Macrocirculatory and Microcirculatory Endpoints in Sepsis Resuscitation

Mok, Garrick; Hendin, Ariel; Reardon, Peter M.; Hickey, Michael; Gray, Sara; Yadav, Krishan

doi:10.1177/0885066620982585

Cited by 23 publications

(20 citation statements)

References 48 publications

(73 reference statements)

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“…Sepsis is a syndrome of systemic inflammatory response caused by infection, which progresses rapidly and can cause shock and multiple organ failures. It is one of the main causes of death of critically ill patients, and it has become an urgent problem to be solved in ICU at present [ 1 ].There is a lack of effective methods to evaluate the prognosis of patients with sepsis. If the patients' condition can be evaluated early and effective intervention can effectively reduce the mortality [ 2 ].It shows that the disorder of immune function plays a vital role in the disease progression of patients [ 3 ], and the change of cellular immune function is earlier than humoral immunity, so people pay attention to immune conditioning.…”

Section: Introductionmentioning

confidence: 99%

Expression of Peripheral Blood DCs CD86, CD80, and Th1/Th2 in Sepsis Patients and Their Value on Survival Prediction

Hao

Luan

2022

Computational and Mathematical Methods in Medicine

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Objective. To explore the expression of peripheral blood dendritic cells (DCs) CD86, CD80, and Th1/Th2 in patients with sepsis and their value on survival prediction. Methods. 118 patients with sepsis from January 2019 to December 2020 were selected, According to the prognosis, the patients were divided into the death group ( n = 46 ) and survival group ( n = 72 ). The general data and pathogen division of the two groups were collected, and the levels of peripheral blood DCs CD86, CD80, and Th1/Th2; APACHE II score; inflammatory factor (procalcitonin (PCT)); and cell growth chemokine (GRO) were compared between the two groups heparin-binding protein (HBP) and myocardial enzyme indexes (creatine kinase (CK), creatine kinase isozyme (CK-MB), and lactate dehydrogenase (LDH)) to explore the relationship between CD86, CD80, Th1/Th2, and various serological indexes and the evaluation value of prognosis. Results. 124 strains of pathogenic bacteria were isolated from 118 patients, including 78 strains of gram-negative bacteria (62.90%), 31 strains of Gram-positive bacteria (25.00%), and 15 strains of fungi (12.10%). The scores of CD86, CD80, Th1, Th2, Th1/Th2, and APACHE II in the dead group were higher than those in the surviving group, and the difference was statistically significant ( P < 0.05 ). PCT, GRO-α, HBP, LDH, CK-MB, and CK levels of patients in death group were higher than those in survival group, and the difference was statistically significant ( P < 0.05 ). The levels of peripheral blood DCs CD86, CD80, and Th1/Th2 were positively correlated with PCT, GRO-α, HBP, LDH, CK-MB, and CK ( P < 0.05 ). ROC curve analysis showed that the AUC of the combined detection of DCs CD86, CD80, and Th1/Th2 in peripheral blood was 0.951, which was higher than 0.882, 0.883, and 0.734 of single index ( P < 0.05 ). Conclusion. All patients with sepsis have immune imbalance, and the peripheral blood CD86, CD80, and Th1/Th2 of the dead patients are higher than those of the survivors. The combined detection of these three indicators has the highest predictive value for the prognosis of patients.

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Section: Introductionmentioning

confidence: 99%

Expression of Peripheral Blood DCs CD86, CD80, and Th1/Th2 in Sepsis Patients and Their Value on Survival Prediction

Hao

Luan

2022

Computational and Mathematical Methods in Medicine

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“…As one of the diagnostic criteria for septic shock, lactate is used as a perfusion indicator 49 and a resuscitation therapy endpoint 50 in clinical practice, although it can also signify numerous causes of non-perfusion. No correlation between Sirt3 and lactate was found in our study, and the reasons for this result may include small sample size and a complex mechanism of lactate elevation.…”

Section: Discussionmentioning

confidence: 99%

Mitochondrial Sirt3 serves as a biomarker for sepsis diagnosis and mortality prediction

Liu

Zhou

Chen

et al. 2022

Sci Rep

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The purpose of this study is to determine whether the levels of serum Sirt3 correlate with disease severity and perfusion indicators in septic patients, as well as to assess the clinical value of Sirt3 as a potential novel marker for sepsis diagnosis and mortality prediction. A total of 79 patients in the ICU were included in the study, of which 28 were postoperatively noninfectious and the remaining 51 patients were all diagnosed with sepsis during the study period. The levels of Sirt3 were detected and dynamically monitored by enzyme-linked adsorption method, Pearson or Spearman coefficient for correlation analysis between Sirt3 and clinical indicators, ROC curve for evaluation of diagnosis and mortality prediction, Kaplan–Meier method for the significance of Sirt3 in 28-day survival. The serum levels of Sirt3 were lower in the sepsis patients on day 1 (P < 0.0001), and the septic shock group had lower Sirt3 levels than the sepsis group (P = 0.013). Sirt3 had good negative correlations with SOFA scores both in sepsis and septic shock groups (Pearson: r2 = − 0.424, − 0.518; P = 0.011, 0.040), and Sirt3 correlated strongly with ScvO2 in the septic shock group (Pearson: r2 = − 0.679, P = 0.004) and with PCT in the sepsis group (Pearson: r2 = − 0.409, P = 0.015). Sirt3 not only performed well in identifying sepsis (AUC = 0.995, 95% CI 0.987–1, P < 0.0001) but also greatly enhanced lactate's specificity in detecting septic shock (from 91.43 to 94.29%). Patients in the low Sirt3 group had higher ScvO2, lactate, APACHE II score, SOFA score, longer ICU stays, and worse indicators of inflammation (TNF-α, IL-6) and infection (PCT) than those in the high Sirt3 group (P < 0.05). Additionally, Sirt3 can predict mortality of sepsis (AUC = 0.746, 95% CI 0.571–0.921, P = 0.022), patients with serum Sirt3 < 10.07 pg/ml have a lower 28-day survival (log-rank P = 0.008). Low serum levels of Sirt3 are significantly correlated with the disease severity. At the same time, Sirt3 increases the sensitivity of lactate to detect “cellular hypoxia” in septic shock. Sirt3 is a promising biomarker for the diagnosis of sepsis and predicting mortality risk in septic patients.

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“…In addition, sepsis-induced myocardial dysfunction may occur, leading to a reduction in cardiac output [19]. On the other hand, microcirculation is impaired because of alterations in microcirculatory autoregulation, mitochondrial dysfunction and microvascular thrombosis; the latter may lead to disseminated intravascular coagulation [20][21][22].…”

Section: Hemodynamicmentioning

confidence: 99%

Neuropsychological Outcome of Critically Ill Patients with Severe Infection

Cavalli

Mascia

2022

Biomedicines

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Sepsis and septic shock represent important burdens of disease around the world. Sepsis-associated neurological consequences have a great impact on patients, both in the acute phase and in the long term. Sepsis-associated encephalopathy (SAE) is a severe brain dysfunction that may contribute to long-term cognitive impairment. Its pathophysiology recognizes the following two main mechanisms: neuroinflammation and hemodynamic impairment. Clinical manifestations include different forms of altered mental status, from agitation and restlessness to delirium and deep coma. A definite diagnosis is difficult because of the absence of specific radiological and biological criteria; clinical management is restricted to the treatment of sepsis, focusing on early detection of the infection source, maintenance of hemodynamic homeostasis, and avoidance of metabolic disturbances or neurotoxic drugs.

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Macrocirculatory and Microcirculatory Endpoints in Sepsis Resuscitation

Cited by 23 publications

References 48 publications

Expression of Peripheral Blood DCs CD86, CD80, and Th1/Th2 in Sepsis Patients and Their Value on Survival Prediction

Expression of Peripheral Blood DCs CD86, CD80, and Th1/Th2 in Sepsis Patients and Their Value on Survival Prediction

Mitochondrial Sirt3 serves as a biomarker for sepsis diagnosis and mortality prediction

Neuropsychological Outcome of Critically Ill Patients with Severe Infection

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