• Markus Castegren, Mikaela Jonasson, Sara Castegren, Miklós Lipcsey, and Jan Sjölin.
• Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden. markus.castegren@karolinska.se.
• Crit Care Resusc. 2015 Sep 1;17(3):174-81.

ObjectiveAnalysis of whether patients with primary, secondary and tertiary sepsis, defined by the presence or absence of recent systemic inflammation-inducing events before the onset of sepsis, differ in clinical presentation, microbiological test results, treatment received and outcome.Design, Setting And ParticipantsA retrospective observational study in a single, general intensive care unit, of all patients treated for severe sepsis or septic shock from 2006 to 2011. Patients with haematological malignancies, with immunosuppressive diseases or being treated with immunosuppressive drugs were excluded.InterventionsNone.Main Outcome MeasuresSequential Organ Failure Assessment score, incidence of organ failure, microbiological results of blood cultures and mortality.ResultsWe included 213 patients, who were classified as having primary (n = 121), secondary (n = 65) or tertiary sepsis (n = 27). The groups differed significantly in SOFA score, the incidence of kidney failure and coagulation failure at onset of sepsis in the ICU, as well as in blood culture findings. No differences in 7-day or 28-day mortality were seen, but the time of death occurred earlier among nonsurvivors in the primary sepsis group.ConclusionsInflammatory insults before the onset of sepsis affect the clinical picture, blood microbial findings, and in non-survivors, the time of death. These results could, if validated in a prospective study, form a basis for a novel and simple strategy for stratifying patients in clinical studies for immunomodulation therapies in sepsis.

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