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


METHODS
5 year-retrospective cohort study.


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


METHODS
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.
Pittet
D
D
Department of Internal Medicine, University Hospital of Geneva, Switzerland.
Thiévent
B
B
Wenzel
R P
RP
Li
N
N
Gurman
G
G
Suter
P M
PM
D000328:Adult; D000367:Age Factors; D000368:Aged; D000437:Alcoholism / Q000453:epidemiology; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015331:Cohort Studies; D015897:Comorbidity; D016001:Confidence Intervals; D016638:Critical Illness; D003920:Diabetes Mellitus / Q000453:epidemiology; D004630:Emergencies; D005260:Female; D005767:Gastrointestinal Diseases / Q000453:epidemiology / Q000601:surgery; D006331:Heart Diseases / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000453:epidemiology; D010343:Patient Admission; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000097:blood / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D012720:Severity of Illness Index; D012907:Smoking / Q000453:epidemiology; D013156:Splenectomy
D000900:Anti-Bacterial Agents