Articles: sepsis.
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Eur. J. Clin. Microbiol. Infect. Dis. · Feb 2018
Multicenter StudySustained high serum caspase-3 concentrations and mortality in septic patients.
Caspase-3 is the main executor of the apoptotic process. Higher serum caspase-3 concentrations in non-survivor compared to survivor septic patients have been found. The objectives of this work (with the increase of sample size to 308 patients, and the determination of serum caspase-3 concentrations also on days 4 and 8 of diagnosis of severe sepsis) were to know whether an association between serum caspase-3 concentrationss during the first week, degree of apoptosis, sepsis severity, and sepsis mortality exists. ⋯ We found higher serum concentrations of caspase-3 and CCCK-18 in non-survivors compared to survivors on days 1 (p < 0.001), 4 (p < 0.001), and 8 (p < 0.001). We found an association between serum caspase-3 concentrations on days 1, 4 and 8 of severe sepsis diagnosis and serum CCCK-18 concentrations (p < 0.001), SOFA (p < 0.001), serum acid lactic concentrations (p < 0.001), and 30-day sepsis mortality (p < 0.001). The new findings of this work were that an association between serum caspase-3 concentrations during the first week, apoptosis degree, sepsis severity, and sepsis mortality exists.
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Journal of critical care · Feb 2018
Multicenter StudyInitial fluid resuscitation following adjusted body weight dosing is associated with improved mortality in obese patients with suspected septic shock.
The optimal initial fluid resuscitation strategy for obese patients with septic shock is unknown. We evaluated fluid resuscitation strategies across BMI groups. ⋯ Using AdjBW to calculate initial fluid resuscitation volume for obese patients with suspected shock may improve outcomes compared to other weight-based dosing strategies. The optimal fluid dosing strategy for obese patients should be a focus of future prospective research.
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Multicenter Study
Multicentre validation of a sepsis prediction algorithm using only vital sign data in the emergency department, general ward and ICU.
We validate a machine learning-based sepsis-prediction algorithm (InSight) for the detection and prediction of three sepsis-related gold standards, using only six vital signs. We evaluate robustness to missing data, customisation to site-specific data using transfer learning and generalisability to new settings. ⋯ InSight outperforms existing sepsis scoring systems in identifying and predicting sepsis, severe sepsis and septic shock. This is the first sepsis screening system to exceed an AUROC of 0.90 using only vital sign inputs. InSight is robust to missing data, can be customised to novel hospital data using a small fraction of site data and retains strong discrimination across all institutions.
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Multicenter Study
Serum lactate cut-offs as a risk stratification tool for in-hospital adverse outcomes in emergency department patients screened for suspected sepsis.
We investigated specific lactate thresholds for adverse outcomes in patients presenting to emergency departments (EDs) with suspected sepsis identified based on the performance of a sepsis screening algorithm. ⋯ ED sepsis screening algorithms intended to identify patient adverse outcomes should incorporate a serum lactate cut-off of ≥2 mmol/L as a threshold for the initiation of specific interventions and increased monitoring.
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Multicenter Study Observational Study
Quick Sequential [Sepsis-Related] Organ Failure Assessment (qSOFA) and St. John Sepsis Surveillance Agent to Detect Patients at Risk of Sepsis: An Observational Cohort Study.
The 2016 Sepsis-3 guidelines included the Quick Sequential [Sepsis-related] Organ Failure Assessment (qSOFA) tool to identify patients at risk of sepsis. The objective was to compare the utility of qSOFA to the St. John Sepsis Surveillance Agent among patients with suspected infection. ⋯ Time-to-event clinical process modeling also was applied. The St. John Sepsis Surveillance Agent, when compared to qSOFA, activated earlier and was more accurate in predicting patient outcomes; in this regard, qSOFA fell far behind on both objectives.