MedStar Authors catalog › Details for: 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. Journal: Journal of critical care.Published: 2016ISSN: 0883-9441.UI/PMID: 26611382.Subject(s): 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 | *Emergency Service, Hospital | Female | *Fever/ep [Epidemiology] | Hospital Mortality | Humans | *Hypoglycemia/ep [Epidemiology] | International Normalized Ratio | Lactic Acid/bl [Blood] | Logistic Models | Male | Middle Aged | Multivariate Analysis | *Neoplasms/ep [Epidemiology] | Resuscitation | Resuscitation Orders | Retrospective Studies | Risk Factors | Sepsis/bl [Blood] | Sepsis/mo [Mortality] | Sepsis/th [Therapy] | Shock, Septic/bl [Blood] | *Shock, Septic/mo [Mortality] | Shock, Septic/th [Therapy] | Tertiary Care Centers | Vasoconstrictor Agents/tu [Therapeutic Use]Institution(s): MedStar Washington Hospital CenterDepartment(s): Emergency MedicineActivity type: Journal Article.Medline article type(s): Journal Article | Observational StudyOnline resources: Click here to access online Digital Object Identifier: http://dx.doi.org/10.1016/j.jcrc.2015.10.015 (Click here) Abbreviated citation: J Crit Care. 31(1):13-20, 2016 Feb.Local Holdings: Available online through MWHC library: 2012 - present.Abstract: 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.Abstract: 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.Abstract: 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.Abstract: 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.