Abstract
BackgroundThe role of site of infection in sepsis has been poorly characterized. Additionally, sepsis epidemiology has evolved. Early mortality has decreased, but many survivors now progress into chronic critical illness (CCI). This study sought to determine if there were significant differences in the host response and current epidemiology of surgical sepsis categorized by site of infection.Study designThis is a longitudinal study of surgical sepsis patients characterized by baseline predisposition, insult characteristics, serial biomarkers, hospital outcomes, and long-term outcomes. Patients were categorized into five anatomic sites of infection.ResultsThe 316 study patients were predominantly Caucasian; half were male, with a mean age of 62 years, high comorbidity burden, and low 30-day mortality (10%). The primary sites were abdominal (44%), pulmonary (19%), skin/soft tissue (S/ST, 17%), genitourinary (GU, 12%), and vascular (7%). Most abdominal infections were present on admission and required source control. Comparatively, they had more prolonged proinflammation, immunosuppression, and persistent organ dysfunction. Their long-term outcome was poor with 37% CCI (defined as > 14 in ICU with organ dysfunction), 49% poor discharge dispositions, and 30% 1-year mortality. Most pulmonary infections were hospital-acquired pneumonia. They had similar protracted proinflammation and organ dysfunction, but immunosuppression normalized. Long-term outcomes are similarly poor (54% CCI, 47% poor disposition, 32% 1-year mortality). S/ST and GU infections occurred in younger patients with fewer comorbidities, less perturbed immune responses, and faster resolution of organ dysfunction. Comparatively, S/ST had better long-term outcomes (23% CCI, 39% poor disposition, 13% 1-year mortality) and GU had the best (10% CCI, 20% poor disposition, 10% 1-year mortality). Vascular sepsis patients were older males, with more comorbidities. Proinflammation was blunted with baseline immunosuppression and organ dysfunction that persisted. They had the worst long-term outcomes (38% CCI, 67% poor disposition, 57% 1-year mortality).ConclusionThere are notable differences in baseline predisposition, host responses, and clinical outcomes by site of infection in surgical sepsis. While previous studies have focused on differences in hospital mortality, this study provides unique insights into the host response and long-term outcomes associated with different sites of infection.
Highlights
Despite decades of intensive research, sepsis remains a common deadly, costly, and debilitating intensive care unit (ICU) syndrome [1,2,3]
They had more prolonged proinflammation, immunosuppression, and persistent organ dysfunction. Their long-term outcome was poor with 37% critical illness (CCI), 49% poor discharge dispositions, and 30% 1-year mortality
Proinflammation was blunted with baseline immunosuppression and organ dysfunction that persisted
Summary
Despite decades of intensive research, sepsis remains a common deadly, costly, and debilitating intensive care unit (ICU) syndrome [1,2,3]. Sepsis has been viewed to be due to an over-exuberant systemic inflammatory response syndrome (SIRS) that caused early deaths from refractory septic shock or unremitting multiple organ failure (MOF) [4,5,6] Once triggered, this systemic process was believed to progress independent of the inciting infection and patients with different types of infection have been grouped together in clinical trials [7]. We hypothesized that patients classified by site of infection will experience different clinical phenotypes when compared by baseline predisposition, initial septic insult characteristics, serial immune biomarker response, and organ dysfunction resolution, as well as their ICU and long-term clinical outcomes. Understanding this heterogeneity will assist clinicians in prognostication and decision-making. This study sought to determine if there were significant differences in the host response and current epidemiology of surgical sepsis categorized by site of infection
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