Time to treatment and mortality for clinical sepsis subtypes

Abstract

Background Sepsis is common, deadly, and heterogenous. Prior analyses of patients with sepsis and septic shock in New York State showed a risk-adjusted association between more rapid antibiotic administration and bundled care completion, but not an intravenous fluid bolus, with reduced in-hospital mortality. However, it is unknown if clinically identifiable sepsis subtypes modify these associations. Methods Secondary analysis of patients with sepsis and septic shock enrolled in the New York State Department of Health cohort from January 1, 2015 to December 31, 2016. Patients were classified as clinical sepsis subtypes (α, β, γ, δ-types) using the Sepsis ENdotyping in Emergency CAre (SENECA) approach. Exposure variables included time to 3-h sepsis bundle completion, antibiotic administration, and intravenous fluid bolus completion. Then logistic regression models evaluated the interaction between exposures, clinical sepsis subtypes, and in-hospital mortality. Results 55,169 hospitalizations from 155 hospitals were included (34% α, 30% β, 19% γ, 17% δ). The α-subtype had the lowest (N = 1,905, 10%) and δ-subtype had the highest (N = 3,776, 41%) in-hospital mortality. Each hour to completion of the 3-h bundle (aOR, 1.04 [95%CI, 1.02–1.05]) and antibiotic initiation (aOR, 1.03 [95%CI, 1.02–1.04]) was associated with increased risk-adjusted in-hospital mortality. The association differed across subtypes (p-interactions < 0.05). For example, the outcome association for the time to completion of the 3-h bundle was greater in the δ-subtype (aOR, 1.07 [95%CI, 1.05–1.10]) compared to α-subtype (aOR, 1.02 [95%CI, 0.99–1.04]). Time to intravenous fluid bolus completion was not associated with risk-adjusted in-hospital mortality (aOR, 0.99 [95%CI, 0.97–1.01]) and did not differ among subtypes (p-interaction = 0.41). Conclusion Timely completion of a 3-h sepsis bundle and antibiotic initiation was associated with reduced risk-adjusted in-hospital mortality, an association modified by clinically identifiable sepsis subtype.

High Mechanical Power and Driving Pressures are Associated With Postoperative Respiratory Failure Independent From Patients’ Respiratory System Mechanics*

“…In addition, the probability for unobserved confounding to substantially contribute to our findings was tested, implying that considerable unmeasured confounding, above and beyond all measured confounders, would be necessary to explain away the observed effect estimate. Although acknowledging the limitations of E-values in estimating residual confounding (20,(49)(50)(51)(52), we believe that there is a low probability that unobserved confounding significantly biased our results. Data from a limited geographical region were analyzed and the findings might therefore not be generalizable to other healthcare settings.…”

Sepsis 3-hour bundle compliance and prognosis in emergency department patients aged 65 years or older

“…Sin embargo, este cumplimien- A partir de las nuevas definiciones de sepsis 1 y la revisión de las guías que se publicaron poco después, nuestro SUH adoptó el algoritmo de actuación conocido como paquete de medidas en las primeras 3 horas 4 . Aunque se ha discutido sobre el beneficio de aplicar estas medidas en la primera hora, su aplicación en los pacientes mayores de 65 años es controvertida 13,14 . A pesar de que el manejo actual supone una mejoría con respecto a estudios previos realizados en este mismo centro 15 , se observa que no se cumple en todos los casos, especialmente en los pacientes muy añosos, lo cual se discute a continuación.…”

Association of Inappropriate Initial Antibiotic Treatment with 30-Day Mortality in Hematological Malignancies Patients with Klebsiella pneumoniae Bloodstream Infection: A Single-Centre Retrospective Study

“…In these cases, timely and appropriate antimicrobial treatment is crucial. Studies have shown that delays in starting such treatment, or the use of inappropriate antimicrobial regimens, are linked to increased mortality rates (2)(3)(4)(5)(6)(7)(8). Despite the well-recognized importance of early and appropriate antibiotic therapy in managing sepsis, adherence to this principle has been disappointingly low.…”