Factors influencing mortality in ICU hospitalized patients with severe sepsis: A systematic review and meta-analysis

Abstract

Sepsis is one of the primary causes of mortality in the world. When the sepsis develops into acute organ dysfunction it is considered severe. Severe sepsis increases the economic burden by means of potential treatment for inflammatory responses and multiple organ failure. Several factors, including age, inappropriate use of antibiotics, comorbidities, multiple organ dysfunction, and site of infection, are considered to increase mortality risk in severe septic patients. This systematic review analyses various factors influencing mortality in ICU-hospitalized patients with severe sepsis. A systematic search for relevant articles up to September 2022 was carried out on 6 electronic databases, including Scopus, MEDLINE, PubMed, ScienceDirect, Embase and Google Scholar. Of 1078 articles, only nine studies were reviewed after meeting the inclusion criteria. Meta-analysis of three studies reveal significantly more fatality in older patients than the younger (OR; 2.28: 1.65, 3.15: 95% CI: I 2 = 11%, P <0.00001). The number of organ failure also significantly influences the mortality with the mortality rate being higher for patients with ≥4 organ failures (OR; 0.19: 0.11, 0.30: 95% CI: I 2 = 93%: P <0.00001). The mortality rates for hospital-acquired, community-acquired and ICU-acquired infections were 0.41 (95% CI; 0.18, 0.69), 0.40 (95% CI; 0.20, 0.63), and 0.42 (95% CI; 0.44, 0.53), respectively. Gender shows no significant difference on mortality rates (OR; 1.05: 0.95, 1.16: 95% CI: I 2 = 27%: p = 0.35). Age, the number of organ failures, and the acquisition sites seem to significantly influence the mortality, while gender has an insignificant influence on the mortality of ICU-admitted severe septic patients.