Early intervention in the critical care resuscitation unit and mortality among patients with sepsis

Introduction: The Critical Care Resuscitation Unit (CCRU) at the University of Maryland Medical Center (UMMC) expedites the transfer of critically ill patients from other hospitals for early intervention, when there is no available intensive care (ICU) bed available. After stabilization, patients are transferred from the CCRU to an appropriate unit for longitudinal care. We hypothesized that early and effective interventions during the CCRU, defined as lactate clearance and Sequential Organ Failure Assessment (SOFA) score reduction for septic patients in the CCRU would be associated with decreased risk of hospital mortality. Methods: This was a retrospective study of adult patients with sepsis conditions and admitted to the CCRU between 01/01/2018 - 12/31/2018. Multivariate logistic regression was used to evaluate the association between lactate clearance and SOFA score reduction during CCRU stay and in-hospital mortality. Results: There were 604 patients admitted to the CCRU with a sepsis diagnosis. Eighteen (2.8%) patients who had Do Not Resuscitated order died during their CCRU stay, and were excluded. A total of 364 patients with full lactate clearance data and 493 patients with full SOFA data were included in our analysis. Mean age was 55 (±16) years, and median CCRU length of stay in the CCRU was 6.42 [3.21-18.53] hours. Among survivors, 290 (49%) patients required emergent surgical interventions within 12 hours of arrival. 61 (10%) patients were intubated, 42 (7.2%) patients were initiated on vasopressors in the CCRU, 17 (2.9%) patients cannulated for Extracorporeal Membrane Oxygenation. 524 (89%) patients survived. The average lactate and SOFA scores on admission were 2.2 (1.8) mmol/L and 4.2 (4.1), respectively. 146 (30%) had SOFA score reduction. Lactate clearance was not associated with reduced in-hospital mortality (OR 0.95, CI 0.77 - 1.16, p = 0.61), but each point of SOFA score reduction during the CCRU stay was associated with 13% reduced odds of hospital mortality (OR 0.87, CI 0.76 - 0.98, p = 0.029). Conclusions: The CCRU transferred approximately half of patients with sepsis for urgent surgical operation and during CCRU stay, 30% achieved SOFA reduction, which was associated with lower odds for hospital mortality. Further study with larger patient population is needed to confirm our study.