Sepsis and underlying comorbidities in intensive care unit patients

Background There is an ongoing debate as to whether death with sepsis is primarily caused by sepsis or, more often, by the underlying disease. There are no data on the influence of a researcher’s background on such an assessment. Therefore, the aim of this analysis was to assess the cause of death in sepsis and the influence of an investigator’s professional background on such an assessment. Materials and methods We performed a retrospective observational cohort study of sepsis patients treated in the medical intensive care unit (ICU) of a tertiary care center. For deceased patients, comorbidities and severity of illness were documented. The cause of death (sepsis or comorbidities or both combined) was independently assessed by four assessors with different professional backgrounds (medical student, senior physician in the medical ICU, anesthesiological intensivist, and senior physician specialized in the predominant comorbidity). Results In all, 78 of 235 patients died in hospital. Agreement between assessors about cause of death was low (κ 0.37, 95% confidence interval 0.29–0.44). Depending on the assessor, sepsis was the sole cause of death in 6–12% of cases, sepsis and comorbidities in 54–76%, and comorbidities alone in 18–40%. Conclusions In a relevant proportion of patients with sepsis treated in the medical ICU, comorbidities contribute significantly to mortality, and death from sepsis without relevant comorbidities is a rare event. Designation of the cause of death in sepsis patients is highly subjective and may be influenced by the professional background of the assessor.