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Improving the diagnosis and prognosis of sepsis according to the sources of infection
  1. Deibie Mendoza1,
  2. Johana Ascuntar2,
  3. Oriana Rosero1,
  4. Fabian Jaimes2,3
  1. 1Facultad de Medicina, Universidad de Antioquia, Medellin, Colombia
  2. 2GRAEPIC (Grupo Académico de Epidemiología Clínica), Universidad de Antioquia, Medellin, Colombia
  3. 3Internal Medicine Department, Universidad de Antioquia, Medellin, Colombia
  1. Correspondence to Dr Fabian Jaimes, University of Antioquia, Medellin, AA 1226, Colombia; fabian.jaimes{at}udea.edu.co

Abstract

Introduction The clinical presentation of sepsis is heterogeneous and largely depends on the primary site of infection. Currently, factors associated with sepsis outcomes do not differentiate between infection sites. The objective of this investigation was to identify variables associated with risk of in-hospital mortality or intensive care unit (ICU) admission, according to infection sites.

Methods This was a secondary analysis of a multicentre prospective cohort of ED patients ≥18 years old from three university hospitals in Medellín, Colombia. Multivariable logistic regression models were performed to estimate the association of factors with in-hospital mortality or ICU admission according to five infection sites: urinary tract infection (UTI), community-acquired pneumonia (CAP), intra-abdominal infection, sepsis without evident source (primary) and other sites.

Results The infection sites of the 1947 patients included were: UTI (n=586), CAP (n=585), intra-abdominal infection (n=213), primary (n=224) and other sites (n=339). In the multivariable model, the factors associated with in-hospital mortality or ICU admission varied by infection site: respiratory rate (RR), systolic blood pressure (SBP) and lactate for UTI; heart rate (HR), RR and temperature <38°C for CAP; Glasgow Coma Scale (GCS), lactate and age <65 for intra-abdominal infection; SBP, GCS, lactate and temperature <38°C for primary and RR, GCS and temperature <38°C for other.

Conclusions Our results suggest that the diagnosis and prognosis of sepsis in emergency care should consider different clinical criteria, based on site of infection. Given the heterogeneity and interindividual variability of sepsis, a more individualised approach could help to direct treatment, monitor response and facilitate initial clinical decisions.

  • infections
  • death
  • critical care

Data availability statement

No data are available.

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Footnotes

  • Handling editor Roland C Merchant

  • Presented at A preliminary summary was presented at the Annual European Society of Intensive Care Medicine Congress LIVES 2020 (Digital congress).

  • Contributors All authors contributed to the conception of the research question and design of the study. JA and FJ contributed to the analysis and interpretation. All authors wrote the article, and all the authors substantially contributed to its revision and approval. FJ is the author responsible for the overall content as the guarantor.

  • Funding Funded by Ministry of Science, Technology and Innovation of Colombia (MINCIENCIAS) (Code 111556933362) and the University of Antioquia (Code 2582).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.