Systemic Endotoxin and Gastric Mucosal pH Are the Best Parameters to Predict Lethal Outcome in a Porcine Model of Abdominal Sepsis According to Multivariate Analysis

2003 ◽  
Vol 16 (1) ◽  
pp. 13-21 ◽  
Author(s):  
Tim Strate ◽  
Claus Schneider ◽  
Emre Yekebas ◽  
Wolfram Knoefel ◽  
Christian Bloechle ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Porcine Model ◽  
Abdominal Sepsis ◽  
Lethal Outcome ◽  
Gastric Mucosal Ph ◽  
Best Parameters

Causes and outcomes of hospitalizations among people living with HIV in Georgia’s referral institution, 2012–2017

2021 ◽  
Vol 32 (7) ◽  
pp. 662-670
Author(s):  
Nino Rukhadze ◽  
Ole Kirk ◽  
Nikoloz Chkhartishvili ◽  
Natalia Bolokadze ◽  
Lali Sharvadze ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Clinical Immunology ◽  
Fatal Outcome ◽  
Cd4 Count ◽  
People Living With Hiv ◽  
Lethal Outcome ◽  
Cell Counts ◽  
Cd4 Cell Counts ◽  
Living With Hiv ◽  
Cd4 Cell

We assessed trends in causes and outcomes of hospitalization among people living with HIV (PLWH) admitted to the Infectious Diseases, AIDS and Clinical Immunology Research Center (IDACIRC) in Tbilisi, Georgia. Retrospective analysis included adult PLWH admitted to IDACIRC for at least 24 h. Internationally validated categorization was used to split AIDS admissions into mild, moderate, and severe AIDS. A total of 2085 hospitalizations among 1123 PLWH were registered over 2012–2017 with 65.1% (731/1123) of patients presenting with CD4 count <200. Of 2085 hospitalizations, 931 (44.7%) were due to AIDS-defining illnesses. In 2012, AIDS conditions accounted for 50.3% of admissions compared to 41.6% in 2017 ( p = 0.16). Overall, 167 hospitalizations (8.0%) resulted in lethal outcome. AIDS admissions had higher mortality than non-AIDS admissions (11.5% vs 5.2%, p < 0.0001). Among 167 deceased patients, 137 (82.0%) had CD4 count <200 at admission. In multivariate analysis, factors significantly associated with mortality included severe AIDS versus non-AIDS admission (OR 2.81, 95% CI: 1.10–7.15), CD4 cell counts <50 (OR 4.34, 95% CI: 2.52–7.47), and 50–100 (OR 2.37, 95% CI: 1.27–4.42) versus >200. Active AIDS disease remains a significant cause of hospitalization and fatal outcome in Georgia. Earlier diagnosis of HIV is critical for decreasing AIDS hospitalizations and mortality.

scholarly journals Which prognostic score for abdominal sepsis? Analysis of final results of PIPAS (Physiological Indicators for Prognosis in Abdominal Sepsis) study in a single center

2018 ◽  
Author(s):  
Stefano Raimondo ◽  
Massimo Sartelli ◽  
Federico Coccolini ◽  
Paola Fugazzola ◽  
Raffaele Bova ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Surgical Complications ◽  
Prognostic Score ◽  
Abdominal Sepsis ◽  
Diffuse Peritonitis ◽  
Single Center ◽  
Oxygen Saturation Level ◽  
Icu Admission ◽  
Level Of Consciousness

Intra-abdominal infections (cIAIs) constitute an important cause of morbidity and mortality. Numerous risk factors may influence prognosis of cIAIs. This study aims to evaluate which parameters and scores may better predict prognostic outcomes in cIAIs. This is a single-center prospective observational study. Data from sixty-five patients were collected during a four-month period. Univariate and multivariate analysis for physiological parameters and ROC curves for SIRS, qSOFA and WISS scores were calculated in relation to mortality, intensive care unit (ICU) admission and surgical complications. Blood oxygen saturation level (SpO2), heart and respiratory rate, systolic blood pressure (SBP), level of consciousness, INR, C-reactive protein (CRP), white blood cells, source control and health care-acquired infections affect prognosis in cIAIs according to univariate analysis. On multivariate analysis level of consciousness, SpO2, CRP, diffuse peritonitis, INR and SBP significantly influenced prognosis in cIAIs. AUROC for WISS score were 0.89 for mortality, 0.86 for major complications, 0.76 for ICU admission. In our study many risk factors adversely affect prognostic outcomes in cIAIs; PIPAS study probably may provide even better results on that. Moreover, WISS score reached remarkable performance in predicting mortality and major surgical complications in abdominal sepsis; qSOFA did not achieve satisfactory results in none of analyzed outcomes.

scholarly journals Severity condition assessment in patients with intra-abdominal surgical infection

2011 ◽  
Vol 4 (1) ◽  
pp. 45-50
Author(s):  
Tatiana Petrovna Gvozdik ◽  
Vladimir Sergeevich Kononov ◽  
Mazhit Akhmetovich Nurtelecom
Keyword(s):  
Liver Dysfunction ◽  
Total Bilirubin ◽  
Severity Of Illness ◽  
High Sensitivity ◽  
Abdominal Sepsis ◽  
Apache Ii ◽  
Lethal Outcome ◽  
Laboratory Findings ◽  
Surgical Infection ◽  
Intra Abdominal Infection

The therapy outcome of 258 patients with intra-abdominal surgical site infection has been evaluated, 205 (79,5%) of which developed abdominal sepsis of different severity degrees. In order to assess risk factors of lethal outcome, the severity of illness and related organ dysfunction scores have been calculated by means of APACHE II, SAPS, MODS и SOFA, as well as the procalcitonin levels test laboratory findings (PCT). In the present study, procalcitonin levels evaluation has shown to be a high sensitivity test that provides objective information for an infectious process assessment, correlating to APACHE II scores (R2=0,86). The concomitant liver dysfunction has been revealed be the most unfavorable factor for intra-abdominal infection prognosis, being the direct cause of death in 28,3% cases. The most sensitive values are total bilirubin, alkaline phosphatase, triglyceride levels, with the highest correlation ratio R2=0,92, R2=0,89, R2=0,93, respectively, which allows their application as an early diagnostic procedure for liver dysfunction detection in this group of patients with the perspectives of its correction.

scholarly journals Cardiac Function Index as a Possible Target Parameter Hemodynamic Correction in Abdominal Sepsis (Pilot Study)

2021 ◽  
Vol 17 (5) ◽  
pp. 9-22
Author(s):  
S. A. Rautbart ◽  
I. N. Tyurin ◽  
A. A. Alexandrovskiy ◽  
I. A. Kozlov
Keyword(s):  
Cardiac Function ◽  
Sensitivity And Specificity ◽  
Abdominal Sepsis ◽  
Model Quality ◽  
Lethal Outcome ◽  
Goal Directed Therapy ◽  
Cardiac Function Index ◽  
Function Index ◽  
Central Hemodynamic ◽  
Cardiac Ejection Fraction

Aim of the study: to determine the predictive value of central hemodynamic parameters in relation to mortality and evaluate their potential acceptability for goal-directed therapy during days 1-4 of treatment in patients with sepsis.Material and methods. The results of investigation and treatment of 62 patients aged 50.9±2.13 years with abdominal sepsis were analyzed. The patient severity on admission to the intensive care unit was 13 [10-15] on the APACHE II scale, 8 [6.75-9.25] on the SOFA scale. Lethal outcome 15.6±1.4 days after admission occurred in 19 (31%) patients. Central hemodynamic parameters were studied by transpulmonary thermodilution according to the standard technique. Infusions and administration of sympathomimetic drugs were performed according to Sepsis-3 guidelines. Statistical analysis was performed using logistic regression and ROC analysis.Results. The median values of the main circulatory parameters during days 1-4 of sepsis treatment were within normal ranges. Cardiac index, afterload-related cardiac performance, global cardiac ejection fraction and cardiac function index were predictors of mortality at all stages of treatment. However, the first three parameters did not provide either sufficient model quality at the study stages or a stable cutoff value with acceptable sensitivity and specificity. The cardiac function index maintained good model quality (area under the ROC curve 0.708-0.753) and a stable cutoff value (≤5.75 to ≤5.81 min-1) with acceptable and balanced sensitivity and specificity of about 70% at all study stages.Conclusion. The cardiac index, afterload cardiac performance, global cardiac ejection fraction and cardiac function index during days 1-4 of intensive care of sepsis are predictors of lethal outcome. At the same time, only the cardiac function index maintains good model quality and consistent cut-off point value with acceptable sensitivity and specificity at all stages of the study. The feasibility of using the cardiac function index as one of the parameters of goal-directed therapy aimed at cardiovascular function improvement in sepsis needs further investigation.

scholarly journals Development of a large animal model of lethal polytrauma and intra-abdominal sepsis with bacteremia

2021 ◽  
Vol 6 (1) ◽  
pp. e000636
Author(s):  
Rachel L O'Connell ◽  
Glenn K Wakam ◽  
Ali Siddiqui ◽  
Aaron M Williams ◽  
Nathan Graham ◽  
...  
Keyword(s):  
Animal Model ◽  
Porcine Model ◽  
Survival Curve ◽  
Abdominal Sepsis ◽  
Injury Pattern ◽  
Long Bone ◽  
Large Animal Model ◽  
Therapeutic Drug ◽  
Large Animal ◽  
Term Survival

BackgroundTrauma and sepsis are individually two of the leading causes of death worldwide. When combined, the mortality is greater than 50%. Thus, it is imperative to have a reproducible and reliable animal model to study the effects of polytrauma and sepsis and test novel treatment options. Porcine models are more translatable to humans than rodent models due to the similarities in anatomy and physiological response. We embarked on a study to develop a reproducible model of lethal polytrauma and intra-abdominal sepsis, which was lethal, though potentially salvageable with treatment.MethodsOur laboratory has a well-established porcine model that was used as the foundation. Animals were subjected to a rectus crush injury, long bone fracture, liver and spleen laceration, traumatic brain injury and hemorrhage that was used as a foundation. We tested various colon injuries to create intra-abdominal sepsis. All animals underwent injuries followed by a period of shock, then subsequent resuscitation.ResultsAll animals had blood culture-proven sepsis. Attempts at long-term survival of animals after injury were ceased because of poor appetite and energy. We shifted to an 8-hour endpoint. The polytrauma injury pattern remained constant and the colon injury pattern changed with the intention of creating a model that was ultimately lethal but potentially salvageable with a therapeutic drug. An uncontrolled cecal injury (n=4) group resulted in very early deaths. A controlled cecal injury (CCI; n=4) group had prolonged time prior to mortality with one surviving to the endpoint. The sigmoid injury (n=5) produced a similar survival curve to CCI but no animals surviving to the endpoint.ConclusionWe have described a porcine model of polytrauma and sepsis that is reproducible and may be used to investigate novel treatments for trauma and sepsis.Level of evidenceNot applicable. Animal study.

scholarly journals New System For Predicting The Outcome Of Secondary Peritonitis

2021 ◽  
Vol 10 (3) ◽  
Author(s):  
Nikolay V. Lebedev ◽  
Sariya B. Agrba ◽  
Vasily S. Popov ◽  
Alexey E. Klimov ◽  
Giorgy T. Svanadze
Keyword(s):  
Statistical Analysis ◽  
Abdominal Sepsis ◽  
Multiple Organ ◽  
Secondary Peritonitis ◽  
Apache Ii ◽  
Diffuse Peritonitis ◽  
Multiple Organ Dysfunction ◽  
Toxic Shock ◽  
Lethal Outcome ◽  
New System

Despite improvements in the methods of diagnostics, surgical interventions and intensive care, the problem of treating patients with diffuse peritonitis remains relevant. Diffuse peritonitis is a major contributor to mortality in all urgent care settings and the second leading cause of sepsis in critically ill patients. At the same time, even in developed countries, the number of patients with peritonitis does not tend to decrease, and mortality rates remain high, reaching 90-93% with the development of abdominal sepsis and toxic shock syndrome. One of the ways to reduce mortality in peritonitis is the use of objective systems for prognosis of the peritonitis outcome, allowing to compare the results of patient treatment and to choose the optimal treatment tactics for each particular patient. The objective — To develop a new system for predicting the outcome of secondary peritonitis (survival or death) focused on the criteria of abdominal sepsis and multiple organ dysfunction syndrome (associated or not associated with peritonitis), and to analyze its accuracy versus the most common comparable systems. Material and Methods — Our study was based on analyzing the treatment outcomes in 352 patients with secondary diffuse peritonitis. On admission, sepsis was diagnosed in 15 (4.3%), and toxic shock in 4 (1.1%) patients. The main causes of death were purulent intoxication and/or sepsis (51 cases or 87.9%), cancer intoxication (4 cases or 6.9%), and acute cardiac failure (3 cases or 5.2%). We analyzed the effectiveness of several systems of predicting the peritonitis outcomes: the Mannheim’s Peritoneal Index (MPI), World Society for Emergency Surgery Sepsis Severity Score (WSES SSS), Acute Physiology and Chronic Health Evaluation II (APACHE II) system, general Sequential Organ Failure Assessment Score (gSOFA), as well as the Peritonitis Prognosis System (PPS) developed by the authors. The probability of the effect of 40 clinical and laboratory parameters on the outcome of patients with secondary peritonitis was analyzed via using parametric and nonparametric methods of statistical analysis (Fisher’s test, Mann-Whitney U test, Chi-squared test with Yates’s continuity correction). The criteria were selected that had a predictive power for the lethal outcome (p <0.05), and they were included in the PPS system. To compare the predictive value of the PPS, ROC analysis was conducted with construction of receiver operating characteristic curves for each analyzed system of predicting the peritonitis outcome. The STATISTICA 8 software was used for performing the statistical analysis. Results — The following criteria were of greatest importance in predicting the lethal outcome: a patient’s age, a presence of a malignant neoplasm, a nature of the exudate, the development of sepsis (toxic shock), as well as multiple organ dysfunction not associated with the developed peritonitis. PPS exhibited the greatest accuracy in terms of predicting mortality in patients with secondary diffuse peritonitis (AUC=0.942) versus minimal in APACHE II (AUC=0.840). Conclusion — APACHE II, MPI, WSES SSS and PPS can be considered reliable in terms of mortality prognosis in peritonitis patients. PPS has the greatest accuracy of predicting the mortality in patients with secondary diffuse peritonitis (94%).

LIPOSOMAL CEFOXITIN IN A PORCINE MODEL OF INTRA-ABDOMINAL SEPSIS

Shock ◽  
1996 ◽  
Vol 6 (Supplement) ◽  
pp. S43-S49 ◽  
Author(s):  
Sandor Soltes ◽  
Pang N. Shek ◽  
Robert A. Mustard ◽  
Ivana Soric ◽  
John M.A. Bohnen ◽  
...  
Keyword(s):  
Porcine Model ◽  
Abdominal Sepsis

LIPOSOMAL CEFOXITIN IN A PORCINE MODEL OF INTRA-ABDOMINAL SEPSIS

Shock ◽  
1996 ◽  
Vol 5 ◽  
pp. S43-49
Author(s):  
Sandor Soltes ◽  
Pang N. Shek ◽  
Robert A. Mustard ◽  
Ivana Soric ◽  
John M.A. Bohnen ◽  
...  
Keyword(s):  
Porcine Model ◽  
Abdominal Sepsis
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