Late mortality after sepsis: propensity matched cohort study
BMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i2375 (Published 17 May 2016) Cite this as: BMJ 2016;353:i2375
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First of congratulations to the authors Hallie C Prescott et al. for such an apt study (1) regarding late mortality after sepsis. The study throws light on the occurrence of increased late mortality after sepsis, which can be either due to preexisting comorbid conditions or due to changes occurring after an episode of sepsis.
Since the study cohort is taken from prospective study population, it envisage the results from a better perspective and matching of the cohort to each of the non admitted population, patients with inflammation but without sepsis and patients with infection without inflammation or sepsis gives it more credibility.
However few questions still remain unanswered. First of all Late mortality after sepsis has been taken as 31 days - two years but whether this '31 days' is taken from the time of admission of a patient, time of onset of sepsis in an admitted patient or the time after patient is discharged after an episode of sepsis. This is important because many patients who are admitted for inflammatory conditions such as acute pancreatitis may develop sepsis during the hospital admission and there admission will be long enough for raising questions whether mortality if any is occurring is indeed a late mortality.
Another question that is arisen is that more than one organ involvement was associated with an increased mortality. The
inclusion of specific organ / organ system along with their different combination/s such as e.g. Renal, Respiratory, Central Nervous System or Cardiovascular system could have increased the value and scope of the study with recommendations/advice on potential therapeutic implications during admission for sepsis.
Nevertheless the study is a milestone for late mortality after sepsis with various learning points.
Dr Ajay Kumar Pal
Assistant Professor
Department of Surgery
King George Medical University
Lucknow, India
email- akpal.jnmc@yahoo.com
References
1. Prescott Hallie C, Osterholzer John J, Langa Kenneth M, Angus Derek C, Iwashyna Theodore J. Late mortality after sepsis: propensity matched cohort study BMJ 2016; 353 :i2375.
Competing interests: No competing interests
Re: Late mortality after sepsis: propensity matched cohort study
In the "sepsis"-cohort, what proportion of patients were ever discharged from the ICU or hospital following "survival to 31 days"? And among those who died after 31 days, how many succumbed while remaining in hospital vs following discharge? Kaplan Meyer curves indicate that most excess mortality was early following survival to 31 days. Does this simply reflect continued care against hopeless odds?
Competing interests: No competing interests