Prompt admission to intensive care is associated with improved survival in patients with severe sepsis and/or septic shock

Li, Qiang; Wang, Jiajiong; Liu, Guomin; Xu, Meng; Qin, Yanguo; Qin, Han; Li, He; Wang, Xiaonan; Wang, Zonghan; Yang, Ke; Gao, Chaohua; Wang, Jincheng; Zhang, Zhongheng

doi:10.1177/0300060518781253

Cited by 10 publications

(9 citation statements)

References 34 publications

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“…951 This is more limited with regard to sepsis, but a report has indicated that every hour of delay from hospital visit to ICU admission in severe septic/septic shock increased the adjusted odds ratio of the mortality rate by 1.11 (95%CI: 1.01 to 1.02). 966 …”

Section: Methods Used For Creating This Guidelinementioning

confidence: 99%

“…RCTs are virtually impossible in this field, and a consensus was reached with the current evidence that critically ill patients should be managed at the ICU even in the Admission, Discharge, and Triage Guidelines 951 . This is more limited with regard to sepsis, but a report has indicated that every hour of delay from hospital visit to ICU admission in severe septic/septic shock increased the adjusted odds ratio of the mortality rate by 1.11 (95%CI: 1.01 to 1.02) 966 …”

Section: Methods Used For Creating This Guidelinementioning

confidence: 99%

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The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J‐SSCG 2020)

Egi

Ogura

Yatabe

et al. 2021

Acute Medicine & Surgery

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The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J‐SSCG 2020), a Japanese‐specific set of clinical practice guidelines for sepsis and septic shock created as revised from J‐SSCG 2016 jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in September 2020 and published in February 2021. An English‐language version of these guidelines was created based on the contents of the original Japanese‐language version. The purpose of this guideline is to assist medical staff in making appropriate decisions to improve the prognosis of patients undergoing treatment for sepsis and septic shock. We aimed to provide high‐quality guidelines that are easy to use and understand for specialists, general clinicians, and multidisciplinary medical professionals. J‐SSCG 2016 took up new subjects that were not present in SSCG 2016 (e.g., ICU‐acquired weakness [ICU‐AW], post‐intensive care syndrome [PICS], and body temperature management). The J‐SSCG 2020 covered a total of 22 areas with four additional new areas (patient‐ and family‐centered care, sepsis treatment system, neuro‐intensive treatment, and stress ulcers). A total of 118 important clinical issues (clinical questions, CQs) were extracted regardless of the presence or absence of evidence. These CQs also include those that have been given particular focus within Japan. This is a large‐scale guideline covering multiple fields; thus, in addition to the 25 committee members, we had the participation and support of a total of 226 members who are professionals (physicians, nurses, physiotherapists, clinical engineers, and pharmacists) and medical workers with a history of sepsis or critical illness. The GRADE method was adopted for making recommendations, and the modified Delphi method was used to determine recommendations by voting from all committee members. As a result, 79 GRADE‐based recommendations, 5 Good Practice Statements (GPS), 18 expert consensuses, 27 answers to background questions (BQs), and summaries of definitions and diagnosis of sepsis were created as responses to 118 CQs. We also incorporated visual information for each CQ according to the time course of treatment, and we will also distribute this as an app. The J‐SSCG 2020 is expected to be widely used as a useful bedside guideline in the field of sepsis treatment both in Japan and overseas involving multiple disciplines.

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Section: Methods Used For Creating This Guidelinementioning

confidence: 99%

Section: Methods Used For Creating This Guidelinementioning

confidence: 99%

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J‐SSCG 2020)

Egi

Ogura

Yatabe

et al. 2021

Acute Medicine & Surgery

View full text Add to dashboard Cite

show abstract

“…RCTs are virtually impossible in this field, and a consensus was reached with the current evidence that critically ill patients should be managed at the ICU even in the Admission, Discharge, and Triage Guidelines [ 989 ]. This is more limited with regard to sepsis, but a report has indicated that every hour of delay from hospital visit to ICU admission in severe septic/septic shock increased the adjusted odds ratio of the mortality rate by 1.11 (95%CI: 1.01 to 1.02) [ 1004 ].…”

Section: Methods Used For Creating This Guidelinementioning

confidence: 99%

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020)

et al. 2021

View full text Add to dashboard Cite

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020), a Japanese-specific set of clinical practice guidelines for sepsis and septic shock created as revised from J-SSCG 2016 jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in September 2020 and published in February 2021. An English-language version of these guidelines was created based on the contents of the original Japanese-language version. The purpose of this guideline is to assist medical staff in making appropriate decisions to improve the prognosis of patients undergoing treatment for sepsis and septic shock. We aimed to provide high-quality guidelines that are easy to use and understand for specialists, general clinicians, and multidisciplinary medical professionals. J-SSCG 2016 took up new subjects that were not present in SSCG 2016 (e.g., ICU-acquired weakness [ICU-AW], post-intensive care syndrome [PICS], and body temperature management). The J-SSCG 2020 covered a total of 22 areas with four additional new areas (patient- and family-centered care, sepsis treatment system, neuro-intensive treatment, and stress ulcers). A total of 118 important clinical issues (clinical questions, CQs) were extracted regardless of the presence or absence of evidence. These CQs also include those that have been given particular focus within Japan. This is a large-scale guideline covering multiple fields; thus, in addition to the 25 committee members, we had the participation and support of a total of 226 members who are professionals (physicians, nurses, physiotherapists, clinical engineers, and pharmacists) and medical workers with a history of sepsis or critical illness. The GRADE method was adopted for making recommendations, and the modified Delphi method was used to determine recommendations by voting from all committee members.As a result, 79 GRADE-based recommendations, 5 Good Practice Statements (GPS), 18 expert consensuses, 27 answers to background questions (BQs), and summaries of definitions and diagnosis of sepsis were created as responses to 118 CQs. We also incorporated visual information for each CQ according to the time course of treatment, and we will also distribute this as an app. The J-SSCG 2020 is expected to be widely used as a useful bedside guideline in the field of sepsis treatment both in Japan and overseas involving multiple disciplines.

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“…3,5 Identifying the severity of disease and likelihood of further deterioration of surgical sepsis patients with high accuracy and rapid turnaround remains a critical unmet need for hospitalized patients, since time to intervention and antimicrobial treatment is a critical determinant of outcome. 6,7 Current in-hospital early warning systems for sepsis (Modified Early Warning System [MEWS]) are used to alert health-care providers to the possibility of sepsis. 8 In many cases, the decision to initiate sepsis resuscitation bundles and more intensive management is an empiric decision made by the health-care provider at the bedside, prior to documentary evidence of microbial infection, organ injury or immunological dyscrasia.…”

Section: Introductionmentioning

confidence: 99%

A Transcriptomic Severity Metric that Predicts Clinical Outcomes in Critically Ill Surgical Sepsis Patients

Brakenridge

Starostik

Ghita

et al. 2021

Preprint

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Purpose: Prognostic metrics for the rapid and accurate prediction of sepsis severity that could elicit a meaningful change in clinical practice are currently lacking. Here, we evaluated a whole blood, multiplex host mRNA expression metric, Inflammatix-Severity-2 (IMX-SEV-2), for identifying septic, hospitalized patients for 30-day mortality, development of chronic critical illness (CCI), discharge disposition, and/or secondary infections. Methods: This is a retrospective, validation cohort analysis of a prospectively enrolled 335 patient study with surgical sepsis treated in the surgical intensive care unit. Whole blood collected in PAXgene Blood RNA collection tubes at 24 hours post sepsis diagnosis was analyzed using a custom 29-mRNA classifier (IMX-SEV-2) in a CLIA-CAP-accredited diagnostic laboratory using the NanoString FLEX profiler. Results: Among patients meeting Sepsis-3 criteria, the IMX-SEV-2 severity score was significantly better (p<0.05) at predicting secondary infections (AUROC 0.71) and adverse clinical outcomes (AUROC 0.75) than C-reactive protein (CRP), absolute lymphocyte counts (ALC), total white blood cell (WBC) count, age and Charlson comorbidity index (and better, albeit nonsignificantly, than IL-6 and APACHE II). Using multivariate logistic regression analysis, only combining the Charlson comorbidity index (AUROC 0.80) or APACHE II (AUROC 0.81) with the IMX-SEV-2 significantly improved prediction of adverse clinical outcomes, and combining with the Charlson comorbidity index for predicting 30-day mortality (AUROC 0.79). Conclusions: The IMX-SEV-2 severity score was superior at predicting secondary infections and overall adverse clinical outcomes versus other common metrics. Importantly, combining a rapidly measured transcriptomic metric with clinical or physiologic indices has sufficient precision to optimize resource utilization and allow adjustments to patient management that may improve outcomes in surgical sepsis. Hospitalized patients who are septic and present with an elevated IMX-SEV2 severity score and pre-existing comorbidities would be strong candidates for clinical interventions aimed at reducing the risk of secondary infections and adverse clinical outcomes.

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Prompt admission to intensive care is associated with improved survival in patients with severe sepsis and/or septic shock

Cited by 10 publications

References 34 publications

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J‐SSCG 2020)

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J‐SSCG 2020)

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020)

A Transcriptomic Severity Metric that Predicts Clinical Outcomes in Critically Ill Surgical Sepsis Patients

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