Epidemiology of Sepsis in Patients Admitted to the Intensive Care Unit of a Multi-Specialty Hospital (Experimental Study)

I N Tyurin,I A Kozlov,G M Mullakaeva,R A Cherpakov,S N Avdeikin,D N Protsenko

doi:10.15360/1813-9779-2019-4-42-57

Abstract

Purpose of the study: to investigate the epidemiology of sepsis in patients with different locations of the infection focus, who were admitted to the intensive care unit (ICU) of a multi-specialty hospital in 2014 and 2016.Material and methods. A retrospective analysis of examination and treatment of 860 patients admitted to ICU of a multi-specialty hospital with the diagnosis ‘sepsis’ in 2014 and 2016 was carried out. Sepsis was diagnosed pursuant to the Sepsis-2 Guidelines and verified by blood procalcitonin test. The gender, age, main diagnosis, patient’s severity at the time of admission to ICU, duration in ICU, and peculiarities of intensive care and outcomes were studied.Results. Sepsis was diagnosed at admission in 2014 in 361 (8.6%) patients out of 4175 patients, in 2016 — in 499 (10.5%) out of 4726 patients who were admitted to ICU and had infection foci of different location. Abdominal sepsis was diagnosed in 72.3% of patients, pulmonary — in 19.7%; in 8% of patients, sepsis complicated the terminal stage of various, mostly oncological, diseases. In 2016, sepsis detectability at admission to ICU increased by 22.1% vs. the 2014 level assumed as 100% (χ2=9.281; P=0.003). In case of the abdominal sepsis, mortality amounted to 50.3% and was not different from mortality in pulmonary sepsis — 52.1% (χ2=0,163; P=0.687). The ICU in-patient duration in case of pulmonary sepsis was considerably longer than in case of abdominal. The age was a predictor of mortality in case of abdominal sepsis (the age older than 65 years predicted the risk of lethal outcome with sensitivity equal to 58.8% and specificity equal to 59.9%), which was not true for pulmonary sepsis. The mortality prognosis during abdominal sepsis was improved by combined analysis of the SOFA score and patient’s age at admission: AUROC of the combined index was equal to 0.816 (95%-confidence interval: 0.783–0.846). Depending on the infection focus location, specificity of influence rendered on mortality by different clinical indices and management methods was determined.Conclusion. Patients admitted to ICU with sepsis represent a group of a high mortality risk amounting to 50% approximately. During chronological analysis, sepsis detectability increases but mortality does not change. Patients with pulmonary sepsis at admission to ICU are characterized by a greater severity of condition due to multiple organ failure than in case of abdominal sepsis; in such patients it is impossible to predict the risk of mortality based on APACHE II and SOFA score. Taking into account heterogeneity of the sepsis patient population, deepening of the knowledge about peculiarities of pathogenesis and clinical pattern of abdominal and pulmonary sepsis is the basic requirement for improvement of the results of treatment of this complication.

Highlights

In spite of deepening of knowledge about the general mechanisms of sepsis pathophysiology [1,2,3,4], the seemingly most substantiated and promising intensive care options tested in multi-center studies failed to significantly reduce mortality [3, 5,6,7]
In view of the above, the purpose of this study is to investigate sepsis epidemiology in patients with different location of the focus of infection, who were admitted to intensive care units (ICU) of a multi-specialty hospital in 2014 and 2016
The most frequent diseases complicated by sepsis were perforated gastric or duodenal ulcer, community-acquired pneumonia, mesenteric thrombosis, necrotizing pancreatitis, acute intestinal obstruction, and acute appendicitis

Summary

Introduction

In spite of deepening of knowledge about the general mechanisms of sepsis pathophysiology [1,2,3,4], the seemingly most substantiated and promising intensive care options tested in multi-center studies failed to significantly reduce mortality [3, 5,6,7]. There is an opinion that the probable reason for these failures is heterogeneity of patients included in studies which is caused by a number of individual peculiarities including a different location of the focus of infection [1, 8]. Attempts have been performed to differentiate sepsis 'sub-types' by the involvement of different organs and systems in multiple organ failure, blood circulation condition, response to the initial infusion load and mortality [8]. Heterogeneity of sepsis patient population is clearly observed in contemporary studies dedicated to epidemiology of this complication [1, 5, 9]. In the global literation there are many publications presenting data of a general audit of sepsis in differ-

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