The impact of septic shock on intensive care unit-acquired pneumonia survival is not homogenous

Abstract

Background: Septic shock (SS) may complicate intensive care unit-acquired pneumonia (ICU-AP) and radically alter the empiric treatment of this condition, as recommended by the 2016 ATS/IDSA guidelines. However, the impact of SS on ICU-AP outcomes is still not fully characterized. Methods: We prospectively evaluated ICU-AP patients admitted into 6 ICUs from a tertiary university hospital. SS was defined as 3 or more points on the cardiovascular component of the Sequential Organ Assessment Failure score. Patients were classified at onset of ICU-AP as not having SS (No-SS), as Transient-SS (if shock persisted ≤ 3 days) and Persistent-SS (> 3 days). Patients who developed SS after the day of ICU-AP diagnosis were excluded. The primary outcome was 90-day survival, which was modelled through Cox regression. Results: We analysed 358 patients, 203 (57%) with No-SS, 82 (23%) Transient-SS and 73 (20%) Persistent-SS. Patients with Transient and Persistent-SS were more severe and presented higher inflammatory response than No-SS. Despite having similar severity and etiologic definition, Persistent-SS group received more commonly inadequate initial antibiotic treatment and had more treatment failure compared with Transient-SS. In-hospital mortality for No-SS, Transient and Persistent-SS was 30, 48 and 62%, respectively. After full-adjustment for potential confounders, only Persistent-SS was independently associated with lower 90-day survival (adjusted-HR 2.0, 1.3-3.2, p Conclusions: SS impacts ICU-AP mortality. Yet, patients at risk of Persistent-SS should be promptly recognised to optimize treatment and outcomes.