Holder Andre L, Gupta Namita, Lulaj Elizabeth, Furgiuele Miriam, Hidalgo Idaly, Jones Michael P, Jolly Tiphany, Gennis Paul, Birnbaum Adrienne
Department of Medicine, Emory University School of Medicine, 1648 Pierce Dr NE, Atlanta, GA, 30307, USA.
Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Grady Memorial Hospital, 80 Jesse Hill Jr. Drive SE, Rm 2D012, Atlanta, GA, 30303, USA.
Int J Emerg Med. 2016 Dec;9(1):10. doi: 10.1186/s12245-016-0106-7. Epub 2016 Feb 24.
Progression from nonsevere sepsis-i.e., sepsis without organ failure or shock-to severe sepsis or shock among emergency department (ED) patients has been associated with significant mortality. Early recognition in the ED of those who progress to severe sepsis or shock during their hospital course may improve patient outcomes. We sought to identify clinical, demographic, and laboratory parameters that predict progression to severe sepsis, septic shock, or death within 96 h of ED triage among patients with initial presentation of nonsevere sepsis.
This is a retrospective cohort of patients presenting to a single urban academic ED from November 2008 to October 2010. Patients aged 18 years or older who met criteria for sepsis and had a lactate level measured in the ED were included. Patients were excluded if they had any combination of the following: a systolic blood pressure <90 mmHg upon triage, an initial whole blood lactate level ≥4 mmol/L, or one or more of a set of predefined signs of organ dysfunction upon initial assessment. Disease progression was defined as the development of any combination of the aforementioned conditions, initiation of vasopressors, or death within 96 h of ED presentation. Data on predefined potential predictors of disease progression and outcome measures of disease progression were collected by a query of the electronic medical record and via chart review. Logistic regression was used to assess associations of potential predictor variables with a composite outcome measure of sepsis progression to organ failure, hypotension, or death.
In this cohort of 582 ED patients with nonsevere sepsis, 108 (18.6 %) experienced disease progression. Initial serum albumin <3.5 mg/dL (OR 4.82; 95 % CI 2.40-9.69; p < 0.01) and a diastolic blood pressure <52 mmHg at ED triage (OR 4.59; 95 % CI 1.57-13.39; p < 0.01) were independently associated with disease progression to severe sepsis or shock within 96 h of ED presentation. There were no deaths within 96 h of ED presentation.
In our patient cohort, serum albumin <3.5 g/dL and an ED triage diastolic blood pressure <52 mmHg independently predict early progression to severe sepsis or shock among ED patients with presumed sepsis.
在急诊科（ED）患者中，从非重症脓毒症（即无器官功能衰竭或休克的脓毒症）进展为重症脓毒症或休克与显著的死亡率相关。在急诊科早期识别那些在住院期间会进展为重症脓毒症或休克的患者，可能会改善患者的预后。我们试图确定在最初表现为非重症脓毒症的患者中，能预测在急诊科分诊后96小时内进展为重症脓毒症、脓毒性休克或死亡的临床、人口统计学和实验室参数。
这是一项对2008年11月至2010年10月期间到一家城市学术急诊科就诊的患者进行的回顾性队列研究。纳入年龄在18岁及以上、符合脓毒症标准且在急诊科测量了乳酸水平的患者。如果患者有以下任何一种组合情况则被排除：分诊时收缩压<90mmHg、初始全血乳酸水平≥4mmol/L，或初始评估时有一组预定义的器官功能障碍体征中的一项或多项。疾病进展定义为在急诊科就诊后96小时内出现上述任何一种情况的组合、开始使用血管升压药或死亡。通过查询电子病历和病历审查收集关于疾病进展的预定义潜在预测因素的数据以及疾病进展的结局指标。使用逻辑回归评估潜在预测变量与脓毒症进展至器官功能衰竭、低血压或死亡的综合结局指标之间的关联。
在这组582例非重症脓毒症的急诊科患者中，108例（18.6%）经历了疾病进展。初始血清白蛋白<3.5mg/dL（比值比4.82；95%可信区间2.40 - 9.69；p<0.01）和急诊科分诊时舒张压<52mmHg（比值比4.59；95%可信区间1.57 - 13.39；p<0.01）与在急诊科就诊后96小时内进展为重症脓毒症或休克独立相关。在急诊科就诊后96小时内无死亡病例。
在我们的患者队列中，血清白蛋白<3.5g/dL和急诊科分诊时舒张压<52mmHg可独立预测疑似脓毒症的急诊科患者早期进展为重症脓毒症或休克。
