Prognostic factors for important clinical outcomes in patients with a severe infection
Tóm tắt
Patients who are admitted with a suspicion of a severe infection usually enter the hospital through the emergency department (ED). The recognition of prognostic factors in an early stage affects further treatment and might improve clinical outcomes. We examined possible prognostic factors for four important outcomes: intensive care unit (ICU) admission, positive blood cultures, mortality and re-admission. All adult patients arriving at the ED with a suspected infection for whom admittance and intravenous (iv) antibiotics were indicated were included between March and December 2006. Possible prognostic variables were obtained from medical history, physical examination and laboratory results during the ED presentation. Data were analysed using logistic regression analysis. A total of 295 ED patients were evaluated, of whom 27 were referred to the ICU, 62 had a positive blood culture, 16 died and 48 were re-admitted. In multivariate analysis, patients with a respiration rate of >25/min were at higher risk for ICU admission. Patients with a positive blood culture had a higher heart rate and a higher percentage of segmented neutrophils. Patients who died during admission were more likely to be older, confused and had lower blood pressure. Patients who were re-admitted within 30 days were more likely to be male, younger and less likely to have a positive blood culture. Routine clinical and biochemical information can be used to predict ICU admission, the presence of bacteraemia, mortality and re-admission (within 30 days) and should be taken into consideration for treatment decisions.
Tài liệu tham khảo
Kumar A, Roberts D, Wood KE, Light B, Parrillo JE, Sharma S et al (2006) Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 34(6):1589–1596
Houck PM, Bratzler DW, Nsa W, Ma A, Bartlett JG (2004) Timing of antibiotic administration and outcomes for Medicare patients hospitalized with community-acquired pneumonia. Arch Intern Med 164(6):637–644
Meehan TP, Fine MJ, Krumholz HM, Scinto JD, Galusha DH, Mockalis JT et al (1997) Quality of care, process, and outcomes in elderly patients with pneumonia. JAMA 278(23):2080–2084
Proulx N, Frechette D, Toye B, Chan J, Kravcik S (2005) Delays in the administration of antibiotics are associated with mortality from adult acute bacterial meningitis. QJM 98(4):291–298
Ziss DR, Stowers A, Feild C (2003) Community-acquired pneumonia: compliance with centers for Medicare and Medicaid services, national guidelines, and factors associated with outcome. South Med J 96(10):949–959
Battleman DS, Callahan M, Thaler HT (2002) Rapid antibiotic delivery and appropriate antibiotic selection reduce length of hospital stay of patients with community-acquired pneumonia: link between quality of care and resource utilization. Arch Intern Med 162(6):682–688
Hoogewerf M, Oosterheert JJ, Hak E, Hoepelman IM, Bonten MJ (2006) Prognostic factors for early clinical failure in patients with severe community-acquired pneumonia. Clin Microbiol Infect 12(11):1097–1104
Fan JS, Kao WF, Yen DH, Wang LM, Huang CI, Lee CH (2007) Risk factors and prognostic predictors of unexpected intensive care unit admission within 3 days after ED discharge. Am J Emerg Med 25(9):1009–1014
Gao H, McDonnell A, Harrison DA, Moore T, Adam S, Daly K et al (2007) Systematic review and evaluation of physiological track and trigger warning systems for identifying at-risk patients on the ward. Intensive Care Med 33(4):667–679
Sogaard M, Schonheyder HC, Riis A, Sorensen HT, Norgaard M (2008) Short-term mortality in relation to age and comorbidity in older adults with community-acquired bacteremia: a population-based cohort study. J Am Geriatr Soc 56(9):1593–1600
Hoogendoorn M, van’t Wout JW, Schijf V, van Dissel JT (2002) [Predictive value of chills in patients presenting with fever to urgent care department]. Ned Tijdschr Geneeskd 146(3):116–120
Tokuda Y, Miyasato H, Stein GH (2005) A simple prediction algorithm for bacteraemia in patients with acute febrile illness. QJM 98(11):813–820
Ehrenstein BP, Ehrenstein V, Henke C, Linde HJ, Salzberger B, Scholmerich J et al (2008) Risk factors for negative blood cultures in adult medical inpatients–a retrospective analysis. BMC Infect Dis 8:148
Jover F, Cuadrado JM, Andreu L, Martinez S, Canizares R, de la Tabla VO et al (2008) A comparative study of bacteremic and non-bacteremic pneumococcal pneumonia. Eur J Intern Med 19(1):15–21
Barlow G, Nathwani D, Williams F, Ogston S, Winter J, Jones M et al (2007) Reducing door-to-antibiotic time in community-acquired pneumonia: Controlled before-and-after evaluation and cost-effectiveness analysis. Thorax 62(1):67–74
Jones AE, Yiannibas V, Johnson C, Kline JA (2006) Emergency department hypotension predicts sudden unexpected in-hospital mortality: a prospective cohort study. Chest 130(4):941–946
Hallerbach M, Francoeur A, Pomerantz SC, Oliner C, Morris DL, Eiger G et al (2008) Patterns and predictors of early hospital readmission in patients with congestive heart failure. Am J Med Qual 23(1):18–23
Almagro P, Barreiro B, de Ochoa EA, Quintana S, Rodriguez CM, Heredia JL et al (2006) Risk factors for hospital readmission in patients with chronic obstructive pulmonary disease. Respiration 73(3):311–317
Jasti H, Mortensen EM, Obrosky DS, Kapoor WN, Fine MJ (2008) Causes and risk factors for rehospitalization of patients hospitalized with community-acquired pneumonia. Clin Infect Dis 46(4):550–556
Jencks SF, Williams MV, Coleman EA (2009) Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med 360(14):1418–1428
Stanley A, Graham N, Parrish A (2008) A review of internal medicine re-admissions in a peri-urban South African hospital. S Afr Med J 98(4):291–294
Henckaerts L, Nielsen KR, Steffensen R, Van SK, Mathieu C, Giulietti A et al (2009) Polymorphisms in innate immunity genes predispose to bacteremia and death in the medical intensive care unit. Crit Care Med 37(1):192–193