TY - JOUR
T1 - Primary Infection Site as a Predictor of Sepsis Development in Emergency Department Patients
AU - Vadhan, Jason D.
AU - Thoppil, Joby
AU - Vasquez, Ofelia
AU - Suarez, Arlen
AU - Bartels, Brett
AU - McDonald, Samuel
AU - Courtney, D. Mark
AU - Farrar, J. David
AU - Thakur, Bhaskar
N1 - Publisher Copyright:
© 2024 Elsevier Inc.
PY - 2024/8
Y1 - 2024/8
N2 - Background: Sepsis is a life-threatening condition but predicting its development and progression remains a challenge. Objective: This study aimed to assess the impact of infection site on sepsis development among emergency department (ED) patients. Methods: Data were collected from a single-center ED between January 2016 and December 2019. Patient encounters with documented infections, as defined by the Systematized Nomenclature of Medicine-Clinical Terms for upper respiratory tract (URI), lower respiratory tract (LRI), urinary tract (UTI), or skin or soft-tissue infections were included. Primary outcome was the development of sepsis or septic shock, as defined by Sepsis-1/2 criteria. Secondary outcomes included hospital disposition and length of stay, blood and urine culture positivity, antibiotic administration, vasopressor use, in-hospital mortality, and 30-day mortality. Analysis of variance and various different logistic regression approaches were used for analysis with URI used as the reference variable. Results: LRI was most associated with sepsis (relative risk ratio [RRR] 5.63; 95% CI 5.07–6.24) and septic shock (RRR 21.2; 95% CI 17.99–24.98) development, as well as hospital admission rates (odds ratio [OR] 8.23; 95% CI 7.41–9.14), intensive care unit admission (OR 4.27; 95% CI 3.84–4.74), in-hospital mortality (OR 6.93; 95% CI 5.60–8.57), and 30-day mortality (OR 7.34; 95% CI 5.86–9.19). UTIs were also associated with sepsis and septic shock development, but to a lesser degree than LRI. Conclusions: Primary infection sites including LRI and UTI were significantly associated with sepsis development, hospitalization, length of stay, and mortality among patients presenting with infections in the ED.
AB - Background: Sepsis is a life-threatening condition but predicting its development and progression remains a challenge. Objective: This study aimed to assess the impact of infection site on sepsis development among emergency department (ED) patients. Methods: Data were collected from a single-center ED between January 2016 and December 2019. Patient encounters with documented infections, as defined by the Systematized Nomenclature of Medicine-Clinical Terms for upper respiratory tract (URI), lower respiratory tract (LRI), urinary tract (UTI), or skin or soft-tissue infections were included. Primary outcome was the development of sepsis or septic shock, as defined by Sepsis-1/2 criteria. Secondary outcomes included hospital disposition and length of stay, blood and urine culture positivity, antibiotic administration, vasopressor use, in-hospital mortality, and 30-day mortality. Analysis of variance and various different logistic regression approaches were used for analysis with URI used as the reference variable. Results: LRI was most associated with sepsis (relative risk ratio [RRR] 5.63; 95% CI 5.07–6.24) and septic shock (RRR 21.2; 95% CI 17.99–24.98) development, as well as hospital admission rates (odds ratio [OR] 8.23; 95% CI 7.41–9.14), intensive care unit admission (OR 4.27; 95% CI 3.84–4.74), in-hospital mortality (OR 6.93; 95% CI 5.60–8.57), and 30-day mortality (OR 7.34; 95% CI 5.86–9.19). UTIs were also associated with sepsis and septic shock development, but to a lesser degree than LRI. Conclusions: Primary infection sites including LRI and UTI were significantly associated with sepsis development, hospitalization, length of stay, and mortality among patients presenting with infections in the ED.
KW - Emergency medicine, SIRS
KW - Infection site
KW - Sepsis
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U2 - 10.1016/j.jemermed.2024.01.016
DO - 10.1016/j.jemermed.2024.01.016
M3 - Article
C2 - 38849253
AN - SCOPUS:85195480677
SN - 0736-4679
VL - 67
SP - e128-e137
JO - Journal of Emergency Medicine
JF - Journal of Emergency Medicine
IS - 2
ER -