Comparing Long-Term Outcomes Between Critically Ill Patients With Medical Versus Surgical Sepsis

Sunday, January 22, 2023

11:15 AM – 12:15 PM PT

Location: Exhibit Hall - RST 02

First Author(s)

Benjamin W. Mancini, BS (he/him/his)

Medical Student (MS4)
Penn State Health, Milton S Hershey Medical Center
Hershey, Pennsylvania, United States

Disclosure information not submitted.

Co-Author(s)

JH

Judie A. Howrylak, MD, PhD

Associate Professor
n/a, United States

Disclosure information not submitted.
AB

Anthony S. Bonavia, MD

Associate Professor
Pennsylvania State Milton S Hershey Medical Center, United States

Disclosure information not submitted.

INTRODUCTION: Advances in sepsis management have led to improved short-term survival, but more patients are experiencing a prolonged disease course. We hypothesized that critically ill, septic patients in the surgical intensive care unit (SICU) would have poorer long-term outcomes as compared with patients in the medical intensive care unit (MICU), based on iatrogenic tissue damage, inflammation and release of damage-associated molecular patterns (DAMPs) from surgery.

METHODS : A prospective, observational study of critically ill, septic, and mechanically ventilated patients at an academic medical center was performed. 1-year outcomes, development of chronic critical illness (CCI, >14 days in intensive care unit) and persistent inflammation, immunosuppression and catabolism syndrome (PICS) were compared between groups.

RESULTS: 74 MICU patients (age 62±16 years, 59% male) and 12 SICU patients (age 62±18 years, 67% male) were included. 25 (34%) of the MICU patients developed CCI, 21 (28%) experienced early death (< 14d of sepsis onset), and 28 (38%) rapidly recovered. By comparison, 5 (42%) of the SICU patients developed CCI, 3 (25%) experienced early death, and 4 (33%) rapidly recovered. APACHE II (p=0.01) and SOFA (p=0.04) scores of MICU patients were higher as compared with SICU patients, although Charlson Comorbidity Index did not differ. There was no difference in the proportion of patients who developed CCI or PICS between groups (p=0.64 for CCI, p=0.19 for PICS). MICU patients had significantly fewer ventilator-free days within the first month (11±11 vs. 22±5 days, p = 0.03), although 28-day mortality was not significantly different. At 1 year follow-up, there was no difference in death-free days (28±57 vs 35±38 days, p=0.79) or Zubrod scores (3.43±1.96 vs 3.09±1.98, p=0.6) between MICU and SICU cohorts, respectively. 28 (90%) MICU survivors were living at home and 3 (10%) survivors were living at a long-term nursing or rehabilitation facility at 1 year. 5 (83%) of SICU survivors were living at home and 1 (17%) was living at a long-term facility.

CONCLUSIONS: Critically ill, ventilated patients who have surgical sepsis do not experience improved outcomes as compared with medical patients who have a higher illness severity and who experience longer mechanical ventilation.