الفهرس 
SEPSISOnly 14 pages are availabe for public view
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Abstract
Background: Sepsis is a syndrome of physiologic, pathologic and biochemical abnormalities induced by infection. Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection, which may progress to septic shock. Sepsis is now officially defined as a dysregulated host response to an infection, causing life-threatening organ dysfunction. This new definition, and accompanying clinical criteria, will hopefully provide a stronger, more consistent base to better inform incidence, outcomes and research. The nature of sepsis is extremely complex. Diagnosis often relies upon clinician image as definitive microbiological evidence of a precipitating infection is often absent.
Aim of the work: The aim of this study is to asses the value of lactate clearance in early prediction of prognosis of septic patients versus traditional tools as (age, initial lactate, SOFA score and APACHII score). The hypothesis of this study that lactate clearance is better stratification tool than initial lactate.
Patient and Methods: After approval of the Medical Ethics Committee of Ain Shams Faculty of Medicine, an informed consent was taken from the patient or next of kin to include his/her data in this study. This study was carried out on 50 adult patients (n=50) who were admitted to the Critical Care Medicine department, Ain Shams Main University Hospital for six months (from 1st of January 2019 to 30th of May 2019) with the diagnosis of sepsis.
Results: This observational study was conducted on 50 adult septic patients of both sexes. Then, they were categorized into 2 groups according to the primary endpoint (outcome) “7-days mortality”.28-days mortality was the secondary endpoint as death due to causes other than infection cannot be fully excluded. 21 patients (42.0%) were died (non-survivors group) and another 29 patients (58.0%) were survived (survivors group).
Conclusion: In the light of the current study, we conclude that:
Pneumonia was the most common cause of sepsis.
Higher APACHE II, CRP level, serum creatinine, respiratory rate, heart rate and temperature were associated with poor prognosis in sepsis patients.
Lower systolic blood pressure or diastolic pressure were also associated with poor prognosis.
Age has significant correlation with 7-days mortality at cut off value of ≥65 years.
SOFA score has significant correlation with 7-days mortality at cut off value of ≥5.
Arterial Lactate level has significant correlation with 7-days mortality at cut off value of ≥3.25 mmol/L.
A new score arbitrarily mentioned “ALSOFA score” consisted of age, arterial lactate and SOFA score could be implemented to stratify patients with sepsis as it showed significant prediction of poor prognosis measured as 7-days mortality at cut off value ≥10.
Recommendations:
Further larger studies should be conducted to test the validity of the new scores.
Stratification of sepsis patients on admission should be done during initial assessment.
Simple, available and cheap markers should be used in such score. Scoring systems should always be evaluated within the context of the individual patient, and not as a hard criterion for ICU admission.
A new stratification score (ALSOFA score) could be used as a stratification tool upon admission