Outcomes In Sepsis Patients Research Articles

Tp-Te Interval and Tp-Te/QT Ratio Are Valuable Tools in Predicting Poor Outcome in Sepsis Patients.

ObjectiveAbout 50% of patients with sepsis have different degrees of myocardial inhibition, known as sepsis-induced myocardial dysfunction (SMD), which increases the mortality rate of sepsis. Tp-Te interval and Tp-Te/QT ratio reflect ventricular transmural dispersion repolarization (TDR), and have good predictive value for death in patients with heart disease. This study aimed to investigate the prognostic value of Tp-Te and Tp-Te/QT in patients with sepsis.MethodsThe current study included a total of 625 participants: 201 patients with sepsis, 213 patients with heart failure, and 211 healthy participants. According to the severity and outcome, the patients with sepsis were divided into the sepsis group and the septic shock group, and the death group and the survival group to explore the differences of indicators among subgroups of sepsis. The ROC curve was used to analyze the predictive value of the indicators for deaths of patients with sepsis and calculate the cutoff point. Then, we investigated the incidence of arrhythmia in patients with sepsis with different TDR. The correlation between Tp-Te/QT and the commonly used predictive indicators in ICU was also discussed.Results(1) Tp-Te and Tp-Te/QT in patients with sepsis and heart failure (HF) were significantly higher than the control group (p < 0.01). (2) Compared with patients with sepsis, the increase of Tp-Te and Tp-Te/QT is more prominent in patients with HF. Especially, the increase of the Tp-Te/QT was statistically significant (p < 0.001). (3) compared with patients with sepsis (no shock), the Tp-Te, Tp-Te/QT, and SOFA were increased in patients with septic shock (p < 0.05). (4) In the death group, Tp-Te /QT, SOFA, and Apache-II were higher; LVEF was lower than the survival group (p < 0.05). (5) ROC curves showed that Tp-Te/QT, SOFA, and LVEF have predictive values for death (p < 0.05; AUC = 0.808, 0.716, 0.412). The cutoff point of Tp-Te/QT was 0.32. (6) The incidence of arrhythmia is different in patients with sepsis with different TDR. (7) There is a significant correlation between Tp-Te/QT and SOFA (p < 0.001, r = 0.79).ConclusionTDR in patients with sepsis is significantly increased, which was between healthy population and patients with HF. Tp-Te and Tp-Te/QT are effective indicators to reflect the severity and poor outcome of patients with sepsis.

Characteristics and outcomes of sepsis patients with and without COVID-19

BackgroundThe aim of this study was to describe and compare clinical characteristics and outcomes in critically ill septic patients with and without COVID-19. MethodsFrom February 2020 to March 2021, patients from surgical and medical ICUs at the University Hospital Dresden were screened for sepsis. Patient characteristics and outcomes were assessed descriptively. Patient survival was analyzed using the Kaplan-Meier estimator. Associations between in-hospital mortality and risk factors were modeled using robust Poisson regression, which facilitates derivation of adjusted relative risks. ResultsIn 177 ICU patients treated for sepsis, COVID-19 was diagnosed and compared to 191 septic ICU patients without COVID-19. Age and sex did not differ significantly between sepsis patients with and without COVID-19, but SOFA score at ICU admission was significantly higher in septic COVID-19 patients. In-hospital mortality was significantly higher in COVID-19 patients with 59% compared to 29% in Non-COVID patients. Statistical analysis resulted in an adjusted relative risk for in-hospital mortality of 1.74 (95%-CI=1.35–2–24) in the presence of COVID-19 compared to other septic patients. Age, procalcitonin maximum value over 2 ng/ml, need for renal replacement therapy, need for invasive ventilation and septic shock were identified as additional risk factors for in-hospital mortality. ConclusionCOVID-19 was identified as independent risk factor for higher in-hospital mortality in sepsis patients. The need for invasive ventilation and renal replacement therapy as well as the presence of septic shock and higher PCT should be considered to identify high-risk patients.

Prehospital administration of broad-spectrum antibiotics for sepsis patients: A systematic review and meta-analysis.

Background and AimsSome studies have suggested that earlier initiation of antibiotics has shown positive outcomes in sepsis patients. We aimed to do a systematic review and meta‐analysis to evaluate the effect of prehospital administration of antibiotics on 28 days mortality and length of stay in hospital and intensive care unit for sepsis patients.MethodsWe formulated a search strategy and used it on search databases PubMed, Scopus, Web of Science, and Embase. We then screened the records for eligibility and included controlled studies, either clinical trials or cohort studies reporting prehospital antibiotic administration for sepsis patients. We excluded duplicates, books, conferences' abstracts, case reports, editorials, letters, author responses, not English studies, and studies with nonavailable full text. Animal and lab studies were also excluded.ResultsThe total number of studies identified is 1811, 19 were eligible for systematic review and 4 for meta‐analysis (three cohort and one clinical trial). The total number of sepsis patients in the four included studies in the 28 days mortality outcome was 3523 (1779 took prehospital antibiotics and 1744 did not take prehospital antibiotics). Of 1779 who took the antibiotics, 190 died, and of 1744 who did not take antibiotics, 292 died (95% confidence interval 0.68–0.97, p = 0.02).ConclusionThis meta‐analysis reveals that receiving prehospital antibiotics can significantly lower mortality in sepsis patients compared to patients who do not receive prehospital antibiotics. However, more clinical trials and multicenter prospective studies with high sample sizes are needed to get strong evidence supporting our findings.

Association Between Gut Dysbiosis and Sepsis-Induced Myocardial Dysfunction in Patients With Sepsis or Septic Shock.

ObjectiveSepsis-induced myocardial dysfunction (SIMD) seriously affects the evolution and prognosis of the sepsis patient. The gut microbiota has been confirmed to play an important role in sepsis or cardiovascular diseases, but the changes and roles of the gut microbiota in SIMD have not been reported yet. This study aims to assess the compositions of the gut microbiota in sepsis or septic patients with or without myocardial injury and to find the relationship between the gut microbiota and SIMD.MethodsThe prospective, observational, and 1:1 matched case–control study was conducted to observe gut microbiota profiles from patients with SIMD (n = 18) and matched non-SIMD (NSIMD) patients (n = 18) by 16S rRNA gene sequencing. Then the relationship between the relative abundance of microbial taxa and clinical indicators and clinical outcomes related to SIMD was analyzed. The receiver operating characteristic (ROC) curves were used to evaluate the predictive efficiencies of the varied gut microbiota to SIMD.ResultsSIMD was associated with poor outcomes in sepsis patients. The beta-diversity of the gut microbiota was significantly different between the SIMD patients and NSIMD subjects. The gut microbiota profiles in different levels significantly differed between the two groups. Additionally, the abundance of some microbes (Klebsiella variicola, Enterobacteriaceae, and Bacteroides vulgatus) was correlated with clinical indicators and clinical outcomes. Notably, ROC analysis indicated that K. variicola may be a potential biomarker of SIMD.ConclusionOur study indicates that SIMD patients may have a particular gut microbiota signature and that the gut microbiota might be a potential diagnostic marker for evaluating the risk of developing SIMD.

Hospital nurse staffing and sepsis protocol compliance and outcomes among patients with sepsis in the USA: a multistate cross-sectional analysis

ObjectivesSepsis is a serious inflammatory response to infection with a high death rate. Timely and effective treatment may improve sepsis outcomes resulting in mandatory sepsis care protocol adherence reporting. How...

Platelet Transfusion in Patients With Sepsis and Thrombocytopenia: A Propensity Score-Matched Analysis Using a Large ICU Database.

PurposeSepsis with thrombocytopenia is highly prevalent in critically ill intensive care unit (ICU) patients and is associated with adverse outcomes. Platelet transfusion is the primary treatment of choice. However, evidence for the beneficial effects of platelet transfusion in patients with sepsis and thrombocytopenia is scarce and low in quality. This study aimed to evaluate the association between platelet transfusion and mortality among ICU patients with sepsis and thrombocytopenia.Patients and MethodsUsing the Medical Information Mart for Intensive Care III database (v. 1.4), the outcomes of sepsis patients with platelet counts of ≤ 150,000/μL were compared between those who did and did not receive platelet transfusion. The primary outcomes were 28- and 90-day all-cause mortalities. The secondary outcomes were red blood cell (RBC) transfusion, ICU-free days, and hospital-free days. Propensity score matching was employed to assemble a cohort of patients with similar baseline characteristics.ResultsAmong 7,765 eligible patients, 677 received platelet transfusion and were matched with 677 patients who did not receive platelet transfusion according to propensity scores. Platelet transfusion, as compared with no platelet transfusion, was associated with an increased risk of 28-day all-cause mortality [36.9 vs. 30.4%, odds ratio (OR), 1.21; 95% confidence interval (CI), 1.01–1.46; p = 0.039], increased risk of 90-day all-cause mortality (50.8 vs. 44.6%, OR, 1.13; 95% CI, 1.00–1.31; p = 0.048), fewer mean (standard deviation) 28-day ICU-free days (15.88 ± 8.97 vs. 18.64 ± 8.33 days, p < 0.001), and fewer hospital-free days (10.29 ± 8.49 vs. 11.43 ± 8.85 days, p = 0.017). The rate of RBC transfusion was not significantly different between the platelet transfusion and non-transfusion groups (p = 0.149). The results were maintained across several subgroup and sensitivity analyses.ConclusionIn this study, platelet transfusion was associated with higher 28- and 90-day all-cause mortalities. These results suggest the potential hazards of platelet transfusion in ICU patients with sepsis and thrombocytopenia.

Hour-1 bundle adherence was associated with reduction of in-hospital mortality among patients with sepsis in Japan.

The updated Surviving Sepsis Campaign guidelines recommend a 1-hour window for completion of a sepsis care bundle; however, the effectiveness of the hour-1 bundle has not been fully evaluated. The present study aimed to evaluate the impact of hour-1 bundle completion on clinical outcomes in sepsis patients. This was a multicenter, prospective, observational study conducted in 17 intensive care units in tertiary hospitals in Japan. We included all adult patients who were diagnosed as having sepsis by Sepsis-3 and admitted to intensive care units from July 2019 to August 2020. Impacts of hour-1 bundle adherence and delay of adherence on risk-adjusted in-hospital mortality were estimated by multivariable logistic regression analyses. The final study cohort included 178 patients with sepsis. Among them, 89 received bundle-adherent care. Completion rates of each component (measure lactate level, obtain blood cultures, administer broad-spectrum antibiotics, administer crystalloid, apply vasopressors) within 1 hour were 98.9%, 86.2%, 51.1%, 94.9%, and 69.1%, respectively. Completion rate of all components within 1 hour was 50%. In-hospital mortality was 18.0% in the patients with and 30.3% in the patients without bundle-adherent care (p = 0.054). The adjusted odds ratio of non-bundle-adherent versus bundle-adherent care for in-hospital mortality was 2.32 (95% CI 1.09-4.95) using propensity scoring. Non-adherence to obtaining blood cultures and administering broad-spectrum antibiotics within 1 hour was related to in-hospital mortality (2.65 [95% CI 1.25-5.62] and 4.81 [95% CI 1.38-16.72], respectively). The adjusted odds ratio for 1-hour delay in achieving hour-1 bundle components for in-hospital mortality was 1.28 (95% CI 1.04-1.57) by logistic regression analysis. Completion of the hour-1 bundle was associated with lower in-hospital mortality. Obtaining blood cultures and administering antibiotics within 1 hour may have been the components most contributing to decreased in-hospital mortality.

High levels of monocytic myeloid-derived suppressor cells are associated with favorable outcome in patients with pneumonia and sepsis with multi-organ failure

BackgroundMyeloid-derived suppressor cells (MDSCs) are immature myeloid cells with immunosuppressive functions sub-classified into monocytic and polymorphonuclear MDSCs (M-MDSCs and PMN-MDSCs). Clinical studies reported increased levels of MDSCs that were associated with poor outcome in sepsis patients. Since sepsis patients exhibit signs of inflammation and immunosuppression, MDSCs may provide benefit by dampening deleterious inflammation in some patients. To test this hypothesis, we measured MDSCs in critically ill sepsis patients with pneumonia and multi-organ dysfunctions and a high likelihood of death.MethodsThis was a prospective multicenter observational cohort study performed in eight ICUs in Athens and Thessaloniki, Greece, enrolling critically ill patients with pneumonia and sepsis with multi-organ dysfunctions. A flow cytometry approach using blood collected at study inclusion in tubes containing lyophilized antibodies combined to unsupervised clustering was developed to quantify M-MDSCs and PMN-MDSCs.ResultsForty-eight patients were included, of whom 34 died within 90 days. At study inclusion, M-MDSCs and PMN-MDSCs were increased in sepsis patients when compared to healthy subjects (3.07% vs 0.96% and 22% vs 2.1% of leukocytes, respectively; p < 10–4). Increased PMN-MDSCs were associated with secondary infections (p = 0.024) and new sepsis episodes (p = 0.036). M-MDSCs were more abundant in survivors than in patients who died within 28 days (p = 0.028). Stratification of patients according to M-MDSC levels revealed that high levels of M-MDSC were associated with reduced 90-day mortality (high vs low M-MDSCs: 47% vs 84% mortality, p = 0.003, hazard ratio [HR] = 3.2, 95% CI 1.4–7.2). Combining high M-MDSC levels with low Acute Physiology and Chronic Health Evaluation (APACHE) II score improved patient stratification (M-MDSCshigh/APACHE IIlow vs M-MDSCslow/APACHE IIlow: 20% vs 80% 90-day mortality, p = 0.0096, HR = 7.2, 95% CI 1.6–32). In multivariate analyses high M-MDSCs remained correlated with improved survival in patients with low APACHE II score (p = 0.05, HR = 5.26, 95% CI 1.0–27.8).ConclusionThis is the first study to associate high levels of M-MDSCs with improved survival in sepsis patients.

POS-182 SDF4 IS A PROGNOSTIC FACTOR FOR 28-DAYS MORTALITY IN PATIENTS WITH SEPSIS VIA NEGATIVELY REGULATING ER STRESS

Sepsis is a heterogeneous syndrome induced by infection and results in high mortality. Even though more than 100 biomarkers for sepsis prognosis were evaluated, prediction of patient outcomes in sepsis continues to be driven by clinical signs because of unsatisfactory specificity and sensitivity of these biomarkers. This study aimed to elucidate the key candidate genes involved in sepsis response and explore their downstream effects based on weighted gene co-expression network analysis (WGCNA). Downstream effects of the hub gene were then explored, which might provide potential targets for sepsis treatment in the future.

Analysis of the Value of the Blood Urea Nitrogen to Albumin Ratio as a Predictor of Mortality in Patients with Sepsis.

PurposeAt present, simple, accurate, and efficient prognostic tools for the evaluation of cases with early-stage sepsis in the emergency department (ED) are lacking. An increased blood urea nitrogen to albumin ratio (BAR) has previously been shown to be a valuable biomarker with predictive utility in several diseases. The relationship between BAR and sepsis patient outcomes, however, is not well-understood. This exploration was thus developed for the exploration of the link between BAR values and the short-term prognosis of cases with sepsis.MethodsThis was a retrospective cohort research of sepsis cases admitted to the West China Hospital of Sichuan University ED from July 2015 to June 2016. Laboratory data were collected upon ED admission, and 7-day all-cause mortality was the primary study endpoint. Relationships between BAR values and APACE II and SOFA scores were generated assessed with correlation coefficient heatmaps. Independent risk factors were identified through multivariate analyses, with the curves of receiver operating characteristic (ROC) being employed to gauge the value of BAR as a predictor of the risk of mortality in sepsis cases.ResultsIn sum, 801 patients participated in the present investigation. BAR values were strongly correlated with APACHE II and SOFA scores. In a multivariate logistic regression assessment, BAR was identified as an independent predictor of mortality among patients with sepsis (HR=1.032, 95% CI: 1.010–1.055, P=0.004). BAR exhibited an AUC of 0.741 (95% CI: 0.688–0.793, P<0.001) when used to predict patient mortality risk, with 5.27 being the optimal BAR cut-off.ConclusionWe found that BAR can be used as a reliable biomarker to predict mortality in patients with sepsis.

Correlation Between Gender and Random Plasma Glucose on The Outcome of Sepsis Patients with Type 2 Diabetes Mellitus in The Internal Medicine Room of Dr. Soetomo General Hospital

Background: Indonesia has a tropical climate, so it cannot be separated from sepsis. Sepsis is a severe health problem with very high mortality worldwide. Type 2 diabetes mellitus comorbidities that Indonesian people often suffer from can affect patient outcomes. The effect of gender on patient outcomes is still controversial. It is estimated that gender differences can affect hormonal responses, which cause differences in immune responses. In addition, random plasma glucose levels can also be associated with the outcome of septic patients with type 2 diabetes mellitus due to impaired immune response that occurs in patients. Method: This research is a retrospective study using the Cross-Sectional method by taking the medical record data of sepsis patients treated in the internal medicine room of Dr. General Hospital. Soetomo Surabaya for January 1, 2020 – December 31, 2020. Result: Of the 215 study subjects divided into two groups, 123 patients died, while 92 patients were discharged. There were no significant results that gender in type 2 diabetes mellitus sepsis patients was associated with patient outcomes from hospital care (p = 0.055). In addition, there was also no significant relationship between random plasma glucose levels of patients and patient outcomes during hospitalization (p = 0.790). Conclusion: Gender and random plasma glucose levels in septic patients with type 2 diabetes mellitus are not associated with hospital outcomes.

A Machine Learning Understanding of Sepsis.

Sepsis is a serious cause of morbidity and mortality and yet its pathophysiology remains elusive. Recently, medical and technological advances have helped redefine the criteria for sepsis incidence, which is otherwise poorly understood. With the recording of clinical parameters and outcomes of patients, enabling technologies, such as machine learning, open avenues for early prognostic systems for sepsis. In this work, we propose a two-phase approach towards prognostic scoring by predicting two outcomes in sepsis patients - Sepsis Severity and Comorbidity Severity. We train and evaluate multiple machine learning models on a dataset of 80 parameters collected from 800 patients at Amrita Institute of Medical Sciences, Kerala, India. We present an analysis of these results and harmonize consistencies and/or contradictions between elements of human knowledge and that of the model, using local interpretable model-agnostic explanations and other methods.

179 Association of CX3CR1 and Myeloid-derived Suppressor Cell with Survival of Sepsis Patients and Risk of Acute Respiratory Distress Syndrome

Peripheral blood immune micro-environment has been shown to influence survival outcomes in sepsis patients. However, the association of immune micro-environment with clinical outcomes of immune-suppression induced by sepsis remains unclear. Here we performed comprehensive analysis of immune cell infiltration and clinically validated association of CX3CR1 and Myeloid-derived suppressor cell (MDSC) with survival of sepsis patients and risk of acute respiratory distress syndrome (ARDS). This study analyzed discovering cohort including all sepsis patients, which grouped by survival status and ARDS occurrence, from the Gene Expression Omnibus database (GSE10474, GSE32707, GSE66890). Core differential expressed genes (DEGs) and immune cell were selected between groups using LASSO and Random Forest machine learning algorithm. Most survival correlated gene and immune cell were validated in validating cohort (GSE65682) using Kaplan-Meier survival analysis. Since gene and immune cell were selected, patients from discovering cohort were divided into higher and lower group. To further explore underlying mechanism, weighted gene co-expression network analysis (WGCNA) were applied. For functional and pathway enrichment analysis, clusterProfiler R package was used for Gene Ontology (GO), Kyoto encyclopedia of genes and genomes (KEGG) analyses. Among 133 sepsis patients from discovering cohort, 110 down-regulated genes and 76 up-regulated genes were identified as DEGs based on the survival status, while 177 down-regulated genes and 89 up-regulated genes were identified as DEGs based on the ARDS risk, respectively. After combining the DEGs screened out via the LASSO and RF algorithms, 13 DEGs between survival status and 16 DEGs between ARDS risk, were selected simultaneously by these two algorithms. The gene of CX3CR1 and immune cell of MDSC were significantly higher in alive group and none-ARDS group, and they two were correlated most (Spearman r = 0.69 p<0.01). Among 479 patients in validating cohort, higher CX3CR1 was associated with better 28-day survival benefit (hazard ratio [HR] 2.657, 95% CI 1.838-3.843) and higher MDSC associated with better 28-day survival benefit (HR 2.205, 95% CI 1.516-2.206). Using the gene modules of WGCNA that correlated most with CX3CR1 expression level and MDSC proliferation level, biological processes of T cell cytokine production and regulation of glial cell migration were significantly enriched. We demonstrated that CX3CR1 and MDSC can predict ARDS risk and contribute survival benefit for sepsis patients. MDSC might be important component of the immune micro-environment and should be integrated into predictive biomarker panels for immune therapy and be validated in future prospective clinical trials.

High cholesterol concentrations as well as low cholesterol concentrations are associated with mortality at 28 days in sepsis: a retrospective cohort study.

Low serum cholesterol is known to be associated with poor prognosis in sepsis patients. On the other hand, there have been few studies on the association between high serum cholesterol, one of the major risk factors for cardiovascular adverse events, and prognosis of sepsis patients. We investigated the relationship between the serum total cholesterol concentration and outcome of sepsis patients. We conducted a multicenter retrospective cohort study at the emergency departments (EDs) of three urban tertiary teaching hospitals. Patients were divided into three groups according to the initial serum total cholesterol concentration: low cholesterol (cholesterol <120 mg/dL), normal cholesterol (cholesterol 120-200 mg/dL), and high cholesterol (cholesterol >200 mg/dL). Multivariable Cox proportional hazard regression model was used to identify the independent association between the serum total cholesterol concentrations and mortality at 28 days. A total of 4,512 patients were included in the final analysis. The mortality at 28 days of the low, normal, and high cholesterol groups were 24.1%, 14.5%, and 20.5%, respectively (P<0.001). Both the low and high cholesterol groups had a higher risk of death than the normal cholesterol group (low cholesterol group [hazard ratio (HR), 1.46; 95% confidence interval (CIs), 1.25-1.71] and high cholesterol group (HR, 1.57; 95% CI, 1.14-2.16). Both low and high serum total cholesterol concentrations were associated with higher mortality at 28 days in sepsis patients.

Surviving Sepsis Campaign: Research Opportunities for Infection and Blood Purification Therapies.

OBJECTIVES:Patients with infection can develop sepsis, and their mortality can be high. An important aspect in the treatment of sepsis is adequate management of the infection.DATA SOURCES:Using a modified Delphi approach, the Surviving Sepsis Campaign research committee recently published a series of 26 priorities for sepsis and septic shock.STUDY SELECTION:Task force members with specific expertise were tasked with generating expanded reviews for all infection questions and a subset of adjunctive therapy questions from the larger list of sepsis priorities. Each question was addressed by one of the six task force members.DATA EXTRACTION:In-depth reviews were then edited by the group as a whole, with added input from the committee cochairs.DATA SYNTHESIS:Six questions were addressed: 1) should empiric antibiotic combination therapy be used in sepsis or septic shock? 2) does optimization of antimicrobial pharmacokinetics and pharmacodynamics impact patient outcomes in sepsis? 3) should viral reactivation resulting from sepsis-induced immunosuppression be treated with antiviral therapy in critically ill septic patients? 4) should rapid diagnostic tests be implemented in clinical practice? 5) what is the role of lung-protective ventilation in sepsis patients without acute respiratory distress syndrome? and 6) how do we determine the efficacy of “blood purification” therapies such as endotoxin absorbers, cytokine absorbers, and plasmapheresis.CONCLUSIONS:The research committee members for the Surviving Sepsis Campaign aimed to explore research questions in order to provide existing evidence and highlight areas of uncertainty and future directions.

Analysis of procalcitonin and urine nitrite to predictor sepsis patients

Background: Sepsis is a significant health problem worldwide. Various sepsis biomarkers have been studied before, but few data link PCT and urinary nitrite levels to culture result in septic patients.Purposes: This study compares PCT, Urine Nitrite on culture results against their sensitivity to determine variables that can be used to predict sepsis patients.Methods: This is a cross-sectional study by taking data on patients with sepsis aged ≥18 years in 207. Diagnostic tests were performed to determine sensitivity and specificity of PCT, Urine Nitrite, and Blood Culture of septic patients. A Chi-square test was carried out to see the relationship between two parameters and the outcome of sepsis.Results: PCT sensitivity was higher than Urine Nitrite: 74.5%. Specificity of Urine Nitrite was higher than PCT: 88.2%. Procalcitonin has a significant relationship with sepsis patient outcomes (p&lt;0.005).Conclusion: PCT can predict septic patients because it has a higher sensitivity than urine nitrite

SDF4 Is a Prognostic Factor for 28-Days Mortality in Patients With Sepsis via Negatively Regulating ER Stress.

Sepsis is a heterogeneous syndrome induced by infection and results in high mortality. Even though more than 100 biomarkers for sepsis prognosis were evaluated, prediction of patient outcomes in sepsis continues to be driven by clinical signs because of unsatisfactory specificity and sensitivity of these biomarkers. This study aimed to elucidate the key candidate genes involved in sepsis response and explore their downstream effects based on weighted gene co-expression network analysis (WGCNA). The dataset GSE63042 with sepsis outcome information was obtained from the Gene Expression Omnibus (GEO) database and then consensus WGCNA was conducted. We identified the hub gene SDF4 (stromal cell derived factor 4) from the M6 module, which was significantly associated with mortality. Subsequently, two datasets (GSE54514 and E-MTAB-4421) and cohort validation (n=89) were performed. Logistic regression analysis was used to build a prediction model and the combined score resulting in a satisfactory prognosis value (area under the ROC curve=0.908). The model was subsequently tested by another sepsis cohort (n=70, ROC= 0.925). We next demonstrated that endoplasmic reticulum (ER) stress tended to be more severe in patients PBMCs with negative outcomes compared to those with positive outcomes and SDF4 was related to this phenomenon. In addition, our results indicated that adenovirus-mediated Sdf4 overexpression attenuated ER stress in cecal ligation and puncture (CLP) mice lung. In summary, our study indicates that incorporation of SDF4 can improve clinical parameters predictive value for the prognosis of sepsis, and decreased expression levels of SDF4 contributes to excessive ER stress, which is associated with worsened outcomes, whereas overexpression of SDF4 attenuated such activation.

The prognostic impact of the serum heart-type fatty acid-binding protein level in patients with sepsis who were admitted to the non-surgical intensive-care unit.

Ongoing myocardial damage at the acme of the sepsis status has not been sufficiently evaluated. The clinical data of 160 sepsis patients who require intensive care and 127 outpatients with chronic heart failure (HF) were compared as a retrospective cohort study. Thereafter, the sepsis patients were divided into 3 groups according to the serum heart-type fatty acid-binding protein (H-FABP) quartiles [low H-FABP = Q1 (n = 39), middle H-FABP = Q2/Q3 (n = 81), and high H-FABP = Q4 group (n = 40)]. The H-FABP level was measured within 15 min of admission. The serum H-FABP levels in the sepsis patients [26.6 (9.3-79.0) ng/ml] were significantly higher than in the choric HF patients [6.6 (4.6-9.7) ng/ml]. A Kaplan-Meier curve showed that the survival rate of the high-H-FABP group was significantly lower than that of the middle- and low-H-FABP groups. The multivariate Cox regression analysis for the 365-day mortality showed that the high-H-FABP group (hazard ratio: 6.544, 95% confidence interval [CI] 2.026-21.140; p = 0.002) was an independent predictor of the 365-day mortality. The same trend in the prognostic impact was significantly (p = 0.015) observed in the cohort that had not been suffering from the cardiac disease before admission. The serum H-FABP level was an independent predictor of the 365-day mortality in the patients who were emergently hospitalized in the intensive-care unit due to sepsis. Ongoing myocardial damage was detected in the majority of patients with sepsis, suggesting that ongoing myocardial damage might be a candidate predictor of adverse outcomes in sepsis patients.

Platelet count patterns and patient outcomes in sepsis at a tertiary care center: Beyond the APACHE score.

Acute physiology and chronic health evaluation II (APACHE-II) scoring system is used to classify disease severity of patients in the intensive care unit. However, several limitations render the scoring system inadequate in identifying risk factors associated with outcomes. Little is known about the association of platelet count patterns, and the timing of platelet count and other hematologic parameters in predicting mortality in patients with sepsis.This retrospective observational study included 205 septic shock patients, with an overall mortality of 47.8%, enrolled at a tertiary care hospital in Riyadh, Kingdom of Saudi Arabia between 2018 and 2020. Bivariate and multivariate regression analyses were used to identify hematologic risk factors associated with mortality. We used the bivariate Pearson Correlation test to determine correlations between the tested variables and APACHE-II score.Two platelet count patterns emerged: patients with a decline in platelet count after admission (group A pattern, 93.7%) and those with their lowest platelet count at admission (group B pattern, 6.3%). The lowest mean platelet count was significantly lower in nonsurvivors (105.62 ± 10.67 × 103/μL) than in survivors (185.52 ± 10.81 × 103/μL), P < .001. Bivariate Pearson correlation revealed that the lowest platelet count and platelet count decline were significantly correlated with APACHE-II score (r = −0.250, P < .01), (r = 0.326, P < .001), respectively. In multiple logistic regression analysis, the independent mortality risk factors were degree of platelet count decline in group A (odds ratio, 1.028 [95% confidence interval: 1.012–1.045], P = .001) and platelet pattern in group B (odds ratio, 6.901 [95% confidence interval: 1.446–32.932], P = .015). The patterns, values, subsets, and ratios of white blood cell count were not significantly associated with mortality.Nadir platelet count and timing, and degree of platelet count decline are useful markers to predict mortality in early septic shock. Therefore, platelet count patterns might enhance the performance of severity scoring systems in the intensive care unit.

Antibacterial therapy of sepsis in extracorporeal detoxication: current problems and ways to solve them

The effectiveness of antibacterial therapy is a critical factor to improve treatment outcomes in sepsis patients. Impaired renal function and renal replacement therapy lead to a significant change in the pharmacokinetic parameters of most intravenous antibacterial drugs, which in many cases is accompanied by insufficient or excessive concentration in the blood which results in antibacterial therapy failure. The article presents current views and describes the current problems of antibacterial therapy for sepsis during the use of extracorporeal detoxification methods. The objective : to analyze publications on antibacterial therapy of sepsis during the extracorporeal detoxification. Results: the most accessible and effective method for solving the problem of inadequate dosage of antibiotics when using extracorporeal detoxification is to develop local protocols based on the results of pharmacokinetic studies.