Not all organ dysfunctions are created equal - Prevalence and mortality in sepsis

Abstract

Purpose: While organ dysfunctions within sepsis have been widely studied, interaction between measures of organ dysfunction remains an understudied area. The objective of this study is to quantify the impact of organ dysfunction on in-hospital mortality in infected population.

Materials and methods: Descriptive and multivariate analyses of retrospective data including patients (age ≥ 18 years) hospitalized at the study hospital from July 2013 to April 2016 who met the criteria for an infection visit (62,057 unique visits).

Results: The multivariate logistic regression model had an area under the curve of 0.9. Highest odds ratio (OR) associated with increased mortality risk was identified as fraction of inspired oxygen (FiO₂) > 21% (OR = 5.8 and 95% Confidence Interval (CI) 1.8-35.6), and elevated lactate >2.0 mmol/L (OR = 2.45 (95% CI = 2.1-2.8)). Most commonly observed measures of organ dysfunction within mortality visits included elevated lactate (> 2.0 mmol/L), mechanical ventilation, and oxygen saturation (SpO₂)/FiO₂ ratio (< 421) at least once within 48 h prior to or 24 h after anti-infective administration.

Conclusion: There exist differences in measures of organ dysfunction occurrence and their association with mortality. These findings support increased clinical efforts to identify sepsis patients to inform diagnostic decisions.

Keywords: Electronic Health Records; Healthcare systems; Organ dysfunction; Sepsis.