Effects of sepsis resuscitation bundle in cirrhotic patients with septic shock

Introduction

The effectiveness of the interventions recommended by the Surviving Sepsis Campaign (SSC) guidelines [1] has never been tested in patients with specific co-morbidities such as chronic liver disease. In this study we evaluated whether the adherence to the resuscitation sepsis bundle improved the outcome of cirrhotic patients with septic shock admitted to the ICU.

Methods

The prospective observational cohort study included 38 patients with documented cirrhosis and septic shock admitted to a multidisciplinary ICU at a university hospital from January 2005 to June 2009. In each patient the compliance to four resuscitation interventions recommended by the SSC guidelines (that is, 6-hour bundle) and the 30-day mortality were measured.

Results

The 6-hour bundle was completed in 50% of the patients. In these patients the MELD and SOFA scores (39 ± 11 and 18 ± 2) were higher (P < 0.05) than those observed in patients without compliance to the 6-hour bundle (31 ± 12 and vs 15 ± 3). The 30-day mortality was 94.7% and 68.4% (P < 0.05) in patients with and without 6-hour bundle compliance, respectively. A Cox regression analysis, after adjustment for MELD and SOFA scores, indicated that none of the single sepsis interventions as well as the 6-hour bundle was independently associated with 30-day survival.

Conclusions

The adherence to the resuscitation interventions recommended by the SSC evidence-based guidelines did not improve the survival rate of cirrhotic patients with septic shock admitted to our ICU.