Prognostic factors of mortality in patients with community-acquired bloodstream infection with severe sepsis and septic shock ☆,☆☆ Arturo Artero MD,PhD a, ⁎ , Rafael Zaragoza MD b , Juan J. Camarena MD,PhD c , Susana Sancho MD,PhD b , Rosa González c , José M. Nogueira MD,PhD c a Department of Internal Medicine, Hospital Universitario Dr Peset Av Gaspar Aguilar 90, 46017 Valencia, Spain b Intensive Care Unit, Hospital Universitario Dr Peset Valencia, 46017 Valencia, Spain c Department of Microbiology, Hospital Universitario Dr Peset Valencia, 46017 Valencia, Spain Keywords: Bacteremia; Sepsis syndrome; Septic shock; Intensive care unit; Mortality; Inadequate empirical antimicrobial treatment Abstract Purpose: The purpose of the study was to determine the independent risk factors on mortality in patients with community-acquired severe sepsis and septic shock. Methods: A single-site prospective cohort study was carried out in a medical-surgical intensive care unit in an academic tertiary care center. One hundred twelve patients with community-acquired bloodstream infection with severe sepsis and septic shock were identified. Clinical, microbiologic, and laboratory parameters were compared between hospital survivors and hospital deaths. Results: One-hundred twelve patients were included. The global mortality rate was 41.9%, 44.5% in septic shock and 34.4% in severe sepsis. One or more comorbidities were present in 66% of patients. The most commonly identified bloodstream pathogens were Escherichia coli (25%) and Staphylococcus aureus (21.4%). The proportion of patients receiving inadequate antimicrobial treatment was 8.9%. By univariate analysis, age, Acute Physiology and Chronic Health Evaluation II score, at least 3 organ dysfunctions, and albumin, but neither microbiologic characteristics nor site of infection, differed significantly between survivors and nonsurvivors. Acute Physiology and Chronic Health Evaluation II (odds ratio, 1.13; 95% confidence interval, 1.06-1.21) and albumin (odds ratio, 0.34; 95% confidence interval, 0.15-0.76) were independent risk factors associated with global mortality in logistic regression analysis. Conclusion: In addition to the severity of illness, hypoalbuminemia was identified as the most important prognostic factor in community-acquired bloodstream infection with severe sepsis and septic shock. © 2010 Published by Elsevier Inc. 1. Introduction Sepsis is an important cause of morbidity and mortality, which accounts for about 2% of hospital admissions [1].A small proportion of these cases progress to severe sepsis and septic shock, which account for 10% of admissions to intensive care units (ICUs) [2]. Bacteremia is the essential ☆ Institution at which the work was performed: Hospital Universitario Dr Peset Av Gaspar Aguilar 90, 46017 Valencia, Spain. ☆☆ No conflicts of interest to disclose. ⁎ Corresponding author. Tel.: +34 961622457; fax: +34 961622301. E-mail addresses: arturo.artero@uv.es (A. Artero), zaragozar@ono.com (R. Zaragoza), juan.camarena@uv.es (J.J. Camarena), Sancho_sus@gva.es (S. Sancho), rosa.gonzalez@uv.es (R. González), jose.m.nogueira@uv.es (J.M. Nogueira). 0883-9441/$ – see front matter © 2010 Published by Elsevier Inc. doi:10.1016/j.jcrc.2009.12.004 Journal of Critical Care (2010) 25, 276–281