Predictive Score Model of Clinical Outcomes Sepsis in Intensive Care Unit Tertier Referral Hospital of Eastern Indonesia

Abstract

AIM: This study aimed to design a predictive score model of clinical outcome sepsis and bacterial profiles of blood and sputum cultures in the intensive care unit (ICU) of a tertiary referral hospital. METHODS: An observational retrospective study was conducted in 2017–2020 using medical record data in the ICU of Dr. Soetomo Hospital as tertiary referral hospital. The predictor of sepsis prognosis was Acute Physiology and Chronic Health Evaluation II (APACHE II), blood and sputum culture results, procalcitonin (PCT) levels, and antimicrobial resistance in blood and sputum cultures. The model was prepared by logistic regression analysis and receiver operating characteristic (ROC) curves. RESULTS: Data from 355 subjects showed that predictor score was APACHE II, blood and sputum culture results; besides PCT levels were found to contribute significantly to predictive score of sepsis clinical output (p<0.05), while the predictor test of antimicrobial resistance in blood and sputum cultures was not significant to predictive score of sepsis clinical output (p > 0.05). The resulting scores to predict sepsis clinical outcomes include PCT level >2 ng/mL (1.61), APACHE score >20 (1), sputum culture as true pathogen (1.1), and blood culture as true pathogen (1.35). When the total score ≥3, the patient will die, while when the score <3, the patient will survive. ROC curves analysis obtained area under curve 0.859 (p < 0.05) which indicates that the equation is statistically significant in predicting the sepsis clinical outcome. Probability scores and death outcomes indicate that the higher the predictive score, the higher the probability of dying, with a score >3 the probability of dying is above 95.27%, whereas if the score is 5, the probability of dying is above 99%. The bacterial profile of blood cultures leading to mortality is predominately Gram-positive (34.4%), consisting of coagulase-negative Staphylococcus (22.9%), and Staphylococcus aureus (4.3%), while Gram-negative is only 14.7%, which consists of Enterobacteriaceae group (8.7%), Acinetobacter baumannii (4%), polymicrobial infection (2%), Burkholderia cepacia (0.8%), and Pseudomonas aeruginosa (0.4%). Sputum culture profile of patients with sepsis who died in the ICU of a tertiary referral RSUD Soetomo is dominated by Gram-negative, namely, A. baumannii (22.1%), Enterobacteriaceae group (20.6%), P. aeruginosa (11.1%), while Gram-positive is S. aureus (22.9%). CONCLUSION: The predictive score model for sepsis clinical outcomes in the ICU of a tertiary referral hospitals can be used as a basis for determining of patient management and the profile of the bacteria that causes sepsis that results in death.

Epidemiology of Escherichia coli as a Critical Pathogen of Bloodstream Infection Patients in Tertiary Referral Hospital

“…Of the Gram-negative bacteria, Enterobacteriaceae showed a proportion of 59%, followed by Acinetobacter baumannii at 29%. 12 The 43 E. coli strains isolated from the blood culture of BSI comprised 20 male patients and 23 females. This data aligns with a systematic literature review report that women were more likely than men to develop E. coli bacteremia overall.…”

Procalcitonin prognostic value in predicting mortality among adult patients with sepsis due to Gram-negative bacteria

“…The Gram-negative bacteria group showed A. baumannii as the most common cause of sepsis. 28 Studies in the USA reported sepsis as the most common cause of death in critically ill patients with various types of organisms in culture-positive infected patients, with Gram-negative bacteria (62.2%) as the most causative types of causal organisms. Most microorganisms isolated from blood cultures in patients with Gram-negative bacteremia were Pseudomonas species (19.9%), E. coli (16%), Klebsiella species (12.7%), Acinetobacter species (8.8%), and Enterobacter (7.0%).…”

“…17 Another study evaluated the role of procalcitonin as the predictor of mortality, yet combining it with Acute Physiology And Chronic Health Evaluation II score, sputum culture interpretation, and blood culture interpretation. 28 Procalcitonin and lactate levels could be used as an evaluation tool for patients with sepsis. Procalcitonin was used to evaluate clinical conditions within 28/30 days of evaluation, yet still has limitations in predicting mortality.…”