Likelihood of infection in patients with presumed sepsis at the time of intensive care unit admission: a cohort study.
BACKGROUND
A clinical suspicion of infection is mandatory for diagnosing sepsis in patients with a systemic inflammatory response syndrome. Yet, the accuracy of categorizing critically ill patients presenting to the intensive care unit (ICU) as being infected or not is unknown. We therefore assessed the likelihood of infection in patients who were treated for sepsis upon admission to the ICU, and quantified the association between plausibility of infection and mortality.


METHODS
We studied a cohort of critically ill patients admitted with clinically suspected sepsis to two tertiary ICUs in the Netherlands between January 2011 and December 2013. The likelihood of infection was categorized as none, possible, probable or definite by post-hoc assessment. We used multivariable competing risks survival analyses to determine the association of the plausibility of infection with mortality.


RESULTS
Among 2579 patients treated for sepsis, 13% had a post-hoc infection likelihood of "none", and an additional 30% of only "possible". These percentages were largely similar for different suspected sites of infection. In crude analyses, the likelihood of infection was associated with increased length of stay and complications. In multivariable analysis, patients with an unlikely infection had a higher mortality rate compared to patients with a definite infection (subdistribution hazard ratio 1.23; 95% confidence interval 1.03-1.49).


CONCLUSIONS
This study is the first prospective analysis to show that the clinical diagnosis of sepsis upon ICU admission corresponds poorly with the presence of infection on post-hoc assessment. A higher likelihood of infection does not adversely influence outcome in this population.


BACKGROUND
ClinicalTrials.gov NCT01905033. Registered 11 July 2013.
Department of Intensive Care Medicine, University Medical Center Utrecht, Room F06.149, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands. p.m.c.kleinklouwenberg@umcutrecht.nl.|Department of Medical Microbiology, University Medical Center Utrecht, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands. p.m.c.kleinklouwenberg@umcutrecht.nl.|Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands. p.m.c.kleinklouwenberg@umcutrecht.nl.
Peter M C
PM
Klein Klouwenberg
Department of Intensive Care Medicine, University Medical Center Utrecht, Room F06.149, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands. o.l.cremer@umcutrecht.nl.
Olaf L
OL
Cremer
Center for Experimental and Molecular Medicine and Division of Infectious Diseases, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands. l.a.vanvught@amc.uva.nl.
Lonneke A
LA
van Vught
Department of Intensive Care Medicine, University Medical Center Utrecht, Room F06.149, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands. d.s.y.ong@umcutrecht.nl.|Department of Medical Microbiology, University Medical Center Utrecht, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands. d.s.y.ong@umcutrecht.nl.|Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands. d.s.y.ong@umcutrecht.nl.
David S Y
DS
Ong
Department of Intensive Care Medicine, University Medical Center Utrecht, Room F06.149, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands. j.f.frencken@umcutrecht.nl.|Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands. j.f.frencken@umcutrecht.nl.
Jos F
JF
Frencken
Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands. marcus.j.schultz@gmail.com.
Marcus J
MJ
Schultz
Department of Medical Microbiology, University Medical Center Utrecht, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands. m.j.m.bonten@umcutrecht.nl.|Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands. m.j.m.bonten@umcutrecht.nl.
Marc J
MJ
Bonten
Center for Experimental and Molecular Medicine and Division of Infectious Diseases, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands. t.vanderpoll@amc.uva.nl.
Tom
T
van der Poll
D000368:Aged; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010343:Patient Admission / Q000706:statistics & numerical data; D011336:Probability; D011446:Prospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality; D016019:Survival Analysis; D016896:Treatment Outcome