Short-term organ dysfunction is associated with long-term (10-Yr) mortality of septic shock
(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.
(Less)
- author
- Linder, Adam LU ; Lee, Terry ; Fisher, Jane LU ; Singer, Joel ; Boyd, John ; Walley, Keith R. and Russell, James A.
- organization
- publishing date
- 2016-08-01
- 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
- pmid:27428136
- wos:000380631000046
- 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
- 2025-01-12 09:23:47
@article{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 <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.</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}},
keywords = {{long-term survival; organ dysfunction; renal replacement therapy; septic shock; vasopressors; ventilation}},
language = {{eng}},
month = {{08}},
number = {{8}},
pages = {{728--736}},
publisher = {{Lippincott Williams & Wilkins}},
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}},
doi = {{10.1097/CCM.0000000000001843}},
volume = {{44}},
year = {{2016}},
}