Genetic Basis for Congenital Heart Disease: Revisited: A Scientific Statement From the American Heart Association
Platelet Count Linked With In-Hospital Mortality In Patients With ESKD
Platelet counts above and below a threshold of 222 × 109/L are associated with increased risks for in-hospital death within 30 days in ICU patients with end-stage kidney disease (ESKD or ESRD).
The finding is from a study of 3700 ICU patients with ESKD in the 2014-2015 US eICU-CRD v2.0 database. Below this inflection point, a 10 × 109/L decrease in platelet count was significantly associated with 6% increased odds of mortality. Above this inflection point, a 10 × 109/L increase in platelet count was significantly linked to 3% increased odds of mortality.
"This discovery explicitly suggests that when ESRD patients are admitted to the ICU, a platelet level closer to 222 × 10⁹/L may predict a lower 30-day in-hospital mortality risk," Zhe Deng, MD, of Shenzhen Second People's Hospital/the First Affiliated Hospital of Shenzhen University Health Science Center in China, and colleagues reported in Scientific Reports.
As platelet count increased from quartile 1 to 3, the mortality rate decreased from 17.85% to 12.04% to 10.37%, then increased in quartile 4 to 12.86%. A stronger association between platelet count and 30-day in-hospital mortality was observed in patients without diabetes.
The investigators pointed out that platelets are essential for hemostasis and coagulation. Thrombocytopenia is associated with hemorrhage and reduced immunity, acting as an indirect marker of more severe illness. Patients with lower platelet counts often warrant treatment intensification.
"These distinctive findings provide new references for clinical assessment of in-hospital mortality risk in ICU patients with ESRD," according to the investigators.
References:
Zhou P, Xiao JH, Li Y, Zhou L, Deng Z. Platelet count has a nonlinear association with 30-day in-hospital mortality in ICU end-stage kidney disease patients: a multicenter retrospective cohort study. Sci Rep. 2024;28;14(1):22535. Doi:10.1038/s41598-024-73717-w
What To Know About Sepsis Symptoms, Causes, And Recovery
Sepsis is a life threatening illness that develops when an existing infection triggers an extreme immune system response in your body.
When you experience an infection, your immune system releases proteins and other chemicals to fight it. Sepsis occurs when this response gets out of control, triggering extensive inflammation.
There are approximately 1.7 million cases of sepsis each year in the United States, according to the Centers for Disease Control and Prevention (CDC). It's also responsible for nearly 350,000 deaths.
Keep reading to learn more about the symptoms, types, and causes of sepsis, as well as how it's treated.
While sepsis often occurs in hospital settings, it can also happen in other locations. In some cases, you might not even know you have an infection that could potentially lead to sepsis.
It's important to seek immediate medical attention if you have any symptoms of sepsis. The earlier you seek treatment, the greater chance you have of recovering.
Symptoms of severe sepsis
Severe sepsis is characterized by organ failure and may be accompanied by the following symptoms:
This could advance very quickly to septic shock, which may be life threatening.
Some symptoms of severe sepsis and septic shock can overlap, but a key sign of septic shock is low blood pressure.
Symptoms in children
Neonatal sepsis occurs when a baby gets a blood infection within the first month of life.
Some symptoms may include:
Sepsis is usually caused by a bacterial infection. The most common include:
According to the CDC, fungal and viral infections may also cause sepsis, including COVID-19 and the flu.
Anyone who gets an infection is at risk of developing sepsis.
A doctor will examine your symptoms and order tests to help diagnose the cause and severity of your infection.
A doctor may also order the following tests to check for bacteria in your body or to view different organs:
Doctors use two sets of criteria to determine the severity of sepsis.
One set is for systemic inflammatory response syndrome (SIRS). SIRS is defined when you meet two or more of the following criteria:
Another tool is the quick sequential organ failure assessment (qSOFA). It uses the results of three criteria:
A positive qSOFA occurs when two or more of the above measurements are abnormal. Some physicians prefer using qSOFA because, unlike the SIRS criteria, qSOFA doesn't require laboratory tests.
The results of either of these assessments will help a doctor determine the best course of treatment.
Sepsis can quickly progress to septic shock and death if it's left untreated. As such, it's important to start treatment with antibiotics as soon as possible after receiving a diagnosis.
Doctors may also use the following medications to help treat sepsis:
Severe sepsis may also require large amounts of IV fluids and a respirator for breathing. If your kidneys are affected, you may require dialysis to help filter your blood.
In some cases, surgery may be needed to remove the source of an infection. This may include draining a pus-filled abscess or removing infected tissue.
Recovering from sepsis depends on the severity of your condition and any pre-existing health issues you might have.
According to the UK Sepsis Trust, around 4 in 10 people experience effects from sepsis.
When you return home after receiving treatment in the hospital for sepsis, you may experience physical, cognitive, and emotional symptoms that may last several months. These may include:
Many people fully recover, but others report lasting effects, which is known as post-sepsis syndrome (PSS). PSS may affect up to 1 in 2 sepsis survivors, according to the Sepsis Alliance.
The CDC notes that PSS may cause long-term effects like:
The best way to prevent sepsis is to treat infections promptly and to practice good hygiene, such as proper wound care, handwashing, and bathing regularly.
Preventing infections is the next best way to prevent sepsis. This may include staying up to date with vaccinations and managing chronic conditions, such as taking medications.
It's important to get immediate medical attention if you experience any symptoms of sepsis. Early diagnosis and treatment could help prevent any complications.
Complications of sepsis are more likely to occur in severe cases of sepsis. They may include:
How long can you survive with sepsis?
The life expectancy for sepsis will depend on the severity of the infection and how early you receive treatment. Many people will survive and experience few complications. That said, a 2020 review found that the mortality rate for sepsis after 90 days was 32.2% and 38.5% for septic shock.
How quickly can an infection turn to sepsis?
The progression from infection to sepsis depends on many factors, such as the type and location of the infection, and how quickly you receive treatment.
For instance, a 2013 study found that people with soft tissue infections were 9% less likely to progress to sepsis or a more severe stage within 7 days than people with urinary tract infections. People with abdominal infections were 32% more likely to progress to sepsis within this timeframe.
Early treatment is vital for slowing down the progression of sepsis. According to the Sepsis Alliance, the risk of sepsis progressing to septic shock and even death rises by up to 9% for each hour without treatment.
Is sepsis contagious?
No, sepsis isn't contagious. However, the pathogens responsible for the original infection, like viral pneumonia or COVID-19, may be contagious.
Sepsis is a life threatening illness that occurs when your body's immune system overreacts to an infection.
People at the highest risk of sepsis include newborns, older adults, and people with pre-existing health conditions.
Sepsis is a medical emergency and may cause symptoms like fever, chills, a rapid heart rate, confusion, and difficulty breathing.
Get immediate medical attention if you suspect you have sepsis, especially if you have a known infection.
Dengue Fever
Dengue (pronounced DEN-gee) fever is a mosquito-borne disease caused by any one of four closely related dengue viruses. You get dengue fever through the bite of an aedes mosquito infected with a dengue virus. The mosquito becomes infected when it bites a person with dengue virus in their blood. It can't be spread directly from one person to another person.
About 400 million people worldwide are infected with dengue virus each year, and 100 million become mildly to severely ill with dengue fever. Most cases happen in tropical areas, such as Southeast Asia, the western Pacific islands, Latin America, and Africa. Cases in the U.S. Are often in people who contracted the infection while traveling abroad. But the risk of getting dengue virus is increasing in parts of the southern U.S.
Dengue viruses come in four types, which doctors call serotypes:
All four serotypes are similar. They spread in the same parts of the world and cause the same symptoms. But each virus reacts differently to antibodies — proteins your immune system makes to protect you against germs.
Malaria is another disease that spreads through the bite of infected mosquitoes in tropical countries. A different type of mosquito carries each disease. Aedes mosquitoes spread the virus that causes dengue fever. Female anopheles mosquitoes carry the parasite that transmits malaria.
Both infections cause a high fever and headache, which can make it hard to tell the two infections apart. Malaria also has symptoms such as:
Malaria causes more deaths worldwide than dengue fever, but it is preventable and treatable. There isn't a specific treatment for dengue fever.
Symptoms, which usually begin 4-10 days after infection, may include:
Sometimes, symptoms are mild and easy to mistake for those of the flu or another viral infection. Younger children and people who have never had dengue fever before tend to have milder cases than older children and adults.
Sometimes, mild cases can become more severe and turn into dengue hemorrhagic fever. It's a rare complication with symptoms such as:
The infection may lead to severe bleeding, shock, and death. This is called dengue shock syndrome (DSS). It's important to get medical attention right away if you have these symptoms.
Doctors can diagnose dengue infection with a blood test to check for the virus or antibodies to it. If you become sick after traveling to a tropical area, inform your doctor. Tests can show whether a dengue infection caused your symptoms.
Dengue fever tests
A few tests can help your doctor diagnose dengue fever, such as:
Serologic or antibody tests. These tests check a sample of your blood for antibodies, which are proteins your immune system makes against viruses such as dengue virus. The MAC-ELISA test detects proteins that fight dengue fever.
Molecular tests. These tests identify genetic material from the virus. The nucleic acid amplification test (NAAT) first makes many copies of (amplifies) the virus's DNA. Amplifying the genetic material makes it easier to find very small amounts of dengue virus in a blood sample. Polymerase chain reaction (PCR) is one type of NAAT.
Complete blood count (CBC). This test counts the number of cells in a sample of your blood. Dengue fever can cause a drop in white blood cells (which fight infection) and platelets (which prevent bleeding). A CBC can help your doctor predict how severe your infection could become.
There is no specific medicine to treat dengue infection. If you think you may have dengue fever, take pain relievers such as acetaminophen (Tylenol). Avoid nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen (Advil, Motrin), which could worsen bleeding. Rest and drink plenty of fluids to prevent dehydration. If your symptoms are severe or they don't improve at home, call your doctor. You may need treatment in a hospital.
The best way to prevent the disease is to avoid bites from infected mosquitoes, especially if you are living in or traveling to a tropical area. This involves protecting yourself and making efforts to keep the mosquito population down.
To protect yourself:
To reduce the mosquito population, get rid of places where mosquitoes can breed. These include old tires, cans, or flower pots that collect rain. Regularly change the water in outdoor bird baths and pets' water dishes.
If someone in your home gets dengue fever, make an extra effort to protect yourself and other family members from mosquitoes. Mosquitoes that bite the infected family member could spread the infection to other people in your home.
Dengue vaccine
A vaccine called Dengvaxia can help prevent dengue in children aged 6 to 16 who have tested positive for the virus before and who live in areas where dengue spreads. The vaccine is about 80% effective, but children need three doses to get full protection against the virus.
The vaccine's manufacturer, Sanofi-Pasteur, has announced that it will stop making Dengvaxia due to a lack of demand. Another vaccine called Qdenga is licensed for children aged 6 to 16, but it's not available in the U.S. A third vaccine, TV005, is in clinical trials.
Severe dengue fever can cause complications such as:
The infection can be life-threatening if you don't treat it. If you're pregnant, you can spread the virus to your baby. Having dengue fever increases the risk of pregnancy complications such as preterm birth and low birth weight.
Dengue fever fatality rate
Worldwide, about 21,000 people die from dengue-related illness each year.
After an infection with one serotype of dengue fever, you'll have lifelong immunity to the virus. That means you can never get sick from that type of dengue again. You'll also be immune against the other three serotypes, but only temporarily. After a few months, you can get an infection with any of the other three types.
Dengue fever is a viral illness that mosquitoes spread in tropical areas of the world. The virus causes symptoms such as a high fever and painful headaches. Dengue fever is often mild and manageable at home with rest, pain relievers, and extra fluids. Severe cases may need treatment in a hospital.
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