Mortality difference between early-identified sepsis and late-identified sepsis

지운,조시온,이재백,진영호,정태오,윤재철,박보영 대한응급의학회 2020 Clinical and Experimental Emergency Medicine Vol.7 No.3

Objective The aim of the study was to compare the mortality rates of patients with early-identified (EI) sepsis and late-identified (LI) sepsis. Methods We performed a retrospective chart review of patients admitted to the emergency department and diagnosed with sepsis. EI sepsis was defined as patients with a Sequential Organ Failure Assessment (SOFA) score ≥2, based on 3 parameters of the SOFA score (Glasgow coma scale, mean arterial pressure, and partial pressure of oxygen/fraction of inspired oxygen ratio), measured within an hour of emergency department admission. The remaining patients were defined as LI sepsis. The primary outcome was in-hospital mortality. Results Of the total 204 patients with sepsis, 113 (55.4%) had EI sepsis. Overall mortality rate was 15.7%, and EI sepsis group had significantly higher mortality than LI sepsis (23.0% vs. 6.6%, P=0.003). The patients with EI sepsis, compared to those with LI sepsis, had higher SOFA score (median: 4 vs. 2, P<0.001); Acute Physiology and Chronic Health Evaluation (APACHE) II score (median: 14 vs. 10, P<0.001); were more likely to progress to septic shock within 6 hours after admission (17.7% vs. 1.1%, P<0.001); were more likely to be admitted to the intensive care unit (2.2% vs. 1.1%, P=0.001). Conclusion Mortality was significantly higher in the EI sepsis group than in the LI sepsis group.

혈청 프로칼시토닌(serum procalcitonin) 측정을 통한 패혈증 진단 및 중등도 평가의 유용성

박태진 ( Tae Jin Park ),임채만 ( Chae Man Lim ),고윤석 ( Youn Suck Koh ),홍상법 ( Sang Bum Hong ) 대한결핵 및 호흡기학회 2011 Tuberculosis and Respiratory Diseases Vol.70 No.1

Background: Early recognition and treatment of sepsis would improve patients` outcome. But it is difficult to distinguish between sepsis and non-infectious conditions in the acute phase of clinical deterioration. We studied serum level of procalcitonin (PCT) as a method to diagnose and to evaluate sepsis. Methods: Between 1 March 2009 and 30 September 2009, 178 patients had their serum PCT tested during their clinical deterioration in the medical intensive care unit. These laboratories were evaluated, on a retrospective basis. We classified their clinical status as non-infection, local infection, sepsis, severe sepsis, and septic shock. Then, we compared their clinical status with level of PCT. Results: The number of clinical status is as follows: 18 non-infection, 33 local infection, 39 sepsis, 26 severe sepsis, and 62 septic shock patients. PCT level of non-septic group (non-infection and local infection) and septic group (sepsis, severe sepsis, septic shock) was 0.36±0.57 ng/mL and 18.09±36.53 ng/mL (p<0.001), respectively. Area under the curve for diagnosis of sepsis using cut-off value of PCT >0.5 ng/mL was 0.841 (p<0.001). Level of PCT as clinical status was statistically different between severe sepsis and septic shock (*severe sepsis; 4.53±6.15 ng/mL, *septic shock 34.26±47.10 ng/mL, *p<0.001). Conclusion: Level of PCT at clinical deterioration showed diagnostic power for septic condition. The level of PCT was statistically different between severe sepsis and septic shock.

Sepsis: Early Recognition and Optimized Treatment

Kim, Hwan Il,Park, Sunghoon The Korean Academy of Tuberculosis and Respiratory 2019 Tuberculosis and Respiratory Diseases Vol.82 No.1

Sepsis is a life-threatening condition caused by infection and represents a substantial global health burden. Recent epidemiological studies showed that sepsis mortality rates have decreased, but that the incidence has continued to increase. Although a mortality benefit from early-goal directed therapy (EGDT) in patients with severe sepsis or septic shock was reported in 2001, three subsequent multicenter randomized studies showed no benefits of EGDT versus usual care. Nonetheless, the early administration of antibiotics and intravenous fluids is considered crucial for the treatment of sepsis. In 2016, new sepsis definitions (Sepsis-3) were issued, in which organ failure was emphasized and use of the terms "systemic inflammatory response syndrome" and "severe sepsis" was discouraged. However, early detection of sepsis with timely, appropriate interventions increases the likelihood of survival for patients with sepsis. Also, performance improvement programs have been associated with a significant increase in compliance with the sepsis bundles and a reduction in mortality. To improve sepsis management and reduce its burden, in 2017, the World Health Assembly and World Health Organization adopted a resolution that urged governments and healthcare workers to implement appropriate measures to address sepsis. Sepsis should be considered a medical emergency, and increasing the level of awareness of sepsis is essential.

Sepsis: Early Recognition and Optimized Treatment

김환일,박성훈 대한결핵및호흡기학회 2019 Tuberculosis and Respiratory Diseases Vol.82 No.1

Sepsis is a life-threatening condition caused by infection and represents a substantial global health burden. Recent epidemiological studies showed that sepsis mortality rates have decreased, but that the incidence has continued to increase. Although a mortality benefit from early-goal directed therapy (EGDT) in patients with severe sepsis or septic shock was reported in 2001, three subsequent multicenter randomized studies showed no benefits of EGDT versus usual care. Nonetheless, the early administration of antibiotics and intravenous fluids is considered crucial for the treatment of sepsis. In 2016, new sepsis definitions (Sepsis-3) were issued, in which organ failure was emphasized and use of the terms “systemic inflammatory response syndrome” and “severe sepsis” was discouraged. However, early detection of sepsis with timely, appropriate interventions increases the likelihood of survival for patients with sepsis. Also, performance improvement programs have been associated with a significant increase in compliance with the sepsis bundles and a reduction in mortality. To improve sepsis management and reduce its burden, in 2017, the World Health Assembly and World Health Organization adopted a resolution that urged governments and healthcare workers to implement appropriate measures to address sepsis. Sepsis should be considered a medical emergency, and increasing the level of awareness of sepsis is essential.

Sepsis: Early Recognition and Optimized Treatment

( Hwan Il Kim ),( Sunghoon Park ) 대한결핵 및 호흡기학회 2019 Tuberculosis and Respiratory Diseases Vol.82 No.1

Sepsis is a life-threatening condition caused by infection and represents a substantial global health burden. Recent epidemiological studies showed that sepsis mortality rates have decreased, but that the incidence has continued to increase. Although a mortality benefit from early-goal directed therapy (EGDT) in patients with severe sepsis or septic shock was reported in 2001, three subsequent multicenter randomized studies showed no benefits of EGDT versus usual care. Nonetheless, the early administration of antibiotics and intravenous fluids is considered crucial for the treatment of sepsis. In 2016, new sepsis definitions (Sepsis-3) were issued, in which organ failure was emphasized and use of the terms “systemic inflammatory response syndrome” and “severe sepsis” was discouraged. However, early detection of sepsis with timely, appropriate interventions increases the likelihood of survival for patients with sepsis. Also, performance improvement programs have been associated with a significant increase in compliance with the sepsis bundles and a reduction in mortality. To improve sepsis management and reduce its burden, in 2017, the World Health Assembly and World Health Organization adopted a resolution that urged governments and healthcare workers to implement appropriate measures to address sepsis. Sepsis should be considered a medical emergency, and increasing the level of awareness of sepsis is essential.

Monocyte distribution width: a marker for sepsis in emergency department

( A-la Woo ),( Sang-bum Hong ),( Dong-kyu Oh ),( Chan-jung Park ),( Won-young Kim ),( Jin-won Huh ),( Chae-man Lim ),( Youn-suck Koh ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-

Background: In sepsis management, early recognition of septic patient is crucial, but the detection of sepsis often delayed due to sepsis criteria requiring much clinical information. Monocyte distribution width (MDW) is a potential early marker of sepsis which was not validated in the Korean population. Methods: A prospective cohort study was conducted to test MDW as a marker of sepsis in the emergency department (ED) of a tertiary referral hospital. Results: Total 666 adult patients presenting in ED and performed complete blood count (CBC) were enrolled from November 2018 through July 2019. They were classified as non-infection (n=170, 25.5%), infection (n=82, 12.3%), systemic inflammatory reaction syndrome (SIRS) (n=76, 11.4%), sepsis (n= 285, 42.8%), severe sepsis (n=12, 1.8%) and septic shock (n=41, 6.2%) according to SEPSIS-2 definition. MDW presented as mean ± standard deviation in non-infection (19.5 U ± 4.7), infection (22.3 U ± 5.2), SIRS (24.4 ± 9.0), sepsis (25.2 U ± 7.6), severe sepsis (29.0 U ± 12.6) and septic shock (34.5 U ± 15.1), respectively. Comparison of diagnostic accuracy of biomarkers was made by the area under the curve (AUC) of the receiver operating curve. C-reactive protein (CRP) showed best abilityto diagnose sepsis among the biomarkers (AUC 0.79, 95% confidential interval [CI] 0.75-0.83) followed by MDW (AUC, 0.71, 95% CI, 0.66-0.75), Procalcitonin (PCT) (AUC, 0.70, 95% CI, 0.66-0.75), and white blood cell count (WBC) (AUC 0.59, 95% CI, 0.54-0.64). With cutoff value 20 U, MDW diagnosed sepsis with 81.4% of sensitivity but only 52.6 % of specificity, negative predictive value was 78.2% while positive predictive value was 57.5%. Conclusions: In the emergency department, increased monocyte distribution width detected sepsis not inferior to other inflammatory markers such as procalcitonin and C-reactive protein.

Emergency medical service personnel need to improve knowledge and attitude regarding prehospital sepsis care

박중민,황승연,신태건,조익준,윤희,이태림,차원철,심민섭 대한응급의학회 2017 Clinical and Experimental Emergency Medicine Vol.4 No.1

Objective We aimed to evaluate the knowledge and attitudes of emergency medical service (EMS) personnel pertaining to sepsis. We also compared EMS personnel’s knowledge of sepsis and their intention to engage in prehospital sepsis management. Methods The survey was conducted during education conferences for EMS personnel in December 2013 and January 2015 in Seoul, Korea. The questionnaire composed of 10 questions relevant to sepsis, was distributed on-scene, and was retrieved by investigators after the conference. We classified subjects into active and passive groups based on intent to participate in prehospital sepsis care. Results A total of 271 questionnaires were distributed; 255 EMS personnel (94%) completed the survey, 126 (49%) of whom were first-degree emergency medical technicians (EMTs). Less than 75% of subjects provided clinically relevant responses to questions about the definitions of sepsis, tachycardia, tachypnea, hypotension, hypothermia, fluid resuscitation, and vasopressor. Only 15% of participants had suspected that a patient had sepsis, and 9% reported that they could identify patients with sepsis during transportation. Overall, first-degree EMTs showed higher levels of knowledge and a positive attitude to sepsis compared with non-first-degree EMTs. Sixty percent of the participants reported that they were actively involved in prehospital sepsis care. The active group showed significantly higher levels of knowledge and more positive responses to the clinical impact of prehospital sepsis care. Conclusion Our study showed that is a substantial portion of EMS personnel lacks appropriate level of knowledge on sepsis care. We also found that the intention to engage in sepsis management was associated with appropriate knowledge of sepsis.

Korean Registry for Improving Sepsis Survival (KISS): Protocol for a Multicenter Cohort of Adult Patients with Sepsis or Septic Shock

김종훈,구남수,Youn Jeong Kim,김홍빈,Hyeri Seok,이동건,Jin Seo Lee,정수진,최정현,Jang Wook Sohn,김민자,박대원 대한감염학회 2020 Infection and Chemotherapy Vol.52 No.1

Sepsis is one of the significant causes of morbidity and mortality. The burden caused by sepsis has continued to increase in recent years in the Korea, highlighting the urgent need for the implementation of strategies to improve sepsis treatment outcomes. We therefore designed a web-based sepsis registry system (“Korean Registry for Improving Sepsis Survival” [KISS]) protocol to be used in hospitals in the Korea for evaluation of the epidemiology and clinical characteristics of patients with sepsis, via an analysis of outcome predictors. The inclusion criteria of this registry are as follows: adult patients ≥18 years admitted to the participating hospitals who are diagnosed with sepsis or septic shock. Demographic and clinical information data of the patients will be collected from hospital medical records and will be recorded in a case report form, which will be entered into a web-based data management system. The analysis of the collected data will be performed as follows: (1) epidemiological and clinical characteristics of sepsis and septic shock, (2) application of sepsis bundles and antibiotic stewardship, and (3) audit and feedback. In conclusion, we aim to build the comprehensive web-based sepsis registry in the Korea through a nation-wide network of participating hospitals. Information collected and analyzed through the KISS can be used for further improvements in the clinical management of sepsis. Furthermore, the KISS will facilitate research leading to the formulation of public health policies regarding sepsis bundle and antibiotic stewardship strategies in the Korea.

Risk Factors of Sepsis and Factors Influencing the Decision to Perform Emergency Drainage in Obstructive Acute Pyelonephritis Secondary to Urinary Calculi

정영환,정승찬,백민기,류동수 대한요로생식기감염학회 2017 Urogenital Tract Infection Vol.12 No.3

Purpose: To investigate the risk factors for sepsis and analyze the criteria for emergency drainage in patients with obstructive acute pyelonephritis (APN) secondary to urinary calculi.Materials and Methods: We included 64 patients with obstructive APN secondary to urinary calculi. Patients were divided into two groups: the sepsis and non-sepsis groups. Independent risk factors for sepsis were also identified. Forty-three patients in the sepsis group were further divided into two subgroups: those who underwent emergency drainage and those who did not. A retrospective analysis was performed.Results: Of the 64 patients, 43 showed signs of sepsis. There was a lower lymphocyte count and lymphocyte percentage, as well as a higher C-reactive protein level and neutrophil-to-lymphocyte ratio (NLR) in the sepsis group compared with the non-sepsis group. Increased sepsis showed a statistically significant association with increased Charlson comorbidity index (CCI). Four out of 21 patients in the non-sepsis group underwent emergency drainage compared with 26 out of 43 patients in the sepsis group. Independent variables for sepsis in a multivariate logistic regression analysis showed positive blood culture, high NLR, and increased CCI score. Among sepsis patients, the likelihood of performing emergency drainage increased with higher creatinine, positive urine culture, and higher CCI score.Conclusions: In patients with obstructive APN secondary to urinary calculi, a high CCI score were associated with a higher probability of progression to sepsis. In patients with higher creatinine and higher CCI scores, proactive treatment is usually necessary.

Performance of Automated Electronic Sepsis Surveillance System Using Adult Sepsis Event Criteria: A Pilot Study

( Su Yeon Lee ),( Dong Kyu Oh ),( Mi Hyeon Park ),( Sang-bum Hong ),( Chae-man Lim ) 대한결핵 및 호흡기학회 2021 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.129 No.-

Background Surveillance by coding or manual reporting may underestimate true incidence of sepsis. Adult sepsis event (ASE) criteria, which automatically detect sepsis based on electronic health records, have been proposed by US centers for disease control and prevention, but are rarely validated outside US. Methods Data were retrospectively retrieved from all adult patients aged ≥ 19 years who visited emergency department, wards, or intensive care units in Asan Medical Center from 5th to 11th November 2019. Primary outcome was the performance of ASE for sepsis diagnosis based on the sepsis-3 criteria. Secondary outcomes were the incidence and the causes of false positive and false negative cases of ASE. Results Among 6,186 patients included, mean age was 57.8 years and male were 50.0% (n=3,096). The incidence of sepsis was 2.4% (n=148) by sepsis-3 and 3.3% (n=207) by ASE. The performance of ASE for sepsis diagnosis was excellent with sensitivity 87.8%, specificity 98.7%, positive predictive value 62.8%, negative predictive value 99.7%, and overall accuracy 98.4%. False positive (ASE, but no sepsis) was observed in 77 and the most common cause was “organ failure without infection” (n=43; 55.8%) followed by “infection without increasing in sequential organ failure assessment (SOFA) score by ≥2 points” (n=21; 27.3%). False negative (no ASE, but sepsis) was assessed in 18 with the most common cause of “increasing in SOFA score by ≥2 points without meeting organ failure criteria of ASE” (n=14; 77.8%) followed by “Infection occurred outside the window period of ASE” (n=4; 22.2%). Conclusions ASE showed excellent performance for the diagnosis of sepsis based on the sepsis-3 criteria. It may be used for the electronic health records-based automated sepsis surveillance system and epidemiologic studies.