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assessing new clinical criteria for septic shock

Eli J Finkelsztein, Daniel S Jones, Kevin C Ma, Maria A Pabón, Tatiana Delgado, Kiichi Nakahira, John E Arbo, David A Berlin, Edward J Schenck, Augustine M K Choi, Ilias I Siempos
BACKGROUND: The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) Task Force recently introduced a new clinical score termed quick Sequential (Sepsis-related) Organ Failure Assessment (qSOFA) for identification of patients at risk of sepsis outside the intensive care unit (ICU). We attempted to compare the discriminatory capacity of the qSOFA versus the Systemic Inflammatory Response Syndrome (SIRS) score for predicting mortality, ICU-free days, and organ dysfunction-free days in patients with suspicion of infection outside the ICU...
March 26, 2017: Critical Care: the Official Journal of the Critical Care Forum
Susan O'Brien, Jeffrey A Jones, Steven E Coutre, Anthony R Mato, Peter Hillmen, Constantine Tam, Anders Österborg, Tanya Siddiqi, Michael J Thirman, Richard R Furman, Osman Ilhan, Michael J Keating, Timothy G Call, Jennifer R Brown, Michelle Stevens-Brogan, Yunfeng Li, Fong Clow, Danelle F James, Alvina D Chu, Michael Hallek, Stephan Stilgenbauer
BACKGROUND: The TP53 gene, encoding tumour suppressor protein p53, is located on the short arm of chromosome 17 (17p). Patients with 17p deletion (del17p) chronic lymphocytic leukaemia have poor responses and survival after chemoimmunotherapy. We assessed the activity and safety of ibrutinib, an oral covalent inhibitor of Bruton's tyrosine kinase, in relapsed or refractory patients with del17p chronic lymphocytic leukaemia or small lymphocytic lymphoma. METHODS: We did a multicentre, international, open-label, single-arm study at 40 sites in the USA, Canada, Europe, Australia, and New Zealand...
October 2016: Lancet Oncology
Mervyn Singer, Clifford S Deutschman, Christopher Warren Seymour, Manu Shankar-Hari, Djillali Annane, Michael Bauer, Rinaldo Bellomo, Gordon R Bernard, Jean-Daniel Chiche, Craig M Coopersmith, Richard S Hotchkiss, Mitchell M Levy, John C Marshall, Greg S Martin, Steven M Opal, Gordon D Rubenfeld, Tom van der Poll, Jean-Louis Vincent, Derek C Angus
IMPORTANCE: Definitions of sepsis and septic shock were last revised in 2001. Considerable advances have since been made into the pathobiology (changes in organ function, morphology, cell biology, biochemistry, immunology, and circulation), management, and epidemiology of sepsis, suggesting the need for reexamination. OBJECTIVE: To evaluate and, as needed, update definitions for sepsis and septic shock. PROCESS: A task force (n = 19) with expertise in sepsis pathobiology, clinical trials, and epidemiology was convened by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine...
February 23, 2016: JAMA: the Journal of the American Medical Association
Manu Shankar-Hari, Gary S Phillips, Mitchell L Levy, Christopher W Seymour, Vincent X Liu, Clifford S Deutschman, Derek C Angus, Gordon D Rubenfeld, Mervyn Singer
IMPORTANCE: Septic shock currently refers to a state of acute circulatory failure associated with infection. Emerging biological insights and reported variation in epidemiology challenge the validity of this definition. OBJECTIVE: To develop a new definition and clinical criteria for identifying septic shock in adults. DESIGN, SETTING, AND PARTICIPANTS: The Society of Critical Care Medicine and the European Society of Intensive Care Medicine convened a task force (19 participants) to revise current sepsis/septic shock definitions...
February 23, 2016: JAMA: the Journal of the American Medical Association
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
Federico Aletti, Costanza Conti, Manuela Ferrario, Vicent Ribas, Bernardo Bollen Pinto, Antoine Herpain, Emiel Post, Eduardo Romay Medina, Cristina Barlassina, Eliandre de Oliveira, Roberta Pastorelli, Gabriella Tedeschi, Giuseppe Ristagno, Fabio S Taccone, Geert W Schmid-Schönbein, Ricard Ferrer, Daniel De Backer, Karim Bendjelid, Giuseppe Baselli
BACKGROUND: The ShockOmics study ( identifier NCT02141607) is a multicenter prospective observational trial aimed at identifying new biomarkers of acute heart failure in circulatory shock, by means of a multiscale analysis of blood samples and hemodynamic data from subjects with circulatory shock. METHODS AND DESIGN: Ninety septic shock and cardiogenic shock patients will be recruited in three intensive care units (ICU) (Hôpital Erasme, Université Libre de Bruxelles, Belgium; Hospital Universitari Mutua Terrassa, Spain; Hôpitaux Universitaires de Genève, Switzerland)...
January 28, 2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Masayuki Sato, Gaku Takahashi, Shigehiro Shibata, Makoto Onodera, Yasushi Suzuki, Yoshihiro Inoue, Shigeatsu Endo
We previously reported that a soluble CD14-subtype (sCD14-ST) immunochromatographic test (ICT) for plasma is more convenient than chemiluminescent enzyme immunoassay (CLEIA), but plasma separation makes bedside measurements difficult. We developed a new sCD14-ST ICT for whole blood and investigated whether quantitative determinations of sCD14-ST by ICT were useful for diagnosing sepsis and severe sepsis/septic shock. We studied 20 patients who fulfilled two or more systemic inflammatory response syndrome (SIRS) criteria and 32 patients who had been diagnosed with sepsis or severe sepsis/septic shock...
2015: PloS One
Yutaka Umemura, Kazuma Yamakawa, Takeyuki Kiguchi, Yoshiaki Yoshikawa, Hiroshi Ogura, Takeshi Shimazu, Toshimitsu Hamasaki, Satoshi Fujimi
BACKGROUND: Current disseminated intravascular coagulation (DIC) criteria are insufficient for predicting mortality. Hemostatic endothelial molecular markers are useful for DIC diagnoses. We aimed to design new DIC criteria involving these markers based on the recently published Japanese Association for Acute Medicine (JAAM) DIC criteria, which exhibit higher sensitivity for mortality. MATERIALS AND METHODS: Patients with severe sepsis or septic shock admitted to a tertiary referral hospital in Japan between September 2009 and November 2011 were included...
March 2016: Clinical and Applied Thrombosis/hemostasis
Eric A Bruder, Ian M Ball, Stacy Ridi, William Pickett, Corinne Hohl
BACKGROUND: The use of etomidate for emergency airway interventions in critically ill patients is very common. In one large registry trial, etomidate was the most commonly used agent for this indication. Etomidate is known to suppress adrenal gland function, but it remains unclear whether or not this adrenal gland dysfunction affects mortality. OBJECTIVES: The primary objective was to assess, in populations of critically ill patients, whether a single induction dose of etomidate for emergency airway intervention affects mortality...
January 8, 2015: Cochrane Database of Systematic Reviews
Andrea Cortegiani, Vincenzo Russotto, Francesca Montalto, Grazia Foresta, Giuseppe Accurso, Cesira Palmeri, Santi Maurizio Raineri, Antonino Giarratano
BACKGROUND: The aim of our study is to test procalcitonin (PCT) as surrogate marker of identification of Candida spp. by blood culture (BC) and real-time-polymerase chain reaction (PCR), whether alone or in association with bacteria, in septic patients. METHODS: We performed a single-centre retrospective study. We reviewed the clinical charts of patients with a diagnosis of severe sepsis or septic shock treated at our general intensive care unit from March 2009 to March 2013...
February 21, 2014: BMC Anesthesiology
Yue Liu, Qing Li, Jin-jin Li, Bin Geng
OBJECTIVE: To evaluate the clinical value and specificity of atrial natriuretic peptide (ANP) in early diagnosis of sepsis. METHODS: A prospective study was performed. Data of patients with sepsis were consecutively collected from September 2007 to December 2012 according to the international criteria for the diagnosis of sepsis, and that of 114 patients admitted to intensive care unit (ICU) and the cadre health care ward were divided into three groups: systemic inflammatory response syndrome (SIRS) group (n=37), sepsis group (n=41) and severe sepsis group (including severe sepsis and septic shock, n=36)...
November 2013: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Klaus Dalhoff, Santiago Ewig, Marianne Abele-Horn, Stefan Andreas, Torsten T Bauer, Heike von Baum, Maria Deja, Petra Gastmeier, Sören Gatermann, Herwig Gerlach, Beatrice Grabein, Gert Höffken, Winfried Kern, Evelyn Kramme, Christoph Lange, Joachim Lorenz, Konstantin Mayer, Irit Nachtigall, Matthias Pletz, Gernot Rohde, Simone Rosseau, Bernhard Schaaf, Reiner Schaumann, Dirk Schreiter, Hartwig Schütte, Harald Seifert, Helmut Sitter, Claudia Spies, Tobias Welte
BACKGROUND: Nosocomial pneumonia is among the most common types of infection in hospitalized patients. The increasing prevalence of multi-drug resistant organisms (MDROs) in recent years points to the need for an up-to-date clinical guideline. METHODS: An interdisciplinary S3 guideline was created on the basis of a systematic literature review in the PubMed and Cochrane Library databases, with assessment and grading of the evidence according to the GRADE system...
September 2013: Deutsches Ärzteblatt International
Ahmad Awada, Agustin A Garcia, Stephen Chan, Guy H M Jerusalem, Robert E Coleman, Manon T Huizing, Aminder Mehdi, Sue M O'Reilly, John T Hamm, Peter J Barrett-Lee, Veronique Cocquyt, Kostandinos Sideras, David E Young, Carol Zhao, Yen Lin Chia, Ute Hoch, Alison L Hannah, Edith A Perez
BACKGROUND: New therapeutic options are needed for patients with heavily pretreated breast cancer. Etirinotecan pegol is a long-acting topoisomerase-I inhibitor designed to provide prolonged tumour-cell exposure to SN38, the active metabolite. We aimed to assess the efficacy and safety of two etirinotecan pegol dosing schedules in patients with previously treated metastatic breast cancer to determine an optimum dosing schedule for phase 3 trials. METHODS: In this randomised, two-stage, open-label phase 2 trial, we recruited patients aged 18 years or older who had received taxane therapy and undergone two or fewer previous chemotherapy regimens for metastatic breast cancer, with an Eastern Cooperative Oncology Group performance status of 0 or 1, from 18 sites in three countries...
November 2013: Lancet Oncology
Pierre Asfar, Yann-Erick Claessens, Jacques Duranteau, Eric Kipnis, Marc Leone, Bruno Lévy, Jean-Paul Mira
Phase III clinical trials on severe sepsis and septic shock published during the past decade have failed to reveal the superiority of any therapeutic intervention on mortality compared with evolving standards of care, with the exception of the Early-Goal Directed Therapy reported in 2001. This viewpoint paper presents an analysis of these studies in order to understand what lessons can be learned and proposes perspectives for future study designs. A total of 102 studies were selected among clinical trials published in the field of severe sepsis and septic shock from 2001 to 2013, based on the assessment of a therapeutic intervention and mortality as an outcome...
2013: Annals of Intensive Care
Prajowl Shrestha, Anant Mohan, Surendra Sharma, Randeep Guleria, Naval Vikram, Naveet Wig, Ravindra Pandey
SESSION TYPE: Sepsis/Shock PostersPRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PMPURPOSE: Although sepsis is one of the leading cause of mortality in hospitalized patients, information regarding early predictive factors for mortality and morbidity is limited.METHODS: Patients fulfilling the Infectious Disease Society of America criteria of sepsis within the Medical ICU were included randomly. Apart from baseline hematological, biochemical and metabolic parameters, Acute Physiology and Chronic Health Evaluation II (APACHE II), Simplified acute physiology score II and III (SAPS II and SAPS III) and Sequential organ function assessment (SOFA) scores were calculated on day 1 of admission...
October 1, 2012: Chest
Eliézer Silva, Luiz Francisco Poli de Figueiredo, Fernando Colombari
Sepsis remains a challenge for intensive care physicians, as it keeps up with high mortality rate in spite of the high costs associated with its treatment. Several studies indicate that the infusion of Drotrecogin-alpha activated (DrotAA) reduce mortality in patients at high risk of death when administered early and secured the appropriate initial treatment of sepsis as recommended by Surviving Sepsis Campaign. Europe and United States of America differ regarding the criteria of high risk of death in sepsis, two or more organ dysfunctions and Acute Physiology and Chronic Health Evaluation 25 or more, respectively...
September 2010: Shock
C Sabatier, R Peredo, A Villagrá, N Bacelar, D Mariscal, R Ferrer, M Gallego, J Vallés
OBJECTIVE: To describe the clinical characteristics and outcomes of patients with community-acquired pneumonia (CAP) admitted to the Intensive Care Unit (ICU). To evaluate new ATS/IDSA criteria to identify patients with CAP who required admission to ICU. DESIGN: Retrospective analysis of prospective collected data in a 7-year period (2000-2007). SETTING: Medical-surgical ICU with 16 beds. PATIENTS: All patients with severe CAP admitted to the ICU (n=147)...
May 2010: Medicina Intensiva
Fu-xin Kang, Rui-lan Wang, Kang-long Yu, Qiao Wei
OBJECTIVE: To assess the clinical value of pro-adrenomedullin (pro-ADM) in the prognosis and risk stratification in sepsis. METHODS: Fifty-one critically ill patients admitted to the intensive care unit (ICU) were prospectively stratified into four groups according to internationally recognized criteria: systemic inflammatory response syndrome (SIRS, 25 cases), sepsis (12 cases), severe sepsis (9 cases) and septic shock (5 cases). The levels of plasma pro-ADM was determined in every patient using a new sandwich immunoassay, and compared with procalcitonin (PCT), C-reactive protein (CRP) and interleukin-6 (IL-6), and the acute physiology and chronic health evaluation II (APACHE II) score...
August 2008: Zhongguo Wei Zhong Bing Ji Jiu Yi Xue, Chinese Critical Care Medicine, Zhongguo Weizhongbing Jijiuyixue
Nita L Seibel, Cindy Schwartz, Antonio Arrieta, Patricia Flynn, Aziza Shad, Edith Albano, James Keirns, Wendi M Lau, David P Facklam, Donald N Buell, Thomas J Walsh
Micafungin (FK463) is a new parenteral echinocandin. A multicenter, phase I, open-label, sequential-group dose escalation study was conducted to assess the safety, tolerability, and pharmacokinetics of micafungin in neutropenic pediatric patients. A total of 77 patients stratified by age (2 to 12 and 13 to 17 years) received micafungin. Therapy was initiated at 0.5 mg/kg per day and escalated to higher dose levels of 1.0, 1.5, 2.0, 3.0, and 4.0 mg/kg per day. Micafungin was administered within 24 h of initiating broad-spectrum antibacterial antibiotics for the new onset of fever and neutropenia...
August 2005: Antimicrobial Agents and Chemotherapy
Alain Cariou, Jean-Daniel Chiche, Julien Charpentier, Jean-François Dhainaut, Jean-Paul Mira
OBJECTIVE: This article aims to address the predictable impact of genetics on the design of clinical trials in the field of critical care medicine, with emphasis on the pathophysiology of sepsis and its treatment. DATA SOURCES: Published articles reporting studies on sepsis and septic shock or assessing the influence of genetics and pharmacogenomics in the treatment of critical illnesses. DATA ANALYSIS: Because most common diseases including sepsis have been shown to be influenced by inherited differences in our genes, completion of the Human Genome Project and the concomitant publication of the human single nucleotide polymorphism map both contribute to change our approach to medicine...
May 2002: Critical Care Medicine
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