UNIVERSA MEDICINA
Univ Med 2025.
44:3-15
pISSN: 1907-3062 / eISSN: 2407-2230 DOI: https://doi.
org/10.
18051/UnivMed.
ORIGINAL ARTICLE
In-hospital mortality and its determinant factors among patients with sepsis Fadrian Fadrian1,2* .
Eva Decroli3,4 .
Armen Ahmad1,2 .
Alexander Kam3,4 .
Disa Hijratul Muharramah5 .
Genta Pradana6 , and Vidola Yasena Putri7 Department of Internal Medicine.
Division of Tropical and Infectious Disease.
Dr.
Djamil Central General Hospital.
Padang.
Indonesia Department of Internal Medicine.
Division of Tropical and Infectious Disease.
Faculty of Medicine.
Universitas Andalas.
Padang.
Indonesia Department of Internal Medicine.
Division of Endocrinology and Metabolic.
Dr.
Djamil Central General Hospital.
Padang.
Indonesia Department of Internal Medicine.
Division of Endocrinology and Metabolic.
Faculty of Medicine.
Universitas Andalas.
Padang.
Indonesia Department of Epidemiology.
Faculty of Public Health.
Sriwijaya University.
Palembang.
Indonesia Department of Internal Medicine.
Faculty of Medicine.
Universitas Andalas.
Padang.
Indonesia Faculty of Medicine.
Universitas Andalas.
Padang.
Indonesia * Correspondence Author:
fadrian@med.
Date of first submission.
November 20, 2024 Date of final revised submission.
January 30, 2025 Date of acceptance.
February 17, 2025 Cite this article as: Fadrian F.
Decroli E.
Ahmad A.
Kam A.
Muharramah DH.
Pradana G.
Putri VY.
In-hospital mortality and its determinant factors among patients with sepsis.
Univ Med
44:3-15
ABSTRACT
BACKGROUND
Sepsis is a heterogeneous syndrome characterized by a variety of clinical features.
Multiple studies have identified sepsis as the leading cause of death in hospitalized patients.
A comprehensive report on the incidence, clinical characteristics, and predictors of sepsis is important.
This study aimed to determine the relative importance of predictors of in-hospital mortality in sepsis.
METHODS
A retrospective cohort study at Dr.
Djamil Central General Hospital focused on sepsis patients.
A total of 200 participants, aged 18 and older, were included based on specific criteria and recruited through consecutive Data was gathered from medical records and laboratory results to identify factors influencing mortality in sepsis patients.
These factors were classified into sociodemographic, intrinsic, and extrinsic Statistical analysis utilized simple and multiple logistic regression.
A p-value of less than 0.
indicated statistical significance for predicting in-hospital mortality in sepsis.
RESULTS
The sepsis patient mortality rate was 69.
Hospital-acquired pneumonia (HAP) emerged as the most common infectious diagnosis, impacting 47.
50% of the patients.
Type 2 diabetes mellitus (Type 2 DM) was identified as the most frequent comorbidity, present in 36.
50% of cases.
Multivariate analysis indicated that HAP .
djusted odds ratio .
OR] 2.
95% confidence interval [CI] 1.
19Ae4.
p=0.
and hyperlactatemia .
OR 2.
95% CI 1.
06Ae4.
p=0.
significantly increased the risk of mortality in sepsis patients.
Copyright@Author.
- https://univmed.
org/ejurnal/index.
php/medicina/article/view/1671 Fadrian F.
Decroli E.
Ahmad A, et al
CONCLUSION
Hospital-acquired pneumonia was the primary predictor of mortality in sepsis patients.
Timely prediction and evaluation of sepsis outcomes are essential for developing strategies to reduce mortality rates.
Keywords: Mortality, risk factors, sepsis, management INTRODUCTION According to international guidelines from the Surviving Sepsis Campaign, sepsis is an acute condition with organ dysfunction caused by the body's response to an infection and can be lifethreatening.
The 2020 Institute for Health Metrics and Evaluation (IHME) Global Burden of Sepsis study reported approximately 48.
9 million sepsis incidents worldwide in 2017, equivalent to 5 cases per 100,000 age-standardized .
In the Asia Pacific region, sepsis rates vary from 120 to 1600 per 100,000 people.
Data on sepsis prevalence in Indonesia is limited.
however, a recent retrospective observational study of 14,076 hospitalized patients with sepsis in four Indonesian centers found that 61.
8% of patients survived.
Sepsis is a major global public health concern hospitalization, with 23.
6% of cases being hospital-acquired (HA).
In intensive care units (ICU.
, 24.
4% of sepsis cases with organ dysfunction occurred during the ICU stay, while 7% had an origin within the hospital.
sepsis, especially in ICUs, is associated with a higher mortality rate and should be a significant .
A 2022 study at Dr.
Djamil Central General Hospital also indicated a notable increase in the sepsis patient mortality rate from 11.
53% to 64% over the past six months.
Sepsis presents a significant financial challenge for the healthcare system due to the high need for vital organ support.
A systematic review by van den Berg et al.
showed that the average hospital costs per patient varied widely between countries, ranging from C1101 to C91,951, with a median cost of C36,191.
Sepsis costs vary widely between different countries but are consistently extremely high.
Meanwhile in Indonesia, the average hospital cost for each surviving and deceased sepsis patient were reported to be US$1,011 and US$1,406, .
Therefore, sepsis remains a condition, leading to substantial financial costs and loss of lives in Indonesia and globally.
A systematic review and meta-analysis by Wu et al.
studied factors affecting mortality in ICU patients with severe sepsis.
The research focused on several variables, including age, antibiotic use, comorbidities, organ dysfunction, and sites of infection.
The findings revealed that older patients faced a significantly higher mortality rate, with an odds ratio (OR) of 2.
% confidence interval [CI] 1.
Additionally, patients with four or more organ failures exhibited a notably high risk of mortality (OR 0.
95% CI 0.
Mortality rates also varied according to infection type: hospitalacquired infections had a mortality rate of 0.
% CI 0.
, whereas for community- and ICU-acquired infections the mortality rate was 40 .
% CI 0.
% CI 0.
, respectively.
A prior cross-sectional study conducted in Vietnam indicated that mechanical ventilation (OR 3.
95% CI 1.
445Ae10.
and renal replacement therapy (OR 2.
95% CI
318Ae6.
are associated with increased mortality in patients with sepsis.
Existing studies have primarily concentrated on one or a few variables, leaving many other important factors unexplored.
Therefore, additional research is needed to investigate other influences, especially laboratory markers, that could impact mortality in patients with sepsis.
Early prediction of sepsis patient outcomes through understanding the factors contributing to sepsis-related mortality is crucial for guiding treatment and reducing mortality.
Traditionally, outcome prediction in sepsis is based on clinical scores, such as sequential organ failure assessment (SOFA), acute physiology and chronic health evaluation (APACHE), or simplified acute physiology score (SAPS).
Such mortality prediction scores for critically ill patients are used worldwide and have been extensively validated.
A study involving 547 medical records of patients with sepsis showed that the mortality rate among patients with sepsis was 46.
2% and mainly attributable to respiratory infections.
Sepsis is not a uniform disease, but a syndrome characterized by the striking variation of biological features.
More sophisticated Universa Medicina.
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Sepsis mortality risk factors definitions of distinct molecular endotypes are based on leukocyte genome-wide expression profiles from samples collected on ICU .
However, the implementation of these complex prognostic and predictive strategies at the bedside of patients is limited.
Therefore, the present study aimed to assess the magnitude and associated factors of mortality among patients with sepsis admitted to the internal medicine ward of Dr.
Djamil Central General Hospital.
METHODS
Study design A hospitalAebased retrospective cohort study was conducted among patients diagnosed with sepsis and admitted to the internal medicine ward of Dr.
Djamil Central General Hospital between February and December 2023.
Research subjects A total of 200 subjects who met the inclusion criteria of being Ou18 years old, diagnosed with sepsis, and admitted to the internal medicine ward of Dr.
Djamil Central General Hospital during the specified period were included in the study.
Participants were required to provide written informed consent to take part in the study.
Patients who refused to participate or had incomplete medical records were excluded.
Study variables This study examines mortality among sepsis patients in the internal medicine ward at Dr.
Djamil Central General Hospital.
The independent variables include sociodemographic factors such as age and sex, intrinsic factors such as comorbidities and illness severityAimeasured by SOFA score, lactate levels, and other clinical markersAiand extrinsic factors such as antibiotic use during hospitalization or in the previous 90 days, bacteriological culture results from infectious sites, and the use of medical devices .
, urinary catheter, nasogastric tube, endotracheal tub.
The intrinsic factors assessed include the SOFA score, which measures organ dysfunction cardiovascular, coagulation, liver, kidney, and This score is calculated on the day sepsis is diagnosed, with a range from 2 to 24.
Hyperlactatemia is defined as lactate levels exceeding 2 mmol/L.
Critical illness-related corticosteroid insufficiency (CIRCI) indicates adrenal insufficiency, identified by cortisol levels under 10 g/dL on the first day of treatment or decreasing levels afterward.
Hypercortisolism is defined as cortisol levels Ou20 AAg/dL, while hypocortisolism is indicated by levels under 10 AAg/dL.
Sepsis-associated liver dysfunction (SALD) is diagnosed by acute liver failure signs.
At least two criteria must be met: bilirubin levels over 2 mg/dL, serum glutamic pyruvic transaminase (SGPT)/serum glutamic-oxaloacetic transaminase (SGOT) more than double the normal value .
bove 112 U/L), and prothrombin time exceeding 5 times the control value or an international normalized ratio (INR) above 1.
An INR above 22 indicates elevation.
SGPT levels greater than 56 U/L also suggest liver dysfunction, while hypoalbuminemia is diagnosed by albumin below 5 g/dL.
Metabolic acidosis is identified with a pH 35 and low bicarbonate (HCO3-) levels.
Respiratory acidosis occurs with a pH below 7.
and high arterial carbon dioxide .
CO.
Hyponatremia is when sodium levels drop below 136 mmol/L.
hypernatremia is when levels reach 146 mmol/L or higher.
Anemia is recognized by hemoglobin levels below 13 g/dL for men and below 12 g/dL for women.
In this research, mortality during treatment is the dependent Statistical analysis The study examined risk factors for sepsis mortality using univariate, bivariate, and multivariate analyses, with a significance level of p<0.
Both bivariable and multivariable logistic regression analyses were employed to identify associated factors.
Variables significant at a p value <0.
25 in the bivariable logistic regression analysis were entered into the multivariable logistic regression model to control for confounding effects.
Adjusted odds ratios .
OR) with 95% CI were computed to evaluate the strength of association and variables with a p value less than 0.
05 were declared statistically significant factors associated with the outcome Ethical approval This study was approved by our Institutional Review Board of Dr.
Djamil Central General Hospital.
Padang
(IRB
LB.
02/5.
7/453/2.
Fadrian F.
Decroli E.
Ahmad A, et al Clinical trials registration The study has been registered in the Thai Clinical Trials Registry (TCTR ID:
TCTR20240627.
https://w.
org/show/TCTR20240627004 under the WHO International Clinical Trials Registry Platform.
RESULTS
The characteristics influencing mortality risk of sepsis The research involved 200 subjects, with 139 .
50%) sepsis patients experiencing mortality.
The main risk factors for sepsis mortality were age (O 65 year.
00% of cases, and females accounting for 56.
Hospital-acquired pneumonia (HAP) was the most common infectious disease diagnosis .
50%), followed by community-acquired pneumonia (CAP) at Comorbidities were present in 88.
00% of sepsis patients, with type 2 diabetes mellitus (Type 2 DM) .
50%), chronic kidney disease (CKD) .
00%), and heart failure .
50%) being the most prevalent conditions.
In the study, the majority of subjects .
50%),
60%), and CIRCI .
60%).
Median values for various parameters such as SOFA score.
Glasgow Coma Scale (GCS).
PO2/FiO2 ratio, bilirubin level, creatinine level, mean arterial pressure (MAP), and platelet count were within specific ranges.
Antibiotic use history 00% and 38.
00% showed multidrugresistant organisms (MDRO) in culture results, with the most common medical device being the nasogastric tube (NGT) at 55.
The results of the analysis presented in Table 1 indicate that the variables satisfy the criteria for multivariate modeling, with a p value of less than 0.
Table 1.
Characteristics and bivariate logistic regression analysis of sepsis mortality risk factors .
Risk factors Demographic risk factors Age .
>65 O65 Sex Male Female Intrinsic risk factors Infectious disease Hospital-acquired pneumonia Community-Acquired pneumonia Skin and soft tissue infections Urinary tract infection Surgical wound infection Intra-abdominal infection Central nervous system infection Other infections Comorbid diseases Presence of comorbidities Diabetes mellitus type 2 Chronic kidney disease Heart failure Stroke Malignancy Chronic lung disease Chronic liver disease Neutropenia Systemic lupus erythematosus Hypertension Human immunodeficiency virus Survivors .
Non Survivors .
N/A
N/A
N/A
N/A
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p-value Sepsis mortality risk factors Table 1.
Continued Hyperlactatemia
CIRCI
Hypercortisolism Hypocortisolism SALD Elevated INR Elevated SGPT Levels Hypoalbuminemia Metabolic acidosisf Respiratory acidosis Hypernatremia Hyponatremia Anemia SOFA score.
Median (Min-Ma.
Glasgow Coma Scale.
Median (Min-Ma.
PO2/FiO2 ratio.
Median (Min-Ma.
Bilirubin levels .
g/dL).
Median (Min-Ma.
Creatinine levels .
g/dL).
Median (Min-Ma.
Platelet count (/mm.
Mean C SD Mean arterial pressure Median .
, (Min-Ma.
Extrinsic risk factors History of antibiotic use Infection source culture MultidrugAeResistant Organisms Medical device Nasogastric tube Urinary catheter Mechanical ventilator 107 .
45 C144611.
41C26733.
*Data presented as n (%).
variables with p<0.
25 included in multivariate logistic regression analysis.
CIRCI : Critical illnessrelated corticosteroid insufficiency.
SALD : Sepsis-associated liver dysfunction.
SOFA : Sequential organ failure assessment.
Factors affecting mortality risk in sepsis The study conducted both bivariate and multivariate analyses to identify the risk factors associated with mortality in patients with sepsis.
Table 2 presents the findings from the multivariate logistic regression analysis, which examined the risk factors linked to death in these patients.
For this analysis, we included all variables with a pvalue of less than 0.
25 from the previous bivariate The results indicated that intrinsic risk factors, particularly HAP, were significantly associated with mortality in sepsis patients.
The crude OR was 1.
% CI 1.
05Ae3.
, while the adjusted OR was 2.
% CI 1.
06Ae4.
contrast, factors such as urinary tract infections, central nervous system infections, comorbidities such as malignancy and chronic lung disease, as well as metrics including hyperlactatemia, elevated INR values, metabolic acidosis, hypernatremia.
SOFA scores, and GCS scores did not show significant associations after adjustment.
In the initial analysis of extrinsic risk factors, a high risk was associated with the use of mechanical ventilators (OR 8.
95% CI 1.
08Ae However, this association lost significance after adjustment .
OR 4.
95% CI 0.
57Ae39.
Ultimately.
HAP emerged as a significant risk factor in the comprehensive model, while other factors did not show a substantial link to mortality in patients with sepsis after adjustment.
Using logistic regression analysis with the backward elimination method, a final model was developed that highlighted the variables significantly linked to mortality in sepsis patients, as shown in Table 3.
The analysis identified HAP .
OR 2.
95% CI 1.
19Ae4.
p=0.
and hyperlactatemia .
OR 2.
95% CI 1.
06Ae4.
p=0.
as significant predictors of death.
Other variables, such as elevated INR .
OR 1.
CI 0.
94Ae4.
p=0.
, metabolic acidosis .
OR 95% CI 0.
97Ae6.
p=0.
, and mechanical ventilator use .
OR 6.
95% CI
86Ae55.
p=0.
, did not reach statistical significance, even though they had high odds Fadrian F.
Decroli E.
Ahmad A, et al Table 2.
Crude OR and adjusted OR on sepsis mortality risk factors after all variables with p<0.
were included into the multivariate logistic regression OR Crude
%CI)
OR Adjusted .
%CI) 96 .
Variable Intrinsic risk factors Infectious disease Hospital-acquired pneumonia Urinary tract infection Central nervous system infection Comorbid diseases Malignancy Chronic lung disease Hyperlactatemia Elevated INR Metabolic Acidosis Hypernatremia SOFA Score Glasgow Coma Scale Extrinsic risk factors Mechanical ventilator *OR : Odds Ratio.
CI : Confidence Interval Table 3.
Multivariate logistic regression analysis for risk factors of sepsis Variable Hospital-acquired pneumonia Hyperlactatemia Elevated INR Metabolic acidosis Mechanical ventilator 95% CI OR Adjusted Lower Upper p value *p-value<0.
05 means that the variable is statistically significant.
OR : Odds Ratio.
CI : Confidence Interval This model shows that hospital-acquired pneumonia (HAP) and hyperlactatemia are major risk factors for mortality in patients with sepsis, with HAP being the most significant predictor of in-hospital mortality among these patients.
The other variables were retained in the logistic regression analysis despite not achieving statistical significance .
>0.
because they may improve the overall fit of the model and account for confounding influences on the significant In the backward elimination method, the removal of variables is based not only on pvalues but also on their contribution to the model's completeness and their interactions with other DISCUSSION The study showed a high sepsis patient mortality rate of 69.
50% at Dr.
Djamil Central General Hospital in West Sumatra.
Indonesia.
The hospital being the main referral center resulted in a higher incidence of terminal conditions and organ dysfunction.
Similar findings were reported in a prior study at RSU Dr.
Saiful Anwar, where 94% of sepsis patients did not survive.
High mortality rates in sepsis patients are associated with organ dysfunction, as evidenced in the study of Pedersen et al.
who found that patients with new organ failures had significantly higher mortality rates compared to those without new organ failures.
According to the statistical analysis, most participants in this study were aged 65 years or younger, accounting for 66.
00% of the subjects.
Similar findings were reported in a study, where 67% of sepsis patients were under 65 years of age, while only 33.
33% were aged 65 years or .
In contrast, a study by Chen et al.
reported that 63.
8% of 254 sepsis patients were 65 years of age or older.
This disparity may be due to their study being limited to ICU patients and to its prospective design.
Regarding gender, the majority of subjects in our study were female at 56.
50%, compared to 50% male subjects.
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Sepsis mortality risk factors differences in sepsis hospitalization similarly found that women experienced sepsis more frequently, with a prevalence of 53.
7% in females 3% in males.
This contrasts with the study by Khwannimit and Bhurayanontachai,.
which indicated a predominance of males .
in severe sepsis and septic shock cases.
This difference may arise from their focus solely on patients with severe conditions and from their prospective research approach.
In the present study.
HAP accounted for 50% of cases, followed by CAP at 45.
Previous research at Dr.
Djamil Central General Hospital yielded similar findings, indicating that the lungs were the primary infection source in sepsis patients, representing 80% of cases.
The vulnerability of the lungs during sepsis is often triggered by lung infection, leading to increased suffering and a higher mortality risk for these patients.
Another study by He et al.
revealed that patients with pulmonary sepsis exhibited higher age, higher APACHE II scores, and increased ICU and oneyear mortality rates compared to those with abdominal sepsis.
In our study, 88.
00% of sepsis patients had A retrospective study showed that 4% of sepsis patients had previously been diagnosed with at least one comorbidity, indicating a significant history of comorbidity in this patient population.
The data is supported by the study of Stenberg et al.
showing that male sex, advanced age, lower education, and the presence of comorbid conditions are all positively Consequently, comorbidities play a significant role in mortality, and the occurrence of death from sepsis without relevant comorbidities is rare.
Our study found that type 2 DM was the most common comorbid condition in sepsis patients at In Indonesia, the prevalence of type 2 DM increased from 6.
9% in 2013 to 8.
5% in 2018.
Another report revealed that 13,733 people in Padang City had type 2 DM.
Poor dietary habits, such as low intake of fruits and vegetables and high consumption of salt, of sweets, and of fatty foods, contribute to the rising prevalence of diabetes mellitus in Indonesia.
In our study, over 70% of subjects showed underperfusion and organ dysfunction.
Sepsis patients with lactate levels exceeding 2 mmol/L indicate organ dysfunction, similar to findings in other studies on sepsis patients.
For instance, a study on 4861 sepsis patients revealed that 53% had hyperlactatemia.
(,.
Additionally, a study by Sheikh et al.
found that 36.
4% of intensive care patients with sepsis had hyperlactatemia, with a higher frequency in elderly patients compared to younger and middle-aged patients.
In the present study, hypercortisolism was found in 57.
60% of participants, while hypocortisolism was present in 11.
These results suggest cortisol dysregulation in sepsis patients, affecting the body's inflammatory In comparison, in the study by Rivas et ,.
the proportion of patients with cortisol levels of Ou20 mcg/dL .
6%) was lower than those with levels of <20 mcg/dL .
4%).
Our research also found a smaller percentage of patients .
1%) with hypocortisolism (<10 mcg/dL), showing similarities with the study of Rivas et al.
In our study.
CIRCI was found in 24.
60% of In addition to its relationship with sepsis and septic shock.
CIRCI is associated with conditions including acute respiratory distress syndrome (ARDS), major trauma, bacterial pneumonia, and non-septic shock scenarios such as those in cardiopulmonary bypass patients, cardiogenic shock, and burns.
In cases of sepsis.
CIRCI conditions ranged from 12% to 75%.
In a cross-sectional analysis, patients with adrenal insufficiency or CIRCI showed nearly identical outcomes, with 25.
3% of sepsis patients being .
In our study, 24.
00% of participants had high SGPT levels, indicating liver dysfunction.
High SGPT levels can be mild, moderate, or severe, corresponding to less than 5 times, 5Ae10 times, and 10Ae50 times the upper limit, respectively.
sepsis, liver dysfunction is part of multiple organ dysfunction syndrome (MODS) and has a poor prognosis .
xact incidence unknow.
Another study found a significant correlation between high SGPT levels and sepsis.
The present study found that 10.
50% of subjects had sepsis-associated liver dysfunction (SALD).
Recent research indicates that liver dysfunction is more common at the onset of sepsis.
Although rare.
SALD in sepsis patients can lead to serious complications.
The presence of SALD in sepsis patients is associated with higher mortality and a poorer prognosis.
A retrospective observational study found that the SALD group had a 24.
7% ICU mortality rate compared to 9.
for the control group, and hospital mortality rates Fadrian F.
Decroli E.
Ahmad A, et al 2% for the SALD group compared to 8% for the control group.
Patients with liver failure and sepsis often develop coagulation disorders associated with SALD, which if progressing to acute liver failure can cause complications, including coagulopathy such as disseminated intravascular coagulation (DIC), typically measured through INR.
In our study, 33.
50% of participants showed increased INR levels.
The study by Wada et al.
reported a higher INR level .
14%).
Research indicated that sepsis patients with organ dysfunction had higher mortality rates due to elevated INR, often associated with an increase in DIC score.
In the present study, the median SOFA score was 7 .
GCS 11 .
PO2/FiO2 ratio 60 .
, bilirubin level 0.
, creatinine level 1.
MAP
, and mean platelet count 226,36 C139,14.
The use of mean values in presenting results could potentially obscure the differences in median values for these two variables.
Discrepancies in sample sizes and research methodologies may also contribute to these In our study, antibiotic use prevalence was At Dr.
Djamil Central General Hospital, a referral center, patients may have previously received antibiotics elsewhere.
The rise in antibiotic resistance is mainly due to increased use of broad-spectrum antibiotics.
A similar study at the hospital found that 73.
5% of patients had used antibiotics, consistent with our findings.
The use of prior antibiotics is associated with mortality, and timely appropriate antibiotic treatment is crucial for patients with sepsis and septic shock.
An observational study found that early inappropriate antibiotic therapy significantly increased the risk of mortality with an OR of .
This aligns with a systematic review, which showed that patients receiving appropriate antibiotics had significantly lower mortality rates compared to those receiving initial inappropriate antibiotics with an OR of 0.
% CI 0.
38Ae .
In a prior hospital study.
Fadrian et al.
evaluated antibiotic use using the Gyssens The study found a 1.
96 and 4.
05 times increased risk of death with inappropriate use (Gyssens I-IV) and use without indications (Gyssens V), respectively.
In this study, culture results showed that 00% were MDRO, 24.
00% were non-MDRO, 00% showed no growth from the infection Factors such as insufficient nutrients, culture media toxicity, or interference by other bacteria may explain the lack of growth.
Fadrian et al.
found a higher prevalence of MDRO .
93%) compared to non-MDRO .
06%) in Conversely.
Cipto Mangunkusumo Central General Hospital, the prevalence of MDRO .
6%) was lower than non-MDRO .
4%) in CAP patients.
The increase in multidrug-resistant organisms has raised the occurrence of sepsis and related deaths, emphasizing the importance of early diagnosis and .
In a study on medical device usage.
NGT was used in 55.
50% of cases, urinary catheters in 00%, and mechanical ventilators in 9.
Increased NGT usage is often associated with addressing the nutritional needs of sepsis patients with reduced consciousness and individuals with chronic swallowing issues.
Furthermore, 88% of the patients had comorbidities such as stroke, malignancies, and others, highlighting the necessity for adequate nutrition.
In this study's multivariate analysis, increased INR levels were not found to be a significant risk factor for mortality among patients with sepsis.
Coagulation issues frequently occur in sepsis and can raise mortality rates.
Initially, patients with sepsis may experience a prothrombotic state.
This is marked by the activation of the extrinsic pathway and heightened coagulation due to cytokines, alongside reduced anticoagulant activity and impaired fibrinolysis.
As sepsis advances.
DIC results in decreased coagulation .
The INR test is often recommended for patients suspected of having DIC due to sepsis.
different retrospective cohort study indicated that a higher INR is associated with increased hospital mortality among these patients.
The odds ratio for hospital mortality was 1.
% CI 1.
37Ae2.
Additionally, the hazard ratio for one-year mortality was 1.
% CI 1.
24Ae1.
While these studies share similarities in design, the differences in sample sizes may lead to variations in their findings.
The use of mechanical ventilators did not emerge as a risk factor for mortality in sepsis Among 200 patients studied, 18 required This contrasts with findings from a retrospective cohort study by Liu et al.
which identified a significant link between intubation and increased mortality.
Sepsis is responsible for approximately 70% of ARDS cases that involve organ failure, especially in the lungs.
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Sepsis mortality risk factors also raises the risk of mechanical injury.
retrospective analysis revealed a 34% incidence of ARDS among sepsis patients, with a corresponding higher mortality rate.
Additionally, the study indicated a notable association between pneumonia and the worsening of ARDS (OR 95% CI 1.
Furthermore, variations in sample sizes and research methodologies used may also contribute to these Among our 200 sepsis patients studied, 38 were found to have metabolic acidosis.
Our multivariate analysisindicated that metabolic acidosis was not a significant risk factor for mortality in these patients.
Renal function, which influences acidosis, is a known predictor of mortality, regardless of whether patients have renal dysfunction.
Interestingly, only 33% of participants had CKD, suggesting that CKD did not primarily cause metabolic acidosis.
Instead, lactic acidosis due to hyperlactatemia was observed, affecting 71% of participants.
This was further supported by the analysis, which showed that hyperlactatemia contributed to a 2.
11-fold increased risk of mortality.
In contrast, a retrospective cohort study at RS.
Dr.
Soetomo in Surabaya found a significant association between metabolic acidosis and mortality (OR 5.
CI 0.
Differences in sample sizes and research methodologies may explain the conflicting results.
In this study, we found that hyperlactatemia is a significant risk factor for mortality in sepsis Lactate is a crucial marker for inadequate tissue oxygenation and perfusion.
Sepsis patients with high lactate levels are at a 2.
11 times higher risk of mortality .
% CI 1.
Another study with 4983 sepsis patients also found a significant association between hyperlactatemia and mortality (HR 1.
95% CI 1.
Hyperlactatemia is characterized by elevated lactate levels exceeding 2 mmol/L.
This condition may arise from escalated lactate production via aerobic or anaerobic pathways, coupled with reduced lactate clearance, consequently leading to An increase in aerobic lactate production, either local or general, can be caused by an inflammatory process and hyperlactatemia is an indicator of a severe inflammatory state.
In the aforementioned study by Liu et al.
it was determined that lactate serves as an independent prognostic indicator for mortality in patients with Additionally, a retrospective study revealed a correlation between lactate levels 3 mmol/L and mortality in septic patients with acidosis (OR 2.
95% CI 2.
In both simple and multiple logistic regression analyses.
HAP emerged as the most significant predictor of mortality in patients with Out of 200 sepsis patients, 95 patients with HAP displayed a notable link between HAP and increased mortality (OR 2.
95% CI 1.
The respiratory tract is the most common location for infections that cause sepsis and is more likely to cause death than any other focus of infection.
Nosocomial infections, also known as hospitalacquired infections (HAI.
, refer to infections that are not present or are in the incubation stage at the time of hospital admission.
These types of infections are typically caused by multi-resistant organisms, which can lead to more severe clinical infections and limit the available options for antibiotic therapy.
In a study by Rose et al.
HAP was the most prevalent HAI in sepsis patients, with rates of 45.
1% and 52.
2% in sepsis and severe sepsis patients, respectively.
Permpikul et al.
found that HAP significantly contributed 2% of 28-day mortality and 53.
8% of overall in-hospital mortality in sepsis patients.
Another prospective cohort study showed a significant association between various sites of infection and in-hospital mortality.
The study revealed a notable correlation between pneumonia and in-hospital mortality (OR 3.
95% CI 2.
The present study has several limitations that must be acknowledged.
Firstly, it was conducted using a retrospective design, which introduces potential biases, particularly in terms of information accuracy.
Furthermore, the research was carried out at a single hospital in Padang.
Indonesia, which limits the geographic scope.
This confinement may affect the applicability of the findings to other healthcare settings and Additionally, the study focuses only on a specific set of factors that influence mortality among sepsis patients.
However, it is important to recognize that many other variables also contribute to sepsis-related mortality.
Due to constraints related to subject availability and research funding, we were unable to investigate all of these factors.
Recognizing these limitations is crucial, as they highlight the need for broader research.
Future studies should aim to include multiple hospitals or explore more diverse geographic This expanded approach would provide a more thorough understanding of in-hospital sepsis Fadrian F.
Decroli E.
Ahmad A, et al mortality and the various determinants involved, ultimately enhancing clinical practices and patient outcomes in treating sepsis.
Data Availability Statement The supplementary dataset for this study will be made available by the corresponding author upon reasonable request.
CONCLUSIONS
Hospital-acquired pneumonia emerged as the strongest predictor of mortality in patients with Identifying the risk factors that contribute to mortality in these patients is crucial for developing effective management strategies to lower death rates.
Furthermore, additional multicenter studies are necessary.
These should focus on gathering detailed data about patient characteristics, clinical outcomes, and relevant diagnostic tests to uncover more predictors of mortality in sepsis.
Declaration the Use of AI in Scientific Writing The authors affirm that artificial intelligence (AI) was not employed in the creation of this REFERENCES Conflict of Interest The authors disclose no conflicts.
Funding The study is supported by Dr.
Djamil Central General Hospital Grant No.
LB.
02/XVI.
2/1508/IX/2023.
Acknowledgment