scholarly journals Mortality of septic shock patients is associated with impaired mitochondrial oxidative coupling efficiency in lymphocytes: a prospective cohort study

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Wagner Luis Nedel ◽  
Afonso Kopczynski ◽  
Marcelo Salimen Rodolphi ◽  
Nathan Ryzewski Strogulski ◽  
Marco De Bastiani ◽  
...  
Keyword(s):  
Septic Shock ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Coupling Efficiency ◽  
Atp Synthesis ◽  
Simplified Acute Physiology Score ◽  
Hospital Ward ◽  
Tertiary Referral Hospital ◽  
Saps 3

Abstract Background Septic shock is a life-threatening condition that challenges immune cells to reprogram their mitochondrial metabolism towards to increase ATP synthesis for building an appropriate immunity. This could print metabolic signatures in mitochondria whose association with disease progression and clinical outcomes remain elusive. Method This is a single-center prospective cohort study performed in the ICU of one tertiary referral hospital in Brazil. Between November 2017 and July 2018, 90 consecutive patients, aged 18 years or older, admitted to the ICU with septic shock were enrolled. Seventy-five patients had Simplified Acute Physiology Score (SAPS 3) assessed at admission, and Sequential Organ Failure Assessment (SOFA) assessed on the first (D1) and third (D3) days after admission. Mitochondrial respiration linked to complexes I, II, V, and biochemical coupling efficiency (BCE) were assessed at D1 and D3 and Δ (D3–D1) in isolated lymphocytes. Clinical and mitochondrial endpoints were used to dichotomize the survival and death outcomes. Our primary outcome was 6-month mortality, and secondary outcomes were ICU and hospital ward mortality. Results The mean SAPS 3 and SOFA scores at septic shock diagnosis were 75.8 (± 12.9) and 8 (± 3) points, respectively. The cumulative ICU, hospital ward, and 6-month mortality were 32 (45%), 43 (57%), and 50 (66%), respectively. At the ICU, non-surviving patients presented elevated arterial lactate (2.8 mmol/L, IQR, 2–4), C-reactive protein (220 mg/L, IQR, 119–284), and capillary refill time (5.5 s, IQR, 3–8). Respiratory rates linked to CII at D1 and D3, and ΔCII were decreased in non-surviving patients. Also, the BCE at D1 and D3 and the ΔBCE discriminated patients who would evolve to death in the ICU, hospital ward, and 6 months after admission. After adjusting for possible confounders, the ΔBCE value but not SOFA scores was independently associated with 6-month mortality (RR 0.38, CI 95% 0.18–0.78; P = 0.009). At a cut-off of − 0.002, ΔBCE displayed 100% sensitivity and 73% specificity for predicting 6-month mortality Conclusions The ΔBCE signature in lymphocytes provided an earlier recognition of septic shock patients in the ICU at risk of long-term deterioration of health status.

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

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.

A multi-center prospective cohort study of patient transfers from the intensive care unit to the hospital ward

2017 ◽  
Vol 43 (10) ◽  
pp. 1485-1494 ◽  
Author(s):  
Henry T. Stelfox ◽  
Jeanna Parsons Leigh ◽  
Peter M. Dodek ◽  
Alexis F. Turgeon ◽  
Alan J. Forster ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Hospital Ward ◽  
Patient Transfers

scholarly journals Plasma sTNFR1 and IL8 for prognostic enrichment in sepsis trials: a prospective cohort study

Critical Care ◽  
2019 ◽  
Vol 23 (1) ◽  
Author(s):  
Brian J. Anderson ◽  
Carolyn S. Calfee ◽  
Kathleen D. Liu ◽  
John P. Reilly ◽  
Kirsten N. Kangelaris ◽  
...  
Keyword(s):  
Septic Shock ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Mortality Risk ◽  
Prospective Cohort ◽  
Tumor Necrosis Factor Receptor ◽  
Enrichment Factors ◽  
Predictive Values ◽  
Increased Risk ◽  
Trial Efficiency

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.

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

2020 ◽  
Vol 179 (7) ◽  
pp. 1147-1155 ◽  
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

scholarly journals Effects of frequent PATient moves on patient outcomes in a large tertiary Hospital (the PATH study): a prospective cohort study

2016 ◽  
Vol 40 (3) ◽  
pp. 324 ◽  
Author(s):  
Joan Webster ◽  
Karen New ◽  
Mary Fenn ◽  
Mary Batch ◽  
Alyson Eastgate ◽  
...  
Keyword(s):  
Patient Safety ◽  
Cohort Study ◽  
Length Of Stay ◽  
Adverse Events ◽  
Patient Outcomes ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Tertiary Hospital ◽  
Tertiary Referral Hospital ◽  
Specific Patient

Objective The aim of the present study was to investigate the incidence of and patient outcomes associated with frequent patient moves. Methods In a prospective cohort study, any bed move and the reason for the move were documented. Patients were assessed on admission for anxiety, social support and delirium. Adverse events, length of stay and satisfaction were recorded. Patients moved three or more times were compared with those moved less than three times. Results In all, 566 patients admitted to a tertiary referral hospital were included in the study. Of these, 156 patients (27.6%) were moved once, 46 (8.1%) were moved twice and 28 (4.9%) were moved at least three times. Those moved three or more times were almost threefold more likely to have an adverse event recorded compared with those moved fewer times (relative risk (RR) 2.75; 95% confidence interval (CI) 1.18, 6.42; P = 0.02) and to have a hospital stay twice as long (RR 7.10; 95% CI 2.60, 11.60; P = 0.002). Levels of satisfaction and anxiety were not affected by frequent moves and there was no effect on delirium. Conclusion Frequent bed moves affect patient safety and prolong length of stay. What is known about the topic? Retrospective and qualitative studies suggest that patient safety and costs may be affected by frequent patient moves. What does this paper add? The present study is the first prospective study to assess the negative effects of frequent patient moves on specific patient outcomes, such as adverse events, length of stay and satisfaction with care. What are the implications for practitioners? Within- and between-ward moves may affect patient safety. Patients should be moved only when there is a clear and unavoidable reason for doing so.

scholarly journals A Single-Center Prospective Cohort Study on Postsplenectomy Sepsis and its Prevention

2020 ◽  
Vol 7 (3) ◽  
Author(s):  
Siegbert Rieg ◽  
Lena Bechet ◽  
Kai Naujoks ◽  
Julia Hromek ◽  
Berit Lange ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Outpatient Service ◽  
Study Entry ◽  
Vaccination Uptake ◽  
Postsplenectomy Sepsis ◽  
The Impact

Abstract Background This study evaluated the impact of a dedicated outpatient service on vaccination uptake after splenectomy and on the incidence of postsplenectomy sepsis. Methods From 2009 to 2016 at the University Hospital Freiburg (Germany), asplenic patients were referred to a dedicated outpatient service, provided with comprehensive preventive care including vaccinations, and enrolled in a prospective cohort study. The impact of the service on vaccination uptake and the occurrence of severe sepsis/septic shock was compared between patients who had splenectomy (or were asplenic) within 3 months of study entry (“early study entry”) and those who had splenectomy (or were asplenic) >3 months before study entry (“delayed study entry”). Results A total of 459 asplenic patients were enrolled, and 426 patients were followed prospectively over a median period of 2.9 years. Pneumococcal vaccine uptake within 3 months of splenectomy or first diagnosis of asplenia was 27% vs 71% among delayed study entry and early study entry patients, respectively (P < .001). Forty-four episodes of severe sepsis or septic shock occurred in study patients: 22 after study entry and 22 before study entry. Streptococcus pneumoniae was more frequent among sepsis episodes that occurred before study entry (8/22) than after study entry (1/22 episodes). For episodes occurring after study entry, only a higher Charlson comorbidity index score was significantly associated with severe sepsis/septic shock postsplenectomy. Conclusions With dedicated outpatient care, high uptake of pneumococcal vaccination postsplenectomy was achieved. Sepsis episodes were largely of nonpneumococcal etiology in patients who had received dedicated postsplenectomy care.

scholarly journals Septic shock with no diagnosis at 24 hours: a pragmatic multicenter prospective cohort study

Critical Care ◽  
2016 ◽  
Vol 20 (1) ◽  
Author(s):  
Damien Contou ◽  
Damien Roux ◽  
Sébastien Jochmans ◽  
Rémi Coudroy ◽  
Emmanuel Guérot ◽  
...  
Keyword(s):  
Septic Shock ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Multicenter Prospective Cohort Study ◽  
Multicenter Prospective Cohort
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