Impact of Clinical Sepsis Phenotypes on Mortality and Fluid Status in Critically Ill Patients

Shald, Elizabeth A; Erdman, Michael; Ferreira, Jason

doi:10.1097/shk.0000000000001864

Cited by 11 publications

(7 citation statements)

References 18 publications

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“…However, sepsis is an acquired disease and other variables contribute to the presentation, clinical course, and eventual outcome. Included in those variables are the type of infection and its primary source (20,26,27). Thus, to assess the contribution of this variable to the genetic host response, we performed whole transcriptomic sequencing in paired human samples of blood exposed to either HKEC or HKSA, two of the most common pathogens in sepsis and sepsis-related mortalities (20,28).…”

Section: Discussionmentioning

confidence: 99%

Differential Signaling Effects of Escherichia Coli and Staphylococcus Aureus in Human Whole Blood Indicate Distinct Regulation of the Nrf2 Pathway

Pourquoi,

Miller,

Koch

et al. 2024

Shock

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Escherichia coli and Staphylococcus aureus are two of the most common bacterial species responsible for sepsis. While it is observed that they have disparate clinical phenotypes, the signaling differences elicited by each bacteria that drive this variance remain unclear. Therefore, we used human whole blood exposed to heat-killed E. coli or S. aureus and measured the transcriptomic signatures. Relative to unstimulated control blood, heat-killed bacteria exposure led to significant dysregulation (upregulated and downregulated) of >5,000 genes for each experimental condition, with a slight increase in gene alterations by S. aureus. While there was significant overlap regarding proinflammatory pathways, Gene Ontology overrepresentation analysis of the most altered genes suggested biological processes like macrophage differentiation and ubiquinone biosynthesis were more unique to heat-killed S. aureus, compared with heat-killed E. coli exposure. Using Ingenuity Pathway Analysis, it was demonstrated that nuclear factor erythroid 2-related factor 2 signaling, a main transcription factor in antioxidant responses, was predominately upregulated in S. aureus exposed blood relative to E. coli. Furthermore, the use of pharmacologics that preferentially targeted the nuclear factor erythroid 2-related factor 2 pathway led to differential cytokine profiles depending on the type of bacterial exposure. These findings reveal significant inflammatory dysregulation between E. coli and S. aureus and provide insight into the targeting of unique pathways to curb bacteria-specific responses.

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Section: Discussionmentioning

confidence: 99%

Differential Signaling Effects of Escherichia Coli and Staphylococcus Aureus in Human Whole Blood Indicate Distinct Regulation of the Nrf2 Pathway

Pourquoi,

Miller,

Koch

et al. 2024

Shock

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“…Admittedly, sepsis is a life-threatening organ dysfunction rooted in a dysregulated host response to infection. 21 A literature review conducted by Lehnhardt et al reported fatality in five of 13 patients who developed sepsis following liposuction. 22 Vongpaisarnsin et al presented a death following cosmetic liposuction because of Pseudomonas aeruginosa septicemia, and he proposed that if we want to better deal with such a fatal complication, hygienic standards in addition to rigorous surgical staff training for handling surgical instruments become the necessity.…”

Section: Discussionmentioning

confidence: 99%

Machine learning prediction algorithm for in-hospital mortality following body contouring

Peng

Yang

et al. 2023

Plastic &Amp; Reconstructive Surgery

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besity is currently a global epidemic; worldwide, 1.9 billion people older than 18 years are overweight. Of these, over 650 million are obese. 1 Indeed, with the increasing prevalence of obesity in the population, in conjunction with the rising number of bariatric operations, there is a mounting emphasis on the surgical treatment of residual contour deformities after weight loss, frequently in the form of body contouring. 2 Postbariatric contouring procedures last year alone accounted of more than 46,577 procedures. 3 Indeed, it is well-known that body contouring can cause an improvement in the health; mobility; and self-esteem, especially increased satisfaction with body figure. 4 However, despite growing popularity and potential benefits, the safety of the body-contouring procedure has been a subject of Background: Body contouring is a common procedure, but it is worth attention because of concern for a variety of complications, and even the potential for death. As a result, the purpose of this study was to determine the key predictors following body contouring and create models for the risk of mortality using diverse machine learning (ML) models. Methods: The National Inpatient Sample database from 2015 to 2017 was queried to identify patients undergoing body contouring. Candidate predictors, such as demographics, comorbidities, personal history, postoperative complications, and operative features, were included. The outcome was inhospital mortality. Models were compared by area under the curve, accuracy, sensitivity, specificity, positive and negative predictive values, and decision curve analysis. Results: Overall, 8214 patients undergoing body contouring were identified, among whom 141 (1.72%) died in the hospital. Variable importance plot demonstrated that sepsis was the variable with greatest importance across all ML algorithms, followed by Elixhauser Comorbidity Index, cardiac arrest, and so forth. The naive Bayes model had a higher predictive performance (area under the curve, 0.898; 95% CI, 0.884 to 0.911) among these eight ML models. Similarly, in the decision curve analysis, the naive Bayes model also demonstrated a higher net benefit (ie, the correct classification of in-hospital deaths considering a tradeoff between false-negatives and false-positives) compared with the other seven models across a range of threshold probability values. Conclusion:The ML models, as indicated by this study, can be used to predict in-hospital death for patients at risk who undergo body contouring. (Plast.

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“…Indeed, definition of sepsis was modified in 2016 to emphasize the critical presence of organ failure (30), while a modification of definition of ARDS was recently proposed (31). Both syndromes are perceived as heterogeneous entities with distinct phenotypes (32,33).…”

Section: Discussionmentioning

confidence: 99%

Prolonged Mechanical Ventilation in Acute Respiratory Distress Syndrome

Andrianopoulos,

Giannakoulis,

Papoutsi

et al. 2023

Shock

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Purpose Trajectory of acute respiratory distress syndrome (ARDS) spans from rapidly improving cases to cases receiving prolonged mechanical ventilation (PMV). We attempted to estimate temporal trends of prevalence and mortality of PMV and to identify risk factors associated with mortality of patients with ARDS receiving PMV. Methods We performed a secondary analysis of individual patient data from six randomized controlled clinical trials conducted by the ARDS Network. PMV was defined as the need for mechanical ventilation for >21 consecutive days. Results Of 4216 patients with ARDS, 646 (15.3%) received PMV. Prevalence of PMV gradually declined from 18.4% in the ARMA (published in 2000) trial to 10.9% in the SAILS (2014) trial (R2 = 0.728, p = 0.031). 90-day mortality of patients receiving PMV did not change over time (R2 = 0.271, p = 0.290) and remained as high as 36.8%. Ιn the three most recent trials, risk factors associated with mortality among the 250 patients with ARDS receiving PMV included age, malignancy, pneumonia as the cause of ARDS, coagulation dysfunction and hepatic dysfunction during the first 21 days after trial enrollment. Conclusion Although prevalence of PMV among patients enrolled in ARDS Network trials gradually declined, mortality did not change. Risk factors associated with mortality were mostly non-modifiable.

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Impact of Clinical Sepsis Phenotypes on Mortality and Fluid Status in Critically Ill Patients

Cited by 11 publications

References 18 publications

Differential Signaling Effects of Escherichia Coli and Staphylococcus Aureus in Human Whole Blood Indicate Distinct Regulation of the Nrf2 Pathway

Differential Signaling Effects of Escherichia Coli and Staphylococcus Aureus in Human Whole Blood Indicate Distinct Regulation of the Nrf2 Pathway

Machine learning prediction algorithm for in-hospital mortality following body contouring

Prolonged Mechanical Ventilation in Acute Respiratory Distress Syndrome

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