Has the mortality of septic shock changed with time?

Friedman, Gilberto; Silva, Eliézer; Vincent, Jean‐Louis

doi:10.1097/00003246-199812000-00045

Cited by 543 publications

(308 citation statements)

References 125 publications

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“…(49.7%) [28], but higher than that reported in the Finnsepsis study (28.3%) [29]. The impact on mortality of nosocomial sepsis versus community-acquired sepsis was similar to the recently published results of Alberti et al [16].…”

Section: Discussionsupporting

confidence: 82%

Sepsis mortality prediction based on predisposition, infection and response

et al. 2007

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Objective: To empirically test, based on a large multicenter, multinational database, whether a modified PIRO (predisposition, insult, response, and organ dysfunction) concept could be applied to predict mortality in patients with infection and sepsis. Design: Substudy of a multicenter multinational cohort study (SAPS 3). Patients: A total of 2,628 patients with signs of infection or sepsis who stayed in the ICU for > 48 h. Three boxes of variables were defined, according to the PIRO concept. Box 1 (Predisposition) contained information about the patient's condition before ICU admission. Box 2 (Injury) contained information about the infection at ICU admission. Box 3 (Response) was defined as the response to the infection, expressed as a Sequential Organ Failure Assessment score after 48 h. Interventions: None. Main measurements and results: Most of the infections were community acquired (59.6%); 32.5% were hospital acquired. The median age of the patients was 65 (50-75) years, and 41.1% were female. About 22% (n = 576) of the patients presented with infection only, 36.3% (n = 953) with signs of sepsis, 23.6% (n = 619) with severe sepsis, and 18.3% (n = 480) with septic shock. Hospital mortality was 40.6% overall, greater in those with septic shock (52.5%) than in those with infection (34.7%). Several factors related to predisposition, infection and response were associated with hospital mortality. Conclusion: The proposed three-level system, by using objectively defined criteria for risk of mortality in sepsis, could be used by physicians to stratify patients at ICU admission or shortly thereafter, contributing to a better selection of management according to the risk of death.

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Section: Discussionsupporting

confidence: 82%

Sepsis mortality prediction based on predisposition, infection and response

et al. 2007

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“…In the USA alone, 750,000 cases of sepsis occur each year, and more than 215,000 patients die of sepsis-induced damage because the known endotoxemia antagonists are only able to partially suppress sepsis symptoms (Martin et al 2003). The growing frequency of sepsis syndrome observed in the modern world may be partially explained by complications often observed after chemotherapy in cancer patients, organ transplantation, cardiac surgery, and prosthesis use (Friedman et al 1998;Vincent 2008). Moreover, in 40-60% of all patients with severe sepsis, acute respiratory distress syndrome often develops, coupled with acute lung dysfunction, which usually results in mortality (Gong et al 2005;MacCallum and Evans 2005).…”

Section: Introductionmentioning

confidence: 99%

Recombinant human Hsp70 protects against lipoteichoic acid-induced inflammation manifestations at the cellular and organismal levels

Винокуров

Ostrov

Yurinskaya

et al. 2012

Cell Stress and Chaperones

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It has been previously reported that pretreatment with exogenous heat shock protein 70 (Hsp70) is able to protect cells and animals from the deleterious effects of bacterial lipopolysaccharide (LPS) produced by Gramnegative bacteria. However, the effects of Hsp70 pretreatment on lipoteichoic acid (LTA) challenge resulted from Gram-positive bacteria infection have not been fully elucidated. In this study, we demonstrated that preconditioning with human recombinant Hsp70 ameliorates various manifestations of systematic inflammation, including reactive oxygen species, TNFα, and CD11b/CD18 adhesion receptor expression induction observed in different myeloid cells after LTA addition. Therefore, exogenous Hsp70 may provide a mechanism for controlling excessive inflammatory responses after macrophage activation. Furthermore, in a rat model of LTA-induced sepsis, we demonstrated that prophylactic administration of exogenous human Hsp70 significantly exacerbated numerous homeostatic and hemodynamic disturbances induced by LTA challenge and partially normalized the coagulation system and multiple biochemical blood parameters, including albumin and bilirubin concentrations, which were severely disturbed after LTA injections. Importantly, prophylactic intravenous injection of Hsp70 before LTA challenge significantly reduced mortality rates. Thus, exogenous mammalian Hsp70 may serve as a powerful cellular defense agent against the deleterious effects of bacterial pathogens, such as LTA and LPS. Taken together, our findings reveal novel functions of this protein and establish exogenous Hsp70 as a promising pharmacological agent for the prophylactic treatment of various types of sepsis.

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“…Despite significant advances in medical diagnosis and treatment, the overall survival in sepsis has not improved substantially over time [2,3]. This can partly be explained by the fact that sepsis is not a disease, but a syndrome comprising heterogeneous pathophysiological entities.…”

Section: Introductionmentioning

confidence: 99%

Influence of diabetes on endothelial cell response during sepsis

et al. 2011

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Aims/hypothesis Several endothelial pathways of cell adhesion, coagulation and vascular endothelial growth factor (VEGF) signalling are activated during sepsis. The objective of this analysis was to investigate the influence of diabetes on biomarkers of endothelial cell activation in sepsis. Methods This was a prospective observational cohort study of a convenience sample of adult patients (age ≥18 years) for whom infection was clinically suspected and who presented to an urban tertiary care emergency department between Results A total of 207 patients (34% with sepsis, 32% with severe sepsis and 34% with septic shock) were studied, including 63 (30%) with diabetes. Compared with patients without diabetes, patients with diabetes had significantly increased E-selectin and sFLT-1 levels overall; this was most pronounced during septic shock in the stratified analysis. Multivariate models including age, sex, sepsis severity and other variables as potential covariates confirmed the association of diabetes with elevated circulating plasma levels of E-selectin (standardised β 0.24, p<0.001) and sFLT-1 (standardised β 0.19, p<0.01), but there was no significant association with VCAM-1, ICAM-1 or PAI-1. Conclusions/interpretation During septic shock, patients with diabetes had higher levels of circulating biomarkers of endothelial cell adhesion (E-selectin) and VEGF signalling (sFLT-1). Future studies should address whether enhanced activation of the endothelium places patients with diabetes at increased risk for the development of sepsis and worsening morbidity and mortality.

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Has the mortality of septic shock changed with time?

Cited by 543 publications

References 125 publications

Sepsis mortality prediction based on predisposition, infection and response

Sepsis mortality prediction based on predisposition, infection and response

Recombinant human Hsp70 protects against lipoteichoic acid-induced inflammation manifestations at the cellular and organismal levels

Influence of diabetes on endothelial cell response during sepsis

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