title: Clinical course of sepsis, severe sepsis, and septic shock in a cohort of infected patients from ten Colombian hospitals.
abstract: BACKGROUND
  Sepsis has several clinical stages, and mortality rates are different for each stage. Our goal was to establish the evolution and the determinants of the progression of clinical stages, from infection to septic shock, over the first week, as well as their relationship to 7-day and 28-day mortality.
  
  
  METHODS
  This is a secondary analysis of a multicenter cohort of inpatients hospitalized in general wards or intensive care units (ICUs). The general estimating equations (GEE) model was used to estimate the risk of progression and the determinants of stages of infection over the first week. Cox regression with time-dependent covariates and fixed covariates was used to determine the factors related with 7-day and 28-day mortality, respectively.
  
  
  RESULTS
  In 2681 patients we show that progression to severe sepsis and septic shock increases with intraabdominal and respiratory sources of infection [OR = 1,32; 95%IC = 1,20-1,46 and OR = 1.21, 95%CI = 1,11-1,33 respectively], as well as according to Acute Physiology and Chronic Health Evaluation II (APACHE II) [OR = 1,03; 95%CI = 1,02-1,03] and Sequential Organ Failure Assessment (SOFA) [OR = 1,16; 95%CI = 1,14-1,17] scores. The variables related with first-week mortality were progression to severe sepsis [HR = 2,13; 95%CI = 1,13-4,03] and septic shock [HR = 3,00; 95%CI = 1,50-5.98], respiratory source of infection [HR = 1,76; 95%IC = 1,12-2,77], APACHE II [HR = 1,07; 95% CI = 1,04-1,10] and SOFA [HR = 1,09; 95%IC = 1,04-1,15] scores.
  
  
  CONCLUSIONS
  Intraabdominal and respiratory sources of infection, independently of SOFA and APACHE II scores, increase the risk of clinical progression to more severe stages of sepsis; and these factors, together with progression of the infection itself, are the main determinants of 7-day and 28-day mortality.
authors.affiliation: Universidad de Antioquia, Medellín, Colombia.
authors.forename: Alba Luz
authors.initials: AL
authors.lastname: León
authors.forename: Natalia Andrea
authors.initials: NA
authors.lastname: Hoyos
authors.forename: Lena Isabel
authors.initials: LI
authors.lastname: Barrera
authors.forename: Gisela
authors.initials: G
authors.lastname: De La Rosa
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Dennis
authors.forename: Carmelo
authors.initials: C
authors.lastname: Dueñas
authors.forename: Marcela
authors.initials: M
authors.lastname: Granados
authors.forename: Dario
authors.initials: D
authors.lastname: Londoño
authors.forename: Ferney Alexander
authors.initials: FA
authors.lastname: Rodríguez
authors.forename: Francisco José
authors.initials: FJ
authors.lastname: Molina
authors.forename: Guillermo
authors.initials: G
authors.lastname: Ortiz
authors.forename: Fabián Alberto
authors.initials: FA
authors.lastname: Jaimes
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D015331:Cohort Studies; D003105:Colombia / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D018805:Sepsis / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality* / Q000473:pathology