1
|
Jia W, Zhang X, Sun R, Li P, Wang D, Gu X, Song C. Value of modified qSOFA, glucose and lactate in predicting prognosis in children with sepsis in the PICU. Ann Med 2024; 56:2337714. [PMID: 38590177 PMCID: PMC11005878 DOI: 10.1080/07853890.2024.2337714] [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: 11/24/2023] [Accepted: 02/29/2024] [Indexed: 04/10/2024] Open
Abstract
The purpose was to investigate how well age-adjusted modified quick Sequential Organ Failure Assessment (qSOFA) scores paired with blood glucose and lactate levels predict the outcomes of septicemic children in the pediatric intensive care unit (PICU). One hundred children who were diagnosed with sepsis and septic shock in the PICU of Henan Children's Hospital were eligible, and other 20 patients in the same hospital at different times were selected as a validation set. Respiratory rate (RR), heart rate (HR), capillary refill time (CRT), and Alert, Voice, Pain, Unresponsive (AVPU) scale were included in the age-adjusted modified qSOFA scoring criteria for scoring. The primary outcome was 28-day all-cause mortality. The predictive values were evaluated by the ROC curve. In the sepsis group, 50 patients were male, and 50 patients were female. The 28-day all-cause mortality rate was 52%. Fifty-one patients with age-adjusted modified qSOFA scores >1. The serum lactate level was 2.4 mmol/L, and the blood glucose level was 9.3 mmol/L. The AUCs for the age-adjusted modified qSOFA score, serum lactate and blood glucose levels for the prediction of 28-day all-cause mortality in children with sepsis were 0.719, 0.719 and 0.737, respectively. The cut-off values were one point, 3.8 mmol/L and 10 mmol/L, respectively. The AUC of the age-adjusted modified qSOFA score for the validation set of was 0.925. When the three indices were combined, the AUC was 0.817, the Hosmer-Lemeshow goodness-of-fit test showed χ2 = 2.428 and p = .965. When children with sepsis are admitted to the ICU, we recommend performing rapid scoring and rapid bedside lactate and glucose testing to determine the early prognosis.
Collapse
Affiliation(s)
- Wanyu Jia
- Department of Emergency Medicine, Henan Province Engineering Research Center of Diagnosis and Treatment of Pediatric Infection and Critical Care, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, China
| | - Xue Zhang
- Department of Emergency Medicine, Henan Province Engineering Research Center of Diagnosis and Treatment of Pediatric Infection and Critical Care, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, China
| | - Ruiyang Sun
- Department of Emergency Medicine, Henan Province Engineering Research Center of Diagnosis and Treatment of Pediatric Infection and Critical Care, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, China
| | - Peng Li
- Department of Emergency Medicine, Henan Province Engineering Research Center of Diagnosis and Treatment of Pediatric Infection and Critical Care, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, China
| | - Daobin Wang
- Department of Pediatrics, Zhecheng County People’s Hospital, Shangqiu, China
| | - Xue Gu
- Department of Emergency Medicine, Henan Province Engineering Research Center of Diagnosis and Treatment of Pediatric Infection and Critical Care, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, China
| | - Chunlan Song
- Department of Emergency Medicine, Henan Province Engineering Research Center of Diagnosis and Treatment of Pediatric Infection and Critical Care, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, China
| |
Collapse
|
2
|
Zhang TY, Du YJ, Hou YZ, Du Q, Dou HR, Gao XM. Heart/breathing rate ratio (HBR) as a predictor of mortality in critically ill patients. Heliyon 2024; 10:e31187. [PMID: 38803872 PMCID: PMC11128922 DOI: 10.1016/j.heliyon.2024.e31187] [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: 12/23/2023] [Revised: 05/08/2024] [Accepted: 05/12/2024] [Indexed: 05/29/2024] Open
Abstract
Objectives The early prediction of death is a challenge for medical staff. We evaluated the ability of the heart/breathing rate ratio (HBR) to predict mortality. Methods This was a single-center retrospective observational study of adult patients who had fever with or without respiratory symptoms, who survived at least 2 h after visiting the hospital, and whose lactate levels and vital signs were tested. We evaluated the distribution of mortality at different HBR levels and compared HBR with lactate. Results A total of 18,872 fever clinic visits were screened, and 183 patients whose lactate levels were tested were recruited. Patients who had HBR values lower than 4·5 or higher than 5·5 had greater mortality than patients who had HBR values between 4·5 and 5·5 (21·3 % vs. 3·4 %, p = 0·003; 28·9 % vs. 3·4 %, p < 0·001, respectively). In patients whose HBR was <5, the AUROC for HBR for mortality was 0·762 (95 % CI: 0.643-0·880), and that for lactate was 0·701 (95 % CI: 0·564-0·837). In patients whose HBR was ≥5, the AUROC for HBR for mortality was 0·721 (95 % CI: 0·584-0·857), and that for lactate was 0·742 (95 % CI: 0·607-0·848). Conclusions HBR is helpful for stratifying mortality risk among critically ill patients in acute care clinics for infectious diseases.
Collapse
Affiliation(s)
- Tong Yan Zhang
- Infectious Diseases Department, Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Ya Jun Du
- TEDA International Cardiovascular Hospital, Tianjin, China
| | - Ya Zhu Hou
- Department of Cardiology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Qian Du
- Department of Pharmacy, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hai Rong Dou
- Infectious Diseases Department, Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xiu Mei Gao
- Tianjin State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| |
Collapse
|
3
|
Beniwal A, Singh O, Juneja D, Beniwal HK, Kataria S, Bhide M, Yadav D. Clinical course and outcomes of cancer patients admitted in medical ICU with sepsis. J Intensive Care Soc 2023; 24:351-355. [PMID: 37841298 PMCID: PMC10572483 DOI: 10.1177/17511437221136831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
Background and aims Sepsis is not only a leading cause of intensive care unit (ICU) admission but also one of the variables which affect outcomes of cancer patients. We aimed to assess the clinical characteristics, clinical course, mortality and risk factors associated with 30-day mortality in medical oncology patients admitted in a multi-disciplinary medical ICU. Methods We conducted a retrospective analysis of 435 consecutive cancer patients admitted in medical ICU over a 28 months period. Patients were divided into two groups based on the presence of sepsis at the time of ICU admission. Data regarding baseline patient characteristics, clinical and laboratory data, need for organ support and 30-day mortality were collected. Sepsis patients were further classified as 30-day survivors and non-survivors and risk factors for mortality in these patients were determined. Results Overall 30-day mortality was 57.8%. It was significantly higher in sepsis group patients (73.9%) as compared to non-sepsis patients (46.6%) (p < 0.001). Most common reason for ICU admission in non-sepsis group was respiratory distress (51.4%) followed by altered sensorium (28.4%). Presence of metastasis [odds ratio, OR: 3.89 (95% confidence interval, CI: 1.536-9.901)], high lactate [OR: 1.374 (95% CI: 1.024-1.843)] and need of invasive mechanical ventilator (IMV) support [OR: 7.634 (95% CI: 2.519-23.256)] or vasopressor support [OR: 3.268 (95% CI: 1.179-9.090)] were directly associated with 30-day mortality. Conclusion Critically ill cancer patients admitted with sepsis had high mortality. Presence of metastasis, high lactate and need of IMV or vasopressor support was associated with worse prognosis in cancer patients admitted with sepsis in ICU.
Collapse
Affiliation(s)
- Anisha Beniwal
- Critical Care Medicine, Max Super Speciality Hospital, Saket, Delhi, India
| | - Omender Singh
- Critical Care Medicine, Max Super Speciality Hospital, Saket, Delhi, India
| | - Deven Juneja
- Critical Care Medicine, Max Super Speciality Hospital, Saket, Delhi, India
| | - Hemant Kumar Beniwal
- Assistant professor, Department of Neurosurgery, Dr S. N. Medical College, Jodhpur, Rajasthan, India
| | - Sahil Kataria
- Critical Care Medicine, Max Super Speciality Hospital, Saket, Delhi, India
| | - Madhura Bhide
- Critical Care Medicine, Max Super Speciality Hospital, Saket, Delhi, India
| | - Devraj Yadav
- Critical Care Medicine, Max Super Speciality Hospital, Saket, Delhi, India
| |
Collapse
|
4
|
Jimenez JV, Garcia-Tsao G, Saffo S. Emerging concepts in the care of patients with cirrhosis and septic shock. World J Hepatol 2023; 15:497-514. [PMID: 37206653 PMCID: PMC10190696 DOI: 10.4254/wjh.v15.i4.497] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/19/2023] [Accepted: 03/23/2023] [Indexed: 04/20/2023] Open
Abstract
Septic shock impacts approximately 6% of hospitalized patients with cirrhosis and is associated with high rates of morbidity and mortality. Although a number of landmark clinical trials have paved the way for incremental improvements in the diagnosis and management of septic shock in the general population, patients with cirrhosis have largely been excluded from these studies and critical knowledge gaps continue to impact the care of these individuals. In this review, we discuss nuances in the care of patients with cirrhosis and septic shock using a pathophysiology-based approach. We illustrate that septic shock may be challenging to diagnose in this population in the context of factors such as chronic hypotension, impaired lactate metabolism, and concomitant hepatic encephalopathy. Furthermore, we demonstrate that the application of routine interventions such as intravenous fluids, vasopressors, antibiotics, and steroids should be carefully considered among those with decompensated cirrhosis in light of hemodynamic, metabolic, hormonal, and immunologic disturbances. We propose that future research should include and characterize patients with cirrhosis in a systematic manner, and clinical practice guidelines may need to be refined accordingly.
Collapse
Affiliation(s)
- Jose Victor Jimenez
- Section of Digestive Diseases, Yale School of Medicine, New Haven, CT 06520, United States
| | - Guadalupe Garcia-Tsao
- Section of Digestive Diseases, Yale School of Medicine, New Haven, CT 06520, United States
| | - Saad Saffo
- Section of Digestive Diseases, Yale School of Medicine, New Haven, CT 06520, United States.
| |
Collapse
|
5
|
Maraziti G, Marchini L, Barbieri G, Falcone M, Corradi F, Graziani M, Ghiadoni L, Becattini C. Arterial lactate as a risk factor for death in respiratory failure related to coronavirus disease 2019: an observational study. Ther Adv Respir Dis 2023; 17:17534666231186730. [PMID: 37646253 PMCID: PMC10469239 DOI: 10.1177/17534666231186730] [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: 12/13/2022] [Accepted: 06/22/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Arterial lactate is a recognized biomarker associated with death in critically ill patients. The prognostic role of arterial lactate in acute respiratory failure due to the novel coronavirus disease 2019 (COVID-19) is unclear. OBJECTIVES We aimed to investigate the prognostic role of arterial lactate levels at admission in patients with COVID-19-related acute respiratory failure. DESIGN AND METHODS Cohorts of consecutive patients admitted to nonintensive care units (ICU) at study centers for COVID-19-related respiratory failure were merged into a collaborative database. The prognostic role of lactate levels at admission was assessed for continuous values and values ⩾2.0 mmol/l, and lactate clearance at 24 h through delta-lactate (ΔLac). The study outcome was 30-day in-hospital death. Cox proportional regression model was used to assess independent predictors of the study outcome. RESULTS At admission, 14.6% of patients had lactate levels ⩾2 mmol/l. In-hospital death at 30 days occurred in 57 out of 206 patients; 22.3% and 56.7% with normal or ⩾ 2 mmol/l lactate at admission, respectively. The median lactate level was 1.0 [interquartile range (IQR) 0.8-1.3] mmol/l and 1.3 (IQR 1.0-2.1) mmol/l in survivors and nonsurvivors, respectively (p-value < 0.001). After adjusting for age, relevant comorbidities, acidemia, and the severity of respiratory failure, lactate ⩾2.0 mmol/l was associated with in-hospital death (HR 2.53, 95% CI 1.29-4.95, p-value 0.0066), while Δ Lac ⩾0 was not (HR 1.37, 95% CI 0.42-4.49). These results were confirmed in patients with a pO2/FiO2-ratio (P/F ratio) ⩽300 mmHg. CONCLUSIONS In our study, increased arterial lactate at admission was independently associated with in-hospital death at 30 days in non-ICU patients with acute respiratory failure related to COVID-19.
Collapse
Affiliation(s)
- Giorgio Maraziti
- Internal Cardiovascular and Emergency Medicine–Stroke Unit, S. Maria della Misericordia Hospital, University of Perugia, Perugia 06156, Italy
| | - Laura Marchini
- Internal Cardiovascular and Emergency Medicine–Stroke Unit, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Greta Barbieri
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
- Emergency Medicine Department, Pisa University Hospital, Italy
| | - Marco Falcone
- Infectious Disease Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Francesco Corradi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
- Anaesthesia and Intensive Care Unit, Ospedali Galliera, Genova, Italy
| | - Mara Graziani
- Internal Cardiovascular and Emergency Medicine–Stroke Unit, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Lorenzo Ghiadoni
- Emergency Medicine Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Cecilia Becattini
- Internal Cardiovascular and Emergency Medicine–Stroke Unit, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| |
Collapse
|
6
|
Risk Factors for Mortality in Sepsis Patients without Lactate Levels Increasing Early. Emerg Med Int 2023; 2023:6620157. [PMID: 36875806 PMCID: PMC9984259 DOI: 10.1155/2023/6620157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 02/26/2023] Open
Abstract
Objectives Our purpose was to investigate the influencing factors for mortality in sepsis patients without lactate levels increasing in the early stage. Methods We conducted a retrospective observational study involving 830 adult sepsis patients admitted to ICU. We calculated time-weighted lactate (LacTW), a dynamic value that incorporates both the magnitude of change and the time interval of such change, to represent lactate levels in the first 24 hours. ROC curve was used to find the cutoff of LacTW for predicting mortality, and the influencing factors for lactate levels and mortality in the low lactate group were further studied. The primary outcome was hospital mortality. Results Among 830 patients, LacTW > 1.975 mmo/L was found to be the cutoff threshold for predicting mortality (AUC = 0.646, P < 0.001). The following indexes related to organ dysfunction influenced LacTW: acute physiology and chronic health evaluation II (APACHE II) score (P < 0.001), activated partial thromboplastin time (APTT) (P = 0.002), total bilirubin (P = 0.012), creatinine (P = 0.037), with hypotension (P < 0.001), chronic kidney disease (P = 0.013), and required continuous renal replacement therapy (CRRT) (P < 0.001). Of the 394 patients in the low lactate group, age (P = 0.002), malignancy (P < 0.001), lactate dehydrogenase (P = 0.006), required treatment such as mechanical ventilation (P < 0.001), CRRT (P < 0.001), vasoactive drugs (P < 0.001), and glucocorticoid (P < 0.001), and failure to reach the target fluid resuscitation of 30 ml/kg within 6 hours (P = 0.003) were independently associated with hospital mortality. Conclusions Due to the lower incidence of early organ dysfunction, lactate levels are not increased or delayed in some septic shock patients in the early stage, thus affecting the alertness of clinicians and the timeliness and adequacy of fluid resuscitation, and finally affects the prognosis.
Collapse
|
7
|
Zhao L, Liu B, Wang Y, Wang Z, Xie K, Li Y. New Strategies to Optimize Hemodynamics for Sepsis-Associated Encephalopathy. J Pers Med 2022; 12:jpm12121967. [PMID: 36556188 PMCID: PMC9784429 DOI: 10.3390/jpm12121967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/07/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Sepsis-associated encephalopathy (SAE) is associated with high morbidity and mortality. Hemodynamic dysfunction plays a significant role in the incidence and mortality of SAE. Therefore, this study aimed to explore the relationship between hemodynamic indicators and SAE. Methods: 9033 patients with sepsis 3.0 were selected in a prospective study cohort. The LASSO regression model was used to select characteristic variables and remove the collinearity between them. In addition, a generalized additive model was used to find the optimal hemodynamic index value for patients with SAE. Multivariate logistic regression models, propensity matching scores, inverse probability weighting, and doubly robust estimation confirmed the reliability of the study results (i.e., the optimal hemodynamic indicators targeting patients with SAE). Results: A mean arterial pressure ≥ 65 mmHg, systolic blood pressure ≥ 90 mmHg, and lactate levels ≤ 3.5 mmol/L decrease the incidence of SAE, whereas a mean arterial pressure ≥ 59 mmHg and lactate levels ≤ 4.5 mmol/L decrease the 28-day mortality in patients with SAE. Conclusions: The hemodynamic indices of patients with SAE should be maintained at certain levels to reduce the incidence and mortality in patients with SAE, such that the mean arterial pressure is ≥65 mmHg, lactate levels are ≤3.5 mmol/L, and systolic blood pressure is ≥90 mmHg. These hemodynamic indicators should be targeted in patients with SAE.
Collapse
Affiliation(s)
- Lina Zhao
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Bin Liu
- Department of Emergency, Chongqing University Central Hospital, Chongqing Emergency Medical Center, No.1 Jiankang Road, Yuzhong District, Chongqing 400014, China
| | - Yunying Wang
- Department of Critical Care Medicine, Chifeng Municipal Hospital, Chifeng Clinical Medical College of Inner Mongolia Medical University, Chifeng 024000, China
| | - Zhiwei Wang
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Keliang Xie
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin 300052, China
- Department of Anesthesiology, Tianjin Institute of Anesthesiology, Tianjin Medical University General Hospital, Tianjin 300052, China
- Correspondence:
| | - Yun Li
- Department of Anesthesiology, Tianjin Institute of Anesthesiology, Tianjin Medical University General Hospital, Tianjin 300052, China
| |
Collapse
|
8
|
Guedes GV, Minicucci MF, Tanni SE. The supplementation of L-carnitine in septic shock patients: Systematic review and meta-analysis. Clinics (Sao Paulo) 2022; 77:100124. [PMID: 36327640 PMCID: PMC9636543 DOI: 10.1016/j.clinsp.2022.100124] [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: 06/23/2022] [Accepted: 09/30/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Sepsis and septic shock are severe and difficult-to-treat conditions with high lethality. There is interest in identifying new adjunct therapies that are effective in reducing mortality. In this context, L-carnitine has been investigated in trials as a potentially beneficial drug. Therefore, the aim of this systematic review was to assess the clinical evidence to support the use of L-carnitine in septic shock patients to reduce the risk of mortality. The objective of this review was to evaluate the effect of L-carnitine compared to placebo or Usual Care (UC) on the mortality rate in hospitalized adult septic shock patients. METHODS The authors exclusively included randomized clinical trials that compared the use of L-carnitine versus placebo in adult (> 18 years old) septic shock patients. The outcome was a mortality rate of 28 days. This systematic review and meta-analysis were performed following the PRISMA guidelines and registered in PROSPERO with the ID CRD42020180499. RESULTS Following the initial search, 4007 citations were identified, with 2701 remaining after duplicate removal. Eight citations were selected for body text reading, and two were selected for inclusion. The studies enrolled 275 patients, with 186 in the carnitine arm and 89 in the placebo arm. The effect of L-carnitine uses in septic shock patients showed a difference risk of -0.03 (95% Confidence Interval: -0.15-0.10, I2 = 77%, p = 0.69) compared to placebo/in mortality rate with low quality of evidence. CONCLUSIONS There is low-quality evidence that the use of L-carnitine has no significant effect on reducing 28-day mortality in septic shock patients.
Collapse
Affiliation(s)
- Gabriel Voltani Guedes
- Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil.
| | - Marcos Ferreira Minicucci
- Internal Medicine Department, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil
| | - Suzana Erico Tanni
- Internal Medicine Department, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil
| |
Collapse
|
9
|
Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Crit Care Med 2021; 49:e1063-e1143. [PMID: 34605781 DOI: 10.1097/ccm.0000000000005337] [Citation(s) in RCA: 831] [Impact Index Per Article: 277.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
10
|
Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, Machado FR, Mcintyre L, Ostermann M, Prescott HC, Schorr C, Simpson S, Wiersinga WJ, Alshamsi F, Angus DC, Arabi Y, Azevedo L, Beale R, Beilman G, Belley-Cote E, Burry L, Cecconi M, Centofanti J, Coz Yataco A, De Waele J, Dellinger RP, Doi K, Du B, Estenssoro E, Ferrer R, Gomersall C, Hodgson C, Møller MH, Iwashyna T, Jacob S, Kleinpell R, Klompas M, Koh Y, Kumar A, Kwizera A, Lobo S, Masur H, McGloughlin S, Mehta S, Mehta Y, Mer M, Nunnally M, Oczkowski S, Osborn T, Papathanassoglou E, Perner A, Puskarich M, Roberts J, Schweickert W, Seckel M, Sevransky J, Sprung CL, Welte T, Zimmerman J, Levy M. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med 2021; 47:1181-1247. [PMID: 34599691 PMCID: PMC8486643 DOI: 10.1007/s00134-021-06506-y] [Citation(s) in RCA: 1325] [Impact Index Per Article: 441.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 08/05/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Laura Evans
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA.
| | - Andrew Rhodes
- Adult Critical Care, St George's University Hospitals NHS Foundation Trust & St George's University of London, London, UK
| | - Waleed Alhazzani
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Massimo Antonelli
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | | | - Flávia R Machado
- Anesthesiology, Pain and Intensive Care Department, Federal University of São Paulo, Hospital of São Paulo, São Paulo, Brazil
| | | | | | - Hallie C Prescott
- University of Michigan and VA Center for Clinical Management Research, Ann Arbor, MI, USA
| | | | - Steven Simpson
- University of Kansas Medical Center, Kansas City, KS, USA
| | - W Joost Wiersinga
- ESCMID Study Group for Bloodstream Infections, Endocarditis and Sepsis, Division of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Fayez Alshamsi
- Department of Internal Medicine, College of Medicine and Health Sciences, Emirates University, Al Ain, United Arab Emirates
| | - Derek C Angus
- University of Pittsburgh Critical Care Medicine CRISMA Laboratory, Pittsburgh, PA, USA
| | - Yaseen Arabi
- Intensive Care Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Luciano Azevedo
- School of Medicine, University of Sao Paulo, São Paulo, Brazil
| | | | | | | | - Lisa Burry
- Mount Sinai Hospital & University of Toronto (Leslie Dan Faculty of Pharmacy), Toronto, ON, Canada
| | - Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University Pieve Emanuele, Milan, Italy.,Department of Anaesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - John Centofanti
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Angel Coz Yataco
- Lexington Veterans Affairs Medical Center/University of Kentucky College of Medicine, Lexington, KY, USA
| | | | | | - Kent Doi
- The University of Tokyo, Tokyo, Japan
| | - Bin Du
- Medical ICU, Peking Union Medical College Hospital, Beijing, China
| | - Elisa Estenssoro
- Hospital Interzonal de Agudos San Martin de La Plata, Buenos Aires, Argentina
| | - Ricard Ferrer
- Intensive Care Department, Vall d'Hebron University Hospital, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | | | - Carol Hodgson
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Morten Hylander Møller
- Department of Intensive Care 4131, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | | | - Shevin Jacob
- Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Michael Klompas
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Younsuck Koh
- ASAN Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Anand Kumar
- University of Manitoba, Winnipeg, MB, Canada
| | - Arthur Kwizera
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Suzana Lobo
- Intensive Care Division, Faculdade de Medicina de São José do Rio Preto, São Paulo, Brazil
| | - Henry Masur
- Critical Care Medicine Department, NIH Clinical Center, Bethesda, MD, USA
| | | | | | - Yatin Mehta
- Medanta the Medicity, Gurugram, Haryana, India
| | - Mervyn Mer
- Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mark Nunnally
- New York University School of Medicine, New York, NY, USA
| | - Simon Oczkowski
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Tiffany Osborn
- Washington University School of Medicine, St. Louis, MO, USA
| | | | | | - Michael Puskarich
- University of Minnesota/Hennepin County Medical Center, Minneapolis, MN, USA
| | - Jason Roberts
- Faculty of Medicine, University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Australia.,Department of Pharmacy, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | | | | | | | - Charles L Sprung
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Anesthesiology, Critical Care and Pain Medicine, Hadassah Medical Center, Jerusalem, Israel
| | - Tobias Welte
- Medizinische Hochschule Hannover and German Center of Lung Research (DZL), Hannover, Germany
| | - Janice Zimmerman
- World Federation of Intensive and Critical Care, Brussels, Belgium
| | - Mitchell Levy
- Warren Alpert School of Medicine at Brown University, Providence, Rhode Island & Rhode Island Hospital, Providence, RI, USA
| |
Collapse
|
11
|
Bozorgi F, Hedayatizadeh-Omran A, Alizadeh-Navaei R, Goli Khatir I, Amjadi O, Khademloo M, Banihashemi AA. Diagnostic value of serum lactate as a predictor and early outcome in multiple trauma patients. Chirurgia (Bucur) 2019. [DOI: 10.23736/s0394-9508.18.04916-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
12
|
Wentling J, Krall SP, McNierney A, Dewey K, Richman PB, Blow O. Predictive Value of Point-of-care Lactate Measurement in Patients Meeting Level II and III Trauma Team Activation Criteria that Present to the Emergency Department: A Prospective Study. J Emerg Trauma Shock 2019; 12:203-208. [PMID: 31543644 PMCID: PMC6735203 DOI: 10.4103/jets.jets_120_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background The aim of this study was to investigate the utility of early point-of-care (POC) lactate levels to help predict injury severity and ultimate emergency department (ED) disposition for trauma patients meeting Level II and III activation criteria. Methods This was a blinded, prospective cohort study including a convenience sample of patients meeting our triage criteria for Level II or III team activation with stable vital signs. Bedside lactate samples were collected during the secondary survey. Clinical care/disposition was at the discretion of physicians who remained blinded to the bedside lactate result. An elevated lactate was defined as >2.0 mmol/L. Results Ninety-six patients were in the study group; mean age was 41 ± 17 years, 26% were female, 57% were Hispanic, and 60% admitted. We found no difference in initial mean POC lactate levels (mmol/L) for admitted versus discharged groups and Injury Severity Score (ISS) ≥9 versus ISS <9 groups (3.71 [95% confidence interval (CI): 3.1-4.4] vs. 3.85 [95% CI: 2.8-4.9]; P = 0.99 and 3.54 [95% CI: 2.7-4.4] vs. 3.89 [95% CI: 3.1-4.6]; P = 0.60, respectively). Performance characteristics of early elevated lactate levels were poor both to predict need for hospital admission (sensitivity = 77% [65%-87%]; specificity = 26% [13%-43%]; negative predictive value [NPV] = 43% [27%-61%]; and positive predictive value [PPV] = 62% [56%-67%]) and to identify patients with ISS scores ≥9 (sensitivity = 76% [59%-89%]; specificity = 24% [14%-37%]; NPV = 65% [47%-80%]; and PPV = 36% [30%-41%]). Conclusions For Level II/III, we found that early bedside lactate levels were not predictive of ISS ≥9 or the need for admission. Level of Evidence III (diagnostic test).
Collapse
Affiliation(s)
- Jessica Wentling
- Department of Emergency Medicine, CHRISTUS Health/Texas A and M Health Science Center, Corpus Christi, TX, USA
| | - Scott P Krall
- Department of Emergency Medicine, CHRISTUS Health/Texas A and M Health Science Center, Corpus Christi, TX, USA
| | - Afton McNierney
- Department of Emergency Medicine, CHRISTUS Health/Texas A and M Health Science Center, Corpus Christi, TX, USA
| | - Kelly Dewey
- Department of Emergency Medicine, CHRISTUS Health/Texas A and M Health Science Center, Corpus Christi, TX, USA
| | - Peter B Richman
- Department of Emergency Medicine, CHRISTUS Health/Texas A and M Health Science Center, Corpus Christi, TX, USA
| | - Osbert Blow
- Department of Acute Care Surgery, Trauma and Surgical Critical Care, Christus Spohn Hospital, Corpus Christi, TX, USA
| |
Collapse
|
13
|
Berg E, Paukovits J, Axelband J, Trager J, Ryan D, Cichonski K, Kopnitsky M, Zweitzig D, Jeanmonod R. Measurement of a Novel Biomarker, Secretory Phospholipase A2 Group IIA as a Marker of Sepsis: A Pilot Study. J Emerg Trauma Shock 2018; 11:135-139. [PMID: 29937645 PMCID: PMC5994858 DOI: 10.4103/jets.jets_29_17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Introduction: Early identification of sepsis is critical as early treatment improves outcomes. We sought to identify threshold values of secretory phospholipase A2 (sPLA2)-IIA that predict sepsis and bacterial infection compared to nonseptic controls in an emergency department (ED) population. Materials and Methods: This is a prospective cohort of consenting adult patients who met two or more systemic inflammatory response syndrome (SIRS) criteria with clinical diagnosis of infectious source likely (septic patients). Controls were nonseptic consenting adults undergoing blood draw for other ED indications. Both groups had blood drawn, blind-coded, and sent to an outside laboratory for quantitative analysis of sPLA2-IIA levels. The study investigators reviewed patients’ inpatient medical record for laboratory, imaging, and microbiology results, as well as clinical course. Results: sPLA2-IIA levels were significantly lower in control patients as compared to septic patients (median = 0 ng/ml [interquartile range (IQR): 0–6.5] versus median = 123 ng/ml [IQR 44–507.75]; P < 0.0001). SPLA2-IIA levels were higher in patients with confirmed source (n = 28 patients, median = 186 ng/ml, 95% confidence interval = 115.1–516.8) as compared to those with no source identified or a viral source (n = 17, median = 68 ng/ml, 95% confidence interval = 38.1–122.7; P = 0.04). Using a cutoff value of 25 ng/ml, sPLA2-IIA had a sensitivity of 86.7% (confidence interval 72.5–94.5) and a specificity of 91.1% (confidence interval 77.9–97.1) in detecting sepsis. Conclusions: sPLA2-IIA shows potential as a biomarker distinguishing sepsis from other disease entities. Further study is warranted to identify predictive value of trends in sPLA-IIA during disease course in septic patients.
Collapse
Affiliation(s)
- Elena Berg
- Department of Emergency Medicine, St. Luke's University Health Network, Bethlehem, PA 18015, USA
| | - Janel Paukovits
- Department of Emergency Medicine, St. Luke's University Health Network, Bethlehem, PA 18015, USA
| | - Jennifer Axelband
- Department of Emergency Medicine, St. Luke's University Health Network, Bethlehem, PA 18015, USA
| | - Jonathan Trager
- Department of Emergency Medicine, St. Luke's University Health Network, Bethlehem, PA 18015, USA
| | - Dina Ryan
- Zeus Scientific Inc., Branchburg, NJ 08876, USA
| | | | | | | | - Rebecca Jeanmonod
- Department of Emergency Medicine, St. Luke's University Health Network, Bethlehem, PA 18015, USA
| |
Collapse
|
14
|
da Costa LGV, Carmona MJC, Malbouisson LM, Rizoli S, Rocha-Filho JA, Cardoso RG, Auler-Junior JOC. Independent early predictors of mortality in polytrauma patients: a prospective, observational, longitudinal study. Clinics (Sao Paulo) 2017; 72:461-468. [PMID: 28954004 PMCID: PMC5577616 DOI: 10.6061/clinics/2017(08)02] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 03/14/2017] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES: Trauma is an important public health issue and associated with substantial socioeconomic impacts and major adverse clinical outcomes. No single study has previously investigated the predictors of mortality across all stages of care (pre-hospital, emergency room, surgical center and intensive care unit) in a general trauma population. This study was designed to identify early predictors of mortality in severely injured polytrauma patients across all stages of care to provide a better understanding of the physiologic changes and mechanisms by which to improve care in this population. METHODS: A longitudinal, prospective, observational study was conducted between 2010 and 2013 in São Paulo, Brazil. Patients submitted to high-energy trauma were included. Exclusion criteria were as follows: injury severity score <16, <18 years old or insufficient data. Clinical and laboratory data were collected at four time points: pre-hospital, emergency room, and 3 and 24 hours after hospital admission. The primary outcome assessed was mortality within 30 days. Data were analyzed using tests of association as appropriate, nonparametric analysis of variance and generalized estimating equation analysis (p<0.05). ClinicalTrials.gov: NCT01669577. RESULTS: Two hundred patients were included. Independent early predictors of mortality were as follows: arterial hemoglobin oxygen saturation (p<0.001), diastolic blood pressure (p<0.001), lactate level (p<0.001), Glasgow Coma Scale score (p<0.001), infused crystalloid volume (p<0.015) and presence of traumatic brain injury (p<0.001). CONCLUSION: Our results suggest that arterial hemoglobin oxygen saturation, diastolic blood pressure, lactate level, Glasgow Coma Scale, infused crystalloid volume and presence of traumatic brain injury are independent early mortality predictors.
Collapse
Affiliation(s)
- Luiz Guilherme V. da Costa
- Divisao de Anestesiologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Grupo de Resgate e Atendimento as Urgencias (GRAU), Secretaria de Estado da Saude, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Maria José C. Carmona
- Divisao de Anestesiologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Luiz M. Malbouisson
- Divisao de Anestesiologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Sandro Rizoli
- University of Toronto Trauma and Acute Care Service, St Michael’s Hospital, Toronto, Canada
| | - Joel Avancini Rocha-Filho
- Divisao de Anestesiologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Ricardo Galesso Cardoso
- Grupo de Resgate e Atendimento as Urgencias (GRAU), Secretaria de Estado da Saude, Sao Paulo, SP, BR
| | - José Otávio C. Auler-Junior
- Divisao de Anestesiologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| |
Collapse
|
15
|
LIU WEI, PENG LIPING, HUA SHUCHENG. Clinical significance of dynamic monitoring of blood lactic acid, oxygenation index and C-reactive protein levels in patients with severe pneumonia. Exp Ther Med 2015; 10:1824-1828. [PMID: 26640556 PMCID: PMC4665687 DOI: 10.3892/etm.2015.2770] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Accepted: 02/26/2015] [Indexed: 01/07/2023] Open
Abstract
The aim of the present study was to analyze the clinical significance of the dynamic monitoring of blood lactic acid levels, the oxygenation index and C-reactive protein (CRP) levels in patients with severe pneumonia. The clinical data of 34 cases with severe pneumonia were collected. According to the clinical outcome, the patients were divided into a survival group (n=26) and a fatality group (n=8). Various factors, including the blood lactic acid level, oxygenation index, CRP level and acute physiology and chronic health evaluation II (APACHE II) score, were retrospectively analyzed in order to investigate whether these values had clinical significance for the prognosis of the patients. No statistically significant differences with regard to age, gender, initial concentrations of blood lactic acid and CRP, and APACHE II scores were observed between the two groups at admission to the Intensive Care Unit. However, the blood lactic acid levels were found to decrease to a normal level within 12-24 h after treatment in the survival group, while the levels were maintained at a higher concentration in the fatality group, even at 72 h after treatment (P<0.05). Furthermore, the oxygenation index in the survival group was significantly higher when compared with that in the fatality group. The oxygenation index was maintained at a normal level in the survival group, while the oxygenation index levels were below normal and continued to decline in the fatality group. A positive correlation was observed between the blood lactic acid level and the APACHE II scores (r=0.656, P<0.05). Therefore, the present study demonstrated that dynamic monitoring of blood lactic acid, oxygenation index and CRP levels in patients with severe pneumonia can be used to evaluate the therapeutic efficiency, in addition to serving as a prognosis indicator, for patients with severe pneumonia.
Collapse
Affiliation(s)
- WEI LIU
- Department of Respiration, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - LIPING PENG
- Department of Respiration, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - SHUCHENG HUA
- Department of Respiration, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| |
Collapse
|
16
|
Vera S, Martínez R, Gormaz JG, Gajardo A, Galleguillos F, Rodrigo R. Novel relationships between oxidative stress and angiogenesis-related factors in sepsis: New biomarkers and therapies. Ann Med 2015; 47:289-300. [PMID: 25998489 DOI: 10.3109/07853890.2015.1029967] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Sepsis is a systemic uncontrolled inflammatory response in the presence of an infection. It remains a major cause of morbidity and mortality in hospitalized patients. According to its severity, sepsis can progress to three different states: severe sepsis, septic shock, and multiple organ dysfunction syndrome, related to organ dysfunction and/or tissue hypoperfusion. Different processes underlie its pathophysiology; among them are oxidative stress, endothelial and mitochondrial dysfunction, and angiogenesis-related factors. However, no studies have integrated these elements in sepsis. The main difficulty in sepsis is its diagnosis. Currently, the potential of inflammatory biomarkers in septic patients remains weak. In this context, the research into new biomarkers is essential to aid with sepsis diagnosis and prognostication. Furthermore, even though the current management of severe forms of sepsis has been effective, morbimortality remains elevated. Therefore, it is essential to explore alternative approaches to therapy development. The aim of this review is to present an update of evidence supporting the role of oxidative stress and angiogenesis-related factors in the pathophysiology of the different forms of sepsis. It proposes a novel convergence between both elements in their role in the disease, and it will cover their utility as new diagnostic tools, predictors of outcome, and as novel therapeutic targets.
Collapse
Affiliation(s)
- Sergio Vera
- Laboratory of Oxidative Stress and Nephrotoxicity, Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile , Santiago , Chile
| | | | | | | | | | | |
Collapse
|
17
|
Pedersen M, Brandt VS, Holler JG, Lassen AT. Lactate level, aetiology and mortality of adult patients in an emergency department: a cohort study. Emerg Med J 2015; 32:678-84. [DOI: 10.1136/emermed-2014-204305] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 02/15/2015] [Indexed: 11/04/2022]
|
18
|
Kapoor D, Srivastava M, Singh P. Point of care blood gases with electrolytes and lactates in adult emergencies. Int J Crit Illn Inj Sci 2014; 4:216-22. [PMID: 25337483 PMCID: PMC4200547 DOI: 10.4103/2229-5151.141411] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Point-of-care testing (POCT) is one of the formidable concept introduce in the field of critical care settings to deliver decentralized, patient-centric health care to the patients. Rapid provision of blood measurements, particularly blood gases and electrolytes, may translate into improved clinical outcomes. Studies shows that POCT carries advantages of providing reduced therapeutic turnaround time (TTAT), shorter door-to-clinical-decision time, rapid data availability, reduced preanalytic and postanalytic testing errors, self-contained user-friendly instruments, small sample volume requirements, and frequent serial whole-blood testing. However, still there is a noticeable debate that exists among the laboratorians, clinicians, and administrators over concerns regarding analyzer inaccuracy, imprecision and performance (interfering substances), poorly trained non-laboratorians, high cost of tests, operator-dependent quality of testing, and difficulty in integrating test results with hospital information system (HIS). On search of literature using Medline/Pubmed and Embase using the key phrases "ppoint-of-care test," "central laboratory testing," "electrolytes," "blood gas analysis," "lactate," "emergency department," "intensive care unit," we found that POCT of blood gases and selected electrolytes may not entirely replace centralized laboratory testing but may transfigure the clinical practice paradigm of emergency and critical care physicians. We infer that further comprehensive, meaningful and rigorous evaluations are required to determine outcomes which are more quantifiable, closely related to testing events and are associated with effective cost benefits.
Collapse
Affiliation(s)
- Dheeraj Kapoor
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Meghana Srivastava
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Pritam Singh
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
| |
Collapse
|
19
|
Zhang Z, Chen K, Ni H, Fan H. Predictive value of lactate in unselected critically ill patients: an analysis using fractional polynomials. J Thorac Dis 2014; 6:995-1003. [PMID: 25093098 PMCID: PMC4120171 DOI: 10.3978/j.issn.2072-1439.2014.07.01] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 06/17/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Hyperlactatemia has long been associated with poor clinical outcome in varieties of intensive care unit (ICU) patients. However, the impact of temporal changes in lactate has not been well established and there are some shortcomings in model building in previous studies. The present study aims to investigate the association of initial lactate and normalization time with hazard by using fractional polynomial Cox proportional hazard model. METHODS A large clinical database named Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC-II) was employed for analysis. Demographics, comorbidities, laboratory findings were extracted and were compared between survivors and non-survivors by using univariable analysis. Cox proportional hazard model was built by purposeful selection of covariate with initial lactate (L0) and normalization time (T) remaining in the model. Best fit model was selected by using deviance difference test and comparisons between fractional polynomial regression models of different degrees were performed by using closed test procedure. MAIN RESULTS A total of 6,291 ICU patients were identified to be eligible for the present study, including 1,675 non-survivors and 4,616 survivors (mortality rate: 26.6%). Patients with lactate normalization had significantly reduced hazard rate as compared to those without normalization (log-rank test: P<0.05). The best powers of L0 in the model were -2 and -1 with the deviance of 19,944.51, and the best powers of T were 0.5 and 3 with the deviance of 7,965.63. The adjusted hazard ratio for the terms L0(-2) and L0(-1) were 1.13 (95% CI: 1.09-1.18) and 0.43 (95% CI: 0.34-0.54); and the adjusted hazard ratio for the terms T(0.5) and T(3) were 7.42 (95% CI: 2.85-19.36) and 3.06×10(-6) (95% CI: 3.01×10(-11)-0.31). CONCLUSIONS Initial lactate on ICU admission is associated with death hazard and the relationship follows a fractional polynomial pattern with the power of -2 and -1. Delayed normalization of lactate is predictive of high risk of death when it is measured within 150 hours after ICU admission.
Collapse
Affiliation(s)
- Zhongheng Zhang
- Department of Critical Care Medicine, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, Jinhua 321000, China
| | - Kun Chen
- Department of Critical Care Medicine, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, Jinhua 321000, China
| | - Hongying Ni
- Department of Critical Care Medicine, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, Jinhua 321000, China
| | - Haozhe Fan
- Department of Critical Care Medicine, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, Jinhua 321000, China
| |
Collapse
|
20
|
Biomarkers for sepsis: a review with special attention to India. BIOMED RESEARCH INTERNATIONAL 2014; 2014:264351. [PMID: 24772418 PMCID: PMC3977532 DOI: 10.1155/2014/264351] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 02/15/2014] [Indexed: 12/27/2022]
Abstract
Sepsis is a serious infection and still a common cause of morbidity and mortality in resource-limited settings such as India. Even when microbiologic diagnostics are available, bacteremia is only identified in a proportion of patients who present with sepsis and bloodstream infections. Biomarkers have been used in a variety of disease processes and can help aid in diagnosing bacterial infections. There have been numerous biomarkers investigated to aid with diagnosis and prognostication in sepsis with the majority suffering from lack of sensitivity or specificity. Procalcitonin has been heralded as the biomarker that holds the most promise for bloodstream infections. Data are emerging in India, and in this review, we focus on the current data of biomarkers in sepsis with particular attention to how biomarkers could be used to augment diagnosis and treatment in India.
Collapse
|
21
|
Steelman SM, Johnson P, Jackson A, Schulze J, Chowdhary BP. Serum metabolomics identifies citrulline as a predictor of adverse outcomes in an equine model of gut-derived sepsis. Physiol Genomics 2014; 46:339-47. [PMID: 24619519 DOI: 10.1152/physiolgenomics.00180.2013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Acute laminitis is an inflammatory disease of the equine foot that often occurs secondarily to sepsis or systemic inflammation associated with gastrointestinal disease. It has been suggested that laminitis is similar to multiple organ dysfunction syndrome in humans, although in horses the weight-bearing laminar epithelium of the foot appears to be the tissue most sensitive to insult and the first "organ" to fail. Metabolomics performed on serum samples collected before (Con) and after (Lmn) experimental induction of gastrointestinal-associated sepsis in six horses detected 1,177 metabolites of both mammalian and bacterial origin in equine serum. Network and correlation analyses suggested a dysregulation of fatty acid metabolism in the Lmn group, as well as an accumulation of organic acids such as lactate. Furthermore, concentrations of the amino acid citrulline were decreased in Lmn samples from all study animals, suggesting that citrulline might be useful as a biomarker to identify critically ill animals that are at risk of developing laminitis. We therefore established normal ranges of plasma citrulline concentrations in a separate group of horses (n = 36) and tested the ability of citrulline to predict adverse outcomes (laminitis or death) in critically ill horses (n = 23). Plasma citrulline was significantly lower in critically ill horses that went on to experience adverse outcomes (n = 6). Further study is required to accurately determine a diagnostic cutoff, but the present data are suggestive of the predictive value of citrulline as a biomarker for laminar failure in equine sepsis.
Collapse
Affiliation(s)
- Samantha M Steelman
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, Texas;
| | - Philip Johnson
- Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, Missouri; and
| | - Amy Jackson
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, Texas
| | | | - Bhanu P Chowdhary
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, Texas
| |
Collapse
|
22
|
Evans CR, Karnovsky A, Kovach MA, Standiford TJ, Burant CF, Stringer KA. Untargeted LC-MS metabolomics of bronchoalveolar lavage fluid differentiates acute respiratory distress syndrome from health. J Proteome Res 2013; 13:640-9. [PMID: 24289193 DOI: 10.1021/pr4007624] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Acute respiratory distress syndrome (ARDS) remains a significant hazard to human health and is clinically challenging because there are no prognostic biomarkers and no effective pharmacotherapy. The lung compartment metabolome may detail the status of the local environment that could be useful in ARDS biomarker discovery and the identification of drug target opportunities. However, neither the utility of bronchoalveolar lavage fluid (BALF) as a biofluid for metabolomics nor the optimal analytical platform for metabolite identification is established. To address this, we undertook a study to compare metabolites in BALF samples from patients with ARDS and healthy controls using a newly developed liquid chromatography (LC)-mass spectroscopy (MS) platform for untargeted metabolomics. Following initial testing of three different high-performance liquid chromatography (HPLC) columns, we determined that reversed phase (RP)-LC and hydrophilic interaction chromatography (HILIC) were the most informative chromatographic methods because they yielded the most and highest quality data. Following confirmation of metabolite identification, statistical analysis resulted in 37 differentiating metabolites in the BALF of ARDS compared with health across both analytical platforms. Pathway analysis revealed networks associated with amino acid metabolism, glycolysis and gluconeogenesis, fatty acid biosynthesis, phospholipids, and purine metabolism in the ARDS BALF. The complementary analytical platforms of RPLC and HILIC-LC generated informative, insightful metabolomics data of the ARDS lung environment.
Collapse
Affiliation(s)
- Charles R Evans
- Department of Internal Medicine, University of Michigan School of Medicine , Ann Arbor, Michigan, United States
| | | | | | | | | | | |
Collapse
|
23
|
Blood lactate concentration after exposure to conducted energy weapons (including TASER® devices): is it clinically relevant? Forensic Sci Med Pathol 2013; 9:386-94. [PMID: 23605975 DOI: 10.1007/s12024-013-9436-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2013] [Indexed: 10/26/2022]
Abstract
In previous studies, blood lactate concentration (BLac) consistently increased in anesthetized animals and in human subjects after exposures to TASER(®) conducted energy weapons (CEWs). Some have suggested the increased BLac would have detrimental consequences. In the current review, the following are evaluated: (a) the nature of muscle contractions due to CEWs, (b) general aspects of increased BLac, (c) previous studies of conventional neuromuscular electrical stimulation and CEW exposures, and (d) BLac in disease states. On the basis of these analyses, one can conclude that BLac, per se (independent of acidemia), would not be clinically relevant immediately after short-duration CEW applications, due to the short time course of any increase.
Collapse
|