Abstract
Risk factors for long term mortality in patients admitted with infection – a prospective population-based cohort study.
Background. There is limited data on prognosis and risk factors that affect long-term mortality after admission to an emergency department (ED) with infection. The aim of this study was to examine long-term mortality among adult ED patients with infectious diseases, and to identify factors associated with long-term mortality.
Methods. A prospective observational cohort study of all adult (≥18 years) infected patients admitted to the ED of Slagelse Hospital from 1 October 2017 to 31 March 2018. All patients with suspected or documented infection upon arrival to the ED, and treated with antibiotics, were included. The primary outcome was long term all-cause mortality. Data on mortality was obtained from the Danish Civil Registration System during March 2020. We followed patients from the date of admission until the end of the follow-up period, emigration or death, whichever came first. We used Cox regression to estimate adjusted hazard ratios (aHR) with 95% confidence intervals (CI) for mortality. We used multiple imputation to impute missing baseline values of laboratory tests in the regression analyses.
Results. A total of 2,110 patients (51.3% female) with a median age of 73 years (IQR 60-83 years) were included. In-hospital and 28-day mortality was 3.7% (95% CI 2.9%-4.5%) and 7.5% (95% CI 6.4%-8.7%), respectively. After a median follow-up of 753 days (2.1 years) (IQR 340-821 days), a total of 758 (35.9%, 95% CI 33.9-38.0%) patients had died. Age (aHR1.05; 95% CI 1.04-1.05), Charlson Comorbidity Index (with zero as reference) of 1-2 (aHR 1.77; 95% CI 1.42-2.20) and 3+ (aHR 3.21; 95% CI 2.55-4.03), if admitted with sepsis within the last year before index admission (aHR 1.38; 95% CI 1.19-1.60), a Sequential Organ Failure Assessment (SOFA) score ≥ 2 (aHR 1.59; 95% CI 1.37-1.85), qSOFA score ≥ 2 (aHR1.50; 95% CI 1.21-1.85) on admission to the ED, and lengths of stay (aHR 1.02; 95% CI 1.02-1.03) were independently associated with long-term mortality. Increasing hemoglobin value (aHR 0.86; 95% CI 0.81-0.91) on admission to the ED was associated with a reduced risk of long-term mortality.
Discussion and Conclusions. More than one-third of a population of patients admitted to an ED with infectious diseases had died during a median follow up period of 2.1 years. Age, comorbidity burden, a history of sepsis before index admission, signs of organ dysfunction upon admission, and length of stay were independent determinants of long-term mortality. Higher hemoglobin concentrations reduced the risk of death.
Background. There is limited data on prognosis and risk factors that affect long-term mortality after admission to an emergency department (ED) with infection. The aim of this study was to examine long-term mortality among adult ED patients with infectious diseases, and to identify factors associated with long-term mortality.
Methods. A prospective observational cohort study of all adult (≥18 years) infected patients admitted to the ED of Slagelse Hospital from 1 October 2017 to 31 March 2018. All patients with suspected or documented infection upon arrival to the ED, and treated with antibiotics, were included. The primary outcome was long term all-cause mortality. Data on mortality was obtained from the Danish Civil Registration System during March 2020. We followed patients from the date of admission until the end of the follow-up period, emigration or death, whichever came first. We used Cox regression to estimate adjusted hazard ratios (aHR) with 95% confidence intervals (CI) for mortality. We used multiple imputation to impute missing baseline values of laboratory tests in the regression analyses.
Results. A total of 2,110 patients (51.3% female) with a median age of 73 years (IQR 60-83 years) were included. In-hospital and 28-day mortality was 3.7% (95% CI 2.9%-4.5%) and 7.5% (95% CI 6.4%-8.7%), respectively. After a median follow-up of 753 days (2.1 years) (IQR 340-821 days), a total of 758 (35.9%, 95% CI 33.9-38.0%) patients had died. Age (aHR1.05; 95% CI 1.04-1.05), Charlson Comorbidity Index (with zero as reference) of 1-2 (aHR 1.77; 95% CI 1.42-2.20) and 3+ (aHR 3.21; 95% CI 2.55-4.03), if admitted with sepsis within the last year before index admission (aHR 1.38; 95% CI 1.19-1.60), a Sequential Organ Failure Assessment (SOFA) score ≥ 2 (aHR 1.59; 95% CI 1.37-1.85), qSOFA score ≥ 2 (aHR1.50; 95% CI 1.21-1.85) on admission to the ED, and lengths of stay (aHR 1.02; 95% CI 1.02-1.03) were independently associated with long-term mortality. Increasing hemoglobin value (aHR 0.86; 95% CI 0.81-0.91) on admission to the ED was associated with a reduced risk of long-term mortality.
Discussion and Conclusions. More than one-third of a population of patients admitted to an ED with infectious diseases had died during a median follow up period of 2.1 years. Age, comorbidity burden, a history of sepsis before index admission, signs of organ dysfunction upon admission, and length of stay were independent determinants of long-term mortality. Higher hemoglobin concentrations reduced the risk of death.
| Original language | Danish |
|---|---|
| Publication date | 2020 |
| Publication status | Published - 2020 |
| Event | The European Society for Emergency Medicine 2020 - Virtuel Duration: 19 Sept 2020 → 22 Sept 2020 |
Conference
| Conference | The European Society for Emergency Medicine 2020 |
|---|---|
| Location | Virtuel |
| Period | 19/09/2020 → 22/09/2020 |
Keywords
- Health Sciences