Associated factors for 28-day mortality in septic patients who received timely sepsis care: a multicenter subgroup analysis

¹Institute of Public Health and Medical Service, Seoul National University Hospital, Seoul, Korea
²Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
³Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
⁴Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
⁵Department of Emergency Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
⁶Department of Emergency Medicine, Hallym University College of Medicine, Chuncheon, Korea
⁷Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Korea
⁸Department of Emergency Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea

Correspondence

Hyeongkyu Kwak ,Tel: 02-2072-0294, Fax: 02-741-7855, Email: oliverpop84@gmail.com,

Received: April 28, 2025; Revised: May 20, 2025 Accepted: May 26, 2025. Published online: June 30, 2025.

ABSTRACT

Objective:
To identify prognostic factors for the 28-day mortality of septic patients who received timely antibiotics and fluid resuscitation in accordance with the Surviving Sepsis Campaign guidelines.
Methods:
This research was a subgroup analysis of a multicenter observational study using data from a sepsis registry. Adult patients were included if they received intravenous antibiotics within 2 hours of emergency department arrival and any volume of fluid resuscitation. Sepsis was defined according to Sepsis-2 (until February 2016) and Sepsis-3 (thereafter). Sequential Organ Failure Assessment (SOFA) scores were applied retrospectively for consistency. The independent predictors of the 28-day all-cause mortality were identified by multivariable logistic regression. The linearity of the continuous variables was evaluated using the Box-Tidwell test, and the multicollinearity was assessed by the variance inflation factor.
Results:
Seven hundred and twenty-two patients were analyzed. Among them, 121 (16.8%) died within 28 days. Multivariable analysis showed that a solid tumor (odds ratio [OR], 1.68; 95% confidence interval [CI], 1.01-2.79), higher SOFA score (OR, 1.28; 95% CI, 1.20-1.37), and lower initial body temperature (OR, 0.76; 95% CI, 0.63-0.91) were independently associated with mortality. Kaplan-Meier analysis revealed significantly lower survival among patients with a malignancy, high SOFA scores, or lower body temperature (log-rank P<0.01 for all).
Conclusion:
In septic patients who received early antibiotics and fluid resuscitation, the 28-day mortality remained significantly associated with solid tumors, higher SOFA scores, and lower initial body temperature. These findings highlight the need for further risk stratification even after timely sepsis care.

Key words: Sepsis; Therapy; Association; Treatment outcome