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8 pages, 211 KiB

Open AccessArticle

An Increasing Neutrophil-to-Lymphocyte Ratio Trajectory Predicts Organ Failure in Critically-Ill Male Trauma Patients. An Exploratory Study

by Duraid Younan, Joshua Richman, Ahmed Zaky and Jean-Francois Pittet

Healthcare 2019, 7(1), 42; https://doi.org/10.3390/healthcare7010042 - 14 Mar 2019

Cited by 21 | Viewed by 4447

Abstract

Background: Although the association of neutrophil proportions with mortality in trauma patients has recently been shown, there is a paucity of research on the association with other outcomes. We sought to investigate the association of neutrophil proportions with organ failure in critically-ill trauma [...] Read more.

Background: Although the association of neutrophil proportions with mortality in trauma patients has recently been shown, there is a paucity of research on the association with other outcomes. We sought to investigate the association of neutrophil proportions with organ failure in critically-ill trauma patients. Methods: We reviewed a randomly-selected group of trauma patients admitted to our level-1 trauma intensive care unit between July 2007 and December 2016. Data collected included demographics, injury mechanism and severity (ISS), neutrophil-to-lymphocyte ratio (NLR) at admission and at 24 and 48 hours and organ failure data. NLR patterns during the first 48 hours were divided into two trajectories identified by applying factor and cluster analysis to longitudinal measures. Logistic regression was performed for the association between NLR trajectories and any organ failure; negative binomial regression was used to model the number of organ failures and stage of kidney failure measured by KDIGO classification. Results: 207 patients had NLR data at all three time points. The average age was 44.9 years with mean ISS of 20.6. Patients were 72% male and 23% had penetrating trauma. The 74 patients (36%) with Trajectory 1 had a mean NLR at admission of 3.6, which increased to 14.7 at 48 hours. The 133 (64%) patients in Trajectory 2 had a mean NLR at admission of 8.5 which decreased to 6.6 at 48 hours. Mean NLR was different between the two groups at all three time points (all p < 0.01). There was no significant difference in ISS, age or gender between the two trajectory groups. Models adjusted for age, gender and ISS showed that relative to those with trajectory 2, patients with the trajectory 1 were more likely to have organ failure OR 2.96 (1.42–6.18; p < 0.01), higher number of organ failures IRR 1.50 (1.13–2.00, p < 0.01), and degree of AKI IRR 2.06 (1.04–4.06, p = 0.04). In all cases, the estimated associations were higher among men vs. women, and all were significant among men, but not women. Conclusions: Trauma patients with an increasing NLR trajectory over the first 48 hours had increased risk, number and severity of organ failures. Further research should focus on the mechanisms behind this difference in outcome. Full article

(This article belongs to the Special Issue The Outcome of Sepsis)

Review

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9 pages, 190 KiB

Open AccessFeature PaperReview

Is Left Ventricular Global Longitudinal Strain by Two-Dimensional Speckle Tracking Echocardiography in Sepsis Cardiomyopathy Ready for Prime Time Use in the ICU?

by Venu Madhav Velagapudi, Rahul Pidikiti and Dennis A. Tighe

Healthcare 2019, 7(1), 5; https://doi.org/10.3390/healthcare7010005 - 3 Jan 2019

Cited by 10 | Viewed by 5435

Abstract

Myocardial deformation imaging (strain imaging) is a technique to directly quantify the extent of myocardial contractility and overcomes several of the limitations of ejection fraction. The application of the most commonly used strain imaging method; speckle-tracking echocardiography to patients with sepsis cardiomyopathy heralds [...] Read more.

Myocardial deformation imaging (strain imaging) is a technique to directly quantify the extent of myocardial contractility and overcomes several of the limitations of ejection fraction. The application of the most commonly used strain imaging method; speckle-tracking echocardiography to patients with sepsis cardiomyopathy heralds an exciting development to the field. However; the body of evidence and knowledge on the utility, feasibility and prognostic value of left ventricular global longitudinal strain in sepsis cardiomyopathy is still evolving. We conducted a review of literature on utility of left ventricular global longitudinal strain in sepsis cardiomyopathy. We discuss the role of left ventricular global longitudinal strain in mortality prediction, utility and limitations of the technique in the context of sepsis cardiomyopathy. Full article

(This article belongs to the Special Issue The Outcome of Sepsis)

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9 pages, 213 KiB

Open AccessReview

Interventions for Pediatric Sepsis and Their Impact on Outcomes: A Brief Review

by Laura A. Watkins

Healthcare 2019, 7(1), 2; https://doi.org/10.3390/healthcare7010002 - 28 Dec 2018

Cited by 8 | Viewed by 5651

Abstract

In the current era, pediatric sepsis remains a public health problem of significant prevalence and impact. With mortality rates practically unchanged over the years, this review hopes to briefly summarize the epidemiology and the current interventions for pediatric sepsis and point towards possible [...] Read more.

In the current era, pediatric sepsis remains a public health problem of significant prevalence and impact. With mortality rates practically unchanged over the years, this review hopes to briefly summarize the epidemiology and the current interventions for pediatric sepsis and point towards possible areas of improvement. Most pediatric studies of sepsis are either small, retrospective or observational. Given information technology spreading across country, and a stronger presence of clinical networks, development of multicenter prospective studies over the next decade should enable better treatments for pediatric sepsis, and improved outcomes. Full article

(This article belongs to the Special Issue The Outcome of Sepsis)

12 pages, 315 KiB

Open AccessReview

Factors Underlying Racial Disparities in Sepsis Management

by Matthew DiMeglio, John Dubensky, Samuel Schadt, Rashmika Potdar and Krzysztof Laudanski

Healthcare 2018, 6(4), 133; https://doi.org/10.3390/healthcare6040133 - 19 Nov 2018

Cited by 23 | Viewed by 7771

Abstract

Sepsis, a syndrome characterized by systemic inflammation during infection, continues to be one of the most common causes of patient mortality in hospitals across the United States. While standardized treatment protocols have been implemented, a wide variability in clinical outcomes persists across racial [...] Read more.

Sepsis, a syndrome characterized by systemic inflammation during infection, continues to be one of the most common causes of patient mortality in hospitals across the United States. While standardized treatment protocols have been implemented, a wide variability in clinical outcomes persists across racial groups. Specifically, black and Hispanic populations are frequently associated with higher rates of morbidity and mortality in sepsis compared to the white population. While this is often attributed to systemic bias against minority groups, a growing body of literature has found patient, community, and hospital-based factors to be driving racial differences. In this article, we provide a focused review on some of the factors driving racial disparities in sepsis. We also suggest potential interventions aimed at reducing health disparities in the prevention, early identification, and clinical management of sepsis. Full article

(This article belongs to the Special Issue The Outcome of Sepsis)

7 pages, 184 KiB

Open AccessReview

Health-Related Quality of Life after Pediatric Severe Sepsis

by Prachi Syngal and John S. Giuliano, Jr.

Healthcare 2018, 6(3), 113; https://doi.org/10.3390/healthcare6030113 - 11 Sep 2018

Cited by 15 | Viewed by 4120

Abstract

Background: Pediatric severe sepsis is a public health problem with significant morbidities in those who survive. In this article, we aim to present an overview of the important studies highlighting the limited data available pertaining to long-term outcomes of survivors of pediatric severe [...] Read more.

Background: Pediatric severe sepsis is a public health problem with significant morbidities in those who survive. In this article, we aim to present an overview of the important studies highlighting the limited data available pertaining to long-term outcomes of survivors of pediatric severe sepsis. Materials and Methods: A review of literature available was conducted using PUBMED/Medline on pediatric severe sepsis outcomes. Long-term outcomes and health-related quality of life (HRQL) following severe sepsis was defined as any outcome occurring after discharge from the hospital following an episode of severe sepsis which affected either the survivor or the survivor’s family members. Results: Many children are discharged with worse clinical and functional outcomes, depending on their diagnosis, treatments received, psychological effects, and the impact of their illness on their parents. Additionally, they utilize healthcare services more than their peers and are often readmitted soon after discharge. However, pediatric HRQL studies with worthwhile outcome measures are limited and the current data on pediatric sepsis is mainly retrospective. Conclusions: There is significant and longstanding morbidity seen in children and their families following a severe sepsis illness. Further prospective data are required to study the long-term outcomes of sepsis in the pediatric population. Full article

(This article belongs to the Special Issue The Outcome of Sepsis)

9 pages, 492 KiB

Open AccessReview

Sepsis: Personalized Medicine Utilizing ‘Omic’ Technologies—A Paradigm Shift?

by Theis Skovsgaard Itenov, Daniel D. Murray and Jens Ulrik Stæhr Jensen

Healthcare 2018, 6(3), 111; https://doi.org/10.3390/healthcare6030111 - 7 Sep 2018

Cited by 21 | Viewed by 4905

Abstract

Sepsis has over the years proven a considerable challenge to physicians and researchers. Numerous pharmacological and non-pharmacological interventions have been tested in trials, but have unfortunately failed to improve the general prognosis. This has led to the speculation that the sepsis population may [...] Read more.

Sepsis has over the years proven a considerable challenge to physicians and researchers. Numerous pharmacological and non-pharmacological interventions have been tested in trials, but have unfortunately failed to improve the general prognosis. This has led to the speculation that the sepsis population may be too heterogeneous to be targeted with the traditional one treatment suits all’ approach. Recent advances in genetic and biochemical analyses now allow genotyping and biochemical characterisation of large groups of patients via the ‘omics’ technologies. These new opportunities could lead to a paradigm shift in the approach to sepsis towards personalised treatments with interventions targeted towards specific pathophysiological mechanisms activated in the patient. In this article, we review the potentials and pitfalls of using new advanced technologies to deepen our understanding of the clinical syndrome of sepsis. Full article

(This article belongs to the Special Issue The Outcome of Sepsis)

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14 pages, 289 KiB

Open AccessReview

Mid-Regional Pro-Adrenomedullin (MR-proADM) as a Biomarker for Sepsis and Septic Shock: Narrative Review

by Uğur Önal, Francisco Valenzuela-Sánchez, Kalwaje Eshwara Vandana and Jordi Rello

Healthcare 2018, 6(3), 110; https://doi.org/10.3390/healthcare6030110 - 3 Sep 2018

Cited by 44 | Viewed by 6497

Abstract

Early identification and diagnosis of sepsis and septic shock is vitally important; despite appropriate management, mortality and morbidity rates remain high. For this reason, many biomarkers and screening systems have been investigated in accordance with the precision medicine concept. A narrative review was [...] Read more.

Early identification and diagnosis of sepsis and septic shock is vitally important; despite appropriate management, mortality and morbidity rates remain high. For this reason, many biomarkers and screening systems have been investigated in accordance with the precision medicine concept. A narrative review was conducted to assess the role of mid-regional pro-adrenomedullin (MR-proADM) as a biomarker for sepsis and septic shock. Relevant studies were collected via an electronic PubMed, Web of Science, and The Cochrane Library search. The review focused on both diagnosis and prognosis in patients with sepsis and septic shock and specifically in subpopulations of patients with sepsis and septic shock with burns or malignant tumors. No exclusion criteria regarding age, sex, intensive care unit admission, follow-up duration, or co morbidities were used so as to maximize sensitivity and due to lack of randomized controlled trials, opinion paper and reviews were also included in this review. A total of 22 studies, one opinion paper, and one review paper were investigated. MR-proADM levels were found to be useful in assessing patients’ initial evolution and become even more useful during follow-up with increased area under curve values in the mortality prognosis by exceeding values of 0.8 in the data shown in several studies. These results also improve along with other biomarkers or severity scores and especially correlate with the organ failure degree. The results of this study indicate that MR-proADM is a good biomarker for the diagnosis and prognosis of sepsis and septic shock patients as well as for organ failure. Although several publications have discussed its role as a biomarker for pneumonia, its value as a biomarker for sepsis and septic shock should now be assessed in randomized controlled trials and more collaborative prospective studies with larger patient samples. Full article

(This article belongs to the Special Issue The Outcome of Sepsis)

11 pages, 564 KiB

Open AccessReview

The “Centrality of Sepsis”: A Review on Incidence, Mortality, and Cost of Care

by Jihane Hajj, Natalie Blaine, Jola Salavaci and Douglas Jacoby

Healthcare 2018, 6(3), 90; https://doi.org/10.3390/healthcare6030090 - 30 Jul 2018

Cited by 88 | Viewed by 10117

Abstract

Sepsis is a serious and fatal medical condition that has overburdened the US healthcare system. The purpose of this paper is to provide a review of published literature on severe sepsis with a distinct focus on incidence, mortality, cost of hospital care, and [...] Read more.

Sepsis is a serious and fatal medical condition that has overburdened the US healthcare system. The purpose of this paper is to provide a review of published literature on severe sepsis with a distinct focus on incidence, mortality, cost of hospital care, and postdischarge care. A review of the nature of postsepsis syndrome and its impact on septic patients is also included. The literature review was conducted utilizing the PubMed database, identifying 34 studies for inclusion. From the evaluation of these studies, it was determined that the incidence of sepsis continues to be on the rise according to three decades of epidemiological data. Readmissions, mortality, and length of stay were all higher among septic patients when compared to patients treated for other conditions. The cost of treating sepsis is remarkably high and exceeds the cost of treating patients with congestive heart failure and acute myocardial infarction. The overall cost of sepsis is reflective of not only the cost of initial hospitalization but also the postdischarge care costs, including postsepsis syndrome and cognitive and functional disabilities that require a significant amount of healthcare resources long term. Sepsis and its impact on patients and the US healthcare system is a current quality-of-life and cost-burden issue that needs to be addressed with a greater focus on preventative strategies. Full article

(This article belongs to the Special Issue The Outcome of Sepsis)

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