Clinical course of sepsis, severe sepsis, and septic shock in a cohort of infected patients from ten Colombian hospitals

BMC Infectious Diseases

Fabián Alberto Jaimes⁷  Guillermo Ortiz⁹  Francisco José Molina⁵  Ferney Alexander Rodríguez⁸  Dario Londoño²  Marcela Granados¹  Carmelo Dueñas⁶  Rodolfo Dennis⁴  Gisela De La Rosa³  Lena Isabel Barrera^1,10  Natalia Andrea Hoyos⁸  Alba Luz León⁸ 

[1] Fundación Valle de Lili, Cali, Colombia;Pontificia Universidad Javeriana y Hospital Universitario San Ignacio, Botogá, Colombia;Hospital Pablo Tobón Uribe, Medellín, Colombia;Pontificia Universidad Javeriana y Fundación Cardio Infantil, Bogotá, Colombia;Universidad Pontificia Bolivariana y Clínica Universitaria Bolivariana, Medellín, Colombia;Universidad de Cartagena, Hospital de Bocagrande y Clínica Madre Bernarda, Cartagena, Colombia;Departamento de Medicina Interna y Grupo Académico de Epidemiología Clínica (GRAEPIC), Universidad de Antioquia y Hospital Pablo Tobón Uribe (Unidad de Investigaciones), Medellín, Colombia;Universidad de Antioquia, Medellín, Colombia;Hospital Santa Clara, Bogotá, Colombia;Universidad del Valle y Hospital, Universitario del Valle, Cali, Colombia

关键词: Cox regression;    GEE;    Progression;    Septic shock;    Severe sepsis;   

Others  :  1146779
DOI  :  10.1186/1471-2334-13-345

 received in 2013-06-13, accepted in 2013-07-16,  发布年份 2013

【 摘 要 】

Background

Sepsis has several clinical stages, and mortality rates are different for each stage. Our goal was to establish the evolution and the determinants of the progression of clinical stages, from infection to septic shock, over the first week, as well as their relationship to 7-day and 28-day mortality.

Methods

This is a secondary analysis of a multicenter cohort of inpatients hospitalized in general wards or intensive care units (ICUs). The general estimating equations (GEE) model was used to estimate the risk of progression and the determinants of stages of infection over the first week. Cox regression with time-dependent covariates and fixed covariates was used to determine the factors related with 7-day and 28-day mortality, respectively.

Results

In 2681 patients we show that progression to severe sepsis and septic shock increases with intraabdominal and respiratory sources of infection [OR = 1,32; 95%IC = 1,20-1,46 and OR = 1.21, 95%CI = 1,11-1,33 respectively], as well as according to Acute Physiology and Chronic Health Evaluation II (APACHE II) [OR = 1,03; 95%CI = 1,02-1,03] and Sequential Organ Failure Assessment (SOFA) [OR = 1,16; 95%CI = 1,14-1,17] scores. The variables related with first-week mortality were progression to severe sepsis [HR = 2,13; 95%CI = 1,13-4,03] and septic shock [HR = 3,00; 95%CI = 1,50-5.98], respiratory source of infection [HR = 1,76; 95%IC = 1,12-2,77], APACHE II [HR = 1,07; 95% CI = 1,04-1,10] and SOFA [HR = 1,09; 95%IC = 1,04-1,15] scores.

Conclusions

Intraabdominal and respiratory sources of infection, independently of SOFA and APACHE II scores, increase the risk of clinical progression to more severe stages of sepsis; and these factors, together with progression of the infection itself, are the main determinants of 7-day and 28-day mortality.

【 授权许可】

   
2013 León et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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