Abstract
BackgroundMost studies about septic shock report a crude mortality rate that neither distinguishes between early and late deaths nor addresses the direct causes of death. We herein aimed to determine the modalities of death in septic shock.MethodsThis was a 6-year (2008–2013) monocenter retrospective study. All consecutive patients diagnosed for septic shock within the first 48 h of intensive care unit (ICU) admission were included. Early and late deaths were defined as occurring within or after 3 days following ICU admission, respectively. The main cause of death in the ICU was determined from medical files. A multinomial logistic regression analysis using the status alive as the reference category was performed to identify the prognostic factors associated with early and late deaths.ResultsFive hundred forty-three patients were included, with a mean age of 66 ± 15 years and a high proportion (67 %) of comorbidities. The in-ICU and in-hospital mortality rates were 37.2 and 45 %, respectively. Deaths occurred early for 78 (32 %) and later on for 166 (68 %) patients in the ICU (n = 124) or in the hospital (n = 42). Early deaths were mainly attributable to intractable multiple organ failure related to the primary infection (82 %) and to mesenteric ischemia (6.4 %). In-ICU late deaths were directly related to end-of-life decisions in 29 % of patients and otherwise mostly related to ICU-acquired complications, including nosocomial infections (20.4 %) and mesenteric ischemia (16.6 %). Independent determinants of early death were age, malignancy, diabetes mellitus, no pathogen identification, and initial severity. Among 3-day survivors, independent risk factors for late death were age, cirrhosis, no pathogen identification, and previous corticosteroid treatment.ConclusionsOur study provides a comprehensive assessment of septic shock-related deaths. Identification of risk factors of early and late deaths may determine differential prognostic patterns.
Highlights
Most studies about septic shock report a crude mortality rate that neither distinguishes between early and late deaths nor addresses the direct causes of death
The combination of anti-infective treatments and aggressive organ failure supports often allows stabilization of the clinical condition, but patients become exposed to intensive care unit (ICU)-acquired complications that significantly impact on the prognosis
Patients’ characteristics During the study period, 543 patients presented with septic shock during the first 48 h following ICU admission (Fig. 1 and Table 1)
Summary
Most studies about septic shock report a crude mortality rate that neither distinguishes between early and late deaths nor addresses the direct causes of death. Improvement in management of severe sepsis and septic shock translated into increased survival rate in observational studies [3,4,5,6,7,8]. This is emphasized by the low mortality. Most epidemiological and interventional studies about septic shock report crude mortality rates that make deaths directly related to the initial septic process or to secondary nosocomial infections hardly distinguishable. The negative results of interventional studies in sepsis despite a robust scientific rationale should question about
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