Improving Long-Term Outcomes After Sepsis

Prescott, Hallie C.; Costa, Deena Kelly

doi:10.1016/j.ccc.2017.08.013

Cited by 44 publications

(38 citation statements)

References 87 publications

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“…Clinical manifestations of cognitive and emotional impairment are frequently noted during sepsis from the initial phase, during the recovery phase, and after hospital discharge [24]. Brain structures including the neuroendocrine system, hippocampus, limbic system, frontal cortex and brainstem of sepsis patients have been found to be damaged [25].…”

Section: Discussionmentioning

confidence: 99%

Qiang Xin 1 Formula Suppresses Excessive Pro-inflammatory Cytokine Responses and Microglia Activation to Prevent Cognitive Impairment and Emotional Dysfunctions in Experimental Sepsis

Wang

Guo

et al. 2019

Preprint

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Background: Sepsis commonly leads to acute and long-term cognitive and affective impairments which are associated with increased mortality in patients. Neuroinflammation characterized by excessive cytokine release and immune cell activation underlies the behavioral changes associated with sepsis. We previously reported that the administration of a traditional Chinese herbal Qiang Xin 1 (QX1) formula improves survival in septic mice. This study was performed to better understand the effects and the mechanisms of QX1 formula treatment on behavioral changes in septic model. Methods: A preclinical septic model was induced by cecal ligation and puncture in mice. QX1 formula was orally administrated daily. Behavior test including Morris water maze, novel object recognition testing, elevated plus maze and open field testing was performed. Elisa, immunofluorescence, microarray analysis, and Real-time PCR were analyzed. Results: QX1 formula administration significantly improved survival, alleviated overall cognitive impairment and emotional dysfunction in septic mice. QX1 formula administration dramatically inhibited short and long-term excessive pro-inflammatory cytokine production both peripherally and centrally, and was accompanied by diminished microglial activation in septic mice. Biological processes including synaptic transmission, microglia cell activation, cytokine production, microglia cell polarization, as well as inflammatory responses related to signaling pathways including the MAPK signaling pathway and the NF-κB signaling pathway were altered prominently by QX1 formula treatment in the hippocampus of septic mice. In addition, QX1 formula administration decreased the expression of the M1 phenotype microglia gene markers such as Cd32, Socs3, and Cd68, while up-regulated M2 phenotype marker genes including Myc, Arg-1, and Cd206. Conclusions: QX1 formula administration attenuates cognitive deficits, emotional dysfunction, and reduces neuroinflammatory responses to improve survival in septic mice. Diminished microglial activation and altered microglial polarization are involved in the neuroprotective mechanism of QX1 formula.

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Section: Discussionmentioning

confidence: 99%

Qiang Xin 1 Formula Suppresses Excessive Pro-inflammatory Cytokine Responses and Microglia Activation to Prevent Cognitive Impairment and Emotional Dysfunctions in Experimental Sepsis

Wang

Guo

et al. 2019

Preprint

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“…Consequently, a patient with BSI can admit to EC with fever or hypothermia, low blood pressure, dysregulation on tissue perfusion, loose of the consciousness, blood clotting abnormalities, metastatic skin lesions, organ failures (especially in kidney), and gastrointestinal symptoms such as vomiting or paralytic ileus [10]. Therefore, immediate treatment of BSI is lifesaving for many patients, and an aggressive treatment approach is needed, which focus not only the antimicrobial therapy but also for the regulation of other life-threatening complications [11]. In this point, the determination of the infecting pathogen is critical since the clinical situation can vary according to its virulence factors.…”

Section: Discussionmentioning

confidence: 99%

The pathogens of blood stream infection in the patients who applied to emergency medicine service: a three year retrospective analysis of a university hospital

Sarıhan¹

2017

Med-Science

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Blood stream infection (BSI) is a critical clinic situation that requires immediate diagnosis and treatment. In this study, we aimed to determine the BSI pathogens among the patients who admitted to emergency medicine clinic (EC). A retrospective surveillance study was conducted to evaluate the results of blood culture of the emergency patients in a university hospital between January 2015 and December 2017. Total 4569 blood culture were performed between the study period, and 802 (17.5%) of them yielded positive result, of which 14 (1.7%) were fungi, and remaining 788 (98.3%) were bacteria. Except the coagulase-negative staphylococci (CNSs) which was the major contaminant of blood cultures; Escherichia coli (n: 170; 21.2%) was the most frequently isolated organisms in this survey, and this was followed by Klebsiella spp. (n: 55; 6.8%) and Staphylococcus aureus (n: 54; 6.7%). The frequency of extended spectrum beta-lactamases (ESBLs) among the members of Enterobacteriaceae was measured as 38.2%, and the methicillin resistance of S. aureus was 7.4%. The common community acquired bacteremia agents were detected as relatively less, in such an order as Streptococcus pneumoniae (n: 14; 1.7%), beta-hemolytic streptococci (n: 11; 1.3%), and Brucella spp. (n: 7; 0.8%). This study indicates that gram negative enteric bacteria are the most frequent pathogens of BSI, and the high antimicrobial resistance mediated by ESBL resistance poses a substantial therapeutic problem in our region. The results also suggest that S. pneumoniae seems to be circulating in the community despite the vaccination campaigns. Emergency departments are critical units to diagnose community-acquired bacteremia and to commence appropriate antimicrobial chemotherapy for the patients with BSI.

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“…With increasing hospitalizations and decreasing case fatality rates, there is a growing number of severe sepsis survivors with complex medical needs [21,22,41,65]. Approximately 25% of elderly patients hospitalized for sepsis are discharged to post-acute care facilities such as a skilled nursing facility (SNF) or long-term acute care hospital (LTACH) [7].…”

Section: Post-acute Care Facility Utilizationmentioning

confidence: 99%

“…Discharge to a care facility has been frequently associated with increased likelihood of readmission among sepsis survivors [5][6][7]68]. Recurrent infection sepsis is one of the most common causes of readmission in this population and is associated with poor long-term outcomes and mortality [22,68]. There is also a great deal of variability in care delivered at SNFs in regards to readmission and mortality rates [49,68].…”

Section: Post-acute Care Facility Utilizationmentioning

confidence: 99%

“…Hospital-based interventions should aim at reducing inter-hospital and intra-hospital variation in clinical management. This includes systematically analyzing physician adherence to treatment protocols and establishing uniform admission to post-acute care facilities [22,23,72]. Administrative efforts should also explore strategies to mitigate the effects of insurance status as a source for disparities in sepsis management [36,37].…”

Section: Interventions To Reduce Racial Disparities In Sepsismentioning

confidence: 99%

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Factors Underlying Racial Disparities in Sepsis Management

DiMeglio

Dubensky

Schadt

et al. 2018

Preprint

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Sepsis, a syndrome characterized by systemic inflammation during infection, continues to be one of the most common causes of patient mortality in hospitals across the United States. While standardized treatment protocols have been implemented, wide variability in clinical outcomes persist across racial groups. Specifically, Black and Hispanic populations are frequently associated with higher rates of morbidity and mortality in sepsis compared to the Caucasian population. While this is often attributed to systemic bias against minority groups, a growing body of literature has found patient, community, and hospital-based factors to be driving racial differences. In this article, we provide a focused review on some of the factors driving racial disparities in sepsis. We also suggest potential interventions aimed at reducing health disparities in the prevention, early identification, and clinical management of sepsis.

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Improving Long-Term Outcomes After Sepsis

Cited by 44 publications

References 87 publications

Qiang Xin 1 Formula Suppresses Excessive Pro-inflammatory Cytokine Responses and Microglia Activation to Prevent Cognitive Impairment and Emotional Dysfunctions in Experimental Sepsis

Qiang Xin 1 Formula Suppresses Excessive Pro-inflammatory Cytokine Responses and Microglia Activation to Prevent Cognitive Impairment and Emotional Dysfunctions in Experimental Sepsis

The pathogens of blood stream infection in the patients who applied to emergency medicine service: a three year retrospective analysis of a university hospital

Factors Underlying Racial Disparities in Sepsis Management

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