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
N1 - Publisher Copyright:
© 2019
PY - 2019/4
Y1 - 2019/4
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
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U2 - 10.1016/j.jcrc.2019.01.005
DO - 10.1016/j.jcrc.2019.01.005
M3 - Article
C2 - 30660915
AN - SCOPUS:85060088273
SN - 0883-9441
VL - 50
SP - 269
EP - 274
JO - Journal of Critical Care
JF - Journal of Critical Care
ER -