scholarly journals The mNUTRIC Score as a Tool to Predict Mortality and Increased Resource Utilization in Intensive Care Patients with Sepsis.

2021 ◽  
Author(s):  
Marek Wełna ◽  
Andrzej Kübler ◽  
Waldemar Goździk ◽  
Barbara Adamik
Keyword(s):  
Septic Shock ◽  
Resource Utilization ◽  
Assessment Tool ◽  
Secondary Analysis ◽  
Nursing Workload ◽  
Roc Curve Analysis ◽  
Nutrition Risk ◽  
Intensive Care Patients ◽  
Discriminative Value ◽  
Sepsis And Septic Shock

Abstract Background: The mNUTRIC score is a nutrition risk assessment tool. The aim of this study was to evaluate mNUTRIC score ability to predict 28-mortality, icu resource utilization and nursing workload for patients with sepsis and septic shock. Methods: We performed a secondary analysis of prospectively collected data from a ICU sepsis registry database. The study included adults diagnosed with sepsis or septic shock, admitted from January to December 2014.Results: The study included 146 patients. In the ROC curve analysis the mNUTRIC score had the ability to predict 28-day mortality with an AUC of 0.833 (95% CI 0.76-0.89). Additionally group of patients with NUTRIC score ≥ 6 points more frequently required vasopressor infusion, mechanical ventilation, renal replacement therapy, thromboprophylaxis and blood products use. Nursing workload was also significantly higher in this group (TISS-28: 36 pts., IQR 33 – 40 vs. 31 pts, IQR 28 – 34, p<0.001).Conclusion: The mNUTRIC score obtained at admission to the ICU provided a good discriminative value for 28-mortality and makes it possible to identify patients who will ultimately require intense use of ICU resources with an associated increase in the nursing workload during ICU sepsis treatment.

scholarly journals 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

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.

scholarly journals Effect of Early Nutritional Support on Clinical Outcomes of Critically Ill Patients with Sepsis and Septic Shock

2021 ◽  
Author(s):  
Jun Kwon Cha ◽  
Hyung-sook Kim ◽  
Eun Ji Kim ◽  
Eunsook Lee ◽  
Jae ho Lee ◽  
...  
Keyword(s):  
Septic Shock ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Protein Delivery ◽  
High Energy ◽  
Nutritional Requirement ◽  
Nutrition Risk ◽  
Log Linear ◽  
Sepsis And Septic Shock

Abstract PurposeThe initial nutritional delivery policy for patients with sepsis admitted to the intensive care unit (ICU) is not fully elucidated. This study aimed to determine whether initial adequate nutrition supply and route of nutrition delivery during the first week of sepsis onset may improve the clinical outcomes of critically ill septic patients. MethodsWe examined 834 adult patients with sepsis and septic shock in the ICU between November 2013 and May 2017 retrospectively. Poisson log-linear and Cox regressions were performed to assess the relationship between clinical outcomes, sex, modified nutrition risk in the critically ill (mNUTRIC) scores, sequential organ failure assessment and acute physiology and chronic health evaluation scores, route of nutrition delivery, and daily energy and protein delivery during the first week since sepsis onset. ResultsPatients who had higher protein intakes during the first week since sepsis onset had lower in-hospital mortality, while higher energy intakes were associated with lower the 30-day mortality. Route of nutrition delivery was not associated with 1-year mortality in the group with > 70% of the nutritional requirement; however, enteral feeding (EN) with supplemental parenteral nutrition (PN) was superior to only EN or only PN in patients who were underfed. ConclusionFor patients with sepsis and septic shock, a high daily average protein intake may lower in-hospital mortality and a high energy intake may lower the 30-day mortality, especially for patients with high mNUTRIC scores. For underfed patients, EN with supplemental PN may be better than EN or PN alone.

scholarly journals Does Whole-Blood Neutrophil Gelatinase-Associated Lipocalin Stratify Acute Kidney Injury in Critically Ill Patients?

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
M. Cuartero ◽  
A. J. Betbesé ◽  
K. Núñez ◽  
J. Baldirà ◽  
J. Ordonez-Llanos
Keyword(s):  
Septic Shock ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Whole Blood ◽  
Point Of Care ◽  
Kidney Injury ◽  
Roc Curve Analysis ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Sepsis And Septic Shock ◽  
Stage 1

Purpose. To analyse the capacity of whole-blood NGAL (wbNGAL) to stratify AKI in critically ill patients with and without sepsis. Methods. Whole-blood NGAL was measured with a point-of-care device at admission and 48 hours later in patients admitted to a general ICU. Patients were classified by the AKIN and KDIGO classifications at admission and 24 and 48 hours. We performed an ROC curve analysis. wbNGAL values at admission were compared in patients with sepsis and septic shock. Results. The study included 100 consecutively admitted patients (40 female) with mean age 59.1±17.8 years. Thirty-three patients presented AKI at admission, and 10 more developed it in the next 48 h. Eighteen patients had AKI stage 3, 14 of them at admission. Nine patients required renal replacement therapy. According to KDIGO at admission, wbNGAL values were 78 μg/L (60-187) in stage 0 (n=67), 263 μg/L (89-314) in stage 1 (n=8), 484 μg/L (333-708) in stage 2 (n=11), and 623 μg/L (231-911) in stage 3 (n=14), p=0.0001 for trend. Ten patients did not complete 48 hours of study: 6 of 10 were discharged (initial wbNGAL 130 μg/L (60-514)) and 4 died (773 μg/L (311-1010)). The AUROC curve of wbNGAL to predict AKI was 0.838 (95% confidence interval 0.76-0.92, p=0.0001), with optimal cut-off value of 178 μg/L (sensitivity 76.7%, specificity 78.9%, p<0.0001). At admission, twenty-nine patients had sepsis, of whom 20 were in septic shock. wbNGAL concentrations were 81 μg/L (60-187) in patients without sepsis, 481 (247-687) in those with sepsis, and 623.5 μg/L (361-798) in the subgroup of septic shock (p<0.0001). Conclusions. Whole-blood NGAL concentration at ICU admission was a good stratifier of AKI in critically ill patients. However, wbNGAL concentrations were higher in septic patients irrespective of AKI occurrence.

scholarly journals Relation of Procollagen Type III Amino Terminal Propeptide Level to Sepsis Severity in Pediatrics

Children ◽  
2021 ◽  
Vol 8 (9) ◽  
pp. 791
Author(s):  
Nagwan Y. Saleh ◽  
Hesham M. Aboelghar ◽  
Sherif S. Salem ◽  
Shimaa E. Soliman ◽  
Doaa M. Elian
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Area Under The Curve ◽  
Critically Ill Children ◽  
Sepsis Severity ◽  
Roc Curve Analysis ◽  
Type Iii ◽  
Procollagen Type ◽  
Amino Terminal ◽  
Sepsis And Septic Shock

Background: Sepsis is still the main etiology of mortality in pediatric intensive care units (PICUs). Therefore, we performed this study to evaluate the value of procollagen Type III amino-terminal propeptide (PIIINP) as a biomarker for sepsis severity diagnosis and mortality. Method: A prospective study was carried out on 170 critically ill children admitted into the PICU and 100 controls. The performed clinical examinations included calculation of the pediatric risk of mortality. Serum PIIINP was withdrawn from patients at admission and from the controls. Results: PIIINP level was significantly more increased in sepsis, severe sepsis, and septic shock than among the controls (p < 0.001). PIIINP was significantly higher in severe sepsis and septic shock (568.3 (32.5–1304.7) and 926.2 (460.6–1370), respectively) versus sepsis (149.5 (29.6–272.9)) (p < 0.001). PIIINP was significantly increased in non-survivors (935.4 (104.6–1370)) compared to survivors (586.5 (29.6–1169)) (p < 0.016). ROC curve analysis exhibited an area under the curve (AUC) of 0.833 for PIIINP, which is predictive for sepsis, while the cut-off point of 103.3 ng/mL had a sensitivity of 88% and specificity of 82%. The prognosis of the AUC curve for PIIINP to predict mortality was 0.651; the cut-off of 490.4 ng/mL had a sensitivity of 87.5% and specificity of 51.6%. Conclusions: PIIINP levels are increased in sepsis, with significantly higher levels in severe sepsis, septic shock, and non-survivors, thus representing a promising biomarker for pediatric sepsis severity and mortality.

Effect of fluid bolus triggers and their combination on fluid responsiveness in optimization phase of severe sepsis and septic shock resuscitation

MedPharmRes ◽  
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.

Sign in / Sign up

Export Citation Format

Share Document