Infections of respiratory or abdominal origin in ICU patients: what are the differences?

Abstract

IntroductionThere are few data related to the effects of different sources of infection on outcome. We used the Sepsis Occurrence in Acutely ill Patients (SOAP) database to investigate differences in the impact of respiratory tract and abdominal sites of infection on organ failure and survival.MethodsThe SOAP study was a cohort, multicenter, observational study which included data from all adult patients admitted to one of 198 participating intensive care units (ICUs) from 24 European countries during the study period. In this substudy, patients were divided into two groups depending on whether, on admission, they had abdominal infection but no respiratory infection or respiratory infection but no abdominal infection. The two groups were compared with respect to patient and infection-related characteristics, organ failure patterns, and outcomes.ResultsOf the 3,147 patients in the SOAP database, 777 (25%) patients had sepsis on ICU admission; 162 (21%) had abdominal infection without concurrent respiratory infection and 380 (49%) had respiratory infection without concurrent abdominal infection. Age, sex, and severity scores were similar in the two groups. On admission, septic shock was more common in patients with abdominal infection (40.1% vs. 29.5%, P = 0.016) who were also more likely to have early coagulation failure (17.3% vs. 9.5%, P = 0.01) and acute renal failure (38.3% vs. 29.5%, P = 0.045). In contrast, patients with respiratory infection were more likely to have early neurological failure (30.5% vs. 9.9%, P < 0.001). The median length of ICU stay was the same in the two groups, but the median length of hospital stay was longer in patients with abdominal than in those with respiratory infection (27 vs. 20 days, P = 0.02). ICU (29%) and hospital (38%) mortality rates were identical in the two groups.ConclusionsThere are important differences in patient profiles related to the site of infection; however, mortality rates in these two groups of patients are identical.

Abdominal infections in the intensive care unit: characteristics, treatment and determinants of outcome

“…In an analysis of patients from the Sepsis Occurrence in Acutely Ill Patients (SOAP) study, Volakli et al reported no differences in mortality rates among patients with abdominal infections and those with respiratory infections [6]. The higher mortality rate in patients with abdominal infections in our study may be explained by a number of differences between abdominal and other infections.…”

“…Abdominal infections are more often associated with septic shock and acute kidney injury than are infections in other sites [5, 6]. The spectrum of disease and severity is broad and management of these infections is challenging [7–9].…”

BCL2 genetic variants are associated with acute kidney injury in septic shock*

“…The relationship between BMI and development of AKI has been demonstrated in prior large cohort studies (11, 48, 49, 50) although only one of these studies evaluated septic patients with AKI (11). We also found that patients with an abdominal source of infection were more likely to develop AKI than patients with a pulmonary source, which confirms prior data (11, 51). …”

Short- and Long-Term Mortality in Severe Sepsis/Septic Shock in a Setting with Low Antibiotic Resistance: A Prospective Observational Study in a Swedish University Hospital

“…It has previously been suggested that abdominal infections may be more severe (30, 31) than respiratory infections. A recent study showed no differences in age, sex, severity score, or mortality rates between the two groups, but the development of septic shock, early coagulation, and acute renal failure was more common in patients with abdominal infections (32). The fact that abdominal infections dominate should, if anything, influence our mortality rates negatively.…”