About: Phenotypic heterogeneity by site of infection in surgical sepsis: a prospective longitudinal study

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About: Phenotypic heterogeneity by site of infection in surgical sepsis: a prospective longitudinal study Goto Sponge NotDistinct Permalink

An Entity of Type : schema:ScholarlyArticle, within Data Space : wasabi.inria.fr associated with source document(s)

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type	Academic Article research paper schema:ScholarlyArticle
isDefinedBy	Covid-on-the-Web dataset
has title	Phenotypic heterogeneity by site of infection in surgical sepsis: a prospective longitudinal study
Creator	Efron, Philip Moldawer, Lyle Moore, Frederick Cox, Michael Brakenridge, Scott Brumback, Babette Ghita, Gabriela Hawkins, Russell Mohr, Alicia Stortz, Julie
Source	PMC
abstract	BACKGROUND: The role of site of infection in sepsis has been poorly characterized. Additionally, sepsis epidemiology has evolved. Early mortality has decreased, but many survivors now progress into chronic critical illness (CCI). This study sought to determine if there were significant differences in the host response and current epidemiology of surgical sepsis categorized by site of infection. STUDY DESIGN: This is a longitudinal study of surgical sepsis patients characterized by baseline predisposition, insult characteristics, serial biomarkers, hospital outcomes, and long-term outcomes. Patients were categorized into five anatomic sites of infection. RESULTS: The 316 study patients were predominantly Caucasian; half were male, with a mean age of 62 years, high comorbidity burden, and low 30-day mortality (10%). The primary sites were abdominal (44%), pulmonary (19%), skin/soft tissue (S/ST, 17%), genitourinary (GU, 12%), and vascular (7%). Most abdominal infections were present on admission and required source control. Comparatively, they had more prolonged proinflammation, immunosuppression, and persistent organ dysfunction. Their long-term outcome was poor with 37% CCI (defined as > 14 in ICU with organ dysfunction), 49% poor discharge dispositions, and 30% 1-year mortality. Most pulmonary infections were hospital-acquired pneumonia. They had similar protracted proinflammation and organ dysfunction, but immunosuppression normalized. Long-term outcomes are similarly poor (54% CCI, 47% poor disposition, 32% 1-year mortality). S/ST and GU infections occurred in younger patients with fewer comorbidities, less perturbed immune responses, and faster resolution of organ dysfunction. Comparatively, S/ST had better long-term outcomes (23% CCI, 39% poor disposition, 13% 1-year mortality) and GU had the best (10% CCI, 20% poor disposition, 10% 1-year mortality). Vascular sepsis patients were older males, with more comorbidities. Proinflammation was blunted with baseline immunosuppression and organ dysfunction that persisted. They had the worst long-term outcomes (38% CCI, 67% poor disposition, 57% 1-year mortality). CONCLUSION: There are notable differences in baseline predisposition, host responses, and clinical outcomes by site of infection in surgical sepsis. While previous studies have focused on differences in hospital mortality, this study provides unique insights into the host response and long-term outcomes associated with different sites of infection.
has issue date	2020-05-07(xsd:dateTime)
bibo:doi	10.1186/s13054-020-02917-3
bibo:pmid	32381107
has license	cc-by
sha1sum (hex)	7f5b16f1038e2fefd12ad8dd0a5b4df27b2c6f49
schema:url	https://doi.org/10.1186/s13054-020-02917-3
resource representing a document's title	Phenotypic heterogeneity by site of infection in surgical sepsis: a prospective longitudinal study
has PubMed Central identifier	PMC7206740
has PubMed identifier	32381107
schema:publication	Crit Care
resource representing a document's body	covid:7f5b16f1038e2fefd12ad8dd0a5b4df27b2c6f49#body_text
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