Current Epidemiology of Surgical Sepsis

Abstract

Objective: We sought to compare traditional inpatient outcomes to long-term functional outcomes and mortality of surgical intensive care unit (SICU) patients with sepsis. Summary of Background Data: As inpatient sepsis mortality declines, an increasing number of initial sepsis survivors now progress into a state of chronic critical illness (CCI) and their post-discharge outcomes are unclear. Methods: We performed a prospective, longitudinal cohort study of SICU patients with sepsis. Results: Among this recent cohort of 301 septic SICU patients, 30-day mortality was 9.6%. Only 13 (4%) patients died within 14 days, primarily of refractory multiple organ failure (62%). The majority (n = 189, 63%) exhibited a rapid recovery (RAP), whereas 99 (33%) developed CCI. CCI patients were older, with greater comorbidities, and more severe and persistent organ dysfunction than RAP patients (all P < 0.01). At 12 months, overall cohort performance status was persistently worse than presepsis baseline (WHO/Zubrod score 1.4 ± 0.08 vs 2.2 ± 0.23, P > 0.0001) and mortality was 20.9%. Of note at 12 months, the CCI cohort had persistent severely impaired performance status and a much higher mortality (41.4%) than those with RAP (4.8%) after controlling for age and comorbidity burden (Cox hazard ratio 1.27; 95% confidence interval, 1.14–1.41, P < 0.0001). Among CCI patients, independent risk factors for death by 12 months included severity of comorbidities and persistent organ dysfunction (sequential organ failure assessment ≥6) at day 14 after sepsis onset. Conclusions: There is discordance between low inpatient mortality and poor long-term outcomes after surgical sepsis, especially among older adults, increasing comorbidity burden and patients that develop CCI. This represents important information when discussing expected outcomes of surgical patients who experience a complicated clinical course owing to sepsis.

Myeloid-derived suppressor cell function and epigenetic expression evolves over time after surgical sepsis

“…7). The similarity of CCI to septic shock is not surprising as septic shock is an independent risk factor for the development of CCI [6].…”

“…Due in large part to the improvements in sepsis recognition and in subsequent treatment in intensive care units (ICUs), less than 10% of surgical sepsis patients (who can be adequately resuscitated) now die within the first 14 days of their hospital admission [6]. Although over half of surgical sepsis survivors rapidly recover and are discharged from the ICU within 14 days, nearly 50% of them (or ~ 1/3 of all surgical sepsis patients) develop what has been described as chronic critical illness (CCI).…”

“…CCI is defined as patients who have prolonged stays in the ICU with unresolved organ dysfunction [7]. CCI can manifest itself as a persistent inflammation, immunosuppression, and catabolism syndrome (PICS) [7–11], which is associated with dismal long-term outcomes, including poor cognitive and physical function, as well as self-reported quality of life [6, 12]. CCI patients extensively utilize resources as well as accrue significant personal and hospital financial burdens [13].…”

The association between refeeding hypophosphatemia and serum appetite regulating hormone levels in critically ill patients-Prospective, Observational, Single-Center: A pilot study

“…In a study conducted in the ICU, GLP-1 level increased 6 times in critically ill patients compared to healthy individuals. It has been concluded that both chronic and acute inflammatory conditions, including sepsis, increase circulating GLP-1 levels (19,20). GLP-1 level tended to decrease in patients who did not develop RH, while it tended to increase in patients who developed RH.…”

Modelling survival

“…Although acute sepsis treatment has led to more survivors, it has become increasingly apparent that the life-threatening effects of sepsis do not end once a patient leaves the hospital (Fleischmann et al, 2016). In fact, patients have an elevated risk of mortality for at least two years following treatment (Prescott et al, 2016), and more than 20% of survivors will die within a year (Brakenridge et al, 2019). Even healthy individuals who survive sepsis rarely return to normal function (Prescott and Angus, 2018a; Prescott and Costa, 2018b).…”