Daily Sepsis Research Analysis

UNLABELLED: This research investigated the efficacy of intravenous vitamin C administration in septic, mechanically ventilated (MV) full-term neonates following surgical interventions. This double-blinded randomized controlled trial included 50 full-term neonates who required mechanical ventilation and developed confirmed sepsis after surgery. Neonates were randomly assigned to receive either standard sepsis management with placebo (No Vitamin C group) or standard protocol with vitamin C infusion, administered as a 0.5 g/kg loading dose followed by a maintenance dose of 0.5 g/kg/h over 6 h, continued for 7 to 10 days (Vitamin C group). Respiratory rate and peak inspiratory pressure were significantly lower at 24 h, 72 h, and 120 h in the Vitamin C group than in the No Vitamin C group. FiO₂ requirements were significantly reduced at 72 h and 120 h in the Vitamin C group. SpO CONCLUSION: Vitamin C infusion significantly improved respiratory parameters and reduced the duration of MV and inotropic support requirements in septic neonates following surgery, though it did not significantly affect the NICU or hospital length of stay or mortality. TRIAL REGISTRATION: registered on ClinicalTrials.gov (ID: NCT06780345) (date: 17/1/2025). WHAT IS KNOWN: • In neonatal intensive care units (NICU), neonatal sepsis continues to be a major cause of death and morbidity. • Vitamin C has become a possible therapeutic intervention given its many pathways in sepsis control. WHAT IS NEW: • Vitamin C infusion significantly improved respiratory parameters and reduced the duration of MV and inotropic support requirements in septic neonates following surgery, though it did not significantly affect the NICU or hospital length of stay or mortality.

BACKGROUND: Procalcitonin (PCT)-guided antibiotic duration for critically ill adults with sepsis may be clinically effective and safe. However, cost-effectiveness analyses using clinical trial data for this precision medicine approach in critical care are lacking. This economic evaluation investigates the cost-effectiveness of a daily PCT-guided protocol to guide the duration of antibiotic treatment in adult patients with sepsis. METHODS: Two analyses were conducted, the first estimating the cost per quality-adjusted life year (QALY) of the ADAPT-Sepsis study, which recruited 2760 patients randomized to a daily PCT-guided protocol, a daily C-reactive protein-guided protocol and standard care. The second analysis used meta-analyzed results from ADAPT-Sepsis and other PCT-guided treatment studies and employed a lifetime horizon. Key outcomes were the incremental costs and QALYs gained from using the daily PCT-guided protocol approach compared with standard care. Other outcome measures included changes in days of antibiotics, days of hospital stay, days of intensive care unit stay, the percentage of deaths and the number of PCT tests performed. RESULTS: Cost-effectiveness results were driven by the assumed impact of PCT testing on mortality although the confidence/credible intervals for ADAPT-Sepsis and the meta-analyzed data both included no effect. Within ADAPT-Sepsis, the use of PCT tests cost €427 more per patient and was associated with a small QALY loss (0.001), which suggests the daily PCT-guided protocol is dominated. Using meta-analyzed data, the daily PCT-guided protocol was assumed to cost €330 more per patient but was associated with 0.139 more QALYs, resulting in a cost per QALY gained of €2384. If only antibiotic use and PCT tests were assumed to differ then PCT testing is estimated to cost no more than €110 per patient with QALYs equal in both arms regardless of whether ADAPT-Sepsis or meta-analyzed data were used. CONCLUSIONS: This economic analysis has shown that a PCT-guided protocol to guide the duration of antibiotic treatment could be cost-effective. Where only differences in antibiotic use and PCT testing are assumed, the increased costs per patient are modest which may be seen as worthwhile to safely improve antibiotic stewardship for critically ill adult patients with sepsis.

BACKGROUND: The impact of pathogen type on the relationship between early nutritional support and prognosis in sepsis patients remains unclear. This study aims to evaluate the effect of early nutritional support on in-hospital mortality in patients with sepsis caused by viral or bacterial infections. MATERIALS AND METHODS: A retrospective cohort study was conducted, including adult patients with sepsis admitted to the intensive care unit (ICU) of Zhongda Hospital, Southeast University, between 2016 and 2023. Early nutritional support was defined as initiating nutritional support within 48 h of sepsis diagnosis. Patients were stratified based on pathogen type, and propensity score matching (PSM) and inverse probability weighting (IPW) were used to adjust for confounding factors. Logistic regression analysis was performed to assess the effect of early nutritional support on in-hospital mortality. RESULTS: A total of 2,278 patients with sepsis were included (119 viral and 2,159 bacterial). After adjustment, in the viral sepsis group, early nutritional support was associated with a lower in-hospital mortality compared to delayed support (25.0% vs. 30.0%, aOR 0.79, 95% CI 0.63-0.99, p = 0.046). In contrast, in the bacterial sepsis group, early nutritional support showed no significant benefit for in-hospital mortality (16.3% vs. 18.5%, aOR 1.02, 95% CI 0.98-1.06, p = 0.328). For bacterial sepsis, early support was associated with longer ICU length of stay and duration of mechanical ventilation among survivors. CONCLUSION: Early nutritional support may offer a potential survival benefit in patients with viral sepsis. Given the small size and borderline statistical significance, these findings should be interpreted with caution and require further validation through prospective randomized controlled trials.