scholarly journals Clinical and Demographic Factors Associated with Antipyretic Use in Gram-Negative Severe Sepsis and Septic Shock

2011 ◽  
Vol 45 (10) ◽  
pp. 1207-1216 ◽  
Author(s):  
Nicholas M Mohr ◽  
Brian M Fuller ◽  
Lee P Skrupky ◽  
Hawnwan Moy ◽  
Robert Alunday ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Medical Center ◽  
Academic Medical Center ◽  
Demographic Factors ◽  
Medication Administration ◽  
Patient Treatment ◽  
Gram Negative ◽  
Factors Associated ◽  
Sepsis And Septic Shock

Background: Antipyretic therapy is commonly prescribed for patients with Infection, but studies of its impact on clinical outcomes have yielded mixed results. No data exist to characterize the use of antipyretic medications in patients with severe sepsis or septic shock. Objective: To identify clinical and demographic factors associated with antipyretic medication administration in severe sepsis and septic shock. Methods: This single-center, retrospective, cohort study assessed febrile patients [temperature ≥38.3°C) with gram-negative severe sepsis or septic shock at an 1111-bed academic medical center between January 2002 and February 2008, Patients were excluded if they had liver disease, acute brain injury, or allergy to acetaminophen. Generalized estimating equations were used to estimate the effect of clinical factors on treatment of patients with antipyretic medications, Results: Although 76% of patients in this febrile cohort (n = 241) were prescribed an antipyretic agent, only 42% received antipyretic therapy; 95% of the doses were acetaminophen. Variables associated with antipyretic treatment were maximum body temperature (OR 2.11, 95% CI 1.53 to 2.89), time after sepsis diagnosis (OR 0.88, 95% CI 0.82 to 0.95), surgery during hospitalization (OR 0.49, 95% CI 0.31 to 0.80), death within 36 hours (OR 0.35, 95% CI 0.15 to 0.85). and mechanical ventilation (OR 0.58, 95% CI 0.34 to 0.98). Severity of illness factors, demographic factors, and patient treatment location did not predict who would receive antipyretic therapy. Conclusions: Most febrile episodes in patients with gram-negative severe sepsis or septic shock were not treated with antipyretic medications. Further studies are needed to demonstrate the effect of antipyretics on clinically relevant outcomes in severe sepsis and septic shock.

Risk factors and pathogenic significance of severe sepsis and septic shock in 2286 patients with gram-negative bacteremia

2011 ◽  
Vol 62 (1) ◽  
pp. 26-33 ◽  
Author(s):  
Cheol-In Kang ◽  
Jae-Hoon Song ◽  
Doo Ryeon Chung ◽  
Kyong Ran Peck ◽  
Kwan Soo Ko ◽  
...  
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Severe Sepsis ◽  
Gram Negative ◽  
Gram Negative Bacteremia ◽  
Sepsis And Septic Shock

scholarly journals Deficiency in 25-Hydroxyvitamin D and 30-Day Mortality in Patients With Severe Sepsis and Septic Shock

2014 ◽  
Vol 23 (5) ◽  
pp. e72-e79 ◽  
Author(s):  
Megan A. Rech ◽  
Todd Hunsaker ◽  
Jennifer Rodriguez
Keyword(s):  
Vitamin D ◽  
Septic Shock ◽  
Severe Sepsis ◽  
Vitamin D Deficiency ◽  
Odds Ratio ◽  
Medical Center ◽  
Academic Medical Center ◽  
Hydroxyvitamin D ◽  
Increased Risk ◽  
25 Hydroxyvitamin D

Background Vitamin D has immunomodulating properties. Objective To determine if vitamin D deficiency within 30 days of admission to the intensive care unit in patients with sepsis might be associated with increased all-cause 30-day mortality. Methods In a retrospective cohort study at a large, tertiary, urban, academic medical center, records of patients who had 25-hydroxyvitamin D levels measured within 30 days of admission for severe sepsis or septic shock from June 2006 to April 2011 were examined. Patients were considered deficient in vitamin D if its serum concentration was 15 ng/mL or less. The primary outcome of interest was 30-day mortality. Results Among the 121 patients in the sample, 65 (54%) were vitamin D deficient. Baseline demographics were similar between vitamin D deficient and nondeficient groups, except that the vitamin D deficient group had more African Americans (P = .01). All-cause 30-day mortality was significantly higher in patients deficient in vitamin D (37% vs 20%; P = .04) and remained higher at 90 days (51% vs 25%, P = .005). In multivariate analysis, age (odds ratio, 1.04; 95% CI 1.01–1.07; P = .01) and vitamin D deficiency (odds ratio, 2.7; 95% CI, 1.39–18.8; P = .02) were independently associated with increased 30-day mortality. Conclusion Patients deficient in vitamin D within 30 days of hospital admission for severe sepsis or septic shock may be at increased risk for all-cause 30-day mortality.

scholarly journals Multicenter validation of a sepsis prediction algorithm using only vital sign data in the emergency department, general ward and ICU

2018 ◽  
Author(s):  
Qingqing Mao ◽  
Melissa Jay ◽  
Jana Hoffman ◽  
Jacob Calvert ◽  
Christopher Barton ◽  
...  
Keyword(s):  
Machine Learning ◽  
Septic Shock ◽  
Severe Sepsis ◽  
San Francisco ◽  
Vital Sign ◽  
Operating Characteristic ◽  
Medical Center ◽  
Prediction Algorithm ◽  
Data Set ◽  
Sepsis And Septic Shock

Objectives: We validate a machine learning-based sepsis prediction algorithm (InSight) for detection and prediction of three sepsis-related gold standards, using only six vital signs. We evaluate robustness to missing data, customization to site-specific data using transfer learning, and generalizability to new settings. Design: A machine learning algorithm with gradient tree boosting. Features for prediction were created from combinations of only six vital sign measurements and their changes over time. Setting: A mixed-ward retrospective data set from the University of California, San Francisco (UCSF) Medical Center (San Francisco, CA) as the primary source, an intensive care unit data set from the Beth Israel Deaconess Medical Center (Boston, MA) as a transfer learning source, and four additional institutions' datasets to evaluate generalizability. Participants: 684,443 total encounters, with 90,353 encounters from June 2011 to March 2016 at UCSF. Interventions: none Primary and secondary outcome measures: Area under the receiver operating characteristic curve (AUROC) for detection and prediction of sepsis, severe sepsis, and septic shock. Results: For detection of sepsis and severe sepsis, InSight achieves an area under the receiver operating characteristic (AUROC) curve of 0.92 (95% CI 0.90 - 0.93) and 0.87 (95% CI 0.86 - 0.88), respectively. Four hours before onset, InSight predicts septic shock with an AUROC of 0.96 (95% CI 0.94 - 0.98), and severe sepsis with an AUROC of 0.85 (95% CI 0.79 - 0.91). Conclusions: InSight outperforms existing sepsis scoring systems in identifying and predicting sepsis, severe sepsis, and septic shock. This is the first sepsis screening system to exceed an AUROC of 0.90 using only vital sign inputs. InSight is robust to missing data, can be customized to novel hospital data using a small fraction of site data, and retained strong discrimination across all institutions.

Fatores de Risco Associados à Mortalidade em Pacientes com Sepse Grave e Choque Séptico na Unidade de Terapia Intensiva de um Hospital Escola do Sul de Minas Gerais/Risk Factors Associated with Mortality in Patients with Severe Sepsis and Septic Shock in

1970 ◽  
Vol 1 (1) ◽  
pp. 72-77
Author(s):  
Nilo César do Vale Baracho ◽  
Gisela Ferraz Lopes ◽  
Thales Duca Araujo ◽  
Thomas Buissa ◽  
Wagner Kendy Yano
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Intensive Care Unit ◽  
Septic Shock ◽  
Severe Sepsis ◽  
Intensive Care ◽  
Minas Gerais ◽  
Factors Associated ◽  
Terapia Intensiva ◽  
Sepsis And Septic Shock

Introdução: A sepse é uma síndrome clínica de resposta inflamatória sistêmica secundária a um processo infeccioso. Sepse grave e Choque Séptico compreendem suas formas mais graves. Representa a principal causa de morte nas Unidades de Terapia Intensiva (UTIs) em todo o mundo. Os preditores de evolução e mortalidade vêm sendo estudados e aplicados, tanto para definir o melhor gerenciamento de recursos financeiros e alterar a conduta terapêutica, quanto para monitorar o desempenho da UTI. Objetivos: Determinar e relacionar os fatores de risco a mortalidade em pacientes com sepse grave e choque séptico internados na Unidade de Terapia Intensiva de um Hospital Escola do Sul de Minas Gerais. Métodos: O estudo foi do tipo caso-controle aninhado a uma coorte prospectiva e observacional, onde foram incluídos pacientes que apresentavam sepse grave ou choque séptico, no período de 30 de julho de 2005 a 30 de junho de 2009. A análise foi realizada com auxílio do programa Minitab versão 15. Foi utilizado o teste de Qui-quadradode Pearson para associação das variáveis categóricas, sendo rejeitada a independência destas, quando p > 0,05. Resultados: O estudo abrangeu 167 pacientes. Após analise estatística, obteve-se que a maioria dos pacientes sépticos que evoluíram a óbito eram homens, idosos, com comorbidades, que ficaram internados por menos de 72h e tiveram o trato respiratório como principal origem da doença. Conclusão: Os parâmetros associados à maior mortalidade foram a idade do individuo, o órgão de origem da sepse, presença de diabetes mellitus e hipertensão arterial.Risk Factors Associated with Mortality in Patients with Severe Sepsis and Septic Shock in Intensive Care Unit of a Hospital School of Southern Minas GeraisIntroduction: Sepsis is a clinical syndrome of systemic inflammatory response secondary to a infection.  Severe sepsis and septic shock are the most severe forms. It represents the main cause of death in Intensive Care Unit (ICU) patients worldwide. The predictors of mortality and prognosis has been studied to set a better management of financial resources and change the therapeutic, as for to control the development of ICU. Objectives: Establish and  make relations of the risk factors to the mortality in patients who were diagnosed with severe sepsis and septic  shock  hospitalized in a ICU of a Hospital in South of Minas Gerais. Methods: The study is a case-control type made with a foresight and observational coorte, which were included patients with  severe sepsis and septic shock, by the period between June 30th of 2005 to June 30th of 2009. The analysis was made using the program Minitab version 15. It was used the Qui-Quadrado of Pearson test to make associations of the categorical variables, not considering those, when p>0,05. Results: the study encompassed 167 patients. After statistic analysis, it was concluded that  most of septic patients who died were elderly males with co morbidities that were hospitalized less than 72 hours and had as the main infection focus the Respiratory System. Conclusion: The most important items associated with the mortality were the patient’s age, septic original organ, the presence of Diabetes Mellitus and Hypertension.  

scholarly journals EPIDEMIOLOGY AND OUTCOME AMONG SEVERE SEPSIS AND SEPTIC SHOCK PATIENTS IN A SOUTH INDIAN TERTIARY CARE HOSPITAL

2017 ◽  
Vol 9 (5) ◽  
pp. 256
Author(s):  
Merin Babu ◽  
Vidya P Menon ◽  
Uma Devi P.
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Tertiary Care ◽  
Positive Culture ◽  
Relevant Information ◽  
Care Hospital ◽  
Gram Negative ◽  
Main Site ◽  
South Indian ◽  
Sepsis And Septic Shock

Objective: The objective of this research was to determine the prevalence of severe sepsis and septic shock and evaluate its outcome.Methods: This was a prospective, observational study, in which adult patients with severe sepsis or septic shock were included. Relevant information was collected from medical records and the hospital information system.Results: A total of 250 patients [mean age 57.2 y (range: 18 to 98 y)] was studied. The majority of the patients suffered from severe sepsis (81.2%). Most of the episodes occurred in males (75.2%). Major comorbidities included diabetes mellitus (51.2%), hypertension (44.8%) and chronic liver disease (30.4%). One hundred and seventy-eight patients (147 patients with severe sepsis and 31 patients with septic shock) had a positive culture with urine being the main site of infection. One hundred and two patients (40.8%) had a monomicrobial infection while seventy-six (30.4%) patients had a polymicrobial infection. Within the monomicrobial infections, the gram negative organisms predominated (54%). The mean hospital stay for patients with severe sepsis was 11.5 d. Mortality was noted in 79 patients (40 patients with septic shock and 39 patients with severe sepsis).Conclusion: The main causative pathogens were gram negative bacteria. Admissions meeting septic shock criteria have a high mortality rate. Hence, it is imperative to identify patients who are at high risk and treat them promptly to reduce serious consequences.

When and How to Cover for Resistant Gram-Negative Bacilli in Severe Sepsis and Septic Shock

2011 ◽  
Vol 13 (5) ◽  
pp. 416-425 ◽  
Author(s):  
Håkan Hanberger ◽  
Christian G. Giske ◽  
Helen Giamarellou
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Gram Negative ◽  
Sepsis And Septic Shock
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