Zeinab Naderpour; Mehdi Momeni; Elnaz Vahidi; Javad Safavi; Morteza Saeedi
Volume 7, Issue 4 , October 2019, , Pages 361-365
Abstract
Objective: To determine the possible relationship of procalcitonin (PCT) and D-dimer with the 28-day-mortality rate and severity of sepsis based on sequential organ failure assessment (SOFA) score. Methods: In this cross-sectional study, patients were enrolled based on their signs and symptoms of ...
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Objective: To determine the possible relationship of procalcitonin (PCT) and D-dimer with the 28-day-mortality rate and severity of sepsis based on sequential organ failure assessment (SOFA) score. Methods: In this cross-sectional study, patients were enrolled based on their signs and symptoms of sepsis confirmed by essential laboratory studies. Demographic data, Glasgow coma scale and vital signs, serum PCT and D-dimer levels, creatinine, bilirubin level, arterial blood gas analysis and platelet count were recorded. Disease severity index was assessed based on SOFA score. Patients’ 28-day-mortality rate and hospital length of stay were compared with the study variables. Results: Sixty-four patients with the mean age of 78.3±11.6 were included of whom 34 cases (53.1%) were male. The 28-day-mortality rate was 17%. The analysis showed that only patients’ age (p=0.01) and platelet count (p=0.02) had a statistically significant association with the mortality rate. SOFA score had no statistically significant correlation with PCT or D-dimer; and these two markers didn’t have any significant correlation in terms of predicting mortality due to the sepsis. Conclusion: In our study, PCT and D-dimer failed to show any significant correlation with 28-day-mortality rate of sepsis.
Joaquin Valle Alonso; John Turpie; Islam Farhad; Gabrielle Ruffino
Volume 7, Issue 1 , January 2019, , Pages 67-71
Abstract
Sepsis and septic shock remain a major cause of morbidity and mortality globally. In septic patient’s bedside physical examination can often be unhelpful in helping to identify the source of infection and, therefore, decide upon appropriate management. Protocols for point-of-care-ultrasound ...
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Sepsis and septic shock remain a major cause of morbidity and mortality globally. In septic patient’s bedside physical examination can often be unhelpful in helping to identify the source of infection and, therefore, decide upon appropriate management. Protocols for point-of-care-ultrasound (POCUS) in critically-ill patients who present with shock or trauma have been described elsewhere including rapid ultrasound in shock (RUSH), focused assessment with sonography for trauma (FAST), and focused cardiac ultrasound (FOCUS). Although the use of POCUS in sepsis has been reported in existing literature, there is not an algorithm for when POCUS is indicated in septic patients. We describe the case of a 70-year-old woman who presented to the emergency department (ED) with a 1-week history of diarrhoea and vomiting. The initial diagnosis in ED was viral gastroenteritis with prerenal acute kidney injury and she was initially referred to the medial team. However, the patient remained hypotensive and oliguric after 2 litters of IV fluids. A point-of-case-ultrasound (POCUS) showed a right kidney with moderate hydronephrosis. Urology team was immediately contacted with a CT that confirmed an obstructive stone causing moderate kidney hydronephrosis. Emergency nephrostomy was performed and the patient was discharged and has remained asymptomatic.
Hassan Mashbari; Mohannad Hemdi; Kevin L. Chow; James C. Doherty; Gary J. Merlotti; Steven L. Salzman; Eduardo Smith Singares
Volume 6, Issue 2 , April 2018, , Pages 100-107
Abstract
Objective: To determine the optimal volume of abdominal irrigation that will prevent surgical site infections (both deep and superficial), eviscerations and fistula formations; and improve 30-day mortality in trauma patients.Methods: We conducted a three-arm parallel clinical superiority randomized controlled ...
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Objective: To determine the optimal volume of abdominal irrigation that will prevent surgical site infections (both deep and superficial), eviscerations and fistula formations; and improve 30-day mortality in trauma patients.Methods: We conducted a three-arm parallel clinical superiority randomized controlled trial comparing different volumes of effluent (5, 10 and 20 liters) used in trauma patients (both blunt and penetrating) age 14 and above undergoing an emergency laparotomy between April 2002 and July 2004 in a busy urban Level 1 trauma center.Results: After randomization, a total of 204 patients were analyzed. All patient groups were comparable with respect to age, gender distribution, admission injury severity score, and mechanism of injury, estimated blood loss and degree of contamination. The mortality rate overall was 1.96% (4/204).No differences were noted with respect to contamination, wound infection, fistula formation, and evisceration. The twenty liter group (Group III) showed a trend toward an increased incidence of deep surgical site infections when compared to the five liter (Group I) (p=0.051) and ten liter (Group II) (p=0.057) groups. This did not however reach statistical significance.Conclusion: The old surgical adage “the solution to pollution is dilution” is not applicable to trauma patients. Our results suggest that using more irrigation, even when large amounts of contamination have occurred, does not reduce post-operative complications or affect mortality; and it may predispose patients to increased incidence of abscess formation.(Trial registration number: ISRCTN66454589).
Khalid Shukri
Volume 1, Issue 2 , April 2013, , Pages 52-55
