Complex Sepsis Presentations, SEP-1 Compliance, and Outcomes.

Area of Science:

• Critical Care Medicine
• Sepsis Management
• Healthcare Quality Improvement

Background:

• The Centers for Medicare & Medicaid Services Severe Sepsis and Septic Shock Management Bundle (SEP-1) aims to improve sepsis care.
• Observational studies suggest SEP-1 compliance correlates with reduced mortality, but often with limited confounder adjustment.
• Understanding clinical factors complicating SEP-1 adherence is crucial for accurate outcome assessment.

Purpose of the Study:

• To identify clinical factors that complicate sepsis diagnosis and management.
• To assess the association of these factors with SEP-1 compliance.
• To evaluate the impact of these factors on mortality in sepsis patients.

Main Methods:

• Retrospective cohort study of 590 adult sepsis patients across 4 academic hospitals (2019-2022).
• Medical records were reviewed to assess SEP-1 compliance and patient characteristics.
• Multivariable models were used to adjust for demographics, comorbidities, infection source, illness severity, and complexity markers.

Main Results:

• 56.8% of patients received SEP-1-compliant care; 43.2% received noncompliant care.
• Noncompliant patients were more likely to be older, have comorbidities, septic shock, kidney dysfunction, and thrombocytopenia.
• Complex presentations (nonfebrile, altered mental status, concurrent noninfectious illness) were more common in the noncompliant group.
• Crude mortality was lower with SEP-1 compliance, but this association disappeared after adjusting for clinical complexity.

Conclusions:

• Complex clinical presentations are more frequent in patients with noncompliant SEP-1 care.
• These clinical nuances confound the observed association between SEP-1 compliance and mortality.
• Accurate assessment of SEP-1's impact requires accounting for the complexity of patient conditions.