Initial levels of organ failure, microbial findings and mortality in intensive care-treated primary, secondary and tertiary sepsis.
OBJECTIVE
Analysis of whether patients with primary, secondary and tertiary sepsis, defined by the presence or absence of recent systemic inflammation-inducing events before the onset of sepsis, differ in clinical presentation, microbiological test results, treatment received and outcome.


METHODS
A retrospective observational study in a single, general intensive care unit, of all patients treated for severe sepsis or septic shock from 2006 to 2011. Patients with haematological malignancies, with immunosuppressive diseases or being treated with immunosuppressive drugs were excluded.


METHODS
None.


METHODS
Sequential Organ Failure Assessment score, incidence of organ failure, microbiological results of blood cultures and mortality.


RESULTS
We included 213 patients, who were classified as having primary (n = 121), secondary (n = 65) or tertiary sepsis (n = 27). The groups differed significantly in SOFA score, the incidence of kidney failure and coagulation failure at onset of sepsis in the ICU, as well as in blood culture findings. No differences in 7-day or 28-day mortality were seen, but the time of death occurred earlier among nonsurvivors in the primary sepsis group.


CONCLUSIONS
Inflammatory insults before the onset of sepsis affect the clinical picture, blood microbial findings, and in non-survivors, the time of death. These results could, if validated in a prospective study, form a basis for a novel and simple strategy for stratifying patients in clinical studies for immunomodulation therapies in sepsis.
Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden. markus.castegren@karolinska.se.
Markus
M
Castegren
Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden.
Mikaela
M
Jonasson
Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden.
Sara
S
Castegren
Section of Anaesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
Miklós
M
Lipcsey
Section of Infectious Diseases, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
Jan
J
Sjölin
D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology* / Q000628:therapy; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology* / Q000628:therapy; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D017063:Outcome Assessment, Health Care; D010865:Pilot Projects; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000382:microbiology* / Q000401:mortality* / Q000628:therapy