Abstract
ObjectivesTo investigate the epidemiology, management, and predictors of mortality in severe sepsis and septic shock in the intensive care units (ICUs) of Trinidad, Trinidad & Tobago.MethodsA prospective observational study in four ICUs over a one-year period (August 2017-August 2018) was conducted. Physiologic variables, treatment data, and outcomes were collected on admission to ICU and daily until 28 days. The 28-day mortality and ICU mortality were recorded. Subgroup analysis was performed based on survival, and predictors of mortality were determined through logistic regression.ResultsOutcome data were available for 163 patients. The 28-day mortality rates for sepsis and septic shock were 42% and 47%, respectively. ICU mortality rate for sepsis was 34%. The most common suspected source of infection was pneumonia (33%). Acute kidney injury (AKI) was common and present in 71% of patients, with renal replacement therapy only being used in 30% of cases. Mechanical ventilation was required in 84% of cases. Moderate-to-severe acute respiratory distress syndrome (ARDS) (OR: 4; 95% CI: 1.9-8.8; p < 0.001) and the development of AKI (all stages) (OR: 10; 95% CI: 3.9-30.2; p < 0.001) were found to be predictive of mortality. Incidence of mechanical ventilation, moderate-to-severe ARDS, stage 3 AKI, septic shock, and failure to achieve a mean arterial pressure of > 60 mmHg within the first 24 hours of admission were higher in patients who did not survive (p < 0.05).ConclusionsSepsis and septic shock are associated with a high 28-day mortality. Organ dysfunction with renal and pulmonary involvement was an important factor in predicting a higher mortality.
Highlights
Over the last decade, there have been several innovations in the diagnosis and management of sepsis and septic shock [1,2]
Moderate-to-severe acute respiratory distress syndrome (ARDS) (OR: 4; 95% CI: 1.9-8.8; p < 0.001) and the development of Acute kidney injury (AKI) (OR: 10; 95% CI: 3.9-30.2; p < 0.001) were found to be predictive of mortality
Moderate-to-severe ARDS, stage 3 AKI, septic shock, and failure to achieve a mean arterial pressure of > 60 mmHg within the first 24 hours of admission were higher in patients who did not survive (p < 0.05)
Summary
There have been several innovations in the diagnosis and management of sepsis and septic shock [1,2]. Current definitions focus on the detection of organ dysfunction instead of inflammatory parameters, with sepsis defined as a dysregulated host response rather than a purely inflammatory condition [2]. Despite these advances, there remains a significant global burden of disease, with 49 million cases of sepsis and 11 million deaths being reported worldwide in 2017 [3]. In developing and low-resource countries, which may not have been represented by trial data, the mortality rate for sepsis is even higher, with an almost 50% mortality rate being reported for severe sepsis and septic shock in developing and resource-poor countries [5,6,7,8].
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