| Abstract |
Background: Sepsis is a major cause of morbidity and mortality worldwide. It is the cause of 10% of intensive care unit admissions (ICUs) and 10-20% of in-hospital mortality. ARDS (acute respiratory distress syndrome) is a devastating complication of sepsis. Sepsis and ARDS have common pathogenetic mechanisms, characterized by inflammation and endothelial dysfunction. In several studies sepsis is reported to be the most common cause of ARDS, accounting for about 40%. Patients with sepsis and ARDS have higher mortality rates than patients with ARDS due to other causes. Early treatment of underlying sepsis and identification of patients at increased risk for ARDS can help reduce its occurrence.
Objective: The aim of the study was to identify risk factors for ARDS development in patients with sepsis, and their association with indicators of outcome and prognosis.
Methods: This is a retrospective, single center observational study, enrolling patients with sepsis admitted to the adult ICU of University Hospital of Heraklion between 2015-2018. Clinical, laboratory and respiratory parameters and therapeutic interventions of these patients were recorded. Factors related to outcome and ARDS development were gender, age, comorbidity, sepsis cause, clinical severity indices (APACHE II και SOFA score), accumulative fluid balance of day 1 and 7, and lactic acid. Septic patients who developed ARDS were compared with those who did not develop ARDS. The outcome indicators studied were duration of mechanical ventilation, the ICU length of stay and mortality in the ICU.
Results: Data were analyzed for 114 patients with sepsis, crude mortality was 40.4% (46/114); 38 patients developed ARDS (32.5%). After logistic multiple regression, independent factors associated with mortality in septic patients were SOFA score (p = 0.016), duration of mechanical ventilation (p = 0.003) and overall fluid balance on day 7 (p <0.001). After ROC Analysis, the best prognostic factors for mortality in septic patients were APACHE II score (AUC 0.711, p <0.001), SOFA score (AUC 0.721, p <0.001), duration of mechanical ventilation (AUC 0.739, p <0.001). ), overall fluid balance on day 7 (AUC 0.802, p <0.001) as well as lactic acid (AUC 0.682, p <0.001). Independent factors associated with the development of ARDS were length of stay in the ICU (p = 0.006), mortality (p = 0.018), and cause of sepsis (0.024), while the factors that could better predict the development of ARDS in sepsis were P/F ratios on day 1 and 2 (PF-D1 AUC 0.768, p <0.001, PF-D2 AUC 0.819, p <0.001), APACHE II score (AUC 0.704, p = 0.001), SOFA score (AUC 0.670, p = 0.005) and duration of mechanical ventilation (AUC 0.814, p = 0.043).
Conclusion: Length of stay in the ICU, mortality and the cause of sepsis are independent factors associated with ARDS, while P / F ratio of the first and second day, APACHE II and SOFA score, and duration of mechanical ventilation are good prognostic factors of the syndrome. Regarding mortality of patients with sepsis, SOFA score, duration of mechanical ventilation and overall fluid balance on day 7 are independent factors related to mortality, while APACHE II and SOFA score, duration of mechanical ventilation, total fluid balance on day 7 and lactic acid are good prognostic factors of mortality.
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