European Journal of Cardiovascular Medicine

Sepsis is described as a systemic inflammatory response syndrome, which is initiated by a proven or assumed infectious etiology. Sepsis has a rapid pathophysiological course towards severe multiorgan dysfunction. It has increased morbidity and mortality profile and in septic shock the mortality accounts to about 16% to 50%.

To prevent mortality and to alleviate morbidity we should be,

1. Able to rapidly classify the patients with SIRS features based on their risk profile for care.
2. Capable of starting EGDT¹ early goal directed therapy within golden period that is first 6 hours which can reduce the mortality to 7% to 16%.
3. Applying these sophisticated and demanding treatment strategies to the patient who has only low risk would be unnecessary, harmful, not cost-effective and also impractical.
4. As there is an increased demand for intensive care beds and scarcity of resources, we should allocate them properly in such a way that the needy get the benefit.

So formed a risk stratification tool which is reliable and reproducible and it improves the management of sepsis and improves the outcome. Such a tool is the

Mortality in Emergency Department Sepsis (MEDS)² score

• It is developed by Shapiro et al in 2003.
• Its unique feature is that it is a basic scoring system.
• Parameters included in this scoring system are readily available from the baseline details gathered and investigated at the time of admission. They are broadly classified into,

1. Predisposing factors,
2. Infection,
3. Immune response,
4. Organ dysfunction criteria.

Based on the total score obtained the patients are categorized into 5 MEDS- risk groups.

Mortality predicted for each group by Shapiro et al is:

OBJECTIVE:

• To prospectively and externally compare the 28-days mortality predictivity of MEDS score in patients who presenting having SIRS at department of surgery in Government medical college and ESI hospital, coimbatore.
• To evaluate association of MEDS risk factors in sepsis patient influencing mortality.
• To evaluate efficacy of Early Goal Directed Therapy in sepsis patients.

METHODOLOGY:

STUDY DESIGN:            Prospective cohort study.

SAMPLE SIZE: 178 patients.

INCLUSION CRITERIA:

• 178 patients presenting to department of surgery at Government medical college & ESI hospital, Coimbatore.
• With features of SIRS:

SIRS is defined as presence of atleast 2 of following characteristics:

• Pyrexia - more than 100.4’F or less than 96.8’F
• Cardiac rate - tachycardia >90/min
• Breath rate - >20/min
• Abnormal Leucocyte count- >12,000 or <4000
• Aged 18 years and above.
• Between July-2015 to Jue-2016.

EXCLUSION CRITERIA:

• Patients who are below 18 years.
• Pregnant patients.

STUDY METHOD:

The MEDS score variables are collected for the patients included in the study. Data will be entered in an excel work sheet.

Based on the total score the patients will be categorized into various MEDS risk groups.

The patients will be followed till recovery from illness or death upto maximum of 28days and the outcome will be recorded.

OUTCOME:

1. Patient died within 28 days,
2. Cured of illness and sent from hospital stable.

Then the obtained outcomes of data will be analysed at the end of the study period.  

Table 1: Sex Distribution In Sample

Table 2: Meds- Risk Category

Table 3: Outcome In Different Meds Group

Table 4: Comparison Of Predicted Mortality In Study And By Shapiro Et Al.

Table 5: Individual Parameters Influencing Mortality.

Sepsis which is a systemic inflammatory response syndrome3, initiated by a proven or proposed infectious etiology. It progress very drastically to an aggressive stage with multi organ dysfunction. It has high morbidity and mortality rates ranging from 16% to 50% in septic shock.

Hence to predict the outcome early and to initiate EGDT, a scoring system devised by Shapiro et al known as MEDS4 score was selected in the study and subjected for validation.

The nine readily available parameters of 178 patients were collected over a period of one year and the patients were categorized into five different risk groups. The variables were analysed using SPSS version 16.0 software.

The MEDS score had an area under receiver operating characteristic curve of 0.88 (95% confidence interval, 0.83-0.92) and has perfect discriminatory5 ability in all five risk categories.

• The MEDS score system predicts 28-day mortality with discriminative ability among patients presenting with features of systemic inflammatory response syndrome to emergency department, Government medical college & ESI hospital, Coimbatore.
• All the nine risk factors included in computing MEDS score has cumulative effect in influencing mortality rate and none has independent risk

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