Examination of prognostic markers in patients with shock who died on intensive therapy

Abstract The prognosis of critically ill patients treated in intensive care units (ICUs) largely depends on the timely recognition and management of acute organ dysfunction. Sepsis, septic shock, and multi-organ failure remain among the leading causes of death. Laboratory-derived parameters are gaining attention as prognostic markers, as they are closely linked to the risk of sepsis and ICU mortality. This study aimed to examine the onset and progression of multi-organ failure in adult patients who died in ICUs, with particular emphasis on the prognostic role of inflammatory biomarkers. We also sought to assess the contribution of laboratory parameters and derived indices in predicting disease progression and mortality risk, and how these vary across different underlying disease groups. We conducted a retrospective study using data from patients who died in the ICUs of the Târgu Mureș County Emergency Clinical Hospital and the Emergency Institute for Cardiovascular Diseases and Transplantation. Data from 53 adult patients were analysed. Laboratory parameters were collected at three time points: hospital admission, ICU admission, and the day of death. Statistical analysis was performed using GraphPad Prism 10.4.1 software. The mean age of the 53 patients (35 men, 18 women) was 59.7 ± 16.02 years. Patients spent an average of 7.79 ± 6.75 days in hospital, including 4.78 ± 4.46 days in intensive care. At the last sampling before death, creatinine, GPT, GOT, LDH, and CRP levels were significantly higher, while haemoglobin was significantly lower compared with hospital admission values (p < 0.05). NLR peaked at ICU admission (p < 0.05) and decreased before death. The albumin/ALP ratio showed a strong positive correlation with the number of ICU days (p < 0.05, r² = 0.79). In patients who died in intensive care, inflammatory and organ function markers showed significant changes during disease progression, reflecting the worsening of multi-organ failure. NLR may serve as an indicator of disease progression, whereas creatinine, CK, and LDH levels may reflect the severity of the terminal stage.