Is Strongyloides stercoralis a risk factor for sepsis severity?

Abstract

Background: We hypothesized that one single episode of acute kidney injury (AKI) reduces long-term survival compared with no acute kidney injury (No AKI) following recovery from critical illness. Materials and methods: A prospective cohort of 2,010 patients admitted to the ICU between 2000 and 2009 at a provincial referral hospital was followed to determine whether AKI influences long-term survival. Results: Of the 1,844 eligible patients, 18.4% had AKI stage 1, 12.1% had stage 2, 26.5% had stage 3, and 43.0% had No AKI, using the KDIGO classification. The mean and median follow-up time was 8.1 and 8.7 years. The 28-day, 1-year, 5-year and 10-year survival rates were 59.6%, 44.9%, 37.4%, and 33.4%, in patients with any AKI (stage 1, stage 2, stage 3), which was significantly worse compared with the critically ill patients with no AKI at any time (P < 0.01). The adjusted 10-year mortality risk associated with AKI was 1.44 (95% CI = 1.2 to 1.7) among 28-day survivors. Patients who had mild AKI (stage 1) had significantly worse survival at 28 days, 1 year, 3 years, 5 years and 10 years compared with No AKI (P < 0.01) ( Figure 1A). Patients with sepsis and AKI who survived 28 days had significantly poorer 5-year and 10-year survival compared with nonseptic AKI (P < 0.01) ( Figure 1B). Conclusions: Patients with one episode of mild (stage 1) AKI have significantly lower survival rates over 10 years than critically ill patients without AKI. The causes and mechanisms of this association warrant further careful study. Close medical follow-up of these patients may be warranted and mechanistic research required understanding how AKI influences distant events. P3Heparin-binding protein improves prediction of severe sepsis in the emergency departmentBackground: The early identification of risk of developing severe sepsis in patients with suspected infection remains a difficult challenge. We hypothesized that an elevated plasma level of heparin-binding protein (HBP), a neutrophil-secreted mediator of vascular leakage, would be a predictor of delayed clinical deterioration and progressive organ dysfunction in emergency department (ED) sepsis patients. Materials and methods: A prospective, multicenter study in Sweden and the US was conducted of 763 patients presenting to an ED with a suspected infection and signs of systemic inflammation. Based on recorded clinical and laboratory parameters and final diagnoses, patients were classified into various groups depending on the severity of the infection and inflammatory response. Plasma levels of HBP were measured and compared with levels of other standard sepsis biomarkers including procalcitonin, lactate, WBC, and C-reactive protein.Results: The final diagnoses were severe sepsis with organ failure in 338 patients, nonsevere sepsis without organ failure in 340 patients, and no infection in 85 patients. One-hundred and forty-three patients (19%) presented without signs of severe sepsis, but developed delayed circulatory failure and/or organ dysfunction within 72 hours of enrolment. ...