The Impact of Acute Organ Dysfunction on Long-Term Survival in Sepsis

Abstract

Objectives: To estimate the impact of each of six types of acute organ dysfunction (hepatic, renal, coagulation, neurologic, cardiac, and respiratory) on long-term mortality after surviving sepsis hospitalization.

Design: Multicenter, retrospective study.

Settings: Twenty-one hospitals within an integrated healthcare delivery system in Northern California.

Patients: Thirty thousand one hundred sixty-three sepsis patients admitted through the emergency department between 2010 and 2013, with mortality follow-up through April 2015.

Interventions: None.

Measurements and main results: Acute organ dysfunction was quantified using modified Sequential Organ Failure Assessment scores. The main outcome was long-term mortality among sepsis patients who survived hospitalization. The estimates of the impact of each type of acute organ dysfunction on long-term mortality were based on adjusted Cox proportional hazards models. Sensitivity analyses were conducted based on propensity score-matching and adjusted logistic regression. Hospital mortality was 9.4% and mortality was 31.7% at 1 year. Median follow-up time among sepsis survivors was 797 days (interquartile range: 384-1,219 d). Acute neurologic (odds ratio, 1.86; p < 0.001), respiratory (odds ratio, 1.43; p < 0.001), and cardiac (odds ratio, 1.31; p < 0.001) dysfunction were most strongly associated with short-term hospital mortality, compared with sepsis patients without these organ dysfunctions. Evaluating only patients surviving their sepsis hospitalization, acute neurologic dysfunction was also most strongly associated with long-term mortality (odds ratio, 1.52; p < 0.001) corresponding to a marginal increase in predicted 1-year mortality of 6.0% for the presence of any neurologic dysfunction (p < 0.001). Liver dysfunction was also associated with long-term mortality in all models, whereas the association for other organ dysfunction subtypes was inconsistent between models.

Conclusions: Acute sepsis-related neurologic dysfunction was the organ dysfunction most strongly associated with short- and long-term mortality and represents a key mediator of long-term adverse outcomes following sepsis.

Figures

Figure 1

Number of patients (left axis) and hospital mortality (right axis) stratified by the maximum total SOFA score within the first 48 hours of hospitalization (top) and maximum total SOFA score over the entire hospitalization (bottom).

Figure 2

Distribution of unique combinations of organ dysfunction sorted by occurrence frequency. The single most common organ dysfunction was cardiac (displayed in the horizontal bar graph in the lower left panel) while the least frequent was liver. The main panel shows each unique combination of organ dysfunctions (as indicated by the corresponding pattern of dots) along with their occurrence frequency in the cohort (vertical bar graph above each unique combination).