Severe Sepsis in Do-not-resuscitate Patients: Intervention and Mortality Rates |
| |
Authors: | Emilie S Powell Kori Sauser Navneet Cheema Matthew J Pirotte Erin Quattromani Umakanth Avula Rahul K Khare D Mark Courtney |
| |
Institution: | ∗ Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois;† Institute for Healthcare Studies and Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois;‡ Center for Simulation Technology and Immersive Learning, Feinberg School of Medicine, Northwestern University, Chicago, Illinois |
| |
Abstract: | BackgroundSevere sepsis is a high-mortality disease, and early resuscitation decreases mortality. Do-not-resuscitate (DNR) status may influence physician decisions beyond cardiopulmonary resuscitation, but this has not been investigated in sepsis.ObjectiveAmong Emergency Department (ED) severe sepsis patients, define the incidence of DNR status, prevalence of central venous catheter placement, and vasopressor administration (invasive measures), and mortality.MethodsRetrospective observational cohort of consecutive severe sepsis patients to single ED in 2009–2010. Charts abstracted for DNR status on presentation, demographics, vitals, Sequential Organ Failure Assessment (SOFA) score, inpatient and 60-day mortality, and discharge disposition. Primary outcomes were mortality, discharge to skilled nursing facility (SNF), and invasive measure compliance. Chi-squared test was used for univariate association of DNR status and outcome variables; multivariate logistic regression analyses for outcome variables controlling for age, gender, SOFA score, and DNR status.ResultsIn 376 severe sepsis patients, 50 (13.3%) had DNR status. DNR patients were older (79.2 vs 60.3 years, p < 0.001) and trended toward higher SOFA scores (7 vs. 6, p = 0.07). DNR inpatient and 60-day mortalities were higher (50.5% vs. 19.6%, 95% confidence interval CI] 15.9–44.9%; 64.0% vs. 24.9%, 95% CI 25.1–53.3%, respectively), and remained higher in multivariate logistic regression analysis (odds ratio OR] 3.01, 95% CI 1.48–6.17; OR 3.80, 95% CI 1.88–7.69, respectively). The groups had similar rates of discharge to SNF, and in persistently hypotensive patients (n = 326) had similar rates of invasive measures in univariate and multivariate analyses (OR 1.19, 95% CI 0.45–3.15).ConclusionIn this sample, 13.3% of severe sepsis patients had DNR status, and 50% of DNR patients survived to hospital discharge. DNR patients received invasive measures at a rate similar to patients without DNR status. |
| |
Keywords: | sepsis mortality do-not-resuscitate |
本文献已被 ScienceDirect 等数据库收录! |
|