Can serum ferritin be employed as prognostic marker of pediatric septic shock and severe sepsis?

Background: The incidence of severe sepsis and septic shock has increased over the past 30 years, and the annual number of cases is now >700,000 (~3 per 1000 population). There are many markers of sepsis which are being evaluated for its diagnosis among which RDW is emerging as a promising marker. Hence this study is being done to see the correlation between RDW and sepsis.Methods: A total of 162 patients-81 survivors and 81 non-survivors of severe sepsis and septic shock fulfilling inclusion and exclusion criteria who were admitted to intensive care unit between October 2013 and September 2015 were included in the study. Baseline variables, laboratory parameters, complications, and RDW were compared between the two groups.Results: Majority of patients - 73(45.06%) were in the age group of 61 - 80 years. Mean RDW was 15.20±2.29 in non-survivors and 13.86±2.20 in survivors, which was statistically significant (p<0.001). Mean RDW was higher and statistically significant among non-survivors with respect to duration of stay and requirement of inotropes.Conclusions: RDW levels measured on admission can be used as a prognostic marker in patients in severe sepsis and septic shock.

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Effect of fluid bolus triggers and their combination on fluid responsiveness in optimization phase of severe sepsis and septic shock resuscitation

MedPharmRes ◽

10.32895/ump.mpr.2.3.27 ◽

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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