ICU-acquired Sepsis Research Articles

Development and validation of a sepsis risk index supporting early identification of ICU-acquired sepsis: An observational study

BackgroundSepsis is a threat to global health, and domestically is the major cause of in-hospital mortality. Due to increases in inpatient morbidity and mortality resulting from sepsis, healthcare providers (HCPs) would accrue significant benefits from identifying the syndrome early and treating it promptly and effectively. Prompt and effective detection, diagnosis, and treatment of sepsis requires frequent monitoring and assessment of patient vital signs and other relevant data present in the electronic health record. MethodsThis study explored the development of machine learning-based models to generate a novel sepsis risk index (SRI) which is an intuitive 0-100 marker that reflects the risk of a patient acquiring sepsis or septic shock and assists in timely diagnosis. Machine learning models were developed and validated using openly accessible critical care databases. The model was developed using a single database (from one institution) and validated on a separate database consisting of patient data collected across multiple ICUs. ResultsThe developed model achieved an area under the receiver operating characteristic curve of 0.82 and 0.84 for the diagnosis of sepsis and septic shock, respectively, with a sensitivity and specificity of 79.1% [75.1, 82.7] and 73.3% [72.8, 73.8] for a sepsis diagnosis and 83.8% [80.8, 86.5] and 73.3% [72.8, 73.8] for a septic shock diagnosis. ConclusionThe SRI provides critical care HCPs with an intuitive quantitative measure related to the risk of a patient having or acquiring a life-threatening infection. Evaluation of the SRI over time may provide HCPs the ability to initiate protective interventions (e.g. targeted antibiotic therapy).

Effect of circRNA_FOXO3 rs12196996 polymorphism and FOXO3 rs2232365 polymorphism on survival rate and severity of intensive care unit-acquired sepsis

ABSTRACT The expression of circRNA_FOXO3 was found to be positively associated with the expression of Forkhead Box O3 (FOXO3), which is targeted and regulated by miR-23a. Polymorphisms in rs12196996 and rs2232365 have been reported in various diseases. In this study, we recruited intensive care unit (ICU)-acquired sepsis patients and grouped them according to their genotypes of rs12196996 and rs2232365. Quantitative real-time PCR was performed to analyze the expression of circRNA_FOXO3, FOXO3 mRNA, and miR-23a. ELISA was carried out to evaluate the abundance of cytokines and luciferase assay was used to explore the inhibitory role of miR-23a on circRNA_FOXO3 and FOXO3. Accordingly, we found that rs12196996 GG and rs2232365 AA were significantly correlated with prolonged survival of ICU-acquired sepsis patients. Rs12196996 GG and rs2232365 AA were also correlated with increased level of miR-23a, IL-10 and decreased level of TNF, IL-2, IFN, IL-6 and IL-1β in the peripheral blood cell samples of patients with ICU-acquired sepsis. The luciferase activity of wild-type (WT) circRNA_FOXO3 and FOXO3 were severely reduced by miR-23a. MiR-23a precursors could effectively suppress the expression of circRNA_FOXO3 and FOXO3 in the cells. Moreover, LPS-induced cell viability loss and dysregulation of cytokines were effectively restored by the knockdown of FOXO3 or circRNA_FOXO3 siRNA in the cells. This study revealed that the minor allele of rs12196996 polymorphism and rs2232365 polymorphism collaboratively contributed to the increased survival and suppressed severity of ICU-acquired sepsis.

Descriptors of Sepsis Using the Sepsis-3 Criteria: A Cohort Study in Critical Care Units Within the U.K. National Institute for Health Research Critical Care Health Informatics Collaborative.

To describe the epidemiology of sepsis in critical care by applying the Sepsis-3 criteria to electronic health records. Retrospective cohort study using electronic health records. Ten ICUs from four U.K. National Health Service hospital trusts contributing to the National Institute for Health Research Critical Care Health Informatics Collaborative. A total of 28,456 critical care admissions (14,332 emergency medical, 4,585 emergency surgical, and 9,539 elective surgical). Twenty-nine thousand three hundred forty-three episodes of clinical deterioration were identified with a rise in Sequential Organ Failure Assessment score of at least 2 points, of which 14,869 (50.7%) were associated with antibiotic escalation and thereby met the Sepsis-3 criteria for sepsis. A total of 4,100 episodes of sepsis (27.6%) were associated with vasopressor use and lactate greater than 2.0 mmol/L, and therefore met the Sepsis-3 criteria for septic shock. ICU mortality by source of sepsis was highest for ICU-acquired sepsis (23.7%; 95% CI, 21.9-25.6%), followed by hospital-acquired sepsis (18.6%; 95% CI, 17.5-19.9%), and community-acquired sepsis (12.9%; 95% CI, 12.1-13.6%) (p for comparison less than 0.0001). We successfully operationalized the Sepsis-3 criteria to an electronic health record dataset to describe the characteristics of critical care patients with sepsis. This may facilitate sepsis research using electronic health record data at scale without relying on human coding.

Outcomes prediction in longitudinal data: Study designs evaluation, use case in ICU acquired sepsis

Outcomes’ prediction in Electronic Health Records (EHR) and specifically in Critical Care is increasingly attracting more exploration and research. In this study, we used clinical data from the Intensive Care Unit (ICU), focusing on ICU acquired sepsis. Looking at the current literature, several evaluation approaches are reported, inspired by epidemiological designs, in which some do not always reflect real-life application’s conditions. This problem seems relevant generally to outcomes’ prediction in longitudinal EHR data, or generally longitudinal data, while in this study we focused on ICU data. Unlike in most previous studies that investigated all sepsis admissions, we focused specifically on ICU-Acquired Sepsis. Due to the sparse nature of the longitudinal data, we employed the use of Temporal Abstraction and Time Interval-Related Patterns discovery, which are further used as classification features. Two experiments were designed using three different outcomes prediction study designs from the literature, implementing various levels of real-life conditions to evaluate the prediction models. The first experiment focused on predicting whether a patient would suffer from ICU-acquired sepsis and when during her admission, given a sliding observation time window, and the comparison of the three study designs behavior. The second experiment focused only on predicting whether the patient will suffer from ICU-acquired sepsis, based on data taken relatively to his admission start time. Our results show that using Temporal Discretization for Classification (TD4C) led to better performance than using the Equal-Width Discretization, Knowledge-Based, or SAX. Also, using two states abstraction was better than three or four. Using the default Binary TIRP representation method performed better than Mean Duration, Horizontal Support, and horizontally normalized horizontal support. Using XGBoost as a classifier performed better than Logistic Regression, Neural Net, or Random Forest. Additionally, it is demonstrated why the use of case-crossover-control is most appropriate for real life application conditions evaluation, unlike other incomplete designs that may even result in “better performance”.

Monocyte distribution width (MDW) parameter as a sepsis indicator in intensive care units.

Patients in Intensive Care Units (ICU) are a high-risk population for sepsis, recognized as a major cause of admission and death. The aim of the current study was to evaluate the diagnostic accuracy and prognostication of monocyte distribution width (MDW) in sepsis for patients admitted to ICU. Between January and June 2020, we conducted a prospective observational study during the hospitalization of 506 adult patients admitted to the ICU. MDW was evaluated in 2,367 consecutive samples received for routine complete blood counts (CBC) performed once a day and every day during the study. Sepsis was diagnosed according to Sepsis-3 criteria and patients enrolled were classified in the following groups: no sepsis, sepsis and septic shock. MDW values were significantly higher in patients with sepsis or septic shock in comparison to those within the no sepsis group [median 26.23 (IQR: 23.48-29.83); 28.97 (IQR: 21.27-37.21); 21.99 (IQR: 19.86-24.36) respectively]. ROC analysis demonstrated that AUC is 0.785 with a sensitivity of 66.88% and specificity of 77.79% at a cut-off point of 24.63. In patients that developed an ICU-acquired sepsis MDW showed an increase from 21.33 [median (IQR: 19.47-21.72)] to 29.19 [median (IQR: 27.46-31.47)]. MDW increase is not affected by the aetiology of sepsis, even in patients with COVID-19. In sepsis survivors a decrease of MDW values were found from the first time to the end of their stay [median from 29.14 (IQR: 26.22-32.52) to 25.67 (IQR: 22.93-30.28)]. In ICU, MDW enhances the sepsis detection and is related to disease severity.

1167. Got Micafungin? The Incidence of Fungemia in Patients with Septic Shock

BackgroundTimely administration of antibiotics in patients presenting with sepsis decreases mortality, however evidence evaluating empiric antifungal coverage has been inconclusive. Recent data have shown no mortality benefit of empiric antifungal therapy in patients with ICU-acquired sepsis. Despite the lack of data, the Surviving Sepsis Campaign recommends empiric coverage for all suspected pathogens, including fungi. The purpose of this study is to determine the frequency of concomitant septic shock and fungemia at UMass Memorial Medical Center, a large tertiary care center.MethodsThis was a retrospective cohort study that included adult patients with a discharge diagnosis of severe sepsis or septic shock and/or fungemia admitted to UMMMC between October 2017 and October 2019. Patients with positive fungal blood cultures were further reviewed to identify if septic shock was present within 24 hours of blood culture collection. Additionally, risk factors for fungemia and 30-day mortality were assessed. Exclusion criteria included pregnancy, cultures from outside hospitals, incarceration, and hospice care.ResultsIn the analysis period, 4,253 patients had a discharge diagnosis of severe sepsis or septic shock. There were 68 cases of fungemia. In total, 54 patients with fungemia were included after applying exclusion criteria. Of the 54 patients with fungemia, 8 patients (15.1%) met criteria for septic shock at the time of positive blood culture, while 81% met SIRS criteria. Of the 4,253 total patients, 0.19% had coexisting fungemia and septic shock. At 30 days, four patients (7.4%) with both septic shock and fungemia had expired out of 12 total deaths. Three of the four deaths had multiple risk factors for fungemia including central line in place for greater than 48 hours, parenteral nutrition, and prolonged antibiotic therapy.ConclusionSeptic shock is a rare presentation of fungemia. Most patients with septic shock and fungemia have known risk factors. Despite recommendations by the Surviving Sepsis Campaign to initiate therapy for all likely pathogens, including fungal species, the incidence of fungemia presenting as septic shock at our academic medical center was very low and does not appear to warrant empiric coverage.Disclosures All Authors: No reported disclosures

Earlier Recognition of Sepsis and Septic Shock With Sepsis-3 Criteria- It's Still Early Days!

To the Editor: Evidence of earlier detection of sepsis would greatly support adoption of the sepsis-3 definition (1). We therefore read with great interest the recent study by Scheer et al. (2), comparatively evaluating sepsis onset based on sepsis-3 criteria in patients identified with the previous SIRS-based approach (sepsis-1). We believe the choice of study population does not permit a fair comparison of sepsis criteria and the study leaves important methodological questions unanswered, motivating us to caution against the rather strong conclusion that sepsis-3 criteria facilitate an earlier and more predictive sepsis diagnosis than sepsis-1. Notably, the study included only patients with severe sepsis and septic shock imposing two restrictions on the study population: it leaves out patients with simple sepsis according to sepsis-1 and patients detected with sepsis-3 not detected by sepsis-1. The first leads to a narrowed patient spectrum that shrinks the denominator of sepsis-1 cases that had to be successfully identified by sepsis-3 to show performance superior to sepsis-1. With the impact of simple sepsis cases unknown, patient selection may have favored sepsis-3, making the comparison unbalanced. Patients who developed severe sepsis or septic shock from simple sepsis would only be detected by this selection procedure once they developed organ dysfunction, although their septic status according to sepsis-1 may have been known before this point in time. In our opinion, evidence must first be provided that simple sepsis in the intensive care unit (ICU) should rather be classified as uncomplicated infection as per sepsis-3 and can, therefore, be deliberately excluded when comparing sepsis criteria. The second restriction disadvantages sepsis-3 as patients detected by sepsis-3 but not sepsis-1 would all formally have been detected earlier by sepsis-3. It also precludes determination of diagnostic specificity. The net effect of both restrictions on the comparison of sepsis criteria for early sepsis detection is unclear. The prospective identification of severe sepsis and septic shock and the retrospective assignment of sepsis-3 represent disparate approaches, and add uncertainty to the validity of the results. This could have been addressed by reporting how suspicion of infection was retrospectively identified, how the absence of SIRS was determined in those detected earlier with sepsis-3, if mechanical ventilation and pharmacological circulatory support masking SIRS (3, 4) were taken into account, and how many of the patients with non-ICU acquired sepsis detected earlier with sepsis-3 were SIRS negative. Unfortunately, we failed to reproduce the reported P value of 0.011 (Fig. 3A in (2)) used as evidence of superior early detection capability of sepsis-3 in ICU-acquired sepsis that, according to the Methods section, appears to come from a one-sided binomial test. Instead, when we compared 93% with 100% with a two-sided chi-squared test with Yates correction, we obtained a P value of 0.0118, which however underscores that a significant proportion went undetected by sepsis-3. Timely recognition was achieved in 86%, which means that in 14% it was delayed on day 0. Instead, the result of 93% on day +1 is emphasized in the study; the reason for granting what appears to be a grace period of 1 day to sepsis-3 remains unclear with the methodology presented. Finally, we wonder what proportion of undetected patients is considered acceptable as a tradeoff for potentially earlier recognition of patients with organ dysfunction. Evidence for global superiority of either set of sepsis criteria, in our view, requires studies with unselected patients and transparent methodology. Sincerely yours,

Association between \u03b2-blocker use and mortality in critically ill patients: a nested cohort study

Backgroundβ-blockers have several indications in critically ill patients and are commonly used. The aim of this study is to examine the relationship between the use of β-blockers in critically ill patients and mortality.MethodsThis was a nested cohort study in which all medical-surgical ICU patients (N = 523) enrolled in a randomized clinical trial of intensive insulin therapy (ISRCTN07413772) were grouped according to β-blocker use during ICU stay. To account for the indication of β-blockers, we constructed a propensity score using selected clinically-relevant and statistically-significant variables related to β-blocker exposure and outcome. The primary endpoints were all-cause ICU and hospital mortality. Secondary endpoints were the development of severe sepsis during ICU stay, ICU and hospital length of stay, and mechanical ventilation duration. Using multivariable models, we adjusted the associations of β-blockers and these outcomes to the propensity score.ResultsOf the 523 patients enrolled in the study, 89 (17.0%) received β-blockers during their ICU stay. There were no significant associations between β-blocker therapy and ICU mortality (adjusted odds ratio [aOR] 1.56, 95% confidence interval [CI] 0.83–2.9, P = 0.16), hospital mortality (aOR 1.09, 95% CI 0.99–1.20, P = 0.73), the risk of ICU-acquired severe sepsis (aOR 1.67, 95% CI 0.95–2.97, P = 0.08), mechanical ventilation duration (P = 0.17), or ICU length of stay (P = 0.22). However, β-blocker use was associated with increased ICU and hospital mortality among nondiabetic patients (aOR 2.93, 95% CI 1.19–7.23, and 2.43, 95% CI 1.05–5.64, respectively).ConclusionsOur study showed that β-blockers during the ICU stay had no significant association with mortality or morbidity. However, β-blocker therapy was associated with increased mortality in non-diabetic patients.Trial registrationISRCTN07413772; (dated 13.07.2005).

Weekly high-dose liposomal amphotericin B (L-AmB) in critically ill septic patients with multiple Candida colonization: The AmBiDex study.

BackgroundTo demonstrate the feasibility and safety of weekly high-dose liposomal amphotericin B (L-AmB) (as a pre-emptive antifungal treatment) for 2 weeks in patients with septic shock and Candida colonization.MethodsPilot, multicentre, open-label, prospective study conducted in seven French ICUs. Non-immunocompromised patients, receiving mechanical ventilation were eligible if they presented ICU-acquired severe sepsis requiring newly administered antibacterial agents and Candida colonization in at least two sites. Exclusion criteria included the need for antifungal therapy and creatinine > 220 μmol/L. All patients were to receive a high-dose L-AmB (10 mg/kg/week) for two weeks. A follow-up period of 21 days following the second administration of L-AmB was conducted. Treated patients were compared to 69 matched untreated controls admitted in the same ICUs before the study period.ResultsTwenty-one patients were included in the study, of which 20 received at least one infusion of high-dose L-AmB. A total of 24 adverse events were identified in 13(61%) patients. Fourteen adverse events were categorized as serious in 8(38%) patients. In four cases the adverse events were considered as potentially related to study drug administration and resulted in L-AmB discontinuation in one patient. Few patients experienced severe renal toxicity since no patient presented with severe hypokalemia. No patients required renal replacement therapy. Compared to matched controls, no significant increase in serum creatinine levels in patients receiving high-dose L-AmB was reported.ConclusionsWeekly administration of high-dose L-AmB has a manageable safety profile and is feasible in patients with ICU-acquired sepsis and multiple Candida colonization. Trials of L-AmB versus other antifungal agents used as pre-emptive antifungal therapy are warranted.Trial registrationClinicalTrials.gov NCT00697944

Empirical Micafungin Treatment and Survival Without Invasive Fungal Infection in Adults With ICU-Acquired Sepsis, Candida Colonization, and Multiple Organ Failure: The EMPIRICUS Randomized Clinical Trial.

Although frequently used in treating intensive care unit (ICU) patients with sepsis, empirical antifungal therapy, initiated for suspected fungal infection, has not been shown to improve outcome. To determine whether empirical micafungin reduces invasive fungal infection (IFI)-free survival at day 28. Multicenter double-blind placebo-controlled study of 260 nonneutropenic, nontransplanted, critically ill patients with ICU-acquired sepsis, multiple Candida colonization, multiple organ failure, exposed to broad-spectrum antibacterial agents, and enrolled between July 2012 and February 2015 in 19 French ICUs. Empirical treatment with micafungin (100 mg, once daily, for 14 days) (n = 131) vs placebo (n = 129). The primary end point was survival without proven IFI 28 days after randomization. Key secondary end points included new proven fungal infections, survival at day 28 and day 90, organ failure, serum (1-3)-β-D-glucan level evolution, and incidence of ventilator-associated bacterial pneumonia. Among 260 patients (mean age 63 years; 91 [35%] women), 251 (128, micafungin group; 123, placebo group) were included in the modified intent-to-treat analysis. Median values were 8 for Sequential Organ Failure Assessment (SOFA) score, 3 for number of Candida-colonized sites, and 99 pg/mL for level of (1-3)-β-D-glucan. On day 28, there were 82 (68%) patients in the micafungin group vs 79 (60.2%) in the placebo group who were alive and IFI free (hazard ratio [HR], 1.35 [95% CI, 0.87-2.08]). Results were similar among patients with a (1-3)-β-D-glucan level of greater than 80 pg/mL (n = 175; HR, 1.41 [95% CI, 0.85-2.33]). Day-28 IFI-free survival in patients with a high SOFA score (>8) was not significantly different when compared between the micafungin vs placebo groups (HR, 1.69 [95% CI, 0.96-2.94]). Use of empirical micafungin decreased the rate of new invasive fungal infection in 4 of 128 patients (3%) in the micafungin group vs placebo (15/123 patients [12%]) (P = .008). Among nonneutropenic critically ill patients with ICU-acquired sepsis, Candida species colonization at multiple sites, and multiple organ failure, empirical treatment with micafungin, compared with placebo, did not increase fungal infection-free survival at day 28. clinicaltrials.gov Idenitfier: NCT01773876.

Association between aspirin therapy and the outcome in critically ill patients: a nested cohort study.

BackgroundAntiplatelet therapy may attenuate the undesirable effects of platelets on the inflammatory cascades in critical illness. The objective of this study was to evaluate the association between aspirin therapy during intensive care unit (ICU) stay and all-cause mortality.MethodsThis was a nested cohort study within two randomized controlled trials in which all enrolled patients (N = 763) were grouped according to aspirin intake during ICU stay. The primary endpoints were all-cause ICU mortality and hospital mortality. Secondary endpoints included the development of severe sepsis during the ICU stay, ICU and hospital length of stay and the duration of mechanical ventilation. Propensity score was used to adjust for clinically and statistically relevant variables.ResultsOf the 763 patients, 154 patients (20 %) received aspirin. Aspirin therapy was not associated with a reduction in ICU mortality (adjusted OR 1.18, 95 % CI 0.69–2.02, P = 0.55) nor with hospital mortality (adjusted OR 0.95, 95 % CI 0.61–1.50, P = 0.82). Aspirin use had no preferential association with mortality among any of the study subgroups. Additionally, aspirin therapy was associated with higher risk of ICU-acquired severe sepsis, and increased mechanical ventilation duration and ICU length of stay.ConclusionOur study showed that the use of aspirin in critically ill patients was not associated with lower mortality, but rather with an increased morbidity.Trial Registration NumberISRCTN07413772 and ISRCTN96294863.

Erratum: Elevated basal levels of circulating activated platelets predict ICU-acquired sepsis and mortality: a prospective study

Platelets are now considered to be immune and inflammatory agents as well as key cells in coagulation, and as such have been implicated in the pathophysiology of sepsis [1]. Thrombocytopenia is associated with sepsis severity and poor prognosis, and hyperactivated platelets probably contribute to microvascular thrombosis and organ failure. In the present study, we evaluated platelet activation markers as potential predictive markers of sepsis and of mortality among four commonly encountered populations of patients admitted to ICUs.

Elevated basal levels of circulating activated platelets predict ICU-acquired sepsis and mortality: a prospective study

Elevated basal levels of circulating activated platelets predict ICU-acquired sepsis and mortality: a prospective study

Genetic polymorphisms of innate and adaptive immunity as predictors of outcome in critically ill patients

Sepsis and septic shock frequently cause the admission or complicate the clinical course of critically ill patients admitted in the intensive care units (ICU). Genetic variations disrupting the immune sensing of infectious organisms, could affect the ability of the immune system to respond to infection, and may influence both the genetic predisposition to infection and the diversity of the clinical presentation of sepsis. The aim of this study was to uncover possible associations between common functional immune gene polymorphisms (of both innate and adaptive immunity) and ICU-acquired sepsis and mortality. The TLR4-D299G (rs4986790), TLR4-T399I (rs4986791), C2-c.841_849+19del28 (rs9332736), TACI-C104R (rs34557412), BAFFR-P21R (rs77874543), and BAFFR-H159Y (rs61756766) polymorphisms were detected in a cohort of 215 critically ill patients, admitted in an 8-bed medical/surgical ICU. Interestingly, TLR4-D299G, TLR4-T399I and BAFFR-P21R carriage was associated with a lower risk of ICU-acquired sepsis. This association applied particularly in medical patients, while in trauma and surgical patients no significant associations were observed. Moreover, carriers of TACI-C104R displayed an undiagnosed mild to moderate hypogammaglobulinemia along with a significantly lower survival rate in the ICU, although lethal events were not attributed to sepsis. These findings further elucidate the role that host immune genetic variations may play in the susceptibility to ICU-acquired sepsis and ICU mortality.

Induced expression and functional effects of aquaporin-1 in human leukocytes in sepsis

IntroductionGene expression profiling was performed via DNA microarrays in leukocytes from critically ill trauma patients nonseptic upon admission to the ICU, who subsequently developed either sepsis (n = 2) or severe sepsis and acute respiratory distress syndrome (n = 3). By comparing our results with published expression profiling studies in animal models of sepsis and lung injury, we found aquaporin-1 to be differentially expressed across all studies. Our aim was to determine how the water channel aquaporin-1 is involved in regulating the immune response in critically ill patients during infection acquired in the ICU.MethodsFollowing the results of the initial genetic screening study, we prospectively followed aquaporin-1 leukocyte expression patterns in patients with ICU-acquired sepsis who subsequently developed septic shock (n = 16) versus critically ill patients who were discharged without developing sepsis (n = 13). We additionally determined aquaporin-1 expression upon lipopolysaccharide (LPS) exposure and explored functional effects of aquaporin-1 induction in polymorphonuclear granulocytes (PMNs).ResultsLeukocyte aquaporin-1 expression was induced at the onset of sepsis (median 1.71-fold increase; interquartile range: 0.99 to 2.42, P = 0.012 from baseline) and was further increased upon septic shock (median 3.00-fold increase; interquartile range: 1.20 to 5.40, P = 0.023 from sepsis, Wilcoxon signed-rank test); no difference was observed between baseline and discharge in patients who did not develop sepsis. Stimulation of PMNs by LPS led to increased expression of aquaporin-1 in vitro, which could be abrogated by the NF-κB inhibitor EF-24. PMN hypotonic challenge resulted in a transient increase of the relative cell volume, which returned to baseline after 600 seconds, while incubation in the presence of LPS resulted in persistently increased cell volume. The latter could be abolished by blocking aquaporin-1 with mercury and restored by incubation in β-mercaptoethanol, which abrogated the action of mercury inhibition.ConclusionsAquaporin-1 is induced in leukocytes of patients with ICU-acquired sepsis and exhibits higher expression in septic shock. This phenomenon may be due to LPS-triggered NF-κB activation that can also lead to alterations in plasma membrane permeability.

PSP/reg and NT-proCNP to predict the occurrence of ICU-acquired sepsis in severe trauma patients: results of a pilot study

PSP/reg and NT-proCNP to predict the occurrence of ICU-acquired sepsis in severe trauma patients: results of a pilot study

Association of preservative-free propofol use and outcome in critically ill patients

Propofol is widely used to provide sedation to patients in the intensive care unit (ICU). This study examined whether preservative-free propofol infusion independently influences outcome in critically ill patients. This was a nested cohort study within a randomized controlled trial. ICU patients who received preservative-free propofol and those who did not were compared. The following data were collected: demographic information, APACHE II score, admission category, chronic severe illnesses, nutritional data, and blood glucose level and insulin dose. The main exposure was the use of preservative-free propofol infusion. The main outcomes were the occurrence of ICU-acquired infections, ICU-acquired sepsis, and ICU and hospital mortality. A total of 523 patients were included (no propofol group, n = 399; propofol group, n = 124). After adjustment for differences in baseline characteristics, preservative-free propofol use was associated with increased risk of ICU-acquired infections (adjustedodds ratio [aOR], 1.89, 95% confidence interval [CI], 1.17-3.06; P = .009) and ICU-acquired severe sepsis and septic shock (aOR, 1.91; 95% CI, 1.12-3.28; P = .02), but not with ICU or hospital mortality. Preservative-free propofol infusion in critically ill patients may be associated with increased risk of ICU-acquired infections and ICU-acquired sepsis, with no significant difference in ICU or hospital mortality. This association might have been related to the use of preservative-free preparations.

SCORING SYSTEMS FOR PREDICTION OF MORTALITY IN PATIENTS WITH INTENSIVE CARE UNIT-ACQUIRED SEPSIS

This study compares the effectiveness of the Pitt bacteremia score, the Charlson weighted index of comorbidity, and the Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring systems for the prediction of mortality in intensive care unit (ICU) patients with sepsis using the retrospective observational method on 134 patients with ICU-acquired sepsis. The statistical analyses show several important findings. First, Pitt bacteremia score is significantly correlated with the APACHE II scoring system (correlation coefficient = 0.738, P < 0.001). Second, the APACHE II scoring system, the Pitt bacteremia score, and the Charlson weighted index of comorbidity are independently correlated with mortality. Third, the Pitt bacteremia score and the APACHE II scores are positively related to mortality in patients with ICU-acquired sepsis. As the result of the analyses, the mortality rate in patients with sepsis in the ICU is better predicted with the Pitt bacteremia score because it provides better estimation of sensitivity and specificity than the APACHE II scoring system and the Charlson weighted index of comorbidity.

ICU-acquired infections and Sepsis: More of a deadly duo

ICU-acquired infections and Sepsis: More of a deadly duo

Extracranial complications in patients with acute brain injury: a post-hoc analysis of the SOAP study

To assess the incidence and severity of nonneurological organ dysfunction and its effect on outcome in acute neurological patients in an international cohort observational study. Analysis of database from the observational Sepsis Occurrence in Acutely Ill Patients (SOAP) study in 198 intensive care units (ICUs) in 24 European countries. All adult patients admitted to the participating ICUs between 1 and 15 May 2002. Of the 3,147 patients in the SOAP database 373 (12%) were admitted with a neurological diagnosis, including 154 (41%) with traumatic brain injury and 186 (50%) with cerebrovascular accident. Patients were followed until death, hospital discharge, or for 60 days. Neurological patients were younger and had a higher incidence of trauma and fewer comorbidities than nonneurological patients. Neurological patients developed ICU-acquired sepsis and respiratory failure more frequently than the other patients. ICU and hospital mortality rates were higher and ICU length of stay longer in neurological than in nonneurological patients. Multivariate logistic analysis showed that, in addition to the Glasgow Coma Score (GCS) and the presence of nontraumatic brain injury, cardiovascular failure, hepatic failure, and ALI/ARDS were the only factors independently associated with a higher risk of death in the ICU in patients with a neurological diagnosis. Although neurological patients were younger and had fewer comorbidities, they developed ICU-acquired sepsis and respiratory failure more frequently than other patients. Efforts should be oriented to reduce cardiovascular, hepatic, and respiratory complications.