Late mortality after sepsis: propensity matched cohort study

Prescott, Hallie C.; Osterholzer, John J.; Langa, Kenneth M.; Angus, Derek C.; Iwashyna, Theodore J.

doi:10.1136/bmj.i2375

Cited by 265 publications

(244 citation statements)

References 42 publications

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“…However, even in well-controlled studies, it is difficult to identify among these factors those related to the sepsis-attributable mortality. A recent controlled study showed that late excess mortality was higher in patients with 3 or more organ dysfunctions, even after adjusting for acute mortality differences [141]. Another recent study observed these [141] effects were significantly higher in male patients, younger patients, those with higher Charlson Comorbidity Index scores, those with higher numbers of organ failure, those admitted to intensive care units, those with shock, and those who required mechanical ventilatory support [142].…”

Section: What Are the Predictors Of Sepsis Long-term Morbidity And Momentioning

confidence: 99%

“…The review's conclusion was subsequently challenged by two well-designed studies. One study showed that mortality was increased, compared with matched non-hospitalized controls, non-septic infected hospitalized patients and patients admitted with sterile inflammatory conditions [141]. Another study demonstrated that septic patients had higher mortality than matched controls from the general population and subjects who were hospitalized for a non-septic cause [142].…”

Section: Post-icumentioning

confidence: 99%

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Surviving sepsis campaign: research priorities for sepsis and septic shock

et al. 2018

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Objective: To identify research priorities in the management, epidemiology, outcome and underlying causes of sepsis and septic shock.Design: A consensus committee of 16 international experts representing the European Society of Intensive Care Medicine and Society of Critical Care Medicine was convened at the annual meetings of both societies. Subgroups had teleconference and electronic-based discussion. The entire committee iteratively developed the entire document and recommendations.Methods: Each committee member independently gave their top five priorities for sepsis research. A total of 88 suggestions (ESM 1 -supplemental table 1) were grouped into categories by the committee co-chairs, leading to the formation of seven subgroups: infection, fluids and vasoactive agents, adjunctive therapy, administration/epidemiology, scoring/identification, post-intensive care unit, and basic/translational science. Each subgroup had teleconferences to go over each priority followed by formal voting within each subgroup. The entire committee also voted on top priorities across all subgroups except for basic/translational science. Results:The Surviving Sepsis Research Committee provides 26 priorities for sepsis and septic shock. Of these, the top six clinical priorities were identified and include the following questions: (1) can targeted/personalized/precision medicine approaches determine which therapies will work for which patients at which times?; (2) what are ideal endpoints for volume resuscitation and how should volume resuscitation be titrated?; (3) should rapid diagnostic tests be implemented in clinical practice?; (4) should empiric antibiotic combination therapy be used in sepsis or septic shock?; (5) what are the predictors of sepsis long-term morbidity and mortality?; and (6) what information identifies organ dysfunction?Conclusions: While the Surviving Sepsis Campaign guidelines give multiple recommendations on the treatment of sepsis, significant knowledge gaps remain, both in bedside issues directly applicable to clinicians, as well as understanding the fundamental mechanisms underlying the development and progression of sepsis. The priorities identified represent a roadmap for research in sepsis and septic shock.

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Section: What Are the Predictors Of Sepsis Long-term Morbidity And Momentioning

confidence: 99%

Section: Post-icumentioning

confidence: 99%

Surviving sepsis campaign: research priorities for sepsis and septic shock

et al. 2018

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“…A maioria das mortes ocorreu nos primeiros seis meses, mas o risco permaneceu elevado aos dois anos. Após a alta do hospital, a sepse comporta um maior risco de morte (até 20%), bem como um risco aumentado de sepse adicional e internações hospitalares recorrentes (até 10% são readmitidos) (15)(16)(31)(32) . …”

Section: Discussionunclassified

Diagnóstico De Sepse Em Pacientes Após Internação Em Unidade De Terapia Intensiva

Moura¹,

Sanches²,

Pereira³

et al. 2017

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Conflito de interesses:Não Contribuição dos autores: JMM coleta, tabulação, delineamento do estudo e redação do manuscrito. EBS delineamento do estudo. RAPM delineamento do estudo e elaboração do manuscrito. ISF orientação do projeto, discussão dos achados, etapas de execução e elaboração do manuscrito, delineamento do estudo e elaboração do manuscrito. LMC orientação do projeto, delineamento do estudo e elaboração do manuscrito. ALW orientação do projeto, discussão dos achados, etapas de execução e elaboração do manuscrito, delineamento do estudo e elaboração do manuscrito. Contato para correspondência: Joice Marques Moura E-mail: joice_aww@hotmail. AbstractIntroduction: Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. Patients with sepsis (formerly called severe sepsis) should still be identified by the same organ dysfunction criteria (including lactate level greater than 2 mmol/L). Organ dysfunction may also be identified in the future using the quick Sepsis-Related Organ Failure Assessment (qSOFA). Currently, sepsis is one of the main causes of mortality in Intensive Care Units. In 2003, the Sepsis Surviving Campaign was created, elaborating a schedule of actions to reduce the incidence of sepsis, especially in intensive care units. Objective: To know the clinical characteristics and outcome of patients who developed sepsis during Intensive Care Units admission. Material and Methods: This is a retrospective, descriptive study using a quantitative approach performed at the Intensive Care Units. Data were obtained through an electronic medical record. The software Epi Info, version 7.2.1.0 was used to analyze data. Results:The largest number of patients hospitalized was male, aged from 51 to 70 years. The most common comorbidities were Systemic Hypertension, Diabetes Mellitus, alcoholism, smoking, and heart disease. The most analyzed post-sepsis outcome was discharge from Intensive Care Units, and the patients were considerably males. Conclusion: We conclude that the patients who most developed sepsis were men (62%), aged ranging from 51 to 70 years (36%). The main comorbidity was systemic hypertension (42%) and the most observed outcome was discharge from the Intensive Care Units (67%). consenso e novas definições de sepse foram publicadas, conhecidas como Sepsis 3, definida pela "presença de disfunção orgânica ameaçadora à vida secundária à resposta desregulada do organismo à infecção" (2) . Para avaliação do diagnóstico clínico de disfunção or gânica, atualmente são observados uma variação de dois ou mais pontos no escore Sequential Organ Failure Assessment (SOFA). Os critérios da síndrome da resposta inflamatória sistêmica (SRIS) não são mais usados para a definição. Os casos de sepse passam a ser considerados como doença grave, assim, não se usa mais a expressão "sepse grave". Choque séptico é definido como "um subgrupo dos pacientes com sepse que apresentam acentuadas anormalidades circulatórias, celulares e metabólicas e associadas com maio...

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“…What these studies highlight is that there is increased long term mortality associated with sepsis that cannot be explained by pre-existing factors such as medical co-morbidities, age, and functional status. The existence of an independent pathobiological septic process has been proposed by numerous studies (8,12) and has been extensively investigated using animal models of sepsis, which would seem to suggest a pro-inflammatory model of accelerated atherosclerosis and chronic immunosuppression. This suggests that earlier aggressive management of sepsis together with longer term emphasis on rehabilitation following sepsis could lead to a significant reduction in long term mortality.…”

mentioning

confidence: 99%

“…In a recently published paper Prescott et al (8) explained an observational matched cohort study which looked to determine if late mortality following sepsis is predominantly explained by pre-existing comorbid pathology or if sepsis itself is responsible for the increased mortality via a pathobiolgical process. In this study late mortality was taken to be 31 days to 2 years, patients with sepsis were matched to three control groups; adults not currently in hospital, patients in hospital with an acute sterile inflammatory process, and lastly patients with non-sepsis infection, patients in each group were matched on the basis of baseline characteristics.…”

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confidence: 99%