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  • Prognostic Accuracy of Sepsis-3 Criteria for In-Hospital Mortality Among Patients With Suspected Infection Presenting to the Emergency Department

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    JAMA. 2017; 317(3):301-308. doi: 10.1001/jama.2016.20329

    This cohort study compares the ability of the quick Sequential Organ Failure Assessment score vs systemic inflammatory response syndrome and severe sepsis criteria for a in-hospital mortality risk among adult patients presenting to the emergency department with suspected infection.

  • JAMA January 17, 2017

    Figure 2: Receiver Operating Characteristic Curves for In-Hospital Mortality

    qSOFA indicates quick Sequential Organ Failure Assessment; SIRS, systemic inflammatory response syndrome; and SOFA, Sequential [Sepsis-related] Organ Failure Assessment. The area under the receiver operating characteristic curves for qSOFA is 0.80 (95% CI, 0.74-0.85); SOFA, 0.77 (95% CI, 0.71-0.82); SIRS, 0.65 (95% CI, 0.59-0.70); and severe sepsis, 0.65 (95% CI, 0.59-0.70).
  • Effect of Hydrocortisone on Development of Shock Among Patients With Severe Sepsis: The HYPRESS Randomized Clinical Trial

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    JAMA. 2016; 316(17):1775-1785. doi: 10.1001/jama.2016.14799

    This randomized clinical trial compares the effects of hydrocortisone vs placebo on development of septic shock among intensive care patients with severe sepsis who were not in septic shock.

  • Evaluating Glucocorticoids for Sepsis: Time to Change Course

    Abstract Full Text
    JAMA. 2016; 316(17):1769-1771. doi: 10.1001/jama.2016.13904
  • JAMA October 18, 2016

    Figure 2: Comparison of Fungal Infection–Free Survival at Day 28 in the Modified Intent-to-Treat Population and in Predefined Subgroups

    All analyses are stratified by center and adjusted on parameters imbalanced between groups (ie, diabetes and body mass index).aColonization index (range, 0-1) indicates the number of positive sites colonized with Candida divided by the number of sites sampled.bCorrected colonization index (range, 0-1) indicates the number of heavily colonized sites divided by the number of sites sampled.cCandida score (range, 0-5) items are surgical admission (1 point), severe sepsis (2 points), multiple sites positive with Candida species (1 point), and parenteral nutrition (1 point).SOFA indicates Sequential Organ Failure Assessment.
  • JAMA October 18, 2016

    Figure 3: Comparison of Survival at Day 28 in the Modified Intent-to-Treat Population and in Predefined Subgroups

    All analyses are stratified by center and adjusted on parameters imbalanced between groups (ie, diabetes and body mass index).aColonization index (range, 0-1) indicates the number of positive sites colonized with Candida divided by the number of sites sampled.bCorrected colonization index (range, 0-1) indicates the number of heavily colonized sites divided by the number of sites sampled.cCandida score (range, 0-5) items are surgical admission (1 point), severe sepsis (2 points), multiple sites positive with Candida species (1 point), and parenteral nutrition (1 point).SOFA indicates Sequential Organ Failure Assessment.
  • JAMA February 23, 2016

    Figure 3: Selection of Surviving Sepsis Campaign Database Cohort

    Hypotension was defined as mean arterial pressure less than 65 mm Hg. Vasopressor therapy to maintain mean arterial pressure of 65 mm Hg or higher is treated as a binary variable. Serum lactate level greater than 2 mmol/L (18 mg/dL) is considered abnormal. The “after fluids” field in the Surviving Sepsis Campaign (SSC) database was considered equivalent to adequate fluid resuscitation. “Before fluids” refers to patients who did not receive fluid resuscitation. Serum lactate level greater than 2 mmol/L after fluid resuscitation but without hypotension or need for vasopressor therapy (group 4) is defined as “cryptic shock.” Missing serum lactate level measurements (n = 4419 [15.7%]) and patients with serum lactate levels greater than 4 mmol/L (36 mg/dL) who did not receive fluids as per SSC guidelines (n = 790 [2.8%]) were excluded from full case analysis. Of the 22 941 patients, 4101 who were coded as having severe sepsis were excluded. Thus, the remaining 18 840 patients were categorized within septic shock groups 1 to 6.aPatients with screening serum lactate levels coded as greater than 2 mmol/L (n=3342) were included in the missing-data analysis.
  • JAMA March 10, 2015

    Figure: Total and Potentially Preventable 90-Day Readmissions Among Survivors of Severe Sepsis and Matched Hospitalizations for Acute Medical Conditions

    Potentially preventable readmission diagnoses include pneumonia, hypertension, dehydration, asthma, urinary tract infection, chronic obstructive pulmonary disease exacerbation, perforated appendix, diabetes, angina, congestive heart failure, sepsis, acute renal failure, skin or soft tissue infection, and aspiration pneumonitis. The shaded areas indicate 95% confidence intervals.
  • Readmission Diagnoses After Hospitalization for Severe Sepsis and Other Acute Medical Conditions

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    JAMA. 2015; 313(10):1055-1057. doi: 10.1001/jama.2015.1410
  • JAMA April 2, 2014

    Figure 1: Mean Annual Mortality in Patients With Severe Sepsis

    Error bars indicate 95% CI.
  • Mortality Related to Severe Sepsis and Septic Shock Among Critically Ill Patients in Australia and New Zealand, 2000-2012

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    JAMA. 2014; 311(13):1308-1316. doi: 10.1001/jama.2014.2637

    Kaukonen and coauthors describe changes in mortality from 2000 to 2012 for severe sepsis with and without shock in 101 064 patients in 171 intensive care units in Australia and New Zealand. In an Editorial, Iwashyna and Angus discuss the challenge of determining changes in the epidemiology of severe sepsis and evaluating improvements in quality of care.

  • Declining Case Fatality Rates for Severe Sepsis: Good Data Bring Good News With Ambiguous Implications

    Abstract Full Text
    JAMA. 2014; 311(13):1295-1297. doi: 10.1001/jama.2014.2639
  • JAMA April 2, 2014

    Figure 2: Adjusted Annual Odds for the Change in Hospital Outcomes Reported as Odds Ratios Referenced Against the Year 2000

    When considered as a continuous variable, there was no difference between patients with severe sepsis or septic shock and other patients in the database for the decline in mortality over time (odds ratio [OR], 0.94 [95% CI, 0.94-0.95] vs 0.94 [95% CI, 0.94-0.94]; P = .37), whereas significant differences were observed in the change over time for discharge to home (OR, 1.03 [95% CI, 1.02-1.03] vs 1.01 [95% CI, 1.01-1.01]; P < .001) and discharge to rehabilitation facilities (OR, 1.08 [95% CI, 1.07-1.09] vs 1.09 [95% CI, 1.09-1.10]; P < .001). Discharge to rehabilitation included discharge to rehabilitation facilities and chronic care facilities such as nursing homes. ICU indicates intensive care unit.
  • JAMA March 20, 2013

    Figure 1: Populations of Patients With Severe Sepsis Who Were Screened and Randomized to Receive Eritoran or Placebo

    aReasons for exclusion after initial screening are not available.
  • Effect of Eritoran, an Antagonist of MD2-TLR4, on Mortality in Patients With Severe Sepsis: The ACCESS Randomized Trial

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    JAMA. 2013; 309(11):1154-1162. doi: 10.1001/jama.2013.2194
    In a randomized, double-blind, placebo-controlled, multinational phase 3 trial in 197 intensive care units (1961 patients), Opal and coauthors explored whether eritoran, a TLR4 antagonist, significantly reduced sepsis-induced mortality.
  • Effect of Empirical Treatment With Moxifloxacin and Meropenem vs Meropenem on Sepsis-Related Organ Dysfunction in Patients With Severe Sepsis: A Randomized Trial

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    JAMA. 2012; 307(22):2390-2399. doi: 10.1001/jama.2012.5833
    Dr Brunkhorst and coauthors for the German Study Group Competence Network Sepsis report on the effect of empirical treatment with moxifloxacin and meropenem vs meropenem on sepsis-related organ dysfunction in patients with severe sepsis.
  • JAMA December 14, 2011

    Figure: Drug for Severe Sepsis Is Withdrawn From Market, Fails to Reduce Mortality

    A medication thought to improve mortality rates of patients with severe sepsis has been removed from the market because a recent study found it fared no better than placebo.
  • Drug for Severe Sepsis Is Withdrawn From Market, Fails to Reduce Mortality

    Abstract Full Text
    JAMA. 2011; 306(22):2439-2440. doi: 10.1001/jama.2011.1755
  • Incident Stroke and Mortality Associated With New-Onset Atrial Fibrillation in Patients Hospitalized With Severe Sepsis

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    JAMA. 2011; 306(20):2248-2254. doi: 10.1001/jama.2011.1615
  • Is Severe Sepsis Associated With New-Onset Atrial Fibrillation and Stroke?

    Abstract Full Text
    JAMA. 2011; 306(20):2264-2266. doi: 10.1001/jama.2011.1730