Development Of Sepsis In Patients Research Articles

Vitamin B12 status and the risk of developing sepsis in patients with bacterial infection: a prospective observational cohort study

BackgroundData have shown that vitamin B12 has immunomodulatory effects via different pathways, which could influence the pathophysiology of sepsis. The objective of this study was to investigate whether vitamin B12 levels, assessed by the measurement of holotranscobalamin (HTC), total vitamin B12 (B12), and methylmalonic acid (MMA, which accumulates in case of B12 deficiency), are associated with the development of sepsis in patients with onset of bacterial infection.MethodsThis was a single-center, prospective observational pilot study. Adult patients who presented to the emergency department with bacterial infection confirmed by a positive microbiological culture result were included in the study and followed up for 6 days to assess whether they developed sepsis or not. The primary objective was to compare HTC concentration in patients who developed sepsis to those who did not develop sepsis. Secondary objectives were the evaluation of B12 and MMA concentrations in those two groups. Multiple logistic regression models were used, with presence of sepsis as the outcome variable, and HTC, B12, and MMA concentrations as predictor variables, separately, and adjusted for potential confounders.ResultsFrom 2019 to 2022, 2131 patients were assessed for eligibility, of whom 100 met the inclusion criteria. One patient was excluded from the analysis due to missing data. Of the 99 patients, 29 developed sepsis. There was no evidence for an association between HTC or B12 concentration and the development of sepsis (OR 0.65, 95% CI 0.31–1.29, p = 0.232, OR 0.84, 95% CI 0.44–1.54, p = 0.584, respectively). There was an association between MMA concentration and the development of sepsis, with a positive effect, i.e. with increasing MMA, the odds for sepsis increased (OR 2.36, 95% CI 1.21–4.87, p = 0.014). This association remained significant when adjusted for confounders (OR 2.72, 95% CI 1.23–6.60, p = 0.018).ConclusionsOur study found an association between elevated MMA concentration and the development of sepsis. We did not find an association between HTC and B12 concentrations and the development of sepsis. Further, larger studies are warranted, as it could lead to interventional trials investigating whether B12 supplementation provides a clinical benefit to patients with infection or sepsis.Trial registrationThe study was registered on ClinicalTrials.gov under the identifier NCT04008446 on June 17, 2019.

Exploring the relationship between HCMV serostatus and outcomes in COVID-19 sepsis.

Sepsis, a life-threatening condition caused by the dysregulated host response to infection, is a major global health concern. Understanding the impact of viral or bacterial pathogens in sepsis is crucial for improving patient outcomes. This study aimed to investigate the human cytomegalovirus (HCMV) seropositivity as a risk factor for development of sepsis in patients with COVID-19. A multicenter observational study enrolled 95 intensive care patients with COVID-19-induced sepsis and 80 post-surgery individuals as controls. HCMV serostatus was determined using an ELISA test. Comprehensive clinical data, including demographics, comorbidities, and 30-day mortality, were collected. Statistical analyses evaluated the association between HCMV seropositivity and COVID-19 induced sepsis. The prevalence of HCMV seropositivity did not significantly differ between COVID-19-induced sepsis patients (78%) and controls (71%, p = 0.382) in the entire cohort. However, among patients aged ≤60 years, HCMV seropositivity was significantly higher in COVID-19 sepsis patients compared to controls (86% vs 61%, respectively; p = 0.030). Nevertheless, HCMV serostatus did not affect 30-day survival. These findings confirm the association between HCMV seropositivity and COVID-19 sepsis in non-geriatric patients. However, the lack of an independent effect on 30-day survival can be explained by the cross-reactivity of HCMV specific CD8+ T-cells towards SARS-CoV-2 peptides, which might confer some protection to HCMV seropositive patients. The inclusion of a post-surgery control group strengthens the generalizability of the findings. Further research is needed to elucidate the underlying mechanisms of this association, explore different patient populations, and identify interventions for optimizing patient management. This study validates the association between HCMV seropositivity and severe COVID-19-induced sepsis in non-geriatric patients, contributing to the growing body of evidence on viral pathogens in sepsis. Although HCMV serostatus did not independently influence 30-day survival, future investigations should focus on unraveling the intricate interplay between HCMV, immune responses, and COVID-19. These insights will aid in risk stratification and the development of targeted interventions for viral sepsis.

Immune Diagnostics and Immunotherapy of Burn Sepsis

The paper analyzes the literature data and authors proper experience in the study of immunopathogenesis and immunodiagnosis of burn sepsis. It argues the issues of effective use of immunocorrection in the complex treatment of severely burned patients.Diagnosis of sepsis after severe burn injury is challenging due to the overlap of signs and clinical manifestations of the hypermetabolic reaction of thermal injury and sepsis. The systemic inflammatory response caused by burns can mimic manifestations of sepsis and complicate its early diagnosis. Considering this, modern immunodiagnostics can serve as an effective tool in identifying damaged key immune markers in burns, determining the severity of immune status disorders in burn disease and the risk of developing septic complications for timely immunocorrection and providing appropriate complex therapy for patients with extensive burns.However, the problem of immunocorrective therapy in severely burned patients remains extremely relevant, debatable and not fully resolved. It is a personalized approach based on immune analysis and clinical recommendations for the complex treatment of burn injury that should be applied in the immunotherapy of burn sepsis to improve the clinical outcomes and, possibly, prevent the development of sepsis in patients with severe burn injury.

Risk factors for the development of sepsis in patients with cirrhosis in intensive care units.

Sepsis is a serious complication of liver cirrhosis. This study aimed to develop a risk prediction model for sepsis among patients with liver cirrhosis. A total of 3130 patients with liver cirrhosis were enrolled from the Medical Information Mart for Intensive Care IV database, and randomly assigned into training and validation cohorts in a 7:3 ratio. The least absolute shrinkage and selection operator (LASSO) regression was used to filter variables and select predictor variables. Multivariate logistic regression was used to establish the prediction model. Based on LASSO and multivariate logistic regression, gender, base excess, bicarbonate, white blood cells, potassium, fibrinogen, systolic blood pressure, mechanical ventilation, and vasopressor use were identified as independent risk variables, and then a nomogram was constructed and validated. The consistency index (C-index), receiver operating characteristic curve, calibration curve, and decision curve analysis (DCA) were used to measure the predictive performance of the nomogram. As a result of the nomogram, good discrimination was achieved, with C-indexes of 0.814 and 0.828 for the training and validation cohorts, respectively, and an area under the curve of 0.849 in the training cohort and 0.821 in the validation cohort. The calibration curves demonstrated good agreement between the predictions and observations. The DCA curves showed the nomogram had significant clinical value. We developed and validated a risk-prediction model for sepsis in patients with liver cirrhosis. This model can assist clinicians in the early detection and prevention of sepsis in patients with liver cirrhosis.

Neutrophilic granulocytes in the patients with burn injury

Severe burn injury (BI) is accompanied by disturbed microcirculation, water-electrolyte and acidbase imbalance within 2-3 days after the accident, and the development of toxemia within 4-12 days. The severity of toxemia depends on the area and depth of the lesion, resorption of tissue decay products, and development of a systemic inflammatory response syndrome. In the patients suffering with deep BI sepsis, it develops in 15% of cases. Pathogenesis of critical conditions is related to the functional activity of myeloid cells, including neutrophilic granulocytes (NG). Тhe determination of NG’s dysfunctions in patients with BI is important, both for prediction of septic complications and administration of rational therapy. The aim of our work was to study the functions of neutrophils in patients with severe BI and to determine early predictors of burn-associated sepsis. The study involved 53 patients with severe BI at the mean age of 43 years (32 to 52); the area of damage was 43% (17 to 63) of the body surface, with deep-burn area of 17 (13 to 27) %. The severity of BI was assessed using the Frank index, at the average value of 74 conventional units (62 to 89). Тwo groups of patients were identified: 24 persons without sepsis, and 29 people with sepsis and severe sepsis. The studies were carried out upon admission, on the 1st, 3rd, 5th, 10th , and 20th day of the burn disease. We determined the numbers of NGs expressing CD18+, CD14+, defensin+; serum contents of soluble defensins (sDеf), IL-6, IL-8 levels (ELISA); procalcitonin, as well as luminol-mediated spontaneous аnd induced NG chemiluminescence. Тhe results of this study showed a relationship between the amounts of NGs containing antimicrobial peptides, contents of NGs expressing CD18+ adhesion molecules, activation of oxidative metabolism, IL-6 overproduction, and development of sepsis in patients with burn injury, as well as with severity of burn trauma.

Association between heme oxygenase one and sepsis development in patients with moderate-to-critical COVID-19: a single-center, retrospective observational study

BackgroundHeme oxygenase one (HO-1) is considered a poor prognostic factor for survival in patients with severe-to-critical coronavirus disease (COVID-19), but the clinical correlation between heme catabolism biomarkers and COVID-19-related sepsis is unknown. The etiopathogenetic hypothesis of HO-1 response during sepsis in patients with poor prognosis should be clarified. This study aimed to investigate sepsis development within 48 h following moderate-to-critical COVID-19 and examined heme/HO-1 catabolism biomarkers associated with sepsis. We also studied the HO-1 and traditional prognostic factors for predicting survival in patients with COVID-19.MethodsThis retrospective observational study included patients unvaccinated for COVID-19 with moderate-to-critical COVID-19 (n = 156) who had been admitted to Taipei Tzu Chi Hospital in 2021. All COVID-19 patients were diagnosed by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcriptase polymerase chain reaction. For analysis of heme catabolism in SARS-CoV-2-induced sepsis, we excluded patients with co-infection and severe anemia. Heme catabolism biomarkers were compared between groups of patients with COVID-19 and sepsis (sepsis) and those with COVID-19 without sepsis (no sepsis), and a control group comprising 100 healthy individuals. All clinical and laboratory data were collected retrospectively and blood specimens were collected from Biobank. Multivariable logistic regression analysis was used to compare all variables between the sepsis and no-sepsis groups. Cox regression analysis was used to determine predictors of survival in patients with COVID-19.ResultsThere were 71 and 85 patients with and without sepsis, respectively. Heme and HO-1 levels differed significantly between the sepsis, no sepsis, and control groups. In multivariate analysis, confusion, blood urea nitrogen, respiration, blood pressure in patients aged > 65 years (CURB-65) (adjusted odds ratio [aOR] 5.331, 95% confidence interval [CI] 2.587–10.987; p < 0.001), albumin (aOR 0.139, 95% CI 0.003–0.636; p = 0.01), d-dimer (aOR 1.001, 95% CI 1.000–1.002; p = 0.032), and HO-1 (aOR 1.116, 95% CI 1.055–1.180; p < 0.001) were significantly associated with 48-h sepsis episodes after adjusting for other confounding factors. HO-1 levels were also significantly associated with 48-h Sequential Organ Failure Assessment Score (SOFA) scores. However, HO-1 did not significantly increase the hazard of in-hospital mortality in moderate-to-critical COVID-19 by Cox regression analysis.ConclusionsHO-1 levels increased with sepsis development within 48 h of admission for COVID-19 after adjusting for other risk factors, but no significant association was observed between HO-1 and COVID-19 mortality. We suppose that HO-1 may have protective effect in early sepsis, but further clinical multicenter prospective studies are needed.

Reactivation of cytomegalovirus infection in sepsis and severe bacterial comorbidity

Cytomegalovirus is a frequent contributor to the infectious process in critically ill patients and may contribute to the clinical outcome of the disease. This study aimed to determine the presence and frequency of HCMV reactivation and contributing factors in critically ill patients with severe bacterial comorbidity. Plasma and sputum samples were collected from 82 patients to determine the frequency of reactivation. HCMV reactivation was determined by the detection of HCMV DNA along with the presence of IgG to HCMV. HCMV reactivation was detected in 36.6% of cases. The presence of sepsis was associated with a higher probability of HCMV reactivation (p&lt;0.01), as well as higher HCMV viral loads both in the blood and sputum of patients in these groups. An association between the presence of HCMV in biological fluids and subsequent development of sepsis in patients with severe bacterial pathology (OR=1.5) was detected.

Effect of Anti-Inflammatory and Antimicrobial Cosupplementations on Sepsis Prevention in Critically Ill Trauma Patients at High Risk for Sepsis.

Background: Sepsis development in patients with trauma is associated with bad prognosis. This study investigated the effect of immunomodulatory interventions in major trauma patients at high risk for sepsis. Methods: In a randomized, double-blinded, controlled design, severe trauma patients were stratified by leukocyte anti-sedimentation rate (LAR) test into high risk (HR) and low risk (LR) for sepsis. The HR patients were randomly allocated into intravenous vitamin C plus vitamin B1 (HR-CB), intramuscular vitamin D plus oral Lactobacillus probiotics (HR-DP), or control (HR-C) groups. The clinical trial was registered at clinicaltrials.gov (https://clinicaltrials.gov/show/NCT04216459). Outcomes: The primary outcome was Acute Physiologic Assessment and Chronic Health Evaluation score II (APACHE II) score. Secondary outcomes included sepsis incidence, changes in Sequential Organ Failure Assessment (SOFA) score, and serum monocyte chemoattractant protein-1 (MCP-1) on day 6 from baseline, 28-day mortality, intensive care unit (ICU), and hospital discharge. Results: The HR-DP, HR-CB, and LR groups showed a significantly lower incidence of sepsis development (20%, 20%, and 16%, respectively, versus 60% in the HR-C group, p-value = 0.004). The three groups also showed a significant improvement in APACHE II and SOFA scores. Besides, MCP-1 levels were significantly decreased in HR-DP and HR-CB groups compared to the HR-C group (p-value ≤ 0.05). Significantly decreased mortality (10% and 16% versus 60% in the HR-C group) and increased ICU discharge (95% and 84% versus 45% in the HR-C group) were observed in HR-CB and LR groups (p-value = 0.001). Conclusion: Both combinations of interventions improved APACHE II scores and reduced sepsis incidence in trauma patients. The LAR combined with injury severity score were good sepsis predictors.

P243 Elevated presepsin levels are a marker of sepsis risk in patients with inflammatory bowel diseases receiving therapy of TNF-α blockers

Abstract Background Sepsis is a severe disease characterized by a systemic inflammatory response syndrome (SARS) associated with infection. Sepsis is registered in 1–2% of all hospitalized patients. IBD patients receiving immunosuppressive therapy have a high risk of developing sepsis. Diagnosis of sepsis is based on internationally agreed criteria. Predicting the course and outcomes of sepsis is evaluated on the MEDS (Mortality in Emergency Department Sepsis) scale. Clinical studies of a new biomarker called presepsin have shown that it is a promising early and predictive marker of sepsis Aim to establish the role of presepsin as a marker of sepsis development in patients with inflammatory bowel diseases (IBD) receiving therapy with genetically of TNF-α blockers. Methods The clinical status of 128 IBD patients receiving of TNF-α blockers therapy (without immunosuppressive drugs) was evaluated in the Department of IBD. 68 patients with ulcerative colitis (UC) and 60 patients with Crohn’s disease (CD). Presepsin level (PSP) was determined in all IBD patients (100.0%). To stratify patients, the following criteria were used for baseline PSP levels (pg/ml): &amp;lt; 200 – very low risk of sepsis; - 200 - 300– low risk of sepsis; - 300 - 500– moderate risk of sepsis; - 500 - 1000 – sepsis; - ≥ 1000-severe sepsis, septic shock Results The distribution among 128 IBD patients receiving of TNF-α blockers by presepsin level was as follows: &amp;lt; 200 -75 (58,6%); - 200 – 300 – 34 (26,6%); - 300 – 500 – 19 (14,8%); - 500 - 1000 – 0 (0%); ≥ 1000 – 0 (0%). Of the 75 IBD patients receiving gibp and having a very low risk, none of the patients developed sepsis; of the 34 IBD patients with a low risk, one patient developed septicemia (2.9%). Among 19 patients with IBD with a moderate risk, the development of a septic condition occurred in 4 (21.0%) patients (HR-0.140, 95% CI 0.017 - 1.162; x2-2,800; p= 0.04997). Conclusion IBD patients receiving of TNF-α therapy, it is advisable to determine the level of presepsin in order to identify risk groups for the development of sepsis. Patients with IBD who receive of TNF-α therapy and have presepsin values in the range of 300–500 pg/ml have a significantly higher risk of developing sepsis.

Infusion therapy for sepsis in patients with burns

Background. Sepsis develops in 8-42.5 % of patients with burns and is the leading cause of death among them. The criteria for sepsis are suspected or documented infection and the presence of two or more criteria on the SOFA scale. The involvement of remote from the primary pathological focus organs or systems in the generalized pathological process is the key sign of sepsis.&#x0D; Objective. To describe infusion therapy (IT) for sepsis in patients with burns.&#x0D; Materials and methods. Analysis of literature data on this topic; own research. The study involved 52 patients with sepsis due to severe burns, who were prescribed individually selected comprehensive treatment. Patients in group 1 received IT according to the following scheme: Ringera lactate (“Yuria-Pharm”) + glucose + isoosmolar crystalloids, group 2 – Ringera lactate + glucose + Reosorbilact (“Yuria-Pharm”) at a dose of 10 ml/kg, group 3 – Ringera lactate + glucose + Reosorbilact at a dose of 15 ml/kg.&#x0D; Results and discussion. Sepsis in patients with burns differs from sepsis in general surgery patients, as the former lose the main protective barrier – their skin. Due to the hypermetabolic response patients with burns for several months may have tachycardia, tachypnea, leukocytosis, shift of the leukocyte formula to the left, fever, signs of multiorgan dysfunction. The development of sepsis in patients with burn disease depends on the area and depth of the injury, as well as on the condition of the patient’s immune system. Treatment of sepsis may include antibiotic therapy, surgery (removal of non-viable tissues, closure of skin defects), IT, vasopressor therapy, heparin, inotropic support, glucocorticoid therapy, administration of blood products, mechanical lung ventilation. Despite the leading role of IT in the treatment of sepsis in patients with burns, the question of the optimal solution and its dose is still unclear. The goals of IT in this case are to ensure the delivery of oxygen to tissues in conditions of increased consumption and detoxification. According to the results of our own study, patients in groups 2 and 3 had a significantly lower heart rate (HR) and higher systolic blood pressure (SBP) than in group 1 (HR: 1st group – 119.5±5.4 bpm, 2nd group – 108.2±4.3 bpm, 3rd group – 104.5±5.3 bpm; SBP: 1st group – 82.6±5.3 mm Hg, 2nd group – 82.5±4.6 mm Hg, 3rd group – 92.4±3.2 mm Hg). The increase in SBP was accompanied by an increase in glomerular filtration rate and rate of diuresis. The use of Reosorbilact at a dose of 10 ml/kg/day reduced the total volume of infusions by 7.8 %, and at a dose of 15 ml/kg/day – by 19.5 % compared with group 1. Patients in both groups of Reosorbilact had a lower frequency of septic shock (11.8 and 12.5 % vs. 15.7 % in group 1) and shorter duration of treatment with vasopressors. The use of Reosorbilact in both doses helped to reduce the level of leukocytes, urea, creatinine, C-reactive protein. Hemodynamic, osmodiuretic and detoxifying effects of Reosorbilact justify its use in patients with severe burns and sepsis.&#x0D; Conclusions. 1. Sepsis develops in 8-42.5 % of patients with burns and is the leading cause of death among them. 2. Sepsis in patients with burns is different from sepsis in general surgery patients. 3. Despite the leading role of IT in the treatment of burn sepsis, the question of the optimal solution and its dose still remains unclear. 4. The use of Reosorbilact helps to reduce heart rate, increase SBP, reduce the total volume of infusions, reduce the frequency of septic shock and reduce treatment with vasopressors.

Presepsin and procalcitonin as predictors of sepsis based on the new Sepsis-3 definitions in obstructive acute pyelonephritis

BackgroundAcute pyelonephritis (APN) with obstructive uropathy often causes sepsis. Recently, sepsis was redefined using the sequential organ failure assessment (SOFA) score, based on the new Sepsis-3 criteria. We investigated predictors for sepsis using this new definition in patients with obstructive APN associated with upper urinary tract calculi.MethodsWe retrospectively evaluated patients who were admitted to our hospital for treatment of obstructive APN associated with upper urinary tract calculi. Blood and urine samples were collected before treatment of obstructive APN. Treatment included adequate antimicrobial therapy and emergency drainage to decompress the renal collecting system. We diagnosed sepsis using the new Sepsis-3 definition. We assessed predictors for sepsis by multivariate logistic regression analysis.ResultsSixty-one patients were included in this study. Overall, all patients underwent emergency drainage, and 11 (18.0%) patients showed sepsis. There were no significant differences in performance status or comorbidities between sepsis and non-sepsis groups. Platelet count and serum albumin level were significantly lower in the sepsis group than in the non-sepsis group (p = 0.001 and p = 0.016, respectively). Procalcitonin (PCT) and presepsin (PSEP) levels were significantly higher in the sepsis group than in the non-sepsis group (p < 0.001 and p < 0.001, respectively). Multivariate analysis showed that PCT elevation (OR = 13.12, p = 0.024) and PSEP elevation (OR = 13.13, p = 0.044) were independent predictors for sepsis.ConclusionsElevation of PCT and PSEP levels before treatment might predict the development of sepsis in patients with obstructive APN.

DISRUPTION OF CARBOHYDRATE METABOLISM IN PATIENTS WITH SEPSIS

Summary. Introduction Every year, 18–20 million cases of sepsis are recorded in the world, 30 % of which result in death. Hopes that with the development of sanitary-hygienic measures the dynamics of sepsis will decrease, turned out to be illusory. The annual increase in the frequency of sepsis is 8.7 %, while it is noted that the number of patients with impaired carbohydrate metabolism increases by 8-27 %.&#x0D; Materials and methods. 5612 case histories of patients with purulent-septic diseases who were treated at the center for the period 2015-2019 were analyzed.&#x0D; Results. It was found that 213 (3.8 %) patients had diabetes mellitus (DM) type I or II (group 1), and the number of patients with complicated diabetic foot syndrome (SDS) was 43.3 % of the total number of patients (2431 patients) — 2 group. The development of sepsis in patients of the 1st group was recorded in 1.4 % of cases (46 patients), while in patients with complicated SDS — in 8.3 % (202 patients). Among the latter, in the overwhelming majority of cases, the starting point in the development of sepsis was “wet” gangrene of the lower extremities.&#x0D; Conclusions. In patients with diabetes, the risk of developing septic complications is significantly higher than in patients without impaired carbohydrate metabolism.

Evaluation of cellular and humoral indicators immunity in the treatment of various types of sepsis in immunocompromised hemoblastosis patients

It was established that the course and development of sepsis in patients with hemoblastosis, are held against the background of complex violations of indicators of cellular and humoral immunity. However, in patients with acute myeloid leukemia, they are more pronounced, which most likely explains the higher mortality rate in this group of patients compared with patients suffering from lymphoproliferative diseases. Some features of the development of post-cytotoxic complications after chemotherapy in patients with hemoblastosis are identified. In addition, the most significant predictors of post-cytotoxic complications in patients with hemoblastosis, who are most susceptible to post-cytotoxic infectious complications and life- threatening emergency conditions, have been identified. The most probable causes of deaths in primary and secondary immunodeficiencies of the cytotoxic type in immunocompromised patients suffering from hemoblastosis with proven sepsis on the background of neutropenia after polychemotherapy are presented. Revealed some post-cytotoxic complications that significantly affect the course and outcome of the disease in patients with hemoblastosis. The nature of these complications and emergency conditions allows you to determine the volume and priority of ongoing proactive intensive therapy after polychemotherapy in the period of neutropenia or agranulocytosis, on the background of a violation of the immune status of patients. An assessment of some humoral and cellular indicators of the immune status of patients with various types of proven sepsis is given.

Evaluation of the Effectiveness of Therapy for Stevens−Johnson Syndrome and Toxic Epidermal Necrolysis: A Review

39 original articles were analyzed. 8 of them were excluded due to the small sample of patients. The effectiveness of the intravenous Ig, systemic glucocorticosteroids, cyclosporin A, biological agents (etranecept, infliximab, thalidomide) on the basis of the SCORTEN scale and the number of lethal outcomes was evaluated. Information was searched for the following databases: PubMed, ScienceDirect, Wiley Online Library, Google Scholar, Cochrane Library. The systemic glucocorticosteroid (GCs) pulse therapy using only in the phase of disease progression was the most appropriate. Some authors showed a high risk of sepsis development in patients treated with GCs. In patients who received high doses of IVIg (2 g/ kg), mortality was 2.5 times lower compared to the lower one. The number of lethal outcomes in the Cyclosporin A (3 mg/kg/day) group was 3.3 times lower. A high mortality rate was observed in patients receiving thalidomide. The effectiveness of a particular method of therapy, as well as the prognosis of the disease, largely depends on the process severity, the presence and type of concomitant pathology (for example, severe course and negative outcome in patients with cancer). There is no a single point of view regarding the therapy of SSJ and TEN. Thus, a large multicenter randomized studies are crucial.

FEATURES OF THE PHENOTYPE AND NAD(P)-DEPENDENT DEHYDROGENASES ACTIVITY IN NEUTROPHIL BY PATIENTS WITH WIDESPREAD PURULENT PERITONITIS IN PROGNOSIS FOR SEPSIS DEVELOPMENT

The aim of the study was to examine the features of phenotype and the levels of NAD(P)-dependent dehydrogenases activity of blood neutrophils in the prognosis of abdominal sepsis development in patients with widespread purulent peritonitis (WPP). 50 patients with WPP of community and hospital origin in the pre-operative period were examined. From the 5th to the 10th day of the postoperative period 35 patients (70%) had developed abdominal sepsis, 15 patients (30%) had absence of complications. As controls 67 respect healthy people were examined. The research blood neutrophils phenotype was performed by f low cytometry using a direct immunofluorescence whole peripheral blood. The levels of surface receptor expression was assessed by the mean fluorescence intensity. The NAD(P)-dependent dehydrogenases activity in the blood neutrophils studied using bioluminescence method. It was established that the inflammatory reaction in patients with WPP is characterized by neutrophilia and changes in the phenotype of blood neutrophils. The markers of the subsequent development of sepsis in WPP are less pronounced (in comparison with the indices of uncomplicated patients), an increase in the number of neutrophils, a decrease in the HLA-DR + -cell count against the background of a high level of neutrophils expressing a high affinity receptor for IgG. The patients without subsequent complications had the number of neutrophils with CD23 receptor expression is increased. Metabolism of neutrophils in patients with WPP is characterized by a decrease in the intensity of plastic processes due to low activity of glucose-6-phosphate dehydrogenase and an imbalance in the activity of the enzymes of the mitochondrial compartment. A feature of the neutrophil metabolism in patients with WPP without subsequent development of sepsis is a high activity of anaerobic lactate dehydrogenase reaction and a decrease in the activity of NADP-dependent decarboxylating malate dehydrogenase. The patients with WPP with subsequent development of sepsis had a high level of NAD-dependent out flow of substrates from the tricarboxylic acid cycle on the amino acid exchange reaction via glutamate dehydrogenase which can affect the activity of aerobic respiration of blood neutrophils. The established differences in the phenotype and activity of enzymes in the blood neutrophils in patients with WPP depending on the subsequent development of sepsis determine the possibility of creating a method for predicting the development of complications and developing immunoactive therapy in the postoperative period of WPP.

Analysis of peripheral blood lymphocyte subsets in critical patients at ICU admission: A preliminary investigation of their role in the prediction of sepsis during ICU stay.

A better knowledge of factors predicting the development of sepsis in patients hospitalized in intensive care unit (ICU) might help deploy more targeted preventive and therapeutic strategies. In addition to the known clinical and demographic predictors of septic syndromes, in this study, we investigated whether measuring T and B lymphocyte subsets upon admission in the ICU may help individualize the prediction of ensuing sepsis during ICU stay. Between May 2015 and December 2016, we performed a prospective cohort study evaluating peripheral blood lymphocyte T-CD4+ (T-helper cells), T-CD8+ (cytotoxic T-cells), T-CD56 + (natural killer cells), and T-CD19+ (B-lymphocytes), using flow cytometry on blood samples collected 2 days after admission in the ICU. We enrolled 176 patients, 65.3% males, with mean age of 61.1 ± 15.4 years. At univariate analyses, higher percentages of CD19 B-cells were significantly associated with ensuing sepsis (20.5% (15.7–27.7)% vs 16.9% (11.3–22)%, P = 0.0001), whereas median interquartile range (IQR) proportions of CD4 T-cells (41.2% (33.4–50.6)% vs 40% (35–47)%, P = 0.5), CD8 T-cells (21.1% (15.8–28.2)% vs 19.6% (14.6–25.1)%, P = 0.2) and CD56 T-cells (1.7% (0.9–3.1)% vs 1.45% (0.7–2.3)%, P = 0.4) did not reveal any significant association. An unexpected, highly significant inverse correlation of CD8 T-cells and CD19 B-cells proportions, however, was observed, suggesting that patients with lower CD19 and higher CD8 proportions might be somehow protected from ensuing sepsis. We therefore studied the ability of the CD8/CD19 ratio to predict ensuing sepsis in our sample. In final models of multivariate logistic regression, the following independent associations were found: previous antibiotic exposure (odds ratio (OR): 3.8 (95% confidence interval (CI): 1.35–10.87), P = 0.01), isolation of at least one multi-drug resistant organism at any time during ICU stay (OR: 8.4 (95% CI: 3.47–20.6), P < 0.0001), decreasing age (OR: 0.9 (95% CI: 0.93–0.99), P = 0.02) and a CD8/CD19 ratio >2.2 (OR: 10.3 (95% CI: 1.91–55.36), P = 0.007). Our data provide preliminary evidence that immune characterization of critically ill patients on ICU admission may help personalize the prediction of ensuing sepsis during their ICU stay. Further polycentric evaluation of the true potential of this new tool is warranted.

Severity of atherosclerotic lesions and foot synovial tendon complex injury as factors of sepsis development in patients with diabetic foot

Severity of atherosclerotic lesions and foot synovial tendon complex injury as factors of sepsis development in patients with diabetic foot

Sepsis in patients with complicated forms of diabetic foot syndrome

The study of special features of septic states development and sepsis in patients with DFS allows prognosticate the clinical course of pyonecrotic processes in aforesaid patients and optimize the schemes of complex pathogenetic treatment. Methods. There were studied the special features of sepsis development and treatment in 117 patients with complicated forms of diabetic foot syndrome. The results of sepsis development in patients with complicated forms of diabetic foot syndrome are the decompensation of diabetes mellitus, toxic syndrome, the raise of anti-inflammatory cytokines (IL-1, IL-6, TNF), the current pyonecrotic process progresses rapidly and assumes an uncontrolled character. Results. An adequate surgical treatment combined with complex medicamental therapy allows save extremities in 54,7 %. The operations of choice for these patients are distal guillotine amputations with surgical treatment of foot to the level of Lisfranc joint or amputations of extremity on the level of shin or thigh. The high amputations are 35,1 % of general postoperative lethality. Conclusions . Depending on character of the clinical course of pathologic process it is necessary to carry out one-phase or multiphase operative interventions on the background of complex multicomponent pathogenetic therapy. The operations of choice for these patients are distal guillotine amputations with surgical treatment of foot to the level of Lisfranc joint or amputations of extremity on the level of shin or thigh. Postoperative lethality in patients with DFS complicated with sepsis is 13,7 % and in most cases it is connected with high amputations of extremities

Risk Factors of Sepsis in Obstructive Acute Pyelonephritis Associated with Urinary Tract Calculi

Purpose: The aim of this study is to identify the risk factors for development of sepsis in patients with obstructive acute pyelonephritis (APN) associated with urinary tract calculi. Materials and Methods: Between January 2004 and December 2013, 73 patients with obstructive APN associated with upper urinary tract calculi were admitted to our institution. Medical records of 73 patients (14 men and 59 women, mean age of 57 years) were reviewed retrospectively. The risk factors for sepsis were analyzed using multivariate logistic regression analysis. Results: Of 73 patients, 37 (50.7%) developed sepsis. Old age and history of hypertension were more common in the sepsis group than in the non-sepsis group (p<0.001 and p=0.018). The white blood cell count, neutrophil count, plateletto-lymphocyte ratio, neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein level were significantly higher in the sepsis group (p=0.011, p=0.001, p=0.042, p<0.001 and p=0.006, respectively). Lymphocyte count, platelet count, and albumin level were significantly lower in the sepsis group (p<0.001, p=0.008 and p<0.001, respectively). Multivariate logistic regression analysis indicated that old age (odds ratio [OR], 2.13; p=0.023), decrease in serum albumin level (OR, 4.27; p=0.041), and high NLR (OR, 3.83; p=0.037) were independent risk factors for development of sepsis. Conclusions: Elderly patients with obstructive APN associated with urinary tract calculi who have low serum albumin levels and high NLR should be treated carefully against development of sepsis.

Immature Platelet Fraction Predicts Outcome and Sepsis Development in Critically Ill Patients Admitted to a General Intensive Care Unit, but Not in Neutropenic Patients

Introduction: Immature platelet fraction (IPF) is a new laboratory parameter, representing a fraction of young platelets in peripheral blood count which is known to correlate with thrombopoiesis. IPF can be reported in absolute numbers or expressed as percentage (IPF%) of total platelet count. IPF% can be used to differentiate individuals at higher risk for bleeding among patients suffering from immune thrombocytopenia and to predict recovery of blood counts after stem cell transplantation (SCT). Moreover, IPF% was also reported to predict the development of sepsis in patients admitted to the general intensive care unit. This study was aimed to prospectively evaluate the value of IPF% as a predictor of clinical outcome and/or mortality in patients susceptible to sepsis.Methods: Two different patient populations at high risk for life-threatening infection, i.e., patients presenting with fever and neutropenia and adults admitted to the general intensive care unit (ICU) of a tertiary health care center for various reasons apart from neutropenic fever were prospectively studied. IPF was measured using the Sysmex XE-2100 analyzer during the first 24 hours of hospitalization. In addition, C-reactive protein (CRP) and Interleukin-6 (IL-6) levels were tested in some of the patients. All patients were monitored and their vital signs, renal function, hemodynamic and respiratory state, as well as final outcome were recorded. For patients with neutropenic fever, the infectious pathogen was listed, whenever identified. Treating physicians were blinded to IPF% results to ensure that clinical decisions were not affected by consideration of this parameter.Results: One hundred and four adults with neutropenic fever and 138 additional adults admitted to the ICU were included in the study.A median age of patients admitted to ICU and those with neutropenic fever was 53 (range 17-88) and 55 (range 18-85) years; males composed 58% and 60% of the cohorts, respectively. A mean IPF% in patients admitted to ICU was significantly higher than that determined in neutropenic patients (8.6 vs 6.8). IPF% levels during the first 24 hours of admission, predicted mortality (p = 0.037) for patients admitted to ICU but not for patients presenting with neutropenic fever. In patients admitted to ICU, high IPF% was also associated with length of stay in the unit, poor hemodynamic status, and death. Neither IL-6 plasma level nor CRP correlated with these clinical outcomes. APACHE-II score (a known disease severity scale in ICU patients) and IPF% were not correlated by Pearson test (p=0.09).Conclusion: IPF% is a valuable biomarker for predicting prognosis in ICU patients independent of APACHE-II score. This study suggests that the validity of IPF% as a predictor of outcome depends on the bone marrow (BM) capacity. In patients with normal bone marrow admitted to ICU, IPF% correlates with the significance of stress and severity of the disease. In patients presenting with neutropenic fever, BM reserve is impaired due to chemotherapy. Larger studies are needed to evaluate the role of IPF% in different patient populations and to determine its application to patients with impaired BM reserves such as immunocompromised patients and those at older age. DisclosuresNo relevant conflicts of interest to declare.