1. Hour-1 bundle adherence was associated with reduction of in-hospital mortality among patients with sepsis in Japan.
- Author
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Umemura, Yutaka, Abe, Toshikazu, Ogura, Hiroshi, Fujishima, Seitato, Kushimoto, Shigeki, Shiraishi, Atsushi, Saitoh, Daizoh, Mayumi, Toshihiko, Otomo, Yasuhiro, Hifumi, Toru, Hagiwara, Akiyoshi, Takuma, Kiyotsugu, Yamakawa, Kazuma, Shiino, Yasukazu, Nakada, Taka-aki, Tarui, Takehiko, Okamoto, Kohji, Kotani, Joji, Sakamoto, Yuichiro, and Sasaki, Junichi
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SEPSIS , *HOSPITAL mortality , *LOGISTIC regression analysis , *INTENSIVE care units , *ODDS ratio - Abstract
Background: The updated Surviving Sepsis Campaign guidelines recommend a 1-hour window for completion of a sepsis care bundle; however, the effectiveness of the hour-1 bundle has not been fully evaluated. The present study aimed to evaluate the impact of hour-1 bundle completion on clinical outcomes in sepsis patients. Methods: This was a multicenter, prospective, observational study conducted in 17 intensive care units in tertiary hospitals in Japan. We included all adult patients who were diagnosed as having sepsis by Sepsis-3 and admitted to intensive care units from July 2019 to August 2020. Impacts of hour-1 bundle adherence and delay of adherence on risk-adjusted in-hospital mortality were estimated by multivariable logistic regression analyses. Results: The final study cohort included 178 patients with sepsis. Among them, 89 received bundle-adherent care. Completion rates of each component (measure lactate level, obtain blood cultures, administer broad-spectrum antibiotics, administer crystalloid, apply vasopressors) within 1 hour were 98.9%, 86.2%, 51.1%, 94.9%, and 69.1%, respectively. Completion rate of all components within 1 hour was 50%. In-hospital mortality was 18.0% in the patients with and 30.3% in the patients without bundle-adherent care (p = 0.054). The adjusted odds ratio of non-bundle-adherent versus bundle-adherent care for in-hospital mortality was 2.32 (95% CI 1.09–4.95) using propensity scoring. Non-adherence to obtaining blood cultures and administering broad-spectrum antibiotics within 1 hour was related to in-hospital mortality (2.65 [95% CI 1.25–5.62] and 4.81 [95% CI 1.38–16.72], respectively). The adjusted odds ratio for 1-hour delay in achieving hour-1 bundle components for in-hospital mortality was 1.28 (95% CI 1.04–1.57) by logistic regression analysis. Conclusion: Completion of the hour-1 bundle was associated with lower in-hospital mortality. Obtaining blood cultures and administering antibiotics within 1 hour may have been the components most contributing to decreased in-hospital mortality. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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