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Title: | The host response in patients with sepsis developing intensive care unit–acquired secondary infections |
Authors: | Vught, Lonneke A. van Wiewel, Maryse A. Hoogendijk, Arie J. Frencken, Jos F. Scicluna, Brendon P. Klein Klouwenberg, Peter M.C. Zwinderman, Aeilko H. Lutter, René Horn, Janneke Schultz, Marcus J. Bonten, Marc M.J. Cremer, Olaf L. Poll, Tom van der |
Keywords: | Biochemical markers -- Diagnostic use Host-virus relationships Intensive care units Septicemia -- Diagnosis |
Issue Date: | 2017 |
Publisher: | American Thoracic Society |
Citation: | Van Vught, L. A., Wiewel, M. A., Hoogendijk, A. J., Frencken, J. F., Scicluna, B. P., Klouwenberg, P. M. K., ... & van der Poll, T. (2017). The host response in patients with sepsis developing intensive care unit–acquired secondary infections. American Journal of Respiratory and Critical Care Medicine, 196(4), 458-470. |
Abstract: | Rationale: Sepsis can be complicated by secondary infections. We explored the possibility that patients with sepsis developing a secondary infection while in the intensive care unit (ICU) display sustained inflammatory, vascular, and procoagulant responses. Objectives: To compare systemic proinflammatory host responses in patients with sepsis who acquire a new infection with those who do not. Methods: Consecutive patients with sepsis with a length of ICU stay greater than 48 hours were prospectively analyzed for the development of ICU-acquired infections. Twenty host response biomarkers reflective of key pathways implicated in sepsis pathogenesis were measured during the first 4 days after ICU admission and at the day of an ICU-acquired infection or noninfectious complication. Measurements and main results: Of 1,237 admissions for sepsis (1,089 patients), 178 (14.4%) admissions were complicated by ICU-acquired infections (at Day 10 [6-13], median with interquartile range). Patients who developed a secondary infection showed higher disease severity scores and higher mortality up to 1 year than those who did not. Analyses of biomarkers in patients who later went on to develop secondary infections revealed a more dysregulated host response during the first 4 days after admission, as reflected by enhanced inflammation, stronger endothelial cell activation, a more disturbed vascular integrity, and evidence for enhanced coagulation activation. Host response reactions were similar at the time of ICU-acquired infectious or noninfectious complications. Conclusions: Patients with sepsis who developed an ICU-acquired infection showed a more dysregulated proinflammatory and vascular host response during the first 4 days of ICU admission than those who did not develop a secondary infection. |
URI: | https://www.um.edu.mt/library/oar/handle/123456789/97363 |
Appears in Collections: | Scholarly Works - FacHScABS |
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