Impact of congestive heart failure on severe sepsis and septic shock survivors: outcomes and performance status after 1-year hospital discharge

The number of oncological patients (OP) admitted to intensive care units (ICU) for sepsis/septic shock has dramatically increased in recent years. The definition of septic shock has been modified, adding hyperlactatemia as a severity biomarker for mortality. However, it remains poorly reported in septic OP. We performed a retrospective analysis from a prospective database of sepsis/septic shock patients admitted to our ICU between September 2017 and September 2019 and followed until day 90. We identified 251 patients and 31.9% had active oncological comorbidity, mainly solid tumor (81.3%). Septic shock criteria were met for 112 (44.6%). Hyperlactatemia was observed in 136 (54.2%) patients and this was associated with a lower survival rate. Overall 90-day mortality was 15.1%. In OP vs. non-OP, hyperlactatemia was more frequent (65% vs. 49.1%, p = 0.013) and associated with lower survival (65.4% vs. 85.7%, p = 0.046). In OP, poor performance status was also associated with lower survival (HR 7.029 [1.998–24.731], p = 0.002) In an adjusted analysis, cancer was associated with lower 90-day survival (HR 2.690 [1.402–5.160], p = 0.003). In conclusion, septic OP remains a high mortality risk group in whom lactate levels and performance status could help with better risk stratification.

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Non activated protein C supplementation in septic pediatric hematological patients

Pediatric Reports ◽

10.4081/pr.2016.6488 ◽

2016 ◽

Vol 8 (2) ◽

Cited By ~ 1

Author(s):

Teresa Perillo ◽

Paola Muggeo ◽

Giampaolo Arcamone ◽

Francesco De Leonardis ◽

Nicola Santoro

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Risk Score ◽

Protein C ◽

Performance Status ◽

Activated Protein C ◽

Hematological Patients ◽

Sepsis And Septic Shock ◽

Expected Mortality ◽

Oncology Center

The purpose of the study was to examine safety and efficacy of non-activated Protein C (PC) supplementation in our cohort of septic pediatric hematological patients. We conducted a retrospective study of 22 septic patients receiving human plasma-derived PC concentrate from 2008 to 2015 at our Pediatric Oncology Center (Bari, Italy). The Surviving sepsis campaign definitions for sepsis, severe sepsis and septic shock were used to define the patients’ septic status. For each patient, we calculated Lansky performance status scale (LPSS) and a risk score defined the Hematologic risk score (HRS) that we created in 2007. Patients were defined as High risk for severe sepsis/septic shock in case of HRS>3. HRS10% PC concentration decrease within 12 hours from the first evaluation. All patients received 80 U/kg/day PC, intravenously, every twenty-four hours. No drug-related adverse event was observed. The observed sepsis-related mortality rate in our cohort was 9%. PC supplementation in our cohort appeared to be safe, and, probably due to prompt PC administration, we observed an overall mortality that was much lower than expected mortality in cancer severe septic patients.

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385 Management Patterns and Outcomes of Patients With Severe Sepsis or Septic Shock Admitted From the Emergency Department With End Stage Renal Disease or Congestive Heart Failure

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2017.07.355 ◽

2017 ◽

Vol 70 (4) ◽

pp. S151

Author(s):

S. Thom ◽

Z. Kalarikkal ◽

P. Kakarla ◽

R. Sherwin

Keyword(s):

Heart Failure ◽

Emergency Department ◽

Septic Shock ◽

Congestive Heart Failure ◽

Severe Sepsis ◽

Renal Disease ◽

End Stage Renal Disease ◽

Stage Renal Disease ◽

End Stage

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313 Outcomes for Patients With Congestive Heart Failure and Chronic Kidney Disease Receiving Fluid Resuscitation for Severe Sepsis or Septic Shock

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2020.09.328 ◽

2020 ◽

Vol 76 (4) ◽

pp. S121

Author(s):

M. Wiczorek ◽

R. Otero ◽

S. Knight ◽

K. Ziadeh ◽

J. Blumline ◽

...

Keyword(s):

Heart Failure ◽

Chronic Kidney Disease ◽

Septic Shock ◽

Congestive Heart Failure ◽

Severe Sepsis ◽

Kidney Disease ◽

Fluid Resuscitation

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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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