ABSTRACT
OBJETIVO: Examinar las características clínicas y los factores pronósticos de los pacientes ingresados por sepsis grave/shock séptico en la Unidad de Cuidados Intensivos del Hospital Universitario Donostia. DISEÑO: Estudio observacional prospectivo durante un período consecutivo de 6 años (1-2-2008 a 31-12-2013). ÁMBITO: Servicio de Medicina Intensiva del Hospital Universitario Donostia, único hospital terciario de Guipúzcoa. RESULTADOS: El número de pacientes con sepsis grave/shock séptico ha aumentado progresivamente hasta un total de 1.136, sin observarse cambios significativos en la edad, el sexo, la puntuación del Acute Physiology and Chronic Health Evaluation II, los valores de procalcitonina ni en los de lactato sérico. En los últimos años ha habido un aumento significativo de los ingresos desde Urgencias respecto a los procedentes de planta, con una mayor incidencia de la sepsis urológica. La afectación hemodinámica y renal han sido las disfunciones más prevalentes, descendiendo la afectación respiratoria y la trombocitopenia y aumentando la coagulopatía. La mortalidad ha descendido significativamente. Mediante un análisis multivariante analizamos factores pronósticos precoces: el tipo de paciente, su procedencia, la etiología de la sepsis, la cifra de lactato y la presencia de disfunciones orgánicas, exceptuando la hiperbilirrubinemia y la hipotensión, fueron las variables más influyentes en la mortalidad. CONCLUSIONES: La sepsis grave/shock séptico genera un creciente número de ingresos. A pesar de que las características clínicas han variado poco en los últimos años, hemos observado un descenso de la mortalidad. Consideramos importante el conocimiento de los factores pronósticos precoces para mejorar el abordaje de estos pacientes
OBJECTIVE: To determine the clinical characteristics and prognostic factors of patients with severe sepsis/septic shock admitted to the Intensive Care Unit of Donostia University Hospital (Guipuzcoa, Spain). DESIGN: A prospective, observational study was carried out during a consecutive 6-year period (1st February 2008-31st December 2013). SETTING: The Intensive Care Unit of Donostia University Hospital, the only third level hospital in the province of Guipuzcoa, with a recruitment population of 700,000 inhabitants. RESULTS: Number of patients with severe sepsis/septic shock has progressively increased over the last years to reach 1,136 patients, yet significant changes in age, sex, Acute Physiology and Chronic Health Evaluation II, procalcitonin and lactate values could not be observed. In the last years, admission rate from Emergency Department has increased in comparison to admissions from hospitalization ward, with a higher incidence of urological sepsis. Hemodynamic and renal dysfunctions have been the most prevalent disorders, respiratory involvement and thrombocytopenia have gone down while coagulopathy has increased significantly. Mortality has decreased significantly. We have performed a multivariate analysis of the early prognostic factors. Type, origin, sepsis etiology, lactate and the presence of organ dysfunction -except for hyperbilirubinemia and hypotension- were the most important mortality factors. CONCLUSIONS: Severe sepsis and septic shock result in growing ICU admissions. Although clinical features have barely changed over the last years, we have observed a decrease in mortality. We find important knowing these early prognostic factors to improve the management of these patients
Subject(s)
Humans , Shock, Septic/epidemiology , Sepsis/epidemiology , Critical Care/methods , Prospective Studies , Early Diagnosis , Intensive Care Units/statistics & numerical data , Hospital MortalityABSTRACT
OBJECTIVE: To determine the clinical characteristics and prognostic factors of patients with severe sepsis/septic shock admitted to the Intensive Care Unit of Donostia University Hospital (Guipuzcoa, Spain). DESIGN: A prospective, observational study was carried out during a consecutive 6-year period (1st February 2008-31st December 2013). SETTING: The Intensive Care Unit of Donostia University Hospital, the only third level hospital in the province of Guipuzcoa, with a recruitment population of 700,000 inhabitants. RESULTS: Number of patients with severe sepsis/septic shock has progressively increased over the last years to reach 1,136 patients, yet significant changes in age, sex, Acute Physiology and Chronic Health Evaluation II, procalcitonin and lactate values could not be observed. In the last years, admission rate from Emergency Department has increased in comparison to admissions from hospitalization ward, with a higher incidence of urological sepsis. Hemodynamic and renal dysfunctions have been the most prevalent disorders, respiratory involvement and thrombocytopenia have gone down while coagulopathy has increased significantly. Mortality has decreased significantly. We have performed a multivariate analysis of the early prognostic factors. Type, origin, sepsis etiology, lactate and the presence of organ dysfunction -except for hyperbilirubinemia and hypotension- were the most important mortality factors. CONCLUSIONS: Severe sepsis and septic shock result in growing ICU admissions. Although clinical features have barely changed over the last years, we have observed a decrease in mortality. We find important knowing these early prognostic factors to improve the management of these patients.
