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Deng J, An Y, Kang M. Using the CLSI rAST breakpoints of Enterobacterales in positive blood cultures. Diagn Microbiol Infect Dis 2024; 109:116335. [PMID: 38703531 DOI: 10.1016/j.diagmicrobio.2024.116335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVES The objective of this study was to provide the clinic with rapid and accurate results of antimicrobial susceptibility testing for the treatment of patients with bloodstream infections. To achieve this, we applied the Clinical and Laboratory Standards Institute (CLSI) blood culture direct rapid antimicrobial susceptibility test (rAST) to assess the susceptibility of the most common Enterobacterales found in blood cultures. METHODS In this study, we utilized the CLSI blood culture direct rapid antimicrobial susceptibility test to assess the susceptibility (rAST) of the most common Enterobacterales present in blood cultures. We chose this method for its simplicity in analysis, and our aim was to predict minimum inhibitory concentrations (MICs) using the rAST. As a benchmark, we assumed that Broth Macrodilution method (BMD) results were 100% accurate. For data evaluation, we employed the terms categorical agreement (CA), very major errors (VME), and major errors (ME). RESULTS Our findings demonstrate that the CLSI rAST method is reliable for rapidly determining the in vitro susceptibility of Enterobacterales to common antimicrobial drugs in bloodstream infections. We achieved a concordance rate of 90% in classification within a 10-hour timeframe. We identified a total of 112 carbapenem-resistant Enterobacterales (CRE) strains, and there was no significant difference in the detection rate of CRE at 6, 10, and 16 hours. This suggests that CRE can be identified as early as 6 hours. CONCLUSION The CLSI rAST is a valuable tool that can be utilized in clinical practice to quickly determine the susceptibility of Enterobacterales to antimicrobial drugs within 10 hours. This capability can greatly assist in the clinical management of patients with bloodstream infections.
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Affiliation(s)
- Jin Deng
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - YunHe An
- Department of Laboratory Medicine, Ding Zhou City People's Hospital, Hebei, China
| | - Mei Kang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China.
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Hou F, Gao J, Zhang L, Liu C. Association of IL-6-572 polymorphism with sepsis: An updated meta-analysis. Cytokine 2024; 179:156597. [PMID: 38643631 DOI: 10.1016/j.cyto.2024.156597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/25/2024] [Accepted: 04/03/2024] [Indexed: 04/23/2024]
Abstract
OBJECTIVES To analyze the relationship between IL and 6 572C/G polymorphism with sepsis. METHODS Searching 8 databases the Cochrane Library, China National Knowledge Infrastructure (CNKI), China Biology Medicine (CBM), Chongqing VIP, Embase, PubMed, WanFang Data, and Web of Science from inception to October 1, 2023. Meta-analysis was performed by using Review Manager 5.4 and STATA 15.0. RESULTS 9 studies were included, 1 study was excluded from the previous meta-analysis, and 6 studies were added. Sensitivity analysis suggested that the results were relatively robust. The P values of Egger test indicated that no conspicuous publication bias was found. CONCLUSION According to the meta-analysis results of existing studies, the IL-6 572C/G GG genotype and G allele are risk factors for sepsis, this result changes the previous conclusion that the IL-6 572 polymorphism is not related to sepsis. However, the results still need to be conservatively treated due to the sample size was not large enough.
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Affiliation(s)
- Fang Hou
- Department of Intensive Care Unit, First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
| | - Jing Gao
- Department of Nursing, First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China.
| | - Li Zhang
- Department of Nursing, First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
| | - Chang Liu
- First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
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Li F, Fu H, Zeng L, Liu P. CIRCVMA21-RELATED PATHWAY ALLEVIATES LIPOPOLYSACCHARIDE-INDUCED HK-2 CELL INJURY. Shock 2024; 62:119-126. [PMID: 38662613 DOI: 10.1097/shk.0000000000002364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
ABSTRACT Background : It is reported that circVMA21 has an inhibition effect on sepsis-induced acute kidney injury (AKI). Therefore, the underlying molecular mechanisms of circVMA21 in AKI are worthy of further investigation. Material and Methods : Lipopolysaccharide (LPS) was used to induce HK2 cell injury. CircVMA21, miR-337-3p and ZEB2 expression was tested by qRT-PCR. Cell growth was detected by CCK8 assay, EdU assay, and flow cytometry. Protein levels were examined by western blot. The levels of inflammatory factors and oxidative stress markers were measured to evaluate cell inflammatory response and oxidative stress. RNA relationship as verified by dual-luciferase reporter assay, RIP assay, and RNA pull-down assay. Results : CircVMA21 had decreased expression in AKI patients. Overexpressed circVMA21 alleviated LPS-induced HK2 cell inflammation, apoptosis, and oxidative stress. Moreover, circVMA21 sponged miR-337-3p, and miR-337-3p targeted ZEB2. The inhibitory effect of circVMA21 on LPS-induced HK2 cell injury was reversed by miR-337-3p overexpression, and ZEB2 overexpression abolished the promotion effect of miR-337-3p on LPS-induced HK2 cell injury. Conclusions : CircVMA21 could inhibit LPS-induced HK2 cell injury via miR-337-3p/ZEB2 axis.
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Affiliation(s)
- Fuzhu Li
- The First Affiliated Hospital, Department of Neurosurgical Intensive Care Unit, Hengyang Medical School, University of South China, Hengyang, China
| | - Hongyun Fu
- The First Affiliated Hospital, Department of Docimasiology, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Linna Zeng
- Department of Endocrinology, The Third People's Hospital of Yongzhou City, Yongzhou City, China
| | - Pingping Liu
- The First Affiliated Hospital, Department of Emergency, Hengyang Medical School, University of South China, Hengyang, China
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Meier N, Munch MW, Granholm A, Perner A, Hertz FB, Venkatesh B, Hammond NE, Li Q, De Bus L, De Waele J, Kauzonas E, Sjövall F, Møller MH, Helleberg M. Empirical carbapenems or piperacillin/tazobactam for infections in intensive care: An international retrospective cohort study. Acta Anaesthesiol Scand 2024; 68:821-829. [PMID: 38549422 DOI: 10.1111/aas.14419] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/14/2024] [Accepted: 03/14/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Critically ill patients in intensive care units (ICU) are frequently administered broad-spectrum antibiotics (e.g., carbapenems or piperacillin/tazobactam) for suspected or confirmed infections. This retrospective cohort study aimed to describe the use of carbapenems and piperacillin/tazobactam in two international, prospectively collected datasets. METHODS We conducted a post hoc analysis of data from the "Adjunctive Glucocorticoid Therapy in Patients with Septic Shock" (ADRENAL) trial (n = 3713) and the "Antimicrobial de-escalation in the critically ill patient and assessment of clinical cure" (DIANA) study (n = 1488). The primary outcome was the proportion of patients receiving initial antibiotic treatment with carbapenems and piperacillin/tazobactam. Secondary outcomes included mortality, days alive and out of ICU and ICU length of stay at 28 days. RESULTS In the ADRENAL trial, carbapenems were used in 648 out of 3713 (17%), whereas piperacillin/tazobactam was used in 1804 out of 3713 (49%) participants. In the DIANA study, carbapenems were used in 380 out of 1480 (26%), while piperacillin/tazobactam was used in 433 out of 1488 (29%) participants. Mortality at 28 days was 23% for patients receiving carbapenems and 24% for those receiving piperacillin/tazobactam in ADRENAL and 23% and 19%, respectively, in DIANA. We noted variations in secondary outcomes; in DIANA, patients receiving carbapenems had a median of 13 days alive and out of ICU compared with 18 days among those receiving piperacillin/tazobactam. In ADRENAL, the median hospital length of stay was 27 days for patients receiving carbapenems and 21 days for those receiving piperacillin/tazobactam. CONCLUSIONS In this post hoc analysis of ICU patients with infections, we found widespread initial use of carbapenems and piperacillin/tazobactam in international ICUs, with the latter being more frequently used. Randomized clinical trials are needed to assess if the observed variations in outcomes may be drug-related effects or due to confounders.
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Affiliation(s)
- Nick Meier
- Department of Intensive Care, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Marie Warrer Munch
- Department of Intensive Care, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Anders Granholm
- Department of Intensive Care, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Anders Perner
- Department of Intensive Care, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Frederik Boëtius Hertz
- Department of Clinical Microbiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Immunology & Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Balasubramanian Venkatesh
- Critical Care Program, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Naomi E Hammond
- Critical Care Program, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Qiang Li
- Critical Care Program, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Liesbet De Bus
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Jan De Waele
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Evaldas Kauzonas
- Department of Intensive and Perioperative Care, Skåne University Hospital, Malmö, Sweden
| | - Fredrik Sjövall
- Department of Intensive and Perioperative Care, Skåne University Hospital, Malmö, Sweden
| | - Morten Hylander Møller
- Department of Intensive Care, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marie Helleberg
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Centre of Excellence for Health, Immunity and Infections, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
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Sisto UG, Di Bella S, Porta E, Franzoi G, Cominotto F, Guzzardi E, Artusi N, Giudice CA, Dal Bo E, Collot N, Sirianni F, Russo S, Sanson G. Predicting sepsis at emergency department triage: Implementing clinical and laboratory markers within the first nursing assessment to enhance diagnostic accuracy. J Nurs Scholarsh 2024. [PMID: 38886920 DOI: 10.1111/jnu.13002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/27/2024] [Accepted: 06/06/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Early identification of sepsis in the emergency department (ED) triage is both valuable and challenging. Numerous studies have endeavored to pinpoint clinical and biochemical criteria to assist clinicians in the prompt diagnosis of sepsis, but few studies have assessed the efficacy of these criteria in the ED triage setting. The aim of the study was to explore the accuracy of clinical and laboratory markers evaluated at the triage level in identifying patients with sepsis. METHODS A prospective study was conducted in a large academic urban hospital, implementing a triage protocol aimed at early identification of septic patients based on clinical and laboratory markers. A multidisciplinary panel of experts reviewed cases to ensure accurate identification of septic patients. Variables analyzed included: Charlson comorbidity index, mean arterial pressure (MAP), partial pressure of carbon dioxide (PetCO2), white cell count, eosinophil count, C-reactive protein to albumin ratio, procalcitonin, and lactate. RESULTS A total of 235 patients were included. Multivariable analysis identified procalcitonin ≥1 ng/mL (OR 5.2; p < 0.001); CRP-to-albumin ratio ≥32 (OR 6.6; p < 0.001); PetCO2 ≤ 28 mmHg (OR 2.7; p = 0.031), and MAP <85 mmHg (OR 7.5; p < 0.001) as independent predictors for sepsis. MAP ≥85 mmHg, CRP/albumin ratio <32, and procalcitonin <1 ng/mL demonstrated negative predictive values for sepsis of 90%, 89%, and 88%, respectively. CONCLUSIONS Our study underscores the significance of procalcitonin and mean arterial pressure, while introducing CRP/albumin ratio and PetCO2 as important variables to consider in the very initial assessment of patients with suspected sepsis in the ED. CLINICAL RELEVANCE Early identification of sepsis since the emergency department (ED) triage is challenging Implementing the ED triage protocol with simple clinical and laboratory markers allows to recognize patients with sepsis with a very good discriminatory power (AUC 0.88).
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Affiliation(s)
- Ugo Giulio Sisto
- Emergency Medicine Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Stefano Di Bella
- Clinical Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
- Infectious Diseases Unit, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Elisa Porta
- Clinical Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Giorgia Franzoi
- Clinical Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Franco Cominotto
- Emergency Medicine Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Elena Guzzardi
- Emergency Medicine Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Nicola Artusi
- Emergency Medicine Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Caterina Anna Giudice
- Emergency Medicine Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Eugenia Dal Bo
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Nicholas Collot
- Clinical Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Francesca Sirianni
- Medicine of Services Department, Clinical Analysis Laboratory, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Savino Russo
- Emergency Medicine Department, Azienda Sanitaria Friuli Centrale, Palmanova, Italy
| | - Gianfranco Sanson
- Clinical Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
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Ishii J, Nishikimi M, De Bus L, De Waele J, Takaba A, Kuriyama A, Kobayashi A, Tanaka C, Hashi H, Hashimoto H, Nashiki H, Shibata M, Kanamoto M, Inoue M, Hashimoto S, Katayama S, Fujiwara S, Kameda S, Shindo S, Komuro T, Kawagishi T, Kawano Y, Fujita Y, Kida Y, Hara Y, Yoshida H, Fujitani S, Shime N. No improvement in mortality among critically ill patients with carbapenems as initial empirical therapy and more detection of multi-drug resistant pathogens associated with longer use: a post hoc analysis of a prospective cohort study. Microbiol Spectr 2024:e0034224. [PMID: 38864641 DOI: 10.1128/spectrum.00342-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 05/09/2024] [Indexed: 06/13/2024] Open
Abstract
Whether empirical therapy with carbapenems positively affects the outcomes of critically ill patients with bacterial infections remains unclear. This study aimed to investigate whether the use of carbapenems as the initial antimicrobial administration reduces mortality and whether the duration of carbapenem use affects the detection of multidrug-resistant (MDR) pathogens. This was a post hoc analysis of data acquired from Japanese participating sites from a multicenter, prospective observational study [Determinants of Antimicrobial Use and De-escalation in Critical Care (DIANA study)]. A total of 268 adult patients with clinically suspected or confirmed bacterial infections from 31 Japanese intensive care units (ICUs) were analyzed. The patients were divided into two groups: patients who were administered carbapenems as initial antimicrobials (initial carbapenem group, n = 99) and those who were not administered carbapenems (initial non-carbapenem group, n = 169). The primary outcomes were mortality at day 28 and detection of MDR pathogens. Multivariate logistic regression analysis revealed that mortality at day 28 did not differ between the two groups [18 (18%) vs 27 (16%), respectively; odds ratio: 1.25 (95% confidence interval (CI): 0.59-2.65), P = 0.564]. The subdistribution hazard ratio for detecting MDR pathogens on day 28 per additional day of carbapenem use is 1.08 (95% CI: 1.05-1.13, P < 0.001 using the Fine-Gray model with death regarded as a competing event). In conclusion, in-hospital mortality was similar between the groups, and a longer duration of carbapenem use as the initial antimicrobial therapy resulted in a higher risk of detection of new MDR pathogens.IMPORTANCEWe found no statistical difference in mortality with the empirical use of carbapenems as initial antimicrobial therapy among critically ill patients with bacterial infections. Our study revealed a lower proportion of inappropriate initial antimicrobial administrations than those reported in previous studies. This result suggests the importance of appropriate risk assessment for the involvement of multidrug-resistant (MDR) pathogens and the selection of suitable antibiotics based on risk. To the best of our knowledge, this study is the first to demonstrate that a longer duration of carbapenem use as initial therapy is associated with a higher risk of subsequent detection of MDR pathogens. This finding underscores the importance of efforts to minimize the duration of carbapenem use as initial antimicrobial therapy when it is necessary.
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Affiliation(s)
- Junki Ishii
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Mitsuaki Nishikimi
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Liesbet De Bus
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Jan De Waele
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | | | - Akira Kuriyama
- Emergency and Critical Care Center, Kurashiki Central Hospital, Okayama, Japan
| | | | - Chie Tanaka
- Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
| | - Hideki Hashi
- Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
| | | | | | - Mami Shibata
- Department of Emergency and Critical Care Medicine, Wakayama Medical University Hospital, Wakayama, Japan
| | - Masafumi Kanamoto
- Department of Anesthesiology, Gunma Prefectural Cardiovascular Center, , Gunma, Japan
| | - Masashi Inoue
- Department of Anesthesiology, Nagoya City University Hospital, Aichi, Japan
| | - Satoru Hashimoto
- Non-Profit Organization ICU Collaboration Network (ICON), Tokyo, Japan
| | - Shinshu Katayama
- Division of Intensive Care, Department of Anesthesiology and Intensive Care Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | | | - Shinya Kameda
- Jikei University School of Medicine Hospital, Tokyo, Japan
| | | | - Tetsuya Komuro
- Department of General Internal Medicine, TMG Muneoka Central Hospital, Saitama, Japan
| | | | | | | | - Yoshiko Kida
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuya Hara
- Yodogawa Christian Hospital, Osaka, Japan
| | - Hideki Yoshida
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Shigeki Fujitani
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Lane RD, Richardson T, Scott HF, Paul RM, Balamuth F, Eisenberg MA, Riggs R, Huskins WC, Horvat CM, Keeney GE, Hueschen LA, Lockwood JM, Gunnala V, McKee BP, Patankar N, Pinto VL, Sebring AM, Sharron MP, Treseler J, Wilkes JJ, Workman JK. Delays to Antibiotics in the Emergency Department and Risk of Mortality in Children With Sepsis. JAMA Netw Open 2024; 7:e2413955. [PMID: 38837160 PMCID: PMC11154154 DOI: 10.1001/jamanetworkopen.2024.13955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/07/2024] [Indexed: 06/06/2024] Open
Abstract
Importance Pediatric consensus guidelines recommend antibiotic administration within 1 hour for septic shock and within 3 hours for sepsis without shock. Limited studies exist identifying a specific time past which delays in antibiotic administration are associated with worse outcomes. Objective To determine a time point for antibiotic administration that is associated with increased risk of mortality among pediatric patients with sepsis. Design, Setting, and Participants This retrospective cohort study used data from 51 US children's hospitals in the Improving Pediatric Sepsis Outcomes collaborative. Participants included patients aged 29 days to less than 18 years with sepsis recognized within 1 hour of emergency department arrival, from January 1, 2017, through December 31, 2021. Piecewise regression was used to identify the inflection point for sepsis-attributable 3-day mortality, and logistic regression was used to evaluate odds of sepsis-attributable mortality after adjustment for potential confounders. Data analysis was performed from March 2022 to February 2024. Exposure The number of minutes from emergency department arrival to antibiotic administration. Main Outcomes and Measures The primary outcome was sepsis-attributable 3-day mortality. Sepsis-attributable 30-day mortality was a secondary outcome. Results A total of 19 515 cases (median [IQR] age, 6 [2-12] years) were included. The median (IQR) time to antibiotic administration was 69 (47-116) minutes. The estimated time to antibiotic administration at which 3-day sepsis-attributable mortality increased was 330 minutes. Patients who received an antibiotic in less than 330 minutes (19 164 patients) had sepsis-attributable 3-day mortality of 0.5% (93 patients) and 30-day mortality of 0.9% (163 patients). Patients who received antibiotics at 330 minutes or later (351 patients) had 3-day sepsis-attributable mortality of 1.2% (4 patients), 30-day mortality of 2.0% (7 patients), and increased adjusted odds of mortality at both 3 days (odds ratio, 3.44; 95% CI, 1.20-9.93; P = .02) and 30 days (odds ratio, 3.63; 95% CI, 1.59-8.30; P = .002) compared with those who received antibiotics within 330 minutes. Conclusions and Relevance In this cohort of pediatric patients with sepsis, 3-day and 30-day sepsis-attributable mortality increased with delays in antibiotic administration 330 minutes or longer from emergency department arrival. These findings are consistent with the literature demonstrating increased pediatric sepsis mortality associated with antibiotic administration delay. To guide the balance of appropriate resource allocation with time for adequate diagnostic evaluation, further research is needed into whether there are subpopulations, such as those with shock or bacteremia, that may benefit from earlier antibiotics.
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Affiliation(s)
- Roni D. Lane
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Primary Children’s Hospital, University of Utah, Salt Lake City
| | | | - Halden F. Scott
- Section of Emergency Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora
| | - Raina M. Paul
- Pediatric Emergency Medicine, Children’s Hospital of Orange County, Orange, California
| | - Fran Balamuth
- Division of Emergency Medicine, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Matthew A. Eisenberg
- Division of Emergency Medicine, Department of Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Emergency Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ruth Riggs
- Children’s Hospital Association, Lenexa, Kansas
| | - W. Charles Huskins
- Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Christopher M. Horvat
- Department of Critical Care Medicine, UPMC, Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Grant E. Keeney
- Department of Pediatric Emergency Medicine, Mary Bridge Children’s Hospital, Tacoma, Washington
| | - Leslie A. Hueschen
- Division of Emergency Medicine, Department of Pediatrics, Children’s Mercy Hospital, University of Missouri-Kansas City, Kansas City
| | - Justin M. Lockwood
- Section of Hospital Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora
| | - Vishal Gunnala
- Division of Critical Care Medicine, Phoenix Children’s Hospital, Phoenix, Arizona
| | - Bryan P. McKee
- Division of Critical Care Medicine, Department of Pediatrics, Akron Children’s Hospital, Akron, Ohio
| | - Nikhil Patankar
- Pediatric Critical Care, Baptist St Anthony’s Health System, Amarillo, Texas
| | - Venessa Lynn Pinto
- Division of Pediatric Critical Care, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Amanda M. Sebring
- Division of Pediatric Critical Care, Department of Pediatrics, Atrium Health Levine Children’s, Charlotte, North Carolina
| | - Matthew P. Sharron
- Division of Critical Care Medicine, Department of Pediatrics, Children’s National Hospital, George Washington University School of Medicine, Washington, DC
| | - Jennifer Treseler
- Program for Patient Safety and Quality, Boston Children’s Hospital, Boston, Massachusetts
| | - Jennifer J. Wilkes
- Division of Cancer and Blood Disorders, Department of Pediatrics, University of Washington School of Medicine, Seattle
| | - Jennifer K. Workman
- Division of Pediatric Critical Care, Department of Pediatrics, University of Utah, Salt Lake City
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Han B, Choukér A, Moser D. Differential effects of acute and chronic hydrocortisone treatment on pyroptosis. Heliyon 2024; 10:e31156. [PMID: 38784563 PMCID: PMC11112316 DOI: 10.1016/j.heliyon.2024.e31156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 05/10/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024] Open
Abstract
Pyroptosis is a programmed and inflammation-inducing cell death that occurs predominantly in macrophages. It is characterized by the inflammasome-mediated activation of caspase-1, leading to cell lysis. During pyroptosis, pro-inflammatory mediators such as IL-1β are released extracellularly to further recruit and activate other immune cells. Thus, pyroptosis plays a crucial role in the prevention of the spread of pathogens. The clinically applied synthetic glucocorticoid, hydrocortisone (HC), has strong immunoregulatory properties. It may act as an immunosuppressive agent by negatively regulating pro-inflammatory gene transcription but has also shown immune-sensitizing properties. The conditions that determine the immunosuppressive or immune-sensitizing actions of HC during an infection are not fully clear. We hypothesized that the outcome may differ depending on the onset and duration of its administration. Therefore, we investigated the impact of acute (treatment upon infection) and chronic (24 h pre-treatment before infection) HC treatment on pyroptosis induction and execution in THP-1 macrophage-like cells. The focus was on pyroptosis-associated signaling pathways, inflammasome assembly and activation, IL-1β, and cell death. Physiological HC concentration and HC deprivation were used as controls. Compared to the physiological concentration, cells displayed augmented inflammasome activation and IL-1β release following acute HC treatment. Conversely, the whole pyroptosis machinery was suppressed by chronic HC administration. These in vitro investigations demonstrate pro-inflammatory actions of acute HC exposure and the immunosuppressive effects of chronic treatment. These differential effects on pyroptosis emphasize the importance of individualized HC medication in patients upon infection, and suggest the inclusion of IL-1β as a marker for current immune capacities.
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Affiliation(s)
- Bing Han
- Laboratory of Translational Research ‘Stress and Immunity’, Department of Anesthesiology, LMU Hospital, Ludwig-Maximilians-Universität in Munich, Germany
| | - Alexander Choukér
- Laboratory of Translational Research ‘Stress and Immunity’, Department of Anesthesiology, LMU Hospital, Ludwig-Maximilians-Universität in Munich, Germany
| | - Dominique Moser
- Laboratory of Translational Research ‘Stress and Immunity’, Department of Anesthesiology, LMU Hospital, Ludwig-Maximilians-Universität in Munich, Germany
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Sandoval LJS, Rojas MA, Idrogo FP. Community-acquired pneumonia associated with immunosuppression due to follicular thyroid cancer: a case report. J Med Case Rep 2024; 18:260. [PMID: 38796490 PMCID: PMC11128121 DOI: 10.1186/s13256-024-04576-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/01/2024] [Indexed: 05/28/2024] Open
Abstract
BACKGROUND We present the case of a woman with cancer, which weakened the immune system and increased the risk of infection. Thus, infections are a frequent complication of cancer. The development of community-acquired pneumonia, an acute respiratory infectious disease that damages the lung parenchyma, caused by the invasion of pathogenic microorganisms, can lead to respiratory failure with multiorgan failure due to respiratory sepsis. CASE PRESENTATION Case report of a 38-year-old mixed-race woman with diabetes mellitus and irregular treatment, who was admitted with community-acquired pneumonia complicated by type I respiratory failure requiring mechanical ventilation. During her hospital stay, she developed ventilator-associated pneumonia, recurrent empyema, bronchopleural fistula, refractory septic shock and multiorgan dysfunction despite multiple interventions. The patient required prolonged mechanical ventilation, vasopressor support and antibiotic therapy. After 62 days, metastatic papillary thyroid carcinoma was diagnosed. She presented with hypoparathyroidism and permanent hypocalcemia. She died after multiple complications and a refractory critical condition. CONCLUSION The case exemplifies the potential severity of community-acquired pneumonia in a patient with risk factors such as diabetes and immunosuppression. It highlights the complexity of treating multiple comorbidities and the importance of multidisciplinary management with close surveillance for timely interventions for complications.
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Diehl-Wiesenecker E, Galtung N, Dickescheid J, Prpic M, Somasundaram R, Kappert K, Bauer W. Blood calprotectin as a biomarker for infection and sepsis - the prospective CASCADE trial. BMC Infect Dis 2024; 24:496. [PMID: 38755564 PMCID: PMC11100246 DOI: 10.1186/s12879-024-09394-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 05/09/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Early in the host-response to infection, neutrophils release calprotectin, triggering several immune signalling cascades. In acute infection management, identifying infected patients and stratifying these by risk of deterioration into sepsis, are crucial tasks. Recruiting a heterogenous population of patients with suspected infections from the emergency department, early in the care-path, the CASCADE trial aimed to evaluate the accuracy of blood calprotectin for detecting bacterial infections, estimating disease severity, and predicting clinical deterioration. METHODS In a prospective, observational trial from February 2021 to August 2022, 395 patients (n = 194 clinically suspected infection; n = 201 controls) were enrolled. Blood samples were collected at enrolment. The accuracy of calprotectin to identify bacterial infections, and to predict and identify sepsis and mortality was analysed. These endpoints were determined by a panel of experts. RESULTS The Area Under the Receiver Operating Characteristic (AUROC) of calprotectin for detecting bacterial infections was 0.90. For sepsis within 72 h, calprotectin's AUROC was 0.83. For 30-day mortality it was 0.78. In patients with diabetes, calprotectin had an AUROC of 0.94 for identifying bacterial infection. CONCLUSIONS Calprotectin showed notable accuracy for all endpoints. Using calprotectin in the emergency department could improve diagnosis and management of severe infections, in combination with current biomarkers. CLINICAL TRIAL REGISTRATION NUMBER DRKS00020521.
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Affiliation(s)
- Eva Diehl-Wiesenecker
- Department of Emergency Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Benjamin Franklin Campus, Zentrale Notaufnahme und Aufnahmestation, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Noa Galtung
- Department of Emergency Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Benjamin Franklin Campus, Zentrale Notaufnahme und Aufnahmestation, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Johannes Dickescheid
- Department of Emergency Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Benjamin Franklin Campus, Zentrale Notaufnahme und Aufnahmestation, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Monika Prpic
- Institute of Diagnostic Laboratory Medicine, Clinical Chemistry and Pathobiochemistry, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Rajan Somasundaram
- Department of Emergency Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Benjamin Franklin Campus, Zentrale Notaufnahme und Aufnahmestation, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Kai Kappert
- Institute of Diagnostic Laboratory Medicine, Clinical Chemistry and Pathobiochemistry, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- Labor Berlin - Charité Vivantes GmbH, Berlin, Germany
| | - Wolfgang Bauer
- Department of Emergency Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Benjamin Franklin Campus, Zentrale Notaufnahme und Aufnahmestation, Hindenburgdamm 30, 12203, Berlin, Germany.
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Teja B, Berube M, Pereira TV, Law AC, Schanock C, Pang B, Wunsch H, Walkey AJ, Bosch NA. Effectiveness of Fludrocortisone Plus Hydrocortisone versus Hydrocortisone Alone in Septic Shock: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials. Am J Respir Crit Care Med 2024; 209:1219-1228. [PMID: 38271488 PMCID: PMC11146553 DOI: 10.1164/rccm.202310-1785oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/25/2024] [Indexed: 01/27/2024] Open
Abstract
Rationale: The use of hydrocortisone in adult patients with septic shock is controversial, and the effectiveness of adding fludrocortisone to hydrocortisone remains uncertain. Objectives: To assess the comparative effectiveness and safety of fludrocortisone plus hydrocortisone, hydrocortisone alone, and placebo or usual care in adults with septic shock. Methods: A systematic review and a Bayesian network meta-analysis of peer-reviewed randomized trials were conducted. The primary outcome was all-cause mortality at last follow-up. Treatment effects are presented as relative risks (RRs) with 95% credible intervals (CrIs). Placebo or usual care was the reference treatment. Measurements and Main Results: Among 7,553 references, we included 17 trials (7,688 patients). All-cause mortality at last follow-up was lowest with fludrocortisone plus hydrocortisone (RR, 0.85; 95% CrI, 0.72-0.99; 98.3% probability of superiority, moderate-certainty evidence), followed by hydrocortisone alone (RR, 0.97; 95% CrI, 0.87-1.07; 73.1% probability of superiority, low-certainty evidence). The comparison of fludrocortisone plus hydrocortisone versus hydrocortisone alone was based primarily on indirect evidence (only two trials with direct evidence). Fludrocortisone plus hydrocortisone was associated with a 12% lower risk of all-cause mortality compared with hydrocortisone alone (RR, 0.88; 95% CrI, 0.74-1.03; 94.2% probability of superiority, moderate-certainty evidence). Conclusions: In adult patients with septic shock, fludrocortisone plus hydrocortisone was associated with lower risk of all-cause mortality at last follow-up than placebo and hydrocortisone alone. The scarcity of head-to-head trials comparing fludrocortisone plus hydrocortisone versus hydrocortisone alone led our network meta-analysis to rely primarily on indirect evidence for this comparison. Although we undertook several sensitivity analyses and assessments, these findings should be considered while also acknowledging the heterogeneity of included trials.
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Affiliation(s)
- Bijan Teja
- Interdepartmental Division of Critical Care Medicine and
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Megan Berube
- The Pulmonary Center, Department of Medicine, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
| | - Tiago V. Pereira
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Anica C. Law
- The Pulmonary Center, Department of Medicine, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
| | - Carly Schanock
- Medical College of Wisconsin Libraries, Milwaukee, Wisconsin
| | - Brandon Pang
- The Pulmonary Center, Department of Medicine, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
| | - Hannah Wunsch
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York; and
| | - Allan J. Walkey
- Division of Health Systems Sciences, Medical School, University of Massachusetts, Boston, Massachusetts
| | - Nicholas A. Bosch
- The Pulmonary Center, Department of Medicine, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
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12
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McAtee R, Wood MW, Daniels JB, Lashnits E. Treatment of Francisella philomiragia bacteremia in a dog. J Vet Intern Med 2024. [PMID: 38738486 DOI: 10.1111/jvim.17104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 05/01/2024] [Indexed: 05/14/2024] Open
Abstract
To describe the diagnosis and successful treatment of systemic francisellosis in a dog. An 11-year-old female spayed Labrador retriever presented for progressive lethargy, hyporexia, and cough. The dog was febrile with a neutrophilia, nonregenerative anemia, thrombocytopenia, and had increased activity in serum of liver-derived enzymes. Francisella philomiragia was isolated from aerobic blood culture. The dog was treated for 6 weeks with enrofloxacin orally. Repeated aerobic blood cultures after 2 and 6 weeks of antibiotic therapy were negative. The dog was clinically normal 7 months after diagnosis with no evidence of relapse.
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Affiliation(s)
- Rae McAtee
- Department of Medical Sciences, University of Wisconsin-Madison School of Veterinary Medicine, Madison, Wisconsin, USA
| | - Michael W Wood
- Department of Medical Sciences, University of Wisconsin-Madison School of Veterinary Medicine, Madison, Wisconsin, USA
| | - Joshua B Daniels
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Erin Lashnits
- Department of Medical Sciences, University of Wisconsin-Madison School of Veterinary Medicine, Madison, Wisconsin, USA
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13
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Rich RL, Montero JM, Dillon KE, Condon P, Vadaparampil M. Evaluation of an Intensive Care Unit Sepsis Alert in Critically Ill Medical Patients. Am J Crit Care 2024; 33:212-216. [PMID: 38688850 DOI: 10.4037/ajcc2024566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
BACKGROUND Sepsis alerts commonly used for intensive care unit (ICU) patients can lead to alert fatigue because these patients generally meet 1 or more of the criteria for systemic inflammatory response syndrome. To identify ICU patients at greatest risk for sepsis-related consequences, an ICU-specific sepsis alert was implemented. OBJECTIVE To evaluate an ICU sepsis alert based on modified criteria for systemic inflammatory response syndrome among critically ill medical patients. METHODS This retrospective evaluation was conducted at a comprehensive tertiary referral center. Patients included were at least 18 years old, were admitted to the critical care medicine service, and had at least 1 sepsis alert between January 1 and February 29, 2020. The sepsis alert identified patients meeting at least 2 modified systemic inflammatory response syndrome criteria (white blood cell count, <4000/μL or >12 000/μL; body temperature, <36 °C or >38.3 °C; heart rate, >110/min; and respiratory rate, >21/min), with at least 1 of the 2 criteria being white blood cell count or body temperature. RESULTS For 128 alerts evaluated, the positive predictive value was 72%. Of 713 patients who were admitted to the critical care medicine service and did not have a sepsis alert, 7 received a sepsis diagnosis. The ICU sepsis alert had a negative predictive value of 99%, sensitivity of 92.9%, and specificity of 95.1%. CONCLUSIONS An ICU sepsis alert using modified systemic inflammatory response syndrome criteria was effective for identifying sepsis in critically ill medical patients.
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Affiliation(s)
- Rebecca L Rich
- Rebecca L. Rich is a critical care clinical pharmacy specialist, Department of Pharmacy, Lakeland Regional Health, Lakeland, Florida
| | - Jennifer M Montero
- Jennifer M. Montero is a quality clinical pharmacy specialist and sepsis coordinator, Department of Clinical Quality, Lakeland Regional Health
| | - Kyle E Dillon
- Kyle E. Dillon is a critical care clinical pharmacy specialist, Department of Pharmacy, Lakeland Regional Health
| | - Patrick Condon
- Patrick Condon is an emergency medicine clinical pharmacy specialist, Department of Pharmacy, Orlando Health, Orlando, Florida
| | - Mathew Vadaparampil
- Mathew Vadaparampil is a pulmonary critical care intensivist, Department of Critical Care Medicine, Lakeland Regional Health
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Ma Y, Zhu C, Ma X, Zhou B, Dong M. Risk factors of acute respiratory distress syndrome in sepsis caused by intra-abdominal infections: A retrospective study. Surgery 2024; 175:1432-1438. [PMID: 38383244 DOI: 10.1016/j.surg.2024.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/22/2023] [Accepted: 01/17/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Intra-abdominal infections are frequently associated with acute respiratory distress syndrome, which significantly affects patient prognosis. However, little is known about the specific risk factors of acute respiratory distress syndrome in sepsis caused by intra-abdominal infections. METHODS This retrospective study included adult patients with intra-abdominal sepsis admitted to the intensive care unit of a tertiary teaching hospital in China between June 2017 and June 2022. Patients were categorized based on the presence or absence of acute respiratory distress syndrome. Data, including vital signs, laboratory values, and severity scores collected within 24 hours of sepsis diagnosis, as well as outcomes within 90 days, were analyzed. Multivariable logistic regression was used to identify independent risk factors associated with acute respiratory distress syndrome. RESULTS A total of 738 patients were included, of whom 218 (29.5%) developed acute respiratory distress syndrome. Patients with acute respiratory distress syndrome were younger, had a higher body mass index and disease severity scores, and exhibited higher proportions of septic shock and hospital-acquired intra-abdominal infections. The mortalities in the intensive care unit and at 28 and 90 days were higher in the acute respiratory distress syndrome group. In the multivariate logistic regression model, age under 65 years (odds ratio [95% confidence interval]: 1.571 [1.093-2.259]), elevated body mass index (2.070 [1.382-3.101] for overweight, 6.994 [3.207-15.255]) for obesity, septic shock (2.043 [1.400-2.980]), procalcitonin (1.009 [1.004-1.015]), hospital-acquired intra-abdominal infections (2.528[1.373-4.657]), and source of intra-abdominal infections (2.170 [1.140-4.128] for biliary tract infection, 0.443 [0.217-0.904] for gastroduodenal perforation) were independently associated with acute respiratory distress syndrome. CONCLUSION In patients with intra-abdominal sepsis, age under 65 years, higher body mass index and procalcitonin, septic shock, hospital-acquired intra-abdominal infections, and biliary tract infection were risk factors for acute respiratory distress syndrome.
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Affiliation(s)
- Yuteng Ma
- Department of Gastrointestinal Surgery, First Hospital of China Medical University, Shenyang, Liaoning Province, China; Department of Critical Care Medicine, First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Chengrui Zhu
- Department of Critical Care Medicine, First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Xiaochun Ma
- Department of Critical Care Medicine, First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Baosen Zhou
- Department of Clinical Epidemiology, First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Ming Dong
- Department of Gastrointestinal Surgery, First Hospital of China Medical University, Shenyang, Liaoning Province, China.
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15
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Neira VM, AlFaraj A, Wiseman L, John R, Andreou P, Cohen A. Stability of Epinephrine, Norepinephrine, and Phenylephrine for Intravenous Infusions Stored in Three Commercial Plastic Syringe Brands. Anesthesiology 2024; 140:1047-1049. [PMID: 38457213 DOI: 10.1097/aln.0000000000004944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
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16
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Ngan C, Zeng X, Lia T, Yin W, Kang Y. Cardiac index and heart rate as prognostic indicators for mortality in septic shock: A retrospective cohort study from the MIMIC-IV database. Heliyon 2024; 10:e28956. [PMID: 38655320 PMCID: PMC11035949 DOI: 10.1016/j.heliyon.2024.e28956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 03/15/2024] [Accepted: 03/27/2024] [Indexed: 04/26/2024] Open
Abstract
Background Septic shock is a life-threatening condition that can lead to organ dysfunction and death. In the ICU, monitoring of cardiac index (CI) and heart rate (HR) is commonly used to guide management and predict outcomes in septic shock patients. However, there is a lack of research on the association between CI and HR and the risk of mortality in this patient population. Therefore, the aim of this study was to investigate the relationship between different levels of CI and HR and mortality in septic shock patients. Methods Data analysis was obtained from the MIMIC-IV version 2.0 database. Sepsis and septic shock were primarily defined by sepsis-3, the third international consensus on sepsis and septic shock. CI was computed using cardiac output (CO) and body surface area (BSA). To evaluate the incidence of CI with respect to each endpoint (7-, 14-, 21-, and 28-day mortality), a restricted cubic spline curve function (RCS) was used. The optimal cutoff value for predicted mortality was determined using the Youden index. Analyses of KM curves, cox regression, and logistic regression were conducted separately to determine the relationship between various CI and HR and 28-day mortality. Results This study included 1498 patients with septic shock. A U-shaped relationship between CI levels and risk of mortality in septic shock was found by RCS analysis (p < 0.001). CI levels within the intermediate range of 1.85-2.8 L/min/m2 were associated with a mortality hazard ratio (HR) < 1. In contrast, low CI (HR = 1.87 95% CI: 1.01-3.49) and high CI (HR = 1.93 95% CI: 1.26-2.97) had a significantly increased risk of mortality. The AUC for heart rate prediction of mortality by Youden index analysis was 0.70 95%CI:0.64-0.76 with a cut-off value of 93.63 bpm. According to the characteristics of HR and CI, patients were divided into six subgroups HR↓+CI intermediate group (n = 772), HR↓+CI↓ group (n = 126), HR↓+CI↑ group (n = 294), HR↑+CI intermediate group (n = 132), HR↑+CI↓ group (n = 24), and HR↑+CI↑ group (n = 150). The KM curves, COX regression, and logistic regression analysis showed that the survival rates the of HR↓+CI intermediate group, HR↓+CI↓ group, and HR↓+CI↑ were higher than the other groups. The risk factors of HR↑+CI intermediate group, HR↑+CI↓, and HR↑+CI↑ with ICU 28-day mortality were HR = 2.91 (95% CI: 1.39-5.97), HR = 3.67 (95% CI: 1.39-11.63), and HR = 5.77 (95% CI: 2.98-11.28), respectively. Conclusion Our retrospective study shows that monitoring cardiac index and heart rate in patients with septic shock may help predict the organismal response and hemodynamic consequences, as well as the prognosis. Thus, healthcare providers should carefully monitor changes in these parameters in septic shock patients transferred to the ICU for treatment.
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Affiliation(s)
- Chansokhon Ngan
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Xueying Zeng
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Thongher Lia
- Department of Urology Surgery, Chengdu Second People's Hospital, Chengdu, Sichuan Province, China
| | - Wanhong Yin
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yan Kang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
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Girardis M, Coloretti I, Antonelli M, Berlot G, Busani S, Cortegiani A, De Pascale G, De Rosa FG, De Rosa S, Donadello K, Donati A, Forfori F, Giannella M, Grasselli G, Montrucchio G, Oliva A, Pasero D, Piazza O, Romagnoli S, Tascini C, Viaggi B, Tumbarello M, Viale P. Adjunctive immunotherapeutic agents in patients with sepsis and septic shock: a multidisciplinary consensus of 23. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2024; 4:28. [PMID: 38689337 PMCID: PMC11059820 DOI: 10.1186/s44158-024-00165-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 04/18/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND In the last decades, several adjunctive treatments have been proposed to reduce mortality in septic shock patients. Unfortunately, mortality due to sepsis and septic shock remains elevated and NO trials evaluating adjunctive therapies were able to demonstrate any clear benefit. In light of the lack of evidence and conflicting results from previous studies, in this multidisciplinary consensus, the authors considered the rational, recent investigations and potential clinical benefits of targeted adjunctive therapies. METHODS A panel of multidisciplinary experts defined clinical phenotypes, treatments and outcomes of greater interest in the field of adjunctive therapies for sepsis and septic shock. After an extensive systematic literature review, the appropriateness of each treatment for each clinical phenotype was determined using the modified RAND/UCLA appropriateness method. RESULTS The consensus identified two distinct clinical phenotypes: patients with overwhelming shock and patients with immune paralysis. Six different adjunctive treatments were considered the most frequently used and promising: (i) corticosteroids, (ii) blood purification, (iii) immunoglobulins, (iv) granulocyte/monocyte colony-stimulating factor and (v) specific immune therapy (i.e. interferon-gamma, IL7 and AntiPD1). Agreement was achieved in 70% of the 25 clinical questions. CONCLUSIONS Although clinical evidence is lacking, adjunctive therapies are often employed in the treatment of sepsis. To address this gap in knowledge, a panel of national experts has provided a structured consensus on the appropriate use of these treatments in clinical practice.
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Affiliation(s)
- Massimo Girardis
- Anesthesia and Intensive Care Medicine, Policlinico Di Modena, University of Modena and Reggio Emilia, Modena, Italy.
| | - Irene Coloretti
- Anesthesia and Intensive Care Medicine, Policlinico Di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Massimo Antonelli
- Dipartimento Di Scienze Biotecnologiche Di Base, Cliniche Intensivologiche E Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento Di Scienze Dell'Emergenza, Anestesiologiche E Della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giorgio Berlot
- Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Stefano Busani
- Anesthesia and Intensive Care Medicine, Policlinico Di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy
- Department of Anaesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
| | - Gennaro De Pascale
- Dipartimento Di Scienze Biotecnologiche Di Base, Cliniche Intensivologiche E Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento Di Scienze Dell'Emergenza, Anestesiologiche E Della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Silvia De Rosa
- Anesthesia and Intensive Care, Santa Chiara Regional Hospital, APSS, Trento, Italy
| | - Katia Donadello
- Department of Surgery, Dentistry, Ginaecology and Paediatrics, University of Verona, and Anesthesia and Intensive Care Unit B, University Hospital Integrated Trust of Verona, Verona, Italy
| | - Abele Donati
- Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria Delle Marche, Ancona, Italy
| | - Francesco Forfori
- Anesthesia and Intensive Care, Anesthesia and Resuscitation Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Maddalena Giannella
- Department of Medical and Surgical Sciences Infectious Diseases Unit, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Giacomo Grasselli
- Department of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giorgia Montrucchio
- Department of Surgical Sciences, Departement of Anesthesia, Resuscitation and Emergency Torino, University of Turin, Turin, Italy
| | - Alessandra Oliva
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Daniela Pasero
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Ornella Piazza
- University Hospital "San Giovanni Di Dio E Ruggi d'Aragona", Salerno, Italy
| | - Stefano Romagnoli
- Department of Health Science, Department of Anesthesia and Intensive Care, University of Florence, Careggi University Hospital, Florence, Italy
| | - Carlo Tascini
- Department of Medicine (DAME), Infectious Diseases Clinic, University of Udine, Udine, Italy
| | - Bruno Viaggi
- Anesthesia and Intensive Care, Careggi University Hospital, Florence, Italy
| | - Mario Tumbarello
- Infectious and Tropical Diseases Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences Infectious Diseases Unit, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
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Hiraiwa H, Kasugai D, Okumura T, Murohara T. Clinical implications of septic cardiomyopathy: A narrative review. Medicine (Baltimore) 2024; 103:e37940. [PMID: 38669408 PMCID: PMC11049701 DOI: 10.1097/md.0000000000037940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/29/2024] [Indexed: 04/28/2024] Open
Abstract
Sepsis is caused by the body's dysregulated response to infection, which can lead to multiorgan injury and death. Patients with sepsis may develop acute cardiac dysfunction, termed septic cardiomyopathy, which is a global but reversible dysfunction of both sides of the heart. This narrative review discusses the mechanistic changes in the heart during septic cardiomyopathy, its diagnosis, existing treatment options regarding severity and course, and emerging treatment approaches. Although no standardized definition for septic cardiomyopathy exists, it is described as a reversible myocardial dysfunction that typically resolves within 7 to 10 days. Septic cardiomyopathy is often diagnosed based on electrocardiography, cardiac magnetic resonance imaging, biomarkers, and direct invasive and noninvasive measures of cardiac output. Presently, the treatment of septic cardiomyopathy is similar to that of sepsis, primarily focusing on acute interventions. Treatments for cardiomyopathy often include angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and diuretics. However, because of profound hypotension in sepsis, many cardiomyopathy treatments are contraindicated in patients with septic cardiomyopathy. Substantial efforts have been made to study the pathophysiological mechanisms and diagnostic options; however, the lack of a uniform definition for septic cardiomyopathy is challenging for physicians when considering treatments. Another challenge for physicians is that the treatment for septic cardiomyopathy has only focused on acute intervention, whereas the treatment for other cardiomyopathies has been provided on a long-term basis. A better understanding of the underlying mechanisms of septic cardiomyopathy may contribute to the development of a unified definition of the condition and novel treatment options.
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Affiliation(s)
- Hiroaki Hiraiwa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Daisuke Kasugai
- Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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19
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Tanaka K, Choudhury ME, Kikuchi S, Takeda I, Umakoshi K, Miyaue N, Mikami K, Takenaga A, Yagi H, Shinabe R, Matsumoto H, Yano H, Nagai M, Takeba J, Tanaka J. A dopamine D1-like receptor-specific agonist improves the survival of septic mice. iScience 2024; 27:109587. [PMID: 38623339 PMCID: PMC11016908 DOI: 10.1016/j.isci.2024.109587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/08/2024] [Accepted: 03/25/2024] [Indexed: 04/17/2024] Open
Abstract
In this study, a murine sepsis model was developed using the cecum ligation and puncture (CLP) technique. The expression of the proinflammatory cytokines tumor necrosis factor alpha (TNF-α) and interleukin-1β (IL-1β) in the brain increased 6 h after CLP but decreased 24 h later when elevated endogenous dopamine levels in the brain were sustained. Methyl-4-phenyl-1,2,3,6-tetrahydropyridine hydrochloride reduced dopamine levels in the striatum and increased mortality in septic mice. Dopamine D1-like receptors were significantly expressed in the brain, but not in the lungs. Intraperitoneally administered SKF-81297 (SKF), a blood-brain barrier-permeable D1-like receptor agonist, prevented CLP-induced death of septic mice with ameliorated acute lung injury and cognitive dysfunction and suppressed TNF-α and IL-1β expression. The D1-like receptor antagonist SCH-23390 abolished the anti-inflammatory effects of SKF. These data suggest that D1-like receptor-mediated signals in the brain prevent CLP-induced inflammation in both the brain and the periphery.
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Affiliation(s)
- Koichi Tanaka
- Advanced Emergency and Critical Care Center, Ehime Prefectural Central Hospital, Kasugamachi, Matsuyama, Ehime 790-0024, Japan
- Department of Aeromedical Services for Emergency and Trauma Care, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Mohammed E. Choudhury
- Department of Molecular and Cellular Physiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Satoshi Kikuchi
- Department of Emergency Medicine, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Ikuko Takeda
- Department of Anatomy and Molecular Cell Biology, Nagoya University Graduate School of Medicine, Nagoya, Aichi 466-8550, Japan
- Division of Multicellular Circuit Dynamics, National Institute for Physiological Sciences, Okazaki, Aichi 444-8585, Japan
| | - Kensuke Umakoshi
- Advanced Emergency and Critical Care Center, Ehime Prefectural Central Hospital, Kasugamachi, Matsuyama, Ehime 790-0024, Japan
| | - Noriyuki Miyaue
- Department of Clinical Pharmacology and Therapeutics, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Kanta Mikami
- Department of Molecular and Cellular Physiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Ayane Takenaga
- Department of Molecular and Cellular Physiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
- Department of Clinical Pharmacology and Therapeutics, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Harumichi Yagi
- Department of Molecular and Cellular Physiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Rintaro Shinabe
- Department of Molecular and Cellular Physiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Hironori Matsumoto
- Department of Emergency Medicine, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Hajime Yano
- Department of Molecular and Cellular Physiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Masahiro Nagai
- Department of Clinical Pharmacology and Therapeutics, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Jun Takeba
- Department of Aeromedical Services for Emergency and Trauma Care, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Junya Tanaka
- Department of Molecular and Cellular Physiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
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20
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Agakidou E, Chatziioannidis I, Kontou A, Stathopoulou T, Chotas W, Sarafidis K. An Update on Pharmacologic Management of Neonatal Hypotension: When, Why, and Which Medication. CHILDREN (BASEL, SWITZERLAND) 2024; 11:490. [PMID: 38671707 PMCID: PMC11049273 DOI: 10.3390/children11040490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/30/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024]
Abstract
Anti-hypotensive treatment, which includes dopamine, dobutamine, epinephrine, norepinephrine, milrinone, vasopressin, terlipressin, levosimendan, and glucocorticoids, is a long-established intervention in neonates with arterial hypotension (AH). However, there are still gaps in knowledge and issues that need clarification. The main questions and challenges that neonatologists face relate to the reference ranges of arterial blood pressure in presumably healthy neonates in relation to gestational and postnatal age; the arterial blood pressure level that potentially affects perfusion of critical organs; the incorporation of targeted echocardiography and near-infrared spectroscopy for assessing heart function and cerebral perfusion in clinical practice; the indication, timing, and choice of medication for each individual patient; the limited randomized clinical trials in neonates with sometimes conflicting results; and the sparse data regarding the potential effect of early hypotension or anti-hypotensive medications on long-term neurodevelopment. In this review, after a short review of AH definitions used in neonates and existing data on pathophysiology of AH, we discuss currently available data on pharmacokinetic and hemodynamic effects, as well as the effectiveness and safety of anti-hypotensive medications in neonates. In addition, data on the comparisons between anti-hypotensive medications and current suggestions for the main indications of each medication are discussed.
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Affiliation(s)
- Eleni Agakidou
- 1st Department of Neonatology and Neonatal Intensive Care, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Ippokrateion General Hospital, 54642 Thessaloniki, Greece; (I.C.); (A.K.); (T.S.); (K.S.)
| | - Ilias Chatziioannidis
- 1st Department of Neonatology and Neonatal Intensive Care, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Ippokrateion General Hospital, 54642 Thessaloniki, Greece; (I.C.); (A.K.); (T.S.); (K.S.)
| | - Angeliki Kontou
- 1st Department of Neonatology and Neonatal Intensive Care, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Ippokrateion General Hospital, 54642 Thessaloniki, Greece; (I.C.); (A.K.); (T.S.); (K.S.)
| | - Theodora Stathopoulou
- 1st Department of Neonatology and Neonatal Intensive Care, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Ippokrateion General Hospital, 54642 Thessaloniki, Greece; (I.C.); (A.K.); (T.S.); (K.S.)
| | - William Chotas
- Department of Neonatology, University of Vermont, Burlington, VT 05405, USA
| | - Kosmas Sarafidis
- 1st Department of Neonatology and Neonatal Intensive Care, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Ippokrateion General Hospital, 54642 Thessaloniki, Greece; (I.C.); (A.K.); (T.S.); (K.S.)
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21
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Perna B, Raparelli V, Tordo Caprioli F, Blanaru OT, Malacarne C, Crosetti C, Portoraro A, Zanotto A, Strocchi FM, Rapino A, Costanzini A, Maritati M, Lazzari R, Spampinato MD, Contini C, De Giorgio R, Guarino M. Sex- and Gender-Based Analysis on Norepinephrine Use in Septic Shock: Why Is It Still a Male World? Microorganisms 2024; 12:821. [PMID: 38674765 PMCID: PMC11052153 DOI: 10.3390/microorganisms12040821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/03/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
Sex and gender are fundamental health determinants and their role as modifiers of treatment response is increasingly recognized. Norepinephrine is a cornerstone of septic shock management and its use is based on the highest level of evidence compared to dopamine. The related 2021 Surviving Sepsis Campaign (SCC) recommendation is presumably applicable to both females and males; however, a sex- and gender-based analysis is lacking, thus not allowing generalizable conclusions. This paper was aimed at exploring whether sex- and gender-disaggregated data are available in the evidence supporting this recommendation. For all the studies underpinning it, four pairs of authors, including a woman and a man, extracted data concerning sex and gender, according to the Sex and Gender Equity in Research guidelines. Nine manuscripts were included with an overall population of 2126 patients, of which 43.2% were females. No sex analysis was performed and gender was never reported. In conclusion, the present manuscript highlighted that the clinical studies underlying the SCC recommendation of NE administration in septic shock have neglected the likely role of sex and gender as modifiers of treatment response, thus missing the opportunity of sex- and gender-specific guidelines.
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Affiliation(s)
- Benedetta Perna
- Department of Translational Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy; (B.P.); (F.T.C.); (O.T.B.); (C.M.); (C.C.); (A.P.); (A.Z.); (F.M.S.); (A.R.); (A.C.); (M.D.S.); (M.G.)
| | - Valeria Raparelli
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00161 Rome, Italy;
| | - Federica Tordo Caprioli
- Department of Translational Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy; (B.P.); (F.T.C.); (O.T.B.); (C.M.); (C.C.); (A.P.); (A.Z.); (F.M.S.); (A.R.); (A.C.); (M.D.S.); (M.G.)
| | - Oana Teodora Blanaru
- Department of Translational Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy; (B.P.); (F.T.C.); (O.T.B.); (C.M.); (C.C.); (A.P.); (A.Z.); (F.M.S.); (A.R.); (A.C.); (M.D.S.); (M.G.)
| | - Cecilia Malacarne
- Department of Translational Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy; (B.P.); (F.T.C.); (O.T.B.); (C.M.); (C.C.); (A.P.); (A.Z.); (F.M.S.); (A.R.); (A.C.); (M.D.S.); (M.G.)
| | - Cecilia Crosetti
- Department of Translational Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy; (B.P.); (F.T.C.); (O.T.B.); (C.M.); (C.C.); (A.P.); (A.Z.); (F.M.S.); (A.R.); (A.C.); (M.D.S.); (M.G.)
| | - Andrea Portoraro
- Department of Translational Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy; (B.P.); (F.T.C.); (O.T.B.); (C.M.); (C.C.); (A.P.); (A.Z.); (F.M.S.); (A.R.); (A.C.); (M.D.S.); (M.G.)
| | - Alex Zanotto
- Department of Translational Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy; (B.P.); (F.T.C.); (O.T.B.); (C.M.); (C.C.); (A.P.); (A.Z.); (F.M.S.); (A.R.); (A.C.); (M.D.S.); (M.G.)
| | - Francesco Maria Strocchi
- Department of Translational Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy; (B.P.); (F.T.C.); (O.T.B.); (C.M.); (C.C.); (A.P.); (A.Z.); (F.M.S.); (A.R.); (A.C.); (M.D.S.); (M.G.)
| | - Alessandro Rapino
- Department of Translational Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy; (B.P.); (F.T.C.); (O.T.B.); (C.M.); (C.C.); (A.P.); (A.Z.); (F.M.S.); (A.R.); (A.C.); (M.D.S.); (M.G.)
| | - Anna Costanzini
- Department of Translational Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy; (B.P.); (F.T.C.); (O.T.B.); (C.M.); (C.C.); (A.P.); (A.Z.); (F.M.S.); (A.R.); (A.C.); (M.D.S.); (M.G.)
| | - Martina Maritati
- Infectious Diseases Unit, Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy; (M.M.); (C.C.)
| | - Roberto Lazzari
- Emergency Department, Hospital de la Santa Creu I Sant Pau, 08041 Barcelona, Spain;
| | - Michele Domenico Spampinato
- Department of Translational Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy; (B.P.); (F.T.C.); (O.T.B.); (C.M.); (C.C.); (A.P.); (A.Z.); (F.M.S.); (A.R.); (A.C.); (M.D.S.); (M.G.)
- Emergency Department, University Hospital of Ferrara, 44124 Ferrara, Italy
| | - Carlo Contini
- Infectious Diseases Unit, Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy; (M.M.); (C.C.)
| | - Roberto De Giorgio
- Department of Translational Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy; (B.P.); (F.T.C.); (O.T.B.); (C.M.); (C.C.); (A.P.); (A.Z.); (F.M.S.); (A.R.); (A.C.); (M.D.S.); (M.G.)
| | - Matteo Guarino
- Department of Translational Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy; (B.P.); (F.T.C.); (O.T.B.); (C.M.); (C.C.); (A.P.); (A.Z.); (F.M.S.); (A.R.); (A.C.); (M.D.S.); (M.G.)
- Emergency Department, University Hospital of Ferrara, 44124 Ferrara, Italy
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22
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Zhang D, Li X, Wang Y, Zhao Y, Zhang H. The clinical importance of metagenomic next-generation sequencing in detecting disease-causing microorganisms in cases of sepsis acquired in the community or hospital setting. Front Microbiol 2024; 15:1384166. [PMID: 38686114 PMCID: PMC11056561 DOI: 10.3389/fmicb.2024.1384166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 03/29/2024] [Indexed: 05/02/2024] Open
Abstract
Objectives Although metagenomic next-generation sequencing (mNGS) is commonly used for diagnosing infectious diseases, clinicians face limited options due to the high costs that are not covered by basic medical insurance. The goal of this research is to challenge this bias through a thorough examination and evaluation of the clinical importance of mNGS in precisely identifying pathogenic microorganisms in cases of sepsis acquired in the community or in hospitals. Methods A retrospective observational study took place at a tertiary teaching hospital in China from January to December 2021. Data on 308 sepsis patients were collected, and the performance of etiological examination was compared between mNGS and traditional culture method. Results Two hundred twenty-nine cases were observed in the community-acquired sepsis (CAS) group and 79 cases in the hospital-acquired sepsis (HAS) group. In comparison with conventional culture, mNGS showed a significantly higher rate of positivity in both the CAS group (88.21% vs. 25.76%, adj.P < 0.001) and the HAS group (87.34% vs. 44.30%, adj.P < 0.001), particularly across various infection sites and specimens, which were not influenced by factors like antibiotic exposure or the timing and frequency of mNGS technology. Sepsis pathogens detected by mNGS were broad, especially viruses, Mycobacterium tuberculosis, and atypical pathogens, with mixed pathogens being common, particularly bacterial-viral co-detection. Based on the optimization of antimicrobial therapy using mNGS, 58 patients underwent antibiotic de-escalation, two patients were switched to antiviral therapy, and 14 patients initiated treatment for tuberculosis, resulting in a reduction in antibiotic overuse but without significant impact on sepsis prognosis. The HAS group exhibited a critical condition, poor prognosis, high medical expenses, and variations in etiology, yet the mNGS results did not result in increased medical costs for either group. Conclusions mNGS demonstrates efficacy in identifying multiple pathogens responsible for sepsis, with mixed pathogens of bacteria and viruses being prevalent. Variability in microbiological profiles among different infection setting underscores the importance of clinical vigilance. Therefore, the adoption of mNGS for microbiological diagnosis of sepsis warrants acknowledgment and promotion.
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Affiliation(s)
| | | | | | | | - Hong Zhang
- Department of Emergency Medicine, The First Affiliated Hospital of Anhui Medical University, Anhui, Hefei, China
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23
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Tanha N, Areskog Lejbman I, De Bus L, De Pascale G, Garnacho-Montero J, Leone M, Fujitan S, De Waele JJ, Torisson G, Sjövall F. Clinical outcomes in combination versus mono antibiotic therapy in ICU admitted patients with a suspected infection - A substudy of the DIANA study. J Crit Care 2024; 80:154501. [PMID: 38128219 DOI: 10.1016/j.jcrc.2023.154501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/02/2023] [Accepted: 12/03/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE In a retrospective cohort study of intensive care unit (ICU) admitted adult patients with suspected or confirmed infection, associations between combination versus mono empirical antibiotic therapy and clinical cure at day 7 as well as mortality at day 7 and 28, were investigated. MATERIALS AND METHODS Patients from the DIANA study were grouped and analysed by combination versus mono antibiotic therapy. Clinical cure was defined as survival and resolution of all signs and symptoms related to the infection. Odds ratios (ORs) were calculated by logistic regression analyses. RESULTS Of the 1398 included patients, 568 patients (41%) received combination therapy. In total, 641(46%) patients achieved clinical cure and 135 (10%) patients had died as of day 7. There were no significant associations between combination and mono therapy relating to clinical cure and mortality. CONCLUSIONS This study found no differences in clinical cure and mortality between empirical combination versus mono therapy in a large cohort of ICU patients with a suspected infection.
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Affiliation(s)
- Nima Tanha
- Department of Perioperative Medicine and Intensive Care Medicine, Skåne University Hospital, Malmö, Sweden.
| | - Ilja Areskog Lejbman
- Department of Perioperative Medicine and Intensive Care Medicine, Skåne University Hospital, Malmö, Sweden.
| | - Liesbet De Bus
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium; Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Gennaro De Pascale
- Department of Basic Biotechnological Sciences, Intensive Clinics and Perioperatives, Cattolica del Sacro Cuore University, Rome, Italy
| | | | - Marc Leone
- Department of Anesthesiology and Intensive care unit, Nord Hospital, Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Marseille, France.
| | - Shigeki Fujitan
- Department of Emergency medicine and Critical care medicine, St. Marianna University, Kanagawa, Japan
| | - Jan J De Waele
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.
| | - Gustav Torisson
- Department of Infectious Diseases, Skåne University Hospital, Malmö, Sweden.
| | - Fredrik Sjövall
- Department of Perioperative Medicine and Intensive Care Medicine, Skåne University Hospital, Malmö, Sweden.
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24
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Watanabe N, Koyama S, Maeda T, Karaushi H, Taji Y, Kawasaki Y, Takahashi N, Mitsutake K, Ebihara Y. Direct Species Identification in Positive Blood Culture Bottles From Patients With Hematologic Malignancies. Cureus 2024; 16:e59043. [PMID: 38800333 PMCID: PMC11128060 DOI: 10.7759/cureus.59043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2024] [Indexed: 05/29/2024] Open
Abstract
Background In patients with hematologic malignancies, faster species identification is particularly important in the management of bloodstream infection because of their immunocompromised and neutropenic status. In the present study, we analyzed direct species identification in patients with hematologic malignancies, and the factors that might influence the results of species identification. Methods We performed direct species identification using a Sepsityper® kit (Bruker Corporation, Billerica, Massachusetts, United States) and compared the results with a conventional method in patients with hematologic malignancies. Forty-five positive blood culture bottles containing single microorganisms from 37 patients were analyzed by matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS). And patients' clinical data were compared between the groups with spectral scores at acceptable and unacceptable levels. Results Direct species identification correctly identified 42 of 45 isolates and three were misidentified. While 35 of 45 isolates showed a spectral score ≥1.7 (acceptable identification), 10 isolates had a spectral score <1.7 (unacceptable identification) including three misidentified isolates. The group with a spectral score ≥1.7 had significantly lower white blood cell (p<0.01), neutrophil (p<0.01), and platelet (p<0.01) counts in addition to more frequent central venous (CV) line insertion (p=0.01). Multivariate analysis revealed that pathogen type (gram-positive or negative) and CV line insertion were associated with spectral scores. Conclusion Direct species identification using the Sepsityper kit is an upcoming approach for blood culture bottles, which were flagged as positive even in patients with hematologic malignancies when the spectral score was ≥ 1.7. Our study also indicates that direct identification is more accurate in patients with CV lines, and may be less accurate when gram-positive bacteria are detected.
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Affiliation(s)
- Noriyuki Watanabe
- Clinical Laboratory, Saitama Medical University International Medical Center, Saitama, JPN
| | - Sachie Koyama
- Clinical Laboratory, Saitama Medical University International Medical Center, Saitama, JPN
| | - Tomoya Maeda
- Department of Hemato-Oncology, Saitama Medical University International Medical Center, Saitama, JPN
| | - Haruka Karaushi
- Department of Infectious Diseases and Infection Control, Saitama Medical University International Medical Center, Saitama, JPN
| | - Yoshitada Taji
- Clinical Laboratory, Saitama Medical University International Medical Center, Saitama, JPN
| | - Yohei Kawasaki
- Department of Biostatistics, Graduate School of Medicine, Saitama Medical University, Saitama, JPN
| | - Naoki Takahashi
- Department of Hemato-Oncology, Saitama Medical University International Medical Center, Saitama, JPN
| | - Kotaro Mitsutake
- Department of Infectious Diseases and Infection Control, Saitama Medical University International Medical Center, Saitama, JPN
| | - Yasuhiro Ebihara
- Department of Laboratory Medicine, Saitama Medical University International Medical Center, Saitama, JPN
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25
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Williams B, Zou L, Pittet JF, Chao W. Sepsis-Induced Coagulopathy: A Comprehensive Narrative Review of Pathophysiology, Clinical Presentation, Diagnosis, and Management Strategies. Anesth Analg 2024; 138:696-711. [PMID: 38324297 PMCID: PMC10916756 DOI: 10.1213/ane.0000000000006888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 02/08/2024]
Abstract
Physiological hemostasis is a balance between pro- and anticoagulant pathways, and in sepsis, this equilibrium is disturbed, resulting in systemic thrombin generation, impaired anticoagulant activity, and suppression of fibrinolysis, a condition termed sepsis-induced coagulopathy (SIC). SIC is a common complication, being present in 24% of patients with sepsis and 66% of patients with septic shock, and is often associated with poor clinical outcomes and high mortality. 1 , 2 Recent preclinical and clinical studies have generated new insights into the molecular pathogenesis of SIC. In this article, we analyze the complex pathophysiology of SIC with a focus on the role of procoagulant innate immune signaling in hemostatic activation--tissue factor production, thrombin generation, endotheliopathy, and impaired antithrombotic functions. We also review clinical presentations of SIC, the diagnostic scoring system and laboratory tests, the current standard of care, and clinical trials evaluating the efficacies of anticoagulant therapies.
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Affiliation(s)
- Brittney Williams
- From the Division of Cardiothoracic Anesthesia, Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland
- Translational Research Program, Department of Anesthesiology & Center for Shock, Trauma and Anesthesiology Research (STAR), University of Maryland School of Medicine, Baltimore, Maryland
| | - Lin Zou
- Translational Research Program, Department of Anesthesiology & Center for Shock, Trauma and Anesthesiology Research (STAR), University of Maryland School of Medicine, Baltimore, Maryland
| | - Jean-Francois Pittet
- Division of Critical Care, Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Wei Chao
- Translational Research Program, Department of Anesthesiology & Center for Shock, Trauma and Anesthesiology Research (STAR), University of Maryland School of Medicine, Baltimore, Maryland
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26
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Acharya S, Mishra S, Ghosh A, Patro S. A prospective observational study on the efficacy of procalcitonin as a diagnostic test to exclude lower urinary tract infection and to minimize antibiotic overuse. Urol Ann 2024; 16:169-174. [PMID: 38818426 PMCID: PMC11135356 DOI: 10.4103/ua.ua_73_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 12/25/2023] [Accepted: 01/15/2024] [Indexed: 06/01/2024] Open
Abstract
Background Urinary tract infection (UTI) stands out as the third-most common infection following gastrointestinal and respiratory tract infections. Over the past decade, the biomarker procalcitonin (PCT) has gained prominence to facilitate the detection of bacterial infections and reduce excessive antibiotic exposure. Objective The objective of this study was to mitigate the overuse of antibiotics, by promoting the noninitiation or early discontinuation of empirical antibiotics, which would significantly help minimize the proliferation of multidrug-resistant bacteria. Methodology A prospective observational study was carried out at the tertiary care center in the Department of General Medicine of Kalinga Institute of Medical Sciences, Bhubaneswar, involving 200 patients with symptoms of lower UTI such as increased frequency, urgency, burning micturition, retention, and suprapubic tenderness with or without positive urinalysis. Detailed demographic profiles along with symptoms at the time of admission were recorded in a pretested structured format. To determine a positive diagnosis of UTI, signs and symptoms of UTI with or without urinary cultures were tested. The PCT level was estimated using enhanced chemiluminescence technique. Other routine tests such as complete blood count, renal function test, liver function test, urine routine microscopy, culture, chest X-ray, and ultrasonography abdomen pelvis were done and recorded. All patients, who had an initial serum PCT level of < 0.5 ng/mL, were kept under observation with only conservative and symptomatic treatments. Patients were further reviewed for improvement in symptoms and repeat urine microscopy. All patients, who had an initial serum PCT level of > 0.5 ng/mL, were initiated with antibiotics as per the culture and sensitivity reports. Patients were followed up for improvement in symptoms with reports of repeated urinalysis. Results Our study reported the fact that 9.5% of the patients with initial serum PCT ≥ 0.5 ng/mL showed no improvement in symptoms despite starting antibiotics while significantly higher number of symptomatic patients (60%) with initial serum PCT < 0.5 ng/ml showed improvement in symptoms with conservative treatment without antibiotics. Conclusion A lower PCT level rules out bacterial invasion and thus can be used as a novel marker in antibiotic stewardship.
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Affiliation(s)
- Swastik Acharya
- Department of General Medicine, Kalinga Institute of Medical Sciences, KIIT Deemed to be University, Bhubaneswar, Odisha, India
| | - Sanjukta Mishra
- Department of Biochemistry, Kalinga Institute of Medical Sciences, KIIT Deemed to be University, Bhubaneswar, Odisha, India
| | - Arpan Ghosh
- School of Biotechnology, KIIT Deemed to be University, Bhubaneswar, Odisha, India
| | - Shubhransu Patro
- Department of General Medicine, Kalinga Institute of Medical Sciences, KIIT Deemed to be University, Bhubaneswar, Odisha, India
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Zhang J, Liu F, Wu Z, Jiang J, Wang B, Qian Y, Suo J, Li Y, Peng Z. ACETATE RINGER'S SOLUTION VERSUS NORMAL SALINE SOLUTION IN SEPSIS: A RANDOMIZED, CONTROLLED TRIAL. Shock 2024; 61:520-526. [PMID: 38369528 DOI: 10.1097/shk.0000000000002324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
ABSTRACT Background: Normal saline solution (NSS) and Ringer's acetate solution (RAS) are commonly given to critically ill patients as a fundamental fluid therapy. However, the effect of RAS and NSS on sepsis patient outcomes remains unknown. Methods: We conducted a single-center prospective open-label parallel controlled trial to enroll adult patients (>18 years old) diagnosed with sepsis. Participants received either RAS or NSS for intravenous infusion for 5 days. The primary outcome was the incidence of major adverse kidney events within 28 days (MAKE28). Secondary outcomes included 30-/90-day mortality, acute kidney injury, and hyperchloremia. The patients were then reclassified as NSS-only, RAS-only, and RAS + NSS groups according to the type of fluid they had received before enrollment. Thereafter, a secondary post hoc analysis was performed. Results: Two hundred fifty-five septic patients were screened, and 143 patients (51.0% in RAS group and 49.0% in NSS group) were enrolled in the study. Each group received a median of 2 L of fluid administration during five interventional days. Of the patients, 39.3% had received 500 mL (500-1,000 mL) of balanced salt solutions (BSSs) before intensive care unit (ICU) admission. There was no statistical difference among the RAS and NSS group on the primary outcome MAKE28 in the initial analysis (23.3% vs. 20.0%; OR, 1.2 [0.6 to 2.2]; P = 0.69). MAKE28 was observed in 23.3% of RAS-only versus 27.3% of NSS-only group patients (0.82 [0.35-1.94], P = 0.65) in the secondary post hoc analysis. The patients in the NSS-only group had a longer invasive mechanical ventilation days and a trend toward the accumulation of serum chloride. Conclusion: This study observed no statistically significant difference on MAKE28 and secondary outcomes among sepsis patients receiving RAS and NSS. However, it is unclear whether the large amount of fluid resuscitation before ICU admission and carrier NSS narrowed the difference between BSSs and NSSs.
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Affiliation(s)
| | | | | | | | - Bingqing Wang
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
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Zhang J, Wang X, Peng Y, Wei J, Luo Y, Luan F, Li H, Zhou Y, Wang C, Yu K. Combined metabolomic and proteomic analysis of sepsis related acute liver injury and its pathogenesis research. Int Immunopharmacol 2024; 130:111666. [PMID: 38412671 DOI: 10.1016/j.intimp.2024.111666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Sepsis-induced acute liver injury is common in patients in intensive care units. However, the exact mechanism of this condition remains unclear. The purpose of this study was to investigate the roles and mechanisms of proteins and metabolites in the liver tissue of mice after sepsis and elucidate the molecular biological mechanisms of sepsis-related liver injury. METHODS First, a lipopolysaccharide (LPS)-induced sepsis mouse model was established. Then, according to alanine aminotransferase (ALT) and aspartate aminotransferase (AST) detection in mouse serum and liver histopathological examination (HE) staining, the septic mice were divided into two groups: acute liver injury after sepsis and nonacute liver injury after sepsis. Metabolomics and proteomic analyses were performed on the liver tissues of the two groups of mice to identify significantly different metabolites and proteins. The metabolomics and proteomics results were further analysed to identify the biological indicators and pathogenesis related to the occurrence and development of sepsis-related acute liver injury at the protein and metabolite levels. RESULTS A total of 14 differentially expressed proteins and 46 differentially expressed metabolites were identified. Recombinant Erythrocyte Membrane Protein Band 4.2 (Epb42) and adenosine diphosphate (ADP) may be the key proteins and metabolites responsible for sepsis-related acute liver injury, according to the correlation analysis of proteomics and metabolomics. The expression of the differential protein Epb42 was further verified by western blot (WB) detection. CONCLUSIONS Our study suggests that the differential protein Epb42 may be key proteins causing sepsis-associated acute liver injury, providing new and valuable information on the possible mechanism of sepsis-associated acute liver injury.
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Affiliation(s)
- Jin Zhang
- Department of Critical Care Medicine, First Affiliated Hospital of Harbin Medical University, 23 Postal Street, Nangang District, Harbin 150001, Heilongjiang, China; Department of Critical Care Medicine, Qingdao Municipal Hospital, University of Health and Rehabilitation Sciences, 1 Jiaozhou Road, Shibei District, Qingdao 266011, Shandong, China
| | - Xibo Wang
- Department of Critical Care Medicine, First Affiliated Hospital of Harbin Medical University, 23 Postal Street, Nangang District, Harbin 150001, Heilongjiang, China
| | - Yahui Peng
- Department of Critical Care Medicine, First Affiliated Hospital of Harbin Medical University, 23 Postal Street, Nangang District, Harbin 150001, Heilongjiang, China
| | - Jieling Wei
- Department of Critical Care Medicine, First Affiliated Hospital of Harbin Medical University, 23 Postal Street, Nangang District, Harbin 150001, Heilongjiang, China
| | - Yinghao Luo
- Department of Critical Care Medicine, First Affiliated Hospital of Harbin Medical University, 23 Postal Street, Nangang District, Harbin 150001, Heilongjiang, China
| | - Feiyu Luan
- Department of Critical Care Medicine, First Affiliated Hospital of Harbin Medical University, 23 Postal Street, Nangang District, Harbin 150001, Heilongjiang, China
| | - Hongxu Li
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, 150 Haping Road, Nangang District, Harbin 150081, Heilongjiang, China
| | - Yang Zhou
- Department of Critical Care Medicine, First Affiliated Hospital of Harbin Medical University, 23 Postal Street, Nangang District, Harbin 150001, Heilongjiang, China
| | - Changsong Wang
- Department of Critical Care Medicine, First Affiliated Hospital of Harbin Medical University, 23 Postal Street, Nangang District, Harbin 150001, Heilongjiang, China.
| | - Kaijiang Yu
- Department of Critical Care Medicine, First Affiliated Hospital of Harbin Medical University, 23 Postal Street, Nangang District, Harbin 150001, Heilongjiang, China.
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Su L, Liu S, Yang Y, Jiang H, Ye X, Weng L, Zhu W, Tian X, Long Y. Positive fluid balance and poor outcomes after initial intensive care unit admission in sepsis resuscitation: a retrospective study. Arch Med Sci 2024; 20:464-475. [PMID: 38757044 PMCID: PMC11094850 DOI: 10.5114/aoms/172160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/12/2023] [Indexed: 05/18/2024] Open
Abstract
Introduction Fluid resuscitation of patients with sepsis is crucial. This study explored the role of fluid balance in the early resuscitation of sepsis patients in the intensive care unit (ICU). Material and methods A retrospective study of patients with sepsis using the Peking Union Medical College Hospital Intensive Care Medical Information System and Database from January 2014 to June 2020 was performed. Based on the survival status on day 28, the training cohort was divided into an alive group (n = 1,803) and a deceased group (n = 429). Univariate and multivariate analyses were used to identify risk factors, and the integrated learning XGBoost algorithm was used to construct a model for predicting outcomes. ROC and Kaplan-Meier survival curves were used to evaluate the effectiveness of the model. A verification cohort (n = 433) was used to verify the model. Results Univariate analysis showed that fluid balance is an important covariate. Based on the scatterplot distribution, a significant difference in mortality was determined between groups stratified with a balance of 1000 ml. There were associations in the multivariate analysis between poor outcomes and sex, PO2/FiO2, serum creatinine, FiO2, platelets, respiratory rate, SPO2, temperature, and total fluid volume (1000 ml). Among these variables, total fluid balance (1000 ml) had an OR of 1.98 (CI: 1.41-2.77, p < 0.001). Therefore, the model was built with these nine factors using XGBoost. Cross validation was used to verify generalizability. This model performed better than the SOFA and APACHE II models. The result was well verified in the verification cohort. A causal forest model suggested that patients with hypoxemia may suffer from positive fluid balance. Conclusions Sepsis fluid resuscitation in the ICU should be a targeted and goal-oriented treatment. A new prognostic prediction model was constructed and indicated that a 6-hour positive fluid balance after ICU initial admission is a risk factor for poor outcomes in sepsis patients. A 6-hour fluid balance above 1000 ml should be performed with caution.
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Affiliation(s)
- Longxiang Su
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Shengjun Liu
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yingying Yang
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Huizhen Jiang
- Information Center, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xiangyang Ye
- Information Center, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Li Weng
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Weiguo Zhu
- Information Center, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xinlun Tian
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yun Long
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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Soltan Dallal MM, Siavashi M, Karimaei S, Siavashi V, Abdi M, Yaseri M, Razavi SA, Bakhtiari R. The effect of thyme essential oil and endothelial progenitor stem cells on lipopolysaccharide-induced sepsis in C57BL/6 mice. Biotechnol Appl Biochem 2024. [PMID: 38515313 DOI: 10.1002/bab.2580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 03/02/2024] [Indexed: 03/23/2024]
Abstract
Sepsis is a potentially fatal syndrome related to severe systemic inflammation developed by infection. Despite different antimicrobial therapies, morbidity and mortality rates remain high. Herbs along with cell therapy have been introduced as a promising option to improve the symptoms of sepsis. The present study aimed to evaluate the therapeutic effect of simultaneous administration of thyme essential oil (TEO) and endothelial progenitor stem cells (EPCs) on lipopolysaccharide (LPS)-induced sepsis in C57BL/6 mice. Sepsis was induced in C57Bl/6J mice by intraperitoneal injection of LPS, followed 2 h later by an intravenous injection of EPCs or oral administration of TEO or simultaneous administration of TEO and EPCs. After 10 days, the complete blood cell, renal and liver factors, serum levels of inflammatory cytokines, and angiogenic factors were measured. Simultaneous treatment with EPCs and TEO significantly increased the survival of mice with sepsis and modulated the inflammatory response by reducing the serum levels of pro-inflammatory cytokines. Moreover, this treatment significantly reduced the level of white blood cells and neutrophils and increased the number of red blood cells, the percentage of hematocrit, and hemoglobin. The combination of TEO with EPCs decreased organ injuries and was assessed by lower levels of the liver enzymes alanine aminotransferase and aspartate aminotransferase compared to the sepsis group. Administration of EPCs and TEO also significantly improved angiogenic factors, lung function, and toll-like receptor 4 expression. EPCs in combination with TEO increase survival in the LPS-induced sepsis mice model by acting on several targets. Thus, the combination of TEO with EPCs can be a feasible approach for the future clinical treatment and control of sepsis.
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Affiliation(s)
- Mohammad Mehdi Soltan Dallal
- Food Microbiology Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Siavashi
- Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Samira Karimaei
- Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Vahid Siavashi
- Department of Clinical Pathology, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Milad Abdi
- Research Center of Tropical and Infectious Diseases, Kerman University of Medical Sciences, Kerman, Iran
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Alireza Razavi
- Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ronak Bakhtiari
- Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Lee KJ, Kim YK, Jeon K, Ko RE, Suh GY, Oh DK, Lim SY, Lee YJ, Lee SY, Park MH, Lim CM, Park S. Shock indices are associated with in-hospital mortality among patients with septic shock and normal left ventricular ejection fraction. PLoS One 2024; 19:e0298617. [PMID: 38470900 DOI: 10.1371/journal.pone.0298617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 01/27/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND The understanding of shock indices in patients with septic shock is limited, and their values may vary depending on cardiac function. METHODS This prospective cohort study was conducted across 20 university-affiliated hospitals (21 intensive care units [ICUs]). Adult patients (≥19 years) with septic shock admitted to the ICUs during a 29-month period were included. The shock index (SI), diastolic shock index (DSI), modified shock index (MSI), and age shock index (Age-SI) were calculated at sepsis recognition (time zero) and ICU admission. Left ventricular (LV) function was categorized as either normal LV ejection fraction (LVEF ≥ 50%) or decreased LVEF (<50%). RESULTS Among the 1,194 patients with septic shock, 392 (32.8%) who underwent echocardiography within 24 h of time zero were included in the final analysis (normal LVEF: n = 246; decreased LVEF: n = 146). In patients with normal LVEF, only survivors demonstrated significant improvement in SI, DSI, MSI, and Age-SI values from time zero to ICU admission; however, no notable improvements were found in all patients with decreased LVEF. The completion of vasopressor or fluid bundle components was significantly associated with improved indices in patients with normal LVEF, but not in those with decreased LVEF. In multivariable analysis, each of the four indices at ICU admission was significantly associated with in-hospital mortality (P < 0.05) among patients with normal LVEF; however, discrimination power was better in the indices for patients with lower lactate levels (≤ 4.0 mmol/L), compared to those with higher lactate levels. CONCLUSIONS The SI, DSI, MSI, and Age-SI at ICU admission were significantly associated with in-hospital mortality in patients with septic shock and normal LVEF, which was not found in those with decreased LVEF. Our study emphasizes the importance of interpreting shock indices in the context of LV function in septic shock.
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Affiliation(s)
- Kyu Jin Lee
- Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Yong Kyun Kim
- Department of Infection, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Kyeongman Jeon
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ryoung-Eun Ko
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Gee Young Suh
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong Kyu Oh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung Yoon Lim
- Department of Pulmonary and Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Yeon Joo Lee
- Department of Pulmonary and Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Su Yeon Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Mi-Hyeon Park
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chae-Man Lim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sunghoon Park
- Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
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Tomazini BM, Besen BAMP, Taniguchi LU, Zampieri FG, Cavalcanti AB. Association between piperacillin/tazobactam use and acute kidney injury in critically ill patients: a retrospective multicentre cohort study. J Antimicrob Chemother 2024; 79:552-558. [PMID: 38252887 DOI: 10.1093/jac/dkae001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/30/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Piperacillin/tazobactam is one of the most common antibiotics prescribed in the ICU and the combination of piperacillin/tazobactam with vancomycin has been associated with acute kidney injury (AKI) in critically ill patients. However, data on the risk of AKI with piperacillin/tazobactam, despite vancomycin co-exposure, are lacking. OBJECTIVES To investigate the association of piperacillin/tazobactam with AKI and renal replacement therapy (RRT) among adult ICU patients. METHODS We analysed data from patients included in two open access databases (MIMIC-IV and eICU). Critically ill patients who received piperacillin/tazobactam or cefepime (a cephalosporin with similar broad-spectrum activity to piperacillin/tazobactam) during their first ICU stay were eligible for the study. Marginal structural Cox models, accounting for time-fixed covariates and time-dependent covariates were performed. The primary outcomes were AKI and need of RRT. RESULTS A total of 20 107 patients were included, with 11 213 in the piperacillin/tazobactam group and 8894 in the cefepime group. Exposure to piperacillin/tazobactam was associated with AKI (HR 1.77; 95% CI 1.51-2.07; P < 0.001) and with need of RRT (HR 1.31; 95% CI 1.08-1.57; P = 0.005). Tests for interaction were not statistically significant for occurrence of AKI and RRT in the subgroup of patients exposed to vancomycin or not (P = 0.26 and P = 0.6, respectively). CONCLUSIONS In critically ill patients, exposure to piperacillin/tazobactam was associated with increased risk of AKI and with increased risk of RRT, regardless of combination therapy with vancomycin.
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Affiliation(s)
- Bruno Martins Tomazini
- Research Institute, Hospital do Coração (Hcor), Sao Paulo, Brazil
- Intensive Care Unit, Hospital Sírio-Libanês, Sao Paulo, Brazil
- Scientific Committee, Brazilian Research in Intensive Care Network (BRICNet), Sao Paulo, Brazil
| | - Bruno Adler Maccagnan Pinheiro Besen
- Intensive Care Unit, Hospital Sírio-Libanês, Sao Paulo, Brazil
- Scientific Committee, Brazilian Research in Intensive Care Network (BRICNet), Sao Paulo, Brazil
- Medical ICU, Internal Medicine Department, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Leandro Utino Taniguchi
- Intensive Care Unit, Hospital Sírio-Libanês, Sao Paulo, Brazil
- Scientific Committee, Brazilian Research in Intensive Care Network (BRICNet), Sao Paulo, Brazil
- Medical ICU, Internal Medicine Department, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Fernando Godinho Zampieri
- Scientific Committee, Brazilian Research in Intensive Care Network (BRICNet), Sao Paulo, Brazil
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Alexandre Biasi Cavalcanti
- Research Institute, Hospital do Coração (Hcor), Sao Paulo, Brazil
- Scientific Committee, Brazilian Research in Intensive Care Network (BRICNet), Sao Paulo, Brazil
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Vezzi NK, Lane SL, Thevelein BA, Brainard BM. Performance evaluation of a Test&Treat rapid detection kit for the diagnosis of septic effusions in dogs and cats. J Vet Emerg Crit Care (San Antonio) 2024; 34:110-115. [PMID: 38430488 DOI: 10.1111/vec.13372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/04/2022] [Accepted: 12/19/2022] [Indexed: 03/03/2024]
Abstract
OBJECTIVE To evaluate the sensitivity and specificity of a veterinary point-of-care (POC) luminometer-based kit for the diagnosis of septic peritoneal or pleural effusion in dogs and cats. DESIGN Prospective study performed between January 2020 and July 2021. SETTING University teaching hospital. ANIMALS Forty-eight animals with naturally occurring peritoneal or pleural effusion collected by aseptic abdominocentesis or thoracocentesis. PROCEDURES Effusion samples were split into filtered (using a 10-micron filter) and unfiltered aliquots and analyzed by the POC instrument according to the manufacturer's instructions and following variable incubation periods. Samples were also plated aerobically on standard and blood agar plates. Proprietary reagents were added to samples, causing bacterial ATP to generate bioluminescence that is detected by the luminometer. Bioluminescence values (relative light units [RLUs]) were recorded and compared with the presence of bacterial growth on the culture plates. Nucleated cell counts in native and filtered effusion samples were recorded. RESULTS Twenty-one samples were septic based on positive culture. RLUs were higher in septic effusions for filtered and native effusions compared with sterile effusions. The use of a filter reduced cell counts. In filtered samples incubated for 30 minutes before testing, the sensitivity and specificity of the luminometer for diagnosis of infection in cavitary effusions were 81% and 82%, respectively, using a cutoff of 12,202 RLUs. CONCLUSIONS The luminometer kit evaluated in this study represents a viable screening tool for diagnosis of septic cavitary effusions and could be used in conjunction with other POC diagnostics to support the rapid diagnosis of infection.
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Affiliation(s)
- Noël K Vezzi
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, Georgia, USA
| | - Selena L Lane
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, Georgia, USA
| | - Britt A Thevelein
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, Georgia, USA
| | - Benjamin M Brainard
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, Georgia, USA
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Joacquim AO, Akinsete AM, Esezobor CI. Acute kidney injury is more common in hospitalised children with sickle cell anaemia in Africa. Acta Paediatr 2024; 113:557-563. [PMID: 37920880 DOI: 10.1111/apa.17025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 11/04/2023]
Abstract
AIM To document the prevalence, severity, hospital outcome and factors associated with acute kidney injury (AKI) in hospitalised children with sickle cell anaemia (SCA). METHODS In this prospective observational study involving children aged 0.5-17 years with SCA requiring hospitalisation, we used serum creatinine level at 0 and 48 h of hospitalisation to determine the presence of AKI. RESULTS The study involved 155 children with SCA aged 0.5-17 years with a median (interquartile range) age of 7.8 (4.3-11.0) years. Acute kidney injury occurred in 27 (17.4%) children with 33.3% reaching stage 3. Hepatomegaly (81.5% vs. 55.4%; p = 0.015), splenomegaly (33.3% vs. 10.9%; p = 0.003), dipstick proteinuria (22.2% vs. 5.4%; p = 0.004), and hematuria (29.6% vs. 3.1%; p = <0.001) were more common in those with AKI. In contrast, children with AKI had lower haematocrit (16.9% vs. 22.2%; p = <0.001) and serum bicarbonate (16.7 vs. 19.1 mmoL/L; p = 0.010) compared with those without AKI. Those with AKI had longer hospital stay (median [interquartile range]: 7 [4-12] days vs. 4 [3-6] days; p = 0.008). CONCLUSION AKI is common among hospitalised children with AKI and is associated with longer hospital stay.
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Affiliation(s)
| | - Adeseye Micheal Akinsete
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Christopher Imokhuede Esezobor
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
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Yarnell CJ, Saito H, Marshall JC. Understanding Heterogeneity in Acute Care Trials: Resource Availability Impacts Outcomes. Am J Respir Crit Care Med 2024; 209:469-471. [PMID: 38300151 PMCID: PMC10919105 DOI: 10.1164/rccm.202401-0232ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 02/02/2024] Open
Affiliation(s)
- Christopher J Yarnell
- Department of Critical Care Medicine and Research Institute Scarborough Health Network Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care Medicine University of Toronto Toronto, Ontario, Canada
| | - Hiroki Saito
- St. Marianna University School of Medicine Kanagawa, Japan
| | - John C Marshall
- Interdepartmental Division of Critical Care Medicine and Department of Surgery University of Toronto Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute Unity Health Toronto Toronto, Ontario, Canada
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Arifin A, Purwanto B, Indarto D, Wasita B, Sumanjar T, Pamungkasari EP, Soetrisno S. Improvement of renal functions in mice with septic acute kidney injury using secretome of mesenchymal stem cells. Saudi J Biol Sci 2024; 31:103931. [PMID: 38304542 PMCID: PMC10831246 DOI: 10.1016/j.sjbs.2024.103931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 12/23/2023] [Accepted: 01/11/2024] [Indexed: 02/03/2024] Open
Abstract
Background A potentially fatal complication of sepsis is septic acute kidney injury. Stem cell therapy is a potential new method of treating sepsis and has been applied to treat some human diseases. Objectives This study investigated the effects of secretome-MSCs on NGAL, CRP, NF-κB, and MMP-9 proteins, and histopathology in mice with septic AKI. Methods A post-test-only group design was conducted in 30 Balb/C male mice, which were randomly assigned to five groups: the control group was intraperitoneally injected with 0.5 ml of 0.9 % NaCl, the septic AKI, and the treatment groups (T1, T2, and T3) were intraperitoneally injected with 0.5 ml of 0.9 % NaCl and 0.3 mg/kg BW LPS single dose for three days. Three-day treatments of 150, 300, and 600 µl secretome-MSCs were administered intraperitoneally into the treatment groups. Furthermore, kidney and blood samples were collected for biochemical and histopathological analyses. Results The T1, T2, and T3 groups had lower expression of NF-κB and MMP-9 and significantly lower CRP and NGAL levels than that of septic AKI group. T1 (1.21 ± 0.19), T2 (0.75 ± 0.22), and T3 (0.38 ± 0.14) groups demonstrated lower average scores for inflammation, necrosis, hemorrhage, and degeneration compared to septic AKI group (2.17 ± 0.13). Conclusions Administration of 600 µl/20 g BW secretome-MSCs suppresses NF-κB and MMP-9 expression and reduces CRP and NGAL levels. Meanwhile, the 150 and 300 µl/20 g BW doses also indicated a greater improvement in renal tissue damage of mice with septic AKI.
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Affiliation(s)
- Arifin Arifin
- Doctoral Program of Medical Sciences, Faculty of Medicine, Universitas Sebelas Maret, Jl. Ir Sutami No 36A, Kentingan, Jebres, Surakarta 57126, Indonesia
- Department of Internal Medicine, Faculty of Medicine, Universitas Sebelas Maret/General Hospital Dr. Moewardi, Jl. Kolonel Sutarto No. 132, Jebres, Surakarta 57126, Indonesia
| | - Bambang Purwanto
- Doctoral Program of Medical Sciences, Faculty of Medicine, Universitas Sebelas Maret, Jl. Ir Sutami No 36A, Kentingan, Jebres, Surakarta 57126, Indonesia
- Department of Internal Medicine, Faculty of Medicine, Universitas Sebelas Maret/General Hospital Dr. Moewardi, Jl. Kolonel Sutarto No. 132, Jebres, Surakarta 57126, Indonesia
| | - Dono Indarto
- Doctoral Program of Medical Sciences, Faculty of Medicine, Universitas Sebelas Maret, Jl. Ir Sutami No 36A, Kentingan, Jebres, Surakarta 57126, Indonesia
- Department of Physiology and Biomedical Laboratory, Faculty of Medicine, Universitas Sebelas Maret, Jl. Ir Sutami No 36A, Kentingan, Jebres, Surakarta 57126, Indonesia
| | - Brian Wasita
- Doctoral Program of Medical Sciences, Faculty of Medicine, Universitas Sebelas Maret, Jl. Ir Sutami No 36A, Kentingan, Jebres, Surakarta 57126, Indonesia
- Department of Anatomic Pathology, Faculty of Medicine, Universitas Sebelas Maret, Jl. Ir Sutami No 36A, Kentingan, Jebres, Surakarta 57126, Indonesia
| | - Tatar Sumanjar
- Doctoral Program of Medical Sciences, Faculty of Medicine, Universitas Sebelas Maret, Jl. Ir Sutami No 36A, Kentingan, Jebres, Surakarta 57126, Indonesia
- Department of Internal Medicine, Faculty of Medicine, Universitas Sebelas Maret/General Hospital Dr. Moewardi, Jl. Kolonel Sutarto No. 132, Jebres, Surakarta 57126, Indonesia
| | - Eti Poncorini Pamungkasari
- Doctoral Program of Medical Sciences, Faculty of Medicine, Universitas Sebelas Maret, Jl. Ir Sutami No 36A, Kentingan, Jebres, Surakarta 57126, Indonesia
- Department of Public Health, Faculty of Medicine, Universitas Sebelas Maret, Jl. Ir Sutami No 36A, Kentingan, Jebres, Surakarta 57126, Indonesia
| | - Soetrisno Soetrisno
- Doctoral Program of Medical Sciences, Faculty of Medicine, Universitas Sebelas Maret, Jl. Ir Sutami No 36A, Kentingan, Jebres, Surakarta 57126, Indonesia
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Sebelas Maret, Jl. Ir Sutami No 36A, Kentingan, Jebres, Surakarta 57126, Indonesia
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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] [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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Ribeiro-do-Valle CC, Bonet M, Brizuela V, Abalos E, Baguiya A, Bellissimo-Rodrigues F, Budianu M, Puscasiu L, Knight M, Lissauer D, Dunlop C, Jacob ST, Shakoor S, Gadama L, Assarag B, Souza JP, Cecatti JG. Aetiology and use of antibiotics in pregnancy-related infections: results of the WHO Global Maternal Sepsis Study (GLOSS), 1-week inception cohort. Ann Clin Microbiol Antimicrob 2024; 23:21. [PMID: 38402175 PMCID: PMC10894467 DOI: 10.1186/s12941-024-00681-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 02/19/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Pregnancy-related infections are important contributors to maternal sepsis and mortality. We aimed to describe clinical, microbiological characteristics and use of antibiotics by source of infection and country income, among hospitalized women with suspected or confirmed pregnancy-related infections. METHODS We used data from WHO Global Maternal Sepsis Study (GLOSS) on maternal infections in hospitalized women, in 52 low-middle- and high-income countries conducted between November 28th and December 4th, 2017, to describe the frequencies and medians of maternal demographic, obstetric, and clinical characteristics and outcomes, methods of infection diagnosis and causative pathogens, of single source pregnancy-related infection, other than breast, and initial use of therapeutic antibiotics. We included 1456 women. RESULTS We found infections of the genital (n = 745/1456, 51.2%) and the urinary tracts (UTI) (n = 531/1456, 36.5%) to be the most frequent. UTI (n = 339/531, 63.8%) and post-caesarean skin and soft tissue infections (SSTI) (n = 99/180, 55.0%) were the sources with more culture samples taken and microbiological confirmations. Escherichia coli was the major uropathogen (n = 103/118, 87.3%) and Staphylococcus aureus (n = 21/44, 47.7%) was the commonest pathogen in SSTI. For 13.1% (n = 191) of women, antibiotics were not prescribed on the same day of infection suspicion. Cephalosporins (n = 283/531, 53.3%) were the commonest antibiotic class prescribed for UTI, while metronidazole (n = 303/925, 32.8%) was the most prescribed for all other sources. Ceftriaxone with metronidazole was the commonest combination for the genital tract (n = 98/745, 13.2%) and SSTI (n = 22/180, 12.2%). Metronidazole (n = 137/235, 58.3%) was the most prescribed antibiotic in low-income countries while cephalosporins and co-amoxiclav (n = 129/186, 69.4%) were more commonly prescribed in high-income countries. CONCLUSIONS Differences in antibiotics used across countries could be due to availability, local guidelines, prescribing culture, cost, and access to microbiology laboratory, despite having found similar sources and pathogens as previous studies. Better dissemination of recommendations in line with antimicrobial stewardship programmes might improve antibiotic prescription.
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Affiliation(s)
- Carolina C Ribeiro-do-Valle
- Department of Gynaecology and Obstetrics, Faculty of Medical Sciences, University of Campinas, R. Alexander Fleming, 101, Campinas, São Paulo, CEP 13083-888, Brazil
| | - Mercedes Bonet
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), WHO, Geneva, Switzerland
| | - Vanessa Brizuela
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), WHO, Geneva, Switzerland
| | - Edgardo Abalos
- Centro Rosarino de Estudios Perinatales (CREP), Rosario, Argentina
| | - Adama Baguiya
- Kaya Health and Demographic Surveillance System (Kaya-HDSS), Research Institute of Health Sciences (IRSS), Ouagadougou, Burkina Faso
| | | | - Mihaela Budianu
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureş, Târgu Mureş, Romania
| | - Lucian Puscasiu
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureş, Târgu Mureş, Romania
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK
| | - David Lissauer
- University of Liverpool, Blantyre, Malawi
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | | | - Shevin T Jacob
- Walimu, Mbarara, Uganda
- Department of Clinical Services, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Sadia Shakoor
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
- Department of Microbiology, Aga Khan University, Karachi, Pakistan
| | - Luis Gadama
- Department of Obstetrics and Gynaecology, University of Malawi, Zomba, Malawi
| | | | - João Paulo Souza
- Department of Social Medicine, Ribeirão Preto Medical School, Ribeirão Preto, Brazil
| | - Jose G Cecatti
- Department of Gynaecology and Obstetrics, Faculty of Medical Sciences, University of Campinas, R. Alexander Fleming, 101, Campinas, São Paulo, CEP 13083-888, Brazil.
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Kumari A, Vertii A. Perspective: "Current understanding of NADs dynamics and mechanisms of Disease". Gene 2024; 894:147960. [PMID: 37923094 DOI: 10.1016/j.gene.2023.147960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/09/2023] [Accepted: 10/31/2023] [Indexed: 11/07/2023]
Abstract
Chromatin architecture is essential for gene regulation, and multiple levels of the 3D chromatin organization exhibit dynamic changes during organismal development and cell differentiation. Heterochromatin, termed compartment B in Hi-C datasets, is a phase-separating gene-silencing form of chromatin, preferentially located at the two nuclear sites, nuclear (lamina-associate chromatin domains, LADs) and nucleoli (nucleoli-associated chromatin domains, NADs) peripheries. LADs and NADs contain both interchangeable and location-specific chromatin domains. Recent studies suggest striking dynamics in LADs and NADs during the differentiation of embryonic stem cells into neural progenitors and neurons. Here we discuss recent advances in understanding NADs changes during neuronal differentiation and future questions on how NADs integrity can contribute to healthy neurodevelopment and neurodevelopment diseases.
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Affiliation(s)
- Amrita Kumari
- Department of Molecular, Cellular and Cancer Biology, University of Massachusetts Medical School, Worcester, MA 1605, US
| | - Anastassiia Vertii
- Department of Molecular, Cellular and Cancer Biology, University of Massachusetts Medical School, Worcester, MA 1605, US.
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Saito N, Tsuchiya J, Itoga M, Okamura Y, Tsuyama H, Kimura M, Inoue F, Kimura T, Ozaki H, Tono Y, Minakawa S, Tomita H. Multiple Blood Culture Sampling, Proper Antimicrobial Choice, and Adequate Dose in Definitive Therapy Supported by the Antimicrobial Stewardship Team Could Decrease 30-Day Sepsis Mortality Rates. Infect Drug Resist 2024; 17:207-219. [PMID: 38283110 PMCID: PMC10812706 DOI: 10.2147/idr.s445917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 01/11/2024] [Indexed: 01/30/2024] Open
Abstract
Objective This study aimed to identify factors that should be focused on by the antimicrobial stewardship team for treating patients with sepsis, by investigating the mortality of patients with sepsis within 30 days and the mortality-related factors in our hospital over a 10-year period from the perspective of appropriate antimicrobial use. Methods Factors associated with 30-day mortality were investigated using hierarchical multiple logistic regression in 1406 patients with pathogen-identified sepsis in Hirosaki University Hospital. These factors were clinical data, microbiological data, antimicrobials used in empiric and definitive therapies, presence/absence of ineffective use, underdosing as evaluated using Monte Carlo simulation, and practice of de-escalation. Results The ineffective use of antimicrobials in empiric therapy and the underdosing and ineffective use in definitive therapy were significantly associated with 30-day mortality (odds ratio [OR] = 2.70, 3.72, and 3.65, respectively). Multiple blood culture sampling was inversely associated with these inappropriate antimicrobial uses. Every year, the 30-day mortality rate has been decreasing, in line with the increase in multiple blood culture sampling and de-escalation; the inappropriate use of antimicrobials has also decreased. Conclusion Multiple blood culture sampling, proper choice of antimicrobial, and using an adequate dose in definitive therapy could decrease the 30-day mortality rate in patients with sepsis and these factors could be supported by the antimicrobial stewardship team.
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Affiliation(s)
- Norihiro Saito
- Division of Infection Control and Prevention, Hirosaki University Hospital, Hirosaki, Aomori, Japan
- Department of Clinical Laboratory Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
- Division of Clinical Laboratory, Hirosaki University Hospital, Hirosaki, Aomori, Japan
| | - Junichiro Tsuchiya
- Division of Infection Control and Prevention, Hirosaki University Hospital, Hirosaki, Aomori, Japan
- Division of Clinical Laboratory, Hirosaki University Hospital, Hirosaki, Aomori, Japan
| | - Masamichi Itoga
- Division of Infection Control and Prevention, Hirosaki University Hospital, Hirosaki, Aomori, Japan
- Department of Clinical Laboratory Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Yuji Okamura
- Division of Infection Control and Prevention, Hirosaki University Hospital, Hirosaki, Aomori, Japan
- Division of Pharmacy, Hirosaki University Hospital, Hirosaki, Aomori, Japan
| | - Hiromasa Tsuyama
- Division of Infection Control and Prevention, Hirosaki University Hospital, Hirosaki, Aomori, Japan
- Division of Pharmacy, Hirosaki University Hospital, Hirosaki, Aomori, Japan
| | - Masahiko Kimura
- Division of Infection Control and Prevention, Hirosaki University Hospital, Hirosaki, Aomori, Japan
- Division of Clinical Laboratory, Hirosaki University Hospital, Hirosaki, Aomori, Japan
| | - Fumio Inoue
- Division of Infection Control and Prevention, Hirosaki University Hospital, Hirosaki, Aomori, Japan
- Division of Clinical Laboratory, Hirosaki University Hospital, Hirosaki, Aomori, Japan
| | - Toshiyuki Kimura
- Division of Infection Control and Prevention, Hirosaki University Hospital, Hirosaki, Aomori, Japan
| | - Hiromi Ozaki
- Division of Infection Control and Prevention, Hirosaki University Hospital, Hirosaki, Aomori, Japan
| | - Yuka Tono
- Division of Infection Control and Prevention, Hirosaki University Hospital, Hirosaki, Aomori, Japan
- Division of Pharmacy, Hirosaki University Hospital, Hirosaki, Aomori, Japan
| | - Satoko Minakawa
- Division of Infection Control and Prevention, Hirosaki University Hospital, Hirosaki, Aomori, Japan
- Division of Clinical Laboratory, Hirosaki University Hospital, Hirosaki, Aomori, Japan
| | - Hirofumi Tomita
- Department of Clinical Laboratory Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
- Division of Clinical Laboratory, Hirosaki University Hospital, Hirosaki, Aomori, Japan
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
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Johansson PI, Henriksen HH, Karvelsson ST, Rolfsson Ó, Schønemann-Lund M, Bestle MH, McGarrity S. LASSO regression shows histidine and sphingosine 1 phosphate are linked to both sepsis mortality and endothelial damage. Eur J Med Res 2024; 29:71. [PMID: 38245777 PMCID: PMC10799523 DOI: 10.1186/s40001-023-01612-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/21/2023] [Indexed: 01/22/2024] Open
Abstract
Sepsis is a major cause of death worldwide, with a mortality rate that has remained stubbornly high. The current gold standard of risk stratifying sepsis patients provides limited mechanistic insight for therapeutic targeting. An improved ability to predict sepsis mortality and to understand the risk factors would allow better treatment targeting. Sepsis causes metabolic dysregulation in patients; therefore, metabolomics offers a promising tool to study sepsis. It is also known that that in sepsis endothelial cells affecting their function regarding blood clotting and vascular permeability. We integrated metabolomics data from patients admitted to an intensive care unit for sepsis, with commonly collected clinical features of their cases and two measures of endothelial function relevant to blood vessel function, platelet endothelial cell adhesion molecule and soluble thrombomodulin concentrations in plasma. We used least absolute shrinkage and selection operator penalized regression, and pathway enrichment analysis to identify features most able to predict 30-day survival. The features important to sepsis survival include carnitines, and amino acids. Endothelial proteins in plasma also predict 30-day mortality and the levels of these proteins also correlate with a somewhat overlapping set of metabolites. Overall metabolic dysregulation, particularly in endothelial cells, may be a contributory factor to sepsis response. By exploring sepsis metabolomics data in conjunction with clinical features and endothelial proteins we have gained a better understanding of sepsis risk factors.
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Affiliation(s)
- Pär I Johansson
- CAG Center for Endotheliomics, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Hanne H Henriksen
- CAG Center for Endotheliomics, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | | | - Óttar Rolfsson
- Biomedical Center, University of Iceland, Reykjavik, Iceland
| | - Martin Schønemann-Lund
- Department of Anaesthesiology and Intensive Care, Copenhagen University Hospital - North Zealand, Hillerod, Denmark
| | - Morten H Bestle
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Anaesthesiology and Intensive Care, Copenhagen University Hospital - North Zealand, Hillerod, Denmark
| | - Sarah McGarrity
- Biomedical Center, University of Iceland, Reykjavik, Iceland.
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Saner FH, Raptis DA, Alghamdi SA, Malagó MM, Broering DC, Bezinover D. Navigating the Labyrinth: Intensive Care Challenges for Patients with Acute-on-Chronic Liver Failure. J Clin Med 2024; 13:506. [PMID: 38256640 PMCID: PMC10816826 DOI: 10.3390/jcm13020506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/07/2024] [Accepted: 01/14/2024] [Indexed: 01/24/2024] Open
Abstract
Acute-on-chronic liver failure (ACLF) refers to the deterioration of liver function in individuals who already have chronic liver disease. In the setting of ACLF, liver damage leads to the failure of other organs and is associated with increased short-term mortality. Optimal medical management of patients with ACLF requires implementing complex treatment strategies, often in an intensive care unit (ICU). Failure of organs other than the liver distinguishes ACLF from other critical illnesses. Although there is growing evidence supporting the current approach to ACLF management, the mortality associated with this condition remains unacceptably high. In this review, we discuss considerations for ICU care of patients with ACLF and highlight areas for further research.
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Affiliation(s)
- Fuat H. Saner
- Organ Transplant Center of Excellence, King Faisal Specialized Hospital & Research Center, Riyadh 12111, Saudi Arabia; (D.A.R.); (S.A.A.); (M.M.M.); (D.C.B.)
| | - Dimitri A. Raptis
- Organ Transplant Center of Excellence, King Faisal Specialized Hospital & Research Center, Riyadh 12111, Saudi Arabia; (D.A.R.); (S.A.A.); (M.M.M.); (D.C.B.)
| | - Saad A. Alghamdi
- Organ Transplant Center of Excellence, King Faisal Specialized Hospital & Research Center, Riyadh 12111, Saudi Arabia; (D.A.R.); (S.A.A.); (M.M.M.); (D.C.B.)
| | - Massimo M. Malagó
- Organ Transplant Center of Excellence, King Faisal Specialized Hospital & Research Center, Riyadh 12111, Saudi Arabia; (D.A.R.); (S.A.A.); (M.M.M.); (D.C.B.)
| | - Dieter C. Broering
- Organ Transplant Center of Excellence, King Faisal Specialized Hospital & Research Center, Riyadh 12111, Saudi Arabia; (D.A.R.); (S.A.A.); (M.M.M.); (D.C.B.)
| | - Dmitri Bezinover
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA;
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Theobald V, Schmitt FCF, Middel CS, Gaissmaier L, Brenner T, Weigand MA. Triggering receptor expressed on myeloid cells-1 in sepsis, and current insights into clinical studies. Crit Care 2024; 28:17. [PMID: 38191420 PMCID: PMC10775509 DOI: 10.1186/s13054-024-04798-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/04/2024] [Indexed: 01/10/2024] Open
Abstract
Triggering receptor expressed on myeloid cells-1 (TREM-1) is a pattern recognition receptor and plays a critical role in the immune response. TREM-1 activation leads to the production and release of proinflammatory cytokines, chemokines, as well as its own expression and circulating levels of the cleaved soluble extracellular portion of TREM-1 (sTREM-1). Because patients with sepsis and septic shock show elevated sTREM-1 levels, TREM-1 has attracted attention as an important contributor to the inadequate immune response in this often-deadly condition. Since 2001, when the first blockade of TREM-1 in sepsis was performed, many potential TREM-1 inhibitors have been established in animal models. However, only one of them, nangibotide, has entered clinical trials, which have yielded promising data for future treatment of sepsis, septic shock, and other inflammatory disease such as COVID-19. This review discusses the TREM-1 pathway and important ligands, and highlights the development of novel inhibitors as well as their clinical potential for targeted treatment of various inflammatory conditions.
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Affiliation(s)
- Vivienne Theobald
- Department of Anesthesiology, Medical Faculty Heidelberg, Heidelberg University, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany
| | - Felix Carl Fabian Schmitt
- Department of Anesthesiology, Medical Faculty Heidelberg, Heidelberg University, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany
| | - Chiara Simone Middel
- Department of Anesthesiology, Medical Faculty Heidelberg, Heidelberg University, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany
| | - Lena Gaissmaier
- Department of Anesthesiology, Medical Faculty Heidelberg, Heidelberg University, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany
| | - Thorsten Brenner
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Markus Alexander Weigand
- Department of Anesthesiology, Medical Faculty Heidelberg, Heidelberg University, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany.
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Dickson K, Zhou J, Lehmann C. Lower Urinary Tract Inflammation and Infection: Key Microbiological and Immunological Aspects. J Clin Med 2024; 13:315. [PMID: 38256450 PMCID: PMC10816374 DOI: 10.3390/jcm13020315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/13/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
The urinary system, primarily responsible for the filtration of blood and waste, is affected by several infectious and inflammatory conditions. Focusing on the lower tract, this review outlines the physiological and immune landscape of the urethra and bladder, addressing key immunological and microbiological aspects of important infectious/inflammatory conditions. The conditions addressed include urethritis, interstitial cystitis/bladder pain syndrome, urinary tract infections, and urosepsis. Key aspects of each condition are addressed, including epidemiology, pathophysiology, and clinical considerations. Finally, therapeutic options are outlined, highlighting gaps in the knowledge and novel therapeutic approaches.
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Affiliation(s)
- Kayle Dickson
- Department of Microbiology and Immunology, Dalhousie University, Halifax, NS B3H 4R2, Canada;
| | - Juan Zhou
- Department of Anesthesiology, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada;
| | - Christian Lehmann
- Department of Microbiology and Immunology, Dalhousie University, Halifax, NS B3H 4R2, Canada;
- Department of Anesthesiology, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada;
- Department of Pharmacology, Dalhousie University, Halifax, NS B3H 4R2, Canada
- Department of Physiology and Biophysics, Dalhousie University, Halifax, NS B3H 4R2, Canada
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Zhou S, Lu Z, Liu Y, Wang M, Zhou W, Cui X, Zhang J, Xiao W, Hua T, Zhu H, Yang M. Interpretable machine learning model for early prediction of 28-day mortality in ICU patients with sepsis-induced coagulopathy: development and validation. Eur J Med Res 2024; 29:14. [PMID: 38172962 PMCID: PMC10763177 DOI: 10.1186/s40001-023-01593-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 12/13/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE Sepsis-induced coagulopathy (SIC) is extremely common in individuals with sepsis, significantly associated with poor outcomes. This study attempted to develop an interpretable and generalizable machine learning (ML) model for early predicting the risk of 28-day death in patients with SIC. METHODS In this retrospective cohort study, we extracted SIC patients from the Medical Information Mart for Intensive Care III (MIMIC-III), MIMIC-IV, and eICU-CRD database according to Toshiaki Iba's scale. And the overlapping in the MIMIC-IV was excluded for this study. Afterward, only the MIMIC-III cohort was randomly divided into the training set, and the internal validation set according to the ratio of 7:3, while the MIMIC-IV and eICU-CRD databases were considered the external validation sets. The predictive factors for 28-day mortality of SIC patients were determined using recursive feature elimination combined with tenfold cross-validation (RFECV). Then, we constructed models using ML algorithms. Multiple metrics were used for evaluation of performance of the models, including the area under the receiver operating characteristic curve (AUROC), area under the precision recall curve (AUPRC), accuracy, sensitivity, specificity, negative predictive value, positive predictive value, recall, and F1 score. Finally, Shapley Additive Explanations (SHAP), Local Interpretable Model-Agnostic Explanations (LIME) were employed to provide a reasonable interpretation for the prediction results. RESULTS A total of 3280, 2798, and 1668 SIC patients were screened from MIMIC-III, MIMIC-IV, and eICU-CRD databases, respectively. Seventeen features were selected to construct ML prediction models. XGBoost had the best performance in predicting the 28-day mortality of SIC patients, with AUC of 0.828, 0.913 and 0.923, the AUPRC of 0.807, 0.796 and 0.921, the accuracy of 0.785, 0.885 and 0.891, the F1 scores were 0.63, 0.69 and 0.70 in MIMIC-III (internal validation set), MIMIC-IV, and eICU-CRD databases. The importance ranking and SHAP analyses showed that initial SOFA score, red blood cell distribution width (RDW), and age were the top three critical features in the XGBoost model. CONCLUSIONS We developed an optimal and explainable ML model to predict the risk of 28-day death of SIC patients 28-day death risk. Compared with conventional scoring systems, the XGBoost model performed better. The model established will have the potential to improve the level of clinical practice for SIC patients.
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Affiliation(s)
- Shu Zhou
- Emergency Internal Medicine, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, People's Republic of China
| | - Zongqing Lu
- The 2nd Department of Intensive Care Unit, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, People's Republic of China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, People's Republic of China
| | - Yu Liu
- Key Laboratory of Intelligent Computing and Signal Processing, Anhui University, Ministry of Education, Hefei, 230601, Anhui, People's Republic of China
| | - Minjie Wang
- The 2nd Department of Intensive Care Unit, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, People's Republic of China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, People's Republic of China
| | - Wuming Zhou
- The 2nd Department of Intensive Care Unit, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, People's Republic of China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, People's Republic of China
| | - Xuanxuan Cui
- The 2nd Department of Intensive Care Unit, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, People's Republic of China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, People's Republic of China
| | - Jin Zhang
- The 2nd Department of Intensive Care Unit, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, People's Republic of China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, People's Republic of China
| | - Wenyan Xiao
- The 2nd Department of Intensive Care Unit, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, People's Republic of China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, People's Republic of China
| | - Tianfeng Hua
- The 2nd Department of Intensive Care Unit, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, People's Republic of China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, People's Republic of China
| | - Huaqing Zhu
- Laboratory of Molecular Biology and Department of Biochemistry, Anhui Medical University, Hefei, 230022, Anhui, People's Republic of China.
| | - Min Yang
- The 2nd Department of Intensive Care Unit, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, People's Republic of China.
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, People's Republic of China.
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Zajonz TS, Habicher M, Böning A, Heringlake M, Ender J, Markewitz A, Brenck F, Sander M. Survey on the Updated German S3 Guideline for Intensive Care in Cardiac Surgery Patients. Thorac Cardiovasc Surg 2024; 72:2-10. [PMID: 36893800 DOI: 10.1055/s-0043-1764230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
BACKGROUND The German guideline on intensive care treatment of cardiac surgical patients provides evidence-based recommendations on management and monitoring. It remains unclear if, respectively, to which degree the guidelines are implemented into the daily practice. Therefore, this study aims to characterize the implementation of guideline recommendations in German cardiac surgical intensive care units (ICUs). METHODS An internet-based online survey (42 questions, 9 topics) was sent to 158 German head physicians of cardiac surgical ICUs. To compare the effect over time, most questions were based on a previously performed survey (2013) after introduction of the last guideline update in 2008. RESULTS A total of n = 65 (41.1%) questionnaires were included. Monitoring changed to increased provision of available transesophageal echocardiography specialists in 86% (2013: 72.6%), SvO2 measurement in 93.8% (2013: 55.1%), and electroencephalography in 58.5% (2013: 2.6%). The use of hydroxyethyl starch declined (9.4% vs. 2013: 38.7%), gelatin 4% presented the most administered colloid with 23.4% (2013: 17.4%). Low cardiac output syndrome was primarily treated with levosimendan (30.8%) and epinephrine (23.1%), while norepinephrine (44.6%) and dobutamine (16.9%) represented the most favored drug combination. The main way of distribution was web-based (50.9%), with increasing impact on therapy regimens (36.9% vs. 2013: 24%). CONCLUSION Changes were found in all questioned sectors compared with the preceding survey, with persisting variability between ICUs. Recommendations of the updated guideline have increasingly entered clinical practice, with participants valuing the updated publication as clinically relevant.
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Affiliation(s)
- Thomas Simon Zajonz
- Department of Anesthesiology, Operative Intensive Care and Pain Medicine, Universitaetsklinikum Giessen und Marburg GmbH, Standort Giessen, Giessen, Hessen, Germany
| | - Marit Habicher
- Department of Anesthesiology, Operative Intensive Care and Pain Medicine, Universitaetsklinikum Giessen und Marburg GmbH, Standort Giessen, Giessen, Hessen, Germany
| | - Andreas Böning
- Department of Cardiovascular Surgery, Universitaetsklinikum Giessen und Marburg GmbH, Standort Giessen, Giessen, Hessen, Germany
- Department of Adult and Pediatric Cardiovascular Surgery, Universitaetsklinikum Giessen und Marburg GmbH, Standort Giessen, Giessen, Hessen, Germany
| | - Matthias Heringlake
- Department of Anesthesiology and Intensive Care Medicine, Heart and Diabetes Center Mecklenburg, Western Pomerania, Karlsburg Hospital, Karlsburg, Germany
| | - Jörg Ender
- Department of Anaesthesiology and Intensive Care Medicine, Leipzig Heart Centre University Hospital, Heart Center Leipzig, Leipzig, Sachsen, Germany
| | - Andreas Markewitz
- Deutsche Gesellschaft für Thorax-, Herz- und Gefäßchirurgie, Berlin, Germany
| | - Florian Brenck
- Department of Anesthesiology, Operative Intensive Care and Pain Medicine, Universitaetsklinikum Giessen und Marburg GmbH, Standort Giessen, Giessen, Hessen, Germany
| | - Michael Sander
- Department of Anesthesiology, Operative Intensive Care and Pain Medicine, Universitaetsklinikum Giessen und Marburg GmbH, Standort Giessen, Giessen, Hessen, Germany
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Cander B, Visneci EF, Karaoglan O, Cakmak F, Tuncar A, Taslidere B. Diagnostic and prognostic value of MR-pro ADM, procalcitonin, and copeptin in sepsis. Open Med (Wars) 2023; 18:20230865. [PMID: 38223899 PMCID: PMC10787304 DOI: 10.1515/med-2023-0865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 10/25/2023] [Accepted: 11/05/2023] [Indexed: 01/16/2024] Open
Abstract
Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. There is a need for biomarkers that can be used for the diagnosis of sepsis and the early identification of patients at high risk of death. In this study, we aimed to investigate the relationship between Mid-regional pro-adrenomedullin (MR-proADM), procalcitonin (PCT), and copeptin in sepsis. A total of 28 sepsis, 32 septic shock, and 30 control patients were included in our prospective study. Patients' MR-proADM, PCT, and copeptin levels were recorded. Sequential organ failure assessment scores, length of hospital stay, and 30-day mortality were also recorded. These values were compared between the sepsis, septic shock, and control groups. The mean age of all participants was 64.04 ± 15.83 years. In the study, 37 (61.6%) patients were female and 23 (39.3%) were male. There was no statistically significant difference in gender/age between all patient groups and the control group (for all, p > 0.05). We found a significant difference between the survivors and nonsurvivors in terms of MR-proADM, PCT, and copeptin levels. There was a significant difference between the sepsis and septic shock groups in terms of MR-proADM and PCT. A significant correlation was found between the length of hospital stay and MR-proADM and copeptin. MR-proADM, PCT, and copeptin may be useful in the prognosis of sepsis and to predict the length of stay in hospital and mortality.
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Affiliation(s)
- Basar Cander
- Department of Emergency Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | | | - Osman Karaoglan
- Department of Emergency Medicine, Konya Numune Hospital, Konya, Turkey
| | - Fatma Cakmak
- Department of Emergency Medicine, Erzurum City Hospital, Erzurum, Türkiye
| | - Alpay Tuncar
- Department of Emergency Medicine, Konya City Hospital, Konya, Türkiye
| | - Bahadir Taslidere
- Department of Emergency Medicine, Bezmialem Vakif University, Istanbul, Turkey
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Kostyak JC, McKenzie SE, Naik UP. The Function of ASK1 in Sepsis and Stress-Induced Disorders. Int J Mol Sci 2023; 25:213. [PMID: 38203381 PMCID: PMC10778746 DOI: 10.3390/ijms25010213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
Apoptosis signal-regulating kinase 1 (ASK1) is a serine-threonine kinase that is ubiquitously expressed in nucleated cells and is responsible for the activation of multiple mitogen-activated protein kinases (MAPK) to regulate cell stress. Activation of ASK1 via cellular stress leads to activation of downstream signaling components, activation of transcription factors, and proinflammatory cytokine production. ASK1 is also expressed in anucleate platelets and is a key player in platelet activation as it is important for signaling. Interestingly, the mechanism of ASK1 activation is cell type-dependent. In this review we will explore how ASK1 regulates a variety of cellular processes from innate immune function to thrombosis and hemostasis. We will discuss how ASK1 influences FcγRIIA-mediated platelet reactivity and how that reactivity drives platelet clearance. Furthermore, we will explore the role of ASK1 in thromboxane (TxA2) generation, which highlights differences in the way ASK1 functions in mouse and human platelets.
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Affiliation(s)
- John C. Kostyak
- Cardeza Center for Hemostasis, Thrombosis, and Vascular Biology, Cardeza Foundation for Hematologic Research, Department of Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA; (S.E.M.); (U.P.N.)
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Wehrenberg K, Mitchell M, Zembles T, Yan K, Zhang L, Thompson N. Antibiotic treatment duration for culture-negative sepsis in the pediatric intensive care unit. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e249. [PMID: 38156219 PMCID: PMC10753480 DOI: 10.1017/ash.2023.502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 10/25/2023] [Accepted: 11/03/2023] [Indexed: 12/30/2023]
Abstract
Objective Sepsis remains a leading cause of morbidity and mortality in children. There is very limited guidance for sepsis treatment when cultures remain negative. This study sought to determine the effectiveness of short versus long course of antibiotics when treating culture-negative sepsis and assess for subsequent multidrug-resistant organism (MDRO) acquisition. Design Retrospective cohort study. Setting Quaternary academic children's hospital. Patients Pediatric intensive care unit (ICU) patients with culture-negative sepsis receiving a minimum of 72 hours of antibiotics. Methods Patients found to have culture-negative sepsis from January 2017 to May 2020 were divided into two groups: short and long course of antibiotics. Various demographic and laboratory results were collected for each subject as available. Primary outcomes included mortality and lengths of stay. The secondary outcome was subsequent acquisition of a new MDRO. Results Eighty-six patients were treated for culture-negative sepsis with 43 patients in both the short- (< or = 7 days) and long-course (>7 days) treatment cohorts. Patients who received a short course of antibiotics had a lower overall mortality than those who received a long course (9.3% vs 25.6% p = 0.047), but there was no difference in 30-day mortality (p > 0.99). Patients in the short-course group had a shorter hospital length of stay (22 vs 30 days p = 0.018). New MDROs were found in 10% of all patients. Conclusions Treatment of culture-negative sepsis with short-course antibiotics was not associated with worse outcomes in ICU patients. These findings warrant further investigation with a larger, prospective, multi-center study.
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Affiliation(s)
- Kelsey Wehrenberg
- Section of Critical Care, Department of Pediatrics, University of Florida, Gainesville, FL, USA
- Section of Critical Care, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Michelle Mitchell
- Section of Infectious Diseases, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Tracy Zembles
- Department of Enterprise Safety, Children’s Wisconsin, Milwaukee, WI, USA
| | - Ke Yan
- Section of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Liyun Zhang
- Section of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Nathan Thompson
- Section of Critical Care, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
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Chudow MB, Condeni MS, Dhar S, Heavner MS, Nei AM, Bissell BD. Current Practice Review in the Management of Acute Respiratory Distress Syndrome. J Pharm Pract 2023; 36:1454-1471. [PMID: 35728076 DOI: 10.1177/08971900221108713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Acute respiratory distress syndrome (ARDS) presents as an acute inflammatory lung injury characterized by refractory hypoxemia and non-cardiac pulmonary edema. An estimated 10% of patients in the intensive care unit and 25% of those who are mechanically ventilated are diagnosed with ARDS. Increased awareness is warranted as mortality rates remain high and delays in diagnosing ARDS are common. The COVID-19 pandemic highlights the importance of understanding ARDS management. Treatment of ARDS can be challenging due to the complexity of the disease state and conflicting existing evidence. Therefore, it is imperative that pharmacists understand both pharmacologic and non-pharmacologic treatment strategies to optimize patient care. This narrative review provides a critical evaluation of current literature describing management practices for ARDS. A review of treatment modalities and supportive care strategies will be presented.
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Affiliation(s)
- Melissa B Chudow
- Department of Pharmacotherapeutics and Clinical Research, University of South Florida Taneja College of Pharmacy, Tampa, FL, USA
| | - Melanie S Condeni
- MUSC College of Pharmacy, Medical University of South Carolina, Charleston, SC, USA
| | - Sanjay Dhar
- Pulmonary Critical Care Ultrasound and Research, Pulmonary and Critical Care Fellowship Program, Division of Pulmonary, Critical Care & Sleep Medicine, University of Kentucky, Lexington, KY, USA
| | - Mojdeh S Heavner
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Andrea M Nei
- Mayo Clinic College of Medicine & Science, Critical Care Pharmacist, Department of Pharmacy, Mayo Clinic Hospital, Rochester, MN, USA
| | - Brittany D Bissell
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, KY, USA
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