Marco Catherine A, Snoad Tori Beth L, Kim Hali, Erturk Quincy, Keenan Kayla, Wang Grace, Hu Eric
Emergency Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, USA.
Emergency Medicine, Penn State College of Medicine, Hershey, USA.
Cureus. 2025 May 28;17(5):e84983. doi: 10.7759/cureus.84983. eCollection 2025 May.
Introduction Sepsis is defined as life-threatening organ dysfunction due to a dysregulated host response to infection, and is one of the leading causes of morbidity and mortality globally. This study was undertaken to investigate the role of healthcare encounters and diagnostic test results in the 30 days preceding a sepsis diagnosis. Methods In this single-center retrospective chart review, eligible subjects were 18 years of age and older who presented to the ED and were diagnosed with either sepsis or septic shock in the ED or inpatient setting between January 2020 and September 2023. Healthcare encounters such as laboratory and diagnostic studies obtained within 30 days prior to the diagnosis of sepsis or septic shock were included in the analysis. Results A total of 363 ED patients with a diagnosis of sepsis were included in the study. The mean age of the patients was 64 years (range 18-99), with 47% being women. At ED presentation, 202 (66%) had an abnormal chest radiograph, and 224 (75%) had an abnormal EKG. Final disposition included discharge home from inpatient setting (n=171; 48%), deceased (n=63; 17.55%), and transfer to an extended care facility (ECF) or rehabilitation center (n=125; 34.82%). A substantial number had a healthcare encounter within the previous 30 days prior to the diagnosis of sepsis (n=131; 36%; range: 1-28). Types of healthcare encounters included ED visit (n=113; 31%), inpatient hospitalization (n=85; 23%), outpatient visit (n=77; 21%), ECF (n=5; 1.2%), and home health visit (n=2; 0.5%). Patients with more encounters within 30 days had higher mortality (deceased patients had a mean of 4.6 visits (95%CI: 3.0, 6.1), and patients discharged home had a mean of 3.0 visits (95%CI (2.3, 3.6) (p = 0.03). Older patients were more likely to be transferred to an ECF/rehabilitation center than discharged home (mean age of patients transferred to ECF: 70.9, 95%CI 68.4, 73.4; mean age of patients discharged home: 58.6, 95%CI 55.7, 61.5; p<0.0001). Conclusions Patients with a diagnosis of sepsis frequently had one or more healthcare encounters and diagnostic tests within 30 days prior to the diagnosis. Abnormal diagnostic tests, including creatinine, bilirubin, and alkaline phosphatase, were associated with higher mortality. Patients with more healthcare encounters and older patients had higher mortality.
引言
脓毒症被定义为由于宿主对感染的反应失调而导致的危及生命的器官功能障碍，是全球发病和死亡的主要原因之一。本研究旨在调查脓毒症诊断前30天内医疗接触和诊断测试结果的作用。
方法
在这项单中心回顾性病历审查中，符合条件的受试者为2020年1月至2023年9月期间在急诊科就诊并在急诊科或住院环境中被诊断为脓毒症或感染性休克的18岁及以上患者。分析包括在脓毒症或感染性休克诊断前30天内进行的实验室和诊断研究等医疗接触。
结果
本研究共纳入363例诊断为脓毒症的急诊科患者。患者的平均年龄为64岁（范围18 - 99岁），其中47%为女性。在急诊科就诊时，202例（66%）胸部X光片异常，224例（75%）心电图异常。最终处置包括从住院环境出院回家（n = 171；48%）、死亡（n = 63；17.55%）以及转至长期护理机构（ECF）或康复中心（n = 125；34.82%）。相当一部分患者在脓毒症诊断前30天内有过医疗接触（n = 131；36%；范围：1 - 28天）。医疗接触类型包括急诊科就诊（n = 113；31%）、住院治疗（n = 85；23%）、门诊就诊（n = 77；21%）、ECF（n = 5；1.2%）和家庭健康访视（n = 2；0.5%）。30天内医疗接触较多的患者死亡率较高（死亡患者平均有4.6次就诊（95%CI：3.0，6.1），出院回家的患者平均有3.0次就诊（95%CI（2.3，3.6）（p = 0.03）。老年患者比出院回家的患者更有可能转至ECF/康复中心（转至ECF的患者平均年龄：70.9，95%CI 68.4，73.4；出院回家的患者平均年龄：58.6，95%CI 55.7，61.5；p < 0.0001）。
结论
诊断为脓毒症的患者在诊断前30天内经常有一次或多次医疗接触和诊断测试。包括肌酐、胆红素和碱性磷酸酶在内的异常诊断测试与较高的死亡率相关。医疗接触较多的患者和老年患者死亡率较高。
