Severe sepsis in do-not-resuscitate patients: Intervention and mortality rates

Emilie S. Powell, Kori Sauser, Navneet Cheema, Matthew J. Pirotte, Erin Quattromani, Umakanth Avula, Rahul K. Khare, D. Mark Courtney

Research output: Contribution to journalArticle

12 Scopus citations

Abstract

Background: Severe sepsis is a high-mortality disease, and early resuscitation decreases mortality. Do-not-resuscitate (DNR) status may influence physician decisions beyond cardiopulmonary resuscitation, but this has not been investigated in sepsis. Objective: Among Emergency Department (ED) severe sepsis patients, define the incidence of DNR status, prevalence of central venous catheter placement, and vasopressor administration (invasive measures), and mortality. Methods: Retrospective observational cohort of consecutive severe sepsis patients to single ED in 2009-2010. Charts abstracted for DNR status on presentation, demographics, vitals, Sequential Organ Failure Assessment (SOFA) score, inpatient and 60-day mortality, and discharge disposition. Primary outcomes were mortality, discharge to skilled nursing facility (SNF), and invasive measure compliance. Chi-squared test was used for univariate association of DNR status and outcome variables; multivariate logistic regression analyses for outcome variables controlling for age, gender, SOFA score, and DNR status. Results: In 376 severe sepsis patients, 50 (13.3%) had DNR status. DNR patients were older (79.2 vs 60.3 years, p < 0.001) and trended toward higher SOFA scores (7 vs. 6, p = 0.07). DNR inpatient and 60-day mortalities were higher (50.5% vs. 19.6%, 95% confidence interval [CI] 15.9-44.9%; 64.0% vs. 24.9%, 95% CI 25.1-53.3%, respectively), and remained higher in multivariate logistic regression analysis (odds ratio [OR] 3.01, 95% CI 1.48-6.17; OR 3.80, 95% CI 1.88-7.69, respectively). The groups had similar rates of discharge to SNF, and in persistently hypotensive patients (n = 326) had similar rates of invasive measures in univariate and multivariate analyses (OR 1.19, 95% CI 0.45-3.15). Conclusion: In this sample, 13.3% of severe sepsis patients had DNR status, and 50% of DNR patients survived to hospital discharge. DNR patients received invasive measures at a rate similar to patients without DNR status.

Original languageEnglish (US)
Pages (from-to)742-749
Number of pages8
JournalJournal of Emergency Medicine
Volume44
Issue number4
DOIs
StatePublished - Apr 1 2013
Externally publishedYes

Keywords

  • do-not-resuscitate
  • mortality
  • sepsis

ASJC Scopus subject areas

  • Emergency Medicine

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    Powell, E. S., Sauser, K., Cheema, N., Pirotte, M. J., Quattromani, E., Avula, U., Khare, R. K., & Courtney, D. M. (2013). Severe sepsis in do-not-resuscitate patients: Intervention and mortality rates. Journal of Emergency Medicine, 44(4), 742-749. https://doi.org/10.1016/j.jemermed.2012.09.034