Anestéziológia a intenzívna medicína 1/2012

Predictors of hospital mortality in intensive care unit patients in teaching hospitals in Trnava in period 2009-2011

Sepsis is a significant public health concern and is the leading cause of morbidity and mortality for patients admitted to an intensive care unit. Our aim was to determine the risk factors hospitals mortality in adult critically ill patients with sepsis. The main outcome measure was hospital mortality. This retrospective single centre study was conducted from January 1, 2008 to December 31, 2011, and included 125 patients (male 66%, age 60, IQR=47-71), of whom 46 (36.8%) were with severe sepsis and 47 (37.6%) had septic shock. Overall, sixty-five (52%) patients have died, 28 (43.1%) in severe sepsis and 33 (50.8%) patients with septic shock. The abdominal infections and lung was the most common site of infection and chronic heart diseases were the most frequent comorbidity. In aetiology of sepsis most prevalent were staphylococci, Klebsiella pneumoniae and Pseudomonas aeruginosa. Hospital associated sepsis acquired 30.4% of patient. Overall 28-day hospital mortality rate were 48.8%. Predictors of mortality were comorbidity (high Charlson comorbidity index), severe sepsis or sepsis shock, high APACHE score and length of stay in hospital before transfer to ICU. Patients with gram-positive aetiology and health care associated sepsis had been more chance to inferior outcome. Better management of sepsis patients on non-ICU departments (emergency care staff), improvement in infection control practice and implementations of new sepsis biomarkers are needed and could improve survival rate from sepsis.

Keywords: hospital mortality, sepsis, risk factors, gram-negative bacteria, comorbidity.