Abstract 14598: The Novel Cardiac Biomarker Secretoneurin Provides Independent Prognostic Information in Severe Sepsis and Septic Shock: Data From the ALBIOS Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Helge Røsjø ◽  
Serge Masson ◽  
Pietro Caironi ◽  
Mats Stridsberg ◽  
Caterina Fanizza ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Cardiac Biomarkers ◽  
Icu Mortality ◽  
Open Label ◽  
Prognostic Information ◽  
Prediction Of Mortality ◽  
Crystalloid Solutions ◽  
Sepsis And Septic Shock

Background: Plasma secretoneurin (SN) is directly correlated to cardiomyocyte Ca 2+ handling and provides independent prognostic information in cardiovascular disease. Whether SN may predict mortality in patients with severe sepsis or septic shock is not established. Methods: We measured SN levels in serial plasma samples collected on days 1, 2, and 7 in 958 patients enrolled in the multicenter, open-label, randomized, controlled ALBIOS trial, that tested either 20% albumin and crystalloid solutions or crystalloid solutions alone in patients with severe sepsis or septic shock. Endpoints were ICU or 90 day mortality. Results: SN levels on day 1 were higher in non-survivors compared to survivors, both for ICU mortality (235 [Q1-Q3 188-290] vs. 192 [155-246] pmol/L, p<0.0001) and for 90 day mortality (227 [183-283] vs. 188 [154-234] pmol/L, p<0.0001). Admission SN levels were influenced by age and lactate, creatinine and NT-proBNP levels. Stratifying patients according to SN quartiles on day 1 separated survivors and non-survivors during follow-up (Figure). After adjusting for clinical risk factors, SAPS II and SOFA scores, and cardiac biomarkers (hs-cTnT and NT-proBNP), SN levels (logarithmical transformed) on day 1 remained significantly associated with ICU mortality (OR 1.29 [95% CI 1.07-1.55], p=0.007) and 90 day mortality (OR 1.22 [1.02-1.47], p=0.03). SN levels on day 2, but not day 7, were also independently associated with ICU and 90 day mortality. SN levels on day 1 and 2 improved prognostic accuracy for ICU and 90 day mortality as assessed by the category-free net reclassification index. We found no interactions between SN levels and randomization to albumin replacement for prediction of mortality during follow-up. Changes in SN levels over time were not predictive of subsequent mortality. Conclusion: SN provides incremental information to established risk models and cardiovascular biomarkers in patients with severe sepsis and septic shock.

scholarly journals Determinants of functional status among survivors of severe sepsis and septic shock: One-year follow-up

2015 ◽  
Vol 10 (2) ◽  
pp. 132 ◽  
Author(s):  
YaseenM Arabi ◽  
MustafaS Al Khalaf ◽  
FatimahH Al Ehnidi ◽  
HasanM Al-Dorzi ◽  
HaniM Tamim ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Functional Status ◽  
One Year ◽  
Sepsis And Septic Shock

scholarly journals Vitamin C, Hydrocortisone, and Thiamine for the Treatment of Severe Sepsis and Septic Shock: A Retrospective Analysis of Real-World Application

2019 ◽  
Vol 8 (4) ◽  
pp. 478 ◽  
Author(s):  
Jane Litwak ◽  
Nam Cho ◽  
H. Nguyen ◽  
Kayvan Moussavi ◽  
Thomas Bushell
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Length Of Stay ◽  
Combination Therapy ◽  
Vitamin C ◽  
Triple Therapy ◽  
Real World ◽  
Standard Care ◽  
Icu Mortality ◽  
Sepsis And Septic Shock

A recent study suggested mortality benefits using vitamin C, hydrocortisone, and thiamine combination therapy (triple therapy) in addition to standard care in patients with severe sepsis and septic shock. In order to further evaluate the effects of triple therapy in real-world clinical practice, we conducted a retrospective observational cohort study at an academic tertiary care hospital. A total of 94 patients (47 in triple therapy group and 47 in standard care group) were included in the analysis. Baseline characteristics in both groups were well-matched. No significant difference in the primary outcome, hospital mortality, was seen between triple therapy and standard care groups (40.4% vs. 40.4%; p = 1.000). In addition, there were no significant differences in secondary outcomes, including intensive care unit (ICU) mortality, requirement for renal replacement therapy for acute kidney injury, ICU length of stay, hospital length of stay, and time to vasopressor independence. When compared to standard care, triple therapy did not improve hospital or ICU mortality in patients with septic shock. A randomized controlled trial evaluating the effects of triple therapy is necessary prior to implementing vitamin C, hydrocortisone, and thiamine combination therapy as a standard of care in patients with septic shock.

scholarly journals Cell-Free Plasma DNA as a Predictor of Outcome in Severe Sepsis and Septic Shock

2008 ◽  
Vol 54 (6) ◽  
pp. 1000-1007 ◽  
Author(s):  
Katri Saukkonen ◽  
Päivi Lakkisto ◽  
Ville Pettilä ◽  
Marjut Varpula ◽  
Sari Karlsson ◽  
...  
Keyword(s):  
Septic Shock ◽  
Regression Analysis ◽  
Severe Sepsis ◽  
Hospital Mortality ◽  
Independent Predictor ◽  
Discriminative Power ◽  
Plasma Dna ◽  
Icu Mortality ◽  
Sepsis And Septic Shock ◽  
Free Plasma

Abstract Background: Increased concentrations of cell-free DNA have been found in plasma of septic and critically ill patients. We investigated the value of plasma DNA for the prediction of intensive care unit (ICU) and hospital mortality and its association with the degree of organ dysfunction and disease severity in patients with severe sepsis. Methods: We studied 255 patients with severe sepsis or septic shock. We obtained blood samples on the day of study inclusion and 72 h later and measured cell-free plasma DNA by real-time quantitative PCR assay for the β-globin gene. Results: Cell-free plasma DNA concentrations were higher at admission in ICU nonsurvivors than in survivors (median 15 904 vs 7522 genome equivalents [GE]/mL, P &lt; 0.001) and 72 h later (median 15 176 GE/mL vs 6758 GE/mL, P = 0.004). Plasma DNA values were also higher in hospital nonsurvivors than in survivors (P = 0.008 to 0.009). By ROC analysis, plasma DNA concentrations had moderate discriminative power for ICU mortality (AUC 0.70–0.71). In multiple regression analysis, first-day plasma DNA was an independent predictor for ICU mortality (P = 0.005) but not for hospital mortality. Maximum lactate value and Sequential Organ Failure Assessment score correlated independently with the first-day plasma DNA in linear regression analysis. Conclusions: Cell-free plasma DNA concentrations were significantly higher in ICU and hospital nonsurvivors than in survivors and showed a moderate discriminative power regarding ICU mortality. Plasma DNA concentration was an independent predictor for ICU mortality, but not for hospital mortality, a finding that decreases its clinical value in severe sepsis and septic shock.

scholarly journals Surviving sepsis campaign guidelines for severe sepsis and septic shock: implementation and outcome of a 3-year follow up

Critical Care ◽  
2009 ◽  
Vol 13 (Suppl 1) ◽  
pp. P340
Author(s):  
A Castellanos Ortega ◽  
B Suberviola ◽  
LA Garcia Astudillo ◽  
MS Holanda ◽  
MA Hernandez ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Surviving Sepsis Campaign ◽  
Sepsis And Septic Shock

scholarly journals Prognostic value of Amino Terminal Pro B-type Natriuretic Peptide (NT-proBNP) in patient with severe sepsis and septic shock in an ICU of tertiary care hospital of Bangladesh.

2018 ◽  
Vol 6 (2) ◽  
pp. 65-70
Author(s):  
Tarikul Hamid ◽  
Rozina Sultana ◽  
ASM Areef Ahsan ◽  
Kaniz Fatema ◽  
Fatema Ahmed ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Tertiary Care ◽  
Whole Body ◽  
Care Hospital ◽  
Inflammatory Reactions ◽  
Icu Admission ◽  
Amino Terminal ◽  
Sepsis And Septic Shock

Background: Severe sepsis and septic shock are the leading cause of ICU admission. Despite the adequate resuscitation, septic shock is frequently associated with multiple system organ failure (MSOF) and death. This study examined the clinical utility of the level of NT-proBNP as an indicator of outcome in severe sepsis and septic shock.Objectives: to find relationship between level of NT-Pro-BNP and the outcome of the patients of severe sepsis and septic shock.Design: This Prospective observational study done in ICU of BIRDEM General Hospital.Method: All consecutive patients who were diagnosed as severe sepsis and septic shock according to SSC (Surviving Sepsis Campaign) guidelines fulfilling the selection criteria were included in the study. Informed written consent was taken from patient’s first degree relatives. Just after admission of severe sepsis and septic shock patients into ICU and development of severe sepsis or septic shock of previously admitted ICU patients, blood sample for serum NT-proBNP level was sent to hospital laboratory. 28 days were taken as follow up period for all patients in this study. Outcome was measured by mortality. Those who were discharged or transferred were classified as survivors and those who were died, categorized as non survivors. Those who were neither discharged nor dead during the study period were classified as survivors. Patient’s resusci-tation and management were done according to the standard ICU protocol of BIRDEM General Hospital.Result: A total 127 of patients fulfilled the criteria of sepsis and septic shock and study inclusion criteria during the study period. The mean & SD of age in this study was 63.69 ± 17.79 years. 52% (n = 66) were male & 48% (n = 61) were female. Here DM was the most common (83.5%) comorbidity and predominant diagnoses were Pneumonia (58.3%) & UTI (30.7%). Among 127 patients, 24.4% (n=31) were in septic shock and 75.6% (n= 96) patients present with severe sepsis. Level of NT-proBNP of severe sepsis patients were 4608.64 ± 7712.12 & Level of NT-proBNP of septic shock patients were 19239.06 ± 13058.05 (P<0.0001). Among 31 (24.4%) septic shock patients, 32.2% (n=10) patients were survivor and NT-proBNP level was 7333.50 ± 10624 pg/ml; 67.8% (n=21) patients were non survivor and NT-proBNP level was 24908.38 ± 10017.87 pg/ml (P <0.001). In this study among 96 (75.6%) patients with severe sepsis, 88.7% (n=86) were survivor and NT-proBNP level was 2436.41 ± 3755.03 pg/ml; 11.3% (n=11) patients were non-survivors and NT-proBNP level was 21238.36 ± 10095.34 pg/ml (P<0.0001).Conclusion: Severe sepsis and septic shock are the leading cause of ICU admission and also leading cause of death. Our study showed that, elderly with diabetes mellitus had developed more sepsis. Pneumonia and UTI are commonest cause of sepsis.Sepsis causes extreme inflammatory reactions involving all organs of whole body including heart, causing release of NT-proBNP. Raised level of this biomarker associated with increased rate of mortality.Bangladesh Crit Care J September 2018; 6(2): 65-70

Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock

2018 ◽  
pp. 47-54
Author(s):  
Namita Jayaprakash ◽  
Joseph Hyder
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Laboratory Assessment ◽  
Goal Directed Therapy ◽  
Sepsis Diagnosis ◽  
Early Goal Directed Therapy ◽  
Sepsis And Septic Shock ◽  
Study Intervention ◽  
Use Of Health Care

This chapter provides a summary of the landmark study known as the EGDT Trial. Among patients with severe sepsis or septic shock, does early goal-directed therapy (EGDT) reduce the incidence of multi-organ dysfunction and mortality and the use of health care resources? Starting with that question, the chapter describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case. Publication of the EGDT trial shifted the paradigm of sepsis diagnosis and care from the ICU to the point of earliest presentation. Sepsis is now recognized for its occult nature, which may be unmasked by vigilance and laboratory assessment with lactate measurement.

scholarly journals A novel score based on age and cardiac biomarkers predicts outcomes in severe sepsis and septic shock

Critical Care ◽  
2007 ◽  
Vol 11 (Suppl 2) ◽  
pp. P450
Author(s):  
A Turley ◽  
A Thornley ◽  
A Roberts ◽  
M Johnson ◽  
M de Belder ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Cardiac Biomarkers ◽  
Sepsis And Septic Shock

scholarly journals Clinical Outcomes of Severe Sepsis and Septic Shock Patients with Left Ventricular Dysfunction Undergoing Continuous Renal Replacement Therapy: A Multicenter Retrospective Study

2020 ◽  
Author(s):  
Guangwei Yu ◽  
Kun Cheng ◽  
Qing Liu ◽  
Zhenhao Zhu ◽  
Fenghui Lin ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Retrospective Study ◽  
Renal Replacement Therapy ◽  
Left Ventricular ◽  
Control Group ◽  
Early Group ◽  
Icu Mortality ◽  
Lv Dysfunction ◽  
Sepsis And Septic Shock

Abstract Background: Baseline left ventricular (LV) dysfunction is associated with subsequent risks of acute kidney injury (AKI) and mortality in patients with sepsis. This study investigated the therapeutic effects of continuous renal replacement therapy (CRRT) in hemodynamically unstable patients with severe sepsis and septic shock combined with LV dysfunction.Methods: In this multicenter retrospective study, severe sepsis and septic shock patients with LV dysfunction were classified into one of two groups according to the timing of CRRT: the early group (before AKI was detected) or the control group (patients with AKI). All-cause intensive care unit (ICU) mortality and ICU stay were compared between the groups. Patients were weighted by stabilized inverse probability of treatment weights (sIPTW) to overcome differences in baseline characteristics.Results: After sIPTW analysis, the ICU mortality was significantly lower in the early group than the control group (25.9% vs 59.0%, p < 0.001). Weighted multivariable analysis showed that early CRRT initiation was a protective factor for the risk of ICU mortality. Early CRRT initiation significantly improved the ICU mortality compared to the control group (OR, 0.322; 95% CI, 0.125-0.834; p = 0.020).Conclusions: Early CRRT in the absence of AKI is suggested for hemodynamically unstable patients with severe sepsis and septic shock combined with LV dysfunction since it benefits survival outcomes.Trial registration: The study was preregistered in the Chinese Clinical Trial Registry (number, ChiCTR2000033083).

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