ArticlePloS one2016
High Mortality in Severe Sepsis and Septic Shock Patients with Do-Not-Resuscitate Orders in East Asia.
Article in PloS one, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.
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Who cites it
16 citing papers in PubMed, 31 citations in OpenAlex.
- Exploring the role of palmitoylation in sepsis: mechanistic insights and future perspectives.Molecular medicine (Cambridge, Mass.) · 2025Review
- The impact of withholding and withdrawal life-sustaining treatment issues on patients with sepsis: a prospective, nationwide, multicenter cohort study.Scientific reports · 2025Article
- Clinical characteristics and prognostic factors of sepsis in patients with malignancy.Scientific reports · 2025Observational
- Early Mortality Stratification with Serum Albumin and the Sequential Organ Failure Assessment Score at Emergency Department Admission in Septic Shock Patients.Life (Basel, Switzerland) · 2024Article
- Sepsis increases the risk of in-hospital cardiac arrest: a population-based analysis.Internal and emergency medicine · 2024Article
- Advancing screening tool for hospice needs and end-of-life decision-making process in the emergency department.BMC palliative care · 2024Article
- Characteristics and outcomes of patients with do-not-resuscitate and physician orders for life-sustaining treatment in a medical intensive care unit: a retrospective cohort study.BMC palliative care · 2024Article
- The Impact of Do-Not-Resuscitate Order in the Emergency Department on Respiratory Failure after ICU Admission.Healthcare (Basel, Switzerland) · 2022Article
- Characteristics and outcomes of patients screened by rapid response team who transferred to the intensive care unit.BMC emergency medicine · 2022Article
- Factors associated with do-not-resuscitate document completion among patients hospitalized in geriatric ward.BMC geriatrics · 2021Article
- Do not attempt cardiopulmonary resuscitation (DNACPR) decisions in people admitted with suspected COVID-19: Secondary analysis of the PRIEST observational cohort study.Resuscitation · 2021Observational
- Causes of Mortality in ICU-Acquired Weakness.Journal of intensive care medicine · 2020Article
- Risk and Prognostic Factors in Very Old Patients with Sepsis Secondary to Community-Acquired Pneumonia.Journal of clinical medicine · 2019Article
- Physician workload associated with do-not-resuscitate decision-making in intensive care units: an observational study using Cox proportional hazards analysis.BMC medical ethics · 2019Observational
- Reduction in the IL-6 level at 24 h after admission to the intensive care unit is a survival predictor for Vietnamese patients with sepsis and septic shock: a prospective study.BMC emergency medicine · 2018Article
- Validation of the Cardiac Arrest Survival Postresuscitation In-hospital (CASPRI) score in an East Asian population.PloS one · 2018Article
Corrections and comments
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Authors and funding
5 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundSevere sepsis is a potentially deadly illness and always requires intensive care. Do-not-resuscitate (DNR) orders remain a debated issue in critical care and limited data exist about its impact on care of septic patients, particularly in East Asia. We sought to assess outcome of severe sepsis patients with regard to DNR status in Taiwan.
methodsA retrospective cohort study was conducted in intensive care units (ICUs) between 2008 and 2010. All severe sepsis patients were included for analysis. Primary outcome was association between DNR orders and ICU mortality. Volume of interventions was used as proxy indicator to indicate aggressiveness of care.
resultsSixty-seven (9.4%) of 712 patients had DNR orders on ICU admission, and these patients were older and had higher disease severity compared with patients without DNR orders. Notably, DNR patients experienced high ICU mortality (90%). Multivariate analysis revealed that the presence of DNR orders was independently associated with ICU mortality (odds ratio: 6.13; 95% confidence interval: 2.66-14.10). In propensity score-matched cohort, ICU mortality rate (91%) in the DNR group was statistically higher than that (62%) in the non-DNR group (p <0.001). Regarding ICU interventions, arterial and central venous catheterization were more commonly used in DNR patients than in non-DNR patients.
conclusionsFrom the Asian perspective, septic patients placed on DNR orders on ICU admission had exceptionally high mortality. In contrast to Western reports, DNR patients received more ICU interventions, reflecting more aggressive approach to dealing with this patient population. The findings in some ways reflect differences between East and West cultures and suggest that DNR status is an important confounder in ICU studies involving severely septic patients.
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