Predictors of 30-day mortality in medical patients with severe sepsis or septic shock

Andreja Sinkovič ,Andrej Markota ,Jure Fluher ,Damjana Rehar

doi:10.22514/sv92.112014.7

Abstract

Objectives. To evaluate independent predictors of 30-day mortality in patients with severe sepsis or septic shock. Background. Severe sepsis and septic shock are associated with increased mortality. Admission APACHE II score is the gold standard for assessing prognosis in critically ill, but several other predictors of mortality have been evaluated. Methods. We retrospectively evaluated clinical and laboratory data in adult patients with severe sepsis or septic shock as predictors of 30-day mortality. Results. Thirty-day mortality was 62.7%. Nonsurvivors in comparison to survivors were significantly more likely to be trea-ted with noradrenalin, renal replacement therapy, mechanically ventilated, to have suffered a fungal infection, had lower admission arterial pH, increased admission Acute Physiology, Age, Chronic Health Evaluation (APACHE) II score and a higher peak lactate level (5.6 ± 6.2 vs 3.1 ± 1.75, p=0.021). Binary logistic regression demonstrated that only peak in-hospital serum lactate level was a significant independent predictor of 30-day mortality (OR 1.367, 95% CI 1.041 to 1.795, p=0.025). Conclusion. Only peak in-hospital lactate significantly and independently predicts 30-day mortality in severe sepsis or septic shock medical patients.

Highlights

The incidence of severe sepsis is increasing within the last decade, reaching 50-100 cases /100.000 people in the general population and approximately 30% in intensive care units. [1,2] Mortality of patients with sepsis depends on the sepsis stage and co-morbidities
In terms of association with outcome, binary logistic regression demonstrated that peak in-hospital lactate level was the most significant independent predictor of 30-day mortality
According to the data in literature it was not surprising that fungal infections in our severely septic patients were significantly associated with 30-day mortality. [12,13] binary logistic regression confirmed that only peak lactate levels significantly and independently predicted 30-day mortality in our septic patients

Summary

Introduction

The incidence of severe sepsis is increasing within the last decade, reaching 50-100 cases /100.000 people in the general population and approximately 30% in intensive care units. [1,2] Mortality of patients with sepsis depends on the sepsis stage and co-morbidities. [1,2] Mortality of patients with sepsis depends on the sepsis stage and co-morbidities It ranges from 10-20% in patients with uncomplicated sepsis to 20-50% in severe sepsis and up to 80% in patients with septic shock. [1] Admission Acute Physiology, Age, Chronic Health Evaluation (APACHE) II score is a standard predictor of mortality in critically-ill patients, including septic patients. A variety of other predictors of mortality in patients with sepsis was evaluated in clinical studies, including inflammatory markers such as C-reactive protein (CRP), lactate clearance, cardiac biomarkers such as troponin and ejection fraction (EF), individual organ system failures, presence of multi-organ failure syndrome (MOFS), etc. [6] These studies were performed in heterogeneous patient populations, ranging from lower risk patients with sepsis to high risk septic shock patients, included from wards to surgical or medical intensive care units (ICU). A variety of other predictors of mortality in patients with sepsis was evaluated in clinical studies, including inflammatory markers such as C-reactive protein (CRP), lactate clearance, cardiac biomarkers such as troponin and ejection fraction (EF), individual organ system failures, presence of multi-organ failure syndrome (MOFS), etc. [6] These studies were performed in heterogeneous patient populations, ranging from lower risk patients with sepsis to high risk septic shock patients, included from wards to surgical or medical intensive care units (ICU). [4,5,6,7,8,9] The primary objective of this study was to investigate which patient characteristics are related to outcome in medical patients with severe sepsis or septic shock

Objectives

Methods

Results

Conclusion