Predictors Of Septic Shock Research Articles

The value of hematological indices as predictors of septic shock in acute obstructive pyelonephritis

The value of hematological indices as predictors of septic shock in acute obstructive pyelonephritis

Presepsin as a predictor of septic shock and mortality in patients with urinary tract infection according to the Sepsis-3 definitions

The objective of this study was to investigate whether presepsin can serve as a useful biomarker for predicting septic shock and mortality rates in patients with urinary tract infections (UTI) as defined by the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). This single-center and prospective observational study was carried out between December 2019 and December 2022 and included 171 UTI patients divided into two groups: a non-septic shock group (n = 121) and a septic shock group (n = 50). The primary outcome of this study was the development of septic shock; the secondary outcome was 30-day hospital mortality. Receiver operating characteristic (ROC) curves and multivariate regression analyses were performed to investigate the predictive value of presepsin levels for septic shock and the Cox proportional hazards model was used to determine the risk factors for 30-day hospital mortality in UTI patients. Septic shock patients had significantly higher serum levels of presepsin when compared to the non-septic shock group (p < 0.001). In multivariate logistic regression analysis, presepsin demonstrated its independent role as a risk factor for septic shock (odds ratio (OR): 1.002; 95% confidence interval (CI): 1.001–1.002; p < 0.001). The multivariate Cox proportional hazards model indicated that presepsin represents a significant predictor of 30-day hospital mortality in septic shock patients (hazard ratio (HR): 1.0005; 95% CI: 1.0001–1.001; p < 0.05). The ROC curve for diagnosing septic shock had an area under the curve (AUC) of 0.739 with a cutoff value of 447 pg/mL for presepsin. For the prediction of 30-day hospital mortality in patients with UTI, an optimal presepsin cutoff of 709 pg/mL was determined; ROC curve analysis yielded an AUC of 0.744. When applying the Sepsis-3 criteria, presepsin levels represented a significant independent risk factor for septic shock and 30-day hospital mortality in UTI patients.

Red Blood Cell Distribution Width (RDW) as a predictor of septic shock in children

Link of Video Abstract: https://youtu.be/Exh1T2szfoE Background: Septic shock is a prevalent PICU condition requiring prompt intervention. Using the PELOD II score, which has multiple characteristics to examine, it is challenging to predict prognosis in healthcare-limited settings. A link has recently been shown between red blood cell distribution width (RDW) and mortality risk in critically ill patients, albeit the exact mechanism is unknown. Methods: This retrospective observational study examined RDW values in pediatric septic or non-septic shock patients. This study examined patient clinical features, RDW hematological markers (RDW-CV, RDW-SD, and RDW/albumin ratio), and the area under the curve to determine the cut-off for the hematological marker, sensitivity, and specificity. Results: Sixty-one pediatric patients met the inclusion criteria (33 with septic shock and 28 with non-septic shock). The red cell distribution width coefficient variation (RDW-CV) (p=0,058), red cell distribution width standard deviation (RDW-SD) (p=0,05), and RDW Albumin Ratio (RAR) (p=0,014) were shown to be significantly different between the septic shock and non-septic shock groups. The cut-off value for RDW-CV was 15.3% (53.6% sensitivity and 97% specificity), 47.4 fl for RDW-SD (64.3% sensitivity and 84.8% specificity), and 5.65 for RDW/albumin ratio (71.4% sensitivity and 84.8% specificity). RDW-CV odd ratio was 36.9 (95% confidence interval (CI) 4.41-308.96, p 0.001), RDW-SD odd ratio was 10.08 (95% confidence interval (CI) 2.95-34.34, p 0,001), and RDW/albumin ratio was 14.00 (95% confidence interval (CI) 3.98-49.16, p 0,001). Conclusion: Increased RDW can be one marker in pediatric patients with septic shock. Increased levels of RDW/albumin ratio are significantly associated with the incidence of septic shock. Through the (ROC) area under the curve, the RDW/albumin ratio has better capabilities compared to other predictor markers.

Quick Sequential Organ Failure Assessment Score Is a Better Predictor of Septic Shock After Percutaneous Nephrolithotomy: A Secondary Analysis of Two Multicenter Prospective Trials.

Introduction: Recent retrospective literature suggests that the quick sequential organ failure assessment (qSOFA) scoring tool is a potentially superior tool over use of the systemic inflammatory response syndrome (SIRS) criteria to predict septic shock after percutaneous nephrolithotomy (PCNL) surgery. Here we examine use of qSOFA and SIRS to predict septic shock within data series collected prospectively on PCNL patients as part of a greater study of infectious complications. Materials and Methods: We performed a secondary analysis of two prospective multicenter studies including PCNL patients across nine institutions. Clinical signs informing SIRS and qSOFA scores were collected no later than postoperative day 1. The primary outcome was sensitivity and specificity of SIRS and qSOFA (high-risk score of greater-or-equal to two points) in predicting admission to the intensive care unit (ICU) for vasopressor support. Results: A total of 218 cases at 9 institutions were analyzed. One patient required vasopressor support in the ICU. The sensitivity/specificity was 100%/72.4% (McNemar's test p < 0.001) for SIRS and was 100%/90.8% (McNemar's test p < 0.001) for qSOFA. Conclusion: Although positive predictive value for both qSOFA and SIRS in prediction of post-PCNL septic shock is low, prospectively collected data demonstrate use of qSOFA may offer greater specificity than SIRS criteria when predicting post-PCNL septic shock.

Elevated endothelial dysfunction-related biomarker levels indicate the severity and predict sepsis incidence

This study was conducted to investigate the relationship between serum endothelial dysfunction-related biomarker levels and organ dysfunction severity in septic patients and the predictive value of these levels during sepsis. In total, 105 patients admitted to the Department of Critical Care Medicine were enrolled between September 2020 and November 2021. Serum syndecan-1 and soluble thrombomodulin(sTM) levels were measured by enzyme-linked immunosorbent assay, and clinical and laboratory data were recorded. Enroll patients were divided into the infection (n = 28), septic nonshock (n = 31), and septic shock (n = 46) groups . Serum syndecan-1 (102.84 ± 16.53 vs. 55.38 ± 12.34 ng/ml), and sTM(6.60 ± 1.44 ng/ml vs. 5.23 ± 1.23 ng/ml, P < 0.01) levels were increased in the septic group compared with those in the infection group. Serum syndecan-1 levels were closely positively correlated with serum sTM (rs = 0.712, r2 = 0.507, P < 0.001). Additionally, serum syndecan-1(rs = 0.687, r2 = 0.472, P < 0.001) and sTM levels (rs = 0.6, r2 = 0.36, P < 0.01) levels were significantly positively correlated with the sequential organ failure assessment scores respectively. Syndecan-1 (AUC 0.95 ± 0.02, P < 0.0001) was more valuable for prediction sepsis than was sTM (AUC 0.87 ± 0.04, P < 0.0001). Compared with sTM (AUC 0.88 ± 0.03, P < 0.001), syndecan-1 (AUC 0.95 ± 0.02, P < 0.001) and SOFA score (AUC 0.95 ± 0.02, P < 0.001) were better predictors of septic shock. Serum syndecan-1 and sTM levels were associated with organ dysfunction severity in septic patients, and both were good predictors for early identification of sepsis, particularly in patients undergoing septic shock.

Monocyte-to-HDL ratio and non-HDL cholesterol were predictors of septic shock in newborns

BackgroundThe association between lipoprotein levels and late-onset neonatal sepsis has shown controversial results. The aims are to assess lipid profile, cytokines, and Monocyte-to-HDL (M/H) ratio as diagnostic and prognostic markers for late-onset neonatal sepsis. MethodsThis prospective study included 49 septic neonates and 17 controls. Cholesterol (CT), Triglyceride (TG), Very-Low-Density (VLDLc), Low-Density (LDLc), and High-Density Lipoproteins (HDLc) were measured at admission (D0) and on days 3, 7 and 10 to evaluate septic shock outcomes. Cytokines and monocytes were evaluated by flow cytometry. ResultsSeptic newborns showed higher IL-6 and IL-8 at D0 and CT levels on D7 and on D10, which also presented higher TG, VLDLc and non-HDL cholesterol concentrations than controls. The septic shock group (n = 22) revealed a higher number of male subjects, CRP, IL-6, IL-8 and IL-10 levels, while lower TG, HDLc, monocyte numbers and M/H ratio at admission compared to the non-shock group (n = 27). M/H ratio and non-HDL cholesterol on D0 were risk factors for septic shock (OR = 0.70, 0.49‒0.99; OR = 0.96, 0.92‒0.99, respectively). Decreasing levels from D0 to D3 of CT (OR = 0.96, 0.93‒0.99), VLDLc (OR = 0.91, 0.85‒0.98), and non-HDL cholesterol (OR = 0.92, 0.87‒0.98) were also predictors of septic shock. ConclusionsLower M/H ratios and non-HDL cholesterol at admission and decreasing levels of cholesterol, VLDLc and non-HDL cholesterol during a hospital stay are associated with the development of septic shock in newborns with late-onset neonatal sepsis.

Presepsin as a predictor of septic shock in patients with urinary tract infection

BackgroundRecently, presepsin has been reported to be a useful biomarker for early diagnosis of sepsis and evaluation of prognosis in septic patients. However, few reports have evaluated its usefulness in patients with urinary tract infections (UTI). This study aimed to evaluate whether presepsin could be a valuable marker for detecting severe sepsis, and whether it could predict the therapeutic course in patients with UTI compared with markers already used: procalcitonin (PCT) and C-reactive protein (CRP).MethodsFrom April 2014 to December 2016, a total of 50 patients with urinary tract infections admitted to Gunma university hospital were enrolled in this study. Vital signs, presepsin, PCT, CRP, white blood cell (WBC) count, causative agents of urinary-tract infections, and other data were evaluated on the enrollment, third, and fifth days. The patients were divided into two groups: with (n = 11) or without (n = 39) septic shock on the enrollment day, and with (n = 7) or without (n = 43) sepsis on the fifth day, respectively. Presepsin was evaluated as a biomarker for systemic inflammatory response syndrome (SIRS) or septic shock.ResultsRegarding the enrollment day, there was no significant difference of presepsin between the SIRS and non-SIRS groups (p = 0.276). The median value of presepsin (pg/mL) was significantly higher in the septic shock group (p < 0.001). Multivariate logistic regression analysis showed that presepsin (≥ 500 pg/ml) was an independent risk factor for septic shock (p = 0.007). ROC curve for diagnosing septic shock indicated an area under the curve (AUC) of 0.881 for presepsin (vs. 0.690, 0.583, and 0.527 for PCT, CRP and WBC, respectively). Regarding the 5th day after admission, the median presepsin value on the enrollment day was significantly higher in the SIRS groups than in the non-SIRS groups (p = 0.006). On the other hand, PCT (≥ 2 ng/ml) on the enrollment day was an independent risk factor for SIRS. ROC curve for diagnosing sepsis on the fifth day indicated an AUC of 0.837 for PCT (vs. 0.817, 0.811, and 0.802 for presepsin, CRP, and WBC, respectively).ConclusionsThis study showed that presepsin may be a good marker for diagnosing septic shock based on admission data in patients with UTI.

Determination of procalcitonin content in blood serum, urine, and ejaculate for the diagnosis of urogenital tract pathology

The determination of the concentration of procalcitonin (PCT) in blood serum and other biological fluids is used for the diagnosis and monitoring of the course of sepsis and the syndrome of a systemic inflammatory reaction. This review summarizes the data on the diagnostic value of the definition of procalcitonin in the practice of urologists and andrologists. The content of procalcitonin in such biological fluids as urine, seminal plasma is almost 10 times higher than the level of this protein in blood serum: this phenomenon is manifested in physiological conditions and in pathological processes. The relationship of clinical and laboratory indicators of inflammation with the severity of urosepsis was analyzed. Elevated serum procalcitonin levels are considered as a predictor of septic shock in patients with urolithiasis, and determine the management tactics of patients with urinary tract obstruction. The marker function of this protein was studied in inflammation in the renal parenchyma, in malignant neoplasms of the kidneys, bladder, ureter, prostate and testis; in the diagnosis of testicular torsion and orchiepididymitis. The article describes the regular changes in the level of urinary procalcitonin depending on the severity of vesicoureteral reflux, the severity of the manifestations of the inflammatory reaction. There were significant differences in the concentration of procalcitonin in seminal plasma between the groups of men with reduced and normal ejaculate fertility.

Serum Lactate: A Predictor of Septic Shock in Childhood Cancers with Febrile Neutropenia.

Early recognition and management are the key elements to prevent febrile neutropenia associated mortality. The prospective observational study aimed to investigate prognostic accuracy of serum lactate to predict septic shock within 48 hours among hemodynamically stable children with febrile neutropenia. In all, 99 pediatric oncology patients who developed febrile neutropenia were enrolled in the study. Clinical information during 48 hours and serum lactate at the time of enrollment were analyzed. Among 99 participating patients, 10 developed septic shock and 4 of those expired. No significant difference was found of patients’ baseline characteristics and basic laboratory parameters between patients with and without septic shock. Serum lactate was significantly elevated among patients developing septic shock (P-value < .001) and those who expired (P-value .002). Receiver operating characteristic (ROC) curve was created to identify the best cutoff value for initial serum lactate associated with the development of septic shock within 48 hours. Baseline serum lactate more than 2.5 mmol/L showed the largest area under the ROC curve to predict the septic shock development within 48 hours (ROC area, 0.90; 95% confidence interval [CI], 0.81-0.98), with sensitivity, specificity, negative predictive value, and accuracy of 80.0%, 92.1%, 97.6%, and 90.9%, respectively. Serum lactate level determined early at the time of febrile neutropenia was an effective surrogate marker for developing septic shock within 48 hours among hemodynamically stable, pediatric oncology patients. The level more than 2.5 mmol/L was the best threshold to start preemptive aggressive hemodynamic monitoring and prompt treatment to ensure adequate tissue perfusion.

The Role of sTREM-1 as a predictor of Septic Shock and Death in Neonatal sepsis

The Role of sTREM-1 as a predictor of Septic Shock and Death in Neonatal sepsis

Trace elements and septic shock in elderly patients

Background: Trace elements l ike copper and zinc have a signi ficant influence on the function of the immunesystem.Aim: To evaluate basel ine trace elements as s predictor of septic shock in Egyptian elderly patients wi thinintensive care set ting.Methods: A prospective study for al l patients admi t ted to Ain Shams Geriat rics intensive care uni t ( ICU) during a 6months period. Patients divided to: group who did not develop septic shock and those who developed septic shock.APACHE II score (Acute Physiology and Chronic Heal th Evalua tion I I) , systemic inflammatory response (SIR) andvi tal signs were veri fied. Routine laboratory tests, conscious level and length of stay were recorded. Traceelements (zinc (Zn) and copper (Cu)) were analysed.Results: The sample included 142 patients (49% females) . The mean age was 69.5±7.3. Septic shock wasobserved in 12% of them. There was a statistical ly signi f icant di fference between sept ic and non -septic shockpatients as regards basel ine serum zinc level (P ≤ 0.001) but no di f ference regarding serum copper level (p ≥0.05) .Conclusions: The study highl ighted that basel ine zinc deficiency may add to the risk of developing septic shock inelderly patients. However, further studies are needed to conf i rm such association

Predictors of septic shock in initially stable patients with pyogenic liver abscess

Objectives: The incidence of pyogenic liver abscess (PLA), a life-threatening condition, is increasing worldwide. This study was designed to evaluate clinical features and outcomes in initially stable patients with PLA and to determine the predictors of septic shock.Methods: The medical records of all adult patients who were hemodynamically stable and diagnosed with PLA in the emergency department from January 2010 to December 2014, inclusive, were reviewed. The primary outcome was septic shock.Results: A review of medical records identified 453 patients (66.7% male), of mean age 61.4 years, diagnosed with PLA. Of these patients, 73 (16.1%) had septic shock and 10 (2.2%) died in-hospital. Of the 73 patients with septic shock, nine (12.3%) died in-hospital. The most common symptom was fever (79.5%), and the most common infectious agent was Klebsiella pneumoniae. Septic shock was significantly associated with age ≥60 years [odds ratio (OR): 2.99, 95% confidence interval (CI): 1.38–6.48], malignancy (OR: 2.11, 95% CI: 1.08–4.09), systolic blood pressure <100 mmHg (OR: 3.63, 95% CI: 1.43–9.21), respiratory rate ≥24/min (OR: 3.15, 95% CI: 1.20–8.28) and lactate concentration ≥2 mmol/L (OR: 4.92, 95% CI: 2.51–9.64). Septic shock also tended to be associated with procalcitonin concentration, but this was not statistically significant (OR: 3.42, 95% CI: 0.96–12.18).Conclusions: Septic shock was frequent in initially stable patients with PLA and was associated with older age, malignancy, low blood pressure, tachypnea and elevated lactate concentration.

Morbidity and mortality predictors of septic shock in children

Lactate is the most commonly used predictor in septic shock. High lactate levels are associated with increased mortality. Septic shock is the most common type of shock with around 50% mortality. Mortality increases by nearly 40% with every hour of delayed treatment.

Can sTREM-1 predict septic shock & death in late-onset neonatal sepsis? A pilot study

The transmembrane glycoprotein TREM-1 triggers an inflammatory response. Its soluble fraction (sTREM-1) has been shown to have diagnostic accuracy for late-onset neonatal sepsis (LONS). Until now, the potential of sTREM-1 to predict septic shock and/or death in septic neonates has not been explored. This study obtained estimates of the incidence and prevalence of septic shock and/or death in septic neonates for future sample size calculations for confirmatory studies and evaluated the feasibility of using sTREM-1 as a predictor of septic shock and/or death in neonates with LONS criteria. A pilot study with a cross-sectional design was performed from May 1(st) to October 31(st), 2012. The participants were hospitalized neonates who, after three days of life, were diagnosed as having LONS. Plasma sTREM-1 was quantified by ELISA. The main outcome measurement was the development of septic shock and/or death. Of 71 eligible subjects, nine (12.7%) progressed to septic shock and/or death. In the LONS-Non-Shock group, the sTREM-1 median and interquartile range (IQR) plasma value were 10 (10 to 70) pg/mL. In the LONS & Shock/Death group, the values were 567 (260 to 649) pg/mL. These values were significantly different (Mann-Whitney's U test, p=0.001). A ROC curve for a proposed sTREM-1 cut-off value of 300 pg/mL exhibited an area under the curve of 0.884 (95% CI=0.73 to 1.0; p<0.0001), with a sensitivity of 0.78 (95% CI=0.46 to 0.94) and specificity of 0.97 (95% CI=0.92 to 0.99); PPV would be 0.78 (95% CI=0.46 to 0.94) and NPV 0.97 (95% CI=0.92 to 0.99). In neonates with LONS, sTREM-1 has the potential to provide an excellent predictive value for septic shock/death. Larger sample sizes are needed to identify the optimal cut-off value of plasma sTREM-1 for this diagnosis and to provide diagnostic accuracy measures.

Risk factors for septic shock in acute obstructive pyelonephritis requiring emergency drainage of the upper urinary tract

To assess the risk factors for septic shock in patients with acute obstructive pyelonephritis requiring emergency drainage of the upper urinary tract. We retrospectively reviewed the records of 48 patients who underwent emergency drainage of the upper urinary tract for sepsis associated with acute obstructive pyelonephritis at our institute. Univariate and multivariate analyses were performed to identify the risk factors. Among 54 events of sepsis, we identified 20 events of septic shock requiring vasopressor therapy. Cases with shock were more likely than those without shock to have ureteral stone (70 vs 38%, p = 0.024) and positive blood culture results (81 vs 28%, p = 0.006). They received drainage significantly earlier than those without shock (1.0 vs 3.5 days, p < 0.001). Univariate analysis demonstrated that acute obstructive pyelonephritis by ureteral stone, rapid progression (the occurrence of symptoms to drainage ≤ 1 day), positive blood culture, leukocytopenia (<4,000/mm(3)), thrombocytopenia (<120,000/mm(3)), and prothrombin time international normalized ratio ≥ 1.20 were correlated with septic shock. Multivariate logistic regression analysis identified thrombocytopenia (p = 0.005) and positive blood culture (p = 0.040) as independent risk factors for septic shock. Thrombocytopenia and positive blood culture were independent risk factors for septic shock in acute obstructive pyelonephritis requiring emergency drainage. Thrombocytopenia would be practically useful as a predictor of septic shock.

Predictors of septic shock following gastrointestinal anastomotic leaks: Only signposts, no destination

Predictors of septic shock following gastrointestinal anastomotic leaks: Only signposts, no destination