Comparison of Sepsis-1, 2 and 3 for Predicting Mortality in Septic Patients of a Middle-Income Country: A Retrospective Observational Cohort Study
Carem Luana Machado LessaGisele BranchiniIsabela DelfinoM. VoosCassiano TeixeiraJorge Amilton HöherFernanda Bordignon Nunes
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Introduction The diagnosis of sepsis is based on expert consensus and does not yet have a “gold standard.” With the aim of improving and standardizing diagnostic methods, there have already been three major consensuses on the subject. However, there are still few studies in middle-income countries comparing the methods. This study describes the characteristics of patients diagnosed with sepsis and evaluates and compares the performance of Sepsis-1, 2, and 3 criteria in predicting 28 days, and in-hospital mortality. Patients and Methods A retrospective observational cohort study was conducted in the intensive care unit of a tertiary hospital. All admissions between January 1, 2018, and December 31, 2019, were reviewed. Patients diagnosed with sepsis were included. Results During the study period, 653 patients diagnosed with sepsis (by any of the studied criteria) were included in the study. The 28 days mortality rate was 45.8%, and the in-hospital mortality rate was 59.7%. We observed that 72.1% of patients met the minimum criteria for diagnosing sepsis according to the three protocols, and this group also had the highest mortality rate. Age and comorbidities such as cancer and liver cirrhosis were significantly associated with in-hospital mortality. The most common microorganisms were Escherichia coli, Klebsiella spp., and Staphylococcus spp. Conclusions The study found that most patients met the diagnostic criteria for sepsis using the three methods. Sepsis-2 showed greater sensitivity to predict mortality, while Sequential Organ Failure Assessment showed low accuracy, but was the only significant one. Furthermore, quick Sequential Organ Failure Assessment (qSOFA) had the highest specificity for mortality. Overall, these findings suggest that, although all three methods contribute to the diagnosis and prognosis of sepsis, Sepsis-2 is particularly sensitive in predicting mortality. Sepsis-3 shows some accuracy but requires improvement, and qSOFA exhibits the highest specificity. More research is needed to improve predictive capabilities and patient outcomes.Keywords:
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Background: Sepsis is a phenomenon caused by an infection that causes physiologic, pathologic, as well as biochemical problems. Objective: This paper aims to evaluate the outcomes of patients with sepsis and find out the mortality rate. Patients and methods: This paper was presented as a cross-sectional study where specialize to evaluate the outcomes of patients with sepsis and find out the mortality rate which get 100 cases in different hospitals in Iraq from 26th August to 18th 2022. This paper was analysed and evaluated of mortality rate with sepsis patients by SPSS program. The characteristics of demographic baseline outcomes were progressed with females and males for ages older than 25 and under than 70 years. Discussion: The interdisciplinary sepsis quality improvement project resulted in a considerable improvement in organizational sepsis mortality at the study hospital, with an observed sepsis mortality decrease of 8%. This resulted in a 37% decrease in sepsis O/E mortality. Patients having sepsis were considerably fewer likely to die following the intervention despite adjusting for patient variables and predicted mortality (OR = 0.64). Septic patients had an ICU stay that was 1.3 days shorter and an overall hospital stay that was 2.6 days shorter. With a baseline rate of death of 30% and an observed rate of mortality of 18.9%, the study team believes that the sepsis campaign saved 56 lives. There is significant evidence that sepsis teaching initiatives have a good impact. The study of complications was found to be fewer in comparisons with previous studies were, got 46 cases, and the risk factor of complications was got a higher percentage considered as death and gangrene, with 24 cases, where that result to blood loss during operative and reduce with blood pressure. Conclusion: The implementation of our study into the sepsis quality improvement program resulted in a decrease within the overall in-hospital sepsis death rate. Patients with sepsis during the treatment period had an approximate 35% decreased probability of dying. ICU days and total hospital LOS were also considerably reduced. Although 44 instances reduced projected direct consequences, the effect was not considered statistically significant.
Surviving Sepsis Campaign
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Sepsis is defined as life-threatening organ dysfunction triggered by an underlying infection. A recent study noted that the overall sepsis-related mortality rate in the United States is stable. In this study, we evaluated the sepsis-related mortality rates and trends associated with the three most common sites of infection.Retrospective population-based study.Multiple Cause of Death (MCOD) database available through the Centers for Disease Control and Prevention website.Decedents with sepsis-related deaths and the source of sepsis were identified using previously validated International Classification of Diseases codes.None.From 2004 to 2018, using the MCOD, the age-adjusted mortality rate per 1,000,000 population from pulmonary sepsis was 111.8, from abdominal sepsis was 46.7, and from genitourinary sepsis was 52. Mortality rates from all three sites increased. Males had a higher mortality rate from pulmonary sepsis and abdominal sepsis and lower mortality rate from genitourinary sepsis. Black and Native American decedents had the highest mortality rates from all three sepsis sites. Compared with White decedents, Hispanic decedents had a higher mortality rate from pulmonary sepsis but lower rate from genitourinary sepsis. Asian decedents had the lowest mortality rates from abdominal and genitourinary sepsis but similar mortality rates from pulmonary sepsis as White decedents. The mortality rate increased in White and Native American decedents for all three sepsis sites, whereas in Hispanic decedents only abdominal and genitourinary sites increased, and in Black and Asian decedents only abdominal sepsis rates increased.Despite the overall stable sepsis-related mortality rates, the rates secondary to pulmonary, abdominal, and genitourinary sepsis are increasing in both sexes and all age groups. This is likely due to improved identification/documentation of a site of infection in patients with sepsis. We noted significant racial variation in mortality rates/trends, which should be considered in future studies.
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Serotoninergic mechanisms are thought to play a role in portal hypertension. Because this biomine is metabolized by the liver, peripheral blood and plasma levels of 5-hydroxytryptamine and 5-hydroxyindole acetic acid (the main metabolite of 5-hydroxytryptamine) were measured in 30 patients with cirrhosis. Whole-blood 5-hydroxytryptamine levels were significantly lower in patients with cirrhosis (158 +/- 28 nM) than in age-matched controls (332 +/- 19 nM), and no correlation was found between these levels and the severity of cirrhosis. Unconjugated plasma 5-hydroxytryptamine levels, an indication of the active form of 5-hydroxytryptamine, were significantly higher in patients with cirrhosis than in controls (6.8 +/- 1.7 nM and 3.4 +/- 0.5 nM, respectively), and in patients with cirrhosis these levels were higher in Pugh grade A than in Pugh grade C patients. Conjugated-plasma 5-hydroxytryptamine levels were not significantly different between patients with cirrhosis (32.2 +/- 8.1 nmol/L) and controls (16.4 +/- 1.4 nmol/L). Plasma 5-hydroxyindole acetic acid was significantly lower in patients with cirrhosis than in controls (1.5 +/- 0.1 nmol/L and 2.3 +/- 0.1 nmol/L, respectively). In conclusion, this study shows that serotoninergic mechanisms are altered in patients with cirrhosis.
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Abstract Background: Sepsis was recently redefined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. With this redefinition (Sepsis-3), clinical and microbiological characteristics of patients with sepsis may differ from the patients fulfilling the previous described definition (Sepsis-2). Purpose: To describe differences in clinical and microbiological characteristics of sepsis episodes between Sepsis-3 and Sepsis-2. The secondary aim was to compare blood culture outcomes between episodes fulfilling Sepsis-3 and Sepsis-2 criteria, respectively. Methods: A prospective study design was used to include patients presenting with clinically suspected sepsis in the emergency department. Six blood culture bottles were collected from each patient. Blood cultures were described as having clinically relevant growth, contaminant growth, or no growth. Clinical and laboratory data were collected from medical records and the laboratory information system. Results: The analysis included 549 episodes. There were 387/549 (70.5%) Sepsis-3 and 443/549 (80.7%) Sepsis-2 episodes. In total, 369/549 (67.2%) episodes fulfilled both Sepsis-3 and Sepsis-2 criteria. Blood cultures were positive for clinically relevant growth in 140/387 (36.1%) and 155/443 (35.0%) episodes in Sepsis-3 and Sepsis-2, respectively. Other clinical and microbiological characteristics did not differ between Sepsis-3 and Sepsis-2. Conclusions: A high proportion of patients included through a sepsis alert system fulfilled both Sepsis-3 and Sepsis-2 criteria. The performance of blood cultures in detection of microorganisms was poor and were similar in Sepsis-3 and Sepsis-2 patients.
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Objective: To investigate the clinical characteristics of HCC with and without liver cirrhosis. Methods: Two hundreds and eighty-one patients with cirrhosis and 147 patients without cirrhosis were studied in terms of the clinical symptoms, and signs and laboratory parametes. Results: The development of HCC with cirrhosis were more insidiously and the prevalence of HbsAg in HCC patients with cirrhosis was significantly higher than in those without cirrhosis (85.1% vs 67.3%, P0.01), AFP and AST were elevated in more patients with cirrhosis than those without cirrhosis (P0.05). Conclusion: The HCC with cirrhosis is more significantly associated with HBV infection than those without cirrhosis. Monitoring serum AFP is useful for cancer detection in patients with cirrhosis, however for those patients without cirrhosis, early ultrasound is more important.
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Purpose To explore the relationship between serum NO and hypoxemia in patients with liver cirrhosis. Methods NO was measured in serum samples collected from 69 patients with liver cirrhosis and 20 healthy controls by colorometric assay. Results Higher serum level of NO were observed in patients with cirrhosis than that in normal controls(p0.01). Higher serum level of NO in cirrhosis patients with hypoxemia than that in cirrhosis patients without hypoxemia (p0.001). The increases of serum NO were inverse proportional to PaO_2(r=-0.99). The levels of serum NO were increased in accordance with the seventy of liver cirrhosis from Child-Pugh A→B→C (p0.05). PaO_2 decrased with the seventy of liver cirrhosis from child pugh A→B→C(p0.01). Conclusions The increase of serum NO may contribute to cirrhosis hypoxemia.
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Since the definition of sepsis has been first proposed in 1991, the main content of the definition has been developed by infection + systemic inflammatory response syndrome as infection + organ dysfunction, and organ dysfunction is indicated by an increase in sequential organ failure assessment(SOFA) score.These are components of Sepsis-3 which was published in 2016.In Sepsis-3, the SOFA score in the identification and diagnosis of sepsis plays an important role, but Sepsis-3 was mainly used in adults, how to adjust it to children, some questions and details were proposed in this article.
Key words:
Sepsis; Diagnosis; Children,
SOFA score
Organ dysfunction
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