Sepsis is a life-threatening organ dysfunction syndrome caused by a dysregulated host response to infection. Due to different infection sources, pathogens and basic conditions of patients, there is significant heterogeneity in clinical manifestations, response to treatment and prognosis of patients with sepsis. Accurate classification and individualized treatment of sepsis will help to further improve the prognosis of patients with sepsis. In recent years, the integration of artificial intelligence and bioinformatics has brought new opportunities for the research of sepsis classification. This review systematically introduces a variety of sepsis classification methods and their clinical application value. The clinical data in the electronic medical record, such as the dynamic changes of vital signs such as body temperature, can be used as the basis for sepsis classification. Different subtypes of body temperature trajectories have differences in physiological characteristics and prognosis, which contributes to predict the prognosis of patients and guide fluid management strategies. Biomarker classification can more comprehensively reflect the pathophysiological state of patients. Immune index classification is helpful to identify immunocompromised patients so as to carry out targeted immunotherapy. Transcriptome data and genotyping reveal the heterogeneity of sepsis at the molecular level and provide a new perspective for precision medicine. In addition, a detailed systematic review of sepsis-related organ function damage, such as acute respiratory distress syndrome (ARDS), acute kidney injury (AKI), and acute liver injury, has also been conducted, which is helpful to develop targeted organ protection and treatment strategies. These typing methods have shown good application prospects in clinical practice. However, there are still limitations in the current research, such as typing stability and biomarker selection, which need to be further explored. Future research should focus on the development of stable and efficient typing tools to achieve precise treatment of sepsis and improve the prognosis of patients.
Humans ; Sepsis/classification* ; Multiple Organ Failure/classification* ; Prognosis ; Artificial Intelligence ; Biomarkers ; Computational Biology ; Respiratory Distress Syndrome

OBJECTIVE: The early prediction of acute kidney injury (AKI) in sepsis and the provision of prompt treatment may improve the outcomes. This study investigated the efficacy of the lactate/albumin ratio (LAR) in predicting severe AKI in cases of septic shock. METHODS: This retrospective, observational cohort study was performed on patients integrated prospectively in a critical pathway of early-goal-directed therapy (EGDT)/SEPSIS. Adult patients with septic shock, who were admitted to the emergency department with a normal kidney function or stage 1 disease based on the Acute Kidney Injury Network classification between January 1, 2014 and September 30, 2017, were analyzed. The outcomes were the development of sepsis-induced severe AKI within 7 days. RESULTS: A total of 343 patients were enrolled. An increase in the LAR value at admission (odds ratio [OR], 1.85; P=0.001) was a strong independent predictor of the development of severe AKI. The increasing predictability of AKI was closely associated with a L/A ratio≥0.794 at admission (OR, 14.66; P < 0.001). The area under the receiver operating characteristic curve value of the L/A ratio (0.821; 95% confidence interval [CI], 0.774–0.861; P < 0.01) was higher than that of lactate (0.795; 95% CI, 0.747–0.838; P < 0.01) for predicting severe AKI (P=0.032). CONCLUSION: L/A ratio was found to be an independent predictor of the development of severe AKI in septic shock. The prognostic performance of the L/A ratio for predicting AKI of critically ill sepsis patients was superior to that of lactate measurements.
Acute Kidney Injury ; Adult ; Albumins ; Classification ; Cohort Studies ; Critical Illness ; Critical Pathways ; Emergencies ; Emergency Service, Hospital ; Humans ; Kidney ; Lactic Acid ; Prognosis ; Prospective Studies ; Retrospective Studies ; ROC Curve ; Sepsis ; Shock, Septic

BACKGROUND/AIMS: Methicillin-resistant Staphylococcus aureus bacteremia (MRSAB) is a major bloodstream infection with a high mortality rate. Identification of factors associated with early mortality in MRSAB patients would be useful for predicting prognosis and developing new therapeutic options. METHODS: A prospective cohort of MRSAB patients was examined between August 2008 and June 2011. Early and late mortality was defined as death within 2 and 28 days of blood culture, respectively. The clinical and microbiological characteristics in the early and late mortality and survival groups were compared. Risk factors associated with severe sepsis or septic shock were also investigated. RESULTS: A total of 385 adult MRSAB patients whose S. aureus isolates were available were enrolled; of these patients, 25 patients (6.5%) and 50 (13%) died early and late, respectively. Compared with both the late-mortality group and the survival group, severe sepsis or septic shock was a statistically significant independent risk factor associated with early mortality. Rapidly or ultimately fatal McCabe and Jackson classification (adjusted odds ratio [aOR], 1.94; 95% confidence interval [CI], 1.25 to 3.02) and pneumonia (aOR, 2.04; 95% CI, 1.03 to 4.02) were independently associated with severe sepsis or septic shock. A vancomycin minimum inhibitory concentration (MIC) ≥ 1.5 μg/mL was associated with a reduced incidence of severe sepsis or septic shock (aOR, 0.53; 95% CI, 0.34 to 0.84). CONCLUSIONS: Severity of illness seems to be the most important risk factor associated with early mortality in MRSAB. Although vancomycin MIC was not independently associated with early mortality, reduced vancomycin susceptibility appears to be linked to reduced disease severity.
Adult ; Bacteremia* ; Classification ; Cohort Studies ; Humans ; Incidence ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus* ; Microbial Sensitivity Tests ; Mortality* ; Odds Ratio ; Pneumonia ; Prognosis ; Prospective Studies ; Risk Factors ; Sepsis ; Shock, Septic ; Vancomycin

BACKGROUND/AIMS: To analyze the incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) sepsis in the early (July to September) and later (October to June) academic months to assess the “July effect”. METHODS: The National Inpatient Sample (2010–2014) was used to identify ERCP-related adult hospitalizations at urban teaching hospitals by applying relevant procedure codes from the International Classification of Diseases, 9th revision, Clinical Modification. Post-ERCP outcomes were compared between the early and later academic months. A multivariate analysis was performed to evaluate the odds of post-ERCP sepsis and its predictors. RESULTS: Of 481,193 ERCP procedures carried out at urban teaching hospitals, 124,934 were performed during the early academic months. The demographics were comparable for ERCP procedures performed during the early and later academic months. A higher incidence (9.4% vs. 8.8%, p<0.001) and odds (odds ratio [OR], 1.07) of post-ERCP sepsis were observed in ERCP performed during the early academic months. The in-hospital mortality rate (7% vs. 7.5%, p=0.072), length of stay, and total hospital charges in patients with post-ERCP sepsis were also equivalent between the 2 time points. Pre-ERCP cholangitis (OR, 3.20) and post-ERCP complications such as cholangitis (OR, 6.27), perforation (OR, 3.93), and hemorrhage (OR, 1.42) were significant predictors of higher post-ERCP sepsis in procedures performed during the early academic months. CONCLUSIONS: The July effect was present in the incidence of post-ERCP sepsis, and academic programs should take into consideration the predictors of post-ERCP sepsis to lower health-care burden.
Adult ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Demography ; Hemorrhage ; Hospital Charges ; Hospital Mortality ; Hospitalization ; Hospitals, Teaching ; Humans ; Incidence ; Inpatients ; International Classification of Diseases ; Length of Stay ; Mortality ; Multivariate Analysis ; Pancreatitis ; Sepsis ; United States

PURPOSE: This study investigated predictive factors for severe neonatal thrombocytopenia, which greatly increases the need for intensive care and is associated with a high mortality rate in premature infants. Factors adopted for prompt identification of at-risk newborns include blood test results and birth history. This study analyzed the relationship between the presence of severe neonatal thrombocytopenia and the mortality rate. The causes of thrombocytopenia in premature infants were also examined. METHODS: This retrospective study evaluated 625 premature infants admitted to the neonatal intensive care unit (NICU) at Chung-Ang University Medical Center. The neonates were classified into 3 groups according to the severity of thrombocytopenia: mild (100×10⁹/L≤platelet < 150×10⁹/L), moderate (50×10⁹/L≤platelet < 100×10⁹/L), or severe (platelet < 50×10⁹/L). Analysis of blood samples obtained at the onset of thrombocytopenia included platelet count, white blood cell (WBC) count, hemoglobin level, hematocrit level, absolute neutrophil count, and high-sensitivity C-reactive protein level. RESULTS: Of the 625 premature infants admitted to our NICU, 214 were detected with thrombocytopenia. The mortality rate in thrombocytopenic neonates was 18.2% (39/214), whereas a mortality rate of only 1.0% was observed in non-thrombocytopenic neonates. The major causes of thrombocytopenia were perinatal insufficiency and sepsis in premature infants. Severe thrombocytopenia was noted more frequently in premature infants with higher WBC counts and in those with a younger gestational age. CONCLUSION: Platelet count, WBC count, and gestational age are reliable predictors for severe neonatal thrombocytopenia. The major causes of thrombocytopenia were perinatal insufficiency and sepsis in premature infants.
Academic Medical Centers ; C-Reactive Protein ; Classification ; Critical Care ; Gestational Age ; Hematocrit ; Hematologic Tests ; Humans ; Infant, Newborn ; Infant, Premature ; Intensive Care, Neonatal ; Leukocytes ; Mortality ; Neutrophils ; Platelet Count ; Reproductive History ; Retrospective Studies ; Sepsis ; Thrombocytopenia ; Thrombocytopenia, Neonatal Alloimmune

PURPOSE: Colonic perforation is a lethal condition presenting high morbidity and mortality in spite of urgent surgical treatment. This study investigated the surgical outcome of patients with colonic perforation associated with retroperitoneal contamination. METHODS: Retrospective analysis was performed for 30 patients diagnosed with colonic perforation caused by either inflammation or ischemia who underwent urgent surgical treatment in our facility from January 2005 to December 2014. Patient characteristics were analyzed to find risk factors correlated with increased postoperative mortality. Using the Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) audit system, the mortality and morbidity rates were estimated to verify the surgical outcomes. Patients with retroperitoneal contamination, defined by the presence of retroperitoneal air in the preoperative abdominopelvic CT, were compared to those without retroperitoneal contamination. RESULTS: Eight out of 30 patients (26.7%) with colonic perforation had died after urgent surgical treatment. Factors associated with mortality included age, American Society of Anesthesiologists (ASA) physical status classification, and the ischemic cause of colonic perforation. Three out of 6 patients (50%) who presented retroperitoneal contamination were deceased. Although the patients with retroperitoneal contamination did not show significant increase in the mortality rate, they showed significantly higher ASA physical status classification than those without retroperitoneal contamination. The mortality rate predicted from Portsmouth POSSUM was higher in the patients with retroperitoneal contamination. CONCLUSION: Patients presenting colonic perforation along with retroperitoneal contamination demonstrated severe comorbidity. However, retroperitoneal contamination was not found to be correlated with the mortality rate.
Classification ; Colon* ; Comorbidity ; Humans ; Inflammation ; Intestinal Perforation ; Ischemia ; Mortality* ; Postoperative Complications ; Retroperitoneal Space ; Retrospective Studies ; Risk Factors* ; Sepsis

Human parechovirus type 3 (HPeV3) is an important pathogen of severe sepsis. HPeV3 is a non- enveloped, single-stranded, positive-sense RNA virus with a linear and continuous genomic RNA. The complete genome of a HPeV3 (BJ-C3174) strain was analyzed from the serum specimen from a child with sepsis hospitalized in Beijing, China, in 2012. The whole genome of BJ-C3174 was 7329 nucleotides (nt) in length excluding a poly (A) tail. One large open reading frame (ORF) of 6531 nt encoding a putative polyprotein precursor of 2177 amino acids (aa) was flanked by a 5' untranslated region (UTR) of 709 nt and 3' UTR of 91 nt. Phylogenetic analysis showed that BJ-C3174 belonged to HPeV3 and was closest to the HPeV3 strain BONN-2 from Germany. Compared with HPeV1-8 reference strains, BJ-C3174 shared the highest similarities with BONN-2 in full length and in each of the gene segments of the genome. The nucleotide and predicted amino acid identities of the whole genome between BJ-C3174 and BONN-2 were 99.3% and 99.8%, respectively, which were higher than those compared with HPeV3 prototype. Recom- bination of the gene segment with other HPeVs types was not identified.
Amino Acid Sequence ; Child ; Genome, Viral ; Humans ; Molecular Sequence Data ; Parechovirus ; classification ; genetics ; Phylogeny ; Sepsis ; blood ; virology

OBJECTIVEHuman parechovirus (HPeV) is a single-stranded, positive sense RNA virus in the Parechovirus genus within the large family of Picornaviridae. As a possible new pathogen of neonatal sepsis, meningoencephalitis and other infections in young children, HPeV gets more and more attention. This study aimed to better understand the association of HPeV with central nervous system (CNS) infectious diseases and sepsis among hospitalized children in Beijing.

METHODA total of 577 cerebrospinal fluid (CSF) samples were retrospectively collected from 557 children suspected of CNS infections in 2012. Three hundred and fifty-one of them were male and 206 were female. HPeV was screened by reverse transcription-nested PCR (RT-nPCR) with the universal primers which target the highly conserved 5'UTR. The positive samples were genotyped by amplifying and sequencing for the VP3/VP1 junction region. The sequences were compared with the HPeV sequences from GenBank and performed phylogenetic analysis.Some samples other than CSF from HPeV positive children, including serum, nasopharyngeal aspirate and stool, were collected and carried out screening for HPeV.

RESULTWith the RT-nPCR by universal primers, HPeVs were detected in 18 out of 577 CSF samples obtained from 18 children with a positive rate of 3.1%. The ratio of male and female was 2: 1. There were no statistically significant differences on infection rate between boys (12/351, 3.4%) and girls (6/206, 2.9%). All of 18 positive CSF samples were negative for enterovirus, Epstein-Barr virus (EBV), human cytomegalovirus (HCMV), and herpes simplex virus 1 and 2 (HSV).HPeVs from 10 positive CSF samples were genotyped successfully, consisting of 7 HPeV3 and 3 HPeV1. In addition, 2 of 8 serum samples were positive for HPeV3 and 1 of 2 stool samples were positive for HPeV 1. HPeVs were identified in CSF from children aged from 15 days to 14 years, in which 7 cases were infants younger than 3 months and 5 cases were infants from 3 months to one year. Three children older than the age of 9 years (9, 13 and 14 years) were positive for HPeV. Most of the children (6/8) infected with HPeV3 were younger than 3 months and were diagnosed as sepsis, while the rest of HPeV3 positive children were diagnosed as meningitis and bronchopneumonia. HPeV3 infection clustered in August, while HPeV1 in January.

CONCLUSIONHPeVs were associated with CNS infections and sepsis in hospitalized children in Beijing, especially in children younger than one year.HPeV3 was the predominant type identified in CSF.

Adolescent ; Age Distribution ; Central Nervous System Infections ; cerebrospinal fluid ; epidemiology ; virology ; Cerebrospinal Fluid ; virology ; Child ; Child, Hospitalized ; Child, Preschool ; Female ; Genotype ; Humans ; Infant ; Infant, Newborn ; Male ; Parechovirus ; classification ; genetics ; isolation & purification ; Picornaviridae Infections ; cerebrospinal fluid ; epidemiology ; virology ; RNA, Viral ; genetics ; Retrospective Studies ; Reverse Transcriptase Polymerase Chain Reaction ; Seasons ; Sepsis ; cerebrospinal fluid ; epidemiology ; virology ; Sequence Analysis, DNA

Food protein-induced enterocolitis syndrome (FPIES) is an under-recognized non-IgE-mediated gastrointestinal food allergy. The diagnosis of FPIES is based on clinical history, sequential symptoms and the timing, after excluding other possible causes. It is definitively diagnosed by an oral food challenge test. Unfortunately, the diagnosis of FPIES is frequently delayed because of non-specific symptoms and insufficient definitive diagnostic biomarkers. FPIES is not well recognized by clinicians; the affected infants are often mismanaged as having viral gastroenteritis, food poisoning, sepsis, or a surgical disease. Familiarity with the clinical features of FPIES and awareness of the indexes of suspicion for FPIES are important to diagnose FPIES. Understanding the recently defined clinical terms and types of FPIES is mandatory to suspect and correctly diagnose FPIES. The aim of this review is to provide a case-driven presentation as a guide of how to recognize the clinical features of FPIES to improve diagnosis and management of patients with FPIES.
Biomarkers ; Classification ; Diagnosis ; Enterocolitis* ; Food Hypersensitivity* ; Foodborne Diseases ; Gastroenteritis ; Humans ; Infant ; Recognition (Psychology) ; Sepsis

OBJECTIVETo apply pyrosequencing technique in the detection of the common pathogens in sepsis.

METHODSThe primers for amplification and sequencing in pyrosequencing were designed according to alignment of the bacterial 16S rRNA sequence. Bacterial genomic DNA was extracted for pyrosequencing, and the pathogen species were determined according to the sequencing data obtained.

RESULTSPyrosequencing effectively yielded the sequencing data of the 28 bp sequences of the pathogens and clearly distinguished the pathogen species of Streptococcus pyogenes, Streptococcus pneumonia, Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumonia, Neisseria meningitides, and Salmonella, but failed to distinguish Staphylococcus epidermidis from Staphylococcus aureus.

CONCLUSIONPyrosequencing technique can effectively distinguish the common pathogens in sepsis at the species level.

Bacteria ; classification ; isolation & purification ; DNA Primers ; DNA, Bacterial ; genetics ; Microbiological Techniques ; Polymerase Chain Reaction ; RNA, Ribosomal, 16S ; Sepsis ; microbiology