A Nationwide Comparison Between Sepsis-2 and Sepsis-3 Definition in Japan

Background: Currently, it remains controversial whether the Sepsis-3 definition provides the most appropriate criteria for clinical use. The purpose of this study was to compare between the Sepsis-2 and Sepsis-3 definitions using Japan’s nationwide registry. Methods: Data were obtained from a multicenter registry conducted at 42 intensive care units (ICUs) throughout Japan, in which patients received treatment for severe sepsis or septic shock between January 2011 and December 2013. Results: A total of 2797 patients diagnosed using the Sepsis-2 criteria were included in the present study. These patients were categorized into “Severe sepsis” (n = 1154) and “Sepsis-2 shock” (n = 1643) groups. Among the “Sepsis-2 shock” group, patients who did not meet the Sepsis-3 criteria for septic shock were categorized into the “Sepsis-2 shock-only” (n = 448, 27.3%) group, while patients who met the Sepsis-3 criteria for septic shock were categorized into “Sepsis-3 shock (n = 1195, 72.7%)” group. The ICU mortality in the “Sepsis-3 shock” group, “Sepsis-2 shock-only” group, and “Severe sepsis” group was 28.5%, 10.9%, and 14.1%, respectively. We observed no significant difference between the “Severe sepsis” and “Sepsis-2 shock-only” groups in terms of in-hospital survival ( P = .098), while the “Sepsis-3 shock” group had the highest in-hospital mortality rate ( P < .001). In a multivariate logistic regression analysis, liver insufficiency and immunocompromised status were independent prognostic factors in the “Sepsis-2 shock-only” group. In contrast, chronic heart disease and chronic hemodialysis were independent prognostic factors in the “Sepsis-3 shock” group. Conclusions: The ICU mortality of the “Sepsis-2 shock-only” group was significantly low. Besides septic shock diagnosed by the Sepsis-3 definition selects patients with more severe cases of sepsis among the “Sepsis-2 shock” group.

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Assessment of Diagnostic and Prognostic Role of Copeptin in the Clinical Setting of Sepsis

BioMed Research International ◽

10.1155/2016/3624730 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 11

Author(s):

Stefania Battista ◽

Umberto Audisio ◽

Claudia Galluzzo ◽

Matteo Maggiorotto ◽

Monica Masoero ◽

...

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Roc Curve ◽

Survival Rates ◽

Threshold Value ◽

Shock Group ◽

Response To Treatment ◽

Sepsis Group ◽

Prognostic Role ◽

Coronary Syndrome

The diagnostic and prognostic usefulness of copeptin were evaluated in septic patients, as compared to procalcitonin assessment. In this single centre and observational study 105 patients were enrolled: 24 with sepsis, 25 with severe sepsis, 15 with septic shock, and 41 controls, divided in two subgroups (15 patients with gastrointestinal bleeding and 26 with suspected SIRS secondary to trauma, acute coronary syndrome, and pulmonary embolism). Biomarkers were determined at the first medical evaluation and thereafter 24, 48, and 72 hours after admission. Definitive diagnosis and in-hospital survival rates at 30 days were obtained through analysis of medical records. At entry, copeptin proved to be able to distinguish cases from controls and also sepsis group from septic shock group, while procalcitonin could distinguish also severe sepsis from septic shock group. Areas under the ROC curve for copeptin and procalcitonin were 0.845 and 0.861, respectively. Noteworthy, patients with copeptin concentrations higher than the threshold value (23.2 pmol/L), calculated from the ROC curve, at admission presented higher 30-day mortality. No significant differences were found in copeptin temporal profile among different subgroups. Copeptin showed promising diagnostic and prognostic role in the management of sepsis, together with its possible role in monitoring the response to treatment.

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Evaluation of red cell distribution width (RDW) as a septic marker in comparison with clinical scores and C-reactive protein

QJM ◽

10.1093/qjmed/hcab086.014 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Ali Ahmed Naga ◽

Mohammed Ismaeil Abdel Fattah ◽

Walid Hamed Nofal ◽

Mohammed Abd-elsalam AlMenshawe

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Controlled Study ◽

Control Group ◽

Study Group ◽

Distribution Width ◽

Clinical Scores ◽

Group I ◽

Significant Difference ◽

Sepsis And Septic Shock

Abstract Background Challenges of diagnosing and treating sepsis only seem more difficult as incidence increases, patients become older and sicker, and pathogenic organisms evolve. New understanding of inflammatory mediators and pathways, immunity, and genetic variability in this disease state suggests that the current definitions of SIRS, sepsis, severe sepsis, and septic shock are oversimplified. Objective The aim of our study is to evaluate the level of RDW, CRP and clinical scores "SOFA and APACHI" as markers in patients with sepsis and their levels on the outcome and resolution of sepsis in ICU. Methodology We conducted a prospective observational controlled study on 90 adult persons of both sex, 45 of them are adult patients and served as the study group (Group I), and the other 45 are healthy adult volunteers and served as the control group (Group II). The study group represented patients admitted to the ICU of Intensive Care Unit at Damanhour Medical National Institute who fulfilled the diagnostic criteria for sepsis, severe sepsis and septic shock on arrival to ICU according to the SCCM/ ESICM/ ACCP/ ATS/SIS International Sepsis Definitions Conference. Results. In the present study we found that CRP measured on admission was not a predictor of mortality, while that measured at day 5 and day 10 predicted mortality, where there was no statistically significant difference in CRP levels between survivors and non-survivors at the day of admission while there were statistically significant differences between survivors and non survivors according to CRP levels at day 5 (p = 0.001*) and at day 10 (p = 0.001*). It was found also that there were statistically significant differences between survivors and non-survivors according to RDW at day 1(p = 0.011*) and at day 5(p = 0.009*), at day 10 was found there was no statistically significant difference between survivors and non-survivors (p = 0.338). Conclusion RDW is a new promising cheap and readily available biomarker that can be able to diagnose patients with sepsis with accuracy comparable to CRP. Also, RDW at admission is able to predict mortality.

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Traditional Chinese Medicine Diagnosis “Yang-Xu Zheng”: Significant Prognostic Predictor for Patients with Severe Sepsis and Septic Shock

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2013/759748 ◽

2013 ◽

Vol 2013 ◽

pp. 1-8 ◽

Cited By ~ 4

Author(s):

Sunny Jui-Shan Lin ◽

Yung-Yen Cheng ◽

Chih-Hung Chang ◽

Cheng-Hung Lee ◽

Yi-Chia Huang ◽

...

Keyword(s):

Septic Shock ◽

Regression Analysis ◽

Severe Sepsis ◽

Host Response ◽

Multivariate Logistic Regression Analysis ◽

Apache Ii ◽

Apache Ii Score ◽

Multivariate Logistic Regression ◽

Sepsis Mortality ◽

Sepsis And Septic Shock

Pathogenesis of sepsis includes complex interaction between pathogen activities and host response, manifesting highly variable signs and symptoms, possibly delaying diagnosis and timely life-saving interventions. This study applies traditional Chinese medicine (TCM)Zhengdiagnosis in patients with severe sepsis and septic shock to evaluate its adaptability and use as an early predictor of sepsis mortality. Three-year prospective observational study enrolled 126 septic patients. TCMZhengdiagnosis, Acute Physiology and Chronic Health Evaluation (APACHE) II score, and blood samples for host response cytokines measurement (tumor necrosis factor-α, Interleukin-6, Interleukin-8, Interleukin-10, Interleukin-18) were collected within 24 hours after admission to Intensive Care Unit. Main outcome was 28-day mortality; multivariate logistic regression analysis served to determine predictive variables of the sepsis mortality. APACHE II score, frequency ofNutrient-phase heat, andQi-XuandYang-Xu Zhengswere significantly higher in nonsurvivors. The multivariate logistic regression analysis identifiedYang-Xu Zhengas the outcome predictor. APACHE II score and levels of five host response cytokines between patients with and withoutYang-Xu Zhengrevealed significant differences. Furthermore, cool extremities and weak pulse, both diagnostic signs ofYang-Xu Zheng, were also proven independent predictors of sepsis mortality. TCM diagnosis “Yang-Xu Zheng” may provide a new mortality predictor for septic patients.

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LIMFOSIT T CD4+SEBAGAI PERAMAL PERJALANAN PENYAKIT PASIEN YANG MENGALAMI SEPSIS

INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY ◽

10.24293/ijcpml.v19i3.418 ◽

2016 ◽

Vol 19 (3) ◽

pp. 178

Author(s):

Lestari Ekowati ◽

Aryati Aryati ◽

Hardiono Hardiono

Keyword(s):

Septic Shock ◽

T Lymphocyte ◽

Roc Curve ◽

Lymphocyte Count ◽

Apache Ii Score ◽

Icu Mortality ◽

Survival Group ◽

Common Cause ◽

Significant Difference ◽

Very High

Sepsis is the most common cause of ICU mortality in USA. Mortality of sepsis in developing countries is still very high, about 50- 70% and has became a 80% incidence in septic shock. There was a decrease of CD4+ T lymphocyte count in patients with sepsis caused by apoptosis indicating septic patients suffered from immune functional impairment. CD4+ T lymphocyte count can reflect the severity of sepsis and predict the prognosis of the patients with sepsis effectively. Eighty eight (88) patients who met sepsis criteria were studied. The researchers collected clinical variables of all patients within 24 hours diagnosis of sepsis, and calculated APACHE II score. At the same time, blood sample were taken to measure the CD4+ T lymphocyte count. The data were analyzed using independent Student-T-test and ROC curve was used for prognosis. There is a significant difference in CD4+ T lymphocyte count between non survival and survival group (non survival group 203±178 cells/μL, survival group 442±303 cells/μL, p<0.001), and the percentage of CD4+ T lymphocyte (non survival group 25.05±11.55%, survival group 34.38±9.15%, p<0.001). There is an under ROC curve for CD4+ T lymphocyte count was 0.81, and for the percentage of CD4+ T lymphocyte was 0.748. Cut off value for CD4+ T lymphocyte count was 204 cells/μL, and the percentage of CD4+ T lymphocytes was 25.23%. Based on this study, the CD4+ T lymphocyte count can be used as a predictor of prognosis in sepsis patients.

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Presepsin as a predictor of severe sepsis in urinary tract infection

10.21203/rs.3.rs-284985/v1 ◽

2021 ◽

Author(s):

Yoshitaka Sekine ◽

Kazuhiko Kotani ◽

Daisuke Oka ◽

Hiroshi Nakayama ◽

Yoshiyuki Miyazawa ◽

...

Keyword(s):

Septic Shock ◽

Risk Factor ◽

Severe Sepsis ◽

Urinary Tract ◽

Urinary Tract Infections ◽

Roc Curve ◽

Independent Risk Factor ◽

Good Marker ◽

Significant Difference ◽

Tract Infections

Abstract Background Recently, presepsin is reported to be a biomarker for early diagnosis of sepsis and evaluation of prognosis in septic patients, but there are few reports about urinary-tract infections. The objective of this study is to evaluate whether presepsin is a recent marker for detecting severe sepsis, and whether it can predict the therapeutic course in UTI when compared with procalcitonin (PCT) and C-reactive protein (CRP), already used markers.Methods From April 2014 to December 2016, a total of 50 patients, who were admitted into Gunma university hospital with urinary-tract infections, were enrolled in this study. Vital signs, presepsin, PCT, CRP, white blood cell (WBC), causative diseases of urinary-tract infections and other data were evaluated at the enrollment, third and fifth days. The patients were divided into two groups; with (n=11) or without (n=39) septic shock at the enrollment day, and with (n=7) or without (n=43) sepsis at the fifth day, respectively. Presepsin was evaluated for systemic inflammatory response syndrome (SIRS) or septic shock. Results Concerning the enrollment day, there was no significant difference of presepsin between SIRS and non-SIRS groups (p=0.276). The median presepsin (pg/mL) was significantly higher in the septic shock group (p<0.001). Multivariate logistic regression analysis showed presepsin (≧ 500 pg/ml) was an independent risk factor associated with septic shock (p=0.007). ROC curve for diagnosing septic shock indicated an area under the curve (AUC) at 0.881 for presepsin (vs. 0.690, 0.583 and 0.527 for PCT, CRP and WBC, respectively). Concerning the 5th day after admission, the median presepsin of the enrollment day was significantly higher in SIRS groups than non-SIRS groups (p=0.006). On the other hand, PCT (≥ 2 ng/ml) of the enrollment day was an independent risk factor associated with SIRS. ROC curve for diagnosing sepsis at the fifth day indicated an AUC at 0.837 for PCT (vs. 0.817, 0.811 and 0.802 for presepsin, CRP and WBC, respectively).Conclusions This study shows that presepsin may be a good marker for diagnosis of severe patients who need vasopressor therapy at the data of admission, and PCT may be a good marker for predicting hard-to-treat cases in UTI.

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Early Infectious Disease Consultation Is Associated With Lower Mortality in Patients With Severe Sepsis or Septic Shock Who Complete the 3-Hour Sepsis Treatment Bundle

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz408 ◽

2019 ◽

Vol 6 (10) ◽

Cited By ~ 4

Author(s):

Theresa Madaline ◽

Francis Wadskier Montagne ◽

Ruth Eisenberg ◽

Wenzhu Mowrey ◽

Jaskiran Kaur ◽

...

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Hospital Mortality ◽

Length Of Hospital Stay ◽

Rank Test ◽

P Value ◽

Analysis Model ◽

Subdistribution Hazard ◽

Significant Difference ◽

The Impact

Abstract Objective Severe sepsis and septic shock (SS/SS) treatment bundles reduce mortality, and early infectious diseases (ID) consultation also improves patient outcomes. We retrospectively examined whether early ID consultation further improves outcomes in Emergency Department (ED) patients with SS/SS who complete the sepsis bundle. Method We included 248 adult ED patients with SS/SS who completed the 3-hour bundle. Patients with ID consultation within 12 hours of ED triage (n = 111; early ID) were compared with patients who received standard care (n = 137) for in-hospital mortality, 30-day readmission, length of hospital stay (LOS), and antibiotic management. A competing risk survival analysis model compared risks of in-hospital mortality and discharge alive between groups. Results In-hospital mortality was lower in the early ID group unadjusted (24.3% vs 38.0%, P = .02) and adjusted for covariates (odds ratio, 0.47; 95% confidence interval (CI), 0.25–0.89; P = .02). There was no significant difference in 30-day readmission (22.6% vs 23.5%, P = .89) or median LOS (10.2 vs 12.1 days, P = .15) among patients who survived. A trend toward shorter time to antibiotic de-escalation in the early ID group (log-rank test P = .07) was observed. Early ID consultation was protective of in-hospital mortality (adjusted subdistribution hazard ratio (asHR), 0.60; 95% CI 0.36–1.00, P = .0497) and predictive of discharge alive (asHR 1.58, 95% CI, 1.11–2.23; P-value .01) after adjustment. Conclusions Among patients receiving the SS/SS bundle, early ID consultation was associated with a 40% risk reduction for in-hospital mortality. The impact of team-based care and de-escalation on SS/SS outcomes warrants further study.

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

Journal of Clinical Medicine ◽

10.3390/jcm8040478 ◽

2019 ◽

Vol 8 (4) ◽

pp. 478 ◽

Cited By ~ 17

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.

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

Clinical Chemistry ◽

10.1373/clinchem.2007.101030 ◽

2008 ◽

Vol 54 (6) ◽

pp. 1000-1007 ◽

Cited By ~ 111

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 < 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.

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