scholarly journals Cell Population Data (CPD) for Early Recognition of Sepsis and Septic Shock in Children: A Pilot Study

2021 ◽  
Vol 9 ◽  
Author(s):  
Paolo Biban ◽  
Martina Teggi ◽  
Marcella Gaffuri ◽  
Pierantonio Santuz ◽  
Diletta Onorato ◽  
...  
Keyword(s):  
Septic Shock ◽  
Cell Population ◽  
Fluorescence Intensity ◽  
Elective Surgery ◽  
Early Recognition ◽  
Pediatric Intensive Care ◽  
Population Data ◽  
Sepsis Diagnosis ◽  
Reactive Protein ◽  
Sepsis And Septic Shock

Objectives: Innovative Cell Population Data (CPD) have been used as early biomarkers for diagnosing sepsis in adults. We assessed the usefulness of CPD in pediatric patients with sepsis/septic shock, in terms of early recognition and outcome prediction. We revised 54 patients (0–15 y) admitted to our Pediatric Intensive Care Unit (PICU) for sepsis/septic shock during a 4-year period. Twenty-eight patients were excluded, 26 septic patients were enrolled (G1). Forty children admitted for elective surgery served as controls (G2). Data on five selected CPD parameters, namely neutrophils fluorescence intensity (NE-SFL), monocytes cells complexity (MO-X), monocytes fluorescence intensity (MO-Y), monocytes complexity and width of dispersion of events measured (MO-WX), and monocytes cells size and width dispersion (MO-WZ), were obtained at time of PICU admission (t0) by a hematological analyzer (Sysmex XN 9000®). As the primary outcome we evaluated the relevance of CPD for diagnosing sepsis/septic shock on PICU admission. Furthermore, we investigated if CPD at t0 were correlated with C-reactive protein (CRP), patient survival, or complicated sepsis course.Results: On PICU admission (t0), NE-SFL, MO-WX, and MO-Y were higher in sepsis/septic shock patients compared to controls. NE-SFL values were correlated with CRP values in G1 patients (r = 0.83). None of the five CPD parameters was correlated with survival or complicated sepsis course.Conclusion: We found higher values of NE-SFL, MO-WX, and MO-Y in children with sepsis/septic shock upon PICU admission. These parameters may be a promising adjunct for early sepsis diagnosis in pediatric populations. Larger, prospective studies are needed to confirm our preliminary observations.

scholarly journals qS-Ne2Mo Score – A New Risk Stratification Tool For Early Detection of Septic Shock in The Field of Emergency Medicine

2021 ◽  
Author(s):  
Peter Erdelyi ◽  
Laszlo Papp ◽  
Imre Foldesi ◽  
Katalin Farkas ◽  
Zsolt Molnar ◽  
...  
Keyword(s):  
Septic Shock ◽  
Risk Stratification ◽  
Cell Population ◽  
Complete Blood Count ◽  
Early Recognition ◽  
Population Data ◽  
The United States ◽  
Receiver Operating Curve ◽  
Suspected Infection ◽  
Risk Stratification Tool

Abstract Background Sepsis is one of the most significant healthcare concerns of the 21st century. In the United States sepsis affect 1.7 million adults, with 270,000 fatal cases, according to the estimation of Centers for Disease Control and Prevention. The management of sepsis relies on early recognition, therefore the emergency departments have distinctive role in sepsis care, hence the need for early reliable risk stratification tools.Methods A retrospective, quantitative study was performed in Department of Emergency, University of Szeged. Hungary. Patients with suspected infection were enrolled to four subgroups based on the results of patient examination and laboratory results. In all cases (N=276), cell population data markers were analyzed along with ordinary infection biomarkers, such as CRP, PCT and WBC. Performance of cell population data parameters were investigated with ROC (Receiver Operating Curve) analysis.Results Almost all cell population biomarkers showed significant differences in the subgroup analysis. Remarkable performance was found in three markers (NE-SFL/M, MO-X/M and NE-WY/M) in patients having septic shock. Combining quick SOFA with these biomarkers (qS-Ne2Mo score) resulted in excellent diagnostic ability for septic shock (AUC 0.914, p<0.001), with good sensitivity (73.9%) and excellent specificity (89 %).Conclusions Since determination of cell population data requires complete blood count analysis, turn-around time of this novel indicator is significantly lower than other methods. qS-Ne2Mo score might be used as an initial screening tool to select only those patients that need more extensive laboratory investigations for their proper treatment and spare inadequate, time and money consuming laboratory requests.Trial Registration: University of Szeged, Ethical Committee ref. nr. 25/2016-SZTE

scholarly journals Plasma lactate levels and lactate clearance as predictors of outcome in patients with sepsis and septic shock

2020 ◽  
Vol 7 (6) ◽  
pp. 1213
Author(s):  
Rashmi Patil ◽  
Chikkanarasareddy P. S. ◽  
Mallesh K.
Keyword(s):  
Septic Shock ◽  
Clinical Decision Making ◽  
Early Recognition ◽  
Early Stage ◽  
Therapeutic Option ◽  
Lactate Clearance ◽  
Plasma Lactate ◽  
Risk Of Death ◽  
Lactate Levels ◽  
Sepsis And Septic Shock

Background: Severe sepsis and septic shock are the major causes of admission and deaths in the ICU, killing one in four (and often more) and increasing in incidence. In order to improve the clinical outcomes in these patients, it is crucial to obtain early recognition of patients who are at risk of death and to optimize the clinical decision making in a timely manner. In order to monitor the metabolic consequences of shock and hemodynamic management, plasma lactate levels can be used in critical illness. Objective of the study is to estimate plasma lactate and lactate clearance in sepsis and septic shock patients and to correlate plasma lactate and lactate clearance as predictors of mortality.Methods: This study is a prospective observational study conducted over 18months. Children with age of 1 month to 18 years admitted to the Paediatric intensive care unit with sepsis and septic shock were enrolled in the study. ABG at admission to document plasma lactate and lactate repeated at 6 and 24 hrs. Lactate clearance calculated at 6 and 24 hrs. The final outcome in terms of survival or death will be recorded.Results: Majority of the children fall in the class between 1-6 months 51(48.11%). Male comprises 69(65.09%). Among these, Sepsis 36(33.96%); followed by Pneumonia 34(32.07%). Survivors group were 35(33.02%) and non-survivor was 71(66.98%). The Non survivor group was observed to have lower mean values of lactate clearance and found to be statistically significant. Specificity of Lactate clearance was 63.52% and Sensitivity 76.02% respectively. The results were positively associated with lactate level at 24 hours found to be significant effect of survivability when compared to non-survivor.Conclusions: Lactate clearance is vital and markable sign for screening of septic shock at early stage for therapeutic option. Further, 24-hours lactate estimation (cut off values) clearance appears superior to 6 h lactate clearance in predicting mortality in such patients.

Performance of Platelet Mass Index as a Marker of Severity for Sepsis and Septic Shock in Children

2021 ◽  
Author(s):  
Madhuradhar Chegondi ◽  
Niranjan Vijayakumar ◽  
Ramya Deepthi Billa ◽  
Aditya Badheka ◽  
Oliver Karam
Keyword(s):  
Septic Shock ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Pediatric Intensive Care ◽  
Prognostic Indicator ◽  
Clinical Value ◽  
Operating Characteristic Curve ◽  
Pediatric Sepsis ◽  
Sepsis And Septic Shock ◽  
Platelet Mass

AbstractPlatelet mass index (PMI) as a prognostic indicator in pediatric sepsis is not reported. In this retrospective observational study, we evaluated PMI's performance as a prognostic indicator in children aged younger than 18 years with sepsis and septic shock in relationship with survival. Over 5 years, we collected data of 122 children admitted to our pediatric intensive care unit (PICU). PMI accuracy was assessed with sensitivity and specificity and its discrimination was assessed using the area under the receiver operating characteristic curve (AUC). The median PMI values on days 1 and 3 of PICU admission were lower among nonsurvivors. On day 1 of PICU admission, a cutoff PMI value of 1,450 fL/nL resulted in a sensitivity of 72% and a specificity of 69%, and the AUC was 0.70 (95% confidence interval [CI]: 0.55–0.86). Similarly, on day 3, a cutoff of 900 fL/nL resulted in a sensitivity of 71% and a specificity of 70%, and the AUC was 0.76 (95% CI: 0.59–0.92). Our exploratory study suggests that low PMI in children with septic shock is associated with increased mortality. Considering the PMI's fair performance, further studies have to assess its clinical value.

Assessment and care of the patient with sepsis

2020 ◽  
pp. 225-257
Author(s):  
Kevin Barrett
Keyword(s):  
Septic Shock ◽  
Early Recognition ◽  
Scoring Systems ◽  
Cardiovascular Responses ◽  
Physiological Changes ◽  
Assessment Framework ◽  
Threatening Condition ◽  
Life Threatening ◽  
Support Mechanisms ◽  
Sepsis And Septic Shock

There has been considerable recent focus on sepsis in both the clinical arena and within the general public to raise awareness of the importance of early recognition of this potentially life-threatening condition. The early recognition of sepsis by ward nurses can both reduce progression of this lethal disease and improve survival for patients in hospital. This chapter focuses on definitions of sepsis and septic shock, physiological changes associated with inflammatory and cardiovascular responses to sepsis, and a clinical assessment framework to guide practice. There is also a discussion of the use of scoring systems and how to escalate support mechanisms for patients with sepsis and septic shock.

scholarly journals Usefulness of the heparin-binding protein level to diagnose sepsis and septic shock according to Sepsis-3 compared with procalcitonin and C reactive protein: a prospective cohort study in China

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e026527 ◽  
Author(s):  
Yixuan Zhou ◽  
Zhen Liu ◽  
Jun Huang ◽  
Guiling Li ◽  
Fengying Li ◽  
...  
Keyword(s):  
Septic Shock ◽  
Cohort Study ◽  
Roc Curve ◽  
Prospective Cohort ◽  
Heparin Binding ◽  
C Reactive Protein ◽  
Suspected Sepsis ◽  
Reactive Protein ◽  
Heparin Binding Protein ◽  
Sepsis And Septic Shock

ObjectivesOur aim was to assess the release level of heparin-binding protein (HBP) in sepsis and septic shock under theThird International Consensus Definitions for Sepsis and Septic Shock(Sepsis-3).DesignProspective cohort study.SettingA general teaching hospital in China.ParticipantsAdult infected patients with suspected sepsis and people who underwent physical examination were included. According to the health status and severity of illness, the research subjects were divided into healthy, local infection, sepsis non-shock and septic shock under Sepsis-3 definitions.Main outcome measuresPlasma levels of HBP, procalcitonin (PCT), C reactive protein (CRP) and complete blood count were detected in all subjects. Single-factor analysis of variance was used to compare the biomarker levels of multiple groups. A receiver operating characteristic (ROC) curve was used to assess the diagnostic capacity of each marker.ResultsHBP levels were significantly higher in patients with sepsis non-shock than in those with local infections (median 49.7ng/mL vs 11.8 ng/mL, p<0.01) at enrolment. Moreover, HBP levels in patients with septic shock were significantly higher than in patients with sepsis without shock (median 153.8ng/mL vs 49.7 ng/mL, p<0.01). The area under the ROC curve (AUC) of HBP (cut-off ≥28.1 ng/mL) was 0.893 for sepsis which was higher than those of PCT (0.856) for a cut-off ≥2.05 ng/mL and of CRP (0.699) for a cut-off ≥151.9 mg/L. Moreover, AUC of HBP (cut-off ≥103.5 ng/mL) was 0.760 for septic shock which was higher than the ROC curve of sequential [sepsis-related] organ failure assessment (SOFA) Score (0.656) for a cut-off ≥5.5. However, there was no significant difference between 28-d survivors (n=56) and 28-d non-survivors (n=37) with sepsis in terms of HBP value (p=0.182).ConclusionsA high level of HBP in plasma is associated with sepsis, which might be a useful diagnostic marker in patients with suspected sepsis.

scholarly journals Procalcitonin, C-Reactive Protein, Albumin, and Blood Cultures as Early Markers of Sepsis Diagnosis or Predictors of Outcome: A Prospective Analysis

2019 ◽  
Vol 12 ◽  
pp. 2632010X1984767 ◽  
Author(s):  
Ana Cristina Schmidt de Oliveira-Netto ◽  
Luis G Morello ◽  
Libera M Dalla-Costa ◽  
Ricardo R Petterle ◽  
Rafael M Fontana ◽  
...  
Keyword(s):  
Septic Shock ◽  
Blood Culture ◽  
Albumin Level ◽  
Culture Collection ◽  
Apache Ii ◽  
Predictors Of Outcome ◽  
Aged Patients ◽  
Logistic Regression Models ◽  
Sepsis Diagnosis ◽  
Sepsis And Septic Shock

Purpose: Sepsis is a condition with high mortality rates and its diagnosis remains a challenge. We assessed epidemiological, clinical data, multiple biomarker profiles, and blood culture with respect to sepsis diagnosis and predictors of outcome. Methods: In total, 183 patients who were suspected of having sepsis and underwent blood culture collection were followed up for 7 days. Sepsis-related Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores were calculated daily; biomarkers and blood culture test results were evaluated. Results: In total, 78 (43%) had sepsis, 50 (27%) had septic shock, and 55 (30%) had no sepsis. Blood culture was positive in 28% and 42% of the sepsis and septic shock groups, respectively ( P < .001). Regarding clinical profiles and biomarker values, there were no differences between the sepsis and non-sepsis groups, but significant differences were observed in the septic shock group. Multivariate logistic regression models revealed that age, serum albumin level, APACHE II, and SOFA 1st day scores were the independent variables for death. Conclusions: The challenge in the diagnosis of sepsis continues as clinical and laboratory differences found between the groups were due to septic shock. Older aged patients with lower albumin levels and higher APACHE II and SOFA 1st day scores have a greater probability of mortality.

scholarly journals The alteration of renal function in sepsis and septic shock patients in pediatric intensive care unit

2011 ◽  
Vol 51 (2) ◽  
pp. 89
Author(s):  
Feiby Julianto ◽  
Adrian Umboh ◽  
Suryadi Tatura
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Renal Function ◽  
Intensive Care ◽  
Mortality Rate ◽  
Correlation Coefficient ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Sepsis Group ◽  
Sepsis And Septic Shock

Background Sepsis is a commonly seen emergency case in the pediatric intensive care unit.1 Severe sepsis mortality rate in developed country andin developing country such as Indonesia are 9% and 50-70%, respectively. Furthennore, the mortality rate in septic shock is 80%.2 Several researches documented increasing rate of acute kidney injury (AKI) incidence correlated 'With sepsis. Clinical intervention identification may decrease AKI and sepsis incidence.Objective To identify the correlation between incidence of AKI in sepsis and in septic shock patients who was treated in pediatric intensive care unit (PICU).Methods A cross sectional study was perfonned in 37 patients diagnosed as sepsis according ACCP/SCCM criteria for children aged 1 month to 13 years. The study was conducted in Pediatric Department, Prof. Dr. R.D. Kandou hospital from April 2009 to June 2009.Results From 37 sepsis patients, 27 were boys and 10 were girls. In the sepsis group (n=27) 10 had AKI, and in the septic shock group (n= 10) had AKI. Phi correlation coefficient applied to statistically analyzed sepsis in correlation with AKI (creatinin serum and GFR). Significant Phi correlation coefficient was (r=0.117; P> 0.05)Conclusions The study concludes that there is no correlation of renal function impainnent Mth sepsis and septic shock.

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