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

Computed tomography, ultrasound, and 67Ga-citrate imaging were analyzed prospectively in patients thought to have a focal source of sepsis. They were divided into three groups: (a) postoperative, fever greater than or equal to 38.3 degrees C; (b) fever greater than or equal to 38.3 degrees C for less than four weeks, unrelated to surgery; and (c) any fever present for more than four weeks. ROC curves showed no significant difference in the ability of the three modalities to differentiate focal from nonfocal sources of sepsis. If any two examinations were used and either study was abnormal, the sensitivity increased from about 60% to nearly 90% while the false-positive rate increased from about 15% to 25%. When focal disease was diagnosed only if two examinations were abnormal, the false-positive ratio dropped to nearly zero but the sensitivity fell to below 40%. The authors concluded tha all three modalities have a similar ability to detect sepsis and that sensitivity can be increased by using any two of them.
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PMID:A prospective study of computed tomography, ultrasound, and gallium imaging in patients with fever. 723 31

In patients with nonpulmonary sepsis, von Willebrand factor antigen (vWF:Ag or Factor VIIR:Ag) levels have been reported to be predictive for the development of the adult respiratory distress syndrome (ARDS). We addressed the ability to generalize these results by measuring serial Factor vWF:Ag levels in 96 patients at risk for the development of ARDS. Patients with sepsis, pancreatitis, hypertransfusion, witnessed aspiration of gastric contents, abdominal trauma, chest trauma, and multiple fractures were studied. Sequential measurements were obtained at enrollment into the study (T = 0), and T = 6, 12, 24, and 48 h. Subjects were grouped into sepsis and nonsepsis categories and analyzed according to the following outcome definitions: ARDS and non-ARDS. The mean values for the sepsis and nonsepsis groups were elevated above normal at all time points. A statistically significant difference occurred in the mean vWF:Ag level for the ARDS and non-ARDS patients in the nonsepsis group at T = 0 (p = 0.05). To assess the clinical utility of these results, ROC (receiver operating characteristics) curves were plotted at T = 0, and optimal cutoff values of vWF:Ag were determined. In the sepsis group, the best value for vWF:Ag above which patients would actually develop ARDS was 399%, resulting in a 70% sensitivity and a 47% specificity. For the non-sepsis patients, the optimal value was 273%, yielding a sensitivity of 64% and a specificity of 52%. We conclude that measuring vWF:Ag levels are not helpful in predicting the progression to ARDS in multiple at-risk patients.
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PMID:von Willebrand factor antigen levels are not predictive for the adult respiratory distress syndrome. 781 45

An assessment was made of the predictive capacity of the following predictive formulation named Nutritional Sepsis Risk: NSR = 14.26 - 1.76 (albumin) - 1.47 (risk area) This was done in a sample of 65 surgery patients with digestive pathology who were candidates for selective surgery. All had undergone a pre-operative nutritional evaluation program, based on anthropometric and analytical data and Retarded Hypersensitivity Cutaneous Tests (RHCT). NSR was calculated pre-operatively. Infections were assessed qualitatively and quantitatively using Elebeute and Stoner's sepsis index. There were a total of five post-operative infections (7.69%). The NSR intersection point was calculated with an ROC curve, situated in a score of 3. The NSR detected the five infections, so is 100% sensitive, with 70% specificity and, in the detection of the septic risk population, surpassed the other nutritional parameters, whether anthropometric or analytical, and the RHCTs, when they were studied individually.
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PMID:[The prediction of postoperative septic complications by means of nutritional parameters. II. The verification of the predictive formula]. 783 80

Scoring systems are mandatory to quantify the severity of abdominal sepsis on the basis of objective criteria. The Mannheim Peritonitis Index (MPI) is a disease-specific score based on easy to handle clinical parameters. APACHE II is a large-scale general scoring system with acute physiological and chronic health parameters. To evaluate the prognostic value of both systems 108 patients with severe abdominal infection managed by open treatment entered a prospective study. 32 patients (29.6%) died, 23 of them due to sepsis and 9 from other causes. Both MPI and APACHE II scores correlated closely with mortality, with three and two significantly different classes, respectively. Statistical validation showed a sensitivity of 93% and a specificity of 16% for MPI, and 89% and 25% for the APACHE II. ROC curves were nearly parallel for both scores. In conclusion there was no significant difference in prognostic value between the scoring systems.
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PMID:[Prognostic scores in peritonitis: the Mannheim Peritonitis Index or APACHE II?]. 784 60

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

A score for quantitative evaluation of the severity of clinical status has been created for a more objective assessment of the clinical status of patients with sepsis and septic shock. The system includes five sections: physiological parameters, level of respiratory support, age, localization of the focus, concomitant diseases. The final score represents a sum of scores for the above sections. ROC analysis demonstrated a higher prognostic value of the proposed score in comparison with the APACHE-II for patients with grave sepsis.
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PMID:[Assessment of the severity of patient status in sepsis and septic shock]. 871 12

Changes in the time courses of serum levels of interleukin-6 (IL6) and the soluble form of CD25 (sCD25) were evaluated in 48 burned patients (31 had sepsis, 21 died). Differences among groups along the time were assessed with ANOVA. The Pearson's r correlation coefficient was used to relate quantitative variables. ROC curves were constructed to analyse the prognostic value of IL6 and sCD25. The values of IL6 and sCD25 were related to treatment outcome and time post-burn. In general, two patterns emerged: In non-survivors, there was a depression of sCD25 with time, and an increase in IL6 levels previous to death, whereas survivors had the opposite pattern. On admission, patients with higher levels of sCD25 had a bad prognosis.
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PMID:Dynamic profiles of interleukin-6 and the soluble form of CD25 in burned patients. 1049 55

Quantitative assessment of the severity of clinical status was carried out and prognostic values of PRISM III, PRISM, SOFA, APACHE II scores and scores proposed by A. Castellanos et al. and K. L. Goitein was evaluated in 105 children (2 months-14 years) with sepsis. Clinical status evaluated in score during the first day of intensive care was correlated to the disease outcome. Sensitivity, specificity, expected values of positive and negative results were evaluated for each score and their discrimination capacity was assessed by ROC analysis. Use of quantitative scores (PRISM, PRISM III, SOFA, APACHE II, and A. Castellanos') is permissible for prospective evaluation of the efficiency of intensive care in children with sepsis, PRISM being the most informative.
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PMID:[Choice of the optimal scale for evaluation of the severity of sepsis in children]. 1133 21

Recent evidence suggests that cell-free plasma DNA has potential use as a prognostic marker in many clinical settings. The aim of the present study was to evaluate the prognostic role of cell-free plasma DNA in the prediction of clinical outcome in intensive treatment unit (ITU) patients. Cell-free plasma DNA was measured by real-time polymerase chain reaction assay for the beta-globin gene and SOFA score, APACHE II score, CRP concentrations, and clinical outcome (duration of stay, ventilation time, and mortality) were noted in 94 patients on admission to the ITU. The median plasma DNA concentration in ITU patients was 5493 GE/mL and this was significantly (P <0.001) higher than the DNA concentration in healthy subjects (1970 GE/mL). DNA concentration demonstrated a significant correlation with serum C-reactive protein (CRP) (r = 0.363) concentration and Sepsis-related Organ Failure Assessment (SOFA) (r = 0.360) score (P <0.001 for both by Pearson correlation) but not with Acute Physiology And Chronic Health Evaluation (APACHE II) score. Patients on ventilation had significantly higher DNA concentrations compared to nonventilated patients (7362 GE/mL versus 4479 GE/mL; P = 0.004). The median DNA concentration in nonsurvivors was 9148 GE/mL, and this was 2.3-fold greater than that in survivors (3921 GE/ml, P <0.001). ROC analysis of the data indicated a sensitivity of 85% and a specificity of 80% when DNA concentration of 6109 GE/mL was taken as a predictor of death. The data suggest that cell-free plasma DNA concentration is potentially useful as a prognostic marker in ITU patients.
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PMID:Cell-free plasma DNA as a prognostic marker in intensive treatment unit patients. 1525 66

This prospective study evaluated serum procalcitonin (PCT) and C-reactive protein (CRP) as markers for systemic inflammatory response syndrome (SIRS)/sepsis and mortality in patients with traumatic brain injury and subarachnoid haemorrhage. Sixty-two patients were followed for 7 days. Serum PCT and CRP were measured on days 0, 1, 4, 5, 6 and 7. Seventy-seven per cent of patients with traumatic brain injury and 83% with subarachnoid haemorrhage developed SIRS or sepsis (P=0.75). Baseline PCT and CRP were elevated in 35% and 55% of patients respectively (P=0.03). There was a statistically non-significant step-wise increase in serum PCT levels from no SIRS (0.4+/-0.6 ng/ml) to SIRS (3.05+/-9.3 ng/ml) to sepsis (5.5+/-12.5 ng/ml). A similar trend was noted in baseline PCT in patients with mild (0.06+/-0.9 ng/ml), moderate (0.8+/-0.7 ng/ml) and severe head injury (1.2+/-1.9 ng/ml). Such a gradation was not observed with serum CRP There was a non-significant trend towards baseline PCT being a better marker of hospital mortality compared with baseline CRP (ROC-AUC 0.56 vs 0.31 respectively). This is the first prospective study to document the high incidence of SIRS in neurosurgical patients. In our study, serum PCT appeared to correlate with severity of traumatic brain injury and mortality. However, it could not reliably distinguish between SIRS and sepsis in this cohort. This is in part because baseline PCT elevation seemed to correlate with severity of injury. Only a small proportion of patients developed sepsis, thus necessitating a larger sample size to demonstrate the diagnostic usefulness of serum PCT as a marker of sepsis. Further clinical trials with larger sample sizes are required to confirm any potential role of PCT as a sepsis and outcome indicator in patients with head injuries or subarachnoid haemorrhage.
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PMID:Serum procalcitonin and C-reactive protein as markers of sepsis and outcome in patients with neurotrauma and subarachnoid haemorrhage. 1567 5


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