Infectious Diseases Unit, Department of Medicine, College of Medicine, University of Lagos; Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria.
Accident and Emergency Department, Lagos University Teaching Hospital, Lagos, Nigeria.
Niger Postgrad Med J. 2023 Jan-Mar;30(1):70-74. doi: 10.4103/npmj.npmj_190_22.
Currently, little is known about the timely application of clinical screening tools and blood sampling for decision-making in the management of patients with suspected sepsis in the accident and emergency units of hospitals in Nigeria.
The aim of the study was to ascertain the association between the time taken for the conduct of serum lactate and blood culture investigations following a clinical suspicion of sepsis, and the mortality of patients admitted to a Nigerian tertiary hospital.
Over a 6-month period (November 2021 to April 2022), 119 patients hospitalised for sepsis or septic shock at the Lagos University Teaching Hospital were followed until discharge or death. The proportion of patients whose serum lactate, serum procalcitonin and blood culture samples was taken was also determined. Predictors of mortality were determined using bivariate analysis and logistic regression. Kaplan-Meier plots were used to predict survival using sepsis diagnostic criteria.
Eighty (67%) of 119 sepsis patients met systemic inflammatory response syndrome or quick sequential (sepsis-related) organ failure assessment criteria. Only 3 (2.5%) patients had blood cultures and serum procalcitonin and 0 (0%) had serum lactate tests. Forty-one (34.5%) patients died, but clinical and laboratory procedures for sepsis management were not linked to death. A shorter hospital stay increased the death risk (χ = 14.83, P = 0.002).
This study revealed low compliance with sepsis care guidelines and no impact of timely clinical and laboratory procedures on sepsis mortalities. Further study is needed to explore patient care models that can improve the objective assessment and treatment of sepsis patients in emergency departments of busy tertiary hospitals.
目前，人们对尼日利亚医院急诊科疑似脓毒症患者管理中临床筛查工具和血液采样的及时应用及其对决策的影响知之甚少。
本研究旨在确定在疑似脓毒症后进行血清乳酸和血培养检查所花费的时间与患者死亡率之间的关联，该研究在尼日利亚的一家三级医院进行。
在 6 个月（2021 年 11 月至 2022 年 4 月）期间，对拉各斯大学教学医院因脓毒症或脓毒性休克而住院的 119 名患者进行了随访，直到出院或死亡。还确定了进行血清乳酸、血清降钙素原和血培养样本的患者比例。使用二变量分析和逻辑回归确定死亡率的预测因素。使用 sepsis 诊断标准的 Kaplan-Meier 图预测生存。
119 例脓毒症患者中有 80 例（67%）符合全身炎症反应综合征或快速顺序（与脓毒症相关）器官衰竭评估标准。只有 3 例（2.5%）患者进行了血培养和血清降钙素原检查，0 例（0%）患者进行了血清乳酸检查。41 例（34.5%）患者死亡，但脓毒症管理的临床和实验室程序与死亡无关。住院时间越短，死亡风险越高（χ=14.83，P=0.002）。
本研究显示脓毒症护理指南的遵从性较低，及时的临床和实验室程序对脓毒症死亡率没有影响。需要进一步研究以探索可以改善繁忙的三级医院急诊科脓毒症患者客观评估和治疗的患者护理模式。
