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Macroscopic postmortem findings in 235 surgical intensive care patients with sepsis
Christian Torgersen1, Patrizia Moser, Günter Luckner
1Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria. christian.torgersen@i-med.ac.at
Background:
Although detailed analyses of the postmortem findings of various critically ill patient groups have been published, no such study has been performed in patients with sepsis. In this retrospective cohort study, we reviewed macroscopic postmortem examinations of surgical intensive care unit (ICU) patients who died from sepsis or septic shock.
Methods:
Between 1997 and 2006, the ICU database and autopsy register were reviewed for patients who were admitted to the ICU because of sepsis/septic shock, or who developed sepsis/septic shock at a later stage during their ICU stay and subsequently died from of sepsis/septic shock. Clinical data and postmortem findings were documented in all patients.
Results:
Postmortem results of 235 patients (84.8%) were available for statistical analysis. The main causes of death as reported in the patient history were refractory multiple organ dysfunction syndrome (51.5%) and uncontrollable cardiovascular failure (35.3%). Pathologies were detected in the lungs (89.8%), kidneys/urinary tract (60%), gastrointestinal tract (54%), cardiovascular system (53.6%), liver (47.7%), spleen (33.2%), central nervous system (18.7%), and pancreas (8.5%). In 180 patients (76.6%), the autopsy revealed a continuous septic focus. The most common continuous foci were pneumonia (41.3%), tracheobronchitis (28.9%), peritonitis (23.4%), uterine/ovarial necrosis (9.8% of female patients), intraabdominal abscesses (9.1%), and pyelonephritis (6%). A continuous septic focus was observed in 63 of the 71 patients (88.7%) who were admitted to the ICU because of sepsis/septic shock and treated for longer than 7 days.
Conclusions:
Relevant postmortem findings explaining death in surgical ICU patients who died because of sepsis/septic shock were a continuous septic focus in approximately 80% and cardiac pathologies in 50%. The most frequently affected organs were the lungs, abdomen, and urogenital tract. More diagnostic, therapeutic and scientific efforts should be launched to identify and control the infectious focus in patients with sepsis and septic shock.
Insights
Postmortem examinations of surgical intensive care unit (ICU) patients revealed a continuous septic focus in approximately 80% of cases. Cardiac pathologies were also prevalent, highlighting the need for better infectious focus identification and control in sepsis and septic shock.
Area of Science:
- Critical Care Medicine
- Pathology
- Infectious Diseases
Background:
- Limited postmortem analyses exist for critically ill patients with sepsis.
- This study addresses this gap by examining postmortem findings in surgical ICU patients who died from sepsis or septic shock.
Purpose of the Study:
- To analyze the macroscopic postmortem findings in surgical intensive care unit (ICU) patients who died from sepsis or septic shock.
- To identify common pathologies and continuous septic foci contributing to mortality in this patient group.
Main Methods:
- Retrospective cohort study of surgical ICU patients from 1997-2006.
- Review of ICU database and autopsy register for patients with sepsis/septic shock who died.
- Documentation of clinical data and postmortem findings.
Main Results:
- Postmortem results from 235 patients were analyzed.
- Main causes of death included multiple organ dysfunction syndrome (51.5%) and cardiovascular failure (35.3%).
- Pathologies were frequent in lungs (89.8%), kidneys (60%), and gastrointestinal tract (54%).
- A continuous septic focus was found in 76.6% of patients, most commonly pneumonia (41.3%) and tracheobronchitis (28.9%).
Conclusions:
- A continuous septic focus (approx. 80%) and cardiac pathologies (approx. 50%) were significant postmortem findings in surgical ICU patients dying from sepsis/septic shock.
- Lungs, abdomen, and urogenital tract were the most affected organs.
- Increased efforts in diagnostics, therapeutics, and research are needed to identify and manage infectious foci in sepsis and septic shock.