Clinical course of sepsis, severe sepsis, and septic shock in a cohort of infected patients from ten Colombian hospitals
Autor: | Francisco Molina, Ferney Alexánder Rodríguez, Marcela Granados, Darío Londoño, Guillermo Ortiz, Alba León, Fabián Jaimes, Natalia Andrea Hoyos, Rodolfo Dennis, Carmelo Dueñas, Gisela De La Rosa, Lena Barrera |
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Jazyk: | angličtina |
Rok vydání: | 2013 |
Předmět: |
Adult
Male medicine.medical_specialty Colombia Sepsis Cohort Studies Internal medicine Intensive care Septic shock medicine Humans GEE Intensive care medicine APACHE Aged Proportional Hazards Models Analysis of Variance APACHE II Progression Proportional hazards model business.industry Mortality rate Middle Aged medicine.disease Severe sepsis Infectious Diseases Cohort Disease Progression Female business Cohort study Research Article Cox regression |
Zdroj: | Repositorio UdeA Universidad de Antioquia instacron:Universidad de Antioquia BMC Infectious Diseases |
Popis: | Background Sepsis has several clinical stages, and mortality rates are different for each stage. Our goal was to establish the evolution and the determinants of the progression of clinical stages, from infection to septic shock, over the first week, as well as their relationship to 7-day and 28-day mortality. Methods This is a secondary analysis of a multicenter cohort of inpatients hospitalized in general wards or intensive care units (ICUs). The general estimating equations (GEE) model was used to estimate the risk of progression and the determinants of stages of infection over the first week. Cox regression with time-dependent covariates and fixed covariates was used to determine the factors related with 7-day and 28-day mortality, respectively. Results In 2681 patients we show that progression to severe sepsis and septic shock increases with intraabdominal and respiratory sources of infection [OR = 1,32; 95%IC = 1,20-1,46 and OR = 1.21, 95%CI = 1,11-1,33 respectively], as well as according to Acute Physiology and Chronic Health Evaluation II (APACHE II) [OR = 1,03; 95%CI = 1,02-1,03] and Sequential Organ Failure Assessment (SOFA) [OR = 1,16; 95%CI = 1,14-1,17] scores. The variables related with first-week mortality were progression to severe sepsis [HR = 2,13; 95%CI = 1,13-4,03] and septic shock [HR = 3,00; 95%CI = 1,50-5.98], respiratory source of infection [HR = 1,76; 95%IC = 1,12-2,77], APACHE II [HR = 1,07; 95% CI = 1,04-1,10] and SOFA [HR = 1,09; 95%IC = 1,04-1,15] scores. Conclusions Intraabdominal and respiratory sources of infection, independently of SOFA and APACHE II scores, increase the risk of clinical progression to more severe stages of sepsis; and these factors, together with progression of the infection itself, are the main determinants of 7-day and 28-day mortality. |
Databáze: | OpenAIRE |
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