Prognostic factors of severe sepsis: a result of Korean sepsis registry system

Background

Severe sepsis is a highly fatal condition, but the prognostic factors of severe sepsis are not yet fully understood.

Materials

One thousand and twenty-six severe sepsis patients (community-acquired infection only) were registered in the Korean Sepsis Registry System from May 2005 to November 2007. The Korean Sepsis Registry System is a web-based ongoing prospective data collection system from 12 tertiary referral hospitals in Korea.

Methods

The Acute Physiology and Chronic Health Evaluation II score, Serial Organ Failure Assessment (SOFA) at admission and serial 1 to 4 days after admission, demographic characteristics, comorbidity conditions with the Charlson score, Glasgow coma scale, organ dysfunction index, infection site, organism, and laboratory data at admission of 1,026 severe sepsis patients were analysed and evaluated to determine the association with 7-day mortality respectively. To develop a prognostic model, decision tree analysis was carried out with SAS 9.1.

Results

The 7-day mortality rate was 13.6/100 patients. Age was an independent risk factor, but the highest mortality (25.3%) was seen in the 60 to 69 years age group. The greater the number of organ dysfunctions, the higher the mortality. The underlying conditions were not statistically significant as a risk factor of 7-day mortality except liver diseases (P = 0.0015). The blood pressure, Charlson score, Acute Physiology and Chronic Health Evaluation II score and SOFA score at admission were all significantly associated with mortality. The initial laboratory values of hemoglobin, white blood cells, platelets, fibrinogen, prothrombin time, partial prothrombin time, arterial pH, potassium and albumin at admission were also statistically significant in bivariate analysis. Systemic infection and central nervous system infection showed 26.7% and 25.0% 7-day mortality. In a prognostic model by decision tree analysis, the blood coagulation factors (prothrombin time, platelet) and SOFA at 5 days after admission were the most significant prognostic factors of 7-day mortality. The sensitivity and specificity of this model were 67.5% and 96.8%, respectively.

Conclusion

The blood coagulation factors and SOFA were the most significant prognostic factors of 7-day mortality.