| Abstract | Cilj istraživanja: Prikazati demografska i klinička obilježja bolesnika liječenih zbog sepse u internističkoj intenzivnoj jedinici u razdoblju od 18 mjeseci.
Materijali i metode: Provedeno je opservacijsko retrospektivno istraživanje u Jedinici intenzivnog liječenja (JIL) Klinike za unutarnje bolesti Kliničkog bolničkog centra Split. Ispitanici su bili bolesnici zaprimljeni u internističku intenzivnu jedinicu zbog sepse i septičkog šoka.
Rezultati: Tijekom opserviranog razdoblja istraživano je 95 bolesnika, od toga 54 žene (56,8%). Žene su bile starije, imali su manje vrijednosti prokalcitonina, te manju potrebu za vazopresorima i dijalizom. Kao septički šok definirano je 37 (38,9%) ispitanika. Ispitanici koji su imali septički šok imali su značajno veću bolničku smrtnost, više su boravili u JIL-u, više koristili vazopresore, dijalizu i mehaničku ventilaciju, imali veće vrijednosti bilirubina, laktata, SAPS II bodova, te manje vrijednosti bikarbonata. Smrtni ishod u bolnici imalo je ukupno 58 (61,1%) ispitanika. Ispitanici koji su preminuli bili su stariji, imali su manje vrijednosti prokalcitonina i bikarbonata, a više vrijednosti laktata i SAPS II bodova pri prijemu. Od ispitanika koji su imali septički šok, 29 (78,4%) je umrlo u bolnici, dok je u skupini ispitanika sa sepsom bez šoka njih 29 (50,0%) preminulo u bolnici (P=0,005). Od klinički pretpostavljenih izvorišta sepse urogenitalni sustav bio je najčešće izvorište (47 ispitanika ili 49,5%). Postoji korelacija između koncentracije laktata u serumu i: protrombinskog vremena (P=0,002), ukupnog bilirubina (P< 0,001) i koncentracije bikarbonata (P<0,001).
Zaključak: Ovim istraživanjem dokazano je kako je sepsa kao dijagnoza prijema u internistički JIL zastupljena u 12,4% svih prijema, sa visokim udjelom septičkog šoka i teških komorbiditeta, te u konačnici sa visokim postotkom prediktivne i stvarne smrtnosti. Najčešći fokus sepse bio je urogenitalni sustav, a najčešći izolat gram negativne bakterije. Žene su bile starije, imali su manje vrijednosti prokalcitonina, te manju potrebu za vazopresorima i dijalizom. Bolesnici sa septičkim šokom imali su značajno veću bolničku smrtnost, veće vrijednosti bilirubina, laktata, SAPS II bodova i manje vrijednosti bikarbonata, te su više su boravili u JIL-u, više koristili vazopresore, dijalizu i mehaničku ventilaciju. Preminuli ispitanici bili su stariji, imali su manje vrijednosti prokacitonina i bikarbonata, a više vrijednosti laktata i SAPS II bodova, manje su boravili u JIL-u i bolnici, te su dulje koristili dijalizu i vazopresore. Dokazan je visoki stupanj korelacije između početne koncentracija laktata u serumu i početnog protrombinskog vremena, bikarbonata i bilirubina. Navedeni laboratorijski paramteri mogu predvidjeti koncentraciju laktata. Čimbenici lošijeg kliničkog ishoda su muški spol, starija dob, postojanje septičkog šoka, više vrijednosti bilirubina, laktata, SAPS II bodova, te manje vrijednosti bikarbonata i prokalcitonina u trenutnu prijema u JIL. |
| Abstract (english) | The aim of the study: To present the demographic and clinical characteristics of patients treated for sepsis in the medical intensive care unit over a period of 18 months.
Materials and methods: An observational retrospective study was conducted in the Intensive Care Unit (ICU) of the Department of Internal Medicine at the University Hospital of Split. The subjects were patients admitted to the ICU due to sepsis and septic shock.
Results: During the observed period, 95 patients were investigated, of whom 54 were women (56.8%). The women were older, had lower procalcitonin values, and had a lower need for vasopressors and dialysis. Septic shock was defined in 37 (38.9%) subjects. Subjects with septic shock had significantly higher in-hospital mortality, spent more time in the ICU, had more need for vasopressors, dialysis, and mechanical ventilation, and had higher values of bilirubin, lactate, SAPS II points, and lower values of bicarbonate. A total of 58 (61.1%) subjects died in the hospital. Subjects who died were older, had lower values of procalcitonin and bicarbonate, and higher values of lactate and SAPS II points at admission. Of the subjects who had septic shock, 29 (78.4%) died in the hospital, while in the group of subjects with sepsis without shock, 29 (50.0%) died in the hospital (P=0.005). Of the clinically presumed sources of sepsis, the urogenital system was the most common source (47 subjects, or 49.5%). There were correlations between serum lactate concentration and: prothrombin time (P=0.002), total bilirubin (P< 0.001) and bicarbonate concentration (P<0.001).
Conclusion: Presented study proved that sepsis as a diagnosis of admission at medical ICU was represented in 12.4% of all admissions, with a high proportion of septic shock and severe comorbidities, and ultimately with a high percentage of predicted and actual mortality. The most common focus of sepsis was the urogenital system, and the most common isolates were gram-negative bacteria. The women were older, had lower procalcitonin values, and had a lower need for vasopressors and dialysis. Patients with septic shock had significantly higher in-hospital mortality, higher values of bilirubin, lactate, SAPS II points, and lower bicarbonate values, and they spent more time in the ICU, and used vasopressors, dialysis, and mechanical ventilation more. The deceased subjects were older, had lower values of procalcitonin and bicarbonate, and higher values of lactate and SAPS II points, spent less time in the ICU and hospital, and used dialysis, and vasopressors for longer. A high degree of correlation between initial serum lactate concentration and initial prothrombin time, bicarbonate, and bilirubin was demonstrated. The mentioned laboratory parameters can predict lactate concentration. Factors associated with a worse clinical outcome are male gender, older age, existence of septic shock, higher values of bilirubin, lactate, SAPS II points, and lower values of bicarbonate and procalcitonin at admission time at the ICU. |
