Critical Care Medicine

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Critical Care Medicine:
doi: 10.1097/CCM.0b013e31829a6e89
Clinical Investigations

Profile of the Risk of Death After Septic Shock in the Present Era: An Epidemiologic Study

Pavon, Arnaud MD1,2; Binquet, Christine MD, PhD2; Kara, Fady MD3; Martinet, Olivier MD4; Ganster, Frederique MD4; Navellou, Jean-Christophe MD5; Castelain, Vincent MD, PhD6; Barraud, Damien MD7; Cousson, Joel MD8; Louis, Guillaume MD9; Perez, Pierre MD10; Kuteifan, Khaldoun MD11; Noirot, Alain MD12; Badie, Julio MD13; Mezher, Chaouki MD14; Lessire, Henry MD15; Quantin, Catherine MD, PhD16,17; Abrahamowicz, Michal PhD18,19; Quenot, Jean-Pierre MD, PhD1,2,16; for the EPIdemiology of Septic Shock (EPISS) Study Group

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Objectives: To investigate mortality of ICU patients over a 3-month period after an initial episode of septic shock and to identify factors associated with mortality.

Design: Prospective multicenter observational cohort study.

Setting: Fourteen ICUs from 10 French nonacademic and university teaching hospitals.

Patients: All consecutive adult patients with septic shock admitted between October 2009 and September 2011 were eligible.

Intervention: None.

Measurements and Main Results: Multivariable analyses were performed using a Cox proportional hazard model and a flexible extension of the Cox model. In total, 1,495 of 10,941 patients (13.7%) had septic shock and 1,488 patients (99.5%) were included. Median age was 68 years (range, 58–78 yr). The majority of admissions (84%) were medical. Median (interquartile range) Simplified Acute Physiological Score II and Sequential Organ Failure Assessment were, respectively, 56 (45–70) and 11 (9–14). ICU and hospital mortality were, respectively, 39.4% and 48.6%. At 3 months, 776 patients (52.2%) had died. Factors significantly associated with increased risk of death in the multivariable Cox model were older age, male sex, comorbidities (immune deficiency, cirrhosis), Knaus C/D score, and high Sequential Organ Failure Assessment score. Flexible analyses indicated that the impact of Sequential Organ Failure Assessment score was greatest early after septic shock, while the onset of the effect of age, nosocomial infection, and cirrhosis was later.

Conclusions: This is the most recent large-scale epidemiological study to investigate medium-term mortality in nonselected patients hospitalized in the ICU for septic shock. Advances in early management have improved survival at the initial phase, but risk of death persists in the medium term. Flexible modeling techniques yield insights into the profile of the risk of death in the first 3 months.

© 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins

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