Timing and causes of death in septic shock
Open accessAbstract
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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Unexplained abdominal distension or gastrointestinal bleeding may be the only signs of acute intestinal ischemia in NOMI and may be undetectable in sedated patients in the ICU in approximately 25% of cases.
“Unexplained abdominal distension or gastrointestinal bleeding may be the only signs of acute intestinal ischemia in NOMI and may be undetectable in sedated patients in the ICU in approximately 25% of cases [71, 72].”
From Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery. (2022) · cites this paper as [71]
The Discussion says non-occlusive mesenteric ischemia is a complication of shock and that diagnosing mesenteric ischemia is often difficult. It does not identify abdominal distension or gastrointestinal bleeding as its only signs, link missed signs to sedation, or give an approximately 25% figure. (LLM, conf=0.79)
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“Unexplained abdominal distension or gastrointestinal bleeding may be the only signs of acute intestinal ischemia in NOMI and may be undetectable in sedated patients in the ICU in approximately 25% of cases [71, 72].”
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- Authors
- Daviaud, F., Grimaldi, D., Dechartres, A., Charpentier, J., Geri, G., Marin, N., Chiche, J.-D., Cariou, A., Mira, J.-P., & Pène, F.
- Affiliations
- Hôpital Cochin (FR)
- Centre National de la Recherche Scientifique (FR)
- Assistance Publique – Hôpitaux de Paris (FR)
- Corresponding author
- Pène, Frédéric
- ORCID
- Venue
- Annals of Intensive Care
- Publisher
- Elsevier BV
- Published
- 2015
- Volume
- 5
- Issue
- 1
- Pages
- 16
- ISSN
- 2110-5820 (ISSN-L)
- PMC
- PMC4474967
- OpenAlex
- W2109310726
- Cited by
- 234
- References
- 44
- Citations by year
- 2026: 8 · 2025: 28 · 2024: 17 · 2023: 22 · 2022: 24 · 2021: 27 · 2020: 30 · 2019: 29 · 2018: 17 · 2017: 12 · 2016: 18 · 2015: 2
- FWCI
- 12.82
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Annals of Intensive Care (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- HAL (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Abdominal Surgery and Complications
- Keywords
- septic shock, causes of death, timing of death, early mortality, late mortality, multiple organ failure, mesenteric ischemia, nosocomial infections, end-of-life decisions, prognostic factors, pathogen identification, corticosteroid therapy, diabetes mellitus, liver cirrhosis
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