Sepsis (or blood infection) is a dangerous thing. I remember first realising this as a Junior doctor in respiratory medicine, when an audit of pneumonia admissions revealed a mortality of 60%. Sadly, this has not improved by much even with the latest antibiotics. As I rotated through, transplant medicine, haem-oncology, and finally into ICU, I found myself forever pre-occupied with watching the CRP – an acute inflammatory marker, in all of my patients.
There was a hard lesson to be learnt in all this, which was what could be modified (treat early), and what couldn’t be modified (age and co-morbidities) once admitted into hospital – a mental weighing scale of sorts. The SARS-CoV2 for many of us, including myself, was a replay of this but on a wider scale.
But, as a neurologist and an MS doctor you very rarely come across data specific to your speciality with regards to ITU admissions. Did I know what to expect; may be not, and probably neither do our patients.
This data from Texas collected over a 7 year period with 19,837 ICU admissions with MS during the study period, of which 6244 (31.5%) had sepsis (i.e. a common reason for ICU admission).
The adjusted probability of short-term mortality was 13.4% (95% CI 13.0–13.7) among ICU admissions with sepsis and 3.3% (95% CI 3.2–3.4) among ICU admissions without sepsis (i.e. four-fold higher mortality if you were septic). The predictors of this short-term mortality are detailed below:
Not surprisingly those >65y had a 3-fold greater mortality, as did those with multiple organ failures.
“Once a septic patient with MS required both mechanical ventilation and haemodialysis, risk-adjusted short-term mortality was markedly higher across all subgroups, reaching 62.2% among those 65 years or older with 3 or more organ dysfunctions“.
Urinary tract infections (UTIs) had much lower odds of short-term mortality, which is good to know as the incidence of UTIs in MS is very high.
However, I do see a great opportunity for education at all levels of medical care providers and with patients. Firstly, being aware of the risk and early escalation, managing modifiable risk factors (for example alcohol misuse) and careful management of co-morbidities throughout an individuals life.
J Crit Care. 2022 Jun;69:153985. doi: 10.1016/j.jcrc.2022.153985. Epub 2022 Jan 11.
The burden of sepsis in critically ill patients with multiple sclerosis: A population-based cohort study
Purpose: Multiple sclerosis (MS) is associated with increased risk of critical illness, sepsis, and sepsis-related death, compared to the general population. The epidemiology of sepsis and its impact on the outcomes of critically ill patients with MS are unknown.
Methods: A statewide dataset was used to identify retrospectively ICU admissions in Texas aged ≥18 years with a diagnosis of MS during 2010-2017. The prevalence of sepsis and its impact on inpatient resource utilization and short-term mortality (a combination of in-hospital death or discharge to hospice) were examined.
Results: Among 19,837 ICU admissions with MS, 6244 (31.5%) had sepsis. Compared to ICU admissions without sepsis, those with sepsis were older (aged ≥65 years 34.1% vs 24.1%), less commonly racial/ethnic minority (32.6% vs 35.2%), and had higher mean [SD] Deyo comorbidity index (1.7 [1.8] vs 1.2 [1.7]). On adjusted analyses, sepsis was associated with 42.7% longer hospital length of stay and 26.2% higher total hospital charges. Risk-adjusted short-term mortality among ICU admissions with and without sepsis was 13.4% vs 3.3%, respectively.
Conclusions: Sepsis was present in nearly 1 in 3 ICU admissions with MS, had substantial adverse impact on hospital resource utilization, and was associated with over 4-times higher short-term mortality.