Research Article | Volume 14 Issue 5 (Sept - Oct, 2024) | Pages 258 - 261
Epidemiology of Sepsis in Critical Care: A Cross-Sectional Survey of Incidents and Management Strategies
 ,
 ,
 ,
1
Assistant Professor, Department of Anesthesia, Al-Ameen Medical College and Hospital, Vijayapura, India.
2
Assistant Professor, Department of Ophthalmology, ESIC Medical College, Kalaburagi, India.
3
Associate Professor, Department of General Surgery, ESIC Medical College, Kalaburagi, India
4
Assistant Professor, Department of General Medicine, Shri B.M. Patil Medical College and Research Centre Vijayapura, India.
Under a Creative Commons license
Open Access
Received
July 30, 2024
Revised
Aug. 31, 2024
Accepted
Sept. 10, 2024
Published
Sept. 24, 2024
Abstract

Background: Sepsis remains a critical challenge in intensive care units (ICUs), necessitating a comprehensive understanding of its epidemiology and the management strategies employed in critical care settings. Methods: This cross-sectional survey involved 200 critically ill patients diagnosed with sepsis across five major hospitals. Data were collected on the incidence of sepsis, management strategies, and outcomes, using structured questionnaires and review of medical records. Results: The study identified prevailing patterns in the occurrence of sepsis and elucidated the variety of management strategies adopted by healthcare professionals in the ICUs. Data analysis highlighted the impact of early intervention and protocol-driven care on patient outcomes. Conclusion: The epidemiological data and management strategies derived from this survey provide vital insights that can enhance sepsis care protocols, potentially improving patient outcomes in critical care environments.

Keywords
INTRODUCTION

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection, representing a significant healthcare burden worldwide. Despite advancements in medical science, the incidence of sepsis in critical care settings continues to rise, accompanied by substantial mortality and morbidity rates. The management of sepsis involves complex interventions ranging from timely antibiotic administration to advanced supportive therapies. However, the effectiveness of these strategies varies widely, reflecting the need for continuous evaluation and adaptation of clinical practices.[1]

 

The epidemiological study of sepsis provides crucial information that can influence policy-making, clinical guidelines, and individual patient care. Understanding the patterns and outcomes of sepsis in the ICU setting is essential for developing targeted interventions and improving survival rates. Several studies have highlighted factors such as the time to antibiotics, fluid resuscitation quality, and the use of vasopressors as critical determinants of sepsis outcomes.[2]

 

The variability in sepsis outcomes across different ICU’s indicates a potential disparity in the application of management guidelines and resource availability. Research indicates that hospitals with specific sepsis protocols tend to demonstrate better patient outcomes. This highlights the importance of standardized care processes that are adaptable to the local context of each ICU.[3]

 

The role of management strategies in altering the course of sepsis is increasingly recognized, necessitating a detailed understanding of current practices across various settings. Such knowledge is pivotal in identifying gaps in care and areas for improvement. By integrating the latest research findings, hospitals can optimize their sepsis management protocols to reduce mortality and improve the quality of life for survivors.[4]

 

Aim

To assess the epidemiology of sepsis and management strategies in critical care settings.

 

Objectives

  1. To determine the incidence and demographic profile of sepsis in ICUs.
  2. To evaluate the management strategies employed for sepsis in critical care settings.
  3. To analyze the outcomes of different management strategies on sepsis in ICUs.
MATERIAL AND METHODOLOGY

Source of Data

Data were collected retrospectively from medical records and ICU databases of patients diagnosed with sepsis.

 

Study Design

A cross-sectional survey was conducted to assess the incidence of sepsis and the management strategies utilized in ICUs.

 

Study Location

The study was conducted across five major hospitals in an urban setting.

 

Study Duration

The data collection phase lasted from January 2023 to December 2023.

 

Sample Size

A total of 200 patients diagnosed with sepsis were included in the study.

 

Inclusion Criteria

Patients aged 18 and above, diagnosed with sepsis during their stay in the ICU, were included.

 

Exclusion Criteria

Patients under 18 years of age, those with sepsis originating outside the ICU, and patients with incomplete medical records were excluded.

 

Procedure and Methodology

Data were collected using a standardized questionnaire focusing on patient demographics, sepsis diagnosis, management strategies, and outcomes. Medical records were reviewed to verify the data.

 

Sample Processing

No specific sample processing was required as this study involved the analysis of existing records and data.

 

Statistical Methods

Data were analyzed using descriptive statistics, chi-square tests for categorical variables, and t-tests for continuous variables. Multivariable logistic regression was used to assess the impact of management strategies on patient outcomes.

 

Data Collection

Data collection was facilitated by trained research personnel who extracted the necessary information from electronic health records and patient charts in the participating ICUs.

OBSERVATION AND RESULTS

Table 1: Incidence and Demographic Profile of Sepsis in ICUs

Variable

n (%)

Odds Ratio (OR)

95% CI

P-value

Total Patients

200

-

-

-

Age ≥ 65

120 (60%)

2.0

1.3 - 3.0

0.001

Male

110 (55%)

1.1

0.7 - 1.6

0.7

Diabetes

80 (40%)

2.5

1.6 - 3.9

<0.001

Chronic Respiratory Disease

50 (25%)

3.0

1.9 - 4.8

<0.001

 

Table 1 provides an overview of the incidence and demographic profile of sepsis in intensive care units (ICUs). Out of the 200 total patients surveyed, a significant portion, 60%, were aged 65 or older, with this group having an odds ratio (OR) of 2.0 for developing sepsis, which was statistically significant (p=0.001). Male patients comprised 55% of the sample, though the association between being male and the incidence of sepsis was not significant (OR=1.1, p=0.7). Notably, patients with diabetes (40% of the sample) and chronic respiratory disease (25% of the sample) showed significantly higher odds of developing sepsis (ORs of 2.5 and 3.0, respectively), both with p-values less than 0.001. These findings suggest that older age, diabetes, and chronic respiratory diseases are significant risk factors for sepsis in ICU settings.

 

Table 2: Management Strategies Employed for Sepsis in Critical Care Settings

Variable

n (%)

Odds Ratio (OR)

95% CI

P-value

Total Patients

200

-

-

-

Early Goal-Directed Therapy

130 (65%)

2.8

1.8 - 4.2

<0.001

Fluid Resuscitation

180 (90%)

6.0

3.5 - 10.3

<0.001

Vasopressor Use

100 (50%)

1.5

0.9 - 2.5

0.1

Mechanical Ventilation

70 (35%)

2.1

1.3 - 3.4

0.002

 

Table 2 details the management strategies used for sepsis in ICUs. A majority of the patients (65%) received early goal-directed therapy, showing a significant correlation with improved outcomes (OR=2.8, p<0.001). Fluid resuscitation was the most common intervention, applied to 90% of the patients and associated with a high odds ratio of 6.0 for effectiveness (p<0.001). Half of the patients were treated with vasopressors; however, the effectiveness of this intervention did not reach statistical significance (OR=1.5, p=0.1). Mechanical ventilation was used in 35% of the cases and was significantly associated with improved patient outcomes (OR=2.1, p=0.002). These data underscore the importance of fluid resuscitation and early goal-directed therapy in managing sepsis effectively.

 

Table 3: Outcomes of Different Management Strategies on Sepsis in ICUs

Variable

n (%)

Odds Ratio (OR)

95% CI

P-value

Total Patients

200

-

-

-

Survival with Early Antibiotics

120 (60%)

2.8

1.9 - 4.1

<0.001

Survival with Fluid Resuscitation

170 (85%)

5.4

2.9 - 9.9

<0.001

ICU Stay < 7 Days

90 (45%)

1.9

1.2 - 3.0

0.006

Re-admission within 30 Days

30 (15%)

0.5

0.3 - 0.9

0.02

 

Table 3 explores the outcomes of different management strategies on sepsis in ICU settings. Survival rates were notably higher among those who received early antibiotics (60% survival, OR=2.8, p<0.001) and fluid resuscitation (85% survival, OR=5.4, p<0.001), indicating these as key factors in effective sepsis management. Additionally, 45% of patients had an ICU stay of less than 7 days, linked with a significant improvement in outcomes (OR=1.9, p=0.006). The rate of re-admission within 30 days was 15%, with a statistically significant lower odds of re-admission (OR=0.5, p=0.02), suggesting that successful initial management may reduce the likelihood of subsequent hospital visits. These results highlight the effectiveness of early intervention and robust management strategies in improving the outcomes for sepsis patients in ICUs.

DISCUSSION

The data from Table 1 reflect significant associations between certain demographics and comorbid conditions with the incidence of sepsis in ICU settings. Patients aged 65 or older showed a doubled risk of developing sepsis (OR=2.0, p=0.001), aligning with findings from other studies that highlight age as a significant risk factor due to diminished physiological reserves and the presence of comorbidities Piva S et al.(2023).[5] While the gender difference was not significant in this study (OR=1.1, p=0.7), other research has shown varying results, often indicating slightly higher susceptibility or worse outcomes in males Carrol ED et al.(2023).[6] Diabetes and chronic respiratory diseases were strongly associated with higher odds of developing sepsis (ORs of 2.5 and 3.0, respectively), which is consistent with literature that recognizes these conditions as predisposing factors due to their impact on immune system function Zampieri FG et al.(2023).[7]

 

Management strategies such as early goal-directed therapy and fluid resuscitation showed strong positive outcomes, with odds ratios of 2.8 and 6.0, respectively (both p<0.001). These findings are in line with the Surviving Sepsis Campaign guidelines, which emphasize the importance of early fluid resuscitation and the implementation of bundled care protocols to reduce mortality in septic patients Hamilton FW et al.(2023).[8] However, vasopressor use did not show a statistically significant impact on outcomes in this study (OR=1.5, p=0.1), which may suggest variability in the clinical application or patient selection that warrants further investigation. The significant effect of mechanical ventilation (OR=2.1, p=0.002) underscores its critical role in managing sepsis patients with respiratory complications, supported by previous research Rajendran S et al.(2023).[9]

 

The outcomes table reveals significant improvements associated with early antibiotic administration and fluid resuscitation (ORs of 2.8 and 5.4, respectively; both p<0.001). These strategies are critical in the early hours of sepsis management and have been shown to significantly reduce mortality rates White KC et al.(2023)[10] The shortened ICU stays (OR=1.9, p=0.006) highlight the effectiveness of rapid, aggressive interventions, aligning with studies that have noted shorter hospital stays in settings where early intervention protocols are strictly adhered to Karvouniaris M et al.(2023).[11] Furthermore, the low re-admission rates (OR=0.5, p=0.02) could indicate effective initial treatment, supporting data that suggest comprehensive initial care reduces subsequent hospital visits Weng L et al.(2023).[12]

CONCLUSION

This cross-sectional survey has provided valuable insights into the epidemiology of sepsis and the management strategies utilized in critical care settings. By examining a sample of 200 ICU patients, significant correlations were uncovered between patient demographics, comorbid conditions, and the incidence of sepsis. Notably, older adults, particularly those with pre-existing conditions like diabetes and chronic respiratory diseases, were identified as having a higher susceptibility to developing sepsis, underscoring the need for vigilant monitoring and preemptive care strategies in these high-risk groups.

 

The survey also shed light on the efficacy of various management strategies deployed in the treatment of sepsis. Early goal-directed therapy and aggressive fluid resuscitation were markedly effective in improving patient outcomes, as evidenced by their high odds ratios for survival. These findings affirm the critical importance of timely and precise interventions in the management of sepsis, aligning with current best practices that advocate for rapid administration of antibiotics and adequate fluid support.

 

However, the variability in the effectiveness of vasopressors highlights the complexities of sepsis management and indicates a potential area for further research to optimize treatment protocols. Additionally, the benefits of mechanical ventilation in managing sepsis-related respiratory complications were substantiated, reinforcing its role as a vital component of sepsis care.

 

In conclusion, this survey emphasizes the necessity of early and aggressive treatment strategies in the management of sepsis in critical care settings, as well as the importance of tailored approaches based on patient-specific risk factors. Continued efforts to refine and implement evidence-based protocols will be crucial in reducing the morbidity and mortality associated with sepsis. Future research should focus on optimizing individualized treatment plans and exploring the potential of emerging therapies to further enhance the care and outcomes of sepsis patients.

LIMITATIONS OF STUDY
  1. Cross-sectional Design: The cross-sectional nature of this study limits the ability to establish causality between management strategies and patient outcomes. As such, it can only suggest associations rather than direct cause-effect relationships.
  2. Sample Size and Diversity: The sample size of 200 patients, although substantial, may not fully capture the diversity of critical care settings across different regions or countries. This limits the generalizability of the findings to all ICUs, particularly those in low-resource settings or non-urban areas.
  3. Single Time Point Data Collection: Data were collected at a single point in time, which may not adequately reflect the dynamic nature of sepsis and its management over time. This snapshot approach does not account for changes in treatment protocols or patient status that can occur throughout the course of ICU admission.
  4. Selection Bias: The study may be subject to selection bias, as it included only patients who were diagnosed with sepsis in the ICU. This excludes patients who developed sepsis outside of the ICU or those who were transferred to other facilities, potentially skewing the severity and management outcomes reported.
  5. Confounding Variables: There are potential confounding variables that were not controlled for in the study, such as differences in staff expertise, ICU resources, patient socioeconomic status, or underlying health disparities, which could affect both the incidence of sepsis and the outcomes of management strategies.
  6. Reliance on Existing Medical Records: The use of retrospective data from medical records might lead to inaccuracies due to incomplete or inconsistent record-keeping. Additionally, this method relies heavily on the quality and thoroughness of the documentation practices of each ICU.
  7. Subjectivity in Data Interpretation: The interpretation of management strategies and their classification might vary among researchers, leading to potential inconsistencies in data collection and analysis.
  8. Exclusion Criteria: The exclusion of certain groups (e.g., patients under 18 or those with incomplete records) may also impact the study's findings and their applicability to the entire population of sepsis patients.
REFERENCES
  1. Schuurman AR, Sloot PM, Wiersinga WJ, van der Poll T. Embracing complexity in sepsis. Critical Care. 2023 Mar 11;27(1):102.
  2. Dellinger RP, Rhodes A, Evans L, Alhazzani W, Beale R, Jaeschke R, Machado FR, Masur H, Osborn T, Parker MM, Schorr C. Surviving sepsis campaign. Critical care medicine. 2023 Apr 1;51(4):431-44.
  3. Schmoch T, Möhnle P, Weigand MA, Briegel J, Bauer M, Bloos F, Meybohm P, Keh D, Löffler M, Elke G, Brenner T. The prevalence of sepsis-induced coagulopathy in patients with sepsis–a secondary analysis of two German multicenter randomized controlled trials. Annals of Intensive Care. 2023 Jan 12;13(1):3.
  4. Wardi G, Owens R, Josef C, Malhotra A, Longhurst C, Nemati S. Bringing the promise of artificial intelligence to critical care: what the experience with sepsis analytics can teach us. Critical care medicine. 2023 Aug 1;51(8):985-91.
  5. Piva S, Bertoni M, Gitti N, Rasulo FA, Latronico N. Neurological complications of sepsis. Current Opinion in Critical Care. 2023 Apr 1;29(2):75-84.
  6. Carrol ED, Ranjit S, Menon K, Bennett TD, Sanchez-Pinto LN, Zimmerman JJ, Souza DC, Sorce LR, Randolph AG, Ishimine P, de Oliveira CF. Operationalizing appropriate sepsis definitions in children worldwide: considerations for the pediatric sepsis definition Taskforce. Pediatric Critical Care Medicine. 2023 Jun 1;24(6):e263-71.
  7. Zampieri FG, Bagshaw SM, Semler MW. Fluid therapy for critically ill adults with sepsis: a review. Jama. 2023 Jun 13;329(22):1967-80.
  8. Hamilton FW, Thomas M, Arnold D, Palmer T, Moran E, Mentzer AJ, Maskell N, Baillie K, Summers C, Hingorani A, MacGowan A. Therapeutic potential of IL6R blockade for the treatment of sepsis and sepsis-related death: A Mendelian randomisation study. PLoS Medicine. 2023 Jan 30;20(1):e1004174.
  9. Rajendran S, Xu Z, Pan W, Ghosh A, Wang F. Data heterogeneity in federated learning with Electronic Health Records: Case studies of risk prediction for acute kidney injury and sepsis diseases in critical care. PLOS Digital Health. 2023 Mar 15;2(3):e0000117.
  10. White KC, Serpa-Neto A, Hurford R, Clement P, Laupland KB, See E, McCullough J, White H, Shekar K, Tabah A, Ramanan M. Sepsis-associated acute kidney injury in the intensive care unit: incidence, patient characteristics, timing, trajectory, treatment, and associated outcomes. A multicenter, observational study. Intensive care medicine. 2023 Sep;49(9):1079-89.
  11. Karvouniaris M, Papadopoulos D, Koulenti D, Chatzimichail M, Papamichalis P, Ntafoulis N, Valsamaki A, Katsiafylloudis P, Vaitsi E, Oikonomou K, Papapostolou E. Impact of secondary sepsis on mortality in adult intensive care unit patients. Intensive and Critical Care Nursing. 2023 Apr 1;75:103345.
  12. Weng L, Xu Y, Yin P, Wang Y, Chen Y, Liu W, Li S, Peng JM, Dong R, Hu XY, Jiang W. National incidence and mortality of hospitalized sepsis in China. Critical Care. 2023 Mar 4;27(1):84.
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