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Kattlun F, Hertel E, Geis C, Scherag A, Wickel J, Finke K. Persistent neurocognitive deficits in cognitively impaired survivors of sepsis are explained by reductions in working memory capacity. Front Psychol 2024; 15:1321145. [PMID: 38449763 PMCID: PMC10915060 DOI: 10.3389/fpsyg.2024.1321145] [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: 10/13/2023] [Accepted: 02/08/2024] [Indexed: 03/08/2024] Open
Abstract
Introduction Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Mounting evidence suggests that many cognitively impaired sepsis survivors show long-term neurocognitive deficits in neuropsychological tasks. To date, the underlying mechanisms of these deficits are insufficiently understood. Based on previous evaluations we hypothesized that visual attention and working memory may be affected in a sample of cognitively impaired sepsis survivors. Methods We utilized psychophysical whole-and partial-report paradigms based on the computational theory of visual attention (TVA) to determine (i) whether sepsis survivors show changes in basic parameters of visual attention and working memory, (ii) whether the affected parameters are related to neuropsychological test results in a standard battery in sepsis survivors and matched healthy control participants, (iii) whether between-group differences in these basic parameters of visual attention could account for underperformance of sepsis survivors in neuropsychological tests when adjusting for potentially relevant clinical variables. Results We showed that, in sepsis survivors, the maximum number of elements consciously maintained in an instant, i.e. the working memory storage capacity K, is reduced (sepsis survivors: M = 3.0; healthy controls: M = 3.4). Moreover, K explained variance in neurocognitive outcomes -17% in attentional and 16 % in executive functions - in a standard neuropsychological battery. The association remained stable when adjusting for clinical variables. Discussion Thus, in our sample of cognitively impaired sepsis survivors, a reduction in working memory capacity seems to be a critical determinant of the neurocognitive sequelae. It should be the subject of future work on mechanisms but may also serve as surrogate outcome measure in interventional studies.
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Affiliation(s)
- Fabian Kattlun
- Department of Neurology, Jena University Hospital - Friedrich Schiller University, Jena, Germany
- Center for Sepsis Control and Care, Jena University Hospital - Friedrich Schiller University, Jena, Germany
| | - Elizabeth Hertel
- Department of Neurology, Jena University Hospital - Friedrich Schiller University, Jena, Germany
- Center for Sepsis Control and Care, Jena University Hospital - Friedrich Schiller University, Jena, Germany
| | - Christian Geis
- Center for Sepsis Control and Care, Jena University Hospital - Friedrich Schiller University, Jena, Germany
- Section Translational Neuroimmunology, Department of Neurology, Jena University Hospital - Friedrich Schiller University, Jena, Germany
| | - André Scherag
- Center for Sepsis Control and Care, Jena University Hospital - Friedrich Schiller University, Jena, Germany
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital - Friedrich Schiller University, Jena, Germany
| | - Jonathan Wickel
- Center for Sepsis Control and Care, Jena University Hospital - Friedrich Schiller University, Jena, Germany
- Section Translational Neuroimmunology, Department of Neurology, Jena University Hospital - Friedrich Schiller University, Jena, Germany
| | - Kathrin Finke
- Department of Neurology, Jena University Hospital - Friedrich Schiller University, Jena, Germany
- Center for Sepsis Control and Care, Jena University Hospital - Friedrich Schiller University, Jena, Germany
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Born S, Matthäus-Krämer C, Bichmann A, Boltz HS, Esch M, Heydt L, Sell S, Streich K, Scherag A, Reinhart K, Hartog CS, Fleischmann-Struzek C. Sepsis survivors and caregivers perspectives on post-acute rehabilitation and aftercare in the first year after sepsis in Germany. Front Med (Lausanne) 2023; 10:1137027. [PMID: 37113609 PMCID: PMC10126403 DOI: 10.3389/fmed.2023.1137027] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/15/2023] [Indexed: 04/29/2023] Open
Abstract
Background Sepsis survivors often suffer from new morbidities. Current rehabilitation therapies are not tailored to their specific needs. The perspective of sepsis survivors and their caregivers on rehabilitation and aftercare is insufficiently understood. We aimed to assess how sepsis survivors in Germany rated the suitability, extent and satisfaction with rehabilitation therapies that they underwent in the year following the acute sepsis episode. Methods Prospective mixed-methods, multicenter study among a cohort of adult ICU-treated sepsis survivors and their caregivers. Interviews were conducted 6 and 12 months after ICU discharge by telephone and comprised closed as well as open-ended questions. Primary outcomes were the utilization and patient satisfaction with inpatient and outpatient rehabilitation and post-sepsis aftercare in general. Open-ended questions were analyzed according to the principles of content analysis. Results Foun hundred interviews were performed with 287 patients and/or relatives. At 6 months after sepsis, 85.0% of survivors had applied for and 70.0% had undergone rehabilitation. Among these, 97% received physical therapy, but only a minority reported therapies for specific ailments including pain, weaning from mechanical ventilation, cognitive deficits of fatigue. Survivors were moderately satisfied with the suitability, extent, and overall results of received therapies and perceived deficits in the timeliness, accessibility, and specificity of therapies as well as deficits in the structural support frameworks and patient education. Conclusion From the perspective of survivors who undergo rehabilitation, therapies should already begin in hospital, be more appropriate for their specific ailments and include better patient and caregiver education. The general aftercare and structural support framework should be improved.
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Affiliation(s)
- Sebastian Born
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
| | - Claudia Matthäus-Krämer
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
| | - Anna Bichmann
- Department of Anesthesiology and Operative Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Hannah-Sophia Boltz
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
| | - Marlene Esch
- Department of Anesthesiology and Operative Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Luisa Heydt
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
| | - Stefan Sell
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
| | - Kathleen Streich
- Department of Anesthesiology and Operative Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - André Scherag
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Jena, Germany
| | - Konrad Reinhart
- Department of Anesthesiology and Operative Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christiane S. Hartog
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
- Klinik Bavaria, Kreischa, Germany
| | - Carolin Fleischmann-Struzek
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
- *Correspondence: Carolin Fleischmann-Struzek,
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Abstract
Sepsis is one of the most serious problems in modern medicine. Long-term outcomes in septic shock patients are very discouraging: 75% individuals who survived sepsis and septic shock demonstrate signs of organ failure and experience persistent functional deficit. Acute sepsis and its management in an intensive care unit (ICU) to a great extent determine the pathogenesis of further complications. We believe that the concept of phenoptosis proposed by Prof. Skulachev deserves a special attention from anesthesiologists and ICU doctors. According to this concept, septic shock is a suicidal mechanism of programmed organism death, which protects human population from dangerously infected individuals. The article suggests a potential approach to the sepsis treatment based on the notion that septic shock can be prevented by identification and blockade of receptors involved in the processing of phenoptotic signal induced by lipopolysaccharide and other substances that initiate septic shock. In view of this, the search for agents that can block molecular mechanisms of the phenoptotic signal transmission seems very promising.
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Affiliation(s)
- Oleg A Grebenchikov
- Negovsky Scientific Research Institute of General Reanimatology, Moscow, 107031, Russia.
| | - Artem N Kuzovlev
- Negovsky Scientific Research Institute of General Reanimatology, Moscow, 107031, Russia
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Apitzsch S, Larsson L, Larsson AK, Linder A. The physical and mental impact of surviving sepsis - a qualitative study of experiences and perceptions among a Swedish sample. Arch Public Health 2021; 79:66. [PMID: 33933171 PMCID: PMC8088073 DOI: 10.1186/s13690-021-00585-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/18/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Sepsis is a critical illness with high morbidity and mortality rates. Each year, sepsis affects about 48.9 million people all over the world. This study aims to illuminate how sepsis survivors experience sepsis and the impact of sepsis, as well as the health-related quality of life thereafter. METHODS An interview study with eight sepsis survivors was carried out in Sweden with an inductive qualitative method. The data were analyzed with content analysis. RESULTS Four themes were identified during the analysis; The experience of health care and being a sepsis patient, New circumstances´ impact on life, Family and social interactions, and The psychological impact on life. The lack of information about how sepsis can impact the survivors' lives and what to expect can lead to prolonged agony. The long recovery time comes as an unexpected and unpleasant surprise to those affected. Initially, the sepsis survivors are almost euphoric that they have survived, which can later lead to chock and trauma when they realize that they could have died. This insight needs to be processed in order to reach reconciliation with life after sepsis. CONCLUSION Sepsis has a huge impact on both physical and mental aspects of life. Many survivors suffer from persistent residual symptoms of varying degrees, to which they have to adapt. The sepsis survivors need individually adjusted information about the sepsis recovery trajectory, and what to expect during and after the hospital stay.
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Affiliation(s)
- Sabine Apitzsch
- The Emergency Department, Skåne University Hospital, Lund, Sweden
| | - Lotta Larsson
- Faculties of humanities and theology, Centre for Languages and Literature, Lund University, Lund, Sweden
| | - Anna-Karin Larsson
- Region Skåne, Department of Quality Management and Production, Lund/Malmö, Sweden
| | - Adam Linder
- Faculty of Medicine, Department of Clinical Sciences Lund, Division of Infection Medicine, Lund University, Lund, Sweden.
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Fleischmann-Struzek C, Kesselmeier M, Ouart D, Hartog CS, Bauer M, Bercker S, Bucher M, Meier-Hellmann A, Petros S, Schreiber T, Simon P, Weidhase L, Born S, Braune A, Chkirni H, Eichhorn C, Fiedler S, Gampe C, König C, Platzer S, Romeike H, Töpfer K, Reinhart K, Scherag A. Mid-German Sepsis Cohort (MSC): a prospective observational study of sepsis survivorship. BMJ Open 2021; 11:e043352. [PMID: 33737430 PMCID: PMC7978081 DOI: 10.1136/bmjopen-2020-043352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE The Mid-German Sepsis Cohort (MSC) aims to investigate mid-term and long-term functional disabilities in sepsis survivors from intensive care unit (ICU) discharge until 1 year after. Secondary, post-acute mortality and morbidity, health-related quality of life and healthcare utilisation will be investigated. PARTICIPANTS The MSC comprises adult (aged ≥18 years) patients who were treated for (severe) sepsis or septic shock on ICU. The participants were recruited between 15 April 2016 and 30 November 2018 from five German centres. Three thousand two hundred and ten patients with sepsis were identified, of which 1968 survived their ICU stay and were eligible for enrolment in the follow-up cohort. Informed consent for follow-up assessment was provided by 907 patients (46.1% of eligible patients). FINDINGS TO DATE The recruitment of the participants for follow-up assessments and the baseline data collection is completed. Incidence of sepsis was 116.7 patients per 1000 ICU patients. In this cohort profile, we provide an overview of the demographics and the clinical characteristics of both the overall sepsis cohort and the ICU survivors who provided informed consent for follow-up assessment (907 out of 1968 ICU survivors (46.1%)). FUTURE PLANS The follow-ups are conducted 3, 6 and 12 months after ICU discharge. Another yearly follow-up up to 5 years after ICU discharge is pursued. Several cooperation and satellite projects were initiated. This prospective cohort offers a unique resource for research on long-term sequelae of sepsis survivors. TRIAL REGISTRATION NUMBER German Clinical Trials Registry (DRKS00010050).
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Affiliation(s)
- Carolin Fleischmann-Struzek
- Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
| | - Miriam Kesselmeier
- Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
- Research Group Clinical Epidemiology, CSCC, Jena University Hospital, Jena, Germany
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Jena, Germany
| | - Dominique Ouart
- Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Christiane S Hartog
- Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Klinik Bavaria Kreischa, Kreischa, Germany
| | - Michael Bauer
- Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Sven Bercker
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Michael Bucher
- Department of Anesthesiology and Critical Care Medicine, Halle-Wittenberg University, Halle, Germany
| | | | - Sirak Petros
- Medical Intensive Care Unit, University Hospital Leipzig, Leipzig, Germany
| | - Torsten Schreiber
- Zentrum für Anästhesie, Intensivmedizin und Notfallmedizin, Zentralklinik Bad Berka GmbH, Bad Berka, Germany
| | - Philipp Simon
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Lorenz Weidhase
- Medical Intensive Care Unit, University Hospital Leipzig, Leipzig, Germany
| | - Sebastian Born
- Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
| | - Anke Braune
- Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
- Center for Clinical Studies, Jena University Hospital, Jena, Germany
| | - Hicham Chkirni
- Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
- Center for Clinical Studies, Jena University Hospital, Jena, Germany
| | - Cornelia Eichhorn
- Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
- Center for Clinical Studies, Jena University Hospital, Jena, Germany
| | - Sandra Fiedler
- Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
- Center for Clinical Studies, Jena University Hospital, Jena, Germany
| | - Christin Gampe
- Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
- Center for Clinical Studies, Jena University Hospital, Jena, Germany
| | - Christian König
- Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Stephanie Platzer
- Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
- Center for Clinical Studies, Jena University Hospital, Jena, Germany
| | - Heike Romeike
- Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
| | - Kristin Töpfer
- Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
| | - Konrad Reinhart
- Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - André Scherag
- Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
- Research Group Clinical Epidemiology, CSCC, Jena University Hospital, Jena, Germany
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Jena, Germany
- Center for Clinical Studies, Jena University Hospital, Jena, Germany
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Schmidt K, Gensichen J, Fleischmann-Struzek C, Bahr V, Pausch C, Sakr Y, Reinhart K, Christian Vollmar H, Thiel P, Scherag A, Gantner* J, M. Brunkhorst* F. Long-Term Survival Following Sepsis. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 117:775-782. [PMID: 33533711 PMCID: PMC7930463 DOI: 10.3238/arztebl.2020.0775] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/07/2020] [Accepted: 06/24/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND There have not yet been any prospective registry studies in Germany with active investigation of the long-term survival of patients with sepsis. METHODS The Jena Sepsis Registry (JSR) included all patients with a diagnosis of sepsis in the four intensive care units of Jena University Hospital from January 2011 to December 2015. Long-term survival 6-48 months after diagnosis was documented by asking the treating general practitioners. The survival times were studied with Kaplan-Meier estimators. Cox regressions were calculated to show associations between possible predictors and survival time. RESULTS 1975 patients with sepsis or septic shock were included. The mean time of observation was 730 days. For 96.4% of the queries to the general practitioners, information on long-term survival was available. Mortality in the intensive care unit was 34% (95% confidence interval [32; 37]), and in-hospital mortality was 45% [42; 47]. The overall mortality six months after diagnosis was 59% [57; 62], the overall mortality 48 months after diagnosis was 74% [72; 78]. Predictors of shorter survival were age, nosocomial origin of sepsis, diabetes, cerebrovascular disease, duration of stay in the intensive care unit, and renal replacement therapy. CONCLUSION The nearly 75% mortality four years after diagnosis indicates that changes are needed both in the acute treatment of patients with sepsis and in their multi-sector long-term care. The applicability of these findings may be limited by their having been obtained in a single center.
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Affiliation(s)
- Konrad Schmidt
- Center for Sepsis Control and Care (CSCC), Jena University Hospital:
- Institute of General Practice and Family Medicine, Jena University Hospital
- Institute of General Practice, Charité–Universitätsmedizin Berlin
| | - Jochen Gensichen
- Institute of General Practice and Family Medicine, Jena University Hospital
- Institute of General Practice and Family Medicine, Munich University Hospital, Ludwig-Maximilians-Universität München
| | | | - Viola Bahr
- Center for Clinical Studies, Jena University Hospital
| | - Christine Pausch
- Center for Sepsis Control and Care (CSCC), Jena University Hospital:
- Institute for Medical Informatics, Statistics and Epidemiology (IMISE), Leipzig University
| | - Yasser Sakr
- Clinic for Anaesthesiology and Intensive Care Medicine, Jena University Hospital
| | - Konrad Reinhart
- Center for Sepsis Control and Care (CSCC), Jena University Hospital:
- Clinic for Anaesthesiology and Intensive Care Medicine, Jena University Hospital
| | - Horst Christian Vollmar
- Institute of General Practice and Family Medicine, Jena University Hospital
- Institute of General Practice and Family Medicine, Ruhr-University Bochum
| | - Paul Thiel
- Center for Sepsis Control and Care (CSCC), Jena University Hospital:
- Institute of General Practice and Family Medicine, Jena University Hospital
| | - André Scherag
- Center for Sepsis Control and Care (CSCC), Jena University Hospital:
- Institute of Medical Statistics, Computer Science and Data Sciences, Jena University Hospital
| | - Julia Gantner*
- * Joint last authors
- Institute of Medical Statistics, Computer Science and Data Sciences, Jena University Hospital
| | - Frank M. Brunkhorst*
- Center for Sepsis Control and Care (CSCC), Jena University Hospital:
- Center for Clinical Studies, Jena University Hospital
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Pohlan J, Hernando MIO, Hogrebe A, Witham D, Muench G, Kwon HJ, Goehler F, Marek A, Praeger D, Dewey M. The role of body computed tomography in hospitalized patients with obscure infection: Retrospective consecutive cohort study. Eur J Radiol 2020; 132:109325. [PMID: 33027726 DOI: 10.1016/j.ejrad.2020.109325] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 09/21/2020] [Accepted: 09/24/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Patients with severe infection or sepsis require fast identification of the focus and prompt eradication. This study aims at investigating the role of body computed tomography (CT) and identifying outcome predictors in a general ward setting of patients with obscure infection. METHODS We retrospectively identified 196 consecutive body CTs acquired in 179 patients with obscure infection, i.e. severe infection or sepsis from general wards with unclear focus, over 12-months in the year 2018. Reports were extracted using a full-text search in the radiological information system (RIS) of a large university medical center. CT reports were classified according to diagnostic confidence of the reader (i.e. certain, likely, possible, no focus), and correlated with clinical and laboratory parameters. The discharge diagnosis was set as the diagnostic reference standard. Contingency tables were prepared for statistical analysis with Chi-squared test amongst other analyses and the calculation of AUC statistics. RESULTS In 133 out of 196 (67.9 %) body CTs from general wards with severe infection or sepsis, body CT identified an infectious focus. 90 % of the infections were located in the chest, abdomen, and genitourinary tract, in descending order. In 76.5 % (150 of 196) of examinations, CT correctly predicted the final infectious source. The positive predictive value (PPV) of a CT-detected focus was 84.2 % (95 % CI 79.0%-88.3%). A high diagnostic confidence of the reader resulted in a PPV of 96.4 % (95 % CI 87.4%-99.1%) while a low confidence resulted in a PPV of 63.3 % (95 % CI 48.2%-76.3%). CONCLUSION In patients with obscure infection treated in general wards, body CT detects the infectious source with a high positive predictive value. Focus detection accuracy highly depends on the diagnostic confidence of the CT reader.
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Affiliation(s)
- Julian Pohlan
- Department of Radiology, Charité - Universitätsmedizin Berlin, Germany.
| | | | - Anna Hogrebe
- Department of Radiology, Charité - Universitätsmedizin Berlin, Germany
| | - Denis Witham
- Department of Radiology, Charité - Universitätsmedizin Berlin, Germany
| | - Gloria Muench
- Department of Radiology, Charité - Universitätsmedizin Berlin, Germany
| | - Ho Jung Kwon
- Department of Radiology, Charité - Universitätsmedizin Berlin, Germany
| | | | - Andrea Marek
- Department of Cardiology and Intensive Care Unit, Charité - Universitätsmedizin Berlin, Germany
| | - Damaris Praeger
- Department of Cardiology and Intensive Care Unit, Charité - Universitätsmedizin Berlin, Germany
| | - Marc Dewey
- Department of Radiology, Charité - Universitätsmedizin Berlin, Germany
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8
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Tian G, Jin X, Wang Q, Ye T, Li G, Liu J. Recent advances in the study of progranulin and its role in sepsis. Int Immunopharmacol 2019; 79:106090. [PMID: 31869774 DOI: 10.1016/j.intimp.2019.106090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/25/2019] [Accepted: 11/28/2019] [Indexed: 12/29/2022]
Abstract
Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. The mortality rate of in-hospital patients whose conditions are complicated by sepsis remains high in spite of intensive-care treatment, therefore placing a significant financial burden on the health care system. In recent years, progranulin (PGRN), a cysteine-rich secretory protein (CRISP), has been found to play a crucial role in sepsis. PGRN participates in the pathogenesis of sepsis via diverse pathways, including bacterial clearance, cell growth and survival, tissue repair, and the regulation of inflammation. PGRN knockout mice suffer from serious infectious processes, whereas therapeutic administration of recombinant PGRN to such mice enhances bacterial clearance and reduces organ injury and mortality rate. Even though PGRN plays an important role in regulating sepsis, its potential mechanisms have not been completely clarified. In this review, we summarize the most recent research advances in the study of PGRN and its role in sepsis.
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Affiliation(s)
- Gang Tian
- Department of Laboratory Medicine, Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - Xinrui Jin
- Department of Laboratory Medicine, Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - Qin Wang
- Sichuan Provincial Center for Gynaecology and Breast Diseases (Affiliated Hospital of Southwest Medical University), Luzhou, Sichuan 646000, China
| | - Ting Ye
- Department of Laboratory Medicine, Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - Guangrong Li
- Department of Laboratory Medicine, Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - Jinbo Liu
- Department of Laboratory Medicine, Affiliated Hospital of Southwest Medical University, Luzhou 646000, China.
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Kumar V. Sepsis roadmap: What we know, what we learned, and where we are going. Clin Immunol 2019; 210:108264. [PMID: 31655168 DOI: 10.1016/j.clim.2019.108264] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 07/02/2019] [Accepted: 09/26/2019] [Indexed: 02/07/2023]
Abstract
Sepsis is a life-threatening condition originating as a result of systemic blood infection causing, one or more organ damage due to the dysregulation of the immune response. In 2017, the world health organization (WHO) declared sepsis as a disease of global health priority, needing special attention due to its high prevalence and mortality around the world. Most of the therapeutics targeting sepsis have failed in the clinics. The present review highlights the history of the sepsis, its immunopathogenesis, and lessons learned after the failure of previously used immune-based therapies. The subsequent section, where to go describes in details the importance of the complement system (CS), autophagy, inflammasomes, and microbiota along with their targeting to manage sepsis. These systems are interconnected to each other, thus targeting one may affect the other. We are in an urgent need for a multi-targeting therapeutic approach for sepsis.
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Affiliation(s)
- Vijay Kumar
- Children's Health Queensland Clinical Unit, School of Clinical Medicine, Faculty of Medicine, Mater Research, University of Queensland, ST Lucia, Brisbane, Queensland 4078, Australia; School of Biomedical Sciences, Faculty of Medicine, University of Queensland, ST Lucia, Brisbane, Queensland 4078, Australia.
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10
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Prescott HC, Iwashyna TJ, Blackwood B, Calandra T, Chlan LL, Choong K, Connolly B, Dark P, Ferrucci L, Finfer S, Girard TD, Hodgson C, Hopkins RO, Hough CL, Jackson JC, Machado FR, Marshall JC, Misak C, Needham DM, Panigrahi P, Reinhart K, Yende S, Zafonte R, Rowan KM. Understanding and Enhancing Sepsis Survivorship. Priorities for Research and Practice. Am J Respir Crit Care Med 2019; 200:972-981. [PMID: 31161771 PMCID: PMC6794113 DOI: 10.1164/rccm.201812-2383cp] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 05/31/2019] [Indexed: 12/25/2022] Open
Abstract
An estimated 14.1 million patients survive sepsis each year. Many survivors experience poor long-term outcomes, including new or worsened neuropsychological impairment; physical disability; and vulnerability to further health deterioration, including recurrent infection, cardiovascular events, and acute renal failure. However, clinical trials and guidelines have focused on shorter-term survival, so there are few data on promoting longer-term recovery. To address this unmet need, the International Sepsis Forum convened a colloquium in February 2018 titled "Understanding and Enhancing Sepsis Survivorship." The goals were to identify gaps and limitations of current research and shorter- and longer-term priorities for understanding and enhancing sepsis survivorship. Twenty-six experts from eight countries participated. The top short-term priorities identified by nominal group technique culminating in formal voting were to better leverage existing databases for research, develop and disseminate educational resources on postsepsis morbidity, and partner with sepsis survivors to define and achieve research priorities. The top longer-term priorities were to study mechanisms of long-term morbidity through large cohort studies with deep phenotyping, build a harmonized global sepsis registry to facilitate enrollment in cohorts and trials, and complete detailed longitudinal follow-up to characterize the diversity of recovery experiences. This perspective reviews colloquium discussions, the identified priorities, and current initiatives to address them.
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Affiliation(s)
- Hallie C. Prescott
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan
- Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan
| | - Theodore J. Iwashyna
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan
- Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan
| | - Bronagh Blackwood
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, United Kingdom
| | - Thierry Calandra
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Linda L. Chlan
- Nursing Research Division, Department of Nursing, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota
| | - Karen Choong
- Department of Pediatrics
- Department of Critical Care, and
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Bronwen Connolly
- Lane Fox Respiratory Unit, St. Thomas’ Hospital, Guy’s and St. Thomas’ National Health Service Foundation Trust, London, United Kingdom
| | - Paul Dark
- National Specialty Lead for Critical Care, National Institute for Health Research, and
- Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Luigi Ferrucci
- National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Simon Finfer
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Timothy D. Girard
- Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Carol Hodgson
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia
| | - Ramona O. Hopkins
- Psychology Department and Neuroscience Center, Brigham Young University, Provo, Utah
- Center for Humanizing Critical Care at Intermountain Healthcare, Murray, Utah
- Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, Utah
| | - Catherine L. Hough
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington
| | - James C. Jackson
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Flavia R. Machado
- Anesthesiology, Pain, and Intensive Care Department, Federal University of São Paulo, São Paulo, Brazil
| | - John C. Marshall
- Department of Surgery
- Department of Critical Care Medicine, and
- Keenan Research Centre for Biomedical Science, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Cheryl Misak
- Department of Philosophy, University of Toronto, Toronto, Ontario, Canada
| | - Dale M. Needham
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, and
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland
| | - Pinaki Panigrahi
- Department of Pediatrics, Georgetown University Medical Center, Washington, DC
| | - Konrad Reinhart
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
- Stiftung Charité Klinik für Anäesthesie Operative Intensivmedizin, Charité Universitätsmedizin, Berlin, Germany
| | - Sachin Yende
- Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Veterans Affairs Pittsburgh Healthcare System, Pittsburg, Pennsylvania
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
- Massachusetts General Hospital, Boston, Massachusetts
- Brigham and Women’s Hospital, Boston, Massachusetts; and
| | - Kathryn M. Rowan
- Intensive Care National Audit and Research Centre, London, United Kingdom
| | - on behalf of the International Sepsis Forum
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan
- Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, United Kingdom
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
- Nursing Research Division, Department of Nursing, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota
- Department of Pediatrics
- Department of Critical Care, and
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Lane Fox Respiratory Unit, St. Thomas’ Hospital, Guy’s and St. Thomas’ National Health Service Foundation Trust, London, United Kingdom
- National Specialty Lead for Critical Care, National Institute for Health Research, and
- Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
- National Institute on Aging, National Institutes of Health, Baltimore, Maryland
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia
- Psychology Department and Neuroscience Center, Brigham Young University, Provo, Utah
- Center for Humanizing Critical Care at Intermountain Healthcare, Murray, Utah
- Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, Utah
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University, Nashville, Tennessee
- Anesthesiology, Pain, and Intensive Care Department, Federal University of São Paulo, São Paulo, Brazil
- Department of Surgery
- Department of Critical Care Medicine, and
- Keenan Research Centre for Biomedical Science, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Philosophy, University of Toronto, Toronto, Ontario, Canada
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, and
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland
- Department of Pediatrics, Georgetown University Medical Center, Washington, DC
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
- Stiftung Charité Klinik für Anäesthesie Operative Intensivmedizin, Charité Universitätsmedizin, Berlin, Germany
- Veterans Affairs Pittsburgh Healthcare System, Pittsburg, Pennsylvania
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
- Massachusetts General Hospital, Boston, Massachusetts
- Brigham and Women’s Hospital, Boston, Massachusetts; and
- Intensive Care National Audit and Research Centre, London, United Kingdom
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Comparative validation of three screening instruments for posttraumatic stress disorder after intensive care. J Crit Care 2019; 53:149-154. [DOI: 10.1016/j.jcrc.2019.06.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 06/17/2019] [Accepted: 06/17/2019] [Indexed: 11/20/2022]
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