Delayed persistence of elevated monocytic MDSC associates with deleterious outcomes in septic shock: a retrospective cohort study

Abstract Background Infection is common in acute-on-chronic liver failure (ACLF), which may worsen the clinical condition and prognosis. However, the characteristics of infection and its influence on prognosis in hepatitis B virus related ACLF (HBV-ACLF) as defined by the European Association for the Study of the Liver (EASL) have not been clarified. We aimed to investigate the characteristics of infection and its influence on mortality in patients with HBV-ACLF defined by EASL in China. Methods We performed a retrospective cohort study in patients with HBV-ACLF defined by EASL in a single center from January 2015 to December 2017. These patients were divided into two groups with and without infection. The incidence, sites of infection, isolated strains, and risk factors associated with mortality were evaluated. Results A total of 289 patients were included, among them 185 (64.0%) were diagnosed with an infection. The most common type of infection was pneumonia (55.7%), followed by spontaneous bacterial peritonitis (47.6%) and others. The gram-negative bacteria were the most frequent (58.3%). Patients with one, two, and three or more infection sites had a gradually increasing incidence of sepsis (P < 0.01), septic shock (P < 0.001), and ACLF-3 (P < 0.05). Also, patients with infection isolated one, two, and three or more strains showed a growing incidence of sepsis (P < 0.01) and septic shock (P < 0.001). Patients with infection showed a significantly higher 28-day mortality than those without (P < 0.01), especially in patients with ACLF-3. Infection was identified as an independent risk factor for 28-day mortality in all HBV-ACLF patients. Pneumonia and sepsis were identified as independent predictors of 28-day mortality for patients with infection. Conclusions Infection is associated with severe clinical course and high mortality in HBV-ACLF defined by EASL. The increased number of infection sites or isolated strains was associated with the occurrence of sepsis and septic shock. Pneumonia and sepsis were independent predictors for mortality in HBV-ACLF patients with infection.

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Therapeutic Plasma Exchange in Neonatal Septic Shock: A Retrospective Cohort Study

American Journal of Perinatology ◽

10.1055/s-0039-1692184 ◽

2019 ◽

Vol 37 (09) ◽

pp. 962-969

Author(s):

Taylor Sawyer ◽

Zeenia Billimoria ◽

Sarah Handley ◽

Kendra Smith ◽

Larissa Yalon ◽

...

Keyword(s):

Septic Shock ◽

Cohort Study ◽

Plasma Exchange ◽

Retrospective Cohort Study ◽

Adjunctive Therapy ◽

Retrospective Cohort ◽

Life Support ◽

Therapeutic Plasma Exchange ◽

Convenience Sample ◽

Icu Discharge

Objective This study aimed to examine the use of therapeutic plasma exchange (TPE) as adjunctive therapy in neonatal septic shock. Study Design This retrospective cohort study was performed on a convenience sample of neonates in a quaternary children's hospital between January 2018 and February 2019. Results We identified three neonates with septic shock who received TPE. Two neonates had adenovirus sepsis, and one had group B streptococcal sepsis. All neonates were on extracorporeal life support (ECLS) when TPE was started. The median duration of TPE was 6 days (interquartile range [IQR]: 3–15), with a median of four cycles (IQR: 3–5). Lactate levels decreased significantly after TPE (median before TPE: 5.4 mmol/L [IQR: 2.4–6.1] vs. median after TPE: 1.2 mmol/L [IQR: 1.0–5.8]; p < 0.001). Platelet levels did not change (median before TPE: 73,000/mm3 [IQR: 49,000–100,000] vs. median after TPE: 80,000/mm3 (IQR: 62,000–108,000); p = 0.2). Organ failure indices improved after TPE in two of the three neonates. Hypocalcemia was seen in all cases despite prophylactic calcium infusions. One neonate died, and two survived to ICU discharge. Conclusion TPE can be safely performed in neonates with septic shock. TPE may have a role as an adjunctive therapy in neonates with septic shock requiring ECLS.

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Management and outcomes of patients presenting with sepsis and septic shock to the emergency department during nursing handover: a retrospective cohort study

BMC Emergency Medicine ◽

10.1186/s12873-018-0155-8 ◽

2018 ◽

Vol 18 (1) ◽

Cited By ~ 2

Author(s):

Sami Alsolamy ◽

Atheer Al-Sabhan ◽

Najla Alassim ◽

Musharaf Sadat ◽

Eman Al Qasim ◽

...

Keyword(s):

Emergency Department ◽

Septic Shock ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Sepsis And Septic Shock

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The impact of obesity in cirrhotic patients with septic shock: A retrospective cohort study

Liver International ◽

10.1111/liv.13648 ◽

2017 ◽

Vol 38 (7) ◽

pp. 1230-1241 ◽

Cited By ~ 5

Author(s):

Beverley Kok ◽

Constantine J. Karvellas ◽

Juan G. Abraldes ◽

Rajiv Jalan ◽

Vinay Sundaram ◽

...

Keyword(s):

Septic Shock ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Cirrhotic Patients ◽

The Impact

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Effects of discontinuing or continuing ongoing statin therapy in severe sepsis and septic shock: a retrospective cohort study

Critical Care ◽

10.1186/cc10317 ◽

2011 ◽

Vol 15 (4) ◽

pp. R171 ◽

Cited By ~ 20

Author(s):

Armand Mekontso Dessap ◽

Islem Ouanes ◽

Nerlep Rana ◽

Beatrice Borghi ◽

Christophe Bazin ◽

...

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Cohort Study ◽

Statin Therapy ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Sepsis And Septic Shock

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Sepsis in two hospitals in Rwanda: A retrospective cohort study of presentation, management, outcomes, and predictors of mortality

PLoS ONE ◽

10.1371/journal.pone.0251321 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0251321

Author(s):

Dennis A. Hopkinson ◽

Jean Paul Mvukiyehe ◽

Sudha P. Jayaraman ◽

Aamer A. Syed ◽

Myles S. Dworkin ◽

...

Keyword(s):

Septic Shock ◽

Cohort Study ◽

Low Income ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Baseline Characteristic ◽

Hiv Seropositivity ◽

Predictors Of Mortality ◽

Referral Hospitals ◽

Mortality Predictors

Purpose Few studies have assessed the presentation, management, and outcomes of sepsis in low-income countries (LICs). We sought to characterize these aspects of sepsis and to assess mortality predictors in sepsis in two referral hospitals in Rwanda. Materials and methods This was a retrospective cohort study in two public academic referral hospitals in Rwanda. Data was abstracted from paper medical records of adult patients who met our criteria for sepsis. Results Of the 181 subjects who met eligibility criteria, 111 (61.3%) met our criteria for sepsis without shock and 70 (38.7%) met our criteria for septic shock. Thirty-five subjects (19.3%) were known to be HIV positive. The vast majority of septic patients (92.7%) received intravenous fluid therapy (median = 1.0 L within 8 hours), and 94.0% received antimicrobials. Vasopressors were administered to 32.0% of the cohort and 46.4% received mechanical ventilation. In-hospital mortality for all patients with sepsis was 51.4%, and it was 82.9% for those with septic shock. Baseline characteristic mortality predictors were respiratory rate, Glasgow Coma Scale score, and known HIV seropositivity. Conclusions Septic patients in two public tertiary referral hospitals in Rwanda are young (median age = 40, IQR = 29, 59) and experience high rates of mortality. Predictors of mortality included baseline clinical characteristics and HIV seropositivity status. The majority of subjects were treated with intravenous fluids and antimicrobials. Further work is needed to understand clinical and management factors that may help improve mortality in septic patients in LICs.

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