Septic death in adults at Surin Hospital: an investigation of real-life clinical practice vs. empirical guidelines.
OBJECTIVE
To explore the cause of death from sepsis and to evaluate the hospital practice in septic patients.


METHODS
A cross-sectional, retrospective study was conducted between October 2004 and September 2005, at Surin Hospital. The present study included 119 adults (> or = 15 year of age) who were admitted with community-acquired sepsis.


RESULTS
According to the ACCP/SCCM definition, 85.7% of the patients had severe sepsis and up to 71.4% had septic shock. The overall hospital mortality was 73.9% for septic patients and 88.2% for patients in septic shock. The factors that were significantly associated with death from sepsis were age > or = 60 years, presence of co-morbidity, septic shock, organ dysfunctions > or = 3, and acidosis (HCO3 < 20 mEq/L). During hospitalization, 5.9% of patients received ICU care, 29.4% adequate fluid resuscitation, but none had been monitored for Svo2 or Scvo2, and 36.4% had more than a 1-hr delay in the administration of antibiotics. The main cause of death was refractory hypotension (77.3%), in which the amount of fluid therapy during initial resuscitation was significantly associated with the survival of septic shock.


CONCLUSIONS
Septic shock is the most common cause of death in septic patients. Delayed and inadequate hemodynamic management, including a delay in the administration of antibiotics are the main problems in real-life clinical management of septic patients.
Chuesakoolvanich
Kittisak
K
Department of Medicine, Surin Hospital, Surin, Thailand. chuesakool@yahoo.com
D000328:Adult; D015510:Clinical Medicine; D003430:Cross-Sectional Studies; D019317:Evidence-Based Medicine; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016134:Organizational Policy; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000150:complications / Q000188:drug therapy / Q000401:mortality; D012772:Shock, Septic / Q000401:mortality* / Q000517:prevention & control; D013785:Thailand; D013997:Time Factors; D016896:Treatment Outcome