Diagnosis Of Abdominal Sepsis Research Articles

Prognostic factors in older patients admitted in ICU with diagnosis of abdominal sepsis (sepsis-3 criteria)

Background & aims. In septic older patients, hospitalization in Intensive Care Unit (ICU) is often associated with unfavourable outcomes. The aim of this study was to estimate the prevalence of geriatric age in patients admitted to ICU for abdominal sepsis and to investigate predictors of mortality, including quickSOFA, a recent prognostic index proposed for septic patients. Methods. Prospective observational study on patients admitted to ICU of St. Anna Hospital (Ferrara) between January and July 2016 with the following inclusion criteria: 1) adults (18 years); 2) abdominal infection treated with surgically techniques; 3) admission to ICU. Demographic, clinical data and survival at 30 and 90-day were collected for each patient. Results. Thirty patients were enrolled, and the majority of geriatric patients (80% ≥ 65 years and 53% ≥ 75 years). The 30 and 90-day mortality was 17 and 37%, respectively. Almost all deaths occurred in older age (mortality rate of 42%). SOFA (Sepsis Related Organ Failure Assessment) score was the prognostic index most frequently associated with exitus at 30 (AUC = 0.702) and 90 days (AUC = 0.730). quickSOFA was only related to early mortality (AUC = 0.640). Conclusions. Our data confirm the high geriatric prevalence among patients admitted to ICU for abdominal sepsis, underlining the advanced age as a negative prognostic factor. SOFA score appears a reliable prognostic indicator of mortality, also in older population, while quickSOFA proved effective only for short-term mortality.

The diagnostic value of interleukin-35 in abdominal sepsis

Objective The aim of the study was to investigate the level and diagnostic significance of interleukin (IL)-35 in acute abdominal conditions. Methods Plasma specimens were obtained from 50 patients with abdominal sepsis, patients with systemic inflammatory response syndrome (SIRS) and healthy persons, respectively. Plasma IL-35, procalcitonin (PCT), C-reactive protein (CRP), white blood cells (WBC) were measured. The receiver operating characteristic (ROC) curve was used to compare the diagnostic values of IL-35, PCT, CRP and WBC. In addition, the correlation of plasma IL-35 and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score in sepsis group was assessed by Spearman correlation analysis. Results The plasma level of IL-35 in the sepsis group was significantly higher than the SIRS group and healthy group (both P=0.000). The plasma level of IL-35 in the death group was markedly higher than the survival group. The ROC for the diagnosis of sepsis versus SIRS showed that the AUC of IL-35 (0.86) was greater than that of PCT (0.78), CRP (0.75) and WBC (0.70). Additionally, in the sepsis group, the plasma IL-35 level was positively correlated with APACHEⅡ score (r=0.500, P=0.043). Conclusion Plasma level of IL-35 might be a significantly sensitive and useful indicator for rapid diagnosis of abdominal sepsis. Key words: Abdominal sepsis; Interleukin-35; Receiver operating characteristic cure

The positron emission tomography in diagnosis of abdominal sepsis

Purpose : In the perioperative phase, sepsis is associated with high morbidity and mortality and is the most important problem for the surgeon. Critically ill patients profit from an early identification and implementation of an interdisciplinary diagnostic and therapy. The purpose of this review on septic peritonitis is to give an update on the diagnosis by the use of image examination, mainly Fluor18-FDG pet scan . Methods: The literature for this review was collected with PubMed and SciElo search using the combination of “FDG,” “peritonitis” “sepsis,” and the specific terms for sepsis. Results : Rapid diagnosis for sepsis is essential for patient´s survival. A bundle of studies was performed on early recognition and on new diagnostic tools for abdominal sepsis. Although surgical intervention is considered as an essential therapeutic step in abdominal sepsis therapy, the time-point of diagnostic and source control is still controversially discussed in the literature. Conclusion: Despite many efforts, mortality of abdominal septic patients remains unacceptably high, the early diagnosis of sepsis is challenging for health care providers, and high performance methods of radiographic imaging like positron emission tomography scan can be helpful in some cases. Their diagnostic impact has to be evaluated in future studies.

Acute intestinal failure in surgical patients: an audit of incidence, management and outcomes in an irish hospital, and compliance with ASGBI guidelines

Acute intestinal failure (AIF) is defined as an inability to tolerate 80% of nutritional requirements delivered enterally for a minimum of 48 h. In surgical patients it commonly relates to abdominal sepsis, intestinal obstruction, or ileus. The prevalence of AIF in surgical units in Ireland has not previously been studied. We retrospectively audited the general surgical and ICU departments in St James's Hospital over a 3-month period to identify patients with AIF and followed their management and outcomes focusing on the need for artificial nutrition and surgical intervention. Fifty-four surgical patients (11.4% of surgical emergency admissions) were diagnosed with AIF over the 3-month period. Of these, 30 (55.6%) required nutritional support; 26 (48.2%) had surgical ± radiological intervention and 6 (11.1%) had radiological intervention alone. Abdominal sepsis was present in 17 (31.5%) patients, a group that required significantly longer parenteral (14.6 vs. 6.7 days, p 0.029) and enteral (13.9 vs. 2.2 days, p 0.005) nutrition than AIF patients without abdominal sepsis. AIF also took longer to resolve in (5.8 vs. 4.2 days, p 0.024) in sepsis versus nonsepsis patients. The majority of patients (n = 43, 80%) were referred to clinical nutrition teams early after having symptoms for 3.77 days (range 1-21) and 72% had complete nutritional assessment clearly documented. AIF is common, and can often be treated conservatively. Early linkage with nutrition services is recommended. Early diagnosis of abdominal sepsis is important as this cohort of patients can be particularly difficult to manage.

INTERLEUKIN-22 DETECTED IN PATIENTS WITH ABDOMINAL SEPSIS

Interleukin 22 (IL-22) is a TH17-like cytokine known to specifically activate epithelial cells, thereby strengthening immune defense at host/environment interfaces. Animal studies suggest that IL-22 may play a crucial role in clinical sepsis. However, little is known about IL-22 in sepsis patients. In a single-center university hospital setting, serum IL-22 levels were assessed in 16 patients with the diagnosis of abdominal sepsis, 16 patients who have undergone elective major abdominal surgery without the diagnosis of sepsis, and 21 healthy volunteers. In accordance with current knowledge, we observed enhanced levels of IL-6 and IL-10 in serum specimens of sepsis patients compared with surgical control patients. Here, we report, for the first time, a modest but significant elevation of serum IL-22 detectable in abdominal sepsis patients (P G 0.001). Median serum concentrations of IL-22 were 111.8 pg/mL, 3.4 or 2.0 pg/mL, and 9.3 pg/mL for abdominal sepsis patients, surgical control patients (presurgery or postsurgery), and healthy volunteers,respectively. Interleukin 22 produced in the course of abdominal sepsis may contribute to host defense and stabilization of mucosal barrier functions under conditions of systemic infection.

Impact of relaparotomy in patients with abdominal sepsis

Abstract Background This study determined whether relaparotomy has a positive or negative effect on prognostic scoring systems. Methods Between April 1995 and January 1997, 46 patients with abdominal sepsis were treated. The diagnosis of abdominal sepsis was defined as meeting the Bone criteria for sepsis before operation, in combination with infection of the abdomen proven by laparotomy. After the first laparotomy there were 41 relaparotomies in these 46 patients. From 2 days before to 3 days after the relaparotomy, data were collected to compile the Acute Physiology and Chronic Health Evaluation (APACHE) III and Multiple Organ Failure (MOF) scores. The scores were compared before and after relaparotomy, and were also compared between patients who had a recurrent infection in the abdomen and those who did not. Results During 41 relaparotomies, 16 patients were found to have a pus collection. Of these clinical infections only 11 had a positive culture. Overall the APACHE III and MOF scores were not significantly different before and after operation. In patients with clinical infection there was also no difference pre and post operative. The same applied for patients with and without positive intraabdominal cultures. Conclusion Relaparotomy in patients with abdominal sepsis did not have a negative effect on prognosis within a few days after reoperation. The authors did not find any reason to use APACHE III or MOF scoring as an indication for relaparotomy.