Sepsis natural history, complications and prognosis
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Synonyms and Keywords: sepsis syndrome; septic shock; septicemia
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.  
If left untreated sepsis can lead to multiorgan failure and eventually death.
- 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 kidney injury occurs in about 30% of patients and about 5% of patients need renal replacement therapy.
- 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.
The serum lactate level may be more predictive of outcomes than the serum bicarbonate.
Mortality can be estimated with the MEDS (Mortality in Emergency Department Sepsis)score. More complicated scores such as the Apache, Sequential Organ Failure Assessment (SOFA), and Logistic Organ Dysfunction System (LODS) can be used as well.
Mortality in Emergency Department Sepsis(MEDS) Point System
The components and their scores for the MEDS are described in the following table
|Rapidly progressing terminal co-morbid illness||6|
|Granulocytic bands are greater than 5%||3|
|If the patient has tachypnea or hypoxia||3|
|If the patient is in shock||3|
|If the patient has a platelet count of less than 150,000 mm3||3|
|Altered mental status||2|
|Resident of a nursing home||2|
|Lower respiratory infection||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
- Nonpersistent hypotension
- Bandemia at least 10%
- Lactate at least 4.0 mmol/L
- Past medical of coronary artery disease
- Female gender
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- GitHub Contributors. Prognosticating in sepsis with decision aids: a living systematic review. GitHub. Available at https://github.com/openMetaAnalysis/Sepsis-prognosticating-with-decision-aids/blob/master/README.md. Accessed January 26, 2017.
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