Time to treatment and mortality for clinical sepsis subtypes
Authors' conclusion
Timely completion of a 3-h sepsis bundle and antibiotic initiation was associated with reduced risk-adjusted in-hospital mortality, an association modified by clinically identifiable sepsis subtype.
Study context
- Population
- Patients with sepsis and septic shock, New York State, January 1, 2015 to December 31, 2016hospitalizations, 155 hospitals
- Participants
- 55,169 patients
- Comparison
- Time to 3-h bundle completion, antibiotic administration and IV fluid bolus completion, across clinical sepsis subtypes (α, β, γ, δ)
- Primary endpoint
- In-hospital mortality
Methodological detailssubtype interaction analysis, multicentre
- Subtype interaction analysis
- Multicentre
Primary result
As reported in the abstract
Risk-adjusted in-hospital mortality per hour to treatment, by subtype
Adjusted odds ratio (95% CI)
δ
1.07(1.05–1.10)
α
1.02(0.99–1.04)
Per hour to 3-h bundle completion, as printed
- Association of bundle and antibiotic timing with mortality differed across subtypes
- p-interactions < 0.05
- Subtype distribution α/β/γ/δ
- 34% α, 30% β, 19% γ, 17% δ
Further findings
In-hospital mortality by clinical sepsis subtype
Time to completion of the 3-h bundle and in-hospital mortality, by subtype (subgroup)
| aOR (95% CI) | ||
|---|---|---|
| δ-subtype | 1.07 (1.05–1.10) | |
| α-subtype | 1.02 (0.99–1.04) | |
| 0.512Adjusted odds ratio (log scale) |
Time to IV fluid bolus completion and risk-adjusted in-hospital mortality
| aOR (95% CI) | ||
|---|---|---|
| Time to intravenous fluid bolus completionNot associated | 0.99 (0.97–1.01) | |
| 0.512Adjusted odds ratio (log scale) |
- Time to completion of the 3-h bundle and in-hospital mortality, by subtype (subgroup) — Association differed across subtypes
- p-interactions < 0.05
- Time to IV fluid bolus completion and risk-adjusted in-hospital mortality — Did not differ among subtypes
- p-interaction = 0.41
- Time to completion of the 3-h bundle and in-hospital mortality, by subtype (subgroup): interaction P: p-interactions < 0.05
- Time to IV fluid bolus completion and risk-adjusted in-hospital mortality: interaction P: p-interaction = 0.41
In-hospital mortality by clinical sepsis subtype
- α-subtype had the lowest and δ-subtype the highest in-hospital mortality
Original publication
Time to treatment and mortality for clinical sepsis subtypes. Crit Care. Published 15 June 2023. doi:10.
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