BackgroundSepsis is one of the most significant causes of mortality in intensive care units. It indicates crosstalk between inflammation and coagulation. In this study, we aimed to identify prognostic markers among sepsis biomarkers and coagulation/fibrinolysis markers.MethodsPatients with sepsis according to the Sepsis-3 criteria were enrolled from January 2013 to September 2015. Univariate and multivariate logistic regression analyses were performed to identify an independent predictive marker of 28-day mortality among sepsis biomarkers and coagulation/fibrinolysis markers on ICU admission. Receiver operating characteristic analysis was performed; the optimal cutoff value of 28-day mortality was calculated using the predictive marker. Patients were classified into two groups according to the cutoff level of the predictive marker. Patient characteristics were compared between the groups.ResultsA total of 186 patients were enrolled in this study; the 28-day mortality was 19.4% (36/186). PAI-1 was identified as the only independent predictive marker of 28-day mortality by univariate and multivariate logistic regression. The area under the curve was 0.72; the optimal cutoff level was 83 ng/ml (sensitivity, 75%; specificity, 61%). Patients were classified into a higher group (PAI-1 level ≥83 ng/ml; n = 85) and a lower group (PAI-1 level <83 ng/ml; n = 101). All disseminated intravascular coagulation (DIC) scores and Sequential Organ Failure Assessment score were significantly higher in the higher group than in the lower group.ConclusionsPAI-1 can predict prognosis in sepsis patients. PAI-1 reflects DIC with suppressed fibrinolysis and organ failure, with microthrombi leading to microcirculatory dysfunction.

No abstract

BackgroundThe purpose of this study was to investigate whether polymyxin B hemoperfusion (PMX-HP) improves the survival of patients with septic shock.MethodsThis was a retrospective, multicenter study conducted on patients treated during a 3-year period. We performed propensity-score analyses of the Japan Septic Disseminated Intravascular Coagulation (JSEPTIC DIC) study database. The study included data on 1723 patients with septic shock aged 16 years or older. Furthermore, we divided patients into to PMX-HP- and non-PMX-HP-treated groups. The primary endpoint was all-cause hospital mortality; secondary endpoints included intensive care unit (ICU) mortality and number of ICU-free days (ICUFDs) in the first 28 days.ResultsOf 1,723 eligible patients, 522 had received PMX-HP. Propensity score matching created 262 matched pairs (i.e., 262 patients in each of the non-PMX-HP and PMX-HP groups). The proportion of all-cause hospital mortality was significantly lower in the PMX-HP group than in the non-PMX-HP group (32.8% vs. 41.2%; odds ratio (OR): 0.681; 95% confidence interval (CI): 0.470–0.987; P = 0.042). The number of ICUFD in the first 28 days was significantly higher in the PMX-HP group than in the non-PMX-HP group (18 (0-22) vs. 14 (0-22) days, respectively; P = 0.045). On the other hand, there was no significant difference in ICU mortality between the two groups (21.8% vs. 24.4%; OR: 0.844; CI: 0.548–1.300; P = 0.443).ConclusionsOur results strongly suggest that PMX-HP reduces all-cause hospital mortality and length of ICU stay in patients with septic shock.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-017-1712-3) contains supplementary material, which is available to authorized users.

No abstract

No abstract