C55-20 Progression of Organ Failure in Hospital Acquired Versus Community Acquired Sepsis

Abstract Introduction Progression of sepsis to septic shock involves a dysregulated response to infection leading to life-threatening organ failure, and is associated with an ICU mortality of over 40%. Hospital-acquired sepsis (HAS), defined as sepsis diagnosed more than 48 hours after admission, has been shown to be associated with higher mortality, length of ICU stay, and healthcare cost than sepsis diagnosed within 48 hours from admission, or community-acquired sepsis (CAS). The aim of our study was to investigate the association between HAS and the likelihood of organ failure progression. Methods We conducted a secondary analysis of a prospective, single-center cohort of 1,260 adult patients with sepsis enrolled between March 2011 and January 2021 at Grady Memorial Hospital. For each patient, we collected demographic data (age, gender), situational data (sepsis date and time relative to hospital admission), laboratory data (bacterial culture results), sequential organ failure assessment (SOFA) scores, and organ support (vasopressor and mechanical ventilation) date and time. The time of sepsis diagnosis was defined as the earliest recorded instance of a SOFA score ≥2 with suspicion of infection. Patients were categorized as community-acquired sepsis (CAS) or hospital-acquired sepsis (HAS) based on whether sepsis onset occurred within or after 48 hours of admission, respectively. The presence or absence of sepsis progression was defined as the need for organ support with vasopressors and/or mechanical ventilation after 2 hours of initial sepsis diagnosis. Logistic regression was used to evaluate the independent association of sepsis type with sepsis progression. Covariates included SOFA score, age, gender, and bacterial culture result. Statistical significance was defined as p 0.05. Results After adjusting for confounding, the presence of HAS did not achieve statistical significance (OR 0.89; CI 0.66 - 1.19). Age, SOFA score, and culture positivity showed trends toward, but did not achieve statistical significance (Table 1). These variables demonstrated a positive association with progression risk, suggesting that higher SOFA scores and positive culture status may be linked to an increased likelihood of progression. Conclusions In our analysis, HAS was not associated with a higher risk of sepsis progression compared to CAS; however, further study may be needed in a larger multicenter cohort. This abstract is funded by: None