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31 ud af 31 tidsskrifter valgt, søgeord (sofa) valgt, emner højest 180 dage gamle, sorteret efter nyeste først. Opdateret for 9 timer siden.17 emner vises.
The seasonal influenza epidemic is an important public health issue worldwide. Early predictive identification of patients with potentially worse outcome is important in the emergency department (ED). Similarly as with bacterial infection, influenza can cause sepsis. This study was conducted to investigate the effectiveness of the Systemic Inflammatory Response Syndrome (SIRS) criteria and the quick Sequential Organ Failure Assessment (qSOFA) score as prognostic predictors for ED patients with influenza.
This single-center, retrospective cohort study investigated data that was retrieved from a hospital-based research database. Adult ED patients (age ≥ 18 at admission) with laboratory-proven influenza from 2010 to 2016 were included for data analysis. The initial SIRS and qSOFA scores were both collected. The primary outcome was the utility of each score in the prediction of in-hospital mortality.
For the study period, 3561 patients met the study inclusion criteria. The overall in-hospital mortality was 2.7% (95 patients). When the qSOFA scores were 0, 1, 2, and 3, the percentages of in-hospital mortality were 0.6, 7.2, 15.9, and 25%, respectively. Accordingly, the odds ratios (ORs) were 7.72, 11.92, and 22.46, respectively. The sensitivity and specificity was 24 and 96.2%, respectively, when the qSOFA score was ≥2. However, the SIRS criteria showed no significant associations with the primary outcome. The area under the receiver operating characteristic curve (AUC) was 0.864, which is significantly higher than that with SIRS, where the AUC was 0.786 (P
The study aimed to investigate the predictive value of the quick sequential organ failure assessment (qSOFA) for clinical outcomes in emergency patients with community-acquired pneumonia (CAP).
A total of 742 CAP cases from the emergency department (ED) were enrolled in this study. The scoring systems including the qSOFA, SOFA and CURB-65 (confusion, urea, respiratory rate, blood pressure and age) were used to predict the prognostic outcomes of CAP in ICU-admission, acute respiratory distress syndrome (ARDS) and 28-day mortality. According to the area under the curve (AUC) of the receiver operating characteristic (ROC) curves, the accuracies of prediction of the scoring systems were analyzed among CAP patients.
The AUC values of the qSOFA, SOFA and CURB-65 scores for ICU-admission among CAP patients were 0.712 (95%CI: 0.678–0.745, P
Fei Zhou, Ting Yu, Ronghui Du, Guohui Fan, Ying Liu, Zhibo Liu, Jie Xiang, Yeming Wang, Bin Song, Xiaoying Gu, Lulu Guan, Yuan Wei, Hui Li, Xudong Wu, Jiuyang Xu, Shengjin Tu, Yi Zhang, Hua Chen, Bin Cao
The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future.
Chang, Y.-Y., Yang, Y.-S., Wu, S.-L., Wang, Y.-C., Chen, T.-L., on behalf of the ACTION study group, Lee, Y.-T.
Carbapenems are currently the preferred agents for the treatment of serious Acinetobacter infections. However, whether cefepime/cefpirome can be used to treat Acinetobacter bloodstream infection (BSI) if it is active against the causative pathogens is not clear. This study aimed to compare the efficacy of cefepime/cefpirome and carbapenem monotherapy in patients with Acinetobacter BSI. The population included 360 patients with monomicrobial Acinetobacter BSI receiving appropriate antimicrobial therapy admitted to four medical centres in Taiwan in 2012–2017. The predictors of 30-day mortality were determined by Cox regression analysis. The overall 30-day mortality rate in the appropriate antibiotic treatment group was 25.0% (90/360 patients), respectively. The crude 30-day mortality rates for cefepime/cefpirome and carbapenem therapy were 11.5% (7/61 patients) and 26.3% (21/80 patients), respectively. The patients receiving cefepime/cefpirome/carbapenem therapy were infected by Acinetobacter nosocomialis (51.8%), A. baumannii (18.4%) and A. pittii (12.1%). After adjusting for age, Sequential Organ Failure Assessment (SOFA) score, invasive procedures, and underlying diseases, cefepime/cefpirome therapy was not independently associated with a higher or lower 30-day mortality compared to the carbapenem therapy. SOFA score (hazard ratio [HR], 1.324; 95% confidence interval [CI], 1.137–1.543; P < 0.001) and neutropenia (HR, 7.060; 95% CI, 1.607–31.019; P = 0.010) were independent risk factors for 30-day mortality of patients receiving cefepime/cefpirome or carbapenem monotherapy. The incidence density of 30-day mortality for cefepime/cefpirome versus carbapenem therapy was 0.40% versus 1.04%. The therapeutic response of cefepime/cefpirome therapy was comparable to that of carbapenems among patients with Acinetobacter BSI receiving appropriate antimicrobial therapy.
Azevedo do Carmo T, Bonifácio Brige Ferreira I, Carvalho de Menezes R, et al.
AbstractBackgroundSeverity stratification scores developed in Intensive Care Units (ICUs) are used in interventional studies to identify the most critically ill. Studies that evaluate accuracy of these scores in ICU patients admitted with pneumonia are lacking. This study aims to determine performance of severity scores as predictors of mortality in critically ill patients admitted with pneumonia.MethodsProspective cohort study in a general ICU in Brazil. ICU severity scores (SAPS 3 and qSOFA), prognostic scores of pneumonia (CURB-65 and CRB-65), clinical and epidemiological variables in the first 6 hours of hospitalization were analyzed.ResultsA total of 200 patients were included between August 2015 and July 2018 with a median age of 81 years (IQR 67-90) and female predominance (52%) primarily admitted from the emergency department (65%) with community acquired pneumonia (80.5%). Poor discriminative performance in predicting mortality was found with SAPS 3, CURB-65, CRB-65 and qSOFA. Multivariate regression identified variables independently associated with mortality that were used to develop a novel pneumonia specific ICU severity score (Pneumonia SHOCK score) that outperformed SAPS3, CURB-65 and CRB-65 (AUC 0.80 vs 0.74, 0.65 and 0.63, respectively). Discriminate function of the Pneumonia SHOCK score was validated in an external multi-center cohort of critically ill patients admitted with community acquired pneumonia (AUC 0.81).ConclusionsWe created a parsimonious score system that accurately identifies elderly and non-elderly patients with pneumonia at highest risk of ICU death. These findings are critical to accurately stratify patients with severe pneumonia in therapeutic trials that aim to reduce pneumonia mortality.
Lind M, Phipps A, Mooney S, et al.
AbstractBackgroundSepsis, a life-threatening immunological response to an infection, disproportionality affects allogeneic hematopoietic cell transplant (HCT) recipients and is challenging to define. Clinical criteria that predict mortality and intensive care unit endpoints in patients with suspected infections (SI) have been adopted in sepsis definitions, but their predictive value among immunocompromised populations is largely unknown. Here, we evaluate three criteria among allogeneic HCT recipients.MethodsWe evaluated Systemic Inflammatory Response Syndrome (SIRS), quick-Sequential Organ Failure Assessment (qSOFA), and National Early Warning Score (NEWS) criteria in relation to short-term mortality among HCT recipients with SIs. Data from the first 100-days post-transplant were analyzed for patients transplanted between September 2010 - July 2017. We used the following cut-points (qSOFA/SIRS: 2+; NEWS: 7+) and restricted to first SI per hospital encounter.ResultsOf the 880 HCT recipients who experienced ≥ 1 SI, 58 (6.6%) died within 28 days and 22 (2.5%) within 10 days of a SI. In relation to 10-day mortality, SIRS was the most sensitive: 91.3% (95% CI:72.0 – 98.9%) but least specific: 35.0% (32.6 – 37.5%) whereas qSOFA was the most specific: 90.5% (88.9 – 91.9%) but least sensitive: 47.8% (26.8 – 69.4%). NEWS was moderately sensitive 78.3% (56.3 – 92.5%) and specific 70.2% (67.8 – 72.4%).ConclusionNEWS outperformed qSOFA and SIRS, but all three criteria had low to moderate predictive accuracy and the magnitude of the known predictive limitations of qSOFA and SIRS were at least as large as in general populations. Our data suggest that population-specific sepsis criteria are needed for immunocompromised patients.
Rehberg S, Morelli A, Jansen G.
To the Editor Compared with placebo, the nonadrenergic vasopressor angiotensin II was shown to increase mean arterial pressure after 3 hours in patients with vasodilatory shock in the Angiotensin II for the Treatment of High-Output Shock (ATHOS-3) trial (primary end point). In addition, angiotensin II also reached the secondary goal of a greater reduction in the cardiovascular Sequential Organ Failure Assessment (SOFA) score after 48 hours vs placebo. As a consequence, research with angiotensin II continued and it was approved by the US Food and Drug Administration.
Cohen I, Mello MM.
In Reply We agree with Mr Kels that HIPAA has involved burdens for physicians—some real and others amplified by uncertainty and fear of liability. However, Kels misread our Viewpoint insofar as he suggests that we are arguing for a private right of action to increase physicians’ liability under HIPAA. Such a move would do little to help regulate many uses of health data by technology companies because they fall outside HIPAA’s scope.
In the Preliminary Communication entitled “Effect of Vitamin C Infusion on Organ Failure and Biomarkers of Inflammation and Vascular Injury in Patients With Sepsis and Severe Acute Respiratory Failure: The CITRIS-ALI Randomized Clinical Trial” published in the October 1, 2019, issue of JAMA, data in Table 1 for vasopressor use and mSOFA scores were incorrect. In addition, a unit of measure was incorrectly added to an mSOFA score in the legend to Figure 2. This article has been corrected online.
Carrie, C., Delzor, F., Roure, S., Dubuisson, V., Petit, L., Molimard, M., Breilh, D., Biais, M.
OBJECTIVE: To assess the appropriateness of recommended regimens for empirical MIC coverage in critically ill patients with open abdomen and negative pressure therapy (OA/NPT).METHODS: Over a 5-year period, every critically ill patient who received amikacin and who underwent therapeutic drug monitoring (TDM) while treated by OA/NPT was retrospectively included. A population PK modelling was performed considering the effect of ten covariates (age, sex, TBW, ABW, BSA, modified SOFA score, vasopressor use, CLCr, fluid balance and amount of fluids collected by the NPT over the sampling day) in patients who underwent or not continuous renal replacement therapy (CRRT). Monte Carlo simulations were employed to determine the fractional target attainment (FTA) for the PK/PD targets (Cmax/MIC ratio ≥ 8 and AUC0-24h/MIC ≥ 75).RESULTS: Seventy critically ill patients treated by OA/NPT (contributing for 179 concentration values) were included. Amikacin PK concentrations were best described by a two-compartment model with linear elimination and proportional residual error, with CLCR and ABW as significant covariates for Vd and CLCR for CL. The reported volume of distribution (Vd) in non-CRRT and CRRT patients was 35.8 and 40.2 L respectively. In Monte Carlo simulations, ABW-adjusted doses between 25 and 35 mg/kg were needed to reach an FTA > 85% for various renal functions.CONCLUSION: Despite an increased Vd and a wide inter-individual variability, desirable PK/PD targets may be achieved using an ABW-pondered loading dose of 25 - 30 mg/kg. When targeting less susceptible pathogens, higher dosing regimens are probably needed in ARC patients. Further studies are needed to assess the effect of OA/NPT in PK parameters of antimicrobial agents.
Gong Y, Yan X, Sun X, et al.
AbstractBackgroundOncostatin-M (OSM) is a pleiotropic cytokine of the IL-6 family. The role of OSM in sepsis remains unknown.MethodsSerum OSM level was determined and analyzed in septic patients on day of intensive care unit (ICU) admission. Furthermore, the effects of OSM on polymicrobial sepsis induced by cecal ligation and puncture (CLP) were assessed.ResultsOn day of ICU admission, septic patients had significantly higher serum OSM levels when compared with ICU patient controls and healthy volunteers, which were related to the severity of sepsis, including parameters such as the Sequential [Sepsis-related] Organ Failure Assessment (SOFA) score, procalcitonin (PCT) level, and white blood cell (WBC) number. A high serum OSM level on ICU admission was associated with 28-day mortality in septic patients. In CLP-induced polymicrobial sepsis, anti-OSM antibody decreased tissue inflammation and injury, and thus improved survival, while local and systemic bacterial dissemination was almost constant. Complementarily, supplementation with recombinant OSM protein in septic mice increased tissue injury, amplified inflammation, and worsened mortality after CLP, while it did not affect bacterial dissemination in septic mice.ConclusionsSepsis results in an increased production of OSM, which might be a potential prognostic biomarker and therapeutic target for sepsis.
Tsolaki, V., Mantzarlis, K., Mpakalis, A., Malli, E., Tsimpoukas, F., Tsirogianni, A., Papagiannitsis, K., Zygoulis, P., Papadonta, M.-E., Petinaki, E., Makris, D., Zakynthinos, E.
Data on the effectiveness of ceftazidime-avibactam (CAZ-AVI) in critically ill, mechanically ventilated patients are limited. The present retrospective observational cohort study, which was conducted in two general Intensive Care Units (ICUs) in central Greece, compared critically-ill, mechanically ventilated patients suffering from carbapenem-resistant enterobacteriaceae (CRE) infections receiving CAZ-AVI to patients who received appropriate available antibiotic therapy. Clinical, microbiological outcomes and safety issues were evaluated. A secondary analysis in patients with blood stream infections (BSI) was conducted. Forty-one patients that received CAZ-AVI (CAZ-AVI group) were compared to thirty-six patients receiving antibiotics other than CAZ-AVI (control group). There was significant improvement in the SOFA score on Day 4 and 10 in the CAZ-AVI compared to the control group (p=0.006, and p=0.003 respectively). Microbiological eradication was accomplished in 33/35 (94.3%) in CAZ-AVI group vs 21/31 (67.7%) patients in control group (p=0.021) and clinical cure was observed in 33/41 (80.5%) vs 19/36 (52.8%) patients (p=0.010), respectively. The results were similar in BSI subgroups for both outcomes (p=0.038 and p=0.014, respectively). 28-day survival was 85.4% in the CAZ-AVI and 61.1% in the control group (log Rank=0.035), while there were 2 and 12 relapses in each group (p=0.042). A CAZ-AVI containing regime was independent predictor of survival and clinical cure (OR 5.575, p=0.012 and OR 5.125, p=0.004, respectively) along with illness severity. In conclusion, no significant side effects were reported. A CAZ-AVI containing regime is more effective than other available antibiotic agents for the treatment of CRE infections in the high-risk, mechanically-ventilated, ICU population.
Ymkje Stienstra, Dorien T Beeres, Richard Phillips, Machiel Vonk, Sofanne J Ravensbergen
We read the Article by David Engelman and colleagues1 with interest. Their overview of the key operational research questions to develop a global control programme for scabies provides a clear research agenda for the years to come.1 Mass drug administration (MDA) using ivermectin reduced the prevalence of both scabies and impetigo tremendously in Fiji with a sustained effect even 24 months after the intervention.2 Future studies should prioritise the inclusion of non-island populations.
Fei Peng, Wei Chang, Chun Pan, Yi Yang
We appreciated the comments by Dr van Oers and colleagues concerning the effect of PCT-guided cessation of antibiotics in patients with the SOFA score less than 8. Our meta-analysis revealed that PCT-guided cessation of antibiotic therapy decreased the short-term mortality in patients with an average SOFA score < 8, suspected sepsis or lower algorithm adherence (< 70%), but not in those with a score > 8, confirmed sepsis or higher adherence(Peng et al., 2019). Compared to the standard care group, PCT-guided antibiotic therapy failed to decrease the mortality or shorten the ICU length of stay, as previous trials reported(Bouadma et al., 2010; Jensen et al., 2011; Bloos et al., 2016).
Jos A.H. van Oers, Maarten W Nijsten, Evelien de Jong, Albertus Beishuizen, Dylan W de Lange
John F. McNamara, Patrick NA. Harris, Mark D. Chatfield, Penelope Lorenc, David L. Paterson
To evaluate the sequential organ failure assessment (SOFA), modified SOFA scoring and a novel performance score based on the Karnofsky score for measuring outcome following a bloodstream infection.
Emily Herrett, Sarah Gadd, Rod Jackson, Krishnan Bhaskaran, Elizabeth Williamson, Tjeerd van Staa, Reecha Sofat, Adam Timmis, Liam Smeeth
A cardiovascular risk-based strategy (QRISK2 ≥10%) could prevent over a third more cardiovascular disease events than the 2011 NICE guideline and a fifth more than the 2019 NICE guideline, with similar efficiency regarding number treated per event avoided.
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