PURPOSE:Sepsis is associated with higher morbidity, mortality and health care cost in the US. Limited data are available regarding the impact of sepsis in lung transplant recipients (LTRs). Therefore, our aim was to determine the impact on mortality for LTRs that develop sepsis due to pneumonia.
METHODS:A retrospective cohort study was conducted on subjects with pneumonia at one transplant center over a four year period. Eligible patients included all LTRs that developed the first episode of pneumonia anytime in the post transplant period. Pneumonia LTRs were stratified as to whether they had criteria for sepsis at the time of clinical suspicion based on the 1993 ACCP consensus recommendations. Chi-square and Student s t-test were used to compare categorical and continuous variables, respectively. Multivariable analysis was performed using 90-day mortality as the dependent variable. Sepsis and APACHE II were used as the independent variables.
RESULTS:Twenty one (44%) of patients out of 48 LTRs that developed pneumonia from 48 hours to 57 months post-transplant met criteria for sepsis. Groups were similar regarding age, gender, and certain comorbidities. Pulmonary hypertension (p=.02) and home oxygen therapy (p=.004) were the only two comorbidities that occurred more frequently in patients with sepsis. Septic LTRs with pneumonia were sicker than non septic LTRs with pneumonia, with higher APACHE II scores (p<.001), and increased: need of mechanical ventilation (p<.001), development of ARDS (p=.04), need for vasopressors (p<.001), acute renal failure (p<.001), need for hemodialysis (p=.04), and multi-organ failure (p=.006). After adjusting for severity of illness, LTRs with pneumonia that develop sepsis were more likely to die at 90 days (Odds ratio 10.7, 95% confidence interval 1.5–76.9, p=0.02) compared to LTRs with pneumonia that did not develop sepsis.
CONCLUSION:Sepsis due to pneumonia in LTR is associated with higher 90-day mortality and with significant number of organ complications and severity of illness.
CLINICAL IMPLICATIONS:Further prospective studies are needed to evaluate the impact of sepsis due to pneumonia in LTR patients.
DISCLOSURE:Juan Sanchez, No Financial Disclosure Information; No Product/Research Disclosure Information