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Importance of pre-existing co-morbidities for prognosis of septicemia in critically ill patients

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Abstract

Objective

To determine admission characteristics associated with the outcome of septicemia in critically ill patients and more specifically assess the prognostic value of pre-existing co-morbidities.

Design

5 year-retrospective cohort study.

Setting

Surgical Intensive Care Unit (ICU-20 beds) in a 1600 bed-tertiary care center.

Patients

Among 5457 patients admitted to the ICU between 1984 and 1988, 176 (3.2%) met prospectively-defined criteria for blood culture-proven septicemia (8.77 per 1000 patient-days). Overall septicemic patients had a 5-fold increased risk of death compared to non-septicemic patients (relative risk 5.03, 95% confidence intervals 4.17–6.07,p<0.0001), and this estimate persisted after stratification according to age, sex, primary diagnosis and conditions of admission to the ICU (emergency/elective).

Results

Prognostic factors recorded on admission to ICU that were associated with mortality from septicemia among 173 patients were older age, higher admission Apache II score, gastrointestinal surgery, ultimately and rapidly fatal diseases and the number of co-morbidities in addition to the principal diagnosis (active smoking, alcohol abuse, non-cured malignancy, diabetes mellitus, splenectomy, recent antibiotic therapy, major surgery, or major cardiac event). In the multivariate analysis with logistic regression procedures, Apache II and co-morbidities were identified as the two independent predictors of mortality.

Conclusions

Pre-existing co-morbidities assessed at the admission to the ICU significantly improved the prediction of mortality from septicemia compared to Apache II score alone.

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References

  1. Meakins JL, Marshall JC (1986) The gastrointestinal tract: the “motor” of MOF. Arch Surg 121:197–201

    Google Scholar 

  2. Manship L, McMillin RD, Brown JJ (1984) The influence of sepsis and multiorgan failure on mortality in the surgical intensive care unit. Am Surg 50:94–101

    CAS  PubMed  Google Scholar 

  3. Pittet D, Herwaldt LA, Massanari RM (1992) The intensive care unit. In: Brachman PS, Bennett JV (eds) Hospital infections, Little, Brown and Company, Boston, MA, pp 405–439k

    Google Scholar 

  4. Monthly vital Statistics Report (1992) National Center of Health Statistics 40:February 1992

  5. Donowitz LG, Wenzel RP, Hoyt JW (1982) High risk of hospital-acquired infection in the ICU patient. Crit Care Med 10:355–357

    Article  CAS  PubMed  Google Scholar 

  6. Pittet D, Omahen J, Tarara D, Wenzel RP (1991) Current risk factors for nosocomial bloodstream infection in a tertiary health care center. 31st Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), September 1991, Chicago, A800

  7. Daschner FD, Frey P, Wolff G, Baumann PC, Suter PM (1982) Nosocomial infections in intensive care wards: a multicenter prospective study. Intensive Care Med 8:5–9

    Article  CAS  PubMed  Google Scholar 

  8. Craven DE, Kunches LM, Lichtenberg DA (1988) Nosocomial infection and fatality in medical and surgical intensive care unit patients. Arch Intern Med 148:1161–1168

    Article  CAS  PubMed  Google Scholar 

  9. Chandrasekar PH, Kruse JA, Matthews MF (1986) Nosocomial infection among patients in different types of intensive care units at a city hospital. Crit Care Med 14:508–510

    Article  CAS  PubMed  Google Scholar 

  10. McCabe WR, Jackson GG (1962) Gram-negative bacteremia. II. Clinical, laboratory, and therapeutic observations. Arch Intern Med 110:856–864

    Article  Google Scholar 

  11. Freid MA, Vosti KL (1968) The importance of underlying disease in patients with gram-negative bacteremia. Arch Intern Med 121:418–423

    Article  CAS  PubMed  Google Scholar 

  12. Knaus WA, Zimmerman JE, Wagner DP, Draper EA, Lawrence DE (1981) Apache-acute physiology and chronic health evaluation: a physiologically based classification system. Crit Care Med 9:591–597

    Article  CAS  PubMed  Google Scholar 

  13. Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) Apache II: a severity of disease classification system. Crit Care Med 13:818–829

    Article  CAS  PubMed  Google Scholar 

  14. Knaus WA, Draper EA, Wagner DP (1982) Evaluating outcome from intensive care: a preliminary multihospital comparison. Crit Care Med 10:491–495

    Article  CAS  PubMed  Google Scholar 

  15. Knaus WA, Le Gall JR, Wagner DP (1982) A comparison of intensive care in the USA and France. Lancet II:642–645

    Article  Google Scholar 

  16. Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1986) An evaluation of outcome from intensive care in major medical centers. Ann Intern Med 104:410–418

    Article  CAS  PubMed  Google Scholar 

  17. Bohnen JMA, Mustard RA, Oxholm SE, Schouten BD (1988) Apache II score and abdominal sepsis. Arch Surg 133:225–229

    Article  Google Scholar 

  18. Dellinger EP, Wertz MJ, Meakins JL, Solomkin JS, Allo MD, Howard RJ, Simmons RL (1985) Surgical infection stratification system for intra-abdominal infection. Arch Surg 120:21–29

    Article  CAS  PubMed  Google Scholar 

  19. Meakins JL, Solomkin JS, Allo MD, Dellinger EP, Howard RJ, Simmons RL (1984) A proposed classification of intra-abdominal infections. Arch Surg 119:1372–76

    Article  CAS  PubMed  Google Scholar 

  20. Ziegler EJ, Fisher CJ, Sprung CL, Straube RC, Sadoff JC, Foulke GE, Wortel CH, Fink MP, Dellinger RP, Teng NNH, Allen IE, Berger HJ, Knatterud GL, LoBuglio AF, Smith CR (1991) Treatment of gram-negative bacteremia and septic shock with HA-1A human monoclonal antibody against endotoxin. A randomized, double-blind, placebo-controlled trial. N Engl J Med 324:429–436

    Article  CAS  PubMed  Google Scholar 

  21. Greenman RL, Schein RMH, Martin MA, Wenzel RP, MacIntyre NR, Emmanuel G, Chmel H, Kohler RB, McCarthy M, Plouffe J, Russell A (1991) A controlled clinical trial of E 5 murine monoclonal IgM antibody to endotoxin in the treatment of gram-negative sepsis. JAMA 266:1097–1102

    Article  CAS  PubMed  Google Scholar 

  22. Munoz E, Sterman H, Cohen J, Goldstein J, Margolis IB, Wise L (1988) Financial risk, hospital cost, complications, and comorbidities in surgical noncomplication- and noncomorbidity-stratified diagnostic related groups. Ann Surg 207:305–309

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Haley RW (1991) Measuring the costs of nosocomial infections: methods for estimating economic burden on the hospital. Am J Med 91(3 B):32–38

    Article  Google Scholar 

  24. Gross PA, DeMauro PJ, Van Antwerpen C, Wallenstein S, Chiang S (1988) Number of comorbidities as a predictor of nosocomial infection acquisition. Infect Control Hosp Epidemiol 9:497–500

    Article  CAS  PubMed  Google Scholar 

  25. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference (1992) Definitions for sepsis and organ failures and guidelines for the use of innovative therapies in sepsis. Crit Care Med 20:864–874

    Article  Google Scholar 

  26. Baker SP, O'Neill B, haddon W, Long WB (1974) The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 14:187–196

    Article  CAS  PubMed  Google Scholar 

  27. Greenspan L, McLellan BA, Greig H (1985) Abbreviated injury scale and injury severity score: a scoring chart. J Trauma 25:60–67

    Article  CAS  PubMed  Google Scholar 

  28. Pine RW, Wertz MJ, Lennard ES, Dellinger EP, Carrico CJ, Minshew BH (1983) Determinants of organ malfunction or death in patients with intra-abdominal sepsis. Arch Surg 118:242–249

    Article  CAS  PubMed  Google Scholar 

  29. Weinstein MP, Murphy JR, Reller LB, and Lichtenstein KA (1983) The clinical significance of positive blood cultures: a comprehensive analysis of 500 episodes of bacteremia and fungemia in adults: II. Clinical observations, with special reference to factors influencing prognosis. Rev Infect Dis 5:54–70

    Article  CAS  PubMed  Google Scholar 

  30. Kreger BE, Craven DE, Carling PC, and McCabe WR (1980) Gram-negative bacteremia. III. Reassessment of etiology, epidemiology and ecology in 612 patients. Am J Med 68:332–343

    Article  CAS  PubMed  Google Scholar 

  31. Bryan CS, Reynolds KL, and Brenner ER (1983) Analysis of 1186 episodes of gram-negative bacteremia in non-university hospitals: the effects of antimicrobial therapy. Rev Infect Dis 5:629–638

    Article  CAS  PubMed  Google Scholar 

  32. Calandra T, Glauser MP, Schellekens J, Verhoef J and the Swiss-Dutch J5 Immunoglobulin Study Group (1988) Treatment of gramnegative septic shock with human IgG antibody to Escherichia coli J5: a prospective, double-blind, randomized trial. J Infect Dis 158:312–319

    Article  CAS  PubMed  Google Scholar 

  33. Roberts FJ, Geere IW, and Coldman A (1991) A three-year study of positive blood cultures, with emphasis on prognosis. Rev Infect Dis 13:34–46

    Article  CAS  PubMed  Google Scholar 

  34. Knaus WA, Wagner DP, Draper EA (1989) The value of measuring severity of disease in clinical research on acutely ill patients. J Chron Dis 37:455–461

    Article  Google Scholar 

  35. Pittet D, Thiévent B, Wenzel RP, Li N, Suter PM (1992) Onset-of-sepsis Apache II is a better predictor of mortality from septicemia than admission Apache II score. 32st Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), October 1992, Anaheim, CA, A7

  36. Knaus WA, Wagner DP, Draper EA et al (1991) The Apache III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest 100:1619–1636

    Article  CAS  PubMed  Google Scholar 

  37. Knaus WA, Wagner DP, Lynn J (1991) Short-term mortality predictions for critically ill hospitalized adults: science and ethics. Science 254:389–394

    Article  CAS  PubMed  Google Scholar 

  38. Davis H, Lefrak SS, Miller D, Malt S (1980) Prolonged mechanically-assisted ventilation: an analysis of outcome and charges. JAMA 243:43–45

    Article  PubMed  Google Scholar 

  39. Hauser JH, Tabak J, Baier H (1982) Survival of patients with cancer in a medical critical care unit. Arch Intern Med 142:527–529

    Article  CAS  PubMed  Google Scholar 

  40. Kruse JA, Thill-Baharozian MC, Carlson RW (1988) Comparison of clinical trial assessment with Apache-II for predicting mortality risk in patients admitted to a medical intensive care unit. JAMA 260:1739–1742

    Article  CAS  PubMed  Google Scholar 

  41. Brannen AL, Godfrey LJ, Groetter WE (1989) Prediction of outcome from critical illness. A comparison of clinical judgment with a prediction rule. Arch Intern Med 149:1083–1086

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Infectious Diseases, Department of Internal Medicine, University Hospital of Geneva, CH-1211, Geneva, Switzerland

    D. Pittet M.D., M.S.

  2. Division of Surgical Intensive Care, Department of Internal Medicine, University Hospital of Geneva, Geneva, Switzerland

    B. Thiévent & P. M. Suter

  3. Department of Anesthesiology, University Hospital of Geneva, Geneva, Switzerland

    D. Pittet M.D., M.S., B. Thiévent & P. M. Suter

  4. Division of General Medicine, Clinical Epidemiology and Health Services Research, University of Iowa College of Medicine, Iowa City, Iowa, USA

    R. P. Wenzel

  5. Division of Biostatistics, University of Iowa College of Medicine, Iowa City, Iowa, USA

    N. Li

  6. General Intensive Care Unit, Division of Anesthesiology, Soroka Medical Center, Beer Sheva, Israel

    G. Gurman

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  1. D. Pittet M.D., M.S.
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  4. N. Li
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  6. P. M. Suter
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Pittet, D., Thiévent, B., Wenzel, R.P. et al. Importance of pre-existing co-morbidities for prognosis of septicemia in critically ill patients. Intensive Care Med 19, 265–272 (1993). https://doi.org/10.1007/BF01690546

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  • DOI: https://doi.org/10.1007/BF01690546

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