Metabolic resuscitation therapy in critically ill patients with sepsis and septic shock: A pilot prospective randomized controlled trial.

The main purpose of our research was to further clarify the effectiveness and potential pathophysiological principles of metabolic resuscitation therapy in critically ill patients with sepsis and septic shock. We found that metabolic resuscitation therapy is beneficial for patients with sepsis and septic shock, shortening the length of intensive care unit (ICU) stay, reducing the duration of vasopressor use, and reducing the ICU mortality rate of patients with sepsis and septic shock, but it does not reduce the hospital mortality rate.

Application of a flexible visitation system in critically ill patients: A randomized clinical trial.

OBJECTIVE: To determine the feasibility of a flexible visitation system in the intensive care unit (ICU). METHODS: A randomized, open-label, parallel group clinical trial was conducted. All patients admitted to the ICU of the Lanzhou University Second Hospital from April to June 2022 were enrolled. The enrolled patients were randomly divided into an experimental group and a control group according to a computer-generated random sequence table. RESULTS: A total of 410 patients were admitted. According to the inclusion and exclusion criteria, 140 patients were included in the experimental group (flexible visitation group) and 140 in the control group (normal visitation group). The average number of visitation minutes per day between the experimental group and the control group was 24.7 versus 23.9 min (p > 0.05).Among the outcome indicators, delirium occurred in 8 (5.7%) patients in the intervention group and in 24 (17.1%) patients in the control group (p = 0.003). Five complaints (mainly pressure ulcers) were received, with one in the experimental group and the others in the control group. There were 28 cases of nosocomial infection in the experimental group and 29 cases in the control group; therefore, the incidence of nosocomial infection was 20% versus 20.7% (p = 0.882). A total of 280 questionnaires were collected, with a retrieval rate of 100%. The satisfaction of patients in the experimental group and the control group was 98.6% and 92.1%, respectively (p = 0.011). The flexible visiting system reduced the ICU length of stay (LOS). The ICU LOS of the experimental group was 6 versus 8 days for the control group (p = 0.041). However, the flexible visiting system did not reduce the hospital stay (17 vs. 19 days, p = 0.923). CONCLUSION: Conducting a flexible visitation system in ICUs could reduce the incidence of delirium in critically ill patients and improve the quality of nursing care; furthermore, the rate of nosocomial infections was not increased. These findings need to be further verified by a multicentre, large-scale clinical trial.

[Development of acute kidney injury prognostic model for critically ill patients based on MIMIC-III database].

OBJECTIVE: To investigate the risk factors affecting the prognosis of patients with acute kidney injury (AKI) in the intensive care unit (ICU) based on the Medical Information Mart for Intensive Care III (MIMIC-III) database, and to establish a prognostic model for AKI. METHODS: Patients (aged ≥ 18 years) with acute renal failure, admitted to the ICU for the first time, and had complete hospital records (the RIFLE diagnostic criteria were used in the database, and the diagnosis was expressed as AKI in this article) were screened from MIMIC-III database according to diagnostic codes. Patients were divided into two groups based on survival state at discharge, and the general information, underlying diseases, injury factors, vital signs and laboratory indicators within 24 hours after AKI, related intervention and prognostic indicators were analyzed. Univariate and multivariate Logistic regression analysis were used to determine the risk factors affecting mortality in patients with AKI and established a prediction model. The receiver operator characteristic curve (ROC curve) was used to analyze the predictive value of the prediction model for the prognosis of AKI patients. RESULTS: There were 4 554 patients with AKI included and 862 died, with mortality of 18.93%. Univariate Logistic regression analysis was performed for factors that might be associated with death in AKI patients, and the results showed that age, hypertension, lymphoma, metastatic carcinoma, vancomycin, aspirin, coagulation abnormalities, cardiac arrest, sepsis or septic shock, invasive mechanical ventilation, white blood cell count (WBC), platelet count (PLT), K+, blood urea nitrogen (BUN), total bilirubin (TBil), renal replacement therapy (RRT) and length of stay (LOS) were independent risk factors [odds ratio (OR) and 95% confidence interval (95%CI) were 1.002 (1.001-1.003), 0.764 (0.618-0.819), 1.749 (1.112-2.752), 2.606 (1.968-3.451), 1.779 (1.529-2.071), 0.689 (0.563-0.842), 1.871 (1.590-2.201), 2.468 (1.209-5.036), 2.610 (2.226-3.060), 2.154 (1.853-2.505), 1.105 (1.009-1.021), 0.998 (0.997-0.998), 1.132 (1.057-1.212), 1.008 (1.006-1.011), 1.061 (1.049-1.073), 2.142 (1.793-2.997), 0.805 (0.778-1.113), all P < 0.05]. Further binary Logistic regression analysis showed that lymphoma, metastatic cancer, vancomycin, cardiac arrest, sepsis or septic shock, coagulation dysfunction, invasive mechanical ventilation, increased BUN, increased TBil, increased or decreased blood K+ and increased WBC were independent risk factors for death [ß values were 0.636, 1.005, 0.207, 0.894, 0.787, 0.346, 0.686, 0.006, 0.051, 0.085, and 0.009; OR and 95%CI were 1.889 (1.177-3.031), 2.733 (2.027-3.683), 1.229 (1.040-1.453), 2.445 (1.165-5.133), 2.197 (1.850-2.610), 1.413 (1.183-1.689), 1.987 (1.688-2.338), 1.006 (1.003-1.009), 1.052 (1.039-1.065), 1.089 (1.008-1.176), and 1.009 (1.004-1.015), respectively, all P < 0.05]. The Hosmer-Lemeshow test showed that the AKI prognostic model was able to fit the observed data well (P = 0.604). ROC curve analysis showed that the area under ROC curve (AUC) of the AKI prognostic model was 0.716 (95%CI was 0.697-0.735), when the cut-off value was 0.320, the sensitivity was 71.9%, the specificity was 60.1%, the positive likelihood ratio was 1.80, and the negative likelihood ratio was 0.47. CONCLUSIONS: The prognostic prediction model of AKI in critically ill patients established and based on the MIMIC-III database may have practical significance for prognostic risk assessment of AKI and later intervention.

Effect of vitamin C in critically ill patients with sepsis and septic shock: A meta-analysis.

The objective of this study was to investigate the efficacy of vitamin C in patients experiencing sepsis and septic shock. The PubMed, Embase and Cochrane Library databases were searched for randomized controlled trials (RCTs) about vitamin C treatments for critically ill patients suffering from sepsis and septic shock from inception until December 31, 2019. The primary outcome was mortality, and the secondary outcomes were the ICU length of stay and the dose of vasopressors. A meta-analysis of nine RCTs with a total of 584 patients (301 in the intervention group and 283 in the control group) was conducted. There were significant differences between the vitamin C group and the control group in 28-day mortality (fixed effects OR = 0.60 95% CI [0.42, 0.85], p = 0.004) and in the dose of vasopressors (SMD = -0.88 95% CI [-1.48, -0.29], p = 0.003); however, the ICU length of stay was the same between the two groups (SMD = -0.33 95% CI [-0.87, 0.20] p = 0.23). This meta-analysis demonstrated that the use of vitamin C (compared with placebo) led to a reduction in ICU mortality and a reduction in the dose of vasopressors in patients with septic shock. However, the ICU length of stay was not significantly different between the two groups. Therefore, multicentre and high-quality RCTs are needed to further clarify the safety and effectiveness of vitamin C among patients with sepsis and septic shock.

[Application of a risk stratification-based model for prediction of acute kidney injury combined with hemoperfusion in patients with sepsis: a prospective, observational, pilot study].

OBJECTIVE: To evaluate the efficacy and safety of a risk stratification-based model for prediction of acute kidney injury (AKI) combined with hemoperfusion (HP) in the treatment of patients with sepsis. METHODS: A prospective, observational, pilot trial was conducted. The patients who met the Sepsis-3 diagnostic criteria admitted to intensive care unit of Lanzhou University Second Hospital from May to December in 2019 were enrolled as the research objects. Through the AKI early warning model established by the research group in the early stage, AKI risk > 30% was defined as AKI high risk. Patients with AKI high risk were enrolled in the observation group, and the remaining patients were enrolled in the control group. All patients were given conventional treatment, including the search and treatment of original infection sites, the use of antibiotics and main organ function support. Patients in the observation group were combined with HP treatment on the basis of conventional treatment, 2.5 hours per day for 3 days. The baseline data of gender, age, infection site, acute physiology and chronic health evaluation II (APACHE II) score, sequential organ failure assessment (SOFA) score, mean arterial pressure (MAP) and serum creatinine (SCr) were recorded. The inflammatory indexes such as interleukin-6 (IL-6), lipopolysaccharide (LPS) and procalcitonin (PCT) were detected at ICU admission, 24 hours and 72 hours after ICU admission, and the length of ICU stay, ICU mortality and bleeding were recorded. RESULTS: Among the 49 patients with sepsis enrolled in this study, the main diagnosis was pneumonia, and Gram-negative (G-) bacilli were the main pathogenic bacteria [61.2% (30/49)]. Among them, 30 patients with AKI risk > 30% were in the observation group, and the remaining 19 patients were in the control group. There was no significant difference in gender, age, infection site, APACHE II score, SOFA score, MAP or other baseline data between the two groups, but the baseline value of SCr in the observation group was significantly higher than that in the control group (µmol/L: 112.2±34.4 vs. 93.4±13.0, P < 0.05). At ICU admission, there was no significant difference in IL-6, LPS or PCT between the two groups. However, with the extension of ICU time, the inflammatory indexes of the two groups showed a downward trend. At 24 hours after ICU admission, there was no significant difference in IL-6, LPS or PCT between the two groups. At 72 hours after ICU admission, IL-6 in the experimental group decreased significantly as compared with the control group (ng/L: 90.9±38.1 vs. 119.1±41.9, P < 0.05), but there was no significant difference in LPS or PCT between the two groups. The length of ICU stay in the experimental group was significantly shorter than that in the control group (days: 9.77±2.76 vs. 12.47±3.85, P < 0.01), but there was no significant difference in the ICU mortality between the experimental group and control group (20.0% vs. 21.1%, P > 0.05). None of the 49 patients had severe bleeding events. CONCLUSIONS: The application of a risk stratification-based model for prediction of AKI combined with HP in septic patients is feasible both in theory and in clinical practice, and shortens the length of ICU stay, but fails to effectively remove inflammatory mediators or reduce sepsis mortality. A large sample, multicenter, randomized controlled study is still needed for further verification.

Circular RNA circ_0001105 protects the intestinal barrier of septic rats by inhibiting inflammation and oxidative damage and YAP1 expression.

The integrity of the intestinal barrier is critical for protecting the host against the intestinal lumen and pathogens. The roles of circRNAs in the intestinal barrier dysfunction in sepsis remained unclear. The present study aims to investigate the role of circ_0001105 in the intestinal mucosal permeability, oxidative damage and morphological changes during sepsis. We found that upregulation of circ_0001105 decreased the levels of serum D-lactic acid, diamine oxidase and fluorescence isothiocyanate dextran in septic rats. Upregulation of circ_0001105 also decreased the malondialdehyde content but enhanced superoxide dismutase activity in the intestinal tissues. Upregulation of circ_0001105 reduced the production of tumor necrosis factor α, interleukin (IL)-6, and IL-1ß and the expression of YAP1. Furthermore, upregulation of circ_0001105 improved the survival of rats with sepsis. In summary, our findings showed that circ_0001105 protects the intestinal barrier function of septic rats by inhibiting intestinal inflammation, oxidative damage and YAP1 expression. Our results provide a novel insight for developing sepsis treatment.