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1.
Ethiop J Health Sci ; 31(3): 485-494, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34483605

RESUMO

Background: Globally, over 3 million newborn die each year, one million of these attributed to infections. The objective of this study was to determine the etiologies and clinical characteristics of sepsis in neonates admitted to intensive care unit of a tertiary hospital in Ethiopia. Methods: A longitudinal hospital based cohort study was conducted from April 1 to October 31, 2018 at the neonatal intensive care unit of Jimma Medical Center, southwest Ethiopia. Diagnosis of sepsis was established using the World Health Organization's case definition. Structured questionnaires and case specific recording formats were used to capture the relevant data. Venous blood and cerebrospinal fluid from neonates suspected to have sepsis were collected. Results: Out of 304 neonates enrolled in the study, 195 (64.1%) had clinical evidence for sepsis, majority (84.1%; 164/195) of them having early onset neonatal sepsis. The three most frequent presenting signs and symptoms were fast breathing (64.6%; 122/195), fever (48.1%; 91/195) and altered feeding (39.0%; 76/195). Etiologic agents were detected from the blood culture of 61.2% (115/195) neonates. Bacterial pathogens contributed for 94.8% (109/115); the rest being fungal etiologies. Coagulase negative staphylococci (25.7%; 28/109), Staphylococcus aureus (22.1%; 24/109) and Klebsiella species (16.5%; 18/109) were the most commonly isolated bacteria. Conclusion: Majority of the neonates had early onset neonatal sepsis. The major etiologies isolated in our study markedly deviate from the usual organisms causing neonatal sepsis. Multicentre study and continuous surveillance are essential to tackle the current challenge to reduce neonatal mortality due to sepsis in Ethiopia.


Assuntos
Unidades de Terapia Intensiva Neonatal , Sepse , Antibacterianos/uso terapêutico , Estudos de Coortes , Etiópia/epidemiologia , Humanos , Recém-Nascido , Sepse/diagnóstico , Sepse/epidemiologia , Centros de Atenção Terciária
2.
Rev Assoc Med Bras (1992) ; 67(3): 449-453, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34468613

RESUMO

OBJECTIVE: Triggering receptor expressed on myeloid cells-1 concentration can be used as a predictive, diagnostic, and prognostic marker in patients with sepsis. The objective of this study was to determine the validity of triggering receptor expressed on myeloid cells-1 levels as a biomarker of sepsis in pediatric patients. METHODS: This was an integrative literature review. PubMed, ScienceDirect, LILACS, MEDLINE, and VHL databases were searched for papers published between 2015 and 2020, using the keywords triggering receptor expressed on myeloid cells-1, sepsis, and child. RESULTS: The review included ten studies, of which four used triggering receptor expressed on myeloid cells-1 as a predictive biomarker; four, as a diagnostic biomarker; and two, as a prognostic biomarker. A total of 1,409 and 1,628 patients were included in primary and review studies, respectively. There was a predominance of significant results for the validity of triggering receptor expressed on myeloid cells-1 levels in the prediction, diagnosis, and prognosis of sepsis in pediatric patients. CONCLUSIONS: Triggering receptor expressed on myeloid cells-1 is a valid predictive, diagnostic, and prognostic biomarker of sepsis with good sensitivity and specificity in the pediatric population.


Assuntos
Sepse , Biomarcadores , Criança , Humanos , Células Mieloides , Prognóstico , Sepse/diagnóstico , Receptor Gatilho 1 Expresso em Células Mieloides
3.
Saudi Med J ; 42(9): 994-1001, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34470838

RESUMO

OBJECTIVES: To analyze the prognostic value of serum presepsin value in community-acquired pneumonia focal sepsis using sepsis-3 criteria and its relationship with other biomarkers and clinical severity scores. METHODS: For this prospective observational study, 176 patients above 18 years old, diagnosed with community-acquired pneumonia, pneumonia focal sepsis and septic shock were included. It was performed in a tertiary hospital between May 2020 and December 2020. Blood samples were obtained from patients for presepsin levels at the time of diagnosis in the emergency room. The serum presepsin levels of 3 groups were statistically compared with each other. RESULTS: The sepsis group had significantly higher serum presepsin levels than the pneumonia group (p=0.004).The septic shock group had serum presepsin levels than sepsis group; however, the difference was not statistically significant (p=0.25). Non survivor patients had significantly higher serum presepsin levels than survivors (p=0.001). Significant correlation determined between serum presepsin level and procalcitonin, C-reactive protein, lactate, pneumonia severity index, and quick sequential organ failure assessment (qSOFA). CONCLUSION: Serum presepsin level is a new biomarker that can be used an indicator of sepsis and mortality in community-acquired pneumonia. However, for determining the prognosis of sepsis, there was no superiority detected over other biomarkers and clinical severity scores.


Assuntos
Fragmentos de Peptídeos/sangue , Pneumonia , Sepse , Adulto , Biomarcadores/sangue , Humanos , Receptores de Lipopolissacarídeos , Pneumonia/diagnóstico , Prognóstico , Sepse/diagnóstico
4.
J Med Case Rep ; 15(1): 466, 2021 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-34507615

RESUMO

BACKGROUND: Troponin levels can be elevated in various diseases other than acute myocardial infarction, including sepsis. In diseases without myocardial necrosis, the elevated troponin levels are relatively low and normalize quickly. CASE PRESENTATION: A 61-year-old Japanese man with impaired consciousness was transported to our hospital. He was diagnosed as having pneumonia and septic shock. His condition was severe, but his clinical course was good. However, his troponin level remained extremely high during admission; on the second day, it was higher than the measurable range. We consulted a cardiologist and performed echocardiography and myocardial perfusion scintigraphy but found no new ischemic changes. CONCLUSION: In septic shock, troponin levels can be extremely high, which can persist even after recovery, as in very large myocardial infarctions.


Assuntos
Sepse , Choque Séptico , Ecocardiografia , Humanos , Masculino , Pessoa de Meia-Idade , Sepse/diagnóstico , Tomografia Computadorizada por Raios X , Troponina
5.
Rev Lat Am Enfermagem ; 29: e3479, 2021.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-34495190

RESUMO

OBJECTIVE: to evaluate the performance of the quickSOFA scores and Systemic Inflammatory Response Syndrome as predictors of clinical outcomes in patients admitted to an emergency service. METHOD: a retrospective cohort study, involving adult clinical patients admitted to the emergency service. Analysis of the ROC curve was performed to assess the prognostic indexes between scores and outcomes of interest. Multivariate analysis used Poisson regression with robust variance, evaluating the relationship between variables with biological plausibility and outcomes. RESULTS: 122 patients were selected, 58.2% developed sepsis. Of these, 44.3% had quickSOFA ≥2 points, 87% developed sepsis, 55.6% septic shock and 38.9% died. In the evaluation of Systemic Inflammatory Response Syndrome, 78.5% obtained results >2 points; of these, 66.3% developed sepsis, 40% septic shock and 29.5% died. quickSOFA ≥2 showed greater specificity for diagnosis of sepsis in 86% of the cases, for septic shock 70% and for mortality 64%, whereas the second score showed better results for sensitivity with diagnosis of sepsis in 87.5%, septic shock in 92.7% and death in 90.3%. CONCLUSION: quickSOFA showed by its practicality that it can be used clinically within the emergency services, bringing clinical applicability from the risk classification of patients for the early recognition of unfavorable outcomes.


Assuntos
Sepse , Choque Séptico , Adulto , Serviço Hospitalar de Emergência , Humanos , Prognóstico , Curva ROC , Estudos Retrospectivos , Sepse/diagnóstico , Sepse/terapia
6.
F1000Res ; 10: 469, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34394916

RESUMO

Background: COVID-19 disease is accompanied by derangement of coagulation with a risk of fatal thromboembolic formation. COVID-19 patients are among those indicative for heparin treatment. Increased heparin administration among COVID-19 patients increased heparin induced-thrombocytopenia's risk with/without thrombocytopenia. Case presentation: We present a 71-year-old male patient who came to the emergency department (ED) with a COVID-19 clinical manifestation that PCR nasopharyngeal swab confirmed. He was assessed to have acute respiratory distress syndrome (ARDS), as shown by rapid progression of hypoxemic respiratory failure and bilateral pulmonary infiltrate. He was then treated with moxifloxacin, remdesivir, dexamethasone, heparin pump, and multivitamins. During admission, his respiratory symptoms got worse, so he transferred to the ICU for NIV support. On the ninth day of admission, he had gross hematuria followed by a rapid fall of platelet count. We used two different scoring systems (4Ts and HEP scoring system) to confirm the diagnosis of heparin-induced thrombocytopenia (HIT). Following the discontinuation of heparin injection, the thrombocyte continued to rise, and hematuria disappeared. Conclusion: Heparin-induced thrombocytopenia is associated with an increased risk of severe disease and mortality among COVID-19 patients. The differential diagnosis of HIT could be difficult among COVID-19 patients as thrombocytopenia can also be caused by infection progression. We use two scoring systems, 4Ts and HEP scoring, that can help us to manage the patient. With good management, we can avoid patient morbidity and mortality.


Assuntos
COVID-19 , Sepse , Trombocitopenia , Idoso , Anticoagulantes/efeitos adversos , Surtos de Doenças , Heparina/efeitos adversos , Humanos , Masculino , SARS-CoV-2 , Sepse/diagnóstico , Trombocitopenia/induzido quimicamente , Trombocitopenia/diagnóstico
7.
BMJ Open ; 11(9): e050754, 2021 09 08.
Artigo em Inglês | MEDLINE | ID: mdl-34497083

RESUMO

INTRODUCTION: Sepsis is a dysregulated host response to infection characterised by activation of proinflammatory and procoagulant mechanisms. Protein C (PC)'s activity as an anticoagulant and antiinflammatory molecule makes it an appealing target for sepsis biomarker studies. To date, there has been no systematic review of PC as a sepsis biomarker. OBJECTIVES: To evaluate the diagnostic accuracy and prognostic strength of PC as a biomarker for adult sepsis. METHODS AND ANALYSIS: Medline, Embase, Cochrane Library, PubMed and Cumulative Index to Nursing and Allied Health Literature (CINAHL) will be searched from inception through 20 January 2021 for prospective observational studies that evaluate the use of PC as a diagnostic or prognostic biomarker for adult sepsis. Title and abstract screening, full-text screening and data extraction will be conducted in duplicate. Risk of bias will be assessed using the Quality Assessment of Diagnostic Accuracy Studies and Quality in Prognostic Studies tools. If sufficient data are available, a meta-analysis will be conducted. The standardised mean difference and 95% CI will be calculated for prognostic and diagnostic studies. If possible, a hierarchical summary receiver operator characteristic curve will be generated to assess overall prognostic and diagnostic biomarker accuracy. I2 statistics will be used to assess heterogeneity. Sensitivity analysis will be performed by removing studies with a high risk of bias and re-examining the meta-analysis results. ETHICS AND DISSEMINATION: Given this is a systematic review and meta-analysis, there is no requirement for ethics approval. Findings will be disseminated through a peer-reviewed publication and social media. PROSPERO REGISTRATION NUMBER: CRD42021229786.


Assuntos
Proteína C , Sepse , Adulto , Humanos , Metanálise como Assunto , Estudos Observacionais como Assunto , Prognóstico , Sepse/diagnóstico , Revisões Sistemáticas como Assunto
8.
J Trop Pediatr ; 67(4)2021 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-34471923

RESUMO

Chromobacterium violaceum, a facultative anaerobic proteobacterium, is isolated from water and soil in tropical areas and has been implicated in infections like septicemia, visceral abscesses, skin and soft tissue infections, meningitis and diarrhea. Chromobacterium violaceum sepsis, a rarely reported phenomenon has a very high mortality rate. Here, we report a unique case of Chromobacterium sepsis in an infant. A 48-day-old baby boy was referred to our institution with h/o fever, loose stools and reduced activity. He was intubated and referred to us in septic shock. Radiological investigations revealed multiple abscesses in the liver, spleen and kidneys. The infant was successfully treated with trimethoprim-sulfamethoxazole and ciprofloxacin.


Assuntos
Infecções por Bactérias Gram-Negativas , Sepse , Antibacterianos/uso terapêutico , Chromobacterium , Ciprofloxacina/uso terapêutico , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Humanos , Lactente , Masculino , Sepse/diagnóstico , Sepse/tratamento farmacológico
9.
Pan Afr Med J ; 38: 398, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34381542

RESUMO

Situs inversus totalis is the complete transpositioning of thoracoabdominal viscera into a mirror image of the normal configuration. Choledochal cyst is the congenital cystic dilation of the biliary tract. Both these conditions coexisting in a patient is extremely rare. We hereby present a case of type IC choledochal cyst in a patient with situs inversus totalis presenting with biliary sepsis secondary to choledocholithiasis. Also detailed are the management and operative strategies employed to deal with this rare entity.


Assuntos
Cisto do Colédoco/diagnóstico , Coledocolitíase/complicações , Sepse/etiologia , Situs Inversus/diagnóstico , Adulto , Doenças Biliares/diagnóstico , Doenças Biliares/patologia , Cisto do Colédoco/patologia , Feminino , Humanos , Sepse/diagnóstico , Situs Inversus/patologia
10.
AMIA Annu Symp Proc ; 2021: 220-228, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34457136

RESUMO

Sepsis is a major cause of mortality in the intensive care units (ICUs). Early intervention of sepsis can improve clinical outcomes for sepsis patients1,2,3. Machine learning models have been developed for clinical recognition of sepsis4,5,6. A common assumption of supervised machine learning models is that the covariates in the testing data follow the same distributions as those in the training data. When this assumption is violated (e.g., there is covariate shift), models that performed well for training data could perform badly for testing data. Covariate shift happens when the relationships between covariates and the outcome stay the same, but the marginal distributions of the covariates differ among training and testing data. Covariate shift could make clinical risk prediction model nongeneralizable. In this study, we applied covariate shift corrections onto common machine learning models and have observed that these corrections can help the models be more generalizable under the occurrence of covariate shift when detecting the onset of sepsis.


Assuntos
Sepse , Humanos , Unidades de Terapia Intensiva , Aprendizado de Máquina , Sepse/diagnóstico
11.
PLoS One ; 16(8): e0256784, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34460840

RESUMO

Viral sepsis has been proposed as an accurate term to describe all multisystemic dysregulations and clinical findings in severe and critically ill COVID-19 patients. The adoption of this term may help the implementation of more accurate strategies of early diagnosis, prognosis, and in-hospital treatment. We accurately quantified 110 metabolites using targeted metabolomics, and 13 cytokines/chemokines in plasma samples of 121 COVID-19 patients with different levels of severity, and 37 non-COVID-19 individuals. Analyses revealed an integrated host-dependent dysregulation of inflammatory cytokines, neutrophil activation chemokines, glycolysis, mitochondrial metabolism, amino acid metabolism, polyamine synthesis, and lipid metabolism typical of sepsis processes distinctive of a mild disease. Dysregulated metabolites and cytokines/chemokines showed differential correlation patterns in mild and critically ill patients, indicating a crosstalk between metabolism and hyperinflammation. Using multivariate analysis, powerful models for diagnosis and prognosis of COVID-19 induced sepsis were generated, as well as for mortality prediction among septic patients. A metabolite panel made of kynurenine/tryptophan ratio, IL-6, LysoPC a C18:2, and phenylalanine discriminated non-COVID-19 from sepsis patients with an area under the curve (AUC (95%CI)) of 0.991 (0.986-0.995), with sensitivity of 0.978 (0.963-0.992) and specificity of 0.920 (0.890-0.949). The panel that included C10:2, IL-6, NLR, and C5 discriminated mild patients from sepsis patients with an AUC (95%CI) of 0.965 (0.952-0.977), with sensitivity of 0.993(0.984-1.000) and specificity of 0.851 (0.815-0.887). The panel with citric acid, LysoPC a C28:1, neutrophil-lymphocyte ratio (NLR) and kynurenine/tryptophan ratio discriminated severe patients from sepsis patients with an AUC (95%CI) of 0.829 (0.800-0.858), with sensitivity of 0.738 (0.695-0.781) and specificity of 0.781 (0.735-0.827). Septic patients who survived were different from those that did not survive with a model consisting of hippuric acid, along with the presence of Type II diabetes, with an AUC (95%CI) of 0.831 (0.788-0.874), with sensitivity of 0.765 (0.697-0.832) and specificity of 0.817 (0.770-0.865).


Assuntos
COVID-19/patologia , Metabolômica , Sepse/diagnóstico , Adulto , Área Sob a Curva , COVID-19/complicações , COVID-19/virologia , Quimiocinas/sangue , Citocinas/sangue , Feminino , Humanos , Cinurenina/sangue , Linfócitos/citologia , Masculino , Pessoa de Meia-Idade , Neutrófilos/citologia , Curva ROC , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2/isolamento & purificação , Sepse/etiologia , Índice de Gravidade de Doença , Triptofano/sangue
12.
Medicina (Kaunas) ; 57(8)2021 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-34440976

RESUMO

The diagnosis and treatment of sepsis have always been a challenge for the physician, especially in critical care setting such as emergency department (ED), and currently sepsis remains one of the major causes of mortality. Although the traditional definition of sepsis based on systemic inflammatory response syndrome (SIRS) criteria changed in 2016, replaced by the new criteria of SEPSIS-3 based on organ failure evaluation, early identification and consequent early appropriated therapy remain the primary goal of sepsis treatment. Unfortunately, currently there is a lack of a foolproof system for making early sepsis diagnosis because conventional diagnostic tools like cultures take a long time and are often burdened with false negatives, while molecular techniques require specific equipment and have high costs. In this context, biomarkers, such as C-Reactive Protein (CRP) and Procalcitonin (PCT), are very useful tools to distinguish between normal and pathological conditions, graduate the disease severity, guide treatment, monitor therapeutic responses and predict prognosis. Among the new emerging biomarkers of sepsis, Presepsin (P-SEP) appears to be the most promising. Several studies have shown that P-SEP plasma levels increase during bacterial sepsis and decline in response to appropriate therapy, with sensitivity and specificity values comparable to those of PCT. In neonatal sepsis, P-SEP compared to PCT has been shown to be more effective in diagnosing and guiding therapy. Since in sepsis the P-SEP plasma levels increase before those of PCT and since the current methods available allow measurement of P-SEP plasma levels within 17 min, P-SEP appears a sepsis biomarker particularly suited to the emergency department and critical care.


Assuntos
Receptores de Lipopolissacarídeos , Sepse , Biomarcadores , Proteína C-Reativa/análise , Serviço Hospitalar de Emergência , Humanos , Recém-Nascido , Fragmentos de Peptídeos , Sepse/diagnóstico
13.
Medicina (Kaunas) ; 57(8)2021 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-34441017

RESUMO

Background and Objectives: The aim of this study was to evaluate the diagnostic accuracy and prognostic value of neutrophil-to-lymphocyte (NLR) and platelet-to-lymphocyte (PLR) ratios and to compare them with other biomarkers and clinical scores of sepsis outside the intensive care unit. Materials and methods: In this retrospective study, 251 patients with sepsis and 126 patients with infection other than sepsis were enrolled. NLR and PLR were calculated as the ratio between absolute values of neutrophils, lymphocytes, and platelets by complete blood counts performed on whole blood by Sysmex XE-9000 (Dasit, Italy) following the manufacturer's instruction. Results: The best NLR value in diagnosis of sepsis was 7.97 with sensibility, specificity, AUC, PPV, and NPV of 64.26%, 80.16%, 0.74 (p < 0.001), 86.49%, and 53.18%, respectively. The diagnostic role of NLR significantly increases when PLR, C-reactive protein (PCR), procalcitonin (PCT), and mid-regional pro-adrenomedullin (MR-proADM) values, as well as systemic inflammatory re-sponse syndrome (SIRS), sequential organ failure assessment (SOFA), and quick-sequential organ failure assessment (qSOFA) scores, were added to the model. The best value of NLR in predicting 90-day mortality was 9.05 with sensibility, specificity, AUC, PPV, and NPV of 69.57%, 61.44%, 0.66 (p < 0.0001), 28.9%, and 89.9%, respectively. Sensibility, specificity, AUC, PPV, and NPV of NLR increase if PLR, PCR, PCT, MR-proADM, SIRS, qSOFA, and SOFA scores are added to NLR. Conclusions: NLR and PLR represent a widely useful and cheap tool in diagnosis and in predict-ing 90-day mortality in patients with sepsis.


Assuntos
Neutrófilos , Sepse , Plaquetas , Humanos , Unidades de Terapia Intensiva , Linfócitos , Prognóstico , Curva ROC , Estudos Retrospectivos , Sepse/diagnóstico
14.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 33(7): 779-785, 2021 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-34412744

RESUMO

OBJECTIVE: To verify the specific differentiated subsets of monocytes in sepsis, and to screen and construct the differential gene set of monocytes used for early diagnosis of sepsis. METHODS: Patients with sepsis admitted to Guangdong Provincial People's Hospital from June 2020 to March 2021 were enrolled, and peripheral blood mononuclear cells (PBMC) were extracted. Single-cell sequencing technology and pseudo-time analysis were used to verify the differential subsets of monocytes. Bioinformatics methods were used to analyze the expression of genes in differential subsets of monocytes and screen out differential genes for the preliminary construction of a candidate differential gene set. The digital polymerase chain reaction (PCR) technology was used to verify the candidate differential genes in PBMC of sepsis patients and sepsis human myeloid leukemia mononuclear cells (THP-1) models, and the Venn diagram was used to construct the final differential gene set of monocytes. Gene Expression Omnibus (GEO) database was used to validate the differential gene set of monocytes. RESULTS: (1) The results of cell annotation and pseudo-time analysis showed that the differentiation of NEAT1+CD163+ monocyte occurred in the early stage of sepsis was significantly different from other subsets, which validated that NEAT1+CD163+ monocyte was the characteristic subset in the pathological process of sepsis. (2) Twenty-two differential genes related to sepsis were screened out from the gene expression of NEAT1+CD163+ monocyte. After further verification by digital PCR, basic leucine zipper ATF-like transcription factor (BATF), JUNB proto-oncogene, carcinoembryonic antigen-related cell adhesion molecule 4 (CEACAM4), chromosome 9 open reading frame 95 (C9orf95), G protein subunit alpha 15 (GNA15), complement C3a receptor 1 (C3AR1), transforming growth factor beta 1 (TGFB1) and mitochondrial carrier homolog 1 (MTCH1) were screened out to construct the final differential gene set of monocytes. (3) The external validation results showed that C9orf95 gene had no data in GSE154918 and GSE133822 from GEO, it was excluded during validation. In GSE154918, the expressions of BATF, JUNB, CEACAM4, GNA15, C3AR1, TGFB1, and MTCH1 in the sepsis group were significantly higher than those in the healthy control group (log2expression level: BATF was 12.78±0.08 vs. 11.39±0.35, JUNB was 16.88±0.07 vs. 16.04±0.03, CEACAM4 was 14.73±0.08 vs. 13.77±0.05, GNA15 was 13.16±0.06 vs. 12.30±0.04, C3AR1 was 14.62±0.13 vs. 12.87±0.05, TGFB1 was 16.95±0.05 vs. 16.57±0.36, MTCH1 was 14.80±0.02 vs. 14.61±0.15, all P < 0.05). In GSE133822, the expressions of BATF, CEACAM4, GNA15, and C3AR1 in the sepsis group were significantly higher than those in the health control group (log2expression level: BATF was 8.66±0.16 vs. 7.92±0.14, CEACAM4 was 9.20±0.16 vs. 8.36±0.20, GNA15 was 10.66±0.18 vs. 10.13±0.16, C3AR1 was 11.49±0.27 vs. 10.48±0.16, all P < 0.05), while the expressions of JUNB, TGFB1, and MTCH1 were not statistically different between two groups. The results of gene set variation analysis (GSVA) showed that the enrichment scores of monocytes differential gene set of sepsis group were significantly higher than those of the healthy control group in both GSE154918 (0.38±0.04 vs. -0.44±0.02) and GSE133822 (0.56±0.02 vs. 0.20±0.05, both P < 0.01). Receiver operator characteristic curve (ROC curve) analysis showed that the differential gene set of monocytes had a reliable diagnostic value for early sepsis with the area under ROC curve (AUC) of 0.993 [95% confidence interval (95%CI) was 0.980-1.000] in GSE154918 and 0.944 (95%CI was 0.873-1.000) in GSE133822. CONCLUSIONS: A differential gene set of monocytes (BATF, JUNB, CEACAM4, GNA15, C3AR1, TGFB1, and MTCH1) screened out by single-cell sequencing and digital PCR technology has a reliable diagnostic value for the early sepsis, and may provide a new idea for the early diagnosis of sepsis.


Assuntos
Monócitos , Sepse , Diagnóstico Precoce , Humanos , Leucócitos Mononucleares , Reação em Cadeia da Polimerase , Sepse/diagnóstico , Sepse/genética , Tecnologia
15.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 33(7): 786-791, 2021 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-34412745

RESUMO

OBJECTIVE: To investigate the association between early central venous pressure (CVP) measurement and mortality in patients with sepsis. METHODS: The adult patients with sepsis were identified from the health data of Medical Information Mart for Intensive Care-III v1.4 (MIMIC-III v1.4). Data of all adult patients with sepsis were collected, including gender, age, comorbidities, length of survival, total length of hospital stay and intensive care unit (ICU) stay, sequential organ failure assessment (SOFA) score, vital signs, laboratory test results on the first day, vasoactive agents usage, fluid input, urine output and fluid balance on the first day, need for renal replacement therapy and mechanical ventilation, diagnosis of sepsis, and the time and value of the first CVP measurement in the ICU. Patients were divided into early measurement and control groups based on whether or not they had a CVP measurement within the first 6 hours of ICU stay. According to the time of the first CVP measurement, the patients were subdivided into four subgroups: ≤ 3 hours, 4-6 hours, 7-12 hours and no measurement within 12 hours. The primary endpoint was 28-day mortality. The relationship between initial CVP and mortality was analyzed by Lowess smoothing method. Kaplan-Meier survival analysis and Log-Rank test were performed for univariate analysis. Cox regression analysis was performed for multivariate analysis to estimate the relationship between timeliness of CVP measurement and mortality. RESULTS: A total of 4 733 sepsis patients were enrolled, 1 673 of whom had CVP measured within 6 hours of admission to the ICU, and the other 3 060 patients served as the control group. There were no differences in demographic characteristics and underlying diseases between the two groups, except that the early CVP measurement group had less underlying renal failure compared with control group. The early CVP measurement group had higher lactic acid (Lac) levels and SOFA scores, indicating worse severity of disease as compared with control group. The 28-day mortality in the early CVP measurement group was significantly lower than that in the control group (34.2% vs. 40.7%, P < 0.01). The early CVP measurement group had shorter length of total hospitalization and longer length of ICU stay, higher rate of mechanical ventilation and vasoactive agents dependent, and more fluid input and fluid balanced in the first day of ICU stay compared with control group. Lowess smoothing analysis showed that a "U"-shaped relationship between initial CVP and mortality was identified, suggesting that too high or too low initial CVP was associated with worse survival. Kaplan-Meier survival analysis showed that compared with the patients without early CVP measurement within 12 hours, the cumulative survival rate of patients with CVP measured within 3 hours was significantly higher (66.7% vs. 59.1%; Log-Rank test: χ2 = 15.810, adjusted P < 0.001); while no significant difference was found in patients with CVP measured between 4 hours and 6 hours and between 7 hours and 12 hours compared with the patients without early CVP measurement within 12 hours (64.4%, 60.3% vs. 59.1%; Log-Rank test: χ2 values were 5.630 and 0.100, and adjusted P values were 0.053 and > 0.999, respectively). Cox multivariate analysis showed that the Cox proportional risk model was established by taking patients without CVP measurement within 12 hours as reference, timely CVP measurement after ICU admission was associated with reduced 28-day mortality of patients with sepsis [≤ 3 hours: hazard ratio (HR) = 0.65, 95% confidence interval (95%CI) was 0.55-0.77, P < 0.001; 4-6 hours: HR = 0.72, 95%CI was 0.60-0.87, P = 0.001; 7-12 hours: HR = 0.80, 95%CI was 0.66-0.98, P = 0.032] after the confounding variables (gender, age, SOFA score, initial Lac, renal failure, maximal blood glucose and white blood cell count, and minimal platelet count within 24 hours) were adjusted. CONCLUSIONS: Early CVP measurement is associated with decreased 28-day mortality in patients with sepsis. CVP should be considered as a valuable and easily accessible safety parameter during early fluid resuscitation.


Assuntos
Análise de Dados , Sepse , Pressão Venosa Central , Humanos , Monitorização Fisiológica , Escores de Disfunção Orgânica , Sepse/diagnóstico
16.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 33(7): 792-797, 2021 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-34412746

RESUMO

OBJECTIVE: To compare the early and late predictive values of critical illness score (CIS) and procalcitonin (PCT) in septic patients with blood stream infection (BSI) induced by intra-abdominal infection (IAI), and to identify the value of PCT in etiological diagnosis. METHODS: The clinical data of patients with at least one positive blood culture within 24 hours admission to the emergency department of China-Japan Friendship Hospital from January 2014 to December 2019 and with final diagnosis of IAI induced sepsis were enrolled. Sequential organ failure assessment (SOFA), mortality in emergency department sepsis (MEDS), Logistic organ dysfunction system (LODS), and acute physiology and chronic health evaluation II (APACHE II) scores were calculated based on the parameters on the day of admission. Differences in various indicators among different Gram-stained bacterial infections and among patients with different prognosis at 28 days or 60 days were compared. Receiver operator characteristic curve (ROC curve) was used to analyze the value of PCT in differential etiological diagnosis of IAI induced sepsis caused by single bacterial infection, and the predictive value of CIS and PCT on 28-day and 60-day death of septic patients with BSI induced by IAI. RESULTS: A total of 221 septic patients with IAI caused by single bacterial infection were enrolled. The 28-day mortality was 19.9% (44/221), and the 60-day mortality was 25.8% (57/221). Mortality caused by Gram-positive (G+) bacterial infection of patients was significantly higher than that caused by Gram-negative (G-) bacterial infection (28 days: 34.6% vs. 11.4%, 60 days: 42.0% vs. 16.4%, both P < 0.01). Compared with patients with G+ bacterial infection, the PCT value of patients with G- bacterial infection was higher [µg/L: 4.31 (0.71, 25.71) vs. 1.29 (0.32, 10.83), P < 0.05]. Compared with survival group, the values of CIS and PCT in death group were higher, either in 28 days or in 60 days [death group vs. survival group in 28 days: SOFA score was 6.0 (4.0, 10.0) vs. 3.0 (2.0, 5.0), MEDS score: 11 (9, 14) vs. 6 (6, 9), LODS score: 4.0 (2.0, 6.0) vs. 1.0 (0, 2.0), APACHE II score: 17.0 (15.0, 24.0) vs. 12.0 (8.0, 15.0), PCT (µg/L): 3.48 (1.01, 26.70) vs. 2.45 (0.32, 15.65); death group vs. survival group in 60 days: SOFA score: 6.0 (4.0, 10.0) vs. 3.0 (2.0, 5.0), MEDS score: 9 (6, 14) vs. 6 (6, 9), LODS score: 4.0 (1.0, 5.0) vs. 1.0 (0, 2.0), APACHE II score: 16.5 (12.0, 20.0) vs. 12.0 (8.0, 15.0), PCT (µg/L): 2.67 (0.98, 17.73) vs. 2.22 (0.31, 16.75); all P < 0.05]. ROC curve showed that: (1) the area under ROC curve (AUC) of PCT in the diagnosis of IAI induced sepsis with single bacterial infection was 0.740 [95% confidence interval (95%CI) was 0.648-0.833]. When the optimal cut-off value of PCT was 1.82 µg/L, the sensitivity of diagnosis of G- bacterial infection was 74.0%, and the specificity was 68.2%. When PCT value was higher than 10.92 µg/L, the specificity of diagnosis of G- bacterial infection could reach 81.8%. (2) In the prediction of 28-day and 60-day mortality for septic patients with BSI induced by IAI, the APACHE II score achieved the highest AUC [28 days: 0.791 (95%CI was 0.680-0.902), 60 days: 0.748 (95%CI was 0.645-0.851)]. APACHE II score higher than 14.5 could help to predict 28-day and 60-day mortality for IAI patients with negative predictive values of 94.9% and 88.5%. However, the predictive value of PCT for septic patients with BSI induced by IAI was relatively lower [28-day AUC: 0.610 (95%CI was 0.495-0.725), 60-day AUC: 0.558 (95%CI was 0.450-0.667)]. CONCLUSIONS: PCT is more reliable in the identification of pathogen type among IAI induced sepsis with BSI, while APACHE II score may perform better in predicting early and late mortality.


Assuntos
Infecções Intra-Abdominais , Sepse , Estado Terminal , Humanos , Infecções Intra-Abdominais/diagnóstico , Pró-Calcitonina , Prognóstico , Estudos Retrospectivos , Sepse/diagnóstico
17.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 33(7): 798-802, 2021 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-34412747

RESUMO

OBJECTIVE: To investigate the value of quick sequential organ failure assessment (qSOFA) score in early identification for sepsis patients of different ages. METHODS: A retrospective study was conducted. The clinical data of 1 529 patients with suspected infection in emergency department of Changshu No.2 People's Hospital from September 2017 to March 2020 were collected. All patients were assessed for qSOFA score, and the diagnosis and treatment were recorded. Sepsis-3 was defined as the diagnostic criteria for sepsis. All the patients were divided into five groups according to age, youth group (< 45 years old), middle-aged group (45-59 years old), presenile group (60-74 years old), elderly group (75-89 years old), and longevity group (≥ 90 years old). The patients' examination results, diagnosis and treatment status were collected. The distribution of different scores of qSOFA was analyzed to calculate the sensitivity, specificity, positive predictive value and negative predictive value of different qSOFA scores for the diagnosis of sepsis in patients with suspected infection of different ages. The receiver operator characteristic curve (ROC curve) was drawn to analyze the diagnostic value of qSOFA score for sepsis in patients with suspected infection at different ages. RESULTS: Of 1 529 suspected infection patients, there were 67 patients in youth group, 129 patients in middle-aged group, 465 patients in presenile group, 778 patients in elderly group and 90 patients in longevity group. There were significant differences in lactic acid (Lac), total bilirubin (TBil), creatinine (Cr), qSOFA score and the increased value of SOFA score compared with the basic value (ΔSOFA) among the suspected infection patients at different ages. Among suspected infection patients at different ages, the patients with qSOFA score ≥ 1 were the most, and the proportion of sepsis patients was larger. Further analysis showed that qSOFA score ≥ 1 had a high diagnostic sensitivity in patients with suspected infection at different ages. In the youth group, the sensitivity was 84.4%, and the specificity was the highest (74.3%). Although qSOFA score ≥ 2 had a high specificity in the diagnosis of sepsis (all > 97%), its sensitivity was very low (all < 44%). In this study, all patients with a qSOFA score of 3 were sepsis, and the positive predictive value of the diagnosis of sepsis in each group was 100%. ROC curve analysis showed that the area under ROC curve (AUC) of qSOFA score for the diagnosis of sepsis in all suspected infection patients was 0.771 [95% confidence interval (95%CI) was 0.747-0.794], when the best cut-off value was 0.5, the sensitivity was 93.4% and the specificity was 45.6%. Among suspected infection patients of all ages, the accuracy of qSOFA score in the diagnosis of sepsis in the youth group and the longevity group was relatively high, with AUC (95%CI) of 0.825 (0.724-0.927) and 0.837 (0.756-0.917), respectively; when the best cut-off value was 0.5, the sensitivity was 84.4% or 92.2%, and the specificity was 74.3% or 56.4%, respectively. CONCLUSIONS: qSOFA score has an early diagnosis value for sepsis, especially in the patients aged < 45 years old or ≥ 90 years old. Using qSOFA score ≥ 2 to screen patients with suspected infection is likely to cause missed diagnosis.


Assuntos
Escores de Disfunção Orgânica , Sepse , Adolescente , Idoso , Idoso de 80 Anos ou mais , Humanos , Pessoa de Meia-Idade , Prognóstico , Curva ROC , Estudos Retrospectivos , Sepse/diagnóstico
18.
BMC Infect Dis ; 21(1): 780, 2021 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-34372784

RESUMO

BACKGROUND: Early recognition of patients hospitalized for sepsis at higher risk of poor clinical outcome is a mandatory task and many studies suggested that indicators of the immune status may be useful for this purpose. We performed a retrospective, monocentric cohort study to evaluate whether lymphocyte subsets may be useful in predicting in-hospital mortality of septic patients. METHODS: Data of all consecutive patients with a diagnosis of sepsis at discharge and an available peripherical blood lymphocyte subset (CD4, CD8, CD16/CD56 and CD19) analysis at hospital entry were retrospectively collected between January 2015 and August 2018. Clinical characteristics of patients, past medical history and other laboratory parameters were also considered. RESULTS: Two-hundred-seventy-eight septic patients, 171 (61.5%) males, mean age 63.2 ± 19.6 years, were enrolled. Total counts of lymphocytes, CD4 T cells, CD8 T cells and B cells were found significantly lower in deceased than in surviving patients. At univariate analyses, CD4 T cells/µL (OR 0.99 for each incremental unit, 95%CI 0.99-1.10, p < 0.0001), age (OR 1.06, 95%CI 1.04-1.09, p < 0.0001), procalcitonin (OR 1.01, 95%CI 1.01-1.02, p < 0.0001) and female gender (OR 2.81, 95%CI 1.49-5.28, p = 0.001) were associated with in-hospital mortality. When a dichotomic threshold of < 400/µL for CD4 T cells as a dependent variable was considered in multivariate models, age (OR 1.04; 95%CI 1.01-1.09, p = 0.018); female gender (OR 3.18; 95%CI 1.40-7.20, p = 0.006), qSOFA (OR 4.00, 95%CI 1.84-8.67, p < 0.001) and CD4 T cells < 400/µL (OR 5.3; 95%CI 1.65-17.00, p = 0.005) were the independent predictors. CONCLUSIONS: In adjunct to biomarkers routinely determined for the prediction of prognosis in sepsis, CD4 T lymphocytes, measured at hospital entry, may be useful in identifying patients at higher risk of in-hospital death.


Assuntos
Biomarcadores , Subpopulações de Linfócitos , Sepse , Estudos de Coortes , Feminino , Mortalidade Hospitalar , Humanos , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sepse/diagnóstico
19.
Rev Med Inst Mex Seguro Soc ; 59(3): 216-223, 2021 Aug 13.
Artigo em Espanhol | MEDLINE | ID: mdl-34369942

RESUMO

Background: Early onset neonatal sepsis (EOS) is a public health problem; antibiotic treatment is often unnecessary and can increase morbimortality. EOS risk calculator are available that allows limiting the use of antibiotics. Objective: To compare the patterns of antibiotic use and hospitalization time in infant newborns (NB) ≥ 34 weeks of gestational age (GA) in a historical cohort attended from November 2017 to April 2018 vs. a prospective cohort from November 2018 to April 2019, before and after implementing the use of an EOS risk calculator, respectively. Material and methods: Ambispective, observational, longitudinal, analytical study in infants NB ≥ 34 GA attended before and after implementing the use of an EOS risk calculator. The patterns of antibiotic´s use were compared. Simple frequencies and proportions, means and standard deviations or medians with ranges, Mann-Whitney U Test and Chi square test with SPSS V. 20.0 statistical package were used; considering significant values of p < 0.05. Results: Thirty patients were included, 15 NB for each period, the gestational age average was 36.8 ± 2.3 GA. there was no statistically significant difference in the frequency of diagnosis of EOS with blood culture or days of hospital stay. Antibiotics were beginning in all the infants attended before the implementation of the EOS risk calculator, unlike 46.7% of the infants after its implementation (p = 0.001). Conclusions: The EOS risk calculator is an easy tool to use, and demonstrated to be useful in decreasing unnecessary use of antibiotics.


Assuntos
Sepse Neonatal , Sepse , Antibacterianos/uso terapêutico , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Sepse Neonatal/diagnóstico , Sepse Neonatal/tratamento farmacológico , Estudos Prospectivos , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Sepse/diagnóstico , Sepse/tratamento farmacológico
20.
BMJ Case Rep ; 14(8)2021 Aug 11.
Artigo em Inglês | MEDLINE | ID: mdl-34380674

RESUMO

We report a case of cellulitis of the soft tissue of the neck with group B streptococcus (GBS) sepsis in a 4-week-old baby boy presented with a 1-day history of fever, irritability and feed refusal. While in the hospital, a left-sided submandibular swelling extending to preauricular area started emerging, which progressed dramatically. Ultrasound scan of the neck confirmed inflammation of the underlying soft tissue while revealing multiple enlarged lymph nodes without any abscess formation and overlying soft tissue oedema. Blood cultures were flagged positive at 9 hours for GBS. The infant was treated with intravenous antibiotics for 2 weeks. GBS is considered a common cause of early-onset sepsis in neonates. However, it can also lead to late-onset sepsis in infancy with variable presentations. In our case, GBS sepsis manifested with cellulitis of the soft tissue of the neck along with swelling of local lymph nodes.


Assuntos
Sepse , Infecções Estreptocócicas , Celulite (Flegmão)/tratamento farmacológico , Humanos , Recém-Nascido , Masculino , Pescoço , Sepse/diagnóstico , Sepse/tratamento farmacológico , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico , Streptococcus agalactiae
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