Abdominal sepsis in the surgical intensive care unit: a description and search for prognostic factors

Introduction

Patients with AS treated in the surgical ICU suffer substantial morbidity and mortality, despite efforts of modern intensive care and economical means being invested. The present study was performed in order to describe this cathegory of patients and if possible to identify factors of potential prognostic importance.

Methods

All consecutive patients treated due to AS in the surgical ICU at Lund University Hospital during the period January 1983 to December 1995 were analysed retrospectively. Information on demography, scoring according to APACHE II, SSS and MODS scores, complications and mortality was assessed.

Results

Totally 210 patients, 75 females and 135 males, with a mean age of 65 years were included in the study. Median time of hospitalization was 26 days including 6 days at the ICU accounting for a median cost of 48.112 USD/ hospital stay. The main cause of AS was visceral perforation (42%). Abdominal bacterial cultures were dominated by enteric bacteria (80%), while blood cultures showed equal frequences of enteric and skin bacteria (21%). Most patients were subjected to surgical intervention (88%).

Complications were frequent, dominated by organ failure, seen in 83%. Pulmonary, cardiac and renal failure were most frequent. Multiple organ failure, defined as failure of >2 organ systems, developed in 52%. The total mortality rate was 28%, the most common cause of death being MODS (69%). APACHE II and SSS scores did not significantly differ between patients with or without concommitant MODS nor between survivors and non-survivors. A trend towards correlation between high scores and poorer outcome could be seen. A MODS score of >4 predicted development of multiple organ failure (P < 0.001), but did not predict mortality.

The presence of previous deseases did not significantly influence on morbidity and mortality, nor did age, sex, underlying diagnosis nor bacterial culture findings. The occurrence of organ failure correlated with poor prognosis and fatal outcome, the more organ systems that failed, the stronger the correlation. Pulmonary (P < 0.05), cardiac (P < 0.001) and renal (P < 0.001) failure all increased the risk of lethal outcome, as did multiple organ failure (P < 0.001).

Conclusions

Abdominal sepsis causes substantial morbidity and mortality, mainly due to the frequent development of multiple organ dysfunction syndrome. The condition consumes substantial economical resources and health care facilities. Factors of prognostic importance are all associated with the development of multiple organ failure syndrome and not to individual factors like age, sex, previous diseases or diagnosis.