Daily Sepsis Research Analysis

BACKGROUND: The Surviving Sepsis Campaign guidelines suggest adding arginine vasopressin (AVP) when norepinephrine (NE) doses reach 0.25-0.50 µg/kg/min in septic shock patients. However, relying solely on a NE threshold has limitations, as other factors may be valuable in guiding AVP therapy during septic shock. Therefore, we aimed to identify additional patient characteristics associated with AVP hemodynamic responsiveness. METHODS: A multicenter, prospective, observational study was conducted among adult ICU patients who met the predefined criteria for septic shock (not reaching the individual target mean arterial pressure despite adequate fluid resuscitation and NE base dose > 0.25 µg/kg/min) and received AVP therapy. AVP hemodynamic responsiveness was the primary study outcome, defined as stabilization or decrease of NE infusion rate two hours after initiating AVP. Secondary outcomes included shock duration and rebound hypotension following termination of AVP infusion. Univariate and multivariable regression analyses were performed to detect associations between characteristics and outcomes. RESULTS: Between May 2020 and October 2023, 200 septic shock patients originating from 11 different ICUs were included. Of these, 153 (79%) met the definition for AVP hemodynamic responsiveness. Obesity and hyperlactatemia was negatively associated with AVP-response (adjusted Odds Ratio [aOR] 0.30, 95%CI 0.14-0.65 and aOR 0.86, 95%CI 0.75-0.99, respectively), while a NE infusion rate ≥ 0.30 µg/kg/min showed positive odds of AVP response (aOR 2.33, 95%CI 1.06-5.14). Incidence of new-onset atrial fibrillation was lower in AVP responders than non-responders (4% vs. 14%, p = 0.013). Higher body mass index (BMI) , NE infusion rate and duration prior to AVP initiation was associated with longer shock duration (aOR 1.06, 95%CI 1.02-1.11, aOR 1.12, 95%CI 1.01-1.25, and 1.01 95% CI 1.00-1.03, respectively), while higher pH associated with lower likelihood of prolonged shock (aOR 0.80, 95%CI 0.64-0.99). Rebound hypotension occurred in 9% when AVP was terminated, and AVP duration > 24 h was negatively associated with rebound hypotension (OR 0.22, 95%CI 0.05-0.85). CONCLUSIONS: Arterial lactate, pH, BMI, and NE duration and dose were associated with AVP responsiveness and shock duration during septic shock, and rebound hypotension occurred in 9% during recovery. Our findings suggest that beyond NE thresholds, specific factors could be considered to optimize adjunctive AVP therapy in septic shock patients.

OBJECTIVE: Antiplatelet therapy has been studied for its potential benefits in various cardiovascular conditions, but its role in sepsis remains less clear. This review aims to systematically analyse the available evidence on the effects of antiplatelet therapy in sepsis to assess its potential benefits and risks. MATERIAL AND METHODS: The studies published until 01st April 2024 from PubMed, Embase and Scopus databases were searched. Pooled effect sizes were reported as relative risks (RR) or weighted mean difference (WMD) with corresponding 95% confidence intervals (CI). Outcomes included mortality, length of intensive care unit (ICU) stay, hospital stay, and the risk of complications. The certainty of evidence was evaluated using GRADE. RESULTS: Twenty-one studies were included. Antiplatelet therapy was associated with significantly lower risk of in-hospital mortality (RR 0.76, 95% CI: 0.67, 0.87), and mortality at one (RR 0.77, 95% CI: 0.66, 0.90) and three months (RR 0.77, 95% CI: 0.66, 0.90) follow up. Risk of complications was comparable in all patients (RR 1.01, 95% CI: 0.84, 1.21). ICU stay (in days) (WMD -0.23, 95% CI: -0.53, 0.07; N=7, I2=97.2%) and overall duration of hospital stay (in days) (WMD 0.63, 95% CI: -0.66, 1.92; N=6, I2=93.2%) was also statistically similar among patients who received and did not receive antiplatelet drugs. The certainty of evidence for the outcomes ranged from "low to very low". CONCLUSION: Antiplatelet therapy appears safe and significantly lowers the risk of short-term mortality in septic patients. While antiplatelet therapy did not impact the duration of ICU or overall hospital stay, our findings underscore the potential of antiplatelet agents as a beneficial adjunctive therapy in sepsis management.

BACKGROUND: The fibrinogen-to-albumin ratio (FAR), a novel inflammatory biomarker, is strongly associated with the incidence of sepsis. Nonetheless, there is a lack of research regarding the FAR and prognosis in individuals with septic acute kidney injury (SAKI). The aim of this study was to assess the correlation between the FAR upon intensive care unit (ICU) admission and overall mortality in patients with SAKI. METHODS: All patient information was retrieved from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. All patients were divided into four distinct categories according to the FAR. The primary endpoints for this study were the 30-day and 365-day all-cause death rates, whereas the secondary endpoints were the 60-day, 90-day and 180-day all-cause death rates. The FAR was quartile, and the Kaplan-Meier curve was used to evaluate the outcomes across the groups. To evaluate the correlation between the FAR and outcomes, we used a Cox proportional hazards regression model and restricted cubic splines (RCSs). RESULTS: Among the 6208 participants, the average age was 65 years, with 3659 (58.94%) identified as male. Patients exhibiting elevated FAR values demonstrated an increased risk of all-cause mortality at 30, 60, 90, 180 and 365 days, as evidenced by the Kaplan-Meier curves (log-rank CONCLUSION: In severely ill patients with SAKI, elevated FAR levels are strongly correlated with an increased risk of all-cause mortality at 30, 60, 90, 180 and 365 days. FAR may serve as a reliable metric for assessing and managing patients with SAKI in the ICU.