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Open Access Highly Accessed Research article

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

Alba Luz León1, Natalia Andrea Hoyos1, Lena Isabel Barrera2, Gisela De La Rosa3, Rodolfo Dennis4, Carmelo Dueñas5, Marcela Granados6, Dario Londoño7, Ferney Alexander Rodríguez1, Francisco José Molina8, Guillermo Ortiz9 and Fabián Alberto Jaimes10*

Author Affiliations

1 Universidad de Antioquia, Medellín, Colombia

2 Universidad del Valle y Hospital, Universitario del Valle, Cali, Colombia

3 Hospital Pablo Tobón Uribe, Medellín, Colombia

4 Pontificia Universidad Javeriana y Fundación Cardio Infantil, Bogotá, Colombia

5 Universidad de Cartagena, Hospital de Bocagrande y Clínica Madre Bernarda, Cartagena, Colombia

6 Fundación Valle de Lili, Cali, Colombia

7 Pontificia Universidad Javeriana y Hospital Universitario San Ignacio, Botogá, Colombia

8 Universidad Pontificia Bolivariana y Clínica Universitaria Bolivariana, Medellín, Colombia

9 Hospital Santa Clara, Bogotá, Colombia

10 Departamento de Medicina Interna y Grupo Académico de Epidemiología Clínica (GRAEPIC), Universidad de Antioquia y Hospital Pablo Tobón Uribe (Unidad de Investigaciones), Medellín, Colombia

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BMC Infectious Diseases 2013, 13:345  doi:10.1186/1471-2334-13-345

Published: 24 July 2013

Abstract

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.

Keywords:
Severe sepsis; Septic shock; Progression; GEE; Cox regression