Prognostic factors of mortality in patients with community-acquired bloodstream infection with severe sepsis and septic shock.
OBJECTIVE
The purpose of the study was to determine the independent risk factors on mortality in patients with community-acquired severe sepsis and septic shock.


METHODS
A single-site prospective cohort study was carried out in a medical-surgical intensive care unit in an academic tertiary care center. One hundred twelve patients with community-acquired bloodstream infection with severe sepsis and septic shock were identified. Clinical, microbiologic, and laboratory parameters were compared between hospital survivors and hospital deaths.


RESULTS
One-hundred twelve patients were included. The global mortality rate was 41.9%, 44.5% in septic shock and 34.4% in severe sepsis. One or more comorbidities were present in 66% of patients. The most commonly identified bloodstream pathogens were Escherichia coli (25%) and Staphylococcus aureus (21.4%). The proportion of patients receiving inadequate antimicrobial treatment was 8.9%. By univariate analysis, age, Acute Physiology and Chronic Health Evaluation II score, at least 3 organ dysfunctions, and albumin, but neither microbiologic characteristics nor site of infection, differed significantly between survivors and nonsurvivors. Acute Physiology and Chronic Health Evaluation II (odds ratio, 1.13; 95% confidence interval, 1.06-1.21) and albumin (odds ratio, 0.34; 95% confidence interval, 0.15-0.76) were independent risk factors associated with global mortality in logistic regression analysis.


CONCLUSIONS
In addition to the severity of illness, hypoalbuminemia was identified as the most important prognostic factor in community-acquired bloodstream infection with severe sepsis and septic shock.
Department of Internal Medicine, Hospital Universitario Dr Peset Av Gaspar Aguilar 90, 46017 Valencia, Spain. arturo.artero@uv.es
Arturo
A
Artero
Rafael
R
Zaragoza
Juan J
JJ
Camarena
Susana
S
Sancho
Rosa
R
González
José M
JM
Nogueira
D018806:APACHE; D000046:Academic Medical Centers; D000368:Aged; D000418:Albumins / Q000032:analysis; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D015897:Comorbidity; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000401:mortality; D013030:Spain
D000418:Albumins; D000900:Anti-Bacterial Agents