Sepsis natural history, complications and prognosis: Difference between revisions
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{{Sepsis}} | {{Sepsis}} | ||
{{CMG}}; '''Associate Editor(s)-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.D.]] [mailto:psingh13579@gmail.com] | {{CMG}}; '''Associate Editor(s)-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.D.]] [mailto:psingh13579@gmail.com] | ||
Please help WikiDoc by adding more content here. It's easy! Click [[Help:How_to_Edit_a_Page|here]] to learn about editing. | |||
==Overview== | ==Overview== | ||
There are many complications associated with sepsis, especially because it is a systemic phenomenon. Sepsis is a severe condition, and the prognosis of the patient will depend greatly on the condition and overall health of the patient. Many factors, such as age, hosts immune response, site of infection, type of infection, appropriate antibiotic therapy, and restoration of circulation of perfusion contribute to the overall prognosis. | There are many complications associated with sepsis, especially because it is a systemic phenomenon. Sepsis is a severe condition, and the prognosis of the patient will depend greatly on the condition and overall health of the patient. Many factors, such as age, hosts immune response, site of [[infection]], type of infection, appropriate [[antibiotic]] therapy, and restoration of circulation of perfusion contribute to the overall prognosis. | ||
==Complications== | ==Complications== | ||
* [[Disseminated intravascular coagulation]] (DIC) can be the result of sepsis | *[[Disseminated intravascular coagulation]] (DIC) can be the result of sepsis. | ||
* [[Acute tubular necrosis]] (ATN) leading to [[acute renal failure]], can be the result of [[hypoperfusion]] of the kidneys in sepsis (i.e. not enough blood gets to the kidney and they stop working properly) | *[[Acute tubular necrosis]] (ATN) leading to [[acute renal failure]], can be the result of [[hypoperfusion]] of the kidneys in sepsis (i.e. not enough blood gets to the kidney and they stop working properly). | ||
* [[Arrhythmia]] is an abnormal heart rhythm; it can be the result of sepsis. | *[[Arrhythmia]] is an abnormal heart rhythm; it can be the result of sepsis. | ||
* [[Ileus]] or [[ischemic colitis]] can be the result (hypoperfusion) or cause of sepsis | *[[Ileus]] or [[ischemic colitis]] can be the result (hypoperfusion) or cause of sepsis. | ||
* [[Multiple organ dysfunction syndrome]] can be the result of sepsis | *[[Multiple organ dysfunction syndrome]] can be the result of sepsis. | ||
* [[Meningitis]], infection of the tissue that covers the [[brain]] and [[spinal cord]], can be a complication or cause of sepsis | *[[Meningitis]], infection of the tissue that covers the [[brain]] and [[spinal cord]], can be a complication or cause of sepsis. | ||
* [[Osteomyelitis]] is an infection of the bone; it can be the cause or result of sepsis | *[[Osteomyelitis]] is an infection of the bone; it can be the cause or result of sepsis. | ||
* [[Endocarditis]], infection of the inner surface of heart which is in contact with blood, can also be a complication or cause of sepsis | *[[Endocarditis]], infection of the inner surface of heart which is in contact with blood, can also be a complication or cause of sepsis. | ||
* [[Pyaemia]] — causes abscesses | *[[Pyaemia]] — causes abscesses. | ||
==Prognosis== | ==Prognosis== | ||
Prognosis can be estimated with the MEDS (Mortality in Emergency Department Sepsis) score.<ref name="pmid12626967">{{cite journal |author=Shapiro NI, Wolfe RE, Moore RB, Smith E, Burdick E, Bates DW |title=Mortality in Emergency Department Sepsis (MEDS) score: a prospectively derived and validated clinical prediction rule |journal=Crit. Care Med. |volume=31 |issue=3 |pages=670-5 |year=2003 |pmid=12626967 |doi=10.1097/01.CCM.0000054867.01688.D1}}</ref> | Prognosis can be estimated with the MEDS (Mortality in Emergency Department Sepsis) score.<ref name="pmid12626967">{{cite journal |author=Shapiro NI, Wolfe RE, Moore RB, Smith E, Burdick E, Bates DW |title=Mortality in Emergency Department Sepsis (MEDS) score: a prospectively derived and validated clinical prediction rule |journal=Crit. Care Med. |volume=31 |issue=3 |pages=670-5 |year=2003 |pmid=12626967 |doi=10.1097/01.CCM.0000054867.01688.D1}}</ref> | ||
===MEDS Score Criteria=== | |||
*Altered mental status | *Altered mental status | ||
*Lower [[respiratory]] infection | *Lower [[respiratory]] infection | ||
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*[[Hypoxia]] | *[[Hypoxia]] | ||
*[[Tachypnea]] | *[[Tachypnea]] | ||
===Point System<ref name="urlRisk Stratifying the Potentially Septic Patient in the ED">{{cite web |url=http://www.epmonthly.com/the-literature/evidence-based-medicine/risk-stratifying-the-potentially-septic-patient-in-the-ed/ |title=Risk Stratifying the Potentially Septic Patient in the ED |format= |work= |accessdate=2012-04-20}}</ref>=== | ===Point System<ref name="urlRisk Stratifying the Potentially Septic Patient in the ED">{{cite web |url=http://www.epmonthly.com/the-literature/evidence-based-medicine/risk-stratifying-the-potentially-septic-patient-in-the-ed/ |title=Risk Stratifying the Potentially Septic Patient in the ED |format= |work= |accessdate=2012-04-20}}</ref>=== | ||
The precise scoring system for the MEDS score is as follows: | The precise scoring system for the MEDS score is as follows: | ||
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*If the patient is a resident of a nursing home - '''2 points''' | *If the patient is a resident of a nursing home - '''2 points''' | ||
*If the patient has a lower [[respiratory]] infection - '''2 points''' | *If the patient has a lower [[respiratory]] infection - '''2 points''' | ||
===Point Correlation<ref name="urlRisk Stratifying the Potentially Septic Patient in the ED">{{cite web |url=http://www.epmonthly.com/the-literature/evidence-based-medicine/risk-stratifying-the-potentially-septic-patient-in-the-ed/ |title=Risk Stratifying the Potentially Septic Patient in the ED |format= |work= |accessdate=2012-04-20}}</ref>=== | ===Point Correlation<ref name="urlRisk Stratifying the Potentially Septic Patient in the ED">{{cite web |url=http://www.epmonthly.com/the-literature/evidence-based-medicine/risk-stratifying-the-potentially-septic-patient-in-the-ed/ |title=Risk Stratifying the Potentially Septic Patient in the ED |format= |work= |accessdate=2012-04-20}}</ref>=== | ||
The total score will be added up and that total will correlate to the mortality percentage with a 95% confidence interval. The following are the point ranges associated with various mortality percentages. | The total score will be added up and that total will correlate to the mortality percentage with a 95% confidence interval. The following are the point ranges associated with various mortality percentages. | ||
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==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Needs content]] | |||
[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Infectious disease]] | [[Category:Infectious disease]] | ||
[[Category:Causes of death]] | |||
[[Category:Intensive care medicine]] | [[Category:Intensive care medicine]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
{{WikiDoc Help Menu}} | {{WikiDoc Help Menu}} | ||
{{WikiDoc Sources}} | {{WikiDoc Sources}} | ||
Revision as of 17:27, 18 December 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.D. [2]
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Overview
There are many complications associated with sepsis, especially because it is a systemic phenomenon. Sepsis is a severe condition, and the prognosis of the patient will depend greatly on the condition and overall health of the patient. Many factors, such as age, hosts immune response, site of infection, type of infection, appropriate antibiotic therapy, and restoration of circulation of perfusion contribute to the overall prognosis.
Complications
- Disseminated intravascular coagulation (DIC) can be the result of sepsis.
- Acute tubular necrosis (ATN) leading to acute renal failure, can be the result of hypoperfusion of the kidneys in sepsis (i.e. not enough blood gets to the kidney and they stop working properly).
- Arrhythmia is an abnormal heart rhythm; it can be the result of sepsis.
- Ileus or ischemic colitis can be the result (hypoperfusion) or cause of sepsis.
- Multiple organ dysfunction syndrome can be the result of sepsis.
- Meningitis, infection of the tissue that covers the brain and spinal cord, can be a complication or cause of sepsis.
- Osteomyelitis is an infection of the bone; it can be the cause or result of sepsis.
- Endocarditis, infection of the inner surface of heart which is in contact with blood, can also be a complication or cause of sepsis.
- Pyaemia — causes abscesses.
Prognosis
Prognosis can be estimated with the MEDS (Mortality in Emergency Department Sepsis) score.[1]
MEDS Score Criteria
- Altered mental status
- Lower respiratory infection
- Granulocytic bands > 5% of WBC
- Patient older than 65
- Shock from sepsis
- Platelet count below 150,000
- Terminal illness with an immediate possibility of death within one month
- Hypoxia
- Tachypnea
Point System[2]
The precise scoring system for the MEDS score is as follows:
- Rapidly progressing terminal co-morbid illness - 6 points
- If the patient is older than 65 years of age - 3 points
- If the granulocytic bands are greater than 5% - 3 points
- If the patient has tachypnea or hypoxia - 3 points
- If the patient is in shock - 3 points
- If the patient has a platelet count of less than 150,000 mm3 - 3 points
- If the patient has an altered mental status - 2 points
- If the patient is a resident of a nursing home - 2 points
- If the patient has a lower respiratory infection - 2 points
Point Correlation[2]
The total score will be added up and that total will correlate to the mortality percentage with a 95% confidence interval. The following are the point ranges associated with various mortality percentages.
- 0-4 points total - 0.6% mortality rate
- 5-7 points total - 5% mortality rate
- 8-12 points total - 19% mortality rate
- 13-15 points total - 32% mortality rate
- 15+ points total - 40% mortality rate
References
- ↑ Shapiro NI, Wolfe RE, Moore RB, Smith E, Burdick E, Bates DW (2003). "Mortality in Emergency Department Sepsis (MEDS) score: a prospectively derived and validated clinical prediction rule". Crit. Care Med. 31 (3): 670–5. doi:10.1097/01.CCM.0000054867.01688.D1. PMID 12626967.
- ↑ 2.0 2.1 "Risk Stratifying the Potentially Septic Patient in the ED". Retrieved 2012-04-20.