PREDICTORS OF MORTALITY FOR PATIENTS ADMITTED WITH SEPSIS AT THE INTENSIVE CARE UNIT AT LAUTOKA HOSPITAL. “A RETROSPECTIVE STUDY”

Researchers: Prasad SS, Bennett E, Vukivukiseru M, Israel J
Researcher Affiliations:
1Department of Medical Sciences, College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji.
2Department of Anesthesia, Intensive Care and Hyperbaric Services, Lautoka Hospital, Lautoka, Fiji.
Key Words: sepsis, mortality, ICU, APACHE II score
Introduction: Sepsis is a global health problem. It leads to high patient morbidity and mortality and consumes large portions of the health budget thereby putting undue financial stress on health systems. Despite this, its impact has not been quantified in Fiji’s setting and no local data exists on what the mortality from sepsis is like and what factors influence mortality. This study aims to determine mortality from sepsis and identify factors associated with mortality in patients admitted at the Intensive Care Unit at Lautoka Hospital.
Method: This is a retrospective study conducted over a 6-month period (1st January-30th June 2018). All patients above 16yrs of age admitted to the adult ICU with clinical sepsis (defined as 2 or more of SIRS response with suspected or confirmed infection) were included. Information was extracted from existing medical records and analysed using SPSS software. Chi Square tests were run to determine association between presence of comorbidities and mortality as well as time to antibiotic administration and mortality. Independent T-tests were done to test if the differences in mean values for clinical and laboratory parameters (Heart rate, MAP, Temp, blood sugar, hematocrits, white cell count, serum creatinine etc.) in the survivor and non-survivor groups were statistically significant. APACHE II scores were used to calculate predicted mortality and a standardized mortality ratio was calculated.
Results: Of the 90 septic patients enrolled in the study, 59 succumbed giving a mortality rate of 65.5%. This was comparatively higher than similar studies but the Standardized Mortality Ratio using the predicted mortality from APACHE II scores was 1.05. This suggests that the higher mortality rate is as expected for this sample. The presence of Diabetes Mellitus or Hypertension or Chronic Renal Failure was found to be significantly associated with mortality. Independent T-tests revealed a statistically significant difference in the mean values between the survivor and non-survivor groups for age, heart rate, ph., white cell count, hematocrits, serum creatinine and APACHE II score.
Conclusion: This study identified that the mortality from sepsis at 65.5% was comparatively higher than other similar studies but the standardized mortality ratio of 1.05 showed that this was the expected mortality as predicted using APACHE II scores. This implied that patients are admitted to ICU at a very advanced stage of illness. Limitations included retrospective nature of study which contributed to missing data, short duration of study with small sample size. A further prospective study would be recommended to determine trends in mortality.