Table 1.
Demographic comparisons of the derivation and validation sites using CMS severe sepsis definition.*
| Development Site After 4 Hours From ED Arrival Until 48 Hours After T0 of Severe Sepsis |
Validation Site After 4 Hours From ED Arrival Until 48 Hours After T0 of Severe Sepsis |
|||
|---|---|---|---|---|
| Demographics | Severe Sepsis Without Shock† | Severe Sepsis With Shock‡ | Severe Sepsis† Without Shock | Severe Sepsis With Shock‡ |
| Patients, n | 4,951 | 365 | 4,403 | 358 |
|
| ||||
| Age (SD), y | 62 (48-73) | 65 (54-74) | 60.5 (47.4-72.1) | 62.2 (53.1-72.9) |
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| ||||
| Men, % | 53.2 | 49.3 | 57.2 | 57.3 |
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| ||||
| Race, % | ||||
| White | 42.5 | 44.7 | 53.7 | 56.4 |
| Black | 50.9 | 50.7 | 9.5 | 9.8 |
| Asian | 3.2 | 1.6 | 8.9 | 6.9 |
| Other | 3.4 | 3.0 | 27.9 | 26.9 |
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| ||||
| ICU LOS (IQR), h | 0 (0-46.5) | 95.1 (51.3-195.5) | 0 (0-16.5) | 87.9 (46.1-169.6) |
|
| ||||
| ED LOS (IQR), h | 6.5 (5.0-8.8) | 5.9 (4.6-7.9) | 9.4 (6.7-16.1) | 8.2 (6.2-11.2) |
|
| ||||
| CCI score, No. (IQR) | 4 (2-6) | 4 (2-7) | 5 (3-8) | 5 (3-8) |
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| ||||
| SOFA, n (IQR) | 2.9 (1.8-4) | 3.8 (2-5.2) | 1.6 (0.5-2.8) | 2.8 (3.4-2) |
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| ||||
| Inpatient mortality, % | 5.5 | 24.9 | 5.5 | 24.3 |
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| ||||
| Transfers to hospice, % | 6.3 | 10.9 | 0.7 | 1.7 |
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| ||||
| Time from ED admission to shock§ (IQR), h | – | 11.9 (7.0-21.0) | – | 10.0 (6.8-16.9) |
|
| ||||
| Time from sepsis to shock (IQR), h | – | 9.9 (5.5-18.8) | – | 7.6 (4.8-13.7) |
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| ||||
LOS, Length of stay; IQR, interquartile range; CCI, Charlson Comorbidity Index.
Patients from the overall cohort were included in the study cohorts (derivation and validation cohorts) if they met all of the following criteria: (1) met sepsis criteria according to CMS guidelines, defined as the time at which the patient had a culture taken with antibiotic administration of at least 3 days, and met systemic inflammatory response syndrome criteria, and had a lactate level greater than 2 mmol/L or other signs of organ dysfunction, as defined in the CMS guidelines18); (2) were admitted to the ED for at least 3 hours and no more than 7 days; (3) developed shock after the first 4 hours of ED admission, if applicable; and (4) developed shock after 2 hours of developing sepsis, if applicable.
Sepsis is defined as the time at which the patient had a culture taken with antibiotic administration of at least 3 days, and met systemic inflammatory response syndrome criteria, and had a lactate level greater than 2 mmol/L or other signs of organ dysfunction, as defined in the CMS guidelines. The time of sepsis onset was the earliest time stamp associated with these events.
Septic shock was defined as patients with sepsis who required vasopressor administration.
Time until septic shock, defined as the time of vasopressor administration in an individual with sepsis.