Identification of Risk of Early Decompensation and Predictors of ICU Admission in Patients Triggering Code Sepsis

Introduction "Code Sepsis" is a protocol, auto-initiated as a system-based trigger in our community-based teaching center. It is designed to be activated in patients with two or more systemic inflammatory response syndrome (SIRS) criteria and organ dysfunction. The purpose is to identify sepsis early and treat it according to the Surviving Sepsis guidelines. If clinically indicated, patients are rapidly evaluated and treated with antibiotics and fluid boluses. Despite proactive measures to improve patient outcomes, clinical deterioration can still occur, which may necessitate ICU admission, vasopressor initiation, and even increased morbidity and mortality. In this study, we aimed to compare patients who triggered a code sepsis requiring ICU admission at a teaching hospital with those who did not require ICU admission, identifying risk factors for early decompensation. Methods We conducted a retrospective study to gather data on all patients admitted to the hospital between September 1, 2022, and December 31, 2022, who triggered code sepsis. Subjects were identified based on whether they triggered code sepsis, and demographic details, admission details, laboratory values, and code sepsis notes were collected using a Redcap questionnaire. The data was reviewed and evaluated using STATA software (Stata Corp., College Station, TX, USA), and means were calculated and compared between the two outcome cohorts. Multivariate logistic regression analysis was performed to determine adjusted odds ratios (OR). Results For patients who triggered code sepsis, the mean age (63.94 vs. 63.71, p=0.963) and mean length of stay (11.94 vs. 10.03 days, p=0.422) were comparable between those who required ICU admission and those who did not. However, there were significant differences in other factors. The mean initial lactate (2.22 vs. 1.40, p=0.017), initial alanine aminotransferase (ALT) level (74.52 vs. 37.11, p<0.05), and aspartate aminotransferase (AST) levels (149.84 vs. 61.03, p=0.005) were significantly higher in patients who required ICU level care. At the time of code sepsis, patients who needed a 30 cc/kg fluid bolus (OR=12.8, p<0.01), or had hypotension in the first hour after the event (OR=7.94, p<0.01) had a higher chance of requiring ICU admission. Patients meeting quick sequential organ failure assessment (qSOFA) criteria (OR= 4.4 and 5, p<0.01) and requiring escalation of antibiotics (OR=19.33, p<0.01) at the time of code sepsis were also more likely to require ICU. White cell count, glucose level, serum creatinine, and troponins at admission were comparable in both groups. There was no statistically significant difference in the distribution of co-morbidities such as type 2 diabetes, hypertension, cardiovascular, or kidney disease among the patients who went to the ICU versus those who did not. Conclusion Code sepsis, triggered by the system or physician, identifies the presence of SIRS and organ dysfunction, thus enabling healthcare providers to intervene and manage sepsis or septic shock earlier. Higher lactate levels, the presence of transaminitis during the initial trigger event, and positive qSOFA criteria indicate a worse prognosis. This may require escalation of care to the ICU, closer monitoring, and possible use of vasopressor support. Early identification of such individuals can lead to better management of their condition.