title: Risk factors for multiorgan failure and mortality in severe sepsis patients who need intensive care unit follow-up.
abstract: BACKGROUND
  Multiorgan failure (MOF) is a primary cause of morbidity and mortality in sepsis patients in intensive care units (ICU). Finding risk factors and solving preventable problems of MOF in patients who have sepsis can be a favourable step for decreasing mortality. We aimed to examine multiorgan failure and mortality related risk factors in intensive care unit patients who have sepsis.
  
  
  METHODS
  A retrospective data collection and prognostic cohort study was performed. Between January 2009-March 2010, patients accepted to the 22-bed pulmonary intensive care unit with the diagnosis of sepsis were enrolled. Patients' demographic data, ICU severity scores, application of mechanical ventilation, causative agent of sepsis, number of ICU days and presence of mortality were recorded. Logistic regression analysis was carried out for risk factors.
  
  
  RESULTS
  347 patients with sepsis were involved in the study. 43 of the patients (12.4%) developed MOF and overall mortality rate was 14.9% (n= 52). Presence of resistant pathogen, presence of shock, application of TPN and high APACHE II score were found to be risk factors for MOF [p= 0.015 Odds ratio (OR) 3.47 confidence interval (CI): 1.27 - 9.47, p= 0.001, OR: 30.8 CI: 11.41 - 83-49, p= 0.028, OR: 3.08, CI: 1.13 - 8.39, p= 0.003, OR: 1.10, CI: 1.04-1.18, respectively]. Risk factors for overall mortality were presence of nosocomial infection, high 3rd day SOFA score, presence of shock, application of TPN and sedation (p= 0.005, OR: 3.39, CI: 1.45 - 7.93; p= 0.001, OR: 1.51, CI: 1.27 - 1.81; p= 0.014, OR: 3.24, CI: 1.27 - 8.25; p= 0.003, OR: 3.64. CI: 1.54 - 8.58; p= 0.001, OR: 3.38, CI: 1.51 - 7.57, respectively).
  
  
  CONCLUSIONS
  In sepsis patients who need ICU follow up, presence of resistant pathogen, presence of shock, application of TPN and high APACHE II scores are risk factors for developing MOF. Thus, rational use of antibiotics, reducing the use of TPN, application of infection control programmes and prevention of shock will further reduce multiorgan failure and mortality.
authors.forename: Ece
authors.initials: E
authors.lastname: Öz
authors.affiliation: Medical Intensive Care Unit, Sureyyapasa Chest Diseases and Chest Surgery Training and Research Hospital, Istanbul, Turkey. csalturk@yahoo.com.
authors.forename: Cüneyt
authors.initials: C
authors.lastname: Saltürk
authors.forename: Zuhal
authors.initials: Z
authors.lastname: Karakurt
authors.forename: Özlem
authors.initials: Ö
authors.lastname: Yazıcıoğlu Moçin
authors.forename: Nalan
authors.initials: N
authors.lastname: Adıgüzel
authors.forename: Gökay
authors.initials: G
authors.lastname: Güngör
authors.forename: Özkan
authors.initials: Ö
authors.lastname: Devran
authors.forename: Merih
authors.initials: M
authors.lastname: Kalamanoğlu
authors.forename: Gülbanu
authors.initials: G
authors.lastname: Horzum
authors.forename: Adnan
authors.initials: A
authors.lastname: Yılmaz
mesh_terms: D018806:APACHE; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D015331:Cohort Studies; D003428:Cross Infection / Q000401:mortality / Q000628:therapy; D004352:Drug Resistance, Microbial; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000453:epidemiology / Q000209:etiology*; D010289:Parenteral Nutrition, Total / Q000706:statistics & numerical data; D011379:Prognosis; D012121:Respiration, Artificial / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000150:complications* / Q000401:mortality / Q000628:therapy; D012772:Shock, Septic / Q000150:complications; D018746:Systemic Inflammatory Response Syndrome / Q000150:complications
chemical_list: D000900:Anti-Bacterial Agents