Risk Factors for Sepsis with Worse Outcomes in the ICU Critically Ill Adult Admissions

Background: Sepsis is a life-threatening organ dysfunction caused by infection. What is the major risk factor of sepsis with poor outcomes? This remains unclear. We aimed to investigate the risk factors of sepsis with worse outcomes in a single intensive care unit (ICU) of China. Methods: A retrospective cohort study linked data from the Affiliated Shuyang Hospital of Xuzhou Medical University (Jan 2018–Nov 2019), China. Acute critically ill patients who were undergone a brain-chest-abdomen computed tomograph (CT) scan before arriving at the ICU were selected as an eligibility criteria. The primary outcome measure was mortality at the first 28 days. Outcomes were compared between patients who were survivors and those who were not. Findings: Of 520 ICU admissions, 214 (41.2%) critically ill adults with sepsis and 82.2% (176/214) of community-acquired sepsis were diagnosed by sepsis-3 criteria. The CT scan in this study has showed that more than 80% of sepsis was caused by community-acquired chest infection/pneumonia and was associated with an increased dynamic profile of inflammatory mediators in the blood. In multivariate analyses, risk factors for sepsis with worse outcomes were presentation with a higher sequential organ function assessment (SOFA) score (OR, 1.5; 95% CI, 1.18-2.04) and a higher systemic inflammatory storm syndrome (SISS) score (OR, 8.1; 95% CI, 2.64-26.38). In Cox regression analysis, acute hypoxemic respiratory failure (AHRF)/ARDS was associated with high risk of death in sepsis nonsurvivors, with HR over 6 times as high in sepsis survivors at 28 days. Interpretation: Sepsis cases are mainly from community-acquired pneumonia. Severe SISS and APRF/ARDS are two major risk factors for sepsis with worse outcomes. Funding: Funding was provided from National Clinical Key Specialty Construction Project. Declaration of Interest: None to declare. Ethical Approval: The study was approved by the ethical committee on clinical research of the Affiliated Shuyang Hospital of Xuzhou Medical University