Research from JAMA — Mortality Related to Severe Sepsis and Septic Shock Among Critically Ill Patients in Australia and New Zealand, 2000-2012

In April 2009, the Mexican Ministry of Health reported an increase in severe pneumonia cases in young adults.¹ The 2009 novel swine-origin influenza A(H1N1) virus was identified as its cause and rapidly led to a worldwide pandemic.² This pandemic began in the northern hemisphere during late spring and early summer and appeared to decrease in intensity within a few weeks.³ Shortly after, at the start of the southern hemisphere winter, it spread to Australia and New Zealand causing an approximately 8-fold greater number of confirmed cases per head of population than in the United States.^4,5

Sepsis remains difficult to define^1-4 but represents a significant burden of disease. A recent meta-analysis estimated its annual global incidence at 31.5 million cases, with 19.4 million cases of severe sepsis, resulting in 5.3 million deaths.⁵ It has been recognized that survival following sepsis is associated with long-term physical, cognitive, and psychosocial morbidity,⁶ and an increased mortality rate up to 2 years after an event.⁷

Research from JAMA — Adjustable Gastric Banding and Conventional Therapy for Type 2 Diabetes — A Randomized Controlled Trial — ContextObservational studies suggest that surgically induced loss of weight may be effective therapy for type 2 diabetes.ObjectiveTo determine if surgically induced weight loss results in better glycemic control and less need for diabetes medications than conventional approaches to weight loss and diabetes control.Design, Setting, and Participants Unblinded randomized controlled trial conducted from December 2002 through December 2006 at the University Obesity Research Center in Australia, with general community recruitment to established treatment programs. Participants were 60 obese patients (BMI >30 and <40) with recently diagnosed (<2 years) type 2 diabetes. InterventionsConventional diabetes therapy with a focus on weight loss by lifestyle change vs laparoscopic adjustable gastric banding with conventional diabetes care.Main Outcome Measures Remission of type 2 diabetes (fasting glucose level <126 mg/dL [7.0 mmol/L] and glycated hemoglobin [HbA1c] value <6.2% while taking no glycemic therapy). Secondary measures included weight and components of the metabolic syndrome. Analysis was by intention-to-treat. Results Of the 60 patients enrolled, 55 (92%) completed the 2-year follow-up. Remission of type 2 diabetes was achieved by 22 (73%) in the surgical group and 4 (13%) in the conventional-therapy group. Relative risk of remission for the surgical group was 5.5 (95% confidence interval, 2.2-14.0). Surgical and conventional-therapy groups lost a mean (SD) of 20.7% (8.6%) and 1.7% (5.2%) of weight, respectively, at 2 years (P < .001). Remission of type 2 diabetes was related to weight loss (R2 = 0.46, P < .001) and lower baseline HbA1c levels (combined R2 = 0.52, P < .001). There were no serious complications in either group. Conclusions Participants randomized to surgical therapy were more likely to achieve remission of type 2 diabetes through greater weight loss. These results need to be confirmed in a larger, more diverse population and have long-term efficacy assessed. Trial Registration actr.org Identifier: ACTRN012605000159651

Research from JAMA — Association Between a Chloride-Liberal vs Chloride-Restrictive Intravenous Fluid Administration Strategy and Kidney Injury in Critically Ill Adults

The consensus definition of severe sepsis requires suspected or proven infection, organ failure, and signs that meet two or more criteria for the systemic inflammatory response syndrome (SIRS). We aimed to test the sensitivity, face validity, and construct validity of this approach.