Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 7.401
Filtrar
1.
Emergencias (Sant Vicenç dels Horts) ; 35(1): 53-64, feb. 2023. tab
Artigo em Espanhol | IBECS | ID: ibc-213770

RESUMO

En noviembre del año 2021, la Surviving Sepsis Campaign (SSC) publicó una actualización de sus recomendaciones y directrices de 2016. Estas fueron recibidas con una enorme expectativa en todo el mundo, especialmente entre los médicos de urgencias y emergencias (MUE). Recientemente, en el marco del CIMU 2022 (33 Congreso Mundial de Medicina de Urgencias celebrado en marzo de 2022 en Guadalajara – México) se ha revisado y analizado, desde la perspectiva del MUE, la Guía SSC de 2021. Los expertos que realizaron esa tarea y también consensuaron algunos de los puntos clave que más interesan y preocupan a los MUE en la actualidad han elaborado este documento. Su objetivo principal es analizar de forma constructiva diez de los puntos clave y recomendaciones de la SSC 2021 para complementarlas con argumentos y propuestas desde la experiencia, evidencia y perspectiva del urgenciólogo. Además, de forma secundaria, pretende ser el punto de partida de la elaboración de las guías para detectar, prevenir la progresión y atender a los pacientes con infección grave y sepsis en urgencias, que supone la meta final de lo que desde la MUE ya se conoce como “la Declaración de Guadalajara”. (AU)


The Surviving Sepsis Campaign (SSC) published a 2021 update of its 2016 recommendations. The update was awaited with great anticipation the world over, especially by emergency physicians. Under the framework of the CIMU 2022 (33rd World Emergency Medicine Conference) in Guadalajara, Mexico in March, emergency physicians reviewed and analyzed the 2021 SSC guidelines from our specialty’s point of view. In this article, the expert reviewers present their consensus on certain key points of most interest in emergency settings at this time. The main aims of the review are to present constructive comments on 10 key points and/or recommendations in the SSC 2021 update and to offer emergency physicians’ experience- and evidence-based proposals. Secondarily, the review’s recommendations are a starting point for guidelines to detect severe sepsis in emergency department patients and prevent progression, which is ultimate goal of what has become known as the Guadalajara Declaration on sepsis. (AU)


Assuntos
Humanos , Sepse/diagnóstico , Sepse/mortalidade , Sepse/prevenção & controle , Choque Séptico , Serviços Médicos de Emergência , Alerta Rápido
2.
Ren Fail ; 45(1): 2162415, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36637012

RESUMO

BACKGROUND: Both sepsis and AKI are diseases of major concern in intensive care unit (ICU). This study aimed to evaluate the excess mortality attributable to sepsis for acute kidney injury (AKI). METHODS: A propensity score-matched analysis on a multicenter prospective cohort study in 18 Chinese ICUs was performed. Propensity score was sequentially conducted to match AKI patients with and without sepsis on day 1, day 2, and day 3-5. The primary outcome was hospital death of AKI patients. RESULTS: A total of 2008 AKI patients (40.9%) were eligible for the study. Of the 1010 AKI patients with sepsis, 619 (61.3%) were matched to 619 AKI patients in whom sepsis did not develop during the screening period of the study. The hospital mortality rate of matched AKI patients with sepsis was 205 of 619 (33.1%) compared with 150 of 619 (24.0%) for their matched AKI controls without sepsis (p = 0.001). The attributable mortality of total sepsis for AKI patients was 9.1% (95% CI: 4.8-13.3%). Of the matched patients with sepsis, 328 (53.0%) diagnosed septic shock. The attributable mortality of septic shock for AKI was 16.2% (95% CI: 11.3-20.8%, p < 0.001). Further, the attributable mortality of sepsis for AKI was 1.4% (95% CI: 4.1-5.9%, p = 0.825). CONCLUSIONS: The attributable hospital mortality of total sepsis for AKI were 9.1%. Septic shock contributes to major excess mortality rate for AKI than sepsis. REGISTRATION FOR THE MULTICENTER PROSPECTIVE COHORT STUDY: registration number ChiCTR-ECH-13003934.


Assuntos
Injúria Renal Aguda , Sepse , Humanos , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/mortalidade , Unidades de Terapia Intensiva , Estudos Prospectivos , Sepse/complicações , Sepse/mortalidade , Choque Séptico/diagnóstico
3.
Am J Emerg Med ; 62: 69-77, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36270096

RESUMO

OBJECTIVE: The aim of this study was to conduct a systematic review and meta-analysis to investigate the effect of the premorbid use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (ACEI/ARB) on short-term mortality in patients with sepsis. DATA SOURCES: Embase, the Cochrane Central Register of Controlled Trials, and MEDLINE were searched for studies based on the below eligibility criteria. The protocol was registered at the PROSPERO (CRD42022309129). STUDY SELECTION: Eligibility criteria were as follows: (1) randomized controlled trials, cohort studies, cross-sectional studies, (2) patients with sepsis aged ≥16 years, and (3) received premorbid ACEI/ARB, or not. DATA EXTRACTION: The patient and study characteristics and outcomes were extracted. All analyses were presented with the use of random-effects models. The primary outcome was short-term mortality defined as ≤30-day, in-hospital, or intensive care unit (ICU)- mortality. The secondary outcome was acute kidney injury (AKI). DATA SYNTHESIS: Fifteen studies (N = 96,159) met the eligibility criteria. Of these, eleven studies (N = 40,360) reported unadjusted short-term mortalities. The pooled odds ratio (OR) of short-term mortality with the premorbid use of ACEI/ARB was as follows: OR, 0.86; 95% confidence interval (CI), 0.67 to 1.11; P = 0.24, I2 = 88%. Five studies reported an adjusted OR of short-term mortality with the premorbid use of ACEI/ARB as follows: OR, 0.74; 95%CI, 0.59 to 0.93; P < 0.01, I2 = 93%. Seven studies reported the pooled adjusted OR of AKI with the premorbid use of ACEI/ARB as follows: OR: 1.57, 95%CI: 1.26-1.96, p < 0.01, I2 = 69%. CONCLUSION: In this meta-analysis, the premorbid ACEI/ARB was associated with significantly lower short-term mortality in patients with sepsis despite the significantly higher risk of AKI.


Assuntos
Antagonistas de Receptores de Angiotensina , Inibidores da Enzima Conversora de Angiotensina , Sepse , Humanos , Injúria Renal Aguda/epidemiologia , Antagonistas de Receptores de Angiotensina/efeitos adversos , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Estudos Transversais , Sepse/tratamento farmacológico , Sepse/mortalidade
4.
Mediators Inflamm ; 2022: 3578528, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35990041

RESUMO

Purpose: This study investigated the prognostic value of the albumin-to-fibrinogen ratio (AFR) in patients with sepsis as a consequence of infection at various sites. Methods: A total of 300 patients with sepsis caused by various infection sites, who met the diagnostic criteria for sepsis hospitalized in the intensive care unit, were enrolled in this study. The observational endpoint was 28-day mortality. Cox proportional hazard regression analysis was performed to determine the potential prognostic factors for 28-day mortality in these septic patients. Receiver operating characteristic (ROC) curve analysis was used to evaluate and compare the prognostic factors for 28-day mortality. Results: Of 300 participants, 147 died, corresponding to a 28-day mortality of 49% (147/300). Baseline Acute Physiology and Chronic Health Evaluation (APACHE II) score (hazard ratio (HR) 1.18 (95% confidence interval (CI) 1.07-1.30); P < 0.001), baseline lactic acid level (HR 1.27 (95% CI 1.08-1.50); P = 0.005), the presence of septic shock (HR 21.44 (95% CI 2.51-182.76); P = 0.005), and baseline AFR (HR 0.70 (95% CI 0.62-0.80); P < 0.001) were independent prognostic factors for 28-day mortality in patients with sepsis according to multivariate Cox analysis. Baseline AFR was an effective predictor of 28-day mortality, with an area under the ROC curve (AUC) of 0.700, and a specificity and sensitivity of 90.8% and 42.1%, respectively. A low baseline AFR level was associated with increased 28-day sepsis-related mortality. The quadruple index, which included the APACHE II score, lactic acid, septic shock, and AFR, showed a more accurate predictive value for septic patients than the APACHE II score, lactic acid, septic shock, and AFR alone, with an AUC of 0.922, and specificity and sensitivity of 86.9% and 83.6%, respectively. Moreover, the triple index, which included the APACHE II score, lactic acid, and septic shock, showed a significantly lower prognostic value for 28-day mortality compared with the ROC curve of the quadruple index and triple index, with an AUC of 0.877 and specificity and sensitivity of 77.8% and 82.3%, respectively. Conclusions: The results of this study demonstrate that AFR is an independent protective factor for predicting 28-day mortality in patients with sepsis due to various infection sites. AFR combined with the APACHE II score, lactic acid, and septic shock showed a higher prognostic value for sepsis prognosis.


Assuntos
Sepse , Albuminas , Doenças Transmissíveis , Fibrinogênio , Humanos , Ácido Láctico , Prognóstico , Curva ROC , Estudos Retrospectivos , Sepse/diagnóstico , Sepse/mortalidade , Choque Séptico/etiologia
6.
Front Immunol ; 13: 965305, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35983035

RESUMO

Sepsis is a life-threatening systemic inflammatory condition causing approximately 11 million annual deaths worldwide. Although key hyperinflammation-based organ dysfunctions that drive disease pathology have been recognized, our understanding of the factors that predispose patients to septic mortality is limited. Due to the lack of reliable prognostic measures, the development of appropriate clinical management that improves patient survival remains challenging. Here, we discovered that a subpopulation of CD49chigh neutrophils with dramatic upregulation of the complement component 1q (C1q) gene expression arises during severe sepsis. We further found that deceased septic patients failed to maintain C1q protein expression in their neutrophils, whereas septic survivors expressed higher levels of C1q. In mouse sepsis models, blocking C1q with neutralizing antibodies or conditionally knocking out C1q in neutrophils led to a significant increase in septic mortality. Apoptotic neutrophils release C1q to control their own clearance in critically injured organs during sepsis; thus, treatment of septic mice with C1q drastically increased survival. These results suggest that neutrophil C1q is a reliable prognostic biomarker of septic mortality and a potential novel therapeutic target for the treatment of sepsis.


Assuntos
Neutrófilos , Sepse , Animais , Complemento C1q/genética , Modelos Animais de Doenças , Humanos , Camundongos , Sepse/mortalidade , Regulação para Cima
7.
Med. clín (Ed. impr.) ; 159(3): 124-129, agosto 2022. tab
Artigo em Espanhol | IBECS | ID: ibc-206640

RESUMO

IntroductionThe increased synthesis of CA125 in mesothelial cells is connected with pathophysiological processes, also present in sepsis, that link inflammation with systemic congestion. We propose to evaluate serum levels of this biomarker in patients with sepsis and to study its association with the severity and evolution of the disease.MethodsLongitudinal retrospective observational study, which included 126 patients admitted to an Intensive Care Unit with sepsis criteria. The main variables analyzed were: CA125 values for 7 days, the variation of its levels according to the source of infection (abdominal, pulmonary, nephrourinary and others), sepsis, septic shock, APACHE-II score and mortality.ResultsCA125 levels remained elevated throughout the study period. The abdominal focus presented higher mean levels of CA125 (62±55.5U/mL; P=.001) and were higher in non-survivors (77.2U/mL; interquartile range 35.9-118.5; P=.0273). CA125 levels>35U/mL throughout the weal had an independently effect on the evolution (relative risk [RR] 3.1; 95% confidence interval [CI] 1.6-6.2; P=.001) and the elevated mean value of CA125 was also associated with mortality (RR 1.004; 95% CI 1.001-1.005; P=.0001).ConclusionsSeptic patients presented high levels of CA125 on the study days, being higher in abdominal infections. In our study, serial determination of CA125 is a prognostic marker of mortality independent of age, origin of infection or severity. (AU)


IntroducciónLa síntesis aumentada de CA125 en las células mesoteliales se asocia a procesos fisiopatológicos presentes en la sepsis, que relacionan la inflamación con la congestión sistémica. Proponemos evaluar los niveles séricos de este biomarcador en la sepsis y estudiar su asociación con la gravedad y evolución de la enfermedad.MétodosEstudio observacional prospectivo longitudinal que incluyó a 126 pacientes que ingresaron en una unidad de cuidados intensivos con criterios de sepsis. Las variables principales analizadas fueron: valores de CA125 durante 7 días, foco causante de la infección (abdominal, pulmonar, nefrourinario y otros), sepsis, shock séptico, escala APACHE-II y mortalidad.ResultadosLos niveles de CA125 se mantuvieron elevados en el período de estudio. El foco abdominal presentó niveles medios de CA125 más elevados (62±55,5U/ml; p=0,001) y fueron superiores en los pacientes que fallecieron (77,2U/ml; rango intercuartil 35,9-118,5; p=0,0273). Los niveles de CA125>35U/ml durante toda la semana tuvieron un efecto sobre la evolución de forma independiente (riesgo relativo [RR] 3,1; intervalo de confianza [IC] 95% 1,6 a 6,2; p=0,001) y el valor medio elevado de CA125 también se asoció a la mortalidad (RR 1,004; IC 95% 1,001-1,005; p=0,0001).ConclusionesLos pacientes sépticos presentaron unos niveles elevados de CA125 en los días de estudio, siendo superiores en infecciones de foco abdominal. En nuestro estudio, la determinación seriada de CA125 es un marcador pronóstico de mortalidad independiente de la edad, el origen de la infección o la gravedad. (AU)


Assuntos
Humanos , Biomarcadores Tumorais , Antígeno Ca-125 , Estado Terminal , Sepse/metabolismo , Sepse/mortalidade , Choque Séptico/metabolismo , Choque Séptico/mortalidade , Unidades de Terapia Intensiva , Estudos Retrospectivos
8.
Arkh Patol ; 84(4): 38-44, 2022.
Artigo em Russo | MEDLINE | ID: mdl-35880598

RESUMO

With sepsis, more than a third of patients die, while the immediate causes of death may remain unknown. Autopsy largely helps to establish them. OBJECTIVE: Identification of discrepancies in the final clinical and autopsy detected diagnoses in patients with sepsis who died in the surgical intensive care unit. MATERIAL AND METHODS: 107 cases of patients with sepsis who died in the Department of Surgical Resuscitation of the Republican Scientific Center for Emergency Medical Care in 2020-2021 were studied. Autopsy was performed in 60 (56%) of the deceased. The autopsy was performed within 24 hours after the death was pronounced. The final clinical and pathoanatomic diagnoses were compared in accordance with the International Goldman System and the Russian Classification of categories of diagnosis discrepancies. RESULTS: As a result of autopsies, 3 (5%) of the deceased had a discrepancy in the diagnoses of class I and 14 (23%) - class II according to the International Goldman System. During his lifetime, diseases or their complications were not recognized in 17 (28%) cases, mainly acute myocardial infarction of type 2 (3 cases) and liver abscesses (3 cases). CONCLUSION: A pathoanatomic autopsy is a modern and important diagnostic tool that can clarify the causes of death.


Assuntos
Autopsia , Unidades de Terapia Intensiva , Sepse , Causas de Morte , Humanos , Sepse/diagnóstico , Sepse/mortalidade
9.
Isr Med Assoc J ; 24(7): 454-459, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35819214

RESUMO

BACKGROUND: Low serum albumin is known to be associated with mortality in sepsis, as it reflects effects of nutrition, catabolism, and edema. OBJECTIVES: To examine the association of albumin levels with in-hospital mortality in adults with sepsis, stratified by age groups. METHODS: This nationwide retrospective cohort study comprised patients admitted with sepsis to intensive care units in seven tertiary hospitals during 2003-2011. Only patients with available serum albumin levels at hospital admission and one week after were included. Patients with an intra-abdominal source of sepsis were excluded. The association between sepsis and mortality was analyzed using multivariate logistic regression models. RESULTS: The study included 3967 patients (58.7% male, median age 69 years). Mean serum albumin levels were 3.1 ± 0.7 g/dl at admission and 2.4 ± 0.6 g/dl one week later. In a multivariate logistic regression model, serum albumin one week after admission was inversely associated with in-hospital mortality (odds ratio [OR] 0.64, 95% confidence interval 0.55-0.73 per 1 g/dl). In an age-stratified analysis, the association was stronger with younger age (OR 0.44 for patients aged < 45 years, 0.60 for patients aged 45-65 years, and 0.67 for patients aged > 65 years). Serum albumin on admission was not associated with in-hospital mortality. CONCLUSIONS: The decline in serum albumin one week after admission is a stronger predictor of mortality in younger patients. Older patients might have other reasons for low serum albumin, which reflect chronic co-morbidity rather than acuity of disease.


Assuntos
Sepse , Albumina Sérica Humana , Idoso , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Masculino , Estudos Retrospectivos , Sepse/mortalidade , Albumina Sérica Humana/análise
10.
Crit Care ; 26(1): 167, 2022 06 08.
Artigo em Inglês | MEDLINE | ID: mdl-35676730

RESUMO

BACKGROUND: The purpose of this study was to clarify the prognostic value of Pentraxin-3 (PTX3) on the mortality of patients with sepsis. METHODS: Publications published up to January 2021 were retrieved from PubMed, EMBASE, and the Cochrane library. Data from eligible cohort and case-control studies were extracted for the meta-analysis. Multivariate regression analysis was used to evaluate the correlation of the outcomes with sample size and male proportion. RESULTS: A total of 17 studies covering 3658 sepsis patients were included. PTX3 level was significantly higher in non-survivor compared to survivor patients (SMD (95% CI): -1.06 (-1.43, -0.69), P < 0.001). Increased PTX3 level was significantly associated with mortality (HR (95% CI): 2.09 (1.55, 2.81), P < 0.001). PTX3 showed good predictive capability for mortality (AUC:ES (95% CI): 0.73 (0.70, 0.77), P < 0.001). The outcome comparing PTX3 level in non-survivors vs. survivors and the outcome of the association between PTX3 and mortality were associated with sample size but not male proportion. AUC was associated with both sample size and male proportion. CONCLUSIONS: PTX3 level was significantly higher in non-survivor compared to survivor patients with sepsis. Elevated PTX3 level was significantly associated with mortality. Furthermore, the level of PTX3 might predict patient mortality.


Assuntos
Proteína C-Reativa , Sepse , Componente Amiloide P Sérico , Biomarcadores , Proteína C-Reativa/análise , Estudos de Coortes , Humanos , Masculino , Prognóstico , Curva ROC , Sepse/mortalidade , Componente Amiloide P Sérico/análise
13.
Diagn Microbiol Infect Dis ; 103(3): 115694, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35427887

RESUMO

Granzyme B could be released from cytotoxic T lymphocytes producing apoptosis activation. The objective of our study was to determine whether an association between septic patient mortality and blood granzyme B concentrations exist. We recruited septic patients admitted in 3 Intensive Care Units. We recorded mortality at 30 days and we determined serum granzyme B concentrations at moment of sepsis diagnosis. We found higher rate of history of diabetes mellitus (P = 0.02), serum granzyme B concentrations (P < 0.001), age (P = 0.001), serum lactic acid levels (P = 0.001) and sepsis-related organ failure assessment (P < 0.001) exhibited non-surviving patients (n = 67) than surviving ones (n = 110). We found in multiple logistic regression analysis an association of serum granzyme B concentrations with mortality (odds ratio = 1.223; 95% confidence interval = 1.104-1.355; P < 0.001) controlling for diabetes mellitus, sepsis-related organ failure assessment, lactic acid and age. That we know, our study is the first reporting the existence of an association of high serum granzyme B concentrations with high septic patients mortality.


Assuntos
Granzimas , Sepse , Granzimas/sangue , Granzimas/imunologia , Humanos , Unidades de Terapia Intensiva , Ácido Láctico/sangue , Prognóstico , Estudos Prospectivos , Sepse/sangue , Sepse/imunologia , Sepse/mortalidade , Choque Séptico/sangue , Choque Séptico/imunologia , Choque Séptico/mortalidade
14.
Rev. esp. quimioter ; 35(supl. 1): 2-5, abr. - mayo 2022.
Artigo em Inglês | IBECS | ID: ibc-205337

RESUMO

Sepsis is one of the main causes of mortality in theemergency department (ED), due to the fact that signs andsymptoms are common to other acute diseases, and this canresult in delayed detection. This diagnostic complexity has ahuge impact on an entity in which early recognition determined treatment, as wells as enhance the patient’s prognosis.Therefore, it is crucial to improve early identification. Differentanalytical tools arise from this approach, such as biomarkers:procalcitonin, C-reactive protein or MR-proadrenomedullin. Inthis review we will focus on a newer biomarker, the monocyte distribution width. The main objectives are to evaluate theusefulness of monocyte distribution width (MDW) in sepsisidentification in ED, its limitations, and to compare it with other biomarkers. (AU)


Assuntos
Humanos , Biomarcadores , Sepse , Medicina de Emergência , Sepse/tratamento farmacológico , Sepse/mortalidade
16.
Dis Markers ; 2022: 5351137, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35242244

RESUMO

BACKGROUND: The aim of this study was to assess the role of prehospital point-of-care N-terminal probrain natriuretic peptide to predict sepsis, septic shock, or in-hospital sepsis-related mortality. METHODS: A prospective, emergency medical service-delivered, prognostic, cohort study of adults evacuated by ambulance and admitted to emergency department between January 2020 and May 2021. The discriminative power of the predictive variable was assessed through a prediction model trained using the derivation cohort and evaluated by the area under the curve of the receiver operating characteristic on the validation cohort. RESULTS: A total of 1,360 patients were enrolled with medical disease in the study. The occurrence of sepsis, septic shock, and in-hospital sepsis-related mortality was 6.4% (67 cases), 4.2% (44 cases), and 6.1% (64 cases). Prehospital National Early Warning Score 2 had superior predictive validity than quick Sequential Organ Failure Assessment and N-terminal probrain natriuretic peptide for detecting sepsis and septic shock, but N-terminal probrain natriuretic peptide outperformed both scores in in-hospital sepsis-related mortality estimation. Application of N-terminal probrain natriuretic peptide to subgroups of the other two scores improved the identification of sepsis, septic shock, and sepsis-related mortality in the group of patients with low-risk scoring. CONCLUSIONS: The incorporation of N-terminal probrain natriuretic peptide in prehospital care combined with already existing scores could improve the identification of sepsis, septic shock, and sepsis-related mortality.


Assuntos
Mortalidade Hospitalar , Peptídeo Natriurético Encefálico , Escores de Disfunção Orgânica , Fragmentos de Peptídeos , Valor Preditivo dos Testes , Sepse/epidemiologia , Sepse/mortalidade , Idoso , Serviços Médicos de Emergência , Serviço Hospitalar de Emergência , Feminino , Hospitalização , Humanos , Masculino , Prognóstico , Estudos Prospectivos , Sepse/diagnóstico
17.
Oxid Med Cell Longev ; 2022: 6339355, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35265263

RESUMO

Objective: To explore the regulation of endogenous sulfur dioxide on oxidative stress in lung injury induced by sepsis. Method: Forty male Sprague Dawley rats were divided into control, sepsis, sepsis + SO2, and SO2 group randomly used to observe survival rate. The other group of twenty-eight rats were randomly divided as the same manner for mechanism research. The number of WBCS and the percentage of PMN cells were calculated. The microphotographs of morphological changes and the index of quantitative assessment (IQA) of lung tissues were calculated. The ratio of wet/dry (W/D) of lung tissues was calculated. Levels of H2O2, MDA, NO, MPO, SOD, GSH-px, and TNF-α in plasma and lung tissues were measured. Result: The number of WBCS and the percentage of PMN cells decreased in sepsis (p all < 0.05), and rebound in sepsis+SO2 (p all < 0.05). The IQA and W/D of lung tissues increased in sepsis (p for W/D < 0.05), and decreased in sepsis+SO2 (p all < 0.05). H2O2 and MDA of plasma and lung tissues increased in sepsis (p all < 0.05) and rebound in sepsis+SO2 (p for H2O2 of plasma and lung tissues <0.05). NO and MPO of plasma and lung tissues increased in sepsis (p for NO and MPO of lung tissues <0.05) and rebound in sepsis+SO2 (p all < 0.05). SOD of plasma and lung tissues in sepsis group decreased (p all <0.05) and increased in sepsis+SO2 (p all < 0.05). GSH-px of plasma and lung tissues decreased in sepsis (p for plasma <0.05) and increased in sepsis+SO2 (p for GSH-px of lung tissues <0.05). TNF-α of plasma and lung tissues increased in sepsis (p all<0.05) and decreased in sepsis+SO2 (p for lung tissue <0.05). Conclusion: Endogenous sulfur dioxide improves the survival rate of sepsis by improving the oxidative stress response during lung injury.


Assuntos
Lesão Pulmonar Aguda/complicações , Lesão Pulmonar Aguda/terapia , Estresse Oxidativo/efeitos dos fármacos , Sepse/tratamento farmacológico , Dióxido de Enxofre/uso terapêutico , Lesão Pulmonar Aguda/mortalidade , Animais , Masculino , Ratos , Ratos Sprague-Dawley , Sepse/mortalidade , Dióxido de Enxofre/farmacologia , Análise de Sobrevida , Taxa de Sobrevida
18.
Sci Rep ; 12(1): 3925, 2022 03 10.
Artigo em Inglês | MEDLINE | ID: mdl-35273276

RESUMO

Sepsis is a major reason for preventable hospital deaths. A cluster-randomized controlled trial on an educational intervention did not show improvements of sepsis management or outcome. We now aimed to test an improved implementation strategy in a second intervention phase in which new intervention hospitals (former controls) received a multifaceted educational intervention, while controls (former intervention hospitals) only received feedback of quality indicators. Changes in outcomes from the first to the second intervention phase were compared between groups using hierarchical generalized linear models controlling for possible confounders. During the two phases, 19 control hospitals included 4050 patients with sepsis and 21 intervention hospitals included 2526 patients. 28-day mortality did not show significant changes between study phases in both groups. The proportion of patients receiving antimicrobial therapy within one hour increased in intervention hospitals, but not in control hospitals. Taking at least two sets of blood cultures increased significantly in both groups. During phase 2, intervention hospitals showed higher proportion of adequate initial antimicrobial therapy and de-escalation within 5 days. A survey among involved clinicians indicated lacking resources for quality improvement. Therefore, quality improvement programs should include all elements of sepsis guidelines and provide hospitals with sufficient resources for quality improvement.Trial registration: ClinicalTrials.gov, NCT01187134. Registered 23 August 2010, https://www.clinicaltrials.gov/ct2/show/study/NCT01187134 .


Assuntos
Antibacterianos/administração & dosagem , Melhoria de Qualidade , Qualidade da Assistência à Saúde , Sepse/tratamento farmacológico , Sepse/mortalidade , Idoso , Feminino , Alemanha , Mortalidade Hospitalar , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Gravidade do Paciente , Resultado do Tratamento
19.
Pediatr Dev Pathol ; 25(4): 409-418, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35227107

RESUMO

PURPOSE AND CONTEXT: Streptococcal Infection (SI) is an important cause of pediatric death in children, yet limited reports exist on autopsy findings in fatal SI cases. METHOD: Case records (1997-2019) of SI with no pre-existing risk factors were reviewed and selected. Their clinical and pathological findings in the autopsy reports were analyzed. RESULTS: In our cohort of 38 cases based on bacterial culture results, SI was most commonly caused by Streptococcus pneumoniae (SPn; 45%) and Streptococcus pyogenes (SPy; 37%). 92% of decedents had some prodromal symptoms prior to terminal presentation. The clinical course was often rapid, with 89% found unresponsive, suddenly collapsing, or dying within 24 hours of hospital admission. 64% of deaths were attributed to sepsis, more frequently diagnosed in the SPy group than in the SPn group (71% vs 48%). Pneumonia was found in both SPn and SPy groups, whereas meningitis was exclusively associated with SPn. CONCLUSION: Our study shows fatal SI is most commonly caused by either SPn or SPy, both of which are frequently associated with prodromal symptoms, rapid terminal clinical course, and evidence of sepsis. Postmortem diagnosis of sepsis is challenging and should be correlated with clinical features, bacterial culture results, and autopsy findings.


Assuntos
Infecções Estreptocócicas , Autopsia , Causas de Morte , Criança , Humanos , Sintomas Prodrômicos , Sepse/diagnóstico , Sepse/microbiologia , Sepse/mortalidade , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/microbiologia , Infecções Estreptocócicas/mortalidade , Streptococcus pneumoniae/isolamento & purificação , Streptococcus pyogenes/isolamento & purificação
20.
Acta Biochim Pol ; 69(1): 113-117, 2022 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-35225489

RESUMO

OBJECTIVE: Sepsis is a host response with life-threatening organ dysfunction caused by an infection. Although the overall mortality rate has increased from 30% to 37% by the surviving sepsis campaign, it is still not acceptable. Early identification, accurate stratification and appropriate intervention can improve the prognosis. In this study we assessed the risk stratification and prognostic value of serum neutrophil gelatinase-associated lipocalin (sNGAL) as a biomarker in sepsis patients. METHODS: A total of 112 sepsis patients (38 patients with sepsis, 41 patients with severe sepsis, 33 patients with septic shock) and 25 healthy controls were enrolled in this study. Serum samples of all patients were collected and frozen before testing. Basic patient information was collected, including age, gender, primary infection, complications, and so on. Results of serum calcitonin, lactic acid, and SOFA score were followed up for 28 days. RESULTS: Levels of serum procalcitonin (PCT), serum lactate, Sequential Organ Failure Assessment (SOFA) score and sNGAL of sepsis patients were significantly higher (p<0.05) than those of controls. The sNGAL level in sepsis patients who were alive on the 28th day of follow-up was significantly lower (p<0.05) than that of sepsis patients who had died before the 28th day of follow-up. Multiple logistic regression analysis showed that sNGAL-0h and lactates were independent risk factors of death due to sepsis within 28 days. At cut-off value of 250 ng/mL, the sensitivity and specificity sNGAL-0h predicting the 28-day mortality in septic patients were 0.838 and 0.827, respectively. The sNGAL level in sepsis patients with acute kidney injury (AKI) was significantly higher (p<0.05) than in sepsis patients without AKI. CONCLUSION: Serum NGAL may contribute to the assessment of the severity of sepsis. Serum NGAL and lactate can be independent risk factors for 28-day mortality in sepsis patients. Serum NGAL has potential of predicting septic-AKI.


Assuntos
Lipocalina-2/sangue , Sepse/sangue , Injúria Renal Aguda/sangue , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Feminino , Humanos , Ácido Láctico/sangue , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/sangue , Gravidade do Paciente , Prognóstico , Medição de Risco , Fatores de Risco , Sepse/mortalidade , Choque Séptico/sangue
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...