PROGNOSIS FOR SECONDARY PERITONITIS OUTCOME

Objectives. To develop a new system for predicting the outcome of secondary peritonitis and analyze its accuracy in comparison with the most common analogous systems. Methods. The study is based on the analysis of treatment results in patients (n=352) with secondary peritonitis. At admission sepsis was diagnosed in 15 (4.3%) patients, septic shock - in 4 (1.1%) persons. There were the following main causes of death in the mortality structure: purulent intoxication and/or sepsis - 51 cases (87.9%), cancer intoxication - 4 (6.9%) cases, acute cardiovascular failure - 3 cases (5.2%). The efficacy of the Mantheim Peritoneal Index (MPI), WSES prognostic score, APACHE-II scale, gSOFA score and Peritonitis Prediction System (PPS) developed by the authors were analyzed. The likelihood of the effect of 85 clinical and laboratory parameters on the outcome of patients with secondary peritonitis using nonparametric methods of statistical research (Fisher’s test, Mann-Whitney test, Chi-square with Yates correction) have been analyzed. Criteria predictively associated with lethal outcome (p <0.05) were selected, they were included in the PPS scale. To compare the predictive value of peritonitis prediction systems, ROC analysis was used with the construction of ROC curves for each of the systems. Results. The most important criteria in predicting fatal outcome are the patient’s age, the presence of malignant tumor, the exudate nature, sepsis (septic shock), and also polyorganic insufficiency which is not associated with developed peritonitis. To assess the prognostic value of peritonitis prediction systems, ROC curve analysis was used. The greatest accuracy in terms of predicting mortality in patients with generalized secondary peritonitis is possessed by PPS (AUC 0.942), minimal - APACHEII (AUC 0.840). Conclusion. APACHEII, MPI, WSESSSS and PPS systems can be considered as reliable in predicting mortality in patients with peritonitis. The greatest accuracy in predicting fatal outcome in patients with generalized secondary peritonitis had PPS (94%). What this paper adds An original system for predicting the outcome of peritonitis (PPS) has been developed. It was found that the criteria of the patient’s age, the presence of a malignant neoplasm, the nature of the exudate, sepsis (septic shock), as well as polyorganic insufficiency not associated with the developed peritonitis are of the greatest importance in predicting the death outcome. When conducting a comparative assessment with the most common similar systems (MPI, WSES SSS, APACHE-II), it was found that the most accurate in terms of predicting mortality in a patient with generalized secondary peritonitis is the PPS (AUC 0.942), the minimum - APACHEII (AUC 0.840).

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Circulating Long Noncoding RNAs Positively Correlate with the Increased Risk, Elevated Severity and Unfavorable Prognosis in the Sepsis Patients

10.21203/rs.3.rs-1131221/v1 ◽

2022 ◽

Author(s):

Jun Yuan ◽

Limian Cao ◽

Junjie Bao ◽

Yutao Zha ◽

Shi Chen ◽

...

Keyword(s):

Septic Shock ◽

Inflammatory Cytokines ◽

Roc Curve ◽

Sofa Score ◽

Noncoding Rnas ◽

Curve Analysis ◽

Long Noncoding Rnas ◽

Clinical Severity ◽

Apache Ii ◽

Roc Curve Analysis

Abstract Objective This study aimed to evaluate the correlation of circulating long noncoding RNAs (lncRNAs) expression with disease risk, severity, inflammatory cytokines levels and prognosis in patients with sepsis. Methods Differential expression profiles of lncRNA in the serum of sepsis rats were screened by high-throughput transcriptome sequencing. Homologous lncRNAs in the upregulation group were identified by homology analysis in rats and humans. The expression differences of these homologous lncRNAs in the serum of 176 sepsis patients and 176 healthy controls (HCs) were detected using reverse transcription quantitative polymerase chain reaction (RT-qPCR). And inflammatory cytokines levels were detected by enzyme-linked immunosorbent assay (ELISA). A receiver operating characteristic (ROC) curve was used to verify the diagnostic and prognosis values. Spearman correlation coefficient was used to analyze the correlation between the variables. Follow-up was performed to observe the 28-day mortality. Results Among the screened differentially up-regulated lncRNAs, only two lncRNAs were homologous in rats and humans, which in human named PKN2-antisense RNA 1 (PKN2-AS1) and AC068888.1, respectively. Those two lncRNAs were significantly increased in patients with sepsis compared with those in HCs (P < 0.001), in patients with septic shock compared with those no septic shock (P < 0.001), and in non-survivors compared with survivors (P < 0.001). And those two lncRNAs were positively correlated with sepsis-related organ failure assessment (SOFA) score, acute physiology and chronic health evaluation (APACHE) II score, lactate (Lac), c-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in sepsis patients. Likelihood ratio forward stepwise multivariate logistic regression analysis revealed that high lncRNA AC068888.1 expression was an independent risk factor for septic shock (P < 0.001) and unfavorable prognosis (P = 0.006), but high lncRNA PKN2-AS1 expression was only for unfavorable prognosis (P = 0.019). The ROC curve exhibited a significant predictive value for sepsis risk with area under the curve (AUC) values of 0.879 and 0.842, respectively. For predicting septic shock risk, combining lncRNA AC068888.1 with SOFA score and Lac level, the ROC curve analysis significantly improved the predictability (AUC = 0.882). For predicting 28-day death risk, combining those two lncRNAs with SOFA and APACHE II scores, the ROC curve analysis also significantly improved the predictability (AUC = 0.860). The Kaplan–Meier curves indicated that the survival probability was much worse with those two lncRNAs high expression compared to low expression in patients with sepsis (P < 0.001). Conclusion The circulating absolute expression levels of lncRNA PKN2-AS1 and AC068888.1 in the serum may be used for the early diagnosis, clinical severity evaluation and prognosis of sepsis.

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The Utility of Red Cell Distribution Width to Predict Mortality of Septic Patients in Tertiary Hospital of Nepal

10.21203/rs.2.10110/v1 ◽

2019 ◽

Author(s):

Rajan Ghimire ◽

Yogendra Man Shakya ◽

Tirtha Man Shrestha ◽

Ram Prasad Neupane

Keyword(s):

Septic Shock ◽

Emergency Room ◽

Likelihood Ratio ◽

Prognostic Score ◽

Apache Ii ◽

Red Cell Distribution Width ◽

Red Cell ◽

Cell Distribution ◽

Distribution Width ◽

Very High

Abstract Background Sepsis is common problem encountered in emergency room which needs to be intervened early. Predicting prognosis is always a difficult task in busy emergency room using present scores which has numbers of variables to calculate. Red cell distribution width (RDW) is easy, cheap and efficacious score to predict severity and mortality of patients with sepsis. Method This prospective analytical study was conducted in emergency room of Tribhuvan University Teaching Hospital among patients of age ≥16 years with clinical diagnosis of sepsis using qSOFA score. 148 patients were analyzed in study by using nonprobability purposive sampling method. Result RDW is more efficacious test to predict mortality in sepsis (Area under the Curve of 0.734; 95% C. I= 0.649-0.818) than APACHE II (AUC of 0.728; 95% C. I= 0.637 to 0.819) or SOFA (AUC of 0.680, 95% C.I =0.591-0.770). Cutoff of RDW 15.05 has sensitivity of 73% (positive likelihood ratio 1.82) and specificity of 60% (negative likelihood ratio 0.45) while cutoff of RDW 16.1 has Sensitivity of 56% (PLR 2.07) and specificity of 73% (NLR 0.6). Out of 44 patients with septic shock 16 died (36.4%) and among 104 patients without septic shock,24 died (22.9%) with odds ratio of 0.713 (p=0.555, 95% C. I= 0.231-2.194). Overall mortality was 27.02% (n=40). RDW subgroup analysis showed no mortality in low RDW (<13.1) subgroup, 3.6% mortality in moderate (13.1 to 14) RDW group, 22.0% mortality in high (14 to >15.6) RDW group and 45.9% mortality in very high (>15.6) RDW group. Significant mortality difference seen in high and very high RDW subgroup with p value 0.003 and 0.008 respectively. Conclusion RDW is more efficacious test to predict mortality in sepsis than APACHE II or SOFA. Cutoff of RDW 15.05 has sensitivity of 73% and specificity of 60%. So RDW can be used as a good prognostic score to predict severity and mortality of patients with sepsis in emergency room.

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Diagnostic and Prognostic Value of Plasma Gelsolin in Multiorgan Failure in Patients with Sepsis

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2021.5281 ◽

2021 ◽

Vol 9 (B) ◽

pp. 29-35

Author(s):

Ahmed El-Maghraby ◽

Hossam Mowafy ◽

Emad Omer ◽

Hazem El-Akabawy ◽

Iris Nessim

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Plasma Concentration ◽

Organ Dysfunction ◽

Multiorgan Failure ◽

Fatal Outcome ◽

Apache Ii ◽

Apache Ii Score ◽

Plasma Gelsolin ◽

Significant Difference

AIM: The aim of this work is to investigate the clinical value of gelsolin plasma concentration in the diagnosis of sepsis and investigate the relationship between gelsolin plasma concentration and the severity of organ dysfunction assessed by the acute physiology and chronic health evaluation (APACHE II) and SOFA scores, and to study the mortality predictive power of gelsolin plasma concentration. METHODS: We analyzed data of patients admitted with sepsis (n = 46) for 5 days. Age- and sex-matched non-specific intensive care unit (ICU) patients (n = 18) served as controls. Septic patients were then divided according to severity of disease to patients with sepsis, severe sepsis, and septic shock. Besides plasma gelsolin (pGSN) classical laboratory parameters and clinical scores (APACHE II and SOFA) were also assessed. RESULTS: Septic patients showed significantly decreased 1st-day GSN levels (170.9 ± 74.3 mg/l) compared to non-septic critically ill patients (225.9 ± 84.5 mg/l, p < 0.05). Furthermore, patients with septic shock had lower gelsolin plasma concentration than with severe sepsis and with sepsis (p < 0.05); furthermore, non-survivors had significantly lower GSN levels compared to survivors (p < 0.05). Septic patients had higher APACHE II and SOFA scores. Lower GSN level was significantly correlated with the development of multiple organ dysfunction syndrome and fatal outcome, also, patients with lower GSN level had longer ICU stay, APACHE II, and SOFA scores. APACHE II score has shown best ability to predict mortality with AUC 0.913 followed by PCT with AUC 0.828. pGSN was the least in the ability to predict mortality with AUC only 0.378 despite significant difference between pGSN levels between survivals and non-survivals. CONCLUSIONS: pGSN might serve as efficient complementary marker in sepsis. However, the prognostic role of pGSN in mortality requires further investigation in larger studies.

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Successful de-escalation antibiotic therapy using cephamycins for sepsis caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae bacteremia: A sequential 25-case series

Open Medicine ◽

10.1515/med-2020-0103 ◽

2020 ◽

Vol 15 (1) ◽

pp. 782-786

Author(s):

Tsukasa Kuwana ◽

Junko Yamaguchi ◽

Kosaku Kinoshita ◽

Satoshi Hori ◽

Shingo Ihara ◽

...

Keyword(s):

Septic Shock ◽

Antibiotic Therapy ◽

Vital Signs ◽

Apache Ii ◽

Empiric Antibiotic Therapy ◽

Apache Ii Score ◽

Beta Lactamase ◽

Extended Spectrum Beta Lactamase ◽

Escalation Therapy ◽

Extended Spectrum

AbstractCarbapenems are frequently used to treat infections caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E), but carbapenem-resistant Enterobacteriaceae bacteria are a clinical concern. Although cephamycins (cefmetazole; CMZ) have been shown to be effective against mild cases of ESBL-E infection, data on their use for severe ESBL-E infections with sepsis or septic shock remain scarce. Herein, we discuss a de-escalation therapy to CMZ that could be used after empiric antibiotic therapy in ICU patients with sepsis or septic shock caused by ESBL-E bacteremia. A sequence of 25 cases diagnosed with sepsis or septic shock caused by ESBL-E bacteria was evaluated. The attending infectious disease specialist physicians selected the antibiotics and decided the de-escalation timing. The median SOFA (Sequential Organ Failure Assessment) and APACHE II (Acute Physiology and Chronic Health Evaluation II) severity scores were 8 and 30; the rate of septic shock was 60%. Infections originated most frequently with urinary tract infection (UTI) (56%) and Escherichia coli (85%). Eleven patients were de-escalated to CMZ after vital signs were stable, and all survived. No patients died of UTI regardless of with or without de-escalation. The median timing of de-escalation antibiotic therapy after admission was 4 days (range, 3–6 days). At the time of de-escalation, the median SOFA score fell from 8 to 5, the median APACHE II score from 28 to 22, and the rate of septic shock from 55% to 0%. We conclude that for sepsis in UTI caused by ESBL-E bacteremia, de-escalation therapy from broad-spectrum antibiotics to CMZ is a potential treatment option when vital signs are stable.

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EVALUATION OF APACHE II, SAPS II, MPM II, AND MEDS FOR THE PROGNOSTICATION OF SEVERE SEPSIS OR SEPTIC SHOCK IN THE EMERGENCY DEPARTMENT.

Critical Care Medicine ◽

10.1097/00003246-200612002-00007 ◽

2006 ◽

Vol 34 ◽

pp. A2 ◽

Cited By ~ 1

Author(s):

Thomas Cho ◽

H Bryant Nguyen ◽

Sean R Hayes ◽

Laura Leistiko ◽

Renee Schroetlin ◽

...

Keyword(s):

Emergency Department ◽

Septic Shock ◽

Severe Sepsis ◽

Apache Ii ◽

Saps Ii

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The Relationship of the ACCP/SCCM Consensus Conference Classification of Sepsis to Mortality and Multiorgan Dysfunction among Medical ICU Patients

Journal of Intensive Care Medicine ◽

10.1177/088506669601100604 ◽

1996 ◽

Vol 11 (6) ◽

pp. 326-334 ◽

Cited By ~ 4

Author(s):

Marin H. Kollef ◽

Paul R. Eisenberg

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Hospital Mortality ◽

Consensus Conference ◽

Organ System ◽

Apache Ii ◽

Apache Ii Score ◽

Icu Patients ◽

Multiorgan Dysfunction

To determine the relation between the proposed ACCP/SCCM Consensus Conference classification of sepsis and hospital outcomes, we conducted a single-center, prospective observational study at Barnes Hospital, St. Louis, MO, an academic tertiary care hospital. A total of 324 consecutive patients admitted to the medical intensive care unit (ICU) were studied for prospective patient surveillance and data collection. The main outcome measures were the number of acquired organ system derangements and hospital mortality. Fifty-seven (17.6%) patients died during the study period. The proposed classifications of sepsis (e.g., systemic inflammatory response syndrome [SIRS], sepsis, severe sepsis, septic shock) correlated with hospital mortality ( r = 0.330; p < 0.001) and development of an Organ System Failure Index (OSFI) of 3 or greater ( r = 0.426; p < 0.001). Independent determinants of hospital mortality for this patient cohort ( p < 0.05) were development of an OSFI of 3 or greater (adjusted odds ratio [AOR], 13.9; 95% confidence interval [CI], 6.4–30.2; p < 0.001); presence of severe sepsis or septic shock (AOR, 2.6; 95% CI, 1.2–5.6; p = 0.002), and an APACHE II score ≥ of 18 or greater (AOR, 2.4; 95% CI, 1.0–5.8; p = 0.045). Intra-abdominal infection (AOR, 19.1; 95% CI, 1.6–230.1; p = 0.011), an APACHE II score ≥ of 18 or greater (AOR, 8.9; 95% CI, 4.2–18.6; p < 0.001), and presence of severe sepsis or septic shock (AOR, 2.9; 95% CI, 1.5–5.4; p = 0.001) were independently associated with development of an OSFI of 3 or greater. These data confirm that acquired multiorgan dysfunction is the most important predictor of mortality among medical ICU patients. In addition, they identify the proposed ACCP/SCCM Consensus Conference classification of sepsis as an additional independent determinant of both hospital mortality and multiorgan dysfunction.

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Diagnostic and Prognostic Value of Presepsin in Patients with Non-Infectious Organ Failure, Sepsis, and Septic Shock: A Prospective Observational Study According to the Sepsis-3 Definitions

10.21203/rs.3.rs-413686/v1 ◽

2021 ◽

Author(s):

Sukyo Lee ◽

Juhyun Song ◽

Dae Won Park ◽

Hyeri Seok ◽

Jae-hyung Cha ◽

...

Keyword(s):

Septic Shock ◽

Observational Study ◽

Organ Failure ◽

Prospective Observational Study ◽

Survival Curve ◽

Curve Analysis ◽

Roc Curve Analysis ◽

Kaplan Meier ◽

Sepsis And Septic Shock ◽

Meier Survival Curve

Abstract Background: Sepsis is life-threatening organ dysfunction due to a dysregulated host response to infection. Early diagnosis of sepsis is challenging due to unknown sources of infection, and mortality prediction is usually complex. We aimed to investigate the clinical value of presepsin for discriminating sepsis from non-infectious organ failure and predicting mortality among sepsis patients in the emergency department (ED).Methods: This prospective observational study included 420 patients divided into three groups according to the Sepsis-3 definitions: non-infectious organ failure (n=142), sepsis (n=141), and septic shock (n=137). Blood samples for biomarker measurement of presepsin, procalcitonin, and C-reactive protein were drawn in the ED and biomarker levels were compared between the groups. Optimal cut-off values for presepsin to discriminate between the three clinical diagnoses were evaluated using receiver operating characteristic (ROC) curve analysis. We also performed ROC curve analysis for each biomarker as a predictor of mortality. After excluding non-infectious organ failure, we extracted the optimal cut-off value of presepsin to predict mortality associated with sepsis and septic shock and performed Kaplan–Meier survival curve analysis according to the cut-off value.Results: Presepsin levels (median [IQR]) were significantly higher in sepsis than in non-infectious organ failure (792 [450–1273] vs. 286 [170–417], p <0.001) and significantly higher in septic shock than in sepsis (1287 [589–2365] vs. 792 [450–1273], p=0.002). The optimal cut-off value for presepsin to discriminate between sepsis and non-infectious organ failure was 582 pg/mL (sensitivity, 70.1; specificity, 89.4; AUC, 0.877; p <0.001) and to discriminate between sepsis and septic shock was 1285 pg/mL (sensitivity, 50.4; specificity, 76.6; AUC, 0.618; p <0.001). The optimal cut-off value for presepsin for predicting 30-day mortality was 821 pg/mL (sensitivity, 68.9; specificity, 50.5; AUC, 0.605; p=0.005) in patients with sepsis and septic shock. Kaplan-Meier survival curve analysis showed that patients with higher presepsin levels (≥821 pg/mL) had significantly higher mortality than patients with lower presepsin levels (<821 pg/mL) (log-rank test; p=0.004). Conclusions: Presepsin levels could effectively differentiate sepsis from non-infectious organ failure and septic shock from sepsis. Presepsin levels could help clinicians predict mortality in patients with sepsis and septic shock.

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Invasive Fungal Infections in Under-Five Diarrheal Children: Experience from an Urban Diarrheal Disease Hospital

Life ◽

10.3390/life12010094 ◽

2022 ◽

Vol 12 (1) ◽

pp. 94

Author(s):

Nusrat Jahan Shaly ◽

Mohammed Moshtaq Pervez ◽

Sayeeda Huq ◽

Dilruba Ahmed ◽

Chowdhury Rafiqul Ahsan ◽

...

Keyword(s):

Septic Shock ◽

Early Diagnosis ◽

Late Onset ◽

Fungal Infections ◽

Severe Acute Malnutrition ◽

Fatal Outcome ◽

Invasive Fungal Infections ◽

Acute Malnutrition ◽

Study Group ◽

Co Morbidity

Invasive fungal infections (IFIs) are opportunistic, especially in immunocompromised and hospitalized patients. Children with IFIs are more vulnerable to a fatal outcome. For early diagnosis and treatment, knowledge of the spectrum and frequency of IFIs among children is prerequisite. In this prospective observational study, we enrolled 168 children of 2–59 months old of either sex from March 2018 to December 2019 admitted to the Dhaka hospital, icddr,b. Study participants with suspected IFIs were with or without severe acute malnutrition (SAM) along with sepsis/pneumonia and fulfilled any of the following criteria: (i) failure to respond to injectable antibiotics, (ii) development of a late-onset hospital-acquired infection, (iii) needed ICU care for >7 days, (iv) took steroids/antibiotics for >2 weeks before hospitalization, and (v) developed thrush after taking injectable antibiotics. The comparison group included non-SAM (weight-for-length Z score ≥ −2) children with diarrhea and fever <3 days in the absence of co-morbidity. We performed real-time PCR, ELISA, and blood culture for the detection of fungal pathogen. Study group children with SAM, positive ELISA and PCR considered to have a IFIs. In the study group, 15/138 (10.87%) children had IFIs. Among IFIs, invasive candidiasis, aspergillosis, histoplasmosis detected in 6 (4.53%), 11 (7.97%), and 1 (0.72%) children, respectively, and (3/15 [2.17%]) children had both candidiasis and aspergillosis. Children with IFIs more often encountered septic shock (26.7% vs. 4.9%; p = 0.013) and had a higher death rate (46.7% vs. 8.9%; p < 0.001) than those without IFIs. IFIs were independently associated with female sex (OR = 3.48; 95% CI = 1.05, 11.55; p = 0.042) after adjusting for potential confounders. Our findings thus implicate that, malnourished children with septic shock require targeted screening for the early diagnosis and prompt management of IFIs that may help to reduce IFIs related deaths.

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Low Lactic Acid and Hypercholesterolemia Reduce 90-day Mortality in Patients Suffering From Septic Shock According to the Sepsis-3 Definition

10.21203/rs.3.rs-380037/v1 ◽

2021 ◽

Author(s):

Dong Wang ◽

Yali Sun ◽

Huan Liu ◽

Xiaojuan Zhang ◽

Xianfei Ding ◽

...

Keyword(s):

Septic Shock ◽

Lactic Acid ◽

Total Cholesterol ◽

Cox Model ◽

Health Assessment ◽

Binary Logistic Regression ◽

Apache Ii ◽

Binary Logistic Regression Model ◽

Cholesterol Levels ◽

Lactate Levels

Abstract Background: Dyslipidemia and lactic acid levels are associated with poor prognosis of septic shock. After the revised definition of sepsis and septic shock (Sepsis-3) in 2016, data on the prognostic value of lactic acid levels and hypocholesterolemia were lacked. This study aimed to evaluate whether lactic acid and cholesterol can be used to predict mortality in ICU patients suffering from septic shock.Methods: Prospective observational study, 349 patients suffering from septic shock as defined by Sepsis-3. The COX model and the binary logistic regression model evaluate the correlation between lactic acid or total cholesterol and death from septic shock, and are adjusted according to the demographics, chronic diseases, and biomarkers of the participants.Results: Total cholesterol, total protein, and albumin levels were significantly lower, and lactic acid, acute physiology, and chronic health assessment (APACHE II) were significantly higher in the surviving group compared to those in the non-surviving group. Lactate levels < 4.4 mmol/L and total cholesterol levels < 2.42 mmol/L were associated with mortality after adjusting for confounders (odd ratio, 3.06 [95% CI, 1.78-5.27] and 1.99 [95% CI, 1.15-3.46]). In multivariate analysis, urogenital origin, albumin levels < 25 g/L, age < 60 years, and APACHE II < 20 were independent risk factors for death from septic shock.Conclusions: In those suffering from septic shock, increased blood lactate levels and decreased total cholesterol levels were associated with higher mortality. Furthermore, it was found that lactic acid and total cholesterol are sensitive markers of mortality in an ICU setting.

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Predictor of Death in Diarrheal Children Under 5 Years of Age Having Severe Sepsis in an Urban Critical Care Ward in Bangladesh

Global Pediatric Health ◽

10.1177/2333794x19862716 ◽

2019 ◽

Vol 6 ◽

pp. 2333794X1986271 ◽

Cited By ~ 1

Author(s):

Monira Sarmin ◽

Farzana Afroze ◽

Sharifuzzaman ◽

Tahmina Alam ◽

Nusrat Jahan Shaly ◽

...

Keyword(s):

Intensive Care Unit ◽

Septic Shock ◽

Severe Sepsis ◽

Early Identification ◽

Fatal Outcome ◽

Shortness Of Breath ◽

Clinical Predictors ◽

Resource Poor ◽

Care Ward ◽

Children Under 5

We aimed to identify clinical predictors of fatal outcome in children under 5 years of age having diarrhea and severe sepsis and treated in the Intensive Care Unit of the Dhaka Hospital of icddr,b from October 2010 through September 2011. Among 191 enrolled children, 70 (37%) died and were considered to be cases, while the remaining 121 (63%) who survived constituted the controls. The cases more often had shortness of breath (SOB), septic shock, dehydrating diarrhea compared with the controls (for all, P < .05). After adjusting for potential confounders using logistic regression analysis, the likelihood of death was higher in children who had septic shock and SOB and lower in children having dehydrating diarrhea (for all, P < .05). Thus, SOB can trigger an early alarm for sepsis recognition; otherwise, these children can end up with fatality from septic shock. In resource-poor settings, early identification of these predictors can alleviate death.

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