Daily Sepsis Research Analysis

OBJECTIVE: To assess real-world RBC transfusion practices during early resuscitation in sepsis and evaluate their association with 60-day mortality. DESIGN: Secondary analysis of a prospective, multicenter observational cohort (the Korean Sepsis Alliance cohort) from September 2019 to December 2022. SETTING: Thirteen ICUs across South Korea. PATIENTS: Adults (19 yr old or older) admitted to the ICU with sepsis were categorized into transfused and non-transfused groups based on whether they received RBC transfusions during ICU days 1-3. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among 2613 patients (mean age 71.9 ± 13.3 yr old), 45.3% received RBC transfusions during the early resuscitation phase. The mean lowest hemoglobin level on the day of transfusion was 8.8 ± 1.7 g/dL. RBC transfusion was associated with clinical factors beyond hemoglobin levels, including higher Simplified Acute Physiology Score 3 and Sepsis-Induced Coagulopathy scores, septic shock, surgical source control, elevated lactate and bilirubin levels, low platelet counts, the use of two or more vasopressors, and continuous renal replacement therapy. In the propensity score-matched cohort, there was no overall difference in 60-day mortality between groups. However, a significant qualitative interaction was observed when stratifying by an ICU day 1 hemoglobin threshold of 10 g/dL ( p for interaction = 0.0124). RBC transfusion was linked to higher mortality at hemoglobin greater than or equal to 10 g/dL, but showed a trend toward decreased mortality below this threshold. CONCLUSIONS: RBC transfusions are common in critically ill patients with sepsis, highlighting a gap between clinical practice and guideline recommendations. Although not associated with overall mortality, a qualitative interaction was observed at a hemoglobin threshold of 10 g/dL. Transfusion decisions may be guided by physiologic markers up to 9-10 g/dL, but should be avoided when hemoglobin levels exceed 10 g/dL due to the potential for harm.

BackgroundArterial catheterization serves as a cornerstone monitoring modality in septic shock management, enabling continuous hemodynamic assessment and serial blood gas analysis. Despite its widespread use, mortality benefits and optimal timing for catheter insertion remains undefined.MethodsAn analysis of clinical data from 6,485 critically ill adult patients, identified as meeting the Sepsis-3 criteria for septic shock, was conducted utilizing the MIMIC-IV database. Through entropy-balanced propensity score matching (PSM, 1:1 ratio) and doubly robust estimation with inverse probability weighting, we compared outcomes between catheterized (≤24 h post-admission) and non-catheterized groups. Restricted cubic spline (RCS) modeling characterized nonlinear temporal associations. The evaluation encompassed both primary and secondary endpoints, including 28-day mortality, mortality within the ICU and hospital settings, length of stay, CRRT requirements, and physiological resuscitation metrics.ResultsAfter PSM (1,416 patients from initial 6,485) with 1:1 ratio, arterial catheterization exhibited significantly reduced mortality across all measured outcomes compared to non-catheterized controls: 28-day mortality (26.1% vs 43.9%; aHR 0.62, 95%CI 0.51-0.75), ICU mortality (aHR 0.76, 0.61-0.94), and in-hospital mortality (HR 0.70, 0.58-0.86), all P < .05. Arterial catheterization was associated with a shorten ICU stay by 0.52 days (95%CI 0.18-0.82, P = .002) and improved physiological parameters. Restricted cubic splines identified optimal intervention timing at 204-290 min post-admission through U-shaped mortality risk association.ConclusionIn a cohort of critically ill patients with septic shock, early peripheral arterial catheterization is significantly associated with improved 28-day mortality outcomes.

Sepsis is a life-threatening disease and among the most common cause of death, which influence a series of following medical conditions. A comprehensive analysis of the cross-talks with temporary order of disease trajectory or trajectory led to cause of death following sepsis remains unclear. By using data from population-based UK Biobank, 8647 septic patients matching with 86386 controls without sepsis were included. Individuals were followed-up from 1 month after the index date until the end of 2019 with linkage of inpatient or death records to the registers. Then conditional Cox regression, binomial test together with conditional logistic regression were conducted to visualize the disease trajectories and trajectories leading to cause of death in sepsis survivors. During a median follow-up of 3.99 years, sepsis significantly increased the risk of 113 subsequent medical conditions. By visualizing disease-disease associations with time-dependent sequence, we identified four main affected disease clusters after sepsis, including circulatory, metabolic, respiratory and genitourinary system disease, further linking a series of downstream health outcomes. We also identified trajectories leading to mortality in three major categories of death in sepsis survivors, which were neoplastic, circulatory and respiratory system disease. In addition, disease trajectory after sepsis differed in gender and age groups were also explored in our study. These trajectory networks visualize a series of pathways linking sepsis to a broad range health conditions and provide potential intervention targeting these diseases for inhibiting adverse events in sepsis patients.