EGDT for sepsis makes no difference in 12-month mortality, HRQoL

  • Higgins AM & al.
  • Crit Care Med
  • 1 Jun 2019

  • International Clinical Digest
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • At the 1-year mark, mortality and health-related QoL (HRQoL) among patients with sepsis were no better after early goal-directed therapy (EGDT) vs usual care (UC).
  • Mortality results echo those of ProCESS and ProMISe trials.

Why this matters

  • Most randomized controlled trials evaluating sepsis care evaluate short-term mortality, but as survival improves, attention is shifting to long-term patient-centered outcomes.
  • ARISE found similar 90-day mortality rates with EGDT vs UC.

Key results

  • EGDT vs usual care:
    • Mortality, 6 months: 21.8% vs 22.6%;
      • OR, 0.95 (95% CI, 0.75-1.21; P=.70).
    • Mortality, 12 months: 26.4% vs 27.9%;
      • OR, 0.93 (95% CI, 0.74-1.16; P=.50).
    • Similar between-group HRQoL scores at 6 and 12 months.
  • HRQoL was lower in both groups than in age-matched populations (all P<.0001>

Study design

  • Analysis of prospective, randomized, parallel-group multicenter analysis ARISE trial (n=1591).
  • Patients presenting to emergency departments with early septic shock were randomly assigned to undergo EGDT vs UC.
  • Outcome: 12-month survival.
  • Funding: National Health and Medical Research Council of Australia; Intensive Care Foundation.

Limitations

  • Many missing baseline HRQoL data.