Appropriateness of empirical antibiotic therapy and added value of adjunctive gentamicin in patients with septic shock: a prospective cohort study in the ICU

Abstract Background Enrichment strategies improve therapeutic targeting and trial efficiency, but enrichment factors for sepsis trials are lacking. We determined whether concentrations of soluble tumor necrosis factor receptor-1 (sTNFR1), interleukin-8 (IL8), and angiopoietin-2 (Ang2) could identify sepsis patients at higher mortality risk and serve as prognostic enrichment factors. Methods In a multicenter prospective cohort study of 400 critically ill septic patients, we derived and validated thresholds for each marker and expressed prognostic enrichment using risk differences (RD) of 30-day mortality as predictive values. We then used decision curve analysis to simulate the prognostic enrichment of each marker and compare different prognostic enrichment strategies. Measurements and main results An admission sTNFR1 concentration > 8861 pg/ml identified patients with increased mortality in both the derivation (RD 21.6%) and validation (RD 17.8%) populations. Among immunocompetent patients, an IL8 concentration > 94 pg/ml identified patients with increased mortality in both the derivation (RD 17.7%) and validation (RD 27.0%) populations. An Ang2 level > 9761 pg/ml identified patients at 21.3% and 12.3% increased risk of mortality in the derivation and validation populations, respectively. Using sTNFR1 or IL8 to select high-risk patients improved clinical trial power and efficiency compared to selecting patients with septic shock. Ang2 did not outperform septic shock as an enrichment factor. Conclusions Thresholds for sTNFR1 and IL8 consistently identified sepsis patients with higher mortality risk and may have utility for prognostic enrichment in sepsis trials.

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Low vasopressin and progression of neonatal sepsis to septic shock: a prospective cohort study

European Journal of Pediatrics ◽

10.1007/s00431-020-03610-x ◽

2020 ◽

Vol 179 (7) ◽

pp. 1147-1155 ◽

Cited By ~ 1

Author(s):

Abhishek S. Aradhya ◽

Venkataseshan Sundaram ◽

Naresh Sachdeva ◽

Sourabh Dutta ◽

Shiv S. Saini ◽

...

Keyword(s):

Septic Shock ◽

Cohort Study ◽

Prospective Cohort Study ◽

Neonatal Sepsis ◽

Prospective Cohort

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OP0088-HPR Prediction of Inpatient Functional Recovery for Patients after Total Hip Arthroplasty: the Added Value of Performance-Based Test to Self-Reported Information: A Prospective Cohort Study

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2014-eular.4560 ◽

2014 ◽

Vol 73 (Suppl 2) ◽

pp. 94.3-95

Author(s):

E. Oosting ◽

T. Hoogeboom ◽

J. Dronkers ◽

S. Appelman ◽

N.V. Meeteren

Keyword(s):

Cohort Study ◽

Total Hip Arthroplasty ◽

Prospective Cohort Study ◽

Functional Recovery ◽

Hip Arthroplasty ◽

Prospective Cohort ◽

Added Value ◽

Total Hip

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Multi-complexity measures of heart rate variability and the effect of vasopressor titration: a prospective cohort study of patients with septic shock

BMC Infectious Diseases ◽

10.1186/s12879-016-1896-1 ◽

2016 ◽

Vol 16 (1) ◽

Cited By ~ 2

Author(s):

Samuel M. Brown ◽

Jeffrey Sorensen ◽

Michael J. Lanspa ◽

Matthew T. Rondina ◽

Colin K. Grissom ◽

...

Keyword(s):

Heart Rate ◽

Septic Shock ◽

Heart Rate Variability ◽

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Complexity Measures

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The Association Between Dynamic Changes in Serum Presepsin Levels and Mortality in Immunocompromised Patients with Sepsis: A Prospective Cohort Study

10.21203/rs.3.rs-115066/v1 ◽

2020 ◽

Author(s):

Jongmin Lee ◽

Seo Hyun Kim ◽

Kyung Hoon Kim ◽

Na Ri Jeong ◽

Seok Chan Kim ◽

...

Keyword(s):

Septic Shock ◽

Cohort Study ◽

Hospital Mortality ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Area Under The Curve ◽

Immunocompromised Patients ◽

Dynamic Changes ◽

Saps 3 ◽

Sepsis And Septic Shock

Abstract Background: Presepsin is a subtype of soluble CD14 that is increased in the blood of septic patients. We investigated the role of dynamic changes in serum presepsin levels in critically ill, immunocompromised patients with sepsis.Methods: This is a prospective cohort study that included 119 adult patients who were admitted to the intensive care unit (ICU) between March 2019 and June 2020. Sepsis and septic shock were defined as Sepsis-3. Patients were classified into one of the following diagnostic groups: no sepsis, sepsis, and septic shock. Presepsin level was measured on day 1 and day 3 after ICU admission. The primary outcome was in-hospital mortality.Results: Of the 119 patients, sepsis was diagnosed in 40 patients (33.6%) and septic shock was diagnosed in 60 (50.4%) patients. The Simplified Acute Physiology Score (SAPS) 3 and Sequential Organ Failure Assessment score on day 1 were 75.5 ± 14.9 and 9.0 (6.5–11.5), respectively, and the overall hospital mortality was 44.5%. In 61 immunocompromised patients, presepsin levels on day 1 were higher in patients with sepsis than those in patients without sepsis (1203.0 [773.0–2484.0] vs. 753.0 [603.5–1092.0] ng/ml; P = 0.004). The area under the curve (AUC) of presepsin for diagnosing sepsis in immunocompromised patients was 0.87, which was comparable with that of procalcitonin (AUC, 0.892). Presepsin levels on day 3 were higher in patients who died in the hospital than in those who survived (1965.0 [1149.0–3423.0] vs. 933.0 [638.0–1571.0]; P = 0.001). In immunocompromised patients who died in the hospital, presepsin levels on day 3 were significantly higher than those on day 1 (P = 0.018). In the multivariate analysis, ΔPresepsin+ (ΔPresepsin concentrations [day3 – day1] > 0) alone was independently correlated with in-hospital mortality in immunocompromised patients (odds ratio, 6.22; 95% confidence interval, 1.33–29.06; P = 0.020).Conclusion: These findings suggest that dynamic changes in presepsin levels between day 1 and day 3 are associated with in-hospital mortality in patients with sepsis, especially in immunocompromised patients.

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A Single-Center Prospective Cohort Study on Postsplenectomy Sepsis and its Prevention

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa050 ◽

2020 ◽

Vol 7 (3) ◽

Cited By ~ 2

Author(s):

Siegbert Rieg ◽

Lena Bechet ◽

Kai Naujoks ◽

Julia Hromek ◽

Berit Lange ◽

...

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Outpatient Service ◽

Study Entry ◽

Vaccination Uptake ◽

Postsplenectomy Sepsis ◽

The Impact

Abstract Background This study evaluated the impact of a dedicated outpatient service on vaccination uptake after splenectomy and on the incidence of postsplenectomy sepsis. Methods From 2009 to 2016 at the University Hospital Freiburg (Germany), asplenic patients were referred to a dedicated outpatient service, provided with comprehensive preventive care including vaccinations, and enrolled in a prospective cohort study. The impact of the service on vaccination uptake and the occurrence of severe sepsis/septic shock was compared between patients who had splenectomy (or were asplenic) within 3 months of study entry (“early study entry”) and those who had splenectomy (or were asplenic) >3 months before study entry (“delayed study entry”). Results A total of 459 asplenic patients were enrolled, and 426 patients were followed prospectively over a median period of 2.9 years. Pneumococcal vaccine uptake within 3 months of splenectomy or first diagnosis of asplenia was 27% vs 71% among delayed study entry and early study entry patients, respectively (P < .001). Forty-four episodes of severe sepsis or septic shock occurred in study patients: 22 after study entry and 22 before study entry. Streptococcus pneumoniae was more frequent among sepsis episodes that occurred before study entry (8/22) than after study entry (1/22 episodes). For episodes occurring after study entry, only a higher Charlson comorbidity index score was significantly associated with severe sepsis/septic shock postsplenectomy. Conclusions With dedicated outpatient care, high uptake of pneumococcal vaccination postsplenectomy was achieved. Sepsis episodes were largely of nonpneumococcal etiology in patients who had received dedicated postsplenectomy care.

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