scholarly journals Thromboelastography Variables, Immune Markers, and Endothelial Factors Associated With Shock and NPMODS in Children With Severe Sepsis

2019 ◽  
Vol 7 ◽  
Author(s):  
Arun Saini ◽  
Philip C. Spinella ◽  
Steven P. Ignell ◽  
John C. Lin
Keyword(s):  
Severe Sepsis ◽  
Immune Markers ◽  
Factors Associated ◽  
Endothelial Factors

Factors Influencing Variability in Compliance Rates and Clinical Outcomes Among Three Different Severe Sepsis Bundles

2007 ◽  
Vol 41 (6) ◽  
pp. 929-936 ◽  
Author(s):  
Jeffrey J Fong ◽  
Karen Cecere ◽  
John Unterborn ◽  
Erik Garpestad ◽  
Mark Klee ◽  
...  
Keyword(s):  
Severe Sepsis ◽  
Quality Indicators ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Healthcare Organizations ◽  
Patient Factors ◽  
Sepsis Bundles ◽  
Factors Associated ◽  
Healthcare Improvement ◽  
Bundle Compliance

BACKGROUND: While 3 different quality indicator bundles are either approved (Voluntary Hospitals of America [VHA], Institute for Healthcare Improvement [IHI]) or proposed (Joint Commission on Accreditation of Healthcare Organizations [JCAHO]) to rate clinical practices in treatment of severe sepsis, it is suspected that differences in the quality indicators among these bundles may lead to discrepant benchmarking data. OBJECTIVE: To compare bundle compliance and patient factors associated with it among the IHI, JCAHO, and VHA severe sepsis bundles and explore possible reasons for any observed variability. METHODS: Using a retrospective, noninterventional design, we evaluated 50 adults (APACHE II score 25 ± 6, organ failure 2 ± 1, and shock 52%) with severe sepsis who were admitted consecutively to an intensive care unit at a 450 bed university-affiliated hospital. RESULTS: Few patients met 100% (IHI 6%, JCAHO 0%, VHA 6%) or 75% or greater (IHI 22%, JCAHO 6%, VHA 22%) of the quality indicators in each bundle. The number of patients who met 50% or more of the quality indicators varied significantly between JCAHO (28%) and both IHI (66%; p < 0.001) and VHA (60%; p < 0.001), but not between IHI and VHA (p = 0.53). Compliance with 50% or more of the quality indicators was more likely to occur when patients had shock (IHI, JCAHO, VHA), an APACHE II score greater than or equal to 25 (VHA), 2 or more organ failures (VHA), or survived hospitalization (IHI). We identified a number of factors that may help explain these differences. CONCLUSIONS: Differences among the IHI, JCAHO, and VHA severe sepsis bundles lead to variability in bundle compliance rates and the patient factors associated with the variability and may lead to confusion when benchmarking practices among institutions. Future efforts should focus on developing a single valid and reliable bundle that allows providers to improve the quality of sepsis care. TRANSFONDO: Tres diferentes organizaciones [“Voluntary Hospitals of America” (VHA), “Institute for Healthcare Improvement” (IHI), “Joint Commission on Accreditation of Healthcare Organizations” (JCAHO)] encargados con mejorar el cuidado médico en instituciones han desarrollado criterios de indicadores de calidad para el manejo apropiado de sepsis. Estas guiás de tratamiento han sido desarrollados con el propósito de proveer instituciones con un mecanismo para comparar la calidad de cuidado que ofrecen a sus pacientes que son admitidos con sepsis severa. Mientras que se han aprobado o propuesto tres diversos criterios de indicadores de calidad para evaluar las prácticas clínicas del manejo de sepsis severa, se sospecha que las diferencias entre estos indicadores pueden resultar en datos de comparación discrepantes.

scholarly journals Factors associated with severe sepsis in diarrheal adults and their outcome at an urban hospital, Bangladesh: A retrospective analysis

2021 ◽  
Author(s):  
Monira Sarmin ◽  
Monjory Begum ◽  
Farhana Islam ◽  
Farzana Afroze ◽  
Lubaba Shahrin ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Metabolic Acidosis ◽  
Clinical Features ◽  
Control Design ◽  
Kidney Injury ◽  
Case Control ◽  
Urban Hospital ◽  
Factors Associated ◽  
Severe Diarrhea

AbstractBackgroundClinical features of sepsis and severe diarrhea often overlap and create a dilemma among the clinicians. To describe factors associated with severe sepsis in diarrheal adults and their outcomes to understand their interplay as clinical features of sepsis and severe diarrhea often overlap.Methods and resultsWe used this retrospective chart analysis employing a case-control design to study critically ill diarrheal adults aged ≥ 18 years treated in ICU Dhaka hospital, icddr,b between January 2011 to December 2015. Diarrheal adults with a diagnosis of severe sepsis were cases and an equal number of randomly selected non-septic patients were the controls. Of 8,863 in-patient adults, 350 fulfilled the criteria of cases. Cases died significantly more (9% vs 3%, p=0.002) than controls. 69% of the cases progressed to septic shock. In logistic regression analysis, steroid intake, ileus, acute kidney injury, metabolic acidosis, and hypocalcemia were significantly associated with severe sepsis in diarrheal adults (all, p<0.05). 12% of cases (40/335) had bacteremia. Streptococcus pneumoniae [9 (22.5%)] was the single most common pathogen and gram-negatives [27 (67.5%)] were prevailing as a group.ConclusionDiarrheal adults who had ileus, AKI, metabolic acidosis, hypocalcemia, and also took steroids were prone to have severe sepsis. Strikingly, gram-negatives were the predominant bacteria among the diarrheal adults having severe sepsis.

scholarly journals Clinical and Demographic Factors Associated with Antipyretic Use in Gram-Negative Severe Sepsis and Septic Shock

2011 ◽  
Vol 45 (10) ◽  
pp. 1207-1216 ◽  
Author(s):  
Nicholas M Mohr ◽  
Brian M Fuller ◽  
Lee P Skrupky ◽  
Hawnwan Moy ◽  
Robert Alunday ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Medical Center ◽  
Academic Medical Center ◽  
Demographic Factors ◽  
Medication Administration ◽  
Patient Treatment ◽  
Gram Negative ◽  
Factors Associated ◽  
Sepsis And Septic Shock

Background: Antipyretic therapy is commonly prescribed for patients with Infection, but studies of its impact on clinical outcomes have yielded mixed results. No data exist to characterize the use of antipyretic medications in patients with severe sepsis or septic shock. Objective: To identify clinical and demographic factors associated with antipyretic medication administration in severe sepsis and septic shock. Methods: This single-center, retrospective, cohort study assessed febrile patients [temperature ≥38.3°C) with gram-negative severe sepsis or septic shock at an 1111-bed academic medical center between January 2002 and February 2008, Patients were excluded if they had liver disease, acute brain injury, or allergy to acetaminophen. Generalized estimating equations were used to estimate the effect of clinical factors on treatment of patients with antipyretic medications, Results: Although 76% of patients in this febrile cohort (n = 241) were prescribed an antipyretic agent, only 42% received antipyretic therapy; 95% of the doses were acetaminophen. Variables associated with antipyretic treatment were maximum body temperature (OR 2.11, 95% CI 1.53 to 2.89), time after sepsis diagnosis (OR 0.88, 95% CI 0.82 to 0.95), surgery during hospitalization (OR 0.49, 95% CI 0.31 to 0.80), death within 36 hours (OR 0.35, 95% CI 0.15 to 0.85). and mechanical ventilation (OR 0.58, 95% CI 0.34 to 0.98). Severity of illness factors, demographic factors, and patient treatment location did not predict who would receive antipyretic therapy. Conclusions: Most febrile episodes in patients with gram-negative severe sepsis or septic shock were not treated with antipyretic medications. Further studies are needed to demonstrate the effect of antipyretics on clinically relevant outcomes in severe sepsis and septic shock.

scholarly journals Blood purification therapy for severe sepsis: a multicenter, observational cohort study in northern Japan

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Kasumi Satoh ◽  
Kyoko Nomura ◽  
Hajime Nakae ◽  
Daisuke Kudo ◽  
Shigeki Kushimoto ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Severe Sepsis ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Logistic Regression Analysis ◽  
Univariate Logistic Regression Analysis ◽  
Factors Associated ◽  
Observational Cohort ◽  
Northern Japan

Abstract Background Sepsis is associated with life-threatening organ dysfunction caused by a dysregulated host response to infection. However, no specific therapy has been shown to improve mortality in patients with sepsis. We conducted a study to clarify the utilization status of various BPTs and the clinical characteristics of patients who received BPTs in northern Japan. In addition, the association of various BPTs with clinical outcomes was examined. Methods This is a sub-analysis of the Tohoku Sepsis Registry, a multicenter, prospective, observational cohort study. To determine whether BPT was independently associated with in-hospital mortality in patients with severe sepsis, the following analyses were performed. Differences between survivors and non-survivors were assessed using Wilcoxon rank sum tests for continuous variables and Chi-square tests for categorical variables. Univariate logistic regression analysis was used to evaluate the factors associated with in-hospital mortality. In the multivariate logistic regression analysis, adjustments were made for the variables that were significant in the univariate logistic regression analysis. Clinical factors associated with mortality were analyzed. Results We enrolled 616 consecutive patients (≥ 18 years) with median Sequential Organ Failure Assessment scores of 8.0. During median of 22 days hospitalization, 139 patients died (mortality 22.6%). 20.7% of patients with severe sepsis received any type of BPT (mortality 38.6%). BPT consisted of 65.1% continuous renal replacement therapy (CRRT) with renal indication (mortality 48.8%), 26.0% CRRT with non-renal indication (mortality 21.2%), 22.2% intermittent renal replacement therapy (mortality 32.1%), and 33.1% polymyxin B-immobilized fiber column-direct hemoperfusion (mortality 42.9%). Meanwhile, no BPT group (mortality 18.5%) showed a significantly lower mortality than any BPT group. Besides, in multivariate analyses, all BPT modes were not independently associated with all-cause mortality. Conclusions This study suggested the clinical status of BPTs for severe sepsis patients in northern Japan. Among all types of BPT, continuous renal replacement therapy (CRRT) for renal indication was most frequently selected. Severe sepsis patients received BPT had a higher mortality and severity; however, the BPT implementation may not be associated with mortality. Trial registration UMIN-CTR, UMIN000010297, Registered on 22 March 2013, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000012055).

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