Korean Society of Critical Care Medicine

BackgroundData regarding the clinical effects of bacteremia on severe community-acquired pneumonia (CAP) are limited. Thus, we investigated clinical characteristics and outcomes of severe CAP patients with bacteremia compared with those of subjects without bacteremia. In addition, we evaluated clinical factors associated with bacteremia at the time of sepsis awareness.MethodsWe enrolled sepsis patients diagnosed with CAP at emergency departments (EDs) from an ongoing nationwide multicenter observational registry, the Korean Sepsis Alliance, between September 2019 and December 2020. For evaluation of clinical factors associated with bacteremia, we divided eligible patients into bacteremia and non-bacteremia groups, and logistic regression analysis was performed using the clinical characteristics at the time of sepsis awareness.ResultDuring the study period, 1,510 (47.9%) sepsis patients were caused by CAP, and bacteremia was identified in 212 (14.0%) patients. Septic shock occurred more frequently in the bacteremia group than in the non-bacteremia group (27.4% vs. 14.8%; p < 0.001). In multivariable analysis, hematologic malignancies and septic shock were associated with an increased risk of bacteremia. However, chronic lung disease was associated with a decreased risk of bacteremia. Hospital mortality was significantly higher in the bacteremia group than in the non-bacteremia group (27.3% vs. 40.6%, p < 0.001). The most prevalent pathogen in blood culture was Klebsiella pneumoniae followed by Escherichia coli in gram-negative pathogens.ConclusionThe incidence of bacteremia in severe CAP was low at 14.0%, but the occurrence of bacteremia was associated with increased hospital mortality. In severe CAP, hematologic malignancies and septic shock were associated with an increased risk of bacteremia.

ObjectiveExploring protein requirements for critically ill patients has become prominent. On the other hand, considering the significant impact of coma therapy and targeted temperature management (TTM) on the brain as well as systemic metabolisms, protein requirements may plausibly be changed by treatment application. However, there is currently no research on protein requirements following the application of these treatments. Therefore, the aim of this study is to elucidate changes in patients’ protein requirements during the application of TTM and coma therapy.MethodsThis study is a retrospective analysis of prospectively collected data from March 2019 to May 2022. Among the patients admitted to the intensive care unit, those receiving coma therapy and TTM were included. The patient’s treatment period was divided into two phases (phase 1, application and maintenance of coma therapy and TTM; phase 2, tapering and cessation of treatment). In assessing protein requirements, the urine urea nitrogen (UUN) method was employed to estimate the nitrogen balance, offering insight into protein utilization within the body. The patient’s protein requirement for each phase was defined as the amount of protein required to achieve a nitrogen balance within ±5, based on the 24-hour collection of UUN. Changes in protein requirements between phases were analyzed.ResultsOut of 195 patients, 107 patients with a total of 214 UUN values were included. The mean protein requirement for the entire treatment period was 1.84±0.62 g/kg/day, which is higher than the generally recommended protein supply of 1.2 g/kg/day. As the treatment was tapered, there was a statistically significant increase in the protein requirement from 1.49±0.42 to 2.18±0.60 in phase 2 (p<0.001).ConclusionOur study revealed a total average protein requirement of 1.84±0.62 g during the treatment period, which falls within the upper range of the preexisting guidelines. Nevertheless, a notable deviation emerged when analyzing the treatment application period separately. Hence, it is recommended to incorporate considerations for the type and timing of treatment, extending beyond the current guideline, which solely accounts for the severity by disease.

<b>Background:</b> Previous studies have suggested that necroptosis, a programmed necrosis mechanism, is involved in the pathogenesis and outcomes of sepsis. Mixed lineage kinase domain-like protein (MLKL) is a final executor of necroptosis. However, association MLKL with severity and mortality of sepsis is not well known. <b>Objectives:</b> The aim of the study was to assess the association of plasma MLKL with severity and outcome of sepsis. <b>Methods:</b> We analyzed data of 188 prospectively-enrolled critically-ill patients admitted to the intensive care unit (ICU) of Samsung Medical Center. Plasma MLKL level was measured with the enzyme-linked immunosorbent assay. <b>Results:</b> Of 188 critically-ill patients, 58 (30.9%) and 84 (44.7%) patients were diagnosed with sepsis and septic shock, respectively. Plasma level of MLKL increased over the groups of control, sepsis, and septic shock (1.10 ng/mL vs. 2.03 ng/mL vs. 3.00 ng/mL, P for trend &lt; 0.001). When 142 sepsis patients were classified into the groups of high and low plasma level of MLKL according to the best cutoff level of 3.16 ng/mL, severity of illness scores of SAPS 3 score, APCHE II score, and SOFA score and lactic acid were higher in the high MLKL group. Furthermore, septic shock and patients in need of vasopressor support were more prevalent in the high MLKL group. There was a significant difference in 7-day, 28-day, and 90-day mortalities between the groups. <b>Conclusions:</b> Plasma level of MLKL was associated with severity of sepsis and predictive of mortality.