RESUMO
PURPOSE: To estimate the effect of each of the EGDT components, as well as of the antibiotics, on length-of-stay and mortality. METHODS: Prospective cohort in three hospitals. Adult patients admitted by the Emergency Rooms (ER) with infection and any of systolic blood pressureâ¯<â¯90â¯mmHg or lactate >4â¯mmol/L. An instrumental analysis with hospital of admission as the instrumental variable was performed to estimate the effect of each intervention on hospital mortality and secondary outcomes. RESULTS: Among 2587 patients evaluated 884 met inclusion criteria, with a hospital mortality rate of 17% (nâ¯=â¯150). In the instrumental analysis, the only intervention associated with an absolute reduction in mortality (21%) was the use of antibiotics in the first 3â¯h. In patients with lactate values ≥4â¯mmol/L in the ER, a non-decrease of at least 10% at six hours was independently associated with mortality (ORâ¯=â¯3.1; 95%CIâ¯=â¯1.5-6.2). CONCLUSIONS: Among patients entering ER with infection and shock or hypoperfusion criteria, the use of appropriate antibiotics in the first 3â¯h is the measure that has the greatest impact on survival. In addition, among patients with hyperlactatemia >4â¯mmol/L, the clearance of >10% of lactate during resuscitation is associated with better outcomes.