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

TitleShort-term organ dysfunction is associated with long-term (10 year) mortality of septic shock
Publication TypeJournal Article
Year of Publication2016
AuthorsLinder, A, Fisher, J, Boyd, J, Walley, KR, Russell, JA
JournalCritical Care Medicine
Volume44
Issue8
Paginatione728-36
Date Published08/2016
ISSNPrint: 0090-349; Online: 1530-0293
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, 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.

DOI10.1097/CCM.0000000000001843