Intra-abdominal hypertension as a risk factor of death in patients with severe sepsis or septic shock

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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Presence of Hypogammaglobulinemia – A Risk Factor of Mortality in Patients with Severe Sepsis, Septic Shock, and SIRS

Prague Medical Report ◽

10.14712/23362936.2014.14 ◽

2013 ◽

Vol 114 (4) ◽

pp. 246-257 ◽

Cited By ~ 4

Author(s):

Miroslav Průcha ◽

R. Zazula ◽

I. Herold ◽

M. Dostál ◽

T. Hyánek ◽

...

Keyword(s):

Septic Shock ◽

Risk Factor ◽

Severe Sepsis ◽

Retrospective Study ◽

Independent Factor ◽

High Incidence ◽

Sepsis And Septic Shock ◽

The Relationship

In this retrospective study we assessed the frequency of hypogammaglobulinemia in 708 patients with SIRS, severe sepsis and septic shock. We evaluated the relationship between hypogammaglobulinemia IgG, IgM and 28 day mortality. Total of 708 patients and 1,513 samples were analyzed. In the three subgroups we investigated, patients met the criteria of SIRS, severe sepsis and septic shock. IgG hypogammaglobulinemia was demonstrated in 114 patients with severe sepsis (25.2%), 11 septic shock patients (24.4%), and in 29 SIRS patients (13.9%). IgM hypogammaglobulinemia was documented in 55 patients with severe sepsis (12.2%), 6 septic shock patients (13.3%), and in 17 SIRS patients (8.1%). Mortality of patients with severe sepsis and normal IgG levels was significantly lower (111 patients; 32.8%) compared with those with IgG hypogammaglobulinemia (49 patients; 43.0%; p=0.001). Mortality of patients with septic shock and IgG hypogammaglobulinemia (n=5) was significantly higher compared with those with normal IgG levels (45.5% vs. 38.2%; p=0.001). Mortality of patients with severe sepsis and IgM hypogammaglobulinemia did not differ from that of patients with normal IgM levels (37.0 vs. 41.8%). Mortality of patients with septic shock and IgM hypogammaglobulinemia was significantly higher compared with those with normal IgM levels (50% vs. 38.5%; p=0.0001). This study documented relatively high incidence of hypogammaglobulinemia IgG and IgM in patients with severe sepsis, septic shock and SIRS respectively. The presence of IgG hypogammaglobulinemia in patients with severe sepsis is independent factor of mortality.

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Cortisol Is an Associated-Risk Factor of Brain Dysfunction in Patients with Severe Sepsis and Septic Shock

BioMed Research International ◽

10.1155/2014/712742 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 9

Author(s):

Duc Nam Nguyen ◽

Luc Huyghens ◽

Haibo Zhang ◽

Johan Schiettecatte ◽

Johan Smitz ◽

...

Keyword(s):

Septic Shock ◽

Risk Factor ◽

Severe Sepsis ◽

Serum Cortisol ◽

Brain Dysfunction ◽

Sedation Scale ◽

Richmond Agitation Sedation Scale ◽

Cortisol Levels ◽

Sepsis And Septic Shock ◽

Mortality Hazard Ratio

Objectives. To investigate cortisol levels in brain dysfunction in patients with severe sepsis and septic shock.Methods. In 128 septic and sedated patients, we studied brain dysfunction including delirium and coma by the evaluation of Richmond Agitation Sedation Scale (RASS), the Confusion Method Assessment in the ICU (CAM-ICU) after sedation withdrawal and the measurement of serum S100B biomarker of brain injury. Serum cortisol and S100B were measured within 12 hours after ICU admission and daily over the next four days.Results. Brain dysfunction was observed in 50% (64/128) before but in 84% (107/128) of patients after sedation withdrawal, and was more common in the patients older than 57 years (P= 0.009). Both cortisol (P= 0.007) and S100B levels (P= 0.028) were higher in patients with than patients without brain dysfunction. Cortisol levels were associated with ICU mortality (hazard ratio = 1.17,P= 0.024). Multivariate logistic regression showed that cortisol (odds ratio (OR): 2.34, 95% CI (2.01, 3.22),P= 0.02) and the combination effect of cortisol with age (OR: 1.004, 95% CI (1.002, 1.93),P= 0.038) but not S100B were associated with brain dysfunction.Conclusions. Cortisol was an associated-risk factor of brain dysfunction in patients with severe sepsis and septic shock.

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A multicentre case-control study of nonsteroidal anti-inflammatory drugs as a risk factor for severe sepsis and septic shock

Critical Care ◽

10.1186/cc7766 ◽

2009 ◽

Vol 13 (2) ◽

pp. R43 ◽

Cited By ~ 24

Author(s):

Annick Legras ◽

Bruno Giraudeau ◽

Annie-Pierre Jonville-Bera ◽

Christophe Camus ◽

Bruno François ◽

...

Keyword(s):

Septic Shock ◽

Risk Factor ◽

Severe Sepsis ◽

Case Control Study ◽

Case Control ◽

Inflammatory Drugs ◽

Anti Inflammatory ◽

Sepsis And Septic Shock ◽

Control Study

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Correlation of Procalcitonin and C-Reactive Protein with Intra-Abdominal Hypertension in Intra-Abdominal Infections: Their Predictive Role in the Progress of the Disease

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2018.112 ◽

2018 ◽

Vol 6 (3) ◽

pp. 479-484 ◽

Cited By ~ 3

Author(s):

Bedri Braha ◽

Dafina Mahmutaj ◽

Mehmet Maxhuni ◽

Burim Neziri ◽

Shaip Krasniqi

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Prospective Study ◽

Abdominal Pressure ◽

C Reactive Protein ◽

Reactive Protein ◽

Abdominal Hypertension ◽

Significant Difference ◽

Predictive Role ◽

Abdominal Infections

AIM: To analyse the correlation of procalcitonin (PCT) and C-reactive protein (CRP) values with increased intra-abdominal pressure and to evaluate their predictive role in the progression of Intra-abdominal infections.MATERIALS AND METHODS: A non-randomized prospective study conducted in the group of 80 patients. We have measured the PCT, CRP and intra-abdominal pressure (IAP).RESULTS: According to IAH grades (G), there was a significant difference of PCT values: G I 3.6 ± 5.1 ng/ml, G II 10.9 ± 22.6 ng/ml, G III 15.2 ± 30.2 ng/ml (p = 0.045) until CRP values were increased in all IAH groups but without distinction between the groups: GI 183 ± 64.5, GII 196 ± 90.2, GIII 224 ± 96.3 (p = 0.17). According to the severity of the infection, we yielded increased values of PCT, IAP and CRP in septic shock, severe sepsis and SIRS/sepsis resulting in significant differences of PCT and IAP.CONCLUSION: Based on the results of our research, we conclude that the correlation of PCT values with IAH grades is quite significant while the CRP results remain high in IAH but without significant difference between the different grades of IAH.

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Respiratory organ dysfunction: a leading risk factor for hospital mortality in patients with severe sepsis or septic shock

Critical Care ◽

10.1186/cc6706 ◽

2008 ◽

Vol 12 (Suppl 2) ◽

pp. P485

Author(s):

H Yang ◽

IT Duling ◽

JS Brown ◽

SG Simonson

Keyword(s):

Septic Shock ◽

Risk Factor ◽

Severe Sepsis ◽

Hospital Mortality ◽

Organ Dysfunction ◽

Respiratory Organ

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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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