Septic Death in Adults at Surin Hospital: An Investigation of Real-Life Clinical Practice vs. Empirical Guidelines
Kittisak Chuesakoolvanich MD*
Affiliation : * Department of Medicine, Surin Hospital, Surin
Objective : To explore the cause of death from sepsis and to evaluate the hospital practice in septic patients.
Materials and Methods : A cross-sectional, retrospective study was conducted between October 2004 and
September 2005, at Surin Hospital. The present study included 119 adults (> 15 year of age) who were
admitted with community-acquired sepsis.
Results : According to the ACCP/SCCM definition, 85.7% of the patients had severe sepsis and up to 71.4%
had septic shock. The overall hospital mortality was 73.9% for septic patients and 88.2% for patients in septic
shock. The factors that were significantly associated with death from sepsis were age > 60 years, presence of
co-morbidity, septic shock, organ dysfunctions > 3, and acidosis (HCO3 < 20 mEq/L). During hospitalization,
5.9% of patients received ICU care, 29.4% adequate fluid resuscitation, but none had been monitored for Svo2
or Scvo2, and 36.4% had more than a 1-hr delay in the administration of antibiotics. The main cause of death
was refractory hypotension (77.3%), in which the amount of fluid therapy during initial resuscitation was
significantly associated with the survival of septic shock.
Conclusion : Septic shock is the most common cause of death in septic patients. Delayed and inadequate
hemodynamic management, including a delay in the administration of antibiotics are the main problems in
real-life clinical management of septic patients.
Keywords : Death, Patient care management, Sepsis, Septic shock, Thailand
