BACKGROUND Hypernatremia represents a significant electrolyte imbalance associated with numerous adverse outcomes,particularly in cases of intensive care unit(ICU)-acquired hypernatremia(IAH).Nevertheless,its relevanc...BACKGROUND Hypernatremia represents a significant electrolyte imbalance associated with numerous adverse outcomes,particularly in cases of intensive care unit(ICU)-acquired hypernatremia(IAH).Nevertheless,its relevance in patients with septic shock remains uncertain.AIM To identify independent risk factors and their predictive efficacy for IAH to improve outcomes in patients with septic shock.METHODS In the present retrospective single-center study,a cohort of 157 septic shock patients with concurrent hypernatremia in the ICU at The First Affiliated Hospital of Soochow University,between August 1,2018,and May 31,2023,were analyzed.Patients were categorized based on the timing of hypernatremia occurrence into the IAH group(n=62),the non-IAH group(n=41),and the normonatremia group(n=54).RESULTS In the present study,there was a significant association between the high serum sodium concentrations,excessive persistent inflammation,immunosuppression and catabolism syndrome and chronic critical illness,while rapid recovery had an apparent association with normonatremia.Moreover,multivariable analyses revealed the following independent risk factors for IAH:Total urinary output over the preceding three days[odds ratio(OR)=1.09;95%CI:1.02–1.17;P=0.014],enteral nutrition(EN)sodium content of 500 mg(OR=2.93;95%CI:1.13–7.60;P=0.027),and EN sodium content of 670 mg(OR=6.19;95%CI:1.75–21.98;P=0.005)were positively correlated with the development of IAH.Notably,the area under the curve for total urinary output over the preceding three days was 0.800(95%CI:0.678–0.922,P=0.001).Furthermore,maximum serum sodium levels,the duration of hypernatremia,and varying sodium correction rates were significantly associated with 28-day in-hospital mortality in septic shock patients(P<0.05).CONCLUSION The present findings illustrate that elevated serum sodium level was significantly associated with a poor prognosis in septic shock patients in the ICU.It is highly recommended that hypernatremia be considered a potentially important prognostic indicator for the outcome of septic shock.展开更多
BACKGROUND Cytomegalovirus(CMV)infections can cause significant morbidity and mortality in immunocompromised individuals.CMV targets dysfunctional lymphocytes.Chronic rituximab(RTX)therapy can cause B-lymphocyte dysfu...BACKGROUND Cytomegalovirus(CMV)infections can cause significant morbidity and mortality in immunocompromised individuals.CMV targets dysfunctional lymphocytes.Chronic rituximab(RTX)therapy can cause B-lymphocyte dysfunction,increasing CMV risk.Rarely,CMV infections present with critical illness such as septic shock.CASE SUMMARY A 64-year-old African American woman presented with generalized weakness and non-bloody watery diarrhea of 4-6 weeks duration.She did not have nausea,vomiting or,abdominal pain.She had been on monthly RTX infusions for neuromyelitis optica.She was admitted for septic shock due to pancolitis.Blood investigations suggested pancytopenia and serology detected significantly elevated CMV DNA.Valganciclovir treatment led to disease resolution.CONCLUSION This case illustrates an extremely rare case of CMV colitis associated with RTX use presenting with septic shock.High suspicion for rare opportunistic infections is imperative in individuals with long-term RTX use.展开更多
BACKGROUND Septic shock,the most severe form of sepsis,remains a major global health challenge with high mortality.The coronavirus disease 2019(COVID-19)pandemic has exacerbated this burden,as severe acute respiratory...BACKGROUND Septic shock,the most severe form of sepsis,remains a major global health challenge with high mortality.The coronavirus disease 2019(COVID-19)pandemic has exacerbated this burden,as severe acute respiratory syndrome coronavirus 2 infection often leads to sepsis and septic shock.Racial and ethnic differences in critical illness outcomes are well-documented,but their impact on COVID-19 associated septic shock remains unclear.AIM To examine epidemiologic data to explore racial and ethnic differences in outcomes in COVID-19 associated septic shock.METHODS Using the National Inpatient Sample(2020–2021),we conducted a retrospective cohort study to assess racial and ethnic disparities in septic shock outcomes among adults(≥18 years)with concurrent COVID-19.Primary and secondary outcomes included in-hospital mortality,acute kidney injury(AKI),AKI requiring dialysis,and mechanical ventilation.Adjusted multivariable logistic regression accounted for demographics,comorbidities,hospital characteristics,and inhospital events.RESULTS Among 396795 weighted hospitalizations,Non-Hispanic Black(NHB)(25.3%)and Hispanic(30.4%)populations were younger and had greater comorbidity burdens than Non-Hispanic White(NHW)patients.Compared to NHW,adjusted analyses showed higher in-hospital mortality[adjusted odds ratio(aOR)=1.21,95%CI:1.15-1.27],mechanical ventilation use(aOR=1.19,95%CI:1.12-1.27)and AKI requiring dialysis(aOR=1.16,95%CI:1.07-1.25,P<0.001)among Hispanic patients.NHB patients had similar mortality to NHWs but had higher risk of mechanical ventilation(aOR=1.15,95%CI:1.09-1.22)and AKI requiring dialysis(aOR=1.65,95%CI:1.54-1.76).Mean length of stay and cost were longest and highest for Hispanic patients.CONCLUSION Our study showed that there was higher mortality in Hispanic patients,and higher renal and respiratory complication in both NHB and Hispanic groups compared to NHW group.Future research identifying the causes of the observed differences in complications are required to inform targeted strategies that may mitigate modifiable risk factors and optimize early detection of organ failure to optimize outcomes in this population.展开更多
BACKGROUND Septic shock represents one of the most severe critical illness types,characterized by significant hemodynamic disorders and neuropsychiatric symptoms.This study aimed to investigate the association mechani...BACKGROUND Septic shock represents one of the most severe critical illness types,characterized by significant hemodynamic disorders and neuropsychiatric symptoms.This study aimed to investigate the association mechanism between hemodynamic indicators and neuropsychiatric symptoms in patients with septic shock,revealing potential pathophysiological connections.AIM To investigate the link between hemodynamic parameters and neuropsychiatric symptoms in septic shock.METHODS A retrospective case-control study involving 132 patients with septic shock.Multiple assessment tools were employed,including the Confusion Assessment Method,Hospital Anxiety and Depression Scale,Posttraumatic Stress Disorder Scale,and Mini-Mental State Examination,systematically evaluating patients’neuropsychiatric symptoms and hemodynamic indicators.RESULTS Patient mean age was 52.4±12.3 years,with 68.5%males.Multivariate analysis revealed significant correlations between neuropsychiatric symptom severity and mean arterial pressure<65 mmHg[odds ratio(OR)=2.7],lactate levels>4 mmol/L(OR=3.1),and elevated interleukin-6 inflammatory factors(OR=2.4).Neuropsychiatric symptom incidence rates were:Delirium 37.1%;anxiety 28.8%;depression 24.2%;and posttraumatic stress disorder 19.7%.CONCLUSION Hemodynamic disorders in patients with septic shock are closely associated with neuropsychiatric symptoms,influencing central nervous system function through complex inflammatory and neurotransmitter pathways.展开更多
BACKGROUND Sepsis and septic shock pose critical public health challenges with high mortality,particularly in critical care.While racial differences in sepsis incidence are documented,the impact of race on sepsis outc...BACKGROUND Sepsis and septic shock pose critical public health challenges with high mortality,particularly in critical care.While racial differences in sepsis incidence are documented,the impact of race on sepsis outcomes remains inconsistent.AIM To evaluate racial disparities in clinical outcomes among patients hospitalized with septic shock,focusing on in-hospital mortality,length of stay(LOS),and hospitalization costs.METHODS We conducted a retrospective cohort study using the National Inpatient Sample database from 2016 to 2021.Patients diagnosed with septic shock were identified using ICD-10 code R65.21.The primary outcome was in-hospital mortality;secondary outcomes included trends in septic shock hospitalizations,mortality,length of stay,and cost of hospitalizations.RESULTS Among 3581504 hospitalizations for septic shock,the racial distribution was 67%Non-Hispanic White(NHW),15%Non-Hispanic Black(NHB),11%Hispanic,and 7%other groups,with a mean age of 66.3 years.In-hospital mortality was 33.6%,highest among other racial groups(36.7%).Mortality was stable across racial groups from 2016-2019 but rose sharply in 2020-2021,especially among Hispanic patients.Adjusted in-hospital mortality were higher for NHB and Hispanic compared to NHW patients.NHB patients had the longest LOS,while other racial groups incurred the highest cost of hospitalizations.CONCLUSION We found higher mortality among NHB,Hispanic,and other racial groups in septic shock patients,likely driven by higher risk of in-hospital complications among these racial groups.This highlights the need for future research to identify the factors contributing to the adverse outcomes in these populations.展开更多
BACKGROUND Refractory septic shock is a critical and multifaceted condition that continues to pose significant challenges in critical care.AIM To systematically review randomized trials on emerging interventions for r...BACKGROUND Refractory septic shock is a critical and multifaceted condition that continues to pose significant challenges in critical care.AIM To systematically review randomized trials on emerging interventions for refractory septic shock,assessing mortality,vasopressor use,intensive care unit(ICU)length of stay,and organ dysfunction.METHODS A systematic search was conducted in PubMed,EMBASE,Cochrane CENTRAL Library,and Web of Science for studies published between 2000 and 2024.Inclusion criteria encompassed randomized controlled trials(RCT)evaluating innovative therapies for refractory septic shock.Variables of interest:The primary outcome was allcause mortality among patients treated with novel interventions.Secondary outcomes included length of stay in the ICU,total hospital length of stay,and use of vasoactive drugs.Methodological rigor was assessed using the Cochrane Risk of Bias tool.RESULTS From 850 records,24 RCTs met the inclusion criteria,evaluating therapies such as methylene blue,vasopressin,terlipressin,and combinations of hydrocortisone,vitamin C,and thiamine.Mortality rates ranged from 28.6%to 56.8%.Methylene blue reduced vasopressor dependency in patients requiring high norepinephrine doses by 1.0 vasopressor-free day,and terlipressin improved renal perfusion by 13.1%.Combination therapies enhanced secondary outcomes,including reductions in Sequential Organ Failure Assessment score.However,no single intervention consistently demonstrated significant survival benefits.CONCLUSION Adjunctive therapies for refractory septic shock may improve hemodynamics and organ function,however,they have not been shown to consistently reduce mortality.Larger trials are needed to confirm these findings.Multimodal approaches targeting inflammation are critical.展开更多
This article summarizes the nursing management of a pediatric patient with severe scrub typhus complicated by hemophagocytic syndrome(HPS)and septic shock.Key nursing interventions included early recognition and manag...This article summarizes the nursing management of a pediatric patient with severe scrub typhus complicated by hemophagocytic syndrome(HPS)and septic shock.Key nursing interventions included early recognition and management of septic shock,rational oxygen therapy,fluid resuscitation,administration of vasoactive agents,early and targeted anti-infective therapy,management of hyperpyrexia,care of eschar and edematous skin,strict infection prevention and isolation protocols,and family health education.After 11 days of intensive treatment and nursing care,the patient recovered and was discharged.展开更多
This study focused on realizing Sustainable Development Goal(SDG)6 for inclusive clean water and sanitation;in particular Target 6.3,which aims to reduce untreated wastewater by 2030 while promoting circular wastewate...This study focused on realizing Sustainable Development Goal(SDG)6 for inclusive clean water and sanitation;in particular Target 6.3,which aims to reduce untreated wastewater by 2030 while promoting circular wastewater reuse and recycling globally.The main objective was to assess the adequacy and efficiency of communal septic tank systems in informal settlements while helping local planners and authorities in their decision-making regarding Target 6.3.Quantitative and qualitative approaches were employed with secondary data from previous researchers,and primary data were collected from field surveys,observations,and interviews with members of the local community.The research was delimited to two village administrative divisions known as Rukun Warga(Village Administrative Division,RW):RW 7 and RW 8 of Lebak Siliwangi Kampung in Coblong District,Bandung,West Java,Indonesia.The findings were also compared with situations in other informal settlements in Brazil,Bangladesh,and Nairobi.The results indicated the inadequacy of communal septic tanks in informal settlements due to factors such as substandard system design,limited support and communication between authorities and residents,and the gap between septic tank availability and capacity vis-a-vis demand.Other limiting factors included limited land availability and irregular geomorphology,the latter of which affected the siting and operation of septic tanks due a lack of room for upgrades or expansion in response to continuous population growth.These findings illustrate the need to complement communal septic systems with flexible centralized or decentralized systems to achieve Target 6.3 of SDG 6.展开更多
Recent studies have revealed that patients with septic shock and acute skin failure(ASF)exhibit significantly higher levels of inflammatory cytokines,lactate,and C-reactive protein,along with elevated skin mottling sc...Recent studies have revealed that patients with septic shock and acute skin failure(ASF)exhibit significantly higher levels of inflammatory cytokines,lactate,and C-reactive protein,along with elevated skin mottling score;modified early warning score(MEWS);and anxiety,depression,and Pittsburgh sleep quality index scores compared to those without ASF.Notably,these indicators are significantly correlated.Patients with septic shock accompanied by ASF tend to have a mean MEWS greater than 9,indicating severe disease progression.Therefore,it is ess-ential to not only manage septic shock but also mitigate anxiety,depression,sleep disorders,and disturbances of consciousness.This article explores the impact of severe anxiety,depression,and sleep disorders on the prognosis of septic shock and discusses intervention strategies.展开更多
Non-O1/non-O139 Vibrio cholerae(NOVC)has multiple pathogenic pathways in humans.The cause of disease in influenced by the virulence genes carried by the infecting strain and the health condition of the host.[1-2]When ...Non-O1/non-O139 Vibrio cholerae(NOVC)has multiple pathogenic pathways in humans.The cause of disease in influenced by the virulence genes carried by the infecting strain and the health condition of the host.[1-2]When seafood,food and water sources are contaminated with feces,people are prone to gastroenteritis,and direct exposure to contaminated water may cause wound infection.展开更多
Group B Streptococcus(GBS;Streptococcus agalactiae)is a gram-positive coccus that colonizes the gastrointestinal and genital tracts in adults,as well as the upper respiratory tract in infants.While it has been thought...Group B Streptococcus(GBS;Streptococcus agalactiae)is a gram-positive coccus that colonizes the gastrointestinal and genital tracts in adults,as well as the upper respiratory tract in infants.While it has been thought that GBS only results in invasive disease in pregnant females and neonates,recent literature has suggested an increasing incidence of invasive GBS among non-pregnant individuals within the United States.展开更多
BACKGROUND Cytokines and inflammatory mediators are the key factors that are involved in the pathology of sepsis.Extracorporeal cytokine hemoadsorption devices offer an innovative clinical support system to alleviate ...BACKGROUND Cytokines and inflammatory mediators are the key factors that are involved in the pathology of sepsis.Extracorporeal cytokine hemoadsorption devices offer an innovative clinical support system to alleviate the effects of the cytokine storm associated with sepsis.AIM To retrospectively evaluate the efficacy of CytoSorb^(R)therapy as an adjunct to standard care in intensive care unit(ICU)patients with septic shock.METHODS A retrospective study was designed.Data were obtained for the patients who were treated with the CytoSorb^(R)adsorber for the past 5 years.The effects of therapy were assessed by changes in vasopressor requirements,specifically,norepinephrine and epinephrine.In addition,cytokine levels,such as interleukin(IL)-6 and inflammatory biomarkers including C-reactive protein(CRP),procalcitonin,as well as substances such as serum lactate and lactate dehydrogenase were also evaluated.In addition,mean arterial pressure(MAP)and ventilator requirements were also recorded.The survival outcomes were analyzed based on the length of patients'stay in the ICU,and the severity of illness was assessed using Acute Physiology and Chronic Health Evaluation(APACHE II)and Sepsisassociated Organ Failure Assessment(SOFA)scores recorded at baseline and post-therapy.RESULTS Following CytoSorb^(R)therapy,the requirement for vasopressor drugs,particularly norepinephrine,was reduced by 40%and a statistically significant improvement in MAP by 7.8%.Additionally,significant reductions were observed in IL-6 and serum lactate levels by 83%and 52%respectively.Around 56%had a delta lactate score of>1.5,while 23%patients had a score ranging from 1 to<1.5,and 16%patients had a score between 0.5 and<1 and merely 5%patients had a score of≤0.5.Besides,serum levels of creatinine,procalcitonin and CRP were significantly reduced by 17.2%,41.5%and 53.8%respectively.There was a significant reduction in scores,including APACHE II[to 23(18-29)from 27(23-33)],and SOFA[to 12(10-14)from 13(11-15)].Mechanical ventilation was required by 96%patients,with a median duration of 12 days,and the median length of hospital stay in overall patients was 26 days,while the median ICU stay was 18 days.CONCLUSION CytoSorb^(R)therapy seems to be a promising adjunctive approach in the management of septic shock.展开更多
目的探讨Phoenix评分在儿童脓毒症的应用价值及预后影响因素。方法回顾性收集2018年1月—2021年12月首都医科大学附属北京儿童医院保定医院儿童重症监护病房确诊为严重脓毒症及脓毒性休克的患儿96例。收集患儿临床资料,包括性别、年龄...目的探讨Phoenix评分在儿童脓毒症的应用价值及预后影响因素。方法回顾性收集2018年1月—2021年12月首都医科大学附属北京儿童医院保定医院儿童重症监护病房确诊为严重脓毒症及脓毒性休克的患儿96例。收集患儿临床资料,包括性别、年龄、基础病、病原资料、器官功能障碍、血清胆红素值、格拉斯哥昏迷评分(Glasgow coma scale,GCS)、血清肌酐等数值计算儿童序贯器官衰竭评估(pediatric sequential organ failure assessment,pSOFA)评分、第三代小儿死亡危险(pediatric risk of mortalityIII,PRISMIII)评分,并统计血清乳酸、C反应蛋白、降钙素原、纤维蛋白原(fibrinogen,FIB)、国际标准化比值(international normalized ratio,INR)、D-二聚体、血小板等数值。根据预后不同将入选患儿分为了存活组和预后不良组,采用Logistic回归分析确定脓毒症患儿预后的影响因素。结果以2005年国际专家共识标准诊断为严重脓毒症的患儿共96例,其中脓毒性休克患儿46例。以Phoenix评分标准可诊断为脓毒症的患儿共91例,阳性率为94.8%,排除者5例,阴性率5.2%。Phoenix评分标准可诊断为脓毒症休克的患儿70例,与原有脓毒症休克患儿存在一定交叉。脓毒症患儿91例,根据临床转归情况分为存活组51例和预后不良组40例。预后不良组FIB低于存活组,D-二聚体、GCS评分、乳酸、血管活性药数量、确诊时Phoenix评分、确诊时pSOFA评分以及确诊时PRISMIII评分高于存活组(P<0.05)。Logistic回归分析结果表明,GCS和FIB水平为严重脓毒症患儿预后转归的影响因素(OR=3.736、2.897,P=0.010、0.039),FIB数值越低,昏迷程度越深,预后越差。脓毒性休克患儿70例,根据临床转归情况分为存活组38例和预后不良组32例。预后不良组FIB低于存活组,INR、D-二聚体、GCS评分、乳酸、血管活性药数量、确诊时Phoenix评分、确诊时pSOFA评分以及确诊时PRISMIII评分高于存活组(P<0.05);Logistic回归分析结果显示,GCS评分是脓毒性休克患儿预后转归的影响因素(OR=3.841,P=0.021),GCS评分越低,昏迷程度越深,预后越差。结论Phoenix评分标准在儿童脓毒症的识别方面具有较高的临床应用价值,有助于更早启动干预。FIB和GCS评分是脓毒症患儿不良预后的影响因素。FIB水平降低可作为脓毒症诱发弥散性血管内凝血的早期预警指标,为临床早期干预提供了参考依据。GCS评分作为评估神经系统功能的重要指标,其下降提示脑功能障碍,这在脓毒症患儿中常预示着更高的死亡风险。展开更多
目的评价SEPTIC（sensing of phage—triggered ion cascade）技术在结核分枝杆菌快速检测中的应用价值。方法制备纳米阱微芯片，用于检测噬菌体感染细菌时导致细胞内离子释放发生的微范围内的电位变化。调整大肠杆菌、结核分枝杆菌、...目的评价SEPTIC（sensing of phage—triggered ion cascade）技术在结核分枝杆菌快速检测中的应用价值。方法制备纳米阱微芯片，用于检测噬菌体感染细菌时导致细胞内离子释放发生的微范围内的电位变化。调整大肠杆菌、结核分枝杆菌、耻垢分枝杆菌及其相应噬菌体的浓度。将细菌和噬菌体等体积混合，37℃孵育1min。取5μl混合液滴于探针上，30S后开始采集数据，每2min采集一个数据文件，共采集10min，计算机分析采集结果。结果当结核分枝杆菌与分枝杆菌噬菌体D29混合反应时，在0—8min内显示了非常明确的1／f功率谱特征。而且功率谱强度明显高于阴性反应的功率谱，并出现了明确的电压超出±4盯范围的波形，持续约0．2S的时间，可认为发生了一次细菌被噬菌体感染的事件，表明探针明确地捕获了细菌被噬菌体感染的事件。结论SEPTIC技术能在较短时间内检测、鉴定出活菌的存在，有可能为结核分枝杆菌的检测提供一种简便、快捷的方法。展开更多
基金Supported by The National Natural Science Foundation of China,No.82072130Key Medical Research Projects in Jiangsu Province,No.ZD2022021Suzhou Clinical Medical Center for Anesthesiology,No.Szlcyxzxj202102。
文摘BACKGROUND Hypernatremia represents a significant electrolyte imbalance associated with numerous adverse outcomes,particularly in cases of intensive care unit(ICU)-acquired hypernatremia(IAH).Nevertheless,its relevance in patients with septic shock remains uncertain.AIM To identify independent risk factors and their predictive efficacy for IAH to improve outcomes in patients with septic shock.METHODS In the present retrospective single-center study,a cohort of 157 septic shock patients with concurrent hypernatremia in the ICU at The First Affiliated Hospital of Soochow University,between August 1,2018,and May 31,2023,were analyzed.Patients were categorized based on the timing of hypernatremia occurrence into the IAH group(n=62),the non-IAH group(n=41),and the normonatremia group(n=54).RESULTS In the present study,there was a significant association between the high serum sodium concentrations,excessive persistent inflammation,immunosuppression and catabolism syndrome and chronic critical illness,while rapid recovery had an apparent association with normonatremia.Moreover,multivariable analyses revealed the following independent risk factors for IAH:Total urinary output over the preceding three days[odds ratio(OR)=1.09;95%CI:1.02–1.17;P=0.014],enteral nutrition(EN)sodium content of 500 mg(OR=2.93;95%CI:1.13–7.60;P=0.027),and EN sodium content of 670 mg(OR=6.19;95%CI:1.75–21.98;P=0.005)were positively correlated with the development of IAH.Notably,the area under the curve for total urinary output over the preceding three days was 0.800(95%CI:0.678–0.922,P=0.001).Furthermore,maximum serum sodium levels,the duration of hypernatremia,and varying sodium correction rates were significantly associated with 28-day in-hospital mortality in septic shock patients(P<0.05).CONCLUSION The present findings illustrate that elevated serum sodium level was significantly associated with a poor prognosis in septic shock patients in the ICU.It is highly recommended that hypernatremia be considered a potentially important prognostic indicator for the outcome of septic shock.
文摘BACKGROUND Cytomegalovirus(CMV)infections can cause significant morbidity and mortality in immunocompromised individuals.CMV targets dysfunctional lymphocytes.Chronic rituximab(RTX)therapy can cause B-lymphocyte dysfunction,increasing CMV risk.Rarely,CMV infections present with critical illness such as septic shock.CASE SUMMARY A 64-year-old African American woman presented with generalized weakness and non-bloody watery diarrhea of 4-6 weeks duration.She did not have nausea,vomiting or,abdominal pain.She had been on monthly RTX infusions for neuromyelitis optica.She was admitted for septic shock due to pancolitis.Blood investigations suggested pancytopenia and serology detected significantly elevated CMV DNA.Valganciclovir treatment led to disease resolution.CONCLUSION This case illustrates an extremely rare case of CMV colitis associated with RTX use presenting with septic shock.High suspicion for rare opportunistic infections is imperative in individuals with long-term RTX use.
文摘BACKGROUND Septic shock,the most severe form of sepsis,remains a major global health challenge with high mortality.The coronavirus disease 2019(COVID-19)pandemic has exacerbated this burden,as severe acute respiratory syndrome coronavirus 2 infection often leads to sepsis and septic shock.Racial and ethnic differences in critical illness outcomes are well-documented,but their impact on COVID-19 associated septic shock remains unclear.AIM To examine epidemiologic data to explore racial and ethnic differences in outcomes in COVID-19 associated septic shock.METHODS Using the National Inpatient Sample(2020–2021),we conducted a retrospective cohort study to assess racial and ethnic disparities in septic shock outcomes among adults(≥18 years)with concurrent COVID-19.Primary and secondary outcomes included in-hospital mortality,acute kidney injury(AKI),AKI requiring dialysis,and mechanical ventilation.Adjusted multivariable logistic regression accounted for demographics,comorbidities,hospital characteristics,and inhospital events.RESULTS Among 396795 weighted hospitalizations,Non-Hispanic Black(NHB)(25.3%)and Hispanic(30.4%)populations were younger and had greater comorbidity burdens than Non-Hispanic White(NHW)patients.Compared to NHW,adjusted analyses showed higher in-hospital mortality[adjusted odds ratio(aOR)=1.21,95%CI:1.15-1.27],mechanical ventilation use(aOR=1.19,95%CI:1.12-1.27)and AKI requiring dialysis(aOR=1.16,95%CI:1.07-1.25,P<0.001)among Hispanic patients.NHB patients had similar mortality to NHWs but had higher risk of mechanical ventilation(aOR=1.15,95%CI:1.09-1.22)and AKI requiring dialysis(aOR=1.65,95%CI:1.54-1.76).Mean length of stay and cost were longest and highest for Hispanic patients.CONCLUSION Our study showed that there was higher mortality in Hispanic patients,and higher renal and respiratory complication in both NHB and Hispanic groups compared to NHW group.Future research identifying the causes of the observed differences in complications are required to inform targeted strategies that may mitigate modifiable risk factors and optimize early detection of organ failure to optimize outcomes in this population.
文摘BACKGROUND Septic shock represents one of the most severe critical illness types,characterized by significant hemodynamic disorders and neuropsychiatric symptoms.This study aimed to investigate the association mechanism between hemodynamic indicators and neuropsychiatric symptoms in patients with septic shock,revealing potential pathophysiological connections.AIM To investigate the link between hemodynamic parameters and neuropsychiatric symptoms in septic shock.METHODS A retrospective case-control study involving 132 patients with septic shock.Multiple assessment tools were employed,including the Confusion Assessment Method,Hospital Anxiety and Depression Scale,Posttraumatic Stress Disorder Scale,and Mini-Mental State Examination,systematically evaluating patients’neuropsychiatric symptoms and hemodynamic indicators.RESULTS Patient mean age was 52.4±12.3 years,with 68.5%males.Multivariate analysis revealed significant correlations between neuropsychiatric symptom severity and mean arterial pressure<65 mmHg[odds ratio(OR)=2.7],lactate levels>4 mmol/L(OR=3.1),and elevated interleukin-6 inflammatory factors(OR=2.4).Neuropsychiatric symptom incidence rates were:Delirium 37.1%;anxiety 28.8%;depression 24.2%;and posttraumatic stress disorder 19.7%.CONCLUSION Hemodynamic disorders in patients with septic shock are closely associated with neuropsychiatric symptoms,influencing central nervous system function through complex inflammatory and neurotransmitter pathways.
文摘BACKGROUND Sepsis and septic shock pose critical public health challenges with high mortality,particularly in critical care.While racial differences in sepsis incidence are documented,the impact of race on sepsis outcomes remains inconsistent.AIM To evaluate racial disparities in clinical outcomes among patients hospitalized with septic shock,focusing on in-hospital mortality,length of stay(LOS),and hospitalization costs.METHODS We conducted a retrospective cohort study using the National Inpatient Sample database from 2016 to 2021.Patients diagnosed with septic shock were identified using ICD-10 code R65.21.The primary outcome was in-hospital mortality;secondary outcomes included trends in septic shock hospitalizations,mortality,length of stay,and cost of hospitalizations.RESULTS Among 3581504 hospitalizations for septic shock,the racial distribution was 67%Non-Hispanic White(NHW),15%Non-Hispanic Black(NHB),11%Hispanic,and 7%other groups,with a mean age of 66.3 years.In-hospital mortality was 33.6%,highest among other racial groups(36.7%).Mortality was stable across racial groups from 2016-2019 but rose sharply in 2020-2021,especially among Hispanic patients.Adjusted in-hospital mortality were higher for NHB and Hispanic compared to NHW patients.NHB patients had the longest LOS,while other racial groups incurred the highest cost of hospitalizations.CONCLUSION We found higher mortality among NHB,Hispanic,and other racial groups in septic shock patients,likely driven by higher risk of in-hospital complications among these racial groups.This highlights the need for future research to identify the factors contributing to the adverse outcomes in these populations.
文摘BACKGROUND Refractory septic shock is a critical and multifaceted condition that continues to pose significant challenges in critical care.AIM To systematically review randomized trials on emerging interventions for refractory septic shock,assessing mortality,vasopressor use,intensive care unit(ICU)length of stay,and organ dysfunction.METHODS A systematic search was conducted in PubMed,EMBASE,Cochrane CENTRAL Library,and Web of Science for studies published between 2000 and 2024.Inclusion criteria encompassed randomized controlled trials(RCT)evaluating innovative therapies for refractory septic shock.Variables of interest:The primary outcome was allcause mortality among patients treated with novel interventions.Secondary outcomes included length of stay in the ICU,total hospital length of stay,and use of vasoactive drugs.Methodological rigor was assessed using the Cochrane Risk of Bias tool.RESULTS From 850 records,24 RCTs met the inclusion criteria,evaluating therapies such as methylene blue,vasopressin,terlipressin,and combinations of hydrocortisone,vitamin C,and thiamine.Mortality rates ranged from 28.6%to 56.8%.Methylene blue reduced vasopressor dependency in patients requiring high norepinephrine doses by 1.0 vasopressor-free day,and terlipressin improved renal perfusion by 13.1%.Combination therapies enhanced secondary outcomes,including reductions in Sequential Organ Failure Assessment score.However,no single intervention consistently demonstrated significant survival benefits.CONCLUSION Adjunctive therapies for refractory septic shock may improve hemodynamics and organ function,however,they have not been shown to consistently reduce mortality.Larger trials are needed to confirm these findings.Multimodal approaches targeting inflammation are critical.
文摘This article summarizes the nursing management of a pediatric patient with severe scrub typhus complicated by hemophagocytic syndrome(HPS)and septic shock.Key nursing interventions included early recognition and management of septic shock,rational oxygen therapy,fluid resuscitation,administration of vasoactive agents,early and targeted anti-infective therapy,management of hyperpyrexia,care of eschar and edematous skin,strict infection prevention and isolation protocols,and family health education.After 11 days of intensive treatment and nursing care,the patient recovered and was discharged.
文摘This study focused on realizing Sustainable Development Goal(SDG)6 for inclusive clean water and sanitation;in particular Target 6.3,which aims to reduce untreated wastewater by 2030 while promoting circular wastewater reuse and recycling globally.The main objective was to assess the adequacy and efficiency of communal septic tank systems in informal settlements while helping local planners and authorities in their decision-making regarding Target 6.3.Quantitative and qualitative approaches were employed with secondary data from previous researchers,and primary data were collected from field surveys,observations,and interviews with members of the local community.The research was delimited to two village administrative divisions known as Rukun Warga(Village Administrative Division,RW):RW 7 and RW 8 of Lebak Siliwangi Kampung in Coblong District,Bandung,West Java,Indonesia.The findings were also compared with situations in other informal settlements in Brazil,Bangladesh,and Nairobi.The results indicated the inadequacy of communal septic tanks in informal settlements due to factors such as substandard system design,limited support and communication between authorities and residents,and the gap between septic tank availability and capacity vis-a-vis demand.Other limiting factors included limited land availability and irregular geomorphology,the latter of which affected the siting and operation of septic tanks due a lack of room for upgrades or expansion in response to continuous population growth.These findings illustrate the need to complement communal septic systems with flexible centralized or decentralized systems to achieve Target 6.3 of SDG 6.
文摘Recent studies have revealed that patients with septic shock and acute skin failure(ASF)exhibit significantly higher levels of inflammatory cytokines,lactate,and C-reactive protein,along with elevated skin mottling score;modified early warning score(MEWS);and anxiety,depression,and Pittsburgh sleep quality index scores compared to those without ASF.Notably,these indicators are significantly correlated.Patients with septic shock accompanied by ASF tend to have a mean MEWS greater than 9,indicating severe disease progression.Therefore,it is ess-ential to not only manage septic shock but also mitigate anxiety,depression,sleep disorders,and disturbances of consciousness.This article explores the impact of severe anxiety,depression,and sleep disorders on the prognosis of septic shock and discusses intervention strategies.
基金supported by the National Natural Science Foundation(82372206)the Jiangsu Provincial Health Commission(H2023107)the project of basic and clinical research on cardiac arrest in the Emergency and Critical Care Department of the Second Affiliated Hospital of Soochow University(XKTJ-XK202408-2).
文摘Non-O1/non-O139 Vibrio cholerae(NOVC)has multiple pathogenic pathways in humans.The cause of disease in influenced by the virulence genes carried by the infecting strain and the health condition of the host.[1-2]When seafood,food and water sources are contaminated with feces,people are prone to gastroenteritis,and direct exposure to contaminated water may cause wound infection.
文摘Group B Streptococcus(GBS;Streptococcus agalactiae)is a gram-positive coccus that colonizes the gastrointestinal and genital tracts in adults,as well as the upper respiratory tract in infants.While it has been thought that GBS only results in invasive disease in pregnant females and neonates,recent literature has suggested an increasing incidence of invasive GBS among non-pregnant individuals within the United States.
文摘BACKGROUND Cytokines and inflammatory mediators are the key factors that are involved in the pathology of sepsis.Extracorporeal cytokine hemoadsorption devices offer an innovative clinical support system to alleviate the effects of the cytokine storm associated with sepsis.AIM To retrospectively evaluate the efficacy of CytoSorb^(R)therapy as an adjunct to standard care in intensive care unit(ICU)patients with septic shock.METHODS A retrospective study was designed.Data were obtained for the patients who were treated with the CytoSorb^(R)adsorber for the past 5 years.The effects of therapy were assessed by changes in vasopressor requirements,specifically,norepinephrine and epinephrine.In addition,cytokine levels,such as interleukin(IL)-6 and inflammatory biomarkers including C-reactive protein(CRP),procalcitonin,as well as substances such as serum lactate and lactate dehydrogenase were also evaluated.In addition,mean arterial pressure(MAP)and ventilator requirements were also recorded.The survival outcomes were analyzed based on the length of patients'stay in the ICU,and the severity of illness was assessed using Acute Physiology and Chronic Health Evaluation(APACHE II)and Sepsisassociated Organ Failure Assessment(SOFA)scores recorded at baseline and post-therapy.RESULTS Following CytoSorb^(R)therapy,the requirement for vasopressor drugs,particularly norepinephrine,was reduced by 40%and a statistically significant improvement in MAP by 7.8%.Additionally,significant reductions were observed in IL-6 and serum lactate levels by 83%and 52%respectively.Around 56%had a delta lactate score of>1.5,while 23%patients had a score ranging from 1 to<1.5,and 16%patients had a score between 0.5 and<1 and merely 5%patients had a score of≤0.5.Besides,serum levels of creatinine,procalcitonin and CRP were significantly reduced by 17.2%,41.5%and 53.8%respectively.There was a significant reduction in scores,including APACHE II[to 23(18-29)from 27(23-33)],and SOFA[to 12(10-14)from 13(11-15)].Mechanical ventilation was required by 96%patients,with a median duration of 12 days,and the median length of hospital stay in overall patients was 26 days,while the median ICU stay was 18 days.CONCLUSION CytoSorb^(R)therapy seems to be a promising adjunctive approach in the management of septic shock.
文摘目的探讨Phoenix评分在儿童脓毒症的应用价值及预后影响因素。方法回顾性收集2018年1月—2021年12月首都医科大学附属北京儿童医院保定医院儿童重症监护病房确诊为严重脓毒症及脓毒性休克的患儿96例。收集患儿临床资料,包括性别、年龄、基础病、病原资料、器官功能障碍、血清胆红素值、格拉斯哥昏迷评分(Glasgow coma scale,GCS)、血清肌酐等数值计算儿童序贯器官衰竭评估(pediatric sequential organ failure assessment,pSOFA)评分、第三代小儿死亡危险(pediatric risk of mortalityIII,PRISMIII)评分,并统计血清乳酸、C反应蛋白、降钙素原、纤维蛋白原(fibrinogen,FIB)、国际标准化比值(international normalized ratio,INR)、D-二聚体、血小板等数值。根据预后不同将入选患儿分为了存活组和预后不良组,采用Logistic回归分析确定脓毒症患儿预后的影响因素。结果以2005年国际专家共识标准诊断为严重脓毒症的患儿共96例,其中脓毒性休克患儿46例。以Phoenix评分标准可诊断为脓毒症的患儿共91例,阳性率为94.8%,排除者5例,阴性率5.2%。Phoenix评分标准可诊断为脓毒症休克的患儿70例,与原有脓毒症休克患儿存在一定交叉。脓毒症患儿91例,根据临床转归情况分为存活组51例和预后不良组40例。预后不良组FIB低于存活组,D-二聚体、GCS评分、乳酸、血管活性药数量、确诊时Phoenix评分、确诊时pSOFA评分以及确诊时PRISMIII评分高于存活组(P<0.05)。Logistic回归分析结果表明,GCS和FIB水平为严重脓毒症患儿预后转归的影响因素(OR=3.736、2.897,P=0.010、0.039),FIB数值越低,昏迷程度越深,预后越差。脓毒性休克患儿70例,根据临床转归情况分为存活组38例和预后不良组32例。预后不良组FIB低于存活组,INR、D-二聚体、GCS评分、乳酸、血管活性药数量、确诊时Phoenix评分、确诊时pSOFA评分以及确诊时PRISMIII评分高于存活组(P<0.05);Logistic回归分析结果显示,GCS评分是脓毒性休克患儿预后转归的影响因素(OR=3.841,P=0.021),GCS评分越低,昏迷程度越深,预后越差。结论Phoenix评分标准在儿童脓毒症的识别方面具有较高的临床应用价值,有助于更早启动干预。FIB和GCS评分是脓毒症患儿不良预后的影响因素。FIB水平降低可作为脓毒症诱发弥散性血管内凝血的早期预警指标,为临床早期干预提供了参考依据。GCS评分作为评估神经系统功能的重要指标,其下降提示脑功能障碍,这在脓毒症患儿中常预示着更高的死亡风险。
文摘目的评价SEPTIC（sensing of phage—triggered ion cascade）技术在结核分枝杆菌快速检测中的应用价值。方法制备纳米阱微芯片，用于检测噬菌体感染细菌时导致细胞内离子释放发生的微范围内的电位变化。调整大肠杆菌、结核分枝杆菌、耻垢分枝杆菌及其相应噬菌体的浓度。将细菌和噬菌体等体积混合，37℃孵育1min。取5μl混合液滴于探针上，30S后开始采集数据，每2min采集一个数据文件，共采集10min，计算机分析采集结果。结果当结核分枝杆菌与分枝杆菌噬菌体D29混合反应时，在0—8min内显示了非常明确的1／f功率谱特征。而且功率谱强度明显高于阴性反应的功率谱，并出现了明确的电压超出±4盯范围的波形，持续约0．2S的时间，可认为发生了一次细菌被噬菌体感染的事件，表明探针明确地捕获了细菌被噬菌体感染的事件。结论SEPTIC技术能在较短时间内检测、鉴定出活菌的存在，有可能为结核分枝杆菌的检测提供一种简便、快捷的方法。
