Elevated plasma levels of heparin-binding protein in intensive care unit patients with severe sepsis and septic shock

Introduction: Rapid detection of, and optimized treatment for, severe sepsis and septic shock is crucial for successful outcome. Heparin-binding protein (HBP), a potent inducer of increased vascular permeability, is a potentially useful biomarker for predicting outcome in patients with severe infections. Our aim was to study the systemic release and dynamics of HBP in the plasma of patients with severe sepsis and septic shock in the ICU. Methods: A prospective study was conducted of two patient cohorts treated in the ICU at Karolinska University Hospital Huddinge in Sweden. A total of 179 patients was included, of whom 151 had sepsis (126 with septic shock and 25 patients with severe sepsis) and 28 a non-septic critical condition. Blood samples were collected at five time points during six days after admission. Results: HBP levels were significantly higher in the sepsis group as compared to the control group. At admission to the ICU, a plasma HBP concentration of >= 15 ng/mL and/or a HBP (ng/mL)/white blood cell count (10(9)/L) ratio of >2 was found in 87.2% and 50.0% of critically ill patients with sepsis and non-septic illness, respectively. A lactate level of >2.5 mmol/L was detected in 64.9% and 56.0% of the same patient groups. Both in the sepsis group (n = 151) and in the whole group (n = 179), plasma HBP concentrations at admission and in the last measured sample within the 144 hour study period were significantly higher among 28-day non-survivors as compared to survivors and in the sepsis group, an elevated HBP-level at baseline was associated with an increased case-fatality rate at 28 days. Conclusions: Plasma HBP levels were significantly higher in patients with severe sepsis or septic shock compared to patients with a non-septic illness in the ICU. HBP was associated with severity of disease and an elevated HBP at admission was associated with an increased risk of death. HBP that rises over time may identify patients with a deteriorating prognosis. Thus, repeated HBP measurement in the ICU may help monitor treatment and predict outcome in patients with severe infections

Psychosocial correlates with depressive symptoms six years after a first episode of psychosis as compared with findings from a general population sample

BACKGROUND: Depression is frequently occurring during and after psychosis. The aim of this study was to analyze if the psychosocial characteristics associated with depression/depressive symptoms in the late phase of a first episode psychosis (FEP) population were different compared to persons from the general population. METHODS: A questionnaire was sent out to all individuals six years after their FEP and to a general population sample. Depressive symptoms were recorded using a self-rating scale, the Major Depression Inventory. RESULTS: Formerly FEP persons had a higher representation of depressive symptoms/depression, unemployment, financial problems and insufficient social network. Depressive symptoms/depression were found to be associated with psychosocial problems. An age and gender effect was found in the general population, but not in the FEP sample. When the psychosocial characteristics were taken into account there were no association between having had FEP and depressive symptoms. CONCLUSIONS: The association between having been a FEP patient and depressive symptoms/depression disappeared when negative social aspects were taken into account

Short- and long-term mortality in severe sepsis/septic shock in a setting with low antibiotic resistance: A prospective observational study in a Swedish University Hospital

Background: There is little epidemiologic data on sepsis, particularly in areas of low antibiotic resistance. Here we report a prospective observational study of severe sepsis and septic shock in patients admitted to the Intensive Care Unit (ICU) at Karolinska University Hospital, Sweden.We aimed to evaluate short and long-term mortality, and risk factors for sepsis related death. A second aim was to investigate patient care in relation to gender. Methods: 101 patients with severe sepsis and septic shock, admitted to the ICU between 2005 and 2009, were prospectively enrolled in the study. Defined primary endpoints were day 28, hospital and 1-year mortality. Risk factors for sepsis related death was evaluated with a multivariate analysis. In the subset of patient admitted to the ICU through the emergency department (ED), time to clinician evaluation and time to antibiotics were assessed in relation to gender. Results: In the septic cohort, the day 28, hospital and 1-year mortality rates were 19%, 29% and 34%, respectively. 93% in the septic cohort received adequate antibiotics from the beginning. Multiresistant bacteria were only found in three cases. Among the 43 patients admitted to the ICU through the ED, the median time to antibiotics was 86 minutes (IQR 52-165), and overall 77% received appropriate antibiotics within 2h. Female patients received antibiotics significantly later compared to male patients (p=0.02). Conclusions: The results demonstrate relatively low mortality rates among ICU patients with severe sepsis/septic shock, as compared to reports from outside Scandinavia. Early adequate antibiotic treatment and the low incidence of resistant isolates may partly explain these findings. Importantly, a gender difference in time to antibiotic therapy was seen

Predicting 5-year outcome in first-episode psychosis: Construction of a prognostic rating scale

Objective: The aim of this study was to construct a rating scale to predict long-term outcome on the basis of clinical and sociodemographic characteristics in patients with symptoms of psychosis who seek psychiatric help for the first time. Method: Patients (N = 153) experiencing their first episode of psychosis (DSM-IV schizophrenia, schizophreniform disorder, schizoaffective disorder, brief psychotic episode, delusional disorder, affective psychosis with mood-incongruent delusions, or psychotic disorder not otherwise specified or being actively psychotic) were consecutively recruited from 17 psychiatric clinics in Sweden from January 1996 through December 1997 (24 months). Baseline characteristics were assessed with an extensive battery of psychiatric rating scales; duration of untreated psychosis, premorbid characteristics, and cognitive functioning were also assessed. The relationship between baseline characteristics and the 5-year outcome was analyzed using a stepwise logistic regression model. Results: In the logistic regression analysis, 5 variables were found to have unique contributions in the prediction of outcome. In order of magnitude of the odds ratios, these variables were Global Assessment of Functioning (GAF) score during the year before first admission, education level, actual GAF score at first admission, gender, and social network. The sensitivity, i.e., correctly identified cases (poor outcome), was 0.84, and the specificity, i.e., the correctly identified non-cases (good outcome), was 0.77. Conclusion: To initiate adequate interventions, it is crucial to identify patients experiencing their first episode of psychosis who are likely to have an unfavorable long-term outcome. The predictive rating scale described here is a feasible tool for early detection of these patients