Improved Methods of Sepsis Case Identification and the Effects of Treatment with Low Dose Steroids: A Dissertation

摘要: Sepsis is the leading cause of death among critically ill patients and 10 th most common overall in United States. The mortality rates increase with severity disease, ranging from 15% for sepsis to 60% septic shock. Patient can present varied clinical symptoms depending on personal predisposition, causal microorganism, organ system involved, disease severity. To facilitate diagnosis, first consensus definitions was published 1991 then updated 2001. Early recognition a patient followed timely appropriate treatment management strategies have been shown significantly reduce sepsis-related mortality, allows care be provided at lower costs. Despite rapid progress knowledge pathophysiological mechanisms its last two decades, identifying therapeutic approaches complications remains challenging critical clinicians. Hence, objectives this thesis were 1) evaluate test characteristics delineate differences profile meeting or not definitions; 2) determine relationship between changes several physiological parameters before onset sepsis, whether these could used identify adults; 3) effect corticosteroids therapy mortality. Data prospectively collected an electronic medical record all adult admitted into seven units (ICUs) tertiary center. Besides analyzing data ICU stay level, we investigated information various time frames, including 24-hour, 12-hour, 6-hour windows. In study thesis, definition found high sensitivity 94.6%, but low specificity 61.0%. 2001 had slightly increased decreased specificity, which 96.9% 58.3%, respectively. areas under ROC curve similar, less than optimal. area both 24-hour window level those unit though slightly. At performed better definition. second study, minimum systolic blood pressure best, by maximum respiratory rate discriminating SIRS patients. Maximum heart differentiate non-SIRS fairly well. combination five 0.74 0.90 comparing non-infectious non-SIRS…