Factors Influencing Outcomes in ED Patients with Suspected Infections and without Meeting Sepsis Criteria

The following is a summary of “Predictors of outcomes in emergency department patients with suspected infections and without fulfillment of the sepsis criteria,” published in the June 2023 issue of Emergency Medicine by Nielsen et al.

There are data on patient characteristics and predictors of severe outcomes for acutely admitted patients with infections who do not meet sepsis criteria. The study’s objective was to characterize acutely admitted emergency department (ED) patients with diseases and a composite outcome of in-hospital mortality or transfer to the intensive care unit without meeting the criteria for sepsis and identify predictors of the mixed product. This was a secondary data analysis from a prospective observational study of patients admitted to the ED between October 1, 2017, and March 31, 2018, with a suspected bacterial infection.

It was presumed that a National Early Warning Score 2 (NEWS2) 5 within the first 4 hours in the ED indicated a sepsis-like condition with a high risk for the composite endpoint. Patients who attained the composite outcome were categorized based on the presence of NEWS2 5 criteria. The researchers estimated the unadjusted and adjusted odds ratio (OR) for the combined endpoint among patients with NEWS2 <5 (NEWS2-) or NEWS2 ≥5 (NEWS2+) using logistic regression analysis. Inclusion criteria included 2,055 patients with a median age of 73 years. 

Among these, 198 (9.6%) met the composite endpoint, with 59 (29.8%) NEWS2- and 139 (70.2%) NEWS2+ patients, respectively. Diabetes (OR 2.23;1.23–4.0), a Sequential Organ Failure Assessment (SOFA) score ≥2 (OR 2.57;1.37–4.79), and a Do-not-attempt-cardiopulmonary-resuscitation order (DNACPR) on admission were independent predictors of the composite endpoint in NEWS2- patients (goodness-of-fit test P= 0.291; area under the receiver operating characteristic curve (AUROC) = 0.70). SOFA score ≥2 (OR 2.79; 1.59–4.91), hypothermia (OR 2.48; 1.30–4.75), and DNACPR order on admission were predictive variables for the composite endpoint (goodness-of-fit test P = 0.62; AUROC for the model = 0.62). Approximately one-third of hospitalized patients with infections and adverse outcomes did not meet the NEWS2 criteria for probable sepsis. Their study identified factors with independent predictive value for developing severe consequences, which should be evaluated in future prediction models.

Source: sciencedirect.com/science/article/abs/pii/S0735675723001365