RESUMEN
Rhabdomyolysis is a clinical condition characterized by the release of intracellular content into the bloodstream, resulting in the breakdown of skeletal muscle. The released intracellular content includes electrolytes, enzymes, and myoglobin, leading to systemic complications. The clinical presentation may vary, ranging from an asymptomatic increase in serum levels of enzymes released from damaged muscles to worrisome conditions such as volume depletion, metabolic and electrolyte abnormalities, and acute kidney injury. The diagnosis is confirmed when the serum creatine kinase (CK) level is > 1000 U/L or at least 5x the upper limit of normal. In this study, we aimed to evaluate a 21-year-old female patient presenting with nontraumatic exercise-unrelated rhabdomyolysis, accompanied by acute renal failure and septic shock.
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Lesión Renal Aguda , Rabdomiólisis , Choque Séptico , Humanos , Femenino , Rabdomiólisis/diagnóstico , Rabdomiólisis/etiología , Rabdomiólisis/terapia , Choque Séptico/diagnóstico , Choque Séptico/etiología , Adulto Joven , Lesión Renal Aguda/etiología , Lesión Renal Aguda/diagnóstico , Creatina Quinasa/sangreRESUMEN
BACKGROUND: Group A Streptococcus causes a variety of human infections, including the life-threatening necrotizing fasciitis, which may be ignored by the patient. From hours to days, the infection may progress from an apparently benign skin lesion, usually mistaken for a spider or insect bite, to a highly lethal disease. We present a case of 57-year-old male with skin lesions on swelling left upper limb. METHODS AND RESULTS: The culture of secretion from epidermis and blood were positive for Group A Streptococcus (GAS), type ß hemolytic streptococcus. Intensive anti-infection therapy was applied. However, the necrosis of the limb deteriorated rapidly. He died from multiple organ failure, streptococcal toxic shock syndrome (STSS) and disseminated intravascular coagulation 13 days later. CONCLUSIONS: Necrotizing fasciitis is a rapidly progressive, destructive bacterial infection. Early recognition is the most important factor for survival.
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Fascitis Necrotizante , Choque Séptico , Infecciones Estreptocócicas , Streptococcus pyogenes , Fascitis Necrotizante/diagnóstico , Fascitis Necrotizante/microbiología , Humanos , Masculino , Persona de Mediana Edad , Streptococcus pyogenes/aislamiento & purificación , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/microbiología , Infecciones Estreptocócicas/tratamiento farmacológico , Resultado Fatal , Choque Séptico/microbiología , Choque Séptico/diagnóstico , Insuficiencia Multiorgánica/diagnóstico , Insuficiencia Multiorgánica/etiología , Insuficiencia Multiorgánica/microbiología , Antibacterianos/uso terapéutico , Coagulación Intravascular Diseminada/diagnóstico , Coagulación Intravascular Diseminada/microbiología , Coagulación Intravascular Diseminada/etiologíaRESUMEN
INTRODUCTION: Sepsis is a severe medical condition that can be life-threatening. If sepsis progresses to septic shock, the mortality rate increases to around 40%, much higher than the 10% mortality observed in sepsis. Diabetes increases infection and sepsis risk, making management complex. Various scores of screening tools, such as Modified Early Warning Score (MEWS), Simplified Acute Physiology Score (SAPS II), Sequential Organ Failure Assessment Score (SOFA), and Acute Physiology and Chronic Health Evaluation (APACHE II), are used to predict the severity or mortality rate of disease. Our study aimed to compare the effectiveness and optimal cutoff points of these scores. We focused on the early prediction of septic shock in patients with diabetes in the Emergency Department (ED). METHODS: We conducted a retrospective cohort study to collect data on patients with diabetes. We collected prediction factors and MEWS, SOFA, SAPS II and APACHE II scores to predict septic shock in these patients. We determined the optimal cutoff points for each score. Subsequently, we compared the identified scores with the gold standard for diagnosing septic shock by applying the Sepsis-3 criteria. RESULTS: Systolic blood pressure (SBP), peripheral oxygen saturation (SpO2), Glasgow Coma Scale (GCS), pH, and lactate concentrations were significant predictors of septic shock (p < 0.001). The SOFA score performed well in predicting septic shock in patients with diabetes. The area under the receiver operating characteristics (ROC) curve for the SOFA score was 0.866 for detection within 48 h and 0.840 for detection after 2 h of admission to the ED, with the optimal cutoff score of ≥ 6. CONCLUSION: SBP, SpO2, GCS, pH, and lactate concentrations are crucial for the early prediction of septic shock in patients with diabetes. The SOFA score is a superior predictor for the onset of septic shock in patients with diabetes compared with MEWS, SAPS II, and APACHE II scores. Specifically, a cutoff of ≥ 6 in the SOFA score demonstrates high accuracy in predicting shock within 48 h post-ED visit and as early as 2 h after ED admission.
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APACHE , Puntuación de Alerta Temprana , Servicio de Urgencia en Hospital , Puntuaciones en la Disfunción de Órganos , Choque Séptico , Humanos , Masculino , Choque Séptico/diagnóstico , Choque Séptico/complicaciones , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Anciano , Puntuación Fisiológica Simplificada Aguda , Curva ROCRESUMEN
Erythroderma is characterized by diffuse erythema and scale covering over 90% body surface area that can affect individuals with inflammatory dermatoses such as psoriasis. Complications of erythrodermic psoriasis include infection and cardiovascular compromise. Here we present a case of a 68 year-old man who was hospitalized for erythrodermic psoriasis refractory to multiple immunosuppressive and immunomodulatory therapies, ultimately developing sepsis due to bacteremia and fungemia complicated by infective endocarditis and a mycotic aneurysm. Although the widespread loss of epidermal function in erythroderma increases the risk of infection by opportunistic pathogens, water loss, and electrolyte imbalances, there are very few reported cases of psoriatic erythroderma complicated by fungemia and mycotic aneurysm. Given the high mortality associated with widespread epidermal dysfunction, there is a great need for evidence-based treatment guidelines for psoriatic erythroderma. J Drugs Dermatol. 2024;23(8): doi:10.36849/JDD.7751.
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Aneurisma Infectado , Dermatitis Exfoliativa , Psoriasis , Choque Séptico , Humanos , Masculino , Psoriasis/complicaciones , Psoriasis/tratamiento farmacológico , Psoriasis/diagnóstico , Anciano , Dermatitis Exfoliativa/diagnóstico , Dermatitis Exfoliativa/etiología , Dermatitis Exfoliativa/terapia , Dermatitis Exfoliativa/tratamiento farmacológico , Choque Séptico/diagnóstico , Choque Séptico/microbiología , Choque Séptico/terapia , Choque Séptico/etiología , Aneurisma Infectado/diagnóstico , Aneurisma Infectado/terapia , Aneurisma Infectado/microbiología , Resultado Fatal , Fungemia/diagnóstico , Fungemia/tratamiento farmacológico , Fungemia/microbiología , Fungemia/complicaciones , Guías de Práctica Clínica como Asunto , Bacteriemia/diagnóstico , Bacteriemia/tratamiento farmacológico , Bacteriemia/complicaciones , Bacteriemia/microbiologíaRESUMEN
MEDICAL HISTORY: A 25-year-old female outpatient presenting with fever and micro-hematuria was treated for urinary tract infection. Her condition worsened over 3 days at home. After experiencing multiple falls caused by leg weakness and mental confusion, she was admitted to a hospital with high fever. DIAGNOSTICS: Initial laboratory findings showed hemolytic anemia, pancytopenia, and acute kidney injury, suggesting hemolytic uremic syndrome. However, a detailed fever evaluation revealed her recent return from Afrika. This prompted a malaria test, which confirmed Plasmodium falciparum infection with 80â% parasitemia. THERAPY AND PROGRESS: Despite the quick reduction of parasitemia following treatment with intravenous administered artesunate and oral Artemether-Lumefantrine, her condition worsened, leading to a septic shock. This required renal replacement and kinetic ventilation therapy, as well as blood transfusions due to persistent hemolysis until the laboratory values normalized after 48 days post-admission. CONCLUSION: The evaluation of fever is often challenging, but most often a detailed patient history is key to early diagnosis and treatment preventing deathly outcomes in severe cases.
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Antimaláricos , Malaria Falciparum , Adulto , Femenino , Humanos , Antimaláricos/uso terapéutico , Combinación Arteméter y Lumefantrina/uso terapéutico , Artesunato/uso terapéutico , Malaria Falciparum/complicaciones , Malaria Falciparum/diagnóstico , Malaria Falciparum/terapia , Plasmodium falciparum/aislamiento & purificación , Choque Séptico/diagnóstico , Choque Séptico/parasitología , Choque Séptico/terapia , Tanzanía , Enfermedad Relacionada con los ViajesRESUMEN
RATIONALE: Kawasaki disease (KD) is a vasculitis syndrome of small to medium-sized arteries that has typical clinical characteristics such as fever, rash, cervical lymphadenopathy, conjunctivitis, and mucosal changes. Cardiac manifestations, including coronary artery aneurysms, myocarditis, myocardial infarction, and sudden cardiac death, are the most serious complications observed in KD. On rare occasions, it may accompanied with reduced organ perfusion due to systolic hypotension, a condition known as Kawasaki disease shock syndrome (KDSS). KDSS is a serious complication that can be presented to the emergency department as an initial feature when typical clinical symptoms of KD have not be detected. PATIENT CONCERNS: We report the case of a 12-year-old boy admitted with prolonged fever, bilateral non-purulent conjunctivitis, and signs of shock such as hypotension and tachycardia. Laboratory findings showed elevated inflammatory markers, hypoalbuminemia, and sterile pyuria. He was initially treated with intravenous cefotaxime and vancomycin considering the possible diagnosis of toxic shock syndrome, while the treatment was not effective. Subsequent chest computerized tomography and ultrasound identified pulmonary consolidation and polyserous effusion. Echocardiography revealed mild biatrial dilatation and mild valvular regurgitation with preserved left ventricular function. DIAGNOSIS: After a multidisciplinary consultation, a diagnosis of KDSS was made. INTERVENTIONS: To prevent coronary artery lesions and other severe complications, the patient immediately received immunoglobulin, corticoid, and acetylsalicylic acid. OUTCOMES: Soon afterwards, he showed significant improvement, with the temperature dropped to normal and hypotension corrected about 24 hours post-intravenous immunoglobulin therapy. Polyserous effusions also disappeared before discharge. Follow-up echocardiography revealed normal results. LESSONS: Clinicians should maintain a high index of suspicion for KD and consider pulmonary involvement and polyserous effusions as potential complications. For children with KD, any symptoms pointing to infection should be carefully considered. When there is no etiologic evidence, antibiotics should be used with caution. Our case also highlights the importance of considering KDSS as a differential diagnosis in children presenting with prolonged fever and shock. Early recognition, timely treatment, and close monitoring are key to preventing severe complications and ensuring favorable outcomes in patients with KDSS.
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Síndrome Mucocutáneo Linfonodular , Choque Séptico , Choque , Humanos , Masculino , Síndrome Mucocutáneo Linfonodular/complicaciones , Síndrome Mucocutáneo Linfonodular/diagnóstico , Síndrome Mucocutáneo Linfonodular/tratamiento farmacológico , Niño , Diagnóstico Diferencial , Choque Séptico/diagnóstico , Choque Séptico/etiología , Choque/etiología , Choque/diagnóstico , EcocardiografíaRESUMEN
Despite available armored personal protection in troops, the incidence of abdominal wounds in modern wars is 6.6-9.0%. Of these, penetrating abdominal injuries comprise 75-80%. Thoracoabdominal injuries occupy a special place with incidence up to 88%. We present the first case of the "Koblenz algorithm" in the treatment of a patient with mine explosion wound, combined injury of the head, limbs, thoracoabdominal trauma, widespread peritonitis, small intestinal obstruction and septic shock in a military hospital. This algorithm was implemented under import substitution considering the peculiarities of abdominal adhesive process in a patient with thoracoabdominal wound. This case demonstrates the advantage of this algorithm for patients with severe combined wounds of the chest and abdomen complicated by diffuse purulent peritonitis. Clinical status of these patients does not allow not only open laparostomy, but also "classical" redo laparotomies.
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Traumatismos Abdominales , Algoritmos , Hospitales Militares , Laparotomía , Traumatismos Torácicos , Humanos , Traumatismos Abdominales/cirugía , Traumatismos Abdominales/diagnóstico , Traumatismos Torácicos/cirugía , Traumatismos Torácicos/diagnóstico , Traumatismos Torácicos/complicaciones , Masculino , Laparotomía/métodos , Peritonitis/cirugía , Peritonitis/etiología , Peritonitis/diagnóstico , Traumatismos por Explosión/cirugía , Traumatismos por Explosión/diagnóstico , Adulto , Resultado del Tratamiento , Traumatismo Múltiple/cirugía , Traumatismo Múltiple/diagnóstico , Choque Séptico/etiología , Choque Séptico/cirugía , Choque Séptico/diagnósticoRESUMEN
A 66-year-old woman with liver cirrhosis and hemodialysis was referred with a 1-week history of pain and rash on the left lower leg. On an examination, the patient was in shock. She was administered catecholamine support for septic shock and ampicillin/sulbactam for severe cellulitis. Streptococcus dysgalactiae subsp. equisimilis (SDSE) was isolated from the blood culture, and she was diagnosed with streptococcal toxic shock syndrome. Despite therapy, the patient died on day 7 of admission. Infective endocarditis (IE) was diagnosed during an autopsy. Clinicians should be aware that overwhelming SDSE-IE can occur even in the absence of necrotizing fasciitis, especially in immunocompromised patients.
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Autopsia , Endocarditis Bacteriana , Choque Séptico , Infecciones Estreptocócicas , Streptococcus , Humanos , Choque Séptico/microbiología , Choque Séptico/diagnóstico , Femenino , Anciano , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/complicaciones , Infecciones Estreptocócicas/microbiología , Streptococcus/aislamiento & purificación , Resultado Fatal , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/complicaciones , Endocarditis Bacteriana/tratamiento farmacológicoRESUMEN
BACKGROUND: HBP, a novel biomarker released from neutrophils, may induce inflammatory responses and exacerbate vascular permeability, representing the pathophysiological characteristics of sepsis and septic shock. However, it remains uncertain whether the combination of HBP with other biomarkers yields enhanced diagnostic capacity for sepsis. We hypothesized that measurements included IL-6·IL-8·HBP, IL-6·IL-8·HBP/ALB and HBP/ALB which based on HBP will improve its diagnostic efficacy and even better than the traditional infection biomarkers. METHODS: Between July 2021 and June 2022, we carried out a comprehensive, multi-center, observational cohort study spanning six leading tertiary hospitals located in Heilongjiang Province, China. Patients were stratified into three categories based on the severity of infection: non-sepsis, sepsis, and septic shock. We collected clinical and laboratory data, along with infection and inflammation biomarkers, for analysis. RESULTS: A total of 195 patients were enrolled. Among the three groups, patients with septic shock (n = 75, 38.5%) had significantly higher baseline levels of HBP, WBC, Lac, CRP, PCT, IL-6, IL-8, and IL-10 compared to non-sepsis patients (n = 43, 22.0%) and sepsis patients (n = 77, 39.5%), with statistically significant differences (p < 0.05) observed for all parameters. When compared to SOFA score and traditional markers of CRP, PCT, IL-6 and IL-8, the combined indexes of IL-6·IL-8·HBP and IL-6·IL-8·HBP/ALB demonstrated significantly improved diagnostic performance for sepsis and septic shock (AUC 0.911 and 0.902 respectively, p < 0.001). CONCLUSIONS: The combined measurements of IL-6·IL-8·HBP and IL-6·IL-8·HBP/ALB can augment the diagnostic capacity of HBP for sepsis, and offer reliable early supplementary indicators to traditional biomarkers for assessing disease severity in patients with infection.
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Biomarcadores , Sepsis , Humanos , Biomarcadores/sangre , Femenino , Masculino , Persona de Mediana Edad , Sepsis/diagnóstico , Sepsis/sangre , Anciano , Estudios de Cohortes , China , Proteínas Sanguíneas/análisis , Interleucina-6/sangre , Péptidos Catiónicos Antimicrobianos/sangre , Choque Séptico/diagnóstico , Choque Séptico/sangre , Interleucina-8/sangre , AdultoRESUMEN
BACKGROUND: Cetobacterium somerae rarely causes infection in humans. Most studies on C. somerae have analyzed its role in the intestinal system of freshwater fish. METHODS: Herein, we report a case of septic shock caused by C. somerae in an elderly patient. RESULTS: Blood culture revealed growth of a gram-negative, rod-shaped anaerobic bacterium, which was identified as C. somerae through MALDI-TOF analyses. Although C. somerae is a resident species in the gut, it can cause systemic infection, which can be fatal. CONCLUSIONS: When C. somerae is identified, consideration should be given to the possibility of the infection originating from the intestinal tract.
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Choque Séptico , Choque Séptico/microbiología , Choque Séptico/diagnóstico , Humanos , Antibacterianos/uso terapéutico , Masculino , Infecciones por Bacterias Gramnegativas/diagnóstico , Infecciones por Bacterias Gramnegativas/microbiología , Anciano , Anciano de 80 o más Años , Espectrometría de Masa por Láser de Matriz Asistida de Ionización Desorción , FemeninoRESUMEN
OBJECTIVE: To construct a nomogram model for predicting the 28-day mortality of patients with septic shock in the emergency medicine department and to validate the predictive efficacy. METHODS: Based on the database of the emergency medicine department of Chu Hsien-I Memorial Hospital of Tianjin Medical University, Tianjin Medical University General Hospital and the Second Hospital of Tianjin Medical University, the data of 913 patients with septic shock admitted to the emergency medicine department from January 2017 to October 2020 were collected, including baseline demographic information and clinical characteristics, laboratory indices, and the main endpoints (28-day mortality). The patients were divided into a training set and a validation set based on simple random sampling. All significant variables from the one-way binary Logistic regression analysis of the training set were included in the multivariate Logistic regression analysis to analyze the risk factors for 28-day mortality in patients with septic shock and to construct a column-line graphical model. The predictive efficacy of the nomogram model was assessed using calibration curves and receiver operator characteristic curve (ROC curve). RESULTS: A total of 860 patients with septic shock meeting the criteria were finally enrolled, including 472 in the training set and 388 in the validation set. The 28-day mortalities were 52.5% (248/472) and 54.1% (210/388) for the training and validation sets, respectively. In the training set, age, respiratory rate (RR), the levels of C-reactive protein (CRP), D-dimer, white blood cell count (WBC), neutrophil count (NEU), neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR), mean platelet volume (MPV), and platelet count (PLT) in the death group were significantly higher than those in the survival group, and the levels of base remaining (BE), lymphocyte count (LYM), hemoglobin (Hb) and the proportion of chronic obstructive pulmonary diseases (COPD) were significantly lower than those in the survival group (all P < 0.05). Multifactorial Logistic regression analysis showed that NLR [odds ratio (OR) = 0.023 0, 95% confidence interval (95%CI) was -0.204 4 to 0.113 0], MPV (OR = 0.179 8, 95%CI was -0.877 6 to 0.172 7), Hb (OR = 0.007 8, 95%CI was 0.010 3 to 0.040 8), procalcitonin (PCT; OR = 1.957 0, 95%CI was 1.243 0 to 3.081 0), and D-dimer (OR = 0.000 1, 95%CI was -0.000 4 to 0.000 1) were independent predictors of 28-day mortality in patients with septic shock in the emergency department (all P < 0.05). A column-line graph model was established based on the above variables, and the ROC curves showed that the area under the ROC curve (AUC) of the nomogram model in the training set and validation set for predicting the 28-day mortality of patients with septic shock was 0.907 (95%CI was 0.864 to 0.940) and 0.822 (95%CI was 0.781 to 0.863), respectively. The calibration curves showed good agreement between the predicted and observed results for both the training and validation sets. CONCLUSIONS: The nomogram model constructed based on NLR, MPV, Hb, PCT and D-dimer has significant clinical value in predicting the 28-day mortality of patients with septic shock in the emergency medicine department.
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Nomogramas , Choque Séptico , Humanos , Choque Séptico/diagnóstico , Choque Séptico/mortalidad , Choque Séptico/sangre , Pronóstico , Factores de Riesgo , Servicio de Urgencia en Hospital , Modelos Logísticos , Curva ROC , Femenino , Masculino , Persona de Mediana Edad , AncianoRESUMEN
Background: Lactate is a commonly used biomarker for sepsis, although it has limitations in certain cases, suggesting the need for novel biomarkers. We evaluated the diagnostic accuracy of plasma renin concentration and renin activity for mortality and kidney outcomes in patients with sepsis with hypoperfusion or hypotension. Methods: This was a multicenter, prospective, observational study of 117 patients with septic shock treated at three tertiary emergency departments between September 2021 and October 2022. The accuracy of renin activity, renin, and lactate concentrations in predicting 28-day mortality, acute kidney injury (AKI), and renal replacement requirement was assessed using the area under the ROC curve (AUC) analysis. Results: The AUCs of initial renin activity, renin, and lactate concentrations for predicting 28-day mortality were 0.66 (95% confidence interval [CI], 0.55-0.77), 0.63 (95% CI, 0.52-0.75), and 0.65 (95% CI, 0.53-0.77), respectively, and those at 24 hrs were 0.74 (95% CI, 0.62-0.86), 0.70 (95% CI, 0.56-0.83), and 0.67 (95% CI, 0.54-0.79). Renin concentrations and renin activity outperformed initial lactate concentrations in predicting AKI within 14 days. The AUCs of renin and lactate concentrations were 0.71 (95% CI, 0.61-0.80) and 0.57 (95% CI, 0.46-0.67), respectively (P=0.030). The AUC of renin activity (0.70; 95% CI, 0.60-0.80) was also higher than that of lactate concentration (P=0.044). Conclusions: Renin concentration and renin activity show comparable performance to lactate concentration in predicting 28-day mortality in patients with septic shock but superior performance in predicting AKI.
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Lesión Renal Aguda , Área Bajo la Curva , Biomarcadores , Hipotensión , Ácido Láctico , Curva ROC , Renina , Choque Séptico , Humanos , Renina/sangre , Choque Séptico/mortalidad , Choque Séptico/sangre , Choque Séptico/diagnóstico , Choque Séptico/complicaciones , Estudios Prospectivos , Masculino , Femenino , Anciano , Persona de Mediana Edad , Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/mortalidad , Lesión Renal Aguda/sangre , Hipotensión/diagnóstico , Hipotensión/sangre , Hipotensión/complicaciones , Hipotensión/mortalidad , Biomarcadores/sangre , Ácido Láctico/sangreRESUMEN
INTRODUCTION: The present systematic review analyses the role of soluble fms-like tyrosine kinase-1 (sFLT-1) as an indirect biomarker of endothelial dysfunction in sepsis or septic shock from articles published in PubMed between 2010 and March 2022. MATERIALS AND METHODS: A systematic review of studies studying sFLT-1 monitoring in intensive care units in adults with sepsis or septic shock vs. controls for sepsis diagnosis and prognosis has been carried out (PROSPERO CRD42023412929 Registry). RESULTS: The endothelial dysfunction of sepsis is one of the keys to the development of the disease. VEGF binds to sFLT-1 acting as a competitive inhibitor of VEGF signalling in endothelial cells and thus neutralizes its pro-inflammatory effects. Endothelial dysfunction is reflected in increased sFLT-1 levels. High values of sFLT-1 were used for the differential diagnosis of sepsis versus other inflammatory pathologies, septic shock versus other types of shock, were elevated over time, estimation of disease prognosis, correlation with sepsis severity, organ dysfunction, and mortality prediction. CONCLUSIONS: It is evident that sepsis is based on endothelial dysfunction. sFLT-1 is one of the main biomarkers of microvascular alteration and is a predictive diagnostic and prognostic biomarker.
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Biomarcadores , Sepsis , Receptor 1 de Factores de Crecimiento Endotelial Vascular , Humanos , Receptor 1 de Factores de Crecimiento Endotelial Vascular/sangre , Sepsis/diagnóstico , Sepsis/sangre , Biomarcadores/sangre , Pronóstico , Choque Séptico/diagnóstico , Choque Séptico/sangre , Endotelio VascularRESUMEN
BACKGROUND: The Sequential Organ Failure Assessment (SOFA) score is an important tool in diagnosing sepsis and quantifying organ dysfunction. However, despite emerging evidence of differences in sepsis pathophysiology between women and men, sex is currently not being considered in the SOFA score. We aimed to investigate potential sex-specific differences in organ dysfunction, as measured by the SOFA score, in patients with sepsis or septic shock and explore outcome associations. METHODS: Retrospective analysis of sex-specific differences in the SOFA score of prospectively enrolled ICU patients with sepsis or septic shock admitted to one of 85 certified Swiss ICUs between 01/2021 and 12/2022. RESULTS: Of 125,782 patients, 5947 (5%) were admitted with a clinical diagnosis of sepsis (2244, 38%) or septic shock (3703, 62%). Of these, 5078 (37% women) were eligible for analysis. A statistically significant difference of the total SOFA score on admission was found between women (mean 7.5 ± SD 3.6 points) and men (7.8 ± 3.6 points, Wilcoxon rank-sum p < 0.001). This was driven by differences in the coagulation (p = 0.008), liver (p < 0.001) and renal (p < 0.001) SOFA components. Differences between sexes were more prominent in younger patients < 52 years of age (women 7.1 ± 4.0 points vs men 8.1 ± 4.2 points, p = 0.004). No sex-specific differences were found in ICU length of stay (women median 2.6 days (IQR 1.3-5.3) vs men 2.7 days (IQR 1.2-6.0), p = 0.13) and ICU mortality (women 14% vs men 15%, p = 0.17). CONCLUSION: Sex-specific differences exist in the SOFA score of patients admitted to a Swiss ICU with sepsis or septic shock, particularly in laboratory-based components. Although the clinical meaningfulness of these differences is unclear, a reevaluation of sex-specific thresholds for SOFA score components is warranted in an attempt to make more accurate and individualised classifications.
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Unidades de Cuidados Intensivos , Puntuaciones en la Disfunción de Órganos , Sepsis , Choque Séptico , Humanos , Femenino , Masculino , Unidades de Cuidados Intensivos/organización & administración , Unidades de Cuidados Intensivos/estadística & datos numéricos , Persona de Mediana Edad , Anciano , Estudios Retrospectivos , Sepsis/clasificación , Sepsis/fisiopatología , Sepsis/diagnóstico , Sepsis/mortalidad , Choque Séptico/fisiopatología , Choque Séptico/mortalidad , Choque Séptico/clasificación , Choque Séptico/diagnóstico , Suiza/epidemiología , Factores Sexuales , Estudios Prospectivos , AdultoRESUMEN
Pyruvate dehydrogenase complex (PDHC) deficiency is a common genetic disorder leading to lactic acidosis, which can also result from several nongenetic conditions, such as septic shock. The present study reports a case of PDHC deficiency masked by septic shock-induced lactic acidosis. This case involved a 16-year-old adolescent with poor exercise tolerance compared with his peers, and no underlying diseases. The disease onset was characterized by cough, fever, and dyspnea, with hypotension and elevated lactate levels, which indicated septic shock. However, severe hypoglycemia and lactic acidosis persisted despite resolution of a pulmonary infection and correction of septic shock, requiring continuous intravenous infusion of 50% glucose. Although the patient did not experience acute kidney injury and had normal urine output, continuous renal replacement therapy was used to regulate the internal environment owing to the severity of the acidosis. The diagnosis of PDHC deficiency was considered on the basis of the persistent hypoglycemia and hyperlactatemia, before genetic mutation testing was completed. The clinical thinking process required a rich accumulation of pathophysiological knowledge. This article reports a case of PDHC deficiency masked by septic shock-induced lactic acidosis to raise awareness of the disease and avoid misdiagnosis and missed diagnosis.
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Acidosis Láctica , Enfermedad por Deficiencia del Complejo Piruvato Deshidrogenasa , Choque Séptico , Humanos , Choque Séptico/diagnóstico , Choque Séptico/etiología , Masculino , Acidosis Láctica/diagnóstico , Acidosis Láctica/etiología , Adolescente , Enfermedad por Deficiencia del Complejo Piruvato Deshidrogenasa/diagnóstico , Hipoglucemia/diagnóstico , Hipoglucemia/etiología , Diagnóstico DiferencialRESUMEN
OBJECTIVE: Given the scarcity of studies analyzing the clinical predictors of pediatric septic cases that would progress to septic shock, this study aimed to determine strong predictors for pediatric emergency department (PED) patients with sepsis at risk for septic shock and mortality. METHODS: We conducted chart reviews of patients with ≥ 2 age-adjusted quick Sequential Organ Failure Assessment score (qSOFA) criteria to recognize patients with an infectious disease in two tertiary PEDs between January 1, 2021, and April 30, 2022. The age range of included patients was 1 month to 18 years. The primary outcome was development of septic shock within 48 h of PED attendance. The secondary outcome was sepsis-related 28-day mortality. Initial important variables in the PED and hemodynamics with the highest and lowest values during the first 24 h of admission were also analyzed. RESULTS: Overall, 417 patients were admitted because of sepsis and met the eligibility criteria for the study. Forty-nine cases progressed to septic shock within 48 h after admission and 368 were discharged without progression. General demographics, laboratory data, and hemodynamics were analyzed by multivariate analysis. Only the minimum diastolic blood pressure/systolic blood pressure ratio (D/S ratio) during the first 24 h after admission remained as an independent predictor of progression to septic shock and 28-day mortality. The best cutoff values of the D/S ratio for predicting septic shock and 28-day mortality were 0.52 and 0.47, respectively. CONCLUSIONS: The D/S ratio is a practical bedside scoring system in the PED and had good discriminative ability in predicting the progression of septic shock and in-hospital mortality in PED patients. Further validation is essential in other settings.
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Presión Sanguínea , Servicio de Urgencia en Hospital , Sepsis , Choque Séptico , Humanos , Masculino , Femenino , Niño , Choque Séptico/mortalidad , Choque Séptico/diagnóstico , Choque Séptico/fisiopatología , Preescolar , Lactante , Adolescente , Sepsis/mortalidad , Sepsis/diagnóstico , Sepsis/complicaciones , Sepsis/fisiopatología , Estudios Retrospectivos , Puntuaciones en la Disfunción de Órganos , Progresión de la Enfermedad , Fiebre , Mortalidad HospitalariaRESUMEN
ABSTRACT: Sepsis remains a complex and costly disease with high morbidity and mortality. This article discusses Sepsis-2 and Sepsis-3 definitions, highlighting the 2021 Surviving Sepsis International guidelines as well as the regulatory requirements and reimbursement for the Severe Sepsis and Septic Shock Management Bundle (SEP-1) measure.
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Guías de Práctica Clínica como Asunto , Sepsis , Humanos , Sepsis/diagnóstico , Sepsis/enfermería , Choque Séptico/enfermería , Choque Séptico/diagnóstico , Choque Séptico/terapia , Paquetes de Atención al PacienteRESUMEN
Plasma N-terminal prohormone of brain natriuretic peptide (NT-proBNP) level is primarily used as a biomarker for left ventricular (LV) dysfunction. It is influenced by various conditions, such as myocardial strain and situations affecting the clearance of NT-proBNP, including sepsis and shock. In this study, we investigated the appropriateness of NT-proBNP as a prognostic factor for septic shock. Patients with septic shock who visited the emergency department of the Ewha Womans' University Mokdong Hospital between January 1, 2018, and December 31, 2020, were classified into the survival group (those who survived in the hospital and were discharged) and the death group (those who died in the hospital). The effectiveness of NT-proBNP, lactate, and blood urea nitrogen as predictive factors of in-hospital mortality was evaluated using the area under the receiver operating characteristic (AUROC) curve. The AUROC curve was 0.678 and 0.648 for lactate and NT-proBNP, respectively, with lactate showing the highest value. However, there was no significant difference between lactate and NT-proBNP levels in the comparison of their AUROC curve (p = 0.6278). NT-proBNP could be a useful predictor of in-hospital mortality in patients with septic shock who present to the emergency department.