Jinfeng Xiao; Hongyuan Zhou; Yuanyuan Guo
Volume 22, Issue 3 , 2020
Abstract
Background: The changes before and after fluid resuscitation in patients with septic shock and their relationship with prognosis have rarely been reported.
Objectives: We aimed to observe the correlation between pulmonary vascular permeability index (PVPI), shock index (SI), and severity of ...
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Background: The changes before and after fluid resuscitation in patients with septic shock and their relationship with prognosis have rarely been reported.
Objectives: We aimed to observe the correlation between pulmonary vascular permeability index (PVPI), shock index (SI), and severity of septic shock.
Methods: This case-control study retrospectively analyzed the clinical data of 154 patients with septic shock treated at our hospital (Weifang, China) from October 2016 to October 2018. They were divided into a survival group or a death group according to the 28-day prognosis. Univariate analysis was performed for vital signs, the acute physiology and chronic health evaluation II (APACHE-II) score, the sequential organ failure assessment (SOFA) score at admission, SI at admission (SI1), SI at 3 h after fluid resuscitation (SI2), PVPI at admission (PVPI1), PVPI at 3 h after fluid resuscitation (PVPI2), and lactate clearance rate (LCR). The correlations of PVPI and SI with the APACHE-II score, SOFA score, and LCR were analyzed by plotting the receiver operating characteristic curves.
Results: Among the 154 cases, 70 survived after 28 days and 84 died. We observed that SI1, SI2, PVPI1, PVPI2, APACHE-II score, and SOFA score were significantly lower in the survival group than in the death group, while LCR was significantly higher (P < 0.05). Also, SI1, SI2, PVPI1, and PVPI2 were positively correlated with APSCHE-II and SOFA scores of patients with septic shock, but negatively correlated with LCR (P < 0.05). Moreover, SI2 predicted the prognosis of patients with septic shock significantly better than SI1, PVPI1, and PVPI2 did. When SI2 was 1.22, the Youden index was 0.822, the sensitivity was 91.23%, the specificity was 89.47%, the positive predictive value was 0.912, and the negative predictive value was 0.924. The positive and negative likelihood ratios were 0.897 and 0.375, respectively.
Conclusions: Based on the study, SI after fluid resuscitation was more valuable for evaluating the prognosis of patients with septic shock than SI at admission, as well as PVPI values at admission and after fluid resuscitation.
Meiling Yu; Benquan Qi; Qi Zou; Shengyong Zheng; Chen Liu; Jingbo Ma
Volume 22, Issue 2 , 2020
Abstract
Introduction: Elizabethkingia meningoseptica (EM) is a non-fermenting Gram-negative bacterium that is a conditional pathogen and easily causes infection in neonates and immunocompromised patients. The infection of the bacterium is prone to develop multi-drug resistance, difficult to treat, ...
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Introduction: Elizabethkingia meningoseptica (EM) is a non-fermenting Gram-negative bacterium that is a conditional pathogen and easily causes infection in neonates and immunocompromised patients. The infection of the bacterium is prone to develop multi-drug resistance, difficult to treat, and associated with a high mortality rate.
Case Presentation: A 28-year-old female was admitted to the intensive care unit (ICU) of our hospital due to fulminant myocarditis, cardiogenic shock, acute heart failure, and multiple organ dysfunction syndrome (MODS) on 24 April 2019. The patient developed a lung infection and sepsis after admission. Two sputum culture tests on 27 April and 4 May showed infection with Pseudomonas aeruginosa and multi-drug resistance. The minimum inhibitory concentration (MIC) for imipenem was 4 mg/L and 8 mg/L, respectively. Four blood cultures on 9 May suggested an EM infection and multi-drug resistance, the MIC for imipenem was ? 16 mg/L. Due to the serious condition of the patient, imipenem-resistant lung infection, and typical sepsis manifestations, we initiated a regimen of polymyxin B combined with meropenem between 3 and 12 May. The infection was well-controlled and the patient was discharged on 14 May.
Conclusions: A polymyxin B-based combinational regimen is effective in the treatment of sepsis due to EM and play an important role in controlling EM-associated mixed infections.
Sinan Soylu; Zeynep Deniz Sahin Inan
Volume 20, Issue 9 , September 2018, , Pages 1-7
Abstract
Background: Sepsis and multiple organ dysfunction syndrome (MODS) are life-threatening conditions common in intensive care units. In this regard, studies have shown that Strontium ranelate has anti-inflammatory activity by blocking tumor necrosis factor- alpha (TNFα). Objectives: This study aimed ...
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Background: Sepsis and multiple organ dysfunction syndrome (MODS) are life-threatening conditions common in intensive care units. In this regard, studies have shown that Strontium ranelate has anti-inflammatory activity by blocking tumor necrosis factor- alpha (TNFα). Objectives: This study aimed to investigate the effect of Strontium ranelate on MODS in an experimental sepsis model. Methods: The study protocol was approved by Cumhuriyet University Institutional Ethics Committee for Animal Experiments (Sivas-Turkiye, date 07/12/2017). Twenty female Wistar-Albino rats were randomly divided into four groups of sham operation, ce- cal ligation and perforation (CLP), CLP + Strontium (S) (oral 40 mg/kg for 7 days), and S (40 mg/kg oral preoperative 5 days) + CLP + S (oral 40 mg/kg for 7 days). Blood samples were taken, and alanine aminotransferase (ALT), aspartate aminotransferase (AST), bloodurea nitrogen (BUN), and creatinine were studied. Tissues were removed, and inflammation scores were determined.Results: The mean inflammation scores of lung, liver, and renal tissues were found to be the lowest in the sham group (0.8 ± 0.45), and they increased in the S + CLP + S (1.6 ± 0.55) and CLP + S (3.4 ± 0.55) groups, respectively, with the highest score in the CLP (3.8 ± 0.45) group. It was found that there was no statistical difference between the sham and S + CLP + S groups (P > 0.05); however, there was a significant difference between the other groups (P < 0.05). The mean ALT, AST, BUN and creatinine values were found to be the lowest in the sham group, and they increased in the S + CLP + S and CLP + S groups, respectively, with the highest score in the CLP group. Regarding the mean ALT results, it was noted that there was no significant difference between the sham and S + CLP + S groups (P > 0.05); however, there was a significant difference between the other groups in terms of mean ALT, and there was asignificant difference between all the groups in terms of mean AST, BUN, and creatinine (P < 0.05).Conclusions: It was concluded that Strontium ranelate reduced the development of life-threatening MODS in patients with sepsis, especially when it was administered before the development of sepsis, by suppressing inflammatory mediators.
Caixia Wang; Shaoyong Luan; Ming Li; Ruiyun Zhang; Xiuxia Chen
Volume 19, Issue 3 , March 2017, , Pages 1-7
Abstract
Background: The exact interacting factor that response to the infection for neonatal sepsis is still needed to urgently to be disclosed.Objectives: This research was aimed to explore the potential biomarkers and illuminate the underlying molecular mechanisms associated with neonatal sepsis via identifying ...
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Background: The exact interacting factor that response to the infection for neonatal sepsis is still needed to urgently to be disclosed.Objectives: This research was aimed to explore the potential biomarkers and illuminate the underlying molecular mechanisms associated with neonatal sepsis via identifying differential modules (DMs).Methods: This is a case-control bioinformatics analysis using already published microarray data of neonatal sepsis. This study was conducted in Qingdao, China from September 2015 to May 2016. We recruited the gene expression profile of neonatal sepsis from the Array Express database (http://www.ebi.ac.uk/arrayexpress) under the accessing number of E-GEOD-25504, which included 27 neonatal samples with a confirmed blood culture-positive test for sepsis (bacterial infected cases) as well as 35 matched controls. Meanwhile, the human protein-protein interaction (PPI) data was collected from the database of Search Tool for the Retrieval ofInteracting Genes/Proteins (STRING, http://string-db.org). All of the data was preprocessed. Then, the differential co expression network (DCN) was constructed by integrating co-expression analysis and differential expression analysis. Next, a systemic module searching strategy, which contained seed genes selection, module searching and refinement of modules, was performed by select DMs.Results: Starting from the gene expression data and PPI data, the DCN that included 430 edges (covering 324 nodes) was constructed, in which each edge was assigned a weight value. From the DCN, we selected a total of 16 seed genes. Starting from these seed genes, a total of 3 modules were identified from the DCN based on the systemic module algorithm. Of them, only one module (Module 3) was considered as DM under P < 0.05. This DM was involved in the progress of ribosome biogenesis in eukaryotes.Conclusions: In the present study, we identified a key gene RPS16 and a significant module involved in ribosome biogenesis in eukaryotes that were related to neonatal sepsis, which might be potential biomarkers for early detection and therapy for neonatal sepsis
Koorosh Ahmadi; Morteza Talebi Doluee; Seyyed Mohsen Pouryaghobi; Fermoozan Nikpasand; Morteza Hariri; Elham Pishbin
Volume 18, Issue 2 , 2016, Pages 1-6
Abstract
Background: On the basis of the literature, vitamin D is known as an important medium in bodily immune function, and it therefore may play a role in the pathogenesis of sepsis. Objectives: In this study, we aimed to evaluate the relationship between vitamin D serum levels and sepsis severity. Patients ...
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Background: On the basis of the literature, vitamin D is known as an important medium in bodily immune function, and it therefore may play a role in the pathogenesis of sepsis. Objectives: In this study, we aimed to evaluate the relationship between vitamin D serum levels and sepsis severity. Patients and Methods: This study was a case-control study that evaluated adult patients admitted to the emergency department of Imam Reza hospital with suspected sepsis. These patients were enrolled in the study as the case group. In addition, healthy individuals without the sepsis diagnostic criteria were included in the control group. For all of the study participants, vitamin D levels were evaluated. The acute physiology age chronic health evaluation (APACHE) was used to evaluate disease severity in the case group. A difference of P < 0.05 was regarded as statistically significant. Results: A total of 112 patients were assessed: 56 in the control group and 56 in the case group. In the case group, 18 patients had sepsis, 25 patients had severe sepsis, and 13 patients were in septic shock. The mean ages of the patients in the case and control groups were 57.7 ± 15.15 and 58.6 ± 15.05 years, respectively (P = 0.741). Vitamin D levels in the case group were lower than in the control group (16.3 ± 10.7 versus 27.9 ± 11.46 ng/mL), and the difference between the groups was significant (P < 0.001). Mean vitamin D levels in the severe sepsis and septic shock groups were lower than in the sepsis group, and the mean level in the septic shock group was lower than in the severe sepsis group (P = 0.001). In the case group, there was a significant reverse correlation between APACHE II criteria and vitamin D levels (P < 0.001, r = -0.586). Conclusions: The results of this study indicated that patients with sepsis had lower serum vitamin D levels than healthy controls. Also, patients with more severe disease had lower serum vitamin D levels, but to evaluate causation and determine whether vitamin D supplementation could be effective in reducing the risk or severity of sepsis, randomized controlled trials should be conducted.
