The following is a summary of “Causes and attributable fraction of death from ARDS in inflammatory phenotypes of sepsis,” published in the May 2024 issue of Critical Care by Evrard et al.
Despite recognizing distinct inflammatory responses in sepsis and Acute Respiratory Distress Syndrome (ARDS), the impact of ARDS on mortality within each sepsis phenotype remains unclear.
Researchers started a retrospective study to estimate the population-attributable fraction of death from ARDS (PAFARDS) in hypoinflammatory and hyperinflammatory sepsis and identify the leading cause of death within each group.
Through latent class analysis, they examined 1,737 patients with sepsis who were categorized into hyperinflammatory or hypoinflammatory groups. The PAFARDS for patients with sepsis was calculated separately for both phenotypes. Organ dysfunction, severe comorbidities, and life support withdrawal data were gathered from medical records for a subset of patients deceased (n = 130/179) in the EARLI cohort. The primary cause of death was determined as the organ system primarily contributed to mortality or life support withdrawal.
The results showed PAFARDS stood at 19% (95%CI 10,28%) for hypoinflammatory sepsis and 14% (95%CI 6,20%) for hyperinflammatory sepsis. The cause of death varied between the two phenotypes (P<0.001). In hypoinflammatory sepsis, respiratory failure was the primary cause of death, whereas circulatory shock was predominant in hyperinflammatory sepsis. Death accompanied by severe underlying comorbidities occurred more frequently in hypoinflammatory sepsis (81% vs. 67%, P=0.004).
Investigators found a limited impact of mortality in ARDS in both sepsis groups, but the cause of death differed significantly, posing difficulties for designing future sepsis and ARDS mortality trials.
Source: ccforum.biomedcentral.com/articles/10.1186/s13054-024-04943-x