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Timing and causes of death in septic shock
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Edité par CCSD ; SpringerOpen -
International audience. Background:Most studies about septic shock report a crude mortality rate that neither distinguishes between earlyand late deaths nor addresses the direct causes of death. We herein aimed to determine the modalities of death inseptic shock.Methods:This was a 6-year (2008–2013) monocenter retrospective study. All consecutive patients diagnosed for septicshock within the first 48 h of intensive care unit (ICU) admission were included. Early and late deaths weredefined as occurring within or after 3 days following ICU admission, respectively. The main cause of death in theICU was determined from medical files. A multinomial logistic regression analysis using the status alive as thereference category was performed to identify the prognostic factors associated with early and late deaths.Results:Five 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 occurredearly for 78 (32 %) and later on for 166 (68 %) patients in the ICU (n= 124) or in the hospital (n= 42). Early deaths weremainly attributable to intractable multiple organ failure related to the primary infection (82 %) and to mesentericischemia (6.4 %). In-ICU late deaths were directly relatedto end-of-life decisions in 29 % of patients and otherwisemostly 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 pathogenidentification, and previous corticosteroid treatment.Conclusions:Our study provides a comprehensive assessment of septic shock-related deaths. Identification of riskfactors of early and late deaths may determine differential prognostic patterns.
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