Clinical Outcome after Application of CPG for Sepsis

OBJECTIVE: To compare clinical outcome before and after application of clinical practice guideline (CPG) for sepsis. METHOD: The study was an observational study with historical control. The data of pre-guideline period collected by retrospective review of medical records during August 1st to October 30th 2005 were compared to those of post-guideline period collected during February 1st to April 30th 2006. The primary outcome was in-hospital mortality and the secondary outcome were organ failure, ICU length of stay and hospital length of stay. Data analysis used the computer’s package for chi-square, and Fisher’s exact test with significant level at 0.05. RESULTS: One hundred and seventy three patients with sepsis or septic shock were included; 90 patients in pre-CPG period and 83 patients in post-CPG period. Baseline characteristics of patients in pre-CPG and post-CPG periods were comparable. The common causes of sepsis were pneumonia, urinary tract infection, gastrointestinal and intra-abdominal infection, consecutively. Hospital mortality rate was significantly reduced from 73.3% in pre-CPG period to 54.2% in post-CPG period (p=0.01). With regard to organ failure, acute respiratory distress syndrome was significantly increased from 26.7% to 44.9% (p=0.02) during the same period. Meanwhile, proportion of acute tubular necrosis and disseminated intravascular coagulopathy were found to be greater after introduction of the guideline. Furthermore, the length of ICU stay and total hospital stay trended longer in post-CPG period. CONCLUSIONS: The CPG for sepsis is effective in reducing in-hospital mortality. The reciprocal increase in morbidity, acute respiratory distress syndrome indicates that the CPG implementation might imperfect and requires further improvement.