Document 0537
 DOCN  M9590537
 TI    Long-term survival after intensive care unit admission with sepsis.
 DT    9509
 AU    Sasse KC; Nauenberg E; Long A; Anton B; Tucker HJ; Hu TW; School of
       Medicine, University of California at San Francisco,; USA.
 SO    Crit Care Med. 1995 Jun;23(6):1040-7. Unique Identifier : AIDSLINE
       MED/95292556
 AB    OBJECTIVE: To evaluate the long-term survival of critically ill patients
       with sepsis and to assess the factors predictive of long-term survival
       (> 1 month after admission date). DESIGN: Prospective, cohort study.
       SETTING: Medical/surgical intensive care unit (ICU) in a
       multidisciplinary community hospital. PATIENTS: All patients admitted to
       the ICU from January 1, 1987 to March 31, 1991 who both demonstrated
       clinical evidence of the systemic inflammatory response syndrome and
       yielded blood cultures positive for a bacterium or fungus (n = 153).
       INTERVENTIONS: Random set of procedures normally performed in an ICU
       setting. MEASUREMENTS AND MAIN RESULTS: Patient characteristics,
       including age, blood culture results, comorbid conditions, and severity
       of illness as estimated by the Acute Physiology Score of the Acute
       Physiology and Chronic Health Evaluation II prognostic system were
       recorded. Follow-up evaluation utilizing the National Death Index
       provided survival outcome for all patients 1 yr after hospital
       discharge. The mortality rate at hospital discharge was 51.0%, and
       mortality rates at 1 month, 6 months, and 1 yr after admission date were
       40.5%, 64.7%, and 71.9%, respectively. A total of 33 patients survived
       beyond the period of observation. The analyses demonstrated the
       following findings: a) the survival rate was negatively correlated with
       the Acute Physiology Score up to 1 month after hospital admission date,
       but uncorrelated thereafter; b) fungal infections, such as Candida, had
       the shortest survival prospects of any blood-borne infection; and c)
       both malignancy and human immunodeficiency virus infection contributed
       to poorer outcomes, but differed in their patterns of long-term
       survival. CONCLUSIONS: The most critical period for surveillance of
       bacteremic patients was in months 2 through 6 after discharge, during
       which time, the percentage of patients surviving decreased dramatically.
       The degree of physiologic derangement, as measured by the Acute
       Physiology Score, was a useful measure of prognosis within the first
       month after the score was assessed at ICU admission. However, beyond
       this period, prognostic utility decreased significantly. Healthcare
       providers should use caution concerning the expected survival of
       hospitalized patients with human immunodeficiency virus, based on
       experience with distinct conditions, such as malignancies.
 DE    Adult  Aged  APACHE  Female  Hospitalization  Human  HIV
       Infections/MORTALITY  Intensive Care Units  Logistic Models  Male
       Middle Age  Outcome Assessment (Health Care)  Predictive Value of Tests
       Prognosis  Proportional Hazards Models  Prospective Studies  Sepsis
       Syndrome/COMPLICATIONS/MICROBIOLOGY/*MORTALITY/THERAPY  Support,
       Non-U.S. Gov't  Survival Analysis  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).