Article Data

  • Views 909
  • Dowloads 121

Original Research

Open Access

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

  • ANDREJA SINKOVIC1
  • ANDREJ MARKOTA1
  • JURE FLUHER 1
  • DAMJANA REHAR1

1,Medical Intensive Care Unit University Medical Centre Maribor

DOI: 10.22514/SV92.112014.7 Vol.9,Issue 2,November 2014 pp.47-52

Published: 03 November 2014

*Corresponding Author(s): ANDREJA SINKOVIC E-mail: andreja.sinkovic@guest.arnes.si

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.

Keywords

severe sepsis, septic shock, 30-day mortality, serum lac-tate

Cite and Share

ANDREJA SINKOVIC,ANDREJ MARKOTA,JURE FLUHER ,DAMJANA REHAR. Predictors of 30-day mortality in medical patients with severe sepsis or septic shock. Signa Vitae. 2014. 9(2);47-52.

References

1. Martin GS. Sepsis, severe sepsis, and septic shock: changes in incidence, pathogens and outcomes. Expert Rev Anti Infect Ther 2012;10:701-6.

2. Vincent JL, Sakr Y, Sprung CL, Ranieri VM, Reinhardt K, Gerlach H, et al. Sepsis occurrence in acutely ill patients. Crit Care Med 2006;34:344-53.

3. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818-29.

4. Hermans MA, Leffers P, Jansen LM, Keulemans YC, Stassen PM. The value of the Mortality in Emergency Department Sepsis (MEDS) score, 

C- reactive protein and lactate in predicting 28-day mortality of sepsis in a Dutch emergency department. Emerg Med J 2012;6:295-300.

5. Glickman SW, Cairns CB, Otero RM, Woods CW, Tsalik EL, Langley RJ. Disease progression in hemodynamically stable patients presen-ting to the emergency department with sepsis. Acad Emerg Med 2010;6:383-90.

6. Ter Avest E, de Jong M, Brûmmer I, Wietasch GJ, Ter Maaten JC. Outcome predictors of uncomplicated sepsis. Int J Emerg Med 2013;6:9.

7. Howell MD, Talmor D, Schuetz P, Hunziker S, Jones AE, Shapiro NI. Proof of principle: the predisposition, infection, response, organ failure sepsis staging system. Crit Care Med 2011;6:322-7.

8. Vorwerk C, Loryman B, Coats TJ, Stephenson JA, Gray LD, Reddy G. Prediction of mortality in adult emergency department patients with sepsis. Emerg Med J 2009;6:254-8.

9. Chen CC, Chong CF, Liu YL, Chen KC, Wang TL. Risk stratification of severe sepsis patients in the emergency department. Emerg Med J 2006;6:281-5.

10. Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, et al. CCM/ESICM/ACCP/ATS/SIS International sepsis definitions confe-rence. Crit Care Med 2003;31:1250-6.

11. Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. J Intensive Care Med 2008;34:17-60.

12. Yang SP, Chen YY, Hsu HS, Wang FD, Chen L, Fung CP. A risk factor analysis of healthcare-associated fungal infections in an intensive care unit: a retrospective cohort study. BMC Infectious Diseases 2013;13:10.

13. Musket H, Shahin J, Eyres G, Harvey S, Rowan K, Harrison D. Risk factors for invasive fungal disease in critically ill adult patients: a sys-temic review. Crit Care 2011;15:R287.

14. Majuran M, Clancy M. Determination of the size of the different sepsis categories presenting to a UK teaching hospital emergency depart-ment. Emerg Med J 2008;6:11-4.

15. Dombrovskiy VY, Martin AA, Sunderram J, Paz HL. Rapid increase in hospitalization and mortality rates for sever sepsis in the United States: A trend analysis from 1993 to 2003. Crit Care Med 2007;6:1244-50.

16. Shapiro NI, Wolge RE, Moore RB, Smith E, Burdick E, Bates DW. Mortality in emergency department sepsis (MEDS) score: a prospectively derived and validated clinical prediction rule. Crit Care Med 2003;6:670-5.

17. Rivers E, Ngyuen B, Havstad S, Ressler J, Muzzin A, Peterson E. Early goal directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001;6:1368-77.

18. Fall PJ, Szerlip HM. Lactic acidosis: from sour milk to septic shock. J Intensive Care Med 2005;20:255-1.

19. Gore DC, Jahoor F, Hibbert JM, DeMaria EJ. Lactic acidosis during sepsis is related to increased pyruvate production, not deficits in tissue oxygen availability. Ann Surg 1996;224:97-102.

20. Levraut J, Bounatirou T, Ichai C, Ciais JF, Jambou P, Hechema R, et al. Reliability of anion gap as an indicator of blood lactate in critically ill patients. Intensive Care Med 1997;23:417-22.

21. Gabow PA, Kaehny WD, Fennessey PV, Goodman SI, Gross PA, Schrier RW. Diagnostic importance of an increased serum anion gap. N Engl J Med 1980;303:854-8.

22. Jones AE, Shapiro NI, Trzeciak S, Arnold RC, Claremont HA, Kline JA. Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial. JAMA 2010;303:739-46.

23. Gallagher EJ, Rodriguez K, Touger M. Agreement between peripheral venous and arterial lactate levels. Ann Emerg Med 1997;29:479-83.

24. Shapiro NI, Fisher C, Donnino M, Cataldo L, Tang A, Trzeciak S, et al. The feasibility and accuracy of point-of-care lactate measurement in emergency department patients with suspected infection. J Emerg Med 2010;39:89-94.

25. Goyal M, Pines JM, Drumheller BC, Gaieski DF. Point-of-care testing at triage decreases time to lactate level in septic patients. J Emerg Med 2010;38:578-81. 

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

IndexCopernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 0.5(2021) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time

Conferences

Top