Sepsis-related deaths in the at-risk population on the wards: attributable fraction of mortality in a large point-prevalence study

Kopczynska, Maja; Sharif, Ben; Cleaver, Sian; Spencer, Naomi; Kurani, Amit; Lee, Camilla; Davis, Jessica; Durie, Carys; Joseph-Gubral, Jude; Sharma, Angelica; Allen, Lucy; Atkins, Billie; Gordon, Alexandra June; Jones, Llewelyn; Noble, Amy; Bradley, Matthew John; Atkinson, Henry; Inns, Joy; Penney, Harriet; Gilbert, Carys; Walford, Rebecca; Pike, Louise; Edwards, Ross; Howcroft, Robyn; Preston, Hazel; Gee, Jennifer; Doyle, Nicholas A.; Maden, Charlotte; Smith, Claire; Azis, Nik Syakira Nik; Vadivale, Navrhinaa; Szakmány, Tamás

doi:10.1186/s13104-018-3819-2

Cited by 16 publications

(23 citation statements)

References 20 publications

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“…In a recent randomised controlled trial of community-acquired sepsis with very similar patient population characteristics to our study, early (within 1-h of recognition) broad spectrum antibiotic administration failed to improve clinical outcomes compared to the usual care group which received antibiotics after assessment in the ED [21]. We have shown, that severe infection leading to organ dysfunction per se is relatively rarely attributable to death in the same patient population [22]. This finding was echoed in a recent study from the US, where Rhee et al found that although sepsis was present in 52% of terminal hospitalisations, underlying causes of death were related to severe chronic comorbidities and most sepsis-associated deaths were unlikely to be preventable through better hospital-based care [23].…”

Section: Discussionmentioning

confidence: 49%

Real World Patterns of Antimicrobial Use and Microbiology Investigations in Patients with Sepsis outside the Critical Care Unit: Secondary Analysis of Three Nation-Wide Point Prevalence Studies

Kopczynska

Sharif

Unwin

et al. 2019

JCM

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Recent description of the microbiology of sepsis on the wards or information on the real-life antibiotic choices used in sepsis is lacking. There is growing concern of the indiscriminate use of antibiotics and omission of microbiological investigations in the management of septic patients. We performed a secondary analysis of three annual 24-h point-prevalence studies on the general wards across all Welsh acute hospitals in years 2016–2018. Data were collected on patient demographics, as well as radiological, laboratory and microbiological data within 48-h of the study. We screened 19,453 patients over the three 24 h study periods and recruited 1252 patients who fulfilled the entry criteria. 775 (64.9%) patients were treated with intravenous antibiotics. Only in 33.65% (421/1252) of all recruited patients did healthcare providers obtain blood cultures; in 25.64% (321/1252) urine cultures; in 8.63% (108/1252) sputum cultures; in 6.79% (85/1252) wound cultures; in 15.25% (191/1252) other cultures. Out of the recruited patients, 59.1% (740/1252) fulfilled SEPSIS-3 criteria. Patients with SEPSIS-3 criteria were significantly more likely to receive antibiotics than the non-septic cohort (p < 0.0001). In a multivariable regression analysis increase in SOFA score, increased number of SIRS criteria and the use of the official sepsis screening tool were associated with antibiotic administration, however obtaining microbiology cultures was not. Our study shows that antibiotics prescription practice is not accompanied by microbiological investigations. A significant proportion of sepsis patients are still at risk of not receiving appropriate antibiotics treatment and microbiological investigations; this may be improved by a more thorough implementation of sepsis screening tools.

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Section: Discussionmentioning

confidence: 49%

Real World Patterns of Antimicrobial Use and Microbiology Investigations in Patients with Sepsis outside the Critical Care Unit: Secondary Analysis of Three Nation-Wide Point Prevalence Studies

Kopczynska

Sharif

Unwin

et al. 2019

JCM

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“…However, the repeated nationwide point-prevalence studies in Wales between 2015-2017 have yielded similar results, in incidence of sepsis, bundle compliance and likely cause of death. 7,24,27,28 Similarly, the international IMPRESS study reported similar rates of sepsis outside of critical care and low bundle compliance. 29…”

Section: Discussionmentioning

confidence: 97%

A Snapshot of Compliance with the Sepsis Six Care Bundle in Two Acute Hospitals in the West Midlands, UK

Frankling

Patel

Sharif

et al. 2019

Indian Journal of Critical Care Medicine

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Background The sepsis six care bundle has been adopted by hospitals in England and Wales for the management of patients with sepsis, with the aim of increasing survival when all elements of the bundle are achieved. Aim To assess compliance with the Sepsis Six Care Bundle in two acute NHS hospitals in the West Midlands. Materials and Methods Adults admitted to hospital over a 24-hour period were screened for sepsis. Sepsis was identified using the Systemic Inflammatory Response (SIRS) criteria and the quick sequential organ failure assessment (qSOFA) score. Adherence to the Sepsis Six Care Bundle was assessed. Results 249 patients were screened and 24 patients were identified as having sepsis (9.6%). One patient received all six elements of the bundle. Compliance was highest for giving intravenous fluids (58.3%) and antibiotics (58.3%), and lowest for measuring urine output (16.7%). Conclusions Further research is needed to establish the reasons for low compliance. How to cite this article Frankling C, Patel J, Sharif B, Melody T, Yeung J, Gao F, et al. A Snapshot of Compliance with the Sepsis Six Care Bundle in Two Acute Hospitals in the West Midlands, UK. Indian J Crit Care Med 2019;23(7):310–315.

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“…It is also noteworthy that, even in non-geriatric settings, only a minority of deaths occurring in patients admitted for sepsis are directly and undoubtedly attributable to the infection [45,46]. The attributable fraction of mortality related to sepsis has been esteemed in 15% of patients admitted to ICUs and 24.1% of patients admitted to non-ICU wards [45,46]. In this scenario, frailty and multimorbidity may play a relevant role in defining the prognostic trajectory, even when an acute, disseminated, and life-threatening infection is present.…”

Section: Discussionmentioning

confidence: 99%

Application of the Sepsis-3 Consensus Criteria in a Geriatric Acute Care Unit: A Prospective Study

Bastoni

Ticinesi

Lauretani

et al. 2019

JCM

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The prognostic value of quick Sepsis-related Organ Failure Assessment (qSOFA) score in geriatric patients is uncertain. We aimed to compare qSOFA vs. Systemic Inflammatory Response Syndrome (SIRS) criteria for mortality prediction in older multimorbid subjects, admitted for suspected sepsis in a geriatric ward. We prospectively enrolled 272 patients (aged 83.7 ± 7.4). At admission, qSOFA and SIRS scores were calculated. Mortality was assessed during hospital stay and three months after discharge. The predictive capacity of qSOFA and SIRS was assessed by calculating the Area Under the Receiver Operating Characteristic Curve (AUROC), through pairwise AUROC comparison, and multivariable logistic regression analysis. Both qSOFA and SIRS exhibited a poor prognostic performance (AUROCs 0.676, 95% CI 0.609–0.738, and 0.626, 95% CI 0.558–0.691 for in-hospital mortality; 0.684, 95% CI 0.614–0.748, and 0.596, 95% CI 0.558–0.691 for pooled three-month mortality, respectively). The predictive capacity of qSOFA showed no difference to that of SIRS for in-hospital mortality (difference between AUROCs 0.05, 95% CI −0.05 to 0.14, p = 0.31), but was superior for pooled three-month mortality (difference between AUROCs 0.09, 95% CI 0.01–0.17, p = 0.029). Multivariable logistic regression analysis, accounting for possible confounders, including frailty, showed that both scores were not associated with in-hospital mortality, although qSOFA, unlike SIRS, was associated with pooled three-month mortality. In conclusion, neither qSOFA nor SIRS at admission were strong predictors of mortality in a geriatric acute-care setting. Traditional geriatric measures of frailty may be more useful for predicting adverse outcomes in this setting.

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Sepsis-related deaths in the at-risk population on the wards: attributable fraction of mortality in a large point-prevalence study

Cited by 16 publications

References 20 publications

Real World Patterns of Antimicrobial Use and Microbiology Investigations in Patients with Sepsis outside the Critical Care Unit: Secondary Analysis of Three Nation-Wide Point Prevalence Studies

Real World Patterns of Antimicrobial Use and Microbiology Investigations in Patients with Sepsis outside the Critical Care Unit: Secondary Analysis of Three Nation-Wide Point Prevalence Studies

A Snapshot of Compliance with the Sepsis Six Care Bundle in Two Acute Hospitals in the West Midlands, UK

Application of the Sepsis-3 Consensus Criteria in a Geriatric Acute Care Unit: A Prospective Study

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