Septic shock: a major cause of hospital death after intensive care unit discharge

Abstract

ObjectiveTo assess the causes and factors associated with the death of patients between intensive care unit discharge and hospital discharge.MethodsThe present is a pilot, retrospective, observational cohort study. The records of all patients admitted to two units of a public/private university hospital from February 1, 2013 to April 30, 2013 were assessed. Demographic and clinical data, risk scores and outcomes were obtained from the Epimed monitoring system and confirmed in the electronic record system of the hospital. The relative risk and respective confidence intervals were calculated.ResultsA total of 581 patients were evaluated. The mortality rate in the intensive care unit was 20.8% and in the hospital was 24.9%. Septic shock was the cause of death in 58.3% of patients who died after being discharged from the intensive care unit. Of the patients from the public health system, 73 (77.6%) died in the intensive care unit and 21 (22.4%) died in the hospital after being discharged from the unit. Of the patients from the Supplementary Health System, 48 (94.1%) died in the intensive care unit and 3 (5.9%) died in the hospital after being discharged from the unit (relative risk, 3.87%; 95% confidence interval, 1.21 - 12.36; p < 0.05). The post-discharge mortality rate was significantly higher in patients with intensive care unit hospitalization time longer than 6 days.ConclusionThe main cause of death of patients who were discharged from the intensive care unit and died in the ward before hospital discharge was septic shock. Coverage by the public healthcare system and longer hospitalization time in the intensive care unit were factors associated with death after discharge from the intensive care unit.

Comparative Validity Sequential Scoring System Organ Failure Assesment (SOFA) and Quick - Sequential Organ Failure Assesment (qSOFA) on Estimating Mortality for Patients Treated in the Intensive Care Unit of Sanglah General Hospital

“…Because if the patient died less than 30 days after discharge from ICU, the cause of death was frequently associated with prior critical illness. From a Brazilian study, the most common cause of death in patients after the discharge from ICU is caused by septic shock [6]. However, if the patient died more than 30 days after discharged from ICU, the patient will be included into survivor group.…”

Perfil Epidemiológico E Seguimento Após Alta De Pacientes Internados Em Unidade De Terapia Intensiva

“…(22)3: e50609, 2017 Quanto à procedência dos pacientes, a maioria teve acesso à UTI a partir do setor de emergência 44% (n = 254), seguido do centro cirúrgico 42% (n = 241). Essa variável está de acordo com algumas pesquisas, aonde o setor de emergência foi o que apresentou a maior taxa de procedência dos pacientes para a UTI, com a porcentagem variando de 26% a 40% (6,(9)(10) mas diverge de outras pesquisas, em que a maioria dos pacientes teve acesso à UTI a partir do centro cirúrgico, com a porcentagem variando de 36% a 55% (3,(7)(8) .…”

“…Dos 573 pacientes pesquisados, 148 morreram durante a 1ª internação na UTI, totalizando 26% da amostra. Na literatura essa taxa variou de 11% a 34,8% (3,(6)(7)(9)(10)12) . Esses pacientes apresentaram maior média de 16 dias de internação e maior mediana de 7 dias de internação, quando comparados à população geral.…”

“…Com relação a esses pacientes, pode-se observar na Tabela 4 aqueles que passaram ≥ 30 dias internados na UTI, durante a 1ª internação, tiveram um RR=6.069 maior (p=<0.001) de ir a óbito em outros setores, quando comparados aos demais. Na literatura podese encontrar taxas de óbito após a alta da UTI que variam de 2% a 4% (5,10) .…”

“…Esses dados estão de acordo com a literatura, que também apresentou uma maior taxa de óbitos na UTI atribuída ao choque séptico, seguido de choque refratário/parada cardiorrespiratória e insuficiência respiratória (10) .…”