2,833 publications from this institution
Th e fi rst ever World Sepsis Day (WSD), a great opportunity to increase awareness about sepsis, is going to be held on Sept. 13. We already have World Diabetes Day, Breast Cancer Awareness Day, World Asthma Day, World AIDS day, even a Rare Disease Day, so why not a day dedicated especially to sepsis? After all, sepsis is estimated to aff ect at least 18 million individuals worldwide, and with mortality rates of 25% to 30% [1,2], severe sepsis kills more individuals annually than prostate cancer, breast cancer, and HIV/AIDS combined, and the numbers of cases are increasing every year. Yet it is a condition that is poorly understood by those outside of medicine. Almost 90% of the public have never even heard of sepsis, and of those who have, less than 60% realize it is a leading cause of death But if the condition is diagnosed early and managed appropriately, lives can be saved.
Phosphorus is a mineral element essential to cellular function. The prevalence of hypophosphatemia is particularly high in critically ill patients. Hypophosphatemia may be the result of increased renal excretion, reduced digestive absorption, intracellular shift accompanied or not by depletion of the total phosphorus pool, and extreme catabolic states. Clinical manifestations are especially apparent in severe hypophosphatemia and include impairments of the respiratory, musculo-skeletal, pulmonary, and neurological systems. Hypophosphatemia must be corrected, especially if it is severe and symptomatic.
Plasma endotoxin and lipopolysaccharide-binding protein (LBP) levels were measured in a group of 253 patients at the onset of severe sepsis and/or septic shock. Endotoxin levels were significantly greater than control levels (n=33; mean +/- SD, 5.1+/-7.3 pg/mL) in 78.3% of patients. Median endotoxin levels in patients with sepsis were 300 pg/mL (25%-75% interquartile range, 110-726 pg/mL). LBP levels were elevated in 97% of patients compared with normal control values of 4.1+/-1.65 microgram/mL. Median LBP levels in patients with sepsis were 31.2 microgram/mL (interquartile range, 22.5-47.7 microgram/mL). Median endotoxin levels at study entry were more highly elevated (515 vs. 230 pg/mL; P<.01), and LBP levels were less highly elevated (28.0 vs. 33.2 microgram/mL; P<.05) in nonsurvivors than survivors over the 28-day study period. No correlation was found between endotoxin and LBP levels. The quantitative level of both endotoxin and LBP may have prognostic significance in patients with severe sepsis.
Over the last 100 years, huge advances have been made in the field of sepsis in terms of pathophysiology, epidemiology, diagnosis, monitoring, and therapeutics. Here, we offer our perspective of the key changes and current situation in each of these areas. Despite these changes, mortality rates remain unacceptably high and continued progress, particularly in early diagnosis and therapy, is urgently needed.
A randomized, multicenter trial conducted in 32 northern European general intensive care units (ICUs) enrolled some patients with septic shock randomly assigned to receive a red blood cell transfusion when the hemoglobin (Hb) level was ≤7 g/dL ("lower threshold"; N.=502) or ≤9 g/dL ("higher threshold"; N.=496) throughout the ICU stay. Patients were excluded if they had an acute coronary syndrome, life-threatening bleeding, acute burn injury, had already been transfused or had previously experienced transfusion-related reactions. The two groups of patients had comparable severity of disease scores and chronic cardiovascular conditions. Median Hb values were 7.7 g/dL in the lower and 9.3 g/dL in the higher threshold groups and these values remained stable during the study period. There was no significant difference in 90-day mortality (primary end-point) between the two groups (216/502, 43.0% in the lower vs. 223/496, 45.0% in the higher group, RR 0.94 [95% CI: 0.78-1.09; P=0.44]), even after adjustment for several confounders. In the higher threshold group, approximately twice as many transfusions were given (3088 vs. 1545 units transfused, P<0.001) as in the lower threshold group. In the lower threshold group, more patients received no RBC transfusion (36% vs. 1.2%, P<0.001) than in the higher threshold group, but there were also more temporary protocol suspensions (5.9 % vs. 2.2%, P=0.004), in particular because of myocardial ischemia (6/488, 1.2% vs. 0/489), life-threatening bleeding (18/488, 3.7% vs. 9/489, 1.8%) and need for higher Hb levels during extracorporeal membrane oxygenation therapy. We discuss how anemia should be managed in patients with sepsis or other critical illness, especially in the context of the potential risks associated with RBC transfusion and data from other recent large randomized trials.
info:eu-repo/semantics/published
Sepsis is a common and serious complication in intensive care unit patients. An important factor in optimizing survival rates in septic patients is the ability to start treatment early in the course of disease; there is, therefore, a need for accurate diagnostic tests. In recent years, there has been a move away from the rather vague and nonspecific signs that were previously used to diagnose sepsis towards the possible adjunctive role of biomarkers. Many biomarkers have been proposed and assessed clinically, but none alone is specific enough to definitively determine diagnosis. The future direction of research is most likely a greater focus on the use of panels or combinations of markers with clinical signs. Some biomarkers may also be useful for prognosis and guiding therapy. Here, the authors will review our changing approaches to sepsis diagnosis and discuss some of the markers that seem most relevant at the present time.
