Do-not-attempt resuscitation independently predict in-hospital mortality in septic patients.

INTRODUCTION

Sepsis patients require timely and appropriate treatment in an intensive care setting. However, "do-not-attempt resuscitation" (DNAR) status may affect physicians' priorities and treatment preferences. The aim of this study was to evaluate whether DNAR status affects the outcomes of septic patients.

METHODS

This was a retrospective cohort study included septic patients admitted to the emergency department intensive care unit (ED-ICU) in a university-based teaching hospital during April-November 2015. Septic patients admitted to the ED-ICU were included.

RESULTS

Of the 132 eligible patients, 49.2% (65/132) had DNAR status (median age 80 years old, IQR, 73-86). The overall in-hospital mortality rate was 28.8% (38/132). Non-survivors had a higher percentage of receiving inotropes/vasopressors (52.6% vs 34.0%, p = 0.048), higher median Charlson comorbidity index scores [8.5 (IQR, 7-11.75) vs 8 (IQR, 6-9), p = 0.012], higher APACHE II score [25 (IQR, 20-30.25) vs 20 (IQR, 17-25), p = 0.002], and higher SOFA score [7 (IQR, 6-11) vs 6 (IQR,4-8), p = 0.012]. There was no significant difference in intubation among the two groups. In a multivariate logistic regression analysis, DNAR status was an independent predictor of in-hospital mortality (odds ratio = 6.22, 95% confidence interval (CI) = (2.71-17.88), p < 0.001). The area under the ROC curve for the logistic regression model was 0.84 [95% CI = (0.77-0.92), p < 0.001]. In subgroup analysis, DNAR status remained an independent predictor of mortality among age ≥65 years and ≥80 years.

CONCLUSION

After adjusting for comorbidities, treatments, and illness severity, DNAR status was associated with in-hospital mortality of septic patients. Further studies should evaluate physicians' attitudes toward septic patients with DNAR status.