Positive outcomes, mortality rates, and publication bias in septic shock trials

2018 ◽  
Vol 44 (9) ◽  
pp. 1584-1585 ◽  
Author(s):  
Harm-Jan de Grooth ◽  
Jean-Jacques Parienti ◽  
Jonne Postema ◽  
Stephan A. Loer ◽  
Heleen M. Oudemans-van Straaten ◽  
...  
Keyword(s):  
Septic Shock ◽  
Publication Bias ◽  
Mortality Rates ◽  
Positive Outcomes

Disease Severity Is an Independent Risk Factor of Mortality and Outcomes in Critically Ill Patients With Carbapenem-resistant Klebsiella Pneumoniae Bloodstream Infections: a 5-year Retrospective Analysis

2021 ◽  
Author(s):  
Yuzhen Qiu ◽  
Wen Xu ◽  
Yunqi Dai ◽  
Ruoming Tan ◽  
Jialin Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Klebsiella Pneumoniae ◽  
Critically Ill Patients ◽  
Bloodstream Infections ◽  
Polymyxin B ◽  
Mortality Rates ◽  
Carbapenem Resistant ◽  
All Cause Mortality ◽  
Independent Risk Factors

Abstract Background: Carbapenem-resistant Klebsiella pneumoniae bloodstream infections (CRKP-BSIs) are associated with high morbidity and mortality rates, especially in critically ill patients. Comprehensive mortality risk analyses and therapeutic assessment in real-world practice are beneficial to guide individual treatment.Methods: We retrospectively analyzed 87 patients with CRKP-BSIs (between July 2016 and June 2020) to identify the independent risk factors for 28-day all-cause mortality. The therapeutic efficacies of tigecycline-and polymyxin B-based therapies were analyzed.Results: The 28-day all-cause mortality and in-hospital mortality rates were 52.87% and 67.82%, respectively, arising predominantly from intra-abdominal (56.32%) and respiratory tract infections (21.84%). A multivariate analysis showed that 28-day all-cause mortality was independently associated with the patient’s APACHE II score (p = 0.002) and presence of septic shock at BSI onset (p = 0.006). All-cause mortality was not significantly different between patients receiving tigecycline- or polymyxin B-based therapy (55.81% vs. 53.85%, p = 0.873), and between subgroups mortality rates were also similar. Conclusions: Critical illness indicators (APACHE II scores and presence of septic shock at BSI onset) were independent risk factors for 28-day all-cause mortality. There was no significant difference between tigecycline- and polymyxin B-based therapy outcomes. Prompt and appropriate infection control should be implemented to prevent CRKP infections.

scholarly journals Continuing chronic beta-blockade in the acute phase of severe sepsis and septic shock is associated with decreased mortality rates up to 90 days

2017 ◽  
Vol 119 (4) ◽  
pp. 616-625 ◽  
Author(s):  
C. Fuchs ◽  
S. Wauschkuhn ◽  
C. Scheer ◽  
M. Vollmer ◽  
K. Meissner ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Acute Phase ◽  
Mortality Rates ◽  
Beta Blockade ◽  
Sepsis And Septic Shock

scholarly journals Mortality rates in pediatric septic shock

2017 ◽  
Vol 56 (5) ◽  
pp. 304 ◽  
Author(s):  
Desy Rusmawatiningtyas ◽  
Nurnaningsih Nurnaningsih
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Intensive Care ◽  
Mortality Rate ◽  
Fluid Overload ◽  
Pediatric Intensive Care ◽  
Developed Countries ◽  
Mortality Rates ◽  
Study Cohort ◽  
Survival Group

Background Septic shock remains a major cause of morbidity and mortality in children admitted to the intensive care unit. Recent investigations from developed countries have reported mortality rates of 20-30%. Few studies have reported mortality rates from pediatric septic shock in intensive care settings in developing countries with limited resources.  Objective  To determine the current mortality rates for pediatric patients with septic shock in a developing country.Methods A retrospective study was conducted in the Pediatric Intensive Care Unit (PICU) at DR. Sardjito General Hospital. Medical records and charts were reviewed and recorded for diagnoses of septic shock, from November 1st, 2011 to June 30th, 2014. Results  A database of all PICU admissions was assembled, and cases with diagnoses of septic shock were reviewed. The final data consisted of 136 patients diagnosed with septic shock. Septic shock was defined as a clinical suspicion of sepsis, manifested by hyperthermia or hypothermia, and accompanied by hypoperfusion  The overall mortality rate for the study cohort was 88.2%.  The median age of patients was 16 months, with 52.2% males. Median initial PRISM III and PELOD scores were 10 and 22, respectively. The median length of PICU stay was 4 days. A total of 48.5% of the subjects were in need of crystalloid and colloid fluid at a median amount of 40 mL/kg. The median time required to complete the initial resuscitation was 60 minutes. Mechanical ventilator support in the first 24 hours was required in 79.4% of the cases. Fluid overload of > 10% (FO>10%) was found in 58.8% of the subjects.Conclusion The mortality rate in pediatric septic shock in our hospital is very high. There is a higher incidence of fluid overload in the non-survival group .

Norepinephrine and Vasopressin Compared With Norepinephrine and Epinephrine in Adults With Septic Shock

2019 ◽  
Vol 53 (9) ◽  
pp. 877-885 ◽  
Author(s):  
Bryan E. Menich ◽  
Todd A. Miano ◽  
Gourang P. Patel ◽  
Drayton A. Hammond
Keyword(s):  
Septic Shock ◽  
Propensity Score ◽  
Propensity Scores ◽  
Variance Estimation ◽  
Mortality Rates ◽  
Matched Cohort ◽  
Free Survival ◽  
Entire Cohort ◽  
Robust Variance ◽  
Robust Variance Estimation

Background: The optimal adjuvant vasopressor to norepinephrine in septic shock remains controversial. Objective: To compare durations of shock-free survival between adjuvant vasopressin and epinephrine. Methods: A retrospective, single-center, matched cohort study of adults with septic shock refractory to norepinephrine was conducted. Patients receiving norepinephrine not at target mean arterial pressure (MAP; 65 mm Hg) were initiated on vasopressin or epinephrine to raise MAP to target. Vasopressin-exposed patients were matched to epinephrine-exposed patients using propensity scores. Mortality outcomes were examined using multivariable Poisson regression with robust variance estimation. Results: Of 166 patients, 96 (entire cohort) were included in the propensity score–matched cohort. Shock-free survival durations in the first 7 days were similar between epinephrine- and vasopressin-exposed patients in the matched cohort (median = 13.2 hours, interquartile range [IQR] = 0-121.0, vs median = 41.3 hours, IQR = 0-125.9; P = 0.51). Seven- and 28-day mortality rates were similar in the matched cohort (7-day: 47.9% vs 39.6%, P = 0.35; 28-day: 56.3% vs 58.3%, P = 0.84). Mortality rates were similar between epinephrine- and vasopressin-exposed patients in propensity score–matched regression models with and without adjustments at 7 (relative risk [RR] = 1.28, 95% CI = 0.92-1.79; RR = 1.21, 95% CI = 0.81-1.81) and 28 days (RR = 1.04, 95% CI = 0.81-1.34; RR = 0.96, 95% CI = 0.69-1.34). Conclusion and Relevance: Shock-free survival durations were similar in matched epinephrine- and vasopressin-exposed groups. Adjuvant epinephrine or vasopressin alongside norepinephrine to raise MAP to target requires further investigation.

scholarly journals Staphylococcus Aureus Bacteremia Due to Central Venous Catheter Infection: A Clinical Comparison of Infections Caused by Methicillin-Resistant and Methicillin-Susceptible Strains

2021 ◽  
Author(s):  
Kazuhiro Ishikawa ◽  
Keichi Furukawa ◽  
Eri Hoshino
Keyword(s):  
Staphylococcus Aureus ◽  
Septic Shock ◽  
Mortality Rate ◽  
Central Venous Catheter ◽  
Antimicrobial Therapy ◽  
Time Lag ◽  
Venous Catheter ◽  
Mortality Rates ◽  
Background Characteristics ◽  
Central Venous

Abstract Background: Staphylococcus aureus (S.aureus) bacteremia has a mortality rate ranging from 20-40%. Central venous catheter (CVC) infection is the leading cause of S.aureus bacteremia. We investigated the differences in background characteristics, complications, and prognosis between patients with methicillin resistant S.aureus (MRSA) and methicillin sensitive S.aureus (MSSA) bacteremia due to CVC infection.Methods: We retrospectively investigated patients who had positive peripheral blood cultures versus positive semi-quantitative cultures for MRSA or MSSA from the CVC tip. We compared the clinical background characteristics, complications, and 60-day mortality rates between both groups. We analyzed our data using Mann-Whitney U test, chi-square test, and Fisher’s exact test.Results: This study had 17 (47%) and 19 (53%) MRSA and MSSA bacteremia patients, respectively. The median ages for MRSA and MSSA patients were 72 ± 27 and 55 ± 33 years, respectively (P<0.01). Comparison between baseline disease occurrence (MRSA vs. MSSA) was 10(59%) patients vs. 3(16%) patients (P=0.01), while complications included septic shock were 8(48%) vs. 3(16%) (P=0.07), respectively. The duration of catheter placement, time lag from onset of fever to CVC removal, and time lag from onset of fever to starting antimicrobial therapy were similar in both groups. Sixty-day mortality rates were 35%(6/17) vs. 5.3%(1/19), (P=0.04), in MRSA vs. MSSA groups, respectively. Conclusions: MRSA carriers and older patients were at a higher risk of MRSA CVC infection compared to MSSA bacteremia patients. MRSA bacteremia patients showed relatively higher rate of septic shock, and had significantly higher 60-day mortality rate despite appropriate antimicrobial therapy.

ST-Elevation Myocardial Infarction Among Septic Shock and Coronary Interventions: A National Emergency Database Study

2021 ◽  
pp. 088506662110617
Author(s):  
Tanveer Mir ◽  
Mohammed Uddin ◽  
Waqas T. Qureshi ◽  
Shady Abohashem ◽  
Shehabaldin Alqalyoobi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Septic Shock ◽  
Logistic Regression ◽  
Coronary Angiography ◽  
The United States ◽  
Mortality Rates ◽  
Exact Matching ◽  
Coronary Interventions ◽  
Significant Difference ◽  
National Emergency

Objective To study coronary interventions and mortality among patients with ST-elevated myocardial infarction (STEMI) who were admitted with septic shock. Methods Data from the national emergency department sample (NEDS) that constitutes 20% sample of hospital-owned emergency departments in the United States was analyzed for the septic shock related visits from 2016 to 2018. Septic shock was defined by the ICD codes. Results Out of 1 375 507 adult septic shock patients, 521 300 had a primary diagnosis of septic shock (mean age 67.41±15.67 years, 51.1% females) in the national emergency database for the years 2016 to 2018. Of these patients, 2768 (0.53%) had STEMI recorded during the hospitalization. Mortality rates for STEMI patients were higher than patients without STEMI (52.3% vs 23.5%). Mortality rates improved with PCI among STEMI patients (43.8% vs 56.2%). Coronary angiography was performed among 16% of patients of which percutaneous coronary intervention (PCI) rates were 7.7% among patients with STEMI septic shock. PCI numerically improved mortality, however, had no significant difference than patients without PCI on multivariate logistic regression and univariate logistic regression post coarsened exact matching of baseline characteristics among STEMI patients. Among the predictors, STEMI was a significant predictor of mortality in septic shock patients (OR 2.87, 95% CI 2.37-3.49; P<.001). Age, peripheral vascular disease, were predominant predictors of mortality in STEMI with septic shock subgroup ( P <.001). Pneumonia was the predominant underlying infection among STEMI (36.4%) and without STEMI group (29.5%). Conclusion STEMI complicating septic shock worsens mortality. PCI and coronary angiography numerically improved mortality, however, had no significant difference from patients without PCI. More research will be needed to improve mortality in such a critically ill subgroup of patients.

“Generic” Creativity as a Predictor or Outcome of Identity Development?

2018 ◽  
Vol 5 (2) ◽  
pp. 159-164
Author(s):  
Baptiste Barbot
Keyword(s):  
Identity Development ◽  
Publication Bias ◽  
Positive Outcomes ◽  
Creativity Research ◽  
Epistemological Position ◽  
The Relationship

AbstractIn this brief commentary to Kaufman’s call for a “new agenda for positive outcomes” of creativity research, I emphasize how the broad construct of “identity” qualifies as such an outcome. While doing so, I challenge the issue of directionality (predictor vs. outcome) of creativity in relation to relevant correlates by outlining the influence of epistemological position and publication bias in directional interpretations of correlational findings. Through illustrations of various levels of relationships between creativity and identity, I also urge creativity researchers to be more explicit regarding how “generic” creativity is being operationalized in their study, so that more targeted hypotheses regarding the relationship between distinct aspects of creativity and such positive out-come variables may be formulated.

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