Association between site of infection and in-hospital mortality in patients with sepsis admitted to emergency departments of tertiary hospitals in Medellin, Colombia

Abstract

Objective To determine the association between the primary site of infection and in-hospital mortality as the main outcome, or the need for admission to the intensive care unit as a secondary outcome, in patients with sepsis admitted to the emergency department. Methods This was a secondary analysis of a multicenter prospective cohort. Patients included in the study were older than 18 years with a diagnosis of severe sepsis or septic shock who were admitted to the emergency departments of three tertiary care hospitals. Of the 5022 eligible participants, 2510 were included. Multiple logistic regression analysis was performed for mortality. Results The most common site of infection was the urinary tract, present in 27.8% of the cases, followed by pneumonia (27.5%) and intra-abdominal focus (10.8%). In 5.4% of the cases, no definite site of infection was identified on admission. Logistic regression revealed a significant association between the following sites of infection and in-hospital mortality when using the urinary infection group as a reference: pneumonia (OR 3.4; 95%CI, 2.2 - 5.2; p < 0.001), skin and soft tissues (OR 2.6; 95%CI, 1.4 - 5.0; p = 0.003), bloodstream (OR 2.0; 95%CI, 1.1 - 3.6; p = 0.018), without specific focus (OR 2.0; 95%CI, 1.1 - 3.8; p = 0.028), and intra-abdominal focus (OR 1.9; 95%CI, 1.1 - 3.3; p = 0.024). Conclusions There is a significant association between the different sites of infection and in-hospital mortality or the need for admission to an intensive care unit in patients with sepsis or septic shock. Urinary tract infection shows the lowest risk, which should be considered in prognostic models of these conditions.

Circulating Th1 and Th2 Subset Accumulation Kinetics in Septic Patients with Distinct Infection Sites: Pulmonary versus Nonpulmonary

“…Whether the infection site impacts clinic outcomes still remains controversial. A significant association between the site of infection and the inhospital mortality in patients with sepsis or septic shock was reported in a secondary analysis of a multicentre prospective cohort study recently [ 24 ], while several studies showed that the evidence for the conclusive statement about the role of the infection site in mortality among sepsis might not be robust for heterogeneity of study population by the present literature [ 25 , 26 ]. However, the impact of the infection site on patterns of organ failures might differ.…”

Risk factors for 28-day mortality in patients with sepsis-related myocardial injury in intensive care units

“…10 Pulmonary infection, possibly due to a high rate of mechanical ventilation, 14 is the most common and major cause of sepsis in patients in the ICU. Caraballo et al 15 showed a significant correlation between pulmonary infection and hospital mortality in patients with sepsis (OR: 3.4, 95% CI: 2.2-5.5). Similar results were also obtained in the present study, indicating that pulmonary infections might help predict survival of patients with sepsis.…”

“…Caraballo et al. 15 showed a significant correlation between pulmonary infection and hospital mortality in patients with sepsis (OR: 3.4, 95% CI: 2.2–5.5). Similar results were also obtained in the present study, indicating that pulmonary infections might help predict survival of patients with sepsis.…”

Predictive factors of in-hospital mortality in patients with laboratory-confirmed Escherichia coli, Klebsiella species or Pseudomonas aeruginosa bloodstream infections

“…In this study, the odds of in-hospital mortality were 3.73 times greater in patients with a respiratory primary focus compared to a LUTI primary focus. It has been reported previously that respiratory infections leading to a BSI have poorer outcomes, whereas urinary tract infections have the lowest associated mortality rates [ 7 , 18 – 22 ]. The recent study by Inada-Kim et.…”