Abstract
Purpose. To evaluate the epidemiology, prognosis, and management of septic shock patients hospitalized in our intensive care unit (ICU). Materiel and Methods. Five-year monocenter observational study including 320 patients. Results. ICU mortality was 54.4%. Independent mortality risk factors were mechanical ventilation (OR = 4.97), Simplify Acute Physiology Score (SAPS) II > 60 (OR = 4.28), chronic alcoholism (OR = 3.38), age >65 years (OR = 2.65), prothrombin ratio <40% (OR = 2.37), and PaO2/FiO2 ratio <150 (OR = 1.91). These six mortality risk factors recovered allow screening immediately septic shock patients with a high mortality risk. Morbidity improved with time (diminution of septic shock complications, increase of the number of days alive free from mechanical ventilation and vasopressors on day 28), concomitant to an evolution of the management (earlier institution of all replacement and medical therapies and more initial volume expansion). There was no difference in mortality. Conclusion. Our study confirms a high mortality rate in septic shock patients despite a new approach of treatment.
Highlights
A better pathophysiologic knowledge and the apparition of international recommendations allowed an improvement of septic shock’s prognosis, but mortality still remains above 50% [1, 2]
We found 6 independent variables associated with mortality: need for mechanical ventilation, Simplify Acute Physiology Score (SAPS) II >60, chronic alcoholism, age >65 years, prothrombin ratio (PR)
We found during the period 2005–2007 an increase in the number of days alive free from mechanical ventilation (P = .0207) and vasopressors (P = .0021) on day 28, and a decrease in septic shock complications (P < .0001)
Summary
A better pathophysiologic knowledge and the apparition of international recommendations allowed an improvement of septic shock’s prognosis, but mortality still remains above 50% [1, 2]. Numerous factors are associated to mortality in septic shock. Recognition of these factors can help to identify the most critical situations and to provoke a more aggressive resuscitation. We realized an observational study including all the patients suffering from septic shock and hospitalized in our intensive care unit (ICU) from 2003 to 2007. We wanted to identify mortality risk factors and evolution of septic shock management in our ICU
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