Time to treatment and mortality for clinical sepsis subtypes

Sepsis is common, deadly, and heterogenous. Prior analyses of patients with sepsis and septic shock in New York State showed a risk-adjusted association between more rapid antibiotic administration and bundled care completion, but not an intravenous fluid bolus, with reduced in-hospital mortality. H...

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Published in:Critical care (London, England) England), 2023-06, Vol.27 (1), p.236-10, Article 236
Main Authors: Yang, Anne, Kennedy, Jason N, Reitz, Katherine M, Phillips, Gary, Terry, Kathleen M, Levy, Mitchell M, Angus, Derek C, Seymour, Christopher W
Format: Article
Language:English
Subjects:
Anti-Bacterial Agents - therapeutic use
Antibiotics
Communicable Diseases
Comorbidity
Critical care
Emergency medical care
Hospitalization
Humans
Hypotension
Mortality
Patients
Precision medicine
Sepsis
Sepsis - drug therapy
Shock, Septic - drug therapy
Subtypes
Time-to-Treatment
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Summary:Sepsis is common, deadly, and heterogenous. Prior analyses of patients with sepsis and septic shock in New York State showed a risk-adjusted association between more rapid antibiotic administration and bundled care completion, but not an intravenous fluid bolus, with reduced in-hospital mortality. However, it is unknown if clinically identifiable sepsis subtypes modify these associations. Secondary analysis of patients with sepsis and septic shock enrolled in the New York State Department of Health cohort from January 1, 2015 to December 31, 2016. Patients were classified as clinical sepsis subtypes (α, β, γ, δ-types) using the Sepsis ENdotyping in Emergency CAre (SENECA) approach. Exposure variables included time to 3-h sepsis bundle completion, antibiotic administration, and intravenous fluid bolus completion. Then logistic regression models evaluated the interaction between exposures, clinical sepsis subtypes, and in-hospital mortality. 55,169 hospitalizations from 155 hospitals were included (34% α, 30% β, 19% γ, 17% δ). The α-subtype had the lowest (N = 1,905, 10%) and δ-subtype had the highest (N = 3,776, 41%) in-hospital mortality. Each hour to completion of the 3-h bundle (aOR, 1.04 [95%CI, 1.02-1.05]) and antibiotic initiation (aOR, 1.03 [95%CI, 1.02-1.04]) was associated with increased risk-adjusted in-hospital mortality. The association differed across subtypes (p-interactions 
ISSN:1364-8535
1466-609X
1466-609X
1364-8535
1366-609X
DOI:10.1186/s13054-023-04507-5