TY  - BOOK
AU  - Goyal, Munish
TI  - Risk factors for mortality despite early protocolized resuscitation for severe sepsis and septic shock in the emergency department
SN  - 0883-9441
PY  - 2016///
KW  - *Emergency Service, Hospital
KW  - *Fever/ep [Epidemiology]
KW  - *Hypoglycemia/ep [Epidemiology]
KW  - *Neoplasms/ep [Epidemiology]
KW  - *Shock, Septic/mo [Mortality]
KW  - Academic Medical Centers
KW  - Adult
KW  - Age Factors
KW  - Aged
KW  - Aged, 80 and over
KW  - Blood Coagulation Disorders/bl [Blood]
KW  - Blood Coagulation Disorders/ep [Epidemiology]
KW  - Blood Glucose
KW  - Blood Urea Nitrogen
KW  - Clinical Protocols
KW  - Cohort Studies
KW  - Comorbidity
KW  - Early Medical Intervention
KW  - Female
KW  - Hospital Mortality
KW  - Humans
KW  - International Normalized Ratio
KW  - Lactic Acid/bl [Blood]
KW  - Logistic Models
KW  - Male
KW  - Middle Aged
KW  - Multivariate Analysis
KW  - Resuscitation
KW  - Resuscitation Orders
KW  - Retrospective Studies
KW  - Risk Factors
KW  - Sepsis/bl [Blood]
KW  - Sepsis/mo [Mortality]
KW  - Sepsis/th [Therapy]
KW  - Shock, Septic/bl [Blood]
KW  - Shock, Septic/th [Therapy]
KW  - Tertiary Care Centers
KW  - Vasoconstrictor Agents/tu [Therapeutic Use]
KW  - MedStar Washington Hospital Center
KW  - Emergency Medicine
KW  - Journal Article
KW  - Observational Study
N1  - Available online through MWHC library: 2012 - present
N2  - CONCLUSIONS: We identified a number of factors that were associated with in-hospital mortality among ED patients with severe sepsis or septic shock despite treatment with early protocolized resuscitation. These findings provide insights into aspects of early sepsis care that can be targets for future intervention.Copyright © 2015 Elsevier Inc. All rights reserved; METHODS: This was a retrospective, observational cohort study in an academic, tertiary care ED. We enrolled 411 adult patients with severe sepsis and lactate >4.0 mmol/L (n = 203) or septic shock (n = 208) who received protocolized resuscitation from 2005 to 2009. Emergency department variables, microbial cultures, and in-hospital outcomes were obtained from the medical record. Multivariable regression was used to identify factors independently associated with in-hospital mortality; PURPOSE: The purpose was to identify risk factors associated with in-hospital mortality among emergency department (ED) patients with severe sepsis and septic shock managed with early protocolized resuscitation; RESULTS: Mean age was 59.5 +/- 16.3 years; 57% were male. Mean lactate was 4.8 mmol/L (3.5-6.7), 54% had positive cultures, and 27% received vasopressors in the ED. One hundred and five (26%) patients died in-hospital. Age, active cancer, do-not-resuscitate status on ED arrival, lack of fever, hypoglycemia, and intubation were independently associated with increased in-hospital mortality. Lactate clearance and diabetes were associated with a decreased risk of in-hospital death
UR  - http://dx.doi.org/10.1016/j.jcrc.2015.10.015
ER  -