• Jason D Vadhan, Joby Thoppil, Ofelia Vasquez, Arlen Suarez, Brett Bartels, Samuel McDonald, D Mark Courtney, J David Farrar, and Bhaskar Thakur.
• Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
• J Emerg Med. 2024 Aug 1; 67 (2): e128e137e128-e137.

BackgroundSepsis is a life-threatening condition but predicting its development and progression remains a challenge.ObjectiveThis study aimed to assess the impact of infection site on sepsis development among emergency department (ED) patients.MethodsData were collected from a single-center ED between January 2016 and December 2019. Patient encounters with documented infections, as defined by the Systematized Nomenclature of Medicine-Clinical Terms for upper respiratory tract (URI), lower respiratory tract (LRI), urinary tract (UTI), or skin or soft-tissue infections were included. Primary outcome was the development of sepsis or septic shock, as defined by Sepsis-1/2 criteria. Secondary outcomes included hospital disposition and length of stay, blood and urine culture positivity, antibiotic administration, vasopressor use, in-hospital mortality, and 30-day mortality. Analysis of variance and various different logistic regression approaches were used for analysis with URI used as the reference variable.ResultsLRI was most associated with sepsis (relative risk ratio [RRR] 5.63; 95% CI 5.07-6.24) and septic shock (RRR 21.2; 95% CI 17.99-24.98) development, as well as hospital admission rates (odds ratio [OR] 8.23; 95% CI 7.41-9.14), intensive care unit admission (OR 4.27; 95% CI 3.84-4.74), in-hospital mortality (OR 6.93; 95% CI 5.60-8.57), and 30-day mortality (OR 7.34; 95% CI 5.86-9.19). UTIs were also associated with sepsis and septic shock development, but to a lesser degree than LRI.ConclusionsPrimary infection sites including LRI and UTI were significantly associated with sepsis development, hospitalization, length of stay, and mortality among patients presenting with infections in the ED.Copyright © 2024 Elsevier Inc. All rights reserved.

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