Photo Credit: Naeblys

Primary infection site is associated with varying likelihood of sepsis development, with LRIs being most associated with sepsis and septic shock development.

A new single-site study suggests that the emergency department patient’s primary infection site can help predict their likelihood of developing sepsis.

“Primary infection site is associated with varying likelihood of sepsis development, with lower respiratory infections being more associated with sepsis and septic shock development than any other infection site,” Jason D. Vadhan, DO, and coauthors wrote in the Journal of Emergency Medicine. “UTIs [urinary tract infections] were also associated with sepsis and septic shock development, but not to the same degree as LRI [lower respiratory tract infections]. SSTI [skin or soft-tissue infections] and URI [upper respiratory tract infections] were not associated with sepsis and septic shock development. Serologic laboratory values did not correlate sepsis incidence or severity.”

Sepsis dysregulates the immune response to infection and quickly damages organs. Sepsis is life threatening and requires prompt antibiotic treatment, but diagnosing the condition remains a challenge.

One of the most prevalent medical emergencies worldwide, sepsis dysregulates the immune response to infection and quickly damages organs, resulting in high morbidity, mortality, and expense. Predicting sepsis development in time to provide prompt antibiotic treatment saves lives and money, but its wide range of symptoms, including tachycardia, altered mental status, localized pain, and hypoxia, make diagnosis difficult.

The effectiveness of screening tools, including systemic inflammatory response syndrome, quick Sequential Organ Failure Assessment, National Early Warning Score, and Modified Early Warning Score, has been debated. Diagnostic tests, such as serologic markers and tissue culture sampling, do not guarantee or predict sepsis development.

Primary Infection Sites as Predictors of Sepsis

In their retrospective, observational study, Dr. Vadhan and colleagues investigated the primary infection sites as potential risk factors in sepsis development. They collected data on 37,168 patients, including 13,938 (37.5%) treated for URI, 4,273 (11.5%) for LRI, 11,587 (31.2%) patients with UTIs, and 7,370 (19.8%) for SSTI between 2016 and 2019 at one academic emergency department.

They investigated the development of sepsis or septic shock, hospital disposition and length of stay, blood and urine culture positivity, antibiotic administration, vasopressor use, in-hospital mortality, and 30-day mortality. Using analysis of variance and logistic regression, they found that:

• LRI was most associated with sepsis (relative risk ratio [RRR], 5.63; 95% CI, 5.07-6.24) and septic shock (RRR, 21.2; 95% CI, 17.99-24.98) development, as well as hospital admission rates (odds ratio [OR], 8.23; 95% CI, 7.41-9.14), intensive care unit admission (OR, 4.27; 95% CI, 3.84-4.74), in-hospital mortality (OR, 6.93; 95% CI, 5.60-8.57), and 30-day mortality (OR, 7.34; 95% CI, 5.869.19).
• UTIs were also associated with sepsis and septic shock development but to a lesser degree than LRI.

“Further prospective, more generalizable studies are warranted to confirm the mediating role of primary infection site on sepsis outcomes in hopes of creating more robust sepsis screening guidelines.”