Understanding and Enhancing Sepsis Survivorship. Priorities for Research and Practice

Prescott, Hallie C.; Iwashyna, Theodore J.; Blackwood, Bronagh; Calandra, Thierry; Chlan, Linda L.; Choong, Karen; Connolly, Bronwen; Dark, Paul; Ferrucci, Luigi; Finfer, Simon; Girard, Timothy D.; Hodgson, Carol; Hopkins, Ramona O.; Hough, Catherine L.; Jackson, James C.; Machado, Flávia Ribeiro; Marshall, John C.; Misak, Cheryl; Needham, Dale M.; Panigrahi, Pinaki; Reinhart, Konrad; Yende, Sachin; Zafonte, Ross; Rowan, Kathy; Angus, Derek C.

doi:10.1164/rccm.201812-2383cp

Cited by 97 publications

(80 citation statements)

References 69 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This study also provides information relevant to future clinical trial design. The low-observed 30-day mortality supports the current consensus that future study endpoints need to focus to long-term outcomes [36]. Additionally, given that sepsis is believed to be due to a dysregulated immune response, our data indicate that these subgroups should be studied independently.…”

Section: Discussionsupporting

confidence: 75%

Phenotypic heterogeneity by site of infection in surgical sepsis: a prospective longitudinal study

et al. 2020

View full text Add to dashboard Cite

Background: The role of site of infection in sepsis has been poorly characterized. Additionally, sepsis epidemiology has evolved. Early mortality has decreased, but many survivors now progress into chronic critical illness (CCI). This study sought to determine if there were significant differences in the host response and current epidemiology of surgical sepsis categorized by site of infection.Study design: This is a longitudinal study of surgical sepsis patients characterized by baseline predisposition, insult characteristics, serial biomarkers, hospital outcomes, and long-term outcomes. Patients were categorized into five anatomic sites of infection. Results:The 316 study patients were predominantly Caucasian; half were male, with a mean age of 62 years, high comorbidity burden, and low 30-day mortality (10%). The primary sites were abdominal (44%), pulmonary (19%), skin/soft tissue (S/ST, 17%), genitourinary (GU, 12%), and vascular (7%). Most abdominal infections were present on admission and required source control. Comparatively, they had more prolonged proinflammation, immunosuppression, and persistent organ dysfunction. Their long-term outcome was poor with 37% CCI (defined as > 14 in ICU with organ dysfunction), 49% poor discharge dispositions, and 30% 1-year mortality. Most pulmonary infections were hospitalacquired pneumonia. They had similar protracted proinflammation and organ dysfunction, but immunosuppression normalized. Long-term outcomes are similarly poor (54% CCI, 47% poor disposition, 32% 1-year mortality). S/ST and GU infections occurred in younger patients with fewer comorbidities, less perturbed immune responses, and faster resolution of organ dysfunction. Comparatively, S/ST had better long-term outcomes (23% CCI, 39% poor disposition, 13% 1-year mortality) and GU had the best (10% CCI, 20% poor disposition, 10% 1-year mortality). Vascular sepsis patients were older males, with more comorbidities. Proinflammation was blunted with baseline immunosuppression and organ dysfunction that persisted. They had the worst long-term outcomes (38% CCI, 67% poor disposition, 57% 1-year mortality). Conclusion: There are notable differences in baseline predisposition, host responses, and clinical outcomes by site of infection in surgical sepsis. While previous studies have focused on differences in hospital mortality, this study provides unique insights into the host response and long-term outcomes associated with different sites of infection.

show abstract

Section: Discussionsupporting

confidence: 75%

Phenotypic heterogeneity by site of infection in surgical sepsis: a prospective longitudinal study

et al. 2020

View full text Add to dashboard Cite

show abstract

“…In the United States, the inpatient admission and subsequent skilled nursing facility costs for sepsis in Medicare beneficiaries have risen up to 62 billion USD in 2018 (5). The full societal impact of sepsis due to reduced productivity of survivors, dependency on support in everyday life, and the multiplying effect on carers, siblings, and children has not been reliably assessed but is likely to exceed the direct sepsis costs several fold (27,28). In contrast to myocardial infarction or cerebral stroke, where the benefits of early rehabilitation are well recognized, current health care systems lack structures to support and rehabilitate sepsis survivors and their families to mitigate these detrimental long-term effects.…”

Section: Recent Insights Into the True Sepsis Burdenmentioning

confidence: 99%

World Sepsis Day: a global agenda to target a leading cause of morbidity and mortality

Schlapbach

Kissoon

Alhawsawi³

et al. 2020

American Journal of Physiology-Lung Cellular and Molecular Phys

Self Cite

View full text Add to dashboard Cite

“…Sepsis is one of the leading causes of death worldwide and is a major public health issue [1][2][3][4][5]. The Intensive Care Over Nations (ICON) Audit [1] showed that sepsis accounts for 30% of reasons for intensive care unit (ICU) admission and is associated with a hospital mortality rate of 35%.…”

Section: Introductionmentioning

confidence: 99%

Sepsis and septic shock in France: incidences, outcomes and costs of care

Dupuis

Bouadma

Ruckly

et al. 2020

Ann. Intensive Care

View full text Add to dashboard Cite

Background Sepsis is one of the leading causes of death worldwide. The associated incidence, mortality and trends do not differ greatly between documented reports. The purpose of this study was to provide an in-depth description of patients with sepsis and septic shock hospitalized in France from 2010 to 2015 and to explore the temporal trends of their clinical characteristics, costs and outcomes. Methods Retrospective cohort study of the French hospital administrative database in which organ failure therapies and severity scores are systematically registered. All patients admitted between 2010 and 2015 for sepsis and septic shock as defined by an ICD-10 code for infection, and for organ failure or the use of organ failure supplementation were included. Incidence, outcomes and trends were analyzed. Subgroup analyses based on several coding strategies and adjusted for severity scores were performed. Results A total of 737,147 patients with sepsis and 492,902 patients with septic shock were included. From 2010 to 2015, the incidence of sepsis and septic shock increased, respectively, from 206 to 243 and from 135 to 171 cases per 100,000 population. Case fatality remained at 34% for sepsis, but decreased from 46 to 44% for septic shock. Median hospital stay costs amounted to €11,400 (IQR: 5036; 24,364) for patients with sepsis and €16,439 (IQR: 7339; 29,360) for patients with septic shock. After adjustment for case-mix and illness severity, the risk of death was stable for sepsis (0.08% [− 0.04; 0.20] per year), but decreased for sepsis patients admitted to the intensive care unit and for cases of septic shock (− 0.33%[ − 0.40; − 0.27] per year). Conclusions Sepsis is common, frequently fatal and expensive to treat. Its incidence has increased. Case fatality has decreased in most severely affected patients, owing partly to general improvements in care.

show abstract

Understanding and Enhancing Sepsis Survivorship. Priorities for Research and Practice

Cited by 97 publications

References 69 publications

Phenotypic heterogeneity by site of infection in surgical sepsis: a prospective longitudinal study

Phenotypic heterogeneity by site of infection in surgical sepsis: a prospective longitudinal study

World Sepsis Day: a global agenda to target a leading cause of morbidity and mortality

Sepsis and septic shock in France: incidences, outcomes and costs of care

Contact Info

Product

Resources

About