News: Sepsis rapid source control lowers mortality by 29%, according to study
One in five patients do not survive hospitalization with sepsis, Medpage Today reported. To improve patient outcomes, rapid source control is recommended—but the timing needs further research. In a retrospective cohort study conducted by JAMA Surgery, an association between the timing of sepsis source control and patient outcome was measured to further improve patient outcome. Findings showed a clear association between the 29% reduction in the risk-adjusted odds of 90-day mortality and source control within six hours of sepsis onset.
Each hour of source-control delay was associated with a greater risk of mortality at 90 days. The adjusted absolute risk difference of mortality at 90 days was as follows:
- 0.5% lower at three hours
- 1% higher at 12 hours
- 3% higher at 24 hours
- 5% higher at 36 hours
The study looked at 4,962 patients with sepsis undergoing source control interventions from 2013 to 2017. The mean patient age was 62, with 85% white patients, a mean length of stay of 11.8 days, a mean body mass index of 30.9, and a sequential organ failure assessment score of 3.8. The median time to receive antibiotics was 1.5 hours, and to source control was 15.4 hours. Six percent of participants died in the hospital, with a 14% mortality at 90 days and 24% at one year. “Early source control was associated with the greatest risk reduction among middle-aged patients (i.e., 35-54 years), not older adults," the study found. Notably, sepsis source control was required 28% of the time for gastrointestinal and abdominal regions, and 21% by soft tissue.
"In my own interpretation of this study in the context of prior studies, I will advocate for early anti-infectives and source control within 6 hours in all patients with community-acquired infections requiring source control when the source of the infection is gastrointestinal, abdominal, or soft tissue in origin," said Pamela Lipsett, MD, MHPE, of Johns Hopkins Hospital in Baltimore, in JAMA’s accompanying editorial.
The study pointed out that sepsis source control by abscess drainage, debridement of infected or necrotic tissue, microbial contamination control, or removal of infected devices, is a key step in early treatment. Early recognition, administration of effective antibiotics, and source control are important goals to improve patient outcome, Lipsett stated.