Risk factors and a prediction model for sepsis: A multicenter retrospective study in China.

Background: Sepsis is typically associated with poor outcomes. There are various risk factors and predictive models for sepsis based on clinical indicators. However, these models are usually predictive of all critical patients. This study explored the risk factors for 28-day outcomes of patients with sepsis and developed a prognosis prediction model. Methods: This was a multicenter retrospective analysis of sepsis patients hospitalized in three intensive care units (ICUs) from September 1st 2015, to June 30th 2020. Demographic, clinical history, and laboratory test data were extracted from patient records. Investigators explored the risk factors affecting 28-day sepsis prognosis by univariate analysis. The effects of confounding factors were excluded by multivariate logistic regression analysis, and new joint predictive factors were calculated. A model predicting 28-day sepsis prognosis was constructed through data processing analysis. Results: A total of 545 patients with sepsis were included. The 28-day mortality rate was 32.3%. Risk factors including age, D-dimer, albumin, creatinine, and prothrombin time (PT) were predictive of death from sepsis. The goodness-of-fit value for this prediction model was 0.534, and the area under the receiver operating characteristic curve was 0.7207. Further analysis of the immune subgroups (n=140) revealed a significant decrease in CD3+, CD4+CD8-, and CD4+CD29+ memory effector T lymphocytes and an increase in CD56+ natural killer (NK) cells in the hypoalbuminemia group compared with the normal albumin group (65.5 vs. 58.3, P=0.005; 41.2 vs. 32.4, P=0.005; 21.8 vs. 17.1, P=0.029; 12.6 vs. 17.6, P=0.004). Conclusions: Risk factors for 28-day sepsis mortality include age, D-dimer, creatinine, PT, and albumin. A decrease in albumin level may exacerbate immunosuppression in patients with sepsis. This study establishes a prediction model based on these indicators, which shows a good degree of calibration and differentiation. This model may provide good predictive value for clinical sepsis prognosis.

Isolation and Characterization of Shiga Toxin-Producing Escherichia coli from Retail Beef Samples from Eight Provinces in China.

While Shiga toxin-producing Escherichia coli (STEC) is a major foodborne pathogen worldwide, data on the molecular and phylogenetic properties of STEC isolates from retail beef samples in China remain scant. Fresh retail beef samples (n = 1062) were collected from eight provinces, and STEC isolates were recovered and characterized. PCR data showed that more than 50% of the samples were stx positive, and 82 STEC isolates were recovered from 14.8% (79/535) stx-positive enriched broths. In contrast, all ciprofloxacin resistant isolates (n = 19) and 13 cefotaxime (CTX) resistant isolates were eae positive and belonged to three serotypes: O111:H8, O26:H11, or O157:H7. Point mutations in quinolone resistance-determining regions and plasmid-mediated quinolone resistance determinants were identified in 16 and 20 isolates, respectively. BlaCTX-M and a point mutation (C-42T) in ampC promoter were detected in 15 and 8 of the CTX resistant isolates, respectively. In addition, macrolide resistance gene mphA was identified in eight azithromycin resistant O111:H8 isolates and one O26:H11 isolate. Single nucleotide polymorphism analysis demonstrated that the O26 and O157 isolates had multiple origins, but the O111 isolates were closely related. Taken together, our data demonstrated that several sequence types associated with hemolytic uremic syndrome from the retail beef samples in China had developed into dangerous multidrug resistant pathogens. The resistant phenotype can facilitate their transmission among the farm animals and human beings when there is an antimicrobial selective pressure.

[Significance and future of anticoagulant therapy for sepsis].

Sepsis is caused by the imbalance of the host body's response to infection, which causes life-threatening organ dysfunction. Disorders of blood coagulation play a very important role in the development of sepsis. In sepsis, the body's coagulation system is activated, leading to hypercoagulability, while the anticoagulation mechanism is significantly inhibited, causing a large number of microthrombi to form, and disseminated intravascular coagulation (DIC) may occur. Although there are obvious controversies about the anticoagulation treatment of sepsis at home and abroad, we cannot deny the significance of anticoagulation treatment in sepsis. Only appropriate anticoagulation can effectively reduce the mortality in septic DIC, septic shock and high-risk population, and ultimately effectively reduce the occurrence of multiple organ dysfunction syndrome. The sepsis-induced coagulation dysfunction (SIC) score is currently used internationally to guide anticoagulation. SIC score is optimized based on the International Society on Thrombosis and Haemostasis (ISTH) overt DIC score and Sepsis-3, including platelet, international normalized ratio (INR) and sequential organ failure assessment (SOFA). The SIC score can sensitively monitor sepsis-induced coagulation dysfunction. When the SIC score is ≥ 4, it is the best timing to initiate anticoagulation therapy. At present, the internationally recommended anticoagulant drugs include antithrombin (AT), thrombomodulin (TM), tissue factor pathway inhibitor (TFPI), heparin, etc., while the domestically recommended anticoagulant drugs are only unfractionated heparin and low molecular weight heparin. Before using anticoagulant drugs, it is necessary to evaluate the possibility of bleeding and thrombosis in the patients. At the same time, it is necessary to pay attention to the patient's primary disease. Try to adopt the treatment strategy of transitioning from unfractionated heparin to low molecular weight heparin without obvious anticoagulation contraindications.