Sepsis-3 Septic Shock Criteria and Associated Mortality Among Infected Hospitalized Patients Assessed by a Rapid Response Team

Fernando, Shannon M.; Reardon, Peter M.; Rochwerg, Bram; Shapiro, Nathan I.; Yealy, Donald M.; Seely, Andrew J. E.; Perry, Jeffrey J.; Barnaby, Douglas P.; Murphy, Kyle; Tanuseputro, Peter; Kyeremanteng, Kwadwo

doi:10.1016/j.chest.2018.05.004

Cited by 47 publications

(45 citation statements)

References 35 publications

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“…The terms SIRS and severe sepsis were dropped. By Sepsis-3, sepsis became a more severe disease with higher mortality than previously defined; studies comparing Sepsis-3 definitions have confirmed that the reclassification of patients is associated with higher mortality than the prior definition [13][14][15].…”

Section: Sepsis Definitionsmentioning

confidence: 99%

Sepsis 2019: What Surgeons Need to Know

Kaafarani

Rattan

et al. 2020

Surgical Infections

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The definition of sepsis continues to be as dynamic as the management strategies used to treat this. Sepsis-3 has replaced the earlier systemic inflammatory response syndrome (SIRS)-based diagnoses with the rapid Sequential Organ Failure Assessment (SOFA) score assisting in predicting overall prognosis with regards to mortality. Surgeons have an important role in ensuring adequate source control while recognizing the threat of carbapenem-resistance in gram-negative organisms. Rapid diagnostic tests are being used increasingly for the early identification of multi-drug-resistant organisms (MDROs), with a key emphasis on the multidisciplinary alert of results. Novel, higher generation antibiotic agents have been developed for resistance in ESKCAPE (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) organisms while surgeons have an important role in the prevention of spread. The Study to Optimize Peritoneal Infection Therapy (STOP-IT) trial has challenged the previous paradigm of length of antibiotic treatment whereas biomarkers such as procalcitonin are playing a prominent role in individualizing therapy. Several novel therapies for refractory septic shock, while still investigational, are gaining prominence rapidly (such as vitamin C) whereas others await further clinical trials. Management strategies presented as care bundles continue to be updated by the Surviving Sepsis Campaign, yet still remain controversial in its global adoption. We have broadened our temporal and epidemiologic perspective of sepsis by understanding it both as an acute, time-sensitive, life-threatening illness to a chronic condition that increases the risk of mortality up to five years post-discharge. Artificial intelligence, machine learning, and bedside scoring systems can assist the clinician in predicting post-operative sepsis. The public health role of the surgeon is key. This includes collaboration and multidisciplinary antibiotic stewardship at a hospital level. It also requires controlling pharmaceutical sales and the unregulated dispensing of antibiotic agents globally through policy initiatives to control emerging resistance through prevention.

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Section: Sepsis Definitionsmentioning

confidence: 99%

Sepsis 2019: What Surgeons Need to Know

Kaafarani

Rattan

et al. 2020

Surgical Infections

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“…These are combined medical and non-cardiac surgical ICUs. We retrospectively examined prospectively collected data from the Ottawa Hospital Data Warehouse, a health administrative database used in previous studies [16][17][18][19]. From hospital admission, data is gathered daily from each patient and stored in the Data Warehouse.…”

Section: Study Design Setting and Subjectsmentioning

confidence: 99%

“…We also examined pre-specified subgroups of patients, including those with suspected infection, sepsis, and septic shock, as based on the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) [20][21][22]. "Suspected infection" was defined as concomitant administration of oral or parenteral antibiotics, and sampling of body-fluid cultures, as performed previously [16,23], and in keeping with the Sepsis-3 definitions [20]. "Sepsis" was defined as suspected infection and an increase in the Sequential Organ Failure Assessment (SOFA) score by greater than 2 points [20,21].…”

Section: Study Design Setting and Subjectsmentioning

confidence: 99%

New-onset atrial fibrillation and associated outcomes and resource use among critically ill adults—a multicenter retrospective cohort study

et al. 2020

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Background: New-onset atrial fibrillation (NOAF) is commonly encountered in critically ill adults. Evidence evaluating the association between NOAF and patient-important outcomes in this population is conflicting. Furthermore, little is known regarding the association between NOAF and resource use or hospital costs. Methods: Retrospective analysis (2011-2016) of a prospectively collected registry from two Canadian hospitals of consecutive ICU patients aged ≥ 18 years. We excluded patients with a known history of AF prior to hospital admission. Any occurrence of atrial fibrillation (AF) was prospectively recorded by bedside nurses. The primary outcome was hospital mortality, and we used multivariable logistic regression to adjust for confounders. We used a generalized linear model to evaluate contributors to total cost. Results: We included 15,014 patients, and 1541 (10.3%) had NOAF during their ICU admission. While NOAF was not associated with increased odds of hospital death among the entire cohort (adjusted odds ratio [aOR] 1.02 [95% confidence interval [CI] 0.97-1.08]), an interaction was noted between NOAF and sepsis, and the presence of both was associated with higher odds of hospital mortality (aOR 1.28 [95% CI 1.09-1.36]) than either alone. Patients with NOAF had higher total costs (cost ratio [CR] 1.09 [95% CI 1.02-1.20]). Among patients with NOAF, treatment with a rhythmcontrol strategy was associated with higher costs (CR 1.24 [95% CI 1.07-1.40]). Conclusions: While NOAF was not associated with death or requiring discharge to long-term care among critically ill patients, it was associated with increased length of stay in ICU and increased total costs.

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“…Previous researches have reported that SOFA, qSOFA, APACHE II, and SIRS scoring systems shows good prediction accuracy for evaluating septic shock, multi-organ failure and ICU mortality. 7,8,[10][11][12]40,41 Here, we con rmed that those with higher SOFA, qSOFA, APACHE II or SIRS scores were more likely to develop ARDS and progress to death in COVID-19 patients. Moreover, we found that elevated in ammatory-related indexes, decreased immune cell subsets and abnormal multiple-organ damage biomarkers were associated with ARDS development and progression from ARDS to death in COVID-19 patients.…”

Section: Discussionmentioning

confidence: 51%

“…6 The sequential organ failure assessment (SOFA), quick SOFA (qSOFA), acute physiology and chronic health evaluation II (APACHE II) and systemic in ammatory response syndrome (SIRS) scores have been considered as good evaluation indexes for sepsis, septic shock, multi-organ dysfunction and even death in patients suffering from bacterial or viral pathogen infection. [7][8][9][10][11][12] Notably, accumulative evidence has shown that SARS-CoV-2 caused in ammatory in ltration of interstitial mononuclear cells is related to disease progression from ARDS to death. 5 Additionally, initial analyses of the patients with ARDS had shown that older age, high fever, neutrophilia, organ and coagulation dysfunction, and elevated D-Dimer levels were the risk factors associated with development of ARDS and death.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors Related to Acute Respiratory Distress Syndrome and Death in Patients with COVID-19: A Retrospective Cohort Study in Wuhan, China

Wang

Jin

et al. 2020

Preprint

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Background: The COVID-19 pandemic has been considered as the great threat to global public health. We aimed to clarify the risk factors associated with the development of acute respiratory distress syndrome (ARDS) and progression from ARDS to death and construct a risk prediction model.Methods: In this single-centered, retrospective, and observational study, 796 COVID-19 patients developed ARDS and 735 COVID-19 patients without ARDS were matched by propensity score at an approximate ratio of 1:1 based on age, sex and comorbidities. Demographic data, symptoms, radiological findings, laboratory examinations, and clinical outcomes were compared between with or without ARDS. Univariable and multivariable logistic regression models were applied to explore the risk factors for development of ARDS and progression from ARDS to death and establish a comprehensive risk model. Results: Higher SOFA, qSOFA, APACHE II and SIRS scores, elevated inflammatory cytokines, dysregulated multi-organ damage biomarkers, decreased immune cell subsets were associated with higher proportion of death (34.17% vs 1.22%; P<0.001) and increased risk odds of death (OR=57.216, 95%CI=28.373-115.378; P<0.001) in COVID-19 patients with ARDS. In addition to previous reported risk factors related to ARDS development and death, such as neutrophils, IL-6, D-Dimer, leukocytes and platelet, we identified elevated TNF-α (OR=1.146, 95%CI=1.100-1.194; P<0.001), CK-MB (OR=1.350, 95%CI=1.180-1.545; P<0.001), declined ALB (OR=0.834, 95%CI=0.799-0.872; P<0.001), CD8+ T cells (OR=0.983, 95%CI=0.976-0.990; P<0.001) and CD3-CD19+ B cells (OR=0.992, 95%CI=0.988-0.997; P=0.003) as novel risk factors. Most importantly, the predictive accuracy of the combined model integrating four score systems and these risk factors demonstrated highest among all models for the development of ARDS (AUC= 0.904) and the progression from ARDS to death (AUC= 0.959).Conclusion: COVID-19 patients with ARDS were more likely to develop into death. The potential risk factors and the comprehensive prediction model could be helpful to identify patients developed ARDS with poor prognosis at an early stage, which might help physicians to formulate a timely therapeutic strategy.

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Sepsis-3 Septic Shock Criteria and Associated Mortality Among Infected Hospitalized Patients Assessed by a Rapid Response Team

Cited by 47 publications

References 35 publications

Sepsis 2019: What Surgeons Need to Know

Sepsis 2019: What Surgeons Need to Know

New-onset atrial fibrillation and associated outcomes and resource use among critically ill adults—a multicenter retrospective cohort study

Risk Factors Related to Acute Respiratory Distress Syndrome and Death in Patients with COVID-19: A Retrospective Cohort Study in Wuhan, China

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