SOFA Score, Hemodynamics and Body Temperature Allow Early Discrimination between Porcine Peritonitis-Induced Sepsis and Peritonitis-Induced Septic Shock

Porcine model of peritonitis-induced sepsis is a well-established clinically relevant model of human disease. Interindividual variability of the response often complicates the interpretation of findings. To better understand the biological basis of the disease variability, the progression of the disease was compared between animals with sepsis and septic shock. Peritonitis was induced by inoculation of autologous feces in fifteen anesthetized, mechanically ventilated and surgically instrumented pigs and continued for 24 h. Cardiovascular and biochemical parameters were collected at baseline (just before peritonitis induction), 12 h, 18 h and 24 h (end of the experiment) after induction of peritonitis. Analysis of multiple parameters revealed the earliest significant differences between sepsis and septic shock groups in the sequential organ failure assessment (SOFA) score, systemic vascular resistance, partial pressure of oxygen in mixed venous blood and body temperature. Other significant functional differences developed later in the course of the disease. The data indicate that SOFA score, hemodynamical parameters and body temperature discriminate early between sepsis and septic shock in a clinically relevant porcine model. Early pronounced alterations of these parameters may herald a progression of the disease toward irreversible septic shock.

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Analisis Hubungan Sequential Organ Failure Assessment (Sofa) Score Dengan Mortalitas Pasien Sepsis

Jurnal Kesehatan Andalas ◽

10.25077/jka.v9i2.1221 ◽

2020 ◽

Vol 9 (2) ◽

pp. 168

Author(s):

Agustin Iskandar ◽

Fran Siska

Keyword(s):

Septic Shock ◽

Sequential Organ Failure Assessment ◽

Organ Failure ◽

Sofa Score ◽

Area Under The Curve ◽

International Consensus ◽

The Third ◽

Failure Assessment ◽

Sepsis And Septic Shock

Sepsis merupakan kondisi disfungsi organ mengancam nyawa yang diakibatkan oleh disregulasi sistem imun pejamu terhadap infeksi dan Sequential Organ Failure Assessment (SOFA) score merupakan suatu skoring untuk menilai kegagalan organ terkait sepsis. Peningkatan SOFA score diasosiasikan dengan outcome pasien yang lebih buruk. Tujuan: Menganalisis korelasi SOFA score dengan mortalitas pada pasien sepsis. Metode: Desain penelitian adalah kohort prospektif yang dilakukan di RSU Dr Saiful Anwar dari Maret 2018 hingga Juni 2019. Kriteria diagnosis sepsis ditegakkan berdasarkan The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). Perhitungan SOFA score dilakukan dalam 2 hari pertama perawatan pasien sepsis di rumah sakit. Analisis data dilakukan pada p < 0,05. Hasil: Didapatkan 85 pasien sepsis dengan luaran meninggal sebanyak 72,94% sedangkan 28,06% membaik. Terdapat perbedaan bermakna antara SOFA score yang meninggal dan yang hidup (p=0,015). SOFA score dipakai untuk memprediksi kematian, didapatkan area under the curve (AUC) 0,74 (p=0,009), dengan cut off point optimum 7. Pada total SOFA score lebih tinggi dari sama dengan 7, didapatkan RR= 3.8, p=0.028. SOFA score merupakan parameter untuk menilai kegagalan organ pada pasien sepsis, dimana total SOFA score yang lebih tinggi dikaitkan dengan peningkatan risiko kematian. Simpulan: SOFA score pada kelompok yang meninggal lebih tinggi daripada yang sembuh. Pasien sepsis dengan SOFA score lebih besar sama dengan 7 memiliki risiko 3,8 kali lebih besar untuk meninggal.Kata kunci: risiko kematian, sepsis, SOFA score

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Sepsis and Septic Shock Definitions in Patients With Cancer Admitted in ICU

Journal of Intensive Care Medicine ◽

10.1177/0885066619894933 ◽

2019 ◽

pp. 088506661989493 ◽

Cited By ~ 1

Author(s):

Neveux Nathan ◽

Jean-Paul Sculier ◽

Lieveke Ameye ◽

Marianne Paesmans ◽

Grigoriu Bogdan-Dragos ◽

...

Keyword(s):

Septic Shock ◽

Hospital Mortality ◽

Sofa Score ◽

Patients With Cancer ◽

Failure Assessment ◽

Predict Hospital Mortality ◽

Definition Of ◽

Qsofa Score ◽

Sepsis And Septic Shock ◽

Sirs Criteria

Introduction: In 2016, a new definition of sepsis and septic shock was adopted. Some studies based on the general population demonstrated that the Sequential Organ Failure Assessment (SOFA) score is more accurate than the systemic inflammatory response syndrome (SIRS) criteria to predict hospital mortality of infected patients requiring intensive care. Patients and Method: We have analyzed all the records of patients with cancer admitted for a suspected infection between January 1, 2013, and December 31, 2016, in our oncological intensive care unit (ICU). Sequential Organ Failure Assessment score and quick SOFA (qSOFA) score as well as SIRS criteria were calculated. We analyzed the accuracy of each score to predict hospital mortality in the setting of the new and old definitions of septic shock. Results: Our study includes 241 patients with a solid tumor and 112 with a hematological malignancy. The hospital mortality rate is 37% (68% in patients with septic shock according to the new definition and 60% according to old definition) between 2013 and 2016. To predict hospital mortality, the SOFA score has an area under the receiver operating characteristic curve of 0.74 (95% confidence interval [CI], 0.68-0.79), the qSOFA of 0.65 (95% CI, 0.59-0.70), and the SIRS criteria of 0.58 (95% CI, 0.52-0.63). In multivariate analysis, a higher SOFA score or a higher qSOFA score indicates poor prognosis: odds ratio (OR) per 1-point increase by 1.28 (95% CI, 1.18-1.39) and 1.48 (95% CI, 1.04-2.11), respectively. Complete remission is a good prognostic factor for hospital mortality: OR 0.39 (95% CI, 0.22-0.67). Conclusion: The new definition of sepsis and septic shock is applicable in an ICU oncological population with the same reliability as in the general population. The SOFA score is more accurate than qSOFA and SIRS criteria to predict hospital mortality.

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Diagnostic Validity of Ratio between Differences of Central Venous to Arterial CO2 and Arterial to Central Venous O2 Content in Diagnosis of Anaerobic Metabolism among Septic Patients

Journal of Current and Advance Medical Research ◽

10.3329/jcamr.v8i1.52548 ◽

2021 ◽

Vol 8 (1) ◽

pp. 34-38

Author(s):

Subroto Kumar Sarker ◽

Umme Kulsum Choudhury ◽

Mohammad Mohsin ◽

Subrata Kumar Mondal ◽

Muslema Begum

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Intensive Care ◽

Anaerobic Metabolism ◽

Venous Blood ◽

Blood Gases ◽

Serum Lactate ◽

Central Venous ◽

College Hospital ◽

Sepsis And Septic Shock

Background: Detection of anaerobic metabolism is very crucial for the management of the septic patients. Objective: The purpose of the present study was to validate the ratio between differences of central venous to arterial CO2 and arterial to central venous O2 content in diagnosis of anaerobic metabolism among septic patients. Methodology: This prospective observational study was conducted in the Intensive Care Unit of the department of Anaesthesia Analgesia, Palliative and Intensive Care Medicine at Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2016 to December 2016. All patients admitted to ICU with the features of severe sepsis and septic shock according to SSC guidelines with the age of more than or equal to 18 years in both sexes were included in this study. The arterial and central venous blood gases were measure simultaneously. At the same time serum lactate was measured. Result: Among the 69 patients, 31(44.9%) were of severe sepsis and 38(55%) were of septic shock patients. In the severe sepsis and septic shock patients the mean P(v-a)CO2/C(a-v)O2 is 1.39±0.41 and 1.11±0.40 respectively. Serum lactate in case of severe sepsis and septic shock patients is 2.85±1.40 and 3.85±1.04 respectively. The ROC analysis showed an area under curve 0.89 and P(v-a)CO2/C(a-v)O2 ratio cutoff value of 1.21 showed sensitivity 0.84 and specificity 0.94. Conclusion: The P(v-a)CO2/C(a-v)O2 ratio is also a another marker of global anaerobic metabolism and it would be used for diagnosis as well as management of septic patient. Journal of Current and Advance Medical Research, January 2021;8(1):34-38

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The Role of Serum Procalcitonin in Predicting Bacterial Sepsis in Patients With Hypothyroidism

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2019-01082 ◽

2019 ◽

Vol 104 (12) ◽

pp. 5915-5922

Author(s):

Aditya S Shirali ◽

James X Wu ◽

Catherine Y Zhu ◽

Alfonso Ocampo ◽

Chi-Hong Tseng ◽

...

Keyword(s):

Septic Shock ◽

Test Performance ◽

Serum Levels ◽

Primary Hypothyroidism ◽

Bacterial Sepsis ◽

Thyroid C Cells ◽

Failure Assessment ◽

History Of ◽

Sepsis And Septic Shock ◽

Design And Methods

Abstract Context Serum levels of procalcitonin (PCT), a protein produced by the thyroid C cells under physiologic conditions, are high during sepsis. Objective To assess the test performance of serum PCT in predicting bacterial sepsis and septic shock in patients with hypothyroidism compared with those who have euthyroidism. Design and Methods This retrospective study evaluated patients with no history of thyroid dysfunction (euthyroid), primary hypothyroidism [medical hypothyroidism (MH)], and postsurgical hypothyroidism from total thyroidectomy (TT) identified from a prospectively maintained database who had PCT testing from 2005 to 2018. Quick Sequential Organ Failure Assessment score ≥ 2 or positive bacterial cultures identified bacterial sepsis, and a mean arterial pressure less than 65 mm Hg or a vasopressor requirement defined septic shock. Sensitivity and specificity of PCT for evaluation of bacterial sepsis and septic shock were measured. Results We identified 217 euthyroid patients, 197 patients with MH, and 84 patients with TT. Bacterial sepsis was found in 98 (45.2%), 92 (46.7%), and 36 (42.9%) of these patients, respectively (P > 0.05). Septic shock was identified in 13 (6.0%), 13 (6.6%), and 5 (6.0%) patients (P > 0.05), respectively. With use of a PCT cutoff of 0.5 µg/L for bacterial sepsis, the sensitivity was 59%, 61%, and 53% (P > 0.05) and specificity was 81%, 77%, and 81% (P > 0.05) for the diagnosis of bacterial sepsis in euthyroid, MH, and TT patients, respectively. With use of a PCT cutoff of 2.0 µg/L for septic shock, the sensitivity was 46%, 62%, and 63% (P > 0.05) and specificity was 86%, 82%, and 91% (P > 0.05) for the diagnosis of septic shock in these patients, respectively. Conclusions Despite the thyroidal origin of PCT, hypothyroidism did not affect the diagnostic performance of serum PCT levels in predicting bacterial sepsis or septic shock.

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Biomarker combination and SOFA score for the prediction of mortality in sepsis and septic shock

Medicine ◽

10.1097/md.0000000000020495 ◽

2020 ◽

Vol 99 (22) ◽

pp. e20495 ◽

Cited By ~ 3

Author(s):

Juhyun Song ◽

Sungwoo Moon ◽

Dae Won Park ◽

Han-Jin Cho ◽

Joo Yeong Kim ◽

...

Keyword(s):

Septic Shock ◽

Sofa Score ◽

Prediction Of Mortality ◽

Sepsis And Septic Shock

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The impact of cardiac dysfunction on acute respiratory distress syndrome and mortality in mechanically ventilated patients with severe sepsis and septic shock: An observational study

Journal of Critical Care ◽

10.1016/j.jcrc.2014.07.027 ◽

2015 ◽

Vol 30 (1) ◽

pp. 65-70 ◽

Cited By ~ 9

Author(s):

Brian M. Fuller ◽

Nicholas M. Mohr ◽

Thomas J. Graetz ◽

Isaac P. Lynch ◽

Matthew Dettmer ◽

...

Keyword(s):

Septic Shock ◽

Acute Respiratory Distress Syndrome ◽

Severe Sepsis ◽

Cardiac Dysfunction ◽

Distress Syndrome ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Sepsis And Septic Shock ◽

The Impact ◽

Ventilated Patients

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Diagnostic and prognostic value of plasma adrenomedullin compared to other biomarkers using Sepsis-3 definitions for sepsis and septic shock

10.21203/rs.2.19873/v1 ◽

2020 ◽

Author(s):

Tetsu Yonaha ◽

Toyoaki Maruta ◽

Go Otao ◽

Koji Igarashi ◽

Sayaka Nagata ◽

...

Keyword(s):

Septic Shock ◽

Organ Failure ◽

Sofa Score ◽

Area Under The Curve ◽

Final Analysis ◽

Operating Characteristics ◽

Diagnosis And Prognosis ◽

Single Center Study ◽

Sepsis And Septic Shock ◽

Monitoring Treatment

Abstract Background Sepsis-3, the recent sepsis definitions, was modified based on a scoring system focused on organ failure; however, it would remain a time-consuming process to detect septic patients using these definitions. Adrenomedullin (AM) is a biomarker for diagnosing sepsis and septic shock, monitoring treatment efficacy, and prognosis. We conducted a study to assess the accuracy of AM for diagnosing and prognosing sepsis and septic shock based on the Sepsis-3 definitions.Methods This is a prospective observational single-center study. Patients admitted to the intensive care unit (ICU) were retrospectively categorized as non-sepsis, sepsis, or septic shock by Sepsis-3 definitions. Total AM (tAM) and mature AM (mAM) were measured upon ICU admission. Receiver operating characteristics (ROC) analyses were performed by calculating the area under the curve (AUC) for diagnosis and prognosis of sepsis and septic shock.ResultsA total of 98 patients were enrolled in the final analysis. Among these, 42, 22, and 34 patients were assigned to non-sepsis, sepsis, and septic shock, respectively. tAM and mAM levels significantly increased according to the severity of sepsis. The AUCs of tAM/mAM for diagnosing sepsis and septic shock were 0.879/0.848 and 0.858/0.830, respectively, whereas those of procalcitonin (PCT)/presepsin (PSEP) were 0.822/0.682 and 0.811/0.661, respectively. The AUCs of tAM/mAM on Day 1 and 3 for predicting 28-day mortality of septic patients were 0.669/0.5741 and 0.931/0.892, respectively, whereas those of sequential organ failure assessment (SOFA) score/lactate were 0.669/0.824 and 0.922/0.794, respectively.Conclusions Both tAM and mAM are reliable, early biomarkers to diagnose sepsis and septic shock according to the Sepsis-3 definitions, and are comparable to PCT. Furthermore, AM level on Day 3 is a reliable biomarker to predict 28-day mortality due to sepsis, which is comparable to that of the SOFA score and lactate level.

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Impact of Serum Phosphate in Mechanically Ventilated Patients With Severe Sepsis and Septic Shock

Journal of Intensive Care Medicine ◽

10.1177/0885066618762753 ◽

2018 ◽

Vol 35 (5) ◽

pp. 485-493 ◽

Cited By ~ 10

Author(s):

Christopher J. Miller ◽

Bruce A. Doepker ◽

Andrew N. Springer ◽

Matthew C. Exline ◽

Gary Phillips ◽

...

Keyword(s):

Septic Shock ◽

Mechanical Ventilation ◽

Severe Sepsis ◽

Clinical Outcomes ◽

Serum Phosphate ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Sepsis And Septic Shock ◽

The Impact ◽

Ventilated Patients

Background: Hypo- and hyperphosphatemia are common in severe sepsis and septic shock. Published outcome data in patients with phosphate derangements primarily focus on hypophosphatemia and the general critically ill population. This study aimed to determine the impact of serum phosphate on clinical outcomes in patients with severe sepsis and septic shock. Methods: A retrospective cohort analysis of adult mechanically ventilated patients with severe sepsis or septic shock was performed. Patients were randomly selected from an internal intensive care unit (ICU) database at an academic medical center in the United States and screened for inclusion and exclusion criteria. Time-weighted phosphate was calculated using all phosphate measurements obtained during ICU admission. The associations between time-weighted phosphate and duration of mechanical ventilation, 28-day mortality, and ICU and hospital length of stay were evaluated using linear or logistic regression as appropriate. Results: One-hundred ninety-seven patients were evaluated: 33 were categorized as hypophosphatemia, 123 as normophosphatemia, and 41 as hyperphosphatemia. Patients with time-weighted hyperphosphatemia had a higher Simplified Acute Physiology Score III score and incidence of septic shock. Significantly higher rates of 28-day mortality were observed among those with time-weighted phosphate levels above 3.5 mg/dL. However, both time-weighted hypo- and hyperphosphatemia were associated with decreased duration of mechanical ventilation. For every 0.5 mg/dL increase in time-weighted phosphate referent values from 4.0 to 6.0, the duration of mechanical ventilation decreased by 8% to 26%. For every 0.5 mg/dL decrease in time-weighted phosphate referent values from 3.0 to 1.0, significant decreases in duration of mechanical ventilation ranged from 14% to 41%. Conclusion: Time-weighted hyperphosphatemia may be associated with increased mortality in mechanically ventilated patients with severe sepsis or septic shock. However, time-weighted hypo- and hyperphosphatemia were associated with decreased duration of mechanical ventilation. Future studies should further describe the impact of hypo- and hyperphosphatemia on clinical outcomes among critically ill patients with severe sepsis or septic shock.

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diagnosis and trEatmEnt of patiEnts in sEptiC shoCK

New Medicine ◽

10.5604/01.3001.0009.7846 ◽

2017 ◽

Vol 21 (1) ◽

pp. 31-36

Author(s):

Jacek wadełek

Keyword(s):

Septic Shock ◽

Organ Dysfunction ◽

Host Response ◽

Signs And Symptoms ◽

Intravenous Fluids ◽

Failure Assessment ◽

Acute Change ◽

Life Threatening ◽

Sepsis And Septic Shock ◽

Clinical Emergency

sepsis and septic shock are a clinical emergency. sepsis is defined as a life-threatening organ dysfunction due to a dysregulated host response to infection, and organ dysfunction is defined as an acute change in sequential organ failure assessment (sofa) score greater than 2 points secondary to an infectious cause. septic shock is defined as sepsis with persisting hypotension requiring vasopressors to maintain a mean arterial pressure of 65 mm hg or higher, and blood lactate level greater than 2 mmol/l (18 mg/dl) despite adequate volume resuscitation. the diagnosis of septic shock begins with medical history and physical examination focused on the signs and symptoms of infection, with the aim of recognizing complex physiologic manifestations of shock. Clinicians should understand the importance of prompt administration of antibiotics, vasopressors and intravenous fluids aimed at restoring adequate circulation. they should also be aware of the limitations of the protocol-based therapy.

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