Renal outcome after vancomycin treatment and renal replacement therapy in patients with severe sepsis and septic shock: A retrospective study

2014 ◽  
Vol 29 (4) ◽  
pp. 656-661 ◽  
Author(s):  
Gordon P. Otto ◽  
Maik Sossdorf ◽  
Hannes Breuel ◽  
Peter Schlattmann ◽  
Ole Bayer ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Retrospective Study ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Renal Outcome ◽  
Sepsis And Septic Shock ◽  
Vancomycin Treatment

scholarly journals Clinical Outcomes of Severe Sepsis and Septic Shock Patients with Left Ventricular Dysfunction Undergoing Continuous Renal Replacement Therapy: A Multicenter Retrospective Study

2020 ◽  
Author(s):  
Guangwei Yu ◽  
Kun Cheng ◽  
Qing Liu ◽  
Zhenhao Zhu ◽  
Fenghui Lin ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Retrospective Study ◽  
Renal Replacement Therapy ◽  
Left Ventricular ◽  
Control Group ◽  
Early Group ◽  
Icu Mortality ◽  
Lv Dysfunction ◽  
Sepsis And Septic Shock

Abstract Background: Baseline left ventricular (LV) dysfunction is associated with subsequent risks of acute kidney injury (AKI) and mortality in patients with sepsis. This study investigated the therapeutic effects of continuous renal replacement therapy (CRRT) in hemodynamically unstable patients with severe sepsis and septic shock combined with LV dysfunction.Methods: In this multicenter retrospective study, severe sepsis and septic shock patients with LV dysfunction were classified into one of two groups according to the timing of CRRT: the early group (before AKI was detected) or the control group (patients with AKI). All-cause intensive care unit (ICU) mortality and ICU stay were compared between the groups. Patients were weighted by stabilized inverse probability of treatment weights (sIPTW) to overcome differences in baseline characteristics.Results: After sIPTW analysis, the ICU mortality was significantly lower in the early group than the control group (25.9% vs 59.0%, p < 0.001). Weighted multivariable analysis showed that early CRRT initiation was a protective factor for the risk of ICU mortality. Early CRRT initiation significantly improved the ICU mortality compared to the control group (OR, 0.322; 95% CI, 0.125-0.834; p = 0.020).Conclusions: Early CRRT in the absence of AKI is suggested for hemodynamically unstable patients with severe sepsis and septic shock combined with LV dysfunction since it benefits survival outcomes.Trial registration: The study was preregistered in the Chinese Clinical Trial Registry (number, ChiCTR2000033083).

scholarly journals Cardiorenal Syndromes and Sepsis

2011 ◽  
Vol 2011 ◽  
pp. 1-8 ◽  
Author(s):  
C. Chelazzi ◽  
G. Villa ◽  
A. R. De Gaudio
Keyword(s):  
Septic Shock ◽  
Renal Function ◽  
Severe Sepsis ◽  
Renal Replacement Therapy ◽  
Endothelial Dysfunction ◽  
Renal Impairment ◽  
Myocardial Function ◽  
Cardiorenal Syndrome ◽  
Kidney Perfusion ◽  
Sepsis And Septic Shock

The cardiorenal syndrome is a clinical and pathophysiological entity defined as the concomitant presence of renal and cardiovascular dysfunction. In patients with severe sepsis and septic shock, acute cardiovascular, and renal derangements are common, that is, the septic cardiorenal syndrome. The aim of this paper is to describe the pathophysiology and clinical features of septic cardiorenal syndrome in light of the actual clinical and experimental evidence. In particular, the importance of systemic and intrarenal endothelial dysfunction, alterations of kidney perfusion, and myocardial function, organ “crosstalk” and ubiquitous inflammatory injury have been extensively reviewed in light of their role in cardiorenal syndrome etiology. Treatment includes early and targeted optimization of hemodynamics to reverse systemic hypotension and restore urinary output. In case of persistent renal impairment, renal replacement therapy may be used to remove cytokines and restore renal function.

scholarly journals The Current State of Renal Replacement Therapy in the Treatment of Sepsis

2021 ◽  
Vol 18 (4) ◽  
pp. 80-89
Author(s):  
T. G. Kim ◽  
M. А. Magomedov ◽  
D. N. Protsenko ◽  
M. V. Zakharov ◽  
А. V. Marukhov ◽  
...  
Keyword(s):  
Septic Shock ◽  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Results Of Treatment ◽  
Current State ◽  
Sepsis And Septic Shock ◽  
Positive Results ◽  
Organ Dysfunctions

Of all cases of acute kidney injury (AKI), 45-70% are associated with sepsis. Lethality in sepsis-associated AKI requiring renal replacement therapy (RRT) ranges from 40 to 50%, and in AKI combined with other organ dysfunctions - 60-80%. In order to improve the results of treatment of sepsis and septic shock, various methods of extracorporeal detoxification (ECD) have been developed. The effectiveness of these methods is controversial. In the treatment of sepsis, RRT is used not only to replace the impaired detoxification function of kidneys, but also to remove excess cytokines from the systemic bloodstream. The literature describes mainly positive results of the use of dialyzers with an adsorbing membrane, however, these data do not have the necessary degree of evidence. Currently, there are no clear criteria for the initiation of RRT, its duration and doses, the choice of methodology determined by specific clinical and laboratory parameters, and staging of this therapy. All this highlights the need for further research in this field.

Association between left ventricular diastolic dysfunction and septic acute kidney injury in severe sepsis and septic shock: A multicenter retrospective study

Perfusion ◽  
2021 ◽  
pp. 026765912198896
Author(s):  
Guangwei Yu ◽  
Kun Cheng ◽  
Qing Liu ◽  
Xiaohong Lin ◽  
Fenghui Lin ◽  
...  
Keyword(s):  
Septic Shock ◽  
Acute Kidney Injury ◽  
Severe Sepsis ◽  
Retrospective Study ◽  
Kidney Injury ◽  
Left Ventricular Diastolic Dysfunction ◽  
Left Ventricular ◽  
Septic Acute Kidney Injury ◽  
Ventricular Diastolic Dysfunction ◽  
Sepsis And Septic Shock

Introduction: Left ventricular diastolic dysfunction (LVDD) adversely impacts renal function, and E/e′ is a significant predictor of adverse kidney events under different clinical conditions. However, no studies have evaluated the association between LVDD and septic acute kidney injury (AKI) among patients with severe sepsis and septic shock. Methods: This multicenter retrospective study evaluated adult patients with severe sepsis or septic shock between January 1, 2013, and December 31, 2019, who underwent echocardiography within 24 hours after admission to an intensive care unit. Results: A total of 495 adult patients were enrolled in the study. LVDD grades II and III were associated with severe (stage 3) AKI ( p < 0.001, p for trend < 0.001). E/e′ and e′ were risk factors for septic AKI (OR, 1.155; 95% CI, 1.088–1.226, p < 0.001; and OR, 7.218; 95% CI, 2.942–17.712, p < 0.001, respectively) in the multivariate logistic regression analysis. The area under the receiver operating characteristic curve of E/e′ and e′ was 0.728 (95% CI, 0.680–0.777, p < 0.001) and 0.715 (95% CI, 0.665–0.764, p < 0.001), respectively. Conclusions: LVDD was associated with septic AKI, and E/e′ and e′ are useful predictors of septic AKI among patients with severe sepsis or septic shock. Trial registration The study was registered at the Chinese Clinical Trial Registry (Protocol No. ChiCTR2000033083).

scholarly journals Presence of Hypogammaglobulinemia – A Risk Factor of Mortality in Patients with Severe Sepsis, Septic Shock, and SIRS

2013 ◽  
Vol 114 (4) ◽  
pp. 246-257 ◽  
Author(s):  
Miroslav Průcha ◽  
R. Zazula ◽  
I. Herold ◽  
M. Dostál ◽  
T. Hyánek ◽  
...  
Keyword(s):  
Septic Shock ◽  
Risk Factor ◽  
Severe Sepsis ◽  
Retrospective Study ◽  
Independent Factor ◽  
High Incidence ◽  
Sepsis And Septic Shock ◽  
The Relationship

In this retrospective study we assessed the frequency of hypogammaglobulinemia in 708 patients with SIRS, severe sepsis and septic shock. We evaluated the relationship between hypogammaglobulinemia IgG, IgM and 28 day mortality. Total of 708 patients and 1,513 samples were analyzed. In the three subgroups we investigated, patients met the criteria of SIRS, severe sepsis and septic shock. IgG hypogammaglobulinemia was demonstrated in 114 patients with severe sepsis (25.2%), 11 septic shock patients (24.4%), and in 29 SIRS patients (13.9%). IgM hypogammaglobulinemia was documented in 55 patients with severe sepsis (12.2%), 6 septic shock patients (13.3%), and in 17 SIRS patients (8.1%). Mortality of patients with severe sepsis and normal IgG levels was significantly lower (111 patients; 32.8%) compared with those with IgG hypogammaglobulinemia (49 patients; 43.0%; p=0.001). Mortality of patients with septic shock and IgG hypogammaglobulinemia (n=5) was significantly higher compared with those with normal IgG levels (45.5% vs. 38.2%; p=0.001). Mortality of patients with severe sepsis and IgM hypogammaglobulinemia did not differ from that of patients with normal IgM levels (37.0 vs. 41.8%). Mortality of patients with septic shock and IgM hypogammaglobulinemia was significantly higher compared with those with normal IgM levels (50% vs. 38.5%; p=0.0001). This study documented relatively high incidence of hypogammaglobulinemia IgG and IgM in patients with severe sepsis, septic shock and SIRS respectively. The presence of IgG hypogammaglobulinemia in patients with severe sepsis is independent factor of mortality.

scholarly journals Evaluation of Continuous Renal Replacement Therapy and Therapeutic Plasma Exchange, in Severe Sepsis or Septic Shock in Critically Ill Children

Medicina ◽  
2019 ◽  
Vol 55 (7) ◽  
pp. 350
Author(s):  
Fatih Aygün ◽  
Fatih Varol ◽  
Cansu Durak ◽  
Mey Talip Petmezci ◽  
Alper Kacar ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Plasma Exchange ◽  
Critically Ill ◽  
Demographic Data ◽  
Therapeutic Plasma Exchange ◽  
Critically Ill Children

Background and objective: Severe sepsis and septic shock are life-threatening organ dysfunctions and causes of death in critically ill patients. The therapeutic goal of the management of sepsis is restoring balance to the immune system and fluid balance. Continuous renal replacement therapy (CRRT) is recommended in septic patients, and it may improve outcomes in patients with severe sepsis or septic shock. Therapeutic plasma exchange (TPE) is another extracorporeal procedure that can improve organ function by decreasing inflammatory and anti-fibrinolytic mediators and correcting haemostasis by replenishing anticoagulant proteins. However, research about sepsis and CRRT and TPE in children has been insufficient and incomplete. Therefore, we investigated the reliability and efficacy of extracorporeal therapies in paediatric patients with severe sepsis or septic shock. Materials and methods: We performed a multicentre retrospective study using data from all patients aged <18 years who were admitted to two paediatric intensive care units. Demographic data and reason for hospitalization were recorded. In addition, vital signs, haemogram parameters, and biochemistry results were recorded at 0 h and after 24 h of CRRT. Patients were compared according to whether they underwent CRRT or TPE; mortality between the two treatment groups was also compared. Results: Between January 2014 and April 2019, 168 septic patients were enrolled in the present study. Of them, 47 (27.9%) patients underwent CRRT and 24 underwent TPE. In patients with severe sepsis, the requirement for CRRT was statistically associated with mortality (p < 0.001). In contrast, the requirement for TPE was not associated with mortality (p = 0.124). Conclusion: Our findings revealed that the requirement for CRRT in patients with severe sepsis is predictive of increased mortality. CRRT and TPE can be useful techniques in critically ill children with severe sepsis. However, our results did not show a decrease of mortality with CRRT and TPE.

Effect of fluid bolus triggers and their combination on fluid responsiveness in optimization phase of severe sepsis and septic shock resuscitation

MedPharmRes ◽  
2018 ◽  
Vol 2 (3) ◽  
pp. 27-32
Author(s):  
Bien Le ◽  
Dai Huynh ◽  
Mai Tuan ◽  
Minh Phan ◽  
Thao Pham ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Septic Shock ◽  
Severe Sepsis ◽  
Fluid Responsiveness ◽  
Statistical Significance ◽  
Venous Pressure ◽  
Fluid Bolus ◽  
Low Blood Pressure ◽  
Low Central Venous Pressure ◽  
Sepsis And Septic Shock

Objectives: to evaluate the fluid responsiveness according to fluid bolus triggers and their combination in severe sepsis and septic shock. Design: observational study. Patients and Methods: patients with severe sepsis and septic shock who already received fluid after rescue phase of resuscitation. Fluid bolus (FB) was prescribed upon perceived hypovolemic manifestations: low central venous pressure (CVP), low blood pressure, tachycardia, low urine output (UOP), hyperlactatemia. FB was performed by Ringer lactate 500 ml/30 min and responsiveness was defined by increasing in stroke volume (SV) ≥15%. Results: 84 patients were enrolled, among them 30 responded to FB (35.7%). Demographic and hemodynamic profile before fluid bolus were similar between responders and non-responders, except CVP was lower in responders (7.3 ± 3.4 mmHg vs 9.2 ± 3.6 mmHg) (p 0.018). Fluid response in low CVP, low blood pressure, tachycardia, low UOP, hyperlactatemia were 48.6%, 47.4%, 38.5%, 37.0%, 36.8% making the odd ratio (OR) of these triggers were 2.81 (1.09-7.27), 1.60 (0.54-4.78), 1.89 (0.58-6.18), 1.15 (0.41-3.27) and 1.27 (0.46-3.53) respectively. Although CVP < 8 mmHg had a higher response rate, the association was not consistent at lower cut-offs. The combination of these triggers appeared to raise fluid response but did not reach statistical significance: 26.7% (1 trigger), 31.0% (2 triggers), 35.7% (3 triggers), 55.6% (4 triggers), 100% (5 triggers). Conclusions: fluid responsiveness was low in optimization phase of resuscitation. No fluid bolus trigger was superior to the others in term of providing a higher responsiveness, their combination did not improve fluid responsiveness as well.

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