title: Sepsis-related mortality in 497 cases with blood culture-positive sepsis in an emergency department.
abstract: OBJECTIVE
  Few studies have sought to establish how often death after sepsis is related to the sepsis and how often underlying diseases have a major role in case fatality.
  
  
  METHODS
  In this retrospective cohort study, data were collected on 497 cases with blood culture-positive sepsis in an emergency department (ED).
  
  
  RESULTS
  Sepsis was categorized as severe in 31% of cases; 7% had septic shock. The quick Sepsis-related Organ Failure Assessment score was positive in 136 out of 473 cases (29%). Ninety-eight patients died by day 90; in 16 of these cases (16%) the death was sepsis-related in a patient without a rapidly fatal underlying disease, in 45 cases (46%) the death was sepsis-related in a patient with a rapidly fatal underlying disease, and in 37 cases (38%) the death was unrelated to sepsis. Sepsis-related death occurred in 58 out of 61 cases (95%) by day 28.
  
  
  CONCLUSIONS
  Underlying diseases were found to have a considerable role in the death of patients suffering from blood culture-positive sepsis in an ED of a developed country, as only 16% of the deaths by day 90 occurred where death was sepsis-related and the patient had a life-expectancy of more than 6 months. Improving the outcome of sepsis with new treatments is thus challenging. It is possible that day 7+day 28 mortality is a more appropriate endpoint than day 90 mortality when studying the outcome of sepsis, as this time-span includes most of the patients whose death was related to sepsis.
authors.affiliation: Department of Internal Medicine, Tampere University Hospital, Box 2000, FI-33521 Tampere, Finland. Electronic address: juha.rannikko@gmail.com.
authors.forename: Juha
authors.initials: J
authors.lastname: Rannikko
authors.affiliation: Department of Internal Medicine, Tampere University Hospital, Box 2000, FI-33521 Tampere, Finland.
authors.forename: Jaana
authors.initials: J
authors.lastname: Syrjänen
authors.affiliation: Department of Clinical Microbiology, Fimlab Laboratories, Tampere, Finland.
authors.forename: Tapio
authors.initials: T
authors.lastname: Seiskari
authors.affiliation: Department of Clinical Microbiology, Fimlab Laboratories, Tampere, Finland.
authors.forename: Janne
authors.initials: J
authors.lastname: Aittoniemi
authors.affiliation: Department of Internal Medicine, Tampere University Hospital, Box 2000, FI-33521 Tampere, Finland.
authors.forename: Reetta
authors.initials: R
authors.lastname: Huttunen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000071997:Blood Culture; D002423:Cause of Death; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D063305:Organ Dysfunction Scores; D012189:Retrospective Studies; D018805:Sepsis / Q000097:blood / Q000209:etiology / Q000401:mortality*
keywords: Attributable mortality; Blood culture; Infectious disease; Related mortality; Sepsis; Survival; qSOFA