Predictive factors of a non-recovery from sepsis-3: comparison with sepsis-2

Abstract

Introduction: After living donor liver transplantation (LDLT), the rate of complications of sepsis is one of the causes of poor short-term results. On the other hand, the definition of sepsis was revised from Sepsis-2 using SIRS to Sepsis-3 using SOFA score in 2016. However, there is no report on sepsis onset based on Sepsis-3 in the field of liver transplantation. The aim of this study was to evaluate the non-recovery predictors based on Sepsis-3 after LDLT and to compare the prediction rate with the non-recovery rate of severe sepsis in Sepsis-2. Method: LDLT was performed in 64 patients at our institute. Based on the definition of Sepsis-3, cases with sepsis within 14 days after LDLT were extracted, and the predictors of non-recovery from sepsis were examined. This prediction rate was compared with the non-recovery rate in severe sepsis extracted from the definition of Sepsis-2. Result: Fourteen patients (21.9%) developed sepsis after LDLT. Out of them 5 patients were included in non-recovery. In the non-recovery, the SOFA score at the sepsis onset was significantly higher than recovery(10.8 ± 0.83 vs. 7.3 ± 2.44; p = 0.01) .The number of lymphocytes also tended to be low in the non-recovery. When the high SOFA score (≧ 10) and low lymphocytes (<583.7 /μL) at the sepsis onset were set as the non-recovery predictor from Sepsis-3, the prediction rate was 100%. On the other hand, 15 patients (23.4%) were included in severe sepsis patients defined by Sepsis-2. Out of them 5 cases (33.3%) were non-recovery. The non-recovery predictive rate at the onset of Sepsis-3 was significantly higher than severe sepsis in Sepsis-2 (p = 0.01). Conclusion: The SOFA score (≥10 points) and lymphocyte count (<583.7/μ L) at sepsis onset can predict non-recovery. The non-recovery patients could be predicted more accurately than severe sepsis in Sepsis-2.