Abstract
Objective
Sepsis is a frequent and often lethal condition. Rapid identification and aggressive therapy in the emergency department (ED) are essential for outcome. Several indexes were found to be significantly related to short-term clinical outcome, but only bedside, rapidly available tests are thought to be useful in the ED. To define the prevalence and mortality of patients with severe sepsis presenting to the ED of a tertiary care hospital in Italy, we furthermore investigated the ability of bedside, non-invasive prognostic indexes to identify patients with adverse short-term clinical outcome.
Methods
All patients admitted to the ED with a diagnosis of severe sepsis or septic shock were included. Retrospective data were collected by a dedicated software program using predefined searching criteria including clinical data, vital sign parameters, sepsis-related organ failure assessment (SOFA) score, and blood tests. The relationship between prognostic indexes and 24-h or 28-day mortality was evaluated by multivariate logistic regression analysis.
Results
Ninety patients were enrolled from June 2004 to June 2005 (0.2% of all incoming patients to ED and 0.7% of all critical patients). Mean age was 77±15 years, 54.4% were women. During follow-up (28 days) 46 patients died (51.1%), 21 patients (23.3%) within 24 h. At multivariate analyses, age >80 (odds ratio [OR] 4.10; 95% confidence intervals [CI] 1.39–11.90, p=0.01), serum lactate >5 mmol/l (OR 3.40; 95% CI 1.21–9.60, p=0.02) and acute renal failure (OR 18.90; 95% CI 1.80–200, p=0.02) were independent predictors of 28-day mortality.
Conclusions
Among critical patients admitted to an Italian ED, those with severe sepsis/septic shock represent about 1%, with a very high mortality rate. Bedside non-invasive prognostic indexes are able to identify with high accuracy patients with adverse short-term clinical outcome.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Smith SW, Pheley A, Collier R, Rahmatullah A, Johnson L, Peterson PK. Severe sepsis in the emergency department and its association with a complicated clinical course.Acad Emerg Med 1998; 5: 1169–76.
Nguyen HB, Rivers EP, Knoblich BP, et al. Early lactate clearance is associated with improved outcome in severe sepsis and septic shock.Crit Care Med 2004; 32: 1637–42.
Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care.Crit Care Med 2001; 29: 1303–10.
Hugonnet S, Harbarth S, Ferriere K, Ricou B, Suter P, Pittet D. Bacteremic sepsis in intensive care: temporal trends in incidence, organ dysfunction, and prognosis.Crit Care Med 2003; 31: 390–4.
Rivers E, Nguyen B, Havstad S, et al., for Early Goal-Directed Therapy Collaborative Group. Early goal-directed therapy in the treatment of severe sepsis and septic shock.N Engl J Med 2001; 345: 1368–77.
Wheeler AP, Bernard GR. Treating patients with severe sepsis.N Engl J Med 1999; 340: 207–14.
Richard P, Wenzel MD. Treating sepsis.N Engl J Med 2002; 347: 966–7.
Shapiro NI, Howell M, Talmor D. A blueprint for a sepsis protocol.Acad Emerg Med 2005; 12: 352–9.
Fee C, Gropper MA. Establishing a comprehensive, evidence-based protocol for the care of patients with sepsis.Acad Emerg Med 2005; 12: 912–3.
Pittet D, Thievent B, Wenzel RP, Li N, Gurman G, Suter PM. Importance of pre-existing co-morbidities for prognosis of septicemia in critically ill patients.Intensive Care Med 1993; 19: 265–72.
Smith N. Sepsis: its causes and effects.J Wound Care 2003; 12: 265–70.
Soufir L, Timsit JF, Mahe C, Carlet J, Regnier B, Chevret S. Attributable morbidity and mortality of catheter-related septicemia in critically ill patients: a matched, risk-adjusted, cohort study.Infect Control Hosp Epidemiol 1999; 20: 396–401.
Harbarth S, Ferriere K, Hugonnet S, Ricou B, Suter P, Pittet D. Epidemiology and prognostic determinants of bloodstream infections in surgical intensive care.Arch Surg 2002; 137: 1353–9.
Deulofeu F, Cervello B, Capell S, Marti C, Mercade V. Predictors of mortality in patients with bacteremia: the importance of functional status.J Am Geriatr Soc 1998; 46: 14–8.
Gogos CA, Lekkou A, Papageorgiou O, Siagris D, Skoutelis A, Bassaris HP. Clinical prognostic markers in patients with severe sepsis: a prospective analysis of 139 consecutive cases.J Infect 2003; 47: 300–6.
Bakker J, Gris P, Coffernils M, Kahn RJ, Vincent JL. Serial blood lactate levels can predict the development of multiple organ failure following septic shock.Am J Surg 1996; 171: 221–6.
Shapiro NI, Wolfe RE, Moore RB, Smith E, Burdick E, Bates DW. Mortality in Emergency Department Sepsis (MEDS) score: a prospectively derived and validated clinical prediction rule.Crit Care Med 2003; 31: 670–5.
Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000.N Engl J Med 2003; 348: 1546–54.
Pagano L, Tacconelli E, Tumbarello M, et al. Bacteremia in patients with hematological malignancies. Analysis of risk factors, etiological agents and prognostic indicators.Haematologica 1997; 82: 415–9.
Marik PE. The clinical features of severe community-acquired pneumonia presenting as septic shock. Norasept II Study Investigators.J Crit Care 2000; 15: 85–90.
Gonzalez-Barca E, Fernandez-Sevilla A, Carratala J, et al. Prognostic factors influencing mortality in cancer patients with neutropenia and bacteremia.Eur J Clin Microbiol Infect Dis 1999; 18: 539–44.
Torres-Tortosa M, Canueto J, Bascunana A, et al. Prognostic evaluation of bacteremia and fungemia in patients with acquired immunodeficiency syndrome.Eur J Clin Microbiol Infect Dis 2002; 21: 262–8.
Vales EC, Abraira V, Sanchez JC, et al. A predictive model for mortality of bloodstream infections. Bedside analysis with the Weibull function.J Clin Epidemiol 2002; 55: 563–72.
Kollef MH, Sherman G, Ward S, Fraser VJ. Inadequate antimicrobial treatment of infections: a risk factor for hospital mortality among critically ill patients.Chest 1999; 115: 462–74.
Shmuely H, Pitlik S, Drucker M, Samra Z, Konisberger H, Leibovici L. Prediction of mortality in patients with bacteremia: the importance of pre-existing renal insufficiency.Ren Fail 2000; 22: 99–108.
Elting LS, Rubenstein EB, Rolston KV, Bodey GP. Outcomes of bacteremia in patients with cancer and neutropenia: observations from two decades of epidemiological and clinical trials.Clin Infect Dis 1997; 25: 247–59.
Arts DG, de Keizer NF, Vroom MB, de Jonge E. Reliability and accuracy of Sequential Organ Failure Assessment (SOFA) scoring.Crit Care Med 2005; 33: 1988–93.
Shapiro NI, Howell MD, Talmor D, et al. Implementation and outcomes of the Multiple Urgent Sepsis Therapies (MUST) protocol.Crit Care Med 2006; 34: 1025–32.
Smith SW, Pheley A, Collier R, Rahmatullah A, Johnson L, Peterson PK. Severe sepsis in the emergency department and its association with a complicated clinical course.Acad Emerg Med 1998; 5: 1169–76.
Nguyen HB, Rivers EP, Knoblich BP, et al. Early lactate clearance is associated with improved outcome in severe sepsis and septic shock.Crit Care Med 2004; 32: 1637–42.
Smith SW, Pheley A, Collier R, Rahmatullah A, Johnson L, Peterson PK. Severe sepsis in the emergency department and its association with a complicated clinical course.Acad Emerg Med 1998; 5: 1169–76.
Shapiro NI, Howell MD, Talmor D, et al. Serum lactate as a predictor of mortality in emergency, department patients with infection.Ann Emerg Med 2005; 45: 524–8.
Levraut J, Ichai C, Petit I, Ciebiera JP, Perus O, Grimaud D. Low exogenous lactate clearance as an early predictor of mortality in normolactatemic critically ill septic patients.Crit Care Med 2003; 31: 705–10.
Angus DC, Burgner D, Wunderink R, et al. The PIRO concept: P is for predisposition.Crit Care 2003; 7: 248–51.
van den Berghe G, Wouters PJ, Bouillon R, et al. Outcome benefit of intensive insulin therapy in the critically ill: Insulin dose versus glycemic control.Crit Care Med 2003; 31: 359–66.
van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in the critically ill patients.N Engl J Med 2001; 345: 1359–67.
Adamik B, Zimecki M, Wlaszczyk A, Kubler A. Immunological status of septic and trauma patients. II. Proliferative response and production of interleukin 6 and tumor necrosis factor alpha by peripheral blood mononuclear cells from septic survivor, nonsurvivor and trauma patients: a correlation with the survival rate.Arch Immunol Ther Exp (Warsz) 1997; 45: 277–84.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Giannazzo, G., Tola, F., Vanni, S. et al. Prognostic indexes of septic syndrome in the emergency department. Int Emergency Med 1, 229–233 (2006). https://doi.org/10.1007/BF02934745
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02934745