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Risk factors for multiorgan failure and mortality in severe sepsis patients who need intensive care unit follow-up
Ece Öz, Cüneyt Saltürk1, Zuhal Karakurt
1Medical Intensive Care Unit, Sureyyapasa Chest Diseases and Chest Surgery Training and Research Hospital, Istanbul, Turkey. csalturk@yahoo.com.
Introduction:
Multiorgan failure (MOF) is a primary cause of morbidity and mortality in sepsis patients in intensive care units (ICU). Finding risk factors and solving preventable problems of MOF in patients who have sepsis can be a favourable step for decreasing mortality. We aimed to examine multiorgan failure and mortality related risk factors in intensive care unit patients who have sepsis.
Materials And Methods:
A retrospective data collection and prognostic cohort study was performed. Between January 2009-March 2010, patients accepted to the 22-bed pulmonary intensive care unit with the diagnosis of sepsis were enrolled. Patients' demographic data, ICU severity scores, application of mechanical ventilation, causative agent of sepsis, number of ICU days and presence of mortality were recorded. Logistic regression analysis was carried out for risk factors.
Result:
347 patients with sepsis were involved in the study. 43 of the patients (12.4%) developed MOF and overall mortality rate was 14.9% (n= 52). Presence of resistant pathogen, presence of shock, application of TPN and high APACHE II score were found to be risk factors for MOF [p= 0.015 Odds ratio (OR) 3.47 confidence interval (CI): 1.27 - 9.47, p= 0.001, OR: 30.8 CI: 11.41 - 83-49, p= 0.028, OR: 3.08, CI: 1.13 - 8.39, p= 0.003, OR: 1.10, CI: 1.04-1.18, respectively]. Risk factors for overall mortality were presence of nosocomial infection, high 3rd day SOFA score, presence of shock, application of TPN and sedation (p= 0.005, OR: 3.39, CI: 1.45 - 7.93; p= 0.001, OR: 1.51, CI: 1.27 - 1.81; p= 0.014, OR: 3.24, CI: 1.27 - 8.25; p= 0.003, OR: 3.64. CI: 1.54 - 8.58; p= 0.001, OR: 3.38, CI: 1.51 - 7.57, respectively).
Conclusions:
In sepsis patients who need ICU follow up, presence of resistant pathogen, presence of shock, application of TPN and high APACHE II scores are risk factors for developing MOF. Thus, rational use of antibiotics, reducing the use of TPN, application of infection control programmes and prevention of shock will further reduce multiorgan failure and mortality.
Insights
Multiorgan failure (MOF) in sepsis patients is linked to resistant pathogens, shock, TPN use, and high APACHE II scores. Addressing these factors can reduce MOF and mortality in intensive care units (ICUs).
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Prognostic Studies
Background:
- Multiorgan failure (MOF) is a significant cause of death in sepsis patients within intensive care units (ICUs).
- Identifying modifiable risk factors for MOF in sepsis is crucial for improving patient outcomes and reducing mortality.
- This study investigates the risk factors associated with MOF and mortality in ICU patients diagnosed with sepsis.
Purpose of the Study:
- To identify risk factors for developing multiorgan failure (MOF) in intensive care unit (ICU) patients with sepsis.
- To determine risk factors associated with overall mortality in sepsis patients requiring ICU care.
- To provide evidence for targeted interventions to reduce MOF and mortality in sepsis.
Main Methods:
- A retrospective prognostic cohort study was conducted involving sepsis patients admitted to a pulmonary ICU between January 2009 and March 2010.
- Data collected included demographics, ICU severity scores (APACHE II, SOFA), mechanical ventilation use, causative agents, ICU length of stay, and mortality.
- Logistic regression analysis was employed to identify risk factors for MOF and mortality.
Main Results:
- Of 347 sepsis patients, 12.4% developed MOF and 14.9% died.
- Risk factors for MOF included resistant pathogens, shock, total parenteral nutrition (TPN) use, and high APACHE II scores.
- Risk factors for mortality comprised nosocomial infection, high 3rd-day SOFA score, shock, TPN, and sedation.
Conclusions:
- Resistant pathogens, shock, TPN administration, and elevated APACHE II scores are significant risk factors for MOF in ICU sepsis patients.
- Reducing TPN use, implementing infection control, preventing shock, and rational antibiotic use are recommended to decrease MOF and mortality.
- These findings highlight the importance of proactive management strategies in critically ill sepsis patients.
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