Detection of organ dysfunction by hypotension and/or hyperlactemia in septic patients

TY - CONF

T1 - Detection of organ dysfunction by hypotension and/or hyperlactemia in septic patients

AU - Nissen, Janet Yde

AU - Dynesen, Jens Jacob Østergaard

AU - Pedersen, Marie Kristine Jessen

AU - Mackenhauer, Julie

AU - Ebdrup, Lotte

AU - Kirkegaard, Hans

PY - 2016

Y1 - 2016

N2 - BackgroundThe definitions of sepsis were updated February 2016[1] - organ dysfunctions remain the turning point between “simple infection” and sepsis (previously severe sepsis). Hypotension and hyperlactatemia define two of many organ dysfunctions presented in the most recent Surviving Sepsis Campaign (SSC-2012) [2]. Blood pressure and lactate are readily available at bedside. We hypothesize, defining hypotension and/or hyperlactemia (“Simple tool”) as early indicators of organ dysfunction, we can identify organ dysfunction in the septic patients with same accuracy as “Gold standard” (SSC-2012).Materials and methods We performed a retrospective cohort study, using manual chart review to identify patients with suspected infection within 24 hours of admission. Inclusion criteria were emergency department (ED) patients from Aarhus University Hospital, Denmark, in March 1st - 31st 2015 (receiving approx. 56.000 patients annually), age ≥18 years, Danish CPR-number, and length of overall hospital stay ≥24 hours. Baseline characteristics, vital signs, blood samples and cultures were extracted from the electronic patient record. A patient was classified as having suspected infection, if the treating physician documented a suspicion/confirmation of infection within the first 24h of admission. Diagnoses were confirmed by expert proof reading, and calculation of inter-rater agreement. Severe sepsis-defining organ dysfunction cut-offs were adapted from SSC-2012 (Gold Standard). “Simple tool” hypotension was defined as systolic blood pressure < 90mmHg and/or hyperlactemia as arterial lactate > 2,5mmol/l within 24 hours of admission. We compared the two cohorts (Gold Standard vs. “Simple tool”) by calculating sensitivity with binomial 95% confidence intervals (CI).ResultsWe enrolled 960 emergency patients fulfilling the inclusion criteria. 494 patients (51%) were suspected to have infection within the first 24h of admission. Inter-rater agreement regarding suspected infection was 81% (p<0.00001). 93 patients had severe sepsis and 16 had septic shock according to SSC-2012. The “Simple tool” detected 73 of the septic patients, giving a sensitivity of 67%, 95%CI [57%-76%].ConclusionHypotension and hyperlactemia detected 67% of the patients with septic organ dysfunction. This indicates, that a "Simple tool" might be useful to identify organ dysfunction. However, a full screening of all organ dysfunction parameters should still be performed to detect all (severe) septic patients.References1. Dellinger RP, Levy MM, Rhodes  A,  et al; Surviving Sepsis Campaign Guidelines Committee Including the Paediatric Subgroup.  Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41(2):580-637.2. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315:801–10.

AB - BackgroundThe definitions of sepsis were updated February 2016[1] - organ dysfunctions remain the turning point between “simple infection” and sepsis (previously severe sepsis). Hypotension and hyperlactatemia define two of many organ dysfunctions presented in the most recent Surviving Sepsis Campaign (SSC-2012) [2]. Blood pressure and lactate are readily available at bedside. We hypothesize, defining hypotension and/or hyperlactemia (“Simple tool”) as early indicators of organ dysfunction, we can identify organ dysfunction in the septic patients with same accuracy as “Gold standard” (SSC-2012).Materials and methods We performed a retrospective cohort study, using manual chart review to identify patients with suspected infection within 24 hours of admission. Inclusion criteria were emergency department (ED) patients from Aarhus University Hospital, Denmark, in March 1st - 31st 2015 (receiving approx. 56.000 patients annually), age ≥18 years, Danish CPR-number, and length of overall hospital stay ≥24 hours. Baseline characteristics, vital signs, blood samples and cultures were extracted from the electronic patient record. A patient was classified as having suspected infection, if the treating physician documented a suspicion/confirmation of infection within the first 24h of admission. Diagnoses were confirmed by expert proof reading, and calculation of inter-rater agreement. Severe sepsis-defining organ dysfunction cut-offs were adapted from SSC-2012 (Gold Standard). “Simple tool” hypotension was defined as systolic blood pressure < 90mmHg and/or hyperlactemia as arterial lactate > 2,5mmol/l within 24 hours of admission. We compared the two cohorts (Gold Standard vs. “Simple tool”) by calculating sensitivity with binomial 95% confidence intervals (CI).ResultsWe enrolled 960 emergency patients fulfilling the inclusion criteria. 494 patients (51%) were suspected to have infection within the first 24h of admission. Inter-rater agreement regarding suspected infection was 81% (p<0.00001). 93 patients had severe sepsis and 16 had septic shock according to SSC-2012. The “Simple tool” detected 73 of the septic patients, giving a sensitivity of 67%, 95%CI [57%-76%].ConclusionHypotension and hyperlactemia detected 67% of the patients with septic organ dysfunction. This indicates, that a "Simple tool" might be useful to identify organ dysfunction. However, a full screening of all organ dysfunction parameters should still be performed to detect all (severe) septic patients.References1. Dellinger RP, Levy MM, Rhodes  A,  et al; Surviving Sepsis Campaign Guidelines Committee Including the Paediatric Subgroup.  Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41(2):580-637.2. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315:801–10.

KW - Sepsis, emergency medicine

M3 - Poster

T2 - The Sepsis Annual Symposium

Y2 - 6 December 2016 through 8 December 2016

ER -