Septic Patient Research Articles

P27 Fever, falling counts and hyperferritinaemia in a septic patient - could it be haemophagocytic lymphohistocytosis?

P27 Fever, falling counts and hyperferritinaemia in a septic patient - could it be haemophagocytic lymphohistocytosis?

Pulmonary aortic endocarditis in patient with patent ductus arteriosus

Introduction: Right-sided heart endocarditis is uncommon, comprising only 5-10% of all infective endocarditis cases. The infective process may be isolated to pulmonary valve or concomitantly involve other valves. Prompt diagnosis by transthoracic echocardiography, aggressive antibiotics from the beginning, and surgical removal of the vegetation for infective endocarditis help prevent the risk of multiorgan failure and fatal pulmonary embolism. Case summary: A 38-year-old female, the medical history was normal, gave birth naturally at a district hospital 3 months ago. She admitted to the hospital because of fever and continuous shortness of breath 1 month before admission. Echocardiography detected: vegetations (10x23mm) on left pulmonary aortic and patent ductus arteriosus. A CT scan showed a mixed-echo mass in the left pulmonary artery. The patient had surgery to remove the vegetation and close the patent ductus arteriosus. The patient was stable after surgery and discharged 2 weeks after surgery. Conclusion: Pulmonary aortic vegetations and patent ductus arteriosus are rare lesions and high risk of death. The diagnosis should be considered in any febrile, septic patient with congenital heart disease. Surgery removal of vegetations and aggressive antibiotic treatment should be performed together to improve the outcome.

“Deep Purple”: un caso di purpura fulminans in asplenia congenita isolata

Asplenic patients are well-known to be at higher risk of infections, which are primarily caused by Streptococcus pneumoniae. Such infections may present with a sudden onset and a fulminant course, potentially leading to septic shock, purpura fulminans and other severe complications. The authors present the case of a 2-year-old child with an undiagnosed asplenia, who developed septic shock caused by S. Pneumoniae, and subsequently, a volvulus due to intestinal malrotation. Purpura fulminans is a rare, life-threatening condition characterised by disseminated intravascular coagulation, extensive tissue thrombosis and haemorrhagic skin necrosis. It is primarily associated with meningococcal or pneumococcal infec-tions. Approximately half of pneumococcal purpura fulminans cases occur in asplenic or hyposplenic patients. Pneumococcal vaccination may reduce the risk of infection in asplenic patients, although it does not entirely eradicate this risk. When encountering a septic patient presenting with purpura fulminans, it is crucial to consider the potential underlying asplenia as part of the differential diagnosis.

Fluid management in the septic peri-operative patient.

This review provides insight into recent clinical studies involving septic peri-operative patients and highlights gaps in understanding fluid management. The aim is to enhance the understanding of safe fluid resuscitation to optimize peri-operative outcomes and reduce complications. Recent research shows adverse surgical and clinical outcomes with both under- and over-hydration of peri-operative patients. The kinetic of intravenous fluids varies significantly during surgery, general anaesthesia, and sepsis with damage to endothelial glycocalyx (EG), which increases vascular permeability and interstitial oedema. Among clinical anaesthesia, neuraxial anaesthesia and sevoflurane have less effect on EG. Hypervolemia and the speed and volume of fluid infusion are also linked to EG shedding. Despite improvement in the antisepsis strategies, peri-operative sepsis is not uncommon. Fluid resuscitation is the cornerstone of sepsis management. However, overzealous fluid resuscitation is associated with increased mortality in patients with sepsis and septic shock. Personalized fluid resuscitation based on a careful assessment of intravascular volume status, dynamic haemodynamic variables and fluid tolerance appears to be a safe approach. Balanced solutions (BS) are preferred over 0.9% saline in patients with sepsis and septic shock due to a potential reduction in mortality, when exclusive BS are used and/or large volume of fluids are required for fluid resuscitation. Peri-operative goal-directed fluid therapy (GDFT) using dynamic haemodynamic variables remains an area of interest in reducing postoperative complications and can be considered for sepsis management (Supplementary Digital Content). Optimization of peri-operative fluid management is crucial for improving surgical outcomes and reducing postoperative complications in patients with sepsis. Individualized and GDFT using BS is the preferred approach for fluid resuscitation in septic peri-operative patients. Future research should evaluate the interaction between clinical anaesthesia and EG, its implications on fluid resuscitation, and the impact of GDFT in septic peri-operative patients.

Elevated level of extracellular vimentin is associated with an increased fibrin formation potential in sepsis: ex vivo swine study

BackgroundSepsis can lead to coagulopathy and microvascular thrombosis. Prior studies, including ours, reported an increased level of extracellular vimentin in blood derived from septic patients. Moreover, we identified the contribution of extracellular vimentin to fibrin formation and to the fibrin clot structure ex vivo in plasma from septic patients. Here, we tested the status of plasma vimentin and its impact on fibrin clots using our recently described swine model of methicillin-resistant Staphylococcus aureus (MRSA) sepsis-induced coagulopathy.ResultsWe employed ELISA, size-exclusion chromatography, vimentin antibodies, confocal microscopy, and turbidity assays on piglet plasma obtained at pre- and post-MRSA inoculation. Plasma vimentin level at 70 h post-MRSA inoculation was on average twofold higher compared to pre-infection (0 h) level in the same animal. Anti-vimentin antibody effectively reduced fibrin formation ex vivo and increased porosity in the fibrin clot structure generated from septic piglet plasma. In contrast to plasma at 0 h, the size-exclusion chromatography revealed that phosphorylated vimentin was in-complex with fibrinogen in septic piglet plasma.ConclusionsThus, our swine model of sepsis-induced coagulopathy, reproduced increased extracellular circulating vimentin and subsequent potentiation of fibrin formation, often observed in septic patient. These outcomes validate the use of large animal models to investigate the dysregulated host immune response to infection leading to coagulopathy, and to develop new therapies for sepsis-induced disseminated microvascular thrombosis.

Management of Sepsis in the First 24 Hours: Bundles of Care and Individualized Approach.

Early diagnosis and prompt management are essential to enhance the outcomes of patients with sepsis and septic shock. Over the past two decades, evidence-based guidelines have guided appropriate treatment and recommended the implementation of a bundle strategy to deliver fundamental treatments within the initial hours of care. Shortly after its introduction, the implementation of a bundle strategy has led to a substantial decrease in mortality rates across various health care settings. The primary advantage of these bundles is their universality, making them applicable to all patients with sepsis. However, this same quality also represents their primary disadvantage as it fails to account for the significant heterogeneity within the septic patient population. Recently, the individualization of treatments included in the bundle has been suggested as a potential strategy for further improving the prognosis of patients with sepsis. New strategies for the early identification of microorganisms and their resistance patterns, advanced knowledge of antibiotic kinetics in critically ill patients, more conservative fluid therapy in specific patient populations, and early use of alternative vasopressors to catecholamines, as well as tailored source control based on patient conditions and site of infection, are potential approaches to personalize initial care for specific subgroups of patients. These innovative methodologies have the potential to improve the management of septic shock. However, their implementation in clinical practice should be guided by solid evidence. Therefore, it is imperative that future research evaluate the safety, efficacy, and cost-effectiveness of these strategies.

Emayella augustorita, New Member of Pasteurellaceae, Isolated from Blood Cultures of Septic Patient.

We report discovery of a new bacterial genus and species of the family Pasteurellaceae by using phylogenetic and metabolic analysis. The bacterium, Emayella augustorita, was isolated from blood cultures of a patient in France diagnosed with an adenocarcinoma of the intestines and who was treated with a biliary prosthesis placement.

Impact of Appropriate Empirical Antibiotic Treatment on the Clinical Response of Septic Patients in Intensive Care Unit: A Single-Center Observational Study.

The appropriate antibiotic treatment of patients with bacterial sepsis in the intensive care unit (ICU) remains a challenge. Considering that current international guidelines recommend 7 days of antibiotic therapy as sufficient for most severe infections, our primary outcome was a comparison of clinical response to initial empirical therapy on day 7 and mortality between two groups of septic patients-with appropriate (AEAT) and inappropriate (IEAT) empirical antibiotic therapy according to the in vitro sensitivity of bacteria detected in a blood culture (BC). Adult patients admitted to the ICU between 2020 and 2023, who were diagnosed with sepsis according to the Sequential Organ Failure Assessment (SOFA) score ≥ 2 in association with a suspected or documented infection, were selected for the study. Of the 418 patients, 149 (35.6%) died within 7 days. Although the AEAT group had a lower mortality rate (30.3% vs. 34.2%) and better clinical improvement (52.8% vs. 47.4%) on day 7 after starting empirical antibiotic therapy, there was no significant difference. A causative organism was isolated from BCs in 30% of septic patients, with gram-negative bacteria (GNB) predominating in 60% of cases, and multidrug-resistant (MDR) or extensively drug-resistant (XDR) bacteria predominantly detected in the BCs of the IEAT group. Although the AEAT group had slightly worse clinical characteristics at the onset of sepsis than the IEAT group, the AEAT group showed faster improvement on days 7 and 14 of sepsis. In this retrospective cross-sectional study, the AEAT group was associated with better clinical response at day 7 after sepsis onset and lower mortality, but without a significant difference. Comorbidities and the type of bacterial pathogen should also be taken into account as they can also contribute to the prediction of the final outcome. These results demonstrate the importance of daily assessment of clinical factors to more accurately predict the clinical outcome of a septic patient.

A Preclinical Model of Sepsis-Induced Myopathy with Disuse in Mice.

Sepsis is a major cause of in-hospital deaths. Improvements in treatment result in a greater number of sepsis survivors. Approximately 75% of the survivors develop muscle weakness and atrophy, increasing the incidence of hospital readmissions and mortality. However, the available preclinical models of sepsis do not address skeletal muscle disuse, a key component for the development of sepsis-induced myopathy. Our objective in this protocol is to provide a step-by-step guideline for a mouse model that reproduces the clinical setting experienced by a bedridden septic patient. Male C57Bl/6 mice were used to develop this model. Mice underwent cecal ligation and puncture (CLP) to induce sepsis. Four days post-CLP, mice were subjected to hindlimb suspension (HLS) for seven days. Results were compared with sham-matched surgeries and/or animals with normal ambulation (NA). Muscles were dissected for in vitro muscle mechanics and morphological assessments. The model results in marked muscle atrophy and weakness, a similar phenotype observed in septic patients. The model represents a platform for testing potential therapeutic strategies for the mitigation of sepsis-induced myopathy.

A synthetic bioactive peptide of the C-terminal fragment of adhesion protein Fibulin7 attenuates the inflammatory functions of innate immune cells in LPS-induced systemic inflammation.

Systemic inflammation is associated with improper localization of hyperactive neutrophils and monocytes in visceral organs. Previously, a C-terminal fragment of adhesion protein Fibulin7 (Fbln7-C) was shown to regulate innate immune functionality during inflammation. Recently, a shorter bioactive peptide of Fbln7-C, FC-10, via integrin binding was shown to reduce ocular angiogenesis. However, the role of FC-10 in regulating the neutrophils and monocyte functionality during systemic inflammatory conditions is unknown. The study sought to explore the role of FC-10 peptide on the functionality of innate immune cells during inflammation and endotoxemic mice. Neutrophils and monocytes were isolated from healthy donors and septic patient clinical samples and Cell adhesion assay was performed using a UV spectrophotometer. Gene expression studies were performed using qPCR. Protein level expression was measured using ELISA and flow cytometry. ROS assay, and activation markers analysis in vitro, and in vivo were done using flow cytometry. Cells were stimulated with LPS (100ng/mL) and studied in the presence of peptides (10μg, and 20μg/mL) in vitro. In an in vivo study, mice were administered with LPS (36.8mg/kg bw) and peptide (20μg). This study demonstrates that human neutrophils and monocytes adhere to FC-10 via integrin β1, inhibit spreading, ROS, surface activation markers (CD44, CD69), phosphorylated Src kinase, pro-inflammatory genes, and protein expression, compared to scrambled peptide in cells isolated from healthy donors and clinical sample. In line with the in vitro data, FC-10 (20μg) administration significantly decreases innate cell infiltration at inflammatory sites, improves survival in endotoxemia animals & reduces the inflammatory properties of neutrophils and monocytes isolated from septic patients. FC-10 peptide can regulate neutrophils and monocyte functions and has potential to be used as an immunomodulatory therapeutic in inflammatory diseases.

Differences in Clinical and Lab Characteristics of Sepsis between Opium User Patients and Patients with No Illicit Drug Addiction.

Sepsis is a significant cause of mortality worldwide. This study aimed to compare clinical and laboratory characteristics of sepsis in patients addicted to illicit drugs versus patients with no illicit drug addiction. In this cross-sectional study, all patients hospitalized with sepsis diagnosis were recruited within six months from September to March 2019. Sixty patients for each group (illicit drugaddicted and non-addicted individuals) were selected. The data relating to illicit drug consumption, serum indices, the current focus of infection, duration of hospitalization, and disease outcomes were collected. Patients who had an illicit drug addiction were compared with non-addicted patients in terms of clinical and laboratory parameters. The data collected were analyzed using SPSS software (version 19). The bacterial load in the urine culture was statistically significant in both groups and higher in the non-addicted group. The frequency distributions of focus of infection, duration of hospitalization, and outcome were not significantly different between the two groups. The serum sodium and total neutrophils were significantly higher in the addicted group. However, the MCHC level was significantly lower (p < 0.05). Opium may have stimulated the immune system and reduced bacterial infection in septic patient users.

A multisite validation of a two hours antibiotic susceptibility flow cytometry assay directly from positive blood cultures

BackgroundRapid antimicrobial susceptibility testing (AST) is urgently needed to provide safer treatment to counteract antimicrobial resistance. This is critical in septic patients, because resistance increases empiric therapy uncertainty and the risk of a poor outcome. We validate a novel 2h flow cytometry AST assay directly from positive blood cultures (PBC) by using a room temperature stable FASTgramneg and FASTgrampos kits (FASTinov® Porto, Portugal) in three sites: FASTinov (site-1), Hospital Ramon y Cajal, Madrid, Spain (site-2) and Centro Hospitalar S. João, Porto, Portugal (site-3). A total of 670 PBC were included: 333 spiked (site-1) and 337 clinical PBC (151 site-2 and 186 site-3): 367 gram-negative and 303 gram-positive. Manufacturer instructions were followed for sample preparation, panel inoculation, incubation (1h/37ºC) and flow cytometry analysis using CytoFlex (Site-1 and -2) or DxFlex (site-3) both instruments from Beckman-Coulter, USA.ResultsA proprietary software (bioFAST) was used to immediately generate a susceptibility report in less than 2 h. In parallel, samples were processed according to reference AST methods (disk diffusion and/or microdilution) and interpreted with EUCAST and CLSI criteria. Additionally, ten samples were spiked in all sites for inter-laboratory reproducibility. Sensitivity and specificity were >95% for all antimicrobials. Reproducibility was 96.8%/95.0% for FASTgramneg and 95.1%/95.1% for FASTgrampos regarding EUCAST/CLSI criteria, respectively.ConclusionFASTinov® kits consistently provide ultra-rapid AST in 2h with high accuracy and reproducibility on both Gram-negative and Gram-positive bacteria. This technology creates a new paradigm in bacterial infection management and holds the potential to significantly impact septic patient outcomes and antimicrobial stewardship.

Polyunsaturated fatty acid-derived lipid mediator Resolvin D1 alleviates sepsis-induced disseminated intravascular coagulation via Caspase-1/Gasdermin D pyroptotic pathway

Sepsis-induced disseminated intravascular coagulation (DIC) is characterised by abnormal blood clotting resulting from severe infection, contributing to organ dysfunction in sepsis. Resolvin D1 (RvD1) is an endogenous lipid mediator, synthesised from the omega-3 polyunsaturated fatty acid (PUFA) docosahexaenoic acid (DHA) through enzymatic processes involving 15-LOX and 5-LOX. RvD1 is recognised for its protective properties against various inflammatory conditions. This study aims to investigate its potential to modulate coagulation dysfunction in sepsis and to evaluate coagulation disorders in septic patients. Sepsis models were established by intraperitoneal injection LPS (20mg/kg) or cecal ligation and puncture (CLP) followed by injection of RvD1 (10μg/kg) or saline. The impact of RvD1 on coagulation dysfunction was assessed by clotting time and coagulation indicators such as TAT, D-dimer, PAI-1, and fibrinogen. The activity of the coagulation system invivo was observed by evaluating dynamic microcirculation, platelets and thrombin in mice using intravital microscopy. The effect of RvD1 on pyroptosis was investigated by measuring NOD-like receptor protein 3 (NLRP3), Caspase-1, Caspase-11, and Gasdermin D (GSDMD) levels via western blot. Caspase-1 knockout mice, GSDMD knockout mice and bone marrow-derived macrophages (BMDMs) were used to elucidate the underlying mechanisms. Lastly, the concentration of RvD1 in plasma from septic patients was quantified to explore its relationship with coagulation and pyroptosis. RvD1 significantly attenuated coagulation dysfunction in septic mice induced by LPS and CLP, and inhibited Caspase-1/GSDMD-dependent pyroptosis in septic mice and bone marrow-derived macrophages. In septic patients, the plasma concentrations of RvD1 was negatively correlated with both coagulation-related indicators and markers of GSDMD activation. The results suggest that RvD1 can improve coagulation dysfunction in sepsis by regulating the Caspase-1/GSDMD pyroptotic pathway. Additionally, the concentration of RvD1 in septic patient plasma is related to prognosis and DIC development. RvD1 could be a potential biomarker and a promising therapeutic alternative in sepsis-induced DIC.

Delayed Diagnosis of Vasopressor-induced Symmetrical Peripheral Gangrene in Septic Shock Patient

Vasopressors are powerful vasoconstrictors used in critically ill patients to raise blood pressure after volume resuscitation attempts fail. These medications, while lifesaving, carry the risk of severe and under-reported side effects, digital ischemia, and gangrene due to decreased digital perfusion. We here present a case of vasopressin-induced digital gangrene in a female patient who underwent elective surgery for nephrolithiasis without any pre-existing peripheral vascular disease or smoking. The patient developed bilateral upper and lower limb symmetrical acronecrosis. The causality assessment as per the World Health Organisation – Uppsala Monitoring Centre scale was suggestive of a “Possible adverse” event. The patient denied surgical intervention, eventually developed multiorgan failure, and died of cardiopulmonary arrest. Although lifesaving, vasopressors due to alpha constricting activity can cause severe limb ischemia with dreadful consequences. These drugs should be used judiciously with careful monitoring and tapering as soon as possible when the condition improves. The consequences could be dreadful if timely surgical intervention and measures are not taken.

Obesity and septic patient outcomes: Shaping the puzzle through age and sex perspectives

While obesity has been reported as a protective factor in septic patients, little is known about the potential modifying effects of age and sex. The objective of this study is to investigate age and sex-specific associations between obesity and the prognosis of septic patients. A retrospective analysis was conducted on a cohort of 15,464 septic patients, categorized by body mass index (BMI) into four groups: underweight (<18.5kg/m2, n=483), normal (18.5-24.9kg/m2, n=4344), overweight (25-29.9kg/m2, n=4949) and obese (≥30kg/m2, n=5688). Multivariable logistic regression and inverse probability weighting were employed to robustly confirm the protective effect of a higher BMI on 28-day mortality, with normal weight serving as the reference category. Subgroup analyses based on age (young: 18-39, middle-aged: 40-64 and elderly: ≥65) and sex were performed. The findings demonstrate that high BMI independently confers a protective effect against 28-day mortality in septic patients. However, the relationship between BMI and 28-day mortality exhibits a non-linear trend, with a BMI of 34.5kg/m2 displaying the lowest odds ratio. Notably, the survival benefits associated with a high BMI were not observed in the young group. Moreover, being underweight emerges as an independent risk factor for middle-aged and elderly female patients, while in males it is only a risk factor in the elderly group. Interestingly, being overweight and obese were identified as independent protective factors in middle-aged and elderly male patients, but not in females. The effect of BMI on mortality in septic patients varies according to age and sex. Elderly individuals with sepsis may derive more prognostic benefits from obesity.

Complete genome sequence of Selenomonas species strain TAMA-11512, isolated from blood culture of a septic patient.

We report the complete sequence of Selenomonas species strain TAMA-11512, isolated from the blood culture of a septic patient. The phylogeny and average nucleotide identity show that the strain TAMA-11512 is considered a novel bacterial species in Selenomonas genus.

Should I Supplement Vitamin D in a Patient With Sepsis?

Sepsis is a potentially fatal organ failure produced by the host's immune response to infection. It is critical to identify risk factors associated with a poor prognosis in septic patients in order to develop new therapy options. Vitamin D deficiency (25-hydroxyvitamin cholecalciferol < 20 ng/mL) is common in critical and septic patients. Serum vitamin D concentrations are associated with an increased incidence of mortality in critically ill adult patients. In critically ill patients, vitamin D supplementation (a very high vitamin D 3 or cholecalciferol loading dosage as a single bolus dose ranging from 400,000 to 540,000 IU) is feasible and safe. Some of the trials and their post-hoc analyses evaluating vitamin D supplementation in severely sick individuals, including septic patients, suggested possible benefits in mortality (reduced 28-day mortality in the range of 8.1%-17.5%), and other outcomes (reduction in hospital length in the range from 9 to 18 days, and decrease in duration of mechanical ventilation in the range from 5 to 10 days). Despite the fact that many studies support the provision of vitamin D to septic patients, there are still many studies that contradict this opinion, and there is still debate about the recommendation to use vitamin D in sepsis. A pragmatic clinical approach in severe sepsis could be supplementation of vitamin D if serum levels are diminished (< 30 ng/mL). It appears that a single ultrahigh dose of vitamin D 3 (cholecalciferol) could be administered to the septic patient via an enteral tube, followed by daily or monthly maintenance doses. Parenteral administration might be reserved for a subgroup of septic patients with gastrointestinal, hepatic, or renal dysfunction. Future clinical trials designed exclusively for septic patients are required to assess the potential advantages of vitamin D. Possible impacts of selective activators of vitamin D receptors, such as paricalcitol, should be elucidated in sepsis. This emphasizes the requirement for more study and confirmation of any potential beneficial effects of vitamin D in sepsis.

Prognostic role of albumin, lactate-to-albumin ratio and C-reactive protein-to-albumin ratio in infected patients

IntroductionThe prognostic evaluation of the septic patient has recently been enriched by some predictive indices such as albumin concentration, lactate/albumin ratio (LAR) and C-reactive protein/albumin ratio (CAR). The performance of these indices has been evaluated in septic patients in intensive care, but until now their performance in infected patients in the Emergency Department (ED) has not been evaluated. AimTo investigate the potential prognostic role of albumin, LAR and CAR in patients with infection in the ED. MethodsSingle-centre prospective study performed between 1 January 2021 and 31 December 2021 at the ED of the Merano Hospital (Italy). All patients with infection were enrolled. The study outcome was death within 30 days. The predictive ability of albumin, LAR and CAR was assessed by area under the receiver operating characteristic curves (AUROCs). A multivariate logistic regression model was used to examine the association of the indices with 30-day mortality, with comorbidity, acute urgency and severity of infection as covariates. ResultsThe study enrolled 962 patients with an infectious status. The overall 30-day mortality rate was 8.9% (86/962). The AUROC of albumin was 0.831 (95% CI 0.795–868), while for LAR this was 0.773 (CI95% 0.719–0.827) and for CAR 0.718 (CI95% 0.664–0.771). The odds ratio for 30-day mortality for albumin was 3.362 (95% CI 1.904–5.936), for ln(LAR) 2.651 (95% CI 1.646–4.270) and for ln(CAR) 1.739 (95% CI 1.326–2.281). ConclusionsAll three indices had a good discriminatory ability for the risk of short-term death in patients with infection, indicating their promising use in the ED as well as in the ICU. Further studies are needed to confirm the better performance of albumin compared to LAR and CAR.

Relationship of Troponin I in Septic Patients Without Cardiac Disease

Background: Septic shock, marked by high morbidity and mortality, entails multiple organ dysfunction. Troponin I (TnI), linked to cardiac injury, rises in septic patient’s sans prior cardiac disease, hinting at myocardial involvement. Methods: A prospective analysis was conducted on n=280 samples collected from patients hospitalized between March and February of 2023, who presented with clinical suspicion of infection. TnI levels were measured upon admission, and patient demographics, clinical characteristics, and outcomes were recorded. Results: Among the patients, 45% exhibited elevated TnI levels upon ICU admission. Of these, 65% progressed to severe sepsis or septic shock during their hospital stay. Additionally, 30% of patients with elevated TnI levels experienced adverse outcomes, including increased mortality and prolonged hospitalization. The mean TnI level in septic patients without known cardiac disease was 0.78 ng/mL (standard deviation: 0.32 ng/mL). Elevated TnI levels showed a significant association with sepsis severity, as evidenced by higher Sequential Organ Failure Assessment (SOFA) scores (p &lt; 0.05), increased in-hospital mortality (p &lt; 0.01), and longer ICU stays (p &lt; 0.05). Conclusions: Elevated TnI levels in septic patients without cardiac disease suggest myocardial involvement in sepsis. TnI's association with adverse outcomes highlights its potential as a prognostic marker, warranting further research for clinical implications.

USING INTRAVENOUS IMMUNOGLOBULIN IN A PATIENT WITH SEPTIC SHOCK AND MULTIPLE COMORBIDITIES: A REVIEW BASED ON A CLINICAL CASE

The review focused on managing sepsis and septic shock patients by administering intravenous immunoglobulins (IVIG). Treatment outcomes and survival prognosis of septic patients were discussed in view of different regimens and dosages of IVIG. The principles of determining the appropriate dosage of IVIG in different medical facilities were compared. Own clinical case of complex treatment of septic shock using IVIG was proposed. The patient experienced a septic shock after transurethral resection of the prostate to treat a prostate abscess. Additionally, the patient was diagnosed with acute cerebrovascular disorder and various cardiovascular ailments, including type 2 diabetes mellitus and stage 2 chronic kidney disease. This septic patient was diagnosed with immunodeficiency disorder with lymphopenia, hypoproteinemia, procalcitoninemia, and significant secondary autoimmune inflammatory disorders. Despite the expected unfavorable prognosis, after comprehensive treatment with early application of moderate doses of IVIG, the patient’s condition stabilized, and organ functions remained satisfactory. Therefore, early administration of intravenous immunoglobulin had a favorable clinical outcome in the treatment of septic shock, thereby indicating the need to utilize a multidisciplinary approach, including involving an immunologist, in managing septic conditions.