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Short-term organ dysfunction is associated with long-term (10-Yr) mortality of septic shock

Linder, Adam LU ; Lee, Terry; Fisher, Jane; Singer, Joel; Boyd, John; Walley, Keith R. and Russell, James A. (2016) In Critical Care Medicine 44(8). p.728-736
Abstract

Objectives: As mortality of septic shock decreases, new therapies focus on improving short-term organ dysfunction. However, it is not known whether short-term organ dysfunction is associated with long-term mortality of septic shock. Design: Retrospective single-center. Setting: Mixed medical-surgical ICU. Patients: One thousand three hundred and thirty-one patients with septic shock were included from 2000-2004. To remove the bias of 28-day nonsurvivors' obvious association with long-term mortality, we determined the associations of days alive and free of ventilation, vasopressors and renal replacement therapy in 28-day and 1-year survivors with 1-, 5- and 10-year mortality in unadjusted analyses and analyses adjusted for age, gender,... (More)

Objectives: As mortality of septic shock decreases, new therapies focus on improving short-term organ dysfunction. However, it is not known whether short-term organ dysfunction is associated with long-term mortality of septic shock. Design: Retrospective single-center. Setting: Mixed medical-surgical ICU. Patients: One thousand three hundred and thirty-one patients with septic shock were included from 2000-2004. To remove the bias of 28-day nonsurvivors' obvious association with long-term mortality, we determined the associations of days alive and free of ventilation, vasopressors and renal replacement therapy in 28-day and 1-year survivors with 1-, 5- and 10-year mortality in unadjusted analyses and analyses adjusted for age, gender, Acute Physiology and Chronic Health Evaluation II and presence of chronic comorbidities. Interventions: None. Measurements and Main Results: Days alive and free of ventilation, vasopressors, and renal replacement therapy were highly significantly associated with 1-, 5-, and 10-year mortality (p <0.0001). In 28-day survivors, using Bonferroni-corrected multiple logistic regression, days alive and free of ventilation (p <0.0001, p = 0.0002, and p = 0.001), vasopressors (p <0.0001, p <0.0001, and p = 0.0004), and renal replacement therapy (p = 0.0008, p = 0.0008, and p = 0.0002) were associated with increased 1-, 5-, and 10-year mortality, respectively. In 1-year survivors, none of the acute organ support and dysfunction measures were associated with 5- and 10-year mortality. Conclusions: Days alive and free of ventilation, vasopressors, and renal replacement therapy in septic shock in 28-day survivors was associated with 1-, 5-, and 10-year mortality. These associations are nullified in 1-year survivors in whom none of the acute organ support measures were associated with 5- and 10-year mortality. This suggests that therapies that decrease short-term organ dysfunction could also improve long-term outcomes of 28-day survivors of septic shock.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
long-term survival, organ dysfunction, renal replacement therapy, septic shock, vasopressors, ventilation
in
Critical Care Medicine
volume
44
issue
8
pages
728 - 736
publisher
Lippincott Williams & Wilkins
external identifiers
  • Scopus:84978756688
ISSN
0090-3493
DOI
10.1097/CCM.0000000000001843
language
English
LU publication?
yes
id
4a54584f-6444-406f-874b-ca972dd35f5d
date added to LUP
2016-08-01 13:50:02
date last changed
2016-11-27 04:41:57
@misc{4a54584f-6444-406f-874b-ca972dd35f5d,
  abstract     = {<p>Objectives: As mortality of septic shock decreases, new therapies focus on improving short-term organ dysfunction. However, it is not known whether short-term organ dysfunction is associated with long-term mortality of septic shock. Design: Retrospective single-center. Setting: Mixed medical-surgical ICU. Patients: One thousand three hundred and thirty-one patients with septic shock were included from 2000-2004. To remove the bias of 28-day nonsurvivors' obvious association with long-term mortality, we determined the associations of days alive and free of ventilation, vasopressors and renal replacement therapy in 28-day and 1-year survivors with 1-, 5- and 10-year mortality in unadjusted analyses and analyses adjusted for age, gender, Acute Physiology and Chronic Health Evaluation II and presence of chronic comorbidities. Interventions: None. Measurements and Main Results: Days alive and free of ventilation, vasopressors, and renal replacement therapy were highly significantly associated with 1-, 5-, and 10-year mortality (p &lt;0.0001). In 28-day survivors, using Bonferroni-corrected multiple logistic regression, days alive and free of ventilation (p &lt;0.0001, p = 0.0002, and p = 0.001), vasopressors (p &lt;0.0001, p &lt;0.0001, and p = 0.0004), and renal replacement therapy (p = 0.0008, p = 0.0008, and p = 0.0002) were associated with increased 1-, 5-, and 10-year mortality, respectively. In 1-year survivors, none of the acute organ support and dysfunction measures were associated with 5- and 10-year mortality. Conclusions: Days alive and free of ventilation, vasopressors, and renal replacement therapy in septic shock in 28-day survivors was associated with 1-, 5-, and 10-year mortality. These associations are nullified in 1-year survivors in whom none of the acute organ support measures were associated with 5- and 10-year mortality. This suggests that therapies that decrease short-term organ dysfunction could also improve long-term outcomes of 28-day survivors of septic shock.</p>},
  author       = {Linder, Adam and Lee, Terry and Fisher, Jane and Singer, Joel and Boyd, John and Walley, Keith R. and Russell, James A.},
  issn         = {0090-3493},
  keyword      = {long-term survival,organ dysfunction,renal replacement therapy,septic shock,vasopressors,ventilation},
  language     = {eng},
  month        = {08},
  number       = {8},
  pages        = {728--736},
  publisher    = {ARRAY(0x9e56528)},
  series       = {Critical Care Medicine},
  title        = {Short-term organ dysfunction is associated with long-term (10-Yr) mortality of septic shock},
  url          = {http://dx.doi.org/10.1097/CCM.0000000000001843},
  volume       = {44},
  year         = {2016},
}