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"Sepsis"

Original Articles

Critical Care

Renal dysfunction as a marker of adverse outcomes in early sepsis in the emergency department
Tamar J. van der Aart, Jan C. ter Maaten, Raymond J. van Wijk, Stephan J.L. Bakker, Hjalmar R. Bouma, Marco van Londen
Clin Exp Emerg Med 2026;13(2):178-187.   Published online January 28, 2026
DOI: https://doi.org/10.15441/ceem.25.136

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Renal dysfunction as a marker of adverse outcomes in early sepsis in the emergency department
Clin Exp Emerg Med. 2026;13(2):178-187.   Published online January 28, 2026
DOI: https://doi.org/10.15441/ceem.25.136
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Renal dysfunction as a marker of adverse outcomes in early sepsis in the emergency department
Clin Exp Emerg Med. 2026;13(2):178-187.   Published online January 28, 2026
DOI: https://doi.org/10.15441/ceem.25.136
Close
Objective
Sepsis is a leading cause of acute kidney injury (sepsis-associated acute kidney injury, SA-AKI) and is associated with multiorgan failure, cardiovascular events, and increased mortality. While research has generally focused on critically ill patients in intensive care units (ICUs), most sepsis cases are managed outside the ICU. This study investigated renal dysfunction as an early risk marker in patients presenting to the emergency department (ED) with severe infection and at risk for early sepsis. Methods This post hoc analysis of patients presenting to the ED used data from the Acutelines cohort (2020–2023). Kaplan-Meier curves and univariable and multivariable Cox regression analyses were performed to assess the association between AKI and all-cause mortality, as well as in-hospital mortality and cardiovascular death, adjusting for potential confounders. Results In total, 2,045 patients presented with sepsis at the ED, of whom 246 (12%) had AKI. The overall mortality rate was 25% over a median follow-up of 346 days. AKI was associated with higher all-cause mortality (38% vs. 26%; P<0.001). After adjustment for sex, age, comorbidities, and sepsis severity, AKI remained independently associated with all-cause mortality (hazard ratio [HR], 1.44; 95% confidence interval [CI], 1.14–1.82; P=0.003), in-hospital mortality (HR, 1.65; 95% CI, 1.16–2.34; P=0.006), and cardiovascular death (HR, 2.50; 95% CI, 1.39–4.48; P=0.001). Similar outcomes were observed in a subanalysis excluding ICU patients. Conclusion SA-AKI at ED presentation is independently associated with increased all-cause, in-hospital, and cardiovascular mortality. These findings underscore the need for earlier recognition across care settings and the implementation of structured follow-up to improve patient outcomes.
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Machine Learning-Based Clusters of Vital Signs and Lactate Levels Predict Vasopressor Use in Sepsis
Daun Jeong, Minyoung Choi, Seung Jin Maeng, Hanbeom Yoon, Jong Eun Park, Gun Tak Lee, Sung Yeon Hwang, Tae Gun Shin, Sung Phil Chung, Tae Ho Lim, on behalf of the Korean Shock Society
In Press, Received October 15, 2025  Accepted December 29, 2025  Available online January 14, 2026  
DOI: https://doi.org/10.15441/ceem.25.247    [Accepted]

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Machine Learning-Based Clusters of Vital Signs and Lactate Levels Predict Vasopressor Use in Sepsis
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Machine Learning-Based Clusters of Vital Signs and Lactate Levels Predict Vasopressor Use in Sepsis
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Objective
Sepsis remains a major clinical challenge because of its complex, heterogeneous, and multidimensional clustering patterns. This study aimed to investigate the association between vasopressor administration and machine learning–derived clusters based on initial vital signs and lactate measurements obtained in emergency department (ED) and intensive care unit (ICU) settings.
Methods
A retrospective cohort analysis was performed using data from the Korean Shock Society Septic Shock (KOSS) Registry (septic shock in the ED) and the Marketplace for Medical Information in Intensive Care (MIMIC)-IV database (ICU patients with suspected infection). To derive clusters, k-means clustering was applied to six initial vital signs and serum lactate measurements. The primary outcome was vasopressor administration. Secondary outcomes included second vasopressor administration and 28-day mortality.
Results
A total of 17,500 patients were included in the analysis (KOSS cohort, n=7,130; MIMIC-IV cohort, n=10,370). K-means clustering identified three distinct clusters in each cohort. In the KOSS cohort, Cluster 3 was characterized by the lowest mean arterial pressure (MAP) (62 mmHg [IQR, 53–71]) and the highest diastolic shock index (DSI) (2.6 [2.3–3.0]). This cluster was associated with the highest rates of vasopressor administration (93.9%), second vasopressor administration (33.5%), and 28-day mortality (25.3%) (all p<0.001). Comparable physiological and clinical patterns were observed in the MIMIC-IV cohort, in which Cluster 3 likewise demonstrated the lowest MAP (68 mmHg [60–76]) and highest DSI (2.0 [1.8–2.3]). This group similarly exhibited the poorest outcomes, including vasopressor administration (41.0%), second vasopressor administration (16.7%), and 28-day mortality (29.0%).
Conclusion
Machine learning–derived clusters based on initial vital signs and serum lactate levels demonstrated different patterns of vasopressor use and mortality. The clinical utility of this approach for guiding timely or targeted vasopressor therapy requires prospective validation.
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Comparison of four noninvasive tools for predicting sepsis and septic shock mortality: a prospective cohort study
Matteo Guarino, Giacomo Maroncelli, Benedetta Perna, Paolo Baldin, Caterina Ghirardi, Alex Zanotto, Silvia Eichner, Matteo Bolognesi, Chiara Pesci, Martina Maritati, Carlo Contini, Roberto De Giorgio, Michele Domenico Spampinato
Clin Exp Emerg Med 2026;13(1):44-52.   Published online December 2, 2025
DOI: https://doi.org/10.15441/ceem.25.075

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Comparison of four noninvasive tools for predicting sepsis and septic shock mortality: a prospective cohort study
Clin Exp Emerg Med. 2026;13(1):44-52.   Published online December 2, 2025
DOI: https://doi.org/10.15441/ceem.25.075
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Comparison of four noninvasive tools for predicting sepsis and septic shock mortality: a prospective cohort study
Clin Exp Emerg Med. 2026;13(1):44-52.   Published online December 2, 2025
DOI: https://doi.org/10.15441/ceem.25.075
Close
Objective
Sepsis, a life-threatening organ dysfunction, is a major global health concern. Early detection remains challenging due to nonspecific symptoms. Noninvasive tools such as the shock index, diastolic shock index, capillary refill time (CRT), and mottling score (MS) could help clinicians assess hemodynamic status and predict mortality, but a comprehensive comparison of their prognostic value is lacking. This study compares the performance of those four tools in predicting mortality in septic patients at 24 hours, 7 days, and 28 days. Methods A single-center, prospective observational study was conducted from January to September 2024. Adult patients (≥18 years) with suspected infection and a National Early Warning Score-2 of ≥5 were enrolled. Demographic data, vital signs, and CRT and MS results were collected at presentation, and mortality outcomes were recorded at 24 hours, 7 days, and 28 days. Results In total, 135 patients were included (median age, 85 years [interquartile range, 79–90 years]; 44.4% female). The mortality rates were 15.6% at 24 hours, 25.2% at 7 days, and 35.6% at 28 days. CRT showed the highest predictive value for 24-hour mortality (area under the curve [AUC], 0.829; 95% confidence interval [CI], 0.755–0.889), and MS had the best performance at 7 days (AUC, 0.732; 95% CI, 0.646–0.806) and at 28 days (AUC, 0.749; 95% CI, 0.662–0.823). No significant differences emerged in pairwise comparisons. Conclusion Although no one tool significantly outperformed the others, all four tools may provide useful, noninvasive mortality prediction in sepsis. CRT may be most effective for early risk stratification and MS correlates with mid-term outcomes, supporting their integration into clinical assessments.

Citations

Citations to this article as recorded by  Crossref logo
  • Meta-Analysis of the Prognostic Value of Skin Perfusion Parameters in Sepsis Patients: Evidence Integration Based on the Mottling Score, Capillary Refill Time, and Peripheral Perfusion Index
    Li Juan Shi, Shu Fen Ke, Li Sang Fu, Li Mei Zhu, Liang Ying Chen, Yao Ning Zhuang
    Shock.2026; 66(2): 303.     CrossRef
  • 2,153 View
  • 107 Download
  • 1 Web of Science
  • 1 Crossref

Review Article

Advances in metabolomics in critically ill patients with sepsis and septic shock
Swarnima Pandey
Clin Exp Emerg Med 2025;12(1):4-15.   Published online July 19, 2024
DOI: https://doi.org/10.15441/ceem.24.211

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Advances in metabolomics in critically ill patients with sepsis and septic shock
Clin Exp Emerg Med. 2025;12(1):4-15.   Published online July 19, 2024
DOI: https://doi.org/10.15441/ceem.24.211
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Advances in metabolomics in critically ill patients with sepsis and septic shock
Clin Exp Emerg Med. 2025;12(1):4-15.   Published online July 19, 2024
DOI: https://doi.org/10.15441/ceem.24.211
Close
Sepsis is associated with high morbidity and mortality rates in hospitalized patients. This condition has a complex pathophysiology and can swiftly progress to the severe form of septic shock, which can lead to organ dysfunction, organ failure, and death. Metabolomics has transformed the clinical and research topography of sepsis, with application to prognosis, diagnosis, and risk assessment. Metabolomics involves detecting and analyzing levels of metabolites in blood (plasma, serum, and/or erythrocytes) and urine; when applied in sepsis, this technology can improve our understanding of the pathogenesis of the disease and aid in better disease management by identifying early biomarkers. For this review article, “metabolomics,” “sepsis,” and “septic shock” were keywords used to search records in various databases including PubMed and Scopus from their inception until December 2023. This review article summarizes information regarding metabolic profiling performed in sepsis and septic shock and illustrates how metabolomics is advancing the diagnosis and prognosis of patients with sepsis.

Citations

Citations to this article as recorded by  Crossref logo
  • Impact of Metabolically Healthy and Unhealthy Obesity on Outcomes of Sepsis Complicated by Septic Shock in Elderly Patients
    Giorgi Chilingarashvili, Diksha Sanjana Pasnoor, Shreya Bajjuri, Ritika Parekh, Nirmala Manjappachar, Jyotsna Gummadi, Athmananda Nanjundappa, Rupak Desai
    Journal of Intensive Care Medicine.2026; 41(6): 486.     CrossRef
  • Effect of norepinephrine initiation timing on mortality in septic shock: a multicenter cohort study
    Jung Won Choi, Tae Gun Shin, Seung Jin Maeng, Sung Yeon Hwang, Sang-Min Kim, Won Young Kim, Kyuseok Kim, Sung-Joon Park, Sung-Hyuk Choi, Sejoong Ahn, Woon Yong Kwon, Taeyoung Kong, Sung Phil Chung, Byuk Sung Ko, Tae Ho Lim
    BMC Anesthesiology.2026;[Epub]     CrossRef
  • Identification of Volatile Organic Compounds (Distinct Biomarkers) Emitted by Cancer Cells Using Gas Chromatography-mass Spectrometry – A Review
    Surendar Balu, Ashok K. Sundramoorthy
    Current Analytical Chemistry.2026; 22(1): 35.     CrossRef
  • Integrative multi-omics and machine learning identify mitochondrial biomarkers for pathogen-specific sepsis stratification and translational prioritization
    Chaoyuan Jin, Ruijinlin Hao, Bate Gonggaoang, Qingxia Dai, Xingxing Ren, Jie Shen
    European Journal of Medical Research.2026;[Epub]     CrossRef
  • Age–Comorbidity Interactions and Clinical Outcomes in Septic Shock: An Emergency Department-Based Multicenter Cohort Study
    Seung Jin Maeng, Jong Eun Park, Gun Tak Lee, Sung Yeon Hwang, Minha Kim, Sejin Heo, Tae Ho Lim, Sung Phil Chung, Sung-Hyuk Choi, Tae Gun Shin
    Healthcare.2026; 14(6): 722.     CrossRef
  • Artificial intelligence-driven cluster analysis for identifying clinical phenotypes in suspected sepsis patients in the emergency department
    Daun Jeong, Jong Rul Park, Seung Jin Maeng, Jung Won Choi, Gun Tak Lee, Sung Yeon Hwang, Chulhong Kim, Jong Eun Park, Tae Gun Shin
    BMC Emergency Medicine.2026;[Epub]     CrossRef
  • Early prediction of renal replacement therapy within 24 hours after septic shock recognition in the emergency department using machine learning: a retrospective analysis of a prospectively collected multicenter registry
    Sangun Nah, Tae Ho Lim, Sung Phil Chung, Gil Joon Suh, Sung-Hyuk Choi, Woon Yong Kwon, Won Young Kim, Kyuseok Kim, Sangchun Choi, Je Sung You, Han Sung Choi, Tae Gun Shin, Sangsoo Han
    BMC Emergency Medicine.2026;[Epub]     CrossRef
  • Early vasopressin administration in septic shock: A systematic review, meta-analysis, and multicenter retrospective observational study
    Chiwon Ahn, Gun Tak Lee, Jae Hwan Kim, Sejoong Ahn, Sung Yeon Hwang, Sang-Min Kim, Won Young Kim, Sung-Joon Park, Sung-Hyuk Choi, Woon Yong Kwon, Taeyoung Kong, Sung Phil Chung, Byuk Sung Ko, Kyung Hun Yoo, Tae Ho Lim, Tae Gun Shin, Kyuseok Kim
    European Journal of Internal Medicine.2026; : 106933.     CrossRef
  • Metabolic footprint of sepsis and septic shock: A narrative review
    Anjali Mishra, Deven Juneja
    World Journal of Critical Care Medicine.2026;[Epub]     CrossRef
  • Neutrophil immunometabolism in ACLF and sepsis: mechanisms, dysfunction, and therapeutic opportunities
    Sonali Mukherjee, Takhellambam Malemnganba, Pragyan Acharya
    Frontiers in Immunology.2026;[Epub]     CrossRef
  • Integrative transcriptomic and bioinformatic analyses predict candidate EMT-related genes in sepsis-associated acute lung injury
    Jun Liu, Yun Chen, Hao Peng, Zheyuan Xu, Yang Wang, Libin Zhang, Han Wang
    Naunyn-Schmiedeberg's Archives of Pharmacology.2026;[Epub]     CrossRef
  • Metabolic reprogramming in sepsis-associated acute kidney injury: insights from lipopolysaccharide-induced oxidative stress and amino acid dysregulation
    Hakan Turk, Ebru Temiz, Ismail Koyuncu
    Molecular Biology Reports.2025;[Epub]     CrossRef
  • Leveraging diverse cell-death patterns in diagnosis of sepsis by integrating bioinformatics and machine learning
    Mi Liu, Xingxing Gao, Hongfa Wang, Yiping Zhang, Xiaojun Li, Renlai Zhu, Yunru Sheng
    PeerJ.2025; 13: e19077.     CrossRef
  • Characterization of metabolism associated with outcomes in severe acute pancreatitis: Insights from serum metabolomic analysis
    Mohd Adnan Siddiqui, Anamika Singh, Swarnima Pandey, Mohammed Haris Siddiqui, Afzal Azim, Neeraj Sinha
    Biophysical Chemistry.2025; 322: 107436.     CrossRef
  • Untargeted lipidomics profiling provides novel insights into pediatric patients with sepsis: an exploratory study
    Reyihangu Awuti, Jiayi Bai, Ye Cheng, Weili Yang, Zimei Cheng, Hetian Zhou, Guoyun Su, Kexin Wang, Yaodong Wang, Tingyan Liu, Ying Liu, Weiming Chen, Hehe Chen, Guoping Lu, Caiyan Zhang
    Metabolomics.2025;[Epub]     CrossRef
  • Multi‐Omics and ‐Organ Insights into Energy Metabolic Adaptations in Early Sepsis Onset
    Lin‐Lin Xu, Zhengyuan Zhou, Sascha Schäuble, Wolfgang Vivas, Karen Dlubatz, Michael Bauer, Sebastian Weis, Mervyn Singer, Roman Lukaszewski, Gianni Panagiotou
    Advanced Science.2025;[Epub]     CrossRef
  • Metabolomics for the Identification of Biomarkers in Rheumatoid Arthritis
    Swarnima Pandey
    Phenomics.2025; 5(3): 343.     CrossRef
  • Understanding metabolic alterations in advanced stage chronic kidney disease patients by NMR-based metabolomics
    Amrita Sahu, Upasna Gupta, Bikash Baishya, Dharmendra Singh Bhadauria, Neeraj Sinha
    Molecular Omics.2025; 21(5): 464.     CrossRef
  • Functional metabolomics: unlocking the role of small molecular metabolites
    Hetao Chen, Jiao Kong, Peipei Du, Qian Wang, Tao Jiang, Xixi Hou, Tingting Feng, Jiajia Duan, Chuanxin Liu
    Frontiers in Molecular Biosciences.2025;[Epub]     CrossRef
  • Recent advances in biomarkers for detection and diagnosis of sepsis and organ dysfunction: a comprehensive review
    Leiyang Chen, Xiuxiu Zhang, Peizhi Shi
    European Journal of Medical Research.2025;[Epub]     CrossRef
  • Metabolomics for the identification of biomarkers in endometriosis
    Swarnima Pandey
    Archives of Gynecology and Obstetrics.2024; 310(6): 2823.     CrossRef
  • 10,332 View
  • 199 Download
  • 22 Web of Science
  • 21 Crossref

Original Article

The mortality of patients with sepsis increases in the first month of a new academic year
Sukyo Lee, Sungjin Kim, Sejoong Ahn, Hanjin Cho, Sungwoo Moon, Young Duck Cho, Jong-Hak Park
Clin Exp Emerg Med 2024;11(2):161-170.   Published online January 29, 2024
DOI: https://doi.org/10.15441/ceem.23.117

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The mortality of patients with sepsis increases in the first month of a new academic year
Clin Exp Emerg Med. 2024;11(2):161-170.   Published online January 29, 2024
DOI: https://doi.org/10.15441/ceem.23.117
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The mortality of patients with sepsis increases in the first month of a new academic year
Clin Exp Emerg Med. 2024;11(2):161-170.   Published online January 29, 2024
DOI: https://doi.org/10.15441/ceem.23.117
Close
Objective
Many studies have examined the July effect. However, little is known about the July effect in sepsis. We hypothesized that the July effect would result in worse outcomes for patients with sepsis. Methods Data from patients with sepsis, collected prospectively between January 2018 and December 2021, were analyzed. In Korea, the new academic year starts on March 1, so the “July effect” appears in March. The primary outcome was 30-day mortality. Secondary outcomes included adherence to the Surviving Sepsis Campaign bundle. Outcomes in March were compared to other months. A multivariate Cox proportional hazard regression was performed to adjust for confounders. Results We included 843 patients. There were no significant differences in sepsis severity. The 30-day mortality in March was higher (49.0% vs. 28.5%, P<0.001). However, there was no difference in bundle adherence in March (42.2% vs. 48.0%, P=0.264). The multivariate Cox proportional hazard regression showed that the July effect was associated with 30-day mortality in patients with sepsis (adjusted hazard ratio, 1.925; 95% confidence interval, 1.405–2.638; P<0.001). Conclusion The July effect was associated with 30-day mortality in patients with sepsis. However, bundle adherence did not differ. These results suggest that the increase in mortality during the turnover period might be related to unmeasured in-hospital management. Intensive supervision and education of residents caring for patients with sepsis is needed in the beginning of training.

Citations

Citations to this article as recorded by  Crossref logo
  • Illness severity modifies the association between sepsis and survival in critically ill patients with acute kidney injury
    Mahnaz Derakhshan, Mory Ghomshei, Hamid Reza Ansarian
    Clinical and Experimental Nephrology.2026; 30(4): 581.     CrossRef
  • 6,882 View
  • 102 Download
  • 1 Web of Science
  • 1 Crossref

Systematic Review

Mortality among adult patients with sepsis and septic shock in Korea: a systematic review and meta-analysis
Myeong Namgung, Chiwon Ahn, Yeonkyung Park, Il-Youp Kwak, Jungguk Lee, Moonho Won
Clin Exp Emerg Med 2023;10(2):157-171.   Published online March 7, 2023
DOI: https://doi.org/10.15441/ceem.23.005

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Mortality among adult patients with sepsis and septic shock in Korea: a systematic review and meta-analysis
Clin Exp Emerg Med. 2023;10(2):157-171.   Published online March 7, 2023
DOI: https://doi.org/10.15441/ceem.23.005
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Mortality among adult patients with sepsis and septic shock in Korea: a systematic review and meta-analysis
Clin Exp Emerg Med. 2023;10(2):157-171.   Published online March 7, 2023
DOI: https://doi.org/10.15441/ceem.23.005
Close
Objective
To evaluate mortality from sepsis and septic shock in Korea during the past 10 years, we conducted a systematic review and meta-analysis.
Methods
We searched six databases for studies on mortality from sepsis and septic shock in adult patients. Primary outcomes were 28- or 30-day mortality and in-hospital mortality from sepsis and septic shock. To assess the risk of bias, we used the Newcastle-Ottawa Scale and Risk of Bias 2 tools. The protocol is registered in PROSPERO (No. CRD42022365739).
Results
A total of 61 studies were included. The mortality rates from sepsis and septic shock at 28 or 30 days were 22.7% (95% confidence interval [CI], 20.0%–25.6%; I2=89%) and 27.6% (95% CI, 22.3%–33.5%; I2=98%), respectively, according to the Sepsis-3 criteria. Furthermore, in accordance with the Sepsis-3 criteria, the in-hospital mortality rates were 28.1% (95% CI, 25.2%–31.1%; I2=87%) and 34.3% (95% CI, 27.2%–42.2%; I2=97%), respectively.
Conclusion
The mortality rates from sepsis and septic shock in Korea are high. In the case of septic shock, the in-hospital mortality rate is approximately 30%.

Citations

Citations to this article as recorded by  Crossref logo
  • Red Blood Cell Transfusion Beyond Restrictive Thresholds in Patients With Septic Shock and an Elevated Lactate Level: A Multicenter Observational Study
    Kyung Hun Yoo, Gil Joon Suh, Woon Yong Kwon, Sung-Hyuk Choi, Sung Phil Chung, Won Young Kim, Kyuseok Kim, Yoo Seok Park, Tae Gun Shin, Byuk Sung Ko, Tae Ho Lim, Yongil Cho
    Journal of Korean Medical Science.2026;[Epub]     CrossRef
  • Free Thyroxine as a Predictor of Mortality in Critically Ill Septic Patients—A Retrospective Study
    Matei Florin Negruț, Vlad Pastor, Robert Bolcaș, Oana Antal, Robert Szabo, Cristina Petrișor
    Diagnostics.2026; 16(5): 680.     CrossRef
  • Comparison of prognosis in emergency department elderly septic shock patients with initial hypotension versus delayed hypotension
    Chaeeun Lee, Gil Joon Suh, Sung-Hyuk Choi, Sung Phil Chung, Won Young Kim, Tae Ho Lim, Sangchun Choi, Tae Gun Shin, Sangun Nah, Sangsoo Han
    European Journal of Emergency Medicine.2026; 33(3): 169.     CrossRef
  • Clinical Profiles, Interventions, and Outcomes of Sepsis and Septic Shock in a Saudi Arabian Tertiary ICU: A Five-Year Retrospective Analysis
    Amer Asiri, Khaled Abdulwahab Amer, Mushary Alqahtani, Lena A. Almathami, Osama Ayed Asiri, Sultan Saad Alnasser, Ahmed Ali Khuzayyim, Bander Abdullah Alqahtani, Fatimah Mohammed Asiri, Hatem Mostafa Asiri
    Healthcare.2026; 14(5): 680.     CrossRef
  • Papaverine Mitigates Acute Kidney Injury in Feces-Induced Polymicrobial Sepsis Through Regulation of the HMGB1–RAGE Axis
    Mehmet Fatih Dasiran, Ahmet Akbaş, Bakiye Akbaş, Ejder Saylav Bora, Hatice Aygun, Oytun Erbas
    Medicina.2026; 62(4): 621.     CrossRef
  • Knowledge, attitudes, and practices of pre-hospital emergency medical care practitioners regarding sepsis recognition: a cross-sectional study in Qatar
    Michael Steven Paul Lewis, Paula J. W. Smith, Ian Lucas Howard, Hassan Farhat, Guillaume Alinier
    BMC Emergency Medicine.2026;[Epub]     CrossRef
  • Outcomes and risk factors in HIV-positive patients with sepsis: a retrospective study
    Qiang Gao, Tingting Wang, Shun Tan, Yu Tian, An Zhang
    European Journal of Medical Research.2025;[Epub]     CrossRef
  • Prognostic Value of the AST/ALT Ratio in Patients with Septic Shock: A Prospective, Multicenter, Registry-Based Observational Study
    Sungwoo Choi, Sangun Nah, Gil Joon Suh, Sung-Hyuk Choi, Sung Phil Chung, Won Young Kim, Tae Ho Lim, Sangchun Choi, Tae Gun Shin, Sangsoo Han
    Diagnostics.2025; 15(14): 1773.     CrossRef
  • Epidemiology and outcomes of septic shock in Japan: a nationwide retrospective cohort study from a medical claims database by the Japan Sepsis Alliance (JaSA) study group
    Taro Imaeda, Takehiko Oami, Tatsuro Yokoyama, Satoshi Nakagawa, Hiroshi Ogura, Nobuaki Shime, Yutaka Umemura, Asako Matsushima, Kiyohide Fushimi, Taka-aki Nakada
    Critical Care.2025;[Epub]     CrossRef
  • Epidemiology of sepsis in emergency departments: insights from the National Emergency Department Information System (NEDIS) database in Korea, 2018–2022
    Tae Gun Shin, Eunsil Ko, So-hyun Han, Taehui Kim, Dai Hai Choi
    Clinical and Experimental Emergency Medicine.2025; 12(3): 185.     CrossRef
  • Predicting septic shock in patients with sepsis at emergency department triage using systolic and diastolic shock index
    Yumin Jeon, Sungjin Kim, Sejoong Ahn, Jong-Hak Park, Hanjin Cho, Sungwoo Moon, Sukyo Lee
    The American Journal of Emergency Medicine.2024; 78: 196.     CrossRef
  • An observational study on the impact of overcrowding towards door-to-antibiotic time among sepsis patients presented to emergency department of a tertiary academic hospital
    Evelyn Yi Wen Chau, Afliza Abu Bakar, Aireen Binti Zamhot, Ida Zarina Zaini, Siti Norafida Binti Adanan, Dazlin Masdiana Binti Sabardin
    BMC Emergency Medicine.2024;[Epub]     CrossRef
  • Ischemia-Modified Albumin, Lactate, and Combination for Predicting Mortality in Patients with Septic Shock in the Emergency Department
    Bo-Yeong Jin, Sukyo Lee, Woosik Kim, Jong-Hak Park, Hanjin Cho, Sungwoo Moon, Sejoong Ahn
    Biomedicines.2024; 12(7): 1421.     CrossRef
  • Temperature trajectories and mortality in hypothermic sepsis patients
    Dongkwan Han, Seung Hyun Kang, Young Woo Um, Hee Eun Kim, Ji Eun Hwang, Jae Hyuk Lee, You Hwan Jo, Yoon Sun Jung, Hui Jai Lee
    The American Journal of Emergency Medicine.2024; 84: 18.     CrossRef
  • Comparison of Early and Late Norepinephrine Administration in Patients With Septic Shock
    Chiwon Ahn, Gina Yu, Tae Gun Shin, Youngsuk Cho, Sunghoon Park, Gee Young Suh
    CHEST.2024; 166(6): 1417.     CrossRef
  • Diagnostic Accuracy of Plasma Renin Concentration and Renin Activity in Predicting Mortality and Kidney Outcomes in Patients With Septic Shock and Hypoperfusion or Hypotension: A Multicenter, Prospective, Observational Study
    Gun Tak Lee, Byuk Sung Ko, Da Seul Kim, Minha Kim, Jong Eun Park, Sung Yeon Hwang, Daun Jeong, Chi Ryang Chung, Hyunggoo Kang, Jaehoon Oh, Tae Ho Lim, Bora Chae, Won Young Kim, Tae Gun Shin
    Annals of Laboratory Medicine.2024; 44(6): 497.     CrossRef
  • The mortality of patients with sepsis increases in the first month of a new academic year
    Sukyo Lee, Sungjin Kim, Sejoong Ahn, Hanjin Cho, Sungwoo Moon, Young Duck Cho, Jong-Hak Park
    Clinical and Experimental Emergency Medicine.2024; 11(2): 161.     CrossRef
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  • Modified Cardiovascular Sequential Organ Failure Assessment Score in Sepsis: External Validation in Intensive Care Unit Patients
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Original Article

Prediction of vasopressor requirement among hypotensive patients with suspected infection: usefulness of diastolic shock index and lactate
Da Seul Kim, Jong Eun Park, Sung Yeon Hwang, Daun Jeong, Gun Tak Lee, Taerim Kim, Se Uk Lee, Hee Yoon, Won Chul Cha, Min Seob Sim, Ik Joon Jo, Tae Gun Shin
Clin Exp Emerg Med 2022;9(3):176-186.   Published online September 30, 2022
DOI: https://doi.org/10.15441/ceem.22.324

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Prediction of vasopressor requirement among hypotensive patients with suspected infection: usefulness of diastolic shock index and lactate
Clin Exp Emerg Med. 2022;9(3):176-186.   Published online September 30, 2022
DOI: https://doi.org/10.15441/ceem.22.324
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Prediction of vasopressor requirement among hypotensive patients with suspected infection: usefulness of diastolic shock index and lactate
Clin Exp Emerg Med. 2022;9(3):176-186.   Published online September 30, 2022
DOI: https://doi.org/10.15441/ceem.22.324
Close
Objective
We evaluated the performance of diastolic shock index (DSI) and lactate in predicting vasopressor requirement among hypotensive patients with suspected infection in an emergency department.
Methods
This was a single-center, retrospective observational study for adult patients with suspected infection and hypotension in the emergency department from 2018 to 2019. The study population was split into derivation and validation cohorts (70/30). We derived a simple risk score to predict vasopressor requirement using DSI and lactate cutoff values determined by Youden index. We tested the score by the area under the receiver operating characteristic curve (AUC). We performed a multivariable regression analysis to evaluate the association between the timing of vasopressor treatment and 28-day mortality.
Results
A total of 1,917 patients were included. We developed a score, assigning 1 point each for the high DSI (≥2.0) and high lactate (≥2.5 mmol/L) criteria. The AUCs of the score were 0.741 (95% confidence interval [CI], 0.715–0.768) at hypotension and 0.736 (95% CI, 0.708–0.763) after initial fluid challenge in the derivation cohort and 0.676 (95% CI, 0.631–0.719) at hypotension and 0.688 (95% CI, 0.642–0.733) after initial fluid challenge in the validation cohort, respectively. In patients with scores of 2 points, early vasopressor therapy initiation was significantly associated with decreased 28-day mortality (adjusted odds ratio, 0.37; 95% CI, 0.14–0.94).
Conclusion
A prediction model with DSI and lactate levels might be useful to identify patients who are more likely to need vasopressor administration among hypotensive patients with suspected infection.

Citations

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Study Protocol

The DEXA-SEPSIS study protocol: a phase II randomized double-blinded controlled trial of the effect of early dexamethasone in high-risk sepsis patients
Kihwan Choi, Jong Eun Park, Anhye Kim, Sojung Hwang, Jinkun Bae, Tae Gun Shin, Kyuseok Kim
Clin Exp Emerg Med 2022;9(3):246-252.   Published online September 20, 2022
DOI: https://doi.org/10.15441/ceem.22.276

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The DEXA-SEPSIS study protocol: a phase II randomized double-blinded controlled trial of the effect of early dexamethasone in high-risk sepsis patients
Clin Exp Emerg Med. 2022;9(3):246-252.   Published online September 20, 2022
DOI: https://doi.org/10.15441/ceem.22.276
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The DEXA-SEPSIS study protocol: a phase II randomized double-blinded controlled trial of the effect of early dexamethasone in high-risk sepsis patients
Clin Exp Emerg Med. 2022;9(3):246-252.   Published online September 20, 2022
DOI: https://doi.org/10.15441/ceem.22.276
Close
Objective
Steroids are used in cases of sepsis, especially in patients experiencing septic shock. However, clinical trials to date have reported contradictory results. Different patient endotypes and variations in the type and dose of steroid may be at fault for this discrepancy, and further investigation is warranted. In this paper, we propose a new DEXA-SEPSIS study design.
Methods
We plan to conduct a multicenter, double-blinded randomized pilot study (DEXA-SEPSIS) investigating the feasibility and safety of early use of dexamethasone in sepsis. Participants will be high-risk septic patients presenting to the emergency department with a systolic blood pressure of <90 mmHg or serum lactate level of >2 mmol/L. Participants will be randomized to the following three groups: control, 0.1 mg/kg of dexamethasone, or 0.2 mg/kg of dexamethasone per day for 1 to 2 days. The primary outcome will be 28-day mortality. Secondary outcomes will include time to septic shock, shock reversal, additional steroid administration, number of ventilator-free days, use of continuous renal-replacement therapy, length of stay in the intensive care unit and/or hospital, delta Sequential Organ Failure Assessment score on days 3 and 7, superinfection, gastrointestinal bleeding, hypernatremia, and hyperglycemia.
Discussion
The DEXA-SEPSIS study will provide insight regarding the feasibility and safety of early use of dexamethasone in high-risk sepsis. The results could provide data to design a future phase III study. Trial registration ClinicalTrials.gov Identifier: NCT05136560

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Original Articles

A quick Sequential Organ Failure Assessment–negative result at triage is associated with low compliance with sepsis bundles: a retrospective analysis of a multicenter prospective registry
Heesu Park, Tae Gun Shin, Won Young Kim, You Hwan Jo, Yoon Jung Hwang, Sung-Hyuk Choi, Tae Ho Lim, Kap Su Han, Jonghwan Shin, Gil Joon Suh, Gu Hyun Kang, Kyung Su Kim, Korean Shock Society investigators
Clin Exp Emerg Med 2022;9(2):84-92.   Published online June 30, 2022
DOI: https://doi.org/10.15441/ceem.22.230

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A quick Sequential Organ Failure Assessment–negative result at triage is associated with low compliance with sepsis bundles: a retrospective analysis of a multicenter prospective registry
Clin Exp Emerg Med. 2022;9(2):84-92.   Published online June 30, 2022
DOI: https://doi.org/10.15441/ceem.22.230
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A quick Sequential Organ Failure Assessment–negative result at triage is associated with low compliance with sepsis bundles: a retrospective analysis of a multicenter prospective registry
Clin Exp Emerg Med. 2022;9(2):84-92.   Published online June 30, 2022
DOI: https://doi.org/10.15441/ceem.22.230
Close
Objective
We investigated the effects of a quick Sequential Organ Failure Assessment (qSOFA)–negative result (qSOFA score <2 points) at triage on the compliance with sepsis bundles among patients with sepsis who presented to the emergency department (ED).
Methods
Prospective sepsis registry data from 11 urban tertiary hospital EDs between October 2015 and April 2018 were retrospectively reviewed. Patients who met the Third International Consensus Definitions for Sepsis and Septic Shock criteria were included. Primary exposure was defined as a qSOFA score ≥2 points at ED triage. The primary outcome was defined as 3-hour bundle compliance, including lactate measurement, blood culture, broad-spectrum antibiotics administration, and 30 mL/kg crystalloid administration. Multivariate logistic regression analysis to predict 3-hour bundle compliance was performed.
Results
Among the 2,250 patients enrolled in the registry, 2,087 fulfilled the sepsis criteria. Only 31.4% (656/2,087) of the sepsis patients had qSOFA scores ≥2 points at triage. Patients with qSOFA scores <2 points had lower lactate levels, lower SOFA scores, and a lower 28-day mortality rate. Rates of compliance with lactate measurement (adjusted odds ratio [aOR], 0.47; 95% confidence interval [CI], 0.29–0.75), antibiotics administration (aOR, 0.64; 95% CI, 0.52–0.78), and 30 mL/kg crystalloid administration (aOR, 0.62; 95% CI, 0.49–0.77) within 3 hours from triage were significantly lower in patients with qSOFA scores <2 points. However, the rate of compliance with blood culture within 3 hours from triage (aOR, 1.66; 95% CI, 1.33–2.08) was higher in patients with qSOFA scores <2 points.
Conclusion
A qSOFA-negative result at ED triage is associated with low compliance with lactate measurement, broad-spectrum antibiotics administration, and 30 mL/kg crystalloid administration within 3 hours in sepsis patients.

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    Tae Han Kim, Daun Jeong, Jong Eun Park, Sung Yeon Hwang, Gil Joon Suh, Sung-Hyuk Choi, Sung Phil Chung, Won Young Kim, Gun Tak Lee, Tae Gun Shin
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  • 12 Crossref
A comparison of scoring systems for predicting mortality and sepsis in the emergency department patients with a suspected infection
Manita Thodphetch, Boriboon Chenthanakij, Borwon Wittayachamnankul, Kamphee Sruamsiri, Theerapon Tangsuwanaruk
Clin Exp Emerg Med 2021;8(4):289-295.   Published online December 31, 2021
DOI: https://doi.org/10.15441/ceem.20.145

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A comparison of scoring systems for predicting mortality and sepsis in the emergency department patients with a suspected infection
Clin Exp Emerg Med. 2021;8(4):289-295.   Published online December 31, 2021
DOI: https://doi.org/10.15441/ceem.20.145
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A comparison of scoring systems for predicting mortality and sepsis in the emergency department patients with a suspected infection
Clin Exp Emerg Med. 2021;8(4):289-295.   Published online December 31, 2021
DOI: https://doi.org/10.15441/ceem.20.145
Close
Objective
We aimed to compare the modified National Early Warning Score (mNEWS), quick Sequential Organ Failure Assessment (qSOFA) score, modified Systemic Inflammatory Response Syndrome (mSIRS) score, and modified Search Out Severity (mSOS) score in predicting mortality and sepsis among patients suspected of first observed infections in the emergency department. The modified scores were created by removing variables for simplicity.
Methods
This was a prospective cohort study that enrolled adult patients presenting at the emergency department with signs and symptoms suggesting infection. The mNEWS, qSOFA score, mSIRS score, and mSOS score were calculated using triage data. The SOFA score was a reference standard for sepsis diagnosis. All patients were monitored for up to 30 days after the initial visit to measure each scoring system’s ability to predict 30-day mortality and sepsis.
Results
There were 260 patients included in the study. The 30-day mortality prediction with mNEWS ≥5 had the highest sensitivity (91.18%). The highest area under the receiver operating characteristic curve (AUC) for the 30-day mortality prediction was mNEWS (0.607), followed by qSOFA (0.605), mSOS (0.550), and mSIRS (0.423). The sepsis prediction with mNEWS ≥5 had the highest sensitivity (96.48%). The highest AUC for the sepsis prediction was also mNEWS (0.685), followed by qSOFA (0.605), mSOS (0.480), and mSIRS (0.477).
Conclusion
mNEWS was an acceptable scoring system screening tool for predicting mortality and sepsis in patients with a suspected infection.

Citations

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  • Early Recognition of Sepsis in Prehospital Settings
    William C. Tirado
    Advanced Emergency Nursing Journal.2025; 47(2): 152.     CrossRef
  • Evaluating Sepsis Mortality Predictions from the Emergency Department: A Retrospective Cohort Study Comparing qSOFA, the National Early Warning Score, and the International Early Warning Score
    German Alberto Devia-Jaramillo, Lilia Erazo-Guerrero, Vivian Laguado-Castro, Juan Manuel Alfonso-Parada
    Journal of Clinical Medicine.2025; 14(14): 4869.     CrossRef
  • Performance of Early Sepsis Screening Tools for Timely Diagnosis and Antibiotic Stewardship in a Resource-Limited Thai Community Hospital
    Wisanu Wanlumkhao, Duangduan Rattanamongkolgul, Chatchai Ekpanyaskul
    Antibiotics.2025; 14(7): 708.     CrossRef
  • Predictive performance of clinical scores and survival outcomes in critically ill patients with sepsis: a prospective longitudinal study at a tertiary medical centre in Ethiopia
    Girum Tesfaye Kiya, Zeleke Mekonnen, Elsah Tegene Asefa, Edosa Kejela, Edosa Tadasa, Esayas Kebede Gudina, Tilahun Yemane, Gemeda Abebe
    PeerJ.2025; 13: e20109.     CrossRef
  • Prognostic value of REDS, SOFA, and D-dimer in critically ill COVID-19 patients with sepsis
    Dejana Bajic, Milica Plazacic, Andrea Mihajlovic
    Srpski arhiv za celokupno lekarstvo.2025; 153(11-12): 542.     CrossRef
  • Navigating the Complexity of Scoring Systems in Sepsis Management: A Comprehensive Review
    Venkat Reddy, Harshitha Reddy, Rinkle Gemnani, Sunil Kumar, Sourya Acharya
    Cureus.2024;[Epub]     CrossRef
  • Comparing 11 early warning scores and three shock indices in early sepsis prediction in the emergency department
    Rex Pui Kin Lam, Zonglin Dai, Eric Ho Yin Lau, Carrie Yuen Ting Ip, Ho Ching Chan, Lingyun Zhao, Tat Chi Tsang, Matthew Sik Hon Tsui, Timothy Hudson Rainer
    World Journal of Emergency Medicine.2024; 15(4): 273.     CrossRef
  • Evaluating the Accuracy of the SIL Score for Predicting the Sepsis Mortality in Emergency Department Triages: A Comparative Analysis with NEWS and SOFA
    German Devia Jaramillo, Lilia Erazo Guerrero, Natalia Florez Zuñiga, Ronal Mauricio Martin Cuesta
    Journal of Clinical Medicine.2024; 13(24): 7787.     CrossRef
  • SIRS, SOFA, qSOFA, and NEWS in the diagnosis of sepsis and prediction of adverse outcomes: a systematic review and meta-analysis
    Xia Qiu, Yu-Peng Lei, Rui-Xi Zhou
    Expert Review of Anti-infective Therapy.2023; 21(8): 891.     CrossRef
  • Prognostic Performance of Sequential Organ Failure Assessment, Acute Physiology and Chronic Health Evaluation III, and Simplified Acute Physiology Score II Scores in Patients with Suspected Infection According to Intensive Care Unit Type
    Sung-Yeon Hwang, In-Kyu Kim, Daun Jeong, Jong-Eun Park, Gun-Tak Lee, Junsang Yoo, Kihwan Choi, Tae-Gun Shin, Kyuseok Kim
    Journal of Clinical Medicine.2023; 12(19): 6402.     CrossRef
  • Screening tools for sepsis identification in paramedicine and other emergency contexts: a rapid systematic review
    Megan De Silva, William Chadwick, Navindhra Naidoo
    Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.2023;[Epub]     CrossRef
  • A quick Sequential Organ Failure Assessment–negative result at triage is associated with low compliance with sepsis bundles: a retrospective analysis of a multicenter prospective registry
    Heesu Park, Tae Gun Shin, Won Young Kim, You Hwan Jo, Yoon Jung Hwang, Sung-Hyuk Choi, Tae Ho Lim, Kap Su Han, Jonghwan Shin, Gil Joon Suh, Gu Hyun Kang, Kyung Su Kim
    Clinical and Experimental Emergency Medicine.2022; 9(2): 84.     CrossRef
  • Audit of a computerized version of the Manchester triage system and a SIRS-based system for the detection of sepsis at triage in the emergency department
    Ken Dewitte, Elyne Scheurwegs, Sabrina Van Ierssel, Hilde Jansens, Karolien Dams, Ella Roelant
    International Journal of Emergency Medicine.2022;[Epub]     CrossRef
  • 15,863 View
  • 339 Download
  • 15 Web of Science
  • 13 Crossref
Comparison of body water status and its distribution in patients with non-septic infection, patients with sepsis, and healthy controls
Jieun Shin, Inwon Park, Jae Hyuk Lee, Jong Soo Han, Byunghyun Kim, Dong-Hyun Jang, Sang-Min Lee, Che Uk Lee, You Hwan Jo
Clin Exp Emerg Med 2021;8(3):173-181.   Published online September 30, 2021
DOI: https://doi.org/10.15441/ceem.20.094

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Comparison of body water status and its distribution in patients with non-septic infection, patients with sepsis, and healthy controls
Clin Exp Emerg Med. 2021;8(3):173-181.   Published online September 30, 2021
DOI: https://doi.org/10.15441/ceem.20.094
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Comparison of body water status and its distribution in patients with non-septic infection, patients with sepsis, and healthy controls
Clin Exp Emerg Med. 2021;8(3):173-181.   Published online September 30, 2021
DOI: https://doi.org/10.15441/ceem.20.094
Close
Objective
Although fluid resuscitation is the cornerstone of treatment for sepsis, the role of body water status in sepsis is poorly understood. This study aimed to understand how body water and its distribution are modified in patients with sepsis and those with non-septic infection compared to healthy individuals.
Methods
Two groups of adults presumed to have non-septic infection (n=87) and sepsis (n=54) were enrolled in this prospective study in a single emergency department, and they were compared to sex-, age-, and height-matched (1:3 ratio) healthy controls (n=11,190) from retrospective data in a health promotion center. Total body water (TBW), intracellular water (ICW), and extracellular water (ECW), determined using direct segmental multi-frequent bioelectrical impedance analysis (InBody S10) were expressed as indices for normalization by body weight (BW). The ratio of ECW to TBW (ECW/TBW) was evaluated to determine body water distribution.
Results
TBW/BW, ICW/BW, and ECW/BW were significantly higher in the non-septic infection group than in the healthy group (P<0.001), but ECW/TBW was not significantly different (P=0.690). There were no differences in TBW/BW and ICW/BW between the sepsis and healthy groups (P=0.083 and P=0.963). However, ECW/BW and ECW/TBW were significantly higher in the sepsis group than in the healthy group (P<0.001).
Conclusion
Compared to the healthy group, the ratio of body water to BW was significantly increased in the non-septic infection group, while ECW/BW and ECW/TBW were significantly increased in the sepsis group. These indices could be utilized as diagnostic variables of body water deficit in septic patients.

Citations

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  • N-myc and STAT interactor is a novel biomarker for predicting the severity and clinical outcome of sepsis: a prospective research
    Xuan Leng, Hui Zhou, Wanying Zhang, Yifei Zeng, Lexin Xia, Chunlu Cheng, Feng Xu
    Frontiers in Cellular and Infection Microbiology.2026;[Epub]     CrossRef
  • Bioimpedance measurements of fibrotic and acutely injured lung tissues
    Mohammad Mir, Jiawen Chen, Aneri Patel, Meghan R. Pinezich, Maria R. Hudock, Alexander Yoon, Mohamed Diane, John O'Neill, Matthew Bacchetta, Gordana Vunjak-Novakovic, Jinho Kim
    Acta Biomaterialia.2025; 194: 270.     CrossRef
  • Community‐Based Pilot Study of a Wrist‐Worn Bioimpedance Hydration Sensor and Its Implications for Understanding the Relationship Between Hydration and Cognitive Function
    Isaac Opoku, Eamon Johnson, Shravan Khare, Adam T. Perzynski, Mary Joan Roach
    Health Science Reports.2025;[Epub]     CrossRef
  • Bioelectrical impedance analysis to assess body water status during fluid infusion in a rat model of extracorporeal membrane oxygenation
    Soojin Lee, Seunghwan Song, Jong Hwan Park, Jun-Hyok Oh, Harin Rhee, Minji Sung, In-Seok Jeong, Mukhammad Kayumov, Hye Won Yun, Yang Hyun Cho
    Scientific Reports.2025;[Epub]     CrossRef
  • Effect of rigorous fluid management using monitoring of ECW ratio by bioelectrical impedance analysis in critically ill postoperative patients: A prospective, single-blind, randomized controlled study
    Yoon Ji Chung, Gyeo Ra Lee, Hye Sung Kim, Eun Young Kim
    Clinical Nutrition.2024; 43(9): 2164.     CrossRef
  • Handgrip strength is correlated with activities of daily living, balance, and body composition in patients with thoracolumbar compression fracture
    Hirokazu Inoue, Yukinori Hayashi, Hideaki Watanabe, Hideaki Sawamura, Yasuyuki Shiraishi, Ryo Sugawara, Atsushi Kimura, Masaaki Masubuchi, Katsushi Takeshita
    Medicine.2023; 102(9): e33141.     CrossRef
  • Sepsis-like Energy Deficit Is Not Sufficient to Induce Early Muscle Fiber Atrophy and Mitochondrial Dysfunction in a Murine Sepsis Model
    Alexandre Pierre, Claire Bourel, Raphael Favory, Benoit Brassart, Frederic Wallet, Frederic N. Daussin, Sylvain Normandin, Michael Howsam, Raphael Romien, Jeremy Lemaire, Gaelle Grolaux, Arthur Durand, Marie Frimat, Bruno Bastide, Philippe Amouyel, Eric B
    Biology.2023; 12(4): 529.     CrossRef
  • Feasibility study using longitudinal bioelectrical impedance analysis to evaluate body water status during fluid resuscitation in a swine sepsis model
    Hwain Jeong, Inwon Park, Jae Hyuk Lee, Dongsung Kim, Sumin Baek, Seonghye Kim, You Hwan Jo
    Intensive Care Medicine Experimental.2022;[Epub]     CrossRef
  • 9,617 View
  • 148 Download
  • 8 Web of Science
  • 8 Crossref
Usefulness of ischemia-modified albumin in the diagnosis of sepsis/septic shock in the emergency department
Seung Hwa Choo, Yong Su Lim, Jin Seong Cho, Jae Ho Jang, Jea Yeon Choi, Woo Sung Choi, Hyuk Jun Yang
Clin Exp Emerg Med 2020;7(3):161-169.   Published online September 30, 2020
DOI: https://doi.org/10.15441/ceem.19.075

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Usefulness of ischemia-modified albumin in the diagnosis of sepsis/septic shock in the emergency department
Clin Exp Emerg Med. 2020;7(3):161-169.   Published online September 30, 2020
DOI: https://doi.org/10.15441/ceem.19.075
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Usefulness of ischemia-modified albumin in the diagnosis of sepsis/septic shock in the emergency department
Clin Exp Emerg Med. 2020;7(3):161-169.   Published online September 30, 2020
DOI: https://doi.org/10.15441/ceem.19.075
Close
Objective
No studies have evaluated the diagnostic value of ischemia-modified albumin (IMA) for the early detection of sepsis/septic shock in patients presenting to the emergency department (ED). We aimed to assess the usefulness of IMA in diagnosing sepsis/septic shock in the ED.
Methods
This retrospective, observational study analyzed IMA, lactate, high sensitivity C-reactive protein, and procalcitonin levels measured within 1 hour of ED arrival. Patients with suspected infection meeting at least two systemic inflammatory response syndrome criteria were included and classified into the infection, sepsis, and septic shock groups using Sepsis-3 definitions. Areas under the receiver operating characteristic curves (AUCs) with 95% confidence intervals (CIs) and multivariate logistic regression were used to determine diagnostic performance.
Results
This study included 300 adult patients. The AUC (95% CI) of IMA levels (cut-off ≥85.5 U/mL vs. ≥87.5 U/mL) was higher for the diagnosis of sepsis than for that of septic shock (0.729 [0.667–0.791] vs. 0.681 [0.613–0.824]) and was higher than the AUC of procalcitonin levels (cut-off ≥1.58 ng/mL, 0.678 [0.613–0.742]) for the diagnosis of sepsis. When IMA and lactate levels were combined, the AUCs were 0.815 (0.762–0.867) and 0.806 (0.754–0.858) for the diagnosis of sepsis and septic shock, respectively. IMA levels independently predicted sepsis (odds ratio, 1.05; 95% CI, 1.00–1.09; P=0.029) and septic shock (odds ratio, 1.07; 95% CI, 1.02–1.11; P=0.002).
Conclusion
Our findings indicate that IMA levels are a useful biomarker for diagnosing sepsis/ septic shock early, and their combination with lactate levels can enhance the predictive power for early diagnosis of sepsis/septic shock in the ED.

Citations

Citations to this article as recorded by  Crossref logo
  • Protein post-translational modifications in sepsis: Molecular mechanisms and biomarkers
    Yuze Wang, Hongyi Li, Qian Zhao, Xiang Li, Xuefan Bu, Chenye Ma, Zhihui Liu, Jinghua Yang, Tongwen Sun
    Ageing Research Reviews.2026; 114: 102958.     CrossRef
  • Clinical utility of biomarkers for outcomes prediction in adults with suspected sepsis presenting to the emergency department: a synthesis of current evidence
    Mari Imamura, Sinead N Duggan, Thenmalar Vadiveloo, Jamie G Cooper, Callum T Kaye, Paul Manson, Gianni Virgili, Lorna Aucott, Mike Clarke, Miriam Brazzelli
    Health Technology Assessment.2026; : 1.     CrossRef
  • Evaluation of Serum Ischemia-Modified Albumin And Oxidative Stress Markers in Patients with Sepsis
    Selçuk Nazik, Selma Ates, Muhammed Seyithanoglu, Hafize Öksüz
    Infection and Drug Resistance.2025; Volume 18: 5079.     CrossRef
  • The Clinical Utility of Albumin with Sequential Organ Failure Assessment (SOFA) in Improving 30-Day Mortality Prediction in Patients with Infection in the Emergency Department
    Gianni Turcato, Arian Zaboli, Serena Sibilio, Michael Mian, Francesco Brigo
    Journal of Clinical Medicine.2023; 12(24): 7676.     CrossRef
  • Evaluation of Serum Ischemia Modified Albumin in Patients With COVID-19 Pneumonia: A Case-Control Study
    Emel Altintas, Ramazan Sabirli, Esra Yuksekkaya, Ozgur Kurt, Aylin Koseler
    Cureus.2022;[Epub]     CrossRef
  • Association between Vitamin C Deficiency and Mortality in Patients with Septic Shock
    Jong Eun Park, Tae Gun Shin, Daun Jeong, Gun Tak Lee, Seung Mok Ryoo, Won Young Kim, You Hwan Jo, Gil Joon Suh, Sung Yeon Hwang
    Biomedicines.2022; 10(9): 2090.     CrossRef
  • Geriatric Sepsis in the COVID-19 Era: Challenges in Diagnosis and Management
    Ozgur Karcıoglu, Sarper Yilmaz, Mazlum Kilic, Neslihan Ergün Suzer, Sedat Ozbay, Ali Cankut Tatlıparmak, Mustafa Ayan
    International Journal of Pharmaceutical Research And Allied Sciences.2022; 11(4): 123.     CrossRef
  • 8,553 View
  • 132 Download
  • 6 Web of Science
  • 7 Crossref
Mortality difference between early-identified sepsis and late-identified sepsis
Woon Jee, Sion Jo, Jae Baek Lee, Youngho Jin, Taeoh Jeong, Jae Chol Yoon, Boyoung Park
Clin Exp Emerg Med 2020;7(3):150-160.   Published online September 30, 2020
DOI: https://doi.org/10.15441/ceem.19.009

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Mortality difference between early-identified sepsis and late-identified sepsis
Clin Exp Emerg Med. 2020;7(3):150-160.   Published online September 30, 2020
DOI: https://doi.org/10.15441/ceem.19.009
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Mortality difference between early-identified sepsis and late-identified sepsis
Clin Exp Emerg Med. 2020;7(3):150-160.   Published online September 30, 2020
DOI: https://doi.org/10.15441/ceem.19.009
Close
Objective
The aim of the study was to compare the mortality rates of patients with early-identified (EI) sepsis and late-identified (LI) sepsis.
Methods
We performed a retrospective chart review of patients admitted to the emergency department and diagnosed with sepsis. EI sepsis was defined as patients with a Sequential Organ Failure Assessment (SOFA) score ≥2, based on 3 parameters of the SOFA score (Glasgow coma scale, mean arterial pressure, and partial pressure of oxygen/fraction of inspired oxygen ratio), measured within an hour of emergency department admission. The remaining patients were defined as LI sepsis. The primary outcome was in-hospital mortality.
Results
Of the total 204 patients with sepsis, 113 (55.4%) had EI sepsis. Overall mortality rate was 15.7%, and EI sepsis group had significantly higher mortality than LI sepsis (23.0% vs. 6.6%, P=0.003). The patients with EI sepsis, compared to those with LI sepsis, had higher SOFA score (median: 4 vs. 2, P<0.001); Acute Physiology and Chronic Health Evaluation (APACHE) II score (median: 14 vs. 10, P<0.001); were more likely to progress to septic shock within 6 hours after admission (17.7% vs. 1.1%, P<0.001); were more likely to be admitted to the intensive care unit (2.2% vs. 1.1%, P=0.001).
Conclusion
Mortality was significantly higher in the EI sepsis group than in the LI sepsis group.

Citations

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  • Association of all glycemic spectrum with the risk of sepsis and mortality: two cohort studies in the UK and USA
    Yanqing Liu, Yanting Cao, Ying Chen, Ning Li, Weiping Li, Xue Wang, Chao Deng, Caie Wang, Yang Yang
    International Journal of Surgery.2026; 112(3): 6804.     CrossRef
  • Lipid nanoparticles from L. meyenii Walp mitigate sepsis through multimodal protein corona formation
    Junsik J. Sung, Jacob R. Shaw, Josie D. Rezende, Shruti Dharmaraj, Andrea L. Cottingham, Mehari M. Weldemariam, Jace W. Jones, Maureen A. Kane, Ryan M. Pearson
    Molecular Therapy Methods & Clinical Development.2025; 33(2): 101491.     CrossRef
  • Optimizing early surgical sepsis management in the emergency department: Risk factors, early detection, and management: A scoping review
    Nikita Nunes Espat, Philip Lee, Samuel Baum, Brian Chin, Ruth Zagales, Zackary Yates, Quratulain Amin, Kathleen R. Schuemann, Adel Elkbuli
    The American Journal of Emergency Medicine.2025; 95: 133.     CrossRef
  • Timing and clinical risk factors for early acquisition of gut pathogen colonization with multidrug resistant organisms in the intensive care unit
    Loren Shamalov, Madison Heath, Elissa Lynch, Daniel A. Green, Angela Gomez-Simmonds, Daniel E. Freedberg
    Gut Pathogens.2024;[Epub]     CrossRef
  • Mortality among adult patients with sepsis and septic shock in Korea: a systematic review and meta-analysis
    Myeong Namgung, Chiwon Ahn, Yeonkyung Park, Il-Youp Kwak, Jungguk Lee, Moonho Won
    Clinical and Experimental Emergency Medicine.2023; 10(2): 157.     CrossRef
  • Modified Cardiovascular Sequential Organ Failure Assessment Score in Sepsis: External Validation in Intensive Care Unit Patients
    Byuk Sung Ko, Seung Mok Ryoo, Eunah Han, Hyunglan Chang, Chang June Yune, Hui Jai Lee, Gil Joon Suh, Sung-Hyuk Choi, Sung Phil Chung, Tae Ho Lim, Won Young Kim, Jang Won Sohn, Mi Ae Jeong, Sung Yeon Hwang, Tae Gun Shin, Kyuseok Kim
    Journal of Korean Medical Science.2023;[Epub]     CrossRef
  • Modified cardiovascular SOFA score in sepsis: development and internal and external validation
    Hui Jai Lee, Byuk Sung Ko, Seung Mok Ryoo, Eunah Han, Gil Joon Suh, Sung-Hyuk Choi, Sung Phil Chung, Tae Ho Lim, Won Young Kim, Woon Yong Kwon, Sung Yeon Hwang, You Hwan Jo, Jonghwan Shin, Tae Gun Shin, Kyuseok Kim, Sangchun Choi, Tae Nyoung Chung, Jae Hy
    BMC Medicine.2022;[Epub]     CrossRef
  • Association between Vitamin C Deficiency and Mortality in Patients with Septic Shock
    Jong Eun Park, Tae Gun Shin, Daun Jeong, Gun Tak Lee, Seung Mok Ryoo, Won Young Kim, You Hwan Jo, Gil Joon Suh, Sung Yeon Hwang
    Biomedicines.2022; 10(9): 2090.     CrossRef
  • Prediction of vasopressor requirement among hypotensive patients with suspected infection: usefulness of diastolic shock index and lactate
    Da Seul Kim, Jong Eun Park, Sung Yeon Hwang, Daun Jeong, Gun Tak Lee, Taerim Kim, Se Uk Lee, Hee Yoon, Won Chul Cha, Min Seob Sim, Ik Joon Jo, Tae Gun Shin
    Clinical and Experimental Emergency Medicine.2022; 9(3): 176.     CrossRef
  • 8,550 View
  • 161 Download
  • 8 Web of Science
  • 9 Crossref
Validation of quick sequential organ failure assessment score for poor outcome prediction among emergency department patients with suspected infection
Young Wha Sohn, Hye Young Jang, Suyeon Park, Youngjoo Lee, Young Shin Cho, Junbum Park, Heajin Chung, Sang-Il Kim
Clin Exp Emerg Med 2019;6(4):314-320.   Published online December 31, 2019
DOI: https://doi.org/10.15441/ceem.18.070

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Validation of quick sequential organ failure assessment score for poor outcome prediction among emergency department patients with suspected infection
Clin Exp Emerg Med. 2019;6(4):314-320.   Published online December 31, 2019
DOI: https://doi.org/10.15441/ceem.18.070
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Validation of quick sequential organ failure assessment score for poor outcome prediction among emergency department patients with suspected infection
Clin Exp Emerg Med. 2019;6(4):314-320.   Published online December 31, 2019
DOI: https://doi.org/10.15441/ceem.18.070
Close
Objective
The quick sequential organ failure assessment (qSOFA) score, which includes mentation, systolic blood pressure, and respiratory rate, was developed to identify serious sepsis in out-of-hospital or emergency department (ED) settings. We evaluated the ability of the qSOFA score to predict poor outcome in South Korean ED patients with suspected infection.
Methods
The qSOFA score was calculated for adult ED patients with suspected infection. Patients who received intravenous or oral antibiotics in the ED were considered to have infection. In-hospital mortality rate, admission rate, intensive care unit (ICU) admission rate, length of hospital stay (LOS), and lactate levels were compared between the qSOFA score groups. Receiver operating characteristic curves and area under the receiver operating characteristic curve values for in-hospital mortality were calculated according to qSOFA cut-off points and lactate levels.
Results
Of 2,698 patients, in-hospital mortality occurred in 134 (5.0%). The mortality rate increased with increasing qSOFA score (2.2%, 6.4%, 17.5%, and 42.4% for qSOFA scores 0, 1, 2, and 3, respectively, P<0.001). The admission rate, ICU admission rate, LOS, and lactate level also increased with increasing qSOFA score (all P<0.001). The area under the receiver operating characteristic curve values for predicting in-hospital mortality associated with qSOFA score, lactate ≥2 mmol/L, and lactate ≥4 mmol/L were 0.719 (95% confidence interval [CI], 0.670 to 0.768), 0.657 (95% CI, 0.603 to 0.710), and 0.632 (95% CI, 0.571 to 0.693), respectively.
Conclusion
Patients with a higher qSOFA score had higher admission, ICU admission, and in-hospital mortality rates, longer LOS, and higher lactate level. The qSOFA score showed better performance for predicting poor outcome than lactate level.

Citations

Citations to this article as recorded by  Crossref logo
  • Clinical utility of biomarkers for outcomes prediction in adults with suspected sepsis presenting to the emergency department: a synthesis of current evidence
    Mari Imamura, Sinead N Duggan, Thenmalar Vadiveloo, Jamie G Cooper, Callum T Kaye, Paul Manson, Gianni Virgili, Lorna Aucott, Mike Clarke, Miriam Brazzelli
    Health Technology Assessment.2026; : 1.     CrossRef
  • Outcome-Specific Prognostic Performance of Pneumonia Severity Assessment Tools for Predicting a Spectrum of Multiple Clinical Events
    Abuzer Özkan, Ahmet Taha Özatak, Soner Yeşilyurt
    Bratislava Medical Journal.2026;[Epub]     CrossRef
  • The Role of qSOFA, Derived Neutrophil-to-Lymphocyte Ratio, MEWS, and PIRO Scores in Predicting the Severity of Odontogenic Infections in Young and Adult Patients
    Serban Talpos Niculescu, Robert Avramut, Tareq Hajaj, Raluca Maracineanu, Antonis Perdiou, Roxana Talpos Niculescu, Marius Pricop, Horatiu Urechescu, Florin Urtila, Roxana Radu, Nicoleta Nikolajevic Stoican, Malina Popa
    Biomedicines.2025; 13(3): 532.     CrossRef
  • Sodium level in patients with sepsis: what is the predictive value?
    Zain Sayed, Ahmed A. Obiedallah, Soheir M. Kasem, Abdelraouf M.S. Abdelraouf, Kareem S.M. Ismail, Alaa O. Ahmed
    Research and Opinion in Anesthesia & Intensive Care.2025; 12(1): 35.     CrossRef
  • Lactate Enhanced Quick Sequential Organ Failure Assessment Score (Lqsofa) as a Tool to Predict the Prognosis in Patients of Sepsis in Surgical Intensive Care Unit
    Akash Sharma, Nitin Garg, Rahul Patel, Pooja Sharma
    International Journal of Recent Surgical and Medical Sciences.2025; 11: e015.     CrossRef
  • Comparative analysis of Glasgow Coma Scale, quick Sepsis-related Organ Failure Assessment, base excess, and lactate for mortality prediction in critically ill emergency department patients
    Gürbüz Meral, Şenol Ardıç, Serkan Günay, Kadir Güzel, Ahmet Köse, Hülya Gençbay Durmuş, Serhat Uysal, Aydın Coşkun
    Turkish Journal of Emergency Medicine.2024; 24(4): 231.     CrossRef
  • 9,064 View
  • 119 Download
  • 3 Web of Science
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Quick Sepsis-related Organ Failure Assessment score is not sensitive enough to predict 28-day mortality in emergency department patients with sepsis: a retrospective review
Kyung Su Kim, Gil Joon Suh, Kyuseok Kim, Woon Yong Kwon, Jonghwan Shin, You Hwan Jo, Jae Hyuk Lee, Huijai Lee
Clin Exp Emerg Med 2019;6(1):77-83.   Published online March 28, 2019
DOI: https://doi.org/10.15441/ceem.17.294

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Quick Sepsis-related Organ Failure Assessment score is not sensitive enough to predict 28-day mortality in emergency department patients with sepsis: a retrospective review
Clin Exp Emerg Med. 2019;6(1):77-83.   Published online March 28, 2019
DOI: https://doi.org/10.15441/ceem.17.294
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Quick Sepsis-related Organ Failure Assessment score is not sensitive enough to predict 28-day mortality in emergency department patients with sepsis: a retrospective review
Clin Exp Emerg Med. 2019;6(1):77-83.   Published online March 28, 2019
DOI: https://doi.org/10.15441/ceem.17.294
Close
Objective
To test the hypothesis that the quick Sepsis-related Organ Failure Assessment (qSOFA) score, derived from vital signs taken during triage and recommended by current sepsis guidelines for screening patients with infections for organ dysfunction, is not sensitive enough to predict the risk of mortality in emergency department (ED) sepsis patients.
Methods
Patients diagnosed with severe sepsis and septic shock using the old definition between May 2014 and April 2015 were retrospectively reviewed in three urban tertiary hospital EDs. The sensitivities of systemic inflammatory response syndrome (SIRS) criteria, qSOFA, and Sequential Organ Failure Assessment (SOFA) scores ≥2 were compared using McNemar’s test. Diagnostic performances were evaluated using specificity, positive predictive value, and negative predictive value.
Results
Among the 928 patients diagnosed with severe sepsis or septic shock using the old definition, 231 (24.9%) died within 28 days. More than half of the sepsis patients (493/928, 53.1%) and more than one-third of the mortality cases (88/231, 38.1%) had a qSOFA score <2. The sensitivity of a qSOFA score ≥2 was 61.9%, which was significantly lower than the sensitivity of SIRS ≥2 (82.7%, P<0.001) and SOFA ≥2 (99.1%, P<0.001). The specificity, positive predictive value, and negative predictive value of a qSOFA score ≥2 for 28-day mortality were 58.1%, 32.9%, and 82.2%, respectively.
Conclusion
The current clinical criteria of the qSOFA are less sensitive than the SIRS assessment and SOFA to predict 28-day mortality in ED patients with sepsis.

Citations

Citations to this article as recorded by  Crossref logo
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    Victoria Castilho Bartolomeu, Luiz Humberto Vieri Piacezzi, Karina Aparecida Lopes da Costa, Ruth Ester Assayag Batista, Cássia Regina Vancini Campanharo, Maria Carolina Barbosa Teixeira Lopes
    Revista da Escola de Enfermagem da USP.2025;[Epub]     CrossRef
  • Avaliação do desempenho dos escores de alerta precoce em pacientes com COVID-19
    Victoria Castilho Bartolomeu, Luiz Humberto Vieri Piacezzi, Karina Aparecida Lopes da Costa, Ruth Ester Assayag Batista, Cássia Regina Vancini Campanharo, Maria Carolina Barbosa Teixeira Lopes
    Revista da Escola de Enfermagem da USP.2025;[Epub]     CrossRef
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Epidemiology of sepsis in Korea: a population-based study of incidence, mortality, cost and risk factors for death in sepsis
Joonghee Kim, Kyuseok Kim, Heeyoung Lee, Soyeon Ahn
Clin Exp Emerg Med 2019;6(1):49-63.   Published online February 20, 2019
DOI: https://doi.org/10.15441/ceem.18.007

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Epidemiology of sepsis in Korea: a population-based study of incidence, mortality, cost and risk factors for death in sepsis
Clin Exp Emerg Med. 2019;6(1):49-63.   Published online February 20, 2019
DOI: https://doi.org/10.15441/ceem.18.007
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Epidemiology of sepsis in Korea: a population-based study of incidence, mortality, cost and risk factors for death in sepsis
Clin Exp Emerg Med. 2019;6(1):49-63.   Published online February 20, 2019
DOI: https://doi.org/10.15441/ceem.18.007
Close
Objective
To investigate the epidemiology of sepsis in Korea and identify risk factors for death in sepsis.
Methods
We conducted a longitudinal, population-based epidemiological study of sepsis in Korea from 2005 to 2012 using the National Health Insurance Service-National Sample Cohort, a population-based cohort representing 2.2% of the Korean population. The primary objective was to assess the incidence, mortality and cost of sepsis. The secondary objective was to identify the risk factors for death in sepsis. Claim records of admitted adult patients (aged ≥15 years) were analyzed. Sepsis was defined as 1) bacterial or fungal infection or the conditions they often complicate, 2) prescription of intravenous antibiotics, and 3) presence of any organ dysfunction. Comorbidities were defined using the Charlson/Deyo method. Risk factors for 6-month mortality were assessed using multivariable logistic regression.
Results
A total of 22,882 cases were identified. Both incidence and 6-month mortality increased from 265.7 (95% confidence interval [CI], 254.7 to 277.1) to 453.1 (95% CI, 439.0 to 467.5) per 100,000 person-years (P-trend <0.001) and from 26.5% (95% CI, 24.4% to 28.8%) to 30.1% (95% CI, 28.4% to 31.9%), respectively. After standardization, the increasing trend of incidence was slower but still significant (P-trend <0.001), while that for mortality was not (P-trend 0.883). The average cost increased by 75.5% (P-trend <0.001). Multivariable logistic regression identified various risk factors for mortality.
Conclusion
The burden of sepsis in Korea was high and is expected to increase considering the aging population. Proactive measures to curtail this increase should be sought and implemented.

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Korean Shock Society septic shock registry: a preliminary report
Tae Gun Shin, Sung Yeon Hwang, Gu Hyun Kang, Won Young Kim, Seung Mok Ryoo, Kyuseok Kim, You Hwan Jo, Sung Phil Chung, Young Seon Joo, Jin Ho Beom, Sung-Hyuk Choi, Young Hoon Yoon, Woon Yong Kwon, Tae Ho Lim, Kap Su Han, Han Sung Choi, Gil Joon Suh
Clin Exp Emerg Med 2017;4(3):146-153.   Published online September 30, 2017
DOI: https://doi.org/10.15441/ceem.17.204

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Korean Shock Society septic shock registry: a preliminary report
Clin Exp Emerg Med. 2017;4(3):146-153.   Published online September 30, 2017
DOI: https://doi.org/10.15441/ceem.17.204
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Korean Shock Society septic shock registry: a preliminary report
Clin Exp Emerg Med. 2017;4(3):146-153.   Published online September 30, 2017
DOI: https://doi.org/10.15441/ceem.17.204
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Objective
To evaluate the clinical characteristics, therapeutic interventions, and outcomes of patients with septic shock admitted to the emergency department (ED). Methods This study was a preliminary, descriptive analysis of a prospective, multi-center, observational registry of the EDs of 10 hospitals participating in the Korean Shock Society. Patients aged 19 years or older who had a suspected or confirmed infection and evidence of refractory hypotension or hypoperfusion were included. Results A total of 468 patients were enrolled (median age, 71.3 years; male, 55.1%; refractory hypotension, 82.9%; hyperlactatemia without hypotension, 17.1%). Respiratory infection was the most common source of infection (31.0%). The median Sepsis-related Organ Failure Assessment score was 7.5. The sepsis bundle compliance was 91.2% for lactate measurement, 70.3% for blood culture, 68.4% for antibiotic administration, 80.3% for fluid resuscitation, 97.8% for vasopressor application, 68.0% for central venous pressure measurement, 22.0% for central venous oxygen saturation measurement, and 59.2% for repeated lactate measurement. Among patients who underwent interventions for source control (n=117, 25.1%), 43 (36.8%) received interventions within 12 hours of ED arrival. The in-hospital, 28-day, and 90-day mortality rates were 22.9%, 21.8%, and 27.1%, respectively. The median ED and hospital lengths of stay were 6.8 hours and 12 days, respectively. Conclusion This preliminary report revealed a mortality of over 20% in patients with septic shock, which suggests that there are areas for improvement in terms of the quality of initial resuscitation and outcomes of septic shock patients in the ED.

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Emergency Medical Services | Critical Care

Emergency medical service personnel need to improve knowledge and attitude regarding prehospital sepsis care
Joongmin Park, Sung Yeon Hwang, Tae Gun Shin, Ik Joon Jo, Hee Yoon, Tae Rim Lee, Won Chul Cha, Min Seob Sim
Clin Exp Emerg Med 2017;4(1):48-55.   Published online March 30, 2017
DOI: https://doi.org/10.15441/ceem.16.159

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Emergency medical service personnel need to improve knowledge and attitude regarding prehospital sepsis care
Clin Exp Emerg Med. 2017;4(1):48-55.   Published online March 30, 2017
DOI: https://doi.org/10.15441/ceem.16.159
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Emergency medical service personnel need to improve knowledge and attitude regarding prehospital sepsis care
Clin Exp Emerg Med. 2017;4(1):48-55.   Published online March 30, 2017
DOI: https://doi.org/10.15441/ceem.16.159
Close
Objective
We aimed to evaluate the knowledge and attitudes of emergency medical service (EMS) personnel pertaining to sepsis. We also compared EMS personnel’s knowledge of sepsis and their intention to engage in prehospital sepsis management.
Methods
The survey was conducted during education conferences for EMS personnel in December 2013 and January 2015 in Seoul, Korea. The questionnaire composed of 10 questions relevant to sepsis, was distributed on-scene, and was retrieved by investigators after the conference. We classified subjects into active and passive groups based on intent to participate in prehospital sepsis care.
Results
A total of 271 questionnaires were distributed; 255 EMS personnel (94%) completed the survey, 126 (49%) of whom were first-degree emergency medical technicians (EMTs). Less than 75% of subjects provided clinically relevant responses to questions about the definitions of sepsis, tachycardia, tachypnea, hypotension, hypothermia, fluid resuscitation, and vasopressor. Only 15% of participants had suspected that a patient had sepsis, and 9% reported that they could identify patients with sepsis during transportation. Overall, first-degree EMTs showed higher levels of knowledge and a positive attitude to sepsis compared with non-first-degree EMTs. Sixty percent of the participants reported that they were actively involved in prehospital sepsis care. The active group showed significantly higher levels of knowledge and more positive responses to the clinical impact of prehospital sepsis care.
Conclusion
Our study showed that is a substantial portion of EMS personnel lacks appropriate level of knowledge on sepsis care. We also found that the intention to engage in sepsis management was associated with appropriate knowledge of sepsis.

Citations

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  • Knowledge, attitudes, and practices of pre-hospital emergency medical care practitioners regarding sepsis recognition: a cross-sectional study in Qatar
    Michael Steven Paul Lewis, Paula J. W. Smith, Ian Lucas Howard, Hassan Farhat, Guillaume Alinier
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  • 157 Download
  • 8 Web of Science
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Critical Care

The effect of liver disease on lactate normalization in severe sepsis and septic shock: a cohort study
Sarah A. Sterling, Michael A. Puskarich, Alan E. Jones
Clin Exp Emerg Med 2015;2(4):197-202.   Published online December 28, 2015
DOI: https://doi.org/10.15441/ceem.15.025

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The effect of liver disease on lactate normalization in severe sepsis and septic shock: a cohort study
Clin Exp Emerg Med. 2015;2(4):197-202.   Published online December 28, 2015
DOI: https://doi.org/10.15441/ceem.15.025
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The effect of liver disease on lactate normalization in severe sepsis and septic shock: a cohort study
Clin Exp Emerg Med. 2015;2(4):197-202.   Published online December 28, 2015
DOI: https://doi.org/10.15441/ceem.15.025
Close
Objective
To describe the effect of liver disease (LD) on lactate clearance during early sepsis resuscitation.
Methods
This is a multicenter randomized clinical trial. An initial lactate >2 mmol/L and subsequent serum lactate measurement within 6 hours were required for inclusion. LD was categorized by two methods: 1) past medical history (PMH) categorized as no LD, mild LD (no Child’s score criteria, but PMH of hepatitis B/C), cirrhosis; and 2) measurable liver dysfunction determined by the liver component of the sequential organ failure assessment (L-SOFA) score as no dysfunction (L-SOFA score 0), mild dysfunction (score 1), moderate-severe dysfunction (score 2 to 4). Primary outcome was the rate of lactate normalization.
Results
One hundred eighty-seven patients were included. When categorized by PMH, 169 patients had no LD, 6 mild LD, and 12 cirrhosis. 63/169 (37%) of patients with no LD achieved lactate normalization, compared to 4/6 (67%) with mild LD, and 1/12 (8%) with cirrhosis (P<0.03). Categorized by L-SOFA score, 59/124 (47%) patients with L-SOFA 0 achieved lactate normalization, compared to 6/31 (19%) with L-SOFA 1, and 3/32 (9%) with L-SOFA 2–4 (P<0.01). Relative lactate clearance [(initial lactate–subsequent lactate)/initial lactate] was lower in patients with more advanced LD by PMH (37.7 vs. 40.4 vs. 21.8, P=0.07), and lower with increasing L-SOFA score (42.0 vs. 30.1 vs. 23.4, P=0.01).
Conclusion
Liver dysfunction was significantly associated with impaired lactate clearance and normalization during the early resuscitation of sepsis.

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Red cell distribution width and early mortality in elderly patients with severe sepsis and septic shock
Sejin Kim, Kyoungmi Lee, Inbyung Kim, Siyoung Jung, Moon-Jung Kim
Clin Exp Emerg Med 2015;2(3):155-161.   Published online September 30, 2015
DOI: https://doi.org/10.15441/ceem.15.037

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Red cell distribution width and early mortality in elderly patients with severe sepsis and septic shock
Clin Exp Emerg Med. 2015;2(3):155-161.   Published online September 30, 2015
DOI: https://doi.org/10.15441/ceem.15.037
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Red cell distribution width and early mortality in elderly patients with severe sepsis and septic shock
Clin Exp Emerg Med. 2015;2(3):155-161.   Published online September 30, 2015
DOI: https://doi.org/10.15441/ceem.15.037
Close
Objective
To investigate the association of red cell distribution width (RDW) with 30-day mortality in elderly patients with severe sepsis and septic shock.
Methods
Patients were recruited from a single tertiary emergency department. Patients with age over 65 years were selected. The main outcome was 30-day mortality. Potential confounders as Acute Physiologic and Chronic Health Evaluation (APACHE) II score and Sequential Organ Failure Assessment (SOFA) score along with initial vital signs were collected. Multivariate Cox proportional hazards analysis was performed to identify independent predictors of 30-day mortality. The discriminative ability of RDW for 30-day mortality was evaluated using receiver operating characteristic curve analysis.
Results
Overall, 458 patients were included. Univariate analysis showed that patients’ survival was significantly associated with sites of infection, comorbidities, and severity scores. In the multivariate Cox proportional hazard model, the RDW was an independent predictor of 30-day mortality (hazards ratio, 1.10; 95% confidence interval, 1.04 to 1.17; P<0.001).
Conclusion
In this study, initial RDW values were significantly associated with 30-day mortality in older patients hospitalized with severe sepsis and septic shock.

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Experimental study | Critical Care

Rapid rewarming after therapeutic hypothermia worsens outcome in sepsis
You Hwan Jo, Kyuseok Kim, Jae Hyuk Lee, Kwang Pil Rim, In Soo Cho
Clin Exp Emerg Med 2014;1(2):120-125.   Published online December 31, 2014
DOI: https://doi.org/10.15441/ceem.14.015

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Rapid rewarming after therapeutic hypothermia worsens outcome in sepsis
Clin Exp Emerg Med. 2014;1(2):120-125.   Published online December 31, 2014
DOI: https://doi.org/10.15441/ceem.14.015
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Rapid rewarming after therapeutic hypothermia worsens outcome in sepsis
Clin Exp Emerg Med. 2014;1(2):120-125.   Published online December 31, 2014
DOI: https://doi.org/10.15441/ceem.14.015
Close
Objective
This study was performed to investigate the effect of the rewarming rate on survival and acute lung injury in sepsis.
Methods
Male Sprague-Dawley rats underwent cecal ligation and incision. After 1 hour of sepsis induction, normothermia (37°C±0.5°C, NT group) or hypothermia (32°C±0.5°C) was induced. Hypothermia was maintained for 4 hours and rats were divided into two groups according to the rewarming rate: RW1 group, 1 hour of rewarming; and RW2 group, 2 hours of rewarming. In the survival study, rats were observed for 12 hours after sepsis induction (n=6 per group). In the second experiment, rats were sacrificed 7 hours after sepsis induction, and lung tissues and plasma were harvested (n=10 per group).
Results
In the survival study, the RW2 group survived longer than the RW1 group (P<0.05), but the RW1 and NT groups showed no significant difference in survival duration (P>0.05). The histological lung injury score and malondialdehyde concentrations in the lung tissues were significantly higher in the RW1 group than in the RW2 group (P<0.05). Plasma interleukin (IL)-6 concentration and the ratio of IL-6 to IL-10 were higher in the RW1 group than in the RW2 group (P<0.05).
Conclusion
Rapid rewarming after therapeutic hypothermia results in a shorter survival period and acute lung injury in sepsis, which could be associated with the inflammatory responses.

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Critical Care

Awareness and knowledge of sepsis in the general Korean population: comparison with the awareness and knowledge of acute myocardial infarction and stroke
Minji Park, Kyuseok Kim, Jae Hyuk Lee, Changwoo Kang, You Hwan Jo, Dong Hoon Kim, Kyeong Won Kang, Soo Hoon Lee, Chanjong Park, Joonghee Kim, Heajin Chung, Hyunmi Park, Sujin Jang
Clin Exp Emerg Med 2014;1(1):41-48.   Published online September 30, 2014
DOI: https://doi.org/10.15441/ceem.14.014

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Awareness and knowledge of sepsis in the general Korean population: comparison with the awareness and knowledge of acute myocardial infarction and stroke
Clin Exp Emerg Med. 2014;1(1):41-48.   Published online September 30, 2014
DOI: https://doi.org/10.15441/ceem.14.014
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Awareness and knowledge of sepsis in the general Korean population: comparison with the awareness and knowledge of acute myocardial infarction and stroke
Clin Exp Emerg Med. 2014;1(1):41-48.   Published online September 30, 2014
DOI: https://doi.org/10.15441/ceem.14.014
Close
Objective

Patients with severe sepsis or septic shock require timely, aggressive management to improve their outcomes, and early presentation of patients to the hospital may also be important. Thus, public awareness about sepsis may be important for improved outcomes. However, there are no studies regarding the public awareness of sepsis in the general Korean population. Therefore, the objective of this survey was to gain insight into the public awareness of sepsis.

 Methods

Prospective paper-based and web-based surveys were issued between May and June 2013 to adults aged ≥18 years.

 Results

A total of 1,081 participants responded to the survey (394 paper-based and 687 web-based). Mean age was 38.7±11.4 years, and 541 participants (50%) were men. Of the 1,081 participants, 831 (76.9%) had heard of the term “sepsis.” Of these participants, only 295 (35%) responded correctly regarding the definition of sepsis. However, 1,019 participants (94.3%) had heard of acute myocardial infarction, and 817 of these (80%) correctly defined acute myocardial infarction. Regarding stroke, 1,047 (96.9%) had heard of stroke, and 975 of these responded (93.1%) correctly to the definition of stroke.

 Conclusion

There is poor public awareness about sepsis compared with that of acute myocardial infarction and stroke. This may limit the timely management of severe sepsis and septic shock.

Citations

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    Sebastian Born, Norman Rose, Silke Piedmont, Daniel Schwarzkopf, Mathias W. Pletz, Wiltrud Abels, Konrad Reinhart, Carolin Fleischmann-Struzek
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Impact of timely antibiotic administration on outcomes in patients with severe sepsis and septic shock in the emergency department
Young Min Joo, Minjung Kathy Chae, Sung Yeon Hwang, Sang-Chan Jin, Tae Rim Lee, Won Chul Cha, Ik Joon Jo, Min Seob Sim, Keun Jeong Song, Yeon Kwon Jeong, Tae Gun Shin
Clin Exp Emerg Med 2014;1(1):35-40.   Published online September 30, 2014
DOI: https://doi.org/10.15441/ceem.14.012

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Impact of timely antibiotic administration on outcomes in patients with severe sepsis and septic shock in the emergency department
Clin Exp Emerg Med. 2014;1(1):35-40.   Published online September 30, 2014
DOI: https://doi.org/10.15441/ceem.14.012
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Impact of timely antibiotic administration on outcomes in patients with severe sepsis and septic shock in the emergency department
Clin Exp Emerg Med. 2014;1(1):35-40.   Published online September 30, 2014
DOI: https://doi.org/10.15441/ceem.14.012
Close
Objective

We aimed to investigate the effect of timely antibiotic administration on outcomes in patients with severe sepsis and septic shock.

 Methods

We analyzed data from a sepsis registry that included adult patients who initially presented to the emergency department (ED) and met criteria for severe sepsis or septic shock. Timely antibiotic use was defined as administration of a broad-spectrum antibiotic within three hours from the time of ED arrival. Multivariable logistic and linear regression analyses were performed to assess associations between timely administration of antibiotics and outcomes, including hospital mortality, 48-hour change in Sequential Organ Failure Assessment (SOFA) score (delta SOFA), and hospital length of stay (LOS).

 Results

A total of 591 patients were included in the study. In-hospital mortality was 16.9% for patients receiving timely antibiotics (n=377) and 22.9% for patients receiving delayed antibiotics (n=214; P=0.04). The adjusted odds ratio for in-hospital survival was 0.54 (95% confidence interval [CI], 0.34 to 0.87; P=0.01) in patients who received timely antibiotics. Timely antibiotic administration was also significantly associated with higher delta SOFA (2 vs. 1) and shorter hospital LOS among survivors (11 days vs. 15 days). Multivariable linear regression analyses showed that timely antibiotic administration was significantly associated with increased delta SOFA and decreased hospital LOS.

 Conclusion

Antibiotic administration within three hours from the time of ED arrival was significantly associated with improved outcomes, including in-hospital survival, reversal of organ failure, and shorter hospital LOS, in patients with severe sepsis and septic shock.

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Review Article
Early management of sepsis
Jean-Louis Vincent, Adriano José Pereira, James Gleeson, Daniel De Backer
Clin Exp Emerg Med 2014;1(1):3-7.   Published online September 30, 2014
DOI: https://doi.org/10.15441/ceem.14.005

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Early management of sepsis
Clin Exp Emerg Med. 2014;1(1):3-7.   Published online September 30, 2014
DOI: https://doi.org/10.15441/ceem.14.005
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Early management of sepsis
Clin Exp Emerg Med. 2014;1(1):3-7.   Published online September 30, 2014
DOI: https://doi.org/10.15441/ceem.14.005
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Increased awareness of the signs and symptoms of sepsis and an emphasis on the importance of early treatment have helped to improve survival rates from this serious and frequent condition in recent years. With no specific, effective anti-sepsis therapies available, management focuses on early source control with adequate and appropriate antibiotics and removal of any source of infection, rapid resuscitation, hemodynamic stabilization and organ support. Use of dedicated teams to care for patients with sepsis can help optimize early management.

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