Nyt fra tidsskrifterne
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/nyheder-udefra?rss_filter=sepsis&setpoint=52947#101249
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/nyheder-udefra?rss_filter=sepsis&setpoint=52947#101215
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/nyheder-udefra?rss_filter=sepsis&setpoint=52947#101194
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/nyheder-udefra?rss_filter=sepsis&setpoint=52947#101076
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/nyheder-udefra?rss_filter=sepsis&setpoint=52947#101074
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/nyheder-udefra?rss_filter=sepsis&setpoint=52947#101052
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/nyheder-udefra?rss_filter=sepsis&setpoint=52947#100903
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/nyheder-udefra?rss_filter=sepsis&setpoint=52947#100848
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/nyheder-udefra?rss_filter=sepsis&setpoint=52947#100849
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/nyheder-udefra?rss_filter=sepsis&setpoint=52947#100766
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/nyheder-udefra?rss_filter=sepsis&setpoint=52947#100702
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/nyheder-udefra?rss_filter=sepsis&setpoint=52947#100667
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/nyheder-udefra?rss_filter=sepsis&setpoint=52947#100601
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/nyheder-udefra?rss_filter=sepsis&setpoint=52947#100544
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/nyheder-udefra?rss_filter=sepsis&setpoint=52947#100550
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/nyheder-udefra?rss_filter=sepsis&setpoint=52947#100458
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/nyheder-udefra?rss_filter=sepsis&setpoint=52947#100447
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/nyheder-udefra?rss_filter=sepsis&setpoint=52947#100349
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/nyheder-udefra?rss_filter=sepsis&setpoint=52947#100328
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/nyheder-udefra?rss_filter=sepsis&setpoint=52947#100313
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/nyheder-udefra?rss_filter=sepsis&setpoint=52947#100270
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/nyheder-udefra?rss_filter=sepsis&setpoint=52947#100236
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/nyheder-udefra?rss_filter=sepsis&setpoint=52947#100218
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/nyheder-udefra?rss_filter=sepsis&setpoint=52947#100198
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/nyheder-udefra?rss_filter=sepsis&setpoint=52947#100190
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/nyheder-udefra?rss_filter=sepsis&setpoint=52947#100191
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/nyheder-udefra?rss_filter=sepsis&setpoint=52947#100192
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/nyheder-udefra?rss_filter=sepsis&setpoint=52947#100193
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/nyheder-udefra?rss_filter=sepsis&setpoint=52947#100174
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/nyheder-udefra?rss_filter=sepsis&setpoint=52947#100175
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/nyheder-udefra?rss_filter=sepsis&setpoint=52947#100176
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/nyheder-udefra?rss_filter=sepsis&setpoint=52947#100177
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/nyheder-udefra?rss_filter=sepsis&setpoint=52947#100068
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/nyheder-udefra?rss_filter=sepsis&setpoint=52947#100060
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/nyheder-udefra?rss_filter=sepsis&setpoint=52947#100053
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/nyheder-udefra?rss_filter=sepsis&setpoint=52947#100055
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/nyheder-udefra?rss_filter=sepsis&setpoint=52947#99955
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/nyheder-udefra?rss_filter=sepsis&setpoint=52947#99946
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/nyheder-udefra?rss_filter=sepsis&setpoint=52947#99900
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/nyheder-udefra?rss_filter=sepsis&setpoint=52947#99852
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/nyheder-udefra?rss_filter=sepsis&setpoint=52947#99728
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/nyheder-udefra?rss_filter=sepsis&setpoint=52947#99729
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/nyheder-udefra?rss_filter=sepsis&setpoint=52947#99659
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/nyheder-udefra?rss_filter=sepsis&setpoint=52947#99653
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/nyheder-udefra?rss_filter=sepsis&setpoint=52947#99637
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/nyheder-udefra?rss_filter=sepsis&setpoint=52947#99606
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/nyheder-udefra?rss_filter=sepsis&setpoint=52947#99623
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/nyheder-udefra?rss_filter=sepsis&setpoint=52947#99580
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/nyheder-udefra?rss_filter=sepsis&setpoint=52947#99474
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/nyheder-udefra?rss_filter=sepsis&setpoint=52947#99475
Søgeord (sepsis) valgt.
703 emner vises.
BMC Infectious Diseases, 28.03.2024
Tilføjet 28.03.2024
Abstract Background This real-world study assessed the epidemiology and clinical complications of Clostridioides difficile infections (CDIs) and recurrences (rCDIs) in hospital and community settings in Germany from 2015 − 2019. Methods An observational retrospective cohort study was conducted among adult patients diagnosed with CDI in hospital and community settings using statutory health insurance claims data from the BKK database. A cross-sectional approach was used to estimate the annual incidence rate of CDI and rCDI episodes per 100,000 insurants. Patients’ demographic and clinical characteristics were described at the time of first CDI episode. Kaplan-Meier method was used to estimate the time to rCDIs and time to complications (colonic perforation, colectomy, loop ileostomy, toxic megacolon, ulcerative colitis, peritonitis, and sepsis). A Cox model was used to assess the risk of developing complications, with the number of rCDIs as a time-dependent covariate. Results A total of 15,402 CDI episodes were recorded among 11,884 patients. The overall incidence of CDI episodes declined by 38% from 2015 to 2019. Most patients (77%) were aged ≥ 65 years. Around 19% of CDI patients experienced at least one rCDI. The median time between index CDI episode to a rCDI was 20 days. The most frequent complication within 12-months of follow-up after the index CDI episode was sepsis (7.57%), followed by colectomy (3.20%). The rate of complications increased with the number of rCDIs. The risk of any complication increased by 31% with each subsequent rCDI (adjusted hazard ratio [HR]: 1.31, 95% confidence interval: 1.17;1.46). Conclusions CDI remains a public health concern in Germany despite a decline in the incidence over recent years. A substantial proportion of CDI patients experience rCDIs, which increase the risk of severe clinical complications. The results highlight an increasing need of improved therapeutic management of CDI, particularly efforts to prevent rCDI.
Læs mere Tjek på PubMedSara Cajander, Matthijs Kox, Brendon P Scicluna, Markus A Weigand, Raquel Almansa Mora, Stefanie B Flohé, Ignacio Martin-Loeches, Gunnar Lachmann, Massimo Girardis, Alberto Garcia-Salido, Frank M Brunkhorst, Michael Bauer, Antoni Torres, Andrea Cossarizza, Guillaume Monneret, Jean-Marc Cavaillon, Manu Shankar-Hari, Evangelos J Giamarellos-Bourboulis, Martin Sebastian Winkler, Tomasz Skirecki, Marcin Osuchowski, Ignacio Rubio, Jesus F Bermejo-Martin, Joerg C Schefold, Fabienne Venet
Lancet Respiratory Medicine, 27.03.2024
Tilføjet 27.03.2024
Sepsis is characterised by a dysregulated host immune response to infection. Despite recognition of its significance, immune status monitoring is not implemented in clinical practice due in part to the current absence of direct therapeutic implications. Technological advances in immunological profiling could enhance our understanding of immune dysregulation and facilitate integration into clinical practice. In this Review, we provide an overview of the current state of immune profiling in sepsis, including its use, current challenges, and opportunities for progress.
Læs mere Tjek på PubMedClinical Infectious Diseases, 26.03.2024
Tilføjet 26.03.2024
Abstract Background Streptococcal bacteremia is associated with high mortality. The study aims to identify predictors of mortality among patients with streptococcal bacteremia.Methods This retrospective study was conducted at the Lausanne University Hospital, Switzerland and included episodes of streptococcal bacteremia among adult patients from 2015 to 2023.Results During the study period, 861 episodes of streptococcal bacteremia were included. The majority of episodes were categorized in the Mitis group (348 episodes; 40%), followed by the Pyogenic group (215; 25%). Endocarditis was the most common source of bacteremia (164; 19%). The overall 14-day mortality rate was 8% (65 episodes). The results from the Cox multivariable regression model showed that a Charlson comorbidity index >4 (P 0.001; HR 2.87, CI 1.58-5.22), S. pyogenes (P 0.011; HR 2.54, CI 1.24-5.21), sepsis (P
Læs mere Tjek på PubMedBMC Infectious Diseases, 22.03.2024
Tilføjet 22.03.2024
Abstract Background Tuberculous sepsis is uncommon in individuals without human immunodeficiency virus (HIV) infection, and some patients may not exhibit clinical signs and symptoms of suspected sepsis upon admission, leading to delayed diagnosis and treatment. Case presentation This report present the case of a 60-year-old female patient who presented with erythema, edema, and pain in her right upper limb accompanied by fever and chills. Further evaluation revealed multiple intermuscular abscesses caused by suspected gram-positive bacteria. Despite receiving anti-infection treatment, the patient rapidly progressed to septic shock and respiratory failure. Metagenomic next-generation sequencing (mNGS) analysis of blood samples detected Mycobacterium tuberculosis complex groups (11 reads). Additionally, mNGS analysis of fluid obtained from puncture of the abscess in the right upper extremity also suggested Mycobacterium tuberculosis complex groups (221 981 reads). Consequently, the patient was diagnosed with tuberculous sepsis resulting from hematogenous dissemination of Mycobacterium tuberculosis. Following the administration of anti-tuberculosis treatment, a gradual recovery was observed during the subsequent follow-up period. Conclusion It is noteworthy that atypical hematogenous disseminated tuberculosis can be prone to misdiagnosis or oversight, potentially leading to septic shock. This case illustrates the importance of early diagnosis and treatment of tuberculosis sepsis. Advanced diagnostic techniques such as mNGS can aid clinicians in the early identification of pathogens for definitive diagnosis.
Læs mere Tjek på PubMedGuirgis, Faheem W.; Black, Lauren Page; Henson, Morgan; Bertrand, Andrew; DeVos, Elizabeth; Ferreira, Jason; Gao, Hanzhi; Wu, Samuel S.; Leeuwenburgh, Christiaan; Moldawer, Lyle; Moore, Frederick; Reddy, Srinivasa T.
Critical Care Medicine, 22.03.2024
Tilføjet 22.03.2024
Objectives: Low cholesterol levels in early sepsis patients are associated with mortality. We sought to test if IV lipid emulsion administration to sepsis patients with low cholesterol levels would prevent a decline or increase total cholesterol levels at 48 hours. Design: Phase II, adaptive, randomized pilot clinical trial powered for 48 patients. Setting: Emergency department or ICU of an academic medical center. Patients: Sepsis patients (first 24 hr) with Sequential Organ Failure Assessment greater than or equal to 4 or shock. Interventions: Patients meeting study criteria, including screening total cholesterol levels less than or equal to 100 mg/dL or high-density lipoprotein cholesterol (HDL-C) + low-density lipoprotein cholesterol (LDL-C) less than or equal to 70 mg/dL, were randomized to receive one of three doses of lipid emulsion administered twice in 48 hours or no drug (controls). The primary endpoint was a change in serum total cholesterol (48 hr – enrollment) between groups. Measurements and Main Results: Forty-nine patients were enrolled and randomized. Two patients randomized to lipid emulsion were withdrawn before drug administration. Data for 24 control patients and 23 lipid emulsion patients were analyzed. The mean change in total cholesterol from enrollment to 48 hours was not different between groups and was 5 mg/dL (sd 20) for lipid emulsion patients, and 2 mg/dL (sd 18) for control patients (p = 0.62). The mean changes in HDL-C and LDL-C were similar between groups. Mean change in triglycerides was elevated in lipid emulsion patients (61 mg/dL, sd 87) compared with controls (20 mg/dL, sd 70, p = 0.086). The 48-hour change in SOFA score was –2 (interquartile range [IQR] –4, –1) for control patients and –2 (IQR –3, 0) for lipid emulsion patients (p = 0.46). Conclusions: Administration of IV lipid emulsion to early sepsis patients with low cholesterol levels did not influence change in cholesterol levels from enrollment to 48 hours.
Læs mere Tjek på PubMedViriya Hantrakun, Ranjani Somayaji, Prapit Teparrukkul, Chaiyaporn Boonsri, Kristina Rudd, Nicholas P. J. Day, T. Eoin West, Direk Limmathurotsakul
PLoS One Infectious Diseases, 21.03.2024
Tilføjet 21.03.2024
by Viriya Hantrakun, Ranjani Somayaji, Prapit Teparrukkul, Chaiyaporn Boonsri, Kristina Rudd, Nicholas P. J. Day, T. Eoin West, Direk Limmathurotsakul
Læs mere Tjek på PubMedBMC Infectious Diseases, 17.03.2024
Tilføjet 17.03.2024
Abstract Background Pasteurella multocida is a zoonotic pathogen that mainly causes local skin and soft tissue infections in the human body through cat and dog bites. It rarely causes bacteraemia (or sepsis) and meningitis. We reported a case of septic shock and meningitis caused by P. multocida in a patient without a history of cat and dog bites. Case presentation An 84-year-old male patient was urgently sent to the emergency department after he was found with unclear consciousness for 8 h, accompanied by limb tremors and urinary incontinence. In the subsequent examination, P. multocida was detected in the blood culture and wound secretion samples of the patient. However, it was not detected in the cerebrospinal fluid culture, but its DNA sequence was detected. Therefore, the patient was clearly diagnosed with septic shock and meningitis caused by P. multocida. The patient had no history of cat or dog contact or bite. The patient was subsequently treated with a combination of penicillin G, doxycycline, and ceftriaxone, and he was discharged after 35 days of hospitalisation. Conclusion This report presented a rare case of septic shock and meningitis caused by P. multocida, which was not related to a cat or dog bite. Clinical doctors should consider P. multocida as a possible cause of sepsis or meningitis and should be aware of its potential seriousness even in the absence of animal bites.
Læs mere Tjek på PubMedEinarsdottir, M. J., Kibiwott Kirui, B., Li, H., Olsson, D., Johannsson, G., Nyberg, F., Ragnarsson, O.
BMJ Open, 15.03.2024
Tilføjet 15.03.2024
ObjectivesWhile glucocorticoid (GC) treatment initiated for COVID-19 reduces mortality, it is unclear whether GC treatment prior to COVID-19 affects mortality. Long-term GC use raises infection and thromboembolic risks. We investigated if patients with oral GC use prior to COVID-19 had increased mortality overall and by selected causes. DesignPopulation-based observational cohort study. SettingsPopulation-based register data in Sweden. ParticipantsAll patients infected with COVID-19 in Sweden from January 2020 to November 2021 (n=1 200 153). Outcome measuresAny prior oral GC use was defined as ≥1 GC prescription during 12 months before index. High exposure was defined as ≥2 GC prescriptions with a cumulative prednisolone dose ≥750 mg or equivalent during 6 months before index. GC users were compared with COVID-19 patients who had not received GCs within 12 months before index. We used Cox proportional hazard models and 1:2 propensity score matching to estimate HRs and 95% CIs, controlling for the same confounders in all analyses. Results3378 deaths occurred in subjects with any prior GC exposure (n=48 806; 6.9%) and 14 850 among non-exposed (n=1 151 347; 1.3%). Both high (HR 1.98, 95% CI 1.87 to 2.09) and any exposure (1.58, 1.52 to 1.65) to GCs were associated with overall death. Deaths from pulmonary embolism, sepsis and COVID-19 were associated with high GC exposure and, similarly but weaker, with any exposure. High exposure to GCs was associated with increased deaths caused by stroke and myocardial infarction. ConclusionPatients on oral GC treatment prior to COVID-19 have increased mortality, particularly from pulmonary embolism, sepsis and COVID-19.
Læs mere Tjek på PubMedEinarsdottir, M. J., Kibiwott Kirui, B., Li, H., Olsson, D., Johannsson, G., Nyberg, F., Ragnarsson, O.
BMJ Open, 15.03.2024
Tilføjet 15.03.2024
ObjectivesWhile glucocorticoid (GC) treatment initiated for COVID-19 reduces mortality, it is unclear whether GC treatment prior to COVID-19 affects mortality. Long-term GC use raises infection and thromboembolic risks. We investigated if patients with oral GC use prior to COVID-19 had increased mortality overall and by selected causes. DesignPopulation-based observational cohort study. SettingsPopulation-based register data in Sweden. ParticipantsAll patients infected with COVID-19 in Sweden from January 2020 to November 2021 (n=1 200 153). Outcome measuresAny prior oral GC use was defined as ≥1 GC prescription during 12 months before index. High exposure was defined as ≥2 GC prescriptions with a cumulative prednisolone dose ≥750 mg or equivalent during 6 months before index. GC users were compared with COVID-19 patients who had not received GCs within 12 months before index. We used Cox proportional hazard models and 1:2 propensity score matching to estimate HRs and 95% CIs, controlling for the same confounders in all analyses. Results3378 deaths occurred in subjects with any prior GC exposure (n=48 806; 6.9%) and 14 850 among non-exposed (n=1 151 347; 1.3%). Both high (HR 1.98, 95% CI 1.87 to 2.09) and any exposure (1.58, 1.52 to 1.65) to GCs were associated with overall death. Deaths from pulmonary embolism, sepsis and COVID-19 were associated with high GC exposure and, similarly but weaker, with any exposure. High exposure to GCs was associated with increased deaths caused by stroke and myocardial infarction. ConclusionPatients on oral GC treatment prior to COVID-19 have increased mortality, particularly from pulmonary embolism, sepsis and COVID-19.
Læs mere Tjek på PubMedBMC Infectious Diseases, 14.03.2024
Tilføjet 14.03.2024
Abstract Background Bloodstream infections (BSI) are highly prevalent in hospitalized patients requiring intensive care. They are among the most serious infections and are highly associated with sepsis or septic shock, which can lead to prolonged hospital stays and high healthcare costs. This study aimed at establishing an easy-to-use nomogram for predicting the prognosis of patients with BSI. Methods In retrospective study, records of patients with BSI admitted to the intensive care unit (ICU) over the period from Jan 1st 2016 to Dec 31st 2021 were included. We used data from two different China hospitals as development cohort and validation cohort respectively. The demographic and clinical data of patients were collected. Based on all baseline data, k-means algorithm was applied to discover the groups of BSI phenotypes with different prognostic outcomes, which was confirmed by Kaplan-Meier analysis and compared using log-rank tests. Univariate Cox regression analyses were used to estimate the risk of clusters. Random forest was used to identified discriminative predictors in clusters, which were utilized to construct nomogram based on multivariable logistic regression in the discovery cohort. For easy clinical applications, we developed a bloodstream infections clustering (BSIC) score according to the nomogram. The results were validated in the validation cohort over a similar period. Results A total of 360 patients in the discovery cohort and 310 patients in the validation cohort were included in statistical analyses. Based on baseline variables, two distinct clusters with differing prognostic outcomes were identified in the discovery cohort. Population in cluster 1 was 211 with a ICU mortality of 17.1%, while population in cluster 2 was 149 with an ICU mortality of 41.6% (p
Læs mere Tjek på PubMedBMC Infectious Diseases, 13.03.2024
Tilføjet 13.03.2024
Abstract Background Bloodstream infections (BSI) are highly prevalent in hospitalized patients requiring intensive care. They are among the most serious infections and are highly associated with sepsis or septic shock, which can lead to prolonged hospital stays and high healthcare costs. This study aimed at establishing an easy-to-use nomogram for predicting the prognosis of patients with BSI. Methods In retrospective study, records of patients with BSI admitted to the intensive care unit (ICU) over the period from Jan 1st 2016 to Dec 31st 2021 were included. We used data from two different China hospitals as development cohort and validation cohort respectively. The demographic and clinical data of patients were collected. Based on all baseline data, k-means algorithm was applied to discover the groups of BSI phenotypes with different prognostic outcomes, which was confirmed by Kaplan-Meier analysis and compared using log-rank tests. Univariate Cox regression analyses were used to estimate the risk of clusters. Random forest was used to identified discriminative predictors in clusters, which were utilized to construct nomogram based on multivariable logistic regression in the discovery cohort. For easy clinical applications, we developed a bloodstream infections clustering (BSIC) score according to the nomogram. The results were validated in the validation cohort over a similar period. Results A total of 360 patients in the discovery cohort and 310 patients in the validation cohort were included in statistical analyses. Based on baseline variables, two distinct clusters with differing prognostic outcomes were identified in the discovery cohort. Population in cluster 1 was 211 with a ICU mortality of 17.1%, while population in cluster 2 was 149 with an ICU mortality of 41.6% (p
Læs mere Tjek på PubMedKyu Jin Lee, Yong Kyun Kim, Kyeongman Jeon, Ryoung-Eun Ko, Gee Young Suh, Dong Kyu Oh, Sung Yoon Lim, Yeon Joo Lee, Su Yeon Lee, Mi-Hyeon Park, Chae-Man Lim, Sunghoon Park, on behalf of the Korean Sepsis Alliance (KSA) investigators
PLoS One Infectious Diseases, 13.03.2024
Tilføjet 13.03.2024
by Kyu Jin Lee, Yong Kyun Kim, Kyeongman Jeon, Ryoung-Eun Ko, Gee Young Suh, Dong Kyu Oh, Sung Yoon Lim, Yeon Joo Lee, Su Yeon Lee, Mi-Hyeon Park, Chae-Man Lim, Sunghoon Park, on behalf of the Korean Sepsis Alliance (KSA) investigators Background The understanding of shock indices in patients with septic shock is limited, and their values may vary depending on cardiac function. Methods This prospective cohort study was conducted across 20 university-affiliated hospitals (21 intensive care units [ICUs]). Adult patients (≥19 years) with septic shock admitted to the ICUs during a 29-month period were included. The shock index (SI), diastolic shock index (DSI), modified shock index (MSI), and age shock index (Age-SI) were calculated at sepsis recognition (time zero) and ICU admission. Left ventricular (LV) function was categorized as either normal LV ejection fraction (LVEF ≥ 50%) or decreased LVEF (
Læs mere Tjek på PubMedLisanne M. van Leeuwen, Elandri Fourie, Gerrie van den Brink, Vincent Bekker, Marlies A. van Houten
Clinical Microbiology and Infection, 10.03.2024
Tilføjet 10.03.2024
An accurate diagnosis of early onset sepsis (EOS) is challenging due to subtle symptoms and the lack of a good diagnostic tool, resulting in considerable antibiotic overtreatment. A biomarker, discriminating between infected and non-infected newborns early in the disease, could improve EOS prediction. Numerous biomarkers have been tested, but have never been compared directly.
Læs mere Tjek på PubMedBMC Infectious Diseases, 8.03.2024
Tilføjet 8.03.2024
Abstract Background Invasive meningococcal disease (IMD), including sepsis and meningitis, can develop when Neisseria meningitidis bacteria breach the barrier and gain access to the circulation. While IMD is a rare outcome of bacterial exposure, colonization of the oropharynx is present in approximately 10% of the human population. This asymptomatic carriage can be long or short term, and it is unknown which determining factors regulate bacterial colonization. Despite descriptions of many bacterial virulence factors and recent advances in detailed genetic identification and characterization of bacteria, the factors mediating invasion and disease vs. asymptomatic carriage following bacterial colonization remain unknown. The pharyngeal epithelia play a role in the innate immune defense against pathogens, and the aim of this study was to investigate the proinflammatory response of pharyngeal epithelial cells following meningococcal exposure to describe the potential inflammatory mediation performed during the initial host‒pathogen interaction. Clinically relevant isolates of serogroups B, C, W and Y, derived from patients with meningococcal disease as well as asymptomatic carriers, were included in the study. Results The most potent cellular response with proinflammatory secretion of TNF, IL-6, CXCL8, CCL2, IL-1β and IL-18 was found in response to invasive serogroup B isolates. This potent response pattern was also mirrored by increased bacterial adhesion to cells as well as induced cell death. It was, however, only with serogroup B isolates where the most potent cellular response was toward the IMD isolates. In contrast, the most potent cellular response using serogroup Y isolates was directed toward the carriage isolates rather than the IMD isolates. In addition, by comparing isolates from outbreaks in Sweden (epidemiologically linked and highly genetically similar), we found the most potent proinflammatory response in cells exposed to carriage isolates rather than the IMD isolates. Conclusion Although certain expected correlations between host‒pathogen interactions and cellular proinflammatory responses were found using IMD serogroup B isolates, our data indicate that carriage isolates invoke stronger proinflammatory activation of the epithelial lining than IMD isolates.
Læs mere Tjek på PubMedBMC Infectious Diseases, 8.03.2024
Tilføjet 8.03.2024
Abstract Background There is limited information about the outcomes of polymicrobial bloodstream infections in patients with sepsis. We aimed to investigate outcomes of polymicrobial bloodstream infections compared to monomicrobial bloodstream infections. Methods This study used data from the Korean Sepsis Alliance Registry, a nationwide database of prospective observational sepsis cohort. Adult sepsis patients with bloodstream infections from September 2019 to December 2021 at 20 tertiary or university-affiliated hospitals in South Korea were analyzed. Results Among the 3,823 patients with bloodstream infections, 429 of them (11.2%) had polymicrobial bloodstream infections. The crude hospital mortality of patients with sepsis with polymicrobial bloodstream infection and monomicrobial bloodstream infection was 35.7% and 30.1%, respectively (p = 0.021). However, polymicrobial bloodstream infections were not associated with hospital mortality in the proportional hazard analysis (HR 1.15 [0.97–1.36], p = 0.11). The inappropriate use of antibiotics was associated with increased mortality (HR 1.37 [1.19–1.57], p
Læs mere Tjek på PubMedInfection, 7.03.2024
Tilføjet 7.03.2024
Abstract Purpose Blood cultures (BCs) are key for pathogen detection in septic patients. We investigated the extent to which sampling was performed and what factors were associated with the absence of general or inadequate BC sampling. Methods We conducted a retrospective cohort study of hospitalized patients with sepsis admitted to one of three EDs in 2018. Primary outcome was the extent of general BC collection of at least 1 set. Secondary outcome was the extent of adequate BC sampling, defined as ≥ 2 sets before antibiotic therapy (AT). Multivariable logistic regression analysis was performed to identify factors associated with deficits in both outcomes. Results 1143 patients were analyzed. BCs were collected from 946 patients. Single BCs were taken from 520 patients, ≥ 2 sets from 426 patients. Overall, ≥ 2 BCs were taken from 349 patients before AT. BC sampling before AT occurred significantly more frequently when ≥ 2 BC sets were taken rather than a single one (81.9%, versus 68.4%, p
Læs mere Tjek på PubMedBMC Infectious Diseases, 7.03.2024
Tilføjet 7.03.2024
Abstract Background Invasive meningococcal disease (IMD), including sepsis and meningitis, can develop when Neisseria meningitidis bacteria breach the barrier and gain access to the circulation. While IMD is a rare outcome of bacterial exposure, colonization of the oropharynx is present in approximately 10% of the human population. This asymptomatic carriage can be long or short term, and it is unknown which determining factors regulate bacterial colonization. Despite descriptions of many bacterial virulence factors and recent advances in detailed genetic identification and characterization of bacteria, the factors mediating invasion and disease vs. asymptomatic carriage following bacterial colonization remain unknown. The pharyngeal epithelia play a role in the innate immune defense against pathogens, and the aim of this study was to investigate the proinflammatory response of pharyngeal epithelial cells following meningococcal exposure to describe the potential inflammatory mediation performed during the initial host‒pathogen interaction. Clinically relevant isolates of serogroups B, C, W and Y, derived from patients with meningococcal disease as well as asymptomatic carriers, were included in the study. Results The most potent cellular response with proinflammatory secretion of TNF, IL-6, CXCL8, CCL2, IL-1β and IL-18 was found in response to invasive serogroup B isolates. This potent response pattern was also mirrored by increased bacterial adhesion to cells as well as induced cell death. It was, however, only with serogroup B isolates where the most potent cellular response was toward the IMD isolates. In contrast, the most potent cellular response using serogroup Y isolates was directed toward the carriage isolates rather than the IMD isolates. In addition, by comparing isolates from outbreaks in Sweden (epidemiologically linked and highly genetically similar), we found the most potent proinflammatory response in cells exposed to carriage isolates rather than the IMD isolates. Conclusion Although certain expected correlations between host‒pathogen interactions and cellular proinflammatory responses were found using IMD serogroup B isolates, our data indicate that carriage isolates invoke stronger proinflammatory activation of the epithelial lining than IMD isolates.
Læs mere Tjek på PubMedTakehiko OamiShabnam AbtahiTakashi ShimazuiChing-Wen ChenYan Y. SweatZhe LiangEileen M. BurdAlton B. FarrisJoe T. RolandSachiko TsukitaMandy L. FordJerrold R. TurnerCraig M. CoopersmithaDepartment of Surgery and Emory Critical Care Center, Emory University School of Medicine, Atlanta, GA 30322bDepartment of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba 260-8670, JapancLaboratory of Mucosal Pathobiology, Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115dDepartment of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA 30322eEpithelial Biology Center, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN 37240fAdvanced Comprehensive Research Organization, Teikyo University, Tokyo 173-0003, JapangDepartment of Surgery and Emory Transplant Center, Emory University School of Medicine, Atlanta, GA 30322
Proceedings of the National Academy of Sciences, 6.03.2024
Tilføjet 6.03.2024
Proceedings of the National Academy of Sciences, Volume 121, Issue 10, March 2024.
Læs mere Tjek på PubMedInfection, 6.03.2024
Tilføjet 6.03.2024
Abstract Purpose Blood cultures (BCs) are key for pathogen detection in septic patients. We investigated the extent to which sampling was performed and what factors were associated with the absence of general or inadequate BC sampling. Methods We conducted a retrospective cohort study of hospitalized patients with sepsis admitted to one of three EDs in 2018. Primary outcome was the extent of general BC collection of at least 1 set. Secondary outcome was the extent of adequate BC sampling, defined as ≥ 2 sets before antibiotic therapy (AT). Multivariable logistic regression analysis was performed to identify factors associated with deficits in both outcomes. Results 1143 patients were analyzed. BCs were collected from 946 patients. Single BCs were taken from 520 patients, ≥ 2 sets from 426 patients. Overall, ≥ 2 BCs were taken from 349 patients before AT. BC sampling before AT occurred significantly more frequently when ≥ 2 BC sets were taken rather than a single one (81.9%, versus 68.4%, p
Læs mere Tjek på PubMedBMC Infectious Diseases, 5.03.2024
Tilføjet 5.03.2024
Abstract Background There is limited information about the outcomes of polymicrobial bloodstream infections in patients with sepsis. We aimed to investigate outcomes of polymicrobial bloodstream infections compared to monomicrobial bloodstream infections. Methods This study used data from the Korean Sepsis Alliance Registry, a nationwide database of prospective observational sepsis cohort. Adult sepsis patients with bloodstream infections from September 2019 to December 2021 at 20 tertiary or university-affiliated hospitals in South Korea were analyzed. Results Among the 3,823 patients with bloodstream infections, 429 of them (11.2%) had polymicrobial bloodstream infections. The crude hospital mortality of patients with sepsis with polymicrobial bloodstream infection and monomicrobial bloodstream infection was 35.7% and 30.1%, respectively (p = 0.021). However, polymicrobial bloodstream infections were not associated with hospital mortality in the proportional hazard analysis (HR 1.15 [0.97–1.36], p = 0.11). The inappropriate use of antibiotics was associated with increased mortality (HR 1.37 [1.19–1.57], p
Læs mere Tjek på PubMedBMC Infectious Diseases, 5.03.2024
Tilføjet 5.03.2024
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.
Læs mere Tjek på PubMedClinical & Experimental Immunology, 2.03.2024
Tilføjet 2.03.2024
Abstract Sepsis is characterised by a dysfunctional host response to infection culminating in life-threatening organ failure that requires complex patient management and rapid intervention. Timely diagnosis of the underlying cause of sepsis is crucial, and identifying those at risk of complications and death is imperative for triaging treatment and resource allocation. Here, we explored the potential of explainable machine learning models to predict mortality and causative pathogen in sepsis patients. By using a modelling pipeline employing multiple feature selection algorithms, we demonstrate the feasibility to identify integrative patterns from clinical parameters, plasma biomarkers and extensive phenotyping of blood immune cells. Whilst no single variable had sufficient predictive power, models that combined five and more features showed a macro area under the curve (AUC) of 0.85 to predict 90 day mortality after sepsis diagnosis, and a macro AUC of 0.86 to discriminate between Gram-positive and Gram-negative bacterial infections. Parameters associated with the cellular immune response contributed the most to models predictive of 90 day mortality, most notably, the proportion of T cells among PBMCs, together with expression of CXCR3 by CD4+ T cells and CD25 by mucosal-associated invariant T (MAIT) cells. Frequencies of Vδ2+ γδ T cells had the most profound impact on the prediction of Gram-negative infections, alongside other T cell-related variables and total neutrophil count. Overall, our findings highlight the added value of measuring the proportion and activation patterns of conventional and unconventional T cells in the blood of sepsis patients in combination with other immunological, biochemical and clinical parameters.
Læs mere Tjek på PubMedAmerson, Stephen J.; Hoffman, McKenna; Abouzahr, Fadi; Ahmad, Mohammad; Sterling, Rachel K.; Gidwani, Hitesh; Sousse, Linda E.; Dellavolpe, Jeffrey D.
Critical Care Explorations, 2.03.2024
Tilføjet 2.03.2024
BACKGROUND: Streptococcal toxic shock syndrome (STSS) is a fulminant complication of predominantly invasive group A streptococcal infections. STSS is often characterized by influenza-like symptoms, including fever, chills, and myalgia that can quickly progress to sepsis with hypotension, tachycardia, tachypnea, and multiple organ failure (kidney, liver, lung, or blood). Mortality can exceed 50% depending on the severity of symptoms. CASE SUMMARY: Here, we describe a novel, multi-extracorporeal intervention strategy in a case of severe septic shock secondary to STSS. A 28-year-old woman 5 days after cesarean section developed STSS with respiratory distress, hypotension, and multiple organ failure. Despite conventional therapy with intubation, antibiotics, vasopressors, and fluid resuscitation, her condition worsened. She was placed on venoarterial extracorporeal membrane oxygenation (VA-ECMO) with subsequent initiation of pathogen hemoperfusion using the Seraph 100 blood filter, followed by immunomodulation with the selective cytopheretic device (SCD). No device-related adverse events were observed. The patient’s condition gradually stabilized with discontinuation of vasopressors after 4 days, ECMO decannulation after 6 days, evidence of renal recovery after 7 days, and extubation from mechanical ventilation after 14 days. She was transferred to conventional hemodialysis after 13 days and discontinued all kidney replacement therapy 11 days later. CONCLUSIONS: This is the first reported use of VA-ECMO, Seraph 100 hemoperfusion, and cell-directed immunomodulation with SCD. This multimodal approach to extracorporeal support represents a promising therapeutic strategy for the most refractory critical care cases. Further studies are needed to assess the safety and efficacy of this sequential approach.
Læs mere Tjek på PubMedNovazzi Federica, Colombini Lorenzo, Perniciaro Simona, Genoni Angelo, Agosti Massimo, Santoro Francesco, Mancini Nicasio
Clinical Microbiology and Infection, 1.03.2024
Tilføjet 1.03.2024
Streptococcus pyogenes (Group A Streptococcus – GAS) is responsible for millions of infections and more than 500,000 deaths worldwide annually [1]. Generally, the primary site of GAS is the oropharynx with pharyngotonsillitis and scarlet fever as its most common “suppurative” manifestations, possibly complicated by “non-suppurative” autoimmune sequelae. However, an increase in invasive GAS (iGAS) infections with detectable bacteremia was reported throughout Europe since late 2022 [2]. Even if less frequently than Streptococcus agalactiae (Group B streptococcus - GBS) and Escherichia coli, GAS can occasionally colonize the female genital tract and cause serious complications including puerperal sepsis and early-onset neonatal sepsis (EOS) [3].
Læs mere Tjek på PubMedFlorian B. Mayr, Derek C. Angus
American Journal of Respiratory and Critical Care Medicine , 1.03.2024
Tilføjet 1.03.2024
American Journal of Respiratory and Critical Care Medicine, Volume 209, Issue 5, Page 468-469, March 1, 2024.
Læs mere Tjek på PubMedMichael A. Matthay, Eric P. Schmidt, Julie A. Bastarache, Carolyn S. Calfee, Charles W. Frevert, Thomas R. Martin
American Journal of Respiratory and Critical Care Medicine , 1.03.2024
Tilføjet 1.03.2024
American Journal of Respiratory and Critical Care Medicine, Volume 209, Issue 5, Page 488-490, March 1, 2024.
Læs mere Tjek på PubMedHallie C. Prescott, David A. Harrison, Kathryn M. Rowan, Manu Shankar-Hari, Hannah Wunsch
American Journal of Respiratory and Critical Care Medicine , 1.03.2024
Tilføjet 1.03.2024
American Journal of Respiratory and Critical Care Medicine, Volume 209, Issue 5, Page 507-516, March 1, 2024.
Læs mere Tjek på PubMedSégolène Gendreau, Thomas Frapard, Guillaume Carteaux, Arthur Kwizera, Neill K. J. Adhikari, Mervyn Mer, Glenn Hernandez, Armand Mekontso Dessap
American Journal of Respiratory and Critical Care Medicine , 1.03.2024
Tilføjet 1.03.2024
American Journal of Respiratory and Critical Care Medicine, Volume 209, Issue 5, Page 517-528, March 1, 2024.
Læs mere Tjek på PubMedJournal of the American Medical Association, 1.03.2024
Tilføjet 1.03.2024
Sepsis has been recognized as an important cause of morbidity and mortality for more than 2800 years. Derived from the Greek word sepo (σηπω, translated as “I rot,”), sepsis appears in writings of Homer, Hippocrates, Aristotle, and Galen. Conceptually, sepsis denotes a “line in the sand” within the broad spectrum of host-microbe interactions. It indicates that not only is the microbe unwanted (in contrast to the many microbes that live on and within us and contribute to health and digestion), but the host’s attempts to eradicate the microbe are resulting in collateral damage.
Læs mere Tjek på PubMedJournal of the American Medical Association, 1.03.2024
Tilføjet 1.03.2024
Everyone must acknowledge the difficulty of distinguishing diseases…whoever denies this may as well deny that there is such a thing as medical art.William Cullen
Læs mere Tjek på PubMedJournal of the American Medical Association, 1.03.2024
Tilføjet 1.03.2024
This article revises criteria to identify sepsis in children after an exhaustive process that involved surveying clinicians, reviewing health record databases, conducting a systematic review and meta-analysis, and undergoing a Delphi consensus process.
Læs mere Tjek på PubMedJournal of the American Medical Association, 1.03.2024
Tilføjet 1.03.2024
This cohort study derives and validates novel criteria for diagnosis of pediatric sepsis and septic shock across high-resource and low-resource international settings.
Læs mere Tjek på PubMedTaylor, Stephanie P.; Kowalkowski, Marc A.; Skewes, Sable; Chou, Shih-Hsiung
Critical Care Medicine, 28.02.2024
Tilføjet 28.02.2024
Objective: To evaluate real-world implications of updated Surviving Sepsis Campaign (SSC) recommendations for antibiotic timing. Design: Retrospective cohort study. Setting: Twelve hospitals in the Southeastern United States between 2017 and 2021. Patients: One hundred sixty-six thousand five hundred fifty-nine adult hospitalized patients treated in the emergency department for suspected serious infection. Interventions: None. Measurements and Main Results: We determined the number and characteristics of patients affected by updated SSC recommendations for initiation of antibiotics that incorporate a risk- and probability-stratified approach. Using an infection prediction model with a cutoff of 0.5 to classify possible vs. probable infection, we found that 30% of the suspected infection cohort would be classified as shock absent, possible infection and thus eligible for the new 3-hour antibiotic recommendation. In real-world practice, this group had a conservative time to antibiotics (median, 5.5 hr; interquartile range [IQR], 3.2–9.8 hr) and low mortality (2%). Patients categorized as shock absent, probable infection had a median time to antibiotics of 3.2 hours (IQR, 2.1–5.1 hr) and mortality of 3%. Patients categorized as shock present, the probable infection had a median time to antibiotics 2.7 hours (IQR, 1.7–4.6 hr) and mortality of 17%, and patients categorized as shock present, the possible infection had a median time to antibiotics 6.9 hours (IQR, 3.5–16.3 hr) and mortality of 12%. Conclusions: These data support recently updated SSC recommendations to align antibiotic timing targets with risk and probability stratifications. Our results provide empirical support that clinicians and hospitals should not be held to 1-hour targets for patients without shock and with only possible sepsis.
Læs mere Tjek på PubMedRaphaël Lecomte, Colin Deschanvres, Alexis Bourreau, Louise Ruffier d'Epenoux, Paul Le Turnier, Benjamin Gaborit, Marie Chauveau, Magali Michel, Thierry Le Tourneau, Pascale Bémer, Stéphane Corvec, David Boutoille
International Journal of Infectious Diseases, 28.02.2024
Tilføjet 28.02.2024
In most cases, treatment of infective endocarditis (IE) is empirical until the causative pathogens are identified, with two major important points. First, empirical antimicrobial therapy (EAT) is the cornerstone of sepsis therapy and any delay in time to appropriate antimicrobial therapy increases sepsis mortality, particularly in cases of septic shock [1]. Second, since Staphylococcus aureus is the leading cause of IE and is associated with higher mortality [2,3], it is crucial that EAT for infective endocarditis includes drugs that have optimal anti-staphylococcal activity [4,5].
Læs mere Tjek på PubMedYue, J., Zhao, H., Li, J., Wu, J., Zheng, R.
BMJ Open, 28.02.2024
Tilføjet 28.02.2024
ObjectivesTo evaluate the knowledge, attitudes and practices towards diagnosing and managing paediatric sepsis among paediatric physicians and nurses. DesignA cross-sectional, questionnaire-based study. Setting21 hospitals in Hubei Province between February 2023 and March 2023. ParticipantsPaediatric physicians and nurses. InterventionsNone. Primary and secondary outcome measuresThe questionnaire contained 35 items across four dimensions (demographic information, knowledge, attitude and practice). ResultsThe study included 295 participants (173 women). The average knowledge, attitude and practice scores were 10.93±2.61 points (possible range, 0–20 points), 32.22±2.65 points (possible range, 7–35 points) and 36.54±5.24 points (possible range, 9–45 points), respectively. Knowledge had a direct influence on both attitude (β=0.240, 95% CI 0.136 to 0.365, p=0.009) and practice (β=0.278, 95% CI 0.084 to 0.513, p=0.010), which also indirectly influenced practice through attitude (β=0.162, 95% CI 0.078 to 0.290, p=0.007). Attitude directly influenced practice (β=0.677, 95% CI 0.384 to 0.902, p=0.025). A higher attitude score was associated with good practice (OR=1.392; 95% CI 1.231 to 1.576; p
Læs mere Tjek på PubMedTilahun, B. D., Yilak, G., Amena, N., Abate, B. B., Fantahun, A., Deribe, L.
BMJ Open, 28.02.2024
Tilføjet 28.02.2024
ObjectiveTo assess the uncertainty associated with parents of preterm infants hospitalised in neonatal intensive care units of selected governmental hospitals in Addis Ababa, Ethiopia, 2022. DesignA cross-sectional study conducted from 3 March 2022 to 30 March 2022. SettingThe research was conducted at a government hospital in Addis Ababa, Ethiopia. ParticipantsOut of 305 eligible participants, 303 were parents of preterm infants’ participants with complete data. Primary outcome measureLevels of parental uncertainty, assessed by using the Mishel scale of uncertainty. Simple and multivariable linear regression analyses were conducted to assess associations between variables. ResultsThe mean uncertainty expressed by parents was 101.3 (SD=21.12). There were significant associations found with various factors. The sex of the respondent fathers (β=–4.65, 95% CI –9.32 to –0.025), length of neonatal intensive care unit (NICU) stay >10 days (β=14.64, 95% CI 8.71 to 20.56), gestational week between 34 and 37 weeks (β=–7.47, 95% CI –11.42 to –3.52), parents with college degrees and above (β=–14.15, 95% CI –22.94 to –5.34), parents with neonates who were preterm and had neonatal sepsis (β=10.42, 95% CI –17.57 to –3.27), parents without a history of neonatal NICU admission (β=–6.16, 95% CI –11.69 to –0.63) and parents who were housewives (β=6.51, 95% CI 1.83 to 12.19) all showed significant associations. ConclusionFactors like educational status, gestational week, neonatal admission history and NICU stay length contribute to parental uncertainty. Promoting empathy and clear communication is crucial. Hospitals should develop compassionate protocols for information delivery, including regular updates and effective addressing of concerns. Fostering a supportive environment helps parents express emotions and seek support.
Læs mere Tjek på PubMedInfection, 26.02.2024
Tilføjet 26.02.2024
Abstract Purpose Sepsis suspicion by Emergency Medical Services (EMS) is associated with improved patient outcomes. This study assessed sepsis incidence and recognition by EMS and analyzed which of the screening tools recommended by the Surviving Sepsis Campaign best facilitates sepsis prediction. Methods Retrospective cohort study of claims data from health insurances (n = 221,429 EMS cases), and paramedics’ and emergency physicians’ EMS documentation (n = 110,419); analyzed outcomes were: sepsis incidence and case fatality compared to stroke and myocardial infarction, the extent of documentation for screening-relevant variables and sepsis suspicion, tools’ intersections for screening positive in identical EMS cases and their predictive ability for an inpatient sepsis diagnosis. Results Incidence of sepsis (1.6%) was similar to myocardial infarction (2.6%) and stroke (2.7%); however, 30-day case fatality rate was almost threefold higher (31.7% vs. 13.4%; 11.8%). Complete vital sign documentation was achieved in 8.2% of all cases. Paramedics never, emergency physicians rarely (0.1%) documented a sepsis suspicion, respectively septic shock. NEWS2 had the highest sensitivity (73.1%; Specificity:81.6%) compared to qSOFA (23.1%; Sp:96.6%), SIRS (28.2%; Sp:94.3%) and MEWS (48.7%; Sp:88.1%). Depending on the tool, 3.7% to 19.4% of all cases screened positive; only 0.8% in all tools simultaneously. Conclusion Incidence and mortality underline the need for better sepsis awareness, documentation of vital signs and use of screening tools. Guidelines may omit MEWS and SIRS as recommendations for prehospital providers since they were inferior in all accuracy measures. Though no tool performed ideally, NEWS2 qualifies as the best tool to predict the highest proportion of septic patients and to rule out cases that are likely non-septic.
Læs mere Tjek på PubMedJournal of Infectious Diseases, 25.02.2024
Tilføjet 25.02.2024
Abstract Klebsiella pneumoniae is the leading cause of neonatal sepsis and is increasingly difficult to treat due to antibiotic resistance. Vaccination represents a tractable approach to combat this resistant bacterium; however, there is currently not a licensed vaccine. Surface polysaccharides, including O-antigens of lipopolysaccharide, have long been attractive candidates for vaccine inclusion. Herein we describe the generation of a bioconjugate vaccine targeting seven predominant O-antigen subtypes in K. pneumoniae. Each bioconjugate was immunogenic in isolation, with limited cross-reactivity among subtypes. Vaccine-induced antibodies demonstrated varying degrees of binding to a wide variety of K. pneumoniae strains. Further, sera from vaccinated mice induced complement-mediated killing of many of these strains. Finally, increased capsule interfered with O-antigen antibodies’ ability to bind and mediate killing of some K. pneumoniae strains. Taken together, these data indicate that this novel heptavalent O-antigen bioconjugate vaccine formulation exhibits limited efficacy against some, but not all, K. pneumoniae isolates.
Læs mere Tjek på PubMedBMC Infectious Diseases, 24.02.2024
Tilføjet 24.02.2024
Abstract Introduction The Neutrophil-Lymphocyte Ratio (NLR) in blood has demonstrated its capability to predict bacteremia in emergency departments, and its association with mortality has been established in patients with sepsis in intensive care units. However, its potential concerning mortality and readmission in patients with Gram-negative bacteremia (GNB) is unexplored. Methods This retrospective cohort study included patients with GNB between 2018 and 2022 from six hospitals in the Capital Region of Denmark. Patients who were immunosuppressed or had missing NLR values on the day of blood culture were excluded. Logistic regression models were used to analyze the association between NLR levels and 90-day all-cause mortality, while the logit link interpretation of the cumulative incidence function was used to assess the association between NLR levels and 60-day readmission. Associations were quantified as odds ratios (OR) with corresponding 95% confidence intervals (CI). Results The study included 1763 patients with a median age was 76.8 years and 51.3% were female. The median NLR was 17.3 and 15.8% of patients had a quick sequential organ failure assessment score of two or three. Urinary tract infection (UTI) was the most frequent focus and Escherichia coli the most frequent pathogen. Statistically significant differences in median NLR were found by age group and pathogen, and for patients with or without hypertension, liver disease, chronic obstructive pulmonary disease, dementia, and alcohol abuse. 378 patients (21.4%) died before 90 days. 526 (29.8%) patients were readmitted to the hospital within 60 days. For each doubling of the NLR, the OR for all-cause 90-day mortality was 1.15 (95% CI, 1.04–1.27) and 1.12 (95% CI, 1.02–1.24) for 60-day readmission. Analysis of subgroups did not show statistically significant differences between groups in relation to the association between NLR and mortality. The discriminatory ability of NLR for mortality was limited and comparable to blood neutrophil or lymphocyte count, producing receiver operating characteristic curves with an area under the curve of 0.59 (95% CI, 0.56–0.63), 0.60 (95% CI, 0.56–0.65) and 0.53 (95% CI, 0.49–0.56), respectively. Conclusion Blood neutrophil-lymphocyte ratio was associated with 90-day all-cause mortality and 60-day readmission in patients with GNB. However, the ratio has limited ability in predicting mortality or readmission.
Læs mere Tjek på PubMedWebb, Lece V; Evans, Jakob; Smith, Veronica; Pettibone, Elisabeth; Tofil, Jarod; Hicks, Jessica Floyd; Green, Sherry; Nassel, Ariann; Loberger, Jeremy M
Critical Care Explorations, 23.02.2024
Tilføjet 23.02.2024
IMPORTANCE: Sepsis is a leading cause of morbidity and mortality in the United States and disparate outcomes exist between racial/ethnic groups despite improvements in sepsis management. These observed differences are often related to social determinants of health (SDoH). Little is known about the role of SDoH on outcomes in pediatric sepsis. OBJECTIVE: This study examined the differences in care delivery and outcomes in children with severe sepsis based on race/ethnicity and neighborhood context (as measured by the social vulnerability index). DESIGN, SETTING, AND PARTICIPANTS: This retrospective, cross-sectional study was completed in a quaternary care children’s hospital. Patients 18 years old or younger who were admitted between May 1, 2018, and February 28, 2022, met the improving pediatric sepsis outcomes (IPSO) collaborative definition for severe sepsis. Composite measures of social vulnerability, care delivery, and clinical outcomes were stratified by race/ethnicity. MAIN OUTCOMES AND MEASURES: The primary outcome of interest was admission to the PICU. Secondary outcomes were sepsis recognition and early goal-directed therapy (EGDT). RESULTS: A total of 967 children met the criteria for IPSO-defined severe sepsis, of whom 53.4% were White/non-Hispanic. Nearly half of the cohort (48.7%) required PICU admission. There was no difference in illness severity at PICU admission by race (1.01 vs. 1.1, p = 0.18). Non-White race/Hispanic ethnicity was independently associated with PICU admission (odds ratio [OR] 1.35 [1.01–1.8], p = 0.04). Although social vulnerability was not independently associated with PICU admission (OR 0.95 [0.59–1.53], p = 0.83), non-White children were significantly more likely to reside in vulnerable neighborhoods (0.66 vs. 0.38, p < 0.001). Non-White race was associated with lower sepsis recognition (87.8% vs. 93.6%, p = 0.002) and less EGDT compliance (35.7% vs. 42.8%, p = 0.024). CONCLUSIONS AND RELEVANCE: Non-White race/ethnicity was independently associated with PICU admission. Differences in care delivery were also identified. Prospective studies are needed to further investigate these findings.
Læs mere Tjek på PubMedNina S. Groeneveld, Sabine E. Olie, Douwe H. Visser, Linde Snoek, Diederik van de Beek, Matthijs C. Brouwer, Merijn W. Bijlsma, NOGBS study group
International Journal of Infectious Diseases, 21.02.2024
Tilføjet 21.02.2024
Neonatal and infant meningitis and sepsis are associated with substantial mortality and long-term morbidity.[1] Early detection of meningitis in suspected sepsis patients is important because of the difference in empiric antibiotic regimen, dosage and duration of antibiotic treatment. Also, it influences the need for monitoring of complications during hospitalization, as well as the risk of long-term neurodevelopmental impairment.[2] The interpretation of CSF parameters in neonates can be difficult due to considerable overlap of CSF characteristics between sepsis and meningitis.
Læs mere Tjek på PubMedJessie J. Goldsmith, Christy Vu, Ziheng Zhu, Jennifer MacLachlan, Tilda N. Thomson, Patricia Therese Campbell, Katherine B. Gibney
International Journal of Infectious Diseases, 21.02.2024
Tilføjet 21.02.2024
Invasive group A streptococcal disease (iGAS) is a rare and life-threatening infection. It occurs when group A Streptococcus bacteria (GAS, Streptococcus pyogenes) invade otherwise sterile sites of the body, such as the blood and cerebrospinal fluid.[1] Globally, it is estimated that 15–25% of iGAS cases are fatal.[1] Severe manifestations such as sepsis, streptococcal toxic shock syndrome (STSS) and necrotising fasciitis have higher case fatality rates, even in well-resourced settings.[1, 2] iGAS is managed with antibiotics, and often requires surgery and supportive care for organ dysfunction.[2] However, patients frequently experience rapid clinical progression and urgent medical attention is critical.[2] It is imperative that the factors that increase the risk of iGAS are well understood to support early diagnosis and rapid institution of life-saving medical care.
Læs mere Tjek på PubMedInfection, 20.02.2024
Tilføjet 20.02.2024
Abstract Purpose Sepsis suspicion by Emergency Medical Services (EMS) is associated with improved patient outcomes. This study assessed sepsis incidence and recognition by EMS and analyzed which of the screening tools recommended by the Surviving Sepsis Campaign best facilitates sepsis prediction. Methods Retrospective cohort study of claims data from health insurances (n = 221,429 EMS cases), and paramedics’ and emergency physicians’ EMS documentation (n = 110,419); analyzed outcomes were: sepsis incidence and case fatality compared to stroke and myocardial infarction, the extent of documentation for screening-relevant variables and sepsis suspicion, tools’ intersections for screening positive in identical EMS cases and their predictive ability for an inpatient sepsis diagnosis. Results Incidence of sepsis (1.6%) was similar to myocardial infarction (2.6%) and stroke (2.7%); however, 30-day case fatality rate was almost threefold higher (31.7% vs. 13.4%; 11.8%). Complete vital sign documentation was achieved in 8.2% of all cases. Paramedics never, emergency physicians rarely (0.1%) documented a sepsis suspicion, respectively septic shock. NEWS2 had the highest sensitivity (73.1%; Specificity:81.6%) compared to qSOFA (23.1%; Sp:96.6%), SIRS (28.2%; Sp:94.3%) and MEWS (48.7%; Sp:88.1%). Depending on the tool, 3.7% to 19.4% of all cases screened positive; only 0.8% in all tools simultaneously. Conclusion Incidence and mortality underline the need for better sepsis awareness, documentation of vital signs and use of screening tools. Guidelines may omit MEWS and SIRS as recommendations for prehospital providers since they were inferior in all accuracy measures. Though no tool performed ideally, NEWS2 qualifies as the best tool to predict the highest proportion of septic patients and to rule out cases that are likely non-septic.
Læs mere Tjek på PubMedSuntornsut, P., Asadinia, K. S., Limato, R., Tamara, A., Rotty, L. W. A., Bramanti, R., Nusantara, D. U., Nelwan, E. J., Khusuwan, S., Suphamongkholchaikul, W., Chamnan, P., Piyaphanee, W., Vu, H. T. L., Nguyen, Y. H., Nguyen, K. H., Pham, T. N., Le, Q. M., Vu, V. H., Chau, D. M., Vo, D. E. T. H., Harriss, E. K., van Doorn, H. R., Hamers, R. L., Lorencatto, F., Atkins, L., Limmathurotsakul, D.
BMJ Open, 20.02.2024
Tilføjet 20.02.2024
ObjectiveBlood culture (BC) sampling is recommended for all suspected sepsis patients prior to antibiotic administration. We examine barriers and enablers to BC sampling in three Southeast Asian countries. DesignA Theoretical Domains Framework (TDF)-based survey, comprising a case scenario of a patient presenting with community-acquired sepsis and all 14 TDF domains of barriers/enablers to BC sampling. SettingHospitals in Indonesia, Thailand and Viet Nam, December 2021 to 30 April 2022. Participants1070 medical doctors and 238 final-year medical students were participated in this study. Half of the respondents were women (n=680, 52%) and most worked in governmental hospitals (n=980, 75.4%). Outcome measuresBarriers and enablers to BC sampling. ResultsThe proportion of respondents who answered that they would definitely take BC in the case scenario was highest at 89.8% (273/304) in Thailand, followed by 50.5% (252/499) in Viet Nam and 31.3% (157/501) in Indonesia (p
Læs mere Tjek på PubMedRoss, James T.; Robles, Anamaria J.; Mazer, Monty B.; Studer, Amy C.; Remy, Kenneth E.; Callcut, Rachael A.
Critical Care Explorations, 19.02.2024
Tilføjet 19.02.2024
OBJECTIVES: Cell-free hemoglobin (CFH) is a potent mediator of endothelial dysfunction, organ injury, coagulopathy, and immunomodulation in hemolysis. These mechanisms have been demonstrated in patients with sepsis, hemoglobinopathies, and those receiving transfusions. However, less is known about the role of CFH in the pathophysiology of trauma, despite the release of equivalent levels of free hemoglobin. DATA SOURCES: Ovid MEDLINE, Embase, Web of Science Core Collection, and BIOSIS Previews were searched up to January 21, 2023, using key terms related to free hemoglobin and trauma. DATA EXTRACTION: Two independent reviewers selected studies focused on hemolysis in trauma patients, hemoglobin breakdown products, hemoglobin-mediated injury in trauma, transfusion, sepsis, or therapeutics. DATA SYNTHESIS: Data from the selected studies and their references were synthesized into a narrative review. CONCLUSIONS: Free hemoglobin likely plays a role in endothelial dysfunction, organ injury, coagulopathy, and immune dysfunction in polytrauma. This is a compelling area of investigation as multiple existing therapeutics effectively block these pathways.
Læs mere Tjek på PubMedBMC Infectious Diseases, 17.02.2024
Tilføjet 17.02.2024
Abstract Background The early identification of sepsis presenting a high risk of deterioration is a daily challenge to optimise patient pathway. This is all the most crucial in the prehospital setting to optimize triage and admission into the appropriate unit: emergency department (ED) or intensive care unit (ICU). We report the association between the prehospital National Early Warning Score 2 (NEWS-2) and in-hospital, 30 and 90-day mortality of SS patients cared for in the pre-hospital setting by a mobile ICU (MICU). Methods Septic shock (SS) patients cared for by a MICU between 2016, April 6th and 2021 December 31st were included in this retrospective cohort study. The NEWS-2 is based on 6 physiological variables (blood pressure, heart rate, respiratory rate, temperature, oxygen saturation prior oxygen supplementation, and level of consciousness) and ranges from 0 to 20. The Inverse Probability Treatment Weighting (IPTW) propensity method was applied to assess the association with in-hospital, 30 and 90-day mortality. A NEWS-2 ≥ 7 threshold was chosen for increased clinical deterioration risk definition and usefulness in clinical practice based on previous reports. Results Data from 530 SS patients requiring MICU intervention in the pre-hospital setting were analysed. The mean age was 69 ± 15 years and presumed origin of sepsis was pulmonary (43%), digestive (25%) or urinary (17%) infection. In-hospital mortality rate was 33%, 30 and 90-day mortality were respectively 31% and 35%. A prehospital NEWS-2 ≥ 7 is associated with an increase in-hospital, 30 and 90-day mortality with respective RRa = 2.34 [1.39–3.95], 2.08 [1.33–3.25] and 2.22 [1.38–3.59]. Calibration statistic values for in-hospital mortality, 30-day and 90-day mortality were 0.54; 0.55 and 0.53 respectively. Conclusion A prehospital NEWS-2 ≥ 7 is associated with an increase in in-hospital, 30 and 90-day mortality of septic shock patients cared for by a MICU in the prehospital setting. Prospective studies are needed to confirm the usefulness of NEWS-2 to improve the prehospital triage and orientation to the adequate facility of sepsis.
Læs mere Tjek på PubMedBMC Infectious Diseases, 17.02.2024
Tilføjet 17.02.2024
Abstract Background Autoimmune diseases (ADs) may be complicated by sepsis when intensive care unit (ICU) admission. But repeated sepsis among AD patients has not been studied yet. The aim of this study is to investigate the impact of repeated in-ICU sepsis on the 1-year overall-cause mortality, septic shock and in-ICU death of AD patients. Methods Data of AD patients with sepsis retrieved from Medical Information Mart for Intensive Care IV (MIMIC-IV) database were divided into the single group and the repeated group according to the frequency of in-ICU sepsis. Propensity score matching was used to balance inter-group bias. Cox proportional hazard regression and sensitivity analysis were utilized to assess the variables on mortality. Results The incidence of repeated in-ICU sepsis in baseline was 19.8%. The repeated in-ICU sepsis was a risk factor for 1-year overall-cause mortality among AD patients (adjusted hazard ratio [HR] = 1.50, 95% CI: 1.16–1.93, P = 0.002), with robust adjusted HRs by the adjustment for confounders in the sensitivity analysis (all P
Læs mere Tjek på PubMedBMC Infectious Diseases, 16.02.2024
Tilføjet 16.02.2024
Abstract Background The early identification of sepsis presenting a high risk of deterioration is a daily challenge to optimise patient pathway. This is all the most crucial in the prehospital setting to optimize triage and admission into the appropriate unit: emergency department (ED) or intensive care unit (ICU). We report the association between the prehospital National Early Warning Score 2 (NEWS-2) and in-hospital, 30 and 90-day mortality of SS patients cared for in the pre-hospital setting by a mobile ICU (MICU). Methods Septic shock (SS) patients cared for by a MICU between 2016, April 6th and 2021 December 31st were included in this retrospective cohort study. The NEWS-2 is based on 6 physiological variables (blood pressure, heart rate, respiratory rate, temperature, oxygen saturation prior oxygen supplementation, and level of consciousness) and ranges from 0 to 20. The Inverse Probability Treatment Weighting (IPTW) propensity method was applied to assess the association with in-hospital, 30 and 90-day mortality. A NEWS-2 ≥ 7 threshold was chosen for increased clinical deterioration risk definition and usefulness in clinical practice based on previous reports. Results Data from 530 SS patients requiring MICU intervention in the pre-hospital setting were analysed. The mean age was 69 ± 15 years and presumed origin of sepsis was pulmonary (43%), digestive (25%) or urinary (17%) infection. In-hospital mortality rate was 33%, 30 and 90-day mortality were respectively 31% and 35%. A prehospital NEWS-2 ≥ 7 is associated with an increase in-hospital, 30 and 90-day mortality with respective RRa = 2.34 [1.39–3.95], 2.08 [1.33–3.25] and 2.22 [1.38–3.59]. Calibration statistic values for in-hospital mortality, 30-day and 90-day mortality were 0.54; 0.55 and 0.53 respectively. Conclusion A prehospital NEWS-2 ≥ 7 is associated with an increase in in-hospital, 30 and 90-day mortality of septic shock patients cared for by a MICU in the prehospital setting. Prospective studies are needed to confirm the usefulness of NEWS-2 to improve the prehospital triage and orientation to the adequate facility of sepsis.
Læs mere Tjek på PubMedArai, Riku; Murata, Nobuhiro; Fukamachi, Daisuke; Okumura, Yasuo; Japan Registry for Percutaneous Ventricular Assist Device (J-PVAD) Investigators
Critical Care Medicine, 15.02.2024
Tilføjet 15.02.2024
Objectives: This study aimed to investigate the current use and impact of pulmonary artery catheters (PACs) in patients with cardiogenic shock (CS) who underwent Impella support. Design: This was a prospective multicenter observational study between January 2020 and December 2021 that registered all patients with drug-refractory acute heart failure and in whom the placement of an Impella 2.5, CP, or 5.0 pump was attempted or successful in Japan. Setting: Cardiac ICUs in Japan. Patients: Between January 2020 and December 2021, a total of 3112 patients treated with an Impella were prospectively enrolled in the Japan registry for percutaneous ventricular assist device (J-PVAD). Among them, 2063 patients with CS were divided into two groups according to the PAC use. Interventions: None. Measurements and Main Results: The primary endpoint was the 30-day mortality, and the secondary endpoints were hemolysis, acute kidney injury, sepsis, major bleeding unrelated to the Impella, and ventricular arrhythmias within 30 days. PACs were used in 1358 patients (65.8%) who underwent an Impella implantation. The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) was significantly higher in the patients with PACs than in those without. Factors associated with PAC use were the prevalence of hypertension, out-of-hospital cardiac arrest, New York Heart Association classification IV, the lesser prevalence of a heart rate less than 50, and the use of any catecholamine. The primary and secondary endpoints did not significantly differ according to the PAC use. Focusing on the patients with VA-ECMO use, the 30-day mortality and hemolysis were univariately lower in the patients with PACs. Conclusions: The J-PVAD findings indicated that PAC use did not have a significant impact on the short-term outcomes in CS patients undergoing Impella support. Further prospective studies are required to explore the clinical implications of PAC-guided intensive treatment strategies in these patients.
Læs mere Tjek på PubMedBolanaki, Myrto; Winning, Johannes; Slagman, Anna; Lehmann, Thomas; Kiehntopf, Michael; Stacke, Angelika; Neumann, Caroline; Reinhart, Konrad; Möckel, Martin; Bauer, Michael
Critical Care Medicine, 15.02.2024
Tilføjet 15.02.2024
Objectives: Consensus regarding biomarkers for detection of infection-related organ dysfunction in the emergency department is lacking. We aimed to identify and validate biomarkers that could improve risk prediction for overt or incipient organ dysfunction when added to quick Sepsis-related Organ Failure Assessment (qSOFA) as a screening tool. Design: In a large prospective multicenter cohort of adult patients presenting to the emergency department with a qSOFA score greater than or equal to 1, admission plasma levels of C-reactive protein, procalcitonin, adrenomedullin (either bioavailable adrenomedullin or midregional fragment of proadrenomedullin), proenkephalin, and dipeptidyl peptidase 3 were assessed. Least absolute shrinkage and selection operator regression was applied to assess the impact of these biomarkers alone or in combination to detect the primary endpoint of prediction of sepsis within 96 hours of admission. Setting: Three tertiary emergency departments at German University Hospitals (Jena University Hospital and two sites of the Charité University Hospital, Berlin). Patients: One thousand four hundred seventy-seven adult patients presenting with suspected organ dysfunction based on qSOFA score greater than or equal to 1. Interventions: None. Measurements and Main Results: The cohort was of moderate severity with 81% presenting with qSOFA = 1; 29.2% of these patients developed sepsis. Procalcitonin outperformed all other biomarkers regarding the primary endpoint (area under the curve for receiver operating characteristic [AUC-ROC], 0.86 [0.79–0.93]). Adding other biomarkers failed to further improve the AUC-ROC for the primary endpoint; however, they improved the model regarding several secondary endpoints, such as mortality, need for vasopressors, or dialysis. Addition of procalcitonin with a cutoff level of 0.25 ng/mL improved net (re)classification by 35.2% compared with qSOFA alone, with positive and negative predictive values of 60.7% and 88.7%, respectively. Conclusions: Biomarkers of infection and organ dysfunction, most notably procalcitonin, substantially improve early prediction of sepsis with added value to qSOFA alone as a simple screening tool on emergency department admission.
Læs mere Tjek på PubMed