Simone Meini (Italy)
Felice Lotti Hospital Internal MedicineAuthor of 1 Presentation
DIAGNOSIS AND PREVALENCE OF COMMUNITY-ONSET SEPSIS IN INTERNAL MEDICINE WARDS: A MULTICENTER, PROSPECTIVE STUDY.
Abstract
Background and Aims
The validity of “Sepsis-3” criteria in identifying patients with sepsis in internal medicine wards (IMWs) is not well known. Real-life data about this topic and on the prevalence of sepsis in IMWs could be useful for improving hospital organization. This study was aimed to assess the validity of "Sepsis-3" criteria in identifying patients with community-onset sepsis in IMWs. Secondary objectives of the study were to evaluate the prevalence of these patients in IMWs and to compare "Sepsis-3" and "Sepsis-1" criteria.
Methods
This is a multicenter, prospective, observational study, carried out in 22 IMWs of Tuscany (Italy). All patients admitted to each of the study centers over a period of 21-31 days were evaluated within 48 hours; those with clinical signs of infection were enrolled. The main outcome was in-hospital mortality.
Results
2,839 patients were evaluated and 938 (33%) met the inclusion criteria. Patients with sepsis diagnosed according to “Sepsis-3” were 522, representing 55.6% of patients with infection and 18.4% of all patients hospitalized; they were older than those without sepsis (79.4+12.5 vs 74.6+15.2 years, p<0.001). In-hospital mortality was significantly higher in patients with sepsis compared to others (13.8% vs 4.6%; p<0.001). “Sepsis-3” criteria showed greater predictive validity for in-hospital mortality than “Sepsis-1” criteria (AUROC=0.71; 95%CI, 0.66-0.77 vs 0.60; 95%CI 0.54-0.66; p=0.0038).
Conclusions
"Sepsis-3" criteria are able to identify patients with community-onset sepsis in IMWs, whose prevalence and in-hospital mortality are remarkably high. Medical departments should adapt their organization to the needs for care of these complex patients