Sepsis Major Cause of True Deterioration

SUMMARY:

  • Sepsis is a major cause of morbidity and mortality globally.

  • Early identification and treatment of any causes of acute deterioration outside the ICU will help improve clinical outcomes.

  • Sepsis, either alone or as part of multiple causes, is the most common cause of deterioration in non-ICU patients.

REVIEW:

Churpek MM, et al. Critical Care Explorations 2024: DOI: 10.1097/CCE.0000000000001161.

  • Clinical deterioration has been previously associated with increased respiratory rates.

    • However, the medical conditions causing this deterioration have been less well described.

  • Retrospective observation review of non-ICU hospital admissions from 2007 to 2020

  • Electronic Cardiac Arrest Risk Triage score (eCART) was calculated in all patients.

    • Uses 33 parameters (vital signs, laboratory data)

    • Predicts patients at highest risk of deterioration

    • Previously validated to be more accurate than MEWS and NEWS to predict cardiac arrest, death and ICU admission

    • Deterioration via eCART score defined as scores in the 95th percentile for each admission

  • 919,319 admissions

    • 91,131 (10%) had eCART scores indicating deterioration

    • Manual chart review by clinicians to determine true deterioration

    • 4,000 randomly selected admissions were reported on

  • RESULTS:

    • 983 (25%) required ICU admission

    • 474 (12%) died during admission

    • True deterioration determined in 2,484 (62%) of the 4,000 patients

  • Causes of True Deterioration
    • Sepsis was most common cause of true deterioration in these non-ICU patients (n=1,024 41%).
      • Next most common causes were: Arrhythmia (19%); Heart Failure (13%); Hypoxemic Respiratory Failure (10%); Electrolyte Abnormality (9%).
    • Most Common Co-Occurring causes of deterioration
      • 7 of the top 11 co-occurring causes were with sepsis.
      • Sepsis & Hypoxemia (n=127 5%)
      • Sepsis & Arrhythmia (n=85 3%)
      • Sepsis & Heart Failure (n=83 3%)
    • Present On Admission vs Hospital Acquired
      • Sepsis was the most common cause of true deterioration that was present on admission (n=863 48%).
      • Arrhythmias were the most common cause of true deterioration which was hospital acquired (n=183 29%).
        • Sepsis was number 2 (n=140 22%)
      • True deterioration due to causes present on admission had a higher in-patient mortality rate compared to hospital acquired deterioration (15.4% vs 10.6% p=0.003).

CONCLUSIONS:

  • Sepsis is the most common cause of clinical deterioration.

  • Hospital acquired sepsis was the second most common cause of clinical deterioration.

  • Sepsis was the most common cause of clinical deterioration when combinations of 2 disease states were found.

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Erkan Hassan is the Co-Founder & Chief Clinical Officer of Sepsis Program Optimization where he designs & oversees the implementation of solutions to optimize sepsis programs.

To discuss your organization’s Barriers of Effective Sepsis Care, contact Erkan by phone (844) 4SEPSIS (844-473-7747), email (erkan@spo.icu), or video chat.