The effects of sociodemographic factors and comorbidities on sepsis: A nationwide Swedish cohort study

Stenberg, Henning; Li, Xinjun; Pello-Esso, Wazah; Lönn, Sara Larsson; Thønnings, Sara; Khoshnood, Ardavan; Knudsen, Jenny Dahl; Sundquist, Kristina; Jansåker, Filip

doi:10.1016/j.pmedr.2023.102326

Cited by 3 publications

(2 citation statements)

References 32 publications

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“…Septic patients with more comorbidities could have higher mortality than immunocompromised patients [18][19][20], but the correlation between SIRS negativity and comorbidities is unclear. We compared the CCI between the two groups and found no signi cant difference.…”

Section: Factors Related To Sirs Negativitymentioning

confidence: 99%

“…The insu cient speci city and high sensitivity of SIRS may lead to misdiagnosis [3,4]. However, in the context of highly contagious infectious diseases such as novel coronavirus pneumonia (COVID- 19), many patients are SIRS negative due to the large population. These patients have mild signs and symptoms and are prone to missed diagnosis [5].…”

Section: Introductionmentioning

confidence: 99%

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Which nonsurviving sepsis patients are SIRS negative during the early stage of sepsis? Identifying “silent sepsis”

Liu,

Luo,

Wang

2024

Preprint

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Background: Despite the very high sensitivity of the Systemic Inflammatory Response Syndrome (SIRS) score for identifying sepsis, there remains a subset of septic patients who exhibit negative SIRS scores, and unfortunately, many of these patients experience poor outcomes. This study aims to investigate the factors associated with SIRS negativity during the early stage of sepsis in deceased patients, and to explore the nonlinear relationships between SIRS negativity and these factors. Objective: To analyse the factors related to systemic inflammatory response syndrome (SIRS) negativity during the early stage of sepsis in nonsurviving septic patients and to explore the nonlinear associations between SIRS negativity and related factors. Methods: Adult septic patients were retrospectively screened in the Medical Information Mart for Intensive Care IV (MIMIC-IV) database from 2008 to 2019. Patients who did not survive after 28 days were assigned to the SIRS-negative or SIRS-positive group according to whether the SIRS score was less than two points within 24 hours of intensive care unit (ICU) admission. The baseline data of patients in the SIRS-negative and SIRS-positive groups were collected and compared. The factors associated with SIRS negativity in septic patients were analysed by logistic regression. The dose‒response relationships of SIRS negativity with SOFA score and age were determined with a restricted cubic spline model. Results: A total of 53,150 patients were screened in the MIMIC-IV database, and 2706 sepsis nonsurvivors were ultimately included, 101 of whom were negative for SIRS. There were significant differences in SOFA scores between groups (8.18±3.58 vs. 9.75±4.28, P<0.001). In addition, differences in several other parameters, such as age (76 [61 to 86] vs. 72 [60 to 82], P=0.053), body mass index (26 [22 to 31] vs. 27 [24 to 32], P=0.056) and Charlson comorbidity index (8 [6 to 9] vs. 7 [5 to 9], P=0.052], approached statistical significance. Logistic regression analysis indicated that both SOFA score (OR=0.93 [95% CI=0.87-1.00], P=0.046) and age (OR=1.04 [95% CI=0.88-1.15], P=0.012) were independent factors related to SIRS negativity in septic patients. Analysis with a restricted cubic spline model showed that the odds ratio (OR) of SIRS negativity continued to increase with age, particularly for those over 80 years old (p for nonlinearity=0.024). The odds ratio of SIRS negativity was more than 1 when the SOFA score was less than 4 (p for nonlinearity=0.261). Conclusions: In septic patients with a poor prognosis, elderly individuals (over 80 years old) are more likely to exhibit SIRS negativity during the early stage of sepsis, particularly when they present with mild organ dysfunction (SOFA score less than 4). Neither comorbidities nor BMI was related to SIRS negativity in septic patients with a poor prognosis.

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Section: Factors Related To Sirs Negativitymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Which nonsurviving sepsis patients are SIRS negative during the early stage of sepsis? Identifying “silent sepsis”

Liu,

Luo,

Wang

2024

Preprint

View full text Add to dashboard Cite

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Factors associated with systemic inflammatory response syndrome negativity at the early stage of sepsis among nonsurviving sepsis patients in intensive care unit

Fu,

Luo,

Wang

et al. 2024

Hong Kong j. emerg. med.

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ObjectivesThis study aims to investigate the factors associated with systemic inflammatory response syndrome (SIRS) negativity during the early stage of sepsis in deceased septic patients.MethodsAdult septic patients were included from the Medical Information Mart for Intensive Care IV (MIMIC‐IV) database between 2008 and 2019. Patients who did not survive after 28 days were assigned to the SIRS‐negative or SIRS‐positive group according to whether the SIRS score was less than two points within 24 h of intensive care unit admission. Logistic regression and a restricted cubic spline model were used to analyze factors and dose–response relationships.ResultsA total of 53,150 patients were screened in the MIMIC‐IV database, and 2706 sepsis nonsurvivors were ultimately included, 101 of whom were negative for SIRS. There were significant differences in sequential organ failure assessment (SOFA) scores between groups (8.18 ± 3.58 vs. 9.75 ± 4.28, p < 0.001). Logistic regression analysis indicated that lactate (odds ratio [OR] = 0.75 [95% CI = 0.62–0.90], p = 0.002), SOFA score (OR = 0.93 [95% CI = 0.87–1.00], p = 0.046), and age (OR = 1.04 [95% CI = 0.88–1.15], p = 0.012) were independent factors related to SIRS negativity in septic patients. Analysis with a restricted cubic spline model showed that the OR of SIRS negativity continued to increase with age, particularly for those over 80 years old (p for nonlinearity = 0.024). The OR of SIRS negativity was more than 1 when the SOFA score was <4 (p for nonlinearity = 0.149) and when the lactate was <1 (p for nonlinearity = 0.014).ConclusionsFor sepsis patients with poor prognoses, elderly individuals are more likely to be SIRS negative when they have mild organ dysfunction damage or mild tissue hypoperfusion in the early stage of sepsis. This warranted an opportunity to provide early diagnosis for elderly population with negative SIRS score in order to prevent poor outcomes.

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Factors associated with SIRS negativity at the early stage of sepsis among nonsurviving sepsis patients in ICU: Targeting “silent sepsis”

Liu,

Luo,

Wang

et al. 2024

Preprint

View full text Add to dashboard Cite

Background Despite the very high sensitivity of the Systemic Inflammatory Response Syndrome (SIRS) score for identifying sepsis, there remains a subset of septic patients who exhibit negative SIRS scores, and unfortunately, many of these patients experience poor outcomes. This study aims to investigate the factors associated with SIRS negativity during the early stage of sepsis in deceased septic patients. Methods Adult septic patients were included from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database between 2008 and 2019. Sepsis was determined based on the Sepsis 3.0 criteria. Patients who did not survive after 28 days were assigned to the SIRS-negative or SIRS-positive group according to whether the SIRS score was less than two points within 24 hours of intensive care unit (ICU) admission. The baseline data of patients in the SIRS-negative and SIRS-positive groups were collected and compared. The factors associated with SIRS negativity in septic patients were analysed by logistic regression. The dose-response relationships of SIRS negativity with SOFA score and age were determined with a restricted cubic spline model. Results A total of 53,150 patients were screened in the MIMIC-IV database, and 2706 sepsis nonsurvivors were ultimately included, 101 of whom were negative for SIRS. There were significant differences in SOFA scores between groups (8.18 ± 3.58 vs. 9.75 ± 4.28, P < 0.001). In addition, differences in several other parameters nearly reached statistical significance, including age (76 [61 to 86] vs. 72 [60 to 82], P = 0.053), body mass index (BMI) (26 [22 to 31] vs. 27 [24 to 32], P = 0.056), and the Charlson comorbidity index (8 [6 to 9] vs. 7 [5 to 9], P = 0.052). Logistic regression analysis indicated that both SOFA score (OR = 0.93 [95% CI = 0.87-1.00], P = 0.046) and age (OR = 1.04 [95% CI = 0.88–1.15], P = 0.012) were independent factors related to SIRS negativity in septic patients. Analysis with a restricted cubic spline model showed that the odds ratio (OR) of SIRS negativity continued to increase with age, particularly for those over 80 years old (p for nonlinearity = 0.024). The odds ratio of SIRS negativity was more than 1 when the SOFA score was less than 4 (p for nonlinearity = 0.261). Conclusions For sepsis patients with poor prognoses, elderly individuals (over 80 years) are more likely to be SIRS negative when they have mild organ dysfunction damage (less than 4 SOFA scores) in the early stage of sepsis. This warranted an opportunity to provide early diagnosis for elderly population with negative SIRS score, in order to prevent poor outcomes.

show abstract

The effects of sociodemographic factors and comorbidities on sepsis: A nationwide Swedish cohort study

Cited by 3 publications

References 32 publications

Which nonsurviving sepsis patients are SIRS negative during the early stage of sepsis? Identifying “silent sepsis”

Which nonsurviving sepsis patients are SIRS negative during the early stage of sepsis? Identifying “silent sepsis”

Factors associated with systemic inflammatory response syndrome negativity at the early stage of sepsis among nonsurviving sepsis patients in intensive care unit

Factors associated with SIRS negativity at the early stage of sepsis among nonsurviving sepsis patients in ICU: Targeting “silent sepsis”

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