Biomedical papers, 2016 (vol. 160), issue 2

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2016, 160(2):287-297 | 10.5507/bp.2015.052

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

Radovan Uvizla, Milan Adamusa, Vladimir Cernyb,c, Ladislav Dusekd, Jiri Jarkovskyd, Vladimir Srameke, Martin Matejovicf, Petr Stouracd,g, Roman Kulah, Jan Malaskai, Pavel Sevcikh,j
a Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
b 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
c Department of Anaesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Canada
d Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech republic
e Department Anaesthesia and Intensive Care, Faculty of Medicine, Masaryk University, Brno and St. Anne's University Hospital in Brno, Czech Republic
f First Medical Department and Biomedical Centre, Faculty of Medicine in Plzen, Charles University in Prague and Teaching Hospital in Plzen, Czech Republic
g Department of Paediatric Anaesthesiology and Intensive Care Medicine, Faculty of Medicine, Masaryk University, Brno and University Hospital Brno, Czech Republic
h Department of Anaesthesiology and Intensive Care Medicine, University Hospital Ostrava, Czech Republic
i Department of Anaesthesiology and Intensive Care Medicine, Faculty of Medicine, Masaryk University, Brno and University Hospital Brno, Czech Republic
j Department of Intensive Care Medicine and Forensic Studies, Faculty of Medicine, University of Ostrava, Czech Republic

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.

Keywords: severe sepsis, septic shoc, lactate, mortality, assessment

Received: June 20, 2015; Accepted: September 22, 2015; Prepublished online: October 23, 2015; Published: June 24, 2016


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