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. 2020 Sep;7(3):150-160.
doi: 10.15441/ceem.19.009. Epub 2020 Sep 30.

Mortality difference between early-identified sepsis and late-identified sepsis

Woon Jee  1 , Sion Jo  2   3   4 , Jae Baek Lee  2   3 , Youngho Jin  2   3 , Taeoh Jeong  2   3 , Jae Chol Yoon  2   3 , Boyoung Park  4
Affiliations

Mortality difference between early-identified sepsis and late-identified sepsis

Woon Jee et al. Clin Exp Emerg Med. 2020 Sep.

Abstract

Objective: The aim of the study was to compare the mortality rates of patients with early-identified (EI) sepsis and late-identified (LI) sepsis.

Methods: We performed a retrospective chart review of patients admitted to the emergency department and diagnosed with sepsis. EI sepsis was defined as patients with a Sequential Organ Failure Assessment (SOFA) score ≥2, based on 3 parameters of the SOFA score (Glasgow coma scale, mean arterial pressure, and partial pressure of oxygen/fraction of inspired oxygen ratio), measured within an hour of emergency department admission. The remaining patients were defined as LI sepsis. The primary outcome was in-hospital mortality.

Results: Of the total 204 patients with sepsis, 113 (55.4%) had EI sepsis. Overall mortality rate was 15.7%, and EI sepsis group had significantly higher mortality than LI sepsis (23.0% vs. 6.6%, P=0.003). The patients with EI sepsis, compared to those with LI sepsis, had higher SOFA score (median: 4 vs. 2, P<0.001); Acute Physiology and Chronic Health Evaluation (APACHE) II score (median: 14 vs. 10, P<0.001); were more likely to progress to septic shock within 6 hours after admission (17.7% vs. 1.1%, P<0.001); were more likely to be admitted to the intensive care unit (2.2% vs. 1.1%, P=0.001).

Conclusion: Mortality was significantly higher in the EI sepsis group than in the LI sepsis group.

Keywords: Mortality; Sepsis; Shock, septic.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.
Standards for the Reporting of Diagnostic Accuracy (STARD) flow diagram. ED, emergency department; EI, early-identified; LI, late-identified.
Fig. 2.
Fig. 2.
Comparison of the in-hospital mortality rate (A), ICU admission rates (B), incidence of septic shock in 6 hours (C) among patients with earlyidentified sepsis (EI sepsis) and late-identified sepsis (LI sepsis).
Fig. 3.
Fig. 3.
Median and interquartile range of SOFA score (A) and APACHE II score (B) among patients with early-identified sepsis (EI sepsis) and late-identified sepsis (LI sepsis).
Fig. 4.
Fig. 4.
The mortality rates according to the Sequential Organ Failure Assessment (SOFA) sub-scores for each organ system in the original study and in this study. (A) Central nervous system, (B) coagulation, (C) cardiovascular, (D) liver, (E) respiratory, and (F) kidney.
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