Differences in Mortality and Sepsis-Associated Organ Dysfunction between Surgical and Non-Surgical Sepsis Patients

Rhabdomyolysis in intensive care unit-distinctive clinical indicators and prognosis

BACKGROUND

Rhabdomyolysis is commonly encountered in intensive care unit (ICU), yet its clinical features and prognostic indicators have not been comprehensively defined. This study aims to identify clinical characteristics and outcomes of ICU patients with rhabdomyolysis, and assess if rhabdomyolysis predicts outcomes.

METHODS

This retrospective study investigated patients admitted to the ICU of Shanghai Baoshan District Wusong Central Hospital from 2022 to 2023. Clinical and laboratory indices, along with discharge outcomes, were analyzed.

RESULTS

The study included 151 patients, divided into Control group (CK ≤ 1000 U/L, n = 117) and RML group (CK > 1000 U/L, n = 34) groups. The RML group showed higher proportions of male gender (76.5% vs. 56.4%, p = 0.035), infection (88.2% vs. 68.4%, p = 0.022), muscle weakness (41.2% vs. 13.7%, p = 0.035), and myoglobin > 1000 U/L (55.9% vs. 14.5%, p < 0.001), but lower incidence of malignant tumors (0% vs. 17.9%, p = 0.017). The poor outcome rate (POR, the combined rate of death and cessation of treatment) was significantly higher in the RML group (52.9% vs. 33.3%, p = 0.038). Multivariate logistic regression analysis identified male gender [OR, 1.120-7.147; p = 0.028], sepsis [OR, 1.234-10.949; p = 0.019], and mechanical ventilation [OR, 1.489-8.478; p = 0.004] as independent risk factors for poor outcome in ICU patients. Rhabdomyolysis was not an independent risk factor.

CONCLUSIONS

ICU patients with rhabdomyolysis experienced a significantly higher rate of poor outcomes. Male gender, sepsis, and mechanical ventilation were identified as independent risk factors for poor outcomes, while rhabdomyolysis itself was not found to be an independent risk factor. Prospective research is needed to validate these findings in diverse ICU populations.

Infectious Foci, Comorbidities and Its Influence on the Outcomes of Septic Critically Ill Patients

Sepsis is among the most frequent diagnoses on admission to the intensive care unit (ICU). A systemic inflammatory response, activated by uncontrolled infection, fosters hypoperfusion and multiorgan failure and often leads to septic shock and mortality. These infections arise from a specific anatomic source, and how the infection foci influence the outcomes is unknown. All patients admitted to the ICU of Hospital de Vila Franca de Xira, between 1 January 2017 and 31 June 2023, were screened for sepsis and categorized according to their infection foci. During the study period, 1296 patients (32.2%) had sepsis on admission. Their mean age was 67.5 ± 15.3 and 58.1% were male; 73.0% had community-acquired infections. The lung was the main focus of infection. Septic shock was present in 37.9% of the patients and was associated with hospital mortality. Severe imbalances were noted in its incidence, and there was lower mortality in lung infections. The hospital-acquired infections had a slightly higher mortality but, after adjustment, this difference was non-significant. Patients with secondary bacteremia had a worse prognosis (one-year adjusted hazard ratio of 1.36, 95% confidence interval 1.06-1.74, p = 0.015), especially those with an isolated non-fermenting Gram-negative infection. Lung, skin, and skin structure infections and peritonitis had a worse prognosis, whilst urinary, biliary tract, and other intra-abdominal infections had a better one-year outcome.

Decrease in Mortality after the Implementation of a Hospital Model to Improve Performance in Sepsis Care: Princess Sepsis Code

Sepsis is a time-dependent disease whose prognosis is influenced by early diagnosis and therapeutic measures. Mortality from sepsis remains high, and for this reason, the guidelines of the Surviving Sepsis Campaign recommend establishing specific care programs aimed at patients with sepsis. We present the results of the application of a hospital model to improve performance in sepsis care, called Princess Sepsis Code, with the aim of reducing mortality. A retrospective study was conducted using clinical, epidemiological, and outcome variables in patients diagnosed with sepsis from 2015 to 2022. A total of 2676 patients were included, 32% of whom required admission to the intensive care unit, with the most frequent focus of the sepsis being abdominal. Mortality in 2015, at the beginning of the sepsis code program, was 24%, with a declining rate noted over the study period, with mortality reaching 17% in 2022. In the multivariate analysis, age > 70 years, respiratory rate > 22 rpm, deterioration in the level of consciousness, serum lactate > 2 mmol/L, creatinine > 1.6 mg/dL, and the focus of the sepsis were identified as variables independently related to mortality. The implementation of the Princess Sepsis Code care model reduces the mortality of patients exhibiting sepsis and septic shock.