Sepsis-related mortality in 497 cases with blood culture-positive sepsis in an emergency department

Abstract

Objective: Few studies have sought to establish how often death after sepsis is related to the sepsis and how often underlying diseases have a major role in case fatality.

Methods: In this retrospective cohort study, data were collected on 497 cases with blood culture-positive sepsis in an emergency department (ED).

Results: Sepsis was categorized as severe in 31% of cases; 7% had septic shock. The quick Sepsis-related Organ Failure Assessment score was positive in 136 out of 473 cases (29%). Ninety-eight patients died by day 90; in 16 of these cases (16%) the death was sepsis-related in a patient without a rapidly fatal underlying disease, in 45 cases (46%) the death was sepsis-related in a patient with a rapidly fatal underlying disease, and in 37 cases (38%) the death was unrelated to sepsis. Sepsis-related death occurred in 58 out of 61 cases (95%) by day 28.

Conclusions: Underlying diseases were found to have a considerable role in the death of patients suffering from blood culture-positive sepsis in an ED of a developed country, as only 16% of the deaths by day 90 occurred where death was sepsis-related and the patient had a life-expectancy of more than 6 months. Improving the outcome of sepsis with new treatments is thus challenging. It is possible that day 7+day 28 mortality is a more appropriate endpoint than day 90 mortality when studying the outcome of sepsis, as this time-span includes most of the patients whose death was related to sepsis.

Keywords: Attributable mortality; Blood culture; Infectious disease; Related mortality; Sepsis; Survival; qSOFA.