THE KEY ROLE OF THE PATHOLOGIST IN SEPSIS-RELATED RISK AND CLAIMS MANAGEMENT OF TERTIARY HOSPITALS

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Debora De Bartolo, Vincenzo Arena, Simone Grassi, Francesco Ausania, Santo Gratteri, Antonio Oliva , Pietrantonio Ricci

Sepsis is one of the leading causes of death even in the tertiary hospitals of Western Countries and sepsis-related in-hospital mortality contributes to define hospital performance and quality of care. A better understanding of its epidemiological and pathological characteristics seems the key to tailor public health interventions aimed at reducing its incidence, morbidity and mortality. A retrospective analysis of 109 autoptic cases of inpatients that acquired sepsis in a tertiary hospital was performed. In particular, we identified and analysed the recurrent anamnestic/clinical factors and histopathological features.  The most common continuous foci were due to respiratory infections. Subendocardial myocardial ischaemia was the clinical cause of death in 56.8% of the study population. An inflammatory infiltrate was identified in specimens of the lung (28.4%), liver (28%), heart (23.5%) and kidneys (15%). Common findings were arteriosclerosis and atherosclerosis (57%), steatosis (24.5%), diffluent spleen (18%) and colliquation of adrenal glands (16.6%). The comorbidities and the autoptic features founded are consistent with the previous evidences in sepsis field. Clinical autopsy is certainly a useful tool to collect data on sepsis, but we did not find any feature that can be considered specific or sensitive for the diagnosis of sepsis. More efforts should be made in the direction of a multidisciplinary approach to in-hospital sepsis autopsies to grant pathologists a key role in the management of claims and clinical risk.

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