Abdominal sepsis patients have a high incidence of chronic critical illness with dismal long-term outcomes

Abstract

Background: As hospital sepsis mortality has decreased, more surgical ICU survivors are progressing into chronic critical illness (CCI). This study documents the incidence of CCI and long-term outcomes of patients with abdominal sepsis. We hypothesized that patients developing CCI would have biomarker evidence of immune and metabolic derangement, with a high incidence of poor 1-year outcomes.

Methods: Review of abdominal sepsis patients entered in a prospective longitudinal study of surgical ICU sepsis.

Results: Of the 144 study patients, only 6% died early, 37% developed CCI (defined as ICU days ≥14 with organ dysfunction) and 57% were classified rapid recovery (RAP). Compared to RAP, CCI patients a) were older (66 vs 58), males who were sicker at baseline (Charlson Comorbidity Index 4 vs 2), b) had persistently elevated biomarkers of dysregulated immunity/metabolism (IL-6, IL-8, sPDL-1, GLP1), c) experienced more secondary infections (4.9 vs 2.3) and organ failure (Denver MOF frequency 40 vs 1%), d) were much more likely to have poor dispositions (85 vs 22%) with severe persistent disabilities by Zubrod Score and e) had a notably higher 1-year mortality of 42% (all p < 0.05).

Conclusion: Over 1/3rd surgical ICU patients treated for abdominal sepsis progress into CCI and experience dismal long-term outcomes.

Keywords: Abdominal sepsis; And catabolism syndrome; Chronic critical illness; Immunosuppression; Long-term outcomes; Persistent inflammation.

Fig. 1.. Organ Failure Trajectory, 1-year Mortality, and Long-term Performance Status.

1A. Daily SOFA score trajectory comparing CCI and RAP patients. *Indicates CCI with significantly higher SOFA scores at all time points tested (days 1, 4, 7, 14). 1B. Kaplan Meier Survival Curve comparing CCI, RAP, and Early Death. *Indicates lower survival (p < 0.001) in CCI group at 1-year. 1C. Long-term performance status after sepsis. *Significantly worse performance status in CCI than RAP at time point. SOFA, Sequential Organ Failure Assessment; CCI, chronic critical illness; RAP, rapid recovery; WHO, World Health Organization.

Fig. 2.. Biomarker Trajectories for inflammation, immunosuppression, and metabolic derangement.

Peripheral blood samples of multiple biomarkers (IL-6, IL-8, sPDL1, GLP-1) collected at 0.5, 1, 4, 7, and 14 days following sepsis diagnosis compared to matched healthy controls. * indicates CCI significantly higher (p < 0.05) than RAP at that time point. Δ indicates each cohort significantly higher (p < 0.01) than healthy controls at that time point. CCI, chronic critical illness; RAP, rapid recovery.