Aged Dependent Long-Term Outcomes after Sepsis in Critically Ill Surgical Patients

Philip Efron; Gabriela Ghita; Zhongkai Wang; Quran Wu; Anna Gardner; Michael Cox; McKenzie Hollen; Russell Hawkins; Julie Stortz; Christiaan Leeuwenburgh; Babette Brumback; Alicia Mohr; Lyle Moldawer; Frederick Moore; Scott Brakenridge

Early detection & treatment has decreased inpatient sepsis mortality. An increasing number of early sepsis survivors now progress into chronic critical illness (CCI = ICU LOS≥14 days with persistent organ dysfunction) & it is unclear how age affects these outcomes.

We hypothesize that the functional outcomes & mortality of rapid recovery (RAP; non-CCI) & CCI patients after surgical sepsis will significantly worsen with increasing age (young adult (YA)≤45yo; middle age (MA)=46-64yo; & older adult (OA)≥65yo).

We performed a prospective, longitudinal (1-year) cohort study of critically ill surgical patients with sepsis. Statistical analyses were performed by SAS (v.9.4) & R. Fisher’s exact, Kruskal–Wallis, & Log-rank tests were used for categorical, continuous & survival variables, respectively.

We enrolled 287 consecutive surgical patients with sepsis. Only 13 (5%) of the patients died within 14 days, while 97 (34%) developed CCI & the remaining 177 (62%) exhibited RAP. In general, CCI compared to RAP patients were older, had greater comorbidity burden, more severe organ dysfunction & had a higher incidence of 2° infections (all p<0.001). OA CCI patients had a 53% mortality at 12 mos, & this was greater than both MA & YA CCI (33% & 14%, respectively; p<0.05; Fig 1).

Importantly, OA CCI sepsis survivors had worse disability ZUBROD scores at 12 mos post-sepsis as compared to OA RAP (3.7±0.26 vs 2.0±0.24, respectively; p<0.05; Fig 2), and at 3 mos even OA RAP had worse ZUBROD scores than their own baseline or YA & MA RAP (p<0.05).

Acute mortality from sepsis is infrequent & CCI is becoming more predominant. Septic OA with CCI have extremely dismal 1-year outcomes, even after ICU discharge. Additionally, OA are more disabled after-sepsis. This is vital information when discussing expected outcomes of surgical sepsis patients & needs to be a focus for future sepsis research.