Sepsis Major Cause of True Deterioration

SUMMARY:

• Sepsis is a major cause of morbidity and mortality globally.
• Early identification and treatment of any causes of acute deterioration outside the ICU will help improve clinical outcomes.
• Sepsis, either alone or as part of multiple causes, is the most common cause of deterioration in non-ICU patients.

REVIEW:

Churpek MM, et al. Critical Care Explorations 2024: DOI: 10.1097/CCE.0000000000001161.

• Clinical deterioration has been previously associated with increased respiratory rates.
• -- However, the medical conditions causing this deterioration have been less well described.
• Retrospective observation review of non-ICU hospital admissions from 2007 to 2020
• Electronic Cardiac Arrest Risk Triage score (eCART) was calculated in all patients.
• -- Uses 33 parameters (vital signs, laboratory data)
• -- Predicts patients at highest risk of deterioration
• -- Previously validated to be more accurate than MEWS and NEWS to predict cardiac arrest, death and ICU admission
• -- Deterioration via eCART score defined as scores in the 95th percentile for each admission
• 919,319 admissions
• -- 91,131 (10%) had eCART scores indicating deterioration
• -- Manual chart review by clinicians to determine true deterioration
• -- 4,000 randomly selected admissions were reported on
• RESULTS:
• -- 983 (25%) required ICU admission
• -- 474 (12%) died during admission
• -- True deterioration determined in 2,484 (62%) of the 4,000 patients

• Causes of True Deterioration
• -- Sepsis was most common cause of true deterioration in these non-ICU patients (n=1,024 41%).
• ---- Next most common causes were: Arrhythmia (19%); Heart Failure (13%); Hypoxemic Respiratory Failure (10%); Electrolyte Abnormality (9%).
• -- Most Common Co-Occurring causes of deterioration
• ---- 7 of the top 11 co-occurring causes were with sepsis.

• ---- Sepsis & Hypoxemia (n=127 5%)
• ---- Sepsis & Arrhythmia (n=85? 3%)
• ---- Sepsis & Heart Failure (n=83? 3%)
• -- Present On Admission vs Hospital Acquired
• ---- Sepsis was the most common cause of true deterioration that was present on admission (n=863? 48%).
• ---- Arrhythmias were the most common cause of true deterioration which was hospital acquired (n=183? 29%).
• ------ Sepsis was number 2 (n=140? 22%)
• ---- True deterioration due to causes present on admission had a higher in-patient mortality rate compared to hospital acquired deterioration (15.4% vs 10.6% p=0.003).

CONCLUSIONS:

• Sepsis is the most common cause of clinical deterioration.
• Hospital acquired sepsis was the second most common cause of clinical deterioration.
• Sepsis was the most common cause of clinical deterioration when combinations of 2 disease states were found.

Erkan Hassan, Pharm.D., FCCM is a transformational healthcare leader with extensive experience developing innovative solutions to improve clinical outcomes, enhance provider experience and increase revenue.

You can reach Erkan at [email protected]