Department of Emergency Medicine, Hanyang University Medical Center, 222-1, Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea.
Department of Emergency Medicine, Gangnam Severance Hospital, 211, Eonju-ro, Gangnam-gu, Seoul 06273, Republic of Korea.
J Crit Care. 2019 Oct;53:176-182. doi: 10.1016/j.jcrc.2019.06.012. Epub 2019 Jun 17.
Current guidelines recommend that rapid source control should be adopted in patients not >6-12 h after sepsis is diagnosed. However, evidence level of this guideline is not specified, and there is no previous study on patients with septic shock visiting the emergency department (ED). Therefore, we aimed to assess the impact of rapid source control in patients with septic shock visiting the ED.
In a prospective, observational, multicenter, registry-based study in 11 EDs, Cox proportional hazards model was used to assess the independent effect of source control and time to source control on 28-day mortality.
Cox proportional hazard models revealed that 28-day mortality was significantly lower in patients who underwent source control (HR 0.538 (0.389-0.744), p < .001). However, no significant association between the performance of source control after 6 h or 12 h from enrollment and 28-day mortality was noted.
Patients with septic shock visiting the ED who underwent source control showed better outcomes than those who did not. We failed to demonstrate the performance of rapid source control reduced the 28-day mortality in septic shock patients. Further studies are required to determine the impact of rapid source control in sepsis and septic shock.
目前的指南建议在脓毒症确诊后 6-12 小时内对患者采取快速源头控制。然而，该指南的证据水平并未具体说明，并且之前没有关于急诊就诊的感染性休克患者的研究。因此，我们旨在评估快速源头控制对急诊就诊的感染性休克患者的影响。
在 11 个急诊室进行的前瞻性、观察性、多中心、基于登记的研究中，我们使用 Cox 比例风险模型评估源头控制和源头控制时间对 28 天死亡率的独立影响。
Cox 比例风险模型显示，接受源头控制的患者 28 天死亡率显著降低（HR 0.538（0.389-0.744），p < 0.001）。然而，在登记后 6 小时或 12 小时后进行源头控制与 28 天死亡率之间没有显著关联。
就诊于急诊的感染性休克患者接受源头控制后，其预后优于未接受源头控制的患者。我们未能证明快速源头控制可降低感染性休克患者的 28 天死亡率。需要进一步研究以确定快速源头控制在脓毒症和感染性休克中的影响。
