Predictors of mortality in patients with severe sepsis or septic shock in the ICU of a public teaching hospital

Oliveira, Argenil José Assis de; Cardoso, Cristina Padre; Rios-Santos, Fabrício; Campos, Ana Paula de Magalhaes; Leite, Edna; Stanislau, Juliana de Assis Silva Gomes; Botoni, Fernando Antônio

doi:10.1186/cc12931

Cited by 6 publications

(6 citation statements)

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“…These findings are similar to those of de Oliveira et al . [ 31 ], where not the PCT level but the SOFA score value was highly associated with mortality in ICU patients with severe sepsis and septic shock. In our study in severe sepsis and septic shock subgroups the values of PCT and SOFA score were significantly different on the 1 st day of therapy, similarly to Lavrentieva's study [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Procalcitonin kinetics – prognostic and diagnostic significance in septic patients

Lipińska-Gediga¹,

Mierzchała-Pasierb²,

Durek³

2016

aoms

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IntroductionSevere sepsis and septic shock are advanced clinical conditions representing the patient's response to infection and having a variable but high mortality rate. Early evaluation of sepsis stage and choice of adequate treatment are key factors for survival. Some study results suggest the necessity of daily procalcitonin (PCT) monitoring because of its prognostic and discriminative value.Material and methodsAn observational and prospective study was conducted to evaluate the prognostic and discriminative value of PCT kinetics in comparison to PCT absolute value measurements. In a group of 50 intensive care unit patients with diagnosis of severe sepsis or septic shock, serum PCT measurements were performed on admission, and on the 2nd, 3rd and 5th day of therapy. The level of PCT was determined with a commercially available test according to the manufacturer's protocol.ResultsThe kinetics of PCT assessed by ΔPCT was statistically significant in the survivors vs. the non-survivors subgroup (ΔPCT3/1, p = 0.022; ΔPCT5/1, p = 0.021). ΔPCT has no statistical significance in the severe sepsis and septic shock subgroups for all analyzed days. Only the 5th day PCT level was significantly higher in the non-survivors vs. survivors group (p = 0.008). The 1st day PCT level in the severe sepsis vs. septic shock group has a discriminative impact (p = 0.009).ConclusionsAccording to the results, single serum PCT measurement, regardless of absolute value, has a discriminative impact but no prognostic significance, during the first 2 days of therapy. The PCT kinetics is of prognostic value from the 3rd day and is of earlier prognostic significance in comparison to changes in the patient's clinical condition evaluated by SOFA score kinetics.

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Section: Discussionmentioning

confidence: 99%

Procalcitonin kinetics – prognostic and diagnostic significance in septic patients

Lipińska-Gediga¹,

Mierzchała-Pasierb²,

Durek³

2016

aoms

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“…Although other studies are required to evaluate the accuracy of these data in different populations, a recent meta-analysis found that IL-10 polymorphisms are associated with sepsis susceptibility in Caucasian and Asian populations ( Pan et al 2015 ). Furthermore, in addition to the risk of septic shock in this study possibly due to increased IL-10 plasma concentrations ( Wang et al 2011 ), it is now well-known that early sepsis diagnosis and correct clinical support compliance play a critical role in mortality ( de Oliveira et al 2013 , van Zanten et al 2014 ). In this context, we speculate that IL-10-induced immunosuppression may have a more important impact on the restriction of infection than on sepsis outcome.…”

Section: Discussionmentioning

confidence: 88%

Interleukin-10 rs1800896 and CXCR2 rs1126579 polymorphisms modulate the predisposition to septic shock

Cardoso

Oliveira

Botoni

et al. 2015

Mem. Inst. Oswaldo Cruz

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Despite major improvements in its treatment and diagnosis, sepsis is still a leading cause of death and admittance to the intensive care unit (ICU). Failure to identify patients at high risk of developing septic shock contributes to an increase in the sepsis burden and rapid molecular tests are currently the most promising avenue to aid in patient risk determination and therapeutic anticipation. The primary goal of this study was to evaluate the genetic susceptibility that affects sepsis outcome in 72 sepsis patients admitted to the ICU. Seven polymorphisms were genotyped in key inflammatory response genes in sepsis, including tumour necrosis factor-α, interlelukin (IL)-1β, IL-10, IL-8, Toll-like receptor 4, CXCR1 and CXCR2. The primary finding showed that patients who were homozygous for the major A allele in IL-10 rs1800896 had almost five times higher chance to develop septic shock compared to heterozygotes. Similarly, selected clinical features and CXCR2 rs1126579 single nucleotide polymorphisms modulated septic shock susceptibility without affecting survival. These data support the hypothesis that molecular testing has clinical usefulness to improve sepsis prognostic models. Therefore, enrichment of the ICU portfolio by including these biomarkers will aid in the early identification of sepsis patients who may develop septic shock.

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“…Human serum albumin masih sering digunakan untuk intervensi gizi atau untuk memperbaiki hipoalbuminemia. [8][9][10][11][12][13][14] Penggunaannya mungkin lebih didasarkan pada kebiasaan daripada alasan secara ilmiah. Karena ketersediaannya yang terbatas dan biaya yang mahal, maka sangat penting untuk membatasi penggunaan albumin hanya pada indikasi yang jelas agar memberikan efikasi dan efisiensi yang nyata.…”

Section: Pendahuluanunclassified

“…1,8 Albumin sering diberikan kepada pasien kondisi kritis dengan hipovolemia yang mengancam jiwa, salah satunya pada kondisi sepsis. [8][9][10][11][12][13][14][15][16] Konsentrasi albumin serum yang rendah terlihat pada berbagai keadaan penyakit, salah satunya pada kondisi sepsis dan mungkin disebabkan oleh kebocoran, peningkatan metabolisme, atau sintesis yang tidak mencukupi di hati. 4 Pada sepsis berat, dari hasil penelitian oleh Albumin Italian Outcome Sepsis (ALBIOS) tidak menunjukkan manfaat kelangsungan hidup terkait dengan pemberian albumin, namun mendapati penurunan mortalitas 90 hari pada subkelompok pasien dengan syok septik.…”

Section: Pendahuluanunclassified

Perbandingan Mortalitas antara Pemberian Albumin Intravena dan Tidak diberikan Albumin Intravena pada Pasien Sepsis dengan Kondisi Hipoalbuminemia dan Faktor yang Berpengaruh terhadap Mortalitas Pasien Sepsis

Marzuki

Supriono

Pratomo

et al. 2020

JPDI

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Pendahuluan. Hipoalbuminemia merupakan prediktor kuat terhadap mortalitas pada pasien non operatif maupun operatif. Albumin berperan mempertahankan tekanan onkotik pada kondisi kritis seperti sepsis. Pemberian human serum albumin (HSA) eksogen pada sepsis dengan kondisi hipoalbuminemia masih kontroversial dengan hasil luaran yang bervariasi. Penelitian ini dilakukan untuk mengetahui perbandingan mortalitas antara pasien sepsis dengan kondisi hipoalbuminemia yang diberikan albumin intravena dan tanpa pemberian albumin intravena serta mengetahui faktor yang berpengaruh terhadap mortalitas pasien sepsis. Metode. Penelitian observasional dengan pendekatan prospektif melibatkan 75 subjek penelitian usia >18 tahun dengan sepsis disertai hipoalbuminemia (<2,5 g/dL) yang dirawat di ruangan high care unit RSUD dr. Saiful Anwar Malang selama periode 1 September 2018-31 Agustus 2019 yang terbagi menjadi dua kelompok, yaitu kelompok albumin dan nonalbumin. Kedua kelompok diikuti selama hospitalisasi sampai pulang atau meninggal dunia. Perbedaan mortalitas antara kedua kelompok dianalisis dengan uji bivariat chi square. Faktor yang paling berpengaruh terhadap mortalitas dianalisis dengan uji multivariat regresi logistik berganda. Hasil. Didapatkan 39 orang (52%) dari kelompok albumin dan 36 orang (48%) dari kelompok non albumin. Perbedaan jumlah mortalitas antara kelompok albumin dan nonalbumin {25 (64,1%) vs. 16 (44,4%) yang mana perbedaan tersebut tidak bermakna secara statistik dengan nilai OR 2 (p=0,138}. Faktor yang berpengaruh terhadap mortalitas antara lain: skor SOFA (OR 34,27, p<0,001), nilai MAP (OR 8, p<0,001), kondisi syok septik (OR 4,31, p=0,03), diabetes melitus (OR 0,28, p=0,009), kondisi gagal nafas (OR 8,02, p<0,001), penurunan kesadaran (OR 64,75, p<0,001), gagal kardiovaskular (OR 6, p<0,001), dan kondisi gagal hematologi (OR 3,05, p=0,027). Faktor yang paling dominan berpengaruh terhadap mortalitas pasien sepsis adalah penurunan kesadaran (OR 2,67, p=0,001). Simpulan. Pemberian transfusi albumin tidak memberikan perbedaan bermakna terhadap kejadian mortalitas pada pasien sepsis dengan kondisi hipoalbuminemia. Faktor yang paling berpengaruh terhadap mortalitas pasien sepsis adalah kondisi penurunan kesadaran.

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Predictors of mortality in patients with severe sepsis or septic shock in the ICU of a public teaching hospital

Cited by 6 publications

References 0 publications

Procalcitonin kinetics – prognostic and diagnostic significance in septic patients

Procalcitonin kinetics – prognostic and diagnostic significance in septic patients

Interleukin-10 rs1800896 and CXCR2 rs1126579 polymorphisms modulate the predisposition to septic shock

Perbandingan Mortalitas antara Pemberian Albumin Intravena dan Tidak diberikan Albumin Intravena pada Pasien Sepsis dengan Kondisi Hipoalbuminemia dan Faktor yang Berpengaruh terhadap Mortalitas Pasien Sepsis

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