Risk factors for mortality despite early protocolized resuscitation for severe sepsis and septic shock in the emergency department.
Risk factors for mortality despite early protocolized resuscitation for severe sepsis and septic shock in the emergency department.
- 2016
Available online through MWHC library: 2012 - present
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.
English
0883-9441
*Emergency Service, Hospital
*Fever/ep [Epidemiology]
*Hypoglycemia/ep [Epidemiology]
*Neoplasms/ep [Epidemiology]
*Shock, Septic/mo [Mortality]
Academic Medical Centers
Adult
Age Factors
Aged
Aged, 80 and over
Blood Coagulation Disorders/bl [Blood]
Blood Coagulation Disorders/ep [Epidemiology]
Blood Glucose
Blood Urea Nitrogen
Clinical Protocols
Cohort Studies
Comorbidity
Early Medical Intervention
Female
Hospital Mortality
Humans
International Normalized Ratio
Lactic Acid/bl [Blood]
Logistic Models
Male
Middle Aged
Multivariate Analysis
Resuscitation
Resuscitation Orders
Retrospective Studies
Risk Factors
Sepsis/bl [Blood]
Sepsis/mo [Mortality]
Sepsis/th [Therapy]
Shock, Septic/bl [Blood]
Shock, Septic/th [Therapy]
Tertiary Care Centers
Vasoconstrictor Agents/tu [Therapeutic Use]
MedStar Washington Hospital Center
Emergency Medicine
Journal Article
Observational Study
Available online through MWHC library: 2012 - present
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.
English
0883-9441
*Emergency Service, Hospital
*Fever/ep [Epidemiology]
*Hypoglycemia/ep [Epidemiology]
*Neoplasms/ep [Epidemiology]
*Shock, Septic/mo [Mortality]
Academic Medical Centers
Adult
Age Factors
Aged
Aged, 80 and over
Blood Coagulation Disorders/bl [Blood]
Blood Coagulation Disorders/ep [Epidemiology]
Blood Glucose
Blood Urea Nitrogen
Clinical Protocols
Cohort Studies
Comorbidity
Early Medical Intervention
Female
Hospital Mortality
Humans
International Normalized Ratio
Lactic Acid/bl [Blood]
Logistic Models
Male
Middle Aged
Multivariate Analysis
Resuscitation
Resuscitation Orders
Retrospective Studies
Risk Factors
Sepsis/bl [Blood]
Sepsis/mo [Mortality]
Sepsis/th [Therapy]
Shock, Septic/bl [Blood]
Shock, Septic/th [Therapy]
Tertiary Care Centers
Vasoconstrictor Agents/tu [Therapeutic Use]
MedStar Washington Hospital Center
Emergency Medicine
Journal Article
Observational Study