Purpose: Hospital services are reduced during off-hour such as nighttime or weekend. Investigations of the off-hour effect on initial management and outcomes in sepsis are very limited. Thus, we tested the hypothesis that patients who were diagnosed with severe sepsis during the nighttime or on non-business days had altered initial management and clinical outcomes. Materials and methods: Patients with severe sepsis from 59 ICUs between 2016 and 2017 were enrolled. The patients were categorized according to the diagnosis time or day and were then compared. The primary outcome was in-hospital mortality. Results: One thousand one hundred and forty-eight patients were analyzed; 769 daytime patients, vs. 379 nighttime patients, and 791 business day patients vs. 357 non-business day patients. There were no significant differences in in-hospital mortality between either daytime and nighttime (24.4% vs. 21.4%, P =.27; nighttime, adjusted odds ratio [OR]1.17, 95% confidence interval [CI], 0.87–1.59, P =.30)or between business and non-business days (22.9% vs. 24.6%, P =.55; non-business day, adjusted OR 0.85, 95% CI 0.60–1.22, P =.85). Time to antibiotics was significantly shorter in the nighttime (114 vs. 89 min, P =.0055). Conclusions: Nighttime and weekends were not associated with increased in-hospital mortality of severe sepsis.

Original languageEnglish
Pages (from-to)97-102
Number of pages6
JournalJournal of Critical Care
Publication statusPublished - 2019 Aug


  • Mortality
  • Nighttime
  • Off-hour effect
  • Sepsis
  • Severe sepsis
  • Weekend


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