Background: Progression from nonsevere sepsisââ?¬â?i.e., sepsis without organ failure or shockââ?¬â?to severe sepsis or\nshock among emergency department (ED) patients has been associated with significant mortality. Early recognition\nin the ED of those who progress to severe sepsis or shock during their hospital course may improve patient outcomes.\nWe sought to identify clinical, demographic, and laboratory parameters that predict progression to severe sepsis, septic\nshock, or death within 96 h of ED triage among patients with initial presentation of nonsevere sepsis.\nMethods: This is a retrospective cohort of patients presenting to a single urban academic ED from November 2008\nto October 2010. Patients aged 18 years or older who met criteria for sepsis and had a lactate level measured in the\nED were included. Patients were excluded if they had any combination of the following: a systolic blood pressure\n<90 mmHg upon triage, an initial whole blood lactate level ââ?°Â¥4 mmol/L, or one or more of a set of predefined signs of\norgan dysfunction upon initial assessment. Disease progression was defined as the development of any combination\nof the aforementioned conditions, initiation of vasopressors, or death within 96 h of ED presentation. Data on\npredefined potential predictors of disease progression and outcome measures of disease progression were collected\nby a query of the electronic medical record and via chart review. Logistic regression was used to assess associations\nof potential predictor variables with a composite outcome measure of sepsis progression to organ failure, hypotension,\nor death.\nResults: In this cohort of 582 ED patients with nonsevere sepsis, 108 (18.6 %) experienced disease progression. Initial\nserum albumin <3.5 mg/dL (OR 4.82; 95 % CI 2.40ââ?¬â??9.69; p < 0.01) and a diastolic blood pressure <52 mmHg at ED\ntriage (OR 4.59; 95 % CI 1.57ââ?¬â??13.39; p < 0.01) were independently associated with disease progression to severe sepsis\nor shock within 96 h of ED presentation. There were no deaths within 96 h of ED presentation.\nConclusions: In our patient cohort, serum albumin <3.5 g/dL and an ED triage diastolic blood pressure <52 mmHg\nindependently predict early progression to severe sepsis or shock among ED patients with presumed sepsis.
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