Sépsis em gastrenterologia: uma entidade subvalorizada?

Abstract

Introduction

Sepsis is a common disorder in all branches of Medicine, namely in Gastroenterology. Its high mortality rate can be decreased by an adequate early management, according to the international guidelines.

Aims

To evaluate the clinical impact of sepsis in a Gastroenterology department and to determine if it was correctly diagnosed and managed.

Patients and methods

Retrospective analysis based on data obtained from the clinical records. Selection of all patients admitted to a Gastroenterology department during one year presenting with sepsis criteria on hospital admission. Evaluation of demographic data and variables related to the appropriateness of the initial management – performance of blood cultures, evaluation of organ dysfunction and institution of prioritary interventions and antibiotic therapy. Statistical analysis was performed with SPSS® version 17 and Qui-square test (significance level of 0.05).

Results

We have identified 55 patients, in 56 hospital admissions (3.9% of the total admissions in the Gastroenterology department). All patients had infection and two or more criteria for systemic inflammatory response syndrome (SIRS), the most frequent being tachycardia (71.4%) and leukocytosis (66.1%). The biliary tract was the infectious source in 64.3% of cases. In 48.2% of the cases severe sepsis or septic shock criteria were present. The following procedures were not performed: blood pressure record in 14.3%, serum lactate measurement in 37.5%, urinary catheterization in 68.9% and central line placement in 94.6%. Blood cultures were obtained in the first 24 hours in 66.1% of cases and the median time to start antibiotics was 8.8 hours. Only 10.7% were admitted to an intensive care unit. The diagnosis of sepsis was established in the clinical records in only 6 cases. The mortality rate in these patients was higher than the overall mortality rate in the department (30.4% vs. 8.6%, p < .0001).

Conclusions

This study found that sepsis in Gastroenterology has a high mortality rate, but it is rarely recognized and its management is not always completely adequate as shown by the lack of severity signs evaluation, delayed antibiotic therapy and low admission rate to an intensive care unit. Therefore, it is necessary to promote continuing medical education about sepsis and to implement local protocols.