Early Sepsis Control associated with Lower 90-Day Mortality: JAMA

Early management of sepsis requires respiratory stabilization. All patients should be given supplemental oxygen. Mechanical ventilation is recommended when supplemental oxygen cannot improve oxygenation if the respiratory failure is imminent, or when the airway cannot be maintained. Rapid source control is recommended to improve patient outcomes in sepsis. Yet there is little data to guide how quickly source control is needed.

A group of researchers conducted a study to determine the relationship between time to source control and patient outcomes in community-acquired sepsis. Multi-hospital integrated healthcare system cohort study of hospitalized adults with community-acquired sepsis (January 1, 2013 - December 31, 2017) identified by Sepsis-3 who underwent source control procedures. Follow-up continued until January 1, 2019, and data analyzes were completed on March 17, 2022.

Results:

• Of 4962 patients with sepsis, source control was performed at a median (IQR) of 15.4 hours after the onset of sepsis, and source control was performed within 6 hours in 1315 patients (27%).

• Crude mortality at 90 days was similar for early and late source control.

• In multivariate models, early source control was associated with reduced risk-adjusted 90-day mortality rates.

• This association was greater between gastrointestinal and abdominal and soft tissue interventions compared to orthopaedic and cranial interventions.

Therefore, source control within 6 hours of the onset of community-acquired sepsis was associated with a reduced risk-adjusted 90-day mortality rate. Prioritizing rapid identification of septic foci and initiation of source control interventions can reduce the number of preventable deaths in patients with sepsis.

Reference:

JAMA Surgery Source Reference: Reitz KM, et al "Association between time to source control in sepsis and 90-day mortality" JAMA Surg 2022;

DOI: 10.1001/jamasurg.2022.2761.