Iva Klobučar, Department of Cardiology, "Sestre Milosrdnice" University Hospital Center, Vinogradska cesta 29, 10 000 Zagreb, Croatia,
Croat Med J. 2020 Oct 31;61(5):429-439. doi: 10.3325/cmj.2020.61.429.
To 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.
This 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.
Out 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).
While 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.
使用 Sepsis-3 定义前瞻性地确定重症监护病房（ICU）中脓毒症和脓毒性休克患者的数量；分析患者的特征、临床体征、诊断试验结果、治疗和结局；并确定 ICU 死亡率的独立危险因素。
这项前瞻性观察性研究纳入了 2017 年 4 月至 2018 年 5 月期间在萨格勒布“斯特雷米尔索尼奇”大学医院中心内科 ICU 接受脓毒症治疗的所有患者。
在 116 名脓毒症患者中，54.3%为女性。中位年龄为 73.5 岁（IQR 63-82）。感染的主要来源是泌尿生殖系统（56.9%），其次是下呼吸道（22.4%）。共有 35.3%的患者发生脓毒性休克。脓毒症 ICU 死亡率为 37.9%：脓毒性休克患者为 63.4%，无休克患者为 24.0%。ICU 死亡率的独立危险因素为活动能力降低（比值比[OR] 11.16，95%置信区间[CI] 2.45-50.91）、急诊科未能早期识别脓毒症（OR 6.59，95% CI 1.09-39.75）、入院时 SOFA 评分较高（OR 2.37，95% CI 1.59-3.52）和抗菌药物治疗不当（OR 9.99，95% CI 2.57-38.87）。
虽然活动能力降低和 SOFA 评分是既定特征，但早期识别脓毒症和选择适当的抗菌药物治疗可能会发生变化。提高急诊科医生对脓毒症的认识，可以改善其早期识别，并增加及时获得微生物培养标本的数量。
