title: Mortality and prognostic factors of patients who have blood cultures performed in the emergency department: a cohort study.
abstract: BACKGROUND
  Early identification and treatment of patients with severe infection improve their prognosis. The aims of this study were to describe the 30-day mortality and to identify prognostic factors among blood-cultured patients in a medical emergency department (MED).
  
  
  METHODS
  This was a hospital-based cohort study including all adult (≥15 years old) blood-cultured patients at the MED at Odense University Hospital between 1 August 2009 and 31 August 2011.
  
  
  RESULTS
  During the study period, 5499/11 988 (45.9%) patients had blood cultures performed within 72 h of arrival and were included in the study. Of those included, 2631 (47.8%) were men, median age 69 years (range 15-103), and 418 (7.6%) were diagnosed with bacteraemia. The overall 30-day mortality among blood-cultured patients was 11.0% (10.2-11.9). In a multivariate Cox regression model, age of more than 80 years [hazard ratio (HR) 4.6 (95% CI 3.6-6.0)], at least two organ failure [HR 3.6 (2.9-4.5)], bacteraemia [HR 1.4 (1.1-1.8)], Charlson Comorbidity Index of at least 2 h [HR 1.7 (1.3-2.0)], SIRS [HR 1.5 (1.2-1.7)], a history of alcohol dependency [HR 1.7 (1.3-2.3)] and late drawing of blood cultures 24-48 h after arrival [HR 1.7 (1.3-2.2)] were found to be prognostic factors of mortality among blood-cultured patients in the MED.
  
  
  CONCLUSIONS
  Among blood-cultured patients in the MED, we found an 11.0% overall 30-day mortality. Factors associated with 30-day mortality were age more than 80 years, at least two organ failure, bacteraemia, Charlson Comorbidity Index of at least 2, SIRS, a history of alcohol dependency and late drawing of blood cultures.
authors.affiliation: Departments of aEmergency Medicine bInfectious Diseases cClinical Microbiology dClinical Biochemistry and Pharmacology, Odense University Hospital, Odense C, Denmark.
authors.forename: Katrine P
authors.initials: KP
authors.lastname: Lindvig
authors.forename: Stig L
authors.initials: SL
authors.lastname: Nielsen
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Henriksen
authors.forename: Thøger G
authors.initials: TG
authors.lastname: Jensen
authors.forename: Hans Jørn
authors.initials: HJ
authors.lastname: Kolmos
authors.forename: Court
authors.initials: C
authors.lastname: Pedersen
authors.forename: Pernille J
authors.initials: PJ
authors.lastname: Vinholt
authors.forename: Annmarie T
authors.initials: AT
authors.lastname: Lassen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000097:blood / Q000175:diagnosis / Q000401:mortality; D000071997:Blood Culture / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007239:Infections / Q000097:blood / Q000175:diagnosis* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D055815:Young Adult