Late recognition and illness severity are determinants of early death in severe septic patients

Late recognition and illness severity are determinants of early death in severe septic patients

Author Machado, Flávia Ribeiro Autor UNIFESP Google Scholar
Salomão, Reinaldo Autor UNIFESP Google Scholar
Rigato, Otelo Google Scholar
Ferreira, Elaine M. Google Scholar
Schettino, Guilherme Google Scholar
Mohovic, Tatiane Google Scholar
Silva, Carla Google Scholar
Castro, Isac Google Scholar
Silva, Eliezer Google Scholar
Institution Universidade Federal de São Paulo (UNIFESP)
Latin American Sepsis Institute
Sírio Libanês Hospital Intensive Care Unit
Hospital Israelita Albert Einstein Intensive Care Unit
Abstract OBJECTIVE: To identify the independent variables associated with death within 4 days after the first sepsis-induced organ dysfunction. METHODS: In this prospective observational study, severe sepsis and septic shock patients were classified into 3 groups: Group 1, survivors; Group 2, late non-survivors; and Group 3, early non-survivors. Early death was defined as death occurring within 4 days after the first sepsis-induced organ dysfunction. Demographic, clinical and laboratory data were collected and submitted to univariate and multinomial analyses. RESULTS: The study included 414 patients: 218 (52.7%) in Group 1, 165 (39.8%) in Group 2, and 31 (7.5%) in Group 3. A multinomial logistic regression analysis showed that age, Acute Physiology and Chronic Health Evaluation II score, Sepsis-related Organ Failure Assessment score after the first 24 hours, nosocomial infection, hepatic dysfunction, and the time elapsed between the onset of organ dysfunction and the sepsis diagnosis were associated with early mortality. In contrast, Black race and a source of infection other than the urinary tract were associated with late death. Among the non-survivors, early death was associated with Acute Physiology and Chronic Health Evaluation II score, chronic renal failure, hepatic dysfunction Sepsis-related Organ Failure Assessment score after 24 hours, and the duration of organ dysfunction. CONCLUSION: Factors related to patients' intrinsic characteristics and disease severity as well as the promptness of sepsis recognition are associated with early death among severe septic patients.
Keywords Prognosis
Mortality
Sepsis
Language English
Sponsor Fundacao de Amparo a Pesquisa do Estado de Sao Paulo
Date 2013-05-01
Published in Clinics. Faculdade de Medicina / USP, v. 68, n. 5, p. 586-591, 2013.
ISSN 1807-5932 (Sherpa/Romeo, impact factor)
Publisher Faculdade de Medicina / USP
Extent 586-591
Origin http://dx.doi.org/10.6061/clinics/2013(05)02
Access rights Open access Open Access
Type Article
Web of Science ID WOS:000320463300002
SciELO ID S1807-59322013000500586 (statistics in SciELO)
URI http://repositorio.unifesp.br/handle/11600/7739

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