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1.
Crit Care ; 24(1): 57, 2020 02 18.
Artículo en Inglés | MEDLINE | ID: mdl-32070393

RESUMEN

BACKGROUND: Persistent critical illness is common in critically ill patients and is associated with vast medical resource use and poor clinical outcomes. This study aimed to define when patients with sepsis would be stabilized and transitioned to persistent critical illness, and whether such transition time varies between latent classes of patients. METHODS: This was a retrospective cohort study involving sepsis patients in the eICU Collaborative Research Database. Persistent critical illness was defined at the time when acute physiological characteristics were no longer more predictive of in-hospital mortality (i.e., vital status at hospital discharge) than antecedent characteristics. Latent growth mixture modeling was used to identify distinct trajectory classes by using Sequential Organ Failure Assessment score measured during intensive care unit stay as the outcome, and persistent critical illness transition time was explored in each latent class. RESULTS: The mortality was 16.7% (3828/22,868) in the study cohort. Acute physiological model was no longer more predictive of in-hospital mortality than antecedent characteristics at 15 days after intensive care unit admission in the overall population. Only a minority of the study subjects (n = 643, 2.8%) developed persistent critical illness, but they accounted for 19% (15,834/83,125) and 10% (19,975/198,833) of the total intensive care unit and hospital bed-days, respectively. Five latent classes were identified. Classes 1 and 2 showed increasing Sequential Organ Failure Assessment score over time and transition to persistent critical illness occurred at 16 and 27 days, respectively. The remaining classes showed a steady decline in Sequential Organ Failure Assessment scores and the transition to persistent critical illness occurred between 6 and 8 days. Elevated urea-to-creatinine ratio was a good biochemical signature of persistent critical illness. CONCLUSIONS: While persistent critical illness occurred in a minority of patients with sepsis, it consumed vast medical resources. The transition time differs substantially across latent classes, indicating that the allocation of medical resources should be tailored to different classes of patients.


Asunto(s)
Enfermedad Crítica , Recursos en Salud , Unidades de Cuidados Intensivos , Sepsis , Anciano , Estudios de Cohortes , Enfermedad Crítica/clasificación , Bases de Datos Factuales , Femenino , Mortalidad Hospitalaria , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Puntuaciones en la Disfunción de Órganos , Alta del Paciente , Estudios Retrospectivos , Sepsis/clasificación , Sepsis/diagnóstico , Sepsis/terapia
2.
Medicine (Baltimore) ; 99(5): e18942, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32000414

RESUMEN

This study analyzed independent risk factors that could improve the qSOFA scoring system among sepsis patients.This retrospective study evaluated 821 patients (2015-2016) who fulfilled the 2001 International Sepsis Definitions Conference diagnostic criteria. Patients were classified based on their survival outcomes after 28 days, and the predictive values of various predictive scores at admission were compared.The independent risk factors for 28-day mortality were fibrinogen, plasma lactic acid, albumin, oxygenation index, and procalcitonin level >0.5 ng/mL (all P < .05). The "PqSOFA" score combined the qSOFA score with procalcitonin, which provided an area under the curve value of 0.751 (95% CI: 0.712-0.790) for predicting 28-day mortality. A cut-off score of 2 points provided sensitivity of 83.2%, specificity of 54.9%, negative predictive value (NPV) of 33.03%, positive predictive value (PPV) of 92.47%, positive-likelihood ratio (PLR) of 1.85, and negative-likelihood ratio (NLR) of 0.31. The area under the curve for predicting 28-day mortality was significantly greater for the PqSOFA score than for the qSOFA score (Z = 7.019, P < .0001). The PqSOFA score was comparable to the SOFA and APACHE II scores.The PqSOFA score independently predicted poor short-term outcomes among high-risk sepsis patients.


Asunto(s)
Sepsis/diagnóstico , Enfermedad Aguda , Estudios Transversales , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Curva ROC , Estudios Retrospectivos , Factores de Riesgo , Sepsis/mortalidad , Sepsis/terapia , Índice de Severidad de la Enfermedad
3.
Medicine (Baltimore) ; 99(4): e18961, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31977913

RESUMEN

This study explored whether sympathovagal modulation assessed through frequency domains of heart rate variability (HRV) can indicate sepsis in patients with suspected infection.In total, 370 consecutive adult patients with suspected infection admitted to the emergency department were enrolled in this single-center cohort study. A continuous 10-minute electrocardiography for HRV analysis was recorded immediately for these patients after inclusion. Patients were stratified into non-sepsis and sepsis groups based on a sepsis-related organ failure assessment score of ≥2 that met the Third International Consensus Definitions for Sepsis. Seven frequency domains of HRV were compared between these 2 groups.Compared with the non-sepsis group (n = 98), the sepsis group (n = 272) had a significantly lower incidence of respiratory tract infection, higher total power, higher very-low-frequency component, higher high-frequency (HF) component, higher normalized HF component, lower normalized low-frequency (LF) component, and lower LF component/HF component ratio (LF/HF). Multiple logistic regression model identified HF component (odds ratio [OR] = 0.994; 95% confidence interval [CI], 0.990-0.999) and LF/HF (OR = 0.494; 95% CI, 0.423-0.578) as significant variables associated with sepsis. The area under receiver operating characteristic curves of HF component and LF/HF was 0.741 (95% CI, 0.685-0.797) and 0.930 (95% CI, 0.900-0.960), respectively, in identifying sepsis in patients with suspected infection.Tilted sympathovagal balance toward increased vagal activity and depressed sympathetic modulation, assessed by the HF component and LF/HF, may indicate sepsis in patients with suspected infection.


Asunto(s)
Frecuencia Cardíaca , Sepsis/diagnóstico , Nervio Vago/fisiopatología , Anciano , Estudios de Casos y Controles , Electrocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Puntuaciones en la Disfunción de Órganos , Estudios Prospectivos , Sensibilidad y Especificidad , Sepsis/fisiopatología
4.
Zhongguo Dang Dai Er Ke Za Zhi ; 22(1): 1-6, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31948515

RESUMEN

Preterm infants are at higher risk of developing early-onset sepsis (EOS). Due to non-specific clinical manifestations and lack of laboratory tests for prompt diagnosis of EOS, inappropriate use of antibiotics is common in preterm infants. Prolonged exposure to antibiotics can lead to antibiotic resistance and significantly increases the risk of mortality and morbidity. Based on the latest progress in the diagnosis and treatment for EOS, both in China and overseas, and considering the current condition in Hunan Province, the expert panel of neonatologists in Hunan have reached this consensus after many discussions. This consensus clarifies the risk factors, proposes the diagnostic criteria, and recommends the antibiotic use strategies for EOS in preterm infants. It is emphasized that blood culture results and clinical manifestations are the main basis for the diagnosis of EOS and the duration of antibiotics use in preterm infants.


Asunto(s)
Recien Nacido Prematuro , Sepsis , Edad de Inicio , Antibacterianos , China , Consenso , Humanos , Recién Nacido , Factores de Riesgo , Sepsis/diagnóstico , Sepsis/tratamiento farmacológico
5.
Hu Li Za Zhi ; 67(1): 12-18, 2020 Feb.
Artículo en Chino | MEDLINE | ID: mdl-31960392

RESUMEN

Sepsis is a significant cause of morbidity and mortality worldwide. Early diagnosis and management of sepsis is critical to improving patient prognoses. Surviving sepsis campaign guidelines issued in 2016 encourage health institutions to establish a screening system to identify patients who are at risk of sepsis. In 2012, the Royal College of Physicians in the UK began to advocate replacing local and regional scoring systems with the National Early Warning Score (NEWS), which is optimized for the identification of sepsis. Although many hospitals continue to use other scoring systems, all healthcare organizations are being encouraged to adopt a standardized scoring system to better promote patient safety by facilitating rapid diagnoses and screenings and thus, subsequently, improving decision-making by clinical staffs. NEWS plays a very important role in the treatment of sepsis patients. Although research findings related to this scoring system differ somewhat, they provide an important reference for clinical nursing staffs. Intelligent systems are not comprehensive in terms of their capabilities. However, combining human intelligence with system features and further optimizing the system should contribute significantly to the reduction of mortality risk in patients with sepsis.


Asunto(s)
Sepsis/diagnóstico , Humanos
6.
J Surg Res ; 246: 490-498, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31635838

RESUMEN

BACKGROUND: Burn patients are at high risk of infection, and as sepsis contributes significantly to morbidity and mortality, early diagnosis is essential. Procalcitonin (PCT) is a biomarker released in response to inflammation and specifically bacterial infection. This study aimed to determine the value of PCT as a diagnostic biomarker of sepsis in burns patients in Johannesburg, South Africa. MATERIALS AND METHODS: All adult patients admitted to two burns intensive care units in Johannesburg over a 3-year study period were included in a retrospective data review. Records of 178 patients were accessible and reviewed. RESULTS: The most significant risk factor for sepsis was percentage total body surface area burned (P = 0.012). A rise in PCT was a significant biomarker for bacterial infection in the early phase after a burn (P = 0.03) but not after day eight. PCT correlated with C-reactive protein as a biomarker for sepsis (P < 0.001), but not with other biomarkers. The mean PCT in patients who died was significantly higher on every study day until death compared with those who remained alive (P < 0.02, consistently). Patients on inotropes also had a significantly increased PCT level (P = 0.0001), as did those who were not discharged from intensive care unit by day 14. CONCLUSIONS: PCT may be useful as an adjunct biomarker of infection in burn patients and has potential as a predictive biomarker of early discharge.


Asunto(s)
Quemaduras/complicaciones , Polipéptido alfa Relacionado con Calcitonina/sangre , Sepsis/diagnóstico , Adulto , Biomarcadores/sangre , Quemaduras/sangre , Quemaduras/diagnóstico , Proteína C-Reactiva/análisis , Femenino , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Persona de Mediana Edad , Alta del Paciente/estadística & datos numéricos , Estudios Retrospectivos , Factores de Riesgo , Sepsis/sangre , Sepsis/etiología , Sudáfrica , Adulto Joven
7.
Scand J Immunol ; 91(1): e12813, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31386235

RESUMEN

BACKGROUND: Sepsis is a life-threatening disease that is an immune disorder response that causes multiple organ dysfunction. In this study, we investigated the dynamic changes in mRNA expression of HLA-DRA gene and the specific transcription factor of helper T cell subsets to explore long-term immunophenotyping and its relationship with prognosis. METHODS: Seventy-eight sepsis patients and twelve healthy controls were recruited in this study. Blood samples were collected at eight-time points during their septic course and were assayed for the gene expression of HLA-DRA and T helper cell subset-specific transcription factors (T-bet: Th1, GATA3: Th2, Foxp3: Treg, RORC: Th17). RESULTS: The levels of HLA-DRA in survivors gradually increased but were maintained at lower levels in non-survivors. The specific transcription factor of Th1 and Th2 cells, T-bet and GATA-3 were significantly lower in sepsis patients than in normal controls, and the non-survivors showed significantly lower levels than the survivors (P < .05). RORC and FOXP3, the specific transcription factor of Treg and Th17 were significantly higher in survivors than in non-survivors and normal controls (P < .05). T-bet and GATA-3 had a linear correlation with HLA-DRA expression (P < .01). CONCLUSIONS: The dynamic changes in HLA-DRA expression in peripheral blood could accurately reflect the immune status of sepsis patients, and the reduction in HLA-DRA may be an important reason for abnormal T cell differentiation. The sustained low levels of the Th cell subsets (Th1 and Th2) suggest the suppression of adaptive immunity, and this persistent immunosuppression may be the leading cause of death in septic patients.


Asunto(s)
Regulación de la Expresión Génica , Cadenas alfa de HLA-DR/genética , Sepsis/etiología , Linfocitos T Colaboradores-Inductores/inmunología , Linfocitos T Colaboradores-Inductores/metabolismo , Adulto , Anciano , Biomarcadores , Estudios de Casos y Controles , Comorbilidad , Femenino , Humanos , Huésped Inmunocomprometido , Masculino , Persona de Mediana Edad , Evaluación del Resultado de la Atención al Paciente , Sepsis/diagnóstico , Sepsis/mortalidad , Subgrupos de Linfocitos T/inmunología , Subgrupos de Linfocitos T/metabolismo
8.
Gene ; 722: 144127, 2020 Jan 05.
Artículo en Inglés | MEDLINE | ID: mdl-31525397

RESUMEN

Complement factor H (CFH) serves as a major down-regulator in the complement system, often utilized by bacterial pathogens to evade complement attack. Yet, little is currently known about the genetic correlation of CFH polymorphisms with sepsis due to various microbial infections. A case-control method (488 septic patients and 527 healthy individuals) was carried out in this study to investigate the genetic relationship between CFH polymorphisms (rs3753394 C/T, rs1065489 G/T and rs1061170 C/T) and susceptibility to sepsis caused by bacterial infections in Chinese Han populations. Our findings indicated that the frequency of rs3753394 CT/TT genotype in the septic patients with P. aeruginosa was significantly higher than that in the control individuals (P = 0.033, OR = 2.668, 95%CI = 1.072-6.334). The rs3753394 T allele frequency in the P. aeruginosa-infected patients was significantly increased, compared to that in the healthy controls (P = 0.014, OR = 1.68, 95%CI = 1.118-2.538). Moreover, these significant differences of rs3753394 genotype and allele frequencies remained after multiple testing corrections [P (corr.) = 0.033 for genotype; P (corr.) = 0.033 for allele]. The current study highlighted the significance of CFH polymorphism rs3753394 as a potential biomarker for targeting P. aeruginosa infection in critically ill patients.


Asunto(s)
Predisposición Genética a la Enfermedad , Infecciones por Pseudomonas/genética , Pseudomonas aeruginosa , Sepsis/genética , Adulto , Anciano , Grupo de Ascendencia Continental Asiática/genética , Estudios de Casos y Controles , China/etnología , Factor H de Complemento/genética , Frecuencia de los Genes , Genotipo , Humanos , Masculino , Persona de Mediana Edad , Infecciones por Pseudomonas/diagnóstico , Infecciones por Pseudomonas/etnología , Sepsis/diagnóstico , Sepsis/etnología , Sepsis/microbiología
9.
Biochem Med (Zagreb) ; 30(1): 010501, 2020 Feb 15.
Artículo en Inglés | MEDLINE | ID: mdl-31839719

RESUMEN

The current scenario of in vitro and in vivo diagnostics can be summarized using the "silo metaphor", where laboratory medicine, pathology and radiology are three conceptually separated diagnostic disciplines, which will increasingly share many comparable features. The substantial progresses in our understanding of biochemical-biological interplays that characterize many human diseases, coupled with extraordinary technical advances, are now generating important multidisciplinary convergences, leading the way to a new frontier, called integrated diagnostics. This new discipline, which is currently defined as convergence of imaging, pathology and laboratory tests with advanced information technology, has an enormous potential for revolutionizing diagnosis and therapeutic management of human diseases, including those causing the largest number of worldwide deaths (i.e. cardiovascular disease, cancer and infectious diseases). However, some important drawbacks should be overcome, mostly represented by insufficient information technology infrastructures, costs and enormous volume of different information that will be integrated and delivered. To overcome these hurdles, some specific strategies should be defined and implemented, such as planning major integration of exiting information systems or developing innovative ones, combining bioinformatics and imaging informatics, using health technology assessment for assessing cost and benefits, providing interpretative comments in integrated reports, developing and using expert systems and neural networks, overcoming cultural and political boundaries for generating multidisciplinary teams and integrated diagnostic algorithms.


Asunto(s)
Enfermedades Cardiovasculares/diagnóstico , Neoplasias/diagnóstico , Sepsis/diagnóstico , Biomarcadores/análisis , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Humanos , Subunidad beta de la Proteína de Unión al Calcio S100/metabolismo , Tomografía , Troponina/análisis
10.
J Pharm Biomed Anal ; 177: 112883, 2020 Jan 05.
Artículo en Inglés | MEDLINE | ID: mdl-31546136

RESUMEN

The article is devoted to the application of modern sample preparation technique - microextraction by packed sorbent (MEPS) - in conjunction with non-conventional type of sorbent - hypercrosslinked polystyrene, that was investigated for the first time in this work. Their combination was used to extract phenylcarboxylic acid-type aromatic microbial metabolites from serum samples of a healthy volunteer with following derivatization and GC-MS detection. As barrel insert and needle for MEPS with hypercrosslinked polystyrene is not produced, we designed a device to imitate the commercial MEPS system with packed granular biporous hypercrosslinked polystyrene. Nine aromatic microbial metabolites, including sepsis associated phenyllactic, 4-hydroxyphenyllactic and 4-hydroxyphenylacetic acids, were extracted from serum samples (recoveries were 20-70%) and a linear dependence was revealed in the most clinically significant range of concentrations (0.5-18 µM). The results obtained demonstrate the perspective of the applying of hypercrosslinked polystyrene in commercial devices for MEPS for the future analyses of biological samples, in particular for the early diagnosis of sepsis and treatment effectiveness control.


Asunto(s)
Bacterias/metabolismo , Fenilacetatos/sangre , Poliestirenos/química , Sepsis/diagnóstico , Microextracción en Fase Sólida/métodos , Reactivos de Enlaces Cruzados/química , Cromatografía de Gases y Espectrometría de Masas/métodos , Voluntarios Sanos , Humanos , Límite de Detección , Fenilacetatos/metabolismo , Sepsis/sangre , Sepsis/microbiología
11.
Artículo en Inglés, Portugués | LILACS, BDENF - Enfermería | ID: biblio-1051214

RESUMEN

Objetivo: avaliar o impacto da sensibilização no setor e adesão ao protocolo de sepse em unidade de tocoginecologia. Método: Trata-se de uma pesquisa-ação no período de janeiro a março/2016, com 63 profissionais que trabalham em unidade de tocoginecologia de um hospital de alta complexidade. Resultados: 51% dos profissionais receberam o treinamento sobre o protocolo de sepse e após, 50% dos pacientes que tinham critérios de SIRS foram incluídos no protocolo de sepse, sendo que o desfecho de 03 destas, foi alta hospitalar e 02 foram transferidas para UTI devido sepse grave. O tempo médio de administração do antibiótico foi 50 minutos, da solicitação do hemograma foi 46,25 minutos e do resultado do lactato foi acima de 30 minutos. Conclusão: Ainda há necessidade de melhoria em relação à adesão pela equipe de Enfermagem para implantação de medidas de combate à sepse


Objective: to evaluate the impact of the sensitization in the sector and adherence to the protocol of sepsis in a unit of tocoginecology. Method: This is an action research from January to March/2016, with 63 professionals working in a tocoginecology unit of a highly complex hospital. Results: 51% of the professionals received training on the sepsis protocol and after that, 50% of the patients who had SIRS criteria were included in the sepsis protocol, and the outcome of 03 of these was hospital discharge and 02 were transferred to the ICU Due to severe sepsis. The mean time of administration of the antibiotic was 50 minutes, the request of the blood count was 46.25 minutes and the result of the lactate was over 30 minutes. Conclusion: There is still a need for improvement regarding adherence by the Nursing team to implement measures to combat sepsis


Objetivo: evaluar el impacto de la sensibilización en el sector y la adhesión al protocolo de sepsis en unidad de tocoginecología. Método: Se trata de una investigación-acción en el período de enero a marzo/2016, con 63 profesionales que trabajan en unidad de tocoginecología de un hospital de alta complejidad. Resultados: 51% de los profesionales recibieron el entrenamiento sobre el protocolo de sepsis y después, 50% de los pacientes que tenían criterios de SIRS fueron incluidos en el protocolo de sepsis, siendo el desenlace de 03 de ellas, fue alta hospitalaria y 02 fueron transferidas a UTI Debido a la sepse grave. El tiempo promedio de administración del antibiótico fue de 50 minutos, de la solicitud del hemograma fue 46,25 minutos y el resultado del lactato fue de más de 30 minutos. Conclusión: Aún hay necesidad de mejora en relación a la adhesión por el equipo de Enfermería para implantación de medidas de combate a la sepsis


Asunto(s)
Humanos , Masculino , Femenino , Embarazo , Adulto , Persona de Mediana Edad , Sepsis/diagnóstico , Sepsis/prevención & control , Tecnología Educacional , Obstetricia/educación , Grupo de Atención al Paciente , Protocolos/métodos
12.
Vasc Health Risk Manag ; 15: 509-516, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31806982

RESUMEN

Introduction: The main pathophysiology of sepsis is considered to be circulation crisis with an imbalance of vasodilation and vasoconstriction mechanisms, which contributes to multiple organ failure. However, sepsis-induced hemodynamic changes have not been fully validated by novel arterial stiffness parameter. The aim of this study was to clarify the acute vascular alteration and hemodynamic change in sepsis using cardio-ankle-vascular index (CAVI). Methods: Twenty-one Japanese patients (14 males and 7 females, age 62.8 ± 19.0 years) with sepsis were recruited. CAVI was measured before and 1-week after sepsis treatment. Results: The leading underlying cause of sepsis was pyelonephritis, followed by pneumonia, lung abscess, hepatic abscess and cholecystitis. All subjects recovered from sepsis. Analysis of all subjects showed a significant increase in CAVI after 1-week treatment (7.9 ± 2.4 to 9.6 ± 1.8, P < 0.001), but no significant change in blood pressure (BP) was observed. Significant correlations were observed for all combinations among the change in CAVI, systolic BP and ln[procalcitonin (PCT)], respectively. Additionally, in subjects with PCT at presentation ≥2.0 ng/mL, the increase in CAVI after treatment was significantly greater compared to those with PCT < 2.0 ng/mL (2.4 ± 1.6 vs 1.1 ± 0.9, P = 0.037). Discussion: CAVI may reflect sepsis-induced vascular alteration which is not indicated by BP change, and is associated with sepsis severity. These findings suggest the usefulness of CAVI in the management of circulatory failure in sepsis patients.


Asunto(s)
Hemodinámica , Sepsis/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Recuperación de la Función , Sepsis/fisiopatología , Sepsis/terapia , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del Tratamiento , Rigidez Vascular
13.
Medicine (Baltimore) ; 98(52): e18546, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31876752

RESUMEN

OBJECTIVE: The predictive accuracies of procalcitonin (PCT) in the diagnosis of catheter-associated bloodstream infection (CABSI) vary widely. This meta-analysis aimed to explore the predictive value of PCT for CABSI. METHODS: We searched PubMed, EMBase, Web of Science, ScienceDirect, Cochrane Library, and studies published up to 10 March 2019. Odds ratios (ORs) with 95% confidence intervals (95%CIs) were calculated to evaluate PCT predictive value using Stata 14.0 software. RESULTS: The meta-analysis was composed of 7 studies, consisting of 347 subjects. Pooled analysis demonstrated that a high PCT was significantly correlated with CABSI (pooled OR = 23.36, 95%CI 12.43-43.91, P < .001) and medium heterogenicity (I = 36.9%, P = .147). The pooled sensitivity and specificity were 85% (95%CI 0.76-0.91) and 89% (95%CI 0.68-0.97), respectively. Although Begg funnel plot (P = .007) indicated the presence of publication bias among the included studies, the stability of the pooled outcomes was verified by the trim-and-fill method. Furthermore, sensitivity analyses did not show important differences in effect estimation. CONCLUSION: PCT is an effective predictor of CABSI. However, high-quality randomized controlled trials are needed to determine whether PCT could predict CABSI.


Asunto(s)
Infecciones Relacionadas con Catéteres/sangre , Polipéptido alfa Relacionado con Calcitonina/sangre , Sepsis/sangre , Biomarcadores/sangre , Infecciones Relacionadas con Catéteres/diagnóstico , Humanos , Valor Predictivo de las Pruebas , Sepsis/diagnóstico , Sepsis/etiología
14.
Scand J Trauma Resusc Emerg Med ; 27(1): 98, 2019 Nov 04.
Artículo en Inglés | MEDLINE | ID: mdl-31685006

RESUMEN

BACKGROUND: Sepsis is defined as a life-threatening organ dysfunction due to a dysregulated inflammation following an infection. However, the impact of this definition on patient care is not fully clear. This study investigated the impact of the current definition on ICU admission of patients with infection. METHODS: We performed a prospective observational study over twelve months on consecutive patients presented to our emergency department and admitted for infection. We analyzed the predictive values of the quick sequential organ failure assessment (qSOFA) score, the SOFA score and blood lactate regarding ICU admission. RESULTS: We included 916 patients with the diagnosis of infection. Median age was 74 years (IQR 62-82 years), and 56.3% were males. There were 219 direct ICU admissions and 697 general ward admissions. A qSOFA score of ≥2 points had 52.9% sensitivity and 98.3% specificity regarding sepsis diagnosis. A qSOFA score of ≥2 points had 87.2% specificity but only 39.9% sensitivity to predict ICU admission. A SOFA score of ≥2 points had 97.4% sensitivity, but only 17.1% specificity to predict ICU admission, while a SOFA score of ≥4 points predicted ICU admission with 82.6% sensitivity and 71.7% specificity. The area under the receiver operating curve regarding ICU admission was 0.81 (95 CI, 0.77-0.86) for SOFA score, 0.55 (95% CI, 0.48-0.61) for blood lactate, and only 0.34 (95% CI, 0.28-0.40) for qSOFA on emergency department presentation. CONCLUSIONS: While a positive qSOFA score had a high specificity regarding ICU admission, the low sensitivity of the score among septic patients as well as among ICU admissions considerably limited its value in routine patient management. The SOFA score was the better predictor of ICU admission, while the predictive value of blood lactate was equivocal.


Asunto(s)
Hospitalización/estadística & datos numéricos , Unidades de Cuidados Intensivos , Sepsis/diagnóstico , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Puntuaciones en la Disfunción de Órganos , Pronóstico , Estudios Prospectivos , Curva ROC
15.
Medicine (Baltimore) ; 98(44): e17744, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31689826

RESUMEN

Congenital syphilis (CS) can cause serious impact on the fetus. However, congenital syphilis presenting as sepsis is a critical condition but hardly identified by the clinic for the first time. In this study, we aimed to identify the benefit of earlier and accurate diagnosis for the infants who suffer congenital syphilis presenting as sepsis.A retrospective study was performed with patients diagnosed of congenital syphilis presenting as sepsis who were the inpatients in the West China Second Hospital between 2011 and 2018. The control group was collected in the neonatal sepsis patients whose blood culture are positive.Fifty-eight patients were included in the study. In the congenital syphilis group, one patient died and 12 (41.3%) patients get worse to MODS (multiple organ dysfunction syndrome). Symptoms, signs, and lab examinations are found to be significantly different (P < .05) between two groups as below, including rash, palmoplantar desquamation, abdominal distension, splenomegaly, hepatomegaly, etc. And, at the aspect of Hb, PLT, WBC, CRP, ALT, AST, these differences occurred in the different groups. It is obvious that the prognosis of children with syphilis is worse. According to a comparison between the different outcomes in the CS, the worse outcome subgroup of patients is significantly younger and have more severely impaired liver function.Because of the high mortality of these infants, pediatricians should improve awareness of CS. Syphilis screening is recommended for pregnant women.


Asunto(s)
Sepsis Neonatal/diagnóstico , Complicaciones Infecciosas del Embarazo/diagnóstico , Sepsis/diagnóstico , Sífilis Congénita/diagnóstico , Sífilis/diagnóstico , Estudios de Casos y Controles , China , Diagnóstico Diferencial , Diagnóstico Precoz , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Insuficiencia Multiorgánica/diagnóstico , Insuficiencia Multiorgánica/microbiología , Insuficiencia Multiorgánica/mortalidad , Sepsis Neonatal/microbiología , Sepsis Neonatal/mortalidad , Embarazo , Complicaciones Infecciosas del Embarazo/microbiología , Complicaciones Infecciosas del Embarazo/mortalidad , Estudios Retrospectivos , Sepsis/microbiología , Sepsis/mortalidad , Sífilis/microbiología , Sífilis/mortalidad , Serodiagnóstico de la Sífilis , Sífilis Congénita/mortalidad
16.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(10): 1224-1230, 2019 Oct.
Artículo en Chino | MEDLINE | ID: mdl-31771719

RESUMEN

OBJECTIVE: To evaluate the application of heparin-binding protein (HBP) in diagnosis of sepsis in adult patients. METHODS: An extensive search for the Chinese and English literatures from the PubMed, Embase, the Cochrane Library, Wanfang data, CNKI and VIP up to July 2019 was performed. The articles regarding HBP for the diagnosing of sepsis in adult patients were enrolled. Two researchers independently extracted related literature. The quality of the studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Meta-Disc 1.4 and STATA 12.0 were used for Meta-analysis. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were calculated. Summary receiver operating characteristic (SROC) curves and area under the curve (AUC) were used to evaluate the diagnostic performance of HBP for sepsis. Deek funnel plot was used to detect publication bias. RESULTS: A total of 10 studies with 1 884 patients were included in this Meta-analysis. The quality of the literature was relatively moderate. HBP in plasma were detected by enzyme linked immunosorbent assay (ELISA) in all studies. The studies showed substantial heterogeneity, and random effect model was used for Meta-analysis. The pooled sensitivity, specificity, PLR, NLR, and DOR were 0.80 [95% confidence interval (95%CI) was 0.77-0.83], 0.80 (95%CI was 0.78-0.82), 3.96 (95%CI was 2.45-6.41), 0.28 (95%CI was 0.20-0.39) and 14.63 (95%CI was 6.83-31.30) respectively. The pooled AUC was 0.86 and the Cochran-Q was 0.79. To explore the potential sources of heterogeneity, subgroup analyses were performed based on the severity of the disease, diagnostic criteria and region. However, the results indicated that no methodological covariates affected the diagnostic accuracy of HBP, indicating that there was still unexplained heterogeneity. In addition, the sensitivity analysis by removing individual studies were performed. No outlier study was identified and the results were relatively stable and reliable. Deek funnel plot showed little publication bias. CONCLUSIONS: There is preferable value of HBP for diagnosis of sepsis in adult patients. However, it needs to be further confirmed by large multicenter studies.


Asunto(s)
Péptidos Catiónicos Antimicrobianos/metabolismo , Proteínas Sanguíneas/metabolismo , Sepsis/diagnóstico , Adulto , Humanos , Sensibilidad y Especificidad , Sepsis/metabolismo
17.
BMC Infect Dis ; 19(1): 968, 2019 Nov 12.
Artículo en Inglés | MEDLINE | ID: mdl-31718563

RESUMEN

BACKGROUND: This study investigated the clinical value of interleukin-6 (IL-6), pentraxin 3 (PTX3), and procalcitonin (PCT) in patients with sepsis and septic shock diagnosed according to the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). METHODS: Serum levels of IL-6, PTX3, and PCT were measured in 142 enrolled subjects (51 with sepsis, 46 with septic shock, and 45 as controls). Follow-up IL-6 and PTX3 levels were measured in patients with initial septic shock within 24 h of hospital discharge. Optimal cut-off values were determined for sepsis and septic shock, and prognostic values were evaluated. RESULTS: Serum IL-6 levels could discriminate sepsis (area under the curve [AUC], 0.83-0.94, P <  0.001; cut-off value, 52.60 pg/mL, 80.4% sensitivity, 88.9% specificity) from controls and could distinguish septic shock (AUC, 0.71-0.89; cut-off value, 348.92 pg/mL, 76.1% sensitivity, 78.4% specificity) from sepsis. Twenty-eight-day mortality was significantly higher in the group with high IL-6 (≥ 348.92 pg/mL) than in the group with low IL-6 (< 348.92 pg/mL) (P = 0.008). IL-6 was an independent risk factor for 28-day mortality among overall patients (hazard ratio, 1.0004; 95% confidence interval, 1.0003-1.0005; p = 0.024). In septic shock patients, both the initial and follow-up PTX3 levels were consistently significantly higher in patients who died than in those who recovered (initial p = 0.004; follow-up P <  0.001). CONCLUSIONS: The diagnostic and prognostic value of IL-6 was superior to those of PTX3 and PCT for sepsis and septic shock.


Asunto(s)
Proteína C-Reactiva/análisis , Interleucina-6/sangre , Polipéptido alfa Relacionado con Calcitonina/sangre , Sepsis/diagnóstico , Componente Amiloide P Sérico/análisis , Choque Séptico/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Área Bajo la Curva , Biomarcadores/sangre , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Curva ROC , Factores de Riesgo , Sensibilidad y Especificidad , Sepsis/mortalidad , Sepsis/patología , Índice de Severidad de la Enfermedad , Choque Séptico/mortalidad , Choque Séptico/patología
18.
Pediatrics ; 144(6)2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31776196

RESUMEN

Pediatric sepsis is a major public health concern, and robust surveillance tools are needed to characterize its incidence, outcomes, and trends. The increasing use of electronic health records (EHRs) in the United States creates an opportunity to conduct reliable, pragmatic, and generalizable population-level surveillance using routinely collected clinical data rather than administrative claims or resource-intensive chart review. In 2015, the US Centers for Disease Control and Prevention recruited sepsis investigators and representatives of key professional societies to develop an approach to adult sepsis surveillance using clinical data recorded in EHRs. This led to the creation of the adult sepsis event definition, which was used to estimate the national burden of sepsis in adults and has been adapted into a tool kit to facilitate widespread implementation by hospitals. In July 2018, the Centers for Disease Control and Prevention convened a new multidisciplinary pediatric working group to tailor an EHR-based national sepsis surveillance approach to infants and children. Here, we describe the challenges specific to pediatric sepsis surveillance, including evolving clinical definitions of sepsis, accommodation of age-dependent physiologic differences, identifying appropriate EHR markers of infection and organ dysfunction among infants and children, and the need to account for children with medical complexity and the growing regionalization of pediatric care. We propose a preliminary pediatric sepsis event surveillance definition and outline next steps for refining and validating these criteria so that they may be used to estimate the national burden of pediatric sepsis and support site-specific surveillance to complement ongoing initiatives to improve sepsis prevention, recognition, and treatment.


Asunto(s)
Vigilancia de la Población , Sepsis/epidemiología , Distribución por Edad , Niño , Costo de Enfermedad , Registros Electrónicos de Salud , Humanos , Incidencia , Lactante , Sepsis/diagnóstico , Estados Unidos/epidemiología
19.
Klin Lab Diagn ; 64(10): 613-619, 2019.
Artículo en Ruso | MEDLINE | ID: mdl-31742955

RESUMEN

Primarily in the study of bacteremia, coagulase-negative staphylococci and representatives of the order Enterobacterales were found. To establish the etiological role of coagulase-negative staphylococcus in making a diagnosis of sepsis in each particular case, it is necessary to consider the condition and age of the child, as well as indicators of markers of systemic inflammation. In 1/3 cases of coagulase-negative staphylococcus indicate colonization of the catheter. Staphylococcus aureus in bacteremia and sepsis - 6.5%, Haemophilus influenzae - 0.6%, Esherichia coli - 7.8%, Streptococcus agalactiae - 2%. For the diagnosis of sepsis, it is necessary to conduct repeated (at least two times) blood culture studies using high-quality nutrient media containing all the necessary growth factors, followed by a mandatory determination of the susceptibility of the isolated strains of microorganisms to antimicrobial agents. Bacteremia as a whole in children of a multidisciplinary hospital amounted to 5.8%. In premature babies, bacteremia was detected in 4.4% of cases, of which sepsis was confirmed in 41,2%.


Asunto(s)
Bacteriemia/diagnóstico , Sepsis/diagnóstico , Niño , Enterobacteriaceae/aislamiento & purificación , Hospitales , Humanos , Lactante , Pruebas de Sensibilidad Microbiana , Infecciones Estafilocócicas/diagnóstico , Staphylococcus/aislamiento & purificación
20.
BMJ ; 367: l6700, 2019 11 28.
Artículo en Inglés | MEDLINE | ID: mdl-31780446
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