Sepsis prognosis

Septic patients may have an elevated, low, or normal temperature. The absence of fever is common in neonates and elderly patients. Hypothermia is associated with a poor prognosis. Hyperventilation may occur before fever and chills and may lead to respiratory alkalosis. Disorientation and confusion may develop early in septic patients, particularly in the elderly and patients with preexisting neurologic impairment. Disorientation and confusion may be related to the infection or due to sepsis signs and symptoms (e.g., hypoxia). 

Delirium can be mistaken for a TIA if mild, when the predominant feature is interpreted as language disorder as opposed to confusion and when important clinical details are unclear such as when a witness account is unavailable, the patient has cognitive impairment or there is a long delay between the event and assessment. Reliable differentiation between TIA and delirium is important because each carries a potentially poor prognosis, though for very different reasons and the treatments are dissimilar (Siddiqi et al. 2006). Features suggestive of delirium as opposed to TIA include the presence of a causative factor such as urinary tract sepsis, an inability of the patient to remember the event clearly, fluctuating disturbance in attention and consciousness and the absence of a clearly sudden onset. 

Staphylococci, streptococci In sepsis, toxic liver damage and portal granulocytic infiltration may be observed. Septic bacterial invasion of the liver mainly entails periportal, circumscribed and non-suppurative septic foci (s. fig. 24.1), and occasionally multiple microabscesses as well. (10) Cholestasis usually suggests a severe course of disease likewise, prolonged jaundice points to a poor prognosis as far as the underlying disease is concerned. (1, 2, 4, 6-8)... 

Retransplantation is required in 5-10% of patients. The main indications are primary graft failure, hepatic arterial thrombosis and chronic rejection. Results of retransplantation are not so satisfactory as with the first LT the survival rate is shorter and mortality (usually due to sepsis) is mostly within 6 months. Nevertheless, the prognosis is improving steadily. (407)... 

Cytokine concentrations reflect the severity of some diseases and are markers of prognosis. This is particularly applicable for infectious diseases (bacterial sepsis and parasitological infections) and immune disorders (autoimmune diseases, such as rheumatoid arthritis and systemic lupus erythematosus, and allergic diseases, such as asthma and skin hypersensitivity). 

At the most recent consensus conference, the definitions were revised to include additional criteria for the diagnosis of SIRS and sepsis. A new staging system was developed to facilitate a more accurate staging of sepsis disease and the associated risks and prognosis. However, extensive testing and further refinement are needed before clinical application. 

Alteration in mental status occurring in patients with systanic sepsis always carries a serious prognosis. The mechanisms of impaired brain function are poorly understood and are probably multifactorial. Considerations include hypoxia, ischemia, mitochondrial dysfunction and anaerobic cerebral energy metabolism, blood-brain barrier dysfunction or impaired transporter function, cerebral edema, toxins like ammonia or endotoxins, and last but not least, clinical use of cerebral depressants and sedatives in severely ill patients. In patients with multi-organ failure, clearance of common short-acting sedatives can become prolonged, resulting in severe and protracted alteration of mentation. 

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