Articles: sepsis.
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Critical care medicine · Feb 2009
Randomized Controlled Trial Multicenter StudyAlkaline phosphatase treatment improves renal function in severe sepsis or septic shock patients.
Alkaline phosphatase (AP) attenuates inflammatory responses by lipopolysaccharide detoxification and may prevent organ damage during sepsis. To investigate the effect of AP in patients with severe sepsis or septic shock on acute kidney injury. ⋯ In severe sepsis and septic shock, infusion of AP inhibits the upregulation of renal inducible NO synthase, leading to subsequent reduced NO metabolite production, and attenuated tubular enzymuria. This mechanism may account for the observed improvement in renal function.
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Multicenter Study
Prognostic value of blood lactate levels: does the clinical diagnosis at admission matter?
Hyperlactatemia and its reduction after admission in the intensive care unit (ICU) have been related to survival. Because it is unknown whether this equally applies to different groups of critically ill patients, we compared the prognostic value of repeated lactate levels (a) in septic patients versus patients with hemorrhage or other conditions generally associated with low-oxygen transport (LT) (b) in hemodynamically stable versus unstable patients. ⋯ Regardless of the hemodynamic status, lactate reduction during the first 24 hours of ICU stay is associated with improved outcome only in septic patients, but not in patients with hemorrhage or other conditions generally associated with LT. We hypothesize that in this particular group a reduction in lactate is not associated with improved outcome due to irreversible damage at ICU admission.
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Critical care medicine · Feb 2009
Randomized Controlled Trial Multicenter StudyTight glycemic control may favor fibrinolysis in patients with sepsis.
To investigate whether tight glycemic control, in patients with sepsis, may restore a normal fibrinolysis by lowering plasminogen activator inhibitor (PAI)-1 levels. ⋯ Fibrinolysis inhibition, in severe sepsis/septic shock, seems to have a relevant pathogenetic role. In this context, tight glycemic control seems to reduce, with time, the fibrinolytic impairment and morbidity.
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The Journal of infection · Feb 2009
Multicenter StudyImpact of inappropriate empirical therapy for sepsis due to health care-associated methicillin-resistant Staphylococcus aureus.
We investigated the influence of empirical therapy on the mortality of patients with health care-associated (HCA) sepsis caused by methicillin-resistant Staphylococcus aureus (MRSA) infections in a multicenter cohort, and the variables associated with inappropriate empirical therapy. ⋯ Inappropriate empirical therapy was independently associated with increased mortality in this multicenter cohort. Clinicians should be aware of the need to consider coverage against MRSA more frequently.
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Liver failure is the principal cause of death after hepatectomy. Its progression towards death and its relationship with sepsis are unclear. This study analysed predictors of mortality in patients with liver dysfunction and the role of sepsis in the death of these patients. ⋯ Sepsis plays a key role in the death of patients with liver dysfunction after hepatectomy. Early recognition and aggressive treatment of sepsis may reduce mortality.