scholarly journals New strategies in multiple organ dysfunction syndrometherapy for sepsis

2005 ◽  
Vol 133 (7-8) ◽  
pp. 379-383 ◽  
Author(s):  
Maja Surbatovic ◽  
Sonja Radakovic ◽  
Krsta Jovanovic ◽  
Predrag Romic
Keyword(s):  
Organ Dysfunction ◽  
Treatment Strategies ◽  
Multiple Organ ◽  
Multiple Organ Dysfunction ◽  
Tight Control ◽  
Goal Directed Therapy ◽  
Early Goal Directed Therapy ◽  
Drotrecogin Alfa Activated ◽  
New Treatment ◽  
New Strategies

Despite more than 20 years of extensive research, sepsis and/or trauma induced multiple organ dysfunction syndrome (MODS) remain the chief cause of death in intensive care units, with mortality rates between 30% and 80%. Early goal-directed therapy (EGDT), use of drotrecogin alfa (activated), tight control of hyperglycaemia, and adrenal replacement therapy (low doses of corticosteroids)all constitute new treatment strategies. In future, a combination of therapies should be individually adjusted for each patient.

scholarly journals Diagnostic Accuracy of Biomarkers for Early Multiple Organ Dysfunction in Critically Ill Patients: A Multicenter Prospective Observational Study

2020 ◽  
Author(s):  
Shigeto Ishikawa ◽  
Yuto Teshima ◽  
Hiroki Otsubo ◽  
Takashi Shimazui ◽  
Taka-aki Nakada ◽  
...  
Keyword(s):  
Emergency Department ◽  
Observational Study ◽  
Critically Ill ◽  
Organ Dysfunction ◽  
Critically Ill Patients ◽  
Characteristic Curve ◽  
Treatment Strategies ◽  
Multiple Organ ◽  
Multiple Organ Dysfunction ◽  
Qsofa Score

Abstract BackgroundShock and organ damage occur in critically ill patients in the emergency department because of biological responses to invasion, and cytokines play an important role in their development. It is important to predict early multiple organ dysfunction (MOD) because it is useful in predicting patient outcomes and selecting treatment strategies. This study examined the accuracy of biomarkers, including interleukin (IL)-6, in predicting early MOD in critically ill patients compared with that of quick sequential organ failure assessment (qSOFA).MethodsThis observational study was conducted at five universities from 2016 to 2018. Data of adult patients with systemic inflammatory response syndrome who presented to the emergency department or were admitted to the intensive care unit were prospectively evaluated. qSOFA score and each biomarker (IL-6, IL-8, IL-10, tumor necrosis factor-α, C-reactive protein, and procalcitonin [PCT]) level were assessed on Days 0, 1, and 2. The primary outcome was set as MOD on Day 2, and the area under the receiver operating characteristic curve (AUROC) was analyzed to evaluate qSOFA scores and biomarker levels.ResultsOf 199 patients, 38 were excluded and 161 were included. Patients with MOD on Day 2 had significantly higher qSOFA, SOFA, and Acute Physiology and Chronic Health Evaluation II scores and a trend toward worse prognosis, including mortality. The AUROC for qSOFA score (Day 0) that predicted MOD (Day 2) was 0.728 (95% confidence interval [CI]: 0.651–0.794). IL-6 (Day 1) showed the highest AUC among all biomarkers (0.790 [95% CI: 0.711–852]). The combination of qSOFA (Day 0) and IL-6 (Day 1) showed improved prediction accuracy (0.859 [95% CI: 0.792–0.907]). The combination model using qSOFA (Day 0) and IL-6 (Day 1) also showed a higher AUROC (0.889 [95% CI: 0.828–0.929]).ConclusionsThe addition of serum IL-6 level to qSOFA scores improved the accuracy of early MOD prediction.

scholarly journals Risk prediction of biomarkers for early multiple organ dysfunction in critically ill patients

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shigeto Ishikawa ◽  
Yuto Teshima ◽  
Hiroki Otsubo ◽  
Takashi Shimazui ◽  
Taka-aki Nakada ◽  
...  
Keyword(s):  
Emergency Department ◽  
Critically Ill ◽  
Organ Dysfunction ◽  
Critically Ill Patients ◽  
Treatment Strategies ◽  
Area Under The Curve ◽  
Multiple Organ ◽  
Multiple Organ Dysfunction ◽  
Combination Model ◽  
Qsofa Score

Abstract Background Shock and organ damage occur in critically ill patients in the emergency department because of biological responses to invasion, and cytokines play an important role in their development. It is important to predict early multiple organ dysfunction (MOD) because it is useful in predicting patient outcomes and selecting treatment strategies. This study examined the accuracy of biomarkers, including interleukin (IL)-6, in predicting early MOD in critically ill patients compared with that of quick sequential organ failure assessment (qSOFA). Methods This was a multicenter observational sub-study. Five universities from 2016 to 2018. Data of adult patients with systemic inflammatory response syndrome who presented to the emergency department or were admitted to the intensive care unit were prospectively evaluated. qSOFA score and each biomarker (IL-6, IL-8, IL-10, tumor necrosis factor-α, C-reactive protein, and procalcitonin [PCT]) level were assessed on Days 0, 1, and 2. The primary outcome was set as MOD on Day 2, and the area under the curve (AUC) was analyzed to evaluate qSOFA scores and biomarker levels. Results Of 199 patients, 38 were excluded and 161 were included. Patients with MOD on Day 2 had significantly higher qSOFA, SOFA, and Acute Physiology and Chronic Health Evaluation II scores and a trend toward worse prognosis, including mortality. The AUC for qSOFA score (Day 0) that predicted MOD (Day 2) was 0.728 (95% confidence interval [CI]: 0.651–0.794). IL-6 (Day 1) showed the highest AUC among all biomarkers (0.790 [95% CI: 0.711–852]). The combination of qSOFA (Day 0) and IL-6 (Day 1) showed improved prediction accuracy (0.842 [95% CI: 0.771–0.893]). The combination model using qSOFA (Day 1) and IL-6 (Day 1) also showed a higher AUC (0.868 [95% CI: 0.799–0.915]). The combination model of IL-8 and PCT also showed a significant improvement in AUC. Conclusions The addition of IL-6, IL-8 and PCT to qSOFA scores improved the accuracy of early MOD prediction.

Drotrecogin alfa (activated) in the treatment of severe sepsis patients with multiple-organ dysfunction: data from the PROWESS trial

2003 ◽  
Vol 29 (6) ◽  
pp. 894-903 ◽  
Author(s):  
Jean-François Dhainaut ◽  
◽  
Pierre-François Laterre ◽  
Jonathan M. Janes ◽  
Gordon R. Bernard ◽  
...  
Keyword(s):  
Severe Sepsis ◽  
Organ Dysfunction ◽  
Drotrecogin Alfa ◽  
Multiple Organ ◽  
Multiple Organ Dysfunction ◽  
Drotrecogin Alfa Activated ◽  
Prowess Trial

Advances in the Understanding of Clinical Manifestations and Therapy of Severe Sepsis: An Update for Critical Care Nurses

2003 ◽  
Vol 12 (2) ◽  
pp. 120-133 ◽  
Author(s):  
E. Wesley Ely ◽  
Ruth M. Kleinpell ◽  
Richert E. Goyette
Keyword(s):  
Critical Care ◽  
Severe Sepsis ◽  
Organ Dysfunction ◽  
Multiple Organ Dysfunction Syndrome ◽  
Protein C ◽  
Multiple Organ ◽  
Critical Care Nurses ◽  
Health Concern ◽  
Multiple Organ Dysfunction ◽  
Drotrecogin Alfa Activated

Severe sepsis is a major public health concern and a burden on the healthcare system. Despite improvements in efforts to control the source of infection and increased recognition by healthcare providers of patients with the disease, the mortality rate remains unacceptably high, from 30% to 50%. The systemic inflammatory response syndrome criteria are used as diagnostic indicators of sepsis when they occur in patients with known or suspected infection. The outcome of a patient with severe sepsis is often related to the occurrence of sepsis-induced multiple organ dysfunction syndrome. Multiple organ dysfunction syndrome appears to result from a cascade of organism-related factors, inflammatory mediators, endothelial injury, disturbed hemostasis, and microcirculatory abnormalities. In patients with severe sepsis, derangements of inflammation and coagulation are tightly linked. Although numerous clinical trials focused on interventions in one or the other of the inflammatory and coagulation systems failed to show reduced mortality due to sepsis, a member of a new class of drugs called “cogins” was effective. In its active form, protein C has anti-inflammatory, antithrombotic, and profibrinolytic properties that can reduce organ injury associated with severe sepsis. A recombinant form of activated protein C, drotrecogin alfa (activated), significantly reduces 28-day mortality due to all causes in patients with severe sepsis and has an acceptable safety profile. This review provides an overview of severe sepsis, highlighting recent advances in treatment of the disease and the role of critical care nurses.

Disseminated intravascular coagulation in meningococcal sepsis

2003 ◽  
Vol 23 (03) ◽  
pp. 125-130 ◽  
Author(s):  
S. Zeerleder ◽  
R. Zürcher Zenklusen ◽  
C. E. Hack ◽  
W. A. Wuillemin
Keyword(s):  
Organ Dysfunction ◽  
Disseminated Intravascular Coagulation ◽  
Skin Necrosis ◽  
Multiple Organ ◽  
Meningococcal Sepsis ◽  
Multiple Organ Dysfunction ◽  
Intravascular Coagulation ◽  
Therapeutic Concepts ◽  
New Therapeutic Concepts ◽  
Coagulation And Fibrinolysis

SummaryWe report on a man (age: 49 years), who died from severe meningococcal sepsis with disseminated intravascular coagulation (DIC), multiple organ dysfunction syndrome and extended skin necrosis. We discuss in detail the pathophysiology of the activation of coagulation and fibrinolysis during sepsis. The article discusses new therapeutic concepts in the treatment of disseminated intravascular coagulation in meningococcal sepsis, too.

Multiple Organ Dysfunction Syndrome of Alcoholic Origin in an 18-Year-Old Patient

2018 ◽  
Vol 2 (12) ◽  
Author(s):  
Francesco Gazia ◽  
Giacomo De Luca ◽  
Imbalzano Gabriele ◽  
Vincenzo Pellicanò
Keyword(s):  
Organ Dysfunction ◽  
Multiple Organ Dysfunction Syndrome ◽  
Multiple Organ ◽  
Multiple Organ Dysfunction

IMPACT probability of poor outcome and plasma cytokine concentrations are associated with multiple organ dysfunction syndrome following traumatic brain injury

2019 ◽  
Vol 131 (6) ◽  
pp. 1931-1937 ◽  
Author(s):  
Sungho Lee ◽  
Hyunsoo Hwang ◽  
Jose-Miguel Yamal ◽  
J. Clay Goodman ◽  
Imoigele P. Aisiku ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Organ Dysfunction ◽  
Multiple Organ Dysfunction Syndrome ◽  
Sofa Score ◽  
Plasma Concentrations ◽  
Multiple Organ ◽  
Multiple Organ Dysfunction ◽  
Poor Outcome ◽  
Initial Plasma

OBJECTIVETraumatic brain injury (TBI) is a major cause of morbidity and mortality. Multiple organ dysfunction syndrome (MODS) occurs frequently after TBI and independently worsens outcome. The present study aimed to identify potential admission characteristics associated with post-TBI MODS.METHODSThe authors performed a secondary analysis of a recent randomized clinical trial studying the effects of erythropoietin and blood transfusion threshold on neurological recovery after TBI. Admission clinical, demographic, laboratory, and imaging parameters were used in a multivariable Cox regression analysis to identify independent risk factors for MODS following TBI, defined as maximum total Sequential Organ Failure Assessment (SOFA) score > 7 within 10 days of TBI.RESULTSTwo hundred patients were initially recruited and 166 were included in the final analysis. Respiratory dysfunction was the most common nonneurological organ system dysfunction, occurring in 62% of the patients. International Mission for Prognosis and Analysis of Clinical Trials (IMPACT) probability of poor outcome at admission was significantly associated with MODS following TBI (odds ratio [OR] 8.88, 95% confidence interval [CI] 1.94–42.68, p < 0.05). However, more commonly used measures of TBI severity, such as the Glasgow Coma Scale, Injury Severity Scale, and Marshall classification, were not associated with post-TBI MODS. In addition, initial plasma concentrations of interleukin (IL)–6, IL-8, and IL-10 were significantly associated with the development of MODS (OR 1.47, 95% CI 1.20–1.80, p < 0.001 for IL-6; OR 1.26, 95% CI 1.01–1.58, p = 0.042 for IL-8; OR 1.77, 95% CI 1.24–2.53, p = 0.002 for IL-10) as well as individual organ dysfunction (SOFA component score ≥ 1). Finally, MODS following TBI was significantly associated with mortality (OR 5.95, 95% CI 2.18–19.14, p = 0.001), and SOFA score was significantly associated with poor outcome at 6 months (Glasgow Outcome Scale score < 4) when analyzed as a continuous variable (OR 1.21, 95% CI 1.06–1.40, p = 0.006).CONCLUSIONSAdmission IMPACT probability of poor outcome and initial plasma concentrations of IL-6, IL-8, and IL-10 were associated with MODS following TBI.

A novel ITPA variant causes epileptic encephalopathy with multiple-organ dysfunction

2020 ◽  
Vol 65 (9) ◽  
pp. 751-757 ◽  
Author(s):  
Masamune Sakamoto ◽  
Den Kouhei ◽  
Muzhirah Haniffa ◽  
Sebastián Silva ◽  
Mónica Troncoso ◽  
...  
Keyword(s):  
Organ Dysfunction ◽  
Epileptic Encephalopathy ◽  
Multiple Organ ◽  
Multiple Organ Dysfunction
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