Outcomes following severe septic shock in a cohort of Aboriginal and Torres Strait Islander people: a nested cohort study from the ADRENAL trial

Abstract

OBJECTIVE: To describe the pattern of acute illness and 6-month mortality and health-related quality-of-life outcomes for a cohort of Aboriginal and Torres Strait Islander patients presenting with septic shock. DESIGN: Nested cohort study of Aboriginal and Torres Strait Islander participants recruited to a large randomised controlled trial of corticosteroid treatment in patients with septic shock. SETTING: Royal Darwin Hospital, Northern Territory. PARTICIPANTS: All Aboriginal and Torres Strait Islander patients recruited to the Adjunctive Corticosteroid Treatment in Critically Ill Patients with Septic Shock (ADRENAL) trial at Royal Darwin Hospital were compared with a non-Indigenous cohort drawn from the same site, and a cohort matched for age, sex and severity of disease. MAIN OUTCOME MEASURES: Mortality at 90 days and 6 months, time to shock resolution, mechanical ventilation requirement, renal replacement therapy requirement, and five-domain, five-level EuroQol questionnaire (EQ-5D-5L) score at 6 months. RESULTS: Aboriginal and Torres Strait Islander patients had significantly reduced risk of death at 90 days when compared with non-Indigenous patients recruited to ADRENAL at Royal Darwin Hospital (12/60 v 23/62; adjusted odds ratio, 0.40 [95% CI, 0.17 to 0.94]) which was robust to additional adjustment for baseline covariates (odds ratio, 0.35 [95% CI, 0.14 to 0.90]). When compared with the matched population drawn from the broader ADRENAL cohort, there was no significant difference in 90-day mortality (12/60 v 16/61; adjusted odds ratio, 1.43 [95% CI, 0.60 to 3.39]; P = 0.42). Only nine Aboriginal and Torres Strait Islander patients provided 6-month health-related quality-of-life data. CONCLUSIONS: Aboriginal and Torres Strait Islander patients had reduced risk of death at 90 days when compared with non-Indigenous patients recruited to the ADRENAL trial at Royal Darwin Hospital, which was robust to adjustment for covariates, but similar outcomes when compared with a cohort matched for age, sex and severity of disease.

Preference-based measures of health-related quality of life in Indigenous people: a systematic review

“…In some cases, the specific ethnicity beyond “Aboriginal” or “Indigenous” was not provided, however, the country is clearly stated. Among the included reports, only 26 described the methods used to determine ethnicity in the sample, such as self-report, or health records [ 10 – 12 , 35 , 42 , 45 , 48 – 50 , 53 , 55 , 57 , 61 , 63 , 69 , 73 , 75 , 89 , 95 , 98 – 100 ].…”

In This Issue of CCR

“… 3 A similar focus on high risk First Nations patients comes from an assessment of outcomes of Indigenous patients enrolled in the ADRENAL trial. 4 …”