Charles Sprung - Academia.edu (original) (raw)

Papers by Charles Sprung

Research paper thumbnail of Use of early corticosteroid therapy on ICU admission in patients affected by severe pandemic (H1N1)v influenza A infection

Intensive Care Medicine, Nov 24, 2010

z ORIGINAL associated with mortality [hazard ratio (HR) 1.3, 95% CI 0.7-2.4, p = 0.4] but was sti... more z ORIGINAL associated with mortality [hazard ratio (HR) 1.3, 95% CI 0.7-2.4, p = 0.4] but was still associated with an increased rate of HAP (OR 2.2, 95% CI 1.0-4.8, p \ 0.05). When only patients developing acute respiratory distress syndrome (ARDS) were analyzed, similar results were observed. Conclusions: Early use of corticosteroids in patients affected by pandemic (H1N1)v influenza A infection did not result in better outcomes and was associated with increased risk of superinfections. Keywords Community acquired pneumonia Á Pandemic (H1N1)v influenza A infection Á Corticosteroid therapy Á ARDS

Research paper thumbnail of Adrenal function in sepsis: The retrospective Corticus cohort study

Critical Care Medicine, Apr 1, 2007

; for the Corticus Study Group Objective: To refine the value of baseline and adrenocorticotropin... more ; for the Corticus Study Group Objective: To refine the value of baseline and adrenocorticotropin hormone (ACTH)-stimulated cortisol levels in relation to mortality from severe sepsis or septic shock. Design: Retrospective multicenter cohort study. Setting: Twenty European intensive care units. Patients: Patients included 477 patients with severe sepsis and septic shock who had undergone an ACTH stimulation test on the day of the onset of severe sepsis. Interventions: None. Measurements and Main Results: Compared with survivors, nonsurvivors had higher baseline cortisol levels (29.5 ؎ 33.5 vs. 24.3 ؎ 16.5 g/dL, p ‫؍‬ .03) but similar peak cortisol values (37.6 ؎ 40.2 vs. 35.2 ؎ 22.9 g/dL, p ‫؍‬ .42). Thus, nonsurvivors had lower ⌬max (i.e., peak cortisol minus baseline cortisol) (6.4 ؎ 22.6 vs. 10.9 ؎ 12.9 g/dL, p ‫؍‬ .006). Patients with either baseline cortisol levels <15 g/dL or a ⌬max <9 g/dL had a likelihood ratio of dying of 1.26 (95% confidence interval, 1.11-1.44), a longer duration of shock, and a shorter survival time. Patients with a ⌬max <9 g/dL but any baseline cortisol value had a likelihood ratio of dying of 1.38 (95% confidence interval, 1.18-1.61). Conclusions: Although delta cortisol and not basal cortisol level was associated with clinical outcome, further studies are still needed to optimize the diagnosis of adrenal insufficiency in critical illness. Etomidate influenced ACTH test results and was associated with a worse outcome.

Research paper thumbnail of Is Red Blood Cell Transfusion Associated With Worse Outcome? Results of the SOAP Stud

Chest, 2003

PURPOSE: Red blood cell (RBC) transfusion is a common practice in the ICU. We investigated the ep... more PURPOSE: Red blood cell (RBC) transfusion is a common practice in the ICU. We investigated the epidemiology of RBC transfusion and its relation to outcome. METHODS: We included all 3147 adult patients admitted to 198 European ICUs between May 1 and May 15, 2002. Patients were followed up until death, hospital discharge, or for 60 days. Patients were classified into those who received RBC transfusion at least once during the ICU stay and those who were not transfused. Propensity score case-matching according to the transfusion status was performed and matched pairs were examined for baseline characteristics and outcome. RESULTS: Of 3147 patients, 1040 (33.0%) received a RBC transfusion (59.2% of patients staying more than 7 days in the ICU) and 2107 (67.0%) did not. The transfused patients were older, had a higher incidence of liver cirrhosis and hematologic dysfunction, were more commonly surgical admissions, had greater SAPS II and SOFA scores, and had higher rates of sepsis syndromes. Both ICU and hospital mortality rates were higher in transfused patients (23.0 vs. 16.3 and 29.9 vs. 22.5%, p<0.001) than in nontransfused patients. Patients receiving ≥ 4 units (n=490) had higher ICU and hospital mortality rates than those who received < 4 units (28.6 vs. 18.0, and 34.7 vs. 25.6% p<0.01). In 821 matched-pairs according to a propensity score, ICU and hospital mortality rates were identical in transfused and non transfused patients (22.7 vs. 22.1 and 29.1 vs. 29.0%, p=NS). Survival at 30 days was similar between the two matched groups (log rank = 2.9; p = 0.09), with a tendency towards lower survival in non transfused patients. CONCLUSIONS: In this observational study, RBC transfusion was not associated with increased mortality. However, higher transfusion rates were associated with worse outcome. CLINICAL IMPLICATIONS: These data contrast with those of other recent studies, possibly due to the implementation of routine blood deleukocytation in Europe. Evaluation of current transfusion strategies may help explain the differences.

Research paper thumbnail of Use of IFNγ/IL10 ratio for stratification of hydrocortisone therapy in patients with septic shock

BackgroundLarge clinical trials testing hydrocortisone therapy in septic shock have produced conf... more BackgroundLarge clinical trials testing hydrocortisone therapy in septic shock have produced conflicting results. Subgroups may however benefit depending on their individual immune response.MethodsWe performed an exploratory analysis of the CORTICUS trial database employing machine learning to a panel of 137 variables collected from 83 patients (60 survivors, 23 non-survivors) including demographic and clinical measures, organ failure scores, leukocyte counts and circulating cytokine levels. The identified biomarker was validated against data collected from patients enrolled into a cohort of the Hellenic Sepsis Study Group (HSSG) (n=162) and two data sets of two other clinical trials. Ex vivo studies were performed on this biomarker to assess a possible mechanistic role.ResultsA low serum IFNγ/IL10 ratio predicted increased survival in the hydrocortisone group whereas a high ratio predicted better survival in the placebo group. Using this ratio for a decision rule, we found signific...

Research paper thumbnail of A Sofa Score Based Index at Icu Discharge Predicts Subsequent Mortality on Referral to General Floors

Critical Care Medicine, 2004

In this cohort, multicenter, observational study, all adult patients admitted to a participating ... more In this cohort, multicenter, observational study, all adult patients admitted to a participating ICU between May 1-15, 2002 were included, and followed until death, hospital discharge, or for 60 days. The index SOFA (SOFAind) was calculated as the by-product of the SOFA score on ...

Research paper thumbnail of Sepsis Occurrence in the Acutely All Patient (Soap): Results of a Large European Multicentric Study

Critical Care Medicine, 2002

Research paper thumbnail of Use of the Pulmonary Artery Catheter Is Not Associated With Worse Outcome in the ICU

Research paper thumbnail of Does Albumin Administration Influence Outcome? Results of the SOAP Study

CHEST Journal, 2003

PURPOSE: We investigated the possible association between albumin administration and worse outcom... more PURPOSE: We investigated the possible association between albumin administration and worse outcome in a large cohort of ICU patients. METHODS: All 3147 adult patients admitted to 198 European ICUs between May 1 and 15, 2002 were followed up until death, hospital discharge, or for 60 days. Patients were classified into those who received albumin at any time during their ICU stay and those who did not. Propensity score case-matching was performed with matched pairs examined for baseline characteristics and outcome. RESULTS: Three hundred fifty-four patients (11.2%) received albumin. On admission, patients who received albumin had a higher incidence of cancer and liver cirrhosis, were more commonly medical admissions, had higher SAPS II and SOFA scores, and had a higher incidence of sepsis syndromes. As expected, ICU and hospital mortality rates were higher in the albumin group (35.3 vs. 16.4, and 41.5 vs. 21.3%, p<0.001) than in other patients. In a Cox regression analysis with ICU mortality at 60 days as the dependent factor, albumin administration was an independent risk factor for death (relative hazard 1.4, 95% confidence interval 1.2-1.8, p<0.001) at 60 days. Moreover, in 343 propensity matched pairs, ICU and hospital mortality rates were higher in patients who received albumin than in those who did not (34.7 vs. 20.7 and 41.1 vs. 25.7%, p<0.001). Survival at 30 days was lower in the albumin group than in its matched group (Log Rank 6.9, p<0.001). Albumin administration was associated with a higher relative hazard of death at 60 days across all subgroups of age, SAPS II and fluid balance (relative hazard >1, p<0.01).

Research paper thumbnail of An evaluation of systemic inflammatory response syndrome signs in the Sepsis Occurrence in Acutely ill Patients (SOAP) study

Intensive Care Medicine, Feb 15, 2006

To define the frequency and prognostic implications of SIRS criteria in critically ill patients h... more To define the frequency and prognostic implications of SIRS criteria in critically ill patients hospitalized in European ICUs. Cohort, multicentre, observational study of 198 ICUs in 24 European countries. All 3,147 new adult admissions to participating ICUs between 1 and 15 May 2002 were included. Data were collected prospectively, with common SIRS criteria. During the ICU stay 93% of patients had at least two SIRS criteria [respiratory rate (82%), heart rate (80%)]. The frequency of having three or four SIRS criteria vs. two was higher in infected than non-infected patients (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01). In non-infected patients having more than two SIRS criteria was associated with a higher risk of subsequent development of severe sepsis (odds ratio 2.6, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01) and septic shock (odds ratio 3.7, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01). Organ system failure and mortality increased as the number of SIRS criteria increased. Although common in the ICU, SIRS has prognostic importance in predicting infections, severity of disease, organ failure and outcome.

Research paper thumbnail of Hydrocortisone Therapy for Patients with Septic Shock

The Journal of Emergency Medicine, 2008

Hydrocortisone did not improve survival or reversal of shock in patients with septic shock, eithe... more Hydrocortisone did not improve survival or reversal of shock in patients with septic shock, either overall or in patients who did not have a response to corticotropin, although hydrocortisone hastened reversal of shock in patients in whom shock was reversed. (ClinicalTrials.gov number, NCT00147004.

Research paper thumbnail of Acute renal failure in the ICU: risk factors and outcome evaluated by the SOFA score

Intensive Care Medicine, 2000

Research paper thumbnail of The importance of religious affiliation and culture on end-of-life decisions in European intensive care units

Intensive Care Medicine, 2007

Research paper thumbnail of End-of-life practices in 282 intensive care units: data from the SAPS 3 database

Intensive Care Medicine, 2009

Objective: To report incidence and characteristics of decisions to forgo life-sustaining therapie... more Objective: To report incidence and characteristics of decisions to forgo life-sustaining therapies (DFLSTs) in the 282 ICUs who contributed to the SAPS3 database. Methods: We reviewed data on DFLSTs in 14,488 patients. Independent predictors of DFLSTs have been identified by stepwise logistic regression. Results: DFLSTs occurred in 1,239 (8.6%) patients [677 (54.6%) withholding and 562 (45.4%) withdrawal decisions]. Hospital mortality was 21% (3,050/14,488); 36.2% (1,105) deaths occurred after Keywords Intensive care Á End-of-life Á SAPS 3 Á Treatment withholding Á Treatment withdrawal

Research paper thumbnail of Communication of end-of-life decisions in European intensive care units

Intensive Care Medicine, 2005

Research paper thumbnail of Reasons, considerations, difficulties and documentation of end-of-life decisions in European intensive care units: the ETHICUS Study

Intensive Care Medicine, 2008

Research paper thumbnail of Posters

Intensive Care Medicine, 1996

Research paper thumbnail of HA-1A in septic patients with ARDS: Results from the pivotal trial

Intensive Care Medicine, 1994

To evaluate the effects of HA-1A, a human monoclonal antiendotoxin antibody, in septic patients w... more To evaluate the effects of HA-1A, a human monoclonal antiendotoxin antibody, in septic patients with ARDS. Substudy of a multicenter, double-blinded, placebo-controlled trial of HA-1A in septic patients. 63 septic patients with ARDS at the time of study entry. A single intravenous injection of HA-1A (100 mg) or placebo. A quantitative radiographic score, the PaO2/FIO2 ratio and an index of the severity of ARDS did not show a significant difference between the treatment and placebo groups at 3, 5 and 7 days after treatment. The duration of endotracheal intubation did not differ between the two groups. 15 of 30 HA-1A treated patients (50%) and 23 of 33 placebo-treated patients (69.7%) died within 28 days. The daily mortality was always lower in the HA-1A group, but this difference was not statistically significant at 28 days. The 28-day survival curves for the two treatment groups adjusted by covariate analysis were not significantly different (p = 0.07). Using logistic regression, a significant independent effect of HA-1A treatment was detected upon the early survival rate at 7 days (p = 0.03) but not at 14 and 28 days. A single injection of HA-1A in septic patients with ARDS did not reverse acute respiratory failure or improve long-term survival.

Research paper thumbnail of Effect of infections on 30-day mortality among critically ill patients hospitalized in and out of the intensive care unit

Critical Care Medicine, 2008

This analysis is part of a multicenter study conducted in Israel to evaluate survival of critical... more This analysis is part of a multicenter study conducted in Israel to evaluate survival of critically ill patients treated in and out of intensive care units (ICUs). To assess the role of infection on 30-day survival among critically ill patients hospitalized in ICUs and regular wards. All adult inpatients were screened on four rounds for patients meeting ICU admission criteria. Retrospective chart review was used to detect presence and type of infection. Mortality was ascertained from day of meeting study criteria to 30 days thereafter. The effect of infection on mortality among patients, treated in and out of the ICU, was compared using Kaplan Meier survival curves. Multivariate Cox models were constructed to adjust interdepartmental comparisons for case-mix differences. Of 641 critically ill patients identified, 36.8% already had an infection on day 0. An additional 40.2% subsequently developed a new infection during the follow-up period, ranging from 64.6% in the ICU to 31.5% in regular wards (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). Resistant infections were more prevalent in ICUs. Infection was independently associated with an increase in mortality, regardless of whether the patient was admitted to the ICU. There was no difference in the adjusted risk of mortality associated with an infection diagnosed on day 0 vs. an infection diagnosed later. Risk of dying was similar in resistant and nonresistant infections. Adjusting for infections, survival of ICU patients was better relative to patients in regular wards (adjusted hazard ratio = 0.7). Among the different types of infection, risk of mortality from pneumonia was significantly lower in ICUs relative to regular wards. There was a protective effect in ICUs among noninfected patients. The risk of acquiring a new infection is greater in the ICU. However, risk of mortality among ICU patients was lower for the most serious infections and for those without any infection.

Research paper thumbnail of Multiple Organ Dysfunction Score

Critical Care Medicine, 1995

Research paper thumbnail of Recommendations for the diagnosis and management of corticosteroid insufficiency in critically ill adult patients: Consensus statements from an international task force by the American College of Critical Care Medicine

Critical Care Medicine, 2008

... The meeting was supported by an unrestricted educational grant from Pfizer. ... to facilitate... more ... The meeting was supported by an unrestricted educational grant from Pfizer. ... to facilitate early diagnosis and optimize management to improve quality of life, prevent complications, and ... surgery difficult if delayed until a later age and could require repeated surgical interventions.

Research paper thumbnail of Use of early corticosteroid therapy on ICU admission in patients affected by severe pandemic (H1N1)v influenza A infection

Intensive Care Medicine, Nov 24, 2010

z ORIGINAL associated with mortality [hazard ratio (HR) 1.3, 95% CI 0.7-2.4, p = 0.4] but was sti... more z ORIGINAL associated with mortality [hazard ratio (HR) 1.3, 95% CI 0.7-2.4, p = 0.4] but was still associated with an increased rate of HAP (OR 2.2, 95% CI 1.0-4.8, p \ 0.05). When only patients developing acute respiratory distress syndrome (ARDS) were analyzed, similar results were observed. Conclusions: Early use of corticosteroids in patients affected by pandemic (H1N1)v influenza A infection did not result in better outcomes and was associated with increased risk of superinfections. Keywords Community acquired pneumonia Á Pandemic (H1N1)v influenza A infection Á Corticosteroid therapy Á ARDS

Research paper thumbnail of Adrenal function in sepsis: The retrospective Corticus cohort study

Critical Care Medicine, Apr 1, 2007

; for the Corticus Study Group Objective: To refine the value of baseline and adrenocorticotropin... more ; for the Corticus Study Group Objective: To refine the value of baseline and adrenocorticotropin hormone (ACTH)-stimulated cortisol levels in relation to mortality from severe sepsis or septic shock. Design: Retrospective multicenter cohort study. Setting: Twenty European intensive care units. Patients: Patients included 477 patients with severe sepsis and septic shock who had undergone an ACTH stimulation test on the day of the onset of severe sepsis. Interventions: None. Measurements and Main Results: Compared with survivors, nonsurvivors had higher baseline cortisol levels (29.5 ؎ 33.5 vs. 24.3 ؎ 16.5 g/dL, p ‫؍‬ .03) but similar peak cortisol values (37.6 ؎ 40.2 vs. 35.2 ؎ 22.9 g/dL, p ‫؍‬ .42). Thus, nonsurvivors had lower ⌬max (i.e., peak cortisol minus baseline cortisol) (6.4 ؎ 22.6 vs. 10.9 ؎ 12.9 g/dL, p ‫؍‬ .006). Patients with either baseline cortisol levels <15 g/dL or a ⌬max <9 g/dL had a likelihood ratio of dying of 1.26 (95% confidence interval, 1.11-1.44), a longer duration of shock, and a shorter survival time. Patients with a ⌬max <9 g/dL but any baseline cortisol value had a likelihood ratio of dying of 1.38 (95% confidence interval, 1.18-1.61). Conclusions: Although delta cortisol and not basal cortisol level was associated with clinical outcome, further studies are still needed to optimize the diagnosis of adrenal insufficiency in critical illness. Etomidate influenced ACTH test results and was associated with a worse outcome.

Research paper thumbnail of Is Red Blood Cell Transfusion Associated With Worse Outcome? Results of the SOAP Stud

Chest, 2003

PURPOSE: Red blood cell (RBC) transfusion is a common practice in the ICU. We investigated the ep... more PURPOSE: Red blood cell (RBC) transfusion is a common practice in the ICU. We investigated the epidemiology of RBC transfusion and its relation to outcome. METHODS: We included all 3147 adult patients admitted to 198 European ICUs between May 1 and May 15, 2002. Patients were followed up until death, hospital discharge, or for 60 days. Patients were classified into those who received RBC transfusion at least once during the ICU stay and those who were not transfused. Propensity score case-matching according to the transfusion status was performed and matched pairs were examined for baseline characteristics and outcome. RESULTS: Of 3147 patients, 1040 (33.0%) received a RBC transfusion (59.2% of patients staying more than 7 days in the ICU) and 2107 (67.0%) did not. The transfused patients were older, had a higher incidence of liver cirrhosis and hematologic dysfunction, were more commonly surgical admissions, had greater SAPS II and SOFA scores, and had higher rates of sepsis syndromes. Both ICU and hospital mortality rates were higher in transfused patients (23.0 vs. 16.3 and 29.9 vs. 22.5%, p<0.001) than in nontransfused patients. Patients receiving ≥ 4 units (n=490) had higher ICU and hospital mortality rates than those who received < 4 units (28.6 vs. 18.0, and 34.7 vs. 25.6% p<0.01). In 821 matched-pairs according to a propensity score, ICU and hospital mortality rates were identical in transfused and non transfused patients (22.7 vs. 22.1 and 29.1 vs. 29.0%, p=NS). Survival at 30 days was similar between the two matched groups (log rank = 2.9; p = 0.09), with a tendency towards lower survival in non transfused patients. CONCLUSIONS: In this observational study, RBC transfusion was not associated with increased mortality. However, higher transfusion rates were associated with worse outcome. CLINICAL IMPLICATIONS: These data contrast with those of other recent studies, possibly due to the implementation of routine blood deleukocytation in Europe. Evaluation of current transfusion strategies may help explain the differences.

Research paper thumbnail of Use of IFNγ/IL10 ratio for stratification of hydrocortisone therapy in patients with septic shock

BackgroundLarge clinical trials testing hydrocortisone therapy in septic shock have produced conf... more BackgroundLarge clinical trials testing hydrocortisone therapy in septic shock have produced conflicting results. Subgroups may however benefit depending on their individual immune response.MethodsWe performed an exploratory analysis of the CORTICUS trial database employing machine learning to a panel of 137 variables collected from 83 patients (60 survivors, 23 non-survivors) including demographic and clinical measures, organ failure scores, leukocyte counts and circulating cytokine levels. The identified biomarker was validated against data collected from patients enrolled into a cohort of the Hellenic Sepsis Study Group (HSSG) (n=162) and two data sets of two other clinical trials. Ex vivo studies were performed on this biomarker to assess a possible mechanistic role.ResultsA low serum IFNγ/IL10 ratio predicted increased survival in the hydrocortisone group whereas a high ratio predicted better survival in the placebo group. Using this ratio for a decision rule, we found signific...

Research paper thumbnail of A Sofa Score Based Index at Icu Discharge Predicts Subsequent Mortality on Referral to General Floors

Critical Care Medicine, 2004

In this cohort, multicenter, observational study, all adult patients admitted to a participating ... more In this cohort, multicenter, observational study, all adult patients admitted to a participating ICU between May 1-15, 2002 were included, and followed until death, hospital discharge, or for 60 days. The index SOFA (SOFAind) was calculated as the by-product of the SOFA score on ...

Research paper thumbnail of Sepsis Occurrence in the Acutely All Patient (Soap): Results of a Large European Multicentric Study

Critical Care Medicine, 2002

Research paper thumbnail of Use of the Pulmonary Artery Catheter Is Not Associated With Worse Outcome in the ICU

Research paper thumbnail of Does Albumin Administration Influence Outcome? Results of the SOAP Study

CHEST Journal, 2003

PURPOSE: We investigated the possible association between albumin administration and worse outcom... more PURPOSE: We investigated the possible association between albumin administration and worse outcome in a large cohort of ICU patients. METHODS: All 3147 adult patients admitted to 198 European ICUs between May 1 and 15, 2002 were followed up until death, hospital discharge, or for 60 days. Patients were classified into those who received albumin at any time during their ICU stay and those who did not. Propensity score case-matching was performed with matched pairs examined for baseline characteristics and outcome. RESULTS: Three hundred fifty-four patients (11.2%) received albumin. On admission, patients who received albumin had a higher incidence of cancer and liver cirrhosis, were more commonly medical admissions, had higher SAPS II and SOFA scores, and had a higher incidence of sepsis syndromes. As expected, ICU and hospital mortality rates were higher in the albumin group (35.3 vs. 16.4, and 41.5 vs. 21.3%, p<0.001) than in other patients. In a Cox regression analysis with ICU mortality at 60 days as the dependent factor, albumin administration was an independent risk factor for death (relative hazard 1.4, 95% confidence interval 1.2-1.8, p<0.001) at 60 days. Moreover, in 343 propensity matched pairs, ICU and hospital mortality rates were higher in patients who received albumin than in those who did not (34.7 vs. 20.7 and 41.1 vs. 25.7%, p<0.001). Survival at 30 days was lower in the albumin group than in its matched group (Log Rank 6.9, p<0.001). Albumin administration was associated with a higher relative hazard of death at 60 days across all subgroups of age, SAPS II and fluid balance (relative hazard >1, p<0.01).

Research paper thumbnail of An evaluation of systemic inflammatory response syndrome signs in the Sepsis Occurrence in Acutely ill Patients (SOAP) study

Intensive Care Medicine, Feb 15, 2006

To define the frequency and prognostic implications of SIRS criteria in critically ill patients h... more To define the frequency and prognostic implications of SIRS criteria in critically ill patients hospitalized in European ICUs. Cohort, multicentre, observational study of 198 ICUs in 24 European countries. All 3,147 new adult admissions to participating ICUs between 1 and 15 May 2002 were included. Data were collected prospectively, with common SIRS criteria. During the ICU stay 93% of patients had at least two SIRS criteria [respiratory rate (82%), heart rate (80%)]. The frequency of having three or four SIRS criteria vs. two was higher in infected than non-infected patients (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01). In non-infected patients having more than two SIRS criteria was associated with a higher risk of subsequent development of severe sepsis (odds ratio 2.6, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01) and septic shock (odds ratio 3.7, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01). Organ system failure and mortality increased as the number of SIRS criteria increased. Although common in the ICU, SIRS has prognostic importance in predicting infections, severity of disease, organ failure and outcome.

Research paper thumbnail of Hydrocortisone Therapy for Patients with Septic Shock

The Journal of Emergency Medicine, 2008

Hydrocortisone did not improve survival or reversal of shock in patients with septic shock, eithe... more Hydrocortisone did not improve survival or reversal of shock in patients with septic shock, either overall or in patients who did not have a response to corticotropin, although hydrocortisone hastened reversal of shock in patients in whom shock was reversed. (ClinicalTrials.gov number, NCT00147004.

Research paper thumbnail of Acute renal failure in the ICU: risk factors and outcome evaluated by the SOFA score

Intensive Care Medicine, 2000

Research paper thumbnail of The importance of religious affiliation and culture on end-of-life decisions in European intensive care units

Intensive Care Medicine, 2007

Research paper thumbnail of End-of-life practices in 282 intensive care units: data from the SAPS 3 database

Intensive Care Medicine, 2009

Objective: To report incidence and characteristics of decisions to forgo life-sustaining therapie... more Objective: To report incidence and characteristics of decisions to forgo life-sustaining therapies (DFLSTs) in the 282 ICUs who contributed to the SAPS3 database. Methods: We reviewed data on DFLSTs in 14,488 patients. Independent predictors of DFLSTs have been identified by stepwise logistic regression. Results: DFLSTs occurred in 1,239 (8.6%) patients [677 (54.6%) withholding and 562 (45.4%) withdrawal decisions]. Hospital mortality was 21% (3,050/14,488); 36.2% (1,105) deaths occurred after Keywords Intensive care Á End-of-life Á SAPS 3 Á Treatment withholding Á Treatment withdrawal

Research paper thumbnail of Communication of end-of-life decisions in European intensive care units

Intensive Care Medicine, 2005

Research paper thumbnail of Reasons, considerations, difficulties and documentation of end-of-life decisions in European intensive care units: the ETHICUS Study

Intensive Care Medicine, 2008

Research paper thumbnail of Posters

Intensive Care Medicine, 1996

Research paper thumbnail of HA-1A in septic patients with ARDS: Results from the pivotal trial

Intensive Care Medicine, 1994

To evaluate the effects of HA-1A, a human monoclonal antiendotoxin antibody, in septic patients w... more To evaluate the effects of HA-1A, a human monoclonal antiendotoxin antibody, in septic patients with ARDS. Substudy of a multicenter, double-blinded, placebo-controlled trial of HA-1A in septic patients. 63 septic patients with ARDS at the time of study entry. A single intravenous injection of HA-1A (100 mg) or placebo. A quantitative radiographic score, the PaO2/FIO2 ratio and an index of the severity of ARDS did not show a significant difference between the treatment and placebo groups at 3, 5 and 7 days after treatment. The duration of endotracheal intubation did not differ between the two groups. 15 of 30 HA-1A treated patients (50%) and 23 of 33 placebo-treated patients (69.7%) died within 28 days. The daily mortality was always lower in the HA-1A group, but this difference was not statistically significant at 28 days. The 28-day survival curves for the two treatment groups adjusted by covariate analysis were not significantly different (p = 0.07). Using logistic regression, a significant independent effect of HA-1A treatment was detected upon the early survival rate at 7 days (p = 0.03) but not at 14 and 28 days. A single injection of HA-1A in septic patients with ARDS did not reverse acute respiratory failure or improve long-term survival.

Research paper thumbnail of Effect of infections on 30-day mortality among critically ill patients hospitalized in and out of the intensive care unit

Critical Care Medicine, 2008

This analysis is part of a multicenter study conducted in Israel to evaluate survival of critical... more This analysis is part of a multicenter study conducted in Israel to evaluate survival of critically ill patients treated in and out of intensive care units (ICUs). To assess the role of infection on 30-day survival among critically ill patients hospitalized in ICUs and regular wards. All adult inpatients were screened on four rounds for patients meeting ICU admission criteria. Retrospective chart review was used to detect presence and type of infection. Mortality was ascertained from day of meeting study criteria to 30 days thereafter. The effect of infection on mortality among patients, treated in and out of the ICU, was compared using Kaplan Meier survival curves. Multivariate Cox models were constructed to adjust interdepartmental comparisons for case-mix differences. Of 641 critically ill patients identified, 36.8% already had an infection on day 0. An additional 40.2% subsequently developed a new infection during the follow-up period, ranging from 64.6% in the ICU to 31.5% in regular wards (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). Resistant infections were more prevalent in ICUs. Infection was independently associated with an increase in mortality, regardless of whether the patient was admitted to the ICU. There was no difference in the adjusted risk of mortality associated with an infection diagnosed on day 0 vs. an infection diagnosed later. Risk of dying was similar in resistant and nonresistant infections. Adjusting for infections, survival of ICU patients was better relative to patients in regular wards (adjusted hazard ratio = 0.7). Among the different types of infection, risk of mortality from pneumonia was significantly lower in ICUs relative to regular wards. There was a protective effect in ICUs among noninfected patients. The risk of acquiring a new infection is greater in the ICU. However, risk of mortality among ICU patients was lower for the most serious infections and for those without any infection.

Research paper thumbnail of Multiple Organ Dysfunction Score

Critical Care Medicine, 1995

Research paper thumbnail of Recommendations for the diagnosis and management of corticosteroid insufficiency in critically ill adult patients: Consensus statements from an international task force by the American College of Critical Care Medicine

Critical Care Medicine, 2008

... The meeting was supported by an unrestricted educational grant from Pfizer. ... to facilitate... more ... The meeting was supported by an unrestricted educational grant from Pfizer. ... to facilitate early diagnosis and optimize management to improve quality of life, prevent complications, and ... surgery difficult if delayed until a later age and could require repeated surgical interventions.