ลักษณะและปัจจัยที่สัมพันธ์กับการเสียชีวิตในผู้ป่วยติดเชื้อในกระแสเลือด และผลลัพธ์จากการใช้แนวทางการรักษา Septic Shock/Sepsis โรงพยาบาลพระนารายณ์มหาราช

Sitthichai  Kingkaewcharoenchai

Authors

Sitthichai Kingkaewcharoenchai King Narai Hospital

Keywords:

bloodstream infection, septic shock, mortality risk factors, lactate, septic shock/sepsis protocol

Abstract

Objectives: To investigate the clinical characteristics, factors associated with mortality among patients with bloodstream infections, and outcomes of implementing the Septic shock/Sepsis management protocol at King Narai Maharaj Hospital.

Methods: This retrospective study reviewed medical records of patients diagnosed with sepsis or septic shock presenting to the emergency department of King Narai Maharaj Hospital between January 1, 2021, and December 31, 2023. A total of 403 patients were included based on predefined inclusion criteria. Data on demographics, infection characteristics, clinical features, and treatment were collected. Descriptive statistics were used to summarize the data. Comparisons between survivors and non-survivors were performed using the Chi-square test, Fisher’s exact test, and independent t-test. Factors associated with mortality were analyzed using binary logistic regression. Statistical significance was set at p-value ≤ 0.05.

Results: The majority of patients were female (58.8%) and aged 61–70 years (43.2%). The most common sites of infection were the urinary tract (42.4%) and the lungs (33.3%). Escherichia coli was the most frequently isolated pathogen (26.8%). Significant differences between survivors and non-survivors were observed in age, mode of hospital presentation, and MEWS score. Factors significantly associated with mortality included systolic blood pressure <110 mmHg, mean arterial pressure ≤65 mmHg, serum creatinine ≥1.15 mg/dL, baseline lactate >4 mmol/L, and lactate clearance at 6 hours <10%.

Conclusion: Patients with bloodstream infections who present with hypotension, impaired renal function, and elevated lactate levels have a higher risk of mortality. Early assessment and prompt, appropriate management according to the Septic shock/Sepsis protocol may help reduce mortality.

Keywords: bloodstream infection, septic shock, mortality risk factors, lactate, septic shock/sepsis protocol

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