I read with interest a recent article on the association between postdischarge ... Moreno R, Carlet J, Le Gall JR, Payen D; Sepsis Occurrence in. Acutely Ill ... Bagshaw SM, George C, Bellomo R; ANZICS Database Management. Committee.
CORRESPONDENCE apolipoprotein A-I and large high-density lipoprotein particles are positively correlated with FEV1 in atopic asthma. Am J Respir Crit Care Med 2015;191:990–1000.
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Renal Replacement Therapy in Sepsis To the Editor: I read with interest a recent article on the association between postdischarge rehabilitation and mortality in sepsis survivors by Chao and colleagues (1). In this database-based cohort study, they reported a high rate of renal replacement therapy (RRT) (57.4 and 54.5%, respectively, for those receiving and not receiving rehabilitation) in sepsis survivors who received intensive care during hospitalization (Chao and colleagues’ Table 1) (1). However, these figures are unusual and not consistent with prior reports (2–6). The incidence of sepsis-associated acute kidney injury ranges from 10 to 50% (2–5). Less than approximately onethird of patients with sepsis-associated acute kidney injury require RRT (2–4). Moreover, the proportional distribution of the number of acute organ dysfunctions cannot explain the high rates of organ support measures in the unmatched study cohort (Chao and colleagues’ Table 1) (1). Specifically, the overall proportion of patients with a single or two or more acute organ dysfunctions was 42.5% (48,485/114,059) and 17.7% (20,242/ 114,059), respectively. However, the overall proportion of patients receiving organ support measures was 45.2% using inotropic agents, 54.9% using RRT, and 45.3% using ventilator, respectively. Together, this means that a significant proportion of patients without acute organ dysfunction may have received one or two of these organ support measures, which is clinically unlikely. Because reliability of the data is crucial to the validity of the risk estimate, the unusual figures and inconsistent data need to be clarified. n Author disclosures are available with the text of this letter at www.atsjournals.org. Hsiu-Nien Shen, M.D. Chi Mei Medical Center Tainan, Taiwan and National Cheng Kung University Tainan, Taiwan
References 1. Chao PW, Shih CJ, Lee YJ, Tseng CM, Kuo SC, Shih YN, Chou KT, Tarng DC, Li SY, Ou SM, et al. Association of postdischarge rehabilitation with mortality in intensive care unit survivors of sepsis. Am J Respir Crit Care Med 2014;190:1003–1011. 2. Vincent JL, Sakr Y, Sprung CL, Ranieri VM, Reinhart K, Gerlach H, Moreno R, Carlet J, Le Gall JR, Payen D; Sepsis Occurrence in Acutely Ill Patients Investigators. Sepsis in European intensive care units: results of the SOAP study. Crit Care Med 2006;34: 344–353.
Correspondence
3. Bagshaw SM, George C, Bellomo R; ANZICS Database Management Committee. Early acute kidney injury and sepsis: a multicentre evaluation. Crit Care 2008;12:R47. 4. Poukkanen M, Koskenkari J, Vaara ST, Pettila¨ V, Karlsson S, Korhonen AM, Laurila JJ, Kaukonen KM, Lund V, Ala-Kokko TI; FINNAKI Study Group. Variation in the use of renal replacement therapy in patients with septic shock: a substudy of the prospective multicenter observational FINNAKI study. Crit Care 2014;18:R26. 5. Alobaidi R, Basu RK, Goldstein SL, Bagshaw SM. Sepsis-associated acute kidney injury. Semin Nephrol 2015;35:2–11. 6. Shen HN, Lu CL, Yang HH. Epidemiologic trend of severe sepsis in Taiwan from 1997 through 2006. Chest 2010;138:298–304.
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Reply From the Authors: We thank Dr. Shen for his interest in our article (1). Because the objective of our study was the long-term outcomes of intensive care unit survivors receiving postdischarge rehabilitation, we did not exclude those patients receiving chronic dialysis or chronic ventilator support before intensive care unit admissions for sepsis. Therefore, patients receiving chronic dialysis or chronic ventilator support would not take into account “acute” renal or respiratory organ dysfunction. This causes the difference between proportional distribution in the number of acute organ failures and organ support measures (e.g., renal replacement therapy and mechanical ventilator) during the intensive care unit stay. This is also why the proportion of dialysis treatments in our cohort is relative higher than that of sepsis-associated acute kidney injury requiring renal replacement therapy. n
Author disclosures are available with the text of this letter at www.atsjournals.org. Chia-Jen Shih, M.D. Taipei Veterans General Hospital Yuanshan Branch Yilan, Taiwan Shuo-Ming Ou, M.D. Taipei Veterans General Hospital Taipei, Taiwan Yung-Tai Chen, M.D. Taipei City Hospital Heping Fuyou Branch Taipei, Taiwan
Reference 1. Chao PW, Shih CJ, Lee YJ, Tseng CM, Kuo SC, Shih YN, Chou KT, Tarng DC, Li SY, Ou SM, et al. Association of postdischarge rehabilitation with mortality in intensive care unit survivors of sepsis. Am J Respir Crit Care Med 2014;190:1003–1011.
Copyright © 2015 by the American Thoracic Society
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