Mortality of patients with hospital-onset sepsis in hospitals with all-day and non-all-day rapid response teams: a prospective nationwide multicenter cohort study

Abstract

Background Hospital-onset sepsis is associated with a higher in-hospital mortality rate than community-onset sepsis. Many hospitals have implemented rapid response teams (RRTs) for early detection and timely management of at-risk hospitalized patients. However, the effectiveness of an all-day RRT over a non-all-day RRT in reducing the risk of in-hospital mortality in patient with hospital-onset sepsis is unclear. We aimed to determine the effect of the RRT’s operating hours on in-hospital mortality in inpatient patients with sepsis. Methods We conducted a nationwide cohort study of adult patients with hospital-onset sepsis prospectively collected from the Korean Sepsis Alliance (KSA) Database from 16 tertiary referral or university-affiliated hospitals in South Korea between September of 2019 and February of 2020. RRT was implemented in 11 hospitals, of which 5 (45.5%) operated 24-h RRT (all-day RRT) and the remaining 6 (54.5%) had part-day RRT (non-all-day RRT). The primary outcome was in-hospital mortality between the two groups. Results Of the 405 patients with hospital-onset sepsis, 206 (50.9%) were admitted to hospitals operating all-day RRT, whereas 199 (49.1%) were hospitalized in hospitals with non-all-day RRT. A total of 73 of the 206 patients in the all-day group (35.4%) and 85 of the 199 patients in the non-all-day group (42.7%) died in the hospital ( P = 0.133). After adjustments for co-variables, the implementation of all-day RRT was associated with a significant reduction in in-hospital mortality (adjusted odds ratio 0.57; 95% confidence interval 0.35–0.93; P = 0.024). Conclusions In comparison with non-all-day RRTs, the availability of all-day RRTs was associated with reduced in-hospital mortality among patients with hospital-onset sepsis. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-04149-z.

Impact of a cumulative positive fluid balance during the first three ICU days in patients with sepsis: a propensity score-matched cohort study

“…We analyzed prospectively collected data of 11,981 patients with sepsis from 20 tertiary referral or university-affiliated hospitals in South Korea between September 2019 and December 2021 as part of an ongoing nationwide, multicenter observational cohort (the Korean Sepsis Alliance registry). The protocols for patient enrollment and data collection have been described previously [ 25 ]. All consecutive patients who presented to the emergency department or hospitalized patients in wards who were managed by a rapid response team were screened for eligibility, and patients aged ≥ 19 years diagnosed with sepsis based on the third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) were included in the registry [ 26 ].…”

Hospital-Onset Sepsis Warrants Expanded Investigation and Consideration as a Unique Clinical Entity

“… 51 Dedicated sepsis response teams have been associated with improved sepsis process of care metrics as well as mortality, although most patients included in these studies had COS and received initial care in the ED. 52 , 53 , 54 Further studies to quantify the benefit of sepsis response teams on outcomes among HOS patients are indicated.…”

The association of arterial partial oxygen pressure with mortality in critically ill sepsis patients: a nationwide observational cohort study

“…This study was conducted based on an ongoing nationwide observational cohort (the Korean Sepsis Alliance registry, KSA), which prospectively collected data on 13,827 patients with sepsis from 15 hospitals in South Korea between September 2019 and December 2022. The registry information, such as inclusion criteria, was introduced in previous studies [16,17]. All patients from the registry aged ≥ 19 years who were admitted to the ICU for sepsis treatment were included.…”