Severe sepsis accounts for one in five admissions to intensive care units (ICUs) and is the leading cause of death in the noncoronary ICU.  Unfortunately, the outcome of sepsis has remained unacceptably high to the tune of 30%–40% despite the development and availability of an increasing array of higher-generation antibiotics with broader spectrum of coverage and advances in intensive supportive measures. Mortality Prediction Systems have been introduced as tools for assessing the performance of ICUs. They help in individual patient outcome prediction by reducing uncertainty and provide an opportunity for improved decision making.

Aims and Objectives: To assess the mortality of patients with sepsis and septic shock and to prognosticate the patients by using defined scores like SAPS II, APACHE II and SOFA scores.

Materials and Methods: This observational study included 120 patients with severe sepsis and septic shock and Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE II) and Simplified Acute Physiological Score II (SAPS II) and Sequential Organ Failure Assessment (SOFA) indices were calculated at baseline to assess the severity of illness.

Results: In this study the maximum number of patients were from the age groups 40 to 50 years (46 patients) and 60 to 80 years (45 years). Out of 120 patients 43 patients did not survive. Male to female distribution in this study noted was 49 and 71patients respectively. Respiratory and urosepsis was noted in 45% and 30% respectively. Among 120 patients, 35 patients had an increasing SOFA trend, out of which 34 did not survive (p<0.05). In this study it was observed that the SAPS II had the highest sensitivity (0.721) and APACHE II scoring had the highest specificity (0.766). When comparing individually all the three scoring systems were significant (p<0.05) in predicting the mortality, but SAPS II had the most area under the ROC curve (p value 0.047) with odds ratio of 1.449.

Conclusion: Individually, all the three scoring systems can be used to detect the outcome of the patient with sepsis and severe sepsis.

Keywords: APACHEE II scoring system, SAPS II scoring system, SOFA scoring system, Sepsis.

1. Sepsis definition 2015-The ACCP-SCCM Consensus Conference on Sepsis and Organ Failure Roger C. Bone, M.D., F.C.C.P. 'Correspondence information about the author M.D., F.C.C.P. Roger C. Bone, William J. Sibbald, M.D., F.C.C.P., Charles L. Sprung, M.D., F.C.C.P.
2. Sands KE, Bates DW, Lanken PN, Graman PS, Hibberd PL, Kahn KL, et al. Epidemiology of sepsis syndrome in 8 academic medical centres. JAMA 1997; 278: 234-40
3. Outcomes of Older Adults With Sepsis at Admission to an Intensive Care Unit, Theresa Rowe, Katy L. B. Araujo, Peter H. Van Ness, Margaret A. Pisani, and Manisha Juthani-Mehta
4. Gender-Based Differences in Outcome in Patients With Sepsis: Soumitra R. Eachempati, MD; Lynn Hydo, RN Philip S. Barie, MD, FCCM, FCCS,Arch, Surg. 1999;134(12):1342-1347. doi:10.1001/archsurg.134.12.1342
5. John M. Goldsmid and Peter A. Leggat. Primer of Tropical Medicine. Australasian College of Tropical Medicine Publication, 2005.
6. A prospective observational study assessing the outcome of Sepsis in intensive care unit of a tertiary care hospital, Peshawar, Arslan Rahat Ullah, Arshad Hussain, Iftikhar Ali, Abdul Samad, Syed Tajammul Ali Shah, Muhammad Yousef, and Tahir Mehmood Khan.
7. Sequential organ failure assessment scoring and prediction of patient's outcome in Intensive Care Unit of a tertiary care hospital, Aditi Jain, Sanjeev Palta, Richa Saroa, Anshu Palta,1 Sonu Sama, and Satinder Gombar
8. SAPS 2 is a better score than APACHE II to predict mortality in the ICU, G Nobre, M Kalichsztein, J Kezen, F Braga, G Almeida, G Penna, P Kurtz, P Araujo, R Vegni, M Freitas, and C Valdez.
9. A Prospective Study of Comparison of APACHE-IV & SAPS-II Scoring Systems and Calculation of Standardised Mortality Rate in Severe Sepsis and Septic Shock Patients,Ajay Somabhai Dabhi, Suhas S Khedekar, and Vadivelan Mehalingam corresponding author.
10. Scoring Systems in Assessing Survival of Critically Ill ICU Patients,Ana D. Sekulic,Sladjana V. Trpkovic, Aleksandar P. Pavlovic, Olivera M. Marinkovic, and Aleksandra N.
11. Sepsis definition criteria Adapted from Levy MM, Fink MP, Marshall JC, et al: 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 2003; 31: 1250–1256.
12. Balk RA. Severe sepsis and septic shock: definitions, epidemiology, and clinical manifestations. Crit Care Clin 2000; 16: 179-92.
13. Todi S, Chatterjee S, Sahu S and Bhattacharyya M. Epidemiology of severe sepsis in India: an update Crit Care. 2010; 14(Suppl 1): 382.
14. Advances in pathogenesis and management of sepsis:Cinel I, Dellinger RP ,Curr Opin Infect Dis. 2007;20 (4):345. 42
15. Gupta R, Arora VK. Performance evaluation of APACHE II score in an Indian patient with respiratory problems. Indian J Med Res. 2004 Jun; 119(6): 273-82.
16. Vincent, JL, Moreno, R, Takala, J, Willatts S, DeMendonca A, Bruining H, et The SOFA (sepsis-related organ failure assessment) score to describe organ dysfunction/failure: on behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 1996;  22: 707-710.
17. Ferreira FL, Bota DP, Bross A, Mélot C, Vincent JL. Serial evaluation of the SOFA scores to predict outcome in critically ill patients. JAMA. 2001 Oct 10; 286(14):1754-1758.
18. Pittet D, Thiévent B, Wenzel RP, Li N, Auckenthaler R, Suter PM. Bedside prediction of mortality from bacteremic sepsis. A dynamic analysis of ICU patients. Am J Respir Crit Care Med. 1996 Feb; 153(2): 684-93.
19. Usefulness of SAPS II Scoring System as an Early Predictor of Outcome in ICU Patients Prashant Prakash, Kavita Krishna, Deepansh Bhatia
20. Jean-Roger Le Gall, MD; Stanley Lemeshow, PhD; Fabienne Saulnier, MD. (1993). A New Simplified Acute Physiology Score (SAPS II) Based on a European/North American Multicenter Study. JAMA. 1993;270:2957-2963.

Dr S.R. Ramakrishnan

Professor, Sri Ramachanra Institute of higher Education and Research, Chennai, India