Risk Factors Associated with Mortality from Sepsis at Sakon Nakhon Hospital

Abstract

             The purpose was to determine the risk factors associated with mortality including the clinical characteristics, treatments, and outcomes of sepsis patients, A retrospective study among adult patients diagnosed according to ICD 10 including sepsis and septic shock in all bacteria who were hospitalized at the medical wards between fiscal year 2021. The information from patients’medical records was retrieved and analyzed by Chi–square or Fisher exact test and logistic regression.

              The study showed that among 1,082 sepsis patients, 96.9% were community acquired. Comorbidities were found in 811 patients, the most common was diabetes mellitus about 33.9%. The blood stream was the most common site of infection, the respiratory tract infection was the second most, 49.4% and 32.8% respectively. The causative pathogens were identified from 55.7% of the patients with gram negative bacterial predominant. The clinical Systemic inflammatory response syndrome was found about 50–70%, initial septic shock was found 29.3%, hyperlactatemia 71.1%, acute respiratory failure 53.8%. The antibiotics were initiated within 1 hour after onset of sepsis about 70.4%. The appropriate empirical antibiotics were given to only 42% of the patients. The fluid resuscitation above 30 ml/kg was given to 45.2% and vasoactive agents were given to 46.5%. The overall mortality rate of the patients with sepsis was 37.5%. The multivariable logistic regression analysis for predicting the risk factors contributing to sepsis mortality showed as follows: age > 70 years (aOR = 1.78), positive culture (aOR = 2.08), administered improper antibiotics (aOR = 1.77), respiratory tract infection (aOR = 1.76), ARDS (aOR = 11.48), respiratory rate > 20 /min or PCO2 < 32 mmHg (aOR = 1.46), creatinine > 2 or urine output < 0.5 ml/kg/hr (aOR = 2.15), INR > 1.5 (aOR = 1.8), septic shock before and after admission (aOR = 2.81 and 6.5, respectively).

             Sepsis is a major health burden with a high mortality rate. Early detection, close monitoring in patients with old age, organ dysfunction, vital sign unstable, respiratory tract infection, acute respiratory failure, corrected cause of sepsis for prevent organ dysfunction and outcome improvement.