What are the independent parameters associated with increased mortality risk in patients with severe sepsis or septic shock in the intensive care unit?

Öz

Objective: Determining the factors associated with prognosis in patients with sepsis admitted to the intensive care unit who were treated according to international guidelines. Patients were evaluated with respect to treatment results, morbidity and mortality rates, infection foci and pathogens. Materials and Methods: A total of 43 patients with severe sepsis who were treated in Trakya University Medical Faculty, Department of Medical Intensive Care, between July 2009 and December 2009, were enrolled in this prospective observational study. Patients were grouped as survivors and non-survivors. Clinical characteristics and APACHE II, SAPS II, SOFA scores were recorded. Factors associated with mortality were analyzed by Cox regression. Results: Overall mortality rate was 23.2%. Patients with failure in three or more organs had higher mortality (p = 0.001). Also, mortality rates were higher in patients with cardiovascular, renal, hematological and neurological failure in the first day (p = 0.002, p = 0.011, p = 0.020, p = 0.019, respectively). All scores at the 24th and 72nd hours were significantly higher in the non-survivor group compared to survivors (p <0.05, for all). While the initial SOFA and APACHE II values were higher in non-survivors compared to survivors (p = 0.013 and p = 0.017, respectively), initial SAPS II scores were similar (p = 0.107). The diagnosis of septic shock (HR: 0.080, 95%CI: 0.007-0.961), chronic heart failure (HR: 0.133, 95%CI: 0.032-0.558), inappropriate empirical antibiotic use (HR: 0.106, 95%CI: 0.034-0.326), the number of organs failing on the first day of admission (HR: 17.091, 95%CI: 2.877-101.529), cardiovascular failure (HR: 0.427, 95%CI: 0.201-0.906) and renal insufficiency (HR: 0.075, 95%CI: 0.016-0.348) were found to be associated with mortality. Conclusion: The presence of chronic heart failure, inappropriately administered empirical antibiotherapy, renal and cardiac failure on the first day of admission were the notable independent factors that increased the mortality risk of patients with severe sepsis and septic shock. In addition, SOFA, APACHE II, and SAPS II scores were higher in sepsis patients who ultimately died. Initiating correct antibiotherapy in the early period and applying appropriate measures against organ failure may increase survival in cases with severe sepsis.

Anahtar Kelimeler

• Intensive care
• severe sepsis
• septic shock
• mortality
• Intensive care, severe sepsis, septic shock, mortality

Yoğun bakım ünitesindeki ağır sepsis veya septik şoklu hastalarda artmış mortalite riski ile ilişkili bağımsız parametreler nelerdir?

Öz

Giriş ve Amaç: Uluslararası kılavuzlara göre tedavi edilen yoğun bakım ünitesinde yatan sepsisli hastalarda prognozu etkileyen faktörlerin belirlenmesi. Hastalar tedavi sonuçları, morbidite ve mortalite oranları, enfeksiyon odakları ve patojenler açısından değerlendirilmiştir. Gereç ve Yöntemler: Bu prospektif gözlemsel çalışmaya Trakya Üniversitesi Tıp Fakültesi Tıbbi Yoğun Bakım Anabilim Dalı'nda Temmuz 2009 ile Aralık 2009 tarihleri arasında tedavi edilen ağır sepsisli toplam 43 hasta alınmıştır. Hastalar hayatta kalanlar ve ex olanlar olarak gruplandırılmıştır. Klinik özellikler ve APACHE II, SAPS II, SOFA skorları kaydedilmiştir. Mortalite ile ilişkili faktörler Cox regresyonu ile analiz edilmiştir. Bulgular: Genel mortalite %23,2'dir. Üç veya daha fazla organ yetmezliği olan hastalarda mortalite daha yüksek bulunmuştur (p = 0.001). Ayrıca ilk gün kardiyovasküler, renal, hematolojik ve nörolojik yetmezliği olan hastalarda mortalite oranları daha yüksek olarak tespit edilmiştir (sırasıyla p = 0,002, p = 0,011, p = 0,020, p = 0,019). 24. ve 72. saatteki tüm skorlar, hayatta kalanlara kıyasla ex olan grupta anlamlı olarak daha yüksektir (tümü için p <0.05). Başlangıç SOFA ve APACHE II değerleri hayatta kalmayanlarda hayatta kalanlara göre daha yüksek bulunmuşken (sırasıyla p = 0,013 ve p = 0,017), başlangıç SAPS II skorları benzer tespit edilmiştir (p = 0,107). Septik şok tanısı (HR: 0.080, %95 GA: 0.007-0.961), kronik kalp yetmezliği (HR: 0.133, %95 GA: 0.032-0.558), uygunsuz ampirik antibiyotik kullanımı (HR: 0.106, %95 GA: 0.034-0.326), başvurunun ilk gününde organ yetmezliği sayısı (HR: 17.091, %95 GA: 2.877-101.529), kardiyovasküler yetmezlik (HR: 0.427, %95 GA: 0.201-0.906) ve böbrek yetmezliğinin (HR: 0.075, %95 GA: 0.016-0.348) mortalite ile ilişkili olduğu tespit edilmiştir. Sonuç: Kronik kalp yetmezliği, uygunsuz ampirik antibiyoterapi uygulanması, ilk gün böbrek ve kalp yetmezliği olması ağır sepsis ve septik şoklu hastalarda mortalite riskini artıran önemli bağımsız faktörler olarak bulunmuştur. İlaveten, ölen sepsis hastalarında SOFA, APACHE II ve SAPS II skorları daha yüksektir. Ağır sepsisli olgularda erken dönemde doğru antibiyotik tedavisine başlanması ve organ yetmezliğine karşı uygun önlemlerin alınması sağkalımı artırabilir.

Anahtar Kelimeler

• Yoğun bakım
• ağır sepsis
• septik şok
• mortalite

Kaynakça

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