Analysis of early risk factors for the lethal outcome of abdominal sepsis as indications for the start of invasive monitoring of central hemodynamics: a retrospective observational study

Abstract

OBJECTIVES. To analyze the predictive significance of clinical and laboratory parameters in relation to the risk of mortality, the assessment of which is available in the first 24 hours of the stay of patients with sepsis in the intensive care unit (ICU), and to assess the feasibility of starting invasive monitoring of central hemodynamics in patients with predictors of poor outcome. MATERIALS AND METHODS. We analyzed the results of examination of 134 patients aged 58.5 (43–71) years with abdominal sepsis. APACHE II score was 13 (11–17) points, SOFA score was 6 (4–8) points; l lethality in ICU — 47 %. Central hemodynamics was studied using transpulmonary thermodilution. Descriptive statistics (data are presented as median, 25 and 75 % quartiles), logistic regression and ROC analysis were used. RESULTS. Independent predictors of death were SOFA score > 8 (OR 1.5712; 95% CI 1.1934–2.0686; p = 0.0001; AUC 0.813; sensitivity 74 %, specificity 81 %) and lactateemia > 1.8 mmol/l (OR 3.5293; 95% CI 1.7421–7.1500; p = 0.0001; AUC 0.799; sensitivity 63 %, specificity 79 %). A combination of established risk factors predicted cardiac index < 2.5 l/min/m2 (OR 37.0; 95% CI 3.9167–349.5290; p = 0.002) and cardiac function index < 5.8 min-1 (OR 11.8182; 95% CI 2.8189–49.5303; p = 0.0007). CONCLUSIONS. Among the clinical and laboratory parameters, the assessment of which is available in the first 24 hours of the stay of patients with sepsis in the ICU, significant predictors of lethal outcome are SOFA score > 8 points and lactateemia > 1.8 mmol/l. Most patients with a combination of these risk factors are characterized by the presence of signs of myocardial dysfunction, and for 50 % — a decrease in CI to a level of < 2.5 l/min/m2, which indicates the advisability of invasive monitoring of central hemodynamics, in particular with transpulmonary thermodilution.