Risk Factors For Sepsis Research Articles

Incidence and Risk Factors of Early-onset Sepsis among Preterm Infants in a Teaching Hospital: A Retrospective Cohort Study

Incidence and Risk Factors of Early-onset Sepsis among Preterm Infants in a Teaching Hospital: A Retrospective Cohort Study

Bacterial profile of wound site infections and evaluation of risk factors for sepsis among road traffic accident patients from Apex Trauma Centre, Northern India.

Background. Among the most significant yet often ignored health issues worldwide are trauma and accidental injuries. India accounts for 11% of global deaths in road accidents, the highest in the world, according to the World Bank report. There are limited data about the bacterial contamination of road traffic accident (RTA) wounds and their antibiotic susceptibility patterns. Materials and Methods. This prospective study was conducted in a tertiary care centre in northern India from January 2023 to January 2024. Wound deep swabs or aspirates were collected from RTA patients with traumatic injuries at different time intervals. Gram stain and culture were performed, and positive aerobic culture was subjected to antibiotic susceptibility testing. Organism identification was done using MALDI-TOF MS and routine biochemical tests. Blood samples were also collected to rule out bloodstream infections during follow-up if the patient became febrile or showed symptoms of systemic infection. Sepsis was defined in those patients who had two or more scores in the systemic inflammatory response syndrome criteria with a positive microbiological culture. Risk factors were evaluated for sepsis on the basis of the patient's vitals, injury characteristics, procalcitonin, Glasgow Coma Scale (GCS) score, need for mechanical ventilation and complete blood count, which were obtained from the patient's admission file. Results. A total of 189 wound samples were collected, of which 99 (52.38%) samples showed the growth of microorganisms. The aerobic isolates included 69 (69.69%) Gram-negative bacilli, of which the majority were Klebsiella pneumoniae, 28 (28.28%) Gram-positive cocci, of which the majority were Staphylococcus aureus and 2 (2.02%) anaerobic isolates. Among the Gram-negative isolates, none of the isolates were resistant to colistin. All S. aureus isolates were susceptible to vancomycin, teicoplanin and levonadifloxacin. Sepsis developed in 50 (26.45 %) patients. Significant risk factors evaluated for sepsis were a raised procalcitonin level, a low GCS score, a higher injury severity score, the need for mechanical ventilation and a raised quick sequential organ failure assessment score. Conclusion. It is essential to ascertain the profile of microorganisms isolated from RTA wounds in order to reduce antibiotic resistance and deliver efficient treatment.

Clinical Characteristics and Risk Factors of Sepsis in Patients with Liver Abscess.

Aims/Background Liver abscess (LA) is a serious medical condition that predisposes patients to sepsis. However, predicting sepsis in LA patients has rarely been explored. This study employed univariate and multivariate logistic regression analyses to identify independent risk factors for sepsis, which would provide guidance for clinical diagnosis and treatment. Methods A total of 122 patients with LA treated in Peking University People's Hospital from 1 January 2016 to 31 October 2022 were recruited. Among the cases, 35 patients had sepsis (sepsis group) while the remaining 87 did not have sepsis (non-sepsis group). Clinical data were collected for all enrolled cases. Univariate analysis was performed to identify potential predictors, which were tested in multivariable logistic analysis to pinpoint the independent risk factors for sepsis in LA patients; these findings were utilized to develop a prediction model. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficacy of the prediction model. Informed consent to participate was obtained from the patients or their relatives. Results The incidence of shivering in the sepsis group was significantly higher than that in the non-sepsis group (p < 0.05). Through the univariate analysis, it was found that the reduction in platelet count and prothrombin time activity and the elevation of glycosylated hemoglobin (HbAlc) and procalcitonin (PCT) were more significant in the sepsis group than in the non-sepsis group (p < 0.05). Multivariate logistic regression analysis revealed that PCT and HbAlc were independent risk predictors of sepsis in LA patients within the derivation cohort (p < 0.05). Conclusion Elevated levels of HbAlc and PCT were independent risk factors for sepsis associated with LA. Patients with LA exhibiting elevated PCT levels demonstrated a 21% increased susceptibility to sepsis, and those with elevated HbAlc levels showed a 38% heightened risk for sepsis.

MPO-DNA Complexes and cf-DNA in Patients with Sepsis and Their Clinical Value.

Background/Objectives: Neutrophils, as the first line of defense in the immune response, produce neutrophil extracellular traps (NETs) upon activation, which are significant in the pathogenesis and organ damage in sepsis. This study aims to explore the clinical value of myeloperoxidase-DNA (MPO-DNA) and cell-free DNA (cf-DNA) in sepsis patients. Methods: Clinical data were collected from 106 sepsis patients, 25 non-sepsis patients, and 51 healthy controls. Sequential Organ Failure Assessment (SOFA) scores were calculated, and levels of MPO-DNA) complexes and cf-DNA were measured using specific kits. Correlation analyses assessed relationships between indicators, while logistic regression identified independent risk factors. Receiver operating characteristic (ROC) curves calculated the area under the curve (AUC) to evaluate the diagnostic value of the biomarkers. Results: Sepsis patients exhibited significantly elevated levels of MPO-DNA and cf-DNA compared to non-sepsis patients and healthy controls. In sepsis patients, MPO-DNA and cf-DNA levels correlated with inflammation, coagulation, and organ damage indicators, as well as procalcitonin (PCT) levels and SOFA scores. Both C-reactive protein (CRP) and cf-DNA were identified as independent risk factors for sepsis, demonstrating moderate diagnostic value. ROC analysis showed that the combination of MPO-DNA and CRP (AUC: 0.837) enhances the AUC value of CRP (0.777). Conclusions: In summary, elevated serum levels of MPO-DNA and cf-DNA in sepsis patients correlate with SOFA scores and PCT levels, providing reference value for sepsis diagnosis in clinical settings.

Study of etiology and risk factors of neonatal sepsis in a tertiary care hospital in North Karnataka

Study of etiology and risk factors of neonatal sepsis in a tertiary care hospital in North Karnataka

Elevated total bile acid levels as an independent predictor of mortality in pediatric sepsis.

The close relationship between bile acid (BA) metabolism and sepsis has been investigated in recent years, as knowledge of the role of the gut microbiome and metabolomics in sepsis has grown and become more comprehensive. Patients with sepsis who were admitted to the PICU of the Children's Hospital, Zhejiang University School of Medicine from January 2016 to December 2021 were enrolled in this study. Preoperative non-infectious pediatric patients undergoing elective surgeries in our hospital's department of surgery were recruited as controls during the same period. Clinical data were collected and analyzed. 702 children were enrolled, comprising 538 sepsis survivors, 164 sepsis fatalities, and 269 non-infected controls. Statistical analysis revealed that total BA (TBA) increased in both the early and severe stages of pediatric sepsis. In the severe stage, TBA (OR = 2.898, 95% CI 1.946-4.315, p < 0.05) was identified as a risk factor for sepsis. A clinical model identified TBA (the cut-off value is >17.95 µmol/L) as an independent predictor of sepsis mortality with an AUC of 0.842 (95% CI 0.800-0.883), sensitivity of 54.9%, specificity of 96.6%, and HR = 7.658 (95% CI 5.575-10.520). The study showed that elevated TBA was associated with a heightened risk of mortality in pediatric sepsis. Many clinical indicators show differences between children with sepsis and the control group, among which the difference in serum total bile acid levels is the most significant. During the hospitalization of the patients, the overall bile acid levels in the sepsis death group were higher and exhibited greater fluctuations compared to the survival group, with significant differences. Serum total bile acid levels can serve as effective biomarker for predicting the prognosis of children with sepsis.

Causal association of immune effector proteins with sepsis: A Mendelian randomization study.

Sepsis is an infection-induced systemic inflammatory response syndrome. Immune regulation plays a crucial role in sepsis. We looked into the link between immune effector-related proteins and sepsis in this study by using both univariate and multivariate Mendelian randomization (MR) analyses. We accessed and collected data from the Integrative Epidemiology Unit's Open About Sepsis genome-wide association study database. The 6 immune effector-associated proteins each contained 10,534,735 single-nucleotide polymorphisms from 3301 samples. Using the weighted median, MR-Egger, simplex, inverse-variance weighting, and weighted mode methods, univariate MR then investigated the link between complement factor H-related protein-5 (CFHR5), Fc epsilon receptor II (FCER2), granzyme B (GZMB), major histocompatibility complex, class II, DQ alpha (HLA-DQA2), mannose-binding lectin 2 (MBL2), or myeloperoxidase (MPO) and sepsis. In the inverse-variance weighted results, the P values of all 6 immune effector-related proteins were <0.05, suggesting a possible causal relationship between them and sepsis. MBL2 (odds ratio [OR] = 1.046) was a risk factor for sepsis, while the other proteins (FCER2: OR = 0.922; GZMB: OR = 0.908; CFHR5: OR = 0.858; HLA-DQA2: OR = 0.896; MPO: OR = 0.875) were safety factors. By revealing a causal link between sepsis and CFHR5, FCER2, GZMB, HLA-DQA2, MBL2, or MPO, our study offers an essential resource for additional investigations on the subject.

Interpretable Machine Learning Models for Predicting Critical Outcomes in Patients with Suspected Urinary Tract Infection with Positive Urine Culture.

(1) Background: Urinary tract infection (UTI) is a leading cause of emergency department visits and hospital admissions. Despite many studies identifying UTI-related risk factors for bacteremia or sepsis, a significant gap remains in developing predictive models for in-hospital mortality or the necessity for emergent intensive care unit admission in the emergency department. This study aimed to construct interpretable machine learning models capable of identifying patients at high risk for critical outcomes. (2) Methods: This was a retrospective study of adult patients with urinary tract infection (UTI), extracted from the Medical Information Mart for Intensive Care IV Emergency Department (MIMIC-IV-ED) database. The critical outcome is defined as either in-hospital mortality or transfer to an intensive care unit within 12 h. ED visits were randomly partitioned into a 70%/30% split for training and validation. The extreme gradient boosting (XGBoost), random forest (RF), and support vector machine (SVM) algorithms were constructed using variables selected from the stepwise logistic regression model. The XGBoost model was then compared to the traditional model and clinical decision rules (CDRs) on the validation data using the area under the curve (AUC). (3) Results: There were 3622 visits among 3235 unique patients diagnosed with UTI. Of the 2535 patients in the training group, 836 (33%) experienced critical outcomes, and of the 1087 patients in the validation group, 358 (32.9%) did. The AUCs for different machine learning models were as follows: XGBoost, 0.833; RF, 0.814; and SVM, 0.799. The XGBoost model performed better than others. (4) Conclusions: Machine learning models outperformed existing traditional CDRs for predicting critical outcomes of ED patients with UTI. Future research should prospectively evaluate the effectiveness of this approach and integrate it into clinical practice.

Early postnatal immature-to-total neutrophil ratio in the histological chorioamnionitis among neonatal intensive care unit infants

ObjectiveHistological chorioamnionitis (hCAM) is a major risk factor for early-onset sepsis. Predictive methods for hCAM are needed in clinical practice during the early postnatal period. To examine the relationship between hCAM and perinatal variables including early postnatal immature-to-total neutrophil ratio (ITR). Study designA single-center study was undertaken at Ohta Nishinouchi Hospital between April 1, 2016 and June 30, 2023. Blood samples and placenta collected from study candidate infants admitted to the neonatal intensive care unit were assessed by univariate analyses and multivariate logistic regression analysis. We also assessed the test performance of ITR and maternal white blood cell (WBC) counts by area under a receiver operating characteristic (ROC) curves. ResultsA total of 725 infants were analyzed (496 in the non-hCAM group and 229 in the hCAM group). Significant relationships were observed between hCAM and ITR (p < 0.001, odds ratio (OR), 1.067; 95% confidence interval (CI), 1.041 to 1.093). Per the ROC curves, an ITR (%) of 7.15 could predict hCAM at a sensitivity of 55.9% and specificity of 71.9% [area under the curve (AUC) = 0.691, p < 0.001, 95% CI, 0.649 to 0.733]. Further, maternal WBC counts of 9.85 ( × 109/L) predicted hCAM with 69.0% sensitivity and 67.3% specificity (AUC = 0.710, p < 0.001, 95%CI, 0.669 to 0.750). ConclusionsEarly postnatal ITR was high in cases with greater leukocyte invasion into the placenta tissue, which may be a biomarker of the presence and/or severity of hCAM. Histological CAM should be considered when the early neonatal ITR (%) is 7.15 or higher.

Effect of Xuebijing injection on acute gastrointestinal injury in patients with sepsis: a retrospective cohort study

To observe the effect of Xuebijing injection on sepsis combined with acute gastrointestinal injury (AGI), and analyze the risk factors of sepsis combined with AGI. A retrospective cohort study was conducted. Patients with non-gastrointestinal origin admitted to the department of intensive care medicine of the First Hospital of Qinhuangdao from May 1, 2021 to October 30, 2023 were enrolled. The baseline data, source of sepsis infection, vital signs, acute physiology and chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA), laboratory tests, comorbidities, interventions during treatment, and the 28-day prognosis were collected. The patients were divided into Xuebijing group and non-Xuebijing group according to whether Xuebijing injection was used or not. According to whether AGI was merged or not, patients were divided into merged AGI group and non-merged AGI group. The main observational indexes were the difference in the incidence of AGI between the Xuebijing group and non-Xuebijing group and the difference in the magnitude of the decline in procalcitonin (PCT), C-reactive protein (CRP), and white blood cell count (WBC) at 7 days after admission, and the difference in the 28-day morbidity and mortality. Risk factors for AGI in septic patients were explored by univariate analysis, and statistically significant indicators were screened and included in binary Logistic regression analysis to determine independent risk factors. A total of 129 patients with sepsis of non-gastrointestinal origin were enrolled, including 57 patients in the Xuebijing group and 72 patients in the non-Xuebijing group. Among 129 patients, 80 patients in the merged AGI group and 49 patients in the non-merged AGI group. There were no statistically significant differences between Xuebijing group and non-Xuebijing group in gender, age, body mass index (BMI), underlying disease, source of infection, vital sign, APACHE II score, SOFA score, and clinical intervention, and there were no statistically significant differences in laboratory tests except for aspartate aminotransferase (AST) and blood urea nitrogen (BUN). The incidence of AGI was significantly lower in the Xuebijing group than that in the non-Xuebijing group [50.87% (29/57) vs. 70.83% (51/72), P < 0.05], and the 28-day mortality was slightly lower than that in the non-Xuebijing group [24.56% (14/57) vs. 30.56% (22/72), P > 0.05]. In the Xuebijing group, the decreases in CRP, PCT and WBC at 7 days after admission were greater than those in the non-Xuebijing group, with statistically significant differences in the decreases of CRP and PCT [CRP (mg/L): 47.12±67.34 vs. 7.76±111.03, PCT (μg/L): 14.08 (-1.22, 50.40) vs. 2.94 (-1.27, 14.80), all P < 0.05]. Univariate analysis showed that the use of acid suppressants, the use of analgesic sedation, the non-use of Xuebijing injections, pulmonary infections, and urinary tract infections were the risk factors for the development of AGI in patients with sepsis. Binary Logistic regression analysis further showed that the use of acid suppressants [odds ratio (OR) = 2.450, 95% confidence interval (95%CI) was 1.021-5.883, P = 0.045], use of analgesic sedatives (OR = 2.521, 95%CI was 1.074-5.918, P = 0.034), and urinary tract infection (OR = 4.011, 95%CI was 1.085-14.831, P = 0.037) were independent risk factors for sepsis combined with AGI, in which the use of Xuebijing injection was a protective factor (OR = 0.315, 95%CI was 0.137-0.726, P = 0.007). Xuebijing injection reduced the incidence of AGI in patients with non-gastrointestinal sepsis. PCT and CRP decreased more markedly than in patients who did not use Xuebijing injection. The use of acid-suppressing agents, analgesic and sedative agents, and urinary tract infections were independent risk factors for sepsis in combination with AGI, while the use of Xuebijing injection is a protective factor.

Predictors of Sepsis and Sepsis-related Mortality in Critically Ill Burn Patients: A Single Tertiary Care Center Experience.

Clinical diagnosis of sepsis is challenging, emphasizing the importance of regular bacterial surveillance, and tailored antimicrobial therapy. This study aims to elucidate the predictors of sepsis in critically ill burn patients. A retrospective analysis was conducted on patients admitted to the burn intensive care unit between 2016 and 2022. Demographics, type of burn, total body surface area (TBSA), presence of inhalation injury, mortality, sepsis, deep vein thrombosis, pulmonary embolism, pneumonia, cultures, and laboratory findings were collected. Descriptive statistics and survival analysis were used to analyze trends during the 7-year period. The study encompassed 196 participants. Among patient factors, men constituted 73.4% (n = 102) of those without sepsis and 86.0% (n = 49) with sepsis, with an association between sepsis and lower age (34 versus 41 years) as well as larger TBSA (41.1% versus 17.3%). Inhalation injury was a significant predictor of sepsis [35.1% (n = 20) versus 11.6% (n = 16)]. Mortality was higher in sepsis cases [17.5% (n = 10) versus 2.9% (n = 4)], as well as positive blood cultures [47.4% (n = 27) versus 2.2% (n = 3)], positive wound cultures [71.9% (n = 41) versus 12.2% (n = 17)], and positive fungal cultures [12.3% (n = 7) versus 0% (n = 0)]. Multivariable analysis identified age and TBSA as significant predictors of sepsis (P = 0.025, P < 0.001). Age, TBSA affected emerge as a strong risk factor for sepsis among critically ill burn patients. It underscores the need for vigilant monitoring to improve outcomes and reduce sepsis-related mortality.

Early identification and diagnosis, pathophysiology, and treatment of sepsis-related acute lung injury: a narrative review.

Sepsis is a life-threatening organ dysfunction, and the most common and vulnerable organ is the lungs, with sepsis-related acute respiratory distress syndrome (ARDS) increasing mortality. In recent years, an increasing number of studies have improved our understanding of sepsis-related ARDS in terms of epidemiology, risk factors, pathophysiology, prognosis, and other aspects, as well as our ability to prevent, detect, and treat sepsis-related ARDS. However, sepsis-related lung injury remains an important issue and clinical burden. Therefore, a literature review was conducted on sepsis-related lung injury in order to further guide clinical practice in reducing the acute and chronic consequences of this condition. This study conducted a search of the MEDLINE and PubMed databases, among others for literature published from 1991 to 2023 using the following keywords: definition of sepsis, acute lung injury, sepsis-related acute lung injury, epidemiology, risk factors, early diagnosis of sepsis-related acute lung injury, sepsis, ARDS, pathology and physiology, inflammatory imbalance caused by sepsis, congenital immune response, and treatment. This review explored the risk factors of sepsis, sepsis-related ARDS, early screening and diagnosis, pathophysiology, and treatment and found that in view of the high mortality rate of ARDS associated with sepsis. In response to the high mortality rate of sepsis-related ARDS, some progress has been made, such as rapid identification of sepsis and effective antibiotic treatment, early fluid resuscitation, lung-protective ventilation, etc. Sepsis remains a common and challenging critical illness to cure. In response to the high mortality rate of sepsis-related ARDS, progress has been made in rapid sepsis identification, effective antibiotic treatment, early fluid resuscitation, and lung-protective ventilation. However, further research is needed regarding long-term effects such as lung recruitment, prone ventilation, and the application of neuromuscular blocking agents and extracorporeal membrane oxygenation.

Examining Sepsis Incidence, Risk Factors, and Mitigation Efforts at PKU Muhammadiyah Gamping Hospital, Yogyakarta: A Retrospective Analysis

Sepsis poses a significant challenge in healthcare settings due to its association with heightened morbidity and mortality rates, prolonged hospitalizations, and increased healthcare expenditures. This study aims to investigate the incidence of sepsis, its associated risk factors, and the efficacy of various mitigation efforts implemented at PKU Muhammadiyah Gamping Hospital in Yogyakarta. Employing a cross-sectional, analytical observational design, this study examined a sample comprising patients diagnosed with sepsis at the hospital between January 2019 and December 2022, meeting predefined inclusion and exclusion criteria. Inclusion criteria encompassed patients diagnosed with sepsis in accordance with hospital protocols and those admitted between January 2019 and December 31, 2022, while exclusion criteria included patients with incomplete bacteremia diagnoses. Consecutive sampling was utilized for sample selection, with data extracted from patient records maintained in the hospital's medical archives. This study was conducted with the approval of PKU Muhammadiyah Gamping Hospital's ethical committee (permit number: 051/KEP-PKU/III/2023). Analysis of four years' worth of data revealed a total of 210 cases of sepsis, comprising 112 male and 98 female patients.

Clinical characteristics and prognosis of patients with early sepsis-related liver injury in Northeast China.

Background: Sepsis-associated liver injury (SALI) occurs in about a third of septic patients, and it is often a poor prognostic factor. However, there are few studies on early SALI and its impact on the clinical course of sepsis. Here we explored the clinical characteristics, risk factors, and prognosis of early SALI. Methods: Two hundred and one patients with confirmed sepsis were divided into those with and without early SALI (on admission) based on liver function. The clinical characteristics and prognosis were compared between groups and associated factors identified by multivariable regression analysis. Results: Sepsis-related liver injury was present in 18.9% of septic patients on admission. High aspartate transaminase (AST), high direct bilirubin, and low plasma thromboplastin antecedent (PTA, factor XI) were risk factors for sepsis with SALI: the area under the AST curve was 0.825, corresponding to a sensitivity of 0.67 and a specificity of 0.93 (cutoff 91.6 U/L), the area under the direct bilirubin curve was 0.86, corresponding to a sensitivity of 0.83 and a specificity of 0.71 (cutoff 8.35 μmol/L), and the area under the PTA curve was 0.678, corresponding to a sensitivity of 0.47 and a specificity of 0.93 (cutoff 54.0). Conclusion: Septic patients with early SALI have early-onset coagulation disorders that must be recognized to instigate early intervention and halt sepsis progression. Elevated AST, PTA, and direct bilirubin may be independent risk markers of sepsis-related liver injury, and extra clinical vigilance is required when these factors are noted in patients with sepsis.

Clinical profile and risk factors associated with Elizabethkingia anophelis infection in neonates born in a tertiary care hospital-a case-control study and outbreak investigation.

The objective of this study was to determine the risk factors associated with Elizabethkingia anophelis infection in neonates admitted to a tertiary care neonatal intensive care unit (NICU). A case-control study was undertaken as part of the outbreak investigation for E. anophelis sepsis in a tertiary care NICU in South India. Thirty-eight neonates with E. anophelis bloodstream infection (BSI) between January 2021 and February 2022 were enrolled as cases, and 38 neonates symptomatic with other BSIs, were selected as controls, and risk factors analysed. The 38 cases were relatively stable neonates, likely to be admitted to level 1 and level 2 NICU, unlike the controls, who were sicker and required level 3 NICU care. Only a third of neonates with Elizabethkingia sepsis had traditional risk factors like central lines, need for respiratory support or perinatal risk factors. Multiple logistic regression analysis revealed that neonates with E. anophelis infection were more likely to be stable and on only enteral feeds, cared in level 1 or 2 of the NICU. This observation, combined with isolation of Elizabethkingia meningosepticum from breast pumps earlier, led us to autoclave the feeding vessels and milk containers along with provision of hot water for cleaning breast pumps, and adoption of general infection control measures, after which incident cases declined. Sanger sequencing of 10 representative isolates obtained from the neonates showed 100% sequence identity to E. anophelis. Infection due to E. anophelis affects relatively stable neonates without traditional risk factors for sepsis. Adherence to asepsis routines and housekeeping protocols helps to prevent the spread of infection.

Risk factors for bacteremic sepsis following live donor liver transplantation: a propensity score-matched analysis

Risk factors for bacteremic sepsis following live donor liver transplantation: a propensity score-matched analysis

Assessment of neutrophil to lymphocyte ratio, platelet to lymphocyte ratio and systemic immune-inflammatory index, as diagnostic markers for neonatal sepsis.

To assess the neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and systemic immune-inflammatory index (SII), as diagnostic markers for neonatal sepsis. This retrospective study involve neonates with sepsis and healthy neonates as controls. NLR, PLR, and SII were compared between groups. In total, 60 neonates with sepsis and 60 healthy controls were involved in the study. Compared with controls, the sepsis group had higher values for NLR, PLR and SII. Logistic regression analysis suggested that the NLR, PLR and SII were independent risk factors for neonatal sepsis. In addition, receiver operating characteristic (ROC) curve analysis indicated that the NLR, PLR and SII were reliable predictors of neonatal sepsis and SII had the best predictive value. NLR, PLR and SII appear to be useful indicators for predicting neonatal sepsis.

Delayed admission to hospital with proper prehospital treatments prevents severely burned patients from sepsis in China: A retrospective study

BackgroundSepsis is one of the major causes of morbidity and mortality in burn patients. However, the optimal timing of admission which can minimize the probability of sepsis is still unclear. This study aims to determine the optimal time period of admission for severely burned patients and find out the possible reasons for it. Method185 victims to the Kunshan factory aluminum dust explosion accident, which happened on August 2nd, 2014, were studied. The optimal cutpoint for continuous variables in survival models was determined by means of the maximally selected rank statistic. Univariate and multivariate analyses were further conducted to verify that admission time was not a risk factor for sepsis. Subgroup analyses were performed to find out possible contributing factors for the result. ResultThe cutoff point for admission time was determined as seven hours, which was supported by the survival curve (p < 0.001). Multivariate analysis showed that, in our study population, delayed admission time was not a risk factor for sepsis (HR = 0.610, 95 %CI = 0.415 - 0.896, p = 0.012). Subgroup analyses showed that “Tracheotomy before admission” (p = 0.002), “Whole blood transfusion” (p < 0.001), “Hemodynamic instability before admission” (p = 0.02), “Has a burn department in the hospital” (p = 0.009), “Has a burn ICU in the hospital” (p < 0.001), “Acute heart failure (AHF)” (p = 0.05), “acute respiratory distress syndrome (ARDS)” (p = 0.05) and “GI bleeding” (p = 0.04) were all statistically significant. ConclusionIn our study population, we found that delayed admission time was not a risk factor associated with a reduced incidence of sepsis among severely burned patients. This might be attributed to variations in prehospital treatments (whole blood transfusion and tracheotomy), whether the hospital had a burn department/ICU, and certain complications (AHF, ARDS and GI bleeding). It can be inferred that early prehospital care plays a crucial role in reducing sepsis risk among severe burn patients.

Amyloid A and lactic acid as a predictor in patients with sepsis in patients with liver cirrhosis

BackgroundSepsis is triggered by pathogenic microorganisms, resulting in a systemic inflammatory response. Liver cirrhosis and sepsis create a vicious cycle: cirrhosis weakens immune function, raising infection risk and hindering pathogen clearance. Optimal treatment outcomes depend on understanding liver cirrhosis patients’ sepsis risk factors. Thus, preventing sepsis involves addressing these risk factors. Therefore, early identification and understanding of clinical characteristics in liver cirrhosis patients with sepsis are crucial for selecting appropriate antibiotics. A case-control study using logistic regression was conducted to examine the prognostic value of amyloid A/lactate level monitoring in identifying sepsis risk factors in liver cirrhosis patients.MethodsFrom March 2020 to March 2022, 136 liver cirrhosis patients treated at our hospital were divided into a sepsis group (n = 35) and a non-sepsis group (n = 101) based on sepsis complications. General clinical data were collected. Univariate analysis screened for liver cirrhosis patients’ sepsis risk factors. Multivariate logistic analysis was subsequently employed to evaluate the risk factors. Sepsis patients were followed up for a month. Based on prognosis, patients were categorized into a poor prognosis group (n = 16) and a good prognosis group (n = 19). Serum amyloid A (SAA) and blood lactic acid (BLA) levels were compared between the two groups. The receiver operating characteristic (ROC) curve was used to evaluate the prognostic value of both individual and combined SAA/BLA monitoring.ResultsPatient data, including age, diabetes history, liver cancer, hepatic artery embolization, recent antibiotic use, invasive procedures within two weeks, APACHE II Scoring, ALB and SAA and BLA levels, were compared between the sepsis and non-sepsis groups, showing significant differences (P < 0.05). Logistic regression identified factors such as age ≥ 70, recent antibiotic use, recent invasive procedures, history of liver cancer, hepatic artery embolization history, high APACHE II scores, decreased albumin, and elevated SAA and BLA levels as independent sepsis risk factors in liver cirrhosis patients (P < 0.05). Among the 35 sepsis patients, 16 had a poor prognosis, representing an incidence rate of 45.71%. Serum SAA and BLA levels were significantly higher in the poor prognosis group than in the good prognosis group (P < 0.05). The AUC for serum SAA and BLA was 0.831 (95%CI: 0.738–0.924), 0.720 (95%CI: 0.600–0.840), and 0.909 (95%CI: 0.847–0.972), respectively. The combined diagnostic AUC was significantly higher than that of single factor predictions (P < 0.05). The predictive value ranked as follows: joint detection > SAA > BLA.ConclusionIn treating liver cirrhosis, prioritize patients with advanced age, a history of hepatic artery embolization, recent invasive operations, history of liver cancer, recent antibiotic exposure, high APACHE II scores and low albumin. Closely monitoring serum SAA and BLA levels in these patients can offer valuable insights for early clinical prevention and treatment.

Development of a Predictive Nomogram for Sepsis in Patients with Urolithiasis-Related Obstructive Pyelonephritis.

Background and Objectives: In patients with urolithiasis-related obstructive pyelonephritis (UROP), sepsis represents a critical and concerning complication that can substantially increase the mortality rate. This study aimed to identify the risk factors for sepsis in UROP patients and to develop a predictive nomogram model. Materials and Methods: We analyzed data from 148 patients who met the UROP criteria and were admitted to Chang Gung Memorial Hospital between 1 January 2016 and 31 December 2021. The primary outcome evaluated was the incidence of sepsis, as defined by the most recent Sepsis-3 guidelines. To identify potential risk factors for sepsis, we employed the Least Absolute Shrinkage and Selection Operator (LASSO) regression technique. Subsequently, we utilized multivariable logistic regression to construct the predictive model. Results: There was a total of 102 non-sepsis cases and 46 sepsis cases. Risk factors for sepsis in multivariable analysis were a history of diabetes mellitus (DM) (OR = 4.24, p = 0.007), shock index (SI) (×10-1) (OR = 1.55, p < 0.001), C-reactive protein (CRP) (mg/dL) (OR = 1.08, p = 0.005), and neutrophil to lymphocyte ratio (NLR) (×10) (OR = 1.58, p = 0.007). The nomogram exhibited an area under the receiver operating characteristic curve of 0.890 (95% CI 0.830-0.949). Conclusions: Our study demonstrated that patients with UROP who have DM, higher SI, higher NLR, and elevated CRP levels are significantly more likely to develop sepsis. These insights may aid in risk stratification, and it is imperative that clinicians promptly initiate treatment for those identified as high risk.