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Sepsis mimics among presumed sepsis patients at intensive care admission: a retrospective observational study

Lengquist, Maria LU orcid ; Varadarajan, Anjali ; Alestam, Shiva LU ; Friberg, Hans LU ; Frigyesi, Attila LU and Mellhammar, Lisa LU (2024) In Infection 52(3). p.1041-1053
Abstract
Background
Diagnosing sepsis remains a challenge because of the lack of gold-standard diagnostics. Since there are no simple, broadly accepted criteria for infection, there is a risk of misclassifying sepsis patients (sepsis mimics) among patients with organ failure. The main objective of this study was to investigate the proportion of non-infected patients (sepsis mimics) in ICU patients with presumed sepsis at intensive care unit (ICU) admission.

Methods
Adult patients were screened retrospectively during 3.5 years in four ICUs in Sweden for fulfilment of the sepsis-3 criteria at ICU admission (presumed sepsis). Proxy criteria for suspected infection were sampled blood culture(s) and concomitant antibiotic... (More)
Background
Diagnosing sepsis remains a challenge because of the lack of gold-standard diagnostics. Since there are no simple, broadly accepted criteria for infection, there is a risk of misclassifying sepsis patients (sepsis mimics) among patients with organ failure. The main objective of this study was to investigate the proportion of non-infected patients (sepsis mimics) in ICU patients with presumed sepsis at intensive care unit (ICU) admission.

Methods
Adult patients were screened retrospectively during 3.5 years in four ICUs in Sweden for fulfilment of the sepsis-3 criteria at ICU admission (presumed sepsis). Proxy criteria for suspected infection were sampled blood culture(s) and concomitant antibiotic administration. Culture-negative presumed sepsis patients were screened for infection according to the Linder-Mellhammar Criteria of Infection (LMCI). Sepsis mimics were defined as without probable infection according to the LMCI. Confirmed sepsis was defined as presumed sepsis after the exclusion of sepsis mimics.

Results
In the ICU presumed sepsis cohort (2664 patients), 25% were considered sepsis mimics. The most common reasons for ICU admission among sepsis mimics were acute heart failure and unspecific respiratory failure. Comparing sepsis mimics and confirmed sepsis showed that confirmed sepsis patients were slightly more severely ill but had similar mortality. C-reactive protein had modest discriminatory power (AUROC 0.71) with confirmed sepsis as the outcome.

Conclusions
One-fourth of a presumed ICU sepsis population identified with the sepsis-3 criteria could be considered sepsis mimics. The high proportion of sepsis mimics has a potential dilutional effect on the presumed sepsis population, which threatens the validity of results from sepsis studies using recommended sepsis criteria. (Less)
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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Infection
volume
52
issue
3
pages
1041 - 1053
publisher
Springer
external identifiers
  • scopus:85183435964
  • pmid:38280062
ISSN
1439-0973
DOI
10.1007/s15010-023-02158-w
language
English
LU publication?
yes
id
9d3127e6-b733-4b31-b281-a6396e831102
date added to LUP
2024-02-14 16:10:01
date last changed
2024-10-14 11:56:52
@article{9d3127e6-b733-4b31-b281-a6396e831102,
  abstract     = {{Background<br/>Diagnosing sepsis remains a challenge because of the lack of gold-standard diagnostics. Since there are no simple, broadly accepted criteria for infection, there is a risk of misclassifying sepsis patients (sepsis mimics) among patients with organ failure. The main objective of this study was to investigate the proportion of non-infected patients (sepsis mimics) in ICU patients with presumed sepsis at intensive care unit (ICU) admission.<br/><br/>Methods<br/>Adult patients were screened retrospectively during 3.5 years in four ICUs in Sweden for fulfilment of the sepsis-3 criteria at ICU admission (presumed sepsis). Proxy criteria for suspected infection were sampled blood culture(s) and concomitant antibiotic administration. Culture-negative presumed sepsis patients were screened for infection according to the Linder-Mellhammar Criteria of Infection (LMCI). Sepsis mimics were defined as without probable infection according to the LMCI. Confirmed sepsis was defined as presumed sepsis after the exclusion of sepsis mimics.<br/><br/>Results<br/>In the ICU presumed sepsis cohort (2664 patients), 25% were considered sepsis mimics. The most common reasons for ICU admission among sepsis mimics were acute heart failure and unspecific respiratory failure. Comparing sepsis mimics and confirmed sepsis showed that confirmed sepsis patients were slightly more severely ill but had similar mortality. C-reactive protein had modest discriminatory power (AUROC 0.71) with confirmed sepsis as the outcome.<br/><br/>Conclusions<br/>One-fourth of a presumed ICU sepsis population identified with the sepsis-3 criteria could be considered sepsis mimics. The high proportion of sepsis mimics has a potential dilutional effect on the presumed sepsis population, which threatens the validity of results from sepsis studies using recommended sepsis criteria.}},
  author       = {{Lengquist, Maria and Varadarajan, Anjali and Alestam, Shiva and Friberg, Hans and Frigyesi, Attila and Mellhammar, Lisa}},
  issn         = {{1439-0973}},
  language     = {{eng}},
  month        = {{01}},
  number       = {{3}},
  pages        = {{1041--1053}},
  publisher    = {{Springer}},
  series       = {{Infection}},
  title        = {{Sepsis mimics among presumed sepsis patients at intensive care admission: a retrospective observational study}},
  url          = {{http://dx.doi.org/10.1007/s15010-023-02158-w}},
  doi          = {{10.1007/s15010-023-02158-w}},
  volume       = {{52}},
  year         = {{2024}},
}