The impact of acute organ dysfunction on long-term survival in sepsis

Alejandro Schuler, David A. Wulf, Yun Lu, Theodore J. Iwashyna, Gabriel J. Escobar, Nigam H. Shah, Vincent X. Liu

Research output: Contribution to journalArticlepeer-review

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 quantifed using modifed 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 longterm mortality and represents a key mediator of long-term adverse outcomes following sepsis.

Original languageEnglish (US)
Pages (from-to)843-849
Number of pages7
JournalCritical care medicine
Volume46
Issue number6
DOIs
StatePublished - 2018
Externally publishedYes

Keywords

  • Brain dysfunction
  • Long-term mortality
  • Organ dysfunction
  • Outcomes research
  • Sepsis

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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