Daily Sepsis Research Analysis

BACKGROUND: Septic shock is a life-threatening syndrome often triggered by respiratory infections, frequently accompanied by coagulation dysfunction, leading to high mortality rates. Heparin, as an anticoagulant, exhibits multiple effects, but its specific prognostic value in such patients remains unclear. OBJECTIVE: To investigate association between early prophylactic heparin therapy and mortality in patients with septic shock secondary to respiratory infections. METHODS: Patient data were extracted from MIMIC-IV database. Inverse probability of treatment weighting (IPTW) was used to adjust for confounding variables. Kaplan-Meier (K-M) curves were utilized to assess survival rates. Cox proportional hazards model was employed to evaluate relationship between early prophylactic heparin therapy and 28-day mortality. Subgroup analyses were performed, along with time-effect (timing of the initial dose) and dose-effect (cumulative dose) association analyses. RESULTS: 882 eligible patients were included, of whom 191 received early prophylactic heparin therapy. K-M survival curves demonstrated that 28-day mortality was significantly lower in heparin-treated group compared to non-heparin group (P = 0.006). After IPTW adjustment, prophylactic heparin use was associated with a reduced risk of 28-day mortality (HR: 0.626, 95% CI: 0.425-0.922, P = 0.018). The sensitivity analysis (propensity score matching) demonstrated a consistent negative correlation trend (HR: 0.754, 95% CI: 0.472-1.203, P = 0.236). Subgroup analyses revealed that both before and after IPTW adjustment, heparin use was significantly associated with reduced 28-day mortality in patients aged ≥ 60 years and those receiving antibiotics (all HR < 1, all P < 0.05). The time-effect analysis demonstrated that patients who received the first dose within 0-6 h showed significant survival benefits compared to the non-heparin group (HR: 0.308, 95% CI: 0.137-0.694, P = 0.005). The dose-effect relationship revealed that patients with a cumulative dose of ≥ 5 doses exhibited significant survival benefits (HR: 0.264, 95% CI: 0.095-0.737, P = 0.011), with a dose-dependent trend observed (P for trend = 0.007). CONCLUSION: Early prophylactic heparin therapy significantly reduced mortality in patients with septic shock secondary to respiratory infections, showing enhanced efficacy when administered within the first 6 hospital hours or reaching cumulative doses of ≥ 5 doses. This finding provides critical evidence for optimizing treatment strategies for septic shock. CLINICAL TRIAL NUMBER: Not applicable.

BACKGROUND: Sepsis mortality remains elevated among elderly populations, yet existing risk stratification tools demonstrate suboptimal predictive accuracy. We explored whether incorporating metabolic parameters into the Sequential Organ Failure Assessment (SOFA) score could enhance prognostic discrimination in this vulnerable cohort. METHODS: This retrospective cohort study analyzed 4,056 elderly sepsis patients (age ≥ 65 years) admitted to intensive care units between 2008 and 2019, identified through ICD coding from the MIMIC-IV database. Random forest-based feature selection and SHAP value analysis identified lactate and bicarbonate as influential mortality predictors. We constructed three nested logistic regression models: Model 1 (SOFA alone), Model 2 (SOFA plus lactate), and Model 3 (SOFA plus lactate and bicarbonate). Multiple imputation addressed missing data. Model performance was evaluated using area under the receiver operating characteristic curve (AUC), net reclassification improvement (NRI), integrated discrimination improvement (IDI), calibration curves, and decision curve analysis. Restricted cubic spline regression characterized nonlinear mortality associations. RESULTS: Twenty-eight-day mortality occurred in 1,259 patients (31%). Model 3 achieved superior discrimination (AUC 0.785, 95% CI 0.770-0.801) compared to SOFA alone (AUC 0.738, 95% CI 0.722-0.754; difference 0.048, P < 0.001). Compared with Model 1, Model 3 demonstrated substantial reclassification improvement (NRI 0.816, 95% CI 0.733-0.893; IDI 0.077, 95% CI 0.072-0.082; both P < 0.001), with balanced gains in event (NRI + 0.401) and non-event (NRI - 0.415) classification. Sensitivity increased from 0.32 to 0.45 while maintaining comparable specificity (0.91 vs. 0.90). Restricted cubic spline analysis revealed nonlinear threshold effects, with mortality risk accelerating sharply beyond SOFA scores of approximately 8 points. Decision curve analysis confirmed clinical utility across relevant threshold probabilities. CONCLUSIONS: Integrating lactate and bicarbonate measurements with SOFA scoring demonstrated improved mortality discrimination in elderly sepsis patients. These hypothesis-generating findings from a single-center derivation cohort require prospective multicenter validation before clinical implementation can be considered. CLINICAL TRIAL NUMBER: Not applicable.

Sepsis disproportionately impacts children in low-resource settings, where diagnostic tools like the Phoenix Sepsis Score (PSS) are constrained by reliance on laboratory testing. The objective of this research was to evaluate the use of continuous physiological data from low-cost wearable biosensors and machine learning models to predict pediatric sepsis, septic shock, and mortality in a low-resource, intensive care setting. This prospective observational single-site study analyzed 96 pediatric intensive care unit patients with suspected sepsis in Dhaka, Bangladesh. Physiological data were collected using a wearable biosensor patch, whereas clinical exams, laboratory tests, and PSS criteria identified sepsis, septic shock, and mortality. Least absolute shrinkage and selection operator (LASSO) regression models were developed and validated through leave-one-group-out cross-validation (LOGO-CV) using biosensor data. Our clinical diagnostic model for sepsis using biosensor-only features demonstrated an area under the receiver operating characteristic curve (AUROC) of 0.78 (null AUROC = 0.58). For septic shock, the model demonstrated an AUROC of 0.85 (null AUROC = 0.61). The mortality model demonstrated an AUROC of 0.87 (null AUROC = 0.64). Sensitivity analyses showed improvement of AUROC to 0.89 for prediction of sepsis with manual recorded oxygen saturation (SpO2) included. Although models were trained and tested retrospectively with internal validation, findings demonstrate the potential of wearable biosensors to support pediatric sepsis diagnosis without reliance on advanced diagnostics. These results encourage further external validation with larger, multisite cohorts and real-time mobile health (mHealth) integration to support clinical use in low-resource settings.