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

Nutritional indices (percentage ideal body weight [IBW], serum albumin, serum transferrin, total lymphocyte count [TLC] and delayed cutaneous hypersensitivity [DH] response) were assessed in 80 consecutive patients (aged 85-100 y) within 24 h of admission to determine their predictive value for mortality. Nine patients died. Pearson correlation analysis demonstrated that death was significantly (p less than 0.05 to less than 0.01) associated with sepsis, serum albumin less than 30 g/L, TLC less than or equal to 1500 cells/mm3, and percentage IBW less than or equal to 90%. However, when serum albumin was controlled for, logit regression analyses demonstrated that the impact of other nutritional indices on death was insignificant. The effect of serum albumin remained significant (p less than 0.05 to less than 0.01) even when age and physician's diagnosis were held constant. With the logit model, serum albumin greater than or equal to 30 g/L had a sensitivity of 0.33, specificity of 0.99, and overall predictive power of 0.91. Serum albumin is thus the simplest and best single predictor of mortality and can provide early identification of elderly people at increased risk of death.
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PMID:Predictive ability of various nutritional variables for mortality in elderly people. 272 72

The pathophysiological changes occurring with increasing grade of encephalopathy were examined in 93 consecutive episodes in 44 patients with liver cirrhosis (37 posthepatic). The incidence of gastrointestinal bleeding and leukocytosis increased significantly when the grade advanced from 1 to 5. The following variables showed a trend for change that did not reach statistical significance: rising serum bilirubin, SGOT, and BUN levels; decreasing serum sodium and chloride levels; and increased incidence of infection. The mean values of the following variables were significantly different in 25 fatal episodes and 68 survivors, implicating a bad prognosis: high serum bilirubin, alkaline phosphatase, and BUN levels; low serum albumin, sodium, and chloride levels; and a higher incidence of severe infections (sepsis, infected ascitic fluid). Because increasing grade of encephalopathy is the most important factor in determining the prognosis of hepatic encephalopathy (mortality 0, 10, 5, 19, and 85 percent in grades 1 to 5, respectively), more efforts should be made to understand and prevent the pathophysiological changes associated with advancing grades of encephalopathy.
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PMID:Pathophysiological changes associated with increasing grade of hepatic encephalopathy. 324 14

DTH skin reactions can identify a population of surgical patients at increased risk for sepsis and related mortality. The usefulness of the technique is increased by repeating the test during the hospital course and by calculating a DTH score, which is the sum of the diameter of induration of all five or six tests expressed in millimeters. Regression analysis of factors that could possibly indicate development of sepsis and death after surgical treatment reveals that the most powerful predictors are serum albumin, DTH score and age of the patient. The population of patients who are anergic are more frequently malnourished than reactive patients, but the DTH response cannot be used to determine the malnourished state in individual patients. The lack of a DTH reaction (anergy) identifies an immune defect characterized by a failure of release of lymphokines in vivo. Lymphokines from normal individuals can restore to normal the absent response of anergic patients to specific antigens. In experimental animals made anergic by a heat injury, the mortality rate from bacterial peritonitis can be significantly lowered by lymphokines. Immunomodulation of demonstrated defects in host resistance is an exciting prospect for the future of surgical patients.
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PMID:Delayed type hypersensitivity testing in surgical patients. 327 96

In a historical cohort study, acute renal failure developed in 16.5% of 157 patients with rhabdomyolysis over a two-year study period. Underlying clinical, laboratory, and causative factors associated with the development of acute renal failure were examined. Factors predictive of renal failure in this setting, determined by multiple logistic regression analysis, included the degree of serum creatine kinase, serum potassium, and serum phosphorus level elevation; the degree of depression of serum albumin level; and the presence of dehydration at presentation or sepsis as the underlying cause. The predictive model that was developed correctly classified 93% of subjects and was statistically validated.
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PMID:Factors predictive of acute renal failure in rhabdomyolysis. 338 1

The incidence and the clinical implications of hypocalcemia were evaluated in acutely ill patients admitted to the Medical Intensive Care Unit of the Detroit Receiving Hospital. Total and ionized calcium levels were prospectively evaluated upon admission for all patients over a three-month interval. A high proportion of patients (62 of 88, 70 percent) were found to have decreased levels of both total and ionized calcium. Known causes of hypocalcemia could be identified in only 28 patients (45 percent). These included hypomagnesemia (17, 28 percent), renal insufficiency (five, 8 percent), alkalosis (four, 6 percent), and acute pancreatitis (two, 3 percent). In the remaining 34 patients (55 percent), no readily identifiable cause could be found. These 34 patients had a lower mean albumin level than did the 23 normocalcemic patients (p less than 0.01), but there were no differences in age, pH, serum creatinine, magnesium, or phosphate between the two groups. Serum albumin correlated directly with ionized calcium levels (n = 82, r = 0.33, p less than 0.01), as well as with total calcium levels (n = 76, r = 0.70, p less than 0.01). There was a strong association between sepsis and hypocalcemia. Patients who survived the hospitalization had higher mean ionized calcium, total calcium, and albumin values than did nonsurvivors, but there were no differences in age, serum creatinine, magnesium, and phosphate between the two groups. The mortality of the hypocalcemic patients (44 percent) was significantly greater (p less than 0.05) than the mortality of the normocalcemic patients (17 percent). These findings suggest that hypocalcemia is a very common abnormality in acutely ill patients and is associated with a poor prognosis.
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PMID:Prevalence and clinical implications of hypocalcemia in acutely ill patients in a medical intensive care setting. 340 50

The nutritional status was analyzed in 37 patients being treated with staged anterior and posterior spinal reconstructive procedures. Using stringent criteria for nutritional and immunologic incompetency, 31 patients (84%) became malnourished during hospitalization. Although the serum albumin on admission had been normal for all patients, it became significantly depressed in 77% following anterior and posterior spinal procedures. In a similar fashion, the total lymphocyte count became significantly depressed in 92%. The postoperative complications were clearly more extensive in patients who were malnourished and immune-deficient using these criteria--15 patients with urinary tract infections, four patients with bacterial sepsis, four patients with wound infections, and four patients with pneumonia (vs. one with a wound infection in the adequately nourished group). The length of hospitalization following the second operative procedure was significantly longer in the malnourished group: 16.2 days versus 12.4 days (p less than 0.05). The main purpose of this study is to create awareness of the ongoing nutritional demands placed on patients treated by two-stage spinal reconstruction surgical procedures. More aggressive nutritional intervention can reduce postoperative complications and length of hospital stay and improve the speed of functional recovery.
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PMID:Nutritional deficiencies after staged anterior and posterior spinal reconstructive surgery. 340 99

1. Plasma fibronectin, a glycoprotein, is an opsonin of the reticuloendothelial system. 2. In ten healthy volunteers starved for 4.5 d, daily measurements showed a rapid reduction in plasma fibronectin, no alteration in either C3 or plasma transferrin and, at the end of the starvation period, an elevated serum albumin. 3. On refeeding, plasma fibronectin rapidly returned to its prestarvation level but plasma transferrin was significantly reduced and did not recover by the end of the study. 4. Changes in plasma fibronectin may be a sensitive index of nutritional status. The reduction of plasma fibronectin in short-term starvation may compromise host defence tolerance of injury and sepsis.
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PMID:Changes in plasma fibronectin during acute nutritional deprivation in healthy human subjects. 366 79

The authors evaluated the host-defence capability of a 33-year-old woman with a history of poor wound healing, gastrointestinal fistulas and bacterial and fungal sepsis after abdominal operations. The following tests gave normal results: hemoglobin, blood neutrophil and monocyte counts, delayed hypersensitivity skin test, serum albumin, immunoglobulin and complement levels, blood T- and B-cell percentages, in-vitro immunoglobulin synthesis and body cell mass. The following tests gave abnormal results: lymphocyte count, leukocyte adherence, in-vivo and in-vitro polymorphonuclear neutrophil chemotaxis, neutrophil bacterial killing and antibody response to tetanus toxoid. Decreased polymorphonuclear neutrophil and humoral immune functions could account for the woman's history of repeated surgical sepsis. Evaluation of host-defence mechanisms can illuminate the cause of repeated episodes of sepsis.
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PMID:Host-defence mechanisms in surgical patients: case report of reduced polymorphonuclear neutrophil and antibody functions associated with surgical sepsis. 370 59

Ten parameters, including delayed cutaneous hypersensitivity testing (DCH), were evaluated with regard to their predictive value in instances of postoperative septic complications. In 302 patients undergoing surgical treatment, 45 complications, including wound infection, abscess, pneumonia and sepsis, were seen postoperatively in 42 patients. When these patients were compared with 260 patients without complications, hemoglobin, leukocyte count, serum albumin, total protein, blood sedimentation rate, age and sex were found not to contribute to the prediction of postoperative complications. In DCH testing, the complication rate increased from 7.5 per cent in normergic patients to 20.6 per cent in anergic patients. With increasing length and severity of operation, the complication rate increased from 6.5 to 26.4 per cent and from 6.5 to 31.8 per cent, respectively. Only in severe, long lasting operations could DCH testing differentiate the complication risk. Normergic patients had a 8.6 per cent complication rate; hypoergic patients, 36.6 per cent, and anergic patients, 37.5 per cent. The results of DCH testing did not correlate with the complication rate in any of the other operative groups. In conclusion, the predictive value of DCH testing is clearly greater in groups of patients highly affected by the operative trauma. The results of this study show that it is important to consider both host defense mechanisms and environmental factors in the assessment of operative risks.
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PMID:The predictive role of delayed cutaneous hypersensitivity testing in postoperative complications. 371 89

Thirty-five patients with serious infections and impaired renal function were treated empirically with 2 to 8 g of cefoperazone per day. Infections included sepsis in 14, nonbacteremic urinary infections in nine, pneumonia in five, intra-abdominal infection in five, fasciitis in one, and malignant otitis externa in one. The average age of this group was 64.3 years, 25 had ultimately fatal underlying diseases, and their average serum creatinine level was 5.2 mg/dl. Infections were caused by Enterobacteriaceae in 23 patients, Streptococcus faecalis in five, Pseudomonas aeruginosa in four, Staphylococcus aureus in four, Hemophilus influenzae in three, and Staphylococcus epidermidis, Streptococcus pneumoniae, and Clostridium sordelli in one each. Overall, 32 patients had clinical and microbiologic cures, two had improvement, and one had failure. Hypoprothrombinemia occurred in 18 of 28 patients not given vitamin K for prophylaxis and occurred more often in those with serum albumin concentrations below 3.5 g/dl. Prothrombin times returned to normal within 36 hours of treatment with vitamin K, although two patients experienced mild hematemesis. In anicteric patients with liver function abnormalities, 2 g every 12 hours produced peak and trough serum concentrations that averaged 254 and 125 micrograms/ml, respectively, compared with 179.5 and 19.5 micrograms/ml, respectively, in five with normal liver function test results. In jaundiced patients treated with 1 g every 12 hours, trough concentrations were comparably elevated. Serum concentrations did not correlate with hypoprothrombinemia, but high levels throughout the dosing interval may have contributed to the excellent cure rate in this study.
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PMID:Cefoperazone for empiric therapy in patients with impaired renal function. 374 81


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