Stortz JA, et al. - Researchers here defined clinical outcomes and incidence of chronic critical illness (CCI) after sepsis. They also assessed whether selected biomarkers of inflammation, immunosuppression, and catabolism differ between these patients and those that rapidly recover (RAP). They observed that in critically ill surgical patients with sepsis, the development of CCI has become the predominant clinical trajectory. Biomarker profiles exhibited by these patients was consistent with an immunocatabolic phenotype of persistent inflammation, immunosuppression, and catabolism.

Methods

• Researchers, in this 3-year prospective observational cohort study (NCT02276417), investigated 145 surgical intensive care unit patients with sepsis for the development of CCI (≥14 days of intensive care unit resource utilization with persistent organ dysfunction).
• They collected patient clinical demographics, outcomes, and serial serum/urine samples for plasma protein and urinary metabolite analyses.

Results

• Researchers enrolled 145 sepsis patients; of these, 19 (13%) died during their hospitalization and 71 (49%) developed CCI.
• They noticed that the CCI patients were significantly older (mean, 63 ± 15 vs 58 ± 13 years, p = 0.006) and more frequently discharged to long-term acute care facilities (32% vs 3%, p < 0.0001), whereas those with RAP were more often discharged to home or a rehabilitation facility.
• In CCI, six-month mortality was significantly higher as compared with RAP cohort (37% vs 2%; p < 0.01).
• In multivariate logistic regression modeling, delayed onset sepsis (>48 hours after admission; odds ratio [OR], 10.93; 95% confidence interval [CI], 4.15–28.82]), interfacility transfer (OR, 3.58; 95% CI, 1.43–8.96), vasopressor-dependent septic shock (OR, 3.75; 95% CI, 1.47–9.54), and Sequential Organ Failure Assessment score of 5 or greater at 72 hours (OR, 5.03; 95% CI, 2.00–12.62) were identified as independent risk factors for the development of CCI.
• In this study, the CCI patients also showed greater elevations in inflammatory cytokines (IL-6, IL-8, IL-10), and biomarker profiles were consistent with persistent immunosuppression (absolute lymphocyte count and soluble programmed death ligand 1) and catabolism (plasma insulin-like growth factor binding protein 3 and urinary 3-methylhistidine excretion).