Clinical course of sepsis, severe sepsis, and septic shock in a cohort of infected patients from ten Colombian hospitals
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
BMC Infectious Diseases 2013, 13:345 doi:10.1186/1471-2334-13-345Published: 24 July 2013
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.
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.
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.
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.