Aibo Liu1,2, Chia-Hung Yo3, Lu Nie4, Hua Yu1,2, Kuihai Wu4, Hoi Sin Tong5, Tzu-Chun Hsu6, Wan-Ting Hsu7, Chien-Chang Lee8,9,10. 1. Department of Laboratory Medicine, Sichuan Provincial People's Hospital University of Electronic Science and Technology of China, Chengdu, China. 2. Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital , Chengdu, China. 3. Department of Emergency Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan. 4. Department of Laboratory Medicine, The First People's Hospital of Foshan, Foshan, Guangdong, China. 5. The University of Hong Kong, Hong Kong, China. 6. Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan. 7. Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA. 8. Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan. hit3transparency@gmail.com. 9. Health Data Science Research Group, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan. hit3transparency@gmail.com. 10. The Centre for Intelligent Healthcare, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan. hit3transparency@gmail.com.
Abstract
BACKGROUND: The association between blood culture status and mortality among sepsis patients remains controversial hence we conducted a tri-center retrospective cohort study to compare the early and late mortality of culture-negative versus culture-positive sepsis using the inverse probability of treatment weighting (IPTW) method. METHODS: Adult patients with suspected sepsis who completed the blood culture and procalcitonin tests in the emergency department or hospital floor were eligible for inclusion. Early mortality was defined as 30-day mortality, and late mortality was defined as 30- to 90-day mortality. IPTW was calculated from propensity score and was employed to create two equal-sized hypothetical cohorts with similar covariates for outcome comparison. RESULTS: A total of 1405 patients met the inclusion criteria, of which 216 (15.4%) yielded positive culture results and 46 (21.3%) died before hospital discharge. The propensity score model showed that diabetes mellitus, urinary tract infection, and hepatobiliary infection were independently associated with positive blood culture results. There was no significant difference in early mortality between patients with positive or negative blood culture results. However, culture-positive patients had increased late mortality as compared with culture-negative patients in the full cohort (IPTW-OR, 1.95, 95%CI: 1.14-3.32) and in patients with severe sepsis or septic shock (IPTW-OR, 1.92, 95%CI: 1.10-3.33). After excluding Staphylococcal bacteremia patients, late mortality difference became nonsignificant (IPTW-OR, 1.78, 95%CI: 0.87-3.62). CONCLUSIONS: Culture-positive sepsis patients had comparable early mortality but worse late mortality than culture-negative sepsis patients in this cohort. Persistent Staphylococcal bacteremia may have contributed to the increased late mortality.
BACKGROUND: The association between blood culture status and mortality among sepsispatients remains controversial hence we conducted a tri-center retrospective cohort study to compare the early and late mortality of culture-negative versus culture-positive sepsis using the inverse probability of treatment weighting (IPTW) method. METHODS: Adult patients with suspected sepsis who completed the blood culture and procalcitonin tests in the emergency department or hospital floor were eligible for inclusion. Early mortality was defined as 30-day mortality, and late mortality was defined as 30- to 90-day mortality. IPTW was calculated from propensity score and was employed to create two equal-sized hypothetical cohorts with similar covariates for outcome comparison. RESULTS: A total of 1405 patients met the inclusion criteria, of which 216 (15.4%) yielded positive culture results and 46 (21.3%) died before hospital discharge. The propensity score model showed that diabetes mellitus, urinary tract infection, and hepatobiliary infection were independently associated with positive blood culture results. There was no significant difference in early mortality between patients with positive or negative blood culture results. However, culture-positive patients had increased late mortality as compared with culture-negative patients in the full cohort (IPTW-OR, 1.95, 95%CI: 1.14-3.32) and in patients with severe sepsis or septic shock (IPTW-OR, 1.92, 95%CI: 1.10-3.33). After excluding Staphylococcal bacteremiapatients, late mortality difference became nonsignificant (IPTW-OR, 1.78, 95%CI: 0.87-3.62). CONCLUSIONS: Culture-positive sepsispatients had comparable early mortality but worse late mortality than culture-negative sepsispatients in this cohort. Persistent Staphylococcal bacteremia may have contributed to the increased late mortality.
Entities:
Keywords:
Inverse probability of treatment weighting; Mortality; Sepsis; Staphylococcus aureus
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