Factors influencing mortality in ICU hospitalized patients with severe sepsis: A systematic review and meta-analysis

Abstract

Sepsis is one of the primary causes of mortality in the world. When the sepsis develops into acute organ dysfunction it is considered severe. Severe sepsis increases the economic burden since funds to be used for developments are diverted to developing and evaluating potential treatments and studying the inflammatory responses and multiple organ failure due to severe sepsis. Several factors, including age, inappropriate use of antibiotics, comorbidities, multiple organ dysfunction, and site of infection, are considered to increase mortality risk in severe septic patients. Therefore, this systematic review evaluated the factors influencing mortality in ICU-hospitalized patients with severe sepsis. A systematic search for relevant articles up to September 2022 was carried out on 6 electronic databases, including Scopus, MEDLINE, PubMed, ScienceDirect, Embase and Google Scholar. Of 1078 articles, only 9 studies were reviewed after meeting the inclusion criteria. Meta-analysis of 3 studies showed that significantly more deaths were observed in older patients than in younger patients (OR; 2.28: 1.65, 3.15: 95% CI: I² = 11%, P <0.00001). The number of organ failure also significantly influenced the mortality with the mortality rate being higher for patients with ≥4 organ failures (OR; 0.19: 0.11, 0.30: 95% CI: I² = 93%: P <0.00001). The mortality rates for hospital-acquired, community-acquired and ICU-acquired infections were 0.41 (95% CI; 0.18, 0.69), 0.40 (95% CI; 0.20, 0.63), and 0.42 (95% CI; 0.44, 0.53), respectively. Gender showed no significant difference on mortality rates (OR; 1.05: 0.95, 1.16: 95% CI: I² = 27%: p = 0.35). Age, the number of organ failures, and the acquisition sites significantly influenced mortality, while gender has an insignificant influence on the mortality of ICU-admitted severe septic patients.