New Strategies for the Diagnosis and Treatment of Sepsis and Septic Shock

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Intensive Care/ Anesthesiology".

Deadline for manuscript submissions: 30 September 2024 | Viewed by 8927

Special Issue Editors


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Guest Editor
Second Department of Critical Care, Attikon General University Hospital, Medical School, National and Kapodistrian University of Athens, 1 Rimini St, Haidari, 12462 Athens, Greece
Interests: sepsis; ICU; mechanical ventilation; critical care medicine; cardiopulmonary resuscitation; hemodynamics; ventilation; CPR; emergency management; respiratory physiology

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Guest Editor
Attikon University Hospital, Athens, Greece
Interests: viral infections; immunopathogenesis of viral disease
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Special Issue Information

Dear Colleagues,

Sepsis is the leading cause of death due to infection, showing increasing incidence and mortality. Despite recent advances in understanding and treatment, its mortality remains unacceptably high. The dysregulated systemic inflammatory response to infection is the main factor for the manifestations of sepsis, leading to life-threatening organ failure. Clinical studies and quality improvement initiatives have highlighted that the prompt diagnosis and treatment of sepsis are fundamental for survival. Therefore, there is intense research interest in the field of novel biomarkers for the early diagnosis of sepsis and outcome prediction. Moreover, understanding the pathophysiologic mechanisms during sepsis is key for the development of successful treatments.

In this context, we launch a Special Issue of the journal Medicina, dedicated to New Strategies for the Diagnosis and Treatment of Sepsis and Septic Shock. This Special Issue will focus on novel sepsis biomarkers and new therapeutic strategies, including but not limited to: risk factors; inflammatory response during sepsis; metabolic alterations; changes in cytokines and chemokines; specific attributes of bacterial, viral, fungal and COVID-19 sepsis; new therapeutic targets; current, experimental and future treatment options including antibiotics, fluid resuscitation, vasopressors, anti-inflammatory agents (corticosteroids and immunomodulators), blood purification (cytokine adsorption) in septic shock, etc.

Updated reviews, mini-reviews, commentaries, or original research papers are welcomed for submission.

Dr. Irene Karampela
Dr. Paraskevi C. Fragkou
Guest Editors

Manuscript Submission Information

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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. Medicina is an international peer-reviewed open access monthly 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 1800 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

  • antibiotics
  • antimicrobials
  • biomarkers
  • corticosteroids
  • cytokines
  • cytokine adsorption
  • fluid resuscitation
  • infections
  • inflammation
  • inflammatory mediators
  • multiple organ failure
  • organ support
  • sepsis
  • septic shock
  • vasopressors

Published Papers (5 papers)

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Editorial

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3 pages, 255 KiB  
Editorial
Future Perspectives in the Diagnosis and Treatment of Sepsis and Septic Shock
by Irene Karampela and Paraskevi C. Fragkou
Medicina 2022, 58(7), 844; https://doi.org/10.3390/medicina58070844 - 24 Jun 2022
Cited by 5 | Viewed by 2420
Abstract
Sepsis, defined as life-threatening organ dysfunction caused by a dysregulated host response to infection, represents the primary cause of death due to infection [...] Full article

Research

Jump to: Editorial

9 pages, 439 KiB  
Article
Intravenous Vitamin C as an Add-on Therapy for the Treatment of Sepsis in an Intensive Care Unit: A Prospective Cohort Study
by Sergio Antonio Gonzalez-Vazquez, Eli Efrain Gomez-Ramirez, Laura Gonzalez-Lopez, Jorge Ivan Gamez-Nava, Juan Angel Peraza-Zaldivar, Aline Priscilla Santiago-Garcia, Melissa Ramirez-Villafaña, Fabiola Gonzalez-Ponce, Jose Jorge Gomez-Camarena, Ana Miriam Saldaña-Cruz, Norma Alejandra Rodriguez-Jimenez, J. Ahuixotl Gutierrez-Aceves, Adriana Jimenez-Lopez, Sylvia Elena Totsuka-Sutto, Ernesto German Cardona-Muñoz and Juan Manuel Ponce-Guarneros
Medicina 2024, 60(3), 464; https://doi.org/10.3390/medicina60030464 - 12 Mar 2024
Viewed by 684
Abstract
Background and Objectives: According to the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3), sepsis is defined as “life-threatening organ dysfunction caused by a dysregulated host response to infection”. The increased presence of free radicals causes an increase in oxidative [...] Read more.
Background and Objectives: According to the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3), sepsis is defined as “life-threatening organ dysfunction caused by a dysregulated host response to infection”. The increased presence of free radicals causes an increase in oxidative stress. Vitamin C is an essential water-soluble vitamin with antioxidant activity and immunoregulatory effects that plays a potential role in the treatment of bacterial infections. Our aim was to evaluate the effectiveness of adding vitamin C to the conventional treatment of sepsis to decrease its mortality rate. Materials and Methods: In a prospective cohort study, we included patients with a diagnosis of sepsis and a SOFA score ≥ 9 who were evaluated in an Intensive Care Unit at a secondary-care hospital. According to the intensive care specialist, they were treated using two different strategies: Group 1—patients with sepsis treated with conventional treatment without vitamin C; Group 2—patients with sepsis with the addition of vitamin C to conventional treatment. Results: We included 34 patients with sepsis. The incidence of mortality was 38%, and 47% of patients used vitamin C as an adjuvant to the basic treatment of sepsis. In the basal analyses, patients treated with use of vitamin C compared to patients treated without vitamin C required less use of glucocorticoids (75% vs. 100%, p = 0.039). At follow-up, patients treated without vitamin C had higher mortality than patients treated with vitamin C as an adjuvant for the treatment of sepsis (55.6% vs. 18.8%, p = 0.03). We observed that the use of vitamin C was a protective factor for mortality in patients with sepsis (RR: 0.54, 95% CI: 0.31–0.96, p = 0.03). Conclusions: The use of vitamin C as an adjuvant to treatment decreases the risk of mortality by 46% in patients with sepsis and SOFA ≥ 9 compared to patients treated without vitamin C as an adjuvant to sepsis. Full article
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18 pages, 3302 KiB  
Article
Diagnostic and Prognostic Value of Serum Omentin-1 in Sepsis: A Prospective Study in Critically Ill Patients
by Irene Karampela, Natalia G. Vallianou, Dimitrios Tsilingiris, Gerasimos Socrates Christodoulatos, Georgios Antonakos, Ioanna Marinou, Evaggelos Vogiatzakis, Apostolos Armaganidis and Maria Dalamaga
Medicina 2023, 59(5), 833; https://doi.org/10.3390/medicina59050833 - 24 Apr 2023
Cited by 3 | Viewed by 1457
Abstract
Background and Objectives: Omentin-1, also known as intelectin-1, is a novel adipokine with anti-inflammatory activities implicated in inflammatory diseases and sepsis. We aimed to explore serum omentin-1 and its kinetics in critically ill patients early in sepsis and its association with severity [...] Read more.
Background and Objectives: Omentin-1, also known as intelectin-1, is a novel adipokine with anti-inflammatory activities implicated in inflammatory diseases and sepsis. We aimed to explore serum omentin-1 and its kinetics in critically ill patients early in sepsis and its association with severity and prognosis. Materials and Methods: Serum omentin-1 was determined in 102 critically ill patients with sepsis during the first 48 h from sepsis onset and 1 week later, and in 102 age- and gender-matched healthy controls. The outcome of sepsis at 28 days after enrollment was recorded. Results: Serum omentin-1 at enrollment was significantly higher in patients compared to controls (763.3 ± 249.3 vs. 451.7 ± 122.3 μg/L, p < 0.001) and it further increased 1 week after (950.6 ± 215.5 vs. 763.3 ± 249.3 μg/L, p < 0.001). Patients with septic shock (n = 42) had higher omentin-1 compared to those with sepsis (n = 60) at enrollment (877.9 ± 241.2 vs. 683.1 ± 223.7 μg/L, p < 0.001) and 1 week after (1020.4 ± 224.7 vs. 901.7 ± 196.3 μg/L, p = 0.007). Furthermore, nonsurvivors (n = 30) had higher omentin-1 at sepsis onset (952.1 ± 248.2 vs. 684.6 ± 204.7 μg/L, p < 0.001) and 1 week after (1051.8 ± 242 vs. 908.4 ± 189.8 μg/L, p < 0.01). Patients with sepsis and survivors presented higher kinetics than those with septic shock and nonsurvivors (Δ(omentin-1)% 39.8 ± 35.9% vs. 20.2 ± 23.3%, p = 0.01, and 39.4 ± 34.3% vs. 13.3 ± 18.1%, p < 0.001, respectively). Higher omentin-1 at sepsis onset and 1 week after was an independent predictor of 28-day mortality (HR 2.26, 95% C.I. 1.21–4.19, p = 0.01 and HR: 2.15, 95% C.I. 1.43–3.22, p < 0.001, respectively). Finally, omentin-1 was significantly correlated with the severity scores, the white blood cells, coagulation biomarkers, and CRP, but not procalcitonin and other inflammatory biomarkers. Conclusions: Serum omentin-1 is increased in sepsis, while higher levels and lower kinetics during the first week of sepsis are associated with the severity and 28-day mortality of sepsis. Omentin-1 may be a promising biomarker of sepsis. However, more studies are needed to explore its role in sepsis. Full article
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13 pages, 1268 KiB  
Article
The Dynamics of the Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios Predict Progression to Septic Shock and Death in Patients with Prolonged Intensive Care Unit Stay
by Ioana Denisa Botoș, Carmen Pantiș, Constantin Bodolea, Andrada Nemes, Dana Crișan, Lucreția Avram, Marcel Ovidiu Negrău, Ioana Elisabeta Hirișcău, Rareș Crăciun and Cosmin Ioan Puia
Medicina 2023, 59(1), 32; https://doi.org/10.3390/medicina59010032 - 23 Dec 2022
Cited by 5 | Viewed by 1643
Abstract
Background and objectives: The prognoses of patients experiencing a prolonged stay in the intensive care unit (ICU) are often significantly altered by hospital-acquired infections (HAIs), the early detection of which might be cumbersome. The aim of this study was to investigate the roles [...] Read more.
Background and objectives: The prognoses of patients experiencing a prolonged stay in the intensive care unit (ICU) are often significantly altered by hospital-acquired infections (HAIs), the early detection of which might be cumbersome. The aim of this study was to investigate the roles of the neutrophil-to-lymphocyte (NLR), derived-NRL (d-NLR), platelet-to-lymphocyte (PLR), and lymphocyte-to-C-reactive protein (LCR) ratios in predicting the progression to septic shock and death. Materials and Methods: A retrospective analysis of a consecutive series of ninety COVID-19 patients with prolonged hospitalization (exceeding 15 days) admitted to the ICU was conducted. The prevalence of culture-proven HAIs throughout their hospital stays was documented. NLR, dNLR, PLR, and LCR were recorded on admission, day 7, and day 14 to assess their discriminative prowess for detecting further progression to septic shock or death. Results: The prevalence of HAIs was 76.6%, 50% of patients met the criteria for septic shock, and 50% died. The median time to the first positive culture was 13.5 days and 20.5 days for developing septic shock. Mechanical ventilation was a key contributing factor to HAI, septic shock, and mortality. On admission and day 7 NLR, dNLR, PLR, and LCR values had no prognostic relevance for events occurring late during hospitalization. However, day-14 NLR, dNLR, and PLR were independent predictors for progression to septic shock and mortality and have shown good discriminative capabilities. The AUCs for septic shock were 0.762, 0.764, and 0.716, while the values for predicting in-hospital death were 0.782, 0.778, and 0.758, respectively. Conclusions: NLR, dNLR, and PLR are quick, easy-to-use, cheap, effective biomarkers for the detection of a more severe disease course, of the late development of HAIs, and of the risk of death in critically ill patients requiring a prolonged ICU stay. Full article
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9 pages, 1127 KiB  
Article
Decreased Monocyte HLA-DR Expression in Patients with Sepsis and Acute Kidney Injury
by Huang-Pin Wu, Li-Pang Chuang, Pi-Hua Liu, Chien-Ming Chu, Chung-Chieh Yu, Shih-Wei Lin, Kuo-Chin Kao, Li-Fu Li and Duen-Yau Chuang
Medicina 2022, 58(9), 1198; https://doi.org/10.3390/medicina58091198 - 01 Sep 2022
Cited by 7 | Viewed by 1700
Abstract
Background and objectives: Acute kidney injury (AKI) is common in critically ill patients, especially those with sepsis. Persistently low human leukocyte antigen (HLA)-DR expression in monocytes reflects the decreased function of antigen-presenting cells, contributing to poor outcomes in sepsis. This study aimed to [...] Read more.
Background and objectives: Acute kidney injury (AKI) is common in critically ill patients, especially those with sepsis. Persistently low human leukocyte antigen (HLA)-DR expression in monocytes reflects the decreased function of antigen-presenting cells, contributing to poor outcomes in sepsis. This study aimed to establish an association between AKI and HLA-DR expression in monocytes of patients with sepsis. Materials and Methods: We detected HLA-DR expression in monocytes and measured plasma levels of S100A12, high-mobility group box 1 (HMGB1), advanced glycation end products (AGE), and soluble receptor for AGE (sRAGE) from septic patients and healthy controls. Results: HLA-DR expression in monocytes was decreased in patients with AKI than in those without AKI (29.8 ± 5.0% vs. 53.1 ± 5.8%, p = 0.005). Compared with AKI patients, the mean monocyte HLA-DR expression in patients with end-stage renal disease was increased without statistical significance. There were no differences in the AGE/sRAGE ratio and plasma levels of S100A12, HMGB1, AGE, and sRAGE between patients with and without AKI. Conclusions: Compared with septic patients without AKI, patients with AKI had significantly lower HLA-DR expression in monocytes. The role of hemodialysis in monocyte HLA-DR expression needs further studies to explore. Full article
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