Abstract
<jats:p>INTRODUCTION: Sepsis in patients with prolonged and chronic critical illness (PCI/CCI) is frequently characterized by recurrent episodes and a high incidence of severe complications; however, risk factors for adverse sepsis outcomes in this population remain insufficiently studied. OBJECTIVE: To identify independent predictors of sepsis unfavorable outcomes in critically ill patients with a prolonged and chronic critical illness. MATERIALS AND METHODS: The analysis was based on the Russian Intensive Care Dataset (RICD) v2.0 (FRCRR, 2017–2024). Patients with confirmed sepsis according to Sepsis-3 criteria were included. Demographic characteristics, comorbidities, clinical scores, laboratory values, and vital parameters at the onset of the first sepsis episode were assessed. Independent predictors were determined using multivariable Cox regression. RESULTS: A total of 336 patients were analyzed (median age, 64 years; male, 54.8 %). ICU mortality was 14.0 %, and the median intensive care unit (ICU) length of stay was 44 days (30; 62). Septic shock occurred in 55 patients (16.4 %) and was independently associated with the hyperinflammatory sepsis phenotype (hazard ratio [HR] 5.23; 95% confidence interval [CI] 1.61–17.04; p = 0.006) and lower diastolic blood pressure at sepsis onset (HR 0.975; 95% CI 0.954–0.996; p = 0.019). Recurrent sepsis was observed in 96 patients (28.6 %); the only independent predictor was the hypoinflammatory phenotype (HR 5.23; 95% CI 1.29–13.01; p = 0.002). Sepsis-induced coagulopathy occurred in 78 patients (23.2 %) and was independently predicted by a reduced platelet count (HR 0.997; 95% CI 0.994–0.999; p = 0.026). CONCLUSIONS: This study is the first to identify independent risk factors for complicated sepsis in patients with PCI/CCI. The findings may be applied to risk stratification and the development of dedicated prognostic models in this high-risk ICU population.</jats:p>