scholarly journals Recent advances in the pathophysiology and management of sepsis: a review

2021 ◽  
Vol 22 (2) ◽  
pp. 133-145
Author(s):  
B.A. Adegboro ◽  
J. Imran ◽  
S.A. Abayomi ◽  
E.O. Sanni ◽  
S.A. Biliaminu
Keyword(s):  
Septic Shock ◽  
Sofa Score ◽  
Clinical Status ◽  
Altered Mental Status ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Acute Increase ◽  
Haematological Changes ◽  
Definition Of ◽  
Sepsis And Septic Shock

Sepsis is a syndrome consisting of physiological, pathological and biochemical anomalies caused by infectious agents. It causes clinical organ dysfunction, which is identified by an acute increase in the Sequential (sepsis-related) Organ Failure Assessment (SOFA) score of two or more points. SOFA score is a score of three components that can be easily used at the bedside to track the clinical status of a patient while on admission, and these are altered respiratory rate of ≥ 22 breaths/minute, altered mental status, and systolic blood pressure of ≤ 100 mmHg. A patient with SOFA score of ≥ 2 has an attributable 2 - 25-fold increased risk of mortality compared to a patient with SOFA score of ˂ 2. This present review provides information on the new definition of sepsis and septic shock, aetiology, pathophysiology, biochemical, pathological and haematological changes, morbidity and mortality parameters, management, andprognostic factors in patients with sepsis. Key words: Sepsis, septic shock, SOFA score, pathophysiology, management bundles

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

2019 ◽  
pp. 088506661989493 ◽  
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.

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

2021 ◽  
Vol 11 (3) ◽  
pp. 164
Author(s):  
Mahmoud Al-Obeidallah ◽  
Dagmar Jarkovská ◽  
Lenka Valešová ◽  
Jan Horák ◽  
Jan Jedlička ◽  
...  
Keyword(s):  
Septic Shock ◽  
Body Temperature ◽  
Sofa Score ◽  
Porcine Model ◽  
Venous Blood ◽  
Mixed Venous Blood ◽  
Mechanically Ventilated ◽  
Multiple Parameters ◽  
Failure Assessment ◽  
Sepsis And 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.

scholarly journals Osteoprotegerin is Higher in Sepsis Than in Noninfectious SIRS and Predicts 30-Day Mortality of SIRS Patients in the Intensive Care

2019 ◽  
Vol 3 (4) ◽  
pp. 559-568 ◽  
Author(s):  
Hans Kemperman ◽  
Irene T Schrijver ◽  
Mark Roest ◽  
Jozef Kesecioglu ◽  
Wouter W van Solinge ◽  
...  
Keyword(s):  
Septic Shock ◽  
Intensive Care ◽  
Complex Disease ◽  
Proportional Hazards ◽  
Vascular System ◽  
Cox Proportional Hazards ◽  
Admission Data ◽  
Increased Risk ◽  
Severity Of The Disease ◽  
Sepsis And Septic Shock

AbstractBackgroundSystemic inflammatory response syndrome (SIRS) is a complex disease involving multiple pathways and organs. Biomarkers reflecting these pathways and organ function could correlate with the severity of the disease. Osteoprotegerin (OPG), mainly known for its role in bone metabolism, is also involved in the immune and vascular system and is therefore an interesting biomarker to study in SIRS patients. In this prospective observational study, we investigated the correlation of plasma OPG concentrations, sepsis, and 30-day mortality of SIRS patients in the intensive care unit (ICU).MethodsThis observational, single-center, cohort study included 313 consecutive patients admitted to the ICU, with an anticipated stay of more than 48 h and SIRS on admission. Data from included patients were collected daily until discharge or death for a maximum of 10 days. Thirty-day mortality was retrospectively assessed. OPG concentrations were measured in the first 48 h after admission. The relation of OPG with no sepsis, sepsis, and septic shock was assessed with the Kruskal–Wallis test and the Mann–Whitney U-test. Cox proportional hazards regression was used to study OPG concentrations and 30-day mortality.ResultsOPG concentrations were higher in patients with sepsis and septic shock than in patients without sepsis. Furthermore, patients with OPG concentrations in the highest tertile at admission in the ICU have an increased risk of mortality within 30 days when compared to patients with OPG concentrations in the lowest and middle tertiles, independent of acute physiologic and chronic health evaluation (APACHE) and sequential organ failure assessment (SOFA) scores.ConclusionsWe show that OPG is a biomarker that correlates with sepsis and predicts mortality of SIRS patients in the ICU.

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

Medicine ◽  
2020 ◽  
Vol 99 (22) ◽  
pp. e20495 ◽  
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

New definition of sepsis and septic shock: What does it give us?

2017 ◽  
Vol 41 (1) ◽  
pp. 38-40
Author(s):  
A. Rodríguez ◽  
I. Martín-Loeches ◽  
J.C. Yébenes
Keyword(s):  
Septic Shock ◽  
Definition Of ◽  
Sepsis And Septic Shock

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

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.

Normalized Low Frequency Power of Heart Rate Variability Correlates Negatively With the SOFA Score in Severe Sepsis and Septic Shock

CHEST Journal ◽  
2011 ◽  
Vol 140 (4) ◽  
pp. 427A
Author(s):  
Subhasis Behera ◽  
Samuel Brown ◽  
Jason Jones ◽  
Michael Lanspa ◽  
Kathryn Kuttler ◽  
...  
Keyword(s):  
Heart Rate ◽  
Septic Shock ◽  
Heart Rate Variability ◽  
Severe Sepsis ◽  
Sofa Score ◽  
Low Frequency ◽  
Low Frequency Power ◽  
Sepsis And Septic Shock ◽  
Frequency Power

Should Vasopressors Be Started Early in Septic Shock?

2021 ◽  
Vol 42 (05) ◽  
pp. 683-688
Author(s):  
Luca Cioccari ◽  
Stephan M. Jakob ◽  
Jukka Takala
Keyword(s):  
Septic Shock ◽  
Tissue Perfusion ◽  
Conclusive Evidence ◽  
Morbidity And Mortality ◽  
Blood Pressure Targets ◽  
Source Of Infection ◽  
Increased Risk ◽  
Resuscitation Strategy ◽  
Definition Of ◽  
Persistent Hypotension

AbstractSepsis can influence blood volume, its distribution, vascular tone, and cardiac function. Persistent hypotension or the need for vasopressors after volume resuscitation is part of the definition of septic shock. Since increased positive fluid balance has been associated with increased morbidity and mortality in sepsis, timing of vasopressors in the treatment of septic shock seems crucial. However, conclusive evidence on timing and sequence of interventions with the goal to restore tissue perfusion is lacking. The aim of this narrative review is to depict the pathophysiology of hypotension in sepsis, evaluate how common interventions to treat hypotension interfere with physiology, and to give a resume of the results from clinical studies focusing on targets and timing of vasopressor in sepsis. The majority of studies comparing early versus late administration of vasopressors in septic shock are rather small, single-center, and retrospective. The range of “early” is between 1 and 12 hours. The available studies suggest a mean arterial pressure of 60 to 65 mm Hg as a threshold for increased risk of morbidity and mortality, whereas higher blood pressure targets do not seem to add further benefits. The data, albeit mostly from observational studies, speak for combining vasopressors with fluids rather “early” in the treatment of septic shock (within a 0–3-hour window). Nevertheless, the optimal resuscitation strategy should take into account the source of infection, the pathophysiology, the time and clinical course preceding the diagnosis of sepsis, and also comorbidities and sepsis-induced organ dysfunction.

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