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Li J, Liu H, Wang N, Wang F, Shang N, Guo S, Wang G. Persistent high sepsis-induced coagulopathy and sequential organ failure assessment scores can predict the 28-day mortality of patients with sepsis: A prospective study. BMC Infect Dis 2024; 24:282. [PMID: 38438863 PMCID: PMC10913246 DOI: 10.1186/s12879-024-09154-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 02/19/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND The performance of the sepsis-induced coagulopathy (SIC) and sequential organ failure assessment (SOFA) scores in predicting the prognoses of patients with sepsis has been validated. This study aimed to investigate the time course of SIC and SOFA scores and their association with outcomes in patients with sepsis. METHODS This prospective study enrolled 209 patients with sepsis admitted to the emergency department. The SIC and SOFA scores of the patients were assessed on days 1, 2, and 4. Patients were categorized into survivor or non-survivor groups based on their 28-day survival. We conducted a generalized estimating equation analysis to evaluate the time course of SIC and SOFA scores and the corresponding differences between the two groups. The predictive value of SIC and SOFA scores at different time points for sepsis prognosis was evaluated. RESULTS In the non-survivor group, SIC and SOFA scores gradually increased during the first 4 days (P < 0.05). In the survivor group, the SIC and SOFA scores on day 2 were significantly higher than those on day 1 (P < 0.05); however, they decreased on day 4, dropping below the levels observed on day 1 (P < 0.05). The non-survivors showed higher SIC scores on days 2 (P < 0.05) and 4 (P < 0.001) than the survivors, whereas no significant differences were found between the two groups on day 1 (P > 0.05). The performance of SIC scores on day 4 for predicting mortality was more accurate than that on day 2, with areas under the curve of 0.749 (95% confidence interval [CI]: 0.674-0.823), and 0.601 (95% CI: 0.524-0.679), respectively. The SIC scores demonstrated comparable predictive accuracy for 28-day mortality to the SOFA scores on days 2 and 4. Cox proportional hazards models indicated that SIC on day 4 (hazard ratio [HR] = 3.736; 95% CI: 2.025-6.891) was an independent risk factor for 28-day mortality. CONCLUSIONS The time course of SIC and SOFA scores differed between surviving and non-surviving patients with sepsis, and persistent high SIC and SOFA scores can predict 28-day mortality.
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Affiliation(s)
- Junyu Li
- Department of Emergency Medicine, Beijing Chao-Yang Hospital, Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Capital Medical University, Beijing, China
- Department of Emergency Medicine, Capital Medical University School of Rehabilitation Medicine, Beijing Bo'Ai Hospital, China Rehabilitation Research Center , Beijing, China
| | - Huizhen Liu
- Department of Emergency Medicine, Beijing Chao-Yang Hospital, Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Capital Medical University, Beijing, China
- Department of Emergency Medicine, Capital Medical University School of Rehabilitation Medicine, Beijing Bo'Ai Hospital, China Rehabilitation Research Center , Beijing, China
| | - Na Wang
- Department of Emergency Medicine, Capital Medical University School of Rehabilitation Medicine, Beijing Bo'Ai Hospital, China Rehabilitation Research Center , Beijing, China
| | - Fengrong Wang
- Department of Emergency Medicine, Capital Medical University School of Rehabilitation Medicine, Beijing Bo'Ai Hospital, China Rehabilitation Research Center , Beijing, China
| | - Na Shang
- Department of Emergency Medicine, Beijing Chao-Yang Hospital, Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Capital Medical University, Beijing, China
| | - Shubin Guo
- Department of Emergency Medicine, Beijing Chao-Yang Hospital, Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Capital Medical University, Beijing, China.
| | - Guodong Wang
- Cardiovascular Department, Capital Medical University School of Rehabilitation Medicine, Beijing Bo'Ai Hospital, China Rehabilitation Research Center, Beijing, China.
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Magoon R. SOFA-based Prognostication in PICU: A Cardiovascular Critique! Indian J Crit Care Med 2023; 27:861-862. [PMID: 37936797 PMCID: PMC10626237 DOI: 10.5005/jp-journals-10071-24524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
How to cite this article: Magoon R. SOFA-based Prognostication in PICU: A Cardiovascular Critique! Indian J Crit Care Med 2023;27(11):861-862.
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Affiliation(s)
- Rohan Magoon
- Department of Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, New Delhi, India
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Lois A, Save S. Author Reply - SOFA-based Prognostication in PICU: A Cardiovascular Critique! Indian J Crit Care Med 2023; 27:863. [PMID: 37936804 PMCID: PMC10626244 DOI: 10.5005/jp-journals-10071-24568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
How to cite this article: Lois A, Save S. Author Reply - SOFA-based Prognostication in PICU: A Cardiovascular Critique! Indian J Crit Care Med 2023;27(11):863.
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Affiliation(s)
- Amoolya Lois
- Department of Pediatric Intensive Care Unit, Manipal Hospital, Bengaluru, Karnataka, India
| | - Sushma Save
- Department of Pediatrics, Topiwala National Medical College and Bai Yamunabai Laxman Nair Charitable Hospital, Mumbai, Maharashtra, India
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Yan W, Yao Z, Ou Q, Ye G. Establishment and validation of a prognosis nomogram for MIMIC-III patients with liver cirrhosis complicated with hepatic encephalopathy. BMC Gastroenterol 2023; 23:335. [PMID: 37770848 PMCID: PMC10538063 DOI: 10.1186/s12876-023-02967-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 09/20/2023] [Indexed: 09/30/2023] Open
Abstract
INTRODUCE The purpose of this study was to establish a comprehensive prognosis nomogram for patients with liver cirrhosis complicated with hepatic encephalopathy (HE) in the intensive care unit (ICU) and to evaluate the predictive value of the nomogram. METHOD This study analyzed 620 patients with liver cirrhosis complicated with HE from the Medical Information Mart for Intensive Care III(MIMIC-III) database. The patients were randomly divided into two groups in a 7-to-3 ratio to form a training cohort (n = 434) and a validation cohort (n = 176). Cox regression analyses were used to identify associated risk variables. Based on the multivariate Cox regression model results, a nomogram was established using associated risk predictor variables to predict the 90-day survival rate of patients with cirrhosis complicated with HE. The new model was compared with the Sequential organ failure assessment (SOFA) scoring model in terms of the concordance index (C-index), the area under the curve (AUC) of receiver operating characteristic (ROC) analysis, the net reclassification improvement (NRI), the integrated discrimination improvement (IDI), calibration curve, and decision curve analysis (DCA). RESULTS This study showed that older age, higher mean heart rate, lower mean arterial pressure, lower mean temperature, higher SOFA score, higher RDW, and the use of albumin were risk factors for the prognosis of patients with liver cirrhosis complicated with HE. The use of proton pump inhibitors (PPI) was a protective factor. The performance of the nomogram was evaluated using the C-index, AUC, IDI value, NRI value, and DCA curve, showing that the nomogram was superior to that of the SOFA model alone. Calibration curve results showed that the nomogram had excellent calibration capability. The decision curve analysis confirmed the good clinical application ability of the nomogram. CONCLUSION This study is the first study of the 90-day survival rate prediction of cirrhotic patients with HE in ICU through the data of the MIMIC-III database. It is confirmed that the eight-factor nomogram has good efficiency in predicting the 90-day survival rate of patients.
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Affiliation(s)
- Wansheng Yan
- Department of Gastroenterology, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Zhihui Yao
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, China
| | - Qiutong Ou
- Department of Gastroenterology, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Gang Ye
- Department of Gastroenterology, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China.
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Ndomba N, Soldera J. Management of sepsis in a cirrhotic patient admitted to the intensive care unit: A systematic literature review. World J Hepatol 2023; 15:850-866. [PMID: 37397933 PMCID: PMC10308287 DOI: 10.4254/wjh.v15.i6.850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 05/22/2023] [Accepted: 05/31/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Sepsis is a severe medical condition that occurs when the body's immune system overreacts to an infection, leading to life-threatening organ dysfunction. The "Third international consensus definitions for sepsis and septic shock (Sepsis-3)" defines sepsis as an increase in sequential organ failure assessment score of 2 points or more, with a mortality rate above 10%. Sepsis is a leading cause of intensive care unit (ICU) admissions, and patients with underlying conditions such as cirrhosis have a higher risk of poor outcomes. Therefore, it is critical to recognize and manage sepsis promptly by administering fluids, vasopressors, steroids, and antibiotics, and identifying and treating the source of infection.
AIM To conduct a systematic review and meta-analysis of existing literature on the management of sepsis in cirrhotic patients admitted to the ICU and compare the management of sepsis between cirrhotic and non-cirrhotic patients in the ICU.
METHODS This study is a systematic literature review that followed the PRISMA statement's standardized search method. The search for relevant studies was conducted across multiple databases, including PubMed, Embase, Base, and Cochrane, using predefined search terms. One reviewer conducted the initial search, and the eligibility criteria were applied to the titles and abstracts of the retrieved articles. The selected articles were then evaluated based on the research objectives to ensure relevance to the study's aims.
RESULTS The study findings indicate that cirrhotic patients are more susceptible to infections, resulting in higher mortality rates ranging from 18% to 60%. Early identification of the infection source followed by timely administration of antibiotics, vasopressors, and corticosteroids has been shown to improve patient outcomes. Procalcitonin is a useful biomarker for diagnosing infections in cirrhotic patients. Moreover, presepsin and resistin have been found to be reliable markers of bacterial infection in patients with decompensated liver cirrhosis, with similar diagnostic performance compared to procalcitonin.
CONCLUSION This review highlights the importance of early detection and management of infections in cirrhosis patients to reduce mortality. Therefore, early detection of infection using procalcitonin test and other biomarker as presepsin and resistin, associated with early management with antibiotics, fluids, vasopressors and low dose corticosteroids might reduce the mortality associated with sepsis in cirrhotic patients.
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Affiliation(s)
- Nkola Ndomba
- Acute Medicine, University of South Wales, Cardiff CF37 1DL, United Kingdom
| | - Jonathan Soldera
- Acute Medicine, University of South Wales, Cardiff CF37 1DL, United Kingdom
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Zhang J, Xie J, Chen H, Li C, Mo M, Qiu H, Yang Y. Development and validation of a clinical score combining the sequential organ failure assessment score with inflammation-based markers to predict outcome of patients with sepsis. Am J Transl Res 2023; 15:1789-1797. [PMID: 37056837 PMCID: PMC10086921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/22/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND Whether combining the Sequential Organ Failure Assessment (SOFA) score at admission with inflammation-based markers can improve performance of prediction and risk stratification of patients with sepsis, compared to use of the SOFA score alone, remains unknown. METHODS Data from septic patients included in the Medical Information Mart for Intensive Care database (MIMIC-IV) database were used for model development and internal validation. We developed a predictive nomogram model that included SOFA score, Charlson Comorbidity Index (CCI), red cell distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and mean corpuscular volume (MCV) values. The primary outcome was the performance of the risk score. RESULTS Data from 4704 septic patients included in the database were used for the primary cohort and to build the model. The multivariate analyses included SOFA score, CCI, RDW, NLR, LMR, and MCV values. These values were used for nomogram model construction. The nomogram model showed good calibration, and had better discrimination in terms of area under the receiver operating characteristic (AUROC) curve results than use of the SOFA score alone (0.724 (95% CI: 0.705-0.743) vs. 0.585 (95% CI: 0.562-0.609), respectively; P<0.001). It also had better classification in terms of net reclassification improvement (20.5% (95% CI: 16.2%-24.7%; P<0.001)) and integrated discrimination improvement (6.0% (95% CI: 5.1%-6.8%; P<0.001)). The validation cohort results supported these findings. CONCLUSION The results suggested that this simple-to-use nomogram model provided a relatively accurate risk of death prediction in patients with sepsis.
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Affiliation(s)
- Junwei Zhang
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast UniversityNanjing 210009, Jiangsu, China
| | - Jianfeng Xie
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast UniversityNanjing 210009, Jiangsu, China
| | - Hui Chen
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast UniversityNanjing 210009, Jiangsu, China
- Department of Critical Care Medicine, The First Affiliated Hospital of Soochow University, Soochow UniversitySuzhou 215000, Jiangsu, China
| | - Cong Li
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast UniversityNanjing 210009, Jiangsu, China
| | - Min Mo
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast UniversityNanjing 210009, Jiangsu, China
| | - Haibo Qiu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast UniversityNanjing 210009, Jiangsu, China
| | - Yi Yang
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast UniversityNanjing 210009, Jiangsu, China
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Hou H, Yang J, Han Z, Zhang X, Tang X, Chen T. Predictive values of the SOFA score and procalcitonin for septic shock after percutaneous nephrolithotomy. Urolithiasis 2022. [PMID: 36214882 DOI: 10.1007/s00240-022-01366-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/04/2022] [Indexed: 11/04/2022]
Abstract
To investigate the value of combination of the Sequential Organ Failure Assessment (SOFA) score and procalcitonin (PCT) for prediction of septic shock after percutaneous nephrolithotomy (PCNL). A total of 1328 patients receiving PCNL for renal calculi were allocated into control group (without septic shock) and septic shock group, and related data were retrospectively collected. Univariate analysis was firstly performed, and the variables with two sided P < 0.10 were then included in logistic regression analysis to determine independent risk factors. Receiver operating characteristic (ROC) curve was utilized to evaluate the predictive values. Area under curve (AUC) was compared using Z test. Postoperative septic shock was developed in 61 patients (4.6%) and not developed in 1267 patients (95.3%). Multivariate analysis demonstrated that SOFA score (OR: 1.316, 95% CI 1.125–1.922), PCT (OR: 1.205, 95% CI 1.071–1.696) and operative time (OR: 1.108, 95% CI 1.032–1.441) were independent risk factors for septic shock with adjustment for sex, history of urolithiasis surgery, positive history of urine culture and history of PCNL. The ROC curves demonstrated that the AUCs of SOFA score and PCT for predicting septic shock after PCNL were 0.896 (95% CI 0.866–0.927) and 0.792 (95% CI 0.744–0.839), respectively. The AUC of their combination was 0.971 (95% CI 0.949–0.990), which was higher than those of individual predictions (vs 0.896, Z = 4.086, P < 0.001; vs 0.792, Z = 6.983, P < 0.001). Both the SOFA score and PCT could be applied in predicting septic shock after PCNL, and their combination could further elevate the diagnostic ability.
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Lorencio Cárdenas C, Yébenes JC, Vela E, Clèries M, Sirvent JM, Fuster-Bertolín C, Reina C, Rodríguez A, Ruiz-Rodríguez JC, Trenado J, Esteban Torné E. Trends in mortality in septic patients according to the different organ failure during 15 years. Crit Care 2022; 26:302. [PMID: 36192781 PMCID: PMC9528124 DOI: 10.1186/s13054-022-04176-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/14/2022] [Indexed: 11/07/2022] Open
Abstract
Background The incidence of sepsis can be estimated between 250 and 500 cases/100.000 people per year and is responsible for up to 6% of total hospital admissions. Identified as one of the most relevant global health problems, sepsis is the condition that generates the highest costs in the healthcare system. Important changes in the management of septic patients have been included in recent years; however, there is no information about how changes in the management of sepsis-associated organ failure have contributed to reduce mortality. Methods A retrospective analysis was conducted from hospital discharge records from the Minimum Basic Data Set Acute-Care Hospitals (CMBD-HA in Catalan language) for the Catalan Health System (CatSalut). CMBD-HA is a mandatory population-based register of admissions to all public and private acute-care hospitals in Catalonia. Sepsis was defined by the presence of infection and at least one organ dysfunction. Patients hospitalized with sepsis were detected, according ICD-9-CM (since 2005 to 2017) and ICD-10-CM (2018 and 2019) codes used to identify acute organ dysfunction and infectious processes. Results Of 11.916.974 discharges from all acute-care hospitals during the study period (2005–2019), 296.554 had sepsis (2.49%). The mean annual sepsis incidence in the population was 264.1 per 100.000 inhabitants/year, and it increased every year, going from 144.5 in 2005 to 410.1 in 2019. Multiorgan failure was present in 21.9% and bacteremia in 26.3% of cases. Renal was the most frequent organ failure (56.8%), followed by cardiovascular (24.2%). Hospital mortality during the study period was 19.5%, but decreases continuously from 25.7% in 2005 to 17.9% in 2019 (p < 0.0001). The most important reduction in mortality was observed in cases with cardiovascular failure (from 47.3% in 2005 to 31.2% in 2019) (p < 0.0001). In the same way, mean mortality related to renal and respiratory failure in sepsis was decreased in last years (p < 0.0001). Conclusions The incidence of sepsis has been increasing in recent years in our country. However, hospital mortality has been significantly reduced. In septic patients, all organ failures except liver have shown a statistically significant reduction on associated mortality, with cardiovascular failure as the most relevant. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-04176-w.
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Affiliation(s)
- Carolina Lorencio Cárdenas
- grid.411295.a0000 0001 1837 4818Intensive Care Department, Hospital Universitari Dr. Josep Trueta, Girona, Spain ,grid.5319.e0000 0001 2179 7512Universitat de Girona. UdG., Girona, Spain
| | - Juan Carlos Yébenes
- grid.414519.c0000 0004 1766 7514Intensive Care Department, Hospital de Mataró, Mataró, Spain
| | - Emili Vela
- grid.418284.30000 0004 0427 2257Digitalization for the Sustainability of the Healthcare System (DS3), IDIBELL., Barcelona, Spain ,grid.22061.370000 0000 9127 6969Àrea de Sistemes d’informació, Servei Català de la Salut (CatSalut), Barcelona, Spain
| | - Montserrat Clèries
- grid.418284.30000 0004 0427 2257Digitalization for the Sustainability of the Healthcare System (DS3), IDIBELL., Barcelona, Spain ,grid.22061.370000 0000 9127 6969Àrea de Sistemes d’informació, Servei Català de la Salut (CatSalut), Barcelona, Spain
| | - Josep Mª Sirvent
- grid.411295.a0000 0001 1837 4818Intensive Care Department, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - Cristina Fuster-Bertolín
- grid.411295.a0000 0001 1837 4818Intensive Care Department, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - Clara Reina
- grid.414519.c0000 0004 1766 7514Intensive Care Department, Hospital de Mataró, Mataró, Spain
| | - Alejandro Rodríguez
- grid.411435.60000 0004 1767 4677Intensive Care Department, Hospital Universitari Joan XXIII, Tarragona, Spain
| | - Juan Carlos Ruiz-Rodríguez
- grid.411083.f0000 0001 0675 8654Intensive Care Department, Shock, Organ Dysfunction and Resuscitation Research Group, Vall d’Hebron, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Josep Trenado
- grid.414875.b0000 0004 1794 4956Intensive Care Department, Hospital Mútua de Terrassa, Terrassa, Spain
| | - Elisabeth Esteban Torné
- grid.411160.30000 0001 0663 8628Pediatric Intensive Care Department, Hospital Universitari Sant Joan de Déu, Barcelona, Spain
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Clerk AM. Sepsis in Intensive Care Unit: Which Score Predicts Better about Outcome? Indian J Crit Care Med 2022; 26:1072-1073. [PMID: 36876204 PMCID: PMC9983663 DOI: 10.5005/jp-journals-10071-24337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 09/15/2022] [Indexed: 11/23/2022] Open
Abstract
How to cite this article: Clerk AM. Sepsis in Intensive Care Unit: Which Score Predicts Better about Outcome? Indian J Crit Care Med 2022;26(10):1072-1073.
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Affiliation(s)
- Anuj M Clerk
- Department of Intensive Care, Sunshine Global Hospitals, Surat, Gujarat, India
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Juneja D. Ideal scoring system for acute pancreatitis: Quest for the Holy Grail. World J Crit Care Med 2022; 11:198-200. [PMID: 36331986 PMCID: PMC9136720 DOI: 10.5492/wjccm.v11.i3.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/12/2022] [Accepted: 03/27/2022] [Indexed: 02/06/2023] Open
Abstract
Clinical scoring systems are required to predict complications, severity, need for intensive care unit admission, and mortality in patients with acute pancreatitis. Over the years, many scores have been developed, tested, and compared for their efficacy and accuracy. An ideal score should be rapid, reliable, and validated in different patient populations and geographical areas and should not lose relevance over time. A combination of scores or serial monitoring of a single score may increase their efficacy.
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Affiliation(s)
- Deven Juneja
- Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, New Delhi 110017, India
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Jung HY, Jeon Y, Jeon S, Lim JH, Kim YL. Superiority of Simplified Acute Physiologic Score II Compared with Acute Physiologic and Chronic Health Evaluation II and Sequential Organ Failure Assessment Scores for Predicting 48-Hour Mortality in Patients Receiving Continuous Kidney Replacement Therapy. Nephron Clin Pract 2022; 146:369-376. [PMID: 35100603 DOI: 10.1159/000521495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/08/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Predicting early mortality is important in patients undergoing continuous kidney replacement therapy (CKRT), especially in the first 48 h. This study aimed to determine the predictive performance of the Simplified Acute Physiologic Score (SAPS) II, the Acute Physiologic and Chronic Health Evaluation (APACHE) II, and the Sequential Organ Failure Assessment (SOFA) scores for early mortality in patients receiving CKRT. METHODS Data from patients with acute kidney injury receiving CKRT were consecutively and retrospectively obtained at a tertiary medical center between August 2017 and March 2021. The outcomes included 48-h and 7-day mortality. The scoring systems were evaluated via discrimination at the time of CKRT initiation (using area under the receiver operating characteristics curve [AUROC]) and calibration (via Hosmer-Lemeshow goodness-of-fit C statistics). RESULTS Among eligible 652 patients, 95 (14.6%) and 212 (32.5%) died within 48 h and within 7 days, respectively. The AUROC for SAPS II (0.71, 95% confidence interval [CI]: 0.65-0.77, p = 0.016 vs. APACHE II score, p = 0.044 vs. SOFA score) was significantly higher than that of the APACHE II (0.66, 95% CI: 0.60-0.72) and SOFA scores (0.66, 95% CI: 0.60-0.72) for 48-h mortality. However, no significant differences in the AUROCs for SAPS II, APACHE II, and SOFA scores for 7-day mortality were observed. The calibration of the SAPS II for 48-h and 7-day mortality was adequate (p = 0.507 and p = 0.141, respectively). CONCLUSIONS The predictive performance of SAPS II for mortality within the first 48 h was superior to that of the APACHE II and SOFA scores in patients with acute kidney injury receiving CKRT.
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Affiliation(s)
- Hee-Yeon Jung
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Yena Jeon
- Department of Statistics, Kyungpook National University, Daegu, Republic of Korea
| | - Soojee Jeon
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Jeong-Hoon Lim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Yong-Lim Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
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Ojima M, Shimizu K, Motooka D, Ishihara T, Nakamura S, Shintani A, Ogura H, Iida T, Yoshiya K, Shimazu T. Gut Dysbiosis Associated with Antibiotics and Disease Severity and Its Relation to Mortality in Critically Ill Patients. Dig Dis Sci 2022; 67:2420-32. [PMID: 33939152 DOI: 10.1007/s10620-021-07000-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 04/14/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The gut microbiota are reported to be altered in critical illness. The pattern and impact of dysbiosis on prognosis has not been thoroughly investigated in the ICU setting. AIMS We aimed to evaluate changes in the gut microbiota of ICU patients via 16S rRNA gene deep sequencing, assess the association of the changes with antibiotics use or disease severity, and explore the association of gut microbiota changes with ICU patient prognosis. METHODS Seventy-one mechanically ventilated patients were included. Fecal samples were collected serially on days 1-2, 3-4, 5-7, 8-14, and thereafter when suitable. Microorganisms of the fecal samples were profiled by 16S rRNA gene deep sequencing. RESULTS Proportions of the five major phyla in the feces were diverse in each patient at admission. Those of Bacteroidetes and Firmicutes especially converged and stabilized within the first week from admission with a reduction in α-diversity (p < 0.001). Significant differences occurred in the proportional change of Actinobacteria between the carbapenem and non-carbapenem groups (p = 0.030) and that of Actinobacteria according to initial SOFA score and changes in the SOFA score (p < 0.001). An imbalance in the ratio of Bacteroidetes to Firmicutes within seven days from admission was associated with higher mortality when the ratio was > 8 or < 1/8 (odds ratio: 5.54, 95% CI: 1.39-22.18, p = 0.015). CONCLUSIONS Broad-spectrum antibiotics and disease severity may be associated with gut dysbiosis in the ICU. A progression of dysbiosis occurring in the gut of ICU patients might be associated with mortality.
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Yang R, Han D, Zhang L, Huang T, Xu F, Zheng S, Yin H, Lyu J. Analysis of the correlation between the longitudinal trajectory of SOFA scores and prognosis in patients with sepsis at 72 hour after admission based on group trajectory modeling. J Intensive Med 2022; 2:39-49. [PMID: 36789228 DOI: 10.1016/j.jointm.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/26/2021] [Accepted: 11/08/2021] [Indexed: 11/22/2022]
Abstract
Background To identify the distinct trajectories of the Sequential Organ Failure Assessment (SOFA) scores at 72 h for patients with sepsis in the Medical Information Mart for Intensive Care (MIMIC)-IV database and determine their effects on mortality and adverse clinical outcomes. Methods A retrospective cohort study was carried out involving patients with sepsis from the MIMIC-IV database. Group-based trajectory modeling (GBTM) was used to identify the distinct trajectory groups for the SOFA scores in patients with sepsis in the intensive care unit (ICU). The Cox proportional hazards regression model was used to investigate the relationship between the longitudinal change trajectory of the SOFA score and mortality and adverse clinical outcomes. Results A total of 16,743 patients with sepsis were included in the cohort. The median survival age was 66 years (interquartile range: 54-76 years). The 7-day and 28-day in-hospital mortality were 6.0% and 17.6%, respectively. Five different trajectories of SOFA scores according to the model fitting standard were determined: group 1 (32.8%), group 2 (30.0%), group 3 (17.6%), group 4 (14.0%) and group 5 (5.7%). Univariate and multivariate Cox regression analyses showed that, for different clinical outcomes, trajectory group 1 was used as the reference, while trajectory groups 2-5 were all risk factors associated with the outcome (P < 0.001). Subgroup analysis revealed an interaction between the two covariates of age and mechanical ventilation and the different trajectory groups of patients' SOFA scores (P < 0.05). Conclusion This approach may help identify various groups of patients with sepsis, who may be at different levels of risk for adverse health outcomes, and provide subgroups with clinical importance.
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Yeşil O, Pekdemir M, Özturan İU, Doğan NÖ, Yaka E, Yılmaz S, Karadaş A, Pınar SG. Performance of qSOFA, SIRS, and the qSOFA + SIRS combinations for predicting 30-day adverse outcomes in patients with suspected infection. Med Klin Intensivmed Notfmed 2021; 117:623-629. [PMID: 34586431 DOI: 10.1007/s00063-021-00870-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 08/04/2021] [Accepted: 08/20/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The use of the quick sequential organ failure assessment score (qSOFA) score and systemic inflammatory response syndrome (SIRS) criteria to identify patients at high risk for adverse outcomes in the emergency department (ED) remains controversial due to their low predictive performance and lack of supporting evidence. This study aimed to determine the predictive performance of qSOFA, SIRS, and the qSOFA + SIRS combinations for adverse outcomes. METHODS All adult patients admitted to the ED with suspected infection were prospectively included. qSOFA scores ≥ 2, SIRS score ≥ 2 were defined as risk-positive for adverse outcome. Furthermore, combination‑1, which was defined as either qSOFA or SIRS positivity, and combination‑2, which was defined as both qSOFA and SIRS positivity, were also considered as risk-positive for adverse outcome. The predictive performance of qSOFA, SIRS, combination‑1, and combination‑2 for a composite adverse outcome within 30 days, including mortality, intensive care unit (ICU) admission, and non-ICU hospitalization, were determined. RESULTS A total of 350 patients were included in the analysis. The composite outcome occurred in 211 (60.3%) patients within 30 days: mortality in 84 (24%), ICU admission in 78 (22.3%), and non-ICU hospitalization in 154 (44%). The sensitivity and specificity, respectively, were determined in predicting composite outcome as 0.34 and 0.93 for qSOFA, 0.81 and 0.31 for SIRS, 0.84 and 0.28 for combination‑1, and 0.31 and 0.96 for combination‑2. CONCLUSION The study results suggest that qSOFA and combination‑2 could be a useful tool for confirming patients at high risk for adverse outcomes. Although SIRS and combination‑1 could be helpful for excluding high-risk patients, the requirement of white blood cell counts limits their utilization for screening.
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Affiliation(s)
- Olcay Yeşil
- Faculty of Medicine, Dept. of Emergency Medicine, Kocaeli University, Kabaoğlu, Baki Komsuoğlu bulvarı No:515, Umuttepe, 41001, İzmit, Kocaeli, Turkey
| | - Murat Pekdemir
- Faculty of Medicine, Dept. of Emergency Medicine, Kocaeli University, Kabaoğlu, Baki Komsuoğlu bulvarı No:515, Umuttepe, 41001, İzmit, Kocaeli, Turkey
| | - İbrahim Ulaş Özturan
- Faculty of Medicine, Dept. of Emergency Medicine, Kocaeli University, Kabaoğlu, Baki Komsuoğlu bulvarı No:515, Umuttepe, 41001, İzmit, Kocaeli, Turkey.
| | - Nurettin Özgür Doğan
- Faculty of Medicine, Dept. of Emergency Medicine, Kocaeli University, Kabaoğlu, Baki Komsuoğlu bulvarı No:515, Umuttepe, 41001, İzmit, Kocaeli, Turkey
| | - Elif Yaka
- Faculty of Medicine, Dept. of Emergency Medicine, Kocaeli University, Kabaoğlu, Baki Komsuoğlu bulvarı No:515, Umuttepe, 41001, İzmit, Kocaeli, Turkey
| | - Serkan Yılmaz
- Faculty of Medicine, Dept. of Emergency Medicine, Kocaeli University, Kabaoğlu, Baki Komsuoğlu bulvarı No:515, Umuttepe, 41001, İzmit, Kocaeli, Turkey
| | - Adnan Karadaş
- Faculty of Medicine, Dept. of Emergency Medicine, Kocaeli University, Kabaoğlu, Baki Komsuoğlu bulvarı No:515, Umuttepe, 41001, İzmit, Kocaeli, Turkey
| | - Seda Güney Pınar
- Faculty of Medicine, Dept. of Emergency Medicine, Kocaeli University, Kabaoğlu, Baki Komsuoğlu bulvarı No:515, Umuttepe, 41001, İzmit, Kocaeli, Turkey
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Nakane T, Esaki J, Ueda R, Honda M, Okabayashi H. Inhaled nitric oxide improves pulmonary hypertension and organ functions after adult heart valve surgeries. Gen Thorac Cardiovasc Surg 2021; 69:1519-1526. [PMID: 34033007 DOI: 10.1007/s11748-021-01651-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/17/2021] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Pulmonary hypertension during cardiac surgery is associated with increased morbidity and mortality. Inhaled nitric oxide serves as a selective pulmonary vasodilator and has other potential extrapulmonary protective roles. Its effects on pulmonary hypertension and organ functions after adult valve surgeries were evaluated. METHODS From April 2017 to March 2000, 30 patients received inhaled nitric oxide therapy for pulmonary hypertension during weaning from cardiopulmonary bypass in valvular surgery (iNO group). The group was compared with a control group of 65 patients who developed pulmonary hypertension during weaning from cardiopulmonary bypass in valvular surgery and received conventional therapy from April 2014 to March 2017. Intraoperative hemodynamic changes and postoperative Sequential Organ Failure Assessment (SOFA) score were evaluated. RESULTS The inhalation of nitric oxide lowered the pulmonary-to-systemic pressure ratio (Pp/Ps) (p < 0.0001) in the iNO group, and this ratio after the inhalation was significantly lower than that in the control group (p = 0.015). Moreover, norepinephrine requirement was lower in the iNO group than in the control group (p = 0.0060). The SOFA total scores, respiratory scores, coagulation scores, and the increase of renal scores within postoperative 2 days were lower in the iNO group than in the control group (p < 0.0001, p = 0.0002, p = 0.0013, and p = 0.037). CONCLUSIONS Inhaled nitric oxide therapy ameliorated pulmonary hypertension and improved postoperative respiratory, coagulation, and renal functions in adult valve surgeries.
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Affiliation(s)
- Takeichiro Nakane
- Department of Cardiovascular Surgery, Mitsubishi Kyoto Hospital, 1 Katsuragosho-cho, Nishikyo-ku, Kyoto, 615-8087, Japan.
| | - Jiro Esaki
- Department of Cardiovascular Surgery, Mitsubishi Kyoto Hospital, 1 Katsuragosho-cho, Nishikyo-ku, Kyoto, 615-8087, Japan
| | - Ryoma Ueda
- Department of Cardiovascular Surgery, Mitsubishi Kyoto Hospital, 1 Katsuragosho-cho, Nishikyo-ku, Kyoto, 615-8087, Japan
| | - Masanori Honda
- Department of Cardiovascular Surgery, Mitsubishi Kyoto Hospital, 1 Katsuragosho-cho, Nishikyo-ku, Kyoto, 615-8087, Japan
| | - Hitoshi Okabayashi
- Department of Cardiovascular Surgery, Mitsubishi Kyoto Hospital, 1 Katsuragosho-cho, Nishikyo-ku, Kyoto, 615-8087, Japan
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Paul R, Sathe P, Kumar S, Prasad S, Aleem M, Sakhalvalkar P. Multicentered prospective investigator initiated study to evaluate the clinical outcomes with extracorporeal cytokine adsorption device (CytoSorb ®) in patients with sepsis and septic shock. World J Crit Care Med 2021; 10:22-34. [PMID: 33505870 PMCID: PMC7805252 DOI: 10.5492/wjccm.v10.i1.22] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 11/11/2020] [Accepted: 11/29/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Sepsis is a severe clinical syndrome related to the host response to infection. The severity of infections is due to an activation cascade that will lead to an auto amplifying cytokine production: The cytokine storm. Hemoadsorption by CytoSorb® therapy is a new technology that helps to address the cytokine storm and to regain control over various inflammatory conditions.
AIM To evaluate prospectively CytoSorb® therapy used as an adjunctive therapy along with standard of care in septic patients admitted to intensive care unit (ICU).
METHODS This was a prospective, real time, investigator initiated, observational multicenter study conducted in patients admitted to the ICU with sepsis and septic shock. The improvement of mean arterial pressure and reduction of vasopressor needs were evaluated as primary outcome. The change in laboratory parameters, sepsis scores [acute physiology and chronic health evaluation (APACHE II) and sequential organ failure assessment (SOFA)] and vital parameters were considered as secondary outcome. The outcomes were also evaluated in the survivor and non-survivor group. Descriptive statistics were used; a P value < 0.05 was considered to be statistically significant.
RESULTS Overall, 45 patients aged ≥ 18 and ≤ 80 years were included; the majority were men (n = 31; 69.0%), with mean age 47.16 ± 14.11 years. Post CytoSorb® therapy, 26 patients survived and 3 patients were lost to follow-up. In the survivor group, the percentage dose reduction in vasopressor was norepinephrine (51.4%), epinephrine (69.4%) and vasopressin (13.9%). A reduction in interleukin-6 levels (52.3%) was observed in the survivor group. Platelet count improved to 30.1% (P = 0.2938), and total lung capacity count significantly reduced by 33% (P < 0.0001). Serum creatinine and serum lactate were reduced by 33.3% (P = 0.0190) and 39.4% (P = 0.0120), respectively. The mean APACHE II score was 25.46 ± 2.91 and SOFA scores was 12.90 ± 4.02 before initiation of CytoSorb® therapy, and they were reduced significantly post therapy (APACHE II 20.1 ± 2.47; P < 0.0001 and SOFA 9.04 ± 3.00; P = 0.0003) in the survivor group. The predicted mortality in our patient population before CytoSorb® therapy was 56.5%, and it was reduced to 48.8% (actual mortality) after CytoSorb® therapy. We reported 75% survival rate in patients given treatment in < 24 h of ICU admission and 68% survival rates in patients given treatment within 24-48 h of ICU admission. In the survivor group, the average number of days spent in the ICU was 4.44 ± 1.66 d; while in the non-survivor group, the average number of days spent in ICU was 8.5 ± 15.9 d. CytoSorb® therapy was safe and well tolerated with no adverse events reported.
CONCLUSION CytoSorb® might be an effective adjuvant therapy in stabilizing sepsis and septic shock patients. However, it is advisable to start the therapy at an early stage (preferably within 24 h after onset of septic shock).
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Affiliation(s)
- Rajib Paul
- Department of Internal Medicine and Critical Care, Apollo Health City, Hyderabad 500033, India
| | - Prachee Sathe
- Department of Critical Care Medicine, Ruby Hall Clinic, Pune 411001, India
| | - Senthil Kumar
- Department of Critical Care Medicine, Apollo Hospital, Chennai 600006, India
| | - Shiva Prasad
- Department of Anesthesiology and Critical Care, Narayana Institute of Cardiac Sciences, Bangaluru 560099, India
| | - Ma Aleem
- Department of Internal Medicine and Critical Care, Apollo Health City, Hyderabad 500033, India
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Yoshida J, Tamura T, Otani K, Inoue M, Miyatake E, Ishimitsu T, Nakahara C, Tanaka M. Mortality related to drug-resistant organisms in surgical sepsis-3: an 8-year time trend study using sequential organ failure assessment scores. Eur J Clin Microbiol Infect Dis 2020; 40:535-540. [PMID: 32954476 PMCID: PMC7892503 DOI: 10.1007/s10096-020-04037-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/10/2020] [Indexed: 11/04/2022]
Abstract
The difference in sequential organ failure assessment (SOFA) scores from the baseline to sepsis is a known predictor of sepsis-3 outcome, but the prognostic value of drug-resistant organisms for mortality is unexplained. We employed sepsis stewardship and herein report an observational study. Study subjects were patients admitted to the Departments of Surgery/Chest Surgery from 2011 through 2018 with a diagnosis of sepsis and a SOFA score of 2 or more. Our sepsis stewardship methods included antimicrobial and diagnostic stewardship and infection control. We determined the primary endpoint as in-hospital death and the secondary endpoint as the annual trend of the risk-adjusted mortality ratio (RAMR). For mortality, we performed logistic regression analysis based on SOFA score, age, sex, comorbid disease, and the presence of methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum beta-lactamase inhibitor–producing bacteria. In a total of 457 patients, two factors were significant predictors for fatality, i.e., SOFA score of 9 or more with an odds ratio (OR) 4.921 and 95% confidence interval [95% CI] 1.968–12.302 (P = 0.001) and presence of MRSA with an OR 1.83 and 95% CI 1.003–3.338 (P = 0.049). RAMR showed a decrease during the study years (P < 0.05). Early detection of MRSA may help patients survive surgical sepsis-3. Thus, MRSA-oriented diagnosis may play a role in expediting treatment with anti-MRSA antimicrobials.
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Affiliation(s)
- Junichi Yoshida
- Department of Surgery/Chest Surgery, Shimonoseki City Hospital, 1-13-1 Koyo-cho, Shimonoseki, 750-8520, Japan.
| | - Tetsuro Tamura
- Department of Surgery/Chest Surgery, Shimonoseki City Hospital, 1-13-1 Koyo-cho, Shimonoseki, 750-8520, Japan
| | - Kazuhiro Otani
- Department of Surgery/Chest Surgery, Shimonoseki City Hospital, 1-13-1 Koyo-cho, Shimonoseki, 750-8520, Japan
| | - Masaaki Inoue
- Department of Surgery/Chest Surgery, Shimonoseki City Hospital, 1-13-1 Koyo-cho, Shimonoseki, 750-8520, Japan
| | - Eiji Miyatake
- Department of Surgery/Chest Surgery, Shimonoseki City Hospital, 1-13-1 Koyo-cho, Shimonoseki, 750-8520, Japan
| | - Toshiyuki Ishimitsu
- Department of Surgery/Chest Surgery, Shimonoseki City Hospital, 1-13-1 Koyo-cho, Shimonoseki, 750-8520, Japan
| | - Chihiro Nakahara
- Department of Surgery/Chest Surgery, Shimonoseki City Hospital, 1-13-1 Koyo-cho, Shimonoseki, 750-8520, Japan
| | - Masao Tanaka
- Department of Surgery/Chest Surgery, Shimonoseki City Hospital, 1-13-1 Koyo-cho, Shimonoseki, 750-8520, Japan
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Nakashima T, Miyamoto K, Shima N, Kato S, Kawazoe Y, Ohta Y, Morimoto T, Yamamura H. Dexmedetomidine improved renal function in patients with severe sepsis: an exploratory analysis of a randomized controlled trial. J Intensive Care 2020; 8:1. [PMID: 31908779 PMCID: PMC6939335 DOI: 10.1186/s40560-019-0415-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 11/20/2019] [Indexed: 11/26/2022] Open
Abstract
Background Dexmedetomidine has been reported to improve organ dysfunction in critically ill patients. In a recent randomized controlled trial (Dexmedetomidine for Sepsis in Intensive Care Unit (ICU) Randomized Evolution [DESIRE]), we demonstrated that dexmedetomidine was associated with reduced mortality risk among patients with severe sepsis. We performed this exploratory sub-analysis to examine the mechanism underlying improved survival in patients sedated with dexmedetomidine. Methods The DESIRE trial compared a sedation strategy with and without dexmedetomidine among 201 mechanically ventilated adult patients with sepsis across eight ICUs in Japan. In the present study, we included 104 patients with Acute Physiology and Chronic Health Evaluation II (APACHE II) scores of ≥ 23 (54 in the dexmedetomidine [DEX] group and 50 in the non-dexmedetomidine [non-DEX] group). Initially, we compared the changes in the sequential organ failure assessment (SOFA) scores from the baseline within 6 days after randomization between groups. Subsequently, we evaluated the variables comprising the organ component of the SOFA score that showed relevant improvement in the initial comparison. Results The mean patient age was 71.0 ± 14.1 years. There was no difference in the median APACHE II score between the two groups (29 [interquartile range (IQR), 25–31] vs. 30 [IQR, 25–33]; p = 0.35). The median SOFA score at the baseline was lower in the DEX group (9 [IQR, 7–11] vs. 11 [IQR, 9–13]; p = 0.01). While the renal SOFA subscore at the baseline was similar for both groups, it significantly decreased in the DEX group on day 4 (p = 0.02). During the first 6 days, the urinary output was not significantly different (p = 0.09), but serum creatinine levels were significantly lower (p = 0.04) in the DEX group. The 28-day and in-hospital mortality rates were significantly lower in the DEX group (22% vs. 42%; p = 0.03, 28% vs. 52%; p = 0.01, respectively). Conclusion A sedation strategy with dexmedetomidine is associated with improved renal function and decrease mortality rates among patients with severe sepsis. Trial registration This trial was registered on ClinicalTrials.gov (NCT01760967) on January 1, 2013.
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Affiliation(s)
- Tsuyoshi Nakashima
- 1Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama City, Wakayama Japan
| | - Kyohei Miyamoto
- 1Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama City, Wakayama Japan
| | - Nozomu Shima
- 1Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama City, Wakayama Japan
| | - Seiya Kato
- 1Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama City, Wakayama Japan
| | - Yu Kawazoe
- 2Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai City, Japan
| | - Yoshinori Ohta
- 3Dividion of General Medicine, Department of Internal Medicine, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya City, Japan
| | - Takeshi Morimoto
- 4Department of Clinical Epidemiology, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya City, Japan
| | - Hitoshi Yamamura
- Osaka Prefecture Nakakawachi Critical Care and Emergency Center, 3-4-13, Nishiiwata, Higashiosaka City, Japan
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Abstract
Introduction Obstetric early warning score (OEWS) has been used conventionally for early identification of deteriorating obstetric patients in the labor room and ward settings. This study was conducted to determine if this simple clinical score could be used for prognosticating a critically ill patient in the ICU setting instead of sequential organ failure assessment score (SOFA) and acute physiology and chronic health evaluation (APACHE II) score. Materials and Methods A cohort study was conducted at Obstetrics Critical Care Unit, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi. A total of 250 obstetric patients were recruited after informed consent. The OEWS, SOFA, and APACHE II scores were calculated within 24 hours of admission. The patients were followed to study the maternal outcome. Results The area under receiver operator characteristic (AUROC) curve of OEWS, SOFA, and APACHE II for prediction of maternal mortality was 0.894 (95% CI, 0.849–0.929), 0.924 (95% CI, 0.884–0.954), and 0.93 (95% CI, 0.891–0.958), respectively. The standardized mortality ratio (SMR) for OEWS, SOFA, and APACHE II was 66.3, 62.5, and 69.15%, respectively. Conclusion Obstetric early warning score is as effective as the conventional SOFA and APACHE II to prognosticate the obstetric patient. Since OEWS is based only on clinical criteria, it can be done immediately on admission and can help in early allocation of appropriate manpower and resources for optimum outcome. Clinical significance The clinical application of this study will help intensivists to prognosticate the critically ill obstetric patients immediately following admission to the critical care unit. How to cite this article Khergade M, Suri J, Bharti R, Pandey D, Bachani S, Mittal P. Obstetric Early Warning Score for Prognostication of Critically Ill Obstetric Patient. Indian J Crit Care Med 2020;24(6):398–403.
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Affiliation(s)
- Monali Khergade
- Department of Obstetrics and Gynecology, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Jyotsna Suri
- Department of Obstetrics and Gynecology, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Rekha Bharti
- Department of Obstetrics and Gynecology, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Divya Pandey
- Department of Obstetrics and Gynecology, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sumitra Bachani
- Department of Obstetrics and Gynecology, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Pratima Mittal
- Department of Obstetrics and Gynecology, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Asai N, Shiota A, Ohashi W, Watanabe H, Shibata Y, Kato H, Sakanashi D, Hagihara M, Koizumi Y, Yamagishi Y, Suematsu H, Mikamo H. The SOFA score could predict the severity and prognosis of infective endocarditis. J Infect Chemother 2019; 25:965-971. [PMID: 31320197 DOI: 10.1016/j.jiac.2019.05.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 05/08/2019] [Accepted: 05/16/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Although infectious endocarditis (IE) is a potentially severe infectious disease, there are no prognostic tools for in-hospital mortality for IE patients. This is the first report documenting that the Sequential Organ Failure Assessment (SOFA) score could evaluate the severity and outcome among IE patients. PATIENTS AND METHODS From 2007 to 2018, we reviewed all patients who were diagnosed as having IE at our institue. Patients diagnosed as definite IE according to the modified Duke criteria or by surgical procedure were included in this study. RESULTS A total of 66 IE patients were enrolled in this study. They were 45 males (68%) and the median age was 70 years. As for prognostic factors for in-hospital death among IE patients, SOFA score ≥6, CCI ≥3, surgical procedure, heart failure, immunological phenomena and detection of S. aureus as a causative pathogen were identified as prognostic factors by univariate analysis. Of these 6 factors, SOFA score ≥6 (OR 7.6, 95%CI 1.3-46.6, p = 0.029), heart failure (OR 9.7, 95%CI 1.1-86.1, p = 0.042), surgery (OR 0.1, 95%CI 0-0.8, p = 0.037) and immunological phenomena (OR 0.1, 95%CI 0-0.9, p = 0.042) were independent prognostic factors for in-hospital mortality among IE by logistic regression analysis. CONCLUSION The SOFA score could be a good prognostic tool to use for IE patients. Also, SOFA score ≥6, surgery, immunological phenomena and heart failure were independent prognostic factors for in-hospital mortality among IE patients.
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Affiliation(s)
- Nobuhiro Asai
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Aichi, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Arufumi Shiota
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Wataru Ohashi
- Division of Biostatistics, Clinical Research Center, Aichi Medical University Hospital, Japan
| | - Hiroki Watanabe
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Aichi, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Yuichi Shibata
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Hideo Kato
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Daisuke Sakanashi
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Mao Hagihara
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Yusuke Koizumi
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Aichi, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Yuka Yamagishi
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Aichi, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Hiroyuki Suematsu
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Aichi, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan.
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Si S, Yan Y, Fuller BM, Liang SY. Predicting complicated outcomes in spinal cord injury patients with urinary tract infection: Development and internal validation of a risk model. J Spinal Cord Med 2019; 42:347-354. [PMID: 29465295 PMCID: PMC6522971 DOI: 10.1080/10790268.2018.1436117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
CONTEXT/OBJECTIVE Patients with chronic SCI hospitalized for UTI can have significant morbidity. It is unclear whether SIRS criteria, SOFA score, or quick SOFA score can be used to predict complicated outcome. DESIGN Retrospective cohort study. A risk prediction model was developed and internally validated using bootstrapping methodology. SETTING Urban, academic hospital in St. Louis, Missouri. PARTICIPANTS 402 hospitalizations for UTI between October 1, 2010 and September 30, 2015, arising from 164 patients with chronic SCI, were included in the final analysis. Outcome/measures: An a priori composite complicated outcome defined as: 30-day hospital mortality, length of hospital stay >4 days, intensive care unit (ICU) admission, and hospital revisit within 30 days of discharge. RESULTS Mean age of patients was 46.4 ± 12.3 years; 83.6% of patient-visits involved males. The primary outcome occurred in 278 (69.2%) hospitalizations. In multivariate analysis, male sex was protective (odds ratio [OR], 0.43; 95% confidence interval [CI], 0.18-0.99; P = 0.048) while Gram-positive urine culture (OR 3.07; 95% CI, 1.05-9.01; P = 0.041), urine culture with no growth (OR, 1.69; 95% CI, 1.02-2.80; P = 0.041), and greater SOFA score (for one-point increments, OR, 1.41; 95% CI, 1.18-1.69; P < 0.001) were predictive for complicated outcome. SIRS criteria and qSOFA score were not associated with complicated outcome. Our risk prediction model demonstrated good overall performance (Brier score, 0.19), fair discriminatory power (c-index, 0.72), and good calibration during internal validation. CONCLUSION Clinical variables present on hospital admission with UTI may help identify SCI patients at risk for complicated outcomes and inform future clinical decision-making.
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Affiliation(s)
- Sheng Si
- John T. Milliken Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Yan Yan
- Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri, USA,Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Brian M. Fuller
- Division of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri, USA,Division of Critical Care Medicine, Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Stephen Y. Liang
- Division of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri, USA,Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA,Correspondence to: Stephen Y. Liang, MD, MPHS, Divisions of Infectious Diseases and Emergency Medicine, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8051, St. Louis, Missouri, 63110, USA. Ph: 314-454-8354.
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Kato H, Yoshimura Y, Suido Y, Shimizu H, Ide K, Sugiyama Y, Matsuno K, Nakajima H. Mortality and risk factor analysis for Candida blood stream infection: A multicenter study. J Infect Chemother 2019; 25:341-345. [PMID: 30718191 DOI: 10.1016/j.jiac.2019.01.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 12/17/2018] [Accepted: 01/11/2019] [Indexed: 11/24/2022]
Abstract
Candida blood stream infection (candidemia) is severe systemic infection mainly develops after intensive medical cares. The mortality of candidemia is affected by the underlying conditions, causative agents and the initial management. We retrospectively analyzed mortality-related risk factors in cases of candidemia between April 2011 and March 2016 in five regional hospitals in Japan. We conducted bivariate and multivariate analysis of factors including causative Candida species, patients' predisposing conditions, and treatment strategies, such as empirically selected antifungal drug and time to appropriate antifungal treatment, to elucidate their effects on 30-day mortality. The study enrolled 289 cases of candidemia in adults. Overall 30-day mortality was 27.7%. Forty-nine cases (17.0%) were community-acquired. Bivariate analysis found advanced age, high Sequential Organ Failure Assessment (SOFA) score, and prior antibiotics use as risk factors for high mortality; however community-acquired candidemia, C. parapsilosis candidemia, obtaining follow-up blood culture, and empiric treatment with fluconazole were associated with low mortality. Logistic regression revealed age ≥65 years (adjusted odds ratio, 2.13) and sequential organ failure assessment (SOFA) score ≥6 (6.30) as risk factors for 30-day mortality. In contrast, obtaining follow-up blood culture (0.38) and empiric treatment with fluconazole (0.32) were found to be protective factors. The cases with candidemia in associated with advanced age and poor general health conditions should be closely monitored. Obtaining follow-up blood culture contributed to an improved prognosis.
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Affiliation(s)
- Hideaki Kato
- Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan.
| | - Yukihiro Yoshimura
- Department of Infectious Diseases, Yokohama Municipal Citizen's Hospital, 56 Okazawa-cho, Hodogaya-ku, Yokohama 240-8555, Japan.
| | - Yoshihiro Suido
- Department of Respiratory Medicine, Yamato Municipal Hospital, 8-3-6 Fukaminishi, Yamato-shi 242-8602, Japan.
| | - Hiroyuki Shimizu
- Department of Clinical Laboratory Medicine, Fujisawa City Hospital, 2-6-1 Fujisawa, Fujisawa 251-0052, Japan.
| | - Kazuo Ide
- Infection Control Team, National Hospital Organization, Yokohama Medical Center, 3-60-2 Harajuku, Totsuka-ku, Yokohama 245-8575, Japan.
| | - Yoshifumi Sugiyama
- Clinical Laboratory Department, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan.
| | - Kasumi Matsuno
- Clinical Laboratory Department, Yokohama Municipal Citizen's Hospital, 56 Okazawa-cho, Hodogaya-ku, Yokohama 240-8555, Japan.
| | - Hideaki Nakajima
- Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan.
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23
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Abstract
Background and aims It has been observed that after any injury which is acute and also in the setting of inflammation or infection, the synthesis and secretion of C-reactive protein (CRP) rises within a few hours. The current study monitors CRP in patients presenting with sepsis and attempts to prove that it is one of the most reliable tests in determining the resolution and predicting the outcome. Materials and methods During 12 months, 97 individuals with culture-proven sepsis were included, and a prospective observational study was done. Patients were assessed clinically by recording vitals, mean arterial pressure, Glasgow coma scale score, sequential organ failure assessment (SOFA) score as well as assessment of arterial blood gas and other blood investigations, which included CRP, total white cell count, differential count, serum creatinine, serum bilirubin on day 0, day 2 and day 5 after initiating antibiotics. To test the statistical significance of the difference in mean percentage changes of the different study variables between living and expired groups at day 2 and day 5, Wilcoxon's rank sum test was applied due to the non-normal distribution of values and small sample sizes. Results The percentage drop of the mean of CRP from day 0 to day 2 was 23.33% in the living group, and there was an increase of 4.73 % in the expired group. The percentage drop of the mean of CRP on day 5 when compared to day 0, was significant in the living group. Conclusion C-reactive protein (CRP) is a more useful tool in predicting improvement and outcome in patients admitted with sepsis when compared to scoring systems like SOFA score. Abbreviations AIMS: Amrita Institute of Medical Sciences, C1q: Complement 1q, CRP: C-reactive Protein, PCT: Procalcitonin, SOFA: Sequential organ failure assessment How to cite this article Anush MM, Ashok VK, Sarma RIN, Pillai SK. Role of C-reactive Protein as an Indicator for Determining the Outcome of Sepsis. Indian Journal of Critical Care Medicine, January 2019; 23(1):11-14.
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Affiliation(s)
- Meeval M Anush
- Kerala Institute of Medical Sciences Hospital, Trivandrum, Kerala, India
| | - Vijay K Ashok
- Department of Internal Medicine, MES Medical College, Perinthalmanna, Kerala, India
| | - Ramakrishna In Sarma
- Department of Internal Medicine, Pushpagiri Medical College, Thiruvalla, Kerala, India
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Dat VQ, Long NT, Hieu VN, Phuc NDH, Kinh NV, Trung NV, van Doorn HR, Bonell A, Nadjm B. Clinical characteristics, organ failure, inflammatory markers and prediction of mortality in patients with community acquired bloodstream infection. BMC Infect Dis 2018; 18:535. [PMID: 30367601 PMCID: PMC6204014 DOI: 10.1186/s12879-018-3448-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 10/16/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Community acquired bloodstream infection (CABSI) in low- and middle income countries is associated with a high mortality. This study describes the clinical manifestations, laboratory findings and correlation of SOFA and qSOFA with mortality in patients with CABSI in northern Vietnam. METHODS This was a retrospective study of 393 patients with at least one positive blood culture with not more than one bacterium taken within 48 h of hospitalisation. Clinical characteristic and laboratory results from the first 24 h in hospital were collected. SOFA and qSOFA scores were calculated and their validity in this setting was evaluated. RESULTS Among 393 patients with bacterial CABSI, approximately 80% (307/393) of patients had dysfunction of one or more organ on admission to the study hospital with the most common being that of coagulation (57.1% or 226/393). SOFA performed well in prediction of mortality in those patients initially admitted to the critical care unit (AUC 0.858, 95%CI 0.793-0.922) but poor in those admitted to medical wards (AUC 0.667, 95%CI 0.577-0.758). In contrast qSOFA had poor predictive validity in both settings (AUC 0.692, 95%CI 0.605-0.780 and AUC 0.527, 95%CI 0.424-0.630, respectively). The overall case fatality rate was 28%. HIV infection (HR = 3.145, p = 0.001), neutropenia (HR = 2.442, p = 0.002), SOFA score 1-point increment (HR = 1.19, p < 0.001) and infection with Enterobacteriaceae (HR = 1.722, p = 0.037) were independent risk factors for in-hospital mortality. CONCLUSIONS Organ dysfunction was common among Vietnamese patients with CABSI and associated with high case fatality. SOFA and qSOFA both need to be further validated in this setting.
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Affiliation(s)
- Vu Quoc Dat
- Department of Infectious Diseases, Hanoi Medical University, no 1 Ton That Tung street, Dong Da district, Hanoi, Vietnam
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Hanoi, 78 Giai Phong street, Dong Da district, Hanoi, Vietnam
- National Hospital for Tropical Diseases, 78 Giai Phong street, Dong Da district, Hanoi, Vietnam
| | - Nguyen Thanh Long
- Department of Infectious Diseases, Hanoi Medical University, no 1 Ton That Tung street, Dong Da district, Hanoi, Vietnam
| | - Vu Ngoc Hieu
- Department of Microbiology, Hanoi Medical University, no 1 Ton That Tung street, Dong Da district, Hanoi, Vietnam
| | - Nguyen Dinh Hong Phuc
- Department of Infectious Diseases, Hanoi Medical University, no 1 Ton That Tung street, Dong Da district, Hanoi, Vietnam
| | - Nguyen Van Kinh
- National Hospital for Tropical Diseases, 78 Giai Phong street, Dong Da district, Hanoi, Vietnam
| | - Nguyen Vu Trung
- National Hospital for Tropical Diseases, 78 Giai Phong street, Dong Da district, Hanoi, Vietnam
- Department of Microbiology, Hanoi Medical University, no 1 Ton That Tung street, Dong Da district, Hanoi, Vietnam
| | - H. Rogier van Doorn
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Hanoi, 78 Giai Phong street, Dong Da district, Hanoi, Vietnam
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, University of Oxford, Oxford, UK
| | - Ana Bonell
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Hanoi, 78 Giai Phong street, Dong Da district, Hanoi, Vietnam
| | - Behzad Nadjm
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Hanoi, 78 Giai Phong street, Dong Da district, Hanoi, Vietnam
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, University of Oxford, Oxford, UK
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Langlais E, Nesseler N, Le Pabic E, Frasca D, Launey Y, Seguin P. Does the clinical frailty score improve the accuracy of the SOFA score in predicting hospital mortality in elderly critically ill patients? A prospective observational study. J Crit Care 2018; 46:67-72. [PMID: 29705407 DOI: 10.1016/j.jcrc.2018.04.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/17/2018] [Accepted: 04/20/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE To determine whether the addition of the frailty status assessed by the clinical frailty scale (CFS) to the SOFA score (SOFA-CFS) improves the performance of the SOFA score alone in predicting the hospital mortality of elderly critically ill patients. METHODS A prospective observational study performed between February 2015 and February 2016 including 189 patients aged ≥65 years and hospitalized ≥24 h in the intensive care unit (ICU). RESULTS The SOFA-CFS score did not improve the performance of the SOFA score alone in predicting hospital mortality (AUC = 0.66, 95% CI 0.58-0.74 vs AUC = 0.63, 95% CI 0.55-0.72, respectively, p = 0.082). The AUC of the CFS score was 0.62 (95% CI 0.53-0.71). In the multivariable analysis, age (OR: 1.09, 95% CI 1.03-1.16, p = 0.006), McCabe score C vs A (reference) and B vs A (reference) (OR: 8.28, 95% CI 2.83-24.27and OR: 2.29, 95% CI 1.02-5.12, p = 0.006, respectively), Glasgow coma score at admission (OR: 0.31, 95% CI 0.14-0.48, p = 0.003), and SOFA score (OR: 1.11, 95% CI 1.01-1.23, p = 0.037) were risk factors for hospital mortality. CONCLUSIONS The performance of the SOFA score in predicting hospital mortality was low, although it was an independent risk factor for mortality. The combination of frailty status with the SOFA score did not improve the performance of the SOFA score alone.
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Affiliation(s)
- Emilie Langlais
- CHU de Rennes, Service d'Anesthésie Réanimation 1, 2 rue Henri Le Guilloux, Rennes 35000, France.
| | - Nicolas Nesseler
- CHU de Rennes, Service d'Anesthésie Réanimation 1, 2 rue Henri Le Guilloux, Rennes 35000, France; Inserm, UMR 1214 NuMeCan, Rennes 35000, France; Inserm 1414, Centre d'Investigation Clinique, Rennes 35000, France; Université Rennes 1, Rennes 35000, France.
| | - Estelle Le Pabic
- Inserm 1414, Centre d'Investigation Clinique, Rennes 35000, France.
| | - Denis Frasca
- CHU de Poitiers, Inserm, UMR 1246, SPHERE, Universités de Nantes et Tours, France.
| | - Yoann Launey
- CHU de Rennes, Service d'Anesthésie Réanimation 1, 2 rue Henri Le Guilloux, Rennes 35000, France; Inserm, UMR 1214 NuMeCan, Rennes 35000, France; Université Rennes 1, Rennes 35000, France.
| | - Philippe Seguin
- CHU de Rennes, Service d'Anesthésie Réanimation 1, 2 rue Henri Le Guilloux, Rennes 35000, France; Inserm, UMR 1214 NuMeCan, Rennes 35000, France; Inserm 1414, Centre d'Investigation Clinique, Rennes 35000, France; Université Rennes 1, Rennes 35000, France.
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Xia R, Wang DH. [The option of critical patients with cancer for ICU]. Zhonghua Zhong Liu Za Zhi 2018; 40:155-9. [PMID: 29502379 DOI: 10.3760/cma.j.issn.0253-3766.2018.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
With the improvement of diagnosis and treatment, tumor has become a chronic disease, and an increasing number of older patients will live with tumors. This change has led to an increase in demand for intensive care unit (ICU) and a challenge to the traditional ICU treatment concept. The option of ICU consists of two parts. The first is the option for admission. Since classic predictors of mortality are no longer relevant, we suggest broadening the criteria for ICU admission. Patients during the first course of cancer therapies should be treated with a full-code status similar to that of other patients without malignancy. Patients whose clinical response to therapy was not available or undetermined should be allowed an ICU trial that consists of unlimited invasive support, including anti-cancer therapies such as ambulatory chemotherapy. Do everything that can be done to save the patients who might benefit from ICU treatment. The second is the option of therapeutic end point. An interdisciplinary meeting, including an ethics consultation, should be held after 3-6 days'ICU trial to make end-of-life decisions with relatives of patients if the SOFA score shows clinical deterioration with no available therapeutic options. The treatment goals should shift from curative or supportive therapies to end-of-life care. we could integrate hospice and palliative care with intensive care more effectively and efficiently. That would be the future of oncological ICUs.
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Esposito AJ, Bhatraju PK, Stapleton RD, Wurfel MM, Mikacenic C. Hyaluronic acid is associated with organ dysfunction in acute respiratory distress syndrome. Crit Care 2017; 21:304. [PMID: 29237497 PMCID: PMC5729515 DOI: 10.1186/s13054-017-1895-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 11/23/2017] [Indexed: 12/11/2022]
Abstract
Background Hyaluronic acid (HA), an extracellular matrix component, is degraded in response to local tissue injury or stress. In various animal models of lung injury, HA has been shown to play a mechanistic role in modulating inflammation and injury. While HA is present in the lungs of patients with acute respiratory distress syndrome (ARDS), its relationship to patient outcomes is unknown. Methods We studied 86 patients with ARDS previously enrolled in the Phase II Randomized Trial of Fish Oil in Patients with Acute Lung Injury (NCT00351533) at five North American medical centers. We examined paired serum and bronchoalveolar lavage fluid (BALF) samples obtained within 48 hours of diagnosis of ARDS. We evaluated the association of HA levels in serum and BALF with local (lung injury score (LIS)) and systemic (sequential organ failure assessment score (SOFA)) measures of organ dysfunction with regression analysis adjusting for age, sex, race, treatment group, and risk factor for ARDS. Results We found that both day-0 circulating and alveolar levels of HA were associated with worsening LIS (p = 0.04 and p = 0.003, respectively), particularly via associations with degree of hypoxemia (p = 0.02 and p < 0.001, respectively) and set positive end-expiratory pressure (p = 0.01 and p = 0.02, respectively). Circulating HA was associated with SOFA score (p < 0.001), driven by associations with the respiratory (p = 0.02), coagulation (p < 0.001), liver (p = 0.006), and renal (p = 0.01) components. Notably, the alveolar HA levels were associated with the respiratory component of the SOFA score (p = 0.003) but not the composite SOFA score (p = 0.27). Conclusions Elevated alveolar levels of HA are associated with LIS while circulating levels are associated with both lung injury and SOFA scores. These findings suggest that HA has a potential role in both local and systemic organ dysfunction in patients with ARDS. Electronic supplementary material The online version of this article (doi:10.1186/s13054-017-1895-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anthony J Esposito
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington, 325 Ninth Avenue, Box 359640, Seattle, WA, 98104, USA
| | - Pavan K Bhatraju
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington, 325 Ninth Avenue, Box 359640, Seattle, WA, 98104, USA
| | - Renee D Stapleton
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Vermont College of Medicine, Burlington, VT, USA
| | - Mark M Wurfel
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington, 325 Ninth Avenue, Box 359640, Seattle, WA, 98104, USA
| | - Carmen Mikacenic
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington, 325 Ninth Avenue, Box 359640, Seattle, WA, 98104, USA.
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Esposito AJ, Bhatraju PK, Stapleton RD, Wurfel MM, Mikacenic C. Hyaluronic acid is associated with organ dysfunction in acute respiratory distress syndrome. Crit Care 2017. [PMID: 29237497 DOI: 10.1186/s13054-017-1895-7.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Hyaluronic acid (HA), an extracellular matrix component, is degraded in response to local tissue injury or stress. In various animal models of lung injury, HA has been shown to play a mechanistic role in modulating inflammation and injury. While HA is present in the lungs of patients with acute respiratory distress syndrome (ARDS), its relationship to patient outcomes is unknown. METHODS We studied 86 patients with ARDS previously enrolled in the Phase II Randomized Trial of Fish Oil in Patients with Acute Lung Injury (NCT00351533) at five North American medical centers. We examined paired serum and bronchoalveolar lavage fluid (BALF) samples obtained within 48 hours of diagnosis of ARDS. We evaluated the association of HA levels in serum and BALF with local (lung injury score (LIS)) and systemic (sequential organ failure assessment score (SOFA)) measures of organ dysfunction with regression analysis adjusting for age, sex, race, treatment group, and risk factor for ARDS. RESULTS We found that both day-0 circulating and alveolar levels of HA were associated with worsening LIS (p = 0.04 and p = 0.003, respectively), particularly via associations with degree of hypoxemia (p = 0.02 and p < 0.001, respectively) and set positive end-expiratory pressure (p = 0.01 and p = 0.02, respectively). Circulating HA was associated with SOFA score (p < 0.001), driven by associations with the respiratory (p = 0.02), coagulation (p < 0.001), liver (p = 0.006), and renal (p = 0.01) components. Notably, the alveolar HA levels were associated with the respiratory component of the SOFA score (p = 0.003) but not the composite SOFA score (p = 0.27). CONCLUSIONS Elevated alveolar levels of HA are associated with LIS while circulating levels are associated with both lung injury and SOFA scores. These findings suggest that HA has a potential role in both local and systemic organ dysfunction in patients with ARDS.
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Affiliation(s)
- Anthony J Esposito
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington, 325 Ninth Avenue, Box 359640, Seattle, WA, 98104, USA
| | - Pavan K Bhatraju
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington, 325 Ninth Avenue, Box 359640, Seattle, WA, 98104, USA
| | - Renee D Stapleton
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Vermont College of Medicine, Burlington, VT, USA
| | - Mark M Wurfel
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington, 325 Ninth Avenue, Box 359640, Seattle, WA, 98104, USA
| | - Carmen Mikacenic
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington, 325 Ninth Avenue, Box 359640, Seattle, WA, 98104, USA.
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Abstract
Despite advances in intensive care and the widespread use of standardized care included in the Surviving Sepsis Campaign Guidelines, sepsis remains a leading cause of death, and the prevalence of sepsis increases concurrent with the aging process. The diagnosis of sepsis was originally based on the evidence of persistent bacteremia (septicemia) but was modified in 1992 to incorporate systemic inflammatory response syndrome (SIRS). Since then, SIRS has become the gold standard for the diagnosis of sepsis. In 2016, the Society of Critical Care Medicine and the European Society of Intensive Care Medicine published a new clinical definition of sepsis that is called Sepsis-3. In contrast to previous definitions, Sepsis-3 is based on organ dysfunctions and uses a sequential organ failure (SOFA) score as an index. Thus, patients diagnosed with respect to Sepsis-3 will inevitably represent a different population than those previously diagnosed. We assume that this drastic change in clinical definition will affect not only clinical practice but also the viewpoint and focus of basic research. This review intends to summarize the pathophysiology of sepsis and organ dysfunction and discusses potential directions for future research.
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Affiliation(s)
- Seitaro Fujishima
- Center for General Medicine Education, Keio University School of Medicine, Tokyo, Japan
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Mori M, Onaka T, Yonezawa A, Kitagawa T, Sasaki Y, Imada K. Direct hemoperfusion using polymyxin-B immobilized fiber for severe septic patients with hematological disorders: a single-center analysis. J Infect Chemother 2014; 20:282-4. [PMID: 24485325 DOI: 10.1016/j.jiac.2013.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 11/30/2013] [Accepted: 12/09/2013] [Indexed: 11/21/2022]
Abstract
The benefit of endotoxin absorption therapy (direct hemoperfusion with polymyxin B-immobilized fiber: PMX-DHP) for severe septic patients is still controversial. There are limited data on the clinical experience and efficacy of PMX-DHP for septic patients with hematological disorders. At our institution, 16 patients with hematological diseases underwent PMX-DHP therapy for gram-negative septic shock from February 2006 to March 2012. Most of the patients had severe neutropenia (median neutrophil counts: 7/μL) due to intensive chemotherapy for their hematological diseases. After the PMX-DHP therapy, six patients recovered from the shock status (favorable group) and ten died of the sepsis (unfavorable group). We analyzed the differences between the two groups based on clinical characteristics just before PMX-DHP therapy. Regarding sequential organ failure assessment (SOFA) score, which is a scoring system to determine the degree of organ dysfunction, all patients in the favorable group scored less than 11. The sensitivity and specificity of SOFA score less than 11 for the therapeutic efficacy were 100% and 80%, respectively. Our results suggest that septic patients with hematological diseases may not be a candidate for PMX-DHP therapy when they have already developed serious organ dysfunction.
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