scholarly journals Is early ventricular dysfunction or dilatation associated with lower mortality rate in adult severe sepsis and septic shock? A meta-analysis

Critical Care ◽  
2013 ◽  
Vol 17 (3) ◽  
pp. R96 ◽  
Author(s):  
Stephen J Huang ◽  
Marek Nalos ◽  
Anthony S McLean
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Mortality Rate ◽  
Ventricular Dysfunction ◽  
Meta Analysis ◽  
Lower Mortality ◽  
Sepsis And Septic Shock

scholarly journals Corticosteroids for severe sepsis and septic shock: a systematic review and meta-analysis

BMJ ◽  
2004 ◽  
Vol 329 (7464) ◽  
pp. 480 ◽  
Author(s):  
Djillali Annane ◽  
Eric Bellissant ◽  
Pierre Edouard Bollaert ◽  
Josef Briegel ◽  
Didier Keh ◽  
...  
Keyword(s):  
Systematic Review ◽  
Septic Shock ◽  
Severe Sepsis ◽  
Meta Analysis ◽  
Sepsis And Septic Shock

scholarly journals Intensity of Continuous Renal Replacement Therapies in Patients with Severe Sepsis and Septic Shock: A Systematic Review and Meta-Analysis

2011 ◽  
Vol 39 (3) ◽  
pp. 373-383 ◽  
Author(s):  
J. Latour-Pérez ◽  
E. Palencia-Herrejón ◽  
V. Gómez-Tello ◽  
A. Baeza-Román ◽  
M. á. García-García ◽  
...  
Keyword(s):  
Systematic Review ◽  
Septic Shock ◽  
Severe Sepsis ◽  
Meta Analysis ◽  
Renal Replacement Therapies ◽  
Continuous Renal Replacement Therapies ◽  
Sepsis And Septic Shock

scholarly journals Blood Purification and Mortality in Sepsis and Septic Shock

2019 ◽  
Vol 131 (3) ◽  
pp. 580-593 ◽  
Author(s):  
Alessandro Putzu ◽  
Raoul Schorer ◽  
Juan Carlos Lopez-Delgado ◽  
Tiziano Cassina ◽  
Giovanni Landoni
Keyword(s):  
Septic Shock ◽  
Relative Risk ◽  
Conventional Therapy ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Polymyxin B ◽  
The United States ◽  
Blood Purification ◽  
Lower Mortality ◽  
Sepsis And Septic Shock

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Sepsis and septic shock are severe inflammatory conditions related to high morbidity and mortality. We performed a systematic review with meta-analysis of randomized trials to assess whether extracorporeal blood purification reduces mortality in this setting. Methods Electronic databases were searched for pertinent studies up to January 2019. We included randomized controlled trials on the use of hemoperfusion, hemofiltration without a renal replacement purpose, and plasmapheresis as a blood purification technique in comparison to conventional therapy in adult patients with sepsis and septic shock. The primary outcome was mortality at the longest follow-up available. We calculated relative risks and 95% CIs. The grading of recommendations assessment, development and evaluation methodology for the certainty of evidence was used. Results Thirty-seven trials with 2,499 patients were included in the meta-analysis. Hemoperfusion was associated with lower mortality compared to conventional therapy (relative risk = 0.88 [95% CI, 0.78 to 0.98], P = 0.02, very low certainty evidence). Low risk of bias trials on polymyxin B immobilized filter hemoperfusion showed no mortality difference versus control (relative risk = 1.14 [95% CI, 0.96 to 1.36], P = 0.12, moderate certainty evidence), while recent trials found an increased mortality (relative risk = 1.22 [95% CI, 1.03 to 1.45], P = 0.02, low certainty evidence); trials performed in the United States and Europe had no significant difference in mortality (relative risk = 1.13 [95% CI, 0.96 to 1.34], P = 0.15), while trials performed in Asia had a positive treatment effect (relative risk = 0.57 [95% CI, 0.47 to 0.69], P < 0.001). Hemofiltration (relative risk = 0.79 [95% CI, 0.63 to 1.00], P = 0.05, very low certainty evidence) and plasmapheresis (relative risk = 0.63 [95% CI, 0.42 to 0.96], P = 0.03, very low certainty evidence) were associated with a lower mortality. Conclusions Very low-quality randomized evidence demonstrates that the use of hemoperfusion, hemofiltration, or plasmapheresis may reduce mortality in sepsis or septic shock. Existing evidence of moderate quality and certainty does not provide any support for a difference in mortality using polymyxin B hemoperfusion. Further high-quality randomized trials are needed before systematic implementation of these therapies in clinical practice.

A Meta-Analysis of Gene Expression Studies in Severe Sepsis and Septic Shock

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 2741-2741 ◽  
Author(s):  
Maiara M L Fiusa ◽  
Benilton S Carvalho ◽  
Rodolfo M E Hubert ◽  
Welliton Souza ◽  
Iscia Lopes-Cendes ◽  
...  
Keyword(s):  
Gene Expression ◽  
Septic Shock ◽  
Severe Sepsis ◽  
Peripheral Blood ◽  
Meta Analysis ◽  
Inclusion Criteria ◽  
Comprehensive List ◽  
Expression Studies ◽  
Gene Expression Studies ◽  
Sepsis And Septic Shock

Abstract Introduction: Sepsis represents a complex inflammatory response to infection. Gene expression studies based on microarrays have shown that this response can affect more than 80% of cellular functions and pathways, in what has been termed a “genomic storm”. For several years, sepsis was regarded as a pro-inflammatory condition, and this concept resulted in several experimental treatment strategies aimed to block inflammation. However, systematic failure of these therapies and recent evidence demonstrating that anti-inflammatory pathways are also activated during sepsis illustrate the complexity and our incomplete knowledge about the pathogenesis of this condition. In the last decade, microarray-based gene expression studies have been used in attempts to improve our understanding about sepsis. Raw data from most of these studies are now collected in public archives, thus offering a unique opportunity to combine the information from different studies by meta-analysis. It has been shown that by analyzing data from multiple experiments, biases and artifacts between datasets can be cancelled out, potentially allowing true relationships to stand out. Accordingly, an increasing number of bioinformatics protocols and guidelines about meta-analysis of gene expression studies have been published in the last years. In the context of sepsis, several high-quality microarray-based gene expression studies are available. However, no systematic meta-analysis of these studies has been performed. In order to identify genes and pathways robustly associated with the pathogenesis of sepsis, we performed a meta-analysis of gene expression studies in human severe sepsis and septic shock. Material and methods: Microarray data were identified by searching two public databases (Gene Expression Omnibus and Array-Express) using the following search criteria: (“sepsis or “septic shock”) AND (“peripheral blood” or “leukocytes”) AND (“homo sapiens”). Inclusion criteria were: studies in humans with severe sepsis or septic shock; RNA obtained from peripheral blood leukocytes; availability of raw data; and matched healthy controls from the same study. To improve consistency, only studies using similar platforms were compared. We used the R/BioConductor environment to preprocess the datasets using the Robust Multi-array Average algorithm (RMA) implemented in the ‘oligo’ package and to perform meta-analysis through the ‘RankProd’ package implementation. This is a non-parametric statistical method that utilizes ranks of the log-ratio statistics for all genes across different studies to generate a list of differentially expressed (DE) genes between two conditions, and considered superior to alternative methodologies. For this study, we selected genes with fold-change of expression above 2 and false discovery rate below 0.01, calculated based on 10,000 permutations. Gene set analysis was initially performed using WebGestalt and confirmed in similar tools (KEGG, Pathway Commons, WikiPathways). Only pathways identified by more than one tool were considered. Results: Forty-five studies were identified, of which five fulfilled inclusion criteria. Our meta-analysis included data from 259 patients and 132 controls. Out of 22,216 probesets, we observed 352 as candidates for DE, 215 of which were up-regulated and 137 down-regulated. Top 5 up-regulated genes were CD177, MMP8, HP, ARG1 and ANXA3. Top 5 down-regulated genes were FCER1A, YME1L1, TRDV3, LRRN3 and MYBL1. The gene ontology term associated with the set of DE genes in both analysis with higher statistical significance was "immune response” (adjP=2.85e-27), and the most significant pathways identified were “Hematopoietic cell lineage” (adjP=8.69e-13), “TCR signaling pathway” (adjP=3.04e-10) and “immune system” (adjP=1.08e-19). Discussion and conclusion: The combined analysis of data generated by high-throughput experiments is an attractive and validated strategy to improve the sensitivity and specificity of genome-wide expression data. This meta-analysis provides a comprehensive list of genes, pathways and expression signatures associated with severe sepsis and septic shock, confirming several results from individual studies. In addition, our meta-analysis potentially provides new biological insights about sepsis, by listing a comprehensive list of new candidate genes with robust associations with this condition. Disclosures No relevant conflicts of interest to declare.

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