Reasons for death in patients with sepsis and septic shock

Moskowitz, Ari; Omar, Yasser G.; Chase, Maureen; Lokhandwala, Sharukh; Patel, Parth; Andersen, Lars W.; Cocchi, Michael N.; Donnino, Michael W.

doi:10.1016/j.jcrc.2016.11.036

Cited by 45 publications

(38 citation statements)

References 22 publications

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“…of patients presenting with a GCS < 9 was significantly higher among patients dying from CNS complications than among patients dying from systemic complications (p = 0.011) that these patients were wrongly labelled due to the retrospective clinical evaluation. Our interrater agreement is comparable to other previous studies and we find the agreement to be acceptable [2,14]. The review of cases with disagreement with a third expert resulted in full agreement.…”

Section: Microbiologysupporting

confidence: 88%

“…The very different courses of disease that lead to death from meningitis emphasize the need for a nuanced view on fatal cases. Categorizing the cause of death as well as characterizing each case has also been suggested in studies of the cause of death from sepsis [12][13][14]. The goal is to be able to prevent complications and to improve the validity of clinical trials by improving study homogeneity.…”

Section: Discussionmentioning

confidence: 99%

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The cause of death in bacterial meningitis

et al. 2020

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Background: Death from bacterial meningitis is rarely attributed to the actual event causing death. The present study therefore categorized and characterized the cause and time of death due to bacterial meningitis. Methods: In a cohort of patients > 15 years of age with community acquired bacterial meningitis the medical records were reviewed, and a clinical cause of death categorized into six main categories: 1) CNS complications, 2) Systemic complications, 3) Combination of systemic and CNS complications, 4) Sudden death, 5) Withdrawal of care, or 6) Unknown. Results: We identified 358 patients of which 84 (23%) died in-hospital. Causes of death were ascribed to CNS complications in 43%, Systemic complications in 39%, Combined CNS and systemic complications in 4%, Sudden death in 7% and withdrawal of care in 5%. Brain herniation, circulatory failure, intractable seizures and other brain injury were the most common specific causes of death within 14 days from admission (55%). Conclusion: Fatal complications due to the primary infectionmeningitis-is most common within 14 days of admission. The diversity of complications causing death in meningitis suggest that determining the clinical cause of death is essential to the evaluation of novel treatment strategies.

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Section: Microbiologysupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

The cause of death in bacterial meningitis

et al. 2020

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“…Sepsis and septic shock are the most common causes of death in the ICU [ 23 , 24 ]. In recent years, the age of patients suffering from sepsis admitted to the ICU has been increasing [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

Reduction in the IL-6 level at 24 h after admission to the intensive care unit is a survival predictor for Vietnamese patients with sepsis and septic shock: a prospective study

et al. 2018

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BackgroundSepsis and septic shock are common problems in intensive care units (ICUs). The mortality of patients with sepsis or septic shock is high. We investigated if reduction in the serum concentration of the cytokines tumor necrosis factor α, interleukin (IL)-6 and IL-10, and the rate of change in the IL-6 level at 24 h after ICU admission were survival predictors for patients with sepsis and septic shock in a Vietnamese population.MethodsThis was a prospective study conducted at an ICU in Cho Ray Hospital, Vietnam, from October 2014 to October 2016. Patients diagnosed with sepsis or septic shock using validated international guidelines were enrolled. Plasma samples were collected upon (T0) and 24 h after (T24) ICU admission for measurement of cytokine concentrations. Blood tests were done to detect organ dysfunction. The duration of ICU stays, hospital stay, APACHE II and SOFA scores, and the in-hospital mortality were compared between survival and non-survival groups. Univariate logistic regression and multivariate analysis were done to determine the association between survival and IL-6 reduction at 24 h after ICU admission.ResultsA total of 123 patients were enrolled. The concentration (in pg/mL) of IL-6 at To was 413.3 in survivors and 530.0 in non- survivors. At T24, the IL-6 level was 65.4 for survivors and 286.9 for non-survivors. The survival rate was 39.0%. At T24, the concentrations of IL-6 and the reduction in IL-6 level were predictors of survival in patients with sepsis and septic shock. We found a significant association between IL-6 reduction and survival at ≥86% with Odds Ratio (OR) 5.67, 95% Confidence Interval (CI); 1.27–25.3, compared with an increase in the IL-6 rate of change.ConclusionsOur findings suggested that a reduction in the IL-6 level of ≥86% at 24 h from ICU admission is a survival predictor for patients with sepsis and septic shock in our population.

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“…Sepsis is a major cause of morbidity and mortality, with an estimated worldwide population incidence rate of 437 cases per 100,000 person years . Despite the availability of antibiotics, sepsis remains a major health concern and currently is the most common reason for death in intensive care units . The majority of sepsis cases are preceded by pneumonia .…”

Section: Introductionmentioning

confidence: 99%

Human Adipose-Derived Mesenchymal Stem Cells Modify Lung Immunity and Improve Antibacterial Defense in Pneumosepsis Caused by Klebsiella pneumoniae

Perlee

Vos

Scicluna

et al. 2019

Stem Cells Translational Medicine

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Adult mesenchymal stem cells exert immunomodulatory effects that might improve the host response during sepsis. Knowledge on the effect of adipose‐derived mesenchymal stem cells (ASCs) in sepsis is limited. Klebsiella (K.) pneumoniae is a common cause of gram‐negative pneumonia and sepsis. This study sought to determine the effect of human ASCs on the host response during pneumosepsis in mice. Mice were infected with K. pneumoniae via the airways to induce a gradually evolving infection in the lung culminating pneumosepsis. One or 6 hours after infection, mice were infused intravenously with ASCs or vehicle, and euthanized after 16 hours or 48 hours, respectively. The effects of freshly cultured and cryopreserved ASCs were compared, the latter formulation being more clinically relevant. Intravenously administered ASCs were visualized in lung tissue by immunostaining at 1 and 3 hours, but not at 15 hours after infusion. Although early after infection, ASCs did not or only modestly influence bacterial loads, they reduced bacterial burdens in lungs and distant organs at 48 hours. ASCs reduced the lung levels of pro‐inflammatory cytokines and attenuated lung pathology, but did not influence distant organ injury. ASCs strongly modified the lung transcriptome in uninfected mice and especially mice with pneumosepsis. Cryopreserved and cultured ASCs induced largely similar effects on the lung transcriptome. These data indicate that human ASCs induce profound immune modulatory effects in the lungs, resulting in reduced bacterial burdens and lung inflammation during pneumosepsis caused by a common human pathogen, suggesting that ASCs may be an adjunctive therapeutic in this condition. Stem Cells Translational Medicine 2019;8:785&796

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Reasons for death in patients with sepsis and septic shock

Cited by 45 publications

References 22 publications

The cause of death in bacterial meningitis

The cause of death in bacterial meningitis

Reduction in the IL-6 level at 24 h after admission to the intensive care unit is a survival predictor for Vietnamese patients with sepsis and septic shock: a prospective study

Human Adipose-Derived Mesenchymal Stem Cells Modify Lung Immunity and Improve Antibacterial Defense in Pneumosepsis Caused by Klebsiella pneumoniae

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