Sepsis and septic shock – an observational study of the incidence, management, and mortality predictors in a medical intensive care unit

Abstract

Aim To prospectively determine the number of patients with sepsis and septic shock in a medical intensive care unit (ICU) using the Sepsis-3 definition; to analyze patients' characteristics, clinical signs, diagnostic test results, treatment and outcomes; and to define independent risk factors for ICU mortality. Methods This prospective observational study enrolled all patients with the diagnosis of sepsis treated in the medical ICU of “Sestre Milosrdnice” University Hospital Center, Zagreb, between April 2017 and May 2018. Results Out of 116 patients with sepsis, 54.3% were female. The median age was 73.5 years (IQR 63-82). The leading source of infection was the genitourinary tract (56.9%), followed by the lower respiratory tract (22.4%). A total of 35.3% of the patients experienced septic shock. Total ICU mortality for sepsis was 37.9%: 63.4% in patients with septic shock and 24.0% in patients without shock. Independent risk factors for ICU mortality were reduced mobility level (odds ratio [OR] 11.16, 95% confidence interval [CI] 2.45-50.91), failure to early recognize sepsis in the emergency department (OR 6.59, 95% CI 1.09-39.75), higher Sequential Organ Failure Assessment score at admission (OR 2.37, 95% CI 1.59-3.52), and inappropriate antimicrobial treatment (OR 9.99, 95% CI 2.57-38.87). Conclusion While reduced mobility level and SOFA score are predetermined characteristics, early recognition of sepsis and the choice of appropriate antimicrobial treatment could be subject to change. Raising awareness of sepsis among emergency department physicians could improve its early recognition and increase the number of timely obtained specimens for microbial cultures.

Molecular mechanisms in septic shock (Review)

“…The incidence of sepsis has been on an ever-increasing pathway in recent years, as a result of longer life expectancy of the population as well as the association of comorbidities, such as cancer, immunosuppression, diabetes mellitus and chronic organ dysfunction ( 19 ). The mortality rate in intensive care units (ICUs) is generally 37% and in hospital wards it is approximately 45% ( 20 ).…”

“…Systemic inflammatory response syndrome (SIRS) is clinically recognized by a series of objective clinical signs, cardinal, that include tachypnea, fever or hypothermia, tachycardia and leukocytosis or leukopenia with left deviation of the leukocyte formula. SIRS may be the result of infectious or non-infectious causes ( 19 ). Non-infectious causes associated with SIRS include trauma, burns, hemorrhagic or hypovolemic shock and, as a major cause, pancreatitis ( 34 ).…”

Perfil clínico e preditores de mortalidade intra-hospitalar em adultos criticamente doentes com sepse: revisão integrativa

“…Além disso, níveis de albumina pré-admissão ≤2,5 apresentaram impacto negativo, após a triagem de risco nutricional (Auiwattanakul et al, 2020). Em estudos realizados, o escore Sequential Organ Failure Assessment (SOFA) obteve alta sensibilidade diagnostica nos casos de sepse, diminuindo falhas no prognostico de reconhecimento por sepse ou falência de órgãos, precocemente, pelos profissionais da saúde (Vucelić et al, 2020;Fortini et al, 2021;Boonmee et al, 2020). Portanto, quanto maior a disfunção orgânica, maior a mortalidade do paciente, sendo a desnutrição um fator negativo, e tratamento precoce, variáveis que contribuem para a diminuição da mortalidade, evitando aumento nos percentuais de óbito.…”

“…Desse modo, estratégias preventivas, assim como a implantação de procedimentos de identificação e tratamento precoces, são métodos ainda subutilizados para diminuir as taxas de morbimortalidade, bem como reduzir os custos dos cuidados com a sepse (Vucelić et al, 2020;Fortini et al, 2021). Logo, para o melhor acompanhamento e controle do processo saúde-doença, é fundamental detectar precocemente as pessoas mais suscetíveis a mortalidade por sespse, objetivando ajudar os indivíduos que foram severamente afetados a recuperar seu funcionamento fisiológico.…”

Prehospital delay is an important risk factor for mortality in community-acquired bloodstream infection (CA-BSI): a matched case–control study

“…7 12 BSI and the risk of transition to sepsis and septic shock with life-threatening organ dysfunction requires early identification for prompt initiation of life-saving measures and improvement in outcome. [13][14][15][16][17] There are many studies focusing on improving early detection of patients at risk for developing sepsis in the emergency department (ED). [18][19][20][21][22] Few studies have addressed prehospital care of sepsis prior to evaluation at the ED or by the paramedic, 23 24 and not one, to our knowledge, on the impact of delay in prehospital care on 30-day mortality in a well-defined casecontrol study on patients with communityacquired BSI (CA-BSI).…”