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Background Hospital- and community-onset sepsis are significant sepsis subgroups. Japanese data comparing these subgroups are limited. This study aimed to describe the epidemiology of hospital- and community-onset sepsis in critical care units in Japan. Methods We performed a retrospective cohort study using the Japanese Diagnosis and Procedure Combination database. Adult patients admitted to critical care units with sepsis from April 2010 to March 2020 were included. Sepsis cases were identified based on ICD-10 codes for infectious diseases, procedure codes for blood culture tests, and medication codes for antimicrobials. Patients’ characteristics, in-hospital mortality, and resource utilization were assessed. The in-hospital mortality between groups was compared using the Poisson regression generalized linear mixed-effect model. Results Of 516,124 patients, 52,183 (10.1%) had hospital-onset sepsis and 463,940 (89.9%) had community-onset sepsis. Hospital-onset sepsis was characterized by younger age, infrequent emergency hospitalization, frequent surgery under general anesthesia, and frequent organ support upon critical care unit admission compared to community-onset sepsis. In-hospital mortality was higher for hospital-onset than for community-onset sepsis (35.5% versus 19.2%; unadjusted mean difference, 16.3% [95% confidence interval (CI) 15.9–16.7]; adjusted mean difference, 15.6% [95% CI 14.9–16.2]). Mean hospital length of stay was longer for hospital-onset than for community-onset sepsis (47 days versus 30 days; unadjusted mean difference, 17 days [95% CI 16–17]; adjusted mean difference, 13 days [95% CI 12–14]). Conclusion Patients with hospital-onset sepsis admitted to critical care units in Japan had a poorer prognosis and more resource utilization including organ support rate, number of days with critical care unit surcharge codes, and hospital length of stay than those with community-onset sepsis.

Background: Polymethyl methacrylate (PMMA) membranes have the unique property of adsorption, which can remove medium-and large-weight molecular substances that cannot be removed by normal hemodialysis and hemodiafiltration. Filtryzer® NF (NF) is a newly developed PMMA membrane that suppresses platelet adhesion on the membrane surface and retains an adsorption property. NF is expected to improve inflammatory conditions and clinical symptoms in hemodialysis patients compared with conventional PMMA membranes.Methods: Thirty-seven maintenance hemodialysis patients treated with polysulfone (PS) membranes and who had detectable chronic inflammation were enrolled into the study. The patients were randomly allocated into the NF and PS groups and observed for 1 year. C-reactive protein (CRP) values were measured as the primary endpoint. Nutrition, blood cell count, and dialysis itchiness were evaluated as secondary endpoints.Results: Significant differences in CRP values were not found between the NF and PS groups. In the PS group, the creatinine generation rate (%CGR) and platelet count, which were included in nutrition and blood cell count, respectively, significantly decreased after 6 and 9 months compared with the start of study, but these parameters did not significantly change in the NF group within 1 year. Dialysis itchiness in the NF group was significantly improved compared with the PS group after 9 months.Conclusions: Our results showed that a new PMMA membrane, NF, has a potential to maintain nutritional conditions and the platelet counts and improve dialysis itchiness.Trial registration: This study is retrospectively registered with the Clinical Trials Registry of the University Hospital Medical Information Network on February 17, 2015 (registration ID, UMIN000016567).

Procalcitonin is a biomarker of systemic inflammation and may have importance in the immune response. The metabolic response to elevated procalcitonin in critical illness is not known. The response to inflammation is vitally important to understanding metabolism alterations during extreme stress. Our aim was to determine if patients with elevated procalcitonin have differences in the metabolomic response to early critical illness. We performed a metabolomics study of the VITdAL-ICU trial where subjects received high dose vitamin D3 or placebo. Mixed-effects modeling was used to study changes in metabolites over time relative to procalcitonin levels adjusted for age, Simplified Acute Physiology Score II, admission diagnosis, day 0 25-hydroxyvitamin D level, and the 25-hydroxyvitamin D response to intervention. With elevated procalcitonin, multiple members of the short and medium chain acylcarnitine, dicarboxylate fatty acid, branched-chain amino acid, and pentose phosphate pathway metabolite classes had significantly positive false discovery rate corrected associations. Further, multiple long chain acylcarnitines and lysophosphatidylcholines had significantly negative false discovery rate corrected associations with elevated procalcitonin. Gaussian graphical model analysis revealed functional modules specific to elevated procalcitonin. Our findings show that metabolite differences exist with increased procalcitonin indicating activation of branched chain amino acid dehydrogenase and a metabolic shift.