LAUSR

BACKGROUND Pulmonary and abdominal sepsis have pathophysiologically distinct phenotypes. This study aimed to compare their clinical characteristics and predictors of mortality. METHODS In this multicenter retrospective trial, 1,359 adult patients who fulfilled the Sepsis-3 criteria were enrolled and classified into the pulmonary sepsis or abdominal sepsis groups. Plasma presepsin were measured, and the scores of Acute Physiological and Chronic Health Assessment (APACHE) II, Mortality in Emergency Department Sepsis (MEDS) and Simplified Acute Physiology Score (SAPS) II were calculated at enrollment. A 28-day mortality was collected for all patients. RESULTS Compared to patients with abdominal sepsis (n = 464), patients with pulmonary sepsis (n = 895) had higher 28-day mortality rate, illness severity scores, incidence of shock and acute kidney injury (AKI), and hospitalization costs. Lactate level, and APACHE II and MEDS scores were independently associated with 28-day mortality in both sepsis types. Independent predictors of 28-day mortality included PaO2/FiO2 ratio (hazard ratio [HR], 0.998; p < 0.001) and AKI (HR, 1.312; p = 0.039) in pulmonary sepsis, and SAPS II (HR, 1.037; p = 0.017) in abdominal sepsis. A model that combined APACHE II score, lactate and MEDS score or SAPS II score had the best area under the receiver operating characteristic curve in predicting mortality in patients with pulmonary sepsis or abdominal sepsis, respectively. Interaction term analysis confirmed the association between 28-day mortality and lactate, APACHE II score, MEDS score, SAPS II, and shock according to the sepsis subgroups. The mortality of patients with pulmonary sepsis was higher than that of patients with abdominal sepsis among patients without shock (32.9% vs. 8.8%; p < 0.001) but not among patients with shock (63.7 vs. 48.4%; p = 0.118). CONCLUSIONS Patients with pulmonary sepsis had higher 28-day mortality than patients with abdominal sepsis. The study identified sepsis subgroup-specific mortality predictors. Shock had a larger effect on mortality in patients with abdominal sepsis than in those with pulmonary sepsis.