Likelihood of infection in patients with presumed sepsis at the time of intensive care unit admission: a cohort studyReport as inadecuate

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Critical Care

, 19:319

First Online: 07 September 2015Received: 30 May 2015Accepted: 15 August 2015


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 NCT01905033. Registered 11 July 2013.

AbbreviationsAPACHEAcute Physiology and Chronic Health Evaluation

CDCCenters for Disease Control and Prevention

CIConfidence interval

CSHRCause-specific hazard ratio

IQRInterquartile range

ISFInternational Sepsis Forum

MARSMolecular Diagnosis and Risk Stratification of Sepsis

SHRSubdistribution hazard ratio

SIRSSystemic inflammatory response syndrome

Electronic supplementary materialThe online version of this article doi:10.1186-s13054-015-1035-1 contains supplementary material, which is available to authorized users.

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Author: Peter M. C. Klein Klouwenberg - Olaf L. Cremer - Lonneke A. van Vught - David S. Y. Ong - Jos F. Frencken - Marcus J.


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