The impact of organ dysfunctions on mortality in patients with severe sepsis: A multicenter prospective observational study

• Published in: Journal of critical care 2018-06, Vol.45, p.178-183
• Main Authors: Kudo, Daisuke, Kushimoto, Shigeki, Miyagawa, Noriko, Sato, Tetsuya, Hasegawa, Masatsugu, Ito, Fumihito, Yamanouchi, Sathoshi, Honda, Hiroyuki, Andoh, Kohkichi, Furukawa, Hajime, Yamada, Yasuo, Tsujimoto, Yuta, Okuyama, Manabu
• Format: Article
• Language: English
• Subjects: Acute kidney injury; Acute respiratory distress syndrome; Adult; Age; Aged; Aged, 80 and over; Disseminated intravascular coagulation; Etiology; Female; Gender; Hospital Mortality; Hospitals; Humans; Incidence; Infections; Intensive care; Intensive Care Units; Japan; Kidney diseases; Kidneys; Male; Middle Aged; Mortality; Multiple organ dysfunction syndrome; Multiple Organ Failure - etiology; Multiple Organ Failure - mortality; Observational studies; Odds Ratio; Organ dysfunction; Patients; Prospective Studies; Quantitative analysis; Risk Factors; Sepsis; Sepsis - complications
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2018.03.011

Disseminated intravascular coagulations (DIC), acute respiratory distress syndrome (ARDS), and acute kidney injury (AKI) are major organ dysfunctions that occur in patients with sepsis. This study aimed to elucidate the impact of these organ dysfunctions on mortality in patients with severe sepsis. A prospective observational study was performed in 10 ICUs to obtain data from patients with severe sepsis. Multivariate analyses to examine in-hospital mortality were performed. Data of 573 patients were analyzed. In-hospital mortality rate was 19.4% (111/573). The incidences of DIC, ARDS, and AKI were 58.4%, 18.7%, and 41.7%, while the associated mortality rates were 28.9%, 36.4%, and 31.8%, respectively. In multiple regression model, DIC (odds ratio 2.71, 95% confidence interval [CI] 1.45–5.27) and AKI stage 3 (odds ratio 1.98, 95% CI 1.07–3.63) were significantly associated with higher in-hospital all-cause mortality. DIC (hazard ratio 2.58, 95% CI 1.53–4.55) and AKI stage 3 (hazard ratio 1.73, 95% CI 1.07–2.80) were also significantly associated with longer survival durations. However, severe ARDS was not associated with these outcomes. DIC and AKI are frequent complications in patients with severe sepsis. In this study, DIC, and AKI stage 3 were independent risk factors of in-hospital mortality. •Organ dysfunctions (OD) are common complications in patients with sepsis.•DIC, acute kidney injury (AKI), and ARDS are ODs.•There was high (DIC and AKI) and low (ARDS) OD incidences in sepsis patients.•DIC and AKI stage 3 were associated with in-hospital mortality in sepsis patients.