The long-term burden of severe sepsis and septic shock: Sepsis recidivism and organ dysfunction. Issue 3 (September 2016)

• Record Type: Journal Article
• Authors: Guirgis, Faheem W.; Brakenridge, Scott; Sutchu, Selina; Khadpe, Jay D.; Robinson, Taylor; Westenbarger, Richard; Topp, Stephen T.; Kalynych, Colleen J.; Reynolds, Jennifer; Dodani, Sunita; Moore, Frederick A.; Jones, Alan E.
• Is Part Of: Journal of trauma and acute care surgery. Volume 81:Issue 3(2016:Sep.)
• Publication Date: 2016-09
• Subjects: Sepsis -- severe sepsis -- septic shock -- organ dysfunction -- organ failure; Surgical intensive care -- Periodicals; Surgical emergencies -- Periodicals; Wounds and injuries -- Surgery -- Periodicals; 617.026
• DOI: 10.1097/TA.0000000000001135
• Languages: English
• ISSNs: 2163-0755

Abstract

Abstract : BACKGROUND: Severe sepsis and septic shock mortality has improved; however, rates of persistent (28–90 days) and long-term (>90 day) organ dysfunction in sepsis survivors are unknown. METHODS: Secondary analysis of a prospective cohort of adult emergency department patients with severe sepsis. RESULTS: Of 110 sepsis admissions, we obtained follow-up on 51 of 78 survivors of whom 41% (21 of 51) had persistent organ dysfunction: pulmonary, 18% (9 of 51); renal, 22% (11 of 51); coagulopathy, 10% (5 of 51); cardiovascular, 6% (3 of 51); hepatic, 2% (1 of 51); and neurologic, 3% (3 of 51). We obtained follow-up on 40 of 73 survivors at more than 90 days of whom 38% (15 of 40) had long-term organ dysfunction: pulmonary, 13% (5 of 40); renal, 18% (7 of 40); coagulopathy, 3% (1 of 40); cardiovascular, 5% (2 of 40); hepatic, 0%; and neurologic, 5% (2 of 40). Readmission rate within 90 days was 32% (25 of 78), and recurrent sepsis was the cause of readmission in 52% (13 of 25). Baseline SOFA scores from the index sepsis admission were compared using Wilcoxon rank-sum test and were significantly different in participants with organ dysfunction versus those without organ dysfunction at less than 90 days ( z, −2.51; p = 0.01). CONCLUSION: Readmission with recurrent sepsis and organ dysfunction occurs frequently in sepsis survivors. Baseline SOFA score may be predictive of sepsis recidivism and persistent or recurrent organ dysfunction. LEVEL OF EVIDENCE: Prognostic/epidemiologic study, level IV. Abstract : Supplemental digital content is available in the text.