1Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden. 2Centre for Health Evaluation and Outcome Science, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada. 3Centre for Heart Lung Innovation and Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.
Crit Care Med. 2016 Aug;44(8):e728-36. doi: 10.1097/CCM.0000000000001843.
As mortality of septic shock decreases, new therapies focus on improving short-term organ dysfunction. However, it is not known whether short-term organ dysfunction is associated with long-term mortality of septic shock.
Retrospective single-center.
Mixed medical-surgical ICU.
One thousand three hundred and thirty-one patients with septic shock were included from 2000-2004. To remove the bias of 28-day nonsurvivors' obvious association with long-term mortality, we determined the associations of days alive and free of ventilation, vasopressors and renal replacement therapy in 28-day and 1-year survivors with 1-, 5- and 10-year mortality in unadjusted analyses and analyses adjusted for age, gender, Acute Physiology and Chronic Health Evaluation II and presence of chronic comorbidities.
None.
Days alive and free of ventilation, vasopressors, and renal replacement therapy were highly significantly associated with 1-, 5-, and 10-year mortality (p < 0.0001). In 28-day survivors, using Bonferroni-corrected multiple logistic regression, days alive and free of ventilation (p < 0.0001, p = 0.0002, and p = 0.001), vasopressors (p < 0.0001, p < 0.0001, and p = 0.0004), and renal replacement therapy (p = 0.0008, p = 0.0008, and p = 0.0002) were associated with increased 1-, 5-, and 10-year mortality, respectively. In 1-year survivors, none of the acute organ support and dysfunction measures were associated with 5- and 10-year mortality.
Days alive and free of ventilation, vasopressors, and renal replacement therapy in septic shock in 28-day survivors was associated with 1-, 5-, and 10-year mortality. These associations are nullified in 1-year survivors in whom none of the acute organ support measures were associated with 5- and 10-year mortality. This suggests that therapies that decrease short-term organ dysfunction could also improve long-term outcomes of 28-day survivors of septic shock.
随着脓毒性休克患者死亡率的降低，新的治疗方法侧重于改善短期器官功能障碍。然而，目前尚不清楚短期器官功能障碍是否与脓毒性休克的长期死亡率相关。
回顾性单中心研究。
混合内科-外科重症监护病房。
纳入了 2000-2004 年期间的 1331 例脓毒性休克患者。为了消除 28 天存活但非幸存者与长期死亡率明显相关的偏差，我们在未调整分析和调整年龄、性别、急性生理学和慢性健康评估 II 以及慢性合并症存在的情况下，分析了 28 天存活但非幸存者的存活天数和无通气、血管加压素和肾脏替代治疗天数与 1 年、5 年和 10 年死亡率的关系。
无。
存活天数和无通气、血管加压素和肾脏替代治疗天数与 1 年、5 年和 10 年死亡率显著相关（p < 0.0001）。在 28 天存活者中，使用 Bonferroni 校正的多因素逻辑回归分析，存活天数和无通气天数（p < 0.0001、p = 0.0002 和 p = 0.001）、血管加压素（p < 0.0001、p < 0.0001 和 p = 0.0004）和肾脏替代治疗（p = 0.0008、p = 0.0008 和 p = 0.0002）与增加的 1 年、5 年和 10 年死亡率相关。在 1 年存活者中，急性器官支持和功能障碍措施均与 5 年和 10 年死亡率无关。
在 28 天存活的脓毒性休克患者中，存活天数和无通气、血管加压素和肾脏替代治疗天数与 1 年、5 年和 10 年死亡率相关。在 1 年存活者中，这些相关性被消除，急性器官支持措施均与 5 年和 10 年死亡率无关。这表明，降低短期器官功能障碍的治疗方法也可能改善脓毒性休克 28 天存活者的长期结局。
