Causes of late mortality among ICU‐treated patients with sepsis

Abstract

BackgroundPatients with sepsis may have an increased risk of late mortality, but the causes of late death are unclear. This retrospective matched cohort study aimed to determine the causes of late death (≥1 year) among patients with sepsis compared to patients without sepsis.Methods8760 patients with severe sepsis or septic shock (2001 consensus criteria) registered in the Swedish Intensive Care Registry (2008‐2013) were compared with a 1:1 matched (gender, age, SAPS3 probability for death, ICU length of stay) control group consisting of non‐septic ICU patients. Causes of death (International Classification of Diseases codes) were obtained from the Swedish Cause of Death Register (2008‐2014).ResultsDuring 2008‐2014, 903 patients with sepsis died at ≥365 days after their initial septic event, compared to 884 patients in the control group. Median time of follow‐up was 313 days (sepsis group, interquartile range 11‐838 days) vs 288 days (control group, 9‐836 days). The most common causes of death were heart diseases (sepsis: 50.2%, non‐septic: 48.6%) and cancer (sepsis: 33.7%, non‐septic: 31.7%). Infectious diseases were significantly more common cause of death in the sepsis group (24.3% vs 19.6%, respectively; P < .05). Pneumonia was a common infectious cause of death in both groups, whereas sepsis was more common in the sepsis group.ConclusionsThe most common causes of late death after ICU admission among patients with and without sepsis were heart diseases and cancer. However, patients with sepsis more frequently had infectious diseases as a cause of late death, compared to non‐septic patients.

Dexmedetomidine Attenuates LPS-Induced Monocyte-Endothelial Adherence via Inhibiting Cx43/PKC-α/NOX2/ROS Signaling Pathway in Monocytes

“…Patients undergoing major surgeries or remaining in intensive care units suffer high-level LPS and experience a long-term supine position [ 5 , 6 ], which greatly increase the risk of monocyte-endothelial adherence and trigger inflammatory vascular injury. It is detrimental to the patient's recovery, especially for critical patients.…”

“…LPS directly activates monocytes, resulting in its adherence to endothelial cells or the extracellular matrix [4]. The levels of LPS are generally elevated in patients undergoing major surgeries or remaining in the intensive care units [5,6]. In addition, long-term supine position also leads monocyte-endothelial adherence to become easier.…”

Sepsis after elective surgery – Incidence, aetiology and outcome

“…Post‐operative sepsis may have delayed or precluded return to intended oncological treatment, which has been associated with reduced survival 43 . Cancer has been shown to be a major contributor to late deaths after ICU treatment for sepsis 44,45 . The predominance of abdominal infections in the elective surgery patients may also have contributed to mortality, as sepsis of abdominal origin has been associated with higher death rates than other sources of infection 46 …”

“…43 Cancer has been shown to be a major contributor to late deaths after ICU treatment for sepsis. 44,45 The predominance of abdominal infections in the elective surgery patients may also have contributed to mortality, as sepsis of abdominal origin has been associated with higher death rates than other sources of infection. 46 We found that patients with sepsis after elective surgery required longer stay in the ICU and the hospital and were more likely to receive invasive mechanical ventilation than other sepsis patients.…”

Effects of Dexmedetomidine on Immune Cells: A Narrative Review

“…At present, there are many known risk factors that increase monocyte-endothelial cell adhesion, including patients undergoing major surgery, intensive care, or long-term bed rest ( Sikorski et al, 2011 ; Ribeiro et al, 2018 ; Schmitt et al, 2020 ; Wilhelms et al, 2020 ; Wu et al, 2020 ). Therefore, the rational use of DEX in critically ill patients should be concerned.…”