Sepsis-related mortality in 497 cases with blood culture-positive sepsis in an emergency department. (May 2017)

• Record Type: Journal Article
• Authors: Rannikko, Juha; Syrjänen, Jaana; Seiskari, Tapio; Aittoniemi, Janne; Huttunen, Reetta
• Is Part Of: International journal of infectious diseases. Volume 58(2017:May)
• Page Start: 52
• Page End: 57
• Publication Date: 2017-05
• Subjects: Attributable mortality -- Blood culture -- Infectious disease -- Related mortality -- Sepsis -- Survival -- qSOFA; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2017.03.005
• Languages: English
• ISSNs: 1201-9712

Abstract

Highlights: Only 16% of deaths by day 90 after culture-positive sepsis are related to sepsis in patients with a life-expectancy of more than 6 months. 95% of sepsis-related deaths occur by day 28. Using day 90 as an endpoint in sepsis research includes mortality related to causes other than sepsis. Summary: Objective: Few studies have sought to establish how often death after sepsis is related to the sepsis and how often underlying diseases have a major role in case fatality. Methods: In this retrospective cohort study, data were collected on 497 cases with blood culture-positive sepsis in an emergency department (ED). Results: Sepsis was categorized as severe in 31% of cases; 7% had septic shock. The quick Sepsis-related Organ Failure Assessment score was positive in 136 out of 473 cases (29%). Ninety-eight patients died by day 90; in 16 of these cases (16%) the death was sepsis-related in a patient without a rapidly fatal underlying disease, in 45 cases (46%) the death was sepsis-related in a patient with a rapidly fatal underlying disease, and in 37 cases (38%) the death was unrelated to sepsis. Sepsis-related death occurred in 58 out of 61 cases (95%) by day 28. Conclusions: Underlying diseases were found to have a considerable role in the death of patients suffering from blood culture-positive sepsis in an ED of a developed country, as only 16% of the deaths by day 90 occurred where death was sepsis-related and the patient had a life-expectancy of more than 6 months. Improving the outcome of sepsis with new treatments is thus challenging. It is possible that day 7 + day 28 mortality is a more appropriate endpoint than day 90 mortality when studying the outcome of sepsis, as this time-span includes most of the patients whose death was related to sepsis.