The direct costs of intensive care management and risk factors for financial burden of patients with severe sepsis and septic shock

Khwannimit, Bodin; Bhurayanontachai, Rungsun

doi:10.1016/j.jcrc.2015.05.011

Cited by 30 publications

(42 citation statements)

References 29 publications

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“…Overall, the in-hospital mortality rate of septic shock patients was 49.3%, which was similar to the result from a previous study. 12 Surprisingly, in our multivariate analysis, time from the diagnosis of sepsis to antibiotic administration was not associated with 28-day mortality. However, the results confirmed outcomes of a recent meta-analysis of 11 studies that showed no mortality benefit of antibiotic administration within 3 h of the ED triage or within 1 h from septic shock recognition.…”

Section: Discussionmentioning

confidence: 57%

“…The majority of septic patients admitted to the medical intensive care unit (MICU) are from 2 sources: hospital wards and the emergency department (ED). 12 Since the settings of these sources are different, the timing of the compliance of appropriate antibiotic administration and lactate measurement is different. One study revealed different times of antibiotic administration between hospital wards and the ED but lacked data on the timing intervals; also, no timing of lactate measurement was reported.…”

Section: Introductionmentioning

confidence: 99%

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Timing of antibiotic administration and lactate measurement in septic shock patients: a comparison between hospital wards and the emergency department

Vattanavanit¹,

Buppodom²,

Khwannimit³

2018

IDR

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BackgroundThe timing of intravenous antibiotic administration and lactate measurement is associated with survival of septic shock patients. Septic shock patients were admitted to the medical intensive care unit (MICU) from 2 major sources: hospital ward and emergency department (ED). This study aimed to compare the timing of antibiotic administration and lactate measurement between hospital wards and the ED.Patients and methodsMedical data were collected from adult patients admitted to the MICU with septic shock from January 2015 to December 2016. “Time Zero” was defined as the time of diagnosis of sepsis. The associations between the times and risk-adjusted 28-day mortality were assessed.ResultsIn total, 150 septic shock patients were admitted to the MICU. The median time interval (hour [h] interquartile range [IQR]) from time zero to antibiotic administration was higher in patients from the hospital wards compared to those from the ED (4.84 [3.5–8.11] vs 2.04 [1.37–3.54], P<0.01), but the lactate level measurement time interval (h [IQR]) from time zero was not different between the hospital wards and the ED (1.6 [0.2–2.7] vs 1.6 [0.9–3.0], P=0.85). In multivariate analysis, higher risk-adjusted 28-day mortality was associated with antibiotic monotherapy (odds ratio [OR]: 19.3, 95% confidence interval [CI]: 2.4–153.1, P<0.01) and admission during the weekends (OR: 24.4, 95% CI: 2.9–199.8, P<0.01).ConclusionAntibiotic administration in septic shock patients from the hospital wards took longer, and there was also less appropriate antibiotic prescriptions seen in this group compared with those admitted from the ED. However, neither the timing of antibiotic administration nor lactate measurement was associated with mortality.

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Section: Discussionmentioning

confidence: 57%

Section: Introductionmentioning

confidence: 99%

Timing of antibiotic administration and lactate measurement in septic shock patients: a comparison between hospital wards and the emergency department

Vattanavanit¹,

Buppodom²,

Khwannimit³

2018

IDR

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“…Sepsis and septic shock is a devastating condition with mortality rates between 20 and 50% [1][2][3]. The pathophysiology of sepsis is remarkably complex, which explains the heterogeneous, often unpredictable clinical appearance of this condition [4,5].…”

Section: Introductionmentioning

confidence: 99%

Extracorporeal cytokine adsorption in septic shock: A proof of concept randomized, controlled pilot study

Hawchar

László

Öveges

et al. 2019

Journal of Critical Care

148

164

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Background: The aim of this proof of concept, prospective, randomized pilot trial was to investigate the effects of extracorporeal cytokine removal (CytoSorb®) applied as a standalone treatment in patients with septic shock. Methods: 20 patients with early (b24 h) onset of septic shock of medical origin, on mechanical ventilation, norepinephrineN10 μg/min, procalcitonin (PCT) N 3 ng/mL without the need for renal replacement therapy were randomized into CytoSorb (n = 10) and Control groups (n = 10). CytoSorb therapy lasted for 24 h. Clinical and laboratory data were recorded at baseline (T 0), T 12 , T 24 , and T 48 hours. Results: Overall SOFA scores did not differ between the groups. In the CytoSorb-group norepinephrine requirements and PCT concentration decreased significantly

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“…It has been estimated that mortality due to sepsis is between 30-50% and it increases up to 70% in the case of septic shock and related multiorgan failure [2]. Despite years of intensive research and advances in supportive care, sepsis remains an enigmatic and very heterogenic syndrome and a tremendous financial burden for the healthcare systems [3].…”

Section: Introductionmentioning

confidence: 99%

RNA-seq analysis of LPS-induced transcriptional changes and its possible implications for the adrenal gland dysregulation during sepsis

Chen

Singh

Schuster

et al. 2019

The Journal of Steroid Biochemistry and Molecular Biology

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Activation of the adrenal gland stress response is of utmost importance to survive sepsis. Experimental and clinical evidence exists demonstrating that adrenal gland often develops functional and structural damage due to sepsis with mechanisms remaining largely unknown. In the present study, we have used RNA Sequencing (RNA-Seq) technology to analyze changes in adrenal transcriptome elucidated by bacterial LPS. We aimed to find particularly alterations in genes that were previously not reported to be involved in the adrenal gland dysregulation in contexts of sepsis. Our results demonstrate that systemic administration of LPS significantly altered expression of 8458 genes as compared to saline injected animals. The subsequent quality and functional analysis of these gene signatures revealed that LPS-induced highly homogenous transcriptional response in total upregulating 4312 and downregulating 4146 genes. Furthermore, functional annotation analysis together with gene enrichment set analysis (GSEA) clearly demonstrated that adrenal response to LPS involved alterations in multiple pathways related to the inflammatory response along with previously unexplored activation of the hypoxia pathway. In addition, LPS strongly downregulated genes involved in the adrenal homeostasis, development, and regeneration. Those alterations were subsequently verified in clinically relevant cecal ligation and puncture (CLP)-induced sepsis model. Collectively, our study demonstrates that RNA-seq is a very useful method that can be applied to search for new unexplored pathways potentially involved in adrenal gland dysregulation during sepsis.

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The direct costs of intensive care management and risk factors for financial burden of patients with severe sepsis and septic shock

Cited by 30 publications

References 29 publications

Timing of antibiotic administration and lactate measurement in septic shock patients: a comparison between hospital wards and the emergency department

Timing of antibiotic administration and lactate measurement in septic shock patients: a comparison between hospital wards and the emergency department

Extracorporeal cytokine adsorption in septic shock: A proof of concept randomized, controlled pilot study

RNA-seq analysis of LPS-induced transcriptional changes and its possible implications for the adrenal gland dysregulation during sepsis

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