Primary Infection Site as a Predictor of Sepsis Development in Emergency Department Patients

• Published in: The Journal of emergency medicine Vol. 67; no. 2; pp. e128 - e137
• Main Authors: Vadhan, Jason D., Thoppil, Joby, Vasquez, Ofelia, Suarez, Arlen, Bartels, Brett, McDonald, Samuel, Courtney, D. Mark, Farrar, J. David, Thakur, Bhaskar
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-08-2024
• Subjects: Adult; Aged; Emergency medicine, SIRS; Emergency Service, Hospital - organization & administration; Emergency Service, Hospital - statistics & numerical data; Female; Hospital Mortality; Humans; Infection site; Length of Stay - statistics & numerical data; Male; Middle Aged; Retrospective Studies; Sepsis; Sepsis - complications; Sepsis - mortality; Shock, Septic - mortality; Soft Tissue Infections - complications; Urinary Tract Infections - epidemiology; Sepsis; Emergency medicine, SIRS; Infection site
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/j.jemermed.2024.01.016

Sepsis is a life-threatening condition but predicting its development and progression remains a challenge.
This study aimed to assess the impact of infection site on sepsis development among emergency department (ED) patients.
Data were collected from a single-center ED between January 2016 and December 2019. Patient encounters with documented infections, as defined by the Systematized Nomenclature of Medicine-Clinical Terms for upper respiratory tract (URI), lower respiratory tract (LRI), urinary tract (UTI), or skin or soft-tissue infections were included. Primary outcome was the development of sepsis or septic shock, as defined by Sepsis-1/2 criteria. Secondary outcomes included hospital disposition and length of stay, blood and urine culture positivity, antibiotic administration, vasopressor use, in-hospital mortality, and 30-day mortality. Analysis of variance and various different logistic regression approaches were used for analysis with URI used as the reference variable.
LRI was most associated with sepsis (relative risk ratio [RRR] 5.63; 95% CI 5.07–6.24) and septic shock (RRR 21.2; 95% CI 17.99–24.98) development, as well as hospital admission rates (odds ratio [OR] 8.23; 95% CI 7.41–9.14), intensive care unit admission (OR 4.27; 95% CI 3.84–4.74), in-hospital mortality (OR 6.93; 95% CI 5.60–8.57), and 30-day mortality (OR 7.34; 95% CI 5.86–9.19). UTIs were also associated with sepsis and septic shock development, but to a lesser degree than LRI.
Primary infection sites including LRI and UTI were significantly associated with sepsis development, hospitalization, length of stay, and mortality among patients presenting with infections in the ED.