Progression into sepsis: an individualized process varying by the interaction of comorbidities with the underlying infection

Dimitrios Sinapidis,Ioannis M Koutelidakis,Evangelos J Giamarellos-Bourboulis,Konstantinos Toutouzas,Aggelos Stefos,Vassileios Kosmas,Karolina Akinosoglou,Konstantinos E Katsaros,Aikaterini Pantazi,Vasileios Vittoros,Magdalini Bristianou,Michael Chrisofos

doi:10.1186/s12879-018-3156-z

Abstract

BackgroundDevelopment of sepsis is a process with significant variation among individuals. The precise elements of this variation need to be defined. This study was designed to define the way in which comorbidities contribute to sepsis development.MethodsThree thousand five hundred nine patients with acute pyelonephritis (AP), community-acquired pneumonia (CAP), intraabdominal infections (IAI) or primary bacteremia (BSI) and at least two signs of the systemic inflammatory response syndrome were analyzed. The study primary endpoint was to define how comorbidities as expressed in the Charlson’s comorbidity index (CCI) and the underlying type of infection contribute to development of organ dysfunction. The precise comorbidities that mediate sepsis development and risk for death among 18 comorbidities recorded were the secondary study endpoints.ResultsCCI more than 2 had an odds ratio of 5.67 for sepsis progression in patients with IAI between significantly higher than AP and BSI. Forward logistic regression analysis indicated seven comorbidities that determine transition into sepsis in patients with AP, four comorbidities in CAP, six comorbidities in IAI and one in BSI. The odds ratio both for progression to sepsis and death with one comorbidity or with two and more comorbidities was greater than in the absence of comorbidities.ConclusionsThe study described how different kinds of infection vary in the degree to which they lead to sepsis. The number of comorbidities that enhances the risk of sepsis and death varies depending on the underlying infections.

Highlights

Development of sepsis is a process with significant variation among individuals
We asked the question if Sinapidis et al BMC Infectious Diseases (2018) 18:242 co-morbidities of patients admitted in the emergency department (ED) influence the development of organ dysfunction and whether this depends on the underlying infection
Primary study endpoint Receiver Operator Characteristics (ROC) curve analysis conducted in the overall study population showed that Charlson’s co-morbidity index (CCI) more than 2 was accompanied by 89.3% sensitivity (86.9–91.2%) to predict 28-day mortality (Fig. 2)

Summary

Introduction

Development of sepsis is a process with significant variation among individuals. The precise elements of this variation need to be defined. Since 2006, the Hellenic sepsis study Group (HSSG) is collectively collecting clinical data for patients with infections presenting with at least two signs of the systemic inflammatory response syndrome (SIRS). Results from these studies on the traits of the innate and of the adaptive immune activation as well as on genotyping characteristics indicated that progression to organ dysfunction varied greatly among individuals and it was dependent on the type of infection [3, 4]. We tried to identify how each of the individual co-morbidities and how their constellation, expressed by the CCI, impacts on the development of organ failure and final outcome

Methods

Results

Conclusion