Systemic symptoms predict presence or development of severe sepsis and septic shock.
BACKGROUND
Severe sepsis is a major cause of mortality and morbidity globally. As the time to adequate treatment is directly linked to outcome, early recognition is of critical importance. Early, accessible markers for severe sepsis are desirable. The systemic inflammatory response in sepsis leads to changes in vital signs and biomarkers and to symptoms unrelated to the focus of infection. This study investigated whether the occurrence of any of six systemic symptoms could predict severe sepsis in a cohort of patients admitted to hospital for suspected bacterial infections.


METHODS
A retrospective, consecutive study was conducted. All adult patients admitted during 1 month to a 550-bed secondary care hospital in western Sweden and given intravenous antibiotics for suspected community-acquired infection were included (n = 289). Symptoms (fever/chills, muscle weakness, localised pain, dyspnea, altered mental status and gastrointestinal symptoms) were registered along with age, sex, vital signs and laboratory values. Patients who fulfilled criteria of severe sepsis within 48 h were compared with patients who did not. Odds ratios for severe sepsis were calculated, adjusted for age, sex and comorbidities.


RESULTS
Criteria for severe sepsis were fulfilled by 90/289 patients (31.1%). Altered mental status (OR = 4.29, 95% CI = 2.03-9.08), dyspnea (OR = 2.92, 95% CI = 1.69-5.02), gastrointestinal symptoms (OR = 2.31, 95% CI = 1.14-4.69) and muscle weakness (OR = 2.24, 95% CI = 1.06-4.75) were more common in patients who had or later developed severe sepsis.


CONCLUSIONS
Systemic symptoms in combination with other signs of infection should be considered warning signs of severe sepsis.
a Department for Infectious Diseases , Södra Älvsborgs Sjukhus , Borås , Sweden.
Jon
J
Edman-Wallér
b Department for Infectious Diseases , Skaraborgs Sjukhus , Skövde , Sweden.
Lars
L
Ljungström
b Department for Infectious Diseases , Skaraborgs Sjukhus , Skövde , Sweden.
Gunnar
G
Jacobsson
c Department for Infectious Diseases , Institute of Biomedicine, University of Gothenburg , Sweden.
Rune
R
Andersson
a Department for Infectious Diseases , Södra Älvsborgs Sjukhus , Borås , Sweden.
Maria
M
Werner
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D004417:Dyspnea / Q000175:diagnosis / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness / Q000175:diagnosis / Q000382:microbiology; D016017:Odds Ratio; D010343:Patient Admission; D012189:Retrospective Studies; D012772:Shock, Septic / Q000150:complications / Q000175:diagnosis*; D018709:Statistics, Nonparametric; D013548:Sweden; D055815:Young Adult
D000900:Anti-Bacterial Agents
Sepsis; altered mental status; dyspnea; gastrointestinal symptoms; muscle weakness; septic shock; severe sepsis; symptoms