Critical Care: Severe Sepsis and Septic Shock |

Site and Number of Organ Dysfunctions Predict Outcomes in Severe Sepsis and Septic Shock FREE TO VIEW

Amanda Deis; Bristol Whiles; Patrick Miller; Steven Simpson
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University of Kansas Department of Internal Medicine, Kansas City, KS

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A186. doi:10.1016/j.chest.2016.02.192
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SESSION TITLE: Severe Sepsis and Septic Shock

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Saturday, April 16, 2016 at 05:15 PM - 06:15 PM

PURPOSE: To determine if specific and/or total number of organ dysfunctions are predictive of severe sepsis outcomes.

METHODS: This is a retrospective cohort study of patients with severe sepsis/septic shock who were admitted through the emergency department between 3/1/07-10/1/14. Patients were identified based on clinical definitions for severe sepsis/septic shock and/or ICD9 codes. Inclusion criteria required the following for each patient: ≥18 years of age, diagnosis of infection, antimicrobial administration, organ dysfunction, length of stay (LOS), and discharge disposition. Specific organ dysfunction sites (ODS) included CNS, lung, kidney, bone marrow, liver, cardiovascular, and lactic acidosis. Regression modeling was used to determine if a correlation existed between the number of ODS and multiple outcomes.

RESULTS: We Identified 7071 patients with severe sepsis, 1573 of whom had septic shock. The overall mortality was 7.0%. The mean number of ODS was 2.63 ± 1.27 (mean ± STDEV). The most common ODS was the bone marrow (67%), and the least common site was the CNS (0.93%). Cardiovascular dysfunction was associated with the highest mortality (26.2%), longest LOS (14.3 ± 15.2 days), and highest rate of ICU admission (74.7%). CNS dysfunction had the lowest mortality rate (6.1%), the second highest ICU admission rate (57.6%), and the highest rate of readmission within 30 days (28.8%). Increased number of ODS positively correlated with hospital LOS (R=0.99, p<.001) and ICU LOS (R=0.91, p<.001). No significant difference in mortality, ICU admission rate, or 30 day readmission was seen in patients with ≤2 ODS vs those who had no ODS. However, the odds of death increased with each additional ODS when there were ≥4 ODS involved, 4 ODS (OR=9.08, 95% CI: 2.21-37.3) and 7 ODS (OR=46.7, 95% CI,:10.42 - 209.62). The odds of ICU admission (3 ODS (OR=21.87 95% CI:1.91-4.89)) and 30 day readmission (4 ODS (OR=6.03, 95% CI:1.13-3.12)) also increased with addtional ODS vs those without ODS.

CONCLUSIONS: Number of ODS is associated with increased mortality, hospital and ICU LOS, and 30-day readmission rates in patients with severe sepsis and septic shock.

CLINICAL IMPLICATIONS: Additional studies are needed to determine if timing of organ dysfunction (present on admission or developing during treatment) predicts outcome or responsiveness to therapy. Identification of multiple organ dysfunctions present at diagnosis of severe sepsis may allow for better prognostic information for providers and for patients.

DISCLOSURE: The following authors have nothing to disclose: Amanda Deis, Bristol Whiles, Patrick Miller, Steven Simpson

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