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BMC Infectious Diseases, 8.11.2024
Tilføjet 8.11.2024
Abstract Background The stress hyperglycemia ratio (SHR) is associated with poor outcomes in critically ill patients. However, the relationship between SHR and mortality in patients with sepsis-associated acute kidney injury (SA-AKI) remains unclear. Methods The data of patients with SA-AKI, identified based on the KDIGO criteria, were retrospectively collected from the Beth Israel Deaconess Medical Center between 2008 and 2019. SHR was calculated as follows: (glycemia [mmol/L]) / (1.59 × HbA1c [%] – 2.59). Primary outcomes were 30-day and 1-year mortality. The cumulative incidence of all-cause mortality was assessed using Kaplan–Meier survival analysis. Multivariable-adjusted logistic and Cox models and restricted cubic spline curves were used to analyze the correlation between SHR and all-cause mortality. Post-hoc subgroup analysis was performed to compare the effects of SHR across different subgroups. Results 1161 patients with SA-AKI were identified and categorized into four SHR quartiles as follows: Q1 (0.26, 0.90), Q2 (0.91, 1.08), Q3 (1.09, 1.30), and Q4 (1.31, 5.42). The median age of patients was 69 years, with 42.7% of the patients being women and 20.2% of the patients having chronic kidney disease. The 30-day and 1-year mortality were 22.1% and 35.0% respectively. Kaplan–Meier survival analysis indicated a gradual decrease in survival probability with increasing SHR quartiles. An increased SHR exhibited a strong correlation with 30-day mortality (hazard ratio [HR], 1.50; 95% confidence interval [CI], 1.18–1.90; P
Læs mere Tjek på PubMedGenevieve E MARTIN, Joshua BRAMWELL, Eden GADIL, Celeste WOERLE, Thomas EWIN, Jane DAVIES, Sonja JANSON, Bart J CURRIE
International Journal of Infectious Diseases, 8.11.2024
Tilføjet 8.11.2024
Infection with Burkholderia pseudomallei (melioidosis), is an important cause of gram-negative sepsis in endemic tropical and subtropical regions including northern Australia [1]. Antimicrobial treatment is divided into two phases: an initial intravenous phase followed by an oral eradication phase [2]. Trimethoprim/sulfamethoxazole is the preferred agent for eradication therapy and is dosed by weight at 240/1200mg (40-60kg), or 320/1600mg orally (>60kg), 12-hourly for adults, with adjustment for renal function and the use of folic acid supplementation at all doses [2].
Læs mere Tjek på PubMedClinical Infectious Diseases, 7.11.2024
Tilføjet 7.11.2024
Edwin Aguirre-Milachay, Darwin A. León-Figueroa, Mario J. Valladares-Garrido
PLoS One Infectious Diseases, 5.11.2024
Tilføjet 5.11.2024
by Edwin Aguirre-Milachay, Darwin A. León-Figueroa, Mario J. Valladares-Garrido Objectives To determine the clinical, laboratory, and hospital factors associated with preoperative complications in older adults with hip fractures. Methodology Analytical observational retrospective cohort study, whose population was older adults with a diagnosis of hip fracture treated in a hospital in northern Peru, during 2017–2019. Results 432 patients with a median age of 83 years (RIC: 77–88) were evaluated, with the female gender being the most prevalent (60.9%). The most common comorbidities included cardiovascular disease (68%) and diabetes (17.6%), and multimorbidity was observed in 47.2% of cases. The median number of geriatric syndromes was 2 (RIC: 1–5). The overall mortality rate was 3.2% (1.7–5.3). Analysis with the Poisson regression model found a significant association with MRC scale 3–5 degree (RR = 1.60), glucose on admission (RR = 1.01), and minimally significantly female sex (RR = 2.41). Conclusions The most commonly observed complications were infectious in nature, including pneumonia, sepsis, and urinary tract infections. The MRC scale from 3 to 5 degrees increases the risk of developing a preoperative complication; the glucose levels upon admission show a clinically irrelevant association; and in females, there is a minimally significant association in older adults with hip fractures.
Læs mere Tjek på PubMedBMC Infectious Diseases, 3.11.2024
Tilføjet 3.11.2024
Abstract Prostatic malakoplakia is an uncommon chronic inflammatory disorder, tumor-like but non-cancerous, the diagnosis of which pivots crucially on the identification of characteristic Michaelis-Gutmann bodies within the pathological tissue. We hereby present an inaugural case report of prostatic malakoplakia concurrent with sepsis caused by multidrug-resistant Escherichia coli, verified through blood culture and metagenomic next-generation sequencing (mNGS). The pathogenesis might be associated with infections by Escherichia coli, immune system irregularities, or lysosomal dysfunction. Although the patient had no chronic underlying diseases, he presented early with sepsis and multi-organ dysfunction. This case emphasizes the imperative to further investigate the association between malakoplakia and Escherichia coli, the necessity for prompt diagnosis, and the supportive role of mNGS, and the treatment strategy focuses on rapid control of infection and systemic inflammatory response.
Læs mere Tjek på PubMedBMC Infectious Diseases, 2.11.2024
Tilføjet 2.11.2024
Abstract Prostatic malakoplakia is an uncommon chronic inflammatory disorder, tumor-like but non-cancerous, the diagnosis of which pivots crucially on the identification of characteristic Michaelis-Gutmann bodies within the pathological tissue. We hereby present an inaugural case report of prostatic malakoplakia concurrent with sepsis caused by multidrug-resistant Escherichia coli, verified through blood culture and metagenomic next-generation sequencing (mNGS). The pathogenesis might be associated with infections by Escherichia coli, immune system irregularities, or lysosomal dysfunction. Although the patient had no chronic underlying diseases, he presented early with sepsis and multi-organ dysfunction. This case emphasizes the imperative to further investigate the association between malakoplakia and Escherichia coli, the necessity for prompt diagnosis, and the supportive role of mNGS, and the treatment strategy focuses on rapid control of infection and systemic inflammatory response.
Læs mere Tjek på PubMedYilkal Negesse, Habtamu Temesgen, Wubetu Woyraw, Melsew Setegn Alie, Ayenew Negesse
PLoS One Infectious Diseases, 1.11.2024
Tilføjet 1.11.2024
by Yilkal Negesse, Habtamu Temesgen, Wubetu Woyraw, Melsew Setegn Alie, Ayenew Negesse Background According to World Health Organization, pregnant women should take an oral iron and folic acid every day for at least 3 months to prevent preterm birth, low birth weight, maternal anemia, and puerperal sepsis. In addition to keeping maternal health, it also plays a key role to support the fetus’s healthy growth and development. Therefore, it is very important to know the magnitude of iron supplementation and its determinants in anemia hot spot regions of Ethiopia using an appropriate statistical analysis method. Objective The aim of this study is to determine the magnitude of iron supplementation and its associated factors in anemia hot spot regions of Ethiopia among pregnant women. Methods The study was done using the 2019 Ethiopian Mini Demographic and Health surveys data. Before any statistical analysis was done, the data were weighted using sampling weight for probability sampling and non-response. Then, a total weighted sample of 2116 reproductive age group women in anemia hot spot regions of Ethiopia were used for this study. A multilevel binary logistic regression model based on the Bayesian approach was fitted using the Brms R package to identify the determinants of iron supplementation in anemia hotspot regions of Ethiopia. Finally, the 95% credible interval (CrI) of the adjusted odds ratio (AOR) was used to assess statistical significance. If the interval includes 1, the result is considered non-significant. Results This study showed that in anemia hotspot regions of Ethiopia, the overall magnitude of iron supplementation among pregnant women is 55.5% (95% CrI: 53.4%- 57.6%). Being rural resident (AOR = 0.57; 95% CrI 0.34–0.93), having higher education level (AOR = 3.2; 95% CrI 1.80–5.7), having secondary education level (AOR = 3.28; 95% CrI 2.13–5.1), being wealthy (AOR = 1.80; 95% CrI 1.27–2.54), being household headed by female (AOR = 0.55; 95% CrI 0.43–0.71) and, have no children (AOR = 0.4;95%CrI 0.17–0.98) were significantly associated with iron supplementation among pregnant women in anemia hotspot regions of Ethiopia. Conclusion The overall magnitude of iron supplementation among pregnant women in anemia hotspot regions of Ethiopia is notably low when compared to the World Health Organization’s recommended target. Significant factors associated with higher iron supplementation included having secondary or higher education, rich in wealth, and being from a male-headed household. Conversely, being a rural resident, female-headed household, and having no children were associated with lower iron supplementation.
Læs mere Tjek på PubMedBandin-Vilar, E., Estany-Gestal, A., Cabaleiro, T., Rial-Pensado, E., Castro-Balado, A., Varela-Rey, I., Mondelo-Garcia, C., Cajade-Pascual, F., Rodriguez-Jato, M. T., Zarra-Ferro, I., Rey-Rilo, M. T., Arca-Suarez, J., Albinana-Perez, M. S., Rascado-Sedes, P., Pose-Reino, A., Valdes, L., Taboada-Muniz, M., Barbeito-Castineiras, G., Mena de Cea, A., Alemparte-Pardavila, E., Fernandez-Ferreiro, A., Study Group, S.
BMJ Open, 31.10.2024
Tilføjet 31.10.2024
IntroductionLinezolid is a broadly used antibiotic to treat complicated infections caused by gram-positive bacteria. Therapeutic drug monitoring of linezolid concentrations is recommended to maximise its efficacy and safety, mainly haematological toxicity. Different pharmacokinetic/pharmacodynamic targets have been proposed to improve linezolid exposure: the ratio of the area under the concentration–time curve during a 24-hour period to minimum inhibitory concentration (MIC) between 80 and 120; percentage of time that the drug concentration remains above the MIC during a dosing interval greater than 85% and the trough concentration between 2 and 7 mg/L. This clinical trial aims to evaluate the safety, efficacy and the clinical and economic utility of personalised dosing of linezolid using Bayesian forecasting methods to attain pharmacokinetic/pharmacodynamic targets, known as model-informed precision dosing. Methods and analysisThis is a pragmatic, multicentre, randomised, parallel, controlled, phase IV and low intervention trial. Participants will be randomly assigned 1:1 to each group (n=346 per group). Control group will receive the standard dose of linezolid. Intervention group will receive personalised dosage of linezolid based on pharmacokinetic–pharmacodynamic adjustments. The primary outcome will be the incidence of thrombocytopenia in both groups. Ethics and disseminationThis protocol was approved by the Ethical Committee of the Investigation with Medicines of Galicia (code 2022/140) and authorised by the Spanish Agency for Medicines and Medical Devices. The trial is implemented in accordance with the Declaration of Helsinki and the international ethical and scientific quality standard, the Good Clinical Practice. The results will be published in peer-reviewed journals. Trial registration numberEudraCT registration code: 2022-000144-30.
Læs mere Tjek på PubMedBMC Infectious Diseases, 30.10.2024
Tilføjet 30.10.2024
Abstract Background Information on the comparison of blood microbiota between human immunodeficiency virus (HIV)-infected and HIV-uninfected patients with suspected sepsis by metagenomic next-generation sequencing (mNGS) is limited. Methods Retrospectively analysis was conducted in HIV-infected and HIV-uninfected patients with suspected sepsis at Changsha First Hospital (China) from March 2019 to August 2022. Patients who underwent blood mNGS testing were enrolled. The blood microbiota detected by mNGS were analyzed. Results A total of 233 patients with suspected sepsis who performed blood mNGS were recruited in this study, including 79 HIV-infected and 154 HIV-uninfected patients. Compared with HIV-uninfected patients, the proportions of mycobacterium (p = 0.001), fungus (p
Læs mere Tjek på PubMedBMC Infectious Diseases, 29.10.2024
Tilføjet 29.10.2024
Abstract Background Information on the comparison of blood microbiota between human immunodeficiency virus (HIV)-infected and HIV-uninfected patients with suspected sepsis by metagenomic next-generation sequencing (mNGS) is limited. Methods Retrospectively analysis was conducted in HIV-infected and HIV-uninfected patients with suspected sepsis at Changsha First Hospital (China) from March 2019 to August 2022. Patients who underwent blood mNGS testing were enrolled. The blood microbiota detected by mNGS were analyzed. Results A total of 233 patients with suspected sepsis who performed blood mNGS were recruited in this study, including 79 HIV-infected and 154 HIV-uninfected patients. Compared with HIV-uninfected patients, the proportions of mycobacterium (p = 0.001), fungus (p
Læs mere Tjek på PubMedShah, Faraaz Ali; Talisa, Victor B.; Chang, Chung-Chou H.; Triantafyllou, Sofia; Tang, Lu; Mayr, Florian B.; Higgins, Alisa M.; Peake, Sandra L.; Mouncey, Paul; Harrison, David A; DeMerle, Kimberley M.; Kennedy, Jason N.; Cooper, Gregory F.; Bellomo, Rinaldo; Rowan, Kathy; Yealy, Donald M.; Seymour, Christopher W.; Angus, Derek C.; Yende, Sachin P.
Critical Care Medicine, 29.10.2024
Tilføjet 29.10.2024
Objectives: The optimal approach for resuscitation in septic shock remains unclear despite multiple randomized controlled trials (RCTs). Our objective was to investigate whether previously uncharacterized variation across individuals in their response to resuscitation strategies may contribute to conflicting average treatment effects in prior RCTs. Design: We randomly split study sites from the Australian Resuscitation of Sepsis Evaluation (ARISE) and Protocolized Care for Early Septic Shock (ProCESS) trials into derivation and validation cohorts. We trained machine learning models to predict individual absolute risk differences (iARDs) in 90-day mortality in derivation cohorts and tested for heterogeneity of treatment effect (HTE) in validation cohorts and swapped these cohorts in sensitivity analyses. We fit the best-performing model in a combined dataset to explore roles of patient characteristics and individual components of early goal-directed therapy (EGDT) to determine treatment responses. Setting: Eighty-one sites in Australia, New Zealand, Hong Kong, Finland, Republic of Ireland, and the United States. Patients: Adult patients presenting to the emergency department with severe sepsis or septic shock. Interventions: EGDT vs. usual care. Measurements and Main Results: A local-linear random forest model performed best in predicting iARDs. In the validation cohort, HTE was confirmed, evidenced by an interaction between iARD prediction and treatment (p < 0.001). When patients were grouped based on predicted iARDs, treatment response increased from the lowest to the highest quintiles (absolute risk difference [95% CI], –8% [–19% to 4%] and relative risk reduction, 1.34 [0.89–2.01] in quintile 1 suggesting harm from EGDT, and 12% [1–23%] and 0.64 [0.42–0.96] in quintile 5 suggesting benefit). Sensitivity analyses showed similar findings. Pre-intervention albumin contributed the most to HTE. Analyses of individual EGDT components were inconclusive. Conclusions: Treatment response to EGDT varied across patients in two multicenter RCTs with large benefits for some patients while others were harmed. Patient characteristics, including albumin, were most important in identifying HTE.
Læs mere Tjek på PubMedNazer, Lama H.; Awad, Wedad; Thawabieh, Hadeel; Abusara, Aseel; Abdelrahman, Deema; Addassi, Awad; Abuatta, Osama; Sughayer, Maher; Shehabi, Yahya
Critical Care Explorations, 25.10.2024
Tilføjet 25.10.2024
OBJECTIVES: To evaluate the effect of procalcitonin-guided management on the duration of antibiotic therapy in critically ill cancer patients with sepsis. DESIGN: Randomized, controlled, single-blinded trial. SETTING: A comprehensive multidisciplinary cancer hospital in Jordan. PATIENTS: Adults with cancer treated in the ICU who were started on antibiotics for suspected infection, met the SEPSIS-3 criteria, and were expected to stay in the ICU greater than or equal to 48 hours. INTERVENTIONS: Patients were randomized to the procalcitonin-guided or standard care (SC) arms. All patients had procalcitonin measured daily, up to 5 days or until ICU discharge or death. For the procalcitonin arm, a procalcitonin-guided algorithm was provided to guide antibiotic management, but clinicians were allowed to override the algorithm, if clinically indicated. In the SC arm, ICU clinicians were blinded to the procalcitonin levels. MEASUREMENTS AND MAIN RESULTS: Primary outcome was time to antibiotic cessation. We also evaluated the number of antibiotic-free days at 28 days, hospital discharge, or death, whichever came first, and antibiotic defined daily doses (DDDs). We enrolled 77 patients in the procalcitonin arm and 76 in the SC arm. Mean age was 58 ± 14 (sd) years, 67% were males, 74% had solid tumors, and 13% were neutropenic. Median (interquartile range [IQR]) Sequential Organ Failure Assessment scores were 7 (6–10) and 7 (5–9) and procalcitonin concentrations (ng/mL) at baseline were 3.4 (0.8–16) and 3.4 (0.5–26), in the procalcitonin and SC arms, respectively. There was no difference in the median (IQR) time to antibiotic cessation in the procalcitonin and SC arms, 8 (4–11) and 8 (5–13), respectively (p = 0.463). Median (IQR) number of antibiotic-free days were 20 (17–24) and 20 (16–23), (p = 0.484) and total DDDs were 1541.4 and 2050.4 in the procalcitonin and SC arms, respectively. CONCLUSIONS: In critically ill cancer patients with sepsis, procalcitonin-guided management did not reduce the duration of antibiotic treatment.
Læs mere Tjek på PubMedDeyi Zhao Miran Tang Zhexiao Ma Panjie Hu Qingxia Fu Zhuocheng Yao Cui Zhou Tieli Zhou Jianming Cao a School of Laboratory Medicine and Life Science, Wenzhou Medical University, Wenzhou, Chinab Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Chinac Key Laboratory of Clinical Laboratory Diagnosis and Translational Research of Zhejiang Province, Wenzhou, Zhejiang, China
Virulence, 21.10.2024
Tilføjet 21.10.2024
Garland, Allan; Li, Na; Sligl, Wendy; Lane, Alana; Thavorn, Kednapa; Wilcox, M. Elizabeth; Rochwerg, Bram; Keenan, Sean; Marrie, Thomas J.; Kumar, Anand; Curley, Emily; Ziegler, Jennifer; Dodek, Peter; Loubani, Osama; Gervais, Alain; Murthy, Srinivas; Neto, Gina; Prescott, Hallie C.; for the Sepsis Canada Network
Critical Care Medicine, 21.10.2024
Tilføjet 21.10.2024
Objectives: Refine the administrative data definition of sepsis in hospitalized patients, including less severe cases. Design and Setting: For each of 1928 infection and 108 organ dysfunction codes used in Canadian hospital abstracts, experts reached consensus on the likelihood that it could relate to sepsis. We developed a new algorithm, called AlgorithmL, that requires at least one infection and one organ dysfunction code adjudicated as likely or very likely to be related to sepsis. AlgorithmL was compared with four previously described algorithms, regarding included codes, population-based incidence, and hospital mortality rates—separately for ICU and non-ICU cohorts in a large Canadian city. We also compared sepsis identification from these code-based algorithms with the Centers for Disease Control’s Adult Sepsis Event (ASE) definition. Subjects: Among Calgary’s adult population of 1.033 million there were 61,632 eligible hospitalizations. Interventions: None. Measurements and Main Results: AlgorithmL includes 720 infection codes and 50 organ dysfunction codes. Comparison algorithms varied from 42–941 infection codes to 2–36 organ codes. There was substantial nonoverlap of codes in AlgorithmL vs. the comparators. Annual sepsis incidence rates (per 100,000 population) based on AlgorithmL were 91 in the ICU and 291 in the non-ICU cohort. Incidences based on comparators ranged from 28–77 for ICU to 11–266 for non-ICU cohorts. Hospital sepsis mortality rates based on AlgorithmL were 24% in ICU and 17% in non-ICU cohorts; based on comparators, they ranged 27–38% in the ICU cohort and 18–47% for the non-ICU cohort. Of AlgorithmL-identified cases, 41% met the ASE criteria, compared with 42–82% for the comparator algorithms. Conclusions: Compared with other code-based algorithms, AlgorithmL includes more infection and organ dysfunction codes. AlgorithmL incidence rates are higher; hospital mortality rates are lower. AlgorithmL may more fully encompass the full range of sepsis severity.
Læs mere Tjek på PubMedChalisa Pinitchun, Wimonrat Panpetch, Thansita Bhunyakarnjanarat, Kanyarat Udompornpitak, Huy Thanh Do, Peerapat Visitchanakun, Dhammika Leshan Wannigama, Suwasin Udomkarnjananun, Monruedee Sukprasansap, Tewin Tencomnao, Pattarin Tangtanatakul, Asada Leelahavanichkul
PLoS One Infectious Diseases, 19.10.2024
Tilføjet 19.10.2024
by Chalisa Pinitchun, Wimonrat Panpetch, Thansita Bhunyakarnjanarat, Kanyarat Udompornpitak, Huy Thanh Do, Peerapat Visitchanakun, Dhammika Leshan Wannigama, Suwasin Udomkarnjananun, Monruedee Sukprasansap, Tewin Tencomnao, Pattarin Tangtanatakul, Asada Leelahavanichkul Introduction Despite the well-established effects of aging on brain function and gut dysbiosis (an imbalance in gut microbiota), the influence of aging on sepsis-associated encephalopathy (SAE) and the role of probiotics in this context remain less understood. Methods C57BL/6J mice (8-week-old) were subcutaneously administered with 8 weeks of D-galactose (D-gal) or phosphate buffer solution (PBS) for aging and non-aging models, respectively, with or without 8 weeks of oral Lacticaseibacillus rhamnosus GG (LGG). Additionally, the impact of the condition media from LGG (LCM) was tested in macrophages (RAW 264.7 cells), microglia (BV-2 cells), and hippocampal cells (HT-22 cells). Result Fecal microbiome analysis demonstrated D-gal-induced dysbiosis (reduced Firmicutes and Desulfobacterota with increased Bacteroidota and Verrucomicrobiota), which LGG partially neutralized the dysbiosis. D-gal also worsens cecal ligation and puncture (CLP) sepsis severity when compared with PBS-CLP mice, as indicated by serum creatinine (Scr) and alanine transaminase (ALT), but not mortality, neurological characteristics (SHIRPA score), and serum cytokines (TNF-α and IL-6). Additionally, D-gal-induced aging was supported by fibrosis in the liver, kidney, and lung; however, CLP sepsis did not worsen fibrosis. Interestingly, LGG attenuated all parameters (mortality, Scr, ALT, SHIRPA, and cytokines) in non-aging sepsis (PBS-CLP) while improving all these parameters, except for mortality and serum IL-6, in aging sepsis (D-gal CLP). For the in vitro test using lipopolysaccharide (LPS) stimulation, LCM attenuated inflammation in some parameters on RAW264.7 cells but not BV-2 and HT-22 cells, implying a direct anti-inflammatory effect of LGG on macrophages, but not in cells from the brain. Conclusion D-gal induced fecal dysbiosis and worsened sepsis severity as determined by Scr and ALT, and LGG could alleviate most of the selected parameters of sepsis, including SAE. However, the impact of LGG on SAE was not a direct delivery of beneficial molecules from the gut to the brain but partly due to the attenuation of systemic inflammation through the modulation of macrophages.
Læs mere Tjek på PubMedGarcia, Bruno; Ter Schiphorst, Benoit; Su, Fuhong; Picod, Adrien; Ikenna-Uba, Theo; Favory, Raphaël; Annoni, Filippo; Mebazaa, Alexandre; Vincent, Jean-Louis; Creteur, Jacques; Taccone, Fabio S.; Herpain, Antoine
Critical Care Explorations, 17.10.2024
Tilføjet 17.10.2024
OBJECTIVES: To analyze dynamic changes in the renin-angiotensin system (RAS) during septic shock, focusing on angiotensin-converting enzyme (ACE) activity and the balance between angiotensin peptides, using a mass spectrometry method. DESIGN: Experimental septic shock model induced by peritonitis in swine. SETTING: Experimental Laboratory, Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles. SUBJECTS: Forty time points from eight mechanically ventilated pigs. INTERVENTIONS: Septic shock was induced using intraperitoneal instillation of autologous feces, followed by standardized fluid resuscitation, norepinephrine infusion, antibiotic administration, and peritoneal lavage. MEASUREMENTS AND MAIN RESULTS: The induction of sepsis resulted in a significant increase in plasma renin activity and levels of angiotensin I and II, with a significant decrease in ACE activity observed from 4 hours post-resuscitation and a notable rise in the angiotensin I/angiotensin II ratio at 12 hours. Additionally, a shift toward the angiotensin-(1–7) axis was observed, evidenced by an increased angiotensin-(1–7)/angiotensin II ratio. CONCLUSIONS: The study highlighted dynamic shifts in the RAS during septic shock, characterized by reduced circulating ACE activity, elevated angiotensin I/II ratio, and a shift toward the angiotensin-(1–7) axis. These findings suggest an adaptive response within the RAS, potentially offering new insights into sepsis management and therapeutic targets.
Læs mere Tjek på PubMedMathieu Marques, Marie Tezier, Maxime Tourret, Laure Cazenave, Clément Brun, Lam Nguyen Duong, Sylvie Cambon, Camille Pouliquen, Florence Ettori, Antoine Sannini, Frédéric Gonzalez, Magali Bisbal, Laurent Chow-Chine, Luca Servan, Jean Manuel de Guibert, Marion Faucher, Djamel Mokart
PLoS One Infectious Diseases, 16.10.2024
Tilføjet 16.10.2024
by Mathieu Marques, Marie Tezier, Maxime Tourret, Laure Cazenave, Clément Brun, Lam Nguyen Duong, Sylvie Cambon, Camille Pouliquen, Florence Ettori, Antoine Sannini, Frédéric Gonzalez, Magali Bisbal, Laurent Chow-Chine, Luca Servan, Jean Manuel de Guibert, Marion Faucher, Djamel Mokart Background Radical cystectomy (RC) is a major surgery associated with a high morbidity rate. Perioperative fluid management according to enhanced recovery after surgery (ERAS) protocols aims to maintain patients in an optimal euvolemic state while exposing them to acute kidney injury (AKI) in the event of hypovolemia. Postoperative AKI is associated with severe morbidity and mortality. Our main objective was to determine the association between perioperative variables, including some component of ERAS protocols, and occurrence of postoperative AKI within the first 30 days following RC in patients presenting bladder cancer. Our secondary objective was to evaluate the association between a postoperative AKI and the occurrence or worsening of a chronic kidney disease (CKD) within the 2 years following RC. Methods We conducted a retrospective observational study in a referral cancer center in France on 122 patients who underwent an elective RC for bladder cancer from 01/02/2015 to 30/09/2019. The primary endpoint was occurrence of AKI between surgery and day 30. The secondary endpoint was survival without occurrence or worsening of a postoperative CKD. AKI and CKD were defined by KDIGO (Kidney Disease: Improving Global Outcomes) classification. Logistic regression analyse was used to determine independent factors associated with postoperative AKI. Fine and Gray model was used to determine independent factors associated with postoperative CKD. Results The incidence of postoperative AKI was 58,2% (n = 71). Multivariate analysis showed 5 factors independently associated with postoperative AKI: intraoperative restrictive vascular filling < 5ml/kg/h (OR = 4.39, 95%CI (1.05–18.39), p = 0.043), postoperative sepsis (OR = 4.61, 95%CI (1.05–20.28), p = 0.043), female sex (OR = 0.11, 95%CI (0.02–0.73), p = 0.022), score SOFA (Sequential Organ Failure Assessment) at day 1 (OR = 2.19, 95%CI (1.15–4.19), p = 0.018) and delta serum creatinine D1 (OR = 1.06, 95%CI (1.02–1.11), p = 0.006). During the entire follow-up, occurrence or worsening of CKD was diagnosed in 36 (29.5%). A postoperative, AKI was strongly associated with occurrence or worsening of a CKD within the 2 years following RC even after adjustment for confounding factors (sHR = 2.247, 95%CI [1.051–4.806, p = 0.037]). Conclusion A restrictive intraoperative vascular filling < 5ml/kg/h was strongly and independently associated with the occurrence of postoperative AKI after RC in cancer bladder patients. In this context, postoperative AKI was strongly associated with the occurrence or worsening of CKD within the 2 years following RC. A personalized perioperative fluid management strategy needs to be evaluated in these high-risk patients.
Læs mere Tjek på PubMedBMC Infectious Diseases, 11.10.2024
Tilføjet 11.10.2024
Abstract Background The impact of liver fibrosis on the clinical outcomes of patients with sepsis-induced coagulopathy (SIC) is not well understood. This study aimed to evaluate the association between liver fibrosis scores and in-hospital mortality in SIC patients. Methods In this retrospective observational cohort study, data were collected from patients diagnosed with sepsis and admitted to the ICU at the First Affiliated Hospital of Wenzhou Medical University between January 2017 and December 2023. Liver fibrosis was evaluated using three scores: Fibrosis-4 (Fib-4), Aspartate Aminotransferase–to–Platelet Ratio Index (APRI), and Nonalcoholic Fatty Liver Disease Fibrosis Score (NFS). Patients were divided into tertiles according to their liver fibrosis scores, and the primary outcome was in-hospital mortality. Multivariable logistic regression and restricted cubic spline regression analyses were used to assess associations, complemented by sensitivity analyses through subgroup evaluations. Results The cohort included 948 patients diagnosed with SIC with an in-hospital mortality of 26.16%. Multivariate logistic regression analysis revealed a significant association between higher liver fibrosis scores and increased in-hospital mortality. Specifically, patients in the highest tertile of Fib-4, APRI, and NFS scores had significantly higher odds of mortality (FIB-4: OR 3.62, 95% CI 1.03–12.69; APRI: OR 2.16, 95% CI 0.88–5.30; NFS: OR 6.80, 95% CI 2.11–21.93) compared to those in the lowest tertile. The restricted cubic spline regression model showed a linear increase in the risk of in-hospital mortality with increasing liver fibrosis score. Sensitivity analysis confirmed the consistency and stability of the results across the different subgroups. Conclusion Our study suggests that elevated liver fibrosis scores, particularly Fib-4 and NFS, are associated with higher in-hospital mortality in SIC patients. Further research, especially larger prospective studies, are needed to validate these findings.
Læs mere Tjek på PubMedMurray, Brian; Athale, Janhavi; Balk, Robert A.; Behal, Michael L.; Brown, Judah E.; Chanas, Tyler; Dumitru, Roxana; Gifford, Dalton C.; Hohlfelder, Benjamin; Jones, Honey M.; Makic, Mary Beth F.; Rausen, Michelle S.; Sacco, Alicia J.; Sines, Benjamin J.; Gurnani, Payal K.
Critical Care Explorations, 10.10.2024
Tilføjet 10.10.2024
OBJECTIVES: We aimed to summarize the most significant and impactful publications describing the pharmacotherapeutic care of critically ill patients in 2023. DATA SOURCES: PubMed/MEDLINE and the Clinical Pharmacy and Pharmacology Pharmacotherapy Literature Update. STUDY SELECTION: Randomized controlled trials and prospective studies of adult critically ill patients assessing a pharmacotherapeutic intervention and reporting clinical endpoints published between January 1, 2023, and December 31, 2023, were eligible for inclusion in this article. DATA EXTRACTION: Articles from a systematic search and the Clinical Pharmacy and Pharmacology Pharmacotherapy Literature Update were included. An a priori defined three-round modified Delphi process was employed to achieve consensus on the most impactful publications based on the following considerations: 1) overall contribution to scientific knowledge and 2) novelty to the literature. DATA SYNTHESIS: The systematic search and Clinical Pharmacy and Pharmacology Pharmacotherapy Literature Update returned a total of 1202 articles, of which 1164 were excluded. The remaining 38 articles underwent a three-round modified Delphi process. In each round, articles were independently scored based on overall contribution to scientific knowledge and novelty to the literature. Included articles are summarized and their impact discussed. Article topics included hydrocortisone for severe community-acquired pneumonia, inhaled amikacin for prevention of ventilator-associated pneumonia, methylene blue for septic shock, restrictive vs. liberal fluid management for sepsis-induced hypotension, andexanet alfa for major bleeding associated with factor Xa inhibitors, and early administration of four-factor prothrombin complex concentrate in patients with trauma at risk for massive transfusion. CONCLUSIONS: This review provides a summary and perspective on the potential impact of the most relevant articles in 2023 describing advances in the pharmacotherapeutic care of critically ill patients.
Læs mere Tjek på PubMedInfection, 9.10.2024
Tilføjet 9.10.2024
Abstract Cefiderocol is a new siderophore-beta-lactam antibiotic used for the treatment of severe multidrug-resistant infections like sepsis, hospital-acquired and ventilator-associated pneumonia in adults, but there are only single reports on its use in the neonatal population. We describe the successful cefiderocol treatment of a newborn with pneumogenic sepsis due to Stenotrophomonas maltophilia.
Læs mere Tjek på PubMedInfection, 8.10.2024
Tilføjet 8.10.2024
Abstract Cefiderocol is a new siderophore-beta-lactam antibiotic used for the treatment of severe multidrug-resistant infections like sepsis, hospital-acquired and ventilator-associated pneumonia in adults, but there are only single reports on its use in the neonatal population. We describe the successful cefiderocol treatment of a newborn with pneumogenic sepsis due to Stenotrophomonas maltophilia.
Læs mere Tjek på PubMedBMC Infectious Diseases, 8.10.2024
Tilføjet 8.10.2024
Abstract Background & objective The Infectious Disease Society of America guidelines recommend vancomycin trough levels of 15–20 mg/L for severe methicillin-resistant Staphylococcus aureus. However, recent consensus guidelines of four infectious disease organizations no longer recommend vancomycin dosing using minimum serum trough concentrations. Therefore, this study aimed to evaluate the impact of low (
Læs mere Tjek på PubMedBMC Infectious Diseases, 3.10.2024
Tilføjet 3.10.2024
Abstract Background The relationship between the dynamic changes in insulin resistance (IR) and the prognosis of septic patients remains unclear. This study aims to investigate the correlation between the clinical subphenotype of IR represented by the triglyceride-glucose (TyG) index trajectory and the mortality rate among patients with sepsis. Methods In this retrospective cohort study, we utilized data from septic patients within the Medical Information Mart for Intensive Care (MIMIC)-IV database version 2.0 to construct trajectories of the TyG index over 72 h. Subsequently, we computed the similarity among various TyG index trajectories with the dynamic time warping (DTW) algorithm and utilized the hierarchical clustering (HC) algorithm to demarcate distinct cluster and identified subphenotypes according to the trajectory trend. Subsequently, we assessed the mortality risk between different subphenotypes using analyses such as survival analysis and validated the robustness of the results through propensity score matching (PSM) and various models. Results A total of 2350 patients were included in the study. Two trajectory trends: TyG index decreasing (n = 926) and TyG index increasing (n = 1424) were identified, which indicated corresponding to the clinical subphenotype of increased and alleviative IR respectively. The 28-day and in-hospital mortality for the increased IR group was 28.51% and 25.49% respectively. In comparison, patients in the alleviative IR group with a 28-day mortality of 23.54% and an in-hospital mortality of 21.60%. These subphenotypes exhibited distinct prognosis, time dependent Cox model showed the increased IR group with a higher 28-day mortality [hazard ratio (HR): 1.07, 95% confidence interval (CI): 1.02–1.12, P = 0.01] and in-hospital mortality [HR: 1.05, 95% CI: 1.00–1.11, P = 0.045] compared to the alleviative IR group. Sensitivity analyses with various models further validated the robustness of our findings. Conclusion Dynamic increase in the TyG index trajectory is associated with elevated mortality risk among patients with sepsis, which suggests that dynamic increased IR exacerbates the risk of poor outcomes in patients.
Læs mere Tjek på PubMedBMC Infectious Diseases, 3.10.2024
Tilføjet 3.10.2024
Abstract Background Heart rate is crucial for patients with septic shock, but there are few studies on the scope of heart rate. Therefore, we studied the relationship between different heart rates and mortality of critically ill patients with septic shock, and explored the optimal heart rate range, in order to provide new insights for clinical treatment of septic shock. Methods This retrospective study utilized time-series heart rate data from the Medical Information Mart for Intensive Care (MIMIC) IV database. Patients with septic shock were identified as the Sepsis 3.0 criteria and received vasopressor therapy in the first 24 h since ICU admission. We calculated the time-weighted average heart rate (TWA-HR) based on the time-series data. The restricted cubic spline (RCS) analysis was employed to investigate the nonlinear relationship between heart rate and 28-day mortality, aiming to explore the optimal heart rate control target for septic patients and using this target as the exposure factor. The primary outcome was 28-day mortality, and the secondary outcome were ICU and in-hospital mortality. For the original cohort, we applied the log-rank test to infer the relationship between heart rate and mortality. To control for bias introduced by confounders, we utilized propensity score matching (PSM) to reduce imbalances between normal TWA-HR and high TWA-HR groups, and we established a series of models [the multivariable Cox model, matching weight (MW)-adjusted Cox model, multivariable logistic regression, MW-adjusted logistic regression, and doubly robust model] as sensitivity analyses and subgroup analyses to demonstrate the robustness of our findings. Results A total of 13492 patients were included in our study. The RCS analysis based on Cox and logistic regression showed increased risk of mortality (P
Læs mere Tjek på PubMedBMC Infectious Diseases, 2.10.2024
Tilføjet 2.10.2024
Abstract Background The relationship between the dynamic changes in insulin resistance (IR) and the prognosis of septic patients remains unclear. This study aims to investigate the correlation between the clinical subphenotype of IR represented by the triglyceride-glucose (TyG) index trajectory and the mortality rate among patients with sepsis. Methods In this retrospective cohort study, we utilized data from septic patients within the Medical Information Mart for Intensive Care (MIMIC)-IV database version 2.0 to construct trajectories of the TyG index over 72 h. Subsequently, we computed the similarity among various TyG index trajectories with the dynamic time warping (DTW) algorithm and utilized the hierarchical clustering (HC) algorithm to demarcate distinct cluster and identified subphenotypes according to the trajectory trend. Subsequently, we assessed the mortality risk between different subphenotypes using analyses such as survival analysis and validated the robustness of the results through propensity score matching (PSM) and various models. Results A total of 2350 patients were included in the study. Two trajectory trends: TyG index decreasing (n = 926) and TyG index increasing (n = 1424) were identified, which indicated corresponding to the clinical subphenotype of increased and alleviative IR respectively. The 28-day and in-hospital mortality for the increased IR group was 28.51% and 25.49% respectively. In comparison, patients in the alleviative IR group with a 28-day mortality of 23.54% and an in-hospital mortality of 21.60%. These subphenotypes exhibited distinct prognosis, time dependent Cox model showed the increased IR group with a higher 28-day mortality [hazard ratio (HR): 1.07, 95% confidence interval (CI): 1.02–1.12, P = 0.01] and in-hospital mortality [HR: 1.05, 95% CI: 1.00–1.11, P = 0.045] compared to the alleviative IR group. Sensitivity analyses with various models further validated the robustness of our findings. Conclusion Dynamic increase in the TyG index trajectory is associated with elevated mortality risk among patients with sepsis, which suggests that dynamic increased IR exacerbates the risk of poor outcomes in patients.
Læs mere Tjek på PubMedBMC Infectious Diseases, 2.10.2024
Tilføjet 2.10.2024
Abstract Background Heart rate is crucial for patients with septic shock, but there are few studies on the scope of heart rate. Therefore, we studied the relationship between different heart rates and mortality of critically ill patients with septic shock, and explored the optimal heart rate range, in order to provide new insights for clinical treatment of septic shock. Methods This retrospective study utilized time-series heart rate data from the Medical Information Mart for Intensive Care (MIMIC) IV database. Patients with septic shock were identified as the Sepsis 3.0 criteria and received vasopressor therapy in the first 24 h since ICU admission. We calculated the time-weighted average heart rate (TWA-HR) based on the time-series data. The restricted cubic spline (RCS) analysis was employed to investigate the nonlinear relationship between heart rate and 28-day mortality, aiming to explore the optimal heart rate control target for septic patients and using this target as the exposure factor. The primary outcome was 28-day mortality, and the secondary outcome were ICU and in-hospital mortality. For the original cohort, we applied the log-rank test to infer the relationship between heart rate and mortality. To control for bias introduced by confounders, we utilized propensity score matching (PSM) to reduce imbalances between normal TWA-HR and high TWA-HR groups, and we established a series of models [the multivariable Cox model, matching weight (MW)-adjusted Cox model, multivariable logistic regression, MW-adjusted logistic regression, and doubly robust model] as sensitivity analyses and subgroup analyses to demonstrate the robustness of our findings. Results A total of 13492 patients were included in our study. The RCS analysis based on Cox and logistic regression showed increased risk of mortality (P
Læs mere Tjek på PubMedChurpek, Matthew M.; Ingebritsen, Ryan; Carey, Kyle A.; Rao, Saieesh A.; Murnin, Emily; Qyli, Tonela; Oguss, Madeline K.; Picart, Jamila; Penumalee, Leena; Follman, Benjamin D.; Nezirova, Lily K.; Tully, Sean T.; Benjamin, Charis; Nye, Christopher; Gilbert, Emily R.; Shah, Nirav S.; Winslow, Christopher J.; Afshar, Majid; Edelson, Dana P.
Critical Care Explorations, 2.10.2024
Tilføjet 2.10.2024
IMPORTANCE: Timely intervention for clinically deteriorating ward patients requires that care teams accurately diagnose and treat their underlying medical conditions. However, the most common diagnoses leading to deterioration and the relevant therapies provided are poorly characterized. OBJECTIVES: We aimed to determine the diagnoses responsible for clinical deterioration, the relevant diagnostic tests ordered, and the treatments administered among high-risk ward patients using manual chart review. DESIGN, SETTING, AND PARTICIPANTS: This was a multicenter retrospective observational study in inpatient medical-surgical wards at four health systems from 2006 to 2020. Randomly selected patients (1000 from each health system) with clinical deterioration, defined by reaching the 95th percentile of a validated early warning score, electronic Cardiac Arrest Risk Triage, were included. MAIN OUTCOMES AND MEASURES: Clinical deterioration was confirmed by a trained reviewer or marked as a false alarm if no deterioration occurred for each patient. For true deterioration events, the condition causing deterioration, relevant diagnostic tests ordered, and treatments provided were collected. RESULTS: Of the 4000 included patients, 2484 (62%) had clinical deterioration confirmed by chart review. Sepsis was the most common cause of deterioration (41%; n = 1021), followed by arrhythmia (19%; n = 473), while liver failure had the highest in-hospital mortality (41%). The most common diagnostic tests ordered were complete blood counts (47% of events), followed by chest radiographs (42%) and cultures (40%), while the most common medication orders were antimicrobials (46%), followed by fluid boluses (34%) and antiarrhythmics (19%). CONCLUSIONS AND RELEVANCE: We found that sepsis was the most common cause of deterioration, while liver failure had the highest mortality. Complete blood counts and chest radiographs were the most common diagnostic tests ordered, and antimicrobials and fluid boluses were the most common medication interventions. These results provide important insights for clinical decision-making at the bedside, training of rapid response teams, and the development of institutional treatment pathways for clinical deterioration.
Læs mere Tjek på PubMedChu-Yun Liu, Yu-Shen Yang, Meng-Qin Pei, He-fan He
PLoS One Infectious Diseases, 1.10.2024
Tilføjet 1.10.2024
by Chu-Yun Liu, Yu-Shen Yang, Meng-Qin Pei, He-fan He The objective of this study was to explore the potential causalities of fat mass, nonfat mass and height (henceforth, ‘anthropometric measures’) with sepsis risk and mortality. We conducted the Mendelian randomization (MR) investigation using genome-wide association study (GWAS) summary statistics of anthropometric measures, sepsis, and sepsis mortality. The GWAS summary data from the UK Biobank was used. Firstly, MR analysis was performed to estimate the causal effect of anthropometric measures on the risk of sepsis. The inverse-variance weighted (IVW) method was utilized as the primary analytical approach, together with weighted median-based method. Cochrane’s Q test and MR-Egger intercept test were performed to assess heterogeneity and pleiotropy, respectively. Finally, we performed a series of sensitivity analyses to enhance the precision and veracity of our findings. The IVW method showed that genetically predicted weight-related measures were suggestively linked to an increased risk of sepsis. However, height displayed no causal association with sepsis risk and mortality. Furthermore, weight-related measures also displayed significant MR association with the sepsis mortality, except body nonfat mass and right leg nonfat mass. However, MVMR analysis indicated the observed effects for weight-related measures in the univariable MR analyses are more likely a bias caused by the interrelationship between anthropometric measures. According to the MR-Egger intercept assessment, our MR examination was not influenced by horizontal pleiotropy (all p>0.05). Moreover, the reliability of the estimated causal association was confirmed by the sensitivity analyses. In conclusion, these findings provided vital new knowledge on the role of anthropometric-related measures in the sepsis etiology.
Læs mere Tjek på PubMedPer Venge, Christer Peterson, Shengyuan Xu, Anders Larsson, Joakim Johansson, Jonas Tydén
PLoS One Infectious Diseases, 27.09.2024
Tilføjet 27.09.2024
by Per Venge, Christer Peterson, Shengyuan Xu, Anders Larsson, Joakim Johansson, Jonas Tydén Introduction Sepsis is a growing problem worldwide and associated with high mortality and morbidity. The early and accurate diagnosis and effective supportive therapy are critical for combating mortality. The aim of the study was to compare the kinetics of four biomarkers in plasma in patients admitted to ICU including sepsis and during antibiotics treatment. Methods The biomarkers evaluated were HBP (Heparin-binding protein), HNL Dimer (Human Neutrophil Lipocalin), HNL Total and PCT (Procalcitonin). Plasma was obtained at admission to ICU and during follow-up at days 2 and 3. Antibiotic treatment was started or reviewed on admission to ICU. The results were compared to SOFA and KDIGO-scores and to survival. 277 patients admitted to ICU were included of which 30% had sepsis. The other groups were categorized as miscellaneous, other medical and trauma. Results The plasma concentrations of all four biomarkers were highly elevated with the highest concentrations in sepsis patients. During the follow-up period HNL Dimer decreased already day 2 and further so day 3 (p
Læs mere Tjek på PubMedDaniel Kühn, Natalie Heinen, Kathrin Sutter, Simon T. Herrmann, Maximilian K. Nocke, Daniel Todt, Peter D. Burbelo, Eike Steinmann, Dominik Ziehe, Björn Koos, Michael Adamzik, Christian Putensen, Alexander Zarbock, Ute Gravemann, Christine Jork, Stephanie Pfaender, SepsisDataNet.NRW and CovidDataNet.NRW research group
Journal of Medical Virology, 26.09.2024
Tilføjet 26.09.2024
Hakkarainen, T., Lahelma, M., Rahkonen, T., Lehtinen, V., Shepelev, J., Gram, T., Heikkila, E.
BMJ Open, 25.09.2024
Tilføjet 25.09.2024
ObjectiveThis study compared the costs and nursing time associated with the delivery of continuous infusion of antibiotics via elastomeric infusion pumps (EIP) versus conventional intermittent infusion (CII) across different care pathways. DesignRetrospective real-world data informed a cost comparison analysis that compared costs and nursing hours between infusion of antibiotics via EIP versus CII across eight care pathways in inpatient or outpatient care during infection episodes. Real-world data were obtained from patients treated within a year with parenteral antimicrobial therapy in Päijät-Häme Region, Finland. SettingInpatient care with hospital admission and outpatient care at hospital at home in Päijät-Häme Region in Finland. Participants3778 patients with a total of 4214 infection episodes treated with intravenous antimicrobial therapy. InterventionsEight treatment strategies with various combinations of EIP and CII administered in inpatient or outpatient care. Primary and secondary outcome measuresDirect costs and nursing time. ResultsSkin and soft tissue infections accounted for the highest number of episodes treated with EIP overall (30.8%; 74 out of 240 episodes) and in outpatient care specifically (53.3%; 128 out of 240 episodes). Compared with inpatient care costs with CII (4590 per episode), treating skin and soft tissue infections in outpatient care with EIP or CII incurred only 24% (1104) and 35% (1620) of the costs, respectively. Across all treatment strategies and infections studied, the use of EIP consistently required less nursing time. The highest nursing time in the outpatient care was observed in sepsis episodes treated with CII (37 hours with CII vs 7 hours with EIP per episode). ConclusionDelivery of antimicrobial therapy using continuous infusions with EIP instead of CII can significantly decrease the nursing time and cost in both inpatient and outpatient care. For skin and soft tissue infections and sepsis, the utilisation of EIP is a cost-saving option in outpatient care compared with the use of CII.
Læs mere Tjek på PubMedCarlton, Erin F.; Rahman, Moshiur; Maddux, Aline B.; Weiss, Scott L.; Prescott, Hallie C.
Critical Care Medicine, 20.09.2024
Tilføjet 20.09.2024
Objectives: To determine the frequency of and risk factors for increased post-sepsis healthcare utilization compared with pre-sepsis healthcare utilization. Design: Retrospective observational cohort study. Setting: Years 2016–2019 MarketScan Commercial and Medicaid Database. Patients: Children (0–18 yr) with sepsis treated in a U.S. hospital. Interventions: None. Measurements and Main Results: We measured the frequency of and risk factors for increased healthcare utilization in the 90 days post- vs. pre-sepsis hospitalization. We defined increased healthcare utilization as an increase of at least 3 days in the 90 days post-hospitalization compared with the 90 days pre-hospitalization based on outpatient, emergency department, and inpatient hospitalization. We identified 2801 patients hospitalized for sepsis, of whom 865 (30.9%) had increased healthcare utilization post-sepsis, with a median (interquartile range [IQR]) of 3 days (1–6 d) total in the 90 days pre-sepsis and 10 days (IQR, 6–21 d) total in the 90 days post-sepsis (p < 0.001). In multivariable models, the odds of increased healthcare use were higher for children with longer lengths of hospitalization (> 30 d adjusted odds ratio [aOR], 4.35; 95% CI, 2.99-6.32) and children with preexisting complex chronic conditions, specifically renal (aOR, 1.47; 95% CI, 1.02–2.12), hematologic/immunologic (aOR, 1.34; 95% CI, 1.03–1.74), metabolic (aOR, 1.39; 95% CI, 1.08–1.79), and malignancy (aOR, 1.89; 95% CI, 1.38–2.59). Conclusions: In this nationally representative cohort of children who survived sepsis hospitalization in the United States, nearly one in three had increased healthcare utilization in the 90 days after discharge. Children with hospitalizations longer than 30 days and complex chronic conditions were more likely to experience increased healthcare utilization.
Læs mere Tjek på PubMedPak, Theodore R.; Sánchez, Sarimer M.; McKenna, Caroline S.; Rhee, Chanu; Klompas, Michael
Critical Care Medicine, 20.09.2024
Tilføjet 20.09.2024
Objectives: To characterize associations between race/ethnicity/sex, time-to-antibiotics, and mortality in patients with suspected sepsis or septic shock. Design: Retrospective cohort study, with race/ethnicity/sex as the exposure, and time-to-antibiotics (relative to emergency department arrival) and in-hospital mortality as the outcome. Setting: Five Massachusetts hospitals. Patients: Forty-nine thousand six hundred nine adults admitted 2015–2022 with suspected sepsis or septic shock (blood cultures drawn and IV antibiotics administered within 24 hr of arrival, plus evidence of organ dysfunction for sepsis, and hypotension or lactate ≥ 4.0 mmol/L for septic shock). Interventions: None. Measurements and Main Results: Among included patients, 22,598 (46%) were women, 36,626 (75%) were White, and 4,483 (9.2%) were Black. Women had longer median time-to-antibiotics than men when presenting with either suspected sepsis (203 vs. 190 min) or septic shock (160 vs. 142 min). Differences in time-to-antibiotics for women vs. men persisted after adjusting for age, race, comorbidities, source of infection, and severity of illness (adjusted odds ratio [aOR] for 3–6 vs. < 3 hr; 1.16 [95% CI, 1.07–1.25] for sepsis and aOR, 1.09 [95% CI, 1.01–1.18] for septic shock). Median time-to-antibiotics was also longer for Black vs. White patients for both sepsis (215 vs. 194 min; aOR for 3–6 vs. < 3 hr; 1.24 [95% CI, 1.06–1.45]) and septic shock (median 159 vs. 148 min; aOR, 1.32 [95% CI, 1.12–1.55]). There was no association between race/ethnicity/sex and in-hospital mortality for sepsis without shock; however, women with septic shock had higher mortality (aOR, 1.16; 95% CI, 1.04–1.29) vs. men. Higher mortality for women with septic shock persisted when also adjusting for time-to-antibiotics (aOR, 1.16; 95% CI, 1.03–1.32). Conclusions: In a large cohort of patients with sepsis, time-to-antibiotics was longer for both women and Black patients even after detailed risk-adjustment. Women with septic shock had higher adjusted in-hospital mortality than men, but this association was not moderated by time-to-antibiotics.
Læs mere Tjek på PubMedMotazedian, Pouya; Beauregard, Nickolas; Letourneau, Isabelle; Olaye, Ida; Syed, Sarah; Lam, Eric; Di Santo, Pietro; Mathew, Rebecca; Clark, Edward G.; Sood, Manish M.; Lalu, Manoj M.; Hibbert, Benjamin; Bugeja, Ann
Critical Care Medicine, 20.09.2024
Tilføjet 20.09.2024
Objectives: The objectives of our systematic review and meta-analyses were to determine the diagnostic accuracy of central venous oxygen saturation (Scvo2) in estimating mixed venous oxygen saturation (Svo2) and cardiac index in critically ill patients. Data Sources: A systematic search using MEDLINE, Cochrane Central Register of Controlled Trials, and Embase was completed on May 6, 2024. Study Selection: Studies of patients in the ICU for whom Scvo2 and at least one reference standard test was performed (thermodilution and/or Svo2) were included. Data Extraction: Individual patient data were used to calculate the pooled intraclass correlation coefficient (ICC) for Svo2 and Spearman correlation for cardiac index. The Quality Assessment of Diagnostic Accuracy Studies-2 and Grading Recommendations Assessment, Development, and Evaluation tools were used for the risk of bias and certainty of evidence assessments. Data Synthesis: Of 3427 studies, a total of 18 studies with 1971 patients were identified. We meta-analyzed 16 studies (1335 patients) that used Svo2 as a reference and three studies (166 patients) that used thermodilution as reference. The ICC for reference Svo2 was 0.83 (95% CI, 0.75–0.89) with a mean difference of 2.98% toward Scvo2. The Spearman rank correlation for reference cardiac index is 0.47 (95% CI, 0.46–0.48; p < 0.0001). Conclusions: There is moderate reliability for Scvo2 in predicting Svo2 in critical care patients with variability based on sampling site and presence of sepsis. There is limited evidence on the independent use of Scvo2 in predicting cardiac index.
Læs mere Tjek på PubMedStanski, Natalja L.; Gist, Katja M.; Hasson, Denise; Stenson, Erin K.; Seo, JangDong; Ollberding, Nicholas J.; Muff-Luett, Melissa; Cortina, Gerard; Alobaidi, Rashid; See, Emily; Kaddourah, Ahmad; Fuhrman, Dana Y.; on behalf of the Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK) Investigators
Critical Care Medicine, 20.09.2024
Tilføjet 20.09.2024
Objectives: Pediatric sepsis-associated acute kidney injury (AKI) often requires continuous renal replacement therapy (CRRT), but limited data exist regarding patient characteristics and outcomes. We aimed to describe these features, including the impact of possible dialytrauma (i.e., vasoactive requirement, negative fluid balance) on outcomes, and contrast them to nonseptic patients in an international cohort of children and young adults receiving CRRT. Design: A secondary analysis of Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK), an international, multicenter, retrospective study. Setting: Neonatal, cardiac and PICUs at 34 centers in nine countries from January 1, 2015, to December 31, 2021. Patients: Patients 0–25 years old requiring CRRT for AKI and/or fluid overload. Interventions: None. Measurements and Main Results: Among 1016 patients, 446 (44%) had sepsis at CRRT initiation and 650 (64%) experienced Major Adverse Kidney Events at 90 days (MAKE-90) (defined as a composite of death, renal replacement therapy [RRT] dependence, or > 25% decline in estimated glomerular filtration rate from baseline at 90 d from CRRT initiation). Septic patients were less likely to liberate from CRRT by 28 days (30% vs. 38%; p < 0.001) and had higher rates of MAKE-90 (70% vs. 61%; p = 0.002) and higher mortality (47% vs. 31%; p < 0.001) than nonseptic patients; however, septic survivors were less likely to be RRT dependent at 90 days (10% vs. 18%; p = 0.011). On multivariable regression, pre-CRRT vasoactive requirement, time to negative fluid balance, and median daily fluid balance over the first week of CRRT were not associated with MAKE-90; however, increasing duration of vasoactive requirement was independently associated with increased odds of MAKE-90 (adjusted OR [aOR], 1.16; 95% CI, 1.05–1.28) and mortality (aOR, 1.20; 95% CI, 1.1–1.32) for each additional day of support. Conclusions: Septic children requiring CRRT have different clinical characteristics and outcomes compared with those without sepsis, including higher rates of mortality and MAKE-90. Increasing duration of vasoactive support during the first week of CRRT, a surrogate of potential dialytrauma, appears to be associated with these outcomes.
Læs mere Tjek på PubMedBMC Infectious Diseases, 19.09.2024
Tilføjet 19.09.2024
Abstract Purpose The prevalence of biliary tract diseases, which are common gastrointestinal disorders, is steadily rising. If it progresses to sepsis or septic shock, it can endanger the patient\'s life. Therefore, it is crucial to promptly diagnose bacterial infection in individuals suffering from biliary diseases and comprehend the risk factors associated with infection. The objective of this study was to examine the types of bacteria present in the bile of patients with biliary tract diseases, assess any alterations in their susceptibility to antimicrobial agents, and identify the risk factors contributing to the development of infection in these patients. Patients and methods From June 2019 to November 2022, 317 patients of biliary tract diseases with positive bile culture were included in this hospital-based descriptive analysis. The hospital\'s computerized medical records were used to collect data on demographic information (including gender, age, and occupation), laboratory, and clinical findings, physical examination results, comorbidities, basic diseases, treatment history, complications, and in-hospital outcomes. The study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) principles. Results Of the 317 patients with positive biliary tract diseases, 247 had benign diseases and 70 had malignant diseases. Patients with benign disease experienced a higher prevalence of statistically significant symptoms such as abdominal pain (81.4% vs. 57.1%, P = 0.000), nausea (31.2% vs. 14.3%, P = 0.005), vomiting (30.0% vs. 12.9%, P = 0.004), and chills (10.9% vs. 2.9%, P = 0.039), while jaundice (12.6% vs. 37.1%, P = 0.000) was more common in patients with malignant disease. At the species level, Escherichia coli (105; 40.5%), Klebsiella pneumoniae (41; 15.8%), and Pseudomonas aeruginosa (30; 11.6%) were the most commonly found Gram-negative bacterial strains in biliary tract infection. Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa were most susceptible to tigecycline, ertapenem and ceftazidime/avibactam, respectively. Conclusion Gram-negative bacteria are the most commonly isolated biliary bacteria. Clinical doctors should pay attention to patients with malignant diseases with low hemoglobin, high total bilirubin and high alkaline phosphatase. Carbapenems, tigecycline, and minocycline are the recommended antibiotics for Enterobacteriaceae. In recent years, the proportion of enterococcus has gradually increased, and clinical attention should be paid to enterococcus infection. Linezolid and vancomycin were recommended for the treatment of Enterococci infections. Overall, this work can provide reference for clinical diagnosis, treatment and effective interventions.
Læs mere Tjek på PubMedDaniel Geleta, Gemeda Abebe, Tsion Tilahun, Didimos Gezahegn, Netsanet Workneh, Getenet Beyene
PLoS One Infectious Diseases, 17.09.2024
Tilføjet 17.09.2024
by Daniel Geleta, Gemeda Abebe, Tsion Tilahun, Didimos Gezahegn, Netsanet Workneh, Getenet Beyene Background Epidemiological profiles and the rundown crisis of antimicrobial resistance from bacterial isolates in neonatal sepsis compel regular surveillance to enhance data-driven decision-making. Accordingly, this study aimed to assess the phenotypic epidemiology and antimicrobial resistance profiles of bacteria isolated from clinically suspected neonatal sepsis in Ethiopia. Methods A total of 342 neonates suspected of clinical sepsis were randomly included in a prospective observational study conducted at the neonatal intensive care unit (NICU) of Jimma medical center (JMC) from May 2022 to July 2023. Blood samples were collected from each neonate and subjected to a culture test for identification of bacterial isolates and their antibiotic resistance profiles following the standardized guidelines. The laboratory results, along with relevant clinical data, were recorded using WHONET and analyzed using STATA software. Results Out of the 342 blood samples that were analyzed, 138 samples (40.4%, 95% CI: 35.1–45.6, P
Læs mere Tjek på PubMedKarakike, Eleni; Metallidis, Simeon; Poulakou, Garyfallia; Kosmidou, Maria; Gatselis, Nikolaos K.; Petrakis, Vasileios; Rovina, Nikoletta; Gkeka, Eleni; Sympardi, Styliani; Papanikolaou, Ilias; Koutsodimitropoulos, Ioannis; Tzavara, Vasiliki; Adamis, Georgios; Tsiakos, Konstantinos; Koulouras, Vasilios; Mouloudi, Eleni; Antoniadou, Eleni; Vlachogianni, Gykeria; Anisoglou, Souzana; Markou, Nikolaos; Koutsoukou, Antonia; Panagopoulos, Periklis; Milionis, Haralampos; Dalekos, George N.; Kyprianou, Miltiades; Giamarellos-Bourboulis, Evangelos J.
Critical Care Explorations, 16.09.2024
Tilføjet 16.09.2024
OBJECTIVES: It is suggested that sepsis may be classified into four clinical phenotypes, using an algorithm employing 29 admission parameters. We applied a simplified phenotyping algorithm among patients with bacterial sepsis and severe COVID-19 and assessed characteristics and outcomes of the derived phenotypes. DESIGN: Retrospective analysis of data from prospective clinical studies. SETTING: Greek ICUs and Internal Medicine departments. PATIENTS AND INTERVENTIONS: We analyzed 1498 patients, 620 with bacterial sepsis and 878 with severe COVID-19. We implemented a six-parameter algorithm (creatinine, lactate, aspartate transaminase, bilirubin, C-reactive protein, and international normalized ratio) to classify patients with bacterial sepsis intro previously defined phenotypes. Patients with severe COVID-19, included in two open-label immunotherapy trials were subsequently classified. Heterogeneity of treatment effect of anakinra was assessed. The primary outcome was 28-day mortality. MEASUREMENTS AND MAIN RESULTS: The algorithm validated the presence of the four phenotypes across the cohort of bacterial sepsis and the individual studies included in this cohort. Phenotype α represented younger patients with low risk of death, β was associated with high comorbidity burden, and δ with the highest mortality. Phenotype assignment was independently associated with outcome, even after adjustment for Charlson Comorbidity Index. Phenotype distribution and outcomes in severe COVID-19 followed a similar pattern. CONCLUSIONS: A simplified algorithm successfully identified previously derived phenotypes of bacterial sepsis, which were predictive of outcome. This classification may apply to patients with severe COVID-19 with prognostic implications.
Læs mere Tjek på PubMedKomorowski, M., Salciccioli, J. D., Shalhoub, J., Gordon, A. C., Marshall, D. C.
BMJ Open, 13.09.2024
Tilføjet 13.09.2024
ObjectivesUnderstanding the burden of disease of sepsis is essential for monitoring the effectiveness of international strategies to improve sepsis care. Our objective was to describe the multinational trend of sepsis-related mortality for the period 1985–2019 from the WHO Mortality Database. DesignRetrospective analysis of the WHO Mortality Database. SettingWe included data from all countries defined by the WHO as having ‘high usability data’ and at least 10 years of total available data. ParticipantsFrom the WHO list of 50 countries with high usability data, 14 (28%) were excluded due to excessive missingness. We included and analysed data separately for male and female. Primary and secondary outcome measuresWe analysed age-standardised mortality rates (ASMR) (weighted average of the age-specific mortality rates per 100 000 people, where the weights are the proportions of people in the corresponding age groups of the WHO standard population). ResultsWe included 1104 country-years worth of data from 36 countries with high usability data, accounting for around 15% of the world’s population. The median ASMR for men decreased from 37.8 deaths/100 000 (IQR 28.4–46.7) in 1985–1987 to 25.8 deaths/100 000 (IQR 19.2–37) in 2017–2019, an approximately 12% absolute (31.8% relative) decrease. For women, the overall ASMR decreased from 22.9 deaths/100 000 (IQR 17.7–32.2) to 16.2 deaths/100 000 (IQR 12.6–21.6), an approximately 6.7% absolute decrease (29.3% relative decrease). The analysis of country-level data revealed wide variations in estimates and trends. ConclusionsWe observed a decrease in reported sepsis-related mortality across the majority of analysed nations between 1985 and 2019. However, significant variability remains between gender and health systems. System-level and population-level factors may contribute to these differences, and additional investigations are necessary to further explain these trends.
Læs mere Tjek på PubMedJournal of Infectious Diseases, 12.09.2024
Tilføjet 12.09.2024
Abstract Background Blood biomarkers of neurological injury could provide a rapid diagnosis of central nervous system (CNS) injury caused by infections. An FDA-approved assay for mild traumatic brain injury (TBI) measures glial fibrillary acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), which signal astrocyte and neuronal injury, respectively. Here, we assessed the applicability of this biomarker assay for determining infection-induced brain injury.Methods We measured serum levels of GFAP and UCH-L1 retrospectively in serum samples from three study populations: 1) human cases infected with Venezuelan equine encephalitis virus (VEEV) and Madariaga virus (MADV) (n = 73), 2) human sepsis patients who were severely ill or diagnosed with encephalitis (n = 66), and 3) sepsis cases that were subsequently evaluated for cognitive impairment (n = 64).Results In the virus infection group, we found elevated GFAP for VEEV (p = 0.014) and MADV (p = 0.011) infections, which correlated with seizures (p = 0.006). In the bacterial sepsis group, GFAP was elevated in cases diagnosed with encephalitis (p = 0.0007) and correlated with headaches (p = 0.0002). In the bacterial sepsis cases with a later cognitive assessment, elevated GFAP (p = 0.0057) at study enrollment was associated with cognitive impairment six months later with a positive prognostic capacity of 79% (CI: 66–95%; p = 0.0068).Conclusions GFAP and UCH-L1 levels measured using an FDA-approved assay for TBI may indicate brain injury resulting from viral or bacterial infections and could predict the development of neurological sequelae.
Læs mere Tjek på PubMedDantuluri, Keerti L.; Ahmed, Amina
Current Opinion in Infectious Diseases, 11.09.2024
Tilføjet 11.09.2024
Purpose of review The American Academy of Pediatrics recently published guidance for the evaluation and management of febrile infants. However, guidance on testing and empiric treatment for neonatal herpes simplex virus (HSV) remains less standardized and subject to clinical practice variation. Recent findings Recent reports reveal that high numbers of infants presenting for sepsis evaluations need to be treated empirically with acyclovir to capture one case of neonatal HSV. Clinical and laboratory risk factors for neonatal HSV identified in the literature can be used for a targeted approach to testing and treating infants for HSV to optimize resource utilization. Summary The literature supports a targeted approach to evaluation and empiric acyclovir treatment for neonatal HSV, but additional studies are needed to validate this approach given the rarity of disease.
Læs mere Tjek på PubMedJournal of the American Medical Association, 11.09.2024
Tilføjet 11.09.2024
Before they can determine the pathogens causing sepsis in patients and treat them with a targeted antibiotic, clinicians must wait for the results of a blood culture test, which can often take 2 to 3 days. Now an ultra-rapid test in development that eliminates the need for blood culture may provide same-day answers, according to a study published in Nature.
Læs mere Tjek på PubMedJournal of the American Medical Association, 11.09.2024
Tilføjet 11.09.2024
Amid the rapid changes that spell the progress of our day, we tend to lose enthusiasm for the novelties that are invading modern life in astonishingly quick succession. Civilized man has become blasé. He has come to expect new discoveries and novel inventions at every turn; and, surfeited by their actual production, he reacts with surprise or gratitude only when some exceptional contribution is made. He is prone to forget the dramatic chapters of medicine that have included the evolution of anesthesia and antisepsis with the consequent development of transfusion and reconstructive surgery, almost within the memory of the living. And the routine care of the sick is today taken for granted; it has become a part of everyday experience that scarcely ever calls for special commendation.
Læs mere Tjek på PubMedInfection, 8.09.2024
Tilføjet 8.09.2024
Abstract Purpose Lautropia mirabilis is a Gram-negative, facultative anaerobic coccus, which has been detected mainly in respiratory sites of immunodeficient patients suffering from HIV or cystic fibrosis. To date, knowledge about the pathogenicity of L. mirabilis is spare due to the small numbers of documented cases. Methods We present a literature review and report the case of a 39-year-old female diagnosed with common variable immunodeficiency (CVID) with IgG and IgA deficiency suffering from a sepsis with L. mirabilis. As no fully closed L. mirabilis genome besides the type strain was available to date, we additionally performed complete genome sequencing of L. mirabilis. Results The patient was admitted to our hospital with recurrent episodes of fever. Here, we detected L. mirabilis in two different blood cultures. The bacterium was tested susceptible to and treated with meropenem. As the origin of L. mirabilis sepsis, we observed an active periodontitis likely due to impaired IgA levels and mucosal insufficiency as a consequence of CVID. Whole genome sequencing of L. mirabilis revealed several genes important for host cell invasion and intracellular survival of the pathogen. Conclusions Our case highlights the importance of L. mirabilis in immunocompromised patients also in other compartments than the respiratory tract.
Læs mere Tjek på PubMedPrabhu Raj Joshi, Sandeep Adhikari, Chinemerem Onah, Camille Carrier, Abigail Judd, Matthias Mack, Pankaj Baral
Science Advances, 7.09.2024
Tilføjet 7.09.2024
Infection, 6.09.2024
Tilføjet 6.09.2024
Abstract Purpose Lautropia mirabilis is a Gram-negative, facultative anaerobic coccus, which has been detected mainly in respiratory sites of immunodeficient patients suffering from HIV or cystic fibrosis. To date, knowledge about the pathogenicity of L. mirabilis is spare due to the small numbers of documented cases. Methods We present a literature review and report the case of a 39-year-old female diagnosed with common variable immunodeficiency (CVID) with IgG and IgA deficiency suffering from a sepsis with L. mirabilis. As no fully closed L. mirabilis genome besides the type strain was available to date, we additionally performed complete genome sequencing of L. mirabilis. Results The patient was admitted to our hospital with recurrent episodes of fever. Here, we detected L. mirabilis in two different blood cultures. The bacterium was tested susceptible to and treated with meropenem. As the origin of L. mirabilis sepsis, we observed an active periodontitis likely due to impaired IgA levels and mucosal insufficiency as a consequence of CVID. Whole genome sequencing of L. mirabilis revealed several genes important for host cell invasion and intracellular survival of the pathogen. Conclusions Our case highlights the importance of L. mirabilis in immunocompromised patients also in other compartments than the respiratory tract.
Læs mere Tjek på PubMedBMC Infectious Diseases, 6.09.2024
Tilføjet 6.09.2024
Abstract Background Sepsis remains a leading cause of mortality in intensive care units, and rapid and accurate pathogen detection is crucial for effective treatment. This study evaluated the clinical application of multi-site metagenomic next-generation sequencing (mNGS) for the diagnosis of sepsis, comparing its performance against conventional methods. Methods A retrospective analysis was conducted on 69 patients with sepsis consecutively admitted to the Department of Intensive Care Medicine, Meizhou People’s Hospital. Samples of peripheral blood and infection sites were collected for mNGS and conventional method tests to compare the positive rate of mNGS and traditional pathogen detection methods and the distribution of pathogens. The methods used in this study included a comprehensive analysis of pathogen consistency between peripheral blood and infection site samples. Additionally, the correlation between the pathogens detected and clinical outcomes was investigated. Results Of the patients with sepsis, 57.97% experienced dyspnea, and 65.2% had underlying diseases, with hypertension being the most common. mNGS demonstrated a significantly higher pathogen detection rate (88%) compared to the conventional method tests (26%). The pathogen consistency rate was 60% between plasma and bronchoalveolar lavage fluid samples, and that of plasma and local body fluid samples was 63%. The most frequently detected pathogens were gram-negative bacteria, and Klebsiella pneumonia. There were no significant differences in the clinical features between the pathogens. Conclusion mNGS is significantly superior to conventional methods in pathogen detection. There was a notable high pathogen consistency detection between blood and local body fluid samples, supporting the clinical relevance of mNGS. This study highlights the superiority of mNGS in detecting a broad spectrum of pathogens quickly and accurately. Trial registration Not applicable.
Læs mere Tjek på PubMedBMC Infectious Diseases, 5.09.2024
Tilføjet 5.09.2024
Abstract Background Sepsis-associated encephalopathy (SAE) patients often experience changes in intracranial pressure and impaired cerebral autoregulation. Mean arterial pressure (MAP) plays a crucial role in cerebral perfusion pressure, but its relationship with mortality in SAE patients remains unclear. This study aims to investigate the relationship between MAP and the risk of 28-day and in-hospital mortality in SAE patients, providing clinicians with the optimal MAP target. Methods We retrospectively collected clinical data of patients diagnosed with SAE on the first day of ICU admission from the MIMIC-IV (v2.2) database. Patients were divided into four groups based on MAP quartiles. Kruskal-Wallis H test and Chi-square test were used to compare clinical characteristics among the groups. Restricted cubic spline and segmented Cox regression models, both unadjusted and adjusted for multiple variables, were employed to elucidate the relationship between MAP and the risk of 28-day and in-hospital mortality in SAE patients and to identify the optimal MAP. Subgroup analyses were conducted to assess the stability of the results. Results A total of 3,816 SAE patients were included. The Q1 group had higher rates of acute kidney injury and vasoactive drug use on the first day of ICU admission compared to other groups (P
Læs mere Tjek på PubMedShenjia GaoRuling ShenJie LiYi JiangHao SunXinyi WuXiya LiChanghong MiaoMiao HeJun WangWankun ChenaDepartment of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai 200032, ChinabShanghai Key Laboratory of Perioperative Stress and Protection, Shanghai 200032, ChinacShanghai Laboratory Animal Research Center, Shanghai 201203, ChinadInstitutes of Brain Science, State Key Laboratory of Medical Neurobiology and Ministry of Education (MOE) Frontiers Center for Brain Science, Shanghai 200032, ChinaeDepartment of Neurobiology, Zhongshan Hospital, Fudan University, Shanghai 200032, ChinafDepartment of Integrative Medicine and Neurobiology, School of Basic Medical Science, Shanghai Key Laboratory of Acupuncture Mechanism and Acupoint Function, Fudan University, Shanghai 200032, ChinagDepartment of Anesthesiology, Shanghai Geriatric Medical Center, Shanghai 201104, ChinahDepartment of Anesthesiology, QingPu Branch of Zhongshan Hospital, Fudan University, Shanghai 201799, China
Proceedings of the National Academy of Sciences, 4.09.2024
Tilføjet 4.09.2024
Proceedings of the National Academy of Sciences, Volume 121, Issue 36, September 2024.
Læs mere Tjek på PubMedBMC Infectious Diseases, 3.09.2024
Tilføjet 3.09.2024
Abstract Background Sepsis-associated encephalopathy (SAE) patients often experience changes in intracranial pressure and impaired cerebral autoregulation. Mean arterial pressure (MAP) plays a crucial role in cerebral perfusion pressure, but its relationship with mortality in SAE patients remains unclear. This study aims to investigate the relationship between MAP and the risk of 28-day and in-hospital mortality in SAE patients, providing clinicians with the optimal MAP target. Methods We retrospectively collected clinical data of patients diagnosed with SAE on the first day of ICU admission from the MIMIC-IV (v2.2) database. Patients were divided into four groups based on MAP quartiles. Kruskal-Wallis H test and Chi-square test were used to compare clinical characteristics among the groups. Restricted cubic spline and segmented Cox regression models, both unadjusted and adjusted for multiple variables, were employed to elucidate the relationship between MAP and the risk of 28-day and in-hospital mortality in SAE patients and to identify the optimal MAP. Subgroup analyses were conducted to assess the stability of the results. Results A total of 3,816 SAE patients were included. The Q1 group had higher rates of acute kidney injury and vasoactive drug use on the first day of ICU admission compared to other groups (P
Læs mere Tjek på PubMed