Outcomes following severe septic shock in a cohort of Aboriginal and Torres Strait Islander people: a nested cohort study from the ADRENAL trial

Lachlan H Donaldson; Naomi E Hammond; Sidharth Agarwal; Sean Taylor; Severine Bompoint; Julieann Coombes; Keziah Bennett-Brook; Rinaldo Bellomo; John Myburgh; Balasubramanian Venkatesh

doi:10.51893/2022.1.OA3

Outcomes following severe septic shock in a cohort of Aboriginal and Torres Strait Islander people: a nested cohort study from the ADRENAL trial

Crit Care Resusc. 2023 Oct 18;24(1):20-28. doi: 10.51893/2022.1.OA3. eCollection 2022 Mar 7.

Authors

Lachlan H Donaldson^{1

2}, Naomi E Hammond^{1

2}, Sidharth Agarwal³, Sean Taylor⁴, Severine Bompoint¹, Julieann Coombes¹, Keziah Bennett-Brook¹, Rinaldo Bellomo^{5

6

7

8}, John Myburgh^{1

9}, Balasubramanian Venkatesh^{1

10

11

12}

Affiliations

¹ The George Institute for Global Health, Faculty of Medicine, UNSW, Sydney, NSW, Australia.
² Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Sydney, NSW, Australia.
³ Intensive Care Unit, Royal Darwin Hospital, Casuarina, NT, Australia.
⁴ Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
⁵ Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia.
⁶ Centre for Integrated Critical Care, University of Melbourne, Melbourne, VIC, Australia.
⁷ Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
⁸ Data Analytics Research and Evaluation Centre, University of Melbourne and Austin Hospital, Melbourne, VIC, Australia.
⁹ Department of Intensive Care Medicine, St George Hospital, Sydney, NSW, Australia.
¹⁰ Princess Alexandra Hospital, Brisbane, QLD, Australia.
¹¹ The Wesley Hospital, Brisbane, QLD, Australia.
¹² Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.

Abstract

Objective: To describe the pattern of acute illness and 6-month mortality and health-related quality-of-life outcomes for a cohort of Aboriginal and Torres Strait Islander patients presenting with septic shock. Design: Nested cohort study of Aboriginal and Torres Strait Islander participants recruited to a large randomised controlled trial of corticosteroid treatment in patients with septic shock. Setting: Royal Darwin Hospital, Northern Territory. Participants: All Aboriginal and Torres Strait Islander patients recruited to the Adjunctive Corticosteroid Treatment in Critically Ill Patients with Septic Shock (ADRENAL) trial at Royal Darwin Hospital were compared with a non-Indigenous cohort drawn from the same site, and a cohort matched for age, sex and severity of disease. Main outcome measures: Mortality at 90 days and 6 months, time to shock resolution, mechanical ventilation requirement, renal replacement therapy requirement, and five-domain, five-level EuroQol questionnaire (EQ-5D-5L) score at 6 months. Results: Aboriginal and Torres Strait Islander patients had significantly reduced risk of death at 90 days when compared with non-Indigenous patients recruited to ADRENAL at Royal Darwin Hospital (12/60 v 23/62; adjusted odds ratio, 0.40 [95% CI, 0.17 to 0.94]) which was robust to additional adjustment for baseline covariates (odds ratio, 0.35 [95% CI, 0.14 to 0.90]). When compared with the matched population drawn from the broader ADRENAL cohort, there was no significant difference in 90-day mortality (12/60 v 16/61; adjusted odds ratio, 1.43 [95% CI, 0.60 to 3.39]; P = 0.42). Only nine Aboriginal and Torres Strait Islander patients provided 6-month health-related quality-of-life data. Conclusions: Aboriginal and Torres Strait Islander patients had reduced risk of death at 90 days when compared with non- Indigenous patients recruited to the ADRENAL trial at Royal Darwin Hospital, which was robust to adjustment for covariates, but similar outcomes when compared with a cohort matched for age, sex and severity of disease.