Critical Care: Sepsis Diagnosis and Resuscitation |

Predictors of Progression to Septic Shock in Patients Meeting Clinical Criteria for Severe Sepsis FREE TO VIEW

Bristol Whiles, BS; Amanda Deis, BS; Steven Simpson, MD
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University of Kansas School of Medicine, Kansas City, KS

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):351A. doi:10.1016/j.chest.2016.08.364
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SESSION TITLE: Sepsis Diagnosis and Resuscitation

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Tuesday, October 25, 2016 at 11:00 AM - 12:15 PM

PURPOSE: To determine identifiable risk factors associated with increased risk of progression of severe sepsis to septic shock.

METHODS: We developed a retrospective cohort study of severe sepsis patients ≥18 years of age admitted through the University of Kansas Hospital emergency department (ED) between 3/1/2007 - 9/30/2015. Severe sepsis was identified by an ICD-9 diagnosis code (995.92) or by clinical criteria with acute organ dysfunction at ≥2 organ sites. Inclusion criteria also required a diagnosed infection, antibiotic administration within 24 hours of ED triage, and recorded length of hospital stay and discharge disposition. The presence of septic shock on presentation at our facility was defined as any of the following within 3 hours of ED triage: 1) systolic blood pressure >90mmHg, 2) mean arterial pressure <65, or 3) vasopressor administration. Since we were interested in the progression of severe sepsis to septic shock, patients with shock on presentation were removed from our study. Progression to septic shock was defined as administration of a vasopressor subsequently during the same hospitalization. Chi-squared, t-test, and multivariate regression modeling was used to determine variables predictive of progression from severe sepsis to septic shock.

RESULTS: A total of 8623 patients with severe sepsis were identified, with an average age of 60.1 ± 16.8 years (mean ± SD) and including 4480 (52.0%) males. Of these patients, 632 (7.33%) progressed to septic shock during their hospitalization. Age, gender, race, BMI, and Charlson Age-Comorbidity Index were similar among those without and with progression to septic shock. Progression to shock was associated with increased hospital LOS, and increased rates of ICU admission, mortality, and 30-day readmission (7.9 ± 8.2 days vs 15.5 ± 13.7 days, p<.0001; 30.1% vs 91.3%, p<.0001 ; 4.1% vs 25.47%, p<.0001). SOFA score and number of infection sites were higher among patients with progression to septic shock vs patients without progression (5.53 ± 3.13 vs 3.01 ± 2.12, p<.0001; 2.2 ± 0.92 vs 1.92 ± 0.89, p<.0001). Specific organ dysfunction types associated with increased risk of progression to septic shock included respiratory and hematologic dysfunction (DIC) (p<.05). Infections most predictive of progression included pulmonary, bacteremia, abdominal, and iatrogenic infections (p<.05). Comorbid conditions associated with increased risk of progression included coagulopathies, fluid and electrolyte disorders, lymphoma, and weight loss (p<.05).

CONCLUSIONS: Specific organ dysfunction, infection, and comorbid condition types are associated with increased progression of severe sepsis to septic shock. Progression to septic shock is associated with adverse patient centered outcomes including longer hospital LOS and higher rates of ICU admission, mortality, and 30-day readmission.

CLINICAL IMPLICATIONS: Many of the risk factors for progression identified in this study are identifiable at the patient’s presentation to the hospital. Recognition of these risk factors may help clinicians to provide more accurate prognostic information and guide more aggressive treatment options.

DISCLOSURE: The following authors have nothing to disclose: Bristol Whiles, Amanda Deis, Steven Simpson

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