Late recognition and illness severity are determinants of early death in severe septic patients

Abstract

OBJECTIVE:To identify the independent variables associated with death within 4 days after the first sepsis-induced organ dysfunction.METHODS:In this prospective observational study, severe sepsis and septic shock patients were classified into 3 groups: Group 1, survivors; Group 2, late non-survivors; and Group 3, early non-survivors. Early death was defined as death occurring within 4 days after the first sepsis-induced organ dysfunction. Demographic, clinical and laboratory data were collected and submitted to univariate and multinomial analyses.RESULTS:The study included 414 patients: 218 (52.7%) in Group 1, 165 (39.8%) in Group 2, and 31 (7.5%) in Group 3. A multinomial logistic regression analysis showed that age, Acute Physiology and Chronic Health Evaluation II score, Sepsis-related Organ Failure Assessment score after the first 24 hours, nosocomial infection, hepatic dysfunction, and the time elapsed between the onset of organ dysfunction and the sepsis diagnosis were associated with early mortality. In contrast, Black race and a source of infection other than the urinary tract were associated with late death. Among the non-survivors, early death was associated with Acute Physiology and Chronic Health Evaluation II score, chronic renal failure, hepatic dysfunction Sepsis-related Organ Failure Assessment score after 24 hours, and the duration of organ dysfunction.CONCLUSION:Factors related to patients' intrinsic characteristics and disease severity as well as the promptness of sepsis recognition are associated with early death among severe septic patients.

Proteomic study revealed cellular assembly and lipid metabolism dysregulation in sepsis secondary to community-acquired pneumonia

“…A total of 425 septic patients were prospectively enrolled in the cohort, and 164 patients met the criteria for blood sampling. Of these 164 patients, 33 had CAP as the primary source of infection 22 and were selected for this study, 20 of whom survived and 13 of whom died during hospitalization (Fig. 1 ).…”

Inflammasome gene profile is modulated in septic patients, with a greater magnitude in non-survivors

“…Sepsis is a complex syndrome with several primary sources of infection. To avoid patient heterogeneity, we selected patients with sepsis secondary to community‐acquired pneumonia from a cohort of septic patients . Thus, our data might not be representative of the spectrum of septic patients or even of patients with less severe pneumonia.…”

“…Patients with a clinical diagnosis of severe sepsis and septic shock admitted to the intensive care units of three large hospitals in São Paulo, Brazil, were enrolled prospectively into the cohort . This study was approved by the ethics committees of the participating hospitals, São Paulo Hospital (study number 1477/06), Albert Einstein Hospital (study number 07/549) and Sirio Libanes Hospital (study number 2006/27).…”

Expression of genes belonging to the interacting TLR cascades, NADPH-oxidase and mitochondrial oxidative phosphorylation in septic patients

“…Patients who were admitted from January 2008 to December 2009 to the intensive care units of the Sao Paulo, Albert Einstein, and Sirio-Libanes Hospitals (all in Sao Paulo, Brazil) with a clinical diagnosis of sepsis according to the ACCP/SCCM consensus conference [ 16 ] were enrolled in a prospective cohort of septic patients [ 17 , 18 ]. The study was approved by the ethics committees of the participating hospitals, Sao Paulo Hospital (Study number 1477/06), Albert Einstein Hospital (Study number 07/549) and Sirio Libanes Hospital (Study number 2006/27).…”