High mortality in severe sepsis and septic shock patients with Do-not-resuscitate orders in East Asia
Journal
PLoS ONE
Journal Volume
11
Journal Issue
7
Pages
e0159501
Date Issued
2016
Author(s)
Abstract
Background Severe sepsis is a potentially deadly illness and always requires intensive care. Do-notresuscitate (DNR) orders remain a debated issue in critical care and limited data exist about its impact on care of septic patients, particularly in East Asia. We sought to assess outcome of severe sepsis patients with regard to DNR status in Taiwan. Methods A retrospective cohort study was conducted in intensive care units (ICUs) between 2008 and 2010. All severe sepsis patients were included for analysis. Primary outcome was association between DNR orders and ICU mortality. Volume of interventions was used as proxy indicator to indicate aggressiveness of care. Results Sixty-seven (9.4%) of 712 patients had DNR orders on ICU admission, and these patients were older and had higher disease severity compared with patients without DNR orders. Notably, DNR patients experienced high ICU mortality (90%). Multivariate analysis revealed that the presence of DNR orders was independently associated with ICU mortality (odds ratio: 6.13; 95% confidence interval: 2.66-14.10). In propensity score-matched cohort, ICU mortality rate (91%) in the DNR group was statistically higher than that (62%) in the non-DNR group (p <0.001). Regarding ICU interventions, arterial and central venous catheterization were more commonly used in DNR patients than in non-DNR patients. Conclusions From the Asian perspective, septic patients placed on DNR orders on ICU admission had exceptionally high mortality. In contrast to Western reports, DNR patients received more ICU interventions, reflecting more aggressive approach to dealing with this patient population. The findings in some ways reflect differences between East and West cultures and suggest that DNR status is an important confounder in ICU studies involving severely septic patients. ? 2016 Huang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
SDGs
Other Subjects
adult; age; aged; artery catheterization; Article; central venous catheterization; cohort analysis; controlled study; disease severity; do not resuscitate order; female; hospital mortality; human; intensive care unit; intervention study; major clinical study; male; medical ethics; mortality rate; observational study; outcome assessment; retrospective study; septic shock; Taiwan; epidemiology; Far East; middle aged; mortality; propensity score; resuscitation; sepsis; Shock, Septic; statistical model; statistics and numerical data; Aged; Far East; Female; Humans; Intensive Care Units; Logistic Models; Male; Middle Aged; Propensity Score; Resuscitation Orders; Retrospective Studies; Sepsis; Shock, Septic
Publisher
Public Library of Science
Type
journal article