Early changes in organ function predict eventual survival in severe sepsis*
Abstract
Objective: Early identification and treatment of severe sepsis can significantly reduce mortality rate. We hypothesized that a risk prediction model based on early (baseline to day 1 of study) response to standard care should be significantly related to 28-day survival. Design: Analysis of organ dysfunction data from two placebo-controlled severe sepsis trials (PROWESS and secretory phospholipase A2 inhibitor trials). Setting: Research laboratory. Patients: The placebo arms of two randomized, double-blind sepsis trials were combined (n = 1036). These patients met criteria for severe sepsis and received supportive standard intensive care and fluid resuscitation. Interventions: None. Measurements and Main Results: Sequential Organ Failure Assessment (SOFA) scores were calculated daily using the most aberrant physiologic or laboratory variables. Baseline and postbaseline SOFA scores categorized as improved, unchanged, or worsened were used in regression analyses correlating organ dysfunction changes with 28-day mortality. Improvement in cardiovascular (p = .0010), renal (p < .0001), or respiratory (p = .0469) function from baseline to day 1 was significantly related to survival. Odds ratios (95% confidence intervals) associated with improved vs. worsened respiratory, cardiovascular, or renal function before start of day 1 were 0.56 (0.35–0.91), 0.33 (0.18–0.59), and 0.30 (0.17–0.52), respectively. Continued improvement in cardiovascular function before start of day 2 and start of day 3 was associated with further improvement in survival (p <. 0001), with odds ratios of 0.15 (0.06–0.39) and 0.11 (0.04–0.31) for patients who improved compared with those who worsened. No other organ system was retained in the model, and improvement beyond day 1 in any other organ function did not add to the model's predictive power. Conclusions: These analyses suggest that outcomes for patients with severe sepsis are closely related to early (baseline to day 1 here) improvement, or lack thereof, in organ function. Also, clinical improvement on subsequent days may have little additional impact on the likelihood of survival. LEARNING OBJECTIVES On completion of this article, the reader should be able to: Explain organ function abnormalities associated with poor patient outcomes from sepsis. Describe the significant time periods to predict outcome. Use this information in a clinical setting. Dr. Levy has disclosed that he is/was the recipient of direct grant/research funds from Eli Lilly & Co., Chiron, Moguel, Phillips, and Edwards; is a consultant for Chiron and Phillips; and is/was on the speakers bureau of Eli Lilly & Co., Edwards, Phillips, and Ortho. Dr. Macias has disclosed that he is/was an employee and a current stock shareholder of Eli Lilly & Co. Dr. Vincent has disclosed that he is/was the recipient of direct grant/research funds from, a consultant for, and on the speakers bureau of Eli Lilly & Co. Mr. Trzaskoma and Dr. Williams have disclosed that they were/are employees and stock shareholders of Eli Lilly & Co. Dr. Silva has disclosed that he is/was a consultant for and was on the speakers bureau of Eli Lilly & Co. Dr. Russell has disclosed that he has no financial relationships with or interests in any commercial companies pertaining to this educational activity. Wolters Kluwer Health has identified and resolved all faculty conflicts of interests regarding this educational activity. Visit the Critical Care Medicine Web site (www.ccmjournal.org) for information on obtaining continuing medical education credit.
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Early improvements in renal function after AKI may lead to better outcomes.
“some studies have shown that early improvements in renal function after AKI may lead to better outcomes [1, 5, 7].”
From Machine learning model for early prediction of acute kidney injury (AKI) in pediatric critical care (2021) · cites this paper as [7]
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Machine learning model for early prediction of acute kidney injury (AKI) in pediatric critical care
Dong, J., Feng, T., Thapa-Chhetry, B., Cho, B. G., Shum, T., Inwald, D. P., Newth, C. J. L., & Vaidya, V. U. (2021) · Critical Care · doi:10.1186/s13054-021-03724-0 · Cited by 233 · see citing works
“Whilst in pediatric intensive care units (PICU) there are often no specific treatments to reverse AKI after it has developed [6], some studies have shown that early improvements in renal function after AKI may lead to better outcomes [1, 5, 7].”
BackgroundLiu, Z.-M., Chen, J., Kou, Q., Lin, Q., Huang, X., Tang, Z., Kang, Y., Li, K., Zhou, L., Song, Q., et al. (2018) · Intensive Care Medicine · doi:10.1007/s00134-018-5267-9 · Cited by 127 · see citing works
- Authors
- Levy, M. M., Macias, W. L., Vincent, J.-L., Russell, J. A., Silva, E., Trzaskoma, B., & Williams, M. D.
- Affiliations
- University of Music and Performing Arts Vienna (AT)
- University of British Columbia (CA)
- Venue
- Critical Care Medicine
- Published
- 2005-10
- Volume
- 33
- Issue
- 10
- Pages
- 2194-2201
- ISSN
- 0090-3493 (ISSN-L)
- OpenAlex
- W1973747304
- Cited by
- 358
- References
- 23
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 5 · 2023: 6 · 2022: 12 · 2021: 9 · 2020: 5 · 2019: 8 · 2018: 12 · 2017: 13 · 2016: 13 · 2015: 12 · 2014: 27 · 2013: 23 · 2012: 31
- FWCI
- 22.22
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Critical Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- Dépôt institutionnel de l'Université libre de Bruxelles (Université Libre de Bruxelles) (submittedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Abdominal Surgery and Complications
- Keywords
- severe sepsis, 28-day survival, organ dysfunction, risk prediction model, cardiovascular function, renal function, respiratory function, fluid resuscitation, intensive care, mortality prediction, PROWESS trial
- MeSH terms
- Adult, Aged, Cardiovascular System, Female, Hematopoietic System, Humans, Kidney, Liver, Male, Middle Aged, Predictive Value of Tests, Respiratory System, Survival Rate, Logistic Models, Sepsis
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