title: Persistent organ dysfunction after severe sepsis: a systematic review.
abstract: OBJECTIVE
  Sepsis is a prevalent disease with high mortality. Survivors of sepsis often suffer significant resultant morbidity, including organ dysfunction. However, little is known about persistent or long-term organ dysfunction in this patient population. Our objective was to systematically review original research studies evaluating organ-specific outcomes at 28 days or greater in patients surviving severe sepsis.
  
  
  METHODS
  We performed a systematic review of studies reporting organ-specific outcomes at 28 days or greater in survivors of severe sepsis.
  
  
  RESULTS
  We identified 1,173 articles and five met our inclusion criteria. No study reported on organ dysfunction at greater than 30 days. Two studies contributed the majority of patients and had consistent rates of 1 month organ dysfunction for adult respiratory distress syndrome (ARDS) (8%-9%), renal (7%-8%), hepatic (3%-7%), and central nervous system (2%-5%). Another study reported higher rates of dysfunction for pulmonary (non-ARDS and ARDS), hepatic and renal but similar rates for central nervous system and disseminated intravascular coagulation when compared to the first two studies. The most recent study had the highest rates of dysfunction (>47%) across all organ systems. For organ failure resolution the rates were highly variable.
  
  
  CONCLUSIONS
  Our review found variable rates of organ dysfunction at 1 month after severe sepsis. Future studies should attempt to characterize organ dysfunction at greater than 1 month after an acute severe sepsis episode to determine the true prevalence long-term organ dysfunction and treatments for prevention. Additionally, standardized objective measures of organ dysfunction are needed so that future studies can be directly compared.
authors.affiliation: University of Florida College of Medicine, Jacksonville, Department of Emergency Medicine, Jacksonville, FL, USA.
authors.forename: Faheem W
authors.initials: FW
authors.lastname: Guirgis
authors.affiliation: State University of New York Downstate, Department of Emergency Medicine, Brooklyn, NY, USA.
authors.forename: Jay D
authors.initials: JD
authors.lastname: Khadpe
authors.affiliation: University of Florida College of Medicine, Jacksonville; Jacksonville, FL, USA.
authors.forename: Gretchen M
authors.initials: GM
authors.lastname: Kuntz
authors.affiliation: University of Florida College of Medicine, Jacksonville, Department of Emergency Medicine, Jacksonville, FL, USA.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Wears
authors.affiliation: University of Florida College of Medicine, Jacksonville, Department of Emergency Medicine, Jacksonville, FL, USA.
authors.forename: Colleen J
authors.initials: CJ
authors.lastname: Kalynych
authors.affiliation: University of Mississippi Medical Center, Department of Emergency Medicine, Jackson, MS, USA. Electronic address: aejones@umc.edu.
authors.forename: Alan E
authors.initials: AE
authors.lastname: Jones
mesh_terms: D000328:Adult; D000368:Aged; D002493:Central Nervous System Diseases / Q000453:epidemiology / Q000209:etiology; D004211:Disseminated Intravascular Coagulation / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000453:epidemiology / Q000209:etiology; D008107:Liver Diseases / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D009928:Organ Specificity; D016032:Randomized Controlled Trials as Topic; D012128:Respiratory Distress Syndrome / Q000453:epidemiology / Q000209:etiology; D018805:Sepsis / Q000150:complications*; D013997:Time Factors
keywords: Long-term organ dysfunction; Long-term outcomes; Organ dysfunction; Organ failure; Sepsis survival; Septic shock; Severe sepsis