Mortality Due to Septic Shock Associated With Thrombocytopenia in the Intensive Care Unit

Background

Sepsis has a high morbidity and mortality, hence is a challenging medical problem throughout the world. Three therapeutic principles must be taken into account to improve organ dysfunction and survival in sepsis: 1) early and adequate antimicrobial therapy; 2) reestablishment of adequate tissue perfusion; and 3) timely identification and control of the septic foci. Moreover, survival in sepsis depends on the timely identification and appropriate treatment. Progressive advances in sepsis management over the past decades have led to reduced mortality indices. Mortality rates have decline progressively from 43% in 1993 to 37% in 2003, to 29% in 2007; furthermore, reaching a low in 2012 of 18.4%. All in all, in order to establish a global outlook and adequate therapeutic algorithms for sepsis, the factors associated with high mortality rates in septic shock must be identified.

Severe sepsis and septic shock are two clinical entities that have a great impact on intra-hospital morbidity and mortality, as well as on the cost of health care systems; accounting for a large proportion among the causes of admission to the intensive care unit (ICU). In the United States in 2013, septicemia was the hospital condition that accounted for the highest cost, reaching a total cost of $23.7 billion dollars (i.e. 6.2% of total hospitalization costs); followed by osteoarthritis (i.e. $16.5 billion dollars, 4.3% of total hospitalization costs), births (i.e. $13.3 billion, 3.5%), complications arising from medical devices, implants or grafts (i.e. $12.4 billion, 3.3%), and acute myocardial infarction (i.e. $12.1 billion, 3.2%).

The prevalence of sepsis at the ICU across multiple centers in Spain ranges between 6 and 30%. Furthermore, more than 50% of patients with sepsis develop severe sepsis and 25% septic shock. Carrillo-Esper and colleagues (2009) report that in Mexican public and private institutions, 27.3% of 40,957 hospitalizations (i.e. 11,183 cases) developed sepsis. This study which included data from ICUs of 24 out of 32 federal entities reports a mortality secondary to sepsis of 30.4%. In Mexico, the hospitalization costs of patients with sepsis is also a cause of concern, with a total estimated cost of $835 million dollars and an average patient cost of $73,000 dollars.

Sepsis definition