Sepsis-Induced Myocardial Dysfunction in Pediatric Septic Shock: Prevalence, Predictors, and Outcome—A Prospective Observational Study

2021 ◽  
Author(s):  
Viresh S. Swami ◽  
Lalitha A. V. ◽  
Santu Ghosh ◽  
Mounika Reddy
Keyword(s):  
Septic Shock ◽  
Observational Study ◽  
Patient Outcomes ◽  
Prospective Observational Study ◽  
Point Of Care ◽  
Myocardial Dysfunction ◽  
Severity Of Illness ◽  
Serum Lactate ◽  
Lactate Levels ◽  
Organ Dysfunctions

AbstractThere is a paucity of literature on the prevalence, predictors, prognostic markers, and outcomes of sepsis-induced myocardial dysfunction (SMD) in pediatric septic shock. The objectives of our study were to estimate the prevalence of SMD in pediatric septic shock by point-of-care functional echocardiography (POCFE) and to study the association of SMD with severity of illness, organ dysfunctions, and outcomes. This prospective, observational study was conducted over a period of 1 year (from July 2018 to July 2019) in a 12-bed, tertiary pediatric intensive care unit (PICU) of an academic and referral hospital in South India. Children presenting with septic shock were enrolled in the study. POCFE was done within 6 hours of PICU admission and patients were categorized as having SMD based on POCFE findings. The prevalence of SMD (left ventricle ± right ventricle) was 32% (32/100). More than half of the children (54.5%) died in SMD group, whereas only 7.5% died in non-SMD group (p < 0.001). SMD was associated with higher organ dysfunctions, worse patient outcomes, and was found to be an independent predictor of mortality. The median lactate levels were higher in SMD group (3.15 [2.7, 5] vs. 2 [1.3, 2.7], p < 0.001) as compared with non-SMD group. We observed significantly lower median lactate clearance at 6 hours in SMD than non-SMD (30.0% [−14.44, 44.22] vs. 59.8% [45.83, 71.43], p < 0.001). Lactate levels at 6 hours with a threshold of 2.4 mmol/L was a good predictor of SMD with sensitivity and specificity of 73 and 80%, respectively. SMD is not an uncommon entity in children with septic shock. SMD was associated with worse patient outcomes, organ dysfunction, and mortality. Serum lactate trends may predict SMD and can be used as prognosticate markers as well.

Association of Microcirculation, Macrocirculation, and Severity of Illness in Septic Shock: A Prospective Observational Study to Identify Microcirculatory Targets Potentially Suitable for Guidance of Hemodynamic Therapy

2016 ◽  
Vol 33 (4) ◽  
pp. 256-266 ◽  
Author(s):  
Timo Sturm ◽  
Julia Leiblein ◽  
Verena Schneider-Lindner ◽  
Thomas Kirschning ◽  
Manfred Thiel
Keyword(s):  
Septic Shock ◽  
Observational Study ◽  
Oxygen Saturation ◽  
Fluid Balance ◽  
Prospective Observational Study ◽  
Lactate Concentration ◽  
Severity Of Illness ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Hemodynamic Therapy

Purpose: Clinically unapparent microcirculatory impairment is common and has a negative impact on septic shock, but specific therapy is not established so far. This prospective observational study aimed at identifying candidate parameters for microcirculatory-guided hemodynamic therapy. : NCT01530932. Materials and Methods: Microcirculatory flow and postcapillary venous oxygen saturation were detected during vaso-occlusive testing (VOT) on days 1 (T0), 2 (T24), and 4 (T72) in 20 patients with septic shock at a surgical intensive care unit using a laser Doppler spectrophotometry system (O2C). Results: Reperfusional maximal venous capillary oxygen saturation (SvcO2max) showed negative correlations with Simplified Acute Physiology Score II (SAPSII)/Sequential Organ Failure Assessment (SOFA) score, norepinephrine dosage, and lactate concentration and showed positive correlations with cardiac index (CI). At T24 and T72, SvcO2max was also inversely linked to fluid balance. With respect to any predictive value, SvcO2max and CI determined on day 1 (T0) were negatively correlated with SAPS II/SOFA on day 4 (T72). Moreover, SvcO2max measured on day 1 or day 2 was negatively correlated with cumulated fluid balance on day 4 ( r= −.472, P < .05 and r = −.829, P < .001). By contrast, CI neither on day 1 nor on day 2 was correlated with cumulated fluid balance on day 4 ( r = −.343, P = .17 and r = −.365, P = .15). Conclusion: In patients with septic shock, microcirculatory reserve as assessed by SvcO2max following VOT was impaired and negatively correlated with severity of illness and fluid balance. In contrast to CI, SvcO2max determined on day 1 or day 2 was significantly negatively correlated with cumulative fluid balance on day 4. Therefore, early microcirculatory measurement of SvcO2max might be superior to CI in guidance of sepsis therapy to avoid fluid overload. This has to be addressed in future clinical studies.

Burn Wound Bacteriological Profiles, Patient Outcomes, and Tangential Excision Timing: A Prospective, Observational Study

2018 ◽  
Vol 64 (8) ◽  
pp. 28-36 ◽  
Author(s):  
Fang Shao ◽  
Wen-Jie Ren ◽  
Wei-Zheng Meng ◽  
Gui-Zhi Wang ◽  
Tian-Yun Wang
Keyword(s):  
Observational Study ◽  
Patient Outcomes ◽  
Prospective Observational Study ◽  
Burn Wound

Predictive value of thyroxine for prognosis in pediatric septic shock: a prospective observational study

2020 ◽  
Vol 33 (5) ◽  
pp. 653-659
Author(s):  
Jia Song ◽  
Yun Cui ◽  
Chunxia Wang ◽  
Jiaying Dou ◽  
Huijie Miao ◽  
...  
Keyword(s):  
Septic Shock ◽  
Thyroid Hormone ◽  
Observational Study ◽  
Hospital Mortality ◽  
Predictive Value ◽  
Prospective Observational Study ◽  
Threshold Value ◽  
Nonthyroidal Illness ◽  
Hormone Levels ◽  
Thyroid Hormone Levels

AbstractBackgroundThyroid hormone plays an important role in the adaptation of metabolic function to critically ill. The relationship between thyroid hormone levels and the outcomes of septic shock is still unclear. The aim of this study was to assess the predictive value of thyroid hormone for prognosis in pediatric septic shock.MethodsWe performed a prospective observational study in a pediatric intensive care unit (PICU). Patients with septic shock were enrolled from August 2017 to July 2019. Clinical and laboratory indexes were collected, and thyroid hormone levels were measured on PICU admission.ResultsNinety-three patients who fulfilled the inclusion criteria were enrolled in this study. The incidence of nonthyroidal illness syndrome (NTIS) was 87.09% (81/93) in patients with septic shock. Multivariate logistic regression analysis showed that T4 level was independently associated with in-hospital mortality in patients with septic shock (OR: 0.965, 95% CI: 0.937–0.993, p = 0.017). The area under receiver operating characteristic (ROC) curve (AUC) for T4 was 0.762 (95% CI: 0.655–0.869). The cutoff threshold value of 58.71 nmol/L for T4 offered a sensitivity of 61.54% and a specificity of 85.07%, and patients with T4 < 58.71 nmol/L showed high mortality (60.0%). Moreover, T4 levels were negatively associated with the pediatric risk of mortality III scores (PRISM III), lactate (Lac) level in septic shock children.ConclusionsNonthyroidal illness syndrome is common in pediatric septic shock. T4 is an independent predictor for in-hospital mortality, and patients with T4 < 58.71 nmol/L on PICU admission could be with a risk of hospital mortality.

scholarly journals Prospective observational study of point-of-care creatinine in trauma

2016 ◽  
Vol 1 (1) ◽  
pp. e000014 ◽  
Author(s):  
Anthony J Carden ◽  
Edgardo S Salcedo ◽  
Nam K Tran ◽  
Eric Gross ◽  
Jennifer Mattice ◽  
...  
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Point Of Care

scholarly journals Prospective, observational study comparing automated and visual point-of-care urinalysis in general practice

BMJ Open ◽  
2016 ◽  
Vol 6 (8) ◽  
pp. e011230 ◽  
Author(s):  
Sanne van Delft ◽  
Annelijn Goedhart ◽  
Mark Spigt ◽  
Bart van Pinxteren ◽  
Niek de Wit ◽  
...  
Keyword(s):  
General Practice ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Point Of Care

scholarly journals Necrotizing Soft Tissue Infections in Intensive Care

2021 ◽  
pp. 088506662110101
Author(s):  
Alexandru Ogica ◽  
Christoph Burdelski ◽  
Holger Rohde ◽  
Stefan Kluge ◽  
Geraldine de Heer
Keyword(s):  
Septic Shock ◽  
Intensive Care ◽  
Soft Tissue ◽  
Sofa Score ◽  
Laboratory Data ◽  
Serum Lactate ◽  
Soft Tissue Infections ◽  
Necrotizing Soft Tissue Infections ◽  
The Mean ◽  
Organ Dysfunctions

Background: Necrotizing soft tissue infections (NSTIs) are typically characterized by extensive soft tissue destruction with systemic signs of toxicity, ranging from sepsis to septic shock. Our aim was to analyze the clinical characteristics, microbiological results, laboratory data, therapies, and outcome of patients with NSTIs admitted to an intensive care unit (ICU). Methods: A monocentric observational study of patients admitted to the ICU of a university hospital between January 2009 and December 2017. The demographic characteristics, comorbidities, clinical features, microbiology and laboratory results, organ dysfunctions, therapies, and outcome were retrospectively analyzed. Results: There were 59 patients and 70% males. The mean age (± SD) was 55 ± 18; type II (monomicrobial) NSTI was present in 36 patients (61%); the most common isolated pathogen was Streptococcus pyogenes in 28 patients (48%). Septic shock was diagnosed in 41 patients (70%). The most common organ dysfunctions were circulatory and renal in 42 (71%) and 38 patients (64%). The mean value (± SD) of serum lactate at admission to the ICU was 4.22 ± 5.42 mmol/l, the median SOFA score and SAPS II were 7 (IQR 4 - 10) and 46 (IQR 30.5 - 53). ICU mortality rate was 25%. Both SOFA score and serum lactate demonstrated a good prognostic value regarding ICU outcome (OR 1.29, 95%CI 1.07-1.57, P < 0.007 and OR 1.53, 95%CI 1.19-1.98, P < 0.001). A cut-off value for serum lactate of 6.55 mmol/L positively predicted mortality with 67% sensitivity and 97% specificity. Conclusion: NSTIs carry a high risk of septic shock and multiple organ dysfunction syndrome and thus are still associated with high mortality. In our study, the value of serum lactate at admission to the ICU correlated well with mortality. This easy-to-measure parameter could play a role in the decision-making process regarding prognosis and continuation of care.

scholarly journals Diagnostic and Prognostic Value of Presepsin in Patients with Non-Infectious Organ Failure, Sepsis, and Septic Shock: A Prospective Observational Study According to the Sepsis-3 Definitions

2021 ◽  
Author(s):  
Sukyo Lee ◽  
Juhyun Song ◽  
Dae Won Park ◽  
Hyeri Seok ◽  
Jae-hyung Cha ◽  
...  
Keyword(s):  
Septic Shock ◽  
Observational Study ◽  
Organ Failure ◽  
Prospective Observational Study ◽  
Survival Curve ◽  
Curve Analysis ◽  
Roc Curve Analysis ◽  
Kaplan Meier ◽  
Sepsis And Septic Shock ◽  
Meier Survival Curve

Abstract Background: Sepsis is life-threatening organ dysfunction due to a dysregulated host response to infection. Early diagnosis of sepsis is challenging due to unknown sources of infection, and mortality prediction is usually complex. We aimed to investigate the clinical value of presepsin for discriminating sepsis from non-infectious organ failure and predicting mortality among sepsis patients in the emergency department (ED).Methods: This prospective observational study included 420 patients divided into three groups according to the Sepsis-3 definitions: non-infectious organ failure (n=142), sepsis (n=141), and septic shock (n=137). Blood samples for biomarker measurement of presepsin, procalcitonin, and C-reactive protein were drawn in the ED and biomarker levels were compared between the groups. Optimal cut-off values for presepsin to discriminate between the three clinical diagnoses were evaluated using receiver operating characteristic (ROC) curve analysis. We also performed ROC curve analysis for each biomarker as a predictor of mortality. After excluding non-infectious organ failure, we extracted the optimal cut-off value of presepsin to predict mortality associated with sepsis and septic shock and performed Kaplan–Meier survival curve analysis according to the cut-off value.Results: Presepsin levels (median [IQR]) were significantly higher in sepsis than in non-infectious organ failure (792 [450–1273] vs. 286 [170–417], p <0.001) and significantly higher in septic shock than in sepsis (1287 [589–2365] vs. 792 [450–1273], p=0.002). The optimal cut-off value for presepsin to discriminate between sepsis and non-infectious organ failure was 582 pg/mL (sensitivity, 70.1; specificity, 89.4; AUC, 0.877; p <0.001) and to discriminate between sepsis and septic shock was 1285 pg/mL (sensitivity, 50.4; specificity, 76.6; AUC, 0.618; p <0.001). The optimal cut-off value for presepsin for predicting 30-day mortality was 821 pg/mL (sensitivity, 68.9; specificity, 50.5; AUC, 0.605; p=0.005) in patients with sepsis and septic shock. Kaplan-Meier survival curve analysis showed that patients with higher presepsin levels (≥821 pg/mL) had significantly higher mortality than patients with lower presepsin levels (<821 pg/mL) (log-rank test; p=0.004). Conclusions: Presepsin levels could effectively differentiate sepsis from non-infectious organ failure and septic shock from sepsis. Presepsin levels could help clinicians predict mortality in patients with sepsis and septic shock.

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