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Prognosis of septic shock
Accepted Manuscript Prognosis of septic shock
Funda Sungur Biteker, Oğuzhan Çelik, Bülent Özlek, Eda Özlek, Murat Biteker PII: DOI: Reference:
S0735-6757(17)30421-7 doi: 10.1016/j.ajem.2017.05.046 YAJEM 56718
To appear in: Received date: Revised date: Accepted date:
12 May 2017 ###REVISEDDATE### 26 May 2017
Please cite this article as: Funda Sungur Biteker, Oğuzhan Çelik, Bülent Özlek, Eda Özlek, Murat Biteker , Prognosis of septic shock, (2017), doi: 10.1016/j.ajem.2017.05.046
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Prognosis of Septic Shock Funda Sungur Biteker, MD 1
PT
Oğuzhan Çelik, MD 2
SC
Eda Özlek, MD 2
RI
Bülent Özlek, MD 2
NU
Murat Biteker, MD, Associate Prof 2
Yatağan State Hospital, Department of Infectious Diseases and Clinical Microbiology 1
MA
Muğla University, Faculty of Medicine, Department of Cardiology 2
D
Address correspondence to Oğuzhan Çelik, MD
PT E
Mugla Sitki Kocman Universitesi Tip Fakultesi
CE
Orhaniye Mah. Haluk Özsoy Cad. 48000/MUĞLA
AC
Phone: +90 252 214 13 26, E-mail: [email protected]
ACCEPTED MANUSCRIPT
Prognosis of Septic Shock We read with great interest the article by April et al. in the American Journal of Emergency
PT
Medicine (1). The authors compared in-hospital mortality among emergency department patients meeting trial-based criteria for septic shock based upon whether presenting with
RI
refractory hypotension versus hyperlactatemia. They found that mortality was 10.9% among
SC
patients with isolated refractory hypotension, 24.4% among patients with isolated hyperlactatemia, and 28.3% among patients with both. The results of this study are similar
NU
with recently published secondary analysis of the ARISE (Australian Resuscitation in Sepsis
MA
Evaluation) trial (2). The ARISE study revealed that the participants enrolled on the basis of isolated hyperlactatemia had a higher 90-day mortality; were less likely to be discharged alive
D
from both intensive care unit and hospital; had longer intensive care unit and hospital duration
PT E
of stay; and received mechanical ventilation more often than participants with isolated refractory hypotension. These observations imply that a blood lactate ≥ 4 mmol/L is likely an
CE
important independent marker of disease severity in sepsis; that it can be used for risk stratification and that it may be a candidate for the defintion of septic shock. However, a
AC
singular ideal biomarker has not yet been identified; an alternative approach is to shift research focus to determine the diagnostic relevancy of multiple biomarkers when used in concert. We think that sepsis often presents alongside other conditions and due to this complexity, a single 'golden' biomarker may not exist, thus research should shift more focus on to assessing the combined diagnostic and prognostic capabilities of multiple biomarkers such as lactate, procalcitonin, C-reactive protein, natriuretic peptides, troponins and etc.
ACCEPTED MANUSCRIPT
References 1. April MD, Donaldson C, Tannenbaum LI, Moore T, Aguirre J, Pingree A, Lantry JH. Emergency department septic shock patient mortality with refractory hypotension vs hyperlactatemia: A retrospective cohort study. Am J Emerg Med. 2017 Apr 27. pii:
PT
S0735-6757(17)30319-4. doi: 10.1016/j.ajem.2017.04.055.
RI
2. Gotmaker R, Peake SL, Forbes A, Bellomo R; ARISE Investigators. Mortality is
SC
Greater in Septic Patients with Hyperlactatemia Than with Refractory Hypotension.
AC
CE
PT E
D
MA
NU
Shock. 2017 Feb 28. doi: 10.1097/SHK.0000000000000861.
Funda Sungur Biteker, Oğuzhan Çelik, Bülent Özlek, Eda Özlek, Murat Biteker PII: DOI: Reference:
S0735-6757(17)30421-7 doi: 10.1016/j.ajem.2017.05.046 YAJEM 56718
To appear in: Received date: Revised date: Accepted date:
12 May 2017 ###REVISEDDATE### 26 May 2017
Please cite this article as: Funda Sungur Biteker, Oğuzhan Çelik, Bülent Özlek, Eda Özlek, Murat Biteker , Prognosis of septic shock, (2017), doi: 10.1016/j.ajem.2017.05.046
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Prognosis of Septic Shock Funda Sungur Biteker, MD 1
PT
Oğuzhan Çelik, MD 2
SC
Eda Özlek, MD 2
RI
Bülent Özlek, MD 2
NU
Murat Biteker, MD, Associate Prof 2
Yatağan State Hospital, Department of Infectious Diseases and Clinical Microbiology 1
MA
Muğla University, Faculty of Medicine, Department of Cardiology 2
D
Address correspondence to Oğuzhan Çelik, MD
PT E
Mugla Sitki Kocman Universitesi Tip Fakultesi
CE
Orhaniye Mah. Haluk Özsoy Cad. 48000/MUĞLA
AC
Phone: +90 252 214 13 26, E-mail: [email protected]
ACCEPTED MANUSCRIPT
Prognosis of Septic Shock We read with great interest the article by April et al. in the American Journal of Emergency
PT
Medicine (1). The authors compared in-hospital mortality among emergency department patients meeting trial-based criteria for septic shock based upon whether presenting with
RI
refractory hypotension versus hyperlactatemia. They found that mortality was 10.9% among
SC
patients with isolated refractory hypotension, 24.4% among patients with isolated hyperlactatemia, and 28.3% among patients with both. The results of this study are similar
NU
with recently published secondary analysis of the ARISE (Australian Resuscitation in Sepsis
MA
Evaluation) trial (2). The ARISE study revealed that the participants enrolled on the basis of isolated hyperlactatemia had a higher 90-day mortality; were less likely to be discharged alive
D
from both intensive care unit and hospital; had longer intensive care unit and hospital duration
PT E
of stay; and received mechanical ventilation more often than participants with isolated refractory hypotension. These observations imply that a blood lactate ≥ 4 mmol/L is likely an
CE
important independent marker of disease severity in sepsis; that it can be used for risk stratification and that it may be a candidate for the defintion of septic shock. However, a
AC
singular ideal biomarker has not yet been identified; an alternative approach is to shift research focus to determine the diagnostic relevancy of multiple biomarkers when used in concert. We think that sepsis often presents alongside other conditions and due to this complexity, a single 'golden' biomarker may not exist, thus research should shift more focus on to assessing the combined diagnostic and prognostic capabilities of multiple biomarkers such as lactate, procalcitonin, C-reactive protein, natriuretic peptides, troponins and etc.
ACCEPTED MANUSCRIPT
References 1. April MD, Donaldson C, Tannenbaum LI, Moore T, Aguirre J, Pingree A, Lantry JH. Emergency department septic shock patient mortality with refractory hypotension vs hyperlactatemia: A retrospective cohort study. Am J Emerg Med. 2017 Apr 27. pii:
PT
S0735-6757(17)30319-4. doi: 10.1016/j.ajem.2017.04.055.
RI
2. Gotmaker R, Peake SL, Forbes A, Bellomo R; ARISE Investigators. Mortality is
SC
Greater in Septic Patients with Hyperlactatemia Than with Refractory Hypotension.
AC
CE
PT E
D
MA
NU
Shock. 2017 Feb 28. doi: 10.1097/SHK.0000000000000861.