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Case Reports
. 2023 Sep 7;59(9):1617.
doi: 10.3390/medicina59091617.

Comparing Long-Term Prognosis in Chronic Critically Ill Patients: A Case Series Study of Medical versus Surgical Sepsis

Benjamin Mancini  1 , Jiabin Liu  2   3 , Abigail Samuelsen  4 , Judie A Howrylak  5 , Lisa Schultz  5 , Anthony S Bonavia  4
Affiliations
Case Reports

Comparing Long-Term Prognosis in Chronic Critically Ill Patients: A Case Series Study of Medical versus Surgical Sepsis

Benjamin Mancini et al. Medicina (Kaunas). .

Abstract

Background and Objectives: Chronic critical illness (CCI) is a syndrome characterized by persistent organ dysfunction that requires critical care therapy for ≥14 days. Sepsis and respiratory failure constitute the two primary causes of CCI. A better understanding of this patient population and their clinical course may help to risk-stratify them early during hospitalization. Our objective was to identify whether the source of sepsis (medical versus surgical) affected clinical trajectory and prognosis in patients developing CCI. Materials and Methods: We describe a cohort of patients having acute respiratory failure and sepsis and requiring critical care therapy in the medical (MICU) or surgical (SICU) critical care units for ≥14 days. Given the relative infrequency of CCI, we use a case series design to examine mortality, functional status, and place of residence (home versus non-home) at one year following their index hospitalization. Results: In medical patients developing CCI (n = 31), the severity of initial organ dysfunction, by SOFA score, was significantly associated with the development of CCI (p = 0.002). Surgical patients with CCI (n = 7) experienced significantly more ventilator-free days within the first 30 days following sepsis onset (p = 0.004), as well as less organ dysfunction at day 14 post-sepsis (p < 0.0001). However, one-year mortality, one-year functional status, and residency at home were not statistically different between cohorts. Moreover, 57% of surgical patients and 26% of medical patients who developed CCI were living at home for one year following their index hospitalization (p = 0.11). Conclusions: While surgical patients who develop sepsis-related CCI experience more favorable 30-day outcomes as compared with medical patients, long-term outcomes do not differ significantly between groups. This suggests that reversing established organ dysfunction and functional disability, regardless of etiology, is more challenging compared to preventing these complications at an earlier stage.

Keywords: chronic critical illness; long-term outcomes; sepsis; surgery.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
STROBE flow charts describing (A) medical versus (B) surgical patients with chronic critical illness. STROBE, Strengthening the Reporting of Observational Studies in Epidemiology [17]. MICU = medical intensive care unit; SICU = surgical intensive care unit.
Figure 2
Figure 2
Kaplan–Meier curves showing one-year survival probabilities for patients with (A) medical versus (B) surgical sepsis and acute respiratory failure. n = 83 (medical sepsis) and n = 17 (surgical sepsis). CCI = chronic critical illness; early death = death within 14 days of sepsis onset; RAP = rapid recovery.
Figure 3
Figure 3
Kaplan–Meier comparing one-year survival probability between patients with medical versus surgical sepsis with acute respiratory failure complicated by chronic critical illness. n = 21 (medical sepsis) and n = 7 (surgical sepsis). CCI = chronic critical illness.
See this image and copyright information in PMC

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