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Scientific article
English

Bedside prediction of mortality from bacteremic sepsis. A dynamic analysis of ICU patients

Contributors

Pittet, Didier; Thievent, B.; Wenzel, R. P.; Li, Ning; Auckenthaler, Raymond; Suter, Peter

Published in

American journal of respiratory and critical care medicine, vol. 153, no. 2, p. 684-693

Publication date

1996

Abstract

The prognosis in patients with sepsis depends on severity of acute illness, underlying chronic diseases, and complications associated with infection. Adjusting for these factors is essential for evaluation of new therapies. The purpose of the present study was to determine variables readily identifiable at the bedside that predict mortality in intensive care unit (ICU) patients with sepsis and positive blood cultures. For a 5-yr period, all patients of a surgical ICU presenting with positive blood cultures and sepsis were systematically analyzed for clinical variables and organ dysfunctions at the day of onset of sepsis and bacteremia and during the subsequent clinical course. The prognostic value of these variables was determined using logistic regression procedures. Of the 5,457 admissions to the ICU, 176 patients developed sepsis with positive blood cultures (3.2 per 100 admissions). The fatality rate was 35% at 28 days after the onset of sepsis; in-hospital mortality was 43%. Independent predictors of mortality at onset of sepsis were previous antibiotic therapy (odds ratio [OR], 2.40; 95% confidence interval [CI95], 1.59 to 3.62; p = 0.034), hypothermia (OR, 1.43; CI95, 1.04 to 2.44; p = 0.030), requirement for mechanical ventilation (OR, 2.97; CI95, 1.96 to 4.51; p = 0.009), and onset-of-sepsis APACHE II score (OR, 1.21; CI95, 1.13 to 1.29; p < 0.001). Vital organ dysfunctions developing after the onset of sepsis influenced outcome markedly. The best two independent prognostic factors were the APACHE II score at the onset of sepsis (OR, 1.13 per unit; CI95, 1.08 to 1.17; p = 0.0016) and the number of organ dysfunctions developing thereafter (OR, 2.39; CI95, 2.02 to 2.82; p < 0.001). In ICU patients with sepsis and positive blood cultures, outcome can be predicted by the severity of illness at onset of sepsis and the number of vital organ dysfunctions developing subsequently. These variables are easily assessed at the bedside and should be included in the evaluation of new therapeutic strategies.

Keywords

  • Apache
  • Aged
  • Anti-Bacterial Agents/therapeutic use
  • Bacteremia/ mortality/therapy
  • Body Temperature
  • Confidence Intervals
  • Female
  • Hospital Mortality
  • Humans
  • Intensive Care Units
  • Male
  • Middle Aged
  • Odds Ratio
  • Prognosis
  • Respiration, Artificial
  • Risk Factors

UNIGE affiliation entities

UNIGE research groups

Citation (ISO format)

PITTET, Didier et al. Bedside prediction of mortality from bacteremic sepsis. A dynamic analysis of ICU patients. In: American journal of respiratory and critical care medicine, 1996, vol. 153, n° 2, p. 684–693. doi: 10.1164/ajrccm.153.2.8564118

Identifiers

Additional URL for this publication

http://ajrccm.atsjournals.org/cgi/content/abstract/153/2/684

Journal ISSN

1073-449X
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Technical informations

Creation

12/07/2010 14:37:13

First validation

12/07/2010 14:37:13

Update

13/03/2026 08:24:19

Status update

13/03/2026 08:24:19

Last indexation

13/03/2026 08:28:01
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