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Shock, Septic --- physiopathology

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Shock, septic --- Physiopathology

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INTRODUCTION: Sepsis, responsible for 2% of ail hospital admissions in one year, has a 30% mortality rate in Intensive Care Units (ICU). Several scores are used to evaluate critical patients and their prognosis. The SOFA score helps to establish the importance of organic dysfonctions and is based on six criteria. One of these criteria is the bilirubin level. During a sepsis, a pathologie level of bi lirubin is associated with a higher risk of death. However the overall evaluation of the liver fonction is important for the prognosis. The main purpose of this study is to determine which enzyme or metabolic product is correlated to a higher risk of death during a septic shock. METHOD: We conducted a prospective study including 100 adult patients hospitalised in the ICU of Saint-Luc Hospital from 20 11 to 2013. Among them, 50 patients presented a severe sepsis or a septic shock. We measured the levels of bilirubin, lactate, INR, glycemia and hepatic enzymes during their hospitalisation period in the ICU. This group was compared to 30 patients who underwent a hepatic transplant, and to 20 patients who had a cardiac surgery and a subsequent vasopressor treatment. The same biologie parameters were measured for those two groups. RESULTS AND DISCUSSION: On average the hospital isation period in ICU of patients with severe sepsis and septic shock lasted for 8, 3 days, with a mortality rate of 30%. Patients who underwent a liver transplant stayed in ICU for 5, 2 days and the mortality after the surgery was 10%.The bilirubin level of patients who died due to sepsis (5,21 mg/dl) is similar to the bilirubin of patients who left the ICU after the liver transplant (5,39 mg/dl). Among septic patients there is a significant difference between the bilirubin levels of patients who died (5,21 mg/dl) compared to those who survived (1,05 mg/dl). On the other hand, among the patients who had a liver transplant, the bilirubin levels were similar in patients who died (5,37 mg/dl) and patients who survived (5,39 mg/dl). We concluded that the bilirubin is not a good prognostic factor after a liver transplant. The death of septic patients occurs with a lactate level 2, 6 times higher than for those who recover (respectively 5, 92 and 2, 27 mmol/l). The same conclusion can be done for the liver transplants, where the lactate level is 2, 68 mmol/l among the recovery group and 9,82 mmol/l for the patients who