Impact of Clinical Sepsis Phenotypes on Mortality and Fluid Status in Critically Ill Patients

Background: In this study, we aimed to investigate the diagnostic and prognostic utilities of presepsin and procalcitonin (PCT) in critically ill patients with suspected sepsis, for whom sepsis was diagnosed clinically based on the Survival Sepsis Campaign (SSC) criteria and to compare it with recent criteria of Sepsis-3. Methods: Blood samples for biomarker measurements of presepsin and PCT were drawn on days 1, 3 and 7 of ICU admission in a total of 26 patients. All patients were followed-up until death or discharge. All studied biomarkers were analyzed according to the diagnosis and severity of sepsis and for prognosis (all-cause mortality) at days 1, 3 and 7. Agreement between the diagnosis of clinical sepsis and presepsin or PCT-based sepsis was assessed using Cohen’s kappa Results: Clinical sepsis (based on Sepsis-3) and presepsin or PCT-based sepsis showed poor agreement (Kappa<0.4). Presepsin levels at day1 correlated significantly with mortality (r=0.45, P; 0.02). The diagnostic value of both presepsin and PCT to diagnose sepsis was weak (Area under curve (AUC) <0.75). The overall agreement in sepsis diagnosis was fair to good based on the both clinical criteria (P<0.05, Kappa: 0.5-0.75). More than 80% of patients (N=21) had sepsis based on presepsin upon admission. Both clinical criteria predicated that less than 20% of patients (N=5) had sepsis upon admission. Conclusion: Based on our findings, the overall agreement between the diagnosis of clinical sepsis and presepsin or PCT-based sepsis was poor. Also, our results show that the new Sepsis-3 definitions were accurate and equal to the previous definition of SSC guideline. Although, availability of diagnostic assays is variable in Iran, but, it seems that addition of developing decision tools that utilize biomarkers to help aid the rapid diagnosis of sepsis is necessary and may improve patient outcomes. Keywords: Presepsin, Pro Calcitonin, Sepsis, Diagnosis

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Development of a Model-Based Clinical Sepsis Biomarker for Critically Ill Patients

IFAC Proceedings Volumes ◽

10.3182/20090812-3-dk-2006.0076 ◽

2009 ◽

Vol 42 (12) ◽

pp. 13-18

Author(s):

Jessica Lin ◽

Jacquelyn D. Parente ◽

J. Geoffrey Chase ◽

Geoffrey M. Shaw ◽

Amy J. Blakemore ◽

...

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Clinical Sepsis ◽

Model Based

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Qualitative Assessment of the Inferior Vena Cava: Useful Tool for the Evaluation of Fluid Status in Critically Ill Patients

The American Surgeon ◽

10.1177/000313481207800439 ◽

2012 ◽

Vol 78 (4) ◽

pp. 468-470 ◽

Cited By ~ 29

Author(s):

Paula Ferrada ◽

Rahul J. Anand ◽

James Whelan ◽

Michel A. Aboutanos ◽

Therese Duane ◽

...

Keyword(s):

Inferior Vena Cava ◽

Critically Ill ◽

Critically Ill Patients ◽

Inferior Vena ◽

Vena Cava ◽

Fluid Challenge ◽

Penetrating Trauma ◽

Qualitative Assessment ◽

Fluid Status

Inferior vena cava (IVC) diameter change on limited transthoracic echocardiogram (LTTE) can provide a useful guide of fluid status evaluation in critically ill patients. Institutional review board approval was obtained. Prospective evaluation of hemodynamic status was performed in hypotensive patients via LTTE. Images were obtained using an ultrasound machine without M-mode capability. Qualitative assessment of the IVC was obtained via subxyphoid window. FLAT IVC was defined as diameter less than 2 cm and FAT IVC when the vein was equal or larger than 2 cm. Collapsibility was assessed by observing respiratory variation of the vessel. Lactate was measured before and after therapy was initiated. A follow-up LTTE was obtained after fluid challenge. A total of 108 LTTE were performed. Patients’ age ranged from 18 to 89 years with an average of 53. Admission diagnosis was blunt trauma in 66 patients, penetrating trauma in 17, whereas 25 had nontraumatic intra-abdominal emergency. Sixty-nine patients were receiving mechanical ventilation at time of LTTE. Seventy-three patients had a FLAT IVC, and received fluid challenge as therapy. All patients had a change in IVC volume from “FLAT” to “FAT” after the fluid challenge. Seventy-one patients (97%) had resolution of hypotension after the first fluid challenge. Two patients had persistent hypotension and received a second fluid challenge. Follow-up LTTE demonstrated a FAT IVC and lack of collapsibility. Lactate decreased in all 73 patients after therapy guided by LTTE ( P < 0.00001) Evaluation of the IVC diameter via LTTE offers a rapid, non invasive way to evaluate fluid status in critically ill patients.

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