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1.
Gene ; 722: 144127, 2020 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-31525397

RESUMO

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.


Assuntos
Predisposição Genética para Doença , Infecções por Pseudomonas/genética , Pseudomonas aeruginosa , Sepse/genética , Adulto , Idoso , Grupo com Ancestrais do Continente Asiático/genética , Estudos de Casos e Controles , China/etnologia , Fator H do Complemento/genética , Frequência do Gene , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Pseudomonas/diagnóstico , Infecções por Pseudomonas/etnologia , Sepse/diagnóstico , Sepse/etnologia , Sepse/microbiologia
3.
Pediatrics ; 144(4)2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31519793

RESUMO

OBJECTIVES: We assessed racial differences in sepsis recognition in a pediatric emergency department (ED) with an established electronic sepsis alert system. METHODS: Quality-improvement data from June 1, 2016 to May 31, 2017 was used in this retrospective cohort study. All ED visits were included for non-Hispanic black (NHB) and non-Hispanic white (NHW) patients. The sepsis pathway was activated through the alert, 2 stages and a huddle, or outside of the alert using clinician judgment alone. We evaluated racial differences in the frequency of alerts and sepsis pathway activation within and outside of the alert. Multivariable regression adjusted for high-risk condition, sex, age, and insurance. RESULTS: There were 97 338 ED visits: 56 863 (58.4%) and 23 008 (23.6%) from NHBs and NHWs, respectively. NHWs were more likely than NHBs to have a positive second alert (adjusted odds ratio [aOR] 2.4; 95% confidence interval [CI] 2.1-2.8). NHWs were more likely than NHBs to have the sepsis pathway activated (aOR 1.4; 95% CI 1.02-2.1). Of those treated within the alert, there was no difference in pathway activation (aOR 0.93; 95% CI 0.62-1.4). Of those recognized by clinicians when the alert did not fire, NHWs were more likely than NHBs to be treated (aOR 3.4; 95% CI 1.8-6.4). CONCLUSIONS: NHWs were more likely than NHBs to be treated for sepsis, although this difference was specifically identified in the subset of patients treated for sepsis outside of the alert. This suggests that an electronic alert reduces racial differences compared with clinician judgment alone.


Assuntos
Afro-Americanos/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Hipotensão/diagnóstico , Sepse/diagnóstico , Taquicardia/diagnóstico , Adolescente , Criança , Pré-Escolar , Intervalos de Confiança , Diagnóstico Precoce , Feminino , Hospitais Pediátricos , Humanos , Lactente , Recém-Nascido , Masculino , Razão de Chances , Philadelphia , Melhoria de Qualidade , Qualidade da Assistência à Saúde , Análise de Regressão , Estudos Retrospectivos , Sepse/etnologia , Sepse/terapia
4.
BMC Infect Dis ; 19(1): 781, 2019 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-31492105

RESUMO

BACKGROUND: Genetic variant is one of the causes of sepsis patients' mortality. Now, many studies have identified several SNPs related to sepsis. However, none of these studies were identified in a genome-wide way. We aimed to detect genetic polymorphisms of sepsis patients. METHODS: The blood samples of eight normal controls and ten sepsis patients were collected for whole exome sequencing. Then, Single Nucleotide Polymorphisms (SNPs) were selected according to quality score and number of sepsis patients who had this variants. Synonymous mutations were removed. Genes including these remaining variants were used for functional analyses. After analyses, the remaining SNPs and indels were validated in 149 normal controls and 156 sepsis patients. Finally, serum levels of proteins coded by genes including these SNPs were evaluated. RESULTS: After whole exome sequencing, 97 SNPs and one indel site were left. Then, functional screening was performed. Only seven SNPs were used for further validation. As a result, the rs2721068 in dominant model and rs17446614 in recessive model were associated with sepsis, and the ORs of these two SNPs were 3.24 (95%CI, 1.25, 8.44) and 0.47 (0.026, 0.88), respectively. These two SNPs were both located in Forkhead box O1 (FOXO1) gene. For rs2721068 (T/T, T/C-C/C) and rs17446614 (A/A-A/G, G/G), serum levels of foxo1 in sepsis patients were both significantly lower in normal controls. CONCLUSIONS: We firstly reported that the rs2721068 and rs17446614 were correlated to genetic predisposition to sepsis.


Assuntos
Proteína Forkhead Box O1/genética , Polimorfismo de Nucleotídeo Único , Sepse/genética , Adulto , Idoso , Grupo com Ancestrais do Continente Asiático/genética , Estudos de Casos e Controles , China/epidemiologia , Feminino , Estudos de Associação Genética , Predisposição Genética para Doença/etnologia , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Sepse/etnologia , Sequenciamento Completo do Exoma
5.
J Surg Res ; 232: 88-93, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30463790

RESUMO

BACKGROUND: The Hispanic population in the United States have previously been shown to have, in some cases, better health outcomes than non-Hispanic whites (NHWs) despite having lower socioeconomic status and higher frequency of comorbidities. This epidemiologic finding is coined as the Hispanic Paradox (HP). Few studies have evaluated if the HP exists in surgical patients. Our study aimed to examine postoperative complications between Hispanic and NHW patients undergoing low- to high-risk procedures. MATERIALS AND METHODS: We conducted a retrospective cohort study analyzing adult patients who underwent high-, intermediate-, and low-risk procedures. The Healthcare Cost and Utilization Project California State Inpatient Database between 2006 and 2011 was used to identify the patient cohort. Candidate variables for the adjusted model were determined a priori and included patient demographics with the ethnic group as the exposure of interest. RESULTS: The median age for Hispanics was 52 (SD 19.3) y, and 38.8% were male (n = 87,837). A higher proportion of Hispanics had Medicaid insurance (23.9% versus 3.8%) or were self-pay (14.2% versus 4.5%) compared with NHWs. In adjusted analysis, Hispanics had a higher odds risk for postoperative complications across all risk categories combined (OR 1.06, 95% CI 1.04-1.09). They also had an increased in-hospital (OR 1.38, 95% CI 1.14-1.30) and 30-d mortality in high-risk procedures (OR 1.34, 95% CI 1.19-1.51). CONCLUSIONS: Hispanics undergoing low- to high-risk surgery have worse outcomes compared with NHWs. These results do not support the hypothesis of an HP in surgical outcomes.


Assuntos
Disparidades em Assistência à Saúde , Hispano-Americanos , Complicações Pós-Operatórias/etnologia , Adulto , Idoso , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Estudos Retrospectivos , Sepse/etnologia , Infecção da Ferida Cirúrgica/etnologia , Infecções Urinárias/etnologia
6.
Br J Nutr ; 120(12): 1415-1421, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30375291

RESUMO

Sepsis - syndrome of infection complicated by organ dysfunction - is responsible for over 750 000 hospitalisations and 200 000 deaths in the USA annually. Despite potential nutritional benefits, the association of diet and sepsis is unknown. Therefore, we sought to determine the association between adherence to a Mediterranean-style diet (Med-style diet) and long-term risk of sepsis in the REasons for Geographic Differences in Stroke (REGARDS) cohort. We analysed data from REGARDS, a population-based cohort of 30 239 community-dwelling adults age ≥45 years. We determined dietary patterns from a baseline FFQ. We defined Med-style diet as a high consumption of fruit, vegetables, legumes, fish, cereal and low consumption of meat, dairy products, fat and alcohol categorising participants into Med-style diet tertiles (low: 0-3, moderate: 4-5, high: 6-9). We defined sepsis events as hospital admission for serious infection and at least two systematic inflammatory response syndrome criteria. We used Cox proportional hazard models to determine the association between Med-style diet tertiles and first sepsis events, adjusting for socio-demographics, lifestyle factors, and co-morbidities. We included 21 256 participants with complete dietary data. Dietary patterns were: low Med-style diet 32·0 %, moderate Med-style diet 42·1 % and high Med-style diet 26·0 %. There were 1109 (5·2 %) first sepsis events. High Med-style diet was independently associated with sepsis risk; low Med-style diet referent, moderate Med-style diet adjusted hazard ratio (HR) 0·93 (95 % CI 0·81, 1·08), high Med-style diet adjusted HR=0·74 (95 % CI 0·61, 0·88). High Med-style diet adherence is associated with lower risk of sepsis. Dietary modification may potentially provide an option for reducing sepsis risk.


Assuntos
Dieta Mediterrânea , Sepse/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Afro-Americanos , Idoso , Estudos de Coortes , Grupos Étnicos , Grupo com Ancestrais do Continente Europeu , Feminino , Frutas , Hospitalização , Humanos , Inflamação , Estilo de Vida , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco , Sepse/complicações , Sepse/etnologia , Classe Social , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/etnologia , Estados Unidos , Verduras
7.
Crit Care Med ; 46(6): 878-883, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29438109

RESUMO

OBJECTIVES: To determine the racial disparities in severe sepsis hospitalizations and outcomes in U.S. academic medical center-affiliated hospitals. DESIGN: Retrospective analysis of sepsis hospitalizations. SETTINGS: U.S. academic medical center-affiliated hospitals participating in Vizient Consortium from 2012 to 2014. PATIENTS: Sepsis hospitalizations using International Classification of Diseases, Ninth revision, discharge diagnoses codes defined by the Angus method. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We compared rates of sepsis hospitalization, ICU admission, organ dysfunction, and hospital mortality between blacks and whites. We repeated the analyses stratified by community-acquired, healthcare-associated, and hospital-acquired sepsis subtypes. Of 10,244,780 hospitalizations in our cohort, 1,114,386 (10.9%) had sepsis. Sepsis subtypes included community-acquired sepsis (61.8%), healthcare-associated sepsis (23.8%), and hospital-acquired sepsis (14.4%). Although the proportion of discharges with sepsis was lower for blacks than whites (106.72 vs 109.43 per 1,000 hospitalizations; p < 0.001), the proportion of black sepsis hospitalizations was higher for individuals greater than 30 years old. Blacks exhibited lower adjusted sepsis hospital mortality than whites (odds ratio, 0.85; 95% CI, 0.84-0.86). The adjusted odds of hospital mortality following community-acquired, healthcare-associated, and hospital-acquired sepsis were lower for blacks than whites. CONCLUSIONS: In this current series of hospital discharges at U.S. academic medical center-affiliated hospitals, blacks exhibited lower adjusted rates of sepsis hospitalizations and mortality than whites.


Assuntos
Centros Médicos Acadêmicos/estatística & dados numéricos , Afro-Americanos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Sepse/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Disparidades em Assistência à Saúde/etnologia , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sepse/etnologia , Estados Unidos/epidemiologia , Adulto Jovem
8.
Crit Care Med ; 46(1): e76-e80, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29068859

RESUMO

OBJECTIVES: Interhospital transfer, a common intervention, may be subject to healthcare disparities. In mechanically ventilated patients with sepsis, we hypothesize that disparities not disease related would be found between patients who were and were not transferred. DESIGN: Retrospective cohort study. SETTING: Nationwide Inpatient Sample, 2006-2012. PATIENTS: Patients over 18 years old with a primary diagnosis of sepsis who underwent mechanical ventilation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We obtained age, gender, length of stay, race, insurance coverage, do not resuscitate status, and Elixhauser comorbidities. The outcome used was interhospital transfer from a small- or medium-sized hospital to a larger acute care hospital. Of 55,208,382 hospitalizations, 46,406 patients met inclusion criteria. In the multivariate model, patients were less likely to be transferred if the following were present: older age (odds ratio, 0.98; 95% CI, 0.978-0.982), black race (odds ratio, 0.79; 95% CI, 0.70-0.89), Hispanic race (odds ratio, 0.79; 95% CI, 0.69-0.90), South region hospital (odds ratio, 0.79; 95% CI, 0.72-0.88), teaching hospital (odds ratio, 0.31; 95% CI, 0.28-0.33), and do not resuscitate status (odds ratio, 0.19; 95% CI, 0.15-0.25). CONCLUSIONS: In mechanically ventilated patients with sepsis, we found significant disparities in race and geographic location not explained by medical diagnoses or illness severity.


Assuntos
Disparidades em Assistência à Saúde/etnologia , Unidades de Terapia Intensiva/ética , Transferência de Pacientes/ética , Racismo , Respiração Artificial/ética , Sepse/etnologia , Sepse/terapia , Grupo com Ancestrais do Continente Africano , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Ética Médica , Feminino , Hispano-Americanos , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Ordens quanto à Conduta (Ética Médica) , Estudos Retrospectivos , Estados Unidos
9.
Crit Care Med ; 45(12): e1209-e1217, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28906287

RESUMO

OBJECTIVES: As sepsis hospitalizations have increased, in-hospital sepsis deaths have declined. However, reported rates may remain higher among racial/ethnic minorities. Most previous studies have adjusted primarily for age and sex. The effect of other patient and hospital characteristics on disparities in sepsis mortality is not yet well-known. Furthermore, coding practices in claims data may influence findings. The objective of this study was to use a broad method of capturing sepsis cases to estimate 2004-2013 trends in risk-adjusted in-hospital sepsis mortality rates by race/ethnicity to inform efforts to reduce disparities in sepsis deaths. DESIGN: Retrospective, repeated cross-sectional study. SETTING: Acute care hospitals in the Healthcare Cost and Utilization Project State Inpatient Databases for 18 states with consistent race/ethnicity reporting. PATIENTS: Patients diagnosed with septicemia, sepsis, organ dysfunction plus infection, severe sepsis, or septic shock. MEASUREMENTS AND MAIN RESULTS: In-hospital sepsis mortality rates adjusted for patient and hospital factors by race/ethnicity were calculated. From 2004 to 2013, sepsis hospitalizations for all racial/ethnic groups increased, and mortality rates decreased by 5-7% annually. Mortality rates adjusted for patient characteristics were higher for all minority groups than for white patients. After adjusting for hospital characteristics, sepsis mortality rates in 2013 were similar for white (92.0 per 1,000 sepsis hospitalizations), black (94.0), and Hispanic (93.5) patients but remained elevated for Asian/Pacific Islander (106.4) and "other" (104.7; p < 0.001) racial/ethnic patients. CONCLUSIONS: Our results indicate that hospital characteristics contribute to higher rates of sepsis mortality for blacks and Hispanics. These findings underscore the importance of ensuring that improved sepsis identification and management is implemented across all hospitals, especially those serving diverse populations.


Assuntos
Grupos de Populações Continentais/estatística & dados numéricos , Mortalidade Hospitalar/etnologia , Hospitais/estatística & dados numéricos , Sepse/etnologia , Sepse/mortalidade , Afro-Americanos/estatística & dados numéricos , Idoso , Estudos Transversais , Coleta de Dados , Grupos Étnicos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/etnologia , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/etnologia , Insuficiência de Múltiplos Órgãos/mortalidade , Estudos Retrospectivos , Risco Ajustado , Choque Séptico/etnologia , Choque Séptico/mortalidade
10.
J Int Med Res ; 45(2): 504-513, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28415941

RESUMO

Objective To examine the potential relationship of EPCR polymorphisms and the risk of sepsis in a Chinese population. Methods Snapshot SNP genotyping assays and DNA sequencing methods were used to detect polymorphisms of the EPCR gene, rs2069948C/T (2532C/T) and rs867186A/G (6936A/G), in 64 patients with sepsis and in 113 controls. Soluble EPCR (sEPCR) was measured by ELISA. Results There were significant differences in the allele and genotype frequencies of EPCR gene rs2069948C/T and allele frequencies of rs867186A/G between male and female patients and controls. Females carrying rs2069948 C/T genotype or T allele and males carrying rs867186 A allele were associated with a significantly increased risk of sepsis. Plasma sEPCR levels of sepsis patients were higher than controls and showed no correlation with EPCR gene polymorphisms. Conclusions EPCR polymorphisms may be associated with increased risk of sepsis, but this has no effect on the release of sEPCR in patients with sepsis.


Assuntos
Antígenos CD/genética , Predisposição Genética para Doença , Polimorfismo de Nucleotídeo Único , Receptores de Superfície Celular/genética , Sepse/diagnóstico , Sepse/genética , Adulto , Idoso , Alelos , Antígenos CD/sangue , Grupo com Ancestrais do Continente Asiático , Estudos de Casos e Controles , Receptor de Proteína C Endotelial , Feminino , Expressão Gênica , Frequência do Gene , Humanos , Masculino , Pessoa de Meia-Idade , Receptores de Superfície Celular/sangue , Risco , Sepse/etnologia , Sepse/patologia , Análise de Sequência de DNA , Fatores Sexuais
11.
BMC Pregnancy Childbirth ; 17(1): 68, 2017 02 20.
Artigo em Inglês | MEDLINE | ID: mdl-28219420

RESUMO

BACKGROUND: Neonatal sepsis is the third leading cause of deaths for infants in their first month of life. The newly cut umbilical cord can be a pathway for bacteria that can cause newborn sepsis and death. Optimal umbilical cord care practices for newborns and during the first week of life, especially in settings with poor hygiene, has the potential to avoid these preventable neonatal deaths. The purpose of this review of cord care practices is to assist in the development of behavior-change strategies to support introduction of novel cord-care regimens, particularly 7.1% chlorhexidine digluconate for umbilical cord care. METHODS: We searched domestic and international databases for articles that were published in English between January 1, 2000, and August 24, 2016. We found 321 articles and reviewed 65 full-text articles using standardized inclusion criteria. The primary criteria for inclusion was a description of substances applied to the umbilical cord stump in the days following birth. RESULTS: We included 46 articles in this review of umbilical cord-care practices. Articles included data from 15 low- and middle-income countries in sub-Saharan Africa (8 countries), Asia (5 countries), North Africa (1 country), and Latin America and the Caribbean (1 country). Findings from this review suggest that documentation of cord-care practices is not consistent throughout low- and middle-income countries, yet existing literature depicts a firm tradition of umbilical cord care in every culture. Cord-care practices vary by country and by regions or cultural groups within a country and employ a wide range of substances. The desire to promote healing and hasten cord separation are the underlying beliefs related to application of substances to the umbilical cord. The frequency of application of the substance (either the number of days or the number of times per day the substance was applied), and source and cost of products used is not well-characterized. CONCLUSIONS: This desire to actively care for the umbilical cord of a newborn-as noted in the variety of cord care practices and beliefs identified in this review-points toward the need to contextualize any behavior change approach to align with the local culture.


Assuntos
Países em Desenvolvimento/estatística & dados numéricos , Cuidado do Lactente/métodos , Doenças do Recém-Nascido/prevenção & controle , Sepse/prevenção & controle , Cordão Umbilical/microbiologia , Anti-Infecciosos Locais/uso terapêutico , Clorexidina/análogos & derivados , Clorexidina/uso terapêutico , Cultura , Feminino , Humanos , Recém-Nascido , Doenças do Recém-Nascido/etnologia , Masculino , Morte Perinatal/prevenção & controle , Sepse/etnologia
12.
Acta Derm Venereol ; 97(5): 607-611, 2017 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-28093595

RESUMO

All-cause and cause-specific mortality among patients with pemphigus compared with the general population is yet to be established. This study investigated overall mortality and cause-specific mortality in a large immunopathologically validated cohort of patients with pemphigus. Mortality of patients with pemphigus was compared with age- and gender-matched control subjects in the general population. All-cause and cause-specific standardized mortality ratios (SMRs) were estimated. The study cohort included 245 patients newly-diagnosed with pemphigus between January 1990 and June 2016, contributing 2,679.4 person-years of follow-up. Overall, 48 deaths were observed during a mean follow-up period of 10.9 ± 8.1 years, which was more than twice the number expected (SMR 2.4; 95% confidence interval (95% CI) 1.82-3.20). The SMRs for death due to infections (22.6; 95% CI 13.6-35.3), namely pneumonia (25.7; 95% CI 11.7-48.8) and septicaemia (8.6; 95% CI 1.7-25.0), and due to cardiovascular diseases (2.8; 95% CI 1.0-6.0) were significantly higher than expected. Overall mortality among patients with pemphigus is 2.4-times greater than for the general population, mainly due to infections.


Assuntos
Pênfigo/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Árabes , Doenças Cardiovasculares/etnologia , Doenças Cardiovasculares/mortalidade , Causas de Morte , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Israel/epidemiologia , Judeus , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Pênfigo/diagnóstico , Pênfigo/etnologia , Pneumonia/etnologia , Pneumonia/mortalidade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Sepse/etnologia , Sepse/mortalidade , Fatores de Tempo , Adulto Jovem
13.
J Racial Ethn Health Disparities ; 4(4): 680-686, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-27553054

RESUMO

BACKGROUND/OBJECTIVES: The objective of this study is to investigate potential racial disparities in time to antibiotics among patients presenting to the emergency department (ED) with severe sepsis or septic shock. METHODS: This was a retrospective observational study of adults >18 years with severe sepsis or septic shock presenting to a large, urban, academic ED and admitted to the ICU from 10/2005 to 2/2012. Time to antibiotic data was abstracted by ICU research staff; other data were abstracted by blinded trained research assistants using standardized abstraction forms. Time from ED arrival to antibiotics was compared in white vs. non-white patients using cumulative events curves followed by Cox proportional hazards regression, controlling for age, gender, ethnicity, source of infection, and SOFA score. RESULTS: Seven hundred sixty-eight patients were included; 19.5 % (n = 150) were non-white. Median minutes to antibiotics was 131 in white patients vs. 158 in non-white patients (p = 0.03, log-rank test). The unadjusted hazard ratio for non-white patients was 0.82 (95 %CI 0.58-0.98). After adjustment, the hazard ratio for race was not significant (0.90, 95 %CI 0.73-1.10). CONCLUSIONS: In a single-center sample of patients with severe sepsis or septic shock, adjustment for factors including age and infectious source eliminated the difference in time to antibiotics by race. Further research should investigate disparities in sepsis care between hospitals with differing patient populations.


Assuntos
Antibacterianos/uso terapêutico , Grupos de Populações Continentais/estatística & dados numéricos , Disparidades em Assistência à Saúde/etnologia , Sepse/etnologia , Choque Séptico/etnologia , Tempo para o Tratamento/estatística & dados numéricos , Centros Médicos Acadêmicos , Idoso , Serviço Hospitalar de Emergência , Feminino , Hospitais Urbanos , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Rhode Island , Sepse/tratamento farmacológico , Choque Séptico/tratamento farmacológico
14.
J Crohns Colitis ; 11(4): 468-473, 2017 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-27683803

RESUMO

Background: Previous reports on racial disparities in the treatment of Crohn's disease [CD] in African American [AA] patients have shown differences in both medical and surgical treatments in this population. No study thus far has examined the effect of AA race on outcomes after surgery for CD. Methods: Utilizing the National Surgical Quality Improvement Program [NSQIP] Participant User File [PUF] for the years 2005-2013, we examined the effect of AA race on postoperative complications in patients with CD undergoing intestinal surgery. Results: AA patients had a significantly higher rate of complications overall compared to non-AA patients [23.5% vs 18.9%, p = 0.002]. Postoperative sepsis [10.9% vs 6.6%, p < 0.001] and surgical site infection [17.6% vs 14.8%, p = 0.037] were most significant. After adjustment for age, sex, preoperative disease severity and lifestyle factors [smoking], race remained a statistically significant factor in postoperative complication rate. Only after additional adjustment was made for comorbidities and American Society of Anesthesiologists class did race lose significance within our model. Conclusion: African Americans experience a greater amount of postoperative complications following surgery for Crohn's disease. Preoperative disease management, addressing smoking status and control of comorbid disease are important factors in addressing the racial disparities in the surgical treatment of Crohn's disease.


Assuntos
Afro-Americanos/estatística & dados numéricos , Doença de Crohn/cirurgia , Complicações Pós-Operatórias/etnologia , Adulto , Doença de Crohn/etnologia , Feminino , Disparidades nos Níveis de Saúde , Humanos , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Sepse/epidemiologia , Sepse/etnologia , Sepse/etiologia , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/etnologia , Infecção da Ferida Cirúrgica/etiologia , Resultado do Tratamento
15.
Antimicrob Agents Chemother ; 60(12): 7402-7406, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27736759

RESUMO

There are no available pharmacokinetic data to guide piperacillin dosing in critically ill Australian Indigenous patients despite numerous reported physiological differences. This study aimed to describe the population pharmacokinetics of piperacillin in critically ill Australian Indigenous patients with severe sepsis. A population pharmacokinetic study of Indigenous patients with severe sepsis was conducted in a remote hospital intensive care unit. Plasma samples were collected over two dosing intervals and assayed by validated chromatography. Population pharmacokinetic modeling was conducted using Pmetrics. Nine patients were recruited, and a two-compartment model adequately described the data. The piperacillin clearance (CL), volume of distribution of the central compartment (Vc), and distribution rate constants from the central to the peripheral compartment and from the peripheral to the central compartment were 5.6 ± 3.2 liters/h, 14.5 ± 6.6 liters, 1.5 ± 0.4 h-1, and 1.8 ± 0.9 h-1, respectively, where CL and Vc were found to be described by creatinine clearance (CLCR) and total body weight, respectively. In this patient population, piperacillin demonstrated high interindividual pharmacokinetic variability. CLCR was found to be the most important determinant of piperacillin pharmacokinetics.


Assuntos
Antibacterianos/farmacocinética , Grupo com Ancestrais Oceânicos , Piperacilina/farmacocinética , Sepse/tratamento farmacológico , APACHE , Adulto , Antibacterianos/sangue , Peso Corporal , Creatinina/sangue , Estado Terminal , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Piperacilina/sangue , Sepse/etnologia , Sepse/microbiologia , Sepse/patologia
16.
Chest ; 150(6): 1251-1259, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27615024

RESUMO

BACKGROUND: Although 28% to 49% of severe sepsis hospitalizations have been described as being "culture negative," there are very limited data on the epidemiology and outcomes of those with culture-negative severe sepsis (CNSS). The objectives of this study were to investigate the proportion and trends of CNSS and its association with mortality. METHODS: Using the Nationwide Inpatient Sample (NIS) database from 2000 to 2010, we identified adults hospitalized with severe sepsis. Those without any specific organism codes were identified as "with CNSS." We examined the proportion of CNSS hospitalizations and rates of mortality associated with it. We also assessed the independent effect of CNSS on mortality. RESULTS: Of 6,843,279 admissions of patients with severe sepsis, 3,226,406 (47.1%) had culture-negative results. The age-adjusted proportion of CNSS increased from 33.9% in 2000 to 43.5% in 2010 (P < .001). Those with CNSS had more comorbidities, acute organ dysfunction (respiratory, cardiac, hepatic, and renal dysfunction), and in-hospital mortality (34.6% vs 22.7%; P < .001), although acute kidney injury requiring dialysis was less frequent (5.3% vs 6.1%; P < .001). CNSS was an independent predictor of mortality in those with severe sepsis (OR, 1.75; 95% CI, 1.72-1.77). CONCLUSIONS: CNSS among hospitalized patients is common, and its proportion is on the rise. CNSS is associated with greater acute organ dysfunction and mortality. Having CNSS is an independent predictor of death.


Assuntos
Hospitalização/estatística & dados numéricos , Sepse/epidemiologia , Distribuição por Idade , Comorbidade , Feminino , Mortalidade Hospitalar/tendências , Humanos , Masculino , Estudos Retrospectivos , Sepse/etnologia , Sepse/mortalidade , Análise de Sobrevida , Estados Unidos/epidemiologia
17.
J Racial Ethn Health Disparities ; 3(4): 625-634, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27294755

RESUMO

BACKGROUND: Differentiating whether disparities in outcomes for sepsis among racial groups are due to differences in hospital care versus pre-hospitalization factors is an important step in developing effective strategies to reduce these disparities. As such, we examined the association between race and case fatality rates among hospitalizations for sepsis. METHODS: This was a case-control study of hospitalizations for sepsis in all acute-care, non-federal California hospitals during 2011. The association between hospital mortality and race was examined using hierarchical logistic regression analysis. RESULTS: Among 131,831 hospitalizations for sepsis, the unadjusted case fatality rates were 15.1 % in whites, 14.0 % in blacks, 13.8 % in Hispanics, and 16.2 % in Asians (P < 0.001). Compared to whites, the odds of hospital mortality was 0.84 (95 % CI 0.79-0.89) for blacks, 0.88 (95 % CI 0.84-0.92) for Hispanics, and 0.93 (95 % CI 0.87-0.98) for Asians after controlling for patient, healthcare systems, and hospital-level factors. There was no difference in the variability of sepsis mortality across hospitals between racial groups. The range of case fatality rates for sepsis among hospitals was 8.3-22.9 % for whites, 9.1-20.5 % for blacks, 7.0-19.1 % for Hispanics, and 10.0-23.0 % for Asians. CONCLUSION: Case fatality rates for sepsis hospitalizations are lower in minority racial groups in California. Future studies and interventions that seek to reduce racial disparities in sepsis need to focus on pre-hospitalization factors that contribute to population-level racial differences in sepsis outcomes.


Assuntos
Hospitalização , Sepse/mortalidade , Adulto , Idoso , California/epidemiologia , Estudos de Casos e Controles , Grupos de Populações Continentais , Grupo com Ancestrais do Continente Europeu , Feminino , Hispano-Americanos , Humanos , Masculino , Pessoa de Meia-Idade , Sepse/etnologia
18.
J Public Health Manag Pract ; 22 Suppl 1: S13-24, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-25946701

RESUMO

CONTEXT: Temporal trends in disparities in the leading causes of death within and between US demographic subgroups indicate the need for and success of interventions to prevent premature death in vulnerable populations. Studies that report recent trends are limited and outdated. OBJECTIVE: To describe temporal trends in disparities in death rates by sex and race/ethnicity for the 10 leading causes of death in the United States during 1999-2010. DESIGN: We used underlying cause of death data and population estimates from the National Vital Statistics System to calculate age-adjusted death rates for the 10 leading causes of death during 1999-2010. We measured absolute and relative disparities by sex and race/ethnicity for each cause and year of death; we used weighted linear regression to test for significance of trends over time. RESULTS: Of the 10 leading causes of death, age-adjusted death rates by sex and race/ethnicity declined during 1999-2010 for 6 causes and increased for 4 causes. But sex and racial/ethnic disparities between groups persisted for each year and cause of death. In the US population, the decreasing trend during 1999-2010 was greatest for cerebrovascular disease (-36.5%) and the increasing trend was greatest for Alzheimer disease (52.4%). For each sex and year, the disparity in death rates between Asian/Pacific Islanders (API) and other groups varied significantly by cause of death. In 2010, the API-non-Hispanic black disparity was largest for heart disease, malignant neoplasms, cerebrovascular diseases, and nephritis; the API-American Indian/Alaska Native disparity was largest for unintentional injury, diabetes mellitus, influenza and pneumonia, and suicide; and the API-non-Hispanic white disparity was largest for chronic lower respiratory diseases and Alzheimer disease. CONCLUSIONS: Public health practitioners can use these findings to improve policies and practices and to evaluate progress in eliminating disparities and their social determinants in vulnerable populations.


Assuntos
Fatores Etários , Causas de Morte/tendências , Grupos de Populações Continentais/estatística & dados numéricos , Acidentes/mortalidade , Afro-Americanos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/etnologia , Doença de Alzheimer/mortalidade , Transtornos Cerebrovasculares/etnologia , Transtornos Cerebrovasculares/mortalidade , Grupos de Populações Continentais/etnologia , Diabetes Mellitus/etnologia , Diabetes Mellitus/mortalidade , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Cardiopatias/etnologia , Cardiopatias/mortalidade , Hispano-Americanos/estatística & dados numéricos , Humanos , Influenza Humana/etnologia , Influenza Humana/mortalidade , Masculino , Pessoa de Meia-Idade , Neoplasias/etnologia , Neoplasias/mortalidade , Nefrite/etnologia , Nefrite/mortalidade , Sepse/etnologia , Sepse/mortalidade , Suicídio/etnologia , Suicídio/estatística & dados numéricos , Estados Unidos/epidemiologia , Estados Unidos/etnologia
19.
Crit Care ; 19: 347, 2015 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-26424079

RESUMO

Race has been identified as an important risk factor for the development of sepsis and as a predictor of poor outcomes in sepsis. For example, black individuals have been demonstrated to be nearly twice as likely to develop sepsis and to have greater mortality from sepsis than white individuals. Recent data from a longitudinal cohort, which examined incident hospitalizations for infections occurring among participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort, contradicts this prior research. Investigators determined that black participants were significantly less likely than white participants to present to the hospital with either infection or sepsis. Although these results are intriguing, they highlight our inadequate understanding of the relationship between race and sepsis and motivate the need for higher quality epidemiologic research to isolate the true role of race in the development of sepsis.


Assuntos
Afro-Americanos/estatística & dados numéricos , Sepse/epidemiologia , Estudos Epidemiológicos , Humanos , Fatores de Risco , Sepse/etnologia , Sepse/etiologia
20.
PLoS One ; 10(3): e0118843, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25734339

RESUMO

BACKGROUND: Recent studies have reported the association between IL-6-174G/C polymorphism and sepsis. However, the results are inconclusive and conflicting. To better understand the role of IL-6-174G/C polymorphism in sepsis, we conducted a comprehensive meta-analysis. METHODOLOGY: Literature search was conducted through PubMed, Embase, Web of Knowledge databases until July 29, 2013. The pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using fixed- or random-effect model based on heterogeneity test in total and subgroup analyses. RESULTS: Twenty studies on the risk of sepsis and seven studies on sepsis mortality were included. None of the results showed evidence of a significant association between IL-6-174G/C polymorphism and sepsis risk in overall analysis or subgroup analyses based on sepsis type, ethnicity, source of control and age under any genetic model (the allele comparison, the codominant, the recessive or the dominant model). Although there was a statistically significant association between IL-6-174 G/C polymorphism and sepsis-related mortality under the recessive model, the significance did not exist after Bonferroni's correction. CONCLUSIONS: Current evidence does not support a direct effect of IL-6-174 G/C polymorphism on the risk of sepsis. In addition, there was no association between IL-6-174 G/C polymorphism and sepsis mortality after Bonferroni's correction. Further analyses of gene-environment interactions and more studies based on larger sample size and homogeneous sepsis patients are required.


Assuntos
Interleucina-6/genética , Polimorfismo de Nucleotídeo Único , Sepse/genética , Sepse/mortalidade , Adulto , Alelos , Criança , Grupos de Populações Continentais , Expressão Gênica , Estudos de Associação Genética , Humanos , Lactente , Modelos Genéticos , Razão de Chances , Risco , Sepse/etnologia , Sepse/patologia , Análise de Sobrevida
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