Cytokine elaboration in critically ill infants with bacterial sepsis, necrotizing entercolitis, or sepsis syndrome: Correlation with clinical parameters of inflammation and mortality

2005 ◽  
Vol 147 (4) ◽  
pp. 462-468 ◽  
Author(s):  
Mary Catherine Harris ◽  
Carl T. D'Angio ◽  
Paul R. Gallagher ◽  
David Kaufman ◽  
Jacquelyn Evans ◽  
...  
Keyword(s):  
Critically Ill ◽  
Sepsis Syndrome ◽  
Clinical Parameters ◽  
Bacterial Sepsis

scholarly journals Procalcitonin and Interleukin-6 for predicting culturenegative and culture positive bacterial sepsis in critically ill patients with systemic inflammatory response syndrome

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Mohd Basri Mat Nor ◽  
Azrina Md Ralib
Keyword(s):  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Interleukin 6 ◽  
Systemic Inflammatory Response ◽  
Bacterial Sepsis ◽  
Saps Ii Score ◽  
Culture Positive ◽  
Culture Negative

Introduction: Differentiation between culture-negative bacterial sepsis (BS), culturepositive BS and non-infectious systemic inflammatory response syndrome (SIRS) among critically ill patients remains a diagnostic challenge to the intensive care unit (ICU) physicians. This study aimed to evaluate the role of procalcitonin (PCT) and interleukin-6 (IL-6) in predicting non-infectious SIRS, culture-negative BS and culture-positive BS in the ICU. Methods: This prospective observational study was conducted in a tertiary ICU in Pahang. The patients were divided into sepsis and non-infectious SIRS based on clinical assessment with or without positive cultures. Patients with positive cultures were further divided into bacteraemia and positive other culture. The PCT and IL-6 were measured daily over the first 3 days. Results: Two hundred and thirty nine consecutive patients diagnosed with SIRS were recruited, of whom 164 (69%) had sepsis. Among sepsis patients, there were 62 (37.8%) culture positive and 102 (62.2%) culture negative. Of these, 27 (16.5%) develop bacteraemia. The most common site of infection was respiratory (34.4%). Post-LSD analyses showed significant difference in the PCT between culture negative sepsis and SIRS (p=0.01); and positive other culture and SIRS (p=0.04).  On the other hand IL-6 cannot differentiate between SIRS and negative culture sepsis (p=0.06). Both PCT and IL-6 predicted bacteraemia with an AUC of 0.70 (0.57 to 0.82) and 0.68 (0.53 to 0.70). IL-6 is independently associated with bacteraemia and other culture after adjusting for age, sex, hypertension, SAPS II score and day 1 PCT. Conclusions: Procalcitonin but not Interleukin-6 is able to differentiate SIRS from culture-negative BS. However, IL-6 is independently associated with bacteraemia and other culture.

scholarly journals Anakinra treatment in critically ill COVID-19 patients: a prospective cohort study

Critical Care ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
Emma J. Kooistra ◽  
◽  
Nicole J. B. Waalders ◽  
Inge Grondman ◽  
Nico A. F. Janssen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Plasma Levels ◽  
Prospective Cohort ◽  
Sensitivity Analyses ◽  
Control Group ◽  
Clinical Parameters ◽  
Inflammatory Parameters ◽  
Anakinra Treatment

Abstract Background A subset of critically ill COVID-19 patients develop a hyperinflammatory state. Anakinra, a recombinant interleukin-1 receptor antagonist, is known to be effective in several hyperinflammatory diseases. We investigated the effects of anakinra on inflammatory parameters and clinical outcomes in critically ill, mechanically ventilated COVID-19 patients with clinical features of hyperinflammation. Methods In this prospective cohort study, 21 critically ill COVID-19 patients treated with anakinra were compared to a group of standard care. Serial data of clinical inflammatory parameters and concentrations of multiple circulating cytokines were determined and aligned on start day of anakinra in the treatment group, and median start day of anakinra in the control group. Analysis was performed for day − 10 to + 10 relative to alignment day. Clinical outcomes were analyzed during 28 days. Additionally, three sensitivity analyses were performed: (1) using propensity score-matched groups, (2) selecting patients who did not receive corticosteroids, and (3) using a subset of the control group aimed to match the criteria (fever, elevated ferritin) for starting anakinra treatment. Results Baseline patient characteristics and clinical parameters on ICU admission were similar between groups. As a consequence of bias by indication, plasma levels of aspartate aminotransferase (ASAT) (p = 0.0002), ferritin (p = 0.009), and temperature (p = 0.001) were significantly higher in the anakinra group on alignment day. Following treatment, no relevant differences in kinetics of circulating cytokines were observed between both groups. Decreases of clinical parameters, including temperature (p = 0.03), white blood cell counts (p = 0.02), and plasma levels of ferritin (p = 0.003), procalcitonin (p = 0.001), creatinine (p = 0.01), and bilirubin (p = 0.007), were more pronounced in the anakinra group. No differences in duration of mechanical ventilation or ICU length of stay were observed between groups. Sensitivity analyses confirmed these results. Conclusions Anakinra is effective in reducing clinical signs of hyperinflammation in critically ill COVID-19 patients. A randomized controlled trial is warranted to draw conclusion about the effects of anakinra on clinical outcomes.

scholarly journals Global tests of haemostasis in critically ill patients with severe sepsis syndrome compared to controls

2006 ◽  
Vol 135 (2) ◽  
pp. 220-227 ◽  
Author(s):  
Peter W. Collins ◽  
Luis I. Macchiavello ◽  
Sarah J. Lewis ◽  
Nichola J. Macartney ◽  
Anton G. Saayman ◽  
...  
Keyword(s):  
Severe Sepsis ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Sepsis Syndrome ◽  
Global Tests

scholarly journals High sPLA2-IIA level is associated with eicosanoid metabolism in patients with bacterial sepsis syndrome

PLoS ONE ◽  
2020 ◽  
Vol 15 (3) ◽  
pp. e0230285
Author(s):  
Nurul Saadah Ahmad ◽  
Toh Leong Tan ◽  
Khaizurin Tajul Arifin ◽  
Wan Zurinah Wan Ngah ◽  
Yasmin Anum Mohd Yusof
Keyword(s):  
Sepsis Syndrome ◽  
Bacterial Sepsis ◽  
Eicosanoid Metabolism

scholarly journals Evaluation of linezolid pharmacokinetics in critically-ill obese patients with severe skin and soft tissue infections

2020 ◽  
Author(s):  
Alison L. Blackman ◽  
Praneeth Jarugula ◽  
David P. Nicolau ◽  
Sai Ho Chui ◽  
Manjari Joshi ◽  
...  
Keyword(s):  
Critically Ill ◽  
Total Body Weight ◽  
Compartment Model ◽  
Sepsis Syndrome ◽  
Obese Patients ◽  
Target Attainment ◽  
Post Infusion ◽  
Cirrhotic Patients ◽  
Total Body ◽  
Higher Doses

Background: Linezolid standard dosing is fixed at 600 mg q12h for adults. Literature suggests critically-ill, obese patients require higher doses. The study aim is two-fold: (i) to describe linezolid PK and (ii) to evaluate if PK/PD target attainment is achieved with standard dosing in critically-ill, obese patients with severe SSTIs. Methods: Adult patients with a body mass index (BMI) ≥ 30 kg/m2 and receiving IV linezolid from August 2018 to April 2019 were eligible for consent in this prospective study. Severe SSTIs were defined as necrotizing fasciitis, myonecrosis, or SSTI with sepsis syndrome. Four blood samples were collected at steady state at 1, 3, 5 hours post-infusion and as a trough. Target attainment was defined as achieving AUC0-24h/MIC ≥ 100 hr*mg/L. Monte Carlo simulations were used to determine probability of target attainment (PTA). Results: Eleven patients were included in the study. The median BMI was 45.7 kg/m2 and median total body weight (TBW) was 136.0 kg. Seven patients received standard linezolid doses and four received 600 mg q8h. A one-compartment model described linezolid PK. Based on AUC0-24h/MIC targets, for non-cirrhotic patients at 140 kg, PTA with standard linezolid doses was 100%, 98.8%, 34.1%, and 0% for MICs 0.5, 1, 2, and 4 mg/L, respectively. Conclusion: Target attainment ≥ 90% is not achieved with standard linezolid doses for non-cirrhotic patients ≥ 140 kg with MICs ≥ 2 mg/L. This study adds to accumulating evidence that standard linezolid doses may not be adequate for all patients.

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