Descriptor: "sepsi" - Searchworks@Jio Institute Digital Library Search Results

Your search keyword '"sepsi"' showing total 362 results

Start Over Descriptor "sepsi"

362 results on '"sepsi"'

1. Peritonite settica nei carnivori domestici: iter diagnostico.

Author: Bouzouraa, Tarek
Abstract: Copyright of Summa, Animali da Compagnia is the property of Point Veterinaire Italie s.r.l. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Published: 2024

2. Conta differenziale leucocitaria e parametri morfometrici determinati con Mindray BC-6800 Plus: un possibile strumento predittivo per lo screening di sepsi.

Author: Pelagalli, Martina, Giovannelli, Alfredo, Calabrese, Cinzia, Sarubbi, Serena, Tomassetti, Flaminia, Minieri, Marilena, Legramante, Jacopo M., Nuccetelli, Marzia, Nicolai, Eleonora, Massoud, Renato, Terrinoni, Alessandro, Pieri, Massimo, and Bernardini, Sergio
Abstract: Background: sepsis is a serious disease with high mortality rate, threatening human health. Clinicians need to diagnose the condition in time to develop an effective treatment plan; therefore, a quick and early screening to rule in or rule out sepsis has become an urgent problem in clinical laboratories. Different markers are used to diagnose sepsis, but they have limitations and require additional examination. The aim of this study is to use leucocyte count and other haematological parameters obtained by Mindray BC-6800-plus, to identify sepsis biomarkers that are early, quickly, conveniently, and at low cost. Methods: a total of 479 venous whole blood samples were collected: 63 control samples (blood donors), and 416 samples hospitalized at the emergency department with symptoms attributable to sepsis with a procalcitonin request. Morphometric parameters are reported using Mindray BC-6800 plus analyzer: white blood cell count-related parameters like cell population data named X, Y, Z, neutrophil-lymphocyte ratio, and index of immature granulocytes. Statistical analysis was performed using the Kruskal-Wallis test to evaluate significative differences among the groups. ROC curves were also examined to extrapolate a cut-off of pathogenicity. Results: we found a significant statistically difference between the control and the sepsis groups for a number of haematological parameters. The ROC curves highlight acceptable sensitivity and specificity values for some parameters, and suggest possible cut-offs. Discussion: some qualitative and quantitative parameters of total count blood can be of help with the screening of sepsis upon admission to the emergency department. [ABSTRACT FROM AUTHOR]
Published: 2023
Full Text: View/download PDF

3. Epidemiology of sepsis in Internal Medicine Units of Apulia: results of SEMINA (SEpsis Management in INternal medicine Apulia) study.

Author: Belfiore, A., Mastroianni, F., Ventrella, F., Errico, M., Suppressa, P., Tomai, M., Sabatino, S., De Palma, G., Pappagallo, F., Erbi, A., Simone, O., Longo, S., Vendemiale, G., Balsamo, M., Tartaglia, I., and Guida, P.
Subjects: INTERNAL medicine, EPIDEMIOLOGY, SEPSIS, HEALTH outcome assessment, STAPHYLOCOCCUS
Abstract: Copyright of Annali di Igiene, Medicina Preventiva e di Comunità is the property of Societa Editrice Universo s.r.l. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Published: 2023
Full Text: View/download PDF

4. Identifying prognostic factors for survival in intensive care unit patients with SIRS or sepsis by machine learning analysis on electronic health records

Author: Mollura, M, Chicco, D, Paglialonga, A, Barbieri, R, Mollura, Maximiliano, Chicco, Davide, Paglialonga, Alessia, Barbieri, Riccardo, Mollura, M, Chicco, D, Paglialonga, A, Barbieri, R, Mollura, Maximiliano, Chicco, Davide, Paglialonga, Alessia, and Barbieri, Riccardo
Abstract: Background Systemic inflammatory response syndrome (SIRS) and sepsis are the most common causes of in-hospital death. However, the characteristics associated with the improvement in the patient conditions during the ICU stay were not fully elucidated for each population as well as the possible differences between the two. Goal The aim of this study is to highlight the differences between the prognostic clinical features for the survival of patients diagnosed with SIRS and those of patients diagnosed with sepsis by using a multi-variable predictive modeling approach with a reduced set of easily available measurements collected at the admission to the intensive care unit (ICU). Methods Data were collected from 1,257 patients (816 non-sepsis SIRS and 441 sepsis) admitted to the ICU. We compared the performance of five machine learning models in predicting patient survival. Matthews correlation coefficient (MCC) was used to evaluate model performances and feature importance, and by applying Monte Carlo stratified Cross-Validation. Results Extreme Gradient Boosting (MCC = 0.489) and Logistic Regression (MCC = 0.533) achieved the highest results for SIRS and sepsis cohorts, respectively. In order of importance, APACHE II, mean platelet volume (MPV), eosinophil counts (EoC), and C-reactive protein (CRP) showed higher importance for predicting sepsis patient survival, whereas, SOFA, APACHE II, platelet counts (PLTC), and CRP obtained higher importance in the SIRS cohort. Conclusion By using complete blood count parameters as predictors of ICU patient survival, machine learning models can accurately predict the survival of SIRS and sepsis ICU patients. Interestingly, feature importance highlights the role of CRP and APACHE II in both SIRS and sepsis populations. In addition, MPV and EoC are shown to be important features for the sepsis population only, whereas SOFA and PLTC have higher importance for SIRS patients.
Published: 2024

5. Utilizzo di un autovaccino per un episodio di sepsi in alcuni vitelli Charolais.

Author: Chantreau, Jérôme and Thiercy, Jean-Yves
Abstract: Copyright of Summa, Animali da Reddito is the property of Point Veterinaire Italie s.r.l. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Published: 2022

6. Serum ferritin levels in inflammation: a retrospective comparative analysis between COVID-19 and emergency surgical non-COVID-19 patients

Author: Filippo Banchini, Gaetano Maria Cattaneo, and Patrizio Capelli
Subjects: COVID, SARS-CoV-2, Ferritin, Sepsi, Surgery, Hepcidin, RD1-811, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract Background SARS-CoV-2 infection has spread worldwide, and the pathogenic mechanism is still under investigation. The presence of a huge inflammatory response, defined as “cytokine storm,” is being studied in order to understand what might be the prognostic factors implicated in the progression of the infection, with ferritin being one of such markers. The role of ferritin as a marker of inflammation is already known, and whether it changes differently between COVID and non-COVID patients still remains unclear. The aim of this retrospective analysis is to understand whether the inflammatory process in these two types is different. Methods In this retrospective analysis, we compared 17 patients affected by SARS-CoV-2, who had been admitted between February and April 2020 (group A) along with 30 patients admitted for acute surgical disease with SARS-CoV-2 negative swab (group B). A further subgroup of Covid negative patients with leukocytosis was compared to group A. Results In group A, the median (interquartile range) serum ferritin was 674 (1284) ng/mL, and it was double the cutoff (300 ng/mL) in 9 out of 17 (52%). The median (IQR) value of ferritin level in the total blood samples of group B was 231, and in the subgroup with leucocytosis, 149 (145). Group A showed a significantly higher ferritin median level compared to the entire group B (two-tailed Mann-Whitney test, p
Published: 2021
Full Text: View/download PDF

7. La gestione del paziente sottoposto alla tecnica dell’addome aperto: una revisione della letteratura.

Author: Finistrella, Martina and Moretti, Camilla
Subjects: DISEASE risk factors, MORTALITY risk factors, ONLINE information services, SURVIVAL, NURSING, MEDICAL information storage & retrieval systems, SYSTEMATIC reviews, ABDOMINAL surgery, LITERATURE reviews, MEDLINE, NURSING interventions, WOUND care
Abstract: Copyright of Italian Journal of Nursing (IJN) / Giornale Italiano di Infermieristica is the property of Collegio IPASVI MI-LO-MB - Ordine Professioni Infermieristiche MI-LO-MB and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Published: 2022

8. Early single session of hyperbaric oxygen therapy mitigates renal apoptosis in lipopolysaccharides-induced endotoxemia in rats.

Author: Lee HY, Kim IJ, Choi HS, Jung YH, Jeung KW, Mamadjonov N, Ma SK, Kim SW, and Bae EH
Abstract: Background: Sepsis-associated acute kidney injury (SA-AKI) is a prominent sepsis complication, often resulting in adverse clinical outcomes. Hyperbaric oxygen therapy (HBOT), known for its anti-inflammatory characteristics, antioxidant effects, and ability to deliver high oxygen tension to hypo-perfused tissues, offers potential benefits for SA-AKI. This study investigated whether HBOT improved renal injury in sepsis and elucidated its underlying mechanisms., Methods: A lipopolysaccharide (LPS)-induced endotoxemia model was established using 8-week-old C57BL/6 mice. Thirty minutes post-LPS administration, a group of mice underwent HBOT at a 2.5 atmospheric pressure absolute with 100% oxygen for 60 minutes. After 24 hours, all mice were euthanized for measurements., Results: Our results demonstrated that HBOT effectively mitigated renal tubular cell apoptosis. Additionally, HBOT significantly reduced phosphorylated p53 proteins and cytochrome C levels, suggesting that HBOT may attenuate renal apoptosis by impeding p53 activation and cytochrome C release. Notably, HBOT preserved manganese-dependent levels of superoxide dismutase, an antioxidant enzyme, compared to the LPS group. Furthermore, transforming growth factor beta (TGF-β)/Smad4 and alpha smooth muscle actin expressions were significantly reduced in the LPS + HBOT group., Conclusion: An early single session of HBOT exhibited renoprotective effects in LPS-induced endotoxemia mice models by suppressing p53 activation and cytochrome C levels to mitigate apoptosis. The observed TGF-β decrease, downstream Smad expression reduction, and antioxidant capacity preservation following HBOT may contribute to these effects.
Published: 2024
Full Text: View/download PDF

9. National Early Warning Score 2. Per identificare la sepsi in pronto soccorso. Una revisione della letteratura.

Author: Marosi, Veronica, Gadda, Giorgio, Timoftica, Claudia, Alberti, Annalisa, and Destrebecq, Anne
Subjects: ONLINE information services, CINAHL database, HOSPITAL emergency services, MEDICAL information storage & retrieval systems, MEDICAL databases, INFORMATION storage & retrieval systems, SYSTEMATIC reviews, SEVERITY of illness index, SEPSIS, RISK assessment, MEDLINE, DISEASE risk factors
Abstract: Copyright of Italian Journal of Nursing (IJN) / Giornale Italiano di Infermieristica is the property of Collegio IPASVI MI-LO-MB - Ordine Professioni Infermieristiche MI-LO-MB and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Published: 2021

10. Attuali applicazioni della determinazione dei livelli plasmatici di copeptina in contesti non-endocrinologici

Author: Berton, Alessandro Maria, Varaldo, Emanuele, Prencipe, Nunzia, Rumbolo, Francesca, Settanni, Fabio, Benso, Andrea, and Grottoli, Silvia
Published: 2022
Full Text: View/download PDF

11. La gestione della sepsi in emergenza. Studio osservazionale retrospettivo presso il pronto soccorso dell'ospedale di Grosseto.

Author: NYKIEFORUK, SIMONE, PONTRANDOLFO, SIMONA, PERI, SONIA, and RONCHESE, FRANCESCO
Subjects: ANTIBIOTICS, HOSPITALS, BLOOD, HOSPITAL emergency services, MEDICAL triage, SCIENTIFIC observation, ACQUISITION of data methodology, CELL culture, PROFESSIONS, EVALUATION of human services programs, RETROSPECTIVE studies, SEPSIS, COMPARATIVE studies, ORGANIZATIONAL change, HUMAN services programs, EMERGENCY medical services, MEDICAL records, HEALTH care teams, LACTATES, QUALITY assurance, SEPTIC shock, EDUCATIONAL outcomes
Abstract: Copyright of SCENARIO: Official Italian Journal of ANIARTI is the property of ANIARTI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Published: 2021
Full Text: View/download PDF

12. Serum ferritin levels in inflammation: a retrospective comparative analysis between COVID-19 and emergency surgical non-COVID-19 patients.

Author: Banchini, Filippo, Cattaneo, Gaetano Maria, and Capelli, Patrizio
Subjects: *IRON metabolism, *COVID-19, *TRANSFERRIN, *INFLAMMATION, *FERRITIN, *PATIENTS, *SURGERY, *RETROSPECTIVE studies, *MANN Whitney U Test, *COMPARATIVE studies, *EMERGENCY medical services, *LEUCOCYTE disorders
Abstract: Background: SARS-CoV-2 infection has spread worldwide, and the pathogenic mechanism is still under investigation. The presence of a huge inflammatory response, defined as "cytokine storm," is being studied in order to understand what might be the prognostic factors implicated in the progression of the infection, with ferritin being one of such markers. The role of ferritin as a marker of inflammation is already known, and whether it changes differently between COVID and non-COVID patients still remains unclear. The aim of this retrospective analysis is to understand whether the inflammatory process in these two types is different. Methods: In this retrospective analysis, we compared 17 patients affected by SARS-CoV-2, who had been admitted between February and April 2020 (group A) along with 30 patients admitted for acute surgical disease with SARS-CoV-2 negative swab (group B). A further subgroup of Covid negative patients with leukocytosis was compared to group A. Results: In group A, the median (interquartile range) serum ferritin was 674 (1284) ng/mL, and it was double the cutoff (300 ng/mL) in 9 out of 17 (52%). The median (IQR) value of ferritin level in the total blood samples of group B was 231, and in the subgroup with leucocytosis, 149 (145). Group A showed a significantly higher ferritin median level compared to the entire group B (two-tailed Mann-Whitney test, p < 0.0001) as well as to the subgroup with leucocytosis (p < 0.0014). Conclusions: The role of iron metabolism appears to be directly involved in COVID infection. On the other hand, in the acute inflammation of patients admitted for surgery, and probably in other common phlogistic processes, iron modifications appear to be self-limited. However, our finding suggests the use of ferritin as a marker for COVID infection. [ABSTRACT FROM AUTHOR]
Published: 2021
Full Text: View/download PDF

13. Effect of a quality improvement program on compliance to the sepsis bundle in non-ICU patients: a multicenter prospective before and after cohort study

Author: Monti, G, Rezoagli, E, Calini, A, Nova, A, Marchesi, S, Nattino, G, Carrara, G, Morra, S, Cortellaro, F, Savioli, M, Capra Marzani, F, Tresoldi, M, Villa, P, Greco, S, Bonfanti, P, Spitoni, M, Vesconi, S, Caironi, P, Fumagalli, R, Monti, Gianpaola, Rezoagli, Emanuele, Calini, Angelo, Nova, Alice, Marchesi, Silvia, Nattino, Giovanni, Carrara, Greta, Morra, Sergio, Cortellaro, Francesca, Savioli, Monica, Capra Marzani, Federico, Tresoldi, Moreno, Villa, Paolo, Greco, Stefano, Bonfanti, Paolo, Spitoni, Maria Grazia, Vesconi, Sergio, Caironi, Pietro, Fumagalli, Roberto, Monti, G, Rezoagli, E, Calini, A, Nova, A, Marchesi, S, Nattino, G, Carrara, G, Morra, S, Cortellaro, F, Savioli, M, Capra Marzani, F, Tresoldi, M, Villa, P, Greco, S, Bonfanti, P, Spitoni, M, Vesconi, S, Caironi, P, Fumagalli, R, Monti, Gianpaola, Rezoagli, Emanuele, Calini, Angelo, Nova, Alice, Marchesi, Silvia, Nattino, Giovanni, Carrara, Greta, Morra, Sergio, Cortellaro, Francesca, Savioli, Monica, Capra Marzani, Federico, Tresoldi, Moreno, Villa, Paolo, Greco, Stefano, Bonfanti, Paolo, Spitoni, Maria Grazia, Vesconi, Sergio, Caironi, Pietro, and Fumagalli, Roberto
Abstract: Objective: Sepsis and septic shock are major challenges and economic burdens to healthcare, impacting millions of people globally and representing significant causes of mortality. Recently, a large number of quality improvement programs focused on sepsis resuscitation bundles have been instituted worldwide. These educational initiatives have been shown to be associated with improvements in clinical outcomes. We aimed to evaluate the impact of a multi-faceted quality implementing program (QIP) on the compliance of a “simplified 1-h bundle” (Sepsis 6) and hospital mortality of severe sepsis and septic shock patients out of the intensive care unit (ICU). Methods: Emergency departments (EDs) and medical wards (MWs) of 12 academic and non-academic hospitals in the Lombardy region (Northern Italy) were involved in a multi-faceted QIP, which included educational and organizational interventions. Patients with a clinical diagnosis of severe sepsis or septic shock according to the Sepsis-2 criteria were enrolled in two different periods: from May 2011 to November 2011 (before-QIP cohort) and from August 2012 to June 2013 (after-QIP cohort). Measurements and main results: The effect of QIP on bundle compliance and hospital mortality was evaluated in a before–after analysis. We enrolled 467 patients in the before-QIP group and 656 in the after-QIP group. At the time of enrollment, septic shock was diagnosed in 50% of patients, similarly between the two periods. In the after-QIP group, we observed increased compliance to the “simplified rapid (1 h) intervention bundle” (the Sepsis 6 bundle – S6) at three time-points evaluated (1 h, 13.7 to 18.7%, p = 0.018, 3 h, 37.1 to 48.0%, p = 0.013, overall study period, 46.2 to 57.9%, p < 0.001). We then analyzed compliance with S6 and hospital mortality in the before- and after-QIP periods, stratifying the two patients’ cohorts by admission characteristics. Adherence to the S6 bundle was increased in patients with severe sepsis in the
Published: 2023

14. Maternal Sepsis in Italy: A Prospective, Population-Based Cohort and Nested Case-Control Study

Author: Ornaghi, S, Maraschini, A, Buoncristiano, M, Corsi Decenti, E, Colciago, E, Cetin, I, Donati, S, Ornaghi S., Maraschini A., Buoncristiano M., Corsi Decenti E., Colciago E., Cetin I., Donati S., Ornaghi, S, Maraschini, A, Buoncristiano, M, Corsi Decenti, E, Colciago, E, Cetin, I, Donati, S, Ornaghi S., Maraschini A., Buoncristiano M., Corsi Decenti E., Colciago E., Cetin I., and Donati S.
Abstract: Maternal sepsis represents a leading cause of mortality and severe morbidity worldwide. In Italy, it is the second cause of direct maternal mortality. Delay in recognition and treatment initiation are the drivers of sepsis-associated adverse outcomes. Between November 2017 and October 2019, the Italian Obstetric Surveillance System coordinated a prospective population-based study on maternal sepsis occurring before or after childbirth from 22 weeks’ gestation onward and up to 42 days following the end of pregnancy. A nested 1:2 matched case-control study on postpartum sepsis was also performed. Maternal sepsis was diagnosed for the presence of suspected or confirmed infection alongside signs or symptoms of organ failure. The aim of this study was to assess maternal sepsis incidence and its associated risk factors, management, and perinatal outcomes. Six Italian regions, covering 48.2% of the national births, participated in the project. We identified an incidence rate of 5.5 per 10,000 maternities (95% CI 4.80–6.28). Seventy percent of patients had a low education level and one third were foreigners with a language barrier. Genital, respiratory, and urinary tract infections were the predominant sources of infection; the majority of cases was caused by E. coli and polymicrobial infections. The presence of vascular and indwelling bladder catheters was associated with a nine-fold increased risk of postpartum sepsis. There were no maternal deaths, but one fourth of women experienced a serious adverse event and 28.3% required intensive care; 1.8% of newborns died. Targeted interventions to increase awareness of maternal sepsis and its risk factors and management should be promoted.
Published: 2023

15. 不同种类细菌所致早产儿院内感染败血症的临床特点.

Author: 方广东, 陈长春, 周勤, 余仁强, 姜善雨, and 周洲
Abstract: Objective To investigate the clinical and laboratory characteristics of sepsis caused by different types of pathogens in preterm infants. Methods Totally 99 premature infants with sepsis treated at our hospital during May 2008 and April 2018 were analyzed. According to the results of blood culture, they were divided into gram negative bacteria group and gram-positive bacterial infection group. The clinical and laboratory results of the two groups were compared. Results The incidence of nosocomial bacterial sepsis in premature infants was 1.16% (99/8 512). Gram-positive pathogens accounted for 70.3%, with Staphylococcus epidermidis as the main pathogen (36.6%). Gram-negative pathogens accounted for 29.7%, with klebsiella pneumoniae as the main pathogen (40.0%). Compared with those in gram-positive pathogens group, the incidences of severe complications, leukocyte decline, CRP elevation, abdominal distention and thrombocytopenia in gram-negative bacteria group increased significantly (P <0.05). Compared with gram-positive pathogens group, the abandonment or mortality rate of gram-negative bacteria group was also increased significantly (P <0.05). Conclusion Gram-positive pathogens are the main pathogens causing sepsis in premature infants. Gram-negative pathogen infection is more prone to complications such as shock, central infection and abdominal distention. Laboratory tests showed leukocyte reduction and thrombocytopenia and elevated CRP. Early selection of antibiotics based on clinical and laboratory results may improve the rationality of clinical medication. [ABSTRACT FROM AUTHOR]
Published: 2019
Full Text: View/download PDF

16. The Role of PCSK9 in Infectious Diseases

Author: Roberta Maria Antonello, Matteo Bassetti, Chiara Sepulcri, Laura Labate, Stefano Di Bella, Laura Magnasco, Daniele Roberto Giacobbe, Roberto Luzzati, Magnasco, Laura, Sepulcri, Chiara, Antonello, Roberta Maria, Di Bella, Stefano, Labate, Laura, Luzzati, Roberto, Giacobbe, Daniele Roberto, and Bassetti, Matteo
Subjects: protozoal infection, Communicable Diseases, Biochemistry, Dengue fever, sepsis, Pathogenesis, Sepsis, Immunity, Drug Discovery, medicine, Animals, Humans, Loss function, Pharmacology, Innate immune system, SARS-CoV-2, business.industry, Septic shock, Organic Chemistry, bacterial infection, COVID-19, HIV, medicine.disease, immunity, Immunity, Innate, HCV, viral infection, Immunology, Molecular Medicine, sepsi, Proprotein Convertase 9, business, Malaria
Abstract: Background: In recent years, many aspects of the physiological role of PCSK9 have been elucidated, in particular regarding its role in lipid metabolism, cardiovascular risk but also its role in innate immunity. Increasing evidence is available on the involvement of PCSK9 in the pathogenesis of viral infections, mainly HCV, as well as in the regulation of host response to bacterial infections, mainly sepsis and septic shock. Moreover, the action of PCSK9 has been investigated as a crucial step in the pathogenesis of malaria infection and disease severity. Objective: Aim of this paper is to review available published literature on the role of PCSK9 in a wide array of infectious diseases. Conclusion: Besides the ongoing investigation on PCSK9 inhibition among HIV-infected patients for the treatment of HIV- and ART-related hyperlipidemia, preclinical studies indicate how PCSK9 is involved in reducing the replication of HCV. Moreover, a protective role of PCSK9 inhibition has also been proposed against dengue and SARS-CoV-2 viral infections. Interestingly, high plasmatic PCSK9 levels have been described in patients with sepsis. Finally, a loss of function in the PCSK9-encoding gene has been reported to possibly reduce mortality in malaria infection.
Published: 2022
Full Text: View/download PDF

17. Ernährung in der Intensivmedizin : Teil 2: spezielle Ernährungsprobleme

Author: Hecker, M., Felbinge, T.W., Mayer, K., Forst, H., Fuchs-Buder, T., Heller, A. R., and Weigand, M.
Published: 2013
Full Text: View/download PDF

18. Maternal Sepsis in Italy: A Prospective, Population-Based Cohort and Nested Case-Control Study

Author: Ornaghi S., Maraschini A., Buoncristiano M., Corsi Decenti E., Colciago E., Cetin I., Donati S., Ornaghi, S, Maraschini, A, Buoncristiano, M, Corsi Decenti, E, Colciago, E, Cetin, I, and Donati, S
Subjects: Microbiology (medical), Virology, sepsis, infection, organ failure, peripartum, near miss, pregnancy, delivery, sepsi, Microbiology, near mi
Abstract: Maternal sepsis represents a leading cause of mortality and severe morbidity worldwide. In Italy, it is the second cause of direct maternal mortality. Delay in recognition and treatment initiation are the drivers of sepsis-associated adverse outcomes. Between November 2017 and October 2019, the Italian Obstetric Surveillance System coordinated a prospective population-based study on maternal sepsis occurring before or after childbirth from 22 weeks’ gestation onward and up to 42 days following the end of pregnancy. A nested 1:2 matched case-control study on postpartum sepsis was also performed. Maternal sepsis was diagnosed for the presence of suspected or confirmed infection alongside signs or symptoms of organ failure. The aim of this study was to assess maternal sepsis incidence and its associated risk factors, management, and perinatal outcomes. Six Italian regions, covering 48.2% of the national births, participated in the project. We identified an incidence rate of 5.5 per 10,000 maternities (95% CI 4.80–6.28). Seventy percent of patients had a low education level and one third were foreigners with a language barrier. Genital, respiratory, and urinary tract infections were the predominant sources of infection; the majority of cases was caused by E. coli and polymicrobial infections. The presence of vascular and indwelling bladder catheters was associated with a nine-fold increased risk of postpartum sepsis. There were no maternal deaths, but one fourth of women experienced a serious adverse event and 28.3% required intensive care; 1.8% of newborns died. Targeted interventions to increase awareness of maternal sepsis and its risk factors and management should be promoted.
Published: 2022
Full Text: View/download PDF

19. Characteristics of Sepsis or Acute Pyelonephritis Combined with Ureteral Stone in the United States: A Retrospective Analysis of Large National Cohort

Author: Francesco Del Giudice, Koo Han Yoo, Sinyeong Lee, Jin Kyu Oh, Hyuk Jin Cho, Sang Youn Kim, Gyeong Eun Min, Sang Hyub Lee, Wansuk Kim, Shufeng Li, Wuran Wei, Jianlin Huang, David R. Brown, Kyle Spradling, Satvir Basran, Federico Belladelli, Riccardo Autorino, Savio Domenico Pandolfo, Simone Crivellaro, Felice Crocetto, Matteo Ferro, Vincenzo Asero, Carlo Maria Scornajenghi, Eugenio Bologna, Alessandro Sciarra, Stefano Salciccia, Ettore De Berardinis, Gian Piero Ricciuti, Stefanie van Uem, Simon Conti, Benjamin I. Chung, Del Giudice, F., Yoo, K. H., Lee, S., Oh, J. K., Cho, H. J., Kim, S. Y., Min, G. E., Lee, S. H., Kim, W., Li, S., Wei, W., Huang, J., Brown, D. R., Spradling, K., Basran, S., Belladelli, F., Autorino, R., Pandolfo, S. D., Crivellaro, S., Crocetto, F., Ferro, M., Asero, V., Scornajenghi, C. M., Bologna, E., Sciarra, A., Salciccia, S., De Berardinis, E., Ricciuti, G. P., van Uem, S., Conti, S., and Chung, B. I.
Subjects: Fluid Flow and Transfer Processes, ureteral calculi, Process Chemistry and Technology, General Engineering, sepsis, pyelonephritis, chronic disease, sepsi, General Materials Science, Instrumentation, pyelonephriti, Computer Science Applications
Abstract: To identify the characteristics of patients with sepsis or acute pyelonephritis (APN) combined with ureteral calculi and to analyze the risk factors in its causation. Methods: We included patients with sepsis or APN caused by ureteral calculi who received treatment in the United States from January 2003 to December 2017 using the Optum® deidentified Clinformatics® Datamart. Demographic factors and risk factors for the receipt of sepsis or APN were subsequently analyzed for statistical significance. Results: Of 467,502 urinary stone patients, age-matched multivariate analysis revealed that a history of urinary tract infection (OR 11.31, 95% CI 10.68–11.99, p < 0.0001) and female gender (OR 2.73, 95% CI 2.62–2.84, p < 0.0001) were significantly related to an increased risk of sepsis or APN. Conversely, a previous past medical history of urolithiasis (OR 0.91, 95% CI 0.87–0.95, p < 0.0001) and cancer (OR 0.91, 95% CI 0.87–0.95, p < 0.0001) were associated with a decreased risk of sepsis or APN. With regards to comorbidities, when more than one comorbidity was present, there was an additive effect with higher OR point estimates, rising to 11.31 (10.68–11.99) when three or more comorbidities present. History of urinary tract infection and female gender are risk factors for sepsis or APN in patients with ureteral calculi. Conclusions: This large national cohort reveals the characteristics of sepsis or APN combined with ureteral stone and provides an important baseline for the treatment of urolithiasis in the future.
Published: 2022
Full Text: View/download PDF

20. Inhibition of transcription factor NFAT activity in activated platelets enhances their aggregation and exacerbates gram-negative bacterial septicemia

Author: Poli, V, Di Gioia, M, Sola-Visner, M, Granucci, F, Frelinger, A, Michelson, A, Zanoni, I, Poli V., Di Gioia M., Sola-Visner M., Granucci F., Frelinger A. L., Michelson A. D., Zanoni I., Poli, V, Di Gioia, M, Sola-Visner, M, Granucci, F, Frelinger, A, Michelson, A, Zanoni, I, Poli V., Di Gioia M., Sola-Visner M., Granucci F., Frelinger A. L., Michelson A. D., and Zanoni I.
Abstract: During gram-negative septicemia, interactions between platelets and neutrophils initiate a detrimental feedback loop that sustains neutrophil extracellular trap (NET) induction, disseminated intravascular coagulation, and inflammation. Understanding intracellular pathways that control platelet-neutrophil interactions is essential for identifying new therapeutic targets. Here, we found that thrombin signaling induced activation of the transcription factor NFAT in platelets. Using genetic and pharmacologic approaches, as well as iNFATuation, a newly developed mouse model in which NFAT activation can be abrogated in a cell-specific manner, we demonstrated that NFAT inhibition in activated murine and human platelets enhanced their activation and aggregation, as well as their interactions with neutrophils and NET induction. During gram-negative septicemia, NFAT inhibition in platelets promoted disease severity by increasing disseminated coagulation and NETosis. NFAT inhibition also partially restored coagulation ex vivo in patients with hypoactive platelets. Our results define non-transcriptional roles for NFAT that could be harnessed to address pressing clinical needs.
Published: 2022

21. Assessing the mortality risk in older patients hospitalized with a diagnosis of sepsis: the role of frailty and acute organ dysfunction

Author: Patrizio, E, Zambon, A, Mazzola, P, Massariello, F, Galeazzi, M, Cavalieri d’Oro, L, Bonfanti, P, Bellelli, G, Patrizio, Enrica, Zambon, Antonella, Mazzola, Paolo, Massariello, Francesca, Galeazzi, Marianna, Cavalieri d’Oro, Luca, Bonfanti, Paolo, Bellelli, Giuseppe, Patrizio, E, Zambon, A, Mazzola, P, Massariello, F, Galeazzi, M, Cavalieri d’Oro, L, Bonfanti, P, Bellelli, G, Patrizio, Enrica, Zambon, Antonella, Mazzola, Paolo, Massariello, Francesca, Galeazzi, Marianna, Cavalieri d’Oro, Luca, Bonfanti, Paolo, and Bellelli, Giuseppe
Abstract: Background: A prognostic stratification of mortality risk in older patients with sepsis admitted to medical wards is often challenging. Aims: To evaluate the ability of the Sequential Organ Failure Assessment (SOFA) score, serum biomarkers (lactate and C-Reactive Protein, CRP), and measures of comorbidity and frailty in predicting in-hospital and 6-month mortality in a cohort of older patients admitted to an Acute Geriatric Unit (AGU) with a diagnosis of sepsis. Methods: All patients aged 70 years and over consecutively admitted to our AGU with sepsis in the study period were included. At admission, a Comprehensive Geriatric Assessment including two measures of frailty (Clinical Frailty Scale [CFS], Frailty Index [FI]) was obtained. To assess the predictivity of candidate prognostic markers, the Area Under the Receiver-Operating Characteristic (AUROC) curves were analyzed. A multivariate logistic regression analysis was also performed. Results: We included 240 patients (median age = 85, IQR = 80–89, 40.8% women), of whom 33.8% died before discharge, and 60.4% at 6 months. The SOFA score (AUROC = 0.678, 95% CI 0.610–0.747) and CRP serum levels (AUROC = 0.606, 95% CI 0.532–0.680) were good predictors of in-hospital mortality. The CFS (AUROC = 0.703, 95% CI 0.637–0.768) and the FI (AUROC = 0.677, 95% CI 0.607–0.746) better predicted 6-month mortality. Results of the regression analysis confirmed the findings of the AUROC study. The combined assessment of SOFA and measures of frailty improved the performance of the model both in the short and the long term. Conclusions: Both the severity of organ dysfunction and frailty scores should be addressed on AGU admission to establish the short- and long-term outcomes of older patients with sepsis.
Published: 2022

22. Ductal ligation timing and neonatal outcomes: a 12-year bicentric comparison

Author: Silvia Martini, Si Emma Chen, Emanuela Angeli, Yogen Singh, Silvia Galletti, Gaetano Gargiulo, Marta Agulli, Luigi Corvaglia, Wilf Kelsall, Martini S., Galletti S., Kelsall W., Angeli E., Agulli M., Gargiulo G.D., Chen S.E., Corvaglia L., Singh Y., Martini, Silvia [0000-0003-2078-7114], and Apollo - University of Cambridge Repository
Subjects: congenital, hereditary, and neonatal diseases and abnormalities, medicine.medical_specialty, Sepsi, education, Patent ductus arteriosus, Aftercare, Sepsis, 03 medical and health sciences, 0302 clinical medicine, Necrotizing enterocolitis, Retrospective Studie, 030225 pediatrics, Ductus arteriosus, Intensive care, medicine, Humans, Necrotizing enterocoliti, Patent ductus arteriosu, 030212 general & internal medicine, Child, Ligation, Ductus Arteriosus, Patent, Retrospective Studies, PDA ligation, business.industry, Infant, Newborn, Preterm infants, Infant, Retrospective cohort study, medicine.disease, Bronchopulmonary dysplasia, Patient Discharge, Cardiac surgery, Treatment Outcome, medicine.anatomical_structure, Anesthesia, Preterm infant, Pediatrics, Perinatology and Child Health, Original Article, business, Human
Abstract: Funder: Alma Mater Studiorum - Università di Bologna, Patent ductus arteriosus (PDA) is common among extremely preterm infants. In selected cases, surgical PDA ligation may be required. The timing for PDA ligation may depend upon a variety of factors, with potential clinical implications. We aimed to investigate the impact of different surgical PDA managements on ligation timing and neonatal outcomes. Inborn infants < 32 weeks of gestation and < 1500 g admitted at two tertiary Neonatal Intensive Care Units that underwent PDA ligation between 2007 and 2018 were enrolled in this retrospective cohort study and split into the following groups based on their surgical management: on-site bedside PDA ligation (ONS) vs. referral to an off-site pediatric cardiac surgery (OFS). Neonatal characteristics, surgical timing, and clinical outcomes of the enrolled infants were compared between the groups. Multivariate analysis was performed to evaluate the impact of PDA ligation timing on significantly different outcomes. Seventy-eight neonates (ONS, n = 39; OFS, n = 39) were included. Infants in the ONS group underwent PDA ligation significantly earlier than those in the OFS group (median age 12 vs. 36 days, p < 0.001) with no increase in postoperative mortality and complications. The multivariate analysis revealed a significant association between PDA ligation timing, late-onset sepsis prevalence (OR 1.045, 0.032), and oxygen need at discharge (OR 1.037, p = 0.025).Conclusions: Compared with off-site surgery, on-site bedside ligation allows an earlier surgical closure of PDA, with no apparent increase in mortality or complications. Earlier PDA ligation may contribute to reduced rates of late-onset sepsis and post-discharge home oxygen therapy, with possible cost-benefit implications. What is known: • Ineffective or contraindicated pharmacological closure of a hemodynamically significant PDA may require a surgical ligation. • Available literature comparing the effect of early vs. late PDA ligation on the main neonatal morbidities has yield contrasting results. What is new: • The availability of a cardiac surgery service performing bedside PDA ligation allows an earlier intervention compared to patient referral to an off-site center, with no difference in postoperative mortality and complications compared to off-site surgery. • Earlier PDA ligation was associated with a lower prevalence of late-onset sepsis and of oxygen need at discharge, with possible cost-benefit implications.
Published: 2021
Full Text: View/download PDF

23. Clinical features and evolution of bacterial infection-related acute-on-chronic liver failure

Author: Carlo Alessandria, Carmine Gambino, Javier Fernández, Hans Van Vlierberghe, Sophie Restellini, Marcos Girala, Luis Colombato, Tae Hee Lee, Nikolaos Pyrsopoulos, Eduardo Fassio, Sang Gyune Kim, Gisela Pinero, Paolo Caraceni, Shivaram Prasad Singh, Do Seon Song, Ji Won Park, Julio Vorobioff, Dong Joon Kim, C. Toledo, Aleksander Krag, Liane Rabinowich, Preetam Nath, Robert A. de Man, Elza Cotrim Soares, Xavier Verhelst, Tiago Sevá Pereira, Gustavo Romero, Macarena Simón-Talero, Sung Eun Kim, Michele Bartoletti, Alexander L. Gerbes, Sebastián Marciano, Tony Bruns, Hyoung Su Kim, Ki Tae Suk, Nicolas M. Intagliata, Annette Dam Fialla, Adrià Juanola, Manuela Merli, Rita de Cassia Ribeiro Barea, Laure Elkrief, Rakhi Maiwall, Laurentius A Lesmana, Pere Ginès, Vikas Gautam, E.L. Yoon, M. Marino, Paolo Angeli, Kalyan Ram Bhamidimarri, Victor Vargas, Virendra Singh, Juan Pablo Roblero, François Durand, Cosmas A. Rinaldi Lesmana, M. V. Maevskaya, Gustavo Navarro, Adrian Gadano, Florence Wong, Pramod Kumar, Tae Hun Kim, Daniela Campion, Salvatore Piano, Giacomo Zaccherini, Barbara Lattanz, Jae Seok Hwang, Sun Young Yim, Thomas D. Boyer, Jeong Han Kim, Carlos Brodersen, Wong F., Piano S., Singh V., Bartoletti M., Maiwall R., Alessandria C., Fernandez J., Soares E.C., Kim D.J., Kim S.E., Marino M., Vorobioff J., Barea R.D.C.R., Merli M., Elkrief L., Vargas V., Krag A., Singh S.P., Lesmana L.A., Toledo C., Marciano S., Verhelst X., Intagliata N., Rabinowich L., Colombato L., Kim S.G., Gerbes A., Durand F., Roblero J.P., Bruns T., Yoon E.L., Girala M., Pyrsopoulos N.T., Kim T.H., Yim S.Y., Juanola A., Gadano A., Angeli P., Bhamidimarri K., Boyer T.D., Brodersen C., Campion D., Caraceni P., de Man R.A., Fassio E., Fialla A.D., Gambino C., Gautam V., Gines P., Hwang J.S., Kim H.S., Kim J.H., Kumar P., Lattanz B., Lee T.H., Rinaldi Lesmana C.A., Maevskaya M., Nath P., Navarro G., Park J.-W., Pinero G., Restellini S., Romero G., Seva -Pereira T., Simon-Talero M., Song D.S., Suk K.T., Van Vlierberghe H., and Zaccherini G.
Subjects: Male, 0301 basic medicine, Cirrhosis, Organ Dysfunction Scores, Antibiotic resistance, medicine.medical_treatment, Liver transplantation, Severity of Illness Index, 0302 clinical medicine, ACLF, MDR, Epidemiology, Cross Infection, Mortality rate, Age Factors, Bacterial Infections, Middle Aged, Prognosis, Community-Acquired Infections, Europe, Hospitalization, Female, 030211 gastroenterology & hepatology, Alcohol-Related Disorders, medicine.medical_specialty, Sepsi, India, Risk Assessment, Sepsis, 03 medical and health sciences, Sex Factors, Spontaneous bacterial peritonitis, Internal medicine, medicine, Humans, XDR, Cirrhosi, Hepatology, business.industry, Acute-On-Chronic Liver Failure, medicine.disease, Pneumonia, 030104 developmental biology, antibiotic resistance, liver transplantation, sepsis, business
Abstract: Background & Aims: Bacterial infections can trigger the development of organ failure(s) and acute-on-chronic liver failure (ACLF). Geographic variations in bacteriology and clinical practice could lead to worldwide differences in ACLF epidemiology, phenotypes and associated outcomes. Herein, we aimed to evaluate regional differences in bacterial infection-related ACLF in patients with cirrhosis admitted to hospital. Methods: This post hoc analysis included 1,175 patients with decompensated cirrhosis (with bacterial infection on admission or nosocomial infection) from 6 geographic regions worldwide. Clinical, laboratory and microbiological data were collected from the diagnosis of infection. Patients were followed-up for organ failure(s) and ACLF development according to the EASL-CLIF criteria from enrolment to discharge/death. Results: A total of 333 patients (28%) had ACLF at diagnosis of infection, while 230 patients developed ACLF after diagnosis of infection, resulting in an overall rate of bacterial infection related-ACLF of 48%, with rates differing amongst different geographic regions (38% in Southern Europe vs. 75% in the Indian subcontinent). Bacterial infection related-ACLF more frequently developed in younger patients (55 ± 13 vs. 58 ± 14 years), males (73% vs. 62%), patients with alcohol-related cirrhosis (59% vs. 45%) and those with a higher baseline MELD score (25 ± 11 vs. 16 ± 5) (all p
Published: 2021
Full Text: View/download PDF

24. Impact of perioperative transfusions and sepsis on long-term oncologic outcomes after curative colon cancer resection. A retrospective analysis of a prospective database

Author: Javier Escrig, Alejandro Espí, Susana Roselló, Eduardo García-Granero, Álvaro García-Granero, Gloria Baguena, Gianluca Pellino, Matteo Frasson, Franco G. Marinello, Andrés Cervantes, Baguena, G., Pellino, G., Frasson, M., Escrig, J., Marinello, F., Espi, A., Garcia-Granero, A., Rosello, S., Cervantes, A., and Garcia-Granero, E.
Subjects: Male, medicine.medical_specialty, Time Factors, Databases, Factual, Survival, Sepsi, Colorectal cancer, 030230 surgery, computer.software_genre, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Septic complication, Sepsis, Local recurrence, medicine, Humans, Anastomotic leak, Perioperative Period, Aged, Retrospective Studies, Aged, 80 and over, Hepatology, Database, Proportional hazards model, business.industry, Mortality rate, Blood transfusion, Hazard ratio, Gastroenterology, Perioperative, Middle Aged, medicine.disease, Colorectal surgery, Colon cancer, Survival Rate, Bowel obstruction, Treatment Outcome, Anastomotic leak, Blood transfusion, Colon cancer, Complicaciones sépticas, Complicación, Complication, Cáncer de colon, Fuga anastomótica, Local recurrence, Recurrencia local, Sepsis, Septic complications, Supervivencia, Survival, Transfusión de sangre, 030220 oncology & carcinogenesis, Colonic Neoplasms, Female, Complication, business, computer, Septic complications
Abstract: Objective: Intra-abdominal septic complications (IASC) affect short-term outcomes after surgery for colon cancer. Blood transfusions have been associated with worse short-term results.The role of IASC and blood transfusions on long-term oncologic results is still debated. This study aims to assess the impact of these two variables on survival after curative colon cancer resection. Patients and methods: Retrospective analysis of a prospectively maintained database of patients who underwent curative surgery for colon cancer at a university hospital, between 1993 and 2010. Cox regression was used to identify the role of IASC and transfusions (alone and combined) on local recurrence (LR), disease-free survival (DES), and cancer-specific survival (CSS). Results: Out of the 1686 patients analyzed, 1277 fit in the inclusion criteria. Colorectal surgeons performed the procedure in 82.2% of the patients. Blood transfusions were administered to 25.8% of the patients. Thirty-day complication and mortality rates were 34.5% and 6.1%. IASC occurred in 9.9%. The mean follow-up was 66 months. The 5-year rates of LR, DES, and CSS were 7%, 79.8%, and 85.1%. The year of surgery and pT (Hazard ratio 9.35, 95% CI 1.23-70.9, for T4) and pN (Hazard ratio 2.57, 95% CI 1.39-4.72, for N2) stages were independent risk factors for LR. The same variables, bowel obstruction and surgeries performed by surgeons not specialized in colorectal surgery, were also associated with worse DES and CSS. IASC and blood transfusions were not associated with LR, DFS, and CSS, whether alone or combined. Conclusions: IASC and transfusions were not associated with worse oncological outcomes after curative colon cancer surgery per se. Other factors were more important predictors of survival. (C) 2019 Published by Elsevier Espana, S.L.U.
Published: 2020
Full Text: View/download PDF

25. New laboratory predictive tools in deep neck space infections

Author: Nicola Quaranta, Paolo Greco, Luigi Madami, Maria Luisa Fiorella, Orazio Valerio Giannico, and Vito Pontillo
Subjects: medicine.medical_specialty, necrotizing fasciitis, Necrotising fasciitis, Physical examination, Review, Sensitivity and Specificity, NLR, Sepsis, sepsis, fasciti necrotizzanti, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Humans, Fasciitis, Necrotizing, Stage (cooking), Neutrophil to lymphocyte ratio, 030223 otorhinolaryngology, Fasciitis, Retrospective Studies, medicine.diagnostic_test, business.industry, medicine.disease, cervicali, neck, Observational Studies as Topic, General Energy, Otorhinolaryngology, 030220 oncology & carcinogenesis, Cohort, sepsi, business, Laboratories, Cohort study, LRINEC
Abstract: Deep neck space infections (DNSIs) are a group of infective suppurative diseases involving deep neck spaces and cervical fascia. Necrotising and septic evolutions are rare, but severe complications can dramatically affect the prognosis and should be promptly managed. Clinical examination often has low sensitivity, although instrumental diagnosis may delay te treatment. We investigated two laboratory tools, LRINEC (Laboratory Risk Indicator for the Necrotizing fasciitis) and NLR (neutrophil to lymphocyte ratio), in the expectation to find a rapidly available predictive indicator that may help in distinguishing necrotising complications and/or systemic septic involvement.A retrospective observational cohort study was performed on 118 patients who had underwent surgical treatment for DNSIs at our Surgical Unit. LRINEC, NLR and the product LRINEC x NLR were calculated.Statistical analysis showed that these scores may have utility in rapidly predicting the risk of necrotising fasciitis and systemic involvement at an early diagnostic stage.Further studies with a larger cohort may be necessary in order to increase the sensitivity and specificity.Nuovi indicatori biochimici predittivi di infezioni suppurative cervicali.Le infezioni suppurative del collo sono un eterogeneo gruppo di patologie a carico degli spazi profondi del collo e delle fasce cervicali. Al suo interno meritano particolare attenzione le temibili fasciti necrotizzanti, caratterizzate dall’elevato tasso di mortalità e di compromissione settica. Risulta pertanto indispensabile una loro pronta diagnosi e un altrettanto tempestivo trattamento. La semeiologia clinica risulta spesso poco sensibile, mentre l’esame TC comporta un inevitabile ritardo nella presa in carico terapeutica. Abbiamo quindi valutato l’applicabilità di due indicatori basati unicamente su parametri laboratoristici, quindi rapidamente disponibili: LRINEC score e NLR ratio.Abbiamo condotto uno studio retrospettivo su 118 pazienti che erano stati sottoposti a drenaggio chirurgico di ascesso cervicale c/o la nostra U.O., calcolando per ciascuno di essi LRINEC, NLR e il loro prodotto di moltiplicazione LRINEC x NLR.L’analisi statistica dimostra un loro possibile ruolo nella diagnosi tempestiva delle fasciti necrotizzanti e/o delle loro complicanze settiche.Ulteriori studi con una maggiore numerosità campionaria potrebbero essere necessari per rafforzare sensibilità e specificità di tali score.
Published: 2020

26. Assessing the mortality risk in older patients hospitalized with a diagnosis of sepsis: the role of frailty and acute organ dysfunction

Author: Enrica Patrizio, Antonella Zambon, Paolo Mazzola, Francesca Massariello, Marianna Galeazzi, Luca Cavalieri d’Oro, Paolo Bonfanti, Giuseppe Bellelli, Patrizio, E, Zambon, A, Mazzola, P, Massariello, F, Galeazzi, M, Cavalieri d’Oro, L, Bonfanti, P, and Bellelli, G
Subjects: Aged, 80 and over, Male, Aging, Fatigue Syndrome, Chronic, Frailty, Organ Dysfunction Scores, Sepsi, Multiple Organ Failure, Frailty Index, Prognosis, C-Reactive Protein, ROC Curve, Sepsis, Sequential organ failure assessment, Humans, Female, Hospital Mortality, Geriatrics and Gerontology, Clinical frailty scale, Mortality, Aged
Abstract: Background: A prognostic stratification of mortality risk in older patients with sepsis admitted to medical wards is often challenging. Aims: To evaluate the ability of the Sequential Organ Failure Assessment (SOFA) score, serum biomarkers (lactate and C-Reactive Protein, CRP), and measures of comorbidity and frailty in predicting in-hospital and 6-month mortality in a cohort of older patients admitted to an Acute Geriatric Unit (AGU) with a diagnosis of sepsis. Methods: All patients aged 70 years and over consecutively admitted to our AGU with sepsis in the study period were included. At admission, a Comprehensive Geriatric Assessment including two measures of frailty (Clinical Frailty Scale [CFS], Frailty Index [FI]) was obtained. To assess the predictivity of candidate prognostic markers, the Area Under the Receiver-Operating Characteristic (AUROC) curves were analyzed. A multivariate logistic regression analysis was also performed. Results: We included 240 patients (median age = 85, IQR = 80–89, 40.8% women), of whom 33.8% died before discharge, and 60.4% at 6 months. The SOFA score (AUROC = 0.678, 95% CI 0.610–0.747) and CRP serum levels (AUROC = 0.606, 95% CI 0.532–0.680) were good predictors of in-hospital mortality. The CFS (AUROC = 0.703, 95% CI 0.637–0.768) and the FI (AUROC = 0.677, 95% CI 0.607–0.746) better predicted 6-month mortality. Results of the regression analysis confirmed the findings of the AUROC study. The combined assessment of SOFA and measures of frailty improved the performance of the model both in the short and the long term. Conclusions: Both the severity of organ dysfunction and frailty scores should be addressed on AGU admission to establish the short- and long-term outcomes of older patients with sepsis.
Published: 2022

27. Inhibition of transcription factor NFAT activity in activated platelets enhances their aggregation and exacerbates gram-negative bacterial septicemia

Author: Valentina Poli, Marco Di Gioia, Martha Sola-Visner, Francesca Granucci, Andrew L. Frelinger, Alan D. Michelson, Ivan Zanoni, Poli, V, Di Gioia, M, Sola-Visner, M, Granucci, F, Frelinger, A, Michelson, A, and Zanoni, I
Subjects: Blood Platelets, Platelet Aggregation, Neutrophils, Immunology, Cell Communication, Cytoplasmic Granules, Extracellular Traps, Mice, Sepsis, Animals, Humans, Immunology and Allergy, coagulation, Blood Coagulation, Inflammation, platelet, neutrophil extracellular trap, NFATC Transcription Factors, neutrophil, gram-negative bacteria, NET, Disease Models, Animal, Infectious Diseases, septic shock, Receptors, Thrombin, sepsi
Abstract: During gram-negative septicemia, interactions between platelets and neutrophils initiate a detrimental feedback loop that sustains neutrophil extracellular trap (NET) induction, disseminated intravascular coagulation, and inflammation. Understanding intracellular pathways that control platelet-neutrophil interactions is essential for identifying new therapeutic targets. Here, we found that thrombin signaling induced activation of the transcription factor NFAT in platelets. Using genetic and pharmacologic approaches, as well as iNFATuation, a newly developed mouse model in which NFAT activation can be abrogated in a cell-specific manner, we demonstrated that NFAT inhibition in activated murine and human platelets enhanced their activation and aggregation, as well as their interactions with neutrophils and NET induction. During gram-negative septicemia, NFAT inhibition in platelets promoted disease severity by increasing disseminated coagulation and NETosis. NFAT inhibition also partially restored coagulation ex vivo in patients with hypoactive platelets. Our results define non-transcriptional roles for NFAT that could be harnessed to address pressing clinical needs.
Published: 2022

28. Sepsis Team Organizational Model to Decrease Mortality for Intra-Abdominal Infections: Is Antibiotic Stewardship Enough?

Author: Carlo Vallicelli, Giorgia Santandrea, Massimo Sartelli, Federico Coccolini, Luca Ansaloni, Vanni Agnoletti, Francesca Bravi, Fausto Catena, Vallicelli C., Santandrea G., Sartelli M., Coccolini F., Ansaloni L., Agnoletti V., Bravi F., and Catena F.
Subjects: Microbiology (medical), Infectious Diseases, intra-abdominal infection, Pharmacology (medical), sepsi, General Pharmacology, Toxicology and Pharmaceutics, Biochemistry, Microbiology, sepsis team
Abstract: Introduction. Sepsis is an overwhelming reaction to infection with significant morbidity, requiring urgent interventions in order to improve outcomes. The 2016 Sepsis-3 guidelines modified the previous definitions of sepsis and septic shock, and proposed some specific diagnostic and therapeutic measures to define the use of fluid resuscitation and antibiotics. However, some open issues still exist. Methods. A literature research was performed on PubMed and Cochrane using the terms “sepsis” AND “intra-abdominal infections” AND (“antibiotic therapy” OR “antibiotic treatment”). The inclusion criteria were management of intra-abdominal infection (IAI) and effects of antibiotic stewardships programs (ASP) on the outcome of the patients. Discussion. Sepsis-3 definitions represent an added value in the understanding of sepsis mechanisms and in the management of the disease. However, some questions are still open, such as the need for an early identification of sepsis. Sepsis management in the context of IAI is particularly challenging and a prompt diagnosis is essential in order to perform a quick treatment (source control and antibiotic treatment). Antibiotic empirical therapy should be based on the kind of infection (community or hospital acquired), local resistances, and patient’s characteristic and comorbidities, and should be adjusted or de-escalated as soon as microbiological information is available. Antibiotic Stewardship Programs (ASP) have demonstrated to improve antimicrobial utilization with reduction of infections, emergence of multi-drug resistant bacteria, and costs. Surgeons should not be alone in the management of IAI but ideally inserted in a sepsis team together with anaesthesiologists, medical physicians, pharmacists, and infectious diseases specialists, meeting periodically to reassess the response to the treatment. Conclusion. The cornerstones of sepsis management are accurate diagnosis, early resuscitation, effective source control, and timely initiation of appropriate antimicrobial therapy. Current evidence shows that optimizing antibiotic use across surgical specialities is imperative to improve outcomes. Ideally every hospital and every emergency surgery department should aim to provide a sepsis team in order to manage IAI.
Published: 2022

29. Beta-lactam monotherapy or combination therapy for bloodstream infections or pneumonia due to Pseudomonas aeruginosa: a meta-analysis

Author: Lorenzo Onorato, Margherita Macera, Federica Calò, Paolo Cirillo, Giovanni Di Caprio, Nicola Coppola, Onorato, Lorenzo, Macera, Margherita, Calò, Federica, Cirillo, Paolo, Di Caprio, Giovanni, and Coppola, Nicola
Subjects: Microbiology (medical), Sepsi, beta-Lactams, Pseudomona, Pseudomonas Infection, Retrospective Studie, Sepsis, Anti-Bacterial Agent, Humans, Pharmacology (medical), Pseudomonas Infections, Prospective Studies, Combination therapy, Retrospective Studies, Pneumonia, Ventilator-Associated, General Medicine, Pneumonia, Monotherapy, Anti-Bacterial Agents, Prospective Studie, Infectious Diseases, Treatment Outcome, Pseudomonas aeruginosa, Bacteraemia, Drug Therapy, Combination, beta-Lactam, Human
Abstract: Objectives: To compare the clinical and microbiological outcomes of patients treated with beta-lactam monotherapy or combination therapy for Pseudomonas aeruginosa infections. Data sources: MEDLINE, Google Scholar and the Cochrane Library.Study eligibility criteria and interventions: Experimental and observational studies published as full papers up to December 2020 that compared the efficacy of beta-lactams used as monotherapy or in combination with other active agents as empirical or targeted therapy for bloodstream infections or hospital-acquired pneumonia/ventilator-associated pneumonia due to P. aeruginosa were included in this meta-analysis. The outcomes evaluated were in-hospital mortality rate, 14 -day-or 30-day-mortality rate, microbiological cure rate and clinical cure rate.Results: Of 8363 citations screened, six randomized controlled trials, six prospective cohort studies and 21 retrospective cohort studies were included in the analysis, accounting for a total of 3861 subjects. Considering the 14 studies evaluating empirical therapy, no significant difference in mortality rate was observed between the two groups [relative risk (RR) 1.06, 95% confidence interval (CI) 0.86-1.30; P = 0.6]. Similar findings were obtained among the 18 studies analysing targeted therapy (RR 1.04, 95% CI 0.83- 1.31; P = 0.708); however, grouping the studies by design, higher mortality was observed among patients receiving monotherapy in five prospective studies (RR 1.37, 95% CI 1.06-1.79; P = 0.018). Finally, no differ-ence was observed between groups in terms of microbiological cure and clinical cure.Conclusions: This meta-analysis demonstrated no difference in mortality rate, clinical cure rate and mi-crobiological cure rate in patients treated with beta-lactam monotherapy or combination therapy for P. aeruginosa infections.(c) 2021 Elsevier Ltd and International Society of Antimicrobial Chemotherapy. All rights reserved.
Published: 2022

30. Optimised versus standard dosing of vancomycin in infants with Gram-positive sepsis (NeoVanc): a multicentre, randomised, open-label, phase 2b, non-inferiority trial

Author: Louise F Hill, Michelle N Clements, Mark A Turner, Daniele Donà, Irja Lutsar, Evelyne Jacqz-Aigrain, Paul T Heath, Emmanuel Roilides, Louise Rawcliffe, Clara Alonso-Diaz, Eugenio Baraldi, Andrea Dotta, Mari-Liis Ilmoja, Ajit Mahaveer, Tuuli Metsvaht, George Mitsiakos, Vassiliki Papaevangelou, Kosmas Sarafidis, A Sarah Walker, Michael Sharland, Michelle Clements, Basma Bafadal, Ana Alarcon Allen, Fani Anatolitou, Antonio Del Vecchio, Mario Giuffrè, Korina Karachristou, Paolo Manzoni, Stefano Martinelli, Paul Moriarty, Angeliki Nika, Vana Papaevangelou, Charles Roehr, Laura Sanchez Alcobendas, Tania Siahanidou, Chryssoula Tzialla, Luca Bonadies, Nicola Booth, Paola Catalina Morales-Betancourt, Malaika Cordeiro, Concha de Alba Romero, Javier de la Cruz, Maia De Luca, Daniele Farina, Caterina Franco, Dimitra Gialamprinou, Maarja Hallik, Laura Ilardi, Vincenzo Insinga, Elias Iosifidis, Riste Kalamees, Angeliki Kontou, Zoltan Molnar, Eirini Nikaina, Chryssoula Petropoulou, Mar Reyné, Kassandra Tataropoulou, Pinelopi Triantafyllidou, Adamantios Vontzalidis, Mike Sharland, Hill L.F., Clements M.N., Turner M.A., Dona D., Lutsar I., Jacqz-Aigrain E., Heath P.T., Roilides E., Rawcliffe L., Alonso-Diaz C., Baraldi E., Dotta A., Ilmoja M.-L., Mahaveer A., Metsvaht T., Mitsiakos G., Papaevangelou V., Sarafidis K., Walker A.S., Sharland M., Clements M., Bafadal B., Alarcon Allen A., Anatolitou F., Del Vecchio A., Giuffre M., Karachristou K., Manzoni P., Martinelli S., Moriarty P., Nika A., Roehr C., Sanchez Alcobendas L., Siahanidou T., Tzialla C., Bonadies L., Booth N., Catalina Morales-Betancourt P., Cordeiro M., de Alba Romero C., de la Cruz J., De Luca M., Farina D., Franco C., Gialamprinou D., Hallik M., Ilardi L., Insinga V., Iosifidis E., Kalamees R., Kontou A., Molnar Z., Nikaina E., Petropoulou C., Reyne M., Tataropoulou K., Triantafyllidou P., and Vontzalidis A.
Subjects: medicine.medical_specialty, Time Factors, Population, Equivalence Trials as Topic, Loading dose, Article, law.invention, Gram-positive, Randomized controlled trial, law, Vancomycin, Intensive care, Internal medicine, Intensive Care Units, Neonatal, Sepsis, Developmental and Educational Psychology, Clinical endpoint, Medicine, Humans, Dosing, education, Infusions, Intravenous, education.field_of_study, business.industry, Infant, Newborn, Infant, dosing, United Kingdom, Anti-Bacterial Agents, Europe, Regimen, Treatment Outcome, Spain, Relative risk, Pediatrics, Perinatology and Child Health, sepsi, business
Abstract: Summary Background Vancomycin is the most widely used antibiotic for neonatal Gram-positive sepsis, but clinical outcome data of dosing strategies are scarce. The NeoVanc programme comprised extensive preclinical studies to inform a randomised controlled trial to assess optimised vancomycin dosing. We compared the efficacy of an optimised regimen to a standard regimen in infants with late onset sepsis that was known or suspected to be caused by Gram-positive microorganisms. Methods NeoVanc was an open-label, multicentre, phase 2b, parallel-group, randomised, non-inferiority trial comparing the efficacy and toxicity of an optimised regimen of vancomycin to a standard regimen in infants aged 90 days or younger. Infants with at least three clinical or laboratory sepsis criteria or confirmed Gram-positive sepsis with at least one clinical or laboratory criterion were enrolled from 22 neonatal intensive care units in Greece, Italy, Estonia, Spain, and the UK. Infants were randomly assigned (1:1) to either the optimised regimen (25 mg/kg loading dose, followed by 15 mg/kg every 12 h or 8 h dependent on postmenstrual age, for 5 ± 1 days) or the standard regimen (no loading dose; 15 mg/kg every 24 h, 12 h, or 8 h dependent on postmenstrual age for 10 ± 2 days). Vancomycin was administered intravenously via 60 min infusion. Group allocation was not masked to local investigators or parents. The primary endpoint was success at the test of cure visit (10 ± 1 days after the end of actual vancomycin therapy) in the per-protocol population, where success was defined as the participant being alive at the test of cure visit, having a successful outcome at the end of actual vancomycin therapy, and not having a clinically or microbiologically significant relapse or new infection requiring antistaphylococcal antibiotics for more than 24 h within 10 days of the end of actual vancomycin therapy. The non-inferiority margin was −10%. Safety was assessed in the intention-to-treat population. This trial is registered at ClinicalTrials.gov ( NCT02790996 ). Findings Between March 3, 2017, and July 29, 2019, 242 infants were randomly assigned to the standard regimen group (n=122) or the optimised regimen group (n=120). Primary outcome data in the per-protocol population were available for 90 infants in the optimised group and 92 in the standard group. 64 (71%) of 90 infants in the optimised group and 73 (79%) of 92 in the standard group had success at test of cure visit; non-inferiority was not confirmed (adjusted risk difference −7% [95% CI −15 to 2]). Incomplete resolution of clinical or laboratory signs after 5 ± 1 days of vancomycin therapy was the main factor contributing to clinical failure in the optimised group. Abnormal hearing test results were recorded in 25 (30%) of 84 infants in the optimised group and 12 (15%) of 79 in the standard group (adjusted risk ratio 1·96 [95% CI 1·07 to 3·59], p=0·030). There were six vancomycin-related adverse events in the optimised group (one serious adverse event) and four in the standard group (two serious adverse events). 11 infants in the intention-to-treat population died (six [6%] of 102 infants in the optimised group and five [5%] of 98 in the standard group). Interpretation In the largest neonatal vancomycin efficacy trial yet conducted, no clear clinical impact of a shorter duration of treatment with a loading dose was demonstrated. The use of the optimised regimen cannot be recommended because a potential hearing safety signal was identified; long-term follow-up is being done. These results emphasise the importance of robust clinical safety assessments of novel antibiotic dosing regimens in infants. Funding EU Seventh Framework Programme for research, technological development and demonstration.
Published: 2021

31. Le best practices per la gestione della sepsi e dello shock settico in ambito intensivo: indagine conoscitiva multicentrica sull'aderenza alle raccomandazioni delle linee guida.

Author: ALGERI, ELENA, BAFFÈ, VALERIA, BOARINI, LAURA, and IMBRÌACO, GUGLIELMO
Subjects: NURSING audit, PREVENTION of communicable diseases, HAND washing, INTENSIVE care units, PROTECTIVE clothing, MEDICAL protocols, NURSES, HEALTH outcome assessment, QUESTIONNAIRES, SEPTIC shock, SEPSIS
Published: 2016

32. Data analytics and clinical feature ranking of medical records of patients with sepsis

Author: Chicco, D, Oneto, L, Chicco, D, and Oneto, L
Abstract: Background: Sepsis is a life-threatening clinical condition that happens when the patient’s body has an excessive reaction to an infection, and should be treated in one hour. Due to the urgency of sepsis, doctors and physicians often do not have enough time to perform laboratory tests and analyses to help them forecast the consequences of the sepsis episode. In this context, machine learning can provide a fast computational prediction of sepsis severity, patient survival, and sequential organ failure by just analyzing the electronic health records of the patients. Also, machine learning can be employed to understand which features in the medical records are more predictive of sepsis severity, of patient survival, and of sequential organ failure in a fast and non-invasive way. Dataset and methods: In this study, we analyzed a dataset of electronic health records of 364 patients collected between 2014 and 2016. The medical record of each patient has 29 clinical features, and includes a binary value for survival, a binary value for septic shock, and a numerical value for the sequential organ failure assessment (SOFA) score. We disjointly utilized each of these three factors as an independent target, and employed several machine learning methods to predict it (binary classifiers for survival and septic shock, and regression analysis for the SOFA score). Afterwards, we used a data mining approach to identify the most important dataset features in relation to each of the three targets separately, and compared these results with the results achieved through a standard biostatistics approach. Results and conclusions: Our results showed that machine learning can be employed efficiently to predict septic shock, SOFA score, and survival of patients diagnoses with sepsis, from their electronic health records data. And regarding clinical feature ranking, our results showed that Random Forests feature selection identified several unexpected symptoms and clinical components as rel
Published: 2021

33. WSES/GAIS/SIS-E/WSIS/AAST global clinical pathways for patients with intra-abdominal infections

Author: Sartelli, M, Coccolini, F, Kluger, Y, Agastra, E, Abu-Zidan, F, Abbas, A, Ansaloni, L, Adesunkanmi, A, Atanasov, B, Augustin, G, Bala, M, Baraket, O, Baral, S, Biffl, W, Boermeester, M, Ceresoli, M, Cerutti, E, Chiara, O, Cicuttin, E, Chiarugi, M, Coimbra, R, Colak, E, Corsi, D, Cortese, F, Cui, Y, Damaskos, D, de' Angelis, N, Delibegovic, S, Demetrashvili, Z, De Simone, B, de Jonge, S, Dhingra, S, Di Bella, S, Di Marzo, F, Di Saverio, S, Dogjani, A, Duane, T, Enani, M, Fugazzola, P, Galante, J, Gachabayov, M, Ghnnam, W, Gkiokas, G, Gomes, C, Griffiths, E, Hardcastle, T, Hecker, A, Herzog, T, Kabir, S, Karamarkovic, A, Khokha, V, Kim, P, Kim, J, Kirkpatrick, A, Kong, V, Koshy, R, Kryvoruchko, I, Inaba, K, Isik, A, Iskandar, K, Ivatury, R, Labricciosa, F, Lee, Y, Leppaniemi, A, Litvin, A, Luppi, D, Machain, G, Maier, R, Marinis, A, Marmorale, C, Marwah, S, Mesina, C, Moore, E, Moore, F, Negoi, I, Olaoye, I, Ordonez, C, Ouadii, M, Peitzman, A, Perrone, G, Pikoulis, M, Pintar, T, Pipitone, G, Podda, M, Rasa, K, Ribeiro, J, Rodrigues, G, Rubio-Perez, I, Sall, I, Sato, N, Sawyer, R, Segovia Lohse, H, Sganga, G, Shelat, V, Stephens, I, Sugrue, M, Tarasconi, A, Tochie, J, Tolonen, M, Tomadze, G, Ulrych, J, Vereczkei, A, Viaggi, B, Gurioli, C, Casella, C, Pagani, L, Baiocchi, G, Catena, F, Sartelli M., Coccolini F., Kluger Y., Agastra E., Abu-Zidan F. M., Abbas A. E. S., Ansaloni L., Adesunkanmi A. K., Atanasov B., Augustin G., Bala M., Baraket O., Baral S., Biffl W. L., Boermeester M. A., Ceresoli M., Cerutti E., Chiara O., Cicuttin E., Chiarugi M., Coimbra R., Colak E., Corsi D., Cortese F., Cui Y., Damaskos D., de' Angelis N., Delibegovic S., Demetrashvili Z., De Simone B., de Jonge S. W., Dhingra S., Di Bella S., Di Marzo F., Di Saverio S., Dogjani A., Duane T. M., Enani M. A., Fugazzola P., Galante J. M., Gachabayov M., Ghnnam W., Gkiokas G., Gomes C. A., Griffiths E. A., Hardcastle T. C., Hecker A., Herzog T., Kabir S. M. U., Karamarkovic A., Khokha V., Kim P. K., Kim J. I., Kirkpatrick A. W., Kong V., Koshy R. M., Kryvoruchko I. A., Inaba K., Isik A., Iskandar K., Ivatury R., Labricciosa F. M., Lee Y. Y., Leppaniemi A., Litvin A., Luppi D., Machain G. M., Maier R. V., Marinis A., Marmorale C., Marwah S., Mesina C., Moore E. E., Moore F. A., Negoi I., Olaoye I., Ordonez C. A., Ouadii M., Peitzman A. B., Perrone G., Pikoulis M., Pintar T., Pipitone G., Podda M., Rasa K., Ribeiro J., Rodrigues G., Rubio-Perez I., Sall I., Sato N., Sawyer R. G., Segovia Lohse H., Sganga G., Shelat V. G., Stephens I., Sugrue M., Tarasconi A., Tochie J. N., Tolonen M., Tomadze G., Ulrych J., Vereczkei A., Viaggi B., Gurioli C., Casella C., Pagani L., Baiocchi G. L., Catena F., Sartelli, M, Coccolini, F, Kluger, Y, Agastra, E, Abu-Zidan, F, Abbas, A, Ansaloni, L, Adesunkanmi, A, Atanasov, B, Augustin, G, Bala, M, Baraket, O, Baral, S, Biffl, W, Boermeester, M, Ceresoli, M, Cerutti, E, Chiara, O, Cicuttin, E, Chiarugi, M, Coimbra, R, Colak, E, Corsi, D, Cortese, F, Cui, Y, Damaskos, D, de' Angelis, N, Delibegovic, S, Demetrashvili, Z, De Simone, B, de Jonge, S, Dhingra, S, Di Bella, S, Di Marzo, F, Di Saverio, S, Dogjani, A, Duane, T, Enani, M, Fugazzola, P, Galante, J, Gachabayov, M, Ghnnam, W, Gkiokas, G, Gomes, C, Griffiths, E, Hardcastle, T, Hecker, A, Herzog, T, Kabir, S, Karamarkovic, A, Khokha, V, Kim, P, Kim, J, Kirkpatrick, A, Kong, V, Koshy, R, Kryvoruchko, I, Inaba, K, Isik, A, Iskandar, K, Ivatury, R, Labricciosa, F, Lee, Y, Leppaniemi, A, Litvin, A, Luppi, D, Machain, G, Maier, R, Marinis, A, Marmorale, C, Marwah, S, Mesina, C, Moore, E, Moore, F, Negoi, I, Olaoye, I, Ordonez, C, Ouadii, M, Peitzman, A, Perrone, G, Pikoulis, M, Pintar, T, Pipitone, G, Podda, M, Rasa, K, Ribeiro, J, Rodrigues, G, Rubio-Perez, I, Sall, I, Sato, N, Sawyer, R, Segovia Lohse, H, Sganga, G, Shelat, V, Stephens, I, Sugrue, M, Tarasconi, A, Tochie, J, Tolonen, M, Tomadze, G, Ulrych, J, Vereczkei, A, Viaggi, B, Gurioli, C, Casella, C, Pagani, L, Baiocchi, G, Catena, F, Sartelli M., Coccolini F., Kluger Y., Agastra E., Abu-Zidan F. M., Abbas A. E. S., Ansaloni L., Adesunkanmi A. K., Atanasov B., Augustin G., Bala M., Baraket O., Baral S., Biffl W. L., Boermeester M. A., Ceresoli M., Cerutti E., Chiara O., Cicuttin E., Chiarugi M., Coimbra R., Colak E., Corsi D., Cortese F., Cui Y., Damaskos D., de' Angelis N., Delibegovic S., Demetrashvili Z., De Simone B., de Jonge S. W., Dhingra S., Di Bella S., Di Marzo F., Di Saverio S., Dogjani A., Duane T. M., Enani M. A., Fugazzola P., Galante J. M., Gachabayov M., Ghnnam W., Gkiokas G., Gomes C. A., Griffiths E. A., Hardcastle T. C., Hecker A., Herzog T., Kabir S. M. U., Karamarkovic A., Khokha V., Kim P. K., Kim J. I., Kirkpatrick A. W., Kong V., Koshy R. M., Kryvoruchko I. A., Inaba K., Isik A., Iskandar K., Ivatury R., Labricciosa F. M., Lee Y. Y., Leppaniemi A., Litvin A., Luppi D., Machain G. M., Maier R. V., Marinis A., Marmorale C., Marwah S., Mesina C., Moore E. E., Moore F. A., Negoi I., Olaoye I., Ordonez C. A., Ouadii M., Peitzman A. B., Perrone G., Pikoulis M., Pintar T., Pipitone G., Podda M., Rasa K., Ribeiro J., Rodrigues G., Rubio-Perez I., Sall I., Sato N., Sawyer R. G., Segovia Lohse H., Sganga G., Shelat V. G., Stephens I., Sugrue M., Tarasconi A., Tochie J. N., Tolonen M., Tomadze G., Ulrych J., Vereczkei A., Viaggi B., Gurioli C., Casella C., Pagani L., Baiocchi G. L., and Catena F.
Abstract: Intra-abdominal infections (IAIs) are common surgical emergencies and have been reported as major contributors to non-trauma deaths in hospitals worldwide. The cornerstones of effective treatment of IAIs include early recognition, adequate source control, appropriate antimicrobial therapy, and prompt physiologic stabilization using a critical care environment, combined with an optimal surgical approach. Together, the World Society of Emergency Surgery (WSES), the Global Alliance for Infections in Surgery (GAIS), the Surgical Infection Society-Europe (SIS-E), the World Surgical Infection Society (WSIS), and the American Association for the Surgery of Trauma (AAST) have jointly completed an international multi-society document in order to facilitate clinical management of patients with IAIs worldwide building evidence-based clinical pathways for the most common IAIs. An extensive non-systematic review was conducted using the PubMed and MEDLINE databases, limited to the English language. The resulting information was shared by an international task force from 46 countries with different clinical backgrounds. The aim of the document is to promote global standards of care in IAIs providing guidance to clinicians by describing reasonable approaches to the management of IAIs.
Published: 2021

34. Higher levels of IgA and IgG at sepsis onset are associated with higher mortality: results from the Albumin Italian Outcome Sepsis (ALBIOS) trial

Author: Alagna, L, Meessen, J, Bellani, G, Albiero, D, Caironi, P, Principale, I, Vivona, L, Grasselli, G, Motta, F, Agnelli, N, Parrini, V, Romagnoli, S, Keim, R, Di Marzo Capozzi, F, Taccone, F, Taccone, W, Bottazzi, B, Bandera, A, Cortegiani, A, Latini, R, Alagna, Laura, Meessen, Jennifer M T A, Bellani, Giacomo, Albiero, Daniela, Caironi, Pietro, Principale, Irene, Vivona, Luigi, Grasselli, Giacomo, Motta, Francesca, Agnelli, Nicolò M, Parrini, Vieri, Romagnoli, Stefano, Keim, Roberto, Di Marzo Capozzi, Francesca, Taccone, Fabio S, Taccone, Walter, Bottazzi, Barbara, Bandera, Alessandra, Cortegiani, Andrea, Latini, Roberto, Alagna, L, Meessen, J, Bellani, G, Albiero, D, Caironi, P, Principale, I, Vivona, L, Grasselli, G, Motta, F, Agnelli, N, Parrini, V, Romagnoli, S, Keim, R, Di Marzo Capozzi, F, Taccone, F, Taccone, W, Bottazzi, B, Bandera, A, Cortegiani, A, Latini, R, Alagna, Laura, Meessen, Jennifer M T A, Bellani, Giacomo, Albiero, Daniela, Caironi, Pietro, Principale, Irene, Vivona, Luigi, Grasselli, Giacomo, Motta, Francesca, Agnelli, Nicolò M, Parrini, Vieri, Romagnoli, Stefano, Keim, Roberto, Di Marzo Capozzi, Francesca, Taccone, Fabio S, Taccone, Walter, Bottazzi, Barbara, Bandera, Alessandra, Cortegiani, Andrea, and Latini, Roberto
Abstract: Background: The role of intravenous immunoglobulins (IVIG) during sepsis is controversial, as different trials on IVIG have observed inconsistent survival benefits. We aimed to elucidate the possible association and clinical significance between circulating levels of immunoglobulins. Methods: In a subset of 956 patients with severe sepsis and septic shock of the multicentre, open-label RCT ALBIOS, venous blood samples were serially collected 1, 2, and 7 days after enrolment (or at ICU discharge, whichever came first). IgA, IgG and IgM concentrations were assayed in all patients on day 1 and in a subgroup of 150 patients on days 2 and 7. Ig concentrations were measured employing a turbidimetric assay, OSR61171 system. Results: IgA on day 1 had a significant predictive value for both 28-day and 90-day mortality (28-day mortality, HR: 1.50 (95% CI 1.18–1.92); 90-day mortality, HR: 1.54 (95% CI 1.25–1.91)). IgG, but not IgM, on day 1 showed similar results for 28-day (HR 1.83 (95% CI 1.33–2.51) and 90-day mortality HR: 1.66 (95% CI 1.23–2.25)). In addition, lower levels of IgG but not of IgA and IgM, at day 1 were associated with significantly higher risk of secondary infections (533 [406–772] vs 600 [452–842] mg/dL, median [Q1–Q3], p = 0.007). Conclusions: In the largest cohort study of patients with severe sepsis or septic shock, we found that high levels of IgA and IgG on the first day of diagnosis were associated with a decreased 90-day survival. No association was found between IgM levels and survival. As such, the assessment of endogenous immunoglobulins could be a useful tool to identify septic patients at high risk of mortality. Trial registration #NCT00707122, Clinicaltrial.gov, registered 30 June 2008.
Published: 2021

35. Low non-carbonic buffer power amplifies acute respiratory acid-base disorders in septic patients: an in-vitro study

Author: Langer, T, Brusatori, S, Carlesso, E, Zadek, F, Brambilla, P, Ferraris Fusarini, C, Duska, F, Caironi, P, Gattinoni, L, Fasano, M, Lualdi, M, Alberio, T, Zanella, A, Pesenti, A, Grasselli, G, Langer, Thomas, Brusatori, Serena, Carlesso, Eleonora, Zadek, Francesco, Brambilla, Paolo, Ferraris Fusarini, Chiara, Duska, Frantisek, Caironi, Pietro, Gattinoni, Luciano, Fasano, Mauro, Lualdi, Marta, Alberio, Tiziana, Zanella, Alberto, Pesenti, Antonio, Grasselli, Giacomo, Langer, T, Brusatori, S, Carlesso, E, Zadek, F, Brambilla, P, Ferraris Fusarini, C, Duska, F, Caironi, P, Gattinoni, L, Fasano, M, Lualdi, M, Alberio, T, Zanella, A, Pesenti, A, Grasselli, G, Langer, Thomas, Brusatori, Serena, Carlesso, Eleonora, Zadek, Francesco, Brambilla, Paolo, Ferraris Fusarini, Chiara, Duska, Frantisek, Caironi, Pietro, Gattinoni, Luciano, Fasano, Mauro, Lualdi, Marta, Alberio, Tiziana, Zanella, Alberto, Pesenti, Antonio, and Grasselli, Giacomo
Abstract: Patients with sepsis have typically reduced concentrations of hemoglobin and albumin, the major components of noncarbonic buffer power (b ). This could expose patients to high pH variations during acid-base disorders. The objective of this study is to compare, in vitro, noncarbonic b of patients with sepsis with that of healthy volunteers, and evaluate its distinct components. Whole blood and isolated plasma of 18 patients with sepsis and 18 controls were equilibrated with different CO2 mixtures. Blood gases, pH, and electrolytes were measured. Noncarbonic b and noncarbonic b due to variations in strong ion difference (b SID) were calculated for whole blood. Noncarbonic b and noncarbonic b normalized for albumin concentrations (b NORM) were calculated for isolated plasma. Representative values at pH = 7.40 were compared. Albumin proteoforms were evaluated via two-dimensional electrophoresis. Hemoglobin and albumin concentrations were significantly lower in patients with sepsis. Patients with sepsis had lower noncarbonic b both of whole blood (22.0 ± 1.9 vs. 31.6 ± 2.1 mmol/L, P < 0.01) and plasma (0.5 ± 1.0 vs. 3.7 ± 0.8 mmol/L, P < 0.01). Noncarbonic b SID was lower in patients (16.8 ± 1.9 vs. 24.4 ± 1.9 mmol/L, P < 0.01) and strongly correlated with hemoglobin concentration (r = 0.94, P < 0.01). Noncarbonic b NORM was lower in patients [0.01 (-0.01 to 0.04) vs. 0.08 (0.06–0.09) mmol/g, P < 0.01]. Patients with sepsis and controls showed different amounts of albumin proteoforms. Patients with sepsis are exposed to higher pH variations for any given change in CO2 due to lower concentrations of noncarbonic buffers and, possibly, an altered buffering function of albumin. In both patients with sepsis and healthy controls, electrolyte shifts are the major buffering mechanism during respiratory acid-base disorders. NEW & NOTEWORTHY Patients with sepsis are poorly protected against acute respiratory acid-base derangements due to a lower noncarbonic buff
Published: 2021

36. Albumin replacement therapy in immunocompromised patients with sepsis - Secondary analysis of the ALBIOS trial

Author: Cortegiani, A, Grasselli, G, Meessen, J, Moscarelli, A, Ippolito, M, Turvani, F, Bonenti, C, Romagnoli, S, Volta, C, Bellani, G, Giarratano, A, Latini, R, Pesenti, A, Caironi, P, Cortegiani, Andrea, Grasselli, Giacomo, Meessen, Jennifer, Moscarelli, Alessandra, Ippolito, Mariachiara, Turvani, Fabrizio, Bonenti, Chiara Maria, Romagnoli, Stefano, Volta, Carlo Alberto, Bellani, Giacomo, Giarratano, Antonino, Latini, Roberto, Pesenti, Antonio, Caironi, Pietro, Cortegiani, A, Grasselli, G, Meessen, J, Moscarelli, A, Ippolito, M, Turvani, F, Bonenti, C, Romagnoli, S, Volta, C, Bellani, G, Giarratano, A, Latini, R, Pesenti, A, Caironi, P, Cortegiani, Andrea, Grasselli, Giacomo, Meessen, Jennifer, Moscarelli, Alessandra, Ippolito, Mariachiara, Turvani, Fabrizio, Bonenti, Chiara Maria, Romagnoli, Stefano, Volta, Carlo Alberto, Bellani, Giacomo, Giarratano, Antonino, Latini, Roberto, Pesenti, Antonio, and Caironi, Pietro
Abstract: Background: The best fluid replacement strategy and the role of albumin in immunocompromised patients with sepsis is unclear. Methods: We performed a secondary analysis of immunocompromised patients enrolled in the ALBIOS trial which randomized patients with severe sepsis or septic shock to receive either 20% albumin (target 30 g per liter or more) and crystalloid or crystalloid alone during ICU stay. Results: Of 1818 patients originally enrolled, 304 (16.4%) were immunocompromised. One-hundred-thirty-nine (45.7%) patients were randomized in the albumin while 165 (54.2%) in the crystalloid group. At 90 days, 69 (49.6%) in the albumin group and 89 (53.9%) in the crystalloids group died (hazard ratio - HR - 0.94; 95% CI 0.69–1.29). No differences were observed with regards to 28-day mortality, SOFA score (and sub-scores), length of stay in the ICU and in the hospital, proportion of patients who had developed acute kidney injury or received renal replacement therapy, duration of mechanical ventilation. Albumin was not independently associated with a higher or lower 90-day mortality (HR 0.979, 95% CI 0.709–1.352) as compared to crystalloid. Conclusion: Albumin replacement during the ICU stay, as compared with crystalloids alone, did not affect clinical outcomes in a cohort of immunocompromised patients with sepsis.
Published: 2021

37. Mesenchymal Stromal Cell-Mediated Treatment of Local and Systemic Inflammation through the Triggering of an Anti-Inflammatory Response

Author: Martinez, J, Evangelopoulos, M, Brozovich, A, Bauza, G, Molinaro, R, Corbo, C, Liu, X, Taraballi, F, Tasciotti, E, Martinez J. O., Evangelopoulos M., Brozovich A. A., Bauza G., Molinaro R., Corbo C., Liu X., Taraballi F., Tasciotti E., Martinez, J, Evangelopoulos, M, Brozovich, A, Bauza, G, Molinaro, R, Corbo, C, Liu, X, Taraballi, F, Tasciotti, E, Martinez J. O., Evangelopoulos M., Brozovich A. A., Bauza G., Molinaro R., Corbo C., Liu X., Taraballi F., and Tasciotti E.
Abstract: The emergence of cell-based therapeutics, specifically the use of mesenchymal stromal/stem cells (MSCs), stands to significantly affect the future of targeted drug delivery technologies. MSCs represent a unique cell type, offering more than only regenerative potential but also site-specific inflammatory targeting and tissue infiltration. In this study, a versatile multicomponent delivery platform, combining MSC tropism with multistage nanovector (MSV)-mediated payload delivery, is debuted. It is demonstrated that the incorporation of drug-loaded MSVs bestows MSCs with the ability to transport anti-inflammatory payloads, achieving a fivefold increase in payload release without negatively impacting cellular functions, viability, extravasation, and inflammatory homing. When incorporated within MSCs, MSVs avoid rapid sequestration by filtering organs and conserve a 15-fold increase in local inflammatory targeting compared to healthy ears. Furthermore, this MSC-mediated MSV platform (M&Ms) rapidly triggers a 4.5-fold reduction of local inflammation compared to free drug and extends survival to 100% of treated mice in a lethal model of systemic inflammation.
Published: 2021

38. Near miss ostetrici in Italia: la sepsi, l’eclampsia, l’embolia di liquido amniotico e l’emoperitoneo spontaneo in gravidanza.

Author: ANTOLINI, LAURA, Colciago, E, VALSECCHI, MARIA GRAZIA, COLCIAGO, ELISABETTA, ANTOLINI, LAURA, Colciago, E, VALSECCHI, MARIA GRAZIA, and COLCIAGO, ELISABETTA
Abstract: Stato dell'arte: gli studi che indagano la mortalità materna offrono preziose informazioni per migliorare la salute di donne e neonati. Tuttavia, in Paesi come l'Italia la mortalità materna è rara. Per ogni donna deceduta, molti altre vanno incontro a gravi complicanze durante il percorso nascita che comportano diversi conseguenze. Le condizioni pericolose per la vita, definite near miss, possono quindi arricchire la conoscenza in campo ostetrico fornendo dati relativi a fattori di rischio, prevenzione e trattamento di qeuste patologie ostetriche, per migliorare l'assistenza ostetrica e la salute di madre e neonati. Il Sistema di Sorveglianza Ostetrico Italiano (ItOSS) è stato generato per monitorare condizioni ostetriche rare in Italia. Nel 2017 ItOSS ha attivato un progetto per raccogliere near miss materni dovuti a sepsis, eclampsia, embolia di liquido amniotico (AFE) e emoperitoneo spontaneo in gravidanza (SHiP) in 9 Regioni italiane. Scopo: stimare l'incidenza di eclampsia, sepsi, AFE e SHiP e descrivere l'assistenza erogata alle donne. Metodi: studio descrittivo population-based, associato a studio caso-controllo per i casi di spesi nel post-partum con l'obiettivo di valutare i fattori di rischio associati al tale complicanza. I dati sono stati raccolti prospetticamente tramite schede di raccolta dati appositamente sviluppate all'interno di una piattaforma on-line tramite il seguente link: http://www.salutedonnabambino.it/ITOSS/login.asp. La conferma dello "zero mensile" era richiesta nel caso non fossero avvenuti casi. La raccolta dati ha avuto inizio in data 1/11/2017, concludendosi in data 31/10/2019 per i casi di sepsi e proseguendo fino al 31/3/2020 per i casi dovuti alle altre complicanze. L'analisi statistica è stata condotta considerando i casi di eclampsia e sepsi peripartum; i dati raccolti relativi ad AFE e SHiP saranno utilizzati per partecipare ad uno studio multi-nazione, promosso dall'International Obstetric Surveillance System Network (INO, Background: Data on maternal mortality offers valuable information to improve women’s health. In countries such as Italy maternal mortality is a rare event. For each death, many other women survive serious complications during pregnancy, birth and the post-natal period that lead to different degree of sequelae. Life-threating conditions, defined as near miss, could provide additional information on disease risk factors, prevention and treatment for promoting best practices, improving quality of care and achieving better health for mothers and babies. The Italian Obstetric Surveillance System (ItOSS) was set up to monitor the maternal morbidity rate in Italy. In 2017 ItOSS activated a project to collect maternal near miss cases due to sepsis, eclampsia, amniotic fluid embolism (AFE) and spontaneous haemoperitoneum in pregnancy (SHiP) in 9 Italian Regions. Aim: To estimate the incidence rate of eclampsia, sepsis, amniotic fluid embolism and spontaneous haemoperitoneum in pregnancy and to describe the care provided during the near miss episode. Method: A Population-based descriptive study was conducted, a case-control design was applied only on post-partum sepsis cases to evaluate risk factors associated to the complication. Data were obtained through a prospective active collection of cases by a monthly call according to the principle of nothing-to-report, along with data collection forms that confirm the diagnosis and gather detailed information. Data collection occurred web-based since November 2017 through http://www.salutedonnabambino.it/ITOSS/login.aspx and was completed on the 31st of October 2019 for the sepsis cases, while the remaining complications were investigated until the 31st of March 2020. Statistical analysis was performed on eclampsia and peripartum sepsis cases; data collected on AFE and SHiP will be used to participate into a multi-national study promoted by INOSS, with the aim to give a stable incidence about this extremely rare conditions. For th
Published: 2021

39. Soluble Urokinase Receptor as a Promising Marker for Early Prediction of Outcome in COVID-19 Hospitalized Patients

Author: Ivan Gentile, Filomena Napolitano, Daniela Spalletti Cernia, Carmine Iacovazzo, Maria Vargas, Bianca Covelli, Nunzia Montuori, Loredana Postiglione, Giuseppe Servillo, Margherita Ricciardone, Gaetano Di Spigna, Biagio Pinchera, Napolitano, F., Di Spigna, G., Vargas, M., Iacovazzo, C., Pinchera, B., Cernia, D. S., Ricciardone, M., Covelli, B., Servillo, G., Gentile, I., Postiglione, L., and Montuori, N.
Subjects: ARDS, medicine.medical_specialty, Complement system, Coronavirus disease 2019 (COVID-19), Sepsi, Article, law.invention, Sepsis, sepsis, law, Internal medicine, Pandemic, Health care, medicine, SuPAR, business.industry, Risk stratification in the emergency room, biomarkers, COVID-19, General Medicine, Biomarker, medicine.disease, Intensive care unit, Urokinase receptor, Medicine, business
Abstract: The Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, has rapidly spread to become a global pandemic, putting a strain on health care systems. SARS-CoV-2 infection may be associated with mild symptoms or, in severe cases, lead patients to the intensive care unit (ICU) or death. The critically ill patients suffer from acute respiratory distress syndrome (ARDS), sepsis, thrombotic complications and multiple organ failure. For optimization of hospital resources, several molecular markers and algorithms have been evaluated in order to stratify COVID-19 patients, based on the risk of developing a mild, moderate, or severe disease. Here, we propose the soluble urokinase receptor (suPAR) as a serum biomarker of clinical severity and outcome in patients who are hospitalized with COVID-19. In patients with mild disease course, suPAR levels were increased as compared to healthy controls, but they were dramatically higher in severely ill patients. Since early identification of disease progression may facilitate the individual management of COVID-19 symptomatic patients and the time of admission to the ICU, we suggest paying more clinical attention on patients with high suPAR levels.
Published: 2021

40. The Value of a Complete Blood Count (CBC) for Sepsis Diagnosis and Prognosis

Author: Marcello Ciaccio, Luisa Agnello, Alessandro Iacona, Concetta Scazzone, Anna Maria Ciaccio, Rosaria Vincenza Giglio, Caterina Maria Gambino, Giulia Bivona, Bruna Lo Sasso, Agnello, Luisa, Giglio, Rosaria Vincenza, Bivona, Giulia, Scazzone, Concetta, Gambino, Caterina Maria, Iacona, Alessandro, Ciaccio, Anna Maria, Lo Sasso, Bruna, and Ciaccio, Marcello
Subjects: lymphocytes, Medicine (General), medicine.medical_specialty, Anemia, Clinical Biochemistry, Context (language use), thrombocytopenia, Review, lymphocyte, RBC, law.invention, Sepsis, sepsis, R5-920, neutrophils, law, Global health, Medicine, Intensive care medicine, medicine.diagnostic_test, business.industry, Complete blood count, neutrophil, Emergency department, CPD, medicine.disease, Intensive care unit, anemia, Settore BIO/12 - Biochimica Clinica E Biologia Molecolare Clinica, monocyte, Biomarker (medicine), biomarker, sepsi, business, monocytes, CBC
Abstract: Sepsis represents an important global health burden due to its high mortality and morbidity. The rapid detection of sepsis is crucial in order to prevent adverse outcomes and reduce mortality. However, the diagnosis of sepsis is still challenging and many efforts have been made to identify reliable biomarkers. Unfortunately, many investigated biomarkers have several limitations that do not support their introduction in clinical practice, such as moderate diagnostic and prognostic accuracy, long turn-around time, and high-costs. Complete blood count represents instead a precious test that provides a wealth of information on individual health status. It can guide clinicians to early-identify patients at high risk of developing sepsis and to predict adverse outcomes. It has several advantages, being cheap, easy-to-perform, and available in all wards, from the emergency department to the intensive care unit. Noteworthy, it represents a first-level test and an alteration of its parameters must always be considered within the clinical context, and the eventual suspect of sepsis must be confirmed by more specific investigations. In this review, we describe the usefulness of basic and new complete blood count parameters as diagnostic and prognostic biomarkers of sepsis.
Published: 2021

41. Catheter-related bloodstream infections by opportunistic pathogens in immunocompromised hosts.

Author: MIRIJELLO, A., IMPAGNATIELLO, M., ZACCONE, V., VENTURA, G., POMPA, L., ADDOLORATO, G., and LANDOLFI, R.
Abstract: Catheter-related bloodstream infections (CRBI) represent a frequent complication of immune-compromised hosts with a high mortality rate. In this setting, opportunistic pathogens can create a biofilm on implanted devices, being the source of infection. We provide a mini-review of the literature, starting from the description of two cases of CRBI by opportunistic pathogens in poly-morbid patients, successfully treated by antibiotic lock-therapy. [ABSTRACT FROM AUTHOR]
Published: 2015

42. Sepsis at ICU admission does not decrease 30-day survival in very old patients: a post-hoc analysis of the VIP1 multinational cohort study

Author: Ibarz, M, Boumendil, A, Haas, L, Irazabal, M, Flaatten, H, de Lange, D, Morandi, A, Andersen, F, Bertolini, G, Cecconi, M, Christensen, S, Faraldi, L, Fjolner, J, Jung, C, Marsh, B, Moreno, R, Oeyen, S, Ohman, C, Bollen Pinto, B, Soliman, I, Szczeklik, W, Valentin, A, Watson, X, Zaferidis, T, Guidet, B, Artigas, A, Schmutz, R, Wimmer, F, Eller, P, Joannidis, M, De Buysscher, P, De Neve, N, Swinnen, W, Abraham, P, Hergafi, L, Schefold, J, Biskup, E, Piza, P, Taliadoros, I, Dey, N, Solling, C, Rasmussen, B, Forceville, X, Besch, G, Mentec, H, Michel, P, Mateu, P, Vettoretti, L, Bourenne, J, Marin, N, Guillot, M, Aissaoui, N, Goulenok, C, Thieulot-Rolin, N, Messika, J, Lamhaut, L, Charron, C, Lauten, A, Sacher, A, Brenner, T, Franz, M, Bloos, F, Ebelt, H, Schaller, S, Fuest, K, Rabe, C, Dieck, T, Steiner, S, Graf, T, Nia, A, Janosi, R, Meybohm, P, Simon, P, Utzolino, S, Rahmel, T, Barth, E, Schuster, M, Aidoni, Z, Aloizos, S, Tasioudis, P, Lampiri, K, Zisopoulou, V, Ravani, I, Pagaki, E, Antoniou, A, Katsoulas, T, Kounougeri, A, Marinakis, G, Tsimpoukas, F, Spyropoulou, A, Zygoulis, P, Kyparissi, A, Gupta, M, Gurjar, M, Maji, I, Hayes, I, Kelly, Y, Westbrook, A, Fitzpatrick, G, Maheshwari, D, Motherway, C, Negri, G, Spadaro, S, Nattino, G, Pedeferri, M, Boscolo, A, Rossi, S, Calicchio, G, Cubattoli, L, Di Lascio, G, Barbagallo, M, Berruto, F, Codazzi, D, Bottazzi, A, Fumagalli, P, Negro, G, Lupi, G, Savelli, F, Vulcano, G, Fumagalli, R, Marudi, A, Lefons, U, Lembo, R, Babini, M, Paggioro, A, Parrini, V, Zaccaria, M, Clementi, S, Gigliuto, C, Facondini, F, Pastorini, S, Munaron, S, Calamai, I, Bocchi, A, Adorni, A, Bocci, M, Cortegiani, A, Casalicchio, T, Melia, S, Graziani, E, Barattini, M, Brizio, E, Rossi, M, Hahn, M, Flattens, H, Kemmerer, N, Streiter, H, Dybwik, K, Legernaes, T, Klepstad, P, Olaussen, E, Olsen, K, Brresen, O, Bjorsvik, G, Maini, S, Fehrle, L, Krawczyk, P, Zietkiewicz, M, Nowak, L, Kotfis, K, Cwyl, K, Gajdosz, R, Biernawska, J, Bohatyrewicz, R, Gawda, R, Grudzien, P, Nasilowski, P, Popek, N, Cyrankiewicz, W, Wawrzyniak, K, Wnuk, M, Maciejewski, D, Studzinska, D, Zukowski, M, Bernas, S, Piechota, M, Nowak-Kozka, I, Fronczek, J, Serwa, M, Stefaniak, J, Wujtewicz, M, Szymkowiak, M, Adamik, B, Polok, K, Wludarczyk, A, Gorka, J, Kozera, N, Gozdzik, W, Catorze, N, Branco, M, Barros, I, Barros, N, Krystopchuk, A, Honrado, T, Sousa, C, Munoz, F, Rebelo, M, Gomes, R, Nunes, J, Dias, C, Fernandes, A, Petrisor, C, Constantin, B, Belskiy, V, Boskholov, B, Rodriguez, E, Rebollo, S, Aguilar, G, Masdeu, G, Jaimes, M, Mira, A, Bodi, M, Barea Mendoza, J, Lopez-Cuenca, S, Guzman, M, Rico-Feijoo, J, Alvarez, J, Kawati, R, Sivik, J, Nauska, J, Parenmark, F, Lyren, J, Rockstrohm, K, Ryden, S, Spangfors, M, Strinnholm, M, Walther, S, De Geer, L, Nordlund, P, Palsson, S, Zetterquist, H, Nilsson, A, Thiringer, K, Jungner, M, Bark, B, Nordling, B, Skold, H, Brorsson, C, Persson, S, Bergstrom, A, Berkius, J, Holmstrom, J, van Dijk, I, Ramnarain, D, Jansen, T, Nooteboom, F, van der Voort, P, Dieperink, W, de Waard, M, de Smet, A, Bormans, L, Dormans, T, Dempsey, G, Mathew, S, Raj, A, Grecu, I, Cupitt, J, Lawton, T, Clark, R, Popescu, M, Spittle, N, Faulkner, M, Cowton, A, Elloway, E, Williams, P, Reay, M, Chukkambotla, S, Kumar, R, Al-Subaie, N, Kent, L, Tamm, T, Kajtor, I, Burns, K, Pugh, R, Ostermann, M, Kam, E, Bowyer, H, Smith, N, Templeton, M, Henning, J, Goffin, K, Kapoor, R, Laha, S, Chilton, P, Khaliq, W, Crayford, A, Coetzee, S, Tait, M, Stoker, W, Gimenez, M, Pope, A, Camsooksai, J, Pogson, D, Quigley, K, Ritzema, J, Hormis, A, Boulanger, C, Balasubramaniam, M, Vamplew, L, Burt, K, Martin, D, Craig, J, Prowle, J, Doyle, N, Shelton, J, Scott, C, Donnison, P, Shelton, S, Frey, C, Ryan, C, Spray, D, Barnes, V, Barnes, K, Ridgway, S, Saha, R, Clark, T, Wood, J, Bolger, C, Bassford, C, Lewandowski, J, Zhao, X, Humphreys, S, Dowling, S, Richardson, N, Burtenshaw, A, Stevenson, C, Wilcock, D, Nalapko, Y, Ibarz M., Boumendil A., Haas L. E. M., Irazabal M., Flaatten H., de Lange D. W., Morandi A., Andersen F. H., Bertolini G., Cecconi M., Christensen S., Faraldi L., Fjolner J., Jung C., Marsh B., Moreno R., Oeyen S., Ohman C. A., Bollen Pinto B., Soliman I. W., Szczeklik W., Valentin A., Watson X., Zaferidis T., Guidet B., Artigas A., Schmutz R., Wimmer F., Eller P., Joannidis M., De Buysscher P., De Neve N., Swinnen W., Abraham P., Hergafi L., Schefold J. C., Biskup E., Piza P., Taliadoros I., Dey N., Solling C., Rasmussen B. S., Forceville X., Besch G., Mentec H., Michel P., Mateu P., Vettoretti L., Bourenne J., Marin N., Guillot M., Aissaoui N., Goulenok C., Thieulot-Rolin N., Messika J., Lamhaut L., Charron C., Lauten A., Sacher A. L., Brenner T., Franz M., Bloos F., Ebelt H., Schaller S. J., Fuest K., Rabe C., Dieck T., Steiner S., Graf T., Nia A. M., Janosi R. A., Meybohm P., Simon P., Utzolino S., Rahmel T., Barth E., Schuster M., Aidoni Z., Aloizos S., Tasioudis P., Lampiri K., Zisopoulou V., Ravani I., Pagaki E., Antoniou A., Katsoulas T. A., Kounougeri A., Marinakis G., Tsimpoukas F., Spyropoulou A., Zygoulis P., Kyparissi A., Gupta M., Gurjar M., Maji I. M., Hayes I., Kelly Y., Westbrook A., Fitzpatrick G., Maheshwari D., Motherway C., Negri G., Spadaro S., Nattino G., Pedeferri M., Boscolo A., Rossi S., Calicchio G., Cubattoli L., Di Lascio G., Barbagallo M., Berruto F., Codazzi D., Bottazzi A., Fumagalli P., Negro G., Lupi G., Savelli F., Vulcano G. A., Fumagalli R., Marudi A., Lefons U., Lembo R., Babini M., Paggioro A., Parrini V., Zaccaria M., Clementi S., Gigliuto C., Facondini F., Pastorini S., Munaron S., Calamai I., Bocchi A., Adorni A., Bocci M. G., Cortegiani A., Casalicchio T., Melia S., Graziani E., Barattini M., Brizio E., Rossi M., Hahn M., Flattens H., Kemmerer N., Streiter H. F., Dybwik K., Legernaes T., Klepstad P., Olaussen E. B., Olsen K. I., Brresen O. M., Bjorsvik G., Maini S., Fehrle L., Krawczyk P., Zietkiewicz M., Nowak L. R., Kotfis K., Cwyl K., Gajdosz R., Biernawska J., Bohatyrewicz R., Gawda R., Grudzien P., Nasilowski P., Popek N., Cyrankiewicz W., Wawrzyniak K., Wnuk M., Maciejewski D., Studzinska D., Zukowski M., Bernas S., Piechota M., Nowak-Kozka I., Fronczek J., Serwa M., Stefaniak J., Wujtewicz M., Szymkowiak M., Adamik B., Polok K., Wludarczyk A., Gorka J., Kozera N., Gozdzik W., Catorze N., Branco M. C., Barros I., Barros N., Krystopchuk A., Honrado T., Sousa C., Munoz F., Rebelo M., Gomes R., Nunes J., Dias C., Fernandes A. M., Petrisor C., Constantin B., Belskiy V., Boskholov B., Rodriguez E., Rebollo S., Aguilar G., Masdeu G., Jaimes M. I., Mira A. P., Bodi M. A., Barea Mendoza J. A., Lopez-Cuenca S., Guzman M. H., Rico-Feijoo J., Alvarez J. T., Kawati R., Sivik J., Nauska J., Parenmark F., Lyren J., Rockstrohm K., Ryden S., Spangfors M., Strinnholm M., Walther S., De Geer L., Nordlund P., Palsson S., Zetterquist H., Nilsson A., Thiringer K., Jungner M., Bark B., Nordling B., Skold H., Brorsson C., Persson S., Bergstrom A., Berkius J., Holmstrom J., van Dijk I., Ramnarain D., Jansen T., Nooteboom F., van der Voort P. H. J., Dieperink W., de Waard M. C., de Smet A. G. E., Bormans L., Dormans T., Dempsey G., Mathew S. J., Raj A. S., Grecu I., Cupitt J., Lawton T., Clark R., Popescu M., Spittle N., Faulkner M., Cowton A., Elloway E., Williams P., Reay M., Chukkambotla S., Kumar R., Al-Subaie N., Kent L., Tamm T., Kajtor I., Burns K., Pugh R., Ostermann M., Kam E., Bowyer H., Smith N., Templeton M., Henning J., Goffin K., Kapoor R., Laha S., Chilton P., Khaliq W., Crayford A., Coetzee S., Tait M., Stoker W., Gimenez M., Pope A., Camsooksai J., Pogson D., Quigley K., Ritzema J., Hormis A., Boulanger C., Balasubramaniam M., Vamplew L., Burt K., Martin D., Craig J., Prowle J., Doyle N., Shelton J., Scott C., Donnison P., Shelton S., Frey C., Ryan C., Spray D., Barnes V., Barnes K., Ridgway S., Saha R., Clark T., Wood J., Bolger C., Bassford C., Lewandowski J., Zhao X., Humphreys S., Dowling S., Richardson N., Burtenshaw A., Stevenson C., Wilcock D., Nalapko Y., Ibarz, M, Boumendil, A, Haas, L, Irazabal, M, Flaatten, H, de Lange, D, Morandi, A, Andersen, F, Bertolini, G, Cecconi, M, Christensen, S, Faraldi, L, Fjolner, J, Jung, C, Marsh, B, Moreno, R, Oeyen, S, Ohman, C, Bollen Pinto, B, Soliman, I, Szczeklik, W, Valentin, A, Watson, X, Zaferidis, T, Guidet, B, Artigas, A, Schmutz, R, Wimmer, F, Eller, P, Joannidis, M, De Buysscher, P, De Neve, N, Swinnen, W, Abraham, P, Hergafi, L, Schefold, J, Biskup, E, Piza, P, Taliadoros, I, Dey, N, Solling, C, Rasmussen, B, Forceville, X, Besch, G, Mentec, H, Michel, P, Mateu, P, Vettoretti, L, Bourenne, J, Marin, N, Guillot, M, Aissaoui, N, Goulenok, C, Thieulot-Rolin, N, Messika, J, Lamhaut, L, Charron, C, Lauten, A, Sacher, A, Brenner, T, Franz, M, Bloos, F, Ebelt, H, Schaller, S, Fuest, K, Rabe, C, Dieck, T, Steiner, S, Graf, T, Nia, A, Janosi, R, Meybohm, P, Simon, P, Utzolino, S, Rahmel, T, Barth, E, Schuster, M, Aidoni, Z, Aloizos, S, Tasioudis, P, Lampiri, K, Zisopoulou, V, Ravani, I, Pagaki, E, Antoniou, A, Katsoulas, T, Kounougeri, A, Marinakis, G, Tsimpoukas, F, Spyropoulou, A, Zygoulis, P, Kyparissi, A, Gupta, M, Gurjar, M, Maji, I, Hayes, I, Kelly, Y, Westbrook, A, Fitzpatrick, G, Maheshwari, D, Motherway, C, Negri, G, Spadaro, S, Nattino, G, Pedeferri, M, Boscolo, A, Rossi, S, Calicchio, G, Cubattoli, L, Di Lascio, G, Barbagallo, M, Berruto, F, Codazzi, D, Bottazzi, A, Fumagalli, P, Negro, G, Lupi, G, Savelli, F, Vulcano, G, Fumagalli, R, Marudi, A, Lefons, U, Lembo, R, Babini, M, Paggioro, A, Parrini, V, Zaccaria, M, Clementi, S, Gigliuto, C, Facondini, F, Pastorini, S, Munaron, S, Calamai, I, Bocchi, A, Adorni, A, Bocci, M, Cortegiani, A, Casalicchio, T, Melia, S, Graziani, E, Barattini, M, Brizio, E, Rossi, M, Hahn, M, Flattens, H, Kemmerer, N, Streiter, H, Dybwik, K, Legernaes, T, Klepstad, P, Olaussen, E, Olsen, K, Brresen, O, Bjorsvik, G, Maini, S, Fehrle, L, Krawczyk, P, Zietkiewicz, M, Nowak, L, Kotfis, K, Cwyl, K, Gajdosz, R, Biernawska, J, Bohatyrewicz, R, Gawda, R, Grudzien, P, Nasilowski, P, Popek, N, Cyrankiewicz, W, Wawrzyniak, K, Wnuk, M, Maciejewski, D, Studzinska, D, Zukowski, M, Bernas, S, Piechota, M, Nowak-Kozka, I, Fronczek, J, Serwa, M, Stefaniak, J, Wujtewicz, M, Szymkowiak, M, Adamik, B, Polok, K, Wludarczyk, A, Gorka, J, Kozera, N, Gozdzik, W, Catorze, N, Branco, M, Barros, I, Barros, N, Krystopchuk, A, Honrado, T, Sousa, C, Munoz, F, Rebelo, M, Gomes, R, Nunes, J, Dias, C, Fernandes, A, Petrisor, C, Constantin, B, Belskiy, V, Boskholov, B, Rodriguez, E, Rebollo, S, Aguilar, G, Masdeu, G, Jaimes, M, Mira, A, Bodi, M, Barea Mendoza, J, Lopez-Cuenca, S, Guzman, M, Rico-Feijoo, J, Alvarez, J, Kawati, R, Sivik, J, Nauska, J, Parenmark, F, Lyren, J, Rockstrohm, K, Ryden, S, Spangfors, M, Strinnholm, M, Walther, S, De Geer, L, Nordlund, P, Palsson, S, Zetterquist, H, Nilsson, A, Thiringer, K, Jungner, M, Bark, B, Nordling, B, Skold, H, Brorsson, C, Persson, S, Bergstrom, A, Berkius, J, Holmstrom, J, van Dijk, I, Ramnarain, D, Jansen, T, Nooteboom, F, van der Voort, P, Dieperink, W, de Waard, M, de Smet, A, Bormans, L, Dormans, T, Dempsey, G, Mathew, S, Raj, A, Grecu, I, Cupitt, J, Lawton, T, Clark, R, Popescu, M, Spittle, N, Faulkner, M, Cowton, A, Elloway, E, Williams, P, Reay, M, Chukkambotla, S, Kumar, R, Al-Subaie, N, Kent, L, Tamm, T, Kajtor, I, Burns, K, Pugh, R, Ostermann, M, Kam, E, Bowyer, H, Smith, N, Templeton, M, Henning, J, Goffin, K, Kapoor, R, Laha, S, Chilton, P, Khaliq, W, Crayford, A, Coetzee, S, Tait, M, Stoker, W, Gimenez, M, Pope, A, Camsooksai, J, Pogson, D, Quigley, K, Ritzema, J, Hormis, A, Boulanger, C, Balasubramaniam, M, Vamplew, L, Burt, K, Martin, D, Craig, J, Prowle, J, Doyle, N, Shelton, J, Scott, C, Donnison, P, Shelton, S, Frey, C, Ryan, C, Spray, D, Barnes, V, Barnes, K, Ridgway, S, Saha, R, Clark, T, Wood, J, Bolger, C, Bassford, C, Lewandowski, J, Zhao, X, Humphreys, S, Dowling, S, Richardson, N, Burtenshaw, A, Stevenson, C, Wilcock, D, Nalapko, Y, Ibarz M., Boumendil A., Haas L. E. M., Irazabal M., Flaatten H., de Lange D. W., Morandi A., Andersen F. H., Bertolini G., Cecconi M., Christensen S., Faraldi L., Fjolner J., Jung C., Marsh B., Moreno R., Oeyen S., Ohman C. A., Bollen Pinto B., Soliman I. W., Szczeklik W., Valentin A., Watson X., Zaferidis T., Guidet B., Artigas A., Schmutz R., Wimmer F., Eller P., Joannidis M., De Buysscher P., De Neve N., Swinnen W., Abraham P., Hergafi L., Schefold J. C., Biskup E., Piza P., Taliadoros I., Dey N., Solling C., Rasmussen B. S., Forceville X., Besch G., Mentec H., Michel P., Mateu P., Vettoretti L., Bourenne J., Marin N., Guillot M., Aissaoui N., Goulenok C., Thieulot-Rolin N., Messika J., Lamhaut L., Charron C., Lauten A., Sacher A. L., Brenner T., Franz M., Bloos F., Ebelt H., Schaller S. J., Fuest K., Rabe C., Dieck T., Steiner S., Graf T., Nia A. M., Janosi R. A., Meybohm P., Simon P., Utzolino S., Rahmel T., Barth E., Schuster M., Aidoni Z., Aloizos S., Tasioudis P., Lampiri K., Zisopoulou V., Ravani I., Pagaki E., Antoniou A., Katsoulas T. A., Kounougeri A., Marinakis G., Tsimpoukas F., Spyropoulou A., Zygoulis P., Kyparissi A., Gupta M., Gurjar M., Maji I. M., Hayes I., Kelly Y., Westbrook A., Fitzpatrick G., Maheshwari D., Motherway C., Negri G., Spadaro S., Nattino G., Pedeferri M., Boscolo A., Rossi S., Calicchio G., Cubattoli L., Di Lascio G., Barbagallo M., Berruto F., Codazzi D., Bottazzi A., Fumagalli P., Negro G., Lupi G., Savelli F., Vulcano G. A., Fumagalli R., Marudi A., Lefons U., Lembo R., Babini M., Paggioro A., Parrini V., Zaccaria M., Clementi S., Gigliuto C., Facondini F., Pastorini S., Munaron S., Calamai I., Bocchi A., Adorni A., Bocci M. G., Cortegiani A., Casalicchio T., Melia S., Graziani E., Barattini M., Brizio E., Rossi M., Hahn M., Flattens H., Kemmerer N., Streiter H. F., Dybwik K., Legernaes T., Klepstad P., Olaussen E. B., Olsen K. I., Brresen O. M., Bjorsvik G., Maini S., Fehrle L., Krawczyk P., Zietkiewicz M., Nowak L. R., Kotfis K., Cwyl K., Gajdosz R., Biernawska J., Bohatyrewicz R., Gawda R., Grudzien P., Nasilowski P., Popek N., Cyrankiewicz W., Wawrzyniak K., Wnuk M., Maciejewski D., Studzinska D., Zukowski M., Bernas S., Piechota M., Nowak-Kozka I., Fronczek J., Serwa M., Stefaniak J., Wujtewicz M., Szymkowiak M., Adamik B., Polok K., Wludarczyk A., Gorka J., Kozera N., Gozdzik W., Catorze N., Branco M. C., Barros I., Barros N., Krystopchuk A., Honrado T., Sousa C., Munoz F., Rebelo M., Gomes R., Nunes J., Dias C., Fernandes A. M., Petrisor C., Constantin B., Belskiy V., Boskholov B., Rodriguez E., Rebollo S., Aguilar G., Masdeu G., Jaimes M. I., Mira A. P., Bodi M. A., Barea Mendoza J. A., Lopez-Cuenca S., Guzman M. H., Rico-Feijoo J., Alvarez J. T., Kawati R., Sivik J., Nauska J., Parenmark F., Lyren J., Rockstrohm K., Ryden S., Spangfors M., Strinnholm M., Walther S., De Geer L., Nordlund P., Palsson S., Zetterquist H., Nilsson A., Thiringer K., Jungner M., Bark B., Nordling B., Skold H., Brorsson C., Persson S., Bergstrom A., Berkius J., Holmstrom J., van Dijk I., Ramnarain D., Jansen T., Nooteboom F., van der Voort P. H. J., Dieperink W., de Waard M. C., de Smet A. G. E., Bormans L., Dormans T., Dempsey G., Mathew S. J., Raj A. S., Grecu I., Cupitt J., Lawton T., Clark R., Popescu M., Spittle N., Faulkner M., Cowton A., Elloway E., Williams P., Reay M., Chukkambotla S., Kumar R., Al-Subaie N., Kent L., Tamm T., Kajtor I., Burns K., Pugh R., Ostermann M., Kam E., Bowyer H., Smith N., Templeton M., Henning J., Goffin K., Kapoor R., Laha S., Chilton P., Khaliq W., Crayford A., Coetzee S., Tait M., Stoker W., Gimenez M., Pope A., Camsooksai J., Pogson D., Quigley K., Ritzema J., Hormis A., Boulanger C., Balasubramaniam M., Vamplew L., Burt K., Martin D., Craig J., Prowle J., Doyle N., Shelton J., Scott C., Donnison P., Shelton S., Frey C., Ryan C., Spray D., Barnes V., Barnes K., Ridgway S., Saha R., Clark T., Wood J., Bolger C., Bassford C., Lewandowski J., Zhao X., Humphreys S., Dowling S., Richardson N., Burtenshaw A., Stevenson C., Wilcock D., and Nalapko Y.
Abstract: Background: The number of intensive care patients aged ≥ 80 years (Very old Intensive Care Patients; VIPs) is growing. VIPs have high mortality and morbidity and the benefits of ICU admission are frequently questioned. Sepsis incidence has risen in recent years and identification of outcomes is of considerable public importance. We aimed to determine whether VIPs admitted for sepsis had different outcomes than those admitted for other acute reasons and identify potential prognostic factors for 30-day survival. Results: This prospective study included VIPs with Sequential Organ Failure Assessment (SOFA) scores ≥ 2 acutely admitted to 307 ICUs in 21 European countries. Of 3869 acutely admitted VIPs, 493 (12.7%) [53.8% male, median age 83 (81–86) years] were admitted for sepsis. Sepsis was defined according to clinical criteria; suspected or demonstrated focus of infection and SOFA score ≥ 2 points. Compared to VIPs admitted for other acute reasons, VIPs admitted for sepsis were younger, had a higher SOFA score (9 vs. 7, p < 0.0001), required more vasoactive drugs [82.2% vs. 55.1%, p < 0.0001] and renal replacement therapies [17.4% vs. 9.9%; p < 0.0001], and had more life-sustaining treatment limitations [37.3% vs. 32.1%; p = 0.02]. Frailty was similar in both groups. Unadjusted 30-day survival was not significantly different between the two groups. After adjustment for age, gender, frailty, and SOFA score, sepsis had no impact on 30-day survival [HR 0.99 (95% CI 0.86–1.15), p = 0.917]. Inverse-probability weight (IPW)-adjusted survival curves for the first 30 days after ICU admission were similar for acute septic and non-septic patients [HR: 1.00 (95% CI 0.87–1.17), p = 0.95]. A matched-pair analysis in which patients with sepsis were matched with two control patients of the same gender with the same age, SOFA score, and level of frailty was also performed. A Cox proportional hazard regression model stratified on the matched pairs showed that 30-day
Published: 2020

43. Survival prediction of patients with sepsis from age, sex, and septic episode number alone

Author: Chicco, D, Jurman, G, Chicco, D, and Jurman, G
Abstract: Sepsis is a life-threatening condition caused by an exaggerated reaction of the body to an infection, that leads to organ failure or even death. Since sepsis can kill a patient even in just one hour, survival prediction is an urgent priority among the medical community: even if laboratory tests and hospital analyses can provide insightful information about the patient, in fact, they might not come in time to allow medical doctors to recognize an immediate death risk and treat it properly. In this context, machine learning can be useful to predict survival of patients within minutes, especially when applied to few medical features easily retrievable. In this study, we show that it is possible to achieve this goal by applying computational intelligence algorithms to three features of patients with sepsis, recorded at hospital admission: sex, age, and septic episode number. We applied several data mining methods to a cohort of 110,204 admissions of patients, and obtained high prediction scores both on this complete dataset (top precision-recall area under the curve PR AUC = 0.966) and on its subset related to the recent Sepsis-3 definition (top PR AUC = 0.860). Additionally, we tested our models on an external validation cohort of 137 patients, and achieved good results in this case too (top PR AUC = 0.863), confirming the generalizability of our approach. Our results can have a huge impact on clinical settings, allowing physicians to forecast the survival of patients by sex, age, and septic episode number alone.
Published: 2020

44. Rapid isolation of rare targets from large fluid volumes

Author: Hedde, P, Bouzin, M, Abram, T, Chen, X, Toosky, M, Vu, T, Li, Y, Zhao, W, Gratton, E, Hedde P. N., Bouzin M., Abram T. J., Chen X., Toosky M. N., Vu T., Li Y., Zhao W., Gratton E., Hedde, P, Bouzin, M, Abram, T, Chen, X, Toosky, M, Vu, T, Li, Y, Zhao, W, Gratton, E, Hedde P. N., Bouzin M., Abram T. J., Chen X., Toosky M. N., Vu T., Li Y., Zhao W., and Gratton E.
Abstract: Rapidly isolating rare targets from larger, clinically relevant fluid volumes remains an unresolved problem in biomedicine and diagnosis. Here, we describe how 3D particle sorting can enrich targets at ultralow concentrations over 100-fold within minutes not possible with conventional approaches. Current clinical devices based on biochemical extraction and microfluidic solutions typically require high concentrations and/or can only process sub-milliliter volumes in time. In a proof-of-concept application, we isolated bacteria from whole blood as demanded for rapid sepsis diagnosis where minimal numbers of bacteria need to be found in a 1–10 mL blood sample. After sample encapsulation in droplets and target enrichment with the 3D particle sorter within a few minutes, downstream analyses were able to identify bacteria and test for antibiotic susceptibility, information which is critical for successful treatment of bloodstream infections.
Published: 2020

45. Open abdomen management for severe peritonitis in elderly. Results from the prospective International Register of Open Abdomen (IROA): Cohort study

Author: Rausei, S, Pappalardo, V, Ceresoli, M, Catena, F, Sartelli, M, Chiarugi, M, Kluger, Y, Kirkpatrick, A, Ansaloni, L, Coccolini, F, Montori, G, Salvetti, F, Fugazzola, P, Negoi, I, Zese, M, Occhionorelli, S, Shlyapnikov, S, Demetrashvili, Z, Dondossola, D, Ioannidis, O, Novelli, G, Nacoti, M, Khor, D, Inaba, K, Demetriades, D, Kaussen, T, Jusoh, A, Ghannam, W, Sakakushev, B, Guetta, O, Dogjani, A, Costa, S, Singh, S, Damaskos, D, Isik, A, Yuan, K, Trotta, F, Martinez-Perez, A, Bellanova, G, Fonseca, V, Hernandez, F, Marinis, A, Fernandes, W, Quiodettis, M, Bala, M, Vereczkei, A, Curado, R, Fraga, G, Pereira, B, Gachabayov, M, Chagerben, G, Arellano, M, Ozyazici, S, Costa, G, Tezcaner, T, Porta, M, Li, Y, Karateke, F, Manatakis, D, Mariani, F, Lora, F, Sahderov, I, Atanasov, B, Zegarra, S, Fattori, L, Ivatury, R, Xiao, J, Lippi, A, Improta, M, Gubbiotti, F, Zharikov, A, Dubuisson, V, Sugrue, M, Rausei S., Pappalardo V., Ceresoli M., Catena F., Sartelli M., Chiarugi M., Kluger Y., Kirkpatrick A., Ansaloni L., Coccolini F., Montori G., Salvetti F., Fugazzola P., Negoi I., Zese M., Occhionorelli S., Shlyapnikov S., Demetrashvili Z., Dondossola D., Ioannidis O., Novelli G., Nacoti M., Khor D., Inaba K., Demetriades D., Kaussen T., Jusoh A. C., Ghannam W., Sakakushev B., Guetta O., Dogjani A., Costa S., Singh S., Damaskos D., Isik A., Yuan K. -C., Trotta F., Martinez-Perez A., Bellanova G., Fonseca V. C., Hernandez F., Marinis A., Fernandes W., Quiodettis M., Bala M., Vereczkei A., Curado R., Fraga G. P., Pereira B. M., Gachabayov M., Chagerben G. P., Arellano M. L., Ozyazici S., Costa G., Tezcaner T., Porta M., Li Y., Karateke F., Manatakis D., Mariani F., Lora F., Sahderov I., Atanasov B., Zegarra S., Fattori L., Ivatury R., Xiao J., Lippi A., Improta M., Gubbiotti F., Zharikov A., Dubuisson V., Sugrue M., Rausei, S, Pappalardo, V, Ceresoli, M, Catena, F, Sartelli, M, Chiarugi, M, Kluger, Y, Kirkpatrick, A, Ansaloni, L, Coccolini, F, Montori, G, Salvetti, F, Fugazzola, P, Negoi, I, Zese, M, Occhionorelli, S, Shlyapnikov, S, Demetrashvili, Z, Dondossola, D, Ioannidis, O, Novelli, G, Nacoti, M, Khor, D, Inaba, K, Demetriades, D, Kaussen, T, Jusoh, A, Ghannam, W, Sakakushev, B, Guetta, O, Dogjani, A, Costa, S, Singh, S, Damaskos, D, Isik, A, Yuan, K, Trotta, F, Martinez-Perez, A, Bellanova, G, Fonseca, V, Hernandez, F, Marinis, A, Fernandes, W, Quiodettis, M, Bala, M, Vereczkei, A, Curado, R, Fraga, G, Pereira, B, Gachabayov, M, Chagerben, G, Arellano, M, Ozyazici, S, Costa, G, Tezcaner, T, Porta, M, Li, Y, Karateke, F, Manatakis, D, Mariani, F, Lora, F, Sahderov, I, Atanasov, B, Zegarra, S, Fattori, L, Ivatury, R, Xiao, J, Lippi, A, Improta, M, Gubbiotti, F, Zharikov, A, Dubuisson, V, Sugrue, M, Rausei S., Pappalardo V., Ceresoli M., Catena F., Sartelli M., Chiarugi M., Kluger Y., Kirkpatrick A., Ansaloni L., Coccolini F., Montori G., Salvetti F., Fugazzola P., Negoi I., Zese M., Occhionorelli S., Shlyapnikov S., Demetrashvili Z., Dondossola D., Ioannidis O., Novelli G., Nacoti M., Khor D., Inaba K., Demetriades D., Kaussen T., Jusoh A. C., Ghannam W., Sakakushev B., Guetta O., Dogjani A., Costa S., Singh S., Damaskos D., Isik A., Yuan K. -C., Trotta F., Martinez-Perez A., Bellanova G., Fonseca V. C., Hernandez F., Marinis A., Fernandes W., Quiodettis M., Bala M., Vereczkei A., Curado R., Fraga G. P., Pereira B. M., Gachabayov M., Chagerben G. P., Arellano M. L., Ozyazici S., Costa G., Tezcaner T., Porta M., Li Y., Karateke F., Manatakis D., Mariani F., Lora F., Sahderov I., Atanasov B., Zegarra S., Fattori L., Ivatury R., Xiao J., Lippi A., Improta M., Gubbiotti F., Zharikov A., Dubuisson V., and Sugrue M.
Abstract: Background: Analyzing the data of the International Register of Open Abdomen (IROA), the feasibility of open abdomen treatment has been demonstrated at every age. This new analysis on the IROA database investigates the risk factors for mortality in elderly patients treated with open abdomen for intra-abdominal infection. Methods: Data were derived from the IROA, a prospective observational international cohort study that enrolled patients treated with open abdomen worldwide. A univariate analysis of potential risk factors was performed. Inclusion criteria were patients older than 65 years and treated with open abdomen for intra-abdominal infection. End point was overall mortality, calculated within 30 days after open abdomen management, after 1-month and 1-year follow-up. Results: A total of 116 patients was analyzed with mean age of 76 ± 7 years. Definitive closure was achieved in 93 patients (93/116, 80.2%) for a mean open abdomen duration of 5.0 ± 5.0 days. Complicated patients were 101 (101/116, 87.1%) for a total of 201 complications. Overall, 62 out of 116 patients (53.4%) died: 23 patients (23/62, 37.1%) during open abdomen management, 29 patients (46.8%) within 30 days after abdominal closure, 9 patients (14.5%) after 1-month follow-up, and 1 patient (1.6%) after 1-year follow-up. Age did not affect mortality (75 ± 6 years in alive patients versus 77 ± 7 years in dead patients, p = 0.773). Definitive abdominal closure was the most important factor to prevent mortality. Conclusions: This study confirmed that age alone cannot be considered a determinant for death, even in elderly patients managed with open abdomen for severe intra-abdominal infection.
Published: 2020

46. Epidemiologic and clinical profiles of bacterial myocarditis. Report of two cases and data from a pooled analysis

Author: Ferrero, P, Piazza, I, Lorini, F, Senni, M, Ferrero P, Piazza I, Lorini F, Senni M, Ferrero, P, Piazza, I, Lorini, F, Senni, M, Ferrero P, Piazza I, Lorini F, and Senni M
Abstract: We aimed to characterize the epidemiology, diagnostic peculiarities and outcome determinants of bacterial myocarditis. Two cases from our institution and literature reports were collected ending up with a total of 66 cases. In 37 (56%) patients, the diagnosis was confirmed by magnetic resonance and histopathological criteria. The other patients were classified as having possible myocarditis. Only occurrence of rhythm disturbances was associated with the specific diagnosis of myocarditis (p = 0.04). Thirty-two (48%) patients presented with severe sepsis that was associated with a worse prognosis. At multivariate analysis, left ventricular ejection fraction (LVEF) at admission and heart rhythm disturbances were associated with incomplete recovery (odds ratio (OR) 1.1, 95% (CI) 1.03–1.2, p = 0.004 and OR 6.6, 95% CI 1.35–32.5, p = 0.02, respectively). In summary, bacterial myocarditis is uncommon. Most commonly, it is secondary to septic dissemination of bacteria or to transient secondary myocardial toxicity.
Published: 2020

47. Managing adult patients with infectious diseases in emergency departments: international ID-IRI study

Author: Cernat Roxana Carmen, Sholpan Kulzhanova, Yasemin Cag, Mohamed Elhassan Abbas Dafalla, Ozay Akyildiz, Amani El-Kholy, Ainur Sadykova, Ahmed Ashraf Wegdan, Anna Liskova, Jordi Rello, Fatma A. Amer, Ilyas Dokmetas, Behrouz Naghili, Natalia Dirani, Svjetlana Grgić, Michael M. Petrov, Sevil Alkan Ceviker, Jameela Alsalman, Jehan El-Kholy, Hakan Hasman, Serkan Oncu, Abu Hena Mostafa Kamal, Kalyan Koganti, Yasemin Yildiz-Kirazaldi, Mateja Jankovic Makek, Hulya Caskurlu, Rusmir Baljic, Selda Aslan, Razi Even Dar, Sergio Ramirez-Estrada, Mateja Logar, Cansu Bulut-Avsar, Joanna Zajkowska, Rosa Fontana Del Vecchio, Handan Alay, Aidos K Konkayev, Marzena Wojewodzka-Zelezniakowicz, Sally Hargreaves, Hakan Erdem, Amjad Mahboob, Ferran Llopis, Dumitru Irina Mgdalena, Ergys Ramosaco, Dilek Bulut, Ameen S. S. Alwashmi, Nikolay Mladenov, Esam Abdalla, Nirav Pandya, Lorenza Lambertenghi, Mustafa Altindiş, Hema Prakash Kumari, Andrea Marino, Yvon Ruch, Filiz Kizilates, Dirar Abdallah, Emine Kubra Dindar-Demiray, Antonio Cascio, Meliha Meric-Koc, Asiye Bahar-Kacmaz, Rehab H. El-Sokkary, Meltem Taşbakan, Ridvan Karaali, Handan Ankarali, Helena Monzón-Camps, Ilad Alavi-Darazam, Ghaydaa A. Shehata, Merve Sefa-Sayar, Fatma Kesmez-Can, Ege Üniversitesi, MERİÇ KOÇ, MELİHA, Erdem H., Hargreaves S., Ankarali H., Caskurlu H., Ceviker S.A., Bahar-Kacmaz A., Meric-Koc M., Altindis M., Yildiz-Kirazaldi Y., Kizilates F., Alsalman J., Cag Y., Kamal A.H.M., Dokmetas I., Dindar-Demiray E.K., Shehata G.A., Hasman H., Sadykova A., Llopis F., Ramosaco E., Logar M., Alay H., Kesmez-Can F., Ruch Y., Bulut D., Makek M.J., Marino A., Mahboob A., El-Kholy A., Abdallah D., Sefa-Sayar M., Karaali R., Aslan S., Dar R.E., Abdalla E., Monzon-Camps H., Baljic R., Mgdalena D.I., Naghili B., Abbas Dafalla M.E., Alwashmi A.S.S., Carmen C.R., Ramirez-Estrada S., Wojewodzka-Zelezniakowicz M., Akyildiz O., Zajkowska J., El-Sokkary R., Pandya N., Amer F., Alavi-Darazam I., Grgic S., Wegdan A.A., El-Kholy J., Bulut-Avsar C., Kulzhanova S., Tasbakan M., Kumari H.P., Dirani N., Koganti K., Konkayev A.K., Petrov M.M., Cascio A., Liskova A., Del Vecchio R.F., Lambertenghi L., Mladenov N., Oncu S., and Rello J.
Subjects: 0301 basic medicine, Point prevalence survey, medicine.medical_specialty, Urologic Neoplasms, Referral, international ID-IRI study-, JOURNAL OF CHEMOTHERAPY, 2021 [Erdem H., Hargreaves S., ANKARALI H., ÇAŞKURLU H., Ceviker S. A. , Bahar-Kacmaz A., Meric-Koc M., ALTINDİŞ M., Yildiz-Kirazaldi Y., Kizilates F., et al., -Managing adult patients with infectious diseases in emergency departments], medicine.drug_class, Organ Dysfunction Scores, 030106 microbiology, Antibiotics, Practice Patterns, emergency, antibiotic, elderly, infection, sepsis, treatment, Global Health, Communicable Diseases, Sepsis, Hospital, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, Pharmacology (medical), Practice Patterns, Physicians', Developing Countries, Respiratory Tract Infections, Pharmacology, Emergency Service, Physicians', Adult patients, business.industry, Patient Acuity, Antimicrobial, medicine.disease, humanities, Drug Utilization, Anti-Bacterial Agents, Infectious Diseases, Oncology, 030220 oncology & carcinogenesis, Emergency medicine, Emergency, sepsi, business, Emergency Service, Hospital
Abstract: We aimed to explore factors for optimizing antimicrobial treatment in emergency departments. A single-day point prevalence survey was conducted on January 18, 2020, in 53 referral/tertiary hospitals in 22 countries. 1957 (17%) of 11557 patients presenting to EDs had infections. The mean qSOFA score was 0.37 +/- 0.74. Sepsis (qSOFA >= 2) was recorded in 218 (11.1%) patients. The mean qSOFA score was significantly higher in low-middle (1.48 +/- 0.963) compared to upper-middle (0.17 +/- 0.482) and high-income (0.36 +/- 0.714) countries ( P < 0.001). Eight (3.7%) patients with sepsis were treated as outpatients. The most common diagnoses were upper-respiratory (n = 877, 43.3%), lower-respiratory (n = 316, 16.1%), and lower-urinary (n = 201, 10.3%) infections. 1085 (55.4%) patients received antibiotics. The most-commonly used antibiotics were beta-lactam (BL) and BL inhibitors (n = 307, 15.7%), third-generation cephalosporins (n = 251, 12.8%), and quinolones (n = 204, 10.5%). Irrational antibiotic use and inappropriate hospitalization decisions seemed possible. Patients were more septic in countries with limited resources. Hence, a better organizational scheme is required.
Published: 2021

48. Serum ferritin levels in inflammation: a retrospective comparative analysis between COVID-19 and emergency surgical non-COVID-19 patients

Author: Patrizio Capelli, Filippo Banchini, and Gaetano Maria Cattaneo
Subjects: Male, Hepcidin, Group A, Gastroenterology, Group B, 0302 clinical medicine, COVID-19 Testing, Interquartile range, Leukocytosis, COVID, Aged, 80 and over, 0303 health sciences, biology, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Transferrin, Middle Aged, COVID-19, Ferritin, Iron, Surgery, Sepsi, SARS-CoV-2, Surgical Procedures, Operative, Emergency Medicine, Female, medicine.symptom, Research Article, Adult, medicine.medical_specialty, lcsh:Surgery, 03 medical and health sciences, Internal medicine, medicine, Humans, 030304 developmental biology, Aged, Retrospective Studies, Inflammation, business.industry, Case-control study, 030208 emergency & critical care medicine, Retrospective cohort study, lcsh:RD1-811, lcsh:RC86-88.9, medicine.disease, Case-Control Studies, Ferritins, biology.protein, Emergencies, Cytokine storm, business, Biomarkers
Abstract: Background SARS-CoV-2 infection has spread worldwide, and the pathogenic mechanism is still under investigation. The presence of a huge inflammatory response, defined as “cytokine storm,” is being studied in order to understand what might be the prognostic factors implicated in the progression of the infection, with ferritin being one of such markers. The role of ferritin as a marker of inflammation is already known, and whether it changes differently between COVID and non-COVID patients still remains unclear. The aim of this retrospective analysis is to understand whether the inflammatory process in these two types is different. Methods In this retrospective analysis, we compared 17 patients affected by SARS-CoV-2, who had been admitted between February and April 2020 (group A) along with 30 patients admitted for acute surgical disease with SARS-CoV-2 negative swab (group B). A further subgroup of Covid negative patients with leukocytosis was compared to group A. Results In group A, the median (interquartile range) serum ferritin was 674 (1284) ng/mL, and it was double the cutoff (300 ng/mL) in 9 out of 17 (52%). The median (IQR) value of ferritin level in the total blood samples of group B was 231, and in the subgroup with leucocytosis, 149 (145). Group A showed a significantly higher ferritin median level compared to the entire group B (two-tailed Mann-Whitney test, p p Conclusions The role of iron metabolism appears to be directly involved in COVID infection. On the other hand, in the acute inflammation of patients admitted for surgery, and probably in other common phlogistic processes, iron modifications appear to be self-limited. However, our finding suggests the use of ferritin as a marker for COVID infection.
Published: 2021

49. Serious infectious events and ibuprofen administration in pediatrics: a narrative review in the era of COVID-19 pandemic

Author: Massimo Martinelli, Annamaria Staiano, Lucia Quaglietta, Quaglietta, Lucia, Martinelli, Massimo, and Staiano, Annamaria
Subjects: Pediatrics, medicine.medical_specialty, COVID19, Sepsi, Ibuprofen, Review, 030204 cardiovascular system & hematology, Cystic fibrosis, Communicable Diseases, Communicable Disease, Sepsis, 03 medical and health sciences, 0302 clinical medicine, Chickenpox, medicine, Humans, 030212 general & internal medicine, Adverse effect, Child, book, Pandemics, Pediatric, Pandemic, business.industry, SARS-CoV-2, organic chemicals, Anti-Inflammatory Agents, Non-Steroidal, lcsh:RJ1-570, COVID-19, lcsh:Pediatrics, General Medicine, Pneumonia, medicine.disease, COVID-19 Drug Treatment, Tolerability, Cystic fibrosi, Pediatric Infectious Disease, book.journal, business, medicine.drug, Human
Abstract: Purpose of review Despite its recognized efficacy and tolerability profile, during the last decade a rise of adverse events following ibuprofen administration in children has been reported, including a possible role in worsening the clinical course of infections. Our aim was to critically evaluate the safety of ibuprofen during the course of pediatric infectious disease in order to promote its appropriate use in children. Recent findings Ibuprofen is associated with severe necrotizing soft tissue infections (NSTI) during chickenpox course. Pre-hospital use of ibuprofen seems to increase the risk of complicated pneumonia in children. Conflicting data have been published in septic children, while ibuprofen in the setting of Cystic Fibrosis (CF) exacerbations is safe and efficacious. No data is yet available for ibuprofen use during COVID-19 course. Summary Ibuprofen should not be recommended for chickenpox management. Due to possible higher risks of complicated pneumonia, we suggest caution on its use in children with respiratory symptoms. While it remains unclear whether ibuprofen may have harmful effects during systemic bacterial infection, its administration is recommended in CF course. Despite the lack of data, it is seems cautious to prefer the use of paracetamol during COVID-19 acute respiratory distress syndrome in children.
Published: 2021

50. Mesenchymal Stromal Cell-Mediated Treatment of Local and Systemic Inflammation through the Triggering of an Anti-Inflammatory Response

Author: Ennio Tasciotti, Francesca Taraballi, Roberto Molinaro, Claudia Corbo, Guillermo Bauza, Xuewu Liu, Ava Brozovich, Michael Evangelopoulos, Jonathan O. Martinez, Martinez, J, Evangelopoulos, M, Brozovich, A, Bauza, G, Molinaro, R, Corbo, C, Liu, X, Taraballi, F, and Tasciotti, E
Subjects: Stromal cell, Materials science, Mesenchymal stem cell, nanovector, Inflammation, Condensed Matter Physics, medicine.disease, Systemic inflammation, Electronic, Optical and Magnetic Materials, Biomaterials, Sepsis, Anti-inflammatory response, inflammation, Drug delivery, drug delivery, Electrochemistry, medicine, Cancer research, mesenchymal stromal/stem cell, sepsi, medicine.symptom
Abstract: The emergence of cell-based therapeutics, specifically the use of mesenchymal stromal/stem cells (MSCs), stands to significantly affect the future of targeted drug delivery technologies. MSCs represent a unique cell type, offering more than only regenerative potential but also site-specific inflammatory targeting and tissue infiltration. In this study, a versatile multicomponent delivery platform, combining MSC tropism with multistage nanovector (MSV)-mediated payload delivery, is debuted. It is demonstrated that the incorporation of drug-loaded MSVs bestows MSCs with the ability to transport anti-inflammatory payloads, achieving a fivefold increase in payload release without negatively impacting cellular functions, viability, extravasation, and inflammatory homing. When incorporated within MSCs, MSVs avoid rapid sequestration by filtering organs and conserve a 15-fold increase in local inflammatory targeting compared to healthy ears. Furthermore, this MSC-mediated MSV platform (M&Ms) rapidly triggers a 4.5-fold reduction of local inflammation compared to free drug and extends survival to 100% of treated mice in a lethal model of systemic inflammation.
Published: 2021

Catalog

Books, media, physical & digital resources

See catalog results

Searchworks

Select search scope, currently: Articles Catalog books, media & more in Jio Institute collections Articles journal articles & other e-resources

Search

Search Constraints

Refine your results

Search Limiters

Topic

Publication Year Range

Language

Publication Type

Journal

Region

Database

Publisher

362 results on '"sepsi"'

Search Results

Catalog

Select search scope, currently: Articles

Catalog

books, media & more in Jio Institute collections

Articles

journal articles & other e-resources