Treatment Of Sepsis In Patients Research Articles

Этиологическая структура и антибиотикорезистентность возбудителей сепсиса у больных COVID-19

The purpose — to study the etiological structure and antibiotic resistance of sepsis pathogens in patients with COVID-19. Material and methods. A retrospective observational, uncontrolled study was conducted. We analyzed the results of an examination survey of 584 patients with severe and extremely severe forms of COVID-19 hospitalized at the Republic Clinical Infectious Diseases Hospital in Kazan from April 1, 2020 to October 1, 2022. Identification of the pathogen in blood and other biological materials was carried out using a Microflex LT Bruker mass spectrometer. The antibiotic sensitivity of the isolated bacterial strains was determined by the disk diffusion method using an ADAGIO analyzer (France). Results. Various types of bacteria were isolated from the blood of 76 (13%) patients with severe and critical forms of COVID-19, including: A. baumannii (23.7%), K. pneumoniae (19.7%), S. haemolyticus (19.7%), S. aureus (7.9%), E. faecium (11.8%), E. faecalis (7.9%), E. coli (3.9%), R. planticola (2.6%), P. aeruginosa (2.6%), S. pneumoniae (2.6%), S. maltophilia (1.3%), and B. cereus (1.3%). In 15 patients (19.7%) associations of 2–3 types of bacteria were isolated from the blood. A. baumannii isolates were resistant to carbapenems (94.5%), fluoroquinolones and aminoglycosides (100%), and trimethoprim-sulfamethoxazole (83.3%) strains. K. рneumoniae strains were resistant to carbapenems (60%), cephalosporins (cefixime, ceftazidime) (73.3%), fluoroquinolones (ciprofloxacin) (80%), aminoglycosides (60%), and semisynthetic penicillins (100%). 33.3% of S. aureus strains were resistant to trimethoprim-sulfamethoxazole, 16.7% — to oxacillin, erythromycin and gentamicin. Resistance of S. haemolyticus to trimethoprim-sulfamethoxazole was detected in 86.7%, to erythromycin — in 80%, to norfloxacin — in 50% of strains. 93.3% of S. haemolyticus strains were methicillin-resistant. 88.9% of E. faecium strains were resistant to ampicillin, 22.2% to tigecycline, 11.1% to linezolid. 50% of E. faecalis strains were resistant to norfloxacin, 16.7% of strains were resistant to amoxicillin, ampicillin and piperacillin. P. aeruginosa 50% of strains were resistant to levofloxacin. R. planticola was resistant to all antibiotics tested. S. maltophilia demonstrated sensitivity to co-trimoxazole only with increased exposure. Conclusion. Bacterial sepsis was diagnosed in 13% of severe and extremely severe patients with COVID-19. The etiological structure of sepsis includes a wide range of pathogens with a predominance of multi-resistant bacteria from the group of ESKAPE pathogens. Data on the etiological structure and antibiotic resistance of isolated pathogens should be taken into account for the rational use of antimicrobial drugs in the treatment of sepsis in patients with COVID-19.

Nurses' and Physicians' Experiences After Implementation of a Quality Improvement Project to Improve Sepsis Awareness in Hospitals.

Previous research has explored nurses´ experience with the implementation of early detection alert systems, and nurses and physicians' perceptions of sepsis management and use of sepsis triage. As one of the first, this study aims to investigate the perceived usefulness of an interdisciplinary quality improvement project including standardized sepsis patient pathway to improve the early identification and treatment of sepsis patients. This study was a qualitative study that employed semi-structured interviews with thirteen ward nurses and five ward physicians recruited by convenience and respondent-driven sampling, respectively. The interviews explored the perceived usefulness of mutual training in sepsis care in medical hospital wards. We applied Systematic Text Condensation to analyze the experiences and knowledge of professional identification and cooperation in early identification of sepsis patients. The results revealed three main themes: Awareness of sepsis, collaboration between nurses and physicians, and clinical assessment and judgement. The findings highlighted the positive impact of the project in terms of raising awareness, improving communication, and enhancing the ability to detect and treat sepsis. The study also identified the importance of repetition and reminders to maintain awareness, the need for ongoing training for new healthcare professionals, and the challenges of collaboration and decision-making processes. The sepsis intervention seemed successful in improving awareness of sepsis and enhancing interprofessional collaboration between nurses and physicians. Health professionals continued to rely on their clinical judgment but increased the use of objective measurements and communication of vital signs. Continuous repetition and education for new colleagues were identified as important factors for the sustainability of the intervention. Overall, the study highlights the importance of standardized protocols and training for early detection and management of sepsis in healthcare settings.

Extensive systemic thrombo-embolism including intra-cardiac thrombosis mimicking an atrial myxoma in a patient with beta thalassaemia major – a case report

BackgroundSepsis and thrombo-embolic disease are well known complications of thalassemia major. Intracardiac thrombi are however rare and can lead to diagnostic dilemmas.Case presentationWe report the case of a 20-year-old female splenectomised thalassaemia major patient with severe iron overload, who presented with life threatening sepsis associated with a liver abscess. Discovery of a large oscillating intra cardiac lesion on 2D echocardiogram confirmed by Contrast Enhanced Computed Tomography (CECT) chest in the right atrium extending from the left hepatic vein through the inferior vena cava complicated the clinical course. After a prolonged Intensive Care Unit (ICU) stay supported with antibiotics and anticoagulation, she recovered with evidence of resolution of the intra cardiac thrombus.ConclusionsEarly recognition and prompt aggressive treatment of sepsis in patients with thalassemia is essential to prevent complications. Intracardiac thrombosis is a potentially treatable cause for an intra cardiac mass in patients with thalassemia major, which should not be missed.

An ultra-sensitive electrochemical biosensor for the detection of procalcitonin in sepsis patients’ serum, using a Cu-BHT-based thin film

Procalcitonin (PCT) is a polypeptide produced by the parafollicular cells of the thyroid gland and serves as a vital marker for the diagnosis and treatment of sepsis and other infectious diseases, as well as multiple organ failure, due to its high expression levels in affected patients. This article reports on a highly sensitive electrochemical biosensor based on MOF composite materials, based on Cu-BHT, for detecting PCT levels. The surface of the glassy carbon electrode may have better charge transfer resistance owing to the nano-composite material made of Cu-BHT, chitosan, and AuNPs. At the same time, the anti-PCT antibody may also be covalently bonded to the composite material and measure PCT concentration using electrochemical impedance spectroscopy (EIS). The results of the investigation demonstrate that the sensor's response has excellent linear conjunction with the logarithm of PCT concentration under optimum circumstances. The detection limit (LOD) is 14.579 × 10−9 μg/mL, and the linear range of detection is 10−7 μg/mL to 10−1 μg/mL. Simultaneously, we successfully applied this method to detect serum PCT before and after treatment in different sepsis patients and compared it with chemiluminescence immunoassay. The findings indicate that the proposed method holds promising potential for timely diagnosis and treatment of sepsis patients.

Histidine-inspired polyacrylonitrile-based adsorbent with excellent hemocompatibility for the simultaneous removal of bacteria and endotoxin in septic blood

Endotoxins (LPS) are components of the cell wall of Gram-negative bacteria that are released when bacterial cell membrane is destroyed, the bacteria and the released LPS have led to serious diseases such as sepsis and septic shock. Histidine functionalized adsorbents have been used to remove LPS, however, the present hemoperfusion adsorbents have drawbacks such as inadequate LPS adsorption capability, high cost of raw material, and so on. Inspired by the structure of histidine and incorporated antibacterial molecules, we synthesize allylamine-modified polyacrylonitrile (PAD)/poly (imidazolium bromide) (PMIBr) composite (PAI) microspheres as hemoperfusion adsorbents. The PAI microspheres show excellent antibacterial ability with high killing efficiency of 98.8% against S. aureus and 95.4% against E. coli. In addition, the adsorption capacity of the microspheres for LPS in PBS is 433.5 EU/g within 3 h, and the LPS concentration could also be reduced from 7.34 EU/mL to below 0.5 EU/mL in the plasma environment. The PAI microspheres exhibit outstanding blood compatibility, antibacterial property and endotoxin removal capability, which have great potential in the treatment of sepsis patients.

Association between different MAP levels and 30-day mortality in sepsis patients: a propensity-score-matched, retrospective cohort study

BackgroundSepsis is a life-threatening organ dysfunction caused by the infection-related host response disorder. Adequate mean arterial pressure is an important prerequisite of tissue and organ perfusion, which runs through the treatment of sepsis patients, and an appropriate mean arterial pressure titration in the early-stage correlates to the positive outcome of the treatment. Therefore, in the present study, we aimed to elucidate the relationship between early mean arterial pressure levels and short-term mortality in sepsis patients.MethodsWe included all suspected sepsis patients from MIMIC-III database with average mean arterial pressure ≥ 60 mmHg on the first day of intensive care unit stay. Those patients were then divided into a permissive low-mean arterial pressure group (60–65 mmHg) and a high-mean arterial pressure group (> 65 mmHg). Multivariate Cox regression analysis was conducted to analyze the relationship between MAP level and 30-day, 60-day, and 100-day mortality of suspected sepsis patients in the two groups. Propensity score matching, inverse probability of treatment weighing, standardized mortality ratio weighting, PA weighting, overlap weighting, and doubly robust analysis were used to verify our results.ResultsA total of 14,031 suspected sepsis patients were eligible for inclusion in our study, among which 1305 (9.3%) had an average first-day mean arterial pressure of 60–65 mmHg, and the remaining 12,726 patients had an average first-day mean arterial pressure of more than 65 mmHg. The risk of 30-day mortality was reduced in the high mean arterial pressure group compared with the permissive low-mean arterial pressure group (HR 0.67 (95% CI 0.60–0.75; p < 0.001)). The higher mean arterial pressure was also associated with lower 60-day and 100-day in-hospital mortality as well as with shorter duration of intensive care unit stay. Patients in the high-mean arterial pressure group also had more urine output on the first and second days of intensive care unit admission.ConclusionsAfter risk adjustment, the initial mean arterial pressure of above 65 mmHg was associated with reduced short-term mortality, shorter intensive care unit stay, and higher urine volume in the first two days among patients with sepsis.

Utility and impact of early diagnostic assessment of sepsis on mortality in an emergency department of a tertiary hospital in Lagos, Nigeria.

Currently, little is known about the timely application of clinical screening tools and blood sampling for decision-making in the management of patients with suspected sepsis in the accident and emergency units of hospitals in Nigeria. The aim of the study was to ascertain the association between the time taken for the conduct of serum lactate and blood culture investigations following a clinical suspicion of sepsis, and the mortality of patients admitted to a Nigerian tertiary hospital. Over a 6-month period (November 2021 to April 2022), 119 patients hospitalised for sepsis or septic shock at the Lagos University Teaching Hospital were followed until discharge or death. The proportion of patients whose serum lactate, serum procalcitonin and blood culture samples was taken was also determined. Predictors of mortality were determined using bivariate analysis and logistic regression. Kaplan-Meier plots were used to predict survival using sepsis diagnostic criteria. Eighty (67%) of 119 sepsis patients met systemic inflammatory response syndrome or quick sequential (sepsis-related) organ failure assessment criteria. Only 3 (2.5%) patients had blood cultures and serum procalcitonin and 0 (0%) had serum lactate tests. Forty-one (34.5%) patients died, but clinical and laboratory procedures for sepsis management were not linked to death. A shorter hospital stay increased the death risk (χ2 = 14.83, P = 0.002). This study revealed low compliance with sepsis care guidelines and no impact of timely clinical and laboratory procedures on sepsis mortalities. Further study is needed to explore patient care models that can improve the objective assessment and treatment of sepsis patients in emergency departments of busy tertiary hospitals.

Superhuman performance on sepsis MIMIC-III data by distributional reinforcement learning.

We present a novel setup for treating sepsis using distributional reinforcement learning (RL). Sepsis is a life-threatening medical emergency. Its treatment is considered to be a challenging high-stakes decision-making problem, which has to procedurally account for risk. Treating sepsis by machine learning algorithms is difficult due to a couple of reasons: There is limited and error-afflicted initial data in a highly complex biological system combined with the need to make robust, transparent and safe decisions. We demonstrate a suitable method that combines data imputation by a kNN model using a custom distance with state representation by discretization using clustering, and that enables superhuman decision-making using speedy Q-learning in the framework of distributional RL. Compared to clinicians, the recovery rate is increased by more than 3% on the test data set. Our results illustrate how risk-aware RL agents can play a decisive role in critical situations such as the treatment of sepsis patients, a situation acerbated due to the COVID-19 pandemic (Martineau 2020). In addition, we emphasize the tractability of the methodology and the learning behavior while addressing some criticisms of the previous work (Komorowski et al. 2018) on this topic.

A Retrospective Investigation: Outcome Comparisons Between Septic Patients With and Without Secondary Diagnosis of Hypothyroidism From a Rural Midwest Hospital.

BackgroundSepsis morbidity and mortality rates have remained high despite recent developments in clinical guidelines aimed to curtail this disease process. Understanding how sepsis interacts with comorbidities and pre-existing disease states is necessary for improving sepsis treatment. Accounting for specific pre-existing conditions in the treatment of sepsis patients may not only improve patient outcomes but also reduce healthcare costs by preventing possible complications. We sought to evaluate whether the presence of hypothyroidism affects outcomes in septic patients.MethodsIn this retrospective observational study, we analyzed the patient dataset from a not-for-profit rural hospital from January 2019 through June 2020. We chose the initial patient sample based on International Classification of Disease (ICD10) codes for sepsis. We then used the ICD10 code for hypothyroidism within that sample to identify the septic patients with hypothyroidism. We did two-sample proportion summary hypothesis tests to identify differences in mortality and 30-day readmission rates.ResultsIn our dataset, we had 1,122 patients with sepsis, of whom 225 had hypothyroidism. There was no difference in sepsis outcomes between patients who had hypothyroidism compared to patients who did not have hypothyroidism. Additionally, we did not find sufficient evidence to conclude that the patient’s sex affects sepsis outcomes in hypothyroid patients. Conclusion Within this Midwest population, the sepsis outcomes were not impacted by having hypothyroidism as a secondary diagnosis. Additionally, there was no sufficient evidence to suggest an impact on sepsis outcomes based on sex, either male or female, when considering concomitant hypothyroidism.

Infusion therapy for sepsis in patients with burns

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

Sepsis and Early Warning Score Systems

Sepsis is a significant cause of morbidity and mortality worldwide. Early diagnosis and management of sepsis is critical to improving patient prognoses. Surviving sepsis campaign guidelines issued in 2016 encourage health institutions to establish a screening system to identify patients who are at risk of sepsis. In 2012, the Royal College of Physicians in the UK began to advocate replacing local and regional scoring systems with the National Early Warning Score (NEWS), which is optimized for the identification of sepsis. Although many hospitals continue to use other scoring systems, all healthcare organizations are being encouraged to adopt a standardized scoring system to better promote patient safety by facilitating rapid diagnoses and screenings and thus, subsequently, improving decision-making by clinical staffs. NEWS plays a very important role in the treatment of sepsis patients. Although research findings related to this scoring system differ somewhat, they provide an important reference for clinical nursing staffs. Intelligent systems are not comprehensive in terms of their capabilities. However, combining human intelligence with system features and further optimizing the system should contribute significantly to the reduction of mortality risk in patients with sepsis.

Microbiological spectrum of nosocomial infection in patients with infectious spondylitis after sepsis

In 2015—2017, a cohort study of 72 cases of infectious spondylitis (is) with severe sepsis was conducted, which amounted, to 5,8% of all operated, patients. The study showed, that Gram. (+) bacteria -52 (55,9%) prevailed, in crops from all media. Gram. (-) bacteria were detected, in 1\3 cases 37(39.8%), and Candida infection in 4 (4,3%). The main traced, sources of NI in patients with is where bedsores (13\18,1%), infection with surgical intervention, fistula (14\19,4), uroinfection (22\30,6%), subclavian catheters (7\55.5%). Gram. (+) bacteria was 26,8% (15 cases) and was mainly found, in wounds and. catheters. Gram. (-) bacteria more prevalent in ulcers in the urine culture (56,4 per cent). In 10 cases (17,8%) the crops were sterile. An increase in the role of S. epidermitis and. K. pneumoniae in the etiology of sepsis was found, in bacteriological typing of media. High resistance of nosocomial strains of Staphylococcus spp is noted. Gram. (-) bacteria to fluoroquin.alon.es and. cephalosporins 3—4 generations, which excludes the possibility of their empirical use in the treatment of severe sepsis in patients with is.

752. Timing of Antibiotics Administration in Emergency Department and Mortality in Sepsis by Sepsis-3 Definition

BackgroundEven after the introduction of the Sepsis-3 definition, there is still debate on the ideal antibiotic administration time in patients with sepsis. This study was performed to evaluate the association between the timing of antibiotic administration and mortality in sepsis patients who visited the emergency room.MethodsA prospective cohort study was conducted on patients who were diagnosed as sepsis with Sepsis-3 definition among patients who visited the emergency department (ED) of Korea University Ansan Hospital from September 2017 to January 2019. The timing of antibiotic administration was defined as the time in hours from ED arrival until the first antibiotic administration. Cox logistic regression analysis was used to estimate the association between time to antibiotics and 7-, 14-, and 28-day mortality.ResultsDuring the study period, a total of 251 patients were enrolled with a 7-, 14-, and 28-day mortality of 16.7%, 36.3%, and 57.4%, respectively. The median time to antibiotic administration was 247 minutes (interquartile range 72 – 202 minutes). The mean age was 72 ± 15 years old and 122 patients (48.6%) were female. The most common site of infection was respiratory infection. The timing of antibiotic administration were not associated with 7-, 14-, and 28-day mortality. Female (adjusted hazard ratio [HR] 2.06 [95% confidence interval (CI) 1.21 – 3.53]; P value = 0.008), SOFA score (aHR 1.17 [95% CI 1.05 - 1.31]; P = 0.005), and initial lactate level (aHR 1.13 [95% CI 1.05 - 1.22]; P = 0.001) increased the risk of 7-day mortality. Female (aHR 2.07 [95% CI 1.48 – 2.89]; P ≤ 0.001), Charlson comorbidity index (aHR 1.12 [95% CI 1.02 - 1.24]; P = 0.025), and initial lactate level (aHR 1.19 [95% CI 1.02 - 1.16]; P = 0.011) increased the risk of 14-day mortality. Female (aHR 1.95 [95% CI 1.50 – 2.54]; P = 0.001) increased the risk of 28-day mortality in patients with sepsis.ConclusionThe timing of antibiotic administration did not increase the risk of mortality in the treatment of sepsis patients who visited ED. Rather, the SOFA score, lactate, female, and comorbidity increased the mortality associated with sepsis. Disclosures All authors: No reported disclosures.

Worldwide scientific productions with immunotherapy of sepsis: a bibliometric analysis.

BackgroundSepsis represents a significant healthcare problem worldwide and causes a high number of deaths every year but remains to be fully understood. During and after sepsis, the host immune response is complex and involves an initial excessive host inflammatory response to infection that is closely related to tissue damage and leads to organ failure. Over the past three decades, immunotherapy for sepsis has vastly improved, but in this area, the most influential articles, journals, authors, and countries have not yet been completely summarized and analyzed.ObjectivePerformed a bibliometric analysis on all the articles concerning immunotherapy for sepsis from 1962 to 2019 was our objective, and we also explored the potential correlations between publications of different countries and their gross domestic product (GDP).MethodsAll articles about immunotherapy for sepsis were extracted from the Scopus database and analyzed. We also retrieved GDP data from all the countries that have published information from the World Bank.ResultsIn summary, we have retrieved 1,483 related articles from the Scopus database starting from the first publication on immunotherapy for sepsis in 1962 through March 16, 2019. Over the past decade, the number of the articles published has increased year by year to reach 866 in total, which accounts for about 58% of all publications, with 2017 being the most prolific year when 179 articles were published. The US published 604 articles (41%), followed by China (n = 163, 11%), and Germany (n = 158, 11%). In terms of publishing media, the journal that published the highest number of the articles was Journal of Critical Care Medicine with 65 articles (4%), followed by Shock with 55 articles (4%), and Critical Care with 35 articles (2%). There was a strong correlation between the GDP of the different countries and their publication numbers (r = 0.811, P < 0.001).ConclusionsOur present study analyzed all types of articles concerning immunotherapy for sepsis over the past 57 years and countries with high GDP tends to make more contributions to the medical field of this field. In the meantime, these studies highlight the importance of immunotherapy in the treatment of sepsis patients. The recognition of the historical status and development trend of this field can promote inter-agency cooperation, guide future research, and ultimately provide the basis for clinical practice guidelines.

Safety and efficacy of heparin free anticoagulant continuous blood purification in treatment of sepsis patients in intensive care unit

Objective To investigate the safety and efficacy of heparin free anticoagulant continuous blood purification (CBP) in the treatment of intensive care unit (ICU) sepsis. Methods From October 2015 to October 2017, a total of 80 patients with sepsis treated in ICU with CBP in No.307 Hospital of PLA were included in this study using the random number table. Patients were divided into study group (n=40) and control group (n=40) according to the anticoagulant methods, of which the study group received heparin free anticoagulation, while the control group was given low molecular-weight heparin anticoagulation. The clinical outcome, renal function index and coagulation function were analyzed retrospectively. Paired t test was used to compare acute physiology and chronic health evaluation (APACHE) Ⅲ scores predicted mortality, urea nitrogen level, serum creatinine level, platelet count, prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT) between two groups before and after treatment. χ2 test was used in analyzing survival rates in 28 d between two groups after treatment. The procedure of this study is in accordance with the requirements of the revised World Medical Association Declaration of Helsinki in 2013. Informed consent was obtained from all participants. Results ① Before treatment, APACHE Ⅲ scores predicted mortality was (89.6±14.8)% in study group, and was (90.1±13.8)%in control group, and there was no significant difference between two groups (P>0.05). After treatment, 28 d survival rate was 40.0% in study group, and was 47.5% in control group, and there was no significant difference between two groups (P>0.05). ② After treatment, urea nitrogen level was (12.8±1.7) mmol/L, blood creatinine level was (162.5±21.7) μmol/L in study group, and all were significantly lower than those before treatment, which were (22.7±3.8) mmol/L and (276.4±35.8) μmol/L, and the differences were statistically significant (t=8.827, 9.102; P=0.002, 0.000). After treatment, urea nitrogen level was (10.7±2.9) mmol/L, and serum creatinine level was (142.4±37.0) μmol/L in the control group, and all were lower than those before treatment, which were (26.1±3.1) mmol/L, (322.3±38.9)μmol/L respectively, and the differences were statistically significant (t=8.182, 8.992; P=0.006, 0.000). And levels of urea nitrogen and blood creatinine in the 2 groups after treatment were not statistically different (P>0.05). ③ After treatment, platelet count was (67.9±18.7) ×109/L, PT was (19.6±6.7) s, APTT was (28.7±6.1) s and TT was (3.0±1.1) s in study group, and all were significantly lower than those before treatment, which were (117.5±26.8) ×109/L, (28.6±7.9) s, (61.9±15.7) s and (24.2±6.9) s respectively, and the differences were statistically significant (t=7.233, 7.527, 6.232, 7.426; P=0.012, 0.011, 0.037, 0.007). Platelets count was (72.7±16.9) ×109/L, PT was (18.6±6.8) s, APTT was (31.9±7.1) s, and TT was (3.0±1.1) s in the control group, and all were significantly lower than these before the treatment, which were (109.7±25.7) ×109/L, (25.8±6.9) s, (56.7±14.9) s, (24.3±6.9) s respectively, and the differences were statistically significant (t=9.125, 6.728, 6.426, 7.529; P=0.000, 0.029, 0.031, 0.006). Platelet count, PT, APTT and TT levels in the 2 groups after treatment were not statistically different (P>0.05). Conclusions Heparin free and low molecular-weight heparin CBP therapy both can improve the clinical symptoms and renal function index of patients with sepsis in ICU. Heparin free anticoagulation CBP could not lead to abnormal coagulation function and increase platelet consumption, and could improve safety. Key words: Anticoagulant; Heparin, low-molecular-weight; Sepsis; Heparin free anticoagulant; Continuous blood purification

Evaluation of thrombomodulin and pentraxin-3 as diagnostic biomarkers in calves with sepsis

Early diagnosis and treatment of sepsis in patients are crucial for their survival and can help reduce mortality rates. Novel biomarkers, such as thrombomodulin and pentraxin-3, have been used as diagnostic, prognostic and mortality indicators in patients with sepsis. Plasma thrombomodulin is a vascular endothelial membrane-bound glycoprotein and pentraxin-3 is an acute-phase protein. In the present study, thrombomodulin and pentraxin-3 levels were determined in calves with sepsis, to determine their diagnostic values as well as usefulness as indicators of health status. To this end, 20 neonatal calves with sepsis (G1) and ten healthy neonatal calves (G2) were used. Additionally, group G1 was also divided into two groups consisting of surviving (G1-S; n = 9) and non-surviving calves (G1-NS; n = 11). A single blood sample was collected from all the calves and the prepared serum samples were used to measure thrombomodulin and pentraxin-3 levels using bovine-specific ELISA kits. The serum concentrations of thrombomodulin and pentraxin-3 were found to be significantly higher (P &amp;lt; 0.01) in the G1 group than in G2. Thrombomodulin and pentraxin-3 levels were also found to be higher in the G1-NS group than in G1-S but the difference was not significant. We conclude that thrombomodulin and pentraxin-3 may have some diagnostic value in calves with sepsis. Furthermore, these findings may also help in understanding the pathogenesis of sepsis in neonatal calves. Further studies are required to determine the importance of thrombomodulin and pentraxin-3 as diagnostic and prognostic biomarkers in calves with sepsis and to evaluate the concentrations of these biomarkers also in other disease states.

Nursing care of early goal-directed therapy in the treatment of sepsis patients

目的 探讨护理干预应用在脓毒症早期目标导向治疗中的应用效果及临床价值。 方法 将脓毒症患者102例采用随机数字表法分为观察组和对照组，每组51例，对照组给予早期目标导向治疗，观察组配合综合护理干预措施，对比两组治疗效果。 结果 观察组干预后急性生理学和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分为(14.06±2.06)分，序贯性器官功能衰竭(SOFA)评分为(7.43±0.42)分；对照组干预后APACHEⅡ评分为(18.45±4.66)分，SOFA评分为(8.87±1.06)分，两组差异均有统计学意义(t＝6.153、9.019，均P<0.05)。观察组干预后中心静脉压(CVP)为(15.66±1.24)mmHg，中心静脉血氧饱和度(ScvO2)为(78.59±9.49)%；对照组干预后CVP为(9.48±0.84)mmHg，ScvO2为(65.69±7.25)%，两组差异均有统计学意义(t＝29.467、7.714，均P<0.05)。观察组发生人工气道非计划拔管3例，胃管非计划拔管4例，呼吸机相关性肺炎2例，特殊医嘱延时执行1例；对照组发生人工气道非计划拔管13例，胃管非计划拔管15例，呼吸机相关性肺炎10例，特殊医嘱延时执行7例，两组差异均有统计学意义(χ2＝7.412、7.826、6.044、4.883，均P<0.05)。 结论 护理干预应用在脓毒症早期目标导向治疗中可以有效改善患者生命体征指标，提升护理质量，值得在临床上推广应用。

529 - Effect of Modified Early Warning Score on Identification and Treatment of Sepsis in Patients Admitted to Huntsman Cancer Hospital's BMT/HEME Unit

529 - Effect of Modified Early Warning Score on Identification and Treatment of Sepsis in Patients Admitted to Huntsman Cancer Hospital's BMT/HEME Unit

Early Characteristics of Circulation in Patients with Poor Outcome of Abdominal Sepsis (Preliminary Report)

Aim: to study characteristics of the central hemodynamics (CHD) in patients with severe abdominal sepsis with different outcomes of the disease. Materials and Methods. 18 patients with abdominal sepsis, aged 50.2±3, with the APACHE II and SOFA severity scoring of 13.7±0.8 and 8.4±0.5, respectively, were enrolled in the retrospective study. The CHD was studied using the transpulmonary thermodilution. The following groups were identified: Group 1 (deceased, n=9) and Group 2 (survivors, n=9). The groups did not differ (P>0.05) in age, sex, and the severity of the condition at admission to the ICU. The significance of differences was assessed using the t-test and the chi-squared test. The prognostic value of the parameters was studied using the ROC analysis. Results. On Day 1, the intergroup differences included the average blood pressure (BPav) (85.3±3.3 and 101.6±4.6 mmHg, respectively (P 7 (sensitivity: 88.9%, specificity: 88.9%) was the most important predictor of the lethal outcome (areas under ROC curves: 0.957—0.994; P<0.05). Conclusion: during the first five days of the intensive treatment of severe sepsis in patients with unfavorable prognosis, a moderate decrease in the cardiac power index and overall cardiac systolic function was registered. The prognostic significance of such parameters as CPI and GEF may become obvious within the first 3 days of the intensive treatment.

COUPLED PLASMAFILTRATION AND ADSORPTION IN SEPTIC COMPLICATIONS IN RENAL TRANSPLANT RECIPIENTS

In the article fi rst experience with the usage of coupled plasma fi ltration and adsorption in the treatment of sepsis in patients after kidney transplantation has been presented. Aim: to make a comparative assessment of the impact of hemo fi ltration and coupled plasma fi ltration and adsorption (CPFA) on systemic hemodynamics and alveolar-capillary diffusion, as well as the dynamics of the pro- and antiin fl ammatory cytokines in patients with sepsis after renal transplantation. Methods and results. The study included 24 recipients. In the main group (n = 14), we used a combination of CPFA and hemo fi ltration. The patients of the comparison group (n = 10) we used an isolated hemo fi ltration. In patients of both groups we observed improvement of hemodynamics and lung function. In doing so by the fi fth day after the second procedure in patients of the main group the results were signi fi cantly better. This effect we mainly associate with a reduction in the activity of the systemic in fl ammatory response and the rate of progression of sepsis. This is con fi rmed by the fact that circulating pro- and anti-in fl ammatory cytokines were expressly removed during the CPFA. Conclusion. As a result of the CPFA and the hemo fi ltration we observed an increase in mean arterial blood pres- sure, improving gas exchange in the lungs, as well as reducing the need for vasopressor support. In this case, the additional sorption removal of circulating in fl ammatory mediators reduces the activity of the systemic in fl am- matory response, which can signi fi cantly increase the effectiveness of the therapy.