Severe Sepsis Group Research Articles

Assessment of serum proprotein convertase subtilisin/kexin type 9 in pediatric sepsis syndrome

Sepsis is a life-threatening condition that arises when the body's response to infection causes injury to its tissues and organs. Proprotein convertase subtilisin/kexin type 9 (PCSK9) is an enzyme released in response to the drop in cholesterol level occurring in sepsis. Our study aimed to evaluate the prognostic role of serum Proprotein convertase subtilisin/kexin type 9 (PCSK9) level in children with sepsis and severe sepsis. Sixty children were included in this study. They were divided into two groups: 30 children in the sepsis group and 30 in the severe sepsis group. Another 30 apparently healthy children were included as a control group. Blood samples were withdrawn from all included children for complete blood count (CBC), renal function tests (RFT), liver function tests (LFT), LDL-cholesterol (LDL-C), blood culture, and serum PCSK9. In this study, PCSK9 and LDL-C were higher in the two sepsis groups than in the control group (p < 0.05). They were also higher in the severe sepsis group than the sepsis group and in the non-survivors than in the survivors (p < 0.05). PCSK9 was positively correlated with length of hospital stay in surviving children (r = 0.67, p = 0.001) and had predicted significant hematological dysfunction (adjusted B = − 96.95, p = 0.03). In conclusion, the PCSK9 assay can be used as a biomarker for bad prognosis in children suffering from clinical sepsis.

Characteristics and Risk Factors for Pediatric Sepsis.

Sepsis is considered a major cause of health loss in children and had high mortality and morbidity. Currently, there is no reliable model for predicting the prognosis of pediatric patients with sepsis. This study aimed to analyze the clinical characteristics of sepsis in children and assess the risk factors associated with poor prognosis in pediatric sepsis patients to identify timely interventions and improve their outcomes. This study analyzed the clinical indicators and laboratory results of septic patients hospitalized in the Pediatric Intensive Care Unit of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, China, from January 1, 2019, to December 31, 2021. Risk factors for sepsis were identified by logistic regression analyses. A total of 355 children with sepsis were enrolled, with 333 children (93.8%) in the good prognosis group, and 22 children (6.2%) in the poor prognosis group. Among them, there were 255 patients (71.8%) in the sepsis group, and 100 patients (28.2%) in the severe sepsis group. The length of hospital stay in the poor prognosis group was longer than that in the good prognosis group (P<0.01). The levels of interleukin 1β (IL-1β) in the poor prognosis group were higher than those in the good prognosis group (P>0.05), and the platelet (PLT), albumin (ALB), and hemoglobin (Hb) levels were lower in the poor prognosis group (P<0.01). The IL-8 levels in the severe sepsis group were higher than those in the sepsis group (P<0.05). Multiple logistic regression analysis suggested that lower Hb levels, ALB levels, peak PLT counts, and higher IL-1β levels were independent risk factors for poor prognosis in children with sepsis. Lower Hb, ALB, and PLT counts and elevated IL-1β are independent risk factors for poor prognosis in children with sepsis.

The Role of Soluble Urokinase Plasminogen Activator Receptor (suPAR) as an Early Indicator of Mortality in Pediatric Septic Shock.

Despite advancements in antibiotic therapy and resuscitation protocols, sepsis and septic shock remain major contributors to morbidity and mortality in children. We aimed to investigate the utility of soluble urokinase plasminogen activator receptor (suPAR) for the early detection of septic shock and to evaluate its accuracy in predicting mortality. A prospective study was conducted in a tertiary pediatric emergency department (ED), enrolling patients diagnosed with the sepsis, severe sepsis, or septic shock. In addition to assessing infection biomarkers such as C-reactive protein and procalcitonin, suPAR levels were quantified upon admission using enzyme-linked immunosorbent assay. The primary outcome measure was 30-day mortality. Overall 72 patients and 80 healthy children included. Plasma suPAR levels demonstrated a statistically significant elevation in the sepsis, severe sepsis, and septic shock groups compared with the control group (p < 0.001 for all). The septic shock group exhibited the highest suPAR levels upon admission, surpassing both the sepsis and severe sepsis groups (p = 0.009 and 0.042). ROC analysis underscored the promising potential of suPAR with an AUC of 0.832 for septic shock. Analysis of mortality prediction revealed significantly higher suPAR levels in nonsurvivors than survivors (9.7 ng/mL vs. 4.2 ng/mL; p < 0.001). Employing plasma suPAR levels to discriminate between mortality and survival, a threshold of ≥7.0 ng/mL demonstrated a sensitivity of 90.9% and specificity of 71.0%. Plasma suPAR levels have the potential as a biomarker for predicting mortality in children with septic shock. In pediatric septic shock, the presence of plasma suPAR ≥7 ng/mL along with an underlying disease significantly increases the risk of mortality.

The prognostic value of platelet aggregation in patients with sepsis.

This study aims to investigate the relevance of platelet aggregation markers, specifically arachidonic acid (AA) and adenosine diphosphate (ADP), in relation to the prognosis of sepsis patients. A cohort of 40 sepsis patients was included and stratified, based on their 28-day post-treatment prognosis, into two groups: a survival group (n = 31) and a severe sepsis group (n = 9. Then, their various clinical parameters, including patient demographics, platelet counts (PLT), inflammatory markers, and platelet aggregation rates (PAR) induced by AA and ADP between the two groups, were compared. Long-term health implications of sepsis were assessed using the Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE II) score, and logistic regression analysis was conducted to evaluate the prognostic significance of PAR in sepsis patients. Patients with severe sepsis exhibited significantly elevated levels of procalcitonin (PCT), platelet adhesion rates, and PAR induced by ADP (P < 0.05), but having lower PLT (P < 0.05), compared to those in the survival group. Logistic regression analysis demonstrated that PAR induced by ADP was a protective factor in predicting prognosis in sepsis patients (P < 0.01). Activation of platelets in sepsis intensifies inflammatory response. Patients with sepsis whose ADP-induced PAR was < 60% displayed significant impairment in platelet aggregation function, and had higher mortality rate. Monitoring ADP-induced PAR is crucial for management of sepsis.

Complicated anorectal sepsis: Validation of scoring system for predicting anorectal sepsis severity.

Anorectal sepsis is a common and potentially serious medical condition characterized by infection and inflammation of the anal canal and surrounding tissues. However, the lack of standardized and comprehensive scoring systems specifically tailored for predicting the severity of anorectal sepsis poses challenges in clinical practice. This study aimed to develop and validate a scoring system for predicting the severity of anorectal sepsis by incorporating relevant patient factors. A retrospective cohort study was conducted at Mansoura University Hospital, a tertiary care center, over a period of 5 years. The study population consisted of 330 patients diagnosed with anorectal sepsis during the study period. A scoring system was developed using multiple variables, with each variable assigned a specific score based on its clinical significance and weight in predicting disease severity. The developed scoring system's predictive performance was evaluated using receiver operating characteristic (ROC) analysis, calculating the area under the ROC curve to assess discriminative ability. Descriptive statistics were used to summarize the demographic and clinical characteristics of the study population. Chi-square tests or t tests were performed to assess differences between non-severe and severe anal sepsis groups. The scoring system consisted of 12 variables, with a maximum total score of 18. The logistic regression analysis revealed significant associations between localized swelling, presentation within 72 hours, multiple drainage sessions, and severe anorectal sepsis. The ROC analysis showed an area under the curve of 0.85, indicating good discriminative ability of the scoring system. The scoring system was developed and validated in a single center, which may limit its generalizability to other settings. The scoring system demonstrated good predictive performance and can be a valuable tool for clinicians in assessing disease severity, guiding treatment decisions, and identifying high-risk patients.

ADAMTS13 in pediatric sepsis: a prognostic biomarker with potential therapeutic implications

BackgroundGrowing evidence implicates a pro-thrombotic state, caused by ADAMTS13 deficiency, in sepsis-associated organ dysfunction, but pediatric data is limited. Our purpose was to evaluate association of ADAMTS13 with prognosis of pediatric sepsis.ResultsThis was prospective observational study, conducted on 70 children with sepsis and 18 healthy controls. Patients were classified upon Pediatric Intensive Care Unit (PICU) admission into sepsis, severe sepsis, and septic shock groups. Serum ADAMTS13 was measured within 24 h of admission. The primary outcome was all-cause PICU mortality. ADAMTS13 was lower among patients than controls [median and interquartile range (IQR): 1.30 (0.88–3.13ng/mL) vs. 6.00 (5.55–6.50 ng/mL); p < 0.001]. ADAMTS13 was lower in both severe sepsis and septic shock than sepsis [median (IQR): 0.90 (0.80–1.75 ng/mL); 1.0 ng/ml (0.90–1.20); and 2.80 (1.00–3.85ng/mL), p = 0.026 and 0.006 respectively]. ADAMTS13 was lower among non-survivors compared with survivors [median (IQR): 0.9 (0.80–1.18 ng/mL) vs. 2.45 (0.98–3.50 ng/mL); p < 0.001]. ADAMTS13 had area under Receiver Operating Characteristic Curve (AUC) of 0.77 for mortality prediction. Lower ADAMTS13 level was associated with mechanical ventilation; vasoactive medications; acute respiratory distress syndrome; and multiple organ dysfunction syndrome. ADAMTS13 correlated with pediatric Sequential Organ Failure Assessment (pSOFA) score (rs = -0.46, p < 0.001); vasoactive infusion days ((rs = -0.48, p < 0.001); and vasoactive-inotropic score on day1 (rs = -0.43, p < 0.001) and day2 ((rs = -0.41; p < 0.001).ConclusionIn pediatric sepsis, lower ADAMTS13 level is a risk factor for organ dysfunction and mortality, lending theoretical foundations to therapeutic interventions aiming at reversing the pro-thrombotic state in sepsis.

Abstract P317: Methylene Blue Preserve The Microcirculation And Reduces Death In Rats Inflammation Models

Introduction: Sepsis is a serious medical condition in response that occurs when the body responds to an infection in an exaggerated way, causing a widespread inflammation that can lead to damage in multiple organs and systems of the body. Sepsis mortality is high, and new and old drugs are being studied to help maintain hemodynamic stability as methylene blue (MB). MB has been used to increase the blood pressure in sepsis showing to be efficient in rebalancing circulatory integrity in physiological patterns. We sought to investigate methylene blue treatment in the sepsis survival rate and mesenteric microcirculation preservation. Methods: Male Hannover rats from University of São Paulo (USP)were treated by intravenous bolus with MB (4 mg/kg) or saline. Mild sepsis was induced by CLp with 4 holes, moderate sepsis with 10 holes, and severe sepsis with 20 holes in the cecum using a 16-gauge needle. The rats survival was observed during 9 days after surgery and expressed as the percentage of animals surviving by the log-rank test (X2, chi-square). Intravital microscopy was performed to evaluate the integrity of the mesenteric microcirculation by analyzing the leukocyte rolling and adhesion by lipopolysaccharide(LPS) sepsis model. LPS was administered intraperitoneal and treatment with intravenously MB by femoral vein. Rolling and adhesion were quantified by intravital microscopy in rats that received treatment with MB or saline. Results: MB treatment improved survival rate in severe sepsis. Severe sepsis groups with MB had a survival rate of30% (p=0.02). MB treatment did not change survival rate in the mild and moderate sepsis groups. The rats that received LPS showed an improvement of leukocyte adhesion and rolling in mesenteric vessels compared with the saline group. Rats that received only MB had similar results to the saline group. Although, when rats received LPS and were treated with MB (after or before LPS), the leukocytes adhered and rolled in the mesentery diminished significantly (p&lt; 0,001)similarly to the saline group. Conclusion: Our data suggest that MB was able to increase survival in the severe sepsis and might be a beneficial drug for the protection of microcirculation. Funding: FAPESP, CAPES, FAEPA.

Pokaznyky tsytokiniv ta biomarkeriv zapalennia u khvorykh na perytonealnyi sepsys iz riznym stupenem tiazhkosty

Introduction. Sepsis, severe sepsis and septic shock are major public health problems worldwide. The consequences of sepsis are especially unfavorable for people with weakened immunity. Biomarkers of inflammation play an important role in the diagnosis of sepsis: C-reactive protein and procalcitonin, the indices of which increase significantly in this pathology. The aim of the study. To investigate quantitative indices of cytokines and biomarkers of inflammation in patients with peritoneal sepsis with different degrees of severity. Materials and methods. A group under examination included 101 patients. The esteemed laboratory indices included interleukins-1β, -2, -6, -10; tumor necrosis factor-α; C-reactive protein and procalcitonin concentration. Results. In patients with sepsis, the interleukin-1β index exceeded control values by 2.9 times. In the severe sepsis group this same index increased by 1.2 times, and in septic shock – by 1.4 times, compared to patients with sepsis. The concentration of tumor necrosis factor-α in the blood of patients with peritoneal sepsis, severe sepsis, and septic shock was 1.1, 9.2, and 2.9 times higher than control values, respectively. While measuring the concentration of interleukin-6, it was detected this index enhancement in all three groups of septic patients. Also it was documented certain decrease in the interleukin-2 index in all patients under investigation, compared to control. In patients with severe sepsis and septic shock, an increase in the level of interleukin-10 in comparison to control values was estimated up to 4.9 and 5.1 times. An increase in C-reactive protein and procalcitonin registered in all groups of septic patients, as well as the observed cytokine imbalance apparently reflect disability of the immune system to respond adequately and resist pathogenic microorganisms due to the deepening of the sepsis severity. Conclusions. In patients with peritoneal sepsis, the level of interleukin-1β exceeded control values by 2.9 times, in patients with severe sepsis – 3.7 times, and with septic shock – 4.2 times. The concentration of tumor necrosis factor-α in the blood of patients with peritoneal sepsis, severe sepsis, and septic shock was 1.1, 9.2, and 2.9 times higher than control values, respectively. Concentration of interleukin-6 in patients with peritoneal sepsis exceeded by 8.4 times, in the severe sepsis – by 18.8 times, and in septic shock – by 17.4 times control values. In patients with sepsis and severe sepsis of peritoneal genesis, the level of interleukin-2 decreased by 1.85 times, and in the septic shock group – by 1.6 times compared to the control values. Interleukin-10 indices in patients with sepsis increased by 1.28 times, in severe sepsis – by 4.9 times, and in septic shock – by 5.1 times in comparison with control values. An increase in C-reactive protein compared to its control values was detected in all patients under investigation: in the sepsis group – by 77.8 times, in severe sepsis – by 128.1 times, and in patients with septic shock – by 95.7 times. Similar enhancement of procalcitonin levels was observed in all patients under investigation with these indices correlation to the severity of the disease. Indices of pro-inflammatory and anti-inflammatory cytokines, as well as C-reactive protein and procalcitonin can be recommended as a reliable markers of the severity of the inflammatory process in patients with peritoneal sepsis. Digital values of cytokines and inflammatory biomarkers can serve as a valuable additional criteria for the assessment severity of the pathological process (sepsis, severe sepsis, and septic shock) of peritoneal origin. Keywords: peritoneal sepsis, severe sepsis, septic shock, interleukins, cytokines, immune imbalance.

Clinical characteristics and outcomes of children with Kawasaki disease combined with sepsis in the pediatric intensive care unit.

Kawasaki disease (KD) is a vascular inflammatory disease with unknown pathogenesis. There are few studies on KD combined with sepsis worldwide. To provide valuable data regarding clinical characteristics and outcomes related to pediatric patients with KD combined with sepsis in pediatric intensive care unit (PICU). We retrospectively analyzed the clinical data of 44 pediatric patients admitted in PICU at Hunan Children's Hospital with KD combined with sepsis between January 2018 and July 2021. Of the 44 pediatric patients (mean age, 28.18 ± 24.28 months), 29 were males and 15 were female. We further divided the 44 patients into two groups: KD combined with severe sepsis (n=19) and KD combined with non-severe sepsis (n=25). There were no significant between-group differences in leukocyte, C-reactive protein, and erythrocyte sedimentation rate. Interleukin-6, interleukin-2, interleukin-4 and procalcitonin in KD with severe sepsis group were significantly higher than those in KD with non-severe sepsis group. And the percentage of suppressor T lymphocyte and natural killer cell in severe sepsis group were significantly higher than those in non-severe group, while the CD4+/CD8+ T lymphocyte ratio was significantly lower in KD with severe sepsis group than in KD with non-severe sepsis group. All 44 children survived and were successfully treated after intravenous immune globulin (IVIG) combined with antibiotics. Children who develop with KD combined with sepsis have different degrees of inflammatory response and cellular immunosuppression, and the degree of inflammatory response and cellular immunosuppression is significantly correlated with the severity of the disease.

Lymphocyte-to-C-Reactive Protein Ratio as an Early Sepsis Biomarker for Neonates with Suspected Sepsis.

Neonatal sepsis is an extremely dangerous and fatal disease among neonates, and its timely diagnosis is critical to treatment. This research is aimed at evaluating the clinical significance of the lymphocyte-to-C-reactive protein ratio (LCR) as an early sepsis indicator in neonates with suspected sepsis. Between January 2016 and December 2021, 1269 neonates suspected of developing sepsis were included in this research. Among them, sepsis was diagnosed in 819 neonates, with 448 severe cases, as per the International Pediatric Sepsis Consensus. Data related to clinical and laboratory tests were obtained via electronic medical records. LCR was calculated as total lymphocyte (109 cells/L)/C-reactive protein (mg/L). Multivariate logistic regression analysis was employed to evaluate the effectiveness of LCR as an independent indicator for determining sepsis in susceptible sepsis neonates. Receiver operating characteristic (ROC) curve analysis was conducted for investigating the diagnostic significance of LCR in sepsis. When suitable, the statistical tool SPSS 24.0 was used for statistical analyses. LCR decreased significantly in the control, mild, and severe sepsis groups. Further analyses exhibited that there was a substantially greater incidence of sepsis in neonates in the low-LCR group (LCR ≤ 3.94) as opposed to the higher LCR group (LCR > 3.94) (77.6% vs. 51.4%, p < 0.001). Correlation analysis indicated a substantial negative association of LCR with procalcitonin (r = -0.519, p < 0.001) and hospital stay duration (r = -0.258, p < 0.001). Multiple logistic regression analysis depicted LCR as an independent indicator for identifying sepsis and severe cases of this disease. ROC curve analysis indicated the optimal cutoff value of LCR in identifying sepsis to be 2.10, with 88% sensitivity and 55% specificity. LCR has proven to be a potentially strong biomarker capable of identifying sepsis in a timely manner in neonates suspected to have the disease.

Predictive value of CRP and albumin ratio in neonatal sepsis

Background: The role of hypoalbuminemia and raised C-reactive protein (CRP) levels in predicting critical prognosis has been described extensively in adult literature. However, there are limited studies in pediatrics, particularly neonates. The study was conducted to assess the predictive value of the CRP vs Serum albumin in earlier identification and as a prognostic indicator of neonatal sepsis. Methods: In this research, from July 2021 to February 2022 a total of 150 studies were enrolled at Adichunchanagiri Institue of medical sciences. Complete clinical and laboratory data were collected. To identify the potential independent risk factor for neonatal sepsis, multivariate logistic regression analysis was performed. Receiver operating characteristic curve analysis was used to evaluate the prediction accuracy of CAR in identifying neonatal sepsis. Results: A total of 150 neonates were included in the study out of which 78 neonates were preterm, 32 neonates were late preterm and 40 neonates were term neonates. CAR levels were higher in neonates with sepsis and showed a gradual increase among the control group, mild sepsis group, and severe sepsis group. The prevalence of neonates with overall sepsis, mild sepsis, and severe sepsis increased significantly from CAR tertile 1 to tertile 3. Multiple logistic regression analysis showed that CAR was an independent risk factor for the presence of sepsis (OR = 11.123, 95% CI 6.74–14.5, p&lt;0.001) and severe sepsis (OR=1.568, 95% CI 1.3-2.4, p&lt;0.001). ROC curve analysis showed that CAR had a well-discriminatory power in predicting sepsis (area under the curve= 0.74, 95% CI, 0.71-0.77, p&lt;0.001) and severe sepsis (AUC=0.70, 95% CI, 0.67-0.74, p&lt;0.001). Conclusions: CAR was an independent predictor for the presence and severity of neonatal sepsis.

Study on the correlation and clinical significance of T-lymphocyte Subsets, IL-6 and PCT in the severity of patients with sepsis.

To evaluate the correlation and clinical significance of T lymphocyte subsets, IL-6 and PCT in the severity of patients with sepsis. One-hundred and twenty patients with sepsis admitted to Baoding No.1 Central Hospital from March 05, 2021 to March 05, 2022 were selected and divided into three groups according to the severity of the disease: the sepsis group, the severe sepsis group and the septic shock group, with 40 cases in each group. The venous blood of all patients was drawn with a sterile vacuum blood collection tube after admission to detect the levels of T lymphocyte subsets CD3+, CD4+, CD8+, CD4+/CD8+, and the venous blood was collected to detect the levels of interleukin-6 (IL-6) and procalcitonin (PCT). The three groups of patients were compared to analyze whether there were differences, and whether there was a correlation between the level of each indicator and the prognosis of patients after treatment. The levels of CD3+, CD4+ and CD4+/CD8+ in the three groups decreased with the aggravation of the disease, with a significant difference (p=0.00). The levels of IL-6 and PCT increased with the aggravation of the disease among the three groups, with statistically significant differences (IL-6, p=0.00; PCT, p=0.01). The better the patients recovered after treatment, the higher the levels of CD4+ and CD4+/CD8+, and the two were positively correlated; While the lower the levels of IL-6 and PCT, the two were negatively correlated. Peripheral blood T lymphocyte subsets and serum IL-6, PCT are abnormally expressed in patients with sepsis, and have a close bearing on the severity of the disease, which has a certain predictive value for patients after recovery. In view of this, the above indicators are of high clinical significance.

Analysis of the Effect of a New Type of Nano-drug Carrier Preparation on the Pathological Changes in Lung and Inducible Nitric-Oxide Synthase Expression in Severe Sepsis.

To explore the effect of a new type of nano-drug carrier preparation on the pathological changes in severe sepsis lung and inducible nitric oxide synthase (iNOS) expression, a new type of nano-drug carrier preparation was prepared based on RNA interference technology in this experiment. The new type of nano-drug carrier preparation was applied to the control group consisting of 120 rats and the experimental group consisting of 90 rats. The nano-drug carrier preparation group was given a drug injection, and the other group was injected with 0.9% sodium chloride injection. The data of mean arterial pressure, lactic acid, nitric oxide (NO) concentration, and iNOS expression level were recorded during the experiment. The results showed that the survival time of rats in each group was less than 36 hours before 24 hours, the mean arterial pressure of severe sepsis rats continued to decrease, while the mean arterial pressure and survival rate of rats given nano-drug carrier preparation increased significantly in the later stage of the experiment. The concentration of NO and lactic acid in severe sepsis rats increased significantly within 36 hours, while the concentration of NO and lactic acid in rats of the nano group decreased in the later stage of the experiment. The expression level of iNOS mRNA in lung tissue of rats in the severe sepsis group increased significantly during 6-24 hours and began to decrease after 36 hours. The expression level of iNOS mRNA in rats injected with nano-drug carrier preparation decreased significantly. In summary, the new type of nano-drug carrier preparation can improve the survival rate and mean arterial pressure of severe sepsis rats, decrease the concentration of NO and lactic acid and the expression level of iNOS, selectively silence the inflammatory factors in lung cells, reduce the inflammatory reaction, inhibit the synthesis of NO, and correct the oxygenation reaction in the body, which was of great significance for the clinical treatment of severe sepsis lung pathological changes.

A study of elevated red cell distribution width (RDW) in early-onset neonatal sepsis

BackgroundNeonatal sepsis is a serious infection occurring within the first 28 days of life. It is a significant cause of mortality and morbidity. Red cell distribution width (RDW) is estimated within the standard CBC profile and considered a simple tool for the diagnosis of neonatal sepsis without additional cost. Our aim in this study is to investigate the potential role of red cell distribution width (RDW) in the diagnosis of early-onset neonatal sepsis (EONS). The aim of our study is to detect the role of red cell distribution width (RDW) in the diagnosis and prognosis of early-onset neonatal sepsis (EONS).ResultsThis case-control study was conducted at the NICU of Beni-Suef University Hospital and revealed that RDW% was highly significantly higher among cases than among controls (16.65 ± 4.28, 11.13 ± 0.62, respectively); regarding the severity of neonatal sepsis, we divided our cases into three groups (sepsis group includes 21 neonates, severe sepsis group includes 31 neonates, and septic shock group includes 48 neonates), there were statistically significant differences between the three groups (sepsis, severe sepsis, and septic shock) regarding RDW (15.15 ± 1.65, 16.78 ± 2.01, 17.02 ± 2.02, respectively) as P value (0.027).ConclusionThis study revealed that RDW is associated with the diagnosis and prognosis of early-onset neonatal sepsis, so further study is needed to prove causation as it is being simple, less expensive, available, and easily repeated as it is routinely done with CBC, so it will be a good indicator for prognosis of neonatal sepsis.

Association of Procalcitonin to Albumin Ratio with the Presence and Severity of Sepsis in Neonates.

PurposePrevious studies have demonstrated that procalcitonin and albumin have a close correlation with sepsis. However, the role of procalcitonin (PCT) to albumin (ALB) ratio (PAR) in sepsis was still unclear, especially in neonates. Thus, this study aimed to investigate the association between PAR and neonatal sepsis.Patients and MethodsA total of 1,196 neonates with suspected sepsis were included in this study. Neonates were divided into control group and sepsis group, according to whether they were diagnosed with sepsis. Neonates with sepsis were further divided into mild sepsis and severe sepsis group according to the severity of sepsis. PAR was calculated as serum PCT (ng/mL)/ALB (mg/mL). All statistical analyses were performed using the statistical package SPSS 24.0, as appropriate.ResultsCompared with the control group, neonates with sepsis had a higher PAR. PAR also showed a significant gradual increase in the control, mild sepsis, and severe sepsis groups (P<0.001). Correlation analysis showed that there was a strong positive correlation between PAR and hsCRP, neonatal sequential organ failure assessment score (nSOFA), and prolonged length of hospital stay (P<0.001). On multiple logistic regression, higher PAR was independently associated with the presence and severity of neonatal sepsis. According to the receiver operating characteristic curve analysis, a PAR ≥0.065 had 64% sensitivity and 72% specificity in predicting the presence of neonatal sepsis (area under curve (AUC)=0.72, 95% CI=0.69–0.75, P<0.001) and a PAR≥0.070 had 69% sensitivity and 63% specificity in predicting the presence of severe sepsis (AUC=0.71, 95% CI=0.68–0.74, P<0.001).ConclusionPAR is significantly higher in neonates with sepsis and correlated with the severity of the disease. Increased PAR is an independent predictor useful for identifying the presence and severity of neonatal sepsis.

Risk factors for progression of Urolith Associated with Obstructive Urosepsis to severe sepsis or septic shock

IntroductionTo analyze the risk factors for progression of urolith associated with obstructive urosepsis to severe sepsis or septic shock, we had done the retrospective cross-sectional study, which would facilitate the early identification of high-risk patients.Materials and methodsDatas were retrospectively reviewed from 160 patients, suffering from obstructive urosepsis associated with urolith between December 2013 and December 2019. There were 49 patients complicating by severe sepsis (severe sepsis group), 12 patients complicating by septic shock (septic shock group), and 99 patients without progressing to severe sepsis or septic shock (sepsis group). The data covered age, gender, BMI (body mass index), time interval from ED (emergency department) to admission, WBC count (white blood cell count), NLR (neutrophil/lymphocyte ratio), HGB (hemoglobin), etc. Datas were analyzed by univariate analyses and multivariate logistic regression analysis. The corresponding nomogram prediction model was drawn according to the regression coefficients.ResultsUnivariate analysis showed that the differences of age, the time interval from ED to admission, history of diabetes mellitus, history of CKI (chronic kidney disease), NLR, HGB, platelet count, TBil (total bilirubin), SCr (serum creatinine), ALB (albumin), PT (prothrombin time), APTT (activated partial thromboplastin time), INR (international normalized ratio), PCT (procalcitonin), and positive rate of pathogens in blood culture were statistically significant (P < 0.05). Multivariatelogistic regression analysis showed that age, SCr, and history of CKI were independent risk factors for progression to severe sepsis, or septic shock (P < 0.05).ConclusionsAged ≥ 65 years, SCr ≥ 248 mol/L, and history of CKI were independent risk factors for progression of urolith associated with obstructive urosepsis to severe sepsis or septic shock. We need to pay more attention to these aspects, when coming across the patients with urolithic sepsis.

Value of heparin-binding protein in the diagnosis of severe infection in children: a prospective study.

To study the value of heparin-binding protein (HBP) in the diagnosis of severe infection in children. This study was a prospective observational study. The medical data of children who were admitted to the pediatric intensive care unit due to infection from January 2019 to January 2020 were collected. According to the diagnostic criteria for severe sepsis and sepsis, the children were divided into a severe sepsis group with 49 children, a sepsis group with 82 children, and a non-severe infection group with 33 children. The three groups were compared in terms of related biomarkers such as plasma HBP, serum C-reactive protein, serum procalcitonin, and platelet count. The receiver operating characteristic (ROC) curve was plotted to investigate the value of plasma HBP level in the diagnosis of severe infection (including severe sepsis and sepsis). The severe sepsis and sepsis groups had a significantly higher plasma HBP level on admission than the non-severe infection group (P<0.05). Compared with the sepsis and non-severe groups, the severe sepsis group had significantly higher serum levels of C-reactive protein and procalcitonin and a significantly lower platelet count (P<0.05). Plasma HBP level had an area under the ROC curve of 0.590 in determining severe infection, with a sensitivity of 38.0% and a specificity of 82.4% (P<0.05). There is an increase in plasma HBP level in children with severe infection, and plasma HBP level has a lower sensitivity but a higher specificity in the diagnosis of severe infection and can thus be used as one of the markers for the judgment of severe infection in children.

Diagnostic Value of Serum Heparin Binding Protein, Blood Lactic Acid Combined with hs-CRP in Sepsis and Its Relationship with Prognosis.

Objective To explore the diagnostic value of serum heparin binding protein (HBP), blood lactic acid (Lac) combined with high-sensitivity C- reactive protein (hs-CRP) in sepsis and its relationship with prognosis. Methods The clinical data of 127 patients with sepsis from March 2019 to March 2021 in our hospital were retrospectively analyzed. 120 outpatients undergoing physical examination in the same period in our hospital were selected as the control group. According to the severity of the disease, 127 sepsis patients were divided into the mild sepsis group (n = 45), severe sepsis group (n = 53), and septic shock group (n = 29). According to the clinical prognosis, the patients were divided into the survival group (n = 96) and death group (n = 31). Serum HBP, Lac, and hs-CRP levels were measured in all subjects. The ROC curves of the subjects were drawn to analyze the predictive value of serum HBP, Lac, and hs-CRP for the prognosis of sepsis patients. Results The levels of serum HBP, Lac, and hs-CRP in the sepsis group were higher than those in the control group (P < 0.05). With the increase of the severity of sepsis, serum HBP, Lac, and hs-CRP levels of patients gradually increased (P < 0.05). The levels of serum HBP, Lac, and hs-CRP in the death group were higher than those in the survival group (P < 0.05). The AUC of serum HBP, Lac, and hs-CRP for predicting the prognosis of sepsis patients was 0.858 (95% CI: 0.763–0.953), 0.694 (95% CI: 0.589–0.799), and 0.843 (95% CI: 0.759–0.927). The AUC of serum HBP, Lac combined with hs-CRP for predicting the prognosis of sepsis patients was 0.961 (95% CI: 0.000–1.000). Conclusion The levels of serum HBP, Lac, and hs-CRP in patients with sepsis were significantly increased and increased with the severity of sepsis. Serum HBP, Lac, and hs-CRP have a good value in predicting the prognosis of patients with sepsis and worthy of clinical application.

Clinical Value of C-Reactive Protein/Platelet Ratio in Neonatal Sepsis: A Cross-Sectional Study

PurposeC-reactive protein (CRP) level and platelet (PLT) count have been demonstrated to be independent risk factor for neonatal sepsis. However, no data is currently available in regarding the association between CRP-to-PLT ratio (CPR) and neonatal sepsis.MethodsA total of 1048 neonates with suspected sepsis were enrolled in this study. Complete clinical and laboratory data were collected. CPR was calculated as CRP (mg/L)/PLT (107 cells/L). Multivariate logistic regression analysis was performed to identify the potential independent risk factors of neonatal sepsis. Receiver operating characteristic (ROC) curve analysis was used to evaluate the prediction accuracy of CPR in predicting neonatal sepsis.ResultsNeonates with sepsis had a higher CPR. CPR also showed a gradual increase in the infection, mild sepsis and severe sepsis groups. Multivariate analysis revealed that CPR was a significant independent predictor of the presence of neonatal sepsis (odds ratio [OR], 1.015; 95% confidence interval [CI], 1.008–1.022, P < 0.001) and severe sepsis (OR, 1.002; 95% CI, 1.000–1.003, P = 0.007). ROC curve revealed showed that CPR had a well-discriminatory power in predicting sepsis (area under curve [AUC], 0.68; 95% CI, 0.65–0.72, P < 0.001) and severe sepsis (AUC, 0.68; 95% CI, 0.65–0.72, P < 0.001).ConclusionThe present study demonstrated that a higher CPR is an independent predictor of the presence and severity of neonatal sepsis.

Epidemiology of sepsis, based on ICD-9 coding, a tertiary care experience from Pakistan

IntroductionThere are limited studies on the burden of sepsis, from low to middle income countries (LMIC). We had carried out an analysis of the epidemiology of sepsis, in our hospital, a tertiary care university hospital in Pakistan, based on ICD-9 coding. MaterialsRetrospective data from electronic discharge records of all patients aged 17 or above, admitted with sepsis from January 2013–January 2014, at our hospital was taken. A validated method requiring a combination of two ICD-9 codes (international classification of diseases, ninth revision, clinical modification) representing infections and acute organ dysfunction, based on the Angus and Martin methodology, along with ICD-9 codes for sepsis, severe sepsis and septic shock, were used to abstract data. ResultsOverall, 8759 patients were identified to have sepsis or severe sepsis, out of total 31,111 admissions between 2013 and 14. Out of these cases, 61.25% (5365) had sepsis while 38.75% (3394) had severe sepsis or septic shock. Out of the total 8759 patients, 58.10% (5089) remained in the ward. 31.93% (2797) utilized the intermediate Care Unit while 9.97% (873) utilized the Intensive Care Unit (ICU). The overall mortality with sepsis, was found to be 9.8% and mortality from septic shock to be around 22.8%. The common comorbidities were diabetes (22.8%), renal disease (14.7%) and COPD (14.7%). The mean length of hospital stay was 3.7 days in mild disease, compared to 7.5 days, in severe sepsis and septic shock group. ConclusionsThe first ICD -9 coding-based study signifies a high burden of disease, along with high mortality from septic shock.