Mortality Risk Factors in Patients With Sepsis due to Intra-Abdominal Infection

Receipt of continuous kidney replacement therapy due to acute kidney injury, coagulopathy, and simplified acute physiology score III (SAPS 3) scores are independently associated with increased mortality risk in patients with sepsis secondary to intra-abdominal infection. These study results were published in BMC Infectious Diseases.

In this post-hoc analysis of a prospective cohort study, researchers evaluated data captured from patients hospitalized at 16 tertiary care hospitals in Korea from September 2019 to February 2020. Included patients (N=219) were older than 19 years and admitted to intensive care units with sepsis due to intra-abdominal infection. The primary objective was to evaluate clinical outcomes and the elements associated with 28-day mortality risk.

The researchers compared patient data from those who survived vs those who died. Chi-squared and Fisher exact testing were used to evaluate categorical variables and student t-testing was used to evaluate continuous variables. Multivariate logistic regression was used to evaluate the relationship between organ dysfunction and the risk of 28-day mortality, with adjustments for age, sex, Charlson comorbidity index (CCI) scores, and lactic acid levels.

There were 156 patients in the survivor cohort and 63 in the non-survivor cohort, of whom the mean age was 69.4±13.0 years, 53.9% were men, and the mean BMI was 23.0±4.2 kg/m². Of note, CCI scores were significantly higher among patients in the non-survivor vs survivor cohorts (5.9±3.0 vs 5.1±2.3; P =.075). The most commonly identified pathogens were gram-negative Escherichia coli (48.4%) and Klebsiella pneumoniae (22.9%), followed by gram-positive Enterococcus faecium (8.9%). The most commonly identified fungus was Candida albicans (3.2%).

Overall, the mortality rate among patients with sepsis due to IAI was 23.3%. Septic shock incidence was significantly higher among patients in the non-survivor vs survivor cohorts (58.7% vs 42.3%; P =.028). Patients in the non-survivor cohort also had significantly higher baseline sequential organ failure assessment (SOFA) scores (12.2±4.6 vs 8.4±3.1; P <.001).

Mortality rates were found to be significantly increased among patients receiving vs not receiving continuous kidney replacement therapy (68.3% vs 16%; P < 0.001).

Multivariate logistic regression was used to investigate associations between organ dysfunction and 28-day mortality risk. After adjustments for age, sex, CCI score, and lactic acid level, only coagulopathy was significantly associated with an increased 28-day mortality risk (odds ratio [OR], 2.78; 95% CI, 1.47-5.23; P =.001). Further analysis showed SAPS 3 scores and receipt of continuous kidney replacement therapy were independently associated with increased 28-day mortality risk (both P <.001).

Limitations of this study include its retrospective design and differences in treatment protocols among the study sites.

According to the researchers “Additional support may be needed in patients with coagulopathy than in those with other organ dysfunctions due to IAI [intra-abdominal infection] because patients with coagulopathy had worse prognosis.”