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1.
PLoS One ; 16(2): e0245772, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33534813

RESUMO

BACKGROUND: As the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has remained in Latin America, Mexico has become the third country with the highest death rate worldwide. Data regarding in-hospital mortality and its risk factors, as well as the impact of hospital overcrowding in Latin America has not been thoroughly explored. METHODS AND FINDINGS: In this prospective cohort study, we enrolled consecutive adult patients hospitalized with severe confirmed COVID-19 pneumonia at a SARS-CoV-2 referral center in Mexico City from February 26th, 2020, to June 5th, 2020. A total of 800 patients were admitted with confirmed diagnosis, mean age was 51.9 ± 13.9 years, 61% were males, 85% were either obese or overweight, 30% had hypertension and 26% type 2 diabetes. From those 800, 559 recovered (69.9%) and 241 died (30.1%). Among survivors, 101 (18%) received invasive mechanical ventilation (IMV) and 458 (82%) were managed outside the intensive care unit (ICU); mortality in the ICU was 49%. From the non-survivors, 45.6% (n = 110) did not receive full support due to lack of ICU bed availability. Within this subgroup the main cause of death was acute respiratory distress syndrome (ARDS) in 95% of the cases, whereas among the non-survivors who received full (n = 105) support the main cause of death was septic shock (45%) followed by ARDS (29%). The main risk factors associated with in-hospital death were male sex (RR 2.05, 95% CI 1.34-3.12), obesity (RR 1.62, 95% CI 1.14-2.32)-in particular morbid obesity (RR 3.38, 95%CI 1.63-7.00)-and oxygen saturation < 80% on admission (RR 4.8, 95%CI 3.26-7.31). CONCLUSIONS: In this study we found similar in-hospital and ICU mortality, as well as risk factors for mortality, compared to previous reports. However, 45% of the patients who did not survive justified admission to ICU but did not receive IMV / ICU care due to the unavailability of ICU beds. Furthermore, mortality rate over time was mainly due to the availability of ICU beds, indirectly suggesting that overcrowding was one of the main factors that contributed to hospital mortality.


Assuntos
Ocupação de Leitos/estatística & dados numéricos , Mortalidade Hospitalar , Idoso , /mortalidade , Causas de Morte , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , México , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/patologia , Estudos Prospectivos , Respiração Artificial , /etiologia , Fatores de Risco , Índice de Gravidade de Doença , Choque Séptico/diagnóstico , Choque Séptico/etiologia , Choque Séptico/mortalidade , Centros de Atenção Terciária
3.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 33(1): 28-32, 2021 Jan.
Artigo em Chinês | MEDLINE | ID: mdl-33565396

RESUMO

OBJECTIVE: To investigate the predictive value of different glycemic variability indexes within 6 hours on the short-term prognosis of septic shock patients. METHODS: A retrospective study was conducted. The 133 patients with septic shock admitted to intensive care unit (ICU) of Nanjing Hospital Affiliated to Nanjing Medical University from December 2014 to December 2019 were enrolled. Patients with septic shock admitted to ICU died during hospitalization were enrolled in the death group and others in the survival group. General data of the patients including gender, age, underlying disease, site of infection, duration of mechanical ventilation, length of ICU stay, whether to use continuous renal replacement therapy (CRRT) and acute physiology and chronic health evaluation II (APACHE II) scores within 24 hours were collected. The blood glucose (GLUadm), mean arterial pressure (MAP), serum creatinine (SCr) and procalcitonin (PCT) were recorded at ICU admission. The patients admitted to ICU received bundle therapy within 6 hours and blood glucose was observed every 2 hours. The blood glucose difference (GLUdif), average blood glucose (GLUave), blood glucose standard deviation (GLUsd) and blood glucose variation coefficient (GLUcv) within 6 hours were calculated. Multivariate Logistic regression analysis was used to analyze the prognostic factors of short-term prognosis of patients with septic shock, and receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic efficacy of glycemic parameters for short-term prognosis of septic shock patients. RESULTS: A total of 133 patients with septic shock were admitted to ICU, among them 87 patients survived and 46 patients died during the ICU hospitalization. Compared with the survival group, the SCr at ICU admission and APACHE II score within 24 hours were significantly higher in the death group [SCr (µmol/L): 208.5 (143.0, 286.5) vs. 172.0 (91.0, 234.0), APACHE II score: 30.28±6.67 vs. 24.03±5.90, both P < 0.05], the length of ICU stay was shorter [days: 4.00 (2.00, 10.25) vs. 9.00 (4.00, 13.00), P < 0.01]. However, there were no significant differences in the baseline data of gender, age, underlying disease, infection site, CRRT ratio, MAP or PCT at ICU admission between the two groups. Compared with the survival group, the GLUsd and GLUcv within 6 hours in the death group were higher [GLUsd (mmol/L): 2.33 (1.95, 3.14) vs. 2.02 (1.66, 2.52), GLUcv: (31.00±7.06)% vs. (23.31±10.51)%, both P < 0.05]. There were no statistically significant differences in the levels of GLUadm, GLUdif or GLUave within 6 hours between the two groups. Multivariate Logistic regression analysis showed that APACHE II score within 24 hours and GLUsd and GLUcv within 6 hours were independent risk factors of the short-term prognosis of septic shock patients [APACHE II score: odds ratio (OR) = 1.173, 95% confidence interval (95%CI) was 1.095-1.256, P = 0.000; GLUsd: OR = 1.465, 95%CI was 1.038-2.067, P = 0.030; GLUcv: OR = 1.089, 95%CI was 1.043-1.138, P = 0.000]. ROC curve analysis showed that GLUsd and GLUcv within 6 hours both had certain predictive value for the short-term prognosis of septic shock patients, the area under ROC curve (AUC) of GLUcv within 6 hours was higher than that of APACHE II score (0.765 vs. 0.753), and AUC of GLUsd within 6 hours was close to APACHE II score (0.629 vs. 0.753); and the diagnostic value of GLUsd combined with GLUcv within 6 hours was higher than the two respectively (AUC: 0.809 vs. 0.629, 0.765), the sensitivity was 97.8%, and the specificity was 66.7%. CONCLUSIONS: GLUsd combined with GLUcv within 6 hours can be used to estimate the short-term prognosis of septic shock patients.


Assuntos
Sepse , Choque Séptico , APACHE , Glicemia , Humanos , Unidades de Terapia Intensiva , Prognóstico , Curva ROC , Estudos Retrospectivos , Choque Séptico/diagnóstico , Choque Séptico/terapia
4.
Arkh Patol ; 83(1): 67-72, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33512131

RESUMO

Based on their extensive experience and literature data, the author outlines difficulties in the morphological diagnosis of sepsis, by taking into account the current clinical classification. Occurring not only in sepsis and lacking clear morphological criteria, a systemic inflammatory response and organ dysfunction cannot be absolute signs of sepsis diagnosis. The author gives the morphological characteristics of the systemic inflammatory response, septic shock, and organ dysfunction.


Assuntos
Sepse , Choque Séptico , Humanos , Insuficiência de Múltiplos Órgãos/diagnóstico , Sepse/complicações , Sepse/diagnóstico , Choque Séptico/diagnóstico
5.
Braz J Med Biol Res ; 54(3): e10152, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33503200

RESUMO

The goal of this study was to identify potential transcriptomic markers in pediatric septic shock prognosis by an integrative analysis of multiple public microarray datasets. Using the R software and bioconductor packages, we performed a statistical analysis to identify differentially expressed (DE) genes in pediatric septic shock non-survivors, and further performed functional interpretation (enrichment analysis and co-expression network construction) and classification quality evaluation of the DE genes identified. Four microarray datasets (3 training datasets and 1 testing dataset, 252 pediatric patients with septic shock in total) were collected for the integrative analysis. A total of 32 DE genes (18 upregulated genes; 14 downregulated genes) were identified in pediatric septic shock non-survivors. Enrichment analysis revealed that those DE genes were strongly associated with acute inflammatory response to antigenic stimulus, response to yeast, and defense response to bacterium. A support vector machine classifier (non-survivors vs survivors) was also trained based on DE genes. In conclusion, the DE genes identified in this study are suggested as candidate transcriptomic markers for pediatric septic shock prognosis and provide novel insights into the progression of pediatric septic shock.


Assuntos
Choque Séptico , Transcriptoma , Biomarcadores , Criança , Biologia Computacional , Perfilação da Expressão Gênica , Humanos , Análise em Microsséries , Choque Séptico/diagnóstico , Choque Séptico/genética
6.
Dtsch Med Wochenschr ; 146(3): 162-166, 2021 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-33513649

RESUMO

Corticosteroids have been found as useful adjunctive therapy in patients with various infections and hyperinflammation-associated disease. They are recommended in practice guidelines for patients with tuberculous and pneumococcal meningitis and patients with immune reconstitution syndrome associated with antiretroviral therapy. A new indication is severe COVID-19. Evidence from clinical trials is insufficient to allow the routine use of steroids among patients with septic shock, community-acquired pneumonia or tuberculous pericarditis.


Assuntos
Corticosteroides/uso terapêutico , Infecções por HIV/complicações , Síndrome Inflamatória da Reconstituição Imune/tratamento farmacológico , Meningite Pneumocócica/tratamento farmacológico , Tuberculose Meníngea/tratamento farmacológico , Abscesso Encefálico/tratamento farmacológico , Quimioterapia Adjuvante , Infecções por HIV/tratamento farmacológico , Humanos , Sepse/tratamento farmacológico , Índice de Gravidade de Doença , Choque Séptico/tratamento farmacológico , Infecções por Spirochaetales/tratamento farmacológico , Tuberculose/tratamento farmacológico
7.
BMC Infect Dis ; 21(1): 113, 2021 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-33494706

RESUMO

BACKGROUND: To examine the clinical characteristics and identify independent risk factors for in-hospital mortality of 2019 novel coronavirus (COVID-19) pneumonia. METHODS: A total of 156 patients diagnosed with COVID-19 pneumonia at the Central Hospital of Wuhan from January 29, 2020, to March 20, 2020, and 20 healthy individuals were enrolled in this single-centered retrospective study. The epidemiological parameters, clinical presentations, underlying diseases, laboratory test results, and disease outcomes were collected and analyzed. RESULTS: The median age of all enrolled patients was 66 years. At least one underlying disease was identified in 101 COVID-19 patients, with hypertension being the most common one, followed by cardiovascular disease and diabetes. The most common symptoms identified upon admission were fever, cough, dyspnea, and fatigue. Compared to survival cases, patients who died during hospitalization had higher plasma levels of D-dimer, creatinine, creatine kinase, lactate dehydrogenase, lactate, and lower percentage of lymphocytes (LYM [%]), platelet count and albumin levels. Most enrolled patients received antibiotics and anti-viral treatment. In addition, 60 patients received corticosteroids, and 51 received intravenous immunoglobulin infusion. Forty-four patients received noninvasive ventilation and 19 received invasive ventilation. Respiratory failure was the most frequently observed complication (106 [67.9%]), followed by sepsis (103 [66.0%]), acute respiratory distress syndrome (ARDS) (67 [42.9%]), and septic shock (50 [32.1%]). Multivariable regression suggested that advanced age (OR [odds ratio] = 1.098, 95% CI [confidence interval]: 1.006-1.199, P = 0.037), shorter duration from onset to admission (OR = 0.853, 95% CI: 0.750-0.969, P = 0.015) and elevated lactate level upon admission (OR = 2.689, 95% CI: 1.044-6.926, P = 0.040) were independent risk factors for in-hospital mortality for COVID-19 infection. Meanwhile, increased LYM (%) at admission (OR = 0.787, 95% CI: 0.686-0.903, P = 0.001) indicated a better prognosis. CONCLUSIONS: In this study, we discovered that age, duration from onset to admission, LYM (%), and lactate level upon admission were independent factors that affecting the in-hospital mortality rate.


Assuntos
/mortalidade , Mortalidade Hospitalar , Adolescente , Corticosteroides/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Antivirais/uso terapêutico , /complicações , Doenças Cardiovasculares/epidemiologia , Criança , China/epidemiologia , Comorbidade , Tosse , Creatina Quinase/sangue , Creatinina/sangue , Diabetes Mellitus/epidemiologia , Surtos de Doenças , Feminino , Febre , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Hospitalização , Humanos , Hipertensão/epidemiologia , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/uso terapêutico , L-Lactato Desidrogenase/sangue , Ácido Láctico/sangue , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Respiração Artificial , Insuficiência Respiratória/etiologia , Estudos Retrospectivos , Fatores de Risco , Sepse/etiologia , Albumina Sérica/metabolismo , Choque Séptico/etiologia , Adulto Jovem
8.
Med Hypotheses ; 146: 110473, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33385879

RESUMO

Severe forms of the Coronavirus disease 2019 (COVID-19) are characterized by an enhanced inflammatory syndrome called "cytokine storm" that produces an aberrant release of high amounts of cytokines, chemokines, and other proinflammatory mediators. The pathogenetic role of the "cytokine storm" has been confirmed by the efficacy of immunosuppressive drugs such as corticosteroids along with antiviral drugs in the treatment of the severe forms of this disease. Phenylmethimazole (C10) is a derivative of methimazole with anti-inflammatory properties. Studies performed both in vitro and in vivo have shown that C10 is able to block the production of multiple cytokines, chemokines, and other proinflammatory molecules involved in the pathogenesis of inflammation. Particularly, C10 is effective in reducing the increased secretion of cytokines in animal models of endotoxic shock. We hypothesize that these effects are not limited to the endotoxic shock, but can also be applied to any disease characterized by the presence of a "cytokine storm". Therefore, C10 may be a potential drug to be used alternatively or in association with the corticosteroids or other immunosuppressive agents in the severe forms of COVID-19 as well as other viral diseases that induce a "cytokine storm". Preclinical and clinical studies have to be performed to confirm this hypothesis.


Assuntos
/tratamento farmacológico , Síndrome da Liberação de Citocina/tratamento farmacológico , Metimazol/análogos & derivados , Tionas/farmacologia , Animais , Anti-Inflamatórios/farmacologia , Antivirais/farmacologia , Síndrome da Liberação de Citocina/imunologia , Citocinas/antagonistas & inibidores , Modelos Animais de Doenças , Avaliação Pré-Clínica de Medicamentos , Humanos , Metimazol/farmacologia , Camundongos , Pandemias , Choque Séptico/tratamento farmacológico , Choque Séptico/imunologia , Pesquisa Médica Translacional
9.
BMC Infect Dis ; 21(1): 19, 2021 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-33407229

RESUMO

BACKGROUND: Exotoxins secreted from Staphylococcus aureus or Streptococcus pyogenes act as superantigens that induce systemic release of inflammatory cytokines and are a common cause of toxic shock syndrome (TSS). However, little is known about TSS caused by coagulase-negative staphylococci (CoNS) and the underlying mechanisms. Here, we present a rare case of TSS caused by Staphylococcus simulans (S. simulans). CASE PRESENTATION: We report the case of a 75-year-old woman who developed pneumococcal pneumonia and bacteremia from S. simulans following an influenza infection. The patient met the clinical criteria for probable TSS, and her symptoms included fever of 39.5 °C, diffuse macular erythroderma, conjunctival congestion, vomiting, diarrhea, liver dysfunction, and disorientation. Therefore, the following treatment was initiated for bacterial pneumonia complicating influenza A with suspected TSS: meropenem (1 g every 8 h), vancomycin (1 g every 12 h), and clindamycin (600 mg every 8 h). Blood cultures taken on the day after admission were positive for CoNS, whereas sputum and pharyngeal cultures grew Streptococcus pneumoniae (Geckler group 4) and methicillin-sensitive S. aureus, respectively. However, exotoxins thought to cause TSS, such as TSS toxin-1 and various enterotoxins, were not detected. The patient's therapy was switched to cefazolin (2 g every 8 h) and clindamycin (600 mg every 8 h) for 14 days based on microbiologic test results. She developed desquamation of the fingers on hospital day 8 and was diagnosed with TSS. Conventional exotoxins, such as TSST-1, and S. aureus enterotoxins were not detected in culture samples. The serum levels of inflammatory cytokines, such as neopterin and IL-6, were high. CD8+ T cells were activated in peripheral blood. Vß2+ population activation, which is characteristic for TSST-1, was not observed in the Vß usage of CD8+ T cells in T cell receptor Vß repertoire distribution analysis. CONCLUSIONS: We present a case of S. simulans-induced TSS. Taken together, we speculate that no specific exotoxins are involved in the induction of TSS in this patient. A likely mechanism is uncontrolled cytokine release (i.e., cytokine storm) induced by non-specific immune reactions against CoNS proliferation.


Assuntos
Síndrome da Liberação de Citocina/complicações , Choque Séptico/complicações , Infecções Estafilocócicas/complicações , Staphylococcus aureus/isolamento & purificação , Staphylococcus/isolamento & purificação , Streptococcus pneumoniae/isolamento & purificação , Idoso , Antibacterianos/administração & dosagem , Hemocultura , Cefazolina/administração & dosagem , Clindamicina/administração & dosagem , Síndrome da Liberação de Citocina/tratamento farmacológico , Citocinas/sangue , Feminino , Humanos , Testes de Sensibilidade Microbiana , Choque Séptico/tratamento farmacológico , Escarro/microbiologia , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Resultado do Tratamento
11.
Mod Rheumatol Case Rep ; 5(1): 101-107, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33019894

RESUMO

Anti-melanoma differentiation-associated gene 5 juvenile dermatomyositis (anti-MDA5 JDM) is associated with high risk of developing rapidly progressive interstitial lung disease (RP-ILD). Here we report an 11-year-old girl with anti-MDA5 JDM and RP-ILD which led to a fatal outcome, further aggravated by SARS-CoV-2 infection. She was referred to our hospital after being diagnosed with anti-MDA5 JDM and respiratory failure due to RP-ILD. On admission, fibrobronchoscopy with bronchoalveolar lavage (BAL) revealed Pneumocystis jirovecii infection so treatment with intravenous trimethoprim-sulfamethoxazole was initiated. Due to RP-ILD worsening, immunosuppressive therapy was intensified using methylprednisolone pulses, cyclophosphamide, tofacitinib and intravenous immunoglobulin without response. She developed severe hypoxemic respiratory failure, pneumomediastinum and pneumothorax, further complicated with severe RP-ILD and cervical subcutaneous emphysema. Three real-time RT-PCR for SARS-CoV-2 were made with a negative result. In addition, she was complicated with a secondary hemophagocytic lymphohistiocytosis and a fourth real-time PCR for SARS-CoV-2 performed in BAS sample was positive. Despite aggressive treatment of RP-ILD due to anti-MDA5 JDM, there was no improvement of respiratory failure in the following days and patient developed refractory septic shock and died. Anti-MDA5 JDM patients with RP-ILD have a poor prognosis with a high mortality rate. For this reason, intensive immunosuppressive therapy is essential including the use of promising drugs such as tofacitinib. COVID-19 in children with underlying health conditions like anti-MDA5 JDM may still be at risk for disease and severe complications.


Assuntos
/complicações , Dermatomiosite/complicações , Imunossupressores/uso terapêutico , Doenças Pulmonares Intersticiais/complicações , Linfo-Histiocitose Hemofagocítica/etiologia , Pneumonia por Pneumocystis/complicações , Monofosfato de Adenosina/análogos & derivados , Monofosfato de Adenosina/uso terapêutico , Alanina/análogos & derivados , Alanina/uso terapêutico , Antibacterianos/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Antivirais/uso terapêutico , Autoanticorpos/imunologia , Broncoscopia , Criança , Ciclofosfamida/uso terapêutico , Dermatomiosite/tratamento farmacológico , Dermatomiosite/imunologia , Progressão da Doença , Evolução Fatal , Feminino , Humanos , Hidroxicloroquina/uso terapêutico , Hospedeiro Imunocomprometido , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Helicase IFIH1 Induzida por Interferon/imunologia , Pulmão/diagnóstico por imagem , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Doenças Pulmonares Intersticiais/imunologia , Doenças Pulmonares Intersticiais/terapia , Linfo-Histiocitose Hemofagocítica/imunologia , Enfisema Mediastínico/etiologia , Metilprednisolona/uso terapêutico , Piperidinas/uso terapêutico , Pneumonia por Pneumocystis/imunologia , Pneumotórax/etiologia , Pirimidinas/uso terapêutico , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Choque Séptico/etiologia , Enfisema Subcutâneo/etiologia , Tomografia Computadorizada por Raios X , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico
12.
BMJ Case Rep ; 13(12)2020 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-33370943

RESUMO

A previously independent 56-year-old immunocompetent woman presented with septic shock in the setting of periorbital swelling and diffuse infiltrates on chest imaging. Blood cultures were positive for growth of group A Streptococcus (GAS). Broad spectrum antimicrobials were initiated with the inclusion of the antitoxin agent clindamycin. Necrosis of periorbital tissue was noted and surgical consultation was obtained. Débridement of both eyelids with skin grafting was performed. GAS was isolated from wound cultures and also observed on periorbital tissue microscopy. The final diagnosis was bilateral periorbital necrotising fasciitis (PONF) associated with invasive GAS infection. The patient had a prolonged intensive care unit course with input from multiple specialist teams. This case demonstrates the importance of early recognition and treatment of PONF, the profound systemic morbidity caused by these infections, and illustrates successful multidisciplinary teamwork.


Assuntos
Fasciite Necrosante/complicações , Choque Séptico/microbiologia , Infecções Estreptocócicas/complicações , Streptococcus pyogenes/isolamento & purificação , Antibacterianos/uso terapêutico , Desbridamento , Quimioterapia Combinada , Pálpebras/microbiologia , Pálpebras/cirurgia , Fasciite Necrosante/diagnóstico , Fasciite Necrosante/microbiologia , Fasciite Necrosante/terapia , Feminino , Humanos , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Choque Séptico/diagnóstico , Choque Séptico/terapia , Transplante de Pele , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/microbiologia , Infecções Estreptocócicas/terapia , Resultado do Tratamento
13.
PLoS One ; 15(12): e0243990, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33373376

RESUMO

BACKGROUND: Increased body temperature in the Emergency Department (BT-ED) and the ICU (BT-ICU) is associated with lower mortality in patients with sepsis. Here, we compared how well BT-ED and BT-ICU predict mortality; investigated mortality in various combinations of BT-ED and BT-ICU, and; compared degree of fever in the ED and ICU and associated quality of care. METHODS: 2385 adults who were admitted to an ICU within 24 hours of ED arrival with severe sepsis or septic shock were included. RESULTS: Thirty-day mortality was 23.6%. Median BT-ED and BT-ICU was 38.1 and 37.6°C. Crude mortality decreased more than 5% points per°C increase for both BT-ED and BT-ICU. Adjusted OR for mortality was 0.82/°C increase for BT-ED (0.76-0.88, p < 0.001), and 0.89 for BT-ICU (0.83-0.95, p<0.001). Patients who were at/below median temperature in both the ED and in the ICU had the highest mortality, 32%, and those with over median in the ED and at/below in the ICU had the lowest, 16%, (p<0.001). Women had 0.2°C lower median BT-ED (p = 0.03) and 0.3°C lower BT-ICU (p<0.0001) than men. Older patients had lower BT in the ICU, but not in the ED. Fever was associated with a higher rate of sepsis bundle achievement in the ED, but lower nurse workload in the ICU. CONCLUSIONS: BT-ED was more useful to prognosticate mortality than BT-ICU. Despite better prognosis in patients with elevated BT, fever was associated with higher quality of care in the ED. Future studies should assess how BT-ED can be used to improve triage of infected patients, assigning higher priority to patients with low-grade/no fever and vice versa. Patients with at/below median BT in both ED and ICU have the highest mortality and should receive special attention. Different BT according to sex and age also needs further study.


Assuntos
Temperatura Corporal , Serviço Hospitalar de Emergência/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , Choque Séptico/patologia , Fatores Etários , Idoso , Cuidados Críticos/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Valor Preditivo dos Testes , Fatores Sexuais , Choque Séptico/epidemiologia , Choque Séptico/mortalidade
14.
Medicine (Baltimore) ; 99(50): e23566, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327314

RESUMO

Improving understanding of the prognostic factors associated with death resulting from sepsis in obstetric patients is essential to allow management to be optimized. This retrospective cohort study aimed to determine the risk factors for death in patients with sepsis admitted to the obstetric intensive care unit of a tertiary teaching hospital in northeastern Brazil between April 2012 and April 2016.The clinical, obstetric, and laboratory data of the sepsis patients, as well as data on their final outcome, were collected. A significance level of 5% was adopted. Risk factors for death in patients with sepsis were evaluated in a multivariate analysis.During the period analyzed, 155 patients with sepsis were identified and included in the study, representing 5.2% of all obstetric intensive care unit (ICU) admissions. Of these, 14.2% (n = 22) died. The risk factors for death were septic shock at the time of hospitalization (relative risk [RR] = 3.45; 95% confidence interval [CI]: 1.64-7.25), need for vasopressors during hospitalization (RR = 17.32; 95% CI: 4.20-71.36), lactate levels >2 mmol/L at the time of diagnosis (RR = 4.60; 95% CI: 1.05-20.07), and sequential organ failure assessment score >2 at the time of diagnosis (RR = 5.97; 95% CI: 1.82-19.94). Following multiple logistic regression analysis, only the need for vasopressors during hospitalization remained as a risk factor associated with death (odds ratio [OR] = 26.38; 95% CI: 5.87-118.51).The need for vasopressors during hospitalization is associated with death in obstetric patients with sepsis.


Assuntos
Unidades de Terapia Intensiva , Unidade Hospitalar de Ginecologia e Obstetrícia , Complicações Infecciosas na Gravidez/mortalidade , Sepse/mortalidade , Adulto , Brasil/epidemiologia , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Unidade Hospitalar de Ginecologia e Obstetrícia/estatística & dados numéricos , Gravidez , Estudos Retrospectivos , Fatores de Risco , Choque Séptico/mortalidade , Adulto Jovem
15.
Eur Rev Med Pharmacol Sci ; 24(24): 13062-13064, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33378059

RESUMO

Cytokine storm in COVID-19 is linked to disease severity and mortality. 40% of patients with severe COVID-19 require mechanical ventilation. Analgesia and sedation are used for treatment of pain, facilitation of mechanical ventilation, or management of acute agitation. Herein, we present the immunomodulating actions of morphine that may either improve or worsen the clinical course of COVID-19 once cytokine storm develops. A literature search was performed to find articles on potential immunomodulatory effects of morphine. Taken together, the results of in vitro and in vivo models in non-COVID-19 conditions suggest that morphine could have a beneficial effect by mitigating the cytokine storm in the early stages of severe COVID-19. In contrast, it could be potentially harmful in late stages of severe COVID-19, especially in the presence of septic shock.


Assuntos
Analgésicos Opioides/efeitos adversos , Síndrome da Liberação de Citocina/imunologia , Imunomodulação , Morfina/efeitos adversos , Analgésicos Opioides/uso terapêutico , Citocinas/imunologia , Humanos , Morfina/uso terapêutico , Respiração Artificial , Choque Séptico/imunologia
16.
Arch. argent. pediatr ; 118(6): e514-e526, dic 2020. tab, ilus
Artigo em Inglês, Espanhol | LILACS, BINACIS | ID: biblio-1146142

RESUMO

El síndrome inflamatorio multisistémico en niños y adolescentes temporalmente relacionado con COVID-19 es una presentación clínica de la infección por SARS-CoV-2. Comparte algunas características con la enfermedad de Kawasaki, el shock tóxico, la sepsis, el síndrome de activación macrofágica y la miocarditis. Son escasas las publicaciones que abordan su manejo inicial, que tiene semejanzas con el propuesto para el shock séptico. Esta revisión analiza dicho abordaje basado en las características propias del síndrome inflamatorio multisistémico relacionado con COVID-19, de acuerdo con el paradigma de construcción de una "guía de práctica institucional", y sugiere estrategias de aproximación terapéutica, que incluyen detección temprana, estabilización, referencia, tratamiento específico y análisis de proceso


Multisystem inflammatory syndrome temporally related to COVID-19 in children and adolescents is a clinical presentation of SARS-CoV-2 infection. It shares some features with Kawasaki disease, toxic shock, sepsis, macrophage activation syndrome, and myocarditis. Few publications have addressed its initial management, which is similar to that proposed for septic shock. This review analyzes such approach based on the characteristics typical of multisystem inflammatory syndrome related to COVID-19 in accordance with the paradigm of an "institutional practice guideline" and suggests therapeutic approach strategies, including early detection, stabilization, referral, specific treatment, and process analysis.


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Infecções por Coronavirus/terapia , Encaminhamento e Consulta , Choque Séptico/fisiopatologia , Choque Séptico/terapia , Infecções por Coronavirus/fisiopatologia , Síndrome de Resposta Inflamatória Sistêmica/fisiopatologia , Síndrome de Resposta Inflamatória Sistêmica/terapia
17.
Arch. argent. pediatr ; 118(6): e527-e535, dic 2020. tab, ilus
Artigo em Inglês, Espanhol | LILACS, BINACIS | ID: biblio-1146143

RESUMO

La sepsis continúa siendo una causa mayor de morbimortalidad. Es ocasionada por una respuesta inmune no regulada frente a un proceso infeccioso, que origina disfunción de órganos y sistemas.La respuesta inflamatoria frente a los microorganismos patógenos implica una sucesión dinámica y compleja de eventos, conducentes a la activación endotelial y del sistema inmunológico. La finalidad de este proceso es controlar la infección y reparar los tejidos. Sin embargo, tanto factores del huésped como del germen pueden llevar al desarrollo de formas graves de inflamación sistémica, con elevada mortalidad. La sepsis se encuadra dentro de este complejo escenario, donde la tormenta inflamatoria y el patógeno que la inició convergen en un cuadro multisistémico grave.Se divide el manuscrito en dos secciones. La primera describe los mecanismos que generan inflamación sistémica y progresión hacia la sepsis, junto con sus principales marcadores biológicos. La segunda analiza los mecanismos que producen disfunción orgánica


Sepsis is still a major cause of morbidity and mortality. It results from a dysregulated immune response to infection that leads to organ and system dysfunction.The inflammatory response to pathogenic microorganisms implies a dynamic, complex chain of events leading to endothelial and immune system activation. The purpose of this process is to control infection and repair tissues. However, both host and microorganism factors may result in severe forms of systemic inflammation with a high mortality rate. Sepsis falls within this complex scenario, where the inflammatory storm and the causative microorganism converge in a severe multisystem presentation.This manuscript is divided into two parts. Part I describes the mechanisms triggering systemic inflammation and progression to sepsis, together with its main biological markers. Part II analyzes the mechanisms leading to organ dysfunction


Assuntos
Humanos , Síndrome de Resposta Inflamatória Sistêmica , Sepse , Choque Séptico , Citocinas , Pró-Calcitonina
18.
BMC Infect Dis ; 20(1): 817, 2020 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-33167878

RESUMO

BACKGROUND: Gastrointestinal (GI) mucormycosis is a rare and often deadly form of mucormycosis. Delayed diagnosis can lead to an increased risk of death. Here, we report a case of GI mucormycosis following streptococcal toxic shock syndrome in a virologically suppressed HIV-infected patient. CASE PRESENTATION: A 25-year-old Thai woman with a well-controlled HIV infection and Grave's disease was admitted to a private hospital with a high-grade fever, vomiting, abdominal pain, and multiple episodes of mucous diarrhea for 3 days. On day 3 of that admission, the patient developed multiorgan failure and multiple hemorrhagic blebs were observed on all extremities. A diagnosis of streptococcal toxic shock was made before referral to Siriraj Hospital - Thailand's largest national tertiary referral center. On day 10 of her admission at our center, she developed feeding intolerance and bloody diarrhea due to bowel ischemia and perforation. Bowel resection was performed, and histopathologic analysis of the resected bowel revealed acute suppurative transmural necrosis and vascular invasion with numerous broad irregular branching non-septate hyphae, both of which are consistent with GI mucormycosis. Peritoneal fluid fungal culture grew a grayish cottony colony of large non-septate hyphae and spherical sporangia containing ovoidal sporangiospores. A complete ITS1-5.8S-ITS2 region DNA sequence analysis revealed 100% homology with Rhizopus microsporus strains in GenBank (GenBank accession numbers KU729104 and AY803934). As a result, she was treated with liposomal amphotericin B. However and in spite of receiving appropriate treatment, our patient developed recurrent massive upper GI bleeding from Dieulafoy's lesion and succumbed to her disease on day 33 of her admission. CONCLUSION: Diagnosis of gastrointestinal mucormycosis can be delayed due to a lack of well-established predisposing factors and non-specific presenting symptoms. Further studies in risk factors for abdominal mucormycosis are needed.


Assuntos
Trato Gastrointestinal/microbiologia , Doença de Graves/complicações , Infecções por HIV/complicações , Mucormicose/complicações , Rhizopus/genética , Choque Séptico/complicações , Infecções Estreptocócicas/complicações , Streptococcus pyogenes/isolamento & purificação , Adulto , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , DNA Fúngico/genética , Evolução Fatal , Feminino , Infecções por HIV/virologia , Humanos , Mucormicose/diagnóstico , Mucormicose/tratamento farmacológico , Mucormicose/microbiologia , Choque Séptico/diagnóstico , Choque Séptico/microbiologia , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/microbiologia , Síndrome , Tailândia
19.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(10): 1183-1188, 2020 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-33198860

RESUMO

OBJECTIVE: To observe the effect of early intervention bundle on clinical prognosis of patients with latent/overt septic shock in emergency department and analyze the risk factors for mortality. METHODS: Patients with latent and overt septic shock admitted to the North Hospital of Huashan Hospital Affiliated to Fudan University from January 2018 to December 2019 were retrospectively analyzed and divided into latent shock group and overt shock group. The gender, age, main infection site, the time of shock diagnosis, the indicators of early (3-hour) intervention bundle, 6-hour compliance rate of intervention bundle, the remission time and 28-day prognosis were observed. Logistic regression analysis was used to identify risk factors for 28-day mortality. Receiver operating characteristic (ROC) curve was used to analyze its prognostic value. RESULTS: Totally 181 patients were included in the analysis. There were 102 cases in the latent shock group, and 28-day mortality was 15.69% (16 cases); 79 cases in the overt shock group, and 28-day mortality was 31.65% (25 cases). Compared with the latent shock group, patients in overt shock group had higher compliance rate of early intervention bundle (93.67% vs. 58.82%), higher blood lactate acid at admission [Lac (mmol/L): 7.09±2.08 vs. 5.69±1.27], higher compliance rate of blood culture before antibiotics (93.67% vs. 63.73%), higher proportion of antibiotics use at the first and second hours (45.57% vs. 31.37%, 54.43% vs. 33.33%), higher proportion of rapid fluid resuscitation at the first hour (crystal liquid: 59.49% vs. 11.76%, crystal fluid combined with human serum albumin: 40.51% vs. 0%), and higher proportion of vasoactive use at the first hour (100% vs. 9.80%). The stable time was significantly prolonged (days: 4.40±1.35 vs. 1.49±0.55), while the onset time (days: 1.47±0.97 vs. 2.95±1.61), the time of diagnosis (minutes: 31.30±12.54 vs. 79.15±13.81), 6-hour lactate clearance [(50.27±21.53)% vs. (61.82±13.12)%], the proportion of antibiotics use at the third hour (0% vs. 35.29%), the proportion of rapid fluid resuscitation at the second and third hour (second hour crystal liquid: 0% vs. 60.78%, second hour crystal fluid combined with human serum albumin: 0% vs. 14.71%, third hour crystal liquid: 0% vs. 12.75%), 6-hour compliance rate of the standard of central venous blood saturation (ScvO2, 60.76% vs. 78.43%) and the success rate of treatment (28-day mortality: 31.65% vs. 15.69%) were lower than those of the latent shock group (all P < 0.05). Ten patients with latent shock developed into overt shock within 24 hours after admission. All patients with overt shock needed vasoactive drugs to maintain mean arterial pressure (MAP) ≥ 65 mmHg (1 mmHg = 0.133 kPa). Compared with the survival patients, the Lac (mmol/L: 7.59±2.27 vs. 5.92±1.24) and the proportion of vasoactive drugs use (65.85% vs. 44.29%) were significantly increased in the death patients, while the 6-hour lactate clearance [(46.58±15.83)% vs. (59.60±17.92)%], the proportion of antibiotics use in the third hour (4.88% vs. 24.29%), and 6-hour compliance rate of urine volume and ScvO2 (56.10% vs. 82.86%, 43.90% vs. 78.57%) were significantly decreased (all P < 0.05). Binary Logistic regression analysis showed that Lac at admission, 6-hour lactate clearance, the use of antibiotics at the third hour, rapid fluid resuscitation at the first hour, and 6-hour compliance rate of ScvO2 were independent risk factors for 28-day mortality [odds ratio (OR) was 1.618, 0.021, 0.100, 0.307 and 3.018, all P < 0.05]. ROC curve analysis showed that the Lac at admission had the highest predictive value for 28-day mortality, the area under the ROC curve (AUC) was 0.706; followed by 6-hour compliance rate of ScvO2 (AUC was 0.673). CONCLUSIONS: Patients with latent/overt septic shock need early diagnosis and intervention bundle to improve the 6-hour blood lactate clearance and 6-hour compliance rate of ScvO2 and reduce the mortality.


Assuntos
Choque Séptico , Serviço Hospitalar de Emergência , Hidratação , Humanos , Prognóstico , Estudos Retrospectivos , Choque Séptico/terapia
20.
World J Gastroenterol ; 26(39): 6087-6097, 2020 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-33132657

RESUMO

BACKGROUND: The coronavirus disease 2019 (COVID-19) is spreading rapidly around the world. Most critically ill patients have organ injury, including acute respiratory distress syndrome, acute kidney injury, cardiac injury, or liver dysfunction. However, few studies on acute gastrointestinal injury (AGI) have been reported in critically ill patients with COVID-19. AIM: To investigate the prevalence and outcomes of AGI in critically ill patients with COVID-19. METHODS: In this retrospective study, demographic data, laboratory parameters, AGI grades, clinical severity and outcomes were collected. The primary endpoints were AGI incidence and 28-d mortality. RESULTS: From February 10 to March 10 2020, 83 critically ill patients out of 1314 patients with COVID-19 were enrolled. Seventy-two (86.7%) patients had AGI during hospital stay, of these patients, 30 had AGI grade I, 35 had AGI grade II, 5 had AGI grade III, and 2 had AGI grade IV. The incidence of AGI grade II and above was 50.6%. Forty (48.2%) patients died within 28 days of admission. Multiple organ dysfunction syndrome developed in 58 (69.9%) patients, and septic shock in 16 (19.3%) patients. Patients with worse AGI grades had worse clinical variables, a higher incidence of septic shock and 28-d mortality. Sequential organ failure assessment (SOFA) scores (95%CI: 1.374-2.860; P < 0.001), white blood cell (WBC) counts (95%CI: 1.037-1.379; P = 0.014), and duration of mechanical ventilation (MV) (95%CI: 1.020-1.340; P = 0.025) were risk factors for the development of AGI grade II and above. CONCLUSION: The incidence of AGI was 86.7%, and hospital mortality was 48.2% in critically ill patients with COVID-19. SOFA scores, WBC counts, and duration of MV were risk factors for the development of AGI grade II and above. Patients with worse AGI grades had a higher incidence of septic shock and 28-d mortality.


Assuntos
Infecções por Coronavirus/fisiopatologia , Gastroenteropatias/fisiopatologia , Mortalidade Hospitalar , Pneumonia Viral/fisiopatologia , Lesão Renal Aguda/epidemiologia , Idoso , Betacoronavirus , China/epidemiologia , Infecções por Coronavirus/epidemiologia , Estado Terminal , Feminino , Gastroenteropatias/epidemiologia , Humanos , Incidência , Contagem de Leucócitos , Hepatopatias/epidemiologia , Masculino , Pessoa de Meia-Idade , Mortalidade , Insuficiência de Múltiplos Órgãos/epidemiologia , Escores de Disfunção Orgânica , Pandemias , Pneumonia Viral/epidemiologia , Prevalência , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Choque Séptico/epidemiologia
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