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New Advances in Treatment of Sepsis
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New Advances in Treatment of Sepsis

A special issue of Journal of Personalized Medicine (ISSN 2075-4426). This special issue belongs to the section "Mechanisms of Diseases".

Deadline for manuscript submissions: closed (27 May 2022) | Viewed by 13502

Special Issue Editor

Dr. Yutaka Umemura

E-Mail Website
Guest Editor
Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, Japan
Interests: sepsis; disseminated intravascular coagulation; infectious diseases; intensive care medicine; trauma surgery

Special Issue Information

Dear Colleagues,

Sepsis is now defined as an organ dysfunction caused by an overwhelming and life-threatening host response to infection. Excessive inflammatory response in sepsis subsequently leads to multiple organ dysfunction syndrome due to vascular endothelial dysfunction, coagulation disorders, alterations in cell function, and dysregulated cardiovascular responses. Despite the progress made in medical management over the past few decades, sepsis remains an important global health problem, with approximately 11 million sepsis-related deaths reported in 2017. Although various strategies to control sepsis-induced inflammation and organ dysfunction have been evaluated over the past several decades, there is still no proven therapeutic intervention benefitting survival. Therefore, updating knowledge on the pathophysiology of sepsis is a vitally important issue to construct a novel therapeutic strategy of sepsis. In this Special Issue of the Journal of Personalized Medicine, we will discuss the etiology, pathophysiology, clinical manifestations, diagnostic, and optimal management to treat critically ill patients with sepsis.

Dr. Yutaka Umemura
Guest Editor

Manuscript Submission Information

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Keywords

  • sepsis
  • inflammatory response
  • organ dysfunction
  • coagulation disorders
  • vascular endothelial dysfunction
  • microcirculation
  • biomarkers
  • antibiotics
  • source control

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Published Papers (5 papers)

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Research

12 pages, 8854 KiB  
Article
Non-linear and Interaction Analyses of Biomarkers for Organ Dysfunctions as Predictive Markers for Sepsis: A Nationwide Retrospective Study
by Yutaka Umemura, Kazuma Yamakawa, Shuhei Murao, Yumi Mitsuyama, Hiroshi Ogura and Satoshi Fujimi
J. Pers. Med. 2022, 12(1), 44; https://doi.org/10.3390/jpm12010044 - 4 Jan 2022
Cited by 2 | Viewed by 1567
Abstract
The Sequential Organ Failure Assessment (SOFA) score is predominantly used to assess the severity of organ dysfunction in sepsis. However, differences in prognostic value between SOFA subscores have not been sufficiently evaluated. This retrospective observational study used a large-scale database containing about 30 [...] Read more.
The Sequential Organ Failure Assessment (SOFA) score is predominantly used to assess the severity of organ dysfunction in sepsis. However, differences in prognostic value between SOFA subscores have not been sufficiently evaluated. This retrospective observational study used a large-scale database containing about 30 million patients. Among them, we included 38,869 adult patients with sepsis from 2006 to 2019. The cardiovascular and neurological subscores were calculated by a modified method. Associations between the biomarkers of the SOFA components and mortality were examined using restricted cubic spline analyses, which showed that an increase in the total modified SOFA score was linearly associated with increased mortality. However, the prognostic association of subscores varied widely: platelet count showed a J-shaped association, creatinine showed an inverted J-shaped association, and bilirubin showed only a weak association. We also evaluated interaction effects on mortality between an increase of one subscore and another. The joint odds ratios on mortality of two modified SOFA subscores were synergistically increased compared to the sum of the single odds ratios, especially in cardiovascular-neurological, coagulation-hepatic, and renal-hepatic combinations. In conclusion, total modified SOFA score was associated with increased mortality despite the varied prognostic associations of the subscores, possibly because interactions between subscores synergistically enhanced prognostic accuracy. Full article
(This article belongs to the Special Issue New Advances in Treatment of Sepsis)
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9 pages, 1566 KiB  
Article
Seasonal Variation and Severity of Acute Abdomen in Japan: A Nine-Year Retrospective Analysis
by Hidero Yoshimoto, Kazuma Yamakawa, Yutaka Umemura, Kensuke Fujii, Eriko Nakamura, Kohei Taniguchi, Keitaro Tanaka, Akira Takasu and Kazuhisa Uchiyama
J. Pers. Med. 2021, 11(12), 1346; https://doi.org/10.3390/jpm11121346 - 10 Dec 2021
Cited by 4 | Viewed by 2516
Abstract
The seasonal incidence of acute abdomens, such as appendicitis, is reportedly more common in summer but is reported less frequently in Asia. Additionally, seasonal variations in the severity of acute abdomens have been evaluated insufficiently. This study evaluated the seasonal variations in the [...] Read more.
The seasonal incidence of acute abdomens, such as appendicitis, is reportedly more common in summer but is reported less frequently in Asia. Additionally, seasonal variations in the severity of acute abdomens have been evaluated insufficiently. This study evaluated the seasonal variations in the incidence and severity of acute abdomens in Japan. This retrospective observational study used a multicenter database containing data from 42 acute hospitals in Japan. We included all patients diagnosed with acute appendicitis, diverticulitis, cholecystitis, and cholangitis between January 2011 and December 2019. Baseline patient data included admission date, sequential organ failure assessment score, presence of sepsis, and disseminated intravascular coagulation. We enrolled 24,708 patients with acute abdomen. Seasonal admissions for all four acute abdominal diseases were the highest in summer [acute appendicitis, (OR = 1.35; 95% CI = 1.28–1.43); diverticulitis, (OR = 1.23; 95% CI = 1.16–1.31; cholecystitis (OR = 1.23; 95% CI = 1.11–1.36); and cholangitis (OR = 1.23; 95% CI = 1.12–1.36)]. The proportion of patients with sepsis and disseminated intravascular coagulation as well as the total SOFA score for each disease, did not differ significantly across seasons. Seasonal variations in disease severity were not observed. Full article
(This article belongs to the Special Issue New Advances in Treatment of Sepsis)
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12 pages, 1273 KiB  
Article
Machine Learning Model to Identify Sepsis Patients in the Emergency Department: Algorithm Development and Validation
by Pei-Chen Lin, Kuo-Tai Chen, Huan-Chieh Chen, Md. Mohaimenul Islam and Ming-Chin Lin
J. Pers. Med. 2021, 11(11), 1055; https://doi.org/10.3390/jpm11111055 - 21 Oct 2021
Cited by 14 | Viewed by 3108
Abstract
Accurate stratification of sepsis can effectively guide the triage of patient care and shared decision making in the emergency department (ED). However, previous research on sepsis identification models focused mainly on ICU patients, and discrepancies in model performance between the development and external [...] Read more.
Accurate stratification of sepsis can effectively guide the triage of patient care and shared decision making in the emergency department (ED). However, previous research on sepsis identification models focused mainly on ICU patients, and discrepancies in model performance between the development and external validation datasets are rarely evaluated. The aim of our study was to develop and externally validate a machine learning model to stratify sepsis patients in the ED. We retrospectively collected clinical data from two geographically separate institutes that provided a different level of care at different time periods. The Sepsis-3 criteria were used as the reference standard in both datasets for identifying true sepsis cases. An eXtreme Gradient Boosting (XGBoost) algorithm was developed to stratify sepsis patients and the performance of the model was compared with traditional clinical sepsis tools; quick Sequential Organ Failure Assessment (qSOFA) and Systemic Inflammatory Response Syndrome (SIRS). There were 8296 patients (1752 (21%) being septic) in the development and 1744 patients (506 (29%) being septic) in the external validation datasets. The mortality of septic patients in the development and validation datasets was 13.5% and 17%, respectively. In the internal validation, XGBoost achieved an area under the receiver operating characteristic curve (AUROC) of 0.86, exceeding SIRS (0.68) and qSOFA (0.56). The performance of XGBoost deteriorated in the external validation (the AUROC of XGBoost, SIRS and qSOFA was 0.75, 0.57 and 0.66, respectively). Heterogeneity in patient characteristics, such as sepsis prevalence, severity, age, comorbidity and infection focus, could reduce model performance. Our model showed good discriminative capabilities for the identification of sepsis patients and outperformed the existing sepsis identification tools. Implementation of the ML model in the ED can facilitate timely sepsis identification and treatment. However, dataset discrepancies should be carefully evaluated before implementing the ML approach in clinical practice. This finding reinforces the necessity for future studies to perform external validation to ensure the generalisability of any developed ML approaches. Full article
(This article belongs to the Special Issue New Advances in Treatment of Sepsis)
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14 pages, 2078 KiB  
Article
Monocyte Distribution Width, Neutrophil-to-Lymphocyte Ratio, and Platelet-to-Lymphocyte Ratio Improves Early Prediction for Sepsis at the Emergency
by Sen-Kuang Hou, Hui-An Lin, Shao-Chun Chen, Chiou-Feng Lin and Sheng-Feng Lin
J. Pers. Med. 2021, 11(8), 732; https://doi.org/10.3390/jpm11080732 - 28 Jul 2021
Cited by 23 | Viewed by 3268
Abstract
(1) Background: Sepsis is a life-threatening condition, and most patients with sepsis first present to the emergency department (ED) where early identification of sepsis is challenging due to the unavailability of an effective diagnostic model. (2) Methods: In this retrospective study, patients aged [...] Read more.
(1) Background: Sepsis is a life-threatening condition, and most patients with sepsis first present to the emergency department (ED) where early identification of sepsis is challenging due to the unavailability of an effective diagnostic model. (2) Methods: In this retrospective study, patients aged ≥20 years who presented to the ED of an academic hospital with systemic inflammatory response syndrome (SIRS) were included. The SIRS, sequential organ failure assessment (SOFA), and quick SOFA (qSOFA) scores were obtained for all patients. Routine complete blood cell testing in conjugation with the examination of new inflammatory biomarkers, namely monocyte distribution width (MDW), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), was performed at the ED. Propensity score matching was performed between patients with and without sepsis. Logistic regression was used for constructing models for early sepsis prediction. (3) Results: We included 296 patients with sepsis and 1184 without sepsis. A SIRS score of >2, a SOFA score of >2, and a qSOFA score of >1 showed low sensitivity, moderate specificity, and limited diagnostic accuracy for predicting early sepsis infection (c-statistics of 0.660, 0.576, and 0.536, respectively). MDW > 20, PLR > 9, and PLR > 210 showed higher sensitivity and moderate specificity. When we combined these biomarkers and scoring systems, we observed a significant improvement in diagnostic performance (c-statistics of 0.796 for a SIRS score of >2, 0.761 for a SOFA score of >2, and 0.757 for a qSOFA score of >1); (4) Conclusions: The new biomarkers MDW, NLR, and PLR can be used for the early detection of sepsis in the current sepsis scoring systems. Full article
(This article belongs to the Special Issue New Advances in Treatment of Sepsis)
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12 pages, 1094 KiB  
Article
Early Vitamin C, Hydrocortisone, and Thiamine Treatment for Septic Cardiomyopathy: A Propensity Score Analysis
by Min-Taek Lee, Sun-Young Jung, Moon Seong Baek, Jungho Shin and Won-Young Kim
J. Pers. Med. 2021, 11(7), 610; https://doi.org/10.3390/jpm11070610 - 28 Jun 2021
Cited by 6 | Viewed by 2256
Abstract
This study investigated the effectiveness of early vitamin C, hydrocortisone, and thiamine among patients with septic cardiomyopathy. In total, 91 patients with septic cardiomyopathy received a vitamin C protocol in September 2018–February 2020. These patients were compared to 75 patients with septic cardiomyopathy [...] Read more.
This study investigated the effectiveness of early vitamin C, hydrocortisone, and thiamine among patients with septic cardiomyopathy. In total, 91 patients with septic cardiomyopathy received a vitamin C protocol in September 2018–February 2020. These patients were compared to 75 patients with septic cardiomyopathy who did not receive a vitamin C protocol in September 2016–February 2018. Relative to the control patients, the treated patients were older and more likely to require mechanical ventilation. The vitamin C protocol was associated with a lower risk of intensive care unit mortality in the propensity score (PS)-matched cohort (aHR: 0.55, 95% CI: 0.30–0.99) and inverse probability of treatment weighting-matched cohort (aHR: 0.67, 95% CI: 0.45–1.00). In the PS-matched cohort (59 patients per group), the vitamin C protocol was associated with decreased values for vasopressor dosage, C-reactive protein concentration, and the Sequential Organ Failure Assessment score during the 4-day treatment period. Patients who started the vitamin C protocol within 2 h after diagnosis (vs. 2–8 h or ≥8 h) had the highest vasopressor weaning rate and the lowest mortality rate. These results suggest that early treatment using a vitamin C protocol might improve organ dysfunction and reduce mortality among patients with septic cardiomyopathy. Full article
(This article belongs to the Special Issue New Advances in Treatment of Sepsis)
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