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Prognostic factors for late death in septic shock survivors: a multi-center, prospective, registry-based observational study

Abstract

Septic shock patients who survive past the acute period are associated with an increased risk of long-term mortality. However, factors for predicting late death remain unclear. We aimed to investigate the prognostic factors associated with late mortality in septic shock patients with 28-day survival after admission. This retrospective observational study used a prospective, multi-center registry of septic shock patients between October 2015 and December 2019 involving 12 emergency departments (EDs) from the Korean Shock Society. Adult septic shock patients visiting the ED with 28-day survival after admission were included. Among 4624 septic shock patients, 3588 (77.6%) who survived past day 28 were analyzed. The 90-day mortality rate was 14.2%. Non-survivors were older (66.8 vs. 68.9 years; p = 0.032) and had higher lactate levels (3.7 vs. 4.0 mmol/L; p = 0.028) than survivors. Pulmonary and hepatobiliary infections and a history of malignancy (27.7 vs. 57.5%; p < 0.001) were more frequent in the non-survivor group than in the survivor group. Independent risk factors for late death on multivariate regression analysis were age; malignancy; and hemoglobin, blood urea nitrogen, and albumin levels. The length of intensive care unit stay and Sequential Organ Failure Assessment score were independently associated with late death. Approximately, one-seventh of septic shock patients who survived past day 28 of admission died by day 90. Physicians must pay attention to survivors with these risk factors during the post-acute period as they have an increased mortality risk.

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The dataset used in the study is available from the corresponding author on reasonable request.

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Correspondence to Won Young Kim.

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Ethical approval

The institutional review board of each institution approved the study protocol, and informed consent was obtained from the patients before data collection (Asan Medical Center Institutional Review Board No. 2015-1283). All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Kim, SM., Ryoo, S.M., Shin, T.G. et al. Prognostic factors for late death in septic shock survivors: a multi-center, prospective, registry-based observational study. Intern Emerg Med 17, 865–871 (2022). https://doi.org/10.1007/s11739-021-02847-0

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  • DOI: https://doi.org/10.1007/s11739-021-02847-0

Keywords

  • Sepsis
  • Septic shock
  • Long-term mortality
  • Chronic medical disease
  • Post-acute period