Abstract Purpose Given its high mortality rate, sepsis poses a significant medical challenge. Despite advances, the sequence of organ dysfunction associated with sepsis has not been fully evaluated. Understanding this sequence may improve diagnosis and intervention and reduce the burden of sepsis on healthcare systems. Methods We utilized the Sequential Organ Failure Assessment score to analyze the progression of organ dysfunction in patients with sepsis using two intensive care unit databases. We further explored patterns of in-hospital mortality and the temporal distribution of absolute and relative orders of organ dysfunction. Results Among 11,838 patients with sepsis, older adults had higher mortality rate than younger patients (16.16% vs. 6.47%, P <0.001), female had higher mortality rate than male (12.93% vs. 10.66%, P <0.001). Mortality rose with the organ dysfunction count. In-hospital mortality increased with the number of organs involved, and two to three organs were the highest number of dysfunctional organs. Cardiovascular dysfunction was most prevalent (42.5%), followed by neurological (18%) and respiratory (14.6%) dysfunction. Liver dysfunction was associated with the highest in-hospital mortality (33.08%). Neurological (21.04%) and respiratory (19.43%) dysfunction were most likely to follow cardiovascular dysfunction. Liver dysfunction (33.08%) that followed renal dysfunction had the highest in-hospital mortality. The onset of subsequent organ dysfunction varied; cardiovascular dysfunction most rapidly precipitated further organ dysfunction (median time: 5 h). Conclusions In summary, the analysis underscores the impact of age, sex, and organ dysfunction order on in-hospital mortality, highlighting the systemic and progressive nature of sepsis and the need for early detection and intervention to enhance outcomes, especially in high-risk individuals.
Zhang et al. (Tue,) studied this question.