Sepsis in a Combined Medical and Surgical High Dependency/Intensive Care Unit in Singapore: A Cohort Study and Survival Analysis

Abstract

Background Sepsis is a common indication for intensive care unit (ICU) admission and is associated with significant mortality and morbidity. The aim of our study was to first assess the incidence, severity, short-term and long-term mortality of sepsis in a combined medical and surgical high dependency/ ICU in Singapore, and to identify factors associated with increasing short-term and long-term mortality. Methods All admissions from July 1 to December 31, 2017 were retrospectively screened and clinical data were collected. Patients were followed up until 3 years post ICU admission. Results Of a total 1526 admissions, 281 had infection at ICU admission, and 254 (16.6%) fulfilled sepsis-3 criteria for sepsis. A total of 141 (9.2%) had septic shock. The 30-day, 1-year, 2-year and 3-year mortality of sepsis patients were 19.3%, 25.2%, 30.3% and 32.3%, respectively. Lung was the most common site of infection. Compared with 30-day sepsis survivors, non-survivors were older (median age 70 vs 63, P <0.001), had higher percentage of lung infection (65.3% vs 36.1%, P <0.05), higher admission Sequential Organ Failure Assessment (SOFA) score (median 9 vs 5, P <0.001), and longer ICU stay (median days: 4 vs 3, P = 0.037). In stepwise Cox regression analysis, lung infection was an independent risk factor for both increasing 30-day and 3-year mortality. Immunocompromised host, increasing age and SOFA score were associated with higher 30-day mortality. Diabetes, admission quick Sequential Organ Failure Assessment (qSOFA) score >1 and unplanned ICU re-admission were associated with increasing 3-year mortality in 30-day survivors. Conclusion Our retrospective cohort single center study first reported sepsis admission incidence of 16.6% in a combined medical and surgical high dependency/ICU in Singapore, with significant short-term and long-term mortality. Lung infection was an independent risk factor for both 30-day and 3-year mortality.

Diversity of uropathogens and their antibiotic resistance among diabetic patients presented to MTI-Lady Reading Hospital, Peshawar

“…3 It is advised to give diabetic patients extra consideration, particularly when it comes to the treatment of bacterial UTIs, as they are at an increased risk of developing UTIs. 4 UTI is linked to a number of risk factors, including age, sexual activity, length of diabetes, inadequate glycemic control, and complications from diabetes. 5 Compared to non-diabetic patients, patients with comorbid illnesses such as diabetes have a higher incidence of urinary tract infections.…”