Online ISSN: 2515-8260

Keywords : sepsis


To compare clinical profile and outcome of pediatric patients with sepsis admitted in pediatric and neonatal intensive care unit in a tertiary care hospital of central India

Jyotsna Mishra, Shashikant Patidar, Chayan Chakma, Naresh Bajaj

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 517-524

Background: Sepsis and septic shock cases in the Neonatal intensive care unit (NICU)
and Pediatric intensive care unit (PICU) remain one of the most significant causes of
morbidity and mortality in pediatric patients. Therefore, studying and comparing the
clinical features and outcomes of pediatric patients with sepsis in ICUs are important,
especially in developing countries.
Methods: From 1st July 2021 to 31st December 2021, we have collected data from both of
our pediatric ICU and neonatal ICU of Shyam Shah Medical College using a preformed
proforma. Complete blood count, C - reactive protein and culture sensitivity reports
were used to diagnose or screen sepsis. We compared clinical features, laboratory data,
microbiologic results, and final outcome for patients with sepsis in both NICU and
PICU.
Results: A total 1509 and 236 cases with sepsis from both NICU and PICU respectively
are included in the study (mean duration of stay in NICU 8.9 days±4.3; in PICU 12.5
days±5.3). Among these cases, culture positive cases with sepsis were 66% and 28% in
NICU and PICU respectively. Common pathogens isolated from blood cultures were E.
coli and pseudomonas in NICU and E.coli and S. aureus in PICU. Mortality, discharges,
refers and Left against medical advice cases were compared as outcomes in our study.
Comparing with NICU (n=24, 10.1%), mortality due to sepsis in PICU (n=111, 7.3%)
was less.
Conclusion: Sepsis in children both in NICU and PICU is associated with high mortality
despite aggressive treatment strategies, but more in NICU. Early recognition and
prompt treatment is the key to improve outcome of sepsis.

50 SHADES OF GREY: DOES SERUM PROCALCITONIN PREDICT ALL CAUSE MORTALITY IN PATIENTS WITH SEPSIS AND SEPTIC SHOCK?

Dr. Anurag Singh Chauhan, Dr. Manisha Thakur, Dr. Kavita Yadav, Dr.Kishori Lal Meena, Dr. Ghanshyam Gahlot

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 11456-11462

Background: The concept, definition and understanding of sepsis may have undergone several changes in the past years, but its omniscient nature in modern day critical care medicine has made accurate diagnosis, early initiation of therapy and relatively accurate prognostication, imperative. In recent times, procalcitonin has been used to initiate, de-escalate and guide antibiotic therapy. However, the data on its ability to predict all cause mortality in patients with sepsis remains nebulous. There is adequate evidence to merit considering both sides of the story.
Methods: We studied 99 consecutive patients meeting the diagnostic criteria for sepsis according to Sepsis 3 consensus criteria. Serum procalcitonin levels were compared head to head with 30-day all-cause mortality. Chi squarepaired and unpaired T and Pearson’s coefficient were used to analyze the data. 
Results: Our study showed that patients with a higher baseline value of serum procalcitonin had higher rate of in-hospital mortality (SD – 1.8 vs SD - 0.68, 2-tailed P<0.001). However, no statistically significant association was noted between baseline PCT and duration of ICU stay.
Conclusions: The predictive value of serum PCT, for mortality has been a matter of debate and controversy with compelling evidence to both sides of the story available in contemporary literature. Our study re-enforces the dictum of early diagnosis and treatment of sepsis in conjunction with the judicious use of serum procalcitonin. On the horizon, the authors see a plethora of newer biomarkers (SUPAR and sTREM-1) which may be used standalone or in combination to improve outcomes.

Inborn error of metabolism disgusing as sepsis

Dr Sangeeta Choudhary, Dr Rahul Singh Bain, Dr Rashi, Dr. Ajit Singh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 5902-5905

Inborn errors of metabolism (IEM) are a genetically inherited disorder that has led to
significant morbidity and mortality in the newborns and infant age group. The true
prevalence of IEM in India is not known. Havingnon-specific clinical presentation and
lack of a routine screening program for newborns in India, it mostly remain
undiagnosed and under-reported. With a wide spectrum of nonspecific
symptoms,misdiagnosis or delayed diagnosis is common, so our objective is toenhance
knowledge and create awareness regarding the red flags of IEM among clinicians so
that even slight suspicion of clinical symptoms should be followed by biochemical
evaluation.
Many IEM presents with clinical features resembling sepsis but detailed investigations
and through history can help us think beyond sepsis. Workup for IEM in our case was
suggestive of Propionic acidemia (PA) and Methyl malonicacidemia (MMA).We provide
a clinical approach for such critically ill newborns diagnosis. If these cases are detected
early and given timely treatment, clinical outcomes can be improved.

Assessment of the role of procalcitonin in the management of severe surgical patients with sepsis

Dr. Ashutosh Singh, Dr. MA Reshamwala, Dr. Kartikeya Sharma

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1394-1397

Background: The assessment of procalcitonin not only provides valuable information about the diagnosis but is also useful in the selection of the corresponding antibiotics for the management of sepsis. The studies related to this procalcitonin role are comparatively sparse.
Objective: The present study was undertaken to observe the role of procalcitonin in the management of severe surgical patients with sepsis.
Materials and methods: A total of 50 patients diagnosed with sepsis and aged more than 18 years including both males and females were part of the study after obtaining the written, voluntary informed consent. Unwilling participants were excluded from the study. Patients with any severe complications were also excluded from the study.
Results: Results were presented in Tables no 1 and 2. Table no 1 presents the gender distribution of the participants. The majority of the participants were males with 56% and females were 44%. Table no 2 presents the levels of procalcitonin levels in the participants. The majority of the participants have excessive levels of procalcitonin levels. That is procalcitonin was more than 10ng/ml in 40 patients which means nearly 80 percent of the patients have excessive levels of procalcitonin. This will testify to the importance of procalcitonin in the diagnosis of sepsis.
Conclusion: Significantly higher levels of procalcitonin levels were observed in the patients with sepsis. The study results testify to the diagnostic value of the procalcitonin. The study recommends further detailed studies in this area to support the procalcitonin in the diagnosis of sepsis.

Assessment of patients with sepsis and septic shock Using Procalcitonin and C-reactive Protein

Abdelhamid Mohammad Abdelhamid, Hassan Mohammad Mageed, Ghada Mohammad Abdel Razik,Sherif M. S. Mowafy .

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 1, Pages 885-894

Background: Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection inside ICU. The aim of the present study was to assess the Relation between levels of procalcitonin and C-reactive protein as markers with severity of sepsis and septic shock.
Patients and methods: This observational study was involved 60 patients who diagnosed with sepsis or septic shock and admitted to Surgical intensive care unit, Zagazig University Hospitals, Egypt. Procalcitonin and C-reactive protein levels were estimated in the 1st, 3rd, and 5th ICU day. APACHE II as well as SOFA Scores were estimated on ICU admission.
Results: Patients were classified according to the need for mechanical ventilation (MV group and non-MV group), CRP showed no significant difference between the two groups on the first day (100.51 and 83.21 mg/dl respectively- p=0.108). The remaining readings showed a significant rise in the patients that needed invasive mechanical ventilation. Serum PCT levels showed a significant rise in the MV group throughout the all study readings (p < 0.001). Likewise, SOFA score recordings were significantly higher in the MV patients (p < 0.001). On assessment of the predictors for vasopressor need, the highest sensitivity was reported for 3rd day CRP (84.1% - cut off = 62.01 mg/dl), and 5th  day PCT (84.1% - cutoff = 0.505 ng/ml). Slight decrease in sensitivity (81.8%) was reported with the application of 1st day PCT and 3rd day SOFA.
Conclusion: PCT and CRP can be used as a  prognostic markers for evaluating the prognosis of patients with sepsis and septic shock.regarding need for vasopressors the highest sensitivity was reported for 3rd day CRP and fifth day PCT, however the length of stay was found to be highly correlated with 3rd day PCT, also 1st day PCT value was better to Predict need for Mechanical ventilation.

Sepsis Markers at PICU and the Utility of Serum Neopterin

Osama GamalAbdElhamid, Samir Mohamed Zamzam, Amr Mogahed Abu Elnga, Nourhan Abdallah Saeed

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 3, Pages 3813-3823

Background:Septicemia is a potential clinical status which is a result of irresistible sickness or a
inflammatory process secondary to infection or injury. Clinical management of septicemia
requires brief research facility finding and plan of successful patient administration techniques that
might incorporate antimicrobial chemotherapy. Despite the fact that the accessible biomarkers of
septicemia, for example, CRP, procalcitonin has ended up being helpful, their disadvantages is
elevation in non-septic conditions like injury, surgery, and different conditions like systemic
inflammatory reaction disorder (SIRS), and insusceptible reaction amid septic conditions.
Considering the way that septicemia because of contamination is microbiologically affirmed just
in 30% of the cases, it is inescapable that there is requirement for different markers of septicemia.
Neopterin is one of biochemical markers of immune activity, which seems to be useful in
monitoring inflammatory diseases. Increased concentration of neopterin in serum is observed in
conditions with involvement of cell mediated immune response. Investigations on critically ill
patients on intensive care units evaluated neopterin levels as tool to discriminate patients with
systemic inflammatory response syndrome with and without infectious etiology. Neopterin levels
were found to have a specificity of 78% for discriminating infectious and noninfectious etiology of
critical illness

Study of Factors associated with pathological and aerobic microbial colonization of Neonatal Gastrointestinal System – A hospital based Case control study

Faheem Moideen; Baliga Kiran; Harris M M; Davdidson Devasia; Ali Kumble

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 3, Pages 3165-3168

The rate and extent of neonatal gastrointestinal tract colonization depends on various perinatal
and neonatal factors. Colonization of gastrointestinal tract (GIT) after birth could be delayed because of
prematurity, caesarean delivery or total parental nutrition. The ill and preterm neonates in NICU acquire
intestinal flora that differ from that of healthy newborn. Objective: Hence we aim to study the factors associated
with pathological colonization of aerobic microbial flora in neonates and find pattern of pathogenic aerobic
microbial colonization of neonates. Methodology: The study was done on 94 neonates in a tertiary teaching
hospital NICU , 51 cases with pathological colonization ,43 control with normal colonization. Data collected
using Performa, Oral and rectal swabs taken Results: 68 neonates who received antibiotics 46 (90.2%) were
cases 22(51.3%) were controls. Staphylococcus aureus was predominant suggesting influence of maternal
colonization. Cases were more in babies born through LSCS and in babies whose mother had received
antibiotics Conclusion: Of all factors influencing establishment of pathological microbiota in neonatal GIT
which are interdependent , neonatal exposure to antibiotics was the most significant . Emergence of MRSA ,
ESBL are of particular concern as these are a constant threat as source of health care associated infection

Prognostic significance ofProcalcitonin, High sensitivity C-reactive proteinandwhite blood cell count incomparison withblood culture in ICU patients with Sepsis and Septic shock inatertiary care Hospital

Dr.Kondle Raghu; Dr. Krishnan Ramalingam

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 3, Pages 2263-2270

Background: Sepsis is a life-threatening condition in ICU with high morbidity and
mortality. Biomarkers which can act as a predictor for diagnosis, prognosis, and patient
outcome in sepsis are needed.
Aim:Aim of the study is to compare the significance of hs-C-reactive Protein (CRP),
Procalcitonin, White blood cell count, and blood culture in patients with bloodstream
infections and compare their prognostic significance with blood cultures in sepsis.
Materials and Methods: This hospital based prospective observational study was conducted
between July 2018 to July 2019 forone year with 216 cases of sepsis. Serial determination
of Procalcitonin and CRP at admission and Day 6 was done. Data was analyzed check to
compare the prognostic significance of the PCT, CRP, and WBC count.
Results:A blood culture positivity rate of 50.9% was reported with male preponderance.
WBC count has significantly reduced after 72hrs of admission (p= 0.007). CRP levels have
significantly reduced on day 6 (p = 0.043) in comparison to at the time of admission (p=
0.032). The serial determination of PCT levels at admission and on day 6 (p= 0.032) was
found to be a better prognostic indicator in patients with sepsis than at the time of
admission. The significant patient outcome in terms of mortality and reduction in length of
hospital stay has been found (p= 0.018, p=0.002). The positive correlation of PCT and CRP
and SOFA score has been reported.
Conclusion: Prognostic significance was found for the biomarkers PCT, CRP, and WBC
count with significant patient outcomes in terms of mortality and hospital stay reduction

VITAMIN C IN TERMS OF COVID-19, CURRENT TRENDS

IlxamdjanKarimdjanov Asamovich,Nozima Sаdiqova Baxadirovna, BotirTadjiev Mirkhashimovich,NurlanDinmukhammadiev Aktamovich, BobirMirkhashimovBotirovich,YaxyayevaKomola Zokirovna,AnvarTursunbayev Karimberdiyevich,FatimaXoltayeva Fayziyevna

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 1, Pages 1341-1351

The role of vitamin C in the prevention and treatment of pneumonia andsepsis has been investigated for past decades. This reviewaimsto translatethese findings into patients with severe coronavirus disease (COVID-19). It has indicatedthat patients with pneumonia and sepsis have low vitamin C status and elevated oxidative stress.Additional oral or intravenous (IV) vitamin C administered patients with pneumonia can mitigate the severity and course ofthe disease. Severely ill patients with sepsis need for intravenous administration of amounts counted in grams ofthe vitamin to achieve adequate plasma levels, an intervention that some studies suggest reduces mortality.The vitamin has physiological functions like pleiotropic, many of which are closely connected to COVID-19.These are its antioxidant, antiinflammatory, antithrombotic and immunomodulatory functions.Previous observational studies found out low vitamin C status in critically ill patients with COVID-19.A number of randomized controlled trials (RCTs) conductedworldwideevaluate intravenous vitamin C as monotherapy in patients with COVID-19. Optimization of the intervention protocolsin future trials, e.g., earlier and continuously administration, is justified to potentially improve itsefficacy. In order to the excellent safety profile, low cost, and potential for rapid enlargement of production,administration of vitamin C to patients, especially with hypovitaminosis C and severe respiratory infections,e.g., COVID-19, appears warranted. In addition, there are few new ways of concurrent using vitamin C and other manipulations or medications.

Compatibility of Endocan Levels with SOFA Scorein Sepsis Patients at Dr.Wahidin Sudirohusodo Hospital Makassar

RizqahAulyna Rachmat; Sudirman Katu; Risna Halim; Syakib Bakri; Haerani Rasyid; Hasyim Kasim; Muhammad Ilyas; Tutik Harjianti; Arifin Seweng

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 8, Pages 969-977

Background:Sepsis is a life-threatening organ dysfunction and the leading cause of death in critically ill patients. The use of biomarkers and scoring systems is an attempt to assist in the diagnosis and assessing the severity of multi-organ dysfunction. C-reactive protein (CRP), procalcitonin (PCT), and the currently reported marker are endocan. Endocan is a biomarker for multiorgan dysfunction in sepsis. Endocan synthesis and release are triggered by proinflammatory cytokineswhich can increase endocan levels in sepsis while the Sequential (Sepsis-related) Organ Failure Assessment (SOFA) is a scoring method for identifying organ dysfunction in sepsis. A SOFA score ≥2 indicates organ dysfunction. Endocan and SOFA scores are both aimed at assessing multiorgan dysfunction and can determine the prognosis in sepsis. This study aims to determine the suitability of endocan levels with SOFA values in septic patients at Dr.WahidinSudirohusodoHospital Makassar.
Purpose: To determine the suitability of SOFA values with endocan levels in septic patients at the Dr.WahidinSudirohusodoHospital and its network hospital.
Methods: This cross-sectional observational study was conducted from December 2019-August 2020. The population of this study was all sepsis patients in the hospital. 
WahidinSudirohusodo. Data were analyzed descriptively. The compatibility of endocan levels with SOFA values in septic patients used the Spearman correlation test.
Results: From a total of 150 subjects, it was found that patients <60 years were 45 subjects (80.04%), men were 34 subjects (60.7%), patients with 2 comorbid were 21 subjects (37.5%), the mean Endocan levels were 361.9 ± 472.4 with tertileendocan 1 (<110.0) as many as 19 subjects (33.9%) and tertile 3 (> 232.0) as many as 19 subjects (33.9%) while SOFA scores Mean 5.6 ± 3.7 with SOFA scores 0-6 as many as 36 subjects (64.3%). The endocan level in sepsis was significantly lower than the control, namely 361.9 (p <0.01). Based on the Spearman correlation test, it was found that there was a significant negative correlation between endocan levels and the SOFA score (p <0.05). In women, there was a significant negative correlation between endocan levels and SOFA scores (p <0.05), at age <60 years, there was a significant negative correlation between endocan levels and SOFA scores (p <0.05). with the number of comorbid 1, there was a significant negative correlation between endocan levels and the SOFA score (p <0.05).
Conclusion: There is a significant negative correlation between endocan levels and SOFA score in septic patients at Dr.WahidinSudirohusodo Makassar.