Background
Methods
Patients and setting
Clinical data
Criteria for organ failure
Date of death
Statistical methods
Ethical considerations
Results
Age groups (% within age group) | |||||
---|---|---|---|---|---|
Total material (680 patients) | < 65 years (228 patients) | 65-84 years (334 patients) | ≥ 85 years (118 patients) | Overall p-value | |
Age in years; median (IQR) | 75 (57.5 - 82) | 50.5 (38–58) | 78 (73–81) | 88 (86–91) | |
Gender; male | 289 (42.5%) | 93 (40.8%) | 160 (47.9%) | 36 (30.5%) | 0.004 |
Bacteraemia caused by E. coli | 450 (66.2%) | 131 (57.5%) | 240 (71.9%) | 79 (66.9%) | 0.002 |
Bacteremia caused by S. pneumoniae | 230 (33.8%) | 97 (42.5%) | 94 (28.1%)* | 39 (33.1%) | |
Comorbidity | |||||
Number of comorbid conditions1; median(IQR) | 1 (0–2) | 0 (0–1) | 1 (0–2)* | 1 (1–2)* | < 0.001 |
Aftrial fibrrillation (chronic or paroxystic) | 75 (11.2%) | 0 | 47 (14.2)* | 28 (24.3)* | < 0.001 |
Ischemic heart disease | 145 (21.6%) | 13 (5.8%) | 91 (27.5%)* | 41 (35.7%)* | < 0.001 |
Congestive heart failure | 91 (13.5%) | 6 (2.7%) | 55 (16.6%)* | 30 (26.1%)* | < 0.001 |
Hypertension | 151 (22.5%) | 25 (11.1%) | 91 (27.5%)* | 35 (30.4%)* | < 0.001 |
Cerebrovascular disorder | 93 (13.8%) | 11 (4.9%) | 59 (17.8%)* | 23 (20.0%)* | < 0.001 |
Chronic obstructive lung disease | 71 (10.6%) | 15 (6.6%) | 50 (15.1%)* | 6 (5.2%) | 0.001 |
Alcohol abuse | 46 (6.8%) | 24 (10.6%) | 21 (6.3%) | 1 (0.9%)* | 0.003 |
Malignant disease (solid cancer, leukemia orlymphoma) | 45 (6.7%) | 16 (7.1%) | 24 (7.3%) | 5 (4.3%) | 0.540 |
Chronic renal failure | 21 (3.1%) | 6 (2.7%) | 12 (3.6%) | 3 (2.6%) | 0.763 |
Diabetes mellitus | 82 (12.2%) | 20 (8.8%) | 49 (14.8%)* | 13 (11.3%) | 0.103 |
Tentative diagnosis by admitting physician: | |||||
Infection | 331 (48.7%) | 132 (57.9%) | 143 (42.8%)* | 56 (47.5%) | 0.002 |
Non-specific2
| 89 (13.1%) | 7 (3.1%) | 59 (17.7%)* | 23 (19.5%)* | < 0.001 |
Organ focused | 158 (23.2) | 56 (24.6%) | 78 (23.4%) | 24 (20.3%) | 0.676 |
Symptoms on infection | |||||
Total number of reported symptoms; median (IQR) | 3 (2–4) | 3 (2–4) | 3 (2–4) | 3 (2–3) | 0.351 |
“Classical symptoms”3≥ 3 | 253 (37.4%) | 110 (48.7%) | 108 (32.5%)* | 35 (29.7%)* | < 0.001 |
Zero ”classical symptoms” | 57 (8.4%) | 7 (3.1%) | 36 (10.8%)* | 14 (11.9%)* | 0.002 |
“Atypical symptoms”4 ≥1 | 337 (49.6%) | 82 (36.0%) | 180 (53.9%)* | 75 (63.6%)* | < 0.001 |
Signs of infection at admission | |||||
Decline in general health | 289 (42.6%) | 81 (35.5%) | 152 (45.6%)* | 56 (47.5%)* | 0.029 |
Leukocytosis (≥ 15000/μl) | 280 (41.2%) | 98 (43.0%) | 129 (38.6%) | 53 (45.3%) | 0.363 |
Leukopenia (< 3000/μl) | 37 (5.4%) | 8 (3.5%) | 24 (7.2%) | 5 (4.3%) | 0.140 |
C-reactive protein (CRP) | |||||
CRP median (IQR);mg/L | 191 (83–311) | 222 (92 -351) | 179 (72-266)* | 180 (94-317) | 0.022 |
CRP ≥ 80 mg/L | 514 (75.6%) | 175 (76.8%) | 245 (73.4%) | 94 (79.7%) | 0.344 |
CRP ≥ 200mg/L | 324 (47.6%) | 123 (53.9%) | 147 (44.0%) | 54 (45.8%) | 0.062 |
Fever (≥ 38.5°C) | 438 (65.8%) | 154 (69.1%) | 208 (64.0%) | 76 (64.4%) | 0.445 |
Hypothermia (< 36°C) | 10 (1.5%) | 7 (3.1%) | 1 (0.3%)* | 2 (1.7%) | 0.027 |
Median number of SIRScriteria (IQR) | 3 (2–3) | 3 (2–3) | 2 (2–3) | 2 (2–3) | 0.099 |
No. of patients withSIRS ≥ 3 | 343 (50.4%) | 127 (55.7%) | 160 (47.9%) | 56 (47.5%) | 0.149 |
No. of patients withSIRS ≥ 2 | 563 (82.8%) | 198 (86.8%) | 270 (80.8%) | 95 (80.5%) | 0.139 |
New-onset atrial fibrillation | 104 (15.5%) | 11 (4.9%) | 72 (21.8%)* | 21 (18.3%)* | < 0.001 |
Age groups (% within age group) | |||||
---|---|---|---|---|---|
Total material (680 patients) | < 65 years (228 patients) | 65-84 years (334 patients) | ≥ 85 years (118 patients) | Overall p-value | |
Acute organ failure within 1 day after admission | |||||
No. of acute organ failures; mean (95% CI)) | 0.69 (0.62 – 0.76) | 0.53 (0.41 – 0.64) | 0.80 (0.70 – 0.90)* | 0.70 (0.53-0.88) | 0.003 |
Presence of ≥ 1 organ failure | 290 (45.9%) | 75 (35.2%) | 165 (53.1%)* | 50 (46.4%) | < 0.001 |
Type of acute organ failure | |||||
Cardiovascularfailure | 80 (11.8%) | 21 (9.3%) | 50 (15.0%)* | 9 (7.6%) | 0.035 |
Respiratory failure | 192 (28.2%) | 54 (23.7%) | 102 (30.5%) | 36 (30.5%) | 0.173 |
Acute renal failure | 30 (4.5%) | 6 (2.7%) | 20 (6.1%) | 4 (3.4%) | 0.144 |
Coagulation failure | 54 (8.4%) | 14 (6.5%) | 32 (10.1%) | 8 (7.3%) | 0.299 |
(platelets <100x103/mm3) | |||||
Reducedconsciousness | 99 (14.6%) | 19 (8.3%) | 55 (16.5%)* | 25 (21.4%)* | 0.002 |
Sepsis-diagnosis at discharge | |||||
Sepsis as main or side diagnosis (ICD-9 orICD-10) | 313 (46.0%) | 86 (37.7%) | 171 (51.2%)* | 56 (47.5%) | 0.007 |
Site of infection | |||||
Urinary tract | 255 (37.5%) | 84 (36.8%) | 132 (39.5%) | 39 (33.1%) | 0.445 |
Respiratory system | 228 (33.5%) | 94 (41.2%) | 95 (28.4%)* | 39 (33.1%) | 0.007 |
Other sites1
| 107 (15.7%) | 32 (14.0%) | 61 (18.3%) | 14 (11.9%) | 0.179 |
Inconclusive | 90 (13.2) | 18 (7.9%) | 46 (13.8%)* | 26 (22.0%)* | 0.001 |
Hospital stay | |||||
Department responsible at admission: | |||||
Surgical department(urology included) | 138 (20.3%) | 60 (26.3%) | 61 (18.3%) | 17 (14.4%) | 0.006 |
Medical department | 525 (77.2%) | 161 (70.6%) | 268 (80.2%) | 96 (81.4%) | |
Other departments; andmissing | 17 (2.5%) | 7 (3.1%) | 5 (1.5%) | 5 (4.2%) | |
Transferred to an ICU within 1 day afteradmission | 153 (22.5%) | 55 (24.1%) | 82 (24.6%) | 16 (13.6%)* | 0.038 |
Length of stay in days; median (IQR) | 8 (5–14) | 7 (5–11) | 9 (6–16)* | 9 (5–15) | 0.008 |
In-hospital mortality | |||||
Total in-hospital mortality | 92 (13.5%) | 12 (5.3%) | 62 (18.6%)* | 18 (15.3%)* | <0.001 |
Day of in-hospital death; median (IQR) | 5 (1–12) | 16.5 (2.25 - 22.75) | 6 (1–11.25) | 2 (0.75 - 7) | 0.065 |
Early in-hospital mortality (within 3 days afteradmission) | 39 (5.7%) | 4 (1.8%) | 23 (6.9%)* | 12 (10.2%)* | 0.003 |
In-hospital mortality within 14 days afteradmission | 72 (10.6%) | 6 (2.6%) | 51 (15.3%)* | 15 (12.7%)* | <0.001 |
One-year mortality | 168 (24.7%) | 30 (13.2%) | 101 (30.3%)* | 37 (31.4%)* | <0.001 |
Patients without organ failure(342 patients;%within this group) | Patients with organ failure(290 patients;%within this group) | Bivariate analyses OR(95% CI) | Multivariate analysis; full maineffects’model*OR(95%CI) | |
---|---|---|---|---|
Age ≥ 65 years | 204 (59.6) | 215 (74.1) | 1.94 (1.38-2.73) | 1.65 (1.09 - 2.49) |
Male gender | 137 (40.1) | 135 (46.6) | 1.30 (0.95 – 1.79) | |
No. of comorbid illnesses | - | - | 1.41 (1.23-1.61) | 1.19 (1.02 - 1.40) |
Corticosteroid on a daily basis1
| 8 (2.4) | 23 (8.0) | 3.55 (1.56 – 8.05) | 2.75 (1.10 - 6.89) |
Cytostatic treatment within last 14 days | 1 (0.3) | 6 (2.1) | 7.10 (0.85 - 59.34) | |
Immunosuppressive treatment | 1 (0.3) | 5 (1.7) | 5.90 (0.69 - 50.77) | |
Number of symptoms ≥ 5 | 35 (10.2) | 41 (14.2) | 1.45 (0.90 – 2.35) | |
“Classical symptoms”2 ≥ 3 | 141 (41.3) | 97 (33.7) | 0.72 (0.52 - 0.99) | 0.67 (0.45 - 0.99) |
“Atypical symptoms”3 ≥ 1 | 151 (44.2) | 169 (58.3) | 1.77 (1.29 - 2.42) | |
Decline in general health (as described in the emergencydepartment) | 112 (32.8) | 166 (57.2) | 2.74 (1.98 - 3.79) | 2.28 (1.58 - 3.27) |
Heart rate > 90 beats per minute | 197 (58.5) | 203 (70.7) | 1.72 (1.23 - 2.40) | 1.50 (1.02 - 2.20) |
Fever (≥ 38.5°C) | 229 (68.4) | 178 (62.2) | 0.76 (0.55 - 1.06) | |
Hypothermia (< 36°C) | 4 (1.2) | 6 (2.1) | 1.77 (0.50 - 6.35) | |
Tachypnoe and/or hyperventilation | 78 (22.8) | 167 (57.6) | 4.60 (3.26 - 6.48) | 3.86 (2.64 - 5.66) |
Leukocytosis (≥ 15000/μl) | 145 (42.4) | 118 (40.7) | 0.93 (0.68 - 1.28) | |
Leukopenia (< 3000/μl) | 6 (1.8) | 31 (10.7) | 6.70 (2.76 - 16.31) | 4.16 (1.59 - 10.91) |
CRP ≥ 80 mg/L | 253 (74.0) | 233 (80.3) | 1.44 (0.99 - 2.10) | |
CRP ≥ 200 mg/L | 157 (45.9) | 153 (52.8) | 1.32 (0.96 -1.80) | |
New-onset atrial fibrillation | 35 (10.4) | 64 (22.1) | 2.45 (1.57 - 3.82) |
Alive at 14 days(608 patients;% within thisgroup) | Patients that died within 14 days(72 patients;%within this group) | Bivariate analyses OR(95% CI) | Multivariate analysis; full main effectsmodel*OR(95%CI) | |
---|---|---|---|---|
Age ≥ 65 years | 386 (63.5) | 66 (91.7) | 6.33 (2.70 - 14.83) | 15.02 (3.68 - 61.29) |
Male gender | 246 (40.5) | 43 (59.7) | 2.18 (1.33 - 3.59) | 1.93 (1.002 - 3.70) |
S. pneumoniae | 196 (32.2) | 34 (47.2) | 1.88 (1.15 - 3.08) | 2.79 (1.43 - 5.46) |
Comorbid illnesses ≥ 1 | 355 (58.1) | 59 (81.9) | 3.27 (1.76 – 6.09) | 2.61 (1.11 - 6.14) |
Immunmodulating and other medication | ||||
Warfarin | 51 (8.5) | 5 (7.0) | 0.82 (0.32 - 2.12) | |
Corticosteroids1 on a daily basis | 28 (4.7) | 6 (8.5) | 1.89 (0.75 - 4.73) | |
Cytostatic treatment within last 14 days | 5 (0.8) | 2 (2.8) | 3.46 (0.66 - 18.15) | |
Immunosuppressive drugs | 6 (1.0) | 1 (1.4) | 1.42 (0.17 - 11.94) | |
Number of symptoms | ||||
Number of symptoms ≥ 5 | 69 (11.4) | 8 (11.3) | 0.99 (0.45 – 2.15) | |
“Classical symptoms”2≥ 3 | 236 (39.0) | 17 (23.9) | 0.49 (0.28 – 0.87) | |
“Atypical symptoms”3 ≥1 | 296 (48.4) | 44 (61.1) | 1.67 (1.02 – 2.76) | |
Prehospital tentative diagnosis | ||||
Infection | 303 (49.6) | 28 (38.9) | 0.65 (0.39 – 1.07) | |
Non-specifica
| 81 (13.3) | 8 (11.1) | 0.82 (0.38 – 1.77) | |
Site of infection | ||||
Urinary tractus | 241 (39.6) | 14 (19.4) | 0.37 (0.20 - 0.67) | |
Lower respiratory tractus | 193 (31.7) | 35 (48.6) | 2.03 (1.24 - 3.33) | |
Othersb
| 95 (15.6%) | 12 (16.7%) | 1.08 (0.56 – 2.08) | |
Inconclusive | 79 (13.0) | 11 (15.3) | 1.21 (0.61 - 2.39) | |
Local immunocompromizing condition (at site of infection) | ||||
Significant anatomical or physiological abnormality | 206 (38.9) | 17 (27.9) | 0.61 (0.34 - 1.09) | |
Surgical procedure performed within 14 days priorto admittance | 54 (8.9) | 1 (1.4) | 0.15 (0.02 - 1.11) | |
Signs of infection in the emergency department | ||||
Fever (≥ 38.5°C) | 402 (67.2) | 36 (52.9) | 0.55 (0.33 - 0.91) | 0.46 (0.24 - 0.89) |
Hypothermia (< 36 ° C) | 7 (1.2) | 3 (4.2) | 3.90 (0.98 – 15.44) | |
Tachycardia | 383 (63.6) | 44 (63.8) | 1.01 (0.60 – 1.69) | |
Tachypnoe and/or hyperventilation | 215 (35.3) | 40 (55.6) | 2.29 (1.40 - 3.75) | |
Leukocytosis (≥ 15000/μl) | 255 (41.9) | 25 (35.2) | 0.75 (0.45 – 1.26) | |
Leukopenia (< 3000/μl) | 21 (3.5) | 16 (22.5) | 8.13 (4.01 - 16.49) | 4.62 (1.88 - 11.37) |
CRP ≥ 80 mg/L | 457 (75.2) | 57 (79.2) | 1.26 (0.69 – 2.28) | |
CRP ≥ 200 mg/L | 280 (46.1) | 44 (61.1) | 1.84 (1.12 – 3.04) | |
Decline in general health | 244 (40.2) | 45 (62.5) | 2.48 (1.50 - 4.10) | |
New-onset atrial fibrillation | 84 (14.0) | 20 (28.2) | 2.41 (1.37 - 4.25) | |
Number of failing organs within one day after admission | - | - | 3.25 (2.48 - 4.26) | 3.06 (2.2 - 4.27) |