The prognostic value of 1-hour bundle completion in septic shock patients

Objective:
Since 2018, the surviving sepsis campaign recommended one-hour bundle therapy in septic shock patients. On the other hand, evidence for the effectiveness of bundle therapy has not been established. The object of this study was to determine the prognostic value of one-hour bundle completion in septic shock patients.
Method:
This prospectively collected registry-based, retrospective observational study, between January 2016 and December 2018. A one-hour bundle in septic shock was defined by the serum lactate measurements, blood cultures, administration of antibiotics, and adequate fluid administration within one hour from emergency department admission. Eligible septic shock patients were included in the analysis, and the prognostic abilities of the completion of the one-hour bundle and each item were analyzed. The primary outcome was the 28-day mortality.
Results:
The study included 381 patients, and the overall 28-day mortality was 24.7%. The overall one-hour bundle completion rate was 11.3%, and each completion rate of serum lactate measurement, blood cultures, administration of antibiotics, and adequate fluid administration were 85.8%, 74.3%, 19.4%, and 48.6%, respectively. On the other hand, overall bundle completion as well as each bundle were not associated with the 28-day mortality except for adequate fluid administration (odds ratio [OR], 0.67 [95% confidence interval (CI), 0.30-1.50]; OR, 1.33 [95% CI, 0.66-2.70]; OR, 1.50 [95% CI 0.85-2.64]; OR, 1.17 [95% CI 0.66-2.07]; and OR, 0.54 [95% CI, 0.34-0.87], respectively). Multivariate logistic regression analysis showed that adequate fluid administration was independently associated with the 28-day mortality (OR, 0.22 [95% CI, 0.09-0.55]; P=0.001).
Conclusion:
In this study, most of the one-hour bundle completions were not associated with 28-day mortality. Although adequate fluid administration was associated with the 28-day mortality, multicenter interventional study will be needed to generalize this result.

Key words: Sepsis; Shock; Mortality; Prognosis