Degree Of Sepsis Research Articles

External validation of the Codman score in colorectal surgery: a pragmatic tool to drive quality improvement.

The simple six-variable Codman score is a tool designed to reduce the complexity of contemporary risk-adjusted postoperative mortality rate predictions. We sought to externally validate the Codman score in colorectal surgery. The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) participant user file and colectomy targeted dataset of 2020 were merged. A Codman score (composed of six variables: age, American Society of Anesthesiologists score, emergency status, degree of sepsis, functional status and preoperative blood transfusion) was assigned to every patient. The primary outcome was in-hospital mortality and secondary outcome was morbidity at 30 days. Logistic regression analyses were performed using the Codman score and the ACS NSQIP mortality and morbidity algorithms as independent variables for the primary and secondary outcomes. The predictive performance of discrimination area under receiver operating curve (AUC) and calibration of the Codman score and these algorithms were compared. A total of 40 589 patients were included and a Codman score was generated for 40 557 (99.02%) patients. The median Codman score was 3 (interquartile range 1-4). To predict mortality, the Codman score had an AUC of 0.92 (95% CI 0.91-0.93) compared to the NSQIP mortality score 0.93 (95% CI 0.92-0.94). To predict morbidity, the Codman score had an AUC of 0.68 (95% CI 0.66-0.68) compared to the NSQIP morbidity score 0.72 (95% CI 0.71-0.73). When body mass index and surgical approach was added to the Codman score, the performance was no different to the NSQIP morbidity score. The calibration of observed versus expected predictions was almost perfect for both the morbidity and mortality NSQIP predictions, and only well fitted for Codman scores of less than 4 and greater than 7. We propose that the six-variable Codman score is an efficient and actionable method for generating validated risk-adjusted outcome predictions and comparative benchmarks to drive quality improvement in colorectal surgery.

Sepsis: A Systematic Review of Antibiotic Resistance and Antimicrobial Therapies

Sepsis is a medical emergency that depicts the body’s systemic immune reaction to an infectious process that could result in organ dysfunction and death. Early sepsis pathogen identification and early delivery of antimicrobial therapy result in better clinical outcomes for patients diagnosed with sepsis and septic shock. Method: Systematic reviews and meta-analyses that discussed sepsis pathogen identification, antibiotic resistance and timing in the treatment of sepsis were taken into account irrespective of the approach of the included studies, quantitative or qualitative. This literature review gathers data from twelve primary studies to perform a systematic review and evaluate existing empirical antibiotic therapies in order to treat the various degrees of sepsis and minimize antibiotic resistance. The remaining reviews, case studies, etc., were used as supplementary references. The studies compiled data from laboratory tests including lactate levels, fluid resuscitation, and diagnostic diagnostics like the SOFA score. Results: This paper identifies multiple factors that must be taken into account when treating individuals with sepsis. Prior to the administration of broad-spectrum empiric antibiotics, the severity and morbidity of the disease must be addressed. Excessive antibiotic usage has been associated with increased sepsis hospitalized mortality rates, and thus it is crucial to minimize antibiotic misuse in non-septic patients. This can be accomplished by differentiating between Gram-negative and Gram-positive bacteria, the purpose of biomarkers and identifying the antibiotic resistance pathway. Many patients from low economic statuses may experience difficulties accessing healthcare services and resources for sepsis treatment when diagnosed with sepsis. Additionally, through educational efforts, promoting awareness of sepsis and the relevance of timing in sepsis therapy can help dispel misconceptions about the illness and minimize sepsis patients from receiving insufficient care.

Step-by-Step Construction of Gene Co-Expression Network Analysis for Identifying Novel Biomarkers of Sepsis Occurrence and Progression

BackgroundSepsis is the leading cause of death in critically ill patients. Although it is well known that the immune system plays a key role in sepsis, exactly how it works remains unknown.MethodsIn our study, we used weighted gene co-expression network analysis (WGCNA) to screen out the immune-related genes that may play a critical role in the process of sepsis.ResultsA total of three sepsis-related hub genes were screened for further verification. Subsequent analysis of immune subtypes suggested their potential predictive effect in the clinic.ConclusionOur study shows that three immune-related genes CHMP1A, MED15 and MGAT1 are important biomarkers of sepsis. The screened genes may help to distinguish normal individuals from patients with different degrees of sepsis.

Relation between inflammatory markers and sepsis in critically ill patients

Background Sepsis and septic shock is a serious complication in ICU patients. Early identification can help to improve the outcome. C-reactive protein (CRP) and neutrophil–lymphocyte ratio (NLR) are suggested markers for diagnosis. The aim of the work is to evaluate the relation between inflammatory markers and sepsis in critically ill patients. Patients and methods The study included 30 patients with different degrees of sepsis and septic shock in addition to age-matched and sex-matched healthy controls. All patients were subjected to full clinical examination. The clinical condition of the patients was further assessed using acute physiology age chronic health evaluation II score and Sequential (sepsis-related) Organ Failure Assessment score. The performed laboratory investigations included complete blood count, coagulation profile, erythrocyte sedimentation rate, CRP, renal function tests (blood urea, serum creatinine, sodium, and potassium), liver function tests (serum albumin and bilirubin), and pan-cultures. Results Among the studied patients, there were 16 (53.3%) patients with sepsis, seven (23.3%) patients with severe sepsis, and seven (23.3%) patients with septic shock. Six (20.0%) patients died at the end of the study. The patients had a significantly higher CRP (46.6±24.3 vs. 6.7±3.3 mg/dl, P Conclusions Use of CRP and NLR as early predictors of sepsis and septic shock development is reliable and convenient.

ARE GADGETS SAVIOURS IN SALVAGING SICK CASES – ULTRASOUND FOR BOTH NERVE BLOCKS AND VASCULAR ACCESS IN A CASE OF SEPTIC SHOCK

Diabetes mellitus and diabetic foot syndrome presents to us with varying degrees of sepsis. We present a 52-year-old male with chronic diabetes with fore foot sepsis in shock. His blood sugar was controlled with insulin and the other parameters were normal. The blood pressure was around 90/50 mm Hg with noradrenaline support of 0.5 mic/kg/min. We secured a right internal jugular venous access with ultrasound (USG). The volume status as assessed by USG of the IVC was satisfactory. We administered popliteal sciatic nerve block along with saphenous nerve block visualizing the nerves with USG. The amputation of forefoot went on for 1 h where the hemodynamics remained stable at 100/70 mmHg. After the surgery was over, the patient was shifted to sick cubicle and in the next 6 h, the inotrope support was weaned off. The control of sugars was continuously monitored and kept under control. Any other form of neuraxial block could have been detrimental to him in the presence of hemodynamic imbalance. Such precise deposition of local anesthetics in the sciatic nerve is very difficult without the use of USG. We conclude that advanced gadgets may bring back hope in salvaging sick patients.

O18 TREATMENT OF ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY (TENTACLE STUDY)

Abstract Aim The aim of this study is to investigate which factors contribute to anastomotic leakage severity and to compose an evidence based anastomotic leakage severity score. Secondly, we aim to investigate which anastomotic leakage characteristics are associated with success of different anastomotic leakage treatments and to compare the effectiveness of different initial anastomotic leakage treatments for anastomotic leakage classified according to severity and leakage characteristics. Background Anastomotic leakage occurs in 0%-30% after esophagectomy for cancer. It is a severe complication with mortality rates approximately ranging from 2%-12%. In addition, it is associated with a prolonged ICU treatment and hospital stay. Anastomotic leakage severity is currently graded according to how it is treated (grade I: conservative treatment, grade II: endoscopic/radiologic intervention and grade III: surgical intervention). However, this scoring system cannot be used to guide decision making when anastomotic leakage is diagnosed in a clinical setting. Factors that may influence the severity of the anastomotic leakage are (amongst others) location of the anastomosis, estimated surface of the defect, estimated circumference of the defect, extent of contamination, degree of sepsis and time from diagnosis until therapy. However, little is known about to what extent these and other factors contribute to anastomotic leakage severity. In addition, there is a paucity of data on what leakage characteristics dictate the success of a specific treatment. Methods We will perform an international multicenter retrospective cohort study. All adult patients with anastomotic leakage according to the ECCG definition after esophagectomy and gastric conduit reconstruction for esophageal cancer are suitable for inclusion. We aim to include at least 1000 patients. The primary outcome parameter is 90-day mortality. Secondary outcome parameters are in-hospital mortality, 30-day mortality, 180-day mortality, comprehensive complications index, total number of reinterventions, hospital and ICU length of stay and hospital related costs. Results Data collection will take place from April 2019 until December 2019. Study results are expected in June 2020. Conclusion We hypothesize that we will be able to identify factors that influence the severity of the anastomotic leakage and to compose a leakage severity score. Furthermore, we expect to identify leakage characteristics dictating the success of a specific treatment.

Invasive Meningococcal Disease: What We Should Know, Before It Comes Back.

BackgroundInvasive meningococcal disease (IMD), sepsis and/or meningitis continues to be a public health problem, with mortality rates ranging from 5% to 16%. The aim of our study was to further knowledge about IMD with a large series of cases occurring over a long period of time, in a cohort with a high percentage of adult patients.MethodsObservational cohort study of patients with IMD between 1977 hand 2013 at our hospital, comparing patients with only sepsis and those with meningitis and several degrees of sepsis. The impact of dexamethasone and prophylactic phenytoin was determined, and an analysis of cutaneous and neurological sequelae was performed.ResultsA total of 527 episodes of IMD were recorded, comprising 57 cases of sepsis (11%) and 470 of meningitis with or without sepsis (89%). The number of episodes of IMD decreased from 352 of 527 (67%) in the first to 20 of 527 (4%) in the last quarter (P < .001). Thirty-three patients died (6%): 8 with sepsis (14%) and 25 with meningitis (5%) (P = .02). Cutaneous and neurological sequelae were present in 3% and 5% of survivors of sepsis and meningitis, respectively. The use of dexamethasone was safe and resulted in less arthritis, and patients given prophylactic phenytoin avoided seizures.ConclusionsThe frequency of IMD has decreased sharply since 1977. Patients with sepsis only have the highest mortality and complication rates, dexamethasone use is safe and can prevent some arthritis episodes, and prophylactic phenytoin might be useful in a selected population. A rapid response and antibiotic therapy may help improve the prognosis.

Sustenance of endothelial cell stability in septic mice through appropriate activation of transient receptor potential vanilloid-4

Therapeutic target transient receptor potential vanilloid-4 (TRPV-4) is frequently applied in endotoxemia research. It has been reported that HC067047, an inhibitor of TRPV-4, mitigated LPS-induced injury. However, the inhibition of TRPV-4 with HC06047 did not attenuate LPS-induced symptoms and exaggerated pathology. This study was carried with a view to unravelling the reason(s) behind these conflicting results. Different doses of the inhibitor were used in the same degree of sepsis, and their effects were determined through assays for sepsis-related physiological indicators such as endothelial injury markers, coagulation index, organ damage indicators, inflammatory factor levels, and cell apoptosis. The results showed that high or low inhibitor levels had no significant effect on sepsis-related physiological indicators. These findings suggest that proper activation of TRPV-4 in sepsis is important for maintaining normal physiological function. Thus, the degree of TRPV-4 activation should match the severity of sepsis.

Alterations in energy substrate metabolism in mice with different degrees of sepsis

BackgroundNutritional management is crucial during the acute phase of severe illnesses. However, the appropriate nutritional requirements for patients with sepsis are poorly understood. We investigated alterations in carbohydrate, fat, and protein metabolism in mice with different degrees of sepsis. Materials and methodsC57BL/6 mice were divided into three groups: control mice group, administered with saline, and low- and high-dose lipopolysaccharide (LPS) groups, intraperitoneally administered with 1 and 5 mg of LPS/kg, respectively. Rectal temperature, food intake, body weight, and spontaneous motor activity were measured. Indirect calorimetry was performed using a respiratory gas analysis for 120 h, after which carbohydrate oxidation and fatty acid oxidation were calculated. Urinary nitrogen excretion was measured to evaluate protein metabolism. The substrate utilization ratio was recalculated. Plasma and liver carbohydrate and lipid levels were evaluated at 24, 72, and 120 h after LPS administration. ResultsBiological reactions decreased significantly in the low- and high-LPS groups. Fatty acid oxidation and protein oxidation increased significantly 24 h after LPS administration, whereas carbohydrate oxidation decreased significantly. Energy substrate metabolism changed from glucose to predominantly lipid metabolism depending on the degree of sepsis, and protein metabolism was low. Plasma lipid levels decreased, whereas liver lipid levels increased at 24 h, suggesting that lipids were transported to the liver as the energy source. ConclusionsOur findings revealed that energy substrate metabolism changed depending on the degree of sepsis. Therefore, in nutritional management, such metabolic alterations must be considered, and further studies on the optimum nutritional intervention during severe sepsis are necessary.

Effect of vitamin D3 on the severity and prognosis of patients with sepsis: a prospective randomized double-blind placebo study

To observe the relationship between vitamin D3 and the severity as well as prognosis in patients with sepsis, and to explore whether exogenous vitamin D3 can improve the prognosis in patients with sepsis. A prospective randomized double-blind placebo study was conducted. Fifty-seven patients with sepsis admitted to intensive care unit (ICU) of Shengjing Hospital Affiliated to China Medical University from March to November in 2015 were enrolled. Twenty patients with systemic inflammatory response syndrome (SIRS) and 20 healthy volunteers with normal physical examination as control were enrolled during the same time. Patients with sepsis were divided into general sepsis group and severe sepsis group (including septic shock) according to the criteria for the diagnosis of severe sepsis and septic shock in 2012. According to the diagnostic criteria established by the American Endocrine Society, and on the basis of 25-hydroxy vitamin D3 [25(OH)D3], the sepsis patients with deficiency [25(OH)D3 20-30 μg/L] or insufficiency [25(OH)D3 < 20 μg/L] of vitamin D were divided into D3 treatment group (supplemented 300 kU vitamin D3) and placebo group (injected 1 mL physiological saline). 28th day was set as the end point, and the patients with sepsis were divided into survival group and death group. The levels of serum 25(OH)D3 in each group were measured by electrochemical luminescence method, and the difference in 25(OH)D3 levels among patients with different severity, gender, and age were recorded. Procalcitonin (PCT), C-reactive protein (CRP), blood routine, liver and kidney function, electrolytes and arterial blood gas analysis, acute physiology and chronic health evaluation II (APACHE II) and sequential organ failure score (SOFA), duration of mechanical ventilation, and length of ICU stay of patients with sepsis were observed. Multivariate Cox proportional hazard regression analysis was used to analyze the risk factors of prognosis in patients with sepsis. (1) In 57 patients with sepsis, there were 15 patients in general sepsis group, and 42 in severe sepsis group; 29 in D3 treatment group, and 28 in the placebo group; 8 patients died within 28 days with mortality rate of 14.04%. (2) The levels of serum 25(OH)D3 in sepsis group and SIRS group were significantly lower than those in healthy control group [μg/L: 3.92 (< 3.00, 11.22), 6.99 (3.51, 9.77) vs. 17.25 (13.48, 22.50), both P < 0.01], but there was no significant difference in the serum 25(OH)D3 level between sepsis group and SIRS group as well as patients with different degrees of sepsis. The serum 25(OH)D3 level in female patients with sepsis (n = 24) was significantly lower than that in male (n = 33), and the difference was statistically significant [μg/L: <3.00 (<3.00, 3.87) vs. 11.96 (5.14, 17.29), Z = -4.020, P = 0.000]. There was no significant difference in serum 25(OH)D3 level between the young (age <60 years old, n = 30) and the old (age ≥ 60 years old, n = 27) patients with sepsis [μg/L: 4.54 (<3.00, 9.88) vs. 3.00 (<3.00, 15.08), Z = -0.601, P = 0.548]. (3) In patients with sepsis, there was no significant difference in the duration of mechanical ventilation [hours: 41.00 (7.50, 82.50) vs. 67.00 (4.75, 127.75)], length of ICU stay (days: 5.48±4.08 vs. 6.68±4.87) and 28-day mortality (10.34% vs. 17.86%) between D3 treatment group and placebo group (all P > 0.05). It was shown by Kaplan-Meier survival curve analysis that there was no significance in 28-day accumulated survived rate between the two groups [log-rank test: χ 2 = 0.222, P = 0.638]. It was shown by multivariate Cox regression analysis that APACHE II score [relative risk (RR) = 8.487, 95% confidence interval (95%CI) = 1.506-47.835, P = 0.015] and 25(OH)D3 < 20 μg/L (RR = 0.088, 95%CI = 0.013-0.592, P = 0.012) were the risk factors of prognosis in patients with sepsis. The serum 25(OH)D3 level in ICU patients with sepsis was lower than that in healthy people, but there was no significant difference between patients with sepsis and SIRS. The serum 25(OH)D3 level in sepsis patients was related with gender, and the level of the female was lower than that of the male, but was not related with age. Exogenous vitamin D3 supplementation cannot improve the prognosis of ICU patients with sepsis. APACHE II score and 25(OH)D3 < 20 μg/L were risk factors for the prognosis in ICU patients with sepsis.

S3-3 H2S in sepsis and shock – A story of mice and men

Role of H 2 S in systemic inflammation and shock is incompletely understood. To date, numerous conflicting data regarding the pro- and anti-inflammatory effects of exogenous and endogenous sulfide have been reported. Although the reasons for these conflicting results are likely multifactorial, purity and/or specificity of chemical H 2 S donors and inhibitors have been questioned. Furthermore, congenital deficiency of cystathionine γ -lyase (CSE) that produces H 2 S endogenously alters levels of other enzymes that affect production and metabolism of H 2 S, making interpretation of experimental results difficult. To elucidate the role of H 2 S in sepsis and shock, we measured levels of H 2 S and its metabolites in mice and human patients with varying degrees of sepsis using the monobromobimane (MBB)-based HPLC method. We observed that endotoxemia decreased plasma sulfide levels in mice. Levels of sulfide metabolites are markedly altered in septic patients. Breathing H 2 S attenuates endotoxin-induced systemic inflammation and improves survival in mice by restoring sulfide and markedly increasing thiosulfate levels. We further demonstrate that administration of sodium thiosulfate (STS) per se dose-dependently improves survival rate of mice after endotoxin challenge. These results are corroborated by our recent findings that congenital deficiency or chemical inhibition of CSE increases thiosulfate levels in the liver and prevents acute liver failure at least in part by augmentation of antioxidant and anti-apoptotic defense mechanisms. Taken together, evidence suggests a complex role of H 2 S in systemic inflammation and shock, that warrant further studies.

New determinants of prognosis in bacterial infections in cirrhosis.

Despite major advances in the knowledge and management of liver diseases achieved in recent decades, decompensation of cirrhosis still carries a high burden of morbidity and mortality. Bacterial infections are one of the main causes of decompensation. It is very important for clinical management to be aware of the population with the highest risk of poor outcome. This review deals with the new determinants of prognosis in patients with cirrhosis and bacterial infections reported recently. Emergence of multiresistant bacteria has led to an increasing failure rate of the standard empirical antibiotic therapy recommended by international guidelines. Moreover, it has been recently reported that endothelial dysfunction is associated with the degree of liver dysfunction and, in infected patients, with the degree of sepsis. It has also been reported that relative adrenal insufficiency is frequent in the non-critically ill cirrhotic population and it is associated with a higher risk of developing infection, severe sepsis, hepatorenal syndrome and death. We advise a change in the standard empirical antibiotic therapy in patients with high risk for multiresistant infections and also to take into account endothelial and adrenal dysfunction in prognostic models in hospitalized patients with decompensated cirrhosis.

Usefulness of Presepsin (Soluble CD14 Subtype) as a Diagnostic Marker of Sepsis in Egyptian Patients with Acute Myeloid Leukemia

Background: Systemic inflammatory response syndrome (SIRS) is a systemic inflammatory response to a variety of insults. Presepsin; the soluble CD14 subtype is a novel soluble CD14 molecule that is useful for diagnosing sepsis. It plays an important role in modulating the immune response to endotoxin in vitro and vivo. The aim: Of the study was to evaluate the usefulness of presepsin as a diagnostic marker of sepsis in acute leukemia. Methods: The current study was carried out on 40 adult patients with acute myeloid leukemia after receiving chemotherapy. 10 clinically normal individuals were included in the study to measure the level of presepsin. Results: This study was conducted on 50 individuals divided into 2 groups. Group I included 40 adult AML patients who fulfilled at least two of the diagnostic criteria for SIRS and Group II were 10 healthy adult persons as a control group. In Group I there were 11 patients (27.5%) having SIRS, 8 (20%) having sepsis, 9 (22.5%) having severe sepsis and 12 (30%) having septic shock. Data indicate that presepsin level was significantly higher in patients than control P = 0.017. Our results showed that the level of presepsin has a significantly positive correlation to the degree of severity of sepsis with P value 0.0001. Using the ROC curve, we found that presepsin was more specific than CRP in detection of sepsis. Conclusion: sCD14-ST (presepsin) is a new important marker for diagnosis and prognosis of sepsis. Its level increases in the first six hours after the onset of sepsis. Our data demonstrated that the concentration of presepsin is specifically increased during sepsis and is directly proportional to the degree of sepsis. Regarding sensitivity and specificity of presepsin in the discrimination of sepsis patients from healthy controls, a high specificity but low sensitivity was reported by most of the studies.

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Introduction: Mortality from sepsis, severe sepsis and septic shock varies between 20 – 70%. This variability is multifactorial and attributed to comorbidities, access of care, and variations in clinical practices. Additionally, the source of ICU admission may influence the outcomes of patients with different degrees of sepsis. We report the outcomes of a large cohort of critically ill septic patients based on their ICU admission source. Methods: Patients meeting conventional criteria for sepsis, severe sepsis, and septic shock within 24 hrs. of MICU admission between January of 2009 and December of 2012 were studied. Data collected included demographics, APACHE III score, sepsis category and source of infection, and ICU and hospital outcomes. Differences between patients admitted from the emergency department (ED) and general hospital wards (HW) were compared using Pearson's chi-squared and Student's t test. Results: 1661 patients were enrolled in the study, 681 (41%) admitted from the ED and 980 (59%) from HW. APACHE III and Acute Physiology Score (APS) were 85.1 ± 34.5 and 71.3 ± 32.9 vs. 85.2 ± 35.9 and 70.9 ± 33.3 respectively for patients admitted from the ED vs. HW, P = NS. ICU LOS was comparable between groups (5.2 ± 8.0 vs. 5.0 ± 5.0 ± 7.0 days), however, those admitted from the ED had a lower hospital LOS 11.5 ± 10.7 vs. 22.0 ± 14.7; P < 0.01. Intrabdominal source of sepsis was more common in HW patients whereas the urinary tract was more common in patients coming from the ED. Respiratory source was comparable. More patients admitted from the ED required mechanical ventilation on ICU admission (38.4 % vs. 34.2 %, P = 0.08). On admission the APACHE IV ICU mortality was statistically significant (0.27 ± 0.2 vs 0.3 ± 0.2) p < 0.0001. Patients admitted from HW had a higher ICU and hospital mortality 23.7% vs. 19.2% (P = 0.03) and 35.7% vs. 24.4% (P < 0.0001), respectively. Conclusions: Event though both groups had an almost identical APACHE and APS on ICU admission, patients admitted from the ED had better clinical outcomes. A more aggressive resuscitation and/or earlier recognition of the septic picture occurring in the ED settings may help explain our findings.

Diagnostic Potential of Endotoxin Scattering Photometry for Sepsis and Septic Shock

Endotoxin scattering photometry (ESP) is a novel Limulus amebocyte lysate (LAL) assay that uses a laser light-scattering particle-counting method. In the present study, we compared ESP, standard turbidimetric LAL assay, and procalcitonin assay for the evaluation of sepsis after emergency gastrointestinal surgery. A total of 174 samples were collected from 40 adult patients undergoing emergency gastrointestinal surgery and 10 patients with colorectal cancer undergoing elective surgery as nonseptic controls. Plasma endotoxin levels were measured with ESP and turbidimetric LAL assay, and plasma procalcitonin levels were assessed with a standard procalcitonin assay. Plasma endotoxin and procalcitonin levels increased corresponding to the degree of sepsis. Endotoxin scattering photometry significantly discriminated between patients with or without septic shock: sensitivity, 81.1%; specificity, 76.6%; positive predictive value, 48.4%; negative predictive value, 93.8%; and accuracy, 77.6%. The area under the receiver operating characteristic curve for septic shock with the ESP assay (endotoxin cutoff value, 23.8 pg/mL) was 0.8532 ± 0.0301 (95% confidence interval, 0.7841-0.9030; P < 0.0001). The predictive power of ESP was superior to that of turbidimetric assay (difference, 0.1965 ± 0.0588; 95% confidence interval, 0.0812-0.3117; P = 0.0008). There was no significant difference in predictive power between ESP and procalcitonin assay. Endotoxin scattering photometry also discriminated between patients with and without sepsis. Area under the receiver operating characteristic curve analysis showed that ESP had the best predictive power for diagnosing sepsis. In conclusion, compared with turbidimetric LAL assay, ESP more sensitively detected plasma endotoxin and significantly discriminated between sepsis and septic shock in patients undergoing gastrointestinal emergency surgery.

Not Every Rise in Procalcitonin is Infection

Introduction: Procalcitonin (PCT) is produced by thyroid and neuro-endocrine cells of the lung and the intestine. Measurement of PCT can be used as a marker of severe sepsis caused by bacteria and generally grades well with the degree of sepsis. PCT is used increasingly as a marker of bacterial infection, with PCT >2 ng/mL advocated as an indicator to initiate antibiotics in patients with presumed infection. However, not every elevated PCT is an infection. Case: 49 year-old women presented in July with fever, nausea, vomiting, confusion, headache, light-headedness, neck stiffness and abdominal pain for one day. Her past medical, family and social history were non-contributory. Examina - tion revealed fever (99.5 °F), tachycardia (pulse 115/min) and dry oral mucosa.

Utility of Biomarkers in Sepsis: Mirror Reflection of Inner Truculent Devil

There is a plethora of biomarkers proposed and being researched in the field of sepsis. The complex pathophysiology of sepsis involves many mediators of inflammation pertaining to coagulation, complement, contact system activation, inflammation, apoptosis, etc. Markers related to those processes can gauge the degree of sepsis. Compared with localized pathology, the systemic nature and involvement of multiple organs in sepsis gives scope for numerous potential biomarkers. There is no 'gold standard' for the diagnosis of sepsis. Currently available/in-research biomarkers are compared for their efficacy with methods used to diagnose and monitor sepsis such as combination of clinical signs and available laboratory variables. An arbitrary classification of these biomarkers is made and the literature surrounding these markers and their efficacy in diagnosis of sepsis is reviewed. DOI: http://dx.doi.org/10.3329/bjms.v12i1.13349 Bangladesh Journal of Medical Science Vol. 12 No. 01 January’13 pp.17-29

Outcome correlation of change in CRP levels and APACHE II in critically sick patients

Background: Sepsis is one of the main causes of morbidity and mortality in the intensive care unit.[1] C Reactive Protein (CRP), is an acute-­phase reactant, which increases markedly within hours after tissue injury.[4] Changes in plasma CRP levels can be useful in the diagnosis and followup.[5] Objective: To investigate the relation between CRP level and APACHE II score over the duration of illness in critically ill. Material &amp; Methods: A prospective, randomized study was conducted, including 200 patients, aged 25-­65 years, of either sex, fulfilling the systemic inflammatory response (SIRS)/sepsis criteria based on ACCP/SCCM definitions.[5] Patients were divided into two groups (I &amp; II) based upon their outcome. Group I included patients who expired in the I.C.U and Group II patients were those who improved and were shifted from the ICU to their respective wards. At the time of admission and each day thereafter APACHE II scores and CRP levels were carried out till the patients were either shifted from the ICU to wards or expired. Collected data was divided into two groups. Serum CRP levels were measured using an immunochemistry analyzer. Results: Observations showed that the mean CRP values declined beyond day 4 in group II while, the values kept on increasing in group I (table 2, figure 1). The difference between the groups was significant (p&lt;0.01). Conclusion: The degree of sepsis and organ dysfunction cannot be identified by a single marker; rather a combination of parameters is more useful. DOI: http://dx.doi.org/10.4038/sljcc.v2i1.1057 Sri Lanka Journal of Critical Care Vol.2(1) 2011 25-28

Blood coagulation disorders in septic patients

Host defense and blood coagulation are tightly connected and interacting systems, necessary for the integrity of an organism. Complex mechanisms regulate the intensity of a host response to invading pathogens or other potentially dangerous situations. Under regular conditions, this response is limited in time and located to the site of injury. Sometimes, however, systemic host response is overwhelming and disproportional and causes damage, not cure. Dependent on the genetical predisposition of the host, its current immunocompetence, or the type of injury, the reaction leads to the clinical picture of the different degrees of sepsis. Septic organ dysfunction is caused by intravascular fibrin deposition as a result of coagulation activation, anticoagulant breakdown, and shut down of fibrinolysis. This article describes the major pathophysiologic reactions in these situations and presents www.SepDIC.eu, an online tool on sepsis and associated coagulopathy.

Death of the septic monocyte: is more better?

Apoptosis is of pivotal importance in the pathogenesis of sepsis. Depending on the cell type involved and the time point of the disease process, apoptosis may be linked to either a good or a bad outcome. Work presented in this issue by Giamarellos-Bourboulis and coworkers suggests that an early increase in the apoptosis of blood monocytes is associated with improved survival in patients with varying degrees of sepsis. Although the mechanism by which monocyte apoptosis influences the outcome of sepsis cannot be determined by this study, these observations represent an important advance in our understanding of this complicated disease process.