scholarly journals 1421: NOREPINEPHRINE EQUIVALENT DOSE IS STRONGLY ASSOCIATED WITH IN-HOSPITAL MORTALITY IN SEPTIC SHOCK

2021 ◽  
Vol 50 (1) ◽  
pp. 713-713
Author(s):  
Ryota Sato ◽  
Ashish Khanna ◽  
Simon Mucha ◽  
Abhijit Duggal ◽  
Siddharth Dugar
Keyword(s):  
Septic Shock ◽  
Hospital Mortality ◽  
Equivalent Dose

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.

The Relationship of the ACCP/SCCM Consensus Conference Classification of Sepsis to Mortality and Multiorgan Dysfunction among Medical ICU Patients

1996 ◽  
Vol 11 (6) ◽  
pp. 326-334 ◽  
Author(s):  
Marin H. Kollef ◽  
Paul R. Eisenberg
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Hospital Mortality ◽  
Consensus Conference ◽  
Organ System ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Icu Patients ◽  
Multiorgan Dysfunction

To determine the relation between the proposed ACCP/SCCM Consensus Conference classification of sepsis and hospital outcomes, we conducted a single-center, prospective observational study at Barnes Hospital, St. Louis, MO, an academic tertiary care hospital. A total of 324 consecutive patients admitted to the medical intensive care unit (ICU) were studied for prospective patient surveillance and data collection. The main outcome measures were the number of acquired organ system derangements and hospital mortality. Fifty-seven (17.6%) patients died during the study period. The proposed classifications of sepsis (e.g., systemic inflammatory response syndrome [SIRS], sepsis, severe sepsis, septic shock) correlated with hospital mortality ( r = 0.330; p < 0.001) and development of an Organ System Failure Index (OSFI) of 3 or greater ( r = 0.426; p < 0.001). Independent determinants of hospital mortality for this patient cohort ( p < 0.05) were development of an OSFI of 3 or greater (adjusted odds ratio [AOR], 13.9; 95% confidence interval [CI], 6.4–30.2; p < 0.001); presence of severe sepsis or septic shock (AOR, 2.6; 95% CI, 1.2–5.6; p = 0.002), and an APACHE II score ≥ of 18 or greater (AOR, 2.4; 95% CI, 1.0–5.8; p = 0.045). Intra-abdominal infection (AOR, 19.1; 95% CI, 1.6–230.1; p = 0.011), an APACHE II score ≥ of 18 or greater (AOR, 8.9; 95% CI, 4.2–18.6; p < 0.001), and presence of severe sepsis or septic shock (AOR, 2.9; 95% CI, 1.5–5.4; p = 0.001) were independently associated with development of an OSFI of 3 or greater. These data confirm that acquired multiorgan dysfunction is the most important predictor of mortality among medical ICU patients. In addition, they identify the proposed ACCP/SCCM Consensus Conference classification of sepsis as an additional independent determinant of both hospital mortality and multiorgan dysfunction.

Impact of Underlying Congestive Heart Failure on In-Hospital Outcomes in Patients with Septic Shock

2021 ◽  
pp. 088506662110614
Author(s):  
Mohinder R. Vindhyal ◽  
Liuqiang (Kelsey) Lu ◽  
Sagar Ranka ◽  
Prakash Acharya ◽  
Zubair Shah ◽  
...  
Keyword(s):  
Heart Failure ◽  
Septic Shock ◽  
Congestive Heart Failure ◽  
Hospital Mortality ◽  
Secondary Analysis ◽  
Kidney Injury ◽  
Cross Sectional ◽  
Increased Risk ◽  
Icd 10 ◽  
Nationwide Readmission Database

Purpose: Septic shock (SS) manifests with profound circulatory and cellular metabolism abnormalities and has a high in-hospital mortality (25%-50%). Congestive heart failure (CHF) patients have underlying circulatory dysfunction and compromised cardiac reserve that may place them at increased risk if they develop sepsis. Outcomes in patients with CHF who are admitted with SS have not been well studied. Materials and Method: Retrospective cross sectional secondary analysis of the Nationwide Readmission Database (NRD) for 2016 and 2017. ICD-10 codes were used to identify patients with SS during hospitalization, and then the cohort was dichotomized into those with and without an underlying diagnosis of CHF. Results: Propensity match analyses were performed to evaluate in-hospital mortality and clinical cardiovascular outcomes in the 2 groups. Cardiogenic shock patients were excluded from the study. A total of 578,629 patients with hospitalization for SS were identified, of whom 19.1% had a coexisting diagnosis of CHF. After propensity matching, 81,699 individuals were included in the comparative groups of SS with CHF and SS with no CHF. In-hospital mortality (35.28% vs 32.50%, P < .001), incidence of ischemic stroke (2.71% vs 2.53%, P = .0032), and acute kidney injury (69.9% vs 63.9%, P = .001) were significantly higher in patients with SS and CHF when compared to those with SS and no CHF. Conclusions: This study identified CHF as a strong adverse prognosticator for inpatient mortality and several major adverse clinical outcomes. Study findings suggest the need for further investigation into these findings’ mechanisms to improve outcomes in patients with SS and underlying CHF.

scholarly journals A risk-model for hospital mortality among patients with severe sepsis or septic shock based on German national administrative claims data

PLoS ONE ◽  
2018 ◽  
Vol 13 (3) ◽  
pp. e0194371 ◽  
Author(s):  
Daniel Schwarzkopf ◽  
Carolin Fleischmann-Struzek ◽  
Hendrik Rüddel ◽  
Konrad Reinhart ◽  
Daniel O. Thomas-Rüddel
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Hospital Mortality ◽  
Claims Data ◽  
Risk Model ◽  
Administrative Claims ◽  
Administrative Claims Data

Association between Source of Infection and Hospital Mortality in Patients Who Have Septic Shock

2014 ◽  
Vol 189 (10) ◽  
pp. 1204-1213 ◽  
Author(s):  
Aleksandra Leligdowicz ◽  
Peter M. Dodek ◽  
Monica Norena ◽  
Hubert Wong ◽  
Aseem Kumar ◽  
...  
Keyword(s):  
Septic Shock ◽  
Hospital Mortality ◽  
Source Of Infection

scholarly journals Prompt admission to intensive care is associated with improved survival in patients with severe sepsis and/or septic shock

2018 ◽  
Vol 46 (10) ◽  
pp. 4071-4081 ◽  
Author(s):  
Qiang Li ◽  
Jiajiong Wang ◽  
Guomin Liu ◽  
Meng Xu ◽  
Yanguo Qin ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Multivariable Model ◽  
Icu Admission ◽  
Survival Status ◽  
Healthcare Data ◽  
Multivariable Regression Model ◽  
Multivariable Regression

Objective To investigate the association between time from hospital admission to intensive care unit (ICU) admission (door to ICU time) and hospital mortality in patients with sepsis. Methods This retrospective observational study included routinely collected healthcare data from patients with sepsis. The primary endpoint was hospital mortality, defined as the survival status at hospital discharge. Door to ICU time was calculated and included in a multivariable model to investigate its association with mortality. Results Data from 13 115 patients were included for analyses, comprising 10 309 survivors and 2 806 non-survivors. Door to ICU time was significantly longer for non-survivors than survivors (median, 43.0 h [interquartile range, 12.4, 91.3] versus 26.7 h [7.0, 74.2]). In the multivariable regression model, door to ICU time remained significantly associated with mortality (odds ratio [OR] 1.11, 95% confidence interval [CI] 1.006, 1.017) and there was a significant interaction between age and door to ICU time (OR 0.99, 95% CI 0.99, 1.00). Conclusion A shorter time from hospital door to ICU admission was shown to be independently associated with reduced hospital mortality in patients with severe sepsis and/or septic shock.

scholarly journals Non-invasive Hemodynamic Monitoring in Prediction of the Outcome and Prognosis in Sepsis

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M S M Zaki ◽  
A A A Kassem ◽  
R H A Mohamed ◽  
N N M Guirguis
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Cardiac Index ◽  
Hospital Mortality ◽  
Hemodynamic Monitoring ◽  
Oxygen Delivery ◽  
Impedance Cardiography ◽  
Hospital Death ◽  
Arterial Blood ◽  
Causal Therapy

Abstract Background Complex disease syndromes such as sepsis require multimodal diagnostic and therapeutic approaches. Besides the diagnosis of septic shock and early causal therapy, one major challenge in its treatment remains the resuscitation and management of cardiocirculatory and respiratory dysfunction. As Pulmonary artery catheterization poses significant risks and requires specialized training. Technological advances allow for more readily available, noninvasive clinical measurements of hemodynamics. Impedance cardiography (ICG) offers the potential for safe, noninvasive hemodynamic monitoring that can be easily applied. Objective To evaluate the effect of cardiac index, mean arterial blood pressure, heart rate, and oxygen delivery as measured noninvasively by impedance cardiography (ICG) in prediction of the outcome and prognosis in sepsis. Patients and Methods This is a prospective, observational convenience trial of patients presenting to the ED or the ICU with severe sepsis or septic shock. The patients were part of a cohort that was followed at day 1, day 3 and day7, or until hospital discharge or in-hospital death. After Approval is obtained from the research ethics committee of anesthesia and intensive care department, Ain Shams University. Oral informed consent is obtained from the patient or designated surrogate before data collection begins. Results Twenty-three were enrolled; three were excluded due to an inability to complete data acquisition. The mean cardiac index in nonsurvivors (2.3 L / minÆm2, 95% CI = 2.1 to 2.6) was less than that for survivors (3.3, 95% CI = 2.9 to 3.5). Oxygen delivery as well as lactate were less in non-survivors group. A cardiac index of &lt; 2.5 L / minÆm2 had a sensitivity of 43% (95% CI = 18% to 71%), specificity of 93% (95% CI = 80% to 95%), for predicting in-hospital mortality. Conclusions Early, noninvasive measurement of the cardiac index in critically ill severe sepsis and septic shock patients can be performed in the ED for those who meet criteria for EGDT. There appears to be an association between an initial lower cardiac index as measured noninvasively and in-hospital mortality.

scholarly journals Erythrocyte selenium concentration predicts intensive care unit and hospital mortality in patients with septic shock: a prospective observational study

Critical Care ◽  
2014 ◽  
Vol 18 (3) ◽  
pp. R92 ◽  
Author(s):  
Nara Costa ◽  
Ana Gut ◽  
José Alexandre Pimentel ◽  
Silvia Maria Cozzolino ◽  
Paula Azevedo ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Intensive Care ◽  
Observational Study ◽  
Hospital Mortality ◽  
Prospective Observational Study ◽  
Selenium Concentration

Comparison of Vasopressor Duration in Septic Shock Patients With and Without Cirrhosis

2020 ◽  
pp. 106002802098072
Author(s):  
Melissa M. Durst ◽  
Elizabeth A. Eitzen ◽  
Scott T. Benken
Keyword(s):  
Septic Shock ◽  
Hospital Mortality ◽  
Medical Center ◽  
Cohort Analysis ◽  
Academic Medical Center ◽  
Treatment Strategies ◽  
Severity Of Illness ◽  
Discharge Disposition ◽  
Increase Risk ◽  
Vasopressor Use

Background Patients with cirrhosis have immune dysfunction, altered inflammatory response, and hemodynamic changes which increase risk of septic shock and potentially prolong management with fluids, vasopressors, and other therapies. Due to limited available guidance, this study aimed to characterize vasopressor use in patients with cirrhosis in relation to patients without cirrhosis in septic shock. Methods This was a retrospective matched cohort analysis of 122 patients admitted to the intensive care unit (ICU) at an academic medical center from January 2015 to November 2017. Patients were grouped based on the presence or absence of cirrhosis and matched based on severity of illness scoring. The primary outcome was vasopressor duration. Secondary comparisons included total vasopressor requirement, length of hospital and ICU stay, in-hospital mortality, change in organ function, and discharge disposition. Results The group with cirrhosis had significantly longer median (interquartile range [IQR]) durations of vasopressor therapy compared with the group without cirrhosis (86.0 [42.0-164.5] vs 39.0 [14.5-82.0] hours; P = 0.003) leading to increased median (IQR) vasopressor exposure (71.7 [15.5-239.5] vs 24.7 [5.3-77.9] mg norepinephrine [NE] equivalents; P = 0.003). No difference was found in in-hospital mortality between groups. However, regression analysis showed vasopressor exposure was associated with in-hospital mortality. Conclusion and Relevance Patients with cirrhosis in septic shock have increased vasopressor durations and overall requirements compared with patients without cirrhosis. Increased durations and requirements is associated with poorer outcomes independent of presence of cirrhosis. Future studies are needed to improve vasopressor treatment strategies and end points utilized in cirrhosis.

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