Elisa Estenssoro1, Vanina S Kanoore Edul2, Cecilia I Loudet1, Javier Osatnik3, Fernando G Ríos4, Daniela N Vázquez5, Mario O Pozo6, Bernardo Lattanzio7, Fernando Pálizas6, Francisco Klein8, Damián Piezny4, Paolo N Rubatto Birri9, Graciela Tuhay8, Anatilde Díaz10, Analía Santamaría11, Graciela Zakalik12, Arnaldo Dubin9. 1. Hospital Interzonal de Agudos San Martin de La Plata, La Plata, Buenos Aires, Argentina. 2. Hospital Juan A Fernández, Ciudad Autónoma de Buenos Aires, Argentina. 3. Hospital Alemán, Ciudad Autónoma de Buenos Aires, Argentina. 4. Hospital Alejandro Posadas, El Palomar, Buenos Aires, Argentina. 5. Sanatorio Anchorena, Ciudad Autónoma de Buenos Aires, Argentina. 6. Clínica Bazterrica, Ciudad Autónoma de Buenos Aires, Argentina. 7. Clínica Santa Isabel, Ciudad Autónoma de Buenos Aires, Argentina. 8. Hospital Universitario Fundación Favaloro, Ciudad Autónoma de Buenos Aires, Argentina. 9. Sanatorio Otamendi y Miroli, Ciudad Autónoma de Buenos Aires, Argentina. 10. Hospital Misericordia, Ciudad de Córdoba, Córdoba, Argentina. 11. Sanatorio de la Trinidad Mitre, Ciudad Autónoma de Buenos Aires, Argentina. 12. Hospital Lagomaggiore, Ciudad de Mendoza, Mendoza, Argentina.
Abstract
OBJECTIVES: The new Sepsis-3 definitions have been scarcely assessed in low- and middle-income countries; besides, regional information of sepsis outcomes is sparse. Our objective was to evaluate Sepsis-3 definition performance in Argentina. DESIGN: Cohort study of 3-month duration beginning on July 1, 2016. SETTINGS: Forty-nine ICUs. PATIENTS: Consecutive patients admitted to the ICU with suspected infection that triggered blood cultures and antibiotic administration. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Patients were classified as having infection, sepsis (infection + change in Sequential Organ Failure Assessment ≥ 2 points), and septic shock (vasopressors + lactate > 2 mmol/L). Patients on vasopressors and lactate less than or equal to 2 mmol/L (cardiovascular dysfunction) were analyzed separately, as those on vasopressors without serum lactate measurement. Systemic inflammatory response syndrome was also recorded. Main outcome was hospital mortality. Of 809 patients, 6% had infection, 29% sepsis, 20% cardiovascular dysfunction, 40% septic shock, and 3% received vasopressors with lactate unmeasured. Hospital mortality was 13%, 20%, 39%, 51%, and 41%, respectively (p = 0.000). Independent predictors of outcome were lactate, Sequential Organ Failure Assessment score, comorbidities, prior duration of symptoms (hr), mechanical ventilation requirement, and infection by highly resistant microorganisms. Area under the receiver operating characteristic curves for mortality for systemic inflammatory response syndrome and Sequential Organ Failure Assessment were 0.53 (0.48-0.55) and 0.74 (0.69-0.77), respectively (p = 0.000). CONCLUSIONS: Increasing severity of Sepsis-3 categories adequately tracks mortality; cardiovascular dysfunction subgroup, not included in Sepsis-3, has distinct characteristics. Sequential Organ Failure Assessment score shows adequate prognosis accuracy-contrary to systemic inflammatory response syndrome. This study supports the predictive validity of Sepsis-3 definitions.
OBJECTIVES: The new Sepsis-3 definitions have been scarcely assessed in low- and middle-income countries; besides, regional information of sepsis outcomes is sparse. Our objective was to evaluate Sepsis-3 definition performance in Argentina. DESIGN: Cohort study of 3-month duration beginning on July 1, 2016. SETTINGS: Forty-nine ICUs. PATIENTS: Consecutive patients admitted to the ICU with suspected infection that triggered blood cultures and antibiotic administration. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS:Patients were classified as having infection, sepsis (infection + change in Sequential Organ Failure Assessment ≥ 2 points), and septic shock (vasopressors + lactate > 2 mmol/L). Patients on vasopressors and lactate less than or equal to 2 mmol/L (cardiovascular dysfunction) were analyzed separately, as those on vasopressors without serum lactate measurement. Systemic inflammatory response syndrome was also recorded. Main outcome was hospital mortality. Of 809 patients, 6% had infection, 29% sepsis, 20% cardiovascular dysfunction, 40% septic shock, and 3% received vasopressors with lactate unmeasured. Hospital mortality was 13%, 20%, 39%, 51%, and 41%, respectively (p = 0.000). Independent predictors of outcome were lactate, Sequential Organ Failure Assessment score, comorbidities, prior duration of symptoms (hr), mechanical ventilation requirement, and infection by highly resistant microorganisms. Area under the receiver operating characteristic curves for mortality for systemic inflammatory response syndrome and Sequential Organ Failure Assessment were 0.53 (0.48-0.55) and 0.74 (0.69-0.77), respectively (p = 0.000). CONCLUSIONS: Increasing severity of Sepsis-3 categories adequately tracks mortality; cardiovascular dysfunction subgroup, not included in Sepsis-3, has distinct characteristics. Sequential Organ Failure Assessment score shows adequate prognosis accuracy-contrary to systemic inflammatory response syndrome. This study supports the predictive validity of Sepsis-3 definitions.
Authors: Luciano Cesar Pontes Azevedo; Alexandre Biasi Cavalcanti; Thiago Lisboa; Felipe Dal Pizzol; Flavia Ribeiro Machado Journal: Rev Bras Ter Intensiva Date: 2018-12-13
Authors: Tim Rahmel; Stefanie Schmitz; Hartmuth Nowak; Kaspar Schepanek; Lars Bergmann; Peter Halberstadt; Stefan Hörter; Jürgen Peters; Michael Adamzik Journal: PLoS One Date: 2020-02-12 Impact factor: 3.240
Authors: Diana M Verboom; Jos F Frencken; David S Y Ong; Janneke Horn; Tom van der Poll; Marc J M Bonten; Olaf L Cremer; Peter M C Klein Klouwenberg Journal: J Intensive Care Date: 2019-08-29
Authors: Arnaldo Dubin; Cecilia Loudet; Vanina S Kanoore Edul; Javier Osatnik; Fernando Ríos; Daniela Vásquez; Mario Pozo; Bernardo Lattanzio; Fernando Pálizas; Francisco Klein; Damián Piezny; Paolo N Rubatto Birri; Graciela Tuhay; Analía García; Analía Santamaría; Graciela Zakalik; Cecilia González; Elisa Estenssoro Journal: Ann Intensive Care Date: 2020-04-15 Impact factor: 6.925