Prognostic factors for very short-term mortality in severe sepsis

Introduction

Short-term mortality studies could be crucial for evaluating new therapies as well as to better understand pathophysiological aspects. This study aims to identify prognostic factors associated with sepsis-related death within 4 days after the first organ dysfunction development.

Methods

All severe sepsis and septic shock patients over 18 years old admitted to three Brazilian ICUs were prospectively included. Demographic, clinical and outcome features, including compliance to the 6-hour Surviving Sepsis Campaign bundle (SSC-6 h), were collected in an electronic clinical research form. Duration of organ dysfunction was defined as the time elapsed between the installation of the dysfunction and its diagnosis by the healthcare provider. Results were expressed as a percentage or as median and interquartiles. Univariate analysis was performed by chi-squared or Student t test. P < 0.05 was considered significant.

Results

Three hundred and eighty-six patients were included, being 30 (7.8%) in Group 1 (short-term mortality group, median time from organ dysfunction to death: 2.39 (1.75 to 3.25) days) and 356 (92.2%) in Group 2. No difference was found between the groups regarding gender (P = 0.14), age (P = 0.80), being in a public hospital (P = 0.94) or duration of organ dysfunction (P = 0.79). Variables related to severity of disease were associated with early mortality: APACHE II score (Group 1: 21.0 (15.0 to 26.0), Group 2: 18.0 (14.0 to 22.0), P = 0.01); SOFA score at admission (SOFA0) (Group 1: 9.0 (8.0 to 11.0), Group 2: 7.0 (5.0 to 9.0), P = 0.003); Day 1 SOFA score (10.0 (8.0 to 12.0), Group 2: 7.0 (5.0 to 10.0), P = 0.0002); Day 3 SOFA score (SOFA3) (Group 1: 9.0 (8.0 to 12.0), Group 2: 7.0 (4.0 to 10.0), P = 0.006) and the delta between SOFA0 and SOFA3 (Group 1: -6.5 (-11.0 to +1.0), Group 2: -1.0 (-3.0 to +9.0), P = 0.003). Delta SOFA with Day 1 was not different between groups. Group 1 patients had a trend towards higher number of organ dysfunction (P = 0.07) and more septic shock episodes (P = 0.09). Regarding treatment adequacy, compliance with any indicator or the entire SSC-6 h bundle was not related to survival. However, achievement of the CPV target was associated with a higher early mortality (Group 1: 69.6%, Group 2: 40.6%, P = 0.013; OR - 3.3.4 (1.33 to 8.40)).

Conclusions

In this observational study, factors related to disease severity rather than to the evidence-based treatment compliance were associated with short-term death among severe septic patients.