Reappraisal of Sepsis-3 and CLIF-SOFA or Mortality in Patients With Cirrhosis and Infection Presenting to the Emergency Department: A Multicenter Study

Background/Aims

Sepsis-3 criteria and quick Sequential Organ Failure Assessment (qSOFA) have been advocated to be used in defining sepsis in the general population. We aimed to compare the Sepsis-3 criteria and Chronic Liver Failure-SOFA (CLIF-SOFA) scores as predictors of in-hospital mortality in cirrhotic patients admitted to the emergency department (ED) for infections.

Methods

A total of 1,622 cirrhosis patients admitted at the ED for infections were assessed retrospectively. We analyzed their demographic, laboratory, and microbiological data upon diagnosis of the infection. The primary endpoint was inhospital mortality rate. The predictive performances of baseline CLIF-SOFA, Sepsis-3, and qSOFA scores for in-hospital mortality were evaluated.

Results

The CLIF-SOFA score proved to be significantly better in predicting in-hospital mortality (area under the receiver operating characteristic curve [AUROC], 0.80; 95% confidence interval [CI], 0.78–0.82) than the Sepsis-3 (AUROC, 0.75; 95% CI, 0.72–0.77, P<0.001) and qSOFA (AUROC, 0.67; 95% CI, 0.64–0.70; P<0.001) score. The CLIF-SOFA, CLIF-C-AD scores, Sepsis-3 criteria, septic shock, and qSOFA positivity were significantly associated with in-hospital mortality (adjusted hazard ratio [aHR], 1.24; 95% CI, 1.19–1.28; aHR, 1.13; 95% CI, 1.09–1.17; aHR, 1.19; 95% CI, 1.15–1.24; aHR, 1.88; 95% CI, 1.42–2.48; aHR, 2.06; 95% CI, 1.55–2.72; respectively; all P<0.001). For CLIF-SOFA scores ≥6, in-hospital mortality was >10%; this is the cutoff point for the definition of sepsis.

Conclusions

Among cirrhosis patients presenting with infections at the ED, CLIF-SOFA scores showed a better predictive performance for mortality than both Sepsis-3 criteria and qSOFA scores, and can be a useful tool of risk stratification in cirrhotic patients requiring timely intervention for infection.

Effect of Different Processing Methods on the Accumulation of the Phenolic Compounds and Antioxidant Profile of Broomcorn Millet (Panicum miliaceum L.) Flour

Broomcorn millet (Panicum miliaceum L.) is an important nutritious ancient minor-cereal food crop. However, this crop is little explored in the food processing arena to improve its functionality. In this context, different processing methods were applied to enhance the secondary compounds of broomcorn millet. Four different individual methods such as roasting, steaming, puffing, and extrusion were applied at 110 °C to enhance the functional attributes of millet flour. It was observed that the significantly highest content of total phenolic (TP) (670 mg/100 g of ferulic acid equivalent) and total flavonoid (TF) (391 mg/100 g of rutin equivalent ) was attained in the roasted whole millet followed by steaming (315 mg/100 g, 282 mg/100 g), puffing (645 mg/100 g, 304 mg/100 g), extrusion (455 mg/100 g, 219 mg/100 g), and control (295 mg/100 g, 183 mg/100 g). The chromatographic analysis showed a greater content of single phenolic acids such as syringic acid, gallic acid, 4-hydroxy benzoic acid, ferulic acid, sinapic acid, and catechin in roasted millet compared to control, and the content of each acid was higher in whole millet than dehulled. Results also indicated that the content of ferulic acid was relatively higher among the quantified single phenolic acid from broomcorn millet. Likewise, in comparison with dehulled millet, the roasted whole millet showed higher total antioxidant capacity, measured by the 2,2-diphenyl-1 picryl hydrazyl (DPPH), the ferric reducing antioxidant power assay (FRAP), the phosphomolybdenum method (PPMD), and the hydroxyl radical scavenging capacity (HRSC) method. Lastly, it is concluded that the roasting method should be taken into consideration in the processing of broomcorn millet to enhance the content of nutraceutical compounds and improve its functionality.

Rational Design of Low Cost and High Energy Lithium Batteries through Tailored Fluorine-free Electrolyte and Nanostructured S/C Composite

We report a new Li-S cell concept based on an optimized F-free catholyte solution and a high loading nanostructured C/S composite cathode. The Li₂ S₈ present in the electrolyte ensures both buffering against active material dissolution and Li⁺ conduction. The high S loading is obtained by confining elemental S (≈80 %) in the pores of a highly ordered mesopores carbon (CMK3). With this concept we demonstrate stabilization of a high energy density and excellent cycling performance over 500 cycles. This Li-S cell has a specific capacity that reaches over 1000 mA h g^-1 , with an overall S loading of 3.6 mg cm^-2 and low electrolyte volume (i.e., 10 μL cm^-2 ), resulting in a practical energy density of 365 Wh kg^-1 . The Li-S system proposed thus meets the requirements for large scale energy storage systems and is expected to be environmentally friendly and have lower cost compared with the commercial Li-ion battery thanks to the removal of both Co and F from the overall formulation.

Unsuccessful switch from insulin to sulfonylurea therapy in permanent neonatal diabetes mellitus due to an R201H mutation in the KCNJ11 gene: a case report

Mutations in KCNJ11 are a common cause of permanent neonatal diabetes mellitus. Previously, all patients carrying an R201H mutation in the KCNJ11 gene showed successful switches from insulin to sulfonylurea. Here, we report an unsuccessful switch in an 18-year-old patient carrying the common R201H mutation in the KCNJ11 gene.

Papillary fibroelastoma of the aortic valve with atypical chest pain: late presentation with acute myocardial infarction and cardiac arrest

We report a case of a 54-year-old female with papillary fibroelastoma of the aortic valve who presented with ST-elevation myocardial infarction and cardiac arrest. Though her initial symptom was only atypical chest pain, life-threatening complications such as acute myocardial infarction and cardiac arrest developed. After cardiopulmonary resuscitation, we promptly resected the fibroelastoma on cardiopulmonary bypass, and the patient was discharged without any other complications.