Sepsis Patients In Intensive Care Unit Research Articles

The Effects of Blood Lactate Level on Mortality in Patients Developing Sepsis in Intensive Care Unit

Aim: Sepsis is a serious condition with high mortality and morbidity in intensive care units (ICUs). Mortality decreases with early and appropriate antimicrobial treatment. We aimed to investigate the relationship between lactate levels and mortality in the ICU of our hospital. Methods: Patient records > 18, hospitalized in the ICU of Konya Meram State Hospital between January 2022-January 2024, were retrospectively examined. All patients microbiologically confirmed to have positive blood culture results and diagnosed sepsis were included in the study. Age on admission, gender, diagnoses at hospitalization, Apache II, length of stay, and mortality in ICU were obtained from patients’ medical records. Mortality rates within the first 28 days were recorded. Lactate levels were compared in patients with and without mortality. The value of lactate in predicting mortality was evaluated statistically. Results: Of 56 patients included in the study, whose diagnoses of sepsis were microbiologically proven, 38 (67.9%) died. The area under ROC curve (AUC) of lactate in predicting mortality was 0.738 [95% confidence interval (CI): 0.590 –0.886, (p=0.004)] (Figure.1). Threshold lactate value for mortality was 1.7 mmol/L (sensitivity: 73.7%, specificity: 61.1%). While lactate levels and length of hospital stay were statistically significant between sepsis patients with and without mortality (p=0.004, p=0.00), gender and Apache II were detected not to be significantly different in exitus patients [mean 27.87, standard deviation (SD): 6.82] and survivors (mean 26.39, SD: 5.94) (p=0.85, p=0.43). Conclusion: Here, we found that lactate level may be a significant biomarker in the early treatment and follow-up of sepsis patients in ICUs.

Predictive Value of Combined Detection of Serum LGALS3BP and GDF-15 for the Prognosis of ICU Sepsis Patients.

This study aims to investigate the effectiveness of combining serum lectin galactoside-binding soluble 3 binding protein (LGALS3BP) with growth differentiation factor 15 (GDF-15) for predicting outcomes in sepsis patients in an intensive care unit (ICU) setting. The study involved 208 sepsis patients from the ICU of our hospital. These patients were categorized based on their 28-day survival outcomes into two groups: 166 in the survival group and 42 in the mortality group. The serum levels of LGALS3BP and GDF-15 were measured using the ELISA technique. Pearson and Spearman methods were utilized for correlation analysis. Factors affecting mortality in ICU sepsis patients were evaluated through multivariate logistic regression analysis. The efficacy of these biomarkers in prognosis prediction was assessed using receiver operating characteristic (ROC) curve analysis. The proportion of septic shock, APACHE II score, SOFA score, and serum LGALS3BP and GDF-15 levels in ICU sepsis patients in the death group were obviously higher than those in the survival group (P<0.05). The severity of ICU sepsis patients, APACHE II score, and SOFA score were obviously positively correlated with serum LGALS3BP and GDF-15 levels (P<0.05). LGALS3BP (OR: 95% CI=2.745:1.583~4.761) and GDF-15 (OR: 95% CI=2.639:1.423~4.893) were independent risk factors for death in ICU sepsis patients (P<0.05). The AUC of serum LGALS3BP and GDF-15 levels alone in predicting death in ICU sepsis patients was 0.859 and 0.854, obviously lower than the AUC of the combination, 0.943 (Z=2.704, 2.287, P<0.05). The AUC for predicting mortality in ICU sepsis patients using the APACHE II and SOFA scores were 0.832 and 0.842, respectively. The differences in comparison to the AUCs of LGALS3BP and GDF-15 were not statistically significant (P > 0.05). Serum levels of LGALS3BP and GDF-15 can both be used as predictive indicators for death in ICU sepsis patients, and their combined predictive efficacy is better.

Comparison of Trends of Procalcitonin and Neutrophil to Lymphocyte Ratio in Patients of Sepsis in Intensive Care Unit.

This study examines the trends of procalcitonin (PCT), neutrophil-to-lymphocyte ratio (NLR), and sequential organ failure assessment (SOFA) scores in intensive care unit (ICU) sepsis patients from different infection sources. Elevations in PCT and NLR reflect infection severity and predict sepsis prognosis. Combining them may enhance diagnostic accuracy and prognostic capabilities, despite variations in cut-off values. The study emphasizes the significance of these biomarkers in improving sepsis management and patient outcomes. This was a prospective observation study of ICU sepsis patients from different infection sources. Procalcitonin and NLR levels were measured on days 0, 2, and 4 of admission. Sequential organ failure assessment scores on these days were also analyzed. The cut-off values were obtained for predicting the prognosis of sepsis ICU patients. The study included 100 sepsis patients with an equal distribution of males and females and a mean age of 72 years. Procalcitonin showed a significant decrease over time, while NLR initially increased before decreasing on day 4, and SOFA scores showed no significant changes. Deceased patients had significantly higher PCT and SOFA scores on days 2 and 4. Receiver operating characteristic curve analysis showed promising predictive results for PCT on day 4 and SOFA scores on days 2 and 4. Understanding the trends of PCT and NLR concerning the infection source can provide deeper insights into their diagnostic and prognostic capabilities. This comparative analysis of PCT, NLR, and SOFA score trends contributes to the improvement of patient outcomes through accurate assessment of sepsis severity and progression, early diagnosis, and timely intervention. Jayara A, Mascarenhas J, Gandhi B, Nimbolkar J. Comparison of Trends of Procalcitonin and Neutrophil to Lymphocyte Ratio in Patients of Sepsis in Intensive Care Unit. Indian J Crit Care Med 2024;28(10):942-951.

Correlation Between Red Cell Distribution Width (RDW) and Sequential Organ Failure Assessment (SOFA) Score in Sepsis Patients

Background: There are an estimated 31.5 million cases of sepsis per year, and approximately 61% end up in sepsis shock, with a potential mortality rate of 5.3 million per year. In addition to the sequential organ failure assessment (SOFA) score, several biomarkers have been used to assess severity and predict mortality, including red cell distribution width (RDW). RDW is increased in conditions of ineffective red blood cell production or destruction that occur in inflammation or infection. RDW above 15.5% is associated with rigid and indestructible red blood cells, which can impede microcirculation and contribute to organ dysfunction, a part of the SOFA score.Objective: The aim of this study was to determine the correlation between RDW and SOFA score in sepsis patients admitted to the intensive care unit (ICU) of Rumah Sakit Umum Pusat Haji Adam Malik Medan.Methods: This study used a cohort-prospective study design with a consecutive sampling technique of the population that met the inclusion criteria. The samples were sepsis patients who were admitted to the ICU of Rumah Sakit Umum Pusat Haji Adam Malik Medan in April–June 2023. The data was analyzed by a Pearson or Spearman analysis test.Result: There was a significant correlation between RDW and SOFA score (r = 0.471; p&lt;0.05) in ICU sepsis patients. There was a significant correlation (p = 0.003) between RDW values and SOFA scores on the third day, where there was a moderate degree of correlation (r = 0.471), but there was no significant correlation (p = 0.103) between RDW values and SOFA scores on the first day. The sensitivity, specificity, and cut-off values of RDW were found to be 76.5%, 75%, and 14.75%, which compared to SOFA were 76.5%, 75%, and 10.5.Conclusion: There is a statistically significant relationship between RDW and SOFA, with a moderate correlation.

Predictive value of the dynamics of absolute lymphocyte counts for 90-day mortality in ICU sepsis patients: a retrospective big data study

ObjectivesThe objective of the study was to assess the clinical predictive value of the dynamics of absolute lymphocyte count (ALC) for 90-day all-cause mortality in sepsis patients in intensive care...

Improved prediction of sepsis-associated encephalopathy in intensive care unit sepsis patients with an innovative nomogram tool.

Sepsis-associated encephalopathy (SAE) occurs as a result of systemic inflammation caused by sepsis. It has been observed that the majority of sepsis patients experience SAE while being treated in the intensive care unit (ICU), and a significant number of survivors continue suffering from cognitive impairment even after recovering from the illness. The objective of this study was to create a predictive nomogram that could be used to identify SAE risk factors in patients with ICU sepsis. We conducted a retrospective cohort study using the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. We defined SAE as a Glasgow Coma Scale (GCS) score of 15 or less, or delirium. The patients were randomly divided into training and validation cohorts. We used least absolute shrinkage and selection operator (LASSO) regression modeling to optimize feature selection. Independent risk factors were determined through a multivariable logistic regression analysis, and a prediction model was built. The performance of the nomogram was evaluated using various metrics including the area under the receiver operating characteristic curve (AUC), calibration plots, Hosmer-Lemeshow test, decision curve analysis (DCA), net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Among the 4,476 sepsis patients screened, 2,781 (62.1%) developed SAE. In-hospital mortality was higher in the SAE group compared to the non-SAE group (9.5% vs. 3.7%, p < 0.001). Several variables were analyzed, including the patient's age, gender, BMI on admission, mean arterial pressure, body temperature, platelet count, sodium level, and use of midazolam. These variables were used to create and validate a nomogram. The nomogram's performance, assessed by AUC, NRI, IDI, and DCA, was found to be superior to the conventional SOFA score combined with delirium. Calibration plots and the Hosmer-Lemeshow test confirmed the accuracy of the nomogram. The enhanced NRI and IDI values demonstrated that our scoring system outperformed traditional diagnostic approaches. Additionally, the DCA curve indicated the practicality of the nomogram in clinical settings. This study successfully identified autonomous risk factors associated with the emergence of SAE in sepsis patients and utilized them to formulate a predictive model. The outcomes of this investigation have the potential to serve as a valuable clinical resource for the timely detection of SAE in patients.

Presepsin is a more useful predictor of septic AKI and ARDS for very-old sepsis patients than for young sepsis patients in ICUs: a pilot study

ObjectiveSepsis is a syndrome of life-threatening organ dysfunction. This study aimed to determine whether presepsin is a useful predictor of septic acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), disseminated intravascular coagulation (DIC), and shock in very-old sepsis patients aged 75 years in intensive care units (ICUs).ResultsA total of 83 adult patients diagnosed with sepsis were prospectively examined and divided into two groups: those aged 75 years and older (over 75 group) and those aged younger than 75 years (under 75 group). Presepsin values were measured after ICU admission. Inflammation-based prognostic scores were also examined. For category classification, total scores (“inflammation-presepsin scores [iPS]”) were calculated. Presepsin values, inflammation-based prognostic scores, and iPS were compared between patients with septic AKI, ARDS, DIC, or shock and those without these disorders in the over 75 and under 75 groups. Areas under the curve of presepsin for predicting septic AKI and ARDS in the over 75 group were both > 0.7, which were significantly higher than those in the under 75 group. In conclusion, presepsin is a more useful predictor of septic AKI and ARDS for very-old sepsis patients (over 75 years) than for younger sepsis patients (under 75 years).

Analysis of the diagnostic and prognostic value of serum PAD2 in patients with sepsis in the intensive care unit

BackgroundSepsis is a common disease in the intensive care unit (ICU). In recent years, the incidence rate and mortality rate remain high. Early diagnosis of sepsis is crucial for treatment and can effectively reduce mortality. So far, the ability of serum peptidylarginine deaminase 2 (PAD2) in the diagnosis and prognosis of sepsis patients is still unclear. We conducted this study to reveal the clinical value of PAD2 as a biomarker for sepsis patients. MethodsA prospective study method was used to select 207 patients in the ICU of Renmin Hospital of Wuhan University from May 2022 to May 2023. They were divided into the sepsis group (n = 135) and control group (n = 72), and data were collected within 24 h of hospitalization. Sepsis patients were divided into a survival group (n = 80) and a non-survival group (n = 55) based on their 28-day survival status. Using statistical methods to evaluate the diagnostic and prognostic value of PAD2 in sepsis. ResultsThe serum PAD2 concentrations in the sepsis group were significantly higher than in the control group (median 16.70 vs 35.32 ng/ml, P < 0.001). Multivariate logistic regression analysis showed that the Quick Sequential Organ Failure Assessment (qSOFA), C-reactive protein (CRP), procalcitonin (PCT), and PAD2 were independent risk factors for sepsis. The Receiver operating characteristic (ROC) curve showed that the combined diagnostic value of qSOFA, CRP, PCT, and PAD2 was the highest. The serum PAD2 concentrations in the non-survival group of patients with sepsis were significantly higher than those in the survival group (median 29.26 vs 50.08 ng/ml, P < 0.05). The COX regression analysis showed that PAD2, sequential organ failure score Assessment (SOFA) score, and Acute Physiology and Chronic Health Evaluation (APACHE II) score were independent factors affecting the prognosis of sepsis patients. The ROC analysis showed that the combined prognostic value of PAD2, SOFA, and APACHE II scores was significantly higher than any single indicator. The Kaplan-Meier survival analysis showed that patients with PAD2 ≤ 48.62 ng/ml had a better prognosis. ConclusionThe significant increase in serum PAD2 concentrations in patients is an independent risk factor affecting the occurrence of sepsis and 28-day mortality. The combination of PAD2 and other indicators can further improve the diagnostic and prognostic value for ICU sepsis patients.

Integrated Analyses of Single-Cell Transcriptome and Mendelian Randomization Reveal the Protective Role of Resistin in Sepsis Survival in Intensive Care Unit.

The high morbidity and mortality rates associated with sepsis highlight the challenges of finding specific remedies for this condition in the intensive care unit (ICU). This study aimed to explore the differentially expressed genes (DEGs) specific to cell types in sepsis and investigate the role of resistin in the survival of sepsis patients through Mendelian randomization (MR) analyses. We used single-cell and bulk transcriptome data to identify cell type-specific DEGs between sepsis and healthy controls. MR analyses were then conducted to investigate the causal relationships between resistin (one of the identified DEGs) levels and the survival of sepsis patients. Additionally, we utilized meQTL (methylation quantitative trait loci) to identify cytosine-phosphate-guanine (CpG) sites that may directly affect sepsis. We identified 560 cell type-specific DEGs between sepsis and healthy controls. Notably, we observed the upregulation of resistin levels in macrophages during sepsis. In bulk transcriptome, RETN is also upregulated in sepsis samples compared with healthy controls. MR analyses revealed a negative association existed between the expression of resistin, at both gene and protein levels, and the mortality or severity of sepsis patients in ICU. Moreover, there were no associations observed between resistin levels and death or organ failure due to other causes. We also identified three methylation CpG sites, located in RETN or its promoter region-cg06633066, cg22322184, and cg02346997-that directly affected both resistin protein levels and sepsis death in the ICU. Our findings suggest that resistin may provide feasible protection for sepsis patients, particularly those with severe cases, without serious side effects. Therefore, resistin could be a potential drug candidate for sepsis treatment. Additionally, we identified two CpG sites, cg06633066 and cg22322184, that were associated with RETN protein levels and sepsis death, providing novel insights into the underlying mechanisms of sepsis.

Causes and prognosis analysis of hyperdynamic left ventricular ejection fraction in intensive care unit patients with sepsis

To analyze the causes of hyperdynamic left ventricular ejection fraction (LVEF) in sepsis patients in the intensive care unit (ICU) and its impact on prognosis. A retrospective cohort study was conducted. The clinical data of 273 sepsis patients admitted to the department of critical care medicine of the Affiliated People's Hospital of Jiangsu University from January 2018 to October 2021 were collected including gender, age, severity score, comorbidities, source of infection, vital signs, transthoracic echocardiographic (TTE) parameters, fluid intake and output, vasoactive drug dose, therapeutic measures and prognostic indicators. The patients were divided into normal LVEF group (LVEF 0.55-0.70), low LVEF group (LVEF < 0.55) and hyperdynamic LVEF group (LVEF > 0.70) according to the TTE examination results within 7 days of ICU admission. The clinical indicators among the three groups were compared and analyzed, and multivariate Logistic regression analysis was used to screen risk factors for the development of hyperdynamic LVEF in patients with sepsis. Spearman correlation analysis was used to determine the correlation between the mortality of different types of LVEF and clinical variables. Among 273 patients, 20 patients with severe valvular or cardiomyopathy at admission and those who did not completed cardiac ultrasound within 7 days of ICU admission were excluded. A total of 253 patients were finally enrolled, including 169 patients in the normal LVEF group, 40 patients in the low LVEF group, and 44 patients in the hyperdynamic LVEF group. There were statistically significant differences in age, sequential organ failure assessment (SOFA) score, central venous pressure (CVP), heart rate (HR), oxygenation index (PaO2/FiO2), blood lactate (Lac), urine output, vasoactive drug dose, ratio of hypertension, ischemic heart disease, chronic liver disease, cancer, invasive mechanical ventilation and renal replacement therapy (RRT), and incidence of septic shock among the different types of LVEF groups. TTE results analysis showed that the hyperdynamic LVEF group had higher stroke volume (SV) and cardiac index (CI) than those in the normal LVEF and low LVEF groups, lower systemic vascular resistance (SVR) than that in the normal LVEF and low LVEF groups, and an increased E/A ratio. The 90-day mortality in the hyperdynamic LVEF group was significantly higher than that in the normal LVEF and low LVEF groups [59.1% (26/44) vs. 24.9% (42/169), 32.5% (13/40), both P < 0.05]. Multivariate Logistic regression analysis showed that chronic liver disease [odds ratio (OR) = 1.712, 95% confidence interval (95%CI) was 0.912-3.234, P < 0.001], cancer (OR = 2.784, 95%CI was 1.296-6.151, P < 0.001), HR (OR = 1.026, 95%CI was 1.014-1.038, P < 0.001), vasoactive drug dose (OR = 1.133, 95%CI was 1.009-1.291, P < 0.001), and invasive mechanical ventilation (OR = 2.141, 95%CI was 1.285-3.651, P < 0.001) were independent factors for hyperdynamic LVEF in ICU sepsis patients. Correlation analysis showed that the mortality of hyperdynamic LVEF, normal LVEF and low LVEF patients was positively correlated with vasoactive drug dose (r value was 0.251, 0.361, 0.289, respectively, all P < 0.001). The mortality of the hyperdynamic LVEF patients was negatively correlated with SVR (r = -0.545, P < 0.001). Chronic liver disease, cancer, HR, vasoactive drugs dose, and invasive mechanical ventilation are independent risk factors for hyperdynamic LVEF in patients with sepsis. Hyperdynamic LVEF is positively associated with mortality in sepsis patients, which may be due to the the decrease of SVR caused by septic vascular paralysis.

Machine Learning for Early Prediction of Sepsis in Intensive Care Unit (ICU) Patients.

Background and Objectives: Early detection of sepsis is crucial and can save lives. However, identifying sepsis early and accurately remains a difficult task in the medical field. This study aims to investigate a new machine-learning approach. By analyzing the clinical laboratory results and vital signs of adult patients in the ICU, this approach can predict and detect the initial signs of sepsis. Materials and Methods: To examine survival rates and predict outcomes, the study utilized several models, including the proportional hazards model and data mining algorithms. We analyzed data from the BESTCare database at KAMC, with a focus on patients aged 14 and older who were admitted to the ICU between April and October 2018. We conducted a thorough analysis of the medical records of a total of 1182 patients who were diagnosed with sepsis. Results: We studied two approaches to predict sepsis in ICU patients. The regression model utilizing survival analysis showed moderate predictive ability, emphasizing the importance of only three factors-time (from sepsis to an outcome; discharge or death), lactic acid, and temperature-had a significant p-value (p = 0.000568, p = 0.01, p = 0.02, respectively). Other data mining algorithms may have limitations due to their assumptions of variable independence and linear classification nature. Conclusions: To achieve progress and accuracy in the field of sepsis prediction, it is important to continuously strive for improvement. By meticulously cleaning and selecting data attributes, we can create a strong foundation for future advancements in this area.

Progress in Rehabilitation Treatments for Sepsis Patients in ICU

Early active mobilisation and rehabilitation in the intensive care unit (ICU) is being used to prevent the long-term functional consequences of critical illness, sepsis patients need early rehabilitation treatment. Individualized rehabilitation is a safe and effective approach for patients with sepsis. This review aimed to introduce the necessity of rehabilitation for patients with sepsis in the ICU, the composition of the rehabilitation team, the time to begin rehabilitation, the focus of rehabilitation, and the main approaches.

Comparison of the predictive value of the Oxford acute severity of illness score and simplified acute physiology score II for in-hospital mortality in intensive care unit patients with sepsis: an analysis based on MIMIC-IV database

To compare the predictive value of Oxford acute severity of illness score (OASIS) and simplified acute physiology score II (SAPS II) for in-hospital mortality in intensive care unit (ICU) patients with sepsis. A retrospective cohort study was conducted using the data in the Medical Information Mart for Intensive Care-IV 0.4 (MIMIC-IV 0.4). Based on Sepsis-3 diagnostic criteria, the basic information of ICU adult sepsis patients with infection and sequential organ failure assessment (SOFA) score ≥ 2 within 24 hours of ICU admission admitted for the first time in the database was extracted, including gender, age, vasopressor drugs, sedative drugs, mechanical ventilation, renal replacement therapy, length of ICU stay, OASIS, SAPS II scores, etc. The primary outcome was in-hospital mortality. A receiver operator characteristic curve (ROC curve) was drawn, and the area under the ROC curve (AUC) was calculated to compare the prognostic value of OASIS score and SAPS II score. A total of 11 098 adult ICU sepsis patients were enrolled in the final analysis, of which 2 320 died and 8 778 survived in hospital, with a mortality of 20.90%. Compared with the survivors, the non-survivors were older [years old: 71 (60, 81) vs. 67 (56, 78)], had longer length of ICU stay [days: 6.95 (3.39, 13.07) vs. 4.23 (2.19, 9.73)] and higher proportions of using vasopressor drugs, sedative drugs, mechanical ventilation and renal replacement therapy [vasopressor drugs: 50.65% (1 175/2 320) vs. 33.05% (2 901/8 778), sedative drugs: 58.53% (1 358/2 320) vs. 48.41% (4 249/8 778), mechanical ventilation: 89.57% (2 078/2 320) vs. 81.66% (7 168/8 778), renal replacement therapy: 11.98% (278/2 320) vs. 6.57% (577/8 778), all P < 0.01]. Moreover, the non-survivors had higher OASIS score [43 (36, 49) vs. 35 (29, 41), P < 0.01] and SAPS II score [49 (40, 60) vs. 38 (31, 47), P < 0.01] as compared with the survivors. ROC curve analysis showed that the AUC of OASIS score and SAPS II score for predicting in-hospital death of ICU patients with sepsis was 0.713 [95% confidence interval (95%CI) was 0.701-0.725] and 0.716 (95%CI was 0.704-0.728), respectively, and the Delong test showed no significant difference in AUC between the two scoring systems (P > 0.05). OASIS score has a good predictive value for in-hospital mortality in sepsis patients, which is similar to SAPS II score. OASIS score is simpler and has a broader clinical application prospect than SAPS II score.

Effect of admission mode of septic patients in intensive care unit on acute kidney injury and prognosis

To investigate the effect of intensive care unit (ICU) admission model on acute kidney injury (AKI) development and the prognosis in patients with sepsis. Patients with sepsis admitted to the ICU of Xinjiang Uygur Autonomous Region People's Hospital from January 2019 to July 2020 were retrospectively analyzed. According to the ICU admission model, the patients were divided into emergency group (first admission or emergency transfer from relevant surgical departments) and delayed group (transferred from the general ward due to disease evolution). Patients were divided into AKI group and non-AKI group according to whether AKI was accompanied. The gender, age, underlying diseases, surgical history, heart rate, laboratory test indicators, acute physiology and chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA), organ failure and acute complications were collected. The incidence of AKI, 28-day mortality and length of ICU stay were recorded. Univariate and multivariate Logistic regression was used to analyze the risk factors of AKI in patients with sepsis. A total of 185 patients with sepsis were enrolled, including 96 cases in the emergency group and 89 cases in the delayed group. 119 cases of AKI occurred while 66 cases without AKI development. The incidence of AKI within 7 days and the 28-day mortality of patients in the delayed group were significantly higher than those in the emergency group [AKI incidence rate: 77.53% (69/89) vs. 52.08% (50/96), 28-day mortality: 24.72% (22/89) vs. 10.42% (10/96), both P < 0.05], and the length of ICU stay was significantly longer than that of the emergency group (days: 18.70±7.29 vs. 14.56±4.75, P < 0.05). Univariate Logistic analysis showed that there were significant differences in age, diabetes, hypertension, organ failure, heart failure, APACHE II score, SOFA score, white blood cell count (WBC), absolute neutrophil value, platelet count (PLT), blood lactate, total bilirubin, and ICU transferred from general wards between AKI group and non-AKI group. Multivariate Logistic regression analysis showed that transfer from general ward to ICU due to disease evolution was an independent risk factor for AKI in ICU sepsis patients [odds ratio (OR) = 5.165, 95% confidence interval (95%CI) was 3.911-6.823, P < 0.001]. Septic patients transferred from general ward to ICU due to disease evolution are more likely to develop AKI, and also had a higher mortality and longer ICU stay. It may be an independent risk factor for AKI complicated by patients with sepsis in ICU.

Prediction Models for Sepsis-Associated Thrombocytopenia Risk in Intensive Care Units Based on a Machine Learning Algorithm.

Sepsis-associated thrombocytopenia (SAT) is a common complication in the intensive care unit (ICU), which significantly increases the mortality rate and leads to poor prognosis of diseases. Machine learning (ML) is widely used in disease prediction in critically ill patients. Here, we aimed to establish prediction models for platelet decrease and severe platelet decrease in ICU patients with sepsis based on four common ML algorithms and identify the best prediction model. The research subjects were 1,455 ICU sepsis patients admitted to Dongyang People's Hospital affiliated with Wenzhou Medical University from January 1, 2015, to October 31, 2019. Basic clinical demographic information, biochemical indicators, and clinical outcomes were recorded. The prediction models were based on four ML algorithms: random forest, neural network, gradient boosting machine, and Bayesian algorithms. Thrombocytopenia was found to occur in 732 patients (49.7%). The mechanical ventilation time and length of ICU stay were longer, and the mortality rate was higher for the thrombocytopenia group than for the non-thrombocytopenia group. The models were validated on an online international database (Medical Information Mart for Intensive Care III). The areas under the receiver operating characteristic curves (AUCs) of the four models for the prediction of thrombocytopenia were between 0.54 and 0.72. The AUCs of the models for the prediction of severe thrombocytopenia were between 0.70 and 0.77. The neural network and gradient boosting machine models effectively predicted the occurrence of SAT, and the Bayesian models had the best performance in predicting severe thrombocytopenia. Therefore, these models can be used to identify such high-risk patients at an early stage and guide individualized clinical treatment, to improve the prognosis of diseases.

Analysis of the Predictive Effect of Lactic Acid Combined with Cardiac Troponin T and 5-Hydroxytryptophan on the Severity of Sepsis in ICU Patients and Its Correlation with Prognosis.

In order to explore the effective markers of presepsis in the prediction of clinical disease and disease severity, the predictive effect of lactic acid (Lac) combined with cardiac troponin T (cTnT) and 5-hydroxytryptophan (5-HT) on the severity of sepsis in intensive care unit (ICU) patients and its correlation with prognosis is investigated. A total of 85 sepsis patients admitted to the ICU of our hospital from January 2020 to June 2021 are selected to establish the ICU sepsis group, and 72 health examination patients who received physical examination in our hospital during the same period are included in the healthy control group. The experimental results demonstrate that combined detection mode of serum Lac, cTnT, and 5-HT indicators has a high predictive value for the condition of patients with ICU sepsis and those indicators are closely correlated with the prognosis of patients. It suggests that the follow-up clinical monitoring of serum Lac, cTnT, and 5-HT indicators for patients with ICU sepsis can evaluate their condition and improve and optimize the clinical diagnosis and treatment plan effectively.

Evaluation of sTREM1 and suPAR Biomarkers as Diagnostic and Prognostic Predictors in Sepsis Patients.

BackgroundThe purpose of this study was to explore the diagnostic role of sTREM1 in the diagnosis of sepsis and in differentiating between sepsis and systemic inflammatory response syndrome (SIRS). We also aimed to assess the prognostic value of suPAR in comparison to sequential organ-failure assessment (SOFA), acute physiology and chronic health evaluation (APACHE) II scores, and 28-day mortality.MethodsThis was a cross-sectional study conducted in the Medical Microbiology and Immunology Department and Central Research Laboratory, Faculty of Medicine, Sohag University from June 2019 to January 2021. The study population was classified into two groups: SIRS (no evidence of infection) and sepsis (with SIRS and evidence of infection). Patients were rated on the SOFA and APACHE II scoring systems at admission and after 7 days. Serum levels of sTREM1 and suPAR were measured by ELISA at the same time points.ResultsCRP and sTREM1 values were significantly higher in the sepsis group than the SIRS group on both days (P<0.0001). The area under the curve (AUC) for CRP was 0.87 on the first day and 0.97 on the seventh, while the AUC for sTREM1 was 1.00 and 0.93 on the first and seventh days, respectively. The sensitivity of sTREM1 was 100% and specificity 84% at a cutoff of 49 pg/mL. There was a significantly positive correlation between CRP and sTREM1 values (P<0.0001). On the seventh day, nonsurvivors had significantly higher serum levels of suPAR (median 4.9 ng/mL) than survivors (median 2.9 ng/mL; P<0.0001). Nonsurvivors also had significantly higher SOFA and APACHE II scores than survivors (P<0.0001 and P<0.0001, respectively).ConclusionsTREM1 can be used as a good indicator for diagnosing sepsis in intensive care–unit patients. suPAR can also be used as a predictor of bad prognosis and poor survival at 7 days following admission.

SARS-CoV-2 RNAemia and proteomic trajectories inform prognostication in COVID-19 patients admitted to intensive care

Prognostic characteristics inform risk stratification in intensive care unit (ICU) patients with coronavirus disease 2019 (COVID-19). We obtained blood samples (n = 474) from hospitalized COVID-19 patients (n = 123), non-COVID-19 ICU sepsis patients (n = 25) and healthy controls (n = 30). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA was detected in plasma or serum (RNAemia) of COVID-19 ICU patients when neutralizing antibody response was low. RNAemia is associated with higher 28-day ICU mortality (hazard ratio [HR], 1.84 [95% CI, 1.22–2.77] adjusted for age and sex). RNAemia is comparable in performance to the best protein predictors. Mannose binding lectin 2 and pentraxin-3 (PTX3), two activators of the complement pathway of the innate immune system, are positively associated with mortality. Machine learning identified ‘Age, RNAemia’ and ‘Age, PTX3’ as the best binary signatures associated with 28-day ICU mortality. In longitudinal comparisons, COVID-19 ICU patients have a distinct proteomic trajectory associated with mortality, with recovery of many liver-derived proteins indicating survival. Finally, proteins of the complement system and galectin-3-binding protein (LGALS3BP) are identified as interaction partners of SARS-CoV-2 spike glycoprotein. LGALS3BP overexpression inhibits spike-pseudoparticle uptake and spike-induced cell-cell fusion in vitro.

Effects of viral infection and microbial diversity on patients with sepsis: A retrospective study based on metagenomic next-generation sequencing.

The study aims to investigate the performance of a metagenomic next-generation sequencing (NGS)-based diagnostic technique for the identification of potential bacterial and viral infections and effects of concomitant viral infection on the survival rate of intensive care unit (ICU) sepsis patients. A total of 74 ICU patients with sepsis who were admitted to our institution from February 1, 2018 to June 30, 2019 were enrolled. Separate blood samples were collected from patients for blood cultures and metagenomic NGS when the patients' body temperature was higher than 38 °C. Patients' demographic data, including gender, age, ICU duration, ICU scores, and laboratory results, were recorded. The correlations between pathogen types and sepsis severity and survival rate were evaluated. NGS produced higher positive results (105 of 118; 88.98%) than blood cultures (18 of 118; 15.25%) over the whole study period. Concomitant viral infection correlated closely with sepsis severity and had the negative effect on the survival of patients with sepsis. However, correlation analysis indicated that the bacterial variety did not correlate with the severity of sepsis. Concurrent viral load correlates closely with the severity of sepsis and the survival rate of the ICU sepsis patients. This suggests that prophylactic administration of antiviral drugs combined with antibiotics may be beneficial to ICU sepsis patients.

Potential Treatments for SARS-CoV-2 Infection.

Potential Treatments for SARS-CoV-2 Infection.