European Journal of Molecular & Clinical Medicine

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.

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.

Background: Sepsis is a disease characterized by rapid disease process advancement
needing immediate therapy adjustments. Assessment of disease severity is vital for
appropriate disease management, preventing and decreasing the incidence of complications,
decreasing mortality rates, and attaining a better prognosis.
Aims: The present study was conducted to assess laboratory and clinical parameters in
subjects with severe septic shock and sepsis. Also, the study assessed Acute Physiology and
Chronic Health Evaluation-II score (APACHE-II) with Echocardiographic evaluation of
cardiac functions. Cardiac biomarkers including creatine phosphokinase myocardial band
(CPK-MB)and Troponin-T were also assessed in the present study.
Materials and Methods: The present prospective clinical study was conducted to assess the
cardiac biomarkers, clinical, and laboratory parameters in subjects with severe septic shock
and sepsis.
Result: It was seen that significant mortality was seen in subjects with positive Troponin-T
and high CPK-MB levels. In subjects with septic shock and sepsis, CPK-MB levels were
raised. Increased levels of CPK-MB and Troponin-T were also indicative of myocardial
injury which could lead to coronary insufficiency in subjects with septic shock and sepsis.
Conclusion: The present study concludes that in critically ill subjects, levels of Troponin are
usually raised. However, more data is needed to prove prognostic and diagnostic significance
with its implications in subjects with septic shock and sepsis.

Aim: Current study designed to identify whether the combination of vitamin C, hydrocortisone, and thiamine, to decrease the mortality and free of vasopressor administration in patients with septic shock.
Method: An open-label, randomized Quasi experimental study conducted in 240 cases of sepsis at intensive care unit for the duration of 3 years. Standard care group consists 120 and Interventional consists 120 (Standard care with Hydrocortisone, Vitamin C, and Thiamine). The primary endpoint hospital survival and secondary outcome the duration of vasopressor therapy and other outcomes were measured.
Result: Among 240 patients who were randomized, the primary outcome measurement recorded as 3cases (1.25%) in Interventional and 31cases (12.91%) in Standard groups. All patients in the interventional group were weaned off vasopressors with a mean of 17.5±10.2 hrs after starting treatment with the vitaminC+thiamine+hydrocortisone infusion. The mean duration of vasopressor use was 35.8±21.5 h in the standard group (p=0.001); 25% patients in the standard group received higher dose of vasopressors and died due to refractory septic shock. The mean duration of vasopressor treatment is 61.4± 33.8 h in the control patients who died compared with 39.5±12.5h in those who survived. The median length of Hospital stay is 13.64 ± 9.04 (4-80) days in the interventional group compared with 10.28 ± 5.93 (2-28) days in the control group. Conclusion: Early use of intravenous vitamin C, together with hydrocortisone and thiamine, may prove to be effective in the reduction of vasopressors dosage and mortality of patients with sepsis and septic shock.

Sepsis is among the major reason of death in hospitalized patients. The hallmarks of sepsis are excessive inflammation, coagulation, and the suppression of fibrinolysis. It requires prompt diagnosis, immediate treatment with antibiotics & hemodynamic support. The early diagnosis of sepsis with immediate treatment can prevent its progression and decrease the mortality rate. The initial antibiotic to be given must be a broad-spectrum dependent over local sensitivity patterns. It should be daily assessed for de-escalation and cessation. The management is influenced more by appropriate treatments along with the antibiotics and fluid than by the specific intensive care.