Incidence and Risk Factors Associated with Mortality from Sepsis at Chaophrayayommarat Hospital
Keywords:
sepsis, mortality, risk factorsAbstract
Objective: The purpose was to determine the epidemiology, clinical characteristics, treatments, and outcomes of sepsis patients, as well as the risk factors associated with hospital mortality.
Methods: A retrospective cohort study among adult patients diagnosed according to ICD10 including sepsis (A41.0-A41.9), severe sepsis (R65.1), and septic shock (R57.2) who were hospitalized at the medical ward between January 1, 2016 and October 31, 2017. . After reviewing the medical records, patients who found that the diagnosis did not meet the definition of sepsis, severe sepsis, and septic shock of the 2015 clinical practice guidelines for the management of sepsis and septic shock from the Thai society of critical care medicine and the patients who received palliative treatment were excluded from this study.
Results: Among 422 sepsis patients, 67.1% were community-acquired. Comorbidities were found in 86.3%, the most common was diabetes. The respiratory tract was the most common site of infection. Causative pathogens were identified from 73.3 % of the patients with Gram-negative bacterial predominant. Organ dysfunction was found in 63% of the patients with a mean APACHE-II score of 24.67±6.94. Hemoculture was taken before administered antibiotics in 91.5% and ATB was initiated within 1 hour after the onset of sepsis in 81.3%. Appropriate empirical antibiotics were given to only 54% of the patients. Of 155 patients who developed septic shock, fluid resuscitation above 30 ml/kg was given to 69.7% and vasoactive agents were given to 98.1%. An overall mortality rate of the patients with sepsis was 34.1%
Conclusion: Sepsis is a major health burden with a high mortality rate. Prevention of hospital-acquired infection, close monitoring in patients with central nervous system dysfunction and metabolic acidosis, appropriated fluid therapy results in achievement the goal of urine output and prevention of acute renal failure are necessary for outcome improvement.
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ลิขสิทธิ์บทความเป็นของผู้เขียนบทความ แต่หากผลงานของท่านได้รับการพิจารณาตีพิมพ์ลงวารสารแพทย์เขต 4-5 จะคงไว้ซึ่งสิทธิ์ในการตีพิมพ์ครั้งแรกด้วยเหตุที่บทความจะปรากฎในวารสารที่เข้าถึงได้ จึงอนุญาตให้นำบทความในวารสารไปใช้ประโยชน์ได้ในเชิงวิชาการโดยจำเป็นต้องมีการอ้างอิงถึงชื่อวารสารอย่างถูกต้อง แต่ไม่อนุญาตให้นำไปใช้ในเชิงพาณิชย์
