Abstract
Introduction
The impact of infectious source on sepsis outcomes for surgical patients is unclear.
The objective of this study was to evaluate the association between sepsis sources
and cumulative 90-d mortality in patients admitted to the surgical intensive care
unit (SICU) with sepsis.
Methods
All patients admitted to the SICU at an academic institution who met sepsis criteria
(2014-2019, n = 1296) were retrospectively reviewed. Classification of source was accomplished
through a chart review and included respiratory (RT, n = 144), intra-abdominal (IA, n = 859), skin and soft tissue (SST, n = 215), and urologic (UR, n = 78). Demographics, comorbidities, and clinical presentation were compared. Outcomes
included 90-d mortality, respiratory and renal failure, length of stay, and discharge
disposition. Cox-proportional regression was used to model predictors of mortality;
P < 0.05 was significant.
Results
Patients with SST were younger, more likely to be diabetic and obese, but had the
lowest total comorbidities. Median admission sequential organ failure assessment scores
were highest for IA and STT and lowest in urologic infections. Cumulative 90-d mortality
was highest for IA and RT (35% and 33%, respectively) and lowest for SST (20%) and
UR (8%) (P < 0.005). Compared to the other categories, UR infections had the lowest SICU length
of stay and the highest discharge-to-home (57%, P < 0.0005). Urologic infections remained an independent negative predictor of 90-d
mortality (odds ratio 0.14, 95% confidence interval: 0.1-0.4), after controlling for
sequential organ failure assessment.
Conclusions
Urologic infections remained an independent negative predictor of 90-d mortality when
compared to other sources of sepsis. Characterization of sepsis source revealed distinct
populations and clinical courses, highlighting the importance of understanding different
sepsis phenotypes.
Keywords
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Article info
Publication history
Published online: December 14, 2022
Accepted:
October 16,
2022
Received in revised form:
September 21,
2022
Received:
March 1,
2022
Identification
Copyright
© 2022 Published by Elsevier Inc.
