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

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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Diagnostic Validity of Ratio between Differences of Central Venous to Arterial CO2 and Arterial to Central Venous O2 Content in Diagnosis of Anaerobic Metabolism among Septic Patients

Journal of Current and Advance Medical Research ◽

10.3329/jcamr.v8i1.52548 ◽

2021 ◽

Vol 8 (1) ◽

pp. 34-38

Author(s):

Subroto Kumar Sarker ◽

Umme Kulsum Choudhury ◽

Mohammad Mohsin ◽

Subrata Kumar Mondal ◽

Muslema Begum

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Intensive Care ◽

Anaerobic Metabolism ◽

Venous Blood ◽

Blood Gases ◽

Serum Lactate ◽

Central Venous ◽

College Hospital ◽

Sepsis And Septic Shock

Background: Detection of anaerobic metabolism is very crucial for the management of the septic patients. Objective: The purpose of the present study was to validate the ratio between differences of central venous to arterial CO2 and arterial to central venous O2 content in diagnosis of anaerobic metabolism among septic patients. Methodology: This prospective observational study was conducted in the Intensive Care Unit of the department of Anaesthesia Analgesia, Palliative and Intensive Care Medicine at Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2016 to December 2016. All patients admitted to ICU with the features of severe sepsis and septic shock according to SSC guidelines with the age of more than or equal to 18 years in both sexes were included in this study. The arterial and central venous blood gases were measure simultaneously. At the same time serum lactate was measured. Result: Among the 69 patients, 31(44.9%) were of severe sepsis and 38(55%) were of septic shock patients. In the severe sepsis and septic shock patients the mean P(v-a)CO2/C(a-v)O2 is 1.39±0.41 and 1.11±0.40 respectively. Serum lactate in case of severe sepsis and septic shock patients is 2.85±1.40 and 3.85±1.04 respectively. The ROC analysis showed an area under curve 0.89 and P(v-a)CO2/C(a-v)O2 ratio cutoff value of 1.21 showed sensitivity 0.84 and specificity 0.94. Conclusion: The P(v-a)CO2/C(a-v)O2 ratio is also a another marker of global anaerobic metabolism and it would be used for diagnosis as well as management of septic patient. Journal of Current and Advance Medical Research, January 2021;8(1):34-38

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Lactate levels from arterial, central venous and peripheral venous blood in severe sepsis and septic shock patients

Critical Care ◽

10.1186/cc5612 ◽

2007 ◽

Vol 11 (Suppl 2) ◽

pp. P452 ◽

Cited By ~ 1

Author(s):

M Assuncao ◽

A Nascente ◽

C Guedes ◽

B Mazza ◽

M Jacki ◽

...

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Venous Blood ◽

Central Venous ◽

Peripheral Venous Blood ◽

Lactate Levels ◽

Sepsis And Septic Shock

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Risk of Mortality in Immunocompromised Children With Severe Sepsis and Septic Shock

Critical Care Medicine ◽

10.1097/ccm.0000000000004329 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Robert B. Lindell ◽

Akira Nishisaki ◽

Scott L. Weiss ◽

Danielle M. Traynor ◽

Julie C. Fitzgerald

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Risk Of Mortality ◽

Sepsis And Septic Shock

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Abstract 14598: The Novel Cardiac Biomarker Secretoneurin Provides Independent Prognostic Information in Severe Sepsis and Septic Shock: Data From the ALBIOS Study

Circulation ◽

10.1161/circ.132.suppl_3.14598 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Helge Røsjø ◽

Serge Masson ◽

Pietro Caironi ◽

Mats Stridsberg ◽

Caterina Fanizza ◽

...

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Cardiac Biomarkers ◽

Icu Mortality ◽

Open Label ◽

Prognostic Information ◽

Prediction Of Mortality ◽

Crystalloid Solutions ◽

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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Utility of venous blood gases in severe sepsis and septic shock

Baylor University Medical Center Proceedings ◽

10.1080/08998280.2018.1460133 ◽

2018 ◽

Vol 31 (3) ◽

pp. 269-275 ◽

Cited By ~ 1

Author(s):

Heath D. White ◽

Alfredo Vazquez-Sandoval ◽

Pedro F. Quiroga ◽

Juhee Song ◽

Shirley F. Jones ◽

...

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Venous Blood ◽

Blood Gases ◽

Sepsis And Septic Shock

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Microcirculatory changes during open label magnesium sulphate infusion in patients with severe sepsis and septic shock

BMC Anesthesiology ◽

10.1186/1471-2253-11-12 ◽

2011 ◽

Vol 11 (1) ◽

Cited By ~ 9

Author(s):

Andrius Pranskunas ◽

Namkje AR Vellinga ◽

Vidas Pilvinis ◽

Matty Koopmans ◽

E Christiaan Boerma

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Magnesium Sulphate ◽

Open Label ◽

Sepsis And Septic Shock

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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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