title: Early changes in organ function predict eventual survival in severe sepsis.
abstract: OBJECTIVE
  Early identification and treatment of severe sepsis can significantly reduce mortality rate. We hypothesized that a risk prediction model based on early (baseline to day 1 of study) response to standard care should be significantly related to 28-day survival.
  
  
  METHODS
  Analysis of organ dysfunction data from two placebo-controlled severe sepsis trials (PROWESS and secretory phospholipase A2 inhibitor trials).
  
  
  METHODS
  Research laboratory.
  
  
  METHODS
  The placebo arms of two randomized, double-blind sepsis trials were combined (n = 1036). These patients met criteria for severe sepsis and received supportive standard intensive care and fluid resuscitation.
  
  
  METHODS
  None.
  
  
  RESULTS
  Sequential Organ Failure Assessment (SOFA) scores were calculated daily using the most aberrant physiologic or laboratory variables. Baseline and post-baseline SOFA scores categorized as improved, unchanged, or worsened were used in regression analyses correlating organ dysfunction changes with 28-day mortality. Improvement in cardiovascular (p = .0010), renal (p < .0001), or respiratory (p = .0469) function from baseline to day 1 was significantly related to survival. Odds ratios (95% confidence intervals) associated with improved vs. worsened respiratory, cardiovascular, or renal function before start of day 1 were 0.56 (0.35-0.91), 0.33 (0.18-0.59), and 0.30 (0.17-0.52), respectively. Continued improvement in cardiovascular function before start of day 2 and start of day 3 was associated with further improvement in survival (p <. 0001), with odds ratios of 0.15 (0.06-0.39) and 0.11 (0.04-0.31) for patients who improved compared with those who worsened. No other organ system was retained in the model, and improvement beyond day 1 in any other organ function did not add to the model's predictive power.
  
  
  CONCLUSIONS
  These analyses suggest that outcomes for patients with severe sepsis are closely related to early (baseline to day 1 here) improvement, or lack thereof, in organ function. Also, clinical improvement on subsequent days may have little additional impact on the likelihood of survival.
authors.affiliation: Brown University School of Medicine, Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903, USA. mitchell_levy@brown.edu
authors.forename: Mitchell M
authors.initials: MM
authors.lastname: Levy
authors.forename: William L
authors.initials: WL
authors.lastname: Macias
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vincent
authors.forename: James A
authors.initials: JA
authors.lastname: Russell
authors.forename: Eliezer
authors.initials: E
authors.lastname: Silva
authors.forename: Benjamin
authors.initials: B
authors.lastname: Trzaskoma
authors.forename: Mark D
authors.initials: MD
authors.lastname: Williams
mesh_terms: D000328:Adult; D000368:Aged; D002319:Cardiovascular System / Q000503:physiopathology*; D005260:Female; D006413:Hematopoietic System / Q000503:physiopathology*; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D008099:Liver / Q000503:physiopathology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012137:Respiratory System / Q000503:physiopathology*; D018805:Sepsis / Q000150:complications / Q000401:mortality* / Q000503:physiopathology; D015996:Survival Rate