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Risk factors for death in septic shock: A retrospective cohort study comparing trauma and non-trauma patients.

Abstract The aim of this study was to compare septic shock directly associated-mortality between severe trauma patients and nontrauma patients to assess the role of comorbidities and age. We conducted a retrospective study in an intensive care unit (ICU) (15 beds) of a university hospital (928 beds). From January 2009 to May 2015, we reviewed 2 anonymized databases including severe trauma patients and nontrauma patients. We selected the patients with a septic shock episode. Among 385 patients (318 nontrauma patients and 67 severe trauma patients), the ICU death rate was 43%. Septic shock was directly responsible for death among 35% of our cohort, representing 123 (39%) nontrauma patients and 10 (15%) trauma patients (P < 0.0). A sequential organ failure assessment score above 12 (odds ratio [OR]: 6.8; 95% confident interval (CI) [1.3-37], P = 0.025) was independently associated with septic shock associated-mortality, whereas severe trauma was a protective factor (OR: 0.26; 95% CI [0.08-0.78], P = 0.01). From these independent risk factors, we determined the probability of septic shock associated-mortality. The receiver-operating characteristics curve has an area under the curve at 0.76 with sensitivity of 55% and specificity of 86%. Trauma appears as a protective factor, whereas the severity of organ failure has a major role in the mortality of septic shock. However, because of the study's design, unmeasured confounding factors should be taken into account in our findings.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 29390356
OWN - NLM
STAT- MEDLINE
DCOM- 20180212
LR  - 20180212
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 50
DP  - 2017 Dec
TI  - Risk factors for death in septic shock: A retrospective cohort study comparing
      trauma and non-trauma patients.
PG  - e9241
LID - 10.1097/MD.0000000000009241 [doi]
AB  - The aim of this study was to compare septic shock directly associated-mortality
      between severe trauma patients and nontrauma patients to assess the role of
      comorbidities and age. We conducted a retrospective study in an intensive care
      unit (ICU) (15 beds) of a university hospital (928 beds). From January 2009 to
      May 2015, we reviewed 2 anonymized databases including severe trauma patients and
      nontrauma patients. We selected the patients with a septic shock episode. Among
      385 patients (318 nontrauma patients and 67 severe trauma patients), the ICU
      death rate was 43%. Septic shock was directly responsible for death among 35% of 
      our cohort, representing 123 (39%) nontrauma patients and 10 (15%) trauma
      patients (P &lt; 0.0). A sequential organ failure assessment score above 12 (odds
      ratio [OR]: 6.8; 95% confident interval (CI) [1.3-37], P = 0.025) was
      independently associated with septic shock associated-mortality, whereas severe
      trauma was a protective factor (OR: 0.26; 95% CI [0.08-0.78], P = 0.01). From
      these independent risk factors, we determined the probability of septic shock
      associated-mortality. The receiver-operating characteristics curve has an area
      under the curve at 0.76 with sensitivity of 55% and specificity of 86%. Trauma
      appears as a protective factor, whereas the severity of organ failure has a major
      role in the mortality of septic shock. However, because of the study's design,
      unmeasured confounding factors should be taken into account in our findings.
CI  - Copyright (c) 2017 The Authors. Published by Wolters Kluwer Health, Inc. All
      rights reserved.
FAU - Medam, Sophie
AU  - Medam S
AD  - Aix Marseille Universite, Service d'anesthesie et de reanimation, Hopital Nord,
      AP-HM.
FAU - Zieleskiewicz, Laurent
AU  - Zieleskiewicz L
AD  - Aix Marseille Universite, Service d'anesthesie et de reanimation, Hopital Nord,
      AP-HM.
FAU - Duclos, Gary
AU  - Duclos G
AD  - Aix Marseille Universite, Service d'anesthesie et de reanimation, Hopital Nord,
      AP-HM.
FAU - Baumstarck, Karine
AU  - Baumstarck K
AD  - Unite d'Aide Methodologique a la Recherche Clinique et Epidemiologique, Aix
      Marseille Universite, Marseille, France.
FAU - Loundou, Anderson
AU  - Loundou A
AD  - Unite d'Aide Methodologique a la Recherche Clinique et Epidemiologique, Aix
      Marseille Universite, Marseille, France.
FAU - Alingrin, Julie
AU  - Alingrin J
AD  - Aix Marseille Universite, Service d'anesthesie et de reanimation, Hopital Nord,
      AP-HM.
FAU - Hammad, Emmanuelle
AU  - Hammad E
AD  - Aix Marseille Universite, Service d'anesthesie et de reanimation, Hopital Nord,
      AP-HM.
FAU - Vigne, Coralie
AU  - Vigne C
AD  - Aix Marseille Universite, Service d'anesthesie et de reanimation, Hopital Nord,
      AP-HM.
FAU - Antonini, Francois
AU  - Antonini F
AD  - Aix Marseille Universite, Service d'anesthesie et de reanimation, Hopital Nord,
      AP-HM.
FAU - Leone, Marc
AU  - Leone M
AD  - Aix Marseille Universite, Service d'anesthesie et de reanimation, Hopital Nord,
      AP-HM.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Observational Study
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
SB  - AIM
SB  - IM
MH  - Adult
MH  - Female
MH  - France
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Shock, Septic/*etiology/*mortality
MH  - Wounds and Injuries/*complications/mortality
EDAT- 2018/02/03 06:00
MHDA- 2018/02/13 06:00
CRDT- 2018/02/03 06:00
PHST- 2018/02/03 06:00 [entrez]
PHST- 2018/02/03 06:00 [pubmed]
PHST- 2018/02/13 06:00 [medline]
AID - 10.1097/MD.0000000000009241 [doi]
AID - 00005792-201712150-00106 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Dec;96(50):e9241. doi: 10.1097/MD.0000000000009241.