Daily Sepsis Research Analysis

BACKGROUND: There are still debates regarding the impact of omega-3 fatty acids on immune response and clinical outcomes in critically ill patients. OBJECTIVE: Explore the effects of omega-3 fatty acids on hyper-inflammatory response and clinical outcomes in critically ill patients. METHODS: We searched five databases from inception to July 18, 2024 and collected randomized controlled trials in which critically ill patients treated in an intensive care unit (ICU) were administered omega-3 fatty acids as a supplement. Data were expressed as mean difference, standard mean difference, or odds ratio with 95% confidence interval (CI). RESULTS: There were 41 randomized controlled trials that met the inclusion criteria, and they involved 3152 patients. The intervention with omega-3 fatty acids significantly reduced the following biomarkers: white blood cell count on day 3 and day 6/7, tumor necrosis factor-α (TNF-α) on day 3 and day 5, interleukin-1 (IL-1), interleukin-6 (IL-6), and procalcitonin at the last observation post-intervention. The intervention also reduced the Sequential Organ Failure Assessment (SOFA) score on day 5 and lowered the risk of secondary infections and new sepsis/septic shock, both determined during follow-up. It also significantly shortened the ICU stay and reduced the 28-day mortality rate, although ICU mortality rate remained unchanged. CONCLUSIONS: Omega-3 fatty acids supplementation may be effective in modulating hyper-inflammatory responses, reducing the risk of complications and disease severity, and improving clinical outcomes. IMPLICATIONS FOR CLINICAL PRACTICE: Omega-3 fatty acids may serve as a potential nutritional therapy for critically ill patients, when medical staff identify the hyperinflammatory status of patients based on medical history, clinical manifestations, and laboratory results.

OBJECTIVES: To evaluate the applicability of the Global Leadership Initiative on Malnutrition (GLIM) criteria in older patients with sepsis and to compare the predictive validity for 28-day mortality of different muscle mass assessment methods in the emergency department. DESIGN: Prospective cohort study. SETTING: Emergency department. PATIENTS: Older patients (≥65 years) with sepsis. MEASUREMENTS: Muscle mass was assessed using three methods: (1) the skeletal muscle index at the third lumbar vertebra (L3) on computed tomography (CT) scans; (2) calf circumference (CC), and (3) mid-upper-arm circumference (MAC). Cox regression analysis was performed to assess the association between the GLIM criteria and 28-day all-cause mortality. Additionally, the C-statistic, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were used to evaluate the predictive validity of the three instruments. Survival curves were assessed using the Kaplan-Meier method and compared using the log-rank test. RESULTS: A total of 598 patients with sepsis were included. The prevalence of malnutrition according to GLIM-CT, GLIM-CC, and GLIM-MAC was 53.3%, 63.0%, and 40.8%, respectively. Cox regression analysis revealed that the GLIM criteria were independent risk factors for all-cause 28-day mortality. Incorporation of GLIM-CT, GLIM-CC, or GLIM-MAC into a base model significantly improved the C-statistic. The model including GLIM-CT had the highest C-statistic, improving the C-statistic of the base model from 0.780 (95% confidence interval [CI]: 0.741-0.819) to 0.823 (95% CI: 0.789-0.857). This improvement in risk prediction was also confirmed via category-free NRI and IDI, suggesting that GLIM-CT had the best performance. Kaplan-Meier survival analysis showed that patients with malnutrition defined according to the GLIM criteria had a greater probability of 28-day mortality (log-rank, P < 0.001). CONCLUSION: Malnutrition, defined via any of the three methods, was predictive of 28-day mortality among older patients with sepsis in the emergency department. GLIM-CT had the best predictive validity.

BACKGROUND: Sepsis is potentially fatal and commonly affects older people. However, little is known of the association between surviving sepsis and older patients' autonomy and dependency following hospital discharge. METHODS: A population-based register study using data from five Swedish national registers included emergency department (ED) visits and in-hospital admission of patients aged 65 years of age and older years with infection or sepsis between 2013 and 2020. The consumption of home care services and residential care, as well as mortality, was examined 1, 6 and 12 months after hospital discharge using mixed models. FINDINGS: 166,188 ED visits with sepsis (23 %) and non-sepsis infections (77 %). Sepsis was associated with an increased risk of becoming dependent on home care (RR=1.09 [1.03-1.15]), residential care (RR=1.05 [1.0-1.1]) and mortality (RR=1.96 [1.89-2.03]) 12 months after in-hospital discharge compared to being diagnosed with infection only. The level of care one month prior to the index ED visit, among the study population, i.e., patients having attended the ED with sepsis and infection, was associated with risk of sepsis OR = 1.31 [1.27-1.35] for patients dependent on home care, and OR = 2.16 [2.09-2.23] for patients dependent on residential care as compared to patients independent on home care. INTERPRETATION: The current study suggests that sepsis is a major debilitating condition in older survivors, and many patients do not recover former dependency levels, one year after discharge as well as an increased mortality risk. Also, prior dependency on home care or residential care was a risk factor for sepsis for those patients who attended the ED with sepsis and infection. FUNDING: Funding was obtained through Örebro University, Sweden and the Research Committee of Region Örebro Län, Sweden.