Sepsis and Critical Illness Research Center investigators: protocols and standard operating procedures for a prospective cohort study of sepsis in critically ill surgical patients

Loftus, Tyler J.; Mira, Juan C.; Ozrazgat‐Baslanti, Tezcan; Ghita, Gabriella; Wang, Zhongkai; Stortz, Julie A.; Brumback, Babette; Bïhorac, Azra; Segal, Mark S.; Anton, Stephen D.; Leeuwenburgh, Christiaan; Mohr, Alicia M.; Efron, Philip A.; Moldawer, Lyle L.; Moore, Frederick A.; Brakenridge, Scott C.

doi:10.1136/bmjopen-2016-015136

Cited by 69 publications

(87 citation statements)

References 48 publications

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“…If not obtained within 96 hours, all patient data and biological samples were destroyed. Details of the study design with inclusion and exclusion criteria as well as the clinical and laboratory standard operating procedure utilized were published . In brief, inclusion criteria included (1) age 18 years or older, (2) clinical diagnosis of sepsis defined by 2001 consensus guidelines, and (3) entrance into an electronic medical record sepsis screening and evidence‐based management protocols.…”

Section: Methodsmentioning

confidence: 99%

“…Performance status was measured by Eastern Cooperative Oncology Group/World Health Organization/Zubrod Performance Status that ranges from 0 to 5, with increasing score reflecting worse performance status: (0) asymptomatic (fully active); (1) Symptomatic but completely ambulatory (restricted in physically strenuous activity); (2) symptomatic, less than 50% of time in bed during the day (ambulatory and capable of all self‐care but unable to perform any work activities); (3) symptomatic, more than 50% of time in bed but not bedbound (capable of only limited self‐care); (4) bedbound (completely disabled, incapable of any self‐care); and (5) death . Baseline (ie, prehospitalization) performance status was based on patient/proxy‐reported 4‐week recall assessment as soon as possible after sepsis onset …”

Section: Methodsmentioning

confidence: 99%

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Older Sepsis Survivors Suffer Persistent Disability Burden and Poor Long‐Term Survival

Mankowski

Anton

Ghita

et al. 2020

J American Geriatrics Society

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Objectives Sepsis has been called a “disease of the elderly,” and as in‐hospital mortality has decreased, more sepsis survivors are progressing into poorly characterized long‐term outcomes. The purpose of this study was to describe the current epidemiology of sepsis in older adults compared with middle‐aged and young adults. Design Prospective longitudinal study with young (≤45 years), middle‐aged (46‐64 years), and older (≥65 years) patient groups. Setting University tertiary medical center. Participants A total of 328 adult surgical intensive care unit (ICU) sepsis patients. Measurements Patients were characterized by (1) baseline demographics and predisposition, (2) septic event, (3) hospital outcomes and discharge disposition, (4) 12‐month mortality, and (5) Zubrod Performance Status, physical function (Short Physical Performance Battery and handgrip strength), and cognitive function (Hopkins Verbal Learning Test, Controlled Oral Word Association, and Mini‐Mental Status Examination) at 3‐, 6‐, and 12‐month follow‐up. Loss to follow‐up was due to death (in 68), consent withdrawal (in 32), and illness and scheduling difficulties: month 3 (in 51), month 6 (in 29), and month 12 (in 20). Results Compared with young and middle‐aged patients, older patients had (1) significantly more comorbidities at presentation (eg, chronic renal disease 6% vs 12% vs 21%), intra‐abdominal infections (14% vs 25% vs 37%), septic shock (12% vs 25% vs 36%), and organ dysfunctions; (2) higher 30‐day mortality (6% vs 4% vs 17%) and fewer ICU‐free days (median = 25 vs 23 vs 20); (3) more progression into chronic critical illness (22% vs 34% vs 42%) with higher poor disposition discharge to non‐home destinations (19% vs 40% vs 62%); (4) worse 12‐month mortality (11% vs 14% vs 33%); and (5) poorer Zubrod Performance Status and objectively measured physical and cognitive functions with only slight improvement over 12‐month follow‐up. Conclusion Compared with younger patients, older sepsis survivors suffer both a higher persistent disability burden and 12‐month mortality.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Older Sepsis Survivors Suffer Persistent Disability Burden and Poor Long‐Term Survival

Mankowski

Anton

Ghita

et al. 2020

J American Geriatrics Society

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“…A prospective observational study was conducted between 2014 and 2018 at UF Health Shands Hospital, a 996-bed level 1 trauma and tertiary care center in Gainesville, Florida, USA (NCT: 02276417) [ 13 ]. The aim of the parent study was to examine the epidemiology, natural history, and long-term outcomes of surgical or trauma patients with sepsis.…”

Section: Methodsmentioning

confidence: 99%

Sepsis is associated with reduced spontaneous neutrophil migration velocity in human adults

et al. 2018

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Sepsis is a common and deadly complication among trauma and surgical patients. Neutrophils must mobilize to the site of infection to initiate an immediate immune response. To quantify the velocity of spontaneous migrating blood neutrophils, we utilized novel microfluidic approaches on whole blood samples from septic and healthy individuals. A prospective study at a level 1 trauma and tertiary care center was performed with peripheral blood samples collected at <12 hours, 4 days, and/or 14 days relative to study initiation. Blood samples were also collected from healthy subjects. Ex vivo spontaneous neutrophil migration was measured on 2 μl of whole blood using microfluidic devices and time-lapse imaging. For each sample, individual neutrophils were tracked to calculate mean instantaneous velocity. Forty blood samples were collected from 33 patients with sepsis, and 15 blood samples were collected from age- and gender-matched healthy, control subjects. Average age was 61 years for septic patients with a male predominance (67%). Overall, average spontaneous neutrophil migration velocity in septic samples was 16.9 μm/min, significantly lower than controls samples at 21.1 μm/min (p = 0.0135). Neutrophil velocity was reduced the greatest at <12 hours after sepsis (14.5 μm/min). Regression analysis demonstrated a significant, positive correlation between neutrophil velocity and days after sepsis (p = 0.0059). There was no significant association between neutrophil velocity and age, gender, APACHE II score, SOFA score, sepsis severity, total white blood cell count, or percentage of neutrophils. Circulating levels of the cytokines IL-6, IL-8, IL-10, MCP-1, IP-10, and TNF were additionally measured using bead-based multiplex assay and found to peak at <12 hours and be significantly increased in patients with sepsis at all three time points (<12 hours, 4 days, and 14 days after sepsis) compared to healthy subjects. In conclusion, these findings may demonstrate an impaired ability of neutrophils to respond to sites of infection during the proinflammatory phase of sepsis.

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“…It was carried out in two 24 bed surgical ICUs at the University of Florida (UF), Shands Hospital (Gainesville, FL; USA), and conducted by the UF SCIRC. A detailed description of the study design with specific inclusion and exclusion criteria as well as the clinical and laboratory standard operating procedure (SOPs) utilized has been published [28]. In brief, overall cohort inclusion criteria included: (1) age ≥ 18 years, (2) clinical diagnosis of sepsis as defined by 2001 international consensus guidelines, and (3) entrance into an electronic medical record sepsis screening and evidence-based ICU management protocol [16,23].…”

Section: Study Design Setting and Participantsmentioning

confidence: 99%

Phenotypic heterogeneity by site of infection in surgical sepsis: a prospective longitudinal study

et al. 2020

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Background: The role of site of infection in sepsis has been poorly characterized. Additionally, sepsis epidemiology has evolved. Early mortality has decreased, but many survivors now progress into chronic critical illness (CCI). This study sought to determine if there were significant differences in the host response and current epidemiology of surgical sepsis categorized by site of infection.Study design: This is a longitudinal study of surgical sepsis patients characterized by baseline predisposition, insult characteristics, serial biomarkers, hospital outcomes, and long-term outcomes. Patients were categorized into five anatomic sites of infection. Results:The 316 study patients were predominantly Caucasian; half were male, with a mean age of 62 years, high comorbidity burden, and low 30-day mortality (10%). The primary sites were abdominal (44%), pulmonary (19%), skin/soft tissue (S/ST, 17%), genitourinary (GU, 12%), and vascular (7%). Most abdominal infections were present on admission and required source control. Comparatively, they had more prolonged proinflammation, immunosuppression, and persistent organ dysfunction. Their long-term outcome was poor with 37% CCI (defined as > 14 in ICU with organ dysfunction), 49% poor discharge dispositions, and 30% 1-year mortality. Most pulmonary infections were hospitalacquired pneumonia. They had similar protracted proinflammation and organ dysfunction, but immunosuppression normalized. Long-term outcomes are similarly poor (54% CCI, 47% poor disposition, 32% 1-year mortality). S/ST and GU infections occurred in younger patients with fewer comorbidities, less perturbed immune responses, and faster resolution of organ dysfunction. Comparatively, S/ST had better long-term outcomes (23% CCI, 39% poor disposition, 13% 1-year mortality) and GU had the best (10% CCI, 20% poor disposition, 10% 1-year mortality). Vascular sepsis patients were older males, with more comorbidities. Proinflammation was blunted with baseline immunosuppression and organ dysfunction that persisted. They had the worst long-term outcomes (38% CCI, 67% poor disposition, 57% 1-year mortality). Conclusion: There are notable differences in baseline predisposition, host responses, and clinical outcomes by site of infection in surgical sepsis. While previous studies have focused on differences in hospital mortality, this study provides unique insights into the host response and long-term outcomes associated with different sites of infection.

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Sepsis and Critical Illness Research Center investigators: protocols and standard operating procedures for a prospective cohort study of sepsis in critically ill surgical patients

Cited by 69 publications

References 48 publications

Older Sepsis Survivors Suffer Persistent Disability Burden and Poor Long‐Term Survival

Older Sepsis Survivors Suffer Persistent Disability Burden and Poor Long‐Term Survival

Sepsis is associated with reduced spontaneous neutrophil migration velocity in human adults

Phenotypic heterogeneity by site of infection in surgical sepsis: a prospective longitudinal study

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