Multisystem Organ Failure of Sepsis Publications (5122)


Multisystem Organ Failure of Sepsis Publications

Bone Joint J
Bone Joint J 2017 Jan;99-B(1):122-127
MetroHealth Medical Center, Case Western Reserve University, Department of Orthopaedic Surgery, 2500 MetroHealth Drive, Cleveland, Ohio, 44109, USA.

The best time for definitive orthopaedic care is often unclear in patients with multiple injuries. The objective of this study was make a prospective assessment of the safety of our early appropriate care (EAC) strategy and to evaluate the potential benefit of additional laboratory data to determine readiness for surgery.
A cohort of 335 patients with fractures of the pelvis, acetabulum, femur, or spine were included. Read More

Patients underwent definitive fixation within 36 hours if one of the following three parameters were met: lactate < 4.0 mmol/L; pH ≥ 7.25; or base excess (BE) ≥ -5.5 mmol/L. If all three parameters were met, resuscitation was designated full protocol resuscitation (FPR). If less than all three parameters were met, it was designated an incomplete protocol resuscitation (IPR). Complications were assessed by an independent adjudication committee and included infection; sepsis; PE/DVT; organ failure; pneumonia, and acute respiratory distress syndrome (ARDS).
In total, 66 patients (19.7%) developed 90 complications. An historical cohort of 1441 patients had a complication rate of 22.1%. The complication rate for patients with only one EAC parameter at the point of protocol was 34.3%, which was higher than other groups (p = 0.041). Patients who had IPR did not have significantly more complications (31.8%) than those who had FPR (22.6%; p = 0.078). Regression analysis showed male gender and injury severity score to be independent predictors of complications.
This study highlights important trends in the IPR and FPR groups, suggesting that differences in resuscitation parameters may guide care in certain patients; further study is, however, required. We advocate the use of the existing protocol, while research is continued for high-risk subgroups. Cite this article: Bone Joint J 2017;99-B:122-7.


Severe traumatic brain injury (STBI) is an important issue in contemporary medicine and treatment strategies are still in need of improvement. The most dangerous complications of STBI are multiple organ failure and severe sepsis. As many as 80% of STBI patients with multiple organ failure have acute respiratory distress syndrome (ARDS). Read More

The need for better treatment strategies for STBI has led to investigations of the positive therapeutic effects of corticosteroids (CS). About 10 to 15 years ago research showed the inexpediency of CS in STBI therapy, but there were also contradictory findings showing their effectiveness. STBI is frequently followed by severe sepsis, which is not usually treated with CS. No scientific papers investigated the usage or non-usage of CS in patients with STBI followed by severe sepsis and ARDS.
The aim of the study was to investigate the influence of CS usage on treatment results in patients with STBI followed by severe sepsis and ARDS.
The study involved an analysis of the treatment results in 267 patients with STBI followed by severe sepsis and ARDS, who were treated with and without CS.
The study showed that patients' mortality decreased 1.24 times with CS use (500 mg/day of Solu-Medrol® for three days, followed by dose reduction by one-half every 3 days). Patients who took CS survived longer than patients without this treatment. The duration mechanical ventilation was shorter in patients who were treated with CS compared to the other group.
Further research into CS use is needed to improve treatment strategies for STBI followed by severe sepsis and ARDS.

Biomed. Pharmacother.
Biomed Pharmacother 2016 Dec 23;86:583-589. Epub 2016 Dec 23.
Department of Pharmacology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

The cyclooxygenase (COX)-2 overexpression is associated with vascular injury and multiple organ failure in sepsis. However, constitutive COX-1 and basal COX-2 expressions have physiological effects. We aimed to investigate the effects of partial and selective COX-2 inhibition without affecting constitutive COX-1 and basal COX-2 activities by celecoxib on mesenteric artery blood flow (MABF), vascular reactivity, oxidative and inflammatory injuries, and survival in septic rats accomplished by cecal ligation and puncture (CLP). Read More

Wistar rats were allocated into Sham, CLP, Sham+celecoxib, CLP+celecoxib subgroups. 2h after Sham and CLP operations, celecoxib (0.5mg/kg) or vehicle (saline; 1mL/kg) was administered orally to rats. 18h after drug administrations, MABF and responses of isolated aortic rings to phenylephrine were measured. Tissue samples were obtained for biochemical and histopathological examinations. Furthermore, survival rate was monitored throughout 96h.
Celecoxib ameliorated mesenteric hypoperfusion and partially improved aortic dysfunction induced by CLP. Survival rate was%0 at 49th h in CLP group, but in CLP+celecoxib group it was 42.8% at the end of 96h. Serum AST, ALT, LDH, BUN, Cr and inflammatory cytokine (tumor necrosis factor-alpha, interleukin-1 beta and interleukin-6) levels were increased in CLP group that were prevented by celecoxib. The decreases in liver and spleen glutathione levels and the increases in liver, lung, spleen and kidney malondialdehyde levels in CLP group were blocked by celecoxib. The histopathological protective effects of celecoxib on organ injury due to CLP were also observed.
Celecoxib has protective effects on sepsis due to its preservative effects on mesenteric perfusion, aortic function and its anti-inflammatory and antioxidative effects.

J. Med. Chem.
J Med Chem 2017 Jan 21;60(1):170-179. Epub 2016 Dec 21.
CRI Center for Chemical Proteomics, Department of Chemistry, Seoul National University , Seoul 08826, Korea.
Turk J Emerg Med
Turk J Emerg Med 2016 Dec 19;16(4):146-150. Epub 2016 Nov 19.
Emergency Department, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Researchers have attempted to design various scoring systems to determine the severity and predict the outcome of critically ill patients. The present study aimed to evaluate the accuracy of SOFA score in predicting 1-month outcome of these patients in emergency department.
The present study is a prospective cross-sectional study of >18 year old non-trauma critically ill patients presented to EDs of 3 hospitals, Tehran, Iran, during October 2014 to October 2015. Read More

Baseline characteristics, SOFA score variables, and 1-month outcome of patients were recorded and screening performance characteristics of the score were calculated using STATA 11 software.
140 patients with the mean age of 68.36 ± 18.62 years (18-95) were included (53.5% male). The most common complaints were decrease in level of consciousness (76.43%) and sepsis (60.0%), were the most frequent final diagnoses. Mean SOFA score of the patients was 7.13 ± 2.36 (minimum 2 and maximum 16). 72 (51.43%) patients died during the following 30 days and 16 (11.43%) patients were affected with multiple organ failure. Area under the ROC curve of SOFA score in predicting mortality of studied patients was 0.73 (95%CI: 0.65-0.81) (Fig. 2). Table 2 depicts screening performance characteristics of this scale in prediction of 1-month mortality in the best cut-off point of ≥7. At this cut-off point, sensitivity and specificity of SOFA in predicting 1-month mortality were 75% and 63.23%, respectively.
Findings of the present study showed that SOFA scoring system has fair accuracy in predicting 1-month mortality of critically ill patients. However, until a more reliable scoring system is developed, SOFA might be useful for narrative prediction of patient outcome considering its acceptable likelihood ratios.

Shock 2016 Dec 9. Epub 2016 Dec 9.
*Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong †State Key Laboratory of Digestive Disease, LKS Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong ‡Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong §The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong ¶Department of Rehabilitation, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.

Sepsis is a systemic host response to an infection leading to organ failure. This is associated with dynamic expression of endogenous host defense peptides. Dysregulation of these peptides is associated with septic morbidity and mortality. Read More

We performed a systematic search of articles indexed in Pubmed, ISI Web of Knowledge, EmBase and Scopus database from inception to October 2016. Both preclinical and clinical studies investigating the role of host defense peptides in pathogenesis and as biomarkers for sepsis were included.
Of the available literatures, cathelicidin, defensin and hepcidin are amongst the best-characterized peptides. These regulate immune response, and crosstalk with pyroptosis and coagulation cascades. The applicability of these peptides as septic biomarkers has been investigated in vitro and in vivo studies. However, numerous studies were based on endotoxemia without an infection, jeopardizing interpretation of the outcomes. Cathelicidin and defensin were frequently reported in adult sepsis while hepcidin in neonatal sepsis. The expression level of these peptides is significantly associated with septic condition. Most of the studies employed a cross-sectional design, precluding the establishment of a temporal relationship between candidate peptide biomarkers and sepsis.
Innate defense peptides have been insufficiently evaluated as either diagnostic or prognostic biomarkers. In the future, evaluation of host defense peptides as septic biomarkers may employ a longitudinal design and consider a panel of multiple peptides.

Shock 2016 Dec 2. Epub 2016 Dec 2.
*Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany †Department Intensive Care Medicine, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany ‡Department of Anesthesiology and Intensive Care Medicine, Center for Sepsis Control and Care (CSCC), and the Center for Molecular Biomedicine (CMB), University Hospital Jena, Hans-Knöll-Str. 2, 07745 Jena, Germany §Clinic and Polyclinic for Vascular Medicine, University Heart Center, Martinistrasse 52, 20246 Hamburg, Germany.
Zhonghua Wai Ke Za Zhi
Zhonghua Wai Ke Za Zhi 2016 Dec;54(12):902-907
Department of Thoracic Surgery, Lung Transplant Center, Affiliated Wuxi People's Hospital, Nanjing Medical University, Key Laboratory of Human Organ Transplant in Jiangsu Province, Wuxi 214023, China.

Objective: To evaluate the effect of lung transplantation for phase Ⅲ silicosis. Methods: From September 2002 to September 2015, 32 patients with end-stage silicosis underwent lung transplantation at Department of Thoracic Surgery, Affiliated Wuxi People's Hospital, Nanjing Medical University. There were 29 male and 3 female patients aged from 24 to 63 years. Read More

Thirty-two patients were diagnosed as phase Ⅲ silicosis by the local occupational disease prevention and control center. Fifteen patients were type Ⅰ respiratory failure and 17 patients were type Ⅱ. There were 14 cases accepted bilateral sequential lung transplantation and 18 cases accepted single lung transplantation, including 13 cases with right single lung transplantation and 5 cases with left single lung transplantation. Extracorporeal membrane oxygenation was used in 13 patients. Pulmonary function monitoring was performed at 3 months, 6 months, 1 year, and 2 years after lung transplantation. Clinical characteristics were compared using t-test, χ(2) test and Fisher exact test between groups, Kaplan-Meier survival curve and Log-rank test were used to find out the factors affecting survival. Results: All the patients received lung transplantation successfully. One patient died of multiple organ failure, 1 died of sepsis, and 1 succumbed to sudden cardiac death. Twenty-nine patients were discharged from hospital. During follow-up, there were 5 deaths, two patients died of sepsis 7 months postoperatively, 1 died of renal failure 5 months post-transplant, 1 died of sudden cardiac death, and the remaining 1 patient died of bronchiolitis obliterans. Twenty-four patients lived a good quality of life, with survival rates of 90.6% at 3 months, 80.8% at 1 year, 76.7% at 3 years, and 76.7% at 5 years. Significant difference was not observed between single and bilateral lung transplantation about long-term survival rate. During follow-up pulmonary function post-transplant (3 months, 6 months, 1 year, and 2 years) were improved dramatically compared with preoperative level, and patients lived a good quality of life. Conclusion: Lung transplantation is beneficial for patients with phase Ⅲ silicosis, long-term survival is probable.

Exp Clin Transplant
Exp Clin Transplant 2016 12 2. Epub 2016 Dec 2.
From the Department of Transplantation, Central Manchester University Hospitals, United Kingdom

Kidney transplant is the gold standard for treatment of renal failure. With the increasing age of the recipient population, which carries significant comorbidities, and the use of more marginal organs, there is potential for increased critical care admissions. In this study, we investigated the incidence, indications, and outcomes of patients admitted to critical care within 1 year of transplant. Read More

We also aimed to identify any precipitating factors or events that may trigger these admissions, as well as establish variables that could affect mortality.
We performed a retrospective analysis of kidney transplant recipients admitted to critical care within 1 year after transplant, between January 2009 and December 2013.
Of 1002 kidney transplants, 53 patients (5.3%) were admitted to critical care within 1 year, with patients separated into 2 groups. Group 1 comprised 32 patients (61%) who were admitted immediately postoperatively, mainly from cardiorespiratory derangements with mean stay of 3.7 days (range, 1-34 days) and 0 mortalities. Group 2 comprised 21 patients (39%) who were admitted later in the postoperative period, principally from sepsis-related complications with a mean stay of 18 days (range, 1-101 days). Most patients in group 2 required intensive therapy, including mechanical ventilation and immunosupprression reduction, incurring a hospital mortality rate of 48%. Hemorrhage with reexploration was higher in group 1. Diabetes mellitus, cardiac comorbidity, prolonged stay, nutritional support, nosocomial infections, and multiple organ failure were found at a higher rate in the group 2 patients who died.
The incidence of critical care admissions 1 year after kidney transplant was 5.3%. Most admissions occurred in the early postoperative period, mostly as preemptive measures for cardiorespiratory monitoring and support. This category of admission is potentially preventable with optimization of preoperative treatment. Later admissions were mostly consequential to sepsis-related complications, with patients having a high mortality rate due to multiple organ failure. Clinical management should therefore focus on the prevention of multiple organ failure to improve patient outcomes.

Transplantation 2016 Dec 1. Epub 2016 Dec 1.
1Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands 2Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands 3Department of Methodology and Statistics, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands 4Department of Nephrology, Maastricht University Medical Center, Maastricht, The Netherlands 5Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.

Extracellular histones are cytotoxic molecules that are related to cell stress and death. They have been shown to play a crucial role in multiple pathophysiologic processes like sepsis, inflammation, vascular dysfunction and thrombosis. Their role in organ donation and graft function and survival is still unknown. Read More

The aim of this study was to assess whether an association exists between the presence of extracellular histones in machine perfusates and deceased donor kidney viability.
Machine perfusates of 390 donation after circulatory death kidneys were analysed for histone concentration and corresponding graft function and survival were assessed.
Extracellular histone concentrations were significantly higher in perfusates of kidneys with posttransplant graft dysfunction (primary non function (PNF) and delayed graft function (DGF)) and were an independent risk factor for DGF (OR=2.152 (1.199-3.863)) and one year graft failure (HR=1.386 (1.037-1.853)), but not for PNF (OR=1.342 (0.900-2.002). One year graft survival was 12% higher in the group with low histone concentrations (p=.008) as compared to the group that contained higher histone concentrations.
This study warrants future studies to probe for a possible role of cytotoxic extracellular histones in organ viability and suggests that quantitation of extracellular histones might contribute to assessment of posttransplant graft function and survival.