IN HOSPITAL MORTALITY BENEFIT WITH COMBINED LOW DOSE VITAMIN C AND HYDROCORTISONE IN SEVERE SEPSIS AND SEPTIC SHOCK

Background: Left ventricular systolic dysfunction (LVSD) and LV diastolic dysfunction (LVDD) are commonly seen in severe sepsis and septic shock; however, their role in patients with concurrent invasive mechanical ventilation (IMV) is less well defined. Methods: This was a prospective observational study on all patients admitted to all the intensive care units (ICUs) at Mayo Clinic, Rochester from August 2007 to January 2009. All adult patients with severe sepsis and septic shock and concurrent IMV without prior heart failure underwent transthoracic echocardiography within 24 hours. Patients with active pregnancy, prior congenital or valvular heart disease, and prosthetic cardiac valves were excluded. Left ventricular systolic dysfunction was defined as LV ejection fraction (LVEF) <50% and LVDD as E/e′ >15. Primary outcome was hospital mortality, and secondary outcomes included IMV duration, ICU length of stay (LOS), and total LOS. Two-tailed P value of <.05 was considered statistically significant. Results: In a total of 106 patients, 58 (54.7%) met our inclusion criteria, with 17 (29.3%), 11 (19.0%), and 5 (8.6%) having LVSD, LVDD, and both, respectively. The cohorts with and without LVSD and LVDD did not differ significantly in their baseline characteristics and laboratory and ventilatory parameters. Compared to those without LVSD, patients with LVSD had higher LV end-systolic diameters but were not different in their left atrial diameters or E/e′ ratio. Patients with LVDD had a higher E velocity and E/e′ ratio compared to those without LVDD. Hospital mortality was not different in patients with and without LVSD (8 [47%] vs 21 [51%], P = 1.00) and LVDD (8 [73%] vs 21 [45%], P = .18). Secondary outcomes were not different between the 2 groups. Conclusion: Left ventricular systolic or diastolic dysfunction did not influence in-hospital outcomes in patients with severe sepsis and septic shock and concurrent IMV.

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Vitamin C, Hydrocortisone, and Thiamine for the Treatment of Severe Sepsis and Septic Shock: A Retrospective Analysis of Real-World Application

Journal of Clinical Medicine ◽

10.3390/jcm8040478 ◽

2019 ◽

Vol 8 (4) ◽

pp. 478 ◽

Cited By ~ 17

Author(s):

Jane Litwak ◽

Nam Cho ◽

H. Nguyen ◽

Kayvan Moussavi ◽

Thomas Bushell

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Length Of Stay ◽

Combination Therapy ◽

Vitamin C ◽

Triple Therapy ◽

Real World ◽

Standard Care ◽

Icu Mortality ◽

Sepsis And Septic Shock

A recent study suggested mortality benefits using vitamin C, hydrocortisone, and thiamine combination therapy (triple therapy) in addition to standard care in patients with severe sepsis and septic shock. In order to further evaluate the effects of triple therapy in real-world clinical practice, we conducted a retrospective observational cohort study at an academic tertiary care hospital. A total of 94 patients (47 in triple therapy group and 47 in standard care group) were included in the analysis. Baseline characteristics in both groups were well-matched. No significant difference in the primary outcome, hospital mortality, was seen between triple therapy and standard care groups (40.4% vs. 40.4%; p = 1.000). In addition, there were no significant differences in secondary outcomes, including intensive care unit (ICU) mortality, requirement for renal replacement therapy for acute kidney injury, ICU length of stay, hospital length of stay, and time to vasopressor independence. When compared to standard care, triple therapy did not improve hospital or ICU mortality in patients with septic shock. A randomized controlled trial evaluating the effects of triple therapy is necessary prior to implementing vitamin C, hydrocortisone, and thiamine combination therapy as a standard of care in patients with septic shock.

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Cell-Free Plasma DNA as a Predictor of Outcome in Severe Sepsis and Septic Shock

Clinical Chemistry ◽

10.1373/clinchem.2007.101030 ◽

2008 ◽

Vol 54 (6) ◽

pp. 1000-1007 ◽

Cited By ~ 111

Author(s):

Katri Saukkonen ◽

Päivi Lakkisto ◽

Ville Pettilä ◽

Marjut Varpula ◽

Sari Karlsson ◽

...

Keyword(s):

Septic Shock ◽

Regression Analysis ◽

Severe Sepsis ◽

Hospital Mortality ◽

Independent Predictor ◽

Discriminative Power ◽

Plasma Dna ◽

Icu Mortality ◽

Sepsis And Septic Shock ◽

Free Plasma

Abstract Background: Increased concentrations of cell-free DNA have been found in plasma of septic and critically ill patients. We investigated the value of plasma DNA for the prediction of intensive care unit (ICU) and hospital mortality and its association with the degree of organ dysfunction and disease severity in patients with severe sepsis. Methods: We studied 255 patients with severe sepsis or septic shock. We obtained blood samples on the day of study inclusion and 72 h later and measured cell-free plasma DNA by real-time quantitative PCR assay for the β-globin gene. Results: Cell-free plasma DNA concentrations were higher at admission in ICU nonsurvivors than in survivors (median 15 904 vs 7522 genome equivalents [GE]/mL, P < 0.001) and 72 h later (median 15 176 GE/mL vs 6758 GE/mL, P = 0.004). Plasma DNA values were also higher in hospital nonsurvivors than in survivors (P = 0.008 to 0.009). By ROC analysis, plasma DNA concentrations had moderate discriminative power for ICU mortality (AUC 0.70–0.71). In multiple regression analysis, first-day plasma DNA was an independent predictor for ICU mortality (P = 0.005) but not for hospital mortality. Maximum lactate value and Sequential Organ Failure Assessment score correlated independently with the first-day plasma DNA in linear regression analysis. Conclusions: Cell-free plasma DNA concentrations were significantly higher in ICU and hospital nonsurvivors than in survivors and showed a moderate discriminative power regarding ICU mortality. Plasma DNA concentration was an independent predictor for ICU mortality, but not for hospital mortality, a finding that decreases its clinical value in severe sepsis and septic shock.

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Global utilization of low-dose corticosteroids in severe sepsis and septic shock: a report from the PROGRESS registry

Critical Care ◽

10.1186/cc9044 ◽

2010 ◽

Vol 14 (3) ◽

pp. R102 ◽

Cited By ~ 48

Author(s):

Richard Beale ◽

Jonathan M Janes ◽

Frank M Brunkhorst ◽

Geoffrey Dobb ◽

Mitchell M Levy ◽

...

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Low Dose ◽

Sepsis And Septic Shock

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Initial Low Oxygen Extraction Ratio Is Related to Severe Organ Dysfunction and High In-Hospital Mortality in Severe Sepsis and Septic Shock Patients

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2015.02.038 ◽

2015 ◽

Vol 49 (3) ◽

pp. 261-267 ◽

Cited By ~ 8

Author(s):

Jong-Su Park ◽

Su-Jin Kim ◽

Sung-Woo Lee ◽

Eui-Jung Lee ◽

Kap-Su Han ◽

...

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Hospital Mortality ◽

Organ Dysfunction ◽

Extraction Ratio ◽

Oxygen Extraction ◽

Low Oxygen ◽

Oxygen Extraction Ratio ◽

Sepsis And Septic Shock

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Comparative analysis of survival between elderly and non-elderly severe sepsis and septic shock resuscitated patients

Einstein (São Paulo) ◽

10.1590/s1679-45082015ao3313 ◽

2015 ◽

Vol 13 (3) ◽

pp. 357-363 ◽

Cited By ~ 6

Author(s):

Henrique Palomba ◽

Thiago Domingos Corrêa ◽

Eliézer Silva ◽

Andreia Pardini ◽

Murillo Santucci Cesar de Assuncao

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Elderly Patients ◽

Hospital Mortality ◽

Length Of Hospital Stay ◽

Apache Ii ◽

Apache Ii Score ◽

Resuscitated Patients ◽

Long Term Impact ◽

Sepsis And Septic Shock

Objective To compare outcomes between elderly (≥65 years old) and non-elderly (<65 years old) resuscitated severe sepsis and septic shock patients and determine predictors of death among elderly patients.Methods Retrospective cohort study including 848 severe sepsis and septic shock patients admitted to the intensive care unit between January 2006 and March 2012.Results Elderly patients accounted for 62.6% (531/848) and non-elderly patients for 37.4% (317/848). Elderly patients had a higher APACHE II score [22 (18-28)versus 19 (15-24); p<0.001], compared to non-elderly patients, although the number of organ dysfunctions did not differ between the groups. No significant differences were found in 28-day and in-hospital mortality rates between elderly and non-elderly patients. The length of hospital stay was higher in elderly compared to non-elderly patients admitted with severe sepsis and septic shock [18 (10-41)versus 14 (8-29) days, respectively; p=0.0001]. Predictors of death among elderly patients included age, site of diagnosis, APACHE II score, need for mechanical ventilation and vasopressors.Conclusion In this study population early resuscitation of elderly patients was not associated with increased in-hospital mortality. Prospective studies addressing the long-term impact on functional status and quality of life are necessary.

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