Early changes in organ function predict eventual survival in severe sepsis

Area of Science:

• Critical care medicine
• Sepsis research
• Clinical epidemiology

Background:

• Severe sepsis poses a significant threat to patient survival.
• Early identification and intervention are crucial for reducing mortality rates in severe sepsis.
• The predictive value of early organ function response to standard care for survival is not fully established.

Purpose of the Study:

• To develop a risk prediction model for 28-day survival in severe sepsis patients.
• To investigate the relationship between early organ function response (baseline to day 1) and 28-day survival.
• To determine if continued organ function improvement beyond day 1 impacts survival.

Main Methods:

• Analysis of organ dysfunction data from the placebo arms of two severe sepsis trials (PROWESS and secretory phospholipase A2 inhibitor trials).
• Calculation of Sequential Organ Failure Assessment (SOFA) scores daily.
• Regression analyses correlating changes in SOFA scores with 28-day mortality.

Main Results:

• Improvement in cardiovascular, renal, or respiratory function from baseline to day 1 was significantly related to survival.
• Early improvement in organ function (baseline to day 1) showed strong inverse correlations with mortality (ORs ranging from 0.30 to 0.56).
• Continued improvement in cardiovascular function by day 2 and day 3 further improved survival, but improvements in other organ systems beyond day 1 did not add predictive power.

Conclusions:

• Early (baseline to day 1) organ function improvement is a strong predictor of 28-day survival in severe sepsis.
• The lack of early improvement in organ function is closely related to adverse outcomes.
• Clinical improvement beyond the first day of standard care may have limited additional impact on survival prediction.