Articles: sepsis.
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Background: Sepsis-induced liver injury (SILI) is an independent risk factor for organ dysfunction and mortality in critical care units. Methods: In this study, the roles of lipocalin 2 (LCN2) in SILI were investigated because LCN2 expression was increased in liver tissues of the septic mice induced by caecal ligation and puncture (CLP), as well as in hepatocytes treated with lipopolysaccharide (LPS). To evaluate liver injury in mice, the levels of alanine transaminase (ALT), aspartate transaminase (AST), and alkaline phosphatase (ALP) were measured in both serum and liver tissues. ⋯ Results: The results demonstrated that LCN2 depletion significantly exacerbated SILI, oxidative stress, and ferroptosis. Moreover, in in vitro sepsis model, LCN2 overexpression notably ameliorated LPS-induced cell injury, oxidative stress, and ferroptosis by inhibiting PTGS2 expression. Conclusion: In conclusion, our study provides evidence that LCN2 depletion aggravates SILI by regulating PTGS2-mediated ferroptosis.
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Sepsis is a heterogeneous syndrome caused by the immune response to severe infection. This study aimed to investigate the value of cardiac troponin I, lactic acid, procalcitonin, and serum complement C3 levels for predicting death in patients with sepsis. Patients with sepsis who were hospitalized in the Department of Critical Care Medicine at our hospital between June 2017 and October 2022 were included in this retrospective study and divided into a survival group and a death group according to their survival status after 28 days. ⋯ The area under the receiver operating characteristic curve (AUC) was 0.882 (95% CI: 0.794-0.941) in patients with sepsis predicted using a combination of cardiac troponin I, lactic acid, procalcitonin, and serum complement C3 levels, which was better than the predictive value of cardiac troponin I (AUC: 0.734, 95% CI: 0.628-0.824), lactic acid (AUC: 0.686, 95% CI: 0.576-0.781), procalcitonin (AUC: 0.727, 95% CI: 0.620-0.817), or serum complement C3 (AUC: 0.684, 95% CI: 0.575-0.780) alone. Cardiac troponin I, lactic acid, and procalcitonin levels are independent predictors of death, whereas serum complement C3 protects against death in patients with sepsis. The combination of cardiac troponin I, lactic acid, procalcitonin, and serum complement C3 levels has a better predictive value for death than any single measure alone in patients with sepsis.
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Comparative Study
Changes in Hospital Adverse Events and Patient Outcomes Associated With Private Equity Acquisition.
The effects of private equity acquisitions of US hospitals on the clinical quality of inpatient care and patient outcomes remain largely unknown. ⋯ Private equity acquisition was associated with increased hospital-acquired adverse events, including falls and central line-associated bloodstream infections, along with a larger but less statistically precise increase in surgical site infections. Shifts in patient mix toward younger and fewer dually eligible beneficiaries admitted and increased transfers to other hospitals may explain the small decrease in in-hospital mortality at private equity hospitals relative to the control hospitals, which was no longer evident 30 days after discharge. These findings heighten concerns about the implications of private equity on health care delivery.
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J. Korean Med. Sci. · Dec 2023
Multicenter Study Observational StudyModified Cardiovascular Sequential Organ Failure Assessment Score in Sepsis: External Validation in Intensive Care Unit Patients.
There is a need to update the cardiovascular (CV) Sequential Organ Failure Assessment (SOFA) score to reflect the current practice in sepsis. We previously proposed the modified CV SOFA score from data on blood pressure, norepinephrine equivalent dose, and lactate as gathered from emergency departments. In this study, we externally validated the modified CV SOFA score in multicenter intensive care unit (ICU) patients. ⋯ In patients with sepsis in the ICU, the modified SOFA score performed better than the original SOFA score in predicting 28-day mortality.
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Observational Study
A clinical decision rule to rule out bloodstream infection in the emergency department: retrospective multicentric observational cohort study.
We aimed to identify patients at low risk of bloodstream infection (BSI) in the ED. ⋯ The BAROC score safely identified patients at low risk of BSI and may reduce BC collection in the ED without the need for laboratory testing.