Risk factors for mortality despite early protocolized resuscitation for severe sepsis and septic shock in the emergency department
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, ter...
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| Veröffentlicht in: | Journal of critical care 2016-02, Vol.31 (1), p.13-20 |
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| creator | Drumheller, Byron C., MD Agarwal, Anish, MD Mikkelsen, Mark E., MD, MSCE Sante, S. Cham, MD Weber, Anita L., PhD Goyal, Munish, MD Gaieski, David F., MD |
| description | 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. |
| doi_str_mv | 10.1016/j.jcrc.2015.10.015 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1762365141</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0883944115005456</els_id><sourcerecordid>3912438491</sourcerecordid><originalsourceid>FETCH-LOGICAL-c542t-543b36e4f15e2b1d42fc2f396266ef7abdd33bebab259d11391313b97647f99b3</originalsourceid><addsrcrecordid>eNqNkkuLFTEQhRtRnOvoH3AhATdu-prKox8gggy-YEDwsQ7pdLWTvt2dNkkPXJf-chPvqDALcXVC-OrAqVNF8RjoHihUz8f9aLzZMwoyfeyT3Cl2IGVdNhXIu8WONg0vWyHgrHgQwkgp1JzL-8UZqyoA3rBd8eOjDQcyaBOdD2RwnszORz3ZeCQ9htVGJKj9dCSrd9EZN9nv2BOPYQvGRh2tW36NBbxGj0nWYAPRS5-f0RoSrpw5ELuQeJWsZvRfcTHZfNU-zrjEh8W9QU8BH93oefHlzevPF-_Kyw9v31-8uiyNFCyWUvCOVygGkMg66AUbDBt4W6UwONS663vOO-x0x2Tbp3gtcOBdW1eiHtq24-fFs5NvSvJtwxDVbIPBadILui0oqCvGKwkC_gOV0LbQNhl9egsd3eaXFCRTXABjrEkUO1HGuxA8Dmr1dtb-qICqXKYaVS5T5TLzX5I09OTGeutm7P-M_G4vAS9OAKa1XVv0KnWStou99Wii6p39t__LW-Nmsos1ejrgEcPfHCowRdWnfE75mkBSKoWs-E837cay</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1753412228</pqid></control><display><type>article</type><title>Risk factors for mortality despite early protocolized resuscitation for severe sepsis and septic shock in the emergency department</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Drumheller, Byron C., MD ; Agarwal, Anish, MD ; Mikkelsen, Mark E., MD, MSCE ; Sante, S. Cham, MD ; Weber, Anita L., PhD ; Goyal, Munish, MD ; Gaieski, David F., MD</creator><creatorcontrib>Drumheller, Byron C., MD ; Agarwal, Anish, MD ; Mikkelsen, Mark E., MD, MSCE ; Sante, S. Cham, MD ; Weber, Anita L., PhD ; Goyal, Munish, MD ; Gaieski, David F., MD</creatorcontrib><description>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.</description><identifier>ISSN: 0883-9441</identifier><identifier>EISSN: 1557-8615</identifier><identifier>DOI: 10.1016/j.jcrc.2015.10.015</identifier><identifier>PMID: 26611382</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Academic Medical Centers ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Antibiotics ; Antimicrobial agents ; Blood Coagulation Disorders - blood ; Blood Coagulation Disorders - epidemiology ; Blood Glucose ; Blood Urea Nitrogen ; Cardiovascular disease ; Clinical Protocols ; Cohort Studies ; Comorbidity ; Confidence intervals ; Critical Care ; Data collection ; Early goal-directed therapy ; Early Medical Intervention ; Emergency Service, Hospital ; Emergency services ; Female ; Fever - epidemiology ; Heart attacks ; Hospital Mortality ; Humans ; Hypoglycemia - epidemiology ; Infections ; International Normalized Ratio ; Laboratories ; Lactic Acid - blood ; Logistic Models ; Male ; Medical records ; Middle Aged ; Mortality ; Multivariate Analysis ; Neoplasms - epidemiology ; Resuscitation ; Resuscitation Orders ; Retrospective Studies ; Risk Factors ; Sepsis ; Sepsis - blood ; Sepsis - mortality ; Sepsis - therapy ; Septic shock ; Shock, Septic - blood ; Shock, Septic - mortality ; Shock, Septic - therapy ; Studies ; Tertiary Care Centers ; Variables ; Vasoconstrictor Agents - therapeutic use</subject><ispartof>Journal of critical care, 2016-02, Vol.31 (1), p.13-20</ispartof><rights>Elsevier Inc.</rights><rights>2015 Elsevier Inc.</rights><rights>Copyright © 2015 Elsevier Inc. All rights reserved.</rights><rights>2015. Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c542t-543b36e4f15e2b1d42fc2f396266ef7abdd33bebab259d11391313b97647f99b3</citedby><cites>FETCH-LOGICAL-c542t-543b36e4f15e2b1d42fc2f396266ef7abdd33bebab259d11391313b97647f99b3</cites><orcidid>0000-0003-2175-0196</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0883944115005456$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26611382$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Drumheller, Byron C., MD</creatorcontrib><creatorcontrib>Agarwal, Anish, MD</creatorcontrib><creatorcontrib>Mikkelsen, Mark E., MD, MSCE</creatorcontrib><creatorcontrib>Sante, S. Cham, MD</creatorcontrib><creatorcontrib>Weber, Anita L., PhD</creatorcontrib><creatorcontrib>Goyal, Munish, MD</creatorcontrib><creatorcontrib>Gaieski, David F., MD</creatorcontrib><title>Risk factors for mortality despite early protocolized resuscitation for severe sepsis and septic shock in the emergency department</title><title>Journal of critical care</title><addtitle>J Crit Care</addtitle><description>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.</description><subject>Academic Medical Centers</subject><subject>Adult</subject><subject>Age Factors</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Antibiotics</subject><subject>Antimicrobial agents</subject><subject>Blood Coagulation Disorders - blood</subject><subject>Blood Coagulation Disorders - epidemiology</subject><subject>Blood Glucose</subject><subject>Blood Urea Nitrogen</subject><subject>Cardiovascular disease</subject><subject>Clinical Protocols</subject><subject>Cohort Studies</subject><subject>Comorbidity</subject><subject>Confidence intervals</subject><subject>Critical Care</subject><subject>Data collection</subject><subject>Early goal-directed therapy</subject><subject>Early Medical Intervention</subject><subject>Emergency Service, Hospital</subject><subject>Emergency services</subject><subject>Female</subject><subject>Fever - epidemiology</subject><subject>Heart attacks</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Hypoglycemia - epidemiology</subject><subject>Infections</subject><subject>International Normalized Ratio</subject><subject>Laboratories</subject><subject>Lactic Acid - blood</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Medical records</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Multivariate Analysis</subject><subject>Neoplasms - epidemiology</subject><subject>Resuscitation</subject><subject>Resuscitation Orders</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Sepsis</subject><subject>Sepsis - blood</subject><subject>Sepsis - mortality</subject><subject>Sepsis - therapy</subject><subject>Septic shock</subject><subject>Shock, Septic - blood</subject><subject>Shock, Septic - mortality</subject><subject>Shock, Septic - therapy</subject><subject>Studies</subject><subject>Tertiary Care Centers</subject><subject>Variables</subject><subject>Vasoconstrictor Agents - therapeutic use</subject><issn>0883-9441</issn><issn>1557-8615</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqNkkuLFTEQhRtRnOvoH3AhATdu-prKox8gggy-YEDwsQ7pdLWTvt2dNkkPXJf-chPvqDALcXVC-OrAqVNF8RjoHihUz8f9aLzZMwoyfeyT3Cl2IGVdNhXIu8WONg0vWyHgrHgQwkgp1JzL-8UZqyoA3rBd8eOjDQcyaBOdD2RwnszORz3ZeCQ9htVGJKj9dCSrd9EZN9nv2BOPYQvGRh2tW36NBbxGj0nWYAPRS5-f0RoSrpw5ELuQeJWsZvRfcTHZfNU-zrjEh8W9QU8BH93oefHlzevPF-_Kyw9v31-8uiyNFCyWUvCOVygGkMg66AUbDBt4W6UwONS663vOO-x0x2Tbp3gtcOBdW1eiHtq24-fFs5NvSvJtwxDVbIPBadILui0oqCvGKwkC_gOV0LbQNhl9egsd3eaXFCRTXABjrEkUO1HGuxA8Dmr1dtb-qICqXKYaVS5T5TLzX5I09OTGeutm7P-M_G4vAS9OAKa1XVv0KnWStou99Wii6p39t__LW-Nmsos1ejrgEcPfHCowRdWnfE75mkBSKoWs-E837cay</recordid><startdate>20160201</startdate><enddate>20160201</enddate><creator>Drumheller, Byron C., MD</creator><creator>Agarwal, Anish, MD</creator><creator>Mikkelsen, Mark E., MD, MSCE</creator><creator>Sante, S. Cham, MD</creator><creator>Weber, Anita L., PhD</creator><creator>Goyal, Munish, MD</creator><creator>Gaieski, David F., MD</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K6X</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><scope>7QL</scope><scope>C1K</scope><orcidid>https://orcid.org/0000-0003-2175-0196</orcidid></search><sort><creationdate>20160201</creationdate><title>Risk factors for mortality despite early protocolized resuscitation for severe sepsis and septic shock in the emergency department</title><author>Drumheller, Byron C., MD ; Agarwal, Anish, MD ; Mikkelsen, Mark E., MD, MSCE ; Sante, S. Cham, MD ; Weber, Anita L., PhD ; Goyal, Munish, MD ; Gaieski, David F., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c542t-543b36e4f15e2b1d42fc2f396266ef7abdd33bebab259d11391313b97647f99b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Academic Medical Centers</topic><topic>Adult</topic><topic>Age Factors</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Antibiotics</topic><topic>Antimicrobial agents</topic><topic>Blood Coagulation Disorders - blood</topic><topic>Blood Coagulation Disorders - epidemiology</topic><topic>Blood Glucose</topic><topic>Blood Urea Nitrogen</topic><topic>Cardiovascular disease</topic><topic>Clinical Protocols</topic><topic>Cohort Studies</topic><topic>Comorbidity</topic><topic>Confidence intervals</topic><topic>Critical Care</topic><topic>Data collection</topic><topic>Early goal-directed therapy</topic><topic>Early Medical Intervention</topic><topic>Emergency Service, Hospital</topic><topic>Emergency services</topic><topic>Female</topic><topic>Fever - epidemiology</topic><topic>Heart attacks</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Hypoglycemia - epidemiology</topic><topic>Infections</topic><topic>International Normalized Ratio</topic><topic>Laboratories</topic><topic>Lactic Acid - blood</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Medical records</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Multivariate Analysis</topic><topic>Neoplasms - epidemiology</topic><topic>Resuscitation</topic><topic>Resuscitation Orders</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Sepsis</topic><topic>Sepsis - blood</topic><topic>Sepsis - mortality</topic><topic>Sepsis - therapy</topic><topic>Septic shock</topic><topic>Shock, Septic - blood</topic><topic>Shock, Septic - mortality</topic><topic>Shock, Septic - therapy</topic><topic>Studies</topic><topic>Tertiary Care Centers</topic><topic>Variables</topic><topic>Vasoconstrictor Agents - therapeutic use</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Drumheller, Byron C., MD</creatorcontrib><creatorcontrib>Agarwal, Anish, MD</creatorcontrib><creatorcontrib>Mikkelsen, Mark E., MD, MSCE</creatorcontrib><creatorcontrib>Sante, S. 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Cham, MD</au><au>Weber, Anita L., PhD</au><au>Goyal, Munish, MD</au><au>Gaieski, David F., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk factors for mortality despite early protocolized resuscitation for severe sepsis and septic shock in the emergency department</atitle><jtitle>Journal of critical care</jtitle><addtitle>J Crit Care</addtitle><date>2016-02-01</date><risdate>2016</risdate><volume>31</volume><issue>1</issue><spage>13</spage><epage>20</epage><pages>13-20</pages><issn>0883-9441</issn><eissn>1557-8615</eissn><abstract>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.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>26611382</pmid><doi>10.1016/j.jcrc.2015.10.015</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0003-2175-0196</orcidid></addata></record> |
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| subjects | Academic Medical Centers Adult Age Factors Aged Aged, 80 and over Antibiotics Antimicrobial agents Blood Coagulation Disorders - blood Blood Coagulation Disorders - epidemiology Blood Glucose Blood Urea Nitrogen Cardiovascular disease Clinical Protocols Cohort Studies Comorbidity Confidence intervals Critical Care Data collection Early goal-directed therapy Early Medical Intervention Emergency Service, Hospital Emergency services Female Fever - epidemiology Heart attacks Hospital Mortality Humans Hypoglycemia - epidemiology Infections International Normalized Ratio Laboratories Lactic Acid - blood Logistic Models Male Medical records Middle Aged Mortality Multivariate Analysis Neoplasms - epidemiology Resuscitation Resuscitation Orders Retrospective Studies Risk Factors Sepsis Sepsis - blood Sepsis - mortality Sepsis - therapy Septic shock Shock, Septic - blood Shock, Septic - mortality Shock, Septic - therapy Studies Tertiary Care Centers Variables Vasoconstrictor Agents - therapeutic use |
| title | Risk factors for mortality despite early protocolized resuscitation for severe sepsis and septic shock in the emergency department |
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