scholarly journals The role of procalcitonin and lactate at single determination in the intensive care unit in the diagnosis and prognosis of hypovolemic and distributive (septic) shock

2021 ◽  
Vol 20 (5) ◽  
pp. 21-28
Author(s):  
A. V. Moldovanov ◽  
V. A. Rudnov ◽  
V. A. Bagin ◽  
M. N. Astafieva ◽  
S. M. Rozanova
Keyword(s):  
Septic Shock ◽  
Blood Plasma ◽  
Hemorrhagic Shock ◽  
Hypovolemic Shock ◽  
Predictive Ability ◽  
Diagnostic Value ◽  
Information Value ◽  
Significant Difference ◽  
Sepsis And Septic Shock ◽  
Informational Value

Introduction. The greatest difficulties arise in the differential diagnosis of hypovolemic or distributive (septic) shock. The aim of this study was to critically analyze the information value of the blood plasma content of lactate and procalcitonin (PCT) in patients with septic and hypovolemic shock.Materials and methods. The diagnosis of «Sepsis» and «Septic shock» in the study was established according to the criteria of «Sepsis-3». 143 IRCs were filled, 34 of them with septic shock, 44 IRCs with hypovolemic, 65 IRCs with sepsis and organ dysfunction (OD).Results. When determining the content of PCT in the blood plasma in patients with septic and hypovolemic shock, we found a statistically significant difference. The level of PKT in infectious shock —33.3 (95% CI 7.9 — 58.0) ng / ml was higher than hypovolemic-0.9 (95% CI 0.43 — 6.45) ng/ml on average more than 30 times. In contrast to PCT, the content of lactate in the blood plasma did not carry a differential diagnostic value. Once measured at admission to the ICU, the level of PCT has no informational significance and does not indicate a likely outcome of the disease, complicated by the development of septic and hemorrhagic shock. Together with the low predictive ability of the nature of shock, lactate was highly informative in relation to the outcome of the disease, complicated by the development of shock syndrome.Discussion. In our analysis, it is obvious that there were observations when the PCT level during hypovolemia was noticeably higher than normal, reaching a maximum of 6.4 ng / ml. Apparently, there was a combination of factors with an obvious activation of a trigger that affects its libration or the presence of endotoxinemia in hypovolemic shock in these specific patients. The informational value of PCT is not absolute and, according to meta-analyzes, is about 80%.Conclusion. The blood content of procalcitonin in shock of an infectious nature was more than 30 times higher than the hypovolemic level on average. The informational value of procalcitonin in terms of predicting the course of the disease in septic and hypovolemic shock is absent. In the absence of predicting the nature of the shock, lactate is informative about the outcome of the shock. The possibility of increasing the blood lactate content in severe hemorrhagic shock with renal damage was noted.

scholarly journals Informational Value of Proadrenomedullin Blood Levels in Patients with Septic Shock, Once Measured Upon Admission to ICU

2021 ◽  
Vol 18 (6) ◽  
pp. 63-70
Author(s):  
V. А. Rudnov ◽  
А. V. Moldovanov ◽  
M. N. Аstafieva ◽  
E. Yu. Perevalova ◽  
V. А. Bagin ◽  
...  
Keyword(s):  
Septic Shock ◽  
Differential Diagnosis ◽  
Roc Analysis ◽  
Venous Blood ◽  
Hypovolemic Shock ◽  
Information Value ◽  
Blood Levels ◽  
Absolute Value ◽  
The Moment ◽  
Informational Value

The objective: to assess the information value of proadrenomedullin (PAM), once measured upon admission to ICU in predicting mortality and differential diagnosis of septic and hypovolemic shock.Subjects and Methods. A prospective cohort retrospective study was carried out. 134 patients in a state of shock were included in the study. Of these, 125 patients had septic shock; 9 ‒ hypovolemic one. The diagnosis of septic shock was established according to the Sepsis-3 criteria. To compare hypovolemic and septic shock, blood levels of proadrenomedullin (PAM), procalcitonin (PCT) and lactate were tested in 9 patients with obvious hypovolemic shock. Samples (venous blood) were collected within 24 hours from the moment the vasopressors began to be used in ICU or by the ambulance team (EMS).Results. The ROC analysis showed comparable predictive value with APACHE II, SOFA and lactate scales in patients with septic shock with cut-off > 4.23 nmol/L. The range of PAM values in patients with septic shock was Me 4.56 (2.9‒6.7) in patients with hypovolemic shock – Me 0.6 (0.1‒1.4).Conclusion. Proadrenomedullin can be used for differential diagnosis of septic shock and hypovolemic shock. Blood levels greater than 2.9 nmol/L are of absolute value for the diagnosis of septic shock. Procalcitonin is inferior to PAM within the range of 1.0–6.45 ng/ml. PAM unlike SCT is a statistically significant predictor of global outcome in septic shock along with lactate and scales. But such scales as SOFA and ARACНE-II are more laborious in comparison with testing proadrenomedullin blood level.

Evaluation of red cell distribution width (RDW) as a septic marker in comparison with clinical scores and C-reactive protein

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ali Ahmed Naga ◽  
Mohammed Ismaeil Abdel Fattah ◽  
Walid Hamed Nofal ◽  
Mohammed Abd-elsalam AlMenshawe
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Controlled Study ◽  
Control Group ◽  
Study Group ◽  
Distribution Width ◽  
Clinical Scores ◽  
Group I ◽  
Significant Difference ◽  
Sepsis And Septic Shock

Abstract Background Challenges of diagnosing and treating sepsis only seem more difficult as incidence increases, patients become older and sicker, and pathogenic organisms evolve. New understanding of inflammatory mediators and pathways, immunity, and genetic variability in this disease state suggests that the current definitions of SIRS, sepsis, severe sepsis, and septic shock are oversimplified. Objective The aim of our study is to evaluate the level of RDW, CRP and clinical scores "SOFA and APACHI" as markers in patients with sepsis and their levels on the outcome and resolution of sepsis in ICU. Methodology We conducted a prospective observational controlled study on 90 adult persons of both sex, 45 of them are adult patients and served as the study group (Group I), and the other 45 are healthy adult volunteers and served as the control group (Group II). The study group represented patients admitted to the ICU of Intensive Care Unit at Damanhour Medical National Institute who fulfilled the diagnostic criteria for sepsis, severe sepsis and septic shock on arrival to ICU according to the SCCM/ ESICM/ ACCP/ ATS/SIS International Sepsis Definitions Conference. Results. In the present study we found that CRP measured on admission was not a predictor of mortality, while that measured at day 5 and day 10 predicted mortality, where there was no statistically significant difference in CRP levels between survivors and non-survivors at the day of admission while there were statistically significant differences between survivors and non survivors according to CRP levels at day 5 (p = 0.001*) and at day 10 (p = 0.001*). It was found also that there were statistically significant differences between survivors and non-survivors according to RDW at day 1(p = 0.011*) and at day 5(p = 0.009*), at day 10 was found there was no statistically significant difference between survivors and non-survivors (p = 0.338). Conclusion RDW is a new promising cheap and readily available biomarker that can be able to diagnose patients with sepsis with accuracy comparable to CRP. Also, RDW at admission is able to predict mortality.

scholarly journals Hydrocortisone Compared with Placebo in Patients with Septic Shock Satisfying the Sepsis-3 Diagnostic Criteria and APROCCHSS Study Inclusion Criteria

2019 ◽  
Vol 131 (6) ◽  
pp. 1292-1300 ◽  
Author(s):  
Balasubramanian Venkatesh ◽  
Simon Finfer ◽  
Jeremy Cohen ◽  
Dorrilyn Rajbhandari ◽  
Yaseen Arabi ◽  
...  
Keyword(s):  
Septic Shock ◽  
Diagnostic Criteria ◽  
Odds Ratio ◽  
Hazard Ratio ◽  
Sensitivity Analyses ◽  
Inclusion Criteria ◽  
International Consensus ◽  
Significant Difference ◽  
Sepsis And Septic Shock ◽  
Post Hoc

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Two recent randomized controlled trials (Adjunctive Glucocorticoid Therapy in Patients with Septic Shock [ADRENAL] and Activated Protein C and Corticosteroids for Human Septic Shock [APROCCHSS]) of corticosteroids in patients with septic shock reported different treatment effects on 90-day mortality. Both trials enrolled patients who met the criteria for septic shock using the second international consensus definitions for sepsis and septic shock (Sepsis-2), but the APROCCHSS trial mandated a greater severity of shock as an inclusion criterion. Methods The authors conducted post hoc sensitivity analyses of the ADRENAL trial to determine the effects of hydrocortisone versus placebo in subgroups selected using third international consensus definitions for sepsis and septic shock (Sepsis-3) diagnostic criteria or APROCCHSS inclusion criteria. Results There were 1,950 subjects (973 hydrocortisone and 977 placebo) who met the Sepsis-3 criteria (ADRENAL–Sepsis-3 cohort) and 905 patients (455 hydrocortisone and 450 placebo) who met the APROCCHSS criteria (ADRENAL–APROCCHSS cohort). At 90 days after randomization, in the ADRENAL–Sepsis-3 cohort, 312 of 963 (32.4%) and 337 of 958 (35.2%) patients assigned to hydrocortisone and placebo, respectively, had died (odds ratio, 0.86; 95% CI, 0.70 to 1.06; P = 0.166). The corresponding figures for the ADRENAL–APROCCHSS cohorts were 187 of 453 (41.3%) and 200 of 445 (44.9%), respectively (odds ratio, 0.84; 95% CI, 0.60 to 1.17; P = 0.303). There was no statistically significant difference in the time to death between the groups during the 90 days after randomization (hazard ratio = 0.87; 95% CI, 0.75 to 1.02; P = 0.082 for ADRENAL–Sepsis-3; and hazard ratio = 0.86; 95% CI, 0.71 to 1.06; P = 0.156 for ADRENAL–APROCCHSS cohorts). In both cohorts, patients assigned to hydrocortisone had faster resolution of shock. In the ADRENAL–Sepsis-3 cohort, patients assigned to hydrocortisone had an increase in the number of days alive and free of mechanical ventilation (57.0 ± 37.2 vs. 53.7 ± 38.2 days; 95% CI, 0.40 to 7.04; P = 0.028) and the number of days alive and free of the intensive care unit (54.3 ± 36.0 vs. 51.0 ± 37.1; 95% CI, 0.82 to 7.24; P = 0.014). Conclusions In a post hoc analysis of the ADRENAL trial participants who fulfilled either the Sepsis-3 or the APROCCHSS inclusion criteria, a continuous infusion of hydrocortisone did not result in a lower 90-day mortality than placebo in septic shock.

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 Deep Learning Model for Screening Sepsis Using Electrocardiography

2021 ◽  
Author(s):  
Joon-myoung Kwon ◽  
Ye Rang Lee ◽  
Min-Seung Jung ◽  
Yoon-Ji Lee ◽  
Yong-Yeon Jo ◽  
...  
Keyword(s):  
Septic Shock ◽  
Deep Learning ◽  
Characteristic Curve ◽  
External Validation ◽  
Medical Emergency ◽  
Validation Dataset ◽  
Internal Validation ◽  
Significant Difference ◽  
Life Threatening ◽  
Sepsis And Septic Shock

Abstract Background: Sepsis is a life-threatening organ dysfunction and is a major healthcare burden worldwide. Although sepsis is a medical emergency that requires immediate management, it is difficult to screen the occurrence of sepsis. In this study, we propose an artificial intelligence based on deep learning-based model (DLM) for screening sepsis using electrocardiography (ECG).Methods: This retrospective cohort study included 46,017 patients who admitted to two hospitals. 1,548 and 639 patients underwent sepsis and septic shock. The DLM was developed using 73,727 ECGs of 18,142 patients and internal validation was conducted using 7,774 ECGs of 7,774 patients. Furthermore, we conducted an external validation with 20,101 ECGs of 20,101 patients from another hospital to verify the applicability of the DLM across centers.Results: During the internal and external validation, the area under the receiver operating characteristic curve (AUC) of an DLM using 12-lead ECG for screening sepsis were 0.901 (95% confidence interval 0.882–0.920) and 0.863 (0.846–0.879), respectively. During internal and external validation, AUC of an DLM for detecting septic shock were 0.906 (95% CI = 0.877–0.936) and 0.899 (95% CI = 0.872–0.925), respectively. The AUC of the DLM for detecting sepsis using 6-lead and single-lead ECGs were 0.845–0.882. A sensitivity map showed that the QRS complex and T wave was associated with sepsis. Subgroup analysis was conducted using ECGs from 4,609 patients who admitted with infectious disease, The AUC of the DLM for predicting in-hospital mortality was 0.817 (0.793–0.840). There was a significant difference in the prediction score of DLM using ECG according to the presence of infection in the validation dataset (0.277 vs 0.574, p<0.001), including severe acute respiratory syndrome coronavirus 2 (0.260 vs 0.725, p=0.018).Conclusions: The DLM demonstrated reasonable performance for screening sepsis using 12-, 6-, and single-lead ECG. The results suggest that sepsis can be screened using not only conventional ECG devices, but also diverse life-type ECG machine employing the DLM, thereby preventing irreversible disease progression and mortality.

Impact of Bi-ventricular systolic function on mortality in patients with sepsis and septic shock

2021 ◽  
Author(s):  
Elif Tükenmez Tigen ◽  
Alper Kepez ◽  
Murat Sünbül ◽  
Beste Özben ◽  
Buket Ertürk Şengel ◽  
...  
Keyword(s):  
Septic Shock ◽  
Hospital Mortality ◽  
Systolic Function ◽  
Myocardial Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Survivor Group ◽  
Significant Difference ◽  
Echocardiographic Examination ◽  
Sepsis And Septic Shock

Objectives: We aimed to evaluate left ventricular (LV) and right ventricular (RV) systolic performance in patients with sepsis or septic shock and possible functional alteration on in-hospital mortality. Patients and Methods: Thirty-seven consecutive patients with the diagnosis of sepsis or septic shock were included in the study. All patients underwent comprehensive transthoracic echocardiographic examination. Data of patients discharged from the intensive care unit was compared with data of patients who died in the hospital. Results: Fifteen patients (40.5%) survived, while 22 patients were died in the hospital (59.5%). A significant difference was detected between survivor and non-survivor groups regarding before discharge or death level of inflammatory markers such as CRP (p=0.05) and procalcitonin (p=0.03) besides BNP (p=0.01) and SOFA (p=0.009) score. There were two patients (5.4%) with EF value less than %50 in the study population. Eight patients (21.6%) displayed hypokinesia on the apical segment, and four patients (10.8%) had TAPSE values below 17 mm. One patient (6.6%) in the survivor group, but seven patients (31.8%) in the non-survivor group had apical hypokinesia with a trend towards significance (p=0.068). One patient in the survivor group (6.6%) and three patients (13.6%) in the non-survivor group had RV systolic dysfunction (p: 0.51). Conclusion: We found a much lower rate of LV and RV systolic dysfunction in patients with sepsis or septic shock compared with previous studies. None of the myocardial dysfunction types was associated with in-hospital mortality. Apical hypokinesia was also more prevalent in non-survivors despite borderline significance.

scholarly journals Deep-learning model for screening sepsis using electrocardiography

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Joon-myoung Kwon ◽  
Ye Rang Lee ◽  
Min-Seung Jung ◽  
Yoon-Ji Lee ◽  
Yong-Yeon Jo ◽  
...  
Keyword(s):  
Septic Shock ◽  
Deep Learning ◽  
Confidence Interval ◽  
Characteristic Curve ◽  
External Validation ◽  
Medical Emergency ◽  
Validation Dataset ◽  
Internal Validation ◽  
Significant Difference ◽  
Sepsis And Septic Shock

Abstract Background Sepsis is a life-threatening organ dysfunction and a major healthcare burden worldwide. Although sepsis is a medical emergency that requires immediate management, screening for the occurrence of sepsis is difficult. Herein, we propose a deep learning-based model (DLM) for screening sepsis using electrocardiography (ECG). Methods This retrospective cohort study included 46,017 patients who were admitted to two hospitals. A total of 1,548 and 639 patients had sepsis and septic shock, respectively. The DLM was developed using 73,727 ECGs from 18,142 patients, and internal validation was conducted using 7774 ECGs from 7,774 patients. Furthermore, we conducted an external validation with 20,101 ECGs from 20,101 patients from another hospital to verify the applicability of the DLM across centers. Results During the internal and external validations, the area under the receiver operating characteristic curve (AUC) of the DLM using 12-lead ECG was 0.901 (95% confidence interval, 0.882–0.920) and 0.863 (0.846–0.879), respectively, for screening sepsis and 0.906 (95% confidence interval (CI), 0.877–0.936) and 0.899 (95% CI, 0.872–0.925), respectively, for detecting septic shock. The AUC of the DLM for detecting sepsis using 6-lead and single-lead ECGs was 0.845–0.882. A sensitivity map revealed that the QRS complex and T waves were associated with sepsis. Subgroup analysis was conducted using ECGs from 4,609 patients who were admitted with an infectious disease, and the AUC of the DLM for predicting in-hospital mortality was 0.817 (0.793–0.840). There was a significant difference in the prediction score of DLM using ECG according to the presence of infection in the validation dataset (0.277 vs. 0.574, p < 0.001), including severe acute respiratory syndrome coronavirus 2 (0.260 vs. 0.725, p = 0.018). Conclusions The DLM delivered reasonable performance for sepsis screening using 12-, 6-, and single-lead ECGs. The results suggest that sepsis can be screened using not only conventional ECG devices but also diverse life-type ECG machines employing the DLM, thereby preventing irreversible disease progression and mortality.

scholarly journals Evaluation of Clinical Pharmacist's Contribution to Sepsis and Septic Shock Management

2021 ◽  
Author(s):  
Nursel Sürmelioğlu ◽  
Kutay Demirkan ◽  
Emre Karakoç ◽  
Murat Gündüz ◽  
Dilek Özcengiz
Keyword(s):  
Septic Shock ◽  
Clinical Pharmacist ◽  
University Hospital ◽  
Control Group ◽  
Study Group ◽  
Drug Related Problems ◽  
Sepsis Management ◽  
Time To Initiation ◽  
Significant Difference ◽  
Sepsis And Septic Shock

Purpose: This study aimed to identify drug-related problems at treatment in patients with sepsis and septic shock and to evaluate the contribution of the clinical pharmacist. Methods: This study was conducted at intensive care units(ICU) of a university hospital. A study group in which the clinical pharmacist participated in the treatment management of septic patients and a control group in which the clinic did not have a pharmacist was formed. In the treatment of the control group, interventions were made for drug-related problems detected by the clinical pharmacist. Study and control group were compared in terms of length of ICU stay, time to initiation of appropriate antimicrobial drug(s), appropriateness of antimicrobial dosing, and drug treatment costs. Results: Total of 65 patients were included in the study group prospectively in which the intervention of clinical pharmacist provided for the drug treatments and retrospectively 65 patients in the control group without any intervention. In the study group, 670 recommendations were made for 753 problems related to their drug therapy. Between groups, improvement in appropriateness of antimicrobials in terms of dose, time to initiation of appropriate antimicrobial therapy, daily antibiotic costs in all patients and antibiotic costs in patients with impaired renal function statistically significant difference were found. Conclusions: As a result of clinical pharmacist involvement in sepsis management, it has been shown to contribute to the prevention and management of drug interactions, to start antimicrobial therapies more quickly, to select the appropriate drug and dose, especially antimicrobials, and to save the costs of antimicrobial drugs.

scholarly journals Exosomal CD63 in critically ill patients with sepsis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yunjoo Im ◽  
Hongseok Yoo ◽  
Ryoung-Eun Ko ◽  
Jin Young Lee ◽  
Junseon Park ◽  
...  
Keyword(s):  
Septic Shock ◽  
Organ Failure ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Mortality Prediction ◽  
Enzyme Linked Immunosorbent Assay ◽  
Linear Regression Method ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Sepsis And Septic Shock

AbstractCD63 is one of the tetraspanin protein family members that is ubiquitously expressed on exosomes and is involved in the signal transduction of various types of immune cells. It may thus contribute to immunometabolic mechanisms of cellular and organ dysfunction in sepsis. Nonetheless, the association of exosomal CD63 with the severity and mortality of sepsis is not well known. Therefore, in the present study, the overall levels of exosomal CD63 were evaluated to ascertain whether they were associated with organ failure and mortality in patients with sepsis. Exosomal CD63 was measured from prospectively enrolled critically-ill patients with sepsis (n = 217) and healthy control (n = 20). To detect and quantify exosomes in plasma, a commercially available enzyme-linked immunosorbent assay kit was used according to the manufacturer’s protocol. The total number of exosomal CD63 was determined by quantifying the immunoreactive CD63. The association between plasma levels of exosomal CD63 and sequential organ failure assessment (SOFA) score was assessed by a linear regression method. The best cut-off level of exosomal CD63 for 28-day mortality prediction was determined by Youden’s index. Among 217 patients with sepsis, 143 (66%) patients were diagnosed with septic shock. Trends of increased exosomal CD63 levels were observed in control, sepsis, and septic-shock groups (6.6 µg/mL vs. 42 µg/mL vs. 90 µg/mL, p < 0.001). A positive correlation between exosomal CD63 and SOFA scores was observed in patients with sepsis (r value = 0.35). When patients were divided into two groups according to the best cut-off level, the group with higher exosomal CD63 levels (more than 126 µg/mL) was significantly associated with 28-day and in-hospital mortality. Moreover, the Kaplan–Meier survival method showed a significant difference in 90-day survival between patients with high- and low-exosomal CD63 levels (log-rank p = 0.005). Elevated levels of exosomal CD63 were associated with the severity of organ failure and predictive of mortality in critically ill patients with sepsis.

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