Bacteremic sepsis leads to higher mortality when adjusting for confounders with propensity score matching

Abstract One can falsely assume that it is well known that bacteremia is associated with higher mortality in sepsis. Only a handful of studies specifically focus on the comparison of culture-negative and culture-positive sepsis with different conclusions depending on study design. The aim of this st...

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Autores principales:	Lisa Mellhammar, Fredrik Kahn, Caroline Whitlow, Thomas Kander, Bertil Christensson, Adam Linder
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/352cfe643df14e7890f6f676e21733c1
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spelling	oai:doaj.org-article:352cfe643df14e7890f6f676e21733c12021-12-02T17:04:36ZBacteremic sepsis leads to higher mortality when adjusting for confounders with propensity score matching10.1038/s41598-021-86346-42045-2322https://doaj.org/article/352cfe643df14e7890f6f676e21733c12021-03-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-86346-4https://doaj.org/toc/2045-2322Abstract One can falsely assume that it is well known that bacteremia is associated with higher mortality in sepsis. Only a handful of studies specifically focus on the comparison of culture-negative and culture-positive sepsis with different conclusions depending on study design. The aim of this study was to describe outcome for critically ill patients with either culture-positive or -negative sepsis in a clinical review. We also aimed to identify subphenotypes of sepsis with culture status included as candidate clinical variables. Out of 784 patients treated in intensive care with a sepsis diagnosis, blood cultures were missing in 140 excluded patients and 95 excluded patients did not fulfill a sepsis diagnosis. Of 549 included patients, 295 (54%) had bacteremia, 90 (16%) were non-bacteremic but with relevant pathogens detected and in 164 (30%) no relevant pathogen was detected. After adjusting for confounders, 90-day mortality was higher in bacteremic patients, 47%, than in non-bacteremic patients, 36%, p = 0.04. We identified 8 subphenotypes, with different mortality rates, where pathogen detection in microbial samples were important for subphenotype distinction and outcome. In conclusion, bacteremic patients had higher mortality than their non-bacteremic counter-parts and bacteremia is more common in sepsis when studied in a clinical review. For reducing population heterogeneity and improve the outcome of trials and treatment for sepsis, distinction of subphenotypes might be useful and pathogen detection an important factor.Lisa MellhammarFredrik KahnCaroline WhitlowThomas KanderBertil ChristenssonAdam LinderNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Lisa Mellhammar Fredrik Kahn Caroline Whitlow Thomas Kander Bertil Christensson Adam Linder Bacteremic sepsis leads to higher mortality when adjusting for confounders with propensity score matching
description	Abstract One can falsely assume that it is well known that bacteremia is associated with higher mortality in sepsis. Only a handful of studies specifically focus on the comparison of culture-negative and culture-positive sepsis with different conclusions depending on study design. The aim of this study was to describe outcome for critically ill patients with either culture-positive or -negative sepsis in a clinical review. We also aimed to identify subphenotypes of sepsis with culture status included as candidate clinical variables. Out of 784 patients treated in intensive care with a sepsis diagnosis, blood cultures were missing in 140 excluded patients and 95 excluded patients did not fulfill a sepsis diagnosis. Of 549 included patients, 295 (54%) had bacteremia, 90 (16%) were non-bacteremic but with relevant pathogens detected and in 164 (30%) no relevant pathogen was detected. After adjusting for confounders, 90-day mortality was higher in bacteremic patients, 47%, than in non-bacteremic patients, 36%, p = 0.04. We identified 8 subphenotypes, with different mortality rates, where pathogen detection in microbial samples were important for subphenotype distinction and outcome. In conclusion, bacteremic patients had higher mortality than their non-bacteremic counter-parts and bacteremia is more common in sepsis when studied in a clinical review. For reducing population heterogeneity and improve the outcome of trials and treatment for sepsis, distinction of subphenotypes might be useful and pathogen detection an important factor.
format	article
author	Lisa Mellhammar Fredrik Kahn Caroline Whitlow Thomas Kander Bertil Christensson Adam Linder
author_facet	Lisa Mellhammar Fredrik Kahn Caroline Whitlow Thomas Kander Bertil Christensson Adam Linder
author_sort	Lisa Mellhammar
title	Bacteremic sepsis leads to higher mortality when adjusting for confounders with propensity score matching
title_short	Bacteremic sepsis leads to higher mortality when adjusting for confounders with propensity score matching
title_full	Bacteremic sepsis leads to higher mortality when adjusting for confounders with propensity score matching
title_fullStr	Bacteremic sepsis leads to higher mortality when adjusting for confounders with propensity score matching
title_full_unstemmed	Bacteremic sepsis leads to higher mortality when adjusting for confounders with propensity score matching
title_sort	bacteremic sepsis leads to higher mortality when adjusting for confounders with propensity score matching
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/352cfe643df14e7890f6f676e21733c1
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Bacteremic sepsis leads to higher mortality when adjusting for confounders with propensity score matching

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