Association of septic shock definitions and standardized mortality ratio in a contemporary cohort of critically ill patients

Rahul Kashyap, Tarun D. Singh, Hamza Rayes, John C. O'Horo, Gregory Wilson, Philippe Bauer, Ognjen Gajic

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Purpose: The newly proposed septic shock definition has provoked a substantial controversy in the emergency and critical care communities. We aim to compare new (SEPSIS-III) versus old (SEPSIS-II) definitions for septic shock in a contemporary cohort of critically ill patients. Material and methods: Retrospective cohort of consecutive patients, age ≥ 18 years admitted to intensive care units at the Mayo Clinic between January 2009 and October 2015. We compared patients who met old, new, both, or neither definition of sepsis shock. SMR were calculated using APACHE IV predicted mortality. Results: The initial cohort consisted of 16,720 patients who had suspicion of infection, 7463 required vasopressor support. The median (IQR) age was 65(54–75) years and 4167(55.8%) were male. Compared to patients with old definition, the patients with new definition had higher APACHE III score (median IQR); (73 (57–92) vs. 70 (56–89), p <.01); SOFA score; (6 (4–10) vs. 6 (4–9), p <.01), were older (70 (59–79) vs. 64 (54–74) years, p =.03). They also had higher hospital mortality, N (%) 71, (19.7%) vs. 40 (12.6%), p <.01) and a higher SMR (0.66 vs. 0.45, p <.01). Conclusions: Compared to SEPSIS-II, SEPSIS-III definition of septic shock identifies patients further along disease trajectory with higher likelihood of poor outcome.

Original languageEnglish (US)
Pages (from-to)269-274
Number of pages6
JournalJournal of Critical Care
Volume50
DOIs
StatePublished - Apr 1 2019

Fingerprint

Septic Shock
Critical Illness
Mortality
APACHE
Emergency Medical Services
Critical Care
Hospital Mortality
Intensive Care Units
Shock
Sepsis
Infection

Keywords

  • Definitions
  • Hospital mortality
  • Intensive care units
  • Septic shock

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Association of septic shock definitions and standardized mortality ratio in a contemporary cohort of critically ill patients. / Kashyap, Rahul; Singh, Tarun D.; Rayes, Hamza; O'Horo, John C.; Wilson, Gregory; Bauer, Philippe; Gajic, Ognjen.

In: Journal of Critical Care, Vol. 50, 01.04.2019, p. 269-274.

Research output: Contribution to journalArticle

Kashyap, Rahul ; Singh, Tarun D. ; Rayes, Hamza ; O'Horo, John C. ; Wilson, Gregory ; Bauer, Philippe ; Gajic, Ognjen. / Association of septic shock definitions and standardized mortality ratio in a contemporary cohort of critically ill patients. In: Journal of Critical Care. 2019 ; Vol. 50. pp. 269-274.
@article{31be600d2f134d6a941fe265fc3b8cb5,
title = "Association of septic shock definitions and standardized mortality ratio in a contemporary cohort of critically ill patients",
abstract = "Purpose: The newly proposed septic shock definition has provoked a substantial controversy in the emergency and critical care communities. We aim to compare new (SEPSIS-III) versus old (SEPSIS-II) definitions for septic shock in a contemporary cohort of critically ill patients. Material and methods: Retrospective cohort of consecutive patients, age ≥ 18 years admitted to intensive care units at the Mayo Clinic between January 2009 and October 2015. We compared patients who met old, new, both, or neither definition of sepsis shock. SMR were calculated using APACHE IV predicted mortality. Results: The initial cohort consisted of 16,720 patients who had suspicion of infection, 7463 required vasopressor support. The median (IQR) age was 65(54–75) years and 4167(55.8{\%}) were male. Compared to patients with old definition, the patients with new definition had higher APACHE III score (median IQR); (73 (57–92) vs. 70 (56–89), p <.01); SOFA score; (6 (4–10) vs. 6 (4–9), p <.01), were older (70 (59–79) vs. 64 (54–74) years, p =.03). They also had higher hospital mortality, N ({\%}) 71, (19.7{\%}) vs. 40 (12.6{\%}), p <.01) and a higher SMR (0.66 vs. 0.45, p <.01). Conclusions: Compared to SEPSIS-II, SEPSIS-III definition of septic shock identifies patients further along disease trajectory with higher likelihood of poor outcome.",
keywords = "Definitions, Hospital mortality, Intensive care units, Septic shock",
author = "Rahul Kashyap and Singh, {Tarun D.} and Hamza Rayes and O'Horo, {John C.} and Gregory Wilson and Philippe Bauer and Ognjen Gajic",
year = "2019",
month = "4",
day = "1",
doi = "10.1016/j.jcrc.2019.01.005",
language = "English (US)",
volume = "50",
pages = "269--274",
journal = "Journal of Critical Care",
issn = "0883-9441",
publisher = "Elsevier BV",

}

TY - JOUR

T1 - Association of septic shock definitions and standardized mortality ratio in a contemporary cohort of critically ill patients

AU - Kashyap, Rahul

AU - Singh, Tarun D.

AU - Rayes, Hamza

AU - O'Horo, John C.

AU - Wilson, Gregory

AU - Bauer, Philippe

AU - Gajic, Ognjen

PY - 2019/4/1

Y1 - 2019/4/1

N2 - Purpose: The newly proposed septic shock definition has provoked a substantial controversy in the emergency and critical care communities. We aim to compare new (SEPSIS-III) versus old (SEPSIS-II) definitions for septic shock in a contemporary cohort of critically ill patients. Material and methods: Retrospective cohort of consecutive patients, age ≥ 18 years admitted to intensive care units at the Mayo Clinic between January 2009 and October 2015. We compared patients who met old, new, both, or neither definition of sepsis shock. SMR were calculated using APACHE IV predicted mortality. Results: The initial cohort consisted of 16,720 patients who had suspicion of infection, 7463 required vasopressor support. The median (IQR) age was 65(54–75) years and 4167(55.8%) were male. Compared to patients with old definition, the patients with new definition had higher APACHE III score (median IQR); (73 (57–92) vs. 70 (56–89), p <.01); SOFA score; (6 (4–10) vs. 6 (4–9), p <.01), were older (70 (59–79) vs. 64 (54–74) years, p =.03). They also had higher hospital mortality, N (%) 71, (19.7%) vs. 40 (12.6%), p <.01) and a higher SMR (0.66 vs. 0.45, p <.01). Conclusions: Compared to SEPSIS-II, SEPSIS-III definition of septic shock identifies patients further along disease trajectory with higher likelihood of poor outcome.

AB - Purpose: The newly proposed septic shock definition has provoked a substantial controversy in the emergency and critical care communities. We aim to compare new (SEPSIS-III) versus old (SEPSIS-II) definitions for septic shock in a contemporary cohort of critically ill patients. Material and methods: Retrospective cohort of consecutive patients, age ≥ 18 years admitted to intensive care units at the Mayo Clinic between January 2009 and October 2015. We compared patients who met old, new, both, or neither definition of sepsis shock. SMR were calculated using APACHE IV predicted mortality. Results: The initial cohort consisted of 16,720 patients who had suspicion of infection, 7463 required vasopressor support. The median (IQR) age was 65(54–75) years and 4167(55.8%) were male. Compared to patients with old definition, the patients with new definition had higher APACHE III score (median IQR); (73 (57–92) vs. 70 (56–89), p <.01); SOFA score; (6 (4–10) vs. 6 (4–9), p <.01), were older (70 (59–79) vs. 64 (54–74) years, p =.03). They also had higher hospital mortality, N (%) 71, (19.7%) vs. 40 (12.6%), p <.01) and a higher SMR (0.66 vs. 0.45, p <.01). Conclusions: Compared to SEPSIS-II, SEPSIS-III definition of septic shock identifies patients further along disease trajectory with higher likelihood of poor outcome.

KW - Definitions

KW - Hospital mortality

KW - Intensive care units

KW - Septic shock

UR - http://www.scopus.com/inward/record.url?scp=85060088273&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85060088273&partnerID=8YFLogxK

U2 - 10.1016/j.jcrc.2019.01.005

DO - 10.1016/j.jcrc.2019.01.005

M3 - Article

VL - 50

SP - 269

EP - 274

JO - Journal of Critical Care

JF - Journal of Critical Care

SN - 0883-9441

ER -