Prognostic factors of sepsis following laparoscopic hiatal hernia repair

Table 1 Baseline characteristics of the study population (n = 214)

Characteristic	Total (n = 214)	Sepsis (n = 42)	Non-sepsis (n = 172)
Age, years	62.1 ± 11.9	67.4 ± 10.3	59.8 ± 11.7
Female sex	128 (59.8)	23 (54.8)	105 (61.0)
BMI, kg/m2	28.4 ± 5.1	30.2 ± 5.8	27.9 ± 4.8
ASA class ≥ III	74 (34.6)	24 (57.1)	50 (29.1)
Hypoalbuminemia	46 (21.5)	16 (38.1)	30 (17.4)
Diabetes mellitus	58 (27.1)	16 (38.1)	42 (24.4)
Operative time, minutes	148 (112–196)	192 (151–247)	138 (106–178)
Hernia type IV	68 (31.8)	16 (38.1)	52 (30.2)
Preoperative creatinine, mg/dL	0.92 ± 0.31	1.08 ± 0.42	0.88 ± 0.27
SOFA score at sepsis onset	—	6.0 (4.0–9.0)	—

Data are presented as mean ± SD, n (%), or median (interquartile range).

ASA: American Society of Anesthesiologists; BMI: Body mass index; SOFA: Sequential Organ Failure Assessment.

Table 2 Multivariable predictors of postoperative sepsis

Variable	OR	95%CI	P value
ASA class ≥ III	3.42	1.68–6.97	0.001
Operative time > 180 minutes	2.85	1.41–5.77	0.003
Preoperative hypoalbuminemia	2.61	1.27–5.35	0.009
Age ≥ 65 years	1.88	0.92–3.86	0.083
Diabetes mellitus	1.64	0.79–3.43	0.187
Hernia type IV	1.42	0.68–2.97	0.350

Reference categories: American Society of Anesthesiologists class I–II; operative time ≤ 180 minutes; albumin ≥ 35 g/L.

ASA: American Society of Anesthesiologists; CI: Confidence interval; OR: Odds ratio.

Table 3 Acute kidney injury stage distribution and associated outcomes among patients with sepsis (n = 42)

Parameter	No AKI (n = 24)	AKI stage 1 (n = 7)	AKI stage 2 (n = 6)	AKI stage 3 (n = 5)
In-hospital mortality	0 (0.0)	1 (14.3)	2 (33.3)	4 (80.0)
ICU admission	6 (25.0)	5 (71.4)	6 (100.0)	5 (100.0)
Vasopressor requirement	4 (16.7)	3 (42.9)	4 (66.7)	5 (100.0)
RRT required	0 (0.0)	0 (0.0)	0 (0.0)	3 (60.0)
ICU LOS, days		5.0 (3.0–7.0)	9.5 (7.0–13.0)	16.0 (10.0–22.0)
Hospital LOS, days	11.0 (8.0–15.0)	16.0 (12.0–21.0)	22.0 (17.0–31.0)	28.0 (19.0–41.0)

Data are presented as n (%) or median (interquartile range).

AKI: Acute kidney injury; ICU: Intensive care unit; LOS: Length of stay; RRT: Renal replacement therapy.

Table 4 Independent predictors of acute kidney injury among patients with sepsis (n = 42)

Variable	OR	95%CI	P value
SOFA score ≥ 8 at sepsis onset	4.73	1.52–14.72	0.007
Vasopressor requirement	3.86	1.24–12.04	0.020
Elevated preoperative creatinine	3.14	1.03–9.61	0.044
Age ≥ 70 years	2.21	0.87–5.64	0.092
Diabetes mellitus	1.83	0.82–4.08	0.141

CI: Confidence interval; OR: Odds ratio; SOFA: Sequential Organ Failure Assessment.

Table 5 Organ failure profile: Acute kidney injury vs non-acute kidney injury among patients with sepsis

Organ failure parameter	AKI (n = 18)	Non-AKI (n = 24)
In-hospital mortality	7 (38.9)	0 (0.0)
Respiratory failure	10 (55.6)	5 (20.8)
Mechanical ventilation	8 (44.4)	2 (8.3)
Cardiovascular failure	12 (66.7)	4 (16.7)
Hepatic dysfunction	6 (33.3)	2 (8.3)
Peak SOFA score	10.5 (8.0–14.0)	5.0 (3.0–7.0)

Data are presented as n (%) or median (interquartile range).

AKI: Acute kidney injury; SOFA: Sequential Organ Failure Assessment.

Table 6 Discriminative performance of prognostic scoring systems for in-hospital mortality

Scoring system	AUC	95%CI	Sensitivity (%)	Specificity (%)
SOFA score at onset	0.891	0.797–0.951	85.7	82.9
KDIGO AKI stage	0.864	0.764–0.933	100.0	72.7
APACHE II score	0.843	0.739–0.917	71.4	85.7
qSOFA score	0.742	0.629–0.836	71.4	71.4
Combined SOFA + KDIGO	0.924	0.852–0.978	100.0	82.9

AKI: Acute kidney injury; APACHE II: Acute Physiology and Chronic Health Evaluation II; AUC: Area under the curve; CI: Confidence interval; KDIGO: Kidney Disease: Improving Global Outcomes; qSOFA: Quick Sequential Organ Failure Assessment; SOFA: Sequential Organ Failure Assessment.