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Early Sepsis Bundle Compliance for Non-Hypotensive Patients with Intermediate Versus Severe Hyperlactemia

Abstract Objective To compare the association of 3-h sepsis bundle compliance with hospital mortality in non-hypotensive sepsis patients with intermediate versus severe hyperlactemia. Methods This was a cohort study of all non-hypotensive, hyperlactemic sepsis patients captured in a prospective qual... Full description

Journal Title: The American journal of emergency medicine 2016, Vol.35 (6), p.811-818
Main Author: Leisman, Daniel E
Other Authors: Zemmel D'Amore, Jason A , Gribben, Jeanie L , Ward, Mary Frances , Masick, Kevin D , Bianculli, Andrea R , Bradburn, Kathryn H , D'Angelo, John K , Doerfler, Martin E
Format: Electronic Article Electronic Article
Language: English
Subjects:
Quelle: Alma/SFX Local Collection
Publisher: United States: Elsevier Inc
ID: ISSN: 0735-6757
Link: https://www.ncbi.nlm.nih.gov/pubmed/28126452
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title: Early Sepsis Bundle Compliance for Non-Hypotensive Patients with Intermediate Versus Severe Hyperlactemia
format: Article
creator:
  • Leisman, Daniel E
  • Zemmel D'Amore, Jason A
  • Gribben, Jeanie L
  • Ward, Mary Frances
  • Masick, Kevin D
  • Bianculli, Andrea R
  • Bradburn, Kathryn H
  • D'Angelo, John K
  • Doerfler, Martin E
subjects:
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents - therapeutic use
  • Antibiotics
  • Blood
  • Blood pressure
  • Bundling
  • Clinical trials
  • Criteria
  • Critical care
  • Databases, Factual
  • Emergency
  • Female
  • Hospital Mortality
  • Humans
  • Hyperlactatemia - epidemiology
  • Hypoxia
  • Infections
  • Intensive care
  • Lactates
  • Lactic acid
  • Lactic Acid - blood
  • Logistic Models
  • Male
  • Medical examination
  • Medical research
  • Medicine, Experimental
  • Middle Aged
  • Mortality
  • Multivariate Analysis
  • Patient compliance
  • Patients
  • Prospective Studies
  • Quality Improvement
  • Sepsis
  • Sepsis - complications
  • Sepsis - drug therapy
  • Sepsis - mortality
  • Severity of Illness Index
  • Systemic Inflammatory Response Syndrome - epidemiology
  • Tertiary Care Centers
  • Time Factors
  • United States
ispartof: The American journal of emergency medicine, 2016, Vol.35 (6), p.811-818
description: Abstract Objective To compare the association of 3-h sepsis bundle compliance with hospital mortality in non-hypotensive sepsis patients with intermediate versus severe hyperlactemia. Methods This was a cohort study of all non-hypotensive, hyperlactemic sepsis patients captured in a prospective quality-improvement database, treated October 2014 to September 2015 at five tertiary-care centers. We defined sepsis as 1)infection, 2) ≥ 2 SIRS criteria, and 3) ≥ 1 organ dysfunction criterion. “Time-zero” was the first time a patient met all sepsis criteria. Inclusion criteria: systolic blood pressure > 90 mmHg, mean arterial pressure > 65 mmHg, and serum lactate ≥ 2.2 mmol/L. Primary exposures: 1)intermediate(2.2–3.9 mmol/L) versus severe(≥ 4.0 mmol/L) hyperlactemia and 2)full 3-h bundle compliance. Bundle elements: 1. Blood cultures before antibiotics 2. Parenteral antibiotics administered ≤ 180 min from ≥ 2 SIRS and lactate ordered, or ≤ 60 min from “time-zero”, whichever occurred first. 3. Lactate result available ≤ 90 min post-order 4. 30 mL/kg crystalloid bolus initiated ≤ 30 min from “time-zero”. The primary outcome was 60-day in-hospital mortality. Results 2417 patients met inclusion criteria. 704(29%) had lactate ≥ 4.0 mmol/L versus 1775 patients with lactate 2.2–3.9 mmol/L. Compliance was 75% for antibiotics and 53% for fluids. Full-compliance was comparable between lactate groups ( n = 200(29%) and 488(28%), respectively). We observed 424(17.5%) mortalities: intermediate/non-compliant – 182(14.9%), intermediate/compliant – 41(8.4%), severe/non-compliant – 147(29.2%), severe/compliant – 54(27.0%) [ difference-of-differences = 4.3%, CI = 2.6–5.9%]. In multivariable regression, mortality predictors included severe hyperlactemia (OR = 1.99, CI = 1.51–2.63) and bundle compliance (OR = 0.62, CI = 0.42–0.90), and their interaction was significant: p(interaction) = 0.022. Conclusion We observed a significant interaction between 3-h bundle compliance and initial hyperlactemia. Bundle compliance may be associated with greater mortality benefit for non-hypotensive sepsis patients with less severe hyperlactemia.
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 0735-6757
fulltext: fulltext
issn:
  • 0735-6757
  • 1532-8171
url: Link


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titleEarly Sepsis Bundle Compliance for Non-Hypotensive Patients with Intermediate Versus Severe Hyperlactemia
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creatorLeisman, Daniel E ; Zemmel D'Amore, Jason A ; Gribben, Jeanie L ; Ward, Mary Frances ; Masick, Kevin D ; Bianculli, Andrea R ; Bradburn, Kathryn H ; D'Angelo, John K ; Doerfler, Martin E
creatorcontribLeisman, Daniel E ; Zemmel D'Amore, Jason A ; Gribben, Jeanie L ; Ward, Mary Frances ; Masick, Kevin D ; Bianculli, Andrea R ; Bradburn, Kathryn H ; D'Angelo, John K ; Doerfler, Martin E
descriptionAbstract Objective To compare the association of 3-h sepsis bundle compliance with hospital mortality in non-hypotensive sepsis patients with intermediate versus severe hyperlactemia. Methods This was a cohort study of all non-hypotensive, hyperlactemic sepsis patients captured in a prospective quality-improvement database, treated October 2014 to September 2015 at five tertiary-care centers. We defined sepsis as 1)infection, 2) ≥ 2 SIRS criteria, and 3) ≥ 1 organ dysfunction criterion. “Time-zero” was the first time a patient met all sepsis criteria. Inclusion criteria: systolic blood pressure > 90 mmHg, mean arterial pressure > 65 mmHg, and serum lactate ≥ 2.2 mmol/L. Primary exposures: 1)intermediate(2.2–3.9 mmol/L) versus severe(≥ 4.0 mmol/L) hyperlactemia and 2)full 3-h bundle compliance. Bundle elements: 1. Blood cultures before antibiotics 2. Parenteral antibiotics administered ≤ 180 min from ≥ 2 SIRS and lactate ordered, or ≤ 60 min from “time-zero”, whichever occurred first. 3. Lactate result available ≤ 90 min post-order 4. 30 mL/kg crystalloid bolus initiated ≤ 30 min from “time-zero”. The primary outcome was 60-day in-hospital mortality. Results 2417 patients met inclusion criteria. 704(29%) had lactate ≥ 4.0 mmol/L versus 1775 patients with lactate 2.2–3.9 mmol/L. Compliance was 75% for antibiotics and 53% for fluids. Full-compliance was comparable between lactate groups ( n = 200(29%) and 488(28%), respectively). We observed 424(17.5%) mortalities: intermediate/non-compliant – 182(14.9%), intermediate/compliant – 41(8.4%), severe/non-compliant – 147(29.2%), severe/compliant – 54(27.0%) [ difference-of-differences = 4.3%, CI = 2.6–5.9%]. In multivariable regression, mortality predictors included severe hyperlactemia (OR = 1.99, CI = 1.51–2.63) and bundle compliance (OR = 0.62, CI = 0.42–0.90), and their interaction was significant: p(interaction) = 0.022. Conclusion We observed a significant interaction between 3-h bundle compliance and initial hyperlactemia. Bundle compliance may be associated with greater mortality benefit for non-hypotensive sepsis patients with less severe hyperlactemia.
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subjectAged ; Aged, 80 and over ; Anti-Bacterial Agents - therapeutic use ; Antibiotics ; Blood ; Blood pressure ; Bundling ; Clinical trials ; Criteria ; Critical care ; Databases, Factual ; Emergency ; Female ; Hospital Mortality ; Humans ; Hyperlactatemia - epidemiology ; Hypoxia ; Infections ; Intensive care ; Lactates ; Lactic acid ; Lactic Acid - blood ; Logistic Models ; Male ; Medical examination ; Medical research ; Medicine, Experimental ; Middle Aged ; Mortality ; Multivariate Analysis ; Patient compliance ; Patients ; Prospective Studies ; Quality Improvement ; Sepsis ; Sepsis - complications ; Sepsis - drug therapy ; Sepsis - mortality ; Severity of Illness Index ; Systemic Inflammatory Response Syndrome - epidemiology ; Tertiary Care Centers ; Time Factors ; United States
ispartofThe American journal of emergency medicine, 2016, Vol.35 (6), p.811-818
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1Zemmel D'Amore, Jason A
2Gribben, Jeanie L
3Ward, Mary Frances
4Masick, Kevin D
5Bianculli, Andrea R
6Bradburn, Kathryn H
7D'Angelo, John K
8Doerfler, Martin E
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descriptionAbstract Objective To compare the association of 3-h sepsis bundle compliance with hospital mortality in non-hypotensive sepsis patients with intermediate versus severe hyperlactemia. Methods This was a cohort study of all non-hypotensive, hyperlactemic sepsis patients captured in a prospective quality-improvement database, treated October 2014 to September 2015 at five tertiary-care centers. We defined sepsis as 1)infection, 2) ≥ 2 SIRS criteria, and 3) ≥ 1 organ dysfunction criterion. “Time-zero” was the first time a patient met all sepsis criteria. Inclusion criteria: systolic blood pressure > 90 mmHg, mean arterial pressure > 65 mmHg, and serum lactate ≥ 2.2 mmol/L. Primary exposures: 1)intermediate(2.2–3.9 mmol/L) versus severe(≥ 4.0 mmol/L) hyperlactemia and 2)full 3-h bundle compliance. Bundle elements: 1. Blood cultures before antibiotics 2. Parenteral antibiotics administered ≤ 180 min from ≥ 2 SIRS and lactate ordered, or ≤ 60 min from “time-zero”, whichever occurred first. 3. Lactate result available ≤ 90 min post-order 4. 30 mL/kg crystalloid bolus initiated ≤ 30 min from “time-zero”. The primary outcome was 60-day in-hospital mortality. Results 2417 patients met inclusion criteria. 704(29%) had lactate ≥ 4.0 mmol/L versus 1775 patients with lactate 2.2–3.9 mmol/L. Compliance was 75% for antibiotics and 53% for fluids. Full-compliance was comparable between lactate groups ( n = 200(29%) and 488(28%), respectively). We observed 424(17.5%) mortalities: intermediate/non-compliant – 182(14.9%), intermediate/compliant – 41(8.4%), severe/non-compliant – 147(29.2%), severe/compliant – 54(27.0%) [ difference-of-differences = 4.3%, CI = 2.6–5.9%]. In multivariable regression, mortality predictors included severe hyperlactemia (OR = 1.99, CI = 1.51–2.63) and bundle compliance (OR = 0.62, CI = 0.42–0.90), and their interaction was significant: p(interaction) = 0.022. Conclusion We observed a significant interaction between 3-h bundle compliance and initial hyperlactemia. Bundle compliance may be associated with greater mortality benefit for non-hypotensive sepsis patients with less severe hyperlactemia.
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13Hospital Mortality
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16Hypoxia
17Infections
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titleEarly Sepsis Bundle Compliance for Non-Hypotensive Patients with Intermediate Versus Severe Hyperlactemia
authorLeisman, Daniel E ; Zemmel D'Amore, Jason A ; Gribben, Jeanie L ; Ward, Mary Frances ; Masick, Kevin D ; Bianculli, Andrea R ; Bradburn, Kathryn H ; D'Angelo, John K ; Doerfler, Martin E
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2Anti-Bacterial Agents - therapeutic use
3Antibiotics
4Blood
5Blood pressure
6Bundling
7Clinical trials
8Criteria
9Critical care
10Databases, Factual
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12Female
13Hospital Mortality
14Humans
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16Hypoxia
17Infections
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abstractAbstract Objective To compare the association of 3-h sepsis bundle compliance with hospital mortality in non-hypotensive sepsis patients with intermediate versus severe hyperlactemia. Methods This was a cohort study of all non-hypotensive, hyperlactemic sepsis patients captured in a prospective quality-improvement database, treated October 2014 to September 2015 at five tertiary-care centers. We defined sepsis as 1)infection, 2) ≥ 2 SIRS criteria, and 3) ≥ 1 organ dysfunction criterion. “Time-zero” was the first time a patient met all sepsis criteria. Inclusion criteria: systolic blood pressure > 90 mmHg, mean arterial pressure > 65 mmHg, and serum lactate ≥ 2.2 mmol/L. Primary exposures: 1)intermediate(2.2–3.9 mmol/L) versus severe(≥ 4.0 mmol/L) hyperlactemia and 2)full 3-h bundle compliance. Bundle elements: 1. Blood cultures before antibiotics 2. Parenteral antibiotics administered ≤ 180 min from ≥ 2 SIRS and lactate ordered, or ≤ 60 min from “time-zero”, whichever occurred first. 3. Lactate result available ≤ 90 min post-order 4. 30 mL/kg crystalloid bolus initiated ≤ 30 min from “time-zero”. The primary outcome was 60-day in-hospital mortality. Results 2417 patients met inclusion criteria. 704(29%) had lactate ≥ 4.0 mmol/L versus 1775 patients with lactate 2.2–3.9 mmol/L. Compliance was 75% for antibiotics and 53% for fluids. Full-compliance was comparable between lactate groups ( n = 200(29%) and 488(28%), respectively). We observed 424(17.5%) mortalities: intermediate/non-compliant – 182(14.9%), intermediate/compliant – 41(8.4%), severe/non-compliant – 147(29.2%), severe/compliant – 54(27.0%) [ difference-of-differences = 4.3%, CI = 2.6–5.9%]. In multivariable regression, mortality predictors included severe hyperlactemia (OR = 1.99, CI = 1.51–2.63) and bundle compliance (OR = 0.62, CI = 0.42–0.90), and their interaction was significant: p(interaction) = 0.022. Conclusion We observed a significant interaction between 3-h bundle compliance and initial hyperlactemia. Bundle compliance may be associated with greater mortality benefit for non-hypotensive sepsis patients with less severe hyperlactemia.
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pmid28126452
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