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 Serum PIIINP was withdrawn from patients at admission and from the controls.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.

scholarly journals Prognostic value of ADAMTS13 in patients with severe sepsis and septic shock

2017 ◽  
Vol 40 (2) ◽  
pp. 49 ◽  
Author(s):  
M Feroz Azfar ◽  
M Faisal Khan ◽  
S Shahid Habib ◽  
Z Al Aseri ◽  
A Mohammad Zubaidi ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Significant Risk ◽  
Area Under The Curve ◽  
Apache Ii ◽  
University Hospital ◽  
Apache Ii Score ◽  
Surgical Intensive Care ◽  
Vasopressor Agents ◽  
Sepsis And Septic Shock

Purpose: ADAMTS13 level was evaluated as a predictor of mortality in patients with severe sepsis and septic shock, and compared with Acute Physiology and Chronic Health Evaluation II (APACHE II) scores. Methods: This prospective observational study was conducted in the Medical and Surgical Intensive Care Units of King Khalid University Hospital. Detailed clinical evaluations were performed on 84 patients (56.08±18.18 years of age) with severe sepsis and septic shock. ADAMTS13 levels were determined (three blood samples at 24 hours intervals) and APACHE II scores, hematological profiles, indices of organ hypo-perfusion, renal functions and coagulation profiles were recorded. Primary outcome was 30 days ICU mortality and secondary outcomes were its comparison with APACHE II score, length of ICU stay and use of vasopressor agents. Results: Hypertension (53.6%) and diabetic mellitus (45.2%) were the commonest comorbidities. The median ADAMTS13 levels were 336.65, 339.35 and 313.9, respectively. ROC analysis showed maximum area under the curve for second ADAMTS13 (AUC=0.760) compared with first (AUC=0.660) and third samples (AUC=0.707) and APACHE II scores (AUC=0.662). Patients were divided into low and high ADAMTS13 groups according to the best cut-off point. Mortality was high in the low ADAMTS13 level group [OR=4.5]and was significantly associated with age, DBP, ADAMTS13, APACHE II score, DIC score and platelet count. ADAMTS13 (OR=5.3), APACHE II (OR=4.13) and DIC scores (OR=7.32) were significant risk factors for mortality. Conclusions: Low ADAMTS13 was associated with increased mortality in patients with severe sepsis and septic shock and was comparable to APACHE II scores for predicting mortality.

Clinical outcome of severe sepsis and septic shock in critically ill children

2020 ◽  
Vol 50 (3) ◽  
pp. 186-190
Author(s):  
Sachin Shah ◽  
Amita Kaul ◽  
Yogesh Jadhav ◽  
Ganesh Shiwarkar
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Clinical Outcome ◽  
Critically Ill Children ◽  
Rapid Progression ◽  
Presenting Symptoms ◽  
Increased Risk ◽  
Co Morbidity ◽  
Sepsis And Septic Shock ◽  
Tropical Infections

Information concerning the clinical outcome of severe sepsis and septic shock among the burden of tropical infections in children is limited, particularly in low-income settings.  We conducted a prospective consecutive cohort study in all children aged 1 month to 16 years needing paediatric intensive care between 1 January 2017 and 31 December 2018.  Demographic details, presenting symptoms and duration, associated co-morbidity and organ dysfunction were recorded. Clinical and laboratory parameters discriminating between survivors and non-survivors were evaluated.  Most presented with respiratory or central nervous system derangement along with cardiovascular dysfunction. Haematological involvement was almost invariably found on diagnostic evaluation. Those children with ≥3 systems involved had higher odds of mortality. Dengue was seen in half the patients, being the commonest tropical infection. Not surprisingly, non-survivors were younger, had rapid progression of illness and needed ventilation more often within the first hour of admission. However, in multivariable regression analysis, only procalcitonin levels were associated with increased risk of mortality. We conclude that that tropical infections causing severe sepsis and septic shock are an important cause of mortality. There are, however, no clinical parameters which differentiate reliably between survivors and non-survivors.

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 Time to First Antimicrobial Administration After Onset of Sepsis in Critically Ill Children

2015 ◽  
Vol 20 (1) ◽  
pp. 37-44 ◽  
Author(s):  
Nicholas M. Fusco ◽  
Kristine A. Parbuoni ◽  
Jill A. Morgan
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Severe Sepsis ◽  
Intensive Care ◽  
Length Of Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Critically Ill Children ◽  
Sepsis And Septic Shock ◽  
Antimicrobial Administration

OBJECTIVES: Delay of antimicrobial administration in adult patients with severe sepsis and septic shock has been associated with a decrease in survival to hospital discharge. The primary objective of this investigation was to determine the time to first antimicrobial administration after the onset of sepsis in critically ill children. Secondary objectives included appropriateness of empiric antimicrobials and microbiological testing, fluid resuscitation during the first 24 hours after onset of sepsis, intensive care unit and hospital length of stay, and mortality. METHODS: Retrospective, chart review of all subjects less than or equal to 18 years of age admitted to the pediatric intensive care unit (PICU) with a diagnosis of sepsis between January 1, 2011, and December 31, 2012. RESULTS: A total of 72 subjects met the inclusion criteria during the study period. Median time to first antimicrobial administration by a nurse after the onset of sepsis was 2.7 (0.5–5.1) hours. Cultures were drawn prior to administration of antimicrobials in 91.7% of subjects and were repeated within 48 hours in 72.2% of subjects. Empiric antimicrobial regimens were appropriate in 91.7% of cases. The most common empiric antimicrobial regimens included piperacillin/tazobactam plus vancomycin in 19 subjects (26.4%) and ceftriaxone plus vancomycin in 15 subjects (20.8%). Median PICU length of stay was 129 (64.6–370.9) hours, approximately 5 days, and median hospital length of stay was 289 (162.5–597.1) hours, approximately 12 days. There were 4 deaths during the study period. CONCLUSIONS: Time to first antimicrobial administration after onset of sepsis was not optimal and exceeded the recommendations set forth in international guidelines. At our institution, the process for treating pediatric patients with severe sepsis and septic shock should be modified to increase compliance with national guidelines.

scholarly journals Combined SuPAR and qSOFA for predicting 28-day mortality in sepsis

2021 ◽  
Author(s):  
Lifeng Wang ◽  
Chao Tang ◽  
Shuangjun He ◽  
Yi Chen ◽  
Cuiying Xie
Keyword(s):  
Septic Shock ◽  
Roc Curve ◽  
Area Under The Curve ◽  
Enzyme Linked Immunosorbent Assay ◽  
Sepsis Severity ◽  
International Consensus ◽  
Net Reclassification Improvement ◽  
Kaplan Meier ◽  
Qsofa Score ◽  
Sepsis And Septic Shock

Abstract Background and Purpose To determine the prognostic performance of soluble urokinase-type plasminogen activator receptor (suPAR) and quick Sequential Organ Failure Assessment (qSOFA) in predicting the 28-day mortality of sepsis patients admitted to the emergency department (ED). Methods A prospective, single-center observational study was conducted between June 2018 and June 2019. In total, 175 patients with sepsis and septic shock admitted to the ED were enrolled based on the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). We assessed the qSOFA score on ED admission and measured serum suPAR levels by quantitative enzyme-linked immunosorbent assay. Kaplan–Meier survival curves and areas under the receiver operating characteristic (ROC) curve for 28-day mortality were calculated. We estimated category-free net reclassification improvement (NRI) when suPAR was added to qSOFA. Results Increased suPAR levels were significantly associated with 28-day mortality (1337(962–2003) pg/ml in survivors vs. 1742(1238–2514) pg/ml in non-survivors, p = 0.011) and with sepsis severity (1337(986–1979) in sepsis vs. 1742(1215–2649) in septic shock, p = 0.039). Kaplan–Meier curves showed that suPAR ≥ 1382 pg/mL was associated with significantly higher 28-day mortality risk(P = 0.0028). The area under the curve (AUC) for the prediction of 28-day mortality was 0.646 for suPAR, 0.832 for qSOFA, and 0.860 for combined suPAR and qSOFA. Serum suPAR did not significantly increase the AUC of the basic qSOFA, but a model containing suPAR and qSOFA had a continuous NRI of 11% (95% CI :3.5–18.5% ; p = 0.004). Conclusion Serum suPAR is associated with sepsis severity and 28-day mortality. Adding suPAR to qSOFA may increase the ROC curve area and improve predictive value of qSOFA for outcome.

scholarly journals Combined suPAR and qSOFA for the prediction of 28-day mortality in sepsis patients

2021 ◽  
Keyword(s):  
Septic Shock ◽  
Roc Curve ◽  
Prediction Models ◽  
Area Under The Curve ◽  
Mortality Prediction ◽  
Enzyme Linked Immunosorbent Assay ◽  
Sepsis Severity ◽  
International Consensus ◽  
Net Reclassification Improvement ◽  
Sepsis And Septic Shock

To determine the prognostic performance of soluble urokinase-type plasminogen activator receptor (suPAR) and quick Sequential Organ Failure Assessment (qSOFA) in predicting the 28-day mortality of sepsis patients admitted to the emergency department (ED). A prospective, single-center observational study was conducted between June 2018 and June 2019. In total, 175 patients with sepsis and septic shock admitted to the ED were enrolled based on the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). We assessed the qSOFA score on ED admission and measured serum suPAR levels by quantitative enzyme-linked immunosorbent assay. Univariate and multivariate analysis was performed to identify predictors of prognosis. Kaplan–Meier survival curves and areas under the receiver operating characteristic (ROC) curve for 28-day mortality were calculated. We estimated category-free net reclassification improvement (NRI) when suPAR was added to qSOFA. Increased suPAR levels were significantly associated with 28-day mortality [1.74 (1.24–2.51) ng/mL in survivors vs. 1.34 (0.96–2.00) ng/mL in non-survivors, p = 0.011] and with sepsis severity [1.34 (0.99–1.98) ng/mL in sepsis vs. 1.74 (1.22–2.65) ng/mL in septic shock, p = 0.039]. The area under the curve (AUC) for the prediction of 28-day mortality was 0.646 (95% confidence interval (CI): 0.553–0.740) for suPAR, 0.832 (95% CI: 0.692–0.923) for qSOFA and 0.864 (95% CI: 0.802–0.928) for combined suPAR and qSOFA. Serum suPAR did not significantly increase the AUC of the basic qSOFA, but a model containing suPAR and qSOFA had a continuous NRI of 11% (95% CI: 3.5–18.5%; p = 0.004). Serum suPAR was associated with sepsis severity and 28-day mortality. Adding suPAR to qSOFA increased the ROC curve area and improved its discrimination, suggesting that this might be a useful tool in sepsis mortality prediction models.

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

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.

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.

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