Clinical profile and predictors of in-hospital mortality in critically ill adults with sepsis: an integrative review
Keywords:Sepsis; Hospital Mortality; Intensive Care Units.
Sepsis is an important cause of death in patients with infection, having substantial impact on health worldwide. The use of in-hospital mortality predictors becomes an alternative for the management of critically ill adult patients with sepsis, as it plays important diagnostic, therapeutic and prognostic roles, reducing deaths in intensive care units. Thus, this study aimed to identify in the literature the main predictors of prognosis and clinical profile for mortality in adult patients admitted to Intensive Care Units (ICU) with sepsis. Searches were performed in electronic journals Medline/Pubmed, Scopus, Web of Science and LILACS, from studies published between 2017 and 2022, using the guiding question: What are the main predictors of prognosis and clinical profile for mortality from sepsis in adult patients admitted to Intensive Care Units (ICU)? A total of 18 publications were included in this review, which identified the presence of advanced age, comorbidities, infections by antibiotic-resistant bacteria, prolonged length of stay and use of invasive procedures or equipment as clinical profile and predisposing variables for increased mortality from sepsis. Therefore, health professionals should know the common impacts of the use of these predictors in patients with sepsis in intensive care unit, minimizing higher percentages of death in the population and appearance of sequelae after treatment, helping to guide a quality care based on scientific evidence.
Abe, T., Ogura, H., Shiraishi, A., Kushimoto, S., Saitoh, D., Fujishima, S., Mayumi, T., Shiino, Y., Nakada, T. A., Tarui, T., Hifumi, T., Otomo, Y., Okamoto, K., Umemura, Y., Kotani, J., Sakamoto, Y., Sasaki, J., Shiraishi, S. I., Takuma, K., Tsuruta, R., JAAM FORECAST group (2018). Characteristics, management, and in-hospital mortality among patients with severe sepsis in intensive care units in Japan: the FORECAST study. Critical care (London, England), 22(1), 322. https://doi.org/10.1186/s13054-018-2186-7.
Antequera, A., Lopez-Alcalde, J., Stallings, E., Muriel, A., Fernández Félix, B., Del Campo, R., Ponce-Alonso, M., Fidalgo, P., Halperin, A. V., Madrid-Pascual, O., Álvarez-Díaz, N., Solà, I., Gordo, F., Urrutia, G., & Zamora, J. (2021). Sex as a prognostic factor for mortality in critically ill adults with sepsis: a systematic review and meta-analysis. BMJ open, 11(9), e048982. https://doi.org/10.1136/bmjopen-2021-048982.
Auiwattanakul, S., Chittawatanarat, K., Chaiwat, O., Morakul, S., Kongsayreepong, S., Ungpinitpong, W., Yutthakasemsunt, S., & Buranapin, S. (2019). Effects of nutrition factors on mortality and sepsis occurrence in a multicenter university-based surgical intensive care unit in Thailand (THAI-SICU study). Nutrition (Burbank, Los Angeles County, Calif.), 58, 94–99. https://doi.org/10.1016/j.nut.2018.06.021.
Boonmee, P., Ruangsomboon, O., Limsuwat, C., & Chakorn, T. (2020). Predictors of Mortality in Elderly and Very Elderly Emergency Patients with Sepsis: A Retrospective Study. The western journal of emergency medicine, 21(6), 210–218. https://doi.org/10.5811/westjem.2020.7.47405.
Bouza, C., & López-Cuadrado, T. (2019). Epidemiology and Trends of Sepsis in Young Adults Aged 20-44 Years: A Nationwide Population-Based Study. Journal of clinical medicine, 9(1), 77. https://doi.org/10.3390/jcm9010077.
Campanelli, F., Soudry-Faure, A., Avondo, A., Roudaut, J. B., Quenot, J. P., Ray, P., & Charles, P. E. (2022). Septic patients without obvious signs of infection at baseline are more likely to die in the ICU. BMC infectious diseases, 22(1), 205. https://doi.org/10.1186/s12879-022-07210-y.
Caraballo, C., Ascuntar, J., Hincapié, C., Restrepo, C., Bernal, E., & Jaimes, F. (2019). Association between site of infection and in-hospital mortality in patients with sepsis admitted to emergency departments of tertiary hospitals in Medellin, Colombia. Revista Brasileira de terapia intensiva, 31(1), 47–56. https://doi.org/10.5935/0103-507X.20190011.
D'Onofrio, V., Meersman, A., Vijgen, S., Cartuyvels, R., Messiaen, P., & Gyssens, I. C. (2020). Risk Factors for Mortality, Intensive Care Unit Admission, and Bacteremia in Patients Suspected of Sepsis at the Emergency Department: A Prospective Cohort Study. Open forum infectious diseases, 8(1), ofaa594. https://doi.org/10.1093/ofid/ofaa594.
Fang, F., Zhang, Y., Tang, J., Lunsford, L. D., Li, T., Tang, R., He, J., Xu, P., Faramand, A., Xu, J., & You, C. (2019). Association of Corticosteroid Treatment With Outcomes in Adult Patients With Sepsis: A Systematic Review and Meta-analysis. JAMA internal medicine, 179(2), 213–223. https://doi.org/10.1001/jamainternmed.2018.5849.
Fleischmann-Struzek, C., Mellhammar, L., Rose, N., Cassini, A., Rudd, K. E., Schlattmann, P., Allegranzi, B., & Reinhart, K. (2020). Incidence and mortality of hospital- and ICU-treated sepsis: results from an updated and expanded systematic review and meta-analysis. Intensive care medicine, 46(8), 1552–1562. https://doi.org/10.1007/s00134-020-06151-x.
Fortini, A., Faraone, A., Cappugi, C., Monsacchi, L., Sbaragli, S., & Beltrame, C. (2021). Prevalence and in-hospital outcome of patients with sepsis in an internal medicine ward. La Clinica terapeutica, 172(2), 134–137. https://doi.org/10.7417/CT.2021.2300.
Garg, R., Tellapragada, C., Shaw, T., Eshwara, V. K., Shanbhag, V., Rao, S., Virk, H. S., Varma, M., & Mukhopadhyay, C. (2022). Epidemiology of sepsis and risk factors for mortality in intensive care unit: a hospital based prospective study in South India. Infectious diseases (London, England), 54(5), 325–334. https://doi.org/10.1080/23744235.2021.2017475.
Haas, L., Boumendil, A., Flaatten, H., Guidet, B., Ibarz, M., Jung, C., Moreno, R., Morandi, A., Andersen, F. H., Zafeiridis, T., Walther, S., Oeyen, S., Leaver, S., Watson, X., Boulanger, C., Szczeklik, W., Schefold, J. C., Cecconi, M., Marsh, B., Joannidis, M., … VIP2 study group (2021). Frailty is associated with long-term outcome in patients with sepsis who are over 80 years old: results from an observational study in 241 European ICUs. Age and ageing, 50(5), 1719–1727. https://doi.org/10.1093/ageing/afab036.
Hu, T., Lv, H., & Jiang, Y. (2021). The association between four scoring systems and 30-day mortality among intensive care patients with sepsis: a cohort study. Scientific reports, 11(1), 11214. https://doi.org/10.1038/s41598-021-90806-2.
Markwart, R., Saito, H., Harder, T., Tomczyk, S., Cassini, A., Fleischmann-Struzek, C., Reichert, F., Eckmanns, T., & Allegranzi, B. (2020). Epidemiology and burden of sepsis acquired in hospitals and intensive care units: a systematic review and meta-analysis. Intensive care medicine, 46(8), 1536–1551. https://doi.org/10.1007/s00134-020-06106-2.
Mendes, K. D. S., Silveira, R. C. D. C. P., & Galvão, C. M. (2008). Revisão integrativa: método de pesquisa para a incorporação de evidências na saúde e na enfermagem. Texto & contexto-enfermagem, 17, 758-764.
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & PRISMA Group (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS medicine, 6(7), e1000097. https://doi.org/10.1371/journal.pmed.1000097.
Morkar, D. N., Dwivedi, M., & Patil, P. (2022). Comparative Study of Sofa, Apache Ii, Saps Ii, as a Predictor of Mortality in Patients of Sepsis Admitted in Medical ICU. The Journal of the Association of Physicians of India, 70(4), 11–12.
Sivayoham, N., Hussain, A. N., Shabbo, L., & Christie, D. (2021). An observational cohort study of the performance of the REDS score compared to the SIRS criteria, NEWS2, CURB65, SOFA, MEDS and PIRO scores to risk-stratify emergency department suspected sepsis. Annals of medicine, 53(1), 1863–1874. https://doi.org/10.1080/07853890.2021.1992495.
Sousa, L. M. M. De, Firmino, C. F., Marques-Vieira, C. M. A., Severino, S. S. P., & Pestana, H. C. F. C. (2018). Revisões da literatura científica: tipos, métodos e aplicações em enfermagem. Revista Portuguesa de Enfermagem de Reabilitação, 1(1), 45–54. https://doi.org/10.33194/RPER.2018.V1.N1.07.4391.
Tonai, M., Shiraishi, A., Karumai, T., Endo, A., Kobayashi, H., Fushimi, K., & Hayashi, Y. (2022). Hospital-onset sepsis and community-onset sepsis in critical care units in Japan: a retrospective cohort study based on a Japanese administrative claims database. Critical care (London, England), 26(1), 136. https://doi.org/10.1186/s13054-022-04013-0.
Vélez, J. W., Aragon, D. C., Donadi, E. A., & Carlotti, A. (2022). Risk factors for mortality from sepsis in an intensive care unit in Ecuador: A prospective study. Medicine, 101(11), e29096. https://doi.org/10.1097/MD.0000000000029096.
Vucelić, V., Klobučar, I., Đuras-Cuculić, B., Gverić Grginić, A., Prohaska-Potočnik, C., Jajić, I., Vučičević, Ž., & Degoricija, V. (2020). Sepsis and septic shock - an observational study of the incidence, management, and mortality predictors in a medical intensive care unit. Croatian medical journal, 61(5), 429–439. https://doi.org/10.3325/cmj.2020.61.429.
Xu, F., Zhang, L., Huang, T., Yang, R., Han, D., Zheng, S., Feng, A., Huang, L., Yin, H., & Lyu, J. (2022). Influence of ambulatory blood pressure-related indicators within 24 h on in-hospital death in sepsis patients. International journal of medical sciences, 19(3), 460–471. https://doi.org/10.7150/ijms.67967.
How to Cite
Copyright (c) 2022 Daniel Alves Cruz; Pedro Victor Sousa Silva; Keila Maria Paiva da Silva; Isabel Rodrigues do Nascimento ; Beatriz Nascimento Vieira de Araújo ; Iracema Teixeira da Silva; Iaciara Silva Costa; Glaciane Pereira de Sousa; Lecássia Nunes de Sousa; José Nilton Mendes de Sousa
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.