Predictors of mortality in cases of abdominal sepsis at a Nicaraguan teaching hospital
Radwan Dipp Ramos; Luis Carlos Lopez; Daithi Heffernan; Stephanie Lueckel; Charles Adams, Jr.; William Cioffi; Andrew Stephen
Background:Abdominal sepsis remains a significant challenge for surgeons worldwide. Currently available scoring systems or predictors of mortality are based on standards established in higher income Western countries. Despite increased globalization of healthcare and international collaborations, little is known regarding applicability of these predictors in less developed countries.
Hypothesis:In this pilot collaborative study, we hypothesize that similar to US based metrics, patient comorbidities and initial presenting physiology will be the best predictors of mortality in patients with abdominal sepsis at a Nicaraguan teaching hospital.
Methods:This is an initial pilot study of 100 adult surgical patients with a diagnosis of abdominal sepsis. 50 consecutive non-survivors and 50 survivors were reviewed for patient factors, presenting laboratory or physiologic parameters, and aspects of management. Abdominal sepsis was diagnosed by an abdominal source of infection combined with the presence of at least 2 SIRS criteria. This pilot study was not powered to detect a statistical difference, but all data approached significance.
Results:Compared to survivors, non-survivors were more often men(64% vs 54%), age greater than 50 years(36% vs 22%), and had pre-illness diabetes(12% vs 6%), hypertension(16% vs 10%), chronic kidney disease(4% vs 0%) or chronic respiratory disease(16% vs 10%). Non-survivors were more likely to be ASA III/IV compared to survivors(60% vs 38%). Although there was no difference in rates of leukocytosis between groups, non-survivors were noted to more likely present with hyperglycemia or acute kidney injury. A colonic source of the sepsis was noted more frequently among non-survivors (42% vs 26%). Hemodynamic compromise, duration of operation greater than 2 hours and metabolic acidosis occurred more often in non-survivors. There was no difference in the utilization of ICU and ICU-related resources between groups.
Conclusions:Sepsis from abdominal sources remains a significant problem worldwide. Similar to more developed settings, our results show that age, comorbidities, health status, and a colonic source of abdominal sepsis affect outcome. It is critical to establish predictors that may have universal applicability to guide triage and management of patients in resource limited environments. This pilot study will form the basis for ongoing international collaboration on surgical sepsis.