Sepsis Research Today is a free monthly online journal that collates and summarizes the latest research about Sepsis, including details on septicemia, diagnosis, symptoms, treatment.

Heart rate variability measures as predictors of in-hospital mortality in ED patients with sepsis.

Chen WL, Chen JH, Huang CC, Kuo CD, Huang CI, Lee LS

Department of Emergency Medicine, Cathay General Hospital, Taipei 10630, Taiwan.

OBJECTIVE: To determine the predictive capability of heart rate variability (HRV) measures of patients with sepsis in the ED for in-hospital death. METHODS: This was a prospective, observational study. A consecutive cohort of patients visiting the ED of a university teaching hospital who met the criteria of sepsis over a 6-month period were enrolled in this study. General demographics, vital signs, laboratory data, and Mortality in Emergency Department Sepsis score were obtained in the ED; the in-patient medical record was reviewed; and a series of continuous 10-minute electrocardiographic signals were recorded for off-line HRV analysis to assess the in-hospital mortality of the patients. RESULTS: One hundred thirty-two patients aged 27 to 86 years who met the inclusion criteria were enrolled. According to the in-hospital outcome, the patients were categorized into 2 groups: nonsurvivors (n = 10) and survivors (n = 122). The baseline HRV measures, including SDNN, TP, VLFP, LFP, and LFP/HFP ratio, of nonsurvivors were significantly lower, whereas the nHFP was significantly higher, than those of survivors. Multiple logistic regression model identified SDNN and nHFP as the significant independent variables in the prediction of in-hospital mortality for ED patients with sepsis. The receiver operating characteristic area for SDNN and nHFP in predicting the risk of death was 0.700 and 0.739, respectively. CONCLUSIONS: Heart rate variability measures, especially the SDNN and nHFP, may be used as valuable predictors of in-hospital mortality in patients with sepsis attending the ED.

Published 15 April 2008 in Am J Emerg Med, 26(4): 395-401.
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Articles on Sepsis published 10 April 2008:

Effect of fluconazole prophylaxis on the incidence of invasive candida infections and bacteraemias in patients with acute leukaemia.   Eur J Haematol, 80(5): 391-6.

OBJECTIVES: The efficacy of fluconazole prophylaxis to prevent invasive candida infections in patients with acute leukaemia receiving chemotherapy is not clear. Fluconazole prophylaxis might increase the number of bacteraemias and cause outbreaks of non-albicans yeast infections. A retrospective single-centre study was conducted to investigate the effect of fluconazole prophylaxis on the incidence and the species of invasive candida infections and on the number of bacteraemias. METHODS: All ... [Abstract] [Full-text]

Articles on Sepsis published 8 April 2008:

Neurotensin increases mortality and mast cells reduce neurotensin levels in a mouse model of sepsis.   Nat Med, 14(4): 392-8.

Sepsis is a complex, incompletely understood and often fatal disorder, typically accompanied by hypotension, that is considered to represent a dysregulated host response to infection. Neurotensin (NT) is a 13-amino-acid peptide that, among its multiple effects, induces hypotension. We find that intraperitoneal and plasma concentrations of NT are increased in mice after severe cecal ligation and puncture (CLP), a model of sepsis, and that mice treated with a pharmacological antagonist of NT, or ... [Abstract] [Full-text]

Serum procalcitonin elevation in critically ill patients at the onset of bacteremia caused by either Gram negative or Gram positive bacteria.   BMC Infect Dis, 8: 38.

BACKGROUND: In the ICU, bacteremia is a life-threatening infection whose prognosis is highly dependent on early recognition and treatment with appropriate antibiotics. Procalcitonin levels have been shown to distinguish between bacteremia and noninfectious inflammatory states accurately and quickly in critically ill patients. However, we still do not know to what extent the magnitude of PCT elevation at the onset of bacteremia varies according to the Gram stain result. METHODS: Review of the ... [Abstract] [Full-text]

Articles on Sepsis published 4 April 2008:

Timing of specimen collection for blood cultures from febrile patients with bacteremia.   J Clin Microbiol, 46(4): 1381-5.

Bloodstream infections are an important cause of morbidity and mortality. Physician orders for blood cultures often specify that blood specimens be collected at or around the time of a temperature elevation, presumably as a means of enhancing the likelihood of detecting significant bacteremia. In a multicenter study, which utilized retrospective patient chart reviews as a means of collecting data, we evaluated the timing of blood culture collection in relation to temperature elevations in 1,436 ... [Abstract] [Full-text]

Fatal levofloxacin failure in treatment of a bacteremic patient infected with Streptococcus pneumoniae with a preexisting parC mutation.   J Clin Microbiol, 46(4): 1558-60.

The fatal outcome of levofloxacin treatment in a patient with bacteremic pneumonia caused by Streptococcus pneumoniae with a preexisting parC mutation is reported. Failure was due to the emergence of a gyrA mutation after 4 days of therapy. Problems encountered in detecting first-step mutation isolates are discussed. [Abstract] [Full-text]

Septic pulmonary emboli and bacteremia associated with deep tissue infections caused by community-acquired methicillin-resistant Staphylococcus aureus.   J Clin Microbiol, 46(4): 1553-5.

We report four adult patients who presented with septic pulmonary emboli and community-acquired methicillin-resistant Staphylococcus aureus bacteremia associated with deep tissue infections, such as pyomyositis, osteomyelitis, and prostatic abscess. The patients lacked evidence of right-sided endocarditis or thrombophlebitis. This association, previously described in children, may also be important in adults. [Abstract] [Full-text]

Articles on Sepsis published 2 April 2008:

Pathophysiology of septic acute kidney injury: what do we really know?   Crit Care Med, 36(4): S198-203.

Septic acute kidney injury accounts for close to 50% of all cases of acute kidney injury in the intensive care unit and, in its various forms, affects between 15% and 20% of intensive care unit patients. However, there is little we really know about its pathophysiology. Although hemodynamic factors might play a role in the loss of glomerular filtration rate, they may not act through the induction of renal ischemia. Septic acute renal failure may, at least in patients with a hyperdynamic ... [Abstract] [Full-text]

Changing patterns in neonatal Escherichia coli sepsis and ampicillin resistance in the era of intrapartum antibiotic prophylaxis.   Pediatrics, 121(4): 689-96.

OBJECTIVE: The goal was to determine current trends in Escherichia coli-related early- and late-onset sepsis and patterns of ampicillin resistance in relation to institutional changes in the use of intrapartum antibiotic prophylaxis. METHODS: A retrospective review of data for all infants with E. coli sepsis at Yale-New Haven Hospital from 1979 to 2006 was performed. Study periods were based on predominant intrapartum antibiotic prophylaxis practices at Yale-New Haven Hospital, that is, (1) ... [Abstract] [Full-text]

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