Daily Sepsis Research Analysis

BACKGROUND: In 2024, new international consensus criteria for pediatric sepsis and septic shock (2024 criteria) were introduced, replacing the 2005 criteria. The 2024 criteria use the Phoenix Sepsis Score (PSS) to define sepsis (score ≥2) and septic shock (cardiovascular PSS ≥1) in children with suspected infection, moving away from the 2005 reliance on systemic inflammatory response syndrome (SIRS). This study compares the two criteria in terms of diagnostic consistency, disease severity, prognosis, and early identification. METHODS: Pediatric patients with infection admitted to the PICU at the Capital Institute of Pediatrics from May 2023 to May 2025 were prospectively enrolled. Those diagnosed with sepsis within 0-6 h of admission were included. Data on demographics, infection sites, pathogens, laboratory markers (platelets, albumin, creatinine, lactate), organ dysfunction scores (PCIS), and clinical outcomes (mechanical ventilation, CRRT, MODS, DIC, mortality) were collected. Diagnostic agreement was assessed using Kappa statistics, and performance was compared using McNemar's test. The 2005 criteria served as the reference for calculating sensitivity, specificity, and predictive values of the 2024 criteria. RESULTS: The 2024 criteria identified fewer sepsis (80 vs. 240) and septic shock (49 vs. 86) cases. Diagnostic agreement was poor (Kappa = 0.161, CONCLUSIONS: The 2024 sepsis criteria improve specificity but may overlook early septic shock. The 2024 septic shock criteria are stricter, potentially delaying diagnosis and treatment. Prospective studies and AI-supported early warning models are needed for better early identification and outcomes.

IMPORTANCE: Albumin supplementation may reduce mortality in patients with septic shock; however, data from randomized clinical trials are limited. OBJECTIVE: To assess the impact of albumin administration on outcomes in patients with septic shock. DESIGN, SETTING, AND PARTICIPANTS: This multicenter, open-label randomized clinical trial was conducted between October 21, 2019, and May 2, 2022. Patients from 23 intensive care units in Germany enrolled within 24 hours of the onset of septic shock were followed up for outcome data up to 90 days. The statistical trial report was completed and filed with the federal authorities in December 2023; additional analyses were completed in October 2024. The study was terminated prematurely due to low enrollment rates. INTERVENTIONS: Protocol group patients received 20% albumin to maintain serum albumin levels of at least 3.0 g/dL for up to 28 days during their intensive care unit admission. The control group received standard fluid administration with crystalloids. MAIN OUTCOMES AND MEASURES: The primary end point was 90-day mortality; secondary end points included 28-day, 60-day, intensive care unit and in-hospital mortality, organ dysfunction or failure, total amount of fluid administration and total fluid balance while in the intensive care unit, duration of intensive care and hospital stays, and frequency of adverse events. RESULTS: Of 440 randomized patients (median [IQR] age, 69 [59-78] years; 290 [65.9%] male), 222 received albumin and 218 received standard fluids. Baseline characteristics were comparable. Ninety-day mortality was 43.3% (91 of 210) in the albumin group vs 45.9% (96 of 209) in controls (relative risk, 0.94; 95% CI, 0.76-1.17; P = .71). No significant differences were observed for secondary end points. CONCLUSIONS AND RELEVANCE: In this randomized clinical trial of patients with septic shock, albumin administration was safe but did not improve 90-day survival. As this trial was prematurely terminated, results remain inconclusive and additional studies are recommended. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03869385.

We aimed to assess markers and risk factors for imminent acute kidney injury (AKI) in emergency patients, as risk stratification in the emergency department is currently not widely used. Using data from a sub-cohort (440 patients) of the prospective multicentre LifePOC study (1434 patients), proenkephalin A 119-159 (penKid) was assessed for early identification of subclinical kidney damage compared to serum creatinine in emergency patients with a qSOFA score ≥1. Logistic regression was applied to assess the usefulness of penKid, four further biomarkers (midregional pro-adrenomedullin, bioactive adrenomedullin, dipeptidyl-peptidase-3, procalcitonin) and clinical risk factors to predict AKI within 24 h, 48 h and 72 h after admission, need for organ support and 28-day mortality. PenKid and bio-adrenomedullin performed moderately to predict AKI within 48 h (AUC 0.645, 95% CI: 0.582-0.703 and AUC 0.647, 95% CI: 0.583-0.707, respectively). Pre-existing chronic kidney disease (OR 2.36, 95% CI: 1.06-5.27), confirmed sepsis (OR 2.41, 95% CI: 1.28-4.56), mechanical ventilation (OR 3.03, 95% CI: 1.48-6.19), and elevated levels of penKid (OR 2.21, 95% CI: 1.60-3.07) at admission were associated with an increased risk of AKI whereas a restrictive fluid management (OR 0.43, 95% CI: 0.26-0.71) was associated with a lower risk of AKI. Patients at high AKI risk may be identified based on specific risk factors, bio-ADM and penKid. The trial was registered in the German Registry for Clinical Trials (DRKS00011188) on 20 October 2016.