Clinical course of sepsis, severe sepsis, and septic shock in a cohort of infected patients from ten Colombian hospitals
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Fecha
2013-07-24Autor(es)
León Álvarez, Alba LuzHoyos Vanegas, Natalia Andrea
Barrera Vergara, Lena Isabel
De La Rosa Echávez, Gisela Del Carmen
Dennis Verano, Rodolfo José
Granados Sánchez, Marcela
Londoño Trujillo, Darío
Rodríguez Dueñas, Ferney Alexander
Molina Pérez, Francisco José
Ortiz Ruiz, Guillermo
Jaimes Barragán, Fabián Alberto
Dueñas Castell, Carmelo
Autor(es) Corporativo(s)
Pontificia Universidad Javeriana. Facultad de Medicina. Departamento de Medicina Interna. Enfermedades Crónicas del Adulto
Tipo
Artículo de revista
ISSN
1471-2334
Páginas
1-9
Tipo de artículo
Artículo de investigación
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Abstract
Background: Sepsis has several clinical stages, and mortality rates are different for each stage. Our goal was to establish the evolution and the determinants of the progression of clinical stages, from infection to septic shock, over the first week, as well as their relationship to 7-day and 28-day mortality.
Methods: This is a secondary analysis of a multicenter cohort of inpatients hospitalized in general wards or intensive care units (ICUs). The general estimating equations (GEE) model was used to estimate the risk of progression and the determinants of stages of infection over the first week. Cox regression with time-dependent covariates and fixed covariates was used to determine the factors related with 7-day and 28-day mortality, respectively.
Results: In 2681 patients we show that progression to severe sepsis and septic shock increases with intraabdominal and respiratory sources of infection [OR = 1,32; 95%IC = 1,20-1,46 and OR = 1.21, 95%CI = 1,11-1,33 respectively], as well as according to Acute Physiology and Chronic Health Evaluation II (APACHE II) [OR = 1,03; 95%CI = 1,02-1,03] and Sequential Organ Failure Assessment (SOFA) [OR = 1,16; 95%CI = 1,14-1,17] scores. The variables related with first-week mortality were progression to severe sepsis [HR = 2,13; 95%CI = 1,13-4,03] and septic shock [HR = 3,00; 95%CI = 1,50-5.98], respiratory source of infection [HR = 1,76; 95%IC = 1,12-2,77], APACHE II [HR = 1,07; 95% CI = 1,04-1,10] and SOFA [HR = 1,09; 95%IC = 1,04-1,15] scores.
Conclusions: Intraabdominal and respiratory sources of infection, independently of SOFA and APACHE II scores, increase the risk of clinical progression to more severe stages of sepsis; and these factors, together with progression of the infection itself, are the main determinants of 7-day and 28-day mortality.
Cobertura espacial
ColombiaEnlace al recurso
http://bibliotecadigital.udea.edu.co/handle/10495/7890Fuente
BMC Infectious Diseases; Vol. 13 Núm. 345 (2013)
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