Study of Various Prognostic Factors for Sepsis Patients Requiring Intensive Medical Care with Special Emphasis on APACHE II Score in Prognostication

Abstract

Background: Sepsis has remained a leading cause of bed occupancy and mortality in medical ICU around the world. There is limited epidemiological information from south Asian countries about the prognostic factors for the outcome in such patients which is very important in planning for treatment strategies. Aim: We investigated various prognostic factors for sepsis and also the use of APACHE II scoring system as a prognostic tool. Methodology: We analysed 50 patients with sepsis admitted to medical ICU. All demographic, etiological, clinical and investigatory parameters were recorded and APACHE II score was calculated for all patients on the day of admission. Patients were followed till discharge or death in hospital. Results: Among wide range of primary diseases causing sepsis in our study, tropical sepsis was one of the major contributors which differ from the western studies. Overall mortality was 28% which is comparable to other parts of the world. Demographic profiles including sex, area of residence and socio-economic status except increasing age did not correlate well with mortality in sepsis patients. Central nervous system and respiratory system involvement led to highest mortality (52%). Number of organ systems involved was found to be statistically significant predictive factor for mortality in severe sepsis (p <0.05). Mean APACHE II score of study patients was 22.84 ± 7.57. Severity grading of sepsis as per APACHE II scoring system correlated very well with mortality (p <0.05) but it did not correlate with length of ICU stay. Conclusion: In the era of many complex scoring systems, along with traditional prognostic factors, age old APACHE II scoring system is still a very user-friendly and inexpensive method which can be used at the bedside for mortality prediction in sepsis patients.