7 (IQR 2-19 days) after ICU entry. The proportions of subjects starting EN within 24, 48 and 72 h after ICU entry was 24.8% (84/352), 32.7% (150/459) and 40.0% (200/541), respectively. The proportion of subjects receiving > 80% estimated energy target within 24, 48, 72 h and 7 days after ICU entry was 10.5% (37/352), 10.9% (50/459), 11.8% (64/541) and 17.8% (162/910), respectively. Using acute gastrointestinal injury (AGI) 1 as the reference in a Cox model, patients with AGI 2-3 were associated with reduced likelihood of EN initiation (HR 0.46, 95% CI 0.353-0.599; p < 0.001). AGI 4 was significantly associated with lower hazard of EN administration (HR 0.056; 95% CI 0.008-0.398; p = 0.004). In a linear regression model, greater Sequential Organ Failure Assessment scores (coefficient - 0.002, 95% CI - 0.008 to - 0.001; p = 0.024) and male gender (coefficient - 0.144, 95% CI - 0.203 to - 0.085; p < 0.001) were found to be associated with lower EN proportion. As compared with AGI 1, AGI 2-3 was associated with lower EN proportion (coefficient - 0.206, 95% CI - 0.273 to - 0.139; p < 0.001). CONCLUSIONS The study showed that EN delivery was suboptimal in Chinese ICUs. More attention should be paid to EN use in the early days after ICU admission.
Collapse
Affiliation(s)
- Juan Xing
- Nanjing General Hospital of Nanjing Military Command, No.305 Zhongshan East Road, Nanjing, 210002 China
| | - Zhongheng Zhang
- Department of emergency medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lu Ke
- Nanjing General Hospital of Nanjing Military Command, No.305 Zhongshan East Road, Nanjing, 210002 China
| | - Jing Zhou
- Nanjing General Hospital of Nanjing Military Command, No.305 Zhongshan East Road, Nanjing, 210002 China
| | - Bingyu Qin
- Henan Provincial People’s Hospital, Zhengzhou, China
| | | | | | - Wenming Liu
- Changzhou No.2 People’s Hospital affiliated to Nanjing Medical University, Nanjing, China
| | - Zhongmin Liu
- Jilin University First Hospital, Changchun, China
| | - Yuhang Ai
- Xiangya Hospital Central South University, Changsha, China
| | - Difeng Wang
- Guizhou Medical University affiliated hospital, Guiyang, China
| | | | | | | | - Kejian Qian
- First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Dongpo Jiang
- Third Military Medical University Daping Hospital, Chongqing, China
| | - Bin Zang
- China Medical University Second Affiliated Hospital, Shenyang, China
| | - Yimin Li
- Guangzhou Medical University First Affiliated Hospital, Guangzhou, China
| | - Xiaobo Huang
- Sichuan Provincial People’s Hospital, Chengdu, China
| | - Yan Qu
- Qingdao Municipal Hospital Group, Qingdao, China
| | | | - Donglin Xu
- Guangzhou First Municipal People’s Hospital, Guangzhou, China
| | - Zhiqiang Zou
- Xiehe Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | | | - Jianbo Liu
- Inner Mongolia People’s Hospital, Huhehaote, China
| | - Feng Guo
- Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China
| | - Yafeng Liang
- Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, Qingdao, China
| | - Qiang Sun
- Tianjing People’s Hospital, Tianjin, China
| | - Hongmei Gao
- Tianjing First Central Hospital, Tianjin, China
| | - Yang Liu
- Tangshan Gongren Hospital, Tangshan, China
| | - Ping Chang
- Southern Medical University Zhujiang Hospital, Guangzhou, China
| | - Aibin Ceng
- North China University of Science and Technology Affiliated Hospital, Tangshan, China
| | | | - Gaiqi Yao
- Peking University Third Hospital, Beijing, China
| | - Yun Sun
- Anhui Medical University Second Affiliated Hospital, Hefei, China
| | - Xiaorong Wang
- Wenzhou Medical University First Affiliated Hospital, Wenzhou, China
| | - Yi Zhang
- Shanxi Provincial People’s Hospital, Taiyuan, China
| | - Yichao Wen
- Guangzhou Medical University Second Affiliated Hospital, Guangzhou, China
| | - Jian Yu
- Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Rongqing Sun
- Zhengzhou University First Affiliated Hospital, Zhengzhou, China
| | - Zhiwei Li
- First People’s Hospital of Kunming, Kunming, China
| | - Shiying Yuan
- Union Hospital Affiliated to Tongji Medical College of Huanzhong University of Science and Technology, Wuhan, China
| | - Yunlin Song
- Xinjiang Medical University Affiliated First Hospital, Wulumuqi, China
| | - Peiyang Gao
- Chengdu University of Traditional Chinese Medicine Affiliated Hospital, Chengdu, China
| | - Haiyan Liu
- First Affiliated Hospital of Anhui Medical University, Hefei, China
| | | | - Yunfu Wu
- Suzhou Municipal Hospital, Suzhou, China
| | - Biao Ma
- Jining Medical College Affiliated Hospital, Jining, China
| | - Qiang Guo
- First Affiliated Hospital of Soochow University, Suzhou, China
| | - Feng Shan
- Qindao University Medical College Affiliated Hospital, Qindao, China
| | - Mingshi Yang
- Central South University Third Xiangya Hospital, Changsha, China
| | - Hailing Li
- 401 Military Hospital of China, Qindao, China
| | - Yuanfei Li
- Changsha Central Hospital, Changsha, China
| | - Weihua Lu
- Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - Lei Wang
- Shanxi Medical University First Affiliated Hospital, Taiyuan, China
| | - Chuangyun Qian
- Kuming Medical University First Affiliated Hospital, Kuming, China
| | - Zhiyong Wang
- Hebei Medical University Third Affiliated Hospital, Shijiazhuang, China
| | - Jiandong Lin
- First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | | | - Peng Wan
- First People’s Hospital of Yichang, Yichang, China
| | - Zhiyong Peng
- Wuhan University Zhongnan Hospital, Wuhan, China
| | - Yuqiang Gong
- Wenzhou Medical University Second Affiliated Hospital, Wenzhou, China
| | - Linxi Huang
- Shantou University Medical College First Affiliated Hospital, Shantou, China
| | - Guobao Wu
- Zhongnan University Xiangya Second Hospital, Changsha, China
| | - Jie Sun
- Yunnan Second People’s Hospital, Kunming, China
| | - Yijun Deng
- Yancheng First People’s Hospital, Yancheng, China
| | - Dongwu Shi
- Shanxi Provincial People’s Hospital, Taiyuan, China
| | - Lixin Zhou
- First People’s Hospital of Foshan, Foshan, China
| | - Fachun Zhou
- Chongqing Medical University First Affiliated Hospital, Chongqing, China
| | - Qindong Shi
- Xi’an Jiao Tong University First Affiliated Hospital, Xi’an, China
| | | | - Xueyan Liu
- Shenzhen People’s Hospital, Shenzhen, China
| | - Weidong Wu
- Shanxi Dayi Hospital of Shanxi Academy of Medical Science, Taiyuan, China
| | | | - Liandi Li
- Qingdao University Affiliated Hospital, Qingdao, China
| | - Weiwei Chen
- Linhai First People’s Hospital, Linhai, China
| | - Shusheng Li
- Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Xianyao Wan
- First Affiliated Hospital of Dalian Medical University, Dalian, China
| | | | - An Zhang
- Chongqing Medical University Second Affiliated Hospital, Chongqing, China
| | - Liming Gu
- People’s Hospital of Yuxi City, Yuxi, China
| | - Wei Chen
- Shijitan Hospital of Capital Medical University, Beijing, China
| | - Jinglan Wu
- Shenzhen Nanshan People’s Hospital, Shenzhen, China
| | - Lihua Zhou
- Affiliated Hospital of Inner Mongolia Medical College, Huhehaote, China
| | | | | | - Yongshun Feng
- Beijing Jingmei Group General Hospital, Beijing, China
| | - Chunli Yang
- Jiangxi Provincial People’s Hospital, Nanchang, China
| | - Yongjian Feng
- Jinan University First Affiliated Hospital, Jinan, China
| | - Sumin Zhao
- General Hospital of Rocket Army, Beijing, China
| | - Fei Tong
- Hebei Medical University Second Affiliated Hospital, Shijiazhuang, China
| | - Dong Hao
- Binzhou Medical College Affiliated Hospital, Binzhou, China
| | - Hui Han
- Chinese PLA General Hospital, Beijing, China
| | - Baocai Fu
- Yantai Mountain Hospital, Yantai, China
| | - Chuanyong Gong
- Tianjing Hospital of ITCWM Nankai Hospital, Tianjing, China
| | - Zhiping Li
- Hunan Provincial People’s Hospital, Changsha, China
| | - Kunlin Hu
- People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Qiuye Kou
- Sun Yat-sen University Sixth Affiliated Hospital, Guangzhou, China
| | - Han Zhang
- China Academy of Chinese Medical Sciences Xiyuan Hospital, Beijing, China
| | - Jie Liu
- Wuhan General Hospital of Guangzhou Military Region, Wuhan, China
| | - Chuming Fan
- First People’s Hospital of Yunnan, Kunming, China
| | - Xin Zhou
- Xinjiang Military General Hospital, Wulumuqi, China
| | | | - Junli Sun
- Luoyang Central Hospital, Luoyang, China
| | - Xuejun Zhou
- Huairou First Hospital of Beijing, Beijing, China
| | - Bin Song
- Military General Hospital of Beijing PLA, Beijing, China
| | - Cheng Sun
- Guangdong Provincial People’s Hospital, Guangzhou, China
| | - Liyun Zhao
- Guangdong Second TCM Hospital, Guangzhou, China
| | | | | | - Dafei Tong
- Shenyang First People’s Hospital, Shenyang, China
| | - Zhiguo Pan
- Guangzhou Military General Hospital, Guangzhou, China
| | - Chuangjie Cai
- Sun Yat-sen University First Affiliated Hospital, Guangzhou, China
| | | | | | - Yuanqi Gong
- Nanchang University Second Affiliated Hospital, Nanchang, China
| | - Zhisong Wu
- Beijing University of Chinese Medicine Affiliated Dongfang Hospital, Beijing, China
| | - Xinke Meng
- Shenzhen Second People’s Hospital, Shenzhen, China
| | - Ping Wang
- Chendu Fifth People’s Hospital, Chendu, China
| | - Weiqin Li
- Nanjing General Hospital of Nanjing Military Command, No.305 Zhongshan East Road, Nanjing, 210002 China
| |
Collapse
|
17
|
Mid-Regional Pro-Adrenomedullin (MR-proADM) as a Biomarker for Sepsis and Septic Shock: Narrative Review. Healthcare (Basel) 2018; 6:healthcare6030110. [PMID: 30177659 PMCID: PMC6164535 DOI: 10.3390/healthcare6030110] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 08/19/2018] [Accepted: 08/29/2018] [Indexed: 02/07/2023] Open
Abstract
Early identification and diagnosis of sepsis and septic shock is vitally important; despite appropriate management, mortality and morbidity rates remain high. For this reason, many biomarkers and screening systems have been investigated in accordance with the precision medicine concept. A narrative review was conducted to assess the role of mid-regional pro-adrenomedullin (MR-proADM) as a biomarker for sepsis and septic shock. Relevant studies were collected via an electronic PubMed, Web of Science, and The Cochrane Library search. The review focused on both diagnosis and prognosis in patients with sepsis and septic shock and specifically in subpopulations of patients with sepsis and septic shock with burns or malignant tumors. No exclusion criteria regarding age, sex, intensive care unit admission, follow-up duration, or co morbidities were used so as to maximize sensitivity and due to lack of randomized controlled trials, opinion paper and reviews were also included in this review. A total of 22 studies, one opinion paper, and one review paper were investigated. MR-proADM levels were found to be useful in assessing patients’ initial evolution and become even more useful during follow-up with increased area under curve values in the mortality prognosis by exceeding values of 0.8 in the data shown in several studies. These results also improve along with other biomarkers or severity scores and especially correlate with the organ failure degree. The results of this study indicate that MR-proADM is a good biomarker for the diagnosis and prognosis of sepsis and septic shock patients as well as for organ failure. Although several publications have discussed its role as a biomarker for pneumonia, its value as a biomarker for sepsis and septic shock should now be assessed in randomized controlled trials and more collaborative prospective studies with larger patient samples.
Collapse
|
18
|
Candel FJ, Borges Sá M, Belda S, Bou G, Del Pozo JL, Estrada O, Ferrer R, González del Castillo J, Julián-Jiménez A, Martín-Loeches I, Maseda E, Matesanz M, Ramírez P, Ramos JT, Rello J, Suberviola B, Suárez de la Rica A, Vidal P. Current aspects in sepsis approach. Turning things around. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2018; 31:298-315. [PMID: 29938972 PMCID: PMC6172679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
The incidence and prevalence of sepsis depend on the definitions and records that we use and we may be underestimating their impact. Up to 60% of the cases come from the community and in 30-60% we obtain microbiological information. Sometimes its presentation is ambiguous and there may be a delay in its detection, especially in the fragile population. Procalcitonin is the most validated biomarker for bacterial sepsis and the one that best discriminates the non-infectious cause. Presepsin and pro-adrenomedullin are useful for early diagnosis, risk stratification and prognosis in septic patients. The combination of biomarkers is even more useful to clarify an infectious cause than any isolated biomarker. Resuscitation with artificial colloids has worse results than crystalloids, especially in patients with renal insufficiency. The combination of saline solution and balanced crystalloids is associated with a better prognosis. Albumin is only recommended in patients who require a large volume of fluids. The modern molecular methods on the direct sample or the identification by MALDI-TOF on positive blood culture have helped to shorten the response times in diagnosis, to optimize the antibiotic treatment and to facilitate stewardship programs. The hemodynamic response in neonates and children is different from that in adults. In neonatal sepsis, persistent pulmonary hypertension leads to an increase in right ventricular afterload and heart failure with hepatomegaly. Hypotension, poor cardiac output with elevated systemic vascular resistance (cold shock) is often a terminal sign in septic shock. Developing ultra-fast Point-of-Care tests (less than 30 minutes), implementing technologies based on omics, big data or massive sequencing or restoring "healthy" microbiomes in critical patients after treatment are the main focuses of research in sepsis. The main benefits of establishing a sepsis code are to decrease the time to achieve diagnosis and treatment, improve organization, unify criteria, promote teamwork to achieve common goals, increase participation, motivation and satisfaction among team members, and reduce costs.
Collapse
Affiliation(s)
| | - Marcio Borges Sá
- Multidisciplinar Sepsis Unit. Intensive Care Unit. Hospital Son Llatzer. Palma de Mallorca
| | - Sylvia Belda
- Department of Intensive Pediatrics. Maternal and Child Health and Development Network. Hospital 12 de Octubre. Madrid
| | - Germán Bou
- Clinical Microbiology Department. Complejo Hospitalario Universitario. La Coruña
| | - José Luis Del Pozo
- Clinical Microbiology and Infectious Diseases Department. Clinica Universitaria Navarra
| | - Oriol Estrada
- Clinical Innovation Management, Germans Trias i Pujol University Hospital. Barcelona
| | - Ricard Ferrer
- Department of Intensive Care. Shock, Organ Dysfunction and Resuscitation Research Group. CIBERES Instituto de Salud Carlos III. Vall d’Hebron University Hospital. Barcelona
| | | | | | - Ignacio Martín-Loeches
- Multidisciplinary Intensive Care Research Organization. CIBERES Instituto de Salud Carlos III. Department of Intensive Care Medicine. St James’s Hospital. Trinity Centre for Health Sciences. Dublin. Ireland
| | - Emilio Maseda
- Department of Anesthesia and Surgical Intensive Care, Hospital Universitario La Paz. Madrid
| | - Mayra Matesanz
- Department of Internal Medicine. Hospital Clínico San Carlos. Madrid
| | - Paula Ramírez
- Critical Care Department. University Hospital la Fe. Valencia
| | - José Tomás Ramos
- José T. Ramos. Department of Public and Mother-Child Health. Hospital Clínico San Carlos, IdISSC Health Research Institute. Universidad Complutense. Madrid
| | - Jordi Rello
- Clinical Research/epidemiology In Pneumonia & Sepsis (CRIPS). CIBERES Instituto de Salud Carlos III. Vall d’Hebron University Hospital. Barcelona
| | - Borja Suberviola
- Critical Care Department. Hospital Universitario Marqués de Valdecilla. Santander
| | | | - Pablo Vidal
- Intensive Care Unit. Complexo Hospitalario Universitario de Ourense
| |
Collapse
|
19
|
Abstract
Acute respiratory tract infection (ARTI) is the most common causes of outpatient visit and hospital admission for children. The study aimed to report epidemiological data on respiratory viruses in a university-affiliated children's hospital.The study was a retrospective study conducted in a university affiliated children's hospital from 2016 May to 2017 April. The results of all nasopharyngeal swab and sputum samples sent for the test for respiratory viruses (adenovirus, influenza A, influenza B, and respiratory syncytial virus) were extracted from the electronic healthcare records. Clinical characteristics were compared between groups with positive versus negative results for respiratory viruses. Multivariable regression models were employed by including age, gender, type of sample (swab vs sputum), source (emergency department vs others), and season to explore the independent factors associated with positive results for respiratory viruses.A total of 34,961 samples were identified during the study period. A total of 3102 (8.9%) samples were positive for adenovirus, 2811 (8.0%) were positive for influenza A, 3460 (9.9%) were positive for influenza B, and 4527 (13.0%) were positive for respiratory syncytial virus. The positive rate of adenovirus was highest in April (50.8%), and lowest in November (3%). The absolute number of positive samples for adenovirus was highest in June (n = 587) and April (n = 544). For the test of influenza A, age was independently associated with positive result. With 1 year increase in age, the odds of positive result increased by 12% (odds ratio [OR]: 1.12; 95% confidence interval [CI]: 1.11-1.13; P < .001). As compared with the autumn, the summer showed significantly lower rate of positive for RSV (OR: 0.49; 95% CI: 0.38-0.62; P < .001), whereas the winter had higher risk of positive result (OR: 3.88; 95% CI: 3.37-4.50; P < .001).The study reported epidemiological data on the prevalence of respiratory viruses in a large tertiary care children's hospital. Age, gender, type of sample, source, and season were associated with the positive rates for respiratory viruses.
Collapse
Affiliation(s)
| | - Tianlin Wang
- Outpatient Department, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
20
|
Comparison of Sepsis-3 Criteria Versus SIRS Criteria in Screening Patients for Sepsis in the Emergency Department. Adv Emerg Nurs J 2018; 40:138-143. [DOI: 10.1097/tme.0000000000000187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
21
|
Zhang Z, Reinikainen J, Adeleke KA, Pieterse ME, Groothuis-Oudshoorn CGM. Time-varying covariates and coefficients in Cox regression models. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:121. [PMID: 29955581 DOI: 10.21037/atm.2018.02.12] [Citation(s) in RCA: 386] [Impact Index Per Article: 64.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Time-varying covariance occurs when a covariate changes over time during the follow-up period. Such variable can be analyzed with the Cox regression model to estimate its effect on survival time. For this it is essential to organize the data in a counting process style. In situations when the proportional hazards assumption of the Cox regression model does not hold, we say that the effect of the covariate is time-varying. The proportional hazards assumption can be tested by examining the residuals of the model. The rejection of the null hypothesis induces the use of time varying coefficient to describe the data. The time varying coefficient can be described with a step function or a parametric time function. This article aims to illustrate how to carry out statistical analyses in the presence of time-varying covariates or coefficients with R.
Collapse
Affiliation(s)
- Zhongheng Zhang
- Department of Emergency Medicine, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Jaakko Reinikainen
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | | | - Marcel E Pieterse
- Department of Psychology, Health and Technology, Centre for eHealth & Well-being Research, University of Twente, Enschede, The Netherlands
| | | |
Collapse
|
22
|
Use of Next Generation Sequencing and Synergy Susceptibility Testing in Diagnosis and Treatment of Carbapenem-Resistant Klebsiella pneumoniae Blood Stream Infection. Case Rep Infect Dis 2018; 2018:3295605. [PMID: 29607230 PMCID: PMC5828565 DOI: 10.1155/2018/3295605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 12/11/2017] [Indexed: 02/05/2023] Open
Abstract
Early diagnosis and appropriate treatment for carbapenem-resistant Klebsiella pneumoniae (CR-Kp) infection is a big challenge for clinicians due to its high mortality. Every effort has been made to improve its clinical outcomes. However, treatment according to synergy susceptibility testing has never been reported in the literature. We reported a 29-year-old systemic lupus erythematosus female with CR-Kp blood stream infection. We highlighted the identification by next generation sequencing and treatment according to synergy susceptibility testing in the case.
Collapse
|
23
|
Zhang Z, Hong Y. Development of a novel score for the prediction of hospital mortality in patients with severe sepsis: the use of electronic healthcare records with LASSO regression. Oncotarget 2017; 8:49637-49645. [PMID: 28548951 PMCID: PMC5564794 DOI: 10.18632/oncotarget.17870] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 05/01/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVE There are several disease severity scores being used for the prediction of mortality in critically ill patients. However, none of them was developed and validated specifically for patients with severe sepsis. The present study aimed to develop a novel prediction score for severe sepsis. RESULTS A total of 3206 patients with severe sepsis were enrolled, including 1054 non-survivors and 2152 survivors. The LASSO score showed the best discrimination (area under curve: 0.772; 95% confidence interval: 0.735-0.810) in the validation cohort as compared with other scores such as simplified acute physiology score II, acute physiological score III, Logistic organ dysfunction system, sequential organ failure assessment score, and Oxford Acute Severity of Illness Score. The calibration slope was 0.889 and Brier value was 0.173. MATERIALS AND METHODS The study employed a single center database called Medical Information Mart for Intensive Care-III) MIMIC-III for analysis. Severe sepsis was defined as infection and acute organ dysfunction. Clinical and laboratory variables used in clinical routines were included for screening. Subjects without missing values were included, and the whole dataset was split into training and validation cohorts. The score was coined LASSO score because variable selection was performed using the least absolute shrinkage and selection operator (LASSO) technique. Finally, the LASSO score was evaluated for its discrimination and calibration in the validation cohort. CONCLUSIONS The study developed the LASSO score for mortality prediction in patients with severe sepsis. Although the score had good discrimination and calibration in a randomly selected subsample, external validations are still required.
Collapse
Affiliation(s)
- Zhongheng Zhang
- 1 Department of Emergency Medicine, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China
| | - Yucai Hong
- 1 Department of Emergency Medicine, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China
| |
Collapse
|
24
|
Zhang Z, Hong Y, Liu N, Chen Y. Association of do-not-resuscitate order and survival in patients with severe sepsis and/or septic shock. Intensive Care Med 2017; 43:715-717. [PMID: 28154886 DOI: 10.1007/s00134-017-4690-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Zhongheng Zhang
- Department of Emergency Medicine, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, No 3, East Qingchun Road, Hangzhou, 310016, Zhejiang, China.
| | - Yucai Hong
- Department of Emergency Medicine, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, No 3, East Qingchun Road, Hangzhou, 310016, Zhejiang, China
| | - Ning Liu
- Department of Emergency Medicine, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, No 3, East Qingchun Road, Hangzhou, 310016, Zhejiang, China
| | - Yuhao Chen
- Department of Emergency Medicine, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, No 3, East Qingchun Road, Hangzhou, 310016, Zhejiang, China
| |
Collapse
|
25
|
Cutuli SL, De Pascale G, Antonelli M. 'σήψις' yesterday, sepsis nowadays: what's changing? J Thorac Dis 2017; 9:E166-E167. [PMID: 28275507 DOI: 10.21037/jtd.2017.02.43] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Salvatore Lucio Cutuli
- Department of Intensive Care and Anesthesiology, Agostino Gemelli University Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Gennaro De Pascale
- Department of Intensive Care and Anesthesiology, Agostino Gemelli University Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Massimo Antonelli
- Department of Intensive Care and Anesthesiology, Agostino Gemelli University Hospital, Catholic University of the Sacred Heart, Rome, Italy
| |
Collapse
|
26
|
|