Short-Term Organ Dysfunction Is Associated With Long-Term (10-Yr) Mortality of Septic Shock. Issue 8 (August 2016)

• Record Type: Journal Article
• Authors: Linder, Adam; Lee, Terry; Fisher, Jane; Singer, Joel; Boyd, John; Walley, Keith R.; Russell, James A.
• Is Part Of: Critical care medicine. Volume 44:Issue 8(2016)
• Publication Date: 2016-08
• Subjects: long-term survival -- organ dysfunction -- renal replacement therapy -- septic shock -- vasopressors -- ventilation; Critical care medicine -- Periodicals; Soins intensifs -- Périodiques; 616.028
• DOI: 10.1097/CCM.0000000000001843
• Languages: English
• ISSNs: 0090-3493

Abstract

Abstract : Objectives: As mortality of septic shock decreases, new therapies focus on improving short-term organ dysfunction. However, it is not known whether short-term organ dysfunction is associated with long-term mortality of septic shock. Design: Retrospective single-center. Setting: Mixed medical-surgical ICU. Patients: One thousand three hundred and thirty-one patients with septic shock were included from 2000-2004. To remove the bias of 28-day nonsurvivors' obvious association with long-term mortality, we determined the associations of days alive and free of ventilation, vasopressors and renal replacement therapy in 28-day and 1-year survivors with 1-, 5- and 10-year mortality in unadjusted analyses and analyses adjusted for age, gender, Acute Physiology and Chronic Health Evaluation II and presence of chronic comorbidities. Interventions: None. Measurements and Main Results: Days alive and free of ventilation, vasopressors, and renal replacement therapy were highly significantly associated with 1-, 5-, and 10-year mortality ( p < 0.0001). In 28-day survivors, using Bonferroni-corrected multiple logistic regression, days alive and free of ventilation ( p < 0.0001, p = 0.0002, and p = 0.001), vasopressors ( p < 0.0001, p < 0.0001, and p = 0.0004), and renal replacement therapy ( p = 0.0008, p = 0.0008, and p = 0.0002) were associated with increased 1-, 5-, and 10-year mortality, respectively. In 1-year survivors, none of the acute organ support and dysfunction measures were associated with 5- and 10-year mortality. Conclusions: Days alive and free of ventilation, vasopressors, and renal replacement therapy in septic shock in 28-day survivors was associated with 1-, 5-, and 10-year mortality. These associations are nullified in 1-year survivors in whom none of the acute organ support measures were associated with 5- and 10-year mortality. This suggests that therapies that decrease short-term organ dysfunction could also improve long-term outcomes of 28-day survivors of septic shock. Abstract : Supplemental Digital Content is available in the text.