scholarly journals Prognostic value of Amino Terminal Pro B-type Natriuretic Peptide (NT-proBNP) in patient with severe sepsis and septic shock in an ICU of tertiary care hospital of Bangladesh.

2018 ◽  
Vol 6 (2) ◽  
pp. 65-70
Author(s):  
Tarikul Hamid ◽  
Rozina Sultana ◽  
ASM Areef Ahsan ◽  
Kaniz Fatema ◽  
Fatema Ahmed ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Tertiary Care ◽  
Whole Body ◽  
Care Hospital ◽  
Inflammatory Reactions ◽  
Icu Admission ◽  
Amino Terminal ◽  
Sepsis And Septic Shock

Background: Severe sepsis and septic shock are the leading cause of ICU admission. Despite the adequate resuscitation, septic shock is frequently associated with multiple system organ failure (MSOF) and death. This study examined the clinical utility of the level of NT-proBNP as an indicator of outcome in severe sepsis and septic shock.Objectives: to find relationship between level of NT-Pro-BNP and the outcome of the patients of severe sepsis and septic shock.Design: This Prospective observational study done in ICU of BIRDEM General Hospital.Method: All consecutive patients who were diagnosed as severe sepsis and septic shock according to SSC (Surviving Sepsis Campaign) guidelines fulfilling the selection criteria were included in the study. Informed written consent was taken from patient’s first degree relatives. Just after admission of severe sepsis and septic shock patients into ICU and development of severe sepsis or septic shock of previously admitted ICU patients, blood sample for serum NT-proBNP level was sent to hospital laboratory. 28 days were taken as follow up period for all patients in this study. Outcome was measured by mortality. Those who were discharged or transferred were classified as survivors and those who were died, categorized as non survivors. Those who were neither discharged nor dead during the study period were classified as survivors. Patient’s resusci-tation and management were done according to the standard ICU protocol of BIRDEM General Hospital.Result: A total 127 of patients fulfilled the criteria of sepsis and septic shock and study inclusion criteria during the study period. The mean & SD of age in this study was 63.69 ± 17.79 years. 52% (n = 66) were male & 48% (n = 61) were female. Here DM was the most common (83.5%) comorbidity and predominant diagnoses were Pneumonia (58.3%) & UTI (30.7%). Among 127 patients, 24.4% (n=31) were in septic shock and 75.6% (n= 96) patients present with severe sepsis. Level of NT-proBNP of severe sepsis patients were 4608.64 ± 7712.12 & Level of NT-proBNP of septic shock patients were 19239.06 ± 13058.05 (P<0.0001). Among 31 (24.4%) septic shock patients, 32.2% (n=10) patients were survivor and NT-proBNP level was 7333.50 ± 10624 pg/ml; 67.8% (n=21) patients were non survivor and NT-proBNP level was 24908.38 ± 10017.87 pg/ml (P <0.001). In this study among 96 (75.6%) patients with severe sepsis, 88.7% (n=86) were survivor and NT-proBNP level was 2436.41 ± 3755.03 pg/ml; 11.3% (n=11) patients were non-survivors and NT-proBNP level was 21238.36 ± 10095.34 pg/ml (P<0.0001).Conclusion: Severe sepsis and septic shock are the leading cause of ICU admission and also leading cause of death. Our study showed that, elderly with diabetes mellitus had developed more sepsis. Pneumonia and UTI are commonest cause of sepsis.Sepsis causes extreme inflammatory reactions involving all organs of whole body including heart, causing release of NT-proBNP. Raised level of this biomarker associated with increased rate of mortality.Bangladesh Crit Care J September 2018; 6(2): 65-70

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.

Outpatient Follow-up Care After Hospital Discharge of Children With Complex Chronic Conditions at a Rural Tertiary Care Hospital

2021 ◽  
pp. 000992282110472
Author(s):  
Andrew Brown ◽  
Mary Quaile ◽  
Hannah Morris ◽  
Dmitry Tumin ◽  
Clayten L. Parker ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Discharge ◽  
Care Coordination ◽  
Chronic Conditions ◽  
Tertiary Care ◽  
Care Hospital ◽  
Icu Admission ◽  
Complex Chronic Conditions

Objective To determine factors associated with completion of recommended outpatient follow-up visits in children with complex chronic conditions (CCCs) following hospital discharge. Methods We retrospectively identified children aged 1 to 17 years diagnosed with a CCC who were discharged from our rural tertiary care children’s hospital between 2017 and 2018 with a diagnosis meeting published CCC criteria. Patients discharged from the neonatal intensive care unit and patients enrolled in a care coordination program for technology-dependent children were excluded. Results Of 113 eligible patients, 77 (68%) had outpatient follow-up consistent with discharge instructions. Intensive care unit (ICU) admission ( P = .020) and prolonged length of stay ( P = .004) were associated with decreased likelihood of completing recommended follow-up. Conclusions Among children with CCCs who were not already enrolled in a care coordination program, ICU admission was associated with increased risk of not completing recommended outpatient follow-up. This population could be targeted for expanded care coordination efforts.

scholarly journals Determinants of functional status among survivors of severe sepsis and septic shock: One-year follow-up

2015 ◽  
Vol 10 (2) ◽  
pp. 132 ◽  
Author(s):  
YaseenM Arabi ◽  
MustafaS Al Khalaf ◽  
FatimahH Al Ehnidi ◽  
HasanM Al-Dorzi ◽  
HaniM Tamim ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Functional Status ◽  
One Year ◽  
Sepsis And Septic Shock

scholarly journals Tricuspid Annular Plane of Systolic Excursion (TAPSE) for the Evaluation of Patients with Severe Sepsis and Septic Shock

2020 ◽  
Vol 21 (2) ◽  
pp. 348-352
Author(s):  
Shadi Lahham ◽  
Clifton Lee ◽  
Qumber Ali ◽  
John Moeller ◽  
Chanel Fischetti ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Length Of Stay ◽  
Large Scale ◽  
Admission Rate ◽  
Hospital Length Of Stay ◽  
Point Of Care Ultrasound ◽  
Septic Cardiomyopathy ◽  
Icu Admission ◽  
Sepsis And Septic Shock

Introduction: Sepsis is a systemic infection that can rapidly progress into multi organ failure and shock if left untreated. Previous studies have demonstrated the utility of point of care ultrasound (POCUS) in the evaluation of patients with sepsis. However, limited data exists on the evaluation of the tricuspid annular plane of systolic excursion (TAPSE) in patients with sepsis. Methods: We prospectively enrolled patients who presented to the emergency department (ED) with concern for severe sepsis or septic shock in a pilot study. In patients that screened positive, the treating physician then performed POCUS to measure the TAPSE value. We compared the intensive care unit (ICU) admission rate, hospital length of stay, and morbidity with their respective TAPSE values. Results: We enrolled 24 patients in the study. Eight patients had TAPSE values less than 16 millimeters (mm), two patients had TAPSE values between 16mm-20mm, and fourteen patients had TAPSE values greater than 20mm. There was no statistically significant association between TAPSE levels and ICU admission (p=0.16), or death (p=0.14). The difference of length of stay (LOS) was not statistically significant in case of hospital LOS (p= 0.72) or ICU LOS. Conclusion: Our pilot data did not demonstrate a correlation between severe sepsis or septic shock and TAPSE values. This may be due to several factors including patient comorbidities, strict definitions of sepsis and septic shock, as well as the absence of septic cardiomyopathy (SCM) in patients with sepsis and septic shock. Future large-scale studies are needed to determine if TAPSE can be beneficial in the ED evaluation of patients with concern for SCM.

scholarly journals Amino-Terminal Pro–B-Type Natriuretic Peptide as Predictor of Mortality in Patients with Symptomatic Peripheral Arterial Disease: 5-Year Follow-Up Data from the Linz Peripheral Arterial Disease Study

2009 ◽  
Vol 55 (1) ◽  
pp. 68-77 ◽  
Author(s):  
Thomas Mueller ◽  
Benjamin Dieplinger ◽  
Werner Poelz ◽  
Georg Endler ◽  
Oswald F Wagner ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Natriuretic Peptide ◽  
Tertiary Care ◽  
Arterial Disease ◽  
Rank Test ◽  
Care Hospital ◽  
Amino Terminal ◽  
All Cause Mortality ◽  
Peripheral Arterial

Abstract Background: Amino-terminal pro–B-type natriuretic peptide (NT-proBNP) has emerged as predictor of mortality endpoints in cardiac disease. In contrast, the prognostic value of NT-proBNP in patients with peripheral arterial disease (PAD) is unclear. Therefore, we aimed to evaluate the capability of NT-proBNP as a marker for long-term prognosis in atherosclerotic PAD. Methods: We obtained NT-proBNP serum concentrations in 487 consecutive patients with symptomatic PAD admitted to a tertiary-care hospital. The endpoint was defined as all-cause mortality, and the study participants were followed for 5 years. Results: Of the 487 patients enrolled, 114 died and 373 survived during follow-up. The median NT-proBNP concentration was higher among decedents than survivors (692 vs 143 ng/L; P &lt; 0.001). Using the median NT-proBNP concentration of the entire cohort (213 ng/L) as threshold level, Kaplan–Meier curve analysis demonstrated that the survival probability was lower in patients with NT-proBNP above the median (log-rank test, P &lt; 0.001). In the fully adjusted Cox proportional-hazards regression analysis, NT-proBNP &gt;213 ng/L had a risk ratio of 2.27 (95% CI 1.27–4.03; P = 0.005) independent of age, sex, glomerular filtration rate, clinical stage of PAD, cardiovascular comorbidity, and other potential confounders. Further analyses showed that NT-proBNP added significantly to the value of established and emerging outcome predictors of PAD. Conclusions: In this study, a NT-proBNP serum concentration &gt;213 ng/L was a robust and independent predictor of 5-year all-cause mortality in patients with symptomatic PAD. Thus, NT-proBNP measurements can be considered a valuable tool for risk stratification in these patients.

scholarly journals Adequate antibiotic therapy prior to ICU admission in patients with severe sepsis and septic shock reduces hospital mortality

Critical Care ◽  
2015 ◽  
Vol 19 (1) ◽  
Author(s):  
José Garnacho-Montero ◽  
Antonio Gutiérrez-Pizarraya ◽  
Ana Escoresca-Ortega ◽  
Esperanza Fernández-Delgado ◽  
José María López-Sánchez
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Hospital Mortality ◽  
Antibiotic Therapy ◽  
Icu Admission ◽  
Sepsis And Septic Shock

Management of severe sepsis and septic shock in the Emergency Department: a follow-up survey

2013 ◽  
Vol 30 (7) ◽  
pp. 602.1-602
Author(s):  
Thomas Boon ◽  
Colette Coyle ◽  
Narani Sivayoham
Keyword(s):  
Emergency Department ◽  
Septic Shock ◽  
Severe Sepsis ◽  
Sepsis And Septic Shock

Abstract 14598: The Novel Cardiac Biomarker Secretoneurin Provides Independent Prognostic Information in Severe Sepsis and Septic Shock: Data From the ALBIOS Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Helge Røsjø ◽  
Serge Masson ◽  
Pietro Caironi ◽  
Mats Stridsberg ◽  
Caterina Fanizza ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Cardiac Biomarkers ◽  
Icu Mortality ◽  
Open Label ◽  
Prognostic Information ◽  
Prediction Of Mortality ◽  
Crystalloid Solutions ◽  
Sepsis And Septic Shock

Background: Plasma secretoneurin (SN) is directly correlated to cardiomyocyte Ca 2+ handling and provides independent prognostic information in cardiovascular disease. Whether SN may predict mortality in patients with severe sepsis or septic shock is not established. Methods: We measured SN levels in serial plasma samples collected on days 1, 2, and 7 in 958 patients enrolled in the multicenter, open-label, randomized, controlled ALBIOS trial, that tested either 20% albumin and crystalloid solutions or crystalloid solutions alone in patients with severe sepsis or septic shock. Endpoints were ICU or 90 day mortality. Results: SN levels on day 1 were higher in non-survivors compared to survivors, both for ICU mortality (235 [Q1-Q3 188-290] vs. 192 [155-246] pmol/L, p<0.0001) and for 90 day mortality (227 [183-283] vs. 188 [154-234] pmol/L, p<0.0001). Admission SN levels were influenced by age and lactate, creatinine and NT-proBNP levels. Stratifying patients according to SN quartiles on day 1 separated survivors and non-survivors during follow-up (Figure). After adjusting for clinical risk factors, SAPS II and SOFA scores, and cardiac biomarkers (hs-cTnT and NT-proBNP), SN levels (logarithmical transformed) on day 1 remained significantly associated with ICU mortality (OR 1.29 [95% CI 1.07-1.55], p=0.007) and 90 day mortality (OR 1.22 [1.02-1.47], p=0.03). SN levels on day 2, but not day 7, were also independently associated with ICU and 90 day mortality. SN levels on day 1 and 2 improved prognostic accuracy for ICU and 90 day mortality as assessed by the category-free net reclassification index. We found no interactions between SN levels and randomization to albumin replacement for prediction of mortality during follow-up. Changes in SN levels over time were not predictive of subsequent mortality. Conclusion: SN provides incremental information to established risk models and cardiovascular biomarkers in patients with severe sepsis and septic shock.

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