Significance of detailed and careful morphological evaluation of organs in sepsis related deaths

Abstract

In this retrospective study we studied macroscopic changes and histology of various organs in sepsis related deaths in correlation with relevant clinical, laboratory and microbiology data. Medical records and autopsy records of all patients were reviewed where final cause of death after complete macroscopic and histological examination of organs following autopsy was given as sepsis/septic shock. Sepsis related death in diabetics, hypertensives, and pregnancy related death and unnatural deaths were excluded from this study.Sixty five cases were selected for this study involving detailed morphological examination of different organs. Most common system involved was respiratory system (33.84%). Lungs were chief primary site of infection mainly pneumonia (35.4%) and tuberculosis (7.7% cases) followed by liver abscess (18%), renal abscess/ pyelonephritis (16.4%) and, peritonitis (16.4%). Most frequent non- specific organ changes presented grossly as diffluent/soft mushy spleen with red pulp congestion (83.08%) followed by mild to moderate cerebral oedema(41.5%) and pulmonary oedema(35. 4%). Most frequent findings that contributed to death was intrapulmonary haemorrhage (33.8%), acute tubular necrosis (11, 17%), disseminated intravascular coagulation/ micro thrombi (8, 12.3%) and, acute respiratory distress syndrome (3, 4. 61%). In this study population, the commonest organism obtained on culture was Pseudomonas (24.07%) followed by E. coli and Klebsiella (20.37% each).Careful and detailed morphological evaluation of various organs at autopsy is significant for both pathologist and clinicians to understand the course of events occurred and to reach an accurate diagnosis of sepsis related death.