Association between site of infection and in-hospital mortality in patients with sepsis admitted to emergency departments of tertiary hospitals in Medellin, Colombia.

Authors:
Johana Ascuntar
Johana Ascuntar
Instituto de Cancerología-Clínica Las Américas
Camilo Restrepo
Camilo Restrepo
Rothman Institute of Orthopaedics
Elisa Bernal
Elisa Bernal
Hospital Pablo Tobón Uribe
Fabian Jaimes
Fabian Jaimes
University of Antioquia
Colombia

Rev Bras Ter Intensiva 2019 Jan-Mar;31(1):47-56

Grupo Académico de Epidemiología Clínica, Universidad de Antioquia - Medellín, Colombia.

Objective: To determine the association between the primary site of infection and in-hospital mortality as the main outcome, or the need for admission to the intensive care unit as a secondary outcome, in patients with sepsis admitted to the emergency department.

Methods: This was a secondary analysis of a multicenter prospective cohort. Patients included in the study were older than 18 years with a diagnosis of severe sepsis or septic shock who were admitted to the emergency departments of three tertiary care hospitals. Of the 5022 eligible participants, 2510 were included. Multiple logistic regression analysis was performed for mortality.

Results: The most common site of infection was the urinary tract, present in 27.8% of the cases, followed by pneumonia (27.5%) and intra-abdominal focus (10.8%). In 5.4% of the cases, no definite site of infection was identified on admission. Logistic regression revealed a significant association between the following sites of infection and in-hospital mortality when using the urinary infection group as a reference: pneumonia (OR 3.4; 95%CI, 2.2 - 5.2; p < 0.001), skin and soft tissues (OR 2.6; 95%CI, 1.4 - 5.0; p = 0.003), bloodstream (OR 2.0; 95%CI, 1.1 - 3.6; p = 0.018), without specific focus (OR 2.0; 95%CI, 1.1 - 3.8; p = 0.028), and intra-abdominal focus (OR 1.9; 95%CI, 1.1 - 3.3; p = 0.024).

Conclusions: There is a significant association between the different sites of infection and in-hospital mortality or the need for admission to an intensive care unit in patients with sepsis or septic shock. Urinary tract infection shows the lowest risk, which should be considered in prognostic models of these conditions.

Download full-text PDF

Source
http://dx.doi.org/10.5935/0103-507X.20190011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6443304PMC
August 2018
1 Read

Publication Analysis

Top Keywords

site infection
16
in-hospital mortality
16
infection in-hospital
16
admitted emergency
12
patients sepsis
12
urinary tract
8
emergency departments
8
logistic regression
8
intra-abdominal focus
8
sites infection
8
care unit
8
association sites
8
intensive care
8
admission intensive
8
focus 95%ci
8
septic shock
8
sepsis septic
8
infection
8
sepsis admitted
8
95%ci
5

Similar Publications