• Adnan Javed, Faheem W Guirgis, Sarah A Sterling, Michael A Puskarich, Jennifer Bowman, Taylor Robinson, and Alan E Jones.
• University of Florida College of Medicine, Jacksonville, Department of Emergency Medicine, 1st Floor, Clinical Center, 655 West 8th Street, C506, Jacksonville, FL 32209, United States.
• J Crit Care. 2017 Dec 1; 42: 30-34.

PurposePatients with severe sepsis who experience rapid, early deterioration and death are of particular concern. Our objective was to identify predictors of early death in Emergency Department (ED) patients with severe sepsis.MethodsSecondary analysis of two prospective studies of adult ED patients with severe sepsis. The primary outcome was early death, defined as death within 24h of triage.ResultsOut of 410 severe sepsis admissions, 20 patients experienced early death. These patients demonstrated significantly higher initial lactate (7.3 versus 3.3mmol/L, p<0.001) and modified SOFA (mSOFA) scores (10 vs 6, p<0.001), were less likely to normalize their lactate (p<0.001), had lower initial pH (p<0.001), and more frequently had early positive blood cultures (p=0.021). Multivariable logistic regression identified initial serum lactate level (OR 1.19, 95% CI 1.06-1.35) and mSOFA score (OR 1.17, 95% CI 1.00-1.36) as independent predictors of early death. A repeat lactate≥5mmol/L had a sensitivity of 55% and specificity of 89% for early death. There were no significant treatment differences between groups.ConclusionInitial serum lactate and mSOFA score were independent predictors of mortality within 24h of ED admission in patients with severe sepsis.Copyright © 2017 Elsevier Inc. All rights reserved.

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