Muge Capan1, Stephen Hoover2, Julie S Ivy3, Kristen E Miller4, Ryan Arnold5. 1. Decision Sciences & MIS Department, LeBow College of Business, Drexel University, Gerri C. LeBow Hall, 3220 Market Street, Philadelphia, PA 19104, USA. Electronic address: Muge.Capan@drexel.edu. 2. Christiana Care Health System, Value Institute, 4755 Ogletown-Stanton Road, Newark, DE 19718, USA. Electronic address: Stephen.Hoover@ChristianaCare.org. 3. Edward P. Fitts Department of Industrial and Systems Engineering, North Carolina State University, Campus Box 7906, 400 Daniels Hall, Raleigh, NC 27695-7906, USA. Electronic address: jsivy@ncsu.edu. 4. National Center for Human Factors in Healthcare, MedStar Institute for Innovation, 3007 Tilden St., NW, Suite 7L, Washington, DC 20008, USA. Electronic address: Kristen.E.Miller@medstar.net. 5. College of Medicine, Hahnemann University Hospital, Drexel University, 2900 W Queen Ln, Philadelphia, PA 19129, USA. Electronic address: rca57@drexel.edu.
Abstract
PURPOSE: While organ dysfunctions within sepsis have been widely studied, interaction between measures of organ dysfunction remains an understudied area. The objective of this study is to quantify the impact of organ dysfunction on in-hospital mortality in infected population. MATERIALS AND METHODS: Descriptive and multivariate analyses of retrospective data including patients (age ≥ 18 years) hospitalized at the study hospital from July 2013 to April 2016 who met the criteria for an infection visit (62,057 unique visits). RESULTS: The multivariate logistic regression model had an area under the curve of 0.9. Highest odds ratio (OR) associated with increased mortality risk was identified as fraction of inspired oxygen (FiO2) > 21% (OR = 5.8 and 95% Confidence Interval (CI) 1.8-35.6), and elevated lactate >2.0 mmol/L (OR = 2.45 (95% CI = 2.1-2.8)). Most commonly observed measures of organ dysfunction within mortality visits included elevated lactate (> 2.0 mmol/L), mechanical ventilation, and oxygen saturation (SpO2)/FiO2 ratio (< 421) at least once within 48 h prior to or 24 h after anti-infective administration. CONCLUSION: There exist differences in measures of organ dysfunction occurrence and their association with mortality. These findings support increased clinical efforts to identify sepsis patients to inform diagnostic decisions.
PURPOSE: While organ dysfunctions within sepsis have been widely studied, interaction between measures of organ dysfunction remains an understudied area. The objective of this study is to quantify the impact of organ dysfunction on in-hospital mortality in infected population. MATERIALS AND METHODS: Descriptive and multivariate analyses of retrospective data including patients (age ≥ 18 years) hospitalized at the study hospital from July 2013 to April 2016 who met the criteria for an infection visit (62,057 unique visits). RESULTS: The multivariate logistic regression model had an area under the curve of 0.9. Highest odds ratio (OR) associated with increased mortality risk was identified as fraction of inspired oxygen (FiO2) > 21% (OR = 5.8 and 95% Confidence Interval (CI) 1.8-35.6), and elevated lactate >2.0 mmol/L (OR = 2.45 (95% CI = 2.1-2.8)). Most commonly observed measures of organ dysfunction within mortality visits included elevated lactate (> 2.0 mmol/L), mechanical ventilation, and oxygen saturation (SpO2)/FiO2 ratio (< 421) at least once within 48 h prior to or 24 h after anti-infective administration. CONCLUSION: There exist differences in measures of organ dysfunction occurrence and their association with mortality. These findings support increased clinical efforts to identify sepsispatients to inform diagnostic decisions.
Authors: Brittany A Zwischenberger; Beverly K Balasuriya; Dwight D Harris; Nisha Nataraj; Allison M Owen; Maria E C Bruno; Sujata Mukherjee; Victor Ortiz-Soriano; William O'Connor; Chenlu Ke; Arnold J Stromberg; Phillip K Chang; Javier A Neyra; Hiroshi Saito; Marlene E Starr Journal: Shock Date: 2021-05-01 Impact factor: 3.454
Authors: Peter Bank Pedersen; Daniel Pilsgaard Henriksen; Mikkel Brabrand; Annmarie Touborg Lassen Journal: BMJ Open Date: 2019-10-30 Impact factor: 2.692