Hypocoagulable Tendency on Thromboelastometry Associated With Severity and Anticoagulation Timing in Pediatric Septic Shock: A Prospective Observational Study

Objective: To identify whether coagulation profiles using thromboelastometry are associated with outcomes in pediatric septic shock. The primary outcomes were the development of disseminated intravascular coagulation (DIC) and the severity of the pediatric intensive care unit (PICU) existing scoring systems, while the secondary outcome was hospital mortality. This study aimed to contribute to current findings of the limitations of conventional tests in determining the optimal timing of anticoagulation in sepsis.Design: A prospective, observational study conducted between August 2019 and August 2020.Setting: PICU at a pediatric tertiary hospital in Hanoi, Vietnam.Patients: Fifty-five pediatric patients who met the septic shock criteria were enrolled.Measurements and Main Results: Fifty-five patients with septic shock were recruited. At the time of diagnosis, thromboelastometry revealed normocoagulability, hypercoagulability, and hypocoagulability in 29, 29, and 42% of the patients, respectively (p > 0.05); however, most patients in the overt DIC and non-survival groups progressed to hypocoagulability (82 and 64%, respectively). The overt DIC, PELOD-2 > 8, PRISM-III > 11, and non-survival group had a significant hypocoagulable tendency according to thromboelastometry parameters [prolonged clotting time (CT) and clot formation time (CFT); and reduced α-angle (α), maximum clot firmness (MCF), thrombodynamic potential index (TPI)] compared to the non-overt DIC, PELOD-2 ≤ 8, PRISM-III score ≤ 11 and survival group (p < 0.05). Conventional parameters between the normocoagulable and hypercoagulable groups were not different (p > 0.05). Hypocoagulability was characterized by lower platelet count and fibrinogen level, higher prolonged prothrombin time (PT), international normalized ratio (INR), and activated partial thromboplastin time (APTT), and higher D-dimer level than in hypercoagulability (p < 0.05). Hypocoagulable tendency on thromboelastometry had a higher hazard at a PT > 16.1 s [area under the curve (AUC) = 0.747, odds ratio (OR) = 10.5, p = 0.002], INR > 1.4 (AUC = 0.754, OR = 6.9, p = 0.001), fibrinogen <3.3 g/L (AUC = 0.728, OR = 9.9, p = 0.004), and D-dimer > 3,863 ng/mL (AUC = 0.728, OR = 6.7, p = 0.004).Conclusions: Hypocoagulable tendency using thromboelastometry is associated with the severity of septic shock. Conventional coagulation tests may fail to detect hypercoagulability, which is crucial in determining anticoagulation timing.

Download Full-text

EVALUATION OF APACHE- IV & SAPS- II SCORING SYSTEMS AND CALCULATION OF STANDARDISED MORTALITY RATE IN SEVERE SEPSIS AND SEPTIC SHOCK PATIENTS- A PROSPECTIVE OBSERVATIONAL STUDY

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2019/188 ◽

2019 ◽

Vol 8 (12) ◽

pp. 843-848

Author(s):

Siddhartha Chakraborty ◽

Sarbari Swaika ◽

Rajat Choudhuri ◽

Suchismita Mallick

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Mortality Rate ◽

Observational Study ◽

Prospective Observational Study ◽

Scoring Systems ◽

Saps Ii ◽

Sepsis And Septic Shock ◽

Apache Iv

Download Full-text

Nghiên cứu giá trị của presepsin huyết thanh trong sốc nhiễm khuẩn

Journal of Clinical Medicine- Hue Central Hospital ◽

10.38103/jcmhch.2020.60.3 ◽

2020 ◽

Author(s):

Quang Hiển Nguyễn Viết

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Observational Study ◽

Prospective Observational Study ◽

Area Under The Curve ◽

Mortality Prediction ◽

Apache Ii Score ◽

Blood Samples ◽

Medical Evaluation ◽

Sepsis And Septic Shock

RESEARCH THE VALUE OF PRESEPSIN IN SEPTIC SHOCK PATIENTS Objective: To investigate the prognostic severity and mortality value of presepsin in patients with severe sepsis and septic shock. Subject and Methods: Eighty patients with severe sepsis and septic shock according to ACCP/SCCM (2001) were included. A prospective, observational study. Blood samples were collected at first medical evaluation to measure presepsin level. Result: The serum presepsin level was positively correlated with SOFA score (r = 0.39, p <0.001), APACHE II score (r = 0.33, p <0.01 ) and number of organ dysfunction (r = 0.36, p <0.05). Area under the curve (AUC) of presepsin in prognostic mortality is 0.77, showed significant (p<0.001), at cut-off value 488,1 pg/ml, sensitivity 83.7% and specificity 100%. Conclusion: Serum presepsin levels correlated with the severity of sepsis and has mortality prediction value in severe sepsis and septic patients Key words: presepsin, severe sepsis, septic shock.

Download Full-text

Predictive value of thyroxine for prognosis in pediatric septic shock: a prospective observational study

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2019-0502 ◽

2020 ◽

Vol 33 (5) ◽

pp. 653-659

Author(s):

Jia Song ◽

Yun Cui ◽

Chunxia Wang ◽

Jiaying Dou ◽

Huijie Miao ◽

...

Keyword(s):

Septic Shock ◽

Thyroid Hormone ◽

Observational Study ◽

Hospital Mortality ◽

Predictive Value ◽

Prospective Observational Study ◽

Threshold Value ◽

Nonthyroidal Illness ◽

Hormone Levels ◽

Thyroid Hormone Levels

AbstractBackgroundThyroid hormone plays an important role in the adaptation of metabolic function to critically ill. The relationship between thyroid hormone levels and the outcomes of septic shock is still unclear. The aim of this study was to assess the predictive value of thyroid hormone for prognosis in pediatric septic shock.MethodsWe performed a prospective observational study in a pediatric intensive care unit (PICU). Patients with septic shock were enrolled from August 2017 to July 2019. Clinical and laboratory indexes were collected, and thyroid hormone levels were measured on PICU admission.ResultsNinety-three patients who fulfilled the inclusion criteria were enrolled in this study. The incidence of nonthyroidal illness syndrome (NTIS) was 87.09% (81/93) in patients with septic shock. Multivariate logistic regression analysis showed that T4 level was independently associated with in-hospital mortality in patients with septic shock (OR: 0.965, 95% CI: 0.937–0.993, p = 0.017). The area under receiver operating characteristic (ROC) curve (AUC) for T4 was 0.762 (95% CI: 0.655–0.869). The cutoff threshold value of 58.71 nmol/L for T4 offered a sensitivity of 61.54% and a specificity of 85.07%, and patients with T4 < 58.71 nmol/L showed high mortality (60.0%). Moreover, T4 levels were negatively associated with the pediatric risk of mortality III scores (PRISM III), lactate (Lac) level in septic shock children.ConclusionsNonthyroidal illness syndrome is common in pediatric septic shock. T4 is an independent predictor for in-hospital mortality, and patients with T4 < 58.71 nmol/L on PICU admission could be with a risk of hospital mortality.

Download Full-text

Mortality prediction using a novel combination of biomarkers in the first day of sepsis in intensive care units

Scientific Reports ◽

10.1038/s41598-020-79843-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Junkun Liu ◽

Chengwen Bai ◽

Binbin Li ◽

Aijun Shan ◽

Fei Shi ◽

...

Keyword(s):

Septic Shock ◽

Scoring Systems ◽

Predictive Performance ◽

Serum Levels ◽

International Normalized Ratio ◽

Individual Performance ◽

Mortality Prediction ◽

New Combination ◽

Thrombin Time ◽

Survivor Group

AbstractEarly identification of infection severity and organ dysfunction is crucial in improving outcomes of patients with sepsis. We aimed to develop a new combination of blood-based biomarkers that can early predict 28-day mortality in patients with sepsis or septic shock. We enrolled 66 patients with sepsis or septic shock and compared 14 blood-based biomarkers in the first 24 h after ICU admission. The serum levels of interleukin-6 (IL-6) (median 217.6 vs. 4809.0 pg/ml, P = 0.001), lactate (median 2.4 vs. 6.3 mmol/L, P = 0.014), N-terminal prohormone of brain natriuretic peptide (NT-proBNP) (median 1596.5 vs. 32,905.3 ng/ml, P < 0.001), prothrombin time (PT) (median 15.6 vs. 20.1 s, P = 0.030), activated partial thrombin time (APTT) (median 45.1 vs. 59.0 s, P = 0.026), and international normalized ratio (INR) (median 1.3 vs. 1.8, P < 0.001) were significantly lower in the survivor group. IL-6, NT-proBNP, and INR provided the best individual performance in predicting 28-day mortality of patients with sepsis or septic shock. Furthermore, the combination of these three biomarkers achieved better predictive performance (AUC 0.890, P < 0.001) than conventional scoring systems. In summary, the combination of IL-6, NT-proBNP, and INR may serve as a potential predictor of 28-day mortality in critically ill patients with sepsis or septic shock.

Download Full-text

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.

Download Full-text

The Correlation Between Whole Blood Copper (Cu), Zinc (Zn) Levels and Cu/Zn Ratio and Sepsis-Induced Left Ventricular Systolic Dysfunction (SILVSD) in Patients with Septic Shock: A Single-Center Prospective Observational Study

International Journal of General Medicine ◽

10.2147/ijgm.s335348 ◽

2021 ◽

Vol Volume 14 ◽

pp. 7219-7234

Author(s):

Jian-Biao Meng ◽

Ma-Hong Hu ◽

Ming Zhang ◽

Gong-Pai Hu ◽

Wei Zhang ◽

...

Keyword(s):

Septic Shock ◽

Observational Study ◽

Whole Blood ◽

Prospective Observational Study ◽

Left Ventricular Systolic Dysfunction ◽

Systolic Dysfunction ◽

Left Ventricular ◽

Single Center ◽

Ventricular Systolic Dysfunction

Download Full-text

The Incidence, Risk Factors, Predictors, and Prognoses of Cytomegalovirus Reactivation in Immunocompetent Mechanical Ventilation Patients: A Prospective Observational Study

10.21203/rs.3.rs-247841/v1 ◽

2021 ◽

Author(s):

Zhihui Zhang ◽

Xuesong Liu ◽

Ling Sang ◽

Sibei Chen ◽

Zhan Wu ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Observational Study ◽

Prospective Observational Study ◽

Area Under The Curve ◽

University Hospital ◽

Laboratory Findings ◽

Cytomegalovirus Reactivation ◽

Cmv Reactivation ◽

Immunocompetent Patients

Abstract Background: Cytomegalovirus (CMV) reactivation can seriously affect the clinical prognoses of critically ill patients. However, the epidemiology and predictors of CMV in immunocompetent patients with mechanical ventilation are not very clear. Methods: A single-center, prospective observational study (conducted from June 30, 2017 to July 01, 2018) with a follow-up of 90 days (September 29, 2018) that included 71 CMV-seropositive immunocompetent patients with mechanical ventilation at a 37-bed university hospital general intensive care unit (ICU) in China. Routine detection of CMV DNAemia was performed once a week until 28 days (Day1, 7, 14, 21, 28) and serology, laboratory findings, and clinical data were obtained at admission.Results: Among 71 patients, 13 (18.3%) showed CMV reactivation within ICU 28-day admission. The median time to reactivation was 7 days. CMV reactivation was related to various factors, including body weight, body mass index (BMI), sepsis, NT-proBNP, BUN, and Hb levels (P< 0.05). In the multivariate regression model, BMI, Hb level, and sepsis were associated with CMV reactivation patients (P< 0.05). Moreover, the area under the curve (AUC) of BMI, Hb and BMI combined Hb was 0.69, 0.70, 0.76, respectively. The rate of complications, duration of mechanical ventilation, hospitalization expense, length of ICU stay, and 90-day all-cause mortality rate in patients with CMV reactivation was significantly higher than in those without CMV reactivation (P< 0.05).Conclusions: Among immunocompetent patients with mechanical ventilation, the incidence of CMV reactivation was high. CMV reactivation can lead to various adverse prognoses. BMI, Hb, and sepsis were independent risk factors for CMV reactivation. BMI and Hb may predict CMV reactivation.

Download Full-text

Transoral Dermoid Cyst Excision: A Multicenter Prospective Observational Study

Otolaryngology ◽

10.1177/0194599818791772 ◽

2018 ◽

Vol 159 (6) ◽

pp. 981-986 ◽

Cited By ~ 5

Author(s):

Jin Pyeong Kim ◽

Dong Kun Lee ◽

Jeong Hwan Moon ◽

Jung Je Park ◽

Seung Hoon Woo

Keyword(s):

Observational Study ◽

Oral Cavity ◽

Dermoid Cyst ◽

Prospective Observational Study ◽

University Hospital ◽

Secondary Outcome ◽

Transoral Surgery ◽

Cyst Excision ◽

Surgery Group ◽

Multicenter Prospective Observational Study

Objective Transoral surgery is becoming a preferred technique because it does not leave any scar after surgery. However, transoral surgery for a dermoid cyst of the oral cavity is not standardized yet, due to the anatomic complexity of this region. The aim of this study was to evaluate the safety and efficacy of a transoral dermoid cyst excision. Study Design Multicenter prospective observational study. Setting University hospital. Subjects and Methods This study was designed as a 4-year prospective multicenter evaluation of dermoid cyst excisions within the floor of mouth. Clinical outcomes and complications related to procedures were evaluated among patients. The primary outcome was the efficacy of the procedure, and the secondary outcome was cosmetic satisfaction of each procedure. Results Twenty-one patients underwent transoral dermoid cyst excisions, and 22 underwent transcervical excisions. In the transoral surgery group, the mean size of the dermoid cyst was 5.35 cm (95% CI, 4.79-5.91), and in the transcervical surgery group, it was 6.19 cm (95% CI, 5.67-6.71). There was no significant differences with respect to overall demographic characteristics between the groups. However, the duration of the operation was shorter with the transoral group than with the transcervical group ( P = .001), and cosmetic satisfaction was much better in the transoral group ( P < .001). Conclusion Transoral dermoid cyst excision is a potentially safe and effective method that can lead to easy and quick removal of an oral cavity dermoid cyst, with excellent cosmetic outcomes.

Download Full-text