Critical care : the official journal of the Critical Care Forum
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Sepsis is a frequent reason for ICU admission and a leading cause of death. Its incidence has been increasing over the past decades. While hospital mortality is decreasing, it is recognized that the sequelae of sepsis extend well beyond hospitalization and are associated with a high mortality rate that persists years after hospitalization. The aim of this study was to disentangle the relative contribution of sepsis (infection with multi-organ failure), of infection and of inflammation, as reasons for ICU admission to long-term survival. This was done as infection and inflammation are both cardinal features of sepsis. We assessed the 3-year mortality of ICU patients admitted with sepsis, with individually matched ICU patients with an infection but not sepsis, and with an inflammatory illness not caused by infection, discharged alive from hospital. ⋯ Both sepsis and non-sepsis infection patients had a significantly increased hazard rate of death in the 3 years after hospital discharge compared with patients with an inflammatory illness. Among sepsis and infection patients, one third died in the next 3 years, approximately 10% more than patients with an inflammatory illness. The fact that we did not find a difference between patients with sepsis or an infection suggests that the necessity for an ICU admission with an infection increases the risk of long-term mortality. This result emphasizes the need for greater attention to the post-ICU management of sepsis, infection, and severe inflammatory illness survivors.
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Multicenter Study
A multicentre prospective registry of one thousand sepsis patients admitted in Indian ICUs: (SEPSIS INDIA) study.
Sepsis is a global health problem with high morbidity and mortality. Low- and middle-income countries have a higher incidence and poorer outcome with sepsis. Large epidemiological studies in sepsis using Sepsis-3 criteria, addressing the process of care and deriving predictors of mortality are scarce in India. ⋯ The general demographics of the sepsis population in the Indian Sepsis Registry is comparable to Western population. The mortality of sepsis cohort was higher (36.3%) but septic shock mortality (50.8%) was comparable to Western reports. Gram negative infection was the predominant cause of sepsis with a high incidence of carbapenem resistance. Eschericia coli, Klebsiella Spp and Acinetobacter Spp were the predominant causative organism. Tropical infection constituted a minority of sepsis population with low hospital mortality. The SOFA score on admission was a comparatively better predictor of poor outcome. Sepsis secondary to nosocomial infections had the worst outcomes, while source control, correct empirical antibiotic selection, and intravenous thiamine were protective. CTRI Registration CTRI:2022/07/044516.
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Understanding how preexisting comorbidities may interact with a critical illness is important for the assessment of long-term survival probability of older patients admitted to the ICU. ⋯ Older ICU patients that survive the first year after an ICU admission return to a mortality rate close to that of the general population having similar baseline comorbidity, but variability is seen depending on the ICU admission diagnosis. Trial registration ClinicalTrials.gov ID: NCT06234709, date 02/01/2024.