Journal of critical care · 2026
Evolution of organ dysfunction in transferred vs non-transferred patients with community sepsis: A propensity-matched analysis.
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Basnet Suresh, Sun Kai, Magder Laurence S, Shanholtz Carl, Gandotra Sheetal
Аннотация
BACKGROUND: Interhospital transfer of patients with sepsis is common, yet its impact on organ dysfunction trajectories remains unclear. Our study aims to evaluate the evolution of organ dysfunction between transferred and non-transferred patients presenting with community-onset sepsis.
STUDY DESIGN AND METHODS: We conducted a retrospective cohort study of adults (≥18 years) presenting with community-onset sepsis between January 2017 and December 2020. Patients were either admitted locally or transferred to a referral center. Propensity score matching (1:1) was performed to balance baseline characteristics. The primary outcome was change in Sequential Organ Failure Assessment (SOFA) score from emergency department presentation to 72 h (ΔSOFA). Secondary outcomes included change in maximum SOFA at 48 and 96 h. Appropriate paired statistical tests were applied to matched cohorts.
RESULTS: Among 6264 patients, 60 (0.95%) were transferred. After matching, 56 patients were included in each group. Transferred patients had higher ICU admission rates prior to matching (26.7% vs 8.8%, p < 0.001). In the matched cohort, transferred patients demonstrated greater improvement in organ dysfunction, with a larger reduction in ΔSOFA at 72 h (mean difference - 1.25; 95% CI -2.37 to -0.13; p = 0.03) and ΔSOFA max at 48 h (-1.14; 95% CI -2.23 to -0.06; p = 0.04). No significant differences were observed at 96 h.
CONCLUSION: In this propensity-matched analysis, interhospital transfer was associated with greater early improvement in organ dysfunction among patients with community-onset sepsis.These findings suggest that access to higher-level care may influence early organ failure trajectories, though residual confounding cannot be excluded.
STUDY DESIGN AND METHODS: We conducted a retrospective cohort study of adults (≥18 years) presenting with community-onset sepsis between January 2017 and December 2020. Patients were either admitted locally or transferred to a referral center. Propensity score matching (1:1) was performed to balance baseline characteristics. The primary outcome was change in Sequential Organ Failure Assessment (SOFA) score from emergency department presentation to 72 h (ΔSOFA). Secondary outcomes included change in maximum SOFA at 48 and 96 h. Appropriate paired statistical tests were applied to matched cohorts.
RESULTS: Among 6264 patients, 60 (0.95%) were transferred. After matching, 56 patients were included in each group. Transferred patients had higher ICU admission rates prior to matching (26.7% vs 8.8%, p < 0.001). In the matched cohort, transferred patients demonstrated greater improvement in organ dysfunction, with a larger reduction in ΔSOFA at 72 h (mean difference - 1.25; 95% CI -2.37 to -0.13; p = 0.03) and ΔSOFA max at 48 h (-1.14; 95% CI -2.23 to -0.06; p = 0.04). No significant differences were observed at 96 h.
CONCLUSION: In this propensity-matched analysis, interhospital transfer was associated with greater early improvement in organ dysfunction among patients with community-onset sepsis.These findings suggest that access to higher-level care may influence early organ failure trajectories, though residual confounding cannot be excluded.