Date of Award

12-2022

Degree Type

Thesis

Degree Name

MS in Epidemiology & Biostatistics

First Advisor

Dr. Muslima Ejaz

Second Advisor

Dr. Shafquat Rozi

Third Advisor

Dr. Nosheen Nasir

Department

Community Health Sciences

Abstract

Introduction: Sepsis is the largest cause of death, in adult population with an estimated 49 million cases worldwide and 11 million fatalities each year. Abnormal coagulation is frequently observed in 30 to 60% of sepsis patients. Usually, sepsis patients have pooroutcomes because of shock and disseminated intravascular coagulation. In cases of coagulopathy with sepsis, mortality ranges from 45% to 75%.
Methods: This is a retrospective cohort study that has been conducted at Aga khan university hospital from 1st January 2020 to 31st December 2021. All adult patients with sepsis were included in the study who fulfils the eligibility criteria. Patients with sepsis[1]induced coagulopathy were considered exposed and patients without coagulopathy were considered non-exposed. For the identification of patients with sepsis we have used the International Society on Thrombosis and Haemostasis (ISTH) score, in which a score of 4 or more out of 6 signifies that the patient is having sepsis-induced coagulopathy, which is our main exposure. The ISTH score of less than 4 indicates that the patient doesn’t have sepsis-induced coagulopathy. The primary outcome was in[1]hospital mortality which is defined as death during the hospital stay. All patients were followed for the total hospital stay in days and were assessed for the outcomes after their final disposition. Descriptive analysis was performed, and normality was assessed by an independent t-test or Wilcoxon rank sum (Mann-Whitney test). Chi-square and Fischer’s exact tests were used for frequencies. Weibull regression was applied, keeping p-value < 0.25 as significance for univariate analysis. Then among them, multivariable analysis and model building was done. Adjusted hazard ratios with 95% confidence intervals were computed.
Results: A total of 361 patients presented with sepsis were included in the study. There were 280 patients in the exposed group and 81 in the unexposed group. 120 patients were censored, and 160 patients in the exposed group experienced an event (death). The hazard of death among patients with ISTH score ≥ 4 was 1.589 (95% CI 1.087 – 2.324) times higher compared to patients with ISTH score of < 4. Patients who experienced shock upon arrival to the hospital have a 2.989 (95% CI 1.966 – 4.544) higher risk of death than patients admitted to the ICU with better medical conditions. Patients who exhibited a glucose level less than 60 mg/dl in the hospital were 1.982 (95% CI 1.0856-3.620) more likely to have died than patients with high blood sugars. With every 1-day additional stay in the ICU, the risk of mortality among septic patients is delayed by 0.814 times (95% CI 0.778 – 0.851) compared to those patients with a shorter stay in the ICU. Female gender is significantly associated with a higher risk of mortality than males due to coagulopathy (Adjusted HR 1.818 with 95% CI 1.352 – 2.44).
Conclusion: In conclusion, the analysis supports the following finding: In comparison to a group that simply had a shock, mortality was higher in the group with sepsis and coagulopathy. It rises even more in the presence of a variable, such as shock, decreased blood glucose level, and a lengthier stay in the ICU. Early detection of patients who have both sepsis and coagulopathy is important, and a multidisciplinary approach combined with early care may reduce mortality.

First Page

1

Last Page

58

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