Welcome to the latest key papers and publications focussing mainly on all things sepsis in the nursing profession.
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Factors and outcomes associated with under- and overdiagnosis of sepsis in the first hour of emergency department care
Abstract: Background: Sepsis remains the leading cause of in-hospital death and one of the costliest inpatient conditions in the United States, while treatment delays worsen outcomes. We sought to determine factors and outcomes associated with a missed emergency physician (EP) diagnosis of sepsis.
Methods: We conducted a secondary analysis of a prospective single-center observational cohort of undifferentiated, critically ill medical patients (September 2020–May 2022). EP gestalt of suspicion for sepsis was measured using a visual analog scale (VAS; 0%–100%) at 15 and 60 min post–patient arrival. The primary outcome was an explicit hospital discharge diagnosis of sepsis that was present on arrival. We calculated test characteristics for clinically relevant subgroups and examined factors associated with initial and persistent missed diagnoses. Associations with process (antibiotics) and clinical (mortality) outcomes were assessed after adjusting for severity.
Results: Among 2484 eligible patients, 275 (11%) met the primary outcome. A VAS score of ≥50 (more likely than not of being septic) at 15 min demonstrated sensitivity 0.83 (95% confidence interval [CI] 0.78–0.87) and specificity 0.85 (95% CI 0.83–0.86). Older age, hypoxia, hypotension, renal insufficiency, leukocytosis, and both high and low temperature were significantly associated with lower accuracy due to reduced specificity, but maintained sensitivity. Of 48 (17%) and 23 (8%) missed cases at 15 and 60 min, elevated lactate, leukocytosis, bandemia, and positive urinalysis were more common in the missed sepsis compared to nonsepsis cases. Missed diagnoses were associated with median (interquartile range) delay of 48 (27–64) min in antibiotic administration but were not independently associated with inpatient mortality as risk ratios remained close to 1 across VAS scores.
Conclusions: This prospective single–academic center study identified patient subgroups at risk of impaired diagnostic accuracy of sepsis, with clinicians often overdiagnosing rather than underdiagnosing these groups. Prompt abnormal laboratory test results can “rescue” initial missed diagnoses, serving as potential clinician- and systems-level intervention points to reduce missed diagnoses. Missed diagnoses delayed antibiotics, but not mortality after controlling for severity of illness.
Source: Pandy Shivansh R. Academic Emergency Medicine, 2024 Dec; 32(3):
Development and validation of a prediction model for in-hospital mortality in patients with sepsis
Abstract: Background: Sepsis, a life-threatening condition marked by organ dysfunction due to a dysregulated host response to infection, involves complex physiological and biochemical abnormalities.
Aim: To develop a multivariate model to predict 4-, 6-, and 8-week mortality risks in intensive care units (ICUs).
Study Design: A retrospective cohort of 2389 sepsis patients was analysed using data captured by a clinical decision support system. Patients were randomly allocated into training (n = 1673) and validation (n = 716) sets at a 7:3 ratio. Least Absolute Shrinkage and Selection Operator (LASSO) regression identified variables incorporated into a multivariate Cox proportional hazards regression model to construct a prognostic nomogram. The area under the receiver operating characteristic curve (AUROC) assessed model accuracy, while performance was evaluated for discrimination, calibration and clinical utility.
Results: A risk score was developed based on 11 independent predictors from 35 initial factors. Key predictors included minimum Acute Physiology and Chronic Health Evaluation II (APACHE II) score as having the greatest impact on prognosis, followed by days of mechanical ventilation, number of vasopressors, maximum and minimum Sequential Organ Failure Assessment (SOFA) scores, infection sources, Gram-positive or Gram-negative bacteria and malignancy. The nomogram demonstrated superior discriminative ability, with AUROC values of 0.882 (95% confidence interval [CI], 0.855–0.909) and 0.851 (95% CI, 0.804–0.899) at 4 weeks; 0.836 (95% CI, 0.798–0.874) and 0.820 (95% CI, 0.761–0.878) at 6 weeks; and 0.843 (95% CI, 0.800–0.887) and 0.794 (95% CI, 0.720–0.867) at 8 weeks for training and validation sets, respectively.
Conclusion: A validated nomogram and web-based calculator were developed to predict in-hospital mortality in ICU sepsis patients. Targeting identified risk factors may improve outcomes for critically ill patients.
Relevance to Clinical Practice: The developed prediction model and nomogram offer a tool for assessing in-hospital mortality risk in ICU patients with sepsis, potentially aiding in nursing decisions and resource allocation.
Source: Shi W. Nursing in Critical Care, 2025 Apr; 30(3):
Investigating key factors of feeding intolerance in sepsis: A scoping review
Abstract: Background: At present, domestic and international research on the current status of feeding intolerance in septicemia patients only stops at the study of influencing factors; however, due to the specificity of the disease, the influencing factors are numerous and controversial.
Aims: To systematically analyse the studies related to the occurrence of feeding intolerance in patients with sepsis, to find out the influencing factors of feeding intolerance in these patients and to provide a reference for nursing staff to develop relevant interventions.
Study Design: The study employed Arksey and O'Malley's methodology to carry out a scoping review. We conducted a systematic search, using the scoping review as a framework, for relevant Chinese and English literature on factors influencing feeding intolerance in patients with sepsis in China Knowledge Network, Wanfang, CINAHL, Pubmed, Web of Science and Google Scholar, covering a time frame from construction to 1 September 2024. We identified research questions, completed literature screening and quality assessment, extracted data and summarized and analysed the data.
Results: The review included a total of 13 papers. Factors influencing feeding intolerance in septicemia patients included patient factors, disease factors, biochemical indicators, feeding determinants, clinical treatment and drug effects.
Conclusions: Factors affecting feeding intolerance in patients with sepsis are multifaceted. We should develop individualized care plans based on relevant risk factors to improve feeding tolerance and shorten hospital stays in patients with sepsis.
Relevance to Clinical Practice: In order to improve the ability of ICU nurses to identify the risk factors of feeding intolerance in patients with sepsis, it is recommended to conduct systematic training on the pathophysiology of sepsis, influencing factors of feeding intolerance and intervention measures and assist nurses to implement appropriate intervention measures.
Source: Ling Y. Nursing in Critical Care, 2025 Apr; 30(3):
The triglyceride glucose index and delirium risk in sepsis patients: A causal inference study
Abstract: Background: Sepsis, a grave systemic infection, presents substantial health challenges. While insulin resistance frequently occurs in sepsis conditions, its relationship with sepsis-associated delirium remains insufficiently explored.
Aim: This study aimed to explore the causal effect between the triglyceride glucose (TyG) index and its risk of delirium in patients with sepsis through the use of causal inference.
Study Design: A cohort of 5461 sepsis patients admitted to the intensive care unit (ICU) was selected from the Medical Information Mart for Intensive Care IV database. Patients were grouped into high TyG (≥9.48) and low TyG (<9.48) categories. Propensity score matching was applied to control for confounders, and the average treatment effect on the treated was calculated.
Results: Of the 5461 patients, 59.6% experienced delirium. The incidence of delirium was higher in the high TyG group (1751 patients; 66.6%) than in the low TyG group (56.3%) (p < .001). The results of the logistic regression analysis indicated that the risk of delirium was significantly higher in the high TyG group (adjusted odds ratio 1.34, 95% confidence interval: 1.16–1.53). Following matching, the delirium risk increased by 6.9% in the high TyG group (T = 3.29), a finding that was confirmed by a Rosenbaum sensitivity analysis.
Conclusions: The TyG index represents a straightforward and efficacious instrument for nursing staff to ascertain the likelihood of delirium in patients with sepsis during the routine monitoring of their condition. The ability to make causal inferences in observational studies provides a novel approach to research.
Relevance to Clinical Practice: The TyG index represents a readily applicable instrument for ICU nurses to identify the risk of delirium in sepsis patients. This enables the possibility of early intervention in high-risk individuals and the optimization of care outcomes.
Source: Li X. Nursing in Critical Care, 2025 Feb; 30(2):
Decreased racial disparities in sepsis mortality after an order set–driven initiative: An analysis of 8151 patients
Abstract: Background: Sepsis is a leading cause of hospital mortality and there is evidence that outcomes vary by patient demographics including race and gender. Our objectives were to determine whether the introduction of a standardized sepsis order set was associated with (1) changes in overall mortality or early antibiotic administration or (2) changes in outcome disparities based on race or gender.
Methods: Patients seen in the emergency department and admitted to the hospital with a diagnosis code of sepsis were identified and divided into a preintervention cohort seen during the 18 months prior to the initiation of a new sepsis order set and an intervention cohort seen during the 18 months after a quality initiative driven by introducing the order set. Associations between time period, race, gender, and mortality were assessed using univariate and multivariate logistic regression models. Other outcomes included early antibiotic administration (<3 h from arrival).
Results: Overall mortality was unchanged during the intervention period (7.8% vs. 7.2%) in both univariate (relative risk [RR] 1.08, 95% confidence interval [CI] 0.93–1.26) and multivariate logistic regression (RR 1.11, 95% CI 0.93–1.28) models. Although male gender tended to have higher mortality, there was no statistically significant association between gender and mortality in either cohort. In the multivariable model, Black race was associated with increased risk of death in the preintervention period (RR 1.41, 95% CI 1.02–1.94), but this association was not present in the intervention period. Patients of color also saw significantly more improvement in early antibiotic administration during the intervention period than White patients.
Conclusions: An order set–driven sepsis initiative was not associated with overall improved mortality but was associated with decreased racial disparities in sepsis mortality and early antibiotics.
Source: Fernandez Olivera Maria L. Academic Emergency Medicine, 2025 Jan; Early View
Diagnostic safety and quality optimization in sepsis study protocol
Abstract: Background: Sepsis ranks among the “Big Three" conditions most prone to harmful diagnostic errors. Despite its high prevalence and severity, health systems lack effective and contextually tailored strategies to optimize diagnostic accuracy for sepsis.
Objectives: The purpose of this study is to understand factors related to high sepsis diagnostic accuracy using principles and tools of safety and implementation science.
Methods: This is a multi-site study involving 20 hospitals across four states in the United States. The primary objectives are to (1) describe hospital-level variability and understand barriers and facilitators to sepsis diagnostic accuracy and (2) apply cross-case and coincidence analysis to determine minimally sufficient and necessary conditions for optimal sepsis diagnosis that minimizes under- and overtreatment. To identify barriers and facilitators of acute sepsis diagnosis, we will conduct electronic surveys and in-depth interviews with key informants from each hospital. We will use data from electronic health records (EHR) and data warehouses to operationalize sepsis diagnostic accuracy.
Results: We have enrolled 20 hospitals and begum data collection. The findings of this study will be used to develop a context-specific toolkit that guides the selection of feasible and important strategies to promote optimal sepsis diagnosis in diverse hospitals settings.
Conclusions: The study uses tools and principles from safety and implementation science to generate first-of-its-kind evidence to improve diagnostic excellence in sepsis.
Source: Shrestha Sachita. Journal of Hospital Medicine, 2025 Apr; Early View
Association between optimum blood glucose level and mortality in critically ill patients with septic shock: A real-world time-series data analysis
Abstract: Background: Sepsis remains a significant health challenge in ICU, with septic shock requiring meticulous glycaemic management due to metabolic dysregulation. Existing research highlights the detrimental effects of both hyperglycaemia and hypoglycaemia on septic patient outcomes, emphasizing the need for effective glycaemic control. Despite extensive studies, optimal glycaemic targets in septic shock patients remain contentious and unclear, necessitating further research.
Aim: Our study aims to identify optimal glycaemic targets for patients in septic shock by analysing time-series blood glucose data.
Study Design: This retrospective observational study utilized the MIMIC-IV database, encompassing ICU patients diagnosed with septic shock from 2008 to 2019. We extracted time-series blood glucose data and applied the Stineman interpolation to achieve a standardized resolution. The primary analysis involved calculating the time-weighted average blood glucose (TWA-BG) and examining its relationship with 28-day mortality using a restricted cubic spline model within a Cox regression framework. Sensitivity analyses with multiple models and subgroup analyses were used to reveal the robustness of the results.
Results: From 34 677 identified septic patients, 11 375 met the inclusion criteria. The optimal TWA-BG range, associated with the lowest 28-day mortality risk, was determined to be 105 to 131 mg/dL. Patients within this range exhibited significantly lower mortality rates compared to those with higher or lower TWA-BG levels. Sensitivity analyses confirmed these findings, indicating robustness across various subgroups and analytical models.
Conclusions: Our findings suggest that maintaining TWA-BG levels between 105 and 131 mg/dL minimizes the risk of 28-day, ICU, and in-hospital mortality in patients with septic shock.
Relevance to Clinical Practice: The results provide evidence-based guidance for ICU nursing interventions, advocating for a precise TWA-BG range to be maintained for septic shock patients, thus potentially setting new benchmarks for glycaemic control in critical care settings.
Source: Muhetaer Gulizeba. Nursing in Critical Care, 2025 Mar; 30(2):
Critical care nurses’ knowledge, confidence, and clinical reasoning in sepsis management: a systematic review
Abstract: Background: Sepsis is a critical condition with high global mortality, accounting for 11 million deaths annually. Nurses are central to sepsis management, and their knowledge, confidence, and clinical reasoning significantly impact patient outcomes.
Aim: This systematic review evaluates critical care nurses’ knowledge, confidence, and clinical reasoning in sepsis management and examines factors influencing these competencies.
Methods: A comprehensive search of PubMed, CINAHL, MEDLINE, Scopus, EMBASE, and the Cochrane Library was conducted, covering studies published from 2014 to 2023. Studies were included if they assessed knowledge, confidence, or clinical reasoning in sepsis management among critical care nurses using quantitative, qualitative, or mixed-methods approaches in clinical settings. Only peer-reviewed studies were considered to ensure academic rigor. The risk of bias was assessed using the JBI Checklist for quantitative studies and the CASP tool for qualitative studies, with discrepancies resolved through discussion or a third reviewer. A total of 70 records were screened, with 25 studies (sample sizes ranging from 28 to 835 nurses) meeting the inclusion criteria. Data extraction focused on study design, tools used, and key outcomes related to knowledge, confidence, and clinical reasoning in sepsis management.
Results: Across 25 studies involving over 5,000 nurses globally, knowledge scores were moderate, with significant gaps in early sepsis recognition (e.g., only 52% of nurses could define sepsis). In three studies, confidence improved with sepsis-specific training, showing a 10–25% increase post-intervention. Clinical reasoning was influenced by organizational factors, experience, and the use of technology, with decision-support tools enhancing timely sepsis recognition and reducing mortality by up to 23%.
Conclusion: This review provides a global perspective on sepsis management among critical care nurses, strengthened by diverse study designs. However, limitations include variability in measurement tools, self-reporting bias, small sample sizes, and language-based selection bias. Continuous education, targeted training, and the integration of AI-driven decision tools are essential to improving sepsis outcomes. Addressing gaps in sepsis knowledge and promoting better clinical reasoning will enhance the overall quality of care in critical settings.
Source: Abdalhafith O. BMC Nursing, 2025 ; 24:
Sepsis and Septic Shock Management and Care: A Case Presentation
Abstract: Approximately 1.7 million adults in America develop sepsis annually (Centers for Disease Control and Prevention [CDC], 2024). [...]350,000 Americans were reported to have died of sepsis in hospital settings. An increased chance of capillary leakage results in hypotension followed by an immunosuppression phase of the immune system. Because of the deregulation of the immune system, the host fails to control the infection; this can cause organ failure and death. Understanding the pathophysiology of sepsis helps nurses provide safe care, improve patients' quality of life, and plan therapeutic interventions to improve patients' survival in hospital settings. Discussion Nurses from the medical-surgical unit need to perform a thorough physical assessment when caring for a patient with sepsis to aid in effective management and treatment. Because sepsis may have widespread effects, the nurse must assess the neurological, respiratory, cardiovascular, gastrointestinal, and genitourinary systems.
Source: Cadet Myriam J. Medsurg Nursing, 2024 Sep/Oct; 33(5):
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Association between comorbidities at ICU admission and post-Sepsis physical impairment: A retrospective cohort study
Abstract: Purpose: Few studies have measured the association between pre-existing comorbidities and post-sepsis physical impairment. The study aimed to estimate the risk of physical impairment at hospital discharge among sepsis patients, adjusting for pre-existing physical impairment prior to ICU admission and in-hospital mortality.
Materials and methods: We analyzed all consecutive adult patients admitted to an ICU in a tertiary community hospital, Kameda Medical Center, with sepsis diagnosis from September 2014 to October 2020. Inverse probability attrition weighting using machine learning was employed to estimate the risk of physical impairment at hospital discharge for sepsis patients with and without pre-existing comorbidities at ICU admission. This estimation was adjusted for baseline covariates, pre-ICU physical impairment, and in-hospital mortality.
Results: Of 889 sepsis patients analyzed, 668 [75.1%] had at least one comorbidity and 221 [24.9%] had no comorbidities at ICU admission. Upon adjusting for baseline covariates, pre-ICU physical impairment, and in-hospital mortality, pre-existing comorbidities were not associated with an elevated risk of physical impairment at hospital discharge (RR: 1.02, 95% CI: 0.92, 1.14).
Conclusions: Pre-existing comorbidities prior to ICU admission were not associated with an increased risk of physical impairment at hospital discharge among sepsis patients after adjusting for baseline covariates and in-hospital mortality.
Source: Gildea A. BMJ, 2024 June; 385: q1173
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Improving Early Identification of Sepsis with a Modified Early Warning Score Review Tool
Abstract: Use of a sepsis screening tool led to a significant decrease in mortality and hospital length of stay, as well as earlier identification of sepsis and timelier treatment. Implementation of the Change in Practice During the unfreezing phase of the change (Lewin, 1951), hospital leaders identified sepsis as an underlying problem in recent morbidity and mortality cases on inpatient units. Hospital leaders, including quality management, and chief nursing and chief medical officers, were briefed on the extent of the problem by the project team (clinical nurse specialist [CNS], CNS student). [...]this project served as a temporary measure until information on the new EHR and its embedded screening tools were released.
Source: Lorenz Megan E. Medsurg Nursing, 2024 Nov/Dec; 33(6): 287-292
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Modified frailty index effectively predicts adverse outcomes in sepsis patients in the intensive care unit
Abstract: Background: Frailty and sepsis have a significant impact on patient prognosis. However, research into the relationship between frailty and sepsis in the general adult population remains inadequate. This paper aims to investigate the association between frailty and adverse outcomes in this population.
Method: This retrospective analysis investigated sepsis patients who were initially admitted to the intensive care unit (ICU). The Modified Frailty Index (MFI) was derived by tracking patients’ International Classification of Diseases (ICD) codes during their hospitalization. Patients were classified into two groups based on their MFI scores: a frail group (MFI ≥ 3) and a non-frail group (MFI = 0–2). The key outcomes were mortality rates at 90 and 180 days, with secondary outcomes including the incidence of delirium and pressure injury.
Result: Of the 21,338 patients who were recruited for this study (median age about 68 years, 41.8 % female), 5,507 were classified as frail and 15,831 were classified as non-frail. Frail patients were significantly more likely to have delirium (48.9 % vs. 36.1 %, p < 0.001) and pressure injury (60.5 % vs. 51.4 %, p < 0.001). After controlling for confounding variables, the multifactorial Cox proportional hazard regression analyses revealed a significantly elevated mortality rate at 90 days (adjusted HR: 1.58, 95 % CI: 1.24–2.02, p < 0.001) and 180 days (adjusted HR: 1.47, 95 % CI: 1.18, 1.83, p < 0.001) in the frail group compared to their non-frail counterparts.
Conclusions: Frailty independently predisposes adult sepsis patients in the ICU to adverse outcomes. Future investigations should concentrate on evaluating frailty and developing targeted interventions to improve patient prognosis.
Implication for clinical practice: The MFI provides a simple clinical assessment tool that can be integrated into electronic medical records for immediate calculation. This simplifies the assessment process and plays a key role in predicting patient outcomes.
Source: Li X. Intensive & Critical Care Nursing, 2024 Oct; 84:
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Early sepsis recognition: Is hypothermia the most neglected symptom?
Abstract: Sepsis is a heterogenous syndrome characterized by a life-threatening organ dysfunction due to a dysregulated host response to infection. Despite all efforts in infection prevention and control and advances in modern medicine, sepsis even nowadays remains an important cause of morbidity and mortality. As early aggressive treatment has been proven to improve survival, sepsis can be considered a time-sensitive emergency: early sepsis recognition results in timely intervention and therefore in better patient outcomes.
Source: Papathanakos G. Intensive & Critical Care Nursing, 2024 Oct; 84:
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Sepsis: the latest guidance on identification and management
Abstract: Sepsis is a life-threatening condition caused by the body's response to an infection. This article explores the role of assessment tools in sepsis identification, as well as the Sepsis Six strategy, which is used to treat the condition. One Sepsis Six intervention is the use of antibiotics; when used unnecessarily, these can contribute to antimicrobial resistance, so considering antimicrobial stewardship is an important aspect of sepsis management.
Source: Ahmed F. Nursing Times, 2024 Oct; 120(10): 36-39
