Infection site is predictive of outcome in acute lung injury associated with severe sepsis and septic shock

Objective: Methods containing only clinical information fail to meet the needs of prediction of acute lung injury (ALI) because of the relatively low positive predictive value. This study aimed to investigate the feasibility of using biomarkers as predictors of ALI in populations with severe sepsis/septic shock and to explore difference among biomarkers after adjustment for potential confounders. Methods: Serum specimens were collected from patients with severe sepsis/septic shock (n = 172) presented to the emergency department. Patients should be ruled out from the study if they were already suffering from ALI or if they deteriorated into ALI within 6 hours after specimen collection. The development of ALI of the remaining patients was tracked. Results: Of all patients with severe sepsis/septic shock who encountered ALI more than 6 hours succeeding to specimen collection, 19 deteriorated into ALI. Elevation in serum interleukin 8 (IL-8) and Parkinson disease 7 (PARK7) levels had significant connection with higher risk of developing ALI ( P = .006; P = .0001). Sepsis treatment and vasopressor application led to a robust connection between PARK7 and succeeding ALI development. Patients who deteriorated into ALI were distinguished accurately from patients who avoided ALI using PARK7 or Lung Injury Prediction Score (LIPS; area under the receiver operating characteristic curve [AUROC], 0.73 and 0.72 for each). Combination of PARK7 and LIPS ameliorated AUROC to 0.86 (vs 0.73, P = .05). On the contrary, serum soluble receptor for advanced glycation end products and von Willebrand factor made no contribution to the prediction of ALI development. Conclusions: Patients with PARK7 or IL-8 levels above normal are more vulnerable to ALI. Patients vulnerable to ALI can be distinguished with the combination of serum biomarkers and clinical prediction scores. In addition, the early rise in PARK7 emphasizes the importance of endothelial injury in the early pathogenesis of ALI.

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ACUTE LUNG INJURY AND ACUTE RESPIRATORY DISTRESS SYNDROME IN SEPSIS AND SEPTIC SHOCK

Critical Care Clinics ◽

10.1016/s0749-0704(05)70111-1 ◽

2000 ◽

Vol 16 (2) ◽

pp. 289-317 ◽

Cited By ~ 86

Author(s):

Alan M. Fein ◽

Mylene G. Calalang-Colucci

Keyword(s):

Septic Shock ◽

Acute Respiratory Distress Syndrome ◽

Acute Lung Injury ◽

Lung Injury ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Sepsis And Septic Shock

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Emergency Department Antithrombin III And Plasminogen Activator Inhibitor-1 Initial Plasma Levels Are Associated With Acute Lung Injury In Patients With Severe Sepsis And Septic Shock

10.1164/ajrccm-conference.2010.181.1_meetingabstracts.a2587 ◽

2010 ◽

Author(s):

Michael G.S. Shashaty ◽

Nancy E. Kohn ◽

Jason D. Christie ◽

Shiv Kapoor ◽

Mark E. Mikkelsen ◽

...

Keyword(s):

Emergency Department ◽

Septic Shock ◽

Severe Sepsis ◽

Acute Lung Injury ◽

Antithrombin Iii ◽

Plasminogen Activator Inhibitor ◽

Plasminogen Activator Inhibitor 1 ◽

Initial Plasma ◽

Sepsis And Septic Shock ◽

Activator Inhibitor

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Outcomes of Severe Sepsis and Septic Shock Patients on Chronic Antiplatelet Treatment: A Historical Cohort Study

Critical Care Research and Practice ◽

10.1155/2013/782573 ◽

2013 ◽

Vol 2013 ◽

pp. 1-9 ◽

Cited By ~ 11

Author(s):

Juan C. Valerio-Rojas ◽

Insara J. Jaffer ◽

Daryl J. Kor ◽

Ognjen Gajic ◽

Rodrigo Cartin-Ceba

Keyword(s):

Septic Shock ◽

Acute Respiratory Distress Syndrome ◽

Severe Sepsis ◽

Cohort Study ◽

Acute Lung Injury ◽

Lung Injury ◽

Confidence Interval ◽

Antiplatelet Therapy ◽

Odds Ratio ◽

Distress Syndrome

Background. Sepsis is characterized by dysfunctional activation of platelets, and antiplatelet therapy could improve the outcomes of septic patients.Methods. We performed a retrospective cohort study of severe sepsis or septic shock adult patients. Outcomes of patients on antiplatelet therapy were compared to those that were not taking antiplatelet therapy by univariate analysis followed by a propensity score analysis based on the probability of receiving antiplatelet therapy.Results. Of 651 patients included in the study 272 (42.8%) were on antiplatelet therapy before the development of severe sepsis or septic shock. After adjusting for important confounding variables antiplatelet therapy was not associated with a decreased risk of hospital mortality (odds ratio 0.73, 95% confidence interval 0.46–1.16). Antiplatelet therapy was associated with a decreased incidence of acute respiratory distress syndrome/acute lung injury (odds ratio 0.50, 95% confidence interval 0.35–0.71) and reduced need of mechanical ventilation (odds ratio 0.62, 95% confidence interval 0.45–87). Incidence of acute kidney injury was similar between both groups (odds ratio 1.08, 95% confidence interval 0.73–1.59).Conclusions. The use of antiplatelet therapy before the diagnosis of severe sepsis or septic shock was not associated with decreased hospital mortality. Antiplatelet therapy was associated with a decreased incidence of acute lung injury/acute respiratory distress syndrome.

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Effect of fluid bolus triggers and their combination on fluid responsiveness in optimization phase of severe sepsis and septic shock resuscitation

MedPharmRes ◽

10.32895/ump.mpr.2.3.27 ◽

2018 ◽

Vol 2 (3) ◽

pp. 27-32

Author(s):

Bien Le ◽

Dai Huynh ◽

Mai Tuan ◽

Minh Phan ◽

Thao Pham ◽

...

Keyword(s):

Blood Pressure ◽

Septic Shock ◽

Severe Sepsis ◽

Fluid Responsiveness ◽

Statistical Significance ◽

Venous Pressure ◽

Fluid Bolus ◽

Low Blood Pressure ◽

Low Central Venous Pressure ◽

Sepsis And Septic Shock

Objectives: to evaluate the fluid responsiveness according to fluid bolus triggers and their combination in severe sepsis and septic shock. Design: observational study. Patients and Methods: patients with severe sepsis and septic shock who already received fluid after rescue phase of resuscitation. Fluid bolus (FB) was prescribed upon perceived hypovolemic manifestations: low central venous pressure (CVP), low blood pressure, tachycardia, low urine output (UOP), hyperlactatemia. FB was performed by Ringer lactate 500 ml/30 min and responsiveness was defined by increasing in stroke volume (SV) ≥15%. Results: 84 patients were enrolled, among them 30 responded to FB (35.7%). Demographic and hemodynamic profile before fluid bolus were similar between responders and non-responders, except CVP was lower in responders (7.3 ± 3.4 mmHg vs 9.2 ± 3.6 mmHg) (p 0.018). Fluid response in low CVP, low blood pressure, tachycardia, low UOP, hyperlactatemia were 48.6%, 47.4%, 38.5%, 37.0%, 36.8% making the odd ratio (OR) of these triggers were 2.81 (1.09-7.27), 1.60 (0.54-4.78), 1.89 (0.58-6.18), 1.15 (0.41-3.27) and 1.27 (0.46-3.53) respectively. Although CVP < 8 mmHg had a higher response rate, the association was not consistent at lower cut-offs. The combination of these triggers appeared to raise fluid response but did not reach statistical significance: 26.7% (1 trigger), 31.0% (2 triggers), 35.7% (3 triggers), 55.6% (4 triggers), 100% (5 triggers). Conclusions: fluid responsiveness was low in optimization phase of resuscitation. No fluid bolus trigger was superior to the others in term of providing a higher responsiveness, their combination did not improve fluid responsiveness as well.

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