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Study IDs factors associated with long-term mortality in sepsis survivors
A study of almost 95,000 adult sepsis survivors identified risk factors present at index critical care admission that were independently associated with long-term mortality and could be used to identify high-risk patients, researchers reported.
They included increasing age, male sex, nonsurgical status, multiple organ dysfunctions and other generic and sepsis-specific risk factors.
“Sepsis survivors, defined as adult patients who survived to hospital discharge following a critical care unit admission for sepsis, are at increased risk of long-term mortality,” Manu Shankar-Hari, PhD, MSc, of the ICU support offices at St. Thomas’ Hospital in London, and colleagues wrote. “Identifying factors independently associated with long-term mortality, known during critical care admission for sepsis, could inform targeted strategies to reduce this risk.”
For their study, Shankar-Hari and colleagues studied a sample of 94,748 adult sepsis survivors from 192 critical care units in England identified from consecutive admissions between April 1, 2009, and March 31, 2014, with survival status ascertained as of March 31, 2015.
Results showed that sepsis survivors had a mean age of 61.3 years, 46% were female and 90.8% were white. Additionally, the researchers found that 46.3% had a respiratory infection — the most common site — and 15% had died by 1 year after hospital discharge.
Additional characteristics that were associated with long-term mortality included having one or more severe comorbidities and prehospitalization dependency. The study showed that having two or three organ dysfunctions was associated with increased risk of long-term mortality compared with one (adjusted HR = 1.07; 95% CI, 1.01-1.13; and adjusted HR = 1.18; 95% CI, 1.03-1.14, respectively), but having four or more was not.
“Our research provides validity to target sepsis survivor populations based on index admission characteristics, for biological characterization and designing interventions to reduce long-term mortality,” the authors concluded. – by Caitlyn Stulpin
Disclosures: The authors report no relevant financial disclosures.
Perspective
Back to TopFor decades, physicians and other medical care providers practicing on the front lines of acute-care medicine have struggled with the ambiguities surrounding the medical condition known as sepsis, to the point that patients and family members seem to be emotionally relieved when told that that one’s diagnosis is a complicated bacteremic UTI instead of sepsis, unaware that they are essentially both the same. Nevertheless, true sepsis accounts for approximately one-third of in-hospital mortalities, lengthy hospital stays and excessive medical expenditures. The observed increase in sepsis diagnoses over the past few decades has been attributed to factors such as an aging population, more persons with immunocompromised conditions and/or undergoing immune suppressant treatments and invasive diagnostic and therapy procedures. However, it seems more plausible to attribute the escalated number of cases to the liberal application of a condition known as systemic inflammatory response syndrome (SIRS) with the requisite that if two of four parameters composed of three commonly observed vital signs (heart rate, respiratory rate, temperature) and one laboratory measurement (white blood cell count and differential) were satisfied, along with a suspicion of infection (proven or not), then the patient was defined as being septic. If and when these prerequisites were met, an array of often unnecessary and potentially deleterious interventions would be set into motion, thus the newly coined term ”code sepsis.” Dependence on the overly sensitive yet nonspecific nature of SIRS in large part surely accounted for the sudden increase in numbers of sepsis cases (larger denominator) and decrease in hospitalized patient sepsis mortality (smaller numerator) regardless of the actions taken (3-h and 6-h and now 1-h surviving sepsis bundles) adopted by many hospitals because a great number of patients deemed to be septic had one of many other qualifying reasons to fulfill the SIRS criteria and their ultimate outcomes were independent of the bundle interventions.
Many of us had hoped that The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3), published in 2016, stating that the new definition is based on our current understanding of sepsis-induced changes in organ function, morphology, cell biology, biochemistry, immunology and circulation — all referred to as pathobiology — would help to improve how potential sepsis cases are diagnosed and managed in the hospital setting. However, because of imposed governmental agency regulations, core measures and financial consequences, the concept and handling of sepsis both practically and administratively remains in “the eye of the beholder.” To that end, the Infectious Diseases Society of America has not endorsed the surviving sepsis campaign guidelines, mostly because of concerns centered on the unwarranted and potentially harmful effects of treating patients who at first appear to suffer from an infection but after a more thorough work-up actually are not septic. The argument opposing this position is found in data in the Sepsis-3 criteria that firmly link improved survival with early and aggressive interventions, including appropriate antimicrobial therapy, in patients presenting with hypotension, respiratory failure, and altered mental status (ie, HAT, qSOFA).