ObjectiveTo evaluate the clinical efficacy of fish oil containing lipid emulsion (FO) in sepsis. MethodsRandomized controlled trials about fish oil containing lipid emulsion in sepsis,which were published from 1980,were searched from the following electronic databases:PubMed,Embase,Foreign Medical Journal Service,Cochrane Library,CNKI,Wanfang Database,and VIP Database. The articles screening,quality assessment and data extraction were conducted by two reviewers independently. The methodological quality of trials was assessed by Jadad's scale. All data was analyzed by Review Manager 5.2 software. ResultsFifteen studies involving 794 participants met the inclusion criteria. The meta-analysis results were as follows:compared with the control group,①FO could shorten the length of ICU stay[WMD=-5.59,95%CI(-7.65,-3.53)] and the length of hospital stay[WMD=-10.48,95%CI(-14.67,-6.29)],and also decrease the 28-day mortality[RR=0.69,95%CI(0.52,0.93)]. ②FO could reduce the concentration of TNF-α[WMD=31.78,95%CI(5.63,57.92)] and improve oxygenation index[WMD=41.95,95%CI(30.80,53.11)] in septic patients. ③There was no statistical significance in the decrease of C-reactive protein (CRP) between two groups(P>0.05). ConclusionThe administration of FO in septic patients can significantly shorten the length of ICU stay and hospital stay,decrease the 28-day mortality,reduce the concentration of TNF-α and improve oxygenation index. However,it shows no significant difference in the decrease of CRP compared with the administration of traditional lipid emulsion. All of the above results show that the septic patients can benefit from the administration of fish oil containing lipid emulsion.
Objective To establish a short-term mortality risk scoring standard for sepsis-associated acute respiratory distress syndrome (sARDS) and provide a reference tool for clinicians to evaluate the severity of sARDS patients. Methods A retrospective cohort study was conducted on sARDS patients admitted to the adult intensive care unit (ICU) of the First Affiliated Hospital, Hengyang Medical School, University of South China from January 1, 2013 to August 31, 2020. They were divided into a death group and a survival group according to whether they died within 28 days after admission to ICU. Clinical data of the patients was collected within 24 hours admitted to ICU. Related risk factors for mortality within 28 days after admission to ICU were screened out through univariate logistic regression analysis. A risk prediction model for mortality within 28 days after admission to ICU was established by multivariate logistic regression analysis. The Hosmer-Lemeshow χ2 test and the area under the receiver operating characteristic (ROC) curve were used to evaluate the model’s goodness-fit and accuracy in predicting 28-day mortality of the sARDS patients, respectively. Finally, the clinical prognosis scoring criteria 28-day mortality of the sARDS patients were established according to the weight coefficients of each independent risk factor in the model. Results A total of 150 patients were recruited in this study. There were 67 patients in the survival group and 83 patients in the death group with a 28-day mortality rate of 55.3%. Four independent risk factors for 28-day mortality of the sARDS patients, including invasive mechanical ventilation, the number of dysfunctional organs≥3, serum lactic acid≥4.3 mmol/L and the severity of ARDS. A risk prediction model for mortality within 28 days of the sARDS patients was established. The area under the ROC curve and 95% confidence interval (CI), sensitivity and specificity of the risk prediction model for 28-day mortality for the sARDS patients were 0.896 (95%CI 0.846 - 0.945), 80.7% and 82.1%, respectively, while that for acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score were 0.865 (95%CI 0.805 - 0.925), 71.1% and 89.6%; for sequential organ failure assessment (SOFA) score were 0.841 (95%CI 0.7799 - 0.904), 68.7%, and 82.1%; for the prediction scores of lung injury were 0.855 (95%CI 0.789 - 0.921), 81.9% and 82.1%, respectively. It was indicated that the prediction accuracy of this risk prediction model of 28-day mortality maybe was better than that of APACHE-Ⅱ score, SOFA score and prediction score of lung injury. In addition, four risk factors were assigned as invasive mechanical ventilation (12 points), serum lactic acid≥4.3mmol /L (1 point), number of organs involved≥3 (3 points), and severity of ARDS (mild for 13 points, moderate for 26 points, severe for 39 points). Further more, the score of each patient was 13 - 55 points according to the scoring criteria, and the score grade was made according to the percentile method: 13 - 23 points for the low-risk group for 28-day mortality, 24 - 34 points for the medium-risk group for 28-day mortality, 35 - 45 points for the high-risk group for 28-day mortality, and over 45 points for the extremely high-risk group for 28-day mortality. According to the scoring criteria, the prognosis of the patients in this study was analyzed. The mortality probability of each group was 0.0% in the low-risk group, 13.8% in the medium-risk group, 51.9% in the high-risk group, and 89.7% in the extremely high-risk group, respectively. Conclusions The invasive mechanical ventilation, the number of involved organs≥3, serum lactic acid≥4.3 mmol /L and the severity of sARDS are independent risk factors for 28-day mortality of the sARDS patients. The scoring criteria may predict the risk of 28-day mortality for the sARDS patients.
ObjectiveTo investigate the distribution and content of endogenous salusin-βin septic rats. MethodsThirty-six SPF male SD rats were randomly divided into sham operation group (n=9) and septic model group (n=27).Only the cecum was turn in the sham operation group and the septic model was made by the cecal ligation and puncture (CLP) in the septic model group.The rats were sacrificed at 6 h, 12 h, and 24 h after modeling in the septic model group.The contents of salusin-βin the tissues of spleen, stomach, small intestine, hypothalamus, and serum specimens were detected by enzyme-linked immunosorbent assay. Results①The salusin-βendogenously generated in the rat tissues including the spleen, stomach, small intestine, hypothalamus, and serum.The content of salusin-βin the spleen tissue was higher than that in the other tissues (P < 0.05).②The contents of salusin-βin the spleen, stomach, small intestine tissues together with the serum increased significantly at 6 h after CLP as compared with the sham operation group (P < 0.05).The contents of salusin-βin the spleen tissue and serum were peaked at 12 h, in the small intestine tissue reached the summit at 24 h.While, the content of salusin-βhad no significant fluctuation in the stomach tissue.The content of salusin-βbegan to increase at 6 h in the hypothalamus tissue, and significantly increased at 12 h after CLP (P < 0.05). ConclusionThe time-dependent change of salusin-βin sepsis rats suggests that salusin-βmight be involved with the pathogenesis of sepsis.
Objective To explore independent risk factors for 30-day mortality in critical patients with pulmonary infection and sepsis, and build a prediction model. Methods Patients diagnosed with pulmonary infection and sepsis in the MIMIC-Ⅲ database were analyzed. The CareVue database was the training cohort (n=934), and the Metavision database was the external validation cohort (n=687). A COX proportional hazards regression model was established to screen independent risk factors and draw a nomogram. We conducted internal cross-validation and external validation of the model. Using the receiver operator characteristic (ROC) curve, Calibration chart, and decision curve analysis, we detected the discrimination, calibration, and benefit of the model respectively, comparing with the SOFA scoring model. Results Age, SOFA score, white blood cell count≤4×109/L, neutrophilic granulocyte percentage (NEU%)>85%, platelet count (PLT)≤100×109/L, PLT>300×109/L, red cell distribution width >15%, blood urea nitrogen, and lactate dehydrogenase were independent risk factors. The areas under the ROC curve of the model were 0.747 (training cohort) and 0.708 (external validation cohort), respectively, which was superior to the SOFA scoring model in terms of discrimination, calibration, and benefit. Conclusion The model established in this study can accurately and effectively predict the risk of the disease mortality, and provide a visual assessment method for early identification of high-risk patients.
Objective To investigate the effects of simvastatin on lung tissue in septic rats by observing the protein expression of nuclear factor kappa B ( NF-κB) and pathologic changes in lung tissue at different time points. Methods 90 healthy male Sprague-Dawley rats were randomly divided into three groups ( n =30 in each group) . All the rats received administration by caudal vein and capacity volume is 2 mL. The rats in the control group were treated with saline ( 2 mL) . The rats in the LPS group were treated with LPS ( 5 mg/kg ) . The rats in the simvastatin group were treated with LPS ( 5 mg/kg) and simvastatin ( 20 mg/kg) . Six rats in each group were killed randomly at 2, 4, 6, and 12 hours after the injection, and the right middle lobe of lung was taken out. Pathological changes of lung tissue wee investigated under light microscope. The expression of NF-κB in lung tissue was determined by immunohistochemistry ( IHC) method. Results Microscopic studies showed that there were not pathological changes in the lung tissue of rats in the control group. While in the LPS group, the alveolar spaces were narrowed and the alveolar wall were thickened. Furthermore, severe interstitial edema of lung and proliferation of epithelial cells were observed. In the simvastatin group, the degree of the infiltration of leukocytes and the lung interstitial edema were less severe than those in the simvastatin group. In the control group, the expression of NF-κB protein in most of lung tissue was negative. In the LPS group, the expression of NF-κB protein was detected at 2h, andreached the peak at 6h, then decreased at 12h. In the Simvastatin group, the NF-κB expression was significantly lower than that in the LPS group at all time points ( P lt; 0. 01) . Conclusion Simvastatin can ameliorate pathological lesions and decrease expression of NF-κB in lung tissue of septic rats.
This article aims to interpret the consensus report of the 30th Acute Disease Quality Initiative (ADQI) workgroup on hemoadsorption (HA) technology, providing reference for clinical practice and research. HA has shown therapeutic advantages in various diseases. The ADQI workgroup assessed the research progress of HA technology, confirming its clinically acceptable short-term biocompatibility, safety, and technical feasibility, as well as experimental demonstration of specified target molecule removal. Preliminary studies have shown a potential benefit of endotoxin-based HA in sepsis. However, due to insufficient clinical evidence, HA is still considered an experimental intervention. The ADQI consensus report focuses on filling existing knowledge gaps, pointing out future research directions, and providing important guidance for the clinical application and further research of HA technology.
Objective To investigate the expression of oncostatin M (OSM) in patients with sepsis and its role in early recognition of sepsis. Methods Thirty-four patients with sepsis admitted in Shanxi Bethune Hospital fromJune 3, 2021 to January 18, 2022 were selected as a sepsis group, 15 patients with community acquired pneumonia (CAP) as a case control group, and 16 adults who underwent physical examination in the same period were selected as a healthy control group. The patients in the sepsis group were followed up for 28 days and divided into a survival group and a death group. The serum OSM level and its correlation with clinical indexes (white blood cell, neutrophil, lymphocyte, sequential organ failure assessment score and acute physiology and chronic health evaluation Ⅱ) were analyzed, and the diagnostic value of OSM expression level in the early identification of sepsis was analyzed. Results Compared with the case control group and the healthy control group, the expression level of OSM in the sepsis group was significantly higher [(502.07±209.93)pg/mL vs. (368.22±65.95)pg/mL and (382.09±73.04)pg/mL, P<0.05]. However, the high expression of OSM had no significant correlation with white blood cell, neutrophil, lymphocyte or disease severity score (P>0.05), and there was no significant difference in serum OSM level between the sepsis survival group and the death group. Compared with white blood cell count, the high expression of OSM has certain diagnostic value in the early identification of sepsis. The area under the receiver operator characteristic curve of OSM in predicting sepsis was 0.794 (95% confidence interval 0.666 - 0.922, P<0.05), with the sensitivity of 79.4% and the specificity of 73.3%. Conclusion The expression of OSM in patients with sepsis is significantly increased, and the high expression of OSM has a certain diagnostic value in the early identification of sepsis.
Sepsis, a serious clinical syndrome known as organs dysfunction caused by an unbalanced host inflammatory response to infection, is of great concern in emergency medicine. Over the past two decades, the definition of sepsis has changed from systemic inflammatory response syndrome lead by infection to organs damage caused by infection. Under the new diagnostic criterion, septic patients are too serious to be treated in Emergency Department, and need intensive treatment of Intensive Care Unit. In this paper, by analyzing the development process from infection to sepsis and expounding the role of cytokines in the development of sepsis, we think that measures should be taken at the early stage of infection in order to prevent and block the occurrence of sepsis.