Evaluation of Definitions for Sepsis

Knaus, William A.; Sun, Xingwei; Nyström, Per‐Olof; Wagner, Douglas P.

doi:10.1378/chest.101.6.1656

Cited by 168 publications

(44 citation statements)

References 31 publications

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“…Although this is the most common infectious complication after renal transplantation [38]–[40], urinary infection might not lead to severe sepsis as frequently as pneumonia even in these immunosuppressed patients. Interestingly, while the data may not be significant, urinary tract infection seems to be associated with lower mortality rates, as previously showed in immunocompetent patients [41]. We also found a higher frequency of microbiologically documented infection by opportunistic pathogens compared with non-transplant patients [1], [8].…”

Section: Discussionsupporting

confidence: 74%

Mortality Predictors in Renal Transplant Recipients with Severe Sepsis and Septic Shock

et al. 2014

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IntroductionThe growing number of renal transplant recipients in a sustained immunosuppressive state is a factor that can contribute to increased incidence of sepsis. However, relatively little is known about sepsis in this population. The aim of this single-center study was to evaluate the factors associated with hospital mortality in renal transplant patients admitted to the intensive care unit (ICU) with severe sepsis and septic shock.MethodsPatient demographics and transplant-related and ICU stay data were retrospectively collected. Multiple logistic regression was conducted to identify the independent risk factors associated with hospital mortality.ResultsA total of 190 patients were enrolled, 64.2% of whom received kidneys from deceased donors. The mean patient age was 51±13 years (males, 115 [60.5%]), and the median APACHE II was 20 (16–23). The majority of patients developed sepsis late after the renal transplantation (2.1 [0.6–2.3] years). The lung was the most common infection site (59.5%). Upon ICU admission, 16.4% of the patients had ≤1 systemic inflammatory response syndrome criteria. Among the patients, 61.5% presented with ≥2 organ failures at admission, and 27.9% experienced septic shock within the first 24 hours of ICU admission. The overall hospital mortality rate was 38.4%. In the multivariate analysis, the independent determinants of hospital mortality were male gender (OR = 5.9; 95% CI, 1.7–19.6; p = 0.004), delta SOFA 24 h (OR = 1.7; 95% CI, 1.2–2.3; p = 0.001), mechanical ventilation (OR = 30; 95% CI, 8.8–102.2; p<0.0001), hematologic dysfunction (OR = 6.8; 95% CI, 2.0–22.6; p = 0.002), admission from the ward (OR = 3.4; 95% CI, 1.2–9.7; p = 0.02) and acute kidney injury stage 3 (OR = 5.7; 95% CI,1.9–16.6; p = 0.002).ConclusionsHospital mortality in renal transplant patients with severe sepsis and septic shock was associated with male gender, admission from the wards, worse SOFA scores on the first day and the presence of hematologic dysfunction, mechanical ventilation or advanced graft dysfunction.

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Section: Discussionsupporting

confidence: 74%

Mortality Predictors in Renal Transplant Recipients with Severe Sepsis and Septic Shock

et al. 2014

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“…Nevertheless, establishing the presence and the site of infection is essential for survivability of the host. Higher mortality rates where reported when sepsis was the result of gastrointestinal or pulmonary causes relative to a genitourinary source [24]. …”

Section: Discussionmentioning

confidence: 99%

“…In a case-control study we analyzed time-matched AF, maternal blood, and urine of 100 women pregnant with singletons in the following groups: i) (+)IAI & PTB (n=48, gestational age (GA): median [interquartile range] 26 [24–28] weeks) of which 11 women had clinical symptoms of chorioamnionitis; ii) (−)IAI & PTB (n=20, GA: 29 [25–32] weeks); iii) (−)IAI & Term Birth (n=14, GA 28 [24–31] weeks) comprised of women with symptoms of preterm labor that delivered at healthy baby at term; iv) (−)IAI & systemic inflammatory response (SIR, n=18, GA: 30 [27–34] weeks) comprised of women with medical inflammatory conditions unrelated to pregnancy. Consecutive cases were selected from a biorepository based on criteria for inclusion in one of the 4 groups described above and availability of the time-matched specimens.…”

Section: Methodsmentioning

confidence: 99%

Compartmentalization of acute phase reactants Interleukin-6, C-Reactive Protein and Procalcitonin as biomarkers of intra-amniotic infection and chorioamnionitis

et al. 2015

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Background The arsenal of maternal and amniotic fluid (AF) immune response to local or systemic infection includes among others the acute-phase reactants IL-6, C-reactive protein (CRP) and procalcitonin (PCT). If these molecules can be used as non-invasive biomarkers of intra-amniotic infection (IAI) in the subclinical phase of the disease remains incompletely known. Methods We used time-matched maternal serum, urine and AF from 100 pregnant women who had an amniocentesis to rule out IAI in the setting of preterm labor, PPROM or systemic inflammatory response (SIR: pyelonephritis, appendicitis, pneumonia) to infection. Cord blood was analyzed in a subgroup of cases. We used sensitive immunoassays to quantify the levels of inflammatory markers in the maternal blood, urine and AF compartment. Microbiological testing and placental pathology was used to establish infection and histological chorioamnionits. Results PCT was not a useful biomarker of IAI in any of the studied compartments. Maternal blood IL-6 and CRP levels were elevated in women with subclinical IAI. Compared to clinically manifest chorioamnionitis group, women with SIR have higher maternal blood IL-6 levels rendering some marginal diagnostic benefit for this condition. Urine was not a useful biological sample for assessment of IAI using either of these three inflammatory biomarkers. Conclusions In women with subclincal IAI, the large overlapping confidence intervals and different cut-offs for the maternal blood levels of IL-6, CRP and PCT likely make interpretation of their absolute values difficult for clinical decision-making.

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“…The decision to require 2 of the 4 criteria to identify sepsis was based on an evaluation of the diagnostic sensitivity of using either 2, 3, or 4 of the criteria in the acute physiology and chronic health evaluation (APACHE) database to identify those individuals with a clinical diagnosis of sepsis 16 . Using 2 of the 4 criteria produced a highly sensitive tool for identifying septic patients 16 .…”

Section: Development Of Sirs Definitionmentioning

confidence: 99%

“…Using 2 of the 4 criteria produced a highly sensitive tool for identifying septic patients 16 . When this definition was used in the setting of noninfectious inflammatory disease or in the setting of burn injury, pancreatitis, trauma, or other insults that can evoke a pro-inflammatory response, the systemic inflammatory response syndrome or SIRS response was defined and was also further defined as severe SIRS when organ dysfunction and/or hypoperfusion resulted from the systemic response 1 .…”

Section: Development Of Sirs Definitionmentioning

confidence: 99%

Systemic inflammatory response syndrome (SIRS)

Balk

2013

Virulence

246

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The concept of a systemic inflammatory response syndrome (SIRS) to describe the complex pathophysiologic response to an insult such as infection, trauma, burns, pancreatitis, or a variety of other injuries came from a 1991 consensus conference charged with the task of developing an easy-to-apply set of clinical parameters to aid in the early identification of potential candidates to enter into clinical trials to evaluate new treatments for sepsis. There was recognition that a diverse group of injuries produced a common inflammatory response in the host and provided attractive targets for new anti-inflammatory molecules designed to prevent further propagation and/or provide specific treatment. Effective application of these new anti-inflammatory strategies necessitated identification of early clinical markers that could be assessed in real-time and were likely to define a population of patients that would have a beneficial response to the targeted intervention. It was felt that early clinical manifestations might be more readily available to clinicians than more sophisticated and specific assays for inflammatory substances that were systemically released by the network of injurious inflammatory events. Therefore, the early definition of a systemic inflammatory response syndrome (SIRS) was built upon a foundation of basic clinical and laboratory abnormalities that were readily available in almost all clinical settings. With further refinement, it was hoped, that this definition would have a high degree of sensitivity, coupled with a reasonable degree of specificity. This manuscript reviews the derivation, application, utilization, potential benefits, and speculation regarding the future of the SIRS definition.

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Evaluation of Definitions for Sepsis

Cited by 168 publications

References 31 publications

Mortality Predictors in Renal Transplant Recipients with Severe Sepsis and Septic Shock

Mortality Predictors in Renal Transplant Recipients with Severe Sepsis and Septic Shock

Compartmentalization of acute phase reactants Interleukin-6, C-Reactive Protein and Procalcitonin as biomarkers of intra-amniotic infection and chorioamnionitis

Systemic inflammatory response syndrome (SIRS)

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