European Journal of Cardiovascular Medicine

Sepsis is a critical and potentially life-threatening medical condition characterized by organ dysfunction resulting from a dysregulated host response to infection. It represents a major global health challenge and is one of the leading causes of morbidity and mortality, particularly in low- and middle-income countries like India. Despite significant advancements in critical care medicine, early diagnosis and effective management of sepsis remain difficult due to its complex pathophysiology and variable clinical presentation. Delayed recognition often leads to rapid progression to severe sepsis, septic shock, and multi-organ failure, thereby increasing the risk of death.

The global burden of sepsis is substantial, with millions of cases reported annually and a high case fatality rate. It places a significant strain on healthcare systems due to prolonged hospital stays, intensive care requirements, and increased healthcare costs. One of the major challenges in managing sepsis is its heterogeneous presentation, which can mimic other clinical conditions. Patients may present with a wide spectrum of symptoms ranging from mild infection to severe organ dysfunction. This variability often leads to delays in diagnosis and initiation of appropriate therapy.

To address these challenges, updated definitions and diagnostic criteria have been introduced. The Sepsis-3 definition emphasizes organ dysfunction as a key component and recommends the use of the Sequential Organ Failure Assessment (SOFA) score for assessment of severity and prognosis. The SOFA score has become a valuable clinical tool in identifying high-risk patients and guiding management decisions. Early identification using such scoring systems, along with prompt initiation of antibiotics and supportive care, is crucial in improving patient outcomes.

Sepsis can arise from various sources of infection, with respiratory tract infections being the most common, followed by urinary tract, abdominal, and bloodstream infections. The clinical course of sepsis is highly variable and unpredictable. While some patients respond well to treatment, others may rapidly deteriorate, developing septic shock and multiple organ dysfunction syndrome. The presence of underlying comorbidities such as diabetes mellitus, hypertension, and chronic kidney disease further worsens the prognosis.

Understanding the clinical profile, including presenting symptoms, laboratory parameters, and source of infection, is essential for early diagnosis and appropriate management. Identifying factors associated with poor outcomes, such as high severity scores, elevated serum lactate levels, and presence of comorbid conditions, can help clinicians stratify patients based on risk and prioritize intensive care.

In this context, the present study was undertaken to evaluate the clinical characteristics, laboratory findings, and outcomes of patients with sepsis admitted to a tertiary care hospital. The findings of this study aim to contribute to better understanding and management of sepsis in similar healthcare settings.

• Study Design

A prospective observational study involves enrolling patients and following them forward in time without any intervention. Data are collected as events occur, ensuring real-time and more reliable observations.

• Study Setting

The study was conducted in a tertiary care teaching hospital, which provides advanced medical facilities and caters to critically ill patients. Such settings ensure availability of diagnostic and intensive care support.

• Study Duration

The study was carried out over a period of 1 year. This duration allows adequate patient recruitment and helps capture variations in disease patterns over time.

• Sample Size

A total of 150 patients were included in the study. This sample size is sufficient to analyze clinical patterns and determine statistically meaningful associations.

• Inclusion Criteria

Patients aged 18 years and above diagnosed with sepsis as per Sepsis-3 criteria were included. This ensures uniformity in diagnosis and relevance to adult population.

• Exclusion Criteria

Patients on immunosuppressive therapy or those with terminal illness were excluded. This helps avoid confounding factors that may independently affect outcomes

• Data Collection

Information on demographics, clinical features, infection source, and comorbidities was recorded. This helps in understanding patient profile and identifying risk factors.

• Laboratory Parameters

Basic and advanced investigations like CBC, serum lactate, renal and liver function tests, and blood cultures were performed. These aid in diagnosis, severity assessment, and identifying causative organisms.

• Severity Assessment

Disease severity was assessed using SOFA score and presence of septic shock. These are standard tools to evaluate organ dysfunction and predict prognosis.

• Outcome Measures

Patient outcomes were categorized as survival or mortality, along with length of hospital stay. This helps in assessing disease burden and effectiveness of management.

• Statistical Analysis

Data were analyzed using mean ± SD for continuous variables and chi-square test for categorical data. Logistic regression identified predictors of mortality, and p<0.05 was considered statistically significant

Baseline Characteristics

The baseline characteristics show that most patients were middle-aged to elderly, with a mean age of 56.3 ± 13.2 years, and a male predominance (60%) compared to females (40%).

Clinical Features

Regarding clinical features, fever was the most common symptom (85%), indicating infection, followed by tachycardia (72%) and hypotension (48%), which reflect systemic involvement and severity of sepsis. Overall, these findings highlight typical clinical presentation of sepsis patients.

Source of Infection

The distribution of infection sources shows that respiratory infections (42%) were the most common cause of sepsis, followed by urinary tract infections (28%) and abdominal infections (18%), while 12% were due to other causes. This indicates that lung infections play a major role in the development of sepsis in hospitalized patients.

Comorbidities

Regarding comorbidities, diabetes (46%) was the most prevalent, followed by hypertension (38%) and chronic kidney disease (15%). These underlying conditions can weaken immunity and increase susceptibility to severe infections, thereby contributing to worse outcomes in sepsis patients.

Outcomes

The outcomes show that 32% of patients died, while 68% survived, indicating a relatively high mortality rate among sepsis patients.

Factors Associated with Mortality

Factors significantly associated with mortality included higher SOFA scores, presence of septic shock, elevated serum lactate levels, and multiple comorbidities. These factors reflect greater disease severity and poor prognosis, and the association was statistically significant (p < 0.05)

The present study highlights the significant burden of sepsis in a tertiary care setting, with a high mortality rate of 32%. The findings are consistent with global data indicating that sepsis remains a major cause of death despite advancements in healthcare.

The majority of patients were middle-aged to elderly, with a male predominance. Respiratory infections were the most common source of sepsis, followed by urinary tract infections, similar to previous studies.

Comorbid conditions such as diabetes and hypertension were commonly observed and were associated with worse outcomes. These conditions may impair immune response, increasing susceptibility to severe infections.

SOFA score proved to be a useful tool in assessing disease severity and predicting mortality. Patients with higher scores had significantly poorer outcomes. Elevated serum lactate was also an important predictor of mortality, reflecting tissue hypoperfusion.

Early identification and aggressive management, including timely antibiotic therapy and supportive care, are essential to reduce mortality.

The management in these cases are controversial with no universally accepted line of management .The younger patients are advised either lifestyle modifications in terms of avoiding strenuous work, exercise or games. These patients would require an annual follow up with either a thallium scan or stress echocardiogram . In patients who are aged more than 35 years, the risk of suffering cardiac death decreases significantly. In patients who require further management -surgical revascularisation or percutaneous intervention, with implantation of stents in the region of the compression are possible alternatives

Limitations

• Single-center study

• Moderate sample size

• Lack of long-term follow-up

Recommendations

• Early sepsis screening protocols

• Use of SOFA score in routine practice

·         Multicentric studies for better generalization

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