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. 2023 Apr 21;11(1):16.
doi: 10.1186/s40560-023-00663-6.

Association between the timing of ICU admission and mortality in patients with hospital-onset sepsis: a nationwide prospective cohort study

Yoon Hae Ahn  1 , Jinwoo Lee  2 , Dong Kyu Oh  3 , Su Yeon Lee  3 , Mi Hyeon Park  3 , Haein Lee  3 , Chae-Man Lim  3 , Sang-Min Lee  1   2 , Hong Yeul Lee  4 ; Korean Sepsis Alliance (KSA) Investigators
Collaborators, Affiliations

Association between the timing of ICU admission and mortality in patients with hospital-onset sepsis: a nationwide prospective cohort study

Yoon Hae Ahn et al. J Intensive Care. .

Abstract

Background: Based on sparse evidence, the current Surviving Sepsis Campaign guideline suggests that critically ill patients with sepsis be admitted to the intensive care unit (ICU) within 6 h. However, limited ICU bed availability often makes immediate transfer difficult, and it is unclear whether all patients will benefit from early admission to the ICU. Therefore, the purpose of this study was to determine the association between the timing of ICU admission and mortality in patients with hospital-onset sepsis.

Methods: This nationwide prospective cohort study analyzed patients with hospital-onset sepsis admitted to the ICUs of 19 tertiary hospitals between September 2019 and December 2020. ICU admission was classified as either early (within 6 h) or delayed (beyond 6 h). The primary outcome of in-hospital mortality was compared using logistic regression adjusted for key prognostic factors in the unmatched and 1:1 propensity-score-matched cohorts. Subgroup and interaction analyses assessed whether in-hospital mortality varied according to baseline characteristics.

Results: A total of 470 and 286 patients were included in the early and delayed admission groups, respectively. Early admission to the ICU did not significantly result in lower in-hospital mortality in both the unmatched (adjusted odds ratio [aOR], 1.35; 95% confidence interval [CI], 0.99-1.85) and matched cohorts (aOR, 1.38; 95% CI, 0.94-2.02). Subgroup analyses showed that patients with increasing lactate levels (aOR, 2.10; 95% CI, 1.37-3.23; P for interaction = 0.003), septic shock (aOR, 2.06; 95% CI, 1.31-3.22; P for interaction = 0.019), and those who needed mechanical ventilation (aOR, 1.92; 95% CI, 1.24-2.96; P for interaction = 0.027) or vasopressor support (aOR, 1.69; 95% CI, 1.17-2.44; P for interaction = 0.042) on the day of ICU admission had a higher risk of mortality with delayed admission.

Conclusions: Among patients with hospital-onset sepsis, in-hospital mortality did not differ significantly between those with early and delayed ICU admission. However, as early intensive care may benefit those with increasing lactate levels, septic shock, and those who require vasopressors or ventilatory support, admission to the ICU within 6 h should be considered for these subsets of patients.

Keywords: Intensive care unit; Patient admission; Prognosis; Sepsis; Septic shock; Transfer.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Study design. Early and delayed admission indicate admission to the ICU within 6 h or beyond 6 h, respectively. Hospital-onset sepsis was defined as sepsis diagnosed in the general ward
Fig. 2
Fig. 2
Kaplan–Meier estimates of 28-day mortality according to the timing of ICU admission. For each time interval, the survival probability was calculated as the number of patients who survived divided by the number of patients at risk
Fig. 3
Fig. 3
Odds ratios for the primary outcome in the prespecified subgroups. In-hospital mortality rates were compared between the early and delayed admission groups. Odds ratios were adjusted for age and the initial sequential organ failure assessment (SOFA) scores. ICU day 1 indicates the day of ICU admission. * Indicates post-hoc subgroup analysis
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