Prognostic indexes of septic syndrome in the emergency department

Abstract

Among critical patients admitted to an Italian ED, those with severe sepsis/septic shock represent about 1%, with a very high mortality rate. Bedside non-invasive prognostic indexes are able to identify with high accuracy patients with adverse short-term clinical outcome.

Usefulness of Severity Scores in Patients with Suspected Infection in the Emergency Department: A Systematic Review

“…The sample size was variable. There were six studies that recruited fewer than 100 patients (29,31,35,(39)(40)(41). Only three studies included more than 2000 patients (23,25,34).…”

“…All the 21 articles included were cohort studies, 15 were prospective and six retrospective [ (13,(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36) and (37)(38)(39)(40)(41)(42), respectively]. The study population in 15 of the articles was defined by the fulfillment of two or more SIRS criteria (13,24,(27)(28)(29)(30)32,33,(35)(36)(37)(39)(40)(41)(42).…”

“…The study population in 15 of the articles was defined by the fulfillment of two or more SIRS criteria (13,24,(27)(28)(29)(30)32,33,(35)(36)(37)(39)(40)(41)(42). In five articles, the suspicion of infection was given only by the request to take hemocultures (23,25,26,31,38).…”

Glucose dysmetabolism and prognosis in critical illness

“…It can be hypothesized that patients with a history of diabetes are more likely to receive intensive insulin treatment during their stay. In a recent paper by Giannazzo et al [26] (and in the Editorial by Ban et al [27]), in a retrospective study performed in patients admitted to the ED with a diagnosis of severe sepsis or septic shock, some therapy with insulin is the only variable related to a lower risk of death and, at univariate analysis, a history of diabetes predicts a favorable outcome. This phenomenon may be related to the fact that diabetics are treated earlier and much more aggressively since they are easily recognized as being at a higher risk of sepsis.…”

A 64-year-old man admitted to the Emergency Department with an unusual case of intestinal obstruction: decision-making in the Emergency Department

“…Our recent data has shown that patients with severe sepsis or septic shock represent 0.2% of all incoming patients to a tertiary care European ED, showing a 51% mortality rate at 28-dayfollow up. Bedside prognostic indexes are useful in the recognition of patients at high risk for adverse short-term outcome [3]. In particular serum lactate ([5 mmol/L) is found to be significantly related to death within 24 h after admission.…”