The “Centrality of Sepsis”: A Review on Incidence, Mortality, and Cost of Care

Hajj, Jihane; Blaine, Natalie; Salavaci, Jola; Jacoby, Douglas

doi:10.3390/healthcare6030090

Cited by 96 publications

(74 citation statements)

References 36 publications

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“…Baseline characteristics of included patients are shown in Table 1. Patients were predominantly male (63%) with a median age of 67 years [54-77], a median APACHE II score of 16 [12][13][14][15][16][17][18][19][20][21] and a median SOFA score of 10 [7][8][9][10][11][12]. Forty-four (92%) patients were in septic shock, 48 (100%) required mechanical ventilation.…”

Section: Population Characteristicsmentioning

confidence: 99%

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Ocular microvascular changes in patients with sepsis: a prospective observational study

Šimkienė

Pranskūnienė

Vitkauskienė

et al. 2020

Ann. Intensive Care

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Background: The aim of the study was to detect differences in the conjunctival microcirculation between septic patients and healthy subjects and to evaluate the course of conjunctival and retinal microvasculature in survivors and non-survivors over a 24-h period of time. Methods: This single-center prospective observational study was performed in mixed ICU in a tertiary teaching hospital. We included patients with sepsis or septic shock within the first 24 h after ICU admission. Conjunctival imaging, using an IDF video microscope, and retinal imaging, using portable digital fundus camera, as well as systemic hemodynamic measurements, were performed at three time points: at baseline, 6 h and 24 h. Baseline conjunctival microcirculatory parameters were compared with healthy controls. Results: A total of 48 patients were included in the final assessment and analysis. Median APACHE II and SOFA scores were 16[12-21] and 10[7-12], respectively. Forty-four (92%) patients were in septic shock, 48 (100%) required mechanical ventilation. 19 (40%) patients were discharged alive from the intensive care unit. We found significant reductions in all microcirculatory parameters in the conjunctiva when comparing septic and healthy subjects. In addition, we observed a significant lower microvascular flow index (MFI) of small conjunctival vessels during all three time points in non-survivors compared with survivors. However, retinal arteriolar vessels were not different between survivors and non-survivors. Conclusions: Conjunctival microvascular blood flow was altered in septic patients. In the 24-h observation period conjunctival small vessels had a significantly higher MFI, but no difference in retinal arteriolar diameter in survivors in comparison with non-survivors.

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Section: Population Characteristicsmentioning

confidence: 99%

“…Sepsis is associated with a high mortality worldwide [8]. Microvascular alterations are considered a key characteristic of sepsis and its severity is related to morbidity and mortality [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Ocular microvascular changes in patients with sepsis: a prospective observational study

Šimkienė

Pranskūnienė

Vitkauskienė

et al. 2020

Ann. Intensive Care

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“…These are symptoms that are also highly correlated with severe sepsis cases. The two diseases also share similar co-morbidity risks including dementia, type 2 diabetes mellitus, coronary heart disease, hypertension and chronic renal failure 8 . Sepsis has been observed in up to 59% of hospitalized COVID-19 patients 9 .…”

Section: Introductionmentioning

confidence: 99%

Identification and Analysis of Shared Risk Factors in Sepsis and High Mortality Risk COVID-19 Patients

Das¹,

Taylor²,

Pearson³

et al. 2020

Preprint

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BACKGROUNDCoronavirus disease 2019 (COVID-19) is a novel coronavirus strain disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease is highly transmissible and severe disease including viral sepsis has been reported in up to 16% of hospitalized cases. The admission characteristics associated with increased odds of hospital mortality among confirmed cases of COVID-19 include severe hypoxia, low platelet count, elevated bilirubin, hypoalbuminemia and reduced glomerular filtration rate. These symptoms correlate highly with severe sepsis cases. The diseases also share similar comorbidity risks including dementia, type 2 diabetes mellitus, coronary heart disease, hypertension and chronic renal failure. Sepsis has been observed in up to 59% of hospitalized COVID-19 patients.It is highly desirable to identify risk factors and novel therapy/drug repurposing avenues for late-stage severe COVID-19 patients. This would enable better protection of at-risk populations and clinical stratification of COVID-19 patients according to their risk for developing life threatening disease. METHODSAs there is currently insufficient data available for confirmed COVID-19 patients correlating their genomic profile, disease severity and outcome, co-morbidities and treatments as well as epidemiological risk factors (such as ethnicity, blood group, smoking, BMI etc.), a direct study of the impact of host genomics on disease severity and outcomes is not yet possible. We therefore ran a study on the UK Biobank sepsis cohort as a surrogate to identify sepsis associated signatures and genes, and correlated these with COVID-19 patients.Sepsis is itself a life-threatening inflammatory health condition with a mortality rate of approximately 20%. Like the initial studies for COVID-19 patients, standard genome wide association studies (GWAS) have previously failed to identify more than a handful of genetic variants that predispose individuals to developing sepsis. RESULTSWe used a combinatorial association approach to analyze a sepsis population derived from UK Biobank. We identified 70 sepsis risk-associated genes, which provide insights into the disease mechanisms underlying sepsis pathogenesis. Many of these targets can be grouped by common mechanisms of action such as endothelial cell dysfunction, PI3K/mTOR pathway signaling, immune response regulation, aberrant GABA and neurogenic signaling. CONCLUSIONThis study has identified 70 sepsis related genes, many of them for the first time, that can reasonably be considered to be potentially relevant to severe COVID-19 patients. We have further identified 59 drug repurposing candidates for 13 of these targets that can be used for the development of novel therapeutic strategies to increase the survival rate of patients who develop sepsis and potentially severe COVID-19.

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“…Sepsis is characterized by high morbidity and mortality worldwide (1). Confronted with a septic patient with high risk of death, it is mandatory to have a prompt attitude in order to establish a rapid diagnosis and an efficient therapy.…”

Section: Introductionmentioning

confidence: 99%

The usefulness of neutrophil/lymphocyte count ratio in the diagnosis and prognosis of bacterial sepsis – An old parameter with new implications

Orfanu

Popescu

Tilişcan

et al. 2020

Revista Romana De Medicina De Laborator

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Aims:To analyze the diagnostic role of neutrophil/lymphocyte count ratio (NLCR) in sepsis and to evaluate its usefulness in appreciating the prognosis of septic patients. Methods : A prospective analysis of patients diagnosed with sepsis between October 2015 and July 2017 was performed. A control group of patients with systemic inflammatory response syndrome (SIRS) with noninfectious causes was recruited. The sensitivity, specificity and AUC of NCLR for sepsis diagnosis were comparatively assessed with other biomarkers including fibrinogen (FIB), C-reactive protein (CRP) and procalcitonin (PCT). The baseline levels of NLCR were correlated with APACHE IV, APS and SOFA scores of severity. Results : We enrolled 105 patients with sepsis and 37 patients with noninfectious SIRS. NLCR had significantly higher levels in the first group (p<0.05). For an optimal cut-off value of 8.18, the sensitivity, specificity and AUC of NLCR for sepsis diagnosis were 70.5%, 72.2% and 0.766, respectively. A cut-off value of 12.0 led to moderate sensitivity (58.7%) and moderate-to-high specificity (89%). For patients with SOFA score over 2 points, the characteristics did not significantly improve. The correlations between baseline NCLR and the severity scores were not statistically significant. Conclusion : NLCR levels were significantly higher in sepsis group compared to noninfectious SIRS group. NLCR had moderate sensitivity and specificity regarding sepsis diagnosis. Baseline levels of NLCR did not correlate with the severity scores, so its usefulness in sepsis prognosis was limited.

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The “Centrality of Sepsis”: A Review on Incidence, Mortality, and Cost of Care

Cited by 96 publications

References 36 publications

Ocular microvascular changes in patients with sepsis: a prospective observational study

Ocular microvascular changes in patients with sepsis: a prospective observational study

Identification and Analysis of Shared Risk Factors in Sepsis and High Mortality Risk COVID-19 Patients

The usefulness of neutrophil/lymphocyte count ratio in the diagnosis and prognosis of bacterial sepsis – An old parameter with new implications

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