scholarly journals First Evaluation of a New Dynamic Scoring System Intended to Support Prescription of Adjuvant CytoSorb Hemoadsorption Therapy in Patients with Septic Shock

2021 ◽  
Vol 10 (13) ◽  
pp. 2939
Author(s):  
Klaus Kogelmann ◽  
Tobias Hübner ◽  
Franz Schwameis ◽  
Matthias Drüner ◽  
Morten Scheller ◽  
...  
Keyword(s):  
Septic Shock ◽  
Scoring System ◽  
Standard Therapy ◽  
Clinical Development ◽  
Early Conclusion ◽  
Mortality Pattern ◽  
Early Start ◽  
Hospital Survival ◽  
Sepsis Therapy ◽  
Dynamic Scoring

Introduction: Despite advances in critical care medicine, adjunctive approaches in sepsis therapy have failed to prove their efficacy. Notwithstanding promising results using hemoadsorption (CytoSorb), questions remain concerning timing and dosing. We created a dynamic scoring system (DSS) to assess patients with early septic shock and performed a first evaluation of the system in this patient population. Methods: Data from 502 patients with septic shock according to Sepsis-3 criteria were retrospectively analyzed. Score parameters were documented at the time of diagnosis (T0) and 6 h later (T6) to calculate a dynamic score. Survival on day 7 and 56 as well as ICU and hospital mortality were analyzed in regard to the score as well as the delay of hemoadsorption therapy. Results: Of the 502 patients analyzed, 198 received adjunctive CytoSorb treatment and 304 received standard therapy. Septic shock was typically represented by 5 points, while >6 points indicated a situation refractory to standard therapy with the worst outcome in patients shown by >8 points. The differences in mortality between the score groups (<6, 6–8, >8 points) were significant. Analysis further showed a significant 56-day, ICU and hospital survival advantage in CytoSorb patients when therapy was started early. Conclusion: We created a scoring system allowing for the assessment of the clinical development of patients in the early phase of septic shock. Applying this approach, we were able to detect populations with a distinct mortality pattern. The data also showed that an early start of CytoSorb therapy was associated with significantly improved survival. As a next step, this easy-to-apply scoring system would require validation in a prospective manner to learn whether patients to be treated with hemoadsorption therapy in the course of septic shock could thereby be identified.

scholarly journals On the Use of Hemadsorption with CytoSorb in Patients with Septic Shock. Comment on Kogelmann et al. First Evaluation of a New Dynamic Scoring System Intended to Support Prescription of Adjuvant CytoSorb Hemoadsorption Therapy in Patients with Septic Shock. J. Clin. Med. 2021, 10, 2939

2022 ◽  
Vol 11 (2) ◽  
pp. 334
Author(s):  
Alexander Supady ◽  
Philipp M. Lepper ◽  
Daniel Duerschmied ◽  
Tobias Wengenmayer
Keyword(s):  
Septic Shock ◽  
Scoring System ◽  
Dynamic Scoring

With great interest we read the article by Klaus Kogelmann and co-authors on the “First Evaluation of a New Dynamic Scoring System Intended to Support Prescription of Adjuvant CytoSorb Hemoadsorption Therapy in Patients with Septic Shock” [...]

Effectiveness of enteral ivabradine for heart rate control in septic shock: A randomised controlled trial

2021 ◽  
pp. 0310057X2110099
Author(s):  
Priyankar K Datta ◽  
Vimi Rewari ◽  
Rashmi Ramachandran ◽  
Preet M Singh ◽  
Bikash R Ray ◽  
...  
Keyword(s):  
Heart Rate ◽  
Septic Shock ◽  
Adverse Events ◽  
Standard Therapy ◽  
Controlled Trial ◽  
Cardiac Pacemaker ◽  
Stroke Volume Index ◽  
Volume Index ◽  
Serious Adverse Events ◽  
Group I

Persistent tachycardia in patients with septic shock predicts poor outcome. This study sought to investigate the effect of the cardiac pacemaker current inhibitor ivabradine on heart rate and cardio-circulatory function in patients with septic shock. After informed consent, 60 patients with septic shock and persistent tachycardia (heart rate >95 /minute) were prospectively randomly assigned to receive either standard therapy for septic shock (group S) or standard therapy along with enteral ivabradine (group I) for the initial 96 hours after enrolment. Primary outcome was the difference in heart rate between the two groups during the first 96 hours. Secondary outcomes included the effect of ivabradine on haemodynamic, oxygenation, myocardial function and organ function parameters, incidence of adverse events and 30-day overall survival. Heart rate was lower in group I compared to group S (median difference in area under the curve –25.6 (95% confidence intervals –31.4 to –15.9) /minute; P <0.001). Vasopressor requirements, blood lactate levels, Sequential Organ Failure Assessment scores and E/e′ ratio were lower in group I compared to group S. Stroke volume index and ejection fraction were higher in group I while cardiac index and oxygen delivery parameters were maintained similar to group S. There was no difference in 30-day mortality or in the incidence of serious adverse events. Enteral ivabradine is effective in reducing heart rate, and improving haemodynamic parameters and cardiac function in patients with septic shock and persistent tachycardia, without increasing the incidence of adverse events.

scholarly journals A NOVEL SCORING SYSTEM: PREDICTING SEPTIC SHOCK AT DIAGNOSIS EASILY IN ACUTE COMPLICATED PYELONEPHRITIS PATIENTS

2016 ◽  
Vol 107 (1) ◽  
pp. 21-27
Author(s):  
Masashi Kubota ◽  
Toru Kanno ◽  
Ryuichi Nishiyama ◽  
Takashi Okada ◽  
Yoshihito Higashi ◽  
...  
Keyword(s):  
Septic Shock ◽  
Scoring System

scholarly journals Dynamic Predictive Scores for Cardiac Surgery-Associated Agitated Delirium: a single-center retrospective observational study

2021 ◽  
Author(s):  
Yu Tian ◽  
Yuefu Wang ◽  
Wei Zhao ◽  
Bingyang Ji ◽  
Xiaolin Diao ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Prediction Model ◽  
Scoring System ◽  
Early Recognition ◽  
Characteristic Curve ◽  
Multivariate Logistic Regression Analysis ◽  
Derivation Cohort ◽  
Preoperative Prediction ◽  
Agitated Delirium ◽  
Dynamic Scoring

Abstract Background Prevention, screening, and early treatment are the mainstays of postoperative delirium management. Score system is an objective and effective tool to stratify potential delirium risk for patients undergoing cardiac surgery Methods Patients undergoing cardiac surgery from January 1, 2012, to January 1, 2019, were enrolled in our retrospective study. The patients were divided into a derivation cohort (n = 45,744) and a validation cohort (n = 11,436). The agitated delirium (AD) predictive systems were formulated using multivariate logistic regression analysis at three time points: preoperation, ICU admittance, and 24 hours after ICU admittance. Results The prevalence of AD after cardiac surgery in the whole cohort was 3.6% (2,085/57,180). The dynamic scoring system included preoperative LVEF ≤ 45%, serum creatinine > 100 umol/L, emergency surgery, coronary artery disease, hemorrhage volume > 600 mL, intraoperative platelet or plasma use, and postoperative LVEF ≤ 45%. The area under the receiver operating characteristic curve (AUC) values for AD prediction of 0.68 (preoperative), 0.74 (on the day of ICU admission), and 0.75 (postoperative). The Hosmer-Lemeshow test indicated that the calibration of the preoperative prediction model was poor (P = 0.01), whereas that of the pre- and intraoperative prediction model (P = 0.49) and the pre-, intra- and postoperative prediction model (P = 0.35) was good. Conclusions Using perioperative data, we developed a dynamic scoring system for predicting the risk of AD following cardiac surgery. The dynamic scoring system may improve early recognition of and interventions for AD.

scholarly journals Prediction of Mortality in Sepsis using Rapid Emergency Medicine Score: A Cohort Study

2020 ◽  
Author(s):  
Santosh Kumar Swain ◽  
Jeetendra Kumar Patra ◽  
S Rajesh Kumar ◽  
Anurag Choudhury ◽  
Prabhat Kumar Padhi ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Septic Shock ◽  
Cohort Study ◽  
Predictive Value ◽  
Scoring System ◽  
Secondary Outcome ◽  
Prediction Of Mortality ◽  
Significant Difference ◽  
Tract Infections ◽  
Sepsis And Septic Shock

Introduction: Organ dysfunction due to sepsis is manifested as acute rise of 2 points in quick Sequential Organ Failure Assessment (qSOFA) score from baseline, which is assessed by: 1) Systolic Blood Pressure (SBP) ≤100 mmHg; 2) Respiration Rate (RR) ≥22/min; 3) altered mentation, each having one point. For timely and specific management, an early diagnosis and stratification of severity of the sepsis is important. To predict the outcome of sepsis many scoring systems like SOFA, Acute Physiology and Chronic Health Evaluation II (APACHE II), Rapid Emergency Medicine Score (REMS), Mortality Prediction Model (MPM) have been developed. REMS is simple and feasible scoring system comprising of simple variables like, age in years, Pulse Rate (PR), RR, Mean Arterial Pressure (MAP), Glasgow Coma Scale (GCS) and SpO2 estimation. Aim: The aim of the study was to evaluate the efficacy of REMS score and to validate its utility in patients with sepsis to predict mortality. Materials and Methods: This was an observational, cohort study conducted in the Department of Medicine of SCB Medical College and Hospital, Cuttack. A total of 100 patients of sepsis admitted to medical wards and Intensive Care Unit (ICU) of Medicine department were included in the study. Vital parameters like PR, SBP, RR, GCS, SpO2 were noted. REMS score was calculated for patients with sepsis and septic shock, among survivors and non survivors. Primary outcome was either death or discharged. The observed data was statistically analysed for utility of REMS score in predicting mortality, which is the secondary outcome of the study. Student’s t-test and Mann-Whitney U test were used for comparing normally and non-normally distributed data respectively. Univariate and multivariate logistic regression was done for all parameters in REMS. Results: The average age of the patients was 49 years (SD 14.5) with males and females almost equally distributed. Major source of infection were pneumonia (24%) followed by urinary tract infections (19%). REMS score was calculated on the day of admission of all 100 patients. It clearly distinguished survivors from non survivors (p<0.001). The median value of REMS among non survivors was 9 (7-10), which was highly significant compared to survivors; median value of REMS among survivors was 3.5 (2-5). REMS score was high among patients with septic shock than patients with sepsis {median REMS: 9 (7-10.5) vs. 4 (2-5.75); p<0.001}. All the variables in REMS were significantly associated with mortality, however with multivariate analysis only the RR was independent predictor of mortality. REMS at cut-off score 7 has sensitivity of 87.5%, specificity of 88.2%, Positive Predictive Value (PPV) of 70%, Negative Predictive Value (NPV) of 95.7%, and accuracy of REMS was 88%. Conclusion: REMS score showed a significant difference among survivors and non survivors with higher score predicting higher mortality. Hence, REMS is a valid scoring system that can be used in resource limited emergency departments to predict the mortality in patients with sepsis and septic shock.

scholarly journals Use of CytoSorb in the emergency department-high dependency unit: A case report and a mini review

2021 ◽  
Vol 17 (4) ◽  
Author(s):  
Emanuela Biscardi ◽  
Giuseppe Carpinteri ◽  
Pietro Castellino ◽  
Lorenzo Malatino
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Septic Shock ◽  
Severe Sepsis ◽  
Standard Therapy ◽  
Blood Purification ◽  
Blood Levels ◽  
Clinical Parameters ◽  
High Dependency Unit ◽  
High Dependency

Circulating inflammatory mediators and cytokines play a pivotal role in the progression of sepsis, leading in turn to septic shock, organ failure and resistance to standard therapy. Blood purification therapies may be adjuvant treatment for severe sepsis, but results have been shown to be so far controversial. Recently, CytoSorb has achieved promising outcomes on reduction of cytokine blood levels, improvement of clinical parameters and mortality in sepsis, as well as in other acute conditions. It is mostly used in Intensive Care Unit (ICU), in isolated hemoperfusion, or inserted in other circuits in addition to Continuous Renal Replacement Therapy (CRRT), heart-lung machines and extracorporeal membrane oxygenation. We report a case of septic shock occurred in our Emergency Department-High Dependency Unit (ED-HDU), resistant to standard therapy and improved after CytoSorb, so avoiding ICU hospitalization.

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