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Open Access 01-12-2015 | Research

Timing and causes of death in septic shock

Authors: Fabrice Daviaud, David Grimaldi, Agnès Dechartres, Julien Charpentier, Guillaume Geri, Nathalie Marin, Jean-Daniel Chiche, Alain Cariou, Jean-Paul Mira, Frédéric Pène

Published in: Annals of Intensive Care | Issue 1/2015

Abstract

Background

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. We herein aimed to determine the modalities of death in septic shock.

Methods

This 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.

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 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.

Conclusions

Our study provides a comprehensive assessment of septic shock-related deaths. Identification of risk factors of early and late deaths may determine differential prognostic patterns.

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Title: Timing and causes of death in septic shock
Authors: Fabrice Daviaud
David Grimaldi
Agnès Dechartres
Julien Charpentier
Guillaume Geri
Nathalie Marin
Jean-Daniel Chiche
Alain Cariou
Jean-Paul Mira
Frédéric Pène
Publication date: 01-12-2015
Publisher: Springer Paris
Published in: Annals of Intensive Care / Issue 1/2015
Electronic ISSN: 2110-5820
DOI: https://doi.org/10.1186/s13613-015-0058-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Timing and causes of death in septic shock

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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