Morbidity and mortality in critically ill patients with invasive Group A streptococcus infection: an observational study

Abstract

Background Group A streptococci (GAS) are known to cause serious invasive infections but little is known about outcomes when patients with these infections are admitted to intensive care. We wanted to describe critically ill patients with severe sepsis or septic shock due to invasive GAS (iGAS) and compare them with other patients with severe sepsis or septic shock. Methods Adult patients admitted to a general intensive care unit (ICU) in Sweden (2007-2019) were screened for severe sepsis or septic shock according to Sepsis 2 definition. Individuals with iGAS infection were identified. The outcome variables were mortality, days alive and free of vasopressors and invasive mechanical ventilation, maximum acute kidney injury score for creatinine, use of continuous renal replacement therapy and maximum sequential organ failure assessment score during the ICU stay. Age, simplified acute physiology score (SAPS 3) and iGAS were used as independent, explanatory variables in regression analysis. Cox regression was used for survival analyses. Results iGAS was identified in 53 of 1021 (5.2%) patients. Patients with iGAS presented lower median SAPS 3 score (62 [56–72]) vs 71 [61–81]), p < 0.001), had a higher frequency of cardiovascular cause of admission to the ICU (38 [72%] vs 145 [15%], p < 0.001) and had a higher median creatinine score (173 [100–311] vs 133 [86–208] µmol/L, p < 0.019). Of the GAS isolates, 50% were serotyped emm 1/T1 and this group showed signs of more pronounced circulatory and renal failure than patients with non- emm 1/T1, ( p = 0.036 and p = 0.007, respectively). After correction for severity of illness (SAPS 3) and age, iGAS infection was associated with lower mortality risk; 95% confidence interval (CI) of hazard ratio (HR) 0.204–0.746, p < 0.001. Morbidity analyses demonstrated that iGAS patients were more likely to develop renal failure. Conclusion Critically ill patients with iGAS infection had a lower mortality risk but a higher degree of renal failure compared to similarly ill sepsis patients. emm 1/T1 was found to be the most dominant serotype and patients with emm1 /T1 demonstrated more circulatory and renal failure than patients with other serotypes of iGAS.

Dynamic APACHE II Score to Predict Outcome Among Intensive Care Unit Patients

“…Predicting ICU mortality plays an important role in patient care and resource allocation, Early identi cation and management are associated with lower mortality [1,2]. At present, there are many predictive scoring systems including Acute Physiology Chronic Health Evaluation II (APACHE II), Organ Dysfunction and Infection System, Sequential Organ Failure Assessment (SOFA) and Simpli ed Acute Physiology Score (SAPS) for hospital outcomes [3][4][5], especially for mortality [6,7], Among which APACHE II score is the most common and well-known effective prediction scoring method. At present, most studies use the APACHE II score within 24 h of admission to predict the outcomes of patients [2,8], However, for the rst 24 h of ICU admission, many patients have several comorbid conditions, and selecting only one principal diagnostic category may be very di cult, Moreover, the condition of patients was unstable and their physiological indexes uctuated greatly, All these factors had a great impact on APACHE II score within 24 h, which leads to inaccurate prognosis of hospital outcomes.…”