Intensive care medicine
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Intensive care medicine · Aug 2017
Multicenter StudyPotentially modifiable factors contributing to sepsis-associated encephalopathy.
Identifying modifiable factors for sepsis-associated encephalopathy may help improve patient care and outcomes. ⋯ Acute renal failure and common metabolic disturbances represent potentially modifiable factors contributing to sepsis-associated encephalopathy. However, a true causal relationship has yet to be demonstrated. Our study confirms the prognostic significance of mild alteration of mental status in patients with sepsis.
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Intensive care medicine · Aug 2017
Randomized Controlled Trial Observational StudyExternal validation of a biomarker and clinical prediction model for hospital mortality in acute respiratory distress syndrome.
Mortality prediction in ARDS is important for prognostication and risk stratification. However, no prediction models have been independently validated. A combination of two biomarkers with age and APACHE III was superior in predicting mortality in the NHLBI ARDSNet ALVEOLI trial. We validated this prediction tool in two clinical trials and an observational cohort. ⋯ We validated a mortality prediction model for ARDS that includes age, APACHE III, surfactant protein D, and interleukin-8 in a variety of clinical settings. Although the model performance as measured by AUC was lower than in the original model derivation cohort, the biomarker/clinical model still performed well and may be useful for risk assessment for clinical trial enrollment, an issue of increasing importance as ARDS mortality declines, and better methods are needed for selection of the most severely ill patients for inclusion.
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Intensive care medicine · Aug 2017
Multicenter StudyPrediction of pediatric sepsis mortality within 1 h of intensive care admission.
The definitions of sepsis and septic shock have recently been revised in adults, but contemporary data are needed to inform similar approaches in children. ⋯ We observed mortality patterns specific to pediatric sepsis that support the need for specialized definitions of sepsis severity in children. We demonstrated the importance of lactate, cardiovascular, and respiratory derangements at ICU admission for the identification of children with substantially higher risk of sepsis mortality.