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Query: UMLS:C0243026 (sepsis)
 52,417 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Background Sepsis remains a major cause of death, with high mortality and morbidity rates in children. The cause of mortality may be associated with several factors, including differences in cultures and the type of organism. This study was aimed at evaluating the characteristics and outcomes of negative bacterial blood culture compared to those of positive bacterial blood culture in children with severe sepsis/septic shock. Methods A retrospective cohort study was conducted at a pediatric intensive care unit (PICU) of a tertiary care medical center. All pediatric patients, from newborn to 14 years of age, admitted between April 2015 and January 2018 were included in the study if they fulfilled the criteria for severe sepsis/septic shock. Results Of the 209 patients, 30 (14.3%) had a positive bacterial blood culture whereas 179 (86.6%) had a negative bacterial blood culture. Mortality was more in positive bacterial blood culture 13 (43%) vs 35 (20%) in negative bacterial blood culture (P = 0.004). Respiratory tract infections were extremely common, present in 108 of 179 (60%) patients, and tended to result in a negative culture. The rate of organ dysfunction was higher in the positive bacterial blood culture group at admission (P = 0.01). However, the results did not reveal a significant finding related to multiorgan dysfunction syndrome (MODS) progression over three days of PICU admission (P = 0.06). Conclusion The negative bacterial blood culture constitutes a substantial proportion of pediatric patients with severe sepsis/septic shock. Furthermore, these pediatric patients have a lower mortality rate compared to positive bacterial blood cultures. The culture-negative sepsis group also had less organ dysfunction.
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PMID:Association Between Culture-Negative Versus Culture-Positive Sepsis and Outcomes of Patients Admitted to the Pediatric Intensive Care Unit. 3285 96

Pneumonia is a well-recognized respiratory infection associated with substantial morbidity and mortality. Despite its effects on the respiratory system, pneumonia can cause or exacerbate cardiovascular complications through various mechanisms. The two main mechanisms that are described in this case report are hypoxia-induced pulmonary hypertension and the effect of sepsis on the cardiovascular system. Pulmonary hypertension (PH) is a disease characterized by raised pulmonary arterial pressure due to a progressive increase in pulmonary vascular resistance, inevitably leading to right ventricular (RV) afterload. For our case, the situation was complicated by sepsis, which further worsened the myocardial function causing left ventricular hypertrophy and left ventricular dysfunction. The main goal of this case report is to highlight the fact that cardiovascular events due to pneumonia are a potential complication even in young patients who are without any comorbidities. We present a case of a 14-year-old patient who presented with symptoms of cough, hemoptysis, fever, chest pain, and dyspnea. After the necessary investigations, he was diagnosed with severe pneumonia, sepsis, moderate PH, and left ventricular dysfunction. The treatment course was focused on stabilizing the patient by oxygen supplementation, treating the underlying cause with the use of antibiotics, and decreasing the already raised arterial pressures through vasodilator therapy. After the patient went through the proper course of treatment, there was a marked improvement in his general condition.Cardiac complications due to pneumonia are potential complications even in relatively young patients who have no noted comorbidities. Clinicians should be aware of these potentially fatal complications of pneumonia and appreciate the significance of this association for timely recognition, diagnosis, and management of these complications.
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PMID:Left ventricular dysfunction and reversible pulmonary hypertension secondary to severe pneumonia in a background of sepsis: a case report and review of the literature. 3306 2

Introduction Lung cancer is the leading cause of cancer-related deaths worldwide. Surgery remains the best treatment for obtaining a cure in patients in resectable stages. Despite the improvements in surgical techniques, perioperative complications are still a major factor of mortality. Several scoring systems for quantifying surgical risks have been proposed but they require large and complex information, usually regarding specific groups or postoperative mortality. Objectives Identify risk factors for major in-hospital perioperative complications (MIPC) after anatomical lung resection for Non- -Small-Cell Lung Cancer (NSCLC) establish a clinical scoring system. Materials and Methods Single center retrospective study of all consecutive patients diagnosed with NSCLC submitted to anatomical lung resection from 2015 to 2019 (N=564). Exclusion criteria: previous lung surgery (29), concomitant non-lung cancer related procedures (10), urgency surgery (5). The population of study was 520 patients. Primary end-point: MIPC defined as a composite endpoint including at least one of the following in-hospital variables - myocardial infarction, cardiac arrest, de novo Atrial Fibrillation, stroke, acute renal lesion, bleeding, acute pulmonary edema, primary respiratory failure, respiratory infection, empyema, sepsis, wound infection and need for reoperation.Univariable and Multivariable analyses were developed to identify predictors of perioperative complications and create a risk score. Discrimination was assessed using the C-statistic. Calibration was evaluated by Hosmer and Lemeshow test and internal validation was obtained by means of bootstrap replication. Results The study population had a mean age of 65 years and 327 (62.9%) were males. Mean hospital stay of 9 days after surgery. Overall MIPC rate was 23.3%.Among 26 clinical variables, male gender (OR 1.9; CI95%:1.16-3.07; p=0.010), hypertension (OR 2.1; CI95%:1.35-3.37; p=0,001), forced expiratory volume in 1s (FEV1) less than 75% (OR 2.5; CI95%:1.53-1.17; p<0.001), thoracotomy (OR 2.1; CI95%:1.20-3.57; p=0.009), bilobectomy/pneumectomy (OR 2.5; CI95%:1.2-4.9; p=0.011) and concomitant lung cancer procedures (OR 2.1; CI95%:1.20-3.58; p=0.009) were independent predictors of MIPC. A risk score based on the odds ratios was developed and ranged between 0 and 14 points. The scoring system was divided in 5 groups: 1-2 points (Positive predicted value (PPV) 15%); 3-4 (PPV 25%); 5-7 (PPV 35%); 8-9 (PPV 60%); >10 points (PPV 88%). The score showed reasonable discrimination (C-statistic=0.70), good calibration (P=.643) and it was internally validated (averaged C-statistic=0,71). Conclusions This study proposes a simple and daily-life risk score system that was able to predict the incidence of perioperative complications, in order to identify patients at a high risk and facilitate clinical decision-making related to treatment strategy selection.
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PMID:Lung Resection For Non-Small-Cell Lung Cancer - A New Risk Score To Predict Major Perioperative Complications. 3328 Feb 97


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