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Crit Care Med. 2018 Jun;46(6):843-849. doi: 10.1097/CCM.0000000000003023.

The Impact of Acute Organ Dysfunction on Long-Term Survival in Sepsis.

Author information

1
Biomedical Informatics Research, Department of Medicine, Stanford University, Stanford, CA.
2
Division of Research, Kaiser Permanente Northern California, Oakland, CA.
3
Department of Medicine and Institute for Social Research, University of Michigan and VA Center for Clinical Management Research, VA Ann Arbor Health Healthcare System, Ann Arbor, MI.

Abstract

OBJECTIVES:

To estimate the impact of each of six types of acute organ dysfunction (hepatic, renal, coagulation, neurologic, cardiac, and respiratory) on long-term mortality after surviving sepsis hospitalization.

DESIGN:

Multicenter, retrospective study.

SETTINGS:

Twenty-one hospitals within an integrated healthcare delivery system in Northern California.

PATIENTS:

Thirty thousand one hundred sixty-three sepsis patients admitted through the emergency department between 2010 and 2013, with mortality follow-up through April 2015.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Acute organ dysfunction was quantified using modified Sequential Organ Failure Assessment scores. The main outcome was long-term mortality among sepsis patients who survived hospitalization. The estimates of the impact of each type of acute organ dysfunction on long-term mortality were based on adjusted Cox proportional hazards models. Sensitivity analyses were conducted based on propensity score-matching and adjusted logistic regression. Hospital mortality was 9.4% and mortality was 31.7% at 1 year. Median follow-up time among sepsis survivors was 797 days (interquartile range: 384-1,219 d). Acute neurologic (odds ratio, 1.86; p < 0.001), respiratory (odds ratio, 1.43; p < 0.001), and cardiac (odds ratio, 1.31; p < 0.001) dysfunction were most strongly associated with short-term hospital mortality, compared with sepsis patients without these organ dysfunctions. Evaluating only patients surviving their sepsis hospitalization, acute neurologic dysfunction was also most strongly associated with long-term mortality (odds ratio, 1.52; p < 0.001) corresponding to a marginal increase in predicted 1-year mortality of 6.0% for the presence of any neurologic dysfunction (p < 0.001). Liver dysfunction was also associated with long-term mortality in all models, whereas the association for other organ dysfunction subtypes was inconsistent between models.

CONCLUSIONS:

Acute sepsis-related neurologic dysfunction was the organ dysfunction most strongly associated with short- and long-term mortality and represents a key mediator of long-term adverse outcomes following sepsis.

PMID:
29432349
PMCID:
PMC5953770
DOI:
10.1097/CCM.0000000000003023
[Indexed for MEDLINE]
Free PMC Article

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