Abstract
Clinical course and mortality in septic patients with low disease severity remain poorly understood and is worth further investigation. We enrolled septic patients admitted to intensive care units (ICUs) between 2010 and 2014 with Acute Physiology and Chronic Health Evaluation II (APACHE II) scores of ≤15. We sought to determine their clinical trajectories and causes of death, and to analyze risk factors associated with in-hospital mortality. A total of 352 patients were included, of whom 89 (25%) did not survive to hospital discharge, at a rate higher than predicted (<21%) by the APACHE II score. Approximately one third (31/89) of non-survivors succumbed to index sepsis; however, more patients (34/89) died of subsequent sepsis. New-onset ICU sepsis developed in 99 (28%) patients and was an independent risk factor for mortality. In addition, septic patients with comorbid malignancy or index infection acquired in the hospital settings were more likely to have in-hospital mortality than those without. In conclusion, septic patients with low APACHE II scores were at a higher mortality risk than expected, and subsequent sepsis rather than index sepsis was the primary cause of death. This study provides insight into unexpected clinical trajectories and outcomes of septic patients with low disease severity at ICU admission and highlights the need for more research and clinical attention in this patient population.
Highlights
Sepsis is a clinical syndrome caused by a dysregulated host response to infection and manifests as physiologic, biologic, and biochemical abnormalities [1,2]
Our study elaborated on critically ill septic patients with a low APACHE II score and the main findings were as follows: (a) septic patients with an APACHE II score of ≤15 on intensive care units (ICUs) admission still carried a significant in-hospital mortality rate of 25% (89/352); (b) a little more than one third (31/89, 35%) of the non-survivors died of the index sepsis; even more patients (34/89, 38%)
Succumbed to the subsequent sepsis; (c) nearly a third (99/352, 28%) of these septic patients developed a new episode of sepsis during their ICU stay; and (d) septic patients with a comorbid malignancy or the index infection acquired in the hospital setting were more likely to experience in-hospital mortality than those without; new ICU-acquired sepsis represented a poor prognostic sign for the in-hospital outcome
Summary
Sepsis is a clinical syndrome caused by a dysregulated host response to infection and manifests as physiologic, biologic, and biochemical abnormalities [1,2]. By updating the definition of sepsis we aim to offer consistency for epidemiologic studies and clinical trials, to facilitate earlier recognition and more timely management of patients with sepsis, and to guide an optimal allocation of healthcare resources and proper disposition of patients to intensive care units (ICUs) [2]. At the time of ICU admission, the Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring system is commonly used to assess disease severity and predict clinical outcome in critically ill patients [12,13,14,15,16]. The aim of the present study was to determine clinical characteristics, trajectories, and causes of death in septic patients with a low predicted mortality risk
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