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<p>In order to reduce sepsis mortality, early treatment implementation and referral to the most appropriate ward (emergency department (ED) or intensive care unit (ICU) are recommended. This multicentre retrospective study aims to study the relationship between 30-day mortality and the admission mode to ICU or ED among patients with septic shock cared for by a prehospital mobile Intensive Care Unit (mobile-ICU). From May 2016 to December 2022, septic shock patients cared for by a prehospital mobile-ICU were retrospectively analysed. To assess the relationship between 30-day mortality rate and the admission mode, a multivariate logistic regression after Inverse Probability Treatment Weighting (IPTW) propensity score matching was performed. Among the 587 patients analysed, pulmonary, urinary and digestive infections were the main septic shock aetiology: 42%, 26% and 17% respectively. The overall 30-day mortality rate was 30%. Three-hundred and twenty-seven patients (58%) were admitted to ICU and 260 (42%) to the ED. On matched population, the multivariate analysis including the followings potential confounders: prehospital fluid expansion, norepinephrine administration, broad-spectrum antibiotic therapy, age, chronic obstructive pulmonary disease, chronic kidney disease, diabetes mellitus, cancer history, hypertension, chronic heart failure, coronary artery disease, hospitalization in the previous 3 months, SAPS-2, management in rural area and prehospital duration, an aRR=1.05 [1.00-1.09] (p=0.025) between 30-day mortality and ED admission. Conversely, the multivariate analysis with the same confounders found aRR=0.90 [0.86-0.95] between 30-day mortality and ICU admission. This study highlighted a positive relationship between ED admission and 30-day mortality of patients in septic shock cared for by a prehospital mobile-ICU suggesting a possible negative effect of ED admission whereas a direct ICU admission may be beneficial.</p>

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Direct admission to the intensive care unit for patients with prehospital septic shock is associated with a lower 30-day mortality rate

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月28日

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  • Romain Jouffroy,
  • Vincent Garrouste,
  • Basile Gilbert,
  • Stéphane Travers,
  • Emmanuel Bloch-Laine,
  • Patrick Ecollan,
  • Vincent Bounes,
  • Josiane Boularan,
  • Benoit Vivien,
  • Papa Gueye

摘要

In order to reduce sepsis mortality, early treatment implementation and referral to the most appropriate ward (emergency department (ED) or intensive care unit (ICU) are recommended. This multicentre retrospective study aims to study the relationship between 30-day mortality and the admission mode to ICU or ED among patients with septic shock cared for by a prehospital mobile Intensive Care Unit (mobile-ICU). From May 2016 to December 2022, septic shock patients cared for by a prehospital mobile-ICU were retrospectively analysed. To assess the relationship between 30-day mortality rate and the admission mode, a multivariate logistic regression after Inverse Probability Treatment Weighting (IPTW) propensity score matching was performed. Among the 587 patients analysed, pulmonary, urinary and digestive infections were the main septic shock aetiology: 42%, 26% and 17% respectively. The overall 30-day mortality rate was 30%. Three-hundred and twenty-seven patients (58%) were admitted to ICU and 260 (42%) to the ED. On matched population, the multivariate analysis including the followings potential confounders: prehospital fluid expansion, norepinephrine administration, broad-spectrum antibiotic therapy, age, chronic obstructive pulmonary disease, chronic kidney disease, diabetes mellitus, cancer history, hypertension, chronic heart failure, coronary artery disease, hospitalization in the previous 3 months, SAPS-2, management in rural area and prehospital duration, an aRR=1.05 [1.00-1.09] (p=0.025) between 30-day mortality and ED admission. Conversely, the multivariate analysis with the same confounders found aRR=0.90 [0.86-0.95] between 30-day mortality and ICU admission. This study highlighted a positive relationship between ED admission and 30-day mortality of patients in septic shock cared for by a prehospital mobile-ICU suggesting a possible negative effect of ED admission whereas a direct ICU admission may be beneficial.