***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE : To identify the independent variables associated with death within 4 days after the first sepsis-induced organ dysfunction . METHODS : In this prospect i ve observational study , severe sepsis and septic shock patients were classified into 3 groups : Group 1 , survivors ; Group 2 , late non-survivors ; and Group 3 , early non-survivors . Early death was defined as death occurring within 4 days after the first sepsis-induced organ dysfunction . Demographic , clinical and laboratory data were collected and su bmi tted to univariate and multinomial analyses . RESULTS : The study included 414 patients : 218 ( 52.7 % ) in Group 1 , 165 ( 39.8 % ) in Group 2 , and 31 ( 7.5 % ) in Group 3 . A multinomial logistic regression analysis showed that age , Acute Physiology and Chronic Health Evaluation II score , Sepsis-related Organ Failure Assessment score after the first 24 hours , nosocomial infection , hepatic dysfunction , and the time elapsed between the onset of organ dysfunction and the sepsis diagnosis were associated with early mortality . In contrast , Black race and a source of infection other than the urinary tract were associated with late death . Among the non-survivors , early death was associated with Acute Physiology and Chronic Health Evaluation II score , chronic renal failure , hepatic dysfunction Sepsis-related Organ Failure Assessment score after 24 hours , and the duration of organ dysfunction . CONCLUSION : Factors related to patients ' intrinsic characteristics and disease severity as well as the promptness of sepsis recognition are associated with early death among severe septic patients BACKGROUND Reduced duration of antibiotic treatment might contain the emergence of multidrug-resistant bacteria in intensive care units . We aim ed to establish the effectiveness of an algorithm based on the biomarker procalcitonin to reduce antibiotic exposure in this setting . METHODS In this multicentre , prospect i ve , parallel-group , open-label trial , we used an independent , computer-generated r and omisation sequence to r and omly assign patients in a 1:1 ratio to procalcitonin ( n=311 patients ) or control ( n=319 ) groups ; investigators were masked to assignment before , but not after , r and omisation . For the procalcitonin group , antibiotics were started or stopped based on predefined cut-off ranges of procalcitonin concentrations ; the control group received antibiotics according to present guidelines . Drug selection and the final decision to start or stop antibiotics were at the discretion of the physician . Patients were expected to stay in the intensive care unit for more than 3 days , had suspected bacterial infections , and were aged 18 years or older . Primary endpoints were mortality at days 28 and 60 ( non-inferiority analysis ) , and number of days without antibiotics by day 28 ( superiority analysis ) . Analyses were by intention to treat . The margin of non-inferiority was 10 % . This trial is registered with Clinical Trials.gov , number NCT00472667 . FINDINGS Nine patients were excluded from the study ; 307 patients in the procalcitonin group and 314 in the control group were included in analyses .  Mortality of patients in the procalcitonin group seemed to be non-inferior to those in the control group at day 28 ( 21.2 % [ 65/307 ] vs 20.4 % [ 64/314 ] ; absolute difference 0.8 % , 90 % CI -4.6 to 6.2 ) and day 60 ( 30.0 % [ 92/307 ] vs 26.1 % [ 82/314 ] ; 3.8 % , -2.1 to 9.7 ) . Patients in the procalcitonin group had significantly more days without antibiotics than did those in the control group ( 14.3 days [ SD 9.1 ] vs 11.6 days [ SD 8.2 ] ; absolute difference 2.7 days , 95 % CI 1.4 to 4.1 , p<0.0001 ) . INTERPRETATION A procalcitonin-guided strategy to treat suspected bacterial infections in non-surgical patients in intensive care units could reduce antibiotic exposure and selective pressure with no apparent adverse outcomes . FUNDING Assistance Publique-Hôpitaux de Paris , France , and Brahms , Germany This prospect i ve , multicenter , epidemiological study was carried out in 99 Italian ICUs , distributed throughout the country , from April 1993 to March 1994 . In the study , we applied the new ACCP/SCCM classification system for sepsis ( SIRS , sepsis , severe sepsis and septic shock ) and determined the prevalence , incidence , evolution and outcome of these categories in critically ill patients . The preliminary analysis of 1101 patients showed that on admission SIRS accounted for about half of the diagnoses ( 52 % ) with sepsis , severe sepsis and septic shock accounting for 4.5 % , 2.1 % and 3 % of patients , respectively . Patients with severe sepsis or septic shock more frequently had high SAPS scores than patients without sepsis . Mortality rates were similar in patients with SIRS ( 26.5 % ) and without SIRS or infection ( 24 % ) , but rose to 36 % in patients with sepsis , to 52 % in those with severe sepsis and to 81.8 % in those with septic shock . Sepsis , severe sepsis and septic shock were more common in patients with medical diagnoses , and neither severe sepsis nor septic shock was observed in trauma patients . With respect to evolution , the incidence of septic shock was progressively higher in patients admitted with more severe “ sepsis-related ” diagnoses , while only a trivial difference in rates of incidence was observed between SIRS patients and those admitted without SIRS or any septic disorder ( nil ) . The breakdown of the various ACCP/SCCM “ sepsis-related ” diagnoses at any time during the study was : SIRS in 58 % of the population , sepsis in 16.3 % , severe sepsis in 5.5 % and septic shock in 6.1 % . It seems reasonable to expect from the final evaluation of our study answers to the questions raised by the ACCP/SCCM Consensus Conference about the correlations between “ sepsis-related ” diagnosis , severity score , organ dysfunction score and outcome Objectives To explore whether a strategy of more intensive antibiotic therapy leads to emergence or prolongation of renal failure in intensive care patients . Design Secondary analysis from a r and omised antibiotic strategy trial ( the Procalcitonin And Survival Study ) . The r and omised arms were conserved from the primary trial for the main analysis . Setting Nine mixed surgical/medical intensive care units across Denmark . Participants 1200 adult intensive care patients , 18 + years , expected to stay + 24 h. Exclusion criteria : bilirubin > 40 mg/dl , triglycerides > 1000 mg/dl , increased risk from blood sampling , pregnant/breast feeding and psychiatric patients . Interventions Patients were r and omised to guideline -based therapy ( ‘ st and ard-exposure ’ arm ) or to guideline -based therapy supplemented with antibiotic escalation whenever procalcitonin increased on daily measurements ( ‘ high-exposure ’ arm ) . Main outcome measures Primary end point : estimated glomerular filtration rate ( eGFR ) < 60 ml/min/1.73 m2 . Secondary end points : ( 1 ) delta eGFR after starting/stopping a drug and ( 2 ) RIFLE criterion Risk ‘ R ’ , Injury ‘ I ’ and Failure ‘ F ’ . Analysis was by intention to treat . Results 28-day mortality was 31.8 % and comparable ( Jensen et al , Crit Care Med 2011 ) . A total of 3672/7634 ( 48.1 % ) study days during follow-up in the high-exposure versus 3016/6949 ( 43.4 % ) in the ‘ st and ard-exposure arm were spent with eGFR < 60 ml/min/1.73 m2 , p<0.001 . In a multiple effects model , 3 piperacillin/tazobactam was identified as causing the lowest rate of renal recovery of all antibiotics used : 1.0 ml/min/1.73 m2/24 h while exposed to this drug ( 95 % CI 0.7 to 1.3 ml/min/1.73 m2/24 h ) vs meropenem : 2.9 ml/min/1.73 m2/24 h ( 2.5 to 3.3 ml/min/1.73 m2/24 h ) ) ; after discontinuing piperacillin/tazobactam , the renal recovery rate increased : 2.7 ml/min/1.73 m2/24 h ( 2.3 to 3.1 ml/min/1.73 m2 /24 h ) ) . eGFR < 60 ml/min/1.73 m2 in the two groups at entry and at last day of follow-up was 57 % versus 55 % and 41 % versus 39 % , respectively . Conclusions Piperacillin/tazobactam was identified as a cause of delayed renal recovery in critically ill patients . This nephrotoxicity was not observed when using other beta-lactam antibiotics . Trial registration Clinical Trials.gov identifier : NCT00271752 Objective : For patients in intensive care units , sepsis is a common and potentially deadly complication and prompt initiation of appropriate antimicrobial therapy improves prognosis . The objective of this trial was to determine whether a strategy of antimicrobial spectrum escalation , guided by daily measurements of the biomarker procalcitonin , could reduce the time to appropriate therapy , thus improving survival . Design : R and omized controlled open-label trial . Setting : Nine multidisciplinary intensive care units across Denmark . Patients : A total of 1,200 critically ill patients were included after meeting the following eligibility requirements : expected intensive care unit stay of ≥24 hrs , nonpregnant , judged to not be harmed by blood sampling , bilirubin < 40 mg/dL , and triglycerides < 1000 mg/dL ( not suspensive ) . Interventions : Patients were r and omized either to the “ st and ard-of-care-only arm , ” receiving treatment according to the current international guidelines and blinded to procalcitonin levels , or to the “ procalcitonin arm , ” in which current guidelines were supplemented with a drug-escalation algorithm and intensified diagnostics based on daily procalcitonin measurements . Measurements and Main Results : The primary end point was death from any cause at day 28 ; this occurred for 31.5 % ( 190 of 604 ) patients in the procalcitonin arm and for 32.0 % ( 191 of 596 ) patients in the st and ard-of-care-only arm ( absolute risk reduction , 0.6 % ; 95 % confidence interval [ CI ] −4.7 % to 5.9 % ) . Length of stay in the intensive care unit was increased by one day ( p = .004 ) in the procalcitonin arm , the rate of mechanical ventilation per day in the intensive care unit increased 4.9 % ( 95 % CI , 3.0–6.7 % ) , and the relative risk of days with estimated glomerular filtration rate < 60 mL/min/1.73 m2 was 1.21 ( 95 % CI , 1.15–1.27 ) . Conclusions : Procalcitonin-guided antimicrobial escalation in the intensive care unit did not improve survival and did lead to organ-related harm and prolonged admission to the intensive care unit . The procalcitonin strategy like the one used in this trial can not be recommended IMPORTANCE High-dose intravenous administration of sodium selenite has been proposed to improve outcome in sepsis by attenuating oxidative stress . Procalcitonin-guided antimicrobial therapy may hasten the diagnosis of sepsis , but effect on outcome is unclear . OBJECTIVE To determine whether high-dose intravenous sodium selenite treatment and procalcitonin-guided anti-infectious therapy in patients with severe sepsis affect mortality . DESIGN , SETTING , AND PARTICIPANTS The Placebo-Controlled Trial of Sodium Selenite and Procalcitonin Guided Antimicrobial Therapy in Severe Sepsis ( SISPCT ) , a multicenter , r and omized , clinical , 2 × 2 factorial trial performed in 33 intensive care units in Germany , was conducted from November 6 , 2009 , to June 6 , 2013 , including a 90-day follow-up period . INTERVENTIONS Patients were r and omly assigned to receive an initial intravenous loading dose of sodium selenite , 1000 µg , followed by a continuous intravenous infusion of sodium selenite , 1000 µg , daily until discharge from the intensive care unit , but not longer than 21 days , or placebo . Patients also were r and omized to receive anti-infectious therapy guided by a procalcitonin algorithm or without procalcitonin guidance . MAIN OUTCOMES AND MEASURES The primary end point was 28- 
    Output:
    
Up-to- date evidence of very low to moderate quality , with insufficient sample power per outcome , does not clearly support the use of procalcitonin-guided antimicrobial therapy to minimize mortality , mechanical ventilation , clinical severity , reinfection or duration of antimicrobial therapy of patients with septic conditions