Sepsis in the intensive care unit: from definitions to outcomes

Sepsis, a life-threatening syndrome caused by a dysregulated response to infection, causes 20% of all deaths worldwide and is the costliest healthcare condition with US$ 32.000 per admission. This thesis investigated the epidemiology, causes of death, potential new mechanisms, treatment, and outcomes of sepsis. It was shown that the new septic shock definition identified a smaller, but more severely ill subpopulation of sepsis patients. One in three patients had an active malignancy and these patients had a 2.5 times higher chance of dying. One in three patients with sepsis dies within 48 hours in the ICU, most often because of multi-organ failure, bowel ischemia, or cardiac arrest. Autopsy in these patients showed major discrepancies with clinical diagnoses. Empirical antibiotic treatment was inadequate in 14% of patients with septic shock, however, adding a second agent did not lead to improved outcome. Mechanically ventilated patients with COVID-19 and a higher degree of coronary artery calcification had more severe organ failure during admission. Cardiac biomarkers were more increased in non-survivors with COVID-19.