Organ Dysfunctions during Severe Sepsis and Septic-Like Syndromes: Epidemiology, Classification, and Mechanisms

Background: Severe sepsis is the leading cause to Intensive Care Unit (ICU) admission. However few studies have described the primary source of the severe sepsis in Bangladesh.Objectives: General objective was to identify the clinical presentation of infection in severe sepsis patients & specific objective was to determine the primary and commonest source of infection in severe sepsis.Methods: This was a prospective cross sectional study done over seven months period starting from June 1, 2012 to December 31, 2012 in the dept. of Critical Care Medicine of BIRDEM General Hospital. All ICU admissions from the emergency department, medical and surgical in patients who were screened daily for the presence of severe sepsis or septic shock using a screening tool, which included definitions of sepsis and organ dysfunctions. All consecutive patients with severe sepsis were enrolled as study subjects.Results: A total of 228 patients were admitted in ICU and among them, 95 patients of severe sepsis were included . The mean age of the patients was 59.56 years & male to female ratio being 3:2. Ninety two (92% ) patients had any kind of comorbidity. Commonest comorbidity was diabetes mellitus (77%). Respiratory, renal dysfunction, and cardiovascular, were the most frequent organ dysfunctions (87% , 64%, 58%, respectively). In severesepsis patients single organ dysfunction was 30 %, double organ dysfunction was also 30% & triple organ dysfunction was 35% of patients. The most common primary source of infection were the respiratory system 70%, followed by urinary tract11% , intravascular catheter related infection 7% and abdomen 5%.Conclusion: Severe sepsis is a significant & common health problem in ICU Patients of Bangladesh. An understanding of the primary sources of severe sepsis is vital for treatment and these information will allow us to make preventive strategy for severe sepsis.Bangladesh Crit Care J September 2015; 3 (2): 45-48

Download Full-text

The impact of organ dysfunctions on mortality in patients with severe sepsis: A multicenter prospective observational study

Journal of Critical Care ◽

10.1016/j.jcrc.2018.03.011 ◽

2018 ◽

Vol 45 ◽

pp. 178-183 ◽

Cited By ~ 5

Author(s):

Daisuke Kudo ◽

Shigeki Kushimoto ◽

Noriko Miyagawa ◽

Tetsuya Sato ◽

Masatsugu Hasegawa ◽

...

Keyword(s):

Severe Sepsis ◽

Observational Study ◽

Prospective Observational Study ◽

Multicenter Prospective Observational Study ◽

The Impact ◽

Organ Dysfunctions

Download Full-text

Severe sepsis with multiple organ dysfunctions caused by Pseudomonas aeruginosa in an immunocompetent child

Critical Care ◽

10.1186/cc11756 ◽

2012 ◽

Vol 16 (S3) ◽

Author(s):

G Jugulete ◽

M Luminos ◽

A Visan ◽

A Draganescu ◽

M Merisescu ◽

...

Keyword(s):

Pseudomonas Aeruginosa ◽

Severe Sepsis ◽

Multiple Organ ◽

Immunocompetent Child ◽

Organ Dysfunctions

Download Full-text

Angiopoietin-2 outperforms other endothelial biomarkers associated with severe acute kidney injury in patients with severe sepsis and respiratory failure

Critical Care ◽

10.1186/s13054-021-03474-z ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

Wen-Kuang Yu ◽

J. Brennan McNeil ◽

Nancy E. Wickersham ◽

Ciara M. Shaver ◽

Julie A. Bastarache ◽

...

Keyword(s):

Acute Kidney Injury ◽

Severe Sepsis ◽

Respiratory Failure ◽

Endothelial Dysfunction ◽

Kidney Injury ◽

Vascular Endothelial ◽

Primary Analysis ◽

Independent Association ◽

Angiopoietin 2 ◽

Organ Dysfunctions

Abstract Background Endothelial dysfunction and injury is a major pathophysiologic feature of sepsis. Sepsis is also the most frequent cause of acute kidney injury (AKI) in critically ill patients. Though most studies of AKI in sepsis have focused on tubular epithelial injury, the role of endothelial dysfunction and injury is less well studied. The goal of this study was first to investigate whether endothelial dysfunction and injury biomarkers were associated with severe AKI in sepsis patients. The second goal was to determine the best performing biomarker for severe AKI and whether this biomarker was associated with severe AKI across different etiologies of sepsis and clinical outcomes. Methods We studied adults with severe sepsis and acute respiratory failure (ARF) enrolled in the prospective observational Validating Acute Lung Injury markers for Diagnosis (VALID) study. Plasma endothelial dysfunction and injury biomarkers, including angiopoietin-2, soluble vascular endothelial cadherin (sVE-cadherin), endocan and syndecan-1, were measured at study enrollment. Primary analysis focused on the association between endothelial biomarker levels with severe AKI (defined as Kidney Disease: Improving Global Outcomes [KDIGO] AKI stage 2 or 3), other organ dysfunctions (defined by Brussels organ failure scores), and comparison of pulmonary versus non-pulmonary sepsis. Results Among 228 sepsis patients enrolled, 141 developed severe AKI. Plasma levels of angiopoietin-2, endocan, sVE-cadherin, and syndecan-1 were significantly higher in sepsis patients with severe AKI compared to those without severe AKI. Among four endothelial biomarkers, only angiopoietin-2 was independently associated with severe AKI (odds ratio 6.07 per log increase, 95% CI 2.34–15.78, p < 0.001). Plasma angiopoietin-2 levels by quartile were significantly higher in sepsis patients with hepatic, coagulation, and circulatory failure. Plasma angiopoietin-2 levels were also significantly higher in patients with non-pulmonary sepsis compared to subjects with pulmonary sepsis. Conclusion Among four biomarkers of endothelial dysfunction and injury, angiopoietin-2 had the most robust independent association with development of severe AKI in patients with severe sepsis and ARF. Plasma angiopoietin-2 levels were also associated with other organ dysfunctions, non-pulmonary sepsis, and death. These findings highlight the importance of early endothelial dysfunction and injury in the pathogenesis of sepsis-induced AKI.

Download Full-text