Management of abdominal sepsis in the emergency department

This study aimed to characterize the epidemiology, etiology, early and accurate diagnosis, rapid resuscitation, effective source control, factors influencing appropriate antimicrobial therapy, and risk factors for mortality in patients evaluated with a preliminary diagnosis of intra-abdominal sepsis in the emergency department. Between January 1, 2018, and January 1, 2023, a total of 233 adult patients presenting to the Adult Emergency Department of Hacettepe University Hospitals were included. These patients were evaluated by the attending physician based on the 'Sepsis 3.0' criteria for sepsis diagnosis, with the focus of sepsis confirmed through imaging, sampling, or culture of the abdomen. The median age of the patients was determined to be 65 years. 45.5% of the patients were in the non￾survivor group. The most common complaints on presentation to the emergency department were abdominal pain (48.1%) and fever (31.3%). Evaluation of initial vital signs revealed lower body temperature in the non-survivor group (p<0.001). The most prevalent comorbidity was malignancy, identified in 63.5% of patients, with a higher prevalence of metastatic solid malignancy in the non-survivor group (p<0.001). The Charlson Comorbidity Index (CCI) score averaged 6.2±2.8, with a higher mean CCI score observed in the non-survivor group (p<0.001). Among the diagnoses causing intra-abdominal sepsis, cholangitis (21.9%) and intra-abdominal abscess (15.9%) were most commonly identified In the non-survivor group, higher SOFA (p=0.02) and SAPS-3 (p<0.001) scores, low BMI (<20) (p=0.02), ICU and total hospital stay durations (p<0.001), incidence of septic shock (p<0.001), need for vasopressor agents and mechanical ventilation (p<0.001) were observed.. The survivor group showed a higher rate of interventional procedures for source control (p<0.001). In conclusion, the data from our study indicate a high mortality rate in intra-abdominal sepsis, highlighting the necessity for developing management algorithms in the diagnosis and treatment of these patients, as well as for the development of predictive risk scoring systems for mortality. Key words: Intra-abdominal infection, sepsis, mortality, emergency department