scholarly journals oXiris® Use in Septic Shock: Experience of Two French Centres

2019 ◽  
Vol 47 (Suppl. 3) ◽  
pp. 29-35 ◽  
Author(s):  
Victor Schwindenhammer ◽  
Thibaut Girardot ◽  
Kevin Chaulier ◽  
Arnaud Grégoire ◽  
Céline Monard ◽  
...  
Keyword(s):  
Septic Shock ◽  
Hospital Mortality ◽  
Sofa Score ◽  
Abdominal Sepsis ◽  
Simplified Acute Physiology Score ◽  
Saps Ii ◽  
Extracorporeal Blood Purification ◽  
Norepinephrine Infusion ◽  
Failure Assessment ◽  
Over Time

Background: Sepsis is a dysregulated host response to an infection and can result in organ dysfunctions and death. Extracorporeal blood purification techniques aim to improve the prognosis of these patients by modulating the unbalanced immune response. This study reports our experience with the use of the oXiris® membrane for septic shock patients requiring continuous renal replacement therapy (CRRT). Summary: Thirty-one patients were diagnosed with septic shock and underwent CRRT with the oXiris® membrane between 2014 and 2019. We compared the observed hospital mortality with that predicted by the Simplified Acute Physiology Score II (SAPS II). Change in the Sequential Organ Failure Assessment (SOFA) score and of the main clinical and biological parameters over time were analyzed. Hospital mortality was lower than predicted for the most severe patients (60 vs. 91% for the [74–87] SAPS II quartile and 70 vs. 98% for the [87–163] SAPS II quartile, p < 0.02). There was no significant improvement in the SOFA score from 0h to 48 h. An 88% relative decrease in norepinephrine infusion was observed (median at 0 h was 1.69 [0.52–2.45] µg/kg/min; at 48 h it was 0.20 [0.09–1.14] µg/kg/min, p = 0.002). Lactataemia and pH were significantly improved over time. Patients with intra-abdominal sepsis as well as those with Gram-negative bacilli (GNB) infections seemed to benefit the most from the therapy. Key Messages: CRRT with the oXiris® haemofilter resulted in higher observed survival than predicted by a severity score (SAPS II) for the most severe patients. Haemodynamic status and lactataemia appeared to improve, especially in intra-abdominal sepsis and GNB infections.

The Association Between Sequential Organ Failure Assessment Scores and Mortality in Patients With Sepsis During the First Week: The JSEPTIC DIC Study

2018 ◽  
Vol 35 (7) ◽  
pp. 656-662 ◽  
Author(s):  
Tsuyoshi Nakashima ◽  
Kyohei Miyamoto ◽  
Toshio Shimokawa ◽  
Seiya Kato ◽  
Mineji Hayakawa
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Hospital Mortality ◽  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Sofa Score ◽  
Assessment Scores ◽  
Coagulation Study ◽  
Failure Assessment ◽  
The Relationship

Objective: Predicting prognosis is a complex process, particularly in patients with severe sepsis or septic shock. This study aimed to determine the relationship between the Sequential Organ Failure Assessment (SOFA) scores for individual organs during the first week of admission and the in-hospital mortality in patients with sepsis. Methods: This study was a post hoc evaluation of the Japan Septic Disseminated Intravascular Coagulation study and included patients admitted to 42 intensive care units in Japan for severe sepsis or septic shock, between January 2011 and December 2013. We assessed the relationship between the organ and total SOFA scores on days 1, 3, and 7 following admission and the in-hospital mortality using logistic regression analysis. Results: We evaluated 2732 patients and found the in-hospital mortality rate was 29.1%. The mean age of the patients (standard deviation) was 70.5 (14.1) years, and the major primary site of infection was the abdomen (33.6%). The central nervous system (CNS) SOFA score exhibited the strongest relationship with mortality on days 1 (adjusted odds ratio [aOR]: 1.49, 95% confidence interval [CI]: 1.40-1.59), 3 (aOR: 1.75, 95% CI: 1.62-1.89), and 7 (aOR: 1.93, 95% CI: 1.77-2.10). The coagulation SOFA scores showed a weak correlation with mortality on day 1, but a strong correlation with mortality on day 7 (aOR: 2.04, 95% CI: 1.87-2.24). Conclusions: The CNS SOFA scores were associated with mortality in patients with severe sepsis on days 1, 3, and 7 following hospitalization. The coagulation SOFA score was associated with mortality on day 7. In clinical situations, the CNS SOFA scores during the acute phase and the CNS SOFA and coagulation SOFA scores during the subsequent phases should be evaluated in order to determine patient prognosis.

scholarly journals Haemogram-Derived Indices for Screening and Prognostication in Critically Ill Septic Shock Patients: A Case-Control Study

Diagnostics ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. 638
Author(s):  
Piotr S. Liberski ◽  
Michał Szewczyk ◽  
Łukasz J. Krzych
Keyword(s):  
Septic Shock ◽  
Organ Failure ◽  
Simplified Acute Physiology Score ◽  
Mortality Prediction ◽  
Apache Ii ◽  
Icu Mortality ◽  
Reactive Protein ◽  
Saps Ii ◽  
Multi Organ Failure ◽  
Failure Assessment

This study aimed (1) to assess the diagnostic accuracy of neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte (PLR), monocyte-to-lymphocyte (MLR) and platelet count-to-mean platelet volume (PLT/MPV) ratios in predicting septic shock in patients on admission to the intensive care unit (ICU) and (2) to compare it with the role of C-reactive protein (CRP), procalcitonin (PCT) and lactate level. We also sought (3) to verify whether the indices could be useful in ICU mortality prediction and (4) to compare them with Acute Physiology and Chronic Health Evaluation II (APACHE II), Simplified Acute Physiology Score II (SAPS II) and Sequential Organ Failure Assessment (SOFA) scores. This retrospective study covered 138 patients, including 61 subjects with multi-organ failure due to septic shock (study group) and 77 sex- and age-matched controls. Septic patients had significantly higher NLR (p < 0.01) and NLR predicted septic shock occurrence (area under the ROC curve, AUROC = 0.66; 95% CI 0.58–0.74). PLR, MLR and PLT/MPV were impractical in sepsis prediction. Combination of CRP with NLR improved septic shock prediction (AUROC = 0.88; 95% CI 0.81–0.93). All indices failed to predict ICU mortality. APACHE II and SAPS II predicted mortality with AUROC = 0.68; 95% CI 0.54–0.78 and AUROC = 0.7; 95% CI 0.57–0.81, respectively. High NLR may be useful to identify patients with multi-organ failure due to septic shock but should be interpreted along with CRP or PCT. The investigated indices are not related with mortality in this specific clinical setting.

Effectiveness of the sequential organ failure assessment, acute physiology and chronic health evaluation II, and simplified acute physiology score II prognostic scoring systems in paraquat-poisoned patients in the intensive care unit

2016 ◽  
Vol 36 (5) ◽  
pp. 431-437 ◽  
Author(s):  
Jun Ho Lee ◽  
Seong Youn Hwang ◽  
Hye Ran Kim ◽  
Yang Won Kim ◽  
Mun Ju Kang ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Sofa Score ◽  
Scoring Systems ◽  
Simplified Acute Physiology Score ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Health Evaluation ◽  
Saps Ii ◽  
Failure Assessment ◽  
Score Apache

Objective: This study was conducted to assess the ability of the sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation (APACHE) II scoring systems, as well as the simplified acute physiology score (SAPS) II method to predict group mortality in intensive care unit (ICU) patients who were poisoned with paraquat. This will assist physicians with risk stratification. Material and methods: The medical records of 244 paraquat-poisoned patients admitted to the ICU from January 2010 to April 2015 were examined retrospectively. The SOFA, APACHE II, and SAPS II scores were calculated based on initial laboratory data in the emergency department and during the first 24 h of ICU admission. The probability of death was calculated for each patient based on the SOFA score, APACHE II score, and SAPS II. The ability of the SOFA score, APACHE II score, and SAPS II method to predict group mortality was assessed using a receiver operating characteristic (ROC) curve and calibration analyses. Results: A total of 219 patients (mean age, 63 years) were enrolled. Sensitivities, specificities, and accuracies were 58.5%, 86.1%, and 64.0% for the SOFA, respectively; 75.1%, 86.1%, and 77.6% for the APACHE II scoring systems, respectively; and 76.1%, 79.1%, and 76.7% for the SAPS II, respectively. The areas under the curve in the ROC curve analysis for the SOFA score, APACHE II scoring system, and SAPS II were 0.716, 0.850, and 0.835, respectively. Conclusion: The SOFA, APACHE II, and SAPS II had different capabilities to discriminate and estimate early in-hospital mortality of paraquat-poisoned patients. Our results show that although the SOFA and SAPS II are easier and more quickly calculated than APACHE II, the APACHE II is superior for predicting mortality. We recommend use of the APACHE II for outcome predictions and risk stratification in paraquat-poisoned patients in the ICU.

Sepsis and Septic Shock Definitions in Patients With Cancer Admitted in ICU

2019 ◽  
pp. 088506661989493 ◽  
Author(s):  
Neveux Nathan ◽  
Jean-Paul Sculier ◽  
Lieveke Ameye ◽  
Marianne Paesmans ◽  
Grigoriu Bogdan-Dragos ◽  
...  
Keyword(s):  
Septic Shock ◽  
Hospital Mortality ◽  
Sofa Score ◽  
Patients With Cancer ◽  
Failure Assessment ◽  
Predict Hospital Mortality ◽  
Definition Of ◽  
Qsofa Score ◽  
Sepsis And Septic Shock ◽  
Sirs Criteria

Introduction: In 2016, a new definition of sepsis and septic shock was adopted. Some studies based on the general population demonstrated that the Sequential Organ Failure Assessment (SOFA) score is more accurate than the systemic inflammatory response syndrome (SIRS) criteria to predict hospital mortality of infected patients requiring intensive care. Patients and Method: We have analyzed all the records of patients with cancer admitted for a suspected infection between January 1, 2013, and December 31, 2016, in our oncological intensive care unit (ICU). Sequential Organ Failure Assessment score and quick SOFA (qSOFA) score as well as SIRS criteria were calculated. We analyzed the accuracy of each score to predict hospital mortality in the setting of the new and old definitions of septic shock. Results: Our study includes 241 patients with a solid tumor and 112 with a hematological malignancy. The hospital mortality rate is 37% (68% in patients with septic shock according to the new definition and 60% according to old definition) between 2013 and 2016. To predict hospital mortality, the SOFA score has an area under the receiver operating characteristic curve of 0.74 (95% confidence interval [CI], 0.68-0.79), the qSOFA of 0.65 (95% CI, 0.59-0.70), and the SIRS criteria of 0.58 (95% CI, 0.52-0.63). In multivariate analysis, a higher SOFA score or a higher qSOFA score indicates poor prognosis: odds ratio (OR) per 1-point increase by 1.28 (95% CI, 1.18-1.39) and 1.48 (95% CI, 1.04-2.11), respectively. Complete remission is a good prognostic factor for hospital mortality: OR 0.39 (95% CI, 0.22-0.67). Conclusion: The new definition of sepsis and septic shock is applicable in an ICU oncological population with the same reliability as in the general population. The SOFA score is more accurate than qSOFA and SIRS criteria to predict hospital mortality.

scholarly journals SOFA Score, Hemodynamics and Body Temperature Allow Early Discrimination between Porcine Peritonitis-Induced Sepsis and Peritonitis-Induced Septic Shock

2021 ◽  
Vol 11 (3) ◽  
pp. 164
Author(s):  
Mahmoud Al-Obeidallah ◽  
Dagmar Jarkovská ◽  
Lenka Valešová ◽  
Jan Horák ◽  
Jan Jedlička ◽  
...  
Keyword(s):  
Septic Shock ◽  
Body Temperature ◽  
Sofa Score ◽  
Porcine Model ◽  
Venous Blood ◽  
Mixed Venous Blood ◽  
Mechanically Ventilated ◽  
Multiple Parameters ◽  
Failure Assessment ◽  
Sepsis And Septic Shock

Porcine model of peritonitis-induced sepsis is a well-established clinically relevant model of human disease. Interindividual variability of the response often complicates the interpretation of findings. To better understand the biological basis of the disease variability, the progression of the disease was compared between animals with sepsis and septic shock. Peritonitis was induced by inoculation of autologous feces in fifteen anesthetized, mechanically ventilated and surgically instrumented pigs and continued for 24 h. Cardiovascular and biochemical parameters were collected at baseline (just before peritonitis induction), 12 h, 18 h and 24 h (end of the experiment) after induction of peritonitis. Analysis of multiple parameters revealed the earliest significant differences between sepsis and septic shock groups in the sequential organ failure assessment (SOFA) score, systemic vascular resistance, partial pressure of oxygen in mixed venous blood and body temperature. Other significant functional differences developed later in the course of the disease. The data indicate that SOFA score, hemodynamical parameters and body temperature discriminate early between sepsis and septic shock in a clinically relevant porcine model. Early pronounced alterations of these parameters may herald a progression of the disease toward irreversible septic shock.

Calcium supplementation prolongs the time of hospitalization and has a double effect on mortality in septic patients: A retrospective study from MIMIC-III

2020 ◽  
Author(s):  
Wencheng He ◽  
Youzhong An ◽  
Lei Huang ◽  
Hua Luo ◽  
Jingying Chen ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Sofa Score ◽  
Calcium Supplementation ◽  
Double Effect ◽  
Calcium Supplement ◽  
Electrolyte Disturbance ◽  
Icu Admission ◽  
Supplement Group ◽  
Failure Assessment ◽  
Mimic Iii

Abstract Background Hypocalcemia is a common electrolyte disturbance in sepsis, calcium administration in those patients remains a controversial issue. The aim of this study was to assess the association of calcium supplementation with the time of hospitalization and mortality in septic patients. Method 5761 eligible septic patients, including 2689 with calcium supplementation and 3072 without calcium supplementation, were extracted from the MIMIC-III database. A total of 1463 pair patients were included in the analysis after propensity score matching according to the age, sex, SOFA score and lactate on first ICU admission. We compared the length of stay (LOS) in the intensive care unit (ICU) and hospital, as well as the 28-day and hospital mortality, which stratified the analysis according to the Sequential Organ Failure Assessment (SOFA) score, and the iCa on the first ICU admission between the matched groups. Results The results showed that either a too-low or a too-high iCa increased the risk for septic patients, but the minimum of the mortality curve in the non-calcium supplement group was locally in the mild hypocalcemia range. Regardless of the SOFA score and iCa, the LOS in both the ICU and hospital were higher in the calcium supplement group than in the non-calcium supplement group. Overall, the 28-day and hospital mortality were greater but not statistically significant in the calcium supplement group than in the non-calcium supplement group (14.83% vs 13.39%, p=0.416; 16.20% vs 13.88%, p=0.079, respectively). However, the survival analysis stratified by SOFA score showed that calcium supplementation reduced mortality when the patient’s SOFA score was >8 (p=0.028), while it worsen the outcome when the SOFA score was ≤4 (p<0.001) and had no significant effect with SOFA scores from 5~8 (p=0.556). Conclusion Our findings suggest that mild hypocalcemia may be protective in septic patients and that calcium supplementation may prolong hospitalization and have a double effect on mortality. The SOFA score may be a valuable clinical index for calcium administration decision making.

scholarly journals Sequential Organ Failure Assessment Component Score Prediction of In-hospital Mortality From Sepsis

2018 ◽  
Vol 35 (8) ◽  
pp. 810-817 ◽  
Author(s):  
Tushar Gupta ◽  
Michael A. Puskarich ◽  
Elizabeth DeVos ◽  
Adnan Javed ◽  
Carmen Smotherman ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Sofa Score ◽  
Statistical Significance ◽  
Predictive Ability ◽  
Hospital Death ◽  
Icu Stay ◽  
Relative Contribution ◽  
Failure Assessment

Objectives: Early organ dysfunction in sepsis confers a high risk of in-hospital mortality, but the relative contribution of specific types of organ failure to overall mortality is unclear. The objective of this study was to assess the predictive ability of individual types of organ failure to in-hospital mortality or prolonged intensive care. Methods: Retrospective cohort study of adult emergency department patients with sepsis from October 1, 2013, to November 10, 2015. Multivariable regression was used to assess the odds ratios of individual organ failure types for the outcomes of in-hospital death (primary) and in-hospital death or ICU stay ≥ 3 days (secondary). Results: Of 2796 patients, 283 (10%) experienced in-hospital mortality, and 748 (27%) experienced in-hospital mortality or an ICU stay ≥ 3 days. The following components of Sequential Organ Failure Assessment (SOFA) score were most predictive of in-hospital mortality (descending order): coagulation (odds ratio [OR]: 1.60, 95% confidence interval [CI]: 1.32-1.93), hepatic (1.58, 95% CI: 1.32-1.90), respiratory (OR: 1.33, 95% CI: 1.21-1.47), neurologic (OR: 1.20, 95% CI: 1.07-1.35), renal (OR: 1.14, 95% CI: 1.02-1.27), and cardiovascular (OR: 1.13, 95% CI: 1.01-1.25). For mortality or ICU stay ≥3 days, the most predictive SOFA components were respiratory (OR: 1.97, 95% CI: 1.79-2.16), neurologic (OR: 1.72, 95% CI: 1.54-1.92), cardiovascular (OR: 1.38, 95% CI: 1.23-1.54), coagulation (OR: 1.31, 95% CI: 1.10-1.55), and renal (OR: 1.19, 95% CI: 1.08-1.30) while hepatic SOFA (OR: 1.16, 95% CI: 0.98-1.37) did not reach statistical significance ( P = .092). Conclusion: In this retrospective study, SOFA score components demonstrated varying predictive abilities for mortality in sepsis. Elevated coagulation or hepatic SOFA scores were most predictive of in-hospital death, while an elevated respiratory SOFA was most predictive of death or ICU stay >3 days.

Sequential Organ Failure Assessment (SOFA) Score As a Predictor of Outcome in Sepsis in Pediatric Intensive Care Unit

2020 ◽  
Author(s):  
A.V. Lalitha ◽  
J.K. Satish ◽  
Mounika Reddy ◽  
Santu Ghosh ◽  
Jiny George ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Pediatric Intensive Care Unit ◽  
Sofa Score ◽  
Severity Of Illness ◽  
Pediatric Intensive Care ◽  
Inotropic Support ◽  
Discriminative Power ◽  
Failure Assessment

AbstractSequential organ failure assessment (SOFA) score is used as a predictor of outcome of sepsis in the pediatric intensive care unit. The aim of the study is to determine the application of SOFA scores as a predictor of outcome in children admitted to the pediatric intensive care unit with a diagnosis of sepsis. The design involved is prospective observational study. The study took place at the multidisciplinary pediatric intensive care unit (PICU), tertiary care hospital, South India. The patients included are children, aged 1 month to 18 years admitted with a diagnosis of sepsis (suspected/proven) to a single center PICU in India from November 2017 to November 2019. Data collected included the demographic, clinical, laboratory, and outcome-related variables. Severity of illness scores was calculated to include SOFA score day 1 (SF1) and day 3 (SF3) using a pediatric version (pediatric SOFA score or pSOFA) with age-adjusted cutoff variables for organ dysfunction, pediatric risk of mortality III (PRISM III; within 24 hours of admission), and pediatric logistic organ dysfunction-2 or PELOD-2 (days 1, 3, and 5). No intervention was observed during the period of study. A total of 240 patients were admitted to the PICU with septic shock during the study period. The overall mortality rate was 42 of 240 patients (17.5%). The majority (59%) required mechanical ventilation, while only 19% required renal replacement therapy. The PRISM III, PELOD-2, and pSOFA scores correlated well with mortality. All three severity of illness scores were higher among nonsurvivors as compared with survivors (p < 0.001). pSOFA scores on both day 1 (area under the curve or AUC 0.84) and day 3 (AUC 0.87) demonstrated significantly higher discriminative power for in-hospital mortality as compared with PRISM III (AUC, 0.7), and PELOD-2 (day 1, [AUC, 0.73]), and PELOD-2 (day 3, [AUC, 0.81]). Utilizing a cutoff SOFA score of >8, the relative risk of prolonged duration of mechanical ventilation, requirement for vasoactive infusions (vasoactive infusion score), and PICU length of stay were all significantly increased (p < 0.05), on both days 1 and 3. On multiple logistic regression, adjusted odds ratio of mortality was elevated at 8.65 (95% CI: 3.48–21.52) on day 1 and 16.77 (95% confidence interval or CI: 4.7–59.89) on day 3 (p < 0.001) utilizing the same SOFA score cutoff of 8. A positive association was found between the delta SOFA ([Δ] SOFA) from day 1 to day 3 (SF1–SF3) and in-hospital mortality (chi-square for linear trend, p < 0.001). Subjects with a ΔSOFA of ≥2 points had an exponential mortality rate to 50%. Similar association was—observed between ΔSOFA of ≥2 and—longer duration of inotropic support (p = 0.0006) with correlation co-efficient 0.2 (95% CI: 0.15–0.35; p = 0.01). Among children admitted to the PICU with septic shock, SOFA scores on both days 1 and 3, have a greater discriminative power for predicting in-hospital mortality than either PRISM III score (within 24 hours of admission) or PELOD-2 score (days 1 and 3). An increase in ΔSOFA of >2 adds additional prognostic accuracy in determining not only mortality risk but also duration of inotropic support as well.

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