Severe abdominal sepsis in the intensive care unit

Objective

To investigate factors that may predict outcome in patients with severe abdominal sepsis that required treatment in an intensive care unit (ICU).

Design

A retrospective record review of survivors and nonsurvivors, comparing clinical, laboratory, microbiological, and therapeutic data, to identify specific poor prognostic factors.

Setting

A tertiary referral centre.

Patients

Consecutive adult patients with abdominal sepsis admitted to the ICU between January 2001 and December 2002.

Measurements and results

Of 54 patients studied there were 16 survivors (29.6%) and 38 nonsurvivors (70.4%). The nonsurvivors had a significantly longer stay in the ICU (22.3 days vs 7.9 days; P = 0.0042), had significantly more laparotomies per patient (4.1 vs 2.4; P = 0.024), had more patients with an open abdomen following surgery (15 vs 1; P = 0.01), had significantly more blood transfusions (10.8 vs 2.9; P = 0.0077), and had a significantly higher mean APACHE II score on admission (16.5 vs 10.7; P = 0.0175). The initial surgery was performed as an emergency procedure in 72% of patients, and of these four were delayed for greater than 48 hours.

Of the survivors, the source was eradicated at the initial laparotomy in 12 of the 14 patients. Most of the patients that died developed multiorgan failure. In this regard none of the patients who survived required dialysis, whereas 44% in the nonsurvivors were dialysed. Nonsurvivors had more organisms isolated from the peritoneal fluid and more bacteremic episodes. The most frequently isolated organism from the peritoneal fluid in nonsurvivors was Escherichia coli.

Conclusions

Patients with abdominal sepsis are at risk of dying if there is delay in surgery and if the source of sepsis cannot be controlled at the first operation. In addition, more than four relook laparotomies, renal failure requiring dialysis, longer ICU stay, culture of pathogens from the peritoneal cavity and blood, higher APACHE II score, and requirement for blood transfusion contribute significantly.