Background: The incidence of sepsis is increasing, especially in elderly populations with more comorbidities. It is now estimated that sepsis is a leading cause of mortality and critical illness worldwide. The Epidemiological data regarding sepsis, septic shock and organ involvement is mainly from western literature. Data from India, especially south India, are less when compared to western data. In this background authors conducted a retrospective study in tertiary care hospital in south India. Objectives of the study was epidemiology of sepsis and its various characteristics in a tertiary care adult-Multi disciplinary ICU in South India.Methods: This study was a retrospective observational study, conducted during the time period of June 2016 and May 2017. The study population was patients above 18 yrs admitted in MDICU with sepsis. The study was conducted in a tertiary care adult -Multidisciplinary ICU in South India. Various characteristics like age group, comorbidities, organ involvement, septic shock, sofa score, need for ventilatory support, RRT support and outcome data was collected.Results: In this study, 497 patients who satisfied the Surviving Sepsis Campaign guidelines were included. The majority of the patients (59.8%) were male; the majority was above 60 yr (range 18 to 92 yr). 76.3% Patients had comorbid disease. Hypertension was the most common co-morbid (62%) followed by diabetes mellitus (51.3%). Chronic Kidney Disease was found in 132 patients (26.6%) and Coronary artery disease in 121 patients (24.3%). 186 patients (46.5%) had single organ involvement 140(35%) patients had 2 organ involvement. 74(18.5%) patients had more than 2 organ involvement. Septic shock was found in 155 patients (31.2%). Renal involvement was the most common organ involvement found in 279 patients(59.9%). Most common source for sepsis was the respiratory system found in 230 patients (46.3%), followed by urinary tract infection in 117 patients (23.5%). The study shows a significant association between SOFA score and mortality (p-value 0.001) 52% of mortality happened in group of patients with SOFA score more than 15 and mortality was 28 % in group with a SOFA score of 10-15.Conclusions: In this retrospective study of sepsis, authors found that the most common source of sepsis was pneumonia (46.3%) followed by urinary tract infection (23.5%). Majority of the patients had one organ involvement (46.5%). Among the organ involvement, Acute Kidney injury was the most common organ involvement (56.1%) followed by septic shock (31.2%) and respiratory support (29.6%). Mortality in this study was higher with higher SOFA score.
BACKGROUND The prevalence of chronic kidney disease (CKD) has steadily increased over the past few decades. Multiple factors including improvements in life expectancy and increasing prevalence of comorbid illness such as hypertension and diabetes have contributed to this. Most common form of treatment in CKD patients is haemodialysis. Depression and anxiety disorders are common psychological problem among haemodialysis patients. However, there is minimal literature on the prevalence of anxiety and depressive symptoms and their impact on patient's quality of life and treatment outcomes. Quality of life (QoL) is another neglected aspect of CKD care, as the available resources are often used to address the general medical needs. The current study aims to assess the prevalence of symptoms of depression and anxiety in patients of haemodialysis and the perceived quality of life in these patients. METHODS A cross sectional observational study was done in 120 haemodialysis patients after approval from Institutional Ethics Committee and after getting informed consent from patients. The study was done in the dialysis unit under Department of Nephrology, Travancore Medical College, Kollam. Patients were screened by a semi-structured questionnaire which includes the patients' socio-demographic data. Hospital Anxiety and Depression Scale (HADS) was used to assess severity of anxiety and depressive symptoms. The Quality of Life (QoL) was assessed using Kidney Disease Quality of Life questionnaire (KDQOL-36™), with higher scores indicating better quality of life. RESULTS The prevalence of anxiety symptoms in study sample is 64.2% and prevalence of depressive symptoms in study sample was found to be 37.5% which was significantly high. There was statistically significant association between anxiety and depressive symptoms with age of patients, gender, duration of dialysis and complication during dialysis. The five domains of KDQOL showed that mean scores of QoL in areas of mental and physical health along with effect of kidney disease on life and burden of having kidney disease were less indicating poor quality of life. Anxiety and depression were negatively correlated to all the domains of KDQOL indicating that anxiety and depressive symptoms worsened quality of life of dialysis patients. CONCLUSIONS Depressive and anxiety symptoms are significantly prevalent in patients undergoing maintenance haemodialysis which usually go un-addressed. Older patients and females were more at risk of developing depressive and anxiety symptoms. Longer periods of dialysis and complications during dialysis were also important contributors to depressive and anxiety symptoms. Quality of Life was poor in patients on dialysis, and symptoms of anxiety and depressive negatively impacted quality of life.
BACKGROUND A rising trend has been reported in Acute Kidney Injury (AKI) in both developed and developing countries and there is an independent association with increased morbidity and mortality with sepsis being the most common predisposing factor. Sepsis and cardiovascular causes resulted in a high incidence of AKI, and older age was also an important risk factor. Our study aims to determine the incidence, outcome and comorbidities associated with AKI in sepsis patients. Sepsis is a serious medical condition characterized by a whole-body inflammatory state (systemic inflammatory-response syndrome) and the presence of a known or suspected infection that has severe consequences, including multiple organ failure. METHODS We did a retrospective observational study in 497 sepsis patients admitted in MDICU. Acute kidney injury in these patients was identified and studied using RIFLE criteria between June 2016 and May 2017. RESULTS A total of 497 patients were studied. Mean age was 60 yrs. 59.8% were males and 40.2% were females. 279 have acute kidney injury; so, incidence of AKI in our study is 56.1%. Significant comorbidities associated with AKI are diabetes mellitus 61.6% (p= 0.001), hypertension 76.7% (p= 0.001), CKD 43.3% (p= 0.001), CAD 28.3% (p 0.020). Out of 279 AKI cases, 167 (59.9%) were under RISK, 94 (33.7%) were under kidney injury, 18 (6.5%) under renal failure. 246 (88.1%) received conservative management and 33 (11.9%) received renal replacement therapy. Out of 33 patients receiving RRT, 18 patients (54.5%) expired during the study period (p value 0.011). 14 patients (50%) of those who received early RRT died and 14 patients (50%) survived, whereas in late RRT 4 (80%) died and 1 patient (20%) survived. There is no statistically significant (p= 0.25) association between mortality and early or late initiation of RRT. CONCLUSIONS As the incidence of AKI is 56.1% and there is significant association between sepsis patients with AKI and comorbidity, high RIFLE score and mortality, RRT and mortality. So Specific goals for reducing incidence and mortality of acute kidney injury has to be formulated and uniform guidelines regarding initiating RRT should be formed.
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