Correlation of SOFA Score and Hormone Value for Predicting 28-days Mortality for Septic Patients

Introduction. Sepsis is a group of symptoms of organ dysfunction that can be life-threatening because of dysregulation of body response toward ongoing infection. Organ dysfunction in sepsis can be measured by Sequential Organ Failure Assessment (SOFA) and T3 hormone. The study was aimed to identify the correlation of T3 in predicting mortality of 28 days patients in Intensive Care Unit RSMH Palembang. Method. This study design is cohort prospective. The inclusion criteria consist of a patient diagnosed with sepsis and septic shock in the Intensive Care Unit, 18-64 years old. Patients with a history of thyroid disease, pregnant or post-pregnancy, the patient admitted in referral from other hospitals, and patients with a history of psychiatry medication and thyroid medication were excluded. Data collected is the patient whose stay in Intensive Care Unit RSMH followed in 28 days from January 2021 until the sample was fulfilled (39 samples). Analyzing data was SPSS version 23 with chi-square analysis and Fisher's Exact to identify the relationship. Pearson correlation to identify correlation coefficient, and Medical application to measure AUC, cutoff value, sensitivity, and specificity. Result. The result showed that age (p=0,445). gender (p=1,00), need of ICU (p=0,228), isolation-nonisolation ward (p=0,437) didn't have any significant relationship toward mortality. SOFA score correlate statistically with positive correlation and medium strength (0,633) toward mortality of sepsis patient (p=0,000). T3 hormon correlate positively with medium strength (0,514) toward mortality of sepsis patient (p=0,001). T3 hormone toward SOFA correlate negatively (-0,365) with significant correlation (p=0,22). T3 hormone has AUC 0,291 with sensitivity 3,3% and specificity 67,7%. Conclusion. T3 hormone has a significant negative correlation to mortality in sepsis patients but cannot be used to predict mortality with a low AUC value (0,291).

Positive Cumulative Fluids Balance Related to Mortality Events in Sepsis Patients Treated at Intensive Care Unit, Dr. Mohammad Hoesin General Hospital Palembang

Introduction. Sepsis is a syndrome that describes physiological dysfunction, pathological, and biochemistry caused by infection. Fluid balance is an indicator that can monitor input and output. This study was aimed to evaluate the relationship between positive cumulative fluid balance and the mortality rate of sepsis patients treated in the intensive care unit. Method: This study design is a retrospective study. The inclusion criteria consist of patients diagnosed with sepsis written in the medical record, 18-65 years old, and patients admitted in intensive care unit dr Moh. Hoesin General Hospital. Data were analyzed using SPSS 22.0 with the normality of data distribution, independent sample t-test, Mann-Whitney analysis, chi-square, Fisher’s Exact to measure the relationship, and using Medcalc version 14 application to measure cut-off value, ROC curve AUC, cross-sectional point, sensitivity, and specificity. Result. The result showed that characteristic between age (p=0,491), gender (p=0,703) did not differ significantly between survived and non-survived patient. Length of stay (p=0,002), balance (p=0,000), and ward unit (p=0,014) has a significant different between survived and non survived patient. In chi square analysis, p value=0,000with odds ratio 7,083. Cut-off value of ROC curve is -97 mL with AUC 0,844, sensitivity 76,1% and specificity 79,3%. Conclusion. Cumulative positive balance patient in the sepsis patient correlates with increased mortality in a sepsis patient in Dr. Mohammad Hoesin General Hospital Palembang.

Correlation Between Albumin Level and 28-Days Sepsis Related Mortality

Introduction: The mortality rate from sepsis is much greater than that from acute coronary syndrome or stroke. Uncontrolled release of cytokines (abnormalities in the inflammatory response) such as TNF-α and IL-1, IL-6 can reduce serum albumin level, so that the presence of hypoalbuminemia conditions can indicate how the inflammatory reaction occurs in septic patients. Albumin can be a predictor of mortality in septic patients. This study aims to determine the correlation between serum albumin level and the 28-day mortality of patients with sepsis. Methods: This study is an analytical observational study with a retrospective cohort design. The research was conducted in September 2020 until the completion of data collection at dr. Mohammad Hoesin Hospital Palembang. The sample in this study were all sepsis patients in the intensive care unit who were registered in the Medical Record Installation of dr. Mohammad Hoesin Hospital Palembang from 1 January 2019 to 31 December 2019 met the inclusion and exclusion criteria. After the data was collected, analysis was carried out using the STATA program. Results: The serum albumin value ≤ of 2.6 mg / dL on the fourth day was significant with the mortality of septic patients. Patients with a serum albumin value ≤ 2.6 mg / dL had a risk of 1.288 times experiencing death compared to an albumin value> 2.6 mg / dL. Albumin in the fourth day had moderate correlation with sepsis patient mortality (r = 0.497; p = 0.001) Conclusion: Albumin serum on the fourth day had a moderate correlation with 28 days sepsis patient mortality

The Outcome of Patients with Sepsis at Tarakan Hospital Central Jakarta in 2018

Background: Sepsis is a common, life-threatening organ dysfunction caused by a dysregulated host response to infection. In 2017, estimated cases for sepsis reached 48.9 million worldwide, with 11 million deaths. Adequate antibiotic therapy is crucial for the treatment of sepsis. Purposes: The objective of this study is to find factors related to sepsis patient outcomes. Methods: We conducted a 1-year retrospective descriptive study with the inclusion criteria of all adult sepsis patients in Tarakan District Hospital in 2018. We compiled 39 samples that fit the inclusion criteria. Results: The distribution gender of this study were 51.2% female and 48.8% male patients; with most patients in the age of <65 years old (53.8%), <7 days in the length of stay (72%), and the most common source of infection was gastrointestinal (33.3%) followed by lungs (28.2%). Conclusion: We found a mortality rate of 59%, with the most common source of infection leading to death was the lungs (81.2%) and treated with single ceftriaxone antibiotic therapy (78.3%). Another factor associated with mortality is inadequate single antibiotic therapy.

SIGNR1 promotes immune dysfunction in systemic candidiasis by modulating neutrophil lifespan via T cell-derived histones and G-CSF

The mechanisms regulating immune dysfunction during sepsis are poorly understood. Here, we show that neutrophil-derived myeloperoxidase delays the onset of immune dysfunction during systemic candidiasis, by controlling microbes captured by splenic marginal zone (MZ) macrophages. In contrast, SIGNR1-mediated microbe capture accelerates MZ colonization and immune dysfunction by triggering T cell death, T celldependent chromatin release and the synergistic induction of G-CSF by histones and fungi. Histones and G-CSF promote the prevalence of immature Ly6Glow neutrophils with defective oxidative burst, by selectively shortening the lifespan of mature neutrophils. Consistently, either T cell deficiency or blocking SIGNR1, G-CSF and histones delayed neutrophil dysfunction. Furthermore, histones and G-CSF in sepsis patient plasma, shortened neutrophil lifespan, induced surface marker changes and correlated with neutrophil mortality markers associated with a poor prognosis. Hence, microbial capture regulates T cell death and alters neutrophil populations post differentiation, by selectively modulating the lifespan of distinct neutrophil populations.

Intensive Care Unit Volume of Sepsis Patients Does Not Affect Mortality: Results of a Nationwide Retrospective Analysis

Background: There is little research evaluating outcomes from sepsis in intensive care units (ICUs) with lower sepsis patient volumes as compared to ICUs with higher sepsis patient volumes. Our objective was to compare the outcomes of septic patients admitted to ICUs with different sepsis patient volumes. Materials and Methods: We included all patients from the eICU-CRD database admitted for the management of sepsis with blood lactate ≥ 2mmol/L within 24 hours of admission. Our primary outcome was ICU mortality. Secondary outcomes included hospital mortality, 30-day ventilator free days, and initiation of renal replacement therapy (RRT). ICUs were grouped in quartiles based on the number of septic patients treated at each unit. Results: 10,716 patients were included in our analysis; 272 (2.5%) in low sepsis volume ICUs, 1,078 (10.1%) in medium-low sepsis volume ICUs, 2,608 (24.3%) in medium-high sepsis volume ICUs, and 6,758 (63.1%) in high sepsis volume ICUs. On multivariable analyses, no significant differences were documented regarding ICU and hospital mortality, and ventilator days in patients treated in lower versus higher sepsis volume ICUs. Patients treated at lower sepsis volume ICUs had lower rates of RRT initiation as compared to high volume units (medium-high vs. high: OR = 0.78, 95%CI = 0.66-0.91, P-value = 0.002 and medium-low vs. high: OR = 0.57, 95%CI = 0.44-0.73, P-value < 0.001). Conclusion: The previously described volume-outcome association in septic patients was not identified in an intensive care setting.