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Patient survival, predictive factors and disease course of severe sepsis in Czech intensive care units: A multicentre, retrospective, observational study.

Abstract

BACKGROUND

Severe sepsis/septic shock is associated with high mortality. In Central Europe, there is a dearth of information on the prevalence and treatment of severe sepsis. The EPOSS (Data-based Evaluation and Prediction of Outcome in Severe Sepsis) project launched in 2011 was aimed at collecting data on patients with severe sepsis/septic shock.

METHODS

The EPOSS study processes data from the EPOSS project database, and is a retrospective, multicentre, observational study. This included all consecutive patients aged 18 and over who were admitted to participating ICUs from 1 January 2011 to 5 November 2013 and met the inclusion criteria of severe sepsis/septic shock. The primary endpoint was to analyse the relationship between in-hospital mortality (either in ICU or after discharge from ICU) and the type and number of fulfilled diagnostic and treatment interventions during the first 6 h after the diagnosis of severe sepsis/septic shock.

RESULTS

The collected dataset involved 1082 patients meeting the criteria of severe sepsis/septic shock. Following data validation, a final dataset of 897 patients was obtained. The average age of the patient group was 64.7 years; mortality at discharge from EPOSS ICUs was 35.5% and from hospital 40.7%. Of the 10 evaluated diagnostic and treatment interventions within the initial 6 hours of identifying severe sepsis/septic shock (i.e. fulfilment of SSC bundles), four or five diagnostic and treatment interventions were administered to 58.4% patients. Combined diagnostic and treatment interventions associated with the lowest in-hospital mortality were: CVP of ≥8-12 mm Hg & MAP of ≥65 mm Hg & Urine output at ≥0.5 mL/kg/h & Lactate of ≤4.0 mmol/L & Initial lactate measured & Antibiotics in the first hour. Lactate at <4 mmol/L and MAP of ≥65 mm Hg remained statistically significant even after adjustment for patient age and APACHE II score. Statistically significantly increased in-hospital mortality was found in patients admitted from general departments (45.7%) or from other ICUs (41.6%), compared to a lower in-hospital mortality of patients transferred from outpatient clinics (26.5%) or Emergency (38.0%). Severe sepsis/septic shock patients transferred from the department of internal medicine were associated with a higher in-hospital mortality (45.1%) than surgical patients (35.5%).

CONCLUSIONS

The most effective measures associated with the lowest in-hospital mortality in septic shock patients were CVP of ≥8-12 mm Hg, MAP of ≥65 mm Hg, urine output at ≥0.5 mL/kg/h, initial lactate level of ≤4.0 mmol/L and administration of antibiotics within the first hour.

Authors+Show Affiliations

Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic.Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic.Department of Research and Development, Department of Anaesthesiology and Intensive Care, Faculty of Medicine in Hradec Kralove, Charles University in Prague and University Hospital Hradec Kralove, Czech Republic. Department of Anaesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Canada.Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech republic.Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech republic.Department Anaesthesia and Intensive Care, Faculty of Medicine, Masaryk University, Brno and St. Anne's University Hospital in Brno, Czech Republic.First Medical Department and Biomedical Centre, Faculty of Medicine in Plzen, Charles University in Prague and Teaching Hospital in Plzen, Czech Republic.Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech republic. Department of Paediatric Anaesthesiology and Intensive Care Medicine, Faculty of Medicine, Masaryk University, Brno and University Hospital Brno, Czech Republic.Department of Anaesthesiology and Intensive Care Medicine, University Hospital Ostrava, Czech Republic.Department of Anaesthesiology and Intensive Care Medicine, Faculty of Medicine, Masaryk University, Brno and University Hospital Brno, Czech Republic.Department of Anaesthesiology and Intensive Care Medicine, University Hospital Ostrava, Czech Republic. Department of Intensive Care Medicine and Forensic Studies, Faculty of Medicine, University of Ostrava, Czech Republic.

Pub Type(s)

Journal Article
Multicenter Study
Observational Study

Language

eng

PubMed ID

26526190

Citation

Uvizl, Radovan, et al. "Patient Survival, Predictive Factors and Disease Course of Severe Sepsis in Czech Intensive Care Units: a Multicentre, Retrospective, Observational Study." Biomedical Papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia, vol. 160, no. 2, 2016, pp. 287-97.
Uvizl R, Adamus M, Cerny V, et al. Patient survival, predictive factors and disease course of severe sepsis in Czech intensive care units: A multicentre, retrospective, observational study. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2016;160(2):287-97.
Uvizl, R., Adamus, M., Cerny, V., Dusek, L., Jarkovsky, J., Sramek, V., Matejovic, M., Stourac, P., Kula, R., Malaska, J., & Sevcik, P. (2016). Patient survival, predictive factors and disease course of severe sepsis in Czech intensive care units: A multicentre, retrospective, observational study. Biomedical Papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia, 160(2), 287-97. https://doi.org/10.5507/bp.2015.052
Uvizl R, et al. Patient Survival, Predictive Factors and Disease Course of Severe Sepsis in Czech Intensive Care Units: a Multicentre, Retrospective, Observational Study. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2016;160(2):287-97. PubMed PMID: 26526190.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Patient survival, predictive factors and disease course of severe sepsis in Czech intensive care units: A multicentre, retrospective, observational study. AU - Uvizl,Radovan, AU - Adamus,Milan, AU - Cerny,Vladimir, AU - Dusek,Ladislav, AU - Jarkovsky,Jiri, AU - Sramek,Vladimir, AU - Matejovic,Martin, AU - Stourac,Petr, AU - Kula,Roman, AU - Malaska,Jan, AU - Sevcik,Pavel, Y1 - 2015/10/23/ PY - 2015/06/20/received PY - 2015/09/22/accepted PY - 2015/11/4/entrez PY - 2015/11/4/pubmed PY - 2017/4/11/medline KW - assessment KW - lactate KW - mortality KW - septic shoc KW - severe sepsis SP - 287 EP - 97 JF - Biomedical papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia JO - Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub VL - 160 IS - 2 N2 - BACKGROUND: Severe sepsis/septic shock is associated with high mortality. In Central Europe, there is a dearth of information on the prevalence and treatment of severe sepsis. The EPOSS (Data-based Evaluation and Prediction of Outcome in Severe Sepsis) project launched in 2011 was aimed at collecting data on patients with severe sepsis/septic shock. METHODS: The EPOSS study processes data from the EPOSS project database, and is a retrospective, multicentre, observational study. This included all consecutive patients aged 18 and over who were admitted to participating ICUs from 1 January 2011 to 5 November 2013 and met the inclusion criteria of severe sepsis/septic shock. The primary endpoint was to analyse the relationship between in-hospital mortality (either in ICU or after discharge from ICU) and the type and number of fulfilled diagnostic and treatment interventions during the first 6 h after the diagnosis of severe sepsis/septic shock. RESULTS: The collected dataset involved 1082 patients meeting the criteria of severe sepsis/septic shock. Following data validation, a final dataset of 897 patients was obtained. The average age of the patient group was 64.7 years; mortality at discharge from EPOSS ICUs was 35.5% and from hospital 40.7%. Of the 10 evaluated diagnostic and treatment interventions within the initial 6 hours of identifying severe sepsis/septic shock (i.e. fulfilment of SSC bundles), four or five diagnostic and treatment interventions were administered to 58.4% patients. Combined diagnostic and treatment interventions associated with the lowest in-hospital mortality were: CVP of ≥8-12 mm Hg & MAP of ≥65 mm Hg & Urine output at ≥0.5 mL/kg/h & Lactate of ≤4.0 mmol/L & Initial lactate measured & Antibiotics in the first hour. Lactate at <4 mmol/L and MAP of ≥65 mm Hg remained statistically significant even after adjustment for patient age and APACHE II score. Statistically significantly increased in-hospital mortality was found in patients admitted from general departments (45.7%) or from other ICUs (41.6%), compared to a lower in-hospital mortality of patients transferred from outpatient clinics (26.5%) or Emergency (38.0%). Severe sepsis/septic shock patients transferred from the department of internal medicine were associated with a higher in-hospital mortality (45.1%) than surgical patients (35.5%). CONCLUSIONS: The most effective measures associated with the lowest in-hospital mortality in septic shock patients were CVP of ≥8-12 mm Hg, MAP of ≥65 mm Hg, urine output at ≥0.5 mL/kg/h, initial lactate level of ≤4.0 mmol/L and administration of antibiotics within the first hour. SN - 1213-8118 UR - https://www.unboundmedicine.com/medline/citation/26526190/Patient_survival_predictive_factors_and_disease_course_of_severe_sepsis_in_Czech_intensive_care_units:_A_multicentre_retrospective_observational_study_ L2 - http://biomed.papers.upol.cz/doi/10.5507/bp.2015.052.html DB - PRIME DP - Unbound Medicine ER -