Daily Sepsis Research Analysis
Analyzed 24 papers and selected 3 impactful papers.
Summary
Analyzed 24 papers and selected 3 impactful articles.
Selected Articles
1. Protective Impact of GLP-1 Therapy on Post-ERCP Outcomes: A TriNetX Retrospective Cohort Analysis.
In a propensity-matched cohort of 21,818 ERCP patients, preprocedure GLP-1 receptor agonist use was associated with substantially lower 30-day adverse events, including sepsis (RR 0.51) and post-ERCP pancreatitis (RR 0.47). Findings were consistent in time-to-event analyses, suggesting a potential anti-inflammatory, cytoprotective peri-procedural effect.
Impact: This large real-world analysis identifies a plausible, drug-related strategy to reduce post-ERCP sepsis and other complications, opening an avenue for prophylactic trials.
Clinical Implications: While not practice-changing yet, these data support considering GLP-1 RA exposure in risk discussions and justify prospective randomized trials to evaluate GLP-1 RAs as adjunctive prophylaxis for ERCP-related complications.
Key Findings
- Preprocedure GLP-1 RA exposure reduced 30-day sepsis after ERCP (RR 0.51, 95% CI 0.46-0.57).
- Marked reduction in post-ERCP pancreatitis (RR 0.47, 95% CI 0.43-0.51).
- Lower risks of cholangitis, GI bleeding, biliary stricture, repeat ERCP, and choledocholithiasis (RR range 0.49–0.66).
- Effects were consistent in time-to-event analyses over 30 days.
Methodological Strengths
- Very large, multicenter real-world dataset with 1:1 propensity score matching on clinical, procedural, and pharmacologic covariates
- Multiple clinically relevant outcomes with both risk ratio and time-to-event analyses
Limitations
- Retrospective design with potential residual confounding and confounding by indication
- Outcome and exposure ascertainment relied on administrative codes; adherence and dosing details unavailable; 30-day follow-up only
Future Directions: Conduct randomized or pragmatic trials to test GLP-1 RAs as adjunctive prophylaxis for ERCP, elucidate mechanisms (e.g., anti-inflammatory signaling), and assess safety and optimal timing/dosing.
INTRODUCTION: Endoscopic retrograde cholangiopancreatography (ERCP) is essential for pancreaticobiliary disease management; however, there are risks associated with the procedure, particularly post-ERCP pancreatitis (PEP). Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), widely used in metabolic disease, possess anti-inflammatory and cytoprotective properties that may influence periprocedural outcomes. Their impact on ERCP adverse events remains unclear; therefore, we aimed to investigate whether GLP-1 influences short-term postprocedural outcomes using a large real-world database. METHODS: We conducted a retrospective cohort study using the TriNetX US Collaborative Network, identifying adults (18 y or older) who underwent ERCP between January 2015 and December 2024. Patients were categorized based on documented preprocedure GLP-1 receptor agonist exposure. Propensity score matching (1:1) was performed using demographic, clinical, procedural, and pharmacologic covariates to minimize confounding, yielding 2 well-balanced cohorts. Thirty-day post-ERCP outcomes-including acute pancreatitis, cholangitis, sepsis, gastrointestinal bleeding, biliary stricture, choledocholithiasis, and repeat ERCP-were assessed using ICD-10 and CPT codes. Risk ratios (RRs) and hazard ratios (HRs) with 95% CIs were calculated. RESULTS: Of 250,502 patients with ERCP screened, 21,818 propensity-matched individuals were included in the final analysis. Compared with matched nonusers, patients receiving GLP-1 receptor agonists had significantly lower 30-day rates of all major ERCP-related adverse events. GLP-1 RA exposure was associated with reduced risks of acute pancreatitis (RR: 0.47, 95% CI: 0.43-0.51), cholangitis (RR: 0.56, 95% CI: 0.50-0.62), sepsis (RR: 0.51, 95% CI: 0.46-0.57), gastrointestinal bleeding (RR: 0.49, 95% CI: 0.40-0.61), biliary stricture (RR: 0.52, 95% CI: 0.48-0.55), repeat ERCP (RR: 0.53, 95% CI: 0.48-0.58), and choledocholithiasis (RR: 0.66, 95% CI: 0.62-0.71). Results were consistent across time-to-event analyses over the 30-day follow-up period. CONCLUSIONS: In this large real-world analysis, preprocedure GLP-1 RA therapy was associated with markedly reduced 30-day ERCP-related adverse events, most notably PEP. These findings highlight a potential protective role of GLP-1 signaling in the periprocedural inflammatory response and support prospective studies evaluating GLP-1 RAs as adjunctive prophylactic agents in ERCP. Further prospective studies are needed.
2. Prognostic Value of Scoring Systems in Elderly Sepsis-Associated AKI Patients: A Multicenter Retrospective Cohort Study.
Across 2,455 elderly sepsis-AKI cases from MIMIC-IV and eICU, SAPS II had the best discrimination for 28-day mortality (AUC 0.803), outperforming LODS and SAPS III. Decision curve analysis supported its clinical net benefit for short-term prognostication.
Impact: Provides comparative evidence for selecting a prognostic tool in a high-risk sepsis subgroup, informing triage and risk communication.
Clinical Implications: SAPS II may be preferred for short-term mortality risk stratification in elderly sepsis-AKI. Implementation could standardize prognostic assessment and guide resource allocation; prospective validation is warranted.
Key Findings
- In elderly sepsis-AKI, SAPS II achieved the highest 28-day mortality discrimination (AUC 0.803, 95% CI 0.782–0.824).
- LODS (AUC 0.772) and SAPS III (AUC 0.759) performed slightly worse for 28-day mortality.
- Decision curve analysis indicated clinical net benefit for SAPS II in short-term prognostication.
- Study leveraged two large critical care databases (MIMIC-IV and eICU) for multicenter generalizability.
Methodological Strengths
- Large multicenter cohort from two independent ICU databases (MIMIC-IV, eICU)
- Use of ROC and decision curve analyses to quantify discrimination and clinical utility
Limitations
- Retrospective EHR-based design subject to coding/missing data biases
- Unclear calibration and external validation beyond included databases; limited details for 90-day performance in abstract
Future Directions: Prospective, external validation of SAPS II thresholds for elderly sepsis-AKI; assessment of calibration, dynamic updating, and integration into decision-support systems.
BackgroundSepsis-associated acute kidney injury (AKI) in elderly patients carries high mortality risks, yet the comparative performance of severity scores in predicting outcomes remains unclear. This study evaluated the prognostic accuracy of SAPS II, LODS, SAPS III, MELD and Charlson Comorbidity Index for 28- and 90-day mortality in this vulnerable population.MethodsA retrospective multicenter cohort study analyzed 2455 elderly (≥65 years) sepsis-AKI patients from MIMIC-IV and eICU databases. Participants were stratified into survival (n = 1693) and non-survival (n = 762) groups. Receiver operating characteristic (ROC) curves and decision curve analysis(DCA) assessed discriminative power of each predictor for mortality endpoints.ResultsFor 28-day mortality, SAPS II demonstrated superior predictive performance (AUC 0.803, 95% CI 0.782-0.824), followed by LODS (AUC 0.772) and SAPS III (AUC 0.759), all
3. Impact of time-to-antibiotics on hospital mortality in patients with hematological malignancies and febrile neutropenia: a single center propensity score matching analysis.
Among 1,089 adults with hematologic malignancies and febrile neutropenia, median TTA was 132 minutes and in-hospital mortality 9.1%. Hourly TTA was not independently associated with mortality, but administration within 4 hours correlated with lower mortality (8.0% vs 11.9%).
Impact: Refines time-to-antibiotics quality metrics for a high-risk population, challenging linear ‘every-hour-counts’ assumptions while supporting a pragmatic ≤4-hour benchmark.
Clinical Implications: Protocols emphasizing delivery within 4 hours for febrile neutropenia appear justified; beyond that, strict hourly penalties may be less informative. Local pathways should target rapid initiation while avoiding unsafe shortcuts.
Key Findings
- Median time-to-antibiotics was 132 minutes; in-hospital mortality was 9.1% in 1,089 patients.
- Hourly increases in TTA were not independently associated with mortality on multivariable analysis.
- Antibiotic administration within 4 hours was associated with lower hospital mortality (8.0% vs 11.9%).
Methodological Strengths
- Large single-center cohort across 15 years with propensity score matching
- Multivariable logistic regression to adjust for confounders
Limitations
- Retrospective single-center design may limit generalizability and is subject to residual confounding
- Abstract truncation limits visibility into effect sizes after matching and secondary outcomes
Future Directions: Prospective multicenter studies to validate a ≤4-hour benchmark, evaluate patient-centered outcomes, and explore factors enabling safe rapid antibiotic delivery.
We performed a retrospective study in patients with febrile neutropenia between 2005 and 2020 to assess the impact of time-to-antibiotics (TTA) on mortality. We included 1089 patients (58% males) aged 58 [46-67] years with hematological malignancies (62% acute leukemias, 20% lymphomas). TTA was 132 [68-271] minutes and hospital mortality was 9.1%. Hourly TTA was not associated with mortality in multivariate logistic regression. Hospital mortality was lower in patients with TTA ≤4 h (8.0% versus 11.9%,