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Cardiovascular Factors under Sepsis

Sepsis


Sepsis is the body’s extreme reaction to an untreated infection. It can become a life-threatening emergency when the body attacks its own organs and tissues leading to tissue damage, organ failure, and even death. The first stage of Sepsis is SIRS, which is Systematic Inflammatory Response Syndrome. SIRS leads to the release of various inflammatory moderators (such as cytokines) into the bloodstream. This inflammatory surge can affect the production and release of red blood cells from the bone marrow, influencing hemoglobin levels.

 

There are basically 4 criteria to assess if patients are in SIRS, Sepsis, Severe Sepsis and Septic Shock stages (Exhibit I). The criteria include – Temperature between 35degrees C and 38 degrees C, Heart Rate more than 90 bpm (beats per minute), more than 20 breaths per minute or PaCo2 < 32 mmHg and Leukocytes between 4000 mm3 and 12000 mm3.


Exhibit I


To analyze these conditions, the data consisting of 43 variables is used to predict the onset of Sepsis among patients. The sample size is 1.5 million. The data can broadly be classified into –Demographics, Vital Signs, Lab Values, Patients. The analysis for this article has been limited to just cardiovascular factors although there is immense scope to study all organs of the human anatomy.


Furthermore, cardiovascular factors or biomarkers are analyzed under the stages of Sepsis. These variables include Heart Rate, Platelets, Hemoglobin, Fibrinogen, White Blood Cells, and Prothrombin Time. The dataset is analyzed through Tableau which is a BI (Business Intelligence) tool. The prediction of Sepsis can be investigated early on based Heart Rate (HR) and BP. The most common symptom is elevated HR – a condition known as Tachycardia. The Normal range of HR is 60 to 100 bpm.  In the early stage of Sepsis, tachycardia might range from 90 to 120 bpm or higher. In the Severe Sepsis stage, HR can often exceed 120 bpm, and values of 130 bpm or higher. Under Septic Shock stage, HR exceeding 130 bpm or even 140 bpm can be observed.

 

There are many factors like hemoglobin, fibrinogen, lactate, and platelet count etc. that affect the heart of the patient. (Exhibit II)


Exhibit II

 Factors relating to Heart under three stages of Sepsis

Stages

Hemoglobin

Fibrinogen

Lactate

Platelet count

Thrombosis

Sepsis

around 12 to 14 grams per deciliter (g/dL)

200 to 500 milligrams per deciliter (mg/dL)

Normal Range: 0.5 to 2.0 millimoles per liter (mmol/L).

Elevated Lactate in Sepsis: 2.0 to 4.0 mmol/L.

.

Mild Thrombocytopenia in Sepsis: 100,000 to 150,000 platelets per microliter.

Microvascular thrombosis may occur, contributing to impaired tissue perfusion.

Severe Sepsis

below 10 g/dL

< 200 mg/dL

Higher Lactate in Severe Sepsis: 4.0 to 6.0 mmol/L.

 

Moderate Thrombocytopenia in Severe Sepsis: 50,000 to 100,000 platelets per microliter.

Microvascular thrombosis may contribute to organ failure, particularly in organs with high microvascular density such as the kidneys and lungs

Septic Shock

below 8 g/dL or even lower

Much lesser

Critical Lactate in Septic Shock: >6.0 mmol/L

Severe Thrombocytopenia in Septic Shock: <50,000 platelets per microliter

Thrombosis in large vessels can occur, leading to complications such as deep vein thrombosis (DVT) or arterial thrombosis

Exploring a Sepsis dataset, Tachycardia could be found most among male patients above 61 years. Even 41-year-old male patients are at risk more than 61-year-old female patients. (Exhibit III)

 

Exhibit III

Correlation among the cardiovascular factors help indicate and detect abnormalities. In the heatmap below, it’s clearly seen that fibrinogen and platelets are highly correlated which might help in detecting coagulation dysfunctionalities. Other negative and mild correlations can be explored through the heatmap (Exhibit IV).


Exhibit IV


Thrombocytopenia is a condition in which the platelets (also called thrombocytes) are low in number, which can result in bleeding problems. Platelets are a type of blood cell that are important for helping blood to clot. Analysis of Sepsis patients in the dataset with high thrombocytopenia has been exhibited by the waffle chart displaying 61- and 80-years old male having the lowest level of platelets. (Exhibit V).

 

Exhibit V


Tableau tool yields an ample opportunity to explore data and present advanced-level charts and graphs implying transformed facts to insightful knowledge. Box plot chart demonstrates higher hemoglobin levels are associated with Sepsis patients (Exhibit VI).

 

Exhibit VI


Tableau works with a worksheet-based interface where individual sheets are created to build visualizations. Fields from data source are dragged and dropped onto rows and columns shelves to start building a variety of visualization types, such as bar charts, line charts, scatter plots, and maps. Apart from this, analysts could create calculated fields using formulas to perform custom calculations. This can include mathematical operations, aggregations, and logical expressions. In the present dataset, SIRS and Septic Shock patient count could be calculated using a range as displayed below (Exhibit VII)


Exhibit VIII










Upon various calculations and applying abnormal counts, out of the total SIRS patients – Sepsis patients were a 2325 (including onset patients) and this number was narrowed down to 298 Septic Shock patients (Exhibit VIII) which are considered high risk and come under abnormal range.

Exhibit VIII

Stages of Sepsis – Patients based on SIRS Criteria


In summary, a more detailed analysis of organ failures can be achieved by refining the counts and numerical data. By considering scores from assessments such as SOFA (Sequential Organ Failure Assessment), APACHE (Acute Physiology and Chronic Health Evaluation), and ABG (Arterial Blood Gas) Analysis, it becomes possible to delve into a more comprehensive understanding of morbidity and the anticipated mortality rates.

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