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

The course of 260 adults with haematological malignancies admitted to a medical intensive care unit was studied to evaluate the value of life support techniques and to research predictive factors. The overall in the medical intensive care unit (MICU) and hospital mortality rates were respectively 43% (113 patients) and 57% (148 patients). Among survivors, 64% (49 patients) were still alive after 6 months and 44% (35 patients) after 1 year. Among 34 haemodialysed patients, the MICU mortality was 67% (23 patients) and among 111 mechanically ventilated patients 85% (94 patients). Prolonged mechanical ventilation, more than seven days, was performed in 11 of the 17 survivors and did not influence long term survival. No individual predictor of mortality was found comparing survivors and non-survivors. However, SAPS, intractable sepsis and failure of more than one organ system were significantly different in non-survivors (p less than 0.001). Among the 20 patients requiring both mechanical ventilation and haemodialysis, only two left the MICU and both died soon thereafter. We conclude that life support therapy should be initiated in patients with haematological disorders and that prolonged mechanical ventilation is compatible with long term survival. However, the combination of mechanical ventilation and haemodialysis is always associated with a poor prognosis and therefore the use of both techniques simultaneously for one patient is questionable.
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PMID:Is intensive care justified for patients with haematological malignancies? 221 52

In 47 medical and postoperative ICU patients with 57 episodes of sepsis and septic shock, cardiovascular parameters including systemic vascular resistance (SVR), cardiac index (CI), stroke volume index (SVI), left ventricular stroke work index (LVSWI) as well as six scoring systems (APACHE II, Elebute, Goris, HIS, SAPS and SSS) were studied regarding their usefulness in the assessment of disease progression and evaluation of response to supplemental sepsis therapy (immunoglobulins, plasmapheresis). Among the hemodynamic parameters, only a prompt SVR improvement significantly discriminated between ultimate survivors and nonsurvivors. Thus, an increase in SVR (greater than 160 dyn*cm-5*sec, within days 0 to 4, persisting for greater than 24 hours) can serve as a prognostically validated "response" criterion (responders/non-responders: 26/31; mortality: 27% vs. 77%). Non-invasively, the APACHE II score was best suited (specificity: 88%, sensitivity: 67%) to classify hemodynamically defined responders to supplemental sepsis treatment (score-reduction greater than or equal to 4 on day 4 after onset of therapy).
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PMID:Cardiovascular parameters and scoring systems in the evaluation of response to therapy in sepsis and septic shock. 227 17

Ingestion of organophosphate (OP) compounds usually results in severe poisoning. We undertook a retrospective study of 52 consecutive patients admitted with severe OP poisoning to determine the value of serum cholinesterase (SChE) in monitoring clinical course. Considering survivors and non-survivors, we evaluate clinical and laboratory baseline characteristics, severity scores (APACHE II, SAPS II), atropine rate (mg/h), SChE evolution at 24, 72 and 120 h and final SChE (SChE at the day of discharge or death). Mortality in the ICU was 28.9% (n = 15). In both groups SChE showed a trend to increase. In survivors, SChE recovery was statistically significant for SChE 24h-SChE 72 h, SChE 24 h-SChE 120 h and SChE initial-SChE 120 h (p = 0.008, p = 0.00003, p = 0.0002 respectively). In this group a simultaneous decrease in atropine requirements was registered. In non-survivors, the rate of atropine remained unchanged up to 120 h. Three groups could be defined in non-survivors according to their final SChE and day of death. Non-survivors-1 (death in the first 24h; 2 patients) and non-survivors-2 (death after the first 24 h; 5 patients) had a final SChE below 10% of normal SChE activity and statistically different from survivors' final SChE. Non-survivors-3 (8 patients) had a final SChE similar to the survivors and death was due to sepsis and multiple organ failure (MOF). We conclude that SChE is useful in OP poisoning diagnosis and also in monitoring clinical course. SChE recovery above 10% of normal seems to correlate with good prognosis. Sepsis and MOF were important determinants of mortality.
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PMID:[Severe poisoning by organophosphate compounds. An analysis of mortality and of the value of serum cholinesterase in monitoring the clinical course]. 748 63

The annual incidence of acute renal failure (ARF) in the general population seems close to 150 per million inhabitants. For the past 20 years, there has been an increase in ARF of medical origin and a simultaneous decrease in surgical, traumatic and obstetrical ARF. Drug-induced ARF accounts for 20% of total cases. Factors of poor prognosis include a poor previous health status, the presence of oliguria, cardiac or respiratory insufficiency, sepsis, coma, a need for mechanical ventilation and, most importantly, the number of failing organs. The three main severity scoring systems used are SAPS, APACHE II and OSF. The predictive value of these scoring systems seems acceptable provided the data are collected when ARF is diagnosed and not on the patients' admission. After years, the overall survival rate does not exceed 30% to 50%. Full renal recovery is observed in 1/3 to 2/3 of surviving patients and varies according to the type of nephropathy. The social and financial consequences of these results emphasize the importance of preventing ARF, especially in its iatrogenic form.
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PMID:[Epidemiology and prognosis of acute renal insufficiency]. 798 47

In 110 patients undergoing elective heart surgery on extracorporeal circulation, various parameters were studied regarding the early assessment of septic complications. In a first step, the Elebute score definition for postoperative sepsis validated in general surgery patients (score > or = 12) could be confirmed in an extended form (> or = 12 on > or = 2 days) for cardiac surgery patients. According to this definition (overall classification accuracy for clinically defined sepsis-related mortality: 94%), septic complications occurred in 16 patients and were associated with a significantly worse prognosis than in non-septic patients (mortality 69% vs. 1%, p < 0.0001). In contrast, SIRS (best classification criterion: positive on > or = 3 days) displayed a lower specificity for clinically defined sepsis-related mortality, at least during the early postoperative course (accuracy: 67%). Based on the Elebute score classification, other more practicable parameters were investigated regarding their usefulness for an early sepsis risk assessment in post cardiac surgical patients. Five additional severity scores (APACHE II, MOF-Goris, HIS, SAPS, SSS) were comparable (ROC area: 0.94 to 0.96) and superior to plasma PMN-elastase and neopterin, haemodynamics and clinical parameters in predicting the risk for septic complications as early as by the first postoperative day.
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PMID:Evaluation of definitions and parameters for sepsis assessment in patients after cardiac surgery. 818 48

This study of the plasma aminogram was done on 35 patients with a moderate to high level of stress and/or sepsis. For the criteria of illness, the SAPS (Simplified Acute Physiological Score) was used on their admission to the intensive Care Unit, and the diagnosis of sepsis was established according to the criteria of Jacobs and Boone. The stress level was calculated according to Bistrian. The plasma aminogram was determined with High Resolution Liquid Chromatography. The plasma samples were taken while nutrient units containing what is considered a standard solution of amino acids were infused. The eight essential amino acids (EAA) and 10 non-essential were quantified. The ratio of ramified to aromatic amino acids (RAA/AAA) was calculated by Fisher's criteria. An increase in AAA (phenylalanine, p < 0.001, and tyrosine, NS) and sulphur containing amino acids (methionine, p < 0.001) was found. The RAA were within normal ranges (valine) or increased (leucine, p < 0.001 and isoleucine, p < 0.001). The RAA/AAA ratio was reduced, p < 0.0001. Glycine was increased, p < 0.0001 and alanine reduced, p < 0.05. Glutamine and glutamic acid were reduced, p < 0.0001 and p < 0.01 as was arginine, p < 0.001. No difference was found in the total concentration of AA. The results confirm the standard plasma aminogram described in situations of metabolic stress and/or sepsis.
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PMID:[Plasma aminogram in critical patients]. 846 96

Since sepsis is a major cause of mortality after cardiac surgery, early identification of the patients at risk of developing septic complications is of considerable importance. In the present study on 110 patients after elective heart surgery, we, therefore, examined scoring systems as well as various single parameters with regard to an early prediction of septic complications. In a first step, the Elebute score definition for postoperative sepsis in general surgery patients (score > or = 12) could be confirmed for cardiac surgery patients as well. Septic complications, defined as an Elebute score > or = 12 on > or = 2 days, occurred in 16 patients and were associated with a significantly worse prognosis than in non-septic patients (mortality 69 vs. 1%). Consequently, other more practicable parameters were investigated: five additional scores (APACHE II, Goris, HIS, SAPS, SSS) were comparable and superior to plasma levels of elastase and neopterin, haemodynamic data, and clinical parameters in predicting septic complications as early as by the 1st postoperative day. For reasons of practicability and availability, the APACHE II score (predictive values: positive 86%, negative 96%, Youden index 0.73; diagnostic cut off point: > or = 19 on the 1st postoperative day) seemed to be best suited. Therefore, this was further investigated within a consecutive prospective study (independent group of 106 patients) which confirmed an APACHE II score > or = 19 as discriminating criterion (mortality 36 vs 0%). Thus, the APACHE II score may be useful for prospective screening, with the intention to treat, of patients after cardiac surgery who are at risk of postoperative septic complications.
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PMID:[Early detection of patients at risk for infection after heart surgery]. 849 53

This prospective, multicenter, epidemiological study was carried out in 99 Italian ICUs, distributed throughout the country, from April 1993 to March 1994. In the study, we applied the new ACCP/SCCM classification system for sepsis (SIRS, sepsis, severe sepsis and septic shock) and determined the prevalence, incidence, evolution and outcome of these categories in critically ill patients. The preliminary analysis of 1101 patients showed that on admission SIRS accounted for about half of the diagnoses (52%) with sepsis, severe sepsis and septic shock accounting for 4.5%, 2.1% and 3% of patients, respectively. Patients with severe sepsis or septic shock more frequently had high SAPS scores than patients without sepsis. Mortality rates were similar in patients with SIRS (26.5%) and without SIRS or infection (24%), but rose to 36% in patients with sepsis, to 52% in those with severe sepsis and to 81.8% in those with septic shock. Sepsis, severe sepsis and septic shock were more common in patients with medical diagnoses, and neither severe sepsis nor septic shock was observed in trauma patients. With respect to evolution, the incidence of septic shock was progressively higher in patients admitted with more severe "sepsis-related" diagnoses, while only a trivial difference in rates of incidence was observed between SIRS patients and those admitted without SIRS or any septic disorder (nil). The breakdown of the various ACCP/SCCM "sepsis-related" diagnoses at any time during the study was: SIRS in 58% of the population, sepsis in 16.3%, severe sepsis in 5.5% and septic shock in 6.1%. It seems reasonable to expect from the final evaluation of our study answers to the questions raised by the ACCP/SCCM Consensus Conference about the correlations between "sepsis-related" diagnosis, severity score, organ dysfunction score and outcome.
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PMID:The Italian SEPSIS study: preliminary results on the incidence and evolution of SIRS, sepsis, severe sepsis and septic shock. 863 31

The objective of this study was to compare the evolution of patients with acute renal failure (ARF) treated conservatively or with different dialytic techniques in an intensive care unit (ICU). From June 1992 to November 1994, 1087 consecutive patients were admitted in our ICU. Two hundred and twenty of these presented with ARF, and were divided into three groups; group I (control group): 156 patients with ARF who did not receive substitutive techniques; group II: 21 patients under intermittent hemodialysis (IHD) or peritoneal dialysis (PD); group III: 43 patients under continuous hemodiafiltration (CHDF). The studied variables were age, etiology of renal failure, requirement of dialysis, type of dialysis, length of ICU and hospital stay, and renal function outcome. APACHE II and SAPS scores were recorded on admission and analyzed for hospital mortality. Chi-square test and the analysis of variance were used for the statistical analysis. Results are presented as mean +/- SD. A p value below 0.05 was considered statistically significant. Although etiology of ARF was multifactorial, we found a high frequency of ARF due to sepsis (56.8%), hypoperfusion (58.7%), and acute tubular necrosis (62.5%). Sepsis and heart failure were clinical conditions associated to a greater mortality. We did not find any statistical difference between the two dialyzed groups for all the studied variables, nor between the three groups regarding APACHE II and hospital stay. Significant differences were found between dialyzed and non-dialyzed patients respect to age, group I: 64.1 +/- 13.6, group II: 56.4 +/- 19.7, and group III: 56.0 +/- 14.1 (p < 0.001), creatinine peak serum levels, group I: 260 +/- 130, group II: 494 +/- 209, and group III: 441 +/- 170 mumol/L (p < 0.0001), and mortality, group I: 46.9%, group II: 66.7%, and group III: 76.2% (p < 0.002). SAPS score showed differences between the control group and the CHDF group 13.9 +/- 4.8 and 16.4 +/- 5.4 (p < 0.007), respectively. The use of dialytic techniques in critically ill ARF patients is associated with greater mortality. Prognostic indexes on admission did not correctly classify our patients with ARF. Continuous hemodiafiltration does not involve greater mortality or length of stay as compared to conventional dialysis.
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PMID:Prognostic indexes and mortality in critically ill patients with acute renal failure treated with different dialytic techniques. 887 94

The results of using recombinant interleukin-2 from yeast for the treatment of patients with the sepsis syndrome are discussed. It is noted that there was a marked immunomodulating effect, the amount of endogenous interleukin-2 increased. The patients' state was shown to become less severe (according to the SAPS criterion), the patients felt better. A conclusion is made of the possibility in principle and expediency of using cytokines for the treatment of patients with the sepsis syndrome.
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PMID:[The principle of cytokine therapy in the sepsis syndrome (a preliminary report)]. 923 67


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