Primary Infection Site as a Predictor of Sepsis Development in Emergency Department Patients

Background Sepsis is a life-threatening condition but, predicting its development and progression remains a challenge. Objective This study aimed to assess the impact of infection site on sepsis development among emergency department patients. Methods Data was collected from a single-center emergency department between January 2016 and December 2019. Patient encounters with documented infections as defined by the Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT) for upper respiratory tract (URI), lower respiratory tract (LRI), urinary tract (UTI), or skin/soft tissue (SSTI) infections were included. Primary outcome was the development of sepsis and/or septic shock as defined by SEP-1/2 criteria. Secondary outcomes included hospital disposition and length of stay, blood and urine culture positivity, antibiotic administration, vasopressor use, in-hospital mortality, and 30-day mortality. ANOVA and various different logistic regression approaches were used for analysis with URI utilized as the reference variable. Results LRI was most associated with sepsis (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 (OR 8.23; 95% CI 7.41-9.14), ICU admission (OR: 4.27; 95% CI 3.84-4.74), as well as in hospital mortality (OR: 6.93; 95% CI: 5.60-8.57), and 30- day mortality (OR: 7.34; 95% CI: 5.86-9.19). UTI's were also associated with sepsis and septic shock development, but to a lesser degree than LRI. Conclusions Primary infection sites including LRI and UTI were significantly associated with sepsis development, hospitalization, length of stay and mortality among patients presenting with infections in the emergency department.