Sepsis and Septic Shock Definitions in Patients With Cancer Admitted in ICU

2019 ◽  
pp. 088506661989493 ◽  
Author(s):  
Neveux Nathan ◽  
Jean-Paul Sculier ◽  
Lieveke Ameye ◽  
Marianne Paesmans ◽  
Grigoriu Bogdan-Dragos ◽  
...  
Keyword(s):  
Septic Shock ◽  
Hospital Mortality ◽  
Sofa Score ◽  
Patients With Cancer ◽  
Failure Assessment ◽  
Predict Hospital Mortality ◽  
Definition Of ◽  
Qsofa Score ◽  
Sepsis And Septic Shock ◽  
Sirs Criteria

Introduction: In 2016, a new definition of sepsis and septic shock was adopted. Some studies based on the general population demonstrated that the Sequential Organ Failure Assessment (SOFA) score is more accurate than the systemic inflammatory response syndrome (SIRS) criteria to predict hospital mortality of infected patients requiring intensive care. Patients and Method: We have analyzed all the records of patients with cancer admitted for a suspected infection between January 1, 2013, and December 31, 2016, in our oncological intensive care unit (ICU). Sequential Organ Failure Assessment score and quick SOFA (qSOFA) score as well as SIRS criteria were calculated. We analyzed the accuracy of each score to predict hospital mortality in the setting of the new and old definitions of septic shock. Results: Our study includes 241 patients with a solid tumor and 112 with a hematological malignancy. The hospital mortality rate is 37% (68% in patients with septic shock according to the new definition and 60% according to old definition) between 2013 and 2016. To predict hospital mortality, the SOFA score has an area under the receiver operating characteristic curve of 0.74 (95% confidence interval [CI], 0.68-0.79), the qSOFA of 0.65 (95% CI, 0.59-0.70), and the SIRS criteria of 0.58 (95% CI, 0.52-0.63). In multivariate analysis, a higher SOFA score or a higher qSOFA score indicates poor prognosis: odds ratio (OR) per 1-point increase by 1.28 (95% CI, 1.18-1.39) and 1.48 (95% CI, 1.04-2.11), respectively. Complete remission is a good prognostic factor for hospital mortality: OR 0.39 (95% CI, 0.22-0.67). Conclusion: The new definition of sepsis and septic shock is applicable in an ICU oncological population with the same reliability as in the general population. The SOFA score is more accurate than qSOFA and SIRS criteria to predict hospital mortality.

scholarly journals SOFA Score, Hemodynamics and Body Temperature Allow Early Discrimination between Porcine Peritonitis-Induced Sepsis and Peritonitis-Induced Septic Shock

2021 ◽  
Vol 11 (3) ◽  
pp. 164
Author(s):  
Mahmoud Al-Obeidallah ◽  
Dagmar Jarkovská ◽  
Lenka Valešová ◽  
Jan Horák ◽  
Jan Jedlička ◽  
...  
Keyword(s):  
Septic Shock ◽  
Body Temperature ◽  
Sofa Score ◽  
Porcine Model ◽  
Venous Blood ◽  
Mixed Venous Blood ◽  
Mechanically Ventilated ◽  
Multiple Parameters ◽  
Failure Assessment ◽  
Sepsis And Septic Shock

Porcine model of peritonitis-induced sepsis is a well-established clinically relevant model of human disease. Interindividual variability of the response often complicates the interpretation of findings. To better understand the biological basis of the disease variability, the progression of the disease was compared between animals with sepsis and septic shock. Peritonitis was induced by inoculation of autologous feces in fifteen anesthetized, mechanically ventilated and surgically instrumented pigs and continued for 24 h. Cardiovascular and biochemical parameters were collected at baseline (just before peritonitis induction), 12 h, 18 h and 24 h (end of the experiment) after induction of peritonitis. Analysis of multiple parameters revealed the earliest significant differences between sepsis and septic shock groups in the sequential organ failure assessment (SOFA) score, systemic vascular resistance, partial pressure of oxygen in mixed venous blood and body temperature. Other significant functional differences developed later in the course of the disease. The data indicate that SOFA score, hemodynamical parameters and body temperature discriminate early between sepsis and septic shock in a clinically relevant porcine model. Early pronounced alterations of these parameters may herald a progression of the disease toward irreversible septic shock.

The Association Between Sequential Organ Failure Assessment Scores and Mortality in Patients With Sepsis During the First Week: The JSEPTIC DIC Study

2018 ◽  
Vol 35 (7) ◽  
pp. 656-662 ◽  
Author(s):  
Tsuyoshi Nakashima ◽  
Kyohei Miyamoto ◽  
Toshio Shimokawa ◽  
Seiya Kato ◽  
Mineji Hayakawa
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Hospital Mortality ◽  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Sofa Score ◽  
Assessment Scores ◽  
Coagulation Study ◽  
Failure Assessment ◽  
The Relationship

Objective: Predicting prognosis is a complex process, particularly in patients with severe sepsis or septic shock. This study aimed to determine the relationship between the Sequential Organ Failure Assessment (SOFA) scores for individual organs during the first week of admission and the in-hospital mortality in patients with sepsis. Methods: This study was a post hoc evaluation of the Japan Septic Disseminated Intravascular Coagulation study and included patients admitted to 42 intensive care units in Japan for severe sepsis or septic shock, between January 2011 and December 2013. We assessed the relationship between the organ and total SOFA scores on days 1, 3, and 7 following admission and the in-hospital mortality using logistic regression analysis. Results: We evaluated 2732 patients and found the in-hospital mortality rate was 29.1%. The mean age of the patients (standard deviation) was 70.5 (14.1) years, and the major primary site of infection was the abdomen (33.6%). The central nervous system (CNS) SOFA score exhibited the strongest relationship with mortality on days 1 (adjusted odds ratio [aOR]: 1.49, 95% confidence interval [CI]: 1.40-1.59), 3 (aOR: 1.75, 95% CI: 1.62-1.89), and 7 (aOR: 1.93, 95% CI: 1.77-2.10). The coagulation SOFA scores showed a weak correlation with mortality on day 1, but a strong correlation with mortality on day 7 (aOR: 2.04, 95% CI: 1.87-2.24). Conclusions: The CNS SOFA scores were associated with mortality in patients with severe sepsis on days 1, 3, and 7 following hospitalization. The coagulation SOFA score was associated with mortality on day 7. In clinical situations, the CNS SOFA scores during the acute phase and the CNS SOFA and coagulation SOFA scores during the subsequent phases should be evaluated in order to determine patient prognosis.

scholarly journals Recent advances in the pathophysiology and management of sepsis: a review

2021 ◽  
Vol 22 (2) ◽  
pp. 133-145
Author(s):  
B.A. Adegboro ◽  
J. Imran ◽  
S.A. Abayomi ◽  
E.O. Sanni ◽  
S.A. Biliaminu
Keyword(s):  
Septic Shock ◽  
Sofa Score ◽  
Clinical Status ◽  
Altered Mental Status ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Acute Increase ◽  
Haematological Changes ◽  
Definition Of ◽  
Sepsis And Septic Shock

Sepsis is a syndrome consisting of physiological, pathological and biochemical anomalies caused by infectious agents. It causes clinical organ dysfunction, which is identified by an acute increase in the Sequential (sepsis-related) Organ Failure Assessment (SOFA) score of two or more points. SOFA score is a score of three components that can be easily used at the bedside to track the clinical status of a patient while on admission, and these are altered respiratory rate of ≥ 22 breaths/minute, altered mental status, and systolic blood pressure of ≤ 100 mmHg. A patient with SOFA score of ≥ 2 has an attributable 2 - 25-fold increased risk of mortality compared to a patient with SOFA score of ˂ 2. This present review provides information on the new definition of sepsis and septic shock, aetiology, pathophysiology, biochemical, pathological and haematological changes, morbidity and mortality parameters, management, andprognostic factors in patients with sepsis. Key words: Sepsis, septic shock, SOFA score, pathophysiology, management bundles

scholarly journals Combining Sequential Organ Failure Assessment (SOFA) Score with Acute Physiology and Chronic Health Evaluation (APACHE) II Score to Predict Hospital Mortality of Critically Ill Patients

2007 ◽  
Vol 35 (4) ◽  
pp. 515-521 ◽  
Author(s):  
K. M. Ho
Keyword(s):  
Hospital Mortality ◽  
Critically Ill ◽  
Sofa Score ◽  
Critically Ill Patients ◽  
Characteristic Curve ◽  
Apache Ii ◽  
Brier Score ◽  
Apache Ii Score ◽  
Failure Assessment ◽  
Predict Hospital Mortality

The ability to accurately adjust for the severity of illness in outcome studies of critically ill patients is essential. Previous studies have showed that Sequential Organ Failure Assessment (SOFA) score and Acute Physiology and Chronic Health Evaluation (APACHE) II score can predict hospital mortality of critically ill patients. The effects of combining these two scores to predict hospital mortality of critically ill patients has not been evaluated. This cohort study evaluated the performance of combining the APACHE II score with SOFA score in predicting hospital mortality of critically ill patients. A total of 1,311 consecutive adult patients admitted to a tertiary 22-bed multidisciplinary intensive care unit (ICU) in Western Australia were considered. The APACHE II, Admission SOFA, Delta SOFA and maximum SOFA score were all related to hospital survival in the univariate analyses. Combining Max SOFA (area under receiver operating characteristic curve 0.875 vs. 0.858, P=0.014; Nagelkerke R2: 0.411 vs. 0.371; Brier Score: 0.086 vs. 0.090) or Delta SOFA score (area under receiver operating characteristic curve 0.874 vs. 0.858, P=0.003; Nagelkerke R2: 0.412 vs. 0.371; Brier Score: 0.086 vs. 0.090) with the APACHE II score improved the discrimination and overall performance of the predictions when compared with using the APACHE II score alone, especially in the emergency ICU admissions. Combining Max SOFA or Delta SOFA score with the APACHE II score may improve the accuracy of risk adjustment in outcome studies of critically ill patients.

scholarly journals Analisis Hubungan Sequential Organ Failure Assessment (Sofa) Score Dengan Mortalitas Pasien Sepsis

2020 ◽  
Vol 9 (2) ◽  
pp. 168
Author(s):  
Agustin Iskandar ◽  
Fran Siska
Keyword(s):  
Septic Shock ◽  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Sofa Score ◽  
Area Under The Curve ◽  
International Consensus ◽  
The Third ◽  
Failure Assessment ◽  
Sepsis And Septic Shock

Sepsis merupakan kondisi disfungsi organ mengancam nyawa yang diakibatkan oleh disregulasi sistem imun pejamu terhadap infeksi dan Sequential Organ Failure Assessment (SOFA) score merupakan suatu skoring untuk menilai kegagalan organ terkait sepsis. Peningkatan SOFA score diasosiasikan dengan outcome pasien yang lebih buruk.  Tujuan: Menganalisis korelasi SOFA score dengan mortalitas pada pasien sepsis. Metode: Desain penelitian adalah kohort prospektif yang dilakukan di RSU Dr Saiful Anwar dari Maret 2018 hingga Juni 2019. Kriteria diagnosis sepsis ditegakkan berdasarkan The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). Perhitungan SOFA score dilakukan dalam 2 hari pertama perawatan pasien sepsis di rumah sakit. Analisis data dilakukan pada p < 0,05. Hasil: Didapatkan 85 pasien sepsis dengan luaran meninggal sebanyak 72,94% sedangkan 28,06% membaik. Terdapat perbedaan bermakna antara SOFA score yang meninggal dan yang hidup (p=0,015).  SOFA score dipakai untuk memprediksi kematian, didapatkan area under the curve (AUC) 0,74 (p=0,009), dengan cut off point optimum 7. Pada total SOFA score lebih tinggi dari sama dengan 7, didapatkan RR= 3.8, p=0.028. SOFA score merupakan parameter untuk menilai kegagalan organ pada pasien sepsis, dimana total SOFA score yang lebih tinggi dikaitkan dengan peningkatan risiko kematian. Simpulan: SOFA score pada kelompok yang meninggal lebih tinggi daripada yang sembuh. Pasien sepsis dengan SOFA score lebih besar sama dengan 7 memiliki risiko 3,8 kali lebih besar untuk meninggal.Kata kunci: risiko kematian, sepsis, SOFA score

Classification of sepsis, severe sepsis and septic shock: the impact of minor variations in data capture and definition of SIRS criteria

2012 ◽  
Vol 38 (5) ◽  
pp. 811-819 ◽  
Author(s):  
Peter M. C. Klein Klouwenberg ◽  
David S. Y. Ong ◽  
Marc J. M. Bonten ◽  
Olaf L. Cremer
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Data Capture ◽  
Definition Of ◽  
Sepsis And Septic Shock ◽  
The Impact ◽  
Sirs Criteria

Evaluating the Predictive Value of Lactate in Patients With Cancer Having Septic Shock

2018 ◽  
Vol 35 (8) ◽  
pp. 789-796
Author(s):  
Lama H. Nazer ◽  
Dalia Rimawi ◽  
Feras I. Hawari
Keyword(s):  
Septic Shock ◽  
Hospital Mortality ◽  
Predictive Validity ◽  
Predictive Value ◽  
Area Under The Curve ◽  
Roc Curves ◽  
Serum Lactate ◽  
Predictive Values ◽  
Patients With Cancer ◽  
Predict Hospital Mortality

Purpose: Limited studies evaluated the predictive value of serum lactate (LA) in critically ill patients with cancer. The main objective of this study was to evaluate the predictive validity of LA single measurements as well as LA clearance in predicting mortality in patients with cancer having septic shock. The study also aimed to determine the LA measurement over the first 24 hours with the highest predictability for hospital mortality. Materials and Methods: A retrospective cohort study of adult patients with cancer having septic shock and LA measurements during the first 24 hours. Three receiver–operating characteristic (ROC) curves were constructed to evaluate the predictive validity for hospital mortality of LA at baseline, at 6 hours and at 24 hours after identifying septic shock. The ROC with the largest area under the curve was analyzed to determine LA level with the highest predictability for hospital mortality. In addition, the ability of LA normalization (LA <2 mmol/L at 6 hours and at 24 hours) and the degree of LA elimination (>10% and >20% at 24 hours) to predict hospital mortality were evaluated by determining the predictive values for each clearance end point. Results: The study included 401 patients. LA >2.5 mmol/L at 24 hours showed the largest area under the ROC curve to predict hospital mortality (ROC area: 0.648; 95% confidence interval: 0.585-0.711) with a sensitivity of 58.4% and specificity of 62.8%. The LA normalization, LA clearance >10%, and LA clearance >20% were also predictors of hospital mortality, with the highest sensitivity for LA normalization at 6 hours (74%) and LA normalization at 24 hours (73.4%). Conclusion: In patients with cancer having septic shock, LA >2.5 mmol/L at 24 hours of septic shock had the highest predictability for hospital mortality. The LA normalization and clearance were also predictors of hospital mortality. However, all LA end points were not strong predictors.

scholarly journals oXiris® Use in Septic Shock: Experience of Two French Centres

2019 ◽  
Vol 47 (Suppl. 3) ◽  
pp. 29-35 ◽  
Author(s):  
Victor Schwindenhammer ◽  
Thibaut Girardot ◽  
Kevin Chaulier ◽  
Arnaud Grégoire ◽  
Céline Monard ◽  
...  
Keyword(s):  
Septic Shock ◽  
Hospital Mortality ◽  
Sofa Score ◽  
Abdominal Sepsis ◽  
Simplified Acute Physiology Score ◽  
Saps Ii ◽  
Extracorporeal Blood Purification ◽  
Norepinephrine Infusion ◽  
Failure Assessment ◽  
Over Time

Background: Sepsis is a dysregulated host response to an infection and can result in organ dysfunctions and death. Extracorporeal blood purification techniques aim to improve the prognosis of these patients by modulating the unbalanced immune response. This study reports our experience with the use of the oXiris® membrane for septic shock patients requiring continuous renal replacement therapy (CRRT). Summary: Thirty-one patients were diagnosed with septic shock and underwent CRRT with the oXiris® membrane between 2014 and 2019. We compared the observed hospital mortality with that predicted by the Simplified Acute Physiology Score II (SAPS II). Change in the Sequential Organ Failure Assessment (SOFA) score and of the main clinical and biological parameters over time were analyzed. Hospital mortality was lower than predicted for the most severe patients (60 vs. 91% for the [74–87] SAPS II quartile and 70 vs. 98% for the [87–163] SAPS II quartile, p < 0.02). There was no significant improvement in the SOFA score from 0h to 48 h. An 88% relative decrease in norepinephrine infusion was observed (median at 0 h was 1.69 [0.52–2.45] µg/kg/min; at 48 h it was 0.20 [0.09–1.14] µg/kg/min, p = 0.002). Lactataemia and pH were significantly improved over time. Patients with intra-abdominal sepsis as well as those with Gram-negative bacilli (GNB) infections seemed to benefit the most from the therapy. Key Messages: CRRT with the oXiris® haemofilter resulted in higher observed survival than predicted by a severity score (SAPS II) for the most severe patients. Haemodynamic status and lactataemia appeared to improve, especially in intra-abdominal sepsis and GNB infections.

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