Predictors of early progression to severe sepsis or shock among emergency department patients with nonsevere sepsis

被引：51

作者：

Holder A.L. ^{[1
,8
]}

Gupta N. ^{[2
]}

Lulaj E. ^{[3
]}

Furgiuele M. ^{[4
]}

Hidalgo I. ^{[5
]}

Jones M.P. ^{[6
]}

Jolly T. ^{[7
]}

Gennis P. ^{[4
]}

Birnbaum A. ^{[4
]}

机构：

[1] Department of Medicine, Emory University School of Medicine, 1648 Pierce Dr NE, Atlanta, 30307, GA

[2] Beacon Health System, Elkhart General Hospital, 600 East Blvd, Elkhart, 46514, IN

[3] Department of Radiology, Emory University School of Medicine, 1648 Pierce Dr NE, Atlanta, 30307, GA

[4] Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210th Street, Rosenthal Red Zone, 2nd Floor, Bronx, 10467, NY

[5] Department of Emergency Medicine, Kingston Hospital, 396 Broadway, Kingston, 12401, NY

[6] Department of Emergency Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 1B-25, Bronx, 10461, NY

[7] Department of Emergency Medicine, Saint Francis Hospital and Medical Center, 114 Woodland Street, Hartford, 06105, CT

[8] Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Grady Memorial Hospital, 80 Jesse Hill Jr. Drive SE, Rm 2D012, Atlanta, 30303, GA

来源：

International Journal of Emergency Medicine | 2016年 / 9卷 / 1期

基金：

美国国家卫生研究院;

关键词：

Disease progression; Nonsevere sepsis; Organ dysfunction; Predictors; Sepsis progression;

D O I：

10.1186/s12245-016-0106-7

中图分类号：

学科分类号：

摘要：

Background: Progression from nonsevere sepsis—i.e., sepsis without organ failure or shock—to severe sepsis or shock among emergency department (ED) patients has been associated with significant mortality. Early recognition in the ED of those who progress to severe sepsis or shock during their hospital course may improve patient outcomes. We sought to identify clinical, demographic, and laboratory parameters that predict progression to severe sepsis, septic shock, or death within 96 h of ED triage among patients with initial presentation of nonsevere sepsis. Methods: This is a retrospective cohort of patients presenting to a single urban academic ED from November 2008 to October 2010. Patients aged 18 years or older who met criteria for sepsis and had a lactate level measured in the ED were included. Patients were excluded if they had any combination of the following: a systolic blood pressure <90 mmHg upon triage, an initial whole blood lactate level ≥4 mmol/L, or one or more of a set of predefined signs of organ dysfunction upon initial assessment. Disease progression was defined as the development of any combination of the aforementioned conditions, initiation of vasopressors, or death within 96 h of ED presentation. Data on predefined potential predictors of disease progression and outcome measures of disease progression were collected by a query of the electronic medical record and via chart review. Logistic regression was used to assess associations of potential predictor variables with a composite outcome measure of sepsis progression to organ failure, hypotension, or death. Results: In this cohort of 582 ED patients with nonsevere sepsis, 108 (18.6 %) experienced disease progression. Initial serum albumin <3.5 mg/dL (OR 4.82; 95 % CI 2.40–9.69; p < 0.01) and a diastolic blood pressure <52 mmHg at ED triage (OR 4.59; 95 % CI 1.57–13.39; p < 0.01) were independently associated with disease progression to severe sepsis or shock within 96 h of ED presentation. There were no deaths within 96 h of ED presentation. Conclusions: In our patient cohort, serum albumin <3.5 g/dL and an ED triage diastolic blood pressure <52 mmHg independently predict early progression to severe sepsis or shock among ED patients with presumed sepsis. © 2016, Holder et al.

引用

页码：1 / 11

页数：10

共 41 条

[1]

Glickman S.W., Caimes C.B., Otero R.M., Woods C.W., Tsalik E.L., Langley R.J., Et al., Disease progression in hemodynamically stable patients presenting to the emergency department with sepsis, Acad Emerg Med., 17, pp. 383-390, (2010)

[2]

Arnold R.C., Sherwin R., Shapiro N., O'Connor J.L., Glaspey L., Et al., Multicenter observational study of the development of progressive organ dysfunction and therapeutic interventions in normotensive sepsis patients in the emergency department, Acad Emerg Med., 20, pp. 433-440, (2013)

[3]

Shapiro N.I., Wolfe R.E., Moore R.B., Smith E., Burdick E., Bates D.W., Mortality in Emergency Department Sepsis (MEDS) score: a prospectively derived and validated clinical prediction rule, Crit Care Med, 31, 3, pp. 670-675, (2003)

[4]

Sakr Y., Vincent J.L., Schuerholz T., Filipescu D., Romain A., Hjelmqvist H., Et al., Early- versus late-onset shock in European intensive care units, Shock, 28, 6, pp. 636-643, (2007)

[5]

Rivers E., Nguyen B., Havstad S., Ressler J., Muzzin A., Knoblich B., Et al., Early goal-directed therapy in the treatment of severe sepsis and septic shock, N Engl J Med, 345, 19, pp. 1368-1377, (2001)

[6]

van Zanten A.R., The golden hour of antibiotic administration in severe sepsis: avoid a false start striving for gold, Crit Care Med., 42, pp. 1931-1932, (2014)

[7]

Puskarich M.A., Trzeciak S., Shapiro N.I., Arnold R.C., Horton J.M., Studnek J.R., Et al., Association between timing of antibiotic administration and mortality from septic shock in patients treated with a quantitative resuscitation protocol, Crit Care Med., 39, pp. 2066-2071, (2011)

[8]

Kumar A., Roberts D., Wood K.E., Light B., Parrillo J.E., Sharma S., Et al., Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock, Crit Care Med., 34, pp. 1589-1596, (2006)

[9]

Ferrer R., Martin-Loeches I., Phillips G., Osborn T.M., Townsend S., Derringer R.P., Et al., Empiric antibiotic treatment reduces mortality in severe sepsis and septic shock from the first hour: results from a guideline-based performance improvement program, Crit Care Med., 42, pp. 1749-1755, (2014)

[10]

Lee S.J., Ramar K., Park J.G., Gajic O., Li G., Kashyap R., Increased fluid administration in the first three hours of sepsis resuscitation is associated with reduced mortality: a retrospective cohort study, Chest., 146, pp. 908-915, (2014)

← 1 2 3 4 5 →