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Published on: June 15, 2019
Primary bacteraemia is associated with a higher mortality risk compared with pulmonary and intra-abdominal infections
Ashham Mansur1, Yvonne Klee1, Aron Frederik Popov2
1Department of Anesthesiology, University Medical Center, Georg August University, Goettingen, Niedersachsen, Germany.
Objective:
To investigate whether common infection foci (pulmonary, intra-abdominal and primary bacteraemia) are associated with variations in mortality risk in patients with sepsis.
Design:
Prospective, observational cohort study.
Setting:
Three surgical intensive care units (ICUs) at a university medical centre.
Participants:
A total of 327 adult Caucasian patients with sepsis originating from pulmonary, intra-abdominal and primary bacteraemia participated in this study.
Primary And Secondary Outcome Measures:
The patients were followed for 90 days and mortality risk was recorded as the primary outcome variable. To monitor organ failure, sepsis-related organ failure assessment (Sequential Organ Failure Assessment, SOFA) scores were evaluated at the onset of sepsis and throughout the observational period as secondary outcome variables.
Results:
A total of 327 critically ill patients with sepsis were enrolled in this study. Kaplan-Meier survival analysis showed that the 90-day mortality risk was significantly higher among patients with primary bacteraemia than among those with pulmonary and intra-abdominal foci (58%, 35% and 32%, respectively; p=0.0208). To exclude the effects of several baseline variables, we performed multivariate Cox regression analysis. Primary bacteraemia remained a significant covariate for mortality in the multivariate analysis (HR 2.10; 95% CI 1.14 to 3.86; p=0.0166). During their stay in the ICU, the patients with primary bacteraemia presented significantly higher SOFA scores than those of the patients with pulmonary and intra-abdominal infection foci (8.5±4.7, 7.3±3.4 and 5.8±3.5, respectively). Patients with primary bacteraemia presented higher SOFA-renal score compared with the patients with other infection foci (1.6±1.4, 0.8±1.1 and 0.7±1.0, respectively); the patients with primary bacteraemia required significantly more renal replacement therapy than the patients in the other groups (29%, 11% and 12%, respectively).
Conclusions:
These results indicate that patients with sepsis with primary bacteraemia present a higher mortality risk compared with patients with sepsis of pulmonary or intra-abdominal origins. These results should be assessed in patients with sepsis in larger, independent cohorts.
Insights
Patients with sepsis originating from primary bacteraemia face a significantly higher 90-day mortality risk compared to those with pulmonary or intra-abdominal infections. This highlights bacteraemia as a critical factor in sepsis outcomes.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Epidemiology
Background:
- Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection.
- Identifying factors influencing sepsis mortality is crucial for improving patient outcomes.
- Common infection sources include pulmonary, intra-abdominal, and bloodstream infections (primary bacteraemia).
Purpose of the Study:
- To determine if the origin of sepsis (pulmonary, intra-abdominal, or primary bacteraemia) influences mortality risk.
- To investigate the association between infection foci and organ failure severity in sepsis patients.
Main Methods:
- Prospective, observational cohort study involving 327 adult patients with sepsis.
- Patients were categorized by infection origin: pulmonary, intra-abdominal, or primary bacteraemia.
- Mortality risk was assessed over 90 days; Sequential Organ Failure Assessment (SOFA) scores were used to monitor organ failure.
Main Results:
- Primary bacteraemia was associated with a significantly higher 90-day mortality risk (58%) compared to pulmonary (35%) and intra-abdominal (32%) sources (p=0.0208).
- Multivariate analysis confirmed primary bacteraemia as an independent predictor of mortality (HR 2.10; p=0.0166).
- Patients with primary bacteraemia exhibited higher SOFA scores and required more renal replacement therapy.
Conclusions:
- Sepsis originating from primary bacteraemia carries a substantially higher mortality risk than sepsis from pulmonary or intra-abdominal sources.
- These findings underscore the importance of the infection source in sepsis prognosis.
- Further validation in larger cohorts is recommended.
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