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Xiao H, Zhang H, Wang G, Wang Y, Tan Z, Sun X, Zhou J, Duan M, Zhi D, Hang C, Zhang G, Li Y, Wu C, Zhang H, Xie M, Li C. COMPARISON AMONG PRESEPSIN, PROCALCITONIN, AND C-REACTIVE PROTEIN IN PREDICTING BLOOD CULTURE POSITIVITY AND PATHOGEN IN SEPSIS PATIENTS. Shock 2024; 61:387-394. [PMID: 37878488 DOI: 10.1097/shk.0000000000002243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
ABSTRACT Background: Sepsis is caused by the invasion of the bloodstream by microorganisms from local sites of infection, leading to high mortality. This study aimed to compare the predictive ability of the biomarkers presepsin, procalcitonin (PCT), and C-reactive protein for bacteraemia. Methods: In this retrospective, multicentre study, a dataset of patients with sepsis who were prospectively enrolled between November 2017 and June 2021 was analyzed. The performances of the biomarkers for predicting positive blood cultures and infection with specific pathogens were assessed by the areas under the receiver operating characteristic curves (AUCs). The independent effects of the pathogen and foci of infection on presepsin and PCT levels were assessed by linear logistic regression models. Results: A total of 577 patients with 170 positive blood cultures (29.5%) were enrolled. The AUC achieved using PCT levels (0.856) was significantly higher than that achieved using presepsin (0.786, P = 0.0200) and C-reactive protein (0.550, P < 0.0001) levels in predicting bacteraemia. The combined analysis of PCT and presepsin levels led to a significantly higher AUC than the analysis of PCT levels alone for predicting blood culture positivity (0.877 vs. 0.856, P = 0.0344) and gram-negative bacteraemia (0.900 vs. 0.875, P = 0.0216). In a linear regression model, the elevated concentrations of presepsin and PCT were both independently related to Escherichia coli , Klebsiella species, Pseudomonas species, and Streptococcus species infections and Sequential Organ Failure Assessment score. Presepsin levels were also associated with Acinetobacter species and abdominal infection, and PCT levels were positively associated with other Enterobacteriaceae and negatively associated with respiratory infection. Combined analysis of presepsin and PCT levels provided a high sensitivity and specificity in identifying E. coli or Klebsiella species infection. Conclusions: Presepsin and PCT were promising markers for predicting bacteraemia and common pathogens at the time of sepsis onset with a synergistic effect.
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Affiliation(s)
- Hongli Xiao
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hanyu Zhang
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Guoxing Wang
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yan Wang
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhimin Tan
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xuelian Sun
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jie Zhou
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Meili Duan
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Deyuan Zhi
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Chenchen Hang
- Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Guoqiang Zhang
- Department of Emergency Medicine, China-Japan Friendship Hospital, Peking Union Medical College, Beijing, China
| | - Yan Li
- Department of Emergency Medicine, China-Japan Friendship Hospital, Peking Union Medical College, Beijing, China
| | - Caijun Wu
- Department of Emergency Medicine, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Haiyan Zhang
- Department of Emergency Medicine, The Hospital of Shunyi District Beijing, China Medical University, Beijing, China
| | - Miaorong Xie
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Chunsheng Li
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Bauer ME, Fuller M, Kovacheva V, Elkhateb R, Azar K, Caldwell M, Chiem V, Foster M, Gibbs R, Hughes BL, Johnson R, Kottukapally N, Rosenstein MG, Cortes MS, Shields LE, Sudat S, Sutton CD, Toledo P, Traylor A, Wharton K, Main E. Performance Characteristics of Sepsis Screening Tools During Antepartum and Postpartum Admissions. Obstet Gynecol 2024; 143:336-345. [PMID: 38086052 PMCID: PMC10922108 DOI: 10.1097/aog.0000000000005480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/19/2023] [Indexed: 02/17/2024]
Abstract
OBJECTIVE To evaluate the performance characteristics of existing screening tools for the prediction of sepsis during antepartum and postpartum readmissions. METHODS This was a case-control study using electronic health record data obtained between 2016 and 2021 from 67 hospitals for antepartum sepsis admissions and 71 hospitals for postpartum readmissions up to 42 days. Patients in the sepsis case group were matched in a 1:4 ratio to a comparison cohort of patients without sepsis admitted antepartum or postpartum. The following screening criteria were evaluated: the CMQCC (California Maternal Quality Care Collaborative) initial sepsis screen, the non-pregnancy-adjusted SIRS (Systemic Inflammatory Response Syndrome), the MEWC (Maternal Early Warning Criteria), UKOSS (United Kingdom Obstetric Surveillance System) obstetric SIRS, and the MEWT (Maternal Early Warning Trigger Tool). Time periods were divided into early pregnancy (less than 20 weeks of gestation), more than 20 weeks of gestation, early postpartum (less than 3 days postpartum), and late postpartum through 42 days. False-positive screening rates, C-statistics, sensitivity, and specificity were reported for each overall screening tool and each individual criterion. RESULTS We identified 525 patients with sepsis during an antepartum hospitalization and 728 patients with sepsis during a postpartum readmission. For early pregnancy and more than 3 days postpartum, non-pregnancy-adjusted SIRS had the highest C-statistics (0.78 and 0.83, respectively). For more than 20 weeks of gestation and less than 3 days postpartum, the pregnancy-adjusted sepsis screening tools (CMQCC and UKOSS) had the highest C-statistics (0.87-0.94). The MEWC maintained the highest sensitivity rates during all time periods (81.9-94.4%) but also had the highest false-positive rates (30.4-63.9%). The pregnancy-adjusted sepsis screening tools (CMQCC, UKOSS) had the lowest false-positive rates in all time periods (3.9-10.1%). All tools had the lowest C-statistics in the periods of less than 20 weeks of gestation and more than 3 days postpartum. CONCLUSION For admissions early in pregnancy and more than 3 days postpartum, non-pregnancy-adjusted sepsis screening tools performed better than pregnancy-adjusted tools. From 20 weeks of gestation through up to 3 days postpartum, using a pregnancy-adjusted sepsis screening tool increased sensitivity and minimized false-positive rates. The overall false-positive rate remained high.
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Affiliation(s)
- Melissa E Bauer
- Department of Anesthesiology and the Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina; the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts; the Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas; the Sutter Health Institute for Advancing Health Equity and the Center for Health Systems Research, Sutter Health, Sacramento, Common Spirit Health, the Department of Systems Clinical Informatics, Common Spirit Health, the Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, and the Department of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, California; the Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas; and Wayne State University School of Medicine, Wayne, and the Department of Obstetrics and Gynecology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
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Main EK, Fuller M, Kovacheva VP, Elkhateb R, Azar K, Caldwell M, Chiem V, Foster M, Gibbs R, Hughes BL, Johnson R, Kottukapally N, Cortes MS, Rosenstein MG, Shields LE, Sudat S, Sutton CD, Toledo P, Traylor A, Wharton K, Bauer ME. Performance Characteristics of Sepsis Screening Tools During Delivery Admissions. Obstet Gynecol 2024; 143:326-335. [PMID: 38086055 PMCID: PMC10922218 DOI: 10.1097/aog.0000000000005477] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/19/2023] [Indexed: 02/17/2024]
Abstract
OBJECTIVE To evaluate the screening performance characteristics of existing tools for the diagnosis of sepsis during delivery admissions. METHODS This was a case-control study using electronic health record data, including vital signs and laboratory results, for all delivery admissions of patients with sepsis from 59 nationally distributed hospitals. Patients with sepsis were matched by gestational age at delivery in a 1:4 ratio with patients without sepsis to create a comparison group. Patients with chorioamnionitis and sepsis were compared with a complete cohort of patients with chorioamnionitis without sepsis. Multiple screening criteria for sepsis were evaluated: the CMQCC (California Maternal Quality Care Collaborative), SIRS (Systemic Inflammatory Response Syndrome), the MEWC (the Maternal Early Warning Criteria), UKOSS (United Kingdom Obstetric Surveillance System), and the MEWT (Maternal Early Warning Trigger Tool). Sensitivity, false-positive rates, and C-statistics were reported for each screening tool. Analyses were stratified into cohort 1, which excluded patients with chorioamnionitis-endometritis, and cohort 2, which included those patients. RESULTS Delivery admissions at 59 hospitals were extracted for patients with sepsis. Cohort 1 comprised 647 patients with sepsis, including 228 with end-organ injury, matched with a control group of 2,588 patients without sepsis. Cohort 2 comprised 14,591 patients with chorioamnionitis-endometritis, of whom 1,049 had sepsis and 238 had end-organ injury. In cohort 1, the CMQCC and the UKOSS pregnancy-adjusted criteria had the lowest false-positive rates (6.9% and 9.6%, respectively) and the highest C-statistics (0.92 and 0.91, respectively). Although other screening criteria, such as SIRS and the MEWC, had similar sensitivities, it was at the cost of much higher false-positive rates (21.3% and 38.3%, respectively). In cohort 2, including all patients with chorioamnionitis-endometritis, the highest C-statistics were again for the CMQCC (0.67) and UKOSS (0.64). All screening tools had high false-positive rates, but the false-positive rates for the CMQCC and UKOSS were substantially lower than those for SIRS and the MEWC. CONCLUSION During delivery admissions, the CMQCC and UKOSS pregnancy-adjusted screening criteria have the lowest false-positive results while maintaining greater than 90% sensitivity rates. Performance of all screening tools was degraded in the setting of chorioamnionitis-endometritis.
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Affiliation(s)
- Elliott K Main
- Department of Obstetrics and Gynecology, Stanford University, Palo Alto, the Sutter Health Institute for Advancing Health Equity and the Center for Health Systems Research, Sutter Health, Sacramento, Common Spirit Health, the Department of Systems Clinical Informatics, Common Spirit Health, and the Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California; the Department of Anesthesiology and the Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina; the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts; the Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas; the Department of Obstetrics and Gynecology and the Department of Anesthesiology, Baylor College of Medicine, Houston, Texas; Wayne State University School of Medicine, Wayne, and the Department of Obstetrics and Gynecology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan; and the Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, Florida
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Choi JW, Yang M, Kim JW, Shin YM, Shin YG, Park S. Prognostic prediction of sepsis patient using transformer with skip connected token for tabular data. Artif Intell Med 2024; 149:102804. [PMID: 38462275 DOI: 10.1016/j.artmed.2024.102804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 09/25/2023] [Accepted: 02/08/2024] [Indexed: 03/12/2024]
Abstract
Sepsis is known as a common syndrome in intensive care units (ICU), and severe sepsis and septic shock are among the leading causes of death worldwide. The purpose of this study is to develop a deep learning model that supports clinicians in efficiently managing sepsis patients in the ICU by predicting mortality, ICU length of stay (>14 days), and hospital length of stay (>30 days). The proposed model was developed using 591 retrospective data with 16 tabular data related to a sequential organ failure assessment (SOFA) score. To analyze tabular data, we designed the modified architecture of the transformer that has achieved extraordinary success in the field of languages and computer vision tasks in recent years. The main idea of the proposed model is to use a skip-connected token, which combines both local (feature-wise token) and global (classification token) information as the output of a transformer encoder. The proposed model was compared with four machine learning models (ElasticNet, Extreme Gradient Boosting [XGBoost]), and Random Forest) and three deep learning models (Multi-Layer Perceptron [MLP], transformer, and Feature-Tokenizer transformer [FT-Transformer]) and achieved the best performance (mortality, area under the receiver operating characteristic (AUROC) 0.8047; ICU length of stay, AUROC 0.8314; hospital length of stay, AUROC 0.7342). We anticipate that the proposed model architecture will provide a promising approach to predict the various clinical endpoints using tabular data such as electronic health and medical records.
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Affiliation(s)
- Jee-Woo Choi
- Mediv Corporation, Cheongju-si, Chungcheongbuk-do, Republic of Korea; Chungbuk National University College of Medicine, Cheongju-si, Chungcheongbuk-do, Republic of Korea
| | - Minuk Yang
- Mediv Corporation, Cheongju-si, Chungcheongbuk-do, Republic of Korea; Chungbuk National University College of Medicine, Cheongju-si, Chungcheongbuk-do, Republic of Korea
| | - Jae-Woo Kim
- AI Research Center, Chungbuk National University Hospital, Cheongju-si, Chungcheongbuk-do, Republic of Korea; Chungbuk National University College of Medicine, Cheongju-si, Chungcheongbuk-do, Republic of Korea
| | - Yoon Mi Shin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju-si, Chungcheongbuk-do, Republic of Korea; Chungbuk National University College of Medicine, Cheongju-si, Chungcheongbuk-do, Republic of Korea
| | - Yong-Goo Shin
- Department of Electronics and Information Engineering, Korea University, Sejong-si, Republic of Korea.
| | - Seung Park
- Department of Biomedical Engineering, Chungbuk National University Hospital, Cheongju-si, Chungcheongbuk-do, Republic of Korea; Chungbuk National University College of Medicine, Cheongju-si, Chungcheongbuk-do, Republic of Korea.
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105
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Palalıoğlu B, Erdoğan S, Atay G, Tugrul HC, Özer ÖF. Diagnostic and Prognostic Value of Pentraxin 3, Interleukin-6, CRP, and Procalcitonin Levels in Patients with Sepsis and Septic Shock. Niger J Clin Pract 2024; 27:317-324. [PMID: 38528351 DOI: 10.4103/njcp.njcp_615_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 12/16/2023] [Indexed: 03/27/2024]
Abstract
INTRODUCTION AND PURPOSE In this prospective study, we aim to evaluate the effects of antibiotherapy on pentraxin-3 (PTX3), C-reactive protein (CRP), and interleukin-6 (IL-6) levels in patients with sepsis and septic shock. MATERIALS AND METHODS In our study, CRP, procalcitonin, IL-6, and PTX3 levels at initial and 48 hours of the antibiotherapy of patients who were admitted to the pediatric intensive care unit (PICU) with the diagnosis of sepsis and septic shock between June 2020 and March 2021 were compared. Patients were compared with the age-appropriate case-control group formed from the patients who received pre-operative routines to investigate the diagnostic value. RESULTS CRP, IL-6, and PTX3 levels of the patients were significantly higher compared to controls (P < 0.05). After the 48th hour of treatment compared to initial CRP, lactate and PCT levels were significantly lower (P < 0.05). The IL-6 and PCT levels were significantly higher in patients with mortality than in surviving patients. Surviving patients showed a significant decrease in CRP level at the 48th hour. IL-6 levels of patients with septic shock were significantly higher than those with sepsis (P = 0.010; P < 0.05). In the diagnosis of septic shock, the area under curve was 0.785 for IL-6 and the standard deviation was 0.09 (P = 0.002, cut-off value, >32 pg/mL, 88.9% sensitivity, 65.6% specifity). CONCLUSION The results of this study indicated that IL-6 level is an appropriate biomarker with high specificity in the diagnosis of sepsis and septic shock and in evaluating the response to treatment and determining the prognosis.
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Affiliation(s)
- B Palalıoğlu
- Department of Pediatrics, University of Health Sciences Zeynep Kamil Training and Research Hospital, Uskudar Opr. Dr. Burhanettin Ustunel Cad. No:10, Istanbul, Turkey
| | - S Erdoğan
- Department of Pediatric Intensive Care, University of Health Sciences Umraniye Training and Research Hospital, Elmalıkent, Adem Yavuz Cd., Istanbul, Turkey
| | - G Atay
- Department of Pediatric Intensive Care, University of Health Sciences Umraniye Training and Research Hospital, Elmalıkent, Adem Yavuz Cd., Istanbul, Turkey
| | - H C Tugrul
- Department of Pediatric Intensive Care, University of Health Sciences Umraniye Training and Research Hospital, Elmalıkent, Adem Yavuz Cd., Istanbul, Turkey
| | - Ö F Özer
- Bezmialem Vakif University, Department of Biochemistry Adnan Menderes Bulvarı (Vatan Cad.) P.K. 34093 Fatih/Istanbul, Turkey
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106
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Zhu J, Dong Y, Liao P, Yin X, He J, Guo L. Prognostic value of hemoglobin in patients with sepsis: A systematic review and meta-analysis. Heart Lung 2024; 64:93-99. [PMID: 38070279 DOI: 10.1016/j.hrtlng.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 11/29/2023] [Accepted: 12/03/2023] [Indexed: 03/18/2024]
Abstract
BACKGROUND Sepsis patients have a high mortality rate and are frequently anemic. The importance of early detection and blood transfusion treatment cannot be overstated. OBJECTIVE A systematic review and meta-analysis of published literature was conducted to evaluate the association between hemoglobin and the prognosis of patients with sepsis. METHODS The PubMed, Embase, Cochrane Library and Chinese Biomedical Literature (CBM) databases were searched from inception to May 21, 2023. Pediatric patients were excluded, and there were no language restrictions. A random effects model was used to calculate pooled odds ratios to assess the relationship between hemoglobin and prognosis in sepsis. RESULTS There were 110,004 patients included in 9 studies, of which 51,568 had a poor prognosis. The results of univariate and multivariate analyzes showed that hemoglobin was associated with the prognosis of patients with sepsis (univariate OR: 1.35, 95 % confidence interval (CI): 1.16-1.58; multivariate OR: 1.26, 95 % CI: 1.13-1.40). Dose-response meta-analysis showed that there was a nonlinear relationship between hemoglobin level and prognosis in patients with sepsis. CONCLUSION The level of hemoglobin at admission is related to the prognosis of patients with sepsis, and decreases in hemoglobin level are associated with an increase in the mortality rate of patients with sepsis. Therefore, early transfusion of red blood cells should be performed in patients with sepsis, and early attention should be given to anemia in patients with sepsis. However, more robust studies are needed to further determine the level of early hemoglobin maintenance in patients with sepsis.
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Affiliation(s)
- Jin Zhu
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Yanyan Dong
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Pengda Liao
- Department of Intensive Care Unit, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, China
| | - Xin Yin
- Department of Intensive Care Unit, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, China
| | - Jianzhuo He
- Department of Intensive Care Unit, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, China
| | - Liheng Guo
- Department of Intensive Care Unit, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, China.
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Alipourfard I, Darvishi M, Khalighfard A, Ghazi F, Mobed A. Nanomaterial-based methods for sepsis management. Enzyme Microb Technol 2024; 174:110380. [PMID: 38147783 DOI: 10.1016/j.enzmictec.2023.110380] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 11/26/2023] [Accepted: 12/12/2023] [Indexed: 12/28/2023]
Abstract
Sepsis is a serious disease caused by an impaired host immune response to infection, resulting in organ dysfunction, tissue damage and is responsible for high in-hospital mortality (approximately 20%). Recently, WHO documented sepsis as a global health priority. Nevertheless, there is still no effective and specific therapy for clinically detecting sepsis. Nanomaterial-based approaches have appeared as promising tools for identifying bacterial infections. In this review, recent biosensors are introduced and summarized as nanomaterial-based platforms for sepsis management and severe complications. Biosensors can be used as tools for the diagnosis and treatment of sepsis and as nanocarriers for drug delivery. In general, diagnostic methods for sepsis-associated bacteria, biosensors developed for this purpose are presented in detail, and their strengths and weaknesses are discussed. In other words, readers of this article will gain a comprehensive understanding of biosensors and their applications in sepsis management.
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Affiliation(s)
- Iraj Alipourfard
- Institute of Biology, Biotechnology and Environmental Protection, Faculty of Natural Sciences, University of Silesia, Katowice, Poland
| | - Mohammad Darvishi
- Infectious Diseases and Tropical Medicine Research Center (IDTMRC), Department of Aerospace and Subaquatic Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Arghavan Khalighfard
- Department of Nursing and Midwifery٫ Faculty of Midwifery٬ Zanjan University of Medical Sciences, Zanjan, Iran
| | - Farhood Ghazi
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz 5154853431, Iran
| | - Ahmad Mobed
- Infectious and Tropical Diseases Research Center, Clinical Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran.
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108
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Goodacre S, Sutton L, Ennis K, Thomas B, Hawksworth O, Iftikhar K, Croft SJ, Fuller G, Waterhouse S, Hind D, Stevenson M, Bradburn MJ, Smyth M, Perkins GD, Millins M, Rosser A, Dickson J, Wilson M. Prehospital early warning scores for adults with suspected sepsis: the PHEWS observational cohort and decision-analytic modelling study. Health Technol Assess 2024; 28:1-93. [PMID: 38551135 PMCID: PMC11017155 DOI: 10.3310/ndty2403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024] Open
Abstract
Background Guidelines for sepsis recommend treating those at highest risk within 1 hour. The emergency care system can only achieve this if sepsis is recognised and prioritised. Ambulance services can use prehospital early warning scores alongside paramedic diagnostic impression to prioritise patients for treatment or early assessment in the emergency department. Objectives To determine the accuracy, impact and cost-effectiveness of using early warning scores alongside paramedic diagnostic impression to identify sepsis requiring urgent treatment. Design Retrospective diagnostic cohort study and decision-analytic modelling of operational consequences and cost-effectiveness. Setting Two ambulance services and four acute hospitals in England. Participants Adults transported to hospital by emergency ambulance, excluding episodes with injury, mental health problems, cardiac arrest, direct transfer to specialist services, or no vital signs recorded. Interventions Twenty-one early warning scores used alongside paramedic diagnostic impression, categorised as sepsis, infection, non-specific presentation, or other specific presentation. Main outcome measures Proportion of cases prioritised at the four hospitals; diagnostic accuracy for the sepsis-3 definition of sepsis and receiving urgent treatment (primary reference standard); daily number of cases with and without sepsis prioritised at a large and a small hospital; the minimum treatment effect associated with prioritisation at which each strategy would be cost-effective, compared to no prioritisation, assuming willingness to pay £20,000 per quality-adjusted life-year gained. Results Data from 95,022 episodes involving 71,204 patients across four hospitals showed that most early warning scores operating at their pre-specified thresholds would prioritise more than 10% of cases when applied to non-specific attendances or all attendances. Data from 12,870 episodes at one hospital identified 348 (2.7%) with the primary reference standard. The National Early Warning Score, version 2 (NEWS2), had the highest area under the receiver operating characteristic curve when applied only to patients with a paramedic diagnostic impression of sepsis or infection (0.756, 95% confidence interval 0.729 to 0.783) or sepsis alone (0.655, 95% confidence interval 0.63 to 0.68). None of the strategies provided high sensitivity (> 0.8) with acceptable positive predictive value (> 0.15). NEWS2 provided combinations of sensitivity and specificity that were similar or superior to all other early warning scores. Applying NEWS2 to paramedic diagnostic impression of sepsis or infection with thresholds of > 4, > 6 and > 8 respectively provided sensitivities and positive predictive values (95% confidence interval) of 0.522 (0.469 to 0.574) and 0.216 (0.189 to 0.245), 0.447 (0.395 to 0.499) and 0.274 (0.239 to 0.313), and 0.314 (0.268 to 0.365) and 0.333 (confidence interval 0.284 to 0.386). The mortality relative risk reduction from prioritisation at which each strategy would be cost-effective exceeded 0.975 for all strategies analysed. Limitations We estimated accuracy using a sample of older patients at one hospital. Reliable evidence was not available to estimate the effectiveness of prioritisation in the decision-analytic modelling. Conclusions No strategy is ideal but using NEWS2, in patients with a paramedic diagnostic impression of infection or sepsis could identify one-third to half of sepsis cases without prioritising unmanageable numbers. No other score provided clearly superior accuracy to NEWS2. Research is needed to develop better definition, diagnosis and treatments for sepsis. Study registration This study is registered as Research Registry (reference: researchregistry5268). Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 17/136/10) and is published in full in Health Technology Assessment; Vol. 28, No. 16. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Steve Goodacre
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
- Emergency Department, Northern General Hospital, Sheffield, UK
| | - Laura Sutton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Kate Ennis
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Ben Thomas
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Olivia Hawksworth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | - Susan J Croft
- Emergency Department, Northern General Hospital, Sheffield, UK
| | - Gordon Fuller
- Emergency Department, Northern General Hospital, Sheffield, UK
| | - Simon Waterhouse
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Daniel Hind
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Matt Stevenson
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Mike J Bradburn
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Michael Smyth
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Gavin D Perkins
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Mark Millins
- Yorkshire Ambulance Service NHS Trust, Wakefield, UK
| | - Andy Rosser
- West Midlands Ambulance Service University NHS Foundation Trust, Midlands, UK
| | - Jon Dickson
- Academic Unit of Primary Medical Care, University of Sheffield, Sheffield, UK
| | - Matthew Wilson
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Zhang W. Critical roles of S100A12, MMP9, and PRTN3 in sepsis diagnosis: Insights from multiple microarray data analyses. Comput Biol Med 2024; 171:108222. [PMID: 38447501 DOI: 10.1016/j.compbiomed.2024.108222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/16/2024] [Accepted: 02/25/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Sepsis, characterized by systemic inflammatory response syndrome and life-threatening organ dysfunction, remains a significant global cause of disability and death. Despite its impact, reliable biomarkers for sepsis diagnosis are yet to be identified. OBJECTIVE This study aims to investigate and identify key genes and pathways in sepsis through the analysis of multiple microarray datasets, providing potential treatment targets for future clinical trials. METHODS Two independent gene expression profiles (GSE54514 and GSE69528) were downloaded from the Gene Expression Omnibus (GEO) database. After merging and batch normalization, differentially expressed genes (DEGs) were obtained using the "limma" package. Gene Ontology (GO) and Gene Set Enrichment Analysis (GSEA) were performed using "R" software. A Protein-Protein Interaction (PPI) network was constructed using the Search Tool for the Retrieval of Interacting Genes (STRING). The top 10 hub genes were identified using Cytoscape. A Nomogram model for predicting sepsis occurrence was constructed and evaluated. RESULTS Bioinformatic analysis of 210 sepsis and 91 control blood samples identified 72 DEGs. GO analyses revealed associations with immune response processes. GSEA indicated involvement in key signaling pathways. S100A12, MMP9, and PRTN3 were identified as independent risk factors for sepsis. CONCLUSION This study unveils critical genes and pathways in sepsis through bioinformatic methods. S100A12, MMP9, and PRTN3 may play essential roles in the immune response to infection, influencing sepsis prognosis.
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Affiliation(s)
- Wenyuan Zhang
- The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
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110
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Bosetti C, Santucci C, Signorini F, Cortellaro F, Villa G, Rossi C, Nattino G, Bertolini G. Diagnosis of sepsis in the emergency department: a real-world analysis from Lombardy, Italy. Intern Emerg Med 2024; 19:313-320. [PMID: 37938481 DOI: 10.1007/s11739-023-03464-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/12/2023] [Indexed: 11/09/2023]
Abstract
Early identification of sepsis is particularly important in the emergency department (ED). However, data on the diagnosis of sepsis in the ED are scanty, especially within the Italian context. To quantify sepsis incidence and recognition in the ED from Lombardy, Italy, we used EUOL data from the Regional Emergency Agency for the years 2017-2022. Sepsis was identified based on the ED discharge diagnosis; recognized sepsis cases were those assigned to a high-priority code at triage, while unrecognized ones were those assigned to a low priority code. Odds ratios (ORs) for sepsis recognition according to various patient characteristics were estimated using multivariable mixed-effects logistic regression models. The rate of sepsis diagnosis in ED was 1.9 per 1000 (6626 patients) in 2017 and increased to 3.4 per 1000 in 2022 (11,508 patients). In 2022, 67% of sepsis cases were correctly identified. Death in the ED was more frequent in patients with recognized sepsis (10.4%) than in those with unrecognized sepsis (2.3%). The probability of sepsis being recognized at ED admission was higher in men (multivariable OR: 1.06), in individuals with advanced age (OR: 1.71 for age ≥ 90 years vs < 60), and in those with access to the second (OR: 1.48) and third ED level (OR: 1.87). Conversely, it was lower in patients arriving at the ED through autonomous transportation (OR: 0.36). This large real-world analysis indicates an increase in sepsis cases referred to the ED in recent years. About one-third of sepsis cases are not correctly identified at triage, although more severe cases appear to be promptly recognized.
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Affiliation(s)
- Cristina Bosetti
- Laboratory of Clinical Epidemiology, Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri, 2, 20156, Milan, Italy.
| | - Claudia Santucci
- Laboratory of Clinical Epidemiology, Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri, 2, 20156, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Fabiola Signorini
- Laboratory of Clinical Epidemiology, Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri, 2, 20156, Milan, Italy
| | | | - Giorgia Villa
- Laboratory of Clinical Epidemiology, Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri, 2, 20156, Milan, Italy
| | - Carlotta Rossi
- Laboratory of Clinical Epidemiology, Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri, 2, 20156, Milan, Italy
| | - Giovanni Nattino
- Laboratory of Clinical Epidemiology, Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri, 2, 20156, Milan, Italy
| | - Guido Bertolini
- Laboratory of Clinical Epidemiology, Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri, 2, 20156, Milan, Italy
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Elhadidi A, Al-Katary M, Abdelhalim M, Negm A, Shouma A. Complicated anorectal sepsis: Validation of scoring system for predicting anorectal sepsis severity. Medicine (Baltimore) 2024; 103:e37377. [PMID: 38428871 PMCID: PMC10906629 DOI: 10.1097/md.0000000000037377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2024] Open
Abstract
Anorectal sepsis is a common and potentially serious medical condition characterized by infection and inflammation of the anal canal and surrounding tissues. However, the lack of standardized and comprehensive scoring systems specifically tailored for predicting the severity of anorectal sepsis poses challenges in clinical practice. This study aimed to develop and validate a scoring system for predicting the severity of anorectal sepsis by incorporating relevant patient factors. A retrospective cohort study was conducted at Mansoura University Hospital, a tertiary care center, over a period of 5 years. The study population consisted of 330 patients diagnosed with anorectal sepsis during the study period. A scoring system was developed using multiple variables, with each variable assigned a specific score based on its clinical significance and weight in predicting disease severity. The developed scoring system's predictive performance was evaluated using receiver operating characteristic (ROC) analysis, calculating the area under the ROC curve to assess discriminative ability. Descriptive statistics were used to summarize the demographic and clinical characteristics of the study population. Chi-square tests or t tests were performed to assess differences between non-severe and severe anal sepsis groups. The scoring system consisted of 12 variables, with a maximum total score of 18. The logistic regression analysis revealed significant associations between localized swelling, presentation within 72 hours, multiple drainage sessions, and severe anorectal sepsis. The ROC analysis showed an area under the curve of 0.85, indicating good discriminative ability of the scoring system. The scoring system was developed and validated in a single center, which may limit its generalizability to other settings. The scoring system demonstrated good predictive performance and can be a valuable tool for clinicians in assessing disease severity, guiding treatment decisions, and identifying high-risk patients.
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Affiliation(s)
- Amro Elhadidi
- Department of Surgery, Mansoura University, Mansoura, Egypt
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Zackoff MW, Cruse B, Sahay RD, Zhang B, Sosa T, Schwartz J, Depinet H, Schumacher D, Geis GL. Multiuser immersive virtual reality simulation for interprofessional sepsis recognition and management. J Hosp Med 2024; 19:185-192. [PMID: 38238875 DOI: 10.1002/jhm.13274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/12/2023] [Accepted: 12/22/2023] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Sepsis is a leading cause of pediatric mortality. While there has been significant effort toward improving adherence to evidence-based care, gaps remain. Immersive multiuser virtual reality (MUVR) simulation may be an approach to enhance provider clinical competency and situation awareness for sepsis. METHODS A prospective, observational pilot of an interprofessional MUVR simulation assessing a decompensating patient from sepsis was conducted from January to June 2021. The study objective was to establish validity and acceptability evidence for the platform by assessing differences in sepsis recognition between experienced and novice participants. Interprofessional teams assessed and managed a patient together in the same VR experience with the primary outcome of time to recognition of sepsis utilizing the Situation Awareness Global Assessment Technique analyzed using a logistic regression model. Secondary outcomes were perceived clinical accuracy, relevancy to practice, and side effects experienced. RESULTS Seventy-two simulations included 144 participants. The cumulative odds ratio of recognizing sepsis at 2 min into the simulation in comparison to later time points by experienced versus novice providers were significantly higher with a cumulative odds ratio of 3.70 (95% confidence interval: 1.15-9.07, p = .004). Participants agreed that the simulation was clinically accurate (98.6%) and will impact their practice (81.1%), with a high degree of immersion (95.7%-99.3%), and the majority of side effects were perceived as mild (70.4%-81.4%). CONCLUSIONS Our novel MUVR simulation demonstrated significant differences in sepsis recognition between experienced and novice participants. This validity evidence along with the data on the simulation's acceptability supports expanded use in training and assessment.
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Affiliation(s)
- Matthew W Zackoff
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Center for Simulation and Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Bradley Cruse
- Center for Simulation and Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Rashmi D Sahay
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Bin Zhang
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Tina Sosa
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
- Division of Pediatric Hospital Medicine, University of Rochester Medical Center, Rochester, New York, USA
- UR Medicine Quality Institute, University of Rochester Medical Center, Rochester, New York
| | - Jerome Schwartz
- Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Holly Depinet
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Daniel Schumacher
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Gary L Geis
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Center for Simulation and Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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113
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You P, Gao RY, Han YZ, Zhang XK, Li WX, Huang LF. Postoperative plasma presepsin as a biomarker of postoperative infectious complications in different surgical departments: A meta-analysis and systematic review. Am J Surg 2024; 229:65-75. [PMID: 38065723 DOI: 10.1016/j.amjsurg.2023.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 03/01/2024]
Abstract
BACKGROUND High rates of postoperative infection persist after different surgical procedures, encompassing surgical site infections (SSIs), remote infections, sepsis, and septic shock. Our aim was to assess presepsin's diagnostic accuracy for postoperative infections in patients across surgical procedures. METHOD We conducted a comprehensive search in seven databases, extracting data independently. Using STATA 14.0, we calculated pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and Under the receiver operator curve and 95 % confidence interval (AUC, 95 % CI) as primary outcomes, with secondary outcomes involving sensitivity and specificity in subgroup analyses. RESULTS This meta-analysis of 14 studies (1891 cases) evaluated presepsin's diagnostic value for postoperative infectious complications. Results include sensitivity of 77 % (70-83), specificity of 81 % (71-88), DOR of 14 (8-26), AUC of 84 (80-87), PLR of 4 (3-6), and NLR of 0.28 (0.21-0.38). Presepsin exhibits promise as a diagnostic tool for postoperative infections. CONCLUSION In summary, compared to conventional markers like C-reactive protein (CRP) and procalcitonin (PCT), presepsin demonstrated superior sensitivity and specificity for detecting postoperative infectious complications across various surgical procedures.
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Affiliation(s)
- Pan You
- Department of Surgical Intensive Care Unit, Beijing Chao-yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China.
| | - Rong-Yue Gao
- Department of Surgical Intensive Care Unit, Beijing Chao-yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China.
| | - Yu-Zhen Han
- Department of Surgical Intensive Care Unit, Beijing Chao-yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China.
| | - Xiao-Ke Zhang
- Department of Surgical Intensive Care Unit, Beijing Chao-yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China.
| | - Wen-Xiong Li
- Department of Surgical Intensive Care Unit, Beijing Chao-yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China.
| | - Li-Feng Huang
- Department of Surgical Intensive Care Unit, Beijing Chao-yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China.
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Hellali R, Chelly Dagdia Z, Ktaish A, Zeitouni K, Annane D. Corticosteroid sensitivity detection in sepsis patients using a personalized data mining approach: A clinical investigation. Comput Methods Programs Biomed 2024; 245:108017. [PMID: 38241801 DOI: 10.1016/j.cmpb.2024.108017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 10/29/2023] [Accepted: 01/09/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND AND OBJECTIVE Sepsis is a life-threatening disease with high mortality, incidence, and morbidity. Corticosteroids (CS) are a recommended treatment for sepsis, but some patients respond negatively to CS therapy. Early prediction of corticosteroid responsiveness can help intervene and reduce mortality. In this study, we aim to develop a data mining methodology for predicting CS responsiveness of septic patients. METHODS We used data from a randomized controlled trial called APROCCHSS, which recruited 1241 septis patients to study the effectiveness of corticotherapy. We conducted a thorough study of multiple machine learning models to select the most efficient prediction model, called "signature". We evaluated the performance of the signature using precision, sensitivity, and specificity values. RESULTS We found that Logistic Regression was the best model with an AUC of 72%. We conducted further experiments to examine the impact of additional features and the model's generalizability to different groups of patients. We also performed a statistical analysis to analyze the effect of the treatment at the individual level and on the population as a whole. CONCLUSIONS Our data mining methodology can accurately predict cortico-sensitivity or resistance in septis patients. The signature has been deployed into the Assistance Publique - Hôpitaux de Paris (APHP) information system as a web service, taking patient information as input and providing a prediction of cortico-sensitivity or resistance. Early prediction of corticosteroid responsiveness can help clinicians intervene promptly and improve patient outcomes.
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Affiliation(s)
- Rahma Hellali
- Université Paris-Saclay, UVSQ, DAVID, Paris, France.
| | - Zaineb Chelly Dagdia
- Université Paris-Saclay, UVSQ, DAVID, Paris, France; Université de Tunis, Institut supérieur de gestion de Tunis, LARODEC, Tunis, Tunisia
| | | | | | - Djillali Annane
- Réanimation medico-chirurgicale, hôpital Raymond-Poincaré, AP-HP, Garches, France
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115
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Jin S, Yin JB, Li W, Zang LL. Effect of neutrophil to lymphocyte ratio on prognosis of elderly patients with severe sepsis combined with diabetes mellitus. BMC Geriatr 2024; 24:211. [PMID: 38424501 PMCID: PMC10905898 DOI: 10.1186/s12877-024-04757-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/30/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND To investigate the predictive value of neutrophil-to-lymphocyte ratio (NLR) in the short-term prognosis of elderly patients with severe sepsis combined with diabetes mellitus (DM). METHODS The clinical data of 162 elderly patients with severe sepsis combined with DM from January 2018 to December 2022 were retrospectively collected. These patients were divided into a survival group (n = 104) and a death group (n = 58) according to 90-day prognosis. The number of neutrophils, lymphocytes, and NLR were compared. The optimal cut-off value for NLR to predict 90-day prognosis in elderly patients with severe sepsis combined with DM was determined using Receiver Operator Characteristic (ROC) curves, and the patients were divided into high and low NLR groups depending on the optimal cut-off value. The Kaplan-Meier method was used to plot the survival curves of the high and low NLR groups. Risk factors for the 90-day death in elderly patients with severe sepsis combined with DM were analyzed by a multivariate cox regression model. RESULTS There were no significant differences in gender, age, history of hypertension and hyperlipidemia, intensive care unit (ICU) stay, duration of mechanical ventilation, and oxygenation index between the survival group and death group (p > 0.05). However, acute physiological and chronic health evaluation II (APACHE II) scores, and sepsis-related organ failure assessment (SOFA) scores were significantly lower in the survival group compared with the death group (p < 0.05). In the survival group, neutrophils counts and NLR were much lower than those in the death group, while lymphocytes counts were much higher (p < 0.05). ROC curves showed that the optimal cut-off value for NLR to predict 90-day mortality in elderly patients with severe sepsis combined with DM was 3.482. Patients were divided into high NLR and low NLR groups based on whether NLR was ≥ 3.482. In terms of the log-rank test results, patients in the low NLR group had a significantly higher 90-day survival rate than those in the high NLR group (Logrank χ2 = 8.635, p = 0.003). The multivariate cox regression model showed that the length of ICU stay longer than 15 days and NLR ≥ 3.482 were independent risk factors for 90-day prognosis in elderly patients with severe sepsis combined with DM. CONCLUSION NLR ≥ 3.482 can be used to predict whether poor prognosis occurs in the short term after illness in elderly patients with severe sepsis combined with DM, and has good assessment value.
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Affiliation(s)
- Shan Jin
- Department of Neurology, Shandong Province 960th Hospital of the People's Liberation Army, 250031, Jinan, Shandong, China.
| | - Jun-Bin Yin
- Department of Neurology, Shandong Province 960th Hospital of the People's Liberation Army, 250031, Jinan, Shandong, China
| | - Wei Li
- Department of Neurology, Shandong Province 960th Hospital of the People's Liberation Army, 250031, Jinan, Shandong, China
| | - Li-Li Zang
- Department of Neurology, Shandong Province 960th Hospital of the People's Liberation Army, 250031, Jinan, Shandong, China
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Barshilia D, Huang JJ, Komaram AC, Chen YC, Chen CD, Syu MY, Chao WC, Chau LK, Chang GE. Ultrasensitive and Rapid Detection of Procalcitonin via Waveguide-Enhanced Nanogold-Linked Immunosorbent Assay for Early Sepsis Diagnosis. Nano Lett 2024; 24:2596-2602. [PMID: 38251930 PMCID: PMC10906069 DOI: 10.1021/acs.nanolett.3c04762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Sepsis, a life-threatening inflammatory response, demands economical, accurate, and rapid detection of biomarkers during the critical "golden hour" to reduce the patient mortality rate. Here, we demonstrate a cost-effective waveguide-enhanced nanogold-linked immunosorbent assay (WENLISA) based on nanoplasmonic waveguide biosensors for the rapid and sensitive detection of procalcitonin (PCT), a sepsis-related inflammatory biomarker. To enhance the limit of detection (LOD), we employed sandwich assays using immobilized capture antibodies and detection antibodies conjugated to gold nanoparticles to bind the target analyte, leading to a significant evanescent wave redistribution and strong nanoplasmonic absorption near the waveguide surface. Experimentally, we detected PCT for a wide linear response range of 0.1 pg/mL to 1 ng/mL with a record-low LOD of 48.7 fg/mL (3.74 fM) in 8 min. Furthermore, WENLISA has successfully identified PCT levels in the blood plasma of patients with sepsis and healthy individuals, offering a promising technology for early sepsis diagnosis.
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Affiliation(s)
- Devesh Barshilia
- Department of Mechanical Engineering, National Chung Cheng University, Chiayi 621301, Taiwan
- Advanced Institute of Manufacturing with High-Tech Innovations (AIM-HI), National Chung Cheng University, Chiayi 621301, Taiwan
| | - Jhen-Jie Huang
- Department of Chemistry and Biochemistry, National Chung Cheng University, Chiayi 621301, Taiwan
| | | | - Yi-Che Chen
- Department of Chemistry and Biochemistry, National Chung Cheng University, Chiayi 621301, Taiwan
| | - Chun-Da Chen
- Department of Laboratory Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin 640, Taiwan
| | - Min-Yu Syu
- Department of Laboratory Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin 640, Taiwan
| | - Wen-Cheng Chao
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung 402202, Taiwan
| | - Lai-Kwan Chau
- Department of Chemistry and Biochemistry, National Chung Cheng University, Chiayi 621301, Taiwan
- Center for Nano Bio-Detection, National Chung Cheng University, Chiayi 621301, Taiwan
| | - Guo-En Chang
- Department of Mechanical Engineering, National Chung Cheng University, Chiayi 621301, Taiwan
- Advanced Institute of Manufacturing with High-Tech Innovations (AIM-HI), National Chung Cheng University, Chiayi 621301, Taiwan
- Center for Nano Bio-Detection, National Chung Cheng University, Chiayi 621301, Taiwan
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Jabornisky R, Kuppermann N, González-Dambrauskas S. Transitioning From SIRS to Phoenix With the Updated Pediatric Sepsis Criteria-The Difficult Task of Simplifying the Complex. JAMA 2024; 331:650-651. [PMID: 38245901 DOI: 10.1001/jama.2023.27988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Affiliation(s)
- Roberto Jabornisky
- Department of Women, Children, and Adolescents, Faculty of Medicine, National University of the Northeast, Corrientes, Argentina
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Montevideo, Uruguay
| | - Nathan Kuppermann
- Departments of Emergency Medicine and Pediatrics, UC Davis School of Medicine and UC Davis Health, Sacramento, California
| | - Sebastián González-Dambrauskas
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Montevideo, Uruguay
- Departamento de Pediatría y Unidad de Cuidados Intensivos de Niños del Centro Hospitalario Pereira Rossell, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
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Carlton EF, Perry-Eaddy MA, Prescott HC. Context and Implications of the New Pediatric Sepsis Criteria. JAMA 2024; 331:646-649. [PMID: 38245890 DOI: 10.1001/jama.2023.27979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Affiliation(s)
- Erin F Carlton
- Department of Pediatrics, University of Michigan, Ann Arbor
- Susan B. Meister Child Health Evaluation and Research, Ann Arbor, Michigan
| | - Mallory A Perry-Eaddy
- University of Connecticut School of Nursing, Storrs
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington
- Pediatric Intensive Care Unit, Connecticut Children's, Hartford
| | - Hallie C Prescott
- Department of Internal Medicine, University of Michigan, Ann Arbor
- VA Center for Clinical Management Research, Ann Arbor, Michigan
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Skei NV, Afset JE, Ehrnström B, Nessan BS, Damås JK, Nilsen TIL, Gustad LT. Coding practice for sepsis 2008-21. Tidsskr Nor Laegeforen 2024; 144:23-0271. [PMID: 38415570 DOI: 10.4045/tidsskr.23.0271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024] Open
Abstract
Background Sepsis has a high incidence and mortality rate. Accurate data are needed for health service planning and for research, and there is a need to identify coding practices in Norway. Material and method All patients over 17 years of age who had been admitted to Norwegian hospitals with sepsis in the period 2008-21 were identified using diagnostic codes for infection plus organ failure, and specific codes for sepsis, from the Norwegian Patient Registry. Results There were 317 705 admissions with diagnostic codes for sepsis, of which 210 391 (66.2 %) were sepsis with a known focus, 77 627 (24.4 %) were of unknown focus and 29 687 (9.3 %) were codes for both a known and unknown focus. The percentage of sepsis episodes coded with a known focus varied between the health regions. The highest percentage was in the Western Norway Regional Health Authority (72.1 %, 95 % confidence interval (CI): 71.8 to 72.5), and the lowest was in the Central Norway Regional Health Authority (59.2 %, 95 %, CI 58.7 to 59.7). The use of codes with a known focus increased each year on average by 3.2 % (95 % CI 2.7 to 3.6, from 47.5 % in 2008 to 82.3 % in 2021), while the use of codes with an unknown focus decreased by 2.3 % (95 % CI -2.7 to -1.9) from 37.8 % in 2008 to 13.0 % in 2021. Known and unknown focus combined also decreased by 0.9 % per year on average (95 % CI -1.0 to -0.8) from 14.3 % in 2008 to 4.1 % in 2021. Interpretation The coding of sepsis in Norwegian hospitals has become more uniform.
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Affiliation(s)
- Nina Vibeche Skei
- Avdeling for anestesi- og intensivmedisin, Sykehuset Levanger, og, Midt-norsk senter for sepsisforskning, Institutt for sirkulasjon og bildediagnostikk, NTNU
| | - Jan Egil Afset
- Institutt for klinisk og molekylær medisin, Fakultetet for medisin og helsevitenskap, NTNU, og, Avdeling for medisinsk mikrobiologi, St. Olavs hospital
| | - Birgitta Ehrnström
- Midt-norsk senter for sepsisforskning, Klinikk for anestesi og intensivmedisin, NTNU, og, Infeksjonsmedisinsk avdeling, Medisinsk klinikk, St. Olavs hospital
| | | | - Jan Kristian Damås
- Midt-norsk senter for sepsisforskning, Institutt for sirkulasjon og bildediagnostikk, NTNU, og, Infeksjonsmedisinsk avdeling, Medisinsk klinikk, St. Olavs hospital
| | - Tom Ivar Lund Nilsen
- Institutt for samfunnsmedisin og sykepleie, NTNU, Tom Ivar Lund Nilsen er professor
| | - Lise Tuset Gustad
- Midt-norsk senter for sepsisforskning, Institutt for sirkulasjon og bildediagnostikk, NTNU, og, Fakultet for sykepleie og helsevitenskap, Nord Universitet, Levanger, og, Klinikk for medisin og rehabilitering, Levanger Sykehus
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Yue J, Zhao H, Li J, Wu J, Zheng R. Knowledge, attitudes and practices towards the diagnosis and management of paediatric sepsis among paediatric physicians and nurses: a cross-sectional study of 21 hospitals in Hubei Province, China. BMJ Open 2024; 14:e079411. [PMID: 38417965 PMCID: PMC10900314 DOI: 10.1136/bmjopen-2023-079411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 02/14/2024] [Indexed: 03/01/2024] Open
Abstract
OBJECTIVES To evaluate the knowledge, attitudes and practices towards diagnosing and managing paediatric sepsis among paediatric physicians and nurses. DESIGN A cross-sectional, questionnaire-based study. SETTING 21 hospitals in Hubei Province between February 2023 and March 2023. PARTICIPANTS Paediatric physicians and nurses. INTERVENTIONS None. PRIMARY AND SECONDARY OUTCOME MEASURES The questionnaire contained 35 items across four dimensions (demographic information, knowledge, attitude and practice). RESULTS The 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<0.001), while not working in a tertiary hospital reduced the odds of good practice (OR=0.443; 95% CI 0.2390.821; p=0.010). CONCLUSIONS The knowledge regarding paediatric sepsis, especially knowledge about sepsis management, is poor among paediatric physicians and nurses in Hubei Province. The findings of this study may facilitate the development and implementation of training programmes to improve the diagnosis and management of paediatric sepsis.
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Affiliation(s)
- Jing Yue
- Department of Emergence, Hubei Province Women and Children Hospital, Wuhan, Hubei, China
| | - Hui Zhao
- Department of Emergence, Hubei Province Women and Children Hospital, Wuhan, Hubei, China
| | - Jie Li
- Department of Emergence, Hubei Province Women and Children Hospital, Wuhan, Hubei, China
| | - Jiannan Wu
- Department of Emergence, Hubei Province Women and Children Hospital, Wuhan, Hubei, China
| | - Ronghao Zheng
- Department of Pediatric Nephrology, Rheumatology, and Immunology, Maternal and Child Health Hospital of Hubei Province, Wuhan, Hubei, China
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Choudhary R, Watakulsin P, Promduangsi P, Chuenchom N, Khemla S, Lurchachaiwong W, Mock P, Heffelfinger JD, MacArthur JR, Bloss E, Thamthitiwat S, Rao CY. Underdiagnosis in clinical documentation of community-acquired sepsis among children admitted to hospitals in two rural provinces: Thailand, October-December 2017. BMJ Paediatr Open 2024; 8:e002293. [PMID: 38413125 PMCID: PMC10900380 DOI: 10.1136/bmjpo-2023-002293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/19/2024] [Indexed: 02/29/2024] Open
Abstract
Paediatric sepsis prevalence data from low-income and middle-income countries are lacking. In a cross-sectional study, we assessed clinician recognition and documentation of non-neonatal community-acquired paediatric sepsis in two rural border provinces in Thailand among children admitted between October and December 2017. Of the 152 children meeting sepsis criteria (26.9 paediatric sepsis patients per 1000 admissions), 15 (9.9%) had a clinician-documented admission diagnosis of sepsis or septic shock and 18 (11.8%) had a discharge diagnosis with International Classification of Diseases-10 codes related to sepsis. Clinician underdocumentation may cause challenges in global paediatric sepsis surveillance.
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Affiliation(s)
- Rewa Choudhary
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Division of Global Health Protection, Centers for Disease Control and Prevention Global Health Center, Atlanta, Georgia, USA
| | - Peeriya Watakulsin
- Department of Disease Control (DDC), Royal Thai Government Ministry of Public Health, Bangkok, Thailand
| | - Pitiphon Promduangsi
- Department of Disease Control (DDC), Royal Thai Government Ministry of Public Health, Bangkok, Thailand
| | | | | | | | - Philip Mock
- Totally Joined for Achieving Collaborative Techniques (TJFACT) LLC, Atlanta, Georgia, USA
| | - James D Heffelfinger
- Division of Global Health Protection, Centers for Disease Control and Prevention Global Health Center, Atlanta, Georgia, USA
- Thailand Ministry of Public Health-US CDC Collaboration, Bangkok, Thailand
| | - John R MacArthur
- Division of Global Health Protection, Centers for Disease Control and Prevention Global Health Center, Atlanta, Georgia, USA
- Thailand Ministry of Public Health-US CDC Collaboration, Bangkok, Thailand
| | - Emily Bloss
- Division of Global Health Protection, Centers for Disease Control and Prevention Global Health Center, Atlanta, Georgia, USA
- Thailand Ministry of Public Health-US CDC Collaboration, Bangkok, Thailand
| | | | - Carol Y Rao
- Division of Global Health Protection, Centers for Disease Control and Prevention Global Health Center, Atlanta, Georgia, USA
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Chen J, Si J, Li Q, Zhang W, He J. Unlocking the potential of senescence-related gene signature as a diagnostic and prognostic biomarker in sepsis: insights from meta-analyses, single-cell RNA sequencing, and in vitro experiments. Aging (Albany NY) 2024; 16:3989-4013. [PMID: 38412321 DOI: 10.18632/aging.205574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/08/2024] [Indexed: 02/29/2024]
Abstract
Cellular senescence is closely associated with the pathogenesis of sepsis. However, the diagnostic and prognostic value of senescence-related genes remain unclear. In this study, 866 senescence-related genes were collected from CellAge. The training cohort, GSE65682, which included 42 control and 760 sepsis samples, was obtained from the Gene Expression Omnibus (GEO). Feature selection was performed using gene expression difference detection, LASSO analysis, random forest, and Cox regression. TGFBI and MAD1L1 were ultimately selected for inclusion in the multivariate Cox regression model. Clustering based on the expressions of TGFBI and MAD1L1 was significantly associated with sepsis characteristics and prognoses (all P < 0.05). The risk signature served as a reliable prognostic predictor across the GSE65682, GSE95233, and GSE4607 cohorts (pooled hazard ratio = 4.27; 95% confidence interval [CI] = 1.63-11.17). Furthermore, it also served as a robust classifier to distinguish sepsis samples from control cases across 14 cohorts (pooled odds ratio = 5.88; 95% CI = 3.54-9.77). Single-cell RNA sequencing analyses from five healthy controls and four sepsis subjects indicated that the risk signature could reflect the senescence statuses of monocytes and B cells; this finding was then experimentally validated in THP-1 and IM-9 cells in vitro (both P < 0.05). In all, a senescence-related gene signature was developed as a prognostic and diagnostic biomarker for sepsis, providing cut-in points to uncover underlying mechanisms and a promising clinical tool to support precision medicine.
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Affiliation(s)
- Jia Chen
- Department of Emergency, Panyu Maternal and Child Care Service Centre of Guangzhou, Hexian Memorial Affiliated Hospital of Southern Medical University, Panyu, Guangzhou 511400, Guangdong Province, China
| | - Jinhong Si
- Department of Respiratory Medicine, Panyu Maternal and Child Care Service Centre of Guangzhou, Hexian Memorial Affiliated Hospital of Southern Medical University, Panyu, Guangzhou 511400, Guangdong Province, China
| | - Qiankun Li
- Department of Emergency, Panyu Maternal and Child Care Service Centre of Guangzhou, Hexian Memorial Affiliated Hospital of Southern Medical University, Panyu, Guangzhou 511400, Guangdong Province, China
| | - Weihong Zhang
- Department of Emergency, Panyu Maternal and Child Care Service Centre of Guangzhou, Hexian Memorial Affiliated Hospital of Southern Medical University, Panyu, Guangzhou 511400, Guangdong Province, China
| | - Jiahao He
- Department of Emergency, Panyu Maternal and Child Care Service Centre of Guangzhou, Hexian Memorial Affiliated Hospital of Southern Medical University, Panyu, Guangzhou 511400, Guangdong Province, China
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123
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Liu Y, Wang R, Zhong S, Qian L, Wang D. Monocyte distribution width as an early predictor of short-term outcome in adult patients with sepsis. Clin Chem Lab Med 2024; 62:562-571. [PMID: 37815315 DOI: 10.1515/cclm-2023-0577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/10/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVES Monocyte distribution width (MDW) is a quantitative measurement of monocyte anisocytosis and has been proposed as an efficient marker for early sepsis detection. This study aimed to assess the prognostic potential of MDW in septic patients. METHODS In this study, a total of 252 adult septic patients were enrolled. Demographic, clinical, and laboratory finding including MDW and traditional inflammatory biomarkers detected at three time points (day 1, day 3 and day 6) after admission were collected and compared between 28-day survivors and non-survivors. Receiver operating characteristic (ROC) curves, Kaplan-Meier survival curve and Cox regression analyses were performed to assess and compare their predictive values. Group-based trajectory modeling was applied to identify MDW trajectory endotypes. Basic characteristics and 28-day outcomes were compared between the trajectories. RESULTS ROC curve analysis showed that MDW levels measured on day 3 after admission (D3-MDW) had moderate prognostic value and was independently associated with 28-day mortality in patients with sepsis. A D3-MDW value of 26.20 allowed discrimination between survivors and non-survivors with a sensitivity of 77.8 % and a specificity of 67.6 %. However, the prognostic accuracy of D3-MDW was diminished in immune-compromised patients and patients who already received antibiotics before admission. Group-based trajectory modeling indicated that excessively elevated and delayed decreased MDW levels during the first week after admission inversely correlated with prognosis. CONCLUSIONS MDW values detected on day 3 after admission and its kinetic change might be potential markers for predicting short-term outcome in adult septic patients.
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Affiliation(s)
- Yin Liu
- Department of Laboratory Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, P.R. China
| | - Ruizhi Wang
- Department of Laboratory Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, P.R. China
| | - Shihua Zhong
- School of Basic Medical Sciences, Southern Medical University, Guangzhou, P.R. China
| | - Liu Qian
- Department of Medical Affair, Danaher Diagnostic Platform, Shanghai, P.R. China
| | - Dong Wang
- Department of Laboratory Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, P.R. China
- Department of Laboratory Medicine, Guangxi Hospital Division of the First Affiliated Hospital, Sun Yat-Sen University, Nanning, P.R. China
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124
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Pandey S. Sepsis, Management & Advances in Metabolomics. Nanotheranostics 2024; 8:270-284. [PMID: 38577320 PMCID: PMC10988213 DOI: 10.7150/ntno.94071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/08/2024] [Indexed: 04/06/2024] Open
Abstract
Though there have been developments in clinical care and management, early and accurate diagnosis and risk stratification are still bottlenecks in septic shock patients. Since septic shock is multifactorial with patient-specific underlying co-morbid conditions, early assessment of sepsis becomes challenging due to variable symptoms and clinical manifestations. Moreover, the treatment strategies are traditionally based on their progression and corresponding clinical symptoms, not personalized. The complex pathophysiology assures that a single biomarker cannot identify, stratify, and describe patients affected by septic shock. Traditional biomarkers like CRP, PCT, and cytokines are not sensitive and specific enough to be used entirely for a patient's diagnosis and prognosis. Thus, the need of the hour is a sensitive and specific biomarker after comprehensive analysis that may facilitate an early diagnosis, prognosis, and drug development. Integration of clinical data with metabolomics would provide means to understand the patient's condition, stratify patients better, and predict the clinical outcome.
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Affiliation(s)
- Swarnima Pandey
- University of Maryland, School of Pharmacy, Department of Pharmaceutical Sciences, Baltimore, MD, USA
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125
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Shimoyama Y, Kadono N, Umegaki O. Presepsin is a more useful predictor of septic AKI and ARDS for very-old sepsis patients than for young sepsis patients in ICUs: a pilot study. BMC Res Notes 2024; 17:53. [PMID: 38378647 PMCID: PMC10877906 DOI: 10.1186/s13104-024-06719-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 02/14/2024] [Indexed: 02/22/2024] Open
Abstract
OBJECTIVE Sepsis is a syndrome of life-threatening organ dysfunction. This study aimed to determine whether presepsin is a useful predictor of septic acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), disseminated intravascular coagulation (DIC), and shock in very-old sepsis patients aged 75 years in intensive care units (ICUs). RESULTS A total of 83 adult patients diagnosed with sepsis were prospectively examined and divided into two groups: those aged 75 years and older (over 75 group) and those aged younger than 75 years (under 75 group). Presepsin values were measured after ICU admission. Inflammation-based prognostic scores were also examined. For category classification, total scores ("inflammation-presepsin scores [iPS]") were calculated. Presepsin values, inflammation-based prognostic scores, and iPS were compared between patients with septic AKI, ARDS, DIC, or shock and those without these disorders in the over 75 and under 75 groups. Areas under the curve of presepsin for predicting septic AKI and ARDS in the over 75 group were both > 0.7, which were significantly higher than those in the under 75 group. In conclusion, presepsin is a more useful predictor of septic AKI and ARDS for very-old sepsis patients (over 75 years) than for younger sepsis patients (under 75 years).
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Affiliation(s)
- Yuichiro Shimoyama
- Department of Anesthesiology, Intensive Care Unit, Osaka Medical and Pharmaceutical University, Osaka Medical and Pharmaceutical University Hospital, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan.
| | - Noriko Kadono
- Department of Anesthesiology, Intensive Care Unit, Osaka Medical and Pharmaceutical University, Osaka Medical and Pharmaceutical University Hospital, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan
| | - Osamu Umegaki
- Department of Anesthesiology, Intensive Care Unit, Osaka Medical and Pharmaceutical University, Osaka Medical and Pharmaceutical University Hospital, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan
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126
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Phoenix sepsis score: redefining paediatric sepsis. Arch Dis Child 2024; 109:194. [PMID: 38373748 DOI: 10.1136/archdischild-2024-326941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 02/21/2024]
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127
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Yew R, Macaskill L, Brown S, Dixie M, Dogar D, Checketts E, Surana P. Impact of adopting a neonatal sepsis risk calculator in a diverse population in Birmingham, UK. Arch Dis Child Fetal Neonatal Ed 2024; 109:227-228. [PMID: 37607807 DOI: 10.1136/archdischild-2023-325883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 08/24/2023]
Affiliation(s)
- Rachel Yew
- Neonatal Unit, Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Laura Macaskill
- Neonatal Unit, Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Sebastian Brown
- PRAM, Paediatric Research Across the Midlands, West Midlands, UK
| | - Michael Dixie
- Neonatal Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Daniel Dogar
- Neonatal Unit, Good Hope Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Elizabeth Checketts
- Neonatal Unit, Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Pinki Surana
- Neonatal Unit, Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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128
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Jouffroy R, Négrello F, Limery J, Gilbert B, Travers S, Bloch-Laine E, Ecollan P, Boularan J, Bounes V, Vivien B, Gueye P. The prehospital NEW score to assess septic shock in-hospital, 30-day and 90-day mortality. BMC Infect Dis 2024; 24:213. [PMID: 38365608 PMCID: PMC10873999 DOI: 10.1186/s12879-024-09104-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 02/06/2024] [Indexed: 02/18/2024] Open
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.
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Affiliation(s)
- Romain Jouffroy
- Intensive Care Unit, Ambroise Paré Hospital- Assistance Publique Hôpitaux Paris, 9 avenue Charles De Gaulle, 92100, Boulogne-Billancourt, Paris, France.
- IRMES - Institute for Research in Medicine and Epidemiology of Sport, INSEP, Paris, France.
- INSERM U-1018, Centre de recherche en Epidémiologie et Santé des Populations - U1018 INSERM, Paris Saclay University, Villejuif, France.
- SAMU 972, Centre Hospitalier Universitaire de Martinique, Fort-de-France Martinique, France.
- UR5_3 PC2E, University of the Antilles, French West Indies, France.
| | - Florian Négrello
- SAMU 972, Centre Hospitalier Universitaire de Martinique, Fort-de-France Martinique, France
- UR5_3 PC2E, University of the Antilles, French West Indies, France
| | - Jean Limery
- SAMU 972, Centre Hospitalier Universitaire de Martinique, Fort-de-France Martinique, France
- UR5_3 PC2E, University of the Antilles, French West Indies, France
| | - Basile Gilbert
- Department of Emergency Medicine, SAMU 31, University Hospital of Toulouse, Toulouse, France
| | | | - Emmanuel Bloch-Laine
- Emergency Department, Cochin Hospital, Paris, France
- Emergency Department, SMUR, Hôtel Dieu Hospital, Paris, France
| | - Patrick Ecollan
- Intensive Care Unit, SMUR, Pitie Salpêtriere Hospital, 47 Boulevard de l'Hôpital, 75013, Paris, France
| | - Josiane Boularan
- Centre Hospitalier Intercommunal Castres-Mazamet, Castres, France
| | - Vincent Bounes
- Department of Emergency Medicine, SAMU 31, University Hospital of Toulouse, Toulouse, France
| | - Benoit Vivien
- Intensive Care Unit, Anaesthesiology, SAMU, Necker Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Papa Gueye
- SAMU 972, Centre Hospitalier Universitaire de Martinique, Fort-de-France Martinique, France
- UR5_3 PC2E, University of the Antilles, French West Indies, France
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Xu H, Ca D, Zhou L. Diagnostic and prognostic value of PCT and RDW in premature infants with septicemia. Medicine (Baltimore) 2024; 103:e35725. [PMID: 38363932 PMCID: PMC10869038 DOI: 10.1097/md.0000000000035725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 09/29/2023] [Indexed: 02/18/2024] Open
Abstract
It aims to study the diagnostic effect of procalcitonin (PCT) and red blood cell distribution width (RDW) in premature septicemia (PS), and to analyze the prognostic evaluation value of PCT and RDW in PS. Ninety eight septicemia premature infants (SPI) who visited the neonatal intensive care unit of our hospital from June 2019 to July 2021 were selected and met the criteria. Based on the patient's condition and the neonatal shock score, they were separated into a severe group (SG) and a mild group (MG). There were 43 children and 55 children in the 2 groups, respectively. According to the survival status of SPI after 3 days of treatment, they were divided into a death group and a SG. It detected and analyzed the peripheral venous blood of SPI before treatment (BT) and after treatment (AT), and observed the changes of PCT and RDW. The comparison of general data between severe and mild SPI and their mothers did not have statistical significance (P > .05). The PCT of the SG was higher than that of the MG BT, on the 1st day and the 3rd day AT; The PCT BT and AT in both groups ranged from high to low on the 1st day and the 3rd day AT and BT (P < .05). The RDW in the SG were higher than those in the MG, and the RDW BT and AT in both groups were the highest on the 1st day AT; The RDW BT in the MG was higher than on the 3rd day AT, while the RDW BT in the SG was lower than on the 3rd day AT (P < .05). The optimal cutoff values for PCT on the 1st and 3rd day AT were 40.594ng/ml and 64.854ng/ml, respectively, with sensitivity of 100.0% and 100.0%, and specificity of 73.2% and 87.1% (P < .05). The optimal cutoff values for RDW on the 1st and 3rd day AT were 16.649% and 18.449%, respectively, with sensitivity of 100.0% and 100.0%, and specificity of 68.5% and 91.8% (P < .05). Monitoring the changes in PCT and RDW can promote the early diagnosis of PS and their prognosis evaluation.
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Affiliation(s)
- Huafen Xu
- Department of Neonatology, Hainan Provincial People’s Hospital, Haikou, Hainan, China
| | - Dong Ca
- Department of Neonatology, Hainan Provincial People’s Hospital, Haikou, Hainan, China
| | - Lixia Zhou
- Department of Neonatology, Hainan Provincial People’s Hospital, Haikou, Hainan, China
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130
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Marin MJ, van Wijk XMR, Chambliss AB. Advances in sepsis biomarkers. Adv Clin Chem 2024; 119:117-166. [PMID: 38514209 DOI: 10.1016/bs.acc.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Sepsis, a dysregulated host immune response to an infectious agent, significantly increases morbidity and mortality for hospitalized patients worldwide. This chapter reviews (1) the basic principles of infectious diseases, pathophysiology and current definition of sepsis, (2) established sepsis biomarkers such lactate, procalcitonin and C-reactive protein, (3) novel, newly regulatory-cleared/approved biomarkers, such as assays that evaluate white blood cell properties and immune response molecules, and (4) emerging biomarkers and biomarker panels to highlight future directions and opportunities in the diagnosis and management of sepsis.
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Affiliation(s)
- Maximo J Marin
- Department of Pathology, Immunology & Laboratory Medicine, University of Florida, Gainesville, Florida, USA
| | | | - Allison B Chambliss
- Department of Pathology & Laboratory Medicine, University of California Los Angeles, Los Angeles, California, USA
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131
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Shahriari S, Damodara S, Selvaganapathy PR. Isoelectric trapping and discrimination of histones from plasma in a microfluidic device using dehydrated isoelectric gate. Mikrochim Acta 2024; 191:131. [PMID: 38351209 DOI: 10.1007/s00604-024-06223-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/19/2024] [Indexed: 02/16/2024]
Abstract
Histones are basic proteins with an isoelectric point around 11. It has been shown that the level of plasma circulating histones increases significantly during sepsis, and circulating free histones are associated with sepsis severity and mortality. It was found that the median plasma total free histone concentration of sepsis ICU non-survivors is higher compared to survivors. Therefore, histone concentration can serve as a prognostic indicator and there is a need for a simple, low-cost, and rapid method for measuring histone levels. In this work, we have developed a microfluidic device containing an isoelectric membrane made of dehydrated agarose gel of a specific pH embedded in a porous membrane for isoelectric trapping of histones rapidly. Although isoelectric gates have been used for trapping proteins before, they have to be introduced at the time of the experiment. Here, we show that isoelectric gates formed by gels loaded in a scaffold can be integrated directly into the fabrication process flow, dehydrated for storage, and rehydrated during the experiment and still function effectively to achieve isoelectric trapping. A low-cost and rapid microfabrication technique, xurography, was used for agarose integration and device fabrication. The integrated device was tested with samples containing buffered histone, histone in the presence of high-concentration bovine serum albumin (BSA), and histone spiked in blood plasma. The results show that the device can be used to distinguish between survivors and non-survivors of sepsis in less than 10 min, making it suitable as a point-of-care device for sepsis prognosis.
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Affiliation(s)
- Shadi Shahriari
- Department of Mechanical Engineering, McMaster University, Hamilton, ON, Canada
| | - Sreekant Damodara
- Department of Mechanical Engineering, McMaster University, Hamilton, ON, Canada
| | - P Ravi Selvaganapathy
- Department of Mechanical Engineering, McMaster University, Hamilton, ON, Canada.
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada.
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Kasputis T, He Y, Ci Q, Chen J. On-Site Fluorescent Detection of Sepsis-Inducing Bacteria using a Graphene-Oxide CRISPR-Cas12a (GO-CRISPR) System. Anal Chem 2024; 96:2676-2683. [PMID: 38290431 PMCID: PMC10867801 DOI: 10.1021/acs.analchem.3c05459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/02/2024] [Accepted: 01/08/2024] [Indexed: 02/01/2024]
Abstract
Sepsis is an extremely dangerous medical condition that emanates from the body's response to a pre-existing infection. Early detection of sepsis-inducing bacterial infections can greatly enhance the treatment process and potentially prevent the onset of sepsis. However, current point-of-care (POC) sensors are often complex and costly or lack the ideal sensitivity for effective bacterial detection. Therefore, it is crucial to develop rapid and sensitive biosensors for the on-site detection of sepsis-inducing bacteria. Herein, we developed a graphene oxide CRISPR-Cas12a (GO-CRISPR) biosensor for the detection of sepsis-inducing bacteria in human serum. In this strategy, single-stranded (ssDNA) FAM probes were quenched with single-layer graphene oxide (GO). Target-activated Cas12a trans-cleavage was utilized for the degradation of the ssDNA probes, detaching the short ssDNA probes from GO and recovering the fluorescent signals. Under optimal conditions, we employed our GO-CRISPR system for the detection of Salmonella Typhimurium (S. Typhimurium) with a detection sensitivity of as low as 3 × 103 CFU/mL in human serum, as well as a good detection specificity toward other competing bacteria. In addition, the GO-CRISPR biosensor exhibited excellent sensitivity to the detection of S. Typhimurium in spiked human serum. The GO-CRISPR system offers superior rapidity for the detection of sepsis-inducing bacteria and has the potential to enhance the early detection of bacterial infections in resource-limited settings, expediting the response for patients at risk of sepsis.
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Affiliation(s)
- Tom Kasputis
- Department
of Biological Systems Engineering, Virginia
Tech, Blacksburg, Virginia 24061, United States
| | - Yawen He
- Department
of Biological Systems Engineering, Virginia
Tech, Blacksburg, Virginia 24061, United States
| | - Qiaoqiao Ci
- Department
of Biological Systems Engineering, Virginia
Tech, Blacksburg, Virginia 24061, United States
| | - Juhong Chen
- Department
of Biological Systems Engineering, Virginia
Tech, Blacksburg, Virginia 24061, United States
- Department
of Bioengineering, University of California, Riverside, California 92521, United States
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133
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Kosmeri C, Giapros V, Serbis A, Baltogianni M. Application of Advanced Molecular Methods to Study Early-Onset Neonatal Sepsis. Int J Mol Sci 2024; 25:2258. [PMID: 38396935 PMCID: PMC10889541 DOI: 10.3390/ijms25042258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 02/10/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
Early-onset sepsis (EOS) is a global health issue, considered one of the primary causes of neonatal mortality. Diagnosis of EOS is challenging because its clinical signs are nonspecific, and blood culture, which is the current gold-standard diagnostic tool, has low sensitivity. Commonly used biomarkers for sepsis diagnosis, including C-reactive protein, procalcitonin, and interleukin-6, lack specificity for infection. Due to the disadvantages of blood culture and other common biomarkers, ongoing efforts are directed towards identifying innovative molecular approaches to diagnose neonates at risk of sepsis. This review aims to gather knowledge and recent research on these emerging molecular methods. PCR-based techniques and unrestricted techniques based on 16S rRNA sequencing and 16S-23S rRNA gene interspace region sequencing offer several advantages. Despite their potential, these approaches are not able to replace blood cultures due to several limitations; however, they may prove valuable as complementary tests in neonatal sepsis diagnosis. Several microRNAs have been evaluated and have been proposed as diagnostic biomarkers in EOS. T2 magnetic resonance and bioinformatic analysis have proposed potential biomarkers of neonatal sepsis, though further studies are essential to validate these findings.
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Affiliation(s)
- Chrysoula Kosmeri
- Department of Pediatrics, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Vasileios Giapros
- Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, 45500 Ioannina, Greece
| | - Anastasios Serbis
- Department of Pediatrics, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Maria Baltogianni
- Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, 45500 Ioannina, Greece
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Zhang H, Liang R, Zhu Y, Hu L, Xia H, Li J, Ye Y. Metagenomic next-generation sequencing of plasma cell-free DNA improves the early diagnosis of suspected infections. BMC Infect Dis 2024; 24:187. [PMID: 38347444 PMCID: PMC10863141 DOI: 10.1186/s12879-024-09043-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 01/22/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Metagenomic next-generation sequencing (mNGS) could improve the diagnosed efficiency of pathogens in bloodstream infections or sepsis. Little is known about the clinical impact of mNGS test when used for the early diagnosis of suspected infections. Herein, our main objective was to assess the clinical efficacy of utilizing blood samples to perform mNGS for early diagnosis of suspected infections, as well as to evaluate its potential in guiding antimicrobial therapy decisions. METHODS In this study, 212 adult hospitalized patients who underwent blood mNGS test in the early stage of suspected infections were enrolled. Diagnostic efficacy of mNGS test and blood culture was compared, and the clinical impact of mNGS on clinical care was analyzed. RESULTS In our study, the total detection rate of blood mNGS was significantly higher than that of culture method (74.4% vs. 12.1%, P < 0.001) in the paired mNGS test and blood culture. Blood stream infection (107, 67.3%) comprised the largest component of all the diseases in our patients, and the detection rate of single blood sample subgroup was similar with that of multiple type of samples subgroup. Among the 187 patients complained with fever, there was no difference in the diagnostic efficacy of mNGS when blood specimens or additional other specimens were used in cases presenting only with fever. While, when patients had other symptoms except fever, the performance of mNGS was superior in cases with specimens of suspected infected sites and blood collected at the same time. Guided by mNGS results, therapeutic regimens for 70.3% cases (149/212) were changed, and the average hospitalized days were significantly shortened in cases with the earlier sampling time of admission. CONCLUSION In this study, we emphasized the importance of blood mNGS in early infectious patients with mild and non-specific symptoms. Blood mNGS can be used as a supplement to conventional laboratory examination, and should be performed as soon as possible to guide clinicians to perform appropriate anti-infection treatment timely and effectively. Additionally, combining the contemporaneous samples from suspected infection sites could improve disease diagnosis and prognoses. Further research needs to be better validated in large-scale clinical trials to optimize diagnostic protocol, and the cost-utility analysis should be performed.
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Affiliation(s)
- Hui Zhang
- Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Ruobing Liang
- Department of Scientific Affaires, Hugobiotech Co., Ltd, Beijing, China
| | - Yunzhu Zhu
- Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Lifen Hu
- Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Han Xia
- Department of Scientific Affaires, Hugobiotech Co., Ltd, Beijing, China.
| | - Jiabin Li
- Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
- Institute of Bacterial Resistance, Anhui Medical University, Hefei, China.
- Anhui Center for Surveillance of Bacterial Resistance, Hefei, China.
| | - Ying Ye
- Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
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Lin Q, Zeng R, Yang J, Xu Z, Jin S, Wei G. Prognostic stratification of sepsis through DNA damage response based RiskScore system: insights from single-cell RNA-sequencing and transcriptomic profiling. Front Immunol 2024; 15:1345321. [PMID: 38404591 PMCID: PMC10884272 DOI: 10.3389/fimmu.2024.1345321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/24/2024] [Indexed: 02/27/2024] Open
Abstract
Background A novel risk scoring system, predicated on DNA damage response (DDR), was developed to enhance prognostic predictions and potentially inform the creation of more effective therapeutic protocols for sepsis. Methods To thoroughly delineate the expression profiles of DDR markers within the context of sepsis, an analytical approach utilizing single-cell RNA-sequencing (scRNA-seq) was implemented. Our study utilized single-cell analysis techniques alongside weighted gene co-expression network analysis (WGCNA) to pinpoint the genes that exhibit the most substantial associations with DNA damage response (DDR). Through Cox proportional hazards LASSO regression, we distinguished DDR-associated genes and established a risk model, enabling the stratification of patients into high- and low-risk groups. Subsequently, we carried out an analysis to determine our model's predictive accuracy regarding patient survival. Moreover, we examined the distinct biological characteristics, various signal transduction routes, and immune system responses in sepsis patients, considering different risk categories and outcomes related to survival. Lastly, we conducted experimental validation of the identified genes through in vivo and in vitro assays, employing RT-PCR, ELISA, and flow cytometry. Results Both single-cell RNA sequencing (scRNA-seq) and bulk transcriptomic analyses have demonstrated a strong correlation between DNA damage response (DDR) levels and sepsis prognosis. Specific cell subtypes, including monocytes, megakaryocytes, CD4+ T cells, and neutrophils, have shown elevated DDR activity. Cells with increased DDR scores exhibited more robust and numerous interactions with other cell populations. The weighted gene co-expression network analysis (WGCNA) and single-cell analyses revealed 71 DDR-associated genes. We developed a four-gene risk scoring system using ARL4C, CD247, RPL7, and RPL31, identified through univariate COX, LASSO COX regression, and log-rank (Mantel-Cox) tests. Nomograms, calibration plots, and decision curve analyses (DCA) regarding these specific genes have provided significant clinical benefits for individuals diagnosed with sepsis. The study suggested that individuals categorized as lower-risk demonstrated enhanced infiltration of immune cells, upregulated expression of immune regulators, and a more prolific presence of immune-associated functionalities and pathways. RT-qPCR analyses on a sepsis rat model revealed differential gene expression predominantly in the four targeted genes. Furthermore, ARL4C knockdown in sepsis model in vivo and vitro caused increased inflammatory response and a worse prognosis. Conclusion The delineated DDR expression landscape offers insights into sepsis pathogenesis, whilst our riskScore model, based on a robust four-gene signature, could underpin personalized sepsis treatment strategies.
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Affiliation(s)
| | | | | | | | | | - Guan Wei
- Department of Emergency Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
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136
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Ye Q, Shang SQ. [Research status and reflection on animal models of sepsis]. Zhonghua Yu Fang Yi Xue Za Zhi 2024; 58:171-176. [PMID: 38387946 DOI: 10.3760/cma.j.cn112150-20230926-00225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
Infectious diseases are the leading cause of death in children. Sepsis is a critical infectious disease that causes death in children globally, with a high morbidity and mortality rate. It poses a serious threat to children's health. Early diagnosis has become the key to treating severe sepsis. The establishment of animal models of sepsis can help people better diagnose sepsis and take interventions to improve the prognosis of sepsis patients. This study reviews the types, advantages and disadvantages of existing animal models of sepsis and proposes the optimization of these models to provide a reference basis for the selection and optimization of experimental models and the promotion of the "reverse transformation" of sepsis into clinical practice.
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Affiliation(s)
- Q Ye
- Department of Clinical Laboratory, Children's Hospital, Zhejiang University School of Medicine,Hangzhou 310052, China
| | - S Q Shang
- Department of Clinical Laboratory, Children's Hospital, Zhejiang University School of Medicine,Hangzhou 310052, China
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137
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Park SW, Yeo NY, Kang S, Ha T, Kim TH, Lee D, Kim D, Choi S, Kim M, Lee D, Kim D, Kim WJ, Lee SJ, Heo YJ, Moon DH, Han SS, Kim Y, Choi HS, Oh DK, Lee SY, Park M, Lim CM, Heo J. Early Prediction of Mortality for Septic Patients Visiting Emergency Room Based on Explainable Machine Learning: A Real-World Multicenter Study. J Korean Med Sci 2024; 39:e53. [PMID: 38317451 PMCID: PMC10843974 DOI: 10.3346/jkms.2024.39.e53] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 12/05/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Worldwide, sepsis is the leading cause of death in hospitals. If mortality rates in patients with sepsis can be predicted early, medical resources can be allocated efficiently. We constructed machine learning (ML) models to predict the mortality of patients with sepsis in a hospital emergency department. METHODS This study prospectively collected nationwide data from an ongoing multicenter cohort of patients with sepsis identified in the emergency department. Patients were enrolled from 19 hospitals between September 2019 and December 2020. For acquired data from 3,657 survivors and 1,455 deaths, six ML models (logistic regression, support vector machine, random forest, extreme gradient boosting [XGBoost], light gradient boosting machine, and categorical boosting [CatBoost]) were constructed using fivefold cross-validation to predict mortality. Through these models, 44 clinical variables measured on the day of admission were compared with six sequential organ failure assessment (SOFA) components (PaO2/FIO2 [PF], platelets (PLT), bilirubin, cardiovascular, Glasgow Coma Scale score, and creatinine). The confidence interval (CI) was obtained by performing 10,000 repeated measurements via random sampling of the test dataset. All results were explained and interpreted using Shapley's additive explanations (SHAP). RESULTS Of the 5,112 participants, CatBoost exhibited the highest area under the curve (AUC) of 0.800 (95% CI, 0.756-0.840) using clinical variables. Using the SOFA components for the same patient, XGBoost exhibited the highest AUC of 0.678 (95% CI, 0.626-0.730). As interpreted by SHAP, albumin, lactate, blood urea nitrogen, and international normalization ratio were determined to significantly affect the results. Additionally, PF and PLTs in the SOFA component significantly influenced the prediction results. CONCLUSION Newly established ML-based models achieved good prediction of mortality in patients with sepsis. Using several clinical variables acquired at the baseline can provide more accurate results for early predictions than using SOFA components. Additionally, the impact of each variable was identified.
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Affiliation(s)
- Sang Won Park
- Department of Medical Informatics, School of Medicine, Kangwon National University, Chuncheon, Korea
- Institute of Medical Science, School of Medicine, Kangwon National University, Chuncheon, Korea
| | - Na Young Yeo
- Department of Medical Bigdata Convergence, Kangwon National University, Chuncheon, Korea
| | - Seonguk Kang
- Department of Convergence Security, Kangwon National University, Chuncheon, Korea
| | - Taejun Ha
- Department of Biomedical Research Institute, Kangwon National University Hospital, Chuncheon, Korea
| | - Tae-Hoon Kim
- University-Industry Cooperation Foundation, Kangwon National University, Chuncheon, Korea
| | - DooHee Lee
- Department of Research and Development, ZIOVISION Co. Ltd., Chuncheon, Korea
| | - Dowon Kim
- Department of Research and Development, ZIOVISION Co. Ltd., Chuncheon, Korea
| | - Seheon Choi
- Department of Research and Development, ZIOVISION Co. Ltd., Chuncheon, Korea
| | - Minkyu Kim
- Department of Research and Development, ZIOVISION Co. Ltd., Chuncheon, Korea
| | - DongHoon Lee
- Department of Research and Development, ZIOVISION Co. Ltd., Chuncheon, Korea
| | - DoHyeon Kim
- Department of Research and Development, ZIOVISION Co. Ltd., Chuncheon, Korea
| | - Woo Jin Kim
- Department of Medical Informatics, School of Medicine, Kangwon National University, Chuncheon, Korea
- Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea
- Department of Internal Medicine, School of Medicine, Kangwon National University, Chuncheon, Korea
| | - Seung-Joon Lee
- Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea
- Department of Internal Medicine, School of Medicine, Kangwon National University, Chuncheon, Korea
| | - Yeon-Jeong Heo
- Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea
- Department of Internal Medicine, School of Medicine, Kangwon National University, Chuncheon, Korea
| | - Da Hye Moon
- Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea
- Department of Internal Medicine, School of Medicine, Kangwon National University, Chuncheon, Korea
| | - Seon-Sook Han
- Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea
- Department of Internal Medicine, School of Medicine, Kangwon National University, Chuncheon, Korea
| | - Yoon Kim
- University-Industry Cooperation Foundation, Kangwon National University, Chuncheon, Korea
- Department of Computer Science and Engineering, Kangwon National University, Chuncheon, Korea
| | - Hyun-Soo Choi
- University-Industry Cooperation Foundation, Kangwon National University, Chuncheon, Korea
- Department of Computer Science and Engineering, Seoul National University of Science and Technology, Seoul, Korea
| | - Dong Kyu Oh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Su Yeon Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - MiHyeon Park
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chae-Man Lim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeongwon Heo
- Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea
- Department of Internal Medicine, School of Medicine, Kangwon National University, Chuncheon, Korea.
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138
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Shen R, Ming S, Qian W, Zhang S, Peng Y, Gao X. A novel post-percutaneous nephrolithotomy sepsis prediction model using machine learning. BMC Urol 2024; 24:27. [PMID: 38308308 PMCID: PMC10837989 DOI: 10.1186/s12894-024-01414-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/22/2024] [Indexed: 02/04/2024] Open
Abstract
OBJECTIVES To establish a predictive model for sepsis after percutaneous nephrolithotomy (PCNL) using machine learning to identify high-risk patients and enable early diagnosis and intervention by urologists. METHODS A retrospective study including 694 patients who underwent PCNL was performed. A predictive model for sepsis using machine learning was constructed based on 22 preoperative and intraoperative parameters. RESULTS Sepsis occurred in 45 of 694 patients, including 16 males (35.6%) and 29 females (64.4%). Data were randomly segregated into an 80% training set and a 20% validation set via 100-fold Monte Carlo cross-validation. The variables included in this study were highly independent. The model achieved good predictive power for postoperative sepsis (AUC = 0.89, 87.8% sensitivity, 86.9% specificity, and 87.4% accuracy). The top 10 variables that contributed to the model prediction were preoperative midstream urine bacterial culture, sex, days of preoperative antibiotic use, urinary nitrite, preoperative blood white blood cell (WBC), renal pyogenesis, staghorn stones, history of ipsilateral urologic surgery, cumulative stone diameters, and renal anatomic malformation. CONCLUSION Our predictive model is suitable for sepsis estimation after PCNL and could effectively reduce the incidence of sepsis through early intervention.
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Affiliation(s)
- Rong Shen
- Department of Urology, Shanghai Changhai Hospital, No.168 Changhai Rd, Shanghai, 200433, China
| | - Shaoxiong Ming
- Department of Urology, Shanghai Changhai Hospital, No.168 Changhai Rd, Shanghai, 200433, China
| | - Wei Qian
- Shanghai Institute of Nutrition and Health, Chinese Academy of Sciences, Shanghai, China
| | - Shuwei Zhang
- Department of Urology, Shanghai Changhai Hospital, No.168 Changhai Rd, Shanghai, 200433, China
| | - Yonghan Peng
- Department of Urology, Shanghai Changhai Hospital, No.168 Changhai Rd, Shanghai, 200433, China.
| | - Xiaofeng Gao
- Department of Urology, Shanghai Changhai Hospital, No.168 Changhai Rd, Shanghai, 200433, China.
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139
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Thibaud P, Chow-Chine L, Gonzalez F, Bisbal M, Servan L, Sannini A, Tezier M, Tourret M, Cambon S, Pouliquen C, Ettori F, de Guibert JM, Faucher M, Caillol F, Mokart D. Septic shock and biliary sepsis: 90-day mortality and associated risk factors. HPB (Oxford) 2024; 26:270-281. [PMID: 37940408 DOI: 10.1016/j.hpb.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 09/24/2023] [Accepted: 10/09/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Biliary sepsis is common in patients with digestive cancer. Recommendations call for antibiotic de-escalation (ADE) as a strategy for antibiotic treatment of sepsis or septic shock. The aim of this study was to identify factors influencing 90-day mortality and to evaluate the impact of ADE. METHODS This retrospective study was conducted between November 2008 and December 2019 in a referral cancer center. Adults with biliary sepsis or septic shock admitted to the ICU were included. Variables associated with 90-day mortality were identified using univariate and multivariate Cox proportional hazards models. RESULTS 122 patients were included. The 90-day mortality was 30.3% (n = 37). After multivariate analysis, the factors independently associated 90-day mortality were metastatic stage (p = 0.004), biliary tract tumour compression (p = 0.001), multi drug resistant (MDR) bacteria carriage on intensive care unit (ICU)admission (p = 0.048), serum lactate on ICU admission (p < 0.001), the use of extra-renal replacement (p = 0.008), factor V < 50% (p = 0.009) and performance status (ECOG-PS) > 2 (p < 0.001). ADE of the pivotal antibiotic (p = 0.041) and recent cancer surgery (p < 0.001) appeared to be associated with survival. CONCLUSION The 90-day mortality of biliary sepsis seems to be favourable. The 90-day mortality is associated with organ dysfunctions, but also with ECOG-PS, cancer stage, MDR bacteria colonisation. ADE seems to be safe.
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Affiliation(s)
- Pierre Thibaud
- Intensive Care Unit, Paoli-Calmettes Institute, Marseille, France
| | | | | | - Magali Bisbal
- Intensive Care Unit, Paoli-Calmettes Institute, Marseille, France
| | - Luca Servan
- Intensive Care Unit, Paoli-Calmettes Institute, Marseille, France
| | - Antoine Sannini
- Intensive Care Unit, Paoli-Calmettes Institute, Marseille, France
| | - Marie Tezier
- Intensive Care Unit, Paoli-Calmettes Institute, Marseille, France
| | - Maxime Tourret
- Intensive Care Unit, Paoli-Calmettes Institute, Marseille, France
| | - Sylvie Cambon
- Intensive Care Unit, Paoli-Calmettes Institute, Marseille, France
| | | | - Florence Ettori
- Intensive Care Unit, Paoli-Calmettes Institute, Marseille, France
| | | | - Marion Faucher
- Intensive Care Unit, Paoli-Calmettes Institute, Marseille, France
| | - Fabrice Caillol
- Endoscopy Unit, Paoli-Calmettes Institute, Marseille, France
| | - Djamel Mokart
- Intensive Care Unit, Paoli-Calmettes Institute, Marseille, France.
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140
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Luan F, Zhou Y, Ma X, Li Y, Peng Y, Jia X, Li N, Wang X, Luo Y, Man M, Zhang Q, Wang C, Yu K, Zhao M, Wang C. Gut microbiota composition and changes in patients with sepsis: potential markers for predicting survival. BMC Microbiol 2024; 24:45. [PMID: 38302899 PMCID: PMC10832068 DOI: 10.1186/s12866-024-03188-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/08/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Sepsis can cause immune dysregulation and multiple organ failure in patients and eventually lead to death. The gut microbiota has demonstrated its precise therapeutic potential in the treatment of various diseases. This study aimed to discuss the structural changes of the gut microbiota in patients with sepsis and to analyze the differences in the gut microbiota of patients with different prognoses. METHODS We conducted a multicenter study in which rectal swab specimens were collected on the first and third days of sepsis diagnosis. A total of 70 specimens were collected, and gut microbiota information was obtained by 16S rRNA analysis. RESULTS The relative abundance of Enterococcus decreased in rectal swab specimens during the first three days of diagnosis in patients with sepsis, while the relative abundance of inflammation-associated Bacillus species such as Escherichia coli, Enterobacteriaceae, and Bacteroidetes increased. By comparing the differences in the flora of the survival group and the death group, we found that the abundance of Veillonella and Ruminococcus in the death group showed an increasing trend (p < 0.05), while the abundance of Prevotella_6 and Prevotella_sp_S4_BM14 was increased in surviving patients (p < 0.05). CONCLUSIONS The Firmicutes/Bacteroidetes ratio, reflecting overall gut microbial composition, was significantly lower on day three of sepsis diagnosis. Changes in the abundance of specific gut microbiota may serve as prognostic markers in patients with sepsis.
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Affiliation(s)
- Feiyu Luan
- Departments of Critical Care Medicine, the First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, 150001, Heilongjiang, China
| | - Yang Zhou
- Departments of Critical Care Medicine, the First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, 150001, Heilongjiang, China
| | - Xiaohui Ma
- Departments of Critical Care Medicine, the First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, 150001, Heilongjiang, China
| | - Yue Li
- Departments of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, 150081, Heilongjiang, China
| | - Yahui Peng
- Departments of Critical Care Medicine, the First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, 150001, Heilongjiang, China
| | - Xiaonan Jia
- Departments of Critical Care Medicine, the First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, 150001, Heilongjiang, China
| | - Nana Li
- Departments of Critical Care Medicine, the First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, 150001, Heilongjiang, China
| | - Xibo Wang
- Departments of Critical Care Medicine, the First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, 150001, Heilongjiang, China
| | - Yinghao Luo
- Departments of Critical Care Medicine, the First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, 150001, Heilongjiang, China
| | - Mingyin Man
- Departments of Critical Care Medicine, the First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, 150001, Heilongjiang, China
| | - Qianqian Zhang
- Departments of Critical Care Medicine, the First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, 150001, Heilongjiang, China
| | - Chunying Wang
- Departments of Critical Care Medicine, the First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, 150001, Heilongjiang, China
| | - Kaijiang Yu
- Departments of Critical Care Medicine, the First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, 150001, Heilongjiang, China.
| | - Mingyan Zhao
- Departments of Critical Care Medicine, the First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, 150001, Heilongjiang, China.
| | - Changsong Wang
- Departments of Critical Care Medicine, the First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, 150001, Heilongjiang, China.
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Miura S, Michihata N. Predicting mortality in pediatric sepsis: A nationwide data analysis using a pediatric sepsis surveillance method. J Infect Chemother 2024; 30:93-97. [PMID: 37979776 DOI: 10.1016/j.jiac.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/29/2023] [Accepted: 11/14/2023] [Indexed: 11/20/2023]
Abstract
INTRODUCTION A sepsis surveillance method using electronic health records is increasingly used to describe the epidemiology of adult sepsis. However, its application in pediatric populations has been limited, and real-world epidemiology of pediatric sepsis remains unknown. We aimed to determine whether this surveillance method could identify children with sepsis at high-risk of mortality. PATIENTS AND METHODS From a nationwide inpatient database in Japan, we included children who underwent blood culture and received antimicrobials for ≥ 4 days between 2014 and 2021. We stratified these children into those with sepsis or without sepsis by the presence of organ dysfunction. We evaluated the discrimination for in-hospital mortality by the sepsis diagnosis and the number of organ dysfunction. RESULTS Among 6553 eligible children, in-hospital mortality was 7.2 % in 875 children with sepsis and 0.2 % in 5678 children without sepsis. Sepsis diagnosis discriminated in-hospital mortality with a sensitivity of 0.84 and a specificity of 0.87. The area under the curve for mortality based on the number of organ dysfunction was 0.88 (95 % confidence interval:0.84 to 0.93). In-hospital mortality incrementally increased with the number of organ dysfunction; zero, 0.2 %; one, 3.4 %; two, 12.7 %; three, 20.9 %; four, 33.3 %; and five, 50.0 %. CONCLUSIONS The surveillance method effectively identified children with sepsis with high-risk of mortality and demonstrated strong discrimination of mortality.
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Affiliation(s)
- Shinya Miura
- Department of Pediatrics, St. Marianna University School of Medicine, Kawasaki, Japan; Teikyo University Graduate School of Public Health, Tokyo, Japan.
| | - Nobuaki Michihata
- Cancer Prevention Center, Chiba Cancer Center Research Institute, Chiba, Japan
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Venczel K, Lesh N, Jouriles N, Seaberg D, Gothard D, Harrell C, Reuter Q. Beyond SEP-1 Compliance: Assessing the Impact of Antibiotic Overtreatment and Fluid Overload in Suspected Septic Patients. J Emerg Med 2024; 66:74-82. [PMID: 38278684 DOI: 10.1016/j.jemermed.2023.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/04/2023] [Accepted: 08/31/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND The Centers for Medicare and Medicaid Services (CMS) developed the Severe Sepsis and Septic Shock Performance Measure bundle (SEP-1) metric to improve sepsis care, but evidence supporting this bundle is limited and harms secondary to compliance have not been investigated. OBJECTIVE This study investigates the effect of an emergency department (ED) sepsis quality-improvement (QI) effort to improve CMS SEP-1 compliance, looking specifically at antibiotic overtreatment and harm from fluid resuscitation. METHODS This was a retrospective observational study conducted between March and July 2021 with patients for whom a sepsis order set was initiated. The primary outcomes included the number of patients treated with antibiotics who were ultimately deemed nonseptic and the number of patients who developed pulmonary edema, with or without need for positive pressure ventilation (PPV), within 48 h of receiving a 30 mL/kg fluid bolus. Data were collected via nonblinded chart reviews, with a free marginal κ-calculation indicating excellent interrater reliability. RESULTS The study cohort included 273 patients, 170 (62.3%) who were ultimately determined to be septic and 103 (37.7%) who were nonseptic. Of the 103 nonseptic patients, 82 (79.6%) received antibiotics in the ED. Of the 121 patients (44.3%) who received a 30 mL/kg bolus, 5 patients (4.1%) developed pulmonary edema and 0 of 121 patients required PPV within 48 h. CONCLUSIONS The QI effort led to moderate rates of antibiotic overtreatment and very few patients developed pulmonary edema due to a 30 mL/kg fluid bolus.
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Affiliation(s)
- Kevin Venczel
- Department of Emergency, Summa Health System, Akron, Ohio; U.S. Acute Care Solutions, Canton, Ohio
| | | | - Nicholas Jouriles
- Department of Emergency, Summa Health System, Akron, Ohio; Northeast Ohio Medical University, Rootstown, Ohio; U.S. Acute Care Solutions, Canton, Ohio
| | - David Seaberg
- Department of Emergency, Summa Health System, Akron, Ohio; Northeast Ohio Medical University, Rootstown, Ohio; U.S. Acute Care Solutions, Canton, Ohio
| | - David Gothard
- Department of Emergency, Summa Health System, Akron, Ohio
| | - Caleb Harrell
- Department of Emergency, Summa Health System, Akron, Ohio; Northeast Ohio Medical University, Rootstown, Ohio; U.S. Acute Care Solutions, Canton, Ohio
| | - Quentin Reuter
- Department of Emergency, Summa Health System, Akron, Ohio; Northeast Ohio Medical University, Rootstown, Ohio; U.S. Acute Care Solutions, Canton, Ohio
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143
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Affiliation(s)
- Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takahiro Inagawa
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
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Park JH, Song Z, Yun TG, Kim HS, Shin MH, Kang MJ, Park MS, Pyun JC. Electrochemical analysis of total phospholipids in human serum for severe sepsis diagnosis. Talanta 2024; 268:125374. [PMID: 37925823 DOI: 10.1016/j.talanta.2023.125374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/07/2023]
Abstract
Electrochemical analysis of total phospholipids was performed for the diagnosis of sepsis. The influence of electrode materials on the analysis of the chromogenic substrate was analyzed using Au, graphite, and pyrolyzed carbon electrodes. The total phospholipid analysis based on electrochemical analysis with pyrolyzed carbon was used for diagnosis of sepsis using sera from healthy volunteers, systemic inflammatory response syndrome (SIRS), and severe sepsis patients. The analysis results using the optical measurement and the electrochemical analysis were compared for the serum samples from sepsis patients and healthy controls. Additionally, the interference of human serum on the optical measurement and electrochemical analysis was estimated by signal-to-noise (S/N) calculation. The assay results of the levels of other biomarkers for sepsis (C-reactive protein and procalcitonin) and the total phospholipid levels obtained using the optical measurement and electrochemical analysis methods were statistically similar. Finally, the mortality of patients, indicated by the results of the total phospholipid assay performed using the electrochemical analysis of the patient samples collected daily (1, 3, and 7 day(s) after admission to hospital), was compared with the patient mortality assessed via conventional severity indexes, such as the SOFA and APACHE Ⅱ scores. The 28-day survival rate was estimated by Kaplan-Meier survival analysis based on the total phospholipid level of patient samples that were obtained after 1, 3, and 7 day(s) from hospital admission.
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Affiliation(s)
- Jun-Hee Park
- Department of Materials Science and Engineering, Yonsei University, 50 Yonsei-Ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Zhiquan Song
- Department of Materials Science and Engineering, Yonsei University, 50 Yonsei-Ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Tae Gyeong Yun
- Department of Materials Science and Engineering, Yonsei University, 50 Yonsei-Ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Hye Soo Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, 03722, South Korea
| | - Mi Hwa Shin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, 03722, South Korea; Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, 03722, South Korea
| | - Min-Jung Kang
- Korea Institute of Science and Technology (KIST), 5 Hwarang-ro 14-gil, Seongbuk-gu, Seoul, 02792, South Korea
| | - Moo Suk Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, 03722, South Korea
| | - Jae-Chul Pyun
- Department of Materials Science and Engineering, Yonsei University, 50 Yonsei-Ro, Seodaemun-gu, Seoul, 03722, South Korea.
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Guo Z, Yan H, Xu R, Ding J, Cheng J, Lv X, Jaffrezic-Renault N, Lin Y, Xu L. An ultra-sensitive electrochemical biosensor for the detection of procalcitonin in sepsis patients' serum, using a Cu-BHT-based thin film. Talanta 2024; 268:125325. [PMID: 37871465 DOI: 10.1016/j.talanta.2023.125325] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/13/2023] [Accepted: 10/17/2023] [Indexed: 10/25/2023]
Abstract
Procalcitonin (PCT) is a polypeptide produced by the parafollicular cells of the thyroid gland and serves as a vital marker for the diagnosis and treatment of sepsis and other infectious diseases, as well as multiple organ failure, due to its high expression levels in affected patients. This article reports on a highly sensitive electrochemical biosensor based on MOF composite materials, based on Cu-BHT, for detecting PCT levels. The surface of the glassy carbon electrode may have better charge transfer resistance owing to the nano-composite material made of Cu-BHT, chitosan, and AuNPs. At the same time, the anti-PCT antibody may also be covalently bonded to the composite material and measure PCT concentration using electrochemical impedance spectroscopy (EIS). The results of the investigation demonstrate that the sensor's response has excellent linear conjunction with the logarithm of PCT concentration under optimum circumstances. The detection limit (LOD) is 14.579 × 10-9 μg/mL, and the linear range of detection is 10-7 μg/mL to 10-1 μg/mL. Simultaneously, we successfully applied this method to detect serum PCT before and after treatment in different sepsis patients and compared it with chemiluminescence immunoassay. The findings indicate that the proposed method holds promising potential for timely diagnosis and treatment of sepsis patients.
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Affiliation(s)
- Zhenzhong Guo
- Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Public Health, Faculty of Medicine, Wuhan University of Science and Technology, Wuhan, 430065, PR China
| | - Hanhui Yan
- Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Public Health, Faculty of Medicine, Wuhan University of Science and Technology, Wuhan, 430065, PR China
| | - Ruijia Xu
- Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Public Health, Faculty of Medicine, Wuhan University of Science and Technology, Wuhan, 430065, PR China
| | - Jingjing Ding
- Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Public Health, Faculty of Medicine, Wuhan University of Science and Technology, Wuhan, 430065, PR China
| | - Jing Cheng
- Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Public Health, Faculty of Medicine, Wuhan University of Science and Technology, Wuhan, 430065, PR China
| | - Xiao Lv
- Department of Cardiology, People's Hospital of Dongxihu District, Wuhan, PR China
| | - Nicole Jaffrezic-Renault
- University of Lyon, Institute of Analytical Sciences, UMR-CNRS 5280, 5, La Doua Street, Villeurbanne, 69100, France.
| | - Yongbo Lin
- Department of Cardiology, People's Hospital of Dongxihu District, Wuhan, PR China.
| | - Lang Xu
- Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Public Health, Faculty of Medicine, Wuhan University of Science and Technology, Wuhan, 430065, PR China.
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Lam RPK, Hung KKC, Lui CT, Kwok WS, Lam WWT, Lau EHY, Sridhar S, Ng PYT, Cheng CH, Tsang TC, Tsui MSH, Graham CA, Rainer TH. Early sepsis care with the National Early Warning Score 2-guided Sepsis Hour-1 Bundle in the emergency department: hybrid type 1 effectiveness-implementation pilot stepped wedge randomised controlled trial (NEWS-1 TRIPS) protocol. BMJ Open 2024; 14:e080676. [PMID: 38307529 PMCID: PMC10836386 DOI: 10.1136/bmjopen-2023-080676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 01/24/2024] [Indexed: 02/04/2024] Open
Abstract
INTRODUCTION Early sepsis treatment in the emergency department (ED) is crucial to improve patient survival. Despite international promulgation, the uptake of the Surviving Sepsis Campaign (SSC) Hour-1 Bundle (lactate measurement, blood culture, broad-spectrum antibiotics, 30 mL/kg crystalloid for hypotension/lactate ≥4 mmol/L and vasopressors for hypotension during/after fluid resuscitation within 1 hour of sepsis recognition) is low across healthcare settings. Delays in sepsis recognition and a lack of high-quality evidence hinder its implementation. We propose a novel sepsis care model (National Early Warning Score, NEWS-1 care), in which the SSC Hour-1 Bundle is triggered objectively by a high NEWS-2 (≥5). This study aims to determine the feasibility of a full-scale type 1 hybrid effectiveness-implementation trial on the NEWS-1 care in multiple EDs. METHODS AND ANALYSIS We will conduct a pilot type 1 hybrid trial and prospectively recruit 200 patients from 4 public EDs in Hong Kong cluster randomised in a stepped wedge design over 10 months. All study sites will start with an initial period of standard care and switch in random order at 2-month intervals to the NEWS-1 care unidirectionally. The implementation evaluation will employ mixed methods guided by the Reach, Effectiveness, Adoption, Implementation and Maintenance framework, which includes qualitative and quantitative data from focus group interviews, staff survey and clinical record reviews. We will analyse the 14 feasibility outcomes as progression criteria to a full-scale trial, including trial acceptability to patients and staff, patient and staff recruitment rates, accuracy of sepsis screening, protocol adherence, accessibility to follow-up data, safety and preliminary clinical impacts of the NEWS1 care, using descriptive statistics. ETHICS AND DISSEMINATION The institutional review boards of all study sites approved this study. This study will establish the feasibility of a full-scale hybrid trial. We will disseminate the findings through peer-reviewed publications, conference presentations and educational activities. TRIAL REGISTRATION NUMBER NCT05731349.
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Affiliation(s)
- Rex Pui Kin Lam
- Department of Emergency Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Accident and Emergency Department, Queen Mary Hospital, Hospital Authority, Hong Kong, China
| | - Kevin Kei Ching Hung
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Hong Kong, China
- Accident and Emergency Department, Prince of Wales Hospital, Hospital Authority, Hong Kong, China
| | - Chun Tat Lui
- Accident and Emergency Department, Tuen Mun Hospital, Hospital Authority, Hong Kong, China
| | - Wai Shing Kwok
- Accident and Emergency Department, Pamela Youde Nethersole Eastern Hospital, Hospital Authority, Hong Kong, China
| | - Wendy Wing Tak Lam
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Eric Ho Yin Lau
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Siddharth Sridhar
- Department of Microbiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Peter Yau Tak Ng
- Accident and Emergency Department, Tuen Mun Hospital, Hospital Authority, Hong Kong, China
| | - Chi Hung Cheng
- Accident and Emergency Department, Prince of Wales Hospital, Hospital Authority, Hong Kong, China
| | - Tat Chi Tsang
- Accident and Emergency Department, Queen Mary Hospital, Hospital Authority, Hong Kong, China
| | - Matthew Sik Hon Tsui
- Accident and Emergency Department, Queen Mary Hospital, Hospital Authority, Hong Kong, China
| | - Colin Alexander Graham
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Hong Kong, China
- Accident and Emergency Department, Prince of Wales Hospital, Hospital Authority, Hong Kong, China
| | - Timothy Hudson Rainer
- Department of Emergency Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Accident and Emergency Department, Queen Mary Hospital, Hospital Authority, Hong Kong, China
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147
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Sheikh F, Chechulina V, Daneman N, Garber GE, Hendrick K, Kissoon N, Loubani O, Russell K, Fox-Robichaud A, Schwartz L, Barrett K. Sepsis policy, guidelines and standards in Canada: a jurisdictional scoping review protocol. BMJ Open 2024; 14:e077909. [PMID: 38307532 PMCID: PMC10836367 DOI: 10.1136/bmjopen-2023-077909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 01/11/2024] [Indexed: 02/04/2024] Open
Abstract
INTRODUCTION To our knowledge, this study is the first to identify and describe current sepsis policies, clinical practice guidelines, and health professional training standards in Canada to inform evidence-based policy recommendations. METHODS AND ANALYSIS This study will be designed and reported according to the Arksey and O'Malley framework for scoping reviews and the Preferred Reporting Items for Systematic Review and Meta-Analyses Extension for Scoping Reviews. EMBASE, CINAHL, Medline, Turning Research Into Practice and Policy Commons will be searched for policies, clinical practice guidelines and health professional training standards published or updated in 2010 onwards, and related to the identification, management or reporting of sepsis in Canada. Additional sources of evidence will be identified by searching the websites of Canadian organisations responsible for regulating the training of healthcare professionals and reporting health outcomes. All potentially eligible sources of evidence will be reviewed for inclusion, followed by data extraction, independently and in duplicate. The included policies will be collated and summarised to inform future evidence-based sepsis policy recommendations. ETHICS AND DISSEMINATION The proposed study does not require ethics approval. The results of the study will be submitted for publication in a peer-reviewed journal and presented at local, national and international forums.
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Affiliation(s)
- Fatima Sheikh
- Department of Health Research Methods, Evidence and Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | | | - Nick Daneman
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
| | - Gary E Garber
- Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, Ontario, Canada
- School of Public Health and Epidemiology, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Niranjan Kissoon
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- The Centre for International Child Health, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Osama Loubani
- Departments of Critical Care Medicine and Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kristine Russell
- Department of Critical Care, University of Calgary, Calgary, Alberta, Canada
| | - Alison Fox-Robichaud
- Medicine, McMaster University, Hamilton, Ontario, Canada
- Thrombosis and Atherosclerosis Research Institute (TaARI), McMaster University, Hamilton, Ontario, Canada
| | - Lisa Schwartz
- Department of Health Research Methods, Evidence and Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Kali Barrett
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Interdepartmental Centre for Critical Care, University Health Network, Toronto, Ontario, Canada
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Schupp T, Weidner K, Rusnak J, Jawhar S, Forner J, Dulatahu F, Dudda J, Brück LM, Hoffmann U, Bertsch T, Akin I, Behnes M. C-reactive protein and procalcitonin during course of sepsis and septic shock. Ir J Med Sci 2024; 193:457-468. [PMID: 37204560 PMCID: PMC10196281 DOI: 10.1007/s11845-023-03385-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 04/20/2023] [Indexed: 05/20/2023]
Abstract
OBJECTIVE The study investigates the diagnostic and prognostic value of C-reactive protein (CRP) and procalcitonin (PCT) in patients with sepsis and septic shock. BACKGROUND Limited data regarding the prognostic value of CRP and PCT during the course of sepsis or septic shock is available. METHODS Consecutive patients with sepsis and septic shock from 2019 to 2021 were included monocentrically. Blood samples were retrieved from the day of disease onset (day 1), day 2, 3, 5, 7, and 10. Firstly, the diagnostic value of CRP and PCT for the diagnosis of a septic shock, as well as for the discrimination of positive blood cultures, was tested. Secondly, the prognostic value of the CRP and PCT was tested for 30-day all-cause mortality. Statistical analyses included univariable t-tests, Spearman's correlations, C-statistics, and Kaplan-Meier analyses. RESULTS A total of 349 patients were included, of which 56% had a sepsis and 44% a septic shock on day 1. The overall rate of all-cause mortality at 30 days was 52%. With an area under the curve (AUC) of 0.861 on day 7 and 0.833 on day 10, the PCT revealed a superior AUC than the CRP (AUC 0.440-0.652) with regard to the discrimination between patients with sepsis and septic shock. In contrast, the prognostic AUCs for 30-day all-cause mortality were poor. Both higher CRP (HR = 0.999; 95% CI 0.998-1.001; p = 0.203) and PCT levels (HR = 0.998; 95% CI 0.993-1.003; p = 0.500) were not associated with the risk of 30-day all-cause mortality. During the first 10 days of ICU treatment, both CRP and PCT declined irrespective of clinical improvement or impairment. CONCLUSION PCT was a reliable diagnostic tool for the diagnosis of septic shock compared to CRP. Both CRP and PCT were shown to have poor predictive value with regard to 30-day all-cause mortality and were not associated with the risk of all-cause mortality in patients admitted with sepsis or septic shock.
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Affiliation(s)
- Tobias Schupp
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Kathrin Weidner
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Jonas Rusnak
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Schanas Jawhar
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Jan Forner
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Floriana Dulatahu
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Jonas Dudda
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Lea Marie Brück
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Ursula Hoffmann
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Thomas Bertsch
- Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany
| | - Ibrahim Akin
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Michael Behnes
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Heidelberg, Germany.
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany.
- First Department of Medicine, University Medical Center Mannheim (UMM), Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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Clemens N, Wilson PM, Lipshaw MJ, Depinet H, Zhang Y, Eckerle M. Association between positive blood culture and clinical outcomes among children treated for sepsis in the emergency department. Am J Emerg Med 2024; 76:13-17. [PMID: 37972503 DOI: 10.1016/j.ajem.2023.10.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 10/02/2023] [Accepted: 10/25/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE Among children treated for sepsis in a pediatric emergency department (ED), compare clinical features and outcomes between those with blood cultures positive versus negative for a bacterial pathogen. DESIGN Single-center retrospective cohort study. SETTING Pediatric emergency department (ED) at a quaternary pediatric care center. PATIENTS Children aged 0-18 years treated for sepsis defined by the Children's Hospital Association's Improving Pediatric Sepsis Outcomes (IPSO) definition. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We analyzed 1307 patients treated for sepsis during the study period, of which 117 (9.0%) had blood cultures positive for a bacterial pathogen. Of children with blood culture positive sepsis, 62 (53.0%) had organ dysfunction compared to 514 (43.2%) with culture negative sepsis (adjusted odds ratio 1.56, 95% confidence interval (CI) 1.04-2.34, adjusting for age, high risk medical conditions, and time to antibiotics). Children with blood culture positive sepsis had a larger base deficit, -4 vs -1 (p < 0.01), and higher procalcitonin, 3.84 vs 0.56 ng/mL (p < 0.01). CONCLUSIONS Children meeting the IPSO Sepsis definition with blood culture positive for a bacterial pathogen have higher rates of organ dysfunction than those who are culture negative, although our 9% rate of blood culture positivity is lower than previously cited literature from the pediatric intensive care unit.
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Affiliation(s)
- Nancy Clemens
- Division of Emergency Medicine, Division of Pediatrics, Geisinger Medical Center, Geisinger Commonwealth School of Medicine, 100 North Academy Ave, Danville, PA 17822, USA.
| | - Paria M Wilson
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, College of Medicine, University of Cincinnati, 3333 Burnett Ave, Cincinnati, OH 45229, USA
| | - Matthew J Lipshaw
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, College of Medicine, University of Cincinnati, 3333 Burnett Ave, Cincinnati, OH 45229, USA
| | - Holly Depinet
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, College of Medicine, University of Cincinnati, 3333 Burnett Ave, Cincinnati, OH 45229, USA
| | - Yin Zhang
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, College of Medicine, University of Cincinnati, 3333 Burnett Ave, Cincinnati, OH 45229, USA
| | - Michelle Eckerle
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, College of Medicine, University of Cincinnati, 3333 Burnett Ave, Cincinnati, OH 45229, USA
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Wen YT, Cheng AC, Podin Y. Precision Medicine for Sepsis Management in Low- and Middle-Income Countries-Melioidosis as a Model? Am J Respir Crit Care Med 2024; 209:237-238. [PMID: 38055331 PMCID: PMC10840778 DOI: 10.1164/rccm.202311-2056ed] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 12/06/2023] [Indexed: 12/08/2023] Open
Affiliation(s)
- Yeo Tsin Wen
- Lee Kong Chian School of Medicine Nanyang Technological University Singapore, Singapore
- National Centre for Infectious Diseases Singapore, Singapore
- Department of Infectious Diseases Tan Tock Seng Hospital Singapore, Singapore
| | - Allen C Cheng
- Professor/Director Infectious Diseases Monash Health School of Clinical Sciences Monash University Melbourne, Victoria, Australia
- Director of Infection Prevention and Healthcare Epidemiology Professor in Infectious Diseases Epidemiology Alfred Hospital Melbourne, Victoria, Australia
| | - Yuwana Podin
- Institute of Health and Community Medicine University of Malaysia, Sarawak Sarawak, Malaysia
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