PURPOSE: Patients with septic shock have a mortality rate of 50–60%. The aim of this study was to compare characteristics, treatments and outcomes of septic shock (SS) patients over a 18 month period.
METHODS: This is a retrospective study. The studied population included SS patients entered in the Cooper Surviving Sepsis Campaign (SSC) data base and the Cerner Project Impact database, who were admitted to the medical/surgical intensive care unit of an urban tertiary care medical center during Mar 2006-Aug 2007. They were divided into two groups for comparison survivors and non-survivors. Acute physiology and chronic health evaluation (APACHE II) scores, systemic manifestations of infection, organ dysfunctions, need for mechanical ventilation (MV), sepsis bundle compliance, hospital length of stay (LOS), ICU LOS, and in-hospital mortality were reviewed.
RESULTS: One hundred and five (105) SS patients were included, mortality was 40.9%. No significant differences were noted among survivors (62) and non-survivors (43) with respect to age, gender, number of organ dysfunctions, lactic acid level, sepsis resuscitation and management bundle compliance and hospital LOS (p not significant). Median systemic manifestations of infection was 3.2 (survivors) vs.2.8 (non-survivors) (p <0.05). Median APACHE II score was 20.6 (survivors) vs. 26 (non-survivors) (p <0.05). MV use was 41.9% (survivors) vs.79% (non-survivors) (p <0.05). Median inspiratory plateau pressure (IPP) was 7.4 (survivors) vs.15.6 (non-survivors) (p <0.05). The median ICU LOS was 5.5 days (survivors) vs.10.2 days (non-survivors), (p <0.05). In the multivariate analysis, odds ratio (OR) of MV use and APACHE II score were 3.655 (95% confidence interval [CI], 1.074–12.436) and 1.122 (CI, 1.005–1.252), respectively, p<0.05.
CONCLUSION: APACHE II score and use of MV in the first 24 hrs were risk factors for high mortality. The data suggests that non-survivors had longer ICU LOS, higher IPP and less systemic manifestations of infection in the time of presentation.
CLINICAL IMPLICATIONS: Patient origin at time of septic shock presentation alter outcomes.
DISCLOSURE: Zhen Wang, None.