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.

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

Diagnostics ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. 60
Author(s):  
Jongmin Lee ◽  
Seohyun Kim ◽  
Kyung Hoon Kim ◽  
Na Ri Jeong ◽  
Seok Chan Kim ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hospital Mortality ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Primary Outcome ◽  
Area Under The Curve ◽  
Immunocompromised Patients ◽  
Soluble Cd14 ◽  
Dynamic Changes

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. This is a prospective cohort study that included 119 adult patients admitted to the intensive care unit (ICU). Presepsin level was measured on day 1 and day 3 after ICU admission. The primary outcome was in-hospital mortality. In immunocompromised patients, presepsin levels on day 1 were higher in patients with sepsis than those in patients without sepsis. 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. In immunocompromised patients who died in the hospital, presepsin levels on day 3 were significantly higher than those on day 1. In the multivariate analysis, ΔPresepsin+ alone was independently correlated with in-hospital mortality in immunocompromised patients. 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.

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.

Incidence and Outcomes of Sepsis-Related Cardiomyopathy: A Prospective Cohort Study

2021 ◽  
Vol 104 (3) ◽  
pp. 497-505
Keyword(s):  
Septic Shock ◽  
Cohort Study ◽  
Hospital Mortality ◽  
Prospective Cohort Study ◽  
Predictive Factors ◽  
Prospective Cohort ◽  
Protective Factor ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Factors Associated

Objective: To determine the incidence, predictive factors, and prognosis of sepsis-related cardiomyopathy. Materials and Methods: The present study was a prospective cohort study that enrolled adult septic shock patients admitted to the ICU of Siriraj Hospital (Bangkok, Thailand) between October 2013 and November 2014. All the patients were treated following the surviving sepsis campaign international guidelines 2012. Transthoracic echocardiography was performed during day 1, and then again during days 3 to 4 after septic shock diagnosis. Sepsis-related cardiopathy was diagnosed in patients who had left ventricular ejection fraction (LVEF) at less than 50%. The primary outcome was hospital mortality. The present study was registered in the Thai Clinical Trials Registry (TCTR20200818004). Results: Of the 75 patients enrolled, 24 (32%) were diagnosed as having sepsis-related cardiomyopathy, and 51 sepsis with preserved LVEF. Six of the 51 patients (11.8%) in the sepsis with preserved LVEF group, and nine of the 24 patients (37.5%) in the sepsis-related cardiomyopathy group died in the hospital (p=0.009). Multivariate analysis identified a maximum vasopressor dosage greater than 0.08 mcg/kg/minute and requiring renal replacement therapy as predictive factors associated with sepsis-related cardiomyopathy, while cirrhosis was identified as a protective factor. Sepsis-related cardiomyopathy, pneumonia, and requiring vasopressor were predictive factors associated with hospital mortality, while achieving tissue perfusion goals within six hours after resuscitation was a protective factor against in-hospital death. Conclusion: Sepsis-related cardiomyopathy was identified as a significant type of organ dysfunction among the present study sepsis or septic shock patients, and the mortality rate was high. Keywords: Incidence, Outcomes, Sepsis-related cardiomyopathy

scholarly journals The SAPS 3 score as a predictor of hospital mortality in a South African tertiary intensive care unit: A prospective cohort study.

PLoS ONE ◽  
2020 ◽  
Vol 15 (5) ◽  
pp. e0233317
Author(s):  
Elizabeth van der Merwe ◽  
Jacinto Kapp ◽  
Sisa Pazi ◽  
Ryan Aylward ◽  
Minette Van Niekerk ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Hospital Mortality ◽  
South African ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Saps 3

scholarly journals Predictive accuracy of risk scales following self-harm: Multicentre, prospective cohort study

2017 ◽  
Vol 210 (6) ◽  
pp. 429-436 ◽  
Author(s):  
Leah Quinlivan ◽  
Jayne Cooper ◽  
Declan Meehan ◽  
Damien Longson ◽  
John Potokar ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Predictive Accuracy ◽  
Area Under The Curve ◽  
Global Scale ◽  
National Guidelines ◽  
Liaison Psychiatry ◽  
Predictive Values ◽  
Self Harm

BackgroundScales are widely used in psychiatric assessments following self-harm. Robust evidence for their diagnostic use is lacking.AimsTo evaluate the performance of risk scales (Manchester Self-Harm Rule, ReACT Self-Harm Rule, SAD PERSONS scale, Modified SAD PERSONS scale, Barratt Impulsiveness Scale); and patient and clinician estimates of risk in identifying patients who repeat self-harm within 6 months.MethodA multisite prospective cohort study was conducted of adults aged 18 years and over referred to liaison psychiatry services following self-harm. Scale a priori cut-offs were evaluated using diagnostic accuracy statistics. The area under the curve (AUC) was used to determine optimal cut-offs and compare global accuracy.ResultsIn total, 483 episodes of self-harm were included in the study. The episode-based 6-month repetition rate was 30% (n = 145). Sensitivity ranged from 1% (95% CI 0–5) for the SAD PERSONS scale, to 97% (95% CI 93–99) for the Manchester Self-Harm Rule. Positive predictive values ranged from 13% (95% CI 2–47) for the Modified SAD PERSONS Scale to 47% (95% CI 41–53) for the clinician assessment of risk. The AUC ranged from 0.55 (95% CI 0.50–0.61) for the SAD PERSONS scale to 0.74 (95% CI 0.69–0.79) for the clinician global scale. The remaining scales performed significantly worse than clinician and patient estimates of risk (P < 0.001).ConclusionsRisk scales following self-harm have limited clinical utility and may waste valuable resources. Most scales performed no better than clinician or patient ratings of risk. Some performed considerably worse. Positive predictive values were modest. In line with national guidelines, risk scales should not be used to determine patient management or predict self-harm.

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