(1425) Long-Term Prognosis in Chronic Critically Ill Patients With Medical Versus Surgical Sepsis

Introduction: Septic patients who develop subsequent chronic critical illness (CCI) account for a minority of total critical care unit admissions. However, they experience significant morbidity, poor long-term outcomes, and high healthcare burden. Sepsis and acute respiratory failure are the main causes of CCI. Unique comorbidity profiles present in critically ill patients treated in the medical intensive care unit (MICU) versus surgical intensive care unit (SICU) may additionally contribute to differing clinical trajectories.

Methods: We describe a case series consisting of septic, adult, CCI patients (patients having persistent organ dysfunction for >14 days) with acute respiratory failure treated in a quaternary care medical center intensive care unit (ICU) between 2013 and 2022. Outcomes of interest included mortality, functional status and place of residence (home versus assisted living facility) at one year following development of CCI.

Results: Thirty-one (38%) patients with acute respiratory failure and with medical (non-surgical) sepsis developed CCI. An approximately equal proportion of patients with surgical sepsis developed CCI (n=7, 41%). In the medical cohort, SOFA score at sepsis onset was significantly associated with the development of CCI (P = 0.002). This was not the case with the surgical cohort (P = 0.420). Surgical patients experienced significantly more ventilator-free days within the first 30 days following sepsis onset (P = 0.004), as well as less residual organ dysfunction at day 14 post-sepsis onset (P < 0.0001). However, one-year mortality, one-year functional status, and residency at home were not significantly different between medical and surgical cohorts with CCI. 57% of surgical patients and 26% of medical patients who developed CCI were living at home at one year following their index hospitalization (P = 0.11).

Conclusions: While surgical patients that develop sepsis-related CCI experience more favorable short-term outcomes as compared with medical patients, long-term outcomes do not differ significantly between groups. This suggests that reversing established organ dysfunction and functional disability, regardless of etiology, is more challenging compared to preventing these complications at an earlier stage.