Clinical risk factors for early mortality in patients with community-acquired septic shock. The importance of adequate source control

• Published in: Medicina intensiva 2021-12, Vol.45 (9), p.541-551
• Main Authors: Vallés, J., Diaz, E., Carles Oliva, J., Martínez, M., Navas, A., Mesquida, J., Gruartmoner, G., de Haro, C., Mestre, J., Guía, C., Rodriguez, A., Ochagavía, A.
• Format: Article
• Language: English
• Subjects: Community-acquired infections; Control del foco; Early mortality; ICU; Infecciones adquiridas en la comunidad; Mortalidad precoz; Septic shock; Shock séptico; Source control; UCI
• ISSN: 0210-5691; 2173-5727; 1578-6749
• DOI: 10.1016/j.medin.2020.05.008

To evaluate the incidence and risk factors for early mortality (EM) in the ICU in patients with community-acquired septic shock (CASS). A retrospective cohort study of patients with CASS admitted to the ICU (2003–2016). ICU at a University Hospital in Spain. All consecutive patients admitted to the ICU with CASS. None. CASS was defined according to the Sepsis-3 definitions. EM were defined as occurring within of 72h following ICU admission. A multinomial logistic regression analysis was performed to identify the risk factors associated with early deaths. During the study period, 625 patients met the Sepsis-3 criteria and admitted with CASS. 14.4% of all patients died within the first 72h. Of 161 patients who died in the ICU, 90 (55.9%) died within the first 72h. The percentage of early and late mortality did not vary significantly during the study period. The need and adequacy of source control were significantly lower in patients with EM. In the multivariate analysis, ARDS, non-respiratory infections, bacteremia and severity at admission were variables independently associated with EM. The only factor that decreased EM was adequate source control in patients with infections amenable to source control. The incidence of EM has remained stable over time, which means that more than half of the patients who die from CASS do so within the first 72h. Infections where adequate source control can be performed have lower EM. Evaluar la incidencia y los factores de riesgo de mortalidad precoz (MP) en la UCI en pacientes con shock séptico adquirido en la comunidad (SSAC). Estudio de cohorte retrospectivo de pacientes con SSAC ingresados en la UCI (2003-2016). La UCI de un hospital universitario en España. Todos los pacientes consecutivos ingresados en la UCI por SSAC. Ninguna. El SSAC se definió según los criterios de Sepsis-3. Una MP se consideró la que ocurría dentro de las 72h posteriores a la admisión en la UCI. Se realizó un análisis de regresión logística multinomial para identificar los factores de riesgo asociados con MP. Durante el período de estudio, 625 pacientes cumplieron los criterios de Sepsis-3 e ingresaron por SSAC. El 14,4% de los pacientes fallecieron en las primeras 72h. De los 161 pacientes que fallecieron en la UCI, 90 (55,9%) lo hicieron dentro de las primeras 72h. El porcentaje de mortalidad precoz y tardía no varió significativamente durante el período de estudio. La necesidad y la eficacia del control del foco de sepsis fueron significativam