Septic shock with no diagnosis at 24 hours: A pragmatic multicenter prospective cohort study.
Open accessAbstract
BACKGROUND: The lack of a patent source of infection after 24 hours of management of shock considered septic is a common and disturbing scenario. We aimed to determine the prevalence and the causes of shock with no diagnosis 24 hours after its onset, and to compare the outcomes of patients with early-confirmed septic shock to those of others. METHODS: We conducted a pragmatic, prospective, multicenter observational cohort study in ten intensive care units (ICU) in France. We included all consecutive patients admitted to the ICU with suspected septic shock defined by clinical suspicion of infection leading to antibiotic prescription plus acute circulatory failure requiring vasopressor support. RESULTS: A total of 508 patients were admitted with suspected septic shock. Among them, 374 (74 %) had early-confirmed septic shock, while the 134 others (26 %) had no source of infection identified nor microbiological documentation retrieved 24 hours after shock onset. Among these, 37/134 (28 %) had late-confirmed septic shock diagnosed after 24 hours, 59/134 (44 %) had a condition mimicking septic (septic shock mimicker, mainly related to adverse drug reactions, acute mesenteric ischemia and malignancies) and 38/134 (28 %) had shock of unknown origin by the end of the ICU stay. There were no differences between patients with early-confirmed septic shock and the remainder in ICU mortality and the median duration of ICU stay, of tracheal intubation and of vasopressor support. The multivariable Cox model showed that the risk of day-60 mortality did not differ between patients with or without early-confirmed septic shock. A sensitivity analysis was performed in the subgroup (n = 369/508) of patients meeting the Sepsis-3 definition criteria and displayed consistent results. CONCLUSIONS: One quarter of the patients admitted in the ICU with suspected septic shock had no infection identified 24 hours after its onset and almost half of them were eventually diagnosed with a septic shock mimicker. Outcome did not differ between patients with early-confirmed septic shock and other patients.
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Accurately diagnosing sepsis is challenging because sepsis can present subtly, and some presentations that first appear to be sepsis turn out to be non-infectious conditions.
“Accurately diagnosing sepsis is challenging as sepsis can present in subtle ways, and some presentations that first appear to be sepsis turn out to be non-infectious conditions [90, 93, 107, 108].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [107]
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Corken, A. L., Ware, J., & Thakali, K. M. (2026) · Physiological Reports · doi:10.14814/phy2.70971
- Authors
- Contou, D., Roux, D., Jochmans, S., Coudroy, R., Guérot, E., Grimaldi, D., Ricome, S., Maury, E., Plantefève, G., Mayaux, J., Mekontso Dessap, A., Brun-Buisson, C., & de Prost, N.
- Affiliations
- Inserm (FR)
- Hôpital Louis-Mourier (FR)
- Melun Hospital (FR)
- Centre Hospitalier Universitaire de Poitiers (FR)
- Assistance Publique – Hôpitaux de Paris (FR)
- Hôpital André Mignot (FR)
- Centre Hospitalier Victor Dupouy (FR)
- Corresponding author
- Contou, Damien
- ORCID
- Venue
- Critical Care
- Published
- 2016-11-06
- Volume
- 20
- Issue
- 1
- Pages
- 360-360
- ISSN
- 1364-8535 (ISSN-L)
- PMC
- PMC5097846
- OpenAlex
- W2548173065
- Cited by
- 58
- References
- 27
- Citations by year
- 2026: 6 · 2025: 5 · 2024: 3 · 2023: 10 · 2022: 7 · 2021: 7 · 2020: 5 · 2019: 10 · 2018: 4 · 2017: 1
- FWCI
- 4.68
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Critical Care (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Abdominal Surgery and Complications
- Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
- Keywords
- septic shock, infection source, delayed diagnosis, adverse drug reactions, acute mesenteric ischemia, Sepsis-3, ICU mortality, vasopressor therapy, intensive care unit outcomes
- MeSH terms
- Aged, Aged, 80 and over, Critical Care, Female, France, Humans, Intensive Care Units, Male, Middle Aged, Mortality, Prospective Studies, Risk Factors, Shock, Septic, Cohort Studies, Time-to-Treatment
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