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Natalie McLymont, Guy W Glover
Sepsis is responsible for the utilisation of a significant proportion of healthcare resources and has high mortality rates. Early diagnosis and prompt interventions are associated with better outcomes but is impeded by a lack of diagnostic tools and the heterogeneous and enigmatic nature of sepsis. The recently updated definitions of sepsis have moved away from the centrality of inflammation and the systemic inflammatory response syndrome (SIRS) criteria which have been shown to be non-specific. Sepsis is now defined as a "life-threatening organ dysfunction caused by a dysregulated host response to infection"...
December 2016: Annals of Translational Medicine
Michal Holub, Ondřej Beran
The article discusses new definitions for sepsis and septic shock called Sepsis-3. The definitions are put in the historical and factual context of the 1992 definition and their extended 2003 version. Also mentioned are potential impacts on clinical practice, with it-being clear that the new definition shifts the sepsis issues more to intensive care as it emphasizes organ failure. In prehospital care, emergency departments and general wards of hospitals where patients are triaged, a new scoring system, the so-called quick SOFA, may be used...
December 2016: Klinická Mikrobiologie a Infekc̆ní Lékar̆ství
Yonathan Freund, Najla Lemachatti, Evguenia Krastinova, Marie Van Laer, Yann-Erick Claessens, Aurélie Avondo, Céline Occelli, Anne-Laure Feral-Pierssens, Jennifer Truchot, Mar Ortega, Bruno Carneiro, Julie Pernet, Pierre-Géraud Claret, Fabrice Dami, Ben Bloom, Bruno Riou, Sébastien Beaune
Importance: An international task force recently redefined the concept of sepsis. This task force recommended the use of the quick Sequential Organ Failure Assessment (qSOFA) score instead of systemic inflammatory response syndrome (SIRS) criteria to identify patients at high risk of mortality. However, these new criteria have not been prospectively validated in some settings, and their added value in the emergency department remains unknown. Objective: To prospectively validate qSOFA as a mortality predictor and compare the performances of the new sepsis criteria to the previous ones...
17, 2017: JAMA: the Journal of the American Medical Association
Eamon P Raith, Andrew A Udy, Michael Bailey, Steven McGloughlin, Christopher MacIsaac, Rinaldo Bellomo, David V Pilcher
Importance: The Sepsis-3 Criteria emphasized the value of a change of 2 or more points in the Sequential [Sepsis-related] Organ Failure Assessment (SOFA) score, introduced quick SOFA (qSOFA), and removed the systemic inflammatory response syndrome (SIRS) criteria from the sepsis definition. Objective: Externally validate and assess the discriminatory capacities of an increase in SOFA score by 2 or more points, 2 or more SIRS criteria, or a qSOFA score of 2 or more points for outcomes among patients who are critically ill with suspected infection...
17, 2017: JAMA: the Journal of the American Medical Association
Adam J Singer, Jennifer Ng, Henry C Thode, Rory Spiegel, Scott Weingart
STUDY OBJECTIVE: The Quick Sequential Organ Failure Assessment (qSOFA) score (composed of respiratory rate ≥22 breaths/min, systolic blood pressure ≤100 mm Hg, and altered mental status) may identify patients with infection who are at risk of complications. We determined the association between qSOFA scores and outcomes in adult emergency department (ED) patients with and without suspected infection. METHODS: We performed a single-site, retrospective review of adult ED patients between January 2014 and March 2015...
January 19, 2017: Annals of Emergency Medicine
Brian C Peach
INTRODUCTION: The Society of Critical-Care Medicine and the European Society of Intensive Care Medicine recently announced a marked change in the sepsis definition. A task force of 19 sepsis clinicians and researchers made the change based on advances in the pathobiological understanding of the septic process. SUMMARY OF CHANGE: The task force determined that there were numerous justifications for a revision of the sepsis definition, which are outlined in this article...
November 24, 2016: Journal of Critical Care
E J Giamarellos-Bourboulis, T Tsaganos, I Tsangaris, M Lada, C Routsi, D Sinapidis, M Koupetori, M Bristianou, G Adamis, K Mandragos, G N Dalekos, I Kritselis, G Giannikopoulos, I Koutelidakis, M Pavlaki, E Antoniadou, G Vlachogiannis, V Koulouras, A Prekates, G Dimopoulos, A Koutsoukou, I Pnevmatikos, A Ioakeimidou, A Kotanidou, S E Orfanos, A Armaganidis, C Gogos
OBJECTIVES: Sepsis-3 definitions generated controversies regarding their general applicability. The Sepsis-3 Task Force outlined the need for validation with emphasis on the quick Sequential Organ Failure Assessment (qSOFA) score. This was done in a prospective cohort from a different healthcare setting. METHODS: Patients with infections and at least two signs of systemic inflammatory response syndrome (SIRS) were analysed. Sepsis was defined as total SOFA ≥2 outside the intensive care unit (ICU) or as an increase of ICU admission SOFA ≥2...
February 2017: Clinical Microbiology and Infection
Kwok M Ho, Norris S H Lan
PURPOSE: We sought to determine whether quick Sequential Organ Failure Assessment (qSOFA) score can be used to predict mortality of patients without suspected infection. MATERIALS AND METHODS: Using prospectively collected data within the first hour of intensive care unit admission, the predictive ability of qSOFA was compared with the Simplified Acute Physiology Score III, Admission Mortality Prediction Model III, Acute Physiology and Chronic Health Evaluation II model, and standard (full-version) SOFA score using area under the receiver operating characteristic (AUROC) curve and Brier score...
October 18, 2016: Journal of Critical Care
Thomas Desautels, Jacob Calvert, Jana Hoffman, Melissa Jay, Yaniv Kerem, Lisa Shieh, David Shimabukuro, Uli Chettipally, Mitchell D Feldman, Chris Barton, David J Wales, Ritankar Das
BACKGROUND: Sepsis is one of the leading causes of mortality in hospitalized patients. Despite this fact, a reliable means of predicting sepsis onset remains elusive. Early and accurate sepsis onset predictions could allow more aggressive and targeted therapy while maintaining antimicrobial stewardship. Existing detection methods suffer from low performance and often require time-consuming laboratory test results. OBJECTIVE: To study and validate a sepsis prediction method, InSight, for the new Sepsis-3 definitions in retrospective data, make predictions using a minimal set of variables from within the electronic health record data, compare the performance of this approach with existing scoring systems, and investigate the effects of data sparsity on InSight performance...
September 30, 2016: JMIR Medical Informatics
K de Leeuw, A S Niemeijer, J Eshuis, M K Nieuwenhuis, G I J M Beerthuizen, W M T Janssen
INTRODUCTION: In patients with severe burns, resuscitation with large volumes of fluid is needed, partly because of an increase in capillary leakage. Corticosteroids might be beneficial by diminishing capillary leakage. This study aimed to assess in severely burned nonseptic patients whether hydrocortisone (HC) improved outcome and diminished capillary leakage. METHODS: Retrospective analyses of a prospectively collected database were performed, including 39 patients (age 52 [35-62] years, 72% male)...
June 23, 2016: Journal of Critical Care
Jun-Yu Wang, Yun-Xia Chen, Shu-Bin Guo, Xue Mei, Peng Yang
OBJECTIVE: The objectives of this study are to investigate the performance of the quick Sepsis-related Organ Failure Assessment (qSOFA) in predicting mortality and intensive care unit (ICU) admission in patients with clinically diagnosed infection and to compare its performance with that of Mortality in Emergency Department Sepsis (MEDS), Acute Physiology and Chronic Health Evaluation (APACHE) II, and Sepsis-related Organ Failure Assessment (SOFA). METHODS: From July to December 2015, we retrospectively analyzed 477 patients clinically diagnosed with infection in the emergency department...
September 2016: American Journal of Emergency Medicine
Panita Worapratya, Apisit Wanjaroenchaisuk, Jutharat Joraluck, Prasit Wuthisuthimethawee
BACKGROUND: Since early goal-directed therapy (EGDT) became standard care in severe sepsis and septic shock patients in intensive care units many years ago, we suppose that the survival rate of severe sepsis and septic shock patients improves if the resuscitative procedure is quickly implemented and is initiated in the emergency room. OBJECTIVE: We aimed at recording emergency department time to improve our patient care system as well as determine the rate at which EGDT goals can be achieved...
2016: Open Access Emergency Medicine: OAEM
Yun-Xia Chen, Jun-Yu Wang, Shu-Bin Guo
BACKGROUND: The quick Sepsis-related Organ Failure Assessment (qSOFA) is a new screening system for sepsis that has prognostic performance equal to the full SOFA for patients with suspected infection outside the intensive care unit (ICU). The predictive value of qSOFA for mortality and site of care in patients with pneumonia is not clear. The present study was designed to investigate the predictive performance of qSOFA, CRB-65 (confusion, respiratory rate ≥30/minute, systolic blood pressure <90 mmHg or diastolic blood pressure ≤60 mmHg, age ≥65 years) and CRB (confusion, respiratory rate ≥30/minute, systolic blood pressure <90 mmHg or diastolic blood pressure ≤60 mmHg) for mortality, hospitalisation and ICU admission in patients with pneumonia in the emergency department (ED)...
June 1, 2016: Critical Care: the Official Journal of the Critical Care Forum
Shengjian Zhong, Chunbao Zhang, Juntao Hu, Zhanhong Tang
OBJECTIVE: To compare the results of thrombelastography (TEG) and the conventional coagulability test in patients with sepsis, and to discuss the value of TEG in monitoring blood coagulation dysfunction in patients with sepsis. METHODS: The clinical data of 92 adult patients with sepsis admitted to Department of Critical Care Medicine of the First Affiliated Hospital of Guangxi Medical University were retrospectively analyzed. The patients were divided into sequential organ failure assessment (SOFA) score ≥ 12 group (n = 47) and SOFA < 12 group (n = 45)...
February 2016: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Christopher W Seymour, Vincent X Liu, Theodore J Iwashyna, Frank M Brunkhorst, Thomas D Rea, André Scherag, Gordon Rubenfeld, Jeremy M Kahn, Manu Shankar-Hari, Mervyn Singer, Clifford S Deutschman, Gabriel J Escobar, Derek C Angus
IMPORTANCE: The Third International Consensus Definitions Task Force defined sepsis as "life-threatening organ dysfunction due to a dysregulated host response to infection." The performance of clinical criteria for this sepsis definition is unknown. OBJECTIVE: To evaluate the validity of clinical criteria to identify patients with suspected infection who are at risk of sepsis. DESIGN, SETTINGS, AND POPULATION: Among 1.3 million electronic health record encounters from January 1, 2010, to December 31, 2012, at 12 hospitals in southwestern Pennsylvania, we identified those with suspected infection in whom to compare criteria...
February 23, 2016: JAMA: the Journal of the American Medical Association
Christin Edmark, Mark J W McPhail, Max Bell, Tony Whitehouse, Julia Wendon, Kenneth B Christopher
PURPOSE: To develop a liver function-related risk prediction tool to identify acute-on-chronic liver failure patients at greatest risk of in-hospital mortality. METHODS: The LiFe (liver, injury, failure, evaluation) score, was constructed based on the opinions of 157 intensivists within the European Society for Intensive Care Medicine. Experts were surveyed and instructed to weigh the diagnostic importance of each feature of a proposed prediction model. We performed a retrospective cohort study of 1916 patients with chronic liver disease admitted to a medical or surgical ICU between 1997, and 2011 in three large hospitals in Boston, USA, and London, UK, with arterial lactate, total bilirubin and INR drawn at ICU admission...
March 2016: Intensive Care Medicine
Eileen M Bulger, Addison May, Andrew Bernard, Stephen Cohn, David C Evans, Sharon Henry, Jacob Quick, Leslie Kobayashi, Kevin Foster, Therese M Duane, Robert G Sawyer, John A Kellum, Adrian Maung, Greg Maislin, David D Smith, Irit Segalovich, Wayne Dankner, Anat Shirvan
BACKGROUND: Necrotizing soft tissue infections (NSTI) represent a rare but devastating disease for which the systemic manifestations have been poorly characterized. In an effort to define an optimal endpoint for clinical trials in this condition, the objective of this study was to establish the pattern of organ dysfunction over time and determine the correlation between organ dysfunction and clinical outcome in patients with NSTI. METHODS: We conducted a multicenter, retrospective clinical study of patients with NSTI presenting to 12 academic medical centers in the U...
December 2015: Surgical Infections
Chen-June Seak, Chip-Jin Ng, David Hung-Tsang Yen, Yon-Cheong Wong, Kuang-Hung Hsu, Joanna Chen-Yeen Seak, Chen-Ken Seak
OBJECTIVE: This study aims to evaluate the performance of Simplified Acute Physiology Score II (SAPS II), the Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and the Sequential Organ Failure Assessment (SOFA) score for predicting illness severity and the mortality of adult hepatic portal venous gas (HPVG) patients presenting to the emergency department (ED). This will assist emergency physicians in risk stratification. METHODS: Data for 48 adult HPVG patients who visited our ED between December 2009 and December 2013 were analyzed...
December 2014: American Journal of Emergency Medicine
Shuichi Hagiwara, Kiyohiro Oshima, Kazumi Furukawa, Takuro Nakamura, Yoshio Ohyama, Jun-ichi Tamura
PURPOSE: The reliable parameter, which can be obtained easily and quickly, is necessary to predict the return of spontaneous circulation (ROSC) of patients with cardiopulmonary arrest (CPA) in the emergency situation. In this study, we evaluated the significance of albumin corrected anion gap (ACAG) for the prediction of ROSC in patients with CPA. PATIENTS AND METHODS: In 166 patients with CPA between January 2009 and December 2010, 132 patients could be analyzed retrospectively...
2013: Annals of Thoracic and Cardiovascular Surgery
Nam K Tran, David H Wisner, Timothy E Albertson, Stuart Cohen, David Greenhalgh, Tina L Palmieri, Christopher Polage, Gerald J Kost
BACKGROUND: The goal of this study is to determine the clinical value of multiplex polymerase chain reaction (PCR) study for enhancing pathogen detection in patients with suspected septicemia after trauma, emergency, and burn surgery. PCR-based pathogen detection quickly reveals occult bloodstream infections in these high-risk patients and may accelerate the initiation of targeted antimicrobial therapy. METHODS: We conducted a prospective observational study comparing results for 30 trauma and emergency surgery patients to 20 burn patients...
March 2012: Surgery
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