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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This study evaluates the use of nutritional assessment indexes measured on the fifth day after injury to predict subsequent wound infections, episodes of septicemia, and other infectious complications in burned patients. Nutritional assessment data collected included anthropometric measurements (weight, height, triceps skinfold, and upper-arm circumference); biochemical testing (serum albumin concentration, serum transferrin concentration, total lymphocyte count, creatinine/height index, and nitrogen balance); and recall skin antigen testing. Seventy-four adult patients (mean age of 35 years) who had burn injuries ranging from 10% to 96% total body surface were studied. Indexes predictive of imminent wound infection include serum transferrin concentrations less than 150 mg/dl (p = .0006) and anergy to the skin test battery (p = .01). Those indexes were also prognostic of the development of septicemia (p = .0002 and p = .0001, respectively). Although statistically insignificant, total lymphocyte count also showed a similar trend toward predicting complications. Serum albumin concentration (less than 3.0 gm/dl), creatinine/height index (less than 60% standard), percent ideal body weight (less than 80%), percent weight change, and nitrogen balance did not contribute to group discrimination. Severe depletion of the visceral protein compartment was documented in a large percentage of patients on the fifth postburn day. Serum transferrin concentration and recall skin antigen testing can be helpful in identifying thermally injured patients who are at high risk of infectious complications.
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PMID:Nutritional assessment indications of postburn complications. 396 44

To identify associations between abnormal measurements and development of life-threatening surgical sepsis, host-defence parameters were assessed in 2202 patients upon admission to hospital for operation. Measurements included the response to delayed type hypersensitivity (DTH) skin-test antigens, circulating blood-cell counts and hemoglobin levels, neutrophil adherence, chemotaxis, phagocytic and bactericidal function, and circulating serum albumin, serum globulin, serum immunoglobulin and complement levels. Sepsis was considered to be present when there was bacteremia, proven cholangitis or intracavitary abscess proven by operation or autopsy. The admission DTH response stratified patients into a reactive group (responding to two or more antigens out of five, 1373 patients), a relatively anergic group (with a response to one antigen, 306 patients) and an anergic group (with no antigen response, 523 patients). Sex, age and type of disease were similar in the three groups. There were abnormalities in neutrophil adherence, neutrophil chemotaxis, serum albumin and blood hemoglobin levels in all groups, compared with out-of-hospital controls. The reactive group had an 8% sepsis rate and a mortality of 4%, compared with 21% and 15% in the relatively anergic and 33% and 31% in the anergic groups respectively (chi 2 = 186, p less than 0.0001). The same observation was made in 1184 patients who were studied preoperatively: sepsis rates were 8%, 16% and 31% in the reactive, relatively anergic and anergic groups respectively (chi 2 = 76, p less than 0.0001) and mortality was 4%, 12% and 27% respectively (chi 2 = 99.7, p less than 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Host-defence mechanisms in surgical patients: a correlative study of the delayed hypersensitivity skin-test response, granulocyte function and sepsis. 397 Dec 21

The phagocytic function of neutrophils has been studied in 50 Egyptians of both sexes and of various ages, suffering from burns of different depths and extents, and the results compared with data from 50 normal persons of similar sex and age. The nitro blue tetrazolium test (Gifford and Malawista, 1970), and the bacterial killing test (Quie et al., 1967), have been used during the first 24 hours, and then repeated at weekly intervals for 4 weeks. The phagocytic power showed no change during the study except in two patients with extensive burns during fatal septicaemia. The bactericidal capacity, and the formazan cell formation showed similar changes with a steady decrease from the first to the third weeks, followed by a rise during the fourth week. Similar changes were noticed in the serum albumin levels. The decline was more marked in burns of more than 50 per cent of the body surface area and during severe sepsis. Improvement coincided with healing.
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PMID:Phagocytic activity of polymorphonuclear leucocytes in burns. 398 43

An elemental diet was used to prepare 11 severely debilitated malnourished patients for operation. Indications included: 1) as a substitute for parenteral hyperalimentation when catheter sepsis occurred with the latter; 2) high small fistulae; 3) short bowel syndrome; 4) radiation enteritis; and 5) partial obstruction of the gastrointestinal tract. All patients were converted to a positive nitrogen balance as evidenced by a substantial gain in weight and in serum albumin levels. All tolerated corrective operations without difficulty and their wounds healed per primum.
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PMID:Use of elemental diets to correct catabolic states prior to surgery. 420 17

A continuous flow immunoadsorption system consisting of a cell separator, protein A-sepharose columns, and a semi-automatic elution component was developed to specifically remove circulating IgG. This system provides extensive absorption with an essentially unlimited column bed volume. Six dogs were treated a total of 19 times. In no case did fever, sepsis, or respiratory distress result from the treatment. Serial blood counts and tests of liver and renal function remained in the normal range. Ex vivo perfusion of one plasma volume caused an acute drop in IgG levels of approximately 50 percent. This was reflected in a similar decrease in specific antibody levels to sheep erythrocytes, bovine serum albumin, and canine parvovirus. Antibody kinetics following immunoadsorption were variable, but in several cases, antibody levels remained lowered. This immunoadsorptive system appears to be a safe and effective alternative to plasma exchange for removal of IgG antibodies.
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PMID:Specific removal of antibodies with an immunoadsorption system. 636 56

Serum albumin concentration is commonly used as an index of nutritional status and as an indicator of nutritional response in hospitalized patients receiving total parenteral nutrition (TPN). One hundred thirty-nine cancer patients receiving TPN for at least two weeks were studied. Albumin intake, serum albumin, fluid balance, and weight change was monitored from 14 to 100 days of TPN. Patients were classified into three groups: A) patients receiving no exogenous albumin; B) patients receiving less than 25 grams of exogenous albumin; and C) patients receiving at least 25 grams of exogenous albumin during their course of TPN. Linear regression analysis of serum albumin levels vs. time on TPN showed a minimal positive correlation for patients in groups B and C (r = 0.154 and r = 0.183, respectively). Further analysis showed a significant elevation of serum albumin levels only in patients in group C (p less than or equal to 0.05). Contingency table analysis showed statistically significant increase in the incidence of sepsis in patients treated with exogenous albumin (X2 = 10.50, df = 2, p less than 0.01). There was no relationship between the change in serum albumin concentrations and the number of patient deaths. In addition, no relationship between tumor burden and subsequent response of serum albumin levels were identified. Serum albumin levels do not increase in cancer patients receiving TPN, unless exogenous albumin is given. Serum albumin appears to be a poor index of nutritional response in cancer patients receiving TPN.
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PMID:Serum albumin levels in cancer patients receiving total parenteral nutrition. 640 95

This prospective randomized controlled clinical trial compares the effects of early parenteral nutrition and traditional delayed enteral nutrition upon the outcome of head-injured patients. Thirty-eight head-injured patients were randomly assigned to receive total parenteral nutrition (TPN) or standard enteral nutrition (SEN). Clinical and nutritional data were collected on all patients until death or for 18 days of hospitalization. Survival and functional recovery were monitored in survivors for 1 year. Of the 38 patients, 18 were randomized to the SEN group and 20 to the TPN group. Demographically, the two groups of patients were similar on admission. There was no significant difference in the severity of head injury between the two groups as measured by the Glasgow Coma Scale (p = 0.52). The outcome for the two groups was quite different, with eight of the 18 SEN patients dying within 18 days of injury, whereas no patient in the TPN group died within this period (p less than 0.0001). The basis for the improved survival in the TPN patients appears to be improved nutrition. The TPN patients had a more positive nitrogen balance (p less than 0.06), and a higher serum albumin level and total lymphocyte count. More adequate nutritional status may have improved the patients' immunocompetence, resulting in decreased susceptibility to sepsis. The data from this study strongly support the favorable effect of early TPN on survival from head injury.
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PMID:The favorable effect of early parenteral feeding on survival in head-injured patients. 640 49

Bone marrow transplantation (BMT) is associated with severe metabolic stress secondary to anorexia, mucositis, enteritis, and infection. We compared nutritional parameters and clinical outcomes of 22 patients who received prophylactic total parenteral nutrition (TPN) to those of 22 controls, matched for age and diagnosis, who received nutritional support ad libitum. Over the 5-week study period, the TPN group averaged caloric intakes greater than 1.5 X basal energy expediture (BEE) per day and gained 2.5% of body weight; the control group averaged less than 0.9 X BEE and lost 3.7% of body weight. Visceral protein status as reflected by serum albumin was not different. Engraftment of donor marrow cells was 3 days earlier (p less than 0.01) in the TPN group than in the controls, despite there being no significant difference in the number of marrow cells each group received. There was no difference in the two groups' clinical outcomes; mortality, duration of hospital stay, and incidences of sepsis, graft-versus-host disease, and return of malignancy were equivalent. Thus, patients who received prophylactic TPN engrafted sooner than patients who did not; however, overall clinical outcome was unaffected by TPN. Controlled studies of prophylactic TPN are indicated for the BMT patient population.
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PMID:Total parenteral nutrition in bone marrow transplantation: a clinical evaluation. 642 May 35

A nutritional support team was used in the assessment and management of patients on a general urological service. Indications for nutritional evaluation included history of weight loss, anorexia, significant infection, chronic neoplastic disease, trauma or major surgery. The fat and protein status of the patient was assessed by anthropomorphic and laboratory determinations. The patient then was categorized as having mild, moderate or severe degrees of nutritional depletion. Deficiencies in vitamins, trace elements or essential fatty acids were not noted. Caloric and protein needs were calculated by multiplication of the basal energy expenditure by a metabolic activity factor, which was derived from the degree of illness or stress. Nutritional support was provided by enteral feedings via oral, nasogastric or jejunal feeding tubes and/or intravenous hyperalimentation via peripheral or central venous nutrient lines. During a 6-month interval nutritional consultation was requested for 50 patients, who represented 7 per cent of the urological admissions. Nutritional support was provided for patients who had obstructive uropathy with or without neoplasms, radiation cystitis, sepsis, urinary fistulas, mental depression, end stage renal disease or neurological dysfunction. In patients in whom urological treatment controlled the disease nutritional support maintained the weight, and stabilized serum albumin and lymphocyte counts. We concluded that a nutritional support program has a significant and, often, unappreciated role in the management of urological patients.
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PMID:Nutritional support in a general urological service. 642 56

Serum immunoglobulins and some complement components (C1q, C3c, C4, factor B, C9) have been evaluated in 99 malnourished patients. The sole abnormality which seems related to protein calorie malnutrition is a C1q decrease significantly correlated to serum albumin, thyroxin binding prealbumin and retinol binding protein. The immunoglobulins modifications seem to be related to pathological conditions associated with malnutrition (sepsis, liver diseases).
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PMID:[Serum immunoglobulins and complement fractions in protein malnutrition]. 642 29


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