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3 results on '"Bacterial Infections and Mycoses::Infection::Sepsis [DISEASES]"'

1. Precision medicine in sepsis and septic shock: From omics to clinical tools

Author

Juan Carlos Ruiz-Rodriguez, Erika P Plata-Menchaca, Luis Chiscano-Camón, Adolfo Ruiz-Sanmartin, Marcos Pérez-Carrasco, Clara Palmada, Vicent Ribas, Mónica Martínez-Gallo, Manuel Hernández-González, Juan J Gonzalez-Lopez, Nieves Larrosa, Ricard Ferrer, Institut Català de la Salut, [Ruiz-Rodriguez JC] Unitat de Cures Intensives, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Grup de Recerca en Xoc, Disfunció Orgànica i Reanimació, Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain. [Plata-Menchaca EP] Grup de Recerca en Xoc, Disfunció Orgànica i Reanimació, Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. Department of Intensive Care, Hospital Clínic de Barcelona, Barcelona 08036, Spain. [Chiscano-Camón L, Ruiz-Sanmartin A, Ferrer R] Unitat de Cures Intensives, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Grup de Recerca en Xoc, Disfunció Orgànica i Reanimació, Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain. [Pérez-Carrasco M] Unitat de Cures Intensives, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Grup de Recerca en Xoc, Disfunció Orgànica i Reanimació, Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. [Palmada C] Unitat de Cures Intensives, Vall d’Hebron Hospital Universitari, Barcelona, Spain. [Martínez-Gallo M, Hernández-González M] Servei d’Immunologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Grup de Recerca en Immunologia Diagnòstica, Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. Departament de Biologia Cel•lular, Fisiologia i Immunologia, Universitat Autònoma de Barcelona, Bellaterra, Spain. [Gonzalez-Lopez JJ, Larrosa N] Servei de Microbiologia Clínica, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Departament de Microbiologia i Genètica, Universitat Autònoma de Barcelona, Bellaterra, Spain, and Vall d'Hebron Barcelona Hospital Campus

Subjects
terapéutica::medicina de precisión [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS], infecciones bacterianas y micosis::infección::sepsis::choque séptico [ENFERMEDADES], Bacterial Infections and Mycoses::Infection::Sepsis [DISEASES], Xoc sèptic, General Medicine, Medicina personalitzada, Septicèmia, infecciones bacterianas y micosis::infección::sepsis [ENFERMEDADES], Bacterial Infections and Mycoses::Infection::Sepsis::Shock, Septic [DISEASES], Therapeutics::Precision Medicine [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT]
Abstract

Endotype; Organ dysfunction; Sepsis Endotipo; Disfunción de órganos; Sepsis Endotip; Disfunció d'òrgans; Sèpsia Sepsis is a heterogeneous disease with variable clinical course and several clinical phenotypes. As it is associated with an increased risk of death, patients with this condition are candidates for receipt of a very well-structured and protocolized treatment. All patients should receive the fundamental pillars of sepsis management, which are infection control, initial resuscitation, and multiorgan support. However, specific subgroups of patients may benefit from a personalized approach with interventions targeted towards specific pathophysiological mechanisms. Herein, we will review the framework for identifying subpopulations of patients with sepsis, septic shock, and multiorgan dysfunction who may benefit from specific therapies. Some of these approaches are still in the early stages of research, while others are already in routine use in clinical practice, but together will help in the effective generation and safe implementation of precision medicine in sepsis.

Published
2022

2. The protective association of endogenous immunoglobulins against sepsis mortality is restricted to patients with moderate organ failure

Author

Adriele Prina-Mello, Eduardo Anton, Jesús Blanco, Rubén Herrán-Monge, Ana Rodriguez-Fernandez, Ignacio Martin-Loeches, Wysali Trapiello, Jordi Solé-Violán, Antonio Artigas, David Andaluz-Ojeda, Arturo Muriel-Bombín, Ana Loza, B. Suberviola, Jesus F. Bermejo-Martin, Pedro Merino, Ricard Ferrer, Leonardo Lorente, Pablo Garcia-Olivares, Eduardo Tamayo, Institut Català de la Salut, [Martin-Loeches I] Multidisciplinary Intensive Care Research Organization (MICRO), St. James’s University Hospitals Dublin, James’s St, Ushers, Dublin 8, Ireland. [Muriel-Bombín A] Intensive Care Department, Hospital Universitario Río Hortega de Valladolid, Calle Dulzaina, 2, 47012 Valladolid, Spain. [Ferrer R] Servei de Medicina Intensiva, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Grup de Shock, Disfunció Orgànica i Ressucitació, Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. ABISS Edusepsis (AntiBiotic Intervention in Severe Sepsis), Servei de Medicina Intensiva, Vall d’Hebron Hospital Universitari, Barcelona, Spain. [Artigas A] ABISS Edusepsis (AntiBiotic Intervention in Severe Sepsis), Servei de Medicina Intensiva, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Critical Care Center, Corporacion Sanitaria Universitaria Parc Tauli, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208 Sabadell, Barcelona, Spain. CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, C/Sinesio Delgado,4, 28029 Madrid, Spain. [Sole-Violan J] ABISS Edusepsis (AntiBiotic Intervention in Severe Sepsis), Servei de Medicina Intensiva, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Critical Care Medicine Service, Hospital Dr Negrin, Barranco de la Ballena, s/n, 35010 Las Palmas de Gran Canaria, Las Palmas, Spain. [Lorente L] ABISS Edusepsis (AntiBiotic Intervention in Severe Sepsis), Servei de Medicina Intensiva, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Critical Care Medicine Service, Hospital Universitario de Canarias, Carretera de Ofra, s/n, 38320 San Cristóbal de La Laguna, Santa Cruz De Tenerife, Spain. [Suberviola B] ABISS Edusepsis (AntiBiotic Intervention in Severe Sepsis), Servei de Medicina Intensiva, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Critical Care Medicine Service, Hospital Universitario Marqués de Valdecilla, Av. Valdecilla, 25, 39008 Santander, Spain. [Loza AM] ABISS Edusepsis (AntiBiotic Intervention in Severe Sepsis), Servei de Medicina Intensiva, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Critical Care Medicine Service, Hospital Nuestra Señora de Valme, Av. de Bellavista, s/n, 41014 Seville, Spain. [Garcia-Olivares P] ABISS Edusepsis (AntiBiotic Intervention in Severe Sepsis), Servei de Medicina Intensiva, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Critical Care Medicine Service, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007 Madrid, Spain. [Anton E] ABISS Edusepsis (AntiBiotic Intervention in Severe Sepsis), Servei de Medicina Intensiva, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Critical Care Medicine Service, Hospital de Manacor, Carretera Manacor Alcudia, s/n, 07500 Manacor, Spain, and Vall d'Hebron Barcelona Hospital Campus

Subjects
medicine.medical_specialty, Immunoglobulin levels, Survival, Sepsis mortality, medicine.medical_treatment, health care facilities, manpower, and services, Immunoglobulins, Endogeny, infecciones bacterianas y micosis::infección::sepsis [ENFERMEDADES], Disease, Critical Care and Intensive Care Medicine, Logistic regression, Severity, Sepsis, 03 medical and health sciences, 0302 clinical medicine, Other subheadings::Other subheadings::Other subheadings::/mortality [Other subheadings], Internal medicine, Anesthesiology, Medicine, 030212 general & internal medicine, aminoácidos, péptidos y proteínas::proteínas::proteínas sanguíneas::inmunoproteínas::inmunoglobulinas [COMPUESTOS QUÍMICOS Y DROGAS], Septicèmia - Mortalitat, Amino Acids, Peptides, and Proteins::Proteins::Blood Proteins::Immunoproteins::Immunoglobulins [CHEMICALS AND DRUGS], Otros calificadores::Otros calificadores::Otros calificadores::/mortalidad [Otros calificadores], biology, business.industry, Research, lcsh:Medical emergencies. Critical care. Intensive care. First aid, 030208 emergency & critical care medicine, Immunosuppression, Retrospective cohort study, lcsh:RC86-88.9, medicine.disease, Surgery, Intravenous Immunoglobulins, biology.protein, Bacterial Infections and Mycoses::Infection::Sepsis [DISEASES], Antibody, Immunoglobulines, business
Abstract

Background: Pre-evaluation of endogenous immunoglobulin levels is a potential strategy to improve the results of intravenous immunoglobulins in sepsis, but more work has to be done to identify those patients who could benefit the most from this treatment. The objective of this study was to evaluate the impact of endogenous immunoglobulins on the mortality risk in sepsis depending on disease severity. Methods: This was a retrospective observational study including 278 patients admitted to the ICU with sepsis fulfilling the SEPSIS-3 criteria, coming from the Spanish GRECIA and ABISS-EDUSEPSIS cohorts. Patients were distributed into two groups depending on their Sequential Organ Failure Assessment score at ICU admission (SOFA < 8, n = 122 and SOFA >= 8, n = 156), and the association between immunoglobulin levels at ICU admission with mortality was studied in each group by Kaplan-Meier and multivariate logistic regression analysis. Results: ICU/hospital mortality in the SOFA < 8 group was 14.8/23.0%, compared to 30.1/35.3% in the SOFA >= 8 group. In the group with SOFA < 8, the simultaneous presence of total IgG < 407 mg/dl, IgM < 43 mg/dl and IgA < 219 mg/dl was associated with a reduction in the survival mean time of 6.6 days in the first 28 days and was a robust predictor of mortality risk either during the acute or during the post-acute phase of the disease (OR for ICU mortality: 13.79; OR for hospital mortality: 7.98). This predictive ability remained in the absence of prior immunosuppression (OR for ICU mortality: 17.53; OR for hospital mortality: 5.63). Total IgG < 407 mg/dl or IgG1 < 332 mg/dl was also an independent predictor of ICU mortality in this group. In contrast, in the SOFA >= 8 group, we found no immunoglobulin thresholds associated with neither ICU nor hospital mortality. Conclusions: Endogenous immunoglobulin levels may have a different impact on the mortality risk of sepsis patients based on their severity. In patients with moderate organ failure, the simultaneous presence of low levels of IgG, IgA and IgM was a consistent predictor of both acute and post-acute mortalities., The GRECIA study was supported by Proyectos de Investigacion en Biomedicina, Consejeria de Sanidad, JCYL (Grant Code BOCYL-D-26072010). The authors thank also Instituto de Salud Carlos III for their financial support (Grant Code EMER 07/050, ISCIII-FIS-PI12-01815). The funding agencies were not involved neither in the design of the study and collection, nor in the analysis, interpretation of data or manuscript writing.

Published
2017
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3. Epidemiology of sepsis in Catalonia: analysis of incidence and outcomes in a European setting

Author

Carol Lorencio, Candelaria De Haro, Luis Zapata, Prof. Ignacio Martin-loeches, Juan Carlos Ruiz-Rodriguez, PAULA VERA, Juan Carlos Yébenes, Berta Cisteró Roig, Artigas Antonio, Andrei Margarit, Teresa M Tomasa, Ricard Ferrer, SEPSIS, INFLAMACIÓN Y SEGURIDAD, Medicina i Cirurgia, Universitat Rovira i Virgili, Institut Català de la Salut, [Yébenes JC] Critical Care Department, Hospital de Mataró, Mataró, Spain. Grup de Recerca en Sepsis, Imflamació i Seguretat (AGAUR 2014-SGR926), Barcelona, Spain. Escola Superior de Ciencies de la Salut, Universitat Pompeu Fabra, Mataró, Spain. Servei de Medicina Intensiva, Hospital de Mataró, Carretera de Cirera s/n, 08304 Mataró, Spain. [Ruiz-Rodriguez JC] Servei de Medicina Intensiva, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Grup Shock, Disfunció Orgànica i Ressucitació, Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra, Spain. [Ferrer R] Servei de Medicina Intensiva, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Grup Shock, Disfunció Orgànica i Ressucitació, Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra, Spain. CIBER Enfermedades Respiratorias, Madrid, Spain. [Clèries M, Bosch A] Divisió d’Anàlisi de la Demanda i l’Activitat, Servei Català de la Salut (CatSalut), Barcelona, Spain. [Lorencio C] Critical Care Department, Hospital Universitari Dr. Josep Trueta, Girona, Spain, and Vall d'Hebron Barcelona Hospital Campus

Subjects
medicine.medical_specialty, Epidemiology, Other subheadings::Other subheadings::/epidemiology [Other subheadings], Population, Septicèmia - Epidemiologia, Context (language use), infecciones bacterianas y micosis::infección::sepsis [ENFERMEDADES], 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, Sepsis, 03 medical and health sciences, 0302 clinical medicine, Septic shock, Mortalitat, medicine, Septicèmia, 030212 general & internal medicine, Mortality, Epidemiologia, education, Ciències de la salut, education.field_of_study, business.industry, Research, Incidence (epidemiology), Public health, Organ dysfunction, Otros calificadores::Otros calificadores::/epidemiología [Otros calificadores], Health sciences, medicine.disease, Ciencias de la salud, 2110-5820, Emergency medicine, Bacterial Infections and Mycoses::Infection::Sepsis [DISEASES], medicine.symptom, business
Abstract

Epidemiologia; Mortalitat; Shock sèptic Epidemiología; Mortalidad; Shock séptico Epidemiology; Mortality; Septic shock Background Up-to-date identification of local trends in sepsis incidence and outcomes is of considerable public health importance. The aim of our study was to estimate annual incidence rates and in-hospital mortality trends for hospitalized patients with sepsis in a European setting, while avoiding selection bias in relation to different complexity hospitals. Methods A large retrospective analysis of a 5-year period (2008–2012) was conducted of hospital discharge records obtained from the Catalan Health System (CatSalut) Minimum Basic Data Set for Acute-Care Hospitals (a mandatory population-based register of admissions to all public and private acute-care hospitals in Catalonia). Patients hospitalized with sepsis were detected on the basis of ICD-9-CM codes used to identify acute organ dysfunction and infectious processes. Results Of 4,761,726 discharges from all acute-care hospitals in Catalonia, 82,300 cases (1.72%) had sepsis diagnoses. Annual incidence was 212.7 per 100,000 inhabitants/year, rising from 167.2 in 2008 to 261.8 in 2012. Length of hospital stay fell from 18.4 to 15.3 days (p < .00001), representing a relative reduction of 17%. Hospital mortality fell from 23.7 to 19.7% (p < .0001), representing a relative reduction of 16.9%. These differences were confirmed in the multivariate analysis (adjusted for age group, sex, comorbidities, ICU admission, emergency admission, organ dysfunction, number of organ failures, sepsis source and bacteraemia). Conclusions Sepsis incidence has risen in recent years, whereas mortality has fallen. Our findings confirm reports for other parts of the world, in the context of scarce administrative data on sepsis in Europe. The study was partially funded by the Mataró Sepsis Challenge (www.sepsischallenge.cat) through the Fundació Salut del Consorci Sanitari del Maresme.

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