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Hour-1 bundle adherence was associated with reduction of in-hospital mortality among patients with sepsis in Japan

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...

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Autores principales: 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, Sasaki, Junichi, Shiraishi, Shin-ichiro, Tsuruta, Ryosuke, Masuno, Tomohiko, Takeyama, Naoshi, Yamashita, Norio, Ikeda, Hiroto, Ueyama, Masashi, Gando, Satoshi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8843226/
https://www.ncbi.nlm.nih.gov/pubmed/35157744
http://dx.doi.org/10.1371/journal.pone.0263936
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author 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
Sasaki, Junichi
Shiraishi, Shin-ichiro
Tsuruta, Ryosuke
Masuno, Tomohiko
Takeyama, Naoshi
Yamashita, Norio
Ikeda, Hiroto
Ueyama, Masashi
Gando, Satoshi
author_facet 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
Sasaki, Junichi
Shiraishi, Shin-ichiro
Tsuruta, Ryosuke
Masuno, Tomohiko
Takeyama, Naoshi
Yamashita, Norio
Ikeda, Hiroto
Ueyama, Masashi
Gando, Satoshi
author_sort Umemura, Yutaka
collection PubMed
description 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.
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spelling pubmed-88432262022-02-15 Hour-1 bundle adherence was associated with reduction of in-hospital mortality among patients with sepsis in Japan 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 Sasaki, Junichi Shiraishi, Shin-ichiro Tsuruta, Ryosuke Masuno, Tomohiko Takeyama, Naoshi Yamashita, Norio Ikeda, Hiroto Ueyama, Masashi Gando, Satoshi PLoS One Research Article 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. Public Library of Science 2022-02-14 /pmc/articles/PMC8843226/ /pubmed/35157744 http://dx.doi.org/10.1371/journal.pone.0263936 Text en © 2022 Umemura et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
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
Sasaki, Junichi
Shiraishi, Shin-ichiro
Tsuruta, Ryosuke
Masuno, Tomohiko
Takeyama, Naoshi
Yamashita, Norio
Ikeda, Hiroto
Ueyama, Masashi
Gando, Satoshi
Hour-1 bundle adherence was associated with reduction of in-hospital mortality among patients with sepsis in Japan
title Hour-1 bundle adherence was associated with reduction of in-hospital mortality among patients with sepsis in Japan
title_full Hour-1 bundle adherence was associated with reduction of in-hospital mortality among patients with sepsis in Japan
title_fullStr Hour-1 bundle adherence was associated with reduction of in-hospital mortality among patients with sepsis in Japan
title_full_unstemmed Hour-1 bundle adherence was associated with reduction of in-hospital mortality among patients with sepsis in Japan
title_short Hour-1 bundle adherence was associated with reduction of in-hospital mortality among patients with sepsis in Japan
title_sort hour-1 bundle adherence was associated with reduction of in-hospital mortality among patients with sepsis in japan
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8843226/
https://www.ncbi.nlm.nih.gov/pubmed/35157744
http://dx.doi.org/10.1371/journal.pone.0263936
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