Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This prospective study evaluated host resistance in a surgical population who walked into the hospital for elective surgery. Patients were stratified into Hospital Reactive (HR, n = 19) if they reacted to two or more of five recall skin test antigens and Walk-in Anergic (WA, n = 26) if they did not react to the antigens. The WA patients were slightly older (74.4 +/- 1.8 years, +/- SEM versus 66.7 +/- 2.7 p less than 0.05). Diagnosis in the HR and WA group were: tumors 13/19 versus 21/26, diverticulitis 3/19 versus 0/19, and miscellaneous 3/19 versus 5/26. Twenty-five laboratory normal controls (LN) were also studied. There were no significant differences in the following parameters between the HR and WA groups: stage of disease; hemoglobin; circulating leukocyte count; polymorphonuclear cell counts; total lymphocyte counts (both groups lower than LN, p less than 0.05), monocyte counts (both higher than LN, p less than 0.05); per cent E-rosettes and lymphocyte blastogenesis to mitogens (phytohemagglutinin, concanavalin-A) and antigens (purified protein derivative and tetanus); phagocytosis of preopsonised Staphylococcus aureus 502A, at 5, 10, and 20 minutes; alpha, beta, and gamma globulins; C3, and total hemolytic complement (CH50) levels; C-reactive protein; and ANA and DNA levels. The HR group demonstrated an increase in the rate of killing of Staphylococcus 502A at 10, 20, 40, and 80 minutes compared to the LN group but the WA group did not show this augmentation (p less than 0.001). The serum albumins were: LN = 4.46, HR = 3.98, WA = 3.43 g/dl (p less than 0.05). Degree and duration of surgery was the same in the HR and WA groups. There were no major sepsis episodes (bacteremia or proven intracavitary abscess) in the HR patients versus 25% in the WA patients (p less than 0.05). There was one death (6%, pulmonary embolus) in the HR group and 8 (40%) in the WA group (p less than 0.05). Antibiotic prophylaxis was equal but the WA patients received therapeutic antibiotics more frequently (65% versus 11% p less than 0.05). Of all the host immunocompetence tests measured in this study, the delayed type hypersensitivity skin test response and the serum albumin were variables abnormal between the survivors and those who died.
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PMID:The walk-in anergic patient. How best to assess the risk of sepsis following elective surgery. 671 20

1. Thirty patients with acute renal failure who were unable to eat adequately were evaluated while they received parenteral nutrition with glucose alone (n = 7), glucose and 21 g/day essential amino acids (EAA, n = 11) or glucose, 21 g/day essential and 21 g/day nonessential amino acids (ENAA, n = 12). Energy intake did not differ with the three treatments. Patients were studied in a prospective double blind fashion. 2. Thirteen patients recovered renal function and 11 survived to leave the hospital. Those in whom renal failure was attributed to hypotension and/or sepsis had a poorer recovery of renal function (17%) and survival (17%). Recovery of renal function and survival was greater in patients on the medical service as compared to the surgical service and in those who received more energy. Recovery of renal function was worse in those treated with dialysis. There were no differences in recovery of renal function of survival among the three treatment groups. 3. Many patients were markedly catabolic as indicated by nitrogen balances, urea in nitrogen appearance rates (UNA), serum protein concentrations, and plasma amino acid levels. There was no correlation between the degree of catabolism and recovery of renal function or survival. Mean UNA in individual patients also correlated with body weight. Among the three groups, however, UNA was significantly less with the group receiving EAA as compared to ENAA. 4. Serum protein concentrations were lower than normal in all treatment groups. Serum albumin fell significantly during the treatment in the more catabolic patients. Plasma amino acid levels tended to fall in all three groups and concentrations at the end of the treatment were frequently lower than normal. 5. These data suggest that acute renal failure patients who are unable to eat adequately are often hypercatabolic and have a high mortality, particularly if hypotension or sepsis is the cause of renal failure. The improved survival in those with higher energy intakes, the high rate of net protein breakdown, the low serum protein levels and the reduced plasma concentrations of both essential and nonessential amino acids suggest that greater quantities of energy and both essential and nonessential amino acids may be beneficial to such patients.
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PMID:Clinical and metabolic responses to parenteral nutrition in acute renal failure. A controlled double-blind study. 678 9

Patients requiring long term intensive care and/or prolonged ventilatory support, are frequently undergoing progressive malnutrition, occasionally complicated by a hypercatabolic state. Sepsis, fever and the requirements for postoperative healing will add further nutritional demands on such patients. In contrast to starvation, critically ill patients maintained on protein-free energy-deficient diet do not adapt to utilization of their lipid to provide energy needs. Mobilization of endogenous fat stores is reduced, and this reduction leads to increased gluconeogenesis from amino acids derived from muscle protein to meet the increased energy needs. Low serum albumin, possible low surfactant production, devitalization of the alveolo-capillary membrane and impaired immunocompetence could contribute to the development of pulmonary transudation, alveolar collapse, low compliance and pulmonary infection. Such sequelae of a protein-free energy-deficient diet would delay weaning patients off prolonged mechanical ventilation. Nutritional assessment, which may be determined serially, and means of nutritional support are outlined.
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PMID:Nutritional support in long term intensive care with special reference to ventilator patients: a review. 678 7

Thirty-nine patients, 25 of whom were suffering from trauma, sepsis, or malignant disease, were studied prospectively to determine the immunologic value of improved protein-calorie balance in this setting. All were suffering from varying degrees of malnutrition, and 72% (P less than 0.05) of the patients with anergy-inducing disease processes were anergic at the time of evaluation. In the presence of disease-induced anergy, skin test reactivity was not helpful in measuring the therapeutic response to nutritional support; among severely wasted patients, significant elevations in absolute lymphocyte count and serum albumin suggest that these are useful parameters when following the severely wasted patient who has concomitant trauma, sepsis, or malignant disease.
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PMID:The effect of nutritional support on immune competency in patients suffering from trauma, sepsis, or malignant disease. 679 29

Eighteen patients requiring intensive outpatient nutritional support were prospectively reviewed to compare the application of enteral and parenteral approaches. Nine patients received home enteral nutritional support (HEN) for a period of 2 to 15 months via Micro Feeding jejunostomy (MFJ) tubes. The other nine patients received home parenteral nutritional support (HPN) for a period of 3 of 32 months via Broviac catheters. The nine patients on HEN for a period of 2 to 15 months had a mean increase in weight, tricep skinfold thickness, arm muscle circumference, and serum albumin of 9.9 kg (p less than 0.001), 2.5 mm (p less than 0.01), 3.7 cm (p less than 0.05), and 0.73 g/dl (p less than 0.02), respectively. One patient suffered accidental loss of the MFJ tube; otherwise there were no significant complications. The nine patients on HPN for a period of 3 to 32 months had a mean increase in weight, triceps skinfold thickness, arm muscle circumference, and serum albumin of 8.5 kg (p less than .001), 3.5 mm (p less than 0.05), 3.4 cm (p less than 0.05), and 1.09 g/dl (p less than 0.001), respectively. Three patients each experienced one episode of catheter sepsis. These complications were far more serious than arising from the MFJ tube. In addition, the average cost of HPN was found to be 10 to 20 times greater than that of HEN. It is concluded that HEN should be selected over HPN as the course of therapy in all possible cases and that the MFJ tube is a safe, useful, and cost-effective approach.
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PMID:Home enteral and parenteral nutritional support: a comparison. 679 47

Reserve albumin concentration (the concentration of albumin available for binding of unconjugated bilirubin) was determined in 95 sera from 76 subjects by dialysis with 14C-monoacetyl diamino diphenyl sulfone (MADDS). An index, I of bilirubin toxicity in the plasma was calculated for each subject, based on the bilirubin and reserve albumin concentrations, the affinity of bilirubin for serum albumin, and the pH-dependent solubility of bilirubin in the plasma. The values of reserve albumin and of I varied significantly with gestational age, clinical condition (whether sick or well), and serum bilirubin level. The value of reserve albumin was decreased and I was increased in association with clinical factors (e.g., hyperbilirubinemia, hypoxia, acidosis, or sepsis) recognized as increasing the risk for bilirubin encephalopathy. The lowest values of reserve albumin and the highest values of I were found in the least mature and sickest infants.
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PMID:Reserve albumin and bilirubin toxicity index in infant serum. 688 Jul 30

In the presence of obstructive jaundice, surgical procedures are associated with high rates of mortality and morbidity. In an endeavour to identify risk factors associated with a poor outcome, a detailed prospective study of 28 jaundiced patients has been performed. Factors associated with a fatal outcome of operation were serum bilirubin level > 300 mumol/1, glomerular filtration rate < 50 ml/min, the presence of an abnormal level of fibrin degradation products (FDP) in serum, and the presence of endotoxaemia. Postoperative deep venous thrombosis was associated with low serum albumin, normal liver enzymes and rapid kaolin clotting time. Postoperative haemorrhage occurred in patients with FDP or endotoxaemia. Patients with normal renal function or elevated levels of liver enzymes were protected from sepsis. Based on the identification of these risk factors and of those patients with inoperable disease, a plan for management is proposed.
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PMID:The identification of risk factors and their application to the management of obstructive jaundice. 693 56

Pemphigus is frequently a fatal skin disease. The cause of death and the events leading to it were investigated by examining patient records and autopsy data of thirteen patients who died as a result of this disease at the UCLA Hospital between 1965 and 1980. The diagnosis was confirmed histologically and/or by immunofluorescent studies of the skin and serum. Infection was the most frequent cause of death, and septicemia was found in nine of thirteen cases. The most commonly found organism was Staphylococcus aureus. The skin was usually the source of infection. Nine patients had pneumonia on chest x-ray and autopsy examination. Most patients had low levels of serum proteins and serum albumin. Since the patients were on long-term high doses of corticosteroids, the signs and symptoms of inflammation were often masked. This study demonstrated that for this reason, long-term corticosteroid therapy is one of the significant factors contributing to the death of these patients. A cautious and judicious use of steroids is suggested.
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PMID:Death in pemphigus. 713 Apr 83

Hypocalcemia is an important metabolic problem in critical care medicine. To determine the frequency of this problem and the patient subsets at risk, a retrospective study of a large series of ICU patients was performed. During the study period, 259 patients were admitted to the ICU, of whom 210 (81%) had a serum calcium (Ca++) measured. Of these 210 patients, 135 (64%) were hypocalcemic (serum Ca++ less than 8.5 mg/dl) and 75 (36%) were normocalcemic. Serum albumin concentration was less than 3.5 g/dl in 70% of the hypocalcemic patients who hd albumin measured, suggesting that the ionized Ca++ concentration may have been normal in many of these patients. On the other hand, 32% of the hypocalcemic patients were alkalotic (pH greater than or equal to 7.45) which indicates that ionized Ca++ levels may have been low because Ca++ binding to protein increases with alkalosis. Gastrointestinal bleeders and postabdominal surgery patients were more likely to have low total serum Ca++ whereas cardiac and neurosurgical patients were more likely to have a normal total serum Ca++ (p less than 0.05). Ionized Ca++ was calculated in 36 of the normocalcemic and 80 of the hypocalcemic patients. The hypocalcemic group had significantly lower ionized Ca++ levels when compared to those of the normocalcemic group (p less than 0.001). Patients with low serum Ca++ values spent a longer time in the ICU (p less than 0.01), had an increased incidence of renal failure and sepsis (p less than 0.01), had an increased mortality rate (p less than 0.001), and received a greater number of blood transfusions (p less than 0.001) than patients in the normocalcemic group. It is concluded that: (1) hypocalcemia is a frequent finding in critically ill patients; (2) determining ionized Ca++ levels is useful because many ICU patients have alterations in both arterial pH and serum albumin levels; (3) hypoalbuminemia, sepsis, red cell transfusions, and renal failure are predisposing factors for hypocalcemia; and (4) hypocalcemic patients do less well clinically than normocalcepatientsmic patients.
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PMID:Hypocalcemia in critically ill patients. 714 Mar 32

The potential of nutritional assessment parameters in predicting sepsis in burn patients was investigated. Sixty-two consecutive patients (mean age 41 years) with an average burn size of 19% were studied. Values were obtained on postburn day 10 for serum albumin, transferrin, nitrogen balance, total lymphocyte count, skin test reactivity, and percentage of ideal body weight. Parameters predictive of imminent septic episode included serum albumin less than 3.0 g/dl (p less than 0.001), total lymphocyte count less than 1500/mm3 (p less than 0.001), anergy (p less than 0.001), and serum transferrin less than 150 mg/dl (p less than 0.001). Nitrogen balance and percentage of ideal body weight were not found to contribute to group discrimination.
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PMID:Nutritional indicators of postburn bacteremic sepsis. 719 89


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