Resumen
Purpose: Septic shock is associated with a mortality of 20–40%. The white blood cell count (WBC) at hospital admission correlates with prognosis in septic shock. Here, we explore whether the trajectory of WBC after admission provides further information about outcomes. We aimed to identify groups of patients with different WBC trajectories and the association of WBC trajectory with mortality. Methods: We included adult patients with septic shock in two academic intensive care units (ICU) in Winnipeg, MB, Canada between 2006 and 2012. We used group-based trajectory analysis to group patients according to their WBC patterns over the first seven days in the ICU. Our primary analysis was the association of WBC trajectory group on 30-day mortality using multivariable Cox proportional hazards regression. Results: We included 917 patients with septic shock. The final model identified seven distinct WBC trajectories. The rising WBC trajectory was independently associated with increased mortality (hazard ratio, 3.41; 95% confidence interval, 1.86 to 6.26; P < 0.001) compared with the stable WBC trajectory. Conclusion: In patients with septic shock, distinct and clinically relevant groups can be identified by analyzing WBC trajectories. A rising WBC trajectory was associated with higher mortality.
| Título traducido de la contribución | White blood cell count trajectory and mortality in septic shock: a historical cohort study |
|---|---|
| Idioma original | French |
| Páginas (desde-hasta) | 1230-1239 |
| Número de páginas | 10 |
| Publicación | Canadian Journal of Anaesthesia |
| Volumen | 69 |
| N.º | 10 |
| DOI | |
| Estado | Published - oct. 2022 |
Nota bibliográfica
Funding Information:Emily Rimmer and Ryan Zarychanski conceived the study. Emily Rimmer , Allan Garland , and Ryan Zarychanski designed the study. Steve Doucette performed the statistical analysis. Emily Rimmer interpreted the data and wrote the manuscript. All authors provided intellectual contributions to the interpretation of the data and read and reviewed the final manuscript. The authors declare there are no relevant conflicts of interest related to this study. This paper is the Master of Science thesis work of Emily Rimmer from the Department of Community Health Sciences at the University of Manitoba and was funded by the Lyonel G. Israels Professorship in Hematology at the University of Manitoba (Winnipeg, MB, Canada). Ryan Zarychanski is the recipient of the Lyonel G. Israels Research Chair in Hematology at the University of Manitoba (Winnipeg, MB, Canada), and receives operating support from the Canadian Institutes of Health Research, Research Manitoba, and the CancerCare Manitoba Foundation. Salaheddin Mahmud’s work is supported, in part, by funding from the Canada Research Chairs Program. Alexis Turgeon holds a Canada Research Chair in Critical Care Neurology and Trauma. The data that support the findings of this study are available from Dr. Anand Kumar but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are, however,– available from the authors upon reasonable request and with permission of Dr. Anand Kumar. This study was approved by the University of Manitoba Health Research Ethics Board (HS21067, H2017:270). This submission was handled by Dr. Donald E. G. Griesdale, Associate Editor, Canadian Journal of Anesthesia/ Journal canadien d’anesthésie.
Funding Information:
This paper is the Master of Science thesis work of Emily Rimmer from the Department of Community Health Sciences at the University of Manitoba and was funded by the Lyonel G. Israels Professorship in Hematology at the University of Manitoba (Winnipeg, MB, Canada). Ryan Zarychanski is the recipient of the Lyonel G. Israels Research Chair in Hematology at the University of Manitoba (Winnipeg, MB, Canada), and receives operating support from the Canadian Institutes of Health Research, Research Manitoba, and the CancerCare Manitoba Foundation. Salaheddin Mahmud’s work is supported, in part, by funding from the Canada Research Chairs Program. Alexis Turgeon holds a Canada Research Chair in Critical Care Neurology and Trauma.
Publisher Copyright:
© 2022, Canadian Anesthesiologists' Society.
ASJC Scopus Subject Areas
- Anesthesiology and Pain Medicine
PubMed: MeSH publication types
- Journal Article