ABSTRACT
Background: Sepsis following surgery or trauma remains one of the leading causes of morbidity and mortality in hospitalpopulations, especially in populations in intensive care units (ICUs). The key to successful control of sepsis-associated infectionsis early prediction and rapid treatment of the disease. Standard clinical and laboratory parameter testing estimate the levels ofexpression of interleukin-1 β (IL-1 β), IL-6, IL-8, and IL-10, tumor necrosis factor-α, FasL (Fas ligand is a type-II transmembraneprotein), and CCL2 (C-C Motif Chemokines Ligand 2) mRNA and growth differentiation factor-15. These are a few measuredby real- time reverse transcriptase polymerase chain reaction.Aim of the Study: In this study, evaluation of the urinary albumin/creatinine ratio (ACR) was used as a prognostic predictorin critically ill sepsis patients.Materials and Methods: In a prospective observational study, 365 adult critically septic patients were included. After clinicalevaluation, urine spot samples were collected on admission and 24 h later for ACR1 and ACR2. Admission Acute Physiologyand Chronic Health Evaluation (APACHE) IV score and the highest recorded Sepsis-related Organ Failure Assessment (SOFA)score of their daily estimation were considered. The need for mechanical ventilation was assessed in addition to inotropic and/or vasoactive support, renal replacement therapy (RRT), and in-hospital mortality.Observations and Results: A total of 365 patients who were critically ill with sepsis were initially recruited to this study. Thepatients included in this study were aged between 28 and 87 with a mean age of 62.37 ± 9.15 years. There were 235 (64.38%)males and 130 females (35.61%). The highest SOFA score was 7.4 (4.0–14.0) ranging from 1 to 17 and APACHE IV scorerecorded within the first 24 h of ICU admission was 76.8 (58.8–98.0) ranging from 46 to 118. Of 365 patients, 191 (52.32%)required ventilator support, 201 (55.06%) needed inotropic and/or vasoactive support to maintain hemodynamics, and 71(19.45%) needed RRT. The mean length of hospital stay in the present study was 17.65 ± 8.60 days.Conclusions: Evaluating the urinary ACR values regularly in all critically ill sepsis patients was a simple, rapid, non-invasive,inexpensive, easy to perform, and interpret test for early prognosis and prediction of mortality
ABSTRACT
Background: The major cause of mortality and morbidity in intensive care units (ICUs) are health care-associated infection(HCAI), especially nosocomial infection (NCI). HCAI and NCI are key factors determining the clinical outcome among patientsadmitted in critical care areas. Few hospitals in India perform regular surveillance for HCAI and NCI in ICUs.Aim of the study: This study aims to study the incidence of HCAI and NCI as risk factors associated with mortality and morbidityICUs.Materials and Methods: A total of 624 patients hospitalized in six different ICUs of a large teaching hospital in Northern Keralawere assessed between April 2016 and March 2018. NCI was defined as the presence of clinical signs and symptoms of infectionin patients at least 48 h after their hospitalization, confirmed by positive cultures of specimens taken from the patients’ blood,urine, wounds, respiratory secretions, and other body fluids. A checklist comprising 109 questions were used to assess thepresence of HCAI and NCI as factors of increased mortality and morbidity.Observations and Results: Among the 624 patients, 364 (58.33%) were male and 260 were female (41.66%). The youngestpatient was aged 16 years and the eldest one was aged 87 years with a mean age of 49.78 ± 11.30. The mean age of patientswho had NCIs was 57.68 ± 09.45 when compared to the mean age of 52.39 ± 8.20 in patients without NCIs with P = 0.781(statistically not significant). The mean age of patients who died with NCIs was 76.15 ± 6.29 and the mean age of patientswith NCIs who survived was 63.20 ± 7.70 with P = 0.021 (statistically significant). Culture positivity of specimens collected andanalyzed was observed in 195 (31.25%) patients. The overall rate of confirmed NCI in the studied patients was 241/624 (38.61%)(confidence interval 95% = 13.25–21.50). General ICU was the most crowded ward consisting of 237/624 admissions (37.98%)and had the highest rate of NCIs 72/159 (38.81%).Conclusions: The patients with prolonged urinary catheterization were prone to NCIs and deaths in ICUs, and hence, theyshould be treated intensively