Abstract:
OBJECTIVES:Recently, the definition of sepsis has changed from a physiologic derangement (Sepsis-1 and -2) to organ dysfunction (Sepsis-3) based. We sought to determine the concordance between the different sepsis phenotypes and how that affected mortality. DESIGN:Retrospective, multicenter study. SETTING:Three academic medical centers. PATIENTS:29,459 patients who had suspected infection, defined as obtaining blood cultures and receiving antibiotics: 18,183 (62%) had either Sepsis-2 or Sepsis-3. MEASUREMENTS AND MAIN RESULTS:Kappa was used to show agreement between phenotypes. Conditional logistic regression was used to create models of associations between factors and phenotypes and between factors and mortality. About 12,981 patients had Sepsis-2; 12,043 had Sepsis-3; and 6,841 patients had both Sepsis-2 and Sepsis-3. Fifty-three percent of Sepsis-2 patients also had Sepsis-3, whereas 57% of Sepsis-3 patients also had Sepsis-2. Agreement between the two phenotypes was poor: kappa = 0.213 ± 0.006. Mortality was 6% in patients with only Sepsis-2, 10% with only Sepsis-3, and 18% in patients who had both phenotypes. Combining the variables in Sepsis-2 and Sepsis-3 improved the discrimination (C-statistic = 0.742 ± 0.005, p < 0.001) of mortality. CONCLUSIONS:We found that Sepsis-2 and Sepsis-3-based sepsis diagnoses represent separate phenotypes with poor agreement. Patients who have both phenotypes are at increased risk of mortality compared with having either phenotype alone. Inclusion of both systemic inflammatory response syndrome and Sequential Organ Failure Assessment criteria in the same model improves the discrimination of mortality.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Engoren M,Seelhammer T,Freundlich RE,Maile MD,Sigakis MJG,Schwann TAdoi
10.1097/CCM.0000000000004449subject
Has Abstractpub_date
2020-09-01 00:00:00pages
1258-1264issue
9eissn
0090-3493issn
1530-0293journal_volume
48pub_type
杂志文章abstract::The Pediatric Risk of Mortality (PRISM) score was developed from the Physiologic Stability Index (PSI) to reduce the number of physiologic variables required for pediatric ICU (PICU) mortality risk assessment and to obtain an objective weighting of the remaining variables. Univariate and multivariate statistical techn...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1097/00003246-198811000-00006
更新日期:1988-11-01 00:00:00
abstract::We evaluated 95 extubated neonates to determine if certain risk factors could predict the development of laryngeal injury. Risk factors were recorded prospectively during the intubation period and correlated with laryngeal injury determined by laryngoscopy after extubation. Duration of intubation greater than or equal...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198306000-00007
更新日期:1983-06-01 00:00:00
abstract:OBJECTIVES:To examine perceptions of nurses and physicians in regard to ethical decision-making climate in the ICU and to test the hypothesis that the worse the ethical decision-making climate, the greater the discordance between nurses' and physicians' rating of ethical decision-making climate with physicians hypothes...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0000000000004017
更新日期:2019-12-01 00:00:00
abstract:OBJECTIVES:Light chains κ and λ are immunoglobulin constituents but also circulate independently in blood as free light chains. We investigated whether a concomitant abnormality in free light chain and immunoglobulin levels could identify a high risk of death sepsis subpopulation to inform future IV immunoglobulin tria...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002627
更新日期:2017-11-01 00:00:00
abstract:OBJECTIVES:Critically ill patients routinely receive vancomycin as empiric antibiotic therapy. A continuous infusion administration strategy may be superior to intermittent infusion by minimizing peak concentrations and variability thereby optimizing safety. We performed a systematic review and meta-analysis to investi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004326
更新日期:2020-06-01 00:00:00
abstract:OBJECTIVES:With the exception of a few single-center descriptive reports, data on critical care organizations are relatively sparse. The objectives of our study were to determine the structure, governance, and experience to date of established critical care organizations in North American academic medical centers. DES...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001200
更新日期:2015-10-01 00:00:00
abstract:OBJECTIVE:Carbon monoxide (CO), an endogenous byproduct of heme metabolism, is produced at high levels in injured tissue via induction of heme-oxygenase-1 activity, where it contributes to the modulation of proinflammatory processes. Alone, CO has potent anti-inflammatory effects in models of acute and chronic inflamma...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000166349.76514.40
更新日期:2005-06-01 00:00:00
abstract::Intralipid elimination patterns were compared in 25 healthy controls, 12 patients recovering from uncomplicated cholecystectomy, and 25 critically ill patients. The intravenous fat tolerance test revealed a similar fractional removal rate (k2) in healthy controls and critically ill patients, but k2 was increased in ch...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198605000-00009
更新日期:1986-05-01 00:00:00
abstract:OBJECTIVE:To review the institutional experience of a national tertiary referral center for extracorporeal life support (ECLS) in severe varicella pneumonia. DATA SOURCES:Hospital records and ECLS flow sheets. STUDY SELECTION:All pediatric (nonneonatal) and adult patients who were treated for varicella pneumonia with...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199706000-00014
更新日期:1997-06-01 00:00:00
abstract:BACKGROUND:Venous thromboembolic disease is among the most common causes of morbidity and mortality during pregnancy. The clinical evaluation alone is insufficient for the diagnosis of venous thromboembolic disease, and the normal pregnant state makes this evaluation even more challenging. DIAGNOSIS:Objective testing ...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/01.ccm.0000183157.15533.4c
更新日期:2005-10-01 00:00:00
abstract:OBJECTIVE:To test the hypothesis that the lectin-like domain of tumor necrosis factor, mimicked by the TIP peptide, can improve lung function after unilateral orthotopic lung isotransplantation. Because of a lack of a specific treatment for ischemia reperfusion-mediated lung injury, accompanied by a disrupted barrier i...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181cdf725
更新日期:2010-03-01 00:00:00
abstract:OBJECTIVES:Peripherally inserted central catheters are increasingly used in ICU as an alternative to centrally inserted central catheters for IV infusion. However, their reliability for hemodynamic measurements with transpulmonary thermodilution is currently unknown. We investigated the agreement between transpulmonary...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003917
更新日期:2019-10-01 00:00:00
abstract::In a prospective randomized trial in patients with a history of preoperative pulmonary hypertension who were undergoing surgery for valvular replacement or annuloplasty, the effects of ketanserin (KET) (12 patients) and sodium nitroprusside (SNP) (14 patients) on the systemic and pulmonary circulation and pulmonary sh...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-198907000-00003
更新日期:1989-07-01 00:00:00
abstract::This report is intended to familiarize the reader with the current legislation concerning state definitions of death, the pertinent judicial decisions concerning termination of life support and the current status of medical/ethical committees. However, it is of paramount importance to all health care personnel to beco...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:
更新日期:1982-01-01 00:00:00
abstract::Over a 2-year period, 14 viable ventilator-dependent patients were transferred from the Medical Intensive Care Unit (MICU) to a general ward floor for nutritional support after failing to wean from mechanical ventilation (MV) while in the MICU. These patients were retrospectively grouped based on their ultimate abilit...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198205000-00001
更新日期:1982-05-01 00:00:00
abstract:OBJECTIVES:Reviews of patient safety efforts suggest that technical/administrative change must be augmented by global factors such as organizational culture and climate. The objective was to outline a comprehensive model for healthcare climate and test one of its elements, the nursing subclimate, in terms of several pa...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/01.CCM.0000262404.10203.C9
更新日期:2007-05-01 00:00:00
abstract:OBJECTIVES:To evaluate knowledge translation after publication of the target temperature management 33°C versus 36°C after out-of-hospital cardiac arrest trial and associated patient outcomes. Our primary hypothesis was that target temperature management at 36°C was rapidly adopted in Australian and New Zealand ICUs. S...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003339
更新日期:2018-11-01 00:00:00
abstract:OBJECTIVE:To examine the role of platelets, fibrin, and adhesion molecules in mediating neutrophil-endothelial cell interactions in septic shock. DESIGN:Controlled experiments using phase contrast microscopy to examine neutrophil, platelet, and endothelial cell interactions in flowing cell suspensions under simulated ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000139918.80602.57
更新日期:2004-09-01 00:00:00
abstract::One hundred patients were ventilated with high-frequency jet ventilation (HFJV) during the initial 24-h postoperative period in the surgical and neurosurgical ICUs. Eighty-three were successfully weaned, 2 could not be ventilated adequately with HFJV, and 15 with criteria of acute respiratory failure received HFJV for...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198409000-00022
更新日期:1984-09-01 00:00:00
abstract:OBJECTIVE:To describe blood conservation strategies for critically ill patients. DATA SOURCES:By using a predefined strategy, we searched the electronic databases of Medline, EMBASE, CINAHL, the Cochrane database of systematic reviews, Cochrane central register of controlled trials, ACP Journal Club, Database of abstr...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/01.CCM.0000099350.50651.46
更新日期:2003-12-01 00:00:00
abstract:OBJECTIVE:To compare the results of cardiac output measurements obtained by lithium dilution and thermodilution. DESIGN:Case series, observational study. SETTING:High-dependency postoperative unit and intensive care unit of a teaching hospital. PATIENTS:Forty patients were studied. Thirty-four patients had undergoin...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章
doi:10.1097/00003246-199711000-00015
更新日期:1997-11-01 00:00:00
abstract:OBJECTIVE:Recent in vivo studies of both septic humans and animals demonstrate that leukocyte delivery is attenuated to sites remote from the primary infection. The mechanisms for this are not entirely clear. L-selectin is integral to rolling, the first step in leukocyte recruitment to an inflammatory site. L-selectin ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200101000-00024
更新日期:2001-01-01 00:00:00
abstract:OBJECTIVES:In-hospital pediatric sepsis mortality has decreased substantially, but long-term mortality and morbidity among children initially surviving sepsis, is unknown. Accordingly, the Life After Pediatric Sepsis Evaluation investigation was conducted to describe the trajectory of mortality and health-related quali...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004123
更新日期:2020-03-01 00:00:00
abstract:BACKGROUND:Hemorrhage in trauma is a significant challenge, accounting for 30% to 40% of all fatalities, second only to central nervous system injury as a cause of death. However, hemorrhagic death is the leading preventable cause of mortality in combat casualties and typically occurs within 6 to 24 hrs of injury. In c...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/CCM.0b013e31817e2ec5
更新日期:2008-07-01 00:00:00
abstract:OBJECTIVES:Procalcitonin (PCT) has been described as an early, discriminating marker of bacteria-associated sepsis in patients. However, little is known of its source and actions, in part because no appropriate animal models have been available. We tested the hypothesis that plasma PCT increases during various pathophy...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200011000-00021
更新日期:2000-11-01 00:00:00
abstract:OBJECTIVE:Conventional outcomes research provides only percentage risk of such end points as mortality rate, utilization of resources, and/or broad groupings of multiple organ system dysfunction. These prognostications generally are not applicable to individual patients. The purpose of the present study was to determin...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章
doi:10.1097/00003246-200205000-00014
更新日期:2002-05-01 00:00:00
abstract:OBJECTIVE:Antioxidant therapy has shown some promise in critical care medicine in which glutathione depletion and heart failure are often seen in critically ill patients. This study was designed to examine the impact of glutathione depletion and the free radical scavenger, metallothionein (MT), on cardiac function. DE...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31817bf925
更新日期:2008-07-01 00:00:00
abstract:OBJECTIVES:Acute hemolysis is associated with organ damage, inflammation, and impaired vascular function. Stimulation of the cholecystokinin-1 receptor-dependent vagal anti-inflammatory reflex with lipid-rich enteral nutrition was demonstrated to prevent tissue damage and attenuate inflammation. This study investigates...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31828e9262
更新日期:2013-11-01 00:00:00
abstract:OBJECTIVES:To assess the feasibility, biochemical efficacy, and safety of liberal versus conventional glucose control in ICU patients with diabetes. DESIGN:Prospective, open-label, sequential period study. SETTING:A 22-bed mixed ICU of a tertiary hospital in Australia. PATIENTS:We compared 350 consecutive patients w...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003087
更新日期:2018-06-01 00:00:00
abstract:OBJECTIVE:Pump-driven extracorporeal gas exchange systems have been advocated in patients suffering from severe acute respiratory distress syndrome who are at risk for life-threatening hypoxemia and/or hypercapnia. This requires extended technical and staff support. DESIGN:We report retrospectively our experience with...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000215111.85483.BD
更新日期:2006-05-01 00:00:00