Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
School of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
J Emerg Med. 2024 Aug;67(2):e128-e137. doi: 10.1016/j.jemermed.2024.01.016. Epub 2024 Feb 5.
Sepsis is a life-threatening condition but predicting its development and progression remains a challenge.
This study aimed to assess the impact of infection site on sepsis development among emergency department (ED) patients.
Data were collected from a single-center ED between January 2016 and December 2019. Patient encounters with documented infections, as defined by the Systematized Nomenclature of Medicine-Clinical Terms for upper respiratory tract (URI), lower respiratory tract (LRI), urinary tract (UTI), or skin or soft-tissue infections were included. Primary outcome was the development of sepsis or septic shock, as defined by Sepsis-1/2 criteria. Secondary outcomes included hospital disposition and length of stay, blood and urine culture positivity, antibiotic administration, vasopressor use, in-hospital mortality, and 30-day mortality. Analysis of variance and various different logistic regression approaches were used for analysis with URI used as the reference variable.
LRI was most associated with sepsis (relative risk ratio [RRR] 5.63; 95% CI 5.07-6.24) and septic shock (RRR 21.2; 95% CI 17.99-24.98) development, as well as hospital admission rates (odds ratio [OR] 8.23; 95% CI 7.41-9.14), intensive care unit admission (OR 4.27; 95% CI 3.84-4.74), in-hospital mortality (OR 6.93; 95% CI 5.60-8.57), and 30-day mortality (OR 7.34; 95% CI 5.86-9.19). UTIs were also associated with sepsis and septic shock development, but to a lesser degree than LRI.
Primary infection sites including LRI and UTI were significantly associated with sepsis development, hospitalization, length of stay, and mortality among patients presenting with infections in the ED.
脓毒症是一种危及生命的病症，但预测其发展和进程仍然是一个挑战。
本研究旨在评估急诊科（ED）患者感染部位对脓毒症发展的影响。
数据来自于 2016 年 1 月至 2019 年 12 月期间的一个单中心 ED。将记录的感染患者纳入研究，感染部位包括上呼吸道（URI）、下呼吸道（LRI）、泌尿道（UTI）或皮肤或软组织感染。主要结局为脓毒症或脓毒性休克的发生，其定义符合 Sepsis-1/2 标准。次要结局包括医院处置和住院时间、血和尿培养阳性、抗生素使用、血管加压素使用、院内死亡率和 30 天死亡率。采用方差分析和各种不同的逻辑回归方法进行分析，将 URI 作为参考变量。
LRI 与脓毒症（相对风险比 [RRR] 5.63；95%CI 5.07-6.24）和脓毒性休克（RRR 21.2；95%CI 17.99-24.98）的发生以及住院率（比值比 [OR] 8.23；95%CI 7.41-9.14）、重症监护病房（OR 4.27；95%CI 3.84-4.74）、院内死亡率（OR 6.93；95%CI 5.60-8.57）和 30 天死亡率（OR 7.34；95%CI 5.86-9.19）的发生显著相关，UTI 与脓毒症和脓毒性休克的发生也有一定关联，但程度低于 LRI。
包括 LRI 和 UTI 在内的主要感染部位与 ED 感染患者脓毒症的发生、住院、住院时间和死亡率显著相关。
