Abstract
IntroductionA clinical suspicion of infection is mandatory for diagnosing sepsis in patients with a systemic inflammatory response syndrome. Yet, the accuracy of categorizing critically ill patients presenting to the intensive care unit (ICU) as being infected or not is unknown. We therefore assessed the likelihood of infection in patients who were treated for sepsis upon admission to the ICU, and quantified the association between plausibility of infection and mortality.MethodsWe studied a cohort of critically ill patients admitted with clinically suspected sepsis to two tertiary ICUs in the Netherlands between January 2011 and December 2013. The likelihood of infection was categorized as none, possible, probable or definite by post-hoc assessment. We used multivariable competing risks survival analyses to determine the association of the plausibility of infection with mortality.ResultsAmong 2579 patients treated for sepsis, 13% had a post-hoc infection likelihood of “none”, and an additional 30% of only “possible”. These percentages were largely similar for different suspected sites of infection. In crude analyses, the likelihood of infection was associated with increased length of stay and complications. In multivariable analysis, patients with an unlikely infection had a higher mortality rate compared to patients with a definite infection (subdistribution hazard ratio 1.23; 95% confidence interval 1.03-1.49).ConclusionsThis study is the first prospective analysis to show that the clinical diagnosis of sepsis upon ICU admission corresponds poorly with the presence of infection on post-hoc assessment. A higher likelihood of infection does not adversely influence outcome in this population.Trial registrationClinicalTrials.gov NCT01905033. Registered 11 July 2013.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-1035-1) contains supplementary material, which is available to authorized users.
Highlights
A clinical suspicion of infection is mandatory for diagnosing sepsis in patients with a systemic inflammatory response syndrome
The clinical suspicion of infection is a crucial factor in making a sepsis diagnosis, little is known about the accuracy of this diagnosis in the context of critically ill patients who present to the intensive care unit (ICU) with signs and symptoms of a “sepsis syndrome”
Our study is the first prospective comparison of sepsis diagnoses made by ICU physicians and post-hoc analyses of infection likelihoods based on strict diagnostic criteria, revealing that the true incidence of sepsis upon ICU admission is probably overestimated
Summary
A clinical suspicion of infection is mandatory for diagnosing sepsis in patients with a systemic inflammatory response syndrome. The clinical suspicion of infection is a crucial factor in making a sepsis diagnosis, little is known about the accuracy of this diagnosis in the context of critically ill patients who present to the ICU with signs and symptoms of a “sepsis syndrome”. Klein Klouwenberg et al Critical Care (2015) 19:319 the clinical practice of an ICU the diagnosis of sepsis is not based on strict diagnostic criteria for infection and that as a consequence the occurrence of sepsis on the ICU might be overestimated. Quantification of this discordance is helpful for estimating incidence rates in epidemiological studies and the possible reduction of antibiotic use. We assessed the association of the likelihood of infection with outcome
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