PREDICTION OF HOSPITAL OUTCOME IN SEPTIC SHOCK

Abstract

Septic shock in adults refers to a state of acute circulatory failure characterized by persistent arterial hypotension unexplained by other causes. Although this clinical syndrome is heterogeneous with regard to factors such as causal micro-organism, patient predisposition, co-morbidity and response to therapy, a key element and unifying feature is the manifestation of cardiovascular dysfunction. Although the underlying cause of death in septic shock is often multifactorial, refractory hypotension and cardiovascular collapse are frequently observed in the terminal phases of the condition. The mortality rate from septic shock is approximately 25-50%, most cases of septic shock caused by gram-positive bacteria followed by endotoxin-producing gram-negative bacteria. Early management of sepsis requires respiratory stabilization. Supplemental oxygen should be given to all patients. Mechanical ventilation is recommended when supplemental oxygen fails to improve oxygenation, when respiratory failure is imminent, or when the airway cannot be protected. Perfusion is assessed after respiratory stabilization. Hypotension signifies inadequate tissue perfusion. Clinical signs of hypoperfusion include cold or clammy skin, altered mental status, oliguria or anuria, and lactic acidosis. After initial respiratory stabilization, treatment consists of fluid resuscitation, vasopressor therapy, infection identification and control, prompt antibiotic administration, and the removal or drainage of the infection source. Early general surgery consultation should be obtained for suspected acute abdomen and necrotizing infections Patients who survive sepsis, regardless of severity, have higher mortality rates after discharge. It is perhaps unsurprising, therefore, that the search for a highly accurate biomarker of sepsis has become one of the holy grails of medicine. Procalcitonin (PCT) has emerged as the most studied and promising sepsis biomarker. For diagnostic and prognostic purposes in critical care, PCT is an advance on C-reactive protein and other traditional markers of sepsis

Cardiac biomarkers including BNP, N-terminal proBNP (NTproBNP) and troponin I in addition to procalcitonin potentially offer prognostic information in the critically ill.

There are several outcome prediction models that are currently available for use in clinical practice. Among them are the Acute Physiology and Chronic Health Evaluation IV Score , the Simplified Acute Physiology Score III , the Logistic Organ Dysfunction Score , the Mortality Probability Model III, and the sequential organ failure assessment score.