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Risk factors for mortality despite early protocolized resuscitation for severe sepsis and septic shock in the emergency department.
J Crit Care. 2016 Feb; 31(1):13-20.JC

Abstract

PURPOSE

The purpose was to identify risk factors associated with in-hospital mortality among emergency department (ED) patients with severe sepsis and septic shock managed with early protocolized resuscitation.

METHODS

This was a retrospective, observational cohort study in an academic, tertiary care ED. We enrolled 411 adult patients with severe sepsis and lactate ≥4.0 mmol/L (n = 203) or septic shock (n = 208) who received protocolized resuscitation from 2005 to 2009. Emergency department variables, microbial cultures, and in-hospital outcomes were obtained from the medical record. Multivariable regression was used to identify factors independently associated with in-hospital mortality.

RESULTS

Mean age was 59.5 ± 16.3 years; 57% were male. Mean lactate was 4.8 mmol/L (3.5-6.7), 54% had positive cultures, and 27% received vasopressors in the ED. One hundred and five (26%) patients died in-hospital. Age, active cancer, do-not-resuscitate status on ED arrival, lack of fever, hypoglycemia, and intubation were independently associated with increased in-hospital mortality. Lactate clearance and diabetes were associated with a decreased risk of in-hospital death.

CONCLUSIONS

We identified a number of factors that were associated with in-hospital mortality among ED patients with severe sepsis or septic shock despite treatment with early protocolized resuscitation. These findings provide insights into aspects of early sepsis care that can be targets for future intervention.

Authors+Show Affiliations

Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce St, Philadelphia PA, 19104. Electronic address: byron.drumheller@gmail.com.Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce St, Philadelphia PA, 19104. Electronic address: anishagarwal3@gmail.com.Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce St, Philadelphia PA, 19104; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce St, Philadelphia PA, 19104. Electronic address: mark.mikkelsen@uphs.upenn.edu.Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce St, Philadelphia PA, 19104. Electronic address: cham_sante@yahoo.com.Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce St, Philadelphia PA, 19104. Electronic address: webera@mail.med.upenn.edu.Department of Emergency Medicine, Washington Hospital Center, Georgetown University School of Medicine, 110 Irving St NW, Washington DC, 20010. Electronic address: munish.goyal@medstar.net.Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, 111 S 11th St, Philadelphia PA, 19107. Electronic address: david.gaieski@jefferson.edu.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

26611382

Citation

Drumheller, Byron C., et al. "Risk Factors for Mortality Despite Early Protocolized Resuscitation for Severe Sepsis and Septic Shock in the Emergency Department." Journal of Critical Care, vol. 31, no. 1, 2016, pp. 13-20.
Drumheller BC, Agarwal A, Mikkelsen ME, et al. Risk factors for mortality despite early protocolized resuscitation for severe sepsis and septic shock in the emergency department. J Crit Care. 2016;31(1):13-20.
Drumheller, B. C., Agarwal, A., Mikkelsen, M. E., Sante, S. C., Weber, A. L., Goyal, M., & Gaieski, D. F. (2016). Risk factors for mortality despite early protocolized resuscitation for severe sepsis and septic shock in the emergency department. Journal of Critical Care, 31(1), 13-20. https://doi.org/10.1016/j.jcrc.2015.10.015
Drumheller BC, et al. Risk Factors for Mortality Despite Early Protocolized Resuscitation for Severe Sepsis and Septic Shock in the Emergency Department. J Crit Care. 2016;31(1):13-20. PubMed PMID: 26611382.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk factors for mortality despite early protocolized resuscitation for severe sepsis and septic shock in the emergency department. AU - Drumheller,Byron C, AU - Agarwal,Anish, AU - Mikkelsen,Mark E, AU - Sante,S Cham, AU - Weber,Anita L, AU - Goyal,Munish, AU - Gaieski,David F, Y1 - 2015/10/26/ PY - 2015/08/09/received PY - 2015/10/03/revised PY - 2015/10/17/accepted PY - 2015/11/28/entrez PY - 2015/11/28/pubmed PY - 2016/8/24/medline KW - Early goal-directed therapy KW - Emergency services KW - Mortality KW - Risk factors KW - Sepsis KW - Septic shock SP - 13 EP - 20 JF - Journal of critical care JO - J Crit Care VL - 31 IS - 1 N2 - PURPOSE: The purpose was to identify risk factors associated with in-hospital mortality among emergency department (ED) patients with severe sepsis and septic shock managed with early protocolized resuscitation. METHODS: This was a retrospective, observational cohort study in an academic, tertiary care ED. We enrolled 411 adult patients with severe sepsis and lactate ≥4.0 mmol/L (n = 203) or septic shock (n = 208) who received protocolized resuscitation from 2005 to 2009. Emergency department variables, microbial cultures, and in-hospital outcomes were obtained from the medical record. Multivariable regression was used to identify factors independently associated with in-hospital mortality. RESULTS: Mean age was 59.5 ± 16.3 years; 57% were male. Mean lactate was 4.8 mmol/L (3.5-6.7), 54% had positive cultures, and 27% received vasopressors in the ED. One hundred and five (26%) patients died in-hospital. Age, active cancer, do-not-resuscitate status on ED arrival, lack of fever, hypoglycemia, and intubation were independently associated with increased in-hospital mortality. Lactate clearance and diabetes were associated with a decreased risk of in-hospital death. CONCLUSIONS: We identified a number of factors that were associated with in-hospital mortality among ED patients with severe sepsis or septic shock despite treatment with early protocolized resuscitation. These findings provide insights into aspects of early sepsis care that can be targets for future intervention. SN - 1557-8615 UR - https://www.unboundmedicine.com/medline/citation/26611382/Risk_factors_for_mortality_despite_early_protocolized_resuscitation_for_severe_sepsis_and_septic_shock_in_the_emergency_department_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0883-9441(15)00545-6 DB - PRIME DP - Unbound Medicine ER -