Clinical outcomes and inflammatory profiles in culture-positive sepsis: A retrospective cohort study

ObjectiveTo describe clinical outcomes and inflammatory profiles in patients with culture-positive sepsis identified using Sepsis-3 criteria and to explore their association with bacterial Gram stain status.MethodsA retrospective cohort study was conducted in adult patients with sepsis hospitalized at a single-center hospital in East Java, Indonesia, in 2023. Patients were identified using Sepsis-3 criteria and included if blood cultures were obtained at admission. Data collected included blood culture results, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, comorbidities, length of hospital stay, and in-hospital mortality. Patients were grouped according to bacterial Gram stain status. Group differences were analyzed using the chi-square test for categorical variables and the Mann-Whitney U test for continuous variables. Multivariate logistic regression was performed to identify factors associated with mortality.ResultsAmong 172 patients clinically diagnosed with sepsis, blood culture was positive in 46 cases (26.7%), indicating that most patients (73.3%) had culture-negative sepsis. Among culture-positive cases, gram-positive organisms predominated (n = 37), whereas gram-negative pathogens were less frequently isolated (n = 9). Increased inflammatory burden, reflected by a higher admission neutrophil-to-lymphocyte ratio, was associated with worse clinical outcomes. In multivariate analysis, gram-negative infection (adjusted odds ratio = 4.00, 95% confidence interval: 1.05-15.30), higher neutrophil-to-lymphocyte ratio (adjusted odds ratio = 1.06 per unit; 95% confidence interval: 1.01-1.11), and acute kidney injury (adjusted odds ratio = 5.30, 95% confidence interval: 1.73-16.50) were independently associated with in-hospital mortality.ConclusionCulture-negative sepsis was common, likely influenced by early antibiotic use. Gram-positive pathogens predominated among culture-positive cases, whereas gram-negative infections were associated with worse clinical outcomes. Elevated neutrophil-to-lymphocyte ratio and acute kidney injury independently predicted in-hospital mortality. These findings support the need for multimodal sepsis assessment integrating clinical judgment and laboratory markers rather than relying solely on culture results.