Articles: sepsis.
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Multicenter Study
Positive predictive value of the AHRQ Patient Safety Indicator "Postoperative Sepsis": implications for practice and policy.
Patient Safety Indicator (PSI) 13, or "Postoperative Sepsis," of the Agency for Healthcare Quality and Research (AHRQ), was recently adopted as part of a composite measure of patient safety by the Centers for Medicare and Medicaid Services (CMS). We sought to examine its positive predictive value (PPV) by determining how well it identifies true cases of postoperative sepsis. ⋯ PSI 13 has relatively poor predictive ability to identify true cases of postoperative sepsis in both the VA and nonfederal sectors. The lack of information on diagnosis timing, confusion about the definition of elective admission, and coding limitations were the major reasons for false positives. As it currently stands, the use of PSI 13 as a stand-alone measure for hospital reporting appears premature.
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Journal of critical care · Jun 2011
Multicenter StudyEarly changes of procalcitonin may advise about prognosis and appropriateness of antimicrobial therapy in sepsis.
The objective of this study is to define if early changes of procalcitonin (PCT) may inform about prognosis and appropriateness of administered therapy in sepsis. ⋯ Changes of serum PCT within the first 48 hours reflect the benefit or not of the administered antimicrobial therapy. Serial PCT measurements should be used in clinical practice to guide administration of appropriate antimicrobials.
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Critical care medicine · Jun 2011
Multicenter StudyPlatelet cytochrome c oxidase activity and quantity in septic patients.
The cytopathic hypoxia theory proposes that there is an impaired cellular oxygen utilization during sepsis. Respiratory complex IV, or cytochrome c oxidase, was only previously studied in muscle biopsies of 16 surviving and 12 nonsurviving septic patients. We hypothesized that higher activities and quantities of this enzyme complex could be associated with septic patient survival. The objective was to evaluate the relationship between cytochrome c oxidase activities and quantities and 6-month survival in a larger series of septic patients using a less invasive method (circulating platelets). ⋯ Platelet cytochrome c oxidase activity and quantity were independent predictors of 6-month survival and could be used as biomarkers of sepsis mortality. This is a rapid, easy, and less invasive protocol to assess mitochondrial function. Patients with lower cytochrome c oxidase activity and quantity could benefit from drugs that improve mitochondrial function.
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Multicenter Study
Validity of the AHRQ Patient Safety Indicator "central venous catheter-related bloodstream infections".
"Central venous catheter-related bloodstream infections" (CR-BSIs) is one of the patient safety indicators (PSI 7) developed by the Agency for Healthcare Research and Quality (AHRQ) to screen for potential safety events. We sought to investigate the validity of this PSI using the medical record as the gold standard. ⋯ PSI 7 has relatively poor predictive ability for identifying true events. Coding-related issues were the main reason for the low PPV. Implementing POA codes and using more specific ICD-9-CM codes would improve its validity. As it currently stands, PSI 7 should not be used as a pay-for-performance measure, but should be limited to use in internal quality improvement efforts.
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Critical care medicine · Apr 2011
Multicenter StudyAngiopoietin-1 and angiopoietin-2 as clinically informative prognostic biomarkers of morbidity and mortality in severe sepsis.
To determine the utility of angiopoietin-1 and angiopoietin-2 as potentially novel biomarkers of morbidity and mortality in patients with severe sepsis. ⋯ Angiopoietin-1 levels at admission and both angiopoietin-1 and angiopoietin-2 levels measured serially correlated with 28-day mortality in severe sepsis. Angiopoietin-2 levels also correlated with organ dysfunction/injury and a validated clinical sepsis score. These results suggest the use of angiopoietins as clinically informative biomarkers of disease severity and patient outcome in severe sepsis.