Jessica Londoño1, César Niño2, Andrea Archila3, Marta Valencia4, Diana Cárdenas3, Mayla Perdomo3, Giovanny Moncayo3, César Vargas5, Carlos E Vallejo6, Carolina Hincapié7, Johana Ascuntar7, Alba León7, Fabián Jaimes8. 1. Department of Internal Medicine, University of Antioquia, Medellín, Colombia; Medical division, Hospital Pablo Tobón Uribe, Medellín, Colombia. 2. Department of Internal Medicine, University of Antioquia, Medellín, Colombia. 3. Medical division, Hospital Pablo Tobón Uribe, Medellín, Colombia. 4. Department of Internal Medicine, University of Antioquia, Medellín, Colombia; Medical division, IPS Universitaria León XIII, Medellín, Colombia. 5. Medical division, Hospital Universitario San Vicente Fundación, Medellín, Colombia. 6. Medical division, IPS Universitaria León XIII, Medellín, Colombia; GRAEPIC - Clinical Epidemiology Academic Research Group (Grupo Académico de Epidemiología Clínica), University of Antioquia; Medellín, Colombia. 7. GRAEPIC - Clinical Epidemiology Academic Research Group (Grupo Académico de Epidemiología Clínica), University of Antioquia; Medellín, Colombia. 8. Department of Internal Medicine, University of Antioquia, Medellín, Colombia; GRAEPIC - Clinical Epidemiology Academic Research Group (Grupo Académico de Epidemiología Clínica), University of Antioquia; Medellín, Colombia; Research Direction, Hospital Universitario San Vicente Fundación, Medellín, Colombia. Electronic address: fabian.jaimes@udea.edu.co.
Abstract
PURPOSE: To estimate the effect of each of the EGDT components, as well as of the antibiotics, on length-of-stay and mortality. METHODS: Prospective cohort in three hospitals. Adult patients admitted by the Emergency Rooms (ER) with infection and any of systolic blood pressure < 90 mmHg or lactate >4 mmol/L. An instrumental analysis with hospital of admission as the instrumental variable was performed to estimate the effect of each intervention on hospital mortality and secondary outcomes. RESULTS: Among 2587 patients evaluated 884 met inclusion criteria, with a hospital mortality rate of 17% (n = 150). In the instrumental analysis, the only intervention associated with an absolute reduction in mortality (21%) was the use of antibiotics in the first 3 h. In patients with lactate values ≥4 mmol/L in the ER, a non-decrease of at least 10% at six hours was independently associated with mortality (OR = 3.1; 95%CI = 1.5-6.2). CONCLUSIONS: Among patients entering ER with infection and shock or hypoperfusion criteria, the use of appropriate antibiotics in the first 3 h is the measure that has the greatest impact on survival. In addition, among patients with hyperlactatemia >4 mmol/L, the clearance of >10% of lactate during resuscitation is associated with better outcomes.
PURPOSE: To estimate the effect of each of the EGDT components, as well as of the antibiotics, on length-of-stay and mortality. METHODS: Prospective cohort in three hospitals. Adult patients admitted by the Emergency Rooms (ER) with infection and any of systolic blood pressure < 90 mmHg or lactate >4 mmol/L. An instrumental analysis with hospital of admission as the instrumental variable was performed to estimate the effect of each intervention on hospital mortality and secondary outcomes. RESULTS: Among 2587 patients evaluated 884 met inclusion criteria, with a hospital mortality rate of 17% (n = 150). In the instrumental analysis, the only intervention associated with an absolute reduction in mortality (21%) was the use of antibiotics in the first 3 h. In patients with lactate values ≥4 mmol/L in the ER, a non-decrease of at least 10% at six hours was independently associated with mortality (OR = 3.1; 95%CI = 1.5-6.2). CONCLUSIONS: Among patients entering ER with infection and shock or hypoperfusion criteria, the use of appropriate antibiotics in the first 3 h is the measure that has the greatest impact on survival. In addition, among patients with hyperlactatemia >4 mmol/L, the clearance of >10% of lactate during resuscitation is associated with better outcomes.