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

• Type of Material: Article
• Authors: Andre Holder, Emory University; Namita Gupta, Elkhart General Hospital; Elizabeth Lulaj, Emory University; Miriam Furgiuele, Albert Einstein College of Medicine; Idaly Hidalgo, Kingston Hospital; Michael P. Jones, Jacobi Medical Center; Tiphany Jolly, Saint Francis Hospital and Medical Center; Paul Gennis, Albert Einstein College of Medicine; Adrienne Birnbaum, Albert Einstein College of Medicine
• Language: English
• Date: 2016-12
• Publisher: SpringerOpen
• Publication Version: Final Published Version
• Copyright Statement: © Holder et al. 2016
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s12245-016-0106-7
• Title of Journal or Parent Work: International Journal of Emergency Medicine
• ISSN: 1865-1372
• Volume: 9
• Issue: 1
• Start Page: 10
• End Page: 10
• Grant/Funding Information: Its contents are solely the responsibility of the authors and do not necessary represent the official view of the NCRR or NIH.; This publication was made possible by the CTSA Grant UL1 RR025750 and KL2 RR025749 and TL1 RR025748 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH roadmap for Medical Research.
• Keywords: Sepsis progression; Nonsevere sepsis; Predictors; Disease progression; Organ dysfunction
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, General

Abstract

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.