Clinical predictors of early death from sepsis

Javed, Adnan; Guirgis, Faheem W.; Sterling, Sarah A.; Puskarich, Michael A.; Bowman, Jennifer; Robinson, Taylor; Jones, Alan E.

doi:10.1016/j.jcrc.2017.06.024

Cited by 31 publications

(34 citation statements)

References 24 publications

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“…1 It is important to note that, irrespective of ARDS diagnosis, we excluded patients from our study who died during the first 24h after hospital admission because their severe symptoms may have skewed the results. 24 This study had several limitations. Firstly, this was a single centre study with a small sample size which may have led to unintentional selection bias and poor statistical power.…”

Section: Discussionmentioning

confidence: 93%

Prevalence, potential risk factors and mortality rates of acute respiratory distress syndrome in Chinese patients with sepsis

Zhao

Cui

et al. 2020

J Int Med Res

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Objective: To investigate the prevalence, risk factors and mortality rate for acute respiratory distress syndrome (ARDS) in Chinese patients with sepsis. Methods: This prospective study was based on data from consecutive patients with sepsis who attended Cangzhou Central Hospital between January 2017 and May 2019 and who developed ARDS. Multivariate logistic regression was used to identify risk factors associated independently with ARDS development. Results: Of the 150 sepsis patients, 41 (27%) developed ARDS. Smoking history, presence of chronic obstructive pulmonary disease (COPD), the C-reactive protein (CRP) levels and the Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were associated with developing ARDS. Moreover, combination of the four factors had an even better predictive value for risk of ARDS than each factor alone. 28-day mortality was higher in sepsis patients with ARDS compared with those without ARDS. Conclusions: In Chinese patients with sepsis, ARDS is relatively common and is associated with increased mortality. Smoking, COPD, CRP levels and APACHE II scores may be useful in predicting sepsis patients who may be at risk of developing ARDS.

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Section: Discussionmentioning

confidence: 93%

Prevalence, potential risk factors and mortality rates of acute respiratory distress syndrome in Chinese patients with sepsis

Zhao

Cui

et al. 2020

J Int Med Res

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“…During lung infection, glycolysis results in the production of pyruvate, which is converted by lactate dehydrogenase to lactate under anaerobic conditions [ 32 ]. Serum lactate levels have been use for many years in the assessment of tissue hypoxia and perfusion status, and are often used clinically as an indicator of the severity of sepsis and of patient outcomes in sepsis/septic shock [ 33 – 35 ]. A previous study showed that a lactate level in arterial blood gas of > 1.8 mmol/L at admission could predict a need for mechanical ventilation, vasopressors, ICU admission or hospital mortality in patients with CAP [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

Metabolic profiles in community-acquired pneumonia: developing assessment tools for disease severity

Zheng

Luo

et al. 2018

Crit Care

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BackgroundThis study aimed to determine whether community-acquired pneumonia (CAP) had a metabolic profile and whether this profile can be used for disease severity assessment.MethodsA total of 175 individuals including 119 CAP patients and 56 controls were enrolled and divided into two cohorts. Serum samples from a discovery cohort (n = 102, including 38 non-severe CAP, 30 severe CAP, and 34 age and sex-matched controls) were determined by untargeted ultra-high-performance liquid chromatography with tandem mass spectrometry (LC-MS/MS)-based metabolomics. Selected differential metabolites between CAP patients versus controls, and between the severe CAP group versus non-severe CAP group, were confirmed by targeted mass spectrometry assays in a validation cohort (n = 73, including 32 non-severe CAP, 19 severe CAP and 22 controls). Pearson’s correlation analysis was performed to assess relationships between the identified metabolites and clinical severity of CAP. The area under the curve (AUC), sensitivity and specificity of the metabolites for predicting the severity of CAP were also investigated.ResultsThe metabolic signature was markedly different between CAP patients and controls. Fifteen metabolites were found to be significantly dysregulated in CAP patients, which were mainly mapped to the metabolic pathways of sphingolipid, arginine, pyruvate and inositol phosphate. The alternation trends of five metabolites among the three groups including sphinganine, p-Cresol sulfate, dehydroepiandrosterone sulfate (DHEA-S), lactate and l-arginine in the validation cohort were consistent with those in the discovery cohort. Significantly lower concentrations of sphinganine, p-Cresol sulfate and DHEA-S were observed in CAP patients than in controls (p < 0.05). Serum lactate and sphinganine levels were positively correlated with confusion, urea level, respiratory rate, blood pressure, and age > 65 years (CURB-65), pneumonia severity index (PSI) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, while DHEA-S inversely correlated with the three scoring systems. Combining lactate, sphinganine and DHEA-S as a metabolite panel for discriminating severe CAP from non-severe CAP exhibited a better AUC of 0.911 (95% confidence interval 0.825–0.998) than CURB-65, PSI and APACHE II scores.ConclusionsThis study demonstrates that serum metabolomics approaches based on the LC-MS/MS platform can be applied as a tool to reveal metabolic changes during CAP and establish a metabolite signature related to disease severity.Trial registrationClinicalTrials.gov, NCT03093220. Registered retrospectively on 28 March 2017.Electronic supplementary materialThe online version of this article (10.1186/s13054-018-2049-2) contains supplementary material, which is available to authorized users.

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“…However, these studies investigated medium-(3 months) or long-term mortality. Javed et al identified initial serum lactate and modified SOFA score as independent predictors of early (within 24 h) death occurring in almost 5% of patients with severe sepsis in the emergency department [16]. Daviaud et al investigated in a comparable cohort of 543 septic shock patients and found that 32% of all ICU deaths occurred in an early stage, namely within three days after ICU admission [8].…”

Section: Discussionmentioning

confidence: 99%

Early ICU-mortality in sepsis – causes, influencing factors and variability in clinical judgement: a retrospective cohort study

Driessen

Heijnen

Hulsewe

et al. 2020

Infectious Diseases

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Background: Sepsis is a global health care problem with a high mortality. Early death seems common; however, data are sparse. The objective of the present study was to report causes and influencing factors of early death in sepsis and septic shock. Methods: All septic ICU patients were included from 2012 to 2017. Early death was predefined as occurring within 48 h. Causes and factors leading up to death were reported by a panel of four intensivists, independently reviewing the medical files. Following factors were assessed: (1) delay in ICU admission; (2) futile ICU treatment; (3) missed diagnosis or inadequate treatment on the ICU. Fleiss kappa was used to assess inter-observer agreement. Results: 1107 septic patients (APACHE II score 25 ± 8) were included. 344 patients died of which 97 (28%) within 48 h. In 33% an autopsy was performed. Primary causes of early death were multiple organ failure, mesenteric ischaemia and death after cardio-pulmonary resuscitation (CPR). Delay in ICU admission was scored in 32% of early deaths with slight agreement (j ¼ 0.180), futile ICU treatment in 29% with moderate agreement (j ¼ 0.415) and missed diagnosis or treatment in 7% of cases with slight agreement (j ¼ 0.122). Conclusions: Early death after ICU admission in sepsis is common and primarily caused by multiple organ failure, mesenteric ischaemia and death after unsuccessful CPR. Influencing factors were delay in ICU admission and futile ICU admission. Fleiss kappa indicates substantial variability in clinical judgement between intensivists, strengthening the necessity for shared decision making.

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Clinical predictors of early death from sepsis

Cited by 31 publications

References 24 publications

Prevalence, potential risk factors and mortality rates of acute respiratory distress syndrome in Chinese patients with sepsis

Prevalence, potential risk factors and mortality rates of acute respiratory distress syndrome in Chinese patients with sepsis

Metabolic profiles in community-acquired pneumonia: developing assessment tools for disease severity

Early ICU-mortality in sepsis – causes, influencing factors and variability in clinical judgement: a retrospective cohort study

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