Age, male sex, a history of cancer, and alcohol use disorder (AUD) were independently associated with an increased risk of all-cause mortality among patients admitted to the emergency department (ED) with suspected bacterial infections, according to results of a study in the American Journal of Emergency Medicine.
These findings were from a secondary analysis of a prospective observational cohort study that assessed all-cause mortality outcomes among adult patients admitted to an ED in Denmark with confirmed or suspected bacterial infections between October 2017 and March 2018. The primary outcome was all-cause mortality, and the median follow-up duration was 2.1 years.
The final analysis comprised 2110 patients, of whom the median age was 73 (IQR, 60.2-82.7) years, 51.3% were women, and approximately 25% were previously hospitalized for sepsis with the past year. The most common chronic diseases included hypertension in 32.5% of patients, chronic obstructive pulmonary disease in 26.0%, and diabetes in 16.8%. On ED admission, 52.5% were diagnosed with lung infections, 25.7% with urinary tract infections, and 10.7% with abdominal infections. Of note, 144 (6.8%) patients had infections at 2 or more sites.
Within the 2.1-year follow-up period, 35.9% of patients died and 7.4% required transfer to an intensive care unit. The rate of In-hospital mortality and 28- and 365-day mortality was 3.7%, 7.5%, and 25.6%, respectively.
Following multivariate analysis, the researchers determined several independent predictors of all-cause mortality, including age (adjusted hazard ratio [aHR], 1.05; 95% CI, 1.04-1.05), male sex (aHR, 1.21; 95% CI, 1.17-1.25), history of cancer (aHR, 1.80; 95% CI, 1.73-1.87), hospitalization for sepsis within the past year (aHR, 1.56; 95% CI, 1.50-1.61), and AUD (aHR, 1.30; 95% CI, 1.22-1.38). They also found that the risk of all-cause mortality was increased among patients with implantable devices (aHR, 7.00; 95% CI, 5.61-8.73). However, this association may be imprecise due to the small number patients (n=4) with implantable devices included in the analysis.
This study was limited by its single-center setting, potential misclassification bias, and the lack of information on patients’ chronic disease severity and smoking status prior to ED admission.
According to the researchers, “the causality and the way in which these individual [predictors] contribute to death should be further explored… [as they may help] clinicians to identify high-risk patients prior to discharge to ensure optimal management… [and decrease] the risk of death.”
Chafranska L, Stenholt OO, Sørensen RH, Bin Abdullah SMO, Nielsen FE. Predictors for mortality in patients admitted with suspected bacterial infections—a prospective long-term follow-up study. Am J Emerg Med. 2022;56:236-243. doi: 10.1016/j.ajem.2022.04.002