Predictors of mortality in adult sepsis

Authors:H V Prashanth , R M Dominic Saldanha , Shalini Shenoy , Shrikala Baliga
Int J Biol Med Res. 2011; 2(4): 856 – 861  |  PDF File

Abstract

Aims: The aim of this study is to identify clinical, laboratory and microbiologic features that may be predictive of mortality in sepsis and help achieve an early stratification to identify those at high risk of death in adult patients. Methods: A total of 298 adult patients with clinical diagnosis of septicaemia were studied. Patients with positive blood culture were included in the study. Other specimens included sputum, urine, pleural fluid, stool, ascitic fluid, burn and surgical wound swabs, throat swabs, intravenous catheter tips and endotracheal tips to identify the source of infections. All samples were processed using standard microbiological techniques Results: Blood culture was positive in 100 patients (33.55%). Gram-negative organisms (70.47%) were more common than gram-positive organisms (29.53%). The overall mortality from bacteraemia was 18%. Bacteraemia associated mortality notable after the age of 45. The mortality rate in polymicrobial septicaemia was 3 out of 5 (60%), which was higher than monomicrobial septicaemia (15.78%). Factors potentially related to the outcome of bacteraemia were nosocomial acquisitions, age >45 years, bacteraemia caused by some difficult to treat organisms, such as Pseudomonas spp. and polymicrobial bacteraemia. The incidence of primary blood stream infection was seen in 25 cases and secondary blood stream infection was seen in 75 cases. The most common source of bacteraemia was gastrointestinal tract (27) followed by respiratory tract (22), wound (11), urinary tract (10) and I. V. catheters (5). The common predisposing factors were recent surgery, Diabetes, cancer, burns, HIV, cirrhosis and neutropenia. Mortality among patients with hospital acquired bacteraemia was more than community acquired bacteraemia. Conclusion: Awareness of the risk factors, clinical signs and symptoms, pathophysiology, and updates in the management of sepsis can enhance the nursing care for patients with severe sepsis to promote best practices for sepsis care in the intensive care unit.