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@article{1342293,
author = {Uvizl, Radovan and Adamus, Milan and Cerny, Vladimir and Dušek, Ladislav and Jarkovský, Jiří and Šrámek, Vladimír and Matejovic, Martin and Štourač, Petr and Kula, Roman and Maláska, Jan and Sevcik, Pavel},
article_location = {Olomouc},
article_number = {2},
doi = {http://dx.doi.org/10.5507/bp.2015.052},
keywords = {severe sepsis; septic shoc; lactate; mortality; assessment},
language = {eng},
issn = {1213-8118},
journal = {Biomedical Papers of the Faculty of Medicine of Palacký University},
title = {Patient survival, predictive factors and disease course of severe sepsis in Czech intensive care units: a multicentre, retrospective, observational study},
volume = {160},
year = {2016}
}
TY - JOUR
ID - 1342293
AU - Uvizl, Radovan - Adamus, Milan - Cerny, Vladimir - Dušek, Ladislav - Jarkovský, Jiří - Šrámek, Vladimír - Matejovic, Martin - Štourač, Petr - Kula, Roman - Maláska, Jan - Sevcik, Pavel
PY - 2016
TI - Patient survival, predictive factors and disease course of severe sepsis in Czech intensive care units: a multicentre, retrospective, observational study
JF - Biomedical Papers of the Faculty of Medicine of Palacký University
VL - 160
IS - 2
SP - 287-297
EP - 287-297
PB - Palacký University
SN - 12138118
KW - severe sepsis
KW - septic shoc
KW - lactate
KW - mortality
KW - assessment
N2 - Background. Severe sepsis/septic shock is associated with high mortality. In Central Europe, there is a dearth of information on the prevalence and treatment of severe sepsis. The EPOSS (Data-based Evaluation and Prediction of Outcome in Severe Sepsis) project launched in 2011 was aimed at collecting data on patients with severe sepsis/septic shock. Methods. The EPOSS study processes data from the EPOSS project database, and is a retrospective, multicentre, observational study. This included all consecutive patients aged 18 and over who were admitted to participating ICUs from 1 January 2011 to 5 November 2013 and met the inclusion criteria of severe sepsis/septic shock. The primary endpoint was to analyse the relationship between in-hospital mortality (either in ICU or after discharge from ICU) and the type and number of fulfilled diagnostic and treatment interventions during the first 6 h after the diagnosis of severe sepsis/septic shock. Results. The collected dataset involved 1082 patients meeting the criteria of severe sepsis/septic shock. Following data validation, a final dataset of 897 patients was obtained. The average age of the patient group was 64.7 years; mortality at discharge from EPOSS ICUs was 35.5% and from hospital 40.7%. Of the 10 evaluated diagnostic and treatment interventions within the initial 6 hours of identifying severe sepsis/septic shock (i.e. fulfilment of SSC bundles), four or five diagnostic and treatment interventions were administered to 58.4% patients. Combined diagnostic and treatment interventions associated with the lowest in-hospital mortality were: CVP of >= 8-12 mm Hg & MAP of >= 65 mm Hg & Urine output at >= 0.5 mL/kg/h & Lactate of <= 4.0 mmol/L & Initial lactate measured & Antibiotics in the first hour. Lactate at <4 mmol/L and MAP of >= 65 mm Hg remained statistically significant even after adjustment for patient age and APACHE II score. Statistically significantly increased in-hospital mortality was found in patients admitted from general departments (45.7%) or from other ICUs (41.6%), compared to a lower in-hospital mortality of patients transferred from outpatient clinics (26.5%) or Emergency (38.0%). Severe sepsis/septic shock patients transferred from the department of internal medicine were associated with a higher in-hospital mortality (45.1%) than surgical patients (35.5%). Conclusions. The most effective measures associated with the lowest in-hospital mortality in septic shock patients were CVP of >= 8-12 mm Hg, MAP of >= 65 mm Hg, urine output at >= 0.5 mL/kg/h, initial lactate level of <= 4.0 mmol/L and administration of antibiotics within the first hour.
ER -
UVIZL, Radovan, Milan ADAMUS, Vladimir CERNY, Ladislav DUŠEK, Jiří JARKOVSKÝ, Vladimír ŠRÁMEK, Martin MATEJOVIC, Petr ŠTOURAČ, Roman KULA, Jan MALÁSKA and Pavel SEVCIK. Patient survival, predictive factors and disease course of severe sepsis in Czech intensive care units: a multicentre, retrospective, observational study. \textit{Biomedical Papers of the Faculty of Medicine of Palacký University}. Olomouc: Palacký University, 2016, vol.~160, No~2, p.~287-297. ISSN~1213-8118. Available from: https://dx.doi.org/10.5507/bp.2015.052.
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