Microcirculatory changes during open label magnesium sulphate infusion in patients with severe 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.

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Higher levels of IgA and IgG at sepsis onset are associated with higher mortality: results from the Albumin Italian Outcome Sepsis (ALBIOS) trial

Annals of Intensive Care ◽

10.1186/s13613-021-00952-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Laura Alagna ◽

Jennifer M. T. A. Meessen ◽

Giacomo Bellani ◽

Daniela Albiero ◽

Pietro Caironi ◽

...

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Venous Blood ◽

Intravenous Immunoglobulins ◽

Open Label ◽

Secondary Infections ◽

Risk Of Mortality ◽

Icu Discharge ◽

Turbidimetric Assay ◽

Sepsis And Septic Shock

Abstract Background The role of intravenous immunoglobulins (IVIG) during sepsis is controversial, as different trials on IVIG have observed inconsistent survival benefits. We aimed to elucidate the possible association and clinical significance between circulating levels of immunoglobulins. Methods In a subset of 956 patients with severe sepsis and septic shock of the multicentre, open-label RCT ALBIOS, venous blood samples were serially collected 1, 2, and 7 days after enrolment (or at ICU discharge, whichever came first). IgA, IgG and IgM concentrations were assayed in all patients on day 1 and in a subgroup of 150 patients on days 2 and 7. Ig concentrations were measured employing a turbidimetric assay, OSR61171 system. Results IgA on day 1 had a significant predictive value for both 28-day and 90-day mortality (28-day mortality, HR: 1.50 (95% CI 1.18–1.92); 90-day mortality, HR: 1.54 (95% CI 1.25–1.91)). IgG, but not IgM, on day 1 showed similar results for 28-day (HR 1.83 (95% CI 1.33–2.51) and 90-day mortality HR: 1.66 (95% CI 1.23–2.25)). In addition, lower levels of IgG but not of IgA and IgM, at day 1 were associated with significantly higher risk of secondary infections (533 [406–772] vs 600 [452–842] mg/dL, median [Q1–Q3], p = 0.007). Conclusions In the largest cohort study of patients with severe sepsis or septic shock, we found that high levels of IgA and IgG on the first day of diagnosis were associated with a decreased 90-day survival. No association was found between IgM levels and survival. As such, the assessment of endogenous immunoglobulins could be a useful tool to identify septic patients at high risk of mortality. Trial registration #NCT00707122, Clinicaltrial.gov, registered 30 June 2008

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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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