Early ICU-mortality in sepsis - causes, influencing factors and variability in clinical judgement: a retrospective cohort study.

Autor: Driessen RGH; Department of Intensive Care Medicine, Maastricht University Medical Center +, Maastricht, The Netherlands., Heijnen NFL; Department of Intensive Care Medicine, Maastricht University Medical Center +, Maastricht, The Netherlands., Hulsewe RPMG; Department of Intensive Care Medicine, Maastricht University Medical Center +, Maastricht, The Netherlands., Holtkamp JWM; Department of Intensive Care Medicine, St. Jans Gasthuis, Weert, The Netherlands., Winkens B; Department of Methodology and Statistics, Maastricht University (CAPHRI), Maastricht, The Netherlands., van de Poll MCG; Department of Intensive Care Medicine, Maastricht University Medical Center +, Maastricht, The Netherlands.; Department of Surgery, Maastricht University Medical Center +, Maastricht, The Netherlands.; School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands., van der Horst ICC; Department of Intensive Care Medicine, Maastricht University Medical Center +, Maastricht, The Netherlands., Bergmans DCJJ; Department of Intensive Care Medicine, Maastricht University Medical Center +, Maastricht, The Netherlands., Schnabel RM; Department of Intensive Care Medicine, Maastricht University Medical Center +, Maastricht, The Netherlands.
Jazyk: angličtina
Zdroj: Infectious diseases (London, England) [Infect Dis (Lond)] 2021 Jan; Vol. 53 (1), pp. 61-68. Date of Electronic Publication: 2020 Sep 15.
DOI: 10.1080/23744235.2020.1821912
Abstrakt: Background: Sepsis is a global health care problem with a high mortality. Early death seems common; however, data are sparse. The objective of the present study was to report causes and influencing factors of early death in sepsis and septic shock.
Methods: All septic ICU patients were included from 2012 to 2017. Early death was predefined as occurring within 48 h. Causes and factors leading up to death were reported by a panel of four intensivists, independently reviewing the medical files. Following factors were assessed: (1) delay in ICU admission; (2) futile ICU treatment; (3) missed diagnosis or inadequate treatment on the ICU. Fleiss kappa was used to assess inter-observer agreement.
Results: 1107 septic patients (APACHE II score 25 ± 8) were included. 344 patients died of which 97 (28%) within 48 h. In 33% an autopsy was performed. Primary causes of early death were multiple organ failure, mesenteric ischaemia and death after cardio-pulmonary resuscitation (CPR). Delay in ICU admission was scored in 32% of early deaths with slight agreement (κ = 0.180), futile ICU treatment in 29% with moderate agreement (κ = 0.415) and missed diagnosis or treatment in 7% of cases with slight agreement (κ = 0.122).
Conclusions: Early death after ICU admission in sepsis is common and primarily caused by multiple organ failure, mesenteric ischaemia and death after unsuccessful CPR. Influencing factors were delay in ICU admission and futile ICU admission. Fleiss kappa indicates substantial variability in clinical judgement between intensivists, strengthening the necessity for shared decision making.
Databáze: MEDLINE
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