The Early Management Bundle for Severe Sepsis/Septic Shock (SEP-1) is a quality metric recommended for all patients with sepsis, but it has been studied mainly in those with community-onset sepsis. In a retrospective cohort study, researchers assessed the association of SEP-1 with mortality and organ function in adults with community- or hospital-onset sepsis.

Hospital-onset sepsis was defined as occurrence of "time 0" after patient arrival on an inpatient unit; community-onset sepsis was defined as occurrence of time 0 after patient arrival in the ED. Treatments evaluated included the SEP-1 care bundle and the four components required within three hours of time 0: blood culture results; broad-spectrum antibiotic treatment; serum lactate level testing; and intravenous fluids if blood pressure was low or the lactate level was high.

SEP-1-adherent care was administered to 39.9% of the 4,108 patients with community-onset sepsis and 12.2% of the 2,296 patients with hospital-onset sepsis.

SEP-1-adherent care wasn't associated with reduced mortality or fewer days requiring vasopressor treatment in either cohort or in the sample overall. Multiple individual components of SEP-1 were, however, associated with improved outcomes in patients with community-onset sepsis. Measurement of serum lactate level was associated with a lower mortality risk, and blood cultures and broad-spectrum antibiotic treatment were associated with fewer vasopressor days. Only broad-spectrum antibiotic treatment was associated with reduced mortality in patients with hospital-onset sepsis.

Current sepsis quality metrics may need to be revised, the authors conclude. They also note that their study had several limitations. The use of propensity scores, for instance, may lead to an inaccurate estimation of the association between treatment and outcomes. Additionally, mortality is a relatively insensitive outcome, and the researchers didn't obtain postdischarge data.