Infection site is predictive of outcome in acute lung injury associated with severe sepsis and septic shock

Fujishima, Seitaro; Gando, Satoshi; Saitoh, Daizoh; Kushimoto, Shigeki; Ogura, Hiroshi; Mayumi, Toshihiko; Takuma, Kiyotsugu; Kotani, Joji; Yamashita, Norio; Tsuruta, Ryosuke; Takeyama, Naoshi; Shiraishi, Shin‐ichiro; Araki, Tsunetoshi; Suzuki, Koichiro; Ikeda, Hiroto; Miki, Yasuo; Suzuki, Yasushi; Yamaguchi, Yoshihiro; Aikawa, Naoki

doi:10.1111/resp.12769

Cited by 41 publications

(32 citation statements)

References 26 publications

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“…So in order to maximize therapeutic effect of antibiotics and minimize its adverse effects, dynamic monitoring of individual pharmacokinetic change of specific antibiotic is needed when accessing effect of certain kind of renal replacement therapy on sepsis. As for infection site, one study shows abdominal infection site is the independent protective factor of in-hospital mortality of sepsis associated acute lung injury, which is consistent with our results (29). To verify the exact mechanism needs further experimental studies.…”

Section: Discussionsupporting

confidence: 88%

Early hemoglobin status is predictive of outcomes and long-term mortality of sepsis

Peng

2020

Preprint

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Background: Hemoglobin change plays a critical role in progress of sepsis. However, the contribution of hemoglobin change to outcomes of patients with sepsis is still unknown. The aim of our study is to investigate the effect of early hemoglobin level within 48h after admission to Intensive Care Unit (ICU) on long term prognosis for sepsis. Methods: In this single centered, cohort study, we included patients from different ICU departments of Xiangya hospital from 2016 to 2018. Out of 1800 ICU patients, 199 patients with sepsis matched inclusion criteria. All 199 patients were divided into three groups according to 70, 80, and 90 g/L hemoglobin statuses, respectively. Results: Our study showed seventy-nine patients (39.7%) with ≤90g/L hemoglobin, forty-seven patients (23.6%) with hemoglobin ≤80g/L, and twenty-five (12.6%) with hemoglobin ≤70g/L at 48h after admission. Compared to survival group, there were higher rates of patients with hemoglobin ≤80g/L (33.7% vs. 15.1%, P=0.003), hemoglobin ≤70g/L (18.5% vs. 7.5%, P=0.031) in non-survival group, but similar rate of hemoglobin ≤90g/L patients (46.7% vs. 34.0%, P=0.081). Kaplan-Meier survival analysis showed that significant difference occurred among all three groups with total one-year survival rates. Furthermore, multivariate cox proportional hazards regression analysis showed that serum hemoglobin concentration ≤ 80g/L at 48h admission (Hazard Ratio HR 1.736, 95% CI 1.131-2.665, P=0.012), the occurrence of ARDS (HR 1.814, 95% CI 1.184-2.778, P=0.006), the use of CRRT (HR 1.569, 95% CI 1.030-2.390, P=0.036), and septic shock (HR 1.776, 95% CI 1.124-2.804, P=0.014) were independent risk predictors for one-year mortality in septic patients. Whereas the infection site from abdomen (HR 0.281, 95% CI 0.113-0.697, P=0.006) was the only independent protective factor for mortality in septic patients. Conclusion: ≤80 g/L hemoglobin within 48h after admission to ICU was the independent risk factor for mortality for patients with sepsis. Attention should be raised up to target early hemoglobin level in course of sepsis to achieve better outcomes of sepsis. Future larger researches and randomized controlled trials are needed to validate our results.

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Section: Discussionsupporting

confidence: 88%

Early hemoglobin status is predictive of outcomes and long-term mortality of sepsis

Peng

2020

Preprint

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“…Site of infection also appeared to be a risk modifier for ARDS in non-pulmonary sepsis. One study showed that abdominal infection was related to with ARDS [23], and another study showed that soft tissue infection was related to without ARDS in population that included pulmonary infection [13,32]. The correlation with indirect ARDS in most previous studies may have been attenuated because pulmonary infection is a major predisposing condition and few studies focused on non-pulmonary infection [2,14,15].…”

Section: Discussionmentioning

confidence: 99%

Risk modifiers of acute respiratory distress syndrome in patients with non-pulmonary sepsis: a retrospective analysis of the FORECAST study

et al. 2020

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Background: Predisposing conditions and risk modifiers instead of causes and risk factors have recently been used as alternatives to identify patients at a risk of acute respiratory distress syndrome (ARDS). However, data regarding risk modifiers among patients with non-pulmonary sepsis is rare. Methods: We conducted a secondary analysis of the multicenter, prospective, Focused Outcomes Research in Emergency Care in Acute Respiratory Distress Syndrome, Sepsis and Trauma (FORECAST) cohort study that was conducted in 59 intensive care units (ICUs) in Japan during January 2016-March 2017. Adult patients with severe sepsis caused by non-pulmonary infection were included, and the primary outcome was having ARDS, defined as meeting the Berlin definition on the first or fourth day of screening. Multivariate logistic regression modeling was used to identify risk modifiers associated with ARDS, and odds ratios (ORs) and their 95% confidence intervals were reported. The following explanatory variables were then assessed: age, sex, admission source, body mass index, smoking status, congestive heart failure, chronic obstructive pulmonary disease, diabetes mellitus, steroid use, statin use, infection site, septic shock, and acute physiology and chronic health evaluation (APACHE) II score. Results: After applying inclusion and exclusion criteria, 594 patients with non-pulmonary sepsis were enrolled, among whom 85 (14.3%) had ARDS. Septic shock was diagnosed in 80% of patients with ARDS and 66% of those without ARDS (p = 0.01). APACHE II scores were higher in patients with ] than in those without , p < 0.01]. In the multivariate logistic regression model, the following were independently associated with ARDS:

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“…Acute lung injury (ALI) is one of the complications of sepsis known for its contribution to sudden deaths and morbidity (Fujishima et al 2016). Although there are many ongoing clinical trials for developing new treatment strategies of ALI, limited achievements have been made in increasing the effectiveness of existing treatment methods of ALI after attack of ALI (Miyashita et al 2016, Zhu et al 2016.…”

Section: Introductionmentioning

confidence: 99%

Elevated Plasma Levels of Gas6 Are Associated with Acute Lung Injury in Patients with Severe Sepsis

Yeh

Huang

Hsieh

et al. 2017

Tohoku J. Exp. Med.

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Acute lung injury (ALI) is one of the complications of severe sepsis, causing sudden deaths. However, information regarding predictive factors for the onset of ALI in severe sepsis is limited. Growth arrestspecific gene 6 (Gas6) is secreted by endothelial cells and is important for the activation of endothelium during inflammation. This study aimed to investigate the predictive effect of plasma Gas6 in patients with severe sepsis. Collection of plasma samples was carried out from 129 participants with severe sepsis following with or without ALI development. We found that the elevated levels of Gas6, interleukin-6 and -8 (IL-6 and IL-8) in plasma were associated with the ALI development (P = 0.003, 0.002, and 0.004, respectively). We also observed the robust correlation between the plasma level of Gas6 and the following ALI development to adjustment for sepsis and administration of vasopressor. Between patients with ALI (n = 18) and those without ALI (n = 111), Gas6 and the Lung Injury Prediction Score (LIPS) showed promising discrimination (AUROC, 0.74 and 0.68, respectively), and in combination with these two indexes, the AUROC was increased to 0.86 (vs. 0.74, P = 0.05), while soluble receptor for advanced glycation end products (sRAGE) and Willebrand factor (vWF) in plasma showed no predictive value for of ALI. Collectively, our findings indicate that higher levels of Gas6 in plasma are obviously correlated with ALI development. An early increase in the plasma Gas6 level suggests that endothelial injury is a key link in the pathogenesis of ALI.

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Infection site is predictive of outcome in acute lung injury associated with severe sepsis and septic shock

Cited by 41 publications

References 26 publications

Early hemoglobin status is predictive of outcomes and long-term mortality of sepsis

Early hemoglobin status is predictive of outcomes and long-term mortality of sepsis

Risk modifiers of acute respiratory distress syndrome in patients with non-pulmonary sepsis: a retrospective analysis of the FORECAST study

Elevated Plasma Levels of Gas6 Are Associated with Acute Lung Injury in Patients with Severe Sepsis

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