A Multi-center Prospective Observational Study Of The Value Of Hour-1 Bundle In Patients With Septic Shock Based On Sepsis-3 Definition

Objective: To explore the value of hour-1 bundle on the 30-day mortality of patients with septic shock based on sepsis-3 definition.Methods: This is a multicentre prospective cohort study.Patients with septic shock based on sepsis-3 definition were admitted to Northern Jiangsu People’s Hospital and Jiangsu Taizhou Hospital in intensive care unit(ICU)from January 2018 to June 2019.Enrolled patients were divided as the hour-1 bundle finished group and the unfinished group according to whether hour-1 bundle treatment was complete.The hour-1 bundle elements are as follows: 1.Measure lactate level,2.Obtain blood culture before using antibiotics,3.Administer broad-spectrum antibiotics,4.Low blood pressure or lactic acid level ≥ 4 mmol/L,start rapid infusion of 30ml/kg crystal fluid,5.Apply vasopressor to maintain the mean arterial pressure≥65mm Hg when patients are still in low blood pressure during or after fluid resuscitation.Record patient’s age,gender,underlying diseases,source of infection,vital signs within 24 hours of admission to ICU,Sequential Organ Failure Assessment(SOFA),Acute Physiology and Chronic Health Evaluation II(APACHE II),time of bundle completion,ICU length of stay,total hospitalization time,30-day mortality and other clinical data.The log-rank test was used to compare Kaplan–Meier survival curves.According to the 30-day prognosis,they were divided into survival group and death group.The multivariate logistic regression was performed to find the risk factors affecting the prognosis of the patients with septic shock.Results: A total of 184 patients with septic shock were enrolled,including 61 patients(33.2%)in the hour-1 bundle finished group and 123 patients(66.8%)in the unfinished group.The 30-day mortality of the hour-1 bundle finished group was 24.6%(15/61)and 36.6%(45/123)in the unfinished group,with no significant difference between the two groups(P= 0.102).Kaplan-Meier survival analysis revealed the 30-day cumulative survival rate of the hour-1 bundle finished group was higher than the unfinished group,but the two groups was not significant(P=0.094).We divided the patients into the completed group and the uncompleted group according to whether the element of hour-1 bundle treatment was completed or not.The 30-day mortality was 23.5% in completed antibiotic group and 39.8% in uncompleted group.The difference between the two groups was statistically significant(P =0.019).However,there was no significant difference in the other element of hour-1 bundle treatment(P> 0.05).Univariate analysis was performed on variables that affected 30-day mortality in patients with septic shock.Age,time to starting antibiotics,SOFA score,APACHE II score,hypertension,hour-1 bundle were analyzed by logistic regression analysis.Age(OR: 1.036,95%CI: 1.010-1.062),SOFA(OR: 1.102,95%CI: 1.002-1.213)and APACHE II(OR: 1.090,95%CI: 1.018-1.618)were independent risk factors for 30-day mortality in patients with septic shock.Conclusion: This study shows that hour-1 bundle cannot reduce 30-day mortality in patients with septic shock.However,giving antibiotics in one hour can reduce the 30-day mortality in patients with septic shock.Age,SOFA and APACHE II scores were independent risk factors for 30-day mortality in patients with septic shock.