Centre Régional Universitaire Des Urgences, Hôpital F. Mitterrand, C.H.U. DIJON, Bd Mal de Lattre de Tassigny, Dijon, France.
Centre d'Investigation Clinique, Hôpital F. Mitterrand, C.H.U. Dijon, 14 rue Gaffarel, Dijon, France.
BMC Infect Dis. 2022 Mar 2;22(1):205. doi: 10.1186/s12879-022-07210-y.
Early identification of sepsis is mandatory. However, clinical presentation is sometimes misleading given the lack of infection signs. The objective of the study was to evaluate the impact on the 28-day mortality of the so-called "vague" presentation of sepsis.
Single centre retrospective observational study.
One teaching hospital Intensive Care Unit.
All the patients who presented at the Emergency Department (ED) and were thereafter admitted to the Intensive Care Unit (ICU) with a final diagnosis of sepsis were included in this retrospective observational three-year study. They were classified as having exhibited either "vague" or explicit presentation at the ED according to previously suggested criteria. Baseline characteristics, infection main features and sepsis management were compared. The impact of a vague presentation on 28-day mortality was then evaluated.
None.
Among the 348 included patients, 103 (29.6%) had a vague sepsis presentation. Underlying chronic diseases were more likely in those patients [e.g., peripheral arterial occlusive disease: adjusted odd ratio (aOR) = 2.01, (1.08-3.77) 95% confidence interval (CI); p = 0.028], but organ failure was less likely at the ED [SOFA score value: 4.7 (3.2) vs. 5.2 (3.1), p = 0.09]. In contrast, 28-day mortality was higher in the vague presentation group (40.8% vs. 26.9%, p = 0.011), along with longer time-to-diagnosis [18 (31) vs. 4 (11) h, p < 0.001], time-to-antibiotics [20 (32) vs. 7 (12) h, p < 0.001] and time to ICU admission [71 (159) vs. 24 (69) h, p < 0.001]. Whatever, such a vague presentation independently predicted 28-day mortality [aOR = 2.14 (1.24-3.68) 95% CI; p = 0.006].
Almost one third of septic patient requiring ICU had a vague presentation at the ED. Despite an apparent lower level of severity when initially assessed, those patients had an increased risk of mortality that could not be fully explained by delayed diagnosis and management of sepsis.
早期识别脓毒症是必要的。然而，由于缺乏感染迹象，临床表现有时会产生误导。本研究的目的是评估所谓的脓毒症“模糊”表现对 28 天死亡率的影响。
单中心回顾性观察性研究。
一家教学医院的重症监护病房。
所有因最终诊断为脓毒症而在急诊科就诊并随后收入重症监护病房的患者均纳入本项回顾性为期 3 年的研究。根据先前提出的标准，他们被分为急诊科表现为“模糊”或明确的患者。比较了基线特征、感染主要特征和脓毒症治疗。然后评估模糊表现对 28 天死亡率的影响。
无。
在纳入的 348 名患者中，103 名（29.6%）有模糊的脓毒症表现。这些患者更容易合并慢性疾病[例如，外周动脉闭塞性疾病：调整后的优势比（aOR）=2.01，（1.08-3.77）95%置信区间（CI）；p=0.028]，但急诊科的器官衰竭可能性更小[SOFA 评分值：4.7（3.2）vs. 5.2（3.1），p=0.09]。相反，模糊表现组的 28 天死亡率更高（40.8%vs.26.9%，p=0.011），诊断时间更长[18（31）vs.4（11）h，p<0.001]，抗生素使用时间更长[20（32）vs.7（12）h，p<0.001]，入住 ICU 时间更长[71（159）vs.24（69）h，p<0.001]。无论如何，这种模糊的表现独立预测 28 天死亡率[aOR=2.14（1.24-3.68）95%CI；p=0.006]。
近三分之一需要入住 ICU 的脓毒症患者在急诊科表现为“模糊”。尽管最初评估时严重程度似乎较低，但这些患者的死亡率风险增加，这不能完全用脓毒症的延迟诊断和治疗来解释。
