PT  - JOURNAL ARTICLE
AU  - Shi, Yue
AU  - Tao, Tianzhu
AU  - Ye, Xiaofei
AU  - Ye, Bo
AU  - Mi, Weidong
AU  - Lou, Jingsheng
TI  - Risk factors for in-hospital mortality in surgical patients with abdominal sepsis in China: a nested case-control study
AID  - 10.1136/bmjopen-2024-092310
DP  - 2025 Apr 01
TA  - BMJ Open
PG  - e092310
VI  - 15
IP  - 4
4099  - http://bmjopen.bmj.com/content/15/4/e092310.short
4100  - http://bmjopen.bmj.com/content/15/4/e092310.full
SO  - BMJ Open2025 Apr 01; 15
AB  - Objectives To delineate the clinical characteristics and investigate the determinants that may affect the prognosis of surgical patients with abdominal sepsis.Design A case-control study was nested in a cohort of surgical patients with abdominal sepsis between 2008 and 2022. We extracted patient’ medical records to execute descriptive statistical analyses. Multiple logistic regression models and subgroup analysis were employed to elucidate the risk factors of in-hospital mortality.Setting Two tertiary hospitals in China.Participants 476 surgical patients diagnosed with abdominal sepsis between 2008 and 2022 were analysed.Interventions None.Outcome measures Descriptive statistics were used to examine pertinent patient information, including demographic details, laboratory findings, surgical interventions and anaesthetic records. Multivariate logistic regression was used to identify independent risk factors for in-hospital mortality. Subgroup analyses were conducted to explore the impact of specific clinical characteristics on outcomes.Results 476 patients diagnosed with abdominal sepsis were analysed, exhibiting an in-hospital mortality rate of 7.56%. Advanced age (OR 6.77, 95% CI 2.46 to 18.66, p<0.001), the presence of diabetes (OR 2.61, 95% CI 1.04 to 6.56, p=0.041) and higher preoperative Sequential Organ Failure Assessment (SOFA) score (OR 3.48, 95% CI 1.16 to 10.43, p=0.026) were identified as significant predictors of increased in-hospital mortality risk through a multinomial logistic regression model. Conversely, individuals afflicted with biliary diseases (OR 0.15, 95% CI 0.04 to 0.64, p=0.010) demonstrated a reduced risk of in-hospital mortality. Subgroup analysis revealed that low serum albumin levels emerged as a risk factor for in-hospital mortality in the patients with gastrointestinal diseases (OR 20.23, 95% CI 2.21 to 184.84, p=0.008) or advanced age (OR 10.52, 95% CI 2.29 to 48.31, p=0.002) through multinomial logistic regression analysis.Conclusion In this retrospective analysis, we delineated the clinical characteristics of surgical patients with abdominal sepsis and pinpointed risk factors associated with in-hospital mortality. These findings underscore the necessity for more tailored perioperative management strategies for patients with sepsis characterised by advanced age, diabetes, higher preoperative SOFA score and reduced preoperative albumin levels. Clinicians should prioritise early recognition and aggressive management of these high-risk individuals, including timely surgical intervention, optimisation of nutritional status and vigilant monitoring of organ function. These insights underscore the critical role of individualised care in enhancing the prognosis of surgical patients with abdominal sepsis.Trial registration number ChiCTR2400081823.Data are available in a public, open access repository. The data supporting the findings of this study are available at (https://doi.org/10.6084/m9.figshare.25523737.v1).