Association between variables measured in the ambulance and in-hospital mortality among adult patients with and without infection: a prospective cohort study
Dublin Core
Title
Association between variables measured in the ambulance and in-hospital mortality among adult patients with and without infection: a prospective cohort study
Subject
Mortality, Infection, Sepsis, Emergency medical services, Prehospital, Emergency care
Description
Background: Patients presenting with infection to the ambulance are common, but risk factors for poor outcome
are not known. The primary aim of the current study was to study the association between variables measured in
the ambulance and mortality among adult patients with and without infection. The secondary aim was to study the
association between these variables and mortality in a subgroup of patients who developed sepsis within 36 h.
Methods: Prospective cohort study of 553 ambulance patients with, and 318 patients without infection, performed
in Stockholm during 2017–2018. The association between 21 variables (8 keywords related to medical history, 6 vital
signs, 4 blood tests, and age, gender, comorbidity) and in-hospital mortality was analysed using logistic regression.
Results: Among patients with infection, inability of the patient to answer questions relating to certain symptoms
such as pain and gastrointestinal symptoms was signifcantly associated with mortality in univariable analysis,
in addition to oxygen saturation<94%, heart rate>110 /min, Glasgow Coma Scale (GCS)<15, soluble urokinase
Plasminogen Activator Receptor (suPAR) 4.0–7.9 ng/mL, suPAR≥8.0 ng/mL and a Charlson comorbidity score≥5.
suPAR≥8.0 ng/mL remained signifcant in multivariable analysis (OR 25.4; 95% CI, 3.2–199.8). Among patients without
infection, suPAR≥8.0 ng/mL and a Charlson comorbidity score≥5 were signifcantly associated with mortality in uni‑
variable analysis, while suPAR≥8.0 ng/mL remained signifcant in multivariable analysis (OR 56.1; 95% CI, 4.5–700.0).
Among patients who developed sepsis, inability to answer questions relating to pain remained signifcant in multi‑
variable analysis (OR 13.2; 95% CI, 2.2–78.9), in addition to suPAR≥8.0 ng/mL (OR 16.1; 95% CI, 2.0–128.6).
Conclusions: suPAR≥8.0 ng/mL was associated with mortality in patients presenting to the ambulance both with
and without infection and in those who developed sepsis. Furthermore, the inability of the ambulance patient with
an infection to answer questions relating to specifc symptoms was associated with a surprisingly high mortality.
These results suggest that suPAR and medical history are valuable tools with which to identify patients at risk of poor
outcome in the ambulance and could potentially signal the need of enhanced attention.
Trial registration: ClinicalTrials.gov, NCT03249597. Registered 15 August 2017—Retrospectively registered, https://
clinicaltrials.gov/ct2/show/NCT03249597
are not known. The primary aim of the current study was to study the association between variables measured in
the ambulance and mortality among adult patients with and without infection. The secondary aim was to study the
association between these variables and mortality in a subgroup of patients who developed sepsis within 36 h.
Methods: Prospective cohort study of 553 ambulance patients with, and 318 patients without infection, performed
in Stockholm during 2017–2018. The association between 21 variables (8 keywords related to medical history, 6 vital
signs, 4 blood tests, and age, gender, comorbidity) and in-hospital mortality was analysed using logistic regression.
Results: Among patients with infection, inability of the patient to answer questions relating to certain symptoms
such as pain and gastrointestinal symptoms was signifcantly associated with mortality in univariable analysis,
in addition to oxygen saturation<94%, heart rate>110 /min, Glasgow Coma Scale (GCS)<15, soluble urokinase
Plasminogen Activator Receptor (suPAR) 4.0–7.9 ng/mL, suPAR≥8.0 ng/mL and a Charlson comorbidity score≥5.
suPAR≥8.0 ng/mL remained signifcant in multivariable analysis (OR 25.4; 95% CI, 3.2–199.8). Among patients without
infection, suPAR≥8.0 ng/mL and a Charlson comorbidity score≥5 were signifcantly associated with mortality in uni‑
variable analysis, while suPAR≥8.0 ng/mL remained signifcant in multivariable analysis (OR 56.1; 95% CI, 4.5–700.0).
Among patients who developed sepsis, inability to answer questions relating to pain remained signifcant in multi‑
variable analysis (OR 13.2; 95% CI, 2.2–78.9), in addition to suPAR≥8.0 ng/mL (OR 16.1; 95% CI, 2.0–128.6).
Conclusions: suPAR≥8.0 ng/mL was associated with mortality in patients presenting to the ambulance both with
and without infection and in those who developed sepsis. Furthermore, the inability of the ambulance patient with
an infection to answer questions relating to specifc symptoms was associated with a surprisingly high mortality.
These results suggest that suPAR and medical history are valuable tools with which to identify patients at risk of poor
outcome in the ambulance and could potentially signal the need of enhanced attention.
Trial registration: ClinicalTrials.gov, NCT03249597. Registered 15 August 2017—Retrospectively registered, https://
clinicaltrials.gov/ct2/show/NCT03249597
Creator
Ulrika Margareta Wallgren, Hans Järnbert‑Pettersson, Jan Sjölin and Lisa Kurland
Publisher
BMC Emergency Medicine
Date
(2022) 22:185
Contributor
Fajar Bagus W
Format
PDF
Language
English
Type
Text
Files
Collection
Citation
Ulrika Margareta Wallgren, Hans Järnbert‑Pettersson, Jan Sjölin and Lisa Kurland, “Association between variables measured in the ambulance and in-hospital mortality among adult patients with and without infection: a prospective cohort study,” Repository Horizon University Indonesia, accessed September 20, 2024, https://repository.horizon.ac.id/items/show/4244.