Utility and impact of early diagnostic assessment of sepsis on mortality in an emergency department of a tertiary hospital in Lagos, Nigeria

CONTEXT

Currently, little is known about the timely application of clinical screening tools and blood sampling for decision-making in the management of patients with suspected sepsis in the accident and emergency units of hospitals in Nigeria.

AIM

The aim of the study was to ascertain the association between the time taken for the conduct of serum lactate and blood culture investigations following a clinical suspicion of sepsis, and the mortality of patients admitted to a Nigerian tertiary hospital.

METHODS

Over a 6-month period (November 2021 to April 2022), 119 patients hospitalised for sepsis or septic shock at the Lagos University Teaching Hospital were followed until discharge or death. The proportion of patients whose serum lactate, serum procalcitonin and blood culture samples was taken was also determined. Predictors of mortality were determined using bivariate analysis and logistic regression. Kaplan-Meier plots were used to predict survival using sepsis diagnostic criteria.

RESULTS

Eighty (67%) of 119 sepsis patients met systemic inflammatory response syndrome or quick sequential (sepsis-related) organ failure assessment criteria. Only 3 (2.5%) patients had blood cultures and serum procalcitonin and 0 (0%) had serum lactate tests. Forty-one (34.5%) patients died, but clinical and laboratory procedures for sepsis management were not linked to death. A shorter hospital stay increased the death risk (χ² = 14.83, P = 0.002).

CONCLUSION

This study revealed low compliance with sepsis care guidelines and no impact of timely clinical and laboratory procedures on sepsis mortalities. Further study is needed to explore patient care models that can improve the objective assessment and treatment of sepsis patients in emergency departments of busy tertiary hospitals.

Prevalence and Pattern of Electrolyte Imbalance in Hypertensives Admitted in Nigerian Teaching Hospitals

BackgroundHypertension not only predispose to cardiovascular diseases, it is also associated with electrolyte imbalances (EIs), which in most cases subtly impacts on morbidity and mortality. We aimed to determine the prevalence and pattern of EI in hospitalized hypertensives from three teaching hospitals in Nigeria.MethodologyThis was a retrospective study of hypertensive patients who were admitted in three teaching hospitals in the cities of Lagos, Kano and Ogbomosho, Nigeria. Medical records and serum electrolyte results done at the point of admission were retrieved and analyzed.Results159 admitted hypertensive patients who had analysis of their electrolytes were recruited of which 106 (66.7%) were males, while 53(33.3%) were females. Majority of patients (138 {86.8%}) had at least one EI, while only 21 (13.2%) had normal electrolytes.  39(24.5%) patients had more than two EIs; 55(34.6%) had two EIs, while 44(27.7%) had one EI. The commonest electrolyte abnormality was hyponatremia seen in 63 (39.6%) patients, followed by hypokalemia, reduced bicarbonate and hypochloremia found in 58 (36.5%), 53(33.3%), and 40 (25.2%) respectively.EI was more prevalent among females (96.2% vs 82.1% in males; p=0.002), patients who had tachycardia (94.3% vs 80.9% of patients without tachycardia; p=0.042) and those with elevated diastolic blood pressure DBP (p=0.034).ConclusionEIs are very common among hospitalized hypertensive patients, with most of them having multiple derangements. EI was more prevalent in females, patients with tachycardia and elevated (DBP).Key words: Hospitalized hypertensive, electrolyte imbalances, Potassium, Sodium, bicarbonate, Chloride.

Medical mortality in an emergency department in Nigeria: the transition is obvious!

Introduction

The emergency department (ED), a major entry point into the hospital, provides an insight to the type of cases seen, the quality of care and mortality spectrum in a health institution. We aim to identify the spectrum of medical causes of mortality in our ED, the demographic pattern and duration of stay before death.

Method

This is a retrospective study that looked at medical mortality in the ED from January 2004 to December 2009. We obtained data on the demographics and causes of death from the medical records and case notes of the deceased.

Results

A total of 16587 patients were admitted during the period under review, of these 1262 (7.61%) died in the ED. The male to female ratio was 1.58:1.0 [772 males (61.2%), and 489 females (38.8%)]. Mortality was highest among the 20–45 years age range, followed by 46–65 years, >65 years and < 20 years in decreasing frequency [589(46.7%), 421(33.4%), 186 (14.8%) and 66(5.2%) respectively]. The three most common causes of death were stroke 315(25%), HIV related illnesses 126(10.0%), and heart failure 123(9.7%). Most deaths occurred less than 24hours of admission, 550(43.6%), followed by one day (36.0%) and two days (10.8%) post admissions respectively.

Conclusion

The commonest cause of death in the ED was stroke. The burden of death was highest in the younger age group, with most occurring less than 24 hours of admission.

Profile of Hospitalized Hypertensives with Preserved and Reduced Left Ventricular Ejection Fraction in Nigeria

Introduction The impact of preserved and reduced left ventricular ejection fraction (LVEF) has been well studied in heart failure, but not in hypertension. We aimed to highlight the prevalence, clinical characteristics, comorbidities and outcomes of hospitalized hypertensives with preserved and reduced LVEF from three teaching hospitals in Nigeria. Methods: This is a retrospective study of hypertensives admitted in 2013 in three teaching hospitals in Lagos, Kano and Ogbomosho, who had echocardiography done while on admission. Medical records and echocardiography parameters of the patients were retrieved and analyzed. Results: 54 admitted hypertensive patients who had echocardiography were recruited, of which 30 (55.6%) had reduced left ventricular ejection fraction (RLVEF), defined as ejection fraction <50%; while 24 (44.4%) had preserved left ventricular ejection fraction (PLVEF). There were 37(61.5%) females and 17 (31.5%) males. Of the male patients 64.7% had RLVEF, while 35.3% had PLVEF. 19(51.4%) of females had RLVEF, while 48.6% had PLVEF. Mean age of patients with PLVEF was 58.83±12.09 vs 54.83± 18.78 of RLVEF; p-0.19. Commonest comorbidity was Heart failure (HF) followed by stroke (found among 59.3% and 27.8% of patients respectively). RLVEF was significantly commoner than PLVEF in HF patients (68.8% vs 31.3%; p- 0.019); no significant difference in stroke patients (46.7% vs 53.3%; p-0.44). Mortality occurred in 1 (1.85%) patient who had RLVEF.         Conclusion: RLVEF was more common than PLVEF among admitted hypertensive patients; they also have more comorbidities. In-hospital mortality is, however, very low in both groups.