Multi-complexity measures of heart rate variability and the effect of vasopressor titration: a prospective cohort study of patients with septic shock

Abstract Background Enrichment strategies improve therapeutic targeting and trial efficiency, but enrichment factors for sepsis trials are lacking. We determined whether concentrations of soluble tumor necrosis factor receptor-1 (sTNFR1), interleukin-8 (IL8), and angiopoietin-2 (Ang2) could identify sepsis patients at higher mortality risk and serve as prognostic enrichment factors. Methods In a multicenter prospective cohort study of 400 critically ill septic patients, we derived and validated thresholds for each marker and expressed prognostic enrichment using risk differences (RD) of 30-day mortality as predictive values. We then used decision curve analysis to simulate the prognostic enrichment of each marker and compare different prognostic enrichment strategies. Measurements and main results An admission sTNFR1 concentration > 8861 pg/ml identified patients with increased mortality in both the derivation (RD 21.6%) and validation (RD 17.8%) populations. Among immunocompetent patients, an IL8 concentration > 94 pg/ml identified patients with increased mortality in both the derivation (RD 17.7%) and validation (RD 27.0%) populations. An Ang2 level > 9761 pg/ml identified patients at 21.3% and 12.3% increased risk of mortality in the derivation and validation populations, respectively. Using sTNFR1 or IL8 to select high-risk patients improved clinical trial power and efficiency compared to selecting patients with septic shock. Ang2 did not outperform septic shock as an enrichment factor. Conclusions Thresholds for sTNFR1 and IL8 consistently identified sepsis patients with higher mortality risk and may have utility for prognostic enrichment in sepsis trials.

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Low vasopressin and progression of neonatal sepsis to septic shock: a prospective cohort study

European Journal of Pediatrics ◽

10.1007/s00431-020-03610-x ◽

2020 ◽

Vol 179 (7) ◽

pp. 1147-1155 ◽

Cited By ~ 1

Author(s):

Abhishek S. Aradhya ◽

Venkataseshan Sundaram ◽

Naresh Sachdeva ◽

Sourabh Dutta ◽

Shiv S. Saini ◽

...

Keyword(s):

Septic Shock ◽

Cohort Study ◽

Prospective Cohort Study ◽

Neonatal Sepsis ◽

Prospective Cohort

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Ability of shock index and heart rate to predict the percentage of body blood volume lost after vaginal delivery as an indicator of severity: results from a prospective cohort study

Journal of Global Health ◽

10.7189/jogh.09.020432 ◽

2019 ◽

Vol 9 (2) ◽

Author(s):

Anderson Borovac-Pinheiro ◽

José Guilherme Cecatti ◽

Rodolfo de Carvalho Pacagnella

Keyword(s):

Heart Rate ◽

Cohort Study ◽

Vaginal Delivery ◽

Blood Volume ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Shock Index

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Association between resting heart rate just before starting the first dialysis session and mortality: A multicentre prospective cohort study

Nephrology ◽

10.1111/nep.13048 ◽

2018 ◽

Vol 23 (5) ◽

pp. 461-468 ◽

Cited By ~ 1

Author(s):

Daijo Inaguma ◽

Shigehisa Koide ◽

Kazuo Takahashi ◽

Hiroki Hayashi ◽

Midori Hasegawa ◽

...

Keyword(s):

Heart Rate ◽

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Dialysis Session ◽

Resting Heart Rate

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The Association Between Dynamic Changes in Serum Presepsin Levels and Mortality in Immunocompromised Patients with Sepsis: A Prospective Cohort Study

10.21203/rs.3.rs-115066/v1 ◽

2020 ◽

Author(s):

Jongmin Lee ◽

Seo Hyun Kim ◽

Kyung Hoon Kim ◽

Na Ri Jeong ◽

Seok Chan Kim ◽

...

Keyword(s):

Septic Shock ◽

Cohort Study ◽

Hospital Mortality ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Area Under The Curve ◽

Immunocompromised Patients ◽

Dynamic Changes ◽

Saps 3 ◽

Sepsis And Septic Shock

Abstract Background: Presepsin is a subtype of soluble CD14 that is increased in the blood of septic patients. We investigated the role of dynamic changes in serum presepsin levels in critically ill, immunocompromised patients with sepsis.Methods: This is a prospective cohort study that included 119 adult patients who were admitted to the intensive care unit (ICU) between March 2019 and June 2020. Sepsis and septic shock were defined as Sepsis-3. Patients were classified into one of the following diagnostic groups: no sepsis, sepsis, and septic shock. Presepsin level was measured on day 1 and day 3 after ICU admission. The primary outcome was in-hospital mortality.Results: Of the 119 patients, sepsis was diagnosed in 40 patients (33.6%) and septic shock was diagnosed in 60 (50.4%) patients. The Simplified Acute Physiology Score (SAPS) 3 and Sequential Organ Failure Assessment score on day 1 were 75.5 ± 14.9 and 9.0 (6.5–11.5), respectively, and the overall hospital mortality was 44.5%. In 61 immunocompromised patients, presepsin levels on day 1 were higher in patients with sepsis than those in patients without sepsis (1203.0 [773.0–2484.0] vs. 753.0 [603.5–1092.0] ng/ml; P = 0.004). The area under the curve (AUC) of presepsin for diagnosing sepsis in immunocompromised patients was 0.87, which was comparable with that of procalcitonin (AUC, 0.892). Presepsin levels on day 3 were higher in patients who died in the hospital than in those who survived (1965.0 [1149.0–3423.0] vs. 933.0 [638.0–1571.0]; P = 0.001). In immunocompromised patients who died in the hospital, presepsin levels on day 3 were significantly higher than those on day 1 (P = 0.018). In the multivariate analysis, ΔPresepsin+ (ΔPresepsin concentrations [day3 – day1] > 0) alone was independently correlated with in-hospital mortality in immunocompromised patients (odds ratio, 6.22; 95% confidence interval, 1.33–29.06; P = 0.020).Conclusion: These findings suggest that dynamic changes in presepsin levels between day 1 and day 3 are associated with in-hospital mortality in patients with sepsis, especially in immunocompromised patients.

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Comparison of Hemodynamic Response following Spinal Anesthesia between Controlled Hypertensive and Normotensive Patients Undergoing Surgery below the Umbilicus: An Observational Prospective Cohort Study

Anesthesiology Research and Practice ◽

10.1155/2021/8891252 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Leake Gebrargs ◽

Bereket Gebremeskel ◽

Bacha Aberra ◽

Assefa Hika ◽

Yusuf Yimer ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Cohort Study ◽

Spinal Anesthesia ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Study Groups ◽

Categorical Variables ◽

Time Interval ◽

Significant Difference

Background. Hypotension and bradycardia are the most common complications associated with spinal anesthesia and more common in patients with a history of hypertension. Regular use of antihypertensive medications can prevent these complications. The occurrence of hypotension under spinal anesthesia among controlled hypertensive and normotensive patients with age 40 years and above is still debated. The objective of the study was to compare blood pressure and heart rate changes following spinal anesthesia between controlled hypertensive and normotensive patients undergoing surgery below the umbilicus at Black lion hospital, Addis Ababa, Ethiopia, 2020. Method. A hospital-based prospective cohort study was conducted. A total of 110 elective patients with controlled hypertension (55) and normotensive (55) patients who underwent surgery with spinal anesthesia at black lion hospital during the study period were included. The sample was selected using a systematic random sampling technique. Continuous data of independent and dependent variables were analyzed using an independent sample t-test for normally distributed and Mann–Whitney U-test for nonnormally distributed between the study groups. Categorical variables between the study groups were analyzed using the chi-square test. Descriptive data were displayed using tables and figures. For continuous and categorical variables, a p value <0.05 was considered statistically significant. Results. The incidence of hypotension in the controlled hypertension group (23.6%) was higher than the normotensive group (7.3%) with p value of 0.018. The occurrence of bradycardia was seen to be 12.7% in each group with a p value >0.05. There was a statistically significant difference in the mean systolic blood pressure, mean arterial pressure, mean heart rate, and vasopressor consumption at the measurement time interval between controlled hypertension and normotensive groups. Conclusion. Under spinal anesthesia, patients with controlled hypertension are more likely to develop hypotension than normotensive patients, but on the occurrence of bradycardia, there was no statistically significant difference between the two groups.

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