Mortality-associated factors in elderly patients with septic shock and severe sepsis

Background

Some beneficial effects of early enteral feeding (EF) have been reported for the immune response, the infectious complications rate, multiple organ failure and antibiotic usage and the length of hospital stay.

Objective

To determine the relationship among early feeding practice, mortality and multiple organ failure, considering the prognostic indices such as APACHE II score, SOFA score, and plasma concentration of albumin, CRP, glucose and lactate.

Design

A cohort study in a general ICU using 65 medical patients requiring intensive care after diagnosis of septic shock or severe sepsis were studied during 18 consecutive months.

Methods

Enteral tube feeding was initiated as soon as possible, considering the absence of abdominal distention, gastric stasis, hyperglycemia >300 mg or clinical signs of severe hypoxia. Over the first day in the ICU, blood levels of albumin, CRP, glucose and lactate were evaluated and the APACHE and SOFA scores were performed.

Results

The mean age was 83 ± 8.2 years, the APACHE score was 19.4 ± 6.2, the SOFA score was 9.31 ± 2.9 and the period of time to initiate EF (tEF) was 0.97 ± 1.1 days. The seriousness of clinical conditions was demonstrated by a death rate of 50.7% and this was not reduced either by tEF nor the use of EF itself. However, it was related to the APACHE II score (P = 0.17), the SOFA score over the first day (P = 0.04), the length of stay in the ICU (5.1 ± 8.9 days) (P = 0.002), the initial diagnosis of septic shock (P = 0.01) and number of organ failures. The difficulty of initiating EF was not associated with the APACHE or SOFA scores over the first day, blood lactate levels, CRP, albumin or number of organ failures. However, hyperglycemia was a factor that retarded the initiation of EF (P = 0.02). It was not possible to initiate EF in 46.1% of patients due to several factors. Pulmonary sepsis was associated with the number of organ failures. Urinary sepsis was not associated with such failures.

Conclusion

Septic shock has a high mortality associated with multiple organ failure. EF, even when early tolerated in patients with severe sepsis or septic shock, was not able to reduce mortality or the number of organ failures. Hyperglycemia was a retarding factor in the initiation of enteral nutrition.