Incidence and outcomes of sepsis after cardiac surgery as defined by the Sepsis-3 guidelines

• Published in: British journal of anaesthesia : BJA Vol. 120; no. 3; p. 509
• Main Authors: Howitt, S H, Herring, M, Malagon, I, McCollum, C N, Grant, S W
• Format: Journal Article
• Language: English
• Published: England 01-03-2018
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Cardiac Surgical Procedures; Critical Care - methods; Female; Hospital Mortality; Humans; Incidence; Intensive Care Units; Length of Stay - statistics & numerical data; Male; Middle Aged; Organ Dysfunction Scores; Patient Outcome Assessment; Postoperative Complications - diagnosis; Postoperative Complications - epidemiology; Postoperative Complications - therapy; Practice Guidelines as Topic; Sepsis - diagnosis; Sepsis - epidemiology; Sepsis - therapy; Survival Analysis; Young Adult; cardiac surgical procedures; sepsis; thoracic surgery
• ISSN: 1471-6771
• DOI: 10.1016/j.bja.2017.10.018

The Sepsis-3 guidelines diagnose sepsis based on organ dysfunction in patients with either proven or suspected infection. The objective of this study was to assess the incidence and outcomes of sepsis diagnosed using these guidelines in patients in a cardiac intensive care unit (CICU) after cardiac surgery.
Daily sequential organ failure assessment (SOFA) scores were calculated for 2230 consecutive adult cardiac surgery patients between January 2013 and May 2015. Patients with an increase in SOFA score of ≥2 and suspected or proven infection were identified. The length of CICU stay, 30-day mortality and 2-yr survival were compared between groups. Multivariable linear regression, multivariable logistic regression, and Cox proportional hazards regression were used to adjust for possible confounders.
Sepsis with suspected or proven infection was diagnosed in 104 (4.7%) and 107 (4.8%) patients, respectively. After adjustment for confounding variables, sepsis with suspected infection was associated with an increased length of CICU stay of 134.1h (95% confidence interval (CI) 99.0-168.2, P<0.01) and increased 30-day mortality risk (odds ratio 3.7, 95% CI 1.1-10.2, P=0.02). Sepsis with proven infection was associated with an increased length of CICU stay of 266.1h (95% CI 231.6-300.7, P<0.01) and increased 30-day mortality risk (odds ratio 6.6, 95% CI 2.6-15.7, P<0.01).
Approximately half of sepsis diagnoses were based on proven infection and half on suspected infection. Patients diagnosed with sepsis using the Sepsis-3 guidelines have significantly worse outcomes after cardiac surgery. The Sepsis-3 guidelines are a potentially useful tool in the management of sepsis following cardiac surgery.