Naslov
Sepsis in the medical intensive care unit: outcome prediction models - a prospective, observational, single centre, clinical study

Autori
Klobučar, Iva ; Vucelić, Vesna ; Degoricija, Vesna

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, znanstveni

Izvornik
Intensive care medicine experimental, 10 (2021), Suppl 1 / - , 2021, 125-126

Skup
34th annual congress European society of intensive medicine lives (ESICM 2021)

Mjesto i datum
Online, 03.10.2021. - 06.10.2021

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
sepsis ; mortality ; prediction models

Sažetak
Introduction Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection, 1 which has the unacceptably high mortality rate (11.9-39.5%)2 despite the huge progress in the intensive care medicine during the past years. Objective The aim of the study was to test the prognostic value of the scores widely used in the intensive care medicine (APACHE II, LODS, SAPS II, SOFA) and to determine additional independent mortality risk factors for the patients with sepsis treated in the medical intensive care unit (ICU). Methods A prospective, observational study conducted in the medical ICU (Sisters of Charity University Hospital Centre, Zagreb, Croatia) between April 2017 and May 2018. All patients treated with the diagnosis of sepsis (according to Sepsis-3 criteria1) were enrolled in the study. Demographic data, vital signs, laboratory test results and scores were assessed at the time of the patients' admission to the ICU. The outcome was recorded at the end of the ICU treatment. Results A total of 116 patients with sepsis were enrolled in the study. The median age was 73.5 years (range 23-98) and 63 (54.3%) were female. Forty-four patients (37.9%) died during the ICU treatment, with 65.9% of these deaths occurring within the first 72 ICU-hours. The mean ICU length of stay for ICU survivors was 6 days (1-34) and 3 days (1- 19) for ICU non-survivors. All mean score values [APACHE II - 25 (15-33) vs 16 (4-31), LODS - 12 (4-14) vs 5 (1-14), SAPS II - 56 (22-89) vs 37 (19-87), SOFA - 8 (4-10) vs 4 (2- 9)] were significantly higher in the ICU non- survivor group compared to the ICU survivors (P<0.001). ROC curves for all scores discriminating ICU outcome are shown in Figure 1. The independent risk factors for ICU mortality, calculated using the multiple binary logistic regression, were: reduced mobility level (odds ratio [OR] 11.16, 95% confidence interval [CI] 2.45-50.91), failure in early sepsis recognition in the emer¬gency department (OR 6.59, 95% CI 1.09-39.75), higher SOFA score at admission (OR 2.37, 95% CI 1.59-3.52), and inappropriate antimicrobial treatment (OR 9.99, 95% CI 2.57- 38.87). Taken together, these variables form a new predictive model for ICU mortality, which significantly improves the predictive power of the SOFA score alone (AU ROCSOFA = 0.894 vs AU ROCmodel = 0.959, Figure 2). Conclusion The ICU mortality rate for patients with sepsis was high in this study. The newly-formed ICU mortality predictive model for patients with sepsis, by adding three binary variables to the SOFA score, exceeds the predictive power of all other widely used scores in intensive care medicine. The limitations of the model are the unavailability of the information about the appropriateness of the antimicrobial treatment at the time of patients' admission to the ICU and the need for its validation on the bigger sets of patient data. References 1 Singer M, Deutschman CS, Warren Seymour C, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016 ; 315:801-810. 2 Sakr Y, Jaschinski U, Wittebole X, Szakmany T, Lipman J, Ńamendys-Silva SA, et al. Sepsis in Intensive Care Unit Patients: Worldwide Data From the Intensive Care over Nations Audit. Open Forum Infect Dis. 2018 ; 5:ofy313.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

POVEZANOST RADA