Predictors of acute decompensation after admission in ED patients with sepsis

Am J Emerg Med. 2010 Jun;28(5):631-6. doi: 10.1016/j.ajem.2009.04.020. Epub 2010 Mar 25.


Purposes: The aim of the study was to identify predictors of acute decompensation within 48 hours of admission among infected emergency department (ED) patients admitted to a regular nursing floor.

Procedures: This used a case control study of infected ED patients admitted to a regular nursing floor and who received a discharge diagnosis of sepsis. A multivariate logistic regression model was constructed with the dependent variable as transfer to an intensive care unit (ICU) within 48 hours of admission.

Findings: Seventy-eight patients were enrolled-34 in the ICU group and 44 in the floor group. Only low bicarbonate (<20 mmol/L) (odds ratio [OR], 7.40; 95% confidence interval [CI], 2.35-23.30) and absence of fever (OR, 3.66; 95% CI, 1.11-12.60) were predictive of ICU transfer.

Conclusions: Among infected ED patients admitted to a regular floor, absence of fever and low bicarbonate were independently associated with ICU transfer within 48 hours. Particular attention should be paid to similar patients to ensure appropriate identification of severe infection and appropriate risk stratification.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Case-Control Studies
  • Emergency Service, Hospital* / statistics & numerical data
  • Female
  • Heart Failure / diagnosis
  • Heart Failure / etiology*
  • Humans
  • Intensive Care Units
  • Logistic Models
  • Male
  • Middle Aged
  • Patient Admission
  • Predictive Value of Tests
  • Risk Factors
  • Sepsis / complications*
  • Shock, Septic