Study of spectrum of sepsis and prediction of its outcome in patients admitted to ICU using different scoring systems

Abstract

INTRODUCTIONSepsis is one of the leading causes of in-hospital mortality and morbidity among medical and surgical patients. Spectrum of sepsis includes sepsis, severe sepsis and septic shock. Severe sepsis accounts for one in five admissions to ICUs and is the leading cause of death in the non-coronary ICU. 1 In spite of this information regarding early predictive factors is limited.Data from western countries puts the overall incidence of sepsis ranging from 10% to 30% with mortality ranging from 10% to 56%. 2,3 Data from India suggest that the overall mortality of all sepsis patients is approximately 14% and that of severe sepsis alone is higher than 50%. 4 The early identification of sepsis and implementation of early evidence-based therapies have been documented to improve outcomes and decrease sepsis-related mortality. 5 Reducing the time to diagnosis of severe sepsis is thought to be a critical component of reducing mortality from sepsis-related multiple organ dysfunction. 6 Lack of early recognition is a major obstacle to sepsis bundle initiation. Sepsis screening tools have been developed to monitor ICU patients and their implementation has been associated with decreased sepsis-related mortality. 5,7 This study is intended to determine the spectrum of sepsis and to identify early and reliable prognostic variables for ABSTRACT Background: Although sepsis is one of the leading causes of mortality in hospitalized patients, information regarding early predictive factors for mortality and morbidity is limited. The aim was to identify reliable and early prognostic variables predicting mortality in patients admitted to ICU with sepsis. Methods: Patients fulfilling the Surviving Sepsis Campaign 2012 guidelines criteria for sepsis within the ICU were included over two years. Apart from baseline haematological, biochemical and metabolic parameters, APACHE II, SAPS II and SOFA scores were calculated on day 1 of admission. Patients were followed till death or discharge from the ICU. Chi-square test, student t-test, receiver operating curve analyses were done. Results: 100 patients were enrolled during the study period. The overall mortality was 35% (68.6% in males and 31.4% in females). Mortality was 88.6% and 11.4% in patients with septic shock and severe sepsis and none in the sepsis group, respectively. On multivariate analysis, significant predictors of mortality were APACHE II score greater than 27, SAPS II score greater than 43 and SOFA score greater than 11 on day the of admission. On ROC analysis APACHE II had the highest sensitivity (92.3%) and SAPS II had the highest specificity (82.9%). Conclusions: All three scores performed well in predicting the mortality. Overall, APACHE II had highest sensitivity, hence was the best predictor of mortality in critically ill patients. SAPS II had the highest specificity, hence it predicted improvement better than death. SOFA had intermediate sensitivity and specificity.