Publications by authors named "Tom Shanley"
Background: One of five global deaths are attributable to sepsis. Hyperferritinemic sepsis (> 500 ng/mL) is associated with increased mortality in single-center studies. Our pediatric research network's objective was to obtain rationale for designing anti-inflammatory clinical trials targeting hyperferritinemic sepsis.
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- The study investigates the impact of early, persistent lymphopenia (low lymphocyte count) on the outcomes of pediatric patients with severe sepsis, aiming to understand its correlation with worse health outcomes.
- Out of 401 children studied, 38% exhibited persistent lymphopenia, which was linked to higher rates of prolonged multiple organ dysfunction syndrome (MODS) and increased mortality in the pediatric intensive care unit (PICU).
- The presence of persistent lymphopenia was found to significantly increase the odds of poor outcomes, with a nearly threefold increase in risk, highlighting the need for further research into immune support therapies for young patients with sepsis.
Article Synopsis
- The study investigates the occurrence and contributing factors of acute disorders of consciousness (DoC) in children under 18 years old suffering from severe sepsis with organ failure, highlighting that 18% of cases exhibited signs of DoC.
- The primary findings indicate that older children and those with multiple organ failure (MOF) are more likely to experience DoC, with increased mortality rates and associations with specific types of MOF, including nonphenotypeable and immunoparalysis-associated.
- The research emphasizes the importance of recognizing DoC in pediatric sepsis cases as it correlates with worse outcomes and provides insight into factors that could inform clinical management.
Mortality Risk in Pediatric Sepsis Based on C-reactive Protein and Ferritin Levels.
Pediatr Crit Care Med
December 2022
Objectives: Interest in using bedside C-reactive protein (CRP) and ferritin levels to identify patients with hyperinflammatory sepsis who might benefit from anti-inflammatory therapies has piqued with the COVID-19 pandemic experience. Our first objective was to identify patterns in CRP and ferritin trajectory among critically ill pediatric sepsis patients. We then examined the association between these different groups of patients in their inflammatory cytokine responses, systemic inflammation, and mortality risks.
View Article and Find Full Text PDFBackground: Thrombotic microangiopathy-induced thrombocytopenia-associated multiple organ failure and hyperinflammatory macrophage activation syndrome are important causes of late pediatric sepsis mortality that are often missed or have delayed diagnosis. The National Institutes of General Medical Science sepsis research working group recommendations call for application of new research approaches in extant clinical data sets to improve efficiency of early trials of new sepsis therapies. Our objective is to apply machine learning approaches to derive computable 24-h sepsis phenotypes to facilitate personalized enrollment in early anti-inflammatory trials targeting these conditions.
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- The study focuses on understanding how genetic factors linked to immunity affect pediatric sepsis, particularly in a group of 330 children admitted to intensive care.
- Using whole-exome sequencing, researchers identified rare genetic variants associated with immunodeficiency in over half of the children, especially among African American children.
- The presence of these variants was correlated with a higher likelihood of detecting infectious pathogens and severe inflammatory responses, suggesting a need for genetic screening in children with severe infections.
Objectives: Ongoing adult sepsis clinical trials are assessing therapies that target three inflammation phenotypes including 1) immunoparalysis associated, 2) thrombotic microangiopathy driven thrombocytopenia associated, and 3) sequential liver failure associated multiple organ failure. These three phenotypes have not been assessed in the pediatric multicenter setting. We tested the hypothesis that these phenotypes are associated with increased macrophage activation syndrome and mortality in pediatric sepsis.
View Article and Find Full Text PDFBackground: The Institute of Medicine calls for the use of clinical guidelines and practice parameters to promote "best practices" and to improve patient outcomes.
Objective: 2007 update of the 2002 American College of Critical Care Medicine Clinical Guidelines for Hemodynamic Support of Neonates and Children with Septic Shock.
Participants: Society of Critical Care Medicine members with special interest in neonatal and pediatric septic shock were identified from general solicitation at the Society of Critical Care Medicine Educational and Scientific Symposia (2001-2006).