Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
5.4
3.9
Journals
JCM
Special Issues
Management of Chronic Critical Illness after Sepsis—Part II
share announcement

Management of Chronic Critical Illness after Sepsis—Part II

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Emergency Medicine".

Deadline for manuscript submissions: closed (15 December 2021) | Viewed by 14725

Special Issue Editors

Prof. Dr. Frederick A. Moore

E-Mail Website
Guest Editor
University of Florida, Gainesville, Florida, USA
Interests: trauma; critical care; sepsis; neutrophils; multiple organ failure; nutrition; phenotypic heterogeneity; persistent inflammation immunosuppression and catabolism syndrome
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Philip A. Efron

E-Mail Website
Guest Editor
University of Florida, Gainesville, FL, USA
Interests: trauma; critical care; sepsis; epigenetics/genetics; inflammation; immunology; immune suppression; leukocytes
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Despite decades of extensive research, sepsis remains a common, costly and debilitating syndrome.  The Surviving Sepsis Campaign (SSC) was initiated in 2004 as an international effort to develop and implement evidence-based care guidelines (EBG). Over the next decade with widespread early use of the SSC EBG “sepsis bundles”, hospital mortality decreased substantially.  However, this tremendous success created a new problem.  A growing epidemic of “sepsis survivors” are now progressing into chronic critical illness (CCI). Increasingly, studies have documented that the majority of CCI patients are discharged to long-term health care facilities with severe physical and cognitive disabilities and do not recover.  Mortality for this cohort can be 40% and 70% within one and three years of their sepsis, respectively. As a result, the next major challenge in sepsis will be the management of these individuals and their maladies.  These include increased cardiovascular events, malnutrition, sepsis recidivism, immobility, neuropathy and frailty, as well as impaired host cognition and a suboptimal host microbiome.  The aim of this Special Issues is to describe these disorders and discuss potential interventions to minimize risk, maximize recovery and prevent long-term mortality.  These articles will work towards promoting multidisciplinary discussion and aid the focus of future research.  The Special Issue has been divided into two parts.  Part 1 consists of multiple review articles, and Part 2 will have additional reviews plus research manuscripts.  We wish to encourage you to submit your work to Part 2 by August 1st.

Prof. Dr. Frederick A. Moore
Prof. Dr. Philip A. Efron
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Sepsis survivors
  • Chronic critical illness
  • Long-term outcomes
  • Sepsis Rehabilitation
  • Sepsis Recidivism
  • Immunosuppression
  • Frailty
  • Delirium
  • Malnutrition

Published Papers (5 papers)

Download All Papers
Order results
Result details
Show export options expand_more Show export options expand_less
Select all
Export citation of selected articles as:

Research

Jump to: Review

17 pages, 832 KiB  
Article
Healthcare Utilization and Costs in Sepsis Survivors in Germany–Secondary Analysis of a Prospective Cohort Study
by Konrad F. R. Schmidt, Katharina Huelle, Thomas Reinhold, Hallie C. Prescott, Rebekka Gehringer, Michael Hartmann, Thomas Lehmann, Friederike Mueller, Konrad Reinhart, Nico Schneider, Maya J. Schroevers, Robert P. Kosilek, Horst C. Vollmar, Christoph Heintze, Jochen S. Gensichen and the SMOOTH Study Group
J. Clin. Med. 2022, 11(4), 1142; https://doi.org/10.3390/jcm11041142 - 21 Feb 2022
Cited by 5 | Viewed by 2908
Abstract
Background: Survivors of sepsis often face long-term sequelae after intensive care treatment. Compared to the period of hospitalization, little is known about the ambulatory healthcare utilization in sepsis patients. The study evaluated healthcare utilization and associated costs of sepsis care including allied [...] Read more.
Background: Survivors of sepsis often face long-term sequelae after intensive care treatment. Compared to the period of hospitalization, little is known about the ambulatory healthcare utilization in sepsis patients. The study evaluated healthcare utilization and associated costs of sepsis care including allied health professions after initial hospitalization. Methods: Secondary analysis was performed on data in 210 sepsis patients prospectively enrolled from nine intensive care study centers across Germany. Data was collected via structured surveys among their Primary care (Family-) physicians (PCPs) within the first month after discharge from ICU (baseline) and again at 6, 12 and 24 months after discharge, each relating to the period following the last survey. Costs were assessed by standardized cost unit rates from a health care system’s perspective. Changes in healthcare utilization and costs over time were calculated using the Wilcoxon rank-sum test. Results: Of the 210 patients enrolled, 146 (69.5%) patients completed the 24 months follow-up. In total, 109 patients were hospitalized within the first 6 months post-intensive care. Mean total direct costs per patient at 0–6 months were €17,531 (median: €6047), at 7–12 months €9029 (median: €3312), and at 13–24 months €18,703 (median: €12,828). The largest contributor to the total direct costs within the first 6 months was re-hospitalizations (€13,787 (median: €2965). After this first half year, we observed a significant decline in inpatient care costs for re-hospitalizations (p ≤ 0.001). PCPs were visited by more than 95% of patients over 24 months. Conclusions: Sepsis survivors have high health care utilization. Hospital readmissions are frequent and costly. Highest costs and hospitalizations were observed in more than half of patients within the first six months post-intensive care. Among all outpatient care providers, PCPs were consulted most frequently. Clinical impact: Sepsis survivors have a high healthcare utilization and related costs which persist after discharge from hospital. Within outpatient care, possible needs of sepsis survivors as physiotherapy or psychotherapy seem not to be met appropriately. Development of sepsis aftercare programs for early detection and treatment of complications should be prioritized. Full article
(This article belongs to the Special Issue Management of Chronic Critical Illness after Sepsis—Part II)
►▼ Show Figures

Figure 1

13 pages, 1225 KiB  
Article
Serum Levels of Acylcarnitines and Amino Acids Are Associated with Liberation from Organ Support in Patients with Septic Shock
by Theodore S. Jennaro, Elizabeth M. Viglianti, Nicholas E. Ingraham, Alan E. Jones, Kathleen A. Stringer and Michael A. Puskarich
J. Clin. Med. 2022, 11(3), 627; https://doi.org/10.3390/jcm11030627 - 26 Jan 2022
Cited by 3 | Viewed by 2940
Abstract
Sepsis-induced metabolic dysfunction is associated with mortality, but the signatures that differentiate variable clinical outcomes among survivors are unknown. Our aim was to determine the relationship between host metabolism and chronic critical illness (CCI) in patients with septic shock. We analyzed metabolomics data [...] Read more.
Sepsis-induced metabolic dysfunction is associated with mortality, but the signatures that differentiate variable clinical outcomes among survivors are unknown. Our aim was to determine the relationship between host metabolism and chronic critical illness (CCI) in patients with septic shock. We analyzed metabolomics data from mechanically ventilated patients with vasopressor-dependent septic shock from the placebo arm of a recently completed clinical trial. Baseline serum metabolites were measured by liquid chromatography-mass spectrometry and 1H-nuclear magnetic resonance. We conducted a time-to-event analysis censored at 28 days. Specifically, we determined the relationship between metabolites and time to extubation and freedom from vasopressors using a competing risk survival model, with death as a competing risk. We also compared metabolite concentrations between CCI patients, defined as intensive care unit level of care ≥ 14 days, and those with rapid recovery. Elevations in two acylcarnitines and four amino acids were related to the freedom from organ support (subdistributional hazard ratio < 1 and false discovery rate < 0.05). Proline, glycine, glutamine, and methionine were also elevated in patients who developed CCI. Our work highlights the need for further testing of metabolomics to identify patients at risk of CCI and to elucidate potential mechanisms that contribute to its etiology. Full article
(This article belongs to the Special Issue Management of Chronic Critical Illness after Sepsis—Part II)
►▼ Show Figures

Figure 1

12 pages, 2089 KiB  
Article
Chronic Critical Illness Elicits a Unique Circulating Leukocyte Transcriptome in Sepsis Survivors
by Dijoia B. Darden, Gabriela L. Ghita, Zhongkai Wang, Julie A. Stortz, Maria-Cecilia Lopez, Michael C. Cox, Russell B. Hawkins, Jaimar C. Rincon, Lauren S. Kelly, Brittany P. Fenner, Tezcan Ozrazgat-Baslanti, Christiaan Leeuwenburgh, Azra Bihorac, Tyler J. Loftus, Frederick A. Moore, Scott C. Brakenridge, Henry V. Baker, Rhonda Bacher, Alicia M. Mohr, Lyle L. Moldawer and Philip A. Efronadd Show full author list remove Hide full author list
J. Clin. Med. 2021, 10(15), 3211; https://doi.org/10.3390/jcm10153211 - 21 Jul 2021
Cited by 5 | Viewed by 1743
Abstract
Surgical sepsis has evolved into two major subpopulations: patients who rapidly recover, and those who develop chronic critical illness (CCI). Our primary aim was to determine whether CCI sepsis survivors manifest unique blood leukocyte transcriptomes in late sepsis that differ from transcriptomes among [...] Read more.
Surgical sepsis has evolved into two major subpopulations: patients who rapidly recover, and those who develop chronic critical illness (CCI). Our primary aim was to determine whether CCI sepsis survivors manifest unique blood leukocyte transcriptomes in late sepsis that differ from transcriptomes among sepsis survivors with rapid recovery. In a prospective cohort study of surgical ICU patients, genome-wide expression analysis was conducted on total leukocytes in human whole blood collected on days 1 and 14 from sepsis survivors who rapidly recovered or developed CCI, defined as ICU length of stay ≥ 14 days with persistent organ dysfunction. Both sepsis patients who developed CCI and those who rapidly recovered exhibited marked changes in genome-wide expression at day 1 which remained abnormal through day 14. Although summary changes in gene expression were similar between CCI patients and subjects who rapidly recovered, CCI patients exhibited differential expression of 185 unique genes compared with rapid recovery patients at day 14 (p < 0.001). The transcriptomic patterns in sepsis survivors reveal an ongoing immune dyscrasia at the level of the blood leukocyte transcriptome, consistent with persistent inflammation and immune suppression. Furthermore, the findings highlight important genes that could compose a prognostic transcriptomic metric or serve as therapeutic targets among sepsis patients that develop CCI. Full article
(This article belongs to the Special Issue Management of Chronic Critical Illness after Sepsis—Part II)
►▼ Show Figures

Figure 1

Review

Jump to: Research

12 pages, 875 KiB  
Review
Sepsis and Cognitive Assessment
by Laura C. Jones, Catherine Dion, Philip A. Efron and Catherine C. Price
J. Clin. Med. 2021, 10(18), 4269; https://doi.org/10.3390/jcm10184269 - 20 Sep 2021
Cited by 4 | Viewed by 2477
Abstract
Sepsis disproportionally affects people over the age of 65, and with an exponentially increasing older population, sepsis poses additional risks for cognitive decline. This review summarizes published literature for (1) authorship qualification; (2) the type of cognitive domains most often assessed; (3) timelines [...] Read more.
Sepsis disproportionally affects people over the age of 65, and with an exponentially increasing older population, sepsis poses additional risks for cognitive decline. This review summarizes published literature for (1) authorship qualification; (2) the type of cognitive domains most often assessed; (3) timelines for cognitive assessment; (4) the control group and analysis approach, and (5) sociodemographic reporting. Using key terms, a PubMed database review from January 2000 to January 2021 identified 3050 articles, and 234 qualified as full text reviews with 18 ultimately retained as summaries. More than half (61%) included an author with an expert in cognitive assessment. Seven (39%) relied on cognitive screening tools for assessment with the remaining using a combination of standard neuropsychological measures. Cognitive domains typically assessed were declarative memory, attention and working memory, processing speed, and executive function. Analytically, 35% reported on education, and 17% included baseline (pre-sepsis) data. Eight (44%) included a non-sepsis peer group. No study considered sex or race/diversity in the statistical model, and only five studies reported on race/ethnicity, with Caucasians making up the majority (74%). Of the articles with neuropsychological measures, researchers report acute with cognitive improvement over time for sepsis survivors. The findings suggest avenues for future study designs. Full article
(This article belongs to the Special Issue Management of Chronic Critical Illness after Sepsis—Part II)
►▼ Show Figures

Figure 1

10 pages, 938 KiB  
Review
Bacteria and Sepsis: Microbiome to the Rescue?
by Hansol Kang and Ryan M. Thomas
J. Clin. Med. 2021, 10(16), 3578; https://doi.org/10.3390/jcm10163578 - 14 Aug 2021
Cited by 6 | Viewed by 3899
Abstract
The microbiome is the metagenome of all microbes that live on and within every individual, and evidence for its role in the pathogenesis of a variety of diseases has been increasing over the past several decades. While there are various causes of sepsis, [...] Read more.
The microbiome is the metagenome of all microbes that live on and within every individual, and evidence for its role in the pathogenesis of a variety of diseases has been increasing over the past several decades. While there are various causes of sepsis, defined as the abnormal host response to infection, the host microbiome may provide a unifying explanation for discrepancies that are seen in septic patient survival based on age, sex, and other confounding factors. As has been the case for other human diseases, evidence exists for the microbiome to control patient outcomes after sepsis. In this review, associative data for the microbiome and sepsis survival are presented with causative mechanisms that may be at play. Finally, clinical trials to manipulate the microbiome in order to improve patient outcomes after sepsis are presented as well as areas of potential future research in order to aid in the clinical treatment of these patients. Full article
(This article belongs to the Special Issue Management of Chronic Critical Illness after Sepsis—Part II)
►▼ Show Figures

Figure 1

Show export options expand_more Show export options expand_less
Select all
Export citation of selected articles as:
 
Displaying articles 1-5
Back to TopTop