• Croatian medical journal · Oct 2020

    Sepsis and septic shock - an observational study of the incidence, management, and mortality predictors in a medical intensive care unit.

    • Vesna Vucelić, Iva Klobučar, Branka Đuras-Cuculić, Gverić Grginić Ana A, Carmen Prohaska-Potočnik, Ines Jajić, Željko Vučičević, and Vesna Degoricija.
    • Iva Klobučar, Department of Cardiology, "Sestre Milosrdnice" University Hospital Center, Vinogradska cesta 29, 10 000 Zagreb, Croatia, iva.klobucar@gmail.com.
    • Croat. Med. J. 2020 Oct 31; 61 (5): 429-439.

    AimTo prospectively determine the number of patients with sepsis and septic shock in a medical intensive care unit (ICU) using the Sepsis-3 definition; to analyze patients' characteristics, clinical signs, diagnostic test results, treatment and outcomes; and to define independent risk factors for ICU mortality.MethodsThis prospective observational study enrolled all patients with the diagnosis of sepsis treated in the medical ICU of "Sestre Milosrdnice" University Hospital Center, Zagreb, between April 2017 and May 2018.ResultsOut of 116 patients with sepsis, 54.3% were female. The median age was 73.5 years (IQR 63-82). The leading source of infection was the genitourinary tract (56.9%), followed by the lower respiratory tract (22.4%). A total of 35.3% of the patients experienced septic shock. Total ICU mortality for sepsis was 37.9%: 63.4% in patients with septic shock and 24.0% in patients without shock. Independent risk factors for ICU mortality were reduced mobility level (odds ratio [OR] 11.16, 95% confidence interval [CI] 2.45-50.91), failure to early recognize sepsis in the emergency department (OR 6.59, 95% CI 1.09-39.75), higher Sequential Organ Failure Assessment score at admission (OR 2.37, 95% CI 1.59-3.52), and inappropriate antimicrobial treatment (OR 9.99, 95% CI 2.57-38.87).ConclusionWhile reduced mobility level and SOFA score are predetermined characteristics, early recognition of sepsis and the choice of appropriate antimicrobial treatment could be subject to change. Raising awareness of sepsis among emergency department physicians could improve its early recognition and increase the number of timely obtained specimens for microbial cultures.

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