title: The long-term burden of severe sepsis and septic shock: Sepsis recidivism and organ dysfunction.
abstract: Severe sepsis and septic shock mortality has improved; however, rates of persistent (28-90 days) and long-term (>90 day) organ dysfunction in sepsis survivors are unknown.
  
  
  
  Secondary analysis of a prospective cohort of adult emergency department patients with severe sepsis.
  
  
  
  Of 110 sepsis admissions, we obtained follow-up on 51 of 78 survivors of whom 41% (21 of 51) had persistent organ dysfunction: pulmonary, 18% (9 of 51); renal, 22% (11 of 51); coagulopathy, 10% (5 of 51); cardiovascular, 6% (3 of 51); hepatic, 2% (1 of 51); and neurologic, 3% (3 of 51). We obtained follow-up on 40 of 73 survivors at more than 90 days of whom 38% (15 of 40) had long-term organ dysfunction: pulmonary, 13% (5 of 40); renal, 18% (7 of 40); coagulopathy, 3% (1 of 40); cardiovascular, 5% (2 of 40); hepatic, 0%; and neurologic, 5% (2 of 40). Readmission rate within 90 days was 32% (25 of 78), and recurrent sepsis was the cause of readmission in 52% (13 of 25). Baseline SOFA scores from the index sepsis admission were compared using Wilcoxon rank-sum test and were significantly different in participants with organ dysfunction versus those without organ dysfunction at less than 90 days (z, -2.51; p = 0.01).
  
  
  
  Readmission with recurrent sepsis and organ dysfunction occurs frequently in sepsis survivors. Baseline SOFA score may be predictive of sepsis recidivism and persistent or recurrent organ dysfunction.
  
  
  
  Prognostic/epidemiologic study, level IV.
authors.affiliation: From the Department of Emergency Medicine (F.W.G., R.W., S.T.T., C.J.K., J.R.), University of Florida College of Medicine, Jacksonville, Florida; Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery (S.B.), University of Florida College of Medicine Gainesville, Florida; University of Florida College of Medicine (S.S., T.R.), Gainesville; Florida; Department of Emergency Medicine (J.D.K.), State University of New York Downstate, Brooklyn, New York; Division of Cardiology, Department of Internal Medicine (S.D.), University of Florida College of Medicine, Jacksonville, Florida; and Department of Emergency Medicine (A.E.J.), University of Mississippi Medical Center, Jackson, Mississippi.
authors.forename: Faheem W
authors.initials: FW
authors.lastname: Guirgis
authors.forename: Scott
authors.initials: S
authors.lastname: Brakenridge
authors.forename: Selina
authors.initials: S
authors.lastname: Sutchu
authors.forename: Jay D
authors.initials: JD
authors.lastname: Khadpe
authors.forename: Taylor
authors.initials: T
authors.lastname: Robinson
authors.forename: Richard
authors.initials: R
authors.lastname: Westenbarger
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Topp
authors.forename: Colleen J
authors.initials: CJ
authors.lastname: Kalynych
authors.forename: Jennifer
authors.initials: J
authors.lastname: Reynolds
authors.forename: Sunita
authors.initials: S
authors.lastname: Dodani
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Moore
authors.forename: Alan E
authors.initials: AE
authors.lastname: Jones
mesh_terms: D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology*; D063305:Organ Dysfunction Scores; D010359:Patient Readmission / Q000706:statistics & numerical data; D011446:Prospective Studies; D012008:Recurrence; D018805:Sepsis / Q000150:complications*; D012772:Shock, Septic / Q000150:complications*