CAP (Community acquired pneumonia) is frequent, with a high mortality rate and a high burden on health care systems. Development of predictive biomarkers, new therapeutic concepts, and epidemiologic research require a valid, reproducible, and quantitative measure describing CAP severity. Using time series data of 1532 patients enrolled in the PROGRESS study, we compared putative measures of CAP severity for their utility as an operationalization. Comparison was based on ability to correctly identify patients with an objectively severe state of disease (death or need for intensive care with at least one of the following: substantial respiratory support, treatment with catecholamines, or dialysis). We considered IDSA/ATS minor criteria, CRB-65, CURB-65, Halm criteria, qSOFA, PSI, SCAP, SIRS-Score, SMART-COP, and SOFA. SOFA significantly outperformed other scores in correctly identifying a severe state of disease at the day of enrollment (AUC = 0.948), mainly caused by higher discriminative power at higher

We studied anthrax immune globulin intravenous (AIG-IV) use from a 2009-2010 outbreak of Bacillus anthracis soft tissue infection in injection drug users in Scotland, UK, and we compared findings from 15 AIG-IV recipients with findings from 28 nonrecipients. Death rates did not differ significantly between recipients and nonrecipients (33% vs. 21%). However, whereas only 8 (27%) of 30 patients at low risk for death (admission sequential organ failure assessment score of 0-5) received AIG-IV, 7 (54%) of the 13 patients at high risk for death (sequential organ failure assessment score of 6-11) received treatment. AIG-IV recipients had surgery more often and, among survivors, had longer hospital stays than did nonrecipients. AIG-IV recipients were sicker than nonrecipients. This difference and the small number of higher risk patients confound assessment of AIG-IV effectiveness in this outbreak.

We studied anthrax immune globulin intravenous (AIG-IV) use from a 2009-2010 outbreak of Bacillus anthracis soft tissue infection in injection drug users in Scotland, UK, and we compared findings from 15 AIG-IV recipients with findings from 28 nonrecipients. Death rates did not differ significantly between recipients and nonrecipients (33% vs. 21%). However, whereas only 8 (27%) of 30 patients at low risk for death (admission sequential organ failure assessment score of 0-5) received AIG-IV, 7 (54%) of the 13 patients at high risk for death (sequential organ failure assessment score of 6-11) received treatment. AIG-IV recipients had surgery more often and, among survivors, had longer hospital stays than did nonrecipients. AIG-IV recipients were sicker than nonrecipients. This difference and the small number of higher risk patients confound assessment of AIG-IV effectiveness in this outbreak.

title: Addition of lactic acid levels improves the accuracy of quick sequential organ failure assessment in predicting mortality in surgical patients with complicated intra-abdominal infections: a retrospective study, doi: 10.1186/s13017-018-0173-6, category: Article

The sequential organ failure assessment (SOFA) score is prognostically superior to the model for end-stage liver disease following paracetamol overdose, reports the latest issue of Alimentary Pharmacology & Therapeutics.. ...

Background: Several cardiac surgery risk prediction models based on postoperative data have been developed. However, unlike preoperative cardiac surgery risk prediction models, postoperative models are rarely externally validated or utilized by clinicians. The objective of this study was to externally validate three postoperative risk prediction models for intensive care unit (ICU) mortality after cardiac surgery. Methods: The logistic Cardiac Surgery Scores (logCASUS), Rapid Clinical Evaluation (RACE), and Sequential Organ Failure Assessment (SOFA) scores were calculated over the first 7 postoperative days for consecutive adult cardiac surgery patients between January 2013 and May 2015. Model discrimination was assessed using receiver operating characteristic curve analyses. Calibration was assessed using the Hosmer-Lemeshow (HL) test, calibration plots, and observed to expected ratios. Recalibration of the models was performed. Results: A total of 2255 patients were included with an ICU ...

Objectives: Scoring systems have been used to risk stratify in intensive care units (ICU), but not routinely used in emergency departments. The aim of this study was to determine accuracy for predicting mortality in emergency medicine with Sequential Organ Failure Assessment (SOFA), Mortality in ED Sepsis (MEDS) score and Simplified Acute Physiology Score (SAPSII). ...

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If a second infection with the same antigen occurs, the memory cells react faster and more vigorously than the initial immune response, such that the symptoms of the infection do not normally appear ...

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Crit Care Med. 2013 Jul;41(7):1761-73. PMID: 23685639 OBJECTIVE: Multiple organ dysfunction syndrome is the main cause of death in adult ICUs and in PICUs. The PEdiatric Logistic Organ Dysfunction score developed in 1999 was primarily designed to describe the severity of organ dysfunction. This study was undertaken to update and improve the PEdiatric Logistic Organ…

Vincent JL, et al; Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Crit Care Med. 1998;26(11):1793-1800. ...

Out of 116 patients with sepsis, 54.3% were female. The median age was 73.5 years (IQR 63-82). The leading source of infection was the genitourinary tract (56.9%), followed by the lower respiratory tract (22.4%). A total of 35.3% of the patients experienced septic shock. Total ICU mortality for sepsis was 37.9%: 63.4% in patients with septic shock and 24.0% in patients without shock. Independent risk factors for ICU mortality were reduced mobility level (odds ratio [OR] 11.16, 95% confidence interval [CI] 2.45-50.91), failure to early recognize sepsis in the emergency department (OR 6.59, 95% CI 1.09-39.75), higher Sequential Organ Failure Assessment score at admission (OR 2.37, 95% CI 1.59-3.52), and inappropriate antimicrobial treatment (OR 9.99, 95% CI 2.57-38.87 ...

TY - JOUR. T1 - Clinical characteristics and outcome of critically ill patients with bacteremia caused by extended-spectrum β-lactamase-producing and non-producing Escherichia coli. AU - Haruki, Yuto. AU - Hagiya, Hideharu. AU - Haruki, Mai. AU - Sugiyama, Tetsuhiro. PY - 2018/11. Y1 - 2018/11. N2 - The number of patients infected with extended-spectrum beta-lactamase (ESBL)-producing organisms has increased dramatically worldwide, and high mortality rates are seen in severely ill patients. This study retrospectively compared the clinical characteristics and outcomes of critically ill patients in an intensive care unit (ICU) at the Tsuyama Chuo Hospital (Okayama, Japan) who were hospitalized for bacteremia caused by ESBL-producing Escherichia coli (ESBL-EC) or non-ESBL-producing E. coli (non-ESBL-EC) between January 2006 and December 2016 (11 years). We analyzed the patients age, sex, underlying disease(s), sequential organ failure assessment scores, primary focus of bacteremia, empiric ...

With most prior epidemiologic studies of sepsis using administrative data with variable accuracy, no reliable differentiation between community-onset (CO) and hospital-onset (HO) disease, and a lack of granular clinical information, relatively little is known about HO sepsis. For a study, researchers compared the risk of in-hospital mortality for patients with HO sepsis with that of those with CO sepsis and without sepsis, controlling for demographics, comorbidities, infectious diagnoses, and severity-of-illness at sepsis onset or on admission among 2.3 million patients at 136 US hospitals. When compared with patients with CO sepsis, those with HO sepsis were younger (66 vs 68 years), but had more comorbidities (median Elixhauser score, 14 vs 11), including heart failure (26% vs 22%), renal disease (23% vs 20%), and cancer (17% vs 11%). HO sepsis patients had higher sequential organ failure assessment scores at sepsis onset (median 4 vs 3), higher rates of intra-abdominal infections (20% vs ...

The study was well powered to assess difference in mortality between groups and the results are largely generalizable to critically ill patients with characteristics similar to the study inclusion criteria. Nonsignificant improvement in survival was noted among patients with high Sequential Organ Failure Assessment scores, which may suggest that certain critically ill subgroups may benefit from empirical therapy. Additionally, there was low participation among patients with postoperative gastrointestinal leakage and acute necrotizing pancreatitis, among which there is a high risk of invasive fungal infection. Previous studies have shown surgical patients may benefit from empirical therapy. ...

Six ICU patients with and six ICU patients without subcutaneous oedema were studied. The characteristics of the index group were: age 57 years, male/female ratio 5/1, body mass index at admission 22.7 kg/m2. The characteristics of the reference group were: age 48 years, male/female ratio 5/1, body mass index at admission 23.9 kg/m2. In the index group creatinine clearance was lower compared with the reference group (81 vs 127 ml/min, P = 0.57). Both mean creatinine clearances were within the normal range. Sequential organ failure assessment score did not differ between the index and reference groups (4 vs 5). Mean arterial pressure was comparable between the index and reference group (87 vs 90 mmHg) and within the normal range. Mean plasma concentrations of factor anti-Xa activity were comparable in both groups. The mean Cmax value was not different between ICU patients with and without subcutaneous oedema (0.15 ± 0.02 vs 0.13 ± 0.03 IU/ml, P = 0.30). In the ICU patients with subcutaneous ...

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Data are presented as means and standard deviations for continuous variables and as numbers (percentages) for categorical variables. We analyzed baseline characteristics, clinical outcomes, and prognoses according to specific pathogens using the Kruskal-Wallis test. We used the Mann-Whitney test to compare data for prognosis according to whether a pathogen or MDR pathogen was identified. Associations between prognostic factors and survival rate were investigated using the Cox proportional-hazard analysis after adjusting for age, sex, Acute Physiology and Chronic Health Evaluation (APACHE) II score [13], Sequential Organ Failure Assessment (SOFA) score [14], Charlson comorbidity index [15], pneumonia severity index [16], the identification of the pathogen or MDR pathogen, and the pneumonia classification. Likelihood ratio tests were used to examine the goodness of fit of the model, and no lack of fit was found. Adjusted odd ratios (aOR) are presented with 95% confidence intervals (CIs). A p , ...

Among septic patients admitted to the intensive care unit (ICU), early recognition of those with the highest risk of death is of paramount importance. Since clinical judgment is sometimes uncertain biomarkers could provide additional information likely to guide critical illness management. We evaluated the prognostic value of soluble Triggering Receptor Expressed by Myeloid cells 1 (sTREM-1), procalcitonin (PCT) and leucocyte surface expression of CD64. This was a prospective cohort study, which included 190 septic patient admitted to the ICU in two hospitals. Blood samples for biomarker measurements were obtained upon admission and thereafter. The Simplified Acute Physiology Score (SAPS) II and the Sequential Organ Failure Assessment (SOFA) score were calculated. The primary outcome was all-cause death in the ICU. The mortality rate reached 25.8 %. The best predictive value of the three biomarkers was obtained with baseline sTREM-1, although clinical scores outperformed this. Accuracy was greater in

Revision in criteria regarding the definition of sepsis & septic shock now targets Sequential Organ Failure Assessment (SOFA) scoring to direct medical response

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We used data from 2,873 mechanically ventilated patients in the Outcomerea® database. Among these patients from 12 intensive care units, 434 (15.1%) experienced VAP; of the remaining patients, 1,969 (68.5%) were discharged alive and 470 (16.4%) died. With the multistate model, VAP-AM was 8.1% (95% confidence interval [95%CI], 3.1-13.1%) for 120 days complete observation, compared to 10.4% (5.6-24.5%) using a matched-cohort approach (2,769 patients) with matching on mechanical ventilation duration followed by conditional logistic regression. VAP-AM was higher in surgical patients and patients with intermediate (but not high) Simplified Acute Physiologic Score II values at ICU admission. VAP-AM was significantly influenced by time to VAP but not by resistance of causative microorganisms. Higher Logistic Organ Dysfunction score at VAP onset dramatically increased VAP-AM (to 31.9% in patients with scores above 7).. ...

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World Health Organization officials said Monday not all people who recover from the coronavirus have the antibodies to fight a second infection, raising concern...

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The program detects if the person is not moving for a time period. This is probably a better way to detect if a person needs help than detecting when the person fall. In a real situation the time period would be set around 2 minutes if the person is on the floor. For the sofa there could be a limit of two hours and for the bed there could be a limit of 12 hours. There are currently not different detection times for the sofa or a bed ...