Prognostic indexes of septic syndrome in the emergency department.
OBJECTIVE
Sepsis is a frequent and often lethal condition. Rapid identification and aggressive therapy in the emergency department (ED) are essential for outcome. Several indexes were found to be significantly related to short-term clinical outcome, but only bedside, rapidly available tests are thought to be useful in the ED. To define the prevalence and mortality of patients with severe sepsis presenting to the ED of a tertiary care hospital in Italy, we furthermore investigated the ability of bedside, non-invasive prognostic indexes to identify patients with adverse short-term clinical outcome.


METHODS
All patients admitted to the ED with a diagnosis of severe sepsis or septic shock were included. Retrospective data were collected by a dedicated software program using predefined searching criteria including clinical data, vital sign parameters, sepsis-related organ failure assessment (SOFA) score, and blood tests. The relationship between prognostic indexes and 24-h or 28-day mortality was evaluated by multivariate logistic regression analysis.


RESULTS
Ninety patients were enrolled from June 2004 to June 2005 (0.2% of all incoming patients to ED and 0.7% of all critical patients). Mean age was 77 +/- 15 years, 54.4% were women. During follow-up (28 days) 46 patients died (51.1%), 21 patients (23.3%) within 24 h. At multivariate analyses, age >80 (odds ratio [OR] 4.10; 95% confidence intervals [CI] 1.39-11.90, p = 0.01), serum lactate >5 mmol/l (OR 3.40; 95% CI 1.21-9.60, p = 0.02) and acute renal failure (OR 18.90; 95% CI 1.80-200, p = 0.02) were independent predictors of 28-day mortality.


CONCLUSIONS
Among critical patients admitted to an Italian ED, those with severe sepsis/septic shock represent about 1%, with a very high mortality rate. Bedside non-invasive prognostic indexes are able to identify with high accuracy patients with adverse short-term clinical outcome.
Giannazzo
Giuseppe
G
Department of Emergency Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. jusmela@tin.it
Tola
Francesco
F
Vanni
Simone
S
Bondi
Ernesta
E
Pepe
Giuseppe
G
Grifoni
Stefano
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004630:Emergencies; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000453:epidemiology; D018746:Systemic Inflammatory Response Syndrome / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality