Prognostic Marker In Sepsis Research Articles

Evaluating the Diagnostic and Prognostic Value of Interleukin-6 (IL-6) and Soluble Triggering Receptor Expressed on Myeloid Cells-1 (sTREM-1) in Systemic Inflammatory Response Syndrome (SIRS) and Sepsis in Adults.

Sepsis and systemic inflammatory response syndrome (SIRS) are significant concerns in intensive care units and contribute significantly to patient mortality. Traditional diagnostic markers such as C-reactive protein (CRP) and procalcitonin (PCT) often lack the sensitivity and specificity needed for early diagnosis and prognosis. Consequently, more reliable biomarkers are needed. This study aimed to evaluate interleukin-6 (IL-6) and soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) as potential biomarkers to improve diagnostic and prognostic capabilities in sepsis and SIRS. The study comprised 64 patients diagnosed with sepsis and SIRS, admitted to the Critical Care Department of the First University Clinic (Tbilisi, Georgia). Changes in the levels of CRP, PCT, IL-6,sTREM-1, and lactate were monitored over a five-day observation period, with measurements taken on days 0, 1, 2, 3, and 5. We found a significant logarithmic relationship between sTREM-1 levels and Acute Physiology and Chronic Health Evaluation II (APACHE II)scores (r = 0.922, p < 0.001), suggesting that sTREM-1 could serve as a valuable biomarker for early risk stratification in sepsis. Furthermore, sTREM-1 exhibited strong correlations with IL-6 and lactate levels, underscoring its potential as a predictor of disease severity. While CRP and PCT were more useful in tracking disease progression over time, their baseline levels were less predictive of early outcomes. Our findings highlight the potential of sTREM-1, IL-6, and lactate as early diagnostic and prognostic markers in sepsis, where sTREM-1 is a critical biomarker for identifying high-risk patients. Further studies with larger cohorts are required to validate these results and explore the sTREM-1 clinical utility in guiding therapeutic interventions in sepsis management.

Evaluation of sRAGE as a New Diagnostic and Prognostic Marker of Sepsis and Septic Shock Cases on Critically Ill Pediatric Patients

Abstract Background Serum sRAGE is a soluble isoform of a receptor for advanced glycation end products in different stages of sepsis. The present study will investigate the possible use of sRAGE as a diagnostic and prognostic marker of sepsis and septic shock in pediatric patients. Objective To study the role of sRAGE as a potential diagnostic and prognostic marker in sepsis and septic shock in pediatric intensive care unit. Patients and Methods This was a case control study that was conducted at Pediatric ICU, Ain Shams University Hospitals. This Studied were divided into 3 groups: 1/ Sepsis group (20 patients). 2/ Septic shock group (20 patients). 3/ healthy control group (40 child). Results In Sepsis cases, ROC curve analysis proved good discriminating power of the Serum RAGE between Non Survivor group and Survivor group where Area under the ROC curve (AUC) = 0.760 with (95% Confidence interval 0.52–0.92); p &amp;lt; 0.001. Cutoff point &amp;gt;270 with sensitivity= 80% and specificity=73.3%. In Septic Shock Cases, ROC curve analysis proved good discriminating power of the Serum RAGE between Non Survivor group and Survivor group where Area under the ROC curve (AUC) = 0.955 with (95% Confidence interval 0.76–0.99); p &amp;lt; 0.001. Cutoff point &amp;gt;310.9 with sensitivity= 90% and specificity=91%. Conclusion Our study suggests that sRAGE may serve as a valuable biomarker for assessing the severity and prognosis of sepsis and septic shock in pediatric patients, although further research with a larger sample size is warranted to validate these findings.

Association between red blood cell distribution width and 30-day mortality in critically ill septic patients: a propensity score-matched study

BackgroundSepsis is the leading cause of death worldwide, and a number of biomarkers have been developed for early mortality risk stratification. Red blood cell distribution width (RDW) is a routinely available hematological data and has been found to be associated with mortality in a number of diseases; therefore, we aim to address the association between RDW and mortality in critically ill patients with sepsis.MethodsWe analyzed data of critically ill adult patients with sepsis on the TriNetX platform, excluding those with hematologic malignancies, thalassemia, and iron deficiency anemia. Propensity score-matching (PSM) (1:1) was used to mitigate confounding effects, and hazard ratio (HR) with 95% confidence (CI) was calculated to determine the association between RDW and 30-day mortality. We further conducted sensitivity analyses through using distinct cut-points of RDW and severities of sepsis.ResultsA total of 256,387 critically ill septic patients were included in the analysis, and 40.0% of them had RDW equal to or higher than 16%. After PSM, we found that high RDW was associated with an increased 30-day mortality rate (HR: 1.887, 95% CI 1.847–1.928). The associations were consistent using distinct cut-points of RDW, with the strength of association using cut-points of 12%, 14%, 16%, 18% and 20% were 2.098, 2.204, 1.887, 1.809 and 1.932, respectively. Furthermore, we found consistent associations among critically ill septic patients with distinct severities, with the association among those with shock, receiving mechanical ventilation, bacteremia and requirement of hemodialysis being 1.731, 1.735, 2.380 and 1.979, respectively.ConclusionWe found that RDW was associated with 30-day mortality in critically ill septic patients, underscoring the potential as a prognostic marker in sepsis. More studies are needed to explore the underlying mechanisms.

Neutrophil-to-lymphocyte Ratio as a Marker for Diagnosis and Prognostication of Sepsis.

Exploring the ideal marker for early diagnosis and prognosis of sepsis is crucial due to limitations of available sepsis indicators. Hence, we aimed to evaluate the neutrophil-to-lymphocyte ratio (NLR) as a diagnostic and prognostic marker of sepsis. This prospective case-control study was conducted at a tertiary care teaching public hospital. NLR values among cases and controls were compared for diagnosis. Among cases, serial trends in NLR values, outcome (survival or death), and various parameters [such as Sequential Organ Failure Assessment (SOFA) score, duration of intensive care unit (ICU) stay, etc.] were compared between survivors and nonsurvivors for prognosis. Analysis was performed using MS Excel and PSPP version 1.0.1. A total of 120 patients (60 cases and 60 controls) were analyzed. The NLR among cases was significantly higher (p = 1.31 × 10-16) than in controls. Using binary logistic regression, a high NLR was found to be a statistically significant predictor of sepsis category (p = 2.25 × 10-5). The association of various variables among survivors and nonsurvivors of cases showed statistically significant differences: NLR (p = 5.29 × 10-5), mean = 13.27, interquartile range (IQR) = 5.90, z-value = -4.042), C-reactive protein (CRP) (p = 4.80 × 10-7), mean = 74.40, IQR = 21.30, z-value = -5.034), D-dimer (p = 4.32 × 10-8), mean = 7.09, IQR = 0.88, z-value = -5.477), SOFA score (p = 0.00118, mean = 8.50, IQR = 3.00, z-value = -3.244), and duration of hospital stay (p = 0.03578, mean = 13.45, IQR = 8.00, z-value = -2.099). The NLR emerges as a valuable marker for both diagnosis and prognosis in sepsis. Elevated NLR levels aid in diagnosing sepsis at very early stages, and the trend of NLR demonstrates a dynamic course throughout the disease process. Persistently elevated NLR and high NLR values correlate with poor outcomes in sepsis. Additionally, NLR can be correlated with other prognostic markers of sepsis and mortality. Therefore, we recommend the utilization of NLR as a quick, easy, and cost-effective marker for both early diagnosis and regular prognostication of sepsis.

Role Of Serum Hepcidin as A Diagnostic and Prognostic Marker For Sepsis among Critically ill Patients

Role Of Serum Hepcidin as A Diagnostic and Prognostic Marker For Sepsis among Critically ill Patients

The Utility of Serial Lipid Measurements as a Potential Predictor of Sepsis Outcome: A Prospective Observational Study in a Tertiary Care Hospital.

Sepsis is the major cause of morbidity and mortality for patients admitted to an intensive care unit worldwide. Currently, procalcitonin (PCT) is a widely used prognostic marker for sepsis. The high cost of estimating Procalcitonin limits its utility in all health facilities. Lipid profile, being a frequently done routine investigation, is studied in sepsis patients to predict the prognosis of sepsis. This study was aimed to assess the association between lipid profile parameters, procalcitonin and clinical outcomes in patients with sepsis. It is a prospective observational study conducted in a tertiary care hospital in the Department of Biochemistry in collaboration with the Intensive Care Unit (ICU). We included 80 sepsis patients from medical and surgical ICUs. Among them, 59 (74%) survived and 21 (26%) expired. Serum lipid profile, procalcitonin and variables required for APACHE II score are measured at two intervals, one during admission and on day 5. All the parameters were compared between the survivors and the non-survivors. Serum PCT levels were reduced on day 5 [3.32 (1.27-11.86)] compared to day 0 [13.42 (5.77-33.18)] in survivors. In survivors, Total Cholesterol, LDL-C and Non-HDL-C were significantly elevated on day 5 compared to day 0. In non-survivors, HDL-C significantly decreased on day 5. Between survivors and non-survivors, HDL-C significantly decreased on day 5 (23.88 ± 10.19 vs 16.67 ± 8.27 mg/dl). A Negative correlation was observed between HDL-C & PCT. Serum Lipid profile levels, namely Total cholesterol, HDL-C and LDL-C, have possible associations with the severity of sepsis. HDL-C have a negative association with the clinical scoring system in sepsis patients. Overall, the findings from our study suggest that lipid profile parameters have possible implications in predicting the outcome of patients with sepsis.

Utility of Platelet Indices as Prognostic Markers of Sepsis: A Medical Intensive Care Unit-Based Cross-Sectional Study at a Rural Setup.

Introduction Even after the breakthrough advancements in the management and prognostic scoring of sepsis, it remains an important cause of morbidity and mortality encountered in intensive care units (ICUs) throughout the globe. This study highlights the utility of platelet indices as prognostic markers of sepsis. Methods In the present prospective cross-sectional study, a total of 177 patients with sepsis were enrolled using the Sepsis-3 criteria. The platelet indices were then linked to severity using the Acute Physiology and Chronic Health Evaluation (APACHE) II score. The correlation of platelet indices to morbidity in terms of the length of ICU stay, need for a mechanical ventilator, types of infection, and mortality was also assessed. Results The results showed that mean platelet volume (p = 0.004) and platelet distribution width (PDW; p = 0.009) were positively correlated with the severity of sepsis. Among all the parameters, plateletcrit (%) was the best predictor of the need for an invasive mechanical ventilator at a cutoff point of ≤0.22 with a 60.90% chance of correctly predicting the need for an invasive mechanical ventilator, as was mortality at a cutoff point of ≤0.22 with a 67.30% chance of correct prediction. Among the platelet indices, only PDW showed a significant association with growth in culture because patients with growth had significantly higher PDW as compared to those who did not have growth (22.4 ± 4.47 vs 20.81 ± 4.29, p = 0.011). Conclusion The difference between the survivors and non-survivor groups was statistically significant for platelet indices, making them easily available, cost-effective, and useful prognostic markers for patients in septic shock. This will help in easy understanding and preventing its morbid complications, even at the primary care physician level.

Analysis of Immune and Prognostic-Related lncRNA PRKCQ-AS1 for Predicting Prognosis and Regulating Effect in Sepsis.

Sepsis was a high mortality and great harm systemic inflammatory response syndrome caused by infection. lncRNAs were potential prognostic marker and therapeutic target. Therefore, we expect to screen and analyze lncRNAs with potential prognostic markers in sepsis. Transcriptome sequencing and limma was used to screen dysregulated RNAs. Key RNAs were screened by correlation analysis, lncRNA-mRNA co-expression and weighted gene co-expression network analysis. Immune infiltration, gene set enrichment analysis and gene set variation analysis were used to analyze the immune correlation. Kaplan-Meier curve, receiver operator characteristic curve, Cox regression analysis and nomogram were used to analyze the correlation between key RNAs and prognosis. Sepsis model was established by lipopolysaccharide-induced HUVECs injury, and then cell viability and migration ability were detected by cell counting kit-8 and wound healing assay. The levels of apoptosis-related proteins and inflammatory cytokines were detected by RT-qPCR and Western blot. Reactive Oxygen Species and superoxide dismutase were detected by commercial kit. Fourteen key differentially expressed lncRNAs and 663 key differentially expressed genes were obtained. And these lncRNAs were closely related to immune cells, especially T cell activation, immune response and inflammation. Subsequently, Subsequently, lncRNA PRKCQ-AS1 was identified as the regulator for further investigation in sepsis. RT-qPCR results showed that PRKCQ-AS1 expression was up-regulated in clinical samples and sepsis model cells, which was an independent prognostic factor in sepsis patients. Immune correlation analysis showed that PRKCQ-AS1 was involved in the immune response and inflammatory process of sepsis. Cell function tests confirmed that PRKCQ-AS1 could inhibit sepsis model cells viability and promote cell apoptosis, inflammatory damage and oxidative stress. We constructed immune-related lncRNA-mRNA regulatory networks in the progression of sepsis and confirmed that PRKCQ-AS1 is an important prognostic factor affecting the progression of sepsis and is involved in immune response.

The Role of Absolute Eosinophil Count as a Diagnostic and Prognostic Marker for Sepsis and Its Relation with Sequential Organ Failure Assessment/Quick Sequential Organ Failure Assessment Score.

Sepsis is a dysregulated host response to an infection that causes organ failure that poses a serious risk to life. Although culture results are not always available right away and the majority of patients continue to test culture negative, microbial culture is still the gold standard for diagnosing sepsis. Therefore, the objective of the current study was to assess absolute eosinophil count as a new marker for diagnosing sepsis and also to assess the prognosis of the patient in relation to Sequential Organ Failure Assessment (SOFA)/quick Sequential Organ Failure Assessment (qSOFA) score. Resources and procedures: In this cross-sectional study, 100 patients with sepsis were enrolled. The other 100 patients without any evidence of sepsis were taken as controls. Absolute eosinophil count (AEC), SOFA/qSOFA scores of all the patients were measured on the 1st, 3rd, and 7th day and data was analyzed statistically. The mean AEC on admission day in sepsis patients was 49.5. The mean AEC among survivors was >50 and nonsurvivors was <50. AEC and SOFA/qSOFA scores exhibit a statistically significant and inverse correlation on the 1st, 3rd, and 7th day of illness. Absolute eosinophil count (AEC) is a simple and cost-effective marker that may be helpful in diagnosis as well as in predicting the prognosis of sepsis as evidenced by its linear inverse correlation with SOFA/qSOFA score.

Efficacy of Neutrophil Lymphocyte Stress Factor in Diagnosis of Sepsis and Prediction of Mortality in Septic Patients Admitted to the ICU

Abstract Background Sepsis is a major public health concern. It is among the most common reasons for admission to intensive care units (ICUs) throughout the world. Severe sepsis and septic shock are associated with 30-60% mortality rate which is very high compared to other common diseases, such as myocardial infarction or breast cancer. Sepsis is now defined as a “life-threatening organ dysfunction due to a dysregulated host response to infection”. Aim of the Work to evaluate the efficacy of neutrophil lymphocyte stress factor (NLSF) in the diagnosis of sepsis and prediction of mortality in septic patients admitted to the ICU. Patients and Methods We conducted this prospective observational study on 60 patients after informed consents were taken from patients or their next of kin. We enrolled adult patients admitted to the ICU with the diagnosis of septic shock. We excluded patients younger than 18 years, pregnant females, patients with terminal malignancy, patients with liver cirrhosis child-pugh C, patients with shock of mixed origin and patients with aplasia, immunosuppressive disease or receiving immunosuppressive therapy. Then we classified patients into 2 main groups according to presence of sepsis into; Septic group (30 patients), and Non-Septic group (30 patients). Results from our study concluded that NLSF can be used in diagnosis of sepsis, although it’s the least accurate diagnostic marker among PCT, CRP and NLSF, it provides the cheapest tool for diagnosis of sepsis. It was also found that NLSF can be used in prediction of mortality in septic patient during the period of our study and that it’s the most accurate prognostic marker of mortality among PCT, CRP and NLSF. Conclusion NLSF in combination with other parameters can be used as a cheap easy tool for the early detection of sepsis in intensive care units. NLSF can be used as a prognostic marker in sepsis for prediction of mortality in ICU. Further studies are required to clarify these results on a larger group of patients and for longer periods of time.

Mean Platelet Volume as a Prognostic Marker in Sepsis in ICU

Abstract Background Sepsis is defined as a systemic inflammatory response to confirmed or suspected infection. It is a major cause of morbidity and mortality, and the incidence is rising, probably due to the growing elderly population, antibiotic resistance, immunosuppressive medication and, invasive surgery. Pneumonia is the most common infection leading to sepsis, followed by urinary tract infections and abdominal infections. These infections are usually localized and controlled by the immune system, but they can sometimes spread and cause sepsis. Objective To correlate between the mean platelet volume in patients with sepsis with C-reactive protein as a prognostic markers. Patients and Methods This is a prospective study conducted on 80 adult critically ill patients of both sexes with sepsis and sever sepsis who admitted to the units of Critical Care Medicine Ain Shams University Hospitals. The samples were collected during the period from 1st October 2019 to 31st March 2020, MPV results were correlated to CRP, SOFA score and APACHE score. Results The results of the present study revealed: 55.8 % were male and 44.2 % were females. Sex did not affect mortality, no statistical significance found. In this study, MPV was a significant parameter in septic patients. The cut off value for MPV was 10.5 fl which was found to be significant and of a magnitude considered to be clinically useful, with sensitivity 57.1%, specificity 80.8%, p value (0.003) and accuracy 72.5% in predicting mortality. A correlation was found between high MPV, CRP, SOFA and APACHE scores. Therefore, MPV may be used as an auxiliary test in the prognosis of sepsis. Conclusion Initial values of MPV were significantly correlated with CRP, APACHE and SOFA scores and with the estimated rate of mortality.

Anion gap(AG) or serum lactate-in search of a better prognostic marker in sepsis a cross-sectional study in a rural tertiary care hospital

Background: In intensive care units, sepsis is a common diagnosis. Serum lactate rise has been established as an essential measure for predicting the outcome of sepsis. Higher anion gap(AG) has been associated with an increased risk of death in critically ill individuals. We measured blood lactate levels and AG and looked at how these predicted in-hospital outcomes (death or discharge).This study aimed to estimate anion gap values in sepsis syndrome, to measure the serum lactate levels in sepsis syndrome, to correlate the anion gap and serum lactate values with the outcome (mortality and discharge) in patients with sepsis syndrome. Methods: The Department of Medicine at Jawaharlal Nehru Medical College conducted this single-center, prospective, observational cross-sectional study with a cohort design. A total of 160 patients with sepsis were screened in the ICU. Sepsis was diagnosed using SEPSIS-3 criteria. Results: In this study, we included 160 patients with sepsis with sequential organ failure assessment (SOFA) score &gt;2.Mean serum lactate was 5.1±1.2 mmol/L and it was ≥4 mmol/L in 90% of patients. Mean AG was 14.0±3.9 and it was ≥12 in 75.6% of patients. Similarly, the proportion of patients who had lactate levels ≥4 mmol/L was higher in those with AG ≥12 than AG &lt;12 (95.9% vs. 71.8%, p&lt;0.0001). The AUC of ROC in predicting mortality was significant for both serum lactate (AUC 0.797, p&lt;0.0001) and AG (AUC 0.835, p&lt;0.0001). Conclusions: Along with other parameters predicting mortality, serum lactate and AG also act as important predictors of mortality in sepsis patients. We conclude that on admission serum lactate ≥4 mmol/L and AG ≥12 can be used in predicting short-term mortality in patients with sepsis.

Platelet‑related parameters as potential biomarkers for the prognosis of sepsis.

Early diagnosis and accurate prognosis are key for reducing the fatality rate and medical expenses associated with sepsis. Platelets are involved in the delayed tissue injury that occurs during sepsis. Therefore, the aim of the present study was to investigate the usefulness of platelets and associated parameters as prognostic markers of sepsis. The present study collected patient samples based on The Third International Consensus Definitions for Sepsis and Septic Shock criteria. Platelet-associated parameters were detected by flow cytometry and their correlation with clinical scores and prognoses was analyzed. Considering the association between endothelial cells and platelet activation, levels of plasma tumor necrosis factor-like weak inducer of apoptosis (TWEAK) and angiopoietin-2 (Ang-2) were analyzed by ELISA. The results showed significant differences in platelet P-selectin expression and phosphatidylserine exposure, mitochondrial membrane potential (Mmp)-Index values and plasma levels of TWEAK and Ang-2 between patients and healthy controls (P<0.05). Except for P-selectin and TWEAK levels, all parameters were correlated with clinical scores (acute physiology and chronic health evaluation II and sequential/sepsis-related organ failure assessment). Additionally, platelet Mmp-Index between admission and the end of therapy was only different in non-survivors (P<0.001) and platelet phosphatidylserine exposure was significantly lower in survivors (P=0.006). Therefore, of the parameters tested, the dynamic monitoring of phosphatidylserine exposure, platelet Mmp-Index values and plasma Ang-2 levels had the most potential for the assessment of disease severity and clinical outcomes.

The Correlation between RDW, PDW, and NLR with the SOFA Score in Septic Patients

Sepsis is one of the main causes of mortality in the intensive care unit. The SOFA score is used to assess organ dysfunction. There are several markers of sepsis such as the combination of RDW, PDW, and NLR to help predict the outcome of sepsis. To determine the role of RDW, PDW, and NLR associated with SOFA scores as prognostic markers in sepsis. A retrospective study with a cross-sectional approach has been conducted using secondary data from the medical records of sepsis patients from January 2018 to December 31, 2020, who met the inclusion criteria and were admitted to the ICU of Dr. Wahidin Sudirohusodo Hospital, Makassar. The sample size was 109 people consisting of 62 (56.9%) males and 47 (43.1%) females. The highest age range is 56–65 years (37.6%). A total of 97 people (89%) died and 12 (11%) improved. There is a positive correlation between changes in RDW and changes in SOFA scores (p=0.031), there is a positive correlation between changes in PDW and changes in SOFA scores (p=0.000), and there is a positive correlation between changes in NLR and changes in SOFA scores (p=0.000). The increase of RDW caused by systemic inflammation can predict disease progression. The state of increased proinflammatory cytokines inhibits the proliferation and maturation of erythrocytes; hence, it causes an increase in RDW. The acceleration of platelet destruction due to the suppression of cytokines in the bone marrow increases PDW. The increase in NLR occurs due to the rise in the inflammatory response, which results in suppressed cellular immunity. RDW, PDW, and NLR are positively correlated with changes in SOFA scores. PDW and NLR have a significant correlation with the outcome. RDW, PDW, and NLR can be used as prognostic markers in septic patients

Platelet indices in critically ill septic patients as a predictor of mortality

ABSTRACT Background Platelet (PLT) indices are used to quantify the total number of PLTs, their morphology, and their proliferation kinetics. The aim of this work was to explore whether platelet indices (PLT count, platelet distribution width (PDW), mean platelet volume (MPV) and platelet crit (PCT) can be used to predict mortality in critically ill septic patients. Methods This prospective cross-sectional study was carried out on 54 critically ill septic patients according to sequential organ failure assessment (SOFA) scores from May 2020 to May 2021. Patients were grouped into: (1) survivors’ group and (2) non-survivors’ group. Complete blood count, C-reactive protein (CRP) and procalcitonin serum levels were measured. Results A rise in MPV, PDW, procalcitonin and CRP and a fall in PLT and PCT was associated with non-survivors’ group. For prediction of mortality, PLT, MPV and PDW at cut-off value ≤183 *103/dl, >10.9 fl and >14% had (57.89%, 84.21% and 78.95%) sensitivity, (71.43%, 80% and 74.29%) specificity, (52.4%, 69.6% and 62.5%) positive predictive value (PPV), negative predictive value (NPV) (75.8%, 90.3% and 86.7%), (0.672, 0.868 and 0.856) area under the curve (AUC) and (0.038, <0.001 and <0.001) P value respectively. For prediction of mortality, procalcitonin at cut-off value 5.6 ng/dl had 94.74% sensitivity, 85.7% specificity, 78.3% PPV, NPV 96.8, 0.919 AUC and <0.001 P value. In multivariate regression analysis, most affecting factors for mortality were procalcitonin, MPV and PDW (P value<0.05). Conclusions Platelet indices are low-cost, readily accessible metrics that have the potential to be valuable prognostic markers in sepsis.

The Influencing Factors of Neutrophil-to-Lymphocyte Ratio as a Prognostic Marker for Sepsis: Analysis from a Large Database

Abstract The neutrophil-to-lymphocyte ratio (NLR) is an important predictive prognostic tool. However, its accuracy for predicting sepsis remains debatable. This study aimed to evaluate the factors influencing the ability of NLR to predict sepsis. Adult patients with sepsis or septic shock from the eICU database were enrolled in this study. Results showed that there was a significant difference in NLR between the survival and nonsurvival groups (median [lower quartile–upper quartile], 15.27 [7.92–26.28] vs. 17.97 [8.94–31.85], P = 0.008). Area under the curve (AUC) of NLR on the sixth day was the highest. AUC of NLR was significantly higher in the Simplified Acute Physiological Score (SAPS) 3 ≤52 group than that in the SAPS3 &gt; 52 group (0.78 ± 0.05 vs. 0.69 ± 0.03, P = 0.007). AUC of NLR in the nonshock group was significantly higher than that in the shock group (0.72 ± 0.04 vs. 0.65 ± 0.05, P &lt; 0.01). The ability of NLR as a prognosis predictor of sepsis was influenced by admission time, SAPS3, and shock.

RDW as a Prognostic Marker of Sepsis and its Comparison with APACHE II Score: A Prospective Observational Cross-sectional Study

Introduction: Sepsis is one of the most important and common cause for Intensive Care Unit (ICU) admission. Life-threatening organ dysfunction is caused by a dysregulated host response to infection. Clinical scoring system is cumbersome for prognosticating sepsis outcome. Red cell Distribution Width (RDW) is a part of routine investigation done in the form of Complete Blood Count (CBC), inexpensive and easily available. Aim: To evaluate RDW as a prognostic marker of sepsis and its comparison with APACHE II (Acute Physiology And Chronic Health Evaluation II) score. Materials and Methods: The present study was a prospective observational cross-sectional study which included 110 patients diagnosed with sepsis. The patients were divided into survivors and non survivors group. CBC, liver function test, kidney function test, serum electrolytes, Arterial Blood Gas (ABG) analysis, blood culture, site-specific culture were done and APACHE II was calculated. Results: Out of the 110 patients enrolled in the study, 61 were males and 49 were females. Mean±SD age of the non survivors (n=42) was 57.45±22.93 years and that of survivors (n=68) was 58.59±17.18 years. APACHE II score in the non survivors was 18.50±6.80 while that among the survivors was 10.51±6.61 (p&lt;0.001). RDW in the non survivors was 17.62±4.29 while that in the survivors was 13.99±1.66 (p&lt;0.001). Conclusion: RDW was found to be significantly higher in non survivor group as compared to survivor in this study. So RDW at admission can be used as simple, easy to perform prognostic marker of sepsis.

Addition of HbA1c to SOFA score for predicting outcomes in diabetic patients with sepsis and septic shock

Sepsis is a common cause of admissions into intensive care units (ICU’s). SOFA (sequential organ failure assessment) score has been validated as a prognostic marker in sepsis and there’s a good correlation between SOFA scoring and mortality of patients. Diabetes is a well-known predisposing factor for sepsis and we studied whether addition of HbA1c to SOFA score was helpful in predicting outcomes in diabetic patients with sepsis and septic shock. H-SOFA max score (HbA1c score added to maximum SOFA measured on any day of hospital stay) was the best predictor for in-hospital mortality. The mean H-SOFA (Max) score in the died (in-hospital mortality) group was 12.21 (±2.78), and in the discharged group was 5.49 (±2.68). Next best predictor was H-SOFA score (HbA1c score added to SOFA score at admission), followed by SOFA score. All the scores had a positive correlation with length of ICU stay. HbA1c (indicator of glycemic control) was helpful in predicting mortality when combined with the SOFA score (but not by itself). These scores may therefore be helpful to physicians and intensivists for prognostication of the patient and during counselling of the relatives, including end of life discussions.

Predictive Value of Frailty Index in Comparison to Traditional Markers of Sepsis in Predicting Mortality among Elderly Admitted in Tertiary Care Hospital

The frailty index's potential as a prognostic marker of sepsis is so far been untapped. Here we studied the predictive value of frailty index in the elderly with sepsis. This prospective cohort study was conducted in a tertiary level hospital in North India. The duration of the study was 18 months starting from January 2020 to July 2021. The frailty index was calculated along with traditional markers of sepsis such as sequential organ failure assessment (SOFA), quick sequential organ failure assessment (qSOFA), and systemic inflammatory response syndrome (SIRS) within 24 hours of admission in elderly patients suspected to have sepsis. The area under the receiver operating characteristic (AUROC) of frailty index, SOFA, qSOFA, and SIRS was compared for in-hospital and 3-month mortality. There was no significant difference between the performance of the frailty index and SOFA (DeLong's test p = 0.242) in predicting in-hospital mortality, but there was a statistical difference between the AUROC of SOFA score (AUC = 0.548) and frailty in predicting 3-month mortality (DeLong's test p ≤0.001). The frailty index had greater sensitivity and negative predictive value among the other scores in predicting in-hospital mortality, whereas SOFA had higher specificity in predicting in-hospital mortality. The frailty index was superior to SOFA and the other prognostic markers of sepsis in predicting 3-month mortality.

N-Terminal B Natriuretic Peptide as a Prognostic Marker in Sepsis Induced Myocardial Dysfunction

BACKGROUND: Sepsis-induced myocardial dysfunction (SIMD) is an increasingly recognized form of transient cardiac dysfunction in sepsis patients. AIM: The aim of the study was to evaluation of N-terminal pro brain natriuretic peptide (NT-pro BNP) as a predictor of SIMD and poor outcome in patients with sepsis or septic shock. METHODS: Forty patients were enrolled and divided into: Group 1 with sepsis; Group 2 with septic shock. Each group was subdivided according to the presence or absence of cardiomyopathy. Echocardiography, NT-pro BNP - assay on the 1st and 2nd days of admission - were performed. RESULTS: NT-pro BNP level was significant predictor for cardiomyopathy in all case group with 75% sensitivity, 70% specificity (cutoff level &gt;334 pg/ml) on 1st day of admission and 65% sensitivity, and 80% specificity (cutoff level &gt;325 pg/ml) on 2nd day. On subgroup analysis, pro-BNP had 70% sensitivity, 90% specificity; cutoff level &gt;334 pg/ml for prediction of cardiomyopathy in sepsis group and 70% sensitivity and 80% specificity; cutoff level &gt;357pg/ml in septic shock group. Pro-BNP on 2nd day was excellent predictor of mortality in septic shock group with 100% sensitivity and specificity; cutoff level &gt;350 pg/ml. CONCLUSION: N terminal pro-BNP is a good diagnostic and prognostic indicator for cardiomyopathy and mortality in septic patients.