#Pathogens #analysis and modeling of #mortality #risk in #sepsis patients with #COVID19 and without COVID-19

 

Abstract

This study compared isolate-level pathogen profiles, antimicrobial susceptibility, clinical characteristics, and mortality predictors between sepsis patients with and without coronavirus disease 2019 (COVID-19), and developed cohort-specific nomograms for in-hospital mortality. This retrospective intensive care unit (ICU) cohort included 608 adults with sepsis: 158 in group COVID-19 and 450 in group non–COVID-19. All patients were assessed for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection status. Patient-level comparisons and mortality modeling used the full cohort, whereas microbiological analyses were restricted to 235 eligible bacterial or fungal isolates from baseline cultures after exclusion of colonizers, contaminants, clinically non-causative organisms, and duplicates. Candidate predictors were selected by least absolute shrinkage and selection operator (LASSO) regression and entered into multivariable logistic regression; coefficients were pooled using Rubin’s rules when multiple imputation was performed. External validation used MIMIC-IV with fixed internal coefficients. Gram-negative organisms predominated, mainly Acinetobacter baumannii and Klebsiella pneumoniae, with substantial antimicrobial resistance. The COVID-19 and non–COVID-19 models showed apparent internal area under the curve values of 0.938 and 0.871, conservative optimism-corrected values of 0.913 and 0.871, and external validation AUC values of 0.841 and 0.859, respectively. Cohort-specific nomograms may provide supplementary risk-stratification information in critically ill patients with sepsis.

Source: 

Link: https://www.nature.com/articles/s41598-026-58450-w

____

Viral #sepsis: #diagnosis, clinical #features, #pathogenesis, and #clinical considerations

Abstract

Sepsis, characterized as life-threatening organ dysfunction resulting from dysregulated host responses to infection, remains a significant challenge in clinical practice. Despite advancements in understanding host-bacterial interactions, molecular responses, and therapeutic approaches, the mortality rate associated with sepsis has consistently ranged between 10 and 16%. This elevated mortality highlights critical gaps in our comprehension of sepsis etiology. Traditionally linked to bacterial and fungal pathogens, recent outbreaks of acute viral infections, including Middle East respiratory syndrome coronavirus (MERS-CoV), influenza virus, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), among other regional epidemics, have underscored the role of viral pathogenesis in sepsis, particularly when critically ill patients exhibit classic symptoms indicative of sepsis. However, many cases of viral-induced sepsis are frequently underdiagnosed because standard evaluations typically exclude viral panels. Moreover, these viruses not only activate conventional pattern recognition receptors (PRRs) and retinoic acid-inducible gene-I (RIG-I)-like receptors (RLRs) but also initiate primary antiviral pathways such as cyclic guanosine monophosphate adenosine monophosphate (GMP-AMP) synthase (cGAS)-stimulator of interferon genes (STING) signaling and interferon response mechanisms. Such activations lead to cellular stress, metabolic disturbances, and extensive cell damage that exacerbate tissue injury while leading to a spectrum of clinical manifestations. This complexity poses substantial challenges for the clinical management of affected cases. In this review, we elucidate the definition and diagnosis criteria for viral sepsis while synthesizing current knowledge regarding its etiology, epidemiology, and pathophysiology, molecular mechanisms involved therein as well as their impact on immune-mediated organ damage. Additionally, we discuss clinical considerations related to both existing therapies and advanced treatment interventions, aiming to enhance the comprehensive understanding surrounding viral sepsis.

Source: Military Medical Research, https://mmrjournal.biomedcentral.com/articles/10.1186/s40779-024-00581-0 

____