Management and Outcome of Severe Sepsis and Septic Shock Patients Admitted to the Emergency Department in a Tertiary Hospital

Lamichhane, Sabitri; Manandhar, Nayan; Dhakal, Shailendra; Shakya, Yagya Laxmi

doi:10.3126/jnhrc.v16i2.20304

Cited by 4 publications

(2 citation statements)

References 17 publications

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“…Higher GCS was associated with lower odds of mortality. Various studies reported that age was an independent risk factor associated with in-hospital mortality of sepsis and septic shock, even with adequate early intervention [18][19][20]. Brakendrige et al examined the association between age and the innate immune response in a cohort study involving septic trauma and surgery patients.…”

Section: Discussionmentioning

confidence: 99%

The Risk Factors for Mortality among Septic Trauma Patients: A Retrospective Cohort Study Using the National Trauma Data Bank

Kattouf

Assaf

Haidar

et al. 2022

Emergency Medicine International

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Introduction. In trauma patients, the development of sepsis as a hospital complication is significantly associated with morbidity and mortality. We aimed to assess the risk factors associated with in-hospital mortality among trauma patients who developed sepsis during their hospital stay. Material and methods. Using the 2017 National Trauma Data Bank, a retrospective cohort study was conducted to identify adult trauma patients who developed sepsis during their hospital stay. The primary outcome of interest was in-hospital mortality. Multivariate analysis was used to determine the risk factors associated with in-hospital mortality. Results. 1782 trauma patients developed sepsis. 567 patients (31.8%) died during their hospital stay. The following patient factors were associated with higher odds of in-hospital mortality: age (OR = 1.045 95% CI = 1.036–1.054), chronic renal failure (OR = 2.564 95% CI = 1.528–4.301), and liver cirrhosis (OR = 3.699 95% CI = 2.267–6.033). Patients who developed cardiac arrest (OR = 4.994 95% CI = 3.381–7.378), acute kidney injury (OR = 3.808 95% CI = 2.837–5.110), acute respiratory distress syndrome (OR = 1.688 95% CI = 1.197–2.379), and stroke (OR = 1.998 95% CI = 1.075–3.714) during their hospital stay had higher odds of mortality. Higher Glasgow Coma Scale (13–15) at presentation was associated with lower odds of mortality (OR = 0.467 95% CI = 0.328–0.667). Conclusion. Among trauma patients who developed sepsis, age, chronic renal failure, cirrhosis, the development of cardiac arrest, acute kidney injury, acute respiratory distress syndrome, and stroke in the hospital were associated with in-hospital mortality. These factors can be used to identify patients who are at higher risk of adverse outcomes and implement standardized or protocol-driven methods to improve patient care.

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Section: Discussionmentioning

confidence: 99%

The Risk Factors for Mortality among Septic Trauma Patients: A Retrospective Cohort Study Using the National Trauma Data Bank

Kattouf

Assaf

Haidar

et al. 2022

Emergency Medicine International

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“…This notable increase in mortality rate and annual health care expenditure (affected by the increased length of stay) has made sepsis treatment and research a critical domain in medical internet research and medical informatics, resulting in a recent surge in the related literature [21][22][23][24]. Studies have shown that improved and effective methods of early sepsis identification can substantially reduce the severity and epidemiological burden of sepsis in the United States [24][25][26][27][28][29]. In addition, several authors have recommended that identifying the prevalent risk factor(s), followed by an instant diagnosis, can reduce the cost in treatment workflow, and further scale down the mortality rate for patients with sepsis to some extent [26,[30][31][32][33].…”

Section: Introductionmentioning

confidence: 99%

Unpacking Prevalence and Dichotomy in Quick Sequential Organ Failure Assessment and Systemic Inflammatory Response Syndrome Parameters: Observational Data–Driven Approach Backed by Sepsis Pathophysiology

et al. 2020

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Background Considering morbidity, mortality, and annual treatment costs, the dramatic rise in the incidence of sepsis and septic shock among intensive care unit (ICU) admissions in US hospitals is an increasing concern. Recent changes in the sepsis definition (sepsis-3), based on the quick Sequential Organ Failure Assessment (qSOFA), have motivated the international medical informatics research community to investigate score recalculation and information retrieval, and to study the intersection between sepsis-3 and the previous definition (sepsis-2) based on systemic inflammatory response syndrome (SIRS) parameters. Objective The objective of this study was three-fold. First, we aimed to unpack the most prevalent criterion for sepsis (for both sepsis-3 and sepsis-2 predictors). Second, we intended to determine the most prevalent sepsis scenario in the ICU among 4 possible scenarios for qSOFA and 11 possible scenarios for SIRS. Third, we investigated the multicollinearity or dichotomy among qSOFA and SIRS predictors. Methods This observational study was conducted according to the most recent update of Medical Information Mart for Intensive Care (MIMIC-III, Version 1.4), the critical care database developed by MIT. The qSOFA (sepsis-3) and SIRS (sepsis-2) parameters were analyzed for patients admitted to critical care units from 2001 to 2012 in Beth Israel Deaconess Medical Center (Boston, MA, USA) to determine the prevalence and underlying relation between these parameters among patients undergoing sepsis screening. We adopted a multiblind Delphi method to seek a rationale for decisions in several stages of the research design regarding handling missing data and outlier values, statistical imputations and biases, and generalizability of the study. Results Altered mental status in the Glasgow Coma Scale (59.28%, 38,854/65,545 observations) was the most prevalent sepsis-3 (qSOFA) criterion and the white blood cell count (53.12%, 17,163/32,311 observations) was the most prevalent sepsis-2 (SIRS) criterion confronted in the ICU. In addition, the two-factored sepsis criterion of high respiratory rate (≥22 breaths/minute) and altered mental status (28.19%, among four possible qSOFA scenarios besides no sepsis) was the most prevalent sepsis-3 (qSOFA) scenario, and the three-factored sepsis criterion of tachypnea, high heart rate, and high white blood cell count (12.32%, among 11 possible scenarios besides no sepsis) was the most prevalent sepsis-2 (SIRS) scenario in the ICU. Moreover, the absolute Pearson correlation coefficients were not significant, thereby nullifying the likelihood of any linear correlation among the critical parameters and assuring the lack of multicollinearity between the parameters. Although this further bolsters evidence for their dichotomy, the absence of multicollinearity cannot guarantee that two random variables are statistically independent. Conclusions Quantifying the prevalence of the qSOFA criteria of sepsis-3 in comparison with the SIRS criteria of sepsis-2, and understanding the underlying dichotomy among these parameters provides significant inferences for sepsis treatment initiatives in the ICU and informing hospital resource allocation. These data-driven results further offer design implications for multiparameter intelligent sepsis prediction in the ICU.

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Physicochemical Assessment of Branded and Generic Linezolid Injection from Different Pharmaceutical Manufacturers

Zhang

Wei

Zhu

et al. 2021

CPA

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Background: Up to date, generic linezolid injections produced by Chinese manufacturers were not widely used in clinic in China. Quality evaluation of linezolid injections produced in China is prerequisite, which has rarely been performed. Objective: This study aimed to evaluate the quality of branded and generic injections from different manufacturers and to provide a basis for the quality control. Methods: In this study, the content of linezolid, related impurities and enantiomer of linezolid were determined by high performance liquid chromatography. The content of glucose was determined by iodine method. The insoluble particles and visible and sub-visible particles were determined by light blockage and lamp test respectively. Osmotic pressure was determined by freezing point depression method. Standard solution control method was used to check the color of the injection. Linezolid injections from different manufacturers were evaluated uniformly. Results: No significant difference was found in the content of linezolid, glucose, related impurities, visible particles, insoluble particles, pH value, and solution color between branded and generic drugs from different manufacturers in China. Conclusion: The quality of samples from different manufacturers is consistent. Although the physicochemical similarity does not guarantee the bioequivalence of studied branded and generic linezolid injections, the results provide references for further bioequivalence study. Generic injections offer more affordable treatment options for patients with infections than expensive branded drugs.

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Management and Outcome of Severe Sepsis and Septic Shock Patients Admitted to the Emergency Department in a Tertiary Hospital

Cited by 4 publications

References 17 publications

The Risk Factors for Mortality among Septic Trauma Patients: A Retrospective Cohort Study Using the National Trauma Data Bank

The Risk Factors for Mortality among Septic Trauma Patients: A Retrospective Cohort Study Using the National Trauma Data Bank

Unpacking Prevalence and Dichotomy in Quick Sequential Organ Failure Assessment and Systemic Inflammatory Response Syndrome Parameters: Observational Data–Driven Approach Backed by Sepsis Pathophysiology

Physicochemical Assessment of Branded and Generic Linezolid Injection from Different Pharmaceutical Manufacturers

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