Risk Of Sepsis Research Articles

Explainable machine learning for early prediction of sepsis in traumatic brain injury: A discovery and validation study

Background People with traumatic brain injury (TBI) are at high risk for infection and sepsis. The aim of the study was to develop and validate an explainable machine learning(ML) model based on clinical features for early prediction of the risk of sepsis in TBI patients. Methods We enrolled all patients with TBI in the Medical Information Mart for Intensive Care IV database from 2008 to 2019. All patients were randomly divided into a training set (70%) and a test set (30%). The univariate and multivariate regression analyses were used for feature selection. Six ML methods were applied to develop the model. The predictive performance of different models were determined based on the area under the curve (AUC) and calibration curves in the test cohort. In addition, we selected the eICU Collaborative Research Database version 1.2 as the external validation dataset. Finally, we used the Shapley additive interpretation to account for the effects of features attributed to the model. Results Of the 1555 patients enrolled in the final cohort, 834 (53.6%) patients developed sepsis after TBI. Six variables were associated with concomitant sepsis and were used to develop ML models. Of the 6 models constructed, the Extreme Gradient Boosting (XGB) model achieved the best performance with an AUC of 0.807 and an accuracy of 74.5% in the internal validation cohort, and an AUC of 0.762 for the external validation. Feature importance analysis revealed that use mechanical ventilation, SAPSII score, use intravenous pressors, blood transfusion on admission, history of diabetes, and presence of post-stroke sequelae were the top six most influential features of the XGB model. Conclusion As shown in the study, the ML model could be used to predict the occurrence of sepsis in patients with TBI in the intensive care unit.

Nutritional interventions in patients with burn injury: an umbrella review of systematic reviews and meta-analyses of randomised clinical trials.

Multiple reviews have examined the impact of nutritional interventions in patients with burn injuries; however, discrepancies among results cast doubt about their validity. We implemented this review to assess the impact of various nutritional interventions in adult patients with burn injuries. We conducted a thorough search of PubMed, Scopus and Web of Science databases until 1 August 2024, to identify relevant meta-analyses of intervention trials, examining the impact of nutritional interventions on burn patients. We adopted the random-effect models to determine the pooled effect sizes while employing the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) to examine evidence certainty. Thirty-three original intervention trials from eleven meta-analyses were entered in our review. Early enteral nutrition could substantially reduce overall mortality (relative risk (RR): 0·36, 95 % CI: 0·19, 0·68, GRADE = moderate certainty), hospital stay (mean difference (MD): -15·3, 95 % CI: -20·4, -10·2, GRADE = moderate certainty) and sepsis risk (RR: 0·23, 95 % CI: 0·11, 0·45, GRADE = moderate certainty). Glutamine showed a notable decrease in the length of hospital stay (MD: -6·23, 95 % CI: -9·53, -2·94, GRADE = low certainty). However, other nutritional interventions, including combined immunonutrition, branched-chain amino acids, fish oil, ornithine α-ketoglutarate and trace elements, did not significantly affect the assessed clinical outcomes. Early enteral nutrition might impose a beneficial effect on mortality, hospital stay length and incidence of sepsis with moderate evidence. Lower length of hospital stay was also seen in burn patients supplemented with glutamine, although the evidence was weak.

The Influence of Regional Anesthesia on the Systemic Stress Response

Background: The systemic stress response to surgery is a complex physiological process characterized by neuroendocrine, sympathetic, and inflammatory activation. While necessary for survival, this response can lead to adverse outcomes such as hyperglycemia, immune suppression, cardiovascular complications, and delayed recovery. Regional anesthesia (RA) has been shown to modulate this stress response more effectively than general anesthesia (GA) by blocking nociceptive signaling and attenuating the release of stress mediators. Objectives: This review aims to elucidate how RA influences the systemic stress response, highlighting its clinical benefits in reducing postoperative pain, improving hemodynamic stability, minimizing inflammatory responses, and preserving immune function. Additionally, this review examines evidence from clinical trials supporting using RA to improve surgical outcomes, particularly in high-risk populations. Methods: A comprehensive narrative review of the literature was conducted to explore the physiological impact of RA on the systemic stress response and its associated clinical outcomes. Studies comparing RA to GA across various surgical procedures were evaluated, focusing on neuroendocrine modulation, sympathetic inhibition, inflammatory attenuation, and the implications for pain management, cardiovascular and pulmonary function, and immune preservation. Results: RA significantly attenuates the neuroendocrine response by reducing the release of cortisol and catecholamines, thereby improving hemodynamic stability and reducing myocardial oxygen consumption. RA also inhibits the sympathetic nervous system, leading to improved cardiovascular outcomes. Furthermore, RA mitigates the inflammatory response by reducing pro-inflammatory cytokine levels, reducing the risk of systemic inflammatory response syndrome (SIRS), sepsis, and pulmonary complications. Clinical studies and meta-analyses consistently demonstrate that RA reduces postoperative pain, opioid consumption, and the incidence of cardiovascular and pulmonary complications, particularly in elderly and high-risk patients. Conclusions: RA offers a significant advantage in modulating the systemic stress response to surgery, improving postoperative outcomes by reducing pain, enhancing cardiovascular stability, and preserving immune function. Its benefits are particularly pronounced in high-risk populations such as the elderly or those with pre-existing comorbidities. Given the growing evidence supporting its efficacy, RA should be considered a critical component of multimodal perioperative care strategies aimed at minimizing the systemic stress response and improving recovery. Future research should optimize RA techniques and identify patient-specific factors to enhance therapeutic benefits.

Antenatal pyelonephritis hospitalisation trends, risk factors and associated adverse outcomes: A retrospective cohort study.

To analyse trends, risk factors and adverse outcomes associated with antenatal pyelonephritis hospitalisations. Retrospective cohort. A national sample of US delivery hospitalisations with associated antenatal hospitalisations. US delivery hospitalisations in the Nationwide Readmissions Database from 2010 to 2020. Antenatal hospitalisations with a pyelonephritis diagnosis within the 9 months before delivery hospitalisation were analysed. Clinical, demographic and hospital risk factors associated with antenatal pyelonephritis hospitalisations were analysed with unadjusted and adjusted logistic regression models with unadjusted and adjusted odds ratios as measures of effect. Temporal trends in antenatal pyelonephritis hospitalisations were analysed with Joinpoint regression to determine the relative measure of average annual percent change (AAPC). Risk for severe maternal morbidity and sepsis during antenatal pyelonephritis hospitalisations was similarly analysed with Joinpoint regression. Of an estimated 10.2 million delivery hospitalisations, 49 140 (0.48%) had an associated antenatal pyelonephritis hospitalisation. The proportion of deliveries with a preceding antenatal pyelonephritis hospitalisation decreased by 29% from 0.56% in 2010 to 0.40% in 2020 (AAPC -2.9%, 95% CI -4.0% to -1.9%). Antenatal pyelonephritis decreased, but risk for sepsis diagnoses increased during these hospitalisations from 3.7% in 2010 to 18.0% in 2020 (AAPC 17.2%, 95% CI 14.2%-21.1%). Similarly, risk for severe morbidity increased from 2.6% in 2010 to 4.4% in 2020 (AAPC 5.5%, 95% CI 0.8%-10.7%). Antenatal pyelonephritis admissions appear to be decreasing in the USA. However, these hospitalisations are associated with a rising risk for sepsis and severe maternal morbidity.

The infection post flexible UreteroreNoscopy (I-FUN) predictive model based on machine learning: a new clinical tool to assess the risk of sepsis post retrograde intrarenal surgery for kidney stone disease.

To create a machine-learning model for estimating the likelihood of post-retrograde intrarenal surgery (RIRS) sepsis. All consecutive patients with kidney stone(s) only undergoing RIRS in 16 centers were prospectively included (January 2022-August 2023). adult, renal stone(s) only, CT scan (within three months), mid-stream urine culture (within 10 days). concomitant ureteral stone, bilateral procedures. In case of symptomatic infection/asymptomatic bacteriuria, patients were given six days of antibiotics according to susceptibility profiles. All patients had antibiotics prophylaxis. Variables selected for the model: age, gender, age-adjusted Charlson Comorbidity Index, stone volume, indwelling preoperative bladder catheter, urine culture, single/multiple stones, indwelling preoperative stent/nephrostomy, ureteric access sheath, surgical time. Analysis was conducted using Python programming language, with Pandas library and machine learning models implemented using the Scikit-learn library. Machine learning algorithms tested: Decision Tree, Random Forest, Gradient Boosting. Overall performance was accurately estimated by K-Fold cross-validation with three folds. 1552 patients were included. There were 20 (1.3%) sepsis cases, 16 (1.0%) septic shock cases, and three more cases (0.2%) of sepsis-related deaths. Random Forest model showed the best performance (precision = 1.00; recall = 0.86; F1 score = 0.92; accuracy = 0.92). A web-based interface of the predictive model was built and is available at https://emabal.pythonanywhere.com/ CONCLUSIONS: Our model can predict post-RIRS sepsis with high accuracy and might facilitate patient selection for day-surgery procedures and identify patients at higher risk of sepsis who deserve extreme attention for prompt identification and treatment.

Selenoprotein P as a prognostic biomarker of burn sepsis: A prospective cohort study

IntroductionSeverely burned patients exhibit increased nutritional requirements and are at high risk of developing sepsis. Selenium is an essential trace element supporting antioxidant and anti-inflammatory pathways, mediated by incorporation into selenoproteins. The selenium status may affect sepsis risk in burn injury. MethodsThis prospective cohort study included 90 adult patients admitted to Zurich Burn Center, Switzerland. All patients received a continuous intravenous infusion of 1000μg sodium selenite per day during the first week as part of local standard of care. Three complementary biomarkers of serum selenium status were determined at nine time-points up to six months postburn, namely total selenium, selenoprotein P, and glutathione peroxidase 3. The resulting data were correlated to clinical parameters and outcomes, with sepsis as primary end point. ResultsA high fraction of the patients displayed selenium deficiency already at admission, and developed sepsis during hospitalization (n = 55; 61%). Selenium status at admission was inversely related to burn severity. Low baseline selenoprotein P was associated with sepsis incidence, irrespective of trauma severity (adjusted HR, 1.94; 95% CI, 1.05–3.63; p = 0.035). Burn severity and baseline concentrations of selenoprotein P and white blood cells corporately predicted sepsis with an area under the curve of 0.84 (95% CI, 0.75–0.93; p < 0.0001). Supplemental selenium was associated with a transient normalization of selenium status. ConclusionConsidering its rapid decline following severe burn injury, the assessment of serum selenoprotein P upon admission may contribute to an early prediction of sepsis risk.

Clinical efficacy and safety of parenteral nutrition in hematopoietic stem cell transplantation: results of a single-center randomized controlled study

BACKGROUND: Hematopoietic stem cell transplantation frequently necessitates nutritional support. However, the safety and tolerance of parenteral nutrition have not been adequately examined, except for its association with infectious complications. AIM: To evaluate the impact of parenteral nutrition on nutritional status and its correlation with complications during the early period following hematopoietic stem cell transplantation. MATERIALS AND METHODS: From 2019–2020, 125 recipients of autologous (n=38) and allogeneic (n=87) hematopoietic stem cell transplantation were included in the study with a median age of 20 years (2–65). The chosen cohort included patients with leukemia (n=67), solid tumors (n=32), dysplasia (n=15) and lymphoproliferation (n=11). The control group (n=55) was composed of patients who did not depend on nutritional support. Parenteral nutrition was administered to the primary group (n=70) using second-generation (n=22) and third-generation (n=24) fat emulsions. In the event of contraindications, parenteral nutrition was administered without fat emulsions (n=24). To mitigate the risk of side effects, the initial dose of parenteral nutrition was 50%, with the achievement of the complete dose by the third day of therapy. RESULTS: In 95.7% of cases, mucositis was the indication for parenteral nutrition. The duration of parenteral nutrition was 2–31 days (median, 11 days). In 58.6% of cases, parenteral nutrition was initiated against the background of nausea and vomiting. During the escalation of the parenteral nutrition dose, increased nausea was observed in 7.1% of patients. Side effects were noted in 22.9% of cases: hyperglycemia (n=7), vomiting (n=6) and hypertriglyceridemia (n=3). Four patients developed complications associated with parenteral nutrition, and nutritional therapy was discontinued in 20% of cases (n=14). After hematopoietic stem cell transplantation, the primary clinical efficacy criterion, body mass index, was observed to decline in each observation group. However, it recovered by day 28 and did not differ between the comparison groups as follows: the control group — from 22.7±6.4 to 21.7±6.1 kg/m2, (p=0.42); group “2 in 1” — from 23.4±6.1 to 21.6±4 kg/m2, (p=0.56); group provided with parenteral nutrition employing second-generation fat emulsions — from 18,8±4,9 to 18.7±4.4 kg/m2, (p=0.72); group administered parenteral nutrition with third-generation fat emulsions — from 18.6±4.2 to 18.3±3.5 kg/m2, (p=0.84). The febrile neutropenia rate was 75.2% and did not vary in the control and comparison groups (p=0.54). The incidence of sepsis was 24.8% and was not influenced by the use of parenteral nutrition (p=0.07). Furthermore, sepsis risk was higher when administering parenteral nutrition “2 in 1” compared to fat emulsions-containing parenteral nutrition (p=0.002). The overall frequency of acute graft versus host disease was 16.1% and was similar in the comparison groups (p=0.65). CONCLUSION: In the cohort of patients treated with hematopoietic stem cell transplantation, parenteral nutrition regimens supplemented with second- and third-generation fat emulsions with a stepwise dose increase varied in acceptable tolerance, infection-related complications, and immunological safety, as well as effectively maintained nutritional status parameters.

Balancing hydrophobicity and surface potential in bio-based bisfuran-containing polyamide coatings for enhanced long-term antibacterial efficacy and endotoxin adsorption

To develop antimicrobial protective materials based on renewable polymers, we synthesized a series of bio-based bisfuran-based polyamide (bFPA) polymers with various functional groups, including allyl quaternary ammonium cations, decyl quaternary ammonium cations, and sulfonate betaine. These bFPA-based coating materials, featuring excellent thermal stability (>230 °C) and biocompatibility, were facilely fabricated on polyurethane (PU) substrates by blending and crosslinking with unsaturated aliphatic PU resin. By altering the combination of different functional groups in bFPA polymers, we controlled the hydrophilicity/hydrophobicity and surface charge properties of the bio-based coating. Compared to pure PU coatings, the bFPA-based coatings with moderate hydrophilicity/hydrophobicity and surface potential significantly reduced the adhesion of model protein and bacteria by approximately 70 % and >99 %, respectively, demonstrating outstanding anti-protein and anti-bacterial adhesion properties. Even after seven cycles of use, the coatings maintained the ability to kill ∼80 % and >99 % of Gram-negative Escherichia coli and Gram-positive Staphylococcus aureus bacteria, respectively, indicating long-lasting antibacterial activity. Additionally, the optimized bFPA-based coatings effectively adsorbed ∼80 % of endotoxins from damaged Gram-negative bacteria through electrostatic interactions, thereby reducing the risk of inflammation and sepsis. The development of bio-based polyamide coatings with long-term antibacterial and endotoxin adsorption properties significantly advances their safe and reliable application of in the field of biomedical devices.

Maternal factors associated with early-onset neonatal sepsis among caesarean-delivered babies at Mbarara Regional Referral Hospital, Uganda: a case-control study

BackgroundBabies born via caesarean section in low-income settings face a higher risk of early-onset neonatal sepsis (EONS), which has greater mortality than late-onset sepsis. However, maternal factors contributing to EONS among caesarean-delivered babies in these settings, including Uganda, are not well documented. We determined maternal factors associated with EONS among term babies delivered by caesarian section at Mbarara Regional Referral Hospital (MRRH), southwestern Uganda.MethodsWe conducted an unmatched case-control study at MRRH from December 2019 to March 2020. Cases were caesarean section-delivered term babies with EONS (within 72 h). Controls were caesarean section-delivered term babies without EONS. We enrolled mother-baby pairs for both groups, obtaining maternal data via structured questionnaires The diagnosis of EONS was made using the WHO Young Infant Integrated Management of Childhood Illnesses algorithm. Cases were consecutively recruited while controls were recruited by simple random sampling in a ratio of 1:2. We excluded newborns whose mothers were too ill to consent. We used multivariable logistic regression analysis to identify maternal factors associated with EONS.ResultsWe enrolled 52 cases and 104 controls. The mean age for the mothers was 27 (± 5.5) years. Neonates born to referred mothers had higher odds of EONS than those born to non-referred mothers (AOR = 6.2, 95% CI: 1.8–21). Additionally, decision-to-delivery time > 1 h for emergency caesarean section (AOR = 16, 95% CI: 4.2–65), antepartum hemorrhage (AOR = 8.0, 95% CI: 1.6–40), primiparity (AOR = 4.8, 95% CI: 1.1–21), and > 3 vaginal examinations after membrane rupture (AOR = 4.3, 95% CI: 1.5–12) were associated with EONS.ConclusionsPrime gravidity, antepartum hemorrhage, multiple vaginal examinations after membrane rupture, long decision-to-delivery time, and referral status were associated with EONS among term babies delivered by caesarean section at MRRH. To reduce EONS risk, clinicians should limit post-membrane rupture vaginal exams or consider prophylactic antibiotics if multiple exams are needed. Screening babies born to primiparous women, those referred, those with antepartum hemorrhage, multiple vaginal exams after membranes rupture, and long decision-to-delivery times, could aid prompt recognition of EONS and timely interventions. Implementing standard procedures to reduce caesarean decision-to-delivery time could reduce risk for EONS in this setting.

Prevalence and incidence of chronic wounds in Austria - a population-based real-world data analysis

Abstract Background Chronic wounds are associated with pain, odor, loss of mobility, an increased risk for infection and sepsis and a reduced quality of life. Treatment costs are rising due to the longevity of the population and increasing number of diabetes cases. For service planning in healthcare, it is thus necessary to describe patient characteristics and estimate the prevalence and incidence of chronic wounds. Currently, no data exists on this subject broken down by age group, gender, and province in Austria. Methods A retrospective analysis of real-world data was conducted using two merged datasets from an outpatient wound centre and the Austrian Health Insurance Fund. The study population consisted of people who resided in Austria and were covered by statutory health insurance from 2018 to 2022. We performed a descriptive, socio-demographic analysis of the data of patients, followed by a set of cluster analyses using the unsupervised K-means algorithm. From these clusters, we derived subgroup characteristics and patient trajectories and calculated prevalence and incidence rates for chronic wounds according to diagnoses, different age groups, gender, and different regions. Results Gender was almost evenly distributed in the wound centre’s data set (n = 4963; 49.6% female). The age distribution revealed the age group from 71-80 years being the largest group. In general, more women than men are affected by chronic wounds from the age of 81 onwards. 31% of chronic wound patients had diabetes as an underlying condition. More men were affected by peripheral arterial occlusive disease and diabetic foot syndrome and, conversely, more women by chronic venous insufficiency. These are preliminary results of the analyses. Conclusions Chronic wound patients were characterised by older age and multi-morbidity. Interestingly, gender differences appeared in the occurrence of comorbidities. Key messages • This study makes a crucial contribution in making routine data usable for the epidemiological study of chronic wounds, a cluster of diseases of complex aetiology. • It thus contributes to filling a knowledge gap. The prevalence estimate serves as a basis of knowledge for health care planning and a basis for the health economic assessment of the problem.

Development of acute kidney injury following repair of Stanford type A aortic dissection is associated with increased mortality and complications: a systematic review, meta-analysis, and meta-regression analysis.

Acute kidney injury (AKI) frequently complicates the repair of Stanford type A aortic dissection (TAAD). This systematic review, meta-analysis, and meta-regression analysis aimed to elucidate the prognostic impact of AKI in these patients. A literature search in PubMed, EMBASE, and Google Scholar identified relevant studies on the predictors and outcomes of AKI following TAAD repair. The primary endpoint was 30-day mortality; secondary endpoints included stroke, dialysis/continuous renal replacement therapy (CRRT), and other complications. Random-effects meta-analyses were used, with significance set at P < 0.05. Twenty-one studies (10 396 patients) were analyzed. AKI was associated with higher risks of 30-day mortality (risk ratio = 3.98), stroke (risk ratio = 2.05), dialysis/CRRT (risk ratio = 32.91), cardiovascular (risk ratio = 2.85) and respiratory complications (risk ratio = 2.13), sepsis (risk ratio = 4.92), and re-exploration for bleeding (risk ratio = 2.46). No significant differences were noted in sternal wound infection, tracheostomy, paraplegia, or hepatic failure. AKI significantly increases mortality, morbidity, hospital, and ICU stay duration in TAAD repair patients.

Bacterial profiles and their antibiotic susceptibility patterns in neonatal sepsis at the University of Gondar Comprehensive Specialized Hospital, Ethiopia.

Neonatal sepsis is a major cause of morbidity and mortality worldwide. Understanding the bacterial profiles and antibiotic susceptibility patterns causing neonatal sepsis is crucial for guiding appropriate treatment, improving patient outcomes, and combating the emergence of antibiotic resistance. Despite its importance, data regarding neonatal sepsis in the study area is limited. Therefore, this study aimed to characterize the bacterial pathogens and identify associated factors among neonates with suspected sepsis at the University of Gondar Comprehensive Specialized Hospital, Ethiopia. A cross-sectional study was conducted by reviewing laboratory records of neonates admitted for suspected sepsis from January 2019 to December 2021. Data were checked for completeness and encoded in a spreadsheet program. Then, data were exported to STATA version 17 for analysis. Descriptive statistics such as frequency and percentage were computed. The association between neonatal sepsis and potential risk factors was assessed using Pearson's chi-square test. A p-value of < 0.05, was considered statistically significant. A total of 1,236 neonates were included. Of these, 96.2% (1,190/1,236) had a fever before admission. The prevalence of culture-confirmed sepsis was 25.4% (314/1,236). Bacterial pathogens accounted for 23% (284/1,236) of these isolates, with Gram-negative bacteria being more prevalent at 75.3% (214/284) than Gram-positive bacteria at 24.7% (70/284). The most frequently isolated bacterial pathogens were K. pneumoniae 38.7% (110/284) and S. aureus 13% (37/284). The isolates demonstrated a high resistance level to commonly used antibiotics, with 61.6% exhibiting multidrug resistance. K. pneumoniae showed the highest rate of multidrug resistance (90.9%). Neonatal sepsis was associated with several factors, including fever before and after admission, hypothermia, increased respiration, suspected pneumonia, and suspected meningitis. This study identified a high prevalence of culture-confirmed sepsis in neonates at UoGCSH, with Gram-negative bacteria, especially K. pneumoniae, dominating the isolated pathogens. The isolated bacteria exhibited alarming resistance to commonly used antibiotics, with a high proportion demonstrating multidrug resistance. Implementing effective antibiotic stewardship programs is crucial to optimize antibiotic use, reduce unnecessary prescriptions, and curb the spread of resistant strains.

Genetic Insights into Sepsis: Mendelian Randomization Analysis of Cerebrospinal Fluid Metabolites.

Sepsis, a life-threatening response to infection leading to systemic inflammation and organ dysfunction, has been hypothesized to be influenced by metabolic alterations in cerebrospinal fluid (CSF). Despite extensive research, the specific metabolic pathways contributing to sepsis remain unclear. This study aims to elucidate the causal relationships between CSF metabolites and sepsis risk using Mendelian Randomization (MR), offering insights that could lead to novel therapeutic strategies. We conducted a two-sample MR analysis using genetic variants as instrumental variables (IVs) to investigate 338 CSF metabolites identified through a genome-wide association study. Data on sepsis-related outcomes were extracted from the genome-wide association study (GWAS) catalog encompassing 486,484 individuals of European descent. IVs were rigorously selected based on stringent genetic association and linkage disequilibrium criteria. Statistical analyses, including inverse variance weighting (IVW) and weighted median methods, were performed using the 'TwoSampleMR' package in R software, supplemented by comprehensive sensitivity analyses to ensure the robustness of our findings. Our analysis identified 19 CSF metabolites causally associated with sepsis risk. Notably, metabolites such as 1-palmitoyl-2-stearoyl-gpc (16:0/18:0) and 2-hydroxyglutarate showed significant negative correlations with sepsis risk. The reverse MR analysis further revealed that sepsis could negatively impact certain CSF metabolite levels, particularly Ribonate, suggesting a bidirectional relationship. These relationships were substantiated by rigorous statistical testing and sensitivity analyses confirming the absence of horizontal pleiotropy and the stability of our results across various MR methods. This study demonstrates significant causal associations between specific CSF metabolites and the risk of developing sepsis, highlighting the potential for these metabolites to serve as biomarkers or therapeutic targets. The bidirectional nature of these findings also suggests that sepsis itself may alter metabolic profiles, offering further avenues for intervention.

Epidemiological characteristics and impact of sepsis on survival after osteoporotic pelvic fracture in Austria.

We performed a retrospective nationwide register-based cohort study which included all in-hospital patients aged ≥ 50 with pelvic fracture (PF) between 2010 and 2018 in Austria. We identified patients who were hospitalized with sepsis within 180 days following a PF event. Aetiology of sepsis was divided by unspecified, gram positive, gram negative and other. Among 59,081 patients hospitalized with PF between 2010 and 2018 we identified 619 (1.05%) patients who were hospitalized with sepsis within 180 days following PF. The cumulative incidence risk of sepsis within 180 days after PF was significantly higher in males (1.4%, 95% CI 1.2%-1.5%) as compared to females (0.92%, 95% CI 0.83%-1.0%), p < 0.001. In the cohort of patients with sepsis, the one-year mortality was 50.4%. Mortality risk was greater for patients who developed sepsis, independently of age, sex and comorbidity status (HR 3.12, 95% CI 2.83-3.44, p < 0.001) as compared to patients without sepsis. With a very high one-year mortality risk among those who develop sepsis, our study emphasizes the substantial impact of sepsis on long term survival in fractured patients. These findings underscore the critical need for sepsis prevention and early detection and management to mitigate its detrimental effects on patient outcomes.

Bacterial Contamination of Donor Blood Units in a Ghanaian Blood Bank: A Critical Concern for Transfusion Safety

Abstract Introduction/Objective Background: Blood transfusions, while life-saving, pose a significant risk to patient safety, with transfusion-associated bacterial sepsis emerging as a persistent and potentially fatal threat. The prevalence and severity of bacterial contamination in donor blood units necessitate regular surveillance to ensure safe and effective transfusion therapy. Aim This study aimed to identify and assess the susceptibility of bacterial isolates in whole blood donor units at the blood bank of Cape Coast Teaching Hospital in the Central Region of Ghana. Methods/Case Report Method(s): One hundred and three (103) units of stored whole blood units, declared safe for transfusion (testing negative for HIV I&amp;II, HBsAg, HCV, and syphilis), were inoculated into Brain Heart Infusion Broth and incubated for 24 hours. The inoculated broths were then cultured on MacConkey agar (MAC), Chocolate agar (CHOC), and Blood agar. Gram-negative and Gram-positive isolates were identified using standard biochemical tests. Antimicrobial susceptibility testing was performed using the disc diffusion method. Results (if a Case Study enter NA) Results: Of the 103 donor blood units tested, 33 (32.03%) were found to have bacterial isolates. Gram-positive organisms accounted for 67.14% of the isolates, including Coagulase negative Staphylococcus, Bacillus spp, and S. aureus. Gram-negative bacteria constituted 32.86% of the isolates, with Citrobacter freundii, Serratia marcescens, E. coli, and Providencia stuartii identified. Notably, 62.9% of the bacterial isolates were skin commensals, while 25.7% were of enteric origin and 11.4% were of nosocomial origin. Resistance to commonly used antibiotics varied among isolates, with Coagulase-negative Staphylococcus exhibiting resistance to amoxicillin (92.86%) and erythromycin (76.19%), while Citrobacter freundii showed resistance to levofloxacin (75.00%) and ofloxacin (75.00%). Conclusion Conclusion(s): The high incidence of bacterial contamination in donor blood units highlights the need for improved phlebotomy procedures and decontamination practices at blood banks in Ghana to reduce the risk of sepsis in transfusion recipients. Furthermore, this study provides valuable information regarding antibiotic resistance patterns in bacterial isolates, emphasizing the importance of antibiotic stewardship in Ghana. In conclusion, this study underscores the urgency of addressing bacterial contamination in donor blood units in Ghanaian blood banks to enhance transfusion safety.

Differences in the Adverse Event Profiles of Sodium-Glucose Cotransporter 2 Inhibitors used in Patients with DiabetesMellitus and Heart Failure: An Analysis Using the Japanese Adverse Drug Event Report Database.

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have recently become a standard treatment for heart failure and renal failure. The number of patients using these drugs is expected to increase further. However, no adverse drug event profiles have been published for the use of SGLT2i in patients without diabetes. To analyze and clarify the differences in adverse event profiles associated with the use of SGLT2i in patients with diabetes or heart failure using the Japanese Adverse Drug Event Report (JADER) database, a Japanese reporting system for adverse events. The JADER database, containing reports submitted between April 2004 and January 2024, was used. Our study focused on patients with diabetes or heart failure, analyzing adverse events associated with empagliflozin and dapagliflozin. The reporting odds ratio (ROR) and 95% confidence interval (CI) were calculated for signal detection. We identified risks of adverse drug events such as ketoacidosis, urinary tract infection, dehydration, and acidosis in both patient groups. However, the risks of cerebral infarction and ischemic heart disease were identified only in patients with diabetes, while risks of renal dysfunction, hypoglycemia, and sepsis were identified only in those with heart failure. Adverse events should be managed appropriately for patients using SGLT2i, as the adverse event profiles differ between those with diabetes and those with heart failure. Understanding these differences is crucial for improving patient safety and optimizing treatment outcomes.

Risk of Intestinal Complications, Extraintestinal Morbidity, and Mortality in Patients with Crohn’s Disease and Ocular Involvement

ABSTRACT Purpose Patients with Crohn’s disease (CD) and subsequent ocular manifestations may have worse outcomes when compared to matched patients with CD without ocular disease. Methods In this retrospective cohort study, an aggregated electronic health records research network, TriNetX (Cambridge, MA, USA), was used to identify patients diagnosed with CD stratified by the presence or absence of ocular involvement with at least 1 year of follow-up. Propensity score matching (PSM) was performed to control for baseline demographics and medical comorbidities. Results Patients with CD with ocular disease showed a greater risk of undergoing bowel resections (RR: 2.06, 95% CI: 1.48–2.85, p < 0.001), developing other CD-related gastrointestinal complications (RR: 1.31, CI: 1.15–1.49, p < 0.001), or acquiring Clostridioides difficile infections (RR: 2.19, CI: 1.89–2.54, p < 0.001). Further, patients with CD with ocular sequelae had a greater risk of developing NASH (RR: 1.43, CI: 1.31–1.56, p < 0.001), CD-related nutrient deficiencies (RR: 1.38, CI: 1.29–1.49, p < 0.001), iron deficiency anemia (RR: 1.41, CI: 1.33–1.50, p < 0.001), CD-related dermatological disease (RR: 1.84, CI: 1.65–2.05, p < 0.001), osteoporosis (RR: 1.49, CI: 1.37–1.64, p < 0.001) and primary sclerosing cholangitis (RR: 1.63, CI: 1.11–2.38, p = 0.011). Among patients with CD with ocular involvement, there was an elevated risk of MI (RR: 1.36, CI: 1.14–1.63, p < 0.001), stroke (RR: 1.42, CI: 1.18–1.70, p < 0.001), VTE (RR: 1.37, CI: 1.22–1.54, p < 0.001), and sepsis (RR: 1.53, CI: 1.37–1.71, p < 0.001). Conclusions Patients who have CD and subsequent ocular involvement have an increased risk of local intestinal complications, extraintestinal morbidity, and cardiovascular complications when compared to patients with CD without ocular involvement.

Amlexanox reduces new-onset atrial fibrillation risk in sepsis by downregulating S100A12: a Mendelian randomization study.

Sepsis is characterized by high morbidity and mortality rates, alongside limited therapeutic efficacy. Atrial fibrillation (AF), the most common arrhythmia, has been closely linked to sepsis in prior research. However, the specific mechanisms through which sepsis leads to new-onset AF remain poorly understood. This study focuses on identifying critical genes that are dysregulated in the development of new-onset AF within the context of sepsis, with the goal of uncovering new potential targets for its diagnosis and prevention. Our study began by applying Mendelian Randomization (MR) to assess the causal link between sepsis and AF. We then sourced sepsis and AF datasets from the Gene expression Omnibus (GEO) database. Using Weighted Gene Co-expression Network Analysis (WGCNA), we pinpointed key modules and genes associated with both sepsis and AF conditions. Protein-protein interaction (PPI) network was constructed. The Transcriptional Regulatory Relationships Unravelled by Sentence-based Text-mining (TRRUST) database helped build the transcription factor (TF) interaction network. Key genes were scrutinized through Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), Gene Set Enrichment Analysis (GSEA) and Gene Set Variation Analysis (GSVA) to delve into their roles in new-onset AF's pathophysiology during sepsis. We employed the CIBERSORT algorithm to evaluate immune infiltration and the association between key genes and immune cells. The Connectivity Map (CMap) database facilitated the prediction of potential small molecule compounds targeting key genes. To culminate, an acute sepsis mouse model was developed to validate the implicated mechanisms of key genes involved in new-onset AF during sepsis, and to assess the prophylactic effectiveness of identified drug candidates. MR revealed potential independent risk factors for new-onset AF in sepsis. S100A12 was identified as a core interaction gene with elevated levels in sepsis and AF, underscoring its diagnostic and predictive significance. S100A12, along with associated genes, was mainly linked to immune and inflammatory response signaling pathways, correlating with immune cell levels. Targeting S100A12 identifies five potential small molecule therapeutics: amlexanox, balsalazide, methandriol, olopatadine, and tiboloe. In animal studies, acute sepsis increased S100A12 expression in serum and atrial tissues, correlating positively with inflammatory markers (IL-1β, IL-6, TNF-α) and negatively with heart rate, indicating a predisposition to AF. Early amlexanox administration can reduced S100A12 expression, dampened inflammation, and lessened new-onset AF risk in sepsis. This study demonstrates that sepsis may independently increase the risk of new-onset AF. We identified S100A12 as a key gene influencing the new-onset AF in sepsis through immune regulation, presenting considerable diagnostic and predictive value. Notably, amlexanox, by targeting S100A12 emerges as the most clinical relevant intervention for managing new-onset AF in sepsis patients.

Assessing the causal relationship between non-small cell lung cancer and sepsis: a Mendelian randomization study

BackgroundA Two-sample Mendelian randomization (MR) Analysis was used to assess the causal relationship between non-small cell lung cancer (NSCLC) and sepsis.MethodSingle nucleotide polymorphisms (SNPs) closely associated with NSCLC were utilized as instrumental variables (IVs) in this study. The Inverse Variance Weighted (IVW) method was used as the primary method for MR analysis, supplemented by the Weighted median, Weighted model, and MR-Egger regression method. Sensitivity analysis was conducted to improve result robustness, and data from various sources were validated and integrated. Bonferroni tests were applied to adjust for multiple comparisons.ResultsAfter Bonferroni tests correcting the combined results, MR analysis revealed a significant association between genetically predicted NSCLC and an increased susceptibility to sepsis (odds ratios [OR]: 1.140, 95% confidence interval [CI]: 1.085–1.199, P = 2.61 × 10− 7). The combined results demonstrated that NSCLC is associated with a heightened risk of sepsis in patients under 75 years of age (OR: 1.085, 95%CI: 1.037–1.353, P = 3.84 × 10− 4). Furthermore, lung adenocarcinoma (LUAD) was found to be potentially associated with an increased susceptibility to sepsis (OR: 1.040, 95% CI: 1.009–1.073, P = 1.16 × 10− 2). These results withstood multiple sensitivity analyses, demonstrating their robustness.ConclusionThis study confirms that NSCLC can significantly increase susceptibility to sepsis at the genetic level, providing valuable insights for the early identification of individuals at risk for sepsis.

AI Algorithms for Modeling the Risk, Progression, and Treatment of Sepsis, Including Early-Onset Sepsis—A Systematic Review

Sepsis remains a significant contributor to neonatal mortality worldwide. However, the nonspecific nature of sepsis symptoms in neonates often leads to the necessity of empirical treatment, placing a burden of ineffective treatment on patients. Furthermore, the global challenge of antimicrobial resistance is exacerbating the situation. Artificial intelligence (AI) is transforming medical practice and in hospital settings. AI shows great potential for assessing sepsis risk and devising optimal treatment strategies. Background/Objectives: This review aims to investigate the application of AI in the detection and management of neonatal sepsis. Methods: A systematic literature review (SLR) evaluating AI methods in modeling and classifying sepsis between 1 January 2014, and 1 January 2024, was conducted. PubMed, Scopus, Cochrane, and Web of Science were systematically searched for English-language studies focusing on neonatal sepsis. Results: The analyzed studies predominantly utilized retrospective electronic medical record (EMR) data to develop, validate, and test AI models to predict sepsis occurrence and relevant parameters. Key predictors included low gestational age, low birth weight, high results of C-reactive protein and white blood cell counts, and tachycardia and respiratory failure. Machine learning models such as logistic regression, random forest, K-nearest neighbor (KNN), support vector machine (SVM), and XGBoost demonstrated effectiveness in this context. Conclusions: The summarized results of this review highlight the great promise of AI as a clinical decision support system for diagnostics, risk assessment, and personalized therapy selection in managing neonatal sepsis.