Daily Sepsis Research Analysis

BACKGROUND: The Centers for Medicare & Medicaid Services (CMS) Severe Sepsis and Septic Shock Management Bundle (SEP-1) is now included in the Hospital Value-Based Purchasing (VBP) Program. PURPOSE: To assess the evidence supporting SEP-1 compliance or SEP-1 implementation in improving sepsis mortality. DATA SOURCES: PubMed, Web of Science, EMBASE, CINAHL Complete, and Cochrane Library from inception to 26 November 2024. STUDY SELECTION: Studies of adults with sepsis that included 3- or 6-hour sepsis bundles defined by SEP-1 specifications. DATA EXTRACTION: Article screening, full-text review, data extraction, and risk-of-bias assessment were independently performed by 2 authors. Level of evidence was determined using GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria and National Quality Forum criteria. DATA SYNTHESIS: A total of 4403 unique references were screened, and 17 studies were included. Twelve studies assessed the relationship between SEP-1 compliance and mortality; 5 showed statistically significant benefit, whereas 7 did not. Among studies showing benefit, 1 did not adjust for confounders, 1 found benefit only among patients with severe sepsis, 1 included only patients with septic shock, and 1 included only Medicare beneficiaries. Five studies assessed the relationship between SEP-1 implementation and sepsis mortality; only 1 showed significant benefit, but it did not adjust for mortality trends before SEP-1 implementation. All 17 studies were observational, and none had low risk of bias. LIMITATIONS: The conclusions are limited by the underlying quality of the available studies, as all were observational. Because there was considerable methodologic heterogeneity among the included studies, a meta-analysis was not performed as the results could have been misleading. CONCLUSION: This review found no moderate- or high-level evidence to support that compliance with or implementation of SEP-1 was associated with sepsis mortality. CMS should reconsider the addition of SEP-1 to the Hospital VBP Program. PRIMARY FUNDING SOURCE: None. (PROSPERO: CRD42023482787).

OBJECTIVES: Sepsis-associated hypotension or shock is a critical stage of sepsis, and a current clinical emergency that has high mortality and multiple complications. A new restrictive fluid resuscitation therapy has been applied, and its influence on patients' renal function remains unclear. The purpose of this study is to evaluate the influence of restrictive fluid resuscitation on incidence of severe acute kidney injury (AKI) in adult patients with sepsis hypotension and shock compared with usual care. DESIGN: Systematic review and meta-analysis using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. DATA SOURCES: PubMed, Embase, Web of Science and Cochrane Library were searched through 1 November 2024. ELIGIBILITY CRITERIA: We included randomised controlled trials that compared restrictive fluid resuscitation with liberal fluid therapy on patients with sepsis-associated hypotension and shock, to find out their effect on the incidence of severe AKI. Severe AKI was defined as the AKI network score 2-3 or Kidney Disease Improving Global Outcomes stages 2 and 3. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers used standardised methods to search, screen and code included trials. Risk of bias was assessed using the Cochrane Systematic Review Handbook for randomised clinical trials. Meta-analysis was conducted using random effects models. Sensitivity and subgroup analyses, trial sequential analysis (TSA), Egger's test and the trim-and-fill method were performed. Findings were summarised in GRADE evidence profiles and synthesised qualitatively. RESULTS: Nine trials (3718 participants) were included in this research and the analysis was conducted in random effects model. There was a significant difference in the incidence of severe AKI (risk ratio 0.87, 95% CI 0.79 to 0.96, p=0.006; I CONCLUSIONS: It is conclusive that fluid restriction strategy is superior to usual care when it comes to reducing the incidence of severe AKI in sepsis-associated hypotension and shock. Shorter duration of ventilation is concerned with fluid restriction as well, but the heterogeneity is substantial. GRADE assessments confirmed moderate and above certainty. Traditional fluid resuscitation therapy has the potential to be further explored for improvements to be more precise and appropriate for a better prognosis. PROSPERO REGISTRATION NUMBER: CRD42023449239.

Rapid and accurate differential diagnosis of infections, sepsis, and septic shock is essential for preventing unnecessary antibiotic overuse and improving the chance of patient survival. To address this, a 3D gold nanogranule decorated gold-silver alloy nanopillar (AuNG@Au-AgNP) based surface-enhanced Raman scattering (SERS) biosensor is developed, capable of quantitatively profiling immune-related soluble proteins (interleukin three receptor, alpha chain: CD123, programmed cell death ligand 1: PD-L1, human leukocyte antigen-DR isotype: HLA-DR, and chitotriosidase: ChiT) in serum samples. The 3D bimetallic nanoarchitecture, fabricated using anodized aluminum oxide (AAO), features a uniform structure with densely packed nanogaps on the heads of Au-Ag alloy nanopillars, enabling fast, simple, and replicable production. The proposed biosensor achieves accurate results even with low detection limits (4-6 fM) and high signal consistency (relative standard deviation (RSD) = 1.79%) within a one-step multi-analytes identification chip with a directly loadable chamber. To enhance the diagnostic performance, a support vector machine (SVM) based machine learning algorithm is utilized, achieving 95.0% accuracy and 95.8% precision in classifying healthy controls, infections with and without sepsis, and septic shock. This advanced 3D plasmonic bimetallic alloy nanoarchitecture-based SERS biosensor demonstrates clinical usefulness for sepsis diagnosis and severity assessment, providing timely and personalized treatment.