Controversies in Sepsis Management—What is the Way Forward?

Lo, Alvin Hy; Kee, Adrian; Li, Andrew; Rubulotta, Francesca

doi:10.47102/annals-acadmedsg.202090

Cited by 10 publications

(6 citation statements)

References 65 publications

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“…Despite having similar admission characteristics, patients in the immunomodulation group required greater PICU support compared to those in the nonimmunomodulation group, including invasive ventilation (38/54, 70.4% vs 26/55, 47.3%; P=0.019) and inotropes (41/54, 75.9% vs 32/55, 58.2%; P=0.067), though this did not reach statistical significance. Ventilator-and ICU-free days were also reduced in the immunomodulator group (20 [0-28] vs 25 [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]; P=0.038 and 15 [0-24] vs 22 (9-26); P=0.024, respectively). In this sepsis cohort, a total of 31 deaths (28.4%) occurred.…”

Section: Resultsmentioning

confidence: 99%

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Immunomodulator use in paediatric severe sepsis and septic shock

Chua

Sultana

Lee

et al. 2021

Ann Acad Med Singap

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Introduction: The use of drugs that modulate the immune system during paediatric severe sepsis and septic shock may alter the course of disease and is poorly studied. This study aims to characterise these children who received immunomodulators and describe their clinical outcomes. Methods: This is a retrospective chart review of patients with severe sepsis and septic shock admitted into the paediatric intensive care unit (PICU). Clinical, haematological and outcome characteristics of patients with or without exposure to immune-modulating drugs were compared. Primary outcome was PICU mortality; secondary outcomes were 28-day ventilator-free days (VFD) and intensive care unit-free days (IFD). Univariate and multivariable analyses were performed for these outcomes. Results: A total of 109 patients with paediatric severe sepsis or septic shock were identified. Of this number, 47 (43.1%), 16 (14.7%) and 3 (2.8%) patients received systemic corticosteroids, intravenous immunoglobulins and granulocyte colony stimulating factor, respectively. Patients who received immune-modulating drugs were more likely to require invasive ventilation (38/54 [70.4%] versus 26/55 [47.3%], P=0.019) compared to those who did not. PICU mortality was indifferent between the 2 groups (20/54 [37.0%] vs 11/55 [20.0%], P=0.058) even after accounting for chronic complex conditions and admission organ dysfunction (PELOD score) (adjusted odds ratio 1.90, confidence interval [0.72–5.01], P=0.193). However, VFD (19.5 [0–28] vs 25 [12–28] days, P=0.038) and IFD (15 [0–24] vs 22 [9–26] days, P=0.024) were decreased in the immunomodulator group compared to the non-immunomodulator group. Conclusion: Immune-modulating drugs were frequently used in paediatric severe sepsis and septic shock. Patients who received these drugs seemed to require more PICU support. Further studies are required to examine this association thoroughly. Keywords: Children, immunomodulatory drugs, infection, paediatric intensive care unit, sepsis

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Section: Resultsmentioning

confidence: 99%

“…However, the use of immunotherapy in treating sepsis has been met with mixed results. 12,13 Recent clinical trials involving corticosteroids showed mixed results regarding mortality and hospitalisation. 14,15 A Cochrane review on intravenous immunoglobulin (IVIG) revealed mortality benefit in adults with sepsis but not in neonates.…”

Section: Discussionmentioning

confidence: 99%

Immunomodulator use in paediatric severe sepsis and septic shock

Chua

Sultana

Lee

et al. 2021

Ann Acad Med Singap

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“…After bacteria or toxins enter the blood circulation, they cause immune-inflammatory mechanism cascading waterfall-like outbreaks, which release a large number of cytokines and inflammatory mediators, resulting in excessive systemic inflammatory response syndrome. [16] Patients with severe sepsis are prone to distant organ insufficiency and inadequate blood perfusion to the visceral tissues because of immune-inflammatory injury, with an extremely high incidence of multiple organ function injury or failure, they need comprehensive and cluster treatment during the initial stage. [17] The timely identification of the severity of the disease and the accurate judgment of the prognosis is beneficial to the timely adjustment and improvement of the treatment plan.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effect of procalcitonin on the severity and prognostic value of elderly patients with a severe infection of oral and maxillofacial space

Lin

Lian

2022

Medicine

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This study aimed to investigate the effect on the severity and prognostic value of serum procalcitonin for elderly patients with oral and maxillofacial infections. We divided 163 elderly patients with severe oral and maxillofacial infection into survival and death groups according to the prognosis between June 2015 and May 2021, measured serum procalcitonin by enzyme-linked immunosorbent assay on the 1st, 2nd, 3rd, 5th, and 7th day after admission for the dynamic changes of serum procalcitonin level, collected the general physiological and biochemical indexes for the scores of acute physiology and general chronic condition, compared the correlation between serum procalcitonin, mean platelet count and APACHE score, analyzed the prognostic value of serum procalcitonin levels at different time after admission by ROC curve. The serum procalcitonin level increased significantly in both groups after admission, sharply increased at first and then rapidly decreased in the survival group, and continued to rise or declined slowly with fluctuation of high level in the death group. There was a negative correlation between serum procalcitonin level and mean platelet count (r = −0.698, P < .05) and a positive correlation between serum procalcitonin and APACHE II (R = 0.803, P < .05). The ROC curve showed that the serum procalcitonin level had little value on the first day and great value on the third day in predicting the prognosis of elderly patients with severe oral and maxillofacial infection (PCT1d = 0.539, PCT3d = 0.875, P < .05). The serum procalcitonin level is correlated with the severity of the disease in elderly patients with severe oral and maxillofacial space infection. Dynamic observation of it is helpful for the prognosis judgment of patients. After admission, serum procalcitonin level on the third day has a great value for the prognosis judgment of elderly patients with severe oral and maxillofacial space infection.

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“…2,3 If sepsis patients do not receive timely and effective treatment at the early stage of the disease, the disease may worsen to a severe level and induce complications such as shock and multiple organ dysfunction syndrome (MODS), which may lead to death in severe cases. 3,4 Clinical studies have found that the earlier antimicrobial drugs are applied after sepsis is confirmed, the greater the benefit to the patient, and intravenous antimicrobial drug therapy should be started as soon as possible within 1 h. 5 Before that, microbial cultures should be obtained and microbiologically confirmed, and antimicrobial drugs should be adjusted according to the drug sensitivity results and clinical signs and symptoms. 4 Traditional pathogenic microbial culture methods and diagnostic pathogenesis found that the most common clinical pathogenic bacteria are gram-negative bacteria, followed by gram-positive bacteria, fungi, anaerobic bacteria, and parasites.…”

Section: Introductionmentioning

confidence: 99%

Pathogenic Profile Characteristics and Clinical Risk Factor Analysis of Patients Who Died from Sepsis Combined with Pulmonary Infection by Metagenomic Next-Generation Sequencing

Chen,

Lin,

Shi

et al. 2023

IDR

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Sepsis is one of the major diseases that seriously threatens human health, and its incidence and in-hospital morbidity and mortality rates remain high. Applying metagenomic next-generation sequencing (mNGS) technology to analyze the differences in pathogenic profiles and clinical factors in patients surviving and dying from sepsis combined with pulmonary infections provides diagnostic value and application for clinical purposes. Methods: Sixty-three BALF samples from patients with sepsis combined with pulmonary infection from Fuqing Hospital Affiliated to Fujian Medical University were collected, and all of them were tested by simultaneous mNGS and conventional microbial combined test (CMT) to compare the pathogenic profiles and clinical indices of patients who survived and died of sepsis combined with pulmonary infection and to further compare the diagnostic differences between mNGS and CMT in patients who survived and died of sepsis combined with pulmonary infection. We analyzed the diagnostic value of mNGS for sepsis combined with pulmonary infection. Results: A total of 141 strains of pathogens were isolated from 63 samples of patients with sepsis combined with pneumonia at suspected infection sites, Klebsiella pneumoniae, Acinetobacter baumannii, and Stenotrophomonas maltophilia are predominant, and higher ApacheII, LAC, P and PT are all risk factors affecting the death of septic patients. Conclusion: Applying the mNGS method to patients with sepsis combined with pneumonia can improve the positive detection rate of pathogenic microorganisms and focus on death-related risk factors such as pathogenic bacteria species as well as clinical laboratory indices, which can guide clinicians to take appropriate measures to treat patients with sepsis and reduce the occurrence of death.

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Controversies in Sepsis Management—What is the Way Forward?

Cited by 10 publications

References 65 publications

Immunomodulator use in paediatric severe sepsis and septic shock

Immunomodulator use in paediatric severe sepsis and septic shock

Effect of procalcitonin on the severity and prognostic value of elderly patients with a severe infection of oral and maxillofacial space

Pathogenic Profile Characteristics and Clinical Risk Factor Analysis of Patients Who Died from Sepsis Combined with Pulmonary Infection by Metagenomic Next-Generation Sequencing

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