Early sepsis bundle compliance for non-hypotensive patients with intermediate versus severe hyperlactemia

Area of Science:

• Critical Care Medicine
• Sepsis Pathophysiology
• Quality Improvement in Healthcare

Background:

• Sepsis management guidelines emphasize early interventions through bundled care.
• Hyperlactemia is a marker of sepsis severity and mortality risk.
• The impact of sepsis bundle compliance on mortality may vary based on initial lactate levels.

Purpose of the Study:

• To investigate the association between 3-hour sepsis bundle compliance and in-hospital mortality.
• To compare this association in non-hypotensive sepsis patients with intermediate versus severe hyperlactemia.

Main Methods:

• A cohort study of 2417 non-hypotensive, hyperlactemic sepsis patients from a prospective quality-improvement database (October 2014 - September 2015).
• Sepsis defined by infection, ≥2 SIRS criteria, and ≥1 organ dysfunction criterion.
• Primary exposures: intermediate (2.2-3.9 mmol/L) vs. severe (≥4.0 mmol/L) hyperlactemia and 3-hour bundle compliance. Primary outcome: 60-day in-hospital mortality.

Main Results:

• Severe hyperlactemia (≥4.0 mmol/L) was present in 29% of patients.
• Overall mortality was 17.5%.
• A significant interaction (p=0.022) was found between bundle compliance and initial hyperlactemia severity. Multivariable analysis showed severe hyperlactemia (OR=1.99) increased mortality, while bundle compliance (OR=0.62) decreased it.

Conclusions:

• A significant interaction exists between 3-hour sepsis bundle compliance and initial hyperlactemia severity.
• Sepsis bundle compliance may be more beneficial in reducing mortality for non-hypotensive patients with less severe hyperlactemia.