Special Issue "Multimodal Diagnostic Methods in Sepsis in the Critically Ill Patients"

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Pathology and Molecular Diagnostics".

Deadline for manuscript submissions: closed (30 April 2021).

Special Issue Editors

Dr. Alexandru Florin Rogobete
E-Mail Website
Guest Editor
1. Faculty of Medicine, Anaesthesia and Intensive Care Department, ”Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
2. Emergency County Hospital ”Pius Brinzeu”, Clinic of Anaesthesia and Intensive Care, Timisoara, Romania
3. Romanian Society of Anesthesia and Intensive Care, Medical Education and Clinical Research Department, Bucharest, Romania
Interests: trauma; anesthesia; critical care; severe burns; health system management
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Dorel Sandesc
E-Mail Website
Guest Editor
1. Faculty of Medicine, Anaesthesia and Intensive Care Department, ”Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
2. Emergency County Hospital ”Pius Brinzeu”, Clinic of Anaesthesia and Intensive Care, Timisoara, Romania
3. Romanian Society of Anesthesia and Intensive Care, Medical Education and Clinical Research Department, Bucharest, Romania
Interests: anesthesia; intensive care; sepsis; mechanical ventilation; nutrition
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Diagnostic methods for sepsis have been evolving and improving step-by-step in recent years. Lately, multimodal diagnostic techniques that ultimately increase the safety of medical acts have been in the public eye. Therefore, modern techniques for diagnosis and continuous monitoring of sepsis have recently been introduced in current clinical practice, especially in intensive care units. Another important aspect in the management of critically ill patients with sepsis and septic shock is the economic aspect, as these patients undergo prolonged stays in intensive care units, high consumption of antibiotics, prolonged mechanical ventilation, and, last but not least, require special extra-corporeal techniques.

This Special Issue will gather international papers on the core topic of modern multimodal monitoring and diagnostic techniques in sepsis, with a focus on patient-oriented therapy based on the individual needs of each patient. Thus, we want to accumulate articles that address this clinical phenomenon multidisciplinary and gather information about diagnostic methods in sepsis, continuous monitoring methods, and implications on energy needs, antibiotic therapy, fluid therapy, not being limited to these examples.

Dr. Alexandru Florin Rogobete
Prof. Dr. Dorel Sandesc
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Sepsis - pathophysiological, genetic, and epigenetic aspects
  • Biomarkers in sepsis / diagnostics methods
  • Genetic and epigenetic biomarkers in sepsis
  • Fluid therapy / volemic replacement therapy in sepsis
  • Antibiotherapy / personalized antibiotherapy
  • Energy expenditure / energy needs / nutrition therapy in sepsis
  • Hemodynamic monitoring techniques in sepsis

Published Papers (4 papers)

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Research

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Article
The Combination of SOFA Score and Urinary NGAL May Be an Effective Predictor for Ventilator Dependence among Critically Ill Surgical Patients: A Pilot Study
Diagnostics 2021, 11(7), 1186; https://doi.org/10.3390/diagnostics11071186 - 30 Jun 2021
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Abstract
Background: Ventilator dependence (VD) has been considered as a serious complication in critically ill patients in the intensive care unit (ICU). Acute kidney injury (AKI) is associated with VD as a result of lung–kidney interaction. The aim of our study was to investigate [...] Read more.
Background: Ventilator dependence (VD) has been considered as a serious complication in critically ill patients in the intensive care unit (ICU). Acute kidney injury (AKI) is associated with VD as a result of lung–kidney interaction. The aim of our study was to investigate novel biomarkers in predicting ventilator dependence in critically ill surgical patients. Methods: Patients who were admitted to surgical ICU were enrolled and their serum and urine samples were collected. Novel biomarkers including gelatinase-associated lipocalin (NGAL), calprotectin, kidney injury molecule-1 (KIM-1), cystatin C, and growth differentiation factor 15 (GDF-15) were analyzed and correlated with clinical outcome. Results: A total of 33 patients were enrolled and analyzed. The majority of them received abdominal surgery prior to ICU admission. Thirteen patients were classified into the VD group, while the remaining 20 were in a non-ventilator dependence group (nVD). Statistical analysis demonstrated that the following were significantly higher in the VD group than in the nVD group: serum NGAL (420.25 ± 45.18 ng/mL vs. 314.68 ± 38.12 ng/mL, p-value 0.036), urinary NGAL (420.87 ± 41.08 ng/mL vs. 250.84 ± 39.45 ng/mL, p-value 0.002), SOFA score (11.3 ± 1.5 vs. 5.6 ± 0.7, p-value 0.001), and APACHE II score (23.2 ± 2.6 vs. 13.6 ± 0.8, p-value 0.001). The area under the ROC curve (AUROC) of urinary NGAL for VD was 0.808. The combination of urinary NGAL and SOFA score could further increase AUROC for VD to 0.835. Conclusions: The current study demonstrated the predictive capability of urinary NGAL for ventilator dependence among critically ill surgical patients. When combined with SOFA score, the predictive ability was further augmented. Further large-scale studies are warranted to validate our findings. Full article
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Article
The Association between Dynamic Changes in Serum Presepsin Levels and Mortality in Immunocompromised Patients with Sepsis: A Prospective Cohort Study
Diagnostics 2021, 11(1), 60; https://doi.org/10.3390/diagnostics11010060 - 02 Jan 2021
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Abstract
Presepsin is a subtype of soluble CD14 that is increased in the blood of septic patients. We investigated the role of dynamic changes in serum presepsin levels in critically ill, immunocompromised patients with sepsis. This is a prospective cohort study that included 119 [...] Read more.
Presepsin is a subtype of soluble CD14 that is increased in the blood of septic patients. We investigated the role of dynamic changes in serum presepsin levels in critically ill, immunocompromised patients with sepsis. This is a prospective cohort study that included 119 adult patients admitted to the intensive care unit (ICU). Presepsin level was measured on day 1 and day 3 after ICU admission. The primary outcome was in-hospital mortality. In immunocompromised patients, presepsin levels on day 1 were higher in patients with sepsis than those in patients without sepsis. The area under the curve (AUC) of presepsin for diagnosing sepsis in immunocompromised patients was 0.87, which was comparable with that of procalcitonin (AUC, 0.892). Presepsin levels on day 3 were higher in patients who died in the hospital than in those who survived. In immunocompromised patients who died in the hospital, presepsin levels on day 3 were significantly higher than those on day 1. In the multivariate analysis, ΔPresepsin+ alone was independently correlated with in-hospital mortality in immunocompromised patients. These findings suggest that dynamic changes in presepsin levels between day 1 and day 3 are associated with in-hospital mortality in patients with sepsis, especially in immunocompromised patients. Full article
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Article
Failure of Lactate Clearance Predicts the Outcome of Critically Ill Septic Patients
Diagnostics 2020, 10(12), 1105; https://doi.org/10.3390/diagnostics10121105 - 18 Dec 2020
Cited by 4 | Viewed by 629
Abstract
Purpose: Early lactate clearance is an important parameter for prognosis assessment and therapy control in sepsis. Patients with a lactate clearance >0% might differ from patients with an inferior clearance in terms of intensive care management and outcomes. This study analyzes a large [...] Read more.
Purpose: Early lactate clearance is an important parameter for prognosis assessment and therapy control in sepsis. Patients with a lactate clearance >0% might differ from patients with an inferior clearance in terms of intensive care management and outcomes. This study analyzes a large collective with regards to baseline risk distribution and outcomes. Methods: In total, 3299 patients were included in this analysis, consisting of 1528 (46%) ≤0% and 1771 (54%) >0% patients. The primary endpoint was intensive care unit (ICU) mortality. Multilevel logistic regression analyses were used to compare both groups: A baseline model (model 1) with lactate clearance as a fixed effect and ICU as a random effect was installed. For model 2, patient characteristics (model 2) were included. For model 3, intensive care treatment (mechanical ventilation and vasopressors) was added to the model. Models 1 and 2 were used to evaluate the primary and secondary outcomes, respectively. Model 3 was only used to evaluate the primary outcomes. Adjusted odds ratios (aORs) with respective 95% confidence intervals (CI) were calculated. Results: The cohorts had no relevant differences regarding the gender, BMI, age, heart rate, body temperature, and baseline lactate. Neither the primary infection focuses nor the ethnic background differed between both groups. In both groups, the most common infection sites were of pulmonary origin, the urinary tract, and the gastrointestinal tract. Patients with lactate clearance >0% evidenced lower sepsis-related organ failure assessment (SOFA) scores (7 ± 6 versus 9 ± 6; p < 0.001) and creatinine (1.53 ± 1.49 versus 1.80 ± 1.67; p < 0.001). The ICU mortality differed significantly (14% versus 32%), and remained this way after multivariable adjustment for patient characteristics and intensive care treatment (aOR 0.43 95% CI 0.36–0.53; p < 0.001). In the additional sensitivity analysis, the lack of lactate clearance was associated with a worse prognosis in each subgroup. Conclusion: In this large collective of septic patients, the 6 h lactate clearance is an independent method for outcome prediction. Full article
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Review

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Review
Hemodynamic Monitoring in Sepsis—A Conceptual Framework of Macro- and Microcirculatory Alterations
Diagnostics 2021, 11(9), 1559; https://doi.org/10.3390/diagnostics11091559 - 28 Aug 2021
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Abstract
Circulatory failure in sepsis is common and places a considerable burden on healthcare systems. It is associated with an increased likelihood of mortality, and timely recognition is a prerequisite to ensure optimum results. While there is consensus that aggressive source control, adequate antimicrobial [...] Read more.
Circulatory failure in sepsis is common and places a considerable burden on healthcare systems. It is associated with an increased likelihood of mortality, and timely recognition is a prerequisite to ensure optimum results. While there is consensus that aggressive source control, adequate antimicrobial therapy and hemodynamic management constitute crucial determinants of outcome, discussion remains about the best way to achieve each of these core principles. Sound cardiovascular support rests on tailored fluid resuscitation and vasopressor therapy. To this end, an overarching framework to improve cardiovascular dynamics has been a recurring theme in modern critical care. The object of this review is to examine the nature of one such framework that acknowledges the growing importance of adaptive hemodynamic support combining macro- and microhemodynamic variables to produce adequate tissue perfusion. Full article
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