Daily Sepsis Research Analysis
A multicenter prospective registry identified clinical factors beyond norepinephrine thresholds that predict vasopressin responsiveness in septic shock. A systematic review and meta-analysis suggests antiplatelet therapy may reduce short-term mortality in sepsis without increasing complications, though certainty is low. Additionally, a large ICU database analysis found the fibrinogen-to-albumin ratio at ICU admission strongly associates with mortality across timepoints in septic acute kidney inj
Summary
A multicenter prospective registry identified clinical factors beyond norepinephrine thresholds that predict vasopressin responsiveness in septic shock. A systematic review and meta-analysis suggests antiplatelet therapy may reduce short-term mortality in sepsis without increasing complications, though certainty is low. Additionally, a large ICU database analysis found the fibrinogen-to-albumin ratio at ICU admission strongly associates with mortality across timepoints in septic acute kidney injury.
Research Themes
- Hemodynamic optimization in septic shock
- Adjunctive antithrombotic strategies in sepsis
- Prognostic biomarkers in septic acute kidney injury
Selected Articles
1. Hemodynamic effects of adjunct arginine vasopressin to norepinephrine in septic shock: insights from a prospective multicenter registry study.
In a prospective multicenter registry of 200 septic shock patients, 79% were hemodynamic responders to adjunct vasopressin within 2 hours. Obesity and higher lactate were associated with lower odds of response, whereas norepinephrine ≥0.30 µg/kg/min increased response likelihood. Rebound hypotension occurred in 9% upon AVP cessation, with durations >24 h reducing its risk.
Impact: These data refine patient selection for vasopressin beyond norepinephrine thresholds, highlighting metabolic and dosing factors that predict response and recovery risks.
Clinical Implications: Consider arterial lactate, pH, BMI, and norepinephrine dose/duration when adding vasopressin in septic shock. Monitor for rebound hypotension at discontinuation and consider longer AVP durations (>24 h) to mitigate it.
Key Findings
- 79% (153/200) met the predefined AVP hemodynamic response (NE stabilized or decreased within 2 h).
- Obesity (aOR 0.30, 95% CI 0.14–0.65) and hyperlactatemia (aOR 0.86, 95% CI 0.75–0.99 per unit) were negatively associated with response.
- NE infusion rate ≥0.30 µg/kg/min increased odds of response (aOR 2.33, 95% CI 1.06–5.14).
- New-onset atrial fibrillation occurred less in responders vs non-responders (4% vs 14%, p=0.013).
- Rebound hypotension occurred in 9% at AVP termination; AVP duration >24 h reduced this risk (OR 0.22, 95% CI 0.05–0.85).
Methodological Strengths
- Prospective multicenter observational design across 11 ICUs
- Predefined primary endpoint and multivariable regression analysis
Limitations
- Observational design with potential residual confounding; no randomization
- Primary endpoint assessed at 2 hours may not capture longer-term hemodynamic stability
Future Directions: Develop predictive models integrating lactate, pH, BMI, and vasopressor kinetics; test individualized AVP strategies in randomized trials.
2. Impact of antiplatelet therapy on outcomes of sepsis: A systematic review and meta-analysis.
Across 21 studies, antiplatelet therapy was associated with reduced in-hospital and 1–3 month mortality without an increase in complications. Lengths of ICU and hospital stay were not significantly affected, and evidence certainty was low to very low.
Impact: Synthesizes the best available evidence suggesting a mortality benefit of antiplatelet agents in sepsis, highlighting a potential adjunctive therapy.
Clinical Implications: Continuation or initiation of antiplatelet therapy in select septic patients may be reasonable given no observed increase in complications, but clinical decisions should be individualized until randomized trials confirm benefit.
Key Findings
- In-hospital mortality reduced with antiplatelet therapy (RR 0.76; 95% CI 0.67–0.87).
- Mortality at 1 and 3 months reduced (both RR 0.77; 95% CI 0.66–0.90).
- No increase in complications (RR 1.01; 95% CI 0.84–1.21).
- ICU length of stay (WMD −0.23 days; 95% CI −0.53 to 0.07; I2=97.2%) and hospital stay (WMD 0.63 days; 95% CI −0.66 to 1.92; I2=93.2%) were not significantly different.
- Certainty of evidence rated low to very low by GRADE.
Methodological Strengths
- Comprehensive database search (PubMed, Embase, Scopus) with predefined outcomes
- Use of GRADE framework and pooled effect estimates (RR/WMD) with 95% CI
Limitations
- Predominantly observational studies with potential residual confounding
- High heterogeneity for length-of-stay outcomes and low certainty of evidence
Future Directions: Randomized controlled trials to test antiplatelet agents as adjunctive therapy in sepsis and to identify patient subgroups most likely to benefit.
3. Fibrinogen-to-albumin ratio is associated with the prognosis of patients with septic acute kidney injury.
In 6,208 SAKI patients from MIMIC-IV, higher ICU-admission fibrinogen-to-albumin ratio was consistently associated with increased all-cause mortality from 30 days to 1 year. Kaplan–Meier, Cox models, and restricted cubic splines supported a robust positive association.
Impact: Identifies a simple, readily available biomarker that stratifies short- and long-term mortality risk in septic AKI.
Clinical Implications: FAR at ICU admission can aid risk stratification and triage in SAKI, potentially informing monitoring intensity and adjunctive therapies.
Key Findings
- N=6,208 SAKI patients; mean age 65 years; 58.94% male.
- Higher FAR quartiles were associated with increased 30-, 60-, 90-, 180-, and 365-day all-cause mortality by Kaplan–Meier analyses.
- Cox proportional hazards and restricted cubic spline models confirmed a positive association between FAR and mortality risk.
Methodological Strengths
- Large critical care cohort from MIMIC-IV with multiple timepoint outcomes
- Use of Cox regression and restricted cubic splines to model risk
Limitations
- Retrospective single-database design with potential residual confounding
- Lack of external validation and unclear optimal FAR thresholds for clinical decision-making
Future Directions: Prospective validation across centers and integration of FAR with other prognostic indices to create calibrated SAKI risk scores.