Faculty Opinions recommendation of Time course of organ failure in patients with septic shock treated with hydrocortisone: results of the Corticus study.

2011 ◽  
Author(s):  
Daniel De Backer
Keyword(s):  
Septic Shock ◽  
Organ Failure ◽  
Time Course

Time course of plasma and pulmonary lymph endothelin-like immunoreactivity during sustained endotoxaemia in chronically instrumented sheep

1991 ◽  
Vol 81 (3) ◽  
pp. 357-365 ◽  
Author(s):  
D. R. Morel ◽  
J. F. Pittet ◽  
K. Gunning ◽  
A. Hemsen ◽  
J. S. Lacroix ◽  
...  
Keyword(s):  
Septic Shock ◽  
Organ Failure ◽  
Thoracic Duct ◽  
Time Course ◽  
Reversed Phase ◽  
Left Ventricular ◽  
Endotoxin Infusion ◽  
Endothelin 1 ◽  
Multi Organ Failure ◽  
Conscious Sheep

1. Endothelin, a novel vasoconstrictor 21-residue peptide isolated from the supernatant of cultured porcine endothelial cells, has been shown to be increased in plasma in a variety of cardiovascular disease states, including acute myocardial infarction, acute renal failure and essential hypertension. We determined the time course of plasma and pulmonary lymph endothelin-like immunoreactivity in relation to the progressive deterioration of cardiopulmonary function in an ovine septic shock model leading to multi-organ failure syndrome and death within 42 h of a continuous intravenous infusion of Escherichia coli endotoxin (40 ng min−1 kg−1). 2. Plasma and pulmonary lymph endothelin-like immunoreactivity were measured by r.i.a. using a specific antiserum raised in rabbits against porcine endothelin-1. Endothelin-like immunoreactivity was further determined in lung tissue and the thoracic duct lymph of endotoxin-treated sheep by reversed-phase h.p.l.c. In control instrumented conscious sheep not infused with endotoxin, there were no significant changes in any of the measured cardiopulmonary and biochemical variables, with plasma and pulmonary lymph endothelin-like immunoreactivity remaining below the detection limit (< 1 pg/tube) throughout the 72 h study period. 3. Conscious sheep receiving endotoxin showed a major hypotensive septic syndrome, including persistently decreased systemic blood pressure, systemic vascular resistance, stroke volume, left ventricular stroke work, associated with sustained pulmonary vasoconstriction and protein-rich pulmonary oedema (> five-fold increase in pulmonary lymph flow and protein clearance), and marked lactic acidosis, leading to the death of animals within 14–42 h despite institution of mechanical ventilation and adequate intravascular volume replacement. 4. Appearance of endothelin-like immunoreactivity, as revealed by r.i.a., in arterial plasma and pulmonary lymph was simultaneous in both circulatory beds, with peak values measured between 4 and 12 h after the start of endotoxin infusion (plasma: 68 ± 8 pg/ml, pulmonary lymph: 88 ± 18 pg/ml, P < 0.05 compared with control sheep). After 12 h of endotoxaemia, endothelin-like immunoreactivity in both fluids progressively decreased up to the death of the animals, although remaining significantly above that measured in control sheep. The analysis of extracts of lung and thoracic duct by reversed-phase h.p.l.c. revealed that the r.i.a. method used in the present study mainly detected endothelin-1. 5. Our results demonstrate the presence of a marked and persistent increase in endothelin-like immunoreactivity in plasma and pulmonary lymph of sheep during lethal endotoxin shock with multi-organ failure, suggesting a continuous production and/or release of endothelin-1 into the pulmonary lymph and the systemic circulation upon continuous endotoxin infusion. These findings suggest that endothelin may contribute to the vasomotor disturbances observed during the development of septic shock, although studies using selective receptor antagonists or synthesis inhibitors are required to definitively confirm a potential pathophysiological role of endothelin during endotoxaemia.

Time course of organ failure in patients with septic shock treated with hydrocortisone: results of the Corticus study

2011 ◽  
Vol 37 (11) ◽  
Author(s):  
R. Moreno ◽  
C. L. Sprung ◽  
D. Annane ◽  
S. Chevret ◽  
J. Briegel ◽  
...  
Keyword(s):  
Septic Shock ◽  
Organ Failure ◽  
Time Course

Time course of organ failure in patients with septic shock treated with hydrocortisone: results of the Corticus study

2012 ◽  
pp. 423-430 ◽  
Author(s):  
R. Moreno ◽  
C. L. Sprung ◽  
D. Annane ◽  
S. Chevret ◽  
J. Briegel ◽  
...  
Keyword(s):  
Septic Shock ◽  
Organ Failure ◽  
Time Course

Combination of Antibiotic Treatment with the Thrombin Inhibitor Recombinant Hirudin for the Therapy of Experimental Klebsiella pneumoniae Sepsis

1994 ◽  
Vol 71 (06) ◽  
pp. 768-772 ◽  
Author(s):  
Gerhard Dickneite ◽  
Jörg Czech
Keyword(s):  
Septic Shock ◽  
Klebsiella Pneumoniae ◽  
Organ Failure ◽  
Therapeutic Effect ◽  
Disseminated Intravascular Coagulation ◽  
Post Infection ◽  
Thrombin Inhibitor ◽  
Bolus Administration ◽  
Bacterial Burden ◽  
Recombinant Hirudin

SummaryRats which were infected with the gramnegative pathogen Klebsiella pneumoniae develop disseminated intravascular coagulation (DIC), multi-organ failure (MOF) and finally die in a septic shock. We investigated the therapeutic effect of antibiotic (tobramycin) treatment combined with the infusion of the highly specific thrombin inhibitor rec. hirudin. Although administration of 2 mg/kg tobramycin alone leads to a decrease of the bacterial burden, DIC could not be prevented. Infusion of rec. hirudin (0.25 mg/kg x h) for 4 h (start of treatment 1 h post infection), in addition to a bolus administration of tobramycin, led to an amelioration of DIC parameters as fibrinogen, thrombin-antithrombin complex (TAT) and platelets. Serum transaminase levels (GOT, GPT) as a marker of MOF were significantly improved by rec. hirudin, the T50 value increased from 17 h in the tobramycin group to 42 h in the tobramycin + rec. hirudin giuup, muilality rates were 90% or 60%, respectively. Combination of heparin (10011/kg x h) and tobramycin was not effective on survival.

scholarly journals Time-course of sFlt-1 and VEGF-A release in neutropenic patients with sepsis and septic shock: a prospective study

2011 ◽  
Vol 9 (1) ◽  
pp. 23 ◽  
Author(s):  
Brunna E Alves ◽  
Silmara AL Montalvao ◽  
Francisco JP Aranha ◽  
Irene Lorand-Metze ◽  
Carmino A De Souza ◽  
...  
Keyword(s):  
Septic Shock ◽  
Prospective Study ◽  
Time Course ◽  
Neutropenic Patients ◽  
Sepsis And Septic Shock ◽  
A Prospective Study

scholarly journals Diagnostic and Prognostic Value of Presepsin in Patients with Non-Infectious Organ Failure, Sepsis, and Septic Shock: A Prospective Observational Study According to the Sepsis-3 Definitions

2021 ◽  
Author(s):  
Sukyo Lee ◽  
Juhyun Song ◽  
Dae Won Park ◽  
Hyeri Seok ◽  
Jae-hyung Cha ◽  
...  
Keyword(s):  
Septic Shock ◽  
Observational Study ◽  
Organ Failure ◽  
Prospective Observational Study ◽  
Survival Curve ◽  
Curve Analysis ◽  
Roc Curve Analysis ◽  
Kaplan Meier ◽  
Sepsis And Septic Shock ◽  
Meier Survival Curve

Abstract Background: Sepsis is life-threatening organ dysfunction due to a dysregulated host response to infection. Early diagnosis of sepsis is challenging due to unknown sources of infection, and mortality prediction is usually complex. We aimed to investigate the clinical value of presepsin for discriminating sepsis from non-infectious organ failure and predicting mortality among sepsis patients in the emergency department (ED).Methods: This prospective observational study included 420 patients divided into three groups according to the Sepsis-3 definitions: non-infectious organ failure (n=142), sepsis (n=141), and septic shock (n=137). Blood samples for biomarker measurement of presepsin, procalcitonin, and C-reactive protein were drawn in the ED and biomarker levels were compared between the groups. Optimal cut-off values for presepsin to discriminate between the three clinical diagnoses were evaluated using receiver operating characteristic (ROC) curve analysis. We also performed ROC curve analysis for each biomarker as a predictor of mortality. After excluding non-infectious organ failure, we extracted the optimal cut-off value of presepsin to predict mortality associated with sepsis and septic shock and performed Kaplan–Meier survival curve analysis according to the cut-off value.Results: Presepsin levels (median [IQR]) were significantly higher in sepsis than in non-infectious organ failure (792 [450–1273] vs. 286 [170–417], p <0.001) and significantly higher in septic shock than in sepsis (1287 [589–2365] vs. 792 [450–1273], p=0.002). The optimal cut-off value for presepsin to discriminate between sepsis and non-infectious organ failure was 582 pg/mL (sensitivity, 70.1; specificity, 89.4; AUC, 0.877; p <0.001) and to discriminate between sepsis and septic shock was 1285 pg/mL (sensitivity, 50.4; specificity, 76.6; AUC, 0.618; p <0.001). The optimal cut-off value for presepsin for predicting 30-day mortality was 821 pg/mL (sensitivity, 68.9; specificity, 50.5; AUC, 0.605; p=0.005) in patients with sepsis and septic shock. Kaplan-Meier survival curve analysis showed that patients with higher presepsin levels (≥821 pg/mL) had significantly higher mortality than patients with lower presepsin levels (<821 pg/mL) (log-rank test; p=0.004). Conclusions: Presepsin levels could effectively differentiate sepsis from non-infectious organ failure and septic shock from sepsis. Presepsin levels could help clinicians predict mortality in patients with sepsis and septic shock.

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