Fatores preditores de morbidade e mortalidade em um grupo de pacientes com sepse grave ou choque séptico admitidos na unidade de cuidados intensivos de um hospital público de ensino

Abstract

Introdution: Sepsis represents a major medical and social impact and has defied science for decades. His knowledge pathophysiological evolution in the diagnosis and treatment of severe sepsis and septic shock is the subject of many studies. Aims to analyze predictors of mortality in severe sepsis and septic shock. Methods: Patients with severe sepsis and septic shock in the first 24 hours of ICU admission.Inclusion criteria were defined as three or more general criteria and one or more criteria inflammatory of SIRS(ACCP/ACCM/2003). We excluded those whose pathologies confound clinical findings and laboratory. Parameters of the APACHE II and SOFA, and biomarkers were evaluated until discharge or death by Cox model. Results: 72 patients, 64% male, age 52±19years, 22% had severe sepsis and 79% septic shock. APACHE was 28(18-35), and SOFA6(5-10). Overall mortality was 18%, and 85% of these due to septic shock. The univariate statistical significance was observed for gender, hypotension, leukopenia, water balance within 24 hours, vasoactive amine, heart rate, duration of mechanical ventilation, dialysis, procalcitonin and lactate. Remained in the final multivariate Cox model with positive impact on mortality, male, hypotension, leukopenia, and positive fluid balance (p <0.038). Tachypnea was protective with regard to death (p<0.036). Glycemic control and the early use of antibiotics were not relevant. However,the use of corticosteroids was associated with the death. Conclusion:In short, early in treatment, judicious use of fluids and individualization of the care benefits presented in treating patients with serious infections.