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Siniscalchi C, Perrella A, Trama U, Bernardi FF, Imbalzano E, Camporese G, Russo V, Scudiero O, Meschi T, Di Micco P. Bacterial Porins and Their Procoagulant Role: Implication in the Pathophysiology of Several Thrombotic Complications during Sepsis. Toxins (Basel) 2024; 16:368. [PMID: 39195778 PMCID: PMC11359280 DOI: 10.3390/toxins16080368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2024] [Revised: 08/16/2024] [Accepted: 08/19/2024] [Indexed: 08/29/2024] Open
Abstract
The association between sepsis and thrombotic complications is still not well known. Different mechanisms have been shown to be involved in the sepsis-induced prothrombotic state, but clinical scenarios may differ. In this review, we have summarized the role that bacterial products such as porins and toxins can have in the induction of the prothrombotic state during sepsis and the interaction that they can have with each other. Furthermore, the above-mentioned mechanisms might be involved in the pattern of the clinical presentation of thrombotic events during bacterial sepsis, which would secondarily explain the association between sepsis and venous thromboembolism, the association between sepsis and disseminated intravascular coagulation, and the association between sepsis and microangiopathic venous thromboembolism.
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Affiliation(s)
- Carmine Siniscalchi
- Internal Medicine Unit, Department of Internal Medicine, University of Parma, 43100 Parma, Italy; (C.S.); (T.M.)
| | - Alessandro Perrella
- UOC Emerging Infectious Disease and High Contagiousness, AORN dei Colli, P.O. Cotugno, 80131 Naples, Italy;
| | - Ugo Trama
- UOD Politica del Farmaco e Dispositivi della DG per la Tutela della Salute SSR, Regione Campania, Via Santa Lucia, 80100 Napoli, Italy;
| | - Francesca Futura Bernardi
- Department of Pharmacology, University of Campania “Luigi Vanvitelli”—Monaldi Hospital, Piazzale Ettore Ruggeri, 80131 Naples, Italy;
| | - Egidio Imbalzano
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy
| | - Giuseppe Camporese
- Department of Internal Medicine DIMED, Padua University Hospital, 35100 Padua, Italy;
| | - Vincenzo Russo
- Cardiology Unit, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”—Monaldi Hospital, Piazzale Ettore Ruggeri, 80131 Naples, Italy;
| | - Olga Scudiero
- Department of Molecular Medicine and Medical Biotechnology, University Federico II of Naples, 80131 Naples, Italy;
| | - Tiziana Meschi
- Internal Medicine Unit, Department of Internal Medicine, University of Parma, 43100 Parma, Italy; (C.S.); (T.M.)
| | - Pierpaolo Di Micco
- UOC Medicina Interna, AFO Medica, P.O. Santa Maria delle Grazie, ASL Napoli 2 Nord, Pozzuoli, 80078 Naples, Italy;
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Wang Y, Gao Z, Zhang Y, Lu Z, Sun F. Early sepsis mortality prediction model based on interpretable machine learning approach: development and validation study. Intern Emerg Med 2024:10.1007/s11739-024-03732-2. [PMID: 39141286 DOI: 10.1007/s11739-024-03732-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 07/27/2024] [Indexed: 08/15/2024]
Abstract
Sepsis triggers a harmful immune response due to infection, causing high mortality. Predicting sepsis outcomes early is vital. Despite machine learning's (ML) use in medical research, local validation within the Medical Information Mart for Intensive Care IV (MIMIC-IV) database is lacking. We aimed to devise a prognostic model, leveraging MIMIC-IV data, to predict sepsis mortality and validate it in a Chinese teaching hospital. MIMIC-IV provided patient data, split into training and internal validation sets. Four ML models logistic regression (LR), support vector machine (SVM), deep neural networks (DNN), and extreme gradient boosting (XGBoost) were employed. Shapley additive interpretation offered early and interpretable mortality predictions. Area under the ROC curve (AUROC) gaged predictive performance. Results were cross verified in a Chinese teaching hospital. The study included 27,134 sepsis patients from MIMIC-IV and 487 from China. After comparing, 52 clinical indicators were selected for ML model development. All models exhibited excellent discriminative ability. XGBoost surpassed others, with AUROC of 0.873 internally and 0.844 externally. XGBoost outperformed other ML models (LR: 0.829; SVM: 0.830; DNN: 0.837) and clinical scores (Simplified Acute Physiology Score II: 0.728; Sequential Organ Failure Assessment: 0.728; Oxford Acute Severity of Illness Score: 0.738; Glasgow Coma Scale: 0.691). XGBoost's hospital mortality prediction achieved AUROC 0.873, sensitivity 0.818, accuracy 0.777, specificity 0.768, and F1 score 0.551. We crafted an interpretable model for sepsis death risk prediction. ML algorithms surpassed traditional scores for sepsis mortality forecast. Validation in a Chinese teaching hospital echoed these findings.
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Affiliation(s)
- Yiping Wang
- Department of Emergency, The First Affiliated Hospital of WenZhou Medical University, Wenzhou, 325000, China
| | - Zhihong Gao
- Department of Computer Technology and Information Management, The First Affiliated Hospital of WenZhou Medical University, Wenzhou, 325000, China
| | - Yang Zhang
- Department of Computer Technology and Information Management, The First Affiliated Hospital of WenZhou Medical University, Wenzhou, 325000, China
| | - Zhongqiu Lu
- Department of Emergency, The First Affiliated Hospital of WenZhou Medical University, Wenzhou, 325000, China.
| | - Fangyuan Sun
- Department of Computer Technology and Information Management, The First Affiliated Hospital of WenZhou Medical University, Wenzhou, 325000, China.
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Fu X, Yan D, Huang W, Xie X, Zhou Y, Li H, Wang Y, Pei S, Yao R, Li N. Efficacy of fresh frozen plasma transfusion in decompensated cirrhosis patients with coagulopathy admitted to ICU: a retrospective cohort study from MIMIC-IV database. Sci Rep 2024; 14:4925. [PMID: 38418492 PMCID: PMC10902319 DOI: 10.1038/s41598-024-54379-0] [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: 10/10/2023] [Accepted: 02/12/2024] [Indexed: 03/01/2024] Open
Abstract
We aimed to explore the association between FFP transfusion and outcomes of DC patients with significant coagulopathy. A total of 693 DC patients with significant coagulopathy were analyzed with 233 patients per group after propensity score matching (PSM). Patients who received FFP transfusion were matched with those receiving conventional therapy via PSM. Regression analysis showed FFP transfusion had no benefit in 30-day (HR: 1.08, 95% CI 0.83-1.4), 90-day (HR: 1.03, 95% CI 0.80-1.31) and in-hospital(HR: 1.30, 95% CI 0.90-1.89) mortality, associated with increased risk of liver failure (OR: 3.00, 95% CI 1.78-5.07), kidney failure (OR: 1.90, 95% CI 1.13-3.18), coagulation failure (OR: 2.55, 95% CI 1.52-4.27), respiratory failure (OR: 1.76, 95% CI 1.15-2.69), and circulatory failure (OR: 2.15, 95% CI 1.27-3.64), and even associated with prolonged the LOS ICU (β: 2.61, 95% CI 1.59-3.62) and LOS hospital (β: 6.59, 95% CI 2.62-10.57). In sensitivity analysis, multivariate analysis (HR: 1.09, 95%CI 0.86, 1.38), IPTW (HR: 1.11, 95%CI 0.95-1.29) and CAPS (HR: 1.09, 95% CI 0.86-1.38) showed FFP transfusion had no beneficial effect on the 30-day mortality. Smooth curve fitting demonstrated the risk of liver failure, kidney failure and circulatory failure increased by 3%, 2% and 2% respectively, for each 1 ml/kg increase in FFP transfusion. We found there was no significant difference of CLIF-SOFA and MELD score between the two group on day 0, 3, 7, 14. Compared with the conventional group, INR, APTT, and TBIL in the FFP transfusion group significantly increased, while PaO2/FiO2 significantly decreased within 14 days. In conclusion, FFP transfusion had no beneficial effect on the 30-day, 90-day, in-hospital mortality, was associated with prolonged the LOS ICU and LOS hospital, and the increased risk of liver failure, kidney failure, coagulation failure, respiratory failure and circulatory failure events. However, large, multi-center, randomized controlled trials, prospective cohort studies and external validation are still needed to verify the efficacy of FFP transfusion in the future.
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Affiliation(s)
- Xiangjie Fu
- Department of Blood Transfusion, Clinical Transfusion Research Center, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Danyang Yan
- Department of Blood Transfusion, Clinical Transfusion Research Center, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wanting Huang
- Department of Blood Transfusion, Clinical Transfusion Research Center, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xi Xie
- Department of Clinical Laboratory, Hunan Prevention and Treatment Institute for Occupational Diseases, University of South China, Changsha, Hunan, China
| | - Yiran Zhou
- Department of Blood Transfusion, Clinical Transfusion Research Center, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Huan Li
- Department of Blood Transfusion, Clinical Transfusion Research Center, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yanjie Wang
- Department of Blood Transfusion, Clinical Transfusion Research Center, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Siya Pei
- Department of Blood Transfusion, Clinical Transfusion Research Center, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Run Yao
- Department of Blood Transfusion, Clinical Transfusion Research Center, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Ning Li
- Department of Blood Transfusion, Clinical Transfusion Research Center, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.
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Roçi E, Puca E, Sula F, Dodaj S, Vyshka G. Multiple cerebral septic emboli sourcing from a ventricular assist device: a case report. AME Case Rep 2023; 7:38. [PMID: 37942042 PMCID: PMC10628398 DOI: 10.21037/acr-23-50] [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: 04/23/2023] [Accepted: 08/13/2023] [Indexed: 11/10/2023]
Abstract
Background Patients carrying portable cardiac devices are at high risk of serious infections, such as endocarditis and sepsis. The event of a neurological complication should be taken into account, despite the fact that this group of patients is as a rule, strictly anticoagulated and monitored duly. Case Description We present the case of a patient of middle age with heart failure awaiting for organ transplantation, and meanwhile having a ventricular assist device (VAD) implanted. The suspicion of an infection was raised following a purulent drainage from the external lead of the device, as well as the clinical picture of malaise, fever and sweating. A right hemiparesis complicated the condition and the brain computerized tomography (CT) scan demonstrated the presence of several hemorrhagic lesions. The suspicion of septic emboli was proven following the result of hemoculture yielding Staphylococcus epidermidis. Conclusions The patient was treated with antibiotics, anti-seizure drugs and with supportive therapy, with good recovery of the clinical picture. He was transferred to a cardiac surgery facility for a revision, or eventually for a replacement of the VAD. There is clearly a need for an increased awareness of probable neurological events among patients holding external heart devices. Available guidelines for their follow-up and monitoring should be strictly respected, in order to avoid complications, and eventually install a prompt and adequate treatment.
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Affiliation(s)
| | - Edmond Puca
- Service of Infectious Diseases, University Hospital Center of Tirana, Tirana, Albania
| | | | - Stela Dodaj
- Biomedical and Experimental Department, Faculty of Medicine, University of Medicine, Tirana, Albania
| | - Gentian Vyshka
- Biomedical and Experimental Department, Faculty of Medicine, University of Medicine, Tirana, Albania
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Fatmi A, Saadi W, Beltrán-García J, García-Giménez JL, Pallardó FV. The Endothelial Glycocalyx and Neonatal Sepsis. Int J Mol Sci 2022; 24:364. [PMID: 36613805 PMCID: PMC9820255 DOI: 10.3390/ijms24010364] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/12/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022] Open
Abstract
Sepsis carries a substantial risk of morbidity and mortality in newborns, especially preterm-born neonates. Endothelial glycocalyx (eGC) is a carbohydrate-rich layer lining the vascular endothelium, with important vascular barrier function and cell adhesion properties, serving also as a mechano-sensor for blood flow. eGC shedding is recognized as a fundamental pathophysiological process generating microvascular dysfunction, which in turn contributes to multiple organ failure and death in sepsis. Although the disruption of eGC and its consequences have been investigated intensively in the adult population, its composition, development, and potential mechanisms of action are still poorly studied during the neonatal period, and more specifically, in neonatal sepsis. Further knowledge on this topic may provide a better understanding of the molecular mechanisms that guide the sepsis pathology during the neonatal period, and would increase the usefulness of endothelial glycocalyx dysfunction as a diagnostic and prognostic biomarker. We reviewed several components of the eGC that help to deeply understand the mechanisms involved in the eGC disruption during the neonatal period. In addition, we evaluated the potential of eGC components as biomarkers and future targets to develop therapeutic strategies for neonatal sepsis.
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Affiliation(s)
- Ahlam Fatmi
- INCLIVA Health Research Institute, Mixed Unit for Rare Diseases INCLIVA-CIPF, 46010 Valencia, Spain
| | - Wiam Saadi
- Department of Biology, Faculty of Nature, Life and Earth Sciences, University of Djillali Bounaama, Khemis Miliana 44225, Algeria
| | - Jesús Beltrán-García
- Center for Biomedical Network Research on Rare Diseases (CIBERER), Institute of Health Carlos III, 46010 Valencia, Spain
- Department of Physiology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain
- Department of Medicine, Division of Regenerative Medicine, University of California, San Diego, CA 92093, USA
| | - José Luis García-Giménez
- INCLIVA Health Research Institute, Mixed Unit for Rare Diseases INCLIVA-CIPF, 46010 Valencia, Spain
- Center for Biomedical Network Research on Rare Diseases (CIBERER), Institute of Health Carlos III, 46010 Valencia, Spain
- Department of Physiology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain
| | - Federico V. Pallardó
- INCLIVA Health Research Institute, Mixed Unit for Rare Diseases INCLIVA-CIPF, 46010 Valencia, Spain
- Center for Biomedical Network Research on Rare Diseases (CIBERER), Institute of Health Carlos III, 46010 Valencia, Spain
- Department of Physiology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain
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Dietrich M, Hölle T, Lalev LD, Loos M, Schmitt FCF, Fiedler MO, Hackert T, Richter DC, Weigand MA, Fischer D. Plasma Transfusion in Septic Shock—A Secondary Analysis of a Retrospective Single-Center Cohort. J Clin Med 2022; 11:jcm11154367. [PMID: 35955987 PMCID: PMC9369152 DOI: 10.3390/jcm11154367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/09/2022] [Accepted: 07/22/2022] [Indexed: 11/16/2022] Open
Abstract
In sepsis, both beneficial and detrimental effects of fresh frozen plasma (FFP) transfusion have been reported. The aim of this study was to analyze the indication for and effect of FFP transfusion in patients with septic shock. We performed a secondary analysis of a retrospective single-center cohort of all patients treated for septic shock at the interdisciplinary surgical intensive care unit (ICU) of the Heidelberg University Hospital. Septic shock was defined according to sepsis-3 criteria. To assess the effects of FFP administration in the early phase of septic shock, we compared patients with and without FFP transfusion during the first 48 h of septic shock. Patients who died during the first 48 h of septic shock were excluded from the analysis. Primary endpoints were 30- and 90-day mortality. A total of 261 patients were identified, of which 100 (38.3%) received FFP transfusion within the first 48 h after septic shock onset. The unmatched analysis showed a trend toward higher 30- and 90-d mortality in the FFP group (30 d: +7% p = 0.261; 90 d: +11.9% p = 0.061). In the propensity-matched analysis, 30- and 90-day mortality were similar between groups. Plasma administration did not influence fluid or vasopressor need, lactate levels, ICU stay, or days on a ventilator. We found no significant harm or associated benefit of FFP use in the early phase of septic shock. Finally, plasma should only be used in patients with a strong indication according to current recommendations, as a conclusive evaluation of the risk-benefit ratio for plasma transfusion in septic shock cannot be made based on the current data.
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Affiliation(s)
- Maximilian Dietrich
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (T.H.); (L.D.L.); (F.C.F.S.); (M.O.F.); (D.C.R.); (M.A.W.); (D.F.)
- Correspondence:
| | - Tobias Hölle
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (T.H.); (L.D.L.); (F.C.F.S.); (M.O.F.); (D.C.R.); (M.A.W.); (D.F.)
| | - Lazar Detelinov Lalev
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (T.H.); (L.D.L.); (F.C.F.S.); (M.O.F.); (D.C.R.); (M.A.W.); (D.F.)
| | - Martin Loos
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (M.L.); (T.H.)
| | - Felix Carl Fabian Schmitt
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (T.H.); (L.D.L.); (F.C.F.S.); (M.O.F.); (D.C.R.); (M.A.W.); (D.F.)
| | - Mascha Onida Fiedler
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (T.H.); (L.D.L.); (F.C.F.S.); (M.O.F.); (D.C.R.); (M.A.W.); (D.F.)
| | - Thilo Hackert
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (M.L.); (T.H.)
| | - Daniel Christoph Richter
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (T.H.); (L.D.L.); (F.C.F.S.); (M.O.F.); (D.C.R.); (M.A.W.); (D.F.)
| | - Markus Alexander Weigand
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (T.H.); (L.D.L.); (F.C.F.S.); (M.O.F.); (D.C.R.); (M.A.W.); (D.F.)
| | - Dania Fischer
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (T.H.); (L.D.L.); (F.C.F.S.); (M.O.F.); (D.C.R.); (M.A.W.); (D.F.)
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