Portal de Periódicos da CAPES

Sepsis 2019

2019; Springer Nature; Volume: 7; Issue: S2 Linguagem: Inglês

10.1186/s40635-019-0254-1

2197-425X

Medicinal Plants and Bioactive Compounds

Sepsis 2019 AbstractsP1 Withdrawn P2 Epigenetic changes are reported in animal model of sepsisMonique Michels1, Mariane Rocha Abatti1, Andriele da Silva Vieira1, Heloisa Borges1, Amanda Indalécio Goulart1, Roger Varella2, Samira Valvassori2, Felipe Dal-Pizzol1 1Laboratory of Experimental Pathophysiology, Extreme University South of Santa Catarina, Criciúma, Brazil; 2Laboratório de Neurociências, Programa de Pós-Graduação em Ciências da Saúde (PPGCS), Universidade do Extremo Sul Catarinense (UNESC), Criciúma, SC, Brazil Correspondence: Monique Michels (moniquemichels@hotmail.com)BackgroundThe presence of oxidative stress and inflammatory mediators in sepsis may lead to epigenetic changes [1,2]. Epigenetic alterations of histones, such as methylation, acetylation and phosphorylation may direct the folding or unfolding of DNA through mechanisms still unknown, thus altering gene transcription [3]. Once gene transcription in sepsis is altered the response may be further exacerbated. Our objective was to report epigenetic changes in brain structures in animal model of sepsis.Materials and MethodsMale Wistar rats were subjected to sham or CLP and cerebral structures were removed in 24h, 72h, 10, 30 and 60 days after sepsis. HAT, HDAC and DNMT enzymes activities were measured in frontal cortex and hippocampus in different times.ResultsNo changes found in HAT activity (Fig. 1). Increased HDAC (Fig. 2) and DNMT activity (Fig. 3) was observed 72h, 10 and 30 days after sepsis and a significant reduction 60 day after.ConclusionsIt’s possible observe epigenetic alterations and deregulation in gene transcription in animal model of sepsis. Since in sepsis the presence of oxidative stress and the release of inflammatory mediators are well reported, these insults can lead to epigenetic changes, such as gene transcription, which may be related to exacerbation of the inflammatory response. Environmental influences can modulate the epigenetic response and therefore, be a therapeutic strategy for the treatment of sepsis.References1. Margueron R, Trojer P, Reinberg D: The key to development: interpreting the histone code? Curr Opin Genet Dev. 2005, 15:163–176.2. Reik W: Stability and flexibility of epigenetic gene regulation in mammalian development. Nature. 2007, 447:425–432.3. Chen Y, Hong T, Wang S, Mo J, Tian T, Zhou X: Epigenetic modification of nucleic acids: from basic studies to medical applications. Chem Soc Rev. 2017, 46(10):2844-2872. Fig. 1 (abstract P2).See text for descriptionFull size image Fig. 2 (abstract P2).See text for descriptionFull size image Fig. 3 (abstract P2).See text for descriptionFull size image P3 Is antibiotic treatment always necessary for chronic critical ill patients?Natalia Beloborodova, Irina Buyakova, Ekaterina ChernevskayaFederal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Laboratory of metabolism in critical state, Moscow, Russia Correspondence: Ekaterina Chernevskaya (chea05@inbox.ru)BackgroundAntibiotics are prescribed to almost all of chronic critical ill (CCI) patients. This often leads to colonization of multi-resistant strains of microorganisms and dramatic disturbances of gut microbiota. Metabolic activity of microbes can be assessed by the measurement of the levels of aromatic microbial metabolite (AMM) in serum, which are associated with the severity and mortality of ICU patients [1]. The modern trend is to reduce the antibacterial pressure. The aim of our study is to estimate the frequency of antibiotic use in CCI patients, to discuss the relationship between change in the neurological status and metabolic profile of AMM.Materials and MethodsThe study included 40 CCI patients with neurological disorders (stroke, traumatic brain injury, neurosurgical intervention for brain tumors). The level of AMM was measured in blood serum using GC-MS (Thermo Scientific). Biomarkers (PCT, S100) were measured using Elecsys immunoassay.ResultsAntibiotics (cephalosporins, aminoglycosides, fluoroquinolones, etc.) were prescribed on 74% of CCI patients in different cases (bacteriuria, leukocyturia, fever, etc.), but the retrospective analysis showed that levels of PCT were low (0.02 to 0.236 ng/ml). A significant increase the level of AMM, mainly due to para-hydrophenylacetic acid (p-HPhAA) was accompanied by the negative dynamics of the somatic and neurological status. Low serum levels of AMM correlated with positive clinical dynamics, a decrease of p-HPhAA level and an increase in para-hydroxybenzoic acid correlated with an improvement in neurological status. AMM`s data are compared with analysis of the gut microbiota using 16S rRNA sequencing in different groups of patients.ConclusionsIn chronic critical ill patients with neurological disorders, the presence of indirect signs of infection is not an indication for antimicrobial therapy, if biomarkers and AMM remain within the reference values, since antibiotics do not contribute to the improvement of the clinical and neurological condition. For this group of patients’, it is necessary to develop new treatment strategies based on the correction of microbiota metabolism.References1. Beloborodova NV, Sarshor YN et al.: Involvement of Aromatic Metabolites in the Pathogenesis of Septic Shock. Shock. 2018, 50(3):273-279.P4 Connection between biomarkers and aromatic metabolites in сerebrospinal fluid in critically ill patientsEkaterina Chernevskaya1, Natalia Beloborodova1, Tatyana Litvinova1, Irina Alexandrova2, Maria Getsina1, Alisa Pautova1 1Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Laboratory of metabolism in critical state, Moscow, Russia; 2Federal State Autonomous Institution “N .N. Burdenko National Scientific and Practical Center for Neurosurgery”, Moscow, Russia Correspondence: Ekaterina Chernevskaya (chea05@inbox.ru)BackgroundSome aromatic derivatives of tryptophane - 5-hydroxyindoleacetic acid (5-HIAA) and 3-indoleacetic acid (3-IAA) are under direct or undirect control of the gut microbiota and may play an important role in gut–brain axis. It was found that in serum high levels of some aromatic microbial metabolites (AMM) of phenolic structure are associated with severity of infection in critically ill patients with sepsis. Neuron specific enolase and S100 protein are biomarkers that reflect the neurotrophic and neurotoxic effects of neuron and glial cells. Procalcitonin (PCT) is a biomarker which is elevated in serum in the case of bacterial infection, however, the usefulness of PCT measurement in CSF has shown conflicting results. Cut-off value of PCT in CSF for bacterial meningitis was lower than serum level of PCT [1]. High level of PCT in CSF may indicate the loss of integrity of the blood-brain barrier, but some microbial metabolites may also penetrate the barrier in critical conditions. The aim of our study was to identify and qualify indolic and phenolic metabolites and evaluate correlation of certain biomarkers in the CSF in critically ill patients.Materials and MethodsThe study included 37 CSF samples taken from neurosurgical critically ill patients with CNS infection, traumatic brain injury. The levels of AMM and 3-IAA were measured in the CSF using GC-MS (Thermo Scientific), biomarkers (PCT, S100, NSE, IL6) were measured by Elecsys immunoassay, 5-HIAA was measured by ELISA (Cloud-Clone Corp).ResultsThe median level of the sum of 6 aromatic metabolites (benzoic, phenyllactic (PhLA), p-hydroxybenzoic (p-HBA), p-hydroxyphenilacetic, homovanilic (HVA) and p-hydroxyphenillactic (p-HPhLA) acid) in the CSF was 4.4 μM. The direct Spearman`s correlation between the level of PCT and sum of AMM (0.35, p<0.05) was revealed. The correlations between neurological biomarkers and some phenolic and indolic metabolites were also revealed (table 1).ConclusionsConnection between aromatic metabolites and neurological biomarkers (S100, NSE) indicates the potential involvement of phenolic and indolic metabolites in the pathogenesis of brain dysfunction.AcknowledgementsSupported by the Russian Science Foundation Grant 15-15-00110Reference1. Zhang L, Ma L et al. Diagnostic Value of Procalcitonin for Bacterial Meningitis in Children: A Comparison Analysis Between Serum and Cerebrospinal Fluid Procalcitonin Levels. Clin Pediatr (Phila). 2018 Oct 29:9922818809477 Table 1 (abstract P4). Correlations between biomarkers and aromatic metabolites (p<0.05)Full size table P5 Association between site of infection and in-hospital mortality among patients with sepsis in the emergency departments of third-level hospitals in Medellin, ColombiaCésar Caraballo1,4, Johana Ascuntar1, Carolina Hincapié1, Camilo Restrepo1, Elisa Bernal2, Fabián Jaimes1,3 1Grupo Académico de Epidemiologíıa Clínica (GRAEPIC), Universidad de Antioquia, Medellín, Colombia; 2Servicio de Medicina Interna, Hospital Pablo Tobón Uribe, Medellín, Colombia; 3Dirección de Investigaciones, Hospital San Vicente Fundación, Medellín, Colombia; 4Center for Outcomes Research and Evaluation (CORE), Yale University School of Medicine, New Haven, CT, USA Correspondence: Fabián Jaimes (fabian.jaimes@udea.edu.co)BackgroundThe impact of infection site in patients with sepsis on hospital mortality have not been reliably estimated1. We aimed to determine, in patients presenting to the emergency department with sepsis or septic shock, the association between the infection site and in-hospital mortality.Materials and MethodsMulticenter prospective cohort in three emergency departments and critical care units of high complexity hospitals in Medellín (Colombia). We recruited patients older than 18 years admitted with sepsis or septic shock as the main diagnosis. The exposure variable was site of infection according to standardized CDC definitions and the primary outcome variable was in-hospital mortality. A hierarchical logistic regression model was fitted for adjusting for acknowledged prognostic factors as comorbidities, organ dysfunction and emergency treatments.ResultsFrom 5022 eligible patients, 2510 were included in the study. The most frequent site of infection was the urinary tract with 27.8% of the cases, followed by pneumonia with 27.5% and intra-abdominal focus with 10.8% of the patients. In the 5.4% of the cases there was not a clear site of infection at admission. Using hierarchical logistic regression models with urinary tract as the reference, there were significant differences in mortality (Table 1).ConclusionsThere is an association between the different sites of infection and in-hospital mortality in patients with sepsis and septic shock and this should be considered in the prognostic models for these conditions.Reference1. Motzkus CA, Luckmann R. Does infection site matter? A systematic review of infection site mortality in sepsis. J Intensive Care Med. 2017;32:473-9. Table 1 (abstract P5). Hierarchical Logistic regression and mortalityFull size table P6 Risk factors for development of sepsis in a pediatric ICUGabriel do Amaral Cavalcante¹, Andrea Ramires Kairala², Rafael Augusto Faust Machado³, Bruno Mamede Lins Brasiliense³, Gabriela Jordão Vieira Gomes4 ¹Medicine department of UniCEUB, Brasília, Brasil; ²Instituto Hospital de Base, Brasília, Brasil; ³Brasil medicine department of UNICEPLAC, Brasília, Brasil; 4Secretaria de Estado de Saúde do Distrito-Federal, Brasília, Brasil Correspondence: Gabriel do Amaral Cavalcante (cavalcante.g@gmail.com)ObjectiveTo determine and evaluate clinical aspects and the main risk factors for development of sepsis in patients admitted in a pediatric Intensive Care Unit (ICU).Materials and methodsWe performed a retrospective and observational study by evaluating electronic medical records of patients, aged between 0 and 12 years old, admitted among January and December of 2017 in a pediatric ICU at a tertiary care hospital in Distrito-Federal. Patients that died in 48 hours of the admission, immunocompromised or admitted in the unit already with sepsis were excluded.ResultsThree hundred and thirty-four children were admitted in 2017, 171 of those were included in the study. The majority were male (N: 102; 59.6%) and under 2 years old (N:107;62.6%). 16 died (9.4%). Most of them hospitalized for 6 to 12 days (N:67; 39.2%). The reason of the hospitalization were clinical (N:92; 53.8%), surgical (N:72; 42.1%) and trauma (N:7; 4.1%). Central venous access was made in 136 (78.9%) patients, followed by tracheal intubation (N:109; 63.7%), thorax drainage (N:20; 11.7%) and 50% had long-standing bladder catheter. In our sample, 52 (30.4%) were diagnosed with sepsis and, among those, 8 evolved to septic shock. 24 (46.2%) of whom with sepsis had age between 28 days and 2 years. Also among those with sepsis, 75% had tracheal intubation, there being statistical correlation between the procedure and sepsis (p-value: 0.043). The other procedures didn’t show correlation with the development of sepsis. The sites of the infection among those with sepsis were mainly pulmonary (67%), central nervous system (13%), urinary tract (3%), abdominal (8%), cardiovascular (3%) and others (6%). 5 patients with diagnosis of sepsis died (9.6%). There was found no relation between the diagnosis of sepsis and age, sex and death, (p-value = 0.758) (p-value = 0.995) and (p-value = 0.939) respectively.ConclusionsIn a pediatric ICU, besides the medical reason of the hospitalization, there are necessary invasive procedures that contribute to the development of infections of many levels; there are mechanisms of protection and investigation that can lower sepsis incidence, also leading to an inferior death risk and incidence of complications during the staying in hospital.P7 Early sepsis diagnosis: lesser internship time and death in a pediatric ICUGabriel do Amaral Cavalcante¹, Andrea Ramires Kairala², Rafael Augusto Faust Machado³, Bruno Mamede Lins Brasiliense³, Gabriela Jordão Vieira Gomes4 ¹Medicine department of UniCEUB, Brasília, Brasil; ²Instituto Hospital de Base, Brasília, Brasil; ³Medicine department of UNICEPLAC, Brasília, Brasil; 4Secretaria de Estado de Saúde do Distrito-Federal, Brasília, Brasil Correspondence: Gabriel do Amaral Cavalcante (cavalcante.g@gmail.com)ObjectiveTo demonstrate the importance of early diagnosis and treatment in patients with sepsis in a pediatric intensive care unit (ICU).Materials and methodsA retrospective observational study by evaluating electronic medical records of patients, aged between 0 and 12 years old, admitted in 2017 in a pediatric ICU at a tertiary care hospital. Patients that died in 48 hours since admission, immunocompromised or already admitted with the diagnosis of sepsis were excluded.ResultsThree hundred and thirty-four children were admitted in 2017, 171 were included in the study. The majority were male (N: 102; 59.6%) and under 2 years old (N:107;62.6%). 16 died (9.4%). Most were hospitalized for 6 to 12 days (N:67; 39.2%). The reason of the hospitalization was clinical (N:92; 53.8%), surgical (N:72; 42.1%) and trauma (N:7; 4.1%). 52 (30.4%) patients were diagnosed with sepsis. 24 (46.2%) of whom with sepsis were aged between 28 days and 2 years old. 5 (9.6%) of them died, which means 2.9% of total patients admitted in the ICU and 31% of total death registered in the unit in 2017 (p-value = 0.033), therefore showing correlation between death and sepsis. The average time from admission and diagnosis was 3.6 days; done in < 5 days in 43 patients. Septic shock was identified in 8 patients, the diagnosis time was < 5 days in all of them. Those with sepsis (N:25; 48.1%) remained > 13 days in the unit; those without sepsis (N:86; 72.2%) remained <13 days in the unit (p-value = 0.025). With regard to the PIM score, patients with sepsis (19.4%) had it between 0 to 1,1; and among those without sepsis (34.5%) were at the same score range (p-value = 0.025). Therefore showing correlation of higher scores and the possibility of the sepsis diagnosis.ConclusionsSepsis is a serious public health issue; the diagnosis is clinical and the faster and aggressive the treatment begins, it alters drastically the prognosis and development of the disease. The primary objective of the first hours of diagnosis is lower the death risk and restore signs of hypoperfusion, lowering the death risk and time of internship.P8 Evaluation of pathogenic agents and antimicrobial susceptibility of chronic suppurative otitis media at Kigali Universality teaching hospitalMarie F Kayitesi1, Claude M Muvunyi2, Evariste Mushuru3, Rajab Mugabo4 1ENT department, Butare University teaching hospital, Butare, Rwanda; 2Microbiology Department, National referral laboratory, Kigali, Rwanda; 3Internal Medicine department, Butare University teaching hospital, University of Rwanda, Butare, Rwanda; 4ENT Department King Faisal hospital, Kighali, Rwanda Correspondence: Marie F Kayitesi (mfkayitesi@gmail.com)BackgroundChronic suppurative otitis media is a chronic inflammation of the middle ear and mastoid cavity, with more than 2 weeks of otorrhea. Various studies have shown that both gram-positive and gram-negative bacteria, which differ according to the sites, are responsible for infection of middle ear. The knowledge of the prevailing flora and their susceptibility to antibiotics is an important step for an appropriate treatmentMaterials and MethodsThe current study was cross sectional survey involving enrolled 110 patients who consulted ENT Department at KUTH with active chronic suppurative otitis media or its complication, from November 2014 up to January 2015. The patient demographics, clinical presentation, microbiology and antibiotic sensitivity were collected using data collection sheet.ResultsThe age of our population ranged between 2 and 89 years, the maximum was in the age range of 16- 30 years (55.5%). The proportion of male to female was almost similar, male constituted 50. 9% while females were 49.1%. The majority had discharge for more than 5 years. For the results of culture and sensitivity, 65.5% showed significant microbial growth of single organism, with majority being Staphylococcus aureus 35%, followed by Klepsiella spp 15%, and Pseudomonas aeruginosa together with Enterobacter spp accounting for 10 % for each. S.aureus showed high sensitivity to ciprofloxacin and clindamycin, but it were resistant to penicillin. For overall of antimicrobial used, ciprofloxacin was revealed to be most effective antimicrobial drug against many organisms at 51.8%. Chloremphenicol was effective at 14.5% while cefotaxim and augmentin showed to be effective at 10% and 8.2% respectively.ConclusionsThere is variation in isolated organisms as well as antimicrobial drugs. For this reason, to know the exact sensitive antibiotic to a certain ear infection treated without success, it is advisable to do culture of discharge and sensitivity.P9 Withdrawn P10 Etiology and antimicrobial resistance patterns of neonatal sepsis at Mulago National Referral Hospital, UgandaJosephine Tumuhamye1,4, Halvor Sommerfelt1, Freddie Bwanga2, James K Tumwine3, David Mukunya1,2, Victoria Nankabirwa1,4 1Centre for Intervention Science in Maternal and Child health (CISMAC) and Centre for International Health, University of Bergen, Norway; 2Department of Medical Microbiology, Makerere University Kampala, Uganda; 3Department of Pediatrics and Child Health, Makerere University Kampala, Uganda, 4Department of Epidemiology and Biostatistics, Makerere University Kampala, Uganda Correspondence: Josephine Tumuhamye (tphynne@gmail.com)BackgroundGlobally, approximately 2.5 million babies die in the first month of life[1]. Nearly all (99%) of these neonatal deaths occur in low income countries. The aim of this study was to describe the bacterial etiology and the antimicrobial resistance patterns of the isolated bacteria among newborns clinically suspected of having sepsisMaterials and MethodsA cross-sectional study was conducted at the Mulago national referral hospital in Kampala, Uganda. Venous blood for culture was collected from 305 newborns with clinical signs of sepsis. Validated questionnaires on mobile devices were used to obtain sociodemographic characteristics. An automated blood culture system was used (BD BactecTM) plus other conventional culture methods. Kirby Bauer disk diffusion method was used for antimicrobial susceptibility testing according to clinical laboratory standard institute. mecA PCR was conducted for confirmation of methicillin resistant Staphylococcus aureus (MRSA)ResultsThe mean birth weight of the neonates was 3.1 kg (SD 0.6), 32% of them were ≤7 days old and 55% were males. The proportion of patients with a bacterial pathogen known to cause sepsis was 14% (95% CI; 10%-19%). This included 27 Staphylococcus aureus isolates, Escherichia coli (6), Klebsiella pneumoniae (5), Streptococcus pneumoniae (1), Neisseria spp (1), Enterobacter spp (1) and Citrobacter freundii (1). All the 5 K.pneumoniae isolates, 5/6 E.coli isolates and 26/27 S.aureus isolates were resistant to ampicillin. Resistance to the most commonly used aminoglycoside varied between species in that 6 (22%) of the S. aureus, one of the E. coli and two of the K. pneumoniae isolates were resistant to gentamicin. Among the twenty seven S.aureus isolated, 20(74%) were MRSA, 19 (70%) were resistant to erythromycin, 10 (37%) were resistant to ciprofloxacin, 7 (26%) were resistant to trimethroprim-sulphamethoxazole and 8(30%) displayed erythromycin inducible clindamycin resistance (D-test positive). However all S.aureus isolates were sensitive to vancomycin. Three Gram-negative enteric bacterial isolates were extended broad spectrum beta lactamase producers; 1 E. coli and 2 K. pneumoniae but were sensitive to imipenem.ConclusionsS. aureus was the most common bacterial isolate among newborns with clinical signs of sepsis at the national referral hospital. The high frequency of MRSA among these isolates is worrisome and questions the empirical management of neonatal sepsis. Erythromycin inducible clindamycin resistance further limits treatment options for MRSA infectionsReference1. Liu L, Oza S, Hogan D, Perin J, Rudan I, Lawn JE, et al. Global, regional, and national causes of child mortality in 2000-13, with projections to inform post-2015 priorities: an updated systematic analysis. Lancet (London, England). 2015;385(9966):430-40.P11 Elevated levels of Nt-proBNP, proinflamatory cytokines, procalcitonin and lactate are associated with increased risk of mortality in Sepsis and Acute Renal Injury patientsLuis Huespe, Silvio Lazzeri, Carlos Mizdraji, Liu Ting, Santiago Ballejos, Lara Costa, Fabian Plano, Juan Melana, Tania Stoyanof, Victoria Aguirre, Monica Auchter, Juan Pablo RodríguezIntensive Care Unit, San Martín University Hospital and Biomolecular Research Laboratory, Faculty of Medicine. UNNE Rivadavia 1250 Corrientes (3400)-Argentina Correspondence: Luis Huespe (dythe_hescuela@hotmail.com)BackgroundSepsis is a potentially fatal organ dysfunction caused by a dysregulated host response to infection. Acute kidney Injury is the most frequent complication in patients with septic shock and is an independent risk factor for death. Patients diagnosed with Sepsis-3 were included in a prospective observational protocol with the following objectives: 1) Mortality at 28 and 90 days, 2) Acute Renal Injury and causes of non-recovery at 7 days and 3) Type-5 Cardiorenal Syndrome.Materials and MethodsAll patients with Sepsis-3 were were included in the study (December 2017-December 2018.) Epidemiological data, SOFA, Nt-proBNP, proinflamatory cytokines, procalcitonin, lactate, primary site of infection, microbiological culture, days of ventilación and standard care were determined. To identify the subgroup of patients with ARF, we used sepsis as an initial insult and the KDIGO criteria to determine creatinine increase ≥ 0.3 mg / dl or 50% of the previous lower value within 48 hours of admission to the protocol, or urine volume 1000 and mortality was 40%. If we compare it to this subgroup over the totality of the annual patients, mortality was 3.63%, renal replacement therapy 1.29%, septic shock 14.02% and sepsis-3 22.07%. The use of vasoactive drugs 10.03% and Cardiorenal Syndrome type-5 was 8.05%. All patients have elevated levels of interleukins 6,7,10 and 12ConclusionsAcute Kidney Injury and non-recovery at seven days after the initial insult in patients with sepsis and septic shock increases the mortality at 90 days. The identification of a subgroup of patients is useful for directing therapeutics and biomarker determinations are necessary. The association of renal involvement and transient cardiac failure can make us suspect the presence of type 5 cardiorenal syndrome.P12 Serum-induced cytotoxicity of patients with sepsis in cell culture HEK- Preliminary results for the development of a rapid AKI diagnostic testLuis Huespe, Silvio Lazzeri, Carlos Mizdraji, Diego Farizano, Rodrigo Sanabria, Juan Melana, Tamara Barnes, Victoria Aguirre, Juan Todaro,Roberto Jabornisky, Monica Auchter, Juan Pablo RodriguezIntensive Care Unit, San Martín University Hospital and Biomolecular Research Laboratory, Faculty of Medicine. UNNE Rivadavia 1250 Corrientes (3400), Argentina Correspondence: Luis Huespe (dythe_hescuela@hotmail.com)BackgroundSepsis is a potentially fatal organ dysfunction caused by a dysregulated host response to infection. Acute kidney Injury is the most frequent complication in patients with septic shock and we hypothesize that the damage is due to toxins related to infection, which is why we use in vitro cultures with HEK -293 cell.Materials and MethodsAll patients with Sepsis-3 were included in the study (December 2017-December 2018.)Patients with ARF, we used sepsis as an initial insult and the KDIGO criteria to determine AKI. Blood samples from patients Sepsis.3 (n 15) were obtained with the prior informed consent and the bioethical standards of the Hospital Committee. The biochemical tests were analyzed in quadruplicate and in vitro test using HEK-293 cell line, in a humid atmosphere with 5% C02 and 37°C. Cell monolayer was grown up to 60% confluence using RPMI with 5% fetal bovine serum. Once the monolayers were obtained, culture medium was removed and washed 3 times with 1X PBS. Inverted optical microscopy was used at different magnifications 40-400XResultsFrom all patients (n=385) admitted to ICU, 54 p with Sepsis-3. Average data showed: Age 44.2 years (20-81y), SOFA 7.3 (2-14), p with KDIGO criteria 22 of which 5 patients (18%) required hemodialysis, 18 patients (33.3%) had an Nt-proBNP> 1000 and mortality was 40%. 15 p of them were analyzed in vitro test using HEK-293 cell line and subsequently, cells were treated as the following: A HEK-293 culture with incomplete RPMI medium (control without fetal bovine serum), B HEK-293 cell treated with non-septic serum, C HEK-293 cell treated with septic serum in concentrations (0.5%, 2.5%, 5%, 10% and 15%). Cell cultures incubated for 24 hs, and morphological analysis for monolayers to evaluate changes compatible with cellular death. Control cell grown in incomplete RPMI medium cells treated with non-septic serum did not show significant differences between them and no cytoplasmatic or nuclear damage was observed. However, treated cells showed cell damage in direct relation to the amount of septic serum added to the culture.ConclusionsAcute Kidney Injury and non-recovery at seven days after the initial insult in patients with sepsis and septic shock increases the mortality. This group demonstrate in vitro damage caused by cytoxin from the infectious focus. This result lead us to think that the development of a rapid technique to diagnose AKI with a cell culture laboratory.P13 The effect of Intelligent Sepsis Management System on survival outcome in patients with sepsis and septic shock in accordance with Sepsis-3 definitionsJuhyun Song1, Daewon Park2, Sungwoo Moon1, Hyeri Seok2, Sejoong Ahn1 1Emergency Department, Korea University Ansan Hospital, Republic of Korea; 2Infectious Diseases, Korea University Ansan Hospital, Republic of Korea Correspondence: Juhyun Song (songcap97@hotmail.com)BackgroundSepsis is a global public health problem representing a leading cause of morbidity and mortality and increased costs in many countries [1]. According to a previous study, implementation of a national sepsis program resulted in improved adherence to sepsis bundles in severe sepsis and septic shock patients and was associated with reduced adjusted in-hospital mortality [2]. Another recent study reported that implementation of multidisciplinary emergency department (ED) sepsis bundle was associated with improved time to achieve key therapeutic interventions and a reduction in 30-day mortality [3]. In other study, the use of a sepsis triage screening tool significantly decreased the time to antibiotics in patients presenting to the ED [4]. Surviving Sepsis Campaign (SSC) 2016 recommends that hospitals have a performance improvement program for sepsis [5]. We have newly developed Intelligent Sepsis Management System (i-SMS) which help clinicians to screen, diagnose, and manage septic patients. The purpose of the present study was to asse