Clinical course of sepsis, severe sepsis, and septic shock in a cohort of infected patients from ten Colombian hospitals

Abstract

BackgroundSepsis has several clinical stages, and mortality rates are different for each stage. Our goal was to establish the evolution and the determinants of the progression of clinical stages, from infection to septic shock, over the first week, as well as their relationship to 7-day and 28-day mortality.MethodsThis is a secondary analysis of a multicenter cohort of inpatients hospitalized in general wards or intensive care units (ICUs). The general estimating equations (GEE) model was used to estimate the risk of progression and the determinants of stages of infection over the first week. Cox regression with time-dependent covariates and fixed covariates was used to determine the factors related with 7-day and 28-day mortality, respectively.ResultsIn 2681 patients we show that progression to severe sepsis and septic shock increases with intraabdominal and respiratory sources of infection [OR = 1,32; 95%IC = 1,20-1,46 and OR = 1.21, 95%CI = 1,11-1,33 respectively], as well as according to Acute Physiology and Chronic Health Evaluation II (APACHE II) [OR = 1,03; 95%CI = 1,02-1,03] and Sequential Organ Failure Assessment (SOFA) [OR = 1,16; 95%CI = 1,14-1,17] scores. The variables related with first-week mortality were progression to severe sepsis [HR = 2,13; 95%CI = 1,13-4,03] and septic shock [HR = 3,00; 95%CI = 1,50-5.98], respiratory source of infection [HR = 1,76; 95%IC = 1,12-2,77], APACHE II [HR = 1,07; 95% CI = 1,04-1,10] and SOFA [HR = 1,09; 95%IC = 1,04-1,15] scores.ConclusionsIntraabdominal and respiratory sources of infection, independently of SOFA and APACHE II scores, increase the risk of clinical progression to more severe stages of sepsis; and these factors, together with progression of the infection itself, are the main determinants of 7-day and 28-day mortality.

Epidemiología y pronóstico de pacientes con infección del torrente sanguíneo en 10 hospitales de Colombia

“…La comparación entre grupos se hizo para las variables continuas por medio de la prueba t de Student o U de Mann-Whitney, según la distribución de los datos y para las variables dicotómicas con la prueba de χ 2 . Con base en la literatura médica disponible y las investigaciones previas de nuestro grupo 30,[35][36][37] , se consideraron los siguientes factores como potencialmente relacionados con mortalidad: edad, sexo, puntajes SOFA y APACHE II, sitio de adquisición de la infección (comunidad versus hospital), clasificación de los hemocultivos (grampositivos, gramnegativos, polimicrobianos u hongos) y comorbilidades: trauma o cirugía durante los últimos 30 días, inmunosupresión (trasplante de órganos, uso crónico de corticosteroides, antecedente de neoplasia o infección por VIH/SIDA), insuficiencia renal crónica, insuficiencia cardiaca congestiva, diabetes mellitus, enfermedad pulmonar obstructiva crónica, cirrosis, drogadicción o alcoholismo. Las anteriores variables se analizaron por medio de un modelo de regresión logística múltiple con la mortalidad a los 28 días como variable dependiente.…”

Predicting the clinical trajectory in critically ill patients with sepsis: a cohort study

“…Our model may thus assist clinicians during initial resuscitation as well as in later decision-making or to estimate the added prognostic value of novel biomarkers. We are aware of only as single other study that uses time-varying covariables to estimate the risk of sepsis progression during the first week in patients treated for infection [11]. They concluded that intraabdominal and respiratory sources of infection, independently of SOFA and APACHE scores, increased the risk of progression to more severe stages of sepsis.…”

Development and Internal Validation of a Model Predicting Safe, Early Discharge Among Patients Presenting to the Emergency Department with an Infection.

“…[5][6][7][8][9][10] Since not all patients with an infection will develop sepsis and only a minority will progress to severe sepsis requiring Intensive Care Unit (ICU) admission. [11][12][13][14][15] Further research should therefore focus on patient improvement, alongside deterioration, of patients presenting to the ED with an infection.…”