Patient Care

Predictors of Sepsis, Septic Shock in Emergency Department Patients


Clinical question: Among patients presenting to the ED with sepsis, who will progress to septic shock within 48 hours of arrival?

Background: This study describes patient characteristics present within four hours of ED arrival associated with developing septic shock between four and 48 hours after arrival.

Study design: Retrospective chart review.

Setting: ED patients hospitalized at two large academic institutions.

Synopsis: A total of 18,100 patients were admitted from the ED, of which 3,960 patients had two or more systemic inflammatory response syndrome criteria, and 1,316 patients had sepsis within four hours of arrival. One hundred eleven patients with sepsis (8.4%) progressed to septic shock between four to 48 hours of ED arrival.

Characteristics associated with the progression included female gender (odds ratio, 1.59; 95% CI, 1.02-2.47), nonpersistent hypotension (odds ratio, 6.24; 95% CI, 3.58-10.86), bandemia at least 10% (odds ratio, 2.60; 95% CI, 1.50-4.51), lactate of at least 4.0 mmol/L (odds ratio, 5.30; 95% CI, 2.59-10.84), and past medical history of coronary artery disease (odds ratio, 2.01; 95% 1.26-3.44).

Bottom line: Although everyone presenting with sepsis should be treated aggressively, special consideration should be given to patients who are “high risk” to develop septic shock, using the predictors delineated above.

Citation: Capp R, Horton CL, Takhar SS, et al. Predictors of patients who present to the emergency department with sepsis and progress to septic shock between 4 and 48 hours of emergency department arrival. Crit Care Med. 2015;43(5):983-988.

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